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

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

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

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

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

The Sei Dareh Bridge is a cable-stayed bridge located in West Sumatra Province, Indonesia. The bridge, which crosses the Batanghari River, has a main span of 123 meters long and 9 meters wide. Traffic load is transmitted through 24 prestressed cables to a 42.4-meter-high pylon made of concrete. The bridge deck and traffic loads are directly supported by steel box girders as main beams that are reinforced laterally with cross beams IWF 800.300.16.24 and stringers IWF 350.350.12.19. This paper discusses static and dynamic testing on the bridge which aims to assess its feasibility before it is opened to the public. Based on the test, it was concluded that a static load of 73% could not be achieved because the deflection that occurred was beyond the allowable deflection. This is exacerbated by a loud clanging sound on the ST2-X1 prestressed cable when loading to 240 tons or 58% of the targeted load. In addition, this bridge is included in the "lazy bridge" category because it takes 24 hours to return to an undeformed condition after loading. As a recommendation for this bridge, it is necessary to carry out a structural health monitoring system (SHMS) regularly on bridge slabs and cables.

Improving HIV testing efficiency saves financial and material resources for health. We conducted a retrospective secondary data analysis of routinely collected HIV risk screening program data in Uganda, from October to November 2019, to determine the performance characteristics of the adolescent and adult HIV risk screening tool in public health facility settings. A total of 19,854 clients had been screened for HIV testing eligibility and tested for HIV. The overall positivity rate (cluster weighted prevalence of HIV) among those screened was 4.5% (95% CI: 4.1%-4.8%) versus 3.71% (95% CI: 3.06-4.50) among those not screened. The sensitivity and specificity of the risk screening tool were 90.7% (95% CI: 88.4%, 92.7%) and 75.8%, (75.2-76.4) respectively. With screening, the number needed to test to identify one PLHIV was reduced from 27 to 22. Although risk screening would have led to a 24.5% (4,825/19,704) reduction in testing volume, 9.3% (68/732) of PLHIV would have been missed, being misclassified as not eligible for testing. The cost per PLHIV identified fell by 3% from $69 without screening to $66.9 with screening. We recommend the use of scientifically validated HIV risk screening tools, and a need to explore the use of HIV self-testing as a test for tirage.

Collaborative action between families and health professionals, in this case nurses, doctors, nutritionists, pharmacies in forming harmonious support is the philosophy of family centered nursing care which aims to involve families as the main focus in care. The aim of this literature review is to identify family-centered family member care: a literatu review. This language method uses literature reviews which are summaries of 10 articles in the publication years of 2020-2021 on search 4 databased electronic searches containing namely Scopus, ProQuest, Pubmed, and Scient Direct. This review used prisms. The eligibility of these studies were from its title, abstract, research methodology, results and discussion. The results of the review were presented in narrative form. The results of a review of 10 articles found that the form family centered care Conclusion: The family is considered a partner in the care of other family members. The concept of family centered care is a philosophy in nursing where the role of the family is very important in caring for family members who are sick.

Deep learning has taken over - both in problems beyond the realm of traditional, hand-crafted machine learning paradigms as well as in capturing the imagination of the practitioner sitting on top of petabytes of data. While the public perception about the efficacy of deep neural architectures in complex pattern recognition tasks grows, sequentially up-to-date primers on the current state of affairs must follow. In this review, we seek to present a refresher of the many different stacked, connectionist networks that make up the deep learning architectures followed by automatic architecture optimization protocols using multi-agent approaches. Further, since guaranteeing system uptime is fast becoming an indispensable asset across multiple industrial modalities, we include an investigative section on testing neural networks for fault detection and subsequent mitigation. This is followed by an exploratory survey of several application areas where deep learning has emerged as a game-changing technology - be it anomalous behavior detection in financial applications or financial time-series forecasting, predictive and prescriptive analytics, medical imaging, natural language processing or power systems research. The thrust of this review is on outlining emerging areas of application-oriented research within the deep learning community as well as to provide a handy reference to researchers seeking to embrace deep learning in their work for what it is: statistical pattern recognizers with unparalleled hierarchical structure learning capacity with the ability to scale with information.

Complexity of care, adequate staffing levels, and workflow are key factors affecting nurses’ workloads. Clinical complexity classification and related staffing adjustment remain notable gaps in the current evidence limiting the capacity for optimal staffing practices. This study aimed to adapt and validate the WANNNT-SC to the Italian context to allow the assessment of newborns admitted to the NICUs. To evaluate the reliability of the tool among different profes-sionals, a correlation test was performed using Pearson’s correlation, which resulted in a strong correlation (r = 0.967, p = 0.01). In the test-retest phase, there was a significant correlation (r = 0.910 and p = 0.01). Using an analysis of variance, we found that the higher the I-WANNNT-SC score, the higher the predicted death rate (F = 13.05 and p < 0.001). The Italian Winnipeg Surgical Complex Assessment of Neonatal Nursing Needs Tool represents the first tool available for the Italian context that aims to measure the nursing workload in neonatal intensive care. It could allow adjustments in nursing staffing based on NICU activities and patient needs. This study was prospectively approved by the local Ethics Committee “Palermo 1” (Protocol CI-NICU-00).

Objectives: Imaging exams are requested in intensive care units as a diagnostic, evaluation, and clinical monitoring method. While Chest Computed Tomography is the gold standard, Chest X-ray is the exam usually performed in routine care. Lung ultrasound has been gaining ground as it is a reliable exam performed at the bedside without exposure to radiation and at a low cost. This study aimed to evaluate the accuracy of bedside lung ultrasounds performed by pediatric intensivists as a diagnostic method. Methods: A prospective, diagnostic test-type study comparing bedside lung ultrasound performed by a pediatric intensivist with the evaluation of chest X-ray and lung ultrasound performed by a radiologist. Result: 48 patients on mechanical ventilation, aged from 1 month to 14 years, were analyzed, corresponding to 95 chest X-ray exams and 95 lung ultrasound exams. The Kappa agreement coefficients between the pediatric intensivist and the radiologist, both analyzing the lung ultrasound, were: normal report (1.0), atelectasis (1.0), pneumothorax (1.0), consolidation (0.97), pleural effusion (0.95), and pulmonary edema (0.90). Sensitivity, specificity, and accuracy of lung ultrasound were, respectively, normal report (50%; 91.8%; 82.1%), consolidation (88.3%; 57.1%; 76.8%), atelectasis (11.1%; 90.7%; 83.2%), edema (0; 70.2%; 70.5%), pneumothorax (83.3%; 94.4%; 93.7%), and pleural effusion (71.4%; 73%; 72.6%). Conclusion: The pediatric intensivist was skilled in examining and diagnosing lung injuries. Lung ultrasound showed good sensitivity, specificity, and accuracy when the pediatric intensivist performed when diagnosing consolidation, pleural effusion, and pneumothorax. Furthermore, lung ultrasound demonstrated better accuracy in evaluating pulmonary edema when compared with chest X-ray.

Over the past few decades, digitalisation has pushed patient care towards a new era, inducing the evolution of health care delivery and enhancing the overall sustainability of health systems worldwide. Despite the ever-evolving technology leading to a change in health care provision, the uptake of these novel technologies by medical professionals is slow, largely because of concerns about the potential impact on patient care and patient safety, and medico-legal implications. Hence, this research aimed to understand doctors’ perceptions of the adoption of digital virtual consultations in the practice setting.In this survey, an online questionnaire, adapted from the construct by Venkatesh and Bala and based on the Technology Acceptance Model by Davis, was distributed to 886 hospital doctors. Altogether 133 responses were obtained.Results suggest that the respondents perceived digital virtual consultations as adjuncts to face-to-face consultations and as able to diminish time and place barriers. Doctors were willing in principle to utilise these alternatives to traditional methods if the appropriate infrastructure and technology were in place. Feasibility and cost-effectiveness studies are recommended to establish the technology-fit factor and the impact of the technology on the workforce, coupled with a stakeholder analysis to include all the actors involved in such a strategy.

In this paper, we propose a novel approach named EmbedHDP to enhance the evaluation models used to assess sentence suggestions within nursing care record applications. The key focus is determining whether these suggestions garner assessments that align with caregivers as human evaluators. It is crucial due to the direct relevance of the information provided to the health or condition of the elderly. The motivation behind this proposal stems from challenges observed in previous models, such as BERTScore, which encountered difficulties in effectively evaluating the nurse care record domain, consistently providing quality assessments of generated sentence suggestions above 60%. Additionally, while widely used, cosine similarity exhibits limitations concerning word order, leading to potential misjudgments of semantical differences within similar word sets. Similarly, relying on lexical overlap, ROUGE tends to overlook semantic accuracy. Furthermore, despite its utility, BLEU neglects semantic coherence in its evaluations. EmbedHDP excels in evaluating nurse care records by effectively handling a variety of sentence structures and medical terminology and providing differentiated and contextually relevant assessments. We used a dataset comprising 320 pairs of sentences with correspondingly equivalent lengths. The results revealed that EmbedHDP outperformed other evaluation models, achieving a coefficient score of 61%, followed by cosine similarity with a score of 59%, and BERTScore with 58%. This shows the effectiveness of our proposed approach in improving the evaluation of sentence suggestions in nursing care record applications.

Mechanical bowel obstruction is a common symptom for admission to emergency services, diagnosed annually in more than 300,000 patients in the States, from whom 51% will undergo emergency laparotomy. This condition is associated with serious morbidity and mortality, but it also causes a high financial burden due to long hospital stay. The EUPEMEN project aims to incorporate the expertise and clinical experience of national clinical specialists into development of perioperative rehabilitation protocols. Providing special recommendations for all aspects of patient perioperative care and the participation of diverse specialists, the EUPEMEN protocol for bowel obstruction, as presented in the current paper, aims to provide faster postoperative recovery and reduce length of hospital stay, postoperative morbidity and mortality rate.

Introduction. The outbreak of the COVID pandemic was a period of uncer-tainty and tension for healthcare managers, resulting from the lack of knowledge, i.e. about the transmission of the virus, but also from the lack of uniform organisational and treatment procedures. It was the period where the ability to prepare to a crisis situation, to adapt to the existing conditions and to draw conclusion from the situa-tion were critical to keep ICUs operating. The aim of this study was to show the prep-aration of an ICU in Poland to ensure resilience, and also the methods of reacting dur-ing the COVID-19 pandemic on both central and local level. Methods. Based on the EC and WHO guidelines on resilience a matrix of 6 elements and 13 standards as-signed to them was created, with a series of questions from a survey questionnaire. Results. Good management in resilient systems is free access to any resource. A free and transparent flow of information and also well motivated human resources in an appropriate number. Conclusion. Appropriate preparation, adaptation to the existing situation and effective management of crisis situations is an important element of ICU resilience.

The different waves of the COVID-19 pandemic caused dramatic issues regarding the organiza-tion of care. In this context innovative solutions have to be developed in a timely manner to adapted the organization of the care. The establishment of middle care (MC) units is a bright example of such an adaptation. A multidisciplinary MC team, including expert and non-expert respiratory nurses, physicians, physiotherapists, psychologists, nutritionists and social workers, was built and trained to work in the COVID-19 MC unit. Important educational resources were set up to ensure rapid and effective training of the MC team, limiting the admission or delaying transfers to ICU and ensuring optimal management of palliative care. We conducted a retrospec-tive analysis of patient data in the MC unit during the second COVID-19 wave. Fifty-two COVID-19 ‘step-up’ patients admitted to the MC unit were included in the study. Thirty-four (65%) patients worsened, of which 12 (23%) were not eligible for ICU access. In total, 42% of the ICU-eligible patients were managed in the MC unit to avoid the ICU. Among the 22 patients transferred to the ICU, 15 were intubated. The establishment of an MC unit during a pandemic, mixing expert and non-expert respiratory team members, is feasible and needed. MC units possi-bly relieve the pressure exerted on ICUs. A highly trained multidisciplinary team is key to ensur-ing the success of an MC unit during a pandemic.

The utilization of person centered care is highlighted as essential for health promotion, yet implementation has been inconsistent and multiple issues remain. There is a dearth of applied re-search exploring the facets of successful implementation. In this paper, a person centered wellbeing program spanning various groups is discussed outlining the central principles that have allowed for successful outcomes. The main data emerges from 10 years of pragmatic pre-post service evaluation. Measures of functional capacity and wellbeing were captured using validated measures. The method for this paper is a narrative exploration of the theory and practices that can explain the continual improvement the clinics have achieved over 10 years. Core principles relate to connecting with people, connecting through groups, and connecting with self. The operationalization and theoretical explanation of these principles is outlined alongside 10 years of data which shows sustained improvement in a range of outcomes. The discussion of these principles posits essential factors to prioritize to advance the implementation of person centered care in health promotion for long term conditions.

While disrespectful treatment of pregnant women attending health care facilities occurs globally, it is more prevalent in low resource countries. In Kenya, a large body of research studies or has studied disrespectful maternity care (DMC) from the perspective of the service users. This paper examines the perspective of health care workers (HWCs) on factors that influence DMC experienced by pregnant women at health care facilities in rural Kisii and Kilifi counties in Kenya. We conducted 24 in-depth interviews with health care workers (HCWs) in these two sites. Data were analyzed deductively and inductively using NVIVO 12. Findings from HCWs reflective narratives identify four areas connected to the delivery of disrespectful care including poor infrastructure, understaffing, service users’ socio–cultural beliefs, and health care workers’ attitudes toward marginalized women. Investments are needed to address health systems influences on DMC including poor health infrastructure and understaffing. Additionally, it is important to reduce cultural barriers through training on HCWs interpersonal communication skills. Further, strategies are needed to affect positive behavior changes among HCWs directed at addressing stigma and discrimination of pregnant women due to socio-economic standing. To develop evidence-informed strategies to address DMC, a holistic understanding of the factors associated with pregnant women’s poor experiences of facility based maternity care is needed. This may best be achieved through an intersectional approach to address DMC by identifying systemic, cultural, and socio-economic inequities as well as the structural and policy features that contribute and determine peoples’ behaviors and choices.

The capacitor-mismatch among diverse defects caused by the manufacturing process variations significantly affects the linearity of capacitor-array used to implement the capacitive digital-to-analog converter (CDAC) in the successive-approximation-register (SAR) analog-to-digital converter (ADC). Accordingly, the linearity of the SAR ADC is limited by that of capacitor-array, resulting in serious yield loss. This paper proposes an efficient foreground self-calibration technique to enhance the linearity of the SAR ADCs by mitigating the capacitor-mismatch based on the split ADC architecture along with variable capacitors. In this work, two ADC channels (i.e., ADC1 and ADC2) for the split ADC architecture include their capacitive DACs (CDACs) whose binary-weighted capacitor-arrays consist of variable capacitors. A charge-sharing SAR ADC is used for each ADC channel. In the normal operation mode, their digital outputs are averaged to be the final ADC output, as in a conventional split ADC. In the calibration mode, every single binary-weighted capacitor for the two ADCs is sequentially calibrated by making parallel or/and antiparallel connection among two or thee capacitors from the two channels. For instance, because the capacitors of the CDACs ideally exhibit the binary-weighted relation as Cn=2×Cn−1, variable capacitor Cn of ADC1 can be updated to be closest to the sum of Cn−1 of ADC1 and Cn−1 of ADC2 for the calibration. For the process, the two capacitor-arrays of the two ADCs can be reconfigured to be connected to each other, so that Cn of ADC1 can be connected with two of Cn−1 of ADC1 and ADC2 in antiparallel. The two voltages at the top and the bottom plates of the CDAC are compared by a comparator of ADC1, and the comparison results are used to update Cn. This process is iterated, until Cn is in agreement with the sum of two of Cn−1. Finally, all the capacitors can be calibrated in this way to have the binary-weighted relation. The simulation results based on the proposed work with a split SAR ADC model verified that the proposed technique can be practically used, by showing that the total-harmonic-distortion and the signal-to-noise-and-distortion ratio were enhanced by 21.8-dB and 6.4-dB, respectively.

(1) Background: Nursing homes’ preparedness in managing a public health crisis has been fragile, with effects on safety culture. The objective of this study was to assess nursing homes’ COVID-19 preparedness in Southern Portugal, including personnel’s work experiences during the pandemic. (2) Methods: We used a COVID-19 preparedness checklist to be completed by management teams, followed by follow-up calls to nursing homes. Thereafter, a survey to personnel was applied. Data analysis included descriptive statistics, exploratory factor analysis, and thematic analysis of open-end questions. (3) Results: In total, 71% (138/195) of eligible nursing homes returned the preparedness checklist. We conducted 83 follow-up calls and received 720 replies to the personnel survey. On average, 25% of nursing homes did not have an adequate decision-making structure to respond to the pandemic. Outbreak capacity and training were fragile areas among nursing homes’ contingency plans. We identified compliance with procedures and nonpunitive response to mistakes as fragile areas of safety culture, and teamwork as a strong safety area. (4) Conclusions: To strengthen how nursing homes cope with upcoming phases of the COVID-19 pandemic or future public health emergencies, nursing homes’ preparedness and safety culture should be fostered and closely monitored.

With the ever-increasing popularity of unmanned aerial vehicles and other platforms providing dense point clouds, filters for identification of ground points in such dense clouds are needed. Many filters have been proposed and are widely used, usually based on the determination of an original surface approximation and subsequent identification of points within a predefined dis-tance from such surface. We present a new filter, Multi-view and shift rasterization algorithm (MVSR) is based on a different principle, i.e., on the identification of just the lowest points in in-dividual grid cells, shifting the grid along both planar axis and subsequent tilting of the entire grid. The principle is presented in detail and compared both visually and numerically to other commonly used ground filters (PMF, SMRF, CSF, ATIN) on three sites with different ruggedness and vegetation density. Visually, the MVSR filter showed the smoothest and thinnest ground profiles, with ATIN the only filter performing comparably. The same was confirmed when comparing ground filtered by other filters with the MVSR-based surface. The goodness of fit with the original cloud is demonstrated by the root mean square deviations (RMSD) of the points from the original cloud found below the MVSR-generated surface (ranging, depending on site, between 0.6-2.5 cm). The MVSR filter performed outstandingly at all sites, identifying the ground points with great accuracy while filtering out the maximum of vegetation/above-ground points. The filter dilutes the cloud somewhat; in such dense point clouds, however, this can be perceived rather as a benefit than as a disadvantage.

With the ever-increasing popularity of unmanned aerial vehicles and other platforms providing dense point clouds, universal filters for accurate identification of ground points in such dense clouds are needed. Many filters have been proposed and are widely used, usually based on the determination of an original surface approximation and subsequent identification of points within a predefined distance from such surface. In this paper, we present a new filter. This Multi-view and shift rasterization algorithm (MVSR) is based on an entirely different principle, i.e., on the identification of just the lowest points in individual grid cells, shifting the grid along both planar axis and subsequent tilting of the entire grid – after each of these steps, one lowest point per cell is detected. The principle is presented in detail and compared both visually and numerically to other commonly used ground filters (PMF, SMRF, CSF, ATIN) on three sites with different ruggedness and vegetation density. Visually, the MVSR filter showed the smoothest and thinnest ground profiles, with ATIN the only filter performing comparably (although the profiles were somewhat thicker and not as complete as MVSR-acquired ground). The same was confirmed when comparing ground filtered by other filters with the MVSR-based surface. The goodness of fit with the original cloud is demonstrated by the root mean square deviations (RMSD) of the points from the original cloud found below the MVSR-generated surface (ranging, depending on site, between 0.6-2.5 cm). ATIN again performed closest to MVSR, with RMSDs of ground filtered points found above MVSR-based surface at individual sites ranging between 4.5-7.4 cm. The remaining filters performed comparable in the simplest flat area but poorly in rugged and much-vegetated sites, with RMSDs above the MVSR surface ranging at such sites from 21 to 95 cm. In conclusion, the novel filter presented in this paper performed outstandingly at all sites, identifying the ground points with great accuracy while filtering out the maximum of vegetation/above-ground points. The filter dilutes the cloud somewhat; in such dense point clouds, however, this can be perceived rather as a benefit than as a disadvantage.

In this paper, we present a relapse based demonstrating way to deal with investigate various arrangement MTC information. A commonplace use of this displaying approach incorporates three stages: first, define a model that approximates the connection between quality articulation and trial factors, with boundaries consolidated to address the exploration premium; second, utilize least-squares and assessing condition methods to gauge boundaries and their relating standard blunders; third, register test insights, P-qualities and NFD as proportions of factual criticalness. The benefits of this methodology are as per the following. To begin with, it tends to the exploration interest in a particular, precise way, and maximally uses all the information and other important data. Second, it represents both orderly and irregular varieties related with the information, and the consequences of such examination give not just quality explicit data applicable to the exploration objective, yet additionally its dependability, in this way helping agents to settle on better choices for subsequent investigations. Third, this methodology is truly adaptable, and can undoubtedly be stretched out to different sorts of MTC considers or other microarray explores by detailing various models dependent on the test plan of the investigations.

The characteristics of powders on a bulk scale are heavily influenced by both the material properties and the size of their primary particles. Throughout the stages of storage and transportation in the powder processing industry, various forms of deformation and stress, such as pressure and shear, impact these materials. Recognizing the point at which a powder undergoes yielding becomes particularly significant in numerous applications. There are also times when you need to understand the level of stress needed to maintain it. Measurement of powder yield and flow properties remains a challenge and is addressed in this study. As part of the CALIPER collaborative project, a number of shear experiments were performed using two shearing devices: Schulze ring shearing device and Anton Paar Powder Cell (APCC). These experiments have three purposes: i) Test reproducibility/consistency between two shear devices and test protocols. ii) To relate bulk behavior to microscopic particle properties, focusing on bulk density and thus the effect of cohesion between particles; iii) Investigate the influence of the temperature of heated powders on the powder flow properties, which is important for the industrial reactors. Interestingly, for samples with small particle size, bulk cohesion increases slightly, but bulk friction increases significantly, because of particle interaction effects. The experimental data not only provide useful insight into the role of microscopically attractive van der Waals gravitational and/or compressive forces on the macroscopic flow behavior of bulk powders, but also have industrial relevance. We also provide a robust datas of cohesive and attritional fine powder for silo design used for calibration and validation of silos, models and computer simulations.

Advances in gene-specific therapeutics for patients with neuromuscular disorders (NMDs) have brought increased attention to the importance of genetic diagnosis. Genetic testing practices vary among adult neuromuscular clinics, with multi-gene panel testing currently being the most common approach; follow-up testing using broad-based methods, such as exome or genome sequencing, is less consistently offered. Here, we use five case examples to illustrate the unique ability of broad-based testing to improve diagnostic yield, resulting in identification of SORD-neuropathy, HADHB-related disease, ATXN2-ALS, MECP2 related progressive gait decline and spasticity, and DNMT1-related cerebellar ataxia, deafness, narcolepsy, and hereditary sensory neuropathy type 1E. We describe in each case the technological advantages that enabled identification of the causal gene, and the resultant clinical and personal implications for the patient, demonstrating the importance of offering exome or genome sequencing to adults with NMDs.

Labyrinth seals are commonly used in turbomachinery in order to control leakage flows. Flutter is one of the most dangerous potential issues for them, leading to High Cycle Fatigue (HCF) life considerations or even mechanical failure. This phenomenon depends on the interaction between aerodynamics and structural dynamics; mainly due to the very high uncertainties regarding the details of the fluid flow through the component, it is very hard to predict accurately. In 2014, as part of the E-Break research project funded by the European Union (EU), an experimental campaign regarding the flutter behaviour of labyrinth seals was conducted at Centro de Tecnologias Aeronauticas (CTA). During this campaign, three realistic seals were tested at different rotational speeds, and the pressure ratio where the flutter onset appeared was determined. The test was reproduced using a linearized uncoupled structural-fluid methodology of analysis based on Computational Fluid Dynamics (CFD) simulations, with results only in moderate agreement with experimental data. A procedure to adjust the CFD simulations to the steady flow measurements was developed. Once this method was applied, the matching between flutter predictions and the measured data improved, but still some discrepancies could be found. Finally, a set of simulations to retain the influence of the external cavities was run, what further improved the agreement with testing data.

With the wide application of flow sensor, their reliability under extreme conditions has been concerned in recent years. The reliability of a Micro Electro Mechanical Systems flow sensor under temperature (Ts) is researched in this paper. Firstly, the Step-stress accelerated degradation test is designed. Because this flow sensor consists flow sensor chip and signal processing system, the accelerated degradation testing is implemented, respectively. While the results show that the biggest drift is 3.15% for flow sensor chips with 150℃ conditions, and 32.91% for this flowmeter. By analysis, it could be found that the attenuation of the signal processing system is significant to the degeneration of this flowmeter. The minimum drift of the signal processing system accounts for 82.01% of this flowmeter. Secondly, using the Coffin-Manson model, the relationship between cycle-index and Ts is established. And the lifetime with different Ts is estimated by the Arrhenius model. In addition, the Weibull distribution is applied to evaluate the lifetime distribution. Finally, the reliability function of the Weibull distribution is demonstrated, and the survival rate within one year is 87.69% with 85℃ conditions. Thus, by the application of accelerated degradation testing, the acquired results are innovative and original. This research illustrates the reliability research, which provides a relational database for the application of this flow sensor.

Background: The COVID-19 pandemic has promoted a shortage of filtering facepiece respirators (FFRs) and the emergence of new FFRs brands. We aimed to determine the fit provided by in-use FFRs in Peruvian healthcare workers (HCWs) during the COVID-19 pandemic. Methods: We enrolled 279 HCWs from 37 primary healthcare centers with highest burden of care for TB in Peru, of which 263 were assessed using quantitative fit tests (QNFT). Results were expressed as real-time fit factor (rt-FF) and overall fit factor (overall-FF), which was categorized as ≥100 (optimal result), 50-99, and <50. Results: We identified 3M 1860 FFRs (33.1%), Xiantao Zhong Yi ZYB-11 FFRs (24.7%) and Makrite 9500 FFRs (20.5%), mainly. Eighty-seven HCWs (33.1%) had an optimal overall-FF, 27 (10.3%) between 50-99, and 149 (56.7%) less than 50. Of the 87 HCWs with optimal over-all-FF, 73 (83.9%) were 3M 1860 FFR. Of the 27 participants with overall-FF between 50-99, 7 (25.9%) were Makrite 9500, while of the 149 with overall-FF less than 50, 58 (38.9%), and 47 (31.5%) were Xiantao Zhong Yi ZYB-11 and Makrite 9500, respectively. Conclusion: The Xiantao Zhong Yi and Makrite FFRs do not adapt adequately to the face of Peruvian HCWs, most having fit factors less than 50.

The altered nature of archaeological metals means they deteriorate at conditions where metals would be stable. The study of deterioration for such materials is hampered by their complexity, variability and difficulties in measuring deterioration. Placing an object in a sealed container, controlling the RH and pollutant gases and measuring any decrease in oxygen concentration is an accessible method to measure deterioration rate. It has been used for research into suitable environmental conditions to manage deterioration rates of such artefacts including differences in response for artefacts from different excavation sites. Some objects need careful control of RH to low values, this is expensive to maintain and poses risks to other artefacts displayed together. Many objects are actually stable up to quite high RH values and oxygen depletion testing has been used to identify those that can be safely displayed with minimal environmental control. The accelerated corrosion, ‘Oddy’ test is frequently used to sift out unsuitable display materials. The visual assessment is widely recognized to be subjective. The test container has been modified and oxygen depletion appears to give good quantitative measurements of corrosion that correspond with both visual comparison and corrosion quantification for copper, lead and steel, but not for silver.

Background: HIV self-testing (HIVST) is one of the recommended approaches for HIV testing services, particularly for helping reach populations who would not normally access facility-based HIV testing. HIVST must be tailored to different populations to ensure uptake. Objective: The main objective of this study was to develop an acceptable HIVST delivery strategy to help improve urban men’s engagement with HIV services. Methods: We invited key stakeholders for urban men’s HIV services to participate in a co-creation workshop aimed at developing HIVST delivery approaches for urban men, using eThekwini municipality as a study setting. We conducted purposive sampling to include health care users and health care providers, representing a range of views across the public sector and voluntary sector. We employed the Nominal Group Technique (NGT) method for data collection. The NGT workshop was conducted in two consecutive phases: phase one was focused on determining barriers for men’s engagement with the current/facility-based HIV testing services; phase two was aimed at determining HIVST delivery strategies. We used the results of the NGT to design a tailored HIVST strategy for urban men in eThekwini District. Results: Participants identified the following psychological factors as the most important barriers to uptake of HIV testing services by urban men: stigma, ignorance about the importance of testing and testing process as well as fear of positive test results. Key stakeholders suggested internal motivation strategies as a potentially effective approach to support HIVST delivery strategy. Guided by the NGT results, we designed a HIVST delivery strategy that is supported by a risk communication approach Conclusion: We designed an evidence-based risk communication mobile health (mHealth) strategy coupled with SARS COV-2 self-testing tailored to improve men’s uptake of HIVST. A follow-up study to evaluate the feasibility of implementing these approaches is recommended.

In the advent of COVID-19 pandemic, testing is highly essential to be able to isolate, treat infected persons, and finally curb transmission of this infectious respiratory disease. Group testing has been used previously for various infectious diseases and recently reported for large-scale population testing of COVID-19. However, possible sample dilution as a result of large pool sizes has been reported, limiting testing methods’ detection sensitivity. Moreover, the need to sample all individuals prior to pooling overburden the limited resources such as test kits. An alternative proposed strategy where test is performed on pooled samples from individuals representing different households is presented here. This strategy intends to improve group testing method through the reduction in the number of samples collected and pooled during large-scale population testing. Moreover, it introduces database system which enables continuous monitoring of the population’s virus exposure for better decision making.

This review paper aims to understand the current processing plant maintenance systems and further identify on-stream phased array corrosion mapping (PACM) to reduce turnaround maintenance (TAM) activity during plant operations. Reducing the TAM duration and extending the TAM interval are common goals of most researchers. Thus, a detailed review was performed to understand the maintenance systems and the problems faced. Furthermore, a review of the current PACM application and the possibility of applying it during on-stream inspection was also per-formed. PACM has better detectability for localized corrosion, and the results can be obtained for a range of thicknesses, which is the main advantage of this method. The challenge is to apply it to a surface with high temperatures, owing to the greater probe contact and the limitation of ultrasonic properties. This literature review provides a more precise direction for future research to evaluate PACM on piping that can be utilized in inspection during plant operation at elevated temperatures. Detecting and monitoring corrosion growth without shutdown.

The Developing Countries Vaccine Manufacturing Network coordinated a multi-laboratory study funded by the US National Institute for Innovation in Manufacturing Biopharmaceuticals to assess the performance of the Pertussis Serological Potency Test (PSPT) in the laboratories of seven whole-cell pertussis vaccine (wP) manufacturers and three National Control Laboratories based in Southeast Asian countries. To this end, common protocols for the immunization of mice and serological testing by ELISA were shared with all laboratories. Each laboratory used their own wP vaccines and the reference vaccine routinely used in the regulatory required mouse protection test (MPT) and assayed the products both in the MPT and PSPT. Whereas in all laboratories the PSPT showed decreased serum IgG levels after immunization with sub-potent compared to potent final batches, some issues were encountered during execution of the assay, which prevented drawing of definitive conclusions on assay performance. Nevertheless, the study provided the participants with the opportunity to familiarize themselves with the PSPT protocols and revealed the next steps to be addressed for implementation of the method.

This study aims at better understanding the damage and fracture kinetics in flax fibres elements at both the unitary and bundle scales using an experimental setup allowing optical observation at high recording rate in the course of tensile loading. Defects issues from flax unitary fibre extraction are quantitated using polarized light microscopy. Tensile loading is conducted according to a particular setup adapted to fibres of 10 to 20 µm in diameter and 10 mm in length. Optical recording using high speed camera is performed during loading up to the failure at acquisition speed ranging from 108,000 to 270,000 frames per second. Crack initiation in polymer layers of fibre elements, propagation as well as damage mechanisms are captured. The results show different failure scenarios depending on the fibre element nature. In particular, fractured fibres underline either a fully transverse failure propagation or a combination of transverse and longitudinal cracking with different balances. Image recordings with high time resolution down to 3.7 μs suggest unstable system and transverse crack speed higher than 4 m/s and a slower propagation for longitudinal crack deviation.

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

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

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

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

A new model for international bed numbers is applied to local area populations for English Clinical Commissioning Groups (CCGs) where the Age Standardized Mortality Rate (ASMR) is used as a measure of population health and hence for total occupied hospital bed demand (elective plus emergency admission types, including acute, rehabilitation, mental health, and maternity), rather than simple bed availability. A 100-unit increase in ASMR (European Standard population) leads to a 15.3 – 30.7 (feasible range) unit increase in occupied beds per 1,000 deaths. ASMR shows why the Australian states of the Northern Territory and Tasmania have an intrinsic higher bed demand than the other states – although in both cases the bed planning methodologies failed to indicate this need and both states show a large bed deficit. Due to the high volatility in bed demand the average bed demand for 2019 was determined by a linear trend using data for 2014/15 to 2019/20 — as the pre-COVID-19 baseline. The slope of the relationship between occupied beds per 1,000 deaths and deaths per 1,000 population shows a power law function. As is to be expected there is scatter around the trend line which will partly arise from uncertainty in the expected occupied beds in 2019, fluctuations in both ASMR and deaths per 1,000 population from one year to another, changes in the number of persons on the elective, outpatient and diagnostic waiting lists, and local area variation in births and consequently upon maternity, neonatal and pediatric bed demand. Additional variation in bed demand will arise from differences in the level of funding for social care, especially elderly care, and to a lesser extent upon patients using private health care, and charitable hospices for palliative care. However, after including the change in bed demand arising from ASMR the model is sufficiently accurate to identify gross differences in bed demand as a prelude to further investigation. The model requires further extension to cover specialty-level demand, and perhaps segregation between elective and emergency types of inpatient demand. A method for benchmarking the whole hospital’s average bed occupancy is given which enables them to run at optimum efficiency and safety. Using this method English hospitals can be shown to operate at highly disruptive and unsafe levels of bed occupancy leading to deleterious ‘turn-away’. Turn-away implies bed unavailability for the next arriving patient. The problems associated with crafting effective bed planning are illustrated using the English NHS as an example.

This study examines the current functioning of Health Care Bioethics Committees (HBCs) in Chile, with the objective of providing recommendations for improving public health care management. Through a comprehensive literature review and a case analysis of the ‘Hospital Clínico de la Universidad de Chile’, the structure, functions and challenges of the CEA are explored. The research reveals the importance of the multidisciplinary composition of the committees, the need for continuing education in bioethics, and the relevance of the consultative role in ethical decision making. The results suggest that the effectiveness of CABs does not necessarily depend on the number of members or the length of their terms of office, but on the quality of their training and experience. It is concluded that for adequate health care management, it is essential to strengthen the role of the CEA in the ethical education of health care personnel and in the development of institutional regulations, as well as to improve their visibility and accessibility within the Chilean health care system.

Traumatic Brain Injury (TBI) is one of the leading causes of death and disability worldwide. Patient treatment and management pose a challenge for healthcare systems. The prognosis of these patients may be influenced by factors such as sex. This study aims to describe the clinical parameters of patients hospitalized in the Intensive Care Unit (ICU) of a Spanish hospital due to Trauma Brain Injury and to establish differences based on sex. Methodology: An observational, cross-sectional, and analytical study was conducted from March 2015 to December 2019. All patients admitted to the ICU during this period who presented isolated significant Traumatic Brain Injury, defined as an abbreviated injury scale (AIS) ≥ 3, were included. Data on baseline characteristics, mechanism of injury, substance use, and acute management in the prehospital and hospital stages (including the need for hospitalization) were recorded. A descriptive and in-ferential analysis was conducted using the chi-square test. Results: A total of 950 patients were ultimately included. The majority of the patients were men (723) with a mean age of 45.16 (± 17.55). There were statistically significant differences in terms of the mechanism of injury (p

The present study examines the long-term care service awareness, needs, and usage intention of elderly male homosexuals in Taiwan and their ideal long-term care service model. This study of five elderly male homosexual subjects aged 66 to 73 years was intended as a preliminary exploration. Interviews were used to collect data. The study determined that the five subjects had high awareness of long-term care services, as they had actual experience of long-term care services or even participated in care service staff training to obtain certificates. Some even had experience in applying for home care services and experienced problems during use. The subjects perceived that they were very likely to require long-term care services in the future and tended to use home care services if they required long-term care services. Due to their personal experiences, the subjects had negative awareness of long-term care services and worried that long-term care service staff had poor attitudes toward homosexuals. The subjects considered the most important aspects of long-term care to be basic medical care and lifestyle care. However, they worried that long-term care staff would delay or refuse to provide such services due to the subjects’ sexual orientation or stereotypes, and they were concerned above all about the “friendly attitude” of long-term care staff. They hoped that long-term care staff were friendly toward homosexuals and did not discriminate against them, and they felt that it would be more appropriate for homosexual long-term care staff to provide assistance. In terms of vision, while preferring organizations with homosexual employees, the subjects worried that they would be stigmatized and discriminated against . With regard to ideal long-term care services, while considering institutions with homosexual staff to be ideal, the subjects also worried that these would be labeled as institutions that were dedicated to homosexuals, potentially resulting in discrimination. Therefore, they hoped that the sexuality sensitivity of long-term care staff could be improved and that they would undergo professional continuing education to learn about homosexuals, the situation and care needs of homosexuals, and care techniques for homosexuals.

Artificial intelligence (AI) has grown in healthcare in recent years. The UK government recognises AI’s potential to enhance NHS services, yet research on AI in primary care (PC) has received limited attention. AI acceptance presents unique challenges in PC, characterised by fragmented structures, heterogeneous data sources, and multiple government departments. The organisational levels within PC are categorised as macro, meso, and micro levels. Existing research has predominantly focused on micro-level stakeholders. Our online survey addressed this research gap by encom-passing stakeholder perspectives at all levels. The results demonstrate the critical role of me-so-level stakeholders in facilitating AI acceptance. Importantly, a lack of understanding of AI terminology and concepts, concerns over potential job displacement, and the importance of em-pathy in patient care are highlighted as key challenges. Stakeholders also express the need for standardised AI terminology, comprehensive training, and regulatory standards to ensure equi-table and effective AI utilisation. This study lays the foundation for future in-depth interviews and further exploration of AI's role in PC. Observations in secondary care indicate that practitioners have substantial concerns about AI, how it works, and its limitations. Explainable AI can help technologists address such concerns, but first, we need to understand primary care's information needs.

Mood and anxiety disorders affect pregnant people and their families at increased rates throughout the perinatal period. Geographic, financial, and social barriers persist in identification and access to care that preclude adequate diagnosis and treatment of anxiety and mood disorders. These challenges have been exacerbated by the COVID-19 pandemic, particularly for Black and Indigenous People and People of Color (BIPOC) who already experience increased risk for adverse mental health outcomes and faced structural barriers to accessing perinatal mental health care at baseline. The literature shows that integrated care can improve mental health outcomes and save billions of dollars in annual healthcare costs. This study evaluated a novel statewide integrated care effort designed to facilitate access to perinatal mental health care for OB/GYN patients. In addition to enrollment data, variables studied were maternal program satisfaction, retention rates, and preliminary maternal mental health outcomes. 285 patients were ever referred for care. Of this, we contacted 259 patients (91%) and enrolled 209 (72%). Of the 209, 48 were lost to follow up, while 107 remained enrolled at the time of data analysis. 54 patients met their treatment goals. 97% of individuals asserted they were satisfied with the services they received. Black race and public insurance predicted faster attrition from treatment; risk for interpersonal violence exposure and substance use were not related to attrition. Preliminary mental health outcomes showed significant decreases in anxiety and depression, with the most dramatic decreases in the first month of treatment. The MC3 Perinatal care program is a viable, patient-endorsed collaborative care model that increases access to perinatal mental health and facilitate access to outside resources.

Background: The importance of community health psychology in providing complex bio-psycho-social care is well-documented. We present a mixed-method study monitoring the efficacy of health psychology services in the Public Health Focused Model Program for Primary Care Development (2012-2017) in four disadvantaged micro-regions in North-East Hungary. Methods: Study 1 assessed the availability of the services using a sample of 17003 respondents. Study 2 applied a follow-up design to measure the efficacy of the health psychology services in a sample of 132 clients. In Study 3, we conducted focus group interviews to assess clients’ lived experiences. Results: More mental health issues and higher education predicted a higher probability of service use. Follow-up showed that individual and group-based psychological interventions resulted in lower depression and (marginally) higher well-being. Thematic analysis of the focus group interviews indicated that participants deemed topics like psychoeducation, a greater acceptance of psychological support, and heightened awareness of individual and community support important. Conclusions: The results of the monitoring studies demonstrate the important role health psychology services can play in primary health care in disadvantaged regions. Community health psychology can improve well-being, reduce inequality, support the population’s health awareness, and address unmet social needs in disadvantaged regions in Hungary.

AIM: Aim of our study was to evaluate incidence and causative factors for acute kidney injury in gastrointestinal and hepatobiliary surgeries. Material and methods: All the gastrointestinal surgeries performed between April 2018 to March 2020, in our institution have been analysed for acute kidney injury. Acute kidney injury defined according to acute kidney injury network classification. Categorical variables were evaluated by chi square test and continuous variables by Mann Whitney U test. Statistical analysis was done using SPSS version 23. P< 0.05 was considered significant Results: We performed 331 gastrointestinal and hepatobiliary surgery from April 2018 to March 2020. After exclusion 317 patients were included in study population.14 patients (4.4%) were defined as having acute kidney injury according to acute kidney injury network classifications. On univariate analysis acute kidney injury was associated with open surgery (p= 0.002, Intra operative hypotension (p=0.006), CDC grade of surgery (p<0.001), increased used to blood products (p=0.004), higher ASA grade (p<0.0001), increased operative time(p<0.0001). On multivariate logistic regression analysis higher ASA grade (p=0.001) and increased operative time (0.015) independently predicted acute kidney injury. Acute kidney injury was also significantly associated with 90 days mortality. ( p= <0.0001) Conclusion:Post-operative acute kidney injury was associated with significant mortality in gastrointestinal and hepatobiliary surgery. Open surgery, higher CDC grade surgery, more blood products, higher ASA grades, increase operative time predicted acute kidney injury in post operative periods. Higher ASA grades and increased operative time predicted acute kidney injury.

The intensive care units in North West London are part of one of the oldest critical carenetworks in the UK, forming a mature and established strategic alliance to shareresources, experience and knowledge for the benefit of its patients. North WestLondon saw an early surge in COVID-19 admissions, which urgently threatened thecapacity of some of its intensive care units even before the UK government announcedlockdown. The pre-existing relationships and culture within the network allowed itsmembers to unite and work rapidly to develop agile and innovative solutions, protectingany individual unit from becoming overwhelmed, and ultimately protecting its patients.Within a short 50-day period 223 patients were transferred within the network todistribute pressures. This unprecedented number of critical care transfers, combinedwith the creation of extra capacity and new pathways, allowed the region to continue tooffer timely and unrationed access to critical care for all patients who would benefitfrom admission. This extraordinary response is a testament to the power and benefitsof a regionally networked approach to critical care, and the lessons learned maybenefit other healthcare providers, managers and policy makers, especially in regionscurrently facing new outbreaks of COVID-19.

This article describes the history of research and development of surface-penetrating radar, starting from the 60s in the USSR, and ending today in Russia and neighboring states formed after the collapse of the USSR. The outstanding role played in the initial period of this technology development by Prof. M.I. Finkelstein and his colleagues is highlighted. Their research had a significant impact on subsequent developments in modern Russia and the neighboring countries.

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

Single-layer core corrugated sandwich panels generally consist of a corrugated core and two layers of panels, while multi-layer core corrugated sandwich panels are formed by stacking multiple layers of panels with multiple layers of core layers. In this study, integrated multilayer core corrugated sandwich panels with different shapes of corrugated cores (triangular, trapezoidal, and rectangular) and the different number of core layers were fabricated using 3D printing technology, and the mechanical behavior of such multilayer core corrugated sandwich panels under quasi-static three-point bending was investigated using experiments and numerical simulations. The effects of core shape and number of core layers on the bending deformation process, damage mode, load carrying capacity, and bending energy dissipation capacity of multilayer core sandwich panels are discussed. Parametric design of multilayer triangular core corrugated sandwich panels was also carried out by finite element software ABAQUS. It was found that a new multilayer corrugated sandwich panel with a multi-layer core is better than the single core shape multilayer corrugated sandwich panel in terms of bending load capacity, energy dissipation capacity and deformation capacity can be obtained through the combination design of different core shapes.

In our previous papers [1,3], using only the concepts of the zero-point energy and quantized space–times, all the fields including gravity were explained. However, the previous papers had the following limitations: First, the concept of the quantized space-time must be experimentally confirmed. Second, we should clarify the meaning of the quantized Einstein’s gravity equation, which is derived in [1]. Moreover, in another paper [2], we succeeded in describing the neutrinos’ self-energy and their oscillations. However, this paper assumes the rest energy of 3-leptons in advance, which is why we needed to uncover the reason why leptons have 3-generations. As mentioned, using the concepts of the zero-point energy and quantized space–times, we derived the quantized Einstein’s gravity equation in our previous paper [1]. The paper provides an analytical solution of this equalized Einstein’s equation, which implies the conservation of angular momentum in terms of quantized space–times. Employing this solution and without the standard big bang model, a unique form of acceleration equation for the acceleration-expansion universe is derived. Moreover, the temperature of the cosmic microwave background (CMB) emission is also obtained. Further, this solution results in an analytical (not numerical) derivation of the gravity wave. Moreover, based on the configuration of quantized space–times in terms of both electric and magnetic fields, we analytically attempted to calculate every equation in terms of electromagnetic and gravity fields, using the solution of the quantized Einstein’s gravity equation. As a result of this theory, first the calculated acceleration and temperature of CMB emission agree with the measurements. Furthermore, the analytical solution of the quantized Einstein’s gravity equation resulted in all the laws of electromagnetic and gravity fields in addition to the analytically derived gravity wave, which agrees well with the recent measurements. Moreover, the calculations of the energies in the basic configuration of the quantized space–times resulted in all 3-leptons’ rest energies. Considering this basic configuration is uniformly distributed everywhere in the universe, we can conclude that τ-particles or static magnetic field energy derived from the basic configuration of the quantized space–times is the identity of dark energy, which also distributes uniformly in the universe.

Accurate diagnosis at an early stage of infection is essential for the successful management of any contagious disease. The COVID-19, caused by the SARS-CoV-2 virus is a pandemic that has affected 214 countries affecting more than 30.8 million people causing 0.957 million deaths as of third week of September, 2020. The primary diagnosis of the infection is done either by the molecular technique of RT-qPCR by detecting portions of the RNA of the viral genome or through immunodiagnostic tests by detecting the viral proteins or the antibodies produced by the host. As the demand for the test increased rapidly many naive manufacturers entered the market with novel kits and more and more laboratories also entered the diagnostic arena making the test result more error-prone. There are serious debates globally and regionally on the sensitivity and specificity of these tests and about the overall accuracy and reliability of the tests for decision making on control strategies. The significance of the test is also complexed by the presence of asymptomatic carriers, re-occurrence of infection in cured patients as well as by the varied incubation periods of the infection and shifting of the viral location in the host tissues. In this paper, we review the techniques available for SARS-CoV-2 diagnosis and probable factors that can reduce the sensitivity and specificity of the different test methods currently in vogue. We also provide a check-list of factors to be taken care to avoid fallacious practices to reduce false positive and false negative results by the clinical laboratories

Previously, a conductivity invariance phenomena (CIP) has been discovered – at a certain lift-off, the inductance change of the sensor due to a test sample is immune to conductivity variations, i.e. the inductance – lift-off curve passes through a common point at a certain lift-off, termed as conductivity invariance lift-off. However, this conductivity invariance lift-off is fixed for a particular sensor setup, which is not convenient for various sample conditions. In this paper, we propose using two parameters in the coil design – the horizontal and vertical distances between the transmitter and the receiver to control the conductivity invariance lift-off. The relationship between these two parameters and the conductivity invariance lift-off is investigated by simulation and experiments and it has been found that there is an approximate linear relationship between these two parameters and the conductivity invariance lift-off. This is useful for applications where the measurements have restrictions on lift-off, e.g. uneven coating thickness which limits the range of the lift-off of probe during the measurements. Therefore, based on this relationship, it can be easier to adjust the configuration of the probe for a better inspection of the test samples.

For Attention Deficit/Hyperactivity Disorder (ADHD) youth transitioning from child to adult services, protocols that guide the transition process are necessary. While some guidelines are available, they do not always consider effective workload and scarce resources. In Italy, there are currently very few guidelines available, and they do not adhere to common standards, possibly leading to a non-uniform use. The present study analyzes 6 protocols collected from different services for ADHD patients that took part in the TransiDEA (Transitioning in Diabetes, Epilepsy, and ADHD patients) Project. Their content is described in parallel to the National Institute for Clinical Health and Excellence (NICE) guidelines. While there are some strong points and several common core elements, a need emerges to standardize practices and to make them more adherent to patients’ needs and to the resources available to clinicians.

Background/Objectives: Home and community care (HCC) nurses experienced increased occupational challenges during the COVID-19 pandemic including increased workloads, job stressors and occupational risks like virus exposure. The objective was to elucidate what factors influenced nurses’ decisions to stay in their role, take a temporary leave, or exit HCC during the COVID-19 pandemic. Methods: A secondary analysis of data collected using a cross-sectional online open survey distributed among HCC Registered Practical Nurses across Ontario between June and September 2022 was conducted. The factors contributing to nurses’ decision to remain in HCC, temporarily leave, or exit the sector were evaluated using multinomial logistic regression (p < 0.05). Results: Of the 664 participants, 54% (n=357) stayed in the HCC sector, 30% (n=199) temporarily left, and 16% (n=108) exited the sector. Nurses with greater years of experience working in HCC and those who avoided infection were more likely to stay in their role in HCC, which may reflect strong relationships with long-term clients, opportunity and accumulated experience to increase income, and maintained good health. Nurses with higher levels of emotional intelligence were more likely to take leaves and exit HCC, suggesting that stepping away may have been a strategy to safeguard themselves. Conclusions: HCC leadership should prioritize the development of solutions to support nurses in the HCC workforce, including those with fewer years’ experience. This may promote nurses’ participation in the sector, particularly during times of heightened occupational challenges and crises like COVID-19.

Introduction: Rural Americans face significant health disparities due to limited access to healthcare services. Telehealth has emerged as a promising solution to mitigate these disparities by facilitating remote access to medical care. This paper comprehensively reviews the advantages, challenges, and implementation strategies of telehealth in rural areas.Method: A narrative review methodology was employed to synthesize existing literature and case studies on telehealth in rural settings. Databases such as PubMed, Google Scholar, and JSTOR were searched for relevant studies published in the last three decades. Keywords such as "telehealth," "rural health," and "healthcare disparities" guided the search process. The review focused on studies assessing the impact of telehealth on healthcare access, cost-effectiveness, and quality of care in rural areas.Results: The review findings indicate that telehealth significantly enhances healthcare access by reducing travel distances, increasing availability of specialist consultations, and promoting patient engagement. It improves chronic disease management and patient satisfaction by enabling convenient access to healthcare services at home. Despite initial setup costs and challenges such as broadband access and regulatory issues, telehealth demonstrates long-term cost savings through reduced travel expenses and improved healthcare efficiency. Quality of care is enhanced through improved communication between healthcare providers and patients, leading to better treatment adherence and health outcomes.Conclusion: Telehealth represents a transformative approach to address healthcare disparities in rural areas. It offers a cost-effective solution to improve access to healthcare services, enhance patient outcomes, and reduce healthcare costs in the long run. However, successful implementation requires addressing infrastructure challenges, refining reimbursement policies, and ensuring regulatory support. Future efforts should focus on expanding broadband infrastructure, refining policy frameworks, and conducting further research to optimize telehealth's impact on rural healthcare delivery.

Background: Virtual care adoption accelerated during the COVID-19 pandemic, highlighting the need for healthcare professionals to develop relevant competencies. However, limited evidence exists on the core competencies required for quality virtual care delivery. Objective: This study aimed to identify the critical competencies physicians, nurses, and other health professionals need for adequate virtual care provision in Saudi Arabia using a Delphi method. Methods: A 3-round Delphi technique was applied with a panel of 42 experts, including policymakers, healthcare professionals, academicians, and telehealth specialists. In round 1, an open-ended questionnaire elicited competencies needed for virtual care. Competencies were distilled and rated for importance in rounds 2 and 3 until consensus was achieved. Results: Consensus emerged on 151 competencies across 33 domains. The most prominent domains were communication (15 competencies), professionalism (13), leadership (12), health informatics (5), digital literacy (5) and clinical expertise (11).

The oral health of older individuals can be negatively impacted by various systemic health factors, leading to rapid oral health deterioration. Older people are at risk of experiencing adverse reactions to medications due to multimorbidity, polypharmacy, and changes in pharmacokinetics and pharmacodynamics. Hyposalivation, a significant side effect of some medications, can be induced by both the type and number of medications used. Frailty, disability, sarcopenia, care dependency, and limited access to professional oral healthcare can also compromise the oral health of older people. To prevent rapid oral health deterioration, a comprehensive approach is required that involves effective communication between oral healthcare providers, other healthcare providers, and informal carers. Regardless of their health status, it is crucial to prioritize the well-being of older people. Oral healthcare providers have a responsibility to advocate for the importance of maintaining adequate oral health and to raise awareness of the serious consequences of weakened oral health. By doing so, we can prevent weakened oral health from becoming a geriatric syndrome.

Objectives: The purpose of this systematic review was to ascertain critical care nurses’ understanding and experiences of patient advocacy in adult critical care settings. The specific objectives were to identify how critical care nurses define patient advocacy, to explore the understanding and experiences of critical care nurses regarding patient advocacy, to explore critical care nurses’ role in patient advocacy, and to ascertain the barriers to encouraging advocacy in the critical care setting. Research design: Systematic literature search of CINAHL and Medline databases, Google Scholar, and Cochrane Database of Systematic Reviews, as well as grey literature search, was conducted. Search dates were restricted from January 2005 to 2015 in both CINAHL and Medline. Findings: 62 studies were identified, of which 6 qualitative research papers were included. Nurses gave varied definitions of patient advocacy, which were categorized into three themes: communication, protection, and doing. Nurses perceive advocacy as truly listening to patients and their families. Conclusion: For critical care nurses to be effective advocates, there must be support, collaboration, and improved working relationship between professional groups. Moreover, nurses must be empowered to be able to give power to patients and family.

This paper investigates the effects of Inter-generational co-residence on health care market, and labor market outcomes, to see whether or not living under the same roof with at least one parent matters in health care market, and labor market behaviors in post-Affordable-Care Act (ACA) USA. The adopted analytical strategy involves not only looking at the gender differences in co-residence, and its effects on outcomes in the two markets, but also accounting for co-residence endogeneity following the recent literature. Unlike the recent literature that relies on instrumental variables methods, this study adopts a switching regression approach, defining inter-generational co-residence as an endogenous selection process using a binary probit equation, and modeled jointly with the extensive margins and intensive margins in the two markets. This novel approach results in a recursive trivariate probit model for each market, and estimated using penalized maximum likelihood methods. The results suggest that ACA by reorganizing the US health care market, seems to have reduced significantly disparities in health care access among males and females based on race, region of residence, place of birth, and citizenship. However not only do we observe significant differences in inter-generational co-residence status between males and females, we also find significant inequalities in the effects of co-residence on health care market, and labor market outcomes. In fact, co-residence is found to increase health care expenditure by 56.7% among females, while this figure increases to 74.2% among males. In addition co-residing individuals, while spending 69.7% more on health care annually are 1.22 times more likely to access health care, but 31% less likely to use health care intensively during the year. In the labor market, co-residence is found to reduce significantly hours of weekly labor supplied by 41% for females, and 55.6% for males. Furthermore co-residing individuals, while not significantly different in their likelihood of labor force participation, are 1.52 times less likely to work full time once they decide to participate, and also spend about 55.4% less time working in the labor market in post-ACA USA.

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

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

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

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

The Single Site Order – a policy restricting staff from working at multiple long-term care homes – was mandated by the Public Health Agency of Canada to control the spread of COVID-19 in long-term care homes, where nearly 70% of COVID-19-related deaths in Canada occurred. This mixed methods study assesses the impact of Single Site Order on long-term care residents in British Columbia. Interviews were conducted (residents (n=6), family members (n=9), staff (n=18), and leadership (n=10) from long-term care homes (n=4)) and analyzed using thematic analysis. Administrative data was collected between April 2019 – March 2020 and April 2020 – March 2021 and analyzed using descriptive statistics and data visualization. Qualitative and quantitative data were triangulated and demonstrate staffing challenges became worse during implementation of the SSO resulting in the mental and physical health deterioration of LTC residents. Qualitative data demonstrated decreased time for personalized and proactive care, increased communication challenges, and increased loneliness and isolation. Quantitative data showed a decline in activities of daily living, increased antipsychotic medication use, pressure ulcers, behavioural symptoms, and an increase in falls. Addressing staff workload and staffing shortages during SSO-related policy implementation is essential to avoid resident health deterioration.

Background: Colorectal Cancer screening programs are effective in reducing incidence and mor-tality. In Europe, every FIT+ patient is referred to colonoscopy. Available data shows that ~75.0% of these patients are negative. It is desirable to select patients at greater risk of having a positive colonoscopy. Methods: 711 subjects, aged 50-74, attending the screening program of ASL-NA-3-SUD (Na-ples, Italy), were enrolled in a cross-sectional study to evaluate the performance of QuantiDNA™ test and non-inferiority of an alternative approach (AAP). This evaluation is based on FIT+ and QuantiDNA™+ patients referred to colonoscopy, compared to Standard of Care (SOC), colon-oscopy following a FIT+ test alone. A non-inferiority margin for Colorectal Neoplasia (CN) and Advanced Adenomas (AA) was set at -10% and at -3.8% for CRC. Results: The odds ratio was 1.76 (p-value= 0.009). The detection rate of AAP was 15.9% for colorectal neoplasia (CN), 13.0% for advanced adenoma (AA), and 3.0% for CRC. The risk dif-ference between AAP and SOC was -5.07% (95% C.I -9.23, -0.90) for CN, -4.02% (95% C.I. -7.89, -0.16) for AA, and -1.04% (95% C.I. -3.16, 1.07) for CRC. This data suggests that AAP is non-inferior to SOC for detecting CN, AA, and CRC. The expected decrease in colonoscopies is 33.4%. Conclusions: The QuantiDNA™ test is straightforward, non-invasive, and well-tolerated. Data from this study indicates it is effective in the reduction of the need for colonoscopy examina-tions (-33.4%) and is non-inferior to SOC in the detection of significant colorectal lesions.

In recent decades, low-yielding seismic devices based on the use of friction dampers have emerged as an excellent solution for the development of building structures with improved reparability and resilience. Achieving an optimal design for such low-yielding seismic devices requires precise control of bolt preloading levels and predictability of the friction coefficient (CoF) between the damper interfaces. While various types of friction devices exist, capable of providing significant energy dissipation, ongoing research is focused on the development of novel friction materials that exhibit a stable hysteretic response, high CoF values, minimal differences between static and dynamic CoF, and predictable slip resistance. In this context, an experimental campaign was conducted at the STRENGTH Laboratory of the University of Salerno to evaluate the behaviour of new friction shims employing specially developed metal alloys. Specifically, the influence of the characteristics of the contact surfaces in the sliding area on the behaviour and performance of the friction device was analysed. The tests followed the loading protocol recommended by EN12159 for seismic device qualification. Monitored parameters included preloading force values and the evolution of slip resistance. The friction value was determined, along with its degradation over time. Finally, the material's performance in terms of hysteretic behaviour was assessed, providing a comparison of the tested specimens in terms of slip force degradation and energy dissipation capacity.

Basketball playing entails the repetitive performance of short intense actions using lower limb explosive power. As such, it is important to measure this capability in basketball players, especially among young players, and to optimize training programs and game plans. After presenting an in-depth understanding of the specific physiological requirements when playing basketball, as well as the type of movements required, The aim of this review is to better understand the importance of the physiological energy systems in basketball, to examine the contribution of each energy system and, accordingly, to heighten awareness of the importance and dominance of the alactic anaerobic physiological system in basketball, for actions requiring high level explosive power. This review of the literature depicts the horizontal and vertical physical movements and physiological requirements entailed in playing basketball, and presents eight standardized anaerobic alactic measurement tools relevant to the game. As some of these tests suit a number of ball games, the findings of this review article are important for making order of the elements unique to basketball as well as additional parameters to consider when testing basketball players. By reliably and validly testing the anaerobic alactic capabilities of basketball players, test results can be used for training purposes and for improving game outcomes. Despite the fact that much of the information in this review is familiar to coaches, highlighting the specific needs of basketball may help them to choose the most suitable tools, and may also shed light on new directions for developing basketball-specific assessment tests.

This paper presents results from numerical simulations validated by experimental results related to the effects of DSSI on the dynamic response of bridges. An in-service overpass was shaken using the T-Rex, a large-amplitude mobile shaker from the National Hazards Engineering Research Infrastructure (NHERI) facilities. Studies implementing Finite Element Modeling to develop time histories, response spectra, and eigenmodes were conducted in a forward-modeling problem setup. Two models were created to assess the DSSI effects on the dynamic response of the bridge. One model included elements that incorporate DSSI effects, while the other had fixed-base boundary conditions. The response from the DSSI FEM model matched the field results better than the fixed-base model, in terms of the peak response amplitudes and identified natural frequencies and modes. The influence of a series of factors, such as the soil shear wave velocity, bridge height, bridge foundation embedment depth and the corresponding rigidity, slenderness, and embedment ratios, on the bridge response is presented.

Bending of solid wood from European oak is one of the most demanding technological processes due to its specific structural and physical properties and variability. We investigated the influence of wood moisture content (MC) and stiffness, determined by NDT, as well as previous drying methods on the bending ability of the wood. The best quality was obtained with bending specimens bent at a moisture content of at least 16 % and quarter or semi-quartersawn. The number of rejected specimens increased slightly when HF bending was used. Single-stage predrying of oak to a final MC of 8 % resulted in a high rejection rate (&gt; 70 %) regardless of drying technique. The acceptance rate was higher for less stiff specimens where the ratio of ultrasonic velocity in the straight (vS) and bent region (vB) was less than 0.5 (vB/vS).

There is increasing interest in automating train operations of mainline services, e.g. to increase network capacity. Automatic train operation (ATO) is already achieved by several pilot projects, but not implemented on a large scale. Before the general introduction of new or adapted technologies can have a transformative effect on the operation of such a complex system as train operation on mainlines, they have to pass functional, interoperability and performance tests. A virtual preliminary analysis is one way to ensure a smooth as well as safe introduction and implementation. This paper aims to present an approach that applies to the performance testing of ATO systems. Therefore, methods and test standards for technologies enabling automatic operation in other transport sectors are reviewed. The main findings have been adapted, transformed and combined to be used as a general strategy for virtual performance testing in the railway sector. Specifically, universal performance indicators, namely punctuality, accuracy, energy consumption, safety and comfort, are presented. A layer model for scenario description is adapted from the automotive sector, as well as the definition of different scenario types. Lastly, factors that can influence the performance of an ATO algorithm are identified. To demonstrate the developed approach, a straightforward investigation of a case study is conducted using a microscopic train simulator in combination with an ATO algorithm.

Dermatophytes are the most common cause of fungal infections worldwide, affecting millions of people annually. The emergence of resistance among dermatophytes along with the availability of antifungal susceptibility procedures suitable for testing antifungal agents against this group of fungi make the combinatorial approach particularly interesting to be investigated. Therefore, we reviewed the scientific literature concerning the antifungal combinations in dermatophytes. A literature search on the subject performed in PubMed yielded 68 publications: 37 articles referring to in vitro studies, and 31 articles referring to case reports/clinical studies. In vitro studies involved over 400 clinical isolates of dermatophytes (69% Trichophyton spp., 29% Microsporum spp., and 2% Epidermophyton floccosum). Combinations included two antifungal agents or an antifungal agent plus another chemical compound including plant extracts/essential oils, calcineurin inhibitors, peptides, disinfectant agents and others. In general, drug combinations yielded variable results spanning from synergism to indifference. Antagonism was rarely seen. In over 700 patients with documented dermatophyte infections an antifungal combination approach could be evaluated. The most frequent combination included a systemic antifungal agent administered orally (i.e.: azole [mainly itraconazole], terbinafine or griseofulvin) plus a topical medication (i.e.: azole, terbinafine, ciclopirox, amorolfine) for several weeks. Clinical results indicate that association of antifungal agents is effective, and it might be useful in accelerate the clinical and microbiological healing of a superficial infection. Antifungal combinations in dermatophytes have gained considerable scientific interest over the years and, in consideration of the interesting results available as far, it is desirable to continue the research in this field.

This study analyzed the relationship between anthropometric measures, cardiorespiratory capacity, strength, power and local muscle endurance with performance in the CrossFit® Open 2020. For this, 17 volunteers (6 women) (29.0 ± 7.2 years; 70.5 ± 9.8 kg) completed, on separate weeks, body composition (dual-energy x-ray absorptiometry), maximal oxygen consumption (2km row test), muscle strength (1RM back and front squat, isometric peak torque), and muscle power (1RM snatch and clean &amp; jerk), and muscle endurance (Tibana test), which were compared with performance during the CrossFit® Open 2020. Multiple linear regression showed that for the CrossFit Open 2020.1 and 2020.2 workouts, the score in the Tibana test was the only variable that explained the outcomes (Beta = -0.78, p &lt; 0.01 for 2020.1 workout and Beta = 0.82, p &lt; 0.01 for 2020.2 workout). Performance in the CrossFit Open 2020.3 and 2020.4 workouts were explained through the relative strength (Beta = 0.58, p = 0.02 for 2020.3 workout and Beta = 0.50, p = 0.04 for 2020.4 workout). Lastly, Tibana test had the greatest influence on CrossFit Open 2020.5 workout (Beta = -0.75, p &lt; 0.01). A local muscle endurance and muscle strength may be used to predict CrossFit® open workout performance.

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

The existence of the hole on a plate affects the calculation of eddy current problems. Consequently, the accuracy for the prediction of the material properties decreases if the effect of the hole is not taken into account. In this paper, a novel analytical method based on the modified integration range is proposed which can address the presence of the hole. Due to the presence of the hole, the conventional Dodd-Deeds analytical solution cannot be used to calculate the inductance change. Therefore, a revised upper integration limit is introduced to replace the original limit -- ∞ when using the co-axially air-core electromagnetic sensor. With the presence of the hole, the magnitude of the received signal reduces, and the peak frequency feature changes. The analytical method is validated by measured and numerical simulation results. It is found that the upper limit is related to the radius of the open hole. With the new technique, the thickness of sample plates with holes can be estimated based on the peak frequency feature.

The objective of this study is to conduct a mineralogical and chemical characterization of the mortars Roman archaeological site of Volubilis to rebuild spare mortars for restoration. We take samples of mortar, broken tile palate garden, and pavement mosaic Falavius Germanus houses. The analysis by X-ray diffraction reveals the coarse mortar Flavius Germanus is made of quartz and calcite with feldspar and probably, mica and dolomite in small amounts. The binder end is formed calcite and quartz. However, the broken tile mortar is formed by coarse particles, clay base mixed with a binder phase dominated by calcite. These results allowed us to reformulate spare mortars for the restoration of damaged Roman mosaics. The mortars are made up by 63.6% of lime and 36.4% of sand(with 4.19% of large grain, 71, 04% of coarse sand, 24.22%, of fine sand and 0.55% fines parts).The performance of these mortars was tested by mechanical testing.

In order to fully perform their functions and be durable, mortars for renders and plasters are requested to have a set of characteristics that can vary with the type of exposure to external environmental actions and the type of substrate. Generally, they need moderate strength, high deformability, some water protection capability, good adhesion to the substrate, and compatibility with the pre-existent materials. The presence of water and its movement inside the pore structure of the mortars are among the most significant causes of degradation. Moreover, several authors consider that the main factors for durability and good performance of lime-based mortars are mostly related with the good quality of the binder and the use of adequate aggregates. This paper intends to study the effect of ageing on the properties and durability of air lime mortars, using aggregates of different mineralogy. For this purpose, different mortars compositions are exposed to an accelerated weathering test under defined conditions. The obtained characteristics are discussed and compared with the results obtained with the same mortars tested in laboratory conditions. The effects of the aggregate type on the durability of mortars seem to be linked to their effects on the mortars porous structure.

Over the last decade, advances in our understanding about the genetic architecture of complex traits and common diseases, have increased our ability to perform susceptibility genetic testing for diseases in asymptomatic individuals. These technological developments raise complex ethical, legal and social considerations. Here we discuss a series of ethical issues associated with susceptibility genetic testing for Alzheimer's and Parkinson's disease. These include, amongst others, informed consent, disclosure of results and unexpected findings, mandatory screening, privacy and confidentiality, and stigma and genetic discrimination. As knowledge of the genetic basis of these diseases continues growing, and as genetic testing becomes more widespread, we anticipate that it will become increasingly important for scientists and clinicians to engage in the conversation about the ethical, social and policy implications of these technologies.

Previous camera self-calibration methods have exhibited certain notable shortcomings. On one hand, they either exclusively emphasized scene cues or solely focused on vehicle-related cues, resulting in a lack of adaptability to diverse scenarios and a limited number of effective features. Furthermore, these methods either solely utilized geometric features within traffic scenes or exclusively extracted semantic information, failing to comprehensively consider both aspects. This limited the comprehensive feature extraction from scenes, ultimately leading to a decrease in calibration accuracy. Additionally, conventional vanishing point-based self-calibration methods often required the design of additional edge-background models and manual parameter tuning, thereby increasing operational complexity and the potential for errors. Given these observed limitations, and in order to address these challenges, we propose an innovative roadside camera self-calibration model based on the Transformer architecture. This model possesses a unique capability to simultaneously learn scene features and vehicle features within traffic scenarios while considering both geometric and semantic information. Through this approach, our model can overcome the constraints of prior methods, enhancing calibration accuracy and robustness while reducing operational complexity and the potential for errors. Our method outperforms existing approaches on both real-world dataset scenarios and publicly available datasets, demonstrating the effectiveness of our approach.

Most real-time terrain point cloud rendering techniques do not address the empty space between the points but rather try to minimize it by changing the way how the points are rendered by either rendering them bigger or with more appropriate shapes such as paraboloids. In this work, we propose an alternative approach to point cloud rendering, which addresses the empty space between the points and tries to fill it with appropriate values to achieve the best possible output. The proposed approach runs in real time and outperforms several existing point cloud rendering techniques in terms of speed and render quality.

In this article, we introduce a relatively new concept of multi-valued (θ;R)-contractions and utilize the same to prove some xed point results for a new class of multi-valued mappings in metric spaces endowed with an amorphous binary relation. Illustrative examples are also provided to exhibit the utility of our results proved herein. Finally, we utilize some of our results to investigate the existence and uniqueness of a positive solution for the integral equation of Volterra type.

Background: Reelin is a large extracellular glycoprotein secreted by Cajal–Retzius cells and has a main role during brain development, especially in neuronal migration. Reelin is comprised of N-terminal F-spondin like domain, eight tandem repeats, and a highly conserved basic C-terminal region (CTR). The CTR main role in the secretion of Reelin has been investigated by advertently inducing deletion in whole or a part of this region; however, the role of CTR point mutations on the secretion of Reelin is shrouded in mystery. Materials and Methods: In this study, we performed experimental analyses on a subregion of Human Reelin containing 5th and 6th repeats (R5-R6), a part of 8 th repeat and the CTR which were amplified from cDNA of K562 and HEPG2 cells and cloned into a mammalian expressional plasmid (pVP22/myc-His). Bioinformatics investigation was performed on the CTR at both level of nucleotide and amino acid as well as mutant type. Random mutagenesis by error-prone PCR method was utilized to induce mutation in the CTR. The secretion efficiency of recombinant wild-type and mutant Reelin constructs compared in cell lysate and supernatant isolated from the transiently transfected HEK 293T cells using 6XHistag ELISA method. Results: In-vitro study demonstrated that the CTR alteration(S3440P) leads to impairment of Reelin secretion even after overexpression. Conclusions: Our results indicate that S3440P substitution in highly conserved structure of the CTR has an important effect on Reelin secretion.

This paper aims at tackling with the task of fusion feature from images and its corresponding point clouds for 3D object detection in autonomous driving scenarios basing on AVOD, an Aggregate View Object Detection network. The proposed fusion algorithms fuse features targeted from Bird’s Eye View (BEV) LIDAR point clouds and its corresponding RGB images. Differs in existing fusion methods, which are simply the adoptions of concatenation module, element-wise sum module or element-wise mean module, our proposed fusion algorithms enhance the interaction between BEV feature maps and its corresponding images feature maps by designing a novel structure, where single level feature maps and another utilizes multilevel feature maps. Experiments show that our proposed fusion algorithm produces better results on 3D mAP and AHS with less speed loss comparing to existing fusion method used on the KITTI 3D object detection benchmark.

Assuming the Multiple Point Principle (MPP) as a new law of Nature, we considered the existence of the two degenerate vacua of the Universe: a) the first Electroweak (EW) vacuum at $v_1\approx 246$ GeV—“true vacuum”, and b) the second Planck scale “false vacuum” at $v_2 \sim 10^{18}$ GeV. In these vacua, we investigated different topological defects. The main aim of the paper is an investigation of the black-hole-hedgehogs configurations as defects of the false vacuum. In the framework of the $f(R)$ gravity, described by the Gravi-Weak unification model, we considered a black-hole solution, which corresponds to a “hedgehog”—global monopole, that has been “swallowed” by the black-hole with mass core $M_{BH}\sim 10^{18}$ GeV and radius $\delta\sim 10^{-21}$ GeV$^{-1}$. Considering the results of the hedgehog lattice theory in the framework of the $SU(2)$ Yang-Mills gauge-invariant theory with hedgehogs in the Wilson loops, we have used the critical value of temperature for the hedgehogs’ confinement phase ($T_c\sim 10^{18}$ GeV). This result gave us the possibility to conclude that the SM shows a new physics (with contributions of the $SU(2)$-triplet Higgs bosons) at the scale $\sim 10$ TeV. This theory predicts the stability of the EW-vacuum and the accuracy of the MPP.

The purpose of this article is to characterize the Caristi type mapping by the absolute derivative. The equivalences of the Caristi mapping with contraction mapping is discussed too. In addition, it was shown that the contraction mapping can be characterized by its absolute derivative.

This paper reports on the optimization of thin-film coating assisted self-sustainable off-grid hybrid power generation systems for cattle farming in rural areas of Bangladesh. Bangladesh is a lower middle-income country with declining rates of poverty among its 160 million people due to persistent economic growth in conjunction with balanced agricultural improvements. Most of the rural households adopt a mixed farming system by cultivating crops and simultaneously rearing livestock. Among the animals raised, cattle are considered as the most valuable asset for the small/medium-scale farmers in terms of their meat and milk production. Currently, along with the major health issue, the COVID-19 pandemic is hindering the world’s economic growth and has thrust millions into unemployment; Bangladesh is also in this loop. However, natural disasters such as COVID-19 pandemic and floods, largely constrain rural smallholder cattle farmers from climbing out of their poverty. In particular, small and medium-scale cattle farmers face many issues that obstruct them from taking advantage of market opportunities and imposing a greater burden on their families and incomes. An appropriate measure can give a way to make those cattle farmers’ businesses both profitable and sustainable. Optimization of thin-film coating assisted self-sustainable off-grid hybrid power generation system for cattle farming is a new and forward-looking approach for sustainable development of the livestock sector. In this study, we design and optimize a thin-film coating assisted hybrid (photovoltaic-battery-generator) power system by using the Hybrid Optimization of Multiple Energy Resources (HOMER, Version 3.14.0) simulation tool. An analysis of the results has suggested that the off-grid hybrid system is more feasible for small and medium-scale cattle farming systems with long-term sustainability to overcome the significant challenges faced by smallholder cattle farmers in Bangladesh.

In the present work we study the existence of solutions for hybrid nonlinear fractional integrodifferential equations. We developed an algorithm by using the operator theoretical techniques in order to obtain the approximate solutions. The main results depend on the Dhage iteration method that were incorporated with the modern hybrid fixed point theorems. The approximate solutions were obtained by using Lipschitz conditions and weaker form of mixed partial continuity. Further, we provide some examples to explain the hypotheses and the related results.

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

Pregnancy planning and genetic testing (PPGT) has emerged as a tool in reproductive healthcare, offering parents-to-be insight in their risks of having a child with a genetic disorder. This paper reviews the advantages, drawbacks and challenges associated with PPGT, providing some practical guidance for health care professionals. Advantages include identification of genetic risks, a possibility to informed reproductive decision-making, and the potential to reduce the parents-to-be risk for an affected child. Challenges and drawbacks include provision of service, ethical considerations, genetic counselling complexities, and the need to increase public and professional awareness by comprehensive education and accessibility. Practical guidance involves considerations for selecting appropriate candidates, counselling strategies, and how to integrate PPGT into existing healthcare frameworks. By addressing these factors, PPGT can offer an increased reproductive informed choice for the individual and the couple reducing the burden of disease in the family.

Cable-supported façades represent a novel approach in the design and technology of double skin façades (DSF). This type of systems not only offer flexibility in terms of exterior finishes, but also regulates the access of solar radiation, thereby transforming the appearance of the building in response to varying daylight conditions. However, the structural performance of these façades under wind, impact and seismic loads remains an active area of research. The study is a groundbreaking work that experimentally evaluates the wind and seismic behaviour of these type of façades. The methodology used for the evaluation of flexible masonry facades includes laboratory tests analysing the individual capacity of the connections and materials of the system under standardized and non-standardized procedures. A full-scale experimental sub-assembly specimen of a representative module of the façade is also subjected to uniformly distributed pressures of wind load tests as well as hard body and soft body impact tests. The setup considered the border conditions, tension loads, and actual materials. Furthermore, the earthquake assessment includes tests of full-scale specimens subjected to these demands. Research findings allowed the refinement and redesign of the system's components granting the validation of the DSF used as a case study.

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

In this paper, the notion of θ∗-weak contraction is introduced, which is utilized to prove some fixed point results. These results are helpful to give a positive response to certain open question raised by Kannan [Amer. Math. Monthly 76:1969] and Rhoades [Contemp. Math. 72:1988] on the existence of contractive definition which does not force the mapping to be continuous at the fixed point. Some illustrative examples are also given to support our results. As applications of our result, we investigate the existence and uniqueness of a solution of non-linear matrix equations and integral equations of Volterra type as well.

Using a theorem of Ulam and Hyers, we will prove the Hyers-Ulam stability of two-dimensional Lagrange's mean value points $(\eta, \xi)$ which satisfy the equation, $f(u, v) - f(p, q) = (u-p) f_x(\eta, \xi) + (v-q) f_y(\eta, \xi)$, where $(p, q)$ and $(u, v)$ are distinct points in the plane. Moreover, we introduce an efficient algorithm for applying our main result in practical use.

Improving the quality and access to healthcare services in rural areas is fundamental to develop sustainable healthcare systems. This research aims to explore the motivations of healthcare professionals to work and settle in rural island areas of Greece with limited access to secondary and tertiary care. The study suggests practical ways to encourage self-motivation and attract more health workers in rural areas. An exploratory qualitative research approach was employed, involving semi-structured interviews with 16 healthcare professionals working in primary care units that lack direct hospital or hospital-health center access. The research was conducted specifically in the rural islands of Cyclades. Thematic analysis was conducted to identify common themes and unique insights from the participants. The analysis revealed three thematic categories. Τhe «attraction» thematic was influenced by personal factors, random selection, origin, accommodation factors, professional factors and obligatoriness. The «recruitment» thematic was associated with understaffing, special care issues, unstable working environment, educational and organizational aspects, and insular lifestyle. The thematic of «retention» highlighted personal issues, accommodation difficulties, economic and work-related issues, and unique challenges posed by an insular lifestyle. This research provides valuable insights into the motivations that drive healthcare professionals to settle, work, and remain in remote island units, as well as the challenges they encounter in making this decision. The study proposes strategies to motivate and attract more healthcare professionals to rural areas. These findings should be considered when formulating or reviewing primary healthcare empowerment policies to ensure equitable healthcare access for all individuals.

The term dehumanisation refers to the ways in which a person is perceived to be less than human or treated as if they are less than human. It involves treating a person as if they are a child or infant, like an animal or non-living object, or as if they are dead, or any other way in which someone fails to be treated like a human being with an adult identity. Dehumanisation is widespread in dementia care; it is a major obstacle to person-centred care and has poor outcomes for people with dementia. This article proposes a new model of dehumanisation. The New Model presents a new way of describing dehumanisation that has been synthesised from current understanding about the phenomenon and reflects what is presently known about the subject. The model aims to summarise existing theories and models of dehumanisation and make dehumanisation theory accessible to students and trainees in healthcare. This article describes the new model, discusses existing models and theories in the literature, and explores the potential role of the new model in solutions for reducing dehumanisation in dementia care.

It is well known that fiber sizing is one of the most important component in the manufacturing of composites, and it does affect the mechanical properties including strength and stiffness. In this work, the influence of fiber sizing levels on the mechanical properties of carbon fibers (CF) is reported at room temperature by using single fiber tensile testing (Favimat+), single fiber pullout testing (SFPO), and interfacial elemental analysis using X-ray photoelectron spectroscopy (XPS). Standard modulus of CF (7±0.2 μm in diameter) were sized using two Michelman commercially available sizing formulations. The average solid content for each sizing formulation is 26.3 ± 0.2% and 34.1 ± 0.2%, respectively. HEXION RIMR 135 with curing agent RIMH 137 was used as a model thermoset epoxy matrix during the SFPO measurements. A predictive engineering fiber sizing methodology is also developed. Sizing amounts of 0.5, 1, and 2 wt. % on the surface of the fiber is achieved for both sizing formulations. For each fiber sizing level, 50 single fiber tensile testing experiments and 20 single fiber pull-out tests were conducted. The ultimate tensile strength (σult) of the carbon fibers and the interfacial shear strength (τ_app) of the single fiber composite were analyzed. it is also investigated the effect of the sizing levels on the interfacial shear stress and the O/C (Oxygen/Carbon) surface composition ratio. As a result, generalized fiber sizing and characterization methods were established. The developed methods can be used to characterize the strength and interfacial shear strength of any man-made fibers with different sizing formulations and solid contents, irrespective of the matrix i.e. thermoset or thermoplastic.

In the context of evolving perceptions of sexuality, particularly within the realm of health and disability, this study investigates the impact of multiple sclerosis (MS) on female sexual function and quality of life. A quantitative study involving 130 female MS patients aged 35 to 50 was conducted, employing measures such as The Female Sexual Function Index (FSFI), The Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19), and The Fatigue Severity Scale (FSS). Results indicate a significant association between greater sexual dysfunction and poorer quality of sex life, alongside the correlation of increased fatigue with diminished sexual satisfaction. Factors such as education level, time of diagnosis, and treatment regimen also influenced outcomes. Findings underscore the importance of supportive interventions, including counseling, to enhance the quality of sex life for women with disabilities, particularly those with MS.

Abstract: (1) Background: Post-COVID syndrome is defined as symptoms that occur simultane-ously with or after COVID-19 infection, last for 12 weeks, and are not due to another diagnosis. Limited data are available on people’s long-term quality of life (QoL) following COVID-19 infection. The aim of this cross-sectional study was to investigate long-term QoL after COVID-19 among employees of the St. Josef Hospital in Paderborn, Germany, and to identify risk factors. (2) Methods: A monocentric, cross-sectional study was conducted using the validated and digitized WHOQOL-BREF questionnaire via Netigate® between 10/2022 and 02/2023. Data on QoL and global health status were collected in the following four domains: physical health, mental health, social relationships, and environment. (3) Results: The response rate was 73.84% (923/1250). Furthermore, 63.45% of hospital staff respondents reported at least one persistent symptom after COVID-19 infection, leading to significant differences in QoL. Pre-existing conditions, persistent symptoms, and disability after COVID-19 infection, as well as high BMI, no partnership, and low educational level were found to significantly contribute to long-term low QoL. (4) Conclusions: Obesity, lack of partnership, and a low level of education were independent risk factors for lower QoL post-COVID-19 infection in this cohort of hospital staff. Further multicenter studies are re-quired to validate the incidence and their suitability as independent risk factors for post-COVID syndrome.

This study assessed health inequality trends and the degree of maternal healthcare services utilization in the DRC, using two consecutive Demographic and Health Surveys, 2007 and 2013-2014. First, we assessed the changes in the magnitude of inequality in the utilization of MHCS using logistics and regressions. Second, we analyzed the distribution of inequality in each MHCS utilization variable using the Gini coefficient and the Lorenz curve. Third, we used the Wagstaff two groups concentration indices comparison method to assess health inequality trends. Finally, we fitted the concentration curves to estimate the inequality in the utilization of MHCS to the economic condition of women. Women were less likely to have their first ANC visit within the first trimester, less likely to receive checkups during ANC visits, and less likely to attend more ANC visits when living in eastern DRC compared to western DRC. Women in rural areas were less likely to have their last birth by C-section, and less likely to receive PNC than women in urban areas. Women with middle, richer, and richest wealth indexes were more likely to complete more ANC visits, more likely to deliver by C-section, most likely to receive PNC, and more likely to receive ANC than those with lower wealth indexes. Over time, inequality in the utilization of MHCS decreased for ANC and PNC but increased for the delivery by C-sections. These findings suggest that innovative strategies are still needed to improve the utilization of MHC services among poorer, rural, and underserved women in post-conflict DRC.

With a reduction in the mortality rate of burn patients, patient length of stay (LOS) is increasingly adopted as an outcome measure. Some studies have attempted to identify factors that explain a burn patient's expected LOS. However, few have investigated the association between LOS and a patient's mental and socioeconomic status. There is anecdotal evidence for links between these factors and uncovering these will aid in better addressing the specific physical and emotional needs of burn patients, and facilitate the planning of scarce hospital resources. Here, we employ machine learning (clustering) and statistical models (regression) to investigate whether a segmentation by socioeconomic/mental status can improve the performance and interpretability of an upstream predictive model, relative to a unitary model derived for the full adult population of patients. Although we found no significant difference in the performance of the unitary model and segment-specific models, the interpretation of the segment-specific models reveals a reduced impact of burn severity in LOS prediction with increasing adverse socioeconomic and mental status. Furthermore, the models for the socioeconomic segments highlight an increased influence of living circumstances and source of injury on LOS. These findings suggest that, in addition to ensuring that the physical needs of patients are met, management of their mental status is crucial for delivering an effective care plan.