The ability to self-direct a research program determines graduate degree completion. Yet, research on incompletion of graduate physics programs assume students’ present level of self-direction adequate and neglects to recognize a lack of self-directed learning as key. One theoretical mathematical physicist focused on changing this challenge of physics graduate education by promoting self-directed learning through the type research flow that has been found to bring the greatest satisfaction to researchers with respect to their insights. This he provided through his space, time, open mindedness and theoretical contributions with his students and in collaboration with his colleagues. A self-directed learner himself, David J. Rowe developed methods of mentoring for encouraging physics graduate students to recognize symmetry as valuable in identifying solutions to problems quickly—helping these students take the lead in finding insightful resolutions to complex, multidimensional, mathematical physics uncertainties. How Rowe set about supporting self-directed learning in his graduate physics education interactions will be examined with the use of narrative research to interpret the texts and conversations with the author he made available. His techniques will be presented and recommendations made regarding how Rowe’s work in this regard can be modeled to improve self-direction in STEM graduate education.

Branching patterns are ubiquitous in nature, consequently over the years many researchers have tried to characterize the complexity of their structures. Due to their hierarchical nature and resemblance to fractal trees, they are often thought to have fractal properties, however their non-homogeneity (i.e., lack of strict self-similarity) is often ignored. In this paper we review and examine the use of the box-counting and sandbox methods to estimate the fractal dimensions of branching structures. We highlight the fact that these methods rely on an assumption of self-similarity that is not present in branching structures due to their non-homogeneous nature. Looking at the local slopes of the log-log plots used by these methods reveals the problems caused by the non-homogeneity. Finally, we examine the role of the canopies (endpoints or limit points) of branching structures in the estimation of their fractal dimensions.

In this paper, we present the idea of Self Supervised learning on the Shape Completion and Classification of point clouds. Most 3D shape completion pipelines utilize autoencoders to extract features from point clouds used in downstream tasks such as Classification, Segmentation, Detection, and other related applications. Our idea is to add Contrastive Learning into Auto-Encoders to learn both global and local feature representations of point clouds. We use a combination of Triplet Loss and Chamfer distance to learn global and local feature representations. To evaluate the performance of embeddings for Classification, we utilize the PointNet classifier. We also extend the number of classes to evaluate our model from 4 to 10 to show the generalization ability of learned features. Based on our results, embedding generated from the Contrastive autoencoder enhances Shape Completion and Classification performance from 84.2% to 84.9% of point clouds achieving the state-of-the-art results with 10 classes.

A sustainable solution for crack maintenance in geopolymers is necessary if they are to be the future of modern green construction. This study thus aimed to develop self-healing biogeopolymers that could potentially rival bioconcrete. First, a suitable healing agent was selected from Bacillus subtilis, B. sphaericus, and B. megaterium by directly adding their spores in the geopolymers and subsequently exposing them to a large amount of nutrients for 14 days. SEM-EDX analysis revealed the formation of biominerals for B. subtilis and B. sphaericus. Next, the effect of biochar-immobilization and co-culturing (B. sphaericus and B. thuringiensis) on the healing efficiencies of the geopolymers were tested and optimized by measuring their ultrasonic pulse velocities weekly over a 28-day healing period. The results show that using co-cultured bacteria significantly improved the observed efficiencies, while biochar-immobilization had a weak effect but yielded an optimum response between 0.3-0.4 g/mL. The maximum crack width sealed was 0.65 mm. Through SEM-EDX and FTIR analyses, the biominerals precipitated in the cracks were identified to be mainly CaCO3. Furthermore, image analysis of the XCT scans of some of the healed geopolymers confirmed that their pulse velocities were indeed improving due to the filling of their internal spaces with biominerals. With that, there is potential in developing self-healing biogeopolymers using biochar-immobilized spores of bacterial cultures.

Transparent binder is used to substitute conventional black asphalt binder and to provide light-colored pavements, whereas nano-TiO2 has the potential to promote photocatalytic and self-cleaning properties. Together, these materials provide multifunction effects and benefits when the pavement is submitted to high solar irradiation. This paper analyses the physicochemical and rheological properties of a transparent binder modified with 0.5%, 3.0%, 6.0%, and 10.0% of nano-TiO2 and compares it to the transparent base binder, and conventional and polymer modified binders (PMB) without nano-TiO2. Their penetration, softening point, dynamic viscosity, master curve, black diagram, Linear Amplitude Sweep (LAS), Multiple Stress Creep Recovery (MSCR), and Fourier-Transform Infrared Spectroscopy (FTIR) were obtained. The transparent binders (base and modified) seem to be workable considering their viscosity and exhibited values between the conventional binder and PMB regarding rutting resistance, penetration, and softening point. They showed similar behavior as the PMB, demonstrating signs of polymer-modification. The addition of TiO2 seems to reduce fatigue life, except for the 0.5% content. Nevertheless, its addition in high contents increases the rutting resistance. The TiO2 modification seems to have little effect on the chemical functional indices. The best percentage of TiO2 was 0.5%, considering fatigue and 10.0% concerning permanent deformation.

In recent years, the individualized demand of customers brings small batches and diversification of orders towards enterprises. The application of enabling technologies in factory, such as the Industrial Internet of Things (IIoT) and Cloud Manufacturing (CMfg), enhances the ability of customer requirement automatic elicitation and the manufacturing process control. The job shop scheduling problem with random job arrival time dramatically increases the difficulty in process management. Thus, how to collaboratively schedule the production and logistics resources in the shop floor is very challenging, and it has a fundamental and practical significance of achieving the competitiveness for an enterprise. To address this issue, the real-time model of production and logistics resources is built firstly. Then, the task entropy model is built based on the task information. Finally, the real-time self-adaption collaboration of production and logistics resources is realized. The proposed algorithm is carried out based on a practical case to evaluate its effectiveness. Experimental results show that our proposed algorithm outperforms three existing algorithms.

Using the culture-work-health model, this study investigates the factors influencing the quality of life of maritime workers. This study conducted a survey of 320 maritime workers who have experience living and working on a ship for more than six months. This self-administered questionnaire included questions on organizational culture and support, self-efficacy, perceived fatigue, as well as the quality of work life. Organizational culture and self-efficacy were identified as factors affecting the quality of work life, while organizational support was found to have an indirect effect after passing through self-efficacy and perceived fatigue. The final model accounts for 63.1% of the variance in maritime workers’ quality of life. As such, this study shows that self-efficacy is important for the quality of life of maritime workers, having both direct and indirect effects. Moreover, organizational support may prove the primary intervention point for relieving perceived fatigue and enhancing self-efficacy, thus improving the quality of work life.

This study explores individual and contextual risk factors for the onset of work interfering with private life (WIL) and private life interfering with work (LIW) among self-employed men and women across European countries. It also studies the relationship between interference (LIW and WIL) and wellbeing among self-employed men and women and the effect of macro level risk factors. Data from the fifth round of European Working Conditions Survey was utilized and a sample of self-employed men and women with active businesses was extracted. Applying multilevel regressions, results show that though business characteristics are important for level of WIL, time demand is the most evident risk factor for WIL and LIW. There is a relationship between wellbeing and WIL and LIW respectively, and time demands is the most important factor in this relationship. Gender equality on the labor market did not relate to level of interference, nor did it mediate the relationship between interference and wellbeing. However, the main and most important risk factor for experiencing WIL and LIW and for how interference relate to wellbeing is gender relation processes in work and life, both on individual and contextual level.

The availability of new self-sensing cement-based strain sensors allows the development of dense sensor networks for Structural Health Monitoring (SHM) of reinforced concrete structures. These sensors are fabricated by doping cement-matrix materials with conductive fillers, such as Multi Walled Carbon Nanotubes (MWCNTs), and can be embedded into structural elements made of reinforced concrete prior to casting. The strain sensing principle is based on the multifunctional composites outputting a measurable change in their electrical properties when subjected to a deformation. Previous work by the authors was devoted to material fabrication, modeling and applications in SHM. In this paper, we investigate the behavior of several sensors fabricated with and without aggregates and with different MWCNTs content. The strain sensitivity of the sensors, in terms of fractional change in electrical resistivity for unit strain, as well as their linearity are investigated through experimental testing under both static and dynamically varying compressive loadings. Moreover, the responses of the sensors when subjected to destructive compressive tests are evaluated. Overall, the presented results contribute to improving the scientific knowledge on the behavior of smart concrete sensors and to furthering their understanding for SHM applications.

Sputtered reactive multilayers applied as a heat source in electronic joining processes are an emerging technology. Their use promises low-stress assembly of components while improving the thermal contact and reducing the thermal resistance. Nanostructured surface modifications can significantly enhance adhesion and reliability of joints between different materials. This work examines reactive multilayer of nickel and aluminum, directly sputtered on nanostructured black silicon surfaces and compares their phase transformation with reference samples deposited on pristine silicon surface. The investigation of the quenched self-propagating reaction reveals a clear influence of the nanostructured surface on the prolongation of the phase transition. Rapid thermal annealing tests result in the formation of Al_1.1Ni_0.9 phase. The nanostructured interface seems to hinder the full transformation of the parent material. The surface modification improves the adhesion of the formed alloy on silicon surfaces and can possibly increase the reliability of joints based on reactive aluminum/nickel multilayer. The use of black silicon, a nanostructured surface modification, is thus a promising approach to realize reliable multi-material joints in complex systems.

Serious damage caused by floor heave in the coal given chamber of a vertical coal bunker is one of the challenges faced in underground coal mines. Engineering practice shows that it is more difficult to maintain the coal given chamber (CGC) than a roadway. More importantly, repairing the CGC during mining practice will pose major safety risks and reduce production. Based on the case of the serious collapse that occurred in the bearing structure of the CGC at the lower part of the 214# coal bunker in Xiashijie mine, China, this work analysed (i) the main factors influencing floor heave and (ii) the failure mechanism of the load-bearing structure in the CGC using FLAC^2D numerical models and expansion experiment. The analysis results indicate that: the floor heave, caused mainly by mine water, is the basic reason leading to the instability and repeated failure of the CGC in the 214# coal bunker. Then a new coal bunker, without building the CGC, is proposed and put into practice to replace the 214# coal bunker. The FLAC^3D software program is adopted to establish the numerical model of the wall-mounted coal bunker (WMCB), and the stability of the rock surrounding the WMCB is simulated and analysed. The results show that: (1) the rock surrounding the sandstone segment is basically stable. (2) The surrounding rock in the coal seam segment, which moves into the inside of the bunker, is the main zone of deformation for the entire rock mass surrounding the bunker. Then the surrounding rock is controlled effectively by means of high-strength bolt–cable combined supporting technology. According to the geological conditions of the WMCB, the self-bearing system, which includes (i) H-steel beams, (ii) H-steel brackets, and (iii) self-locking anchor cables, is established and serves as a substitute for the CGC to transfer the whole weight of the bunker to stable surrounding rock. The stability of the new coal bunker has been verified by field testing, and the coal mine has gained economic benefit to a value of 158.026174 million RMB over three years. The new WMCB thus made production more effective and can provide helpful references for construction of vertical bunkers under similar geological conditions.

Many clinical research datasets have a large percentage of missing values that directly impacts their usefulness in yielding high accuracy classifiers when used for training in supervised machine learning. While missing value imputation methods have been shown to work well with smaller percentages of missing values, their ability to impute sparse clinical research data can be problem specific. We previously attempted to learn quantitative guidelines for ordering cardiac magnetic resonance imaging during the evaluation for pediatric cardiomyopathy, but missing data significantly reduced our usable sample size. In this work, we sought to determine if increasing the usable sample size through imputation would allow us to learn better guidelines. We first review several machine learning methods for estimating missing data. Then, we apply four popular methods (mean imputation, decision tree, k-nearest neighbors, and self-organizing maps) to a clinical research dataset of pediatric patients undergoing evaluation for cardiomyopathy. Using Bayesian Rule Learning (BRL) to learn ruleset models, we compared the performance of imputation-augmented models versus unaugmented models. We found that all four imputation-augmented models performed similarly to unaugmented models. While imputation did not improve performance, it did provide evidence for the robustness of our learned models.

In cardiac surgery, post-sternotomy pain is a significant issue, peaking within 48 hours and requiring proper analgesia for both acute relief and to avoid chronicization. Opioids are commonly used for pain management post-surgery but pose risks like adverse effects and dependency. Post-cardiac surgery pain can stem from various sources - somatic, visceral, and neuropathic, making opioid reliance a concern. Multimodal analgesia, combining different medications and regional anesthesia techniques, is increasingly recommended to decrease opioid use and its related problems. Strategies include acetaminophen, gabapentinoids, NMDA antagonists, alpha-2 agonists, intravenous lidocaine, anti-inflammatory drugs, and regional anesthesia. Implementing these approaches can enhance pain control, lessen opioid reliance, and improve cardiac surgery outcomes. The ERAS® Cardiac Society strongly advocates for an opioid-sparing multimodal approach to benefit patient recovery by reducing complications and enhancing satisfaction. This review aims to consolidate current evidence to assist healthcare providers in customizing pain management for patients post-cardiac surgery, emphasizing reduced opioid use and optimizing the recovery process.

Emerging pollutants pose significant threats to Uganda's ecosystems and public health amidst rapid urbanization, industrial growth, and intensified agriculture. This systematic review comprehensively assessed these pollutants by analyzing existing Ugandan literature and research studies, revealing various types in different environmental compartments. These pollutants, including pharmaceuticals, personal care products, pesticides, industrial chemicals, heavy metals, radionuclides, biotoxins, disinfection byproducts, hydrocarbons, and microplastics, originate from urban, industrial, and agricultural regions. Wastewater and improper waste disposal are major contributors. From an initial search of 794 articles across multiple databases such as PubMed, African Journal Online (AJOL), Web of Science, Science Direct, and Google Scholar, 138 were found relevant. The review underscores potential ecological and health impacts, including antibiotic resistance, endocrine disruption, and carcinogenicity. Existing monitoring and regulation efforts are discussed, alongside the need for specific regulations, improved data collection, and public awareness campaigns. Recommendations include advanced wastewater treatment, sustainable agriculture, and source control measures. Emphasis is placed on further research to address knowledge gaps and develop effective policies and interventions. Uganda can mitigate these risks by implementing comprehensive monitoring, robust regulations, and sustainable practices, safeguarding the environment and public health.

This study evaluates the accessibility of primary care physicians (PCPs) in Eastern Quebec using an enhanced two-step floating catchment area (E2SFCA) methodology. The E2SFCA methodology considers both the population supply of PCPs and the travel time between PCPs and dissemination areas, and was found to be effective in identifying possibly underserved areas. The availability of primary care services is contingent upon the presence of adequate road infrastructure, and populations residing in areas with limited access to main road networks may experience compromised access to primary care. The study concludes that the E2SFCA methodology can facilitate the identification of areas experiencing a shortage of PCPs, and this information can be used to inform the development of regional medical workforce programs and support the establishment of rural residency initiatives.

Serum albumin (ALB), one of the most important proteins in human physiology, has the main functions of maintaining plasma oncotic pressure and plasma volume, transporting hormones, vitamins, oligominerals and drugs, and exerting a powerful antioxidant-antiinflammatory role. Its prognostic value in liver and malabsorption syndromes is well known. In this narrative review, an analysis of the most important studies evaluating the prognostic significance of low serum ALB levels in hospitalized patients was performed. Specifically, the risk in emergency medicine, cardiovascular diseases, COVID-19 infection, nephrology, oncology and autoimmune rheumatic diseases has been examined to fully explore its clinical value. ALB is a negative acute-phase reactant and the reduction of its serum levels represents a threatening parameter for long-term survival in several clinical settings, and a strong poor prognostic biomarker in most diseases. Therefore, clinicians should consider serum ALB as a valuable tool to assess the efficacy of specific therapies, both in hospitalized patients and in chronic follow-up.

Nebulized thrombolysis offers locally targeted therapy with potentially lower bleeding risk than systemic administration for coronavirus disease 2019 (COVID-19) respiratory failure. In a proof-of-concept safety study, adult patients with COVID-19-induced respiratory failure and a <300mmHg PaO2/FiO2 (P/F) ratio, requiring invasive mechanical ventilation (IMV) or non-invasive respiratory support (NIRS) received nebulized rt-PA in two cohorts (C1 and C2), alongside standard of care during the first two UK COVID-19 waves. Matched historical controls (MHC; n=18) were used in C1. Safety co-primary endpoints were treatment-related bleeds and fibrinogen reduction to <1.0–1.5 g/L. A dose escalation strategy for improved efficacy with the least safety concerns was determined in C1 for use in C2; patients were stratified by ventilation type to receive 40–60 mg rt-PA per day for ≤14 days. Nine patients in C1 (IMV, 6/9; NIRS, 3/9) and 26 in C2 (IMV, 12/26; NIRS, 14/26) received nebulized rt-PA for a mean (SD) of 6.7 (4.6) and 9.1(4.6) days, respectively. Four bleeding events (one severe and three mild) in three patients were considered treatment-related. No significant fibrinogen reductions were reported. Greater improvement in mean P/F ratio from baseline to end of study was observed in C1 compared with MHC [C1; 154 to 299 vs MHC; 154 to 212). In C2, there was no difference in the baseline P/F ratio of NIRS and IMV patients. However, a larger improvement in P/F ratio was observed in NIRS patients [NIRS; 126 to 240 vs IMV; 120 to 188) and they required fewer treatment days (NIRS; 7.86 vs IMV; 10.5). Nebulized rt-PA appears to be well-tolerated, showing a trend of improved oxygenation and faster recovery in patients with acute COVID-19-induced respiratory failure requiring respiratory support; this effect was more pronounced in the NIRS group. Further investigation is required to study the potential of this novel treatment approach.

Emerging organic contaminants (EOCs) of anthropogenic origins are ubiquitous in environmental compartments, including aquatic systems. Thus, EOCs have attracted considerable research and public attention due to their potential human and ecological health risks. However, compared to other aquatic environments such as wastewater systems, comprehensive reviews focussing on the occurrence and human health risks of EOCs in drinking water systems are still lacking. Therefore, to address this knowledge gap, the current review posits that drinking water systems harbour a cocktail of toxic EOCs, which pose public health risks via multiple exposure routes. In the present review, global evidence is examined to track EOCs along the source-pathway-receptor-impact-mitigation (SPRIM) continuum. Evidence shows that, various groups of EOCs, including pharmaceuticals and personal care products, solvents, plasticizers, endocrine disrupting compounds, gasoline additives, per- and polyfluoroalkyl substances (PFAS), food colourants, artificial sweeteners, and musks and fragrances, have been detected in drinking water systems. The anthropogenic sources of EOCs detected in drinking water systems, including wastewater systems and industrial emissions, are summarized. Further, the behaviour and fate of EOCs in the drinking water systems, including removal processes are discussed. Once in drinking water systems, human exposure to EOCs may occur via ingestion of contaminated drinking water and cooked foods, and possibly dermal contact and inhalation. The high-risk environments, and risk factors and behaviours predisposing humans to EOC exposure are discussed. Evidence on the human health risks of the various EOCs and a critique of the data are presented. Notably, besides inferential data, quantitative epidemiological evidence directly relating the occurrence of EOCs in drinking water systems to specific adverse human health outcomes is still scarce. Lastly, future research directions, including the need for quantitative public health risk assessment, and the application of emerging detection tools are discussed.

All humans will experience the process of birth, old age, illness, and death. However, when faced with life-sustaining decisions, the families of patients are often faced with medical decisions as surrogates. In recent years, the families of patients have started to value the importance of the right to palliative care, although this often requires lengthy discussions. Therefore, this study explored the predictability of factors that affect the feeling experienced by patients’ families when signing Do-Not-Resuscitate Consent. This study used a cross-sectional study and interviewed 90 family members using a structural questionnaire. The study hypotheses were tested using a t-test, one-way analysis of variance, product–moment correlation, and hierarchical regression analysis. Attribute variables of family members, such as gender and whether they live with the patient, are predictors that affect the family member’s feeling experience when signing Do-Not-Resuscitate Consent. The emotional support from medical professionals to family members helps the family member to express their negative feelings on signing Do-Not-Resuscitate Consent; more informational support information provided to family members by medical professionals can alleviate negative feelings felt by family members when signing Do-Not-Resuscitate Consent. This study identified that family members’ knowledge about Do-Not-Resuscitate acquired from medical professionals is relatively low. It is suggested that critical care units regularly conduct training on hospice palliative care, implement standard care procedures of hospice palliative care at critical care units, and provide detailed medical information about advanced decisions to family members so as to reduce their emotional stress. This will ensure that intensive care units can also achieve the goal of critically ill hospice palliative care.

Statistical data extracted from national databases demonstrate a continuous growth in the incidence and prevalence of chronic kidney disease (CKD) and the ineffectiveness of current policies and strategies based on individual risk factors to reduce them, as well as their mortality and costs. Some innovative programs, telemedicine and government interest in the prevention of CKD, did not facilitate timely access to care, continuing the increased demand for dialysis and transplants, high morbidity and long-term disability. In contrast, new forms of kidney disease of unknown etiology affected populations in developing countries and underrepresented minorities, who face socioeconomic and cultural disadvantages. With this background, we analyze in the existing literature the effects of social determinants in CKD, concluding that it is necessary to strengthen current kidney health strategies, designing in a transdisciplinary way, a model that considers demographic characteristics integrated into individual risk factors and risk factors population, incorporating the population health perspective in public health policies to improve results in kidney health care, since CKD continues to be an important and growing contributor to chronic diseases.

This study demonstrated that antibiotic residue in milk can be reduced when dairy farmers use Ethno-veterinary Practices (EVP) based on herbal alternatives to prevent and cure common clinical conditions in cattle instead of antibiotics. Of the 220 farmers selected for the study, 140 were trained and motivated to use validated herbal formulations, 80 were kept as control. Milk samples from the selected farmers (except Thirukanurpatti milk society) tested positive for antibiotic residue in the baseline survey. One year after interventions, the milk from 123 (87.86%) farmers out of 140, were without any detectable antibiotic residue, while samples from 11 farmers (7.85%) were low positive for either Beta-lactams or sulphonamides and 6 (4.29%) were positive for Beta lactams and/or sulphonamides. These 17 (11 + 6) farmers had used antibiotics along with herbal formulations. The milk samples from the control groups were positive for beta lactam and sulphonamide. There was suggestive significance of change in knowledge, attitude and practice of EVP among the farmers from Kerala and Tamil Nadu. A progressive reduction in the incidence of mastitis, enteritis, repeat breeding and cowpox were observed from 2016 to 2019 among the cows treated with EVP. Use of herbal alternative also resulted in a significant reduction in health care expenditure of cattle.

A striking aspect of COVID-19 is the difference in the outcome of the infection between different countries, and different ethnic groups within one country. We surveyed the literature on SARS-CoV-2 complemented with comparative publications on SARS-CoV and other coronaviruses to capture the current understanding of virus – host interactions including virus subtypes, transmission, zoonotic aspects, and potential host determinants.

(1) Background: Pedestrian injuries (PIs) represent a significant proportion of road traffic injuries. We aimed at investigating the incidence and mortality of PIs in different age groups and Socio-demographic Index (SDI) categories between 1990 and 2017. (2) Method: Estimates of age-standardized incidence and mortality along with trends of PIs by SDI levels were obtained from the Global Burden of Disease from 1990 to 2017. We also calculated forecasts until 2040. (3) Results: Globally, PIs incidence increased by 3.31% (–9.94 to 16.56) in 2017 compared to 1990. Men have a higher incidence of PIs than women. Forecasted incidence was 132.02 (127.37 to 136.66) per 100,000 population in 2020, 101.52 (65.99 to 137.05) in 2030 and reduced further to 71.02 (10.62 to 152.65) by 2040. Globally across all SDI categories, there was a decreasing trend in mortality due to PIs with the global estimated percentage reduction of 37.12% (–45.19 to –29.04). (4) Conclusions: The results show that PIs are still a burden for all SDI categories despite some variation. Although incidence and mortality are expected to decrease globally, some SDI categories may require particular attention in addition to specific vulnerable age groups. Further studies addressing incidence and mortality patterns in vulnerable SDI categories are needed.

As a complementary and alternative medicine in the western countries for decades, traditional Chinese medicine (TCM) has been used for more than 2000 years in China. Because of the characteristics of the philosophical style and the unknown mechanism of action, TCM sometimes has been biasedly described as "fraught with pseudoscience". From the scientific basis of the systems biology, here we promoted a novel medical model called the entropic systems medicine which could be applied to scientize TCM in future. In entropic systems medicine, TCM and Western modern biomedicine target the different variables of the entropic system. For instance, while Western modern biomedicine directly targets the phenotypes and its SOCs of macrostates, TCM differently targets the microstates, entropy and entropic force to generate SOTFs gradually causing the differentiated syndromes to be slowly rearranged. The prerequisites to modernize TCM are the entropic systems biology having been well established so that the variables could be precisely monitored and mathematically calculated.

Acute myeloid leukemias (AMLs) are heterogeneous hematologic cancers that occur prevalently in older patients as the result of a complex pathobiology. The clinical outcomes of older patients with AML, often unsuitable for intensive chemotherapy and allogeneic stem cell transplantation, are generally disappointing. However, recent advances in understanding molecular pathogenesis and other biological mechanisms recognized in AML development and progression have changed the treatment approach, especially for this particularly vulnerable category of patients. Indeed, non-intensive biologically tailored approaches, such as combining venetoclax with hypomethylating agents, have changed the therapeutic paradigm in this field. Moreover, other promising compounds and treatment strategies are currently under advanced clinical development. This article delves into the latest biological understanding and therapeutic advances in the clinical management of older AML patients into new conceptual frameworks that progressively transform the clinical practice in this challenging setting.

Autism Spectrum Disorder (ASD), a neurodevelopmental disorder, is increasingly diagnosed and significantly affects communication, behavior, and social interaction. The current diagnostic framework, guided by the DSM-5, has limitations that may lead to clinical gaps due to overlapping symptoms of ASD and other disorders. This study proposes a comprehensive approach to enhance ASD diagnosis through clinical stratification based on comorbidities. We applied precision medicine techniques to identify and categorize ASD into ten clinical profiles. Our findings contribute to a more profound understanding of ASD, including its varied clinical manifestations and comorbidities, and facilitate the development of personalized therapeutic strategies.

Background: Pediatric Rapid Response Teams (RRTs) are expected to significantly lower pediatric mortality in healthcare settings. This study evaluates RRTs' effectiveness in decreasing cardiac arrests and unexpected Pediatric Intensive Care Unit (PICU) admissions. Methods: A quasi-experimental study (2014-2017) at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, involved 3,261 pediatric inpatients, split into pre-intervention (1,604) and post-intervention (1,657) groups. The intervention entailed pediatric specialists collaboratively managing acute decompensations following set protocols. Results: RRT was activated 471 times, primarily for respiratory distress (29.30%), sepsis (22.30%), clinical anxiety (13.80%), and hematological abnormalities (6.7%). Family concerns triggered 0.1% of activations. Post-RRT implementation, unplanned PICU admissions significantly reduced (RR = 0.552, 95% CI 0.485-0.628, P < 0.0001), and non-ICU cardiac arrests were eliminated (RR = 0). Patient care improvement was notable, with a -9.61 coefficient for PICU admissions (95% CI: -12.65 to -6.57, P < 0.001) and a -1.641 coefficient for non-ICU cardiac arrests (95% CI: -2.22 to -1.06, P < 0.001). Sensitivity analysis showed mixed results for PICU admissions, while zero-inflation Poisson analysis confirmed a reduction in non-ICU arrests. Conclusions: The deployment of pediatric RRTs is associated with fewer unexpected PICU admissions and non-ICU cardiopulmonary arrests, indicating improved PICU management. Further research using robust scientific methods is necessary to conclusively determine RRTs' clinical benefits.

Background: Carers (or care partners) of adults in LTC contribute substantially to the health and well-being of their loved ones by providing physical care, emotional support, and companionship. Despite their critical role, little is known about how caregivers have been impacted by the pandemic. The purpose of this study was to explore the lived experiences of caregivers of people living in long-term care (LTC) homes during the initial phases of the COVID-19 pandemic and potential supports and resources needed to improve caregivers’ quality of life.Design: An interpretive descriptive approach that incorporated photovoice method was used. Methods: Using purposive sampling strategy, six family carers in Ontario, Canada were recruited between September and December 2021. Over a four-week period, caregivers took pictures depicting their experience of the pandemic that were shared in a virtual focus group. Visual and text data were analyzed using thematic analysis with an inductive approach.Findings: Caregivers expressed feelings of frustration, confusion, and joy. Emerging themes included: (i) feeling like a “criminal” amidst visitor restrictions and rules; (ii) experiencing uncertainty and disappointment in the quality of care of long-term care homes; (iii) going through burnout; and (iv) focusing on small joys and cherished memories.Conclusions: The combination of visual and textual methods provided unique insight into the mental distress, isolation, and intense emotional burdens experienced by caregivers during the pandemic. Impact: Our findings underscore the need for LTC organizations to work in unison with caregivers to optimize the care of residents and support mental health of caregivers.

Bipolar disorder is a severe mood disorder and is one of the top 20 reasons of disability in the world. It causes a huge burden on society. In this study, the prediction models of bipolar disorder were constructed based on the concept of knowledge distillation. The input data consisted of patients of bipolar disorder and matched controls, all of which were selected from the open database MIMIC. The method of kernel density estimation (KDE) was exploited to generate probability density functions (PDF) which identify distributions of input data. The PDF values referred to as the soft labels were combined with the input data to construct the prediction models of bipolar disorder using decision tree and artificial neural network respectively. According to the evaluation results, indicators for identifying positive samples of bipolar disorder were improved. Meanwhile, the indicators for identifying negative samples have also been advanced. In addition, the branching attributes selected by the decision trees can be mapped back to specific disease diagnoses, which are all associated with bipolar disorder. In conclusion, using KDE to generate the soft label information of the input data can make knowledge distillation work and has improved the performances of prediction models for bipolar disorder.

Background: The use of peripherally inserted central catheters and midline catheters is growing due to their potential benefits. These devices can increase patient safety and satisfaction while reducing the use of resources. As a result, many hospitals are establishing vascular access specialist teams staffed by nurses who are trained in the insertion and maintenance of these catheters. Objective: Evaluate ex-ante whether the benefits of replacing peripheral venous catheters, peripherally inserted central catheters and midline catheters with ultrasound-guided peripherally inserted central catheters and midline catheters by a vascular access specialist team outweigh their costs. Methods: Cost-benefit analysis from the perspective of the healthcare provider based on administrative data. The study estimates the reduction in resources used when replacing peripherally inserted central catheters, midline catheters and peripheral venous catheters with ultrasound-guided peripherally inserted central catheters and midlines, as well as the additional resources required for their use. Results: Each ultrasound-guided peripherally inserted central catheter replacing a peripherally inserted central catheter, results in a measurable resource reduction of approximately €31. When 3 peripheral venous catheters are replaced by an ultrasound-guided peripherally inserted central catheter, the saving is €63. Similarly, each ultrasound-guided midline catheter replacing a midline, results in a reduction of €16, while each ultrasound-guided midline catheter replacing 3 peripheral venous catheters results in a reduction of €96. Conclusion: The benefits of replacing peripheral venous catheters, peripherally inserted central catheters and midline catheters by introducing a vascular access specialist team trained in the implantation of ultrasound-guided peripherally inserted central catheters and midline catheters, outweigh its cost mainly because of the decrease in hospital stay due to the lowered risk of healthcare-associated infections. These results motivate the implementation of the service, adding to previous experience suggesting that it is also preferable from the point of view of patient safety and satisfaction.

8-Hydroxydeoxyguanosine (8-OHdG) was the most widely used oxidative stress biomarker of the free radical-induced oxidative damage product of DNA, which may allow a premature assessment of various diseases. This paper designed a label-free, portable biosensor device to direct detect 8-OHdG by plasma coupled electrochemistry on transparent and conductive indium tin oxide (ITO) electrode. We reported a flexible printed ITO electrode made from particle-free silver and carbon inks. After inkjet printing, the working electrode was sequentially assembled by gold nanotriangles (AuNTAs) and platinum nanoparticles (PtNPs). This nanomaterial-modified portable biosensor showed excellent electrochemical performance for 8-OHdG detection from 10 μg/mL to 100 μg/mL by our self-developed constant voltage source integrated circuit system. This work demonstrated a portable biosensor for simultaneously integrating nanostructure, electroconductivity, and biocompatibility to construct advanced biosensors for oxidative damage biomarkers. The proposed nanomaterial modified ITO-based electrochemical portable device was a potential biosensor to approach 8-OHdG point-of-care testing (POCT) in various biological fluid samples, such as saliva and urine samples.

Lung ultrasound (LUS) allows the detection of a series of manifestations of COVID-19 such as B lines and consolidations. The objective of this work was to study the inter-rater reliability (IRR) when detecting signs associated with COVID-19 in the LUS, as well as the impact of performing the test in the longitudinal or transverse orientation. 33 physicians with advanced experience in LUS, independently evaluated ultrasound videos previously acquired with the ULTRACOV system of 20 patients with confirmed COVID-19. In each patient, 24 videos of 3 seconds were acquired (using 12 positions with the probe in longitudinal and transverse orientations). Physicians had no information about the patients or other previous evaluations. The score assigned to each acquisition followed the convention applied in previous studies. A substantial IRR was found in the cases of normal LUS (κ = 0.74), only a fair IRR for the presence of individual B lines (κ = 0.36) and for confluent B lines occupying &lt;50% (κ = 0.26), and a moderate IRR in consolidations and B-lines &gt;50% (κ = 0.50). No statistically significant differences between the longitudinal and transverse scans were found. The IRR in LUS of COVID-19 patients may benefit from more standardization of the clinical protocols.

The World Health Organization has developed the Integrated Care of Older People (ICOPE) strategy, a program based on the measurement of intrinsic capacity (IC) as “the composite of all physical and mental attributes on which an individual can draw”. Multicomponent interventions appear to be the more effective approach to enhance IC and to prevent frailty and dependence, being adapted physical activity is the preventive intervention that has shown more evidence in the treatment of frailty and risk of falls. The present study aims to describe the development of a multi-domain group-based intervention addressed to frail older people living in the community aimed to improve and/or maintain intrinsic capacity by means of promoting physical activity, healthy nutrition, and psychological wellbeing in frail older people. We used the GUIDED checklist to describe the development process of AMICOPE (Aptitude Multi-domain group-based intervention to improve and/or maintain IC in frail Older PEople). The intervention was built upon the ICOPE framework and it is described with Template for Intervention Description and Replication (TIDieR) guidelines and it includes dietary advice, cognitive stimulation strategies, medication review, goal setting, and activities to strengthen social support and manage depressive symptoms, as well as strength, balance and flexibility exercise using the Vivifrail program. The study represents the first stage of the UK Medical Research Council framework for developing and evaluating a complex intervention. The next step should be carrying out a feasibility study for the AMICOPE intervention, and in a later stage, assessing the effectiveness in a randomized controlled trial.

Virtual reality (VR) describes a family of technologies which immerse users in sensorily-stimulating virtual environments. Such technologies have increasingly found applications in the treatment of neurological and mental health disorders. Depression, anxiety, and other mood abnormalities are of concern in the growing elderly population – especially those who reside in long-term care facilities (LTCFs). The transition from the familiar home environment to the foreign LTCF introduces a number of stressors that can precipitate depression. However, recent studies reveal that VR therapy (VRT) can promote positive emotionality and improve cognitive abilities in the elderly, both at home and in LTCFs. VR thus holds potential in allowing elderly individuals to gradually adapt to their new environments – thereby mitigating the detrimental effects of place attachment and social exclusion. Nevertheless, while the current psychological literature is promising, the implementation of VR in LTCFs faces many challenges. LTCF residents must gain trust in VR technologies, care providers require training to maximize the positive effects of VRT, and decision makers must evaluate both the opportunities and obstacles in adopting VR. Here, we concisely review the implications of depression related to place attachment in LTCFs, and explore the potential therapeutic applications of VR.

Biosensors are measurement devices that can sense several biomolecules, and are widely used for the detection of relevant clinical pathogens such as bacteria and viruses, showing outstanding results. Because of the latent existing risk of facing another pandemic like the one we are living due to COVID-19, researchers are constantly looking forward to developing new technologies for diagnosis and treatment of infections caused by different bacteria and viruses. Regarding that, nanotechnology has improved biosensors design and performance through the development of materials and nanoparticles that enhance their affinity, selectivity, and efficacy in detecting these pathogens, such as employing nanoparticles, graphene quantum dots, and electrospun nanofibers. Therefore, this work aims to present a comprehensive review that exposes how biosensors work in terms of bacterial and viral detection, and the nanotechnological features that are contributing to achieving a faster yet still efficient COVID-19 diagnosis at the point-of-care.

It has become practically impossible to survey the literature on cells derived from adipose tissue with the aim to apply them in regenerative medicine. The aim of this review is to provide a jump start to understanding the potential of UA-ADRCs (uncultured, unmodified, fresh, autologous adipose derived regenerative cells isolated at the point of care) in regenerative medicine. We show that serious and adequate clinical research demonstrates that tissue regeneration with UA-ADRCs is safe and effective. ADRCs are neither 'fat stem cells' nor could they exclusively be isolated from adipose tissue, as ADRCs contain the same adult (depending on the definition) pluripotent or multipotent stem cells that are ubiquitously present in the walls of small blood vessels. Of note, the specific isolation procedure used has significant impact on the number and viability of the cells and hence on safety and efficacy of UA-ADRCs. Furthermore, there is no need to further separate adipose-derived stem cells (ASCs) from ADRCs if the latter were adequately isolated from adipose tissue. Most importantly, UA-ADRCs have the physiological capacity to adequately regenerate tissue without need for manipulating, stimulating and/or (genetically) reprogramming the cells for this purpose. Tissue regeneration with UA-ADRCs fulfills the criteria of homologous use.

This study considers ways to increase the consumption of sustainable fashion, given the significant environmental and social damages, associated with the industry. A series of experiments were conducted examining the impacts of choice architecture (nudges) under field conditions in collab-oration with one of Israel’s largest shopping centers. The study sought to identify which inter-ventions at the retail level successfully motivate sustainable fashion behavioral change regarding purchases and willingness to pay more, along with agreement with several statements regarding the climate crisis and sustainable fashion. Among the types of nudges examined in this field study were providing information, increasing accessibility to sustainable alternatives and appealing to social identity, in relation to demographics and green self-image. The study found that offering alterna-tives to consumers constitutes the most effective way to “nudge” consumers toward more sus-tainable purchasing behavior. Nonetheless, this does not negate the contribution of providing in-formation and strengthening social norms regarding sustainable fashion. Additionally in all groups, most participants reported that they do not know how to distinguish between sustainable and non-sustainable fashion, nor do they believe that the clothes they purchased were actually sustainable. The findings emphasize the need for policies that will increase the accessibility of sustainable fashion.

An innovative concrete that incorporates the advantages of self-compacting concrete with geopolymer is called self-compacting geopolymer concrete. The objective of this study was the Manufacturing of M30-grade self-compacting geopolymer concrete by adding industrial materials like fly ash (FA), ultrafine ground granulated blast furnace slag (UFGGBS), and silica fume (SF) as minerals. The disposal of these industrial wastes can be substantially overcome, as they lead to land pollution. The fixed powder content was 500 kg/m³. A mixture of sodium silicate (Na₂SiO₃) and sodium hydroxide (NaOH) created an alkaline solution that activated the cementitious binders. In this study, slump flow, L-box, V Funnel, T50 V Funnel, and J ring tests were carried out to determine the fresh qualities of the concrete. These tests were conducted under the regulations for self-compacting concrete provided by EFNARC (2005). To improve the flexural strength of the SCGC, 1.5 % glass fibre was added. This study illustrates how an artificial neural network (ANN) model can determine the concrete mix proportion. The characteristics of SCGC, both fresh and hardened properties test were investigated for molarities of 8, 10, and 12. The microstructural outcomes were determined using Fourier-transform infrared spectroscopy (FT-IR), scanning electron microscopy (SEM), and X-ray diffraction (XRD).

The prolonged static sitting at the workplace is considered as one of the main risks for development of musculoskeletal disorders (MSDs) and adverse health effects. Factors such as poor posture and extended sitting are perceived to be a reason for conditions such as lumbar hyperlordosis and lower back pain (LBP), even though the scientific explanation of this relationship is still unclear and raises disputes in the scientific community. This publication proposes the low back pain assessment (LBPA) dataset collected through experiment with 100 participants and consisting of photogrammetric images with intentionally placed body markers, calculated postural angles and tags correct and incorrect posture assessed by habilitated rehabilitator, as well as questionnaire-based self-reports regarding the occurrence of LBP and similar symptoms among the participants. Machine learning models trained with this data are employed for recognizing incorrect body postures. Two scenarios have been elaborated for modeling purposes: scenario 1, based on natural body posture tagged as correct and incorrect, and scenario 2, based on incorrect body postures, corrected additionally by the rehabilitator. The achieved accuracies of respectively 75.3% and 85% for both scenarios reveal the potential for future research in enhancing awareness and actively managing posture-related issues that elevate the likelihood of developing lower back pain symptoms.

The aim of this randomized controlled clinical trial was to compare the 2-year clinical performance of resin composite restorations placed at non-caries cervical lesions (NCCL) with one-step self-etch, total-etch, and selective enamel etch & self-etch adhesive techniques. Thirty-two patients received three resin composite restorations each at NCCLs (Tetric EvoCeram/Ivoclar/Vivadent), bonded with a total-etch adhesive agent (ExciTE F/Ivoclar/Vivadent) and a self-etch (AdheSE One F/Ivoclar/Vivadent) without and with selective enamel etching. All restorations were evaluated by two examiners at baseline, 6-, 12-, 18- and 24-months post-operation regarding retention, caries occurrence, marginal adaptation, and marginal staining. A logistic regression analysis with generalized estimating equations was used. After 2 years, the retention rate was 86,8% for total-etch, 92.26% for self-etch, and 93.63% for selective enamel etching & self-etch. No caries were detected during all the restorations. Concerning marginal adaptation, the clinically perfect restorations were 26.9% for the total-etch technique, 16% for self-etch, and 25,9% for selective enamel etch & self-etch. All three adhesive strategies provided restorations with no significant differences in the retention rate and the marginal adaptation, whereas the total etch yielded better performance for marginal staining. All the restorations were assessed as clinically acceptable after 2 years.

Aims: This study aims to evaluate the impact of family-centered empowerment on Jordanian adolescents with type 1 diabetes (T1DM), focusing on their HbA1c levels, self-efficacy, and quality of life (QOL). Background: Poor glycemic management in adolescents with type 1 diabetes increases complications. Improved control is linked to various variables, but few studies focus on Middle Eastern populations. Methods: An experimental study involved 68 adolescents with T1DM visiting Jordanian Royal Medical Services' clinics. Two sets of participants were created: control (n = 34) and intervention (n = 34). Data was collected through face-to-face interviews and medical records. Results: The study found significant differences in self-efficacy scores between the intervention and control groups, with the intervention group experiencing a significant decrease in HbA1c readings and a significant difference in QOL between pre-program and post-program phases. Discussion: Family empowerment can significantly improve the lives of Jordanian teenagers with type 1 diabetes. This strategy leads to improved glycemic management, increased self-efficacy, and improved quality of life. Future treatments and health policies should recognize and value the critical role families play in the care of this population. Conclusion: The study suggests that patients with T1DM should receive continuous care education sessions, including self-care training, to improve their health. Nurses should also incorporate these training into treatment plans and educational programs for adolescents to enhance their QOL.

Abstract: Fetal Alcohol Spectrum Disorder (FASD) is considered a lifelong disability that has been framed by neurobiological descriptions focused on the brain. These are important features but fail to tell the story of living with FASD. By surveying those with FASD, this work expands upon prior survey work which illustrated a multitude of early onset physiological issues occurring at rates much higher than typical of the general population. The current project, again using an anonymous survey methodology, seeks to open up other direct experiences to better understand the complexity of living with FASD. An anonymous online survey was used to gather data on advresity in childhood, schooling, employment, housing and finances, involvement with the criminal justice system as well as relationships and parenting. Results inform how supports can be enhanced and targeted with a goal of improving the quality of life. The survey was developed by adults living with FASD who have served as a long-standing advocacy and educational group influencing policy and practice in the field.

We explore 3D printing modules for self-assembling spacecraft and robots – structure, actuators, electrics. Self-assembly has long been viewed as a highly desirable capability for autonomous construction of large space structures. We review self-assembly in space which focusses on the self-assembly of modules that demonstrate the range of applications. However, self-assembly may be synergised with 3D printing to offer an automated capability from raw material to modules for assembling new spacecraft or habitats. One application of 3D printing is using space debris on-orbit as an in-situ resource - defunct spacecraft may be salvaged as raw material for in-situ construction on demand. The common features of all self-assembling modules are that the modules constitute a structure housing a computer-controlled actuator internally and a reversible latching mechanism externally. We have demonstrated a 3D printed DC electric motor in which the only components that were not 3D printed are the wire coils. We have married our 3D printed motor prototype as an actuated joint between two 3D printed trigon-type panels developed as part of a trigon self-assembling system concept. The trigon concept underlies a modular approach to self-assembling and self-deploying structures. The 3D printed motorised panel system demonstrates that the motor aspect and structural aspects of robotic self-assembling machines are amenable to 3D printing. This has implications for self-assembling systems into modular satellites as a solution to space debris.

With the development of artificial intelligence, the ability of capturing the background characteristics of hyperspectral imagery (HSI) is improved and promising performance in hyperspectral anomaly detection (HAD) tasks is yielded. However, existing methods proposed in recent years still suffer from certain limitations: 1) constraints are lacking in the deep feature learning process in terms of the issue for absence of prior background and anomaly information. 2) hyperspectral anomaly detectors with traditional self-supervised deep learning methods fail to ensure prioritized reconstruction of the background. 3) architectures of fully connected deep network in hyperspectral anomaly detectors lead to low utilization of spatial information and destruction for original spatial relationship of hyperspectral imagery, and disregard spectral correlation between adjacent pixels. 4) hypotheses or assumptions for background and anomaly distributions restrict the performance of many hyperspectral anomaly detectors because the distributions of background land covers are usually complex and not assumable in real-world hyperspectral imagery. With the consideration of above problems, in this paper, we propose a novel fully convolutional auto-encoder based on dual clustering and latent feature adversarial consistency (FCAE-DCAC) for HAD which is carried out in a self-supervised learning-based processing. Firstly, the density-based spatial clustering of applications with noise algorithm and connected component analysis are utilized for successive spectral and spatial clustering to obtain more precise prior background and anomaly information, which facilitates the separation between background and anomaly samples during the training of our method. Subsequently, a novel fully convolutional auto-encoder (FCAE) integrated with spatial-spectral joint attention (SSJA) is proposed to enhance the utilization of spatial information and augment feature expression. In addition, a latent feature adversarial consistency network is proposed to achieve pure background reconstruction with the ability of learning actual background distribution in hyperspectral imagery. Finally, a triplet loss is introduced to enhance the separability between background and anomaly, and the reconstruction residual serves as the anomaly detection result. We evaluate the proposed method on seven groups of real-world hyperspectral datasets, and the experimental results confirmed the effectiveness and superior performance of the proposed method versus nine state-of-the-art methods.

The study focuses on a novel porous TiNi-based material for ophthalmic orbital implants which was produced by self-propagating high-temperature synthesis (SHS) and, after proper surface modification, possesses a specific microstructure of its surface pores, which makes it attractive for biomedical use in implants. After preparation via SHS, the obtained porous TiNi material was etched in acidic environment, to get rid of its surface Ti2Ni secondary-phase particles. This was found to improve the material’s surface morphology, adding micro-roughness to its macro-rough pores. As a result, cell growth tests conducted on the material demonstrated improved cell adhesion and growth kinetics on such a porous material with improved roughness. Finally, the material was tested in vivo as an ophthalmic orbital implant, demonstrating good biocompatibility, good degree of biointegration with surrounding eyeball tissues, and no signs of rejection after as long as 180 days. Thus, the novel porous TiNi-based material shows promise for its use in ophthalmic implantology, for instanse for manufacturing musculoskeletal stumps of the eyeball after evisceration, as it is biocompatible, has a high tissue-implant integration potential and demonstrates reduced risks of exposure and rejection of the implant.

This work deals with a novel porous TiNi-based material for ophthalmic orbital implants that was produced by high-temperature synthesis (SHS) and possesses a specific microstructure of its surface pores, which makes it attractive for biomedical use in implants. After preparation via SHS, the obtained porous TiNi material was etched in acidic environment, to get rid of its surface Ti2Ni secondary-phase particles. This was found to improve the material’s surface morphology, adding micro-roughness to its macro-rough pores. As a result, cell growth tests conducted on the material demonstrated improved cell adhesion and growth kinetics on such a porous material with improved roughness. Finally, the material was tested in vivo as an ophthalmic orbital implant, demonstrating good biocompatibility, good degree of biointegration with surrounding eyeball tissues, and no signs of rejection after as long as 180 days. Thus, the novel porous TiNi-based material shows promise for its use in ophthalmic implantology, for instanse for manufacturing musculoskeletal stumps of the eyeball after evisceration, as it is biocompatible, has a high tissue-implant integration potential and demonstrates reduced risks of exposure and rejection of the implant.

In an outstanding article published in 2008, Suzuki obtained a nice generalization of the Banach contraction principle from which derived a characterization of metric completeness. Although Suzuki’s theorem has been successfully generalized and extended in several directions and contexts, we here show by means of a simple example that the problem of achieving, in an obvious way, its full extension to the framework of w-distances does not have an emphatic response. Motivated by this fact we introduce the concept of presymmetric w-distance on metric spaces, we give some properties and examples of this new structure and show that it provides a reasonable setting to obtain a real and hardly forced w-distance generalization of Suzuki’s theorem. This is realized in our main result, which is a fixed point theorem that involves presymmetric w-distances and certain contractions of Suzuki-type. We also discuss the relationship between our main result and the well-known w-distance full generalization of the Banach contraction principle, due to Suzuki and Takahashi. Connected to this approach we prove another fixed point result that compare with our main result through some examples. Finally, we state a characterization of metric completeness by using our fixed point results.

In today’s competitive landscape, achieving customer-centricity is paramount for the sustainable growth and success of organisations. This research is dedicated to understanding customer preferences in the context of the Internet of Things (IoT) and employs a two-part modeling ap-proach tailored in this digital era. In the first phase, we leverage the power of the Self-Organizing Map (SOM) algorithm to segment IoT customers based on their connected device usage patterns. This segmentation approach reveals three distinct customer clusters, with the second cluster demonstrating the highest propensity for IoT device adoption and usage. In the second phase, we introduce a robust Decision Tree methodology designed to prioritize various factors influencing customer satisfaction in the IoT ecosystem. We employ the Classification and Regression Tree (CART) technique to analyze 17 key questions that assess the significance of factors impacting IoT device purchase decisions. By aligning these factors with the identified IoT customer clusters, we gain profound insights into customer behaviour and preferences in the rapidly evolving world of connected devices. This comprehensive analysis delves into the factors contributing to customer retention in the IoT space, with a strong emphasis on crafting logical marketing strategies, en-hancing customer satisfaction, and fostering customer loyalty in the digital realm. Our research methodology involves surveys and questionnaires distributed to 207 IoT users, categorizing them into three distinct IoT customer groups. Leveraging analytical statistical methods, regression analysis, and IoT-specific tools and software, this study rigorously evaluate the factors influencing IoT device purchases. Importantly, this approach not only effectively clusters the IoT Customer Relationship Management (IoT-CRM) dataset but also provides valuable visualizations that are essential for understanding the complex dynamics of the IoT customer landscape. Our findings underscore the critical role of logical marketing strategies, customer satisfaction, and customer loyalty in enhancing customer retention in the IoT era. This research makes a significant contri-bution to businesses seeking to optimize their IoT -CRM strategies and capitalize on the oppor-tunities presented by the IoT ecosystem.

Premature failure and degradation of layers are the main problems for transportation infrastruc-ture. Addressing these issues necessitates implementing structural health monitoring (SHM) for transportation layers. This strategic approach is instrumental in mitigating maintenance expenses, prolonging the operational lifespan, and preventing accidents resulting from abrupt layer col-lapse. To this end, this research investigated the stress/strain and damage detection capabilities of a self-sensing cementitious composite developed for potential utilization in the construction of an intelligent subgrade layer. The prepared self-sensing cementitious composite consisted of 10% cement and hybrid conductive fillers, including multiwalled carbon nanotubes (MWCNTs) and graphene nanoplatelets (GNPs) in sand. Initial findings reveal that the electrical resistivity of the composite is significantly affected by the concentration of MWCNTs/GNPs, with a minimum concentration of more than 0.5% needed to achieve a responsive cementitious composite. More-over, the piezoresistive analysis indicates that an increase in the concentration of MWCNTs/GNPs and stress levels leads to an improvement in the stress/strain sensing perfor-mance. When the self-sensing cementitious composite is subjected to equivalent stress levels, variations in the FCR exhibit an increasing trend with decreasing resilient modulus, stemming from a decrease in stiffness due to the increased concentration of MWCNTs/GNPs. Additionally, the EIS analysis demonstrates a contraction for the Nyquist curves under compressive ramp loading prior to failure, followed by the expansion of these curves postfailure. Scanning electron microscopy (SEM) images visually showcase the bridging effects of MWCNTs and the filling ef-fects of GNPs within the composite structure.

Block copolymers are a class of materials particularly interesting for their ability to self-assemble into ordered structures. In this context, the coupling between environment and dynamics is particularly relevant, given that movements at the molecular level influence various properties of macromolecules. Mixing the polymer with a second macromolecule appears to be an easy way to study these relationships. In this work, we studied a system based on two diblock copolymers of methyl methacrylate as first block and 3-methyl-4-[6-(methylacryloyloxy)-hexyloxy]-4’-pentyloxy azobenzene as second block and their blends with PMMA. The relaxational properties of these systems were investigated by electron spin resonance (ESR) spectroscopy sensitive to nanometric length-scales. The results of the study on the blends were related to the dynamic behavior of the copolymer. The study evidenced the presence of fast and slow molecular sites for the molecular reorientation at nanoscale, modulated by the ability of block copolymer to form supramolecular structures. For blends, the heterogeneities at nanoscale are still detected. However it was found that the presence of the PMMA as the major component of the blends modified their dynamic behaviour.

Medical Self-service Terminals (MST) offer potential for process optimization and enhanced patient convenience in hospitals, including the elderly. However, the behavioral inclination (BI) of elderly Chinese individuals towards MST adoption remains suboptimal. This study aims to elucidate BI determinants for MST among the aging demographic, focusing on User Interface (UI) attributes within the extended Unified Technology Acceptance and Use Theory (UTAUT) Model. The empirical inquiry examines seven factors, comprising three key UI attributes and four fundamental UTAUT factors. Results reveal significant positive associations of Performance Expectancy (β=0.40, p&lt;0.001), Effort Expectancy (β=0.50, p&lt;0.001), and Social Influence (β=0.25, p&lt;0.05) with BI. Notably, User Interface Design positively correlates with Performance Expectancy (β=0.89, p&lt;0.001) and Effort Expectancy (β=0.81, p&lt;0.001). These findings emphasize the interplay between objective UI attributes and subjective UTAUT determinants. This research enhances understanding of UI's impact on MST BI and acceptance, particularly within the Chinese elderly population, urging MST researchers to prioritize elderly attitudes for effective technological integration in healthcare.

Life in the modern century is heavily reliant on an enormous amount of electricity consumption as technology has become the most integral part of daily life. In this context, smart grid systems play a pivotal role to maintain the uninterrupted power supply which needs to be monitored in a timely fashion to keep track of the electric consumers’ usage pattern. The smart meter is the one of smart applications of the smart grid that collects huge amounts of consumer load data on a daily basis which has become a focus for various researchers and analyzers to study load characterization. In this paper, an approach has been proposed to recognize the energy consumption patterns among diverse types of consumers ranging from residential to industrial levels. This approach is worth considering not only for load pattern recognition but also for involving customers in different events such as demand response or peak shaving. In such a way, this analytical mechanism certainly assists in reducing power wastage and saving costs. The proposed methodology is based on a two-fold clustering algorithm with the use of state-of-the-art technology, machine learning. The primary goal is to classify electric customers' data collected from smart meters. Then, analyzing the classified results with an aim to predict power consumption patterns for the customers in the future and making the right energy policy that will benefit both the grid operator and consumers as well.

Attention deficit hyperactivity disorder (ADHD) results in various functioning impairments in children’s lives and families. Parents of children with ADHD report high levels of parenting stress, low levels of parental self-efficacy and use of more authoritarian and/or permissive parenting practices than parents of typically developing children. Intervention programs need to address both children’s and parents’ needs and multimodal intervention programs could cover this demand. The aim of this study was to examine the efficacy of “Child ViReal Support Program” - a multi-level evidence-based comprehensive program - on parenting stress, parental self-efficacy, parenting practices, and the core symptoms of children’s ADHD. Families with a child diagnosed with ADHD (n = 16) were randomly allocated to two groups (PC and CP; P = parent training, C = child training) and a cross-over design was utilized. Participating parents completed, in four different times during the study, the Parenting Stress Index-Short Form, the Parenting Sense of Competence Scale, the Parenting Styles and Dimensions Questionnaire-Short Version and the parent form of the ADHD Rating Scale-IV. Parents from both groups, after their participation in the parent training, demonstrated reduced parenting stress, enhanced parental self-efficacy and increased the employ of democratic parenting practices. More than that, they reported decreased levels of inattention and impulsivity/hyperactivity for their children. Evidence-based multi-level intervention programs could produce positive effects in parents and children by incorporating effective methods and tools in accordance with the needs and the demands of the family context.

Abstract: Hox gene clusters are crucial in Embryogenesis. It was observed that some Hox genes were located in order along the telomeric to centromeric direction of the DNA sequence: Hox1, Hox2, Hox3…. These genes were expressed in the same order in the ontogenetic units of the Drosophila embryo along the Anterior-Posterior axis. The two entities (genome and embryo) differ significantly in linear size and in-between distance. This strange phenomenon was named Spatial Collinearity (SP). Later, it was observed that, particularly in the Vertebrates, a Temporal Collinearity (TC) coexists: first is Hox1 expressed, later Hox2 and even later Hox3,…,. Hox clusters are irreversibly elongated along the force direction. According to a Biophysical Model (BM), pulling forces act at the anterior end of the cluster while a cluster fastening applies at the posterior end. During Evolution, the elongated Hox clusters are broken at variable lengths thus split clusters may be created. An Empirical Rule was formulated distinguishing development due to a complete Hox cluster from development due to split Hox clusters. BM can explain this Empirical Rule. In an accidental mutation where the cluster fastening is dismantled, a minimal pulling force can automatically shift the cluster inside the Hox activation domain. This cluster translocation can probably explain the absence of temporal collinearity in Drosophila.

Abstract. Can we nowadays keep a qualitative difference between the primitive and advanced Theory-of-Mind? The old criteria have become blurry. In addition, it is clear that in ‘apes’ lifestyle’ it is not necessary to use the communicative-cognitive basic abilities which became indispensable in ‘the new lifestyle’. Thus, it is usual to conclude that apes would have to some degree such abilities. However, this article tries to reformulate and defend that qualitative difference. Thus, after underlining the contrast between two kinds of mental states (‘contents’ and ‘expectations’), I apply it to the detection of foreign mental states as well. Then, three points are proposed: First, ‘vicarious expectations’ sustain the primitive ToM; second, a subject can have no expectation of inner states which are intrinsically impossible for him; third, the state of interacting with ourselves as with a different person –e.g., the thinking what others think of us– cannot be a vicarious expectation of ours, but it requires the estimation of foreign contents. From this hypothesis, I deduce that vicarious expectations are unable to sustain self-conscious emotions or the really effective reception of pointing gestures. These abilities could appear only when ‘the estimation of foreign contents’ –i.e., the origin of the advanced ToM– arose.

The practice of quantified-self sleep tracking is increasingly common nowadays among healthy individuals as well as patients with sleep problems. However, existing sleep-tracking technologies only support simple data collection and visualization, and are incapable of providing actionable recommendations that are tailored to users' physical, behavioral and environmental context. Here we coined the term context-aware sleep health recommender system (CASHRS) as an emerging multidisciplinary research field that bridges ubiquitous sleep computing and context-aware recommender systems. In this paper, we presented a narrative review to analyze the type of contextual information, the recommendation algorithms, the context filtering techniques, the behavior change techniques, the system evaluation, and the challenges in peer-reviewed publications that meet the characteristics of CASHRS. Analysis results identified current research trends, the knowledge gap, and future research opportunities in CASHRS.

The article continues the author's publications about the matrix-tensor study of universal rules of stochastic (probabilistic) organization of long single-stranded DNA sequences in eukaryotic and prokaryotic genomes. The author reveals that corresponding matrices of probabilities of n-plets in n-textual representations of each genomic DNA are numerically interrelated each with other in such algebraic form, which has analogies with formalisms of the known tensor-matrix theory of digital antenna arrays. These arrays combine many separate antennas into a single coordinated ensemble with unique emergent properties, due to which antenna arrays are widely used in devices of medicine, astrophysics, avionics, etc. The noted analogies allow putting forward the author's hypothesis that stochastic organization of genomic DNAs is connected with bio-antenna arrays. From the point of view of this hypothesis, many known facts about using principles of antenna arrays in inherited physiological phenomena are collected in a single grouping with genomic DNA: echolocation of dolphins and other animals; complex faceted eyes of insects; images on butterfly wings, consisting of many photonic crystals as nanoantenna arrays, etc. This new topic about the biological meaning of profitable properties of antenna arrays includes problems of biological evolution, the origin of the genetic code, regenerative medicine, development of algebraic biology, which are discussed.

Background / Objective: Historically, fasting has not only been practiced for medical but also for religious reasons. Bahá’ís follow an annual religious fast of 19 days. We assessed motivation behind and subjective health impacts of Bahá’í fasting. Methods: A convergent parallel mixed methods design was embedded in a clinical single arm observational study. Semi-structured interviews were conducted with six fasters before, during and after fasting. Three months after the fasting period, two focus group interviews were conducted. 146 Bahá’í volunteers answered an online survey at five time points before, during and after fasting. Results: Interviews: Fasting was found to play a central role for the religiosity of interviewees, implying changes in daily structures, spending time alone, engaging in religious practices, and experiencing social belonging. Results show an increase in mindfulness and well-being, accompanied by behavioural changes and experiences of self-efficacy and inner freedom. Survey: Scores point to an increase in mindfulness and well-being during fasting, while stress, anxiety and fatigue decreased. Mindfulness remained elevated even three months after the fast. Conclusion: Bahá'í intermittent dry fast seems to enhance participants’ mindfulness and well-being, lowering stress levels and reducing fatigue. Some of these effects lasted more than three months after fasting.

The structure of self-reinforced composites (SRCs) based on ultra-high molecular weight 21 polyethylene (UHMWPE) was studied by means of Wide-Angle X-Ray Scattering (WAXS), X-Ray 22 tomography, Raman spectroscopy, Scanning Electron Microscopy (SEM) and in situ tensile testing 23 in combination with advanced processing tools like Avizo, ImageJ, and Ncorr to determine the cor-24 relation between the processing conditions, on the one hand, and the molecular structure and 25 mechanical properties, on the other. SRCs were fabricated by hot compaction of UHMWPE fibers at 26 different pressure and temperature combinations without addition of polymer matrix or softener. 27 It was found by WAXS that higher compaction temperatures led to more extensive melting of 28 fibers with the corresponding reduction of the Herman’s factor reflecting the degree of molecular 29 orientation, while the increase of hot compaction pressure suppressed the melting of fibers within 30 SRCs at a given temperature. X-Ray tomography proved the absence of porosity while polarized 31 light Raman spectroscopy measurements for both longitudinal and perpendicular fiber orienta-32 tions showed qualitatively the anisotropy of SRC samples. SEM revealed that the matrix was 33 formed by interlayers of molten polymer entrapped between fibers in SRCs. Moreover, in situ 34 tensile tests demonstrated the increase of Young’s modulus and tensile strength with increasing 35 temperature.

Biological technologies are fundamentally unlike any other because biology evolves. Bioengineering therefore requires novel design methodologies with evolution at their core. Knowledge about evolution is currently applied to the design of biosystems ad hoc. Unless we have a unified engineering theory of evolution, we will neither be able to meet evolution’s potential as a design tool, nor understand or limit its unintended consequences on our designs. Our concept of the evotype offers a conceptual framework for engineering the evolutionary potential of biosystems. We show how a biosystem’s evolutionary properties might be rationally designed by engineering aspects of genetic variation, designed function, and natural selection. This idea could apply to all biosystems – from individual proteins to communities of whole-cells or even entire ecosystems – whether the goal is to direct evolution in the design process, or to limit its impacts during application. These principles could even be used beyond the realm of bioengineering to design entirely synthetic evolving auto-adaptive technologies.

In today's world it is very much important to maintain the security of information and its risks. The biometric-based techniques are very much useful in these problems. Among the several kinds of biometric-based technique, face detection is much complex and much more important. Due to the age and several other problems, a human face structure changes over time, again a human has lots of expressions. Sometimes due to the lighting condition or the variation of the angle of an input device, the pattern of a human face structure also changed. As a result, the face cannot be detected properly. In this paper, a method is proposed that can detect the human faces both automatically and manually very efficiently. In manual mode, a user can select the input faces referred by the system according to their choice. In automated mode, the system detected all possible face areas using the Kohonen Self-Organizing Feature Map technique. This method reduced the complex color image into a vector quantized image with desired colors. Then a color segmentation technique is used to detect the possible face skin areas from the vector quantized image. Then the Histogram Oriented Gradient technique used to detect the feature from the faces and K-Nearest Neighbour Classifier is used to compare both face images detected by the two modes. The automated method prosed better accuracy than the manual method.

Recently, several research groups have reported on anomalous enhancement of the self-field critical currents, Ic(sf,T), at low temperatures in superconductor/Dirac-cone material/superconductor (S/DCM/S) junctions. Some papers attributed the enhancement to the low-energy Andreev bound states arising from winding of the electronic wave function around DCM. In this paper, Ic(sf,T) in S/DCM/S junctions have been analyzed by two approaches: modified Ambegaokar-Baratoff and ballistic Titov-Beenakker models. It is shown that the ballistic model is an inadequate tool to analyze experimental data from S/DCM/S junctions. The primary mechanism for limiting superconducting current in S/DCM/S junctions is different from the conventional view that the latter is the maximum value within the order parameter phase variation. Thus, there is a need to develop a new model for self-field critical currents in S/DCM/S systems.

In this paper, we study a generalised CIR process with externally-exciting and self-exciting jumps, and focus on the distributional properties and applications of this process and its aggregated process. The first and second moments of this jump-diffusion process are used to calculate the insurance premium based on mean-variance principle. The Laplace transform of the aggregated process is derived, and this leads to an application for pricing default-free bonds which could capture the impacts of both exogenous and endogenous shocks. Illustrative numerical examples and comparisons with other models are also provided.

In emergency scenarios service vehicles must identify potential route(s) and use the best available route. However, route identification requires intelligent decision-support systems which generally use non-traditional approaches with tools characterised by flexible non-hierarchical structures. Conventional models using group decision-support systems have been applied; however, when used in smart urban environments, emergency response services have limitations in their ability to identify unobstructed paths (routes) in dynamic operating environments. In this paper we introduce a novel path planning method for autonomous vehicle control in emergency situations. The proposed model uses self-organizing maps in an integrated Spiral STC algorithm termed the: Hybrid SOM-Spiral STC model which uses hedge algebras and \emph{Kansei} evaluation in group decision-support. The proposed model has been designed to quantify qualitative factors using sensor derived data processed with human sensibilities and preferences in emergency decision support. The experimental results show that the proposed model achieves significant improvements in group decision-support under dynamic uncertainty. We posit that our novel approach holds the prospect of improvements in the provision of emergency services.

The contribution of extra-tropical synoptic cyclones to the formation of summer-mean atmospheric circulation patterns in the Arctic is investigated by clustering the dominant Arctic circulation patterns by the self-organizing maps (SOMs) using the daily mean sea level pressure (MSLP) in the Arctic domain (≥ 60°N). Three SOM patterns are identified: one with prevalent low pressure anomalies in the Arctic Circle (SOM1) and two opposite dipoles with primary high pressure anomalies covering the Arctic Ocean (SOM2 and SOM3). The time series of summertime occurrence frequencies demonstrate the largest inter-annual variation in the SOM1, the slight decreasing trend in the SOM2, and the abrupt upswing after 2007 in the SOM3. The relevant analyses with produced cyclone track data confirm that the vital contribution. The Arctic cyclone activity is enhanced in the SOM1 because the meridional temperature gradient increases over the land–Arctic Ocean boundaries co-located with major extra-tropical cyclone pathways. The composite daily synoptic evolutions for each SOM reveal that the persistence of all the three SOMs is less than 5 days on average. These evolutionary short-term weather patterns have substantial variability at inter-annual and longer timescales. Therefore, the synoptic-scale activity is central to forming the seasonal-mean climate of the Arctic.

Ovarian Cancer (OC) is a type of cancer that affects ovaries in women, and is difficult to detect at initial stage due to which it remains as one of the leading causes of cancer death. The ovarian cancer data generated from the Internet of Medical Things (IoMT) was used and a novel approach was proposed for distinguishing the ovarian cancer by utilizing Self Organizing Maps (SOM) and Optimal Recurrent Neural Networks (ORNN). SOM algorithm was utilized for better feature subset selection and was also utilized for separating profitable, understood and intriguing data from huge measures of medical data. In supervised learning techniques, the SOM-based feature selection seems to be a tougher challenge because of the absence of class labels that would guide the search for relevant information to the classifier model. The classification approach can identify ovarian cancer data as benign/malignant. The ovarian cancer detection process can be improved by optimizing the weights of RNN structure using Adaptive Harmony Search Optimization (AHSO). The proposed model in this study can be used to detect cancer at early stages with high accuracy and low Root Mean Square Error (RMSE).

The diagnosis of Cardio-Vascular diseases (CVD) is highly dependent on analysis of ECG signals. ECG analysis can be helpful in estimating the underlying cause and condition of heart in cardiac abnormality. The effectiveness of ECG signal analysis in detection of CVDs is widely accepted by professional healthcare service provider. Many algorithms have been proposed but almost all of them have some kind of limitations, and these limitations largely influence the effectiveness of ECG analysis. The performed research work is dedicated for design of unique self-organizing maps (SOMs) based neural network for classification of arrhythmia according to a particular ECG signal, the generation of SOMs is based on the certain unique signatures of ECG signals and have potential to classify different cardiac conditions. For extraction of unique features from ECG signals, we have proposed to use Fast Discrete Stockwell Transform (FDST). Since the proposed technique is a result of combining two different techniques hence called as hybrid technology. The purpose of using FDST is to identify unique signatures of ECG signals in a more improved manner than existing one, the term improved is used because it has several advantages over existing techniques such as wavelet and Fourier Transform based methods. Results obtained from the implementation of the technique are capable in visualizing the ECG sinus rhythm and arrhythmia conditions in form of unique SOM for each associated arrhythmia condition. This unique SOM based classification makes them ideal for being used as a diagnostic tool. This ability of arrhythmia classification using FDST and SOMs makes the technique unique and useful providing valuable information about patient condition. Using proposed technology a portable diagnosis tool for monitoring of patient at their site may be facilitated later, that will improve the quality of life of the patient by diagnosing cardiac condition.

Fluid flow in human body is generally known to influence a variety of cellular behaviors. Different nanoparticle properties as well as cell type, interaction with other cells and cellular environments also show significant effect on nanoparticle uptake and drug efficacy. The aim of this study was to evaluate the effect of shear stress on cellular behaviors of biocompatible and biodegradable nanoparticles to cancer cells (A549 cell lines) in a biomimetic microfluidic system. We prepared a gelatin-oleic conjugate (GOC) as an amphiphilic biomaterial to prepare self-assembled gelatin-oleic nanoparticles (GON). Coumarin-6 and paclitaxel were used as the fluorescence marker and model drug, respectively, and were loaded into GONs by incubation (C-GONs; PTX-GONs). Additionally, we evaluated the cellular uptake of fluorescence labeled C-GONs and the drug efficacy of PTX-GONs. The cellular uptake of C-GONs by A549 cells in the absence of shear stress revealed that the mean fluorescence intensity was slightly decreased compared to that in the presence of shear stress. The results also indicated that negatively charged PTX-GONs had a lower cancer killing effect under dynamic conditions than that under static conditions. It also suggested that fluidic shear stress did not significantly affect drug uptake and efficiency in case of PTX-GONs. The cellular interactions between nanoparticles and cells in drug delivery should be carefully examined according to the physicochemical properties of nanoparticles such as the type of materials, size and mainly surface charge in a biomimetic microfluidic condition.

Introduction: On March 11, 2020, the World Health Organization (WHO) declared Coronavirus disease 2019 (COVID-19) as a pandemic. The spread of the Delta variant of coronavirus started in June 2021 and accounted for the fifth peak of COVID-19 in Iran in July 2021. According to reports from other countries, vaccination protects against severe diseases caused by COVID-19, including the Delta variant. Studies have also shown that vaccination provides strong protection against SARS-CoV-2 infection, COVID-19-related hospitalization, and mortality. This retrospective cohort study was designed based on the medical care monitoring center (MCMC) database of Sayyad Shirazi Hospital.Methods: The following patient data were extracted for this study: demographic characteristics, signs and symptoms, ICU admission, need for aggressive oxygen therapy, including intubation, mortality, and vaccination status. Results: Being vaccinated was associated with a 4.14-fold increase in survival (adjusted OR=4.14; 95% CI: 2.22 to 7.69; P<0.01), and individuals in a younger age group demonstrated a 5.58-fold higher likelihood of surviving (adjusted OR=5.58; 95% CI: 4.25 to 8.14; P<0.01). The risk of severe COVID-19 was significantly lower in vaccinated individuals, showing a 3.12-fold decrease in risk (adjusted OR=3.12; 95% CI: 2.06 to 4.72; P<0.01), and in younger age groups, the risk exhibited a 3.28-fold decrease (adjusted OR=3.28; 95% CI: 2.66 to 4.04; P<0.01).Conclusion: The present results suggest that receiving at least one dose of COVID-19 vaccine had a significant relationship with decreased COVID-19 severity and mortality in vaccinated patients compared to unvaccinated patients.

Today, numerous studies have shown that the physical environment in hospitals can significantly influence patients' well-being, comfort, and recovery. However, this is currently neglected in hospitals in the Global South. Therefore, there is an urgent need to increase the awareness to make it more applicable worldwide. Thus, this study focuses on improving the healing environment standards, by exploring the impact of evidence-based design and patient-centred care in hospitals for cancer patients; particularly the architectural space quality, on patient health outcomes as well as hospital staff health and wellbeing. In Global North countries, such as the UK, the Achieving Excellence Design Evaluation Toolkit (AEDET), is used by its National Health Services, to assess the effectiveness of various environmental attributes. However, these toolkits have not been designed for and do not work well within Global South countries, such as Northern Cyprus. To examine and compare the effectiveness of different physical environmental attributes and to evaluate user responses, the Post-Occupancy Evaluation Method and the AEDET toolkit have been used in the study. These were applied to both public and private hospitals in Northern Cyprus, involving cancer patients, staff, and professionals (n=220). The findings reveal the strength and weaknesses in terms of environmental comfort based on the aspects of evidence-based design of the hospitals such as natural light, air quality, noise, view, infection control, etc., to create a more optimal physical environment for better psychological outcomes. This is the first study to propose an adaptation of the AEDET toolkit to assist architects in designing healthcare facilities that are responsive to the requirements of hospital patients and staff; and to promote the quality of healing environment for improved health and well-being outcomes.

Our objective was to evaluate whether pregnancy is prolonged by use of a proteomics-based maternal serum screening test followed by treatment interventions. This is a secondary analysis of the PREVENT-PTB randomized trial comparing screening with the PreTRM test versus no screening. The primary trial analysis found no significant between-group difference in preterm birth rate. Rather than considering a dichotomous outcome (preterm vs term), we treated gestational age at birth as a continuous variable using survival analysis. We also evaluated between-group difference in NICU length of stay and duration of respiratory support. Results indicated that pregnancy was significantly prolonged in subjects screened with PreTRM test compared to controls (adjusted hazard ratio 0.53, 95% confidence interval 0.36-0.78, P &lt;0.01). Newborns of screened subjects had significantly shorter NICU stay but no significant decrease in duration of respiratory support. In the PreTRM screen-positive group, interventions that were associated with pregnancy prolongation included care management and low-dose aspirin but not 17-hydroxyprogesterone caproate. We concluded that screening with the PreTRM test followed by interventions for screen-positive pregnancies can prolong pregnancy and reduce NICU-LOS.

Background: The Covid-19 pandemic abruptly disrupted global healthcare systems, necessitating rapid adaptations. This study evaluates the impact on health systems and services in the aftermath of the first wave in the Indian context. It analyses the disruptions, adaptive measures, and changes made, as well as the challenges faced by healthcare providers and seekers. Valuable insights from this study will enhance the resilience and preparedness of healthcare systems for future challenges. Methods: The eligible studies included primary studies conducted in the Indian context that explore the impact of COVID-19 on health services provision, utilisation, and the well-being of healthcare providers and seekers. Electronic searches were conducted in six databases: PubMed, MEDLINE, Embase, Global Health, CINAHL, and the WHO database on COVID-19. The results were analysed using detailed narrative synthesis. Results: The review includes 38 articles, incorporating a total of 22,502 subjects. There has been a substantial impact on health service provision, particularly in outpatient departments (OPD) (n=19) and elective services (n=16), while emergency services continued at sub-optimal levels (n=20). Various adaptations and changes were implemented in precautionary measures, protocols, staff allocation and training, usage of personal protective equipment (PPE), preoperative, operative, and postoperative measures, as well as physical infrastructure and resources. Depression and stress (n=14), fear of contracting the infection (n=6), stigmatisation (n=5), and financial repercussions (n=5) significantly affected the mental health of healthcare providers, and healthcare seekers also faced significant challenges (n=11). Conclusion: The study reveals COVID-19's substantial impact on health services. The healthcare system responded by quickly adjusting staff management, resource allocation, and infection prevention measures. The study also highlights the mental health challenges faced by healthcare providers and the concerns of healthcare seekers regarding delays and suboptimal care. Looking ahead, the findings underscore the importance of preparedness for future pandemics, including improved healthcare infrastructure, resource optimisation, and comprehensive protocols. Lessons learned from COVID-19 should inform strategies to mitigate disruptions and ensure the well-being of healthcare providers and seekers in future outbreaks.

While the global COVID-19 pandemic has been widely acknowledged to affect the mental health of health care workers (HCWs), attention to measures that protect those on the front lines of health outbreak response has been limited. In this cross-sectional study, we examine workplace contextual factors associated with how psychological distress was experienced in a South African setting where a severe first wave was being experienced with an objective of identifying factors that can protect against HCWs experiencing negative impacts. Consistent with mounting literature on mental health effects, we found a high degree of psychological distress (57.4% above General Health Questionnaire cut-off value) and a strong association between perceived risks associated with the presence of COVID-19 in the healthcare workplace and psychological distress (adjusted OR = 2.35, p <.01). Our research indicates that both training (adjusted OR 0.41, 95% CI 0.21 – 0.81) and the reported presence of supportive workplace relationships (adjusted OR 0.52, 95% CI 0.27 – 0.97) were associated with positive outcomes. This evidence that workplace resilience can be reinforced to better prepare for the onset of similar outbreaks in the future suggests that pursuit of further research into specific interventions to improve resilience is well merited.

We aimed to delineate cardiopulmonary interactions in acute bronchiolitis and to evaluate the capacity of a combined cardiopulmonary ultrasonography to predict the need for respiratory support. This was a prospective observational single-center study that includes infants < 12 month of age admitted to a hospital due to acute bronchiolitis. All the included patients under-went clinical, laboratory and cardiopulmonary ultrasonographic evaluation at the same time point within 24 hours of hospital admission. The existence of significant correlation between car-diac and respiratory parameters was the primary outcome. The association of different cardio-pulmonary variables with the need of respiratory support higher than O2, the length of stay hos-pitalization, the PICU stay, and the duration of respiratory support were a secondary outcome. We enrolled 112 infants (median age 1 (0.5-3) months; 62% males) hospitalized with acute bron-chiolitis. Increased values of the pulmonary variables (BROSJOD score, pCO2 and LUS) showed moderate correlations with NT-proBNP and all echocardiographic parameters indicative of pulmonary hypertension and myocardial dysfunction. Up to 36 (32%) infants required respira-tory support during the hospitalization. This group presented with higher lung ultrasound score (p<0.001), and increased values of Tei index (p<0.001) and pulmonary artery pressures (p<0.001). All the analyzed respiratory and cardiac variables showed moderate to strong correlations with the LOS hospitalization and the time of respiratory support. Lung ultrasound and echocardiog-raphy showed a moderate to strong predictive accuracy for the need of respiratory support in the ROC analysis, with AUC varying from 0.74 to 0.87. Conclusion: Those cases of bronchiolitis with a worse pulmonary status presented with a more impaired cardiac status. Cardiopulmonary ul-trasonography could be a good strategy to easily identify high-risk population for a complicated acute bronchiolitis hospitalization.

The three-armed cluster-randomized trial ARena (Sustainable reduction of antibiotic-induced antimicrobial resistance) aimed to foster appropriate antibiotic use and reduce overprescribing in German ambulatory care to counter antibiotic resistance. Multi-faceted interventions targeted primary care physicians, teams and patients. This study examined effectiveness of the implementation program. ARena was conducted in 14 primary care networks with 196 practices. All arms received data-based feedback on antibiotics prescribing and quality circles. Arms II and III received different add-on components each. Primary outcome examined is the prescribing rate for systemic antibiotics for cases with non-complicated acute infections (upper respiratory tract, bronchitis, sinusitis, tonsillitis, otitis media). Secondary outcomes refer to prescribing of quinolones and guideline-recommended antibiotics. Based on pseudonymized quarterly claims data, mixed logistic regression models examined pre-post intervention antibiotic prescribing rate changes and compared to matched standard care. A significant rate reduction (arm I 11.7%; arm II 9.9%; arm III 12.7%) and significantly lower prescribing rates were observed for all arms (20.1%, 18.9% and 23.6%) compared to matched standard care (29.4%). Fluoroquinolone prescribing was reduced in all intervention arms and rates for recommended substances generally increased. No significant post-interventional difference between intervention arms was detected. Findings indicate implementation program impact compared to standard care. Trial registration: ISRCTN, ISRCTN58150046

Hand gestures may play an important role in medical applications for health care of elderly people, where providing a natural interaction for different requests can be executed by making specific gestures. In this study we explored three different scenarios using a Microsoft Kinect V2 depth sensor then evaluated the effectiveness of the outcomes. The first scenario utilized the default system embedded in the Kinect V2 sensor, which depth metadata gives 11 parameters related to the tracked body with five gestures for each hand. The second scenario used joint tracking provided by Kinect depth metadata and depth threshold together to enhance hand segmentation and efficiently recognize the number of fingers extended. The third scenario used a simple convolutional neural network with joint tracking by depth metadata to recognize five categories of gestures. In this study, deaf-mute elderly people execute five different hand gestures to indicate a specific request, such as needing water, meal, toilet, help and medicine. Then, the requests were sent to the care provider’s smartphone because elderly people could not execute any activity independently. The system transferred these requests as a message through the global system for mobile communication (GSM) using a microcontroller.

Using pumps operating as turbines (PATs) offers the possibility of increasing the sustainability of water and energy systems by recovering the excess of energy that would be otherwise lost in pressure reducing valves or head loss chambers. In on-grid applications, there are many research works and implementations of PATs. However, there is still limited research for the optimization of efficiency and stability of PATs operating in off-grid systems. This work contributes to the development of stable direct current (DC) off-grid electric systems based on PATs, by optimizing and analysing the energy efficiency and stability for a wide range of operation. A self-excited induction generator (SEIG) coupled to the PAT is provided to cover the conventional type of electric ma-chines typically coupled to the hydraulic pumps. In this context, a methodology is proposed, based on the hydraulic, mechanical and electric subsystems, to define the PAT-SEIG operational area, to maximize energy conversion and the system efficiency. This will guarantee stable electric output quantities when operating in a DC off-grid system. In addition, an analytical model is proposed to estimate the PAT-SEIG operation under specific conditions. With this, water managers are suitable to design and optimize an off-grid PAT-SEIG system and to define the best hydraulic machines, electronic equipment, and all different control elements to maximize energy conversion within the target of operational limits. To develop and verify this new methodology, two micro PAT-SEIG setups were implemented in the hydraulic laboratory of IST/CERIS under typical operating conditions. The proposed solution proved to be resilient under a variable load regime. The system's maximum efficiency can be adapted using different capacitor values for the excitation of the SEIG, and the operational range is limited to the electric components. Considering the nominal efficiencies of the system’s components, the maximum p.u. efficiency obtained for each PAT-SEIG system were between 0.7 and 0.8 p.u.

Transformer models have emerged as frontrunners in the field of natural language processing, primarily due to their adept use of self-attention mechanisms to grasp the semantic linkages between words in sequences. Despite their strengths, these models often face challenges in single-task learning scenarios, particularly when it comes to delivering top-notch performance and crafting strong latent feature representations. This challenge is more pronounced in the context of smaller datasets and is particularly acute for under-resourced languages such as Arabic. In light of these challenges, this study introduces a novel methodology for text classification of Arabic texts. This method harnesses the newly developed Reverse Positional Encoding (RPE) technique. It adopts inductive-transfer learning (ITL) framework combined with a switching self-attention shared encoder, thereby increasing the model's adaptability and improving its sentence representation accuracy. The integration of Mixture of Experts (MoE) and Reverse Positional Encoding (RPE) techniques empowers the model to process longer sequences more effectively. This enhancement is notably beneficial for Arabic text classification, adeptly supporting both the intricate five-point and the simpler ternary classification tasks. The empirical evidence points to its outstanding performance, achieving accuracy rates of 87.20% for the HARD dataset, 72.17% for the BRAD dataset, and 86.89% for the LABR dataset, as evidenced by the assessments conducted on these datasets.

The Reactive Spark Plasma Sintering (R-SPS) method is compared in this work with the two-steps SHS-SPS route, based on combination of the Self-propagating High-temperature Synthesis (SHS) with the SPS process, for the fabrication of dense (Hf0.2Mo0.2Ti0.2Ta0.2Nb0.2)B2-SiC and (Hf0.2Mo0.2Ti0.2Ta0.2Zr0.2)B2-SiC ceramics. A multiphasic and inhomogeneous product, containing various borides, is obtained at 2000°C/20min by R-SPS, from transition metals, B4C and Si. In contrast, if the same precursors are first reacted by SHS, and then processed by SPS under the optimized condition of 1800°C/20min, the desired ceramics are successfully attained. Both High-Entropy-Boride/SiC products display densities > 97%, uniform microstructures and contained only small amounts of residual oxides (<2.4 wt.%). The presence of SiC makes the sintering temperature milder, i.e. 150°C below to that needed by the corresponding additive-free system. Fracture toughness is also markedly improved, particularly when considering the Nb-containing system processed at 1800°C/20min, whereas KIC progressively decreases (from 7.35 to 5.36 MPa m1/2) as the SPS conditions become more severe. SiC addition is found to inhibit the volatilization of metal oxides like MoO3 formed during oxidation experiments, thus avoiding mass loss in the ceramics. The benefits above also likely take advantage of the fact that the two composite constituents are synthesized in parallel, according to the SHS-SPS approach, rather than being produced separately and combined subsequently, so that strong interfaces between them are formed.

As distinct human societies, three unique intentional communities are investigated regarding their preferred consensus decision-making practices. It is Identified that each has adopted a different form of consensus decision-making to solve potential group-wide interpersonal conflict. The individual attributes of these three consensus decision-making practices are considered, both from the perspective of maintaining group stability and in relation to individual member's mental health. The communities are a Canadian self-directed public senior elementary and secondary school, an annual English conference for those self-identifying as on the autistic spectrum, and a self-producing Korean popular music (K-pop) group. It is found that the intentional community and participants’ mental health are sustained regarding each of the three consensus decision-making practices. Nevertheless, the resulting decisions generate various stresses within the communities, both as a whole and concerning the individual members. To retain group cohesion and maintain individual mental health, these stresses must be recognized and understood by participants. The novel finding of this research is that, dependent on the time available for decision-making, and the members’ perspective adopted, intentional communities might practice more than one form of consensus decision-making and still support both group cohesion and individual mental health, maintaining the democracy of these distinct societies.

In air-breathing proton exchange membrane fuel cells (Air PEM FCs), high rate of water evaporation from the cathode might influence the resistance of the membrane electrode assembly (MEA), which is highly dependent on the water content of the Nafion membrane. We propose a dead-end hydrogen anode as a means of intermediate storage of water/humidity for self-humidification of the membrane. Such inflatable bag integrated with the PEM FC has a potential in blimp applications for anode self-humidification. A dynamic numerical water balance model, validated by experimental measurements, is derived to predict the effect of MEA configuration, membrane’s hydration state, and water transfer rate at the anode on MEA resistance and performance. The experimental setup included humidity measurements, polarization and electrochemical impedance spectroscopy tests to quantify the effect of membrane hydration on its resistance in a lightweight MEA integrated with an inflatable dead-end hydrogen storage bag. Varying current density (20 mA, 40 mA and 60 mA) and cathode humidity (20, 50 and 80%) were examined and compared with the numerical results. The validated model predicts that the hydration state of the membrane and water transfer rate at the anode can be increased by using a thin membrane and thicker gas diffusion layer.

Alcohol use disorder (AUD) is a chronic and relapsing biopsychosocial condition that leads to a wide range of medical, psychological, social, economic, and personal issues. The study investigated the predictors of quality of life (QoL) among male patients seeking treatment for AUD based on attention, cognitive instability, motor impulsiveness, perseverance, and self-control dimensions of trait impulsivity. The study also investigated the potential mediating effect of anxiety and alcohol use severity in this relationship. After an initial assessment, participants underwent comprehensive evaluations, including sociodemographic data, clinical history, and QoL domains. Evaluations also covered AUD severity, impulsivity dimensions, cognitive functions, craving intensity, depression, anxiety and self-efficacy. Multiple linear regressions were employed to identify associations between independent variables and QoL. Attention dimension of impulsivity and anxiety symptoms significantly predicted physical health QoL. Self-control dimension and severity of alcohol use disorder predicted psychological QoL. Indirect effect of attention dimension on physical health was significant [effect =-1.082,95% CI (-2.008, -0.3598)].The significance of impulsivity in influencing QoL for individuals with AUD has profound clinical implications. These findings underscore the importance of addressing anxiety and impulsivity in managing AUD, given their considerable impact, particularly on QoL, ultimately shaping treatment outcomes.

Self-phase modulation (SPM) broadening of laser spectra was studied in a transmission mode in natural and synthetic diamonds at variable laser wavelengths (515 and 1030 nm), pulse energies and widths (0.3 - 12 ps, positively chirped pulses), providing their filamentary propagation. Besides the monotonous SPM broadening of the laser spectra versus pulse energy, more pronounced for the (sub)picosecond pulsewiths and more doped natural diamond, periodical low-frequency modulation was observed in the spectra at the shorter laser pulsewidths, indicating dynamic Bragg filtering of the supercontinuum due to ultrafast plasma and nanoplasmonic effects. Damping of broadening and ultramodulation for the longer picosecond pulsewidths was related to thermalized electron-hole plasma regime established for the laser pulsewidths longer, than 2 ps. Unexpectedly, at higher pulse energies and corresponding longer microfilaments, the number of spectral modulation features increases, indicating dynamic variation of the periods in the longitudinal plasma Bragg gratings along the filaments due to prompt secondary laser-plasmon interactions.

Scientists are gradually becoming aware of the challenges in the understanding of the very root mechanisms of massively parallel computations that are observed in literally all scientific disciplines ranging from cosmology, physics, across chemistry, biochemistry, and ending in biology. This leads us to the main motivation and simultaneously to the central thesis of this review: “Can we design artificial, massively-parallel, self-organized, emergent, error-resilient, computational environments?” A large number of simulations along with examples and counter-examples, finalized by a list of the future directions, are giving hints and partial answers to the main thesis. This all together is opening the crucial question whether there is existing a deeper, beyond the Turing machine theoretical description of massively-parallel computing. Important information dealing with this topic is reviewed along with highly expressive animations generated by the open-source, Python software GoL-N24. The perspective, future directions including applications in robotics and biology of this research are discussed in the light of known information.

In a complex working environment, the fault signal of the gearbox is greatly affected by the outside world, and fault feature recognition is difficult, so the fault diagnosis accuracy is difficult to meet the expected requirements. To solve this problem, this paper proposes a gearbox fault diagnosis method based on an optimized stacked denoising auto encoder (SDAE) and kernel extreme learning machine (KELM). Firstly, the Particle Swarm Optimization algorithm in Adaptive Weight (SAPSO) was adopted to optimize the SDAE network structure, and the number of hidden layer nodes, learning rate, noise addition ratio and iteration times were adaptively obtained to make SDAE obtain the best network structure. Then, the best SDAE network structure was used to extract the deep feature information of weak faults in the original signal. Finally, the extracted fault features are fed into KELM for fault classification. Experimental results show that, compared with existing commonly used methods of fault diagnosis, the fault diagnosis model proposed in this paper can reduce the influence of noise in the original signal can better learn the deep-level features in the original signal and has higher diagnosis accuracy, faster diagnosis speed and good generalization in fault diagnosis.

This article describes the transition of an undirected active network, used for numerical and logical analysis, and made up of communicating operators and nodes, and being self-extensible, into a network of semantic structures, and the extensions necessary to handle language. The network, called Active Structure, was infused with knowledge in the form of tens of thousands of definitions taken from a human-readable dictionary. Where the dictionary fell short, from circularity, lack of a hierarchical form for its senses and sub senses, or inadequate detail around verbs, the entries were extensively curated. The result is a machine which has access to every meaning of every word in its vocabulary, and needs to manage the right meaning for every use of a word, a task that our unconscious minds now handle. To demonstrate that such a network can aspire to human-level tasks, we have begun loading an Anti-Money Laundering Act so that the machine can devise and test strategies against money launderers. There is a higher goal being aimed at, the breaking of the Four Pieces Limit. That is, the network is not intended to save money on human cognitive labor, but to raise an absurdly low limit on it.

In the context of the Education-2030 Framework for Action, an important goal for initial STEM teacher education is to provide professional development on equality and gender awareness. This study explored whether STEM prospective secondary teachers are prepared to implement a sustainable gender-sensitive practice upon graduation. To this end, we cross-culturally validated the TEGEP (Teacher Self-Efficacy for Gender Equality practice) scale and compared STEM student teachers’ perceptions of self-efficacy by country and sex. Participants were 205 STEM (science, technology, engineering, and mathematics) secondary school student teachers (136 Greek and 69 Spanish) drawn from seven public universities (six Greek, one Spanish). Statistical analysis confirmed the structure and factor invariance of the TEGEP across country and between sexes showing evidence that gender equality self-efficacy level is only moderate and that perceived competence in gender knowledge was significantly higher in Greek than in Spanish STEM student teachers, while the latter felt more competent than the Greek in developing values and attitudes in regards to gender. The study provides a cross-validated instrument to measure gender equality self-efficacy in STEM teacher education and evaluate sustainable changes after planned interventions.

Symmetry in biological and physical systems is a product of self-organization driven by evolutionary processes, or mechanical systems under constraints. Symmetry-based feature extraction or representation by neural networks may unravel the most informative contents in large image databases. Despite significant achievements of artificial intelligence in recognition and classification of regular patterns, the problem of uncertainty remains a major challenge in ambiguous data. In this study, we present an artificial neural network that detects symmetry uncertainty states in human observers. To this end, we exploit a neural network metric in the output of a biologically inspired Self-Organizing Map, the Quantization Error (SOM-QE). Shape pairs with perfect geometric mirror symmetry but a non-homogenous appearance, caused by local variations in hue, saturation, or lightness within and/or across the shapes in a given pair produce, as shown here, longer choice RT for ‘yes’ responses relative to symmetry. These data are consistently mirrored by the variations in the SOM-QE from unsupervised neural network analysis of the same stimulus images. The neural network metric is thus capable of detecting and scaling human symmetry uncertainty in response to patterns. Such capacity is tightly linked to the metric’s proven selectivity to local contrast and color variations in large and highly complex image data.

In the current manuscript we assess to what extent X-ray photoelectron spectroscopy is a suitable tool for probing the dipoles formed at interfaces between self-assembled monolayers and metal substrates. To that aim, we perform dispersion-corrected, slab-type band-structure calculations on a number of biphenyl-based systems bonded to a Au(111) surface via different docking groups. In addition to changing the docking chemistry (and the associated interface dipoles), also the impacts of polar tail-group substituents and varying dipole densities are investigated. We find that for densely-packed monolayers the shifts of the peak positions of the simulated XP-spectra are a direct measure for the interface dipoles. In the absence of polar tail-group substituents they also directly correlate with adsorption-induced work-function changes. At reduced dipole-densities this correlation deteriorates, as work function measurements probe the difference between the Fermi-level of the substrate and the electrostatic energy far above the interface, while core level shifts are determined by the local electrostatic energy in the region of the atom from which the photoelectron is excited.

Fabrics comprised of porous fibers could provide effective passive protection against chemical and biological (CB) threats whilst maintaining high air permeability (breathability). Here, we fabricate hierarchically porous fibers consisting of regenerated silk fibroin (RSF) and activated-carbon (AC) prepared through two fiber spinning techniques in combination with ice-templating – namely cryogenic solution blow spinning (Cryo-SBS) and cryogenic wet-spinning (Cryo-WS). The Cryo-WS RSF fibers had exceptionally small macropores (as low as 0.1 µm) and high specific surface areas (SSAs) of up to 79 m2 g-1. The incorporation of AC could further increase the SSA to 210 m2 g-1 (25 wt. % loading) whilst also increasing adsorption capacity for volatile organic compounds (VOCs).

Imaging lidars are one of the hottest topics in the optronics industry. The need to sense the surroundings of every autonomous vehicle has pushed forward a career to decide the final solution to be implemented. The diversity of state-of-the art approaches to the solution brings, however, a large uncertainty towards such decision. This results often in contradictory claims from different manufacturers and developers. Within this paper we intend to provide an introductory overview of the technology linked to imaging lidars for autonomous vehicles. We start with the main single-point measurement principles, and then present the different imaging strategies implemented 8 in the different solutions. An overview of the main components most frequently used in practice is also presented. Finally, a brief section on pending issues for lidar development has been included, 10 in order to discuss some of the problems which still need to be solved before an efficient final implementation.Beyond this introduction, the reader is provided with a detailed bibliography containing both relevant books and state of the art papers.

Silymarin, a mixture of flavonolignan and flavonoid polyphenolic compounds extractable from the milk thistle seed, Silybum marianum, has anti-oxidant, anti-inflammatory, anti-cancer and anti-viral activities potentially useful in the treatment of several liver disorders, such as chronic liver diseases, cirrhosis and hepatocellular carcinoma. Equally promising are the effects of silymarin in protecting the brain from the inflammatory and oxidative stress effects by which metabolic syndrome contributes to neurodegenerative diseases. However, despite clinical trials have proved that silymarin is safe at high doses (>1500 mg/day) in humans, it suffers limiting factors such as low solubility in water (<50 μg/mL), low bioavailability and poor intestinal absorption. To improve its bioavailability and provide a prolonged silymarin release at the site of absorption, the use of nanotechnological strategies appears to be a promising method to potentiate the therapeutic action and promote sustained release of the active herbal extract. The purpose of this study is to review the different nanostructured systems available in literature as delivery strategies to improve the absorption and bioavailability of silymarin.

The interest on the use of renewable energy resources is increasing, especially towards wind and hydro powers, which should be efficiently converted into electric energy via suitable technology tools. To this aim, data--driven control techniques represent viable strategies that can be employed for this purpose, due to the features of these nonlinear dynamic processes working over a wide range of operating conditions, driven by stochastic inputs, excitations and disturbances. Some of the considered methods, such as fuzzy and adaptive self--tuning controllers, were already verified on wind turbine systems, and similar advantages may thus derive from their appropriate implementation and application to hydroelectric plants. These issues represent the key features of the work, which provides some guidelines on the design and the application of these control strategies to these energy conversion systems. The working conditions of these systems will be also taken into account in order to highlight the reliability and robustness characteristics of the developed control strategies, especially interesting for remote and relatively inaccessible location of many installations.

The interest on the use of renewable energy resources is increasing, especially towards wind and hydro powers, which should be efficiently converted into electric energy via suitable technology tools. To this aim, self--tuning control techniques represent viable strategies that can be employed for this purpose, due to the features of these nonlinear dynamic processes working over a wide range of operating conditions, driven by stochastic inputs, excitations and disturbances. Some of the considered methods were already verified on wind turbine systems, and important advantages may thus derive from the appropriate implementation of the same control schemes for hydroelectric plants. This represents the key point of the work, which provides some guidelines on the design and the application of these control strategies to these energy conversion systems. In fact, it seems that investigations related with both wind and hydraulic energies present a reduced number of common aspects, thus leading to little exchange and share of possible common points. This consideration is particularly valid with reference to the more established wind area when compared to hydroelectric systems. In this way, this work recalls the models of wind turbine and hydroelectric system, and investigates the application of different control solutions. The scope is to analyse common points in the control objectives and the achievable results from the application of different solutions. Another important point of this investigation regards the analysis of the exploited benchmark models, their control objectives, and the development of the control solutions. The working conditions of these energy conversion systems will be also taken into account in order to highlight the reliability and robustness characteristics of the developed control strategies, especially interesting for remote and relatively inaccessible location of many installations.

Results-Based Financing (RBF) in pediatrics, in regions with scarce resources like Northern Uganda, provides an innovative approach to enhancing healthcare delivery. RBF aligns financial incentives with desired health outcomes, boosting service quality, efficiency, and effectiveness by tying compensation to achieving specific, measurable health targets. Lacor and Kalongo hospitals, before the introduction of RBF, faced numerous challenges, including limited resources, staffing shortages, and inconsistent quality of care. RBF adoption requires critical health outcomes to target, such as lowering child mortality rates, enhancing vaccination coverage, and increasing the frequency of timely prenatal care visits. The empirical application of RBF in pediatric services at Lacor and Kalongo Hospital from 2018 to 2024 shows improved healthcare quality and outcomes. Healthcare systems can identify ways to implement RBF models better, ensuring that financial incentives effectively contribute to attaining superior health outcomes.

Chronic diseases, such as type 2 diabetes (T2D), are difficult to manage because they demand continuous therapeutic review and monitoring. Beyond achieving the target HbA1c, new guidelines for the therapy of T2D have been introduced with the new groups of antidiabetics (GLP-1ra and SGLT2-in). Despite new guidelines, clinical inertia, that can be caused by physicians, patients or healthcare system, results in T2D not being effectively managed. This opinion paper explores the shift in T2D treatment, challenging assumptions and evidence-based recommendations, particularly for family physicians, considering the patient's overall situation in decision-making. We looked for the possible reasons of clinical inertia and poor application of guidelines in the management of T2D. Guidelines for antidiabetic drugs should be more precise, providing case studies and clinical examples to define clinical contexts and contraindications. Knowledge communication can improve confidence and should include clear statements on areas of decision-making not supported by evidence. Precision medicine initiative in diabetes aims to identify subcategories of T2D patients (including frail patients) using clustering techniques from data science applications, focusing on CV and poor treatment outcomes. Clear, unconditional recommendations for personalized T2D management may encourage drug prescription, especially for family physicians dealing with diverse patient contexts and clinical settings.

This study explores the complexities of risk communication practices in orthodontics, specifically examining the perspectives of orthodontists in Greece and Slovakia. Informed by the foundational importance of effective communication in health sciences, particularly in facilitating valid consent and shared decision-making, this research addresses gaps identified in the literature concerning the consistent communication of potential treatment risks based on demographic and cultural characteristics. The study identifies 15 potential critical risks with orthodontic treatment. These risks include root necrosis; temporary undesired changes to the occlusion; sleep difficulties; not achieving an ideal result; development of black triangles between teeth; taking additional X-rays; speech difficulties; using a protective splint during sports; duration of treatment; number of visits; transmission of infectious diseases; and swallowing orthodontic appliances. The questionnaire, distributed electronically to orthodontists in Greece (n=570) and Slovakia (n=210) from Sept. 2022 to Dec. 2022, aimed to assess risk communication practices, with consideration to country, gender, and degree-related variations. 168 valid questionnaires (91 from Slovakia and 77 from Greece) were obtained indicating significant disparities in the risks emphasized and preferred forms of consent. The Greek orthodontists focused more on the risks involved such as on relapse, root resorption, temporal occlusal changes, and failure of desired movement, while the Slovak practitioners tend to be interested more about sleeping difficulties, temporal occlusal changes and not achieving an ideal result. They also tend to obtain written or digital consent from patients or their parents/guardians more frequently than the Greek team. Male orthodontists discussed specific risks more frequently, including relapse and extractions, whereas females preferred written or digital consent. PhD-trained orthodontists prioritized certain risks, indicating the need for tailored approaches. This study underscores the dynamic nature of risk assessment in orthodontic practice, emphasizing its ethical and strategic dimensions. The findings advocate for tailored risk communication strategies, that recognize individual, contextual, and cultural factors and the need of an orthodontic informed consent protocol for tailored communication approach for patients to elevate the standard of care in European orthodontics. The reliance on digital tools reflects contemporary trends in enhancing patient understanding, thereby supporting ongoing innovation in orthodontic practices.

The interrelatedness of social-structural aspects and psychological features with the vaccination intention provides the context to explore personal psychological fea-tures related to general decision-making and vaccine-related dispositions, and their contribution to the intention to vaccinate, within post-pandemic circumstances, after the imposed possibility of choosing a vaccine brand. The aim of our study was to map the function (promotive, protective, risk, vulnerability) of a set of psychological aspects in the intention to vaccinate, in people with different social roles regarding the vaccination. We surveyed three samples of people: healthcare providers (HPs), parents, and lay people, within the context of the after-pandemic. Negative vaccine attitudes lower intention to vaccinate in all regression models (all βs ranging from -.128 to -.983, all ps < .01). The main results indicate that, regardless of the sam-ple/social role, there is a shared attitudinal core for positive vaccination intention. This core consists of [high] trust in large corporations, government, and healthcare systems, as well as perceived consensus on vaccine safety/efficacy and experience of freedom (protective factors), and [low] vaccination conspiracy beliefs, trust in social media, and choice overload (risk and vulnerability factors, respectively). There are no common promotive factors of intention to vaccinate; for parents, perceived consensus on vaccines, and trust in corporations and the healthcare system play such roles, for HPs experience of freedom is obtained as a unique promotive factor. In contrast, for laypeople, no unique promotive factors were found. These results and guidelines for the promotion of positive vaccination behavior are further discussed.

SARS-CoV-2, influenza A/B virus (IAV/IBV) and respiratory syncytial virus (RSV) are among the common viruses causing acute respiratory infections. Clinical diagnosis to differentiate these viruses is challenging due to similar clinical presentations, thus laboratory-based real-time RT PCR is the gold standard for diagnosis. The study aimed to evaluate the diagnostic performance of STANDARD M10 Flu/RSV/SARS-CoV-2 (SD Biosensor Inc, Seoul, Korea). This retrospective study was conducted with archived respiratory samples positive and negative for SARS-CoV-2, IAV, IBV or RSV. The evaluation study involved a total of 322 respiratory samples comprising 215 positive samples (49 SARS-CoV-2, 48 IAV, 53 IBV, 65 RSV) and 107 negative samples. All samples were tested with both STANDARD M10 and either Xpert Xpress SARS-CoV-2 or Xpert Xpress Flu/RSV (Cepheid, USA). The sensitivity, specificity, positive predictive value and negative predictive value rates of STANDARD M10 were very similar to Xpert Xpress SARS-CoV-2 or Xpert Xpress Flu/RSV ranges for each virus (98-100%). The overall agreement was 99.4% with 99.1% agreement for positive samples and 100% agreement for negative samples. In conclusion, the STANDARD M10 point-of-care test is suitable for rapid simultaneous detection of SARS-CoV-2, IAV, IBV and RSV.

There is little understanding of patients' experiences and perceptions with satisfaction by health professionals such as medical and dental clinicians. Furthermore, patient satisfaction is not well understood. The objective of this article is to better understand patients' satisfaction with their medical and dental care. The methods of the current article are based on a narrative review of the literature strategy. Patient satisfaction's multidimensional nature has been established since the perceived reasons for satisfaction varied widely among patients. Many aspects of the treatment influence participant satisfaction at different stages of the intervention's process. An improved understanding of the basis for managing patients' expectations with information reiteratively and efficiently may ultimately reduce patients' potential for negative feelings toward the medical and dental treatment experience. The consumerist method may misrepresent the concept of satisfaction in health service.