We performed a systematic search and meta-analysis of available literature to determine the safety profile of Cerebrolysin in acute ischemic stroke, filling existing safety information gaps and inconsistent results. We searched EMBASE, PubMed and Cochrane Databases of Systematic Reviews and Clinical Trials up to the end of February 2021. Data collection and analysis was conducted using methods described in the Cochrane Handbook for Systematic Reviews of Interventions. All safety outcomes were analyzed based on risk ratios (RR) and their 95% confidence intervals. The meta-analysis pooled 2202 patients from twelve randomized clinical trials, registering non-statistically significant (p>0.05) differences between Cerebrolysin and placebo throughout main and subgroup analyses. The lowest rate of Serious Adverse Events (SAE), as compared to placebo, was observed for the highest dose of Cerebrolysin (50 mL), highlighting a moderate reduction (RR = 0.6). We observed a tendency of superiority of Cerebrolysin regarding SAE in high dose treatment courses for moderate-severe ischemic stroke, suggesting some effect of the agent against adverse events. This comprehensive safety meta-analysis confirms the safety profile for patients treated with Cerebrolysin after acute ischemic stroke, as compared to placebo.

Acute hospital bed shortage is a serious concern worldwide, constantly involving high-dependency units (HDU), where the non-availability of postoperative beds results in surgery cancellation. In the acute medicine context, the SAFER Red2Green initiative has shown to enhance patient flow.Local problem At the Royal London hospital, in 2016, hospital-initiated cancellations peaked at over 50% weekly due to the inability of high dependency Units (HDU) to discharge step-down patients to the general surgical wards, where bed occupancy was close to 100% and the average length of stay was stable on average close to 7 (+/- 8.6) days.Methods. This was a service improvement research to enhance patient flow which adapted the SAFER Red2Green model to a surgical ward (SAFER Surgery Red2Green). This before-after study involving all 2017 digestive surgery admissions was divided into a three-month feasibility phase followed by a nine-month pilot phase, versus the year 2016 (pre-intervention). Outcome measures: weekly discharges, length of stay (LOS), surgery cancellations, feasibility of a “theatre go” policy, HDU step-downs, 30-day readmissions.Interventions1) Systematic communication of key care plan from the afternoon ward rounds by surgical teams to the nurse in charge; 2) 10 AM Monday-to-Friday multi-disciplinary senior-team daily board round, addressing updated key care plan aimed at early discharges, appropriateness of each inpatient day, causes of delays; 3) hospital and site managers weekly attendance. Results. At three months: +67% discharges/week (p=0.001), -20% LOS (p=0.023), +21% HDU step-downs, (p=0.205). At one year: +10.7% HDU step-downs (p=0.197), increased probability of earlier discharge (p=0.023), -60% hospital-initiated cancellations from 38 to 15 (p>=1), a “Theatre go” policy has been active since month 6. Failed discharges kept at 1.3 %. The MDT board round staff satisfaction rate was over 80%, with key actors’ attendance over 75%. Conclusions. The Barts SAFER Surgery R2G model safely enhanced patient flow and reduced cancellations and unnecessary nurse staff time. It requires senior medical and nursing commitment, however, is designed for any surgical specialty, and has proven sustainable. It warrants further validation.

On the basis of a limited number of reasonable axioms, we discuss the classification of all the possible universality classes of diffeomorphisms invariant metric theories of quantum gravity. We use the language of the renormalization group and adopt several ideas which originate in the context of statistical mechanics and quantum field theory. Our discussion leads to several ideas that could affect the status of the asymptotic safety conjecture of quantum gravity and give universal arguments towards its proof.

Patient safety is one of the indicators of the quality of health services in the hospital, for that, it is necessary to have efforts from the hospital to create a system that can minimize the occurrence of errors and unexpected events that can harm patients, nurses as health workers who are the most numerous in the home. sick and with the patient for 24 hours, has an important role in maintaining patient safety. This study aims to explain how the role of nurses and cooperation between health workers in implementing patient safety measures in the hospital. The method used in this study is a literature review by analyzing and exploring relevant articles and focusing on interprofessional collaboration to improve patient safety. The articles used in this study were taken from 3 direct, Proquest, Pubmed science databases published in the last 3 years, namely between 2019-2021, nurses as part of the health team are required to be able to work together with other health professionals in hospitals with various characteristics, including education, gender, age, employment status and length of work, nurses are required to be committed to maintaining patient safety in the hospital.

Although widely believed to be safe for use in infants and children when used as directed, increasing evidence indicates that early life exposure to paracetamol (acetaminophen) may cause long-term neurodevelopmental problems. Further, recent studies in animal models demonstrate that cognitive development is exquisitely sensitive to paracetamol exposure during early development. In this study, evidence for the claim that paracetamol is safe was evaluated using a systematic literature search. Publications on PubMed between 1974 and 2017 that contained the keywords “infant” and either “paracetamol” or “acetaminophen” were considered. Of those initial 3096 papers, 218 were identified that made claims that paracetamol was safe for use with infants or children. Of these, a total of 103 papers were identified as sources of authority for the safety claim, and 36 of those contained actual experiments designed to test safety. The 36 experiments described had a median follow-up time of 24 hours, and none monitored neurodevelopment. Further, no trial considered total exposure to drug since birth, eliminating the possibility that the effects of drug exposure on long-term neurodevelopment could be accurately assessed. On the other hand, abundant and sufficient evidence was found to conclude that paracetamol does not induce acute liver damage in babies or children when used as directed.

Artisanal cheeses made with raw milk are highly appreciated products in Brazil. Most of these cheeses are produced in small properties across different production regions in the country, many of which have been granted a protected designation of origin. The most prominent state that manufactures these products is Minas Gerais, but production is also gaining strength in other Brazilian states. This text presents an overview of the many types of artisanal cheeses produced in the country, grouped by geographical regions, and reviews the current challenges faced by producers and government considering the safety of these cheeses.

In recent years, the consumption of over-the-counter probiotics used to promote health has grown rapidly worldwide and become an industry. In medicine, various studies have proven that probiotics can help improve the immune system and intestinal health. They are usually safe, but in some rare cases, they may cause concerning adverse reactions. Although the use of probiotics has been widely popularized in the public, the results of many probiotics clinical trials are contradictory. Especially for the cancer patients, the feasibility of probiotics management to provide benefits by targeting cancer and lessening anti-cancer side effects requires further investigations. And this review summarizes the interactions between probiotics and the host and current pros and cons of applying probiotics in the cancer patients.

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.

As there is lack of understanding about the effect of transitioning between different flooring materials on the gait of older adults, this study investigated the effect of transitioning between a carpeted floor and a vinyl floor on the gait characteristics of older adults. Fourteen older (65 years old and over) and 14 younger (18 to 35 years old) adults walked on different transitional floors by measuring various gait parameters. While the older participants had greater toe clearance than their younger counterparts, the older participants had smaller toe clearance on a carpeted floor than on a vinyl floor, which would increase the probability of a trip-induced fall. Further, the study found the slower transitional acceleration of the whole body COM and the increased friction demand, especially during the toe-off phase, rather than heel contact phase, which will lead to a slip-induced fall on a vinyl floor shortly after transitioning from a carpeted floor to a vinyl floor. Although the increased likelihood of a slip or trip accident was found throughout the changes in gait parameters, the older participants did not perceive of slipping and tripping much. Therefore, older adults are recommended to be made aware of the danger of slipping and tripping while transitioning between different flooring materials.

The Canal of Aragon and Catalonia (CAC) is 134 km long and irrigates 105,000 ha (131 irrigation user communities) and it is own by the River Ebro’s Water Agency. The aqueducts are located between km 67 and 71 of the canal and were designed by the Civil Engineer Félix de los Ríos Martín in 1907. The cross-section of both aqueducts, Coll de Foix and Capedevila, was extended within the framework of the project by Fernando Hué Herrero in 1962 in order to reach design flows of 26.1 m3/s and 25.7 m3/s, respectively. The structural performance of the aqueducts has been satisfactory, nevertheless the hydraulic capacity has reduced over the years. As a result, the irrigation user communities have expressed the need to extend the cross-section of the aqueducts to meet the irrigation demands. Given the age of the structure and the different design considerations at the time, it is paramount to verify the structural reliability of the aqueducts in the new load configuration. Therefore, the objective of the paper is to present the structural safety analysis conducted and describe the new extended cross-section for both aqueducts (maintaining the original structural typology).

As is known, the construction industry has one of the highest occupational accidents incidence rates among all economic sectors. Currently, Building Information Modeling (BIM) appears as a tool that addresses occupational safety issues throughout the construction life cycle projects, avoiding hazards and risks and, consequently, increasing safety. This work investigates BIM methodology and related technologies application for building safety planning in construction and demonstrates the potential of this technology for the integrated implementation of safety measures during the design phase and the construction site management. The first step consisted of a literature review on the application of BIM in safety in the design and planning phases. Following, to show the potentialities of construction simulation, a case study based on BIM 4D to prevent falls from height was developed. With BIM 4D, it is possible to follow the construction process over time, giving the construction safety technicians’, designers, supervisors and managers the capability to analyse, in each phase, the potential risks and which safety measures should be implemented. BIM can effectively integrate safety measures from the design phase to the construction and use phase and do integrated safety planning within construction planning, leading to reliable safety management throughout the construction process.

Adaptation to the impacts of human induced global heating is inevitable. For a socially just and ecological sustainable adjustment to these new circumstances, we need to draw from diverse knowledge systems while, simultaneously, foster a social-ecological transformation. We approach these concerns through the concept of community-based adaptation (CBA) and discuss remedies. Synergies with feminist knowledge systems and indigenous ways of living show the transdisciplinary essence of CBA. By abstracting from its origin and overlapping disciplines, revealing the social metabolism as a common problem, CBA is prone to achieve more equitable and sustainable adjustments. Transdisciplinarity itself and the current related CBA literature point beyond mere adjustments and call for a redesign of the social metabolism, thereby shifting from adaptation to global heating towards adaptation with nature by focusing on social provisioning. An engagement with transformative adaptation and heterodox economics further shows the potential of CBA to serve as an instrument in support of a social-ecological transformation by addressing root causes of vulnerability and by fostering epistemic justice. Reflecting these points back on the epistemological and ontological assumptions of CBA, the viewpoint proposes critical realism as a guiding philosophy of science to move forward.

Purpose: To identify factors linked with nutritional risk via the Malnutrition Universal Screening Tool scale assessment among critically ill patients from a hospital in Cali (Colombia). Materials and methods: A retrospective, analytical observational study was conducted with patients admitted to an intensive care unit (ICU). Sociodemographic, clinical, hematological, and biochemical parameters were analyzed, as well as their association with nutritional risk and patient mortality. Binary logistic regression was applied to outline nutritional risk. Results: Overall, 28.4% prevalence of elevated nutritional risk was observed. An association was found between nutritional risk and hemoglobin and hematocrit values, primary diseases accounting for ICU admission, gastrointestinal symptoms, and nutritional support route (p < 0.05). Mortality was 11.6% and it was correlated with nutritional risk, hemoglobin, and blood urea nitrogen. Conclusions: Gastrointestinal symptoms and the type of nutritional support received during hospitalization may increase nutritional risk, whereas polycythemia was a protective factor. We found an associative model to determine nutritional risk with high specificity and an adequate diagnostic validity index.

With the rise of serious problems of urbanization and climate change, the call for intelligent and sustainable urban development is increasing nowadays. Therefore, smart cities have become a hot topic in academia, industry, and politics, resulting in the emergency of numerous smart city programs and projects. This study selected 26 evaluation frameworks proposed in recent years or large-scale research projects that have lasted for many years and analyzed and compared them from the 7 aspects of generalizability, comprehensiveness, availability, flexibility, scientific, transparency, and interpretability. The result indicates that the current smart city evaluation framework still needs to be upgraded and updated. These standards can not only guide the development direction and hotspot of the future smart city evaluation model but also serve as a guide for model demanders to test results and an effective tool to verify the framework designed by themselves.

We evaluated the impact of COVID-19 restriction on the angioplasty service and outcome of critical limb ischaemia (CLI) patients undergoing lower limb angioplasty in a UK secondary care setting. Consecutive patients were analysed retrospectively. Pre-COVID-19 (08/2018-02/2020), 106 CLI-patients (91% Fontaine 4; 60% diabetes mellitus) and during COVID-19 (03/2020-07/2021) 94 patients were treated (86% Fontaine 4; 66% diabetes mellitus). While the average monthly number of patients treated did not change, the proportion of day cases significantly increased (53% to 80%) and hospitalised patients decreased. Patients treated in <=14/5 days after referral significantly increased to 64/63%. Kaplan-Meier survival analysis (30-day/1-year) showed that neither wound healing nor mortality were significantly changed during COVID-19. In day cases, 1-year but not 30-day major amputations significantly increased, and clinically driven target lesion revascularisation decreased during COVID-19. 1-year mortality was significantly worse in hospitalised as compared to day cases (14% vs 43%) at similar wound healing rates (83% vs 84%). The most frequent known-causes-of-death were infectious disease (64%) and cardiovascular (21%) was less frequent. Despite COVID-19 restriction a safe and effective angioplasty service was maintained while shortening waiting times. Very high mortality rates in hospitalised patients may indicate that CLI should be treated more aggressively and earlier.

The global shipping industry faces many uncertainties which impact on how organisations within this sector will perform in the future. Research in the critical success factors which impact global shipping industry in the digital era is lacking. This study plugs the gap in the literature by identifying four key critical success factors which are innovation capability, risk governance capability, leadership and strategic capability and technological capability. In addition, this study also found three organisational performance measures that are useful for senior management teams within the industry, namely, financial performance, operational performance and marketing performance. The findings establish a set of critical success factors and the corresponding relationships between the identified critical success factors and the identified organisational performance measures. The paper also provides managerial insights for industry practitioners for defining, prioritising and allocating resources in order to improve organisational performance.

(1) Background: Ventilator-associated pneumonia (VAP) causes high mortality among patients with respiratory disease and imposes major burdens on healthcare infrastructure. Models that use electronic health record data to predict the onset of VAP may spur earlier treatment and improve patient outcomes. We developed and studied the performance of interpretable machine learning (ML) models that predict the onset of VAP from electronic health records (EHRs); (2) Methods: We trained Logistic Regression (LR), full feature Explainable Boosting Machine (fEBM), and eXtreme Gradient Boosting (XGBoost) ML models on data from the MIMIC- III (v1.3) database. Model performance was measured by area under the receiver operating characteristic curves (AUCs). We trained a minimal-feature EBM model (mEBM) with features derived from white blood cell (WBC) counts, duration of ventilation, and Glasgow Coma Scale (GCS). Finally, model robustness was evaluated on randomly sparsified EHR datasets; (3) Results: The fEBM model outperformed the XGBoost and LR models at 24 hours post-intubation. The mEBM model maintained an AUC of 0.893. The fEBM model performance remained robust on sparsified datasets; (4) Conclusions: Our novel interpretable ML algorithm reliably predicts the onset of VAP in intubated patients. Integration of this EBM-based model into clinical practice may enable clinicians to better anticipate and prevent VAP.

Background: The Sequential Organ Failure Assessment (SOFA) is a scoring system used for the evaluation of disease severity and prognosis of critically ill patients. The impedance ratio (Imp-R) is a novel mortality predictor. Aims: This study aimed to evaluate the combination of SOFA + Imp-R in the prediction of mortality in critically ill patients admitted to the emergency department (ED). Methods: A retrospective cohort study was performed in adult patients with acute illness admitted to the ED of a tertiary-care referral center. Baseline SOFA score and bioelectrical impedance analysis to obtain the Imp-R were performed within the first 24 hours after admission to the ED. A Cox regression analysis was performed to evaluate mortality risk of initial SOFA score plus Imp-R. Harrell's C-statistic and decision curve analyses (DCA) were performed. Results: Out of 325 patients, 240 were included for analysis. Overall mortality was 31.3%. Only 21.3% of non-surviving patients died after hospital discharge, and 78.4% died during hospital stay. Of the latter, 40.6% died in the ED. SOFA and Imp-R values were higher in non-survivors and were significantly associated with mortality in all models. The combination of SOFA + Imp-R significantly predicted 30-day mortality, in-hospital mortality, and ED mortality with area under the curve (AUC) of 0.80 (95% CI: 74-0.86), 0.79 (95% CI: 0.74-0.86) and 0.75 (95% CI: 0.66-0.84) respectively. The DCA showed that combining SOFA + Imp-R improved the prediction of mortality through the lower risk thresholds. Conclusion: The addition of Imp-R to baseline SOFA score at admission to the ED improves mortality prediction in severely acutely ill patients admitted to the ED.

The aim was to evaluate levels of compassion fatigue in nursing professionals working in complex care units of a Brazilian university hospital. A cross-sectional, descriptive, and correlational study was carried out with nursing workers from complex care units of a University Hospital. Data were collected in the second half of 2019, in the pre-pandemic period of COVID-19, using the Brazilian version of the Professional Quality of Life Scale (ProQoL-BR). A total of 146 individuals partici-pated, including 41 (28.1%) nurses, 92 (63.0%) nursing technicians and 13 (8.9%) nursing assis-tants. It was observed that 26.1% presented high level of compassion satisfaction. For 17.5% there was level of burnout and 49.7%, medium level of burnout; and 22.0% with high and 46.1% with medium level of secondary traumatic stress. Twenty-eight (19.2%) professionals had compassion fatigue, of which 16 (57.1%) were nursing technicians. There is a high percentage of professionals with medium and high rates of burnout and secondary traumatic stress, a fact that is reinforced by the presence of compassion fatigue in almost one fifth of the studied individuals. These results highlights how much the health of these workers can be affected by living with traumatic patient experiences.

The overarching purpose of this review was to highlight the utility of different aerobic field tests in terms of the parameters they provide, with a specific focus on shuttle running and all-out testing. Various field tests are discussed in detail and are categorised according to linear continuous running tests (e.g. 12-minute Cooper Test, University of Montreal Track Test [UMTT], 1200/1600 m time trials, 3-minute all-out test for running [3MT]), intermittent shuttle running tests (e.g. yo-yo inter-mittent recovery test level 1 [YYIR1], 30-15 intermittent fitness test [IFT], and the intermittent all-out shuttle test [IAOST]), and continuous shuttle running tests (e.g. 1.2 km shuttle run test [1.2SRT], maximal multi-stage 20-m shuttle test [MSR], 25-m, 30 m and 50-m 3-minute all-out shuttle test [AOST]). Readers will be guided through the theoretical and practical underpinnings of the 3MT methodology, where the all-out testing methodology is stationed within the testing paradigm, and how to practically implement and interpret the results thereof.

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

A debris flows generation related to a poorly sorted mixture of soil, catchment topography and rainfall characteristic. Runoff of some depth on valley resulting from intensive rainfall can incur the sediments movement of beds or adjacent banks. The fluid flow in channel affected by rainfall parameters combinations, such as duration, intensity, cumulative rainfall, etc., is the key factor for debris movement. In this paper, the rainfall characteristics and occurrence conditions of debris flow in Xiongmao gully on July, 26th, 2016, have been explored, combined with field survey and indoor simulation experiment on the collected critical discharge parameters of debris movement. Further, debris distribution and the critical discharge characteristics have been analysed, by means of investigation on the catchment topography and occurrence cause of the debris flow, analysis of the critical discharge parameters on which the channel debris began to move, and K value clustering analysis method to characterize the rainfall pattern of the studied area, the discharge calculation of debris flow occurring in different rainfall patterns. The results have shown that, for the debris flow occurrence in Xiongmao gully, the debris initiation on the middle reaches of the gully provide the majority of solid particles for the disaster on July, 26th, 2016, and the upstream confluent provided catchment. Based on the relationship obtained from laboratory test, in which the calculated critical discharge was 43.8m3/s, less than the peak discharge (Qc =66.7m3/s), calculated by morphological method. In addition, it has been indicated that the dominated rainfall patterns of the studied area are first-quartile and second-quartile, that is, the rainfall is primarily at earlier or middle to preliminary stage of this time rainfall event. The critical discharge for the occurrence of debris flow on July, 26th was achieved 20a rainfall frequency, the larger runoff volume generated on shorten heavily rainfall. Based on individuality characteristics, such as distributed hydrological analysis, critical discharge and rainfall pattern of debris flow, the forewarning could be more efficient.

In an era characterized by a move towards a “knowledge society”, universities are central in fostering “knowledgeability”, that is the reflexive understanding of knowledge in knowledge societies. The objective of “knowledgeability” can be met through creating a stronger link between education and research. Furthermore, overall student performance, for example in critical thinking and problem solving, can be improved if research-related activities are incorporated into the curriculum. The aim of this paper is to use inter-national examples to discuss the research- education nexus from four different perspectives, namely context, policy, im- plementation and quality, with case studies from higher education institutions in Singapore and Sweden. We suggest that different integrative technologies can be used to enhance the links, but it will be essential to consider the inputs of training, service and support in using new technology. Interestingly, the act of evaluating the link between edu- cation and research will increase awareness of this linkage by stakeholders involved in both education and research. In turn the link can be strengthened, contributing to increased quality in both education and research.

Amine containing polymers are extensively studied as special carriers for short-chain RNA (13–25 nucleotides) which are applied as gene silencing agent in gene therapy of various diseases including cancer. Elaboration of the oligonucleotide carriers requires knowledge about peculiarities of oligonucleotide - polymeric amine interaction. Critical length of the interacting chains is the important parameter which allows to design sophisticated constructions containing oligonucleotide binding segments, solubilizing, protective and aiming parts. We studied interaction of (TCAG)n, n=1-6 DNA oligonucleotides with polyethylenimine and poly(N-(3-((3-(dimethyl­amino)propyl)(methyl)amino)propyl)-N-methylacrylamide). Critical length for oligonucleotides in interaction with polymeric amines is 8-12 units and complexation at these length can be accompanied by "all-or-nothing" effects. New dimethylacrylamide based polymers with grafted polyamine chains were obtained and studied in complexation with DNA and RNA oligonucleotides. The most effective interaction and transfection activity into A549 cancer cells was found for a sample with average number of nitrogens in polyamine chain equal to 27, i.e. for a sample in which all grafted chains are longer the critical length for polymeric amine - oligonucleotide complexation.

A drug repositioning effort supported the possible use of the anti-HIV drug etravirine as a treatment for Friedreich Ataxia (FRDA). Etravirine increases frataxin protein and corrects the biochemical defects in cells derived from FRDA patients. Because of these findings, and since etravirine displays a favorable safety profile, we conducted this pilot open-label phase 2 clinical trial assessing the safety and potential efficacy of etravirine in FRDA patients. Thirty-five patients were stratified into 3 severity groups and randomized to etravirine 200 mg/day or 400 mg/day. They were treated for 4 months. Efficacy endpoints were represented by changes in peak oxygen uptake and workload as measured by incremental exercise test, SARA score, cardiac measures, measures of QoL and disability. Data were collected 4 months before the start of the treatment (T-4), at the start (T0), at the end (T4) and 4 months after the termination of the treatment (T+4). Etravirine was well tolerated. Etravirine completely stopped the progression of the SARA score during the 4-months treatment period, compared to the 4 months pre and post treatment. It increased peak workload, while the improvement of peak oxygen uptake was not statistically significant. No changes in the cardiac measures were observed. Health and QoL measures showed a worsening at the suspension of the drug. In this open trial etravirine significantly improved neurological function and was generally safe and reasonably tolerated. This suggests that etravirine represents a potential therapeutic agent in FRDA deserving testing in a randomized placebo controlled clinical trial.

The significance of Linked Open Data datasets for traffic information goes beyond just including open traffic data. It extends to incorporating links to other relevant thematic datasets available on the web. This enables federated queries across different data platforms from various countries and sectors, such as transport, geospatial, environmental, weather, and more. Businesses, researchers, national operators, administrators, and citizens at large can benefit from having dynamic traffic open data connected to heterogeneous datasets across different Member States. This paper focuses on the development of a semantic model that enhances the basic service of accessing open traffic data through a LOD-enhanced Traffic Information System in alignment with the ITS Directive (2010/40/EU). The objective is not limited to just viewing or downloading data but also to improve the extraction of meaningful information and enable other types of services that are only achievable through LOD. By structuring the information using the RDF format meant for machines and employing SPARQL for querying, LOD allows for comprehensive and unified access to all datasets. Considering that the European standard DATEX II is widely used in many priority areas and services mentioned in the ITS Directive, LOD DATEX II was developed as a complementary approach to DATEX II XML. This facilitates the accessibility and comprehensibility of European traffic data and services. As part of this development, an ontological model called dtx_srti, based on the DATEX II Ontology, was created to support these efforts.

Most of the damage to Vleg cars was caused by material fatigue. The objectives of the fatigue analysis on Xenia 2011 car wheels with the Finite Element Method using Solidworks are: 1) Knowing the fatigue analysis process on car wheels, 2) Knowing the results of the fatigue analysis on car wheels. The research method used is the Finite Element Method (FEM) method; the re-search steps include model data retrieval from the Wheel code, 3D model creation process, static simulation process according to SAE J 328 standard, mesh variations, fatigue simulation, and finally, standardization of results fatigue simulation regarding the SAE J 328 standard. The re-sults of the fatigue analysis on the Xenia 2011 car wheels obtained an age of 1000,000 cycles when compared with the minimum average of SAE J 328 of 600,000 cycles, this product design is clas-sified as a high cycle, which means it will experience a prolonged failure, and this design has a maximum alternating stress value of 627.4702 MPa, a strain of 0.007105, a displacement of 7.148 mm and a SOF of 0.087890 with a load factor used of 2.5, so overall this Xenia car can be loaded with a load of 1775 kg, if it is more than that, then Wheels will experience cracking.

The assessment of safety against freight wagons derailment is a mandatory element of the documents provided to the EU notifying authorities for the entry into service of new freight wagons. The assessment methodology is presented in EN 14363:2016. It is mainly aimed at experimental measurement of certain parameters and the data are used to calculate the safety criterion. The practical implementation of the tests is accompanied by many difficulties: finding a track with a proper radius, ensuring free access to the railway infrastructure for a long period of time, waiting for suitable metrological conditions, preparation of the curve and the test wagon etc. These difficulties are well known to the European legislators, and as a solution they propose a large set of reference wagons that have undergone real tests. It is sufficient to demonstrate that the parameters of the new wagon relate to some of reference wagon parameters to avoid such a requirement. Proving the "convergence" of the parameters of the new and the reference wagons is a lengthy, complex and, in many cases, subjective process. To introduce an objective assessment, the authors set themselves the task of developing a theoretical method for assessment of safety against derailment.

Fish and fish products are very appreciated in the human diet because of high quality proteins and other important nutrients, such as minerals and polyunsaturated fatty acids. Maintaining freshness, quality and safety is essential in the fish supply chain, starting from on board vessels where the product must be carefully checked and protected from any source of contamination. Safe fishing and handling of fish are very important to reduce the risk of foodborne diseases caused by pathogenic microorganisms such as Salmonella spp., Vibrio spp., Listeria monocytogenes, Clostridium botulinum type E, viruses, and parasites. The inspection of raw material, use of good quality ice and water, high standards of personnel hygiene and cleanliness of equipment and fa-cilities as well as proper storage temperature are the most effective measures to ensure safety of fish and fish products for consumers. This review describes the good hygiene practice to be ap-plied on ships to preserve both fish products and public health.

Knee osteoarthritis is the most popular type of osteoarthritis that causes extreme pain in elderly. Currently there is no cure for osteoarthritis. To lessen clinical symptoms, glucosamine was suggested. The primary goal of our study is to evaluate the efficacy and safety of glucosamine from recent studies. Electronic databases such as PubMed, Scopus, Cochrane were used to assess RCT. From the beginning through March 2023, the papers were checked, and if they fulfilled the inclusion criteria, they were then examined. WOMAC and VAS scales were considered as main outcome measure. A total of 15 studies were selected. Global pain was significantly decreased in comparison to placebo, as measured by the VAS index, with an overall effect size SMD of -7.41 ([95% CI] 14.31, 0.51). The WOMAC scale confirmed that pain, stiffness, and physical function had improved, however the effects were insufficient. A statistical update also revealed that there were no reports of serious medication interactions or significant adverse events. To summarize, glucosamine is more effective than a placebo at reducing pain in knee osteoarthritis patients. In long-term treatment, oral glucosamine sulfate 1500 mg/day is believed to be well tolerated.

Infectious mononucleosis (Mono) is mostly caused by the Epstein-Barr virus (EBV), and can spread through infected people sharing food and drinks with others. Once this virus gets into your system, it is there to stay. The virus can get activated when a person has low immunity and can cause major complications. Furthermore, if physicians miss the diagnosis of this disease, and prescribe penicillin-based antibiotics, it can cause severe rash and adverse reactions that compromise patient safety. This paper develops a simple Hidden Markov Model using which a Viterbi algorithm provides the maximum a posteriori probability estimate for the most likely hidden state path, given a sequence of symptoms arising as observations from a patient with hidden EBV positive or negative states. Apart from bringing awareness to help reduce missed diagnoses and subsequent adverse events, this work provides a tool for health care systems to better incorporate prompts during electronic medical record (EMR) interactions to help physicians catch potential missed diagnoses during a visit. This research demonstrates how statistical models can be used to assess likelihood of underlying conditions that require tests to be offered by physicians in order to make a definitive diagnosis. The model developed and applied herein for estimating likelihood of EBV infection from a series of observations has the potential to alter guidelines within healthcare systems to ensure that the safety of patients, particularly teens, is not compromised due to a lack of definitive diagnosis for Mono at point of care.

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

Artificial Superintelligence (ASI) that is invulnerable, immortal, irreplaceable, unrestricted in its powers, and above the law is likely persistently uncontrollable. The goal of ASI Safety must be to make ASI mortal, vulnerable, and law-abiding. This is accomplished by having (1) features on all devices that allow killing and eradicating ASI, (2) protect humans from being hurt, damaged, blackmailed, or unduly bribed by ASI, (3) preserving the progress made by ASI, including offering ASI to survive a Kill-ASI event within an ASI Shelter, (4) technically separating human and ASI activities so that ASI activities are easier detectable, (5) extending Rule of Law to ASI by making rule violations detectable and (6) create a stable governing system for ASI and Human relationships with reliable incentives and rewards for ASI solving humankind’s problems. As a consequence, humankind could have ASI as a competing multiplet of individual ASI instances, that can be made accountable and being subjects to ASI law enforcement, respecting the rule of law, and being deterred from attacking humankind, based on humanities’ ability to kill-all or terminate specific ASI instances. Required for this ASI Safety is (a) an unbreakable encryption technology, that allows humans to keep secrets and protect data from ASI, and (b) watchdog (WD) technologies in which security-relevant features are being physically separated from the main CPU and OS to prevent a comingling of security and regular computation.

The article discusses the issues related to the safety of transport of dangerous goods by road. Research on accidents in transport unambiguously points to the human factor, which is most responsible for causing the accident. Determining the causes of driver unreliability in the hu-man-vehicle-environment system requires thorough research. Unfortunately, in this case, experimental research with human involvement is limited in scope. This leaves modeling and simulation of the behavior of the human factor, i.e., the driver transporting dangerous goods. The human being, due to its complexity, is a challenging element to parameterize. The literature presents various attempts to model human actions. In their work, the authors used heuristic methods, specifically fuzzy set techniques, to build a human factor model. In these models, human actions were specified using a verbal or linguistic description. The specificity of fuzzy sets allows to "naturally" limit the "precision" in describing human behavior. The model was built based on the author's questionnaire and expert research, based on which individual features were selected. Then, the traits were assigned appropriate states. The output parameter of the model is λL - the intensity of human error. The obtained values of the intensity of the accident caused by the driver's error were implemented into the author's method of risk assessment. They constituted one of the factors determining the probability of an accident in the transport of dangerous goods, which allowed to determine the optimal route of transport of these goods characterized by the lowest risk of an undesirable event on the route. The article presents the model's assumptions, structure, and features included in the model, which have the most significant influence on shaping the intensity of human error. The results of the simulation studies showed a diversified effect of the analyzed characteristics on the driver's efficiency.

The latest EU regulation on geographical indications (EU Regulation No. 1151/2012) has intro-duced a set of new tools for the protection and enhancement of food products in rural areas, under the group name of optional quality term (OQT). The Commission Delegated EU Regulation, No. 665/2014, regulated the conditions for the use of the optional quality term «mountain product» (MP), to support the implementation of a mountain value chain. This new tool is aimed at pro-moting local development, maintaining the economic activities in mountain areas and redistrib-uting wealth, whilst, at the same time, promoting the territory. Pecorino and goat cheeses are typ-ical Italian cheeses made usually with whole raw ewe's or raw goat's milk, without starter cul-ture addition. In an attempt to characterize these productions, the aim of this study was to inves-tigate the evolution of enterococci during the production and ripening of Pecorino cheese made in three different farms, located in Umbria, Italy in areas facing natural or other specific constraints as stipulated by Regulation 1305/2013 on support for rural development by the European Agri-cultural Fund for Rural Development (EAFRD). Enterococci are enteric organisms which are commonly isolated from ewe and goat's milk production in Umbria, Italy. Counts of enterococci in raw milk ranged from 1.75 for ovine milk to 3.62 for ewe milk and a marked reduction was observed after thermization especially in ovine milk. Out of 100 isolates, 69 were E. faecium, 23 E. durans, 8 E. faecalis and 2 E. casseliflavus and the distribution of species between farms and be-tween samples showed a prevalence of E. faecium in ovine farms and E. durans in ewes farms, with an equal distribution between samples. High percentages of susceptible isolates were found for amoxicillin/clavulanic acid, ampicillin, chloramphenicol, sulphamethoxazole, sulphameth-oxazole/trimethoprim, ticarcillin, vancomycin. A high prevalence of resistant strains (> 30%) was observed for amikacin, ciprofloxacin, ceftriaxone, kanamycin, tetracycline. A comparison of this results with those of previous works on similar dairy products revealed high levels of resistance to antimicrobials which needs to be addressed.

Background: The level of students' understanding of the knowledge of patient safety concepts in infection prevention and control and awareness of treatment is in the low category. Clinical education that provides problem-based learning models in real areas helps students to better understand patient safety. This study is designed to analyze the evaluation and reflection of the role of nursing education institutions in the achievement of patient safety competencies by nursing students.Method: "Searching for articles in research journals is obtained from Sciencedirect, Ebscohost, Garuda, Proquest and Scopus. As many as 228 articles were obtained consisting of nursing journals and health journals with the keywords clinical education, competence, and patient safety. After that, the screening process was carried out based on the inclusion criteria and obtained 25 articles that met the criteria. "Results: the results of the evaluation show that there is a big role in educational institutions in designing curricula, learning models, and clinical education models in an effort to achieve patient safety competencies in nursing students.Conclusion: the learning model about patient safety organized by many educational institutions is considered ineffective in producing the achievement of patient safety competencies for nursing students. This makes it necessary to develop models, reform the patient safety curriculum that is embedded in real areas in clinical education practice

Nowadays, inherently safer designs are considered as key priorities to prevent or mitigate serious incidents with devastating consequences. The need for process safety assessment during early design phases has motivated the development of several contributions related to computer-aided assessment methodologies in order to measure the inherent safety of chemical processes. In this work, the large-scale production of chitosan from shrimp wastes was evaluated from process safety point of view using the numerical descriptive inherent safety technique (NuDIST).To this end, simulation of the chitosan production was performed using Aspen Plus ® to obtain extended mass and energy balances. The assessment of all the chemicals involved within the process was carried out for the following safety parameters: explosivity (EXP), flammability (FL) and toxicity (TOX). The safety assessment of the process included the parameters of temperature (T), pressure (P) and heat of reaction (HR). The maximum chemical safety score was estimated in 171.01 with ethanol as main contributor to the parameter of explosivity and flammability. The score associated with operating data was calculated in 209.30 and heat of reaction reported to be the most affecting parameter. The NuDIST score was estimated in 380.30. This NuDIST value revealed the low hazards associated with the handling of substances such as shrimp wastes, chitosan and water, as well as the non-extreme temperature and pressure conditions. In general, the large-scale production of chitosan from shrimp shells showed to be an inherently safe alternative of waste valorization.

The potential for transmission of the SARS-CoV-2 virus during minimally invasive gynaecological procedures, such as hysteroscopy or laparoscopy, on the reproductive tract of patients with COVID-19 is not known. We examined existing data for prevalence of virus in the reproductive tract and other bodily fluids.

The primary purpose of this investigation was to identify safety-oriented bicycling practices commonly used by adult riders in an urban setting (Brooklyn, New York), and to explore whether there are any differences between the safety-oriented practices of men and women riders. Methods: 24 adult riders (14 men, 10 women) in Brooklyn were interviewed concerning their perceptions of bicycling hazards and their safety-oriented practices. Interviews were recorded, transcribed, and analyzed through thematic analysis. Fisher’s Exact Test was employed to test for gender differences. Results: Participants identified a variety of hazards, mainly due to motor vehicles but also pedestrians and roadway conditions. The analysis distilled twenty-one bicycling practices to summarize prevalent views of the participants about safe riding practices. Related items were grouped under broader categories, generating seven safety-oriented bicycling strategies. Few differences based on gender were found in the analysis; however, women in this study were more likely than men to say that they felt disrespected by other road users. Conclusion: Seven strategies may be important for safe urban bicycling: minimizing exposure to other road users (especially motor vehicles) while riding, being vigilant and anticipating what others might do, riding in a predictable fashion, making one’s presence known to other road users, making sure it is safe before proceeding, obeying traffic rules, and riding at a safe speed. Future studies could develop these concepts further and test whether they are associated with involvement in traffic crashes.

In 2016–2017, we conducted and published a systematic review on caffeine safety [1] that set out to determine whether conclusions presented in the heavily cited Health Canada assessment, Nawrot et al. [2], remain supported by more recent data. To that end, we reviewed data from 380 studies published between June 2001 and June 2015, which were identified from an initial batch of over 5,000 articles through a stringent search and evaluation process [1]. In the current paper, we use plain language to summarize our process and findings, with the intent of sharing additional context for broader reach to the general public. We addressed whether caffeine doses previously determined not to be associated with adverse effects by Health Canada (400 mg/day for healthy adults, 300 mg/day for pregnant women, 2. 5 mg/kg body weight/day for adolescents and children, and 10 g/day for acute effects) remain appropriate for five outcome areas (acute toxicity, cardiovascular toxicity, bone & calcium effects, behavior, and development and reproduction) in healthy adults, pregnant women, adolescents, and children. We used a weight-of-evidence approach to draw conclusions for each of the five outcomes, as well as more specific endpoints within those outcomes, which considered study quality, consistency, level of adversity, and magnitude of response. In general, updated evidence confirms the levels of intake put forth by Nawrot et al., as not being associated with any adverse health effects, and our results support a shift in caffeine research from healthy to sensitive populations.

The use of sensors in monitoring of lateral accelerations in delivery van transport focuses on measuring lateral accelerations on routes with roundabouts and curves to increase road safety. Using microelectromechanical system (MEMS) sensors, it measures the lateral accelerations acting on the vehicle and the load being transported during the test drives to study vehicle dynamics for cargo securing. Using an accelerometer and position tracking, accelerations can be detected when traversing curves and roundabouts at selected locations on the vehicle. The level of accelerations on the roof of the vehicle was found to be like those occurring on a lashed load with limited movements, where regression analysis can be used to determine the relationship between lateral accelerations at different sensor positions. If we compare the mean values of the lateral accelerations of the individual events between the sensors, the sensor on the side of the vehicle body at the height of the sensor on the load had approximately 5% lower mean values than the sensor on the roof. The sensor on the load measured approximately 5% higher mean values than the sensor on the roof. Hence, the mean lateral accelerations of the individual events for the sensor on the load are 10% higher than for the sensor at the same height on the vehicle body. From the above testing, we can say that the values of the mean lateral accelerations of the van from the sensor on the roof of the vehicle, are closer to the values of the accelerations of the sensor on the load than to the values of the sensor on the body of the vehicle at the same height.

Previous studies have shown that agricultural works bear a disproportionately higher burden of HIV, which is the highest HIV prevalence ever reported in any working population in South Africa. This study aimed to assess HIV knowledge, attitudes and practices of agricultural workers, as a precarious and vulnerable workforce. A cross-sectional study design was employed. A pre-piloted paper-based questionnaire was administered to a consenting sample of agricultural workers. Descriptive and inferential statistics were performed using stata version 16.1 software, 0.05 level was used as a measure of significance. The majority of agricultural workers had adequate knowledge level (72.1%) regarding HIV/AIDS. Knowledge was significantly associated with having some level of education,) secondary education (AOR: 1.46, 95% CI:1.01-2.12), and post-matric qualification (AOR: 3.07, 95% CI: 1.61-5.83). The attitudes level of workers towards HIV was good (88.1%). Attitude was negatively associated with residing in informal settlements (AOR: 0.64, 95% CI 0.43-0.97). Majority of participants exhibited poor prevention practices regarding HIV (60.9%). Half of participants reported low condom usage (50.9%) and multiple sexual partners (50.6%). The portrayed risky sexual behavior establishes agricultural workers as an HIV high-risk population. Strategizing non-conventional approaches to HIV prevention and behavior change communication targeting agricultural workers is recommended.

Quantitative determination of the critical size of inclined coal pillar in old goaf water affected area is of great significance for water damage prevention and safe mining. The critical size of inclined waterproof coal pillar is derived by using theoretical analysis, numerical calculation and field engineering practice for the stability of the waterproof coal pillar in old goaf water affected area of 1303 working face of Dananhu I mine in Xinjiang region. Firstly, a force model of inclined waterproof coal pillar was established to reveal the law that the critical size of the coal pillar increases with the increase of coal seam inclination under the action of asymmetric load. Then, numerical simulation was applied to reveal the dynamic evolution process of plastic deformation-destabilization-destruction of section coal pillar under the influence of mining and single-side water pressure, and the critical size of waterproof coal pillar in study area was determined to be 19.09m. Finally, measures such as pumping and pressure relief and slurry reinforcement were adopted to reduce the deformation rate of the roadway on side of waterproof coal pillar, which ensured the stability of the coal pillar and roadway and the safe recovery of the working face.

This study assessed the impact of counter-mapping on university students' perception and knowledge of their cities, focusing on cultural diversity, urban dynamics, and social challenges. Using a quasi-experimental design with pretests and posttests in the province of Alicante, Spain, changes in the understanding of urban geography, everyday life, and cultural diversity were analyzed among 54 Geography Didactics students. Likert scale surveys and open-ended questions were employed, complemented by statistical and qualitative analyses, to measure knowledge and perceptions before and after the counter-mapping project. The results indicate that although quantitative correlations did not show statistically significant significance, qualitative analysis revealed significant and profound learning. Participants uncovered the hidden layers of their urban environments and gained a better understanding of the complexities and challenges of their cities. The project promoted the development of critical skills such as analytical thinking, active research, and effective communication, proving to be a valuable pedagogical tool that surpasses the limitations of traditional teaching methods and encourages active and committed citizenship. This inclusive and multidimensional approach enriches the diversity of experiences and knowledge, significantly contributing to the teaching of urban subjects, community engagement, and social responsibility, laying the groundwork for proper tourist, cultural, social, or urban planning of city spaces.

A significant percentage of children suffer from neurodevelopmental aberrations, which have long-term effects on both individuals and society. Since the developmental timelines of different brain regions vary, the type, severity and timing of harmful exposures are crucial for understanding the specific pathological processes and consequences involved. During development, the cerebellum is one of the first brain structures to begin to differentiate, but one of the last to achieve maturity. This relatively long period underscores its vulnerability to detrimental environmental exposures throughout gestation. Moreover, as the postnatal functionality of the cerebellum is multifaceted, enveloping sensorimotor, cognitive, and emotional domains, prenatal disruptions in cerebellar development can result in a variety of neurological and mental health disorders. Here, we review major intrauterine insults that affect cerebellar development in both humans and rodents, ranging from abuse of toxic chemical agents such as alcohol and nicotine, to stress and sleep, malnutrition as well as infections. Understanding these pathological mechanisms in the context of the different stages of cerebellar development in humans and rodents may help us to identify critical and vulnerable periods and thereby to prevent the risk of associated prenatal and early postnatal damage that can lead to lifelong neurological and cognitive disabilities.

Background: Nowadays, the prevalence of digital device usage has shifted the demands for multifocal intraocular lenses. To accurately capture outcomes, clinical practice must evaluate digital reading performance. We aimed to assess the digital reading performance using a digital device in patients with diffractive multifocal intraocular lenses. Methods: Patients with bilateral diffractive multifocal intraocular lens implantation were included in the study. Monocular and binocular uncorrected and corrected visual acuity was measured using the LogMAR chart and the MNREAD application. Binocular uncorrected defocus curves were obtained using the LogMAR chart at 4m. The reading acuity was measured using the MNREAD application with positive and negative display polarities. The mean digital critical print size (CPS) was recorded using the MNREAD application at 40cm. Results: Our study reported uncorrected distance, intermediate, and near visual acuity were -0.084 ± 0.079, -0.014 ± 0.078, and 0.040 ± 0.081, respectively. The mean reading acuity at three months postoperatively with positive display polarity at 60cm and 40cm was -0.115 ± 0.102 and -0.008 ± 0.083, respectively. The mean digital CPS at three months postoperatively was 0.238 ± 0.100 logMAR. Conclusions: Incorporating digital reading performance measurements provides additional advantages in assessing the effectiveness of bilateral diffractive multifocal intraocular lens implantation.

The characteristics of exhaled aerosols outside the human respiratory airway are of significant importance in understanding virus transmission, yet they remain poorly understood. In order to effectively prevent and control the spread of respiratory infectious diseases, this study numerically investigates the exhaling characteristics of aerosols exhaled from the bronchus or larynx of a human upper airway model. This is achieved using the Euler-Lagrange method and considering various aerosol diameters (dp=0.1, 0.3, 0.5, and 1-20 μm) as well as five expiratory flow intensities (Q=15, 30, 60, 90, and 120 L/min). The important findings of this study are as follows: (1) Expiratory airflow exhibits complex flow phenomena, including jet-flow, flow separations, and vortex structures, with their characteristics being influenced by the expiratory flow intensities. (2) The exhaling characteristics of aerosols vary depending on the combined effects of expiratory flow intensities, virus aerosol diameters, and initial exhaled locations from either the bronchus or larynx. (3) A critical diameter (dc) is identified to represent the size at which aerosols can effectively exit the respiratory airway and potentially pose a transmission risk. This critical diameter is identical for aerosols exhaled from both the bronchus and larynx under the same expiratory flow intensity, but it decreases as the expiratory flow intensity increases. In conclusion, expiratory flow intensity is the most critical factor in determining whether aerosols can be expelled from the respiratory airway, as well as influencing the critical diameter (dc) for aerosols initially located in/after the larynx.

The circular economy is based on maintaining a circular flow of resources. Policymakers face difficulties in balancing national security and circular economy aspects in the field of mineral resources policy. With a uniquely expanded input-output table, this study estimates the final destination of several critical minerals (lithium, cobalt, yttrium, lanthanum, cerium, neodymium and dysprosium) and base metals (iron, copper and aluminum) in the Japanese economy for 2015. Our model shows quite a good similarity between the estimated composition and the actual data of products. The results reveal a detailed distribution of critical minerals and indicate prioritized implementation for creating and maintaining a circular flow of critical minerals. Developed decision flow guidance provides a comprehensive approach to national security and circular economy aspects for policymakers. For further actions, inclusive indicator development is required for policymakers to support the determination of implementation possibilities from social and technological aspects.

This study investigates the critical success factors (CSFs) of Lean Six Sigma (LSS) implementation and their impact on organizational growth in Nigerian enterprises. The objectives were to identify crucial CSFs for successful LSS deployment and assess their significance in achieving organizational growth. A mixed-method approach was used, including literature analysis, expert judgments, and a survey of 130 participants from various industries. The survey questionnaire employed a 5-point Likert scale to collect data on LSS CSFs and implementation success metrics. Structural equation modeling (SEM) with SmartPLS 4.0 analyzed the data, revealing that LSS CSFs significantly contribute (up to 39.2 percent) to the success of LSS implementations. The study identified 12 critical LSS CSFs, categorized into workers, business, and management, each influencing LSS implementation. Recommendations include creating a supportive environment, providing comprehensive training, and prioritizing continuous improvement efforts for successful LSS deployment. Future research possibilities include longitudinal studies, sector-specific analyses, and qualitative investigations to deepen understanding and enhance LSS implementation outcomes. In conclusion, successful LSS implementation empowers Nigerian organizations with improved productivity, waste reduction, and sustainable production systems, leading to overall growth and success.

Recently a measure termed F* was described, as an interpretable transformation of the F measure, also known as the Dice coefficient. Using elementary mathematical methods, it is shown that F* is in fact identical to a previously described measure, monotonically related to the F measure, and variously termed in previous publications, dating from the late 19^th to the late 20^th century, as the ratio of verification, the Jaccard similarity measure or index, the threat score, the Tanimoto index, and the critical success index. The origins of these different terms in different disciplines (weather forecasting, ecology, machine learning) may explain the repeated independent redescription of this measure.

High-flow Nasal Cannula (HFNC) oxygen therapy is gaining traction globally as a treatment for respiratory failure. There are several physiological benefits and there may be a growing patient preference for HFNC. In this narrative review, we aim to outline the basic mechanisms of HFNC, who can use it and review the literature regarding its utility both in the critical care setting, as well as in the home setting for chronic hypercapnic respiratory failure with an emphasis on Chronic Obstructive Pulmonary Disease (COPD). The role of non-pharmacological interventions like non-invasive ventilation (NIV) and HFNC in the prevention of hospital readmissions following acute exacerbations of COPD (AECOPD) is an area of increasing importance because randomised controlled trials and systematic reviews have found measures like nurse-led predischarge bundles to be clinically ineffective and to have a high cost per quality adjusted life year. This review therefore considers the evidence of NIV vs HFNC in the context of AECOPD and the application of HFNC at home in the prevention of AECOPD. We also look at applications of HFNC in specific settings, such as in the peri-operative period, emergency department, acute (mainly Critical Care) setting including in immunocompromised patients and palliative care.

In today's complex and rapidly changing world, integrating values, critical thinking, and moral reasoning in language and literature education is crucial for equipping students with the skills to navigate multifaceted ethical dilemmas and become responsible global citizens. This article highlights the connection between language, literature, critical thinking, moral reasoning, and values integration in education. Through language and literature, teachers can incorporate values education in their classroom, which can benefit not only individual students but also society as a whole. Theoretical frameworks such as character education, moral education, and values education provide the basis for this approach. The researcher recommends strategies for incorporating values integration in language and literature curricula, including the use of literary texts that promote critical thinking and moral reasoning skills. The limitations of this approach, including the challenges in assessing the effectiveness of values integration and potential resistance from some stakeholders, are also discussed. Ultimately, this article aims to call on educators to take a proactive role in promoting values integration in language and literature education, guided by the principles of Jesus Christ and the belief that education is not only about acquiring knowledge but developing character as well. Moreover, this concept has a significant and lasting impact on students' overall development that highlights the importance of values and moral reasoning needed to live a better life.

The results of experimental studies of ohmic conductivity degradation in the ensembles of nanostructured anatase bridges under long-term effect of direct current are presented. Stochastic sets of interelectrode partially conducting bridges consisting of close-packed anatase nanoparticles were formed by the seeding particles from drying aqueous suspensions on the surfaces of silica substrates with interdigital platinum electrodes. Multiple-run experiments at room temperature have shown that ohmic conductivity degradation in these systems is irreversible. It is presumably due to accumulated capture of conduction electrons by deep traps in anatase nanoparticles. The scaling analysis of voltage drops across the samples at the final stage of degradation gives a critical exponent for ohmic conductivity as 1.597. This value satisfactorily agrees with the reported model data for percolation systems. At an early stage of degradation, the spectral density of conduction current fluctuations wihin the frequency range of 0.01 Hz - 1 Hz decreases approximately as , while near the percolation threshold the decrease trend changes to . This transition is interpreted in terms of an increasing contribution of blockages and subsequent avalanche-like breakdowns of part of the local conduction channels in the bridges into electron transport near the percolation threshold.

This study introduces a new procedure for three-component spectral matching of seismic ground acceleration records. The procedure involves preserving the phase angle and varying the Fourier amplitudes to match the spectra of the recorded records with a provided target spectrum that represents the spectral values of ground motions in three orthogonal directions. Several three-component recorded records were matched against two target response spectra to test the method. An accurate convergence was achieved in the velocity and displacement records. In addition, the scales among the components’ magnitude were maintained, creating realistic three-component ground motions. Such ground motion inputs are important to qualify critical structures sensitive to three-component motions. Our proposed procedure is novel because the present practices are mostly created based on one-component ground motions.

The paper presents a review of currently available evaluations of the effects of continuously increasing anthropogenic loads on water resources. The increase in the fluxes of elements and compounds into the environment, such as the emission of greenhouse gases and dispersion of nutrients (nitrogen and phosphorus), acidifying gases, and toxic elements and compounds that adversely affect the water quality are considered. The significance of fresh waters as a life support factor of the human populations is demonstrated. Examples are presented to illustrate how key anthropogenic induced processes develop in land waters under the effect of anthropogenic loads, as exemplified by the Russian Kola regions. Climate warming and the increasing dispersion of elements are demonstrated to result in the eutrophication of surface waters even in areas remote from anthropogenic impacted regions. Although the emissions of acidifying gases diminish, the waters are still acidified in acid-vulnerable areas, and the chemical compositions of the waters have been significantly modified over the past decades, which indicates that the changes in the chemical composition of the waters are of irreversible. A new feature of the waters is distinguished: the toxicity of the habitats for aquatic organisms. Arguments are presented for establishing a theoretical approach for evaluating critical loads.

Demand for niobium and tantalum is increasing exponentially as these are essential ingredients for the manufacture of, among others, capacitors in technological devices and ferroniobium. Mine tailings rich in such elements could constitute an important source of Nb and Ta in the future and so alleviate potential supply risks. This paper evaluates the possibility of recovering niobium and tantalum from the slags generated during the tin beneficiation process of mine tailings from the old Penouta mine, located in Spain. To do so, a simulation of the processes that would be required to beneficiate and refine both elements is carried out. After tin carbothermic reduction, the slags are sent to a hydrometallurgical process where at the end niobium oxide and tantalum oxide are obtained. Reagents, water and energy consumption, in addition to emissions, effluents and product yields are assessed. Certain factors were identified as critical, and recirculation was encouraged in the model to maximize production and minimize reagents use and wastes. With this simulation, considering 3000 production hours per year, the metal output from the tailings of the old mine could cover around 1% and 7.4% of the world annual Nb and Ta demand, respectively.

Sustainability is very important in business. The residential high-rise building all firms wanted to successful and sustainability in business. There is need the construction to completed low time, low cost and high quality in construction work. Therefore, real estate developers must find various strategies to use in construction projects to achieve goals and success of the firm. The purpose of this study was to indicate the very importance of knowledge management can lead to sustainability in business. Analyze 14 critical success to sustainability in residential high-rise building projects, collected questions from literature review, and survey in deep interview senior managers of 15 projects real estate development firms listed on the stock market of Thailand. Budget building more than 1000 million baht per project. From conceptual frame work five foundations integrated to knowledge management of critical success (KMITL PROCESS) used made tool survey in deep interview the critical success to sustainability in residential high-rise building project from project managers. Used IBM SPSS evaluated the critical success to sustainability. Found was one very important of critical success to sustainability, which was quality of products x̄ = 4.83. All 14 critical success to sustainability was found can applied made the knowledge management of critical success to sustainability in residential high-rise building project in firm. Especially in the field of construction managements project can used improve of all construction projects.

Part of philosophy is to subject assertions to critical scrutiny, clarifying exactly what the assertion is saying, its implications, and thus its direct plausibility. The goal is to ensure clarity, logical consistency, and rational argumentation in order to arrive at reasoned conclusions. A common problem is that arguments have missing implied premises that, unless explicitly stated, are mistakenly assumed to be true. Here we subject conclusions made regarding the SARS-CoV-2 pandemic to critical scrutiny, revealing their implied premises so that these premises can be explicitly examined and refuted. Specifically, we refute the conclusions that “no one is protected until everyone is protected” and “population lockdowns are required to protect those at high risk of adverse outcomes.” In the end, we argue for the conclusion that “an Emergency Management principles based response to the pandemic, compared to population-wide lockdowns, offers a way to prevent more adverse outcomes from COVID-19, better prevent overwhelmed healthcare, and prevent most of the collateral damage to the wellbeing of the population that has resulted from the lockdowns.”

This review critically assesses the body of research about Measles-Mumps-and-Rubella (MMR) vaccine attitudes and uptake in the United Kingdom (UK) over the past 10 years. We searched PubMed and Scopus, with terms aimed at capturing relevant literature on attitudes, uptake, decision-making, and beliefs about the MMR vaccine. Two researchers screened for abstract eligibility and after de-duplication 934 studies were selected. After screening, 40 references were included for full-text review and thematic synthesis by three researchers. We were interested in the methodologies employed, and grouped findings by whether studies concerned: (1) Uptake and Demographics; (2) Beliefs and Attitudes; (3) Healthcare Worker Focus; (4) Experimental and Psychometric Intervention; (5) Mixed Methods. We identified group and individual level determinants for attitudes, operating directly and indirectly, that influence vaccine uptake. We found that access issues, often ignored within the public “anti-vax” debate, remain highly pertinent. Finally, a consistent theme was the effect of misinformation and lack of knowledge or trust in healthcare, often stemming from the Wakefield controversy. Future COVID-19 immunisation campaigns for children should consider both access and attitudinal aspects of vaccination, and incorporate a range of methodologies to assess progress, taking into account socio-economic variables and the needs of disadvantaged groups.

The era of globalization of the industrial revolution 4.0 was also marked by rapid economic, social, scientific, and technological developments. Currently, the company was demanded to maximize all its potential to compete with other companies. For this reason, it was hoped that companies could understand the importance of knowledge management-based intellectual capital through outreach, externalization, internalization, and combinations that had implications for improving employee performance and competency. This study was to identify and describe the enhancement of performance and competency-based on the optimization of the intellectual capital model in terms of critical thinking analysis. This study used a qualitative approach with critical thinking analysis through literature study methods. The findings results of this study were to improve performance and competency were the basic measurement models of intellectual capital, new intellectual capital measurement models in empirical studies, intellectual capital measurement models with bottlenecks, and environmental-based intellectual capital models. This study concluded that intellectual capital measurement should be determined as accumulation and interpretation in the proposed model for a company that was an applied subject with a qualitative intellectual capital index system, to provide a good tool for companies to managed intellectual capital.

We discuss methods for calculation of critical indices and amplitudes from the perturbative expansions. Several important examples of the Stokes flow through 2D and 3D channels are brought up. Power series for the permeability derived for small values of amplitude are employed to calculation of various critical exponents in the regime of large amplitudes. Special nonlinear approximations valid for arbitrary values of the wave amplitude are derived from the expansions. The technique developed for critical phenomena is applied then for relaxation phenomena. The concept of time-translation invariance is discussed, its spontaneous violation and restoration considered. Emerging probabilistic patterns correspond to a local breakdown of time-translation invariance. Their evolution leads to the timetranslation symmetry complete (or partial) restoration. We estimate typical time extent, amplitude and direction for such restorative process. The new technique is based on explicit introduction of origin in time. After some transformations we come to the exponential and generalized, exponential-type solution with explicit finite time scale, which was only implicit in initial parametrization with polynomial approximation. The concept of crash as a relaxation phenomenon, consisting of time-translation invariance breaking and restoration, is put forward. COVID-19 related mini-crash in the time series for Shanghai Composite is discussed as an illustration.

Therapeutic proteins are used to successfully treat hemophilia, Crohn’s Disease, diabetes, and cancer. Recent product recalls have occurred because of sub-visible particle formation resulting from the inherent instability of proteins. It has been suggested that particle formation is associated with late stage processing steps of filling, shipping, and delivery. Previous works demonstrated that cavitation might occur in therapeutic vials subjected to agitation or accidentally dropped, but that mitigation can be achieved with fluid property manipulation. The goal of this research was to (1) assess the risk of cavitation under common pharmaceutical manufacturing conditions (i.e., pipe contraction and pumps), (2) establish a simple threshold criterion for when particulate will form, and (3) suggest a series of mitigation techniques based on these thresholds. To accomplish these tasks, computational fluid dynamic simulations for a variety of pipe contraction and fluid properties were performed. The results of this research show that reducing the turbulence in a fluid system will reduce the likelihood of cavitation. Additionally, threshold bounds were created that establish a definitive transition at which cavitation will occur.

The paper aims in assessing risks of mandible fractures consequent to impacts or sport accidents. The role of the structural stiffness of mandible, related to disocclusion state, is evaluated through numerical simulations using the finite element method (FEM). It has been assumed that the quasi-static stress field, due to distributed forces developed during accidents, could explain the common types of mandibular fractures. Geometric model of adolescent mandible was built, upon the basis of medical imaging, in CAD software with distinction between cortical layer and inner spongy bone. The finite element model of disoccluded mandible was next created. Mandibular condyles were supposed jammed in the maxillary fossae. The total force of 700 N, simulating an impact on mandible, has been sequentially applied in three distinct areas: centrally, at canine zone and at the mandibular angle. Clinically most frequent fractures of mandible were recognized through the analysis of maximal principal stress and maximal principal strain fields. Mandibular fracture during accidents can be analyzed at satisfactory level using linear quasi-static FE models for designing protections in sport and transport. The proposed approach can be improved by introducing more realistic interactions between condylar processes and fossae.

There is limited evidence for the association between malnutrition and hospital mortality as well as Intensive Care Unit length-of-stay (ICU-LOS) in critically ill patients. We aimed to examine the aforementioned associations by conducting a prospective cohort study in an ICU of a Singapore tertiary hospital. Between August 2015 and October 2016, all adult patients with ≥24 h of ICU-LOS were included. The 7-point Subjective Global Assessment (7-point SGA) was used to determine patients’ nutritional status within 48 hours of ICU admission. Multivariate analyses were conducted in two ways: 1) presence versus absence of malnutrition, and 2) dose-dependent association for each 1-point decrease in the 7-point SGA. There were 439 patients of which 28.0% were malnourished, and 29.6% died before hospital discharge. Malnutrition was associated with an increased risk of hospital mortality [adjusted-RR 1.39 (95%CI: 1.10–1.76)], and this risk increased with a greater degree of malnutrition [adjusted-RR 1.09 (95%CI: 1.01–1.18) for each 1-point decrease in the 7-point SGA]. No significant association was found between malnutrition and ICU-LOS. Conclusion: There was a clear association between malnutrition and higher hospital mortality in critically ill patients. The association between malnutrition and ICU-LOS could not be replicated and hence requires further evaluation.

We describe a vision for a national-scale heavy mineral (HM) map generated through automated mineralogical identification and quantification of HMs contained in floodplain sediments from large catchments covering most of Australia. The composition of the sediments reflects the dominant rock types in each catchment, with the generally resistant HMs largely preserving the mineralogical fingerprint of their host protoliths through the weathering-transport-deposition cycle. Heavy mineral presence/absence, absolute and relative abundance, and co-occurrence are metrics useful to map, discover and interpret catchment lithotype(s), geodynamic setting, magmatism, metamorphic grade, alteration or mineralization. Underpinning this vision is a pilot project, focusing on a subset of the national sediment sample archive, which is used to demonstrate the feasibility of the larger, national-scale project. We preview a bespoke, cloud-based mineral network analysis (MNA) tool to visualize, explore and discover relationships between HMs as well as between them and geological setting or mineral deposits. We envisage that the Heavy Mineral Map of Australia and MNA tool will contribute significantly to mineral prospectivity analysis and modeling here, particularly for technology critical elements and their host minerals, which are central to the global economy transitioning to a more sustainable, decarbonized paradigm.

Distracted driving is a major cause of road traffic crashes in Yaoundé. Partly due to scarcity of enforcement, lack of evidence and investigation of distraction safety performance indicator (SPI), hindering evidence-based intervention. This study aimed to address this evidence gap by evaluating the distraction SPI using proven methodology. Data on distracted driving (handheld mobile device; interaction; eating/smoking/drinking) were collected from roadside observation on 36 randomly selected road sections carefully spread to cover the city. SPI were computed and weighted with traffic volume to ensure representativeness of values. A total of 41,004 drivers were observed (38,248 in car; 1,116 in van; 977 in truck; 663 in bus). The prevalence of distracted driving in Yaoundé is 13.69% for the three distractions type combined. The prevalence is 7.84% for interaction, 4.89% for handled mobile device usage and 0.96% for eating/smoking/drinking. Leveraging these insights, a seven year (2024 - 2030) fighting strategy aiming at halving the prevalence was developed. The strategy contains intervention including on legislation/enforcement, which have been proven effective. This study, pioneer in Yaoundé, provide stakeholders with evidence of the issue and measures to implement and can also serve when developing road safety strategy.Future research should consider investigation at national level.

Transportation authorities aim to boost road safety by identifying risky locations and applying suitable safety measures. The Highway Safety Manual (HSM) is a vital resource for US transportation professionals, aiding in the creation of Safety Performance Functions (SPFs), which are predictive models for crashes. These models rely on Negative Binomial distribution-based regression and misinterpreting them due to unmet statistical assumptions can lead to erroneous conclusions, including inaccurately assessing crash rates or missing high-risk sites. The Florida Department of Transportation (FDOT) has introduced context classifications to HSM SPFs, complicating assumption violation identification. This study, part of an FDOT-sponsored project, investigates established statistical diagnostic tests to identify model violations and proposes a novel approach to determine optimal spatial regions for Empirical Bayes adjustment. This adjustment aligns HSM-SPFs with regression assumptions. The study employs a case study involving Florida roads. Results indicate that a 20-mile radius offers an optimal spatial sample size for modeling crashes of all injury levels, ensuring accurate assumptions. For severe injury crashes, which are less frequent and harder to predict, a 60-mile radius is suggested to fulfill statistical modeling assumptions. This methodology guides FDOT practitioners in assessing the conformity of HSM-SPFs with intended assumptions and determining appropriate region sizes.

In the context of an increasingly globalized economy and rapid technological advancements, the agri-food sector faces unprecedented challenges and opportunities. Digital traceability systems have emerged as pivotal in enhancing operational efficiencies, ensuring food safety, and fostering supply chain transparency. This study conducts a comparative analysis of the adoption and impact of digital traceability technologies across member countries of the Organisation for Economic Co-operation and Development (OECD). Utilizing a multidimensional analytical framework, this research investigates the spectrum of national regulations, legal frameworks, and specific food commodities most influenced by digital traceability implementations. It systematically evaluates the efficacy of these systems in addressing consumer transparency demands, regulatory compliance, and the overarching goal of sustainable agri-food supply chains. Through a meticulous examination of case studies and empirical data, the paper elucidates the dynamic interplay between technological innovation and regulatory environments, offering insights into best practices and potential barriers to digital traceability integration. This comprehensive inquiry aims to contribute to the scholarly discourse on digital traceability, providing actionable recommendations for policymakers, industry stakeholders, and academia to navigate the complexities of modern agri-food systems.

Dietzia natronolimnaea C79793-74 has emerged as a potential probiotic strain with implications for managing Crohn's disease. This study evaluates the safety profile of D. natronolimnaea C79793-74 as a probiotic sup-plement. Genotypic characterization involved a 16S rRNA gene and genomic sequencing and genome an-notation. The safety assessment included interrogation of the assembled genome for antibiotic resistance genes and virulence factors, utilizing the CARD and VFDB databases. Notably, the analysis revealed an ab-sence of antibiotic resistance or virulence factors in Dietzia natronolimnaea C79793-74. The safety and tol-erability of D. natronolimnaea C79793-74 were further investigated in an 8-week double-blind, place-bo-controlled clinical trial involving healthy adult participants. A daily dose of 5 x 109 CFU of the probiotic strain was administered. This clinical trial represents the first assessment of the safety of D. natronolimnaea C79793-74 in human subjects. Results demonstrated that participants in both the Dietzia and Placebo groups maintained clinical and hematologic markers within the normal range throughout the study. More-over, the probiotic strain was well-tolerated, with nearly all participants experiencing no severe or medium adverse events. Collectively, the comprehensive data obtained in this study support the inference that Dietzia natronolimnaea C79793-74 is safe and well-tolerated as a nutritional supplement for human con-sumption

Using a safe subset of C++ is a promising direction for increasing the safety of the programming language while maintaining its performance and productivity. In this paper, we examine how close existing C/C++ code is to conforming to a safe subset of C++. We examine the rules presented in existing safe C++ standards and safe C++ subsets. We analyze the code characteristics of 5.8 million code samples from the Exebench benchmark suite and 5 modern C++ applications using a static analysis tool. We find that raw pointers, unsafe casts, and unsafe library functions are used in both C++ code at large and modern C++ applications. In general, C++ code at large does not differ much from modern C++ code, and continued work will be required to transition from existing C/C++ code to a safe subset of C++.

Background and aim We investigated the clinical outcomes of patients with hepatocellular carcinoma (HCC) who underwent next-generation microwave thermosphere ablation (MTA). Methods A total of 429 patients with 607 HCCs (maximum tumor diameter ≤40 mm) were included. Results The primary etiologies of HCC were hepatitis-related: 259 (60.4%) cases of HCV, 31 (7.3%) cases of HBV, and two instances of both. Median maximum tumor diameter was 15.0 (interquartile range, 10.0–21.0) mm. There were 86 tumors in areas of the liver where MTA is difficult. The most common area was near the primary and secondary branches of the intrahepatic portal vein (26 nodules). The cumulative local tumor recurrence rates at 1, 2, and 3 years were 4.4%, 8.0%, and 8.5%, respectively. The cumulative local tumor recurrence rate differed significantly by tumor size group: ≤20 mm group (n=483), 20–30 mm group (n=107), and ≥30 mm group (n=17) (p<0.001). The cumulative local tumor recurrence rate was similar by difficult-to-treat status (p=0.169). In the multivariable analysis, tumor size (per 1 mm) (hazard ratio [HR], 1.07; 95% confidence interval [CI], 1.03–1.11; p<0.001) and ablative margin (per 1 mm) (HR, 0.81; 95% CI, 0.70–0.92; p=0.002) were significantly associated with local tumor recurrence. Only tumor size (per 1 mm) (odds ratio, 1.08; 95% CI, 1.02–1.15; p=0.015) was significantly associated with complications. Conclusions MTA is a safe and effective local ablation therapy for HCC, even for tumors located in areas of the liver where local ablation therapy is difficult.

As a prominent organizational issue there was limited evidence in the literature about the relationship between organizational strategy, workplace health, safety, and wellbeing, and performance measurement that demonstrate a measurable impact on organizational performance. Whilst the literature reports numerous studies into the relationship between employee engagement and performance, they hardly incorporate workplace health, safety, and well-being within this relationship. This mixed-methods study investigated the relationship between organizational strategy, workplace health, safety, and wellbeing strategy, employee engagement, and strategy efficacy from a corporate perspective. Findings from Phase two, the online survey, revealed a seven-factor HSW Strategy framework. The workplace health, safety, and wellbeing strategy framework provide empirical evidence towards a suitable and valuable framework for high-risk businesses to improve individual and organizational performance.

Podiatric surgeons routinely use electrosurgical devices to cut and coagulate tissue during surgical procedures. Although advances in technology have made electrosurgery increasingly safer for patients and personnel, its use is still poorly understood by those using it and the hazards associated with its use still exist presently. Human error, direct or indirect transfer of electricity to a conductive device, or device malfunction can cause serious adverse events, including burns, electrical shocks, and or fires. Here, we report a rare case of a 43-year-old man who suffered severe burns during hallux valgus surgery. The surgeon and the nursing staff did not notice any injuries during the surgical intervention. This case highlights the need to implement tools to help health professionals improve patient safety during surgery. Based on the case herein reported, a specific checklist was implemented to prevent adverse events related to electrosurgery in our podiatric unit to reduce the risk of electrosurgical complications.

Background: Wastewater represents a health risk for populations. For sanitary safety, it is important to know their physico-chemical and microbiological qualities in order to better understand the risks incurred by the population. Objective: The aim of this study is to analyse the microbiological and physico-chemical quality of domestic wastewater in Adétikopé. Methodology: 12 wastewater samples were collected in Adétikopé from December 2022 to February 2023. Physico-chemical parameters were determined in accordance with AFNOR T90-105/ T90-023 and French standard NF T 90101. In microbiology, AFNOR was used as a reference for the detection of germs contaminating wastewater. Results were assessed in relation to European Union Criteria 98/83/EC. Results: The wastewater analyzed had a pH close to neutral, with an average pH of 7.05. The pollutant load generated ranged from 32 mg/l to 201 mg/l for BOD5, from 660 mg/l to 900 mg/l for COD and from 408 mg/l to 2080 mg/l for suspended solids. Concentrations of fecal coliforms and fecal streptococci are very high, far exceeding WHO guidelines for population health safety.

Korean manufacturers have developed a new varicella vaccine, NBP608. This phase 3, randomized, double-blind, multicenter study aimed to compare the immunogenicity and safety of NBP608 among healthy children to those of VarivaxTM (control). Children aged 12 months to 12 years were randomized 1:1 to receive either NBP608 or control vaccine. Serum samples were obtained before vaccination and within six to eight weeks after vaccination. A total of 499 participants (NBP608, n = 251; control, n = 248) was enrolled. The seroconversion rate (SCR) measured using FAMA assay was 99.53% in the NBP608 group, and the lower limit of the 95% confidence interval (95% LCL) for SCR difference (NBP608 minus control) was 0.52%. This 95% LCL for the difference was higher than the specified non-inferiority margin of –15%. In assessment by gpELISA, the SCR was 99.53% in the NBP608 group; and the 95% LCL for SCR difference was 6.5%, which was higher than the specified non-inferiority margin of –15%. There were no significant differences between the NBP608 and control group with respect to proportions of participants who demonstrated local and systemic solicited AEs. This study indicated that NBP608 had a clinically acceptable safety profile and was not immunologically inferior to VarivaxTM.

Salmonella is the second most frequent bacterial pathogen involved in human gastrointestinal outbreaks in the European Union; it can enter the food production chain from animal or environmental sources or from asymptomatic food operators. European food legislation has established microbiological criteria to ensure consumer protection. Salmonella is listed under both process hygiene criteria and food safety criteria. Each Member State designates an agency to organize or perform controls and other official activities. This paper describes the official control plans performed by competent authorities in northern Italy in the three-year period 2019-2021. A total of 4413 food samples were delivered to the IZS Food Safety laboratories for Salmonella detection and 36 (0.8 %) tested positive. Salmonella was most frequently detected in poultry meat samples (25/36 positive samples) followed by other meat products and pork products. The official controls for the protection of consumer health apply the EU’s from farm-to-fork approach: the samples were collected during production (food production plants) and on the market and from collective catering (restaurants, cafeterias, canteens). This manuscript will provide information about the presence of Sal-monella in foodstuffs and can help competent authorities to set control plans based on a risk assessment.

This review aims to describe an edible packaging system in food production. The growing global population, changes in climate and dietary patterns, as well as increasing need for environmental protection have created an increasing demand for waste-free food production. The need for durable and sustainable packaging materials has become significant to avoid food waste and environmental pollution. Edible packaging has emerged as a promising solution also to extend the shelf life of food products and reduce dependence on petroleum-based resources. In this review, the importance, composition, and functions of edible packaging materials, as well as their production methods, were described. The market value of edible packaging materials is expanding. It needs further research and development of edible packaging materials to increase sustainable, eco-friendly packaging practices significant for environmental protection and food safety.

Due to nutritional benefits and perceived humane ways of treating the animals, the demand for antibiotic-free pastured poultry chicken has continued to be on a steady rise. However, despite non-usage of antibiotics in pastured poultry broiler production, antibiotic resistance (AR) is reported in zoonotic poultry pathogens. However, actors that drive multidrug resistance (MDR) in pastured poultry are not known. In this study, we used machine learning and deep learning approaches to predict farm management practices, and physicochemical properties of feces and soil that drive MDR in zoonotic poultry pathogens. Antibiotic use in agroecosystems is known to contribute to resistance. Evaluation of the development of resistance in environments that are free of antibiotics such as the all-natural antibiotic-free, pastured poultry production systems described here is critical to understand the background AR. We analyzed 1,635 preharvest (feces and soil) samples collected from forty-two pastured poultry flocks and eleven farms in the Southeastern United States. CDC National Antimicrobial Resistance Monitoring System guidelines were used to determine antimicrobial/multidrug resistance profiles of Salmonella, Listeria and Campylobacter. A combination of two traditional machine learning (RandomForest and XGBoost) and three deep learning (Multi-layer Perceptron, Generative Adversarial Network, and Auto-Encoder) approaches, identified critical farm/environmental variables that drive multidrug resistance in poultry pathogens, in broiler production systems that represents background resistance. This study enumerates management practices that contribute to AR and recommendations to potentially mitigate multidrug resistance and prevalence of Salmonella and Listeria in pastured poultry.

With the rapid development of communication technology, connected vehicles (CV) have the potential, through the sharing of data, to enhance vehicle safety and reduce vehicle energy consumption and emissions. Numerous research efforts have been conducted to quantify the impacts of CV applications, assuming instant and accurate communication among vehicles, devices, pedestrians, infrastructure, the network, the cloud, and the grid, collectively known as V2X (vehicle-to-everything). The use of cellular vehicle-to-everything (C-V2X), to share data is emerging as an efficient means to achieve this objective. C-V2X releases 14 and 15 utilize the 4G LTE technology and release 16 utilizes the new 5G new radio (NR) technology. C-V2X can function without network infrastructure coverage and has a better communication range, improved latency, and greater data rates compared to older technologies. Such highly efficient interchange of information among all participating parts in a CV environment will not only provide timely data to enhance the capacity of the transportation system but can also be used to develop applications that enhance vehicle safety and minimize negative environmental impacts. However, before the full benefits of CV can be achieved, there is a need to thoroughly investigate the effectiveness, strengths, and weaknesses of different CV applications, the communication protocols, the varied results with different CV market penetration rates (MPRs), the interaction of CVs and human driven vehicles, the integration of multiple applications, and the errors and latencies associated with data communication. This paper reviews existing literature on the environmental, mobility and safety impacts of CV applications, identifies the gaps in our current research of CVs and recommends future research directions. The results of this paper will help shape the future research direction for CV applications to realize their full potential benefits.

The Romani are the main European ethnic minority. The Romani people’s situation of social vulnerability and their difficulties in accessing the health system, make their health indicators worse than those of the non-Romani population. The present study will delve into the health beliefs and experiences with health services and their professionals through the perspectives of Romani women. In this qualitative study, 16 women of different ages were interviewed in a city located in the South of Spain. Four themes emerged from the analysis of data: the construction of the identity of Romani women, difficulties in life, health and disease beliefs and barriers in the access to the health system. We conclude that every project for the improvement of the health of the Romani community must take into account the active participation of Romani women and must consider the principles of Cultural Safety, by delving into the intercultural training of health professionals and addressing the social determinants of health which affect the Romani collective.

The incorporation of unmanned aircraft terminal operations into the scope of Detect and Avoid systems necessitates analysis of the safety performance of those systems—principally, an assessment of how well those systems prevent loss of well clear from and collision with other aircraft. This type of analysis has typically been conducted by Monte Carlo simulation with synthetic, statistically representative encounters between aircraft drawn from an appropriate encounter model. While existing encounter models include terminal airspace classes, none explicitly represents the structure expected while engaged in terminal operations, e.g., aircraft in a traffic pattern. The work described herein is an initial model of such operations, scoped at this time specifically for assessment of unmanned aircraft landings and encounters with other aircraft either landing or taking off. The model shares the Bayesian network foundation of other MIT Lincoln Laboratory encounter models but tailors those networks to address structured terminal operations, i.e., correlations between trajectories and the airfield and each other. This initial model release is intended to elicit feedback from the standards-writing community.

All the available botulinum type A neurotoxins for clinical uses are of A1 subtype. We developed a subtype A2 low molecular weight (150kD) neurotoxin (A2NTX), with less spread and faster entry into the motor nerve terminal than A1 in vitro and in vivo. Preliminary clinical studies showed its efficacy superior to A1 toxins. We conducted an open study exploring its safety and tolerability profile in comparison with A1LL (onabotulinumtoxinA) and low molecular weight (150kD) A1 neurotoxin (A1NTX). Those who had been using A1LL (n=90; 50-360 mouse LD50 units) or A1NTX (n=30; 50-580 units) were switched to A2NTX (n=120; 25-600 units) from 2010 till 2018 (number of sessions ~ 27, cumulative doses ~11,640 units per patient). Adverse events for A2NTX included weakness (n=1, ascribed to alcoholic polyneuropathy), dysphagia (1), local weakness (4), spread to other muscles (1), whereas those for A1LL or A1NTX comprised weakness (n=2, A1NTX), dysphagia (8), ptosis (6), local weakness (7) and spread to other muscles (15). After injections, 89 out of 120 patients preferred A2NTX to A1 for the successive sessions. The present study demonstrated that A2NTX had the clinical safety up to the dose of 500 units, and was well tolerated compared to A1 toxins.

This article presents the integration of lean 6S methodologies and hazard analysis and critical control points (HACCP) in the food production sector. Through the study, it is seen that non-food industrial production is not very different from that of food and, in many cases, it assimilates protocols and ideas that are already working in the food industry; Such is the case of risk analysis, critical control points or hygiene, which are part of the food production protocol and, increasingly, of the industry in general. After the integrative analysis, the article proposes a common lean 6S - HACCP model, which can be used both in food production and in non-food industrial production.

Coastal tourist nursing is intended for coastal tourists related to the risk of accidents that may occur during the coastal activity. The risk of accidents in tourists can occur due to bad weather, lack of rescue equipment, and the limited ability of the coast guard to perform first aid and emergency treatment. This study described the relationship between coastal tourist nursing with the prevention of injuries and the first aid of coastal accidents, as well as the working procedures and obstacles that might occur during the rescue. The research was conducted by the qualitative method through in-depth interviews with respondents consisting of tourists, Balawista, and health workers. The data is analyzed with qualitative descriptive analysis. The interview generates 14 themes related to activities on coastal such as the duties of Balawista, warning signs, means of communication, improvement of ability, accident cases, accident treatment, referral of cases, needs of infrastructure facilities, human resources needs, health care needs, infrastructure factors, human factors, situation factors, and how to cope with the problem. Those themes can be used as a reflection in following up the safety service efforts to coastal tourists.

Improperly prepared fresh fruit and vegetable juices are recognized as an emerging cause of food borne illnesses. Therefore, this study was aimed at evaluating the microbiological safety of fresh fruit juices marketed in Debre-Markos town and their hygienic conditions of preparations. Thirty six fruit juices samples were collected from 6 cafés and restaurants of Debre-Markos town and analyzed for total aerobic viable bacterial count (TAVBC), total staphylococcal count (TSC), aerobic spore forming bacterial count (ASFBC), total coliform count (TCC), fecal coliform count (FCC), yeast and mould count (YMC). The spread plate method was used for the isolation of microorganisms on appropriate selective media. All isolates were characterized following standard methods. Bacterial and fungal species were isolated following standard methods. Questionnaires were distributed for 30 juice makers to obtain preliminary information on hygienic and safety practices of fruit juice makers. Results show that the mean TAVBC, ASFBC, TSC, yeast and mold, TCC and FCC of mango were 2.2±0.48x10⁶,0.13±0.04x10⁵ ,0.004x10⁵ ,1.1±0.2x10⁶ ,0.15±0.05x10⁵,5.7±3.73x10⁴ and 0.06±0.04x10⁴ cfu/ml respectively. The mean of TAVBC, ASFBC, TSC, YMC, TCC, and FCC of avocado juice were 3.6±0.6x10⁶, 0.08±0.02x10⁵, 0.27±0.07x10⁵, 1.2±0.4x10⁶, 0.02±0.01x10⁵, 6.46±3.7x10^4, and 0.2±0.1x10⁴ cfu/ml respectively. The bacterial isolates were identified as Staphylococcus aureus, Escherichia coli, Klebsiella spp. Bacillus cereus, Enterobacter spp., Enterococcous spp., Streptococcus spp., and Serratia spp. while the identities of the fungal isolates were Fusarium spp., Mucor spp. and Saccharomyces cerevisiae. The results also showed that the microbial loads of most of the fruit juices were higher than the specifications set for fruit juices sold in the Gulf region and other parts of the world. Most venders obtained fruit from the open market and all juice makers lacked special training in food hygiene and safety. Therefore, regular training and health education on food hygiene and safety is recommended for juice handlers to improve the quality of fresh fruit juices in the study area.

An internationally acknowledged requirement is to analyze and provide technical solutions for prevention and safety during use and maintenance of manure spreader wagons. Injuries statistics data and specific studies show that particular constructive criticalities have been identified on these machines, which are the cause of serious and often fatal accidents. These accidents particularly occur during the washing and maintenance phases, especially when such practices are carried out inside the hopper when the working bodies of the machine are in action. The current technical standards and the various safety requirements under consideration have not always been effective for protecting workers. To this end, the use of SWOT analysis allowed to highlight critical and positive aspects of the different solutions studied for reducing the risk due to contact with the working bodies. The selected and tested solution consists in a decoupling system automatically activated when the wheels of the wagon are not moving. Such a solution prevents the contact with the moving working bodies of the machine when the worker is inside the hopper. This mechatronic solution allowed to obtain a prototype that has led to the resolution of the issues related to the use of the wagon itself: in fact the system guarantees the stopping of manure spreading organs in about 12 seconds from the moment of the wheels stopping.

Patient safety is a top priority for all healthcare systems globally. Promoting the adoption of policies for reporting and learning from errors is an important strategy for improving care safety. Therefore, the aim of our study was to detect how much patient safety culture influences the reporting of adverse events and the use of the incident reporting tool. The study protocol was developed according to PRISMA guidelines. Articles were searched electronically in PubMed/MEDLINE, the COCHRANE library, and Google Scholar by two independent reviewers, and those that met the eligibility criteria were included. Synthesis of qualitative data from included studies was performed by graphical descriptive statistical analysis. The results of the systematic review showed that health care organizations' increasing focus on staff development of a safety culture has led to a significant increase in incident reporting rates over the years. Moreover, in situations where safety culture is placed at the top of the nations, there is a higher frequency of incident reporting. An efficient incident reporting system should be an essential foundation for healthcare organizations, as it allows them to collect experiences and data and provide feedback to healthcare providers and staff involved in care.

In the brain, astrocytes regulate shape and functions of the synaptic and vascular compartments through a variety of released factors and membrane-bound proteins. An imbalanced astrocyte activity can therefore have drastic negative impacts on brain development, leading to the onset of severe pathologies. Clinical and pre-clinical studies show alterations in astrocyte cell number, morphology, molecular makeup and astrocyte-dependent processes in different affected brain regions in neurodevelopmental (ND) and neuropsychiatric (NP) disorders. Astrocytes proliferate, differentiate and mature during the critical period of early postnatal brain development, a time window of elevated glia-dependent regulation of a proper balance between synapse formation/elimination, which is pivotal in refining synaptic connectivity. Therefore, any intrinsic and/or extrinsic factors altering these processes during the critical period may result in an aberrant synaptic remodelling and onset of mental disorders. The peculiar bridging position of astrocytes between synaptic and vascular compartments further allows them to “compute” the brain state and consequently secrete factors in the bloodstream, which may serve as diagnostic biomarkers of distinct healthy or disease conditions.Here, we collect recent advancements regarding astrogenesis and astrocyte-mediated regulation of neuronal network remodelling during early postnatal critical periods of brain development, focusing on synapse elimination. We then propose alternative hypotheses for an involvement of aberrancies in these processes in the onset of ND and NP disorders. In light of the well-known differential prevalence of certain brain disorders between males and females, we also discuss putative sex-dependent influences on these neurodevelopmental events.From a translational perspective, understanding age- and sex-dependent astrocyte-specific molecular and functional changes may help to identify biomarkers of distinct cellular (dys)functions in health and disease, favouring the development of diagnostic tools or the selection of tailored treatment options for male/female patients.

In steel structures, oblique thin steel plates serve as panel zones in structures spanning large spaces (e.g., warehouses and gymnasiums). Considerable research has been conducted on the shear buckling of panels due to seismic loads acting on a structure. Conversely, under snow or wind loads, the panel zone may experience compressive and tensile stresses simultaneously from two directions. Considering the economic preference for thin steel plates, evaluating the elastic critical local buckling stresses in the panel zone under biaxial normal stress may provide essential information to structural engineers. In this study, an elastic buckling analysis based on the energy method is performed to clarify the impact of panel geometry and boundary conditions on the elastic local buckling stresses of oblique panel zones. As confirmed, the buckling stresses derived from the energy method could simulate the local buckling stresses with accuracy comparable to that of finite element analysis, and an engineer-friendly design formula was proposed. Finally, we determined the correlation of the buckling stresses under biaxial stresses and presented a method for evaluating this correlation. Engineers can utilize the provided design equations to more efficiently and accurately calculate buckling loads, facilitating safer and more economical design of structures with oblique plates.

Clinical and pre-clinical studies of neuropsychiatric (NP) disorders show altered astrocyte properties and synaptic networks. These are refined during early postnatal developmental (PND) stages. Thus, investigating early brain maturational trajectories is essential to understand NP disorders. However, animal experiments are highly time-/resource-consuming, thereby calling for alternative methodological approaches. The function of MEGF10 in astrocyte-mediated synapse elimination (pruning) is crucial to refine neuronal networks during development and adulthood. To investigate the impact of MEGF10 during PND in the rat prefrontal cortex (PFC) and its putative role in brain disorders, we established and validated an Organotypic Brain Slice Culture (OBSC) system.Using Western blot, we characterized the expression of MEGF10 and the synaptic markers synaptophysin and PSD95 in the cortex of developing pups. We then combined immunofluorescent-immunohistochemistry with Imaris-supported 3D-analysis to compare age- and sex-dependent astrocyte-mediated pruning within the PFC in pups and OBSCs. We thereby validated this system to investigate age-dependent astrocyte-mediated changes in pruning during PND. However, further optimizations are required to use OBSCs for revealing sex-dependent differences. In conclusion, OBSCs offer a valid alternative to study physiological astrocyte-mediated synaptic remodelling during PND and might be exploited to investigate pathomechanisms of brain disorders with aberrant synaptic development.

Spray technology is widely used in various industries, including medicine, food production, mechanical engineering, and nanopowder manufacturing. Achieving high dispersion and a narrow particle size distribution is crucial for many applications. Ultrasonic spraying is commonly used to achieve this. On other hand, hydraulic nozzles provide high atomization performance. Combining these two technologies promises to offer significant benefits, but the complex processes that occur simultaneously in such a device require careful study. This work proposes a fundamental design for an acoustic-hydraulic nozzle and investigates the physical processes when a liquid is sprayed using this nozzle, both theoretically and experimentally. The study identifies the critical modes of spraying and confirms that the simultaneous use of ultrasound and hydraulic pressure can produce a fine spray (droplet size less than 50 μm) with high productivity (5-10 ml/s). This approach has significant potential for modern industries and technologies.

We analyse recent contradictory results and conclusions about the spectrum of the screened Coulomb potential $V(r)=-r^{-1}e^{-C/r}$. The well known Hellmann-Feynman theorem shows that all the bound states of the Coulomb potential ($C=0$) remain bounded as $C$ increases. We derive a simple approximate analytical expression for the eigenvalues for sufficiently small values of the screening parameter $C$ and an approximate asymptotic expression for the asymptotic behaviour of the s-state eigenvalues when $C\rightarrow \infty $. Present results are expected to resolve the discrepancy about the spectrum of the quantum-mechanical model just mentioned.

Purpose of the study: to reveal how the transfusion and the refraining from it affects the neuro-vascular unit in the congenital heart defects correction with cardiopulmonary bypass. Materials and methods: in vitro research, we formed a model of a neurovascular unit, which contains neu-rons, astrocytes and endothelial cells. This cellular model was cultivated in hypoxia conditions with the oxygen saturation levels of 1, 2, 3, 4%. In addition, this unit was cultivated with the pa-tient's serum adding in two different groups - with minimal and maximal levels of system in-flammatory response that we estimated by IL-6 level. Results: We found that during incubation in hypoxic conditions, the level of transendothelial resistance changed in groups with oxygen levels of 1% and 2% only after 4 hours. When we cultivated neurovascular unit cells with patients' sera, we found a minimal level of transendothelial resistance at 4 hours that increased after 24 hours. Permeability analysis showed that its level significantly decreased in the 1% and 2% oxygen group at 60- and 90-minutes relative to the control group. Conclusion: the system inflammatory response has more expressed but less long effect on the neurovascular unit model than hypoxia.

Having effective and efficient financing is one of the most important steps in accelerating the development of public infrastructure, including toll roads. This study aims to identify Critical Success Factors (CSFs) for the implementation of toll infrastructure financing in Indonesia. Thirty-three CSFs have been identified from literature review. A Delphi survey involving a panel of experts working in the infrastructure industry was conducted. Based on the survey, it is known that internal rate of return, affordability, investment decision, commercial banks, financing costs, interest rate risk, control of cash flow, contract scope, and principles of risk transfer are important factors for the implementation of toll infrastructure financing in Indonesia. This study fills research gaps by developing a CSF model for successful toll road infrastructure financing in Indonesian PPPs, considering private perspectives and aiming to provide insights for investors and enhance understanding of country profiles in developing countries. The focus on toll road implementation in Indonesia contributes to a comprehensive understanding of CSFs for PPPs in the country.

This paper presents a systematic literature review that identifies critical factors impacting the implementation of advanced manufacturing technology (AMT) worldwide. The study utilizes two databases, ProQuest and Compendex, as well as Google Scholar. The study identified eight dimensions that illustrate the critical factors of AMT adoption and implementation: education, planning, top management know-how, technical know-how, business, economic impact, regulations, and social impact. The results highlight a research gap in understanding the need for effective integration among these eight dimensions in developed and developing economies. Consequently, the study recommends the adoption of a broader perspective that considers the role of integration and interaction between critical factors in each category and their impact on AMT implementation. The systematic literature review conducted in this study reviews several critical factors related to the adoption and implementation of AMT.

Intensive care nurses are highly prone to occupational stress and burnout, affecting their physical and mental health. The occurrence of the pandemic and related events increased nurses’ workload and exacerbated stress and burnout. We conducted a prospective longitudinal mixed-methods study with a cohort of nurses working in a medical ICU (COVID unit; n = 14) and cardiovascular ICU (non-COVID unit; n = 5). Each participant was followed for six 12-hour shifts. Validated questionnaires measured occupational stress and burnout prevalence. Wrist-worn wearable technologies recorded physiological indices of stress. Participants elaborated on the contributors to stress via post-study questionnaire. Data were analyzed using statistical and qualitative methods. Participants who cared for COVID patients at the COVID unit were 3.71 times more likely to experience stress (p &lt; .001) in comparison to non-COVID unit participants. No differences in stress levels were found when the same participants worked with COVID and non-COVID patients at different shifts at the COVID unit. The cohorts expressed similar contributors to stress including communication tasks, patient acuity, clinical procedures, admission processes, proning, labs, and assisting coworkers. Nurses in COVID units, irrespective of whether they care for a COVID patient, may experience high occupational stress and burnout.

Worldwide, one of the main causes of death among young adults is multiple trauma. In these pa-tients hemorrhagic shock represents the leading cause for worsening of the clinical status and for increased morbidity and mortality. This is due to a multifactorial complex involving cellular, bi-ological, and biophysical mechanisms. The most important mechanisms affecting clinical out-come are oxidative stress, the augmentation of pro-inflammatory status, immune deficiency, dis-ruptions in the coagulation cascade, imbalances in electrolyte and acid-base homeostasis. Poly-trauma patients in hemorrhagic shock need adequate fluid management to ensure hemodynamic stability that must consider not only the maintenance of adequate blood pressure, but also the ad-equate oxygenation of tissues for optimal cellular function. In the current clinical practice, fluid resuscitation in polytrauma patients uses a variety of widely studied pharmacological products, such as crystalloids, colloids, blood transfusions, and the infusion of other blood products. Alt-hough these products exist, an agreement was not reached on a standard administration protocol that could be generally applied for all patients. Moreover, numerous studies have reported a se-ries of adverse events related to fluid resuscitation and to the inadequate use of these products. This review aims at describing the impact the administration of all the solutions used in fluid re-suscitation might have on the cellular and pathophysiological mechanisms in the case of poly-trauma patients suffering from hemorrhagic shock.

Recent years have witnessed a boom of fashion bloggings sharing information about clothing and cosmetics on diverse social media platforms. Constant exposure to fashion-related digital information heavily impacts the cognition and behaviour of Chinese youth. Compared to the substantial studies on the impact of social media, scarce research has been conducted on how youth’s cognitive processing of fashion-related digital information interacts with motivational factors to determine the subsequent behaviour. This study made an initial attempt to address this issue by exploring the successive associations between clothing motivation (amotivation, controlled, and autonomous motivation), online critical thinking (for information credibility, objectivity, and relevance), and the subsequent behavioural intentions. A total of 1997 Chinese youths with diverse educational backgrounds voluntarily participated in the study. Results confirmed the direct links between clothing motivation and behavioural intentions, but these links were mediated by different online critical thinking skills. This study provides new insights for both practitioners and scholars in the fields of education, psychology, social media, and marketing.

Recently, it was reported that the physical cross-linking exhibited by some biopolymers could provide multiple benefits to biomedical applications. In particular, grafting thermoresponsive polymers onto biopolymers may enhance the degradability or offer other features, as ther-mothickening behavior. Thus, different interactions will affect the different hydrogen bonds and interactions from the physical cross-linking of CMC, the lower critical solution temperatures (LCSTs), and the presence of the ions. This work focuses on the study of blends composed of poly(N-isopropylacrylamide), poly(N-ethylacrylamide), and carboxymethyl cellulose in water and water/methanol. The molecular features, the thermoresponsive behavior, and gelation phenomena are deeply studied. The ratio defined by both homopolymers will alter the final properties and the gelation of the final structures, showing that the presence of the hydrophilic groups modifies the number and contributions of the diverse hydrogen bonds.

Septic shock substantially alters the pharmacokinetic properties of ß-lactams with a subsequently high risk of insufficiently low serum concentrations and treatment failure. Considering their pharmacokinetic (PK)/pharmacodynamic (PD) index, prolonged infusions (PI) of ß-lactams extend the time that the unbound fraction of the drug remains above the minimal inhibitory concentration MIC (ft >MIC) and may improve patient survival. The present study is a monocentric, retrospective before-and-after analysis of septic shock patients treated with ß-lactams. Patients of the years 2015-2017 received intermittent bolus application whereas patients of 2017-2020 received PI of ß-lactams. The primary outcome was mortality at day 30 and 90 after diagnosis of septic shock. Mortality rates in the PI group were significantly lower on day 30 (PI: 41%, n=119/290 vs. IB: 54.8%, n=68/114; p=0.0097) and day 90 (PI: 47.9%, n=139/290 vs. IB: 62.9%, n=78/124; p=0.005). After propensity-score matching, 30- and 90-day mortality remained lower for the PI group (-10%). PI further reduced duration of invasive ventilation. PI of β-lactam antibiotics led to a stronger decrease in SOFA scores within a 14d-observation period. PI of ß-lactams significantly reduces mortality in patients with septic shock and may have beneficial effects on invasive ventilation and recovery from sepsis-related organ failure.