The nature of Artisanal mining in Ghana exposes its workers to various levels of health, safety and environmental (HSE) threats. These miners are mostly liable for their own HSE state at work. In an attempt to understand the HSE dynamics of artisanal miners, this study sought to assess the effect of HSE conditions on self-protection at work by artisanal goldminers in Ghana. A nested binary logistic regression model was fitted to a cross sectional survey of 500 artisanal goldminers while controlling for compositional and contextual factors. Of the HSE conditions, only health (OR= 1.653, p<0.001) and safety conditions (OR= 1.935, p<0.001) were robust in predicting self-protection in all three models. Goldminers who reported good health and safety conditions were more likely to fully protect themselves at work as compared to their counterparts who reported poor health and safety conditions. For compositional factors, female goldminers were 84% less likely to protect themselves. Miners who had senior high (OR= 1.759, p<0.001) or tertiary education (OR= 1.875, p<0.001) were more likely to protect themselves at work as compared to those with no formal education. Likewise, miners who undertook routine medical checkups (OR= 2.533, p<0.001) and the most experienced miners (OR= 2.734, p<0.001) were more likely to protect themselves at work. Counterintuitively, miners who earned more monthly income ($174 and above) were less likely to protect themselves. At the contextual level, miners who worked in non-production departments (OR= 2.001, p<0.001) and miners who worked in the medium scale subsector (OR= 5.311, p<0.001) were more likely to protect themselves at work. To increase consciousness of self-protection in artisanal mining, there is the need for a national dialogue on how to improve HSE conditions and in the absence of legislation, the complexities in managing HSE in the sector needs to be decoupled to achieve fair and standard HSE conditions as championed by the World Health Organization.

As Solar Photovoltaics in buildings reaches maturity, grid integration and economic yield are topics of greater interest. The traditional design of photovoltaic installations has considered the optimal orientation of photovoltaic modules to be that which yields the maximum annual energy production. The influence of the consumption patterns and the hourly-variable electricity prices implies that this traditional optimal design might not be the most profitable. Using a full-year dataset for a residential installation, alternative installations using canopies and modules attached to the façades are simulated. Simulating the energy balances for different annual consumptions, it is found that the canopy and façade installations offer better self-consumption of the PV produced energy, reflected in a 9% higher self-consumption degree using modules on façades and a 5% using canopies. The economic evaluation under the new electricity tariffs in Spain shows a better profit for PV self-consumption, reducing by more than 2 years the time of return on investment. The analysis of different alternatives for an industrial PV has allowed us to identify several benefits for these orientations, such as an increase in annual energy production of up to 59% over the optimal-producing orientation, that are confirmed after several months of operation.

Body-Esteem Scale is an assessment tool for adolescents and adults that evaluate three dimensions of self-evaluations of one’s body. Body-Esteem Scale has been translated and validated in some countries since America down to Europe. Lack of translation and reliability evidence in Portugal was detected. This study aimed to translate and test the validity and reliability of the Body Esteem Scale for Adolescents and Adults (BESAA) in students in the context of Portuguese higher educa-tion. A total of 173 students (60.7% are female) with a mean age of 19.7 (standard deviation = 2.2) years participated. Categorical Principal Component Analysis was used to assess the underlying dimensions of BESAA. Construct validity was evaluated through correlation with the Appearance Schemas Inventory – Revised and a three-factor model (“Appearance”, ‘‘Weight’’ and “Attribu-tion’’) was established. Confirmatory factor analysis was performed to verify the construct validity of the instrument. Items that had factor weights (λ)<.40 were removed, as well as those that were considered redundant by the modification indices estimated by the Lagrange Multipliers (LM) method (LM>11, p<.001). We observed high correlations between theoretically similar factors, and low correlations between different factors. The Portuguese BESAA showed adequate validity and reliability.

This study examined the effects of group art therapy on depression, burden, and self-efficacy in primary family caregivers of patients with brain injuries. This was a quasi-experimental, nonequivalent control group and a pre- and post-test design. This study was carried out in one national rehabilitation hospital targeting 41 primary family caregivers of patients with brain injuries. Group art therapy intervention was carried out three days per week for 12 times over four consecutive weeks. The experimental group (n = 20) received group art therapy, whereas the control group (n = 21) did not. We used a time difference method to minimize the risk of contaminating the control group by sampling sequentially. The experimental group showed a significantly greater decrease in burden (t = 2.462, p = 0.020) and significantly greater improvement in self-efficacy (t = −6.270, p &lt; 0.001) than the control group. Group art therapy may be an effective nursing intervention for primary family caregivers of patients with brain injuries.

Sarcasm is a linguistic expression often used to communicate the opposite of what is said, usually something that is very unpleasant with an intention to insult or ridicule. Inherent ambiguity in sarcastic expressions, make sarcasm detection very difficult. In this work, we focus on detecting sarcasm in textual conversations from various social networking platforms and online media. To this end, we develop an interpretable deep learning model using multi-head self-attention and gated recurrent units. Multi-head self-attention module aids in identifying crucial sarcastic cue-words from the input, and the recurrent units learn long-range dependencies between these cue-words to better classify the input text. We show the effectiveness of our approach by achieving state-of-the-art results on multiple datasets from social networking platforms and online media. Models trained using our proposed approach are easily interpretable and enable identifying sarcastic cues in the input text which contribute to the final classification score. We visualize the learned attention weights on few sample input texts to showcase the effectiveness and interpretability of our model.

A phosphate/molybdate and cerium-modified phosphate/molybdate conversion coatings were deposited on a carbon steel surface and their protective and self-healing abilities were evaluated. Surface morphology and inner structure of the coatings were examined using FE-SEM-FIB and TEM techniques, chemical composition and element distribution depth profiles in conversion layers were determined using EDX measurements, whereas XPS was applied for the analysis of Mo and Ce oxidation states. Voltammetric measurements and EIS were performed to assess the corrosion behavior of the samples. The higher protective and stronger self-healing abilities were found for phosphate/molybdate/cerium conversion coating deposited in a sulphate-containing solution. This was attributed to higher values of both: total cerium and Ce(IV) content in the conversion layer as well as to lower number of structural defects in the coating. It was demonstrated that the micro-structural characteristics of protective coatings are also important in determining self-healing abilities.

This review will explore the four major pillars required for design and development of an saRNA vaccine: antigen design, vector design, non-viral delivery systems, and manufacturing (both saRNA and lipid nanoparticles (LNP)). In will report on the major innovations, preclinical and clinical data reported in the last five years and will discuss future prospects.

The effect of the strain rate on damage in carbon black filled EPDM stretched during single and multiple uniaxial loading is investigated. This has been performed by analysing the stress-strain response, the evolution of damage by Digital Image Correlation (DIC), the associated dissipative heat source by InfraRed thermography (IR), and the chains network damage by swelling. The strain rates were selected to cover the transition from quasi-static to medium strain rate conditions. In single loading conditions, the increase of the strain rate yields in a preferential damage of the filler network while rubber network is preserved. Such damage is accompanied by a stress softening and an adiabatic heat source rise. Conversely, increasing the strain rate in cyclic loading conditions yields in a filler network accommodation and a high self-heating whose combined effect is proposed as a possible cause of the ability of filled EPDM to limit damage, by reducing cavities opening during loading and favoring cavities closing upon unloading.

Social distancing, washing hands and good hygiene are essential and currently the most potent methods available to curb down the unprecedented speed by which the new coronavirus is spreading across the globe. Even under lockdown, which is necessary to significantly reduce the number of people that get infected by an ill person, are there additional measures that each of us can embrace to even further reduce the risk of infection and the severity of the COVID-19 disease? Given the lack of licensed drugs that target SARS-CoV-2 specifically, we have to look into additional non-specific defense mechanisms that animals and humans evolved to protect themselves from pathogen invasions. The goal of this article is to describe how various of our non-specific defense mechanisms work, which actually precede the inflammatory response, and to discuss whether we can exploit the unique features of the coronavirus envelope and the self-cleaning machinery of the human respiratory tract to strengthen our self-defense. The challenge is to actively interfere with supportive measures during the short time window between getting exposed and before an inflammatory response gets initiated.

There are many criterion to generalize the concept of numerical radius; one of the most recent interesting generalization is what so called the generalized Euclidean operator radius. Simply, it is the numerical radius of multivariable operators. In this work, several new inequalities, refinements and generalizations are established for this kind of numerical radius.

In this paper, the columnar supramolecular aggregates of photosensitive star-shaped azobenzenes with benzene-1,3,5-tricarboxamide core and azobenzene arms are analysed theoretically applying a combination of computer simulation techniques. Without a light stimulus, the trans-stars build one-dimensional columns of stacked molecules during the first stage of the noncovalent association. These columnar aggregates represent the structural elements of more complex experimentally observed morphologies -- fibers, spheres, gels and others. Upon UV light exposure, the azobenzene arms isomerise from thermodynamically stable planar trans- to a metastable kinked cis-state influencing the aggregate morphology. Here, we determine the most favourable mutual orientations of the \textit{trans}-stars in the stack in terms of (i) the pi-pi distance between the cores lengthwise the aggregate, (ii) the star slipped displacements and (iii) the rotation promoting the helical twist and chirality of the aggregate by calculating the binding energy diagrams using density functional theory. The model predictions are further compared with available experimental data. The intermolecular forces responsible for the stability of the stacks made of trans-azobenzene stars in crystals are quantified using Hirshfeld surface analysis. Finally, to characterize the self-assembly mechanism of such stars in solution, we calculate the hydrogen bond lengths, the normalized dipole moment and the binding energies as the functions of the columnar length using molecular dynamics trajectories, and conclude about the cooperative nature of this process.

Nanostructured anodic oxide layers on an FeAl₃ intermetallic alloy were prepared by two-step anodization in 20 wt.% H2SO4 at 0°C. The voltage range was 10.0 – 22.5 V with a step of 2.5 V. The structural and morphological characterizations of the received anodic oxide layers were performed by FE-SEM. Therefore, the formed anodic oxide was found to be highly porous with a high surface area, as indicated by the FE-SEM studies. It has been shown that the morphology of fabricated nanoporous oxide layers is strongly affected by the anodization potential. The oxide growth rate first increased slowly (from 0.010 μm/s for 10 V to 0.02 μm/s for 15 V) and then very rapidly (from 0.04 μm/s for 17.5 V up to 0.13 μm/s for 22.5 V). The same trend was observed for the change in the oxide thickness. Moreover, for all investigated anodizing voltages, the structural features of the anodic oxide layers, such as the pore diameter and interpore distance, increase with increasing anodizing potential. The obtained anodic oxide layer was identified as a crystalline FeAl₂O₄, Fe₂O₃ and Al₂O₃ oxide mixture.

This paper provides estimates of the elasticity of substitution between operational and managerial jobs in the US economy covering a period of almost five decades, derived from an aggregate CES production function. Estimating the long-term relationship between (the log of) the aggregate employment/self-employment ratio and (the log of) the returns from paid-employment relative to self-employment and testing for structural breaks, we report different estimates of the elasticity of substitution in each of the two regimes identified. Our results help to understand and interpret one of the most intriguing aspects in the evolution of self-employment rates in developed countries: the reversal of the trend in self-employment rates. Our estimates show that a higher level of development is associated with a greater number of entrepreneurs and smaller firms. Some rationales for understanding the growth of the elasticity between paid-employment and self-employment, including the recent trends in the digital economy—are also suggested.

In the present work, we designed a mild strategy to make Cu₂(OH)PO₄ (CHP) nanoparticles on cotton fabrics (CFs) to achieve multi-functionalities. The phytic acid (IP6) assisted method was employed to synthesize nanoparticles (CHP-IP6). Under Fourier-transform infrared spectroscopy (FTIR), X-ray diffraction (XRD), scanning electron microscopy (SEM), energy-dispersive X-ray (EDX), transmission electron microscope (TEM), X-ray photoelectron spectroscopy (XPS) as well as thermogravimetric analysis (TGA), we characterized the coated cotton fabrics. The CHP-IP6 treated fabrics showed prominent photocatalytic activity, excellent photocatalytic stability and thorough discoloration of methylene blue (MB) stain under sunlight irradiation.

System level diagnosis is an abstraction of high level and, thus, its practical implementation to particular cases of complex systems is the task which requires additional investigations, both theoretical and modeling. Mostly, diagnosis at system level intends to identify only permanently faulty units. In the paper, we consider the case when both permanently and intermittently faulty units can occur in the system. Identification of intermittently faulty units has some specifics which we have considered in this paper. We also suggest the method which allows distinguishing among different types of intermittent faults. Diagnosis procedure was suggested for each type of intermittent faults.

The first group to build artificial general intelligence or AGI stands to gain a significant strategic and market advantage over competitors, so companies, universities, militaries, and other actors have strong incentives to race to build AGI first. An AGI race would be dangerous, though, because it would prioritize capabilities over safety and increase the risk of existential catastrophe. A self-regulatory organization (SRO) for AGI may be able to change incentives to favor safety over capabilities and encourage cooperation rather than racing.

The purpose of this study is to examine the self-esteem levels of visually handicapped individuals who do sports and do’t do sports. There were 106 sportsmen and 94 persons with visual handicapped (200 in total) who participated in the research clubs in the province of Izmir. As the sub-problems, the relationship between the genders of participant who visually handicapped and not visually handicapped was investigated. The study consists of two parts. In the first part, the demographic characteristics of the participants were determined; in the second part Rosenberg Self Value scale consisting of 10 questions was used. Data were analyzed with SPSS 18.00 package program. T test, correlation analysis, descriptive statistics were applied to test hypotheses of the study. The research found that there is a significant difference between the self-esteem levels of individuals with and without visually handicapped sports (P <0.05). No statistically significant difference was found between the self-esteem levels of the sportsmen and the sportswomen (P> 0,05). There was no significant difference in the self-esteem levels of visually handicapped individuals who played individual sports and team sports (P> 0,05). As a result, it has been seen that sports have a positive effect on self-esteem in visually handicapped individuals and they contribute and hold to life more meaningful.

By manipulating the various physico-chemical properties of amino acids, design of peptides with specific self-assembling properties has been emerging since more than a decade. In this context, short peptides possessing detergent properties (so-called “peptergents”) have been developed to self-assemble into well-ordered nanostructures that can stabilize membrane proteins for crystallization. In this study, the peptide with “peptergency” properties, called ADA8 extensively described by Zhang et al., is studied by molecular dynamics for its self-assembling properties in different conditions. In water, it spontaneously forms beta sheets with a β barrel-like structure. We next simulated the interaction of this peptide with a membrane protein, the bacteriorhodopsin, in the presence or absence of a micelle of dodecylphosphocholine. According to the literature, the peptergent ADA8 is thought to generate a belt of β structures around the hydrophobic helical domain that could help stabilize purified membrane proteins. Molecular dynamics is here used to challenge this view and to provide further molecular details for the replacement of detergent molecules around the protein. To our best knowledge, this is the first molecular mechanism proposed for ''peptergency''. In addition, our calculation approach should serve as a predicting tool for the design of beta peptergent with diverse amphipathic properties.

The synthesis these past few years of novel organic molecules that spontaneously self-assemble into a large variety of molecular architecture, particularly generating organogels, has opened up new horizons for preparing functional materials. Here, we present an original preparation path of such materials through the making of hybrid gels of these molecules together with covalent polymers. Three types of systems are described: i) intermingled gels where a polymer gel and an organogel pervade one another; ii) encapsulation of self-assembled filaments in polymer fibrils, which provides a system with unusual magnetic properties; iii) the reverse situation where self-assembled nanotubes sheathe polymer fibrils. Here two covalent polymers are considered: a neutral polymer, namely stereoregular polystyrene (isotactic or syndiotactic), and a semi-conducting polymer, P3BT. In the latter case, semi-conducting nanowires are obtained.

Chitosan is a cationic polysaccharide usually obtained by alkaline deacetylation of chitin poly(N-acetylglucosamine). It is biocompatible, biodegradable, mucoadhesive and non-toxic. These excellent biological properties make chitosan a good candidate for a platform in developing drug delivery systems having improved biodistribution, increased specificity and sensitivity, and reduced pharmacological toxicity. In particular, chitosan nanoparticles are found to be appropriate for non-invasive routes of drug administration: oral, nasal, pulmonary and ocular routes. These applications are facilitated by the absorption-enhancing effect of chitosan. Many procedures for obtaining chitosan nanoparticles have been proposed. Particularly, the introduction of hydrophobic moieties into chitosan molecules by grafting to generate a hydrophobic-hydrophilic balance promoting self-assembly is a current and appealing approach. The grafting agent can be a hydrophobic moiety forming micelles that can entrap lipophilic drugs or it can be the drug itself. Another suitable way to generate self-assembled chitosan nanoparticles is through the formation of polyelectrolyte complexes with polyanions. This paper reviews the main approaches for preparing chitosan nanoparticles by self-assembly through both procedures and illustrates the state of the art of their application in drug delivery.

Development of early math skills is linked to future success in mathematics and other academics. Educational videogames have been shown to promote academic achievement; however, few rigorous studies have evaluated the use of educational videogames in supporting math development, especially in early primary education. In the current study, an open-label randomized controlled trial was conducted involving 134 first grade students to determine, using standardized assessments, the impact of the educational mathematics tablet-based videogame, Knowledge Battle, on math scores and self-competency. Overall, Knowledge Battle did improve math skills in participants who played the game. Among those with lower pre-game math skills, the Knowledge Battle group’s mean math score increased more than the control group’s mean math score (9.7 vs. 6.0; p=0.02). There was no association between perceived sense of self-competency and total math score (p=0.8141). However, players who had a higher sense of self-competency were more likely to enjoy playing the game. In conclusion, our findings suggest that Knowledge Battle was an acceptable and enjoyable educational mathematical videogame for first grade students, and may be most impactful for those with low math skills.

Background: Suicide is a major health problem. The aim of this study was a comparative study of the causes and methods of completed suicide referred to legal Medicine Organization in Bushehr Province during the years 2006- 2015. Methods: This consideration has been done as a retrospective cross-sectional study; the data were collected by the check list. After coordination to the medico legal 343 cases of completed suicide lead to death over a ten year period from 2006 to 2015 were extracted and the data were analyses by SPSS software. Results: The rate of completed suicide was 2.43 and 1.12 suicides per 100,000 people in male and female, respectively. The mean age were 29.25 and 27.61 years in male and female, respectively p>0.05. A higher completed suicide rate was found among single people. The most common ways of a suicide among people who live in Bushehr were hanging out 184(53.6%), self-Immolation 83(24.2%) and firearms 37(10.8%). Motive of suicide was psychological disorders, Physical disease, Conflict with family and substance abuse. 43(12.5%) people smoking and 22(6.4%) people were both smoking and opioid. During the ten year period of studied, throughout the all years that frequency of hanging out has been higher than others. Conclusion: Due to the high incidence of completed suicide in young people and unmarried individuals also hanging out in male and self-burning in females are prevalent. So determination of preventive measures appears to be necessary. Social factors such as psychological disorders and family conflicts have a noticeable role from .Bushehr people.

To resolve problems in the dietary life of university athletes, education is essential for enabling athletes to change their own dietary behavior. The purpose of this research, it was decided to verify the effectiveness of sports nutrition education based on self-determination theory (SDT). Methods, the subjects were thirty-six male university rowers. A stratified randomized comparison test was conducted by student year (SDT group and control group). Sports nutrition education was held three times, via an Internet conferencing system. Furthermore, group work over social media was used for the SDT group. Four evaluations were carried out based on anthropometric measurements, brief-type self-administered diet history questionnaire (BDHQ),sports nutrition knowledge (SNK), and treatment self-regulation questionnaire (TSRQ). Results, for the intra-group factor "Protein," a significant difference was evident in the self-determination theory group (50.0±28.5, 78.6±28.1, 81.0±21.5, p<0.000, units: %), and there were significant differences between after and before, and between three months after and before (p=0.002, p=0.002). For BDHQ, significant differences were evident for green/yellow vegetables, fruits, and dairy between after and before for the self-determination theory group (159.1±74.2-126.7±70.6, p=0.009, 306.0±196.2-195.2±146.1, p=0.020, 257.0±147.0-183.3±167.9, p=0.040, units: g). In conclusion, sports nutrition education based on SDT improved dietary knowledge and increased dietary intake.

Regionalization of food systems for shortening supply chains and developing local agriculture to feed city-regions presents particular challenges for food planning and policy. Existing foodshed approaches enable to assess the theoretical capacity of food self-sufficiency of a specific region, but they struggle to consider the diversity of existing crops in a way that could be usable for informing decisions and support urban food strategies. Most studies are based on the definition of the area required to meet local consumption, obtaining a map represented as an isotropic circle around the city, without considering the site-specific pedoclimatic, geographical and socio-economic conditions, which are essential for the development of local food supply chains. In this study we propose a first stage to fill this gap by combining the Metropolitan Foodshed and Self-sufficiency Scenario (MFSS) model, which already considers regional yields and specific land use covers, with spatially explicit data on cropping pattern, soil and topography. We use European-wide available data and apply the methodology in the city-region of Avignon (France), initially considering a foodshed with a radius of 30 Km. Our results show that even though a theoretical high potential self-sufficiency could be achieved for the whole food commodities consumed (>80%), when considering the specific pedological conditions of the area, this could be suitable only for domestic plant-based products, whereas for animal products an expansion of the initial foodshed to a radius of 100Km was required to provide >70% of self-sufficiency. We conclude that it is necessary to shift the analysis from the size assessment to the commodity-group specific spatial configuration of the foodshed based on biophysical and socio-economic features, and discuss avenues for further researches enabling to develop a foodshed assessment as a complex of complementary pieces: the foodshed archipelago.

Dietary supplements are widely embraced by cancer patients seeking complementary and integrative approaches to their care. Unfortunately, many patients do not discuss supplement use with physicians, often due to perceptions of physician indifference or negativity toward supplements. This communication gap exposes patients to unreliable information sources and, potentially, unnecessary risk. As the healthcare landscape evolves, patients increasingly value physicians who recognize their pivotal role in shaping healthcare decisions. This patient-centered perspective emphasizes the provision of evidence-based information tailored to individual needs, open discussions on potential risks, and shared decision-making. It underscores the importance of respecting patient autonomy, offering alternative options, documenting preferences, and ensuring ongoing support while coordinating with the healthcare team. To address these needs, healthcare providers should transform their perspectives and become expert guides who embrace patients as informed, empowered participants. This approach prioritizes open dialogue that considers both facts and uncertainties regarding dietary supplement use, allowing for mutually informed decision-making. Here, we review the literature and present a practical approach emphasizing open discussions, transparency, and respect for patient autonomy. Following this approach, healthcare providers can empower patients to navigate the complexities of dietary supplement use in the context of cancer care, ultimately safeguarding patient safety and well-being.

Older adults with diabetes are at elevated risk of complications following hospitalization. Home health care services mitigate the risk of adverse events and facilitate a safe transition home. In the United States, when home health care services are prescribed, federal guidelines require they begin within two days of hospital discharge. This study examined the association between timing of home health care initiation and 30-day rehospitalization outcomes in a cohort of 786,734 Medicare beneficiaries following a diabetes-related index hospitalization. Of these patients, 26.6% were discharged to home health care. To evaluate the association between timing of home health care initiation and 30-day rehospitalizations, multivariate logistic regression models including patient demographics, clinical, geographic variables, and neighborhood socio-economic variables were used. Inverse probability-weighted propensity scores were incorporated into the analysis to account for potential confounding between the timing of home health care initiation and the outcome in the cohort. Compared to patients who received home health care within the recommended first two days, patients who received delayed services (3-7 days after discharge) had higher odds of rehospitalization (OR 1.28, 95% CI 1.25-1.32). Among patients who received late services (8-14 days after discharge), the odds of rehospitalization were four times greater than for patients receiving services within 2 days (OR 4.12, 95% CI 3.97-4.28). Timely initiation of home health care following diabetes-related hospitalizations is one strategy to improve outcomes.

Background: The use of technology in paediatrics is increasing, and new health technology will change the way in which paediatric care is delivered in the future. This review is part of the Royal College of Paediatrics and Child Health Paediatrics 2040 project, which is developing a credible vision for the future of paediatrics in the UK. Aims: To summarise the impact of health technology on the delivery of paediatric care over the last ten years. To learn from existing technology use and make recommendations for future implementation. Methods: A search strategy was developed and two databases (Cochrane Library and PubMed) were systematically searched in August 2019 for relevant publications in English. Searches were limited to papers published between January 2009 and August 2019 (with further rapid review of papers published between September 2019 and November 2020). We included papers that studied young people up to the age of 24 or on those providing care for this population. A thematic synthesis of the data from the included studies was undertaken using seven domains of paediatric care. Results: 128 studies were included, grouped by domain of care. Most included studies were defined as digital (n=55) or communication (n=37). Studies looked at the different types of health technology used within different domains of care, including secondary and tertiary care (n=39), public health and prevention (n=29), and community (n=20). Studies were assessed on delivery of care outcomes using positive, negative, mixed and no effect. The most common outcomes reported were adherence and satisfaction. Discussion: This review highlights the growing importance of technology in delivering paediatric care. Six themes emerged: the importance of clear guidelines, continuity of care, confidentiality and privacy, digital poverty, using a personalised approach, and using technology to supplement rather than replace. In future, technology development should involve the end user throughout the design process.

(1) Background: In a society with an advancing aging rate, medical systems are coming under pressure due to an increasing flow of elderly patients with multiple somatic diseases, exacerbated by their fragile psychological and sociological backgrounds. We aimed to investigate the relationship be-tween frailty and loneliness in elderly people. Our research question was “Is there a link between the loneliness and frailty in elderly people?” (2) Methods: To assess the link between loneliness and frailty, we conducted a search accessing Index Medicus and PubMed; the timeframe of our research was from 2013 till 2023. Data regarding the study population, as well as loneliness and fragility assessments and approaches, were extracted. (3) Results: A positive relationship between loneliness and the appearance and progression of frailty in elderly people is argued for. (4) Conclusions: Maintaining a balance in the body’s functionality for as long as possible requires the diagnosis and periodic assessment of health status at any age and, due to the various socio-financial and emotional implications, is particularly imperative for elderly patients. Frailty can be prevented, and it appears that it could even be reversed if early diagnosis and appropriate interventions are made. Therefore, knowledge of relevant risk factors—most likely including loneliness—is an absolute necessity to slow down, stop, and even reverse the frailty process.

Patients who survived critical COVID-19 frequently reported post-acute sequelae of COVID-19 (PASC) such as psychosomatic and neurocognitive health problems. The goal of this study was to identify clinical risk factors and other predictors for such long-term consequences in severely ill COVID-19 patients. Adult COVID-19 intensive care unit (ICU) survivors from August 2020 to May 2021 were enrolled. A broad range of clinical, laboratory and chest computed tomography (CT) data was collected during ICU stay. The association between ICU predictors and psychosomatic, respiratory and neurocognitive assessments 12 months after ICU discharge was analyzed using univariate regression analysis. In 17 patients (mean age 58.9 ± 11.4 years), laboratory markers (CRP, lymphocytes, hemoglobin), ICU severity (SOFA, SAPS II, need for mechanical ventilation), complications (ARDS), and lung CT data (ground-glass opacity) were promising predictors of depressive and anxiety symptoms, fatigue, and sleep problems. Recovery of psychosomatic health such as fatigue, depression and anxiety correlated with lower levels of inflammation and high hemoglobin levels. ARDS, mechanical ventilation and worse SOFA and SAPS II scores were further risk factors for depressive and anxiety symptoms. Our study identified novel associations such as pulmonary ground-glass opacity being positively associated with depression, anxiety, fatigue, and insomnia levels.

The architectural configuration of the space plays a crucial role in the acoustics of Neonatal Intensive Care Units (NICUs). The design of the environment, the materials used in construction, and the organisation of noise sources within the room significantly influence the noise levels present in these critical areas. For this research, noise levels found in two hospitals, with different architectural configurations and sizes but similar construction materials, have been analyzed. Data were recorded at 1-second intervals over a period of more than 24 hours. The data collected in these hospitals confirm the magnitude of the noise problem in NICUs, highlighting the urgent need to address it effectively to ensure an appropriate and safe environment for the recovery of neonates. Good architectural planning can help mitigate noise, while poor configuration can exacerbate acoustic problems, negatively affecting both patients and healthcare staff. It is crucial to involve architects, acoustic engineers, and healthcare staff in the design and renovation of NICUs to create spaces that not only meet medical needs but also consider the auditory well-being of neonates.

Background Main treatment modality for spinal meningiomas (SM) is gross total resection (GTR). However, optimal timing of surgery, especially in cases with absent or mild neurological symptoms remains unclear. The aim of this study is to assess the impact of early-stage resection on neurological outcome, quality of life (QoL) and quality of care. The primary objective was a favorable neurological outcome (McCormick scale 1); Methods: We retrospectively analyzed data from patients operated on SM between 2011 and 2021. Patients with mild neurological symptoms preoperatively (McCormick scale 1 and 2) were compared to those with more severe neurological symptoms (McCormick scale 3-5). Disabilities and QoL were assessed according to validated questionnaires (SF36, ODI, NDI). Results: Age, spinal cord edema, thoracic localization, and spinal canal occupancy ratio were associated with more severe neurological symptoms (all p<.05). Patients presented with mild symptoms were associated with favorable neurological outcome (OR: 14.778 (95%CI 3.918-55.746, p<.001), which is associated with shorter hospitalization, better QoL and less disabilities (p<.05). Quality of care was comparable in both cohorts; Conclusions: Early surgical intervention of SM, before the development of severe neurological deficits, should be considered as it is associated with a favorable neurological outcome and quality of life.

Introduction: Emotional intelligence plays a critical role in nursing leadership, influencing organizational dynamics and patient care. However, there is limited understanding of the impact of Emotional Intelligence on leadership in Primary Health Care in the Greek context. Methods: A longitudinal experimental design assessed the effects of an educational intervention on EI and leadership among Greek Primary Health Care nurses. Questionnaires, including the Wong and Law Emotional Intelligence Scale (WLEIS) and Multifactor Leadership Questionnaire - form 5x (MLQ), were administered pre- and post-intervention. Results: The intervention group exhibited significant improvements in Emotional Intelligence and adoption of transformational leadership styles compared to the control group. Tables highlighted nuanced changes in leadership dynamics post-intervention. Conclusions: Educational interventions effectively enhance nurses' Emotional Intelligence and influence leadership styles, emphasizing the need for tailored professional development programs in nursing education.

Introduction: Hospitalization in a COVID-19 unit represents a significant source of stress and psychological distress for patients. Our study aims to determine the factors of psychological distress in the therapeutic and psychosocial management of patients hospitalized with a COVID-19 infection. Methods: This cross-sectional study was carried out over 8 months at the COVID-19 zone of the CHU HASSAN II of FES. 99 patients were evaluated within days of diagnosis by psychometric scales of anxiety, depression, and post-traumatic stress. In the course of this follow-up, we found the presence of psychological impacts in these patients, and we tried to find correlating factors between the occurrence of psychiatric disorders and the set of factors related to sociodemographic data, hospitalization course and treatments taken, as well as family support. Results: 35% of patients had scores in favor of post-traumatic stress disorder, 37% of the patients had definite depression and 50% had anxiety. Post-traumatic stress, depression, and anxiety were correlated with sociodemographic factors, hospitalization, treatments received, and length of stay. Conclusion: The prevalence of anxiety-depressive disorders and post-traumatic stress disorder was high in patients with COVID-19, hence the interest in providing psychological and psychosocial care in the emergency department.

Objective: The long-term care insurance (LTCI) system was introduced in 2000 to provide financial support for long-term care services to older adults. What is known on this topic report focuses on a comparative analysis of how the LTCI system has affected older people in Japan. Methods: We obtained data from the literature about the LTCI system, compared and analysed the collected articles, and concluded. Results: The LTCI system has improved access to long-term care services, with more older adults receiving care than before the system’s implementation. This service has improved the quality of life for many elderly individuals who require assistance with daily activities. Furthermore, the LTCI system has alleviated the financial burden of long-term care services since the insurance covers a large portion of the costs. It has made older adults maintain their independence and dignity, as they can afford the necessary care without relying solely on their savings or burdening their families. Conclusions: Japan’s LTCI system has positively impacted older adults by improving access to long-term care services and alleviating financial burdens. However, challenges such as increasing demand and variations in service quality need to be addressed to ensure the system effectively supports older people in Japan.

The process of blood coagulation, wherein circulating blood transforms into a clot in response to internal or external injury, is a critical physiological mechanism. Monitoring this coagulation process is vital to ensure that blood clotting occurs neither too rapidly nor too slowly. Anticoagulants, a category of medications designed to prevent and treat blood clots, require meticulous monitoring to optimise dosage, enhance clinical outcomes, and minimise adverse effects. This review article delves into the various stages of blood coagulation, explores commonly used anticoagulants and their targets within the coagulation enzyme system, and emphasises the electrochemical methods employed in anticoagulant testing. Electrochemical sensors for anticoagulant monitoring are categorised into two types. The first type focuses on assays measuring thrombin activity via electrochemical techniques. The second type involves modified electrode surfaces that either directly measure the redox behaviour of anticoagulants or monitor the response of standard redox probes in the presence of these drugs. The review provides a comprehensive list of different electrode compositions and their detection and quantification limits. Additionally, it discusses the potential of employing a universal calibration plot to replace individual drug-specific calibrations. The insights presented are anticipated to significantly contribute to the sensor community's efforts in this field.

Humming is probably more effective than speech improving mothers' cardiorespiratory function and infants' self-regulation. We intend to understand the effects of: 1) maternal humming vs. speech on preterm infants’ physiological parameters; 2) maternal humming vs. speech on mothers’ physiological parameters; 3) humming melodic contours and of the lengthening of the final note on preterm infants’ physiological parameters. This study was designed as a single group repeated measure, using microanalytical methodology (ELAN software), with a protocol (silent baseline / speech or humming / silence / humming or speech / silence) applied to preterm dyads (N = 36). Audio and video observations were recorded. Infants’ and mothers’ heart rate (HR) and O2 saturation were observed once a minute. Proportion of O2 saturation relative to HR (Prop. O2 saturation/HR) was estimated for both partners during protocol. We found an infants’ HR mean significantly lower during humming (p = .028), a significantly higher Prop. O2 saturation/HR during humming for infants (p = .027) and for mothers (p = .029). The duration of sinusoidal contours together with the lengthening of the final note predict infants’ Prop. O2 saturation/HR. Musical features of humming seem to improve the physiological stability of preterm infants during kangaroo care.

More than one million curable sexually transmitted infections occur every day. Trichomonas vaginalis is one of the main responsible for these epidemiological data, however, the diagnosis of this protozoan is still mainly based on microscopic and culture identification. The commerciali-zation of immunological tests and the development of molecular techniques have improved the sensitivity of classical methods. Nevertheless, the fact that trichomoniasis is a neglected parasitic infection, hinders the development of novel techniques and their implementation in routine di-agnosis. This review article shows the different methods developed to identify T. vaginalis in population and the difficulties to diagnose male and asymptomatic patients. The importance of including this parasite in routine gynecological screening, especially in pregnant women, and the importance of considering T. vaginalis as an indicator of high-risk sexual behavior is also discussed.

Versatility, sensitivity and accuracy have made the real-time polymerase chain reaction (qPCR) a crucial tool for research as well as diagnostic applications. However, for point-of-care (PoC) use traditional qPCR faces two main challenges: long run times mean results are not available for half an hour or more and the requisite high-temperature denaturation requires more robust and pow-er-demanding instrumentation. This study addresses both issues and revised primer and probe designs, modified buffers and low ∆T protocols which, together, speed up qPCR on conventional qPCR instruments and will allow the development of robust, point-of-care devices. Our approach, called "FlashPCR", also allows efficient reverse transcription as part of a one-step RT-qPCR pro-tocol, making it universally applicable for both rapid research and diagnostic applications.

Pressure ulcers carry a significant risk in clinical practice and require effective preventive measures. This paper proposes a practical and interpretable approach to estimate the risk levels of pressure ulcers using decision tree models. In order to address the common problem of imbalanced learning in nursing classification datasets, various oversampling configurations are analyzed to improve data quality prior to modeling. The decision trees built are based on three easily identifiable and clinically relevant pressure ulcer risk indicators: mobility, activity and skin moisture. Their analysis allows nursing professionals to predict the risk levels of pressure ulcer and make informed decisions about patient care. Additionally, this research introduces a novel tabular visualization method to enhance the usability of the decision trees in clinical practice. The approach proposed aims to support nursing professionals in making timely decisions regarding the appropriate preventive interventions according to the risk levels of pressure ulcers, thus improving patient outcomes and healthcare costs. The usefulness and effectiveness of the models presented make them a valuable resource for nursing care in the prevention of pressure ulcers.

Osteoarthritis (OA) poses a growing challenge for the aging population, especially in hip and knee joints, contributing significantly to disability and societal costs. Conventional clinical evaluations, typically performed in controlled settings, face difficulties in capturing the dynamic characteristics of rehabilitation and functioning in real-life scenarios. The study assessed the use of automated unsupervised evaluations in the rehabilitation process for patients after hip and knee replacements. We analyzed data from 1144 individuals who used a digital application after surgery, activity data were collected using the Garmin Vivofit 4. Several parameters such as the Peak 6-Minute Consecutive Cadence (P6MC) and Peak 1-Minute Cadence (P1M) were computed and analyzed on a daily basis. The results indicated that cadence measurements, specifically, can effectively differ among individuals with hip and knee conditions as well as the recovery process. Moreover, these metrics demonstrated a high level of responsiveness in monitoring the progress of recovery, surpassing the effectiveness of simply measuring the total number of steps taken. The study highlighted the capacity of technology-driven, patient-centered rehabilitation to improve accuracy, tailor therapy to individual patients, and increased patient involvement. This research also highlighted the significance of automated, unsupervised assessments in enhancing rehabilitation results for OA patients following hip and knee replacement, as tele-rehabilitation becomes increasingly important.

Post-extubation dysphagia (PED) can lead to serious health problems in critically ill patients. Contrasting its high incidence rate of 12.4% reported in a recent observational study, many ICUs lack routine bedside screening, likely due to limited awareness. This study aimed to establish baseline data on the current approaches and the status of perceived best practices in PED screening and treatment, as well as to assess awareness of PED. A nationwide cross-sectional, online survey was conducted in all fourteen adult ICUs in the Republic of Cyprus in June 2018, with a 100% response rate. Over 85% of ICUs lacked a standard screening protocol for PED. The most commonly reported assessment methods were cough reflex testing and the water swallow test. Treatment approaches included muscle strengthening exercises without swallowing and swallowing exercises. Only 28.6% of ICUs acknowledged PED as a common issue. The study identified significant gaps in awareness and knowledge regarding PED screening and treatment in Greek-Cypriot ICUs. Urgent implementation of comprehensive dysphagia education programs within the units is necessary, and interdisciplinary collaboration among nurses, intensivists, and speech and language therapists is crucial to improve the quality of care provided.

(1) Background: Mobile health (mHealth) solutions can become means of improving functional recovery and reducing the peri-operative burden and costs associated with arthroplasty procedures. Aim of this study is to explore the objectives, functionalities, and outcomes of a platform designed to provide personalized surgical experiences to qualified patients, along with the associated problems and opportunities. (2) Methods: A survey-based analysis was conducted on patients who were prescribed the use of a specific care management platform and underwent primary Robotic total knee arthroplasty (rTKA) between January 2021 and February 2023. (3) Results: Patients registered on the platform who have undergone primary Robotic TKA (rTKA) were considered. The mean age of registered patients is 68,6 years. The male (M) / female (F) ratio is 45.1% / 54.9%. The patients interviewed were at an average distance of 485 days from the intervention, with a standard deviation of 187.5. The survey highlighted appreciation for the App and its features but limits in its use and in its perception from the patients. All these data were evaluated according to the Wald principles and strategies to improve patient recruitment, enhance adherence, and create a comprehensive patient journey for optimized surgical experiences were analyzed. (4) Conclusions: This patient care platform may have the potential to impact surgical experiences by increasing patient engagement, facilitating remote monitoring, and providing personalized care. There is the need to emphasizes the importance of integrating the recruiting process, improving adherence strategies, and creating a comprehensive patient journey within the platform

The contemporary landscape of eHealth is characterized by major concerns related to electronic medical records (EMRs). In an EMR, critical patient health information gets its own repository, which is the core of the eHealth system. Notably, the EMR not only retrieves health information generated in ambulatory clinical settings but also includes court-generated records. These overlapping records assume the role of a foundational data source for a comprehensive electronic health record (EHR). This scholarly review sheds light on recent trends in medical records and associated challenges, while at the same time providing insights into Saudi Arabia’s targeted approaches to healthcare delivery. Additionally, the talk expands to include a description of blockchain technology and its underlying conceptual framework. This demonstration positions blockchain technology as a promising approach that requires consideration for future use in the healthcare system.

Background: Patients with chronic obstructive pulmonary disease (COPD) often suffer from acute exacerbations. Our objective was to describe recurrent exacerbations in a GP based Swiss COPD cohort, and develop a statistical model for predicting exacerbation. Methods: In a questionnaire-based COPD cohort, demographic and medical data were recorded for 24 months. Data set was split into training (75%) and validation (25%) datasets. A negative binomial regression model was developed using the training dataset to predict the exacerbation rate within 1 year. An exacerbation prediction model was developed, and the overall performance was validated. A nomogram was created to facilitate the clinical use of the model. Results: Of the 229 COPD patients analyzed, 77% of patients had no exacerbation during the follow-up. The best subset in the training dataset found that lower forced expiratory volume, high scores on the MRC dyspnoea scale, exacerbation history, being on combination therapy of LABA+ICS or LAMA+LABA at baseline were associated with a higher rate of exacerbation. When validated, the area-under-curve (AUC) was 0.75 for one or more exacerbations. Calibration was accurate (predicted 0.34 exacerbations vs observed 0.28 exacerbations). Conclusion: Nomograms built from these models can assist clinicians in the decision-making process of their COPD care.

Background Ultrasonographic measurement of the optic nerve sheath diameter (ONSD) is helpful in the assessment of intracranial pressure. The aim of this study was to determine whether the Trendelenburg position during laparoscopic urological surgery changed the ONSD and whether changes correlated with postoperative complications. Methods In this prospective study, we measured ONSD before patients were placed in the Trendelenburg position. Then the Trendelenburg position was established by tilting the operating table to 20-25 degrees. After surgery, the patients were placed in a horizontal position, and the second measurement of ONSD was obtained. Results The study included 69 patients. The average preoperative ONSD in the right eye was 5.8 ± 0.7 mm and 5.8 ± 0.8 mm in the left eye. The average postoperative ONSD in the right eye was 6.6 ± 0.8 mm and 6.6 ± 0.7 mm in the left eye. The differences between postoperative and preoperative values in the right and left eyes were statistically significant (p <0.000001). ONSD increases above the norm did not correlate with the incidence of postoperative nausea (p = 0.94), delirium (p = 0.81), or the time to patient awakening (p = 0.29). Conclusion ONSD increased in patients who underwent surgical procedures performed in the Trendelenburg position, but the increase did not correlate with postoperative complications.

There is some evidence that aspects of nurse-doctor communication are associated with the quality of care and treatment patients receive whilst they are in hospital. To date, no studies have examined stakeholder perceptions of how patient care is influenced by clinical communication between nurses and doctors. We conducted a concept mapping study to generate a deep understanding of how clinical communication impacts patient care. Concept mapping has six phases: preparation, idea generation, structuring, representation, interpretation, and utilization. Twenty patients, 21 nurses, and 21 doctors participated in the study. Brainstorming generated 69 discreet statements about how nurse-doctor communication impacts patient care. The structuring (rating and clustering) phase was completed by 48 participants. The data interpretation workshop selected a five-cluster solution: effective communication, trust, patient safety, impediments to patient care, and interpersonal skills. On the final concept map, the five clusters were arranged in a circle around the center of the map. Clusters were relatively equal in size suggesting, each concept makes a broadly equal contribution to how nurse-doctor communication influences patient care. Our study suggests that there are multiple aspects of clinical communication that impact patient care. Candidate interventions to enhance nurse-doctor communication may need to consider the complex nature of interprofessional working. Registration: This study was prospectively registered with the Open Science Framework (OSF) (https://osf.io/9np8v/) prior to recruiting the first participant.

The right to live with dignity during the final stages of existence, enshrined in national and supranational Charters of Rights, represents a significant step towards humanizing medicine and is integral to the right to health. Palliative Care, rooted in health, dignity, and therapeutic self-determination, has emerged as a fundamental human right and a moral imperative within health systems. It seeks to alleviate suffering, emphasizing the holistic well-being of patients with life-limiting illnesses. This paper provides a comprehensive global perspective on Palliative Care, with special attention to its implementation in Italy. Palliative Care is a crucial dimension of care, designed to enhance the quality of life for patients suffering from progressive and incurable diseases. Despite its growing need due to an aging population and increased prevalence of chronic illnesses, still remains a significant disparity in access to these essential services worldwide. Insufficient resources, legislative constraints, and limited training for healthcare providers pose challenges to the widespread adoption of Palliative Care. In Italy, although laws have been enacted to ensure the provision of Palliative Care, its availability remains inconsistent across different regions. Financial constraints and insufficient support hinder the comprehensive dissemination of these services. Recognizing the significance of Palliative Care, the Catholic Church also endorses its implementation as a response to human suffering and an approach to end-of-life care. Efforts to strengthen Palliative Care are critical to meeting the rising demand and ensuring access to compassionate and dignified care for all individuals in need. Through legislative advancements and adequate resources, Italy can make significant strides in advancing the provision of Palliative Care.

High-flow Nasal Cannula (HFNC) oxygen therapy is gaining traction globally as a treatment for respiratory failure. There are several physiological benefits and there may be a growing patient preference for HFNC. In this narrative review, we aim to outline the basic mechanisms of HFNC, who can use it and review the literature regarding its utility both in the critical care setting, as well as in the home setting for chronic hypercapnic respiratory failure with an emphasis on Chronic Obstructive Pulmonary Disease (COPD). The role of non-pharmacological interventions like non-invasive ventilation (NIV) and HFNC in the prevention of hospital readmissions following acute exacerbations of COPD (AECOPD) is an area of increasing importance because randomised controlled trials and systematic reviews have found measures like nurse-led predischarge bundles to be clinically ineffective and to have a high cost per quality adjusted life year. This review therefore considers the evidence of NIV vs HFNC in the context of AECOPD and the application of HFNC at home in the prevention of AECOPD. We also look at applications of HFNC in specific settings, such as in the peri-operative period, emergency department, acute (mainly Critical Care) setting including in immunocompromised patients and palliative care.

In this work we present a study of impact of textile materials used in health care facilities on microbial colonization of textile surfaces. Polypropylene yarns doped with silver phosphate glass and zinc pyrithione were prepared and used for production of bed sheets and clothing for healthcare personnel. Subsequently measurements of airborne particles and viable microorganisms on given textiles were conducted in a private surgery clinic during 3 weeks comparing the counts of viable microorganisms before and after replacing of staff clothing and bedding on examination and surgical bed with said polypropylene cloth. In this study a significant reduction of viable airborne fungi and viable microorganisms on monitored textiles was observed by multiple methods.

The nursing process in clinical practice can be assessed using standardized language systems. The purpose is to find evidence on the effectiveness of the nursing process with standardized terminology using NANDA International, Nursing Interventions Classification, and Nursing Outcome Classification improving diag-nostic accuracy, nursing interventions, health outcomes, and people’s satisfaction. A systematic review was carried out in Medline and PreMedline, Embase, The Cochrane Library, CINAHL, SCI-EXPANDED, SSCI and Scielo and LILACS including randomized clinical trials, quasi-experimental, cohort and case-control studies. Selection and critical appraisal were conducted by two independent reviewers. The certainty of the evidence was assessed with Grading of Recommendations Assessment, Development and Evaluation Methodology. 17 studies were included with variability in the level and certainty of evidence. According to outcomes, 6 evaluated improvements in diagnostic accuracy and 11 evaluated improvements in individual health outcomes. No studies evaluated improvements in intervention efficacy or population satisfaction. There is a need to increase studies with rigorous methodologies that address diagnostic accuracy and indi-viduals’ health outcomes using NANDA International, Nursing Interventions Classification, and Nursing Outcome Classification; as well as implementing studies that evaluate the use of these terminologies for improvements in the efficacy of nurses' interventions and population satisfaction with the nursing process.

Introduction: The "second victim" phenomenon, (SVP) refers to a health professional who was involved in an adverse event (AE) and continues to suffer from the event to the detriment of personal and professional functioning. The Second Victims Natural History of Recovery Model predicts stages of the phenomenon from AE occurrence until the ‘moving on’ stage and serves as a suitable structure for many organizational support programs worldwide. Purpose: Using the Second Victims Natural History of Recovery Model to examine the impact of SVP on Israeli nurses, with a specific focus on the organizational support they felt they required as compared to the support they felt that they had received from their organizations. Methods: Fifteen in-depth interviews were conducted, using a semi-structured questionnaire, among nurses who had experienced SVP. The interviews were recorded subject to the interviewee's consent, transcribed, and analyzed using thematic content analysis. Findings: Throughout all six stages of recovery, all interviewees reported physical and emotional manifestations following exposure to an AE, regardless of type of event or severity. They also reported difficulty in emotion regulation, as well as damage to functioning and overall quality of life. Most of the nurse interviewees reported a need to share the events with someone, but despite this desire to receive appropriate support, almost none of them proactively requested help from a professional source, nor did their organizational management initiate proactive support. This lack of referral for further assistance is possibly explained through limited awareness of SVP as a valid response to an AE, perceived lack of legitimacy to receive organizational support and personal barriers that accompany the phenomenon. Conclusions: Appropriate organizational support, offered proximal to an AE as well as over time, is essential for the nurse, the patient and the organization. Personal barriers, together with limited awareness, may challenge the identification and provision of appropriate assistance. Hence, it is important to address the phenomenon as part of general organizational policy to improve quality of care and patient safety.

Extracts of Cordyceps militaris which possess the bioactive capacity such as antimicrobial activity and DPPH-free radical scavenging capacity, are applied to the serum product. This finished serum product has been evaluated the in vitro bioactivity and the stability with expect to find out a good extract with a suitable percentage used for serum product as natural materials on preservatives and antioxidation.

Inflammatory bowel disease (IBD), comprising Crohn's disease (CD) and ulcerative colitis (UC), defines as an idiopathic, chronic, relapsing, inflammatory disease affecting the gastrointestinal tract and leading to chronic damage. Endoscopy with biopsies is considered the gold standard for IBD diagnosis, whereas magnetic resonance (MRI) for CD extension and complication assess-ment. However, the latter are invasive procedures; thus, the need for a reliable, accessible and noninvasive way to perform IBD diagnosis and monitoring in the tight control era, like intestinal ultrasound (IUS) is. Compared to endoscopy and MRI, IUS has shown reliable diagnostic accuracy in assessing CD and UC severity and extension. Performing IUS in a point-of-care setting (POCIUS) can guide the clinician in driving the diagnostic and therapeutic pathway, thus accel-erating clinical decisions. POCIUS performed with pocket devices can represent the future of physical examination in outpatient or inpatient examination. Accordingly, we performed a liter-ature review about the application of IUS in CD and UC diagnosis. Furthermore, we explored the technical aspects of this imaging technique and its application in a point-of-care setting.

The COVID-19 pandemic and associated lockdown measures have been associated with substantial disruptions to health care services, including screening for human immunodeficiency virus (HIV) and management of people living with HIV (PLWH). Methods: Data from 3265 patients were examined in a retrospective cohort study. We compared outpatient follow-up for PLWH, the number of new patients, treatment adherence, hospitalizations, and deaths during the “pandemic period” (March 2020 to February 2021) to the “pre-pandemic period” (the equivalent timeframe in 2019) and the “post-pandemic period” (March to September 2021). Results: During the pandemic period, the number of new patients seen at the HIV clinic (116), as well as the requested viral load tests (2414), decreased significantly compared to the pre-pandemic (204 and 2831, respectively) and post-pandemic periods (146 and 2640, respectively)(p<0.01 for all the comparisons). However, across the three study periods, the number of drug refills (1385, 1330, 1411, respectively), the number of patients with undetectable viral loads (85%, 90%, 93%, respectively), and the number of hospital admissions among PLWH remained constant. Conclusions: Despite the COVID-19 pandemic impact, our findings show stability in the retention of clinical care, adherence to treatment, and viral suppression of PLWH, with no significant impact on hospitalization rates and all-cause mortality.

Background: dementia is a significant health issue worldwide. Mild cognitive impairment (MCI) can transform into dementia over time. General practitioners may be the first to notice the cognitive deficit, so they may need a screening test in the event of suspicion, which they must be able to use under great time pressure. We examined the usability of the Hungarian Test Your Memory (TYM-Hun) self-administered dementia test in general practice, and with the results of the received tests, we tried to draw conclusions regarding the population. Methods: In the four Hungarian cities with medical universities, general practitioners filled out 368 questionnaires with their clients over 50 years of age. Results: the total scores of the test showed a significant correlation with education and the type of occupation, while a significant negative correlation with age. We found the clock drawing test and recall indicates cognitive decline the earliest. Based on the TYM-Hun results, the prevalence levels for MCI and dementia are slightly higher in Hungary than globally. Conclusion: the test can sensitively indicate MCI and early-stage dementia as a screening test, and two of its subtests can raise the possibility of cognitive impairment at an earlier age than the others.

Introduction. The main task of the study was to measure the workload of nurses in the care of a patient with a developmental defect–congenital diaphragmatic hernia (CDH)–in the neonatal intensive care unit, which was evaluated on the basis of standardized tools Therapeutic Intervention Scoring System (TISS–28), Nine Equivalents of Nursing Manpower use Score (NEMS) and Nursing activities Score (NAS). Methods. Retrospective study. The workload was measured using TISS–28, NEMS and NAS tools. Descriptive statistics were used to analyze the data, and a single-sample test was used to verify the research hypotheses. Results. The sample consisted of medical records of 33 patients; 592 observations were analyzed. Studies prove the need for research on the workload of nurses in neonatal intensive care units. A patient with CDH should receive nursing care as required. Conclusion. It is necessary to implement a model for measuring the workload of nurses in neonatal intensive care units, taking into account the evaluation of work and its optimization.

The COVID-19 pandemic has led to numerous delays in cancer-related care and cancer-specific screening, but the extent is not fully understood. For those that experience a delay or disruption in care, health related self-management is required to re-engage in care pathways and the role of health literacy in this pathway has not been explored. The purpose of this analysis is to (1) report the frequency of self-reported delays in cancer treatment and preventative screening services at an academic, NCI-designated center during the COVID-19 pandemic and (2) investigate cancer-related care and screening delays among those with adequate and limited health literacy. A cross-sectional survey was administered from an NCI-designated Cancer Center with a rural catchment area during November 2020 through March 2021. Nearly 19 percent of participants were categorized as having limited health literacy. Twenty percent of those with a cancer diagnosis reported a delay in cancer-related care; and 23-30% of the sample reported a delay in cancer screening. In general, the proportions of delays among those with adequate and limited health literacy were similar with the exception of colorectal cacner screening. There was also a notable difference in the ability to re-engage in cervical cancer screening among those with adequate and limited health literacy. Thus, there is a role for those engaged in cancer-related education and outreach to offer additional navigation resources for those at risk to cancer-related care and screening disruptions. Future study is warranted to investigate the role of health literacy on cancer care engagement.

The personalist ethics of Edith Stein and her feminist thought are intrinsically interrelated. This unique connection constitutes perhaps the main novelty of Stein’s ethical thought that makes her a forerunner of some recent developments in feminist ethics, particularly ethics of care. A few scholars noticed the resemblance between Stein’s feminist personalism and care ethics, yet none of them have properly explored it. This paper offers an in-depth discussion of the overlaps and differences between Stein’s ethical insights and the core ideas of care ethics. It argues that both Stein and care ethicists relocate a certain set of practices, values and attitudes from the periphery to the center of ethical reflection. This includes relationality, emotionality and care. The paper finally argues that it is plausible and fruitful to read Stein’s advocacy of ‘woman’s values and attitudes’ in a critical feminist way, rather than as an instance of essentialist difference feminism.

The aim was to analyze the coping strategies used by primary health care (PHC) professionals. A cross-sectional, descriptive-analytical study was conducted with professionals working in primary health care units in São José do Rio Preto, a large city in the interior of São Paulo, Brazil. For data collection we used an instrument developed by the researchers, containing sociodemographic and professional variables, as well as the Problem Coping Modes Scale (EMEP). We evaluated 333 PHC professionals. A difference was observed between the scores of the four coping strategies (p<0.001), with the highest score for the problem-focused strategy (3.8) and the lowest score for the emotion-focused strategy (2.4). Physicians had the lowest scores in coping strategies focused on religious practices/fantastical thinking (p<0.001) and pursuit of social support (p=0.045), while community health agents had the highest scores in these coping strategies). Professionals working in PHC have different coping strategies for the problems and stressful situations experienced in the work environment. These strategies can involve more positive attitudes focused on confrontation and problem solving, to emotional responses that involve attitudes of avoidance and denial that involve attitudes of avoidance and denial of the problem.

Multicomponent training is recommended for people with dementia living in long-term care homes. Nevertheless, evidence is limited and people with severe dementia are often excluded from trials. Hence, the aim of this study was to investigate (1) the feasibility and (2) the requirements regarding a multicomponent training for people with moderate to severe dementia. The study was conducted as an uncontrolled single arm pilot study with a mixed methods approach. 15 nursing home residents with a mean age of 82 years (range: 75-90 years; female: 64%) with moderate to severe dementia received 16 weeks of multicomponent training. Feasibility and requirements of the training were assessed by a standardized observation protocol. Eleven participants regularly attended the intervention. The highest active participation was observed during gait exercises (64%), the lowest during strength exercises (33%). It was supportive if exercises were task-specific or related to everyday life. This study confirms that a multicomponent training for the target group is (1) feasible and well accepted. To enhance active participation (2) individual instructions and the implementation of exercises related to everyday life is required. The effectiveness of the adapted training should be tested in future randomized controlled trials.

Background: Care home residents have complex healthcare needs but may have faced barriers to accessing hospital treatment during the first wave of the COVID-19 pandemic. Objective: To examine trends in the number of hospital admissions for care home residents during the first months of the COVID-19 outbreak. Methods: Retrospective analysis of a national linked dataset on hospital admissions for residential and nursing home residents in England (257,843 residents, 45% in nursing homes) between 20 January 2020 and 28 June 2020, compared to admissions during the corresponding period in 2019 (252,432 residents, 45% in nursing homes). Elective and emergency admission rates, normalised to the time spent in care homes across all residents, were derived across the first three months of the pandemic between 1 March and 31 May and primary admissions reasons for this period were compared across years. Results: Hospital admission rates rapidly declined during early March 2020 and remained substantially lower than in 2019 until the end of June. Between March and May, 2,960 admissions from residential homes (16.2%) and 3,295 admissions from nursing homes (23.7%) were for suspected or confirmed COVID-19. Rates of other emergency admissions decreased by 36% for residential and by 38% for nursing home residents (13,191 fewer admissions in total). Emergency admissions for acute coronary syndromes fell by 43% and 29% (105 fewer admission) and emergency admissions for stroke fell by 17% and 25% (128 fewer admissions) for residential and nursing home residents, respectively. Elective admission rates declined by 64% for residential and by 61% for nursing home residents (3,762 fewer admissions). Conclusions: This is the first study showing that care home residents’ hospital use declined during the first wave of COVID-19, potentially resulting in substantial unmet health need that will need to be addressed alongside ongoing pressures from COVID-19.

Aim: Reporting 3 year outcomes of a community shared care scheme run by specialised independent prescribing (IP) optometrists for stable glaucoma and ocular hypertension (OHT) patients in West Kent, England. Purpose: Shared Care Schemes for glaucoma exist to alleviate the burden on Hospital Eye Services (HES) glaucoma clinics. We studied the effectiveness of community care by highly trained and qualified IP optometrists in terms of disease stability and referral rate into HES.Methods: Retrospective longitudinal review of 200 eyes with stable early to moderate stage glaucoma and OHT followed-up in two specialist optometry practices. Outcome measures included visual field mean deviation (VFMD), intraocular pressure (IOP), changes to treatment and referral rate into HES. Inclusion criteria included all patients with OHT and glaucoma (open angle and primary angle closure) referred for community follow-up. Incomplete data sets were excluded.Results: Mean age 71yrs (range 28 - 93yrs) and equal male: female ratio. n= 159 at year 3. The results for both outcomes showed no significant change from baseline at 12 or 24-month time points. However, a significant change from baseline at 36 months was observed for both outcomes: mean reduction of 0.7 mmHg in IOP, and a mean reduction of 0.3 dB in VFMD. There was a statistically significant change in the number of drops used at 36 months (p=0.001). 11 patients had a change in medication within 3 years. One patient was referred back to HES for uncontrolled IOP and consideration of trabeculectomy.Conclusion: Community follow-up of stable cases of glaucoma and OHT by highly qualified IP optometrists was safe, with stability of disease maintained and few referrals back to HES.

This paper reports on in-depth qualitative interviews conducted with 69 disabled people in England and Scotland, and with 28 key informants from infrastructure organisations in the voluntary and statutory sectors, about the impact of COVID-19, and measures taken to control it. Participants were recruited through voluntary organisations. As with everyone, the Pandemic has had a huge impact: we discuss the dislocations it has caused in everyday life; the failures of social care; the use of new technologies; and participants’ view on leadership and communication. We conclude with suggestions for urgent short term and medium term responses, so that the United Kingdom and other countries can respond better to this and other pandemics, and build a more inclusive world.

Migraine is one of the leading causes of disability worldwide [1,2]and patients with acute migraine frequently present to emergency departments (ED)[3]. The current literature suggests that ED treatment of migraine headache varies across institutions [4-7]. Considering this, we conducted a scoping review to summarize trends in medication prescribing patterns for acute migraine treatment in the ED setting. Trends were evaluated for factors influencing treatment choices, with particular attention placed on opioids and migraine specific therapy. This scoping review was based on the Arksey and O'Malley methodological framework[8]and included studies published between 1 January 2000 until 31 May 2020. 14 publications met the inclusion criteria. The most common classes of medication prescribed were often anti-emetics or Non-steroidal anti-inflammatory drugs (NSAID), but rates varied between studies. There was a concerning trend towards an underutilization of triptans and overutilization of opiates. The use of specific clinical goals of treatment (e.g. two-hour pain free freedom response) was also not evident. Additionally, 88% (n=8) of the 9 studies commenting on adherence to hospital or evidence-based guidelines stated that practices were non-adherent. Overall, the reviewed literature reveals treatment practices for acute migraine in the ED are heterogeneous and deviate from established international recommendations.

Laryngopharyngeal reflux (LPR) is a prevalent disease in the general population and may have acute or chronic clinical presentation. LPR may be misdiagnosed in primary care medicine regarding the lack of gastroesophageal reflux disease symptoms and the lack of findings at the gastrointestinal endoscopy. Depending on the physician field of expertise and experience, LPR may be clinically over- or under-diagnosed. The management of LPR is possible in primary care medicine but primary care physician has to consider some red flags that requires to address the patient to otolaryngologist or gastroenterologist. The use of patient-reported outcome questionnaire such as reflux symptom score-12 and the consideration of some oral and pharyngeal findings visualized through the mouth opening may help the primary care physician to evaluate the LPR findings at the diagnosis time and throughout treatment. In this review, we provide a practical algorithm of management of LPR for primary care physician or other specialists that cannot perform fiberoptic examination. In this algorithm, physician has to exclude some confounding conditions such as allergy or other causes of pharyngolaryngitis and red flags. Physician may prescribe an empirical treatment based on diet and behavioral changes with or without medication, depending on the complaint severity of the patient. In case of prescription of medication, proton pump inhibitors and alginate have to be considered in association to protect the upper aerodigestive tract mucosa from acid, weakly acid and alkaline pharyngeal reflux events.

Designed by a group of ME/CFS researchers and health professionals, the European Network on Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (EUROMENE) has received funding from the European Cooperation is Science and Technology (COST) (https://www.cost.eu/cost-actions/what-are-cost-actions/ ) - COST action 15111 - from 2016 to 2020. The main goal of the Cost Action was to assess the existing fragmented knowledge and experience on health care delivery for people with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) in European countries, and to enhance coordinated research and health care provision in this field. We report on the recommendations for clinical diagnosis, heath services and care for people with ME/CFS in Europe, as prepared by the group of clinicians and researchers from 22 countries and 55 European health professionals and researchers, who have been informed by people with ME/CFS (https://www.cost.eu/actions/CA15111/#tabs|Name:overview).

Rationale: Examining trends in patient characteristics, processes of care and outcomes, across an epidemic, provides important opportunities for learning. Objectives: To report and explore changes in admission rates, patient characteristics, processes of care and outcomes for all patients with COVID-19 admitted to intensive care units (ICUs) in England, Wales and Northern Ireland. Methods: Population cohort of 10,287 patients with COVID-19 in the Case Mix Programme national clinical audit from 1 February to 2 July, 2020. Analyses were stratified by time period (pre-peak, peak, post-peak) and geographical region. Multivariable logistic regression was used to estimate differences in 28-day mortality, adjusting for patient characteristics over time. Main results: Admissions to ICU peaked simultaneously across regions on 1 April, with ongoing admissions peaking ten days later. Compared with pre- and post-peak periods, patients admitted during the peak were slightly younger but had greater respiratory and renal dysfunction. Use of invasive ventilation and renal replacement reduced over time. Twenty-eight-day mortality reduced from 43.5% (95% CI 41.6% to 45.5%) pre-peak to 34.3% (95% CI 32.3% to 36.2%) post-peak; a difference of −8.8% (95% CI: −5.2%, −12.3%) after adjusting for patient characteristics. London experienced the highest admission rate and had higher mortality during the peak period but a greater reduction in post-peak mortality. Conclusion: This study highlights changes in patient characteristics, processes of care and outcomes, during the UK COVID-19 epidemic. After adjusting for the changes in patient characteristics and first 24-hour physiology, there was substantial improvement in 28-day mortality over the course of the epidemic.

Introduction: Dental health problems including dental plaque are common health problems affecting people of different age groups globally. Air-polishing is a safe tooth polishing technique used by dental professionals for stain and plaque removal and as preventive procedure for dental health. Here we report the technical improvisation of existing air-polishing technique by supplementing cannabinoid powder into the classic polishing powder for effective removal of supragingival and subgingival plaque and inhibition of plaque forming bacteria. Methods: The cannabidiol (CBD) powder was added to the tooth polishing powder (AIR-N-GO, classic) at 1% (wt/wt) ratio. The study was conducted on 12 patients, of which 6 received regular polishing treatment and 6 received CBD-supplemented polishing treatment. The dental plaque samples were collected before and after each treatment and subjected to in vitro microbiological analysis and the colony forming units (CFU) were analyzed using automated colony counter. Results: Based on in vitro microbiological analysis, the average CFU of interdental space samples collected from post-CBD-supplemented polishing treatment was significantly reduced (linear fold change between 3.9-18.4) compared to that of post-regular polishing (linear fold change between 1.0-2.6) treatment. Conclusions: CBD-supplemented polishing powder can help in effective removal and killing of dental plaque bacteria during the polishing treatment. CBD powder can be added as enhancing supplement to the existing polishing powders.

Disease related malnutrition (DRM) is prevalent in hospitals and is associated with increased care needs, prolonged hospital stay, delayed rehabilitation and death. Nutrition care process related activities such as screening, assessment and treatment has been advocated by scientific societies and patient organizations but implementation is variable. We analyzed the cross-sectional nutritionDay database for prevalence of nutrition risk factors, care processes and outcome for medical patients. In 59126 medical patients included between 2006-2015 the prevalence of recent weight loss (45%), history of decreased eating (48%) and low actual eating (53%) was more prevalent than low BMI (8%). Each of these risk factors was associated with a large increase in 30 days hospital mortality. Nutrition care processes increases slightly with presence of risk factors but never done in more than 50% of patients. Only a third of patients not eating in hospital receive oral nutritional supplements or artificial nutrition. We suggest that political action should be taken to raise awareness and formal education on all aspects related to DRM for all stakeholders, to create and support responsibilities within hospitals, and to create adequate reimbursement schemes. Collection of routine and benchmarking data is crucial to tackle DRM.

Health information and communication are key elements that allow patients and family members to make decisions about end-of-life process and guarantee a death with dignity. Objective: To understand carers’ experiences regarding health information and communication during the illness and death of family members. Methods: This qualitative study was conducted in Andalusia based on the paradigm of hermeneutic phenomenology. Participants were carers who had accompanied a family member at the end of life for over 2 months and less than 2 years. Five nominal groups and 5 discussion groups were established, and 41 in-depth interviews with 123 participants were conducted. Atlas.ti 7.0 software was used to analyse the discourses. Results: Four dimensions of the dying process emerged: differences in carers’ perceptions of information and communication, a conspiracy of silence, consequences of the absence or presence of information, and the need for a culture change. Conclusions: Poor management of health information and communication at the end of life suffering and discomfort patients and their families. The culture of denying and avoiding death is still present today. A change in education about death would better enable health professionals to care for patients at the end of life.

Due to its devastating consequences, late life depression is an important public health problem. The aim of the study was the analysis of variables which may potentially influence risk of depression (GDS-SF). Furthermore, the aim was to study possible mediating effect of given variables on the relationship between the total protein concentration and risk of depression in older-adults with chronic diseases, and physical function impairment. The research sample included a total of 132 older adults with chronic conditions and physical function impairments, remaining under a long-term care in residential environment. Negative linear correlation was observed between patients’ physical functionality, total protein concentration, concentration of HDL cholesterol, arm circumference, and the risk of depression. Considerably stronger relationship was observed between total protein concentration, and GDS-SF, in elderly suffering from sensory dysfunction (b = −6.42, 95% CI = −11.27; −1.58). The effect of the mediation between depression risk is correlated to total protein concentration in blood serum, and the mediators are probably low function impairment and low levels of 25 (OH)D vitamin. Cohort control research is suggested to confirm the hypothesis.

This study was undertaken to investigate and analyze noise pollution in a large Chinese governmental hospital’s medical intensive care unit and compare to the WHO guidelines.This cross-sectional study was conducted in a MICU at a public governmental teaching hospital in Fujian province between July and August of 2017. A WENSN® WS1361 Integrated Sound Level Meter (China) was used for continuous every five seconds one week noise levels recording. After this measurement, the decibel meter was used for recording different location of isolation rooms and open bays, including occupied and unoccupied patient, and recording sound events occurs in the ICU to identify sources of noise. Peak and average noise levels were obtained from the meter, and data were downloaded from the WS1361 into a laptop computer. The measured mean equivalent sound pressure levels (L) and standard Aeq deviation over one week period were 66.64±7.57 dB(A), with acute spikes reaching 119.7 dB(A), the average sound level for a 24 hour period in a work day was 68.03±5.07 dB(A). These are higher than the current daytime environmental noise limit of 40-45 decibels in China and WHO. Mean work day noise was significantly louder than weekend time, there was a significant difference in work days and weekend (t=16.85;P=0.000).There was a statistical difference between the day time and night time shifts (t=34.67;P=0.000). The isolation rooms were significantly quieter than the open-bay rooms(t=46.15; p=0.00), sound levels in the occupied and unoccupied rooms also had significant difference(t=17.26; P=0.000).Two types of noise resources, including twenty kinds sources were identified and measured, mean noise levels ranged from of 61.33 to 79.21 dB(A). This study shows noise levels in intensive care units were exceeded the recommended. The study of the influence of noise on patient and staff is needed, and noise reduction strategies must be conduct in ICU.

Comprehensive geriatric assessment, defined as an interdisciplinary assessment and development of an overall plan of treatment and follow-up, has become a fundamental part of clinical geriatric care. Since the 1970s, the Veterans Administration has encouraged the development of geriatric evaluation and management programs. Evolution of geriatric evaluation and management has occurred over time and many VA medical centers have transferred inpatient geriatric evaluation programs to long-term care Community Living Centers (CLC) and outpatient settings. Availability of resources and trained personnel across the continuum of care as well as administrative facilitation of collaboration between care components are critical to the efficient utilization of geriatric services. Facilities may need to prioritize their resources and utilize the most effective and relevant elements of geriatric evaluation and management according to patient population needs, available space, resources, and institutional priorities.

The rapid growth rate of the elderly population is a serious current issue in most countries, affecting them economically through needed medical treatment and healthcare planning. The priority concern is how to reduce the number of elderly people requiring long-term healthcare and raise the number who are able to live independently. This study executed a behavior assessment of elderly person’s self-reported use of electric scooters and analyzed their degree of acceptance of these assisted living tools, partly through a related factor analysis of our survey instrument. We used this questionnaire survey as our research method, applying SPSS22 software for factor analysis that revealed five survey facets.

Since the systematic evolution of ligands by exponential enrichment (SELEX) method was developed, aptamers have made significant contributions as bio-recognition sensors. Microdevice systems allow for low reagent consumption, high-throughput of samples, and disposability. Due to these advantages, there has been an increasing demand to develop microfluidic-based aptasensors for analytical technique applications. This review introduces the principal concepts of aptasensors and then presents some advanced applications of microdevice-based aptasensors on several platforms. Highly sensitive detection techniques such as electrochemical and optical detection have been integrated into lab-on-a-chip devices and researchers have moved towards the goal of establishing point-of-care diagnoses for target analyses.

This article takes an approach to explaining the behavioral manifestations of the decision making in US companies’ offer of health insurance that is grounded not only on their cost minimizing behavior, but also in a humanness dimension based on the African concept of Ubuntu. In this way, we define an Ubuntu based Random Utility modeling framework, describing the choice process as a tripartite decision making, and implemented using a nationally representative random sample of 1,061 American companies from the Dunn and Bradstreet Business data, supplied by Survey Sampling International to the Associated Press-NORC Center for Public Affairs Research. The results from the three sequentially implemented specifications showed that the relationship between management culture and health plan offering strategy is dependent on other relevant co-variates, which when left out, leads to the problem of omitted variables bias. However, when all variables are included but assumed to enter the relationship exogenously, this results in management culture not having any statistically significant effect on companies' decisions about scope of health plan offering. When the exogeneity assumption is relaxed through a recursively Bivariate Probit model, the system of two equations produces a highly significant management culture effect. In fact, in this later case we see that companies with groups and formal committee management culture are 1.58 times less likely to choose a multiple plan strategy over a single plan strategy, hence failing to show the more wholesome plan offering that would theoretically prevail under Ubuntu style management.

Research on fall and movement detection with wearable devices has witnessed promising growth. However, there are few publicly available datasets, all recorded with smartphones, that prevent authors to evenly compare their new proposals. Here, we present a dataset of falls and activities of daily living (ADL) acquired with a self-developed device composed of two types of accelerometer and one gyroscope. It consists of 19 ADL and 15 fall types performed by 23 young adults, 15 ADL types performed by 14 healthy and independent participants over 62 years old, and data from one participant of 60 years old that performed all ADL and falls. These activities were selected based on a survey and a literature analysis. We test the dataset with widely used feature extraction and a simple to implement threshold based classification, achieving up to 96~\% of accuracy in fall detection. An individual activity analysis demonstrates that most errors coincide in a few number of activities where algorithms could be focused on. Finally, validation tests with elderly people significantly reduced the fall detection performance of the tested features. This validates findings of other authors and encourages to develop new strategies with this new dataset as benchmark.

The Industrial Revolution 4.0 (IR4.0) is transforming the global economy, necessitating mall and medium-sized enterprises (SMEs) to adopt new technologies like artificial intelligence (AI), the Internet of Things (IoT), blockchain, and cloud computing. Therefore, SMEs need to assess their readiness to identify capabilities and areas for improvement to remain competitive. However, existing IR4.0 readiness assessment such as the Industry4WRD Readiness Assessment and Industry 4.0-Readiness by IMPULS German are time-consuming and restrict the participation of various sectors. Using the understanding of theories such as Technology Acceptance Model (TAM), Unified Theory of Acceptance and Use of Technology (UTAUT), Technology Readiness Index (TRI), and Diffusion Of Innovation (DOI), this study developed an initial research model that identifies the dimensions of IR4.0 readiness; (i) organization, (ii) data, (iii) infrastructure, (iv) analytics, and (v) IT, development and operations. This study carried out qualitative methods through four different phases. The first phase is a systematic literature review, and data collection through participant observation (PO) in IR4.0 skills training programs, seminars, and workshops. The second phase is the development of an initial research model to identify the dimensions of IR4.0 readiness that will be used in the next phase. The third phase is a survey on SME’s IR4.0 readiness via the IR4.0 e-Readiness Checker (IR4.0 eRC) readiness assessment system, which produces the final research model, IR4.0 SME Readiness Model. In the fourth phase, the IR4.0 Readiness Model is confirmed for use by SMEs in Malaysia through interviews with three industry experts in Malaysia. Based on the 50 responses in the IR4.0 eRC evaluation, the average IR4.0 readiness of SMEs is 66%, and only 10 SMEs with less than 50%, showing room and improvement opportunities for the continuous research and development of IR4.0 transformation. This study developed IR4.0 readiness model for SMEs to assess readiness for IR4.0 transformation, support investments in IoT projects and employee upskilling programs.

Multicellularity is one of the major evolutionary transitions, and its rise provided the ingredients for the emergence of a biosphere inhabited by complex organisms. Over the last decades, the potential for bioengineering multicellular systems has been instrumental in interrogating nature and exploring novel paths to regeneration and disease, as well as cognition and behaviour. Here, we provide a list of open problems that encapsulate many of the ongoing and future challenges in the field, and we suggest conceptual approaches that may facilitate progress.

The aim of the present study was to predict the response of non-small cell lung cancer (NSCLC) patients to immune checkpoint inhibitors (ICIs) by leveraging computed tomography (CT) images using deep learning techniques. Retrospectively, 624 sequential CT images were gathered from 156 patients at Jiangsu Province Hospital, along with their clinical data. The dataset was subsequently partitioned into three groups: training (n=547), validation (n=64), and test (n=64). Moreover, an external validation cohort included 37 CT images from patients at Nanjing Pukou Peoples' Hospital, accompanied by comprehensive clinical data. An advanced Video Vision Transformer (ViViT) model incorporating global self-attention was utilized to analyse patients treated with ICIs and predict their response. The ViViT model's efficacy was evaluated using a confusion matrix and a receiver operating characteristic curve (ROC). Notably, the ViViT model demonstrated predictive prowess for ICIs response, yielding respective areas under the receiver operating characteristic curve (AUC) of 0.74 (95% CI: 0.69-0.78), 0.74 (95% CI: 0.61-0.86), 0.76 (95% CI: 0.62-0.88), and 0.69 (95% CI: 0.5-0.87) in the training, validation, test, and external validation cohorts. The present study illustrates how a deep learning model can provide a non-invasive means to predict clinical outcomes in NSCLC patients undergoing ICIs, potentially transforming personalized treatment approaches for individuals with NSCLC.

Polymeric composites are prone to undergo damage, such as microcracks, during their operation, that can ultimately lead to catastrophic failure. To contradict such problem, effort has been put, by the scientific community, towards developing self-healing composites that, by mimicking biological systems, can autonomously and prematurely repair flaws, extending durability and improving security of materials. The present review explores the progress being made in such area, focusing on extrinsic self-healing methods, considering that they can be employed to a variety of materials. Reservoir-based techniques, that resort to capsules, hollow fibers or microvascular networks, and thermoplastic-based ones are overviewed, prioritizing innovative approaches made in recent years. At last, promising practical applications for self-healing composites are highlighted and future challenges and opportunities are pointed out.

The present paper reports exact results for the muon self-energy and anomalous g-factor. A unique to the muon cut-off terms that remove the radial singularity in the system and regularize the corresponding electrodynamics are presented. Equations of motion and a transcendental equation satisfied by the muon anomalous g-factor are derived, with solution a_m=0.001165920162(198). The obtained value matches the latest experimental one found in the literature to about 0.43 ppb ruling out a possible tension between theory and experiment.

Background. The role of exercise programs during Substance Use Disorder (SUD) treatment is considered particularly supportive in fostering positive psychological and behavioral changes. The aim of this feasibility study was to explore the acute effects of cycling exercise in an immersive virtual reality (IVR) environment on attentional control and self-efficacy expectations of indi-viduals undergoing SUD treatment. Methods. A total of 20 individuals (mean age of 37.75 years) enrolled in a SUD treatment program participated in the study. They were instructed to complete a single session of cycling with a self-selected duration within the IVR system. Results. Following the cycling session, pre-post measures indicated a statistically significant im-provement in self-efficacy expectations and attentional control measured with the Stroop test. The results revealed that participants expressed high levels of intention for future use, inter-est/enjoyment, and positive attitudes toward the IVR exercise system. Qualitative data indicated that participants found the IVR exercise system enjoyable, expressed a strong intention to use it, and did not encounter technical difficulties or negative emotions. Conclusions: In conclusion, it seems that engaging in a brief period of self-selected exercise within a virtual environment can result in temporary activation of cognitive changes, heightened self-efficacy expectations, and a motivating approach to increasing physical activity participation among individuals with SUD, thus suggesting the feasibility of this approach.

Objective: To explore the functions that physical activity (PA), life satisfaction, and self-efficacy have in the process of coping with anxiety among Chinese college students, and to explore the mediating role of life satisfaction and self-efficacy in this process. Methods: Participants were 358 college students (186 males, 172 females, mean age 20.88, SD=±1.80). Psychosocial tests including the Physical Activity Rating Scale (PARS-3), College Student Life Satisfaction Scale (CSLSS), General Self-Efficacy Scale (GSES), and Generalized Anxiety Disorder Scale (GAD-7) were completed. Correlations between variables were calculated using Pearson's test. The mediation model was tested using the SPSS 26.0 PROCESS macro and regression bootstrap. Results: Physical activity showed a negative correlation with anxiety (β= -0.1617, p < 0.001), life satisfaction and self-efficacy played a role in the relationship between physical activity and anxiety, and, more importantly, physical activity affected anxiety through the parallel mediating effects of life satisfaction and self-efficacy, with a total mediating effect of 55.34%. Conclusion: By increasing college students' participation in physical activity, it helps to promote the growth of their life satisfaction and self-efficacy, which is the key to reducing anxiety and promoting college students' mental health.

The study explores how different dimensions of perfectionism influence psychological well-being (PWB) in emerging adults. Literature has deepened the relationships between maladaptive perfectionism (e.g., excessive self-criticism, perceived discrepancy from the standards) and low PWB. Less is known about whether and how adaptive perfectionism (e.g., pursuing personal standards) relates to PWB. Secondly, the study has investigated whether self-compassion (i.e., self-benevolence, seeing personal imperfections as a common condition) may mediate the relationships between adaptive/maladaptive perfectionism and PWB. Participants (N=217, 18-35 y. o.) completed self-report questionnaires measuring: adaptive/maladaptive perfectionism (Almost Perfect Scale-Revised, APS-R: high standards and order/discrepancy, respectively), PWB, and self-compassion (SCS). Adaptive perfectionism resulted associated with PWB, particularly higher presence of purpose in life, environmental mastery, self-acceptance, and personal growth. Conversely, discrepancy resulted the most robust predictor of low PWB (β=-.68), followed by high standards with a positive direction (β=.23; Rc²=.514, p&lt;.001). A strong negative association emerged between discrepancy and SCS (r=-.67, p&lt;.001). A mediation analysis shows that self-compassion has an indirect effect reducing the strength of the relationship between discrepancy and low PWB. Results suggest focusing on self-compassion as a buffer factor that reduces the negative impact of maladaptive perfectionism on psychological well-being. Implications for education and health psychology are discussed.

In this paper, a new type of self-excited thermomechanical oscillator containing an oscillating shape memory alloy (SMA) filament with two symmetrically arranged spheres is investigated. The self-excitation of the oscillations is due to a heater of constant temperature, which causes periodic contractions of the filament when it approaches it. The contracted filament moves away from the heater a distance sufficient to cool it. Under the action of the weight of the spheres, the cooled filament re-approaches the heater, causing the above processes to repeat periodically. On the basis of experimental studies, approximating functions of the heater's heat field distribution are derived. A dynamic model of the oscillator has been created, in which the minor and major hysteresis in the SMA alloy and the distribution of the heat field around the heater have been taken into account. By numerical solutions of the differential equations, the laws of motion of the spheres are obtained. The displacements of the spheres in two perpendicular directions were measured using an experimental system. The obtained experimental results validate the proposed dynamic model and its assumptions with a high degree of confidence. Conclusions are drawn about the stochastic nature of the oscillations due to the hysteresis properties of the SMA and the temperature variation of the natural frequency of the oscillating system.

Objective: Diabetes disproportionately affects African Americans leading to higher morbidity and mortality. This study explores the experiences of African Americans adults who successfully self-manage their type 2 diabetes (called Peer Ambassadors) and provided phone-based peer support in a 6-month culturally tailored diabetes self-management program for African Americans guided by the Information-Motivation-Behavioral skills model. Design: A group discussion using a semi-structured discussion guide was conducted. Qualitative content analysis was used to identify the facilitators and barriers to completing the role of a Peer Ambassador, and to develop strategies for overcoming possible challenges in the future. Setting: Key informant discussions were conducted in a community location to gain insights into Ambassadors’ motivations and challenges in delivering peer support. Participants: Three Peer Ambassadors completed ethics training, peer mentor training and received a phone call guide before providing support to their peers. Results: There were four core themes related to Peer Ambassador experiences: (1) Motivation to be a Peer Ambassador, (2) Program elements that supported Peer Ambassador role, (3) Key elements of achieving engagement, and (4) Challenges related to being a Peer Ambassador. Conclusions: This study showed Peer Ambassadors in a culturally tailored peer-supported self-management program found fulfillment in sharing experiences and supporting peers. They highly valued educational group sessions for knowledge updates and sustaining their health-related goals, suggesting the potential benefits of recognizing milestones or providing advanced training for future program sustainability. Findings suggest the importance of recruiting motivated patients and providing effective facilitation for peer support roles, including addressing barriers such as time commitment and lack of socialization opportunities.

Diabetes is one of the fastest spreading diseases of civilisation in the 21st century. The aim of the study was twofold: 1) to find differences in personality traits, self-esteem, body- esteem, and imagery between healthy women and women with diabetes 2) to check whether there are differences in analyzed factors in women with diabetes who participate in sports compared to women who do not. We used 3 questionnaires: Imagination: in sport - short form, Self-Esteem Scale (SES), and BFIS Personality, which were tested online. We found that women with diabetes were characterised by significantly higher neuroticism and lower extraversion and higher conscientiousness (marginally significant). We also found that women with diabetes who practice sport rated their bodies more highly in terms of sexual attractiveness and made better use of imagined affirmations than healthy women who were not active. Our study provides new insights into diabetics in terms of coping with the disease.

Cutaneous melanoma (CM) is a candidate for screening programs, since its prognosis is excellent when diagnosed in an early disease stage. Targeted screening of those at high risk for developing CM, a cost-effective alternative to population-wide screening, requires valid procedures to identify the high-risk group. Self-assessment of the number of nevi has been suggested as a component of such procedures, but its validity has not yet been established. We analyzed the level of agreement between self-assessments and expert assessments of the number of melanocytic nevi in the area between the wrist and the shoulder of both arms based on 4548 study subjects in whom mutually blinded double counting of nevi was performed. Nevus counting followed the IARC protocol. Study subjects received written instructions, photographs, a mirror, and a “nevometer” to support self-assessment of nevi larger than 2 mm. Nevus counts were categorized based on the quintiles of the distribution into five levels defining a nevus score. Cohen’s weighted kappa-coefficient was estimated to measure the level of agreement. In the total sample, agreement between self-assessments and expert-assessments was moderate (raw agreement: 50.29%, weighted κ=0.596). Self-assessed nevus counts were higher than those determined by experts (mean differ-ence: 3.33 nevi). The level of agreement was independent of sociodemographic and cutaneous factors; however, participants’ eye color had a significant impact on the level of agreement. Our findings show that even with comprehensive guidance, only a moderate level of agreement between self-assessed and expert-assessed nevus counts can be achieved. Self-assessed nevus information does not appear to be reliable enough to be used in individual risk assessment to target screening activities.

Radish (Raphanus sativus L.), a root vegetable belonging to the Brassicaceae family, is considered as one of the representative crops displaying sporophytic self-incompatibility (SSI). The utilization of a self-incompatibility system in F1 breeding can improve the efficiency of cross combinations, leading to a reduction in breeding time and aiding in the development of novel F1 varieties. The successful implementation of this system necessitates the rapid and accurate identification of S haplotypes in parental lines. In this study, we identified a total of 9 S haplotypes among 22 elite radish lines through Sanger sequencing. Subsequently, we obtained sequences for showing 95% similarity to 9 S haplotypes, along with sequences identified by other researchers using BLAST. Following this, multiple sequence alignment (MSA) was conducted to identify SRK and SLG sequence similarities, as well as polymorphisms within the class I, II groups. Subsequently, S haplotype-specific marker sets were developed, targeting polymorphic regions of SRK and SLG alleles. These markers successfully amplified each of 9 S haplotypes. these markers will play a crucial role in the rapid and precise identification of parental S haplotypes in the radish F1 breeding process, proving instrumental in the radish F1 purity test.

Wireless Sensor Networks (WSNs) are gaining traction in the realm of network communication, renowned for their adaptability, configuration, and flexibility. The forthcoming network traffic within WSNs can be forecasted through temporal sequence models. In this correspondence, We present a method (TSENet) that can accurately predict the traffic in the cellular network. TSENet is composed of transformers and self-attention network. We have designed a temporal transformer module specifically for extracting temporal features. This module accomplishes this by modeling the traffic flow within each grid of the communication network at both near-term and periodical intervals. Simultaneously, we amalgamate the spacial features of each grid with information from its correlated grids, generating spacial predictions within the spacial transformer. Furthermore, we employ self-attention aggregation to capture dependencies between external factor features and celluar data features. Empirical assessments performed on a genuine cellular traffic dataset offer compelling evidence substantiating the efficacy of TSENet.

For many engineering applications it is sufficient to use the concept of simple materials. However, higher gradients of the kinematic variables are taken into account to model materials with internal length scales as well as to describe localization effects using gradient theories in finite plasticity or fluid mechanics. In many approaches length scale parameter have been introduced that are related to a specific micro structure. An alternative approach is possible, if a thermodynamically consistent framework is used for material modelling as shown in the present contribution. However, even if sophisticated and thermodynamically consistent material models can be established there are still not yet standard experiments to determine higher order material constants. In order to contribute to this ongoing discussion system identification based on the method of self-adaptive filtering is proposed in this paper. To evaluate the effectiveness of this approach it has been applied to second-order gradient materials considering longitudinal vibrations. Based on thermodynamically consistent models that have been solved numerically it has been possible to prove that system identification based on self-adaptive filtering can be used effectively for both narrow-band and broadband signals in the field of second-order gradient materials. It has also been found that the differences identified for simple materials and gradient materials allow for condition monitoring and detection of gradient effects in the material behavior.

The feeling of emotional self-efficacy helps people understand how to handle positive and negative emotions. Emotion regulation indicates the process that helps modulate emotions, to adapt suitably to the demands of the environment. This study has a two-fold aim. Firstly, it analyses the relationships among emotion regulation; the personality traits of extraversion and emotional stability; and the feeling of efficacy of positive and negative emotions in an adolescent population. Secondly, it analyses the mediating role of personality traits (extraversion and emotional stability) in the relationship between emotion regulation and self-efficacy for positive and negative emotions. There were 703 adolescents who took part (49.9% male and 50.1% female) aged between 15 and 18 years (M=15.86, TD=0.30). The results observe the significant relationships among emotion regulation; the personality traits of extraversion and emotional stability; and self-efficacy for positive and negative emotions. The structural equation model confirms that the link between emotion regulation and self-efficacy is direct and is also mediated by the personality traits of extraversion and emotional stability. The study confirms that emotional self-efficacy beliefs are connected to the emotional regulation strategies used. Effective emotional regulation favours self-perception and emotional coping. There is a discussion about the results, which are connected to previous research.

In our latest studies with the help of the self-similar Ansatz we derived new type of 1 solutions for the regular diffusion equation which are much more complex than the well-known 2 Gaussian and error functions. These solutions contain additional Kummer’s M and Kummer’s U 3 functions with quadratic argument. In the present treaties we perform an analogous analysis for the 4 regular diffusion equation which has a complex diffusion coefficient. Formally, it is equivalent to 5 the free Schrödinger equation however it is far from being trivial how the solutions can be given 6 quantum mechanical interpretation. We investigate both the one dimensional Cartesian and the 7 spherical symmetric equations. We find solutions which fulfill the L2 integrability criteria therefore 8 might have quantum mechanical relevance in the future.

The benefits of event-driven architecture (EDA) derive from how systems and components are loosely coupled, which can facilitate independent development and deployment of systems, improved scaling and fault tolerance, and integration with external systems, especially in comparison to monolithic architectures. With the advent of new technologies such as containers, and microservices, a new generation of distributed event streaming platforms are commonly used in event-driven architecture for efficient event-driven communication. However, the asynchronous and distributed nature of EDA poses several problems that include handling failures, the dependence of an end-to-end transaction on individual component stability, etc. In this paper, we describe a new approach to designing self-regulating distributed applications with autopoietic and cognitive workflow management. This approach is based on the new science of information processing structures derived from the General Theory of Information. Just as a genome enables self-organizing and self-regulating biological structures, a digital genome enables a specific software application with several components, the ability to use distributed resources and self-regulate the evolution of the system based on functional and non-functional requirements, and best-practice policies that maintain the stability, safety, and survival under non-deterministic fluctuations in the demand for resources. In addition, cognitive workflow management assures end-to-end transaction delivery.

The phenomenon of ordered self-assembly on solid substrates is a topic of interest in both fundamental surface science research and its applications in nanotechnology. The regulation and control of two-dimensional (2D) self-assembled supra-molecular structures on surfaces have been realized through applying external stimuli. By utilizing scanning tunneling microscopy (STM), researchers can investigate detailed phase transition process about self-assembled monolayers (SAMs), providing insight into the interplay between intermolecular weak interactions and substrate-molecule interactions, which govern the formation of molecular self-assembly. This review will discuss the structural transition of self-assembly probed by STM in response to external stimuli and provide state-of-art methods such as tip induced confinement for the alignment of SAM domains and selective chirality. Finally, we discuss the challenges and opportunities in the field of self-assembly and STM.

Incarceration negatively affects well-being and can shift an individual’s identity through labeling theory and prisonization. Seven incarcerated girls at a juvenile residential facility were administered self-esteem and life satisfaction questionnaires, and interviews were conducted to assess the impacts of incarceration on happiness and well-being. Afterwards, an eight-week music program was implemented. Results indicated that life satisfaction was significantly lower than self-esteem (p = .037), yet all participants expressed an optimistic outlook on their future in their interviews, sharing a desire to pursue further education. Participant feedback following the music program suggests positive impacts on their emotional state and well-being.

Graphene nanostructures (GNS) are among the most promising materials for creating supercapacitors. However, GNS are still not used in creating supercapacitors due to the impossibility of obtaining large volumes of high-quality material at an acceptable cost. In this work, we investigated the efficiency of using few-layer graphene (FLG) with the number of layers is not more than 5 synthesized under Self-propagating high-temperature synthesis (SHS) conditions as basic material for supercapacitors. Using the SHS process makes it possible to synthesize large volumes of FLG without Stone-Wales defects. It was found that the synthesized FLG makes it possible to obtain better results than using classical materials, namely activated carbon (AC). It was found that the sample based on FLG has a higher specific capacitance – 65 F×g-1 compared to the sample from AC, the specific capacitance of which is 35 F×g-1, for a speed of 5 mV×s-1 these values are 170 and 64 F×g-1, respectively. The drop in capacitance over 1000 cycles was 4%, which indicates a sufficiently high stability of FLG and allows us to consider FLG as perspective material for use in supercapacitors.

Semiconductor nanowhiskers, in particular, nanostructured whiskers based on zero-dimensional (0D) C70 fullerene, are being actively discussed due to the great potential of their application in modern electronics. For the first time, we proposed and implemented a method for the synthesis of nanostructured C70 fullerene whiskers based on the self-organization of C70 molecules during thermal evaporation of C70 droplets on the substrate surface. We found that the onset of the synthesis of C70 nanowhiskers upon evaporation of drops of a C70 solution in toluene on the substrate surface depends on the substrate temperature. We have provided experimental evidence that an increase in both the C70 concentration in the initial drop and the substrate temperature leads to an increase in the geometric dimensions of C70 nanowhiskers. The obtained results provide useful vision on the role of solute concentration and substrate temperature in the synthesis of one-dimensional materials.

The dynamics of the topological charge of a vortex optical beam propagating in a turbulent air with accounting for the cubic nonlinearity is theoretically considered. On a number of examples, we show that the optical beam self-focusing manifests itself ambiguously depending on optical wave power. At near-critical values of beam power, self-focusing leads to enhanced spatial localization of optical vortices and substantial suppression of vortex walk-off relative to the beam axis caused by air turbulence. However, with increasing of optical intensity the modulation instability imposed by cubic nonlinearity becomes significant and contributes jointly with medium turbulence to faster divergence of vortex beams.