This paper identifies preschool teachers' sources of stress, the times they experience high stress, and their ways of coping with stress levels. The study was conducted using a phenomenological design, one of the qualitative research models. The data were collected through semi-structured interviews with 36 preschool teachers working with children aged 0-6 in state and private schools. As a result of the content analysis, stressors were identified primarily at both interpersonal (positive, and effective interactions), and organizational levels (school management, and leadership style). It was also found that intense stress was experienced when children were difficult to control, such as during sleeping, eating, and cleaning. Finally, these results confirmed that the teachers used active/active behavioral, and passive/avoidant coping strategies. However, it was understood that preschool teachers perceived stress negatively, and did not see stress as a personal development situation. These results are discussed in terms of their ramifications for preschool education.

The importance of contact with nature for human health was confirmed by numerous research. One of the sometimes neglected fields is the landscape design of hospital premises. This study focuses on the perception and preferences of prospective patients regarding the hospital site design. The methodology included anonymous survey with images and lists of adjectives. The online questionnaire was distributed using e-mails and social media from 4th May to 8th July 2024. The objective was to include all age groups. The results confirm previous studies and demonstrate the importance of landscape architecture design of hospital premises for the well-being of patients. The findings may inform the design of hospital sites.

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

Cancer patients, susceptible to severe COVID-19 outcomes, exhibit varied vaccine responses, particularly those who are receiving chemotherapy. This prospective cohort study enrolled 115 cancer patients, and data from 91 patients who received two doses of COVID-19 vaccines were analyzed. Blood was drawn at baseline, day 28, and 6 months post-second dose for neutralizing antibody analysis. The primary outcome was seroconversion rate against wild type and Omicron at day 28. Secondary outcomes included seroconversion at 6 months, factors associated with seroconversion, and safety. Of the 157 cancer patients screened, 91 were enrolled, with 45% receiving chemotherapy. Seroconversion rates at day 28 were 77% for the wild type and 62% for Omicron. Chemotherapy did not affect seroconversion (p=0.789 for wild type, p=0.597 for Omicron). Vaccine type positively correlated with seroconversion, with an adjusted ORR of 25.86 (p=0.029) for the wild type and 17.38 (p<0.001) for Omicron with the primary heterologous vaccine. Adverse events were grade 1 in 34.0% and grade 2 in 19.7% of participants. Despite lower seroconversion against Omicron, no difference was noted between chemotherapy and non-chemotherapy groups. COVID-19 vaccinations demonstrated good tolerability. This data underscores vaccine efficacy considerations in cancer patients, informing tailored strategies for this vulnerable population.

The aim of the study was to compare the standard baseline imaging, with extended radiological staging. To assess our hypothesis, we performed a prospective, single-centre study which included 132 participants recruited between October 2015 and March 2020. Descriptive statistics, the Friedman and chi-squared tests were performed and p &lt; 0.05 was considered significant. Patients were grouped into two cohorts, CT scan cohort (n=87) and PET-CT cohort (n=43). In the first group the originally determined disease stage changed in 36.8 % of cases, in second group in 51.2 %. The consistency between assessment of axillary lymph nodes by imaging (cN) and the postoperative pathology report (pN) was evaluated. In most cases, clinical and pathological evaluation of involved nodes was consistent, for CT scan the result was χ2(1) = 18.98; p &lt; 0.001, for PET-CT the result was χ2(1) = 6.41; p = 0.03. Highly customized radiation therapy defined as dose boost within the involved lymph nodes, not covered by surgeon, was applied in nine patients.

The BNT162b2 vaccine is globally used for preventing morbidity and mortality related to COVID-19. Cancer patients have had priority for receiving the vaccine due to their diminished immunity. This study reports the response of administering the 3rd and 4th vaccine doses to can-cer patients receiving active anti-neoplastic treatment. 142 patients have received two doses of the mRNA-based BNT162b2 COVID-19 vaccine, while 76 and 25 patients have received three and four doses, respectively. The efficacy of the humoral response following two vaccine doses was diminished in cancer patients, especially in the group of patients receiving chemotherapy. In a multivariate analysis, patients after three and four BNT162b2 vaccine doses were more likely to have antibody titers in the upper tertile compared to patients after two doses of the vaccine (odds ratio (OR) 7.62 (95% CI 1.38-42.12), p=0.02 and 17.15 (95% CI 5.01-58.7), p<0.01, respective-ly). Unlike the response after two doses, the 3rd and 4th BNT162b2 vaccine booster doses, had an increased efficacy of 95-100% in cancer patients while on active treatment. This result could be explained by different mechanisms including the development of memory B cells.

This study aimed to investigate Romanian physicians' awareness, recommendation practices, and opinions regarding using Foods for Special Medical Purposes (FSMPs) products. A total of ten physicians were interviewed using a structured questionnaire, and their responses were analysed using thematic content analysis. The study found that physicians were aware of FSMPs and recommended them to their patients based on nutritional deficits, weight loss, or deglutition impairments. In addition, disease stage, treatment scheme, taste, affordability, and availability were identified as factors influencing the recommendation and use of FSMPs. While physicians generally did not consult clinical trials, clinical experience was deemed essential for recommending FSMPs to patients. Patients' feedback regarding the usage and sourcing of FSMPs was generally positive, with some expressing concerns about the availability of different flavours and the costs of purchasing the products. The study concludes that physicians play a vital role in recommending FSMPs to patients and ensuring they have the necessary nutritional support during treatment. However, more patient education materials and collaboration with nutritionists may be required to improve patient outcomes and reduce patient financial burden.

Objectives: Human herpes viruses can cause life-threatening diseases in immunocompromised children, especially leukemic patients. Therefore, the aim of this study is to detect the human herpes viruses (HHV1-7) and to investigate its clinical significance in Middle Eastern Pediatric Leukemia Patients by using 2 Independent PCR assays. Methods: Detection of human herpes virus DNA has been done in blood samples of 200 pediatric leukemia patients in addition to 90 blood donors as a control group using multiplex PCR assays. When a ‘‘positive’’ result was observed, real-time PCR was performed to measure the viral load. Results: The most frequent herpes virus infection in Middle Eastern Pediatric Leukemia cases was CMV, followed by EBV, then HHV6, VZV, HHV7, HSV1, and HSV2, where they were 92/200 (46%), 76/200 (38%), 72/200 (36%), 48/200 (24%), 12/200 (6%), 8/200 (4%), and 2/200 (1%) respectively. Also, there was a statistically significance difference between leukemic patients and their controls regarding CMV, EBV, HHV6, and VZV (P <0.05). Correlation between percentage of co-infection, and clinical parameters for the 7 herpes viruses has been studied, and there is an increase in absolute neutrophilic count (ANC), total leukocyte count (TLC) and duration of fever and neutropenia in age group 6-11 years for HHV6/CMV, then in age group 12-18 years especially for EBV/CMV and CMV/HHV6. Also, our results show that multiplex PCR assay is close to single PCR assay in relation to specificity and sensitivity which in turn prove its validity for early diagnosis of herpes viral infection. Conclusions: Adopting multiplex PCR technique is helpful in screening of virus infections. It will save time, effort, cost effective and will assist in rapid diagnosis. However, the clinical relevance of the virus infection needs to be evaluated by quantitative real-time PCR which in turn will help patient's management by using appropriate antiviral treatment.

This study presents three forms of interdisciplinary expertise in the healthcare design context to approach a particular multifaceted problem around the current healthcare for older adult patients with chronic low-back pain (LBP). Using an interdisciplinary co-design framework, first, our design approach performs the role of an initiator to define the problem by exploring the current context of healthcare. Second, it facilitates the experiences of experts and patients to reach the roots of the problem by functioning as a mediator. Third, our approach fulfills the primary role of healthcare design in producing new meanings considering the principles of patient-centeredness. These roles significantly contributed to the design of healthcare innovations. Our framework transformed the distributed disciplinary knowledge developed while tackling the multifaceted problem into new forms of expertise for collaboration in healthcare innovation.

Diabetics or Diabetic Mellitus is a metabolic disorder of blood sugar levels in the human body. It is a major non-communicable disease and involved many serious health risk issues. This disease is rapidly increasing in India. It is a chronic condition and it occurs when a body doesn't produce enough insulin hormone to control the blood sugar level. In this study, different variables have been analyzed that cause the diabetics, and different machine learning algorithms are used to predict whether an unknown sample is diabetes or not. For this purpose, PIMA diabetic detection for Female patients was used. Here 10 different classification model is used for prediction. Finally, the detailed performance analysis of the different variables of the PIMA dataset and also the classification model are discussed.

This observational study aims to depict the impact of gender and socio-economic issues on the health status of Italian Orthopaedic patients during the COVID-19 lockdown. An Ad Hoc ques-tionnaire was developed and online administered. The following data were extracted from the questionnaire: age, body mass index (BMI), education level, distance from hospital, orthopaedic disease, concomitant medical comorbidities, living status (with/without cohabitants) and physical activity level (according to Tegner Activity Scale). The impact of the COVID-19 lockdown was studied analyzing differences related to the above-mentioned parameters. A significant increase of the call number to general practitioner and to the orthopaedic surgeon was observed during the COVID-lockdown, especially in patients with higher education level. Nonetheless, a reduced compliance in drugs assumption was observed in patients with higher education level during lockdown (p=0.007). Almost all the analyzed items were significantly in-fluenced by the distance between patient’s domicile and the nearest hospital. However, no sig-nificant differences were observed comparing pre-COVID to COVID lockdown. In the present study patients’ gender and education level revealed a significant impact on the social behavior during the COVID lockdown, compared with the pre-COVID period.

With the outbreak of coronavirus disease 2019 (COVID-19), there is a need for efficient management of patients with mild or no symptoms, which account for the majority. The aim of this study is to introduce the structure and operation protocol of a living and treatment support centre (LTSC) operated by Seoul National University Hospital in South Korea. The existing accommodation facility was converted into a 'patient centre' where patients was isolated. A few Medical staff here performed medical tests and responded to emergencies. Another part of the LTSC was 'remote monitoring centre'. In this center, patients’ self-measured vital signs and symptoms were monitored twice a day, and the medical staff staying here provided video-consultation via a smartphone. During the 3 weeks from March 5 to March 26, 2020, 113 patients were admitted and treated. LTSC could be an efficient alternative to hospital admission in pandemic situation like COVID-19.

Background: Differential diagnosis between polymyalgia rheumatica (PMR) and seronegative elderly-onset rheumatoid arthritis (SEORA) is not easy, to the point that in the past they were considered the same entity. In these patients, sleep disorders have been scarcely assessed, and considered as expression of mood disorders such as depression and anxiety. Methods: In 38 Caucasian elderly patients (median age: 73.9 ± 8.06 years) consecutively referred to two outpatient clinics from January to May 2018 with diagnosis of PMR and SEORA, sleep impairment was assessed using the Medical Outcomes Study-Sleep scale (MOS-SS). Depression and anxiety were assessed using the Neuropsychiatric Inventory (NPI) score, with point 0 for absent and point 3 for severe. Comorbidities were assessed using the Cumulative Illness Rating Scale (CIRS). Patients taking medications used to treat sleep disturbance or that could favor sleep disturbances were excluded. The study was approved by the local ethics committee and carried out in accordance with the Helsinki Declaration, revised 2013. Every patient signed an informed consent form at the time of the first visit. Results: MOS-SS total point in PMR patients was significantly higher than in SEORA patients (47.60 ± 8.4 vs 28.26 ± 12.4; P = 0.000). After six-month therapy with prednisone (12.5–15 mg/day, followed after 4 weeks by gradual tapering), MOS-SS total point improved in the two groups of patients, with no significant difference (17.0 ± 6.2 vs 17.8 ± 4.2; P = 0.644). No correlation was found between MOS-SS and comorbidities, and between MOS-SS, anxiety or depression. Conclusions: Our data suggest that the assessment of sleep impairment could be very useful in the differential diagnosis between PMR and SEORA. Up today, the reasons why patients with PMR have—at the time of diagnosis—a sleep impairment higher than SEORA are speculative. Further ad hoc complementary studies in multicenter cohorts are needed.

Brewers’ spent grain (BSG) is the major by-product of beer production (70-80% moisture) and the feasibility of its application in foodstuffs depends primarily on its drying. Our objective was to evaluate the effect of physical separation with or without ultrasound application on color, total phenolic content (TPC), antioxidant activity, proximate composition, total dietary fibers, and particles size distribution of BSG powders. From wet BSG (W), two processes, without (A) or with (B) ultrasound, encompassing pressing, convective air-drying, sieving, fraction separation, and milling were evaluated. Powders A1, A2, B1 and B2 were generated. The total color difference compared with W increased throughout both processes, ranging from 1.1 (B1 x A1) to 5.7 (B1 x A2). No significant difference was observed for TPC, while lower antioxidant activity (ABTS+) was observed for process B powders, especially for B2, likely due to the release of antioxidant compounds to the liquid during pressing after ultrasound application. Nevertheless, process B powders showed higher content of total dietary fiber (p < 0.05). In conclusion, process B, with ultrasound application, may be interesting for further extraction of soluble fibers. However, the developed process A may be feasible for industrial and craft brewers, and further studies regarding the effect of their application in foods should be encouraged.

We prove that the probability of “A OR B”, where A and B are events or hypotheses that are recursively dependent (OR is the logico-probabilistic operator) is given by a "Hyperbolic Sum Rule” (HSR) relation isomorphic to the hyperbolic-tangent double-angle formula, and that this HSR is Maximum Entropy (MaxEnt). The possibility of recursive probabilities is excluded by the “Conventional Sum Rule” (CSR) which we also prove MaxEnt (within its narrower domain of applicability). The concatenation property of the HSR is exploited to enable analytical, consistent and scalable calculations for multiple recursive hypotheses: such calculations are not conveniently available for the CSR, and are also intrinsic to current artificial intelligence and machine learning architectures presently considered intractable to analytical study and methodological validation. We also show that it is as reasonable to state that “probability is physical” (it is not merely a mathematical construct) as it is to state that “information is physical” (now recognised as a truism of communications network engineering). We relate this treatment to the physics of Quantitative Geometrical Thermodynamics which is defined in complex hyperbolic (Minkowski) spacetime, and show how the HSR is isomorphic to other physical quantities including certain components important for digital signal processing.

Drawing from literature and Geert Hofstede’s cultural dimensions, this study delves into the impact of cultural factors on family structures, roles, and relationships. Ghana and Latvia have different cultural and social orientations that influence family dynamics. Through a comparative lens, this paper will contribute to understanding how a country’s culture influences family dynamics, highlighting the influence of Power Dynamics of parenting style and Individualism vs. Collectivism on interaction levels within the family.

The appropriate concentration of vitamin D in the athlete’s body is essential for its proper functioning, especially in terms of muscular health, by enhancing recovery and oxygen consumption. Soccer players are required to perform frequent sprints and change of directions during training and competition. The aim of the present study was to establish whether the level of vitamin D (measured by 25-hydroxyvitamin D concentrations- 25(OH)D) in blood serum has any influence on speed (s) and change of direction (COD, s) performance. Material and methods: Twenty male soccer players from the top league in Poland participated in the study. All subjects' were evaluated for the serum concentration of 25(OH)D at the beginning of the preseason. . The linear sprint test was performed at 5m and 30m and COD (time and deficit), was evaluated at 30m at the beginning and after 6 weeks of preparatory period. Results: The results revealed that 50% of soccer players had an insufficient level or a deficit of 25(OH)D (≤ 30 ng/ml), with 20% having a significant deficiency of 30 ng/ml).There were no statistically significant correlations between the training effect for the variables ∆5m (before - after) and ∆30m (before - after). Statistically significant positive correlations were found between the training effect for the variables ∆COD (before - after) (R=0.62/p=0.003) and ∆deficit (before-after) (R=0.47/p=0.039). With a higher concentration of vitamin D in the blood, the training effect for COD and the deficit increased, which was visible in the faster performance of the COD test. No statistically significant differences were found for the mean values of the variables ∆5m (before - after) and ∆30m (before - after) in the group of subjects whose 25(OH)D concentration was 30mg /ml. Significant differences were noticed for the variables ∆COD (m=0.60 [s]) and ∆deficit (m=0.56[s]) in the group of subjects whose 25(OH)D concentration was 30mg /ml. The training effect was significantly higher for the group of subjects whose 25(OH)D concentration was above 30 mg/ml, which was observed by the faster performance of the COD test in this group of subjects. Conclusions: The serum concentration of vitamin D affects training adaptations of muscles. A lower concentration of Vitamin D seems to have a detrimental effect on the change of direction performance. Soccer players whose blood serum 25(OH)D concentrations were >30mg/ml achieved better results in the applied fitness tests.

A relativistic positioning system is a set of four emitters broadcasting their proper times by means of light signals. The four emitter times received at an event constitute the emission coordinates of the event. Covariant quantities associated with relativistic positioning systems are analysed relatively to an observer in Minkowski space-time by splitting them in their relative space-like and time-like components. The location of a user in inertial coordinates from a standard set of emission data (emitted times and satellite trajectories) is solved in the underlying 3+1 formalism. The analytical location solution obtained by Kleusberg for the GPS system is recovered and interpreted in a Minkowskian context.

Recent studies have shown that the endogenous cannabinoid system (ECS) of the brain is essentially involved in the pathogenesis of Parkinson's disease (PD), influencing its symptoms by regulating the level of endogenous cannabinoids and altering the activation of cannabinoid receptors (CBR). Therefore, modulation of ECS with new drugs developed for this purpose may prove to be a promising strategy in the treatment of PD. However, fine regulation of ECS is quite a challenge due to the functional diversity of CBR in the basal ganglia. Our review analyses the effects of ECS modulators on experimental PD models and in patients with PD, as well as presents the outlooks for the development of new cannabinoid drugs for the treatment of motor and non-motor symptoms in PD.

Objective: To explore motivation to exercise, support, and self-management needs among people with Parkinson’s (PwP), family-members and physiotherapists. Methods: Purposeful and maximum difference sampling methods (age, sex, geographical setting, and disease severity) were employed. PwP and family-members were recruited through physiotherapy services and local support groups. Semi-structured interviews with 12 PwP, focus groups with four family-members, and five physiotherapists were conducted. Interview guides were informed by patient-public input, and a recent systematic review. Interviews were recorded, transcribed, and analysed using thematic analysis. Results: Four common themes emerged: 1) The value of an intrinsic connection with exercise: but there are challenges. A greater connection to exercise led to long-term compliance. 2) Tailoring exercise is essential. Preferred exercises and environments were mixed, with differences emerging between sexes. 3) Physiotherapists’ aim to only maintain physical function led to frustration. Limited self-management opportunities, stigma and dehumanisation were discussed. 4) Non-motor symptoms, stigma, fear, and determination. Apathy, pain, and low mood were discussed. Conclusion: Exercise provided physical, emotional, and social rewards. Supports are necessary; however, challenges arise when PwP’s motivation are mismatched to family-members’ and physiotherapists’ goals. Co-created goals, tailored to their preferences, and exercise plans with supported self-management are recommended.

Defining integrals over volume element in curved spacetime together with the mass and energy densities within that region of spacetime is apparently equivalent to the given energy and mass of that body or particle. With this in mind equations involving energies and mass can be rewritten in terms of their densities and the integral over the volume element. The idea find its place in the Hamiltonian formulations, and can be carried over into quantum mechanical frameworks systematically accounting for the effect of spacetime volume structures and gravity on dynamics of quantum systems. This article briefly explores this concept and runs through various frameworks and equations relevant to this idea, particularly the schrodinger-Newton equation and discusses the cosmological constant as a vacuum energy density.

This study examines the impact of executives implicated in fraud on firms' investment decisions using AAERs in the US, aiming to address the underexplored aspect of rationalization within the fraud triangle. Executives implicated in fraud often display abnormal attitudes to justify accounting irregularities, prompting an investigation into how abnormal investment decisions are used for rationalizing fraud, given their critical role in a firm's long-term sustainability. Analysis of AAERs spanning from 1981 to 2013 reveals that implicated executives, particularly CEOs and CFOs, tend to make abnormal investment decisions, and that collusive fraud exacerbates this behavior. Notably, such executives lean towards overinvestment, particularly in R&amp;D expenditures, to hide or justify fraud; the duration of fraud amplifies its impact on investment decisions. By shedding light on the rationalization aspect of the fraud triangle, this research contributes valuable insights for investors, regulators, and academia emphasizing the significance of public disclosure of fraud to enhance transparency in capital markets and the importance of ethics-focused education in accounting to prevent corporate fraud.

Ecuador is an important center of biodiversity of the plant family Amaryllidaceae, specially the subfamily Amaryllidoideae, known as a source of important bioactive molecules. The aim of this study was to assess the chemical and biological potential of four different species of Amaryllidoideae collected in Ecuador: Urceolina formosa, Urceolina ruthiana, Clinanthus incarnatus, and Stenomesson aurantiacum. Sixteen alkaloids were identified in the bulb extract of these species by GC-MS, which the extract of S. aurantiacum exhibiting the greatest structural diversity. The potential of these three genera against Alzheimer’s disease was evaluated by measuring their AChE and BuChE inhibitory activity, revealing that C. incarnatus and U. formosa (from Sucumbíos province) showed the best results with IC50 values of 1.73 ± 0.25 and 30.56 ± 1.56 g·ml-1, respectively. Molecular dynamic assays were conducted to elucidate the possible interactions that occurs among 2-hydroxyanhydrolycorine and AChE enzyme, suggesting some similarity with those observed for galanthamine. This study enhances our understanding of the biodiversity of Amaryllidoideae species from Ecuador, highlighting their potential as a source of chemical compounds with pharmaceutical potential.

Alzheimer's Disease (AD) presents a significant challenge in the wake of its multifaceted nature, characterized by cognitive decline, memory impairment, and neuroinflammation. Despite extensive research, effective pharmacological interventions remain elusive, prompting exploration into non-pharmacological approaches. Microcurrent therapy (MC), utilizing imperceptible currents, has emerged as a potent clinical protocol. While previous studies have focused on its therapeutic effects, this study investigates its impact on neuronal damage and neuroinflammation in an AD mouse model, specifically addressing potential side effects. Utilizing 5xFAD transgenic mice, we examined the effects of MC therapy on neuronal integrity and inflammation. Our findings suggest that MC therapy attenuates memory impairment and reduces neurodegeneration, as evidenced by improved performance in memory tests and preservation of neuronal structure. Additionally, MC therapy significantly decreases amyloid-beta (Aβ) plaque deposition and inhibits apoptosis, indicating its potential to mitigate AD pathology. Our study discovered that MC therapy effectively reduces glial activation by inhibiting the TLR4-MyD88-NFκB pathway, consequently leading to decreased levels of inflammatory factors TNF-α, IL-1β, and IL-6, thus implicating TLR4 in neurodegenerative disease-related neuroinflammation. Furthermore, while our study did not observe significant adverse effects, further clinical trial into potential side effects and neuroinflammatory responses associated with MC therapy is warranted.

Entropy as a mathematical concept is the first of its own kind, and second to none. Barely one or two papers in literature have investigated fractal dimensions of very basic entropies, such as Shannon, Tsallis, and Rényi entropic expressions. This was a thoughtful inspiration to delve into a step forward towards a unified information- theoretic fractal theory. The storytelling of this current paper starts by introducing my third entropy formula, namely Ismail’s entropy, , as a novel generalization to Shannonian entropy with a visionary link to both long- and short-range interactions, (LRIs), (SRIs) respectively. Clearly, this would generate a fourfold unification with statistical mechanics as well as contemporary physics. Hence, this adds more credibility and weight for this study. The fractal dimension of , is identified in this paper. As an essential part of this work, it was influential to spotlight the importance of fractal geometry to space industry as well as education, which is crucial to develop our societies. Thus, some potential fractal applications to CubeSat Technologies and Education are highlighted. So, will the deep search for more ground-breaking research has come to an end. Certainly, not. This was another inspiration to propose new open problems to widen research gates to the scientific community for more research pathways. Consequently, the paper ends with closing remarks combined with some challenging open problems and the next phase of research.

Gilbert's syndrome (GS) is a common hereditary condition characterized by mild increases in serum bilirubin levels due to inherited defects in bilirubin metabolism. This review, based on data from peer-reviewed articles and journals spanning from 1977 to January 2024, provides a comprehensive overview of over four decades of research on GS. Early studies primarily focused on defining the clinical and genetic characteristics of the syndrome, laying the foundation for subsequent investigations. More recent research has delved into the genetic mechanisms underlying the reduced expression of bilirubin UDP-glucuronosyltransferase, which has significantly enhanced our understanding of the pathogenesis of GS. Furthermore, recent studies have shed light on the clinical implications of GS, including its association with non-alcoholic fatty liver disease and mortality risk, highlighting the complex interplay between genetic factors, bilirubin metabolism, and clinical outcomes. Despite its generally benign nature, thorough research is essential to fully understand the impact of GS on patients' lives. This review emphasizes the importance of ongoing research to deepen our understanding of GS and its broader implications.

Burn patients still represent an important challenge in critical care medicine today. These patients can develop significant neurological conditions up to intracranial hypertension, but as they find themselves hospitalized outside of neurocritical care and are often subjected to sedation for the complex management, they are sometimes underestimated. The aim of this study is to evaluate the feasibility of non-invasive methods for the early diagnosis of intracranial hypertension in these patients. In this prospective observational study, adult burn patients admitted to intensive care within the first 8 hours of the event were enrolled. These patients were studied through ultrasound measurement of optic nerve sheath diameter and intracranial vessel velocimetry with transcranial Doppler. In the 20 patients studied, no frankly pathological values were identified in the 3 different measurement stages (within 8 hours of the burn, then at 48 and 96 hours) and no correlations were identified between the measured values and the extension of the burn with the related risk of mortality. However, this study, one of a kind, demonstrates that these non-invasive methods are applicable to this specific patient population, and can represent an effective method for reducing the incidence of complications that are dangerous for survival.

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

The aim of the study is to develop a population pharmacokinetic (PopPK) model and to investigate the influence of CYP3A5/CYP3A4 and ABCB1 single nucleotide polymorphisms (SNPs) on the Tacrolimus PK parameters after LCP-Tac formulation in stable adult renal transplant patients. The model was developed using NONMEM v7.5, from full PK profiles from a clinical study (n=30) and trough concentrations (C0) from patient follow-up (n=68). The PK profile of the LCP-Tac formulation was best described by a two-compartment model with linear elimination, parameterised in elimination (CL/F) and distributional (CLD/F) clearances and central compartment (Vc/F) and peripheral compartment (Vp/F) distribution volumes. A time lagged first order absorption process was characterized using transit compartment models. According to the structural part of the base model, the LCP-Tac showed an absorption profile characterized by 2 transit compartments and a mean transit time of 3.02 hours. Inter-individual variability was associated with CL/F, Vc/F and Vp/F. Adding inter-occasion variability (IOV) on CL/F caused a statistically significant reduction in the model minimum objective function MOFV (p<0.001). Genetic polymorphism of CYP3A5 and cluster of CYP3A4/A5 SNPs statistically significantly influenced Tac CL/F. In conclusion a PopPK model was successfully developed for LCP-Tac formulation in stable renal transplant patients. CYP3A4/A5 SNPs as a combined cluster including three different phenotypes (high, intermediate, and poor metabolizers) was the most powerful covariate to describe part of inter-individual variability associated with apparent elimination clearance. Incorporating this covariate in the initial dose calculation and during the therapeutic drug monitoring (TDM) would probably optimize Tac exposure attainments.

(1) Background: The COVID-19 pandemic significantly affected worldwide, with varying responses implemented to control its spread. This study aimed to compare the epidemic data compiled by the World Health (2) Methods: Organization to understand the impact of the measures adopted by each country on the mortality rate. The increase or decrease in the number of confirmed cases was understood in logarithmic terms, for which logarithmic growth rates “K” were used. The mortality rate was calculated as the percentage of deaths from the confirmed cases, which was also used for logarithmic comparison. (3) Results: Countries that effectively detected and isolated patients had a mortality rate 10 times lower than those that did not. Although strict lockdowns were once effective, they could not be implemented on an ongoing basis. In fact, after their cancelation, large outbreaks occurred because of medical breakdowns. The virus variants mutated with increased infectivity, which impeded the measures that were once effective, including vaccinations. Although the designs of mRNA vaccines were renewed, they could not keep up with the virus mutation rate. The only effective defence was steadily identifying and isolating patients. (4) Conclusions: These findings have crucial implications for the complete containment of the pandemic and future pandemic preparedness.

We aimed to provide a comprehensive assessment of exercise physiology of adult Fontan patients (FP) and factors limiting functional capacity (FC). A prospective single-centre study of 37 FP aged ≥16years and 19 healthy-controls (HC), who underwent CPET on cycle-ergometer in February-March 2022. Lung function was impaired in FP, mostly mild restrictive pattern (56.8%). Mean peakVO2 was 21±5.4ml/kg/min, 55% predicted. Morphologically left-single ventricle showed higher peakVO2%predicted (57.4±14.4% vs 43.4±8.1%, p=0.045). A lower peakVO2%predicted was observed in patients with an early flattened and/or descending O2 pulse at maximal exertion (52±14% vs 62±12.5, p=0.04 and 47.6±9% vs 60±14 respectively, p=0.018) and chronotropic insufficiency (53±12% vs 69.8±20%, p=0.008). Strong positive correlation was observed between %OUES and peakVO2%predicted (r=0.726, p>0.001). PeakVO2%predicted was progressively higher as the level of physical activity increased (low-level 49.5±14%, moderate-level 55±12%, intense-level 69±20%). FP showed lower inspiratory muscle strength compared to HC but it was no statistically associated with either peakVO2 or VE/VCO2 slope. In FP OUES is a useful submaximal parameter in those who fail to reach maximal exertion. Chronotropic insufficiency and early flattened or descending oxygen pulse slope were factors associated with low peakVO2. Regular intense physical activity improves FC. Although FP have inspiratory muscle weakness, its impact on FC is unclear.

Abstract: Tuberculosis (TB) and human immunodeficiency virus (HIV) epidemics in South Africa have been closely related and persistent, posing a significant burden for healthcare provision. We explored the patients perspectives on challenges and barriers of scaling up TB and HIV integrated services. A descriptive cross-sectional study applying a qualitive research approach was used. Through focus group discusssions (FGDs), we interviewed 29 patients accessing TB and HIV services at the study sites which were selected at primary health care (PHC) clinics in the O.R Tambo district in Eastern Cape, South Africa. Anonymised data was analysed using both content and thematic analysis technique. Challenges and barriers identified included a lack of health education about TB and HIV; an inadequate counselling for antiretroviral drugs (ARVs) and HIV; a lack of awareness of the National TB control program; and poor quality of services provided by the health care facilities. These findings suggest that the O.R. Tambo district needs to strengthen its TB-HIV integration immediately. Keywords: TB-HIV integration; Challenges and barriers; Patients; O.R Tambo District; Eastern Cape; South Africa

Assessment of stigma among cancer patients is of utmost importance as stigma may lead to various psychological sequelae and lower quality of life. This study aimed to translate the English version of the Shame and Stigma Scale (SSS) into Malay and validate the Malay version of the SSS (SSS-M) among cancer patients in Malaysia. Initially, concurrent translation and back translation of the SSS-M was performed, and face and content validity were assessed. Then, the SSS-M was administered to a total of 234 patients of mixed types of cancer to assess its reliability (internal consistency and test-retest reliability), construct validity (convergent and discriminant validity), exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The SSS-M total score registered good internal consistency (Cronbach’s α of 0.886) and test-retest reliability (intraclass correlation coefficient of 0.846, p < 0.001). EFA and CFA confirmed that the SSS-M consisted of 20 items in 5 domains. Its convergent and discriminant validity were achieved. Hence, the SSS-M demonstrated good psychometric properties and is available for use to assess stigma among cancer patients in Malaysia.

At present, the health systems of many countries face complex challenges even if their priority objectives remain the same - to provide sustainable health systems at the current and the prognostic demographic changes and requirements in a health system. The quality and the efficiency of healthcare delivery and their mutual conformity have been brought to public attention. Similarly, the quality and the efficiency of an entire process depends on the instrumentation and its procurement that represents a significant economic and procedural issue in the healthcare systems for a long time. Many reports of the public procurement processes and research studies declare this fact. The primary aim of this study is to evaluate the public procurement efficiency in the health system by means of the valuation approach, or savings’ estimates that are achieved by the public procurement. The savings were defined as a percentage difference between the estimated and the final contract price. The secondary objective is to examine an influence of selected variables on a creation of savings in the public procurement process by means of a regression analysis. The researched variables are as follows: time, method, procurement, NUTS level of procurement, Common Procurement Vocabulary Code, number of offers. The analysis results showed interesting findings. The number of offers has a significantly positive impact on the savings. It means that if the number of offers increases by one unit, the savings will increase by 15.6%. Also, time variable (year) has a positive impact on the savings. Consequently, it may be assumed that the public procurement process is improving from a time perspective. It may be partially caused by the fact that a new public procurement legislative has been valid since 2015. The NUTS level has also an impact on the savings in relation to the public procurement. The public procurements which took place at the level of a state were more beneficial as the public procurements at the regional level. Also, the procurement method was statistically significant parameter of a regression analysis. The competition actions together with a negotiation process created higher savings in comparison to tenders. In case of the CPV codes, the most significant savings were achieved in the group of ‘various medicinal products’. The study’s results provide a valuable knowledge for the creators of policies and a realization of the national strategic plans within the health system. Also, these results support a creation of national and international benchmarks in this area and a networking of international partnerships in the area of a public procurement that focus on a development of methodologies and comparative platforms creation.

Objective: to evaluate the effects of excitatory repetitive transcranial magnetic stimulation (rTMS) of the international 10-20 system P3 point (intraparietal sulcus region) in chronic patients with a frontal lesion and parietal sparing due to stroke on the impaired upper (UL) and lower limb (LL) as measured by Fugl-Meyer Assessment (FMA). Methods: three patients (C1: 49.83/2.75, C2: 53.17/3.83, C3: 63.33/3.08 years-old at stroke/ years post-stroke, respectively) received two weeks (five days/ week) of rTMS at 10 Hz of P3. A patient was treated in similar conditions with a sham coil (S1: 56.58/4.33). No complimentary therapy was delivered during the study. Patients were evaluated before, after- and two months post-treatment (A1, A2 and A3, respectively). Results: we found increased scores for LL in motor function subsection for C1 and C3 and in sensory function for C2 by A2 that remained at A3. We also found an increased score for UL motor function for C2 and C3, but the score decreased by A3 for C2. C3 score for UL range of motion increased by A3 compared to A1 and A2. Conclusion: In a variable way, P3 excitatory rTMS increased FMA scores in different upper and lower limb subsections of our three treated patients.

We report positive correlations between letter frequency and symmetry (more symmetric symbols are more frequent) in English and Russian languages and in four types of numerals (Western, Roman, Arabic, and Chinese) with the coefficients of determination of R2=0.899 (English), R2=0.693 (Russian) and R2=0.740 (numerals). For comparison, we studied "symbol-like" 2D colloidal clusters and found negative correlations between frequency and symmetry (R2=0.814 and R2=0.994). While in human-made systems the frequency of using of a symbol is the driving force which leads to symbols simplification and symmetrizing, in natural system, symmetry leads to lower frequency of occurrence because there are fewer ways of building symmetric clusters than asymmetric ones. We interpret these results as a correlation between the symbol as a type and as a token and we attribute this correlation to the inherent iconicity of symbols

Parkinson’s disease (PD) is a common multisystem neurodegenerative disorder affecting 1% of the population above 60 years. The main neuropathological features of PD are the loss of dopaminergic neurons in the substantia nigra pars compacta (SNpc) and the presence of alpha synuclein (Syn)-rich Lewy bodies both manifesting with classical motor signs. Syn has emerged as a key protein in PD pathology as it can spread through synaptic networks to reach several anatomical regions of the body contributing to the appearance of non-motor symptoms (NMS) considerate prevalent among individuals before PD diagnosis and persisting throughout the patient’s life. NMS mainly include loss of taste and smell, constipation, psychiatric disorders, dementia, rapid eye movement (REM) sleep behavior impairment, urogenital dysfunction, and cardiovascular impairment. This review summarizes the more recent findings showing the impact of Syn deposits on several prodromal NMS and emphasizes the importance of early detection of Syn toxic species in biofluids and peripheral biopsies as prospective biomarkers in PD.

The excessive and prolonged use of the electronic devices with digital screens may cause some serious health problems. The ocular surface problems particularly Dry Eye Syndrome may be the most common and preventable one of them. In this study, unfavourable and potentially harmful effects of digital screens on lacrimal system and tear functions were evaluated in 221 participants. Their ocular surface conditions were evaluated by Ocular Surface Disease Index (OSDI) scores and their lacrimal functioning was measured by Schirmer’s test.. A reciprocal and statistically significant relationship was found between dry eye symptoms and OSDI scores. This relationship was more prominent especially in long duration use of smartphones with brighter background lights..

Parkinson’s disease (PD) is the second most common degenerative disease which may cause blood pressure abnormalities due to autonomic dysfunction. Early morning rise of blood pressure which is called morning surge is found to be related with some cardiovascular diseases when it is exaggerated. We wanted to search the relation of Morning blood pressure surge (MBPS) and inflammation in PD. Method: Ambulatory blood pressure monitoring for 24 hours, fibrinogen to albumin ratio, hs-CRP are used in this retrospective study. Fifty idiopathic PD patients and 50 age and sex matched control cases were included. MBPS, it has been defined as the difference between morning BP (measured 2 hours after awakening) and the lowest night-time BP. Body mass index (BMI) is used as an independent variable. Results: Median value of MBPS for PD group (21,63) was significantly different from the control group values (18,63) (p

With the increasing occurrence of rotator cuff injuries every year, there is a great need for a reliable treatment option. Wharton’s Jelly contains several components that can positively impact the replacement and repair of musculoskeletal defects. The overall objective of this study is to evaluate the improvement of patient-reported pain scales after applying Wharton’s Jelly (WJ) in rotator cuff defects. Eighty-seven patients with rotator cuff defects who failed at least eight weeks of conservative treatment were selected from the retrospective repository. 2cc of WJ flowable allograft was applied to the specific affected anatomy, the most common being supraspinatus tendon, biceps tendon insertion, labral tear, and subscapularis tear. No adverse reactions were reported. Statistically significant improvements were found from the initial to Day 90 in all scales. Patient satisfaction was calculated using minimal clinically important differences. No statistically significant differences were found in mean changes between gender, BMI, and age. Scanning Electron Microscopy images reveal the similarities between the collagen matrix in WJ and the rotator cuff. The significant improvement in patient outcomes coincides with current literature analyzing WJ applications with other structural defects around the body. WJ is a promising alternative for musculoskeletal defects when the standard of care fails.

Côte d’Ivoire has substantially neglected crop residues from farms in rural areas. This study aims to provide strategies for the sustainable conversion of crop residues to hydrogen. Using existing data and theoretical approaches, up to 16,801,306 tons of crop residues of 11 crop types were available in Côte d’Ivoire in 2019. A theoretical hydrogen potential of 1,296,424.84 tons was estimated from the crop residues. Technically, 907,497.39 tons of hydrogen is expected annually. Three scenarios of hydrogen project implementation developed indicated that the Ivorian industries can be supplied with 9,026,635 gigajoules of heat. Moreover, 17,910 cars and 4,732 buses can be supported in the transport sector. It is estimated that 817,293.95 tons of green ammonia for farmers can be supplied. Five million, seven hundred twenty-seven thousand, nine hundred ninety-two (5,727,992) households are expected to have access to 1,718.40 gigawatts of electricity. Due to these changes in transport, energy, industry, and agricultural sectors, a reduction of 1,644,722.08 tons of carbon dioxide per year can be achieved theoretically. With the scenarios, some 263,276.87 tons of hydrogen are exportable to other countries. Conversion of crop residues to hydrogen is a promising opportunity with environmental and socio-economic impact. Therefore, this study requires further extensive research.

Cow’s Milk (CM) is a healthy food consumed worldwide by individuals of all ages. Unfortunately, 'lactase deficient' individuals cannot digest milk's carbohydrate lactose depriving themselves of highly beneficial milk proteins like casein, lactoalbumin and lactoglobulin, due to lactose intolerance (LI), while other individuals develop cow milk allergy specifically against these proteins (CMPA). The management of these conditions is distinctly different and an inappropriate diagnosis or treatment may have significant implications for the patients, especially if they are infants or very young children, resulting in unnecessary dietary restriction or avoidable adverse reactions. Omics technologies play a pivotal role in elucidating the intricate interactions between nutrients and the human body, spanning from genetic factors to the microbiota profile and metabolites. This comprehensive approach enables the precise delineation and identification of distinct cohorts of individuals with specific dietary requirements, so that tailored nutrition strategies can be developed. This is what is called personalized nutrition or precision nutrition (PN), the area of nutrition that focuses on the effects of the nutrients over the genome, proteome and metabolome, promoting well-being and health, preventing diseases, reducing chronic disease incidence, and so increasing life expectancy. Here, we report the scientific community opinion proposing to replace the approach “one size fits all” with tailor-made nutrition programs, designed by integrating nutrigenomic data together with clinical parameters and microbiota profiles, taking into account the individual lactose tolerance threshold and needs in terms of specific nutrients intake. This customized approach could help LI patients to improve their quality of life, overcoming depression or anxiety, often resulting from the individual perception of this condition as different from a normal state.

Intrusion detection is generally carried out by matching network traffic patterns with known attack patterns or by identifying abnormal network traffic patterns. One statistical methodological approach used in intrusion detection is Statistical Process Control (SPC) by constructing a control chart. Hotelling’s T2 control chart is a multivariate control chart commonly used to monitor the mean process. The performance of the T2 chart in monitoring mean shifts can be increased if a robust estimator is utilized. Based on previous research, T2 based on the Fast-MCD estimator has good performance in monitoring low to medium outlier contaminated data. Therefore, the MRCD estimator can be used to detect intrusion. On the other hand, this research focuses on developing a bootstrap-based robust Hotelling’s T2 charts with Fast-MCD and MRCD estimators for evaluating performance in detecting intrusion on intrusion detection datasets. Based application of UNSW-NB15, the proposed chart has better performance than the conventional T2 and Fast-MCD-based T2 despite the longer execution time.

The work is devoted to the development of methods for constructing asymptotic formulas as x→∞ of a fundamental system of solutions of linear differential equations generated by a symmetric two-term differential expression of odd order. The coefficients of the differential expression belong to classes of functions that allow oscillation (for example, those that do not satisfy the classical Titchmarsh-Levitan regularity conditions). As a model equation, the 5th order equation i2p(x)y′′′′′+p(x)y′′′′′+q(x)y=λy, for which various cases of behavior of the coefficients p(x),q(x), is investigated. New asymptotic formulas are obtained for the case when the function h(x)=−1+p−1/2(x)∉L1[1,∞) significantly influences the asymptotics of solutions to the equation. The case when the equation contains a nontrivial bifurcation parameter is studied.

Culture signifies the customs, language, ceremonies, Indigenous Medical Knowledge (IMK) and other material objects of a tribe. These and many other features are a representation of identity for many Zambian communities. IMK practices are skills inherent by certain individuals in a tribal grouping who are chosen by the spirits (gods) or trained by those who practice. This intrinsic skill is in danger of diminishing as a result of modern medication. This article attempts to understand the role of traditional healers (also known as asing’anga in local language) in preservation of IMK in Chibombo District of Zambia. In so doing, the paper examined methods of preservation used by asing’anga and the challenges faced. Using hermeneutic phenomenology and linear snowball sampling, findings revealed that preservation was done through training. The study found unwillingness, expiration, and spirituality as challenges in the process of preserving IMK. The study recommended that the Lenje Cultural Association consider documenting and disseminating information to the local people by showcasing what is available in the Mukuni Culture Village Museum and Library. This was seen as a way through which many youths would be encouraged to appreciate the indigenous values in their culture.

Physical activity is especially important of children's everyday life with chronic disease. The aim of the study was to show whether asthma is a barrier to physical activity in our society. The correlation between the severity of the disease, body mass index, and physical activity were analyzed, and, parents' opinion whether children should participate in active sports was assessed. Physical activity of children with asthma was analyzed by questionnaires and activity-measuring armbands. 93 parents and their children were involved in the survey, while 20 children were wearing the armband. The age of children was 12.6±3.5 years (mean±SD), 69.9% were boys, 30.1% were girls. 93.4% of the respondents participated in physical education program and 56.5% also attended sporting activities on a regular basis. 61.2% of the children had mild, 37.6% moderate, and 1.2% severe asthma. 6.5% of the respondents stated that their illness had been consistently or frequently limiting the performance concerning their school or home duties over the past 4 weeks. Twelve percent of parents felt that physical activity was not appropriate in the context of this disease. We conclude, that fear of the consequences of physical activity depends largely on education which should involve their parents, teachers and coaches.

Blood biomarkers represent a promising future for studying cognitive impairment, particularly in Alzheimer's Disease (AD), as they offer a non-invasive alternative to cerebrospinal fluid tests and have potential as population screening tools. However, the relationships between these biomarkers and specific cognitive functions, as well as their utility in predicting longitudinal cognitive decline, are not yet fully understood. This descriptive review surveys the literature from 2018 to 2023, focusing on the associations between Amyloid-β, Total Tau, Phosphorylated Tau (p-tau), Neurofilament Light (Nfl), and Glial Fibrillary Acidic Protein (GFAP) with cognition. The reviewed studies are heterogeneous, varying in design and population (mixed, cognitively impaired, or unimpaired), and show results that are sometimes conflicting. Generally, cognition positively correlates with Aβ levels, especially when evaluated through the Aβ42/Aβ40 ratio. In contrast, Tau, Nfl, and GFAP levels typically show a negative correlation with cognitive performance. While p-tau measures tend to show stronger associations with cognitive functions than other biomarkers, no single blood marker has emerged as predominantly associated with a specific cognitive domain. These findings add to our understanding of the complex relationship between blood biomarkers and cognitive performance and underscore their potential utility in clinical evaluations of cognition.

Purpose: Proximal Femur Fractures (PFFs) in elder patients lead to decreased productivity. Skilled nursing facilities (SNFs) and inpatient rehabilitation facilities (IRFs) are non-home destinations for post-discharge disposition. This study aims to evaluate the loss of independence (LOI) following PFFs and examine the economic impact it entails. Method: Literature from various databases was collected and analyzed retrospectively. The inclusion criteria included patients age >18 years and articles published after 1990. All studies were screened and a PRISMA chart was used to demonstrate the search process. 24 studies were finally used for review. Results: LOI following PFFs significantly increases with age. Fractures in geriatrics avail a significant amount of post-care resources and had longer lengths of stay. Furthermore, six pre-operative risk factors were identified for non-home disposition including age >75, female, non-Caucasian race, Medicare status, prior depression, Charlson Comorbidity Index. Patients discharged directly to home have lower total cost compared to those discharged to rehabilitation units. Loss of independence increases with advancing age. Discussion: PFFs can lead to serious loss of independence among elderly patients with direct impact on economic, social, psychological aspects and the healthcare system.

Abstract: Colistin is a last-resort antimicrobial for treating multidrug-resistant Gram-negative bacteria. Phe-notypic colistin resistance is highly associated with plasmid-mediated mobile colistin resistance (mcr) genes. mcr-bearing Enterobacteriaceae have been detected in many countries, with the emergence of colistin-resistant pathogens a global concern. This study assessed the distribution of mcr-1, mcr-2, mcr-3, mcr-4, and mcr-5 genes with the phenotypic colistin resistance in isolates from diarrheal infants and children in Bangladesh. Bacteria were identified using the API-20E biochemical panel and 16s rDNA gene sequencing. Polymerase chain reac-tions detected mcr gene variants in the isolates. Their susceptibilities to colistin were determined by agar dilu-tion and E-test by minimal inhibitory concentration (MIC) measurements. Over 30.0% (69/225) of isolates showed colistin resistance by agar dilution assessment (MIC> 2.0 μg/mL). Overall, 15.5% of isolates carried mcr genes (7, mcr-1; 17, mcr-2; 13, mcr-3; and co-occurrence occurred in 2 isolates). Clinical breakout MIC val-ues (≥ 4 μg/mL) were associated with 91.3% of mcr-positive isolates. The mcr-positive pathogens include twenty Escherichia spp., five Shigella flexneri, five Citrobacter spp., two Klebsiella pneumoniae, and three Pseudo-monas parafulva. mcr-genes appeared to be significantly associated with phenotypic colistin resistance phe-nomena (p=0.000), with 100% colistin-resistant isolates showing MDR phenomena. Age and sex of patients showed no significant association with detected mcr variants. Overall, mcr-associated colistin-resistant bacte-ria have emerged in Bangladesh, which warrants further research to determine their spread and instigate ac-tivities to reduce resistance.

Radiological imaging is essential for acute patient management in Intensive Care Units (ICUs); however, it introduces the risk of exposure to ionizing radiation. This review synthesizes research on radiation exposure in intensive care unit (ICU) settings, highlighting its rise during the COVID-19 pandemic and repetitive imaging. Our analysis extends to radiation safety thresholds, revealing that some ICU patients exceed annual occupational limits, emphasizing the need to balance diagnostic utility against potential long-term risks, such as cancer. Prospective studies have demonstrated an increase in the median Cumulative Effective Dose (CED) in patients with trauma over time, prompting calls for improved awareness and monitoring. Moreover, innovative dose-reduction strategies and optimized protocols, especially in neuro-ICU units, promise to mitigate these risks. This review highlights the essential but risky role of radiological imaging in critical care. It advocates rigorous radiation management protocols to safeguard patient health, while ensuring the continuity of high-quality medical care.

(1) Background: Persistent postural-perceptual dizziness (PPPD) is a syndrome described as secondary when it is the consequence of an organic disorder (s-PPPD) or primary when no somatic triggers cannot be identified. We evaluated a group of patients diagnosed as s-PPPD with Benign Positional Paroxysmal Vertigo (BPPV) as the main somatic trigger with the aim to identify predictive clinical elements of evolution towards PPPD.; (2) Methods: We compared the clinical characteristics of the 51 patients with s-PPPD having as trigger a BPPV (group 1) with 107 subjects diagnosed as BPPV but with no evolution in PPPD (control group). Results: A significant statistical difference in the mean age was found between s-PPPD and the non-s-PPPD group. The latency between the onset of BPPV and the final diagnosis was 25.2 days in the group 1 and 12.8 days in the control group; (4) Conclusions: The parameters mostly involved as potential precipitants of PPPD after BPPV are represented by the age of the patients and a long latency between the onset of BPPV and the final diagnosis: the mean age of the subjects who developed a PPPD following BPPV is significantly higher. These findings lead us to emphasize the importance of an early identification and treatment of BPPV, especially in older patients.

This study aimed to present a systematic meta-analysis examining the association between Helicobacter pylori (H. pylori) infection, hemoglobin A1c levels, and the development of type 1 diabetes mellitus. The initial search identified 451 articles related to the association between H. pylori infection and T1DM. Among them, 14 articles had 2,971 participants meeting the inclusion criteria for advanced meta-analysis. A significant association was observed between H. pylori infection and T1DM, with an odds ratio (OR) of 1.87 (95% confidence interval [CI]: 1.27–2.78, p = 0.002). A subgroup analysis on H. pylori status showed that a longer duration of diabetes diagnosis and higher hemoglobin A1c levels were significantly associated with H. pylori infection (p < 0.001 for both). However, there was no significant association between H. pylori infection and the diagnostic age of diabetes (p = 0.306). These findings contribute to the understanding of the association between H. pylori infection and T1DM, thereby highlighting the potential role of H. pylori in influencing the duration and glycemic control of diabetes.

Background: Malnutrition in critically ill paitents is closely linked with clinical outcomes. During acute inflammatory states, nutrition cannot reverse the loss of body cell mass completely. Studies on nutritional screening and strategy considering metabolic changes not yet been conducted. We aimed to identify nutrition strategies using the modified Nutrition Risk in the Critically ill (mNUTIRC) score. Methods: Nutrition support data, laboratory nutrition indicators, and prognosis indices were prospectively collected on the 2nd and 7th day after admission. It is to identify the effect of changes on the metabolic status and critical target of nutrition intervention. To discriminate the high-risk group of malnutrition, receiver operating characteristic curves were plotted. Risk factors associated with 28 day-mortality were evaluated using multivariable Cox proportional hazards regression. Results: A total of 490 and 266 patients were analyzed on the 2nd and 7th day, respectively. Only the mNUTRIC score showed significant differences in nutritional risk stratification. The use of vasopressors, hypo-protein supply (< 1.0 g/kg/day), high mNUTRIC score and hypoalbuminemia (<2.5 mg/dl) in the recovery phase was strongly associated with 28-day mortality. Conclusions: The implementation of the mNUTRIC score and protein supply in the post-acute phase is critical to improve 28-day mortality in critically ill patients.

Telehealth is the delivery of many health care services and technologies to individuals at different geographical areas and is categorized as asynchronously or synchronously. The coronavirus disease 2019 (COVID-19) pandemic has caused major disruptions in health care delivery to breast cancer (BCa) patients and there is increasing demand for telehealth services. Globally, telehealth has become an essential means of communication between patient and health care provider. The application of telehealth to the treatment of BCa patients is evolving and increasingly research has demonstrated its feasibility and effectiveness in improving clinical, psychological and social outcomes. Two areas of telehealth that have significantly grown in the past decade and particularly since the beginning of the COVID-19 pandemic are telerehabilitation and teleoncology. There two technological systems provides opportunities at every stage of the cancer care continuum for BCa patients. We conducted a systematic literature review that examined the use of telehealth services via its various modes of delivery among BCa patients particularly in areas of screening, diagnosis, treatment modalities, as well as satisfaction among patients and health care professionals. The advantages of telehealth models of service and delivery challenges in delivery to patients in remote arears are discussed.

Background: The t (2; 5) chromosomal rearrangement and resulting nucleophosmin (NPM1) -ALK fusion was first observed in 1994 in anaplastic large cell lymphoma (ALCL), a T-cell lymphoma responsive to cyclophosphamide, abriblastine, vincristine and prednisone in approximately 80% of cases; refractory cases usually respond favorably to brentuximab-vedotin. These treatments are regarded as a bridge to allogeneic hematopoietic stem cell transplantation (allo-SCT). Nowadays, transplant procedures and monitoring of chemotherapy patients proceed very slowly because the SARS-CoV-2 pandemic has heavily clogged the hospitals in all countries. Results: A 40-year-old Caucasian woman was first seen at our clinical center in June 2020. She had ALCL ALK +, a history of failure to two previous therapeutic lines and was in complete remission after 12 courses of Brentuximab, still pending allo-SCT after two failed donor selection. Facing of a new therapeutic failure, we requested the Italian drug regulatory agency, and obtained the authorization, to administer 250 mg twice a day of Crizotinib, a drug incomprehensibly not registered for ALCL ALK +. Conclusions: The response to Crizotinib was optimal, since no adverse event occurred, and CT-PET persisted negative; this drug has proved to be a valid bridge to allo-SCT

Background To develop and validate the American-English version of the self-reporting Acute Cystitis Symptom Score (ACSS), a suitable tool for diagnosis and patient-reported outcome in female patients with acute uncomplicated cystitis (UC). Methods After certified translation into American-English and cognitive assessment, the clinical validation of the ACSS was performed as an embedded study in a US phase II trial (ClinicalTrials.gov Identifier: NCT03129295). Results A total of 167 female patients with typical symptoms of UC were included in the study following FDA guidance. At Day 1 (diagnosis) the mean(SD) sum score of the six ACSS typical symptoms reached 10.60(2.51). Of 100 patients followed-up last time on Day 5 or 6 (End-of-treatment, EoT), 91 patients showed clinical success according to the favoured ACSS criteria (sum score of typical symptoms 0.98(1.94)). There was no correlation between the severity of symptoms on Day 1 or between clinical success rate at EoT and level of bacteriuria on Day 1. Conclusion The American-English ACSS showed high predictive ability and responsiveness, and excellent levels of reliability and validity. It can now be recommended as the new master version in clinical and epidemiological studies, in clinical practice or for self-diagnosis of women with symptoms of UC.

Patients with inflammatory bowel diseases (IBD), including both ulcerative colitis (UC) and Crohn's disease (CD), are at a higher risk of developing colorectal cancer (CRC). However, advancements in endoscopic imaging techniques, integrated surveillance programs, and improved medical therapies have led to a decrease in the incidence of CRC among IBD patients. Currently, the management of patients with IBD who have a history of or ongoing active malignancy is an unmet need. This involves balancing the risk of cancer recurrence/progression with the potential exacerbation of IBD if the medications are discontinued. The objective of this review is to provide an updated summary of the epidemiology, causes, risk factors, and surveillance approaches for CRC in individuals with IBD, and to offer practical guidance on managing IBD patients with history of previous or active cancer.

Background: Monogenic Alzheimer's disease (AD) has severe health and socioeconomic repercussions. Its rarest cause are presenilin 2 (PSEN2) gene mutations. We present two new cases with presumed PSEN2-AD, with unusual clinical and neuroimaging findings in order to provide more information on the pathophysiology and semiology of these patients. Methods: Women aged 69 and 62 years at clinical onset, marked by prominent behavioral and language dysfunction, progressing to severe dementia within three years. Neuroimaging, laboratory study, genetic testing. In addition, a systematic review of the PSEN2-AD were performed. Results: Neuroimaging revealed pronounced frontal white matter hyperintensities (WMH) and frontotemporal atrophy/hypometabolism. The genetic study unveiled PSEN2 variants: c.772G>A (p.Ala258Thr) and c.1073-2_1073-1del. Both cerebrospinal fluid (CSF) and experimental blood biomarkers shouldered AD etiology. Conclusions: Prominent behavioral and language dysfunction suggesting frontotemporal dementia (FTD) may be underestimated in the literature as a clinical picture in PSEN2 mutations. Thus, it may be reasonable to include PSEN2 in genetic panels when suspecting FTDL. PSEN2 mutations may cause striking WMH, arguably related with myelin disruption induced by amyloid accumulation.

(1) Background: Alzheimer’s Disease (AD) accounts for 70% of dementia cases and with no effective pharmacological treatments, new rehabilitation methods are needed. Motor activities and transcranial direct current stimulation (tDCS) have shown promise in stabilizing and enhancing cognitive functions. Objective: We want to investigate the effects of combined motor or cognitive activity with tDCS on cognitive functions in AD patients. (2) Methods: Patients with mild or moderate AD were randomized into four groups: motor activity or cognitive activity associated with anodic or sham tDCS (MotA, MotS, CogA, CogS). They received two weeks of treatment (45 minutes, 5 days/week), with the first 15 minutes using 2mA tDCS on the dorsolateral prefrontal cortex. Cognitive assessments were conducted pre-treatment (T0), post-treatment (T1), and one week after (T2). (3) Results: Twenty patients were included. Mann-Whitney test showed significant improvements in anodic groups (MotA+CogA) in the global cognitive status (p=.042), in selective attention (p=.012), and sustained attention (p=.012) at T1, but not at T2. In addition, MotA improved in the Picture Recognition Test (p=.027) and in sustained attention (p=.047) at T2. (4) Conclusion: Combined motor or cognitive activity with anodic tDCS could slow cognitive decline in AD patients, with notable improvements in global cognitive state and attention at T1.

The study aims at evaluating the demand of forest bathing in the Northern Italy’s regions underlining the willingness to pay and the potential tourists’ habits and flows on attending alpine contexts. Through the submission of a questionnaire, the sample’s answers have been analyzed employing a stratified sampling methodology considering three different macro areas (Northwest regions, Northeast regions, and Friuli Venezia Giulia region). After analyzing the sample attitudes, the research approached the estimation section by calculating the flow as the number of potential forest bathing hikes per year and the willingness to pay trough the Contingent Valuation Method. The main results indicate that Forest Bathing activity in Northern Italy have a considerable monetary value and it is generally compared with positive feelings, particularly concerning well-being, and fascination factors.

The once near-extinct Russell’s viper has recently come back to the area beyond its historical range. A couple of decades ago, its distribution was confined to 11 districts of Bangladesh. Hence, the study aims to update the distributional map of Russell’s Viper (Daboia russelii) across the country and find out the surges' causal factors. Both primary and secondary data were utilized in this study. It revealed that the distributional range of this snake was expanded from 22 to 33 districts in 2024. The respondents noted that climatic stressors like high humidity accompanied by hot weather, increased salinity, and increased frequency of flooding facilitated the spreading of the viper across the country. The cropping pattern and crop diversification were another major contributing factor. The shifting of the single-cropped area to a multi-cropped area in the Barind tract increased its main prey rats. Contrarily, the killing of natural predators such as foxes, monitor lizards and mongoose led to the rise in the snake population. The destruction of vegetation coverage in the upper part of the Padma Basin facilitated the movement of Russell's vipers downstream.

The Ro60 autoantigen is an RNA-binding protein, and a core component of nucleocytoplasmic ribonucleoprotein (RNP) complexes. Ro60 is essential in RNA metabolism, cell stress response pathways, and cellular homeostasis. It stabilises and mediates quality control and cellular dis-tribution of YRNAs, retroelement transcripts, and misfolded RNAs. Ro60 transcriptional dysregulation or loss of function can result in the generation and release of RNA fragments from YRNAs and other small RNAs. Small RNA fragments can instigate an inflammatory cascade through endosomal TLRs and cytoplasmic RNA sensors, which typically sense patho-gen-associated molecular patterns (PAMPs) and mount the first line of defence against invading pathogens. However, recognition of host-originating RNA moieties from Ro60 RNP complexes can activate inflammatory response pathways and compromise self-tolerance. Autoreactive B cells may produce antibodies targeting extracellular Ro60 RNP complexes. Ro60 autoantibodies serve as diagnostic markers for various autoimmune diseases including Sjögren's disease (SjD) and systemic lupus erythematosus (SLE), and they may also act as predictive markers for an-ti-drug antibody response among rheumatic patients. Understanding Ro60’s structure, function, and role in self-tolerance can enhance our understanding of the underlying molecular mecha-nisms of autoimmune conditions.

A difficult open problem that has never been fully resolved in the literature to date is the behaviour of the (TDCDP) third approximation. As a giant step towards modern control theory, this cutting-edge paper will advance control theory and other relevant inter-disciplinary subjects. Because control theory is important in industry and engineering, this study will be especially beneficial to anyone working in these disciplines who wish to understand more about recent advances in control theory settings. In contrast, the wealth of applications of Fokker Planck Kolmogorov (FPK) equations numerous disciplines As a result, the study instantly gains more taste and credibility. At the end of the paper, there are several challenging open problems, some concluding remarks, and recommendations for further investigation.

Our starting point is the covariant coordinate transformation equation of a relativistic positioning system in Minkowski space-time, which maps the receiver’s emission coordinates (proper times broadcast by the emitters) to its coordinates in some inertial reference frame. Bancroft’s analytical (closed-form) solution to the basic pseudorange navigation equations with four emitters is recovered and the subjacent elements are geometrically interpreted. The case of four static beacons is analized as a clarifying situation.

Educational institutions must identify students who are academically struggling to provide them with necessary support to improve their performance. In this context, recommendation systems powered by deep learning techniques are vital for detecting and categorizing such students. These systems help students plan their future by uncovering patterns in their historical academic data. This study introduces a new deep learning model designed to classify academically underperforming students in educational settings. The model incorporates a Gated Recurrent Neural Network (GRU) and includes specific neural network features like a dense layer, max-pooling layer, and the ADAM optimization algorithm. The model's training and evaluation were conducted using a dataset comprising 15,165 student assessment records from various academic institutions. The performance of the developed GRU model was benchmarked against other educational recommendation systems, including Recurrent Neural Network models, AdaBoost, and the Artificial Immune Recognition System v2. The proposed GRU model demonstrated remarkable accuracy, achieving an overall rate of 99.70%.

Since late December 2021, the Hunga Tonga-Hunga Ha'apai underwater volcano has been erupting in a series of large explosions. On Friday, January 15th, 2022, a particularly significant explosion sent a massive ash cloud high into the atmosphere. This study depicts the modeling of the volcanic ash dispersion from the event while incorporating meteorological data assimilation within the inline Weather Research and Forecasting model coupled with chemistry (WRF-Chem). Two forecast scenarios: one with only meteorology and no chemistry (OMET) and one with gas, aerosol chemistry, and no assimilation (NODA) were undertaken and compared to the third forecast impacting data assimilation to distinguish the Flux Adjusting Surface Data Assimilation System (FASDAS)'s effects. Data assimilation, a process that combines real-time observations with numerical models, plays a pivotal role in enhancing the accuracy of various scientific simulations and predictions.Analysis of different scenarios reveals that the FASDAS result in lessening of planetary boundary layer height (PBLH), downward surface shortwave flux, and 2m temperature by up to 800m, 250 W.m-2 and 6°C on the land portion, respectively, while the opposite is observed nearby the eruption site. Model validation against the observations shows that the inclusion of FASDAS nudging in WRF-Chem significantly enhances the model performance in retrieving meteorological variables. The simulations also revealed significant biases in the concentration of volcanic ash around the ash cloud. Additionally, data analysis from the Copernicus TROPOspheric Monitoring Instrument Sentinel-5 Precursor (TROPOMI-S5P) indicates that total SO2 emissions traveled west. This work demonstrates the significant contribution of data assimilation on the results of operational air quality predictions during violent volcanic eruption events.

Smoker’s paradox usually refers to the common observation of a favourable outcome of smoker patients in acute myocardial infarction. The interpretation of this phenomenon is still controversial and not fully explained. We aimed at assessing whether smoking could be associated with mortality in a large cohort of prospectively enrolled patients with ST segment elevation myocardial infarction (STEMI) referred to primary percutaneous coronary intervention (pPCI). From April 2006 to December 2018 a population of 2456 STEMI patients treated with primary PCI were prospectively enrolled in the MATRIX registry. Ischemic time, clinical, demographics, angiographic data and 1-year follow-up were collected. Among 2546 patients admitted with STEMI 1007 (41%) were current smokers. Smokers were 10 years younger and had lower crude in-hospital and 1-year mortality (1.5% vs 6%, p&lt;0.0001 and 5% vs 11%, p&lt;0.0001), shorter ischemic time (203 [147-299] vs 220 [154-334] minutes, p=0.002) and shorter decision time (60 [30-135] vs 70 [36-170] minutes, p=0.0063). After propensity-matching, age, cardiogenic shock and low TIMI score were associated with in-hospital mortality, while smoking habit was still associated with reduced mortality. Smoking was also associated with reduced death rate at 1-year follow-up (HR 0.54, 95% CI [0.37 - 0.78]; p&lt;0.001). Our data show a protective link between smoking status and mortality in patients with STEMI, the so called “smoker’s paradox”. This could be explained not only by the shorter ischemic time and younger age of the smoking population but also by a specific pathogenetic effect of smoking underlying the onset of STEMI and response to therapies.

Any malocclusion can be associated with various face development patterns, including hyper, neutral and hypodivergent growth patterns. We measured face height ratios, angle formed by Y axis to SN and growth patterns in various malocclusions in a group of patients from Timis county. The pretreatment digital cephalograms of 350 participants were split into three groups based on Angle's classification of dentoalveolar malocclusion. Every cephalogram was digitally traced and analyzed using a composite cephalometric method analysis utilizing the WebCeph imaging cephalometric program, which included two linear and one angular. In general, patients from Timis county have a hypodivergent development pattern. Hypodivergent development pattern predominated in group I, II, and III. Group I hyperdivergent 5.14%, normodivergent 16.01%, hypodivergent 78.85%. Group II hyperdivergent 2.78%, normodivergent 14.44%, hypodivergent 82.78%. Group III hyperdivergent 10.53%, normodivergent 10.53%, hypodivergent 78.94%. In all three groups, the value of the angle formed by Y axis to SN is within normal limits group I 65.4 ±4.34°, group II 63.87± 3.86° and group III 64.66 ±5.28°. A strong negative correlation was found between angle: Y axis to SN and facial height ratio (r= -0,766; p &lt;0.001). In all kinds of malocclusion, patients from Timis county show primarily a hypodivergent development pattern.

Background: Parkinson's disease (PD) is a global disease. However, there is a lack of research specifically focused on the AfrAbia population. Climate change, driven mainly by global warming, is linked to detrimental health impacts, including an increased frequency and intensity of heat waves. Neurological diseases, including neurodegenerative syndromes like Alzheimer's disease, Parkinson's disease, and motor neuron illnesses, have been increasingly seen and recorded in scientific literature. Although there is much literature demonstrating the growth in neurodegenerative disorders, the relationship between environmental variables such as global warming, air pollution, heavy metals, and pesticides and the higher occurrence of these illnesses is still unknown. Objective: The current article primarily aims to examine the relationship between climatic changes, air pollution, pesticides, heavy metals, and the occurrence of PD. Initially, we evaluate the influence of exposure to these variables on the cause or origin of Parkinson's disease. In addition, we will investigate how these variables disrupt processes such as excitotoxicity, oxidative stress, and neuroinflammation, all of which are strongly linked to Parkinson's disease (PD). Conclusions: This research presents a plausible rationale for the adverse effects of environmental influences on the brain, which are pivotal in the progression or onset of Parkinson's disease from an AfrAbian standpoint.

The early detection of cognitive decline and timely non-pharmacological management or drug therapy are extremely important in providing care for Parkinson’s disease with dementia (PDD). In this study, we first conducted a discovery study to identify six plasma microRNAs that may allow for the differentiation of PD with or without mild cognitive impairment via NGS. A total of 120 participants were further recruited in a validation cohort and divided into four subgroups, namely, normal controls (HC), PD with no dementia (PDND), PD with mild cognitive impairment (PD-MCI) and PDD. Among the six candidates, miR-203a-3p was successfully detected in the plasma of the validation cohort using droplet digital PCR (ddPCR). Our results show that the ratio of miR-203a-3p/miR-16-5p observed in PDD was significantly increased compared to in PD-MCI (p < 0.001) and PDND (p = 0.041). Moreover, the ratio of miR-203a-3p/miR-16-5p showed a significant correlation with MoCA scores (r = -0.237, p = 0.024) in patients with PD (PwP). The ROC curve of the logistic regression model, consisting of the variables of age, the ratio of miR-203a-3p/miR-16-5p and the UPDRS III score, also demonstrated an average AUC of 0.883 via 5-fold cross-validation. In conclusion, the ratio of miR-203a-3p/miR-16-5p may serve as a potential biomarker for distinguishing cognitive dysfunction from PwP.

: Crohn’s disease (CD) is a multifactorial chronic disorder that involves a combination of factors as genetic, immune response and gut microbiota. Actually, the therapy comprises salicylates, immunosuppressive agents, corticosteroids, biologic drugs. International guidelines don’t recommend the use of antibiotics except for septic complications of CD patients. The increased evidence of the implication of gut bacteria in this chronic disease support the rationale for using antibiotics as primary treatment of active CD. In the last decades several pathogens have been reported to be involved in the development of CD, but only Escherichia coli (E.coli) species and Mycobacterium avium paratubercolosis (MAP), aroused the interest due to their strong association with CD pathogenesis. Several meta-analyses have been published concerning antibiotic treatment in CD patients but randomized trials of antibiotic treatments against E.coli and MAP did not show prolonged benefits, and only generated conflicting results so much so that several questions are still unresolved regarding trial design, antibiotic dosing, the formulation used, the treatment course and the outcome measures. In this article we attempted to provide an overview and update of the trials on antibiotic treatment in active CD patients taking into account the role of pathogens, the mechanism by which the different antibiotics act on harmful pathogens, and antibiotic resistance. Finally, we also tried to draw new lines for future studies to use antibiotics to treat active CD patients

Damaged connective tissues between the bone and tendons or ligaments are common among adults regardless of activity level. Achilles tendinosis is one of the most common tissue defects and enthesopathies. The patient in this study is a 54-year-old female with chronic Achilles tendinosis from chronic enthesopathy at the Achilles tendon insertion with a retrocalcaneal exostosis for three years who has failed standard-of-care practices for over two years. The patient received extracorporeal pulsed-activated therapy (EPAT) before applying 2ml of CryoText, a Wharton’s jelly tissue allograft. The patient then received class IV laser therapy treatments twice weekly for three weeks. The patient started with a 10/10 VAS at the initial visit. At five weeks post-application, the patient’s score had improved by 80% at 2/10 VAS. By week 13, the patient rated her pain as 0/10 VAS. The improvement in patient-reported pain and functionality reported in this study after the application of Wharton’s Jelly, EPAT, and class IV laser therapy warrants future research studying the safety and efficacy of these patient care modalities together.

Homelessness continues to be a pervasive public health problem throughout Canada. Hospital Emergency Departments (EDs) and inpatient wards have become a source of temporary care and shelter for homeless patients. Upon leaving the hospital, homeless patients are not more equipped than before to find permanent housing. The Bridge Healing Program in Edmonton, Alberta has emerged as a novel approach to addressing homelessness by providing transitional housing for those relying on repeated visits to the ED. This paper describes the three essential components to the Bridge Healing model: partnership between the ED and a Housing First community organization; facility design based on The Eden Alternative™ principles, and; grassroots community funding. This paper in conjunction with the current pilot project of the Bridge Healing facilities serves as a proof of concept for the model and can inform transitional housing approaches in other communities.

We are losing love. By studying porn movies to understand love, I discovered that love originally comes from the body, from positive emotions and vibrations of the wonderful body, from the heart and all other parts of the body, such as sexual organs. António Damásio made Descartes’ error by postulating that feelings increase their power from homeostasis (mechanisms of life regu-lation from bacteria to humans). He made this mistake unconsciously because many people un-consciously have a very bad opinion of sexual organs. We consider them ugly because they come from the prehistoric period. I have combined António and Hanna Damásio’s work (body emotions, thinking and language). I discovered that porn actors do not talk during sex, and this is striking. Porn actors mirror what happens in society. This means that people come from prehistory, do not talk during sex, and still unconsciously behave like primitive animals during sexual intercourse; we do not respect the body sufficiently during sex. Therefore, love, which comes from the body, is smothered and buried. We must very delicately talk to the wonderful, delicious and respectful body to wake up love feelings, body emotions and vibrations during sex. We must invent talking movies with porn films. Language of positive emotions associated with the language of wonderful and delicious body will warm love feelings and will give envy to love through sexual intercourse because António Damásio discovered that emotions are social.

In this article we have constructed a basic methodology from which important perspectives for both the Collatz conjecture and Beal's conjecture can be derived. We falsified the conjecture we previously developed on Beal's conjecture and made the falsified conjecture usable for Collatz conjecture. In this regard, we have clearly expressed the numbers that can reach 1 in the Collatz conjecture. Then, using this, we created a limit for the numbers that should be considered for the Collatz conjecture. Thanks to the analysis of this limit, we have clearly expressed the recursive Collatz function in an equation. Using this structure, we wrote a function that indicates how many times the Collatz function repeats certain numbers to reach 1.

Elevated levels of homocysteine (Hcy) and related metabolites are associated with Alzheimer’s disease (AD). Severe hyperhomocysteinemia causes neurological deficits and worsens behavioral and biochemical traits associated with AD. Although Hcy is precluded from entering the Genetic Code by proofreading mechanisms of aminoacyl-tRNA synthetases, and thus is a non-protein amino acid, it can be attached to proteins via an N-homocysteinylation reaction mediated by Hcy-thiolactone. Because N-homocysteinylation is detrimental to protein’s function and biological integrity, Hcy-thiolactone detoxifying enzymes – PON1, BLMH, BPHL – have evolved. This review provides an account of the biological function of these enzymes and of consequences of their impairments leading to phenotypes characteristic of AD.

Heat waves represents a major concern for the tourism industry in the Mediterranean area. Therefore, it is necessary to deepen the study of the influence of high temperatures and their effects on tourist behavior. This research aims to develop a structural model that allows measuring how heat waves affect the behavior of external tourist demand in coastal destinations. The results are useful for the design by tourist destinations of adaptation measures to climate change. The proposed hypotheses have been contrasted using non-linear structural equations (SEM), estimated with data from the National Institute of Statistics on external demand in Spain. The results confirm lower tourist flows with the increase in high temperatures to the coasts of the Spanish Mediterranean area from traditional source markets, such as the United Kingdom. Furthermore, the tourist flow to the Balearic Islands decreases with high temperatures.

This study investigates how students' well-being relates to sustainable development and education for sustainability at Prince Mohammad Bin Fahd University, Saudi Arabia. The authors endeavor to answer the question "How Does Students' Well-Being Relate to Sustainable Development Via Education for Sustainable Development?" and four sub-questions. Primary data were collected by semi-structured interviews exploring the viewpoints of twenty female and male students (n=26) aged between 18 and 26. The content analysis results have identified additional well-being and education for sustainability factors that influence sustainable education and, therefore, sustainable development. These antecedents include workload, transparency, grading criteria, fairness, belonging, work-life balance, mental health support, missing emotional intelligence factors, factors related to Education for Sustainable Development, such as instructors' role models, institutional commitment, leadership, and collaboration with government. In addition, the study developed a theoretical model for the relationship between antecedents for Education for Sustainable Development, Education for Sustainable Development, and Sustainable Development in the Saudi context. Finally, the study answers four research questions: What factors contribute to education for sustainable development? What are the antecedents of education for sustainable development? How do university educators contribute to sustainable education? How do the antecedents of education for sustainable development, education for sustainable development, and sustainable development relate?

Athlete’s heart is characterised by structural, functional, and electrical remodelling. During an exercise session, the heart increases the use of oxygen, which is associated with decreased vascular resistance in the lungs’ circulation. Left ventricular hypertrophy is an echocardiographic modification especially met in endurance athlete’s heart. Moreover, left atrial dilatation represents another important characteristic of endurance athletes. Electrical modulation in the athletic heart induces neurological modifications leading to sinus arrhythmia, bradycardia, early repolarisation, and first-grade atrioventricular (AV) blocks. Athletes' nutritional status involves the assimilation of macronutrients such as proteins, carbohydrates, and fats. Depending on the duration of physical exercise, ATP can be obtained in aerobic or anaerobic conditions. This systematic review aims to find correlations between different evaluative methods of cardiac adaptation and present the metabolism in performance athletes.

We solve the problem of Apollonius by applying the Lorentz transformation within the frame- work of special relativity to go to a frame of simultaneity, where the solutions are the circum- center. We transform back to get the solutions in a general frame. We show that the solutions in a general frame are the foci of the ellipse going through the centers of the given 3 circles.

Pig farms management is involved in multiple factors such as environmental conditions, animal behavior, weight gaining and others. In all those scenarios, it is fundamental to detect each individual and its development as it grows to reach the shipment phase. Therefore, the objective of this study was to apply an automatic individual pig detection algorithm using Deep Learning Techniques, in frames taken from videos recorded during the weaning phase in real production conditions of small and medium producers in tropical conditions in Colombia. The weaning phase was selected because individual detection in each cage is more difficult due to environmental adaptations that piglets undergo after nursing. Piglets tend to cluster together during this phase, making image processing more challenging compared to the fattening phase, where animals are more isolated. The You Only Look Once (YOLOv7) algorithm and VGG Image Annotator were used to detect individuals in two pens separated by gender. All animal postures, lighting conditions were considered. The Precision, Recall and mAP metrics were used to assess the model performance with different confidence values. A precision of 98.3% in a threshold of 0.9 was reached, Recall of 98.5% in a threshold of 0.85. Data augmentation techniques were important to increase the dataset and to have a more realistic model for individuals’ detection. The method used allowed us to identify all the complete pigs’ bodies under different posture and lighting situations.

Deterministic simulations using the SWAN model were conducted along a stretch of the Tietê-Paraná waterway in the Ilha Solteira dam reservoir, São Paulo, Brazil, to assess the water waves generated by winds. Simultaneously employs a probabilistic metamodeling approach (PCE) and Sobol indices, to quantify uncertainty of the five involved physical parameters (wind velocity and direction, bottom friction (JONSWAP), whitecapping and depth-induced breaking index). In the deterministic part, Janssen’s formulation yielded the most successful and accurate estimations of wave heights. Probabilistic analysis underscored the importance of wind data and the whitecapping parameter in model calibration, with a significant influence of wind speed indicated by Sobol indices. The results not only refined the model calibration process, but also allowed the creation of contour maps for wave height and period that offer practical pre-project applications. This work advances understanding of wind wave hydrodynamics deterministically and probabilistically, with good concordance and performance indices compared to field data, despite being scarce.

Pharmacists must acquire the necessary knowledge to provide better drug therapy to patients. In other words, educational programs need to facilitate behavioral changes among pharmacists. Therefore, this study aimed to evaluate how the behavior of pharmacists changed after attending a palliative care educational program. We conducted a web-based questionnaire survey examining the behavior of pharmacists regarding palliative care before participating in the program, two months after participating in the program, and eight months after participating in the program, to determine the behavior and changes over time. For all questions, scores were higher at two and eight months after attending the program than before attending the program (P &lt;0.05). In addition, no significant difference was observed between two and eight months after attending the program for all questions (P =0.504-1.000). The knowledge gained from the educational program was used to repeatedly intervene with patients with cancer, to address the various symptoms they experienced and maintain their behavior. The proven effectiveness of this program serves as a stepping stone for a nationwide rollout across Japan’s 47 prefectures.

The clinical features of increasing muscle weakening are shared by a diverse set of illnesses known as muscular dystrophies. In early childhood, males with Duchenne muscular dystrophy (DMD) exhibit proximal muscle weakening and calf enlargement, making it the most frequent X-linked disease of muscular dystrophy in children. Development of motor skills is typically delayed, and wheelchair confinement eventually leads to early death from heart or lung problems. In terms of function, ambulation, quality of life, and life expectancy, treatment approaches like corticosteroid therapy and intermittent positive pressure breathing have improved. This is a case report of a 6-year-old kid who had early ambulatory stage Duchenne Muscular Dystrophy and complained to the neuro-physiotherapy department about frequent falls, walking difficulties, and dyspnea when walking. Other grievances included being unable to get off the ground and having trouble ascending stairs. He had physiotherapy and dynamic neuromuscular stabilization for his complaints. The main goals of treatment were educating the family, respiratory training, preventing ankle plantar flexors, maintaining strength, balance and gait training.

Polymer electrolyte was used as a medium for testing the performance of microband electrodes under conditions of linear diffusion. Cyclic voltammetry and chronoamperometry experiments were performed in such viscous medium, where diffusion rates are much slower than in fluid solutions. Confirmation of the existence of such conditions from the log i vs. log v or log i vs. log t relationships in the current equation always yielded values lower than the expected value of 0.5. This could indicate impure linear diffusion profile, i. e. some contribution from radial diffusion (edge effect). However, performing these tests in monomeric solvents of similar viscosities, such as glycerol or propylene glycol, gave the desired value of 0.5. These results lead to the conclusion that current equations which are based on Fick’s laws may not be applicable for polymer electrolytes, where various obstruction to diffusion make it a more complicated process than in monomeric solvents.

Cholinesterase (ChE) and secretase (BACE) inhibitors, and fibril- and β-amyloid-suppressing medicines are used to treat Alzheimer's disease (AD) symptomatically. The prevalence and complex nature of AD have increased the urgent need for multi-targeted directed ligands (MTDLs). This is because MTDLs can prevent potential drug-drug interactions during poly-therapy and have a better therapeutic profile than single targeted agents. Using piperazine linker or spacer and two primary scaffolds, benzofuran and 8-hydroxyquinoline, a unique class of multi-targeted medicines was recently reported by our group. These compounds showed re-markable effectiveness in inhibiting Aβ1-42 aggregation and acting as iron chelators.The results prompted us to synthesize an additional series of compounds as multimodal anti-AD agents and investigate its inhibitor activities to ChE (AChE/BChE) and BACE1 enzymes. The resulting in-hibitory effects suggested that the compounds under study might be used to improve cognitive function. The docking analysis' findings revealed that the compounds bind to AChE and BChE by forming H-bond interactions with amino acid residues at binding sites and µ-stacking inter-actions with aromatic residues, whereas the binding to BACE1 only revealed H-bond interac-tions with amino acid residues at binding sites.

Chronic Fatigue Syndrome (CFS) can be triggered by different factors and create a complex health situation. In the last decades incidence has been increasing. This situation is a clear example of how humans, viruses, and the environment are all connected. In the 90s cases related to CFS, com-plaints about a feeling of chronic fatigue, inability for everyday tasks, dull pain, cephalalgia, de-pression, anxiety, poor concentration. Clinical tests for EBV, HHV, CMV, IgG, IgM, T4 and T8 subsets were tested, along with hormones and hemogram tests. Most of the cases were women. The timeline of the medical history showed also myomas, breast lumps, premenstrual syndrome previously to CFS development. The nature of these conditions promoted the idea of a possible common link among them and CFS. Some cases also suffered from allergies, food intolerances, candidiasis, intestinal impairment, thyroid implications, endometriosis. As an initial working hypothesis, The Liver Link (TLL) was proposed in order to understand those different conditions affecting body, mind and emotional wellbeing. Considering liver implication can make a differ-ence in treatment and recovery. Low grade inflammatory conditions are related to Th2 predom-inance and liver functions. Functional disharmonies are very important because they usually still do not appear in any conventional tests. In 2002, TLL was presented as a framework to explain the concomitance of CFS and other conditions and the relationship with some viruses such as EBV, HHV, CMV, as a lecture in a congress at the University of Westminster (London). When SARS-CoV-2 outbroke, TLL helped to warn about the post-covid syndrome more likely to occur in specific individuals.

Caused by age or trauma, collapsed connective tissue can cause nerve entrapment and damage within the tarsal tunnel. Tarsal tunnel syndrome is relatively underdiagnosed. This study presents an intervention targeting damaged tissues surrounding the nerves and replacing the structural cushioning with a Wharton’s jelly tissue allograft. The eight selected patients from four clinical sites had tarsal tunnel-related defects. Patient outcomes were tracked on a 90-day calendar utilizing the Numeric Pain Rating Scale (NPRS) and the Western Ontario and McMaster University Arthritis Index (WOMAC). All patients had failed standard care practices for at least six weeks. Each patient received a Wharton’s jelly tissue allograft to sites around the affected tarsal tunnel. No patients experienced adverse reactions. Percent change calculated from the initial application to the 90-day follow-up showed an improvement of 59.43% in NPRS and a 37.58% improvement in WOMAC. This study provides evidence that WJ allograft applications are safe, minimally invasive, and efficacious for patients who have failed standard care treatments for tissue defects associated with Tarsal Tunnel syndrome. Limitations include the small cohort size and nonblinded nature. The results of this study warrant further research to confirm the efficacy, optimal dose, protocol, and durability of Wharton's jelly.

In our investigation of the time evolution of energy states Einstein’s interpretation from more than a century ago is found to have greater internal consistency than that of non-relativistic quantum mechanics. We choose to align more closely with his methods by abandoning the non-relativistic Hamiltonian method, which has been the standard for nearly a century, in favor of a relativistically correct Lagrangian method. Integral equations of motion for the absorption and emission of radiation are derived that underlie and anticipate the differentially motivated Schrödinger equation. This new interpretation applies to a large volume of experimental evidence of both classical and quantum mechanical origin. Among the examples discussed in support are Planck’s law describing black body radiation, matrix mechanics, the function of the simplest quantum mechanical system an electron cyclotron, chaos theory, and evolutionary biology.

Considering bitemark evidence, forensic dentists must give testimony that could have catastrophic consequences. A bitemark is often the only physical evidence on a body, and odontologists' testimony should be powerful and simple to understand. Given that perpetrators may be executed or imprisoned for life, a defective bitemark analysis is comparable to dentists' most crucial clinical decisions regarding diagnosis. Bias affects human bitemark analysis, and forensic dentists must examine its invisible impacts to avoid making mistakes. The aim of this study was to explore the potential of different types of bias in bitemark analysis and methods during analysis by conducting a scoping review. The majority of the 14 articles that were taken into consideration were published in 2019. USA, UK, Australia, New Zealand, and the Netherlands published the most articles. 36% of the publications addressed contextual bias, while 57% acknowledged cognitive bias. Preventive measures have been recommended to address bias in bitemark analysis. These consist of limiting the availability of unrelated data during the research, employing several comparison samples for a more impartial assessment, and repeating the analysis while being blind to past findings. These preventative measures reduce cognitive and contextual bias and improve bitemark analysis in forensic investigations.

Background: During the COVID-19 pandemic, hygiene behaviors such as keeping distance, avoid-ing masses, wearing face masks and adhering to hand hygiene recommendations became impera-tive. The current study aims to determine factors interrelating with hygiene behaviors. Methods: 4,049 individuals (1,305 male, 2,709 female, aged 18-80 years) were recruited from rehabilitation clinics or freely on the internet and surveyed via online questionnaire between May 2020 and August 2021. Socio-demographics, hygiene behaviors, emotions (fear), life-satisfaction, risk factors and disability as well as communication were assessed. Results: Prevalence for hygiene behaviors was: keeping the distance 84.9%, avoiding mass gatherings 84.6%, wearing face masks 96.5% and hand hygiene 80.7%. Hygiene behaviors were significantly related to fear with linear and quad-ratic associations. Conclusion: Individuals with disabilities, risk factors and psychological symp-toms are more compliant. Especially hand hygiene should be targeted to achieve higher compli-ance rates. A medium level of fear is more functional than too elevated fear. Behavioral interven-tions and targeted communication aiming at improving different behaviors in orchestration can help individuals to remain healthy and maintain a high life-satisfaction. Thereby, communication in the healthcare setting is imperative and all involved individuals should become more aware of this to ensure high hygiene standards and patient safety.

I demonstrate that Bell's theorem is based on circular reasoning and thus a fundamentally flawed argument. It unjustifiably assumes the additivity of expectation values for dispersion-free states of contextual hidden variable theories for non-commuting observables involved in Bell-test experiments, which is tautologous to assuming the bounds of ±2 on the Bell-CHSH sum of expectation values. Its premises thus assume in a different guise the bounds of ±2 it sets out to prove. Once this oversight is ameliorated from Bell's argument by identifying the impediment that leads to it and local realism is implemented correctly, the bounds on the Bell-CHSH sum of expectation values work out to be ±2√2 instead of ±2, thereby mitigating the conclusion of Bell's theorem. Consequently, what is ruled out by any of the Bell-test experiments is not local realism but the linear additivity of expectation values, which does not hold for non-commuting observables in any hidden variable theories to begin with. I also identify similar oversight in the GHZ variant of Bell's theorem, invalidating its claim of having found an inconsistency in the premisses of the argument by EPR for completing quantum mechanics. Conceptually, the oversight in both Bell's theorem and its GHZ variant traces back to the oversight in von~Neumann's theorem against hidden variable theories identified by Grete Hermann in the 1930s.

In the extended malfatti problem, the numbers of circles in the triangle are triangle numbers, because the tangency properties among the internal circles and 3 sides of the triangle have special type of structure. That is, the corner circle tangent to two sides of the triangle and two boundary circles, the boundary circles tangent to one side of the triangle and 4 other circles, and the inner circles always tangent to 6 other circles. The circles we find in extended general Malfatti’s problem has the property that the smallest radius and the largest radius for the circle has big difference. In this paper, we proposed algorithms to solve the problem that the tangency properties among circles and sides of triangle is not fixed, so that the number of circles in the triangle is not necessary a triangle numbers. The purpose of this change is try to find the radii of the circles in the triangle is within a small range.

Crohn’s disease (CD) is a chronic inflammatory disease associated with a significant burden in terms of quality of life and health care costs and is frequently associated with several complications, including the development of intestinal strictures. Stricturing CD requires a careful multidisciplinary approach involving medical therapy and surgery, still posing a continuous management challenge; in this context, endoscopic treatment represents a valuable, in-between opportunity as a minimally invasive strategy, endorsed by extensive yet heterogeneous evidence and evolving research and techniques. This review summarizes current knowledge on the role of therapeutic endoscopy in stricturing CD, focusing on evidence gaps, recent updates, and novel techniques intended for optimizing efficacy, safety, and tailoring of this approach in the view of precision endoscopy.

Malignant lymphoma is an unusual form of gallbladder neoplasm. Almost all of these tumors are diffuse large B-cell lymphomas or mucosa-associated lymphoid tissue-type lymphomas. Herein, we report a rare case of a gallbladder Burkitt’s lymphoma (BL) in a child living with HIV. As far as we are concerned, this is the first report in the pediatric population and in an individual living with HIV. The patient attended the Federal Hospital of Lagoa, Rio de Janeiro, Brazil, underwent cholecystectomy and the postoperative pathological analysis of the gallbladder revealed a diagnosis of BL. Also, HIV serology was performed and returned positive. She was transferred to the Martagão Gesteira Institute of Pediatrics and Childcare for oncological treatment, dying from sepsis and disease progression about 18 months later. Patient did not undergo ART/cART. Previous cases of gallbladder BL were analyzed to characterize the clinicopathological features. BL can occur in the gallbladder both in the context of HIV infection and in the pediatric population. Biopsy is mandatory in cases with suggestive findings of lymphoma, and an early diagnosis can change the course of the disease. Furthermore, the case highlights the importance of an early initiation of ART/cART in people living with HIV (PLWH).

This study aims to provide an understanding of the preferences of student tourists regarding service attributes related to domestic accommodation. To clarify how lodging firms formulate policies for the student travel market, a “Relative to an Identified Distribution” (RIDIT) analysis in which responses are treated as ordinal data instead of equally spaced data is performed to examine the Likert-scale data obtained from 296 university students in Taiwan. In our RIDIT analytical results, respondents’ preferences are sorted in a descending importance. Of the examined attributes, “Cleanliness of rooms” is the attribute most prioritized by the students, followed by “Located in a safe neighborhood/feeling safe in the room,” and “Close to scenic area for meeting the trip requirement.” The attribute least prioritized by the students is “Interaction with other guests.” This analysis provides conclusions that differ from those obtained through commonly used techniques including the arithmetic average and exploratory factor analysis. The preference rankings indicate that managers should focus on the most prioritized service attributes and implement the necessary measures to enhance their service quality and maximize customer satisfaction.

The green synthesis of metallic nanoparticles is an emerging and promising field owing to its environmentally friendly nature and diverse applications. In this article, a new technology for the green synthesis of functional ultrastable biopolymer gold nanoparticles is introduced. This approach employs thiolated single-stranded DNA (ssDNA-SH) aptamers instead of conventional self-assembled monolayers, resulting in the production of highly stable aptamer-tagged gold-core-shell nanoparticles. A comprehensive discussion on the use of glucose as a simple reducing agent for the green synthesis of Au nanoparticles and the utilization of ssDNA-SH aptamers as smart and biologically functional capping agents is provided. The potential of this innovative approach for the green synthesis of nanoparticles is demonstrated through a case study involving the use of the naked eye for qualitative detection of human fungal infections caused by Candida albicans for women's health.

Yeast, crucial in beer production, holds promise as a valuable by-product resource, known as brewer's spent yeast (BSY), with potentially beneficial physiological effects. This study aimed to compare the composition and soluble polysaccharide content of Brewer's spent yeast with those of pure cultured yeast strains, namely Saccharomyces cerevisiae (SC) and S. boulardii (SB), to facilitate the utilization of BSY as an alternative source of functional polysaccharides. BSY exhibited significantly higher carbohydrate content and lower crude protein content than SC and SB cells. The residues recovered through autolysis were 53.11%, 43.83%, and 44.99% for BSY, SC, and SB, respectively. Notably, the polysaccharide content of BSY residue (641.90 μg/mg) was higher than that of SC (553.52 μg/mg) and SB (591.56 μg/mg). The yields of alkali-extracted water-soluble polysaccharides were 40%, 30%, and 35% for BSY, SC, and SB, respectively, with BSY comprising a higher proportion of water-soluble saccharides than SC and SB, including 49.3% mannan and 20.1% β-glucan. Furthermore, BSY demonstrated antioxidant activities, including superoxide dismutase (SOD), ABTS, and DPPH scavenging potential, suggesting its ability to mitigate oxidative stress. BSY also exhibited a significantly higher total phenolic compound content, indicating its potential as an effective functional food material.

The CACCC-box motif emerges as a pivotal cis-regulatory element implicated in diverse developmental processes and diseases, particularly cardiovascular diseases (CVDs). This study centers on the intricate interplay between the CACCC-box and its binding proteins such as: the Krüppel-like family (KLF) of transcription factors as primary effectors in the context of CVDs. Our analysis was through a bioinformatics approach, which reveal significant transcriptional activity among KLF subgroup 2, exhibiting the highest number of interactions focusing on the established roles: pluripotency, cancer, and cardiovascular development and diseases. Our analysis reveals KLF's interactions with GATA4, MEF2C, NKX2.5 and other ~ 90 potential genes that participate in the regulation of the hypertrophic environment (or CVD's Environment). Also, the GO analysis showed genes containing the motif CACCC were enriched for multiple CVD’s, in combination with STRING analysis these results pointed to a link between KLFs and these diseases. The analysis further identifies other potential CACCC-box binding factors, such as SP family members, WT1, VEZF1, and -SALL4, which are implicated in cardiac contraction, remodeling, and inflammation processes.

Synanthropic flora (weeds, spontaneously developed plants) are plants that accompany humans, appearing as a result of anthropopressure as well as after its cessation. The potential of synanthropic flora in shaping green areas usually brings many measurable benefits that depend on land management in cities. The study aimed to determine the preferences and attitudes of adults towards synanthropic flora in settlement units. The article presents survey results from 447 city residents. The obtained results were statistically analyzed using the k-means clustering method to identify segments of respondents with similar attitudes and preferences toward synanthropic flora. Mann-Whitney U tests were employed to determine statistical differences in the demographic variables among the analyzed clusters of respondents. Additionally, multiple regression analysis was performed to identify the opinions and attitudes towards synanthropic flora, that may influence their greater acceptance in the vicinity of residential areas. The results obtained in multiple regression allow for the statement that the respondent’s evaluation of the level of support for the introduction of more synanthropic vegetation into urban greenery (Yw) grows with the increase of acceptance of synanthropic plants occurrence in surroundings. Respondents’ opinions on the subject of the presence of synanthropic plants were studied using such variables concerning: synanthropic vegetation found in turfgrasses has a positive impact on the visual attractiveness of a site (X1), synanthropic plant communities present themselves better than others (X2), presence of synanthropic vegetation in an estate improves the quality of life in that location (X3), introduction of synanthropic flora into estate arrangements is a positive (X4), support for the use of synanthropic flora for educational purposes - as elements of playgrounds or in the form of environmental workshops (X5). Residents’ acceptance of synanthropic flora in green areas is at a relatively high level.