Zr-2.5%Nb Pressure tubes (PT) house uranium fuel bundles in the fuel channels of CANDU® nuclear reactors. Preventing a failure mode caused by contact of the PT with an outer calandria tube (CT) is performed by inspection using eddy current (EC) testing and ultrasonic testing (UT) to measure the PT-CT gap. EC gap measurements are particularly sensitive to circumferential variation of the PT’s electrical resistivity, due to microstructural variations. A full-factorial experiment was performed to examine the statistical significance of variations in EC test parameters and manufacturing conditions on average circumferential electrical resistivity of as-manufactured PTs. It was found that 79% of the variance in the data could be attributed to variations caused by any of the test factors or combinations of test factors. The parameters that accounted for the majority of the variance were; 1) heat treatment (HT); 2) HT and EC frequency; 3) probe inner or outer surface placement; and 4) EC frequency. Measurements of circumferential resistivity showed up to ± 2.3% variation from the average of either surface. HT caused average PT resistivity to decrease at a rate of 1.53±0.08 (μΩ⋅cm)/log⁡(hr) and 1.1±0.4 (μΩ⋅cm)/log⁡(hr) for inner and outer PT surfaces, respectively. Results are correlated with literature reported differences in average β_Zr ribbon thickness in the axial-transverse cross-section between inner and outer PT surfaces. Results demonstrate potential for EC based resistivity measurements to characterize variations and changes in microstructure of Zr-2.5%Nb PT material.

Ultrasonic transducers are widely used for non-destructive testing (NDT) and evaluation in various industries. While capacitive micromachined ultrasonic transducers (CMUTs) have emerged as significant novel transducers, their application in NDT has been limited. This study designed and fabricated a novel two-element CMUT device for NDT applications. The CMUT’s structural parameters were introduced, and the device was fabricated using silicon fusion wafer-bonding technology. The transducer’s sensitivity, bandwidth, and pulse-echo response performance were tested and analyzed. Testing with aluminum blocks demonstrated that the two-element transducer can transmit and receive ultrasonic waves, with central operating frequencies of 3.35 MHz. In addition, at 3.4 MHz, the receive sensitivities of both elements were –197.434 dB and –197.413 dB, respectively, meeting the requirements for NDT systems. In pulse-echo response testing, the CMUT successfully detected signals from the aluminum block interface and located the interface’s position. This study highlights the potential of CMUTs for NDT testing and evaluation applications.

Pharmaceutical packaging is very crucial in as much as it plays the role of enhancing the stability, efficacy as well as safety of the produced medicine through the material used in packaging. It is important to note that cGMP Chapters 661 and 671 are focused on explaining how one should assess the quality of container materials in the sphere of pharmaceuticals. These chapters encompass a number ofmatters among them being Plastic and glass containers and performance testing; they serve as a resource that aids in assuring all standards are met with profound proficiency. Following this, the performance of two core chapters of USP known as Chapter 661 on “Containers—Glass” and Chapter 671 on “Containers—Performance Testing” will be dealt with in a step-by-step manner in the following paper while providing a comprehensive review of both at the same time. Understanding and legal obedience to these rules, as stipulated in the above-mentioned chapter, are indispensable for almost all the parties involved in the production of the drugs, together with the policies and legislation on the same. Thus, the purpose of this paper is to describe and discuss the major aspects of the understanding, application, requirements and evaluation procedures depending on the USP Chapters 661 and 671 in the sphere of the pharmaceutical market.

The global antibiotic resistance crisis, driven by antibiotic overuse and misuse, is multifaceted. This study aimed to assess the microbiological and genetic characteristics of raw retail pork meat, including the isolation, antibiotic susceptibility testing (AST), whole genome sequencing (WGS) of selected indicator bacteria, antibiotic residue testing, and metagenomic sequencing. Samples were purchased from 10 randomly selected retail stores in Gauteng, South Africa. Samples were aseptically separated, with a portion sent to an external laboratory for isolating indicator bacteria and antibiotic residue testing. Identification of the isolated bacteria was reconfirmed using matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF MS). AST was performed using the Microscan Walkaway system. WGS and metagenomic sequencing were performed using the Illumina NextSeq 550 instrument. The isolated E. coli and enterococci exhibited little phenotypic resistance, with WGS revealing tetracycline resistance genes. Isolated bacteria and meat samples all harboured tetracycline resistance genes, and the antibiotic residue concentrations were within acceptable limits for human consumption. In the metagenomic context, most identified bacteria were of food/meat spoilage and environmental origin, with the resistome analysis primarily indicating beta-lactam, tetracycline and multidrug resistance genes. Further research is needed to understand the broader implications of these findings on environmental health and antibiotic resistance.

Wireline Formation Testing is an important technique in the oil field of exploration and development. Not only it can make real fluid samples of the formation directly obtained to know exactly oil existed in formation or not; but it can also show flowing pressure change to see the production capacity of the formation. So it is important measurement for formation evaluation during the drilling process and supports for activities of the exploration and development in the oil field. A numerical simulation model in this article is researched and established based on the Finite Volume Method with considering the influence of sensitive parameters such as reservoir heterogeneity, probe suction area, and mud-filtrate invasion depth during the drilling. The model is capable to design and evaluate for formation fluid sampling operations with calculating hydrocarbon content and flowing pressure. Furthermore, through case application, the performance and effect in the process of Wireline Formation Testing was demonstrated. The results indicate that this technology can be served as an effective auxiliary tool for fluid sampling operations with the function of optimizing fluid sampling measures. It can improve the accuracy of predicting indicators such as hydrocarbon content and breakthrough time during the sampling process. This study provides important backups and technical guidance for professionals in geological exploration and oilfield development.

Background: Removable prostheses have seen a fundamental change recently because of advances in polymer materials, allowing improved durability and performance. Despite these advancements, notable differences still occur amongst various polymer materials and processing technologies, requiring a thorough grasp of their mechanical, physical, and therapeutic implications. Methods: Fours different processing techniques, all utilizing Polymethyl methacrylate (PMMA) as the main material, were used to construct complete dentures. The specimens underwent a mechanical test. Results: All the specimens broke under the influence of a certain force, rather than yielding through flow, as is characteristic for plastic materials. For each specimen, the maximum force (N) was recorded (figure 4), as well as the breaking energy, Conclusions: The best results were obtained in the case of the thermoplastic injection system and, surprisingly and contrary to those in the specialized literature, the worst results were recorded in the case of 3D printed samples.

Human exposure to foodborne inorganic nanoparticles (NPs) is a growing concern. However, identifying potential hazards linked to NP ingestion often requires long-term exposure in animals. Owing these constraints, intestinal organoids are a promising alternative to in vivo experiments, as such an in vitro approach should enable rapid and reliable assessment of the effects on the gut of ingested chemicals. However, this remains to be validated for inorganic substances. In our study, a transcriptomic analysis and immunofluorescence staining were performed to compare the effects of food-grade TiO2 (fg-TiO2) on enteroid-derived monolayers (EDMs) from murine intestinal organoids to known impacts of TiO2 on intestinal epithelium. After validating their ability to dose-dependently respond to a pro-inflammatory cytokine cocktail, EDMs were exposed to 0.1, 1 or 10 µg fg-TiO2/mL for 24h. In line with known data, a dose-related increase of muc2, vilin 1 and chromogranin A gene markers of cell differentiation was observed. In addition, fg-TiO2 induced apoptosis and dose-dependent genotoxicity, while a decreased expression of genes encoding for antimicrobial peptides, and of genes related to tight junction function was observed. These results validated the use of EDMs as a reliable model for toxicity testing of foodborne NPs likely to affect the intestinal barrier.

Hepatocellular carcinoma (HCC) results in high mortality due to ineffective systemic therapy. Human immortalized cell lines are commonly used to study anti-tumour effects in the context of new anti-tumour therapies and tumour biology. As immortalized cell lines have limited biological relevance and heterogeneity compared to primary cells, patient-derived tumour tissues and corresponding immune cells are the gold standards for studying the complexity of individual tumour entities. However, culturing primary HCC cells has a low success rate. Here, we aimed to establish a reproducible approach to preserve the patient-derived liver cancer cells for in vitro and in vivo studies. The underlying study aimed to establish an in vitro pre-screening platform to test treatment options' effectivity and dosage, e.g., for new substances, autologous modified immune cells, or combined therapies in HCC. We initially employed 15 surgical resection specimens from patients with different HCC entities for isolation and preservation. The isolated liver cancer cells from four HCC-diagnosed patients were used for orthotopic transplantation into the healthy liver of immunodeficient mice, allowing them to grow for six months before human liver cancer cells were isolated and cultured. As a result, we generated and characterized four new primary-like liver cancer cell lines. Compared to immortalized HCC cell lines, freshly generated liver cancer cells displayed individual morphologies and heterogenous protein-level characteristics. We assessed their ability to proliferate, migrate, form spheroids, and react to common medications compared to immortalized HCC cell lines. All four liver cancer cell lines exhibit strong migration and colony-forming characteristics in vitro, comparable to extensively investigated immortalized HCC cell lines. Moreover, the four etiological different liver cancer cell lines displayed differences in the response to 5-FU, Sorafenib, Axitinib and Interferon-alpha treatment, ranking from non-responders to responders depending on the applicated medication. In sum, we generated individual patient-derived liver cancer cell lines suitable for predictive in vitro drug screenings and moreover for xenograft transplantations to realize the in vivo investigation of drug candidates. We overcame the low cultivation success rate of liver cancer cells derived from patients and analyzed their potential to serve a pre-clinical model.

Blood testing is a crucial application in the field of clinical studies for disease diagnosis and screening, biomarkers discovery, organ function assessment, and personalized medication. Therefore, it is of utmost importance to collect precise data in a short time. In this study, we utilized Raman spectroscopy to analyze blood samples and extracted comprehensive biological information, including the primary components and compositions present in the blood. We conducted short-wavelength (532 nm green light) Raman scattering spectroscopy on blood samples, plasma, and serum, and subsequently analyzed the biological characteristics detected in each sample type. Our results indicated that whole blood had high hemoglobin content, which suggests that hemoglobin is a major component of blood. The characteristic Raman peaks of hemoglobin were observed at 690, 989, 1015, 1182, 1233, 1315, and 1562–1649 cm−1. Analysis of plasma and serum samples indicated the presence of β-carotene, which exhibited characteristic peaks at 1013, 1172, and 1526 cm−1. Additionally, in the field of medical blood testing, the novel 3D Silicon micro-channel device technology holds immense potential. It can serve as a substrate and helps to detect various diseases and biomarkers, providing real-time data to help medical professionals and patients better understand their health conditions. Changes in biological data collected in this manner could potentially be used to diagnose clinical diseases.

This study aimed evaluating 7 years’ outcome in 118 very preterm newborn (VPN, gestational age=26±1.4wks) involved in a randomized controlled trial. They presented neonatal respiratory distress (RDS) requiring ventilation for 14±2 days post-natal age (PNA). Repeated instillation of 200mg/kg Poractant alfa (SURF) did not improve early bronchopulmonary dysplasia, but SURF infants needed less re-hospitalization than controls for respiratory problem at 1- and 2-years PNA. There was no growth difference at 7.1±0.3 years for 41 SURF vs. 36 controls (80% eligible children); 7.9% SURF vs. 28.6% controls presented asthma (p=0.021). Children underwent cogni-tive assessment (WISC IV) and pulmonary function testing (PFT) measuring spirometry, lung volumes and airway resistance. Spirometry showed differences (p<0.05) between SURF and con-trols (mean±standard deviation (median z-score)) for FEV1 (L/s) (1.188±0.690(-0.803) vs. 1.080±0.243(-1.446)); FEV1 after betamimetics (1.244±0.183(-0.525) vs. 1.091±0.209(-1.342)); FVC (L) (1.402±0.217 (-0.406) vs. 1.265±0.267(-1.141)), and FVC after betamimetics 1.452±0.237 (-0.241) vs. 1.279±0.264(-1.020)). PFT showed no difference in volumes or airway resistance. Global IQ median [Inter-quartile Range] was 89[82:99] vs. 89[76:98] with 61% children >85 in both groups. Former VPN presenting severe neonatal RDS treated with repeated Surfactant have improved lung function and less asthma at 7 years PNA. There were no differences in neurodevelopmental outcome

High-dimensional measurement error data are becoming more prevalent across various fields. Research on measurement error regression models has gained increasing attention due to the risk of drawing inaccurate conclusions if measurement errors are ignored. When the dimension p is larger than the sample size n, it is challenging to develop statistical inference methods for high-dimensional measurement error regression models due to the existence of bias, nonconvexity of objective function, high computational cost and many other difficulties. Over the past few years, some works have overcome the aforementioned difficulties and proposed several statistical inference methods. This paper mainly reviews the current development on estimation, hypothesis testing and variable screening methods for high-dimensional measurement error regression models and shows the theoretical results of these methods with some directions worthy of exploring for future research.

Blood testing is a crucial medical application. In this study, we applied Raman spectroscopy to test blood samples and obtained complete biological information, including the main components and compositions in these samples. Short-wavelength (532-nm green light) Raman scattering spectroscopy was conducted on samples of normal blood, abnormal blood in 3 types of preparation including whole blood, plasma, and serum, and the underlying information reflected by the biological characteristics detected in each sample type were analyzed. Raman spectroscopy results indicated that normal blood had high hemoglobin content, which suggests that hemoglobin is a major component of blood. Hemoglobin affects blood oxygen level. The characteristic peaks of hemoglobin were observed at 690, 989, 1015, 1182, 1233, 1315, and 1562–1649 cm−1. Analysis of plasma and serum samples indicated the presence of β-carotene, which exhibited characteristic peaks at 1013, 1172, and 1526 cm−1. In addition, surface-enhanced Raman spectroscopy was used to collect biological signals that are difficult to obtain in conventional Raman spectroscopy, including those of small molecules such as hormones, antibodies, and enzymes. Changes in biological information collected in this manner can be used as a basis for potentially diagnosing clinical diseases.

As with every new technology, safety demonstration is a critical component of bringing products to market and gaining public acceptance for cultured meat and seafood. This manuscript develops research priorities from the findings from a series of interviews and workshops with governmental scientists and regulators from food safety agencies in fifteen jurisdictions globally.  The interviews and workshops aimed to identify the key safety questions and priority areas of research. Participants raised questions about which aspects of cultured meat and seafood production are novel, and the implications of the paucity of public information on the topic. Novel parameters and targets may require the development of new analytical methods or adaptation and validation of existing ones, including for a diversity of product types and processes. Participants emphasized that data sharing of these efforts would be valuable, similar to those already developed and used in the food and pharmaceutical fields. Contributions to such databases from the private and public sectors would speed general understanding as well as efforts to make evaluations more efficient. In turn, these resources, combined with transparent risk assessment, will be critical elements of building consumer trust in cultured meat and seafood products.

Cystic fibrosis (CF) is characterized by mutations of CFTR that lead to increased viscous secretions, bacterial colonization and recurrent infections. Chronic P. aeruginosa infection in persons with CF is associated with progressive and accelerated lung function decline despite aggressive antibiotic treatment. We report the management of respiratory infections in persons with CF with antibiotic therapy that was based on the recommendations of AtbFinder, a novel, rapid, culture-based diagnostic test system that employs a novel paradigm of antibiotic selection. AtbFinder mimics bacterial interactions with antibiotics at concentrations that can be achieved in affected tissues or organs, and models conditions of interbacterial interactions within polymicrobial biofilms. This open-label, single-arm, investigator‐initiated clinical study was designed to identify the efficacy of antibiotics selected using AtbFinder in persons with CF. Microbiological and clinical parameters were assessed following the change of antibiotic therapy to antibiotics selected with AtbFinder between January 2016 and December 2018 and retrospectively compared with clinical data collected between January 2013 and December 2015.We enrolled 35 persons with CF (33 with chronic P. aeruginosa colonization). Antibiotics selected using AtbFinder resulted in clearance of P. aeruginosa in 81.8% of subsequent cultures, decreased pulmonary exacerbations from 1.21 per patient per annum to 0, and an increase in predicted FEV1% up to 28.4% from baseline. The number of systemic antibiotic courses used in patients after switching to the AtbFinder selected therapy was reduced from 355 to 178. These findings describe the superiority of antibiotic regimens selected with AtbFinder compared with routine antimicrobial susceptibility testing.

For the soil in different regions, the nutrient fertility contained in it is different, and the detection and zoning management of soil nutrients before tillage every year can improve grain yield. In this paper, an integrated learning strategy model based on black soil hyperspectral data is designed for rapid classification of organic matter content classification of black soil. Soil hyperspectral image dataset of Xiangyang Experimental Base was collected; by changing the internal structure of the stacking model, an LSVM-stacking model with (MLP, SVC, DTree, XGBl, kNN) five classifiers as the L1 layer was built, and the simulated annealing algorithm was used for hyperparameter optimization. Compared to other stacking models, the LSVM-stacking metrics are significantly improved. The accuracy rate of hyperparameter optimization is improved by 38.6515%, the accuracy rate of the independent test data set is 0.9488, and the comparison of individual learners can improve the recognition classification accuracy of label"1" to 1.0.

In Los Angeles, at one point, the Covid-19 testing positivity rate was 6.25%, or one in sixteen. This translates to, on average, one in sixteen specimens testing positive and the vast majority testing negative. Usually, we run sixteen tests on sixteen specimens to identify the positive one(s). This process can be time consuming and expensive. Since a group of negative specimens pooled together for testing will produce a negative result, one single test could potentially eliminate many specimens. Only when the pooled specimen tests positive do we need further testing to identify the positive one(s). Based on this concept, we designed a strategy that will identify the positive specimen(s) efficiently. Assuming one in sixteen specimens is positive, we find that only four tests are needed. Furthermore, we can run them simultaneously, saving both resources and time. Although, in the real world, we cannot make the assumption of only one positive specimen, the same strategy works with slight modification and proves to be much more efficient than the conventional testing. Our strategy returns an answer 48% of the time in four tests and one time cycle. Overall, the average number of tests is seven or eight depending on the follow-up testing, and the average time cycle is about one and a half.

Meier–Gorlin syndrome (MGS) is a rare genetic developmental disorder that causes primordial proportional dwarfism, microtia, absent or hypoplastic patellae and other skeletal anomalies. Overlapping skeletal symptoms make MGS difficult to diagnose clinically. We describe a 3-year-old boy with short stature, recurrent respiratory infections, short-rib dysplasia, tower head and facial dysmorphisms who was admitted to the Tomsk Genetic Clinic to verify a clinical diagnosis of Jeune syndrome. Clinical Exome sequencing revealed two variants (compound heterozygosity) in the ORC6 gene: c.2T&gt;C(p.Met1Thr) and c.449+5G&gt;A. In silico analysis showed the pathogenicity of these two mutations and predicted a decrease in donor splicing site strength for c.449+5G&gt;A. An in vitro minigene assay demonstrated that variant c.449+5G&gt;A causes a complete skipping of exon 4 in ORC6 gene. The parents asked for urgent prenatal testing for MGS for the next pregnancy, but it ended in a miscarriage. Thus, this case report may help to prevent MGS misdiagnosis in the future. We also performed in silico and functional analyses of ORC6 mutations and developed a restriction fragment length polymorphism and haplotype-based short-tandem-repeat assay for prenatal genetic testing for MGS. These findings should elucidate MGS aetiology and improve the quality of genetic counselling for affected families.

Guided by the Conceptual Model of Implementation Research, we explored the acceptability, appropriateness, and feasibility of: 1) automated screening approaches utilizing existing health data to identify those who require subsequent diagnostic evaluation for familial hypercholesterolemia (FH) and 2) family communication methods including chatbots and direct contact to communicate information about inherited risk for FH. Focus groups were conducted with 22 individuals with FH (2 groups) and 20 clinicians (3 groups). These were recorded, transcribed, and analyzed using deductive (coded to implementation outcomes) and inductive (themes based on focus group discussions) methods. All stakeholders described these initiatives as: 1) acceptable and appropriate to identify individuals with FH and communicate risk with at-risk relatives; and 2) feasible to implement in current practice. Stakeholders cited current initiatives, outside of FH (e.g., pneumonia protocols, colon cancer and breast cancer screenings), that gave them confidence for successful implementation. Stakeholders described perceived obstacles, such as nonfamiliarity with FH, that could hinder implementation and potential solutions to improve systematic uptake of these initiatives. Automated health data screening, chatbots, and direct contact approaches may be useful for patients and clinicians to improve FH diagnosis and cascade screening.

The performance of a normal-strength SHCC under impact loading was studied using the results obtained from a split Hopkinson tension bar (SHTB). The focus of the investigation is to explain the mechanisms behind the peculiar rate-dependent behavior of SHCC under tensile loading. With the help of frames obtained by high-speed cameras and the subsequent Digital Image Correlation (DIC) analysis, the stress-strain relation of the SHCC obtained in SHTB was analyzed. The investigation of the composite’s behavior was supported by constituent-level experiments on the non-reinforced matrix of the SHCC and on the fiber-matrix bond. In the case of the constituent matrix, the well-known apparent increase in the tensile strength of the cement-based matrix and its influence on the behavior of SHCC was studied. For this purpose, experiments on the SHCC specimens with different geometries were performed in the SHTB. The results obtained from these experiments and those obtained by DIC show that commonly used analytical models, in which the specimen is assumed elastic, cannot capture the effects of structural inertia on the results. Thus, an alternative novel method based on the results of DIC has been used to explain and quantify the contribution of structural inertia. The rate-dependent behavior of the fiber-matrix bond was studied by performing high-speed single fiber pullout tests in a miniaturized split Hopkinson tension bar. This novel experimental technique enabled explanation of the rate-dependent bridging action of the fibers in SHCC. Based on the results, the enhanced behavior of SHCC under impact loading is explained.

The manual muscle test (MMT) is a flexible diagnostic tool, which is used in many disciplines, applied in several ways. The main problem is the subjectivity of the test. The MMT in the version of a “break test” depends on the tester’s force rise and the patient’s ability to resist the applied force. As a first step, the investigation of the reproducibility of the testers’ force profiles is required for valid application. The study examined the force profiles of n=29 testers (n=9 experiences (Exp), n=8 little experienced (LitExp), n =12 beginners (Beg)). The testers performed 10 MMTs according to the test of hip flexors, but against a fixed leg to exclude the patient’s reaction. A handheld device recorded the temporal course of the applied force. The results show significant differences between Exp and Beg concerning the starting force (padj=0.029), the ratio of starting to maximum force (padj=0.005) and the normalized mean Euclidean distances between the 10 trials (padj=0.015). The slope is significantly higher in Exp vs. LitExp (p=0.006) and Beg (p=0.005). The results also indicate that experienced testers show inter-tester differences and partly even a low intra-tester reproducibility. That highlights the necessity of an objective MMT-assessment. Furthermore, an agreement on a standardized force profile is required – a suggestion is given.

A COVID-19 disease threatens the population and the economies of the countries significantly. Till now, this pandemic has affected 215 counties or territories. Unavailability of vaccine is the primary concern for the society. To avoid the spread of this disease, social isolation must be preserved and the inter and intra-population movement must be minimized. To reduce the possibility of transmission, the categorization of regions based on susceptibility to COVID-19 infection is a must.Due to the unavailability of a large amount of paper collection for this novel COVID-19 diseases, we used current literature available on a COVID-19 susceptibility of the diabetic patient, human reproductivity, hemodialysis patient’s, pregnant women and meteorological factors and geographical location. Countries in the cold region are more susceptible to the risk of COVID-19 transmission. There was no evidence of the spread of this disease from non-respiratory bodies. Diabetic patients and pregnant women were found to be more susceptible to COVID-19 infection. Anosmia was observed in the majority of the COVID-19 infected cases in European countries. No evidence indicates COVID-19's impact on the human reproductive system explicitly. No cases of vertical transmission of this disease have been observed until now. All the studies available till now is the small scale study. Correlation with something always does not mean causation. There are certain factor like pollution level, temperature Diurnal temperature range, geographical factor, humidity, pollution level, wind speed, population density, medical healthcare facilities social and political factor plays a critical role in transmitting the SARS-COV-2 virus. Besides the adverse effects, it has taught us to shed our selfish goals and to promote the welfare of all.

It is unclear why European countries have been more severely affected by COVID-19 than East Asian countries. In this ecological study we compared the COVID-19 epidemics (cumulative incidence and mortality rates), host genetic susceptibility and national responses (testing intensity) in all European versus all Western Pacific/East Asian countries reporting cases in the first month of the epidemic. The host-genetic-susceptibility assessment was limited to the frequency of the D-allele of the angiotensin converting enzyme-1 (ACE-1) which has been found to be positively associated with COVID-19 incidence within European countries. Despite earlier epidemics, countries from the Western Pacific reported lower cumulative numbers of COVID-19 cases/100 000 inhabitants than European countries (P=0.0002). The Western Pacific countries also reported fewer cumulative COVID-19 deaths/100 000 (P=0.0024). Whilst there was little difference in the cumulative number of tests conducted/100 000, the percent of COVID-19 tests reported positive was higher in Europe than the Western Pacific (P=0.0076). The frequency of the ACE-1 D-allele was lower in the Western Pacific than European countries (P=0.0007). Our results suggest that a combination of different testing strategies and host genetic susceptibility contribute to difference in severity of the COVID-19 epidemics in the Western Pacific/East Asia and Europe.

Duchenne muscular dystrophy (DMD) is a fatal X-linked recessive neuromuscular disorder most commonly caused by mutations disrupting the reading frame of the dystrophin (DMD) gene. DMD codes for dystrophin, which is critical for maintaining the integrity of muscle cell membranes. Without dystrophin, muscle cells receive heightened mechanical stress, becoming more susceptible to damage. An active body of research continues to explore therapeutic treatments for DMD as well as to further our understanding of the disease. These efforts rely on having reliable animal models that accurately recapitulate disease presentation in humans. While current animal models of DMD have served this purpose quite well, each comes with their own limitations. To help overcome this, clustered regularly interspaced short palindromic repeats (CRISPR)-based technology has been extremely useful in creating novel animal models for DMD. This review focuses on animal models developed for DMD that have been created using CRISPR, their advantages and disadvantages as well as their applications in the DMD field.

The Gurney flap (GF) is a miniature lift-enhancement device and is usually mounted at the trailing edge of an airfoil. The GF and has been successfully applied to isolated airfoils, multi-element airfoils, and aircraft wings as well as helicopter rotor due to its attractive features of simplicity, cost-effective and separation control. The GF also has aroused the attention of researchers in the turbomachinery industry. However, limited studies are currently available on the application of a GF to an axial fan.Hence, in this paper, we conduct a wind tunnel and computational fluid dynamic (CFD) investigation on an axial fan profiled with a NACA 65-(12)10 airfoil to evaluate the effect of the GF on the performance of the fan. We also present the detailed flow features of the fan with and without the GF after validating the simulation results with the experimental results. The experimental results show that as the GF is installed higher on the fan blade, it can produce a higher total pressure rise accompanied with a greater loss of efficiency. The installation of the GF also enlarges the work capacity of the fan. Detailed flow field analysis, including the surface pressure distribution, vorticity distribution at the trailing edge and streamline distribution of the fan, is carried out to understand the mechanisms of the effect of the GF on the performance of the fan.

Georgia is ranked fifth highest among states for rates of HIV diagnosis. About 4% of persons living with HIV infection in the United States reside in Georgia, and almost 19% of these people do not know their HIV status. The present study examined the trends and associated factors of HIV testing among adults in Georgia between 2010 and 2014 by analyzing data of the Behavioral Risk Factor Surveillance System (BRFSS). A total of 30,791 persons aged ≥18 years were identified who responded to the question “Have you ever been tested for HIV?” Overall, there were 11,543 respondents who had been tested for HIV, with a decrease in percentage from 49.4% in 2010 to 43.7% in 2014 (p<0.001). Factors associated with HIV testing were being black (p<0.001), being younger than 55 years (p<0.001), single (p=0.02), attaining education level above high school (P<0.001), engaging in HIV high-risk behaviors (p<0.001), and not having healthcare coverage (p=0.03). Overall in Georgia, there has been a decline in the temporal trend of HIV testing, and more than half of adults have never been tested for HIV. For reducing HIV transmission in Georgia, enhancing access and utilization of HIV testing should be a public health priority.

Northern Nigeria has had historically low antenatal care (ANC) utilization rates with poor health outcomes. Group antenatal care (gANC) improves ANC behavior and pregnancy outcomes. The gANC has been adopted in Kaduna and Kano states, Nigeria. This paper presents baseline findings from the evaluation of the implementation of the gANC program to support scaling in real-world setting. Baseline data were collected from a cohort of 1,269 and 1,200 pregnant women enrolled in gANC at health facilities in Kaduna and Kano states respectively from March to April 2024. Analyses of socio-demographic and pregnancy behavior data were done. Participants were mostly between ages 19-31 years, married or living with a partner, with over 50% having their own businesses. Over 62% and 34% had completed secondary or higher-level education with 60% and 80% living in urban areas in Kaduna and Kano States, respectively. In Kano State, >60% of the women had their last delivery at home with 41.6% not assisted by a skilled birth attendant. In Kaduna, >63% delivered in the hospital and >50% had skilled attendance during labor. Almost half had not used contraceptives previously. Subsequent longitudinal data will examine the impact of gANC utilization on perinatal outcomes.

This study proposes a new maximum power point tracking (MPPT) method based on machine learning with improved power production efficiency for application to photovoltaic (PV) systems. Power loss occurs in the incremental conductance (InC) method, depending on the size of the voltage step used to track the maximum power point. Additionally, the size of the voltage step must be specified by the initial user; however, an appropriate size cannot be determined in a rapidly changing environment. To solve this problem, this study presents a gradient descent InC (GD InC) method that optimizes the size of the voltage step by applying an optimization method based on machine learning. The effectiveness of the GD InC method was verified and the optimized size of the voltage step was confirmed to produce the largest amount of power. When the size of the voltage step was optimized, a maximum difference of 4.53% was observed compared to case when the smallest amount of power was produced. The effectiveness of the GD InC method, which improved the efficiency of power production by optimizing the size of the voltage step, was verified. Power can be produced efficiently by applying the GD InC method to PV systems.

Numerical simulations of the sub-critical flow past a circular cylinder at the Reynolds number, Re=130,000 are performed using two numerical platforms, commercial, Ansys Fluent and open source, OpenFoam (finite volume method and large eddy simulation based on a differential equation for the sub-grid kinetic energy). An overview of the available experimental data and similar large eddy simulation studies is presented. A detailed analysis of all accumulated data demonstrates satisfactory agreement between them with a dispersion of the order of 10% (for the main integral flow parameters). A detailed comparison of the results obtained by single- and double-precision numerical methods using Ansys Fluent did not reveal any noticeable discrepancies for the integral and local flow parameters, as well as spectral characteristics. It is shown that the behavior of the dynamic system of the fluid dynamic equations computed with single precision is stable by Lyapunov and does not lead to any loss of accuracy. The reconstructed attractors of the dynamic systems in the phase space are limited by an ellipsoid.

Microscale swimmers have to face the dominance of viscous forces over inertial forces, the so-called low Reynolds number (hereafter Re) regime. The undulatory motion of an elastic tail is one of the few possible mechanisms for the self-propulsion of microswimmers in the particular conditions of low Re. Instead of using a complex arrangement of multiple actuators along the body of the swimmer, this work studies the propulsion of a swimming microrobot that is able to generate a non-reciprocal motion by moving a passive elastic tail with non-uniform properties using only a single actuator located at its head. A simulation model is developed in MATLAB to evaluate the effect of different mass and elasticity distributions in the tail on the microrobot propulsion. The results are used to observe the undulating motion of the tail and to optimize the design of the robotic microswimmers in terms of efficiency.

Smart agriculture is a new way of farming that uses advanced technology. It makes a significant contribution to improving the efficiency and productivity of farming practices. Systems that use drones to monitor pests and spray pesticides greatly reduce the burden on farmers. In addition, remote sensing technology facilitates the monitoring of crop growth conditions and the early detection of diseases and pests. However, the high cost of equipment to communicate sensor data is preventing farmers from adopting sensing systems. As a result, many studies have been conducted to make the sensing system available at a low cost. Nevertheless, many farmers have not yet adopted them. Therefore, this paper proposes an agricultural sensor network system using drones and optical camera communication (OCC). The proposed system aims to achieve high-density farm sensing at low cost. The proposed system uses OCC as the communication method for sensor data. Low cost light sources such as LED panels can be used as transmitters. In addition, existing agricultural drones equipped with cameras can be used as receivers. We also propose a trajectory control algorithm for the receiving drone to efficiently collect the sensor data. The proposed system is suitable for deploying sensor networks in areas with underdeveloped infrastructure and radio silence. In this paper, we conducted a preliminary experiment at a leaf mustard farm in Kamitonda-cho, Wakayama to demonstrate the effectiveness of the proposed system using a Mavic 2 Pro drone, launched by DJI Co., Ltd.

Pipelines extend thousands of kilometers to transport and distribute oil and gas. Given the challenges often faced with corrosion, fatigue, and other issues on steel pipes, the demand for glass fiber reinforced plastics (GFRP) pipes is increasing in the oil and gas gathering and transmission systems. However, the medium transported through these pipelines contains multiple acid gases such as CO2 and H2S, as well as ions including Cl-、Ca2+、Mg2+、SO42-、CO32- and HCO3-. These substances can cause a series of problems, such as aging, debonding, delamination, and fracture. In this study, a series of aging damage experiments were conducted on V-shaped GFRP pipes with depths of 2mm and 5mm. The aging and failure of GFRP were studied under the combined effects of external force and acidic solution using acoustic emission (AE) techniques. It was found that the acidic aging solution promoted matrix damage, fiber/matrix desorption, and delamination damage in GFRP pipes over a short period. However, the overall aging effect was relatively weak. Based on the experimental data, the SSA-LSSVM algorithm was proposed and applied to the damage pattern recognition of GFRP. An average recognition rate of up to 90% was achieved, indicating that this method is highly suitable for analyzing AE signals related to GFRP damage.

This paper presents a novel segmentation algorithm specially developed for applications in 3D point clouds with high variability and noise, particularly suitable for heritage building 3D data. The method can be categorized within the segmentation procedures based on edge detection. In addition, it uses a graph-based topo-logical structure generated from the supervoxelization of the 3D point clouds, which is used to make the clo-sure of the edge points and to define the different segments. The algorithm provides a valuable tool for generating results that can be used in subsequent classification tasks and broader computer applications dealing with 3D point clouds. One of the characteristics of this segmentation method is that it is unsupervised, which makes it particularly advantageous for heritage applications where labelled data is scarce. It is also easily adaptable to different edge point detection and supervoxelization algorithms. Finally, the results show that the 3D data can be segmented into different architectural elements, which is important for further classification or recognition. Extensive testing on real data from historic buildings demonstrates the effectiveness of the method. The results show superior performance compared to three other segmentation methods, both globally and in the segmentation of planar and curved zones of historic buildings.

This paper introduces a novel method for accurately calculating the upper biomass of single trees using Light Detection And Ranging (LiDAR) point cloud data. The proposed algorithm involves classifying the tree point cloud into two distinct ones: the trunk point cloud and the crown point cloud. Each part is then processed using specific techniques to create a 3D model and determine its volume. The trunk point cloud is segmented based on individual stems, with each stem further divided into slices that are modeled as cylinders. On the other hand, the crown point cloud is analyzed by calculating its footprint and gravity center. The footprint is further divided into angular sectors, with each being used to create a rotating surface around the vertical line passing through the gravity center. All models are represented in a matrix format, simplifying the process of minimizing and calculating the tree’s upper biomass, consisting of crown biomass and trunk biomass. To validate the proposed approach, both terrestrial and airborne datasets are utilized. A comparison with existing algorithms in the literature confirms the effectiveness of the new method. The study shows that the proposed algorithm achieves an average fit between 0.01 m and 0.49 m for individual trees.

This research focuses on the Hopf bifurcation occurring at a singular point with high-order degeneracy in a class of three-dimensional systems. Based on center manifold theorem, by expanding the technique for determining singular point values of degenerate singularities in two-dimensional systems, the formal series method to determine the singular point values at the high-order degenerate critical point is discussed. Furthermore, a class of specific three-dimensional differential systems with high-order degenerate singularities is explored. By computing the singular point values and determining center conditions, we proved that a minimum of 5 small-amplitude limit cycles in the vicinity of the origin. This research provides new perspectives on the center problem and limit cycle bifurcation in high-dimensional systems with high-order degenerate singular points.

Interactions between mobile robots and human operators in common areas require a high safety especially in terms of trajectory planning, obstacle avoidance and mutual cooperation. In this connection the crossings of planned trajectories, their uncertainty based on model fluctuations, system noise and sensor noise,play an outstanding role. This paper discusses the calculation of expected areas of interactions du ring human-robot navigation with respect to fuzzy and noisy information. Expected crossing points of possible trajectories are nonlinearily associated with positions and orientations of robot and human. The nonlinear transformation of a noisy system input, such as directions of motion of human and robot, to a system output, the expected area of intersection of their trajectories, is done by two methods: statistical linearization and the sigma-point-transformation. For both approaches fuzzy approximations are presented and the inverse problem is discussed where the input distribution parameters are computed from given output distribution parameters.

Point defects induced by doping rare earth elements RE (Nd, Er) into the magnesium oxide host were investigated by classical atomistic simulations utilising the General Utility Lattice Program (GULP). Formation and association energies were calculated for the potential defect structures. Both isolated defects and defect complexes were considered. The most energetically favourable structures of defect complexes were found for rare earth doped and Li co-doped systems. The correlation between the association energy and the structure of the defect complex was investigated. The influences of Li were revealed with respect to energy and structure. The simulation results contribute to the understanding of the point defects of doped MgO and how Li influences the doping of rare earth elements in the MgO host.

Accurate classification of objects in 3D point clouds is a significant problem in several applications, such as autonomous navigation and augmented/virtual reality scenarios, which has become a research hot spot. In this paper, we presented a deep learning strategy for 3D object classification in augmented reality. The proposed approach is a combination of the GRU and LSTM. LSTM networks learn longer dependencies well, but due to the number of gates, it takes longer to train; on the other hand, GRU networks have a weaker performance than LSTM, but their training speed is much higher than GRU, which is The speed is due to its fewer gates. The proposed approach used the combination of speed and accuracy of these two networks. The proposed approach achieved an accuracy of 0.99 in the 4,499,0641 points dataset, which includes eight classes (unlabeled, man-made terrain, natural terrain, high vegetation, low vegetation, buildings, hardscape, scanning artifacts, cars). Meanwhile, the traditional machine learning approaches could achieve a maximum accuracy of 0.9489 in the best case.

Precise individual tree or sample-based inventories derived from 3D point cloud data of mobile laser scanning can improve our comprehensive understanding of the structure, function, resilience, biodiversity, and ecosystem services of urban forests. This study assessed the performance of a hand-held laser scanning system for the extraction of tree position, diameter at breast height (DBH) and tree height (H) in an urban area. A total of 2083 trees of 13 species from 34 plots were analyzed. The results showed that the registration of tree positions using ground control points (GCPs) demonstrated high accuracy, with errors consistently below 0.4 m, except for a few instances. The extraction accuracy of DBH for all trees and individual species remained consistently high, with a total root mean square error (RMSE) of 2.06 cm (6.89%) and a bias of 0.62 cm (2.07%). Notably, broad-leaved trees outperformed coniferous trees, with RMSE and bias values of 1.86 cm (6%) and 0.76 cm (2.46%) compared to 2.54 cm (9.46%) and 0.23 cm (0.84%). Tree height extraction accuracy varied significantly among different species, with R2 values ranging from 0.65 to 0.92. Generally, both DBH and height were underestimated. Linear mixed effects models (LME) were applied to evaluate factors affecting the performance of HLS with the plot as a random factor. LME analysis revealed that plant type and terrain significantly influenced the accuracy of DBH and H derived from HLS data. Other fixed factors of plot area, tree density and trajectory length didn’t have significance. With a large sample size, we concluded that the HLS demonstrated sufficient accuracy in extracting individual tree parameters in urban forests.

The most commonly used real-time augmentation services in China are International GNSS Service (IGS) real-time service, PPP-B2b service, and BeiDou Satellite-Based Augmentation System (BDSBAS) dual-frequency augmentation service. However, the research on the performance evaluation, comparison and application scope of these three products is still unknown and unrevealed. This article introduces methods for obtaining real-time augmentation information and real-time orbit and clock offset recovery. Based on real-time orbit and clock offset accuracy, positioning accuracy, and positioning availability, it systematically evaluates the performance of CNES, PPP-B2b, and BDSBAS augmentation information. The results indicate that the radial accuracy of CNES and PPP-B2b real-time orbit products is consistent, and the Root Mean Square (RMS) is better than 5 cm. CNES can achieve centimeter-level accuracy in both along-track and cross-track components, surpassing the decimeter-level accuracy of PPP-B2b. Both services demonstrate consistent accuracy in real-time clock offset, with PPP-B2b showing similar standard deviations (STD) of 0.16 ns for different satellites. However, for CNES, the STD of real-time clock offset varies for GPS, BDS-3 MEO, and BDS-3 IGSO satellites, with values of 0.10 ns, 0.19 ns, and 0.60 ns, respectively. The accuracy and availability of the two PPP services exhibit the same levels, with centimeter-level accuracy achieved after convergence and positioning availability exceeding 99%. Therefore, the difference between the two services in application areas depends on the acquisition of augmentation information. However, BDSBAS, which concentrates on code observations, demonstrates lower accuracy in real-time orbit and clock offset, positioning accuracy, and positioning availability compared to the other two services. Its primary application is in the aviation and maritime domains, where there is a greater need for service integrity, continuity, and reliability.

Rational delineation of urban–rural boundaries is a foundational prerequisite for holistic urban and rural development planning and rational resource allocation. However, the results of division of urban–rural boundaries extracted using a single data source are non-comprehensive. To address this problem, the present study proposes a method for using multiple sources such as population data, nighttime light data, land use, and points of interest (POI) data to extract urban–rural boundaries. Considering Guizhou Province for a case study, we here present a two-step method for identifying urban–rural boundaries. First, the random forest model was combined with the dasymetric mapping method to obtain the population spatialization data with a 30-m resolution in the studied province. Second, using the breaking point method, we extracted the urban–rural boundary for Guizhou Province in 2020 based on the spatialized population. This method fully integrated the benefits of various data and judiciously extracted the boundaries of the main urban areas and small- and medium-sized towns of each city in the study province at the same spatial scale. The stratified random sampling method revealed that the average overall accuracy was 88.05%. The method proposed has certain universality and application value and allows identifying the urban–rural boundaries more accurately and practically.

The management and classification of solid waste is one of the most important challenges around the world, in order to sustain economic growth and preserve the environment. The objective is to propose the use of Smart Ecological Points as a strategy to address the problem related to the solid waste management system at the source, which has become one of the biggest problems globally and Colombia is no exception. The article describes the current state of the problem in the country and in turn, presents the possibility of developing a prototype corresponding to a low-cost Smart Ecological Point supported by the use of an experimental capacitive sensor and Machine Learning algorithms, which will reduce the time necessary for the classification of recyclable and non recyclable waste, minimizing the health risks and increasing the percentage of waste that can be reused, by reducing the probability of being contaminated at the source, an aspect that is very common when done manually. According to the results obtained, it was evident that the proposed prototype made an adequate classification of waste, generating the possibility of being manufactured with existing technology in the environment, in order to promote adequate waste classification at the source.

High-precision ground point cloud data has a wide range of applications in various fields, and the separation of ground points from non-ground points is a crucial preprocessing step. Therefore, designing an efficient, accurate, and stable ground extraction algorithm is of great significance for improving the processing efficiency and analysis accuracy of point cloud data. The study area in this article was a Park in Guilin, Guangxi, China. The point cloud was obtained by utilizing the UAV platform. In order to improve the stability and accuracy of the Filter algorithm, this article proposed a triangular grid filter based on Slope Filter, found violation points by the spatial position relationship within each point in the triangulation network, improved KD-Tree-Based Euclidean Clustering, and applied it to the non-ground points extraction, this method has good accuracy, stability and achieves good results in separating ground points from non-ground points. At first, using Slope Filter to remove some non-ground points, to reduce the error of taking ground points as non-ground points; Secondly, established a triangular grid based on the triangular relationship between each point, the violation-triangle can determin through the grid, and then the corresponding violation points were found in the violation-triangle; Thirdly, according to the three-point collinear method to extract the regular points, used these points to extract the regular landmarks by KD-Tree-Based Euclidean Clustering and Convex Hull Algorithm; Finally, removed disperse points and irregular landmarks by Clustering Algorithm. In order to confirm the superiority of this algorithm, this article compared the filter effects of various algorithms on the study area and filtered the 15 sample data provided by ISPRS, and obtained an average error of 3. 46%. The results showed that the algorithm in this article have a high processing efficiency and accuracy, which can greatly improve the processing efficiency of point cloud data in practical applications.

3D point cloud classification tasks have been a hot topic in recent years. Most existing point cloud processing frameworks lack context-aware features due to the deficiency of sufficient local feature extraction information. Therefore, we design an augmented sampling and grouping (ASG) module to efficiently obtain fine-grained features from the original point cloud. In particular, this method strengthens the domain near each centroid and makes reasonable use of the local mean and global standard deviation to mine point cloud’s local and global features. In addition to this, inspired by the transformer structure UFO-ViT in 2D vision tasks, we first try to use a linearly-normalized attention mechanism in point cloud processing tasks, investigating a novel transformer-based point cloud classification architecture UFO-Net. An effective local feature learning module is adopted as a bridging technique to connect different feature extraction modules. Importantly, UFO-Net employs multiple stacked blocks to better capture feature representation of the point cloud. Extensive ablation experiments on public datasets show that our method outperforms other state-of-the-art methods. For instance, our network performed with 93.7% overall accuracy on the ModelNet40 dataset, which was 0.5% higher than PCT. Our network also archived 83.8% overall accuracy on the ScanObjectNN dataset, which is 3.8% better than PCT.

The paper's main goal is to introduce a novel type of interpolative convex contraction and build up some fresh findings for it using the interpolative convex contractions' progressive approach. We have established certain conclusions using orbitally S-complete and Suzuki type contractions in F-metric spaces. My research aims to examine the fixed point method's efficacy in solving fractional differential equation with boundary conditions.

Spatial approach based on the deformation measurement of volcanic dome and crater rim is key to evaluate the activity of a volcano, such as Merapi volcano where associated disaster risk is regularly taking lives. Within this framework, this study aime to detect localized deformation and change in the summit area that has occurred concomitantly with the dome growth and explosion reported. The methodology was focused on two sets of data, one LiDAR-based dataset of 2012 and one UAV-dataset of 2014. The results show that during the period 2012-2014, the crater walls are 100 m to 120 m high above the crater floor at its maximum (North to East-South-East sector), while the West and North sector presents a topographic range of 40 to 80 m. During the period 2012 – 2014, the evolution of the crater rim around the dome is generally stable (no large collapse). The opening of a new vent on the surface of the dome has displaced an equivalent volume of 2.04 E+04 m3 corresponding to a maximum -9 m (+/- 0.9 m) vertically. This concludes that during the period 2012 – 2014 when the dome of Merapi experienced phreatic or phreatomagmatic explosions, the topography around the dome rose. This rise does not seem to be related to large wall collapses, and it is likely that modification in the subsurface have triggered those changes.

The ACC feature when activated augments the engine performance in real-time. This article presents a novel methodology to predict the optimal adaptive cruise control set speed profile (ACCSSP) by considering all the effecting parameters. This paper investigates engine operating conditions (EOC) criteria to develop a predictive model of ACCSSP in real-time. We developed a deep learning (DL) model using the NARX method to predict engine operating point (EOP) mapping the vehicle-level vectors (VLV). We used real-world field data obtained from Cadillac test vehicles driven by activating the ACC feature for developing the DL model. We used a realistic set of assumptions to estimate the VLV for the future time steps for the range of allowable speed values and applied them at the input of the developed DL model to generate multiple sets of EOP’s. We imposed the defined EOC criteria on these EOPs, and the top three modes of speeds satisfying all the requirements are derived for each second. Thus three eligible speed values are estimated for each second, and an additional criterion is defined to generate a unique ACCSSP for future time steps. Performance comparison between predicted and constant ACCSSPs indicates that the predictive model outperforms constant ACCSSP.

General relativity is a theory for gravitation based on Riemannian geometry, difficult to compatibilize with quantum mechanics. This is evident in relativistic problems in which quantum effects cannot be discarded. For example in quantum gravity, gravitation of zero-point energy or events close to a black hole singularity. Here, we set up a mathematical model to select general relativity geodesics according to compatibility with the uncertainty principle. To achieve this, we derived a geometric expression of the uncertainty principle (GeUP). This formulation identified proper space-time length with Planck length by a geodesic-derived scalar. GeUP imposed a minimum allowed value for the interval of proper space-time which depended on the particular space-time geometry. GeUP forced the introduction of a “zero-point” curvature perturbation over flat Minkowski space, caused exclusively by quantum uncertainty but not to gravitation. When applied to the Schwarzschild metric and choosing radial-dependent geodesics, our mathematical model identified a particle exclusion zone close to the singularity, similar to calculations by loop quantum gravity. For a 2 black hole merger, this exclusion zone was shown to have a radius that cannot go below a value proportional to the energy/mass of the incoming black hole multiplied by Planck length.

In this paper, by using the variational method, a sufficient condition for the unique existence of the stationary solution of the reaction-diffusion ecosystem is obtained, which directly leads to the global asymptotic stability of the unique equilibrium point. Besides, employing impulse control technique derives the globally exponential stability criterion of delayed feedback ecosystem.And numerical examples illuminate the effectiveness of impulse control, which has a certain enlightening effect on the actual epidemic prevention work . That is, in the face of the epidemic situation, taking a certain frequency of positive and effective epidemic prevention measures is conducive to the stability and control of the epidemic situation. particularly, the newly-obtained theorems quantifies this feasible step.

This paper introduces a method for tunnel point cloud and BIM model integration and cross-section monitoring, providing information to analyse tunnel cross-sections and surrounding rock deformation, and support for tunnel maintenance and reconstruction. Three types of data are processed for the integration: laser scanning point cloud, BIM tunnel model and terrain model from oblique photogrammetry. An adaptive BIM modelling scheme is proposed for tunnels with alien structures. Precise spatial registration of the data sets is conducted by applying singular value decomposition (SVD) algorithm to calculate transformation parameters from the point cloud model to the BIM model. Since the tunnel central line has high-order derivability, a cross-section calculation method based on tangent vector is proposed to obtain the cross-sectional profile of tunnels at any mileage. The proposed method has been verified by applying it to a tunnel reconstruction project. The experiment results show that the tunnel point cloud and the BIM model were highly coincident after the integration. The developed program can effectively get the cross-section of the tunnel at any mileage, and correctly express the spatial relationship between the BIM tunnel, the point cloud of tunnel and the external mountainous terrain.

Background: In recent years, the abusive use of the smartphone has reached a situation that could be considered pathological, although there is no such classification in the DSM-IV. In this sense, different instruments to assess this problematic use or addiction to the smartphone are used. Among them, we found the SPAI, which has been validated in the Spanish language. The main difficulty of these scales is to establish a cut-off point that determines such mobile addiction. On the other hand, self-perception has been used in different addictions as a predictor of the problem. Aim: The objective of this study is to establish the cutting point in the scores of the SPAI scale validated in Spanish, using as a referent the self-perception of addiction values. Methods: A receiver operating characteristics (ROC) analysis was carried out, establishing as the cut-off point the one that presented a higher value of Youden J, indicative of its sensitivity and specificity. Results: 2598 participants from the university community completed the SPAI-Spain questionnaire. When using the self-perception of smartphone addiction as the benchmark value, a score of 44 has been established as the cutting point of the SPAI questionnaire, with a Youden J corresponding to 0.416. Conclusions: The implementation of a cut-off point of the SPAI questionnaire makes it an instrument that allows early identification of those individuals at risk of addiction as well as the establishment of preventive and/or intervention measures.

We present an improved algorithm for fast calculation of the inverse square root for single-precision floating-point numbers. The algorithm is much more accurate than the famous fast inverse square root algorithm and has a similar computational cost. The presented modification concern Newton-Raphson corrections and can be applied when the distribution of these corrections is not symmetric (for instance, in our case they are always negative).

To determine the photon emission or absorption probability for a diatomic system in the context of the semiclassical approximation it is necessary to calculate the characteristic canonical oscillatory integral which has one or more saddle points. Integrals like that appear in a whole range of physical problems, e.g. the atom-atom and atom-surface scattering and various optical phenomena. A uniform approximation of the integral, based on the stationary phase method is proposed, where the integral with several saddle points is replaced by a sum of integrals each having only one or at most two real saddle points and is easily soluble. In this way we formally reduce the codimension in canonical integrals of "elementary catastrophes" with codimensions greater than 1. The validity of the proposed method was tested on examples of integrals with three saddle points ("cusp" catastrophe) and four saddle points ("swallow-tail" catastrophe).

The aim of this article is to extend the local as well as the semi-local convergence analysis of multi-point iterative methods using center Lipschitz conditions in combination with our idea, of the restricted convergence region. It turns out that this way a finer convergence analysis for these methods is obtained than in earlier works and without additional hypotheses. Numerical examples favoring our technique over earlier ones completes this article.

We consider Pisot family substitution tilings in $\R^d$ whose dynamical spectrum is pure point. There are two cut-and-project schemes(CPS) which arise naturally: one from the Pisot family property and the other from the pure point spectrum respectively. The first CPS has an internal space $\R^m$ for some integer $m \in \N$ defined from the Pisot family property, and the second CPS has an internal space $H$ which is an abstract space defined from the property of the pure point spectrum. However it is not known how these two CPS's are related. Here we provide a sufficient condition to make a connection between the two CPS's. In the case of Pisot unimodular substitution tiling in $\R$, the two CPS's turn out to be same due to [5, Remark 18.5].

In this paper, we introduced many new notions and new contraction named as S-weakly contraction after that we obtained the p-common best proximity point theorems for different types of contractions in the setting of complete metric spaces by using weak P_p-property and proved the uniqueness of these points. Also we presented some examples to prove the validity of our results.

Filamentous fungi such as Aspergillus spp. are opportunistic pathogens, which cause highly invasive infections, especially in immunocompromised individuals. Control of such fungal pathogens is increasingly problematic due to the small number of effective drugs available for treatment. Moreover, the increased incidence of fungal resistance to antifungal agents makes this problem a global human health issue. The cell wall integrity system of fungi is the target of antimycotic drugs echinocandins, such as caspofungin (CAS). However, echinocandins cannot completely inhibit the growth of filamentous fungal pathogens, which results in survival/escape of fungi during treatment. Chemosensitization was developed as an alternative intervention strategy, where co-application of CAS with the intervention catalyst octyl gallate (OG; chemosensitizer) greatly enhanced CAS efficacy, thus achieved ≥ 99.9% elimination of filamentous fungi in vitro. Based on hypersensitive responses of Aspergillus antioxidant mutants to OG, it is hypothesized that, besides destabilizing cell wall integrity, the redox-active characteristic of OG may further debilitate fungal antioxidant system.

The safe and reliable operation of autonomous vehicles in complex and dynamic environments is heavily dependent upon exteroceptive and proprioceptive sensors. A LiDAR system generates accurate 3D point clouds, which are crucial for the detection, classification, and tracking of multiple targets. LiDAR data, however, presents significant challenges due to its density, noise, and varying sampling rates. In this study, various clustering and MTT techniques for LiDAR point clouds will be identified and classified within the context of autonomous driving to assess the state-of-the-art methods’ key challenges and their performances. We have categorized clustering and MTT methods used in AV applications, identified research gaps and challenges and analyzed existing algorithms and their challenges in detail. Researchers and practitioners in the field of autonomous driving will find this review to be a valuable resource.

Background: Empathy and assertiveness are two essential soft skills for health professionals such as nurses or physiotherapists. Both professions are characterised by their contribution to preserving and improving health and human care, and for their vocation of service. One of the achievements of the training is the voluntary, conscious, and individually inspired career choice; Objetives: This study aimed to evaluate the empathy, assertiveness, and care vocational levels among undergraduate students enrolled in the Nursing and Physiotherapy Degree programmes and to investigate the relationship between these soft skills and the care vocation; Methods: A cross-sectional study of nursing and physiotherapy students was conducted in the 2022/2023 academic year. The Interpersonal Reactivity Index scales for empathy, the Rathus test for assertiveness, and the “Vocation of Service for Human Care” questionnaire were used as study tools. Finally, 226 students participated in the study; Results: The empathy, assertiveness and vocation of service for human care of the students was found to be acceptable. Significant differences were also observed according to the gender variable or career in the students, with female students presenting better results in empathy subscales or vocation (p < 0.05). Students who are working or have clinical experience in other professions score lower on the empathy personal distress subscale (p < 0.05); Conclusions: Both nursing and physiotherapy students demonstrate satisfactory levels of empathy, assertiveness and vocation for human care. However, gender and previous work experience do notably influence these scores. It would be beneficial to conduct long-term studies with educational interventions to train and develop empathy, assertiveness and vocation for human care.

Background: To investigate the association between enteral feeding and the risk of pneumonia in critical care adult patients. Methods: An updated literature review of studies discussing between 2016 and 2023. CINAHL, Cochrane, Embase, PubMed, Scopus, and Web of science databases were used to explore studies regarding our subject, the association between enteral feeding and the risk of pneumonia in critical care adults. Results: Enteral nutrition (EN) has been linked to a significant reduction in pneumonia, as well as shorter ICU or hospital stays, and decreased mechanical-ventilation duration in numerous studies. Conversely, pneumonia risk and other infections, as well as the fatality rate, has been found to increase with EN. Early initiation of EN within 48 hours, along with a low-calorie diet containing (< 600 Kcal/day) demonstrated a notable decrease in the occurrence of Ventilator-Associated Pneumonia (VAP) when contrasted with delayed EN and a high-calorie diet. EN was associated with a marked decrease in adverse events including aspiration pneumonia, emesis, and the escalation of respiratory support. Conclusion: EN is safe and effective in critically ill patients. It is advisable for future research to investigate the monitoring of larger sample sizes to ascertain the most effective feeding methods in the intensive care unit.

Background/Objectives: the prevalence of metabolic syndrome (MetS) is increasing worldwide, and an increasing number of cases are diagnosed in younger age groups. This study aimed to propose predictive models based on demographic, anthropometric and clinical non-invasive variables to predict MetS in adolescent. Methods: a total of 2,064 adolescents aged 18-19 from São Luís-Maranhão-Brazil were enrolled. Demographic, anthropometric, and clinical variables were considered, and three criteria for diagnosing MetS were employed: Cook et al. (2003), De Ferranti et al. (2004), and the International Diabetes Federation (IDF, 2007). A feed-forward artificial neural network (ANN) was trained to predict MetS. Accurate, sensitivity, and specificity were calculated to assess the ANN performance. The ROC curve was constructed, and the area under the curve was analyzed to assess the discriminatory power of the networks. Results: the prevalence of MetS in adolescents ranged from 5.7% to 12.3%. The ANN that used the Cook et al. criterion performed best in predicting MetS. ANN 5, which included age, sex, waist circumference, weight, and systolic and diastolic blood pressure, showed the best performance and discriminatory power (sensitivity, 89.8%; accuracy, 86.8%). ANN 3 considered the same variables, except for weight, and exhibited good sensitivity (89.0%) and accuracy (87.0%). Conclusions: using non-invasive measures allows for predicting MetS in adolescents, thereby guiding the flow of care in primary healthcare and optimizing the management of public resources.

Chronic wounds are a major health problem because of delayed healing and cause hardships for the patient. The infection present in these wounds plays a role in delayed wound healing. Silver wound dressings have been used for decades, beginning in the 1960s with silver sulfadiazine for infection prevention for burn wounds. Since that time, there has been a large number of commercial silver dressings that have cleared FDA approval. In this review, we examine the literature involving in vitro, in vivo, and clinical studies with commercial silver dressings and attempt to glean the important characteristics of these dressings in treating infected wounds. The primary presentation of the literature is in the form of detailed tables. The narrative part of the review focuses on the different types of silver dressings, including the supporting matrix, the release characteristics of the silver into the surroundings, and their toxicity. Though there are many clinical studies of chronic and burn wounds using silver dressings that we discuss, it is difficult to compare the performances of the dressings directly because of the differences in the study protocols. We conclude that silver dressings can assist in wound healing, though it is difficult to provide general treatment guidelines.

Abstract: Background: The optimal strategy for the microelimination of HCV within community settings remains ambiguous. We evaluated the percentage of participants who achieved linkage to care (LTC) following the conclusion of the screening campaign, and examined the diverse factors influencing LTC among these individuals. The effectiveness of recall intervention for the non-LTC population and its barriers were analyzed. Methods: We initiated an HCV patients recall program to identify the HCV participants who might not be treated after the HCV screening campaign. A program staff recalled HCV participants who lost to follow-up through the telephone from March 2019 to June 2019. They were informed of HCV treatment's importance, efficacy, availability, and safety. Result: Among 185 HCV-infected participants, 109 (58.9%) HCV-infected participants had obtained LTC. Compared with those who had LTC, those without LTC were older, lower education levels, were less aware of their HCV infection, less frequently lived in urban areas, and had less health insurance. At the end of the recall program, 125 (67.6 %) persons had liked to care. The proportion of LTC increased by 8.7 %. 119 persons had an HCV RNA test, and 82 (68.9%) had viremia. Of 82 patients with viremia, 78 (95.1%) received antiviral therapy. 76 (97.4 %) of them achieved a sustained virological response. Conclusion: After a community screening campaign, 59 % of participants with anti-HCV positive had LTC. The recall program can increase by 9 %. However, there were still 32% of HCV participants who couldn't be linked to care. Outreach care for non-LTC patients is a way worth trying to achieve micro-elimination of HCV in the rural community.

Background: Electrical Impedance Tomography (EIT), combined with variable ventilation strate-gies and Artificial Intelligence (AI), is poised to revolutionize critical care by transitioning from reactive to predictive approaches. This integration aims to enhance patient outcomes through personalized interventions and real-time monitoring. Methods: This narrative review explores the principles and applications of EIT, variable ventilation, and AI in critical care. EIT’s impedance sensing creates dynamic images of internal physiology, aiding in the management of conditions like Acute Respiratory Distress Syndrome (ARDS). Variable ventilation mimics natural breathing variability to improve lung function and minimize ventilator-induced lung injury. AI enhances EIT through advanced image reconstruction techniques, neural networks, and digital twin technology, offering more accurate diagnostics and tailored therapeutic interventions. Conclu-sions: The confluence of EIT, variable ventilation, and AI represents a significant advancement in critical care, enabling a predictive, personalized approach. EIT provides real-time insights into lung function, guiding precise ventilation adjustments and therapeutic interventions. AI inte-gration enhances EIT's diagnostic capabilities, facilitating the development of personalized treatment plans. This synergy fosters interdisciplinary collaborations and sets the stage for in-novative research, ultimately improving patient outcomes and advancing the future of critical care.

Background: The aim of the current study is to evaluate the effects of inflammation markers, on infection and mortality in patients over 65 years of age monitored in the intensive care unit. In the study, the significance of pan-immune inflammation (PIV), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), monocyte-lymphocyte ratio (MLR), systemic immune-inflammatory index (SII), systemic immune response index (SIRI), multi-inflammatory index (MII) 1-2-3, and CRP/albumin ratios, new biomarkers, were attempted to be determined as prognostic and mortality markers in patients over 65 years of age monitored in the ICU. Methods: This multicenter, retrospective cohort study was conducted in two tertiary-level ICUs with patients aged 65 and over who were admitted. Patients with cirrhosis, bone marrow transplantation, hematologic malignancy, undergoing chemotherapy, and neutropenia at admission to the ICU were excluded from the study. Results: A total of 333 patients were included in the study. The 28-day mortality was found to be 31.8%. When each inflammatory marker associated with 28-day mortality was examined the CRP/albumin ratio performed better than both NLR and SIRI, and the results were statistically significant (AUC: 0.665, 95% CI: 0.604-0.726 and p <0.001). NLR had a moderate discriminative ability in distinguishing mortality risk (AUC: 0.593, 95% CI: 0.526-0.660 and p = 0.006). Although SIRI was lower than NLR, it had a statistically significant result (AUC: 0.580, 95% CI: 0.514-0.646 and p = 0.019). CRP/albumin ratio was the most effective inflammatory marker in predicting mortality risk in geriatric patients admitted to the ICU.

Prostate Cancer remains a prevalent health concern, emphasizing the critical need for early diagnosis and precise treatment strategies to mitigate mortality rates. Accurate prediction of cancer grade is paramount for timely interventions. This paper introduces an approach to prostate cancer grading, framing it as a classification problem. Leveraging ResNet models on multi-scale patch-level digital pathology and the Diagset dataset, the proposed method demonstrates notable success, achieving an accuracy of 0.999 in identifying clinically significant prostate cancer. The study contributes to the evolving landscape of cancer diagnostics, offering a promising avenue for improved grading accuracy and, consequently, more effective treatment planning. By integrating innovative deep-learning techniques with comprehensive datasets, our approach presents a step forward in the pursuit of personalized and targeted cancer care.

Background: Assessing the impact of bone health clinical management in breast cancer (BC) patients receiving adjuvant endocrine therapy and designing a personalized clinical pathway to reduce bone loss, in an Italian research hospital. Methods: The primary endpoint was to assess (through the process improvement organizational method) the clinical pathway that post-surgical BC patients prescribed with endocrine therapy undergo to prevent bone loss. The secondary endpoint was to design a personalized clinical pathway for a prompt implementation of guidelines, to assess and possibly prescribe antiresorptive therapy. Results: During the first year of the new diagnostic therapeutic assistance pathway execution, an 60% increase in Dual-Energy X-ray Absorptiometry evaluations within 30 days and a 39.5% increase in antiresorptive therapy prescription within 90 days (since prescription of endocrine therapy) were shown, thus increasing patients’ compliance. Conclusion: Case managers and bone health specialists in this context can improve patients’ adherence to therapies and bone health, helping physicians to expand their collaboration.

Background: The adoption of self-care behaviors among patients with congestive heart failure (CHF) is essential for the management of their health condition. However, there is a lack of tools for estimating self-care in CHF patients. We aim to develop and validate the Hippocratic heart failure self-care scale (HHFSCS). Methods: the scale includes 22 items which are reviewed by a committee of experts. Individuals indicate the frequency at which they follow each self-behavior on a five-point Likert scale. Adult patients with CHF (n=250) from a General Hospital, in Athens, were participated in the study from June 2020 to March 2021. Reliability coefficients and Explanatory Factor Analysis (EFA), using a Varimax rotation and the Principal Components Method were used to assess the psychometric measurements. Results: The Cronbach’s alpha coefficient of the HHFSCS was 0.807. The exploratory factor analysis identified two domains that accounted for 88.44% of the variance of the scale items; however, each sub-scale could not be used as an independent scale. Finally, the test-retest showed a significant strong correlation (r=0.973, p&lt;0.001). Conclusions: The HHFSCS is a reliable and valid tool for assessing self-behaviors in CHF patients. Health professionals can use it in their clinical practice to improve the management of patient’s health conditions.

The experiment assessed the impact of the interaction of two care treatments on the growth and flowering of two varieties of Panicle Hydrangea bushes. The first treatment considered was plant pruning. The second simultaneous treatment was one of the three mentioned, root application of Trichoderma atroviride and BlackJak biostimulator and foliar application of a multi-component fertilizer. The strongest impact on improving the length of hydrangea shoots compared to the control (18%) had their simultaneous pruning and inoculation of the plants with Trichoderma atroviride mycelium. These two treatments used together also increased the number of flowers (16-47% depending on the variety) and the fresh weight of plants (10-28%) compared to the control. The application of T. atroviride alone improved the number of flowers in both varieties (19-24%) and the diameter of inflorescences in the 'Silver Dollar' one (17%). Foliar nutrition in particular increased the mass of plants, depending on the variety and pruning, from 7 to 57%, as well as the diameter and number of inflorescences, but only in one of the varieties considered. Combined with pruning, it intensified the growth of shoots of both varieties (5-10%). The use of the BlackJak biostimulator gave ambiguous results. When pruning plants, the length of shoots improved (15%) for one of the tested varieties and the fresh weight for the other (18%). Without pruning, it increased the number of flowers (16%) and the diameter of inflorescences (9%) in one of the varieties considered, as well as the fresh weight of plants in both varieties (19-21%). Pruning the plants, regardless of the other treatments used, increased the length of the shoots and the fresh mass of the plants. On the other hand, it reduced the number of flowers and their diameter. In most cases, positive effects of the use of biostimulants and foliar fertilization on improving the growth and flowering of plants were obtained. After their use in combination with plant pruning, an improvement in the growth of hydrangea bushes was observed, while the number and diameter of flowers were reduced. The most beneficial care treatments for the growth and flowering of panicle hydrangea were the simultaneous application of T. atroviride and pruning of plants during container cultivation in a nursery.

Background: There is a lack of knowledge about how nurses and general practitioners (GPs) collaborated during the COVID-19 pandemicin primary care settings. Our study examined the roles of primary care nurses during the pandemic’s first wave, between March and June 2020, in Switzerland. Methods: The study involved all eight general practices implementing of a nursing role to the practice’s team. Primary care practice staff members (nurses, GPs and medical assistants) have been involved on the development of a new organizational model. A mixed-methods design study collected quantitative data using daily activity monitoring and an electronic survey. Additionally, eight nurses and nine GPs participated in a focus group discussion and individual interviews. Results: GPs recognized the substantial contributions, versatility, and autonomy of the primary care nurses in their practices during the pandemic. Those nurses experienced their involvement positively, mainly thanks to their perceived autonomy. The distribution of activities between primary care practice professionals was heterogenous due to extrinsic and intrinsic factors. Conclusion: Both nurses and GPs agreed that there was added value in having primary care nurses ingeneral practices in time of crisis, and this agreement will bolster plans to integrate this workforce across the canton. The development of nurses’ roles in primary care during the pandemic was reliant on many factors, including practice organization and Switzerland’s healthcare reimbursement and payment system

Introduction: Physiotherapy exercises administered to preterm infants in the NICU can enhance motor skills and expedite the discharge process for infants born before 30 weeks of gestational age. The research delves into the influence of physiotherapy programs on these preterm infants' activity and participation levels. Methods: The intervention group received a one-month physiotherapy program including massage around the mouth, mobilization and weight-bearing exercises, and massage therapy for the extremities, while the control group did not. The motor skills were evaluated by the Test of Infant Motor Performance (TIMP), Dubowitz Neurological examination, and Preterm Oral Feeding Readiness Scales (POFRAS). Results: There was a significant difference in The TIMP, Dubowitz Optimal Score, Type of Non-Invasive Ventilation, TIMP Range, and POFRAS scores in the physiotherapy group rather than the control group (p<0.05). There were no differences in the length of stay in the NICU, respiration rate, heart rate, body temperature, oxygen saturation, body weight on the evaluation day, body weight at discharge, head circumference at discharge between the groups (p>0.05) Discussion: We conclude that physiotherapy in NICU improves the motor outcomes, activity and participation in preterm infants rather than the body functions and structure like vital signs and infants’ body weight.

Managing severe bleeding, particularly in soft tissues and visceral injuries, remains a significant challenge in trauma and surgical care. Traditional hemostatic methods often fall short in wet and dynamic environments. This study addresses the critical issue of severe bleeding in soft tissues, proposing an innovative solution using a Polyethylene Glycol (PEG)-based hydrogel combined with zinc oxide (ZnO). The developed hydrogel forms a dual-network structure through amide bonds and metal ion chelation, resulting in enhanced mechanical properties and adhesion strength. The hydrogel, exhibiting excellent biocompatibility, is designed to release zinc ions, promoting coagulation and accelerating hemostasis. Comprehensive characterization, including gelation time, rheological properties, microstructure analysis, and swelling behavior, demon-strates the superior performance of the PEG/ZnO hydrogel compared to traditional PEG hydro-gels. Mechanical tests confirm increased compression strength and adhesive properties, crucial for withstanding tissue dynamics. In vitro assessments reveal excellent biocompatibility and en-hanced procoagulant ability attributed to ZnO. Moreover, in vivo experiments using rat liver and tail bleeding models demonstrate the remarkable hemostatic performance of the PEG/ZnO hy-drogel, showcasing its potential for acute bleeding treatment in both visceral and peripheral sce-narios.

Research is scarce regarding antimicrobial use and antimicrobial resistance (AMR) for specific localities in Northern Ireland (NI). Additionally, the effects of COVID-19 on antimicrobial pre-scribing patterns and AMR are unknown. Between the European Union (EU) and United States (US), AMR causes approximately 68,000 deaths annually. This study will provide a better understanding of antimicrobial use and prescribing patterns in Belfast and link with AMR. An electronic survey was developed and distributed to eighty-five community pharmacists in Belfast. Yearly and monthly prescription data was gathered from the Business Services Organisation and COVID-19 statistics from Gov.uk. All data was analysed on Microsoft Office Excel® and IBM® SPSS® Statistics 25. Overall response rate was 46%. Most pharmacists (82%) failed to address prescriber non-compliance with guidelines and antimicrobial dosing errors (59%). The most common in-dication for antibiotics was upper respiratory tract infections (URTIs). Overprescribing of anti-biotics was perceived as the leading cause of AMR, therefore 69% of pharmacists indicated in-creased General Practitioner (GP) compliance with guidelines would reduce AMR. Pharmacists’ are in an ideal position to reduce AMR through patient education however, it is demonstrated that pharmacists failed to adequately counsel patients on antibiotic use. All GP practices demonstrated inappropriate antibiotic use, especially for URTIs which suggests antibiotic appropriateness should be reviewed. Many patients avoided contact with GP’s during COVID-19 which may have resulted in reduced antibiotic use. This research established amoxicillin as the most commonly prescribed antibiotic, which is contributing to increased AMR with its broad-spectrum activity and has recognised a decrease in antibiotic prescribing during COVID-19. Based on the results found and a critical review of the literature it is recommended antimicrobial guidelines should be re-viewed and improved, enhanced training should be provided to pharmacists and the antibiotic guardian (AG) campaign should be reenergised.

Although child-centred care is increasingly referred to within the nursing literature, a clear definition of child-centred care and clarity around the concept is yet to be achieved. The objectives of this review were to examine: 1) What constitutes the concept of child-centred care in healthcare? 2) How has the concept of child-centred care developed? 3) What is the applicability of child-centred care and what are its limitations? and 4) How does the concept of child-centred care benefit and inform children’s healthcare? In total, 2984 papers were imported for screening, following removal of duplicates and screening, 21 papers were included in the scoping review.The findings suggest that child-centred care is an emerging, ambiguous, poorly defined concept; no clear consensus exists about what constitutes child-centred care. Although it seems antithetical to argue against child-centred care, little robust evidence was identified that demonstrates the impact of, and benefit from, child-centred care. If child-centred care is to be a sustainable, convincing model to guide practice and compete with other models of care it needs to establish robust evidence of its effectiveness, impact on children and their families as well as the wider impacts on the healthcare system.

Background: Two types of medicinal systems are available in Korea: Western and oriental. These exist as separate services that independently provide medical care to patients. We determined the utility and benefits of compressive and integrated medical services (CIMS) comprising 12 sessions of acupuncture and healing programs over 6 weeks. Methods: In this two-group parallel single-center randomized controlled assessor-blinded trial, 24 participants were assigned to either the experimental (conventional medical treatment plus CIMS, n = 12) or control (conventional medical treatment, n = 13) group. Spinal nerve root block was performed on the compressed spinal nerve root (identified using magnetic resonance imaging) when no improvement was observed after the initial treatment. The experimental group received 12 cycles of acupuncture and manual therapy for 6 weeks; the control group received conventional medical treatment alone. Results: The average age of participants in the experimental and control groups was 70.73 ± 5.95 and 67.33 ± 8.89 years, respectively. There were no significant differences between the groups in terms of age, body mass index, Leeds Assessment of Neuropathic Symptoms and Signs, sex, and current medical history. We found high compliance for both programs (acupuncture and healing). On exclusion of between-group effects, the visual analog scale (VAS) score improved significantly over time (p = 0.045). Further, comparison of the groups after excluding the effects of visits revealed significantly lower VAS scores in the experimental group than in the control group (p = 0.000). Conclusions: Patients with degenerative lumbar spinal stenosis who mainly complain of radiating pain in the lower leg may benefit from CIMS after spinal nerve root block for ≤3 months after treatment. Our study findings suggest that this treatment improves spinal function and Oswestry Disability Index score. However, CIMS did not improve QoL.

Multi-cancer early detection (MCED) tests are being developed, but little is known about patient receptivity to their use for cancer screening. The current study assessed patient interest in such testing. Our team conducted a prospective, observational study among primary care patients in a large, urban health system. They were asked to complete a telephone survey that briefly described a new blood test in development to identify multiple types of cancer, but was not currently recommended or covered by insurance. The survey included items to assess respondent background characteristics, perceptions about MCED testing, and interest in having such an MCED test. We also used multivariable analyses to identify factors associated with patient interest in test use. In 2023, we surveyed 159 (32%) of 500 identified patients. Among respondents, 125 (79%) reported a high level of interest in having an MCED test. Interest was not associated with personal background characteristics, but was positively associated with the following expectations: testing would be recommended for cancer screening, be convenient, and be effective in finding early-stage disease (OR=11.70, 95% CI: 4.02, 34.04, p < 0.001). Research is needed to assess patient interest and actual uptake when detailed information on testing is presented in routine care.

Objectives This article focuses on exploring the evolution of Palliative Care in Portugal. Ten years after the approval of its Basic Law, the aim was to investigate the quality of the path followed and the guidelines that could promote its development. Thus, this study sought to identify a) the goals of the current members of parliament concerning Palliative Care, b) the major priorities that should guide the development of Palliative Care in the coming decade, c) the facilitating or hindering factors to accelerating the process, and d) to propose consensually agreed measures for an integral development of Palliative Care within the health system. Methods Qualitative data analysis was performed from the reading of literature and interviews conducted via Zoom with several intentionally chosen participants, leading to the creation of a Focus Group. The NVivo® 10 was used for data processing and categorisation. Results Three key themes emerged concerning the current status of palliative care: the policymakers, the technicians, and the society. This first line of structuring is explained by a second set of categories, namely, a) knowledge about palliative care; b) Palliative care organisation from the policymakers’ perspective. In the technicians' domain: a) knowledge about palliative care, b) clinical training, and c) medical specialty. Finally, in society: a) knowledge about palliative care. Significance of the Results Advancing general education, increasing qualitative training for the different health professionals, reformulating laws supporting them, promoting flexibility of the implementation methodologies, and establishing medical specialty, are crucial to achieving the proposed goal.

Access to maternal healthcare services is a challenge in most low and middle-income countries. South Africa is one of the countries striving to improve the accessibility of maternal healthcare services. Although South Africa has put some interventions to improve the accessibility of maternal healthcare services, vulnerable women including women with disabilities are still facing numerous challenges when trying to access maternal healthcare services. The aim of the study was to explore the experiences of women with disabilities in the province of KwaZulu-Natal in South Africa in accessing public maternal healthcare services. Twelve women with disabilities (four with physical impairments, four with hearing impairments and four with visual impairments) were interviewed for this study. Data were transcribed verbatim and analysed utilising the Framework of Assessing Access to Maternal Healthcare Services by Peters et al. 2008. The study found that narrow passages and information in inaccessible formats were a challenge for women with visual impairments. The women with hearing impairments had challenges in communication as most facilities did not have sign language interpreters, negative attitudes of health care workers and being ignored when they asked for help. The women with physical impairments encountered inaccessible buildings, narrow passages, small consultation rooms and equipment which is not adjustable such as beds and scales.

Audit&amp;Feedback (A&amp;F) consists of multidimensional quality improvement activities, but its optimal design is still debated. Our study aims to outline how interventions of the Italian EASY-NET research program were designed, to explore whether desirable characteristics of an "ideal" A&amp;F were adopted. A&amp;F design included description of the working group, targeted clinical behaviors, selected indicators, sources, feedback procedures, corrective actions expected. Information was classified into four topics: nature of the desired action, type of data available, feedback display and delivery. Out of 9 projects, 3/9 aimed at changing a focused clinical behavior, 6/9 were generic; all projects identified clinicians as recipients, 8 explicitly considered managers. It was planned to develop an average of 27 indicators from administrative databases, as needed supplemented by ad hoc data collection. Five projects included outcome measures. Comparators derived from scientific literature or from territorial real-life data. Feedback was scheduled every 12, 6 or 3 months, or upon request, delivered as aggregate data (graphs and tables) via web platforms, e-mail, workshops, and individual meetings. In conclusion, at an early stage the projects were mostly “wide focused”, but improvements in A&amp;F design and delivery have been introduced, and projects, still ongoing, will offer interesting insights on A&amp;F effectiveness.

The study follows the interaction between the individual and the social context regarding the development of adolescents protected in residential houses from the child protection system in Iasi County, Romania. Starting from the evidence that in situations of providing relatively identical material and social resources, the results obtained by these children vary greatly, we examine how the meaning (understood mainly as purpose and mattering) can constitute a developmental resource. Considering theoretical models and previous research, the study aims to describe, through a qualitative approach, how these young people see themselves and the external environment (family and residential care), how they project their future (their purpose and objectives), and how these constructions and perceptions can influence their quality of life and social integration. We conducted three focus groups with 35 adolescents and young people (the ages 13-21) protected in and for different periods in residential houses (period 1-20 years). The results highlighted that a specific meaning is reconfigured as compensatory when affected by a trauma or adverse external event and thus can be a resource for resilience. On the other hand, the research highlighted that only the existence of goals alone is insufficient to generate action, and the unrealistic meanings given to own persons, experiences, and resources can be dangerous.

Disinfection byproducts (DBPs) are formed whenever disinfectant ingredients are in contact with organic matter. Due to widespread increase in production and use of disinfectants and antiseptics, the presence of their components in coastal environments is increasing. However, very limited scientific literature is available in regard to the occurrence of DBPs and related compounds in the coastal zone and particularly in seawater. In this context, the aim of this preliminary compilation is to outline the main up-to-date findings and raise awareness on their increasing occurrence in coastal environments. Sampling and analysis of marine samples in the USA, Spain, China, Taiwan, Malaysia, Korea, Kuwait and Hong-Kong revealed the presence of several categories of DBPs and related compounds in coastal environments, with the highest levels being detected in urban areas, probably related to the nearby wastewater treatment plants. The investigations considered in this preliminary compilation, report the detection of DBPs and related compounds as well as the formation of toxic brominated and iodinated DBPs in high levels due to chlorination of wastewater, especially after use of seawater for flushing in toilets. New DBP groups have also been detected, namely halogenated phenolic DBPs and halopyrroles.

Fragile X Syndrome (FXS) is a pervasive developmental disorder and the most common monogenic cause of autism spectrum disorder (ASD). Female heterozygous (HET) carriers play a major role in the transmission of the pathology and present several FXS- and ASD-like behavioral alterations. Despite their clear genetic origins, FXS symptoms are known to be modulated by environmental factors, e.g., the exposure to chronic stress, especially during critical life periods, such as pregnancy. Pregnancy, together with pups’ care, constitutes maternal experience, i.e., another powerful environmental factor affecting several neurobehavioral functions in females. Here we investigated the impact of maternal experience on the long-term effects of stress in Fmr1-HET female mice. Our findings demonstrated that the behavioral abnormalities of HET females, i.e., hyperactivity and memory deficits, were unaffected by stress or maternal experience. In contrast, stress, independently of maternal experience, induced the appearance of cognitive deficits in WT mice. Maternal experience increased anxiety levels in all mice and enhanced their corticosterone levels, concomitantly promoting the effects of stress on social communication and adrenal glands. Our results advance our understanding of the environmental modulation of the behavioral alterations observed in FXS mice and highlight the long-term impact of maternal experience and its interactions with chronic stress.

The ever deepening population aging has brought opportunities and challenges to the continued expansion of tourism consumption in China. In this article, the impact of population aging on household tourism consumption was studied from both theoretical and empirical aspects. First, the micro mechanisms of the impact of population aging on household tourism consumption were analyzed, which include economic condition mechanism, intergenerational care mechanism, health status mechanism and Internet use mechanism. Subsequently, the impact of population aging on household tourism consumption and its impact mechanisms were tested, and the heterogeneity analysis was conducted, by using the data of China Family Panel Studies (CFPS) from 2014, 2016 and 2018. The main conclusions of the article are as follows: (1) Population aging has a significant negative impact on household tourism consumption, and a series of robustness test results such as endogenous treatment support this finding. (2) The results of the impact mechanism test show that population aging has a negative mediating effect on household tourism consumption by reducing household economic conditions. The moderating effect of intergenerational care on the effect of population aging on household tourism consumption is insignificant. Health status of the elderly and Internet use have a significant positive moderating effect on the impact of population aging on household tourism consumption. (3) The results of the heterogeneity analysis show that the negative impact of population aging on household tourism consumption in urban areas is greater than that in rural areas, and the negative impact of population aging on household tourism consumption of families with the old-old elderly is greater than that of falimies with the young-old elderly. The conclusions of this article provide important references for activating tourism consumption in China in the context of population aging.

Although, central venous pressure (CVP) is among the most frequent estimated hemodynamic parameters in the critically ill setting, extremely little is known on how intensive care unit (ICU) nurses use this index in their decision-making process. The purpose of the study was to develop a new questionnaire for accessing how ICU nurses use CVP measurements to address patients’ he-modynamics investigating its validity and reliability. A cross-sectional study was conducted among 120 ICU nurses from four ICUs of Greece. Based on a comprehensive literature review and the evaluation of a five-experts panel a new questionnaire, named “CVP-Score”, was created having 8 items. The construct validity and the reliability of the questionnaire were examined. The half of the study participants’ (51.7%) was working at a specialized ICU, and they had a mean [±Standard Deviation (SD)] ICU experience of 13(±7.1) years. The estimated construct validity of the new-developed tool was acceptable, while the internal consistency reliability as measured by Cronbach alpha was excellent (0.901). CVP Score had acceptable test-retest reliability (r=0.996, p<0.001) and split-half reliability (0.855). CVP Score is a valid and reliable instrument for measuring how critical care nurses use CVP measurements in their decision-making process.

Most head and neck cancers are diagnosed in advanced stages, when the curative interventions are no longer possible. The assessment and the multidisciplinary therapeutic approach of the locally advanced cases are difficult since the onset of the disease becomes a significant challenge for the whole attending team (including both the patient and his family) because they have to deal with to an extensive symptomatology (abundant secretions, refractory pain, mutilations predominantly in the cephalic area), with the cure of stomas (tracheostomy, gastrostomy) and with various post-therapeutic sequelae. The present paper reflects the impact of late diagnosis, the complexity of the multimodal specific oncological treatment (chemotherapy, radiotherapy, immunotherapy, pal-liative and terminal treatment), the adaptation of medical care to the psycho-emotional structure, having as an example the case of 54-year old patient (with his consent) diagnosed with pharyn-golaryngeal neoplasm who presented himself to “St. Luca” Chronic Disease Hospital, the Oncol-ogy-Palliative Care Department, in September 2021. In patients with locally advanced head and neck cancers, besides the specifically oncological therapeutic decisions, the empathic-emotional connection between the medical team with the patient and his family plays a key role in the ther-apeutic conduct.

Interprofessional collaboration between general practitioners (GPs) and community pharmacists (CPs) is central to implement antimicrobial stewardship (AMS) programs in primary care. This study aimed to design a GP-pharmacist antimicrobial stewardship (GPPAS) model in Australian primary care. A seven-component exploratory study was conducted since 2017 to 2021 to inform a GPPAS model. We generated both secondary and primary evidence through a systematic review, a scoping review, a rapid review, nationwide surveys of Australian GPs and CPs including qualitative components and a pilot study of a GPPAS model. All study evidence was synthesised, reviewed, merged and triangulated to design a prototype GPPAS model using a Systems Engineering Initiative for Patient Safety theoretical framework. Secondary evidence informed effective GPPAS interventions, and primary evidence captured interprofessional issues, challenges and future needs to implement GPPAS interventions by GPs and CPs. A GPPAS model framework involving GP-pharmacist team-based five GPPAS sub-models were successfully designed to foster AMS education, antimicrobial audits, diagnostic stewardship, delayed prescribing, and routine review of antimicrobial prescription by improved GP-CP collaboration. A GPPAS model could be used as a guide to collaboratively optimise antimicrobial use by GPs and CPs. Implementation studies on GPPAS model and sub-models are required to integrate GPPAS model into GP-pharmacist interprofessional care models in Australia.

(1) Background: Ventilator-associated pneumonia (VAP) causes high mortality among patients with respiratory disease and imposes major burdens on healthcare infrastructure. Models that use electronic health record data to predict the onset of VAP may spur earlier treatment and improve patient outcomes. We developed and studied the performance of interpretable machine learning (ML) models that predict the onset of VAP from electronic health records (EHRs); (2) Methods: We trained Logistic Regression (LR), full feature Explainable Boosting Machine (fEBM), and eXtreme Gradient Boosting (XGBoost) ML models on data from the MIMIC- III (v1.3) database. Model performance was measured by area under the receiver operating characteristic curves (AUCs). We trained a minimal-feature EBM model (mEBM) with features derived from white blood cell (WBC) counts, duration of ventilation, and Glasgow Coma Scale (GCS). Finally, model robustness was evaluated on randomly sparsified EHR datasets; (3) Results: The fEBM model outperformed the XGBoost and LR models at 24 hours post-intubation. The mEBM model maintained an AUC of 0.893. The fEBM model performance remained robust on sparsified datasets; (4) Conclusions: Our novel interpretable ML algorithm reliably predicts the onset of VAP in intubated patients. Integration of this EBM-based model into clinical practice may enable clinicians to better anticipate and prevent VAP.

Background: The COVID-19 pandemic has changed the way dentistry has been practiced world over , this study sought to assess the impact of the COVID-19 pandemic on the patterns of attendance for dental treatment in a large hospital in Kuwait compare them to data from the year prior to the pandemic Methods: A total of 176,690 appointment records of 34,250 patients presenting to the AlJahra specialist hospital, Kuwait for dental treatment from April 2019 to March 2021 were analyzed. Types of procedures and the departments to which they presented were analyzed and the patterns of attendance before and during the pandemic were compared; Results: While there was a significant reduction in the number of orthodontic, endodontic and periodontal procedures there was no impact on oral surgery, restorative procedures or pediatric dentistry; Conclusions: There has been a return in the numbers of patients availing dental treatment, however, there has been a definite shift in the use of certain dental procedures .

Clinicians are key in reclaiming the medical arts ceded to clinically irrelevant technology and thereby aligning patient with fast-changing biological realities. Narrowing the chasm between virtual and real perceptions of health hazards requires: 1) becoming acutely aware of the habitat loss aggravating the pervasive dissemination of chemicals via conventional food, air, and consumer products and the proliferation of non-ionizing radiation; and 2) making strategic use of slow, system 2 thinking so as to respond wisely to the rampant epidemics of chronic low-dose toxicity disregarded or misdiagnosed for half a century. To respond adaptively, take a moment during each patient encounter to add chronic ambient poisoning to the differential diagnosis and investigate subtle symptoms and signs of irritation in vulnerable organ systems. Enacting adaptive response across our profession could ease the suffering of millions, help avert the sixth extinction, and contribute to continuation of evolved life as we know it.

Background: The Sequential Organ Failure Assessment (SOFA) is a scoring system used for the evaluation of disease severity and prognosis of critically ill patients. The impedance ratio (Imp-R) is a novel mortality predictor. Aims: This study aimed to evaluate the combination of SOFA + Imp-R in the prediction of mortality in critically ill patients admitted to the emergency department (ED). Methods: A retrospective cohort study was performed in adult patients with acute illness admitted to the ED of a tertiary-care referral center. Baseline SOFA score and bioelectrical impedance analysis to obtain the Imp-R were performed within the first 24 hours after admission to the ED. A Cox regression analysis was performed to evaluate mortality risk of initial SOFA score plus Imp-R. Harrell's C-statistic and decision curve analyses (DCA) were performed. Results: Out of 325 patients, 240 were included for analysis. Overall mortality was 31.3%. Only 21.3% of non-surviving patients died after hospital discharge, and 78.4% died during hospital stay. Of the latter, 40.6% died in the ED. SOFA and Imp-R values were higher in non-survivors and were significantly associated with mortality in all models. The combination of SOFA + Imp-R significantly predicted 30-day mortality, in-hospital mortality, and ED mortality with area under the curve (AUC) of 0.80 (95% CI: 74-0.86), 0.79 (95% CI: 0.74-0.86) and 0.75 (95% CI: 0.66-0.84) respectively. The DCA showed that combining SOFA + Imp-R improved the prediction of mortality through the lower risk thresholds. Conclusion: The addition of Imp-R to baseline SOFA score at admission to the ED improves mortality prediction in severely acutely ill patients admitted to the ED.

The aim was to evaluate levels of compassion fatigue in nursing professionals working in complex care units of a Brazilian university hospital. A cross-sectional, descriptive, and correlational study was carried out with nursing workers from complex care units of a University Hospital. Data were collected in the second half of 2019, in the pre-pandemic period of COVID-19, using the Brazilian version of the Professional Quality of Life Scale (ProQoL-BR). A total of 146 individuals partici-pated, including 41 (28.1%) nurses, 92 (63.0%) nursing technicians and 13 (8.9%) nursing assis-tants. It was observed that 26.1% presented high level of compassion satisfaction. For 17.5% there was level of burnout and 49.7%, medium level of burnout; and 22.0% with high and 46.1% with medium level of secondary traumatic stress. Twenty-eight (19.2%) professionals had compassion fatigue, of which 16 (57.1%) were nursing technicians. There is a high percentage of professionals with medium and high rates of burnout and secondary traumatic stress, a fact that is reinforced by the presence of compassion fatigue in almost one fifth of the studied individuals. These results highlights how much the health of these workers can be affected by living with traumatic patient experiences.

Decision-making using evidence-based practice (EBP) is generally universally accepted by nurses. Such acceptance may affect the personnel’s behaviour towards patients, which is also demonstrated by taking into consideration the patient’s preferences, including the patient’s spiritual needs, in the care plan. The provision of such care requires the development of an attitude of approval and an adequate level of communicative competence, which will enable the actual implementation of the EBP. The purpose of our study was to assess the perception of spirituality and the nurse’s role in providing spiritual care, as well as the perception of the significance of communication skills in the approval of EBP in professional practice. A multi-centre cross-section study was conducted on a population of 1176 participants (459 undergraduate (Bachelor programme, BP) and 717 postgraduate students (Master programme, MP)) from 10 medical universities in Poland. Three tools were used in the study to evaluate the participants’ approach: Evidence-Based Practice Competence Questionnaire (EBP-COQ), The Spirituality and Spiritual Care Rating Scale (SSCRS), and Communication Skills Attitude Scale (CSAS). Structural equation modelling was used for the analysis. An analysis of structural equations revealed the presence of positive relationships of the attitude to spiritual care and the role of communicative competences with the approach to EBP regardless of the cohort. A significant difference was found related to the influence of age on the attitude toward learning communicative competences. The approval in this respect was observed to decrease with age in the MP group. Increasing approval of EBP requires strengthening the approach to activity-centred spiritual care, with the simultaneous development of a positive attitude towards learning communicative competences. The model reveals the need to integrate a humanistic approach with EBP, which can be achieved by planning different interventions in different groups of recipients: nurses, academic teachers and students.

Aim: The aim of this study was to estimate the number of nurses who independently care for pa-tients with severe respiratory failure receiving mechanical ventilation (MV) or veno-venous ex-tracorporeal membrane oxygenation (VV-ECMO). Additionally, the study analyzed the actual role of nurses in the treatment of patients with MV and VV-ECMO. Methods: We conducted a cross-sectional study using postal surveys. The study included 725 Japanese intensive care units (ICUs). Descriptive statistics were conducted. Results: Among the 725 ICUs, we obtained 302 re-sponses (41.7%) and analyzed 282 responses. The median number of nurses per bed was 3.25. The median proportion of nurses who independently cared for patients with MV was 60% [IQR: 42.3-77.3]. The median proportion of nurses who independently cared for patients with VV-ECMO was 46.9 (35.7-63.3%) in the ICU experiencing VV-ECMO use. Concerning task-sharing, 33.8% of ICUs and nurses did not facilitate weaning from MV. Nurses always ti-trated sedatives in 44.5% of ICUs. Conclusion: Nurse staffing might be inadequate in all ICUs, es-pecially for severe respiratory failure. The proportion of competent nurses for caring for severe respiratory failure in ICUs should be considered when determining the work force of nurses.

Background Although aminoglycosides are often used as treatment for Gram-Negative infections, optimal dosing regimens remains unclear, especially in ICU patients. This is due to a large between- and within-subject variability in the aminoglycosides’ pharmacokinetics in this population. Objective The review provides comprehensive data on the pharmacokinetics of aminoglycosides in patients hospitalized in ICU by summarizing all published PopPK models in ICU patients for amikacin, gentamicin, and tobramycin. The objective was to determine the presence of a consensus on the structural model used, significant covariates included, and therapeutic targets considered during dosing regimen simulations. Methods A literature search was conducted from the Medline/PubMed database, using the terms: ‘amikacin’, ’gentamicin’, ’tobramycin’, ‘pharmacokinetic(s)’, nonlinear mixed effect’, population’, ‘intensive care’ and ‘critically ill’. Results Nineteen articles were retained where amikacin, gentamicin and tobramycin pharmacokinetics were described in six, eleven and five models, respectively. Two-compartment model best described amikacin and tobramycin pharmacokinetics, whereas one-compartment model majorly described gentamicin pharmacokinetics. The most recurrent significant covariates were renal clearance and bodyweight. Across all aminoglycosides, mean interindividual variability in clearance and volume of distribution were 41.6% and 22.0%, respectively. A common consensus for an optimal dosing regimen for each aminoglycoside was not reached. Conclusion This review showed models developed for amikacin, from 2015 until now and for gentamicin and tobramycin from the past decades. Despite growing challenges of external evaluation, the latter should be more considered during model development. Further research including new covariates, additional simulated dosing regimens and external validation should be considered to better understand aminoglycosides pharmacokinetics in ICU patients.

Bacground, the increasing number of elderly is a new challenge for health care systems around the world. The phenomenon of the complex health problems experienced by the elderly encourages families to bring the elderly to a nursing home. The purpose of this study was to describe the condition of the elderly living in nursing homes and their care needs. Methodology, this research design is a literature review, article search using 5 databases, namely Scopus, ProQuest, Pubmed, CINAHL and Scient Direct. Articles reviewed from 2019 to 2021. Protocol and evaluation of literature review using the PRISMA checklist, and the assessment guide using the Joanna Briggs Institute Guideline. Results, the health conditions of the elderly who live in the orphanage are mostly aged 60 years and over, physically experiencing disturbances in their daily activities and dependence. Psychologically experiencing anxiety, depression, loneliness and even mental disorders and socially need family support. The care needs of the elderly in nursing homes include services by competent and culturally sensitive staff and nurses, safe and comfortable nursing home environmental services, privacy needs and social interactions, spiritual needs services, social guidance services, and skills guidance services. Conclusion, based on the literature review, it can be seen that nursing services should be provided in a humanistic and holistic manner, the elderly are clients who have both bio-psycho-socio-cultural and spiritual needs. So that nursing services are aimed at meeting the needs of the elderly in a comprehensive manner.

Direct and indirect anthropogenic factors play a massive role in driving wildlife species towards extinction. Longitudinal retrospective studies identify key ‘factors’ responsible for the decline in numbers of wildlife, however, lack the reasoning behind the events leading to mortality. The overarching aim of this study was to categorize these ‘factors’ into different stressor categories faced by reptiles to understand its impact on an individual, and to compare how each stressor category influences the survival of an individual. The results from this study indicated that almost half of the number of reptiles being hospitalized were due to exposure to preliminary stressors such as lawn mowing incidents and pet attack. Primary and secondary admissions were fairly equal in number, however the mortality rate for secondary admissions was drastically high (~80%). The discussion integrates species’ ecology and stress physiology which can prove to have multi-faceted benefits across the fields of ecology and animal welfare. Ecologists can use the results from this study to comprehend species’ activity patterns to better plan reptilian conservation programs, whereas, for wildlife clinicians and rehabilitators, assignment of stressor categories could be a beneficial tool for bolstering the welfare monitoring program for small native reptiles in clinical settings.

Objectives: A wealth of literature has established risk factors for social isolation among older people, however much of this research has focused on community-dwelling populations. Relatively little is known about how risk of social isolation is experienced among those living in long-term care (LTC) homes. We conducted a scoping review to identify possible risk factors for social isolation among older adults living in LTC homes. Methods: A systematic search of five online databases retrieved 1535 unique articles. Eight studies met the inclusion criteria. Results: Thematic analyses revealed that possible risk factors exist at three levels: individual (e.g., communication barriers), systems (e.g., location of LTC facility), and structural factors (e.g., discrimination). Discussion: Our review identified several risk factors for social isolation that have been previously documented in literature, in addition to several risks that may be unique to those living in LTC homes. Results highlight several scholarly and practical implications.

Loneliness is a frequent negative feeling among older people. A programme aimed at alleviating loneliness among older people by promoting social capital, i.e. social support and participation, was conducted in primary health care centres in Spain. We aimed to explore participants’ experiences of loneliness and social participation before the programme, perceived programme effects and contextual influences. A descriptive-interpretative qualitative design was used. 41 persons were included comprising older people, health and social care professionals, and volunteers. Data were collected through three focus groups, 36 semi-structured interviews and participant-observation of the intervention. A thematic content analysis was applied. Older persons with diverse profiles of loneliness and participation decreased their loneliness, increased their knowledge and participation in local community assets, and developed companionship, a sense of belonging, peer support and friendship. Their mental wellbeing increased and participants could deal better with health or family problems. An empowerment process was observed. However, loneliness persisted among some widowed participants and health and social vulnerabilities hampered some impacts. Conflicts and exclusion were occasional unintended effects. The promotion of social capital in ageing to alleviate loneliness involves complex processes interrelated with health and socio-economic factors. Future programmes should be adapted to local contexts and participants’ characteristics.

Although it may seem paradoxical, primary care and mental health professionals develop prejudices and discriminatory attitudes towards people with mental health problems in a very similar way to the rest of the population. The main objective of this project was to design, implement and evaluate two awareness interventions respectively tailored to reduce stigma and discrimination beliefs and attitudes towards persons with a mental health diagnosis among primary care (PC) and mental health (MH) professionals. These interventions were developed by Obertament, the Catalan alliance against stigma and discrimination in mental health. The TLC3 (Targeted, Local, Credible, Continuous Contact) methodology was adapted to the Catalan PC and MH professional contexts. Activists with lived experience of mental health diagnosis carried out awareness-raising interventions in PC and MH health centres. The efficacy of these interventions was evaluated using two prospective double-blind cluster-wait-list-randomized-controlled trial experimental designs. Stigmatizing beliefs and behaviours were measured with the Opening Minds Stigma Scale for Health Care Providers in primary care centres and with the Beliefs and Attitudes towards Mental Health Service users’ rights in mental health centres. Positive reductions in both PC and MH professionals’ stigmatising beliefs and attitudes were found in the 1-month follow-up, although a ‘rebound effect’ at the 3-month follow up was also detected. This emphasizes the importance of the continuity of the presence of anti-stigma activities and messages. Attrition rates where high, which can hamper the reliability of the results. Further follow-up studies should enquiry effects of long-term interventions aimed at reducing stigmatising beliefs and attitudes among primary care and mental health professionals.

The cluster randomized trial ARena (Sustainable reduction of antibiotic-induced antimicrobial resistance, 2017-2020) promoted the appropriate use of antibiotics for acute non-complicated infections in primary care networks (PCNs) in Germany. A process evaluation aimed to provide insights into determinants of practice and explored factors associated with antibiotic prescribing patterns. In a nested mixed-methods approach, a three-waves survey used study-specific questionnaires for participating physicians and medical assistants to assess potential impacts and uptake of the complex intervention program. Stakeholders received a one-time online questionnaire to reflect on network-related aspects. Semi-structured, open-ended interviews with a purposive sample of physicians, medical assistants and stakeholders explored aspects regarding the acceptance of the program components for daily practice and the perceived sustainability of intervention component effects. The intervention components were perceived to be smoothly integrable into practice routines. The highest uptake was reported for the educational components: feedback reports, background information, e-learning modules, and disease specific quality circles. Participation in PCNs was seen as motivational factor for guideline-oriented patient care and the adoption of new routines Future approaches to fostering appropriate use of antibiotics by targeting health literacy competencies and clinician’s therapy decisions should combine evidence-based information sources, audit and feedback reports and QCs.

In this retrospective report we present five cases of critically ill pregnant or newly delivered women positive for Covid-19 admitted to our obstetrical departments at Karolinska University Hospital. They compose 6% of eighty-three pregnant women that tested positive for SARS-CoV-2 during the period March 25 to May 4, 2020. Three patients were at the time of admission in gestational week between 21+4 to 22+5 and treated during their antenatal period, meanwhile the other two were admitted within 1 week postpartum. All of them were in a need of intensive care, one was treated with high flow oxygen therapy, the other four with invasive mechanical ventilation (three with endotracheal intubation and one with extra corporeal membrane oxygenation). Age above thirty, overweight and gestational diabetes are notable factors in the cases presented. At the time of admission, they all presented with symptoms as fever, cough and dyspnea. Chest imaging with computer tomography scan was performed in each case and demonstrated multifocal pneumonic infiltrates in all of them but no pulmonary embolism was confirmed in any. Neither did the echocardiogram indicates any cardiomyopathy. Four of the patients have been discharged from the hospital, with an average of 20 hospital days. One antenatal pregnant woman needed prolonged ECMO therapy, in gestational week 27+3 she went into cardiac arrest, resulting in an urgent c-section on maternal indication. At the time of writing she is still hospitalized. In coherence with other published reports our cases indicate that critically ill pregnant women infected by SARS-Cov-2 may develop severe respiratory distress syndrome requiring prolonged intensive care. The material is limited for conclusions to be taken, more detailed information on symptoms, treatment, and outcomes for pregnant and postpartum women managed in intensive care is therefore needed.