Introduction Older people with complex, chronic conditions often receive insufficient or inefficient care provision. And few instruments are able to measure their perception on care provision. The "User Reported Measure of Care Coordination" instrument has been satisfactorily used to evaluate chronic care provision and integration. The aim of this study is to validate this instrument into Spanish. Methods The questionnaire was adapted and validate in two phases: translation and cultural adaptation of the questionnaire, and psychometric property measurement. Study population were chronic care conditions patients. Results A total of 332 participants completed test re-test as part of the questionnaire validation process. The final version of the questionnaire had 6 domains: Health and Well-being (D1), Health day to day (D2), Social Services (D3), Planned Care (D4), Urgent Care (D5) and Hospital Care (D6). Cronbach's alpha for the overall questionnaire was 0.86, indicating good internal consistency. When analysing each domain, only Planned Care (D4) and Urgent Care (D5) had Cronbach’s Alphas slightly lower than 0.7, although this could be related to the low number of items in each domain. A good temporal stability was observed for the distinct subscales and items, with intraclass correlation coefficients varying from 0.412 to 0.929 (p < 0.05). Conclusion The adapted version of the “User Reported Measure of Care Coordination” into Spanish proved to be a practical tool for use in our daily practice and an efficient instrument for assessment of care coordination in chronic, complex conditions in older people across services and levels of care.

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

The sustainability of irrigated agriculture depends on the quality of irrigation water used. The electrolyte concentration (EC) of irrigation water may lead to the accumulation of salts in the root zone layers and affect the physiological functions of the crop by osmotic and ion toxicity effects. Further, the cationic and anionic composition of the water may alter the exchangeable cation composition of the soil and as well as its pH. Because of the dominance of sodium salts in many sources of irrigation water, parameters related to sodium such as exchangeable sodium percentage (ESP) of soils and sodium adsorption ratio (SAR) of soil solutions have been commonly used to study the effects of sodium in irrigation water on soil structural stability. Quirk and Schofield concept of ‘threshold electrolyte concentration’ (TEC) has shown the importance of electrolytes in preventing the effects of sodium on soil structure. Based on this concept, several models have been proposed to relate ESP or SAR with EC to predict the possible impacts of irrigation water on soil structural stability. However, many research reports indicate that this relationship varies with soils and a given model is not suitable for all types of soils. Further, the effects of potassium and magnesium in the processes leading to clay dispersion are disregarded in these models. This essay analyses all the factors involved in the structural failure of soils with different cationic composition, identify the defects in these TEC models and re-defines TEC on the basis of new insights on dispersive and flocculating charges of soils. This review does not deal with EC effects on crops and also the role of contaminant ions not involved with soil structural stability.

This work assesses sea-level rise using three different models created on Free and Open-Source Software for Geographic Information System (FOSS4GIS). Based on regional projections of Special Report on Climate Change and Oceans and Cryosphere (SROCC) of the Intergovernmental Panel on Climate Change (IPCC), the models were applied to a case of study on Rio Grande do Sul coast – Brazil under different sea-level rise scenarios by the end of this century. The End Point Rate for QGIS (EPR4Q), calculates a shoreline projection using End Point Rate method. The Uncertainty Bathtub Model (uBTM), analyses the sea-level rise impact by the uncertainty of sea-level projec-tions and vertical error of the Digital Elevation/Terrain Model (DEM/DTM). The Bruun Rule for Google Earth Engine Model (BRGM) predicts the shoreline position with sea-level rise, using topographic and bathymetric data from Unmanned Aerial Vehicles (UAV) and Coastal Modelling System (SMC – Brazil), respectively. The results indicated a maximum shoreline retreat for 2100 of -502 m and -1727 m using EPR4Q and BRGM, correspondingly. The uBTM using the land-use of Mapbiomas showed a maximum of 44.57 km2 of urban area impacted by the sea-level flood. This research highlights the possibility of performing coastal management analysis in GIS environ-ment using non-commercial software.

There is significant need for development of a new environmentally friendly, extraction-free sample collection medium that can effectively preserve and protect genetic material for point-of-care, and/or self-collection, home-collection, and mail-back testing. Systematic Evolution of Ligands by Exponential Enrichment (SELEX) was used to create anti-ribonuclease (RNase) Deoxyribonucleic acid (DNA) aptamers against purified RNase A conjugated to paramagnetic carboxylated beads. Following 8 rounds of SELEX carried out under various stringency conditions, e.g., selection using Xtract-Free™ (XF) specimen collection medium, and elevated ambient temperature of 28 ºC, a panel of 5 aptamers was chosen following bioinformatic analysis using next-generation sequencing. The efficacy of aptamer inactivation of RNase was assessed by monitoring Ribonucleic acid (RNA) integrity by fluorometric and real-time RT-PCR analysis. Inclusion of aptamers in reaction incubations resulted in an 8,800 to 11,200-fold reduction of RNase activity, i.e., digestion of viral RNA compared to control. Thus, anti-RNase aptamers integrated into XF collection medium as well as other commercial reagents and kits have great potential for ensuring quality intact RNA for subsequent genomic analysis.

The right to live with dignity during the final stages of existence, enshrined in national and supranational Charters of Rights, represents a significant step towards humanizing medicine and is integral to the right to health. Palliative Care, rooted in health, dignity, and therapeutic self-determination, has emerged as a fundamental human right and a moral imperative within health systems. It seeks to alleviate suffering, emphasizing the holistic well-being of patients with life-limiting illnesses. This paper provides a comprehensive global perspective on Palliative Care, with special attention to its implementation in Italy. Palliative Care is a crucial dimension of care, designed to enhance the quality of life for patients suffering from progressive and incurable diseases. Despite its growing need due to an aging population and increased prevalence of chronic illnesses, still remains a significant disparity in access to these essential services worldwide. Insufficient resources, legislative constraints, and limited training for healthcare providers pose challenges to the widespread adoption of Palliative Care. In Italy, although laws have been enacted to ensure the provision of Palliative Care, its availability remains inconsistent across different regions. Financial constraints and insufficient support hinder the comprehensive dissemination of these services. Recognizing the significance of Palliative Care, the Catholic Church also endorses its implementation as a response to human suffering and an approach to end-of-life care. Efforts to strengthen Palliative Care are critical to meeting the rising demand and ensuring access to compassionate and dignified care for all individuals in need. Through legislative advancements and adequate resources, Italy can make significant strides in advancing the provision of Palliative Care.

Introduction: The "second victim" phenomenon, (SVP) refers to a health professional who was involved in an adverse event (AE) and continues to suffer from the event to the detriment of personal and professional functioning. The Second Victims Natural History of Recovery Model predicts stages of the phenomenon from AE occurrence until the ‘moving on’ stage and serves as a suitable structure for many organizational support programs worldwide. Purpose: Using the Second Victims Natural History of Recovery Model to examine the impact of SVP on Israeli nurses, with a specific focus on the organizational support they felt they required as compared to the support they felt that they had received from their organizations. Methods: Fifteen in-depth interviews were conducted, using a semi-structured questionnaire, among nurses who had experienced SVP. The interviews were recorded subject to the interviewee's consent, transcribed, and analyzed using thematic content analysis. Findings: Throughout all six stages of recovery, all interviewees reported physical and emotional manifestations following exposure to an AE, regardless of type of event or severity. They also reported difficulty in emotion regulation, as well as damage to functioning and overall quality of life. Most of the nurse interviewees reported a need to share the events with someone, but despite this desire to receive appropriate support, almost none of them proactively requested help from a professional source, nor did their organizational management initiate proactive support. This lack of referral for further assistance is possibly explained through limited awareness of SVP as a valid response to an AE, perceived lack of legitimacy to receive organizational support and personal barriers that accompany the phenomenon. Conclusions: Appropriate organizational support, offered proximal to an AE as well as over time, is essential for the nurse, the patient and the organization. Personal barriers, together with limited awareness, may challenge the identification and provision of appropriate assistance. Hence, it is important to address the phenomenon as part of general organizational policy to improve quality of care and patient safety.

Health information and communication are key elements that allow patients and family members to make decisions about end-of-life process and guarantee a death with dignity. Objective: To understand carers’ experiences regarding health information and communication during the illness and death of family members. Methods: This qualitative study was conducted in Andalusia based on the paradigm of hermeneutic phenomenology. Participants were carers who had accompanied a family member at the end of life for over 2 months and less than 2 years. Five nominal groups and 5 discussion groups were established, and 41 in-depth interviews with 123 participants were conducted. Atlas.ti 7.0 software was used to analyse the discourses. Results: Four dimensions of the dying process emerged: differences in carers’ perceptions of information and communication, a conspiracy of silence, consequences of the absence or presence of information, and the need for a culture change. Conclusions: Poor management of health information and communication at the end of life suffering and discomfort patients and their families. The culture of denying and avoiding death is still present today. A change in education about death would better enable health professionals to care for patients at the end of life.

AbstractBackground: Maternal health service (MHS) use is a key strategy to reduce maternal mortality. However, the existing evidence is scarce to design efficient intervention strategies in Ethiopia. Thus, we aimed to explore community members and health care providers' perceptions of MHS, and barriers, and facilitators of MHS use in southern Ethiopia. Methods: A phenomenological qualitative study was conducted from November 14-30, 2022, in the northern zone of the Sidama region. Sixteen in-depth interviews, nine focus group discussions, and 15 key informant interviews were done with 112 study participants. A maximum variance sampling method was used to select study participants. Data coding and analysis were done using MAXQAD 2020 software and presented in narratives. Results: Communities have positive perceptions and good practices of skilled antenatal care (ANC) and health facility delivery (HFD), but lack awareness of postnatal care (PNC) services and schedules. Some have experienced negative interactions with health care providers, health facilities, and ambulance drivers. The main identified barriers to ANC use were lack of awareness of ANC benefits, distance from a health facility, costs associated with ANC use, long waiting time, lack of access to road, and women being busy with different household chores. Distance from health facility, costs associated with HFD use, unpredicted labour, lack of an ANC visit, lack of a birth preparedness plan, and non-dignified care were the main barriers to HFD. The major identified barriers to PNC use were home delivery, lack of awareness of PNC service and schedule, and socio-cultural beliefs. The main identified facilitators of MHS use were previous experience and fear of obstetric complications, health extension workers and women’s development teams, and pregnant women's forum.Conclusions: Rural women still encounter several challenges when using MHS, even though communities have positive perceptions and good practices of skilled MHS. Bad experiences mothers faced in health facilities, challenges associated with the costs of MHS use, poor awareness of service, and unpredictable labour continued to be basic barriers to MHS use. Intervention approaches should consider inter-sectoral collaboration to address barriers at the community and health facility levels. The programs must emphasize the transportation arrangements during unpredictable labour, the needs of poor mothers, and women who have poor awareness of MHS at the community level.

The rapid ageing of populations around the World is creating complex challenges for national governments. The establishment of sustainable and equitable long-term care systems for old and dependent people is one of the main issues of social policy in developed countries. The aim of this work is to define a cost model for residential and day care centres for dependent persons in Cantabria (Spain). The cost model will make it possible to establish the theoretical cost of attending to the needs of the different types of dependent persons in the different types of care centres, and the methodology used could be extrapolated to other regions. The daily cost per user for elderly residential care is €53.72. The cost per user in elderly day centres (5 days) is 32.56 euros. In residential centres for people with disabilities, the values range between €47.41 and €75.25 depending on the category of the centre. In three categories of centres the public price is not enough to cover the cost (physical disability, intellectual disability, mental illness – low care), and therefore the administration should reconsider their public prices for these kind of centres if they want to really contribute to the sustainability of these residential care centres. This research will have important implications for policy-makers in a context of fulfilment of SDGs and where better support for old and disabled people and their carers, as well as fair and efficient financing of social care services, are essential to address the current and future challenges of dependency.

This paper proposes a high-performance and low-cost in-flight collision avoidance system based on background subtraction for unmanned aerial vehicles (UAVs). The pipeline of proposed in-flight collision avoidance system is as follows: (i) dynamic background subtraction to remove the background and to detect moving objects, (ii) denoise using morphology and binarization methods, (iii) Euclidean clustering to cluster the moving object and to remove noise blobs, (iv) distinguish independent objects and track the movement using Kalman filter, and (v) collision avoidance using proposed decision-making techniques. This work focuses on the design and the demonstration of a vision-based fast moving object detection and tracking system with decision-making capabilities to perform evasive maneuvers to replace high vision system such as event camera. The development of high-performance, low-cost unmanned aerial vehicles paired with rapid progress in vision-based perception systems herald a new era of autonomous flight systems with mission-ready capabilities. One of the key features of an autonomous UAV is a robust mid-air collision avoidance strategy. The novelty of our method lies in the motion-compensating moving object detection framework, which accomplishes the task with background subtraction via 2-D transformation approximation. Clustering and tracking algorithms process detection data to track independent objects, and stereo-camera-based distance estimation is conducted to estimate the 3-D trajectory, which is then used during decision-making procedures. The examination of the system is conducted with a quadrotor UAV test vehicle, and appropriate algorithm parameters for various requirements are deduced.

Inherent in every Active Magnetic Bearing (AMB) are differences between the expected geometric axes and the actual magnetic axes due to a combination of discrepancies, including physical variation from manufacturing tolerances and misalignment from mechanical assembly, fringing and leakage effects, as well as variations in magnetic material properties within a single AMB. A method is presented here for locating the magnetic axes of an AMB that will facilitate the accurate characterization of the bearing air gaps for potential improvement in field tuning, performance analyses and certain shaft force measurement techniques. This paper presents an extension of the application of the bias current perturbation method for the determination of the magnetic center [4] to the determination of magnetic axes for the further development of accurate current-based force measurement techniques [1].

Long-term care (LTC) settings are increasingly used for palliative care in Japan. This study aimed to assess the proportion of LTC settings that provide palliative care services for older clients with advanced dementia in Japan and the trends across the types of settings. A nationwide questionnaire survey was conducted between November 2022 and January 2023, targeting 1,000 geriatric hospitals (GHs), 1,000 geriatric health services facilities (GHSFs), and 1,000 home nursing care stations (HNCSs). The palliative care practices for older patients with advanced dementia and their families in the agencies were assessed. Less than half of the GHs supported family participation or the spiritual needs of their older clients with dementia, while many had access to pain and symptom assessments and analgesic prescriptions by physicians. Less than half the GHSFs used pain assessment tools, assessed and supported family caregivers' pain and distress, and supported family participation in palliative care. More than 80% of the HNCSs practiced most of the listed palliative care. Current palliative care practices for older adults with dementia vary among GHs, GHSFs, and HNCSs. This emphasizes the need for targeted approaches to improve the provision of palliative care for patients with dementia across LTC settings in Japan.

Goals: To use visual logistics for interpreting COVID-19 molecular and rapid antigen test (RAgT) performance, determine prevalence boundaries where risk exceeds expectations, and evaluate benefits of recursive testing along home, community, and emergency spatial care paths. Methods: Mathematica/open access software helped graph relationships, compare performance patterns, and perform recursive computations. Results: Tiered sensitivity/specificity comprise: T1) 90%/95%; T2) 95%/97.5%; and T3) 100%/≥99%, respectively. In emergency medicine, median RAgT performance peaks at 13.2% prevalence, then falls below T1, generating risky prevalence boundaries. RAgTs in pediatric ERs/EDs parallel this pattern with asymptomatic worse than symptomatic performance. In communities, RAgTs display large uncertainty with median prevalence boundary of 14.8% for 1/20 missed diagnoses, and at prevalence >33.3-36.9% risk 10% false omissions for symptomatic subjects. Recursive testing improves home RAgT performance. Home molecular tests elevate performance above T1, but lack adequate validation. Conclusions: Widespread RAgT availability encourages self-testing. Asymptomatic RAgT and PCR-based saliva testing present the highest chance of missed diagnoses. Home testing twice, once just before mingling, and molecular-based self-testing help avoid false omissions. Community and ER/ED RAgTs can identify contagiousness in low prevalence (<22%). Real-world trials of performance, cost-effectiveness, and public health impact could identify home molecular diagnostics as the optimal diagnostic portal.

Of all the renewable energy sources, solar photovoltaic (PV) power is estimated to be a popular source due to several advantages such as its free availability, absence of rotating parts, integration to building such as rooftops, and less maintenance cost. The nonlinear current-voltage (I–V) characteristics and power generated from a PV array primarily depend on solar insolation/irradiation and panel temperature. The extracted PV output power is influenced by the accuracy with which the nonlinear power–voltage (P–V) characteristic curve is traced by the maximum power point tracking (MPPT) controller. In this paper, a bio-inspired roach infestation optimization (RIO) algorithm is proposed to extract the maximum power from the PV system (PVS). To validate the usefulness of the RIO MPPT algorithm, MATLAB/Simulink simulations are performed under varying environmental conditions, for example, step changes in solar irradiance, and partial shading of the PV array. Furthermore, the search performance of the RIO algorithm is examined on different unconstrained benchmark functions, and it is that realized that the RIO algorithm has improved convergence characteristics in terms of finding the optimal solution than Particle swarm optimization (PSO). The results demonstrated that the RIO-based MPPT performs remarkably in tracking with high accuracy as the PSO-based MPPT.

This paper deals with the form, the stability character, the periodicity and the global behavior of solutions of the following four rational difference equations x_{n+1} = ((±1)/(x_{n}(x_{n-1}±1)-1)) x_{n+1} = ((±1)/(x_{n}(x_{n-1}∓1)+1)).

The contemporary landscape of eHealth is characterized by major concerns related to electronic medical records (EMRs). In an EMR, critical patient health information gets its own repository, which is the core of the eHealth system. Notably, the EMR not only retrieves health information generated in ambulatory clinical settings but also includes court-generated records. These overlapping records assume the role of a foundational data source for a comprehensive electronic health record (EHR). This scholarly review sheds light on recent trends in medical records and associated challenges, while at the same time providing insights into Saudi Arabia’s targeted approaches to healthcare delivery. Additionally, the talk expands to include a description of blockchain technology and its underlying conceptual framework. This demonstration positions blockchain technology as a promising approach that requires consideration for future use in the healthcare system.

Critically the paper argues that a truly people-centered technology supported chronic care system can only be designed by understanding and responding to the needs, attributes and capabilities of the most vulnerable in society. The paper suggests innovative ways of supporting interactions with these ‘end-users’ and highlights how reflection on these approaches can contribute to emancipating both the health system to move towards more socially inclusive e-health solutions.

Objective: This study examined the impact of Japan’s state of emergency on trends in diabetes care during the coronavirus disease 2019 (COVID-19) pandemic. Design: A descriptive and retrospective study. Setting: Showa University Hospital, Japan. Participants: Patients with diabetes who received medical treatment from 2018 to 2020. Determinants of interest: Number of patients with diabetes visiting the hospital per week. To examine the impact of the Japan’s state of emergency, the number hospital visiting by patients with diabetes was summarized from 28 weeks of data, from calendar week 8 to week 35, for each year. Results: Compared with the mean of 2018 and 2019, no significant difference was found between the three periods (before, during, and after the state of emergency). However, the numbers of patients from both inside and outside Tokyo increased at 7 weeks after the state of emergency was lifted. Conclusions: A significant increase in the numbers of patients with diabetes was seen compared with the same period in 2018 and 2019, suggesting that the state of emergency may have hindered diabetes care. Therefore, patients with diabetes should be followed up continuous of diabetes care while keeping a close eye on measures.

Background: Recently, the management of musculoskeletal disorders with the patients' own stem cells, isolated from the walls of small blood vessels, which can be found in great numbers in the adipose tissue, has received considerable attention. On the other hand, there are still misconceptions about these adipose-derived regenerative cells (ADRCs) that contain vascular-associated pluripotent stem cells (vaPS cells) in regenerative medicine. Methods: Based on our previous publications on this topic, we have developed a concept to describe the significance of the ADRCs/vaPS cells in the field of orthobiologics as briefly as possible and at the same time as precisely as possible. Results: The ADRCs/vaPS cells belong to the group of orthobiologics that are based on autologous cells. Because the latter can both stimulate a patient’s body's localized self-healing power and provide new cells that can integrate into the host tissue during the healing response when the localized self-healing power is exhausted, this group of orthobiologics appears more advantageous than cell-free orthobiologics and orthobiologics that are based on allogeneic cells. Within the group of orthobiologics that are based on autologous cells, enzymatically isolated, uncultured ADRCs/vaPS cells have several advantages over non-enzymatically isolated cells/microfragmented fat as well as over uncultured bone marrow aspirate concentrate and cultured cells (adipose-derived stem cells, bone marrow-derived mesenchymal stem cells). Conclusions: The use of ADRCs/vaPS cells can be seamlessly integrated into modern orthopedic treatment concepts, which can be understood as the optimization of a process which - albeit less efficiently - also takes place physiologically. Accordingly, this new safe and effective type of treatment is attractive in terms of holistic thinking and personalized medicine.

Holistic care in the nursing care consists of physical, psychological, socio-cultural, developmental and spiritual aspects. However, the spiritual has received less attention than the other four aspects. The aim of this study was to review paper related to spiritual care in nursing care practices. The method in this study is a review using the CINAHL database. CINAHL was used because the articles focus on nursing topics. The keywords used were "Spirituality" OR "Spiritual care" OR "Spiritual" AND "Nurse". The inclusion criteria for the article were English language and published from 2019-2021, for adult range between 18-44 years old. Exclusion criteria were article not in English language, not full paper article, not in Human and not psychometric study also master thesis. This study recorded 64 articles, screened according to the topic, then the final results recorded 19 articles. This article focuses on the use of spiritual care in patients, nurses and caregivers, as well as both of patients and caregivers. The results of the review showed that spiritual care was important for mental health, physical health, and well-being, quality of life, increasing expectations for patients, nurses or caregivers. The significance of the study was spiritual care should be addressed in nursing care practices and it must include in the nursing curriculum, because spiritual care has many benefits for patients and nurses.

Autonomous electronic area, territory, or space protection is getting more important. One of the areas of application of the system is to monitor the quarantine zones created during epidemics. The idea to create a system of mobile sensory units for defending quarantine zones was born during one of the phases of the Covid epidemic in 2020. The paper contains a brief technical description of a mobile sensor units and their network. This network surrounds an area of interest. The work includes a mathematical and data model of the protected area. In addition, the paper presents a method for distributing mobile sensor units in areas of interest.

(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.

In this paper, we propose a novel approach to the development of green public policies. We emphasize the significance of the System of Systems (SoSs) methodology, which concentrates on understanding and managing complex systems by contemplating their interdependencies and interactions as a single integrated system. Based on this perspective, we view green public policy as a system interacting with the energy, health, pollutants, and economic systems of the SoSs. We employ both Decision-Making Trial and Evaluation Laboratory (DEMATEL) and Interpretive Structural Modeling (ISM) techniques as a method of systematic structural analysis to comprehend the relationships between the aforementioned systems. We provide a comprehensive literature review on the application of these soft operation research (SOR) techniques. We note that SOR methods are suitable for the formulation of effective and long-lasting public policies. Using an example, we demonstrate the primary advantage of DEMATEL and ISM, which is the establishment of easily comprehendible causal relationships between the systems in the SoSs.

Riemann’s method is one of the definitive ways of solving Cauchy’s problem for a second order linear hyperbolic partial differential equation in two variables. The first review of Riemann’s method was published by E. T. Copson in 1958. This study extends that work. Firstly, three solution methods were overlooked in Copson’s original paper. Secondly, several new approaches for finding Riemann functions have been developed since 1958. Those techniques are included here and placed in the context of Copson’s original study. There are also numerous equivalences between Riemann functions that have not previously been identified in the literature. Those links are clarified here by showing that many known Riemann functions are often equivalent due to the governing equation admitting a symmetry algebra isomorphic to $SL(2,R)$. Alternatively, the equation admits a Lie-Bäcklund symmetry algebra. Combining the results from several methods, a new class of Riemann functions is then derived which admits no symmetries whatsoever.

Water resources, especially safe, potable water, are limited for many Haitians. In areas where shallow groundwater is available, many household water needs such as laundry, bathing, and cooking are supplied by hand-dug wells. In order to better understand the water quality and prevalence of these household wells, 35 hand-dug wells were surveyed and sampled near the Hôpital Albert Schweitzer (HAS) in Deschapelles, Haiti. Water samples were collected and tested for fecal coliform and E. coli using the IDEXX Colilert-18 method. Of the samples collected, 89 percent were determined unsafe to use as a drinking water source based on the World Health Organization standard of 1.0 colony-forming unit (cfu) Escherichia Coli (E. coli) per 100 mL. 66 percent of the wells exceeded recreational/body contact standards for the state of Michigan (130 cfu/100 mL). Some of these wells were deemed suitable for conversion to a new well type called In-Situ Filtration (ISF) wells. ISF wells are installed with an internal sand filter pack, PVC casing, pump, and cap which seals the well from surface contamination and provides additional water treatment as water is pumped. Previous ISF installations have reduced E. coli to safe drinking water levels within 90 days.

We construct a real square system related to a given over-determined real system. We prove that the simple real zeros of the over-determined system are the simple real zeros of the related square system and the real zeros of the two systems are one-to-one correspondence with the constraint that the value of the sum of squares of the polynomials in the over-determined system at the real zeros is identically zero. After certifying the simple real zeros of the related square system with the interval methods, we assert that the certified zero is a local minimum of the sum of squares of the input polynomials. If the value of the sum of the squares of the input polynomials at the certified zero is equal to zero, it is a zero of the input system. As an application, we also consider the heuristic verification of the isolated zeros of polynomial systems and their multiplicity structures. Notice that a complex system with complex zeros can be transformed into a real system with real zeros.

Important policy developments in dementia and palliative care in nursing homes between 2010 and 2015 in Flanders, Belgium might have influenced which people die in nursing homes and how they die. We aimed to examine differences between 2010 and 2015 in the prevalence and characteristics of residents with dementia in nursing homes in Flanders, and their palliative care service use and comfort in the last week of life. We used two retrospective epidemiological studies, including 198 residents in 2010 and 183 in 2015, who died with dementia in representative samples of nursing homes in Flanders. We found a 23%-point increase in dementia prevalence (P-value<0.001), with a total of 11%-point decrease in severe to very severe cognitive impairment (P=0.04). Controlling for this difference in resident characteristics, in the last week of life, there were increases in the use of pain assessment (+20%-point; P<0.001) and assistance with eating and drinking (+10%-point; P=0.02) but no change in total comfort. The higher prevalence of dementia in nursing homes with no improvement in residents’ total comfort while dying emphasize an urgent need to better support nursing homes in improving their capacities to provide timely and high-quality palliative care services to more residents dying with dementia.

Although cancer care is often contextualized in terms of survival, there are other important cancer care outcomes, such as quality of life and cost of care. The ASCO Value Framework assesses the value of cancer therapies not only in terms of survival but with consideration of quality of life and financial cost. Early palliative care for patients with advanced cancer is associated with improved quality of life, mood, symptoms, overall survival, and cost savings. While palliative care has been shown to have numerous benefits, the impact of real-world implementation of outpatient embedded palliative care on value-based metrics is not fully understood. We sought to describe the association of outpatient embedded palliative care in a multidisciplinary thoracic oncology clinic on inpatient value-based metrics. We performed a retrospective cohort study of 215 patients being treated for advanced thoracic malignancies with non-curative intent. We evaluated the association of outpatient embedded palliative care with inpatient clinical outcomes including emergency room visits, hospitalizations, intensive care unit admissions, hospital charges, as well as hospital quality metrics including 30-day readmissions, admissions within 30 days of death, inpatient mortality, and inpatient hospital charges. Outpatient embedded palliative care was associated with lower hospital charges per day ($3,807 versus $4,695, p=0.024). Furthermore, patients who received outpatient embedded palliative care had decreased hospital admissions within 30 days of death (O.R. 0.50; 95% CI 0.34, 0.74; P<0.001) and decreased inpatient mortality (O.R. 0.46; 95%CI 0.23, 0.94; p=0.032). Our study further supports that outpatient palliative care is a high-value intervention and alternative models of palliative care, including one embedded into a multidisciplinary thoracic oncology clinic, is associated with improved value-based metrics.

Studying the two famous old problems that why the moon can move around the Sun and why the orbit of the Moon around the Earth cannot be broken off by the Sun under the condition that calculating with F=GMm/R^2, the attractive force of the Sun on the Moon is almost 2.2 times that of the Earth. We found that the planet and moon are unified as one single gravitational unit which results in that the Sun cannot have the force of F=GMm/R^2 on the moon. The moon is moved by the gravitational unit orbiting around the Sun. It could indicate that the gravitational field of the moon is limited inside the unit and the gravitational fields of both the planet and moon is unified as one single field interacting with the Sun. The findings are further clarified by reestablishing Newton’s repulsive gravity.

Based on a new model of a possible origin of life, we establish an efficient and stable system undergoing structural reproduction, self-optimization and molecular evolution. This system is being formed under realistic conditions by the interaction of two cyclic processes, one of which offering vesicles as the structural environment, the other supplying peptides from a variety of amino acids as versatile building blocks. We demonstrate that structures growing in a combination of both cycles have the potential to support their own existence, to undergo chemical and structural evolution and to develop unpredicted functional properties. The key mechanism is the mutual stabilization of the peptides by the vesicles and of the vesicles by the peptides together with a constant production and selection of both. The development of the proposed system over time not only would represent one of the principles of life, but could also be a model for the formation of self-evolving structures ultimately leading to the first living cell. The experiment yields clear evidence on a vesicle-induced accumulation of membrane-interacting peptide which could be identified by liquid chromatography combined with high-resolution mass spectroscopy. We found that the selected peptide has an immediate effect on the vesicles, leading to i) reduced vesicle size, ii) increased vesicle membrane permeability, and iii) improved thermal vesicle stability.

The late diagnosis of Type 2 Diabetes Mellitus can occur due to lack of access to the primary health care system and the non-manifestation of symptoms. Faced with this problem, this work presents the creation of a mobile application, called DiabetesCheck, for predicting the risk of Type 2 Diabetes Mellitus. A mathematical model is used, which classifies the risk of Type 2 Diabetes Mellitus for a group of patients with intervention and for a comparative group, using Fuzzy Classification and Decision Trees. The proposed application allows the health professional to monitor patients through the history stored in a database, allowing a representation of the evolution of patients and indication of medications. Therefore, this proposal aims to carry out the diagnosis in the initial phase of the disease and help in the prescription of more effective treatments and in the proposition of public policy strategies in epidemiology and screening.

As of now, anthropogenic habitat injury via dissemination of manufactured chemicals is injuring the world’s ecosystems, but doctors have yet to recognize its consequences to humans. Recognition of overt toxicity due to chronic low-dose exposure will open the door to diagnosis, sequential elimination studies, and prescriptions for preventive cure that represent a first step in preventing escalating chronic diseases. This paper offers a diagnostic construct for such use: chronic ambient poisoning. Incorporating it into clinical practice can reduce misdiagnosis of gastro- and near-toxicity that doctors and patients presently suppress rather than remove, and reduce patient co-dependence with proton-pump inhibitors, anxiolytics, and antidepressants—and the thriving “alternative” health industry. This diagnostic elephant-in-the-room is presently missed for reasons of habit (when an ailment is not recognized, it cannot be included in the differential diagnosis) and of poor conduct and interpretation of non-clinical research studies that are taken to mean an absence of evidence is evidence of absence. Moreover, modern methods fail when: the exposure comprises a “daily cocktail” of poisons acting additively, interactively, and cumulatively over a lifetime; when there is no normal, unexposed comparison group; and when absence of a robust etiopathogenetic model disallows inapt statistics. Only patient-led, consultant-informed sequential elimination studies can “peel the onion” of toxicity and its recognition and “preventive cure”. Clinical use of the chronic ambient poisoning diagnosis can thus open the door to stemming and reversing anthropogenic epidemics.

Background: The concept of Quality of Work Life (QWL) has been built multidimensionally through social reproduction; it is impacted by the perceptions of each individual and by the relationship between workers and the work environment. Objective: to analyze the Work Process and QWL of assisting nurses in public health. Methods: Research in a critical paradigm, descriptive, exploratory with a qualitative approach. The population corresponds to Nurses who work in care work. Semi-structured guiding questions were applied and were analyzed with content analysis. Results: seven participants declared female; all Chilean; seven are young adults; six singles; only one has children, and one has a person dependent on her care; six are heads of household, and five receive help with housework. All have a nursing degree, five have a diploma, but none have a postgraduate. Work Process has three subcategories: work object, instrument, organization, and work conditions; the QWL category has six subcategories: definition and perception of QWL, QWL potentiating factors, QWL exhausting factors, QWL improvement strategies, the emotional burden associated with QWL, and Health problems. Conclusions: In this way, the lifestyle built by the assistance in the health area has repercussions on the quality of life and health in general.

Racial and ethnic disparities exist in diabetes prevalence, health services utilization, and out-comes including disabling and life-threatening complications. Home health care may especially benefit older adults with diabetes through individualized education, advocacy, care coordina-tion, and psychosocial support for patients and their caregivers. This study examined factors as-sociated with hospital discharge to home health care and subsequent utilization of home health care among a cohort of Medicare beneficiaries with diabetes, age 50 and older, living in the United States. The cohort (n=786,758) was followed for 14 days after a diabetes-related index hospitalization, using linked Medicare administrative, claims, and assessment data (2014-2016). Multivariate logistic regression models included patient demographics, comorbidities, hospital length of stay, geographic region, neighborhood area deprivation, and rural/urban setting. In ful-ly adjusted models, hospital discharge to home health care was significantly less likely among Hispanic (OR 0.8, 95% CI 0.8-0.8) and American Indian (OR 0.8, CI 0.8-0.8) compared to white patients. Among those discharged to home health care, all racial/ethnic minority patients were less likely to receive services within 14-days. Further work should focus on eliminating systemic racism in home health care referral and systemic barriers to receiving home health care services.

Purpose: This research compared the dissociated phoria at near and distance fixation in free space using three techniques: the Howell test, alternate Cover test, and Thorington test. Methods: 220 healthy Mexican children (age 5.06-17.11) participated in this study. Phorias were quantified at both distances using each test, from the least to the most disruptive. The stereopsis degree and near point of convergence (break/recovery) were analyzed to understand their role on the visual system's sensorimotor balance. Results: For the exophoria/esophoria at near, the alternate Cover and Thorington tests showed similar values. The exophoria at distance, was similar with the alternate Cover and Howell tests, while esophoria, with the alternate Cover and Thorington tests. The break value and near exophoria relates to each other and affect the stereopsis degree, whereas age is associated with the stereopsis degree and break value. Conclusions: The analysis revealed that alternate Cover and Thorington tests can substitute one another, but not with the Howell test. The test's specific dissociation method may explain these results. Analyzing the binocular visual system provides information about its sensorimotor balance and fragility when faced to the technique’s degree of dissociation.

In this research paper, a hybrid Artificial Neural Network (ANN)-Fuzzy Logic Control (FLC) tuned Flower Pollination Algorithm (FPA) as a Maximum Power Point Tracker (MPPT) is employed to emend root mean square error (RMSE) of photovoltaic (PV) modeling. Moreover, Gaussian membership functions have been considered for fuzzy controller design. This paper interprets Luo converter occupied brushless DC motor (BLDC) directed PV water pump application. Experimental responses certify the effectiveness of the suggested motor-pump system supporting diverse operating states. Luo converter is newly developed dc-dc converter has high power density, better voltage gain transfer and superior output waveform and able to track optimal power from PV modules. For BLDC speed controlling there is no extra circuitry and phase current sensors are enforced for this scheme. The recentness of this attempt is adaptive neuro-fuzzy inference system (ANFIS)-FPA operated BLDC directed PV pump with advanced Luo converter has not been formerly conferred.

Restraint use in Australian residential aged care has been highlighted by the media, and investigated by researchers, government and advocacy bodies. In 2018, the Royal Commission into Aged Care selected ‘Restraint’ as a key focus of inquiry. Subsequently, Federal legislation was passed to ensure restraint is only used in residential aged care services as the ‘last resort’. To inform and develop Government educational resources, we conducted qualitative research to gain greater understanding of the experiences and attitudes of aged care stakeholders around restraint practice. Semi-structured interviews were held with 28 participants, comprising nurses, care staff, doctors, physiotherapists, pharmacists and relatives. Two focus groups were also conducted to ascertain the views of residential and community aged care senior management staff. Data were thematically analyzed using a pragmatic approach of inductive and deductive coding and theme development. Five themes were identified during the study: 1. Understanding of restraint; 2. Support for Legislation; 3. Restraint-free environments are not possible; 4. Low-level restraint, and 5. Restraint in the community is uncharted. Although most staff, health practitioners and relatives have a basic understanding of restraint, more education is needed at a conceptual level to enable them to identify and avoid restraint practice, particularly ‘low-level’ forms and chemical restraint. There was strong support for the new restraint regulations, but most interviewees admitted they were unsure what the legislation entailed. With regards to resources, stakeholders wanted recognition that there were times when restraint was necessary and advice on what to do in these situations, as opposed to unrealistic aspirations for restraint-free care. Stakeholders reported greater oversight of restraint in residential aged care but stated that community restraint use was largely unknown. Research is needed to investigate the extent and types of restraint practice in community aged care.

Multi-view stereo (MVS) employs multi-point photography for image point positioning and three-dimensional reconstruction technology. Recently, this technology has been introduced into the monitoring of road slopes due to advances in photography and computing technology. In general, the various phases of post-image processing procedures are applied to various photographic data. In this study a novel, automated image-monitoring system is proposed to improve the ability of automatic processing. First, an Internet of things (IoT)-based digital photography system architecture was constructed to provide automatic control of camera photography and real-time transmission of image data. In addition, a visual SfM-MVS 3D reconstruction technique was used to develop related software and hardware interfaces based on the built-in Python computing framework of Photoscan Pro. The software integrates fully automatic photography, image transmission, monitoring of data processing and product release programs. The experimental results show that the system architecture can be applied to fully automatic three-dimensional monitoring of road slopes.

System-of-systems (SoS) evolution is a complex and unpredictable process. Although various principles to facilitate collaborative SoS evolution have been proposed, there is a lack of experimental data validating their effectiveness. To address these issues, we present an Agent-Based Model (ABM) for SoS evolution in the Internet of Vehicles (IoV) , serving as a quantitative analysis tool for SoS research. By integrating multiple complex and rational behaviors of individuals, we aim to simulate real-world scenarios as accurately as possible. To simulate the SoS evolution process, our model employs multiple agents with autonomous interactions and incorporates external environmental variables. Furthermore, we propose three evaluation metrics: evolutionary time, degree of variation, and evolutionary cost, to assess the performance of SoS evolution. Our study demonstrates that enhanced information transparency significantly improves the evolutionary performance of distributed SoS. Conversely, the adoption of uniform standards only brings limited performance enhancement to distributed SoSs. Although our proposed model has limitations, it stands out from other approaches that utilize Agent-Based Modeling to analyze SoS theories. Our model focuses on realistic problem contexts and simulates realistic interaction behaviors. This study enhances the comprehension of SoS evolution processes and provides valuable insights for the formulation of effective evolutionary strategies.

We point out an inconsistency in Newton's equations of celestial mechanics. A set of differential equations implied by Newton's equations are shown to be free of this inconsistency. We then investigate the integrals of motion associated with this relative difference system.

There is a long standing ‘two times problem’ in that a satisfactory reconciliation between the time of physics and that of psychology has not been realized. A partial solution to the past/present/future phenomenon has been successfully given by the Hartle information gathering and processing system (IGUS) view. That model IGUS robot is enhanced here for the entire ‘two times problem’ to deal with not only the temporal experiences of the flow of time but also those of manifest time. A dualistic robot is proposed which has a veridical system of temporal experiences that are compatible with various spacetime cosmologies. It also has an illusory system of corresponding temporal experiences. This dualistic IGUS robot was made possible by discovering temporal experience within the brain that correspond to those of physics. The dualistic theory suggests that the veridical system, as a result of evolution, begets the illusory system to enhance behavioral adaptation. Thus, there is just one fundamental physical time which the brain does, indeed, possess and then enhances with illusory counterparts. Therefore, there should no longer be a need to reify illusory temporal experiences as modern spacetime cosmologies tend to do. Physical time already resides within human time.

Diet-related diseases impact populations across the globe. While intertemporal preferences—a fundamental preference for the distribution of benefits across time—have been used to explain low-quality food choices, recent literature proposes another cause: inattention to future implications (or opportunity costs) of the options faced. Food choices tend to become habitual to conserve cognitive resources, rather than carefully modeling future health impacts. Both low discount rates for future benefits and attention to future health impacts predict healthier decisions. While intertemporal preferences are stable, attention may provide an opportunity to intervene in the decision process to promote healthier decisions. In this study, we test the impact of a simple message that highlights health during food choice on the healthiness of foods chosen and on health consideration and intertemporal preferences. Our results show that actively considering health outcomes and lower discount rates lead to healthier food choices. We find that messaging increases the consideration of health outcomes during food choice but does not affect intertemporal preferences, suggesting that simple prompts may be an effective way to promote decisions balancing short and long-term benefits by drawing attention to overlooked opportunity costs of choices.

Resuscitation plans (RP) are an important clinical indicator relating to care at the end of life in pediatrics. A retrospective review of the medical records of children who had been referred to the Royal Children’s Hospital, Brisbane, Australia who died in the calendar year 2011 was performed. Of 62 records available, 40 patients (65%) had a life limiting condition and 43 medical records (69%) contained a documented (RP). This study demonstrated that both the underlying condition (life-limiting or life-threatening) and the setting of care (PICU or home) influenced the development of resuscitation plans. Patients referred to the paediatric palliative care (PPC) service had a significantly longer time interval from documentation of a resuscitation plan to death and were more likely to die at home. All of the patients who died in the paediatric intensive care unit (PICU) had a RP which was documented within the last 48 hours of life. Most RPs were not easy to locate. Documentation of discussions related to resuscitation planning should accommodate patient and family centered care based on individual needs. With varied diagnoses and settings of care, it is important that there is inter-professional collaboration (particularly involving PICU and PPC services) in developing protocols of how to manage this difficult but inevitable clinical scenario.

Nowadays, there are implemented devices whose purpose is to perform massive computations by saving resources at the time they reduce the latency of arithmetic operations. These devices are usually GPUs, FPGAs and other specialised devices such as "Coral". Neural networks, digital filters and numerical simulators take advantage of the massively parallel operations of such devices. One way to reduce the amount of resources used is to limit the size of the registers that store data. This has led to the proliferation of numeric formats with a length of less than 32 bits, known as short floating point or SFP. We have developed several SFP’s for use in our neural network accelerator design, allowing for different levels of accuracy. We use a 16-bit format for data transfer and different formats can be used simultaneously for internal operations. The internal operations can be performed in 16-bit, 20-bit and 24-bit. The use of registers larger than 16-bit allows the preservation of fractional information while increasing precision. By leveraging some of the FPGA’s arithmetic resources, our design outperforms designs implemented from scratch and is competitive with specialized arithmetic circuits already implemented in the FPGA.

This study considers the change-point test problem for time series based on the self-normalization ratio statistic test, which is constructed using residuals obtained from a support vector regression (SVR)-autoregressive moving average (ARMA) model. Under the null hypothesis, the series is a stationary process, and our test statistic converges to a non-degenerate distribution. Under the alternative hypothesis, there are change-points in the time series, and the self-normalization test statistic diverges to infinity. The simulations show that our proposed new test has better finite sample performance than other SVR-based tests in the literature. Finally, we illustrate its usefulness by analyzing two actual data sets.

This article will provide an overview on internet of things (IoT), 5G communication System and Distributed Clouds. The basic concepts and benefits will be briefly presented, along with current standardization activities. In a nutshell, but the research will focus on relating internet of things, 5G and Distributed Cloud Computing.

Capturing complexity is both a conceptual and a practical challenge in palliative care. The HexCom model has proved to be an instrument with strong reliability and valid for describing the needs and strengths of patients in home care. In order to explore whether it is also perceived to be helpful in enhancing coordinated and patient-centered care at a practical level, a methodological study was carried out to assess the face validity of the model. Particularly, a Delphi method involving a group of 15 experts representing the full spectrum of healthcare professionals involved in palliative care was carried out. The results show that there is a high level of agreement, with a Content Validity Index-Item greater than 0.92 both with regard to the complexity model and the HexCom-Red, HexCom-Basic and HexCom-Clin instruments, and higher than 0.85 regarding the HexCom-Figure and the HexCom-Patient instruments. This consensus confirms that the HexCom model and the different instruments that are derived from it are valued as useful tools for a broad range of healthcare professional in coordinately capturing of complexity in healthcare practice.

Background: This study investigated the prevalence of worsening problems using Post Stroke Checklist (PSC) at 3, 6, and 12 months post-stroke and their associations with health-related quality of life. Methods: In stroke patients admitted between June 2014 and December 2015, PSC and EuroQol-5Dthree level (EQ-5D-3L) were assessed at post-stroke 3 (n=181), 6 (n=175), and 12months (n=89). The prevalence of worsening problems and its association withEQ-5D-3L at post-stroke 3 and 6months were analyzed. Results: An average of 0.59 (range 0–12), 1.47 (range 0–12), and 1.00 (range 0–10) worsening problems per patient was identified at 3, 6, and 12months after stroke, respectively. The most frequently and continuously identified worsening problems were mood disturbances (reported by 8.8%, 16.0% and13.5% of patients at 3, 6, and 12 months post-stroke, respectively). Worsening mobility was significantly associated with worse EQ-5D index at post-stroke 3 months (β,-0.583; 95% CI, -1.045 to -0.120). The worsening of mobility and communication was significantly associated with worse EQ-5D index at post-stroke 6 months (mobility: β,-0.170; 95% CI, -0.305 to -0.034, communication: β,-0.164; 95% CI, -0.309 to -0.020). Conclusions: PSC may be useful for the detection of various subjective worsening problems during serial clinical follow-up after stroke. Appropriate rehabilitation and management strategy to solve the identified problems could improve the quality of life in stroke survivors.

Acetylcholine (ACh) is the best one characterized neurotransmitter. Its central roles in the cholinergic areas and central nervous system (CNS) and peripheral (PNS) synapses are well known. It was the first molecule identified as a neurotransmitter and appears to be phylogenetically the oldest one signaling molecules. ACh was detected in bacteria, protozoa, fungi, algae and primitive plants, indicating that the cholinergic system was widely distributed in living organisms before its appearance in the nervous system. The autonomous nervous system (ANS) is an integral part animal kingdom history. It determines fight-escape reactions as well as outlining the vital and cognitive functions bio-organization rhythms. The virus (Covid-19) extraneous effects acting on it could help to better understand its functions. The Blast results show some factors like protein that can be implicated such as bungaro-toxins, phospholipase A2 and the similar prothrombin activator protein. A positive correlation with different toxins is obtained and the Covid-19 double pathogenic mechanism theory is proposed. The process allows us to outline the possibility about toxic-like factors presence.

The elegance of mathematical models in quantum mechanics has often been seen with awe, and especially frustration. Nonetheless, the mathematical physics of quantum mechanics is fascinating beyond measure. And fortunately, there are quite baffling things about quantum mechanics that showed us what we never thought could be seen, making it simpler to figure out the behavior of physical systems without having to delve into the subtleties of the subject. In this paper, we present a review on the density of quantum states in an intuitive fashion that is easily comprehensible to undergraduate students with an elementary background in physics.

Coatings of reliable materials of thickness in few atoms to several microns on a viable substrate is the basic need of society which attend regular attention of scientific community working in various fields. Decorative and protective coatings, transparent and insulating coatings, coatings of medical implants and surgical instruments, coatings for drug delivery and security purposes, ultra-precision machine coatings and coatings of other miscellaneous uses are in routine demand for research and commercial purposes. Different hard coatings develop with significant composition of different nature atoms where their force-energy behaviors when recovering certain transition states provide provision for electron of outer ring belonging to gas atom to react for another clamp of energy knot clamping unfilled state of outer ring belonging to solid atom. Set suitable process conditions regulate switching force-energy behaviors of different nature atoms, which are nearly opposite to the ones originally existing in them. Thus, different nature transition state atoms locate points of developing hard coating between their original ground points as the gaseous nature atoms increase their potential energy as per increasing the gravitational force exerting at electron level while the solid atoms decrease their potential energy as per decreasing the gravitational force exerting at electron level. Ti-atom to Ti-atom binding is taken place under the difference of expansion level of lattice in the just land atom and landed atom where the position of nitrogen atoms becomes nearly at their interstitial site. Thus, different nature transition state atoms accommodate to be deposited at substrate surface positioned in the deposition chamber under suitable set parameters. In random arc-based vapor deposition system, depositing different nature atoms at substrate surface depends on the supplied energy where non-conserved forces are remained engage to keep adherence. On undertaking electron (of gas atom), another clamp of energy knot (of solid atom) is being endorsed by the mutually adjusting expansion-contraction of lattices belonging to two different nature atoms developing structure in the form of hard coating, which is known since antiquity. Different properties and characteristics of hard coatings emerged as per engaged forces under the set conditions of involved energy. The present study sets new trends not only in the field of films and coatings but also in the diversified class of materials, wherever, atoms recall their roles.

This study aimed to investigate the prevalence, location, and characteristics of new-onset chronic pain by using a new definition in long-term survivors after discharge from a tertiary emergency center. We conducted a single-center ambidirectional cohort study from January to May 2022. A survey of patients was conducted by postal mail 2-2.5 years since their discharge from a tertiary emergency center. We used the Brief Pain Inventory to investigate chronic pain parameters, and the painDETECT questionnaire to investigate neuropathic pain. Patient information during hospitalization was collected retrospectively from medical records. The survey was sent to 78 patients, 63 (81%) of whom responded and were included in the analysis. Nine of the 63 patients (14%) had new-onset chronic pain. Of these, six (67%) had chronic pain of moderate or severe intensity which interfered with daily life. The most frequent location of chronic pain was the ankle/foot (n=4, 44%). Neuropathic pain was present in four (44%) patients with new-onset chronic pain. New-onset chronic pain may occur for up to 2-2.5 years after discharge from a tertiary emergency center, and this may interfere with daily life. Therefore, a follow-up system for chronic pain is warranted.

Older adults with diabetes are at elevated risk of complications following hospitalization. Home health care services mitigate the risk of adverse events and facilitate a safe transition home. In the United States, when home health care services are prescribed, federal guidelines require they begin within two days of hospital discharge. This study examined the association between timing of home health care initiation and 30-day rehospitalization outcomes in a cohort of 786,734 Medicare beneficiaries following a diabetes-related index hospitalization. Of these patients, 26.6% were discharged to home health care. To evaluate the association between timing of home health care initiation and 30-day rehospitalizations, multivariate logistic regression models including patient demographics, clinical, geographic variables, and neighborhood socio-economic variables were used. Inverse probability-weighted propensity scores were incorporated into the analysis to account for potential confounding between the timing of home health care initiation and the outcome in the cohort. Compared to patients who received home health care within the recommended first two days, patients who received delayed services (3-7 days after discharge) had higher odds of rehospitalization (OR 1.28, 95% CI 1.25-1.32). Among patients who received late services (8-14 days after discharge), the odds of rehospitalization were four times greater than for patients receiving services within 2 days (OR 4.12, 95% CI 3.97-4.28). Timely initiation of home health care following diabetes-related hospitalizations is one strategy to improve outcomes.

Abstract: A prevalence boundary (PB) marks the point in prevalence where the false omission rate, RFO=FN/(TN+FN), exceeds the tolerance limit for missed diagnoses. Objectives were to mathematically analyze rapid antigen test (RAgT) performance, determine why PBs are breeched, and evaluate the merits of testing three times over five days, now required by the US Food and Drug Administration for asymptomatic persons. Equations were derived to compare test performance patterns, calculate PBs, and perform recursive computations. An independent July 2023 FDA-university-commercial evaluation of RAgTs provided performance data used in theoretical calculations. Tiered sensitivity/specificity comprise: Tier-1) 90%, 95%; Tier-2) 95%, 97.5%; and Tier-3) 100%, ≥99%, respectively. Repeating a T2 test improves the PB from 44.6% to 95.2% (RFO 5%). In the FDA-university-commercial evaluation, RAgTs generated sensitivity of 34.4%, which improved to 55.3% when repeated, then 68.5% with the third test. With RFO=5%, PBs were 7.37/10.46/14.22%, respectively. PB analysis suggests RAgTs should achieve clinically proven sensitivity of 91.0-91.4%. When prevalence exceeds PBs, missed diagnoses can perpetuate virus transmission. Repeating low-sensitivity RAgTs delays diagnosis. In homes, high-risk settings, and hotspots, PB breaches may prolong contagion, defeat mitigation, facilitate new variants, and transform outbreaks into endemic disease. Molecular diagnostics can help avoid these potential vicious cycles

The article outlines a creative approach by fusing ideas from fuzzy contractions, graph mappings, and Kannan mappings to create a brand-new notion known as "Kannan-graph-fuzzy contraction." This combination of concepts makes it possible to create a unique framework for resolving real-world issues controlled by nonlinear models. It is anticipated that using Kannan-graph-fuzzy contractions will offer a fresh approach to discussing solution existence in situations where these ideas overlap. This strategy might have a significant impact on a lot of real-world applications, proving how practical multidisciplinary techniques are for tackling issues in the real world originating from technology and engineering. The article includes several illustrated examples based on computer simulations, making the results more explicit.

The calculation of the exact value of the square root of 2 is requested. In order to obtain its infinite value, A new concept is proposed where the accumulations of the infinitely many of finity is indicated by the change in direction which means that there is a jump from finity to infinity .The meaningless for an infinite number with a decimal point is indicated by this jump because any decimal number only have meanings within a finite range values and there is only an infinite integer quantity that can not be operated by algorithms like operations of multiplication，division,addition, and subtraction . The final result of the change in direction is two quantity where the second quantity and the first quantity extend in parallel line and never intersect and the second quantity represent the size of the first quantity. The first quantity is the infinitely great that can't be talked about anything outside of it and can compress any quantities outside of it to nothing and it is the exact value of the square root of 2 .

Knowing the symbolizations constructed in people's consciousness, based on lived experiences, is crucial to understanding how they structure their lives. Palliative Sedation (PS) integrates treatment in terminal palliative care, with the purpose of offering support and relief of refractory symptoms that may occur at the end of life. This study aimed at interpreting psychic fantasies that permeate thoughts, as reported by a sample of nurses when administering palliative sedation to patients in the final stage of life. This is a clinical-qualitative study conducted in a large hospital in the city of São Paulo (state of São Paulo, Brazil), a national reference in oncology. The study included 11 nurses working in the care of cancer patients. For data collection, we used the technique of SDIOQD – Semi-Directed Interview with Open-ended Questions in-Depth. The treatment by CQCA - Clinical-Qualitative Content Analysis is grounded on psychodynamic concepts. The interpretation of the meaning cores found in the interviews, complemented by observation of the para-verbal and nonverbal manifestations of the interviewees, led to the construction of three categories: (1) to symbolically serve death on a tray; (2) the act of sedation and its unfortunate coincidences; (3) palliative sedation as an agent of mercy death. This study suggests that nurses face dilemmatic situations, going through periods of self-questioning and moments of the ambivalence of feelings of beneficence and maleficence. When sedating a patient, the nurses envision to be offering dignity in death. Euthanasia fantasies in the process of administering sedation are latent in consciousness.

The supply of mental health processes in primary care has gaps. This study aims to analyze the association of agreement criteria and flows between primary care teams and the Family Health Support Center (NASF) for mental health collaborative care, considering the difference between capital and non-capital cities in Brazil. This cross-sectional study was conducted based on secondary data from the Primary Care Access and Quality Improvement Program. Agreement criteria and flows were obtained from 3883 NASF teams of the matrix support or collaborative care. The Chi-square test and multiple Poisson regression were used; p &lt; 0.05 was considered statistically significant. Prevalence ratios of negative associations demonstrated protective factors for support actions: follow-up at Psychosocial Care Center, management of psychopharmacotherapy, offer of other therapeutic actions, care process for users of psychoactive substances, and offer of activities to prevent the use of psychoactive substances. Collaborative care in primary care was effective, and capital cities were a protective factor compared with non-capital cities.

Aim: Aim of our study was to evaluate incidence and causative factors for acute kidney injury in hepatopancreaticobiliary (HPB) surgeries. Material and Methods: All the HPB surgeries performed between April 2018 to March 2020, in our institution have been analysed for acute kidney injury. Acute kidney injury defined according to acute kidney injury network classification. Categorical variables were evaluated by chi square test and fisher t test wherever approptiate and continuous variables by Mann Whitney U test. Statistical analysis was done using SPSS version 23. P< 0.05 was considered significant. Results: We performed 195 HPB surgeries between April 2018 to March 2020, Which included 114 biliary surgeries, 57 liver surgeries and 23 pancreas surgeries. 10 patients developed Acute Kidney Injuries. (AKI) On Univariate analysis AKI was associated with open surgeries, intra operative hypotension and liver surgeries, higher ASA grade, increase operative time, more blood products used, higher CDC grade of surgery and more hospital stay before diagnosis of AKI. However on multivariate analysis only higher ASA score independently predicted Acute Kidney Injury. (p=0.003, odds ratio 15.659, 95% confidence interval 2.54-93.36). AKI was also significantly associated with mortality. (p <0.0001). Conclusion: Pre operative higher ASA grade independently predicted post operative acute kidney injury. Post operative AKI is significantly associated with mortality.

This article analyzes and compares the integration of two different maximum power point tracking (MPPT) control methods, which are tested under partial shading and fast ramp conditions. These MPPT methods are designed by Improved Particle Swarm Optimization (IPSO) and a combination technique between Neural Network and Perturb & Observe method (NN_P&O). These two methods are implemented and simulated for photovoltaic systems (PV), where various system responses, such as: voltage and power are obtained. The MPPT techniques were simulated using Matlab/Simulink environment. A comparison of the performance of IPSO and NN_P&O algorithms is carried out to confirm the best accomplishment of the two methods in terms of speed, accuracy and simplicity.

In a depolarizing instrument, such as a broadband imaging spectrometer, the depolarizers are placed on the system for stabilization the optical signal. They are also used to reduce measurements offsets due to strong polarization dependence, which produce drastic deterioration of the signal to noise ratio. Dynamic depolarizer with a controllable degree of polarization is also required to study the effect of noise on quantum information. The article described a new instrument for characterization the variable depolarizer with features which make it different from a polarimetric system. The analysing system based on the simple structural design and has good stability for real-time measurement. A practical application of the described interferometer system for variable depolarizer characterization is also presented.

The article presents the original derivation method of transformations for kinematics with a universal reference system. This method allows to derive transformations that meet the results of the Michelson-Morley and Kennedy-Thorndike experiments only in some frame of reference, e.g. in laboratories moving in relation to a universal frame of reference with small speeds. The obtained transformations are the basis for the derivation of the new physical theory, which has been called the Special Theory of Ether. The generalized transformations can be expressed by relative speeds (26)-(27) or by the parameter δ (v) (37)-(38). Based on conclusions of the Michelson-Morley’s and Kennedy-Thorndike’s experiments, the parameter δ (v) was determined. This allows the transformations to take a special form (81)-(82), which is consistent with experiments in which velocity of light is measured. On the basis of obtained transformations, the formulas for summing speed and relative speed were also determined. The entire article includes only original research conducted by its author.

Recently it was found from Cassini data that the mean recession speed of Titan from Saturn is v = 11.3 ± 2.0 cm/yr which corresponds to a tidal quality factor of Saturn Q ≈ 100 while the standard estimate yields Q ≥ 6 · 10⁴ . It was assumed that such a large speed v is due to a resonance locking mechanism of five inner mid-sized moons of Saturn. In this paper, we show that an essential part of v may come from a local Hubble expansion, where the Hubble-Lemaˆıtre constant H0 recalculated to the Saturn-Titan distance D is 8.15 cm/(yrD). Our hypothesis is based on many other observations showing a slight expansion of the Solar system and also of our Galaxy at a rate comparable with H0. We demonstrate that the large disproportion in estimating the Q factor can be just caused by the local expansion effect. [Accepted for publication in "Gravitation and Cosmology". The paper is to appear in Vol. 28, Issue 2 (2022) of the journal Gravitation and Cosmology.]

The mining wastes generated during the last decades in the mining region of Pachuca-Real del Monte in Mexico, still contains silver values of interest. For this reason, the present work is a preliminary study of the leaching kinetics of silver contained in these residues, using as a leaching reagent the thiosemicarbazide-oxygen system, with the aim of proposing this leaching system as a less toxic alternative than cyaniding process. Previous the leaching process, representative samples were wholly characterized, finding 56 g of Ag and 0.6 g of Au per ton. For the kinetic study in the mentioned system, were evaluated the reagent concentration, temperature, partial pressure of oxygen, pH and stirring rate. According the experimental results found, it was observed that [CH₅N₃S] concentration showed a significant effect on the leaching rate, obtaining a reaction order of n = 0.93, in the range of 20 - 40 mol CH₅N₃S × m^-3, getting so a silver recovery up to 76.9%. The effect of temperature gave an activation energy of Ea = 45.55 KJ mol^-1, which was indicative of a chemical reaction control. Finally, partial pressure of oxygen has a notable effect on leaching rate, but pH and stirring rate have not apparent effect.

Diverse forms of artificial intelligence (AI in further text) are at the forefront of triggering digital security innovations, based on the threats that are arising in this post COVID world. On the one hand, companies are experiencing difficulty in dealing with security challenges with regard to a variety of issues ranging from system openness, decision making, quality control and web domain, just to mention a few. On the other hand, in the last decade, research has focused on security capabilities based on tools such as platform complacency, intelligent trees, modeling methods and outage management systems, in an effort to understanding the interplay between AI and those issues. The dependence on the emergence of AI in running industries and shaping the education, transports and health sectors is now well known in literature. AI is increasingly employed in managing data security across economic sectors. Thus, a literature review of AI and system secu-rity within the current digital society is opportune. This paper aims at identifying research trends in the field through a Systematic Bibliometric Literature Review (LRSB) of research on AI and system security. The review entails 77 articles published in Scopus® database, presenting up-to-date knowledge on the topic. The LRSB results were synthesized across current research subthemes. Findings are presented. The originality of the paper relies on its LRSB method, together with extant review of articles that have not been categorized so far. Implications for future re-search are suggested.

This article proposes a new photovoltaic (PV) solar tracker design based on the advantage that installation latitude offers according to efficiency in function of orientation (EFO) of PVs. First, is described a methodology to let incorporate a low-precision, low-cost and high-availability solar tracking mechanism and control system. The design methodology considers the installation location (latitude and azimuth) as a starting point for establishing an adequate angular range of EFO, simultaneity the aspects of available technology and the knowledge accords to developer. Finally, the design technique is experimentally validated by the implementation of a solar tracker at latitude of 28° longitude of 109° and evaluates the efficiency on a specific day. According to result the feasibility of this type of solar tracker for latitudes close to or greater than 30° is highlighted, given that this tracking system costs 30% less than traditional commercial systems as slew drive with its incorporation of lower-resolution azimuth tracking mechanisms. It also increases collection efficiency by 26%, just as continuous or time-based dual-axis solar trackers do, without the more complex controls and mechanisms of these designs.

Background: Parents of preterm infants face major mental health challenges in the Neonatal Intensive Care Unit (NICU). Family-centered music therapy actively integrates and empowers parents in their infant’s care. With the aim to better understand and address parental needs separately from their babies’, a music therapy (MT) self-care group was implemented as part of clinical practice at the hospital Clínica de la Mujer in Bogotá, Colombia. Methods: The group is provided for both parents twice a week in the NICU. Music guided relaxations, breathing techniques, and self-expression are at the center of the MT group sessions. Parents complete a pre/post self-administered Numeric Rating Scale (NRS) including anxiety levels, stress levels, mood and motivation. Results: Parents highly value the MT self-care group at the NICU. On average there is a 37% improvement in anxiety levels, 28% in stress levels, and 12% in mood, restfulness and motivation. Being able to relax, to distract themselves from their worries and having time for themselves are amongst the most frequently mentioned benefits. Conclusions: Addressing parents’ needs separately form their babies’ treatment with culturally sensitive interventions aimed to improve parental mental health, is essential for continuing the development of family-centered music therapy interventions in the NICU.

The main channel for disseminating information is now the Internet. Users have different expectations for the calibre of websites regarding the posted and presented content. The WEB site's quality is influenced by up to 120 factors, each represented by two to fifteen attributes. A major challenge is quantifying the features and evaluating the quality of a website based on the feature counts. One of the aspects that determines a website's quality is its completeness, which focuses on the existence of all the objects and their connections with one another. It isn’t easy to build an expert model based on feature counts to evaluate website quality, so this paper has focused on that challenge. Both a methodology for calculating a website's quality and a parser-based approach for measuring feature counts are offered. We provide a multi-layer perceptron model that is an expert model for forecasting website quality from the "Completeness" perspective. The accuracy of the predictions is 98%, whilst the accuracy of the nearest model is 87%.

Longitudinal image registration of pulmonary computed tomography (PCT) images may serve as an essential tool for investigating the relationship between radiation dose distribution and the occurrence and phenotype of radiation-induced lung disease (RILD). Although numerous longitudinal registration algorithms have been developed for PCT, most similarity-based approaches are not suitable for PCT involving RILD due to the complex tissue variation between two PCT images. Moreover, conventional feature-based approaches might fail to find a sufficient number of matched pairs of feature points due to the disparate lung deformation caused by breathing and RILD. To overcome the challenges resulting from RILD, component structure coherence point drift (CSCPD) was proposed to establish a deformation model by decomposing the chest into several components and matching them with individual parameters based on coherence point drift (CPD). Moreover, a regional vascular point matching (RVPM) algorithm was proposed to generate a vascular subtree and to substantially increase the number of corresponding pairs between two images. Eventually, the components were recomposed and aligned by a thin plate spline algorithm. A performance assessment on 15 pairs of PCT images of patients with RILD yielded recall and precision values of 0.85 and 0.89 for RVPM, respectively. Moreover, the target registration error of CSCPD with RVPM (2.3 ± 1.79) was significantly better than that of conventional CPD with RVPM (2.95 ± 1.89) and conventional CPD (5.04 ± 2.87). Therefore, the proposed registration system is robust enough to address the disparate deformation of lungs with RILD, and it improves registration accuracy within the parenchyma.

The rapid progress in artificial intelligence, machine learning, and natural language processing has led to the emergence of increasingly sophisticated large language models (LLMs) enabling their use in healthcare. The study assesses the performance of two LLMs: the GPT-3.5 and GPT-4 models in passing the medical examination for access to medical specialist training in Spain MIR. Our objectives included gauging the model's overall performance, analyzing discrepancies across different medical specialties, discerning between theoretical and practical questions, estimating error proportions, and assessing the hypothetical severity of errors committed by a physician. We studied the 2022 Spanish MIR examination after excluding those questions requiring image evaluations or having acknowledged errors. The remaining 182 questions were presented to the LLM ChatGPT4 and GPT-3.5 in Spanish and English. Logistic regression models analyzed the relationships between question length and question sequence d performance. GPT-4 outperformed GPT -3.5, scoring 86.81% in Spanish (p<0.001). English translations had a slightly enhanced performance. Among medical specialties, GPT-4 achieved a 100% correct response rate in several areas, with specialties like Pharmacology, ICU, and Infectious Diseases showing lower performance. The error analysis revealed that while a 13.2% error rate existed, gravest categories like "error requiring intervention to sustain life" and "error resulting in death" had a 0% rate. Conclusions: GPT-4 performs robustly on the Spanish MIR examination, varying its capability to discriminate knoweldge across specialties. While the model's high success rate is commendable, understanding the error severity is critical, especially when considering AI's potential role in real-world medical practice and its implication on patient safety.

Purpose: During the COVID-19 pandemic, the health care workers (HCWs) at the frontline have been largely exposed to infected patients, running an high risk of being infected by the SARS-CoV-2 virus. This study investigates the epidemiological, clinical and lifestyles characteristics that might play roles in the susceptibility of HCWs to COVID-19 in a hit Italian hospital. Methods:Demographic, lifestyle, work-related and comorbidities data of 1447 HCWs which underwent a nasopharyngeal swab for SARS-CoV-2 were retrospectively collected. For the 164 HCWs positive for SARS-CoV-2, data about safety in the workplace, symptoms and clinical course of COVID-19 were also collected. Cumulative incidence of SARS-CoV-2 infection was estimated. Risk factors for SARS-CoV-2 infection were assessed using a multivariable Poisson regression. Results: The cumulative incidence of SARS-CoV-2 infection among the screened HCWs was 11.33 (9.72-13.21). Working in a COVID-19 ward, being a former smoker (vs being a person who never smoked) and BMI were positively associated with SARS-CoV-2 infection, whereas being a current smoker was negatively associated with this variable. Conclusions: Assuming an equal accessibility and proper use of PPE of all the HCWs of our Hospital, the great and more prolonged contact with COVID-19 patients remains the crucial risk factor for SARS-CoV-2. Therefore, increased and particular care needs to be focused specifically on the most exposed HCWs groups, which should be safeguarded. Furthermore, in order to limit the risk of asymptomatic spread of SARS-CoV-2 infection, the HCWs mild symptoms of COVID-19 should be considered when evaluating the potential benefits of universal staff testing

The workforce crisis of primary care is reflected in the increasing number of general medical practices (GMP) with vacant general practitioner (GP) position, and the GPs’ ageing. Our study aimed to describe the association between this crisis and premature mortality. Age-sex-standardized mortality for 18-64 years old adults were calculated for all Hungarian GMPs annually in the period from 2006 to 2014. The relationship of premature mortality with GPs’ age and vacant GP position were evaluated by standardized linear regression controlled for list size, urbanization, geographical location, clients’ education, and type of the GMP. The clients’ education was the strongest protective factor (beta=-0175; p<0.001), followed by urban residence (beta=-0.149; p<0.001), and the bigger list size (beta1601-2000=-0.054; p<0.001; beta2001-X=-0.096; p<0.001). The geographical localization influenced significantly also the risk. Although, GMP with a GP aged older than 65 years (beta=0; p=0.995) did not affected the risk, GP vacancy was associated with higher risk (beta=0.010; p=0.033), but the corresponding number of attributable cases was 23.54 for 9 years. The vacant GP position is associated with significant but hardly detectable increased risk of premature mortality without considerable public health importance. Nevertheless, employment of GPs aged more than 65 does not impose premature mortality risk elevation.

Not a lot is known about either death or the dying process. Politicians and many in the medical profession in the UK tend to shy away from interfering with it by not allowing euthanasia as an end of life option for the patient. This is the first paper in a series of two, comparing the situation in human medicine and veterinary medicine, in which euthanasia is well practiced for relieving suffering at the end of an animal’s life. This first part takes the form of a literature review including best practice around end of life care, its deficiencies and the need for assisted dying. Veterinary surgeons are well trained in the ethics of euthanasia and put it to good use in the best interest of their animal patients. In countries which have legalized physician assisted suicide for the terminally ill reporting indicates that it works well, without increases in involuntary euthanasia and most importantly without intimidation of the vulnerable. However, there is still an ever increasing tendency to overuse sedation and opioids at the end of life, which merits further investigation. With advances in medical science able to significantly prolong the dying process, patient autonomy demands a review of the law in the UK.

Three-temperature heating systems consist of a heat engine and a heat pump, enabling thus maximum usage of the primary thermal source for the heating of buildings. This analysis has revealed obvious advantages and disadvantages that the combining of thermodynamic systems has in future development, also with respect to environmental and economic issues. It appears that the combination of a Stirling engine or a similar heat drive with a heat pump is especially suitable. In order to analyze the effectiveness of such a system, a comprehensive calculation procedure is used: its basis lies in accounting for all types of energy and their relationship to the original natural resource. The present paper aims to point out that the combination of Stirling engine and a heat pump is a useful solution thanks to the most favorable resultant economic impact if compared to the usage of a diesel, four-stroke gas, or, most commonly used, electric drive.

Collaborative action between families and health professionals, in this case nurses, doctors, nutritionists, pharmacies in forming harmonious support is the philosophy of family centered nursing care which aims to involve families as the main focus in care. The aim of this literature review is to identify family-centered family member care: a literatu review. This language method uses literature reviews which are summaries of 10 articles in the publication years of 2020-2021 on search 4 databased electronic searches containing namely Scopus, ProQuest, Pubmed, and Scient Direct. This review used prisms. The eligibility of these studies were from its title, abstract, research methodology, results and discussion. The results of the review were presented in narrative form. The results of a review of 10 articles found that the form family centered care Conclusion: The family is considered a partner in the care of other family members. The concept of family centered care is a philosophy in nursing where the role of the family is very important in caring for family members who are sick.

Over the past few decades, digitalisation has pushed patient care towards a new era, inducing the evolution of health care delivery and enhancing the overall sustainability of health systems worldwide. Despite the ever-evolving technology leading to a change in health care provision, the uptake of these novel technologies by medical professionals is slow, largely because of concerns about the potential impact on patient care and patient safety, and medico-legal implications. Hence, this research aimed to understand doctors’ perceptions of the adoption of digital virtual consultations in the practice setting.In this survey, an online questionnaire, adapted from the construct by Venkatesh and Bala and based on the Technology Acceptance Model by Davis, was distributed to 886 hospital doctors. Altogether 133 responses were obtained.Results suggest that the respondents perceived digital virtual consultations as adjuncts to face-to-face consultations and as able to diminish time and place barriers. Doctors were willing in principle to utilise these alternatives to traditional methods if the appropriate infrastructure and technology were in place. Feasibility and cost-effectiveness studies are recommended to establish the technology-fit factor and the impact of the technology on the workforce, coupled with a stakeholder analysis to include all the actors involved in such a strategy.

In this paper, we propose a novel approach named EmbedHDP to enhance the evaluation models used to assess sentence suggestions within nursing care record applications. The key focus is determining whether these suggestions garner assessments that align with caregivers as human evaluators. It is crucial due to the direct relevance of the information provided to the health or condition of the elderly. The motivation behind this proposal stems from challenges observed in previous models, such as BERTScore, which encountered difficulties in effectively evaluating the nurse care record domain, consistently providing quality assessments of generated sentence suggestions above 60%. Additionally, while widely used, cosine similarity exhibits limitations concerning word order, leading to potential misjudgments of semantical differences within similar word sets. Similarly, relying on lexical overlap, ROUGE tends to overlook semantic accuracy. Furthermore, despite its utility, BLEU neglects semantic coherence in its evaluations. EmbedHDP excels in evaluating nurse care records by effectively handling a variety of sentence structures and medical terminology and providing differentiated and contextually relevant assessments. We used a dataset comprising 320 pairs of sentences with correspondingly equivalent lengths. The results revealed that EmbedHDP outperformed other evaluation models, achieving a coefficient score of 61%, followed by cosine similarity with a score of 59%, and BERTScore with 58%. This shows the effectiveness of our proposed approach in improving the evaluation of sentence suggestions in nursing care record applications.

Mechanical bowel obstruction is a common symptom for admission to emergency services, diagnosed annually in more than 300,000 patients in the States, from whom 51% will undergo emergency laparotomy. This condition is associated with serious morbidity and mortality, but it also causes a high financial burden due to long hospital stay. The EUPEMEN project aims to incorporate the expertise and clinical experience of national clinical specialists into development of perioperative rehabilitation protocols. Providing special recommendations for all aspects of patient perioperative care and the participation of diverse specialists, the EUPEMEN protocol for bowel obstruction, as presented in the current paper, aims to provide faster postoperative recovery and reduce length of hospital stay, postoperative morbidity and mortality rate.

The different waves of the COVID-19 pandemic caused dramatic issues regarding the organiza-tion of care. In this context innovative solutions have to be developed in a timely manner to adapted the organization of the care. The establishment of middle care (MC) units is a bright example of such an adaptation. A multidisciplinary MC team, including expert and non-expert respiratory nurses, physicians, physiotherapists, psychologists, nutritionists and social workers, was built and trained to work in the COVID-19 MC unit. Important educational resources were set up to ensure rapid and effective training of the MC team, limiting the admission or delaying transfers to ICU and ensuring optimal management of palliative care. We conducted a retrospec-tive analysis of patient data in the MC unit during the second COVID-19 wave. Fifty-two COVID-19 ‘step-up’ patients admitted to the MC unit were included in the study. Thirty-four (65%) patients worsened, of which 12 (23%) were not eligible for ICU access. In total, 42% of the ICU-eligible patients were managed in the MC unit to avoid the ICU. Among the 22 patients transferred to the ICU, 15 were intubated. The establishment of an MC unit during a pandemic, mixing expert and non-expert respiratory team members, is feasible and needed. MC units possi-bly relieve the pressure exerted on ICUs. A highly trained multidisciplinary team is key to ensur-ing the success of an MC unit during a pandemic.

The utilization of person centered care is highlighted as essential for health promotion, yet implementation has been inconsistent and multiple issues remain. There is a dearth of applied re-search exploring the facets of successful implementation. In this paper, a person centered wellbeing program spanning various groups is discussed outlining the central principles that have allowed for successful outcomes. The main data emerges from 10 years of pragmatic pre-post service evaluation. Measures of functional capacity and wellbeing were captured using validated measures. The method for this paper is a narrative exploration of the theory and practices that can explain the continual improvement the clinics have achieved over 10 years. Core principles relate to connecting with people, connecting through groups, and connecting with self. The operationalization and theoretical explanation of these principles is outlined alongside 10 years of data which shows sustained improvement in a range of outcomes. The discussion of these principles posits essential factors to prioritize to advance the implementation of person centered care in health promotion for long term conditions.

While disrespectful treatment of pregnant women attending health care facilities occurs globally, it is more prevalent in low resource countries. In Kenya, a large body of research studies or has studied disrespectful maternity care (DMC) from the perspective of the service users. This paper examines the perspective of health care workers (HWCs) on factors that influence DMC experienced by pregnant women at health care facilities in rural Kisii and Kilifi counties in Kenya. We conducted 24 in-depth interviews with health care workers (HCWs) in these two sites. Data were analyzed deductively and inductively using NVIVO 12. Findings from HCWs reflective narratives identify four areas connected to the delivery of disrespectful care including poor infrastructure, understaffing, service users’ socio–cultural beliefs, and health care workers’ attitudes toward marginalized women. Investments are needed to address health systems influences on DMC including poor health infrastructure and understaffing. Additionally, it is important to reduce cultural barriers through training on HCWs interpersonal communication skills. Further, strategies are needed to affect positive behavior changes among HCWs directed at addressing stigma and discrimination of pregnant women due to socio-economic standing. To develop evidence-informed strategies to address DMC, a holistic understanding of the factors associated with pregnant women’s poor experiences of facility based maternity care is needed. This may best be achieved through an intersectional approach to address DMC by identifying systemic, cultural, and socio-economic inequities as well as the structural and policy features that contribute and determine peoples’ behaviors and choices.

The purpose of this original study is to critically analyze the emergence and development of the national models of financial regulation; international standards and codes; regional and national financial regulation and supervision (the case of UK, USA, Sweden, EU and Finland). The research raises both academic and regulatory concerns. It aims at shaping changes (innovations) in the supervisory practices of national and international regulators in response to new developments in FinTech markets, digital products, financial instruments and risks. Secondly, it will stimulate more systematic work on regulatory databases, registration and reporting procedures in various economies in different financial markets. The author identifies five main systems of national financial regulatory markets: the multi-tiered, multi-agency US system; the Twin Peaks model (UK); the mega-regulatory model (Sweden). There is a thorough review of international standards and institutions that work for the stability of financial systems. The analysis of regional and national systems of financial regulation and supervision is based on the examples of the EU and Finnish institutions. National macro and microeconomic regulation and supervision have been examined with a focus on the US Federal Reserve and the US Treasury. National and international regulatory institutions have been evolving along several lines. First, minimum capital and credit risk requirements for banks (80s of the 20th century) are complemented in the 21st century by buffer reserves, liquidity and leverage standards. Second, regulation focuses on ensuring the sustainability of the national economy. The regulatory focus is on ensuring the sustainability of national and global financial systems. Third, there is an increase in the number of supervised institutions. Fourth, there is a division of functions between central banks (macroeconomic regulation) and one or two mega-regulators (microeconomic regulation and supervision). Fifth, there is a division of labour between the international financial institutions (BIS, IMF, WB) and national regulators. Sixth, the focus is on protecting consumers and investors, and countering money laundering and the financing of terrorism. Seventh, there is an understanding for a common approach by central banks to new financial technologies and cybersecurity.

A novel scheme that can simultaneously measure the Doppler frequency shift (DFS) and angle of arrival (AOA) of microwave signals is proposed. At the signal receiving unit (SRU), two echo signals and the reference signal are modulated by a Sagnac loop structure and sent to the central station (CS) for processing. At the CS, two low-frequency electrical signals are generated after polarization control and photoelectric conversion. The DFS without direction ambiguity and wide AOA measurement can be real-time acquired by monitoring the frequency and power of the two low-frequency electrical signals. In the simulation, an unambiguous DFS measurement with errors of ±3×10-3 Hz and a -90° to 90° AOA measurement range with errors of less than ±0.5° are realized. The safety and robustness of the system to environmental disturbance are improved, and it is more suitable for the modern electronic warfare system.

This paper aims to investigate the global asymptotic stability of following system of higher order difference equations with quadratic terms: x_{n+1}=A+B((y_{n})/(y_{n-m}²)),y_{n+1}=A+B((x_{n})/(x_{n-m}²)) where A and B are positive numbers and the initial values are positive numbers. We also study the rate of convergence and oscillation behaviour of the solutions of related system.

(1) Background: Nursing homes’ preparedness in managing a public health crisis has been fragile, with effects on safety culture. The objective of this study was to assess nursing homes’ COVID-19 preparedness in Southern Portugal, including personnel’s work experiences during the pandemic. (2) Methods: We used a COVID-19 preparedness checklist to be completed by management teams, followed by follow-up calls to nursing homes. Thereafter, a survey to personnel was applied. Data analysis included descriptive statistics, exploratory factor analysis, and thematic analysis of open-end questions. (3) Results: In total, 71% (138/195) of eligible nursing homes returned the preparedness checklist. We conducted 83 follow-up calls and received 720 replies to the personnel survey. On average, 25% of nursing homes did not have an adequate decision-making structure to respond to the pandemic. Outbreak capacity and training were fragile areas among nursing homes’ contingency plans. We identified compliance with procedures and nonpunitive response to mistakes as fragile areas of safety culture, and teamwork as a strong safety area. (4) Conclusions: To strengthen how nursing homes cope with upcoming phases of the COVID-19 pandemic or future public health emergencies, nursing homes’ preparedness and safety culture should be fostered and closely monitored.

Soil conditions is a major aspect of interest for farmers due to the knowing of the physicochemical properties of the same can help with any necessary restoration of soil that guarantees the quality and the production of their crop. However, technology and analysis of the soil become of difficult access mainly in developing countries, by which the present paper shows the development of a system thought to estimate physicochemical variables of soils growing sugar cane through studies of spectroscopy. Its characteristic is that it is a portable system, with low cost, easy to use and can estimate physicochemical variables in-situ with the objective of knowing the degree of degradation present in the soil and through this help the farmers define possible strategies to restore it. The device uses the frequency response of the soil determining values of magnitude and phase, which are used by algorithms of artificial intelligence capable of getting an estimation of the physicochemical properties. The obtained results show errors below 8% in the estimation of the variables compared to the analysis results of the soil at laboratories.

Thanks to rapid advances in the Internet of Things (IoT) and Edge-Fog-Cloud Computing technologies, Smart Public Safety (SPS) system has become feasible by integrating heterogeneous computing devices and different types of networks to collaboratively provide seamless public safety services. While SPS facilitates convenient exchanges of surveillance data streams among device owners and third-party applications, the existing monolithic service oriented architecture (SOA) architecture is unable to provide scalable and extensible services in a large-scale heterogeneous network environment. Moreover, traditional security solutions rely on centralized trusted third-party authority, which not only can be a performance bottleneck or the single point of failure, but it also incurs privacy concerns on improperly use of private information. Inspired by blockchain and microservices technologies, this paper proposed a BLockchain-ENabled Decentralized Smart Public Safety (BlendSPS) system. Leveraging hybrid blockchain fabrics, a microservices based security mechanism is implemented to enable decentralized security architecture, and it supports immutability, auditability and traceability for secured data sharing and operations among participants of the SPS system. An extensive experimental study verified the feasibility of the proposed Blend-SPS that possesses security and privacy proprieties with limited overhead on IoT based edge networks.

The issue of actualization of labor interests as a motivational driver and one of the sources of labor productivity is little-studied in applied and organizational psychology. The study given in the paper fills some “blanks” of this problem. The leading approach to research is the motivational system proposed on the basis of theoretical analysis and the developed psychological model of labor interests. Using the methods of a special survey, questioning and interview guides, the analysis and comparative assessment of the labor interests of 50 candidates for the service manager position (entertainment and restaurant industry field) was conducted; as well as of 45 employees in this industry aged 18 to 25. The main results of the paper show the connection of labor interests with the company's personnel management system, namely with the processes of selection, adaptation, and training. It was revealed that the candidates selected for the service manager position were of primary group interest and financial incentive was secondary. At the same time, financial incentive contributed to the successful passage of the adaptation period. Occupational interests of employees depended on their education and job specifics. Career interests were influenced by the time spent with the company. The recommendations necessary for employers to create the conditions corresponding to the leading labor interests of employees were substantiated.

In this paper, we propose a system of nonlinear mixed variational inequality problems, which consists of two elliptic mixed variational inequality problems on Banach spaces. Under suitable assumptions, using the Kakutani-Ky Fan fixed point theorem and Minty techniques, we prove the solution set to the system of nonlinear mixed variational inequality problem is nonempty, weakly compact and unique. Additionally, we suggest a stability result for the system of nonlinear mixed variational inequality problem by perturbing the duality mappings. Furthermore, we present an optimal control problem governed by the system of nonlinear mixed variational inequality problems and establish a solvability result.

"The wisdom of crowd'' is so often observed in social discourses and activities around us. The manifestations of it are, however, so intrinsically embedded and behaviorally accepted that an elaboration of a social phenomenon evidencing such wisdom is often cheered as a discovery; or at least an astonishing fact. One such scenario is explored here, namely conceptualization and modeling of a food safety system, a system directly related to social cognition. Food safety is an area of concern these days. Models representing the food safety systems are recently published to study the effect of interactions between important entities of the system. For example, Knowles’s model finds conditions leading to a more efficient and dependable system of entities like consumers, regulators and stores with specific focus on regulators behavior and their impact on the food safety. The first contribution of this paper is reevaluation of Knowles’s model towards a more conscious understanding of ``the wisdom of crowd'' effects on inspection and consuming behaviors. The second contribution is augmenting of the model with social networking capabilities, which acts as a medium to spread information about stores and help consumers find stores which are not contaminated. Simulation results reveal that stores’ respecting social cognition improve effectiveness of the food safety system for consumers and stores both. Simulation findings also reveals that an active society has a capability to self-organize effectively even in the absence of any regulatory compulsion.

With the ever-increasing popularity of unmanned aerial vehicles and other platforms providing dense point clouds, filters for identification of ground points in such dense clouds are needed. Many filters have been proposed and are widely used, usually based on the determination of an original surface approximation and subsequent identification of points within a predefined dis-tance from such surface. We present a new filter, Multi-view and shift rasterization algorithm (MVSR) is based on a different principle, i.e., on the identification of just the lowest points in in-dividual grid cells, shifting the grid along both planar axis and subsequent tilting of the entire grid. The principle is presented in detail and compared both visually and numerically to other commonly used ground filters (PMF, SMRF, CSF, ATIN) on three sites with different ruggedness and vegetation density. Visually, the MVSR filter showed the smoothest and thinnest ground profiles, with ATIN the only filter performing comparably. The same was confirmed when comparing ground filtered by other filters with the MVSR-based surface. The goodness of fit with the original cloud is demonstrated by the root mean square deviations (RMSD) of the points from the original cloud found below the MVSR-generated surface (ranging, depending on site, between 0.6-2.5 cm). The MVSR filter performed outstandingly at all sites, identifying the ground points with great accuracy while filtering out the maximum of vegetation/above-ground points. The filter dilutes the cloud somewhat; in such dense point clouds, however, this can be perceived rather as a benefit than as a disadvantage.

With the ever-increasing popularity of unmanned aerial vehicles and other platforms providing dense point clouds, universal filters for accurate identification of ground points in such dense clouds are needed. Many filters have been proposed and are widely used, usually based on the determination of an original surface approximation and subsequent identification of points within a predefined distance from such surface. In this paper, we present a new filter. This Multi-view and shift rasterization algorithm (MVSR) is based on an entirely different principle, i.e., on the identification of just the lowest points in individual grid cells, shifting the grid along both planar axis and subsequent tilting of the entire grid – after each of these steps, one lowest point per cell is detected. The principle is presented in detail and compared both visually and numerically to other commonly used ground filters (PMF, SMRF, CSF, ATIN) on three sites with different ruggedness and vegetation density. Visually, the MVSR filter showed the smoothest and thinnest ground profiles, with ATIN the only filter performing comparably (although the profiles were somewhat thicker and not as complete as MVSR-acquired ground). The same was confirmed when comparing ground filtered by other filters with the MVSR-based surface. The goodness of fit with the original cloud is demonstrated by the root mean square deviations (RMSD) of the points from the original cloud found below the MVSR-generated surface (ranging, depending on site, between 0.6-2.5 cm). ATIN again performed closest to MVSR, with RMSDs of ground filtered points found above MVSR-based surface at individual sites ranging between 4.5-7.4 cm. The remaining filters performed comparable in the simplest flat area but poorly in rugged and much-vegetated sites, with RMSDs above the MVSR surface ranging at such sites from 21 to 95 cm. In conclusion, the novel filter presented in this paper performed outstandingly at all sites, identifying the ground points with great accuracy while filtering out the maximum of vegetation/above-ground points. The filter dilutes the cloud somewhat; in such dense point clouds, however, this can be perceived rather as a benefit than as a disadvantage.

In this paper, we present a relapse based demonstrating way to deal with investigate various arrangement MTC information. A commonplace use of this displaying approach incorporates three stages: first, define a model that approximates the connection between quality articulation and trial factors, with boundaries consolidated to address the exploration premium; second, utilize least-squares and assessing condition methods to gauge boundaries and their relating standard blunders; third, register test insights, P-qualities and NFD as proportions of factual criticalness. The benefits of this methodology are as per the following. To begin with, it tends to the exploration interest in a particular, precise way, and maximally uses all the information and other important data. Second, it represents both orderly and irregular varieties related with the information, and the consequences of such examination give not just quality explicit data applicable to the exploration objective, yet additionally its dependability, in this way helping agents to settle on better choices for subsequent investigations. Third, this methodology is truly adaptable, and can undoubtedly be stretched out to different sorts of MTC considers or other microarray explores by detailing various models dependent on the test plan of the investigations.

Micro-plastics (MPs) become significantly important to society since their commercial manufacture began in the 1950s because of their low production costs, stability, light weight, and adaptability. Plastic was produced in 400 million tons worldwide in 2020, compared to 1.5 million tons just 60 years earlier. Scientists predict that by 2050, plastic production would increase to 33 billion tons. MPs are a rising scientific and societal issue in the environment as a new type of contaminant that is widely disseminated in aquatic ecosystems and organisms. Aquatic species that come into contact with MPs for an extended period of time experience ecotoxicity, which includes oxidative stress, genotoxicity, neurotoxicity, and reproductive issues. In aquatic environments, MPs not only transport chemicals within animals but also serve as mediators for chemicals or other contaminants. As a result of co-exposure of MPs and chemical contaminants, various toxicity incidences involving aquatic organisms have been reported. The final exposure of MPs occurs in humans through biomagnification of aquatic edible products. This study presents an important overview of the literature on MP ingestion by aquatic biota. It covers topics such as the present scenario of plastic pollution worldwide, the pathways that MPs take to reach humans and aquatic species, the eco-toxicological impacts of MPs on aquatic species, the relation between MPs and other environmental pollution and the ensuing effects on aquatic organisms, and the MP pollution status in Bangladesh.

Recently, e-commerce companies have been adopting and continuously enhancing personalized product recommendation systems, and there is active research in this field within academia. However, personalized product recommendations in offline retail stores have not yielded significant outcomes thus far. Especially for small-format offline retail businesses like convenience stores, where customer information might be limited, providing personalized product recommendations poses even greater challenges. To address this issue, this study aimed to find a solution by shifting the perspective on recommendation methods and altering the target of recommendations in existing personalized recommendation models. In this study, recommending products that customers need in an offline store was defined as suggesting products that should be introduced and displayed within the store. In other words, the recommendation focus shifted from individuals to the stores themselves. This recommendation system proposes products that individual stores have not yet introduced but are anticipated to be purchased by customers among the products managed by the headquarters. Building upon this, we devised a store-based product recommendation system. The widely used user-based collaborative filtering model, a common technique in existing recommendation systems, was adapted into a store-based collaborative filtering model. Furthermore, various rules and logic pertinent to store operations and business considerations for convenience stores were integrated to implement this store product recommendation system. The accuracy and effectiveness of the system were demonstrated through its application in actual convenience stores. Results from the pilot implementation of the system showed that 88% of the newly recommended products in individual stores were sold based on one week of sales data, and the sales revenue was 1.75 times higher than the average sales revenue of those products across the entire company. Survey results on business owners' satisfaction yielded a score of 4.2 out of 5, indicating a high level of contentment. Additional observed effects included the expansion of product range and reduction in order lead times. However, 12% of the total recommended SKUs did not sell within one week, and 34% of the SKUs did not meet the overall average sales quantity. This research holds significance in extending the scope of personalized recommendation studies from primarily online platforms to offline retail businesses like convenience stores. It provides tangible methodologies and outcomes that can be implemented in real-world settings through the construction and validation of an actual system. The study also suggests avenues for future research to address some of the identified limitations.

In this paper we investigate the global asymptotic stability of following system ofhigher order difference equations with quadratic terms:xn+1=A+Byn/yn−m^2, yn+1=A+Bxn/xn−m^2, where A and B are positive numbers and the initial values are positive numbers.We also study the boundedness, rate of convergence and oscillation behaviour of thesolutions of related system.

The mining wastes generated during the last decades in the mining region of Pachuca-Real del Monte in Mexico, still contains silver values of interest. For this reason, the present work is a preliminary study of the leaching kinetics of silver contained in these residues, using as a leaching reagent the thiosemicarbazide-oxygen system, with the aim of proposing this leaching system as a less toxic alternative than cyaniding process. Previous the leaching process, representative samples were wholly characterized, finding 56 g of Ag and 0.6 g of Au per ton. For the kinetic study in the mentioned system, were evaluated the reagent concentration, temperature, partial pressure of oxygen, pH and stirring rate. According the experimental results found, it was observed that [CH5N3S] concentration showed a significant effect on the leaching rate, obtaining a reaction order of n = 0.93, in the range of 20 - 40 mol CH5N3S ⋅ m-3, getting so a silver recovery up to 76.9%. The effect of temperature gave an activation energy of Ea = 45.55 KJ mol-1, which was indicative of a chemical reaction control. Finally, partial pressure of oxygen has a notable effect on leaching rate, but pH and stirring rate have not apparent effect.

For a wide field of view (FoV) wavefront coding athermalized infrared imaging system with a single decoding kernel, the off-axis aberration tends to cause artefacts. In order to correct off-axis aberration, many pieces of lenses will reduce the transmission efficiency and increase the weight and cost. To meet requirements for wide FoV, wide operating temperature and low weight of infrared imaging systems, this paper reports a wide-FoV wavefront coding athermalized infrared imaging system with a two-piece lens. Its principle, design, manufacture, measurement and performance validation are successively discussed. This paper constructs an optimization problem which maximizes the weighted mean of PSF consistency for both the FoV and operating temperature range. The two-piece lens contains four surfaces, where three aspheric surfaces are introduced to reduce optical off-axis aberrations and a cubic surface is introduced to achieve athermalization. The optical phase mask containing an aspheric surface and a cubic surface is manufactured by nano-metric machining of ion implanted material(NiIM). Experimental results validate that our wide-FoV wavefront coding athermalized infrared imaging system has a full FoV of 26.10° and an operating temperature over -20°C to +70°C.

Measles remains a highly contagious and potentially severe infectious disease, necessitating high vaccine coverage. However, misinformation and measles vaccine hesitancy/resistance posed significant challenges to achieving this goal. The COVID-19 pandemic further exacerbated these challenges, leading to a measles outbreak in Jordan in 2023. This study aimed to investigate the acceptance of the Measles-Rubella (MR) vaccine among parents in Jordan and identify its associated determinants. This cross-sectional questionnaire-based study was conducted using a previously Arabic-validated version of the Parental Attitudes towards Childhood Vaccines (PACV) survey instrument. Data collection took place in October 2023, and the final study sample comprised a total of 391 parents, with mothers representing 69.8% of the participants (n = 273). The majority of participating parents expressed either resistance (n = 169, 43.2%) or hesitancy (n = 168, 43.0%) towards MR vaccination, while only 54 participants (13.8%) expressed MR vaccine acceptance. Multivariate analysis revealed that trust in vaccine safety/efficacy, behavior, and having fewer offspring were significantly associated with MR vaccine acceptance. The current study revealed a concerning level of MR vaccine hesitancy/resistance among parents in Jordan. Urgent and targeted interventions are strongly recommended to address this issue, including mass campaigns aimed at building trust in the MR vaccine safety/efficacy. Additionally, there is an urgent need for effective public health initiatives to ensure sufficient measles vaccine coverage to prevent future outbreaks of this serious disease.