Naturally-derived synthetic leather is a widely used and high-quality type of faux leather or synthetic leather. Many consumers prefer authentic leather goods due to their exceptional qualities, including high water vapor permeability and superior wearing comfort. Consequently, the exploration of artificial leather made from natural materials with exceptional qualities as an alternative to genuine leather has garnered significant interest and is now a highly studied subject. Synthetic leather, sometimes known as imitation leather, has gained popularity recently as a highly suitable alternative to genuine leather. Continuous advances in this area of research increase the range of uses for synthetic leather using natural fibers. Thus, this research aims to explore synthetic leather materials using orange peel waste, which can be applied to the fashion industry. This research applies several types of orange peel waste, such as Pomelo, Sweet orange, and Sunkist orange, to different compositions and strengthening materials, such as bandages and dacron. The resulting bio-composite materials' morphology, mechanics, and adhesive properties were evaluated following ASTM D 2209-00 and ASTM D 4533-04 standards. The results indicate that specimen 1A (Pomelo using bandage as reinforcement) has the most significant effects, with a tensile test value of approximately 472 N/cm2, an elongation of roughly 67.28 % was the highest value on sweet orange using bandage as reinforcement, and a tear resistance of around 14.28 N/cm2 for Pomelo with bandage as reinforcement. Furthermore, the test results also show that composition 2B still does not meet the standards of SNI 1294:2009 and ISO 3376 for tensile strength and ISO 3377-1 for tear strength. Additionally, statistical analysis showed no appreciable changes in the samples analyzed. Furthermore, statistical evaluations showed no significant alterations in the studied samples. The results of this experimental investigation can be explored further and used as a basic framework for the creation of bio-composites from orange peel waste for future fashion.

Coronary artery disease is the most prevalent cardiovascular disease, claiming millions of lives annually around the world. The current treatment includes surgically inserting a tubular construct called as a stent inside arteries to restore blood flow. However, due to lack of patient-specific design, the commercial products cannot be used with different vessel anatomies. In this review, we have summarized the drawbacks in existing commercial metal stents which face problems of restenosis and inflammatory responses, owing to the development of neointimal hyperplasia. Further, we have highlighted the fabrication of stents using biodegradable polymers, which can circumvent most of the existing limitations. In this regard, we elaborated on utilization of new fabrication methodologies based on additive manufacturing such as three-dimensional printing to design patient-specific stents. Finally, we have discussed on the functionalization of these stent surfaces with suitable bioactive molecules which can prove to enhance their properties in preventing thrombosis and better healing of injured blood vessel lining.

During the last forty years, the use of strontium isotopes in archaeology and biogeochemical research has spread widely. These isotopes, alone or in combination with others, can contribute to trace past and present environmental conditions. However, the interpretation of the isotopic values of strontium is not always simple and requires good knowledge of geochemistry and geology. This short paper on the use of strontium isotopes is aimed at those who use this tool (archaeologists, but not only) but who do not have a thorough knowledge of mineralogy, geology, and geochemistry necessary for a good understanding of natural processes involving these isotopes. We report basic knowledge and suggestions for a correct use of these isotopes. The isotopic characteristics of bio-assimilable strontium depend not so much on the isotopic characteristics of the bulk rock as, rather, on that of its more soluble minerals. Before studying human, animal and plant remains, the state of conservation and any conditions of isotopic pollution should be carefully checked. Samples should be collected according to random sampling rules. The data should be treated by a statistical approach. To make comparisons between different areas, it should be borne in mind that the study of current soils can be misleading since the mineralogical modification of the soil over time can be very rapid.

This study explores the impact of temperature and molarity on the pyrolysis of Açaí seeds (Euterpe Oleraceae, Mart.) activated with KOH on the yield of bio-oil, hydrocarbon content of bio-oil, an-tioxidant activity of bio-oil and chemical composition of aqueous phase. The experiments were carried out at 350, 400, and 450 °C and 1.0 atmosphere, with 2.0 M KOH, and at 450 °C and 1.0 atmosphere, with 0.5 M, 1.0 M and 2.0 M KOH, in laboratory scale. The composition of bio-oils and aqueous phase determined by GC-MS, while the acid value, a physical-chemical property of fundamental importance in biofuels, of bio-oils and aqueous phases by AOCS methods. The an-tioxidant activity of bio-oils determined by the TEAC method. The solid phase (biochar) charac-terized by X-ray diffraction (XRD). The diffractograms identified the presence of Kalicinite (KHCO3) in biochar, and those higher temperatures favor the formation peaks of Kalicinite (KHCO3). The pyrolysis of Açaí seeds activated with KOH show bio-oil yields from 3.19 to 6.79 (wt.%), aqueous phase yields between 20.34 and 25.57 (wt.%), solid phase yields (coke) between 33.40 and 43.37 (wt.%), and gas yields from 31.85 to 34.45 (wt.%). The yield of bio-oil shows a smooth exponential increase with temperature. The acidity of bio-oil varied between 12.3 and 257.6 mgKOH/g, decreasing exponentially with temperature, while that of aqueous phase between 17.9 and 118.9 mgKOH/g, showing and exponential decay behavior with temperature, demonstrating that higher temperatures favor not only the yield of bio-oil but also bio-oils with lower acidity. For the experiments with KOH activation, the GC-MS of bio-oil identified the presence of hydro-carbons (alkanes, alkenes, cycloalkanes, cycloalkenes, and aromatics) and oxygenates (carboxylic acids, phenols, ketones, and esters). The concentration of hydrocarbons varied between 10.19 to 25.71 (area.%), increasing with temperature, while that of oxygenates from 52.69 to 72.15 (area.%), decreasing with temperature. For the experiments with constant temperature, the concentrations of hydrocarbons in bio-oil increase exponentially with molarity, while those of oxygenates de-crease exponentially, showing that higher molarities favor the formation of hydrocarbons in bio-oil. The antioxidant activity of bio-oils decreases with increasing temperature, as the content of phenolic compounds decreases, and decreases with increasing KOH molarity, as higher molarities favors the formation of hydrocarbons. Finally, it can be concluded that chemical activation of Açaí seeds with KOH favors the not only the yield of bio-oil but also the content of hydrocarbons. The study of process variables is of utmost importance in order to clearly assess reaction mechanisms, economic viability and design goals that could be derived from chemically activated biomass pyrolysis processes.

The aerospace industry demands high-performance materials that can withstand extreme conditions and maintain efficiency in a variety of applications. Bio-inspired polymer coatings have emerged as a promising approach to meet these demands, by drawing inspiration from natural systems to develop new coatings that exhibit enhanced properties, such as self-cleaning, anti-icing, thermal management, and corrosion resistance. In this review, recent developments in the field of bio-inspired polymer coatings for aerospace applications are presented, covering a range of coatings and their respective properties. We discuss the recent developments and applications of bio-inspired coatings, with a focus on their advantages and challenges in aerospace applications. We also highlight the potential for future research and development in this field, including the integration of advanced technologies such as nanotechnology and additive manufacturing. The review aims to provide insights into the current state-of-the-art of bio-inspired polymer coatings for aerospace applications and to inspire further research in this rapidly growing field.

The current concerns of both society and materials industries about the environmental impact of thermoset composites, as well as new legislation, have led the scientific sector to search for more sustainable alternatives to reduce the environmental impact of thermoset composites. Until now, to a large extent, sustainable reinforcements have been used to manufacture more sustainable composites and thus contribute to the reduction of pollutants. However, in recent years, new alternatives have been developed such as thermosetting resins with bio-based content and/or systems such as recyclable amines and vitrimers that enable recycling/reuse. Throughout this review, some new bio-based thermoset systems as well as new recyclable systems and sustainable reinforcements are described and a brief overview of the biocomposites market and its impact is shown.

Latterly, the development of green synthesized polymeric nanoparticles with anticancer studies has been an emerging field in academia, and in the pharmaceutical and chemical industry. Vegetable oils are potential substitutes for petroleum derivatives, as they present themselves as a clean and environmentally friendly alternative and are available in high quantities at relatively low prices. Biomass-derived chemicals can be converted into monomers with unique structures, generating materials with new properties for the synthesis of sustainable monomers and polymers. In this way, the production of bio-based polymeric nanoparticles appears as a great application of green chemistry for biomedical uses. There is an increasing demand for biocompatible and biodegradable materials for specific applications in biomedical as cancer therapy, encouraging scientists in working on research towards designing polymers, with enhanced properties and clean processes, containing oncology active pharmaceutical ingredients (APIs). The nanoencapsulation of these APIs in bio-based polymeric nanoparticles can control the release of the substances, increase bioavailability, reduce problems with volatility and degradation, reduce side effects, and increase treatment efficiency. Thus, this review aims to discuss the use of green chemistry for bio-based nanoparticle production and its application in anticancer medicine. The use of vegetable oils for the production of renewable monomers and polymers will be discussed, bringing castor oil as an ideal candidate for such application, as well as more suitable methods for the production of bio-based nanoparticles and some oncology APIs available for anticancer application.

Pyrolysis has been applied in the human economy for many years, and it has become a significant alternative to the production of chemical compounds, including biofuels. The article focuses mostly on recent achievements in the technical and processing aspects of pyrolysis. This review provides an overview of the recent advanced pyrolysis technology used in gas, bio-oil, and biochar production. The key parameters to maximize the production of specific chemical compounds were discussed and considered during the construction of the reactors. The emphasis is put on optimizing the process parameters, technical requirements, and renewable energy use in the process and conception to improve the efficiency of product production. The application of pyrolysis gas, oil, and biochar as valuable chemical compounds are related to the intensifying effects of climate change, biofuel production, and waste management in accordance with the principles of sustainable development.

Fossil-based plastics are significant contributors to global warming through CO₂ emissions. For more sustainable alternatives to be successful, it is important to ensure that consumers become aware of the benefits of innovations such as bio-based plastics, in order to create demand and a willingness to initially pay more. Given that consumer attitudes and (inaccurate) beliefs can influence the uptake such new technologies, we investigated participants’ attitudes towards fossil-based and bio-based plastic, their perceived importance of recycling both types of plastic, their willingness to pay, and their perceptions of bio-based plastic in four studies (total N = 961). The pre-registered fourth study experimentally manipulated information about bio-based plastic and measured willingness to pay for different types of plastic. The results suggest participants hold very favourable attitudes and are willing to pay more for bio-based products. However, they also harbour misconceptions, especially overestimating bio-based plastic’s biodegradability, and they find it less important to recycle bio-based than fossil-based plastic. Study 4 provided evidence that educating consumers about the properties of bio-based plastic can dispel misconceptions, retain a favourable attitude and a high willingness to pay. We found mixed evidence for the effect of attitudes on willingness to pay, suggesting other psychological factors may also play a role. We discuss how attitudes and misconceptions affect the uptake of new sustainable technologies such as bio-based plastics and consumers’ willingness to purchase them.

Bio-surfactants are surface-active molecules which are produced by the wide range of microbes including bacteria, fungi, and yeast. This study was conducted to identify bio-surfactants by Bacillus subtilis combined with use of cheap substrates and industrial wastes (Mustard cake, Whey and Soya cake) which are found locally in Nepal. Bacillus subtilis, one of the most potential bio-surfactants producer; was isolated from soil sample of hydrocarbon contaminated site. Isolates were grown in a Minimal Salt Media (MSM) with 10% (v/v) mustard oil cake, whey and soya cake separately. The presence and potential of surfactant was determined by the oil spreading technique, emulsification index (%E24) and surface tension measurement. It was revealed that the surface tensions of cell free extract were 54.41, 60.02 and 56.64 mN/m for from mustard cake, whey and soya cake respectively as compared to distilled water (72.09) at 25oC. The emulsification index values are was found to be highest in engine oil from the bio-surfactant extracted from mustard cake, soya cake and whey respectively. Similarly, mustard oil showed the lowest value of emulsification index. The highest emulsification activity was shown in mustard oil i.e. 1.13 from the cell free extract from mustard oil and lowest in engine oil i.e., 0.07, by the extract from soya cake medium, when measured in spectrophotometer at 540 nm. In conclusion, strain of Bacillus subtilis was found to be the potential surface active agent producers on the mustard oil cake, which can be useful medium for various environmental, food and industrial processes.

Carboxylic acids such as acetic acid and propionic acid have been investigated as representative components for fast pyrolysis (FP) bio-oil upgrading. Selective catalytic conversion of carboxylic acids can enhance bio-refinery processing economics through catalyst preservation and process intensification. Various metal-doped molybdenum carbide bead catalysts have been synthesized and developed in this work. Our aim is to enable selective conversion of carboxylic acids. In the case of acetic acid conversion, calcium doped Mo₂C beads offer the highest yield of acetone ~96% at 450 °C among undoped and Ca or Ni doped catalysts. By comparing hot gas filter with and without Ca-Mo₂C catalyst tested with real FP vapors, the former showed a 36.7% reduction of acetic acid, a 37.5% reduction of small ketones in aqueous phase, and a ~50% reduction of methoxies (methoxy phenols and methoxy aromatics) in organic phase. The conversion resulted in the formation of more long chain chemicals in the organic phase, which are more amendable for downstream upgrading.

High density polyethylene (HDPE) and poly(lactic) acid (PLA) blends with different ratios of both polymers, namely 30:70, 50:50 and 70:30, were produced. Polyethylene grafted maleic anhydride and a random copolymer of ethylene and glycidyl methacrylate, were also proposed as compatibilizers to modify HDPE-PLA optimal blends and were added in the amounts of 1, 3 and 5 wt.%. Blends properties have been evaluated through different aspects by performing tensile tests, scanning electron microscopy to analyze blend morphology and interfaces, and thermomechanical analysis through differential scanning calorimetry, thermo-gravimetric analyses and infrared spectroscopy. The second blend, the one with equal amounts of HDPE and PLA seems to represent a good balance between high amount of bio-derived charge and acceptable mechanical properties. This suggests a good potential of these blends, which would be a good starting point for the production of composites with lingo-cellulosic fillers.

The species and bio-availability of phosphorus (P) in primary, secondary and digested sludge were fractionated and further analyzed in this study. Results showed that inorganic P (IP) was the primary P fraction in the secondary sludge and digested sludge, in which non-apatite IP (NAIP) amounted to 91.6% and 69.3% of IP, respectively. Organic P (OP), accounting for about 71.7% of total P (TP), was the dominant P composition in primary sludge. The content of bio-available P was about 9.7, 43.4, 29.8 mg-P/g-TS in primary sludge, secondary sludge and digested sludge, respectively, suggesting secondary sludge is the optimal choice when land application of sewage sludge is taken into consideration, followed by digested sludge and primary sludge. Polyphosphate and orthophosphate, comprising approximately 54.3% and 89.2% of TP, was the dominant P species in the secondary sludge and digested sludge, respectively. Monoester-P (54.6% of TP in extract) and diester- P (24.1%) were identified as OP species in primary sludge by Phosphorus-31 nuclear magnetic resonance (31PNMR). The present results would be helpful for P recovery and recycle from sewage sludge in wastewater treatment plant.

Adenine nucleotide (AN) 2^nd messengers such as 3’,5’-cyclic adenosine monophosphate (cAMP) are central elements of intracellular signaling, but many details of underlying processes remain still elusive. Like all nucleotides, cyclic nucleotide monophosphates (cNMPs) are net-negatively charged at physiologic pH which limits their applicability in cell-based settings. Thus, many cellular assays rely on sophisticated techniques like microinjection or electroporation. This setup is not feasible for medium- to high-throughput formats, and the mechanic stress that cells are exposed to raises the probability of interfering artefacts or false-positives. Here, we present a short and flexible chemical route yielding membrane-permeable, bio-reversibly masked cNMPs for which we employed the octanoyloxybenzyl (OB) group. We further show hydrolysis studies on chemical stability and enzymatic activation, and present results of real-time assays, where we used cAMP and Ca²⁺ live cell imaging to demonstrate high permeability and prompt intracellular conversion of some selected masked cNMPs. Consequently, our novel OB-masked cNMPs constitute valuable precursor-tools for non-invasive studies on intracellular signaling.

The impact of nanomaterials on lung fluids or on the plasma membrane of living cells has prompted researchers to examine the interactions between nanoparticles and lipid vesicles. Recent studies have shown that nanoparticle-lipid interaction leads to a broad range of structures including supported lipid bilayers (SLB), particles adsorbed at the surface or internalized inside vesicles, and mixed aggregates. Today, there is a need to have simple protocols that can readily assess the nature of structures obtained from particles and vesicles. Here we apply the method of continuous variation for measuring Job scattering plots and provide analytical expressions for the scattering intensity in various scenarios. The result that emerges from the comparison between modeling and experimental measurements is that electrostatics plays a key role in the association, but it is not sufficient to induce the formation of supported lipid bilayers.

1) Background: The environmental, financial and social questions in Africa remain unanswered up-to-date, with the rapid increase in human population and the demand for fuel energy, trigger the need to generate data on the socio-economic factors influencing the knowledge of use and adoption of family-sized bio-digesters. The increasing prices of fossil fuels and taxes on energy sources require finding the alternative, clean and economical sources of energy for households in developing countries. Moreover, in Africa, the consumption of firewood and charcoal continues to increase, with wood fuel consumption predicted to increase by 2030 to over 140%. The study objectives were 1) to determine the socio-economic characteristics of the people in Ngoma district, 2) to assess socio-economic factors influencing people to use and adopt family-sized bio-digesters. 2) Methods: Quantitative data collected with semi-structured questionnaires and interviews were analyzed using descriptive statistics. 3) Results: The results show that many households had not realized the potential benefits of biogas use and adoption in Rwanda. The study further found that a number of factors such as household income levels, socio-economic, technological, and institutional influence the household use and adoption of biogas energy. 4) Conclusions: At the end, the study suggests the need for all players such as Government, Non-Governmental Organizations (NGO's) and local communities to work together to provide incentives and favorable environment that can attract individual households to invest in biogas energy production and utilization.

Background: The clinical impact of withdrawal of sodium-glucose cotransporter 2 inhibitor (SGLT2i) on the all-cause readmission in patients with heart failure remains unknown. Methods: Consecutive 212 patients who were hospitalized for heart failure and received SGLT2i during the index hospitalization between February 2016 and July 2022 were evaluated. Of these, 51 patients terminated SGLT2i during or after their index hospitalization. The primary outcome was defined as an all-cause readmission rates/times. Results: Over a median of 23.2 months, an all-cause readmission occurred in 38 of 51 patients (74.5%) withdrawn from SGLT2i and 93 of 161 patients (57.8%) with continuation of SGLT2i (p = 0.099). The total number of all-cause readmissions per year was 0.97 [0-1.50] in patients withdrawn from SGLT2i and 0.50 [0-1.03] in patients with continuation of SGLT2i (p = 0.030). There was no significant difference in total medical cost (62,906 [502-187,246] versus 29,236 [7,920-180,305] JPY per month, p = 0.866) between both patient groups. Conclusions: Termination of SGLT2i may be associated with incremental all-cause readmission and no benefit in reducing total medical costs.

This study investigates the pivotal areas where Artificial Intelligence (AI) integration in healthcare warrants further exploration, leveraging insights from Boston Specialists, a forefront healthcare provider in AI adoption. Employing a qualitative case study approach, enriched by in-depth interviews and comprehensive literature reviews, we identify three main domains for potential AI expansion: scheduling efficiency, clinical documentation, and AI-driven medical research. Our results underscore the substantial enhancements AI brings to operational workflows and patient care, notably through improved scheduling systems, accuracy in medical documentation, and the facilitation of data-driven research methodologies. These findings suggest a critical need for healthcare institutions to further invest in AI technologies, focusing on these key areas to harness AI's full potential in personalizing care, optimizing efficiency, and advancing medical knowledge. The study concludes with a call for continued investigation into AI's integration within healthcare settings, emphasizing the importance of a supportive organizational infrastructure, ethical considerations, and data security in realizing AI's transformative impact on healthcare delivery and patient outcomes.

During the pandemic, educational digitization experienced a significant increase. In Mexico, social service is a crucial component of technical and professional training, a phase during which individuals apply the knowledge gained throughout their university education. The aim of this study is to standardize a digital model for the management of social service in the health care sector within health care units. This study employed an analytical, observational, retrospective, and longitudinal approach, involving two groups of trainees: Group A (n=133), utilizing a Non-Digital Model, and Group B (n=50), employing a Digital Model. In Stage I. the model design underwent validation through the Delphi method with a panel of three experts. The model was implemented on a Classroom® digital platform with the integration of the elements 1) a monthly rotation rubric 2) care services rubric 3) clinical cases or nursing process rubric, and 4) innovation project rubric. The validation of the model achieved 100% agreement (K=1). The variables measured for each group included the school of origin, career, unit of assignment, timely enrolment, and timely delivery of rubrics on the platform. The difference between the two groups was measured using Chi-Square. To measure the impact, the difference in the timeliness of the products was considered. From the University of Quintana Roo, the difference was 20.3 vs 34%. According to the Unit of Attachment the most frequent was HGR No. 17 with Group A at 22.5 vs 52%. According to the product the least delivered was Product 4, with 69% vs 81%. Timely enrollment was observed in Group A at 89% vs Group B at 80% p=0.001. Overall timely delivery in Group A was 81% vs Group B at 91% p=0.001 in the first 6 months post-implementation. Demonstrating that the implementation of the digital platform was effective, representing a significant advance in the adaptation of medical education to the circumstances imposed by the pandemic, highlighting the feasibility and effectiveness of digital teaching methods in the training of health professionals.

Cosmetic surgery is the subfield of plastic surgery that enhances appearance mainly for aesthetic reasons. Currently, cosmetic surgery interventions are highly considered appealing and popular all around the world. Several factors have contributed in this rapidly evolving field such as scientific and economic development, breaking down barriers and cultural norms, globalization, social media and mental disorders. Nowadays, the morality of cosmetic surgery is facing many dilemmas due to its benefits and drawbacks. It is proven that the advantages of cosmetic surgery include improved body confidence, mental health, and function. Additionally, aesthetic corrections can upscale the quality of life and create career opportunities for special targeted groups. Also, cosmetic surgery has a major impact in gender affirmation procedures. Although, herein we also describe the disadvantages of this widely developing field such as minor and major medical complications, potential postoperative risks and addiction in plastic surgeries associated with damaging economic issues. Lack in self-confidence, altered mental health status and ethical crisis consist another negative aspects of aesthetic surgery’s impact.

The aim of this review was to summarize the available literature regarding resident and medical student education utilizing the spaced repetition program Anki. This review enables current residents and medical students to recognize and utilize evidence-proven study techniques to increase learning efficacy. A systemic review of papers across all medical journals available on Pubmed was conducted to identify studies published without time constraints. The search was for (Anki) and (spaced repetition residency). Available outcome data was collected and discussed independently for students and residents. Many studies showed a statistically significant increase in exam performance associated with Anki use and high levels of satisfaction among residents and medical students. Further research is warranted to provide high-quality evidence of Anki’s applications and there is a need for exploration in additional residency specialties. Anki use has steadily increased with both medical students and residents. The application demonstrated consistent improvement on exam-based performance and was regarded highly by users. As burnout and time constrictions threaten educational workflow, Anki may serve as a powerful tool to improve the quality of learning. Further data needs to be collected and analyzed in specialties where Anki use may already exist.

ChatGPT is gaining widespread acceptance for its ability to generate natural language sentences in response to various inputs and is expected to become a supplementary tool for diagnosing and determining treatment policies in clinical settings. ChatGPT was used to evaluate its ability to perform clinical inference and accuracy in answering questions on the 117th Japanese National Medical Licensing Examination held in February 2023. The exam questions were manually inputted into ChatGPT's window, and the accuracy of ChatGPT's responses was determined based on answers provided by a preparatory school. ChatGPT provided answers for 389 out of 400 questions, and its overall correct answer rate was 55.0%. The correct answer rate for 5-choice-1, 5-choice-2, and 5-choice-3 were 57.8%, 42.9%, and 41.2%, respectively. The highest correct answer rate was for the compulsory exam (67.0%), followed by the specific knowledge exam (54.1%) and the cross category exam (47.9%). The correct answer rate for non-image questions was 56.2% and for image questions, it was 51.5%. The study suggests that ChatGPT has potential to support healthcare professionals in clinical decision-making in Japanese clinical settings, but caution should be exercised in interpreting and using the answers generated by ChatGPT due to room for improvement in performance.

Background: Health policy is a set of comprehensive principles and legislations that guide how healthcare should be effectively delivered in the community. Medical schools should prepare students to undertake managerial responsibilities by incorporating health policy in the curriculum to deal with the intricacies of healthcare systems and their clinical roles in their future professional careers. Objective: To examine medical students' perception at a Public University in Malaysia regarding teaching health policy and their participation in health policy roles. Material and Methods: A cross-sectional study using universal sampling was carried out among the medical students using a paper-based questionnaire to collect the data. Results: Most respondents opined their willingness to learn health policy (80.9%) and that teaching health policy (83.6%) should be compulsory for medical students. The respondents thought health policy should be introduced earlier in Year 1 or 2. The student scores on their knowledge regarding health policy and year of study were significantly associated with their involvement in the health policy roles in both the simple and multiple logistic regression. Both statistical tests reported higher participation in health policy roles with the higher year of study, though only Year 4 and 5 were significant in the simple logistic regression and only Year 5 in the multiple logistic regression compared to Year 1. On the other hand, age and type of admission show significant results only in the simple logistic regression, while the race was only significant at the multivariate level. Conclusion: This study demonstrated that most respondents showed their willingness to learn health policy, participate in the health policy programs, and recommend that health policy be considered an essential topic in the medical curriculum, which should be taught right from the first year of medical school. We recommend encouraging students’ participation in health policy activities.

The cannabis plant has been known for millennia for its properties such as textile fiber, food, recreational and medicinal use. Since the origin of its domestication in Asia, cannabis has been transported to the rest of the continents by merchants, nomads, settlers, and slaves, who have also carried with them valuable knowledge about its uses. Its medical use was one of the major contributions of this plant in the various civilizations through which it passed. This article aims to understand its origins, dissemination, and medical use over the years to the present day.

Background: Necrotizing enterocolitis (NEC) is one of the leading causes of death in newborns, however, little is understood of which patients can be treated medically or require surgery. The purpose of our study is to analyze the associated factors of surgically treated patients compared to patients requiring only medical treatment. Methods: Patients diagnosed with necrotizing enterocolitis over a period of 14 years in a single children’s hospital were retrospectively enrolled. Demographics and clinical data patients were collected and analyzed. Results: A total of 189 patients with NEC were included. Surgically treated patients had a lower gestational age (P = .018), body weight at birth (P = .034), and percentage of exclusive breast milk feeding (P= .001). They had increased comorbidity with respiratory distress syndrome (RDS) (P = .005), number of days of antibiotic use (P = .014), and length of hospital stay (P = .000). In multivariate logistic analysis, a lower percentage of exclusive breast milk feeding (OR = 0.366, 95% CI: 0.164-0.817) and a longer hospital stay (OR = 1.010, 95% CI: 1.001- 1.019) was associated with surgical NEC. Conclusion: Comparing medical and surgical NEC, a significantly lower percentage of surgical NEC patients were exclusively fed breast milk and their hospital stays were longer.

COVID-19 greatly challenges human beings in the health sector and leaves behind a large amount of medical waste that poses many potential threats to the environment. In this paper, we compiled relevant data released by official agencies and the media, and conducted data supplementation based on previous studies to calculate the net value of medical waste production in Hubei Province during COVID-19 with the help of a neural network model. Then, we reviewed the data related to the environmental impact of medical waste per unit and designed four scenarios to estimate the environmental impact of new medical waste generated during the epidemic. The results showed that at a medical waste generation rate of\ 0.\ 5\ kg/(\ bed\ \cdot\ d) COVID-19 resulted in a net increase in medical waste volume of about 3366.99 tons in Hubei Province. In the four scenario assumptions, if the medical waste brought by COVID-19 is completely incinerated, it will have a large impact on the air quality. If it is disposed by distillation sterilization, it will produce a large amount of wastewater and waste residue. Based on the results of the study, three policy recommendations are proposed in this paper: strict control of medical wastewater discharge, reduction and transformation of the emitted acidic gases, and attention to the emission of metallic nickel in exhaust gas and chloride in soil. These policy recommendations provide a scientific basis for controlling medical waste pollution.

Objectives: To determine the effects of caffeine consumption on the sleep habits and lifestyle of medical students. Methods: A cross-sectional study was conducted at Jinnah Sindh Medical University (JSMU) and Hamdard College of Medicine. On 422 undergraduate students aged 18-25 years, through random sampling. The duration of the study was from January 2019 to June 2019. The data was collected through self-administered questionnaire which included data regarding sleep habits and lifestyle of medical students. Results: Majority (81.6%) of the students consumed caffeine while only (18.4%) did not. One third of the participants (31.8%) reported caffeine consumption increased their academic performance and (57.3%) reported that it does not. More than half of the participants (63.3%) who consumed caffeine slept during class, whereas (47.2%) never had difficulty in falling asleep during the night. Conclusion: This research concluded that caffeine does have some role on sleep habits of medical students as they tend to have less sleep hours, experience day time dysfunction, average quality of sleep, and falling asleep during class. It has been concluded that caffeine has no effect on eating habits of medical students however, it does increase the screening time, keeping them active.

Visible light photography diagnostic images are coloured ex vivo medical images popularly used in Dermatology and Endoscopy for diagnosis and monitoring. The need to protect the integrity of these images as well as associated patient data calls for techniques such as image steganography and watermarking. This research explores and compares the effect of watermarking on the YIQ and YCbCr colour transforms used in processing digital coloured images and video in recent times. Using a new spread spectrum watermarking algorithm, it was found that YIQ has better distortion performance than YCbCr in the order of 3dB while YCbCr had lower BER for accurate watermark retrieval and tamper detection in the order of 1.3 x 10-3.

Five years after the introduction of the Prescribing Safety Assessment (PSA) in the UK, the role pharmacists play to help prepare medical students for this challenge is uncertain. Our study explored pharmacists’ perceptions about their role in undergraduate medical training for the Prescribing Safety Assessment (PSA). Study participants were emailed a qualitative questionnaire aimed at ascertaining their current involvement in undergraduate medical education, particularly the preparation for PSA. Responses received were thematically-analysed. A total of 27 UK hospital pharmacists and 3 pharmacists from local education and training boards completed the questionnaire. Pharmacists were positive about their involvement in medical student training, recognising the added value they could provide in prescribing practice. However, respondents expressed concerns in relation to resource availability and the need for formal educational practice mentoring. This research highlights the potential value of pharmacists’ input into medical education and the need for a discussion on strategies to expand this role to maximise the benefit from pharmacist skill mix in teaching safe prescribing.

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

Biomass as a whole offers a more diverse potential for valorisation than any other renew-able energy source. As one of the stages in the separation of bio-oil involves the liquid mixture of acetol and acetic acid, and as both components are particularly well suited for valorisation, a hybrid method has been developed for their separation with a high purity level through an approach combining liquid-liquid extraction and rectification. In order to design and simulate the flowsheet, the ChemCAD 7.0 simulation software has been used. Sensitive analyses have been carried out to investigate the influence of the different pa-rameters in the rectification columns such as the reflux ratio, the feed stage location, and the vapour/bottom molar flow ratio. The effect of different extractants and of their excess on the separation process as well as the possibility of regenerating the extractant has also been studied. Tri-n-octylamine has accordingly been selected as a separating agent which has been fully recycled. The end result for separating an initial 48/52 wt% ace-tol/acetic-acid liquid mixture has been acetol with a purity of 99.4 wt% and acetic acid with a purity of 100 wt%.

The reagents and raw materials used, as well as the products obtained (bio-oil, reaction condensates, polyols and sugar phases) were characterized by elemental analysis, infrared spectroscopy, thermogravimetry and high performance liquid chromatography with mass spectrometry. The heating value of the bio-oils is higher than that of the original biomass (higher heating value of Eucalyptus sawdust bio-oil 29 MJ/kg versus 19.5 MJ/kg of the original Eucalyptus sawdust). The analyses of the bio-oils allowed to identify the presence of high added-value compounds, such as levulinic acid and furfural. Finally, a study of the accelerated aging of the liquefied biomass showed that the biofuel density increases with the storage time due to the occurrence of repolymerization reactions.

Amidst the strong demand for wood-based products, and the clamor of environmental consciousness, more functional and green solutions arise to meet both of these goals. Pursuant to this, the study looked into the potential of a bio-waste taken from Cocos nucifera tree known as phellem—the tree’s outermost skin made of dead tissues, to be a main component of a new construction material. This study builds on existing research showing phellem is impermeable, buoyant, elastic, has a slow burn rate, and repels water during precipitation, which supports the hypothesis that phellem may be a potential substitute material for dry wall boards. To test this, three (3) formulations were developed as experimental setups to test the physico-mechanical properties of coconut palm phellem (COPAP): Formulation A (40% COPAP and 60% cement); Formulation B ( 25% COPAP and 75% cement); and lastly, Formulation C that was (10% COPAP and 90% cement). The study tested (1) which among these formulations exhibited the best physico-mechanical properties, then it (2) compared the formulations with common dry wall products available in the market, and subsequently, (3) identified the possible architectural applications of COPAP board as a new building material. Of the three setups, Formulation C exhibited the best physico-mechanical properties in terms of compressive and flexural strength, fire resistivity, and water absorption. It fared better than the particle board in terms of compressive strength, better than wafer and particle board in fire resistivity, performed best in the water absorption test, and was almost equivalent in flexural strength to fiber cement board. With these findings, the study concluded that COPAP board can be used for projects that entail a high number of interior partitions, such as offices, BPO firms and commercial stalls in shopping malls, etc. The findings were conclusive only for interior applications, as the results clearly suggest that the COPAP boards are not load-bearing. Future investigations may explore and assess other properties of COPAP boards like thermal and sound insulation, resistance to rot and other properties that may prove its competitive advantage as a construction material.

In the production of grafted vines, losses are caused by fungal pathogens during callus forming or after planting in the soil. To control or reduce natural fungal infections in nurseries, certain applications were conducted in sapling cultivation stage to analyse the efficacy of cyprodinil + fludioxonil, floupyram + tebuconazole active substances and Trichoderma harzianum biological preparation. 1103 Paulsen rootstock and Vitis viniferea L. Sultana cultivars were stored in fungicide suspensions for 60 minutes before and after grafting in the study. After grafting, the seedlings were divided into i) cutting + sawdust ii) cutting + sawdust + soil application groups and transferred to the callus room. Fungicides were applied 1 to 7 days after the callus development to wet the seedling roots 1 to 7 days after they were planted. After nine months in the nursery, the plants were uprooted, classified as diseased or healthy, and analysed for morphological and molecular diagnosis of fungal species, isolation incidence, and seedling quality and yield. After callus development, Fusarium solani was most frequently isolated pathogen in the roots (21.5%), cyprodinil + fludioxonil reduced the Ilyonectria sp. isolation rate in both shoots and roots. Botryosphaeria obtusa and I. liriodendri pathogens were not detected in sick and healthy cyprodinil + fludioxonil-treated saplings. The highest seedling yield was observed with fludioxonil + cyprodinil, cutting + sawdust + soil (78.75%) and cutting + sawdust (70.68%) applications. According to the results of this study, it was found that fungicide applications before and after grafting prevented soil-borne pathogen infections and improved sapling quality.

This study explores the impact of temperature and molarity on the pyrolysis of Açaí seeds (Euterpe Oleraceae, Mart.) activated with KOH on the yield of bio-oil, hydrocarbon content of bio-oil, antioxidant activity of bio-oil and chemical composition of aqueous phase. The experiments were carried out at 350, 400, and 450 °C and 1.0 atmosphere, with 2.0 M KOH, and at 450 °C and 1.0 at-mosphere, with 0.5 M, 1.0 M and 2.0 M KOH, in laboratory scale. The composition of bio-oils and aqueous phase determined by GC-MS, while the acid value, a physical-chemical property of fundamental importance in biofuels, of bio-oils and aqueous phases by AOCS methods. The antioxidant activity of bio-oils determined by the TEAC method. The solid phase (biochar) characterized by X-ray diffraction (XRD). The diffractograms identified the presence of Kalicinite (KHCO3) in bio-char, and those higher temperatures favor the formation peaks of Kalicinite (KHCO3). The pyrolysis of Açaí seeds activated with KOH show bio-oil yields from 3.19 to 6.79 (wt.%), aqueous phase yields between 20.34 and 25.57 (wt.%), solid phase yields (coke) between 33.40 and 43.37 (wt.%), and gas yields from 31.85 to 34.45 (wt.%). The yield of bio-oil shows a smooth exponential increase with temperature. The acidity of bio-oil varied between 12.3 and 257.6 mgKOH/g, decreasing exponentially with temperature, while that of aqueous phase between 17.9 and 118.9 mgKOH/g, showing and exponential decay behavior with temperature, demonstrating that higher temperatures favor not only the yield of bio-oil but also bio-oils with lower acidity. For the experiments with KOH activation, the GC-MS of bio-oil identified the presence of hydrocarbons (alkanes, alkenes, cycloalkanes, cycloalkenes, and aromatics) and oxygenates (carboxylic acids, phenols, ketones, and esters). The concentration of hydrocarbons varied between 10.19 to 25.71 (area.%), increasing with temperature, while that of oxygenates from 52.69 to 72.15 (area.%), decreasing with temperature. For the experiments with constant temperature, the concentrations of hydrocarbons in bio-oil in-crease exponentially with molarity, while those of oxygenates decrease exponentially, showing that higher molarities favor the formation of hydrocarbons in bio-oil. The antioxidant activity of bio-oils decreases with increasing temperature, as the content of phenolic compounds decreases, and de-creases with increasing KOH molarity, as higher molarities favors the formation of hydrocarbons. Finally, it can be concluded that chemical activation of Açaí seeds with KOH favors the not only the yield of bio-oil but also the content of hydrocarbons. The study of process variables is of utmost importance in order to clearly assess reaction mechanisms, economic viability and design goals that could be derived from chemically activated biomass pyrolysis processes.

The aim of this study was to investigate the effect of condensed tannin (CTs) with differing molecular weight on their capacity to modify the fatty acid profile in milk. Twenty multiparous crossbred lactating dairy goats were assigned in a randomized complete block design (RCBD), and were subjected to receive the dietary treatments as followings; T1: control (with no CTs supplementation), T2: supplemented with mangosteen peel in a concentrate as a source of low molecular weight CTs at level of 3.0 %DM of CTs equivalent, T3: supplemented with the same diet with T2 but added with polyethylene glycol (PEG, as tannin inactivator) as the control of T2, and T4: supplemented with quebracho CT extract (UNITAN ATO, Buenos Aires, Argentina; 75-77 % tannins) in a concentrate as a source of high molecular weight CTs at level of 3.0 %DM of CTs equivalent, and T5) supplemented with the same diet with T4 but added with PEG as the control of T4. No significant change was detected for feed intake and nutrient digestibility indicate that CTs at level of 3.0 %DM of diet did not showed the detrimental effect to feed intake and nutrient digestibility, however, ruminal fermentation parameters and milk yield and milk compositions did not affected by different source of CT inclusion.

This research seeks to interpret the component analysis of an innovative bio-asphalt binder using guayule resin in addition to crumb rubber modifier (CRM) at high concentrations. Such asphalt modification aims to minimize the dependency on virgin asphalt binder and provide new solutions concerning sustainable, flexible pavement industry. Guayule resin is a promising bioresource for asphalt binder replacement. By now, it could be considered a no value byproduct extracted during the guayule natural rubber production. CRM is a recycled material derived from scrap tires. The provided interpretation could help in understanding the asphalt-rubber-guayule interaction mechanism. Fourier transform infrared spectroscopy (FTIR), supported by thermo-gravimetric analysis (TGA), was used to investigate the component analyses of guayule resin composition, asphalt guayule interaction, and asphalt rubber guayule interaction, compared to corresponding asphalt rubber interaction. Additionally, the rheological properties at elevated temperatures were provided to link the microscale properties with the final product performance. The study clarified the distinct carbon and hydrogen compositional elements of guayule resin. Asphalt and guayule resin have similarities in chemical composition and rheological behavior with temperature susceptibility. The asphalt guayule binder had physical interaction. However, when both interacted with rubber, a chemical interaction was attributed, with no difference in rubber dissolution tendency, in asphalt rubber guayule, compared to asphalt rubber. A bio-binder composed of 62.5% asphalt, 25% guayule and 12.5% CRM had the potential to provide rheological properties better than base asphalt. Such behavior was interpreted by a high release of rubber components.

Phloem-feeding insects strive to offset the disadvantageous effects of stressors to sustain their offspring and survive. Adaptive responses to environmental stress are not well understood under complex influences of companion planting, natural enemies, and host gradient. In this study, under predation by lacewing Chrysoperla carnea Stephens (Neuroptera: Chrysopidae), we survey the responses of green peach aphid Myzus persicae Sulzer (Hemiptera: Aphididae), reared on different densities of cabbage Brassica oleracea L. (Brassicales: Brassicaceae) to its shallot companion Allium cepa (L.) var. aggregatum G. Don (Asparagales: Amaryllidaceae). Firstly, aphid aggregative abundance was strongly influenced by shallot perturbation, predator presence and changes in cabbage-host biomass, altering aphid phenotypic plasticity. Interestingly, the shallot and predation negative impacts can be of similar magnitudes. Secondly, changes in the cabbage-host availability and biomass, especially under predation, had a strong impact on aphid traits. Our study underscores the benefits of including shallots as crop-companions in augmenting pest control, but also suggests that the outcome of coupling companion planting with natural enemies is context-dependent and thus should be empirically applied. At the confluence of ecology and agronomy, this work provides insights on how manipulated functional biodiversity may function as an alternative strategy for pestilent herbivory management in model and green-house systems.

The procedures for the extraction and separation of lipids and nutraceutics from microalgae using classic solvents have been used many times. However, these production methods usually require expensive and toxic solvents. Based on our studies involving the use of eco-sustainable methodologies and alternative solvents, we select ethanol (EtOH) and cyclopentyl methyl ether (CPME) for extracting bio-oil and lipids from algae. Different percentage of EtOH in CPME favors the production of an oil rich of SFA useful to production biofuel or rich of compounds bioactive. The proposed method for obtain a rich extract of saturated or unsaturated fatty acids from dry algal biomass is disclosed is eco-friendly and allows a good extraction yield. The method is compared both in extracted oil percentage yield and in extracted fatty acids selectivity to extraction by supercritical carbon dioxide.

Bacteriophages can provide alternative measures for the control of E. coli O157:H7 that is currently an emerging food-borne pathogen of severe public health concern. This study was aimed at characterising E. coli O157:H7 specific phages as potential biocontrol agents for these pathogens. Fifteen phages were isolated and screened against 69 environmental E. coli O157:H7. Only 3 phages displayed broad lytic spectra against environmental shiga toxin-producing E. coli O157:H7 strains. These 3 lytic phages were designated V3, V7 and V8. Subsequent characterization indicated that they displayed very high degree of similarities despite isolation from different locations. Transmission Electron microscopy (TEM) of the phages revealed that they all had isometric heads of about 73 – 77 nm in diameter and short tails ranging from 20 - 25 nm in diameter. Phages V3, V7 and V8 were assigned to the family Podoviridae based on their morphology. Pulsed field gel electrophoresis (PFGE) genome estimation of the 3 phages demonstrated identical genome sizes of ~ 69 nm. The latent periods of these phages were 20 min, 15 min, and 20 min for V3, V7 and V8 respectively while the burst sizes were 374, 349 and 419 PFU/ infected cell respectively. While all the phages were relatively stable over a wide range of salinity, temperatures and pH values, their range of infectivity or lytic profile was rather narrow on environmental E. coli O157:H7 strains isolated from cattle faeces. This study showed that the Podoviridae bacteriophages are the dominant E. coli O57:H7-infecting phages harboured in cattle faeces in the North-West Province of South Africa and due to their favourable characteristics can be exploited in the formulation of phage cocktails for the bio-control of E. coli O157:H7 in meat and other meat products.

Background A body composition monitor (BCM) has a role not only in determining over-hydration (OH) but also as an aid to nutritional assessment. For dialysis patient-specific clinical applications of BCM, it is necessary to clarify the relationship between body composition parameters and OH in healthy Chinese individuals. Methods This cross-sectional study involved 314 healthy individuals with a mean age of 45.7±13.1 years. BCM measurements were performed while the subjects were fasting. Results The mean OH level was 0.379±0.81 L. Lean tissue index (LTI) and Lean tissue mass (LTM) were significantly higher in males (p<0.001), while fat tissue index (FTI) was significantly higher in females (p<0.001). In univariate correlation analysis, FTI, Fat, and ATM had a negative correlation with OH in females and all subjects (p<0.05), while LTM and BCM had a positive correlation in all subjects (p<0.05). There was a significant negative correlation between phase angle (PhA) and OH in males, females, and all subjects (r=-0.634, p<0.001; r=-0.666, p<0.001; r=-0.484, p<0.001, respectively). In multivariate linear regression analysis, PhA (b=-1.266, p<0.001), LTM (b=0.987, p<0.001), age (b=-0.307, p<0.001) were independent predictors of OH. Conclusions This study demonstrated that age, LTM and especially PhA, had important roles in predicting OH in healthy Chinese individuals. In the future, PhA may aid in clinical assessment by helping to titrate dry weight among hemodialysis patients with malnutrition.

In this paper, the far field and near field optical responses of a gold nanoparticle are studied and simulated numerically. The electromagnetic field was excited by an electric dipole located near one end of the nanorod, which is used to model the emission of a quantum dot. Another excitation method was also simulated in which an incident plane wave is used. The excitation of dark plasmon modes of the gold nanorod is presented. The Poynting equation was solved numerically to study the influence of the gold nanorod on the dipole radiative power. In addition, the extinction cross section of the gold nanoparticle illuminated by the incident plane wave was calculated to estimate the amount of the scattered and absorbed light.

This paper presents an overview of the principal structural and dynamics characteristics of reverse micelles (RMs) in order to highlight their structural flexibility and versatility, along with the possibility to modulate their parameters in a controlled-manner. The multifunctionality in a large range of different scientific fields is exemplified in two distinct directions: a theoretical model for mimicry of biological microenvironment and practical application in the field of nanotechnology and nano-based sensors. RMs represents a convenient experimental approach that limits the drawbacks of the conventionally biological studies in vitro, while the particular structure confers them the status of simplified mimics of cells by reproducing a complex supramolecular organization in an artificial system. The biological relevance of RMs is discussed in some particular cases referring to the confinement and crowding environment, molecular dynamics of water and cell membrane structure. The use of RMs in different range of applications seems to be more promising due to their structural and compositional flexibility, a high efficiency and selectivity being achieved. The advance in nanotechnology is based on developing new methods of nanomaterials synthesis and deposition. This review highlighting the advantages of using RMs in synthesis of nanoparticles with specific properties and in nano (bio)sensors design.

In this study we investigated the potential of two non-edible oil extracts from seeds of Colliguaya Integerrima (CIO) and Colliguaja Salicifolia (CSO) to use as a renewable source for polyols and eventually polyurethane foams or biodiesel. For this purpose, two novel polyols from the aforementioned oils were obtained in a one-single step reaction using a mixture of hydrogen peroxide and acetic acid. The polyol derivatives obtained from the two studied oils were characterized by spectral (FT-IR, ¹H NMR and ¹³C NMR), physico-chemical (e.g. chromatographic analysis, acid value, oxidizability values, iodine value, peroxide value, saponification number, kinematic viscosity, theorical molecular weights, density, hydroxyl number and hydroxyl functionality) and thermal (TGA) analyses according to standard methods. Physico-chemical results revealed that all parameters, with the exception of the iodine value, were higher for bio-polyols (CSP and CIP polyols) compared to the starting oils. The NMR, TGA and FT-IR analyses demonstrated the formation of polyols. Finally, the OH functionality values for CIP and CSP polyols were 4.50 and 5.00, respectively. This result indicated the possible used of CIP and CSP polyols as a raw material for the preparation of polyurethane rigid foams.

Suboptimal knowledge of clinical pharmacology, therapeutics, and toxicology (CPT) and poor-quality prescribing are threats to patient safety. Our previous national survey of medical faculty identified limited confidence in medical student graduates’ ability to prescribe safely and an interest in a national prescribing competence assessment. Given the in-person challenges posed by the restrictions related to the COVID-19 pandemic, we aimed to re-evaluate opinions and gauge interest in e-learning resources and assessments. Using public sources, a sampling frame of medical school leaders from all 17 Canadian medical schools, including deans, vice-deans, and program directors for clerkship, residency, and e-learning, were invited to participate in a cross-sectional survey. Survey questions were finalized after several rounds of testing and analyses were descriptive.Of 1448 invitations, 411 (28.4%) individuals reviewed the survey, and among them, 278 (67.6%) completed at least one survey question with representation from all schools. While more than 90% of respondents agreed that medical students should meet a minimum standard of prescribing competence, only 17 (7.9%) could vouch for their school meeting objectives in CPT and many had significant concerns about their own or other schools’ recent graduate prescribing abilities. Given the lack of local CPT eCurricula resources, there was strong interest in a national online course and assessment in CPT. Our national survey results suggest an ongoing inadequacy of medical trainees’ prescribing competence and provide a strong endorsement for both a national online CPT course and assessment during medical school.

Introduction: At the end of 2019 the Covid-19 pandemic caused a huge amount of restrictions across the world which affected teaching around the world as it was not prepared to move from traditional face-to-face to an online conversion overnight, so the aim of this paper is to determine the changes in undergraduate anatomy teaching strategies post-pandemic compared to pre-pandemic. Methods: A systematic review was conducted based on the PRISMA statement. Data were retrieved from the searches conducted in the different databases, and the articles to be retrieved were selected with the help of the Rayyan platform. Using the OPMER and JBI tools, the quality of evidence was assessed for the selection of the articles included in the review. Results: The teaching of medicine, specifically anatomy, presented serious problems due to the fact that throughout history it has been taught in the classroom by means of cadaveric dissection and when this ceased to be available, new methods arose through the use of digital resources to try to make up for the needs of the lack of dissection laboratories which lost a great deal of content in this restructuring, which have been improving with the passing of the courses taught and the development of new material that has been better adapted to the needs of the students. Discussion: The authors agree that in the future the best way to teach anatomy will continue to be face-to-face dissection without neglecting the strategies developed during this pandemic and to be taken if necessary to restructure curricula in the future to improve teaching.

Recently, Artificial Intelligence (AI)-based algorithms have revolutionized the medical image segmentation processes. Thus, the precise segmentation of organs and their lesions may contribute to an efficient diagnostics process and a more effective selection of targeted therapies as well as increasing the effectiveness of the training process. Thus, AI may contribute to the automatization of the image scan segmentation process and increase the quality of the resulting 3D objects, which may lead to the generation of more realistic virtual objects. In this paper, we focus on the AI-based solutions applied in the medical image scan segmentation, and intelligent visual-content generation, i.e. computer-generated three-dimensional (3D) images in the context of Extended Reality (XR). We consider different types of neural networks used with a special emphasis on the learning rules applied, taking into account algorithm accuracy and performance, as well as open data availability. This paper also attempts to summarize the current development of AI-based segmentation methods in medical imaging and intelligent visual content generation that are applied in XR. Finally, this paper concludes with possible developments and open challenges in AI application in Extended Reality-based solutions. Finally, the future lines of research and development directions of Artificial Intelligence applications both in medical image segmentation and Extended reality-based medical solutions are discussed.

Spinal deformity refers to a range of disorders that are defined by anomalous curvature of the spine and may be classified as scoliosis, lordosis, or kyphosis. Among these, scoliosis stands out as the most common type of spinal deformity in human beings, and it can be distinguished by abnormal lateral spine curvature accompanied by axial rotation. Accurate identification of spinal deformity is crucial for a person's diagnosis, and numerous assessment methods have been developed by researchers. Therefore, the present study aims to systematically review recent works on spinal deformity as-assessment for scoliosis diagnosis, utilizing image processing techniques. To gather relevant studies, a search strategy was conducted on three electronic databases (Scopus, ScienceDirect, and PubMed) between 2012 and 2022, using specific keywords and focusing on scoliosis cases. A total of 17 papers fully satisfied the established criteria and were extensively evaluated. Despite variations in methodological designs across the studies, all reviewed articles obtained quality ratings higher than satisfactory. Various diagnostic approaches have been employed, including artificial intelligence mechanisms, image processing, and scoliosis diagnosis systems. These approaches have the potential to save time and, more significantly, can reduce the incidence of human error. While all assessment methods have potential in scoliosis diagnosis, they possess several limitations that can be ameliorated in forthcoming studies. Therefore, the findings of this study may serve as guidelines for the development of a more accurate spinal deformity assessment method that can aid medical personnel in the real diagnosis of scoliosis.

Fractures of the talar neck and body are associated with spine fractures and scoliosis deformity, which affect cosmetic appearance and cause difficulty in ambulation. The implant design for talus surgery is thriving as a functional alternative in case of severe talar destruction, focusing on segmentation and reconstruction of the talus’s shape. However, manual segmentation of the talus is time-consuming and subjective. In this study we exploited the automatic segmentation framework to efficiently train a deep learning-based model to accurately segment the talus based on computed tomography imaging. We developed three model configurations with nnU-Net and investigated their Dice similarity coefficients (DSC) and 95% Hausdorff distances (HD95) for talus segmentation on a CT image dataset. The three configurations performed well (DSC > 0.95, HD95 < 0.6). When tested on the same samples, one of the configurations was more efficient while ensuring higher accuracy. We propose to focus on talus anatomic variations with increasing age based on this framework and apply it to clinical trials at the next stage.

: BACKGROUND: The prevalence of smoking among students is a growing concern, particular-ly among medical students. Being associated with stress, competitiveness, and various social in-fluences, smoking can have detrimental effects on self-esteem and self-efficacy and may create a vicious cycle that may contribute to students’ well-being and academic performance out-comes.METHODS: A cross-sectional study on 456 medical students was conducted via an online survey using structured questionnaires on socio-demographic characteristics, smoking habits, nicotine dependence, self-esteem, and self-efficacy. RESULTS: The prevalence of smoking was 31.1% The scores of self-esteem and self-efficacy were positively correlated with smoking habits (W1=0.957, W2=0.975, P<0.05). Students presented rather low smoking addiction with male stu-dents having slightly higher scores than female students on self-esteem and self-efficacy, mili-tary students had higher self-esteem scores than civilians with physical activity having a posi-tive correlation with non-smoking behavior. CONCLUSION: According to our results, self-esteem and self-efficacy were slightly positively correlated with smoking habits. Furthermore, there was no statistically significant association between other social factors and smoking. Our results may develop a theoretical basis for medical students’ psychological variables studying for further implementation of university educational programs and preventive interventions em-powering students towards an overall better quality of life, addressing, among others, smoking behaviors.

Chronic non-cancer pain is a highly debilitating condition affecting approximately 20% of the global population. Chronic pain may lead to significant physical disability, emotional distress, social isolation and financial burden. Whilst^. pharmacological therapies remain the cornerstone of pain management in non-cancerous chronic pain, factors including the current opioid epidemic have led to non-pharmacological techniques becoming a more attractive proposition. We explored the prevalence of medical device use and their treatment efficacy in non-cancer pain management. A systematic methodology was developed, peer reviewed and published in PROSPERO (CRD42021235384). Key words of medical device, pain management devices, chronic pain, lower back pain, back pain, leg pain and chronic pelvic pain using Science direct, PubMed, Web of Science, PROSPERO, MEDLINE, EMBASE, PorQuest and ClinicalTrials.gov. All clinical trials, epidemiology and mixed methods studies that reported the use of medical devices for non-cancer chronic pain management published between the 1^st of January 1990 and the 30^th of April 2022 were included. 13 studies were included in systematic review, of these 6 were used in the meta-analysis with 173 participants. Our meta-analysis for pain reduction in each study showed that transcutaneous electrical nerve stimulation combined with instrument-assisted soft tissue mobilization treatment and pulsed electromagnetic therapy produced significant treatment on chronic lower back pain patients. Pooled evidence revealed the use of medical device related interventions resulted in 0.7 degree of pain reduction under a 0-10 scale. Significant improvement in disability scores, with a 7.44 degree reduction in disability level compared to a placebo using a 50 score range was also seen. The application of medical devices in patients with chronic pain has gained popularity due to increasingly cost effective techniques, minimally invasiveness and greater awareness of risks associated with pharmacological management. Our analysis has shown that the optimal use of medical devices in a sustainable manner requires further extensive research, needing larger cohort studies with greater gender parity, in a more diverse range of geographical locations.

Depression and anxiety in cardiovascular disease worsen the prognosis of patients. Treatments for these disorders often provide limited improvement. The present study aimed to test, for the first time, the impact of educational technology on anxiety and depressive symptoms in patients participating in a cardiac rehabilitation program. A 12-month randomized controlled trial was conducted, in which 207 patients were randomly assigned to either the experimental (n=76) or control (n=69) groups. The intervention involved a structured patient education program provided by medical students who had undergone specially designed training in cardiac rehabilitation. The primary outcomes were death, hospitalization, heart failure, and recurrent myocardial infarction. The study also assessed anxiety and depression. A year later, the experimental group showed a statistically significant decrease in anxiety and depression on the HADS scale, with reductions of 2.0 and 1.9 points respectively (p&lt;0.05). The control group showed reductions of 1.5 and 1.2 points (p&lt;0.05). The difference in depression (HRDS) between the groups at 12 months was -1.29 in favor of the main group (95% CI, -0.7 to -1.88), and the standardized effect size (SMD) was 0.36 (95% CI, 0.03 to 0.69). No treatment-related adverse events were observed. The results suggest that educational interventions can have a positive impact on mental health. The study's strengths include a structured intervention, randomization, and long-term follow-up. Limitations include the lack of blinding of study participants and a relatively small sample size.

Introduction. Covid-19 faced the world with serious health and socioeconomic issues. At the very beginning of the pandemics, the vaccine was considered by health authorities and the medical community the only way to curb the spread of the virus. One of the measures that have been proposed to increase vaccinations was the mandatory policy. The purpose of this study was to compare determinants of voluntary and mandatory vaccination among students of Albanian University. Methodology: This cross-sectional study by means of an online survey, was conducted among students enrolled in the private University “Albanian University”, Tirana, Albania during the last week of winter semester 7-14 Feb 2022. Results: 878 students participated in this study, among them 612 (69.7%) were females, 266 (30%) were males. 506 (57%) of the participants were enrolled in Medical Sciences (MS), 372(42.3%) were Non-Medical Science (Non-MS) group. 773 (88%) was vaccinated against Covid-19, 105 (11.8%) were not vaccinated. 466 (53%) reported voluntary vaccination, 412 (46.9%) reported mandatory vaccination. Among students that vaccinated voluntary 266 (57%) were from MS group, 200(42.9%) from Non-MS group. 237(57.5%) of students in mandatory vaccination group were from MS group, 175 (42.4%) from Non-MS. Conlusion. Vaccine safety and efficacy were hindering factors of vaccination. Also, based on the results of this study, the students felt encouraged to vaccinate by the academic staff. This clearly demonstrates that the staff does not lack the skills to enhance stu-dents' knowledge about the risk of infectious diseases and the importance of vaccination. Therefore, to influence as much as possible students’ attitude toward vaccination, comprehensive educational programs including modification of existing curricula should be considered.

Alzheimer’s disease has become a major concern in the healthcare domain as it is growing rapidly. Many researches have been conducted to detect it from MRI images through various deep-learning approaches. However, the problem of the availability of medical data and the privacy of the patients still exists. To mitigate this issue in Alzheimer’s disease detection, we have implemented the federated approach which is found to be more efficient, robust, and consistent compared to the conventional approach. For this, we needed deep excavation on various orientations of MRI images and transfer learning architectures. Then, we utilized the publicly available two datasets (OASIS, and ADNI), and designed various cases to evaluate the performance of the federated approach. In almost all of them, the federated approach achieved better accuracy and sensitivity. In distinguishing between two classes equally, the capability of the models was better in the found model when trained with federated approach compared to the conventional approach. In this approach. MobileNet, which is a low-cost transfer learning architecture, achieved the highest 95.24%, 81.94%, and 83.97% accuracy in OASIS, ADNI, and merged (ADNI+OASIS) test set, which was way higher than the achieved performance in Conventional approach. Moreover, in this approach, only the weights of the model were shared which keeps the original MRI images in their respective hospital or institutions, mitigating the privacy concern in the healthcare domain.

Innovation development in healthcare has paved the path towards the improvement in system efficiency, patient care and cost-effective healthcare services, increasing the overall efficiency of the healthcare system in a significant manner. Electronic medical record system has fostered interoperability and collaboration in healthcare departments by enabling different systems to exchange and use patient data. This trend has been accelerated dominantly by the pandemic, leading to increased use of telemedicine, referring specifically to the use of electronic communication to provide healthcare services remotely. Moreover, an increased prevalence towards the use of artificial intelligence and machine learning in healthcare has contributed effectively towards the rigorous and informed analysis of large amounts of data as well as to identify patterns or trends that may be useful for improving care delivery or identifying potential issues. A unified electronic medical record System that will generate competitive opportunities and success prospects with reference to enhanced interoperability in US healthcare departments, can contribute towards the improvement in the quality and efficiency of care by making it easier for healthcare providers to access and share patient information as well as reducing the risk of errors in effective patient care.

During the creation and integration of a health care system based on medical knowledge graphs, it is necessary to review and select the vocabularies and definitions that best fit the information requirements of the system being developed. This implies the reuse of medical knowledge graphs; however, full importation of knowledge graphs is not a tractable solution in terms of memory requirements. In this paper we present a modularization-based method for knowledge graph reuse. A case study of graph reuse is presented by transforming the original model into a lighter one.

This study is a cross-sectional survey involving physicians around Indonesia aimed to explore physician hesitancy to treat COVID-19 patients after experiencing COVID-19 infection coupled with associated occupational risk factors. The questionnaire was distributed via contact information from the Indonesian Physician Association database. Out of 383 participants, 25.6% suffered from moderate symptoms of COVID-19 and 2.9% were admitted for critical care. Hesitancy to treat suspected, probable, or confirmed COVID-19 patients was found in 20.3% of physicians. A higher hesitancy rate was found in older physicians and those with less experience in treating COVID-19 patients. Specialist trainees and those who work in public hospitals were physicians with the lowest hesitancy in treating COVID-19 patients. There is a significant hesitancy in treating COVID-19 patients among physicians who have suffered from COVID-19 which calls for further action by management and policy makers.

Convolutional neural network architectures have become increasingly complex, which has improved the performance slowly on well-known benchmark datasets in the recent years. In this research, we have analyzed the true need for such complexity. We have introduced G-Net light, a lightweight modified GoogleNet with improved filter count per layer to reduce feature overlaps and complexity. Additionally, by limiting the amount of pooling layers in the proposed architecture, we have exploited the skip connections to minimize the spatial information loss. The investigations on the proposed architecture are evaluated on three retinal vessel segmentation publicly available datasets. The proposed G-Net light outperforms other vessel segmentation architectures by reducing the number of trainable parameters..

Background: Emergency medical services (EMS) are the first health care contact for the majority of stroke patients. However, there is a lack of data on the current paramedics’ hospital-directed feedback and training needs across different health care settings. We aimed to evaluate paramedics’ prehospital stroke care knowledge, training needs, and current status of feedback on suspected stroke patients. Methods: We surveyed paramedics from the Vilnius region from September to November 2019, and compared the answers between the city and the district agencies. The questionnaire content included questions on paramedics’ demographic characteristics, prehospital stroke care self-assessment, knowledge on stroke mimics, stroke training needs, and the importance of hospital-directed feedback on suspected stroke patients. Results: A total number of 161 paramedics were surveyed, with more district paramedics rating their prehospital stroke care knowledge as inadequate (44.8% (95% confidence interval (CI) 32.8–57.6) vs 28.1% (95% CI 20.1–27.8), p = 0.028). In addition, more district paramedics indicated a need for additional stroke training (83.1% (95% CI 71.5–90.5) vs 69.8% (60.0–78.1), p = 0.043). However, respondents reported being the most confident while dealing with stroke (71.3%, 95% CI 63.8–77.7) compared to other time-critical conditions (p < 0.001). Vertigo (60.8%, 95% CI 53.0–68.0), brain tumours (56.3%, 95% CI 48.5–63.8), and seizures (54.4%, 95% CI 46.7–62.0) were indicated as the most common stroke mimics. Only 6.2% (95% CI 3.4–11.1) of respondents received formal feedback on the outcome of suspected stroke patients brought to the emergency department. Conclusion: A high proportion of paramedics self-perceive having inadequate stroke knowledge and an urgent need for further stroke training. The EMS staff indicate receiving an insufficient amount of feedback on suspected stroke patients, even though the usefulness is perceived to be paramount.

The success of total hip arthroplasty depends on the experience of the surgeon, and one of the ways the surgeon currently determines the final implant insertion depth is to listen to the change in audible pitch of the hammering sound. We investigated the use of acoustic vibration emissions as a novel method for insertion quality assessment. A non-invasive contact microphone-based measurement system for insertion depth estimation, fixation and fracture detection was developed using a simplified in vitro bone/implant (n=5). 2583 audio recordings were analysed in vitro to obtain energy spectral density functions. Out of the four main resonant peaks under in vitro conditions, broach insertion depth statistically correlates to increasing 3rd and 4th peak frequencies. Degree of fixation was also observed as higher goodness of fit (0.26-0.78 vs. 0.12-0.51 between two broach sizes, the latter undersized). Finally, however, the moment of fracture could not be predicted. A cadaver in situ pilot study suggests comparable resonant frequencies in the same order of magnitudes with the bone model. Further understanding of the signal patterns are needed for an early warning system diagnostic system for imminent fractures, bone damage, improving accuracy and quality of future procedures.

CVDs are a leading cause of death globally. In CVDs, the heart is unable to deliver enough blood to other body regions. Since effective and accurate diagnosis of CVDs is essential for CVD prevention and treatment, machine learning (ML) techniques can be effectively and reliably used to discern patients suffering from a CVD from those who do not suffer from any heart condition. Namely, machine learning algorithms (MLAs) play a key role in the diagnosis of CVDs through predictive models that allow us to identify the main risks factors influencing CVD development. In this study, we analyze the performance of ten MLAs on two datasets for CVD prediction and two for CVD diagnosis. Algorithm performance is analyzed on top-two and top-four dataset attributes/features with respect to five performance metrics –accuracy, precision, recall, f1-score, and roc-auc – using the train-test split technique and k-fold cross-validation. Our study identifies the top two and four attributes from each CVD diagnosis/prediction dataset. As our main findings, the ten MLAs exhibited appropriate diagnosis and predictive performance; hence, they can be successfully implemented for improving current CVD diagnosis efforts and help patients around the world, especially in regions where medical staff is lacking.

Nutraceuticals are combination of nutrients and pharmaceuticals and these are derived from various plants, microbes and animals too. The food products that are considered as nutraceuticals are categorised based on the availability in the market. It is a medical approach to improve health and remedy for illness. Nowadays there is an increase in shift towards use of nutraceuticals as its usage provides preventive therapies to various chronic diseases. Various natural nutraceuticals are based on extracts from Ginger, turmeric, garlic, amla, cinnamon, aloe vera etc. A wide variety of therapeutic values are provided by them such as anti-inflammatory, antibacterial, antifungal properties, allergy relief, antidiabetic and cardiovascular problems. India is in its infancy stage but have many emerging companies that are trying to meet the demand of growing population. Overall ‘Nutraceuticals’ has been known as a new era of well being, in which the food industry has become a main player.

Introduction: Travel-based continuing medical education (CME) has become a popular format for physicians looking to combine education with travel. Emergency Medicine Update Europe is a biennial accredited CME program combining high quality Emergency Medicine education with structured group activities including cycling, hiking and social activities. This unique design incorporates innovative educational practices but as a whole has not yet been evaluated. Methods: This was a participant observation-based, ethnographic-style case study of the Emergency Medicine Update Europe conference in Provence, France in 2015. Participant interviews and embedded observation methods were used to collect data. Data was then analyzed using thematic content analysis techniques. Results: We describe three phenomena from the data that we feel are highly influential in the success of the program and impact on learning. These include “social engagement and a sense of community”; “the value of a stimulating escape” and “the ‘flat’ faculty-learner relationships”. Discussion: These unique features, prioritized by participants, seem to be key to the apparent success of this model over more traditional CME approaches. To our knowledge this is the first empirical research in this area and improves our understanding of how to leverage these more sociologic components for more effective continuing medical education.

Demand for green technologies and energy is in continuous growth in the last years. Compact efficient antennas are crucial for energy harvesting portable systems. Small antennas have low efficiency. The efficiency of communication and energy harvesting systems may be improved by using efficient passive and active antennas. The system dynamic range may be improved by connecting amplifiers to the printed antenna feed line. Design, design considerations, computed and measured results of wearable meta-materials antennas with high efficiency for energy harvesting applications are presented in this paper. All antennas were analyzed by using 3D full-wave software. The antennas electrical parameters on human body are presented. The directivity and gain of the antennas with Split-ring resonators, SRR, is higher by 2.5dB than the antennas without SRR. The resonant frequency of the antennas with SRR is lower by 5% to 10% than the antennas without SRR.

This paper investigates the role of English language proficiency (ELP) as a measure of cultural integration on U.S. immigrant families’ economic integration, as measured by annual earnings, and health care market integration, as captured by annual medical care spending. Bayesian Markov Chain Monte Carlo (MCMC) estimation of a mixed bivariate ordered probit (MBOP) model of annual earnings and medical care spending is conducted using a nationally representative pooled cross-sectional sample data from the U.S. National Health Interview Surveys (NHIS). The results reveal that limited English proficiency is associated with lower marginal earnings propensities (-$44.83, -$50.66, and -$56.97), and higher marginal medical care spending propensities ($8.09, $6.09, and $4.32) for each of the three decreasing levels of ELP. Furthermore, we find a small yet statistically significant positive 7.2% correlation between immigrant families’ annual earnings and medical care spending propensities. Therefore investing to raise immigrants’ families ELP in the U.S. would not only contribute to more effective socio-economic integration, but also strengthen the U.S. workforce and economy for decades to come.

Cheating during examination is now day serious problem spatially in Ethiopia where many students sit in one class to exam. When cheating occurs in medical schools, it has serious consequences for human life, social values, and the economy. Even though, cheating on exams has existed in any department, with unknown reason, prevalence of cheater among 2^nd year laboratory students were high. So that assessing factors and improving cheating behavior of the students are mandatory to create competitive graduated students. To identify factors and to improve cheating behavior action research study design was conducted among 2^nd year medical laboratory student. Criterion sampling technique was used to selects sixteen cheater students among 2^nd year laboratory students. To gather necessary data, we used focus group discussions, individual interview, open-ended questionnaire and observation and collected information by using hand writing notes. During exam different cheating methods used by students like using a system of signals, writing on hands, desks and copy the other students answer. While the compelling reasons for cheating were like hard courses, hard exams, time pressure and fear of failure. To improve cheating behavior of the student’s different action strategies were taken like prepared exam by using code, arrangement sitting style during exam and sit with brainy students during class, reading and discussion. Most students were trying to done exam by themselves but their results are not good as previously. So that, we need more future action plan to avoid cheating behavior of the students. During, the next action plan we will be taken the remaining main action strategies and action evaluation we will be expected 50% of participants will be avoided their cheater behavior and done exam independently without forced by the environment.

For decades, sepsis research has been motivated by the idea of a dangerous overreaction of the immune system in sepsis. But is it true that the response to sepsis is dysregulated? This review surveys the history of sepsis trials and found that evidence for dysregulation does not exist in many of the physiologic mechanisms of sepsis. It is time to consider the alternative hypothesis, that sepsis traits are often functional, and do more harm than good. This review discusses the implications of this perspective for the future of sepsis research

In the last decades bioresorbable and biodegradable polymers have gained a very good reputation both in research and in industry thanks to their unique characteristics. They are, indeed, able to ensure high performances and biocompatibility, at the same time avoiding post-healing surgical interventions for devices removal. In the medical device industrial use of such biopolymers, it is widely known that product formulation and manufacturing need to follow specific procedures in order to ensure both proper mechanical properties and desired degradation profile. Moreover, also the sterilization method is crucial and its impact on physical properties is generally underestimated. In this work we focused our attention on the effect of different terminal sterilization methods on two commercially available poly(L-lactide-co-ε-caprolactone) with equivalent chemical composition (70% PLA and 30% PCL) and relatively similar initial molecular weight, but different chains arrangement and crystallinity. Results obtained show that crystallinity plays a key role, helping in preserving the narrow distribution of chains and, as a consequence, defined physical properties. These statements can be used as guidelines for a better choice of the most adequate biodegradable polymers in the production of resorbable medical devices.

Machine learning (ML) offers potential opportunities to enhance the learning, teaching and assessments within veterinary medical education including but not limited to assisting with admissions processes as well as student progress evaluations. The purpose of this primer is to assist veterinary educators in appraising and potentially adopting these rapid upcoming advances in data science and technology. In the first section, we introduce ML concepts and highlight similarities/differences between ML and classical statistics. In the second section, we provide a step-by-step worked example using simulated veterinary student data to answer a hypothesis driven question. Python syntax with explanations is provided within the text to create a random forest ML prediction model and within each step, specific considerations such as how to manage incomplete student records are highlighted when applying ML algorithms within the veterinary education field. The results from the simulated data demonstrate how decisions by the veterinary educator during ML model creation may impact the most important features contributing to the model. These results highlight the need for the veterinary educator to be fully transparent during the creation of ML models and future research is needed to establish guidelines for handling data not missing at random in medical education, and preferred methods for model evaluation.

The objective of this study is to evaluate how two varying amounts of sepiolite-based powder, infused with indigo extract, affect the appearance and durability of a water-based white primer. To examine the influence of this eco-friendly pigment on the coatings' overall appearance, assessments were performed for color, gloss, and surface roughness. Additionally, the coatings were investigated through optical and electron microscopic observations, to evaluate the distribution of the pigment within the polymer matrix. The effect of the pigment on the coating's durability was assessed through accelerated tests, including exposure in a salt spray chamber and a UV-B chamber. These tests aimed to evaluate the emergence of defects and changes in the appearance of the samples over time. Furthermore, the impact of different quantities of sepiolite-based powder on the coating's ability to act as a barrier was assessed using liquid resistance tests and contact angle measurements. These evaluations aimed to understand how the coating responded to various liquids and its surface properties concerning repellency or absorption. In essence, this study underscores the considerable influence of the eco-friendly pigment, demonstrating its capacity to introduce unique color and texture variations to the paint. Moreover, the inclusion of the pigment has enhanced the coating's color stability, its ability to act as a barrier, and overall durability when exposed to harsh environments.

This research explores the enhancement of bio-oil quality through upgrading with the magnetic bimetallic oxide (CuO-Fe3O4) catalysts supported on the activated rice straw biochar (AcB). These catalysts were employed in a supercritical ethanol-based upgrading process. Various characterization techniques, including elemental analysis, XRD, BET, TGA, and SEM, were utilized to characterize the prepared catalyst. The study revealed significant improvements in the physical characteristics and chemical composition of the bio-oil, with higher heating value (HHV) increasing from 21.3 to 32.1 MJ/kg. Esterification and transesterification were identified as key reactions contributing to this improvement. Notably, the pH of bio-oil increased from 4.3 (raw bio-oil) to 5.63 (after upgrading), signifying reduced acidity. The analysis of the bio-oil's chemical composition highlighted a decrease in oxygen content and an increase in carbon and hydrogen content. At the optimum conditions, the application of supercritical ethanol proved to be an efficient method for enhancing the bio-oil's properties. A crucial transformation occurred during the upgrading process and more than 90% % of carboxylic acids were converted into esters, primarily ethyl acetate at the optimal conditions. This study has demonstrated the effective enhancement of raw bio-oil from rice straw through the utilization of carbon-based bimetallic oxide catalysts in a supercritical upgrading procedure.

Metachrony is defined as coordinated asynchronous movement throughout multiple appendages, such as the cilia of cells and swimmerets of crustaceans. We investigate the process of metachronal propulsion, notably used by species of crustaceans and microscopic cells to move through fluid. A rigid crustacean model with paddles moving in symmetric strokes was created to simulate metachronal movement. Coupled with the surrounding fluid domain, we employ the immersed boundary method to analyze fluid-structure interactions. To explore the effect of nonlinear morphology on the efficiency of metachronal propulsion, we generate and simulate a range of crustacean body shapes, from upward curves to downwards curves. We found that the highest propulsion velocity is achieved when the crustacean model morphology follows a downwards curve, specifically a parabola of leading coefficient k=−0.4. This curved morphology results in 4.5% higher velocity compared to the linear model. As k deviates from −0.4, the propulsion velocity decreases with increasing magnitude, forming a concave downward trend. The impact of body shape on propulsion velocity is shown by how the optimal velocity with k=−0.4 is 71.5% larger than the velocity at k=1. Overall, this study suggests that morphology has a significant impact on metachronal propulsion.

Chitin/chitosan and collagen are two of the most important bioactive compounds with applications in the pharmaceutical, veterinary, nutraceutical, cosmetic, biomaterials, and other industries. When extracted from fish and shellfish non-edible parts, by-catches, and invasive species, their use contributes to a more sustainable and circular economy. The present article reviews the scientific knowledge and publication trends along the marine chitin/chitosan and collagen value-chains and assesses how researchers, industry players, and end-users can bridge the gap between scientific understanding and industrial applications. Overall, research on chitin/chitosan remains focused on the compound itself rather than its market applications. Still, chitin/chitosan use is expected to increase in food and biomedical applications, while that of collagen is expected to increase in biomedical, cosmetic, pharmaceutical, and nutritional applications. Sustainable practices, such as the reuse of waste materials, contribute to strengthen both value-chains; the identified weaknesses include the lack of studies considering market trends, social sustainability, and profitability, as well as insufficient examination of intellectual property rights. Government regulations, market demand, consumer preferences, technological advancements, environmental challenges, and legal frameworks play significant roles in shaping both value-chains. Addressing these factors is crucial for seizing opportunities, fostering sustainability, complying with regulations, and maintaining competitiveness in these constantly evolving value-chains.

This work demonstrates that microbial fuel cells (MFCs), optimized for energy recovery, can be used as an effective tool to detect the presence of antibiotics in water-based environments. MFCs directly convert chemical energy of organic matter in electrical energy thanks to electroactive biofilms. The efficiency of the conversion process can be significantly affected by the presence of contaminants acting as toxicants for the biofilm. In the present work, we demonstrate that MFCs can successfully detect the presence of antibiotic residues in water and water-based electrolytes associated to the food industry, especially using honey as a new and more complex electron donor. The effectiveness of MFCs to sense antibiotics is here demonstrated for tetracycline that was added to both water and water/honey electrolytes with a minimum concentration close to 3.5 μg⁄kg. MFCs not only efficiently detect the presence of tetracycline in both the electrolytes, but also recover the same performance after each cycle of exposure, showing to a be very robust and reliable technology for both biosensing and energy recovery.

With the development of bioinspired green solutions for sustainable construction over the past two decades, bio-cementation, which exploits the naturally occurring phenomenon of calcium carbonate precipitation in different environments, has drawn a lot of attention in both building construction and soil stabilization. Various types of microorganisms, along with specific enzymes derived from these microorganisms, have been utilized to harness the benefits of bio-cementation. Different application methods for incorporating this mechanism into the production process of the construction material, as well as a variety of experimental techniques for characterizing the outcomes of bio-cementation, have been developed and tested. Despite the success of bio-cementation as a sustainable method to construction has been demonstrated in a significant body of literature at the laboratory scale, the expansion of this strategy to construction sites and field application remains a pending subject. The issue may be attributed to two primary challenges. Firstly, the complexity of the bio-cementation phenomenon is influenced by a variety of factors. Secondly, the extensive body of literature examines various types of microorganisms under different conditions, leading to a wide range of outcomes. Hence, this study aims to examine the recent advancements in utilizing the most commonly employed microorganism, Sporosarcina Pasteurii, to emphasize the significance of influential factors identified in the literature, discuss the findings that have been brought to light, and outline future research directions toward scaling up the process.

While biologic originators’ patents are expiring, biosimilars are emerging to take their place, offering significant cost savings to healthcare systems. Many challenges still need to be addressed in the clinical practice of inflammatory bowel disease (IBD). A global survey was organized to highlight physicians’ current knowledge and beliefs and to gain insight about their practical management and remaining concerns and obstacles associated with starting a biosimilar, switching from an originator to a biosimilar, or switching from one biosimilar to another (multiple switches and reverse switching). Fifteen physicians with expertise in the field of IBD from 13 countries attended a virtual international consensus meeting to develop practical guidance regarding biosimilar adoption worldwide, considering the survey results. Consensus was reached on 10 statements regarding biosimilar effectiveness, safety, indications and rationale, multiple switches, therapeutic drug monitoring of biosimilars, non-medical switching and future perspectives.

This study investigates the influence of the porous structure, on the density and the mechanical behaviour of new foam concretes incorporating hemp shives. A total of eight batches of foam concretes were manufactured and tested, made with a protein-based foam agent, containing cement, ground granulated blast furnace slag and Metakaolin as binder and hemp shives as natural aggregate. The effect of several parameters is studied, elaboration method (direct and preformed), amount of pozzolanic additions (0% and 30%) and incorporation of hemp shives (5 and 15 vol%) on the resulting physical properties, microstructure, porous structure and mechanical behaviour of the concretes. Hemp shives incorporation results in increased concrete porosity and air bubble radius, decreased uniformity and mechanical strength, and lower cohesion with the cement matrix compared to standard concretes.

Polymeric wet-strength agents are important additives used in the paper industry to improve the mechanical properties of paper products, especially when they come in contact with water. These agents play a crucial role in enhancing the durability, strength, and dimensional stability of paper products. The aim of this review is to provide an overview of the different types of wet-strength agents available and their mechanisms of action. We will also discuss the challenges associated with the use of wet-strength agents and the recent advances in the development of more sustainable and environmentally friendly agents. As the demand for more sustainable and durable paper products continues to grow, the use of wet strength agents is expected to increase in the coming years.

Bionic robotic hand can perform many movements similar to human hand. But there is still a significant gap in manipulation between robot and human hand. It is necessary to understand the finger kinematics and motion patterns of human hand to improve the performance of robotic hand. This study aimed to comprehensively investigate normal hand motion patterns by evaluating the kinematics of hand grip and release in healthy individuals. The data corresponding to rapid grip and release were collected from the dominant hand of 22 healthy people by sensory glove. The kinematics of 14 finger joints were analyzed, including the dynamic range of motion (ROM), peak velocity, joint sequence and finger sequence. The results show that the proximal interphalangeal (PIP) joint had a largest dynamic ROM than metacarpophalangeal (MCP) and distal interphalangeal (DIP) joints. Besides, the PIP joint had the highest peak velocity, both in flexion and extension. For joint sequence, the PIP joint moved prior to the DIP or MCP joints during flexion, while extension started in DIP or MCP joints, followed by PIP joint. Regarding the finger sequence, the thumb started to move before four fingers, and stopped moving after the fingers during both grip and release. This study explored the normal motion patterns in hand grip and release, which provided kinematic reference for the design of robotic hand and thus contribute to its development.

From the merge of arts and crafts towards a practice for mass production of desirability, consumption and product development in a capitalist economy of scale, design has lost its natural ability of problem comprehension and tension alleviation. The modern world needs the creativity, flexibility, and responsiveness embedded into design practices, mostly when a behavioural change, either individual or organizational, is intended. Still, the informality nature of the field is creating a gap between the study, research, and industrial design practice. Here it is presented the Biology of Creativity Model (BoC) which is a design-by-analogy method that promotes an empowered design practice through analysis of mostly biology reference texts for enhanced creativity and innovation performance in a diverse array of contexts.

Rice is considered as the most important crop for most of the world population. Utilization of seaweed as bio-stimulant can be an alternative way to enhance rice plant growth and productivity, as well as a strategic move to reduce the use of inorganic fertilizer that is harmful to the environment. Seaweed and its derivative products have been widely used as bio-stimulant in the agricultural industry because of their potential use in increasing plant growth and productivity. Auxins, gibberellins, and cytokinin are some of growth regulators found in seaweed extract, as well as macro and micronutrients required for plant growth and development. Several studies have found that seaweed extract has a variety of favorable effects as a plant growth promoter, including early seed germination and establishment, improved nutritional quality, increased yield and crop performance, and increased tolerance to environmental stress. The purpose of this paper is to give a comprehensive overview of the impacts of several seaweed species on seed germination, crop development and production, enhancement of rice plants (Oryza sativa) nutritional quality and the modes of action of seaweed extract includes the chemical components that might be causing plant physiological changes.

Literature revealed the potential of using guayule resin for asphalt cement replacement from the binder’s perspective. However, monitoring guayule resin through binder-aggregate mixture could disclose its performance through field. In this study, designated binders were employed to investigate the applicability of such an innovative replacer through mixture, which were neat asphalt and guayule-based binders (neat guayule, asphalt-rubber-guayule, guayule-rubber binders). Consecutively, field-simulated lab mixtures were prepared to investigate the major distresses. Moisture damage, rutting, fatigue cracking, and thermal cracking resistances were investigated using the modified Lottman (TSR) test, rut test by asphalt pavement analyzer (APA), semi-circular bending (SCB) test, and disk-shaped compact tension (DCT) test, respectively. Additionally, the Hamburg wheel-tracking (HWT) test was employed to evaluate moisture susceptibility and rutting resistance. Outcomes revealed that the neat guayule was susceptible to moisture damage at a 7% air content (V_a) when the TSR test was employed. In contrast, all investigated mixtures yielded perfect performances against moisture susceptibility under the HWT test. Guayule-based mixtures perfectly resisted rutting, as analyzed by the rut test and HWT test. Generally, changing parameters (e.g., V_a, rubber addition, and partial asphalt replacement by guayule and rubber) enhanced the guayule-based mixture resistance to rutting and moisture damage resulting in acceptable performances. Guayule-based mixture had a high fracture toughness at low temperatures, hence fatigue fracture resistance at intermediate temperatures. Neat guayule mixture with or without rubber addition did not entirely resist thermal fracture. However, partial asphalt replacement by guayule and rubber resisted the thermal fracture to a great extent.

Bacteria a Microscopic organisms are the most inexhaustible and flexible of microorganisms and constitute a huge division of the whole living earthly biomass, certain microorganisms were found to amass metallic components at a high limit Was Known as Bacterial Bio-sorption Due to their little size, capacity to become under controlled conditions, and their Accommodation to an extensive variety of ecological situations; Potent metal bio-sorbents among microorganisms, at low pH esteems, cell divider ligands are protonated and contend essentially with metals for official. With expanding pH, more ligands, such as amino and carboxyl groups, could be exposed, leading to attraction between these negative charges and the metals, and consequently increment bio-sorption onto the cell surface. Starting with Isolation and identification of heavy metal-resistant bacteria from rock Ore. Studying Factors Affecting Uranium Bio-sorption, Optimization of bacterial growth conditions and optimum for metal uptake by free and immobilized bacterial cells and Desorption ratio of uranium ions adsorbed by Coli. /alginate, All this evidence suggest that functions groups Represented in our study are responsible for metal uptake in our bacterial biomass beside change in peaks position which assigned for it's groups confirm bio-sorption of metal ions from waste due to ions charge interaction comparing with immobilized we found increase in no of binding sites indicate that immobilized bacterial have high efficiency for metal up take which also change in peaks position which assigned for its groups confirm bio-sorption of metal ions from waste due to ions charge interaction, Where the high bio-sorption yield obtained by bacteria, the Uranium & heavy metal bioremediation process expects microorganisms to be joined to a strong surface.

Artificial reefs have been deployed in multiple regions of the world for different purposes including habitat restoration and protection, biodiversity and fish stock enhancement, fisheries management and recreation. Artificial reefs can be a valuable tool for ecosystem protection and rehabilitation, helping mitigate the effects of anthropogenic impacts that we face today. However, knowledge on artificial reefs is unevenly distributed worldwide, with some regions having much more quality information available and published (e.g. European Mediterranean Sea area), while others, for instance the North-East Atlantic area, do not. Here, we provide a characterization of purposely built artificial reefs in North-East Atlantic area based on all available literature (i.e. research papers and reports), highlighting the needs and gaps that are vital for establishing future perspectives for artificial reef deployment and research. In the North-East Atlantic area, sixty-one purposely built artificial reefs have been deployed since 1970, mostly between the years 1990-2009, with Spain being the country with the highest number of artificial reefs. The most reported purpose for their deployment is fisheries productivity and habitat/species protection, although, most artificial reefs are multipurpose in order to maximise the benefits of a given financial investment. The majority of artificial reefs were submerged at < 50 m, mainly between 10-20 m of depth. The most used designs were cubic blocks and complex designs made by an array of combined shapes, which mostly consist of concrete (79%). From all the analysed data on artificial reefs, 67% of the cases reported surveys to assess biodiversity after the deployment. However, in 26% of those cases, data was not available. When data was available, only 31% of cases reported long-term biomonitoring surveys (3 years or more). Based upon these findings, we noticed a general lack of scientifically robust data, including records of species and abundance of both fish and invertebrates, as well as macroalgae. Preventing an adequate determination of the best balance between shape, construction material and bio-colonization. Critiques and suggestions are discussed in the light of current available data in order to perform more efficient research, evaluation and functioning of future artificial reefs.

Ca-bentonite (CB) alone and in a mixture with limestone (L), tobacco biochar (TB) and zeolite (Z) on the fixation, geochemical fractions and absorption of Cd and Zn by Chinese cabbage in smelter heavily polluted (S-HP) and smelter low polluted (S-LP) soils were investigated. The results showed that the CB+TB and CB+L+TB treatments significantly immobilized Cd up to 22.03% and 29.68%, respectively, and reduced uptake by Chinese cabbage shoot to 35.98% with CB+Z+L and 61.35% with CB+L in S-HP and S-LP soils compared with the control. The CB+ Z+ L+TB treatment mobilized Cd up to 4.45% and increased absorption in the shoot by 9.85% in S-HP soil. The greatest immobilization of Zn was 53.18% and 58.20% with the CB+Z+L+TB treatment, which reduced Zn uptake in the plant shoot by 9.94% with CB + L and 58.04 with CB+Z+L+TB in S-HP and S-LP soils. The CB+Z+TB and CB+TB treatments mobilized Zn up to 35.40% and 4.80%, respectively, in both soils. Furthermore, the uptake of Zn in plant shoot was observed by 58.96% and 7.82% with application of CB+Z and CB+TB treatments, respectively, in S-HP and S-LP soils. Overall, our results suggest that Ca-bentonite alone and in mixtures with different amendments can be used to reduce the phyto-extraction of Cd and Zn in Zn-smelter polluted soils.

Egyptian mongoose (Herpestes ichneumon) is a medium-size carnivore that in Europe is restricted to Iberia. The bio-ecology of this species remains to be elucidated in several dimensions, including gut microbiota that is nowadays recognized as a fundamental component of mammals. In this work, we investigated the gut microbiota of this herpestid by single-molecule real-time sequencing of twenty paired male (n=10) and female (n=10) intestinal samples. This culture-independent approach enabled microbial profiling based on 16S rDNA and investigation of taxonomical and functional features. The core gut microbiome of the adult subpopulation was dominated by Firmicutes, Fusobacteria, Actinobacteria, and Proteobacteria. Eight genera were uniquely found in adults and five in non-adults. When comparing gut bacterial communities across sex, four genera were exclusive of females and six uniquely found in males. Despite these compositional distinctions, alpha- and beta-diversity analyses showed no statistically significant differences across sex or between adult and non-adult specimens. However, males presented a significantly higher abundance of amino acid and citrate cycle metabolic pathways, compared to the significant overrepresentation in females of galactose’ metabolic pathways. Adults showed a significantly higher abundance of cationic antimicrobial peptide resistance pathways, while non-adults bared a significant overrepresentation of two-component systems associated with antibiotic synthesis, flagellin production and chemotaxis control. This study adds new insights into mongoose bio-ecology palette, highlighting taxonomical and functional microbiome dissimilarities across sex and age classes, possibly related to primary production resources and life-history traits that impact on behavior, diet and gut ecosystem.

Developments in technology have enabled envisioning the derivation of materials and products from renewable biomass, as an alternative to finite fossil-based resource consumption. Therefore, bioeconomy is regarded as an opportunity for sustainable economic growth. Countries are formulating strategies in accordance with their goals to attain from bioeconomy. Proper measurement, monitoring and reporting of the outcomes of these strategies is crucial for long-term success. This study aims to critically evaluate the national methods used for the measurement, monitoring and reporting of bioeconomy contribution to the total economy. For this purpose, research and surveys have been conducted on selected countries (Argentina, Germany, Malaysia, the Netherlands, South Africa and the United States). The results reveal that the bioeconomy targets set up in the strategies often reflect country’s priorities and comparative advantages. However, comprehensive approaches to measure and monitor bioeconomy progress are frequently lacking. Most countries only measure the contribution to gross domestic product (GDP), turnover and employment of the sectors included in their bioeconomy definition, which may provide an incomplete picture. In addition, this study identifies the mismatch between the targets and measurement methods, as the environmental and social impacts of bioeconomy are often foreseen, but not measured. It is concluded that existing global efforts towards a sustainable bioeconomy monitoring can be strengthened and leveraged to measure progress towards sustainable goals.

This work deals with the numerical investigation of the delivery of potential therapeutic agents through dentinal discs (i.e. a cylindrical segment of the dentinal tissue) towards the dentin-pulp junction. The aim is to assess the main key features (i.e. molecular size, initial concentration, consumption rate, disc porosity and thickness) that affect the delivery of therapeutic substances to the dental pulp and consequently to define the necessary quantitative and qualitative issues related to a specific agent before its potential application in clinical practice. The CFD code used for the computational study is validated with relevant experimental data obtained using micro Laser Induced Fluorescence (μ-LIF) a non-intrusive optical measuring technique. As the phenomenon is diffusion dominated and strongly dependent on the molecular size, the time needed for the concentration of released molecules to attain a required value can be controlled by their initial concentration. Finally, a model is proposed which, given the maximum acceptable time for the drug concentration to attain a required value at the pulpal side of the tissue along with the aforementioned key design parameters, is able to estimate the initial concentration to be imposed and vice versa.

The objective of this study was to identify the key elements used by prehospital emergency physicians (EP) to decide whether or not to attempt advanced life support (ALS) in asystolic out-of-hospital cardiac arrest (OHCA). From 01.01.2009 to 01.01.2017, all adult victims of asystolic OHCA in Geneva, Switzerland, were retrospectively included. Patients with signs of "obvious death" or with a Do-Not-Attempt-Resuscitation order were excluded. Patients were categorized as having received ALS if this was mentioned in the medical record, or, failing that, if at least one dose of adrenaline had been administered during cardio-pulmonary resuscitation (CPR). Prognostic factors known at the time of EP's decision were included in a multivariable logistic regression model. 784 patients were included. Factors favourably influencing the decision to provide ALS were witnessed OHCA (OR=2.14, 95%CI1.43–3.20) and bystander CPR (OR=4.10, 95%CI2.28–7.39). Traumatic aetiology (OR=0.04, 95%CI0.02–0.08), age >80 years (OR=0.14, 95%CI0.09–0.24) and a Charlson comorbidity index greater than 5 (OR=0.12, 95%CI0.06–0.27) were the factors most strongly associated with the decision not to attempt ALS. Factors influencing the EP’s decision to attempt ALS in asystolic OHCA are the relatively young age of the patients, few comorbidities, presumed medical aetiology, witnessed OHCA and bystander CPR.

COVID-19 is a severe global problem, and AI can play a significant role in preventing losses by monitoring and detecting infected persons in early-stage. This paper aims to propose a high-speed and accurate fully-automated method to detect COVID-19 from the patient's CT scan images. We introduce a new dataset that contains 48260 CT scan images from 282 normal persons and 15589 images from 95 patients with COVID-19 infections. At the first stage, this system runs our proposed image processing algorithm to discard those CT images that inside the lung is not properly visible in them. This action helps to reduce the processing time and false detections. At the next stage, we introduce a novel method for increasing the classification accuracy of convolutional networks. We implemented our method using the ResNet50V2 network and a modified feature pyramid network alongside our designed architecture for classifying the selected CT images into COVID-19 or normal with higher accuracy than other models. After running these two phases, the system determines the condition of the patient using a selected threshold. We are the first to evaluate our system in two different ways. In the single image classification stage, our model achieved 98.49% accuracy on more than 7996 test images. At the patient identification phase, the system correctly identified almost 234 of 245 patients with high speed. We also investigate the classified images with the Grad-CAM algorithm to indicate the area of infections in images and evaluate our model classification correctness.

Previous research showed that intersex people face specific challenges in their sexual development, including uncertainties or confusion about their gender, a negative genital self-image, and hesitance to engage in romantic and sexual relationships. However, in-depth knowledge of a central period of this development, adolescence, is missing. In our qualitative study, we explore which factors influence the relational and sexual development of intersex youth and what elements contribute to a positive development. We interviewed eighteen intersex persons aged 18-38. We identified three main themes: (1) intersex experiences, (2) the described sexual and relational life course, and (3) factors influencing a positive development. Our findings show that intersex youth face many obstacles to their relational and sexual development, many of which related to healthcare. However, their life stories also illuminate how healthcare professionals but also parents, friends, partners, teachers and others can make a substantial difference in intersex lives by breaking normative, binary thinking on sex and gender.

Early treatment is the mainstay of sepsis therapy. We suspected that early recognition of sepsis by prehospital healthcare providers may shorten time to antibiotic administration in the Emergency Department. We retrospectively evaluated all patients above 18 years of age that were diagnosed with sepsis or severe infection in our Emergency Department between 2018 and 2020. We recorded the suspected diagnosis at time of presentation, type of referring healthcare provider and time until initiation of antibiotic treatment. Differences between groups were calculated using Kruskal-Wallis rank sum test. Of the 277 patients that were diagnosed with severe infection or sepsis in the emergency department, an infection was suspected in 124 (44.8%) patients and sepsis was suspected in 31 (11.2%) patients by referring healthcare providers. Time to initiation of antibiotic treatment was shorter in patients where sepsis or infection had been suspected prior to arrival for both patients with severe infections (p = 0.022) and sepsis (p = 0.004). Given the well described outcome benefits to early sepsis therapy, recognition of sepsis needs to be improved. Appropriate scores should be used as part of routine patient assessment to reduce time to antibiotic administration and improve patient outcomes.

University students, particularly those in the healthcare disciplines, constitute a category of particular interest in regard to COVID-19 vaccines and the attitudes to vaccination, as their future professional role will enable them to inform and educate citizens regarding vaccination. The objectives of the study were to investigate the vaccination coverage with a COVID-19 vaccine among students from different degree programs at the Medical universities in Bulgaria behaviors and attitudes toward vaccination with a COVID-19 vaccine. A prospective cross-sectional study in the period September 2021- March 2022 was conducted. Information on demographics, university program, year of study, general attitudes and behavior towards vaccines and attitudes and personal experience with COVID-19 and COVID-19 vaccines were collected. The chi-square test was used to test for associations and binominal logistic regression was used to identify possible predictors for vaccination. A total of 3050 students with a median age of 22 years, predominantly female took part in the study. Three-thirds of the students (73.5%) have been vaccinated against COVID-19. The main reasons for vaccine hesitancy in both group of students were the fear of side effects and the doubts about the safety of the vaccines although non-vaccinated students significantly more frequently express those fears. Respondents who considered to have: a) limited access to sufficient information to inform COVID-19 vaccine uptake; b) lack of public awareness and education campaigns about effectiveness and safety of COVID-19 vaccines; c) insufficient information about COVID-19 vaccines during the University education; and d) had a positive COVID-19 diagnosis were less likely to be vaccinated. Students who have not completed the mandatory immunization cycle according to country schedule were also less likely to have completed COVID-19 vaccination. The students showed an overall positive attitude towards the COVID-19 vaccines. Promoting informational campaigns that emphasize the vaccine's safety will be more effective to further increase the vaccination coverage with COVID-19 vaccines.

The Internet of Things (IoT) technology and devices constitute an exciting field in computer science that is rapidly emerging worldwide. IoT devices function by connecting real-world objects to the internet, resulting in a higher number of interconnected devices than ever witnessed in history. Through internet connectivity, these devices can be utilized in various ways, such as monitoring and tracking. Their prevalence is increasing exponentially, coinciding with advancements in wireless networking technologies. The internet’s enhanced connectivity has played a vital role in fostering the proliferation of IoT devices. Presently, almost any everyday object can be network-connected. The demand for automation and efficiency has also been a contributing factor to the advancements in this technology. This paper aims to review the emergence of IoT devices, analyze their common applications, and explore the future prospects in this promising field of computer science. The examined applications encompass healthcare, agriculture, and smart cities. Although IoT technology exhibits similar deployment trends, this paper will explore different fields to discern the subtle nuances that exist among them. IoT technology can be applied to nearly any domain, and each use case has unique requirements. To comprehend the future of IoT, it is essential to comprehend the driving forces behind its advancements in various industries. By gaining a better understanding of the emergence of IoT devices, readers will develop insights into the factors that have propelled their growth and the conditions that led to technological advancements. Moreover, a comprehensive understanding of the prevalent methodologies will enable readers to distinguish between current practices and future methods. Given the rapid rate at which IoT technology is advancing, this paper aims to provide researchers with an understanding of the factors that have brought us to this point and the ongoing efforts to shape the future of IoT.

The presence of burnout, anxiety and depression among health professionals is a crucial issue that must be carefully addressed. The aim of the present study is to investigate levels of burnout, anxiety and depression among health professionals (medical and nursing staff) during the pandemic crisis, the association of burnout with anxiety and depression as well as the impact of occupational and demographic factors. One hundred twenty-five health professionals (medical and nursing staff) participated who were working in a public hospital in the broader area of Athens (sample of convenience). Specifically, 41 males and 84 females with the majority of them being in the category of 36-45 years of age. For the data collection, the Maslach Burnout Inventory (MBI) and the HADS questionnaire were used. The results showed that there was a statistically significant and negative correlation of emotional exhaustion to HADS total (r= -0,377, p=0,000) as well as HADS anxiety (r= -0,417, p=0,000). Also, there was a statistically significant and negative correlation of depersonalization to HADS total (r= -0,370, p=0,000) as well as HADS anxiety (r= -0,431, p=0,000). Moreover, there was a statistically significant effect (p<0,05) of occupational and demographic characteristics.

Currently, the number of lightning casualties and casualty rates have significantly reduced in developed countries, but there has been no significant reduction in developing countries. On the one hand, this is due to the high frequency of lightning; on the other hand, the vulnerability of people in developing countries is also an influencing factor. Through case analysis and summary, this paper expounds on lightning injury’s mechanism and clinical manifestations. It points out that lightning injury is mainly related to heart problems and the impact on the nervous system, rather than burns, which usually cause fewer consequences. Medical treatment needs to pay attention to the order and principles of treatment. Implementing CPR and auxiliary AED is the most effective way to save lives. Attention should be paid to the practical and effective treatment and nursing of lightning stroke sequelae. Finally, combined with the situation of lightning casualties in china, the existing problems are put forward during the process of early treatment, post-hospital treatment, and nursing observation, which provides an objective basis for the cognition of the scientific nature of the lightning injury.

Background: Articles published in scholarly journals form part of the scientific evidence base. It is the responsibility of the scientific community to maintain its integrity. In 2011 the BMJ commissioned a feature article to draw attention to an article that had appeared in another journal- The Lancet 13 years previously. The Lancet had already retracted the article. These actions exemplify the best traditions of scientific record-keeping. Objective: This submission examines whether the main claims summary made in the BMJ were factual. Method: We examine what was published in the Lancet against what was published in the BMJ and verify against the findings in the GMC hearings transcripts and verdict of the UK High Court. Results: The 6 points highlighted in BMJ had errors and need to be corrected. Conclusions: There are significant differences between what was reported in the Lancet paper and what was alleged to be there by the BMJ. This article aims only to point to errors in the BMJ article, to set the record straight. It does not show there was a causal association between MMR vaccination and autism.

Laser therapy devices (LTDs) operating with near-infrared laser light are increasingly being used in sports medicine. For several reasons the users cannot evaluate whether or not such devices emit laser beams according to the specifications provided by the manufacturer and the settings of the device. In this study the laser beams from two different LTDs that can be used in sports medicine were thoroughly characterized by measuring the emitted power, pulse shapes and lengths, and spatial intensity distributions using professional, high-fidelity laser measurement technology. This was repeated for three units of each LDT independently to distinguish problems of individual units from potential intrinsic instrument design errors. The laser beams from the units of one LTD agreed with the settings at the device, with the measured average power for these units being within 3.3% of the set power. In contrast, the laser beams from the units of the other LTD showed large deviations between the settings and the actual emitted light. This device came with three laser diodes that could be used independently and simultaneously. The average power differed greatly between the units as well as between the laser diodes within each unit. Some laser diodes emitted essentially no light, which could lead to a lack of treatment of patients. Other laser diodes emitted much more power than set at the device (up to 230%) that could result in skin irritations or burnings of patients. These findings indicate a need for better standardization and consistency of therapeutic laser light sources.

To evaluate the impact of a new Substance Use Disorder (SUD) education program on medical students' representations, we selected the Substance Abuse Attitude Survey (SAAS) questionnaire, which we adapted to our curriculum and cultural context. To validate this adapted version, we conducted an exploratory factor analysis following the administration of our 29-items bSAAS questionnaire to 657 medical students in Belgium (response rate: 71,1%). 23 items correlated to 3 factors namely "Stereotypes and moralism", "Treatment optimism" and "Specialised treatment" were retained (70% of total variance explained, Cronbach's alpha= 0.80) and constituted the new questionnaire called beSAAS. The factor "Specialised treatment", stood out from previous studies which could be explained by our target population and the impact of the formal, informal, and hidden curriculum in medical education. This study highlighted certain factors influencing stereotypical representations such as age, gender, origin, and personal or professional experience with substance use. Our study allowed us to retain the beSAAS as a good questionnaire to evaluate SUD stigma and highlighted interesting findings to improve SUD training in medicine. Further studies are needed to complete its validity and reliability.

Breast cancer (BC) is a heterogeneous disease representing a substantial economic burden. In order to develop policies that successfully decrease this burden, the factors affecting costs need to be fully understood. Evidence suggests that early detection in Stage I has a lower cost than late detection. We aim to provide conservative estimates of BC's stage-wise medical costs from German healthcare and the payer's perspective. To this end, we conducted a literature review of articles evaluating stage-wise costs of BC in Germany through PubMed, Web of Science, and Econ Lit databases supplemented by Google Scholar. We developed a decision tree model to estimate BC related medical costs in Germany using available treatment and cost information. The review generated seven studies; none estimated the stage-wise costs of BC. The studies were classified into two groups: (1) case scenarios (five studies) and two studies based on administrative data. The first sickness funds data study (Gruber, Stock, et al. 2012) used 1999 information to approach BC attributable cost; their results suggest a range between €3,929 and €11,787 depending on age. The second study (Kreis, Plöthner, et al. 2020) used 2011-2014 data and suggested an initial phase incremental cost of €21,499, an intermediate phase cost of €2,620, and a terminal phase cost of €34,513 per incident case. Our decision tree model based BC stage-wise cost estimates were €21,523 for Stage I, €25,679 for Stage II, €30,156 for Stage III, €42,086 for Stage IV. Alternatively, the modeled cost estimates are €20,284 for the initial phase of care, €851 for the intermediate phase of care, and €34,963 for the terminal phase of care. Our estimates for phases of care are consistent with recent German estimates provided by Kreis and Plöthner et al. Furthermore, the data collected by sickness funds are collected primarily for reimbursement purposes, where the German ICD-10 classification system defines a cancer diagnosis. As a result, claims data lack the clinical information necessary to understand stage-wise BC costs. Our model-based estimates fill the gap and inform future economic evaluations of BC interventions.