Abstract: Appetite loss is common in older patients and an independent risk factor for sarcopenia, which is associated with high mortality. However, few studies have explored the phenomenon of appetite loss after discharge from the intensive care unit (ICU). Therefore, we aimed to describe the prevalence of appetite loss and the relationship between appetite loss and depression in patients living at home 12 months after intensive care. We conducted a post hoc analysis, which was a published ambidirectional study examining post-intensive care syndrome at 12 months after discharge. We included patients aged > 65 years. The Short Nutritional Assessment Questionnaire (SNAQ) and Hospital Anxiety Depression Scale (HADS) were used for the analysis. Descriptive statistics and a multilevel generalized linear model were used to clarify the relationship between appetite loss and depression. Data from 468 patients were analyzed. The defined appetite loss was 25.4% (95%CI, 21.5–29.4). High severity of depression was an independent factor for high probability of appetite loss (OR, 1.2; 95%CI, 1.14–1.28; p=0.00). Poor appetite is common 12 months after intensive care and is associated with the severity of depression.

Background: Nursing services provided by nurses are based on knowledge and competence in the field of nursing science developed in accordance with Client needs, scientific developments, and the demands of globalization. These health services include nursing services that are carried out responsibly, accountably, with quality, and safely by nurses who have obtained registration and permission to practice. Nursepreneur is innovation and courage to take risks and is ready to work hard to achieve goals with optimism. Which has important components namely: 1) quality, 2) role, 3) option and success. The post-pandemic new world, especially in the health care system, continues to grapple with the demands of costs to provide patient care and safety. By using the application of the nursing theory model. Purpose :. Assessing scientific studies on the application of evidence-based intervention in wound care using nursing theory, identifying the important role of telenursing in improving nursing services in Nerspreneurship, Method: literature study Conclusion: Telenursing in nursing focuses on providing nursing care through information technology, such as telephone, computers, and the Internet that can be used to improve treatment outcomes among older people, especially those with low literacy skills and low financial status (Esmaeilpour-BandBoni et al., 2020). The statement from the results of the study refutes that Telenursing is intended for patients who have higher education and middle and upper economic states.

Background: Accreditation is a qualitative assessment aimed at technical-professional quality, but above all, at organizational and measurable aspects through process and outcome checks. Method: There are few references in the literature relating to the accreditation and improvement of the quality and safety of care and treatment in the field of primary care. Clinical Governance must also be applied and certified in the field of primary care. Results: An accreditation system for general medicine is proposed based on a new dynamic model and implement that meets different requirements and assessed on the basis of indicators. Discussion: In the current Italian health system, accreditation of health structures is addressed only to public hospitals and private structures and to providers of services and services, however primary care. GPs / PLS do not have quality and safety guarantee systems or models or systems or public or private accreditation certifications with the SSR and SSN. Conclusion: Given the fundamental importance in the NHS of primary care of MG / PLS as the main and fundamental provider of services to the patient in all his socio-welfare and clinical needs, it is considered essential to think and implement an accreditation system extended to the territorial general practice as already present and in place for all affiliated and provider structures on behalf of the NHS.

Objective: To map the literature pertaining to adult Person-Centered Rehabilitation (PCR).Data Sources: Following our previously published scoping review protocol, data were identified through: three major databases, snowball searches and expert consultation.Study Selection: Two independent reviewers identified English-language papers which addressed adult physical rehabilitation and met one or more of the six pre-defined inclusion categories for PCR content. Data Extraction: Two independent reviewers extracted key characteristics of included papers (e.g. aims, methods, participants). Quantitative methods (descriptive statistics, regression analysis) and qualitative content analyses were used to synthesize the results. Data synthesis: Of 5084 unique records initially screened, 145 papers were included: 111 empirical, including 11 systematic reviews. Empirical papers had data from 13498 clients and 3849 providers, in total. Yearly publications grew exponentially from 2000 to 2017 (r²= 0.65; p<0.01). Publications were unevenly distributed by countries (e.g. United States’ publications per population size was 45 times lower than New Zealand’s). Most papers focused in more than one profession, setting-type or health conditions, respectively 57.2%, 66.2%, and 60.7%. Finally, more than half of the empirical papers (53.2%) studied implementation of PCR approaches, including its effect. Conclusion: This scoping review synthesizes key characteristics and publication trends in the PCR literature, which is mainly empirical and growing exponentially over time. Stakeholders can use the identified trends, gaps, and literature map to guide further PCR research, and both clinical and organizational practices. The high prevalence of papers focused on multiple professions, settings-type, or health conditions reinforces the need for developing a transdisciplinary, trans-service model of PCR, which will be derived from a thematic analysis of this body of literature.

Context: A clinical video telehealth (CVT) program was implemented improve access and quality of dementia care to patients and their caregivers in rural areas. The program was offered as part of an established dementia clinic/geriatric primary care clinic in collaboration with five community-based outpatient clinics (CBOC’s) affiliated with the Tennessee Valley Healthcare System (TVHS) in middle Tennessee. Telehealth support was provided by a physician – social worker team visit. Methods: Telehealth training and equipment were provided to clinic personnel, functioning part-time with other collateral clinical duties. Patients and caregivers were referred by primary care providers and had an average of 1 to 2 CVT encounters originating at their local CBOC lasting 20 to 30 minutes. Clinical characteristics and outcomes of patients and caregivers receiving CVT support were collected by retrospective electronic medical record (EMR) review. Results: Over a 3-year period 45 CVT encounters were performed on patient-caregiver pairs, followed for a mean of 15 (1-36) months. Some 80% patients had dementia confirmed and 89% of these had serious medical comorbidities, took an average of 8 medications, and resided at a distance of 103 (76-148) miles from the medical center. Dementia patients included 33% with late stage dementia, 25% received additional care from a mental health provider, 23% took antipsychotic medications, 19% transitioned to a higher level of care, and 19% expired an average of 10.2 months following consultation. Caregiver distress was present in 47% of family members. Consult recommendations included 64% community-based long-term care services and supports (LTSS), 36% medications, and 22% further diagnostic testing. Acceptance of the CVT encounter was 98%, with 8770 travel miles saved. Conclusion: CVT is well received and may be helpful in providing dementia care and supporting dementia caregivers to obtain LTSS for high-need older adults in rural areas.

This study presents the development and pilot implementation of an assessment and shared deci-sion-making methodology called the Gezamenlijk Inschatten van Zorgbehoeften (GIZ), designed for youth (health) care professionals working with children and families. The three-phase approach included a needs assessment, development of the GIZ methodology, and pilot implementation in a preventive youth health care and youth care setting, involving parents, adolescents, and youth (health) care professionals. The needs assessment produced nine criteria that the GIZ methodology needed to meet. Based on these criteria, the GIZ methodology was developed and described using the Template for Intervention Description and Replication (TIDieR). The pilot implementation demonstrated high client engagement, satisfaction, and feasibility in daily practice. The GIZ ap-proach promotes appropriate support for families by improving the joint assessment and shared decision-making process in youth (health) care. This study supports the implementation of GIZ in youth (health) care practice and highlights the need for further focus on implementation and sus-tainability.

A new intervention model for promoting healthy ageing grounded on integrated value-based care was developed and tested in the city of Valencia (Spain). Its implementation raised relevant barriers for older adults in their access to health, health promotion, and health self-management linked with their health and digital literacy. This new intervention model included several aspects. On the one hand, researchers together with older adults and their informal caregivers participating in the study, designed personalised care plans, based on older adults’ specific needs, to be implemented with the support of a digital solution. On the other hand, researchers and health and social professionals implemented a series of six workshops in different locations of the city to encourage the sense of community among participants, reinforcing their trust in the new care model and increasing their adherence. Social activities were at the core of the workshops to understand older people’s interaction with the health and social services provided in the neighbourhood. Qualitative and quantitative methods were combined to extract information from older participants on how to engage them as active actors of their own health and understanding their values and preferences. Qualitative results show that after a post-pandemic situation, they were more concerned about social isolation and desired face-to-face contact with their professional care team; however, feelings of loneliness and/or sadness were not considered amongst the reasons to visit health professionals. Some of the conclusions reveal that the use of technology as a supportive tool is well received but with a stress on its role as “supportive”, and not replacing the close contact with healthcare professionals. Professionals recognised the benefits of this new approach but required more time and incentives to dedicate the effort needed.

This paper proposes a solution for the problem of mobile robot navigation and trajectory interpolation in dynamic environments with large scenes. The solution combines a semantic laser SLAM system that utilizes deep learning and a trajectory interpolation algorithm. The paper first introduces some open-source laser SLAM algorithms and then elaborates in detail on the general framework of the SLAM system used in this paper. Secondly, the concept of voxel is introduced into the occupation probability map to enhance the ability of local voxel maps to represent dynamic objects. Then, in this paper, we propose a PointNet++ point cloud semantic segmentation network combined with deep learning algorithms to extract deep features of dynamic point clouds in large scenes and output semantic information of points on static objects. A descriptor of the global environment is generated based on its semantic information. Closed-loop completion of global map optimization is performed to reduce cumulative error. Finally, T-trajectory interpolation is utilized to ensure the motion performance of the robot and improve the smooth stability of the robot trajectory. The experimental results indicate that the combination of the semantic laser SLAM system with deep learning and the trajectory interpolation algorithm proposed in this paper yields better graph building and loop closure effects in large scenes at SIASUN large scene campus. The use of T-trajectory interpolation ensures vibration-free and stable transitions between target points.

Traditional underground pipeline inspection primarily relies on closed-circuit television (CCTV) systems, capturing visual data of deformations within sewer systems for manual assessment of their types and severity. However, these methods heavily rely on human expertise, which leads to subjective detection with limited accuracy. Moreover, they lack the capability for quantitative analysis of deformation extent, hindering accurate assessments and limiting overall inspection effectiveness. To address these challenges, this paper proposes a method for quantitatively detecting geometric deformations in underground pipe corridors using laser point cloud data. The approach, employing laser scanning with a 3D scanner, enables objective detection of internal pipeline deformations and quantitative assessment of blockage levels. In comparison to traditional CCTV-based methods, this approach offers advantages in objectivity and quantification, thereby improving detection reliability, accuracy, and overall efficiency.

Point-contact spectroscopy has been performed on bulk samples of electron-doped high temperature superconductor Nd2-xCexCuO4-. The samples were characterized by X-ray diffraction and scanning electron microscopy equipped with a wavelength dispersive spectrometer and an electron backscatter diffraction detector. The samples with a Ce content x = 0.15, show the absence of spurious phases and randomly oriented grains, most of which have dimensions of approximately 220 µm2. The low-bias spectra in the tunnelling regime, i.e., high transparency interface, exhibit a gap feature at about ±5 meV and no zero-bias conductance, consistent with the most literature data on oriented samples. The high-bias conductance has also been measured in order to obtain information on the properties of the barrier. A V-shape has been in some cases observed, instead of the parabolic behavior expected for tunnel junctions.

Non-rigid registration presents a significant challenge in the domain of point cloud processing. The general objective is to model complex non-rigid deformations between two or more overlapping point clouds. Applications are diverse and span multiple research fields, including registration of topographic data, scene flow estimation, and dynamic shape reconstruction. To provide context, we begin with a general introduction to the topic of point cloud registration, including a categorization of methods. Next, we introduce a general mathematical formulation for point cloud registration and extend it to address non-rigid registration. A detailed discussion and categorization of existing approaches to non-rigid registration follows. We then introduce our own method where the usage of piece-wise tricubic polynomials for modeling non-rigid deformations is proposed. Our method offers several advantages over existing methods. These advantages include easy control of flexibility through a small number of intuitive tuning parameters, a closed-form optimization solution, and an efficient transformation of huge point clouds. We demonstrate our method through multiple examples that cover a broad range of applications, with a focus on remote sensing applications - namely, the registration of Airborne Laser Scanning (ALS), Mobile Laser Scanning (MLS), and Terrestrial Laser Scanning (TLS) point clouds. The implementation of our algorithms is open source and can be found on GitHub.

The relationship between living things and their respective environments highly dependent on body temperature regulation. The human capacity to effectively thermoregulate evolved at a time when the environmental temperature was likely around 25°C during the Eocene epoch, some ~ 50-60 million years ago. This effectively meant that homeothermy settled on a core temperature balance point of ~ 37°C. When Homo split from chimpanzee around 5 million years ago the Earth was entering a cooling period where the balance point temperature was always well above that of the environment and body heat balance could be maintained. Following this cooling period, the Earth’s rewarming by 7 °C took over approximately 5,000 years, whereas the current estimates indicate 0.7 °C over the past 100 years; ten times the rate of ice-age-recovery warming, or 20 times faster compared with the last 2 million years. As such, if the predicted continued rise in global temperature continues, and surface temperature reaches values where heat load cannot be dumped as the body temperature balance point is at or near the environmental temperature, areas of the Earth would become inhospitable. This effectively means that we will need to deal with both physiological and behavioral limitations since our ability to adapt will be limited by a thermoregulatory strategy that evolved over millions of years for a different kind of environment, not one that is predicted to change rapidly over the next century. This paper outlines the basis on which Homo settled on a thermoregulatory balance point and what limitations this presents for us in the future.

Urban scene point cloud pose significant challenges for registration due to its large data volume, similar scenarios and dynamic objects. In this paper, we propose PCRMLP, a model for urban scene point cloud registration that achieves comparable registration performance to prior learning-based methods. Compared to previous works which focus on extracting features and estimating correspondence, the model estimates the transformation implicitly from concrete instances. An instance-level urban scene representation method is introduced to extract instance descriptors via semantic segmentation and DBSCAN, which enable the model to obtain robust instance features, filter dynamic objects and estimate transformation in a more logical manner. Then a lightweight network consisting of MLPs is employed to obtain transformation in an encoder-decoder manner. We validate the approach on KITTI dataset. Experimental results demonstrate that PCRMLP can obtain a satisfactory coarse transformation from instance descriptors just in 0.0028s. With a subsequent ICP refinement module, the proposed method achieves higher registration accuracy and computational efficiency than prior learning-based works.

For the symmetrical mixture model and mixture test area, the lattice point set is used to partition, and then the corresponding test statistics can be constructed. In this paper, we first proposes the partition methods under the lattice point sets and obtains several sub-simplexes without common interior points. Furthermore, we present the method for constructing a uniform design on the simplex using the center points of these sub-simplexes. The designs satisfy the uniformity of maximum distance deviation and provide good results for the mean square error deviation. Finally, the uniformity test on the mixture region is considered and illustrated by examples.

Bubble (point defect) – a precursor of fuzz or under dense nanostructure formation is crystal lattice defect. Suitable selection of crystal lattice which inhibit Frenkel pair generation and intrinsically promotes self- interstitial solid solution strengthening contributes effectively towards making plasma facing material. For this, interstitial sites, their size, amount / fraction, positions, tendency of occupation and diffusion parameters (e.g. activation energies (Q), activation volumes) are determined. Fcc iron carbon alloys (austenitic stainless steels AISI / SAE 321, fcc structure, Pearson code cF4, space group Fm3̅m) are proposed as suitable candidates. Along with their room temperature fcc structure having 12 interstitial positions (4 octahedral, 6 coordination sites and 8 tetrahedral, 4 coordination sites / unit cell) to allow insertion of self (iron) atoms, they have excellent corrosion resistance, thermal conductivity, and non- magnetic properties. After their melting, casting, and machining to required dimensions and geometry, stabilizing heat treatment is applied to precipitate all carbon as TiC and prevent formation of Cr23C6 (sensitization). This resist heat and surface degradation and yield excellent architecture which not onlyinhibit Frankel pair generation but will also allow bulk assimilation or surface annihilation (loop punching) of this lattice point defect. A superior thermal, fluid, and structural design augment above. A second choice is presented as Co base superalloys owing to same fcc crystal structure and excellent properties (such as strength, dimensional stability, oxidation resistance) at high temperature.

A novel approach has been suggested to use isoelectric points of viral and human proteins to quickly identify proteins that are effective in not allowing virus particles to attach to human receptor cells by virtue of their electrical charge. The method has been applied to SARS CoV-2 to suggest potentially important human proteins that can be suitable for making anti-viral drugs.

Theoretical analysis into the energetics of a novel putative electromagnetic field propulsion device by the author, found that it was able to impart momenergy to the ground state of the electromagnetic field; some rest-energy of the craft was converted to kinetic energy of the craft. Electrical analysis showed that the propulsor was always a net electrical load – if the device accelerated from one frame, then deaccelerated to the original frame, both processes would consume electrical work. The aim of this paper is to look further into this sinking of high-grade electrical energy into the field ground state and to show that an even more pernicious form of 2^nd Law of Thermodynamics exists.

If an algebra of type $A$ contains a subalgebra which is also an algebra of type $B$, then it is a Smarandache $B$-type $A$-algebra provided the subalgebra of type $B$ contains at least two elements. This generalizes the notion of Smarandache group, where the group of order $\geq 2$ is a subsemigroup of a semigroup. In this paper we investigate a number of such pairings and we deduce a number of conclusions as a consequence.

This paper is devoted to change-point detection using only the ordinal structure of a time series. A statistic based on the conditional entropy of ordinal patterns characterizing the local up and down in a time series is introduced and investigated. The statistic requires only minimal a priori information on given data and shows good performance in numerical experiments.

Sequential hypothesis test and change-point detection when the distribution parameters are unknown is a fundamental problem in statistics and machine learning. We show that for such problems, detection procedures based on sequential likelihood ratios with simple one-sample update estimates such as online mirror descent are nearly second-order optimal. This means that the upper bound for the algorithm performance meets the lower bound asymptotically up to a log-log factor in the false-alarm rate when it tends to zero. This is a blessing, since although the generalized likelihood ratio (GLR) statistics are optimal theoretically, but they cannot be computed recursively, and their exact computation usually requires infinite memory of historical data. We prove the nearly second-order optimality by making a connection between sequential analysis and online convex optimization and leveraging the logarithmic regret bound property of online mirror descent algorithm. Numerical and real data examples validate our theory.

We generalize the point information gain (PIG) and derived quantities, i.e., point information gain entropy (PIE) and point information gain entropy density (PIED), for the case of the Rényi entropy and simulate the behavior of PIG for typical distributions. We also use these methods for the analysis of multidimensional datasets. We demonstrate the main properties of PIE/PIED spectra for the real data on the example of several images, and discuss further possible utilizations in other fields of data processing.

We introduce the notion of generalized contraction on dualistic partial metric spaces. A fixed point theorem for mappings satisfying above mentioned contraction is obtained. Some consequences of our result are obtained. We construct an example to demonstrate the effectiveness of our result among the corresponding results in partial metric spaces. Our results provide substantial generalizations and improvements of several well known results existing in the comparable literature. We discuss an application of our fixed point results to show the existence of solution of functional equations.

With the continuous development of 3D city modeling, traditional close-range photogrammetry is limited by complex processing procedures and incomplete 3D depth information, making it unable to meet high-precision modeling requirements. In contrast, the integration of LiDAR and camera in mobile measurement systems provides a new and highly effective solution. The LiDAR can quickly and accurately acquire the 3D spatial coordinates of target objects, while optical imagery contains abundant color information. If the two can be integrated, they can play an important role in multiple fields such as streetscape modeling, archaeology and digital city, etc. Currently, integrated mobile measurement systems commonly require cameras, lasers, POS and IMU, thus the hardware cost is relatively expensive and the system integration is complex. Therefore, in this paper we propose a simple ground mobile measurement system composed of a LiDAR and a GoPro camera without a POS system, providing a more convenient and reliable way to automatically obtain 3D point cloud data with spectral information. The automatic point cloud coloring based on video images mainly includes four aspects: (1) Establishing models for radial distortion and tangential distortion to correct video images. (2) Establishing a registration method based on normalized Zernike moments to obtain the exterior orientation elements. Normalized Zernike moments are region-based shape descriptors that can reflect the features of images in multiple dimensions even for low-quality video images. The results show that registration based on normalized Zernike moments provides a good result, with an error accuracy of 0.5-1 pixel, which is far higher than registration based on a collinearity equation. (3) Establishing adjacent video image relative orientation based on essential matrix decomposition and nonlinear optimization. This involves uniformly using the SURF algorithm with distance restriction and RANSAC to select corresponding points, which can improve the reliability of the corresponding points. The results indicate that the accuracy of the relative orientation method is high. Moreover, this method can converge to good results for stereo image pairs with large rotation angles and displacement amounts. Therefore, relative orientation based on essential matrix decomposition and nonlinear optimization has good applicability. (4) The video imagery suffers from significant motion blur and boundary distortion. Therefore, a point cloud coloring method based on Gaussian distribution with central region restriction is adopted. Only pixels within the central region are considered valid for coloring. Then, the point cloud is colored based on the mean of the Gaussian distribution of the color set. Experimental results show that the coloring accuracy between the video imagery and point cloud data is high, meeting the accuracy requirements of applications such as tunnel detection, street-view modeling and 3D urban modeling.

An explanation of the origin of dark matter is suggested in this work. The argument is based on symmetry considerations about the concept of mass. In the Wigner's view, the rest mass and the spin of a free elementary particle in flat space-time are the two invariants that characterize the associated unitary irreducible representation of the Poincar\'e group. The Poincar\'e group has two and only two deformations with maximal symmetry. They describe respectively the de Sitter (dS) and Anti de Sitter (AdS) kinematic symmetries. Analogously to their shared flat space-time limit, two invariants, spin and energy scale for de Sitter and rest energy for Anti de Sitter, characterize the unitary irreducible representation associated with dS and AdS elementary systems. While the dS energy scale is a simple deformation of the Poincaré rest energy and so has a purely mass nature, AdS rest energy is the sum of a purely mass component and a kind of zero-point energy derived from the curvature. An analysis based on recent estimates on the chemical freeze-out temperature marking in Early Universe the phase transition quark-gluon plasma epoch to the hadron epoch supports the guess that dark matter energy might originate from an effective AdS curvature energy.

All humans will experience the process of birth, old age, illness, and death. However, when faced with life-sustaining decisions, the families of patients are often faced with medical decisions as surrogates. In recent years, the families of patients have started to value the importance of the right to palliative care, although this often requires lengthy discussions. Therefore, this study explored the predictability of factors that affect the feeling experienced by patients’ families when signing Do-Not-Resuscitate Consent. This study used a cross-sectional study and interviewed 90 family members using a structural questionnaire. The study hypotheses were tested using a t-test, one-way analysis of variance, product–moment correlation, and hierarchical regression analysis. Attribute variables of family members, such as gender and whether they live with the patient, are predictors that affect the family member’s feeling experience when signing Do-Not-Resuscitate Consent. The emotional support from medical professionals to family members helps the family member to express their negative feelings on signing Do-Not-Resuscitate Consent; more informational support information provided to family members by medical professionals can alleviate negative feelings felt by family members when signing Do-Not-Resuscitate Consent. This study identified that family members’ knowledge about Do-Not-Resuscitate acquired from medical professionals is relatively low. It is suggested that critical care units regularly conduct training on hospice palliative care, implement standard care procedures of hospice palliative care at critical care units, and provide detailed medical information about advanced decisions to family members so as to reduce their emotional stress. This will ensure that intensive care units can also achieve the goal of critically ill hospice palliative care.

Background: Low-level physical activity (PA) among Chronic Low Back Pain (cLBP) is associated with various biopsychosocial factors. This research aimed to study the predictors of PA behavior among cLBP patients. Methods: In the present study 300 eligible patients with cLBP who referred to comprehensive health service centers in the Shahid Beheshti University of Medical Sciences (SBUMS) in Tehran, Iran were random selected.To diagnose the predictors of PA behavior, all the Theory of Reasoned Action (TRA) constructs were examined as risk factors to see if they influence on the probability of PA behavior occurrence and were interpreted through odds ratio (OR). SPSS version 19 was used to analyze the data. Results: Totally 280 cLBP patients with mean age of 57.07 ±13.09 years old participated in the study. This study showed that motivation to comply significant predictor the cLBP patients for subjective norm OR (%95CI): 2.095(0.116-2.792), p-value<0.001), intention was significant predictor for perform the PA behavior OR (%95CI): 1.431(0.138-1.538), p-value <0.001), behavior beliefs could predictor for attitude OR (%95CI): 1.276(0.106-1.355), p-value= 0.002). attitude, normative beliefs, subjective norm ,and evaluation outcome behavior could predictors the cLBP patients for intention to perform the PA behavior OR (%95CI): 1.188(0.032-1.312), p-value<0.001)., OR (%95CI): 1.158(0.076-2.208), p-value=0.003) ., OR (%95CI): 1.104(0.076-1.128), p-value<0.001) ., OR (%95CI): 0.814(0.301-1.440), p-value=0.007). Conclusions: This study showed that the cLBP patients who were normative beliefs and evaluation regarding PA behavior could effect on the intention to engage in greater PA than those via other constructs (attitude and subjective norm). This study showed that the cLBP patients who were normative beliefs and evaluation regarding PA behavior could effect on the intention to engage in greater PA than those via other constructs (attitude and subjective norm). This study showed that the cLBP patients who were normative beliefs and evaluation regarding PA behavior could effect on the intention to engage in greater PA than those via other constructs (attitude and subjective norm).

Burnout represents a concern for all healthcare providers, particularly those specializing in emergency medical care for whom burnout outcomes have been well-documented. What remains unknown is the effect of burnout on redeployed medical specialists during the COVID-19 pandemic from an appointment-centered practice to emergency care directed by public health considerations. This research aims to identify and assess the burnout responses of fourteen medical specialties noted in searched returns of the four most cited articles published since 2020 about non-emergency physicians regarding their burnout brought on by the unanticipated need for them to provide emergency care during the recent pandemic. The hypothesis is that medical specialists accustomed to planning for emergency possibilities in their appointment-centered practice would demonstrate the least burnout regarding COVID-19-related emergencies. Considering coping as a process based on Lazarus's research, comparing and ranking the COVID-19 emergency responses across the various normally appointment-centered medical specialties in their employed coping strategies determines the outcome. With the hypothesis supported, suggested interventions for future pandemics—when these specialists are, again, redeployed to emergency care directed by public health considerations—are those coping strategies identified as most effective in reducing burnout while maintaining the viability of the medical specialty and excellent patient care.

Stroke is a global leading cause of death and disability. Knowledge of related guidelines is crucial for Emergency Department (ED) staff, influencing early diagnosis and timely treatment. We investigated Greek-Cypriot ED healthcare professionals' (nurses and physicians) knowledge in recognizing and managing stroke. A descriptive cross-sectional study spanned November 2019 to April 2020, encompassing four private and seven public EDs in the Republic of Cyprus. The data were collected through a self-reported questionnaire developed by the research team, consisting of 37 questions. Eight questions focused on sociodemographic and employment characteristics, 28 assessed knowledge in stroke recognition and management (each item was equally weighted without deliberate prioritization), and one question addressed self-assessment of knowledge in stroke care. 255 nurses [Response Rate (RR): 74.1%] and 26 physicians (RR: 47.3%) completed the questionnaire. The average correct response rate was 12.9 out of 28 statements (SD: 4.2), with nurses and physicians scoring 12.6 (SD: 4.1) and 15.7 (SD: 4), respectively. Work experience significantly influenced stroke knowledge, with all groups demonstrating superiority over those with less than one year of experience. Participants with previous training scored an average of 1.45 additional correct answers while educational attainment did not significantly influence stroke knowledge. Investigating stroke knowledge among Emergency Department nurses and physicians in the Republic of Cyprus revealed significant deficits. The study stresses targeted interventions, including, education, yearly examinations, workshops with hands-on training, and repeated training, to address these gaps and enhance the overall stroke care capabilities of the healthcare professionals.

Alzheimer’s disease and related dementias (ADRD) remain a public health challenge in developing counties. We developed a needs-based essential care service package (ECSP) for care planning of persons living with dementia (PLWD) using a cross-sectional survey among PLWD in institutions in six cities in China (n= 1,299). Face-to-face interviews were conducted with caregivers of PLWD by trained staff between 2018 and 2019. Care service needs and utilization by the level of cognitive impairment were summarized. The average age of PLWD was 80.7 years. 76% of participants had severe cognitive impairment. The needs-based ECSP with 30 service items would be sufficient in supporting care services of PLWD in China, of which seven items are core care. The selection plan for ECSP at different levels is designed as “General Care Services + Selective Care Services”, in which service items for low-, mid-and high-level care for PLWD are 7+3, 7+6, and 7+10, respectively. The findings provide the first large-scale data on service needs and utilization of PLWD in mainland China. The ECSP for PLWD advanced in the paper was a practicable and effective quantitative management means. It is deserved to application in a large scale.

The study investigated the impact of traditional medicine on life expectancy in Nasarawa State, Nigeria. The study adopted a quantitative research approach. Purposive or judgmental sampling was used to elucidate the data set used for the study. Cross-sectional data were gathered with the help of a well-designed questionnaire from a total of three hundred and fifty-seven (357) respondents who were available for the survey. The data set collected was analysed using descriptive and linear regression using Ordinary Least Squares (OLS). From the results, 53%, 87%, and 56% were male, below 50 years old, and in the low-income class, respectively, suggesting that the bulk of the respondents under investigation were male, young, and had rather modest incomes. Also, 53% were married, and all had one form of formal education. 67% of respondents acknowledge using traditional medicine; however, the majority of respondents preferred Orthodox medical care over alternative kinds of care. Traditional medicine (TM) and factors that contribute to the advancement of traditional medicine (FITM) have a negative impact on life expectancy, according to the regression analysis. On the other hand, TM has no statistically significant impact on life expectancy, despite FITM having a statistically significant effect at the 5% level. All available data, however, indicates that TM and FITM have an impact on life expectancy, either directly or indirectly. Based on the results, this study concluded that traditional medicine has the potential to significantly increase life expectancy in Nasarawa State and throughout Nigeria. The study recommends that traditional health professionals, stakeholders, and concerned government agencies should put efforts in place to improve and promote modern traditional medicine among the people, especially its effectiveness and medicinal quality, increase its accessibility to people, and efficiently regulate its prices to increase its affordability for low-income earners

The second external cause of death from unintentional injuries is falls in people over 60, a worldwide public health problem. Associated factors are identified early in Primary Health Care. Thus, we analyze professional narratives about older adults/old age and the organization of services in the presence of fall-inducing frailty. A structured narrative was applied under the following stages: understanding the context; setting/plot/character analysis; and interpretive synthesis. Data were collected from August to November 2022, distributing 21 health professionals in three Narrative Focus Groups. In the analyses, the collective conceptions dialogued with Bourdieu’s Epistemology of field, habitus, and capital. Among the results, technical and common sense representations of older adults were simultaneously observed, along with the belief of old age as a problematic life stage. Care is centered on the installed disease/ailment. Encouraging autonomy and self-care emerges in integrative health practices, which older adults underestimate. Professionals access the lives of older adults according to their habitus, which, in turn, is structured (structuring) in the disputes for installed capital. Thus, the care provided disregards subjectivities and symbolic systems associated with falls.

(1) Background: There is not much research about obesity in nursing homes although knowledge will help us to develop customized treatment plans and prevention strategies, which may help to decrease the burden for all persons involved. The objective of conducting this study was to describe the prevalence of obesity and the association between obesity and care problems in nursing home patients. (2) Methods: This study is a secondary data analysis of data collected in an annually performed cross-sectional study called “Nursing Quality Measurement 2.0”. A standardized and tested questionnaire was used to collect data. (3) Results: 1236 nursing home patients took part and 16.7% of them were obese. The multivariate logistic regression analysis results show that urinary incontinence is significantly associated with the presence of obesity (OR 2.111). The other care problems of pressure injuries, fecal and double incontinence, physical restraints, falls and pain were not associated with obesity. (4) Conclusion: The results indicate that, in the nursing home setting, health care staff should pay special attention to the patients’ nutritional and continence status and help patients maintain a normal, healthy weight. Conducting more studies with larger sample sizes is recommended, as this will allow differentiation among different obesity classes.

(1) Background: Our paper aimed to examine the ways in which the care centers for the elderly acted and adapted during the pandemic period, by taking into account the opinions of the beneficiaries, of the employees and of the managers of those centers. (2) Methods: in order to conduct the research we used a mixed-method approach. Considering the quantitative research, we applied a questionnaire to 430 institutionalized elderly from Timis county, Romania. Considering the qualitative analysis, we conducted interviews with 31 institutionalized elderly, with 7 employees and 4 managers. (3) Results: most institutionalized elderly were mainly satisfied with their life in the care centers, the main difficulties they had were: the impossibility of being close to loved ones, and the difficulty of adapting to the living conditions within the center, and the elderly were satisfied with the interactions they had with the staff of the care centers. (4) Conclusions: the research conducted provides a view on the lifestyle of the elderly from care centers during the pandemic, it highlights the struggles of the elderly and it can be used as a point of reference for the further improvement of the lifestyle of the elderly within the care centers.

Background: To identify and appraise the impacts and effectiveness of counseling interventions based on the 5A model on indicators of physical activity in adults. Methods: In May, 2022, a systematic review was carried out. Searches were performed in Embase, Lilacs, Pubmed, Scielo, Scopus, Sportdiscus and Web of Science. To avoid potential losses searches also were made in Google Scholar and in reference lists. Assessment of studies, data extraction and synthesis took place independently by two researchers. Results: Four studies composed the synthesis, which involved people with an average age between 40 and 55 years, being women in the majority of the samples. It was observed that counseling was carried out in conjunction with other strategies, such as drawing up an action plan, sending text messages and offering educational material. Only one study showed a statistically significant difference between the intervention and control groups in the “daily number of steps” indicator. Conclusions: counseling based on the 5A model did not reflect significant findings in relation to physical activity. Considering that behavior change for many people is neither a simple nor a quick process and that the 5A model is promising for other behavioral indicators, we indicate the need to carry out new intervention studies, with an expanded focus in relation to themes related to physical activity (e.g., types, dos-es, risks, benefits, identification of barriers and assessment) and, in parallel, the offer of practices in the Primary Health Care setting.

Family-Centered Care (FCC) as a philosophy is defined as a care provider that emphasizes and involves the important role of the family. However, there are several obstacles in implementing family center care for children where parents have different perceptions from health workers. Parents are angry when they are involved in a job they consider to be a nurse's job and the attitude of nurses prevents parents from participating. This difference in perception causes the implementation of Family Center Care (FCC) has not been carried out optimally, this has an impact on discomfort during treatment. Along with the not yet optimal implementation of family center care when providing care to children, further discussion is needed regarding the philosophy of child nursing with a family center care approach. The reasons for the importance of implementing family center care include building a collaborative system, focusing on family strengths and resources.

OBJETIVES: During the COVID-19 pandemic, the risk of collapse of the health system created great difficulties. We will demonstrate that Intermediate Respiratory Care Units (IRCU) provide adequate management of patients with non-invasive respiratory support, which is particularly important in patients with SARS-CoV-2 pneumonia. METHODS: A prospective observational study of patients with COVID-19 admitted to the ICU of a tertiary hospital. Sociodemographic data, comorbidities, pharmacological, respiratory support, laboratory and blood gas variables were collected. The overall cost of the unit was subsequently analyzed. RESULTS: 991 patients were admitted, 56 to the IRCU (of the 81 a critical care unit). Mean age was 65 years (SD 12.8), Barthel Index 75 (SD 8.3), Charlson 3.1 (SD 2.2), HTN 27%, COPD 89% and obesity 24%. Significant relationship (p <0.05) with higher mortality of the following: fever greater than or equal to 39oC [OR 5.6; 95% CI (1.2-2.7); p = 0.020], protocolized pharmacological treatment [OR 0.3; 95% CI (0.1-0.9); p = 0.023] and IOI [OR 3.7; 95% CI (1.1-12.3); p = 0.025]. NIMV showed less of a negative impact [OR 1.8; 95% CI (0.4-8.4); p = 0.423] than IOI. The total cost of the IRCUs amounted to €66,233. The cost per day of stay in the IRCU was €164 per patient. The total cost avoided was €214,865. CONCLUSION: The pandemic has highlighted the importance of IRCUs in facilitating the management of a high patient volume. The treatment carried out in IRCUs is effective and efficient, reducing both admissions to and stays in the ICU.

(1)Background: When the COVID-19 pandemic arrived, changes had to be made to several management aspects at our Pediatric Oncology Center. We investigated how the families per-ceived these changes. (2) Methods: Two questionnaires were developed at the Pediatric Oncology Unit of the Istituto Nazionale dei Tumori in Milan, to explore how the pandemic has affected the experience of patients who had been or were being treated at our hospital, and their families. These were administered to three samples of individuals. (3) Results: Between July and October 2020, 120 questionnaires were administered to parents of patients. The impact of school closures and the impossibility of attending sports and social activities outside the hospital were regarded as im-portant. 77.5% of parents judged the social distancing to have affected their children. Regarding the changes introduced in the management of the ward and outpatient clinic, most parents’ opinions were positive. Differences in the opinions expressed by Groups 2 and 3 were statistically significant on the topic of relationships on the ward and staff workload. The aspect most negatively affected by the pandemic was the support that patients’ parents were able to give each other. Regardless of whether patients were treated before the pandemic or after the first lockdown, their parents of all indicated a strong degree of satisfaction with the care received, and with the organizational ar-rangements. (4) Conclusions: The results of our study point us in the right direction to further improve our daily work and better respond to the needs of our patients and their families.

In Rwanda, more than 90% of the population is insured for health care. Despite the comprehensiveness of health insurance coverage in Rwanda, some health services at partner institutions are not available, causing insured patients to pay unintended cost. We aimed to analyze the effect of health insurance on health care utilization and factors associated with the use of health care services in Rwanda. This is an analysis of secondary data from the Rwanda integrated living condition survey 2016-2017. The survey gathered data from 14580 households, and decision tree and multilevel logistic regression models were applied. Among 14580 households only (20%) used health services. Heads of households aged between [56-65] years (AOR=1.28, 95% CI:1.02-1.61), aged between [66-75] years (AOR=1.52, 95% CI: 1.193-1.947), aged over 76 years (AOR=1.48, 95% CI:1.137-1.947), households with health insurance (AOR=4.57, 95% CI: 3.97-5.27) displayed a significant increase in the use of health services. This study shows evidence of the effect of health insurance on health care utilization in Rwanda: a significant increase of 4.57 times greater adjusted odds of using health services compared to those not insured. The findings from our research will guide policymakers and provide useful insights within the Rwanda context as well as for other countries that are considering moving towards universal health coverage through similar models.

Abstract: The study aimed to determine the factors associated with the avoidance of dental preventive care in adolescents and their parents in the framework of The Youth and Parents Risk Factor Behavior Survey in Slovakia has been initiated during the years 2015/2016. The data were collected using two separate standardized questionnaires: (i) the questionnaire for adolescents (n=515) and (ii) the questionnaire for parents (n=681). The study group consisted of 57 adolescents (54.4% males) who did not visit the dentist for preventive care in the previous year. The control group consisted of 458 adolescents (35.8% males) who visited a dentist for preventive care at least once in the previous year. A significantly higher number of males (54.4%), older adolescents (21.4%) were not visiting dental preventive care regularly. Incomplete family (56.1%), stressful situations at home (17.5%), and feeling unwell were observed as the factors contributing to the avoidance of dental preventive care. More than 34.5% of adolescents were not visiting either dental preventive care but also pediatric preventive care (AOR=5.14; 95%CI=2.40, 10.99). Divorced mothers and mothers with household income lower than 900 € had significantly higher dental care avoidance in their children. A significantly higher percentage of fathers from the exposed group were not visiting dental preventive care regularly (47.8%; p&lt; .05). The results of the study can be used as an educational intervention steps focusing on the influence of parental and adolescent behavior in dental preventive care.

Background: Monk healers provide an accessible and popular service in Southeast Asia, but little is known on the substance use status of their clients. This investigation intended to assess and compare the rate and correlates of substance use disorders in two different treatment settings (monk healers=MH and primary health care=PHC) in Thailand. Methods: In a cross-sectional study, 1024 patients (591 of MH and 613 of PHC) responded to screening measures of the “World Health Organization Alcohol, Smoking, and Substance Involvement Screening Test Lite”, and two common mental disorders (major depression and generalized anxiety disorder) from November 2018 to February 2019. Logistic regression was used to estimate the determinants of any substance use disorder in the MH and PHC setting. Results: The prevalence of substance use disorder was higher in MH clients than PHC patients: any substance use disorder 11.7% (95% Confidence Interval-CI: 9.3%-14.5%) vs 5.4% (95% CI: 3.9%-7.5%), tobacco use disorder 7.6% (95% CI: 5.7%-9.9%) vs 2.5% (95% CI: 1.5%-4.0%), alcohol use disorder 10.0% (95% CI: 8.4%-13.6%) vs 4.3% (95% CI: 3.0%-6.3%), any drug use disorder 4.2% (95% CI: 2.8%-6.1%) vs 0.3% (95% CI: 0.08%-1.3%), and any past three months drug use 8.2% (95% CI: 6.2%-10.7%) vs 1.5%, 95% CI: 0.8%-2.8%). In adjusted logistic regression analysis, among MH clients, male sex (Adjusted Odds Ratio-AOR: 9.52, 95% Confidence Interval-CI: 5.06-17.92) was positively, and were married (AOR: 0.32, 95% CI: 0.16-0.61) and high social support (AOR: 0.40, 95% CI: 0.16-0.99) were negatively associated with any substance use disorder. Among PHC patients, male sex (AOR: 7.05, 95% CI: 2.99-16.63) was positively and age (AOR: 0.95, 95% CI: 0.92-0.98) was negatively associated with any substance use disorder. Conclusion: The proportion of substance use disorders among MH attendees was more than twice that of PHC attenders in Thailand, calling for collaboration in controlling substance use disorders between the two treatment systems.

Introduction: Type 2 diabetes (T2D) is a major driver of health care costs, thus treatments enabling T2D reversal may reduce expenditures. We examined the impact of a T2D continuous care intervention (CCI) on health care utilization. Previous research documented that CCI, including individualized nutrition supported by remote care, simultaneously reduced hemoglobin A1c and medication use and improved cardiovascular status after two years; however, the impact on utilization is unknown. Methods: This study used four years of data (two years pre-intervention, two years post-intervention) from the Indiana Network for Patient Care (INPC) health record. Two methods estimated the impact of CCI on utilization. First, an interrupted time series (ITS) including only CCI participants (n=193) compared post-intervention utilization to expected utilization had the pre-intervention trend persisted. Deviation from the trend was estimated non-parametrically for each 6-month interval after the implementation of CCI . Second, a 1:3 matched comparator group (n=579) was constructed and used for a difference-in-differences (DiD) analysis. The primary outcome was annualized outpatient encounters. Secondary outcomes included emergency encounters and hospitalizations. Results: In two years prior to intervention, CCI participants had a mean of 5.77 annualized encounters (5.62 outpatient, 0.04 hospitalizations, 0.11 emergency). The CCI group showed a reduction in outpatient utilization after intervention. In ITS analysis, 1.6 to 1.9 fewer annualized outpatient encounters occurred in each 6-month interval post-intervention relative to expected utilization based on pre-intervention trends (p<0.01 each 6-month period; 28-33% reduction). The DiD analysis suggested a larger reduction; 5 fewer annualized outpatient encounters in the quarter after intervention, diminishing to 2.5 fewer after 2 years (p<0.01 each quarter). The study was underpowered to draw conclusions about hospitalization and emergency encounters due to the limited number of CCI patients and the rarity of encounters. Conclusions: Outpatient encounters were significantly reduced for a T2D patient population up to 2 years after receiving an individualized intervention supporting nutrition and behavior change through remote care.

This study aimed to know the conditioning factors of the transition process to the self-care of women diagnosed with HIV/AIDS. This qualitative study was carried out from June to September 2015 with seven seropositive women, users of a specialized service in sexually transmitted diseases in the municipality of Imperatriz, Maranhão State, Brazil. For the data collection, an individual interview was used, and data analysis was performed by content analysis delineated by Hsieh and Shannon (2005). The resources that influence the self-care in the transition process of women with HIV/AIDS are represented by personal conditioning factors, such as the meaning they attribute to the living with the disease, personal attitudes and cultural beliefs, socioeconomic status, preparation and knowledge about the disease, and by conditioning factors found in the community and society. The transition theory can provide important insights about the resources present in the adaptation process of women diagnosed with HIV so that they can perform their self-care satisfactorily.

INTRODUCTION Recently there has been a significant increase in age in the United States. It is necessary to better understand the physiological and surgical needs of these patients in order to optimize outcomes. The vast majority of procedures performed in adult patients are low-risk operations, such as laparoscopic cholecystectomy. Our aim is to investigate the outcomes, including length of stay, morbidity, mortality, re-admission and discharge disposition of the elderly population (>80) undergoing low-risk operations in our tertiary community hospital. METHODS A retrospective chart review was done at a tertiary community hospital. The time frame utilized was 2011-2015. Patients were excluded only on the basis of their age (< 80) at the time of operation. RESULTS There were a total of 30 patients who underwent laparoscopic cholecystectomy from 2011 to 2015. 21 patients (70%) were female and 9 (30%) were male. No patients were converted to an open procedure. The average age was 86.4 years and average ASA classification prior to surgery was 2.88. Higher ASA class, specifically those that were class III/IV were more likely to have an increased length of stay that was statistically significant. Overall age greater than 80 was an independent risk factor for transfer to a higher level of care upon discharge (SNF, LTAC, etc.), a surrogate marker for physical decompensation following surgery. CONCLUSIONS Routine surgery, such as the laparoscopic cholecystectomy, effects the elderly population in a more substantial way, and early recognition coupled with increased education for physicians regarding geriatric patients can help to reduce length of stay, morbidity, and overall physical and mental deconditioning.

Pharmacists’ roles in providing patient care remain limited in Indonesia, hence this study aimed to determine the preparedness of pharmacy graduates from one university in Indonesia to deliver patient care. Pharmacy graduates (both registered pharmacists [104] and recent graduates eligible for registration [45]) were sent a validated self-administered survey. The survey sought their perceptions about whether they had acquired 16 patient care related attributes. Further, it sought their opinion on the desirability of having those attributes. Data were analysed using SPSS version 22.0. Sixteen of 104 (15.4%) registered pharmacists and 40 of 45 (88.9%) recent pharmacy graduates participated in the study. More than 50% of participants in both groups were female and most participants were aged in their 20s. Of the recent pharmacy graduates the majority perceived they had at least partially acquired four of 16 list attributes. Male and female recent graduates had significantly different beliefs about their leadership ability (p=0.004). In comparison, most registered pharmacists perceived they had 10 out of the 16 listed attributes. The findings of this study suggested that pharmacy graduates should be better prepared to deliver patient care, and that curriculum redesign with expansion of experiential learning is required.

Background: Carers (or care partners) of adults in LTC contribute substantially to the health and well-being of their loved ones by providing physical care, emotional support, and companionship. Despite their critical role, little is known about how caregivers have been impacted by the pandemic. The purpose of this study was to explore the lived experiences of caregivers of people living in long-term care (LTC) homes during the initial phases of the COVID-19 pandemic and potential supports and resources needed to improve caregivers’ quality of life.Design: An interpretive descriptive approach that incorporated photovoice method was used. Methods: Using purposive sampling strategy, six family carers in Ontario, Canada were recruited between September and December 2021. Over a four-week period, caregivers took pictures depicting their experience of the pandemic that were shared in a virtual focus group. Visual and text data were analyzed using thematic analysis with an inductive approach.Findings: Caregivers expressed feelings of frustration, confusion, and joy. Emerging themes included: (i) feeling like a “criminal” amidst visitor restrictions and rules; (ii) experiencing uncertainty and disappointment in the quality of care of long-term care homes; (iii) going through burnout; and (iv) focusing on small joys and cherished memories.Conclusions: The combination of visual and textual methods provided unique insight into the mental distress, isolation, and intense emotional burdens experienced by caregivers during the pandemic. Impact: Our findings underscore the need for LTC organizations to work in unison with caregivers to optimize the care of residents and support mental health of caregivers.

Canadians overwhelmingly do not want to live in long-term-care (LTC) facilities when they age; yet many end up there for lack of homecare, because family caregivers burn out, or because they and their professional advisors are unaware of alternatives to institutions. Not only is institutional dementia care problem-driven, it segregates disabled people, thereby abrogating human rights. Because systemic ageism and ableism cloud elder care, institutions remain the default option for Canadians with dementia. Yet, decades of deinstitutionalization enabled younger disabled Canadians to live in the community with supports. Why not elders? We describe a plethora of noninstitutional dementia-care alternatives. We then present a roadmap for considering all relevant care options in service plans, one that incorporates supported decision-making by people with dementia. We propose a paradigm shift in how Canada serves its elder citizens—not just the current generation, but those to come, including ourselves.

Background and Objectives: In recent years, electric scooters have gained widespread popularity as an easy and affordable mode of transport in urban areas worldwide. Simultaneously, trauma centres have observed an increasing number of associated injuries to users. While injury patterns associated with other vehicles are now well-researched, electric scooter-related injuries are a new topic in the literature. Our study aims to investigate the disparities in injury patterns and other critical accident characteristics among bicycle, electric scooter, and scooter riders. Materials and Methods: In this one-year prospective observational study, we examined patients who sustained injuries while riding bicycles, electric scooters, or scooters between April 2021 and March 2022 at Hungary's largest trauma centre in Budapest. During this one-year period, we identified 1938 patients, 1378 cyclists, 370 electric scooters and 190 scooter users. We collected basic demographic information, recorded injury type and severity, time of day the injury occurred, and alcohol intoxication. Results: While 4.6% of cyclists and 5.8% of scooter riders had consumed alcohol, 26.8% of electric scooter riders were intoxicated at the time of their accident. 45.8% of electric scooter-related injuries occurred at night, compared to only 9.2% and 14.1% of bike and scooter-related injuries, respectively. Sober patients were more likely to suffer mild and severe limb injuries (Odds Ratio (OR): 3.85, P = .0001 and OR: 3.26, P = .0001), but less likely to experience mild and severe head injuries (OR: 0.1, P = .0001 and OR: 0.25, P = .0001) than intoxicated patients. Cyclists had significantly fewer cases of severe head trauma than those injured while using electric scooters (OR: 0.34, P = .0166). Conclusions: Severe craniofacial injuries are more common in intoxicated patients and in patients injured using electric scooters.

A small proportion of health care users are recognised to use a significantly higher proportion of health system resources, largely due to systemic, inequitable access and disproportionate health burdens. These high-resource health system users are routinely characterised as older, with multiple comorbidities, and reduced access to adequate health care. Geographic trends also emerge, with more rural and isolated regions demonstrating higher rates of high-resource use than others. Despite known geographical discrepancies in health care access and outcomes, health policy and research initiatives remain focused on urban population centers. To alleviate mounting health system pressure from high-resource users, their characteristics must be better understood within the context in which it arises. To examine this, a scoping review was conducted to provide an overview of characteristics of high-resource users in rural and remote communities in Canada and Australia. In total, 21 papers were included in the review. Using qualitative thematic coding, primary findings characterised rural high-resource users as those of an older age; with increased comorbid conditions and condition severity; lower socioeconomic status; and elevated risk behaviours.

Relatives play an important role in mental health service users’ care. Interventions directed either at service users or their relatives may influence the other person as well. The project Activa’t per la salut mental (Get active for mental health) consisted of a series of four interventions addressed at people diagnosed with mental disorders and their relatives to help them in their recovery process, increasing their agency and quality of life. The objective of the present study is to evaluate the interaction of the participation of service users on their relatives’ outcomes and vice versa. The impact of the project was evaluated within an RCT. The treatment group had access to all the circuit interventions while the control group received treatment as usual and could only access one of the interventions. All participants were evaluated at baseline, six months, and twelve months after the end of the first intervention. Service users were evaluated with the Stages of recovery questionnaire, and relatives with the Family Burden Interview Schedule II and the Duke-UNC-11 questionnaires. The interaction between service users and their relatives was analysed by means of correlational analyses within the intervention group. Service users baseline characteristics influenced in the level of participation of relatives and vice versa. The results also indicated an interaction between service users’ recovery score changes on the change of care burden of relatives. Service users’ participation levels interacted with the decrease of relatives’ burden. These results can be extremely helpful in fostering interactive benefits in future projects addressing the wellbeing of mental health service users and their relatives. Future studies could use specific designs to explore the directionality of the causality of these effects.

Hip fractures are an important socio-economic problem in western countries. Over the past 60 years orthogeriatric care has improved the management of older patients admitted to hospital after suffering hip fractures. Orthogeriatric co-management units have increased quality of care, reducing adverse events during acute admission, length of stay, both in-hospital and mid-term mortality, as well as healthcare and social costs. Nevertheless, a large number of areas of controversy regarding the clinical management of older adults admitted due to hip fracture remain to be clarified. This narrative review, centered in the last 5 years, combined the search terms “hip fracture”, “geriatric assessment”, “second hip fracture”, “surgery”, “perioperative management” and “orthogeriatric care”, in order to summarise the state of the art of some questions such as the optimum analgesic protocol, the best approach for treating anemia, the surgical options recommendable for each type of fracture and the efficiency of orthogeriatric co-management and functional recovery.

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

This work presents the synthesis and self-organization of the calamitic fluorinated mesogen, 1,1,2,2-tetrafluoro-2-(1,1,2,2-tetrafluoro-4-iodobutoxy)ethanesulfonic acid, a potential model for perfluorosulfonic acid membranes (PFSA). The compound is derived in three steps from 1,1,2,2-tetrafluoro-2-(1,1,2,2-tetrafluoro-2-iodoethoxy)ethanesulfonyl fluoride, achieving an 78% overall yield. The resulting compound exhibits intricate thermal behavior. At 150 °C, a crystal-to-crystal transition is observed due to the partial disordering of calamitic molecules, which is followed by isotropization at 218 °C. Upon cooling, sample ordering occurs through the formation of large smectic liquid crystalline phase domains. This thermotropic state transforms into a layered crystal phase at lower temperatures, characterized by alternating hydrophilic and hydrophobic layers. Using X-ray diffraction, crystalline unit cell models at both room temperature and 170 °C were proposed. Computer simulations of the molecule across varying temperatures support the idea that thermal transitions correlate with a loss of molecular orientation. Importantly, the study underscores the pivotal role of precursor self-organization in aligning channels during membrane fabrication, ensuring controlled and oriented positioning.

We measured the anelastic, dielectric and structural properties of the metal-free molecular perovskite (ABX$_{3}$) (MDABCO)(NH$_{4}$)I$_{3}$, which has already been demonstrated to become ferroelectric below $T_{\text{C}}=$ 448~K. Both the dielectric permittivity measured in air on discs pressed from powder and the complex Young's modulus measured on resonating bars in vacuum show that the material starts deteriorating with loss of mass just above $T_{\text{C}}$, introducing defects and markedly lowering $T_{\text{C}}$. The elastic modulus softens of 50\% when heating through the initial $T_{\mathrm{C}}$, contrary to usual ferroelectrics, which are stiffer in the paraelectric phase. This suggests improper ferroelectricity, where the primary order parameter of the transition is not the electric polarization, but the orientational order of the MDABCO molecules. The degraded material presents thermally activated relaxation peaks in the elastic energy loss, whose intensities increase together with the decrease of ~$T_{\mathrm{C}}$. The peaks are much broader than pure Debye, due to the general loss of crystallinity, also apparent from X-ray diffraction, but their relaxation times have parameters typical of point defects. It is argued that the major defects should be of the Schottky type, mainly due to the loss of (MDABCO)$^{2+} $ and I$^{-}$, leaving charge neutrality, and possibly also (NH$_{4}$)$^{+}$ vacancies. The focus is on an anelastic relaxation process peaked around 200~K at $\sim 1$~kHz, whose relaxation time follows the Arrhenius law with $\tau $$_{0}$~$\sim $\ $10^{-13}$\ s and $E\simeq 0.4$~eV. This peak is attributed to I vacancies (V$_{\text{X}}$) hopping around MDABCO vacancies (V$_{\text{A}}$) and its intensity presents a peculiar dependence on temperature and content of defects. The phenomenology is thoroughly discussed in terms of lattice disorder introduced by defects and of partition of V$_{\text{X}}$ among sites that are far from and close to the cation vacancies. A method is proposed for calculating the relative concentrations of V$_{\text{X}}$, that are untrapped, paired with V$_{\text{A}}$ or forming V$_{\text{X}}$--V$_{\text{A}}$--V$_{\text{X}}$ complexes.

In the realm of autonomous vehicle environment perception, the primary objective of point cloud target detection is to swiftly and accurately identify three-dimensional objects from point cloud data. To meet this requirement, the prevalent network architecture employed in the industry is the voxel-based PointPillars model. Nonetheless, this model faces challenges in maintaining detection accuracy when objects are obscured or diminutive in size. In response to this issue, we introduce AGPNet, a novel model that seamlessly integrates four key modules: Data Augmentation, Dynamic Graph CNN, Pillar Feature Net, and Detection Head (SSD). The Data Augmentation module enhances the adaptability of point cloud data to complex and ever-changing real-world environments. The Dynamic Graph CNN module endows the network structure with geometric features, which encapsulate not only the point itself but also its adjacent points. The Pillar Feature Net module translates three-dimensional point cloud data into pseudo-image data through the utilization of voxels. Subsequently, the Detection Head (SSD) module leverages this pseudo-image data to conduct target detection of three-dimensional objects. Our experiments, conducted on the KITTI dataset, demonstrate that our proposed method boosts object detection accuracy by 6-7 percentage points compared to the PointPillars model, while maintaining similar detection times.

Hydraulic conductivity is the key and one of the most uncertain parameters in groundwater modeling. The grid based numerical simulation require spatial distribution of sampled hydraulic conductivity at un-sampled locations in the study area. This spatial interpolation has been routinely performed using variogram based models (two-point geostatistics methods). These traditional techniques fail to capture the complex geological structures, provides smoothing effects and ignore the higher order moments of subsurface heterogeneities. In this work, a multiple-point geostatistics (MPS) method is applied to interpolate hydraulic conductivity data which will be further used in WASH123D numerical groundwater simulation model for regional smart groundwater management. To do this, MPS need ‘training images (TIs) as a key input. TI is a conceptual model of subsurface geological heterogeneity which was developed by using concept of ages, topographic slope as an index criteria and knowledge of geologist. After considerations of full physics of study area, an example shows the advantages of using multiple-point geostatistics compared with the traditional two-point geostatistics methods (such as Kriging) for the interpolation of hydraulic conductivity data in a complex geological formation.

This paper aims to introduce the notions of various types of Qc-contractions for which we establish some fixed circle and fixed disc theorems in the setting of metric spaces. Some illustrative examples are also provided to support our results. Moreover, we present some fixed circle and fixed disc results of integral type contractive self-mappings.

In this paper, inspired by Jleli and Samet [journal of inequalities and applications 38 (2014) 2 1–8] we introduce two new classes of auxiliary functions and utilize the same to define (q, y)R-weak 3 contractions. Utilizing (q, y)R-weak contractions, we prove some fixed point theorems in the setting 4 of relational metric spaces. We employ some examples to substantiate the utility of our newly proved 5 results. Finally, we apply one of our newly proved results to ensure the existence and uniqueness of 6 solution of a Volterra-type integral equation.

This short communication makes use of the principle of singular perturbation to approximate the ordinary differential equation (ODE) of prompt neutron (in the point kinetics model) as an algebraic equation. This approximation is shown to yield a large gain in computational efficiency without compromising any significant accuracy in the numerical simulation of primary coolant system dynamics in a PWR nuclear power plant. The approximate (i.e., singularly perturbed) model has been validated with a numerical solution of the original set of neutron point-kinetic and thermal–hydraulic equations. Both models use variable-step Runge–Kutta numerical integration.

Laser scanning is an effective tool for acquiring geometric attributes of trees and vegetation, which lays a solid foundation for 3-dimensional tree modelling. Existing studies on tree modelling from laser scanning data are vast. Nevertheless, some works don’t ensure sufficient modelling accuracy, while some other works are mainly rule-based and therefore highly depend on user inputs. In this paper, we propose a novel method to accurately and automatically reconstruct tree branches from laser scans. We first extract an initial tree skeleton from the input tree point cloud, then simplify the skeleton through iteratively removing redundant components. A global-optimization approach is performed to fit a sequence of cylinders to approximate the geometry of the tree branches. Experiments on various types of trees from different data sources demonstrate the effectiveness and robustness of our method. The resulted tree models can be further applied in the precise estimation of tree attributes, urban landscape visualization, etc.

How to disentangle the possible genuine quenching of gA caused by scale anomaly of QCD parameterized by the scale-symmetry-breaking quenching factor qssb from nuclear correlation effects is described. This is done by matching the Fermi-liquid xed (FLFP) point theory to the "Extreme Single Particle (shell) Model" (acronym ESPM) in superallowed Gamow-Teller transitions in heavy doubly-magic shell nuclei. The recently experimentally observed indication for (1-qssb) ≠0 - that one might identify as "fundamental quenching (FQ)" - in certain experiments seems to be alarmingly signicant. I present arguments how symmetries hidden in the matter-free vacuum can emerge and suppress such FQ in strong nuclear correlations. How to conrm or refute this observation is discussed in terms of the superallowed Gamow-Teller transition in the doubly-magic nucleus 100Sn and in the spectral shape in the multifold forbidden β decay of 115In.

This study presents established methods, along with new algorithmic developments, to automate the point cloud processing within the Field Information Modeling (FIM)™ framework. More specifically, given an n-D designed information model, and the point cloud’s spatial uncertainty, the problem of automatic assignment of the point clouds to their corresponding elements within the designed model is considered. The methods addressed two classes of field conditions, namely, (i) negligible construction errors; and (ii) existence of construction errors. The emphasis was given to describing and defining the assumptions in each method and shed light on some of their potentials and limitations in practical settings. Considering the shortcomings of current point cloud processing frameworks, three new and generic algorithms were developed to help solve the point cloud to model assignment in field conditions with both negligible, and existence (or speculation) of construction errors. The effectiveness of the new methods was demonstrated in real-world point clouds, acquired from construction projects, with promising results.

Our objective was to evaluate whether pregnancy is prolonged by use of a proteomics-based maternal serum screening test followed by treatment interventions. This is a secondary analysis of the PREVENT-PTB randomized trial comparing screening with the PreTRM test versus no screening. The primary trial analysis found no significant between-group difference in preterm birth rate. Rather than considering a dichotomous outcome (preterm vs term), we treated gestational age at birth as a continuous variable using survival analysis. We also evaluated between-group difference in NICU length of stay and duration of respiratory support. Results indicated that pregnancy was significantly prolonged in subjects screened with PreTRM test compared to controls (adjusted hazard ratio 0.53, 95% confidence interval 0.36-0.78, P &lt;0.01). Newborns of screened subjects had significantly shorter NICU stay but no significant decrease in duration of respiratory support. In the PreTRM screen-positive group, interventions that were associated with pregnancy prolongation included care management and low-dose aspirin but not 17-hydroxyprogesterone caproate. We concluded that screening with the PreTRM test followed by interventions for screen-positive pregnancies can prolong pregnancy and reduce NICU-LOS.

I show how the quantum paradoxes occurring when we adopt a standard realist framework (or a framework in which the collapse implies a physical change of the state of the system) vanish if we abandon the idea that a measurement is related (directly or indirectly) to a physical change of state. In Convivial Solipsism, similarly to Everett’s interpretation, there is no collapse of the wave function. But contrary to Everett’s interpretation, there is only one world. This allows also to get rid of any non-locality and to provide a solution to the Wigner’s friend problem and its more recent versions.

We propose a new theory beyond the standard model of elementary-particle physics. Employing the concept of a quantized spacetime, our theory demonstrates that the zero-point energy of the vacuum alone is sufficient to create all the fields, including gravity, the static electromagnetic field, and the weak and strong interactions. No serious undetermined parameters are assumed. Furthermore, the relations between the forces at the quantum-mechanics level is made clear. Using these relations, we quantize Einstein’s gravitational equation: Beginning with the zero-point energy of the vacuum, and after quantizing Newtonian gravity equation, we combine the energies of a static electromagnetic field and gravity in a quantum spacetime. Applying these results to the Einstein gravity equation, we substitute the energy density derived from the zero-point energy in addition to redefining differentials in a quantized spacetime. This is how we derive the quantized Einstein gravitational equation without assuming the existence of macroscopic masses. For the weak interaction, by considering plane-wave electron and the zero-point energy, we obtain a wavefunction that represents a β collapse. In this process, from a different point of view than Weinberg-Salam theory, we derive the masses of the W and Z bosons and the neutrino, and we calculate the radius and lifetime of the neutron. For the strong interaction, we previously reported an analytical theory for calculating the mass of a proton by providing a specific linear attractive potential obtained from the zero-point energy, which agrees well with the measurements. In the present study, we further calculate the strong interaction between two nucleons, i.e., the mass of the pi-meson. The resulting calculated quantities agree with the measurements, which verifies our proposed theory.

Deep learning image reconstruction (DLIR) algorithms employs convolutional neural networks (CNNs) for CT image reconstruction to produce CT images with a very low noise level, even at low radiation dose. The aim of this study was to assess whether the DLIR algorithm reduces the CT effective dose (ED) and im-proves CT image quality in comparison with filtered back projection (FBP) and iterative reconstruction (IR) algorithms in intensive care unit (ICU) patients. We identified all consecutive patients referred to the ICU of a single hospital who underwent at least two consecutive chest and/or abdominal contrast-enhanced CT scans within a time period of 30 days using DLIR and subsequently FBP or IR algorithm (Advanced Mod-eled Iterative Reconstruction model-based algorithm [ADMIRE], or Adaptive Iterative Dose Reduction 3D [AIDR 3D]) for CT image reconstruction. The radiation ED, noise level, and signal-to-noise ratio (SNR) were compared between the different CT scanners. The non-parametric Wilcoxon test was used for statistical comparison. Statistical significance was set at p < 0.05. A total of 83 patients (mean age, 59 ± 15 years [standard deviation]; 56 men) were included. DLIR vs FBP reduced ED (18.45 ± 13.16 mSv vs 22.06 ± 9.55 mSv, P < 0.05), while DLIR vs FBP and vs ADMIRE and AIDR 3D IR algorithms reduced image noise (8.45 ± 3.24 vs 14.85 ± 2.73 vs 14.77 ± 32.77 and 11.17 ± 32.77\, P < 0.05) and increased SNR (11.53 ± 9.28 vs 3.99 ± 1.23 vs 5.84 ± 2.74 and 3.58 ± 2.74, P < 0.05). CT scanners employing DLIR reduced radiation ED and im-proved SNR compared to CT scanners using FBP, whereas CT scanners using DLIR improved SNR com-pared to CT scanners using FBP or IR algorithms in ICU patients.

Background: We assessed the pertinence of yearly updating the International Working Group on the Diabetic Foot (IWGDF) risk classification in people with diabetes by quantifying the changes in the risk group and its accuracy in identifying those developing an ulcer (DFU) in a primary care setting. Methods: In our retrospective cohort study, we included all people with diabetes with a foot as-sessment registry between January 2016 and December 2018 in the Baixo Alentejo Local Health Unit. Foot-related data was collected at baseline after one and two years. DFU and/or death until December 2019 were registered. The proportion of people changing their risk status each year was calculated. Accuracy measures of the IWGDF classification to predict DFU occurrence at one, two, and three years were calculated. Results: A total of 2097 people were followed for three years, during which 0.1% died, and 12.4% developed a DFU. After two years, 3.6% of the participants had progressed to a higher-risk group. The IWGDF classification presented specificity values superior to 90% and negative predictive values superior to 99%. Conclusion: Foot risk status can be safely updated every two years instead of yearly. The IWGDF classification can accurately identify those not at risk of DFU.

Among natural disasters, earthquakes have a considerable impact and are among the ten deadliest, with an extreme impact on the healthcare sector. This study aimed to analyze best practices in nursing care for earthquake victims. An in-depth analysis was carried out by using a scoping review, a method used in accordance with the PRISMA-ScR recommendations to identify best nursing practice in these circumstances based on searches of eight databases: MEDLINE via PubMed; Cochrane Library; Embase; VHL; PDQ-Evidence; Scopus; ProQuest; Google Scholar. Twenty-one studies were selected. The nursing practices identified were grouped into two distinct dimensions, each subdivided into four subcategories: (i) care practices: a) immediate care, b) intermediate care, psychosocial care and d) ethical care; (ii) care management and coordination practices, which cover (a) care coordination, (b) victim care network organization, (c) teamwork and (d) training. By analyzing these nursing practices during care and relief operations for earthquake victims, this study identified the various actions carried out, the nursing skills to be developed and the reinforcement of these advanced practices through the systematization of nurses’ skills, in order to promote victims’ rehabilitation, minimize their suffering and improving their quality of life during and after an earthquake.

Over the years there has been an increase in the development of assistive technologies (AT’s). The implementation and scaling of AT’s at care organizations remains challenging. Moreover, to date, it has been underexplored during which stages of dementia these technologies can be best implemented. Previous work has developed an infographic providing guidance on when best to introduce AT’s for people with dementia. Although this infographic is relevant, it was based solely on the experience of the authors during various national and international projects. However, over the years a wide spread of studies has been conducted in the field of dementia on the use and implementation of technology for PwD. Therefore, in this paper we will revise the current infographic based on the insight gained from existing literature and complement these by interviews with expert on the implementation of care technology

In 2021, the American Association of Colleges of Nursing (AACN) added “the impact of climate change on environmental and population health” into The Essentials: Core Competencies for Professional Nursing Education. Presently, little guidance exists for nursing faculty new to climate education. The year prior, the Nurses Climate Challenge (NCC) - a campaign to educate 50,000 health professionals about health impacts of climate change - launched the School of Nursing Commitment through a series of focus groups and collaborative content development. With an aim of increasing access to knowledge and tools to support education about the health impacts of climate change, the NCC Commitment partners with nursing schools and provides a community of practice. Partner schools use NCC resources in courses and report the number of students educated. Within three years, 61 nursing schools in 30 states joined the Commitment. Participants included academic health centers, research institutions, multi-state schools, and small private colleges, and programs ranged from AD to PhD. Faculty 1) integrated resources into didactic and clinical settings such as population or organ-system content, leadership, and policy and 2) used resources to support assignments. In four years, faculty reported educating over 37,700 students using NCC resources in 439 educational sessions. The Commitment may be valuable for faculty fulfilling AACN Essentials by bringing climate change to the classroom, community, and bedside. Furthermore, the Commitment may be a replicable model for health professional education and inspiring action on climate change.

Prior work has suggested that discrimination and immigration-related stress may impede mental health care seeking and utilization among Latinx populations. These effects may be more nuanced as both discrimination and immigration-related stress may increase symptomology, particularly posttraumatic stress disorder (PTSD) and depression. Both symptoms may in turn prompt attempts to seek care. The current study examined the direct effects of discrimination and immigration-related stress on care access, as well as potentially indirect effects with PTSD and depression symptoms as mediators. Interviews and online surveys were completed with 234 Latinx residents of the Midwest assessing everyday discrimination, discrimination in healthcare, PTSD symptoms, depression symptoms, current mental health utilization, and previous unsuccessful attempts to seek care. Direct effects of discrimination and immigration-related stress were largely unrelated to care access variables. Discrimination in healthcare settings predicted both unsuccessful attempts to seek care and current use, but this effect was positive. The indirect effect was largely supported, but only for PTSD symptoms and not depression. Results indicate further investigation is necessary to understand the direct effects of discrimination on care access. Further, discrimination and immigration-related stress may indirectly prompt attempts to seek mental health care.

Lophomonas are flagellated protozoa which have been increasingly associated with upper and lower airway infection in humans. The prevalence and characterization of this disease in the critically ill remains poorly understood. We present a series of eleven ICU patients with confirmed Lophomonas spp. identification in respiratory samples.

Despite the advancements in evidence-based medicine, many hospitals still maintain high rates of patients undergoing prolonged preoperative fasting. The goal of this study is to determine the prevalence of prolonged fasting time among patients undergoing elective surgeries at a Brazilian university hospital and its associations with clinical and sociodemographic variables. This cross-sectional study was conducted between May and November 2019 and included patients of all ages undergoing elective surgeries. Out of the 293 patients analyzed, 64.2% were male, with ages ranging from 1 to 85 years, and 93.9% were classified as ASA I or II. The prevalence of preoperative fasting exceeding 8 hours was 89.4%. An average fasting time exceeding 11 hours was observed across all age groups. Patients who underwent procedures in the afternoon had an average fasting time that was 16% longer than those in the morning period (13.84 vs. 11.92, p<0.001). Surgery time (r=0.134, p<0.03) and anesthesia times (r=0.121, p<0.04) demonstrated a weak correlation with fasting time. Despite the international consensus on preoperative fasting time, our study demonstrated low adherence to current recommendations. Therefore, healthcare professionals should ensure the comprehension of fasting guidelines, and further studies should aim to identify effective solutions to mitigate prolonged fasting.

The maternal death rate remains high in South Africa despite the availability of many existing strategies to improve the quality of service. A 30% increase in maternal mortality rate was reported between 2020-2021, with Limpopo ranking fourth highest out of nine provinces. Vhembe district remained number three with a high maternal death rate. This study explored strategies to reduce the maternal death rate and improve the provision of quality maternal healthcare services in selected hospitals of Vhembe district, Limpopo province. One hospital was purposively sampled from every four municipalities. A qualitative approach using phenomenological design was employed. Twenty-eight participants were sampled using a convenience sampling method. The semi-structured interview guide was used to collect data. An audio recorder was also used until data saturation. Data saturation was reached at the 20th participant, but the researcher continued until 28 sampled participants were interviewed. Interpretative phenomenological analysis was used following the analytical stages of interpretative data analysis. The study proposal was ethically cleared by the University of Venda Ethics Committee (FHS/22/PH/08/3108). Results indicate that despite implementing strategies to improve maternal healthcare services and reduce the maternal death rate, several factors, such as lack of material resources, shortage of staff, incompetent staff, and poor infection control, affect the quality of maternal health service in Vhembe district. Limpopo Department of Health and hospital management should ensure that hospitals have all necessary resources and support healthcare professionals through in-service training to ensure the functionality of existing strategies.

Background: There are ongoing workforce challenges with the delivery of long-term care (LTC), such as staffing decisions based on arbitrary standards. The Synergy tool, a resident-centered approach to staffing, pro-vides objective, real-time acuity and dependency scores (Synergy scores) for residents. The purpose of this study was to implement and evaluate the impact of the Synergy tool on LTC delivery. Methods: A longitudinal mixed methods study took place within two publicly-funded LTC homes in British Columbia, Canada. Quantitative data included weekly Synergy scores for residents (24 weeks), monthly aggregated resident falls data (18 months) and a six-month economic evaluation. Qualitative data were gathered from family caregivers and thematically analyzed. Results: Quantitative findings from Synergy scores revealed considerable variability for resident acuity/dependency needs within and across units; and falls decreased during implementation. The six-month economic evaluation demonstrated some cost savings by comparing Synergy tool training and implementation costs with savings from resident fall rates reductions. Qualitative analyses yielded three positive impacts themes (improved care delivery, better communication, and improved resident-family-staff relationships), and two negative structural themes (language barrier and staff shortages). Conclusions: The Synergy tool provides useful data for enhancing a ‘fit’ between resident needs and available staff.

Background : Diabetic wounds are very easy to experience complications in the form of infection due to bacterial invasion, and sugar conditions blood which tall encourage the growth of bacteria.Bacteria that can cause infection in diabetic wounds wrong one is staphylococci aureus . Wound diabetes can treated with honey. Honey contains antibacterial , antioxidant and hydrogen peroxide properties that help kill bacteria dangerous. Objective : The purpose of this study was to determine the effect of the wound dressing contains honey against bacterial colonization Staphylococcus aureus on wound diabetic . Methods : The research design used is pre-experimental with o ne-group pre-test and post-test design . Sampling method using consecutive sampling as many as 7 respondents. Results : Analysis data use test dependent t-test and obtained score p value 0.000 ( p value < = 0.05), so could concluded there is influence care wound use honey to colonization bacteria Staphylococcus aureus in wounds diabetic Diabetes Mellitus patients in the region work Public health center Banjarmasin . Conclusion : best Use honey as product care wound because nature the antibacterial which could prevent infection and speed up process healing wound .

BackgroundGood management behavior in patients with diabetes mellitus can reduce disease complications and improve quality of life. This philosophical problem is very important for nurses who are able to provide management care for diabetic patients. The purpose of this literature review is to describe the concept, model or theory that can be used in improving the management of diabetes mellitus patients.MethodsThe method used is by searching several studies published through the Scopus database, PubMed, CINAHL, SpingerLink, and web of science (WOS). The search strategy uses a combination of the terms MeSH Terms. The research questions were designed using the principles of the PICOS framework. Selected studies were published from 2017-2022.ResultsA total of 15 studies were included, with 12 using quantitative methodology and 3 were qualitative. The studies were conducted across various countries. The majority of articles used the concept of self-management intervention based on digital-based development and e-health (n=6), Dorothea Orem's self-care deficit nursing theory n=2) and the transtheoretical model (n=2). These concepts, models and theories are able to improve good self-management through lifestyle changes, psychosocial, cultural acculturation and increase in spiritual values (n=6).ConclusionTransitional change focuses on changing the modifiable factors found in the concepts, models and theories of the articles obtained. Future research can be developed to assess the existence of elaborations and modifications based on the philosophy that people with diabetes are responsible for their own health.

Objective: Several authors have analyzed the impact of the pandemic on the incidence rates of different conditions. Our aim was to analyze the impact of the COVID-19 pandemic on primary care new diagnoses of respiratory diseases. Methods: This was an observational retrospective study performed to describe the impact of COVID-19 pandemic on primary care new diagnosis of respiratory diseases other than lung cancer. Incidence rate ratio between pre-pandemic and pandemic period was calculated. Results: We found an decrease in the incidence of respiratory conditions (IRR 0.65) during the pandemic period. When we compared the different groups of diseases according to ICD-10, we found a significant decrease in the number of new cases during the pandemic period, except in the case of pulmonary tuberculosis, abscesses or necrosis of the lungs and other respiratory complications. Instead, we found increases in new diagnoses of flu and pneumonia (IRR 2.17) and respiratory interstitial diseases (IRR 1.41). Conclusion: There has been a decrease in new diagnosis of most respiratory diseases during the COVID-19 pandemic. The real clinical impact of this situation is still unknown. Large-scale real-life studies will make it possible to evaluate the long-term true impact of COVID-19 pandemic on the respiratory diseases management.

Background: in 2016 an IT system was developed at MUL for the documentation of nursing practice. Preparing nursing students for the implementation of eHealth solutions under simulated conditions is crucially important for achieving digital competencies necessary for the health care systems in the future. Scientific evidence demonstrates that the use of an IT system in clinical practice shortens the time required for preparation of documentation, increases the safety of clinical decisions and provides data for analysis and for creation of predictive models for the purposes of HB HTA. Methods: The system was created by cooperation of an interprofessional team at the Medical University of Łódź. The ADPIECare system was implemented in 2016 at 3 universities in Poland, and in 2017 a study of its usability was conducted using a questionnaire made available by Healthcare Information and Management Systems Society “Defining and Testing EMR Usability MASTER V2 Final” on 78 nurses — students of MA in Nursing at Medical University of Łódź. Findings: Over 50% of the surveyed nurses have indicated the usability of the system for the “effectiveness of documentation” variable. The same group of respondents have confirmed that a positive attitude towards patient care planning with the use of the assessed system. In the opinions of the examined parties positive opinions predominated, such as e.g.: “the system is intuitive,” “the system facilitates work,” “all patient assessments are in one place,” “the time needed for data entry would be shortened.”

Background and Aim: Multiple sclerosis (MS) is known as an autoimmune disease and a chronic inflammatory condition, inducing a wide variety of mood affective disorders, including depression and feelings of hopelessness in many aspects of patients’ quality of life (QoL). In view of the positive side effects of spirituality and spiritual care on finding appropriate strategies for further adaptation, this study aimed to determine the impact of group spiritual care (GSC) on levels of hope in patients suffering from MS. Materials and Methods: This clinical trial was conducted on a total number of 96 patients with MS, referring to the National Multiple Sclerosis Society (NMSS) in the city of Zahedan, Iran. Following sample selection via the convenience sampling technique, the patients meeting the inclusion criteria were randomized into two groups, i.e., intervention and control. The data collection tools for this purpose included a demographic information form and the Adult Hope Scale (AHS, Snyder et al. 1991), completed by the subjects at the pre- and post-intervention stages. As well, the intervention group received five sessions of GSC during three weeks but the control group members only talked over daily issues along with their mental health problems. The data were also analyzed using the SPSS Statistics software (ver. 14). Results: The Kruskal-Wallis test results revealed that the GSC intervention could have a significant positive effect on raising hope in the patients with MS (p<0.001). Moreover, a significant growth was observed in the scores of hope dimensions including agency and pathway (p<0.001). Conclusion: GSC can effectively boost levels of hope in patients suffering from MS in all dimensions. Therefore, it is recommended to utilize this type of care in order to nurture hope in such individuals.

Delirium occurs in 50-80% of end-of-life patients but it is often misdiagnosed. Identification of clinical factors potentially associated with delirium onset can lead to a correct early diagnosis. To this aim, we conducted an observational prospective study on patients from an Italian Palliative Care Unit (PCU) in 2018-2019 and evaluated the presence of clinical factors at patients’ admission. We then compared their presence in patients who developed delirium and in those who did not during follow-up. On 503 enrolled patients, 95 (18.9%) developed delirium. In univariate analyses, factors significantly more frequent in patients with delirium were advanced age, care in hospice, very compromised performance status, hypoxia, high number of simultaneous clinical factors, presence of breathlessness, poor well-being, severe drowsiness, and background therapy with haloperidol and drugs acting on CNS. In multivariate analyses, setting of care (odds ratio, OR, 1.68 for hospice versus home care, 95% confidence interval, CI 1.02-2.75; p=0.040), and administration of psychiatric drugs (OR 1.74 for administration versus no administration, 95% CI 1.08-2.81; p=0.023) were significantly associated with the risk of developing delirium, while the associations with age (OR 1.82 for > 80 years versus ≤ 70 years, 95% CI=0.98-3.36; p=0.046) and presence of breathlessness (OR 1.70, 95%, CI 0.99-2.89, p=0.053) were of borderline significance. The study indicates that some clinical factors are associated with the probability of delirium onset. Their evaluation in PC patients could help the healthcare professionals to timely identify the development of delirium in those patients.

Background: Distance to a health facility for inpatient care in developing countries has been a huge hindrance towards the achievement of the Sustainable Development Goal three. The United Nation encourages countries to research on access to inpatient care, so as to form health policies based on data. Methods: Data on four hundred and eighty-one participants of all ages from forty-seven counties in Kenya who sought inpatient care in Kenya in 2018 were analyzed. Distance to a health facility was captured as a continuous variable and was self-reported by the respondent. The response exhibited a discrete mass at zero and continuous characteristic, therefore a Tweedie distribution was adopted for modelling. Due to the correlation nature of clustered data, we embraced the Generalized Estimating Equations approach with an exchangeable correlation. Since no standard software was available to analyze this problem, we developed an R functions. We assessed the best model fit using the QICu and criteria, in which the lowest value for the former and the highest for the later are preferred.Findings: Differences in employment, ability to pay for the service and household size are associated with the distance covered to access government facilities. Interpretation: Poor people tend to have large households and are more likely to live in rural areas and slums, thus are forced to travel for long distance to access inpatient care. Compared to unemployed, the employed could have better socio-economic status and possibly live within reach of the inpatient health facilities, therefore travel less distances to access. Longer distances are associated with high payments, signifying some form of specialized treatment care due to the complexity of the medical cases, that are expensive to treat.

Aims and Objectives: Our primary aim was to study association between nonsurgical techniques related complications and mortality and our secondary aim was to determine factors responsible for non surgical technique related complications. Material and Methods: All gastrointestinal and hepatobiliary procedures performed in last 3 years have been evaluated retrospectively. Nonsurgical procedure related postoperative complications were defined as perioperative complications nonrelated to surgical procedures or techniques and related to patients’ physiological health or comorbidities. To avoid selection bias in attempt to evaluate effect of non-surgical procedural related complication on mortality, we did 1:1 propensity score matching analysis with nonsurgical technique related complications as dependent factor. Propensity scores were calculated using logistic regression. Pre operative confounding factors like age, sex, American society of Anesthesia score (ASA), emergency surgery, type of surgeries like HPB surgeries, Upper gastrointestinal surgeries, small bowel surgeries, colorectal surgeries, hernia surgeries, open or laparoscopic surgeries were entered in model as covariates. We used nearest neighbor matching protocol with a calipher of 0.2. Cases were not reusable after matching. Statistical analysis was done using SPSS version 23. Results: Total 348 patients underwent various abdominal surgeries (gastrointestinal and hepatobiliary) in our department from April 2017 to March 2020. Total 24 patients developed nonsurgical technique related complications. Before Propensity score matching nonsurgical technique related complications were significantly higher in Upper Gastrointestinal surgeries (gastric and esophageal), emergency surgeries, Open surgeries, in patients who developed intraoperative hypotension, patients operated for malignancies, patients with higher ASA grades, patients in whom more blood products were used and patient who had more operative time. ASA scores independently predicted nonsurgical technique related complications. [P=0.001. Odds Ratio 3.955 (95% C.I.) 1.774-8.813)]. After Matching 24 patients patients were included in nonsurgical complication related complication group and they were compared with 23 matched controls. After matching also nonsurgical procedural related complications were significantly associated with mortality. (p< 0.0001). No intraoperative factors like intraoperative hypotension, blood product requirement, operative time predicted non-surgical technique related complication. Surgery related complications were not associated with mortality after matching. Conclusion: Nonsurgical technique related complications are associated with significant increase risk of mortality.

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a disabling condition affecting millions of adults and children worldwide. Despite the development of multiple criteria sets for defining this disorder, agreement on the core symptoms and other implications of ME/CFS point to the importance of understanding their role in oral health care. Overall, care for the homebound and bedbound population with ME/CFS issues has been under-addressed in the literature to date and there has been little consideration of the oral health needs of this population. Evaluation, diagnosis and treatment of dental concerns may be hindered by many of the diverse symptoms of ME/CFS. The present paper utilizes the International Consensus Criteria (ICC) in discussing treatment considerations for the most severely affected patients with ME/CFS, both in oral evaluation and active care. While no specific dental pathology is linked to ME/CFS, proper care for the patient so affected must take into account the disorder’s symptoms and severity.

Although man is still rapidly evolving, he has not co-evolved with all of the modern chemicals made by man, including those in cosmetic products. Care must be taken when formulating products so that commonly used ingredients, such as polyethylene glycol, can be substituted with safer ingredients to which man has adapted and that will not cause irritation and inflammation. This is especially important given that induction of skin inflammation will cause systemic inflammation. A review of the literature and of commercially available products was made to highlight techniques and products that remediate inflammation or induce inflammation. Many skin care products contain chemicals that induce irritation and inflammation that may lead to chronic, systemic inflammation. Well studied natural products, especially skin identical chemicals, may offer an advantage compared to recent man-made chemicals in cosmetic and topical formulations and help to reduce skin inflammation as well as skin derived systemic chronic inflammation.

Importance: Because of the high prevalence of myopia in Taiwan, understanding the risk factors for its development and progression is important to public health. Background: This study investigated the risk factors for myopia and their influence on the progression of myopia in schoolchildren in Taiwan. Design: Patients’ clinical records were obtained retrospectively from ophthalmologists. Questionnaires were given to collect demographic information, family background, hours spent on daily activities, myopia progression, and treatment methods. Participants: A total of 522 schoolchildren with myopia from a regional medical hospital in northern Taiwan participated the study. Written informed consent was obtained from the participants of legal age or the parents or legal guardians. Methods: Multivariable regression analyses were performed. Myopia measured in dioptres was analysed, controlling for patients’ family and demographic information as well as their daily behaviours. Main Outcome Results: Children with high myopic parents were more myopic. Earlier onset age of myopia was associated with a higher level of myopia and greater annual myopic progression. Children reporting more near work activities had higher levels of myopia and greater progression of myopia. Lower levels of myopia were associated with more exercise, longer periods of sleep, and better vision care knowledge in children and parents. Intake of food supplements had no effect on myopia. Conclusions and Relevance: In addition to genetics, education, environment, and near work activity can influence the development of myopia. Health policies for schoolchildren should promote protective activities and vision care knowledge in order to protect the eyesight of schoolchildren.

Human resources are the major input of health systems therefore the equitable distribution of human resources in health care remain critical in making progress towards the goal of universal health coverage and thus to sustainable development. The purpose of this study is to evaluate the health care human resources distribution across regions of Poland between 2010 and 2017 and estimate the level of equity. This research by applying to Polish conditions will allow to fill in the gap in existing literature. Data was derived from the Knowledge Database Health and Health Care of Statistic Poland and Polish Statistical Yearbook. In purpose to examine the distribution of health resources against population size and geographic size in Poland, the Gini coefficient calculated based on the Lorenz Curve was engaged. This study has several major findings. The amount of most types of human resources – as apart from internist, obstetrics and gynecology, occupational medicine - when expressed as number of them per 10,000 population or 1 square km increased in 2017 compared to 2010. Moreover, for most types of health care human resources the level of access slightly changed during analysied period as Gini coefficients decreased. However, the geographical distribution of all types of human resources is less equitable then in case of population distribution. The most troublesome is relatively lower equity in case of oncologist, family medicine and occupational medicine and cardiologist in both population and geographical distribution. Thus this research provides some implications for policy and practice. As the main reason to establish National Health Fund (which meant the centralization of the system) in Poland was to to eliminate regional differences in access to health care, thus this research confirms that still some more corrective actions, in this field, should be undertaken.

The quadruple burden of diseases, early discharge from hospital and hospital at home have resulted in home-based care services becoming a requirement in South Africa. The home-based care services generate a significant amount of health care risk waste that is mismanaged. However, more attention is given to the health care risk waste generated in hospitals and clinics than to health care risk waste generated by home-based caregivers. Therefore, this study investigates the health care risk waste management practices by home-based caregivers. The study adopted a mixed research approach, qualitative and quantitative methods, using a literature review, interviews, and questionnaires as means of data collection. Results show that there are different types of health care risk waste generated as a result of different activities performed by home-based caregivers, but that the waste was found to be managed in an unsafe manner. The majority of households receiving home-based care did not have basic sanitation facilities such as toilets, running water and waste removal services, aggravating the issue of health care risk waste mismanagement. The study recommends a new policy framework that will lead to safe management practices of generated health care risk waste to be adopted by home-based caregivers.

In this study, 6 residents of a long-term care facility were asked to try on Virtual Reality glasses and report their first experiences with Virtual Reality. The results show that Virtual Reality is of great interest to elderly residents of in-patient long-term care facilities. The wearing period was longer than expected and no symptoms of cyber sickness occurred. For the residents it was exciting to explore the virtual environments. Austrian destinations, nature scenes in the mountains and forests but also trips to the zoo, the museum, in churches or even densely populated areas like shopping streets or train stations would be places for the residents, they would like to explore virtually. Far-off destinations such as Rio de Janeiro or the Caribbean are more of an exception. Biographically relevant places such as the parental home or the location of their wedding were not named. Concerning the usability, an adjustment of the VR glasses is necessary for a longer-term use in any case.

Monge-Ampere equations have important research significance in many fields such as geometry, convex geometry and mathematical physics. In this paper, under some superlinear and sublinear conditions, the existence of nontrivial solutions for a system arising from Monge-Ampere equations with two parameters is investigated based on Guo-Krasnosel'skii fixed point theorem. In the end, two examples are given to illustrate our main results.

The study of dog point following has been increasingly popular, at least partially due to the initial claims that dogs outperform apes and the suggestion that our domestication process caused dogs to have a biological capacity to communicate with humans. We take the view that dog pointing is more complicated than was initially reported, and in this study, we explore several potential variables that may make a difference. Our variables include point type (ipsilateral (same-side) vs contralateral (cross-body) points), position (standing vs seated), and distance (proximal vs distal). We find that most dogs follow ipsilateral points while less than half of the dogs in our sample follow contralateral points, and that position and distance also affect dogs’ success. We suggest that dogs acquire ipsilateral points via associative mechanisms, but that contralateral points require the dogs to understand the humans’ communicative intent.

The consumption of fiber in the human diet is a global recommendation to ensure a healthy diet. Quinoa (Chenopodium quinoa Willd.), a gluten-free grain, and chia (Salvia hispanica), a seed, contain high fiber content and both have the potential to be explored in the development of nutraceutical and pharmaceutical formulations. An interesting characteristic of chia is its ability to form viscous mucilage when in contact with water, bringing the prospect of a binder in solid formulations. To produce tablets with a high fiber content, it is more appropriate to transform the material into granules using a wet process, with the help of a tool that exploits this possibility. Therefore, the objective of the present work was to study, using the Mixer Torque Rheometer, the feasibility of using chia as a binder to produce granulated quinoa and the development of chewable tablets. To this end, an experimental design was carried out to evaluate the impact of variables on the rheometer results for subsequent granulation. It was possible to obtain the granulation point for the formulations and after producing the granules, physical tests were carried out in which we noticed improvements in the flow. In the end, a formulation was selected for the development of chewable tablets containing quinoa and chia fibers.

Recently, Li et al [1] investigated the nonlinear Langevin equations existence including two fractional orders with infinite-point boundary conditions. It has shown that the outcomes given it does count on the solution form for which it has boundary values. It means that their solution needs more to be in the final step. In current work, we will have discussion about the existence and uniqueness for the same boundary conditions by investigating the closely explicit solution form that has no boundary values. Numerical example is supported to have more vision to compare the between new and previous results. It turns out that our results are superior.

This paper presents a new algorithm for semi-supervised action recognition using adaptive feature analysis. We model the samples of the same action as the same manifold and those of different actions as different manifolds, and integrate feature correlation mining and visual similarity mining into a joint framework. By maximizing the separability between different classes based on the labeled data, the proposed algorithm learns multiple features from labeled data and utilizes the intrinsic geometric structure of the data distribution between labeled and unlabeled data to boost the recognition. We introduce Projected Barzilai-Borwein (PBB) to train a subspace projection matrix as classifier. Extensive experiments on three benchmark datasets demonstrate that our algorithm outperforms the existing semi-supervised action recognition algorithms when there are a few labeled training samples.

The point cloud is a form of three-dimensional data that comprises various detailed features at multiple scales. Due to this characteristic and its irregularity, point cloud analysis based on deep learning is challenging. While previous works utilize the sampling-grouping operation of PointNet++ for feature description and then explore geometry by means of sophisticated feature extractors or deep networks, such operations fail to describe multi-scale features effectively. Additionally, these techniques have led to performance saturation. And it is difficult for standard MLPs to directly "mine" point cloud. To address above problems, we propose the Detail Activation (DA) module, which encodes data based on Fourier transform after sampling and grouping. We activate the channels at different frequency levels from low to high in the DA module to gradually recover finer point cloud details. As training progresses, the proposed Point-MDA can uncover local and global geometries of point cloud progressively. Our experiments show that Point-MDA achieves superior classification accuracy, outperforming PointNet++ by 3.3% and 7.9% in terms of overall accuracy on the ModelNet40 and ScanObjectNN dataset, respectively. Furthermore, it accomplishes this without employing complicated operations, while exploring the full potential of PointNet++.

The link of fracture analysis of large ships is an essential part of the structural safety of ships. However, the finite element analysis of large structure according to the traditional method not only has high requirements on the computer, but also the influence of the mesh encryption at special locations makes further requirements on the accuracy of the ship. In this paper, based on the extended finite element method (XFEM) and the multi-point constraint method (MPC), the dynamic crack expansion process of the rectangular plate containing cracks under the multi-scale model is comparatively studied by using ABAQUS simulation software Finally, the applicability of the method is verified by applying the multi-scale model of ship nodes. The results show that the computational effort of the multi-scale model is significantly reduced with the same accuracy and allowable error, which proves the accuracy and efficiency of the method.

Ammonia known as harmful gas that could impact on health and environment. Typically, ammonia gas emitted by fertilizer industry, rubber factory, etc. There are many options for advance industry to control ammonia gas pollution, absorption tower using water scrubber and using activated carbon as adsorption reaction could be an option. But for middle- and lower-class industry, it is common in Indonesia, as seen on many rubber factories, ammonia gas pollution is serious problem to control, actually they have used wet scrubber but eficiency is lower about 47%. This study measure performance for ammonia elimination as gas pollutant using absorption tower and adsorption tower in laboratory scale. Using electrochemical gas sensor, we measure both ammonia concentration for inlet and outlet simultaneously to settle saturation point of these two types of ammonia emission control. In conclusion, Ammonia absorbed in water proportional to saturation time and absorbent volume. Highest absorbed ammonia concentration 1.538 mg/L on 4000 mL absorbent. For Adsorption system, saturation time proportional and correlated to adsorbent weight and Adsorption capacity reverse correlated to adsorbent weight. Optimum adsorption point can be achieved from intersection curve between saturation time and adsorption capacity which is 1200 grams adsorbent

This work involves results of research on short-term and long-term DC-drifts in electro-optical modulators based on annealed proton exchange waveguides in LiNbO3 crystals after wafer pre-annealing. The relaxation time of the DC-drift of the operating point for a short-term drift is minutes, and for a long-term drift, hours and days. DC-drift was measured by applying bias voltage and changing crystal temperature. Obtained results shows significant impact on stability of operating point in EO-modulators after treatment of defective structure of the near-surface layer of a LiNbO3 crystal. Treatment of the disturbed near-surface layer of a LiNbO3 crystal results in twice reduction of short-term DC-drift and increase of operation stability of electro-optical modulators during long-term measurement of temperature by activation energy calculation.

In this paper, we consider with a class of system of differential equations whose argument transforms are involution. In this an initial value problem for a differential equation with involution is reduced to an initial value problem for a higher order ordinary differential equation. Than either two initial conditions are necessary for a solution, the equation is then reduced to a boundary value problem for a higher order ODE.

Abstract: This study was aimed to determine the influence of the volume fraction of steel fibers and on fracture parameters of concrete. Fifty notched steel fiber reinforced concrete (SFRC) beams and ordinary concrete beams with dimensions of 100mm×100mm×515mm were cast and tested via three-point bending test. Among them, the type of steel fiber is milling type (MF), and the volume fraction of steel fiber added is 0%, 0.5%, 0.5%, 1.5%, 1.5%, 2%, respectively. The effects of the steel fiber volume fraction (VF) on the critical stress intensity factor (KIC), fracture energy (GF), the deflection at failure(δ0), the critical crack mouth opening displacement (CMODC) and the critical crack tip opening displacement (CTODC)were studied. Through the analysis of test phenomena and test data such as load-deflection (P-δ) curve, load-crack mouth opening displacement (P-CMOD) curve and load-crack tip opening displacement (P-CTOD) curve following conclusions are drawn: With the increase of steel fiber volume fraction, some fracture parameters increase gradually and maintain a certain linear growth. The gain ratio of fracture parameters increases significantly, and the gain effect is obvious. Through this law of growth, the experimental statistical formulas of fracture energy and critical stress intensity factor are summarized.

Indoor Positioning Systems (IPSs) are designed to provide solutions for location-based services. Wireless local area network (WLAN)-based positioning systems are the most widespread around the globe and are commonly found to have a ready-to-use infrastructure composed mostly of access points (APs). They provide useful information on signal strength to be processed by adequate location algorithms, which are not always capable of achieving the desired localization error only by themselves. In this sense, this paper proposes a new method to improve the accuracy of IPSs by optimizing some of their most relevant infrastructure components. Included are the arrangement of APs over the environment, the number of reference points (RPs), and the number of samples per location estimation test. A simulation environment is also proposed, in which the impact of key influencing factors on system accuracy is analyzed. Finally, a case study is simulated to validate an optimal combination of design parameters and its compliance with the requirements of localization error and the limited number of access points. Our simulation results clearly show that the desired localization accuracy, which is set as a goal, can be achieved while maintaining the factors already mentioned at minimal levels, which decreases both system deployment costs and computational effort.