Background: Early-stage interventions in a potential pandemic are important tounderstand as they can make the difference between runaway exponential growththat is hard to turn back and stopping the spread before it gets that far. COVID-19 is an interesting case study because there have been very different outcomesin different localities. These variations are best studied after the fact if precisionis the goal; while a pandemic is still unfolding less precise analysis is of value inattempting to guide localities in the early stages to learn lessons of those that pre-ceded them. Methods: I examine three factors that could differentiate strategy: asymptomaticspread, differences in use of the Bacillus Calmette-Guerin (BCG) tuberculosis vac-cine and cloth face masks.Results:Differences in disease progression as well as the possibility of alternativestrategies to prevent COVID-19 from entering the runaway phase or damping itdown later can be elucidated by a study of asymptomatic infection. A study todemonstrate not only what fraction are asymptomatic but how contagious they arewill also inform policy on universal mask wearing. Conclusions: While a COVID-19 outbreak is at a level that makes accurate trace-and test possible, investigation of asymptomatic transmission is viable and shouldbe attempted to enhance understanding of spread and variability in the disease aswell as policy options for slowing the spread.

From June 18 to 19, 2013, the Ésera river in the Pyrenees, Northern Spain, caused widespread damage due to flooding as a result of torrential rains and sustained snowmelt. We estimate the contribution of snow melt to total discharge applying a snow energy balance to the catchment. Precipitation is derived from sparse local measurements and the WRF-ARW model over three nested domains, down to a grid cell size of 2 km. Temperature profiles, precipitation and precipitation gradient are well simulated, although with a possible displacement regarding the observations. Snowpack melting was correctly reproduced and verified in three instrumented sites, and according to satellite images. We found that the hydrological simulations agree well with measured discharge. Snowmelt represented 33% of total runoff during the main flood event and 23% at peak flow. The snow energy balance model indicates that most of the energy for snow melt during the day of maximum precipitation came from turbulent fluxes. This approach forecast correctly peak flow and discharge during normal conditions at least 24h in advance and could give an early warning of the extreme event 2.5 days before.

Background: Microbiome-Inspired Green Infrastructure (MIGI) was recently proposed as an integrative system to promote healthy urban ecosystems, through multidisciplinary design. Specifically, MIGI is defined as nature-centric infrastructure restored and/or designed and managed to enhance health-promoting interactions between humans and environmental microbiomes, whilst sustaining microbially-mediated ecosystem functionality and resilience. MIGI also aims to stimulate a research agenda that focuses on considerations for the importance of urban environmental microbiomes. Objectives: In this paper we provide details of what MIGI entails from a bioscience and biodesign perspective, highlighting the potential dual benefits for human and ecosystem health. We present ‘what is known’ about the relationship between urban microbiomes, green infrastructure and environmental factors that may affect urban ecosystem health (ecosystem functionality and resilience as well as human health). We discuss how to start operationalising the MIGI concept based on current available knowledge, and present a horizon scan of emerging and future considerations in research and practice. We conclude by highlighting challenges to the implementation of MIGI and propose a series of workshops to discuss multi-stakeholder needs and opportunities. Discussion: This article will enable urban landscape managers to incorporate initial considerations for the microbiome in their development projects to promote human and ecosystem health. However, overcoming the challenges to operationalising MIGI will be essential to furthering its practical development. Although the research is in its infancy, there is considerable potential for MIGI to help deliver sustainable urban development driven by considerations for reciprocal relations between humans and the foundations of our ecosystems –– the microorganisms.

Abstract The aim of this research is to conduct a systematic review analysing the role of the physiotherapy interventions in palliative care. PRISMA as a critical appraisal tool was utilised for the selection of the research articles. The inclusion criteria were based on the year of publication, ease of availability, language, geographical location, and study type. To ensure the credibility, databases such as Elsevier, Proquest, and EBSCO Host were used to filter the grey content. Data published in the past ten years (2009-onwards) was only included to ensure the selection of the most recent interventions used by the physiotherapists. A total of 11 articles were selected which determined that physiotherapy interventions involving breathing exercises, aerobic exercises, manual therapies, and educational awareness were critical to promoting the functional capability and empower the patients.

A cosmological model was developed using the equation of state of photon gas, as well as cosmic time. The primary objective of this model is to see if determining the observed rotation speed of galactic matter is possible, without using dark matter (halo) as a parameter. To do so, a numerical application of the evolution of variables in accordance with cosmic time and a new state equation was developed to determine precise, realistic values for a number of cosmological parameters, such as energy of the universe , cosmological constant Λ, curvature of space k, energy density , age of the universe etc. Some assumptions were put forth in order to solve these equations. The current version of the model partially explains several of the observed phenomena that raise questions. Numerical application of the model has yielded the following results, among others: Initially, during the Planck era, at the very beginning of Planck time, , the universe contained a single photon at Planck temperature Planck energy in the Planck volume. During the photon inflation phase (before characteristic time ~10^-9 ), the number of original photons (alphatons) increased at each unit of Planck time and geometrical progression ~n³, where n is the quotient of cosmic time over Planck time . Then, the primordial number of photons reached a maximum of N~10⁸⁹, where it remained constant. It's primordial photons (alphatons) are still present today and represents the essential of the energy contained in the universe via the cosmological constante . Such geometric growth in the number of photons can bring a solution to the horizon problem through exchange and a photon energy volume that is in phase with that of the the volume energy of the universe. The age of the universe in cosmic time that is in line with positive energy conservation (in terms of conventional thermodynamics) and the creation of proton, neutron, electron, and neutrino masses, is ~76 [Gy] (observed . The predicted total mass (p, n, e and n), based on the Maxwell-Juttner relativistic statistical distribution, is ~7x10⁵⁰ . The predicted cosmic neutrino mass is ≤ 8.69x10^-32 (≤ 48.7 ) if based on observations of SN1987A. The temperature variation of the cosmic microwave background (CMB), as measured by Planck, can be said to be partially due to energy variations in the universe (DU/U) during the primordial baryon synthesis (energy jump from the creation of protons and neutrons). In this model, what is usually referred to as dark energy actually corresponds to the energy of the universe that has not been converted to mass, and which acts on the mass created by the energy-mass equivalence principle and the cosmological gravity field, , associated with the cosmological constant, which is high during primordial formation of the galaxies (<1 [Gy]). A look at the Casimir effect makes it possible to estimate a minimum Casimir pressure and thus determine our possible relative position in the universe at cosmic time 0,1813 (t₀/t_W=13,8 /76,1 ). Therefore, from the observed age of 13,8 [Gy], we can derive a possible cosmic age of 76,1 [Gy]. That energy of the universe, when taken into consideration during the formation of the first galaxies (< 1 [Gy]), provides a relatively adequate explanation of the non-Keplerian rotation of galactic masses. Indeed, such residual, non-baryonic energy, when considered in Newton’s gravity equation, adds the term , which can partially explain, without recourse to dark matter, the rotations of some galaxies, such as M33, UGC12591, UGC2885, NGC3198, NGC253, DDO161, UDG44, the MW and the Coma cluster. Today, in the MW, that cosmological gravity force is in the order of 10²⁶ times smaller than the conventional gravity force. The model predicts an acceleration of the mass in the universe (q~ 0,986); the energy associated with curvature is the driving force behind the expansion of the universe, rather than the energy associated with the cosmological constant . An equation to determine expansion is obtained using the energy form of the Friedmann equation relative to Planck power and cosmic time or Planck force acting at the frontier of the universe moving at c. This constant Planck force, from unknown sources, acts everywhere to the expansion of the universe as a stretching effect on the volume. Finally, the model partly explains the value a₀ of the MOND theory. Indeed, a₀ is not a true constant, but depends on the cosmological constant at the time the great structures were formed (~1 [Gy]), as well as an adjustment of the typical mass and dimension of those great structures, such as galaxies. The constant a₀ is a different expression of the cosmological gravity force as expressed by the cosmological constant, Λ, acting through the energy-mass equivalent during the formation of the structures. It does not put in question the value of G.

The rapid transmission of COVID-19 in school communities has been a major concern. To ensure that mitigation systems were in place and support was available, a digital intervention to encourage and facilitate infection control behaviours was rapidly adapted and optimised for implementation as a whole school intervention. Using the person-based approach, ‘Germ Defence’ was iteratively adapted, guided by relevant literature, co-production with Patient and Public Involvement representatives, and think aloud interviews with forty-five school students, staff, and parents. Suggested infection control behaviours deemed feasible and acceptable by the majority of participants included handwashing/hand-sanitising and wearing a face covering in certain contexts such as crowded public spaces. Promoting a sense of collective responsibility was reported to increase motivation for the adoption of these behaviours. However, acceptability and willingness to implement recommended behaviours seemed to be influenced by participants’ perceptions of risk. Barriers to the implementation of recommended behaviours in school and at home primarily related to childcare needs and physical space. We conclude that it was possible to rapidly adapt Germ Defence to provide an acceptable resource to help mitigate against infection transmission within and from school settings. Adapted content was considered acceptable, persuasive, and accessible.

Recent interest in intestinal hormones has risen with the idea that they modulate glucose tolerance and food intake through a variety of mechanisms, and such hormones like peptide YY (PYY), ghrelin, glucagon-like peptide (GLP)-1 and 2, and cholecystokinin (CKK) are therefore excellent therapeutic candidates for the treatment of diabetes and obesity. Furthermore, in the recent years, multiple studies suggest that the microbiota is critically important for normal host functions, while impaired host microbiota interactions contribute to the pathogenesis of numerous common metabolic disorders. In this study, we considered the nutraceutical effects of β-glucans added to pasta at the concentration of 6g\100g. Ten participants have been recruited and hematochemical analyses and intestinal hormones tests have been performed before and after 30 days of pasta intake. Stool specimens have been studied for Lactobacillus Fermentum, Lactobacillus acidophilus, Lactobacillus salivarius, Bifidobacterium longum, and Enterococcus faecium presence before and after 30 days of nutritional intervention. After 30 days of regular intake of pasta enriched by β-glucans results have been evaluated. In conclusion, pasta prepared from barley flour enriched with β-glucans at 6% exhibit promising responses on glucose metabolism, on intestinal hormones responses and on microbiota modification.

The outbreak of coronavirus disease 2019 (COVID-19) was identified in Wuhan, China, in December 2019. As of April 17, 2020, more than 2 million cases of COVID-19 have been reported worldwide. Northern Italy is one of the world’s centers of active coronavirus cases. In this study, we predicted the spread of COVID-19 and its burden on hospital care under different conditions of social distancing in Lombardy and Emilia-Romagna, the two regions of Italy most affected by the epidemic. To do this, we used a Susceptible-Exposed-Infectious-Recovered (SEIR) deterministic model, which encompasses compartments relevant to public health interventions such as quarantine. A new compartment L was added to the model for isolated infected population, i.e., individuals tested positives that do not need hospital care. We found that in Lombardy restrictive containment measures should be prolonged at least until early July to avoid a resurgence of hospitalizations; on the other hand, in Emilia-Romagna the number of hospitalized cases could be kept under a reasonable amount with a higher contact rate. Our results suggest that territory-specific forecasts under different scenarios are crucial to enhance or take new containment measures during the epidemic.

A 24 week-controlled trial was conducted in menopausal women (mean age:61.5) to assess serum 25-hydroyvitaminD (s25OHD) evolution in relation to three interdependent determinants: doses of supplemented (Suppl.) vitamin D₃ (VitD₃); baseline status; seasonality. Participants were randomized into 3 groups (Gr): Gr.Suppl.0, time-controls maintaining dietary habits; Gr.Suppl.5 and Gr.Suppl.10 consuming one and two 125 g servings of VitD₃-fortified yogurts with 5 and 10 µg daily doses, respectively. The 16 intervention-weeks lasted from early-January to mid-August, the 8 follow-up-weeks from late-August to mid-October. Before enrollment, subjects were randomized into two s25OHD strata: “Low stratum (LoStr)“: 25-50 nmol/L; “High stratum (HiStr)“: >50-75 nmol/L. All enrolled participants remained compliant until study end: Gr.Suppl.0 (n=45), Gr.Suppl.5 (n=44) Gr.Suppl.10 (n=44). Over the 16 intervention and 8 follow-up weeks, s25OHD increased in both supplemented groups, more in Gr.Suppl.10 than Gr.Suppl.5. The constant rate of s25OHD per supplemental VitD₃ microgram was greater in LoStr than HiStr. s25OHD increase was greater with late (mid-March) than early (mid-January) inclusion. In conclusion, this randomized trial demonstrates: -a dose-dependent s25OHD improvement related to fortified yogurt consumption; -an inversely baseline-dependent increase in s25OHD; -a seasonal effect that highlights the importance of vitamin D₃ supplementation during winter, even at 5µg/d, in healthy menopausal women.

Severe early childhood caries remains the most common chronic disease affecting children. Its multifactorial etiology has established a controversy about which risk factors were more significant to its development. Therefore our study aimed through meticulous statistical analysis to arrange the “well agreed upon” common risk factors in order of significance, to aid the clinician in tailoring an adequate preventive program for this affected age group. The study reshuffled the risk factors contributing to severe early childhood caries and placed them in the order of their significance as follows: snacking of sugary food several times a day, increased number of siblings to 3 or more, night feeding, child self-employed brushing, mother caries experience, 2 siblings, on demand feeding, once/day sugary food, sharing utensils, 1 Sibling, male gender, father’s education, late first child dental visit, brushing time, mother’s education, no dental visit, decreased brushing frequency & no night brushing.

Suicide and suicidal behavior are major public health concerns and affect 3-9% of the population worldwide. Despite growing evidence, there are still few effective interventions available to reduce suicide risk. In this article, we describe theoretical models of suicide ideation and behavior and propose to examine the possible effectiveness of a new and innovative preventive strategy. A model of suicidal intrusion (mental imagery related to suicide, also referred to as suicidal flash-forwards) is presented describing one of the assumed mechanisms in the etiology of suicide and the mechanism of therapeutic change. We provide a brief rationale for an Eye Movement Dual Task (EMDT) treatment for suicidal intrusions describing techniques that can be used to target these suicidal mental images and thoughts to reduce overall behavior. Based on the available empirical evidence for the mechanisms of suicidal intrusions, this approach appears to be a promising new treatment to prevent suicidal behavior as it potentially targets one of the linking pins between suicidal ideation and suicidal actions.

To help reduce the impact of geohazards, an innovative landslide early-warning technology based on an energy demodulation-based fiber optic sensing (FOS-LW for short) technology, is introduced in this paper. FOS-LW measures the energy change in a sensing fiber at the segment of micro-bending, which can be caused by landslide movements, and automatically raises an alarm as soon as the measured signal intensity in the fiber reaches a pre-set threshold. Based on the sensing of micro-bending losses in the fiber optics, a two-event sensing algorithm has been developed for the landslide early-warning. The feasibility of the FOS-LW technology is verified through laboratory simulation and field tests. The result shows that FOS-LW has some unique features such as the graded alarm, real-time responses, remote monitoring, low cost and passive optical network, and can be applied in the early-warning of landslides.

Malnutrition and dental caries in early childhood remain persistent and intertwined global health challenges, particularly for indigenous and geographically-remote populations. To examine the prevalence and associations between early childhood dental caries, parent-reported mouth pain and malnutrition in the Amazonian region of Ecuador, we conducted a cross-sectional study of the oral health and nutrition status of 1,407 children from birth through age 6 in the “Alli Kiru” program (2011-2013). We used multivariate regression analysis to examine relationships between severe caries, parent-reported mouth pain measures, and nutritional status. The prevalence of dental caries was 65.4%, with 44.7% of children having deep or severe caries, and 33.8% reporting mouth pain. The number of decayed, missing and filled teeth dmft) increased dramatically with age. Malnutrition was prevalent, with 35.9% of children stunted, 1.1% wasted, 7.4% underweight, and 6.8% overweight. As mouth pain increased in frequency, odds for severe caries increased. For each unit increase in mouth pain frequency interfering with sleeping, children had increased odds for underweight (AOR: 1.27; 95% CI: 1.02 – 1.54) and decreased odds for overweight (AOR: 0.76; 95% CI: 0.58 – 0.97). This relationship was most pronounced among 3-6 year-olds. Early childhood caries, mouth pain and malnutrition were prevalent in this sample of young children. Parent-reported mouth pain was associated with severe caries, and mouth pain interfering with sleeping was predictive of poor nutritional status. We demonstrate the utility of a parsimonious parent-reported measure of mouth pain to predict young children’s risk for severe early childhood caries and malnutrition, which has implications for community health interventions.

(1) Background: It is unclear whether the reported presenting clinical features of coronavirus disease 2019 (COVID-19) are useful in identifying high-risk patients for early testing and isolation in the emergency department (ED). We aimed to compare the exposure history, clinical, laboratory, and radiographic features of ED patients who tested positive and negative for COVID-19; (2) Methods: We conducted a case-control study in seven EDs during the first five weeks of the COVID-19 outbreak in Hong Kong. Thirty-seven laboratory-confirmed COVID-19 patients were compared with 111 age- and gender-matched controls; (3) Results: There were no significant differences in patient characteristics and reported symptoms between the groups, except patient-reported fever. A positive travel history or contact history was the most significant predictor for COVID-19 infection. After adjustment for age and presumed location of acquiring the infection in Wuhan/Hubei, patient-reported fever (OR 2.6, 95% CI 1.1 to 6.3), delayed presentation (OR 5.0, 95% CI 2.0 to 12.5), having medical consultation before ED presentation (OR 7.4, 95% 2.9 to19.1), thrombocytopenia (OR 4.0, 95% CI 1.6 to 9.7), raised lactate dehydrogenase (OR 5.9, 95% CI 1.9 to 18.5), haziness, consolidation or ground-glass opacity on chest radiography (OR 5.6, 95% CI 2.0 to 16.0), and bilateral changes on chest radiography (OR 13.2, 95% CI 4.7 to 37.4) were associated with a higher odds of COVID-19 separately while neutrophilia was associated with a lower odds (OR 0.3, 95% CI 0.1-0.8); and (4) Conclusions: This study highlights several features that may be useful in identifying high-risk patients for early testing and isolation while waiting for test result. Further studies are warranted to verify the findings.

This study examines the exchange rate rebound effects of the Central Bank intervention in the selected ECOWAS economies. An empirical understanding of these effects is very important to trade adjustment as well as the macroeconomic stability in these countries. Using the panel data modelling framework, the study finds that the impact of the Central Bank intervention on exchange rate is insignificant and it does not lead to the exchange rate rebound. In addition, money supply as well as monetary policy rate implemented by the monetary authorities significantly influences the level of exchange rate in a positive direction.

Here we mathematically model black holes and the early universe following dynamics similar to RLC electrical models, focusing on their similarities at the singularity. We use this mathematically modelling to hypothesize the evolution of an expanding universe as the result of a black hole collapse followed by its evaporation. Or model consists of several steps defined by: (1) the formation of a black hole following general relativity equations; (2) growth of the black hole modelled as a resistance-capacitance-like electrical circuit; (3) expansion of space-time following the disintegration of the black hole, modelled by RLC-like dynamics. In updating this article, version 2, we will expand by presenting three additional examples related to the theory of the generalization Boltzmann's constant in curved space-time and the theory of general and especial relativity. We will calculate the critical mass to produce a black hole in the LHC, the existence of a high temperature Bose-Einstein condensate and finally we will demonstrate the existence of a tangential force to the repulsion force in the disintegration of subatomic particles. In the update of this article, version 3, we will expand to develop two examples. First, we will present the relationship between M-theory, extra dimensions with the theory of the generalization of Boltzmann's constant in curved space-time. Secondly, we will propose the idea of ​​updating the Lambda-CDM model, considering the primordial gravitational waves to correctly describe the evolution of the universe.

In the recent concrete industry, high fluidity concrete is being widely used for the pouring of dense reinforced concrete. Normally, in the case of high fluidity concrete, it includes high binder contents, so it is necessary to replace part of the cement through admixtures such as fly ash to procure economic feasibility and durability. This study shows the mechanical properties and field applicability of high fluidity concrete that using mass of fly ash as alternative materials of cement. The high fluidity concrete mixed with 50% fly ash was measured to manufacture concrete that applies low water/binder ratio to measure the mechanical characteristics as compressive strength and elastic modulus. Also, in order to evaluate the field applicability, high fluidity concrete containing high volume fly ash was evaluated that fluidity, compressive strength, heat of hydration and drying shrinkage of concrete.

Recent analyses of cosmic microwave background surveys have revealed hints that there may be a non-trivial running of the running of the spectral index. If future experiments were to confirm these hints, it would prove a powerful discriminator of inflationary models, ruling out simple single field models. We discuss how isocurvature perturbations in multi-field models can be invoked to generate large runnings in a non-standard hierarchy, and find that a minimal model capable of practically realising this would be a two-field model with a non-canonical kinetic structure. We also consider alternative scenarios such as variable speed of light models and canonical quantum gravity effects and their implications for runnings of the spectral index.

Here, applying the theory of the generalization of the Boltzmann constant in curved space-time, we will model the mechanism by which elementary particles are formed. We will determine the relationship between gravity and each of the elementary particles that form the standard model following analogies to that of stellar bodies. In order to achieve our goal, we will propose new models for photons, quarks and gluons; with this, we will demonstrate why there are stable and unstable elementary particles; why the first family of elementary particles forms hadrons and why the second and third families cannot form hadrons; why the fermions comply with the Pauli exclusion principle and why the bosons do not comply with the Pauli exclusion principle, etc. Finally, we will analyse the generalization of the ADS/CFT correspondence and propose a theory of everything (T.O.E.).

Here we will electrically-quantum model the neutron and proton as a three-phase alternating current electric generator, for this, we will use the theory of three-phase electric generators and vector or phasor diagrams. We will use this model to hypothesize how the quarks that form neutrons and protons with a combined mass of 10 MeV/c², can generate, through quarks-antiquarks-gluon interactions, a mass of 939.56 MeV/c² for the neutron and a mass of 938.27 MeV/c² for the proton. Using quantum mechanics and the theory of the generalization of the Boltzmann constant in curved space-time we will calculate the number of quarks-antiquarks-gluons and gravitons inside a neutron. We will also analyse βˉ decay using vector diagrams, we will calculate the tension of the string T₀ and the length of the string ℓs between quarks-antiquark and finally, we will model a black hole using a neutron equivalent model. In version 2 of this article, we will update the vector diagrams of the βˉ decay and theoretically calculate the energy of the W⁻ boson, the Z⁰ boson, and the Θ angle, Θ = arc cos (W⁻/Z⁰). We will demonstrate, through vector diagrams, that quarks-antiquarks-gluon interactions are the cause of the origin of the W⁻ boson and the Z⁰ boson. We will also demonstrate how the fine structure constant α originates. It is important to make clear, in future updates, we will describe the relationship that exists between the theory described in this paper and the Isospin theory, flavour and colour theory

Landslides are natural disasters that normally cause misery over the Mount Elgon region, especially in Bududa district. A landslide early warning system was developed in collaboration with the community and this study investigated it’s effectiveness in disseminating warnings to the community. The data were collected from 82 respondents (mean age 43) and 4 focus group discussions (one per village). Majority of the respondents lost crops (35.9%); land (29.8%); lives and livestock (6.9%). The frequent occurrence of landslides is due to the changes in landuse patterns; settlement on steep slopes; and prolonged rainfall of low intensities. The study found that, 93.2% of respondents have ever received the warnings and alerts. 78.8% of those who received the warnings evacuated. The use of radios to disseminate warnings is the most efficient communication channel (44.4%) followed by using the clan members (19.5%). Only 40% of the women received the early warning through radios, an indicator that this channel puts women at a disadvantage. The main challenges regarding utilization of early warning system were: poor timing (29.9%); poor coordination (20.7%); and poor sensitization (18.4%). There is need to strengthen the community networks, and with continuous sensitization, the effectiveness of the landslides early warning will improve and this is expected to enhance the resilience of the community to landslides.

Young women with breast cancer represent 15% of cancer cases in Latin America. Genomic studies have found that early-onset breast-cancer cases exhibit a higher genetic susceptibility and a specific genomic signature as compared to their older counterparts. The aim of this study was to describe clinically relevant germline mutations in a cohort of young women with breast cancer. To achieve this, we analyzed hereditary-cancer genes from whole-exome sequencing data in 108 unrelated women with an extreme phenotype of breast cancer (≤40 years of age), diagnosed and treated at the National Cancer Institute of Mexico; 11% of the patients carried a pathogenic variant. BRCA2 comprised 46% of the mutations, followed by BRCA1 with 23%; PALB2 with 15%; and TP53 and RAD51C with 8 % each. This article describes a novel pathogenic mutation in RAD51C c.519dupT. The median age at diagnosis was 35 years overall; however, it was six years younger in patients with mutations. Age at diagnosis (OR=0.82, CI 95% 0.71-0.94; P= 0.008) and first-degree family history of cancer (OR=8.26, CI95% 1.35-50; P= 0.022) were the only epidemiological variables associated with mutational status. We found no differences in disease-free survival (p=0.403) or overall survival (p=0.735) among mutational status subgroups.

Background: The incidence of fracture and surgery of the hip and lower extremities is still high. Long postoperative bed rest has the potential to increase the incidence of various complications that may increase the morbidity and mortality rate of patients after hip and lower extremities surgery. Aim: This literature review aimed to identify the effects of early mobilization in hip and lower extremity postoperative. Method: Search for articles on several databases such as ProQuest, ScienceDirect, CINAHL, Medline, Wiley Online and Scopus, using the Boolean operator by combining several keywords according to the literature review topic, with inclusion criteria are published in the last 3 years (2019-2021), used a quantitative design, written in English and full text articles. A total of 435 articles were obtained, then screened and reviewed, so that there were 16 (sixteen) eligible articles.Result: There were 11 (eleven) effects of early mobilization, i.e. reducing length of stay, reducing the risk of deep vein thrombosis (DVT), reducing pulmonary infections (pneumonia), reducing urinary tract infections, reducing the risk of wound infection, improving extremity function and ability to walk, reducing postoperative pain, reducing the risk of pressure sores, reducing postoperative delirium, reducing readmission and lowering hospitalization costs. Conclusion: This literature review showed that early mobilization is safe and effective in postoperative patients to reduce the risk of complications and adverse events. Nurses and health workers who care for patients could implement early mobilization and motivate patients to be cooperative in undergoing early mobilization.

COVID-19 is fast spreading around the globe in a highly contagious manner. In this article we have described that after prolonged interventions the percentage growth curve for COVID-19 cases showed a flattened nature, after prolonged volatility in number of COVID-19 cases. The stability in the growth curve was continuously maintained from 18 April, 2020 to 29 April, 2020. The significance of this sustained stable curve on survival & doubling time has been discussed. One significant part of the study reflected that the doubling time of COVID-19 cases showed a negative correlation with the percent increase in COVID-19 cases (R=0.301). It is plausible that if such negative correlation is maintained with further flattening of the growth curve at a lower level, it may influence the infective ability of nCoV-19 & ultimately have a positive evolutionary implication on the spread of COVID-19 among the population.

Changes in curricula, publication policy and information technology, notably in China have led to concentrations in the role of STEM (science, technology, engineering and mathematics) education in early childhood and applauded to proliferations of imported up-to-date reading materials and mobile apps in English. This paper proposes a longitude study of a Chinese toddler learning STEM by reading picture books and playing with tablet and suggests new horizons in parenting and in STEM education during children's early years. The present study carried out from 2016, when the participant reached one year old, eligible to learn to speak and to concentrate on the picture books read by parents who had filled a language background questionnaire with information on themselves and the participant. Tablet playing brought about for the two-year-old toddler and collections of STEM books in English was added for the second year. Data collection lasted for two years with an iLab video camera, capturing utterances and motions for five minutes per week transcribed by VoiceScript software. Tests were given quarterly at private home by tapping in mobile app "Bilingual Child Learning" which consists of 20 basic STEM themes before scores were collected. Findings indicate that (1) it is accessible for children of very early years to be engaged in English STEM resources, (2) kids' limited English dominance does not impede learning STEM, (3) and to think in English in early STEM contributes to children's English.

In Kenya, millions of children have limited access to nurturing care. With the COVID-19 pandemic, it is anticipated that vulnerable children will bear the biggest brunt of the direct and indirect impacts of the pandemic. This review aimed to deepen understanding of the effects of COVID-19 on nurturing care from conception to four years of age, a period where the care of children is often delivered through caregivers or other informal platforms. The review has drawn upon the empirical evidence from previous pandemics and epidemics, and anecdotal and emerging evidence from the ongoing COVID-19 crisis. Multifactorial impacts fall into five key domains: direct health; health and nutrition systems, economic, social and child protection, and child development and early learning. The review proposes program and policy strategies to guide the re-orientation of nurturing care, prevent the detrimental effects associated with deteriorating nurturing care environments, and support the optimal development of the youngest and most vulnerable children. These include the provision of cash transfers and essential supplies for vulnerable households, and strengthening of community-based platforms for nurturing care. Further research on COVID-19 and the ability of children’s ecology to provide nurturing care is needed, as is further testing of new ideas.

Flails are one of the more contentious and misunderstood classes of medieval weaponry, despite their prevalence in popular media: some researchers question their existence entirely and the bulk of historians are sceptical of widespread temporal and geographical prevalence while others, and a significant volume of period evidence, would argue the contrary. While the expansive use of flails in Eastern Europe and Byzantium is familiar, many Central, Western, and Southern European sources are less well-known or largely forgotten, especially those stemming from the later-early and early-high medieval eras (up to 1250). In this work, I collate and discuss the bulk of the available literary references and artistic depictions of flails and their use alongside some of the archaeological finds from Western, Central, and Southern Europe, with an emphasis on the 12^th and 13^th Centuries. The significance of this volume of evidence is examined, and an assessment of flails as a part of medieval culture and warfare is considered. Collectively, this would suggest that knowledge of flails as instruments of war and associated cultural connotations, if not their actual prevalence and use in warfare, was far more widespread across Europe this time period than has been previously estimated.

Since association between myocardial infarction (MI) and respiratory infections has been described for influenza-viruses and other respiratory viral agents, understanding possible physiopathological links between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and acute coronary syndromes (ACS) is of the greatest importance. First data suggest an underestimation of ACS cases all over the world, but acute MI still represents a major cause of morbidity and mortality worldwide and should not be overshadowed during the coronavirus disease (Covid-19) pandemic. No common consensus regarding the most adequate healthcare management policy for ACS is currently available. Indeed, important differences have been reported between the measures employed to treat ACS in China during the first disease outbreak and what currently represents clinical practice across Europe and the USA. This review aims to discuss: pathophysiological links between MI, respiratory infections, and Covid-19; epidemiological data related to ACS at the time of the Covid-19 pandemic; what emerged so far from several catheterization labs and coronary care units all over the world, in order to shed some light on the current strategies for optimal management of ACS patients with confirmed or suspected SARS-CoV-2 infection.

Molecular autism research is evolving towards a biopsychosocial framework that is more informed by autistic experiences. In this context, research aims are moving away from correcting external autistic behaviors and towards alleviating internal distress. Autism Spectrum Conditions (ASCs) are associated with high rates of depression, suicidality and other comorbid psychopathologies, but this relationship is poorly understood. Here, we integrate emerging characterizations of internal autistic experiences within a molecular framework to yield insight into the prevalence of psychopathology in ASC. We demonstrate that descriptions of social camouflaging and autistic burnout resonate closely with the accepted definitions for early life stress (ELS) and chronic adolescent stress (CAS). We propose that social camouflaging could be considered a distinct form of CAS that contributes to allostatic overload, culminating in a pathophysiological state that is experienced as autistic burnout. Autistic burnout is thought to contribute to psychopathology via psychological and physiological mechanisms, but these remain largely unexplored by molecular researchers. Building on converging fields in molecular neuroscience, we discuss the substantial evidence implicating mitochondrial dysfunction in ASC to propose a novel role for mitochondrial allostatic load in the relationship between autism and psychopathology. An interplay between mitochondrial, neuroimmune and neuroendocrine signaling is increasingly implicated in stress-related psychopathologies, and these molecular players are also associated with neurodevelopmental, neurophysiological and neurochemical aspects of ASC etiology. Together, this suggests an increased exposure and underlying molecular susceptibility to ELS that increases the risk of psychopathology in ASC. This article describes an integrative framework shaped by autistic experiences that highlights novel avenues for molecular research into mechanisms that directly affect the quality of life and well-being of autistic individuals. Moreover, this framework emphasizes the need for increased access to diagnoses, accommodations, and resources to improve mental health outcomes in autism.

Social media HPV vaccination interventions show promise for increasing HPV vaccination rates. An important consideration for the implementation of effective interventions into real-world practice in the translation potential, or external validity, of the intervention. To this end, we conducted a systematic literature review to describe the current body of evidence regarding the external validity of social media HPV vaccination-related interventions. Constructs related to external validity were based on the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework. Seventeen articles published between 2006 and 2020 met inclusion criteria. Three researchers independently coded each article using a validated RE-AIM (reach, effectiveness/efficacy, adoption, implementation, maintenance) framework. Discrepant codes were discussed with a fourth reviewer to gain consensus. Of these 17 studies, three were pilot efficacy studies, 10 were RCTs to evaluate effectiveness, one was a population-based study, and three did not explicitly state which type of study was conducted. Reflecting this distribution of study types, across all studies the mean level of reporting RE-AIM dimensions varied with reach recording 90.8%, effectiveness (72.1%), adoption (40.3%), implementation (45.6%), and maintenance (26.5%). This review suggests that while the current HPV vaccination social media-driven interventions provide sufficient information on internal validity (reach and effectiveness), few have aimed to gather data on external validity needed to translate the interventions into real world implementation. Our data suggest that implementation research is needed to move HPV vaccination-related interventions into practice. Included in this review are recommendations for enhancing the design and reporting of these HPV vaccination social media-related interventions.

Many emotionally disturbed children who have been maltreated and are legally separated from their parents or primary caregivers live in group homes and receive compulsory education. Such institutions provide various special intervention programs. Taiko, a Japanese style of group drumming, is one such program because playing drums in a group may improve children’s emotional well-being. However, evidence for its efficacy has not been well established at the biological level. In this study, we measured salivary levels of oxytocin (OT), a neuropeptide associated with social memory and communication, in three conditions (recital, practice, and free sessions) in four classes of school-aged children. Following the sessions, OT concentrations showed changes in various degrees and directions (no change, increases, or decreases). However, the mean OT concentration changes after each session increased, ranging from 112% to 165%. Plasma OT concentrations were equally sensitive to drum playing in school-aged boys and girls. However, the difference between practice and free play sessions was only significant among elementary school boys aged 8-12 years. The results suggest that younger boys are most responsive to this type of educational music intervention.

The Armillaria genus represents one of the most common causes of chronic root rot disease in woody plants. The disease damage prompt assessment is crucial for pest management. However, the disease detection current methods are limited at the field scale. Therefore, an alternative approach that can enhance or supplement traditional techniques is needed. In this study, we investigated the potential of hyperspectral methods to identify the changes between fungi-infected and uninfected plants of Vitis vinifera in early detecting the Armillaria disease. The hyperspectral imaging sensor Specim-IQ was used to acquire images of leaves of the Teroldego Rotaliano grapevine cultivar. We analysed three groups of plants: healthy, asymptomatic, and diseased. Highly significant differences were found in the Near infrared (NIR) spectral region with a decreasing pattern from healthy to diseased plants attributable to internal leaf structure changes. Asymptomatic plants emerged from the other groups due to a smaller reflectance in the red-edge spectrum (around 705nm). Hypothetically associated with the presence of secondary metabolites involved in plant defence strategy. Furthermore, significant differences were observed in the wavelengths close to 550 nm in diseased plants versus asymptomatic. We used linear discriminant analysis from a machine learning context to classify the leaves based on the most significant variables (vegetation indices and single bands), with resulting overall accuracies of 85% and 84% respectively in healthy vs. diseased and healthy vs. asymptomatic. To our knowledge, this study represents the first report on the possibility of using hyperspectral data for root rot disease diagnosis on woody plants. Although further validation studies are required, it appears that the spectral reflectance technique, possibly implemented on unmanned aerial vehicles (UAV), could be a promising tool for a cost-effective, non-destructive method of Armillaria disease early diagnosis and mapping in the field, contributing to a significant step forward in precision viticulture.

Complete pathologic response (pCR) predicts the long-term outcome of neoadjuvant treated (NAC) breast cancer (BC) but is reached in <10% of hormone-receptor-positive patients. Biomarkers able to guide adjustment or interruption of an ineffective therapy are desired. Here, we evaluated whether shifts in the serum concentration of thymidine kinase 1 (sTK1) during NAC could be utilized as a biomarker. In the PROMIX trial, women with localized HER2- BC received neoadjuvant epirubicin/docetaxel in six cycles. sTK1 was measured with an ELISA in 54 patients at cycles 1-4 and in a total of 131 patients before and 48h after cycle 1. The prognostic significance of the results was evaluated by log-rank tests of Kaplan–Meier estimates. Treatment resulted in a 2-fold increase of sTK1 before and 3-fold increase 48h after the cycles, except for the first cycle, where half of patients reacted with a decrease (post/pre sTK1- ratio <1.12) and the other half reacted with an increase (ratio >1.12). OS rates in ER+ patients with ratios of >1.12 and <1.12 were 97.7% and 78% (p=0.005), respectively, and DFS rates were 90.7% and 68% (p=0.006), respectively. Thus, response of sTK1 at the first cycle of chemotherapy could be used both as an early biomarker for guidance of chemotherapy and for the study of inherent tumor chemo-sensitivity, which could predict long-term outcome prior to therapy.

Virtual reality (VR) technology gains theoretical support from rehabilitation and pedagogical theories and offers a variety of capabilities in educational and interventional contexts with affordable products. VR is attracting increasing attention in the medical and healthcare industry as it provides fully interactive three-dimensional simulations of real-world settings and social situations, which are particularly suitable for cognitive and performance training including social and interaction skills. The worldwide rising trend in the prevalence of autism spectrum disorder calls for innovative and efficacious techniques for assessment and treatment. The article offers a summary of current perspectives and evidence-based applications of VR technology as an educational and intervention tool for individuals with autism spectrum disorder, with a primary focus on social communication including social functioning, emotion recognition, and speech and language. Technology- and design-related limitations as well as the disputes over the application of virtual reality to autism research and therapy are discussed and future directions of this emerging field are highlighted with regards to application expansion and improvement, technology enhancement, and the development of brain-based research and theoretical models.

Molecular methods have revolutionised virtually every area of biology, and metazoan phylogenetics is no exception: molecular phylogenies, molecular clocks, comparative phylogenomics, and developmental genetics have collectively transformed our understanding of the evolutionary history of animals. Moreover, the diversity of methods and models within molecular phylogenetics has resulted in significant disagreement among molecular phylogenies as well as between these and traditional phylogenies. Here, I argue that tackling this multifaceted problem lies in integrating evidence to infer the best evolutionary scenario. I begin with an overview of recent developments in early metazoan phylogenetics, followed by a discussion of key conceptual issues in phylogenetics revolving around phylogenetic evidence and theory. I then argue that integration of different kinds of evidence is necessary for arriving at the best evolutionary scenario rather than the best-fitting cladogram. Finally, I discuss the prospects of this view in stimulating interdisciplinary cross-talk in early metazoan research and beyond.

The prevalence of autism in children in the world is estimated as one per 62 children, higher levels reported in some countries. These children experience significant problems with the development of social, behavioural and verbal and non-verbal communication skills. The skills impairment levels varies from an individual to another and that made teaching autistics a challenge for caregivers such as teachers and relatives. Hence, there are quite a number of frameworks of a software learning systems which focus on gaining the children’s attention using representational visual illustration as a learning method instead of the textual form. However, majority of these tools are lacking the personalisation ability to suite everyone in the spectrum. Assistive technology offers an alternative way to attract children with autism. Therefore, this research is proposing an Adaptive Content Management Learning System (ACMLS) model to assist caregivers to produce, design and fine-tune or customise the learning materials appropriately so that the system interface and the materials are suitable for every individual in the spectrum according to each child personal profile aiming to make learning attractive and to contribute in improving their social, communication and behavioural skills and nonetheless, their attention level to the delivered educational topics. The ACMLS model design adopts four main components which are: (1) Design component: which covers the visual design, design principles and the mental model of the children with autism. (2) Technology component: which covers the assistive technology tools and the architecture of the ACMLS system. (3) Education component: Which covers the learning objectives, styles, strategies, methods and the cognitive model. (4) Participants component: which covers the main participants who’re playing a role in the ACMLS model such as: caregivers and children with autism.

The monophyly of Nymphaeaceae (water lilies) represents a critical question in understanding the evolutionary history of early-diverging angiosperms. A recent plastid phylogenomic investigation claimed new evidence for the monophyly of Nymphaeaceae, but its results could not be verified from the available data. Moreover, preliminary gene-wise analyses of the same dataset provided partial support for the paraphyly of the family. The present investigation aims to re-assess the previous conclusion of the monophyly of Nymphaeaceae under the same dataset and to determine the congruence of the phylogenetic signal across different plastome genes and data partition strategies. To that end, phylogenetic tree inference is conducted on each of 78 protein-coding plastome genes, both individually and upon concatenation, and under four data partitioning schemes. Moreover, the possible effects of various sequence variability and homoplasy metrics on the inference of specific phylogenetic relationships are tested using multiple logistic regression. Differences in the variability of polymorphic sites across codon positions are assessed using parametric and non-parametric analysis of variance. The results of the phylogenetic reconstructions indicate considerable incongruence among the different gene trees as well as the data partitioning schemes. The results of the multiple logistic regression tests indicate that the fraction of polymorphic sites of codon position 3 has a significant effect on the recovery of the monophyly of Nymphaeaceae. Taken together, these results indicate that the monophyly of Nymphaeaceae currently remains indeterminate, and that specific phylogenetic conclusions are strongly dependent on the precise plastome gene, data partitioning scheme, and codon position evaluated. In closing, I discuss the importance of archiving all data of an investigation in publicly accessible data repositories, along with sufficient details to replicate the published results, and provide recommendations on future plastid phylogenomic investigations of Nymphaeales.

This paper reviews research on community efforts to reduce greenhouse gas emissions. We conducted a systematic search of relevant literature and supplemented our findings with an analysis of review papers previously published on the topic. Results indicate that there have been no peer-reviewed experimental evaluations of community-wide interventions to reduce greenhouse gases involving electricity, refrigeration, or food. The lack of findings limits the conclusions which can be made about the efficacy of these efforts. As a result, we are not accumulating effective interventions and some communities may be implementing strategies that are not effective. We advocate the funding of experimental evaluations of multi-sector community interventions to reduce greenhouse gas emissions. Such interventions would attempt to engage every sector of the community in identifying and implementing policies and practices to reduce emissions. Comprehensive multi-sector interventions are likely to have synergistic effects, such that the total impact is greater than the sum of impact of individual components. We describe the value of interrupted time-series designs as an alternative to randomized trials because these designs confer particular advantages for evaluating strategies in entire communities.

High fructose and sugar-sweetened soft drink (SSSD) intakes are associated with elevated blood uric acid concentrations and increased risk of gout and cardiovascular disease. Fruits are naturally high in fructose but their effect on cardiometabolic risk is unknown. We examined the effect on serum uric acid and cardiometabolic risk factors of consuming fructose from either fruit or SSSD in overweight adults. 48 healthy, overweight (BMI≥ 28 kg/m²) men (n=21) and women (n=20) were randomised to either a fruit (n = 19) or SSSSD (n = 22) intervention for 4 weeks. The fruit group received 6 items of fresh and dried fruit per day and the SSSD group received 955ml of SSSD per day with treatments matched for energy and fructose content. Serum uric acid concentrations were significantly reduced in men in the fruit group compared to the SSSD group (difference 57.2 μmol/L [95% CI: 16.4, 98.0], p= 0.008) but there was no difference amongst women (1.3 μmol/L [95%CI: -9.5, 6.9], p= 0.295). There differences in weight change or other cardiometabolic risk factors. These findings suggest no need to restrict fruit intake in individuals with elevated serum uric acid concentrations, such as those with gout.

: The performance of the students in academics depends on many different factors. One of these factors is the economic status of their families. Education in public schools, though it is free, some parents cannot afford to send their children to school due to financial constraints. Education as a free is every individual's right in society, but it becomes a privilege because of a lack of financial support. This research work is a comparative study of students' or learners' performance in mathematics among students from working and non-working. This research article's ultimate objective is to investigate and compare a significant difference in their performance in the subject mathematics. The research methodology utilizes a t-test to analyze and synthesize primary data sources collected via interview and academic records, and diverse literature on the study area. However, the research findings revealed no significant difference in the two groups (the working and non-working group of learners). Therefore, it is recommended that secondary schools should be provided with adequate books and facilities and faculty school interventions and programs and promote the usage of SIM or Strategic Intervention Materials for learning and memory enhancement among learners.

This systematic review followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement to synthesizes the existing literature with a goal to review current conceptual frameworks of mental health of forced migrants for further practice research priorities in social work. The search was done between January 2015 to January 2021. As a result, 29 studies met inclusion criteria. Medicalizing mental health issues by relying solely on the effectiveness of medicine was a controversial risk factor that negatively affected the daily life activities of refugees and reduced their willingness for seeking professional mental health services. Empowering vulnerable minorities by giving them back their power and agency to be able to speak for themselves and raise voices of trauma and recovery was the missing protective factor for sustainable mental health practice. The benefits of group-based interventions are highlighted in which communities and individuals address mental health issues as well as isolation through building collective identities and support networks. Information and communication technologies (ICTs) can add more strength to any kind of mental health intervention. Finally, the benefits of applying ecological perspective for the mental health of refugees, and its implications for a sustainable intercultural practice are discussed. Social workers in this model are the representatives of at-risk groups, thus need more agency and creativity in reflecting client’s concrete needs.

The COVID-19 pandemic has had devastating consequences for health, social, and economic domains, but what has received far less focus is the effect on people’s relationship to vital ecological supports, including access to greenspace. We assessed patterns of greenspace use in relation to individual and environmental factors and their relationship with experiencing psychological symptoms under the pandemic. We conducted an online survey recruiting participants from social media for adults in Korea for September–December 2020. The survey collected data on demographics, patterns of using greenspace during the pandemic, and major depression (MD) and generalized anxiety disorder (GAD) symptoms. The Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder 2-item (GAD-2) were applied to identify probable cases of MD and GAD. A logistic regression model assessed the association decreased visits to greenspace after the outbreak compared to 2019 and probable MD and GAD. Among the 322 survey participants, prevalence of probable MD and GAD were 19.3% and 14.9%, respectively. High rates of probable MD (23.3%) and GAD (19.4%) were found among persons currently having job-related and financial issues. Of the total participants, 64.9% reported decreased visits to greenspace after the COVID-19 outbreak. Persons with decreased visits to greenspace had 2.06 higher odds (95% CI: 0.91, 4.67) of probable MD at the time of the survey than persons whose visits to greenspace increased or did not change. Findings suggest that barriers to greenspace use could deprive people of mental health benefits and affect mental health during pandemic; an alternative explanation is that those experiencing poor mental health may be less likely to visit greenspaces during pandemic. This implies the need of adequate interventions on greenspace uses under an outbreak especially focusing on how low-income populations may be more adversely affected by a pandemic and its policy responses.

Traditional applications of Interferometric Synthetic Aperture Radar (InSAR) data involved inverting an interferogram stack to determine the average displacement velocity. While this approach has useful applications in continuously deforming regions, much information is lost by simply fitting a line through the time series. Thanks to regular acquisitions across most of the the world by the ESA Sentinel-1 satellite constellation, we are now in a position to explore opportunities for near-real time deformation monitoring. In this paper we present a simple statistical approach for detecting offsets and gradient changes in InSAR time series. Our key assumption is that 5 years of Sentinel-1 data is sufficient to calculate the population standard deviation of the detection variables. Our offset detector identifies statistically significant peaks in the first, second and third difference series. The gradient change detector identifies statistically significant movements in the second derivative series. We exploit the high spatial resolution of Sentinel-1 data and the spatial continuity of geophysical deformation signals to filter out false positive detections that arise due to signal noise. When combined with near-real time processing of InSAR data these detectors, particularly the gradient change, could be used to detect incipient ground deformation associated with geophysical phenomena, for example from landslides or volcanic eruptions.

This paper builds upon a theory of emerging-state actors using ISIS as a case study. This paper seeks to apply the theory in analyzing intervention & containment policies to use against emerging-state actors, using ISIS as the case study. Two baseline scenarios are used for evaluation – one replicating the historical foreign intervention against ISIS and a counter-factual where no foreign intervention occurred. Eleven contemporary military policies were tested against these baseline in isolation, combination, at different timing windows and under hypothetical “best case” conditions as well as operationally constrained. Insights of these tests include the influence of ethnographic envelopes, timing windows. Finally, a policy based on emerging-state actor theory is tested performing substantially better across primary measures than other policies or the historical baseline. This is compared against a falsified-policy designed to disprove that emerging-state actor theory contributed to the benefits. This paper’s contributions are a practical application of system dynamics simulations and systems-thinking to current problems, generate insights into the dynamics of emerging-state actors and intervention strategies, and demonstrate utility for future application of the underlying simulation in other scenarios involving non-state actor irregular conflict including terrorism, insurgents, or emerging-state actors.

Eating Disorders (ED) constitute a serious public health issue affecting predominantly women and appearing typically in adolescence or early adulthood. EDs are extremely difficult to treat as these disorders are ego-syntonic and many patients do not seek treatment. It is vital to focus on the development of successful early-intervention programs for individuals presenting at-risk and are on a trajectory towards developing EDs. This study is a randomized controlled trial evalu-ating an innovative digital gamified Acceptance and Commitment early-intervention program (AcceptME) for young females showing signs and symptoms of an ED and at high-risk for an ED. Participants (N=92; Mage=15.30 years, SD=2.15) received either AcceptME (N=62) or a waitlist control (N=30). Analyses indicated that the AcceptME program effectively reduced weight and shape concerns, with large effects when compared to waitlist controls. Most participants scored below the at-risk cut-off (WCS score<52) in the AcceptME at end-of-intervention (57.1%) com-pared to controls (7.1%) with odds of falling into the at-risk group being 14.5 times higher for participants in the control group. At follow-up, 72% of completers reported scores below the at-risk cut-off in the AcceptME group. The intervention also resulted in a decrease in ED symp-tomatology and increased body image flexibility. Overall, results suggest that the AcceptME program holds promise for early-intervention of young women at-risk for developing an ED.

Intercultural education can be seen as a cornerstone in the sustainability of the current culturally diverse society. In addition, through the establishment of policies and strategies to reverse situations of discrimination and exclusion, there is a consensus on the importance of the social inclusion of groups at risk of exclusion. In this context, actions are suggested to reverse high dropout rates and school failure within the Roma population. The aim of this systematic review in the educational context is to analyze investigations of programs and interventions that have been made to promote the educational inclusion of Roma students. Three databases are used, Scopus, Web of Science, and Eric, to examine 419 articles, which after a selection, based on an inclusion criterion which follows the guidelines given by the Declaration PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyzes), 17 articles were chosen for the analysis. The main findings shed light on data for programs and interventions developed mostly within the school setting and for students of elementary and secondary education. These programs provide answers for the molding of intercultural education and the policies for educational inclusion of Roma people.

The first attempt to control and mitigate an epidemic outbreak caused by a previously unknown virus occurs primarily via non-pharmaceutical interventions (NPIs). In case of the SARS-CoV-2 virus, which since the early days of 2020 caused the COVID-19 pandemic, NPIs aimed at reducing transmission enabling contacts between individuals. The effectiveness of contact reduction measures directly correlates with the number of individuals adhering to such measures. Here, we illustrate by means of a very simple compartmental model how partial noncompliance with NPIs can prevent these from stopping the spread of an epidemic.

Glaucoma is a disease associated with retina of eye. Presently, millions of human being is suffering from this disease. Early detection of these diseases can save the people from blindness. Therefore, various methods have been developed for its detection. In this paper, we have studied the reported methods and summarized their performance in terms of accuracy of detection.

Crop-type mapping is an important intermediate step for cost-effective crop management at the field level, as an overview of all fields with a particular crop type can be used for monitoring or yield forecasting, for instance. Our study used a data set with 2400 fields and corresponding satellite observations from the federal state of Bavaria, Germany. The study classified corn, winter wheat, winter barley, sugar beet, potato, and winter rapeseed as the main crops grown in Upper Bavaria. We additionally experimented with a rejection class "Other", which summarised further crop types. Corresponding Sentinel-2 data included the normalised difference vegetation index (NDVI) and raw bands from 2016 to 2018 for each selected field. The influence of raw bands compared to NDVI was analysed and the classification algorithms, i.e. support vector machine (SVM) and random forest (RF), were compared. The study showed that the use of an index should be critically questioned and that raw bands provided a wider spectral bandwidth, which significantly improved the mapping of crop types. The results underline the use of RF with raw bands and achieved overall accuracies (OA) of up to 92%. We also predicted crop types in an unknown year with significantly different weather conditions and several months before the end of the growing season. Thus, the influence of climate anomalies and the accuracy depending on the time of prediction were assessed. The crop types of a test site and year without labels could be determined with an OA of up to 86%. The results demonstrate the usefulness of the proof-of-concept and its readiness for use in real applications.

A new model of cosmology is proposed, where the state of high energy density commonly associated with the big bang is generated by the collapse of an antineutrino star that has exceeded its Chandrasekhar limit. To allow the first neutrino stars and antineutrino stars to form naturally from an initial quantum vacuum state, matter and antimatter are assumed to gravitationally repel. In this scenario, a degenerate antineutrino star in effective hydrostatic equilibrium has a density that is similar to the dark energy density of the ΛCDM model. When viewed from the core, such a star could today accelerate matter radially and emit the isothermal cosmic microwave background radiation, which addresses the horizon and flatness problems. This model and the ΛCDM model are in similar quantitative agreement with supernova distance measurements. The presented model is also in qualitative agreement with observed large-scale anisotropy and inhomogeneity, which distinguishes it from the ΛCDM model.

School-aged children may benefit from education interventions focused on healthy eating and physical activity to improve their quality of life. This article aims to review scientific evidence on food and nutrition education (FNE) in Spanish-speaking countries for the prevention of overweight and obesity in school-aged children (6-12 y). Articles were searched between April and August 2021. The searches were conducted using MEDLINE, Google Scholar, and SciELO. The primary search for articles focused on the experience of FNE interventions in Spanish-speaking countries. Overall, 518 articles were found and 33 studies were eligible for data extraction. Forty-two percent of the studies had a focus on FNE and 64% were focused on describing the eating habits of schoolchildren. Nutritional assessments (anthropometric) were found frequently with 91% and 30% of the studies focused on physical activity. All interventions focused on preventing or reducing overweight and obesity in school-age children. Educational, cognitive, dietary, and physical activity practices were described, whit being educational the most frequent intervention. Interventions reported positive effects of FNE interventions to improve knowledge and practices of healthy lifestyles in school-age children.

Abstract Aim: To determine the efficacy of health beliefs model –based intervention in changing the belief related to substance use among university student in Mosul city-Iraq. Design: A randomized controlled trial. Methods: A probability (simple random sample) of (N=80) undergraduate student in different specialties would be selected. The study sample will be recruited from (4) colleges in the University of Mosul's Engineering, Sciences, Medicine and Education Colleges. The sample will be randomly assigned into experimental and control groups of (40) undergraduate student for each group. Such chosen is employed of pool of topics that have the criteria contain students who have using on (Smoking, Hookah, Drug abuse and Alcohol).For during from 25of October / 2019 till 1 of February/2021. Data is analyzed using the "Statistical Package for Social Science" (SPSS) software for Windows (V:26). Results: This finding indicated that before the intervention, mean scores for all concepts of HBM, add to Motivation, Control, and behaviors intensions of students they were almost equal. However, after the intervention were significantly different in the study group, while it was not significant in the control group. Conclusion:This study concluded that designing an HBM-based study could affect students' understanding and their behaviors in the field of substance abuse. Considering the positive correlation between construct of HBM, particularly in "perceived benefits and perceived severity" related to students’ beliefs. These beliefs implied a significant correlation with each other and with the attention to the prevention of addiction.

The purpose of interdisciplinary communication during the early architectural design stage is to achieve the early integration of knowledge in different professional fields, which can help architects to choose correct design development strategies during the early architectural design stage. However, because there is too little information at the early design stage, and design solutions are still rapidly changing and developing, the uncertainties at this stage make it difficult for consultants in other disciplines to provide their views and analysis. In spite of this situation, the emergence of generative modeling is changing design procedures and methods of communication and cooperation for architectural teams, and has brought about a shift in the way architects transmit design information from "what" (declarative information) to "how" (procedural information). Generative modeling is like an aircraft's dashboard: It can provide a basis for interdisciplinary communication, provide interdisciplinary knowledge packages, and bring about a shift in interdisciplinary communication that will reduce the architectural team's communication needs and cost. This study uses a real design case to show the feasibility of generative modeling. Employing generative modeling as a basis, architects can enhance the efficiency of design change and multi-disciplinary communication during the early design stage, integrate specialized knowledge in relevant fields, use this knowledge to formulate design criteria for the next stage, and effectively transmit design decisions. As a consequence, the changes to the cost structure of design revisions and communication between different disciplines has initiated a paradigm shift toward multi-disciplinary communication in architectural design.

Due to the continuing high suicide rates among young men, there is a need to understand help-seeking behaviour and engagement with tailored suicide prevention interventions. The aim of this study was to explore help-seeking behaviour and engagement for young men aged 18 to 30 years who attended a therapeutic centre for men in a suicidal crisis. In this prospective cohort study, data were collected from 546 men who were referred into a community-based therapeutic service in North West England. Of the 546 men, 337 (52%) received therapy; 161 (48%) were aged between 18 and 30 years (mean age 24 years, SD=3.4). One third (n=54; 34%) of the men were seen within 48 hours of their referral. Analyses included baseline differences, symptom trajectories for the CORE-34 Clinical Outcome Measure (CORE-OM) and engagement with the therapy. For the CORE 34 there was a clinically significant reduction in mean scores between assessment and discharge (p<0.001), with all outcomes demonstrating a large effect size. Future research needs to assess the long-term effects of help-seeking using a brief psychological intervention for young men in order to understand whether the effects of the therapy are sustainable over a period of time following discharge from the service.

Weed competitive ability (WCA) is a desirable key trait for the improvement of grain yield under direct-seeded rice (DSR) and the aerobic rice ecosystem. The present study targeted screening of 167 introgression lines (ILs) of a Green Super Rice (GSR) IR2-6 population derived from a cross between Weed Tolerant Rice 1 (WTR1) as the recipient parent and Y134 as the donor parent developed at IRRI for weed competitiveness in screen house conditions (SHC). The ILs were phenotyped for WCA traits such as early seed germination (ESG) and early seedling vigor (ESV) in Petri dishes and pot experiment conditions. The results of phenotypic variance revealed ESG-related traits, especially first germination count (1st GC) that positively correlated with second germination count (2nd GC), germination percentage (GP), total dry weight (TDW), total fresh weight (TFW), and vigor index (VI-1), whereas, in ESV, all the traits were positively correlated with each other except for three traits: root dry weight (RDW), 1st GC, and GP-2. The ESG and ESV traits are vital for weed competitiveness. A 6K SNP array was used to study the genetic association for the WCA traits. Forty-four QTLs for WCA traits were mapped on all chromosomes (except on chromosomes 4 and 8) through single marker analysis (SMA). Out of 44 QTLs, 29 were associated with ESG traits and 15 with ESV traits, with LOD scores of 2.93 to 8.03 and 2.93 to 5.04 and explained phenotypic variance ranging from 7.85% to 19.9% and from 7.85% to 13.2%, respectively. However, 31 QTLs were contributed by a negative additive allele from Y134, whereas a positive additive allele was contributed by WTR1 in 13 QTLs. Among them, two QTL hotspot regions were mapped on chromosome 11 (24.7-27.9 Mb) and chromosome 12 (14.8-17.4 Mb). The majority of the QTLs related to WCA traits were grouped into two QTL hotspots: QTL hotspot-I (qAFW11.1, qFC11.1, qFC11.2, qSC11.1, qGP-111.1, qGP-111.2, qTFGS11.1, qVI-111.1, and qVI-111.2) and QTL hotspot-II (qFC12.1, qFC12.2, qSC12.1, qFC12.2, qGP-112.1, qGP-112.2, qTFGS12.1, qTFGS12.2, qVI-112.1, qIV12.2, qFC12.1, and qGC12.2), and a few of them were co-localized on chromosomes 11 and 12. Further, we fine-tuned in the genomic regions of QTL hotspots and identified a total of 13 putative candidate genes on chromosomes 11 and 12 collectively. The present study is the first report on the genetic basis of WCA-related traits and the co-localized QTLs, which could be highly valuable in future breeding programs aiming to improve WCA in rice.

This paper proposes a radiation pattern synthesis of the almost periodic antenna arrays including mutual coupling effects (that extracted by the Floquet analysis according to our previous work), which principally has a high directivity and large bandwidth. For modeling the given structures, the moment method combined with the Generalized Equivalent Circuit (MoM-GEC) is proposed. The artificial neural network (ANN) as a powerful computational model has been successfully applied to the antenna array pattern synthesis. The results showed that the multilayer feedforward neural networks are rugged and can successfully and efficiently resolve various distinctive complex almost periodic antenna patterns (with different source amplitudes) (in particular, both periodic and randomly aperiodic structures are taken into account). However, the artificial neural network (ANN) is capable of quickly producing the synthesis results using generalization with the early stopping (ES) method. A significant time gain and memory consumption are achieved by using this given method to improve the generalization (called early stopping). To justify this work, several examples are developed and discussed.

Background: Indonesia is an archipelago with various cultured, will bee affects all aspects of people's lives, including beliefs related to health behavior and health care. One problem that needs serious attention is the elderly group because the elderly are a vulnerable group who have a high risk of experiencing health problems, such as anemia with hypertension, so they need good care management. The research objective was to determine self-management intervention for hypertensive elderly. Methods: This research is a literature review with five databases (Scopus, CINAHL, ScienceDirect, PubMed, Proquest), the study design used is an experimental, descriptive, cross-sectional, and review systematic, in March 2021. Guidelines for using JBI to measure quality and listing check out Prisma in this review guide. A feasibility study based on title, abstract, full text, and research methodology. The data analysis used narrative analysis based on the research findings. Results: Twelve articles met the predefined review inclusion criteria. The study found eight interventions for self-management in elderly hypertension, namely: 1) Knowledge of hypertension, 2) Regulation of physical activity, 3) Limitation of alcohol and cigarette consumption, 4) Sleep rest and stress management, 5) Diet and body weight management, 6) Blood pressure control, 7) Family and social support, 8) Adherence to therapy regimens. Conclusion: The conclusion of the study results obtained eight elderly self-management interventions, this done properly will affect compliance in optimizing the health of the elderly.

Background: It is necessary to apply a behavior-based safety (BBS) program to prevent at-risk behavior. An effective BBS program requires the implementation of not only behavioral definitions and a customized critical behavior checklist (CBC) but also observations of behavior, coupled with customized interventions at power plants. Method: In this study, a customized CBC and behavioral definition were developed through a review of five different sites that previously used a CBC. The rules of observation, flow, and target were established to initiate the observations. Customized interventions were selected to increase safe behaviors. CBC scoring was used to evaluate observed safe behaviors for three years. Recognized safe behaviors were evaluated with a questionnaire that included four items each for conformity and participation behaviors and were then analyzed through a factor analysis and a t-test. The questionnaires were conducted three months before and after the implementation of the BBS program. Results: The customized CBC, behavioral definition, and interventions were effective, such that observed safe behaviors and the levels of workers’ recognized safe behaviors increased. Conclusion: The application of the BBS program was found to increase the observed and recognized safe behaviors. Therefore, the program applied to this site can help increase safe behaviors at other identical or similar sites, as well as prevent an accident, which also corresponds with the results of prior studies.

Chronic myelogenous leukemia (CML) was the first malignancy for which clinical outcome was drastically improved by kinase inhibitor therapy. Kinase inhibitors targeting other well-known oncogenes have been introduced into clinical practice, but none have shown the same magnitude of clinical benefit as ABL1 inhibition in CML. We argue that early detection is an underappreciated, but critically important factor in success of ABL1 inhibitors in treatment of CML. We show that CML provides a window into how many types of cancer may look and behave at an early stage, prior to diagnosis and the development of additional genomic alterations. The remarkable clinical benefits of ABL1 inhibition is likely due to early detection of CML at a stage in which the tumor is driven by single oncogenic alteration which can be successfully controlled by the inhibitor. Thinking of CML as a prototype for effective systemic treatment based on early cancer detection may help to develop strategies for improving treatment for other types of cancer.

Parent education programs, offered via family-school partnerships, offer an effective means for promoting the mental health and educational functioning of children and adolescents at a whole-of-school level. However, these programs often have low uptake. This study aimed to identify strategies for increasing the uptake of parent education programs within preschool and school settings. A three-round Delphi procedure was employed to obtain expert consensus on strategies that are important and feasible in educational settings. First, thirty experts rated statements identified from the literature and a stakeholder forum. Next, experts re-appraised statements, including new statements generated from the first round. Ninety statements were endorsed by ≥ 80% of the experts. Primary themes include strategies for program selection, strategies for increasing the accessibility of programs and the understanding of educational staff on parent engagement and child mental health, strategies for program development, promotion, and delivery, as well as strategies for increasing parent and community engagement. This study offers a set of consensus strategies for improving the uptake of parent education programs within family-school partnership.

While it is generally accepted that food habits established during infancy will track into later childhood, longitudinal analysis of children’s food preferences is rare. This paper examines whether maternal-reported child food preferences at five years of age are the same as that reported at two years; and identifies any patterns of change from two- to five- years. Mothers in the Australian NOURISH trial reported child food preferences at two and five years of age. A four point scale was utilised - ‘like’, ‘neither like or dislike’, ‘dislike’, ‘never tried’. The proportion of children having the same preference at the two time points was calculated (95%CI) for 48 foods (cereals, 4; vegetables, 20; fruit, 14; meat/alternatives, 6; dairy, 4). For foods where ≤50% children had consistent preferences, the pattern of food preference change was determined. For 40/48 foods, more than half of the children were reported to have the same preference at two years of age, and three years later, at age five. Foods for which ≤50% children had the same preference at both ages were high-sugar breakfast cereals, zucchini, mushrooms, eggplant, spinach, lettuce, cabbage and celery. Findings reinforce the importance of promoting a consistent message regarding early and frequent exposure to a variety of healthy foods, particularly during the first 2 years of life, as the preferences established in these early years are likely to be maintained over time.

This study examines the effectiveness of the peer-delivered, school-based intervention Healthy by Design (HbD). Data were collected in two cross-sectional surveys before and after invention implementation. In total 1,177 vocational students (before: 557, after: 620) participated in an online health behaviour survey. Multilevel logistic and multilevel linear models explored the effect of the intervention over time and the effect of the intervention dose received on (determinants of) dietary of physical activity behaviours. A significant positive effect over time was found for moderate intensity physical activity. A high intervention dose was positively associated with increased water, breakfast and fruit consumption and higher levels of moderate and vigorous physical activity compared to no intervention dose received. A moderate and high intervention dose was negatively associated with high calorie snacks consumption compared to no intervention dose received. Effects of HbD on the investigated dietary and physical activity behaviours over time are limited, but these effects may be hard to demonstrate and link to the intervention due to the nature of the intervention design and the natural school-setting of this quasi-experimental study. However, a higher intervention dose showed a strong relation with healthier dietary and physical activity behaviours.

Abstract Background: Premature babies have a greater risk for having health issues after being discharged from the hospital whilst the mother ability to provide premature baby care still has many issues as well. Interventions are needed to be given to mothers at home to improve the ability of mothers to care their premature babies. Methods: Search for articles used the bolean operator of “or” and “and” with the keywords used were “preterm or premature”, “intervention or program”, and “mother and home”. Data based used were Sciencedirect, Ebscohost, PubMed, SAGE, Proquest and Scopus with inclusion criteria using full text in English from 2018 to 2021. There were 428 articles obtained, the articles were then screened by reading the main focus of articles with paying attention to the topic and the suitability of article content and we obtained 13 suitable articles. Results: The interventions at home carried out for mothers and premature babies were divided into two namely the follow-up interventions from the hospital and the interventions carried out at the patient's home. Seven articles about research of interventions that were as a combination from hospital intervention with follow-up hospital intervention plus five full interventions at the patient's home. Interventions were provided through home visits (12 articles) and by telephone (1 article). The results of the article analysis resulted in 4 main themes of intervention for mothers and premature babies, they were health education, counceling, support, and care for premature babies. Conclusion: Quality care is essential for the best health, growth and development of premature babies. Interventions need to be carried out by health workers to ensure the readiness and ability of mothers to care for their babies. Maternal readiness and abilities can be improved by providing health education, counseling, support and care for premature babies.

Based on the Graph Model of Conflict Resolution (GMCR), a two-stage decision framework is developed to reveal the essence of brownfield incidents and facilitate the resolution of brownfield conflicts caused by the incidents. More particularly, the forward GMCR is utilized in Stage I, the negotiation stage, to simulate the evolution of a brownfield conflict (BC) and predict its potential resolution via stability analysis. If no acceptable equilibrium can be obtained, the BC progresses into Stage II, the third-party-intervention stage, where the inverse GMCR is used to assist a third party in intervening the conflict to achieve a desirable outcome. To illustrate the practicality of this framework, a recent BC occurred in Changzhou, China, is taken as a case study. Invaluable insights are provided through the computation and investigation of the corresponding preference relationships.

The purpose of this study was to present the challenges faced when implementing a diet and exercise intervention for low-income older Hispanics with type 2 diabetes with an observational study of recruitment, attendance, and characteristics of Hispanic adults with type 2 diabetes in a community congregate meal site pre and post administration of a diet and exercise intervention. This report evaluates retentions and diabetes self-management beliefs Hispanic adults ≥60 years with type 2 diabetes (n=17) at baseline, and completion of the six-month intervention in terms of the Health Belief Model. There was limited interest in controlling diabetes with diet and exercise. Major barriers included lack of perceived vulnerability to diabetes complications and a belief that medication alone is sufficient to stabilize blood glucose. Environmental barriers included lack of transportation, access to exercise groups, access grocery stores, and limited ability to pay for healthy foods. A lesson learned from this intervention was that the diet and exercise intervention given was insufficient as a cue to action for this population interventions to engage low-income, older Hispanics with diabetes in diet and exercise need to consider strategies to overcome barriers such as health beliefs, transportation issues, lack of access to nutritious food and group exercise classes.

The question of whether the early visual cortex (EVC) is involved in visual mental imagery remains a topic of debate. In this paper, I propose that the inconsistency in findings can be explained by the unique challenges associated with investigating EVC activity during imagery. During perception, the EVC processes low-level features which means that activity is highly sensitive to variation in visual details. If the EVC has the same role during visual mental imagery, any change in the visual details of the mental image would lead to corresponding changes in EVC activity. Within this context, the question should not be whether EVC is ‘active’ during imagery but how its activity relates to specific imagery properties. Studies using methods that are sensitive to variation in low-level features reveal that imagery can recruit the EVC in similar ways as perception. However, not all mental images contain a high level of visual details. Therefore, I end by considering a more nuanced view which states that imagery can recruit the EVC, but that does not mean that it always does so.

Background: Clozapine (CLZ) use is precarious due to its neurological, cardiovascular, and hematological side effects; however, it is the gold standard in therapy-resistant schizophrenia (TRS) in adults and is underused. Objective: to examine the most recent CLZ data on (a) side effects concerning (b) recent pharmacological mechanisms, (c) therapy benefits, and (d) the particularities of the COVID-19 pandemic. Data sources: a search was performed in two databases (PubMed and Web of Science) using the specific keywords "clozapine" and "schizophrenia," "side effects," "agranulocytosis," "TRS," or "bipolar affective disorder (BAF)" for the last ten years. Study eligibility criteria: clinical trials on adults with acute symptoms of schizophrenia or related disorders. Results: We selected 37 studies, randomized controlled trials (RCTs), and clinical case series (CCS), centered on six main topics in the search area: (a) CLZ in schizophrenia, (b) CLZ in bipolar disorder, (c) side effects during the clozapine therapy, (d) CLZ in pregnancy, (e) CLZ in early-onset schizophrenia, and (f) CLZ therapy and COVID-19 infection. Limitations: We considered RCTs and CCS from two databases, limited to the search topics. Conclusions and implications of key findings: (a) Clozapine doses should be personalized for each patient based on pharmacogenetics testing when available; the genetic vulnerability postulates predictors of adverse reactions' severity; patients with a lower genetic risk could have less frequent hematological monitoring; (b) CLZ-associated risk of pulmonary embolism imposes prophylactic measures for venous thromboembolism; (c) convulsive episodes are not an indication for stopping treatment; the plasma concentration of clozapine is a better side effect predictor than the dosage; (d) COVID-19 infection may enhance clozapine toxicity, generating an increased risk of pneumonia. Therapy must be continued with proper monitoring of the white blood count, and the clozapine dose decreased by half until three days after the fever breaks; psychiatrists and healthcare providers must act together. Background: Clozapine (CLZ) use is precarious due to its neurological, cardiovascular, and hematological side effects; however, it is the gold standard in therapy-resistant schizophrenia (TRS) in adults and is underused. Objective: to examine the most recent CLZ data on (a) side effects concerning (b) recent pharmacological mechanisms, (c) therapy benefits, and (d) the particularities of the COVID-19 pandemic. Data sources: a search was performed in two databases (PubMed and Web of Science) using the specific keywords "clozapine" and "schizophrenia," "side effects," "agranulocytosis," "TRS," or "bipolar affective disorder (BAF)" for the last ten years. Study eligibility criteria: clinical trials on adults with acute symptoms of schizophrenia or related disorders. Results: We selected 37 studies, randomized controlled trials (RCTs), and clinical case series (CCS), centered on six main topics in the search area: (a) CLZ in schizophrenia, (b) CLZ in bipolar disorder, (c) side effects during the clozapine therapy, (d) CLZ in pregnancy, (e) CLZ in early-onset schizophrenia, and (f) CLZ therapy and COVID-19 infection. Limitations: We considered RCTs and CCS from two databases, limited to the search topics. Conclusions and implications of key findings: (a) Clozapine doses should be personalized for each patient based on pharmacogenetics testing when available; the genetic vulnerability postulates predictors of adverse reactions' severity; patients with a lower genetic risk could have less frequent hematological monitoring; (b) CLZ-associated risk of pulmonary embolism imposes prophylactic measures for venous thromboembolism; (c) convulsive episodes are not an indication for stopping treatment; the plasma concentration of clozapine is a better side effect predictor than the dosage; (d) COVID-19 infection may enhance clozapine toxicity, generating an increased risk of pneumonia. Therapy must be continued with proper monitoring of the white blood count, and the clozapine dose decreased by half until three days after the fever breaks; psychiatrists and healthcare providers must act together.

There are many ‘faces’ of early life adversity (ELA), such as childhood trauma, institutionalization, abuse or exposure to environmental toxins. These have been implicated in the onset and severity of a wide range of chronic non-communicable diseases later in life. The later-life disease risk has a well-established immunological component. This raises the question as to whether accelerated immune-ageing mechanistically links early-life adversity to the lifelong health trajectory resulting in either ‘poor’ or ‘healthy’ ageing. Here we examine observational and mechanistic studies of ELA and inflammageing, highlighting common and distinct features in these two life stages. Many biological processes appear in common including reduction in telomere length, increased immuno-senescence, metabolic distortions and chronic (viral) infections. We propose that ELA shapes the developing immune, endocrine and nervous system in a non-reversible way, creating a distinct phenotype with accelerated immuno-senescence and systemic inflammation. We believe that ELA acts as an accelerator for inflammageing and age-related diseases. Furthermore, we now have the tools and cohorts to be able to dissect the interaction between early life adversity and later life phenotype. This should, in the near future, allow us to identify the ecological and mechanistic processes that are involved in ‘healthy’ or accelerated immune-ageing.

The coronavirus disease 2019 (COVID-19) has spread over the world for more than one year. COVID-19 often develops life-threatening hypoxemia. Endothelial injury caused by the viral infection leads to intravascular coagulation and ventilation-perfusion mismatch. However, besides above pathogenic mechanisms, the role of alveolar edema in the disease progression has not been discussed comprehensively. Since the exudation of pulmonary edema fluid was extremely serious in COVID-19 patients, we bring out a hypothesis that severity of alveolar edema may determine the size of poorly-ventilated area and the blood oxygen content. Treatments to pulmonary edema (alcohol-oxygen vapor therapy and fluid management) may be great helpful for reducing occurrence of severe cases. Given that late mechanical ventilation may cause mucus (edema fluid) to be blown to the deep of the small airways, oxygen therapy should be given at the early stages. The optimal time and SpO₂ threshold for oxygen therapy are also discussed.

Significant efforts in the past decades to teach evidence-based practice (EBP) implementation has emphasized increasing knowledge of EBP and developing interventions to support adoption to practice. These efforts have resulted in only limited sustained improvements in the daily use of evidence-based interventions in clinical practice in most health professions. Many new interven-tions with limited evidence of effectiveness are readily adopted each year - indicating openness to change is not the problem. The selection of an intervention is the outcome of an elaborate and complex cognitive process which is shaped by how they represent the problem in their mind and is mostly invisible processes to others. Therefore, the complex thinking process which support appropriate adoption of interventions should be taught more explicitly. Making the process visible to clinicians increases the acquisition of the skills required to judiciously select one in-tervention over others. The purpose of this paper is to provide a review of the selection process and the critical analysis that is required to appropriately decide to trial or not trial new intervention strategies with patients.

Color can direct visual attention to specific locations through bottom-up and top-down mechanisms. Using Continuous Flash Suppression (CFS) as way to investigate the factors that gate access to consciousness, the current study investigated whether color also directly affected the timing of conscious perception. Low or high spatial frequency (SF) gratings with different orientations were shown as targets to the non-dominant eye of human participants. CFS patterns were presented at a rate of 10Hz to the dominant eye to delay conscious perception of the targets, and participants had the task to report the target’s orientation as soon as they could see it. With low-SF targets, two types of color-based effects became evident. First, when the targets and the CFS patterns had different colors, the targets entered consciousness faster than in trials where the targets and CFS patterns had the same color. Second, when participants searched for a specific target color, targets that matched these search settings entered consciousness faster compared to conditions where the target color was irrelevant and could vary from trial to trial. Thus, the current study demonstrates that color is a central feature of human perception and leads to faster conscious perception of visual stimuli through bottom-up and top-down attentional mechanisms.

Many governments particularly in Europe are designing social interventions for the first post COVID-19 emergency phase. Definition of a ‘best practice’ for restriction release is urgent. Although data uncertainty generate difficulties, we believe near term analysis must shift from attempting to understand the numerous ‘unknowns’ to the clarification and interpretation of the few ‘knowns’, to create stepping stones towards rapid evidence-based decision making.Here, open access data on COVID-19 severity in three European countries were analyzed. Spain’s data were more comprehensive than those from Italy and Germany. Overall, COVID-19 severity shows a remarkable nonlinear growth with age that is significantly higher in adult males. Hence, age-adaptive and gender-balanced social interventions might represent efficient repopulation options for public health policymakers. Furthermore, we urge wider governmental effort for open access to relevant data. Their analysis will allow consolidation of existing trends, validation of key observations and thus facilitation of timely decisions.

Objective: To highlight opportunities for future nutrition intervention research within early childhood and education care (ECEC) settings, with a focus on generating evidence that has applicability to real-world policy and practice. Methods: An overview of opportunities to progress the field was developed by authors using a collaborative writing approach and informed by recent research in the field. The group developed a list of recommendations aligned with the reach, effectiveness, adoption, implementation and maintenance (RE-AIM) framework. Pairs of authors drafted individual sections of the manuscript, which was then reviewed by a separate pair. The first and senior author consolidated all sections of the manuscript and sought critical input on draft iterations of the manuscript. Results: Interventions that employ digital platforms (Reach) in ECEC settings, as well as research in the family day care setting (Effectiveness) were identified as areas of opportunities. Research understanding the determinants of and effective strategies for dissemination (Adoption), implementation of nutrition programs, in addition to de-implementation (Implementation) of inappropriate nutrition practices, is warranted. For maintenance, there is a need to better understand sustainability and sustainment of interventions, in addition to undertaking policy-relevant research. Conclusions: The ECEC setting is prime for innovative and practical nutrition intervention research.

It is agreed that before the creation of particles, space was absolutely devoid of matter and radiation. In this study, we assume that the absolute void comprises four dimensions; three spatial dimensions and a force equivalent representing the factor of change among the elementary dimensions. Our hypothesis is based on the expansion of the spatial dimensions, and the subsequent space instability. We demonstrated that when the outward force equivalent strength exceeds a critical limit, it collapses inward to restore equilibrium in the system. Then, the void inside the collapsed force equivalent acts as a void in a confined system, the energy of the system remains conserved at all stages. With the decrease of the spatial dimensions due to the collapse the energy density increases, at the final stage the energy in the confined system is concentrated forming a solid state of energy. In which, this solid state of energy is a particle become the source of the elementary particles. The created high-energy sources are controlled by the internal and external forces of the source and all entities in its external force field until equilibrium is reached. The article gives the summary of Big bang theory and its problems which are further discussed in inflation. This article will help in understanding that how elementary dimensions play a role in the formation of elementary particles. The quark gluon plasma, inflation, gravitational collapse, and gravitational lensing provide evidence supporting the elementary dimensions theory presented in this paper.

In this study, we discuss the properties of absolute vacuum space and how these properties can play a vital role in creating a mechanism in which the very first particle gets created simultaneously everywhere and we find the limit in which when the absolute vacuum volume reaches will lead to the collapse that leads to the creation of the first particle. This discussion is made following to the elementary dimensions theory study that was peer-reviewed at the end of 2020, everything in the universe is made from four elementary dimensions, these dimensions are the three spatial dimensions (X, Y, and Z) and the Vacuum resistant as the factor of change among the four, time itself wasn’t considered as the fourth dimension, rather time corresponds to a factor of change, and during the research it was found out that the Vacuum resistant is the factor of change in the Absolute Vacuum space, where time is a hypothetical concept, that represents changes during certain events compared to a constant change rate event.Therefore, time does exist, but as a factor of change, and as the Vacuum resistant in the absolute vacuum space, Time= factor of change= Vacuum resistant. In the study, the internal and external vacuum resistant volume equivalent is found, External Vacuum resistant=3.2857602*10^15 *mass. This equation is used to identify the amount of Free external vacuum resistant created during nuclear fission and fusion: Initial mass of the excited nucleuses mass of the created new nucleuses+ 3.2857602*10^15 * the lost Mass. In elementary dimensions, the energy created during nuclear reactions is equivalent to the free External vacuum resistant created through nuclear reactions, and mass is equivalent to the internal Vacuum resistant.

Samarinda City is one of the most attractive cities in Borneo Island (Indonesia) and also as a capital city of EastBorneo Province. The expansion of urban areas becomes essential due to rapid population and housing demand. Base on the statistical report, the annual population growth rate is 0.018% from the year 2016-2017 with a total population of 843446 inhabitants. Many natural disasters occur in some areas in this city, especially flooding. This natural disaster occurs almost every year, many people suffered and forced to evacuate. In 2018 there is 3 flood event with 28311 people was suffered and evacuated, and 5170 houses were flooded [1]. During the flood event, it was very possible to gain damages to their property and make traffic stuck. One common way to reducing the damages is using Early Warning Systems (EWS). Early warning is a major element for disaster risk reduction, including damages. To prevent and mitigate the impact of a disaster, many countries had taken action to build various methods of a public warning system. An effective early warning system focused on people-centered and comprises the following element, such as risk knowledge, technical monitoring and service, communication and dissemination of warnings, and community response capability [2]. Related to the existing condition which Samarinda is a Muslim-dominated city and obviously has a lot of a number of mosques. This is a good potency to develop an early warning system because every mosque has a loudspeaker for echoing Adzan (Muslim prayer-calling). With this existing condition, the loudspeaker can be utilized as a flood outdoor-voice warning announcer. The aim of this study is to briefly introduce the strategy of dissemination early warning by utilizing mosques. The hope of early warning dissemination is giving enough time to the people to evacuate their property to reduce damages and possibly to giving information to avoiding traffic stuck (in a certain location)due to flooding. The results of this study can be used as input for decision-makers to develop effective flood management strategies and policies, especially in the case of an early warning system where not well-developed in Samarinda.

Individuals residing in more deprived areas have a lower diet quality. While several studies have shown that individuals with a lower diet quality have a higher mortality risk, a low quality diet might also lead to poor health in highly deprived areas. We aimed to examine the association between deprivation within an area and all-cause mortality risk according to diet quality. Methods: We conducted a population-based prospective study on 27994 men and 33273 women aged 45–75 years. Neighborhood deprivation was assessed using the Japanese areal deprivation index (ADI). Dietary intakes were assessed using a validated 147-item food frequency questionnaire. Subsequently, Japanese Food Guide Spinning Top scores were calculated. Hazard ratios (HR) and 95% confidence intervals (CI) of mortality were calculated according to tertiles of ADI by diet quality score. Results: Individuals residing in the most deprived area had the lowest dietary scores. During the 16.7-year follow-up, compared to individuals with a high quality diet residing in the least deprived area, individuals with a low quality diet had a higher risk of mortality according to increment of ADI (P trend = 0.02); the multivariate adjusted HR (95% CI) was 1.07 (1.00-1.15), 1.15 (1.07-1.24), and 1.18 (1.08-1.29) in those residing in the lowest through the highest third of ADI, respectively. However, individuals with a high quality diet had no significant association between ADI and mortality (P trend =0.87). Conclusion: A well-balanced diet may prevent early death associated with neighborhood socioeconomic status among those residing in highly deprived areas.

Understanding behavioral factors associated with obesity is of importance in addressing this issue. This study examined the association between cognitive restraint, uncontrolled eating, emotional eating and body mass index (BMI) and amount of food plated, consumed, leftovers, and leftover food thrown into the trash (food wasted) in early adolescent girls nine to 13 years in O’ahu, Hawai’i (n = 93). Food plated, consumed, leftovers, and food wasted were estimated using a three-day mobile food record (mFR). Weight and height were measured to compute BMI (kg/m2). The three-factor eating questionnaire provided a score from 0 to 100 for cognitive restraint, uncontrolled eating, and emotional eating. Higher scores are indicative of greater cognitive restraint, uncontrolled eating, and emotional eating. Pearson’s correlation and general linear models were computed to examine the relationship between three factor eating scores, BMI, and food plated, consumed, leftovers, and food wasted. There was no clinically significant association between cognitive restraint and amount of food wasted. Cognitive restraint was positively correlated with BMI (r=0.36, p<0.001) and with BMI z score (r=0.40, p<0.001). Uncontrolled eating and emotional eating were positively correlated with amount of leftover food at dinner (r=0.30, p=0.006; r=0.33, p=0.003, respectively). Emotional eating was positively associated with percentage of leftover food at dinner (r=0.24, p=0.30). Additional research should examine the specific roles of cognitive restraint, uncontrolled eating, emotional eating and food waste in the development of obesity in adolescents.

A common fault in turbomachinery is rotor--casing rub. Shaft vibration, measured with proximity probes, is the most powerful indicator of rotor-stator rub. However, in machines such as aeroderivative turbines, with increasing industrial relevance in power generation, constructive reasons prevent the use of those sensors, being only acceleration signals at selected casing locations available. This implies several shortcomings in the characterization of the machinery condition, associated with a lower information content about the machine dynamics. In this work we evaluate the performance of the Continuous Wavelet Transform to isolate the accelerometer signal features that characterize rotor-casing rub in an aeroderivative turbine. The evaluation is carried out on a novel rotor model of a rotor flexible casing system. Due to damped transients and other short-lived features that rub induces in the signals, the Continuous Wavelet Transform proves being more effective than both Fourier and Cepstrum Analysis. This creates the chance for enabling early fault diagnosis of rub before it may cause machine shutdown or damage.

Digital Educational Recourses (DER) have undergone a rapid evolution and integration into the educational contexts. Teachers play a fundamental role in incorporating technology into their classrooms, so it is important to identify the value that teachers on DER and reflect on the implications for their practice. Through the qualitative methodology the necessary data is obtained with open-response inter-views with teachers. This dataset was analysed and categorised using AQUAD. The results suggest that teachers acknowledge the importance of integrating digital re-sources into their classrooms, although there was no consensus regarding the appropriate level at which to do so. Further the inter-views revealed that younger teachers tend to use more self-elaborated or selected resources. Teachers noted the benefits of using technology, especially in regard to maintaining student motivation, how-ever they also highlighted a number of extrinsic challenges and limitations. The results indicate there is a relationship between teachers’ perceptions and their practice, although this could be improved.

Early Life Adversity (ELA) is closely associated with the risk for developing diseases later in life, such as autoimmune diseases, type-2 diabetes and cardiovascular diseases. In humans, early parental separation, physical and sexual abuse or low social-economic status during childhood are known to have great impact on brain development, in the hormonal system and immune responses. Maternal deprivation (MD), the closest animal model available to the human situation, is known to similarly induce long lasting behavioural effects, to cause changes in the HPA axis and to have an impact in the immune system. Even though the immune responses to potential pathogens after early stress have been somehow documented, the mechanisms by which they occur are still not fully understood. Here, we have demonstrated that maternal separation, in both humans and rats, significantly affects the sensitivity of the immune system in adulthood. Particularly, NK cells’ profile and response to target cell lines are significantly changed after childhood adversity. These immune cells in rats are not only less cytotoxic towards YAC-1 cells, but also show a clear increase in the expression of maturation markers after 3h of maternal separation. Similarly, individuals who suffered from ELA display significant changes in the cytotoxic profile of NK cells together with decreased degranulation capacity. Altogether, these results lead us to conclude that one of the key mechanisms by which the immune system becomes impaired after ELA might be due to a shift on the senescent state of the cells, specifically NK cells. Elucidation of such a mechanism highlights the importance of ELA prevention and how NK targeted immunotherapy might help attenuating ELA consequences.

Objective: In this pilot study, we described the gross motor development of infants aged 4 to 24 months with congenital heart disease (CHD) and assessed through a systematic develop­mental screening programme, with individualised motor interventions. Methods: Thirty infants who had cardiac repair underwent gross motor evaluations using the AIMS at 4 months, and the Bayley-III at 12 and 24 months. Results: Based on AIMS, 80% of 4-month-old infants had a delay in gross motor development and required physical therapy. Gross motor abilities significantly improved by 24 months. Infants who benefited from regular physiotherapy tended to show better improvement in motor scores. Conclusion: Our study highlights the importance of early motor screening in infants with CHD and suggests a potential benefit of early physical therapy in those at-risk. Further research is needed to assess the effectiveness of systematic developmental screening and individualized inter­vention programmes at identifying at risk patients, and their impact on developmental outcomes.

Objective: The study investigated the benefit of practicing the art of bonsai and the well-being of practitioners. The art promotes relaxation, focus and art therapy that can have personal and emotional value in a self-help setting. When the bonsai tree is used as a healing object, it may improve the ability of the bonsai practitioner to adapt to adverse and stressful life events, such as the present global COVID-19 pandemic. Method: International bonsai artists (n = 255) participated in a study that examined the effect their bonsai had on their mental well-being. Semi-structured interviews were conducted with bonsai artists answering the question: “How has bonsai helped you?”. Results: Most participants acknowledged that being able to take care of their bonsais affected their mood in a positive manner. Discussion: Although the participants did not report overall improved mental health, participants expressed an improvement in their mood when being able to work on a bonsai tree. Conclusion: These findings are significant in that it can be useful in as a preventative and restorative manner in the mental well-being of people who practice the art.

This research paper is mainly aimed to elaborate the initial risk management and measures which government of Pakistan took towards Novel Corona Virus (COVID-2019). This initial response and planning was devised after the early outbreak of COVID-2019 in Wuhan, China in early time of January 2020. Pakistan devised a comprehensive plan that not to evacuate their student from Wuhan, China. The government of Pakistan in compliance with the National Institute of Health (NIH) devised and documented comprehensive plans such as the flight operations postponed related to Umerah pilgrims, which were intended to go to sacred places of KSA (The Kingdom of Saudi Arabia). The process of visa, immigration policy totally changed and the government of Pakistan notified it officially that, no new visas of visit, student, and business would be issued in due course of uncertainty due to COVID-2019. The government of Pakistan also announced medical emergency and notified through the country’s provinces the process of testing and treatment of COVID-2019. The government of Pakistan also allocated funds for medical supplies and named out the particular country’s best laboratories. The government of Pakistan also locked down all the cities with the emergency announcement that people should stay inside the home in quarantine or self-isolation. NIH (The National Institute of Health) played a vital role in executing the planning to cope with COVID – 2019). The National Institute of Health responded as “The Centre for Disease Control”. In aid to the government, the national army of Pakistan responded in a proactive manner towards planed execution. The medical corps of Pakistan army dedicated themselves to treat the suspected patients of COVID – 2019. Due to plans, policies being documented, implemented in such a way productive way that from February 28, 2020 to till date there is not much critical situation and issues are not present. There are much productive results as there is not much boom in a rise of COVID-2019 patients. This lockdown under the authority of the provinces resulted in fruitful outcomes. Background: On January 02, 2020, authorities of the People Republic of China elaborated that they have encountered with a novel type of infectious viral disease 2019. Later on January 12, the authorities from China elaborated the related sequence of Corona Virus diseases 2019 names as COVID – 2019. When COVID-2019 being identified in Wuhan, Hubei China, as an early response the Government of Pakistan in support of the National Institute of Health (Field Epidemiology & Disease Surveillance Division) published a health advisory about novel coronavirus. Methods: According to Global Health Security Index, Pakistan is ranked as 105th country among 195 countries in GHS index. Overall Score of Pakistan is 35.5. The score of Early Detection and Reporting for Epidemics of Potential International Concern is 41.7. A Graphical depiction of the COVID-19 cases placed until April 10, 2020 as well as a graph trend line of recovered as well as death rate is also depicted. According to the graphical facts of Government of Pakistan and World meters, the recovery rate of COVID-19 is about 98 percent and 2.1 percent death rate is reported against the total cases. Trend analysis with line graph was drawn based on available data from official dashboard web portal of the government of Pakistan and worldometers.info. Data figures were incorporated from March to August 18, 2020 in MS Excel and then subsequently deployed to draw trend analysis from managing risk to recovery. Results: The line graph showed a slowdown in the COVID-19 cases and high rate of recoveries from COVID-19 in Pakistan. On March 11, 2020, there were 20 confirmed cases of coronavirus reported in Pakistan. No death was recorded in very first seven days, on March 18, 2020 only two deaths were reported. On August 18, 2020, there were 272128 recoveries, 6201 deaths, total confirmed cases 290445, and total test were 2340072 in Pakistan. As a results, we can report that due to early measures taken by government of Pakistan no mass scale destruction in terms of death and cases been recorded in Pakistan. Conclusions: To till date, the government of Pakistan tried its level best to minimize the coronavirus cases as much as they can. However, the ending of the potential attack of an outbreak would depend upon the well organized and coordinated approach at all levels such as true directed decisions, fully preparedness, as well implementation and evaluation of continuous decisions. As the recovery rate of the cases is 98 percent and merely death rate is 2.1 percent, concluded that in future it would be a good sign to stop the potential outbreak. Also, lock down as well as precautionary measurement taken by the provincial governments resulted a decline number of COVID-19 cases in the country. Another good sign is that merely 4 percent population of Pakistan is of more than 60 years of old it can be concluded that there are less chances of mass death due to outbreak of COVID-19.

Understanding the nature of the Dark Matter (DM) is one of the current challenges in modern astrophysics and cosmology. Knowing the properties of the DM particle would shed light on physics beyond the Standard Model and even provide us with details of the early Universe. In fact, the detection of such a relic would bring us information from the pre-Big Bang Nucleosynthesis (BBN) period, an epoch from which we have no data, and could even hint at inflationary physics. In this work, we assume that the expansion rate of the Universe after inflationary is governed by the kinetic energy of a scalar field ϕ, in the so-called “kination” model. We assume that the ϕ field decays into both radiation and DM particles, which we take to be Weakly Interacting Massive Particles (WIMPs). The present abundance of WIMPs is then fixed during the kination period through either a thermal “freeze-out” or “freeze-in” mechanism, or through a non-thermal process governed by the decay of ϕ. We explore the parameter space of this theory with the requirement that the present WIMP abundance provides the correct DM relic budget. Requiring that BBN occurs during the standard cosmological scenario sets a limit on the temperature at which the kination period ends. Using this limit and assuming the WIMP has a mass m_χ = 100 GeV, we obtain that the thermally-averaged WIMP annihilation cross section has to satisfy the constraints 3.5 × 10⁻¹⁶ GeV⁻² ≲ (σv) ≲ 1.4 × 10⁻⁵ GeV⁻² in order for having at least one of the production mechanism to yield the observed amount of DM. This result shows how the properties of the WIMP particle, if ever measured, can yield information on the pre-BBN content of the Universe.

This study explored father involvement as a social determinant of child health within the context of macro-environmental changes in Mongolia. Using data for children aged 3-4 from UNICEF’s Multiple Indicator Cluster Surveys, this cross-sectional analysis examined the association between father presence and engagement with child health and educational outcomes. Multivariate regression modeling was employed to identify associations between father presence, engagement, and child outcomes including fever, respiratory illness, diarrhea and preschool attendance. In unadjusted analyses, father engagement was associated with higher odds of pre-school attendance (OR=1.12; 95% CI 1.04-1.20) but not with child illness (OR=1.04; 95% CI 0.95-1.14). Father engagement was no longer associated with pre-school attendance after controlling for potentially confounding variables (ORadj = 0.95; 95% CI 0.88-1.03). Unadjusted and adjusted analyses showed that father presence was not associated with acute illness or preschool attendance. Results also suggest that a larger proportion of children were engaged in activities by their mother compared to their father or other adults. Data indicate that father presence and engagement were not associated with child illness or pre-school attendance. Factors such as maternal education, household wealth, and region of residence are stronger predictors of preschool attendance and should continue to be considered for promoting child health and development in Mongolia.

Increasing evidence suggests that prenatal exposure to opioids can adversely influence brain development, yet, limited data exists on the effects of opioid-exposure on preschool language development. Our study aimed to characterize the nature and prevalence of language problems in children prenatally exposed to opioids, and the factors that support or hinder language acquisition. A sample of 100 children born to pregnant women in methadone maintenance treatment and 110 randomly identified non-exposed children were studied from birth to age 4.5 years. At 4.5 years, 89 opioid-exposed and 103 non-exposed children completed the preschool version of the Clinical Evaluation of Language Fundamentals (CELF-P) as part of a comprehensive neurodevelopmental assessment. Children prenatally exposed to opioid had poorer receptive and expressive language outcomes at age 4.5 years compared to non-exposed children. After adjustment for child sex, maternal education, other pregnancy substance use, maternal pregnancy nutrition and prenatal depression, opioid exposure remained a significant independent predictor of children’s total CELF-P language score. Examination of a range of potential intervening factors showed that a composite measure of the quality of parenting and home environment at 18 months and early childhood education participation at 4.5 years were important positive mediators.

The topic of technology development and its disruptive effects has been the subject of much debate over the last 20 years with numerous theories at both macro and micro scale offering potential models of technology progression and disruption. This paper focuses on how the potential theories of technology progression can be integrated and considers whether suitable indicators of this progression and any subsequent disruptive effects (particularly considering these geographically) might be derived, based on the use of big data analytic techniques. Given the magnitude of the economic, social and political implications of many disruptive technologies, the ability to quantify disruptive change at the earliest possible stage could deliver major returns by reducing uncertainty, assisting public policy intervention and managing the technology transition through disruption into deployment. However, determining when this stage has been reached is problematic because small random effects in the timing, direction of development, the availability of essential supportive technologies or “platform” technologies, market response or government policy can all result in failure of a technology, its form of adoption or optimality of implementation. This paper reviews some of the key models of technology evolution and their disruptive effect including, in particular, the geographical spread of disruption. It suggests a methodology for utilising the recent explosion of open and web-discoverable data to determine a methodology to achieve this earlier determination and considers the potential exploitation of big data modelling and predictive analytical techniques to achieve this goal.

Social and spatial characteristics of a population often interact to influence health outcomes, suggesting a need to jointly analyze both to offer useful insights in community health. However, researchers have used either social or spatial analyses to examine community-based health issues and inform intervention programs. We propose a combined socio-spatial analytic approach to develop a social network with spatial weights and a spatial statistic with social weights, and apply them to an ongoing study of mental and physical well-being of rural Latino immigrants in North Florida, USA. We demonstrate how this approach can be used to calculate measures, such as social network centrality, support contact dyads, and spatial kernel density based on a health survey data. Findings reveal that the integrated approach accurately reflected interactions between social and spatial elements, and identified community members (who) and locations (where) that should be prioritized for community-based health interventions.

We compared the efficacy of a tailored and a targeted intervention designed to increase clinical breast exam (CBE), mammography, and genetic services/testing among young breast cancer survivors (YBCS) (diagnosed <45 years old) and their blood relatives. A two-arm cluster randomized trial recruited a random sample of YBCS from the Michigan cancer registry and up to two of their blood relatives. Participants were stratified according to race and randomly assigned as family units to the tailored (n=637) or the targeted (n=595) intervention. Approximately 40% of participants were Black; 12% YBCS and 27% relatives were living in more than 20 different U.S. States. Higher screening rates were reported by YBCS (CBE p=0.05; mammography p=0.04) and relatives (CBE p<0.01; mammography p=0.04) in the tailored arm, and by White/Other YBCS (CBE p=0.02) and relatives (CBE p<0.01; mammography p=0.03). YBCS genetic testing rates increased from 22% to 26% (p=0.11). Black YBCS and relatives reported higher self-efficacy and intention for genetic testing, and higher satisfaction and intervention acceptance. The tailored intervention improved CBE and mammography uptake - despite having minimal contact with participants. Professional referrals will improve genetic testing uptake. Intervention materials increased self-efficacy and satisfaction for Black women but could not overcome multiple access barriers.

(1) Background: Benefits and timing of percutaneous dilatational tracheostomy (PDT) in Intensive Care Unit (ICU) COVID-19 patients are still controversial. PDT is considered a high risk procedure for transmission of SARS CoV-2 to health care workers (HCWs). The present study analyzed optimal timing of PDT, clinical outcomes of patients undergoing PDT and safety of HCWs performing PDT. (2) Methods: 133 COVID-19 patients underwent PDT in our ICU from April 1, 2020 to March 31, 2021, 23 patients were excluded and 110 patients were enrolled. A trained medical team was dedicated to the PDT procedure. Demographic, clinical history and outcome data were collected. Patients who underwent PDT were stratified into two groups: early group, PDT ≤ 12 days from orotracheal-intubation (OTI) and late group, &gt;12 days from OTI; HCW surveillance program was performed. (3) Results: Early group included 57 patients and late group included 53 patients. Early group patients showed shorter ICU length of stay and fewer days of mechanical ventilation than the late group (p&lt;0.001). At day 7 after tracheostomy, early group patients required fewer intravenous anesthetic drugs and experienced an improvement of ventilation parameters, PaO2/FiO2-Ratio, PEEP and FiO2 (p&lt;0.001). No difference in case fatality ratio between the two groups was reported. No SARS-CoV-2 infection was reported in HCWs performing PDT. (4) Conclusions: PDT was safe and effective for COVID-19 patients, since it improved respiratory support parameters, reduced ICU length of stay and duration of mechanical ventilation, and optimized the weaning process. The procedure was safe for all HCWs involved in the dedicated medical team. The development of standardized early PDT protocols should be implemented and PDT procedure could be considered as first line approach in ICU COVID-19 requiring prolonged mechanical ventilation.

Background and Aims: Screening and assessment of cognitive changes in adults with Intellectual Disabilities, mainly Down Syndrome (DS), is crucial to offer appropriate services to their needs. We present a systematic review of the existing instruments assessing dementia, aiming to support researchers and clinicians’ best practice. Methods: Searches were carried out in the databases Web of Science; PubMed; PsycINFO in March 2019 and updated in May 2020. Studies were selected and examined if they: (1) focused on assessing age-related cognitive changes in person with ID; (2) included adults and/or older adults; (3) included scales and batteries for cognitive assessment. Results: Forty-eight cross-sectional studies and twenty-six longitudinal studies were selected representing a total sample of 5,851 participants (4,089 DS and 1,801 with other ID). In those studies, we found 38 scales, questionnaires, and inventories, and 14 batteries for assessing cognitive and behavioural changes in adults with DS and other ID. Conclusion: The most used instrument completed by an informant or carer was the Dementia Questionnaire for Learning Disabilities (DLD), and its previous versions. We discuss the strengths and limitations of the instruments and outline recommendations for future use.

Objectives: Studies evaluating machine learning (ML) algorithms on cross-lingual RadLex® mappings for developing context-sensitive radiological reporting tools are lacking. Therefore, we investigated whether ML-based approaches can be utilized to assist radiologists in providing key imaging biomarkers – such as The Alberta stroke programme early CT score (APECTS). Material and Methods: A stratified random sample (age, gender, year) of CT reports (n=206) with suspected ischemic stroke was generated out of 3997 reports signed off between 2015-2019. Three independent, blinded readers assessed these reports and manually annotated clinico-radiologically relevant key features. The primary outcome was whether ASPECTS should have been provided (yes/no: 154/52). For all reports, both the findings and impressions underwent cross-lingual (German to English) RadLex®-mappings using natural language processing. Well-established ML-algorithms including classification trees, random forests, elastic net, support vector machines (SVMs) and boosted trees were evaluated in a 5 x 5-fold nested cross-validation framework. Further, a linear classifier (fastText) was directly fitted on the German reports. Ensemble learning was used to provide robust importance rankings of these ML-algorithms. Performance was evaluated using derivates of the confusion matrix and metrics of calibration including AUC, brier score and log loss as well as visually by calibration plots. Results: On this imbalanced classification task SVMs showed the highest accuracies both on human-extracted- (87%) and fully automated RadLex® features (findings: 82.5%; impressions: 85.4%). FastText without pre-trained language model showed the highest accuracy (89.3%) and AUC (92%) on the impressions. Ensemble learner revealed that boosted trees, fastText and SVMs are the most important ML-classifiers. Boosted trees fitted on the findings showed the best overall calibration curve. Conclusions: Contextual ML-based assistance suggesting ASPECTS while reporting neuroradiological emergencies is feasible, even if ML-models are restricted to be developed on limited and highly imbalanced data sets.

Flushing tap water is often promoted as a simple and low cost approach to reducing water lead exposures. This study evaluated lead reduction when prevailing flush guidelines (30 seconds-2 minutes) are implemented in a city compliant with lead-associated water regulations (New Orleans, LA). Water samples (n=1,497) collected from a convenience sample of 376 residential sites (2015-2017) were analyzed for lead in samples collected: at 1) first draw (n=375), and after incremental flushes of 2) 30-45 seconds (n=375), 3) 2.5-3 minutes (n=373), and 4) 5.5-6 minutes (n=218). There was no significant reduction when compared to the first draw lead level, until the 6 minute flush (p<0.05); but most sites (52%) still had detectable lead (≥1 ppb) after 6 minutes. Older homes (pre-1950) and low occupancy sites had significantly higher WLLs (p<0.05).Each sample type had health-based standard exceedances at over 50% of sites sampled (max: 58 ppb). While flushing is an effective short-term approach to remediate high lead, prevailing flush recommendations are an inconsistently effective exposure prevention measure that can often inadvertently increase exposures. Public health messages should be modified to ensure appropriate application of flushing for specific cities, while acknowledging its short-comings and practical limitations.

The World Health Organization has developed the Integrated Care of Older People (ICOPE) strategy, a program based on the measurement of intrinsic capacity (IC) as “the composite of all physical and mental attributes on which an individual can draw”. Multicomponent interventions appear to be the most effective approach to enhance IC and to prevent frailty and disability, since adapted physical activity is the preventive intervention that has shown most evidence in the treatment of frailty and risk of falls. Our paper describes the development of a multi-domain group-based intervention addressed to older people living in the community, aimed at improving and/or maintaining intrinsic capacity by means of promoting physical activity, healthy nutrition, and psychological wellbeing in older people. The process of intervention development is described following the Guidance for reporting intervention development studies in health research (GUIDED. The result of this study is the AMICOPE intervention (Aptitude Multi-domain group-based intervention to improve and/or maintain IC in Older PEople) built upon the ICOPE framework and described following the Template for Intervention Description and Replication (TIDieR) guidelines. This study represents the first stage of the UK Medical Research Council framework for developing and evaluating a complex intervention. The next step should be carrying out a feasibility study for the AMICOPE intervention, and in a later stage, assessing the effectiveness in a randomized controlled trial.

The effect of aqueous extracts of the biomass of the adult Ulomoides dermestoides beetle on the delayed effects of the defoliant paraquat causing parkinsonism in experimental mice was evaluated. The motor activity of the animals was analyzed in behavioral tests using a rotarod and a vertical pole. The number of tyrosine hydroxylase-immunopositive neurons in the ventral part of the substantia nigra of the midbrains of experimental and control mice was studied by immunohistochemistry. In the model in vitro system with SH-SY5Y human neuroblastoma, the effect of the extracts on cell proliferation was examined in the absence and presence of the neurotoxin MPP⁺. The isolation of biologically active substances from raw biomass using cavitation effects made it possible to obtain extracts with protective properties in the model of an early stage of Parkinson's disease used in this study.

Background: HIV poses a threat to global health. With effective treatment options available, education and testing strategies are essential in preventing transmission. Text messaging is an effective tool for health promotion and can be used to target higher risk populations. This study reports on the design, delivery and testing of a mobile text messaging SMS intervention for HIV prevention and awareness, aimed at adults in the construction industry and delivered during the COVID-19 pandemic. Method: Participants were recruited at Test@Work workplace health promotion events (21 sites, n=464 employees), including health checks with HIV testing. Message development was based on a participatory design and included a focus group (n=9) and message fidelity testing (n=291) with assessment of intervention uptake, reach, acceptability, and engagement. Barriers to HIV testing were identified and mapped to the COM-B behavioural model. 23 one-way push SMS messages (19 included short web links) were generated and fidelity tested, then sent via automated SMS to two employee cohorts over a 10-week period during the COVID-19 pandemic. Engagement metrics measured were; opt-outs, SMS delivered/read, number of clicks per web link, and four two-way pull messages exploring repeat HIV testing, learning new information, perceived usefulness and behaviour change. Results: 291 people participated (68.3% of eligible attendees). A total of 7,726 messages were sent between March and June 2020, with 91.6% successfully delivered (100% read). 12.4% of participants opted out over 10 weeks. Of delivered messages, links were clicked an average of 14.4%, max 24.1% for HIV related links. The number of clicks on web links declined over time (r= -6.24, p=0.01). Response rate for two-way pull messages was 13.7% of participants. Since the workplace HIV test offer at recruitment, 21.6% reported having taken a further HIV test. Qualitative replies indicated behavioural influence of messaging on exercise, lifestyle behaviours and intention to HIV test. Conclusion: SMS messaging for HIV prevention and awareness is acceptable to adults in the construction industry, has high uptake, low attrition and good engagement with message content, when delivered during a global pandemic. Data collection methods may need refinement for audience and effect of COVID-19 on results is yet to be understood.

Timely diagnosis of Alzheimer's diseases(AD) is crucial to obtain more practical treatments. In this paper, a novel approach Based on Multi-Level Fuzzy Neural Networks (MLFNN) for early detection of AD is proposed. The focus of study was on the problem of diagnosing AD and MCI patients from healthy people using MLFNN and selecting the best feature(s) and most compatible classification algorithm. In this way, we achieve an excellent performance using only a single feature i.e. MMSE score, by fitting the optimum algorithm to the best area using optimum possible feature(s) namely one feature for a real life problem. It can be said, the proposed method is a discovery that help patients and healthy people get rid of painful and time consuming experiments. Experiments shows the effectiveness of proposed method in current research for diagnosis of AD with one of the highest performance (accuracy rates of 96.6%), ever reported in the literature.

Introduction: People with schizophrenia have poor cardiometabolic health, with elevated 10-year cardiovascular disease risk (CVD-R) scores and poor quality of life (QOL). There is lack of understanding of these issues in early psychosis. Aims: To quantify CVD-R in people with early psychosis and profile their obesity prevalence, lifestyle behaviours and QOL. Secondary aim was to explore associations between lifestyle behaviours/treatment characteristics and CVD-R/QOL. Method:Baseline data from 81 RCT participants were used to profile cardiometabolic health risks (QRISK®3, BMI and waist circumference). Participants self-reported lifestyle behaviours and QOL. Relationships between modifiable treatment/lifestyle factors and QOL/CVD-R were explored using bivariate analyses. Results: Participants’ relative risk for CVD over 10 years was 1.93 times higher than healthy counterparts; 39% also had an obese BMI and physical QOL was poor. No significant associations were observed between CVD-R or QOL with treatment characteristics and lifestyle factors. Discussion: Despite positive lifestyle behaviours, participants had elevated CVD-R scores and poor physical health related QOL. Quantifying CVD-R with QRISK®3 may highlight the need for health promotion interventions. Implications for practice: Mental health professionals should be alert to elevated cardiometabolic health risks in early psychosis, particularly as these can occur in the context of relatively healthy lifestyle behaviours.

The prevalence of autism in children in the world is estimated as one per 62 children, higher levels reported in some countries. These children experience significant problems with the development of social, behavioural and verbal and non-verbal communication skills. The skills impairment levels varies from an individual to another and that made teaching autistics a challenge for caregivers such as teachers and relatives. Hence, there are quite a number of frameworks of a software learning systems which focus on gaining the children’s attention using representational visual illustration as a learning method instead of the textual form. However, majority of these tools are lacking the personalisation ability to suite everyone in the spectrum. Assistive technology offers an alternative way to attract children with autism to use. Therefore, this research is proposing Autism Content Management Learning System (ACMLS) Framework to assist caregivers to produce, design and fine-tune or customise the learning materials appropriately so that the system interface and the materials are suitable for every individual in the spectrum according to each child personal profile aiming to make learning attractive and to contribute in improving their social, communication and behavioural skills and nonetheless, their attention level to the delivered educational topics. The ACMLS framework design adopts four main components which are: (1) Design component: which covers the visual design, design principles and the mental model of the children with autism. (2) Technology component: which covers the assistive technology tools and the architecture of the ACMLS system. (3) Education component: Which covers the learning objectives, styles, strategies, methods and the cognitive model. (4) Participants component: which covers the main participants who’re playing a role in the ACMLS framework such as: caregivers and children with autism.