Introduction The prevalence of adolescent electronic cigarette (e-cigarette) use has increased in most countries. This study determines the relation between the frequency of e-cigarette use and the frequency and intensity of cigarette smoking. Furthermore, it evaluates the association between the reasons for e-cigarette use and the frequency of its use. Materials and Methods Participants were 68,043 middle and high school students aged 13–18 years from the 2015 Korean Youth Risk Behavior Web-Based Survey. Of the 68,043 participants, we analyzed 6,655 adolescents with an experience of e-cigarette use. Results The prevalence of ever using and current (past 30 days) use of e-cigarettes was 10.1% and 3.9%, respectively. Of the ever e-cigarette users, approximately 40% used e-cigarettes for ≥1/month and 8.1% used e-cigarettes daily. Daily e-cigarettes users were 10 times greater among daily cigarette smokers than among cigarette users for <1/month (18.1% vs. 1.8%) and 16 times more prevalent among those smoking ≥20 cigarettes/day than among those smoking <1 cigarette/month (38.9% vs. 2.4%). The most common reason for e-cigarette use was curiosity (22.9%), followed by less harmful than conventional cigarettes (18.9%), smoking cessation (13.1%), and indoor use (10.7%). Curiosity was the most common reason among less frequent e-cigarette users; however, smoking cessation and indoor use were the most common reasons among more frequent users. Conclusions Results showed a positive relation between frequency or intensity of conventional cigarette smoking and frequency of e-cigarette use among Korean adolescents, and frequency of e-cigarette use differed according to the reason for the use of e-cigarettes.

The popularity of electronic cigarettes in the United States and around the world has led to a startling rise in youth nicotine use. The Juul e-cigarette was introduced in the U.S. market in 2015 and had captured approximately 13% of the U.S. market by 2017. Unlike many other contemporary electronic cigarette companies, the founders behind the Juul® e-cigarette approached their product launch like a traditional high-tech start-up company, not like a tobacco company. This article presents a case study of Juul’s corporate and product development history in the context of US regulatory actions. The objective of this article is to demonstrate the value of government-curated archives as leading indicators which can (a) provide insight into emergent technologies and (b) inform emergent regulatory science research questions. A variety of sources were used to gather data about the Juul e-cigarette and the corporations that surround it. Sources included government agencies, published academic literature, non-profit organizations, corporate and retail websites, and the popular press. Data was disambiguated, authenticated, and categorized prior to being placed on a timeline of events. A timeline of four significant milestones, nineteen corporate filings and events, twelve US regulatory actions, sixty four patent applications, eighty seven trademark applications, twenty three design patents and thirty two utility patents related to Juul Labs and its associates is presented spanning the years 2004 thought 2020. This work demonstrates the probative value of findings from patent, trademark, and SEC filing literature in establishing a premise for emergent regulatory science research questions which may not yet be supported by traditional archival research literature. The methods presented here can be used to identify key aspects of emerging technologies before products actually enter the market, this shifting policy formulation and problem identification from a paradigm of being reactive in favor of becoming proactive. Such a proactive approach may permit anticipatory regulatory science research and ultimately shorten the elapsed time between market technology innovation and regulatory response.

Escherichia coli or E. coli is a member of the fecal coliform group and is a more specific indicator of fecal contamination than other fecal coliform species, its presence indicate possibly presence of harmful bacteria which will cause diseases and it also suggests the extent as well as the nature of the contaminants. E. coli bacteria able to survive in water for 4 – 12 weeks and at present, it appears as an indicator to provide the accurate bacterial contamination of fecal matter in drinking water, because of the availability of simple, affordable, fast, sensitive and exact detection techniques. According to the laboratory experiment based techniques, 24 - 48 hours are required for the bacterial concentration to be reported. So, there is a necessity for continuous monitoring. Techniques for detection of many pathogenic bacterial strains are not yet available, sometimes days to weeks are required to get the results. To overcome the difficulties, expensive and time-consuming techniques are required to detect, count and identify the presence of specific bacterial strain. Public health relies on online monitoring of water quality that depends majorly on examination of fecal indicator bacteria, thus protection of health requires fecal pollution indicator so that it is not required to analyze drinking water to overcome the problems associated with waterborne diseases. This paper will brief the classification, sources, survival of E. coli bacteria and its correlation with basic water quality parameters in water sources.```

Very well into the dawn of the fourth industrial revolution (industry 4.0), we hardly distinguish between what is artificial and what is natural (e.g. man-made virus and natural virus). Thus, the level of discombobulation among people, companies or countries is indeed unprecedented. The fact that industry 4.0 is explosively disrupting or retrofitting each and every industrial sector, makes industry 4.0 the famous buzzword amongst researchers today. However, the insight of industry 4.0 disruption in the industrial sectors remains ill-defined in both academic and non-academic literature. The present study aimed at identifying industry 4.0 neologisms, understanding the industry 4.0 disruption and illustrating the disruptive technologies convergence in the major industrial sectors. A total of 99 neologisms of industry 4.0 were identified. Industry 4.0 disruption in Education industry (Education 4.0), Energy industry (Energy 4.0), Agriculture industry (Agriculture 4.0), Healthcare industry (Healthcare 4.0), and Logistics industry (Logistics 4.0) are described. The convergence of 12 disruptive technologies including 3D printing, Artificial intelligence, Augmented reality, Big Data, Blockchain, Cloud computing, Drones, Internet of things, Nanotechnology, Robotics, Simulation and Synthetic biology in agriculture, healthcare and logistics industries are illustrated.

The world is currently, subjected to the worst health crisis documented in modern history; an epidemic led by the novel coronavirus disease 2019 (COVID-19). At the epicenter of this crisis, healthcare professionals continue working to safeguard our well-being. To the regular high levels of stress, COVID new heights even more to healthcare professionals so depending on the area, specialty, and type of work. Here we investigated what are the tendencies, or areas most affected. Through an adaptation of the original COVID-stress scale, we developed a remote, fast test designed for healthcare professionals of the Northeastern part of Mexico, an important part of the country with economic and cultural ties to the US. Our results showed 4 key correlations as highly dependent: Work area – Xenophobia (p &lt; 0.045), Work with COVID patients - Traumatic stress (p &lt; 0.001) and Total number of COVID patients per day – Traumatic stress (p &lt; 0.027), and Total number of COVID patients - Compulsive checking and reassurance. Overall concluding that normal levels of stress have increased (mild – moderate). Additionally, we further determine that the fear of being an asymptomatic patient (potential to spread without knowing) continues being a concern.

Objectives: This study aimed to analyze the awareness of local residents regarding healthcare projects and to suggest some ideas for the revision of local ones. Methods: To delve into the opinions of local residents, the author of this study created a questionnaire composed of eight questions on the general characteristics of the respondents, eight questions on satisfaction with health centers, 16 questions on the awareness of healthcare projects, and 22 questions on local healthcare. The survey was conducted for 409 residents who visited public centers in Gimcheon from 15 March to 14 April 2021. Results: Data analysis revealed the following: The proportion of local residents who use health centers was 39.1%, and those users visit health centers, on average, 3.92 times a year. Among healthcare projects, the project known by the highest proportion of people was vaccinations (84.5%), which was also the project that was most used (38.1%). Among healthcare projects needed in the with-COVID-19 age, respondents awarded the highest score to vaccinations (4.15 points on a five-point Likert scale) and the second highest score to infectious disease management (4.12). Conclusions: For healthcare projects, central and local governments should focus on activating vaccinations, solving the problem of medical accessibility through untact remote treatment and establishing national infectious disease-specializing hospitals and local infectious disease management based on such national hospitals.

The novel coronavirus (SARS-CoV-2) is a human pathogen recently emerged in China, causing a global pandemic of severe respiratory illness (COVID19). SARS-CoV-2 makes entry into human cells through its spike (S) protein that binds to cell surface receptors. Widespread of SARS-CoV-2 has been attributed to high affinity of S protein to its receptor. A homology model of the receptor binding domain of SARS-CoV-2 S protein (RBD) was built. RBD- receptor docking and published molecular dynamics data were used to map the key RBD-receptor interaction hotspot (RBDhp) on the RBD. Primary virtual screening was carried out against RBDhp using more than 3300 compounds approved by U.S Food and Drug Administration (FDA) and other authorities for human use. Compounds that bind to hpRBD with a binding energy ≤ - 6.5 kcal/mol were subjected to secondary screening using a recently published cryo EM (2.9 Å) structure of RBD. A cardiac glycoside (dgitoxin), two anthracyclines (zorubicin and aclarubicin), a tetracycline derivative (rolitetracycline), a cephalosporin (cefoperazone) and a food dye (E-155) were predicted to be most potent inhibitors of RBD – receptor interaction. An anti-asthmatic drug (zafirlukast) and several other drugs (itrazol, fazadinium, troglitazone, gliquidone, Idarubicin, Oxacillin) were found to be high affinity binders that may have a potential to inhibit RBD – receptor interaction.

Contact tracing has become an indispensable tool of various extensive measures to control the spread of COVID-19 pandemic due to novel coronavirus. This essential tool helps to identify, isolate and quarantine the contacted persons of a COVID-19 patient. However, the existing contact tracing applications developed by various countries, health organizations to trace down the contacts after identifying a COVID-19 patient suffers from several security and privacy concerns. In this work, we have identified those security and privacy issues of several leading contact tracing applications and proposed a blockchain-based framework to overcome the major security and privacy challenges imposed by the applications. We have discussed the security and privacy measures that are achieved by the proposed framework to show the effectiveness against the security and privacy issues raised by the existing mobile contact tracing applications.

Based on the demographic shift and the related challenges resulting from the growing number of elderly and persons with chronic diseases, the idea of smart home that supports its inhabitants in the daily life, gains importance. The purpose of this paper was to examine in a prototypic Ambient Assisted Living environment if users after interaction with different health-supporting applications intend to use such in the future. Two experimental studies exemplary show possible applications of home-integrated technology that can support, assist and accompany the target group in different contexts, and examine to what extent participants are willing to future use such sophisticated technology at home. The results show that people in general, but especially the old and chronically ill ones are quite fascinated of health-supporting ambient technology and the majority intends to use such ambient assistance in the future (study I). Moreover, serious games for healthcare are shown as a hedonic use of technology in smart homes that have a great potential to retain or improve the physical health, mobility and the overall well-being of the inhabitants (study II). The article provides two examples of ambient technology to leverage the demographic change and presents important user factors for facilitating high user acceptance.

Blockchain technology enables a decentralized and distributed environment with no need for a central authority. Transactions are simultaneously secure and trustworthy due to the use of cryptographic principles. In recent years, blockchain technology has become very trendy and penetrated different domains, mostly due to the popularity of cryptocurrencies. One field where blockchain technology has tremendous potential is healthcare, due to the need for a more patient-centric approach to healthcare systems and to connect disparate systems and increase the accuracy of electronic healthcare records (EHRs). In this systematic review, an analysis of state-of-the-art blockchain research in the field of healthcare is conducted. The aim is to reveal the potential applications of the technology and to highlight the challenges and possible directions of blockchain research in healthcare. First, background information is discussed, followed by a description of the exact methodology used in this paper. Next, an analysis of the results is given, which includes a bibliometric overview, an analysis of gathered data and its properties, and the results of a literature quality assessment. Lastly, there is a discussion of the results from the analysis. The findings indicate that blockchain technology research in healthcare is increasing and it is mostly used for data sharing, managing health records and access control. Other scenarios are very rare. Most research is aimed at presenting novel structural designs in the form of frameworks, architectures or models. Findings also show that technical details about the used blockchain elements are not given in most of the analyzed publications and that most research does not present any prototype implementation or implementation details. Often even with a prototype implementation, no details about blockchain elements are given.

Background: Over 900,000 cases of COVID-19 and 23,000 deaths have been reported till 13 July in India. Preserving the limited healthcare workforce is part of the strategy against the pandemic. Mortality and morbidity data have a role in customising this strategy. At this time, there is no published study on COVID-related mortality among doctors or other healthcare workers in India. Methods: A multi-pronged search was made for all reported deaths linked with COVID-19 among doctors in India. Details of COVID-linked deaths reported by mainstream media and by multiple professional social media sources were collected, screened, verified and analysed. Violent deaths occurring in the setting of pandemic-related work were separately listed. Deaths from other diseases were excluded. Results: Among 108 COVID-linked deaths among doctors, there were four pandemic-related violent deaths including three road accidents and a suicide. Of the 104 non-violent deaths, 55.5% were below 60 years of age, while 29.6% and 21% were below the age of 50 and 40 respectively. The average age at death was 56.3 (range 22 - 96). Over half of the deaths occurred among general practitioners, while surgical specialties accounted for 27% of the mortality. The geographic distribution of deaths of doctors correlated with the reported number of COVID-19 patients in each state. The total number of COVID-related healthcare worker deaths was 136, out of which eight (5.8%) were violent, and occurred in young individuals with an average age of 27.8 years. Conclusions: The majority of the 104 COVID-related non-violent deaths among doctors (55.5%) occurred below the age of 60. The average at death was 56.6 years. The states with highest number of COVID-19 cases had greater number of doctor deaths. Violent deaths among young healthcare workers in the setting of the pandemic requires special attention.

Reflection in healthcare education is an emergent topic with many studies and reviews being published. The purpose of the present review is to map the literature in this field by performing a systematic review of reviews (umbrella review) and to explore which definitions and models are currently in use, how reflection impacts on design, evaluation and assessment and future challenges. Nineteen reviews were identified that satisfied inclusion criteria. Emerging themes were: reflection is currently portrayed as self-reflection and critical reflection with the epistemology-of-practice notion not being as much as expected in tandem with the evidence-based-medicine paradigm modern science advocates. Reflective techniques were recognised in multiple settings (e.g. summative, formative, group vs individual etc.) and have been associated with learning but assessment remains a research topic with issues of validity, reliability and replicability. Future challenges involve the epistemology of reflection in healthcare education and how to practice and assess reflection without losing its theoretical background.

Suicidal behaviour remains difficult to predict and prevent, even for experienced mental health care professionals. The known distal risk factors for suicidal behaviour are not sufficiently specific to fully understand the complex dynamic processes that precede a suicide attempt. Real-time mobile monitoring data can be used to analyse proximal risk mechanisms within the suicidal process. At the same time smartphone-based safety planning and self-monitoring may enhance a patient’s self-management skills thereby increasing their capacity to respond to a suicidal crisis and to become more aware of crisis symptoms. The current paper describes the theoretical and conceptual rationale for the CASPAR study which applies an innovative approach to the study of suicidal processes. It uses basic science approaches to inform the implementation of an innovative suicide prevention intervention. We aim to develop and implement mobile safety plan in conjunction with real-time monitoring in order to both directly implement suicide prevention interventions and to study the ongoing dynamics of individual suicidal behaviour by applying network analysis.

Background: Health insurance (HI) run by government is providing health care service to large population. Due to poor accountability, participation and sustainability, cooperative health insurance is becoming more popular and effective in low and middle income and some high-income countries too. In Nepal, there are public and cooperative HI is in practice. The aim of this study is to compare the effectiveness of public (government) and cooperative HI in relation to benefit packages, population coverage, inclusiveness, health care utilization, and promptness for treatment in these two health insurance models in Nepal. Method: This is an institution based concurrent mixed study consists of qualitative and quantitative variables from public and cooperative groups. We included all public HI operated by government hospitals and cooperatives groups those purchased hospital service in contract. Two separate study tools were applied to access the effectiveness of insurance models. The key questions were asked for the representatives of government and private health insurance. The numeric information consisted of in quantitative data and subjective response was included in qualitative approach. Descriptive statistics and Mean Whitney U test was applied in numeric data and qualitative information were analyzed by inductive approach Results: The study revealed that new enrolment was not increased, health care utilization rate was increased and the benefit package was almost same in both groups. The overall inclusiveness was higher for the government HI, but enrolment from the religious minority, proportion of negotiated amount during treatment were significantly higher (p<0.05). During illness, the response time to reach hospital was significantly faster in cooperative health insurance than government health insurance. Qualitative findings showed that level of participation, accountability, transparency and recording system was better in cooperative health insurance than public. Conclusion: Cooperative HI could be more sustainable and accountable to the community for all; low, middle and high-income countries.

In the context of the COVID-19 pandemic, countries around the world varied in the strength and timeliness of their responses. In Romania, specific challenges were faced with regards to managing the spread and limiting the impact of the disease, ranging from healthcare infrastructure to demographic and sociocultural aspects. As the country has a sizeable diaspora, major difficulties were faced when large numbers of individuals from highly affected areas returned to Romania. However, the fast implementation of control measures successfully averted a surge in the number of COVID-19 cases. This delayed the overburdening of an already challenged healthcare system during the initial phases of the epidemic. Furthermore, early control was facilitated by the exploitation of communication channels that penetrated all layers of society, from ordinary citizens to governmental authorities and high-ranking religious figures. The management of the COVID-19 crisis in Romania illustrates the importance of a fast initial response which takes into account the role played by sociocultural aspects in the context of an epidemic. As the challenges faced by Romania are not unique, these results could inform future public health strategies worldwide.

Despite the uptake of tobacco smoking declining in the UK, smoking is still the leading cause of preventable poor health and premature death. While improved approaches to smoking cessation are necessary, encouraging and assisting smokers to switch by using substantially less toxic non-tobacco nicotine products may be a possible option. To date few studies have investigated the rates of smoking cessation and smoking reduction associated with the free provision of electronic-cigarettes (e-cigarette) to smokers. In this study the Blu Pro e-cigarette was given to smokers for use in place of tobacco for 90 days. The rates of smoking abstinence and daily smoking patterns were assessed at baseline 30 days, 60 days and 90 days. The response rate was 87%. After 90 days, the complete abstinence rate was 36.5% from 0% at baseline. Frequency of daily smoking reduced from 88.7% to 17.5% (P<0.001) and median consumption of cigarettes/day from 15 to 5 (P<0.001). Median days per month participants smoked also dropped from 30 to 13 after 90-days (P<0.001). On the basis of these results there may be value in smoking cessation services and other services ensuring that smokers are provided with e-cigarettes at zero or minimal costs for at least a short period of time.

COVID-19 has affected 212 countries around the world, killing nearly 300,000 and infecting more than 4.4 million by May 14, 2020. Bangladesh, a South Asian low-middle-income economy, has experienced a demographic and epidemiological transition with rapid urbanization and a gradual increase in life expectancy. It is the seventh most populous country in the world and population of the country is expected to be nearly double by 2050. The increasing burden of communicable diseases in Bangladesh can be attributable to rapid urbanization and nearly 50% of all slum dwellers of the country live in Dhaka division. In 2017, National Rapid Response Team of IEDCR investigated 26 incidents of disease outbreak. The joint survey of the Power and Participation Research Centre and BRAC Institute of Governance and Development reveals that per capita daily income of urban slum and rural poor drops by 80% due to present countrywide shutdown enforced by the government to halt the spread of Covid-19. 40%-50% of these population took loans to meet the daily expenses. However, the country has just 127,000 hospital beds, 91,000 of them in government-run hospitals. Researchers say, the country’s economy is economy is losing BDT 33 billion every day from its service and agriculture sectors during the nationwide shutdown.

Multi-sensor data fusion of E-tongue and E-nose can provide a more comprehensive and more accurate analysis results. However, it also brings some redundant information, it is a hot issue to reduce the feature dimension for pattern recognition. In this paper, the taste-olfactory data fusion based on E-tongue and E-nose combined with Support Vector Machine (SVM) was used to classify five different beers. First, the taste and olfactory feature information were obtained based on E-tongue and E-nose. Second, the original feature data of single system were fused, then Principal Component Analysis (PCA) was applied to extract principal components, Genetic Algorithm-Partial Least Squares (GA-PLS) was used to select the characteristic variables, 20 subsets were generated with those variables based on the best Variable Importance of Projection (VIP) score. Finally, the classification models based on SVM were established, also c and g of SVM were calculated by Grid Search (GS), Genetic Algorithm (GA), and Particle Swarm Optimization (PSO), the classification results of all subsets were obtained. The results showed that the classification accuracy using data fusion was much higher over single E-tongue and single E-nose, and the variable selection method by VIP had the best classification performance in #12 subset coupled with GA-SVM.

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: Fluoride toothpaste (FT) has recently been included in the World Health Organization’s (WHO) Model List of Essential Medicines. Whereas it is essential for preventing dental caries, its current affordability around the globe remains unclear. This study aimed to analyse the affordability of FT in as many as possible countries worldwide. Methods: A standardized protocol was developed to collect country-specific information about the characteristics of the cheapest FT at a common point of purchase. 82 members of the WHO Global Oral Health Network of Chief Dental Officers (CDOs), directors of WHO Collaborative Centres and other oral health experts collected data using mobile phone technology. The Fluoride Toothpaste Affordability Ratio (FTAR) was calculated as the price associated with the recommended annual consumption of FT, relative to the daily wage of the lowest-paid unskilled government worker (FTAR >1 = unaffordable spending on fluoride toothpaste). The daily expenditure per capita of the poorest 15% of the income distrubition was used as the main proxy of the daily wage, using World Bank data. Alternatively, we used the daily minimum wage as a proxy of the daily wage. Stratified descriptive statistics were undertaken with respect to different World Bank Income Groups and WHO Regions. Results: There are significant discrepancies in the affordability of FT across 78 countries. FT was strongly affordable in high-income countries, relatively affordable in upper middle-income countries, and strongly unaffordable in lower middle-income and low-income countries. The affordability of FT across WHO Regions was dependent upon the economic mix of WHO Regions’ member states. Conclusion: FT is still unaffordable for many people, particularly in low-resource settings. Health policy members should develop better strategies to address and improve the universal affordability of FTs, for the incidence of dental caries to be reduced at a global level.

The present study was aimed to evaluate the levels of oxidative stress markers in breast diseases by measuring the 8-hydoxy-2-deoxyguanosine (8-OHdG), vitamin A, vitamin C, vitamin E and total antioxidant status (TAS) alterations in relation to cell proliferation activity and disease progression. Significant increases in the level of oxidative damage marker 8-OHdG and cell proliferation activity were observed in breast carcinoma patients in comparison to benign and normal controls, which were accompanied by significant decrease in non enzymatic antioxidants and TAS concentrations. 8-OHdG and cell proliferation level were negatively correlated with non enzymatic antioxidants viz., Vitamin A, Vitamin C, vitamin E level and total antioxidant activity. Altered levels of biomarkers of oxidative stress and cell proliferation activity amongst the malignant, benign and controls suggest a correlation of increased oxidative stress and cell proliferation activity in the progression of disease in breast carcinoma patients. Among the oxidative stress markers and cell proliferation index, decreased level of vitamin A, vitamin C, vitamin E, TAS and increased level of 8-OHdG, cell proliferation index emerged as best predicted biomarkers for subjects with malignancy and benign breast disease.

This paper presents an overview of the smart electro-clothing systems (SeCSs) targeted at health monitoring, sports benefits, fitness tracking, and social activities. Technical features of the available SeCSs, covering both textile and electronic components, are thoroughly discussed and their applications in the industry and research purposes have been highlighted. In addition, it also presents the developments in the associated areas of wearable sensor systems and textile-based dry sensors. As it became evident during the literature research, such a review on SeCSs covering all relevant issues has not been presented before. This paper will be particularly helpful for new generation researchers investigating the design, development, function and comforts of the sensor integrated clothing materials.

Polyhydroxyalcanoates (PHAs) are biodegradable polymers synthesized in cytoplasmic granules in bacteria, such as Cupriavidus necator (Ralstonia eutropha), Alcaligenes latus, Pseudomonas spp., Comamonas spp. and other species. PHAs accumulation occurs in response to stress conditions, i.e. under high carbon and low nitrogen (24:1 ratio). PHA can be synthesized using recombinant microorganisms (provided with the operon phbA/phbB/phbC), escaping the constrains of nutrient request, except addition of high amount of sugar (glucose, lactose, fructose). In this study; E. coli was genetically modified for PHB production in biofermentors. The production of PHA at industrial scale requires a continuous supplementation of fermentable sugars to support the availability of nutrients and to assess the level of the exponential growth phase; since sugars are required either for bacterial growth either for PHA synthesis and energy storage. The biofermentors need to be run in automated system. Sensors are used at many points in fermentators; in the evaluation of parameters: consumption of sugars; cell density; quantification of PHB synthesis. The need of operational control during the fermentation has prompted us to application of three measurements; one unit linked to a Nanodrop to evaluate OD; one linked to a reaction chamber to measure sugars consumed by enzyme based fluorescence detection; and one for bacteria Nile Blue staining and fluorescence intensity reads. The growth of bacteria on three different plant by-products was monitored and PHB production in four days using a banana by-product feed was optimised. These detectors will make possible to exploit the full potential of bioreactors optimizing the time of use and maximizing the number of bacteria synthesizing PHA.

Lectins are carbohydrate-interacting proteins playing a pivotal role in multiple physiological and developmental aspects of all organisms. They can specifically interact with different bacterial and viral pathogens through the carbohydrate-recognition domains (CRD). In addition, lectins are also of biotechnological interest because of their potential use as biosensor for capturing and identification of bacterial species. In this work, we have characterized the bacterial agglutination properties of three C-type lectins from the Lepidoptera Spodoptera exigua. One of these lectins, BLL2, was able to agglutinate cells from a broad range of bacterial species at an extremely low concentration, becoming a very interesting protein to be used as biosensor or other biotechnological applications involving bacterial capturing.

The greater Wellington region, New Zealand, is highly vulnerable to large earthquakes because it is cut by active faults. Bulk water supply pipelines cross the Wellington Fault at several different locations, and there is considerable concern about severe disruption of the provision of reticulated water supplies to households and businesses in the aftermath of a large earthquake. A number of policy initiatives have been launched encouraging householders to install rainwater tanks to increase post-disaster resilience. However, little attention has been paid to potential health hazards associated with consumption of these supplies. To assess health hazards for householders in emergency situations, six 200-litre emergency water tanks were installed at properties across the Wellington region, with five tanks being allowed to fill with roof-collected rainwater and one tank being filled with municipal tapwater as a control. Such tanks are predominantly set aside for water storage, and once filled, feature limited drawdown and recharge. Sampling from these tanks was carried out fortnightly for one year, and samples analysed for E. coli, pH, conductivity, a range of major and trace elements, and organic compounds, enabling an assessment of the evolution of water chemistry in water storage tanks over time. Key findings were that the overall rate of E.coli detections in the rain-fed tanks was 17.7%, which is low in relation to other studies. We propose that low incidences of E.coli may be due to biocidal effects of high zinc concentrations in tanks, originating from unpainted galvanised steel roof cladding. Lead concentrations were high compared to other studies, with 69% of rain-fed tank samples exceeding the World Health Organisation’s health-based guideline of 0.01 mg/L. Further work is required to determine risks of short-term consumption of this water in emergency situations.

To improve carbon efficiency for urban logistics service system composed of a third-party logistics service provider (3PLs) and an e-business enterprise, low-carbon operation game between them was studied. Considering low carbon technology investment cost and sales expansion effect of low carbon level, profit functions for both players were constituted. Based on their different bargaining capabilities, totally 5 types of game scenarios were designed. Through analytical solution, Nash Equilibria under varied scenarios were obtained. By analyzing these equilibria, 4 major propositions were given, in which, some key variables and system performance index were compared. Results show that the best system yields could only be achieved under the fully cooperative situation; limited cooperation only for carbon emission reduction would not benefit the system performance improvement; E-business enterprise-leading game’s performance overtook 3PLs-leading ones.

The SARS-CoV-2 virus that causes the COVID-19 disease has wreaked havoc on the world community in terms of every imaginable parameter. The research output on COVID-19 has been nothing short of phenomenal, especially in the medical and biomedical sciences, where the search for a potential vaccine is being conducted in earnest. Much of the advanced research has been distributed in the leading medical journals, including the Journal of the American Medical Association (JAMA), where the latest research is distributed on a daily basis. The purpose of this paper is to provide some perspectives on 44 interesting and highly topical research papers that have been published in JAMA, at the time of writing, within the past two weeks. The diverse topics include public health, general medicine, internal medicine, oncology, paediatrics, geriatrics, and biostatistics.

In service economy, scholars and practitioners focus on the development and the appliance of innovative services. The importance of service innovation is rising in many sectors and among different organizations. Several disciplines (e.g. marketing, management, operations research, etc.) focus on this innovation, a concept widely used, but with different definitions. In this paper, service innovation has been analyzed according to SD Logic and a service ecosystem perspective. Literature still call for a deeper understanding of how new or renewed resources’ combination affect the shaping of service ecosystems. To contribute to fill this gap, the study explores the practices that different actors, internal and external to a healthcare service ecosystem, enact to co-create value in novel ways that is service innovation. The paper is structured as follows. In the next section, the main academic contributions on service research have been reviewed, focusing on healthcare service innovation. Follows, the research method and the discussion of research findings. Finally, theoretical and managerial implications have been detailed and an agenda for future research suggested. The paper offers interesting insights to develop new or renewed practices that foster the reshaping and maintaining of a healthcare service ecosystem. Some recommendations are included to support managers in the development of service innovation strategies.

With an increasing demand for quality of care and lower costs, hospitals are looking for industry-based methods to improve efficiency in their processes. This study aims to reduce waste in a public hospital in Mexico by improving the medical supply process for the operating room. To this end, a lean healthcare (LH) implementation following the DMAIC approach (Define-Measure-Analyze-Improve-Control) is carried out. We analyze the value stream of the supply process, including main surgical procedures and their related medical supplies, and identify different causes of inefficiency, which are evaluated and controlled through different tools, including a value stream map, Kanban, and the 5S program. As a result, five types of waste were reduced. Over-processing requests were reduced by 15.3%, defective identification numbers were reduced by 46.5%, redundant processing was improved by 94.8%, near 2.8% of the unnecessary inventory was reduced, and transportation waste was reduced by up to 16.7%. Finally, the lead-time for the main supplies was reduced by 33 days. This work demonstrates that LH and DMAIC are effective in reducing waste and are highly conducive to improving sustainability in healthcare processes. Moreover, it provides practical insights for practitioners regarding the implementation of LH in public hospitals in developing countries.

Dengue virus (DENV), the causative agent of dengue fever (DF), is one of the most important mosquito-borne viruses that can infect humans. Although much effort has been made on prevention and control of dengue, there are currently no anti-viral drugs or worldwide approved vaccines yet. In this study, we immunized six-week-old Balb/c mice with DNA vaccine candidates E and NS1-2a of DENV serotype 2 or the combination of them (E+NS1-2a) via an electroporation (EP)-assisted intramuscular gene delivery system and evaluated the immune response and protection. The highest specific antibody titres and cytokine levels secreted by splenocytes as well as the highest survival rate were observed in the E+NS1-2a group, followed by E group and NS1-2a group. Our data suggested that the combination of E and NS1-2a delivered by EP may be a superior preventive strategy against DENV.

Hepatitis E virus (HEV) is a common cause of acute hepatitis worldwide, accounting for approximately 25% of deaths among pregnant women. We previously reported that pregnancy serum facilitates HEV replication in vitro. However, the differences in host cells with HEV infection induced by pregnancy serum and fetal bovine serum (FBS) are unclear. In this study, differentially expressed proteins were identified in HEV-infected hepatoma cells (HepG2) supplemented with different sera by using isobaric tags for relative and absolute quantitation. Proteomic analysis indicated that HEV infection significantly induced 1014 differentially expressed proteins in HEV-infected HepG2 cells when supplemented with FBS compared with pregnancy serum. Further validation by Western blot confirmed that filamin A, heat-shock proteins 70 and 90, Cytochrome c, and Thioredoxin were associated with HEV infection. This comparative analysis provides an important basis to further investigate HEV pathogenesis in pregnant women and HEV replication.

Background: Serious games are conceptualized as a broad topic and overlap segments of more modern forms of education: e-learning, edutainment, game-based learning, and digital game-based learning. Serious Games aligns with digitalization and the modern era and creates novel opportunities for learning and assessment in medical education. Escape rooms, a type of serious games, merge mental and physical aspects to reinforce critical skills useful in daily life. It challenges logic and reasoning and demands careful analysis of situations to correlate and solve different stages of the escape room under pressurized, timed conditions. Furthermore, it serves as an adequate environment to build problem-solving skills, communication skills, and leadership skills through the collaboration of people to achieve a common goal. The aim of this study was to investigate the applications of escape rooms in Medical Education. Method: This study investigated the applications of escape rooms in medical education. Serious games are expanding in education and have attained great relevance due to their intriguing and intrinsically motivating attributes. Within serious games, we focused on escape rooms in which participants are locked in a room, faced with puzzles that must be solved to ‘escape the room’. Compiling the data from the first 100 hits of medical application of escape rooms, we found 72 cases and categorized them by year, specialty, participants structure, simulation experience, and design. Results: We reported on escape rooms in medical education by the year in which they were reported, the medical specialty, the participant structure, grouped or individual, the experience design; real, hybrid, or digital, and the modality of the delivery. 72% of the escape rooms focused on four main areas: nursing education (25.0%), emergency medicine (22.2%), pharmacy (12.5%), and interprofessional education (12.5%). Most of the escape rooms had a group-based physical design and little attention was given to provide a detailed description of the design considerations, such as the pathway type (linear, semi-linear, open). Conclusion: Escape rooms are applied in a wide range of medical education areas. In Medical Education, group-based on-site escape rooms with a focus on nursing, emergency medicine, pharmacy and interprofessional education dominates the implementation landscape. To further advance the field, stronger emphasis on making explicit the design considerations will advance the research and inform implementations.

With Internet of Things (IoT) gaining presence throughout different industries a lot of new technologies have been introduced to support this undertaking. Implications on one such technology, wireless systems allowed for the use of different communication methods to achieve the goal of transferring data reliably, with more cost efficiency and over longer distances. Anywhere from a single house with only a few IoT devices such as a smart light bulb or a smart thermostat connected to the network, all the way to a complex system that can control power grids throughout countries, IoT has been becoming a necessity in everyday lives. This paper presents an overview of the devices, systems and wireless technologies used in different IoT architectures (Healthcare, Vehicular Networks, Mining, Learning, Energy, Smart Cities, Behaviors and Decision Making), their upbringings and challenges to this date and some foreseen in the future.

With the development of information technology and the popularization of mobile devices, collecting various types of customer data such as purchase history or behavior patterns became possible. As the customer data being accumulated, there is a growing demand for personalized recommendation services that provide customized services to customers. Currently, global e-commerce companies offer personalized recommendation services to gain a sustainable competitive advantage. However, previous research on recommendation systems has consistently raised the issue that the accuracy of recommendation algorithms does not necessarily lead to the satisfaction of recommended service users. It also claims that customers are highly satisfied when the recommendation system recommends diverse items to them. In this study, we want to identify the factors that determine customer satisfaction when using the recommendation system which provides personalized services. To this end, we developed a recommendation system based on Deep Neural Networks (DNN) and measured the accuracy of recommendation service, the diversity of recommended items and customer satisfaction with the recommendation service. The experimental results of is the study showed that both recommendation system accuracy and diversity would have a positive effect on customer satisfaction. These results can further improve customer satisfaction with the recommendation system and promote the sustainable development of e-commerce.

In recent years information and communication technologies (ICT) play a significant role in all aspects of modern society and impact socioeconomic development in sectors as education, administration, business, medical care and agriculture. The benefits of such technologies in agriculture can be appreciated only if farmers use them. In order to predict and evaluate the adoption of these new technological tools, the technology acceptance model (TAM) can be a valid aid. The paper measures the potential acceptance of an e-learning tool designed for EU farmers and agricultural entrepreneurs. Starting from a literature review of the technology acceptance model, by analyzing the most commonly used external variables in the fields of e-learning, Agriculture, and Virtual reality, the analysis shows that computer self-efficacy, individual innovativeness, computer anxiety, perceived enjoyment, social norm, content and system quality, experience and facilitating conditions are the most common determinants addressing technology acceptance. Furthermore, findings evidenced that the external variables have a different impact on the two main beliefs of the TAM Model, Perceived Usefulness (PU) and Perceived Ease of Use (PEOU). This study is expected to bring theoretical support for academics when determining the variables to be included in TAM extensions.

Background: The healthcare workers are exposed to dangerous pathogen agents during the outbreak of the new coronavirus COVID-19. To minimize the risk of becoming infected by this virus, healthcare workers need to wear the most appropriate personal protective equipment (PPE). Objective: The objective of this study was to analyze the guidelines that the World Health Organization (WHO) and the Centers for the Disease Control and Prevention (CDC) recommend for the rational use of EPP to protect healthcare workers against the novel coronavirus COVID-19.Methodology: To learn how to effectively protect healthcare workers against the COVID-19, a detailed analysis and comparison of the WHO and CDC guidelines related to the proper use of personal protection equipment (PPE) in different healthcare settings was carried out. Results: The results of this study based on an analysis of PPE recommended by the World Health Organization (WHO) and the Centers for the Disease Control and Prevention (CDC) indicated that the safety and protection of healthcare workers can be maximized if the guidelines suggested by these institutions are followed. In general, the WHO and CDC recommendations based on medical practices are similar, and depending on the healthcare activities and settings where the healthcare workers perform their work, suggest wearing medical/surgical facemasks, respirators, googles and face shields (eye protection), gloves, gowns and aprons. Conclusions: The protection and safety of the healthcare workers can be maximized during the outbreak of COVID-19 by following the WHO and CDC recommendations described in this study. The general guidelines offered by these institutions are similar and based on medical practices.

Nowadays, the transparency of governments with respect to the sustainability of public services is a very interesting issue for stakeholders and academics. It has led to previous research and international organisations (EU, IMF, OECD, United Nations, IFAC, G-20, World Bank) to recommend promotion of the online dissemination of economic, social and environmental information. Based on previous studies about e-government and the influence of administrative cultures on governmental accountability, this paper seeks to identify political actions useful to improve the practices of transparency on economic, social and environmental sustainability in European local governments. We perform a comparative analysis of sustainability information published on the websites of 72 local governments in 10 European countries grouped into main three cultural contexts (Anglo-Saxon, Southern European and Nordic). Using international sustainability reporting guidelines, our results reveal significant differences in local government transparency in each context. The most transparent local governments are the Anglo-Saxon ones, followed by Southern European and Nordic governments. Based on individualized empirical results for each administrative style, our conclusions propose useful policy interventions to enhance sustainability transparency within each cultural tradition, such as development of legal rules on transparency and sustainability, tools to motivate local managers for online diffusion of sustainability information and analysis of information needs of stakeholders.

The geometry of Poincare disk itself is interpreted without any mapping to dierent spaces. Our approach might be one of the shortest and is intended for educational contribution.

This article aims to provide a comprehensive understanding of vaping from various perspectives that contributes to the origin, development, achievement, and consequences of the greed of e-cigarette manufacturers. In our analysis, multiple elements of the social landscape, including economic, cultural, moral, psychological, and philosophical dimensions, contributed to the origin and development of the vaping greed and shaped people’s behaviors. Further discussion was made on how the specific characteristics of e-cigarette products and the marketing strategies of the companies, especially social media marketing, fostered the growth of such greed. Through interviews, we have also discussed the unfolding of this greed within the community of teenage vapers. The growth of the vaping greed was manifested in the large market share taken by the companies, but these all significantly harm people’s health and the communities. Nicotine and other chemicals in e-liquids promote each other’s negative effects in the mechanism leading to pulmonary symptoms and addiction, which are not limited to the physical level. We described that addiction could be transgenerational and can induce trauma both at an individual level and a community level. Overall, the greed of the vaping industry is a very complex system. The treatment of the greed shall be complicated as well: Besides the public health measures taken to treat the symptoms of the greed, we should educate individuals to be aware of their unfulfilled needs to regain authenticity and establish an infallible authority to enforce universal morality, which eradicates the complications of addiction and the root of the capitalists’ greed, respectively.

Vitamin A and E are important during pregnancy, the neonatal period, and childhood. The objective of this study was to assess whether maternal RRR-a-tocopherol supplementation affects serum and breast milk retinol. Serum was collected at baseline and twenty days later, and breast milk, at baseline, and on days 1, 7, and 20 after delivery. After the baseline serum collection, the supplemented group (n=16) received a single 400 IU of RRR-α-tocopherol. The control group (n=18) was only performed collections. Retinol and alpha tocopherol levels were determined by liquid chromatography. Serum retinol and alpha tocopherol at baseline and 20 days after delivery indicated proper vitamin A (> 20 µg/dL) and E (> 516 μg/dL) statuses in the control and supplemented groups (p > 0.05). Colostrum retinol levels on days 1 and 7 after delivery were significantly higher in the supplemented group (p = 0.018 and p = 0.012, respectively). Maternal vitamin E supplementation increased colostrum retinol by 52.23% and 111.2%, 24 hours and 7 days, respectively. However, retinol in mature milk did not differ between the groups (p > 0.05). In conclusion, the supplementation with 400 IU of RRR-α-tocopherol improved vitamin A bioavailability in breast milk.

The radar sensor described realizes healthcare monitoring capable of detecting subject chest-wall movement caused by cardiopulmonary activities, and wirelessly estimating the respiration and heartbeat rates of the subject without attaching any devices to the body. No conventional Doppler only can capture Doppler signatures because of a lack of bandwidth information with noncontact sensors. In contrast, we take full advantages of impulse radio ultra-wideband (IR-UWB) radar to achieve low power consumption and convenient portability, with a flexible detection range and desirable accuracy. A noise reduction method based on improved ensemble empirical mode decomposition (EEMD) and a vital sign separation method based on continuous-wavelet transform (CWT) are proposed jointly to improve the signal-to-noise ratio (SNR) in order to acquire accurate respiration and heartbeat rates. This noncontact healthcare sensor system proves the commercial feasibility and considerable accessibility of using compact IR-UWB radar for emerging biomedical applications. Compared with traditional contact measurement devices, experimental results utilizing a 2.3 GHz bandwidth transceiver, demonstrate 100% similar results.

Infection control among patients is critical for diseases like COVID-19. The concentration of patients in a few facilities burdens healthcare providers and the healthcare system. This study examined the operations of an extended anteroom in a dedicated COVID-19 hospital. It presents issues to consider in the deployment and operation of an extended anteroom through discussions by expert working groups. The subjects covered included efficient space, staffing, equipment management, and education. The process involved wearing personal protective equipment (PPE; in this case, Level D), and if necessary, wearing additional powered air purification respirators (PAPR), after moving from the preparation room to the dressing room, and when entering the hospital through the entrance passage. When leaving the hospital, personnel used a mandatory exit-only passage; in the dressing room, they undressed, and then went outside, in this order. The efficient spatial composition of the anteroom facilitated entry and exit and the separation of contaminated areas and non-contaminated areas using colors and lines. It is necessary to develop operational guidelines for hospitals that treat infectious diseases and conduct research to improve care. The study indicated the need to develop educational programs and use educational simulations to address regionally spread infectious diseases

Background: Biomarkers are essential for identification of individuals at high risk of mild cognitive impairment (MCI) for potential prevention of dementia. We investigated DNA methylation in the ApoE gene and plasmatic apolipoprotein E (ApoE) levels as MCI biomarkers in Colombian subjects with MCI and controls. Methods: 100 participants were included (71% women, average age, 70 yrs., range 43-91). MCI was diagnosed by neuropsychological testing, medical and social history, activities of daily living, cognitive symptoms and neuroimaging. Multivariate logistic regression models adjusted by age and gender were performed to examine the risk association of MCI with plasma ApoE and APOE methylation Results: MCI was diagnosed in 41 subjects (average age, 66.5±9.6 yrs.) and compared with 59 controls. Elevated plasma ApoE and APOE methylation of CpGs 165, 190, and 198 were risk factors for MCI (P<0.05). Higher CpG-227 methylation correlated with lower risk for MCI (P=0.002). Only CpG-227 was significantly correlated with plasmatic ApoE levels (correlation coefficient=-0.665; P=0.008). Conclusion: Differential APOE methylation and increased plasma ApoE levels were correlated with MCI. These epigenetic patterns can be used as potential biomarkers to identify early stages of MCI.

After conducting a detailed survey among the villagers of Pallissery and Karukutty, it was observed that in most of the villages the native people have to travel long distances for their basic health needs. Also most of the villagers lack knowledge regarding live health updates. At times, these problems have even resulted in death of many people including pregnant women and children. The objective of our research is to propose an integrated and easy to use Medical Kiosk that can be installed at various locations in rural areas. The Kiosk will provide an integrated environment for all medical related activities and would perform numerous functions like sending notifications regarding medical camps, mobile medical help, important dates for vaccinations, child care, insurance policies and provide other live medical updates to the villagers. It would also support the basic facilities for measurement of body parameters like height, weight, BMI, blood pressure, and heartbeat and also facilitate live consultation facilities with specialized doctors through video and voice chats.

When all countries are battling Covid-19 by adopting different policies, it could help address the issue of government response policy efficiency. This study examines the efficiency of government intervention policies in 19 countries, the efficiency of preventing the spread, and also the mortality caused by the virus. The policies are categorized based on the Oxford COVID-19 Government Response Tracker, which combines various indicators, including Containment and closure, Economic response, and Health systems. Given that the governments apply a top-down approach to design these policies, the current research evaluates the efficiency of policies based on the same approach. Here, two different models have been used to calculate the efficiency of policies. We designed a combined index in both models and applied Window DEA method to determine the output quantities in the efficiency ratio. The results of our study show that in both models, Japan, Finland and Thailand had the highest level of government response efficiency. The countries with the lowest government response efficiency were the United States, Spain, and Russia in the first model, and China, Italy, and Spain in the second.

Although the complexity of physically based models continues to increase, they still need to be calibrated. In recent years, there has been an increasing interest in using new satellite technologies and products with high resolution in model evaluations and decision-making. The aim of this study is to investigate the value of different remote sensing products and groundwater level measurements in the temporal calibration of a well-known hydrologic model i.e. HBV. This has been rarely done for conceptual models as satellite data are often used in spatial calibration of the distributed models. Three different soil moisture products from ESA CCI SM v04.4, AMSR-E and SMAP, and total water storage anomalies from GRACE are collected and spatially averaged over the Moselle River Basin in Germany and France. Different combinations of objective functions and search algorithms all targeting a good fit between observed and simulated streamflow, groundwater and soil moisture are used to analyse the contribution of each individual source of information. Firstly, the most important parameters are selected using sensitivity analysis and then, these parameters are included in a subsequent model calibration. The results of our multi-objective calibration reveal substantial contribution of remote sensing products to the lumped model calibration even if their spatially distributed information is lost during the spatial aggregation. Inclusion of new observations such as groundwater levels from wells and remotely sensed soil moisture to the calibration improves the model’s physical behaviour while it keeps a reasonable water balance that is the key objective of every hydrologic model.

IgE-mediated wheat allergy is a gluten-related disorder. Wheat is one of the five most common food allergens in children. However, the natural history of IgE-mediated wheat allergy has seldom been described in the research literature. This study presents the current state of knowledge about the IgE-mediated wheat allergy in children.

The alkylation of 1,1,2-trimethyl-1H-benzo[e]indole with 2-chloroacetamide, followed by work-up of the reaction mixture with a base and the subsequent treatment of a crude product with acetic acid gives 10a,11,11-trimethyl-10a,11-dihydro-8H-benzo[e]imidazo[1,2-a]indol-9(10H)-one. The structure assignments were based on data from ¹H, ¹³C and ¹⁵N NMR spectroscopy. The optical properties of the obtained compound were studied by UV-vis and fluorescence spectroscopy.

The purpose of this study is to find out the e-reputation management of the hotel industry, as well as the social media channels used as the tools of hotel e-reputation building. This study used a qualitative approach by analyzing the in-depth interviews with hotel marketing communication practitioners of 15 hotel companies in Bandung City. The findings identified that e-reputation is considered a crucial factor in determining hotel performance due to the change of customers’ behaviors today and identified also three types of e-reputation management activities implemented by hotel companies, such as online activities, offline activities, and online/offline activities. The results of this study have implications for the hospitality industry, as a reference for formulating their marketing strategies.

The greenhouse gases and air pollution generated by extensive energy use have exacerbated climate change. An electric-bus (e-bus) transportation system favors reducing pollution and carbon emissions. This study analyzed the minimization of construction costs for an all battery-swapping public e-bus transportation system. A simulation was conducted according to existing timetables and routes. Daytime charging was incorporated during the hours of operation; the two parameters of the daytime charging scheme were the residual battery capacity and battery-charging energy during various intervals of daytime peak electricity hours. The parameters were optimized using three algorithms: particle swarm optimization (PSO), a genetic algorithm (GA), and a PSO–GA. This study observed the effects of optimization on cost changes (e.g., number of e-buses, on-board battery capacity, number of extra batteries, charging facilities, and energy consumption) and compared the plug-in and battery-swapping e-bus systems. The results revealed that daytime charging can reduce the construction costs of both systems. In contrast to the other two algorithms, the PSO–GA yielded the most favorable optimization results for the charging scheme. Finally, according to the cases investigated and the parameters of this study, the construction cost of the plug-in e-bus system was lower than that of the battery-swapping e-bus system.

Traditionally understood in reference to distance education, cognitive presence may be defined as "the extent to which the participants in any particular configuration of a community of inquiry can construct meaning through sustained communication. The purpose of this paper was to create a blueprint for the reflective ePortfolio as the capstone project for my graduate degree. The blueprint was accomplished by adapting for use cognitive presence as a tool for both analysis and framing, which has never been done to the best of my knowledge. I considered myself to be a participant in a “community of inquiry” model and substituted the result of my interaction with each of the required instructor-course content pairings I took to serve as fellow participants in this community model. The result of my participation was understood to be the knowledge and experience that I have gained, which was reflected in eight of my academic research papers. These selected papers were the artifacts around which my ePortfolio was ultimately developed and demonstrated my participation as an active member in this community of inquiry constructing meaning through sustained communication.

There is much interest in effective copper chelators to correct copper dyshomeostasis in neurodegenerative and oncological diseases. In this study, a recombinant fusion protein for expression in E. coli cells was constructed from glutathione-S-transferase (GST) and the N-terminal domain (ectodomain) of human high affinity copper transporter CTR1 (hNdCTR1), which has three metal-bound motifs. Several biological properties of the GST-hNdCTR1 fusion protein were assessed. It was demonstrated that in cells, the protein was prone to oligomerization, formed inclusion bodies and displayed no toxicity. Treatment of E. coli cells with copper and silver ions reduced cell viability in a dose- and time-dependent manner. Cells expressing GST-hNdCTR1 protein demonstrated resistance to the metal treatments. These cells accumulated silver ions and formed nanoparticles that contained AgCl and Ag0. In this bacterial population, filamentous bacteria with length about 10 μm were often observed. The possibility for the fusion protein carrying extracellular metal binding motifs to integrate into the cell’s copper metabolism and its chelating properties are discussed.

Rare earths are classified as most important and critical material for US economy and defense by Congress and a mandate has been set to increase their in-house production, domestic resource utilization and decrease reliance on foreign resources and reserves. They are widely available in earth crust as ore (bastnaesite (La, Ce)FCO₃, monazite, (Ce, La, Y, Th)PO₄, and xenotime, YPO₄), but their so-called economic reserves are sparsely located geographically. They may be produced by various means such as beneficiation (physical, chemical, mechanical, or electrical), reduction (direct or indirect), electrolysis (of aqueous or molten / fused single or mixed salt systems) at high temperature or hydrometallurgy. Out of these, direct reduction also known as metallothermic reduction (La and Ca reduction) is mostly utilized. Its variant, high temperature electrowinning of fused salts is also practiced widely. These processes are material and application specific. In this study, author will employ thermodynamics (Ellingham diagrams, free energy of formation, reduction potential, Nernst equation, Pourbaix (E_h-pH) diagrams, E-pO^-2 diagrams), kinetics and energetic of a chemical reaction (chemical metallurgy) to reduce rare earth oxide / salt to rare earth metals (REO/RES – REM). It is shown that materials and energy requirement vary greatly depending on type of mineral ore, production facility, and beneficiation / mineral processing method selected. Aim is to reduce dependence on coal deposits. It is anticipated this route will be able to produce rare earths with > 35% yield and > 98% purity which be described in subsequent studies and patents.

In this ‘New Normal' post-COVID-19 modern world, people's health is becoming increasingly important to track. An advanced technology that uses sensory instruments to track and record critical parameters and communicates with others is the need of the time. It's difficult to keep track of all of the medical parameters and post-operative data of people with non-communicable diseases like diabetes and heart disease on a continuous basis. The system discussed here to be designed for patients who are confined to their homes, particularly when going out and being exposed to the outer world is prohibited. This paper proposed a groundbreaking health management system based on the Internet of Things (IoT) for accessing patient medical parameters in both local and remote areas. When a person's wellbeing becomes urgent, this initiative seeks to send an emergency alert to family members or loved ones. A cloud server records data from the patient's temperature sensor and pulse sensor; the data is analyzed using support vector machine algorithms to identify irregular conditions, and an emergency message is sent to the rest of the family via a mobile application, as well as a warning message to the nearest hospital.

A rapid, precise, accurate and low cost method for the determination of vitamin E (α-tocopherol) in cereal products and biscuits was developed. The uncertainty was calculated for the first time and the methods were performed in different cereal products and biscuits, characterized as “superfoods”. The limits of detection and quantification were calculated. Accuracy and precision were estimated using the certified reference material FAPAS T10112QC and the determined values were in good accordance with the certified values. The health claims according to the daily reference values for vitamin E were calculated and the results proved that the majority of the samples examined showed %daily value higher than 15%.

There has been widespread criticism about the rates of participation of students enrolled on MOOCs (Massive Open Online Courses), more importantly, the percentage of students who actively consume course materials from beginning to the end. This study sought to investigate this trend by examining the factors that influence MOOC adoption and use by students in selected Ghanaian universities. The Unified Theory of Acceptance and Use of Technology (UTAUT) was extended to develop a research model. A survey was conducted with 270 questionnaires administered to students who had been assigned MOOCs; 204 questionnaires were retrieved for analysis. Findings of the study show that MOOC usage intention is influenced by computer self-efficacy, performance expectancy, and system quality. Results also showed that MOOC usage is influenced by facilitating conditions, instructional quality, and MOOC usage intention. Social influence and effort expectancy were found not to have a significant influence on MOOC usage intention. The authors conclude that universities must have structures and resources in place to promote the use of MOOCs by students. Computer skills training should also be part of the educational curriculum at all levels. MOOC designers must ensure good instructional quality by using the right pedagogical approaches and also ensure that the sites and learning materials are of good quality.

Abstract: The human race has always innovated, and in a relatively short time went from building fires and making stone-tipped arrows to creating smartphone apps and autonomous robots. Today, technological progress will undoubtedly continue to change the way we work, live, and survive in the coming decades. Since the beginning of the new millennium, the world has witnessed the emergence of social media, smartphones, self-driving cars, and autonomous flying vehicles. There have also been huge leaps in energy storage, artificial intelligence, and medical science. We are facing immense challenges in global warming and food security, among many other issues. While human innovation has contributed to many of the problems we are facing, it is also human innovation and ingenuity that can help humanity deal with these issues “New directions in science are launched by new tools much more often than by new concepts. The effect of a concept-driven revolution is to explain old things in new ways. The effect of a tool-driven revolution is to discover new things that have to be explained”. (F. Dyson, 1997 In this article, we review the impact of technology as evolving at beginning of 21st Century on future prospect of Energy demand either renewable or non-renewable form, Economy, to Ecommerce, Education and any other E-related of Modern Technology.

Based on K-ε Standard Wall turbulence model (2-Equation) and Navier-Stokes (N-S) equations defined for incompressible fluids, fluid flow behaviour around hyperloop pods in an evacuated tube was simulated using ANSYS fluent solver assuming steady state and two dimensional conditions. In this research, to develop the case studies, using combination of different head and tail shape profile, four kind of hyperloop pods were developed with the aid of SolidWorks. These four pods have been investigated for their aerodynamic behaviour as four different case scenarios. The results of simulation depicts that an atmospheric pressure of 100 Pa with blockage ratio of 0.36 in tube provides the best possible aerodynamic behaviour for the designed hyperloop pod models. This research finds that overall aerodynamic behaviour of hyperloop pods can be varied by changing the head and tail shape profile of pods and a particular combination of head and tail shape profile can provide optimally best aerodynamic capabilities. Thus, this research paper provides a novel method of obtaining best aerodynamic capabilities in hyperloop pods by designing head profile optimally in combination with tail profile. This outcome will provide major contribution towards the development of hyperloop pods in future with better aerodynamic behaviour resulting in lesser electrical energy required to propel the hyperloop pods in evacuated tube.

In this work, two embroidered textile moisture sensors are characterized with three different conductive yarns. The sensors are based on a capacitive interdigitated structure embroidered on a cotton substrate with an embroidered conductor yarn. The performance comparison of 3 different type of conductive yarns has been addressed. In order to evaluate the sensor sensitivity, the impedance of the sensor has been measured by means of a LCR meter from 20 Hz to 20 kHz on a climatic chamber with a sweep of the relative humidity from 30% to 65% at 20 ºC. The experimental results show a clear and controllable dependence of the sensor impedance with the relative humidity and the used conductor yarns. This dependence points out the optimum conductive yarn to be used to develop wearable applications for moisture measurement.

The emergence of acute, severe non hepA–E hepatitis of unknown etiology (ASHUE) has attracted global concern owing to the very young age of the patients and its unknown etiology. Although this condition has been linked to several possible causes, including viral infection, drugs, and/or toxin exposure, the exact cause remains unknown; this makes treatment recommendations very difficult. In this review, we summarize recent updates on the clinical manifestations, complemented with laboratory results, case numbers with the global distribution and other epidemiological characteristics, and the possible etiologies. We also provide the proposed actions that could be undertaken to control and prevent further spread of this hepatitis. Since many etiological and pathological aspects of the acute non hepA–E hepatitis remain unclear, further research is needed to minimize the severe impact of this disease.

Malaysia implemented a movement control order (MCO) to curb the spread of the SARS-CoV-2 virus in March 2020. Despite healthcare services remaining operational, rising COVID-19 infections and MCO restrictions have forced healthcare professionals to seek a compromise between service capacity and standard operating procedure compliance. A cross-sectional survey was conducted among public and private sector doctors, dentists and pharmacists to determine how lockdown measures impacted healthcare services. Responses from 413 doctors, 193 dentists, and 163 pharmacists were analysed. Pharmacy services remained mostly unaffected throughout the MCO. In contrast, operational capacities for surgical and dental services were severely affected during the MCO. All service sectors reported restricting patients or accompanying individuals at the workplace, reductions in staffing capacity, and shortened patient contact time at various degrees. Many pharmacy and medical participants reported supplying extended medication supplies to patients. Adoption of virtual healthcare services was generally poor. All private service sectors suffered financial losses ranging between 59 to 75%. Periodic assessments of the healthcare system throughout the pandemic are required to identify which patients have their treatment compromised so that healthcare managers and policy makers can plan and implement appropriate interventions that help alleviate pressure within the health system.

Implications of the novel usage adoption of the internet of things in various sectors of works and life are researched and documented at pace. This is related to the overall high rate at which new technologies are adopted in modern society. Healthcare is a vital aspect of everyday activities and as such overlaps with the increasingly important role played by use of the internet and associated technologies. The purpose of this review article is to draw attention to the potential social, ethical, legal and professional limitations to using IoT in the context of healthcare. The social and ethical aspects in particular, focus on IoT usage in care of the elderly with relevant case studies as reference.

This paper presents an effective heart disease prediction model through detecting the anomalies, also known as outliers, in healthcare data using the unsupervised K-means clustering algorithm. Most existing approaches for detecting anomalies are based on constructing profiles of normal instances. However, such techniques require an adequate number of normal profiles to justify those models. Our proposed model first evaluates an \textit{optimal} value of K using Silhouette method. Next, it intends to locate anomalies that are far from a certain threshold distance with respect to their clusters. Finally, the five most popular classification techniques such as K-Nearest Neighbor (KNN), Random Forest (RF), Support Vector Machines (SVM), Naive Bayes (NB), and Logistic Regression (LR) are applied to build the resultant prediction model. The effectiveness of the proposed methodology is justified using a benchmark dataset of heart disease.

E-commerce businesses employ recommender models to assist in identifying a personalized set of products for each visitor. To accurately assess the recommendations’ influence on customer clicks and buys, three target areas—customer behavior, data collection, user-interface —will be explored for possible sources of erroneous data. Varied customer behavior misrepresents the recommendations’ true influence on a customer due to the presence of B2B interactions and outlier customers. Non-parametric statistical procedures for outlier removal are delineated and other strategies are investigated to account for the effect of a large percentage of new customers or high bounce rates. Subsequently, in data collection we identify probable misleading interactions in the raw data, propose a robust method of tracking unique visitors, and accurately attributing the buy influence for combo products. Lastly, user-interface issues discuss the possible problems caused due to the recommendation widget’s positioning on the e-commerce website and the stringent conditions that should be imposed when utilizing data from the product listing page. This collective methodology results in an exact and valid estimation of the customer’s interactions influenced by the recommendation model in the context of standard industry metrics such as Click-through rates, Buy-through rates, and Conversion revenue.

Machine learning has become an increasingly ubiquitous technology, as big data continues to inform and influence everyday life and decision-making. Currently in healthcare, as well as in most other industries, the two most prevalent machine learning paradigms are supervised learning and transfer learning. Both practices rely on large-scale, manually annotated datasets to train increasingly complex models. However, the requirement of data to be manually labeled leaves an excess of unused, unlabeled data available in both public and private data repositories. Self-supervised learning (SSL) is a growing area of machine learning that has the ability to take advantage of unlabeled data. Contrary to other machine learning paradigms, SSL algorithms create artificial supervisory signals from unlabeled data and pretrain algorithms on these signals. The aim of this review is two-fold: firstly, we provide a formal definition of SSL, divide SSL algorithms into their four unique subsets, and review the state-of-the-art published in each of those subsets between the years of 2014-2020. Second, this work surveys recent SSL algorithms published in healthcare, in order to provide medical experts with a clearer picture of how they can integrate SSL into their research, with the objective of leveraging unlabeled data.

Synthetic fuels play an important role in the defossilization of future aviation transport. To reduce the ecological impact of remote airports due to long range transportation of kerosene, a decentralized on-site-production of synthetic paraffinic kerosene is applicable, preferably as near-drop-in fuel or alternatively as blend. One possible solution for such a production of synthetic kerosene is the Power-to-Liquid process. The basic development of a simplified plant layout addressing the specific challenges of a decentralized kerosene production which differ from most current approaches for infrastructural well-connected regions is described. The decisive influence of the Fischer-Tropsch synthesis on the PtL process is shown by means of a steady-state reactor model which was developed in Python and serves as basis for further development of a modular environment able to represent entire process chains. The reactor model is based on reaction kinetics according current literature. The effects of adjustments of the main operation parameters on the reactor behavior are evaluated and the impacts on up- and downstream processes are described. The results prove the governing influence of the Fischer-Tropsch reactor on the PtL process and show its flexibility regarding the desired product fraction output, which makes it an appropriate solution for a decentralized kerosene production.

Accurate estimates of daily rainfall are essential for understanding and modeling the physical processes involved in the interaction between the land surface and the atmosphere. In this study, daily satellite soil moisture observations from the Advanced Microwave Scanning Radiometer - Earth Observing System (AMSR-E) generated by implementing the standard NASA- algorithm are employed for estimating rainfall, firstly, through the use of recently developed approach, SM2RAIN (Brocca et al., 2013) and, secondly, the nonlinear autoregressive network with exogenous inputs (NARX) neural modelling at five climate stations in the Karkheh river basin (KRB), located in southwest Iran. In the SM2RAIN method, the period 1 January 2003 to 31 December 2005 is used for the calibration of algorithm and the remaining 9 months from 1 January 2006 to 30 September 2006 is used for the validation of the rainfall estimates. In the NARX model, the full study period is split into a training (1 January 2003 to 31 September 2005) and a testing (1 September 2005 to 30 September 2006) stage. For the prediction of the rainfall as the desired target (output), relative soil moisture changes from AMSR-E and measured air temperature time series are chosen as exogenous (external) inputs in NARX. The quality of the estimated rainfall data is evaluated by comparing it with observed rainfall data at the five rain gauges in terms of the correlation coefficient R, the RMSE and the statistical bias. For the SM2RAIN method, R ranges between 0.44 and 0.9 for all stations, whereas for the NARX- model the values are generally slightly lower. Moreover, the values of the bias for each station indicate that although SM2RAIN is likely to underestimate large rainfall intensities, due to the known effect of soil moisture saturation, its biases are somewhat lower than those of NARX. In conclusion, the results of the present study show that with the use of AMSR-E soil moisture products in the physically based SM2RAIN- algorithm as well as in the NARX neural network, rainfall for poorly gauged regions can be fairly predicted.

The majority of E-commerce transactions reveal private information such as customers' identities, order contents, and payment information during the transaction. Other personal information such as health conditions, religion, and even ethnicity may be also deduced. Even when deploying electronic cryptocurrencies such as Bitcoin, anonymity cannot be fully guaranteed. Also, many anonymous payment schemes suffer from possible double spending circumstances. E-commerce privacy is basically a difficult problem as it involves parties with concurring interests. Three major e-commerce requirements are highly difficult to resolve: anonymous purchase, anonymous delivery, and anonymous payment. This work presents a possible e-commerce system addressing all three anonymity requirements for electronic-items business on open networks. The system offers anonymous entities authentication mechanisms up to completing a fair anonymous e-commerce transaction. The system is based on deploying a physically clone-resistant hardware token for each relevant involved party. The tokens are made clone-resistant by accommodating a Secret Unknown Cipher (SUC) in each hardware-token as a digital PUF-like identity. A set of novel generic system-setups for units, protocols and e-commerce schemes is introduced. The proposed anonymization is basically attained by virtually-replacing relevant e-commerce entities by low-cost, unique and clone-resistant tokens/units using SUCs. The units act as trustable anonymous, authenticated and non-replaceable entities monitored by their acting users.

While it is not new that Nigeria is challenged by a huge infrastructure deficit, the COVID-19 pandemic has exposed the country’s comatose healthcare system. Given the country’s dwindling revenue, massive debt profile and the inability of the public-sector to efficiently manage public facilities in the country, this paper examines how the public-private partnership model of infrastructure procurement can be deployed as a solution for Nigeria’s healthcare crisis. In addition to the above, this paper takes a look at how a partnership with the private sector can aid Nigeria’s quest towards achieving healthcare-related Sustainable Development Goals. The paper also considers two healthcare-based projects as case studies to serve as lessons for future projects in the country. Among others, the paper recommends a holistic long-term solution for the country’s healthcare needs.

Educational data-mining is an evolving discipline that focuses on the improvement of self-learning and adaptive methods. It is used for finding hidden patterns or intrinsic structures of educational data. In the arena of education, the heterogeneous data is involved and continuously growing in the paradigm of big-data. To extract meaningful information adaptively from big educational data, some specific data mining techniques are needed. This paper presents a clustering approach to partition students into different groups or clusters based on their learning behavior. Furthermore, personalized e-learning system architecture is also presented which detects and responds teaching contents according to the students’ learning capabilities. The primary objective includes the discovery of optimal settings, in which learners can improve their learning capabilities. Moreover, the administration can find essential hidden patterns to bring the effective reforms in the existing system. The clustering methods K-Means, K-Medoids, Density-based Spatial Clustering of Applications with Noise, Agglomerative Hierarchical Cluster Tree and Clustering by Fast Search and Finding of Density Peaks via Heat Diffusion (CFSFDP-HD) are analyzed using educational data mining. It is observed that more robust results can be achieved by the replacement of existing methods with CFSFDP-HD. The data mining techniques are equally effective to analyze the big data to make education systems vigorous.

The purposes of this study are to introduce the concept of Service Quality (SQ) in E-Supply Chain Management (E-SCM) and its impact on increasing Customer Satisfaction (CS) and provide insightful enhancements to the literature. In addition, the paper also examines the influence of SQ of E-SCM on CS in online shopping. After a comprehensive literature review, four key factors for measuring the E-Supply Chain (Process Control, Interaction with Supplier, Management Support, and Focus on Customers), four key factors for measuring CS (Informing Customers, Attention to Customers’ Needs, Staff Performance Accuracy, and Easy Access to Services), and four factors for measuring the quality of identification services (Assurance, Accountability, Tangibility and Reliability) were selected. The proposed conceptual model was then presented. This model was validated by data collected through a survey of 150 respondents in order to identify customer satisfaction, including that of customers of online websites in Iran. The sample data was analyzed using SPSS21, after which the interrelationships between the model and factors were examined based on the Partial Least Square-Structural (PLS). Model fit indices were then calculated for the dataset. The proposed model was validated using factor analysis and structural equation modeling techniques. The results indicated that E-SCM has a direct impact on CS. The effect of SQ was also confirmed. A positive and significant relationship was identified between E-SCM and CS, E-SCM and SQ, as well as SQ and CS (P> 0.05). The first limitation was to convince respondents to cooperate with the researchers. The second one was the lack of research-related background due to the subject being relatively new. This study, to the best of the authors’ knowledge, is the first empirical analysis on the CS assessment of SQ of E-Supply Chain in online shopping. This important link to online shopping has rarely been explored. It is expected that by filling this gap, this study will help in strengthening online shopping, which needs a change in the marketing area.

It is not new in medical history to propose a global concern to be classified as a disease. Defining a concern into disease allows to assign ethical responsibilities to develop powerful and effective interventions. It also allow to appropriate distribute the resources uniformly economically and morally. In 2003, World Health Organization report stated that 30-50 % of patients do not take their medications as prescribed associated with morbidity, mortality and health cost. It was considered a global concern, however, irrespective of decades of researches conducted on medication adherence, we are still unable to state that medication adherence issues are being resolved. In this review, we have described few apprehensions in current understandings of medication adherence that have limited its research. We have also proposed medication adherence as disorder and provided its’ definition and classification

— Big Data analytics has come a long way since its inception. This field is growing day by day. With the advent of large handling capacity of computational analysis of modern computing systems as well as Internet of Things (IoT), this field has revolutionized the way we think about data. It has influenced the major domains such as healthcare, automobile, computing, climatology, and space communications. Of late, the health care sector has been largely influenced by this. This communication deals with the areas of healthcare where big data analytics has been largely influential. Encompassing the basics of Big Data Analytics (BDA) driven by IoT, the applications of it in healthcare sector are outlined, accompanied by future expectations. Additionally, it also presents a comprehensive analysis of recent application with special reference to Covid-19 in this sector.

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

The burnout syndrome, which affects so many healthcare workers, has recently awakened wide interest due to the severe repercussions related to its appearance. Even though job factors are determinant to its development, not all individuals exposed to the same work conditions show burnout, which demonstrates the importance of individual variables such as personality. The purpose of this study was to determine personality characteristics of a sample of nursing professionals based on the Big Five model, and then, having determined the personality profiles, analyze the differences in burnout and engagement based on those profiles. The sample was made up of 1236 nurses. An ad hoc questionnaire was prepared to collect the sociodemographic data, and the Brief Burnout Questionnaire, the Utrecht Work Engagement Scale and the Big Five Inventory-10 were used. The results showed that the existence of burnout in this group of workers, is associated negatively with extraversion, agreeableness, conscientiousness and openness to experience, and positively with the neuroticism personality trait. These personality factors showed the opposite pattern with regard to engagement. Three different personality profiles were also found in nursing personnel, in which professionals who had a profile marked by strong neuroticism and low scores on the rest of the personality traits where those who were most affected by burnout.

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

Exploring the dynamic behavior of cellular metabolism requires a standard laboratory method that guarantees rapid sampling and extraction of the cellular content. We propose a versatile sampling technique applicable to cells with different cell wall and cell membrane properties. The technique is based on irreversible electroporation with simultaneous quenching and extraction by using a microfluidic device. By application of electric pulses in the millisecond range, permanent lethal pores are formed in the cell membrane of Escherichia coli and Saccharomyces cerevisiae, facilitating the release of the cellular contents; here demonstrated by the measurement of glucose-6-phosphate and the activity of the enzyme glucose-6-phosphate dehydrogenase. The successful application of this device was demonstrated by pulsed electric field treatment in a flow-through configuration of the microfluidic chip in combination with sampling, inactivation, and extraction of the intracellular content in a few seconds. Minimum electric field strengths of 10 kV/cm for E. coli and 7.5 kV/cm for yeast S. cerevisiae were required for successful cell lysis. The results are discussed in the context of applications in industrial biotechnology, where metabolomics analyses are important.

Purpose: The ongoing COVID-19 crisis has created the need for social distancing between medical staff and patients, therefore, healthcare robotics is increasingly important as regards infectious control. The purpose of this study was to design and fabricate a remote controlled transport robot that could provide an optimum technology base for developing countries, having dual functions of telepresence and delivery operations inside or outside buildings, is easy to assemble and also easily able to be cleaned using standard chemical agents.Methods: This machine was designed and fabricated to incorporate two main functions; delivery and telepresence. The robot consists of a base frame, DC motors for driving and steering systems, actuator motor for driving wheel elevation, Wi-Fi AP/Repeater, network camera, and a necessary a back-up power system.Results: This robot can be used both indoors and outdoors. It can carry loads of more than 80 kg. The machine can cross obstacles greater than 3 cm. It can be cleaned by disinfectant agents. An actuator motor can lift the driving wheels above the surface to prevent gear damage. Conclusion: This article demonstrates the concept of a healthcare telepresence and delivery robot that can provide distancing during the present COVID-19 crisis, using optimum technology for low and middle-income countries. In the future, the researcher should consider development of the delivery controls, combined with the telepresence system using the internet of things, to improve the navigation system, the manipulator system for supporting multi-floor transportation, and also other multi-functional purposes.

COVID-19 has been a major issue in most countries throughout the world with 213 countries being affected till date due to the disease. The pandemic has raised concerns over the healthcare facilities available in various countries and question the government decisions made during this period of outbreak. Despite having the best healthcare facilities several countries across Europe and America have found it difficult to contain the disease outbreak questioning the available solutions to contain an area. This paper focuses on presenting information on solutions available to control outbreaks in order to prevent another pandemic occurring in the future. The paper also highlights the strategies and plans implemented by various governments who have been successful in combatting the disease with minimum damage. By using available resources such as technology, scientific innovation and digitalized healthcare this paper focuses on providing solutions which are already available to be utilized in the right manner.

The aim of the study was to determine the possibility of suppression of the prostaglandin synthesis by new derivatives of N-phenylanthranilic acids; they inhibit the activity of the microsomal prostaglandin E synthase-1 (mPGES-1) enzyme using the method of a flexible molecular docking. For the docking studies the crystallographic structural models with high resolution from Protein Data Bank were used: mPGES-1 in the complex with glutathione (pdb code 4AL0). A flexible molecular docking was carried out using the Molecular Operating Environment (MOE) software package. According to the results of the docking studies four scoring functions were calculated (Affinity dG Scoring, Alpha HB Scoring, London dG Scoring, GBVI/WSA dG Scoring). The values of the scoring functions calculated indicate the thermodynamic probability and energy favorability of forming complexes between molecules of the substances under research and the specified receptor, in which arrangement of ligands in the active site of the receptor and residues of amino acids of side chains are of similar geometry and types of binding of the known inhibitors of mPGES-1 determined on the basis of the crystallographic studies.

The burden of COVID-19 pandemic on health systems and the physical and mental health of healthcare workers (HCWs) has been substantial. This cross-sectional study aims to assess the effects of Covid-19 on the psychological wellbeing of mental health workers who provide care to a vulnerable patient population that have been particularly affected during this crisis. A total of 387 HCWs from across a large urban mental health service completed a self-administered questionnaire consisting of socio-demographic, lifestyle and work-based information and validated psychometric scales. Depression and anxiety were measured using the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder Scale (GAD-7) respectively, sleep problems with the Athens Insomnia Scale (AIS), burnout with the Maslach Burnout Inventory (MBI) and resilience with the Resilience Scale-14 (RS-14). Multivariable logistic regression analysis was performed to determine potential mediating factors. Prevalence of burnout was notable, with 52% recording moderate/severe in Emotional Exhaustion, 19.5% moderate/severe in Depersonalisation and 55.5% low/moderate Personal Accomplishment. Over half of all respondents (52%) experienced sleep problems; the presence of depressive symptoms was a significant predictor of insomnia. An increase in potentially harmful lifestyle changes, such as smoking, alcohol consumption and over-eating was also observed. However, high Resilience was reported by 70% of the sample and the importance of this is highlighted. Female gender was associated with increased levels of depression and emotional exhaustion while those with a history of mental health conditions were most at risk of affective symptoms, insomnia and burnout. Overall, our study revealed considerable levels of psychological distress and maladaptive coping strategies but also resilience and satisfaction with organizational support provided. Findings can inform tailored interventions in order to mitigate vulnerability and prevent long-term psychological sequelae.

Health information technology has been widely used in healthcare, which has contributed a huge amount of data. Health data has four characteristics: high volume; high velocity; high variety and high value. Thus, they can be leveraged to i) discover associations between genes, diseases and drugs to implement precision medicine; ii) predict diseases and identify their corresponding causal factors to prevent or control the diseases at an earlier time; iii) learn risk factors related to clinical outcomes (e.g., patients’ unplanned readmission), to improve care quality and reduce healthcare expenditure; and iv) discover care coordination patterns representing good practice in the implementation of collaborative patient-centered care. At the same time, there are major challenges existing in data-driven healthcare research, which include: i) inefficient health data exchanges across different sources; ii) learned knowledge is biased to specific institution; iii) inefficient strategies to evaluate plausibility of the learned patterns and v) incorrect interpretation and translation of the learned patterns. In this paper, we review various types of health data, discuss opportunities and challenges existing in the data-driven healthcare research, provide solutions to solve the challenges, and state the important role of the data-driven healthcare research in the establishment of smart healthcare system.

Analyzing the cells in various body fluids can greatly deepen the understanding of the mechanisms governing the cellular physiology. Because of the variability of physiological and metabolic states, it is important to be able to perform such studies on individual cells. Therefore, we developed an optofluidic system in which we precisely manipulated and monitored individual cells of Escherichia coli. We used laser tweezers Raman spectroscopy (LTRS) in a microchamber chip to manipulate and analyze individual E. coli cells. We subjected the cells to antibiotic cefotaxime, and we observed the changes by the time-lapse microscopy and Raman spectroscopy. We found observable changes in the cellular morphology (cell elongation) and in Raman spectra, which were consistent with other recently published observations. We tested the capabilities of the optofluidic system and found it to be a reliable and versatile solution for this class of microbiological experiments.

Background: Health Care Workers (HCWs) are at increased risk of acquiring and transmitting COVID-19 infection. Also, they present role models for communities with regards to attitudes towards COVID-19 vaccination. Hence, hesitancy of HCWs towards vaccination can crucially affect the efforts aiming to contain the pandemic. Previously published studies paid little attention to HCWs in Arab countries, which has a population of over 440 million. Objectives: to assess the rates of COVID-19 vaccine hesitancy in Arabic-speaking HCWs residing in and outside the Arab countries, and their perceived barriers towards vaccination. Methods: a cross-sectional study based on an online survey was conducted from 14-Jan 2021 to 29-Jan 2021, targeting Arabic-speaking HCWs from all around the world. Results: the survey recruited 5,708 eligible participants (55.6% males, 44.4% females, age 30.6±10 years) from 21 Arab countries (87.5%) and 54 other countries (12.5%). Our analysis shows a significant rate of vaccine hesitancy among Arabic-speaking HCWs residing in and outside Arab countries (25.8% and 32.8%, respectively). The highest rates of hesitancy were among participants from the west region of the Arab world (Egypt, Morocco, Tunisia, and Algeria). The most cited reasons for hesitancy were concerns about side effects and distrust in vaccine expedited production and healthcare policies. Factors associated with higher hesitancy included age of 30-59, previous or current suspected or confirmed COVID-19, female gender, not knowing the vaccine type authorized in the participant’s country, and not regularly receiving the influenza vaccine. Conclusion: this is the first large-scale, multinational, post-vaccine-availability study on COVID-19 vaccine hesitancy among HCWs. It reveals high rates of hesitancy among Arab-speaking HCWs. Unless addressed properly, this hesitancy can impede the efforts for achieving widespread vaccination and collective immunity.

This research assess the effects of training program based on the usage of the digital learning objects in teaching practice at the Northern Borders University staff. E Assessment through the tablets and smart phones and the teachers’ attitudes towards such way of evaluation is the major objective of this study as the researcher expects that the assessment mechanism in the university through utilization of tablets and smart phones and its application will inevitably bring in a systematic improvement in the assessment and evaluation process of the curricula. Moreover, making use of the e learning objects in training will make a significant change in e training program of the university. Hence, the researcher has chosen voluntary random samples from the university teaching staff (men\women) from various different faculties (medicine, medical sciences, science, education and arts, business administration, home economics, and science and literature). These samples included 300 members of the teaching staff. In a group of 20 to 25 members, a personal training was conducted regarding the usage of tablets and smart phones and its applications in the assessment process. Each group participated by producing a complete e-assessment for their students in the Northern Borders University and by the e learning system i.e. Blackboard and Question Mark. The research also depends on the semi-experimental design of multiple groups and on testing the groups’ pre and post achievement tests. In addition, the research identifies the level of the university teaching staff in using the tablets and the smartphones and its applications in the assessment process by the note card that the individuals have during the test.

Apoptosis and cell cycle arrest induction are targeted in the strategy of cancer therapy. Furthermore, bacterial toxin such as shiga-like toxin producing Escherichia coli has been suggested to be used as novel therapeutic agent against tumor malignancies either as independent anti-neoplastic agents or in combination treatment with chemo or radiotherapy. The aim of study was to investigate the potency of shiga-like toxin originated from local strains of E. coli O157:H7 as a new cancer therapy. As many as 10 culture cells T47D cell line were subjected by crude extract Shiga like toxin originated from five local isolates of E. coli O157:H7 i.e. KL-48(2), SM-25(1), SM-7(1), DS-21(4), and one isolate ATCC 43894 as a control with IC50 doses, respectively. The treatment was observed for 24 h, with two replications. An FITC-Annexin V and PI assay was used to observe apoptosis and necrosis effect, and simultaneously with cell cycle analysis using propidium iodide (PI) staining. Results of study showed T47D cell treated with Shiga-like toxin from local strain KL-48 (2) show the lowest viable cell, followed by SM 7(1), ATCC 43894, SM-25(1), DS-21(4) and contrary with control with each percentages as 15.20, 16.36, 22.17, 22.64, 33.86, and 94.36%, respectively. The results were also confirmed by the induction of the cell cycle arrest in phase G0-G1 as inactive phase, i.e. 66.41, 63.37, 61.52, 55.36 and 47.28% for T47D cell treated with toxin of KL-48(2), ATCC 43894, SM 25(1), SM 7(1), and DS 21(4), respectively. These results show tendency deleterious effect of Shiga-like toxin from local isolates on T47D cell, so that concluded they have potency as a good anticancer drug in Gb3-expressing breast cancer.

Immunosensors have been widely developed to use antibodies to detect a pathogen of interest; it is interesting to look at the effect of nonspecific antibody binding to E. coli using electrochemical methods. IgG antibody not specific to E. coli O157:H7 was crosslinked onto a screen-printed carbon electrode. The presence of E. coli at 4, 4 × 10², 4 × 10⁵, and 4 × 10⁸ CFU/mL on the electrode surface was detected via linear sweep voltammetry (LSV) and electrochemical impedance spectroscopy (EIS). Current transfer at both electrodes was reduced as the concentration of bacteria increased; however, the calibration of number of cells to decreased current was nonlinear for IgG-modified electrodes. The nonlinearity is confirmed by EIS measurements which showed highest impedance at 4 CFU/mL E. coli when impedance should be the lowest. FESEM images showed higher binding of cells when IgG is present compared to electrodes with reduced graphene oxide (rGO) alone. Electrodes with rGO alone show less attachment of E. coli, with EIS showing a linear calibration profile, while LSV shows not much difference in current values for all concentrations aside from the highest concentration. These results suggest that nonspecific binding can provide false signals in electrochemical measurements, and it is crucial to provide proper controls.

Electronic-health applications rely on large computer networks to facilitate patients' information access and to communicate various types of medical data. To examine the effectiveness of these networks, the traffic parameters need to be analysed. Due to quantity of the information carrying packets, examining each packet's transmission parameters individually is not practical, especially when a real time operation is needed. Sampling allows a subset of packets that accurately represents the original traffic to be formed. In this study an adaptive sampling method based on regression and fuzzy inference system was developed. It dynamically updates the number of packets sampled by responding to the traffic variations. Its performance was found to be superior to the conventional non-adaptive sampling methods.

Candida albicans as an opportunistic pathogen exploits the host immune system and causes a variety of life-threatening infections. The polymorphic nature of this fungus gives it tremendous advantage to breach mucosal barriers and cause a variety of oral and disseminated infections. Enterococcus faecalis, another opportunistic pathogen co-exists with C. albicans in several niches in the human body, including the oral cavity and gastrointestinal tract. However, interactions between E. faecalis and C. albicans on oral mucosal surfaces remain unknown. Here, for the first time, we comprehensively characterized the interactive profiles between laboratory and clinical isolates of C. albicans (SC5314 and BF1) and E. faecalis (OG1RF and 846) on an organotypic oral mucosal model. Our results demonstrated that the two species formed robust biofilms on the mucosal tissue surface with profound surface erosion and fungal invasion. Specifically, this effect was more pronounced in the laboratory isolates than in the clinical isolates. Notably, several genes of C. albicans involved in tissue adhesion, hyphal formation, fungal invasion, and biofilm formation were significantly upregulated in the presence of E. faecalis. This study highlights the strain-dependent cross-kingdom interactions between E. faecalis and C. albicans on oral mucosa, demonstrating the requisite to study more substrate-dependent polymicrobial interactions.

This work investigated the effects of manufacturing variations including coil resistance, initial pod mass, and e-liquid color on coil lifetime and aerosol generation of Vuse ALTO pods. Random samples of pods were used until failure (where e-liquid was consumed, and coil resistance increased to high value indicating a coil break). Initial coil resistance, initial pod mass, and e-liquid net mass ranged between 0.89 to 1.14 [], 6.48 to 6.61 [g], and 1.88 to 2.00 [g] respectively. Coil lifetime with light color e-liquid was (mean) = 149, (standard deviation) = 10.7 puffs while pods with dark color e-liquid was = 185, = 22.7 puffs with a difference of ~36 puffs (p &lt;0.001). Total mass of e-liquid consumed until coil failure was = 1.93, = 0.035 [g]. TPM yield per puff of all test pods for the first session (brand new pods) was = 0.0123, = 0.0003 [g]. During usage, TPM yield per puff of pods with light color e-liquid was relatively steady while it was continuously decreasing for pods with dark e-liquid. Coil lifetime and TPM yield per puff were not correlated with either variation in initial coil resistance or variation in initial pod mass. The absence of e-liquid in the pod is an important factor in causing coil failure. Small bits of the degraded coil could be potentially introduced to the aerosol. There is a potential correlation of e-liquid color with both coil lifetime and TPM yield per puff. Change of e-liquid color might have been a result of oxidation which changed some nicotine into nicotyrine.

The use of Learning Management Systems (LMS) has had a rapid growth over the last decades. Great efforts have been recently made to assess the level of performance of the students online due to the COVID-19 pandemic. Faculty members with limited experience in the use of LMS such as Moodle, Edmodo, MOOC, Blackboard and Google Classroom can have some problems creat-ing online tests. In this work, a new plugin for Moodle is presented: FastTest PlugIn. This plugin is based on a Microsoft® Excel spreadsheet and it can be used to export questions to Moodle. Us-ers of FastTest PlugIn can create question pools in an easy and intuitive way. A literature review about plugins used to import/export questions in Moodle is carried out. Then, the characteristics of FastTest PlugIn are presented. At the end, the characteristics of the main plugins found in the literature are discussed and compared with the ones of FastTest PlugIn.

The experience gained over the last hundred years clearly indicates that two groups of viruses represent the main risk for the development of highly transmissible epidemics and pandemics in the human species: influenza viruses and coronaviruses (CoV). Although the search for viruses with pandemic potential in the environment may have an important predictive and monitoring role, it is still based on empirical methodologies, mostly translated from the clinic and not fully validated for environmental matrices.As far as the SARS-CoV-2 pandemic, currently underway, is concerned, environmental monitoring activities aiming at checking the presence of SARS-CoV-2 in wastewater can be extremely useful to predict and control the diffusion of the disease. For this reason, the present study aims to evaluate the SARS-CoV-2 diffusion by means of a wastewater-based environmental monitoring developed in Piedmont, N-W Italy, during the pandemic second and third waves. Sampling strategies, sampling points, sample pre-treatments and analytical methods have been developed and validated to give representative and reliable results. The outcomes highlighted by the present paper demonstrate a strong correlation between SARS-CoV-2 concentration in untreated wastewater and epidemic evolution in the considered areas as well as a predictive potential that could provide decision-makers with indications for establishing effective policies to mitigate the effects of the ongoing pandemic and to prepare response plans for future pandemics that could certainly arise in the decades to come.Moreover, the study highlights the potential of wastewater treatment plants to degrade the genetic material referable to SARS-CoV-2 as well.In conclusion, the preliminary data reported in the present paper, although they need to be complemented by further studies considering other geographical regions as well, are very promising.

Wound infections evidently appeared in times of World War I that accounted a significant mortality and morbidity rate among injured soldiers. Currently, around 11 million people worldwide require medical treatment for wound infections and 300,000 die every year due to untreated wound infection. The extensive use of antibiotics to treat wound infection leads to emerging new microbial strains that are resistant to many antibiotics. There is a growing concern on the emergence and re-emergence of drug-resistant pathogens such as multi-resistant bacterial strains. Hence, the development of new antimicrobial compounds or the modification of those that already exist to improve antibacterial activity is a high priority area of research. During the past few decades, nanotechnology has arisen with new promising technology for synthesis of nanobiomaterials. Metallic nanoparticles (NPs) are considered as new alternative treatment with superior antibacterial activity. In this study, new formulation of titanium oxide (TiO2) NPs with different sizes were synthesized and characterized. Genotoxicity, mutagenicity and antibacterial activities of TiO2 NPs against the causative agents of wound infection were investigated. Antibacterial activity of TiO2 NPs was conducted against three ATCC ® bacterial strains: methicillin-resistant Staphylococcus aureus (MRSA), Escherichia coli and Pseudomonas aeruginosa. The results clearly illustrate a superior antibacterial activity of all newly formulated TiO2 NPs against the most causative agents of wound infection. Most of our TiO2 NPs showed non-genotoxic and non-mutagenic results at the maximum concentrations. Findings of this study will enhance the future of the therapeutic strategies against the resistant pathogenic strains that cause wound infections.

The epithelial-mesenchymal (E/M) hybrid state has emerged as an important mediator of elements of cancer progression, facilitated by epithelial mesenchymal plasticity (EMP). We review here evidence for the presence, prognostic significance, and therapeutic potential of the E/M hybrid state in carcinoma. We further assess modelling predictions and validation studies to demonstrate stabilised E/M hybrid states along the spectrum of EMP, as well as computational approaches for characterising and quantifying EMP phenotypes, with particular attention to the emerging realm of single-cell approaches through RNA sequencing and protein-based techniques.

In the wake of the novel coronavirus, SARS-CoV-19, the world has undergone a critical situation in which grave threats to global public health emerged. Among human populations across the planet, travel restraints, border enforcement measures, quarantine, and isolation provisions were implemented in an attempt to control and limit the spread of the contagion. Decisions on how to implement and enforce various control policies should be determined based on available real-world evidence and theoretical prediction. In this study, we propose a novel exportation- importation epidemic model associated with the quarantine and hospitalized-isolation policies by considering the two-body system: a source country of a contagious disease and a neighboring country that is initially disease-free. The model is first applied to the original COVID-19 data in China, Italy, and the Republic of Korea (ROK) and observed through consistent fitting results with equivalent goodness-of-fit. Then, the data are estimated per the fitting parameters. Driven by these parametric settings and considering the normalized population, the numerical analysis, and epidemiological exploration, this work further elucidates the substantial impact of quarantine policies, healthcare facilities, and the public counter-compliance effect.

Technology advancements are evident in the healthcare field; numerous new opportunities and applications have emerged during the last years based on embedded intelligence and related to real-time diagnosis of medical issues, tele-care and telemedicine, remote monitoring of patients, computer-assisted “smart” transportation in case of emergencies, as well as new types of remotely controlled surgical operations. This paper aims to provide an overview of the application of embedded intelligence in the field of healthcare; it gathers the main critical requirements, related technologies and research advancements up to date, and it presents the most important challenges that are yet to be faced. The main focus is given in the development and optimization of Body Area Networks (BANs) based on advanced embedded sensing devices, the optimization of smart gateways in such networks, and the provision of holistic scalable and secure solutions in the healthcare domain. In addition, the paper presents two principal use cases that stem from the combination of novel information and communication technologies with classic healthcare practices, explaining the functional and non-functional requirements, as well as the mixed criticality characteristics of the associated systems.

With the diversified development of media forms, livestreaming e-commerce has become a new sales model. Unlike the traditional sales model, this paper constructs a three-party game model composed of manufacturers, social media influencers and consumers based on the livestreaming model. It explores the equilibrium strategy selections of each participant in the supply chain system. In analyzing the evolutionary game stability of each participant, this paper obtains the equilibrium strategy and stability factors by analysis of the income and expenditure matrix. It uses the simulation model to analyze reasons for strategy selections of different game participants in the livestreaming e-commerce model. The results show that the strategies of manufacturers, social media influencers and consumers' selections have different impacts on their decision-making mechanism, and man-ufacturers are more sensitive to consumers' active participation in livestreaming e-commerce.

: E-commerce sales surge represents a huge challenge for urban freight transport. Parcel lockers constitute a valid solution for addressing the challenges home deliveries imply. In fact, eliminating courier-consumer contact (also relevant for health-related issues, as made evident by COVID19 pandemic) and delivering in few predefined places might help coping with missed deliveries substantially. Furthermore, this option enables consolidated shipping and reducing delivery trip costs. This paper analyses and compares consumers’ preferences for alternative collection strategies. It investigates home delivery vs parcel locker use and forecasts their future market shares. This is performed based on both customers’ socio-economic variables and attributes characterising these alternative logistic fulfilment strategies. The case study considered rests upon a stated preference survey deployed in the city of Rome. The investigation specifically targets young people (i.e., population under 30 years) since they represent early adopters. Discrete choice models allow both quantifying the monetary value of parcel lockers attributes (i.e., willingness to pay measures) and estimating the potential demand for this innovative delivery scheme. Results show that distance and accessibility are the main choice determinants. Furthermore, there is an overall high propensity to adopt parcel lockers. This research can support policymakers when implementing such solutions.

The novel coronavirus pneumonia epidemic is still raging around the world. Therefore, during the period of a global pandemic, maintaining the normal circulation of medicine and health fields is the key to fight against the epidemic. This paper based on relevant data such as the export volume of cross-border e-commerce in Hangzhou, China from 2015 to 2019, the article uses system dynamics modeling to explore the impact of overseas warehouse services on cross-border e-commerce export transactions. Studies have shown that the introduction of overseas warehouses has significantly improved customer satisfaction and improved the quality of cross-border logistics services, which has a positive impact on cross-border e-commerce export transactions. Through sensitivity analysis, it can be seen that under the same conditions, the efficiency of customs clearance has the greatest impact on overseas warehouse services. Therefore, when allocating various investments in overseas warehouses, you can favor the customs clearance process to enhance the competitiveness of the cross-border e-commerce market and provide a feasible experience for healthcare supplies export from cross-border e-commerce.

In the present work we study the properties of geodesic sub-$ (\alpha,b,s) $-preinvex functions on Hadamard manifolds and establish some basic properties in both general and differential cases. Further, we study sufficient conditions of optimality and proved some new inequalities under geodesic sub-($ \alpha,b,s $)-preinvexity.