Background: Neurofeedback (NFB) or EEG-Biofeedback is a non-invasive therapeutic method, based on the theory of operating conditioning, and designed to change the functioning of the brain by sending feedback that provides positive or negative reinforcement. The goal is to teach the patient how to perceive specific cortical activation states and how to achieve them on purpose. NFB has been used to treat various mental disorders, including Post-traumatic Stress Disorder (PTSD). Traditional treatments for PTSD have several limitations; very few individuals are willing to relive the traumatic experience. Placing itself as an effective alternative, Neurofeedback allows the unresponsive patient to recourse to an alternative intervention to relieve their symptoms without reliving the anguish of trauma, consequently presuming a lower percentage of drop-out. Considering the importance of integrated approaches to clinical practice, NFB was integrated with Trauma-Informed Motivational Interviewing (TIMI). The TIMI approach is a new therapeutic paradigm for clinical interviews that aims to help users work through their trauma and transform it from a point of weakness to a point of strength. Integrating TIMI with NFB can help overcome the current trend of passive implementation of intervention tools, leading to greater user responsiveness and fewer residual symptoms. To improve treatment adherence, moreover, it has been suggested to incorporate Virtual Reality (VR) into the NFB system. VR, through the "sense of presence," provides a more immersive experience than 2D visualization, potentially resulting in faster cortical training. Lastly, the research protocol aims to focus on a population at high risk of PTSD that is often overlooked in research, such as workers who are victims of occupational PTSD.Methods: The study design involves in-depth analysis of a specific clinical case. Baseline measurements were taken for enrollment and at the following time points: T1 (pre-treatment), T2 (post-treatment), and T3 (follow-up). These measurements included various psychometric assessments to evaluate PTSD symptoms, treatment acceptability, safety, and adherence, as well as biological measures related to the brain's electrophysiological activity.Results and Conclusion: Our research reveals that the synergy between virtual reality-mediated Neurofeedback and trauma-motivational interviewing produces significant results. TIMINB stands out as a low-cost, effective, and completely risk-free procedure. This approach could represent a groundbreaking innovation in the field of Cyberpsychology and psychological therapies.

Accurate estimation of the state of health (SOH) of batteries for automotive applications, particularly in electric vehicle battery management systems (EV-BMS), is still under study and is highly relevant to ensure battery system availability. This paper proposes a comprehensive SOH estimation method that goes beyond the methods that are based on the estimation of the battery available capacity by the integral of the current, or the estimation of the increase of the internal resistance of the battery. The SOH estimator is based on a partial capacity discharge method and a linear state of charge (SOC) observer based on an equivalent electrical circuit model. This method uses readily available manufacturer data and is designed for real-time applications. The proposed method was tested and validated with three different automotive battery technologies in a Model-In-Loop (MIL) environment with OPAL-RT platform, utilizing voltage and current measurements of pulsed discharge current profiles at temperature-controlled conditions and an electric vehicle’s driving profile.

Many children on the autism spectrum engage in challenging behaviors, like aggression, due to difficulties communicating and regulating their stress. Identifying effective intervention strategies is often subjective and time-consuming. Utilizing unobservable internal physiological data to predict strategy effectiveness may help simplify this process for teachers and parents. This study examined whether heart rate data can predict strategy effectiveness. Teachers and coders from the research team recorded behavioral and heart rate data over three months for each participating student on the autism spectrum using the KeepCalm app, a platform that provides in-the-moment strategy suggestions based on heart rate and past behavioral data, across 226 instances of strategy interventions. A binary logistic regression was performed to assess whether heart rate reduction, time to return to heart rate baseline, and documented skills and challenging behaviors predicted strategy effectiveness. Results suggested that heart rate reduction may be a significant predictor, and supported the existing practice of using behavioral patterns as proxies for strategy effectiveness. Additional analyses indicate proactive strategies are more effective and are associated with greater reduction in heart rate, relative to reactive strategies. Further exploration of how internal physiological data can complement observable behaviors in assessing intervention strategy effectiveness is warranted given the novelty of our findings.

This study aimed to determine the impact of garden-based learning on youth with intellectual disabilities (YwID). As it is not easy for YwID to collect information, experience situations, and make decisions independently, this study needed to devise an approach that could help the participants properly utilize the garden’s resources. Accordingly, it developed and operated a customized learning program for YwID and analyzed its impact. The findings show that gar-den-based learning generates specific changes in the knowledge, skills, and attitudes of YwID, such as emotional healing to recover psychological stability, social healing through social rela-tionships, physical healing through new activities, and independent healing through individu-alized plans. Participants experienced sympathizing with others and maintaining positive rela-tionships and obtaining knowledge, skills, and attitudes for behaving responsibly through gar-dening. Garden-based learning utilizing flowers and plants enhanced physical and mental health, improved functioning, helped YwID adapt to the environment, and integrated YwID into society. This is a form of vocational training by which people with disabilities could become employable by learning gardening skills, promoting their participation in society, and upgrading their quality of life. Hence, garden-based learning may transform people’s perception of disability and help people with disabilities respond to challenges.

Aims: The aim of our work was to demonstrate the possibility, in carefully selected cases, to perform operations under local anesthesia with a benefit to the patient and savings for national health care. Method: 123 patients with breast cancer underwent quadrantectomy or wide tumorectomy and sentinel lymph node removal under local anesthesia in out-patient surgery. Results: Of the 123 patients, 9 had micro-metastases and 4 had macro-metastases and only three of this had metastasis in other lymph nodes. Conclusions: Our results demonstrate that it is possible in selected cases to operate on breast cancer in out-patient surgery, with an advantage for the patient and savings for national health care.

Children account for a significant proportion of the world's population and are a particularly vulnerable subpopulation regarding environmental factors. In a scoping review of a total of 3130 articles compiled from relevant medical literature, including 107 publications, we provide an empirical overview of the literature on masks in connection with children, particularly with regard to its' expected effects on viruses during the pandemic 2020-2023 versus scientific reality and evidence, including the side effects. While masks lack ecological validity from a strictly empirical point of view (transferability of experimental results from laboratories and modelling to the real world, e.g. to situations or environments typical of everyday life) and high-quality studies are showing little evidence of their effectiveness in real-world scenarios, whereas the side effects appear to be clear. An individual risk-benefit analysis is necessary and also a consideration of the situations, in which the use of masks in children could be justified. This review including the literature found and analysed will be able to help when making decisions in this regard.

Severe acute respiratory infection (SARI) is mainly caused by viral pathogens, with a high prevalence in high-risk populations such as infants and older adults. Co-infections by different viruses are frequent and, in some cases, associated with severe disease outcomes. Purpose: The main purpose of this study was to identify respiratory viruses circulating in Barranquilla during the COVID-19 pandemic peaks and estimate the prevalence of viral co-infections in samples from individuals with different degrees of respiratory infection. Methods: Between August and October 2021, 101 samples were collected from individuals with influenza-like illness (ILI) by the District Health Laboratory of Barranquilla and four local health care institutions and analyzed at Universidad Simón Bolívar. Eighteen respiratory viruses, including SARS-CoV-2, were analyzed via qRT-PCR using nasal swabs or nasopharyngeal aspirate samples. Results: Of the 101 study individuals, 56 were male and 45 were female (55.5% and 44.5%, respectively); 25.7% of individuals were infected with at least one of the evaluated viruses. Respiratory syncytial virus (RSV) and human rhinovirus (HRV) were the two most frequently detected viruses (30.7% and 15.4% of total positives, respectively). Co-infections with two or more respiratory viruses accounted for 42% of the total positive cases. Conclusion: Our findings indicate the presence of different respiratory viruses in swab or nasopharyngeal aspirate samples from individuals with ILI, including coinfection. These results reveal the circulation of several respiratory viruses in the city of Barranquilla, confirming their importance as potential causes of SARI in Colombia and the need for their active surveillance.

Prevalence estimates of Parkinson’s disease (PD) – the fastest growing neurodegenerative disease – are underestimated due to issues surrounding diagnostic accuracy, symptomatic undiagnosed cases, suboptimal prodromal monitoring, and limited screening access. Remotely monitored wearable devices and sensors provide precise, objective, and frequent measures of motor and non-motor symptoms. Here, we used consumer-grade wearable device and sensor data from the WATCH-PD study to develop a PD screening tool aimed at eliminating gaps between patient symptoms and diagnosis. Early-stage PD (n=82) and age-matched comparison (n=50) participants completed a multidomain assessment battery during a one-year longitudinal multicenter study. Using disease- and behavior-relevant feature engineering and multivariate machine learning modeling of early-stage PD status, we developed a highly accurate (92.3%), sensitive (90.0%), and specific (100%) Random Forest classification model (AUC=0.92) that performed well across environmental contexts. These findings provide robust support for further exploring consumer-grade wearable devices and sensors for global population-wide PD screening and surveillance.

Background: Bacteria, among the earliest life forms on Earth, are integral to both human health and environmental ecosystems. They contribute to essential processes such as digestion, nutrient absorption, and immune defense, and play key roles in the biogeochemical cycles that sustain life. Objective: This paper explores the indispensable role of bacteria in human life and environmental health, emphasizing their contributions to digestion, nutrient absorption, immune protection, and ecosystem functioning. It also discusses advances in understanding the human microbiome and their implications for health and therapeutic interventions. Methods: The study reviews existing literature on the human microbiome, probiotics, and the role of bacteria in environmental nutrient cycling. It analyses experimental evidence and case studies, particularly focusing on the impact of fecal microbiota transplantation (FMT) as a therapeutic tool. Metagenomic analysis techniques are examined to highlight the diversity and functionality of gut bacteria. Results: Bacteria are found to be essential for breaking down food, providing vital nutrients, and protecting against pathogens. They play a critical role in maintaining a healthy immune system and are involved in the biogeochemical cycles necessary for ecosystem health. Metagenomic analysis reveals significant variations in bacterial populations associated with health and disease, emphasizing the importance of a balanced microbiota. FMT shows promise as an effective treatment for various diseases, including gastrointestinal, metabolic, and neurological disorders. Conclusions: Bacteria are crucial for human health and environmental stability. Maintaining a balanced microbiota is vital for overall well-being, and interventions such as probiotics and FMT can offer significant health benefits. Future research should focus on further understanding the complex interactions between bacteria and their hosts to develop targeted therapies for various health conditions.

This paper presents an on-device semi-supervised human activity detection system that can learn and predict human activity patterns in real time. The proposed semi-supervised learning (SSL) framework uses sparsely labelled user activity events acquired from Inertial Measurement Unit (IMU) sensors installed as wearable device. The objective is to learn classification of multiple classes of human activities in real-time. The proposed cluster-based learning model in this approach is trained with data from the same target user, thus preserving data privacy while providing personalized activity detection services. Two different cluster labelling strategies, namely, population-based, and distance-based, are employed to achieve the desired classification performance. A comparative study of these strategies has been presented in terms of classifiability and classification accuracies. The proposed system is shown to be computationally efficient, which is relevant in the context of limited computing resources on typical wearable devices. The trade-off between classification accuracy and computation complexity is analyzed for different algorithmic hyper-parameters and other system parameters. Extensive experimentation and simulation study have been conducted on a multi-user human activity data from the public do-main in order to validate the proposed learning paradigm.

Bioactive peptides are sequences of amino acids, cut from the parent protein with en-zymes or high pressure processing that can impart a tertiary health benefit to the con-sumer that goes beyond basic human nutrition. This study explores mesopelagic fish in-cluding Maurolicus muelleri and Benthosema glaciale as sources of peptides with an-ti-inflammatory, heart health beneficial, antioxidant and other bioactivities. Bioactive peptides were generated post-catch using different enzymatic hydrolysis processes ap-plied to mesopelagic species caught from experimental cruises targeting these fish. Maurolicus muelleri and Benthosema glaciale were the dominant species processed. Bi-oactive hydrolysates included a Maurolicus muelleri Alcalase hydrolysate and a Maurolicus muelleri autolysis. Hundreds of peptide sequences were identified using mass spectrome-try from active hydrolysates. In silico analysis was used to rank identified peptide se-quences in terms of overall bioactivity using Peptide Ranker, anti-inflammatory activity using PrepAIP, ability to impart Umami flavours with Umami-MRNN and dipeptidyl peptidase IV inhibitory potential using AntiDMPpred . Thirty peptides were selected fol-lowing in silico analysis. Several of the selected peptides had sequence homology with peptides derived from other fish proteins including Atlantic salmon (peptide QCPLHR-PWAL) and thin-lipped mullet (peptide FDAFLPM). Seven peptides predicted to have an-ti-inflammatory, anti-type 2 diabetes or Umami potential using in silico strategies were chemically synthesized and their anti-inflammatory activities confirmed using in vitro bioassays with COX-1 and COX-2 enzymes. The peptide QCPLHRPWAL inhibited COX-1 and COX-2 by 82.90% (+/-0.54) and 53.84% respectively and had a selectivity index greater than 10. This peptide warrant further research as a novel anti-inflammatory/pain relief peptide. Other bioactivities associated with DPP-IV inhibition and Umami flavours de-velopment are discussed. Identified peptides offer potential for use in functional foods or topical agents to prevent pain and inflammation associated with diseases like psoriasis, arthritis and inflammatory bowel disease, however further research in vivo is required.

Sepsis still remains one of the most difficult conditions to diagnose as it presents unspecific clinical signs and symptoms, which makes early detection crucial. Our study aimed to enhance the accuracy of sepsis diagnosis by integrating multimodal monitoring technologies with traditional diagnostic methods. The research involved 121 newborns, comprising 39 cases of late-onset sepsis, 35 cases of early-onset sepsis, and 47 control subjects. Biosignals including pulse oximetry (PO), near-infrared spectroscopy (NIRS), and skin temperature (ST) were continuously monitored and an algorithm was developed using Python for identifying early signs of sepsis. The model demonstrated the ability to detect sepsis 6 to 48 hours in advance with an accuracy rate of 87.67% ± 7.42%. Sensitivity and specificity were recorded at 76% and 90%, respectively, with NIRS and ST having the most significant impact on predictive accuracy. Despite the promising results, limitations such as sample size, data variability, and potential biases were noted. The findings highlight the critical role of non-invasive biosensing methods in conjunction with traditional biomarkers and cultures, offering a robust framework for early sepsis detection and improved neonatal care. Further studies are recommended to validate these results across diverse clinical settings.

Among earth’s microbial populations are the genes, functional capacities, generational memory and sentient cognition that enable microorganisms to adapt and thrive in the full range of ecological conditions found on planet earth. In prior sequential publications, we considered fundamental properties (e.g., use of and responses to sound, light, vibrations) and features of microorganisms that cause them to be critical co-partners of human and other holobionts as well as the potential benefits for humanity that can be gained by fully applying quantum-related and novel capacities of microbial life. In this narrative review we: 1) discuss key concepts concerning a microbially-enhanced and sustainable future, and 2) focus on electric- and magnetic- based features of microorganisms that make them pivotal for myriad benefits ranging from beyond pharma-based health and wellness to free- and/or renewable energy and restorative agriculture to improved human networking. While the benefits are many, the risks posed by hazardous electric or magnetic field exposures to both holobionts and microbial communities are significant. This review concludes that microbes and their remarkable capacities offer both humanity and the planet a much brighter future if we reverse the demonization of microbes and wanton microbiome degradation that has predominated much of the past century.

The global issues of overweight and sedentary lifestyles demand comprehensive responses from health systems, yet health education still needs to be more cohesive and less sporadic. This study focuses on primary school children as a specific target for instilling healthy habits, employing ac-tive learning strategies to address healthy diet and physical activity. Through Problem-Based Learning projects, the study engaged fourth-grade primary students in acquiring healthy habits. The study was carried out over four consecutive years at a school with two lines, allowing the employment of an opportunity sample and evaluating intervention and control groups by com-paring their corresponding scores. Control groups integrated a total of 54 students, while the in-tervention group included a total of 159 students. A pre-test and post-test questionnaire were used for data collection. Evaluation differential scores revealed statistically significant higher scores in the intervention groups: 3.62 points in control groups and 6,94 in intervention groups, particu-larly in attitudinal competences. These strategies not only facilitated the development of crucial skills such as information search, synthesis, representation, analysis, decision-making, teamwork, and intrapersonal awareness but also significantly broadened the knowledge acquired in aspects related to healthy habits. This approach proved effective in helping children comprehend the im-portance of healthy choices and encouraged integrating such habits into their daily lives.

Preventing childhood obesity and associated comorbidities is often hampered by disproportionate disparity in healthcare provision in minority ethnic populations. This study contextualised lifestyle factors influencing childhood obesity and related comorbidity from the perspectives and experiences of parents of ethnic minority children with obesity comorbidity. Families of Black, Asian and Minority Ethnicities (BAME) in the Northeast of England (n=180) were contacted, and families with a child diagnosed with obesity and comorbidity (non-alcoholic fatty liver disease, musculoskeletal problems, respiratory disorder, or polycystic ovarian disease) were interviewed (n=11). Semi-structured interviews and qualitative thematic analysis included parents’ perspective and experience on how their children were impacted by obesity and comorbidities, healthcare preventative interventions including lifestyle physical activity and nutrition, and views on tackling obesity. Parents’ perspectives and experience revealed eleven themes centred around living with a child with obesity, risks and impact of obesity diseases; access to lifestyle nutritional and physical activity, and ethnicity specific barriers. Parents revealed social disadvantage, fear of victimisation by social services, perceptions on their cultural and religious traditions when dealing with nutrition and exercise, and child’s weight racial stigmatisation. Parents reported closer bonding with their children than health authorities to protect from obesity consequences. Work pressure, time, and lack of professionals’ guidance were seen as barriers to healthy lifestyle, while support from friends and family bond in adopting healthy lifestyle behaviours were facilitators. Parents reported no awareness of health service provision of nutritional and physical activity obesity prevention programmes. Minority ethnic communities’ perspective on childhood obesity prevention does not match the healthcare system preventative offerings. Community and family-oriented obesity preventative approaches, especially lifestyle nutrition and physical activity interventions are needed beyond those administered by the primary healthcare system.

This review focuses on the emerging evidence for the association between estimated cardiorespiratory fitness (eCRF) and metabolic risk factors. Given the challenges associated with directly measuring cardiorespiratory fitness (CRF) in large populations, eCRF presents a practical alternative for predicting metabolic health risks. A literature search identified six relevant cohort studies from 2021 to 2024 that investigated the association of eCRF with hypertension, hyperglycemia, dyslipidemia, and obesity. The review findings highlight a consistent inverse relationship between higher eCRF and lower incidence of metabolic risks in line with CRF cohort studies. This review highlights the importance of low eCRF as a primordial indicator for metabolic risks and underscores the need for broader application. Future research directions should include exploring eCRF's predictive accuracy across diverse populations and health outcomes and testing its real-world applicability in healthcare and public health settings.

Capturing atmospheric CO2 and storing it in natural rock systems (i.e., alkaline earth silicate and hydroxide minerals) through carbonation reactions is a promising greenhouse gas mitigation research, and largely depends on the use of hydrated ultramafic rocks (serpentinites), which are widespread in orogenic belts around the globe. The Jurassic ophiolites in the Southern Apennines represent a natural analogue and a great opportunity for the mineralogical sequestration of CO2. Serpentinites of the Pollino ophiolite Massif have been widely studied for their mineralogical, petrographic, and chemical characteristics, providing major findings on their impact on environmental and human health issues. Serpentinites here have been divided into cataclastic and massive types based on their structures and are characterized by pseudomorphic and vein textures. The mineralogy of the studied serpentinites consists of lizardite, antigorite, clino-crysotile, Cr-chlorite, magnetite, tremolite, actinolite, pyroxene and calcite, and the most commonly occurring serpentine minerals are polymorphs of serpentine including lizardite, clino-crysotile and antigorite. Systematic petrographic and mineralogical studies of serpentinites in ophiolites, such as those outcropping in the Southern Apennines can represent a starting point for the study of natural materials, which can be used for CO2 storage and sequestration. A particular attention must be given to those carbonate phases, produced by carbonation processes to check whether the serpentinites of the Pollino Massif can be used for the induced mineral Carbon Capture Storage (CCS). If successful, this technique and the Pollino Massif serpentinites can become highly significant in safeguarding the health of our planet's climate.

Mercury contamination in the Amazon is a significant public health concern arising from both natural sources and intensive mining activities in the region. This metal is used to separate Au from sediments, forming an amalgam that facilitates the extraction of precious metals. Accordingly, this study aimed to address the following question: What is the impact of mining on mercury contamination in the animal and human populations of the Amazon? The overall objective of this study was to conduct a systematic review of the existing literature to identify gaps in geographic coverage and assess the impact of Hg contamination on human and animal populations in the Amazon region. Our hypothesis was that higher mercury concentrations in tissue samples would be found closer to the mining areas. We employed the PECO and PRISMA-ScR protocols to collect articles published between 2017 and 2023, selected based on criteria representing projected points on a map within the biogeographic boundaries of the Amazon. Mercury concentrations increase with trophic levels, reaching high values of 3.7 µg/g in the muscles of predatory fish and 34.9 µg/g in human hair. The average level of mercury in humans exceeds 6 µg/g, surpassing tolerance levels. Although mining regions show high concentrations of Hg, the highest incidence was observed among populations with fish-based diets. Research on fish is crucial for assessing the risk to human health, given that fish are the main source of protein in the region.

The traditional manual recording of vaccination records in Germany faced challenges during the COVID-19 pandemic, prompting the introduction of a Covid smartphone app with QR codes. However, this solution brought new challenges, emphasizing the need for a centrally managed European digital vaccination record for efficiency and validity. Thus, this study assesses the feasibility of using the HL7 FHIR standard in the healthcare industry for implementing a digital vaccination pass management and monitoring system. The system aims to offer convenience and improved efficiency for both patients and healthcare providers while promoting interoperability with other healthcare systems. We developed a prototype using modern technologies, such as React, Quarkus, and Keycloak, evaluating the applicability of FHIR in promoting interoperability within the healthcare industry. Results indicate potential benefits for patients and healthcare providers, offering secure access to immunization records, personalized recommendations, and streamlined management. However, challenges in integrating nuanced vaccination processes into the standardized FHIR system, necessitating custom extensions, and issues with manual data entry and identity provider integration, pose obstacles. Despite these challenges, the study suggests that implementing HL7 FHIR can enhance efficiency, data accessibility, and accuracy in the vaccination process, supporting broader digitization efforts in the German healthcare system and beyond.

In the era of digital information consumption, YouTube has emerged as a prominent platform for disseminating knowledge across various domains. One such area that has gathered significant attention is teeth whitening, with a plethora of videos offering insights into professional proce-dures, home remedies, and personal experiences. This study delves into the vast landscape of teeth whitening content on YouTube, meticulously categorizing videos into professional and amateur domains. The aim is to critically analyze the information presented, considering its accuracy, re-liability, and potential impact on public perceptions and oral health choices. A total of 100 videos in Greek (n1= 73) and in English (n2= 27) were studied. The analysis was based on views, likes, publication year, duration, presence of background music, and the presence of a description. The completion date of the search was October 7, 2023. Professional videos predominantly present whitening as a painless, conservative, and economical procedure, emphasizing safety measures. Bleaching mechanisms involving hydrogen peroxide and carbamide are explored, with various application techniques discussed, including whitening strips, splints, and in-office procedures. Contradictory findings on the efficacy of home versus in-office treatments are highlighted. In-ternal and external discoloration factors are delineated, with contraindications specified. Amateur videos, garnering greater public appeal, present personal experiences, product promotions, and homemade remedies, reflecting a concerning trend of misinformation. The analysis incorporates viewer engagement metrics, emphasizing the impact of non-professional content. As social media platforms play an increasingly influential role in shaping healthcare narratives, understanding the nuances of dental discourse on YouTube becomes crucial for both practitioners and the public. This exploration encompasses a spectrum of topics, ranging from the chemical intricacies of bleaching agents to the societal dynamics influencing viewer preferences. By unraveling the complexities of online dental information, this study seeks to contribute valuable insights to the evolving land-scape of oral health education in the digital age. Future research should adopt a multi-platform approach and explore the dynamic interaction between content creators and viewers for a more holistic comprehension of online dental information.

AbstractBackground: Maternal health service (MHS) use is a key strategy to reduce maternal mortality. However, the existing evidence is scarce to design efficient intervention strategies in Ethiopia. Thus, we aimed to explore community members and health care providers' perceptions of MHS, and barriers, and facilitators of MHS use in southern Ethiopia. Methods: A phenomenological qualitative study was conducted from November 14-30, 2022, in the northern zone of the Sidama region. Sixteen in-depth interviews, nine focus group discussions, and 15 key informant interviews were done with 112 study participants. A maximum variance sampling method was used to select study participants. Data coding and analysis were done using MAXQAD 2020 software and presented in narratives. Results: Communities have positive perceptions and good practices of skilled antenatal care (ANC) and health facility delivery (HFD), but lack awareness of postnatal care (PNC) services and schedules. Some have experienced negative interactions with health care providers, health facilities, and ambulance drivers. The main identified barriers to ANC use were lack of awareness of ANC benefits, distance from a health facility, costs associated with ANC use, long waiting time, lack of access to road, and women being busy with different household chores. Distance from health facility, costs associated with HFD use, unpredicted labour, lack of an ANC visit, lack of a birth preparedness plan, and non-dignified care were the main barriers to HFD. The major identified barriers to PNC use were home delivery, lack of awareness of PNC service and schedule, and socio-cultural beliefs. The main identified facilitators of MHS use were previous experience and fear of obstetric complications, health extension workers and women’s development teams, and pregnant women's forum.Conclusions: Rural women still encounter several challenges when using MHS, even though communities have positive perceptions and good practices of skilled MHS. Bad experiences mothers faced in health facilities, challenges associated with the costs of MHS use, poor awareness of service, and unpredictable labour continued to be basic barriers to MHS use. Intervention approaches should consider inter-sectoral collaboration to address barriers at the community and health facility levels. The programs must emphasize the transportation arrangements during unpredictable labour, the needs of poor mothers, and women who have poor awareness of MHS at the community level.

In exploring the intricacies of financial analysis, this study delves into the efficacy of traditional financial ratios versus cash flow ratios in foreseeing a company's fiscal well-being. By harnessing the PRISMA 2020 framework, an exhaustive and systematic dissection of diverse scholarly articles was embarked upon. The quest was to unearth the more reliable predictor of financial stability among these two sets of ratios. With a methodical examination of academic writings, this inquiry juxtaposed various models, scrutinizing their foresight capabilities. The revelations were telling; cash flow ratios emerged as more potent forecasters compared to their traditional counterparts. Intriguingly, models that blend both ratio types showed a marked improvement in predictive accuracy, hinting at a synergistic effect. This underscores the insight that while traditional ratios are informative, their amalgamation with cash flow ratios yields a richer, more rounded grasp of a company’s fiscal state. Conclusively, for stakeholders, especially investors, adopting this dual-ratio approach is pivotal for enlightened decision-making. This research enriches the financial analysis domain by spotlighting the salience of cash flow ratios, advocating for their integration with conventional methods for a sharper financial health appraisal.

Clinical trials often involve new substances characterized or developed for a specific pathology or class of pathologies. At other times, a clinical trial is observational; in other words, a known sub-stance has a range of effects on a given cohort of subjects. The types of trials are different and complex, and often, young clinical novice and the inexperienced researchers may struggle to evaluate how to proceed correctly. In this paper, we aim to create a mini-guide for beginners in clinical trials and provide elements for designing a clinical trial. Our intention is to highlight where to find the materials and how to adapt, even in the absence of sponsors, so that even the most inexperienced and under-resourced researcher can gain an understqanding of the complexi-ty of the process andaddress it appropriately. We do not claim to be exhaustive or cover all ele-ments, but rather, we aim to create a checklist. With this approach, starting discussioms about the experimental phases of the drug and concluding with the clinical trial, we aim to assist those facing this challenging "world."

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

Accurate estimation of body fat percentage is essential for various health and fitness applications. Traditional methods for measuring body fat, such as underwater weighing, can be costly and inconvenient. In this study, we apply machine learning techniques to predict body fat percentage using easily accessible body measurements and data. The results highlight the effectiveness of regression models in estimating body fat, with Linear Regression, Ridge Regression, and Bayesian Ridge models achieving R-squared scores of approximately 74%, 73%, and 73%, respectively. These models provide a practical and cost-effective solution for individuals and professionals seeking reliable body fat estimates.

(1) Background: Human-generated greenhouse gas (GHG) emissions are the largest contributor to climate change worldwide. Climate change negatively impacts human and planetary health threatening the existence of life on earth. The healthcare industry is responsible for approximately 8.5% of carbon emissions in the United States. Measuring baseline GHG emissions is the first step in emissions reduction. However, very few models of measurement exist for health care organizations. This project aimed to develop and implement a program to measure and track GHG emissions at a Midwestern Academic Medical Center (MAMC) and to educate staff to manage the process. (2) Methods: A Plan, Do, Study, Act (PDSA) cycle and Quality Improvement methodology was used to develop, implement, and assess a standardized GHG emission inventory process to measure Scope 1 and Scope 2 baseline emissions, and provide virtual training and education to the accountable staff. A pre- and post-survey design was used to measure the knowledge and readiness of the staff after the implementation of the GHG inventory training. (3) Results: The GHG inventory process was validated through an external verification process and the measurement of Scope 1 and Scope 2 baseline GHG emissions was completed and verified for accuracy through a data comparison review. The pre-post-training survey showed an increase in the knowledge and readiness of staff in maintaining a GHG inventory. (4) Conclusions: This work shows the feasibility of obtaining baseline GHG emissions data at large medical centers. It represents the initial phase of the overarching goal to develop site-wide and system-wide carbon reduction strategies and a climate action plan within this health system.

As digital technologies rapidly integrate into Health Professions Education (HPE), gaining a comprehensive understanding of cyberethics becomes crucial. This scoping review aimed to explore the pedagogy of cyberethics within HPE, with an emphasis on its definitions, conceptualizations, theoretical foundations, and interventions. Drawing from 37 documents spanning 2012-2022, primarily originating from the U.S. and encompassing both peer-reviewed and grey literature, the study highlighted a significant gap in the explicit definition and conceptualization of cyberethics. Additionally, the evident lack of specific theoretical frameworks in the majority of these documents could hamper the progression and replicability of research. Among the reviewed articles, only four introduced cyberethics educational interventions, indicating a substantial avenue for future research. While the study utilized comprehensive search methods, limitations such as language biases and the potential omission of pertinent documents were present. Future investigations should broaden the cyberethics discourse to encompass emerging technologies and their ethical implications within HPE. Crafting comprehensive, culturally sensitive, and inclusive guidelines is pivotal in nurturing ethical digital practices in the health care community.

Hemodialysis (HD) patients experience significant psychological stress related HD. Coping strategies are utilized to help these patients cope with this stress. Prevalence of different types of coping strategies in relation with differential levels of HD-related stress scores and by demographics were assessed. HD patients aged 18 years and above who were seeking regular treatment in a specific HD-unit of a hospital in the upper Midwest, were surveyed between March 2020 and July 2020. Descriptive statistics, correlational analyses, and regression analyses were performed. Females could be expected to have emotional coping scores 8 units greater than males, as B = 8.017 for sex in the model, p =.000. Females could be expected to have coping scores 6.4 points higher than males when adjusted for stress levels, as: B = 6.351, p =.001 for sex in the model. For each 1point increase in Stress Score, the Coping Score could be expected to: increase 6.8 points when adjusted for Sex, where B = 6.751 and p =.000. Increased prevalence of emotional pre-occupation was only observed among female patients which increased with the increase in stress. Psychological interventions in female HD patients should be strongly considered in addressing emotional pre-occupation coping.

A growing number of clinical data suggests that the use of antiplatelets and/or statins pre-stroke are associated with reduced severity and better functional outcomes for ischemic stroke. Studies have shown that the long-term use of ACEI/ARB pre-stroke is beneficial in reducing severity at onset and improving functional outcomes. We aimed to compare stroke severity and early functional outcome between patients taking ACEI/ARB and those who were not, and to identify any additional effects to taking ACEI/ARB with antiplatelets, statins, or both. In this retrospective case-control study, we assessed 218 patients who presented with ischemic stroke to the stroke unit in Padeh-Poriyah Hospital between 2019-2020. Of these patients, 119 took ACEI/ARB pre-stroke. A significantly higher percentage of ACEI/ARB-treated patients had a history of hypertension (HTN) and hyperlipidemia and were taking antiplatelets and/or statins, compared to the non-ACEI/ARB group. We observed that pre-stroke treatment with ACEI/ARB is associated with worsened stroke severity and reduced early functional outcomes. No significant benefit to taking ACEI/ARB with antiplatelets and/or statins pre-stroke was observed. Due to the nature of our study, the data should be interpreted as suggestive. Thus, prospective studies of these medications on ischemic stroke severity and early outcomes are warranted.

Patient safety is a top priority for all healthcare systems globally. Promoting the adoption of policies for reporting and learning from errors is an important strategy for improving care safety. Therefore, the aim of our study was to detect how much patient safety culture influences the reporting of adverse events and the use of the incident reporting tool. The study protocol was developed according to PRISMA guidelines. Articles were searched electronically in PubMed/MEDLINE, the COCHRANE library, and Google Scholar by two independent reviewers, and those that met the eligibility criteria were included. Synthesis of qualitative data from included studies was performed by graphical descriptive statistical analysis. The results of the systematic review showed that health care organizations' increasing focus on staff development of a safety culture has led to a significant increase in incident reporting rates over the years. Moreover, in situations where safety culture is placed at the top of the nations, there is a higher frequency of incident reporting. An efficient incident reporting system should be an essential foundation for healthcare organizations, as it allows them to collect experiences and data and provide feedback to healthcare providers and staff involved in care.

Through a partnership with three Federally Qualified Health Centers (FQHCs), the local health department in Los Angeles County implemented a produce prescription program (PPR) to increase fresh fruit and vegetable purchases among patients with diabetes or prediabetes. The PPR, which began in 2020, provided eligible patients with a $40 voucher every month for 6 months to promote the purchase of fresh produce at large chain grocery stores. This qualitative assessment describes staff experiences with the PPR, documenting the facilitators and barriers they encountered while implementing the program. Fifteen clinic staff (i.e., PPR implementers) were interviewed for this assessment. Thematic analysis and coding were conducted using the ATLAS.ti software; the coding was carried out by two separate coders. Interviewees discussed the importance of having preexisting partnerships and programs to support the PPR at their clinic site. Hidden costs related to implementing the program included a large and unexpected amount of staff time devoted to enrolling patients into the program. Collecting quality data and having limited expertise to rigorously evaluate the program were other challenges. Because patients often share their food with their family, the monthly $40 incentive was generally not enough to support their needs; interviewees suggested giving a higher inventive amount to those with a larger household. Future PPR efforts and similar food incentive programs should consider these and other facilitators and barriers to implementation and sustainability, especially when making adjustments to these programs to improve services and access to food resources.

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

Coffee production generates significant amounts of by-products, posing challenges for waste management in the industry. Recent research has revealed that coffee by-products are rich in bioactive compounds suitable to produce functional food ingredients and nutraceuticals. In this review, we explore biorefinery strategies for extracting and utilizing bioactive compounds from coffee by-products, including the production of bio-based chemicals and materials, as well as the extraction of phenolic compounds, antioxidants, and dietary fiber for food applications. We propose a stepwise approach for the development of functional food ingredients and nutraceuticals from coffee by-products, covering the identification of needs, comprehensive characterization, in vitro and in vivo research, unraveling the mechanism of action, food and nutraceutical formulation, sensory analysis, shelf-life stability, scale-up, randomized control trials, and biostatistic and bioinformatic integration. Additionally, we discuss the market potential, regulatory issues, and technological innovation surrounding the commercialization of coffee by-product-based products. Emphasizing the importance of regulatory compliance and sustainability in the coffee industry, this review highlights the potential of coffee by-products to be transformed from waste into valuable functional food ingredients and nutraceuticals, offering a promising avenue for waste reduction and promoting sustainability in the coffee industry.

Background: Cancer patients require cross-professional care during the diagnosis and treatment periods. Therefore, methods for effectively carrying out case management are essential to tumor care. Purpose: To investigate the effects of using the community software LINE Official Ac-count on oral cancer case management. Methods: An experimental design was used; 100 patients were randomly divided into two groups by using a computer-generated random number table. The experimental group used LINE Official Account, which gave them self-care information, timely messages, and one-on-one health-care consultations. The control group followed standard healthcare practices. Results: The experimental group was satisfied with the self-care information provided by LINE Official Account (86.9%), patients regularly checked the self-care information (89.4%) and would check the information when receiving a push notification (54.3%). Ten patients used the one-on-one consultation(20.0%). LINE Official Account had a significant effect on the rate of participation in support groups. Generalized estimating equations indicated a significant difference between the two groups regarding the overall quality of life over 7 days (P = 0.023). Conclusion: Community software applications used in oncological case management can improve self-management and empower, also enable tracking of long-term follow-up effectiveness and reinforce the case manager’s role as a family therapist. Therefore, this study recommends that case manager systems be incorporated into mobile applications to increase the sustainable management, accessibility, effectiveness, and satisfaction of oncological management systems. This study also provides the value of Sustainable Development Goals (SDGs) with Good Health and Well-being, and decreased social withdrawal among patients with oral cancer.

From 2020 to 2023 many people around the world were forced to wear masks for large proportions of the day based on mandates and laws. We aimed to study the potential of face masks for the content and release of inanimate toxins. A scoping review of 1003 studies was performed (database search in PubMed/MEDLINE, qualitative and quantitative evaluation). Twenty-four studies were included (experimental time 17 min to 15 days) evaluating content and/or release in 631 masks (273 surgical, 228 textile and 130 N95 masks). Most studies (63%) showed alarming results with high micro- and nanoplastics (MPs and NPs) release and exceedances could also be evidenced for volatile organic compounds (VOCs), xylene, acrolein, per-/polyfluoroalkyl substances (PFAS), phthalates (including di(2-ethylhexyl)-phthalate, DEHP) and for Pb, Cd, Co, Cu, Sb and TiO₂. Of course, masks filter bacteria, dirt and plastic particles and fibers from the air we breathe and have specific indications, but according to our data they also carry risks. Depending on the application, a risk-benefit analysis is necessary. However, mask mandates during the SARS-CoV-2 pandemic have been generating an additional source of potentially harmful exposition to toxins at population level with almost zero distance to the airways.

The nursing home (NH) population becomes increasingly frail, suffering several chronic ill-nesses, high symptom severity, and short remaining lifespan after admission; all this requires skilled, well-organized professional care. Little is known about how NH managers influence the caring and learning environment (CLE) to ensure competencies in meeting NH patients’ needs. The aim of this study is to explore how NH managers influence the CLE to provide basic nursing education for students and apprentices, in order to improve it. This study applies a qualitative design, using multiple methods and focusing on NHs as a context involving complex adaptive systems and on basic nursing as a complex issue. NH managers express a constant struggle to keep workloads manageable, and NHs come across as exhausted organizations with little surplus. Both managers and staff look for ways to execute the work with as little effort as pos-sible and mainly stick to well-established routines. Not participating directly in either daily caring or placement learning, NH managers influence the CLE indirectly through taming and coping strategies, largely using taming strategies that lead to serious unintended outcomes. Coping strategies involve leading collaborative processes in holding environments that are feasible with their workload and roles as managers.

The TeNDER project aims to improve the Quality of Life (QoL) of chronic patients through an integrated care ecosystem. This study evaluates the Health Recommender System (HRS) developed for the project, which offers personalized recommendations based on data collected from a set of monitoring devices. The list of notifications covered different areas of daily-life such as physical activity, nutrition, and sleep. We conducted this case of study to evaluate the effectiveness and usability of the HRS in providing accurate and relevant recommendations to users. Evaluation process consisted on survey administration for QoL assessment, and the satisfaction and usability of the HRS. The four-week pilot study involved several patients and caregivers, and demonstrated that the HRS was perceived as user-friendly, consistent, and helpful, with a positive impact on patients’ QoL. However, the study highlights the need for improvement in terms of personalization of recommendations.

Artificial intelligence (AI) has the potential to revolutionize research by automating data analysis, generating new insights, and supporting the discovery of new knowledge. The top 10 contribution areas of AI towards public health were gathered in this feasibility study. We utilized the “text-davinci-003” model of GPT-3, using OpenAI playground default parameters. The model was trained with the largest training dataset any AI had, limited to a cut-off date in 2021. This study aimed to test the ability of GPT-3 to advance public health and to explore the feasibility of using AI as scientific co-author. The AI was asked for input including scientific quotations and the human authors reviewed responses for plausibility. We found that GPT-3 was able to assemble, summarize, and generate plausible text blocks relevant for public health concerns, elucidating valuable areas of application for itself. However, most quotations were invented by GPT-3 and thus, invalid. Ac-cording to today’s rules, we conclude that AI can contribute to public health research as a team member. Nevertheless, good scientific practice needs to be also followed for AI contributions, and a broad scientific discourse on AI contributions is needed. Policies for good scientific practice should be updated timely following this discourse.

This paper examines the potential of Artificial Intelligence (AI) to address societal megatrends, with a specific focus on OpenAI’s Generative Pre-Trained Transformer 3 (GPT-3). To do this, we con-ducted an analysis using GPT-3 in order to explore the benefits of AI for digitalization, urbanization, globalization, climate change, automation and mobility, global health issues and aging population. We also looked at emerging markets as well as sustainability in this study. Interaction with GPT-3 was done solely through prompt questions and generated responses were analyzed. Our results indicate that AI can significantly improve our understanding of these trends by providing insights into how they develop over time and what solutions could be implemented. Further research is needed to determine how effective AI will be in addressing them successfully but initial findings are encouraging. Our discussion focuses on the implications of our findings for society going forward and suggests that further investigation should be done into how best to utilize new technologies like GPT-3 when tackling these challenges. Lastly, we conclude that while there is still much work left to do before any tangible effects can be seen from utilizing AI tools such as GPT-3 on societal mega-trends; early indications suggest it may have a positive impact if used correctly.

Many apps have been created for food and health-related purposes, given our app’s secondary focus on calorie metrics and health, surveying existing apps, and previous approaches to curtailing the dining experience and promoting health will be helpful. An important aspect to consider when designing an app is a user engagement and how many people one can expect to use an app. Research has been done to study usage metrics and user experiences and opinions regarding mobile app usage, particularly in the health and diet app sector, which pertains to our app’s health features. Even with high user engagement, an app's overall utility and benefit also need to be considered and measured in some qualitative and quantitative sense. Numerous studies have been conducted to determine the effectiveness of food and diet apps on personal behavior. Although the app that is the subject of this proposal is not mainly a “dieting” app, its features, such as the calorie counter, can help facilitate these use cases for users inclined to do so.

The average age of in-service bridges has increased in recent years in the United States. To address this issue, structural health monitoring and damage identification approaches can be employed to prioritize maintenance/replacement of aging bridges. Among the damage identification and operational health monitoring approaches, finite element (FE) model updating methods can offer a solution to evaluate the mechanics-based characteristics of bridges. However, in a real-world setting, unidentifiability and mutual dependency between model parameters, modeling errors, especially due to boundary conditions, as well as ill-conditioning of updating algorithms can pose challenges to the application of FE model updating methods. To address these challenges, this study presents a two-step FE model updating approach. In the first step, modal-based model updating is used to estimate linear model parameters mainly related to the stiffness of boundary conditions and material properties. In the second step, in order to refine parameter estimation accounting for nonlinear response behavior of the bridge, a time-domain model updating is carried out. In this step, boundary conditions are fixed at their final estimates using modal-based model updating. To prevent the convergence of updating algorithm to local solutions, the initial estimates for nonlinear material properties are selected based on their corresponding final estimates in the modal-based model updating. To validate the applicability of the two-step FE model updating approach, a series of forced-vibration experiments are designed and carried out on a pair of decommissioned and deteriorated prestressed bridge I-girders. After carrying out the two-step FE model updating, the final estimates of concrete compressive strength are shown to provide reasonable assessment of the damage extent in the girders.

We present an integrable, sensor inlay for monitoring crack initiation and growth inside bondlines of structural carbon fiber reinforced plastic (CFRP) components. The sensing structures are sandwiched between crack stopping polyvinyliden fluoride (PVDF) and a thin reinforcing polyetherimide (PEI) layer. Good adhesion at all interfaces of the sensor system and to the CFRP material is crucial as weak bonds can counteract the desired crack stopping functionality. At the same time, the chosen reinforcing layer must withstand high strains, safely support the metallic measuring grids and possess outstanding fatigue strength. We show that this robust sensor system, which measures the strain at two successive fronts inside the bondline, allows to recognize cracks in the proximity of the inlay regardless of the mechanical loads. Feasibility is demonstrated by static load tests as well as cyclic long-term fatigue testing with up to 1,000,000 cycles. In addition to pure crack detection, crack distance estimation based on sensor signals is illustrated. The inlay integration process is developed with respect to industrial applicability. Thus, implementation of the proposed system will allow the potential of lightweight CFRP constructions to be better exploited by expanding the possibilities of structural adhesive bonding.

Age estimation in dental radiographs Orthopantomography (OPG) is a medical imaging technique that physicians and pathologists utilise for disease identification and legal matters. For example, for estimating post-mortem interval, detecting child abuse, drug trafficking, and identifying an unknown body. Recent development in automated image processing models improved the age estimation's limited precision to an approximate range of +/- one year. While this estimation is often accepted as accurate measurement, age estimation should be as precise as possible in most serious matters, such as homicide. Current age estimation techniques are highly dependent on manual and time-consuming image processing. Age estimation is often a time-sensitive matter in which the image processing time is vital. Recent development in Machine learning-based data processing methods has decreased the imaging time processing; however, the accuracy of these techniques remains to be further improved. We proposed an ensemble method of image classifiers and transfer learning techniques to enhance the accuracy of age estimation using OPGs from one year to a couple of months (1-3-6). This hybrid model is based on convolutional neural networks (CNN) and K nearest neighbours (KNN). The hybrid (HCNN-KNN) model was used to investigate 1,922 panoramic dental radiographs of patients aged 15 to 23. These OPGs were obtained from the various teaching institutes and private dental clinics in Malaysia. To minimise the chance of overfitting in our model, we used the principal component analysis (PCA) algorithm and eliminated the features with high correlation. To further enhance the performance of our hybrid model, we performed systematic image pre-processing. We applied a series of classifications to train our model. We have successfully demonstrated that combining these innovative approaches has improved the classification and segmentation and thus the age-estimation outcome of the model. Our findings suggest that our innovative model, for the first time, to the best of our knowledge, successfully estimated the age in classified studies of one year old, six months, three months and one-month-old cases with accuracies of 99.98, 99.96, 99.87, and 98.78 respectively.

Research has consistently found that people with mental illness (known as consumers) experience lower levels of participation in meaningful activities, which can limit their opportunities for recovery support. The aim of this study was to describe the outcomes of participation in a group program designed to address all stages of activity participation, known as Pathways to Participation (P2P). A descriptive longitudinal design was utilized, collecting data at three time points. Outcomes were measured by the Camberwell Assessment of Need Short Appraisal (CANSAS), Recovery Assessment Scale – Domains and Stages (RAS-DS), Behaviour and Symptom Identification Scale (BASIS-24), Living in the Community Questionnaire (LCQ) and time use diaries. All data was analysed using descriptive statistics, and Chi square analyses. Seventeen consumers completed baseline data, eleven contributed post program data and eight provided follow up data. Most were female (63.64%) and had been living with mental illness for 11.50 (± 7.74) years on average. Reductions in unmet needs and improvements in self-rated recovery scores were re-ported, but no changes were identified in either time use or psychosocial health. The findings indicate the P2P program may enable consumers to achieve positive activity and participation out-comes as part of their personal recovery.

Medically underserved communities have limited access to effective disease management resources in the U.S. Mobile health applications (mHealth apps) offer patients a cost-effective way to monitor and self-manage their condition and to communicate with providers; however, current diabetes self-management apps have rarely included end-users from underserved communities in the design process. This research documents key stakeholder-driven design requirements for a diabetes self-management app for medically underserved patients. Semi-structured survey-interviews were carried out with 97 patients with diabetes and 11 healthcare providers from medically underserved counties in South Texas to elicit perspectives and preferences regarding a diabetes self-management app, and their beliefs regarding such an app’s usage and utility. Patients emphasized the need for accessible educational content and for quick access to guidance on regulating blood sugar, diet, and exercise and physical activity using multimedia rather than textual form. Healthcare providers indicated that glucose monitoring, educational content, and graphical visualization of diabetes data were among the top-rated app features. These findings suggest that specific design requirements for the underserved may improve the adoption, usability, and sustainability of such interventions. Designers should consider health literacy and numeracy, linguistic barriers, data visualization, data entry complexity, and information exchange capabilities.

Results from a behavioral economic laboratory experiment are used to enhance our understanding of public health decisions made during the COVID-19 pandemic. The identification of systematic biases from optimal decision theory found in controlled experiments could help inform public policy design for future public health crises. The laboratory and the shelter-in-place decisions made during COVID-19 included elements of risk, uncertainty and ambiguity. The lab findings found individuals adopt different decision rules depending on both personal attributes and on the context and environment in which the decision task is conducted. Key observations to consider in the context of the COVID-19 decision environment include the importance of past experience, the ability to understand and calculate the odds of each action, the size and differences in economic payoffs given the choice, the value of information received, and how past statistical independent outcomes influence future decisions. The academic space encompassing both public health and behavioral economics is small, yet important, particularly in the current crisis. The objective of continued research in this area would be to develop a more representative model of decision-making processes, particularly during crisis, that would serve to enhance future public health policy design.

In light of the urgency raised by the COVID-19 pandemic, global investment in wildlife virology is likely to increase, and new surveillance programs will identify hundreds of novel viruses that might someday pose a threat to humans. Our capacity to identify which viruses are capable of zoonotic emergence depends on the existence of a technology—a machine learning model or other informatic system—that leverages available data on known zoonoses to identify which animal pathogens could someday pose a threat to global health. We synthesize the findings of an interdisciplinary workshop on zoonotic risk technologies to answer the following questions: What are the prerequisites, in terms of open data, equity, and interdisciplinary collaboration, to the development and application of those tools? What effect could the technology have on global health? Who would control that technology, who would have access to it, and who would benefit from it? Would it improve pandemic prevention? Could it create new challenges?

Background University students’ psychological health is linked to their academic satisfaction. This study aimed to investigate students’ psychological health and academic satisfaction in the context of COVID-19 and academic year-end stress. Methods Standardized self-filled scales for anxiety, depression, stress, psychological well-being, and an ad-hoc COVID-19 stress scale were used in this cross-sectional study. Participants were first- to third-year students of eight different health-related tracks in Geneva, Switzerland. Descriptive statistics and hierarchical regression analyses were applied. Results In June 2020, out of 2835 invited students, 433 (15%) completed the survey. Academic satisfaction was a stronger mental health predictor than COVID-19, which mainly predicted stress and anxiety. Lower academic satisfaction scores were significantly associated with stress (β = -.53, p < .001), depression (β = -.26, p < .001), anxiety (β = -.20, p < .001), while higher scores with psychological well-being (β = .48, p < .001). Being female was strongly associated with anxiety and stress but not with depression or psychological well-being. Lower age was associated with stress only. The nature of the academic training had a lesser impact on mental health and the academic year none. Compared to students starting the academic year, year-end students reported significantly lower academic satisfaction, higher depression, and particularly higher anxiety and stress. There was, however, no difference in psychological well-being. Conclusion Students suffer more from anxiety, stress, depression, and lower satisfaction with studies at the end of the academic year than at the beginning. Academic satisfaction plays a more substantial role than COVID-19 in predicting students’ overall mental health status. Training institutions should address the underlying factors that can enhance students’ academic satisfaction, especially during the COVID-19 period, in addition to ensuring that they have a continuous and adequate learning experience, as well as access to psychosocial services that help them cope with mental distress and enhance their psychological well-being.

We aimed to explore university students’ perceptions and experiences of SARS-CoV-2 mass asymptomatic testing, social distancing and self-isolation during the COVID-19 pandemic. This qualitative study comprised of four rapid online focus groups conducted at a higher education institution in England during high alert (tier 2) national COVID-19 restrictions. Data were analysed thematically. Participants were purposively sampled university students (n = 25) representing a range of gender, age, living circumstances (on/off campus) and SARS-CoV-2 testing/self-isolation experiences. Six themes with 16 sub-themes emerged from the analysis of the qualitative data: ‘Term-time Experiences’, ‘Risk Perception and Worry’, ‘Engagement in Protective Behaviours’, ‘Openness to Testing’, ‘Barriers to Testing’ and ‘General Wellbeing’. Students described feeling safe on campus, believed most of their peers are adherent to protective behaviours and were positive towards asymptomatic testing in university settings. University communications about COVID-19 testing and social behaviours need to be timely and presented in a more inclusive way to reach groups of students who currently feel marginalised. Barriers to engagement with SARS-CoV-2 testing, social distancing and self-isolation were primarily associated with fear of the mental health impacts of self-isolation, including worry about how they will cope, high anxiety, low mood, guilt relating to impact on others and loneliness. Loneliness in students could be mitigated through increased intra-university communications and a focus on establishment of low COVID-risk social activities to help students build and enhance their social support networks. These findings are particularly pertinent in the context of mass asymptomatic testing programmes being implemented in educational settings and high numbers of students being required to self-isolate. Universities need to determine the support needs of students during self-isolation and prepare for the long-term impacts of the pandemic on student mental health and welfare support services.

There is a lack of knowledge concerning the effects of ambient heat exposure on morbidity in Northern Europe. Therefore, this study aimed to evaluate the relationships of daily summer-time temperature and heatwaves with cardiorespiratory hospital admissions in the Helsinki metropolitan area, Finland. Methods: Time-series models adjusted for potential confounders such as air pollution were used to investigate the associations of daily temperature and heatwaves with cause-specific cardiorespiratory hospital admissions, during summer months of 2001-2017. Daily number of hospitalizations was obtained from the national hospital discharge register, weather information from the Finnish Meteorological Institute. Results: Increased daily temperature was associated with decreased risk of total respiratory hospital admissions and asthma. Heatwave days were associated with 20.5% (95% CI: 6.9, 35.9) increased risk of pneumonia admissions and during long or intense heatwaves also with total respiratory admissions in the oldest age group (≥ 75 years). There were also suggestive positive associations between heatwave days and admissions due to myocardial infarction and cerebrovascular diseases. In contrast, risk of arrhythmia admissions was decreased 20.8% (95% CI: 8.0, 31.8) during heatwaves. Conclusions: Heatwaves, rather than single hot days, are a health threat affecting the morbidity even in a Northern climate.

Bayesian model calibration techniques are commonly employed in the characterization of nonlinear dynamic systems, as they provide a conceptual and effective framework to deal with model uncertainties, experimental errors and procedure assumptions. This understanding has resulted in the need to introduce a model discrepancy term to account for the differences between model-based predictions and real observations. Indeed, the goal of this work is to enhance model-driven Structural Health Monitoring procedures by incorporating the posterior uncertainty linked to updated model discrepancy, and thus make relevant considerations for its use in the Structural Health Monitoring. Specifically, the Bayesian inference has been applied to the calibration of nonlinear hysteretic systems to both provide: (i) most probable values (MPV) of the parameters following the calibration, and; (ii) estimates of the model discrepancy posterior distribution. The effect of the model discrepancy in the calibration is first illustrated recurring to a single degree of freedom Bouc-Wen type oscillator, and then applied for calibrating a reference nonlinear Bouc-Wen model, deriving from real data acquired on a monitored masonry building.

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

One third of a person’s life is spent on sleep, therefore the quality and habit of sleep affects health. A single case study indicated that perspiration could serve as a prognostic marker. Diagnosing nocturnal perspiration is common clinical practice, since this serves as a major symptom in many pathologies. Till this day no specific evidence-based approach for diagnosing nocturnal perspiration exists. By introducing the Q-strip, a device which quantitatively measures nocturnal perspiration, this could be acquired. The Q-strip could serve a purpose in diagnosing nocturnal perspiration more efficient without being intrusive. In addition to its health sensing potentials, the Q-strip makes it possible to visualise perspiration patterns. This introduces the possibility to examine the quality of sleep. Future research is recommended to investigate this.

Chronic diseases are still known as incurable diseases, and we suspect that the medical research model is unfit for characterizing chronic diseases. In this study, we examined accuracy and reliability required for characterizing chronic diseases, reviewed implied presumptions in clinical trials and assumptions used in statistical analysis, examined sources of variances normally encountered in clinical trials, and conducted numeric simulations by using hypothetical data for several theoretical and hypothetical models. We found that the sources of variances attributable to personal differences in clinical trials can distort hypothesis test outcomes, that clinical trials introduce too many errors and too much inaccuracies that tend to hide weak and slow effects of treatments, and that the means of treatments used in statistical analysis have little or no relevance to specific patients. We further found that a large number of uncontrolled co-causal or interfering factors normally seen in human subjects can greatly enlarge the means and the variances of the experimental errors, and the use of high rejection criteria (e.g., low p values) further raises the chances of failing to find treatment effects. As a whole, we concluded that the research model using clinical trials is wrong on multiple grounds, under any of our realistic theoretical and hypothetical models, and that misuse of statistical analysis is most probably responsible for failure to identify treatment effects for chronic diseases and to detect harmful effects of toxic substances in the environment. We proposed alternative experimental models involving the use of single-person or mini optimization trials for studying low-risk weak treatments.

High-tech augmentative and alternative communication (AAC) methods are on a constant rise; however, the interaction between the user and the assistive technology is still challenged for an optimal user experience centered around the desired activity. This review presents a range of signal sensing and acquisition methods utilized in conjunction with the existing high-tech AAC platforms for speech disabled individuals, including imaging methods, touch-enabled systems, mechanical and electro-mechanical access, breath-activated methods, and brain computer interfaces (BCI). The listed AAC sensing modalities are compared in terms of ease of access, affordability, complexity, portability, and typical conversational speeds. A revelation of the associated AAC signal processing, encoding, and retrieval highlights the roles of machine learning (ML) and deep learning (DL) in the development of intelligent AAC solutions. The demands and the affordability of most systems were found to hinder the scale of usage of high-tech AAC. Further research is indeed needed for the development of intelligent AAC applications reducing the associated costs and enhancing the portability of the solutions for a real user’s environment. The consolidation of natural language processing with current solutions also needs to be further explored for the amelioration of the conversational speeds. The recommendations for prospective advances in coming high-tech AAC are addressed in terms of developments to support mobile health communicative applications.

The purpose of work is to quantify the changes of the organism functional reserves during the successive phases of the human health Space-Time Continuum (STC) on the basis of postulates of reliability complex systems theory. The study is devoted to the problem of age-related human involution, which is evaluated not from the causal, but from the kinetic point of view. The analysis of 10 most important basic life support systems of human body — cardiovascular (CVS), respiratory (RS), nervous (NS), digestive (DS), endocrine (ES), immune (IS), excretory (EXS), brain (BS), musculo-skeletal (MSS), hematopoietic (HS) was carried out. Based on this analysis two levels of ensuring the reliability of organism’s work were revealed: sequential and parallel. The system of logical equations for reduced sequential system is: Ys1 = CVS ∧ RS ∧ BS, where ∧ is the notation for the conjunctions of set elements. The system of logical equations for the reduced parallel system is: Ys2 = NS ∨ DS ∨ ES ∨ IS ∨ HS ∨ EXS ∨ MSS ,where ∨ is the disjunction of the scheme elements. Visualization of human STC changes the concept of the kinetics of age-related changes in the organism and the role of determinants of health as a stable factor accompanying a uniform, smooth transition from the most pronounced functions of the body to their gradual extinction. For human STC is formulated the following regularity kinetics of involutionary processes: after 30 years of age in the human body morphological changes regress in arithmetic progression, and the functions of organs in a geometric one. Assumption of health as a state redundancy of functions is suggested.

A large body of evidence reports about the positive effects of physical activity in pathophysiological conditions associated with aging. Physical exercise, alone or in combination with other medical therapies, unquestionably causes reduction of symptoms in chronic non-transmissible diseases often leading to significant amelioration or complete healing. The molecular basis of this exciting outcome, however, remain largely obscure. Epigenetics, exploring at the interface between environmental signals and the remodelling of chromatin structure, promises to shed light on this intriguing matter possibly contributing to the identification of novel therapeutic targets. In this review, we shall focalize on the role of sirtuins (Sirts) a class III histone deacetylases (HDACs) which function has been frequently associated, often with a controversial role, to the pathogenesis of aging-associated pathophysiological conditions including cancer, cardiovascular, muscular, neurodegenerative, bones and respiratory diseases. Numerous studies, in fact, demonstrate that Sirt-dependent pathways are activated upon physical and cognitive exercises linking mitochondrial function, DNA structure remodelling and gene expression regulation to designed medical therapies leading to tangible beneficial outcomes. However, in similar conditions, other studies assign to sirtuins a negative pathophysiological role. In spite of this controversial effect, it is doubtless that studying sirtuins in chronic diseases might lead to an unprecedented improvement of life quality in the elderly.

Very little is known about laboratory confirmed blood stream infections (LCBIs) in neonatal intensive care units (NICUs) in resource-limited settings. The aim of this cohort study was to determine the incidence, risk factors, and causative agents of LCBIs in a level-2 NICU in India. The diagnosis of LCBIs was established using the Centre for Disease Control, USA criteria. A predesigned questionnaire containing risk factors associated with LCBIs was filled-in. A total of 150 neonates (43% preterm) were included in the study. The overall incidence of LCBIs was 31%. The independent risk factors for LCBIs were: preterm neonates (relative risk (RR) 2.23), duration of NICU stay more than 14 days (RR 1.75), chorioamnionitis in the mother (RR 3.18), premature rupture of membrane in mothers (RR 2.32), neonate born through meconium-stained amniotic fluid (RR 2.32), malpresentation (RR 3.05), endotracheal intubation (RR 3.41), umbilical catheterization (RR 4.18), and ventilator-associated pneumonia (RR 3.17). The initiation of minimal enteral nutrition was protective from LCBIs (RR 0.22). The predominant causative organisms were gram-negative pathogens (58%). The results of the present study can be used to design antibiotic interventions to reduce LCBIs in resource-limited settings.

The scarcity and pollution of freshwater are extremely crucial issues today and the expansion of water reuse have been considered as an option to reduce its impact. This study aims to assess the efficiency of an integrated greywater treatment system and hydroponic lettuce production as a part of a green wall structure and to evaluate the health risk associated with the production and consumption of lettuce through quantitative microbial risk assessment (QMRA) and chemical health risk assessment. The study was conducted based on the unique configuration of source separation system; on-site greywater treatment system; green wall structure as a polishing step; and hydroponic lettuce production in the green wall structure. The final effluent from the system was used to grow three lettuce varieties by adding urine as a nutrient solution. Both water samples and plant biomass were collected and tested for E. coli and heavy metals contamination. The system has gained a cumulative 5.1 log10 reduction of E. coli in the final effluent and no E. coli found in the plant biomass. QMRA results indicated that the system attained the health-based targets, 10–6 DALYs per person per year. Similarly, health risk index (HRI) and targeted hazard quotient (THQ) results did not exceed the permissible level, thus the chemical health risk concern was insignificant.

The present study aimed to evaluate the multivariate relationships between variables related to burnout and job stress in healthcare workers, evaluating if the relationship between these dimensions, the variables related to personal factors (age, seniority of service), and work–family balance factors (overwork related to unused vacation days, accumulated overtime hours) change when the worker is engaged in double-caregiving activities. Indeed, the twofold activities of home caregiving and caring at work might expose workers to challenging situations. To accomplish our aim, we carried out network analyses on data from 466 workers (77.90% females). Participants completed the Link Burnout Questionnaire (LBQ) and the Job Satisfaction Scale (OSI). Contrary to expectations, the variables related to work–life balance played a marginal role with respect to job satisfaction and burnout risk for the whole sample. In addition, no significant differences emerged between workers who reported dual- caregiving tasks, compared with those who did not. However, some peculiar aspects of the relationship between burnout and job satisfaction emerged in the two subsamples. The findings are discussed, highlighting a framework for understanding the interactions among the assessed variables.

In Åhlberg (2021, 2022b), I presented evidence for 57 health-promoting substances that all green vascular WEPs contain. I continued searching for health-promoting substances in the plant cells' basic structures and processes. While reading research reports of five invasive species, I found eight more health-promoting substances all green vascular wild edible plants have. This article adds eight new substances to the earlier 57, bringing the total to 65. This is a novel finding for which I provide research evidence. I present the latest research on five invasive wild edible plants (WEPs) species. Each contains at least the same 65 health-promoting substances and a varying number of species-specific health-promoting substances. Each WEP has 1) shared health-promoting substances that all green vascular plants have and 2) species-specific health-promoting substances. I also present how many of these substances prevent Alzheimer’s disease, according to experimental research.

The zinc oxide (ZnO) arrester is positioned on locomotive roof preventing other onboard electrical equipment from the harm caused by external and internal overvoltages. A number of locomotive arrester burnout and explosion accidents occur during traction supply network harmonic resonance causing train stoppages and power outages in the network. This study firstly carries out high-frequency tests to investigate the wide frequency band electrical characteristics of the locomotive arrester, explaining that the arrester is prone to fault during resonance. Consequently, a prognostics and health management (PHM) for locomotive arrester is proposed providing on online monitoring, fault warning and health assessment solutions, which is beneficial to the operation and maintenance of arresters in the future. The testing method and PHM scheme presented in this paper can be not only applied to the arrester, also readily expanded to other high-voltage electrical equipment on the electric locomotive.

The rapid development of specific-purpose Large Language Models (LLMs), such as Med-PaLM, MEDITRON-70B, and Med-Gemini, has significantly impacted healthcare, offering unprecedented capabilities in clinical decision support, diagnostics, and personalized health monitoring. This paper reviews the advancements in medicine-specific LLMs, the integration of Retrieval-Augmented Generation (RAG) and prompt engineering, and their applications in improving diagnostic accuracy and educational utility. Despite the potential, these technologies present challenges, including bias, hallucinations, and the need for robust safety protocols. The paper also discusses the regulatory and ethical considerations necessary for integrating these models into mainstream healthcare. By examining current studies and developments, this paper aims to provide a comprehensive overview of the state of LLMs in medicine and highlight the future directions for research and application. The study concludes that while LLMs hold immense potential, their safe and effective integration into clinical practice requires rigorous testing, ongoing evaluation, and continuous collaboration among stakeholders.

In Mexico, 1.9% of child mortality among children aged 3 to 15 years is attributed to waterborne gastrointestinal diseases (WGD). This study employs a generalized bivariate logit econometric model to simulate the relationships between mortality risks and seven explanatory variables. Based on the model results and sensitivity analysis of the estimated parameters, a set of policies was designed to reduce the likelihood of child mortality. The proposed strategy involves im-plementing the following public policies, primarily targeting communities with extreme and high marginalization: increasing access to drinking water, improving housing conditions, expanding parental basic education coverage, and providing nutrition and healthcare to children from an early age. The findings reveal that children who speak an indigenous language face a mortality risk from WGD that is three times higher than those who do not, while children who receive medical services have a 29% lower risk of mortality compared to those who do not have access to them. It is recommended to offer free medical care in indigenous languages within high-marginalization communities. The combined impact of these policies is expected to signifi-cantly reduce child mortality due to WGD.

Considering animal welfare, the free-range laying hen farming model is increasingly gaining attention. However, in some countries, large-scale farming still relies on the cage-rearing model, making the focus on the welfare of caged laying hens equally important. To evaluate the health status of caged laying hens, a dataset comprising visible light and thermal infrared images was established for analyses, including morphological, thermographic, comb, and behavioural as-sessments, enabling a comprehensive evaluation of the hens' health, behaviour, and population counts. To address the issue of insufficient data samples in the health detection process for indi-vidual and group hens, a dataset named BClayinghens was constructed containing 61,133 images of visible light and thermal infrared images. The BClayinghens dataset was completed using three types of devices: smartphones, visible light cameras, and infrared thermal cameras. All thermal infrared images correspond to visible light images and have achieved positional alignment through coordinate correction. Additionally, the visible light images were annotated with chicken head labels, obtaining 63,693 chicken head labels, which can be directly used for training deep learning models for chicken head object detection and combined with corresponding thermal infrared data to analyze the temperature of the chicken heads. To enable the constructed deep-learning object detection and recognition models to adapt to different breeding environ-ments, various data enhancement methods such as rotation, shearing, colour enhancement, and noise addition were used for image processing. The BClayinghens dataset is important for ap-plying visible light images and corresponding thermal infrared images in the health detection, behavioural analysis, and counting of caged laying hens under large-scale farming.

The study investigated the application of Wastewater-Based Epidemiology (WBE) as a tool for monitoring SARS-CoV-2 prevalence in a city in Northern Italy from October 2021 to May 2023. Starting from a widely applied deterministic model, this study proposed a variation to take into account population characteristics and virus biodegradation in the sewer network. The model calculated virus loads and corresponding COVID-19 cases over time in different areas of the city and was validated with healthcare data while considering viral mutations, vaccinations, and testing variability. The correlation between the predicted and reported cases was high across the three waves that occurred in the considered period, demonstrating the model’s capacity to predict relevant fluctuations in the number of cases. Population characteristics did not substantially influence the predicted and reported infection rates. Conversely, biodegradation significantly reduced the virus load reaching the wastewater treatment plant, resulting in a 30% reduction in the total virus load produced in the study area. This approach can be applied for comparing virus load values across cities with varying population demographics and sewer network structures, enhancing the comparability of WBE data for effective surveillance and intervention strategies.

End-of-life electric vehicle (EV) batteries can be reused to reduce their environmental impact and economic costs. However, the growth of a second-life market is limited by the lack of information on the characteristics and performance of these batteries. As the volume of end-of-life EVs may exceed the amount of batteries needed for stationary applications, investigating the possibility of repurposing them in mobile applications is also necessary. This article presents an experimental test that can be used to collect the data necessary to fill a battery passport. The proposed procedure can facilitate the decision making process regarding the suitability of a battery for reuse at the end of its first life. Once the battery passport has been completed, the performance and characteristics of the battery are compared with the requirements of several mobile applications. Mobile charging stations and forklift trucks were identified as relevant applications for the reuse of high capacity prismatic cells. Finally, a definition of a state of health (SoH) is proposed to track the suitability of the battery during use in the second life application considering not only energy but also power and efficiency of the battery. This SoH shows that even taking into account accelerated ageing data, a repurposed battery can have an extended life of 11 years at 25~°C. It has also been shown that energy fade is the most limiting performance for lifetime and that cell-to-cell variation should be tracked as it has been shown to have a significant impact on battery life.

In May of 2022, millions of U.S. parents faced uncertainty in safely feeding their infants due to the infant formula shortage. Methods: An anonymous, electronic, cross-sectional, retrospective survey was used. Results: U.S. parents (n =187) whose infants were 10.2 weeks old during the short-age completed the survey. Eighty-one percent of parents switched formulas during the shortage, 87% switched because they could not find the formula they typically used, 34% switched 3-5 times, 29% of parents visited ≥ 4 stores/24 hours and 26% of parents traveled >20 miles/24 hours to purchase formula. Use of infant formula increased (p< 0.01); in infants requiring specialty for-mula, use of intact cow’s milk formula increased (p < 0.05) and use of premature infant formulas decreased (p < 0.05). Infants relying on specialty formulas experienced at least one undesirable outcome compared with non-specialty users. Parents used social media, relatives/friends, and healthcare providers for support during the shortage, but their helpfulness scores were suboptimal. Parents reported needs for greater infant formula availability, free prenatal lactation education and postpartum lactation support. Conclusions: Government, regulatory and healthcare policy oversight are needed to protect the infant feeding system, including more commercially available products, access to banked donor milk and lactation support.

Abstract Big datasets are becoming increasingly common and can be challenging to understand and apply in public health. One method for lowering the dimensionality of these datasets and improving interpretability while minimizing information loss is data reduction using principal component analysis (PCA). It achieves this by successively maximizing variance through the creation of new, uncorrelated variables. PCA is an adaptive data analysis technique because it simplifies the process of finding new variables, or principal components, by solving an eigenvalue or eigenvector problem. These new variables are determined by the dataset being used, rather than by the analyst starting from scratch. It is also adaptable in another way because varieties of the method have been designed to adjust to various data structures and types. However, there are serious problems in the theoretical understanding and practical application of PCA in public health researchers, whereas its application is becoming popular in developing countries. Therefore, this article, which concentrated on using PCA to reduce data, began by outlining the fundamental concepts of PCA and going over what it can and cannot do, as well as when and how to use it. We also discussed the fundamental assumptions, benefits, and drawbacks of PCA. Furthermore, this article demonstrated and resolved PCA practical application problems in public health that most scholars are unaware of, such as variable preparation, variable inclusion and exclusion criteria for PCA, iteration steps, wealth index analysis, interpretation, and ranking.

The assessment of Health-Related Quality of Life (HRQoL) in Thalassemia offers a holistic approach to the disease and facilitates better communication between physicians and patients. This study aimed to evaluate the HRQoL of Transfusion-Dependent Thalassemia (TDT) patients in Greece. This was a multicentre, cross-sectional study conducted in 2017, involving 283 adult TDT patients. All participants completed a set of two QoL questionnaires, the generic SF-36v2 and the disease-specific TranQol. Demographic and clinical characteristics were used to predefine patient subgroups. Significant factors identified in univariate analysis were entered into a multivariate analysis to assess their effect on HRQoL. The SF-36 scores of TDT patients were consistently lower, compared to the general population in Greece. The mean summary score of TranQol was relatively high (71±14%), exceeding levels observed in national surveys in other countries. Employment emerged as the most significant independent factor associated with better HRQoL, whereas age had the most significant negative effect. This study represents the first comprehensive QoL assessment in a representative sample of the TDT population in Greece. The implementation of TranQol allowed for the quantification of HRQoL in Greece, establishing a baseline for future follow-up, and identifying more vulnerable patient subgroups.

Respiratory viral infections (RVI) are common reasons for healthcare consultations. The inpatient management of RVI consumes significant resources. From 2009-2014, we assessed the costs of RVI management in 4776 hospitalized chil-dren aged 0-18 years participating in a quality improvement program, where all ILI patients underwent virologic testing at the National Reference Centre followed by de-tailed recording of their clinical course. The direct (medical or non-medical) and indirect costs of inpatient management outside the ICU (“non-ICU”) versus management requiring ICU-care (“ICU”) added up to 2,767.14€ (non-ICU) vs. 29,941.71€ (ICU) for Influenza, 2,713.14€ (non-ICU) vs. 16,951.06€ (ICU) for RSV infections, and 2,767.33€ (non-ICU) vs. 14,394.02€ (ICU) for human rhinovirus (hRV) infections, respectively. Non-ICU inpatient costs were similar for all 8 RVI studied: Influenza, RSV, hRV, ade-novirus (hAdV), metapneumovirus (hMPV), parainfluenzavirus (hPIV), bocavirus (hBoV) and seasonal coronavirus (hCoV) infections. ICU-costs for Influenza however, ex-ceeded all other RVI. At the time of the study, Influenza was the only RVI with antivi-ral treatment options available for children, but only 9.8% of Influenza patients (non-ICU) and 1.5% of ICU-patients with Influenza received antivirals; only 2.9% were vac-cinated. Future studies should investigate the economic impact of treatment and pre-vention of Influenza-, COVID-19-, and RSV post vaccine introduction.

(1) Background: Prevention of acute cardiovascular events in patients with cardiovascular diseases (CVDs) requires promoting health-protective behaviors (e.g., physical activity) and preventing health-compromising behaviors (sitting). Digital health interventions provide much potential. Based on multiple behavioral change theory, an intervention (reCardial app) was evaluated, and the following hypotheses were tested: H1: Health behaviors (physical activity, sitting) and disease self-management (self-care maintenance, self-care confidence) are closely interrelated. H2: Change in health behaviors and disease self-management indicators over time is more pronounced in reCardial app-users. H3: In the intervention group, changes in systolic and diastolic blood pressure indicate a positive trajectory. (2) Methods: A study with the design of a randomized controlled trial over 12 weeks was conducted. 40 CVD-patients were randomized equally to the Intervention Group (35% women; Mage=60.6years) and Control Group (45% women; Mage=61.5years). (3) Results: Findings support H1 with significant correlations between health behaviors (r=0.45-0.63**), and disease self-management (r=-0.32-0.54**), H2 with Eta²=0.21 (not statistically significant) and H3 partially with d=0.101 for systolic blood pressure but not regarding diastolic blood pressure. (4) Conclusions: Replications are needed with larger samples and more objective measures. The app can help prevent and manage CVD by means of promoting health-protective behaviors and preventing health-compromising behaviors. Taking different behaviors into account can increase intervention effects and with that support of users.

Gentiopicroside (GPS) is a leading component of several plant species from Gentianaceae botanical family. As a compound with plenty biological activities and a component that is often consumed in dietary supplements and herbal drugs, GPS has an important role in the regulation of physiological processes in humans. Recent studies on the type 2 receptors shed new light on GPS applications showing its agonistic properties that could be meaningful in the future therapeutic strategies of Parkinson’s disease, thyroid disorders or cancer states. This review aims to collect previously published reports on the biological properties of GPS as a single compound that were confirmed by in vitro and in vivo studies, and to draw attention at the newly discovered role of this bitter-tasting secoiridoid as a type 2 receptor agonist. Thanks to these properties, the research on this substance could be revisited.

Diabetes mellitus is a widespread chronic metabolic disorder demanding regular blood glucose level surveillance (BGLs). Current invasive techniques, such as finger-prick tests, often result in discomfort for patients, leading to infrequent monitoring and potential health complications. The primary objective of this study was to design a novel, portable, non-invasive system for diabetes detection using breath samples, named as DiabeticSense, an affordable digital health device for early detection, encouraging immediate intervention. The device employed MOSFET-based electrochemical sensors to assess volatile organic compounds in breath samples, whose concentrations differ between diabetic and non-diabetic individuals. The system merged body vital signs with sensor voltages obtained by processing breath sample data to predict diabetic conditions. Our research used readings from 100 patients at a nationally recognised hospital to form the dataset. Data was then processed 10 using a Gradient Boosting Classifier model, and performance was cross-validated. The proposed system attained a promising accuracy of 86.6%, marking an improvement of 20.72% over an existing regression technique. The developed device introduces a non-invasive, cost-effective, and user-friendly solution for preliminary diabetes detection. It has the potential to increase patient adherence to regular monitoring.

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

The COVID-19 pandemic had a significant impact on the mental health of individuals globally, and primary healthcare (PHC) nurses play a critical role in providing mental healthcare services. However, limited research has explored the experiences of PHC nurses in providing mental healthcare services during the COVID-19 pandemic. This study explored the experiences of PHC nurses in providing mental healthcare services during the pandemic in Durban, South Africa. The aim was to identify the challenges faced by healthcare providers and the potential for innovative approaches to improve access to care. A qualitative, exploratory design guided the study, and data were collected through in-depth interviews with twelve PHC nurses purposively selected. Thematic analysis was used to analyse the data. Findings from interviews with primary healthcare nurses reveal that the pandemic exacerbated existing challenges, including medication adherence issues, fear and uncertainty among patients, vaccine hesitancy, decreased clinic visits, and the mental and emotional toll on both patients and healthcare workers. PHC nurses adapted their services by increasing outreach efforts, prioritising patient care, and utilising technology and non-governmental organisations’ (NGO) support. Challenges included reduced patient visits, complexities in healthcare provision, and lack of adequate support. Positive changes observed include increased mental health awareness among healthcare professionals and younger generations. Recommendations include implementing outreach and awareness campaigns, providing accurate information about COVID-19 and vaccinations, and promoting cultural sensitivity in mental healthcare provision.

This paper discusses the development process regarding a group of four Augustana College seniors' research. The project is a mobile app for Android built-in Android Studio called Augustana Health and Dining. This application will improve the dining experience at Augustana College, provide additional health metrics for personal use and promote healthier lifestyles. The app features the menus of various on-campus dining areas, with calories, allergens, and other essential food information. It also includes a profile section that will display campus meal credits and a calorie counting metric that can be used to track calories consumed to display this information to users so they can make more informed choices on their meals and health.

In the European Union (EU), cannabidiol products require pre-marketing authorisation under the novel food regulation. Currently, 19 CBD applications are under assessment at the European Food Safety Authority (EFSA). During the initial assessment of the application files, the EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA) located several knowledge gaps in their 07 June 2022 statement on safety of cannabidiol as a novel food that need to be addressed before the evaluation of CBD can be concluded. Namely, the effect of CBD on the liver, gastrointestinal tract, endocrine system, nervous system, psychological function, and reproductive system needs to be clarified. Nevertheless, the available literature allows a benchmark dose (BMD)-response modelling of several bioassays, resulting in a BMD lower confidence limit (BMDL) of 20 mg/kg bw/day for liver toxicity in rats. Human data in healthy volunteers found increases in the liver enzymes alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in a study at 4.3 mg/kg bw/day, which was defined by EFSA NDA panel as a lowest observed adverse effect level (LOAEL). The EFSA NDA panel currently concluded that the safety of CBD as a novel food cannot be evaluated, leading to a so-called clock stop of the applications until the applicants provide the required data. Meanwhile, the authors suggest that CBD products still available as food supplements on the EU market despite the lack of authorisation must be considered as “unsafe”. Products exceeding a health-based guidance value of 10 mg/day must be considered as being “unfit for consumption” (Article 14(1) and (2) (b) of Regulation No 178/2002), while the ones in exceedance of the human LOAEL must be considered “injurious to health” (Article 14(1) and (2) (a) of Regulation No 178/2002).

The World Health Organization estimates that every year air pollution kills seven million people worldwide. As it is expected that climate change will affect future air quality patterns, the full understanding of the links between air pollution and climate change, and how they affect human health, are challenges of future research. In this scope, a methodology to assess the air quality impacts on health was developed. The WRF-CAMx modelling framework was applied for the medium-term future climate (considering the SSP24.5 scenario) and for the recent past (considered as baseline). Following the WHO recommendations, mortality health indicators were used to estimate health impacts of long-term exposures. For that, the Aveiro Region, in Portugal, was considered as a case study. Future climate results indicate the occurrence of higher temperatures, and lower total precipitation. Despite that, improvements in the main pollutants’ concentrations, and consequently in the reduction of the related premature deaths are foreseen, mainly due to the reduction of pollutants emissions imposed by the European legislation for the upcoming years. The applied approach constitutes an added value in this research field, being crucial to anticipate the effects of climate change on air quality and evaluate their impacts on human health.

The health of the landing gear retraction and extension hydraulic system may be assessed using fuzzy comprehensive evaluation (FCE), however the traditional FCE method depends solely on human assessment by specialists, which is excessively subjective. To address the issue of excessive human subjective variables in the assessment, an improved FCE model based on enhanced risk coefficient is provided, which includes four consideration indexes: failure probability, failure severity, failure detection difficulty, and failure repair difficulty. To reduce subjective human judgment errors entirely due to expert experience, the improved FCE takes into account the likelihood of failure using a statistical method, the severity of failure using a fault simulation analysis based on the LMS Imagine.Lab AMESim simulation platform, and the difficulty of fault detection and repair using the aircraft manufacturer's professional maintenance information. As part of the evaluation model, the range of health assessment values and accompanying treatment methods are included, making it easier to implement on a daily basis in aircraft maintenance. As a final step, the simulation is evaluated and the simulated faults are calculated.

School Feeding Programmes are social safety net interventions providing educational and health benefits to vulnerable children in developing countries. This study assessed the impact of Osun Elementary School Feeding and Health Programme (O-MEALS) on the enrolment and retention of rural primary schools in Osun State. Multi stage sampling technique was used to select 188 respondents while data was collected through interview schedule. Percentages, Chi-square, PPMC and T-test were used for data analysis. Findings revealed that over half (51.6%) of the respondents were male, aged 9.38 ± 1.84 years and majority (83.0%) had a family size of 6-10 people. Food incentives (=1.25), health challenge (=0.69), and peer influence (=0.67) were major factors affecting school attendance. More than half (53.2%) of the respondents had unfavourable perception towards the school feeding programme. Results showed a significant difference between pupils’ enrolment (t = 5.332, p = 0.006) and retention rate (t = 58.386, p = 0.000) before and after the commencement of O-MEALS. Furthermore, pupils’ enrolment and retention (r = 0.993, p = 0.001) after the commencement of O-MEALS was significantly related. Food incentive was a major factor affecting school attendance, which fostered an improvement in the poor enrolment and retention previously experienced. Since a good number of the pupils possessed unfavourably perception towards the school feeding programme, it was recommended that effective monitoring be established to checkmate food vendors’ activities in delivering quality and satisfactory services. Likewise, the Government’s policies on school restructuring and levy, which had proved counterproductive, should be reviewed.

The aerospace industry develops prognosis and health management algorithms to ensure better safety on board. Particularly for in-flight controls where jamming is dreaded. For that, vibration signals are monitored to predict future defect occurrences. However, time series are not labeled according to severity level, and the user can only assess the system health from the data mining procedure. To that extent, we developed a clustering algorithm using a deep neural network core. We encoded the time series into pictures to be feed into an artificially trained neural network: U-NET. From the segmented output, one-dimensional information on cluster frontiers is extracted and filtered without any parameter selection. Then, a kernel density estimation finally transforms the signal into an empirical density. Ultimately, a Gaussian mixture model extracts the latter independent components. The method empowered us to reveal different degrees of severity faults in the studied data, with their respective likelihood without prior knowledge. We compared it to state-of-the-art machine learning algorithms. However, internal clustering results evaluation for time series is an open question. As state-of-the-art indexes were not producing relevant results, we built a new indicator to fulfill this task. We applied the whole method to an actuator consisting of an induction machine linked to a ball screw. This study lays the groundwork for future training of diagnosis and prognosis structures in the health management framework.

Background: Globally, infections are the third leading cause of neonatal mortality. Predominant risk factors for facility-born newborns are poor hygiene practices that span both the facility and home environments. Current improvement interventions focus on only one environment and tar-get limited caregivers, primarily birth attendants and mothers. To inform the design of a hand hygiene behaviour change intervention in rural Cambodia, a formative mixed-methods research study was conducted to investigate the context specific behaviours and determinants of hand-washing among healthcare workers, maternal and non-maternal caregivers along the early new-born care continuum. Methods: Direct observations of hygiene practices of all individuals providing care to 46 newborns across eight facilities and associated communities were completed and hand hygiene compliance assessed in analysis. Semi structured interactive interviews were subsequently conducted with 35 midwives and household members to explore the corresponding cognitive, emotional, and environmental factors influencing the observed key hand hygiene behaviours. Results: Hand hygiene opportunities during newborn care were frequent in both set-tings (n = 1319) and predominantly performed by mothers, fathers and non-parental caregivers. Compliance to hand hygiene protocol across all caregivers, including midwives, was inadequate (0%). Practices were influenced by the lack of accessible physical infrastructure, time, increased workload, low infection risk perception, nurture-related motives, norms and inadequate knowledge. Conclusion: Our findings indicate that an effective intervention in this context should be multi-modal to address the different key behaviour determinants and target a wide range of caregivers.

How can neuroscience help everyone to live and care for our confined brains? Understanding and studying human behaviour allows us to measure the impact of such confinement on each of us and to identify those who need help. The challenges are to understand the psychological repercussions following confinement and to understand how neuroscience and neurotechnology can be very interesting tools for dealing with the health crisis. Neuroscience is changing our traditional philosophical and ethical views by providing information about the biological basis of our moral behaviour. The exception of the brain is at the heart of neuroethical thinking and discourse. Neuroethics is an interdisciplinary discipline placed at the intersection between the human sciences and the neurosciences, and aims to help understand how knowledge and research in neurosciences and neurotechnologies will affect the future of society, their impact on humans, relationships, daily life, the labour market ... but also how they can help and provide solutions and answers to the questions of citizens in a health crisis. But it's a double-edged sword, collecting and analyzing brain data in real time seems to be increasingly simple and within everyone's reach, without having the hindsight of the real meaning of these data, allowing one day to read people's thoughts, control them and manipulate them. It is becoming clear that the boundaries between medical and non-medical uses of neuroscience and neurotechnology are becoming very porous, inviting us to reflect on neuroethical issues in order to put safeguards on these uses.

Drought-induced plant mortality has increased globally during the last decades and is forecasted to influence global vegetation dynamics. Timely information on plant water dynamics is essential for understanding and anticipating drought-induced plant mortality. The most common metric that has been used for decades for measuring water stress is leaf water potential (Ψ_L), which is measured destructively. To obtain information on water dynamics from trees and forested landscapes, remote sensing methods have been developed. However, the spatial and temporal resolution of the existing methods have limited our understanding of water dynamics and diurnal variation of Ψ_L within single trees. Thus, we investigated the capability of terrestrial laser scanning (TLS) intensity in observing diurnal variation in Ψ_L during a 50 hour monitoring period and aimed to improve understanding on how large part of the diurnal variation in Ψ_L can be captured using intensity observations. We found that TLS intensity at 905 nm wavelength was able to explain 78% of the variation in Ψ_L for three trees of two tree species with a root-mean square error of 0.137 MPa. Based on our experiment with three trees, time-series of TLS intensity measurements can be used in detecting changes in Ψ_L, and thus it is worthwhile to expand the investigations to cover a wider range of tree species and forests and further increase our understanding of plant water dynamics at wider spatial and temporal scales.

Observing air quality from sensors onboard light rail cars in Salt Lake County, Utah began as a pilot study in 2014 and has now evolved into a five-year state-funded program. This metropolitan region suffers from both elevated ozone levels during summer and high PM2.5 events during winter. Pollution episodes result predominantly from local anthropogenic emissions but are also impacted by regional transport of dust, chemical precursors to ozone, and wildfire smoke as well as being exacerbated by the topographical features surrounding the city. Two electric light-rail train cars from the Utah Transit Authority light-rail Transit Express (“TRAX”) system were outfitted with PM2.5 and ozone sensors to measure air quality at high spatial and temporal resolution in this region. Pollutant concentration data underwent quality control procedures to determine whether the train motion affected the readings and how the sensors compared against regulatory sensors. Quality assurance results from data obtained over the past year show that TRAX Observation Project sensors are reliable, which corroborates earlier preliminary validation work. Two case studies from summer 2019 are presented to illustrate the strength of the finely-resolved air quality observations: 1) an elevated ozone event and 2) elevated particulate pollution resulting from 4th of July fireworks. The mobile observations were able to capture spatial gradients as well as pollutant hotspots during both of these episodes. Sensors have been recently added to a third light rail train car, which travels on a north-south oriented rail line along which we were unable to monitor air quality previously. The TRAX Observation Project is currently being used to provide reliable pollutant data for health studies and inform urban planning efforts. Links to real-time data displays and updated information on the quality-controlled data from this study are available at https://atmos.utah.edu/air_quality/trax/.

Studies comparing provider and patient views and experiences of self-management within primary healthcare are particularly scarce in disadvantaged settings. In this qualitative study, patient and provider perceptions of self-management were investigated in five socio-economically disadvantaged communities in Stockholm. Twelve individual interviews and three group interviews were conducted. Semi-structured interview guides included questions on perceptions of diabetes diagnosis, diabetes care services available at primary health care centers, patient and provider interactions, and self-management support. Data was analysed using thematic analysis. Two overarching themes were identified. These were characterized by inherent dilemmas representing confusions and conflicts that patients and providers experienced in their daily life or practice respectively: adopting and maintaining new routines through practical and appropriate lifestyle choices (patients); and balancing expectations and pre-conceptions of self-management (providers). Patients found it difficult to tailor information and lifestyle advice to fit their daily life. Healthcare providers recognized that patients were in need of support to change behavior, but saw themselves as inadequately equipped to deal with the different cultural and social aspects of self-management. This study highlights patient and provider dilemmas that influence the interaction and collaboration between patients and providers with respect to communication and uptake of self-management advice.

In this paper, we investigated transducer placement strategies for detecting crack in primary aircraft structures using ultrasonic Structural Health Monitoring (SHM). The approach developed is for an expected damage location based on fracture mechanics, for example fatigue crack growth in a high stress location. To assess the performance of the developed approach, finite-element (FE) modelling of a damage tolerant aluminum fuselage has been performed by introducing an artificial crack at a rivet hole into the structural FE model and assessing its influence on the Lamb wave propagation, compared to a baseline measurement simulation. The efficient practical sensor position was determined from the largest change in area that is covered by reflected and missing wave scatter using an additive color model. Blob detection algorithms were employed in order to determine the boundaries of this area and to calculate the blob centroid. To demonstrate that the technique can be generalized, the results from different crack lengths and from tilted crack are also presented.

To cope with a projected global population increase from 7.2 bn to 9.6 bn by 2050, many more cities must be built. Although there are great benefits to modern urban living, there also great costs, such as the seemingly unstoppable rise in Type 2 diabetes, obesity, coronary issues and various cancers. The new towns should be designed to contain or constrain the epidemic of those ‘Western Lifestyle Diseases’ that currently plagues today’s cities. But how might this be achieved? It is suggested here that a greater understanding of human evolution combined with the potency of the ‘Palaeolithic genome’ holds the key to our future urban wellbeing. Consequently, a new paradigm is suggested that underpins positive forward thinking on townplanning and city lifestyles to create healthier urban environments. This builds directly on the ‘Evolutionary Determinants of Health’ programme initiated at University College London (UCL). A four-stage model is proposed that integrates and develops both evolutionary-concordant personal and institutional health behaviours with appropriately reconfigured town-planning and building regulations. When integrated, these strands could deliver a healthier urban culture within greened, active townscapes by proactively constraining or eliminating some of the key underlying causes of the so-called ‘Western Lifestyle Diseases’.

This paper deals with the environmental characterization of a large and densely populated area, with a poor reputation for contamination, considering the contribution of environmental features (air, soil, soil hydraulic and groundwater) and the potential effects on human health. The use of Geographic Information System (GIS) has made possible a georeferenced inventory and, by overlaying environmental information, an operational synthesis of comprehensive environmental conditions. The cumulative effects on environmental features were evaluated, taking into account superposition effects, by means of the spatial multicriteria decision analysis (S-MCDA). The application of the S-MCDA for converging the combination of heterogeneous factors, related to soil, land and water, deeply studied by heterogeneous groups of experts, constitutes the novelty of the paper. The results confirmed an overall higher potential of exposure to contaminants in the environment and higher mortality rates in the study area for some tumours, but hospital admissions for tumours were generally similar to the regional trend. Besides, mortality data may be strictly dependent on the poor socioeconomic conditions, quality of therapy and a lack of welfare in the area relative to the rest of Italy. Finally, as regards the possible relationship between presence of contaminants in the environment and health conditions of the population no definite conclusions can be drawn, although the present study encourages the use of the new proposed methods, that increase the possibilities for studying the combined effect of more environmental factors.

Citizens Advice on Prescription (CAP), a Liverpool (UK) based service, provides welfare advice and link worker social prescribing support to people experiencing and at risk of financial or social hardship. CAP, which receives referrals from healthcare and third sector services, aims to improve service users’ financial security, health, and wellbeing. A mixed-method Social Return on Investment (SROI) analysis was used to evaluate the service. Between May 2022 and November 2023, a subset of service users (n=538) completed the Short Warwick-Edinburgh Mental Wellbeing Survey (SWEMWBS) at baseline and 2-month follow-up. Supporting quantitative and qualitative economic data was also collected (Feb 2023 - Feb 2024) through semi-structured interviews (n=16). Social value changes were generated using the change in SWEMWBS scores and social valuations from the Mental Health Social Value Bank (MHSVB). SROI ratios were calculated from change of social value against service provision costs. The mean service provision cost was £148.66 per person. The overall study reported a positive SROI return of £1: £3.40-£4.69. Results indicate that non-clinical support services, like CAP, can be an effective intervention to address the wider determinants of health and wellbeing.

Context: The impact of forced migration on mental health is far reaching and compounded by post- migration contexts in which social determinants of health, such as resettlement, employment and gender, play a key role. Research on refugee men has shown that employment and life transitions are key determinants of mental health. However, a gap in knowledge exists on refugee men’s perspectives on the factors that impact their mental health. Methodology: This study used community-based participatory action research and the arts-based method of Photovoice to understand Syrian refugee men’s (n = 11) experiences of forced migration, resettlement, and employment in a Canadian context, as well as the impacts of these experiences on their mental health. Analysis and Results: Drawing on the critical theoretical perspective of intersectionality, we analyzed photographs taken by research participants, which showed that language and literacy barriers, time and stage of life, isolation and loneliness, belonging and identity and gender-based stress intersected to shape their mental health. Conclusion: Meaningful employment was central to the men’s identities; however, they engaged in low wage, precarious work due to both discriminatory policies that favored Canadian experience and credentialing assessment processes that devalued their experience and knowledge. Adopting gender-responsive and caring policies and practices could shift dominant discourses on masculinity and support the mental health of refugee men in resettlement contexts.

Data privacy is a critical concern in health informatics, where the management of sensitive patient information requires robust and secure database systems. This study aims to explore the data privacy challenges faced in health informatics and conduct a comparative analysis of popular Database Management Systems (DBMS), including MySQL, MongoDB, PostgreSQL, and Oracle, with a focus on their effectiveness in safeguarding patient data. Through a review of existing literature, case studies, and interviews with database administrators, the research identifies common privacy threats such as data breaches and unauthorized access. It examines the security features of each DBMS, such as encryption methods, access controls, and user authentication mechanisms. The findings reveal variations in the privacy protection capabilities of different DBMS, highlighting the trade-offs between security, performance, and usability. The study provides recommendations for healthcare organizations in selecting a DBMS that balances privacy with operational needs and offers insights for policymakers to improve regulatory frameworks in health data security. This research contributes to the ongoing discourse on enhancing data privacy in health informatics and suggests directions for future studies to integrate emerging technologies for more secure health data management.

US life expectancy now lags significantly behind the majority of high-income countries, having grown more slowly since 1980 for reasons that are not evident and have been debated. An exploratory system dynamics model is presented that reproduces the full pattern of US life expectancy from 1960 to the present. Multiple socioeconomic and behavioral factors help to explain the historical pattern, two of them apparently most responsible for the stagnation since 1980: the growth of obesity and the leveling off of growth in social spending. Some of the factors in the model are traced back to earlier causes, and obesity’s growth in particular is traced back to excess growth in private health care spending and its adverse effect on workers’ wages. The model’s base run does a good job of reproducing a variety of historical time series data going back to the 1960s, and counterfactual testing produces plausible results. The model may thus be considered a reasonable starting point for more conclusive future modeling of US life expectancy.

Background: This study conducts a comparative historical analysis of two significant drug crises: the opium epidemic in 19th-century Qing Dynasty China and the ongoing opioid crisis in the United States, aiming to extract applicable lessons for current global drug policies. Methodology: A historical case study approach was employed, integrating examinations of historical records, policy documents, and contemporary data to compare the development, impact, and responses to these crises within their respective contexts. Results: The analysis reveals significant parallels in socioeconomic impacts and governmental challenges. Key differences include the evolution from predominantly prohibitionist approaches in Qing China to more comprehensive public health-oriented strategies in the U.S. The study highlights the critical role of national power, particularly military capability, in effectively addressing drug crises. Conclusions: The findings underscore four key lessons: (1) Purely prohibitionist approaches often lead to unintended consequences such as black markets and increased criminal activity; (2) Addressing underlying socioeconomic factors contributing to drug abuse is crucial; (3) Aggressive anti-drug policies can escalate into severe diplomatic tensions, necessitating careful consideration of international relations in policy formulation; (4) A nation's military and economic strength significantly influences its ability to implement effective drug policies and resist external pressures that may exacerbate the crisis. These insights suggest that effective management of drug crises requires a balance of strong domestic policies, international cooperation, and maintenance of national power to ensure policy autonomy.

Social Anxiety Disorder (SAD) is a common mental health condition characterized by an intense fear of social situations, leading to significant impairments in daily functioning. Traditional exposure therapies, including Cognitive-Behavioral Therapy (CBT), have shown efficacy in treating SAD but are often limited by logistical challenges and patient reluctance. Virtual Reality Exposure Therapy (VRET) has emerged as a promising alternative, providing a controlled and immersive environment for exposure to anxiety-provoking scenarios. This paper explores the integration of Generative Adversarial Networks (GANs) into VRET to enhance the personalization, realism, and adaptability of therapeutic scenarios. GANs, which consist of a generator and a discriminator network, allow for the creation of highly realistic virtual environments tailored to the specific fears and triggers of individual patients. By offering real-time adjustments and personalized exposure scenarios, GAN-enhanced VRET addresses key limitations of traditional therapies, increasing patient engagement and treatment adherence. This review synthesizes findings from key studies on GAN-enhanced VRET, evaluating its efficacy in reducing anxiety symptoms and discussing the potential for broader application across various anxiety disorders. The results indicate that GAN-enhanced VRET offers a significant advancement in the treatment of SAD, providing a more accessible, engaging, and effective approach to exposure therapy. Future directions include expanding accessibility through cost reduction, integrating additional AI techniques, and exploring applications beyond SAD to improve mental health outcomes across diverse patient populations.

Background/Objectives: The aim of this study is the operationalization of the International Classification of Functioning, Disability and Health in the rehabilitation care performed at the Institute of Cancer of the State of São Paulo through structuring a goal-oriented tool with relevant categories of evaluation and follow-up for cancer outpatients to be applied by physiatrists, physiotherapists, physical educators, occupational therapists, and psychologists. Methods: A qualitative study based on a literature review and a modified Delphi exercise, Estimate-Talk-Estimate (ETE) technique, was performed with the service’s rehabilitation experts. Consensus was obtained after four rounds under the 80% agreement threshold. Results: Forty categories were identified for neuropsychological evaluation and thirty-three for psychoaffective support, with 12 goals. Thirty-five categories with 13 goals were accounted for physiotherapy. Physical educators identified 18 categories, with 7 goals. Occupational therapists selected 54 categories, with 10 goals. A referral for personal factors was established. Functional Assessment of Cancer Therapy-General (FACT-G) was the quality of life tool chosen to be applied. Conclusions: A set of relevant ICF categories was structured, tailored by a clinically meaningful routine of assessment and follow-up of cancer outpatients based on specialists’ clinical practice and scientific literature. It will contribute for analyzable and more specific and quantifiable institutional health data. Its implementation and future discussion may promote the instrument’s refinement for its use in this population.

(1) Background: Youths with multiple risks and severe disadvantages experience poorer health and educational outcomes than less disadvantaged peers. To address problems with coping and self-regulation in this group, mental skills training (MST) approaches more commonly used in sport are an emerging intervention approach. (2) Methods and Results: This narrative review synthesizes literature to explain the need for MST, how it works, and evidence to support it works by focusing on two well evaluated programmes: LifeMatters and My Strengths Training for Life™. (3) Conclusions: To support positive youth development, MST is a strengths-based, flexible and adaptable approach to help fill the shortage of available evidence-based programs for those youths facing multiple disadvantages. The findings of this review may facilitate policy makers, commissioners, program planners, and researchers in the uptake of MST or similar psychoeducational approaches in future.

The application of distributed fiber optic strain and temperature measurement can be utilized to address a multitude of measurement tasks across a diverse range of fields, particularly in the context of structural health monitoring in the domains of building construction, civil engineering, and special foundation engineering. However, a comprehensive understanding of the influences on the measurement method and the sensors is essential to prevent misinterpretations or measurement deviations. In this context, this study investigated the effects of moisture exposure, including various salt solutions and a high pH value, on a distributed strain measurement using Rayleigh backscattering. Three fiber optic sensors with different coating materials and one uncoated fiber were exposed to five different solutions for 24 hours. The study revealed significant discrepancies in deformation between the three coating types depending on the surrounding solution. Furthermore, in contrast to the prevailing literature, which predominantly describes swelling effects, a negative deformation was observed in a magnesium chloride solution. The findings of this study indicate that corresponding effects can impact the precision of measurement, potentially leading to misinterpretations. Conversely, these effects could be used to conduct large-scale monitoring of chemical components using distributed fiber optic sensing.

Teachers’ time resources are becoming increasingly scarce and time poverty will have a direct impact on the long-term sustainability of their professional development. However, the current state of teachers’ time poverty and its potential harmful consequences are unclear. Therefore, this research conducts two cross-sectional studies to investigate the current situation and group differences in time poverty among Chinese teachers (Sample 1), as well as the influence of teachers’ time poverty on job burnout (Sample 2). The results indicate that: (1) there is a high level of time poverty among teachers; (2) there is no significant difference in gender, teaching years, or teaching section, and there is a significant difference in teaching responsibilities; (3) time poverty could positively and significantly predict job burnout, and job burnout could positively and significantly predict mental health; (4) mental health factors (including depression, anxiety and stress) play the mediating role in the relationship between teachers’ time poverty and job burnout. To create a sustainable development environment for teachers, it is suggested that teachers improve time management skills and establish a self-regulation mechanism; schools should clarify the boundaries of teachers’ work and respect their right to rest; and society should provide positive and adequate spiritual support.