New developments in broadcast technology, such as the ad hoc wireless network and the detection devices that work, enable daily connections to the Internet, commonly referred to as the Internet of Things (IoT). IoT saw this as a support for the development of creative and contextual services and applications. The service can respond to the user's environment and preferences. Finite state machines are recently making waves when the issue of self-controlling systems come into the picture of designs. This research focuses on the design of a fault tolerant system that controls random failures impressed on the network. The method comprises of diodes, Resistors, Optocouplers, ESP8266 WI-FI Module Webpage with button, and two Arduinos which in effect will determine iteratively who to handle a failure at hand modelled as when the button on the webpage is pressed. In this work, a Heartbeat Detection and Monitoring System will be made using Arduino that detect the electrical state using the Pulse Sensor and show the readings in Beats Per Minute on the LED connected a microcontroller. It sends the texts to the server using the Wi-Fi module ESP8266 to signals can be monitored from the monitoring zone via the internet. This is reflected by the declaration of a master state by either of two Arduinos whenever the push button is pressed as observed on the codes. The result obtained from the research shows apparently, the state of the fault tolerance system none power deny of heartbeat condition connected to the LED.

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.

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.

The nondestructive testing of reinforced concrete chimneys, especially the high ones, is an important element of the assessment of their condition, making it possible to forecast their safe service lifespan. Industrial chimneys are often exposed to the strong action of acidic substances – they are adversely affected by the flue gas condensate on the inside and by acid precipitation on the outside. Initially, this results in the corrosion of the shell concrete and then in the corrosion of the reinforcing steel. During the service life of such chimneys their condition should monitored in order to prevent structural failures and indicate the most endangered parts of the structure. Owing to thermographic surveys one can monitor the hazards leading to the degradation of the chimney structure, which is particularly vital when due to the character of the production process the chimney cannot be put out of operation. The methods for the interpretation of results from thermovision studies to determine the safety and durability of industrial chimneys are shown.

Semi-destructive and non-destructive techniques are not commonly used for masonry as they are complex and difficult to perform. This paper describes validation of the following methods: semi-destructive and non-destructive, ultrasonic technique for autoclaved aerated concrete (AAC). The research subject was the compressive strength of AAC test elements with declared various density classes of: 400, 500, 600 and 700 (kg/m3) and various moisture levels. Empirical data including the shape and size of specimens, were established from tests on 494 cylindrical and cuboid specimens, and standard cube specimens 100×100×100 mm using the general relationship for standard concrete (Neville’s curve). The effect of moisture on AAC was taken into account while determining the strength fBw for 127 standard specimens tested at different levels of water content (w = 100%, 67%, 33% 23% and 10%). Defined empirical relations can be used to correct the compressive strength of dry specimens. For 91 specimens 100×100×100 mm, the P-wave velocity cp was tested with the transmission method using using the ultrasonic pulse velocity method with exponential transducers. The curve (fBw – cp) for determining the compressive strength of AAC elements with any moisture level (fBw) was established.

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 TeNDER project aims to improve the Quality of Life (QoL) of chronic patients through an integrated care ecosystem. This study evaluates the Health Recommender System (HRS) developed for the project, which offers personalized recommendations based on data collected from a set of monitoring devices. The list of notifications covered different areas of daily-life such as physical activity, nutrition, and sleep. We conducted this case of study to evaluate the effectiveness and usability of the HRS in providing accurate and relevant recommendations to users. Evaluation process consisted on survey administration for QoL assessment, and the satisfaction and usability of the HRS. The four-week pilot study involved several patients and caregivers, and demonstrated that the HRS was perceived as user-friendly, consistent, and helpful, with a positive impact on patients’ QoL. However, the study highlights the need for improvement in terms of personalization of recommendations.

Data-Flow and Higher-Order Mutation are white-box testing techniques. To our knowledge, no work has been proposed to compare data flow and higher-order mutation. This paper compares all def-uses data-flow and second-order mutation criteria. This compassion investigates the subsumption relation between these two criteria and evaluates the effectiveness of test data developed for each. To compare the two criteria, a set of test data satisfying each criterion is generated, which is used to explore whether one criterion subsumes the other criterion and assess the effectiveness of the test set that was developed for one methodology in terms of the other. The results showed that the mean mutation coverage ratio of the all du-pairs adequate test cover is 80.9%, and the mean data flow coverage ratio of the 2nd-order mutant adequate test cover is 98.7%. Consequently, 2nd-order mutation “ProbSubsumes” the all du-pairs data flow. The failure detection efficiency of the mutation (98%) is significantly better than the failure detection efficiency of data flow (86%). Consequently, 2nd-order mutation testing is “ProbBetter” than all du-pairs data flow testing. In contrast, the size of the test suite of 2nd-order mutation is more significant than the size of the test suite of all du-pairs.

The ABCDEFG Protocol provides an evolving tool for imposing structure on the flow of Covid infection information obtained from community testing, collective policy and individual compliance. ABCDEFG Protocol could not assume soundness, invariance, symmetry and completeness of the available information and relied on signaling game theory to design solutions that could evolve with the variable narratives, theories, individual utilities and pathogen variants. Thus, ABCDEFG Protocol suggests a novel and a very flexible pool-testing and badging protocol in the context of controlling contagious epidemics and tackling the far-reaching associated challenges, including understanding and evaluating individual and collective risks of returning prior infected individuals to normal society and other economic and social arrangements and interventions to protect against disease. AbCDEFG Proto uses both control theoretic and game theoretic mathematical models that may be centralized (an optimizing policy maker mandates behavior based on estimated models) or decentralized (a strategizing individual selects their behavior based on available asymmetric information). ABCDEFG protocol demonstrates how society can continue to carry out plausible economic activities in addition to controlling the prevalence of a contagious disease by keeping the number of infected people below a desired limit without compromising an individuals' privacy despite the presence of deception and selfishness among people, and limitations of available resources. Different types of badges would come with different restrictions. Badges would be reissued periodically by third-party testing centers via suitably frequent pool testing of samples of the participants. The size of the pools, frequency of tests, and allowable activities for people with a given type of badge would depend on the available resources, the prevalence of the disease, and the efficacy of the equipment used in the tests.

Graphically-rich applications such as games are ubiquitous with attractive visual effects of Graphical User Interface (GUI) that offers a bridge between software applications and end-users. However, various types of graphical glitches may arise from such GUI complexity and have become one of the main component of software compatibility issues. Our study on bug reports from game development teams in NetEase Inc. indicates that graphical glitches frequently occur during the GUI rendering and severely degrade the quality of graphically-rich applications such as video games. Existing automated testing techniques for such applications focus mainly on generating various GUI test sequences and check whether the test sequences can cause crashes. These techniques require constant human attention to captures non-crashing bugs such as bugs causing graphical glitches. In this paper, we present the first step in automating the test oracle for detecting non-crashing bugs in graphically-rich applications. Specifically, we propose GLIB based on a code-based data augmentation technique to detect game GUI glitches. We perform an evaluation of GLIB on 20 real-world game apps (with bug reports available) and the result shows that GLIB can achieve 100\% precision and 99.5\% recall in detecting non-crashing bugs such as game GUI glitches. Practical application of GLIB on another 14 real-world games (without bug reports) further demonstrates that GLIB can effectively uncover GUI glitches, with 48 of 53 bugs reported by GLIB having been confirmed and fixed so far.

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.

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)).

Human adenoviruses are one of the most important pathogens detected in acute respiratory diseases in pediatrics and immunocompromised patients. In 1953, Wallace Rowe described it for the first time in oropharyngeal lymphatic tissue. To date, more than 85 types of HAdV have been described, with different cellular tropisms. They can cause respiratory and gastrointestinal symptoms, even urinary tract inflammation, although most infections are asymptomatic. However, there is a population at risk that can develop serious and even lethal conditions. These viruses have a double-stranded DNA genome, 25-48 kbp, 90 nm in diameter, without a mantle, stable in the environment, and resistant to fat-soluble detergents. Currently the diagnosis is made with lateral flow immunochromatography or molecular biology through a polymerase chain reaction. The objective of this review is to recognize the variability of HAdV, the pandemic potential that a recombinant could present between HAdV-3 and 7 viral types, known to produce aggressive outbreaks in health facilities. The review determined the characteristics of HAdV, from the infection to treatment, vaccine development and the evaluation of the social determinants of health associated with HAdV, guiding the necessary measures for future sanitary control, and preventing disasters such as the SARS-CoV-2 pandemic.

Among the different steps in software development software testing is one of the inevitable steps. Manual testing is considered to be more expensive and time-consuming, and this led to the formation of automated testing tools. Automated software testing tools offer a comprehensive system testing solution that minimizes the risk of any errors that could result in financial losses. One such tool is selenium. Selenium testing is an advantageous method employed by developers and testers to assess their code. Selenium is compatible with numerous widelyused programming languages like C#, Java, Python, and more. This paper focuses on understanding the in and outs of software testing using selenium

Introduction: Mucopolysaccharidosis type I (MPSI) is an autosomal recessive lysosomal storage disorder characterized by deficient or absent α-L-iduronidase (IDUA) enzyme activity due to pathogenic variants in IDUA gene. Early treatment with hematopoietic stem cell transplantation and/or enzyme replacement therapy is associated with improved outcomes in this progressive multisystem disease. The diagnosis is usually delayed due to late presentation and nonspecific symptoms resulting in high morbidity and mortality. The incidence of MPSI in US is estimated to be 0.26:100,000, however, it is unknown in Kuwait. This pilot study was undertaken to screen MPSI in all Kuwaiti neonates born at Farwaniya Hospital over a period of 12-months. This study examined the incidence of MPSI in a major center in Kuwait for inclusion in the national newborn screening program to enable its early detection and adequate treatment. Methods: All Kuwaiti neonates born at Farwaniya Hospital, Kuwait from December 2021 to December 2022, were screened for MPSI. The screening consisted of determining IDUA enzyme activity in dried blood spots (DBS)-derived samples by Tandem Mass Spectrometry. A follow-up genetic analysis of IDUA gene is planned to screen the cases with diminished IDUA enzyme activity as second-tier testing. Results: A total of 618 newborns, including 331 (54%) males and 287 (46%) females, were screened. Twenty of them had deficient IDUA enzyme activity but showed negative genetic testing for IDUA. However, we have diagnosed one additional female baby with MPSI, who belonged to Farwaniya Hospital, but the parents chose to deliver in a private hospital. She presented at age three months with recurrent upper airway infections, snoring and extensive Mongolian spots. The molecular study revealed previously reported pathogenic nonsense variant in IDUA c.1882C>T; p.(Arg628Ter), associated with severe phenotype. That being included, MPSI is estimated to be about 0.3% among tested females and 0.2% of all screened cases in Kuwait. Conclusion: Our study is the first to evaluate the incidence of MPSI in Kuwait. Given the single center, small number of screened babies and the short study duration thus far, it is premature to calculate the incidence of MPSI. It is anticipated that as the study continues and more infants are examined, we would be able to estimate the incidence of this disease in our population correctly. Further studies including screening newborns in all maternity hospitals in Kuwait are needed to calculate the actual incidence of MPSI. Our data supports including MPSI in national newborn screening program to allow early initiation of treatment and thus improve disease outcome.

The present paper aims to increase knowlodge of the methods of resistance estimating of concrete in situ by means of non-destructive tests used to integrate the quantitative results from cylindrical specimens (core). The results of experimental investigations carried out on concrete conglomerate samples of a school building are shown. The experimental campaign then will be presented like a case study, conducted on a series of concrete beams and pillars of an existing building. The distructive tests on cores were conducted at the Civil Structures Laboratory of the Engineering Department of the University of Campania "Luigi Vanvitelli". The expression obtained through the calibration procedure of the values of non-destructive tests with those provided by the core drills allowed to estimate the average values of the compressive strength of the concrete. It is highlighted how this result was achieved with a very limited core number provided that they are extracted in selected points and that there was a proportionality link with the resistances obtained from non distructive tests.

Lift-offs of the sensor could significantly affect the measurement signal and reconstruction of material properties when using the electromagnetic (inductive) eddy current sensor. Previously, various methods (including novel sensor designs, and features like zero-crossing frequency, lift-off point of intercept) have been used for eliminating the measurement error caused by the lift-off distance effect of the sensor. However, these approaches can only be applied for a small range of lift-off variations. In this paper, a linear relationship has been found between the sensor lift-off and ratio of dual-frequency eddy current signals, particularly under the high working dual frequencies. Based on this linear relationship, the lift-off variation can be reconstructed firstly with a small error of 2.5 % when its actual value is up to 10 mm (10.1 % for 20 mm). The reconstructed lift-off is used to further get the property of the material under a low single frequency. Experiments on different ferrous metals have been carried out for the testing of the reconstruction scheme. Since the inductance is more sensitive to the material property (and less sensitive to the lift-off) under low frequencies, the reconstruction error of the material property is much smaller than that of the lift-off, with 1.4 % under 12 mm (and 4.5 % under 20 mm).

Stroke survivors often face diverse unmet needs, highlighting the significance of identifying and addressing these needs to enhance rehabilitation outcomes and overall quality of life. This study aimed to validate the modified Needs Assessment Questionnaire (mNAQ) as a reliable and valid tool for assessing the needs of stroke patients in the Greek context. Additionally, the research sought to identify potential differences in the assessment of stroke patients' needs based on their stroke phase and National Institutes of Health Stroke Scale (NIHSS) scores. A sample of 71 adult stroke survivors, adhering to World Health Organization guidelines and providing autonomous consent, participated in the study. The mNAQ, comprising 141 items across 12 domains, was uti-lized to evaluate stroke patients' needs. The NIHSS and Barthel Index (BI) were employed for functional independence and mobility assessment. Data analysis incorporated confirmatory fac-tor analysis, exploratory factor analysis, and Cronbach's reliability analysis to establish con-struct validity and internal consistency. Concurrent and known-groups validity analyses were conducted, and Spearman’s rho correlation explored the relationship between mNAQ and BI scores. Non-parametric analyses were applied to identify differences based on stroke phase and NIHSS scores. The study revealed that the mNAQ initially lacked satisfactory psychometric properties in the Greek context. Subsequent modifications, guided by confirmatory and explora-tory factor analyses, resulted in a refined three-factor scale encompassing 31 items in the domains of communication, mobility, and social functioning needs. This adapted measure effectively dif-ferentiated between acute and chronic stroke patients and those with minor and moderate strokes. In conclusion, the validated 31-item Greek mNAQ emerges as a crucial tool for compre-hensively assessing the needs of stroke patients. Its application holds promise for optimizing post-stroke care, improving functional outcomes, and ultimately enhancing the overall well-being and quality of life for stroke survivors.

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.

This article presents a hybrid approach to assessing students’ foreign language proficiency in a cyber-physical educational environment. It focuses on the advantages of integrated assessment of student knowledge by considering the impact of automatic assessment, learners’ independent work, and their achievements to date. An assessment approach is described using the mathematical theory of fuzzy functions, which are employed to ensure fair evaluation of students. The largest possible number of students, whose re-evaluation of test results will not affect the overall performance of the student group, is automatically determined. The study also models the assessment process in the cyber-physical educational environment through the formal semantics of calculus of context-aware ambients (CCA).

(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.

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.

Ensemble fuzzing in parallel with heterogeneous fuzzers has been proposed to leverage the advantages of diverse fuzzers and improve testing efficiency. However, in current ensemble fuzzing methods, the collaboration among different fuzzers is achieved solely by synchronizing the seeds discovered by each fuzzer. This results in a high likelihood of different fuzzers choosing the same seeds and creating a large number of equivalent testcases, thus reducing overall fuzzing efficiency. Meanwhile, the existing task division method proposed by AFLTeam is highly coupled with the fuzzer specially designed for it, making it challenging to apply to ensemble fuzzing directly. So, in this paper, we proposed a callgraph-based task division method suitable for ensemble fuzzing. Firstly, we divided the target program’s callgraph into subgraphs (subtasks) balancing expected workloads. Then, we divided the global seed corpus into sub-corpora, each corresponding to a subtask, making fuzzers easily accept the subtasks. Finally, we designed synchronization mechanisms for coverage bitmaps and seeds to realize the collaborative fuzzing among different fuzzers, and a cyclic subtask scheduling strategy to fully leverage the benefits of ensemble fuzzing. We have implemented a prototype called TAEF. The evaluation results show that in the best-case scenario, our method has up to 24% more branch coverage than previous work.

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.

Industrial data scarcity is one of the largest factors holding back the widespread use of machine learning in manufacturing. To overcome this problem, the concept of transfer learning was developed and it achieved high attention in recent industrial research. Our paper focuses on the problem of time series segmentation and presents the first in-depth research about transfer learning for deep-learning based time series segmentation on the example of industrial end-of-line pump testing. In particularly, we investigate if the performance of deep learning models can be increased by pretraining the network with data from other domains. Three different scenarios are analyzed: source and target data being closely related, source and target data being distantly related, and source and target data being non-related. The results demonstrate that transfer learning can enhance the performance of time series segmentation models in respect to accuracy and training speed. The benefit is most clearly seen in scenarios where source and training data are closely related and the number of target training data samples is lowest. However, in the scenario of non-related datasets, cases of negative Transfer Learning were observed as well. Thus, the research emphasizes the potential, but also the challenges of industrial Transfer Learning.

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.

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.

Metals are particularly sensitive to some pollutant gases. Many museum showcases and store rooms present atmospheres that can corrode cultural heritage artefacts containing metals. Whilst numerous strategies have been reported to mitigate such situations, avoiding them is preferable. Several approaches to testing materials used in construction, fitting out or dressing are used. The relative merits and drawbacks will be discussed. Several parameters of the most widely used, the accelerated corrosion ‘Oddy’ test have been investigated. The influence of abrasive on subsequent corrosion of lead and copper coupons have been assessed. Quantification methods for tested coupons are reviewed. The influence of test duration and temperature were assessed through comparison with real life, long term experience of materials behaviour. Direct contact tests with the material tested touching the test material has been investigated. Several materials present in artefacts are known to potentially cause corrosion when enclosed with metals in other artefacts. A number of situations have been investigated with pollution and RH and some corrosion rate measurements. Ways to isolate artefacts or mitigate are explored and a decision support model has been developed.

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.

Objectives: This paper presents a statistical review of modelling simulations for frequency and sensitivity of COVID-19 testing paradigms. Methods: We performed a review of preprints and published articles on PubMed from January 1, 2020 – March 1, 2021 using the search terms “COVID screening testing”, “COVID testing frequency”, “COVID testing frequency screening” and “SARS-CoV-2 testing frequency”.Results: Several authors’ conclusions support the claim that test frequency and test sensitivity both play a role in reducing SARS-CoV-2 transmission. We highlight the interplay between frequency of testing, test sensitivity and the speed at which test results are available in our review. Conclusions: Evidence suggests that sensitivity and frequency of testing both play a part in decreasing transmission of disease. We conclude that, overall, test sensitivity plays less of a role in reducing disease transmission in a population compared to the frequency of testing and how quickly test results are available.

The current clinical model for genetic-testing is based on clinical-criteria/family-history(FH) and a pre-defined mutation probability threshold. It requires people to develop cancer before identifying unaffected individuals in the family to target prevention. This process is inefficient, resource intense and misses >50% of individuals/mutation carriers at risk. Population genetic-testing can overcome these limitations. It is technically feasible to test populations on a large scale; genetic-testing costs are falling and the acceptability/awareness is rising. MEDLINE/EMBASE/Pubmed/CINAHL/PsychINFO databases were searched using a free-text and MeSH terms; reference lists of publications retrieved screened; additionally web-based platforms, Google, and clinical-trial registries were searched. Quality of studies were evaluated using appropriate check-lists. A number of studies have evaluated population-based BRCA-testing in the Jewish-population. This has been found to be acceptable, feasible, clinically-effective, safe, associated with high satisfaction rates and extremely cost-effective. Data support change in guidelines to population-based BRCA-testing in the Jewish-population. Population panel-testing for BRCA1/BRCA2/RAD51C/RAD51D/BRIP1/PALB2 gene mutations is the most cost-effective genetic-testing strategy in general-population women and can prevent thousands more breast/ovarian cancers than current clinical-criteria based approaches. A few ongoing studies are evaluating population-based genetic-testing for multiple cancer susceptibility genes in the general-population but more implementation studies are needed. A future population-testing programme could also target other chronic diseases.

In reservoir engineering, one of the main sources of information for the characterization of reservoir and well parameters is well testing. Among the unconventional well testing methodologies, Harmonic Well Testing (HPT) is appealing from an economic standpoint because it could provide well performance and reservoir behavior monitoring without having to interrupt field production. Recorded pressure analysis is performed in the frequency domain by adopting a derivative approach similar to conventional well testing. To this end, pressure and rate data must be decomposed into harmonic components. Test interpretability can be significantly improved if pressure data are detrended prior to interpretation, filtering out non periodic events such as discontinuous production from neighboring wells and flow regime variations which did not respect the designed test periodicity. Therefore, detrending offers the possibility of overcoming the limitation of HPT applicability due to the difficulty of imposing a regularly pulsing rate for the whole test duration (typically lasting several days). This makes HPT attractive for well performance monitoring, especially in gas storage fields. In this paper, the application of different detrending methodologies to synthetic HPT pressure data generated in different reservoir and operational scenarios is presented and discussed. Moreover, a real case application is also presented.

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.

The current state-of-the-art does not provide a universal and rapid method of determining the state of health (SOH) of a battery or a supercapacitor without carefully examining the degradation of hundreds of full charge/discharge cycles. Lithium-ion batteries, sodium-ion batteries and supercapacitors of different cell chemistries were studied by impedance spectroscopy during lifetime tests. Faradaic and capacitive charge storage are distinguished by the relationships between stored electric charge and capacitance. For batteries, impedance spectroscopy is best applicable in the flat region of the voltage-charge curve. An approximately linear correlation between pseudocapacitance and Ah capacity is observed as long as overcharge and deep discharge are avoided. The correct calculation of quantities related to complex impedance and differential capacitance is outlined – which may also be useful as an introductory text and tutorial for newcomers to the field. Novel diagram types are proposed for the purpose of instant performance and failure diagnosis of batteries and supercapacitors.

Sleep-disordered breathing affects the growth and development, mental aspect, and learning ability of affected children. Postoperative scarring causes anteroposterior and vertical develop-mental disorders of the maxilla. Obstructive apnea is likely to occur due to the influence on the maxillofacial and airway morphology. In this study, we investigated the sleep-respiratory dynamics of school-aged children with unilateral cleft lip and palate by performing a simple over-night sleep study, maxillofacial morphology and airway analysis using lateral cranial radiographs, and model analysis. Children with unilateral cleft lip and palate showed a significantly higher respiratory event index (REI) than normal children; the maxilla was located in the posterior position in terms of maxillofacial morphology, and airway morphology showed narrow values for all distance measurement items. Moreover, the width and length of the dental arch and the width of the alveolar base arch were significantly smaller. Furthermore, there was a negative correlation between REI and SNA, ANB, REI, and alveolar base arch width. Children with unilateral cleft lip and palate are more likely than normal children to develop sleep-disordered breathing due to in-creased airway resistance caused by undergrowth of the maxilla and narrowing of the upper airway and oral volume.

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.

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.

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.

Eddy current testing can be used to interrogate steels but it is hampered by the lift-off distance of the sensor. Previously, the lift-off point of intersection (LOI) feature has been found for the pulsed eddy current (PEC) testing. In this paper, a lift-off invariant inductance (LII) feature is proposed for the multi-frequency eddy current (MEC) testing, which merely targets the ferromagnetic steels. That is, at a certain working frequency, the measured inductance signal is found nearly immune to the lift-off distance of the sensor. Such working frequency and inductance are termed as the lift-off invariant frequency (LIF) and LII. Through simulations and experimental measurements of different steels under the multi-frequency manner, the LII has been verified to be merely related to the sensor parameters and independent of different steels. By referring to the LIF of the test piece and using an iterative inverse solver, one of the steel properties (either the electrical conductivity or magnetic permeability) can be reconstructed with a high accuracy.

This is an article or technical note which is intended to provides an insight journey of Machine Learning Systems (MLS) testing, its evolution, current paradigm and future work. Machine Learning Models, used in critical applications such as healthcare industry[1], Automobile [2], [3] and Air Traffic control, Share Trading etc., and failure of ML Model can lead to severe consequences in terms of loss of life or property. To remediate this, developers, scientists, and ML community around the world, must build a highly reliable test architecture for critical ML application. At the very foundation layer, any test model must satisfy the core testing attributes such as test properties and its components. This attribute comes from the software engineering [5], [6], but the same cannot be applied in as-is form to the ML testing and we will tell you “why”.

In many advanced industrial applications, the thickness is a critical index, especially for metallic coatings. However, the variance of lift-off spacing between sensors and test pieces affects the measured voltage or impedance, which leads to unreliable results from the sensor. Massive research works have been proposed to address the lift-off issue, but few of them applies to the thickness measurement of planar metallic films with finite-size circular (disk) geometry. Previously, a peak-frequency feature from the swept-frequency inductance was used to compensate the measurement error caused by lift-offs, which was based on the slow-changing rate of impedance phase term in the Dodd-Deeds formulas. However, the phase of measured impedance is nearly invariant merely on a limited range of sample thicknesses and working frequencies. Besides, the frequency sweeping is time-consuming, where a recalibration is needed for different sensor setups applied to the online real-time measurement. In this paper, a single-frequency algorithm has been proposed, which is embedded in the measurement instrument for the online real-time retrieval of thickness. Owing to the single-frequency measurement strategy, the proposed method does not need to recalibrate for different sensor setups. The thickness retrieval is based on a triple-coil sensor (with one transmitter and two receivers). The thickness of metallic disk foils is retrieved from the measured electrical resistance of two transmitter-receiver sensing pairs. Experiments on materials of different electrical conductivities (from direct current), thicknesses and planar sizes (radii) have been carried out to verify the proposed method. The error for the thickness retrieval of conductive disk foils is controlled within 5 % for lift-offs up to 5 mm.

Previously, various techniques have been proposed for reducing the lift-off effect on the thickness measurement of the non-magnetic films, including the peak-frequency feature and phase feature in the Dodd-Deed analytical formulation. To realise a real-time feedback response on the thickness monitoring, the phase term in the Dodd-Deeds formulation must be taken off the integration. Previous methods were based on the slow change rate of the phase term when compared to the rest of the term – the magnitude term. However, the change rate of the phase term is still considerable for a range of working frequencies. In this paper, a high-frequency feature has been found. That is, the ratio between the imaginary and real part of the phase term is proportional to the integral variable under high frequencies. Based on this proportion relationship, the phase term has been taken out; and a thickness algorithm has been proposed. By combing the measured impedance from the custom-built sensor (three coils), the thickness of the metallic film can be reconstructed. Experiments have been carried out for the verification of the proposed scenario. Results show that the thickness of the metal film can be reconstructed with a small error of less than 2 %, and immune to a reasonable range of lift-offs.

This paper presents a new approach of eddy current methods for determining the size of the co-axial hole in the metallic circular disk. In recent decades, for the air-cored sensor probe, the impedance change due to the presence of an infinite metal plate can be calculated by the Dodd-Deeds model. However, in practical measurements, the sample cannot match with the condition required - ‘infinite’, thus the Dodd-Deeds model could not be applied to the disk with finite size and certainly not a co-axial hole in the center. In this paper, a dual-constraint analytical method is proposed. That is, the upper and lower limits of the integration are substituted with specific values instead of the original 0 and . Besides, it is found that, once the outer radius of the disk is fixed (i.e. the lower limit of integration is fixed), the upper limit reduces linearly as the size of the coaxial hole increases. Both the FEM simulation and experiments have been carried out to validate this method. The radius of the hole can be estimated based on the dual-constraint integration feature.

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.

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.

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.

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.

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.

Background/Aims: Screening for gestational diabetes mellitus (GDM) are currently done at 24 - 28 weeks of conception, missing out on the most vulnerable period of organogenesis and thus preventing clinicians from starting treatments until the late second or third trimester. MicroRNAs (miR) are small non-coding RNA molecules that could aid in detecting or predicting GDM through establishing a novel non-invasive prenatal testing (NIPT) tool. The objective of this study was to summarize the most recent updates on plasma microRNAs as GDM diagnostic biomarkers. Methods: Between April and June 2021, a PubMed literature search was undertaken to review recent articles on human plasma miR associated with GDM. Animal studies and papers that are written in languages other than English were excluded. Only plasma miRNAs were used to avoid coagulation biases. Results: A total of 31 miRNAs were found significantly upregulated in the plasma samples of patients with GDM. It was found mainly during the 2nd or 3rd trimester except for miR-223 and miR-23a that were upregulated at 9 – 11 weeks of gestation. Conclusion: Though extensive prospective cohort studies are required, miR-223 and miR-23a should be considered the most promising to develop a successful NIPT tool because they were found to be upregulated earliest, during the first trimester.

This paper describes a new optimization methodology of testing vector sets reduction for testing of soft-processor cores and their individual blocks. The deterministic test vectors both for whole core and its individual blocks are investigated that significantly reduce the testing time and amount of test data that needs to be stored on the tester memory. The processor executes an assembler program which together with determined testing vectors ex-ercise its functionality. The new BIST methodology applicable at industrial testing of processor cores, diagnostics and dynamic reconfiguration of FPGA is proposed. This novel methodology combined with dynamic reconfiguration of FPGAs can be profitable applied for missions-critical i.e. FPGAs operate in space, or other difficult condition where are explore on radiation. Experimental results demonstrate that the proposed approach reduces many times testing time.

This study aimed to develop a Laotian adolescent version of the Center for Epidemiologic Studies Depression Scale (CES-D), determine its reliability and validity, and examine its factorial properties. The study targeted at 7,554 students in lower secondary schools and teacher training colleges in Lao PDR. Self-administered questionnaires were collected from 2012 to 2014. Exploratory factor analysis performed in three age groups using the weighted least square mean and variance adjusted estimation with robust maximum likelihood methods. The factor structure for each age group was the same; therefore, data from the full sample were analyzed further. The model was then tested by confirmatory factor analysis. A 2-factor model was determined as a common model among the age groups by using paralleled analysis. We determined a best-fitting structure comprising two factors: “Negative affect” and “Positive affect.” The Cronbach’s alpha was .81. “Effort” items loaded on the “Somatic and retarded activity” factor in the original model but loaded on the “Positive affect” factor in the adolescent model. “Depressed affect,” “Somatic and retarded activity,” and “Interpersonal” items were combined into the “Negative affect” factor in the adolescent model.

The Sei Dareh Bridge is a cable-stayed bridge located in West Sumatra Province, Indonesia. The bridge, has a main span of 123 meters length and 9 meters wide, crosses the Batanghari River. Traffic load is transmitted through 4 prestressed cables to a 42.4 meter high pylon made of concrete. Bridge deck and traffic loads are directly supported by steel box girders as main beams that are reinforced laterally with cross beams IWF 800.300.16.24 and stringers IWF 350.350.12.19. This paper discusses static and dynamic testing on the bridge which aims to assess the feasibility before it is opened for public. Based on the test, it was concluded that the 73% static load could not be achieved because the deflection that occurred was beyond the allowable deflection. This is exacerbated by the sound of a loud clanging sound on the ST2-X1 prestressed cable when loading to 240 tons or 58% of the targeted load. In addition, this bridge is included in the "lazy bridge" category because it takes 24 hours to return to an undeformed condition after loading. As a recommendation for this bridge, it is necessary to carry out a structural health monitoring system (SHMS) regularly on the vehicle floor and cables.

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.

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.

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.

Introduction. The outbreak of the COVID pandemic was a period of uncer-tainty and tension for healthcare managers, resulting from the lack of knowledge, i.e. about the transmission of the virus, but also from the lack of uniform organisational and treatment procedures. It was the period where the ability to prepare to a crisis situation, to adapt to the existing conditions and to draw conclusion from the situa-tion were critical to keep ICUs operating. The aim of this study was to show the prep-aration of an ICU in Poland to ensure resilience, and also the methods of reacting dur-ing the COVID-19 pandemic on both central and local level. Methods. Based on the EC and WHO guidelines on resilience a matrix of 6 elements and 13 standards as-signed to them was created, with a series of questions from a survey questionnaire. Results. Good management in resilient systems is free access to any resource. A free and transparent flow of information and also well motivated human resources in an appropriate number. Conclusion. Appropriate preparation, adaptation to the existing situation and effective management of crisis situations is an important element of ICU resilience.

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.

(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.

The Sei Dareh Bridge is a cable-stayed bridge located in West Sumatra Province, Indonesia. The bridge, which crosses the Batanghari River, has a main span of 123 meters long and 9 meters wide. Traffic load is transmitted through 24 prestressed cables to a 42.4-meter-high pylon made of concrete. The bridge deck and traffic loads are directly supported by steel box girders as main beams that are reinforced laterally with cross beams IWF 800.300.16.24 and stringers IWF 350.350.12.19. This paper discusses static and dynamic testing on the bridge which aims to assess its feasibility before it is opened to the public. Based on the test, it was concluded that a static load of 73% could not be achieved because the deflection that occurred was beyond the allowable deflection. This is exacerbated by a loud clanging sound on the ST2-X1 prestressed cable when loading to 240 tons or 58% of the targeted load. In addition, this bridge is included in the "lazy bridge" category because it takes 24 hours to return to an undeformed condition after loading. As a recommendation for this bridge, it is necessary to carry out a structural health monitoring system (SHMS) regularly on bridge slabs and cables.

Improving HIV testing efficiency saves financial and material resources for health. We conducted a retrospective secondary data analysis of routinely collected HIV risk screening program data in Uganda, from October to November 2019, to determine the performance characteristics of the adolescent and adult HIV risk screening tool in public health facility settings. A total of 19,854 clients had been screened for HIV testing eligibility and tested for HIV. The overall positivity rate (cluster weighted prevalence of HIV) among those screened was 4.5% (95% CI: 4.1%-4.8%) versus 3.71% (95% CI: 3.06-4.50) among those not screened. The sensitivity and specificity of the risk screening tool were 90.7% (95% CI: 88.4%, 92.7%) and 75.8%, (75.2-76.4) respectively. With screening, the number needed to test to identify one PLHIV was reduced from 27 to 22. Although risk screening would have led to a 24.5% (4,825/19,704) reduction in testing volume, 9.3% (68/732) of PLHIV would have been missed, being misclassified as not eligible for testing. The cost per PLHIV identified fell by 3% from $69 without screening to $66.9 with screening. We recommend the use of scientifically validated HIV risk screening tools, and a need to explore the use of HIV self-testing as a test for tirage.

Deep learning has taken over - both in problems beyond the realm of traditional, hand-crafted machine learning paradigms as well as in capturing the imagination of the practitioner sitting on top of petabytes of data. While the public perception about the efficacy of deep neural architectures in complex pattern recognition tasks grows, sequentially up-to-date primers on the current state of affairs must follow. In this review, we seek to present a refresher of the many different stacked, connectionist networks that make up the deep learning architectures followed by automatic architecture optimization protocols using multi-agent approaches. Further, since guaranteeing system uptime is fast becoming an indispensable asset across multiple industrial modalities, we include an investigative section on testing neural networks for fault detection and subsequent mitigation. This is followed by an exploratory survey of several application areas where deep learning has emerged as a game-changing technology - be it anomalous behavior detection in financial applications or financial time-series forecasting, predictive and prescriptive analytics, medical imaging, natural language processing or power systems research. The thrust of this review is on outlining emerging areas of application-oriented research within the deep learning community as well as to provide a handy reference to researchers seeking to embrace deep learning in their work for what it is: statistical pattern recognizers with unparalleled hierarchical structure learning capacity with the ability to scale with information.

The capacitor-mismatch among diverse defects caused by the manufacturing process variations significantly affects the linearity of capacitor-array used to implement the capacitive digital-to-analog converter (CDAC) in the successive-approximation-register (SAR) analog-to-digital converter (ADC). Accordingly, the linearity of the SAR ADC is limited by that of capacitor-array, resulting in serious yield loss. This paper proposes an efficient foreground self-calibration technique to enhance the linearity of the SAR ADCs by mitigating the capacitor-mismatch based on the split ADC architecture along with variable capacitors. In this work, two ADC channels (i.e., ADC1 and ADC2) for the split ADC architecture include their capacitive DACs (CDACs) whose binary-weighted capacitor-arrays consist of variable capacitors. A charge-sharing SAR ADC is used for each ADC channel. In the normal operation mode, their digital outputs are averaged to be the final ADC output, as in a conventional split ADC. In the calibration mode, every single binary-weighted capacitor for the two ADCs is sequentially calibrated by making parallel or/and antiparallel connection among two or thee capacitors from the two channels. For instance, because the capacitors of the CDACs ideally exhibit the binary-weighted relation as Cn=2×Cn−1, variable capacitor Cn of ADC1 can be updated to be closest to the sum of Cn−1 of ADC1 and Cn−1 of ADC2 for the calibration. For the process, the two capacitor-arrays of the two ADCs can be reconfigured to be connected to each other, so that Cn of ADC1 can be connected with two of Cn−1 of ADC1 and ADC2 in antiparallel. The two voltages at the top and the bottom plates of the CDAC are compared by a comparator of ADC1, and the comparison results are used to update Cn. This process is iterated, until Cn is in agreement with the sum of two of Cn−1. Finally, all the capacitors can be calibrated in this way to have the binary-weighted relation. The simulation results based on the proposed work with a split SAR ADC model verified that the proposed technique can be practically used, by showing that the total-harmonic-distortion and the signal-to-noise-and-distortion ratio were enhanced by 21.8-dB and 6.4-dB, respectively.

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.

The characteristics of powders on a bulk scale are heavily influenced by both the material properties and the size of their primary particles. Throughout the stages of storage and transportation in the powder processing industry, various forms of deformation and stress, such as pressure and shear, impact these materials. Recognizing the point at which a powder undergoes yielding becomes particularly significant in numerous applications. There are also times when you need to understand the level of stress needed to maintain it. Measurement of powder yield and flow properties remains a challenge and is addressed in this study. As part of the CALIPER collaborative project, a number of shear experiments were performed using two shearing devices: Schulze ring shearing device and Anton Paar Powder Cell (APCC). These experiments have three purposes: i) Test reproducibility/consistency between two shear devices and test protocols. ii) To relate bulk behavior to microscopic particle properties, focusing on bulk density and thus the effect of cohesion between particles; iii) Investigate the influence of the temperature of heated powders on the powder flow properties, which is important for the industrial reactors. Interestingly, for samples with small particle size, bulk cohesion increases slightly, but bulk friction increases significantly, because of particle interaction effects. The experimental data not only provide useful insight into the role of microscopically attractive van der Waals gravitational and/or compressive forces on the macroscopic flow behavior of bulk powders, but also have industrial relevance. We also provide a robust datas of cohesive and attritional fine powder for silo design used for calibration and validation of silos, models and computer simulations.

Advances in gene-specific therapeutics for patients with neuromuscular disorders (NMDs) have brought increased attention to the importance of genetic diagnosis. Genetic testing practices vary among adult neuromuscular clinics, with multi-gene panel testing currently being the most common approach; follow-up testing using broad-based methods, such as exome or genome sequencing, is less consistently offered. Here, we use five case examples to illustrate the unique ability of broad-based testing to improve diagnostic yield, resulting in identification of SORD-neuropathy, HADHB-related disease, ATXN2-ALS, MECP2 related progressive gait decline and spasticity, and DNMT1-related cerebellar ataxia, deafness, narcolepsy, and hereditary sensory neuropathy type 1E. We describe in each case the technological advantages that enabled identification of the causal gene, and the resultant clinical and personal implications for the patient, demonstrating the importance of offering exome or genome sequencing to adults with NMDs.

Labyrinth seals are commonly used in turbomachinery in order to control leakage flows. Flutter is one of the most dangerous potential issues for them, leading to High Cycle Fatigue (HCF) life considerations or even mechanical failure. This phenomenon depends on the interaction between aerodynamics and structural dynamics; mainly due to the very high uncertainties regarding the details of the fluid flow through the component, it is very hard to predict accurately. In 2014, as part of the E-Break research project funded by the European Union (EU), an experimental campaign regarding the flutter behaviour of labyrinth seals was conducted at Centro de Tecnologias Aeronauticas (CTA). During this campaign, three realistic seals were tested at different rotational speeds, and the pressure ratio where the flutter onset appeared was determined. The test was reproduced using a linearized uncoupled structural-fluid methodology of analysis based on Computational Fluid Dynamics (CFD) simulations, with results only in moderate agreement with experimental data. A procedure to adjust the CFD simulations to the steady flow measurements was developed. Once this method was applied, the matching between flutter predictions and the measured data improved, but still some discrepancies could be found. Finally, a set of simulations to retain the influence of the external cavities was run, what further improved the agreement with testing data.

With the wide application of flow sensor, their reliability under extreme conditions has been concerned in recent years. The reliability of a Micro Electro Mechanical Systems flow sensor under temperature (Ts) is researched in this paper. Firstly, the Step-stress accelerated degradation test is designed. Because this flow sensor consists flow sensor chip and signal processing system, the accelerated degradation testing is implemented, respectively. While the results show that the biggest drift is 3.15% for flow sensor chips with 150℃ conditions, and 32.91% for this flowmeter. By analysis, it could be found that the attenuation of the signal processing system is significant to the degeneration of this flowmeter. The minimum drift of the signal processing system accounts for 82.01% of this flowmeter. Secondly, using the Coffin-Manson model, the relationship between cycle-index and Ts is established. And the lifetime with different Ts is estimated by the Arrhenius model. In addition, the Weibull distribution is applied to evaluate the lifetime distribution. Finally, the reliability function of the Weibull distribution is demonstrated, and the survival rate within one year is 87.69% with 85℃ conditions. Thus, by the application of accelerated degradation testing, the acquired results are innovative and original. This research illustrates the reliability research, which provides a relational database for the application of this flow sensor.

Background: The COVID-19 pandemic has promoted a shortage of filtering facepiece respirators (FFRs) and the emergence of new FFRs brands. We aimed to determine the fit provided by in-use FFRs in Peruvian healthcare workers (HCWs) during the COVID-19 pandemic. Methods: We enrolled 279 HCWs from 37 primary healthcare centers with highest burden of care for TB in Peru, of which 263 were assessed using quantitative fit tests (QNFT). Results were expressed as real-time fit factor (rt-FF) and overall fit factor (overall-FF), which was categorized as ≥100 (optimal result), 50-99, and <50. Results: We identified 3M 1860 FFRs (33.1%), Xiantao Zhong Yi ZYB-11 FFRs (24.7%) and Makrite 9500 FFRs (20.5%), mainly. Eighty-seven HCWs (33.1%) had an optimal overall-FF, 27 (10.3%) between 50-99, and 149 (56.7%) less than 50. Of the 87 HCWs with optimal over-all-FF, 73 (83.9%) were 3M 1860 FFR. Of the 27 participants with overall-FF between 50-99, 7 (25.9%) were Makrite 9500, while of the 149 with overall-FF less than 50, 58 (38.9%), and 47 (31.5%) were Xiantao Zhong Yi ZYB-11 and Makrite 9500, respectively. Conclusion: The Xiantao Zhong Yi and Makrite FFRs do not adapt adequately to the face of Peruvian HCWs, most having fit factors less than 50.

The altered nature of archaeological metals means they deteriorate at conditions where metals would be stable. The study of deterioration for such materials is hampered by their complexity, variability and difficulties in measuring deterioration. Placing an object in a sealed container, controlling the RH and pollutant gases and measuring any decrease in oxygen concentration is an accessible method to measure deterioration rate. It has been used for research into suitable environmental conditions to manage deterioration rates of such artefacts including differences in response for artefacts from different excavation sites. Some objects need careful control of RH to low values, this is expensive to maintain and poses risks to other artefacts displayed together. Many objects are actually stable up to quite high RH values and oxygen depletion testing has been used to identify those that can be safely displayed with minimal environmental control. The accelerated corrosion, ‘Oddy’ test is frequently used to sift out unsuitable display materials. The visual assessment is widely recognized to be subjective. The test container has been modified and oxygen depletion appears to give good quantitative measurements of corrosion that correspond with both visual comparison and corrosion quantification for copper, lead and steel, but not for silver.

Background: HIV self-testing (HIVST) is one of the recommended approaches for HIV testing services, particularly for helping reach populations who would not normally access facility-based HIV testing. HIVST must be tailored to different populations to ensure uptake. Objective: The main objective of this study was to develop an acceptable HIVST delivery strategy to help improve urban men’s engagement with HIV services. Methods: We invited key stakeholders for urban men’s HIV services to participate in a co-creation workshop aimed at developing HIVST delivery approaches for urban men, using eThekwini municipality as a study setting. We conducted purposive sampling to include health care users and health care providers, representing a range of views across the public sector and voluntary sector. We employed the Nominal Group Technique (NGT) method for data collection. The NGT workshop was conducted in two consecutive phases: phase one was focused on determining barriers for men’s engagement with the current/facility-based HIV testing services; phase two was aimed at determining HIVST delivery strategies. We used the results of the NGT to design a tailored HIVST strategy for urban men in eThekwini District. Results: Participants identified the following psychological factors as the most important barriers to uptake of HIV testing services by urban men: stigma, ignorance about the importance of testing and testing process as well as fear of positive test results. Key stakeholders suggested internal motivation strategies as a potentially effective approach to support HIVST delivery strategy. Guided by the NGT results, we designed a HIVST delivery strategy that is supported by a risk communication approach Conclusion: We designed an evidence-based risk communication mobile health (mHealth) strategy coupled with SARS COV-2 self-testing tailored to improve men’s uptake of HIVST. A follow-up study to evaluate the feasibility of implementing these approaches is recommended.

In the advent of COVID-19 pandemic, testing is highly essential to be able to isolate, treat infected persons, and finally curb transmission of this infectious respiratory disease. Group testing has been used previously for various infectious diseases and recently reported for large-scale population testing of COVID-19. However, possible sample dilution as a result of large pool sizes has been reported, limiting testing methods’ detection sensitivity. Moreover, the need to sample all individuals prior to pooling overburden the limited resources such as test kits. An alternative proposed strategy where test is performed on pooled samples from individuals representing different households is presented here. This strategy intends to improve group testing method through the reduction in the number of samples collected and pooled during large-scale population testing. Moreover, it introduces database system which enables continuous monitoring of the population’s virus exposure for better decision making.

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.