Hydrological models have been widely used for many purposes in water sector projects, including streamflow prediction and flood risk assessment. Among the input data used in such hydrological models, the spatial-temporal variability of rainfall datasets has a significant role on the final discharge estimation. Therefore, accurate measurements of rainfall are vital. On the other hand, ground-based measurement networks, mainly in developing countries, are either nonexistent or too sparse to capture rainfall accurately. In addition to in-situ rainfall datasets, satellite-derived rainfall products are nowadays available globally with high spatial and temporal resolution. An innovative approach called SM2RAIN that estimates rainfall from soil moisture data has been applied successfully to various regions. In this study, firstly soil moisture content derived from the Advanced Microwave Scanning Radiometer for the Earth observing system (AMSR-E) is used as input into the SM2RAIN algorithm to estimate daily rainfall, SM2R-AMSRE, at different sites in the Karkheh river basin (KRB), southwest Iran. Secondly, the SWAT (Soil and Water Assessment Tool) hydrological model is applied to simulate runoff using both ground-based observed rainfall and SM2R-AMSRE rainfall as input. The results reveal that the SM2R-AMSRE rainfall data are, in most cases, in good agreement with ground-based rainfall, with correlations R ranging between 0.58 and 0.88, though there is some underestimation of the observed rainfall, due to soil moisture saturation, not accounted for in the SM2RAIN equation. The subsequent SM2R-AMSRE- SWAT- simulated monthly runoff reproduces well the observations at the 6 gauging stations (with coefficient of determination, R² > 0.72), though with slightly worse performances in terms of bias (Bias) and root-mean-square error (RMSE) and, again, some systematic flow underestimation than the SWAT model with ground-based rainfall input. Furthermore, rainfall estimations of two satellite products of the Tropical Rainfall Measuring Mission (TRMM), 3B42 and 3B42RT, are used in the calibrated SWAT- model. The monthly runoff obtained with 3B42- rainfall have 0.39< R2 < 0.70 and are slightly better than those obtained with 3B42RT- rainfall, but not as good as the SM2R-AMSRE- SWAT- simulated runoff above. Therefore, in spite of the afore-mentioned limitations, using SM2R-AMSRE rainfall data in a hydrological model like SWAT, appears to be a viable approach in basins with limited ground-based rainfall data.

WHO was informed on 31 December 2019 of cases of unknown cause pneumonia in Wuhan City, China. On 7 January 2020 Chinese authorities reported a novel coronavirus as the cause and was temporarily labeled "2019-nCoV." Coronaviruses (CoV) are a wide family of viruses which cause diseases ranging from common cold to more serious illnesses. A novel coronavirus (nCoV) is a new strain not previously found in humans. Countries around the globe have stepped up their surveillance to quickly detect any new 2019-nCoV cases. Blockchain is developing into a safe and efficient network for secure data sharing in applications such as the financial industry, operations management, food industry, energy market, the Internet of Things and healthcare. In this paper, we are using blockchain technology as a mean to share authentic data, tracking of relevant information and help speed up the treatment process. At the same time it will preserve person’s identity. Timely deployment and suitable implementation of the proposed model have the opportunity to curb COVID-19 transmissions and associated mortality, especially in environments with inadequate access to testing facilities. This work will also facilitate in the treatment of other infectious diseases. Smart contract have been designed and implemented using the ethereum blockchain platform which has been presented in this paper. This work would facilitate multiple stakeholders who are involved within the medical system to curb the transmission of this disease.

The Internet of Things (IoT) has a growing presence in society's daily lives. These lightweight devices can be easily deployed and maintained, enabling extensive adoption in different environments. Furthermore, one of the most promising areas for using IoT devices is healthcare, comprising devices referred to as the Internet of Medical Things (IoMT). Several examples of healthcare services are supported by IoMT devices, e.g., continuous health monitoring. Conversely, there is an increasing concern with the cybersecurity aspects of these devices, and several attacks against IoT infrastructures have been launched in the past few years. These cybersecurity concerns also apply to healthcare applications, where the tradeoff between the benefits and security of IoMT devices must be observed. Given the complexity and amount of data IoMT network traffic generates, advanced methods become especially useful in these environments. Although Machine Learning (ML) brings various techniques and solutions to improve cyberattack detection, prevention, and mitigation, essential features are not addressed in the current state-of-the-art benchmark dataset contributions. Thereupon, the main goal of this research is to propose a realistic benchmark dataset to enable the development and evaluation of IoMT security solutions. In order to accomplish this, 18 attacks were executed against an IoMT testbed composed of 40 IoMT devices (25 real devices and 15 simulated devices), considering the plurality of protocols used in healthcare (e.g., Wi-Fi, MQTT, and Bluetooth). These attacks are categorized into five classes: DDoS, DoS, Recon, MQTT, and spoofing. This effort aims to establish a baseline complementary to the state-of-the-art contributions. The outcome supports researchers in investigating and developing new solutions to make healthcare systems more secure using different mechanisms (e.g., machine learning - ML). This research goes beyond merely conducting attacks on IoMT devices. We also attempt to capture the lifecycle of these devices in different vital phases, from the moment they join the network until they leave, which is called profiling. Profiling allows the different classifiers to identify anomalies of each device individually in the healthcare network. The CICIoMT2024 dataset has been published on CIC's dataset page, making it available for other researchers to use.

We are calling for a paradigm shift in engineering education. In times of the Fourth Industrial Revolution (“4IR”), a myriad of potential changes is affecting all industrial sectors leading to increased ambiguity that makes it impossible to predict what lies ahead of us. Thus, incremental culture change in education is not an option any more. The vast majority of engineering education and training systems, having remained mostly static and underinvested in for decades, are largely inadequate for the new 4IR labor markets. Some positive developments in changing the direction of the engineering education sector can be observed. Novel approaches of engineering education already deliver distinctive, student centered curricular experiences within an integrated and unified educational approach. We must educate engineering students for a future whose main characteristics are volatility, uncertainty, complexity and ambiguity. Talent and skills gaps across all industries are poised to grow in the years to come. The authors promote an engineering curriculum that combine timeless didactic tradition, such as Socratic inquiry, project-based learning and first-principles thinking with novel elements (e.g. student centered active and e-learning by focusing on the case study and apprenticeship pedagogical methods) as well as a refocused engineering skillset and knowledge. These capabilities reinforce engineering students’ perceptions of the world and the subsequent decisions they make. This 4IR engineering curriculum will prepare engineering students to become curious engineers and excellent communicators better navigating increasingly complex multistakeholder ecosystems.

From professors overwhelmed by anxiety-driven e-mails from students, through faculty and administrative staff wasting valued time on e-mail minutia, misuse of electronic mail in the academy has become ubiquitous. After a brief overview of the unique features of e-mail communication, this study provides insight and guidelines to plan new educational activities on healthy and productive utilization of e-mail in the academy of the digital era. The overall aim is to prioritize scholarly deep work by focusing on teaching and research work, freeing working time wasted on unproductive use of e-mail.

Artificial Intelligence (AI) refers to the simulation of human intelligence in machines, using machine learning, deep learning and neural networks. AI enables machines to learn from experience and perform human-like tasks. The field of AI research has been developing fast over the past five to ten years, due to the rise of ‘big data’ and increasing computing power. In the medical area, AI can be used to improve diagnosis, prognosis, treatment, surgery, drug discovery, or for other applications. Therefore, both academia and industry are investing a lot in AI. This review investigates the biomedical literature (in the PubMed and Embase databases) by looking at bibliographical data, observing trends over time and occurrences of keywords. Some observations are made: AI has been growing exponentially over the past few years; it is used mostly for diagnosis; COVID-19 is already in the top-5 of diseases studied using AI; the United States, China, United Kingdom, South Korea and Canada are publishing the most articles in AI research; MIT is the world’s leading university in AI research; and convolutional neural networks are by far the most popular deep learning algorithms at this moment. These trends could be studied in more detail, by studying more literature databases or by including patent databases. More advanced analyses could be used to predict in which direction AI will develop over the coming years. The expectation is that AI will keep on growing, in spite of stricter privacy laws, more need for standardization, bias in the data, and the need for building trust.

A significant attention has been made to the accurate detection of diabetes which is a big challenge for the research community to develop a diagnosis system to detect diabetes in a successful way in the IoT e-healthcare environment. Internet of Things (IOT) has emerging role in healthcare services which delivers a system to analyze the medical data for diagnosis of diseases applied data mining methods. The existing diagnosis systems have some drawbacks, such as high computation time, and low prediction accuracy. To handle these issues, we have proposed a IOT based diagnosis system using machine learning methods, such as preprocessing of data, feature selection, and classification for the detection of diabetes disease in e- healthcare environment. Model validation and performance evaluation metrics have been used to check the validity of the proposed system. We have proposed a filter method based on the Decision Tree (Iterative Dichotomiser 3) algorithm for highly important feature selection. Two ensemble learning Decision Tree algorithms, such as Ada Boost and Random Forest are also used for feature selection and compared the classifier performance with wrapper based feature selection algorithms also. Machine learning classifier Decision Tree has been used for the classification of healthy and diabetic subjects. The experimental results show that the Decision Tree algorithm based on selected features improves the classification performance of the predictive model and achieved optimal accuracy. Additionally, the proposed system performance is high as compared to the previous state-of-the-art methods. High performance of the proposed method is due to the different combinations of selected features set and GL, DPF, and BMI are more significantly important features in the dataset for prediction of diabetes disease. Furthermore, the experimental results statistical analysis demonstrated that the proposed method would be effectively detected diabetes disease and can easily be deployed in IOT wireless sensor technologies based e-healthcare environment.

Human Activity Recognition (HAR) is a process to automatically detect human activities based on stream data generated from various sensors, including inertial sensors, physiological sensors, location sensors, cameras, time, and many others. Unsupervised contrastive learning has been excellent, while the contrastive loss mechanism is less studied. In this paper, we provide a temperature (τ) variance study affecting the loss of SimCLR model and ultimately full HAR evaluation results. We focus on understanding the implications of unsupervised contrastive loss in context of HAR data. In this work, also regulation of the temperature(τ) coefficient is incorporated for improving the HAR feature qualities and overall performance for downstream tasks in healthcare setting. Performance boost of 1.3% is observed in experimentation.

Tinnitus is a complex and heterogeneous psycho-physiological disorder responsible for causing a phantom ringing or buzzing sound albeit the absence of an external sound source. It has a direct influence on affecting the quality of life of its sufferers. Despite being around for a while, there hasn’t been a cure for tinnitus, and the usual course of action for its treatment involves use of tinnitus retaining and sound therapy, or Cognitive Behavioral Therapy (CBT). One positive aspect about these therapies is that they can be administered face-to-face as well as delivered via internet or smartphone. Smartphones are especially helpful as they are highly personalized devices, and offer a well-established ecosystem of apps, accessible via respective marketplaces of differing mobile platforms. Note that current therapeutic treatments such as CBT have shown to be effective in suppressing the tinnitus symptoms when administered face-to-face, their effectiveness when being delivered using smartphones is not known so far. A quick search on the prominent market places of popular mobile platforms (Android and iOS) yielded roughly 250 smartphone apps offering tinnitus-related therapies and tinnitus management. As this number is expected to steadily increase due to high interest in smartphone app development, a contemporary review of such apps is crucial. In this paper, we aim to review scientific studies validating the smartphone apps, particularly to test their effectiveness in tinnitus management and treatment. We use the PRISMA guidelines for systematic identification of studies on major scientific literature sources and delineate the outcomes of identified studies.

We performed an epi and molecular characterization of two healthcare workers MPXV occupational infection. Five days after the sampling collection, nurses developed typical MPXV infection symptoms. Infection was confirmed by qPCR and whole genome sequencing. The most likely transmission route was through contact with fomites in the patient belonging/house.

Universitas Sebelas Maret (UNS) through SMART UNS Company has conducted research and development of e-motorcycle conversion using Li-ion battery pack as a substitute for ICE energy source from the conventional motorcycle. Currently, the battery-pack that used for e-motorcycle conversion is in the development phase towards commercialization. The challenge of estimating production costs is the complicated production process and storing hidden expenses that can be a problem. This hidden cost is often a missing or varied factor that costs less or more expensive. This study presents an integrated parametric cost estimation model with activity-based cost assignments to estimate production costs through cost calculations for each activity. Activity-based costs break the production process into a specific cost element for each step. Each activity's cost is put into a parametric cost estimation model to calculate the cost of each activity into the total cost of production. Cost estimation results will be analyzed using a regression method to determine which variables most affect the production cost of Li-ion battery packs for the conversion of e-motorcycles in the SMART UNS company.

Background: Disability and caste are two different forms of oppression, however Dalits and people with disabilities commonly face similar types of marginalities. Dalit women with disabilities may experience double discrimination because of the intersectionality of disability and caste. This study examines whether the disability and caste identity of women together affects and compounds the utilization of maternal healthcare services. Methods: A cross-sectional survey was conducted using a semi-structured questionnaire among a total of 354 Dalit and non-Dalit women, with and without a disability aged between 15 – 49 years. Maternal healthcare service utilization was assessed by Ante-Natal Care (ANC), health facility (HF) delivery, and Post-Natal Care (PNC) during the last pregnancy. Logistic regression was performed to detect the predictors of service utilization and identify whether disability and caste were associated with service utilization. First, disability and caste were fitted separately in models. Secondly, the intersectionality of disability and caste was tested by the inclusion of disability*caste interaction term. Finally, the confounding effect of socio-demographic factors was investigated. Results: Out of surveyed women, 73% had 4+ ANC visits, 65% had HF delivery and 29% had a PNC visit during their last pregnancy. Women with a disability had lower odds of HF delivery (OR 0.50, CI 0.30 – 0.84) and PNC (OR 0.47, CI 0.25 – 0.88) than women without a disability. Adjustment for women’s age and household wealth explained associations in HF delivery by women with disabilities. There was no association between caste and service utilization. Disability overrode caste and there was no other evidence of effect modification by women’s caste status in the utilization. However, a weak interaction effect in the utilization of ANC services was found in the caste group by their education (OR 0.19, 95% CI 0.05 – 0.74). Conclusions: Disabled women – whether Dalit or non-Dalit - had lower rates of utilizing all maternal healthcare services than non-disabled women. However, Dalit women with disabilities were more likely to receive PNC than non-Dalit women with disabilities. Increasing equity in maternal healthcare service utilization requires that traditional approaches to service development and program intervention to be re-examined and more nuanced interventions considered to ensure improved access and outcome among all vulnerable groups.

Epithelial-mesenchymal transition (EMT) is a cellular biological process involved in migration of primary cancer cells to secondary sites facilitating metastasis. Besides, EMT also confers properties such as stemness, drug resistance and immune evasion which can aid a successful colonization at the distant site. EMT is not a binary process; recent evidence suggests that cells in partial EMT or hybrid E/M phenotype(s) can have enhanced stemness and drug resistance as compared to those undergoing a complete EMT. Moreover, partial EMT enables collective migration of cells as clusters of circulating tumor cells or emboli, further endorsing that cells in hybrid E/M phenotypes may be the ‘fittest’ for metastasis. Here, we review mechanisms and implications of hybrid E/M phenotypes, including their reported association with hypoxia. Hypoxia-driven activation of HIF-1α can drive EMT. In addition, cyclic hypoxia, as compared to acute or chronic hypoxia, shows the highest levels of active HIF-1α and can augment cancer aggressiveness to a greater extent, including enriching for a partial EMT phenotype. We also discuss how metastasis is influenced by hypoxia, partial EMT and collective cell migration, and call for a better understanding of interconnections among these mechanisms. We discuss the known regulators of hypoxia, hybrid EMT and collective cell migration and highlight the gaps which needs to be filled for connecting these three axes which will increase our understanding of dynamics of metastasis and help control it more effectively.

Background: Simulation plays a crucial role in health studies, as it helps medical students apply their theoretical knowledge in real-life situations. Moulage is one of the techniques that helps in making simulation more realistic or high-fidelity. It uses special effects to emulate wounds for a better understanding of what the wound is like visually. Still, moulage is expensive, time-consuming, resource-intensive, and requires the training of staff, which is why we need to find low-cost substitutes for moulage materials. Method: When searching the database “PubMed” for the terms “Low-cost and Medical moulage”, we retrieved 222 studies, out of which when excluding results not related to low-cost, we obtained 62 studies, from which when removing studies that do not contain information regarding moulage, we found two papers, after referring to citations and cited articles of those papers, we ended up with six studies. Based on the selected articles and additional articles sourced from their reference list, a total of 11 studies were included in the review. Results: We understand that moulage is a technique that helps make simulations come alive, but the resources required to use it are at times, expensive, which is why we need to find methods to do low-cost moulage, and many studies address that it can be as simple as using homemade ingredients. Students from a previous study have talked about their opinions regarding the realistic component of moulage and whether if it is any different from other moulages. Most of the students agreed that the moulage ranked well in face and content validity. However, further innovations must be introduced in the field to be widely spread and lead to newer opportunities. Conclusion: Although the research done under moulage is limited, it is accepted that moulage is helpful for simulation-based studies and that low-cost moulage can help make medical studies a better experience for students studying it. Students have a favorable opinion on the realistic aspect of the low-cost moulage applied to them. Newer methods can be introduced to moulage, and it can be implemented in low-income countries.

Recent reports have it that over 85\% of data breaches are still caused by the human element, of which healthcare is one of the suitable organizations mostly targeted by cybercriminals. The work of healthcare staff is often associated with high workloads, high emergency cases, and a broad range of psychological, social, and cultural factors. The significance of these factors could undermine conscious care information security (IS) practice leading to serious violations. This study comprehensively examined the correlation between the psycho-social-cultural factors, work factors with IS and privacy behaviour in a hospital that has fully adopted electronic health records (EHR) management system. The findings are to facilitate the decision-making process towards improving the cyber-security practice in healthcare. A quantitative approach was adopted where we collected responses from 212 healthcare staff through an online questionnaire survey. A broad range of constructs was selected from psychological, social, cultural perception and work factors based on earlier review work. These were therefore related to some security practices, to assess the IS knowledge, attitude and behaviour gaps among healthcare staff in a comprehensive way. From the study, IS self-reported conscious care behaviour (ISCCB) risk was relatively higher as compared to information security knowledge (ISK) risks and information security attitude (ISA) risk. Furthermore, the study revealed that work emergency has a positive correlation with ISCCB (r=1.95, p-value =0.001) risk. Conscientiousness also had positive correlation with ISCCB risk (r=0.157, p-value=0.05) however agreeableness negatively correlated with ISK risk (r=-0.166, p-value =0.05), and ISA risk (r=-0.140, p-value =0.05). Based on these findings, intrinsic and extrinsic motivation methods combined with cutting-edge technologies can be explored to discourage IS risks behaviours while enhancing conscious care security practice.

The rise in the volume, variety and complexity of data in healthcare has made it as a fertile-bed for Artificial intelligence (AI) and Machine Learning (ML). Several types of AI are already being employed by healthcare providers and life sciences companies. The review summarises a classical machine learning cycle, different machine learning algorithms; different data analytical approaches and successful implementation in haematology. Although there are many instances where AI has been found to be great tool that can augment the clinician’s ability to provide better health outcomes, implementation factors need to be put in place to ascertain large-scale acceptance and popularity.

Functional ZnO nanostructured surfaces are important in a wide range of applications. Here we report facile fabrication of ZnO surface structures at near room temperature with morphology resembling that of sea urchins, with densely packed, μm-long, tapered nanoneedles radiating from the urchin centre. The ZnO urchin structures were successfully formed on several different substrates with high surface density and coverage, including silicon (Si), glass, polydimethylsiloxane (PDMS), and copper (Cu) sheets, as well as Si seeded with ZnO nanocrystals. Time-resolved SEM revealed growth kinetics of the ZnO nanostructures on Si, capturing the emergence of “infant” urchins at the early growth stage and subsequent progressive increase in the urchin nanoneedle length and density, whilst the spiky nanoneedle morphology was retained throughout the growth. ε-Zn(OH)₂ orthorhombic crystals were also observed alongside the urchins. The crystal structures of the nanostructures at different growth time were confirmed by synchrotron X-ray diffraction measurements. On seeded Si substrates, a two-stage growth mechanism was identified, with a primary growth step of vertically aligned ZnO nanoneedle arrays preceding the secondary growth of the urchins atop the nanoneedle array. The antibacterial, anti-reflective, and wetting functionality of the ZnO urchins—with spiky nanoneedles and at high surface density—on Si substrates was demonstrated. First, bacteria colonisation was found to be suppressed on the surface after 24 h incubation in Gram-negative E. coli culture, in contrast to control substrates (bare Si and Si sputtered with 20 nm ZnO thin film). Secondly, the ZnO urchin surface, exhibiting superhydrophilic property with a water contact angle ~0°, could be rendered superhydrophobic with a simple silanization step, characterised by a water static contact angle θ of 159° ± 1.4° and contact angle hysteresis ∆θ < 7°. The dynamic superhydrophobicity of the surface was demonstrated by bouncing-off of a falling 10 μL water droplet, with a contact time of 15.3 milliseconds (ms), captured using a high-speed camera. Thirdly, it was shown that the presence of dense spiky ZnO nanoneedles and urchins on the seeded Si substrate exhibited a reflectance R < 1% over the wavelength range λ = 200–800 nm. The ZnO urchins with unique morphology via a facile fabrication route at room temperature, readily implementable on different substrates, may be further exploited for multifunctional surfaces and product formulations.

Development of supervised AI algorithms requires a large amount of labeled images. Image labelling is both time-consuming and expensive. Therefore, we explored the value of e-learning derived annotations for AI algorithm development in medical imaging. Methods We have developed an e-learning platform that involves image-based single click labelling as part of the educational learning process. Ten radiology residents, as part of their residency training, trained the recognition of pneumothorax on 1161 chest X-rays in posterior-anterior projection. Using this data, multiple AI algorithms for detecting pneumothorax were developed. Classification and localization performance of the models was tested on an independent internal testing dataset and on the public NIH ChestX-ray14 dataset. Results The AI models F1 scores on the internal and the NIH dataset were 0.87 and 0.44, respectively. Sensitivity was 0.85 and 0.80 for classification and specificity 0.96 and 0.48 for classification. F1 scores were 0.72 and 0.66, sensitivity 0.72 and 0.72. False positive rate was 0.36 and 0.32 for localisation. Conclusion Our results demonstrated that e-learning derived annotations are a valuable data source for algorithm development. Further work is needed to include additional parameters such as user performance, consensus of diagnosis, and quality control in the development pipeline.

With the availability of wearable health monitoring sensor modules like 3-Lead Electrocardiogram (ECG), Pulse Oximeter (SpO2), Galvanic Skin Response (GSR), Hall effect sensor (for measuring Respiratory Rate), Blood Pressure and Temperature measuring and sensing elements, it has now become possible to device a composite health status monitoring kit that can measure vital signs and other physiological parameters pertaining to human health in real time. Traditionally, the physiological parameters along with vital signs related examination was possible only in a hospitalized or ambulatory environment, however due to advances in sensing and embedded system technology and miniaturization of data acquisition and processing elements health monitoring has become possible even when individuals remain engaged in their day to day activities at the convenience of space and location. The patients or individuals subject to monitoring may suffer from a traumatic experience due to their medical condition and may need emergent incidence response and the critical care team may have to prepare for the treatment only after the patient arrives, which often is too late, as in case of cardiac arrests or severe injuries. The research focused on real-time health status monitoring and trauma scoring using standard physiological parameters along with standard telemetry protocols to make the critical care team aware of an emergent situation and prepare for a medical emergency. Vital signs and physiological parameters (heart rate, temperature, respiratory rate, and blood pressure, SpO2) were measured in real time from human subjects non-invasively. In order to enable monitoring of the patients engaged in day to day activities, errors due to the motion were removed using stationary wavelet transform correction (correlation coefficient of 0.9 after correction) and signals from various sensors were denoised, filtered and were encoded in a format suitable for further data analysis. A composite sensor kit capable of monitoring vital signs and physiological parameters can be very useful in incident response when an individual undergoes a traumatic experience related to stroke, cardiac arrest, fits or even injury, as along with monitoring information the kit can calculate scores related to trauma like the Injury Severity Score (ISS), National Early Warning Signs (NEWS), Revised Trauma Score (RTS). Trauma Injury Severity Score (TRISS), Probability of Survival (Ps) score. An open access database of vital signs and physiological parameters from Physionet, MIMIC 2 Numerics (mimicdb/numerics) database was used to calculate NEWS and RTS and to generate correlation and regression models using the vital signs/physiological parameters for a clinical class of patients with respiratory failure and admitted to Intensive Care Unit (ICU). NEWS and RTS scores showed no significant correlation (r = 0.25, p<0.001) amongst themselves, however together NEWS and RTS showed significant correlation with Ps (blunt) (r = 0.70, p<0.001). RTS and Ps (blunt) scores showed some correlation (r = 0.63, p<0.001) and NEWS score showed significant correlation (r = 0.79, p<0.001) with Ps (blunt) scores. Furthermore, since individuals have to be monitored regardless of location, these kits have to have a built-in capability to locate the individual so that the incident response team can locate the individual based on Global Positioning System coordinates (GPS). A Quantum GIS (Geographical Information System) application using real-time GPS coordinates (OpenStreetMap coordinates) was used to calculate the shortest path using QGIS Network Analysis tool to demonstrate the calculation of shortest path and direction to locate the nearest service provider in shortest time. Along with locating the nearest healthcare service provider, it would help if the critical care team could be made aware of the physiological parameters and trauma scores using standard protocols accepted across the globe. The physiological parameters from the sensors along with the calculated trauma scores were encoded according to a standard Systematized Nomenclature of Medicine-Clinical Terms (SNOMED-CT) coding system and International Code of Diseases (ICD) codes and the trauma information was logged to Electronic Health Records (EHR) using Fast Health Interoperability Resources (FHIR) servers. FHIR servers provided interoperable web services to log the event information in real time. It could be concluded that analytical models trained on existing datasets can help in analyzing a traumatic experience or an injury and the information can be logged using a standard telemetry protocol as a telemedicine initiative. These scores enable the healthcare service providers to estimate the extent of trauma and prepare for medical emergency procedures and find applications in general and military healthcare.

Mungbean [Vigna radiata (L.) Wilczek] in Australia has been transformed from a niche opportunistic crop into a major summer cropping option for dryland growers in the summer-dominant rainfall regions of Queensland and New South Wales. This transformation followed stepwise genetic improvements in both grain yields and disease resistance. For example, more recent cultivars such as ‘Crystal’, ‘Satin II’ and ‘Jade-AU‘ have provided up to a 20% yield advantage over initial introductions. Improved agronomic management to enable mechanised management and cultivation in narrow (<50 cm) rows has further promised to increase yields. Nevertheless, average yields achieved by growers for their mungbean crops remain less than 1 t/ha, and are much more variable than other broad acre crops. Further increases in yield and crop resilience in mungbean are vital. In this review, opportunities to improve mungbean have been analysed at four key levels including phenology, leaf area development, dry matter accumulation and its partitioning into grain yield. Improving the prediction of phenology in mungbean may provide further scope for genetic improvements that better match crop duration to the characteristics of target environments. There is also scope to improve grain yields by increasing dry matter production through the development of more efficient leaf canopies. This may introduce additional production risks as dry matter production depends on the amount of available water, which varies considerably within and across growing regions in Australia. Improving crop yields by exploiting photo-thermal sensitivities to increase dry matter is likely a less risky strategy for these variable environments. Improved characterisation of growing environments using modelling approaches could also better define and identify the risks of major abiotic constraints. This would assist in optimising breeding and management strategies to increase grain yield and crop resilience in mungbean for the benefit of growers and industry.

This study presents three forms of interdisciplinary expertise in the healthcare design context to approach a particular multifaceted problem around the current healthcare for older adult patients with chronic low-back pain (LBP). Using an interdisciplinary co-design framework, first, our design approach performs the role of an initiator to define the problem by exploring the current context of healthcare. Second, it facilitates the experiences of experts and patients to reach the roots of the problem by functioning as a mediator. Third, our approach fulfills the primary role of healthcare design in producing new meanings considering the principles of patient-centeredness. These roles significantly contributed to the design of healthcare innovations. Our framework transformed the distributed disciplinary knowledge developed while tackling the multifaceted problem into new forms of expertise for collaboration in healthcare innovation.

Abstract: Escherichia coli are remarkably versatile microorganisms and important members of the normal intestinal microbiota of humans and animals. This harmless commensal organism can acquire a mixture of comprehensive mobile genetic elements that contain genes encoding viru-lence factors, becoming an emerging human pathogen capable of causing a broad spectrum of intestinal and extraintestinal diseases. Nine definite enteric E. coli pathotypes have been well characterized, causing diseases ranging from various gastrointestinal disorders to urinary tract infections. These pathotypes employ many virulence factors and effectors subverting the func-tions of host cells to mediate its virulence and pathogenesis. This review summarizes new de-velopments in our understanding of diverse virulence factors associated encoding genes used by different pathotypes of enteric pathogenic E. coli to cause intestinal and extraintestinal diseases in humans.

The history of health records (later also called medical records), including ones regarding individual patients, is thousands of years old. It finds it roots in the first ancient civilisations. Up until the 19^th century the records’ purpose was mainly an educational one. In the 19^th and 20^th century they started becoming significant in other roles as well, including those not strictly limited to medicine. In particular, to account for medical procedures, insurance proceeds or legal action. Currently we are living in a revolutionary era when it comes to health records, in which their character has changed from a “paper-based” to an electronic one. This paper presents the development of health records from the ancient to modern times, mainly in Europe and North America. Other cultures and civilisations, including China and India, are not discussed. An analysis of available sources was conducted, inter alia digital versions of manuscripts up to hundreds of years old. The analysis was based on PubMed and Google Scholar (several key words, all the available sources). Sources published in non-international languages (e.g. Dutch) were also investigated. Overall, approximately 600 articles were analysed, 158 of which were used and cited in this paper. The conclusions drawn from the analysis are as follows: (1) Health records, priorly used mostly for educational purposes, for about 100 years now have acquired a fully formal status. (2) We are currently facing the most revolutionary changes regarding the transformation of paper-based records into electronic ones. (3) The consequences of this process include systematic applications of solutions within the area of e-health, which allow us to make medical services more flexible, improve the health of individual patients and entire populations and potentially limit expenditure. (4) In the light of the ongoing COVID-19 pandemic, introducing electronic health records could be beneficial in terms of limiting the potential sources of contamination (physical copies of health records), saving time and resources, and improving the network of communication between medical centres.

Background: Healthcare attention is sometimes considered purely technical, but communication has proven to be closely related to clinical results and patient satisfaction. Therefore, evaluation of communication in the scope of healthcare is a priority. The purpose of this study was to validate and adapt, if necessary, the Spanish version of the Communication Styles Inventory (CSI) in a sample of nursing professionals. (2) Methods: The sample was made up of 2313 nursing professionals selected at random from various medical centers in Spain, and is therefore a sample actively employed at the time data were acquired. We started out from the Communication Style Inventory, a questionnaire for evaluating the predominance of certain individual communication behaviors on six scales (expressiveness, preciseness, verbal aggressiveness, questioningness, emotionality and impression manipulativeness). (3) Results: Confirmatory Factor Analysis of the model proposed showed god fit indices. The reliability of the model shown by the Cronbach’s alpha of α=.81 was adequate, and so was single-level and aggregate consistency. Finally, in the analysis of variance by type of contract, configural, metric and scalar invariance was acceptable, but not strict invariance. (4) Conclusions: This instrument progresses in measuring non-technical attributes, such as communication styles, in nursing personnel.

Clinical training in medical schools in Spain is performed by rotations in university hospitals. During these internships, students are expected to acquire and master basic procedural skills. However, the assessment tools available rarely check whether these skills are completely acquired by the students. We have used an e-portfolio to determine the optimal number of times the students need to repeat a procedure to be able to perform it independently. The results were compared with the actual performance during the internships. An e-portfolio collected qualitative information about the internships. Quantitative information was also requested about the number of times each clinical skill was performed. Later, a survey asked these students and their teachers the optimal number of times each skill should be repeated before it could be considered fully acquired. The questionnaire was answered by 98.6% of the students and 70.3% of their teachers. Out of the 21 clinical skills and procedures selected, both students and their tutors agreed in a similar optimal value in 16 of them; only in five of them, teachers thought that students needed a greater number of times than that selected by the students. When these optimal values were compared with the actual values recorded in the portfolio during the internships, it was found that about half of the clinical skills were carried out less frequently than expected, thus providing an important feedback about the internships. Quantitative information collected in portfolios reveals a moderate mismatch between students and tutors perceptions of their training needs.

Many various using of this new-born fuzzy model for solving real-world problems and urgent requirements involve introducing new concept for analyzing the situations which leads to solve them by proper, quick and ecient method based on statistical data. This gap between the model and its solution cause that we introduce nikfar domination in neutrosophic graphs as creative and eective tool for studying a few selective vertices of this model instead of all ones by using special edges. Being special selection of these edges aect to achieve quick and proper solution to these problems. Domination hasn't ever been introduced. So we don't have any comparison with another denitions. The most used graphs which have properties of being complete, empty, bipartite, tree and like stu and they also achieve the names for themselves, are studied as fuzzy models for getting nikfar dominating set or at least becoming so close to it. We also get the relations between this special edge which plays main role in doing dominating with other special types of edges of graph like bridges. Finally, the relation between this number with other special numbers and characteristic of graph like order are discussed.

Studies have shown that aerosols generated from flavored e-cigarettes contain Reactive Oxygen Species (ROS), promoting oxidative stress-induced damage within pulmonary cells. Our lab investigated the ROS content of e-cigarette vapor generated from disposable vape bars, a product exempt from the Federal Drug Enforcement Agency’s (FDA) 2020 flavor ban. Specifically, we analyzed vape bars belonging to multiple flavor categories (Tobacco, Minty Fruit, Fruity, Minty/Menthol, Desserts, and Drinks), manufactured by various vendors and of various nicotine concentrations (0-6.8%). Aerosols from these flavored vape bars were generated by a single puff aerosol generator and individually bubbled through a fluorogenic solution to detect and semi-quantify ROS in H2O2 equivalents generated by the vape bars. We compared and contrasted the ROS levels generated by each flavor as an indirect determinant of oxidative stress potential by these disposable vape bars. Our results showed that ROS concentration (μM) of aerosols produced from the vape bars varied significantly between different flavors and a function of nicotine concentration. Likewise, our results suggest that flavoring chemicals and nicotine concentration play a role in alerting ROS production in e-cigarette aerosols. Our study provides insight into the differential health effects of flavored disposable vape bars and the need for their regulation.

Numerous goods and services are now offered through online platforms due to the recent growth of online transactions like e-commerce. Users have trouble locating the product that best suits them from the numerous products available in online shopping. Many studies in deep learning-based recommender systems (RSs) have focused on the intricate relationships between the attributes of users and items. Deep learning techniques have used consumer or item-related traits to improve the quality of personalized recommender systems in many areas, such as tourism, news, and e-commerce. Various companies, primarily e-commerce, utilize sentiment analysis to enhance product quality and effectively navigate today's business environment. Customer feedback regarding a product is gathered through sentiment analysis, which uses contextual data to split it into separate polarities. The explosive rise of the e-commerce industry has resulted in a large body of literature on e-commerce from different perspectives. Researchers have made an effort to categorize the recommended future possibilities for e-commerce study as the field has grown. There are several challenges in e-commerce, such as fake reviews, frequency of user reviews, advertisement click fraud, and code-mixing. In this review, we introduce an overview of the preliminary design for e-commerce. Second, the concept of deep learning, e-commerce, and sentiment analysis are discussed. Third, we represent different versions of the commercial dataset. Finally, we explain various difficulties facing RS and future research directions.

An artificial intelligence (AI)-based conversational large language model (LLM) was launched in November 2022 namely, “ChatGPT”. Despite the wide array of potential applications of LLMs in healthcare education, research and practice, several valid concerns were raised. The current systematic review aimed to investigate the possible utility of ChatGPT and to highlight its limitations in healthcare education, research and practice. Using the PRIMSA guidelines, a systematic search was conducted to retrieve English records in PubMed/MEDLINE and Google Scholar under the term “ChatGPT”. Eligibility criteria included the published research or preprints of any type that discussed ChatGPT in the context of healthcare education, research and practice. A total of 280 records were identified, and following full screening, a total of 60 records were eligible for inclusion. Benefits/applications of ChatGPT were cited in 51/60 (85.0%) records with the most common being the utility in scientific writing followed by benefits in healthcare research (efficient analysis of massive datasets, code generation and rapid concise literature reviews besides utility in drug discovery and development). Benefits in healthcare practice included cost saving, documentation, personalized medicine and improved health literacy. Concerns/possible risks of ChatGPT use were expressed in 58/60 (96.7%) records with the most common being the ethical issues including the risk of bias, plagiarism, copyright issues, transparency issues, legal issues, lack of originality, incorrect responses, limited knowledge, and inaccurate citations. Despite the promising applications of ChatGPT which can result in paradigm shifts in healthcare education, research and practice, the embrace of this application should be done with extreme caution. Specific applications of ChatGPT in health education include the promising utility in personalized learning tools and shift towards more focus on critical thinking and problem-based learning. In healthcare practice, ChatGPT can be valuable for streamlining the workflow and refining personalized medicine. Saving time for the focus on experimental design and enhancing research equity and versatility are the benefits in scientific research. Regarding authorship in scientific articles, as it currently stands, ChatGPT does not qualify to be listed as an author unless the ICJME/COPE guidelines are revised and amended. An initiative involving all stakeholders involved in healthcare education, research and practice is urgently needed to set a code of ethics and conduct on the responsible practices involving ChatGPT among other LLMs.

Internet-led labour market has become so competitive forcing many organisations from different sectors to embrace e-recruitment. However, realising the value of the e-recruitment from a Requirements Engineering (RE) analysis perspective is challenging. This research is motivated by the results of a failed e-recruitment project conducted in military domain which is used as a case study in this research. After reviewing the various challenges faced in that project through a number of related research domains, this research focuses on two major problems which are the (1) difficulty of scoping, representing, and systematically transforming recruitment problem knowledge towards e-recruitment solution specification; and (2) the difficulty of documenting e-recruitment best practices for reuse purposes in an enterprise recruitment environment. In this paper, a Problem-Oriented Conceptual Model (POCM) with a complementary Ontology for Recruitment Problem Definition (Onto-RPD) is proposed to contextualise the various recruitment problem viewpoints from an enterprise perspective and to elaborate those problem viewpoints towards a comprehensive recruitment problem definition. The POCM and Onto-RPD are developed incrementally using action-research conducted on three real case studies: (1) Secureland Army Enlistment, (2) British Army Regular Enlistment, and (3) UK Undergraduate Universities and Colleges Admissions Service (UCAS). They are later evaluated in a focus group study against a set of criteria. The study showed that the POCM and Onto-RPD provide a strong foundation for representing and understanding the e-recruitment problems from different perspectives.

Microbiome First Medicine is a suggested 21st century healthcare paradigm that prioritizes the entire human, the human superorganism, beginning with the microbiome. To date, much of medicine has protected and treated patients as if they were a single species. This has resulted in unintended damage to the microbiome and an epidemic of chronic disorders [e.g., noncommunicable diseases and conditions (NCDs)]. Along with NCDs came loss of colonization re-sistance, increased susceptibility to infectious diseases, and increasing multimorbidity and polypharmacy over the life course. To move toward sustainable healthcare, the human micro-biome needs to be front and center. This paper presents microbiome-human physiology from the view of systems biology regulation. It also details the ongoing NCD epidemic including the role of existing drugs and other factors that damage the human microbiome. Examples are provided for two entryway NCDs, asthma and obesity, regarding their extensive network of comorbid NCDs. Finally, the challenges of ensuring safety for the microbiome are detailed. Under Microbiome First Medicine and considering the importance of keystone bacteria and critical windows of development, changes in even a few microbiota-prioritized medical decisions could make a significant difference in health across the life course.

The tribal belt of Pakistan-the Pak-Afghan border region is famous for its unique culture, ethnography and wild food plants and traditional knowledge. People of these regions gather wild plants for number of purposes including plants or plant parts for direct use, use it in the traditional cuisines and selling in local markets. However, there is huge lack of documentation of food system particularly the Wild Food Plants (WFPs). In current study we have focused on the uses and contributions of the WFPs in the tribal traditional food system. The ethnobotanical data were gathered through questionnaire surveys with Eighty-four informants 69 men and 15 women belonging to 21 different villages. We documented Sixty-three WFP species belonging to 34 botanical families, of which 27 were used as vegetables, 24 as fruits, 6 in different kinds of chutneys (starters) formation and six as fresh food species. Fruits were the mostly used part (40%) followed by leaves (24%), aerial parts (24%), seeds (7%), stem (3%), legume (2%) and young inflorescence (1%). Use of Carthamus oxycanthus & Pinus roxburghii seeds and Marsillea quadrifolia leaves were the novel reports for the gastronomy of Pakistan. The results elucidate that WFPs have a significant contribution in the Tribal Food Systems. Tribal people use WFPs not only due to their nutritional importance but also as a cultural practice - an inseparable component of the tribal communities. This important traditional Knowledge about the consumption of WFPs has been eroding with an alarming speed among the younger generations due to introduction of fast food chains, modernization, and globalization. Therefore, appropriates strategies are imperative not only to safeguard traditional knowledge but also the cultural heritage, food security and hence public healthcare via food supplement in the region.

This article is an effort to scrutinize the role of Information Technology development in the chronological transformation of Urban Planning domain using the exploratory research approach. In this research, it is argued that the theoretical and practical understanding of Urban Planning should absorb and integrate the bright outcome of the rise of Information and Technology to foster congruent future urban development. The article addresses the trends of transformation in the urban planning domain through the myopic lens of the expansion of information and communications technology era followed by investigating the key drivers shaping the interaction between modern-day urban planning and information technology considering both the dark and bright sides into account.

A E. Crassipes is considered a problem in different aquatic ecosystems, due to its abundance could become a solution to design and build economic and efficient treatment plants, and especially for the production of biofuels such as bioethanol. The objective of this research is to design and implement a sustainable development process between phytoremediation and bioethanol production with E. crassipes, evaluating the incidence of chromium adhered to the biomass of this plant in the production of bioethanol. Materials and methods: A system was installed to evaluate the phytoremediation with E crassipes with water loaded with chromium, determining the effectiveness of this plant to remove this heavy metal even if it is alive in a body of water. After this process, we proceeded to bring the biomass loaded with chromium to bioreactors to evaluate the production of bioethanol, assessing three types of biomass, one without chromium adhered and the other two with chromium adhered to its plant structure. There was an impact of the ethanol production of the E crassipes due to the presence of chromium, but this production can be taken into account for the assembly of an integral system of phytoremediation and bioethanol production, making the most of this biomass.

Modern electronic textiles are moving towards flexible wearable textiles, so-called e-textiles that have micro-electronic elements embedded onto the textile fabric that can be used for varied classes of functionalities. There are different methods of integrating rigid microelectronic components into/onto textiles for the development of smart textiles, which include, but are not limited to, physical, mechanical and chemical approaches. The integration systems must satisfy being flexible, lightweight, stretchable and washable to offer a superior usability, comfortability and non-intrusiveness. Furthermore, the resulting wearable garment needs to be breathable. In this review work, three levels of integration of the microelectronics into/onto the textile structures are discussed, the textile-adapted, the textile-integrated, and the textile-based integration. The textile-integrated and the textile- adapted e-textiles have failed to efficiently meet being flexible and washable. To overcome the above problems, researchers studied the integration of microelectronics into/onto textile at fiber or yarn level applying various mechanisms. Hence, a new method of integration, textile-based, has risen to the challenge due to the flexibility and washability advantages of the ultimate product. In general, the aim of this review is to provide a complete overview of the different interconnection methods of electronic components into/onto textile substrate.

The contents of Education for Sustainable Development (ESD) should be included in teachers’ initial and advanced training programs. In order to determine the key competences for sustainability, creating a Sustainable Consciousness is one of the main foundations. However, there are not many empirical studies that deal with consciousness from education. In this context, e-portfolio appears as a tool that promotes reflection and critical thinking, key competences for consciousness development. This work intends to propose a categorization system to extract types of consciousness and identify trainee teachers’ levels of consciousness. For this research work, of an eminently qualitative nature, we have selected twenty-five portfolios of students in the last year of the School of Education at the University of Macerata (Italy). The qualitative methodological procedure followed allowed to deduce three bases that shape trainee teachers’ consciousness: thinking, representation of reality and type of consciousness. We concluded that the attainment of a Sustainable Consciousness in teachers requires activating and developing higher levels of thinking, as well as a projective and macrostructural representation of reality.

Background: The practices of various health-care professionals have been improvised to accommodate the on-going covid-19 pandemic situation. Different guidelines have been set in place to ease the process of re-opening of non-elective healthcare services like out-patient physiotherapy clinics. Although the measures taken should be guided by evidence based information, major consensus amongst practicing therapists needs to guide the India physiotherapy clinics. Objective: To identify and present the opinions of different physiotherapists about the various strategies for re-opening the out-patient physiotherapy clinics. Methods: An online cross-sectional survey was conducted. Over 169 participants were selected to participate in the survey according to the pre-decided inclusion and exclusion criteria. The data was collected and saved via google forms. Result and conclusion: A majority of respondents had a consensus over different strategies for re-opening the physiotherapy OPDs. These were regarding different measures to be adapted including modifications in the clinic infrastructure and the practice pattern. This would help in smoothly re-instating the physiotherapy services post the covid-19 lockdown.

Through the half-unit circle area computation using the integration of the corresponding curve power series representation, we deduce a slow converging positive infinite series to $\pi$. However, by studying the remainder of that series we establish sufficiently close inequalities with equivalent lower and upper bound terms allowing us to estimate, more precisely, how the series approaches $\pi$. We use the obtained inequalities to compute up to four-digit denominator, what are in this sense, the best rational numbers that can replace $\pi$. It turns out that the well-known convergents of the continued fraction of $\pi$, $22/7$ and $355/113$ called, respectively, Yuel\"{u} and Mil\"{u} in China are the only ones found. Thus we apply a similar process to find rational estimations to $\pi+e$ where $e$ is taken as the power series of the exponential function evaluated at $1$. For rational numbers with denominators less than $2000$, the convergent $920/157$ of the continued fraction of $\pi+e$ turns out to be the only rational number of this type.

Health care workers (HCWs), specifically dentists, are at the front line for acquiring blood-borne virus infections. The highest proportion of occupational transmission is through percutaneous injuries via hollow-bore needles. Several studies around the world have reported that hepatitis viruses and human immunodeficiency virus are the main pathogens for most cases of occupationally acquired blood-borne infection. We aim to investigate the prevalence of hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis E virus (HEV), and human immunodeficiency virus (HIV) among Mexican dentists. Methods. We included 159 dentists who attended the annual meeting at the Medica Sur Clinic & Foundation held in Mexico City in May 2016. A survey was applied in order to obtain data of occupational exposure to blood-borne viruses (BBV). Serum samples were screened serologically using enzyme-linked immunosorbent assays. Results. Two dentists (1.2%) were positive for antibodies against HCV antigen, one (0.6%) was positive for antibodies against HBV antigen and three (1.8%) were positive for the detection of IgG antibodies against HEV. Two cases (1.2%) were positive for antibodies against HIV. Conclusions. The infection by HEV was the most prevalent among dentists. However, the prevalence of BBV in dentists was similar to that in the general population.

Artificial Intelligence (AI) describes computer systems able to perform tasks that normally require human intelligence, such as visual perception, speech recognition, decision-making, and language translation. Examples of AI techniques are machine learning, neural networks and deep learning. AI can be applied in many different areas, such as econometrics, biometry, e-commerce and the automotive industry. In recent years, AI has found its way into healthcare as well, helping doctors to make better decisions (‘clinical decision support’), localizing tumors in magnetic resonance images, reading and analyzing reports written by radiologists and pathologists, and much more. However, AI has one big risk: it can be perceived as a ‘black box’, limiting trust in its reliability, which is a very big issue in an area in which a decision can mean life or death. As a result, the term Explainable Artificial Intelligence (XAI) has been gaining momentum. XAI tries to ensure that AI algorithms (and the resulting decisions) can be understood by humans. In this narrative review, we will have a look at the current status of XAI in healthcare, describe several issues around XAI, and discuss whether it can really help healthcare to advance, for example by increasing understanding and trust. Finally, alternatives to increase trust in AI are discussed, as well as future research possibilities in the area of XAI.

The Rybczynski theorem describes the trade effect within production analyses between factor endowments and outputs. The Stolper-Samuelson theorem focuses on cost analyses between factor reward and commodity price. This paper examines the trade effect of changes of factor endowments on prices, based on general equilibrium. The study shows that changes of factor endowments cause domestic output changes (the Rybczynski effect), which affect output prices and factor prices (the Stolper-Samuelson effect). It is like a chain of effects that the Rybczynski’s trade effect triggers the Stolper-Samuelson’s trade effect. The analysis of this paper shows that a small increase of a factor endowment of any country rewards another factor and the commodity using the latter factor intensively. It displays a tuneful circle. Trade brings a well-balanced development to the world.

Biofilms enable the persistence of pathogens in food processing environments. In order to inactivate these microorganisms, sanitizing agents are needed that are effective against pathogens entrapped in biofilms which are more difficult to inactivate than planktonic cells that are displaced and found on equipment surfaces. We examined conditions to develop, analyze, and enumerate robust biofilms of 3 different foodborne pathogens assisted by fluorescence adherence assay and enzymatic detachment. We compared 3 different isomeric forms of fluorescent substrates that are readily taken up by bacterial cells based on carboxy-fluorescein diacetate (5-CFDA, 5,6-CFDA, 5,6-CFDA,SE). Biofilm-forming strains of L. monocytogenes, E.coli O157:H7, and Salmonella serovars were detected using the chosen substrate in a microplate fluorescence assay define previously for use with Listeria. Adherence levels were determined by differences in relative fluorescence units (RFU). Multiple hydrolytic enzymes were examined for each representative pathogen for the most suitable enzyme for detachment and enumeration to confirm data obtained by fluorescence assay. Cultures were grown overnight in microplates, incubated, washed and replenished with fresh sterile growth medium; this cycle was repeated 7 times before used as ‘biofilms’. All treatments were performed in triplicate and compared by one-way analysis of variance (ANOVA) to determine significant differences (p < 0.05). Analysis of 7-day biofilms by SEM indicated possible extracellular polysaccharide involvement with Salmonella and E. coli.

The importance of measuring sustainability in tourism has been significantly advancing in recent years, following the need to manage the impact of tourism on territories and hosting communities. It was further boosted by the pandemic, where sustainability has been defined as one of the central elements to restart global tourism. The ETIS model, developed by the European Commission, is a point of reference based on self-assessment, data collection and analysis by the destinations themselves. The application of ETIS toolkit has faced many challenges, especially at sub-national level, mostly related to the lack of available and updated data to feed the model. The hypothesis explored by the authors is to solve the implementation issues, developing an indicator based on the use of the Sentiment Analysis to frame e-reputation and tourism satisfaction, and further combining it with other open data sources. The Tourism Sustainability Index (TSI) can provide a scalable and geo-referenced evaluation of tourism sustainability, measuring the four pillars and sub-components referenced to ETIS criteria, applicable to any tourism destination. Results show that the TSI can be seen as a consistent and valid tool for destinations to analyze sustainability, monitor its evolution through time periods and sub-areas, and compare it to other benchmark or competitive areas.

Background: Sudden changes in clinical practice and the altered ability to care for patients due to the COVID-19 pandemic have been associated with moral distress and mental health concerns in healthcare workers internationally. This study aimed to investigate the severity, prevalence, and predictors of moral distress experienced by Australian healthcare workers during the COVID-19 pandemic. Methods: A nationwide, voluntary, anonymous, single time-point, online survey of self-identified frontline healthcare workers was conducted between 27th August and 23rd October 2020. Participants were recruited through health organisations, professional associations or colleges, universities, government contacts, and national media. Results: 7846 complete responses were received from nurses (39.4%), doctors (31.1%), allied health staff (16.7%) or other roles (6.7%). Many participants reported moral distress related to resource scarcity (58.3%), wearing PPE (31.7%) limiting their ability to care for patients, exclusion of family going against their values (60.2%), and fear of letting co-workers down if they were infected (55.0%). Many personal and workplace predictors of moral distress were identified, with those working in certain frontline areas, metropolitan locations, and with prior mental health diagnoses at particular risk of distress. Moral distress was associated with an increased risk of adverse mental health outcomes. Feeling appreciated by the community mitigated this risk in healthcare workers. Conclusions: Safeguarding healthcare workforces during crises is important for both patient safety and workforce longevity. Targeted interventions are required to prevent or minimise moral distress and associated mental health concerns in healthcare workers during COVID-19 and other crises.

Background: Cancer patients may fail to distinguish COVID-19 symptoms such as anosmia, dysgeusia/ageusia, anorexia, headache, and fatigue, which are frequent after cancer treatments. We aimed to identify symptoms associated with COVID-19 and to assess the strength of their association in cancer and cancer-free populations. Methods: The prospective multicenter cohort study PAPESCO-19 included 878 cancer patients and 940 healthcare workers (HCWs) systematically tested for SARS-CoV-2-specific antibodies. Participants reported the results of routine screening RT-PCR and thirteen COVID-19 symptoms. Backward logistic regression identified the symptom combinations significantly associated with COVID-19. Results: COVID+ proportions were similar in patients (8%) and HCWs (9.5%, p=0.26), whereas symptomatic proportions were lower in patients (32%) than HCWs (52%, p&lt;0.001). Anosmia, anorexia, fever, headache, and rhinorrhea together accurately discriminated (c-statistic=0.7027) COVID-19 cases in patients. Anosmia, dysgeusia/ageusia, muscle pain, intense fatigue, headache, and chest pain better discriminated (c-statistic=0.8830) COVID-19 cases in HCWs. Anosmia had the strongest association in patients (OR=7.48, 95% CI: 2.96–18.89) and HCWs (OR=5.71, 95% CI: 2.21–14.75). Conclusions: COVID-19 symptoms and their diagnostic performance differ in cancer patients and HCWs. Anosmia is associated with COVID-19 for patients, while dysgeusia/ageusia are not. Cancer patients deserve tailored preventive measures due to their particular COVID-19 symptom pattern.

Several studies have quantified the responses of Eucalyptus globulus plantations to weed control on its early development (2-3 years after establishment). However, long-term results of competing vegetation effects have been rarely incorporated into growth and yield models that forecast the long-term effects of reducing the intensity of competing vegetation control and its interaction with site resource availability on stem volume production close to rotation age. We compared several models predicting stand stem volume yield of Eucalyptus globulus plantations established across a water and fertility gradient growing under different intensity levels of free area of competing vegetation maintained during the first 3 years of stand development. Four sites were selected encompassing a gradient in rainfall and amount of competing vegetation. Treatments were applied at stand establishment and were monitored periodically until age 9 years. Competing vegetation control intensity levels considered 0, 5, 20, 44 and 100% weed-free cover around individual E. globulus seedlings. Maximum competing vegetation biomass production during the first growing season were 2.9, 6.5, 2.2 and 12.9 Mg ha^-1, for sites ranging from low to high annual rainfall. As expected, reductions in volume yield at age 9 years were observed as competing vegetation control intensity decreased during the first growing season. A strong relationship was established between stem volume yield loss and the intensity of competing vegetation control, the amount of competing vegetation biomass produced during the first growing season and mean annual rainfall. The slope of the relationship was different among sites and was related mainly to water and light limitations. Our results, suggest that the biomass of competing vegetation (intensity of competition) affecting site resource availability, contribute to observed long-term effects on E. globulus plantations productivity. The site with the lowest mean annual rainfall showed the highest volume yield loss at age 9 years. Sites with highest rainfall showed contrasting results related to the amount of competing vegetation biomass.

The USDA-FSIS considers mechanically-tenderized beef as ‘non-intact’ and a food safety concern because of the potential for translocation of surface E. coli O157:H7 into the interior of the meat that may be cooked ‘rare or medium-rare’ and consumed. We evaluated 14 potential spray interventions on E. coli O157:H7-inoculated lean beef wafers (~10⁶ CFU/cm² , n=80) passing through a spray system (18 sec dwell time, ~40 PSI) integrated into the front end of a Ross TC-700MC tenderizer. Inoculated and processed beef wafers were stomached with D/E neutralizing broth and plated immediately, or were held in refrigerated storage for 1-, 7-, or 14 days prior to microbial plating. Seven antimicrobials that showed better performance in preliminary screening on beef wafers were selected for further testing on beef subprimals in conjunction with blade tenderization. Boneless top sirloin beef subprimals were inoculated at ~2 x 10⁴ CFU/cm² with a four-strain cocktail of Escherichia coli O157:H7 and passed once, lean side up, through an integrated spray system and blade tenderizer. Core samples obtained from each subprimal were examined for the presence/absence of E. coli O157:H7. Absence of E coli O157:H7 translocated into core samples correlated with the ability of the antimicrobials to reduce bacterial levels on the surface of beef prior to blade tenderization.

Healthcare sector is a truly dynamic and multidisciplinary system. Progressive practice of computational technologies in healthcare has enhanced electronic therapeutic measures in the care units. The healthcare decision-makers are accenting on the operational usage of digital technology in the system, to improve the health service by reducing human error and excessive load also by increasing possibility to attend more patients simultaneously. Sophisticated medical instruments are using advanced robotics, artificial intelligence to enhance their efficacy. Virtual treatments, self-diagnostics is increasing over time with the advancement of technical support in health. Electronic Health Records (EHR) of patients has created huge medical data (clinical information), which is undoubtedly a good resource for health professionals to take critical decisions and implement them accordingly. The aim of this article is to elucidate how technological developments are associated with clinical improvements in terms of constructing an upgraded health ecosystem. It is imperative to analyze how recent digital paradigms in health are helping to tackle regular and rare clinical challenges.

Background: COVID-19 booster uptake remained poor among healthcare workers (HCW) despite evidence of improved immunity against Delta and Omicron variants. While most studies used a questionnaire to assess hesitancy, this study aimed to identify factors affecting true booster hesitancy by examining actual vaccine uptake across time. Method: COVID-19 vaccination database records among HCW working at 7 Singaporean public primary care clinics between January to December 2021 were extracted, with gender, profession, place of practice, vaccination type and dates. Time to booster was calculated from the date of vaccination minus date of eligibility. Chi-square test was used to compare relationship between 1st dose and booster hesitancy, Kaplan-Meier method and Log-rank test were adopted to evaluate differences in cumulative booster uptake. Multivariate cox regression was used to investigate predictors for timely booster vaccination. Vaccination rate was charted across time and corroborated with media releases pertaining to legislative changes. Results: 877 of 891 (98.9%) primary care HCW were fully vaccinated, 73.8% of eligible HCW had taken the booster. HCW were less booster hesitant [median 16 (5-31.3) days] compared to the 1st dose [median 39 (13-119.3) days]. 1st dose hesitant HCW were more likely to be booster hesitant (OR=3.66, 95%CI 2.61-5.14). Adjusting for sex, workplace and time to 1st dose, ancillary (HR=1.53, 95%CI 1.03-2.28), medical (HR=1.8, 95%CI 1.18-2.74) and nursing (HR=1.8, 95%CI 1.18-2.37) received boosters earlier compared with administrative staff. No temporal relationship was observed between booster uptake, legislative changes and COVID-19 infection numbers. Conclusion: Vaccine hesitancy among HCW had improved from booster to 1st dose, with timely booster vaccination among medical and nursing staff. Tailored education, risk messaging and strategic legislation might help to reduce delayed booster vaccination.

Background: Electronic cigarette (e-cigarette) use among youth in Poland has become very popular. The aim of this study was to identify potential points of access to these products among students aged 16-17 before implementation of sales restrictions to minors in Poland in November 2016. Methods: A school-based, cross-sectional survey was administered in 2015-2016 in 21 secondary/technical schools across two regions of Poland. Analyses focused on 341 students aged 16-17 who reported past 30-day use of e-cigarettes. Pearson chi-square analyses were utilized to examine associations between access-related items, e-cigarette use, and demographics. Results: Among youth e-cigarette users, the most common access to their first e-cigarette was from a friend (38%), followed by purchasing from vape shops (26%). Similar patterns emerged when students were asked about the access to their currently used e-cigarette. Most youth reported no difficulty purchasing cartridges/e-liquid containing nicotine (90%); the majority of users (52%) reported buying such products in vape shops. Conclusions: Prior to implementing age-related sales restrictions, youth access to e-cigarettes and paraphernalia did not pose any significant barriers. Poland’s introduction of a new age limit on e-cigarette sales may help limit the number of youth who purchase e-cigarettes from vape shops.

(1) Background: Factors reported in literature associated with inappropriate prescribing of antimicrobials, such as physicians with less experience, uncertain diagnosis, and patient caregiver influences on physicians' decisions. Monitoring antimicrobial resistance is critical for identifying emerging resistance patterns, developing, and assessing the effectiveness of mitigation strategies. Improvement in prescribing `antimicrobials would minimize the risk of resistance and, consequently, improve patients' clinical and health outcomes. The purpose of the study is to delineate factors associated with antimicrobial resistance, describe the factors influencing prescriber’s choice during prescribing of antimicrobial, and examine factors related to consequences of inappropriate prescribing of antimicrobial. (2) Methods: Cross-sectional study conducted among healthcare providers (190) in six tertiary hospitals in the Eastern province of Saudi Arabia. The research panel has developed validated and piloted survey specific with closed-ended questions. A value of P &lt;0.05 was considered for statistical significance. All data analysis was performed using Statistical Package for Social Sciences (IBM SPSS version 23.0). (3) Results: 72.7% of the respondents have agreed that poor skills and knowledge are key factors that contribute to the inappropriate prescribing of antimicrobials. All the respondents acknowledged effectiveness and previous experience with the antimicrobial, and reading scientific materials (such as books, articles, and the internet) were key factors influencing physicians’ choice during antimicrobial prescribing. (4) Conclusion: The current study has identified comprehensive education and training needs for healthcare providers about antimicrobial resistance. Using antimicrobials unnecessarily, insufficient duration of antimicrobial use, and using broad spectrum antimicrobials, were reported to be common practices. Further, poor skills and knowledge were a key factor that contributed to the inappropriate use and overuse of antimicrobials and using antimicrobials without physician prescription (self-medication) were the key factors which contribute to AMR from participants’ perspectives. Furthermore, internal policy and guidelines are needed to ensure that the antimicrobials are prescribed in accordance with standard protocols and clinical guidelines.

(1) Background: Spain launched an official campaign, #EsteVirusLoParamosUnidos, to try and unite the efforts of the entire country through citizen cooperation to combat coronavirus. The research goal is to analyze the Twitter campaign’s repercussion on general citizen feeling. (2) Methods: The research is based on a composite design that triangulates from a theoretical model, a quantitative analysis and a qualitative analysis. (3) Results: Of the 7357 tweets in the sample, 72.32% were found to be retweets. Four content families were extracted: politics, education, messages to society and defense of occupational groups. The feelings expressed ranged along a continuum, from unity, admiration and support at one end to discontent and criticism regarding the health situation at the other. (4) Conclusions: The development of networked sociopolitical and technical measures that enable citizen participation facilitates the development of new patterns of interaction between governments and digital citizens, increasing citizens’ possibilities of influencing the public agenda and therefore strengthening citizen engagement vis-à-vis such situations.

The arrival of new developments in the field of power electronics circuit’s applications in power systems builds new control strategy to improve voltage quality for power grid by overcome interruptions. Wind energy resources are unconventional resources and get advanced problems to power grid when it is connected. Uncertainty of load sharing, peak energy management, climatic conditions, wind velocity and wind energy injected into power grid leads many of power quality problems on power grid based on the existing guidelines specified in IEC-61400 standard. This system plans efficient operation of DFIG to eliminate the voltage collapse and mismatch frequency to power grid. The DFIG connected diode rectifier and rotor side converter wind generator works as an Efficient Static Synchronous Compensator (E-SATCOM) for supplying the demand of reactive power for power grid to mitigate PQ problems. The benefit of using a combined controller was verified by simulink/Matlab and its simulated results used Doubly Fed Induction Generator (DFIG), wind Turbine. This simulation results gives good quality transient and stable state response to manage and support reactive power for both symmetrical and unsymmetrical faults in connection of grid codes to provide continuous quality of power supply, multiple wind generators are required for 140 bus power grid.

Hypercytokinemia, or cytokine storm, is one of the severe complications of viral and bacterial infections, involving the release of abnormal amounts of cytokines, resulting in a massive inflammatory response. Cytokine storm is associated with COVID-19 and sepsis high mortality rate by developing epithelial dysfunction and coagulopathy, leading to thromboembolism and multiple organ dysfunction syndrome. The anticoagulant therapy is an important tactic to prevent thrombosis in sepsis and COVID-19, but recent data show the incompatibility of modern direct oral anticoagulants and antiviral agents. It seems relevant to develop dual-action drugs with antiviral and anticoagulant properties. At the same time it was shown that azolo[1,5-a]pyrimidines are heterocycles with a broad spectrum of antiviral activity. We have synthesized a new family of azolo[1,5-a]pyrimidines and their condensed polycyclic analogs by cyclocondensation reactions and direct CH-functionalization and studied their anticoagulant properties. Five compounds among 1,2,4-triazolo[1,5-a]pyrimidin-7-ones and 5-alkyl-1,3,4-thiadiazolo[3,2-a]purin-8-ones demonstrated higher anticoagulant activity than the reference drug, dabigatran etexilate. Antithrombin activity of lead compounds was confirmed using lipopolysaccharide (LPS) treated blood to mimic conditions of cytokine release syndrome. The studied compounds affected only the thrombin time value, reliably increasing it 6.5–15.2 times as compared to LPS-treated blood.

Health literacy is an indicator of a society’s ability to make better health judgement for themselves and the people around them. This study investigates the prevalence of health literacy among Malaysian adults and provides an overall picture of the current health literacy state of the society. The study also highlights socio-demographics markers of communities with limited health literacy which may warrant future intervention. A population based self-administered survey using the Health Literacy Survey Malaysian Questionnaire18 (HLS-M-Q18) instrument was conducted as part of the National Health Morbidity Survey 2019 in Malaysia. The nationwide survey utilized two-staged stratified random sampling method. A sample of 9478 individuals aged 18 and above participated in the study. The health literacy score was divided into three levels; limited, sufficient and excellent. Findings showed that majority Malaysian population has sufficient health literacy level, albeit leaning towards the lower end of the category with an average score of 35.5. The limited health literacy groups are associated with respondents with older age, lower education level and lower household income. Overall health literacy state for Malaysia is categorized at a lower sufficient level. Health literacy improvements should focus on communities with limited health literacy level.

At present, there are no hardware or biochemical systems allow to assess the severity of post-COVID syndrome in vivo. The hardware of the proposed biotechnical system is based on routine transthoracic electrical impedance rheography, which makes it possible to register the frequency characteristics of the patient's bioimpedance response to controlled stress stimulation, thereby simultaneously fixing the characteristics of his productive heart, the state of the hemomicrocirculatory bed, the efficiency of the gas transport function of his blood, and also reliably assess personal reactivity and adaptive potential. Subsequent mathematical approximation of the obtained biometric data by an original neural network makes it possible to rank the results obtained and automatically generate a program of medical rehabilitation for a particular patient, depending on the severity of his post-COVID syndrome. The study results proved two reliable physiological signs confirming the presence of latent post-COVID complications: a decrease in the base impedance value for light exercise and an increase in the length of the systolic arc of the rheocardiogram.

Marketing is one of the important stages, the decisive factor affecting the success of production and business activities of every business. Therefore, marketing is considered to be the first and most important stage in the process of introducing, bringing products to market and branding of businesses, especially in the period when the disease situation is taking place very complicated worldwide. This study provides both qualitative and quantitative results for the following research objectives. Firstly, the study will assess the situation and analyze the appropriateness of marketing models in the current market situation trend. Secondly, the study proposes an approach in building a new type of marketing model, which is 3D web-based marketing applied in e-commerce to support the modeling of enterprise products in the form of Interactive 3D products are similar to real products. Thirdly, testing and evaluating 3D e-commerce web marketing model at Truong Hai Auto Showroom, Thai Nguyen City branch. This study also proposes a number of solutions for the research and deployment of 3D web marketing model application for businesses in the current market situation.

Background - Chronic kidney disease with unknown aetiology (CKDu) is a progressing disease which is affecting many Sri Lankans’ yearly, this disease is slow progressive, irreversible and asymptomatic disease. Patients suffering from CKDu over the past two decades have been evaluated using the estimated glomerular filtration rate (e-GFR). This is the standard test performed under WHO guidelines to investigate and grade the CKDu, and this creatinine clearance is measured in this in order to grade the patient. Backache has been a common symptom presented in most of the chronic kidney disease patients (CKD), patients with CKDu are liable to get backache due to the renal failure that takes place (Jayathilake et al., 2013; Redmon et al., 2016). Objective – To detect a correlation between serum creatinine values and level of backache presented in the patient. Method -Using an interview based questionnaire to assess patients’ body condition and the degree of backache is assessed, 59 patients were part of the study for a period of five months and had an average age of 60.3 years. The questionnaire answers are scaled into four main types of backache from the least to the most painful based on the pain scale adapted from Kapkia. Serum creatinine is measured using an automated analyzer which is measured using Jaffe’s reaction. Using Pearson R correlation, the relationship was determined between serum creatinine and backache (Kafkia et al., 2011). Results – The results were obtained for 58 patients (n=58), where the mean backache score was 2.30 and mean serum creatinine value 2.77. The Pearson R value obtained was 0.01 which is indicating almost no relationship between backache and serum creatinine. Patients with stage 3 kidney disease (n=14) had an average E-GFR of 38.0, stage 4 (n=38) with 22.3 and stage 5 (n=6) with 14.0. Conclusion – Backache can be used an indicator of CKDu since it is presented in most patients’ suffering from the disease but unable to be used to determine the stage of CKDu suffered by the patient due to the external causes that leads to backache. Several predisposing factors such as temperature, water source and agricultural activity can influence the backache.

Despite the research conducted worldwide, there is no treatment specific for SARS-CoV-2 infection with efficacy proven by randomized controlled trials. A chance for a breakthrough is vaccinating the majority of the global population. The public opinion surveys on vaccine hesitancy prompted our team to investigate the Polish medical community's attitude towards the SARS-CoV-2 and influenza vaccinations. In-person and online surveys of Healthcare Workers (HCWs): doctors, nurses, medical students, and other allied health professionals (n=419) took place between 14.09.2020 and 5.11.2020. In our study, 68.7% of respondents would like to be vaccinated with the COVID-19 vaccine. The safety and efficacy of vaccination against COVID-19 would persuade 86.3% of hesitant and those who would refuse to be vaccinated. 3.1% of all respondents claimed that no argument would convince them to get vaccinated. 61.6% of respondents declared a willingness to receive an influenza vaccination, of which 83.3% were also inclined to receive the planned COVID-19 vaccination. Although a significant part of respondents - 62.5% (262/419) indicated, they trusted the influenza vaccine more than the COVID-19 vaccine in direct comparison, more respondents intended to get the COVID-19 vaccination than the influenza vaccine in the 2020/2021 season.

The adverse relationship between viral hepatitis and pregnancy in developing countries was seen as a reflection of retrospective biased hospital-based data collection by the West. However, the discovery of HEV from an epidemic of non-A, non-B hepatitis in Kashmir and documenting increased incidence and severity of hepatitis E in pregnancy from a house-to-house survey unmasked the unholy alliance. Among the family of HEV’s, genotype (gt)-1, with a unique ORF4-encoded protein enhancing viral polymerase activity and viral replication, is the sole HEV that shows this adverse relationship. The epidemics caused by HEV-gt1 and not by HEV-gt2 show adverse relationship with pregnancy. The pathogenesis of the unholy alliance is complex and at present not well understood. Possibly multiple factors play a role in causing severe liver disease in the mother including: infection, replication and damage to the maternal-foetal interface by HEV-gt1; vertical transmission of HEV to foetus causing severe foetal/neonatal hepatitis; and combined viral and hormone related immune dysfunction of diverse nature in the mother promoting viral replication. Management is multidisciplinary and needs a close watch for the development and management of ALF. Preliminary data suggest beneficial maternal outcomes by early termination of pregnancy in patients with lower grades of encephalopathy.

Nowadays, according to spectacular improvement in health care and biomedical level, a tremendous amount of data is recorded by hospitals. In addition, the most effective approach to reduce disease mortality is to diagnose it as soon as possible. As a result, data mining by applying machine learning in the field of diseases provides good opportunities to examine the hidden patterns of this collection. An exact forecast of the mortality after heart surgery will cause Successful medical treatment and fewer costs. This research wants to recommend a new stacking predictive model after utilizing the random forest feature importance method to foresee the mortality after heart surgery on a highly unbalanced dataset by using the most practical features. To solve the unbalanced data problem, a combination of the SVM-SMOTE over-sampling algorithm and the Edited-Nearest-Neighbor under-sampling algorithm is used. This research compares the introduced model with some other machine learning classifiers to ensure efficiency through shuffle hold-out and 10-fold cross-validation strategies. In order to validate the performance of the implemented machine learning methods in this research, both shuffle hold-out, and 10-fold cross-validation results indicated that our model had the highest efficiency compared to the other models. Furthermore, the Friedman statistical test is applied to survey the differences between models. The result demonstrates that the introduced stacking model reached the most accurate predicting performance after Logistic Regression.

The impact of organizational accreditation and professional certification and the evidence-based measurable impact of those for both academic programs and affiliates is one of specific interest to universities and individuals in the healthcare management field [1]. The authors’ analysis examined the impact of hiring graduates from higher education programs that held external accreditation from the Commission on Accreditation of Healthcare Management Education (CAHME). Graduates’ affiliation with the American College of Healthcare Executives (ACHE) professional healthcare leadership organization was also assessed as an independent variable. Study outcomes focused on these graduates’ respective healthcare organization’s performance measures (cost, quality, and access) to assess the researchers’ inquiry into the perceived value of a CAHME-accredited graduate degree in healthcare administration and a professional ACHE affiliation [2]. The results from this study found no effect of CAHME accreditation or ACHE affiliation on healthcare organization performance outcomes. The study findings support the need for future research surrounding healthcare administration professional graduate degree program characteristics and leader development affiliations, as perceived by various industry stakeholders.

Introduction: Blood transfusion involves the transfer of blood from donors to patients. A blood transfusion is carried out every 2 seconds in the US. It is made up of about 29000 units of red blood cells and is transfused every day in the US. When blood transfusion is done correctly, it can result in the saving of lives and the improvement of healthcare. However, it may also lead to immediate, late, delayed, and chronic complications. No previous studies have been conducted in Qatar to address this issue. Methods: This is a cross-sectional study intended to determine the knowledge, attitude, and practice toward blood transfusion among healthcare providers at Hamad Medical Corporation (HMC), which is the principal healthcare provider in Qatar. Participants between 18 and 25 years of age were selected for the research study. A 10-item online questionnaire that people can fill out on their own will be used to get the data needed for the analysis and meet the study's goals. Results: the analysis has indicated that facing negative reactions after blood transfusion and being worried about getting affected by any infection have a small positive association, with the specific values coming in at r = 0.317, p = 0.000. Fever after blood transfusion and feeling like refusing blood transfusion have a significant and moderate positive correlation, with the specific values coming in at r = 0.630 and p = 0.000. Conclusion: The findings of this study have helped us figure out how healthcare providers feel, what they know, and what they do during a blood transfusion.

Metabolites are essential intermediate products in metabolism, and metabolism dysregulation indicates different types of diseases. Previous studies have shown that cigarette smoke dysregulated metabolites; however, limited information is available with electronic cigarette (E-cig) vaping. We hypothesized that E-cig vaping and cigarette smoking altered systemic metabolites, and we propose to understand the specific metabolic signature between E-cig users and cigarette smokers. Plasma from non-smoker controls, cigarette smokers, and e-cig users were collected, and metabolites were identified by UPLC–MS (Ultraperformance liquid chromatography-mass spectrometer). Nicotine degradation was activated by e-cig vaping and cigarette smoking with increased concentrations of cotinine, cotinine N-oxide, (S)-nicotine, and (R)-6-hydroxynicotine. Additionly, we found significant decreased concentrations in metabolites associated with tricarboxylic acid (TCA) cycle pathways in e-cig users verses cigarette smokers, such as: D-glucose, (2R,3S)-2,3-dimethylmalate, (R)-2-hydroxyglutarate, O-phosphoethanolamine, malathion, D-threo-isocitrate, malic acid, and 4-acetamidobutanoic acid. Cigarette smoking significant up-regulated sphingolipid metabolites, such as D-sphingosine, ceramide, N-(octadecanoyl)-sphing-4-enine, N-(9Z-octadecenoyl)-sphing-4-enine, and N-[(13Z)-docosenoyl]sphingosine, verses e-cig vaping. Overall, e-cig vaping dysregulated TCA cycle realted metabolites while cigarette smoking altered sphingolipid metabolites. Both e-cig and cigarette smoke increased nicotinic metabolites. Therefore, specific metabolic signature altered by e-cig vaping and cigarette smoking could serve as potential systemic biomarkers for early cardiopulmonary diseases.

Given the rise in the number of cases and their recurrences, Urinary Tract Infections (UTI) are one of the major burdens on public healthcare worldwide. Rapid, inexpensive and selective detection of Uropathogenic E. coli (UPEC), a major contributor to UTIs, is the need of the hour for effective treatment, given the rise of antibiotic-resistant bacteria due to improper diagnosis. Here we present a rapid, real-time, selective and label-free detection of UPEC using an integrated sensing platform based on Crossed Surface Relief Gratings (CSRGs) as nanoplasmonic sensors. Detection is achieved due to the unique Surface Plasmon Resonance (SPR)-based light energy exchange attributed to the CSRGs, allowing real-time sensing in a very narrow bandwidth of the incident light to pass where the SPR energy conversion occurs. The sensing ability of the platform is experimentally demonstrated by the detection of bulk Refractive Index (RI) changes, with a bulk sensitivity of 382.2 nm/RIU and a resolution in the order of 10-6 RIU. We demonstrate selective capture and detection of clinical concentration of UPEC, as opposed to other gram-negative bacteria, in real-time, a first for CSRGs. This work is particularly important for effective treatment of UTIs, allowing point-of-care diagnosis for economically disadvantaged regions around the world.

Although there are extensive literature reports on the use of gold nanoparticle (AuNP) based homogeneous assays for detection of biomolecules, very few experimental description and procedures involving their preparation are described. In this study, AuNPs conjugated to Bovine Serum Albumin or Envelope protein from Dengue II were developed as a homogeneous immunoassay for antibody detection. We report here optimization of key parameters to prepare an immunoassay like conjugation protein concentration, centrifugation time, electrolyte addition and assay temperature. We determined that saturating protein concentrations improved AuNPs surface coverage and uniformity of the assay and addition of sodium chloride improved sensitivity of the antibody detection method and assay stability. Furthermore, we showed that dynamic light scattering can be used to monitor changes in gold nanoparticles in the preparation and detection steps. Additionally, numerical simulations of the plasmonic optical response of AuNPs were carried out to scan for size-dependent response of the AuNPs. The AuNPs homogeneous immunoassay developed was further used in the detection of antibodies in vitro to detect Dengue virus infection.

With the rapid development of urbanization and industrialization in China, environmental issues have become a knotty problem, especially issues related to air, water, and solid-waste pollution. These pollutants pose threats to the health of the population and to that of communities and have a vicious influence on the healthcare system. Additionally, pollution also exhibits spill-over effects, which means that pollution in the local region could affect the healthcare services in a neighbouring region. Therefore, it is necessary to explore the relationship between pollution and healthcare. A spatial autocorrelation analysis was conducted and spatial panel econometric models were constructed to explore the characteristics of pollution and healthcare services in China and the relationship between them using data on all 31 provinces over twelve consecutive years (2006-2017). The results showed that the utilization of healthcare services and environmental pollution were not randomly distributed; unsurprisingly, air pollution and solid-waste pollution were mainly found in parts of northern China, while water pollution was highest in southern and coastal China. In addition, environmental pollution exhibited spill-over effects on healthcare services. For example, a 1% increase in solid waste in one specific geographical unit was estimated to increase the inpatient visits per capita in adjacent counties by 0.559%. Specifically, pollution showed different degrees of influence on healthcare services, which means that the impact of environmental pollution on the number of outpatient visits is greater than on the number of inpatient visits. Our results provide the government with evidence for effectively formulating and promulgating policies, especially policies aimed at tackling spill-over effects among different regions.

The COVID-19 pandemic is shifting teaching to an online setting all over the world. The Galaxy framework facilitates the online learning process and makes it accessible by providing a library of high-quality community-curated training materials, enabling easy access to data and tools, and facilitates sharing achievements and progress between students and instructors. By combining Galaxy with robust communication channels, effective instruction can be designed inclusively, regardless of the students' environments.

Replacement of fee-for-service with capitation arrangements, forces physicians and institutions to minimize health care costs, while maintaining high-quality care. In this report we describe how patients, their families (and caregivers) can work with members of the medical care team to achieve these twin goals of maintaining (and perhaps improving) high-quality care and minimizing costs. We describe how increased self-management enables patients and their families/caregivers to provide electronic patient-reported outcomes (i.e., symptoms, events) (ePROs) as frequently as the patient or the medical care team consider appropriate. These capabilities also allow greater reliance on the use of mobile technologies (mHealth) to provide ongoing assessments of physiologic measurements/phenomena. Remote surveillance of these communications allows longer intervals between (fewer) visits of patients to the medical-care team when this is appropriate and earlier interventions when that is appropriate. Systems are now available that alert medical care providers to situations when interventions might be needed.

There is a systematic exclusion of gender-based violence, safe abortion, reproductive cancers, infertility services, comprehensive sexuality education, sexuality services, and STI’s other than HIV in essential health packages in LMICs. To accelerate progress on sexual reproductive health (SRH), the Guttmacher–Lancet Commission proposed the adoption of these interventions into an essential health package of SRH services that should be universally available. In this commentary, we use a healthcare priority-setting processes lens to review the importance of these services for universal health coverage. We isolate inherent challenges in social value judgments for terminal, process and content evidence for their healthcare priority-setting. We then advance promising emerging practical examples from low to middle-income countries on evidence-informed decision-making processes. We recommend capacity development through regional support, generating equity and efficiency evidence and strengthening political and publicly acceptable processes to institutionalise and operationalise evidence-informed decision-making.

DDX3 is an ATP-dependent RNA helicase involved in multiple cellular activities, including RNA metabolism and innate immunity. DDX3 is known to assist the replication of some viruses while restricting some others through direct interaction with the viral proteins. However, the role of DDX3 in the replication of the hepatitis E virus (HEV) is unknown. In this study, DDX3 is shown to interact with the HEV capsid protein and provide an indispensable role in HEV replication. The DDX3 C-terminal domain was demonstrated to interact with the capsid protein, which was previously demonstrated to inhibit the production of type I interferons. Knockdown of DDX3 compromised the capsid protein-mediated blockage of interferon induction. Notably, DDX3 silencing led to a significant reduction in HEV replication. Also, the ATPase activity of DDX3 is required for the HEV replication as an ATPase-null mutant DDX3 failed to rescue the viral replication in the DDX3-silenced cells. These results demonstrate a pro-viral role of DDX3 in HEV replication, providing further insights into the virus-cell interactions.

In the context of the COVID-19 pandemic, thousands of healthcare workers (HCWs) infected with COVID-19 have lost their lives worldwide. At the early stage of the epidemic, when COVID-19 was still not considered as a pandemic, a large number of Chinese HCWs were infected. Officials reported that more than 3,000 HCWs in Hubei contracted the virus at the early stage of the outbreak due to limited knowledge of the virus. Following reports of overloaded local hospitals, more than 42,000 medical staff, including those from the military, were dispatched to Hubei from across the country. At the peak of the fight, one in 10 intensive care medics in China were working in Wuhan. During fighting against COVID-19 in China, although a large number of HCWs were infected by SARS-CoV-2 in the early stages of the epidemic, the timely adoption of measures indicated that, a faster rate of diagnosis could be achieved, patients were isolated in-time, HCWs’ safety was prioritized, training on basic protective knowledge and unified management of HCWs was strengthened, and effective protective measures were implemented. This resulted in the accomplishment of zero SARS-CoV-2 infection among the 42,632 members of the national medical teams sent to Hubei, and the number of COVID-19 cases among HCWs in local hospitals also significantly decreased, thereby indicating that hospital-acquired infections of SARS-CoV-2 among HCWs are fully preventable.

Genome sequencing is enabling precision medicine—tailoring treatment to the unique constellation of variants in an individual’s genome. The impact of recurrent pathogenic variants is often understood, leaving a long tail of rare genetic variants that are uncharacterized. The problem of uncharacterized rare variation is especially acute when it occurs in genes of known clinical importance with functionally consequent frequent variants and associated mechanisms. Variants of unknown significance (VUS) in these genes are discovered at a rate that outpaces current ability to classify them using databases of previous cases, experimental evaluation, and computational predictors. Clinicians are thus left without guidance about the significance of variants that may have actionable consequences. Computational prediction of the impact of rare genetic variation is increasingly becoming an important capability. In this paper, we review the technical and ethical challenges of interpreting the function of rare variants in two settings: inborn errors of metabolism in newborns, and pharmacogenomics. We propose a framework for a genomic learning healthcare system with an initial focus on early-onset treatable disease in newborns and actionable pharmacogenomics. We argue that (1) a genomic learning healthcare system must allow for continuous collection and assessment of rare variants, (2) emerging machine learning methods will enable algorithms to predict the clinical impact of rare variants on protein function, and (3) ethical considerations must inform the construction and deployment of all rare-variation triage strategies, particularly with respect to health disparities arising from unbalanced ancestry representation.

The protection of electronics against environmental influences and mechanical loads is important for integration of conventional electronics in textile conductive tapes. For this purpose, the sensors on the tapes are molded with plastic locally. This process step is recognized in the injection molding process. The molding compound is then later selected depending on: The field of application, the parameters of the manufacturing process and the textile tape properties. We have designed a mould for liquid silicone (LSR) as well as for the textile and electronic insertions. The cavities are sealed by a local compression of the textile and the two inserts are positioned with position pins representing the main aspect of the mould design. The sampling tool and the process parameter optimization are mainly based on the material properties of the silicone and the mechanical sensitivity of the inserts. To reduce the deformation of the circuit boards by the melt front and ensuring the functionality of the electronics a low-pressure process is used.

Electric moped scooter sharing services have recently experienced strong growth rates, particularly in Europe. Due to their compactness, environmental-friendliness and convenience, shared e-mopeds are suitable modes of transport in urban mobility to help reduce the environmental impact. However, its traffic-related, economic and environmental effects are merely represented in academic research. We used passenger car traffic data in Berlin generated by the multi-agent transport simulation framework MATSim to develop a python-based simulation, resembling an e-moped sharing system. Based on the results, a total cost of ownership and a life cycle assessment for fleet sizes of 2,500, 10,000 and 50,000 vehicles were conducted. The results indicate that a substantial part of all passenger car trips in Berlin can be substituted. The larger the fleet, the more and longer trips are replaced. Simultaneously, the efficiency in terms of fleet utilization decreases. The scenario with 10,000 e-mopeds offers the lowest total distance-based costs for sharing operators, whereas a fleet consisting of 2,500 vehicles exhibits the lowest environmental emissions per kilometer driven over the expected lifespan of a shared e-moped. Based on the renewable energy potential for 2050 forecasted by the German Federal Environment Agency, a significant overall decline in environmental impacts can be achieved.

Today, across the most critical problems faced by hospitals and health centers are those caused by the existence of patients who do not attend their appointments. Among others, this practice generates waste of resources and increases the patients’ waiting list. To handle these problems, hospitals are actively trying to implement methods to reduce the idle time caused by patient no-shows. Many scheduling systems developed require predicting whether a patient will show up for an appointment or not. Although, a challenging problem resides in obtaining these estimates precisely. The goal of this work is to analyze how objective factors influence a patient not to attending their appointment, to identify the main causes that contribute to a patient’s decision, and to be able to predict whether or not the patient will attend the scheduled appointment. As a result, the obtained model is tested on a real dataset collected in a health center linked to the University of Vale do Itajaí (UNIVALI), which includes 25 features and about 5000 samples. The algorithm that produced the best results for the available dataset is the Random Forest classifier. It reveals the best recall rate (0.91), since it measures the ability of a classifier to find all the positive instances and achieves a receiver operating characteristic curve rate of 0.969.

Immune escape is observed with SARS-CoV-2 Omicron (Pango lineage B.1.1.529), the predominant circulating strain worldwide. Booster dose was shown to restore immunity against Omicron infection, however, real world data comparing mRNA (BNT162b2; Comirnaty) and inactivated vaccine (CoronaVac; Sinovac) homologous and heterologous boosting is lacking. A retrospective study was performed to compare the rate and outcome of COVID-19 in healthcare workers (HCWs) with various vaccination regime during a territory-wide Omicron outbreak in Hong Kong. During the study period 1 Feb – 31 Mar 2022, 3167 HCWs were recruited, 871 HCWs reported 746 and 183 episodes of significant household and non-household close contact. 737 HCWs acquired COVID-19 which were all clinically mild. Time dependent Cox regression showed that, comparing with 2-dose vaccination, 3-dose vaccination reduced infection risk by 31.7% and 89.3% in household contact and non-household close contact respectively. Using 2-dose BNT162b2 as reference, 2-dose CoronaVac recipient had significantly higher risk of being infected (HR 1.69 P<0.0001). Three-dose BNT162b2 (HR 0.4778 P<0.0001) and 2-dose CoronaVac + BNT162b2 booster (HR 0.4862 P=0.0157) were associated with lower risk of infection. Three-dose CoronaVac and 2-dose BNT162b2 + CoronaVac booster were not significantly different from 2-dose BNT162b2. The mean time to achieve negative RT-PCR or E gene cycle threshold 31 or above was not affected by age, number of vaccine dose taken, vaccine type and timing of the last dose. In summary, we have demonstrated lower risk of breakthrough SARS-CoV-2 infection in HCWs given BNT162b2 as booster after 2 doses of BNT162b2 or CoronaVac.

Background: During the COVID-19 pandemic some family physicians were overburdened and experienced difficulties reaching vulnerable patients and meeting the increased need for psycho-social support. This randomized controlled trial (RCT) tested whether a primary healthcare (PHC) based community health worker (CHW) intervention could tackle psychosocial suffering due to physical distancing measures in patients with limited social networks. Methods: CHWs provided 8 weeks of tailored psychosocial support to the intervention group. Control group patients received ‘care as usual’. The impact on feelings of emotional support, social isolation, social participation, anxiety and fear of COVID-19 were measured longitudinally using a face-to-face survey to determine their mean change from baseline. Self-rated change in psychosocial health at 8 weeks was determined. Results: We failed to find a significant effect of the intervention on the prespecified psychosocial health measures. However, the intervention did lead to significant improvement in self-rated change in psychosocial health. Conclusions: This study confirms partially the existing evidence on the effectiveness of CHW in-terventions as a strategy to address mental health in PHC in a COVID context. Further research is needed to elaborate the implementation of CHWs in PHC to reach vulnerable populations during and after health crises.

In this work, an embroidered textile moisture sensor is presented. The sensor is based on a capacitive interdigitated structure embroidered on a cotton substrate with an embroidery conductor yarn composed by 99% pure silver plated nylon yarn 140/17 dtex. 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 25% to 65% at 20 ºC. The experimental results show a clear and controllable dependence of the sensor impedance with the relative humidity. Moreover, the reproducibility of the sensor performance subject to the manufacturing process variability and washing process is also evaluated. The results show that the manufacturing variability introduce a moisture measurement error up to 4%. The washing process impact on the sensor behavior after applying the first washing cycle implies a sensitivity reduction higher than 14%. Despite these effect, the textile sensor keeps its functionality and can be reused in standard conditions. Therefore, these properties point out the usefulness of the proposed sensor to develop wearable applications on health and fitness scope including the user needs to have a life cycle longer than one-time use

Here, we propose a novel scheme based on advanced techniques of digital modulation in optical communications to achieve a single-channel transmission rate above 100 Gb/s. We utilize a hybrid scheme amplitude/phase/frequency/dual polarization, combined with multidimensional dual lattice and a low-density parity-check-coded modulation. The Stokes parameters are applied to the proposed scheme to map the four-dimensional classical polarization \({I_X},{Q_X},{I_Y},{Q_Y}\) in a three-dimensional space. In addition, in the proposed system, the packing theory is applied to the bit interleaver process, three wavelengths are packaged before being transmitted over a wavelength-division multiplexing optical channel. This modulation process is carried out using symmetrical geometric shapes, such as a hypercube or a polyhedron, based on the molecular links theory using a grouping of 12 and 13/15 bits for the cubic and spherical lattices, respectively. The proposed technique is evaluated in the context of long distance communications over distances up to 100 km. The bit error rate results showed that the optical signal-to-noise ratio was approximately 4 dB over a distance of 50 km. In addition, the power spectral efficiency was found to be 3 lambda, which is considered good performance considering the effects of distance and the non-linear effects influencing the number of lambdas. Also, we use an optical time division multiplexing scheme (OTDM) in order to achieve a transmission rate beyond 1Tbit/s, where the speed effect is evaluated, taking into consideration that the power spectral efficiency is degraded. Furthermore, the average noise floor is -60dBm for all transmission distances. These findings are expected to contribute to the future implementation of robust long-distance optical communication infrastructure.

Organ transplantation centers set criteria for candidate qualification, which has led to disparate healthcare resource allocation practices affecting those with a substance use history. These individuals are denied organ transplants by committees and healthcare providers who assign them lower priority status. The lower priority argument claims that healthcare resources should not be provided equally to individuals failing to share responsibility for not doing enough in addressing the diseases associated with substance use. The purpose of this work is to explore the interrelatedness between the ethics of a merit-based system of moral responsibility and lower priority setting involved in healthcare resource allocation pertaining to those with substance use histories. An integral approach to the argument against the lower prioritists with a focus on the relationship between different organ allocation practices affecting substance users and the justification for resource allocation practices in healthcare and transplant committees. Lower priority setting is challenged, and an argument offered in which substance users are assigned higher priority when relying on “doing enough” in a merit-based system of moral responsibility. It is determined that one cannot substantiate assigning a lower priority status since a lack of success in rehab does not imply a lack of effort. Additionally, neither to confirmatory behavior, nor to non-conforming behavior may freedom be justifiably ascribed in a merit-based system of responsibility because freedom to choose can neither be established a priori, nor a posteriori with respect to meritorious behavior.

Supported Wellbeing Centres have been set up in UK hospital trusts in effort to mitigate the psychological impact of COVID-19 on healthcare workers, although the extent to which these are utilised and the barriers and facilitators to access are not known. The aim of the study was to determine facility usage and gather insight into employee wellbeing and the views of employees towards this provision. The study included i) 17-week service use monitoring, ii) employee online survey with measures of wellbeing, job stressfulness, presenteeism, turnover intentions, job satisfaction, and work engagement as well as barriers and facilitators to accessing the Wellbeing Centres. Over 17 weeks, 14,934 facility visits were recorded across two sites (peak attendance in single week n= 2,605). Facilities were highly valued, but the service model was resource intensive with 134 wellbeing buddies supporting the centres in pairs. 819 hospital employees completed an online survey (88% female; 37.7% working in COVID-19 high risk areas; 52.4% frontline workers; 55.2% had accessed a wellbeing centre). There was moderate-to-high job stress (62.9%), low wellbeing (26.1%), presenteeism (68%) and intentions to leave (31.6%). Wellbeing was higher in those that accessed a wellbeing centre. Work engagement and job satisfaction were high. Healthcare organisations are urged to mobilise access to high-quality rest spaces and Psychological First Aid, but this should be localised and diversified. Strategies to address presenteeism and staff retention should be prioritised, and high dedication of healthcare workers should be recognised.

Historical legacy of Eastern European and Balkans’ health systems was mutually interdependent and shaped by local socioeconomic circumstances. Three distinctive systems of risk sharing and health financing to develop since the late XIX century were the Bismarck, Beveridge, and Semashko systems. Modern day healthcare systems in these countries are challenged by population ageing, accelerated innovation in medical technology, growing purchasing power and rising demand for healthcare services. Supply side changes contribute to demand side efficiency bottlenecks in financing, driving the costs of the already expensive medical care up. All of the nations have a large share of citizens experiencing difficulty with affordability and access to medical care, particularly in rural and remote areas. Network of Health technology assessment agencies have mushroomed over the past three decades. Principles of health economics theory and cost-effective resource allocation are slowly gaining ground in governing authorities’ mindset and decision-making process. For many years to come, pharmaceuticals and medical services will remain dependent on out-of-pocket spending. Currently accelerating and spreading 4.0 Industrial Revolution, together with the Belt and Road Initiative, are likely to substantially impact the further economic development of this vast region. Post-Pandemic ‘Green’ Recovery strategies adopted by many of the Eastern European governments shall also make this transition towards sustainable development more difficult and challenging given the large dependency of all these economies upon traditional carbon fuels.

Pseudomonas aeruginosa is an emerging opportunistic pathogen responsible for cystic fibrosis and nosocomial infections. In addition, empirical treatments are become inefficient due to their multiple-antibiotic resistance and extensive colonizing ability. Quorum sensing (QS) plays a vital role in the regulation of virulence factors in P. aeruginosa. Attenuation of virulence by QS inhibition could be an alternative and effective approach to control infections. Therefore, we sought to discover new QS inhibitors (QSIs) against LasR receptor in P. aeruginosa using chemoinformatics. Initially, a structure-based high-throughput virtual screening was performed using the LasR active site that identified 61404 relevant molecules. E-pharmacophore (ADAHH) screening of these molecules rendered 72 QSI candidates. In standard-precision docking, only 7 compounds were found as potential QSIs due to their higher binding affinity to LasR receptor (-7.53 to -10.32 kcal/mol compared to -7.43 kcal/mol of native ligands). The ADMET properties of these compounds were suitable to be QSIs. Later, extra-precision docking and binding energy calculation suggested ZINC19765885 and ZINC72387263 as the most promising QSIs. The dynamic simulation of the docked complexes showed good binding stability and molecular interactions. The current study suggested that these two compounds could be used in P. aeruginosa QS inhibition to combat bacterial infections.

The Ministry of Health evaluates hospital management in accordance with the standard of quality of service. The concept of Shariah hospitals offers management services that exceed the standard of quality of hospital care. The study aims to illustrate the concept of Shariah hospitals in Indonesia. We collect related literature from various media via online search with the keywords “Shariah hospitals,” “implementation of Shariah hospitals,” and “application of Shariah hospitals.” Main findings: The study finds that the Shariah hospitals built by the philosophy of Islam are willing to provide the best health-care services to patients. A code of conduct must be fulfilled by the hospital management in Shariah hospitals: (1) general liability, (2) obligations to society and the environment, (3) obligations to patients, (4) obligations to the leaders, staff, and employees, and (4) relationships with related institutions. The foremost challenges include the improvement of health personnel performance and the quality of services in addition to perceptions that are not inclusive of the system of Shariah hospitals. This implementation should run consistently and with the commitment of all parties. Such insight, in turn, can be counted as an input to an approach to health services, particularly in increasing the performance rates, such as hospital. This study is the first to provide new insight into discussion about shariah hospital by presenting its focuses on Islamic approaches in meeting the quality standards of health services in hospitals so as to obtain more value. However, exclusive principles—Islamization, heterogeneity, and the performance of health workers—challenge the implementation of this hospital system.

Geomagnetic induced current (GIC) is a ground end manifestation associated with the space weather perturbations that should be greatly taken into account by the society. Although the GICs implication to the power system is not regular, it can cause large scale of system failure. In equatorial, the power system is considered safe since the most intense of geomagnetic storm happened in high latitude. However, the internal damage due to GICs which finally led to the South African power system failure has totally changed the normal perception. Therefore, a preliminary investigation on the GICs activity in equatorial region is performed to understand the space weather impact to the power system. Time derivative of the horizontal magnetic field component (dB/dt) is done to indicate the GICs activity value based on Faraday’s law. All the reported power failures are compiled to produce the threshold value of dB/dt, which possibly cause the harmful effect to the system. Then, dB/dt analysis is extended to show the pattern of GICs activity in function of magnetic latitude and local time. The results reveal that power network in equatorial region has possibly suffered by GIC. Plus, high number of intense GIC activity in this region occurred during dayside.

The COVID-19 outbreaks have caused universities all across the globe to close their campuses and forced them to initiate online teaching. This article reviews the pedagogical foundations for developing effective distance education practices, starting from the assumption that promoting autonomous thinking is an essential element to guarantee full citizenship in a democracy and for moral decision making in situations of rapid change, which has become a pressing need in the context of a pandemic. In addition, the main obstacles related to this new context are identified, and solutions are proposed according to the existing bibliography in learning sciences.

Increased proliferation of IT services in all sectors has reinforced the adoption and diffusion across all levels of education and training institutions. However, lack of awareness of and knowledge about the key challenges and opportunities of elearning, seem to allude policymakers, resulting in low adoption or increased failure rate of many e-learning projects. Our study tries to address this problem through a review of relevant literature in e-learning. Our goal was to draw from the existing literature, insights into the opportunities and challenges of e-learning diffusion, and the current state-of-research in the field. To do this, we employed a systematic review of literature on some of the salient opportunities and challenges of e-learning innovation for educational institutions. These results aimed to inform policymakers and suggest some interesting issues to advance the research and adoption and diffusion of e-learning. Moreover, the bibliometric analysis shows that the field is experiencing high research attraction among scholars. However, several research areas in the field witnessed relatively low research paucity. Based on these findings, we discussed topics for possible future research.

For any odd positive integer $x$, define $(x_n)_{n\geqslant 0} $ and $(a_n )_{n\geqslant 1} $ by setting $x_{0}=x, \,\, x_n =\cfrac{3x_{n-1} +1}{2^{a_n }}$ such that all $x_n $ are odd. The 3x+1 problem asserts that there is an $x_n =1$ for all $x$. Usually, $(x_n )_{n\geqslant 0} $ is called the trajectory of $x$. In this paper, we concentrate on $(a_n )_{n\geqslant 1} $ and call it the E-sequence of $x$. The idea is that, we consider any infinite sequence $(a_n )_{n\geqslant 1} $ of positive integers and call it an E-sequence. We then define $(a_n )_{n\geqslant 1} $ to be $\Omega-$convergent to $x$ if it is the E-sequence of $x$ and to be $\Omega-$divergent if it is not the E-sequence of any odd positive integer. We prove a remarkable fact that the $\Omega-$divergence of all non-periodic E-sequences implies the periodicity of $(x_n )_{n\geqslant 0} $ for all $x_0$. The principal results of this paper are to prove the $\Omega-$divergence of several classes of non-periodic E-sequences. Especially, we prove that all non-periodic E-sequences $(a_n )_{n\geqslant 1} $ with $\mathop {\overline {\lim } }\limits_{n\to \infty } \cfrac{b_n }{n}>\log _23$ are $\Omega-$divergent by using the Wendel's inequality and the Matthews and Watts's formula $x_n =\cfrac{3^n x_0 }{2^{b_n }}\prod\limits_{k=0}^{n-1} {(1+\cfrac{1}{3x_k })} $, where $b_n =\sum\limits_{k=1}^n {a_k } $. These results present a possible way to prove the periodicity of trajectories of all positive integers in the 3x + 1 problem and we call it the E-sequence approach.

This study investigated the prevalence and severity of depression, anxiety, and stress and determined the association between various factors, social support, and depression and anxiety among university healthcare workers in Malaysia after the government lifted the movement control order (MCO) put in place to curb the coronavirus disease 2019 (COVID-19) pandemic. This online, cross-sectional survey recruited 399 participants from two university hospitals, and they were administered a self-reported questionnaire on demographic, personal, and clinical characteristics; COVID-19-related stressors; and coping. In addition, they completed the Multidimensional Scale of Perceived Social Support (MSPSS) to measure perceived social support, as well as the 21-item Depression, Anxiety, and Stress Scale (DASS-21) to assess depression, anxiety, and stress. We found that the prevalence of depression, anxiety, and stress were 21.8%, 31.6%, and 29.1%, respectively. Participants with moderate to extremely severe depression, anxiety, and stress made up 13.3%, 25.8%, and 8.1% of the sample, respectively. Being single or divorced, fear of frequent exposure to COVID-19 patients, those who agreed that their area of living had a high prevalence of COVID-19 cases, and uncertainty regarding the prevalence of COVID-19 cases in the area of living were associated with higher odds of depression and anxiety. Conversely, having more than three children and greater perceived friend support were associated with lower odds of depression and anxiety. The prevalence of depression, anxiety, and stress remained elevated even after the MCO was lifted.

Genetic variations at the Apolipoprotein E (ApoE) and microtubule-associated protein tau (MAPT) loci have been implicated in multiple neurogenerative diseases, but their exact molecular mechanisms are unclear. In this study we performed transcript level linear modelling using the blood whole transcriptome data and genotypes of the 570 subjects in the Parkinson’s progression markers initiative (PPMI) cohort. ApoE, MAPT haplotypes and two SNPs at the SNCA locus (rs356181, rs3910105) were used to detect expression quantitative trait loci eQTLs associated with the transcriptome and differential usage of transcript isoforms. As a result, we identified 151 genes associated with the genotypic variations, 29 cis and 122 trans eQTL positions. Profound effect with genome-wide significance of ApoE e4 haplotype on the expression of TOMM40 transcripts was identified. This finding potentially explain in part the frequently established genetic association with the APOE e4 haplotypes in neurodegenerative diseases. Moreover, MAPT haplotypes had significant differential impact on 23 transcripts from the 17q21.31 and 17q24.1 loci. MAPT haplotypes had also the largest (256) and smallest (-178) effect sizes measured as beta values on two different transcripts from the same gene (LRRC37A2). Intronic SNP in the SNCA gene, rs3910105, differentially induces expression of three SNCA isoforms. In conclusion, this study established clear association between well-known haplotypic variance and transcript specific regulation in the blood. APOE e4 and MAPT H1/H2 haplotypic variants are associated with the expression of several genes related to the neurodegeneration.

In open, sustainable policymaking, we are expecting to develop the valuable results that will bring us closer to a fairer and more balanced society. One way to involve the public in these processes is to engage them in online e-participation projects. Despite the hopes, empirical analyses show that many e-participation initiatives have failed to deliver expected benefits. Revealing what actually works in examined projects and what requires improvement would allow for better policy planning in the future. In this article, I made an attempt to identify and assess the cognitive processes enabling emergence of collective intelligence (CI) in a singular e-participation project. For this reason, I worked out and tested an evaluation technique, combining the MILCS framework for group cognition and the results of empirical research on CI. A case study method based on semi-structured interviews was selected to evaluate a sample participatory budgeting initiative, Civic Budget of the City of Kraków. Results reveal that most cognitive processes are working satisfactorily, but the real problem is using collective memory, which works only to a very limited extent. A guideline for future policymakers should be to develop a shared memory system, to which all community members should have access.

Nowadays, wearable devices for human health monitoring are increasingly become popular and widely used. Typically, the wearable device is small size and operates with batteries. Therefore, the wearable device acquires bio-signals and transfers to smartphones or personal computers (PC) via WiFi/ Bluetooth for processing data. To reduce power consumption is one of the most important challenges of designing wearable devices. To solve this problem, the proposed signal quality valuation (SQV) method can be select the high-quality signal and reduce the transfer time to other devices. In this paper, the proposed SQV and data compression method rely on real-time PPG signals analysis to retain important information of PPG signal, improve performance and power consumption of PPG devices. Besides, we also proposed Heuristic rules for heart rate (HR) estimation with compression data. The experimental results show that the highest compression ratio (CR) is 387.8 with BIDMC Physionet database (sampling frequencies of 125 Hz) and HR error as 1.43 bpm for averaging absolute error (avAE), the standard deviation absolute error (sdAE as 0.4) and relative error mean (avRE as 0.019). The proposed real-time PPG measurement system (sampling frequency as 100/ 200/ 400 Hz) reduce power consumption and open the new structure for healthcare application systems

Type 2 diabetes (T2D) is associated with increased cardiovascular morbidity, mortality, and hospital admissions. There is variability in clinical practice. The objectives are to analyze the variability in the control of Blood Pressure (BP), HbA1c, and LDL-C in T2D patients and its influence on admissions due to cardiovascular events (CVE) Methods: We analyzed the electronic records in Primary Care Health centers in Navarra (Spain) and hospital admission for CVE. We follow 480637 people from 2012 to 2016. We calculated indicators of control of patients with T2D for each year, percentage with: HbA1c &lt; 7%; HbA1c &gt;= 9%; BP &lt;140/90 mmHg; LDL-C &lt;100 mg/dl. We used logistic and Cox regression. Results: Patients in the best control GP practices cluster are 2.5 times more likely to have HbA1c &lt;7% [OR: 2.46 (95% CI: 2.29-3.64)]. Poor HbA1c control ≥ 9% is more likely in the worst control cluster [OR: 1.73 (95% CI:1.63-1.83)]. The probability of admission for CVE increases with age, being male, low income, obesity, history of CVE, having HbA1c ≥ 9%, and belonging to a GP practice in the cluster of HbA1C ≥ 9% worst control. In contrast, it decreases in patients with HbA1c &lt;7%, BP&lt;140/90 mmHg and LDL &lt;100 mg/dl.

In hospitals and smart nursing homes, ambient-intelligent care rooms are equipped with many sensors. They can monitor environmental and body parameters, and detect wearable devices of patients and nurses. Hence, they continuously produce data streams. This offers the opportunity to collect, integrate and interpret this data in a context-aware manner, with a focus on reactivity and autonomy. However, doing this in real-time on huge data streams is a challenging task. In this context, cascading reasoning is an emerging research approach that exploits the trade-off between reasoning complexity and data velocity by constructing a processing hierarchy of reasoners. Therefore, a cascading reasoning framework is proposed in this paper. A generic architecture is presented allowing to create a pipeline of reasoning components hosted locally, in the edge of the network, and in the cloud. The architecture is implemented on a pervasive health use case, where medically diagnosed patients are constantly monitored, and alarming situations can be detected and reacted upon in a context-aware manner. A performance evaluation shows that the total system latency is mostly lower than 5 seconds, allowing for responsive intervention by a nurse in alarming situations. Using the evaluation results, the benefits of cascading reasoning for healthcare are analyzed.

Pneumonia is the leading cause of hospitalization in pediatric patients. Disease severity greatly influences pneumonia progression and adverse health outcomes such as hospital readmission. Hospital readmissions have become a measure of healthcare quality to reduce excess expenditures. The aim of this study was to examine 30-day all-cause readmission rates and evaluate the association between pneumonia severity and readmission among pediatric pneumonia hospitalizations. Using 2018 Nationwide Readmissions Database (NRD), we conducted a cross-sectional study of pediatric hospitalizations for pneumonia. Pneumonia severity was defined by the presence of respiratory failure, sepsis, mechanical ventilation, dependence on long-term supplemental oxygen, and/or respiratory intubation. Outcomes of interest were 30-day all-cause readmission, length of stay, and cost. The rate of 30-day readmission for the total sample was 5.9%, 4.7% for non-severe pneumonia, and 8.7% for severe pneumonia (p&lt;0.01). Among those who were readmitted, hospitalizations for severe pneumonia had a longer length of stay (6.5 vs. 5.4 days, p&lt;0.01) and higher daily cost ($3,246 vs. $2,679, p&lt;0.01) than admissions for non-severe pneumonia. Factors associated with 30-day readmission were pneumonia severity, immunosuppressive conditions, length of stay, and hospital case volume. To reduce potentially preventable readmissions, clinical interventions to improve the disease course and hospital system interventions are necessary.

This study emphasizes the necessity of introducing a blockchain-based joint logistics system to strengthen the competency of medical supply chain management (SCM) and tries to develop a healthcare supply chain management (HSCM) competency measurement item through an analytic hierarchy process. The variables needed for using blockchain-based joint logistics are the performance expectations, effort expectations, promotion conditions, and social impact of the UTAUT model, and the HSCM competency results in increased reliability and transparency, enhanced SCM, and enhanced scalability. Word cloud results, analyzing the most important considerations to realize work efficiency among medical industry-related agencies, mentioned numerous words, including sudden situations, delivery, technology trust, information sharing, effectiveness, urgency, etc. This might imply the need to establish a system that can respond immediately to emergency situations during holidays. It could also suggest the importance of real-time information sharing to increase the efficiency of inventory management. Therefore, there is a need of a business model that can increase the visibility of real-time medical SCM through big data analysis. By analyzing the importance of securing reliability based on the blockchain technology in the establishment of a supply chain network for HSCM competency, we reveal that joint logistics can be achieved and synergistic effects can be created by implementing the integrated database to secure HSCM competency. Strengthening partnerships, such as joint logistics, will eventually lead to HSCM competency. In particular, HSCM should seek ways to upgrade its competitive capabilities through big data analysis based on the establishment of a joint logistics system.

(1) Background: Emergencies confront civilian and military healthcare providers with medical and hygienic challenges due to the lack of potable water. This pilot study aimed to describe the application of two different methods for microbiological monitoring of water in a harsh environment in terms of performance, ease of use, availability, and the possibility of using the results to evaluate water quality. (2) Methods: Samples from raw water, Potable water, and water for consumers were taken from two different camps with the same raw water source. The samples were analyzed by using IDEXX industry-standard methods (Colilert and Enterolert enzymatic test kits) and a combination of membrane filtration and 3M-Petrifilm. (3) Results: The IDEXX method used at the Norwegian Camp are easier to utilize and has a broader range of analyzing kits for drinking water analysis. In addition, IDEXX is better adapted to the requirements of the national legislation. However, the combination of membrane filtration followed by incubation on 3M-Petrifilm ™, as used at the Swedish camp, is a better field alternative compared to traditional bacteriology, as it eliminates the need to produce and store agar plates. (4) Conclusions: This pilot study highlights the need for adapted technical equipment and tools for internal microbiological control of water production in a harsh field environment and may facilitate the use of a relatively simple method for water control and ensure the safety of deployed staff in both civilian and military settings.

Objectives: As institutions modified medical practices to mitigate the spread of the SARS-CoV-2 virus, providers were forced to modify care through the implementation of telemedicine. The objective of this article is to review the current practices of otolaryngology during the COVID-19 pandemic and the limitations of telemedicine in current practice. Methods: A thorough review of the PubMed and MEDLINE databases was performed for publications between 2020 and 2021. Studies discussing telemedicine in otolaryngology during COVID-19 pandemic were selected. Results: As worldwide cases of COVID-19 continue to oscillate, we must continue to be vigilant in our clinical practice, implementing safe techniques to mitigate the spread of the SARS-CoV-2 virus through the continual use of telemedicine in all specialties of otolaryngology. Trends of increased patient acceptance of the use of telemedicine have been seen across subspecialities, including otolaryngology. Conclusion: Currently there are challenges associated with the implementation of telemedicine in the field of otolaryngology that rely heavily on adjunct physical examination, imaging studies, and specialty procedures. However, telemedicine has tremendous potential and can be adapted to include in the otolaryngologist’s toolbelt during public health emergencies such as the COVID-19 pandemic.

Sexual issues and treatment side effects are not routinely discussed with men receiving treatment for prostate cancer and support to address these concerns is not consistent across settings. This study evaluates a brief e-learning resource designed to improve sexual wellbeing support and examine its effects on healthcare professionals’ sexual attitudes and beliefs. Healthcare professionals (n=44) completed an online questionnaire at baseline which included a modified 12-item sexual attitudes and beliefs survey (SABS). Follow-up questionnaires were completed immediately after the e-learning and at 4 weeks. Data were analysed using one-way, repeat measures ANOVAs to assess change in attitudes and beliefs over time. Significant improvements were observed at follow-up for a number of survey statements including ‘knowledge and understanding’, ‘confidence in discussing sexual wellbeing’ and the extent to which participants felt ‘equipped with the language to initiate conversations’. The resource was seen as concise, relevant to practice, and as providing useful information on potential side effects of treatment. Brief, e-learning has potential to address barriers to sexual wellbeing communication and promote delivery of support for prostate cancer survivors. Practical methods and resources should be included with these interventions to support implementation of learning and long-term changes in clinical behaviour.