Objectives: The aim of the present study was to evaluate the association between psoriasis and osteoporosis using two different studies. Methods: Data from the Korean National Health Insurance Service-Health Screening Cohort of participants who were ≥ 40 years old were collected from 2002 to 2013. Psoriasis and osteoporosis were included using ICD-10 codes. In study I (a follow-up study), a total of 25,306 psoriasis participants were matched to 101,224 controls with respect to age group, sex, income group, and region of residence, and the occurrence of osteoporosis was analyzed. Crude (simple) and adjusted hazard ratios (HRs) were analyzed using a stratified Cox proportional hazard model. In study II (a nested case–control study), a total of 79,212 osteoporosis patients were matched to 79,212 controls, and a previous history of psoriasis was analyzed. Crude and adjusted odds ratios (ORs) were analyzed using a conditional logistic regression analysis. Subgroup analyses were conducted according to age group and sex. Results: The adjusted HR of osteoporosis was 1.11 (95% confidence interval [CI] = 1.07-1.15, P < 0.001) in study I. In the subgroup analysis according to age and sex, the results were consistent except for the ≥ 60-year-old women. The adjusted OR of psoriasis was 1.22 (95% CI = 1.16-1.28, P < 0.001) in study II. All subgroups demonstrated high adjusted ORs of osteoporosis for psoriasis. Conclusions: Psoriasis increased the risk of osteoporosis in the population of participants aged ≥ 40 years in Korea.

The consumption of sweet beverages, including sugar-sweetened beverages (SSB), artificially sweetened beverages (ASB) and fruit juices (FJ) is associated with the risk of different cardiometabolic diseases and probably with some tumors as well. We carried out a systematic review and meta-analysis of observational studies aimed at evaluating the association between sweet beverage intake and different types of cancer risk. Suitable papers published up to June 2020 were searched through PubMed, Web of Science and SCOPUS databases, using relevant keywords. Overall, 64 studies were identified for the systematic review, of which 27 were selected for the meta-analysis. This was performed by analyzing the multivariable-adjusted OR, RR or HR of the highest compared with the lowest sweet beverage intake categories. Random effects showed significant positive association between SSBs intake and breast (RR: 1.14, 95% CI: 1.01 – 1.30) and prostate cancer risk (RR: 1.18, 95% CI: 1.10 – 1.27), also between FJs and prostate cancer risk (RR: 1.03, 95% CI: 1.01 – 1.05). Associations between SSBs and colorectal and pancreatic cancer risk, FJs and breast, colorectal and pancreatic cancer risk, ASBs and pancreatic cancer risk tended to be positive but did not reach the statistically significant threshold. This study supports the recommendation to limit the consumption of SSBs and FJs for cancer prevention and proposes to further investigate the potential harmful role of ASBs intake in cancer risk.

About half of the world's population is at risk of dengue infection. Epidemics of dengue fever caused an increased risk of morbidity and mortality in recent years, which led to the exploration of vaccines as a preventive measure. This systematic review and meta-analysis aimed to evaluate the efficacy, immune response, and safety of dengue vaccines in children by analyzing clinical trials. The review followed standard procedures for data extraction using PRISMA guidelines, and searching multiple databases including PubMed, CINAHL, Medline, Health Source, Science Direct, and Academic Search Premiere. Eligible studies involved children (0-17 years). Cochrane Collaboration criteria were used for quality assessment, with thematic data synthesis and meta-analysis. Among 38 selected studies, dengue vaccines showed varying efficacy against all four serotypes. CYD-TDV (Dengvaxia®), and Tekade (TAK-003) vaccines demonstrated strong protection against severe dengue, but their long-term efficacy varied. Vaccines triggered satisfactory immune responses, notably in those previously exposed to dengue. Safety profiles were mostly favorable, noting mild adverse events post-vaccination. Meta-analysis supported vaccine efficacy and immune response, but safety concerns warrant further exploration. In conclusion, dengue vaccines demonstrated promising efficacy and immune response, particularly against severe manifestations.

The current performance indicator for universal salt iodization (USI) is the percent of households using adequately iodized salt. However, the proportion of dietary salt from household salt is decreasing with the increase in consumption of processed foods and condiments globally. This paper reports on case studies supported by the GAIN-UNICEF USI Partnership Project to investigate processed food industry use of adequately iodized salt in contrasting national contexts. Studies were conducted in Egypt, Indonesia, the Philippines, the Russian Federation, and Ukraine. In all cases, the potential iodine intake from iodized salt in selected food products was modelled according to the formula: Quantity of salt per unit of food product x minimum regulated iodine level of salt at production x average daily per capita consumption of the product. The percent of adult recommended nutrient intake for iodine potentially provided by the average daily intake of bread and frequently consumed foods and condiments was from 10% to 80% at the individual product level. The potential contribution to iodine intake from the use of iodized salt in the processed food industry is of growing significance. National USI strategies should encourage co-operative industry engagement and include regulatory monitoring of iodized salt use in the food industry in order to achieve optimal population iodine status.

Purpose – The paper aims to view how researchers have operationalized social impact assessment for construction projects over the last ten years. Design/methodology/approach – A systematic review was used to investigate case studies in the Social Life-Cycle Assessment (S-LCA) to analyze the application of the methodology. A qualitative study of 19 articles published between 2012 and 2022 was used to collect content on multiple categories impeding S-LCA through case studies in the construction industry. Findings – Our results showed the existence of limitations on the qualitative and quantitative aspects in measuring the social indicators. They were associated with the scoring method and the lack of data in some articles. Social implications – From this review, we understood that S-LCA has flaws in terms of the quality of the measurement, scoring method, and the lack of social data. Lack of social data means social impacts are being neglected and not assessed properly since there are several challenges pointed out throughout literature Originality/value – The originality of this research is that it focuses on case studies in the construction industry. It studies the operationalization of the S-LCA in this specific industry showing the different characteristics and challenges in the last 10 years.

When drilling oil and gas wells, hole cleaning efficiency is crucial, particularly in the curved or severely deviated sections. Although many hole-cleaning procedures and models have been developed, most of them have substantial limitations or are difficult to apply in real time. This study aimed to develop a model for the hole cleaning index (HCI) that could be integrated into the drilling operations to provide an automated and real-time evaluation of deviated drilling hole cleaning. The new model herein was developed based on the mechanical drilling parameters, enhanced estimated drilling fluid properties, and cuttings characteristics. This HCI model was validated and tested in the field, as it was applied when drilling 12.25”-intermediate directional sections in two wells with a total length of approximately 2000 ft each. The integration of the HCI helped to attain a much better well drilling performance (50% enhancement) and mitigation of potential problems like pipe sticking and the slower rate of penetration. Since the developed index incorporates the changes in wellbore geometry and other spontaneous field data, the new model could be utilized for real-time optimization and intermediate interventions by drilling teams, unlike commercial software tools which are only useful during the planning phase. For this reason, the HCI can be linked to the driller's control panel to provide timely evaluation and corrective measures related to hole cleaning.

COVID-19 pandemic put pregnant women in high risk, but behavioural changes has also led to lower rates of preterm births in high-income countries. The main goal in this article is to study the impact that COVID-19 pandemic is having on pregnancy control and outcomes. This is a joint analysis of two cohorts. A pre-pandemic one includes 969 pregnant women recruited in 2018. The pandemic cohort comprises 1168 pregnant women recruited in 2020. Information on demographic and socio-economic characteristics, reproductive history, characteristics of the current pregnancy and its outcome were obtained from medical records. Caesarean section was more frequent in the pre-pandemic cohort (24% vs. 18%, p = 0.004). Birth with less than 37 weeks of gestational age was more frequent in the pre-pandemic cohort (6% vs. 5%, p = 0.04). Weight at birth lower than 2500 grams occurred more frequently in the pre-pandemic cohort (9% vs. 6%, p = 0.001). Exclusive breastfeeding at hospital discharge was more frequent in the pandemic cohort than in the pre-pandemic one (60% vs. 54%, p = 0.005). We are reporting reductions in Caesarean section and preterm birth during the pandemic in a hospital located Northern of Spain. Further analysis would clarify if these lessening are related to changes in health-related behaviour or health-care functioning.

Despite the rising interest in smart city initiatives worldwide, governmental theories along with the managerial perspectives of city planning are a great lack in the literature. It is definitely understandable that the adoption of configurational pathways towards the ‘smart’ ‘governance’ models is required as key factor and smartness’ facilitator in modern cities. In this manuscript, we display an exhaustive analysis on the importance of the n-Helix models along with a benchmarking critical approach through selected European case-studies. The study, through the literature review, revealed the lack of exhaustive analyses for the methodological investigation, identification and adoption of the most appropriate governance model and collaborative approaches per project and collaborative approaches and create modular frameworks to address efficiently the continuous urban challenges, such as the rapid urbanization or the climate change.

Background: Despite advances in diagnosis and treatment, the incidence and mortality of infective endocarditis (IE) have increased in recent decades despite advances in diagnosis and treatment. Studies on the risk factors for mortality in endocarditis in Latin America are scarce. Methods: This retrospective cohort study included 240 patients diagnosed with IE according to the modified Duke criteria who were admitted to two university hospitals in Rio de Janeiro, Brazil from January 2009 to June 2021. Poisson regression analysis was performed for trend tests. The multivariate Cox proportional hazards model was used to estimate the hazard ratio (HR) of predictors of in-hospital mortality. Findings: The median age was 55 years (IQR: 39-66 years), 57% were male, and 41% had a Charlson comorbidity index (CCI) score &gt; 3. Healthcare-associated infective endocarditis (54%), left-sided native valve IE (77.5%), and staphylococcal IE (26%) predominated. Overall in-hospital mortality was 45.8%, and mortality was significantly higher in the following patients: aged ≥ 60 years (53%), CCI score ≥ 3 (60%), healthcare-associated infective endocarditis (HAIE) (53%), left-sided IE (51%), and enterococcal IE (67%). Poisson regression analysis showed no trend in in-hospital mortality per year. The adjusted multivariate model determined that age ≥ 60 years was an independent risk factor for in-hospital mortality (HR = 1.9; 95% CI 1.2-3.1; p = 0.008). Interpretation: In this 12-year retrospective cohort, there was no evidence of an improvement in survival in patients with IE. Since older age is a risk factor for mortality, consensus is needed for the management of IE in this group of patients.

During the COVID-19 pandemic, the high prevalence of comorbidities in Mexico, as well as the disparities between public and private health subsystems, substantially contributed to the severe impact it had in the country. The objective of this study was to evaluate and compare risk factors present at admission for mortality of hospitalized patients with COVID-19. A 2-year retrospective cohort study of hospitalized adult patients with COVID-19 was conducted at a private tertiary care center. The study population consisted of 1,258 patients with a median age of 56 ± 16.5 years, of whom 1,093 recovered (86.8%) and 165 died (13.1%). In the univariate analysis, older age (p &lt;0.001), comorbidities such as hypertension (p &lt;0.001) and diabetes (p &lt;0.001), signs and symptoms of respiratory distress, and markers of acute inflammatory response were significantly more frequent in non-survivors. The multivariate analysis showed that older age (p &lt;0.001), the presence of cyanosis (p 0.005) and previous myocardial infarction (p 0.032) were independent predictors for mortality. In the studied cohort, risk factors present at admission associated with an increased risk of death were older age, cyanosis and a previous myocardial infarction, which can be used as valuable predictors for patients’ outcomes. To our knowledge, this is the first study analyzing predictors of mortality in COVID-19 patients attended on a private tertiary hospital in Mexico.

(1) Background: Patients with schizophrenia have higher mortality, with cardiovascular diseases being the first cause of mortality. This study aims to estimate the excess risk of hospital admission for cardiovascular events in schizophrenic patients, adjusting for comorbidity and risk factors. (2) Methods: The APNA study is a dynamic prospective cohort of all residents in Navarra, Spain. 505889 people over 18 years were followed for five years. The endpoint was hospital admissions for a cardiovascular event. Direct Acyclic Graphs (DAG) and Cox regression were used. (3) Results: Schizophrenic patients had a Hazard Ratio (HR) of 1.414 (95% CI 1.031-1.938) of hospital admission for a cardiovascular event after adjusting for age, sex, hypertension, type 2 diabetes, dyslipidemia, smoking, low income, obesity, antecedents of cardiovascular disease, and smoking. In non-adherent to antipsychotic treatment schizophrenia patients, the HR was 2.232 (95% CI 1.267-3.933). (4) Conclusions: Patients with schizophrenia have a higher risk of hospital admission for cardiovascular events than persons with the same risk factors without schizophrenia. Primary care nursing interventions should monitor these patients and reduce cardiovascular risk factors.

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

Congenital malformations are functional and structural alterations in embryonic or foetal development resulting from a variety of factors including maternal health status. This study aimed to investigate the association between maternal birth weight (MBW) and the prevalence of congenital malformations in the offspring using data from a nationwide birth cohort study in Japan including 103,060 pregnancies. A binary logistic regression model with adjustment for various covariates revealed that MBW of &lt;2,500 g (low MBW) was associated with increased risk of congenital heart disease (adjusted odds ratio: 1.388, [95% confidence interval: 1.075–1.792]), angioma (1.491 [1.079–2.059]), and inguinal hernia (1.746, [1.189–2.565]), while MBW of ≥4,000 g (high MBW) with congenital anomalies of the urinary tract (2.194, [1.261–3.819]), and arrhythmia (1.775, [1.157–2.725]), compared with those with MBW of 3,000-3,499 g. Low MBW was associated with cleft lip and/or palate (1.473, [1.052–2.064]), congenital heart disease (1.615, [1.119–2.332]), genital organs(1.648, [1.130–2.405]), hypospadias (1.804, [1.130–2.881]), and inguinal hernia (1.484, [1.189–1.851]) in male infants and CAKUT (1.619, [1.154–2.273]) in female infants, whereas high MBW was associated with congenital heart disease(1.745, [1.058–2.877]) and CAKUT (2.470, [1.350–4.517]) in male infants. The present study is the first to demonstrate a link between MBW and congenital malformations in Japanese children. While these results must be interpreted with caution, MBW should be considered a major predictor of congenital malformation risk.

To explore impact of weight change (WC) on risk of atherosclerosis measured by cIMT, 20,700 participants from the CLSA follow-up were included in analysis. WC was defined as the difference of weight measured at follow-up and baseline, then quartered into four groups (Q1–Q4). cIMT>1.0 mm was defined as high-risk for atherosclerosis. Adjusted odds ratio (OR, [95% CI]) from logistic regression models were used to evaluate the association between WC and risk of atherosclerosis. At follow-up, participants have gained 0.118 kg weight, on average, and 16.4% of them were at high-risk for atherosclerosis. The mean levels of cIMT were comparable between participants from Q1 to Q4. Compared to Q2 (reference), the ORs (95% CI) were 1.00 (0.86, 1.15), 1.19 (1.03,1.38), and 1.25 (1.08,1.45) for Q1, Q3, and Q4, respectively. A similar pattern was observed when analyses conducted by <65 vs. 65+ years separately, but it was weaker for those aged 65+ years. Results from the jointed distribution analyses indicated that weight loss might increase risk for atherosclerosis among participants with obese at baseline, but not for those with cardiovascular events status at baseline. Weight gain, however, would increase risk for atherosclerosis regardless of cardiovascular events status, or overweight/obese at baseline.

(1) Background: The aim of the research was to present and emphasize the importance of magnetic resonance imaging (MRI) in diagnosing Achilles tendon (AT) ruptures by presenting case reports. (2) Materials and Methods: The sample of respondents included 7 patients (4 males and 3 females, 2 athletes and 5 non-athletes), aged 25 to 58 years, with AT injuries, who were examined and treated at the Institute for Treatment and Rehabilitation "Niška Banja", Niš, Serbia. Ankle examinations with MRI were conducted using the Esaote O-scan 0.3 T machine. The examinations were performed without the application of a paramagnetic contrast agent and without the use of anesthesia. Results: The MRI method's sensitivity and overall diagnostic accuracy were excellent, with 100% true positives. In our study, the method accurately detected the presence, location, and severity of AT injuries in all cases. MRI is an important and reliable method for detecting AT injuries, classifying them, monitoring the course of recovery, and assessing the effects of therapy. Conclusions: An unrecognized or delayed diagnosis of an AT injury can lead to chronic changes. Timely diagnosis (clinical examination, ultrasonography, magnetic resonance imaging) and appropriate treatment (conservative or operative) enable patients to return to normal activities, including sports. Unfortunately, the use of MRI is limited by restricted access and the cost of the examination.

Lymphedema refers to a group of disorders characterized by the accumulation of protein-rich fluid in the interstitial tissues, resulting from an imbalance between lymph production and it’s drainage via lymphatic vessels. More than 10 types of isolated primary LD is described, and among them CELSR1-associated lymphedema are one of the less studied. A family with two sibs, a 17-year-old boy and an 8-year-old girl, both diagnosed with primary LD, presented to the clinic. Both patients were observed with primary symptoms of LD at 2-3 months of age, presented by the swelling of right foot. Lymphatic pathologies were not diagnosed in parents or close relatives. The rare c.7664A>C variant, resulting in the H2555P missense mutation in the intracellular loop of CELSR1 transmembrane domain, was discovered in a patients. The clinical signs, MRL scanning data, in silico predictors and the absence of known pathogenic mutations or rare variants of unknown significance in other genes, associated with the development of primary lymphedema, allow us to assume that c.7664A>C variant of CELSR1 may be responsible for pathogenesis of the disease in the presented family case.

This case study was conducted to disentangle the stories of unsuccessful LET examinees, their responses to failure, and their perspectives of the factors that contributed to their failure. The results demonstrate five themes related to the failure experience. Factors related to the physical environment, psychological well-being, and preparedness influenced the performance of the examinees. Contributory factors to failure provided several implications to teacher education practice. Educators have a responsibility to identify, inform, and intervene with students who are at high risk of failing the LET, and this responsibility could be executed capably. However, the role should be extended beyond graduation. The responsibility to help graduates transition from failure to licensure is the final step of successful undergraduate teacher education.

Abstract: This study aimed to evaluate the long-term impact of paediatric dentistry programmes on children and adolescents to reduce oral health inequalities. It measures and assesses the improvement effects of paediatric dentistry programmes on the oral health of children and adolescents as part of the efforts to decrease oral health disparities in this age group. It included 406 individuals who participated in student and paediatric dentistry programmes between 2013 and 2019 at screening facilities in Gwangjin-gu, Seoul. Frequency analysis was conducted for demographic characteristics, and binary logistic regression analysis was performed to identify factors influencing the prevalence of dental caries as the dependent variable. Data were analysed using PASW Statistics with the statistical significance level set at α=0.05. Regarding oral health indicators based on the frequency of participation in paediatric dentistry programmes for children and adolescents, participants with seven or more sessions had lower prevalence rates of dental caries, malocclusion, and periodontal disease than those with only one session. Second, when comparing oral health indicators in paediatric dentistry programmes between primary and adolescent age groups, individuals under continuous management showed a decrease in permanent teeth affected by dental caries, dental caries prevalence, and malocclusion prevalence (excluding primary school age). Third, binary logistic regression analysis revealed significant influences (p

Free-of-charge HCV screening in some key populations and in 1969–1989 birth cohorts have been funded in Italy as the first step to diagnosing individuals unaware of their infection. The aim of this study is to use available in-hospital routine screening data to understand the inpatients HCV screening in a region of North Italy. A retrospective search of in-hospital patients tested for HCV-antibody (HCV-Ab) from January 2017 to the end of December 2022, was conducted according to age categories (older than 76 years, birth group 1947-1968; birth group1969-1989 and two other categories with patients younger than 33 years) using the TriNetX network. Of 42,805 in-hospital patients tested, 1,297 (3.03%) resulted HCV-Ab positive. The proportion decreased from 2017 to 2022 (from 2.03% to 0.36%) years). The higher prevalence of HCV-Ab was in patients older than 76 years (5.3%) while, the lowest was in the younger birth cohort (2000-2022, 0.16%). Of 1,297 patients found HCV-Ab positive, only 198 (15.3%) were tested for the presence of HCV RNA. Although the birth cohort 1969-1989 had a lower seroprevalence (1.5%), they represented the most affected age group with 44.4% of HCV RNA positivity. The in-hospital HCV screening including birth cohort 1947-1989 could be a valuable option respect to the screening for birth group 1969-1989 in the general population. Since a high proportion of patients were not tested for HCV RNA during hospitalization, reflex testing promptly ascertaining an active infection could facilitate linkage to care to stop the burden of HCV.

Suboptimal micronutrient intake in children remains a public health concern around the world. This study examined the relationship between a previously defined dietary carbohydrate quality index (CQI) and the risk of micronutrient intake inadequacy in a pediatric cohort of Spanish preschoolers. Children aged 4-5 years old were recruited at their medical center or at school, and information on sociodemographic, dietary, and life-style variables were collected through a self-administered online questionnaire. Dietary information was obtained from a validated 147-item semi-quantitative food frequency questionnaire. We calculated the CQI and categorized participants in quartiles according to their score. We assessed the intakes of 20 micronutrients and evaluated the probability of intake inadequacy using the Estimated Average Requirement cut-off point. Generalized estimating equations were used to adjust for potential confounders and account for the intra-cluster correlations between siblings. The adjusted proportions of children with inadequate intake of ≥3 micronutrients were 23%, 12%, 11% and 9% in the first, second, third and fourth quartiles of the CQI, respectively. Children in the highest quartile of CQI had 0.22-fold lower odds (95%CI 0.10-0.48) of having ≥3 inadequate micronutrient intakes than their peers in the lowest quartile. These findings reinforce the relevance of carbohydrate quality in children’s diets.

Studies suggest that elevated postnatal blood lead levels (BLLs) are negatively associated with child growth. This study aimed to investigate associations of childhood BLLs at age one-year and growth outcomes at age six-years (n=661) in a cohort of children in Allada, Benin. The growth outcomes studied are weight-for-age Z-score (WAZ), height-for-age Z-score (HAZ) and BMI-for-age Z-score (BMIZ), head circumference (HC), underweight, stunting, and wasting. Multivariable regression models examined associations between blood lead levels, growth outcomes with adjustment for potential confounders. The geometric mean BLLs was 59.3 μg/L and 82% of children had BLLs &gt;35 μg/L at one year. After adjusting for confounding factors, no association was found between BLLs quartiles and HAZ, WAZ, BMIZ, and height and weight growth velocities. However, boys in the highest quartile had 1.02 cm lower HC (95% CI: [-1.81, -0. 24]) as compared to those in the lowest quartile with a dose-response trend across quartiles (Ptrend =0.02). Furthermore, an increased risk of being stunted was observed in children in the highest quartile of exposure compared to the first (OR: 2.43; 95% CI: [1.11 – 5.33]) with a dose-response trend (Ptrend =0.03). Blood lead was found to be associated with an increased risk of childhood stunting and lower head circumference in a resource-limited setting.

Background: Treatment at stabilization center is an important intervention to avert the huge burden of mortality for children with complicated severe acute malnutrition (SAM). Recent reviews indicated a wide range in recovery rate (34-88%) due to several context-specific factors. This study aimed to estimate time to recovery and to determine predictors of time to recovery among children aged 6-59 month with severe acute malnutrition. Method: Retrospective cohort study was used among 375 children aged 6-59 months admitted in Jimma university medical center, from September 2015 to September 2017. Kaplan Meir estimate and survival curve was used to compare the time to recovery using log-rank test among different characteristics. Cox Proportional Hazard Model was used to identify significant predictors of time to recovery. Results: Median time of recovery for cohort of SAM children’s was 19 days (95%CI: 17.95-20.05). Independent predictors of time to recovery were: Play stimulation, vaccination status, Tuberculosis, malaria, use of amoxicillin, deworming and shock. Conclusion: The findings of this study showed that the average length of stay on treatment and median time for recovery are within the sphere standard. Psychosocial stimulation, appropriate provision of routine medication and management of medical co-morbidity are needed to promote fast recovery.

In recent years, more attention has been paid to behavioral problems in children. However, for the most part, risk factors for these problems have yet to be determined. The current prebirth cohort study investigated the relationship between maternal calcium consumption during pregnancy and behavioral problems in five-year-old Japanese children. Subjects were 1199 mother-child pairs. Dietary intake was assessed using a diet history questionnaire. Emotional problems, conduct problems, hyperactivity problems, and peer problems were assessed using the Strengths and Difficulties Questionnaire. Logistic regression analysis was conducted to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for four behavioral problems under study according to the quartile of calcium intake, with the lowest quartile as the reference. Adjustment was made for maternal age, gestation at baseline, region of residence at baseline, number of children at baseline, maternal and paternal education, household income, maternal depressive symptoms during pregnancy, maternal alcohol intake during pregnancy, maternal smoking during pregnancy, child's age, child's birth weight, postnatal secondhand smoke exposure at home during the first year of life, and breastfeeding duration. Higher maternal calcium intake during pregnancy was independently associated with a decreased risk of childhood emotional and hyperactivity problems; the adjusted ORs between extreme quartiles (95% CIs, P for trend) were 0.46 (0.27–0.79, 0.01) and 0.60 (0.37–0.97, 0.046). No such inverse associations were observed for childhood conduct problems or peer problems. Maternal calcium intake during pregnancy may decrease the risk of childhood emotional and hyperactivity problems.

Background: Few studies have investigated the longitudinal association between cervical spondylosis (CS) and migraine by using a nationwide population-based database. Methods: We conducted a retrospective cohort study from 2000 to 2011 identifying 27,930 cases of cervical spondylosis and 111,720 control subjects (those without cervical spondylosis) from a single database. The subjects were frequency-matched on the basis of sex, age, and diagnosis date. The non- cervical spondylosis cohort was four times the size of the cervical spondylosis cohort. To quantify the effects of cervical spondylosis on the risk of migraine, univariate and multivariate Cox proportional hazard regression analyses were used to calculate the hazard ratio (HR) and 95% confidence interval (CI). Results: After a 10-year follow-up controlling for potential confounding factors, overall migraine incidence was higher in the cervical spondylosis cohort than in the non- cervical spondylosis cohort (5.16 and 2.09 per 1,000 people per year, respectively; crude hazard ratio = 2.48, 95% confidence interval = 2.28–2.69) with an adjusted hazard ratio of 2.03 (95% confidence interval = 1.86–2.22) after accounting for sex, age, comorbidities, and medication. Individuals with myelopathy in the cervical spondylosis cohort had a 2.19 times (95% confidence interval = 1.80–2.66) higher incidence of migraine compared than did those in the non- cervical spondylosis cohort. Conclusion: Individuals with cervical spondylosis exhibited a higher risk of migraine than those without cervical spondylosis. The migraine incidence rate was even higher among individuals with cervical spondylotic myelopathy.

It is important to be familiar with the presentation of Turner syndrome and to understand the common causes of death associated with the disease. Using the autopsy case as an example, this case report will outline the classic presentation of Turner syndrome, go over its physiology, epidemiology, pathogenesis and explain the cause of death in this particular case while also highlighting other common causes of death/risk factors within Turner syndrome. Differential diagnosis and mimicking disease processes will also be discussed. This report will also highlight the molecular tests used for the diagnosis of Turner syndrome, discuss developments using in situ hybridization, and discuss why this method is best for the determination of Turner syndrome over conventional karyotyping.

Efficient use of the operating room (OR) is crucial for any hospital. One of the major inefficiencies in the OR is surgical cases not starting or finishing on time as scheduled. When a case is delayed, it affects all subsequent cases in that OR. This study uses discrete choice analysis to determine the significant factors, including team familiarity, that influence OR case on-time start and finish. A case is considered on-time if the documented procedure start and finish times are no more than 10 minutes after the scheduled start and finish times. The analysis uses surgical case data from a large tertiary referral hospital and academic center in Greenville, South Carolina. The case data includes all surgical cases (15,091) performed during regular workdays in 2013. Two binary logit models are developed: one for case on-time start and one for case on-time finish. Results indicate that higher team familiarity between surgeon and anesthesiologist, surgeon and circulating nurse, surgeon and scrub nurse, and surgeon and CRNA improve the likelihood of an OR case on-time start and on-time finish. This finding indicates that the OR scheduling staff in the study hospital make a concerted effort to schedule the surgical teams with members who have worked well together in the past.

Survival models have become popular for credit risk estimation. Most current credit risk survival models use an underlying linear model. This is beneficial in terms of interpretability but is restrictive for real-life applications since it cannot discover hidden nonlinearities and interactions within the data. This study uses discrete time survival models with embedded neural networks as estimators of time to default. This provides flexibility to express nonlinearities and interactions between variables, and hence allows for models with better overall model fit. Additionally, the neural networks are used to estimate Age-Period-Cohort (APC) models so that default risk can be decomposed into time components for loan age (maturity), origination (vintage) and environment (e.g., economic, operational and social effects). These can be built as general models, or as local APC models for specific customer segments. The local APC models reveal special conditions for different customer groups. The corresponding APC identification problem is solved by a combination of regularization and fitting the decomposed environment time risk component to macroeconomic data, since the environmental risk is expected to have a strong relationship with macroeconomic conditions. Our approach is shown to be effective when tested on a large publicly available US mortgage data set. This novel framework can be adapted by practitioners in the financial industry to improve modelling, estimation and assessment of credit risk.

The basis of this project is a health literacy cohort study (LISA) being developed in the county of Leiria. The study aims to reach and monitor the adult population of the county over time. Counting with a multidisciplinary team, the study stakeholders asked the designers to develop the study’s brand so it could be more advertisable to the population, turning the communication between the stakeholders and the public easier. The development of the brand identity and elements of communication used some graphic design approaches. These approaches were reinforced by the opinions given by the interviewed sample of the population, that answered some of the study’s questions. The interviews held by designers allowed the team to receive information about what was expected the study to be, and how and where to better communicate the LISA’s Study. Trough the aforementioned process resulted in the current finalized outcomes of the study’s brand and communication materials. Both printable and digital communication elements (i.e., roll-up, id cards, flyers, QR Code, and website) were developed and disseminated according to the brand's strategy. Concluding, the communication elements created are seen as the first phase of this project, leaving a second phase related to the design and structuration of the Study to be developed, and published in future articles.

Objective: The goal of the present study was to evaluate the treatment with Canephron® after the diagnosis of acute cystitis or urinary tract infection (UTI) with regards to the risk of a sporadic recurrent UTI, frequent recurrent UTIs, UTI associated sick leave, additional antibiotic prescriptions, and renal complications (pyelonephritis) compared to standard antibiotic treatment. Methods: This retrospective cohort study was based on data from the IMS® Disease Analyzer database (IQVIA), and included outpatients in Germany with at least one diagnosis of acute cystitis or UTI with a prescription of either Canephron® or standard antibiotics between January 2016 and June 2019 in general practitioner (GP), gynecologist, or urologist practices from which data were obtained. Multivariable regression models were used to investigate the association between Canephron® prescription and the amount of sporadic or frequent recurrent UTIs, as well as the duration of UTI associated sick leave, amount of additional antibiotic prescriptions, and cases of pyelonephritis. The effects of Canephron® were adjusted for age, sex, insurance status, and Charlson Comorbidity Score (CCI). Results: 2,320 Canephron® patients and 158,592 antibiotic patients were available for analysis. Compared to antibiotic prescription, Canephron® prescription was significantly associated with less sporadic recurrences of UTI infections 30-365 days after the index date (odds ratio [OR]: 0.66; 95% confidence interval [CI]: 0.58–0.72), as well as with less frequent recurrences of UTI infections (OR: 0.61; 95% CI: 0.49–0.88), and with minor additional antibiotic prescription within 31-365 days (OR: 0.57; 95% CI: 0.52-0.63). No significant differences were observed between the Canephron® and antibiotic cohorts with regard to the likelihood of sick leave (OR: 0.99; 95% CI: 0.86–1.14), new antibiotic prescription within 1-30 days (OR: 1.01; 95% CI: 0.87-1.16) and occurrences of pyelonephritis (Hazard Ratio (HR): 1.00; 95% CI: 0.67-1.48). Conclusion: These real world data show that Canephron® is an effective and safe symptomatic treatment for acute cystitis or UTI. It should be considered as an alternative treatment in particular also to strengthen antimicrobial stewardship strategies.

Background: The aim of this study was to investigate the risk of obstructive sleep apnea (OSA) among ankylosing spondylitis (AS) patients in a nationwide population. Methods: We conducted a nationwide cohort study between 2003 and 2013 using the Taiwan National Health Insurance Research Database. The AS cohort included 2210 patients who were newly diagnosed between 2003 and 2013. Randomly selected non-AS controls were matched at a 1:4 ratio based on age, sex and index date. The endpoint of OSA was occurrence or the end of 2013. Cumulative incidences, hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated after adjusting for age, gender, comorbidities and co-medications. Multivariate analyses were performed using Cox proportional hazards model. Due to violation of the proportionality assumption, landmark analysis was conducted to explore the risk of OSA during specific follow-up periods. Results: The adjusted HR (aHR) of OSA for the AS group was 2.826 (95% C.I. = 1.727–4.625) compared to the control group. On landmark analysis, aHR was 7.919 (95% C.I. = 3.169–19.792) for AS group 0–24 months from index date, and decreased to 1.816 (95% C.I. = 0.944–3.494) at ≥ 24 months from index date. On subgroup analyses increased risks of OSA in AS group compared to the control group were found for both males and females (aHRs were 4.533 (95% C.I. = 1.441–14.262) and 2.672 (95% C.I. = 1.522–4.692) for females and males, respectively). On age stratified analysis, there was significant risk only for the 40–59 age group with aHR of 3.913 (95% C.I. = 1.890–8.102). Conclusions: A higher risk of developing OSA was found among newly diagnosed AS cohort during the 12-year follow-up period, especially within 2 years after AS index date and in the 40–59 age group.

Food security (FS) during infancy is associated with lifelong outcomes. New Zealand is a developed economy that reports poor childhood nutrition-related health statistics, particularly among minority children, yet has no measure of FS applicable to infancy. The objective was to develop a FS index for New Zealand infants and examine its association with demographic covariates and health outcomes. Within a large (n=6853) nationally representative cohort, variables describing infant food consumption, breastfeeding, and maternal food-related coping methods were collected from mothers during late infancy. A FS index was derived using confirmatory factor analysis. Associations were assessed by logistic regressions and described using odds ratios (OR) and ≥95% confidence intervals (CI). 15% of the cohort was highly FS, 43% tenuously food insecure (FIS), and 16% highly food insecure (FIS). Infants from minority ethnic groups had lower odds of being food secure, as did those born to the youngest mothers, mothers who smoked, or lived in low-income households. FIS infants had higher odds of morbidity. Interventions to improve infant FS should focus on improving dietary quality, and give particular consideration to minority infants. We identified that FIS shows wide ethnic and socioeconomic inequity, and is associated with poorer health. The most important driving factors of FIS included poor quality weaning diets, and poverty and its proxies. Any interventions to improve infant FS should focus on increasing fruit and vegetable consumption to recommended intake levels, and give particular consideration to minority infants.

Xanthogranulomatous orchitis is a chronic, non-neoplastic inflammation that is quite rare. In this paper, we discuss the case of a 79-year-old male patient who presented with bilateral scrotum swelling and dysuria that persisted for two weeks. Despite two weeks of anti-infection treatment, the patient's symptoms persisted, leading to a decision to perform transurethral prostate resection and bilateral orchiectomy after careful consideration. After the surgery, the postoperative pathology indicated that the patient had xanthogranulomatous orchitis on the left side and acute positive orchitis with hemorrhage on the right side. Fortunately, three months after the procedure, the patient experienced no negative events and was pleased with the postoperative results.

Pulmonary arterial hypertension (PAH) is a pathophysiological condition characterized by pulmonary vascular remodeling and elevated vascular resistance, which may ultimately result in cardiovascular failure and sudden cardiac death. In recent years, the occurrence of pregnancy complicated by pulmonary arterial hypertension has witnessed a notable increase, whereas the incidence of postpartum pulmonary arterial hypertension is comparatively rare. This study presents a case involving a 39-year-old female who exhibited severe pulmonary arterial hypertension, finally diagnosed as idiopathic pulmonary arterial hypertension, within 2 days postpartum. The diagnosis was made following a thorough clinical examination. This case report emphasizes the significance of promptly initiating targeted therapy as an initial step in effectively managing patients and the criticality of conducting a thorough assessment of multidisciplinary collaboration in postpartum management. Furthermore, the report has the potential to enhance awareness and education regarding the future management of similarly intricate conditions.

Inert gas asphyxiation is a rarely observed form of suffocation in which the decedent breathes in an inert chemical, such as helium or nitrogen, in the absence of oxygen. The ultimate cause of death is not a result of the chemical itself, but rather from the oxygen starvation as the inert gas displaces vital oxygen. In this case report, a 66-year-old Caucasian female with a history of gastroparesis, degenerative disc disease, and chronic pain was found deceased with a plastic bag secured around her head. Plastic tubing terminated inside the bag and connected to a nearby canister of nitrogen gas. This case study discusses the challenges in determining inert gas asphyxiation as the cause of death in a postmortem setting and emphasizes the importance of understanding the decedent’s history and context of the environment in which they were found.

Worldwide, diarrhoea in children under-five years of age is the second leading cause of death. Despite having high morbidity and mortality, diarrhoeal diseases can be averted by simple and cost-effective interventions. The Integrated Management of Childhood Illness (IMCI) has proposed the use of Oral Rehydration Salt (ORS) and zinc together with adequate food and fluid intake for the management of acute non-dysenteric watery diarrhoea in children. In the past, few studies examined the determinants of adherence to diarrhoea case management. Therefore, this study measured the determinants of therapeutic and dietary adherence to diarrhoea case management using the third and fourth wave of Pakistan Demographics & Health Surveys (PDHS) datasets. Data from 4,068 children between 0 to 59.9 months with positive history of diarrhoea were included, while data on children with dysentery, severe dehydration, and co-morbid condition was excluded. This study reported therapeutic adherence in less than 10% of children in Pakistan, while dietary adherence was reported in 39.2% of children (37.7% in 2012-2013 ~ 40.7% in 2017-2018). A significant improvement in therapeutic (0.8% in 2012-2013 ~ 8.1% in 2017-2018) and dietary adherence (37.7% in 2012-2013 ~ 40.7% in 2017-2018) was reported in the 2017-2018 survey, compared to the 2012-2013 survey. In general, children over the age of one year (compared to children <1 year) and of the richer/richest socioeconomic class (compared to poorest/poorer socioeconomic class) have showed higher therapeutic and dietary adherence. Therapeutic and dietary adherence among diarrhoeal children can be improved by increasing the awareness and accessibility of ORS, zinc, and essential foods.

Background: This study aimed to present the development process and characteristics of the Korean Registry of Acute Myocardial Infarction for Regional Cardiocerebrovascular Centers (KRAMI-RCC). Methods: We developed KRAMI-RCC, a web-based registry for patients with AMI. Patients from 14 RCCs were registered for more than 3 years from July 2016. It includes an automatic error-checking system, and user training and on-site monitoring are performed to manage data quality. Results: A total of 11,700 AMI patients were registered in KRAMI-RCC over 3 years (73.9% men). The proportions of patients with ST-elevation and non-ST-elevation myocardial infarction at discharge were 43.4% and 56.6%, respectively. Of the total 3-year patients, 5.6% died in the hospital and 4.4% died 12 months after discharge. The case fatality within 12 months was 9.7%. Prehospital care data showed delayed arrival time after onset of symptoms (median 153 min) and low transportation rate by public ambulance (25.2%). Post-hospital care data showed lower participation rate in the second rehabilitation program (16.8%). Conclusions: The recently developed KRAMI-RCC registry has been more focused on pre-hospital and post-hospital data, which will be helpful in understanding the current state of AMI disease management and in making policy decisions to reduce case fatality in Korea.

Covid-19 has now become a public health concern worldwide. The infection primarily involves the respiratory tract. Hitherto, some Covid-19 pneumonia patients carry the viral nucleic acids, and the active virus was detected in stool specimens. The virus discharged with feces is a potential contagious source. In the present study, three Covid-19 respiratory tract infection patients showed no gastrointestinal symptoms, and two were positive for viral nucleic acids in anal swab specimens remained positive 6 and at least 14 days after virus turned negative in the respiratory tract, respectively (details of the patients were listed in Fig 1). Thus, for Covid-19-infected patients with or without gastrointestinal symptoms, viral nucleic acids in stool specimens or anal swab specimens should be focused on for testing in order to decide the isolation duration of the patient.

Through history, particular attention has been paid of the study of the relationship between the energy use and the city structure. Improving energy efficiency in modern agglomerations is the most promising means to mitigate climate change and its impacts. In this current context of globalisation, European Union proposes initiatives and policy targets to rethink the urban development strategies towards the ‘zero energy objectives’. Providing a methodological approach with a simulation district analysis, the present article summarizes how the ‘zero energy’ challenge is analyzed in an existing district (Epinlieu) to articulate the users’ requirements in energy. This study contributes to the scientific discussion of the districts’ urban structure and energy planning by establishing a linkage among the beneficial influence of the KPIs of the districts’ form to increase their energy efficiency and its application in a real case study in Belgium.

Background: The prevalence of physical inactivity has been rising in many countries in recent years, adding to the burden of non-communicable diseases and affecting overall health worldwide. The aim of this study is to determine the impact of physical activity on mortality from ischemic heart disease (IHD) separately for those respondents who were diagnosed with IHD and for those who were not diagnosed with IHD in their baseline health survey. Methods: In the baseline survey (2006–2008), 7100 men and women ages 45–72 were examined within the framework of the international study Health, Alcohol, and Psychosocial Factors in Eastern Europe (HAPIEE). 6770 participants were available for statistical analysis (after excluding 330 respondents due to missing information on study variables). Physical activity was determined by leisure-time physical activities (hours/week). All participants in the baseline survey were followed up for IHD mortality events until December 31, 2018. Results: Using multivariate Cox regression analysis, it was found that moderate and higher levels of physical activity significantly reduced the risk of IHD mortality (HR=0.54 and HR=0.60 respectively) in men who were not diagnosed with IHD at baseline compared with physically inactive subjects. It was found that among men and women who were diagnosed with IHD at baseline, physical activity reduced the risk of mortality from IHD compared with those who were physically inactive (HR=0.54 and HR=0.41 respectively). Using mediation analysis, was found that physical activity directly predicted statistically lower IHD mortality (P&lt;0.05) in men and women. Conclusion: Physical activity was a significant factor that directly predicted statistically lower IHD mortality, regardless of whether subjects had IHD at baseline or not.

Cervical cancer is a public health issue with high disease burden and mortality in Brazil. The objectives of the present study were analyzing age, period, and cohort effects on cervical cancer mortality in women 20 years old or older from 1980 to 2019 in the North, South, and Southeast Regions of Brazil; and evaluating whether the implementation of a national screening program and the expansion of access to public health services caused impacts over the examined period and reduced the risk of death over the past years and among younger cohorts. The effects were estimated by applying Poisson regression models with estimable functions. The highest mortality rate by 100,000 women was found in Amazonas (24.13), and the lowest in São Paulo (10.56). A positive gradient was obtained for death rates as women’s age increased. The states in the most developed regions (South and Southeast) showed a reduction in the risk of death in the period that followed the implementation of the screening program and in cohort from the 1960s onwards. The North Region showed a decreased risk of death only in Amapá (2000–2004) and Tocantins (1995–2004; 2010–2019). The findings indicated that health inequities remain in Brazil and suggested that the health system has limitations regarding decreasing mortality associated with this type of cancer in regions with lower socioeconomic development.

Background: We aimed to assess the risk of chemotherapy- and radiotherapy-related cognitive impairment in colorectal cancer patients. Methods: We randomly selected 40% of colorectal cancer patients from Korean National Health Insurance Database (NHID), 2004-2018 (N=148,848). Patients with one or more ICD-10 diagnostic codes for dementia or mild cognitive impairment was defined as cognitive impairment cases. Patients who were aged 18 or younger, diagnosed with cognitive impairment before colorectal cancer (N=8,225) and did not receive primary resection (N=45,320) were excluded. The effects of each chemotherapy agent on cognitive impairment were estimated. We additionally estimated the effect of radiotherapy in rectal cancer patients. Time-dependent competing risk Cox regression was conducted to estimate overall and age-specific hazard ratios (HR) separately for colon and rectal cancer. Results: In colon cancer, capecitabine and irinotecan was associated with higher cognitive im-pairment, while 5-fluorouracil was not. In rectal cancer, no chemotherapy agents increased the risk of cognitive impairment, nor did radiotherapy. Hazardous association of irinotecan was estimated larger in elderly patients compared with younger counterparts. Conclusion: Heterogeneous associations between various chemotherapy agents and cognitive impairment were observed. Elderly patients were more vulnerable to possible adverse cognitive effects. Radiotherapy did not increase the risk of cognitive impairment.

Background: Malnutrition is associated with a complication problem affecting critically ill patients throughout the trajectory of their illness and which may increase the duration of hospitalization and mechanical ventilation and mortality. To explore nutritional factors impact on the duration of mechanical ventilation in critically ill patients. Methods: In this single-center, prospective observational study in a critical care unit. The sample of the study consisting of a total of 100 critically ill patients who were included in the regression analyzed by purposive sampling, performed to address the research objectives. The data were collected for each patient who participated in the study for 2 consecutive days with SGA, Dyspnea assessment form, APACHE II, and time to initial EN on the 24 hours of hospital admitted and the daily calories target requirement on the seven days. Results: At the end of monitoring, the nutrition status, time to initial EN, and calories, target requirements were moderate positive statistically significant related to the duration of mechanical ventilation (R = 0.54, R = 0.30, R= 0.40, p < 0.05). However, age, the severity of illness, and dyspnea scales were not related to the duration of mechanical ventilation (p> 0.05). Therefore, nutrition status and calory target requirements could be a predictor of the duration of mechanical ventilation. The predictive power was 28.0 percent of variance (R2 = 0.28, p< 0.01). Conclusion: The finding supports which assessment of the nutritional status and calory target requirement within 7 days revealed with reducing the duration of mechanical ventilation in critically ill patients.

Digital twin technology is already improving efficiencies and reducing costs across multiple industries and sectors. As the earliest adopters, space technology and manufacturing sectors have made the most sophisticated gains with automobile and natural resource extraction industries following close behind with recent investments in digital twin technology. The application of digital twins within the livestock farming sector is the next frontier. The possibilities that this technology may fuel are nearly endless as digital twins can be used to improve large-scale precision livestock farming practices, machinery and equipment usage, and the health and well-being of a wide variety of farm animals. Currently, many pioneers of digital twins in livestock farming are already applying sophisticated AI technology to monitor both animals and environment around the clock, which leads to a better understanding of animal behavior and distress, disease control and prevention, and smarter business decisions for the farmer. Mental and emotional states of animals can be monitored using recognition technology that examines facial features such as ear postures and eye white regions. Used with modeling, simulation and augmented reality technologies, digital twins can help farmers build more energy-efficient housing structures, predict heat cycles for breeding, discourage negative behaviors of livestock, and potentially much more. As with all disruptive technological advances, the implementation of digital twin technology will demand a thorough cost and benefit analysis by individual farms. Digital twin application will need to overcome challenges and accept limitations that arise. However, regardless of these issues, the potential of digital twins promises to revolutionize livestock farming in the future.

Studies reported adverse behavioral development including internalizing and externalizing problems in association with prenatal exposure to bisphenol A (BPA) and phthalates, however, findings were not sufficient due to using different assessment tools and child ages among studies. This study aimed to examine associations between maternal serum levels of BPA and phthalate metabolites and behavioral problems at preschool age. The Strengths and Difficulties Questionnaire (SDQ) was used to assess behavioral problems at 5 years of age. BPA and phthalate metabolite levels in the 1^st trimester maternal serum was determined by LC-MS/MS for 458 children. Variables used for adjustment were parental ages, maternal cotinine levels, family income during pregnancy, child sex, birth order and age at SDQ completed. The median concentrations of BPA, MnBP, MiBP, MEHP and MECPP were 0.062, 26.0, 7.0, 1.40, and 0.20 ng/ml, respectively. BPA level was associated with increased hyperactivity/inattention risk among girls (OR=1.66, 95% CI: 0.95-2.90) and∑DBP_m (MnBP + MiBP) level was associated with decreased total difficulties risk overall and among girls (OR=0.48, 95% CI: 0.20-1.13, OR=0.24, 95% CI: 0.06-1.03, respectively) without significance. MECPP level was associated with increase conduct problems risk (OR=2.78, 95% CI: 1.36-5.68). Our analyses found no significant association between BPA or summation of phthalate metabolite levels and any of the behavioral problems at 5 years of age, however, suggested possible association between MECPP levels and increased risk of conduct problems.

Smart cities are a new approach to facilitating urban development and transformation, driving coordinated development between regions, and achieving sustainable urban development. In the era of smart cities, industrial cloud platforms, as a concrete representation and carrier of “industrial brains”, are gradually becoming one of the core competences of urban manufacturing industries. Case study and qualitative comparative analysis (QCA) of a knitting industrial platform in Yiwu City, China are carried out. The following conclusion can be drawn: the construction mechanism and path of the manufacturing “industrial brain” in the smart city are divided into three stages according to the construction of the industrial platform. These include: functional development (FD), trust-building (TB), and value co-creation (VCC). The research conclusion helps to more deeply understand the effects of industrial platforms on constructing “industrial brains”. It provides effective transformation strategies and guidance for the manufacturing industry in the smart city, and pushes the industry to develop towards an intelligent, efficient, and environmental-friendly one. The research provides useful reference for applying the industrial platform to other industries and fields. Exploring the construction mechanism and path of the manufacturing “industrial brain” in the smart city can also contribute to the establishment of a new industrial ecosystem in the era of smart cities.

This policy paper explores various strategies that would facilitate transitioning the traditional Jordanian electrical grid to a secure smart grid. It includes comprehensive recommendations from academia and industry for the regulatory and governmental sector in Jordan to achieve specific roadmap objectives. As Jordan is heavily dependent on fossil fuels, This policy paper also provides recommendations for incorporating more renewables into its energy mix, thereby facilitating a sustainable future. The proposed policies will emphasise the creation of an enabling environment where innovation, research, and development initiatives flourish, thereby promoting private sector engagement.

Tuberculosis (TB) is a major public health concern in low and middle-income countries including Ethiopia. This study aimed to assess the spatiotemporal distribution and identify TB risk factors in Ethiopia's Oromia region. Descriptive and spatiotemporal analyses were conducted. Bayesian spatiotemporal modeling was employed to identify covariates that accounted for variability and spatiotemporal distribution of TB. A total of 206,278 new pulmonary TB cases were reported in the Oromia region between 2018 and 2022, with the lowest annual TB case notification (96.93 per 100,000 population) reported in 2020 (i.e., during the COVID-19 pandemic) and the highest TB case notification (106.19 per 100,000 population) reported in 2019. Substantial spatiotemporal variations in the distribution of notified TB case notifications were observed at zonal and district levels with most of the hotspot areas detected in the northern and southern parts of the region. The spatiotemporal distribution of notified TB incidence was positively associated with different ecological variables. The findings of this study indicated that preventive measures considering socio-demographic and health system factors can be targeted to high-risk areas for effective control of TB in the Oromia region. Further studies are needed to develop effective strategies for reducing the burden of TB in hotspot areas.

As a representative of Exponential Organizations, MI went from obscurity to the Fortune 500 in just ten years. Mi's success is inextricably linked to its outstanding business model. This paper summarizes the elements of MI's business model from four perspectives: value proposition, value creation, value delivery, and value capture, as well as its measures for developing into an exponential organization. Expecting to provide theoretical references for the transformation and upgrading of manufacturing organizations.

Community-based case managers in health have been compared to glue which holds the dynamic needs of clients to a disjointed range of health and social services. However, case manager roles are difficult to understand due to poorly defined roles, confusing terminology, and low visibility in New Zealand. This review aims to map the landscape of case management work to advance workforce planning by clarifying the jobs, roles, and relationships of case managers in Aotearoa New Zealand (NZ). Our scoping and mapping review includes peer-reviewed articles, grey literature sources, and interview data from 15 case managers. Data was charted iteratively until convergent patterns emerged and distinctive roles identified. A rich and diverse body of literature describing and evaluating case management work in NZ (n=148) is uncovered with at least 38 different job titles recorded. 18 distinctive roles are further analysed with sufficient data to explore the research question. Social ecology maps highlight diverse interprofessional and intersectoral relationships. Significant innovation and adaptations are evident in this field, particularly in the last five years. Case managers also known as health navigators, play a pivotal but often undervalued role in NZ health care, through their interprofessional and intersectoral relationships. Their work is often unrecognised which impedes workforce development and the promotion of person-centred and integrated health care.

Background: Asthma is a very prevalent disease with special characteristics during pregnancy, however little is known about its relation to the psychological wellbeing of women in this period; We aimed to know whether depression and anxiety symptoms are more frequent in asthmatic pregnant women. (2) Methods: Family Apgar (week 20), Edinburgh (weeks 20 and 32) and STAI (week 32) tests were administered to 738 pregnant women (81 asthmatics) in the NELA birth cohort; (3) Results: There were no significant differences between asthmatic and non-asthmatic pregnant women in any of the different tests at any of the time points. The mean? scores for the different tests and timepoints between asthmatic and non-asthmatic pregnant women were: Apgar 20, 17.9±2.2 vs. 10.0±2.2; Edinburgh 20, 6.7±4.2 vs. 6.9±4.3; Edinburgh 32, 5.9±4.4 vs. 5.6±4.3; and STAI 32, 16.7±8.4 vs. 15.8±8.3. The proportion of pregnant women out of the normal range score for any of the tests and time points was also similar in both populations. (4) Conclusions: Asthma is not associated with the psychological wellbeing among pregnant women.

Type 2 diabetes (T2D) is associated with increased cardiovascular morbidity, mortality, and hospital admissions. There is variability in clinical practice. The objectives are to analyze the variability in the control of Blood Pressure (BP), HbA1c, and LDL-C in T2D patients and its influence on admissions due to cardiovascular events (CVE) Methods: We analyzed the electronic records in Primary Care Health centers in Navarra (Spain) and hospital admission for CVE. We follow 480637 people from 2012 to 2016. We calculated indicators of control of patients with T2D for each year, percentage with: HbA1c &lt; 7%; HbA1c &gt;= 9%; BP &lt;140/90 mmHg; LDL-C &lt;100 mg/dl. We used logistic and Cox regression. Results: Patients in the best control GP practices cluster are 2.5 times more likely to have HbA1c &lt;7% [OR: 2.46 (95% CI: 2.29-3.64)]. Poor HbA1c control ≥ 9% is more likely in the worst control cluster [OR: 1.73 (95% CI:1.63-1.83)]. The probability of admission for CVE increases with age, being male, low income, obesity, history of CVE, having HbA1c ≥ 9%, and belonging to a GP practice in the cluster of HbA1C ≥ 9% worst control. In contrast, it decreases in patients with HbA1c &lt;7%, BP&lt;140/90 mmHg and LDL &lt;100 mg/dl.

Gonorrhea is a major global public health problem with emergence of multiple drug-resistant strains with no effective vaccine. This retrospective cohort study aimed to estimate the effectiveness of the New Zealand meningococcal B vaccine against gonorrhea associated hospitalization. The cohort consisted of individuals born 1984-1999 residing in New Zealand, therefore eligible for meningococcal B vaccination during 2004-2008. Administrative datasets of demographics, customs, hospitalization, education, income tax and immunization, were linked using the national Integrated Data Infrastructure. The primary outcome was hospitalization with a primary diagnosis of gonorrhea. Cox’s proportional hazards models were applied with a Firth correction for rare outcomes to generate estimates of hazard ratios. Vaccine effectiveness estimates were calculated as 1-Hazard Ratio expressed as percent. There were 1,143,897 eligible cohort members, with 135 missing information on gender, 16,245 missing ethnicity and/or 197,502 missing deprivation hence 935,496 were included in the analysis. After adjustment for gender, ethnicity and deprivation, vaccine effectiveness (MeNZB™) against hospitalization caused by gonorrhea was estimated to be 24% (95% CI 1-42%). In conclusion, vaccination with MeNZB™ significantly reduced the rate of hospitalization from gonorrhea. This supports prior research indicating possible cross protection of this vaccine against gonorrhea acquisition and disease in the outpatient setting.

The resolution of façade construction is not considered in the design process, as it can be expressed by complex technological innovations that emphasize the beauty of buildings. Nevertheless, resorting to this type of technology solution may not always be necessary. This study demonstrates this hypothesis through the investigation of five iconic case studies emphasizing the construction system analysis and the revelation of the brainwave idea. The brainwave idea defines the construction innovation that enables the detail by simplification rather than sophistication. Notable, unlike complex technological innovation, standard systems or elements applied strategically are considered little innovations to facilitate the resolutions of the façade complexity. Many of these innovations occur during the visual and constructive prototype progress required to validate the proposed solution and its performance. Therefore, real-scale prototype development that operates as a real-scale laboratory is necessary to correct and validate successive solutions.

Human Epidermal Growth Factor Receptor 2(HER2) is a transmembrane glycoprotein receptor with intracellular tyrosine kinase activity. It is generally considered as a poor prognostic marker. Targeted therapies, such as small molecule tyrosine kinase inhibitors (TKIs), showed limited efficacy in HER2-mutant advanced Non-Small Cell Lung Cancer (NSCLC). In the 2023 NCCN guidelines for NSCLC, Antibody-Drug Conjugate(ADC) Trastuzumab emtansine (T-DM1) is recommended for the treatment of HER2-mutant Lung Cancer (LC). However, this medication is currently not approved in certain regions.So it is necessary to explore alternative treatment options for HER2-mutant NSCLC patients.In our study of a patient with HER2 exon 20ins Lung Adenocarcinoma who had previously failed multiple TKI treatments, we discovered that Sunvozertinib could stabilize the patient's condition, achieving a progression-free survival (PFS) of 87 days. This is a novel finding that may provide new treatment options for HER2 exon 20ins patients who have failed TKI therapy.

Cerebrotendinous xanthomatosis (CTX) is a rare inherited metabolic disease attributed to the mutation of the gene CYP27A1, resulting in sterol 27-hydroxylase deficiency characterized by deposition of cholestanol and cholesterol in several tissues, like the central nervous system and tendons. Furthermore, cataracts, gallstones, diarrhea and premature atherosclerosis have been reported. Nonetheless, clinical development is extremely heterogeneous in CTX. We report here two cases of CTX genetic alteration in the absence of cholestanol elevation in plasma and tendons but with prominent xanthomas. We propose that CTX may not be characteized by increased plasma cholestanol concentration due to alteration in the sterol 27-hydroxylase gene, but is a more complex pathology that may result from additional genetic alterations that require further analyses.

Active-case finding (ACF) using chest X-ray is an essential method of finding and diagnosing TB cases that may be missed in Indonesia's routine TB case finding. This study compares active and passive TB case-finding strategies. A retrospective study of TB case notification was conducted. Data between January 1 and December 31, 2021, was used. The population in this study were TB cases notified from Kulon Progo District health facilities, including those found through routine activities or active-case finding. A total of 255 TB cases were diagnosed in Kulon Progo in 2021, and 106 (41.6%) were bacteriologically confirmed. The TB patients' mean age was 46.3 (SD 21.4, range 0-85 years). The majority of cases were male (58.8%) and mostly among people aged 16-60 years old (63.5%). ACF diagnosed 91 TB cases (35.7% total cases, 91/255). The proportion of clinical TB cases (n=68, 74.7%) among those found through ACF was higher than found through passive-case finding. Use of chest X-ray in ACF likely contributed to the detection of a higher proportion of clinical TB than bacteriologically confirmed.

Background: To our knowledge, the sudden onset of symptomatic pulmonary hypertension after COVID-19 vaccination has not been described. Both cases presented here resulted in functional limitations and likely permanent organ damage. Case Summary: We report two cases of acute onset pulmonary hypertension in previously healthy adult males within three weeks of receiving the second dose of the Pfizer (BNT162b2) mRNA COVID-19 vaccine from different lots. Both patients experienced the sudden onset of severe fatigue and dyspnea on exertion with negative COVID-19 PCR testing. The diagnosis was made by serial transthoracic echocardiography in the first case and by both transthoracic echocardiography and right heart catheterization in the second. Discussion: Pulmonary hypertension is a serious disease characterized by damage to lung vasculature and restricted blood flow through narrowed arteries from the right to left heart. The onset of symptoms is typically insidious, progressive and incurable, leading to right heart failure and premature death. The World Health Organization (WHO) classifies pulmonary hypertension into 5 categories and recently re-defined as a resting mean pulmonary artery pressure greater than 20 mmHg. Sudden onset pulmonary hypertension would only be expected in the settings of surgical pneumonectomy or massive pulmonary emboli with compromise of at least 50% of the lung vasculature.

Vaccination against SARS-CoV-2 has significantly contributed to the recent pandemic control. COVID-19 vaccines are available with different platforms and the primary clinical trials results presented acceptable safety profile of the approved vaccines. Nevertheless, the long-term assessment of the adverse events or rare conditions need to be investigated. The present systematic review, aimed at classification of Iranian case reports following COVID-19 immunization. To achieve this goal, the related published case reports were explored via PubMed, Web of Science and Google scholar according to PRISMA guideline and available up to 14th Dec, 2022. Out of 437 explored studies, the relevant data were fully investigated which totally led to 40 studies including 64 case reports with a new onset of a problem. The cases were then classified according to the various items such as the type of adverse event manifestations and COVID-19 vaccine. The reported COVID-19 vaccines in the studied cases included Sinopharm, AstraZeneca, and COVAXIN. The results showed that the adverse events presented in 8 different categories from which cutaneous problems accounted as the most prevalent manifestations (43.7%) in which rare diseases were also screened such as Steven-Johnson syndrome, Morphea and Toxic Epidermal Necrolysis. Notably, almost 60% of the cases had no comorbidities. Moreover, the obtained data revealed nearly half of the incidences occurred after the first dose of injection and the mean duration of improvement after the symptom onset was 18.72±24.69 days. 73% of all the cases were either significantly improved or fully recovered. Although the advantages of COVID-19 vaccination is undoubtedly significant, the high risk individuals including those with a history of serious disease or comorbidities immunodeficiency conditions should be vaccinated with the utmost caution.

Despite the increasing interest in ‘smart city’ initiatives worldwide, current literature still lacks the approaches and models that address challenges in organization and collaboration, which boost sustainability and ‘smartness’ in modern cities. This paper provides an overview of ‘smart city’ ecosystems as a mechanism to promote the expected outcomes of their sustainable development, and highlights the importance of conceptualizing cities from organizational and managerial perspectives. Representative exploratory models of ‘city organization’, which emphasize on the role of ‘governance’ and synergies, are presented to ‘decode’ complex city mechanisms and to determine key components that lead to ‘smart’ initiatives. Interesting case studies and applications are then analysed to examine the practical dimension of these approaches. As a review paper, this article lays out a general framework on the importance of ‘collaboration’, ‘governance’, ‘management’, and ‘ecosystem’. However, 'planning smartly’ and achieving ‘sustainability’ at the level of city ‘organization’ remain as challenges in this pioneering study of smart cities.

The initial outbreak of COVID-19 was first reported in Wuhan (China) during the latter part of December 2019. Indonesia has the fourth-largest population globally and reported the country’s first case of the virus on 2nd March 2020. The World Health Organisation (WHO) in addition to several neighbouring provinces and educational institutions within the region began questioning the Indonesian government upon the initial case reported. The objective of this study was to describe the epidemiological characteristics of the COVID-19 outbreak in Indonesia during March 2020. The data were collected from Indonesian government databases and non-government organisations (NGOs). The data were analysed using Microsoft Office 2019 (Excel) and Adobe Illustrator 2017 software, was used in drawing the map depicting the distribution of COVID-19 in Indonesia. As at 31st March 2020, a total of 1,528 people in Indonesia have been infected by COVID-19, in addition to 136 mortalities (CFR of 8.9%). Jakarta, as the principal capital of Indonesia, quickly has become the epicentre of the virus since this period. Most patient cases were attributed to those aged between 31 and 70 years (72.64%), with male patients (64.93%) representing the highest incidence of cases compared to female patients (35.07%). The number of ventilating machines was 3,326, with hospital numbers at 859. The distribution of cases depicting COVID-19 was mainly seen in urban areas compared to rural areas. Males compared to females, are at a higher risk of contracting COVID-19, including those aged below 30, between 30 and 60 or above. Indonesia also has the highest case fatality rate (CFR) with respect to mortalities in Southeast Asia and has the second-highest CFR globally. Similarly, while the number of ventilator machines as at 31st March 2020 were sufficient in meeting the growing number of COVID-19 cases in the country, it is possible that the government may need to increase the number of ventilators if the cases continue to escalate.

Estimation of the reality can easily be flawed, hence, in order to result in accurate and useful estimates the process has to be protected from bias and confounding and should follow other methodological milestones inherent to different types of empirical observations. Candidate-gene association studies are a specific form of observations that have been rather extensively applied in psychiatry yielding valuable information on various aspects – when methodologically adequate and used in appropriate settings. However, certain flaws that may occur in such studies might not be bluntly obvious, at least not at first glance, and may pass unnoticed by researchers and reviewers. This case study uses two recent published candidate-gene association reports suggesting involvement of cannabinoid receptor type 1 and of heat shock protein single nucleotide polymorphisms in development of neurocognitive performance and psychopathology in a cohort of adult first episode psychosis patients to point-out the types of flaws inevitably resulting in inaccurate and useless estimates.

Coronavirus, also known as COVID-19, has been declared a pandemic by the World Health Organization (WHO). At the time of conducting this study, it had recorded over 1.6 million cases while more than 105,000 have died due to it, with these figures rising on a daily basis across the globe. The burden of this highly contagious respiratory disease is that it presents itself in both symptomatic and asymptomatic patterns in those already infected, thereby leading to an exponential rise in the number of contractions of the disease and fatalities. It is therefore crucial to expedite the process of early detection and diagnosis of the disease across the world. The case-based reasoning (CBR) model is an effective paradigm that allows for the utilization of cases’ specific knowledge previously experienced, concrete problem situations or specific patient cases for solving new cases. This study therefore aims to leverage the very rich database of cases of COVID-19 to solve new cases. The approach adopted in this study employs the use of an improved CBR model for state-of-the-art reasoning task in classification of suspected cases of Covid19. The CBR model leverages on a novel feature selection and semantic-based mathematical model proposed in this study for case similarity computation. An initial population of the archive was achieved with 68 cases obtained from the Italian Society of Medical and Interventional Radiology (SIRM) repository. Results obtained revealed that the proposed approach in this study successfully classified suspected cases into their categories at an accuracy of 97.10%. The study found that the proposed model can support physicians to easily diagnose suspected cases of Covid19 base on their medical records without subjecting the specimen to laboratory test. As a result, there will be a global minimization of contagion rate occasioned by slow testing and as well reduce false positive rates of diagnosed cases as observed in some parts of the globe.

Background: World Health Organization (WHO) declared that COVID-19 as a pandemic on March 11, 2020. There is sudden need of statistical modeling due to onset of COVID-19 pandemic across the world. But health planning and policy requirements the estimates of disease problem form clinical data. Objective: To predict recovery rate, cases load rate on the basis of cumulative confirmed Novel Corona virus (NCV) cases, recovered cases and deaths form COVID-19 in India. Methods: The reported COVID-19 cases in the country were obtained from website (https://datahub.io/core/covid-19#resource-covid-19_zip/). The cumulative NCV confirmed cases; recovery cases and deaths were used for estimating recovery rate, cases load rate and death rate till date 24 April 2020. Results: A total of 24530 NCV confirmed cases were reported nationwide in India on 24 April 2020. It is found that the recovery rate increased 22% and case load rate decreased 74%. Death rate is found to be very low 3%. The difference of cases load rate and recovery rate (delta) coincide at 50 % then NCV cases expected would be declined. Conclusion: The epidemic in the country was mainly caused by the importation of India. Lockdown as restricting the migration of population and decided to quarantine of population may greatly reduce the risk of continued spread of the epidemic in India. This study predicts that by 20 May 2020, the cases load rate lesser than recovery rate there after COVID-19 patients would be started to reducing.

This paper contributes to the understating of tornadoes in South Africa using case study analysis. In South Africa tornadoes are the recurring phenomenon (the climatology) but so far they have received less attention. Damages from storms itself (tornadoes inclusive) are significant in South Africa relative to other weather-related disasters for example floods, heat waves, and droughts. For their understanding, a case study approach was adopted in the current study. Data were in courtesy of the following, National Oceanic and Atmospheric Administration (NOAA), National Centers for Environmental Predictions (NCEP), Eumetsat Germany, and South African Weather Service (SAWS). The aim of the study was to provide an overview of the occurrence of tornadoes in South Africa using a Klerksdorp tornado, which occurred on March 4, 2007, Northwest Province in South Africa. From the case study analysis, the tornado was associated with the cold front and cut-off low (both are extratropical circulation) which were the dominant weather systems of the day. Therefore we conclude that, a case study approach may be the best way to study events of these nature for a more informed decision, for example, issuing an early warning system. In future, case studies, for example, involving interaction between extratropical and tropical circulation will also be an interesting study.

Background: In 1962, Susser and Stein observed that the mortality rates of peptic ulcers in England and Wales increased markedly in the 1910s, maintained at a high level during the 1910s-1940s, and began to decline steadily since the early 1950s. They termed this epidemic pattern a birth-cohort phenomenon, but its mechanism has never been elucidated. Susser and Stein speculated that the occurrences of extraordinary social environmental factors roughly fit the fluctuations, but the role of environmental factors in peptic ulcers has never been identified. Objectives: This study aims to elucidate the mechanism of the birth-cohort phenomenon of peptic ulcers and identify the role of environmental factors in the disease. Methods: Starting from an etiology identified recently, this study uses the two inverse operations in calculus, differentiation, and integration, to analyze the existing data. First, a fluctuation curve in the birth-cohort phenomenon is differentiated into multiple annual mortality rates caused by individual environmental factors. Second, these annual mortality rates are integrated to reproduce the fluctuation curve in the birth-cohort phenomenon. Results: The differentiation reveals a parallel relationship between the psychological impacts of environmental factors and the mortality rates of peptic ulcers, whereas the integration reproduces a representative fluctuation curve in the birth-cohort phenomenon. The successive occurrences of multiple social environmental factors from the 1910s to 1940s maintained the increase in mortality rates, while the sustained improvements in living environments explained the steady decline of the mortality rates from the early 1950s. Conclusion: The parallel relationship suggests a causal role of environmental factors in peptic ulcers, whereas the reproduction of a representative fluctuation curve indicates that multiple environmental factors caused the birth-cohort phenomenon by Superposition Mechanism. Significantly, this study challenges the current reductionist approach used to study disease in modern medicine by demonstrating the effectiveness of an opposite methodological concept focused on integration.

DNA methylation is an epigenetic mechanism for gene expression modulation and can be used as a predictor of future disease risks. A prospective birth cohort study was performed to clarify the effects of neurotoxicants on child development, namely, the Tohoku Study of Child Development, in Japan. This study aimed to evaluate the association of prenatal exposure to five toxic metals—arsenic, cadmium, mercury, lead (Pb), antimony (Sb), and polychlorinated biphenyls (PCBs, N = 166)—with global DNA methylation in umbilical cord blood DNA. DNA methylation markers, 5-methyl-2’-deoxycytidine (mC) and 5-hydroxymethyl-2’-deoxycytidine (hmC), were determined using liquid chromatography-tandem mass spectrometry. The mC content in cord blood DNA was positively correlated with Pb and Sb levels (r = 0.442 and 0.288, respectively) but not with cord blood PCBs. We also observed significant positive correlations among Pb levels, maternal age, and hmC content (r = 0.159 and 0.243, respectively). The multiple regression analysis among the potential predictors demonstrated consistent positive associations between Pb and Sb levels and mC and hmC content. Our results suggest that global DNA methylation is a promising biomarker for prenatal exposure to Pb and Sb.

In March 2020, several mass gathering events were related to the Falles festival in Borriana (Spain), resulting in a 536 laboratory-confirmed COVID-19 cases outbreak among participants. Our objective was to estimate anti-SARS-CoV-2 antibodies persistence six months after and factors associated with antibody response. A prospective population-based cohort study was carried out by the Public Health Center of Castellon and the Emergency and Clinical Analysis and Microbiology Services of Hospital de la Plana in Vila-real. In October 2020, sero-epidemiologic study to estimate the persistence of anti-SARS-CoV-2 antibodies by a electrochemiluminescence immunoassay (ECLIA) was implemented. We enrolled 484 (90.2%) of the 536 members of the initial outbreak cohort and detected persistent antibodies in 479 (99%) without re-infection episodes. Five participants had a negative antibody test. Factors associated with a negative result were a lower body mass index (BMI), and less contact with other COVID-19 cases. Among the 469 participants with two ECLIA tests, 96 (20.5%) had an increase of antibodies and 373 (79.5%) a decline. Increased antibodies were associated with older age, higher BMI, more severe illness, and low current smokers. After a COVID-19 infection, a high proportion of cases maintained detectable anti-SARS-CoV-2 antibodies.

Physical symptoms are defined as symptoms for which adequate examination does not reveal a sufficient underlying root cause, e.g., pain and fatigue. The extant literature of the neurobiological underpinnings of physical symptoms has been largely inconsistent and primarily consists of (clinical) case-control studies with relatively small samples sizes. Therefore, we studied the association of brain morphology with physical symptoms in pre-adolescents from two independent and population-based cohorts. This study included 2,683 individuals from the Generation R Study (51% girls, 10.1 ± 0.6 years old) and 10,567 pre-adolescents from the ABCD Study (48% girls, 9.9 ± 0.6 years old). High- resolution structural magnetic resonance imaging (MRI) was collected using 3-Tesla MRI systems. Physical symptoms were evaluated using the somatic complaints syndrome scale from the parent-reported school-age version of the Child Behavior Checklist. Linear regression models were fitted for global brain metrics (i.e., cortical and subcortical grey matter volume and total white matter volume) as well as surface-based vertex-wise measures (surface area and cortical thickness). Analyses were initially conducted separately in each cohort and later meta-analysed. No associations were observed in either cohort separately. In the combined vertex-wise meta-analysis of both cohorts; the right hemisphere surface area, most notably the rostral middle frontal gyrus, superior frontal gyrus and anterior cingulate cortex, were related to physical symptoms after correcting for multiple comparisons (cluster area = 1,882 mm2). The present study, which is the most representative and well-powered to date, suggests that surface area, but not other measures of brain morphology, are modestly related to physical symptoms in pre- adolescents. While these effects are subtle, future longitudinal research is warranted to elucidate whether such associations indicate a cause or a consequence of the physical symptoms.

Background and introduction: Lung cancer is a prevalent and deadly disease globally. Non-small cell lung cancer (NSCLC) is the most common subtype, comprising 85% of cases; Case report: A 65-year-old ex-smoker man presented to our facility with nocturnal cough. Various investigations revealed that he had metastatic NSCLC, for which he underwent chemotherapy with cisplatin and gemcitabine, followed by immunotherapy with Nivolumab. He achieved a complete response to the therapy and has remained free from recurrence for over 7 years since the initial diagnosis; Discussion and Conclusion: The treatment of metastatic NSCLC remains a significant therapeutic challenge, but the implementation of new therapeutic techniques has expanded the possibilities of achieving complete and durable eradication of the disease.

Visceral leishmaniasis (VL) is a severe parasitic disease transmitted by phlebotomine sandflies. VL is endemic in West Pokot County, Kenya, where effective strategies to interrupt transmission are impeded by the limited understanding of VL risk factors. Therefore, this case-control study aimed to explore environmental, behavioral and household determinants of VL in West Pokot. From November 2022 to January 2023, a structured questionnaire was administered to 36 symptomatic primary VL cases attending the Kacheliba Sub-County Hospital and to 50 controls from local villages. The VL status of all participants was confirmed using an rK39 rapid diagnostic test. In an age-corrected univariate logistic regression analysis, significant associations were found between VL and housing characteristics, such as window presence and floor type. Furthermore, outdoor activities, including traveling outside the residence for more than 2 weeks, activities near termite mounds, and forest activities during the rainy season increased the risk of VL. VL cases more frequently reported the presence of cattle, dogs and sheep in their house yards at night. VL was also associated with cutting down trees in the house yard and house proximity to several Acacia tree species. To conclude, this work reports a number of previously undescribed risk factors for VL in the understudied West Pokot focus. Our findings warrant further research into sandfly ecology and potential zoonotic parasite reservoirs in West Pokot.

In recent years, with the increase in maritime trade, the necessity of increasing the capacities of the ports has emerged. However, while it is planned to increase the capacities of the ports, it is important that the port continues to operate at the same time. In this respect, the old port structures should not be damaged during the capacity increase. In this study, the strengthening of a port in Guinea is discussed as a case study. In the study, the existing quay wall was evaluated, and geotechnical and structural alternatives of the new structure to be built for capacity increase were evaluated. A combined system was designed as a pile foundation and a reinforced foundation with plastic piles so as not to damage the existing quay wall. The pile capacities obtained as a result of the analyses were verified by loading tests.

Introduction: Ehlers-Danlos syndromes (EDS) constitute a rare entity of genetic disorders, affecting the collagen of all types all. Herein, we describe a case of vascular type of EDS, with coexisting segmental absence of intestinal musculature, while performing simultaneously a narrative review of the existing literature. Case Presentation: A 23-year-old male patient with a history of multiple abdominal operations due to recurrent bowel perforations and the presence of high-output enterocutaneous fistula was admitted to our surgical department for further evaluation and treatment. After detailed diagnostic testing, the diagnosis of vascular type of EDS (vEDS) was made and a conservative therapeutic approach was adopted. In addition, a comprehensive review of the international literature was carried out by applying the appropriate search terms. Results: The diagnosis of vEDS was molecularly confirmed by means of genetic testing. The patient was treated conservatively, with parenteral nutrition and supportive methods. Thirty-four cases of bowel perforation in vEDS have been reported so far. Interestingly, this case is the second one ever to report with co-existence of vEDS with Segmental Absence of Intestinal Musculature. Conclusions: Establishing the diagnosis of vEDS promptly is of vital significance in order to ensure that patients receive appropriate treatment. Due to initial non-specific clinical presentation, EDS should always be included in the differential diagnoses of young patients with unexplained perforations of the gastrointestinal tract.

The odontogenic cysts can lead to a bone destruction that can hamper the dental implant place-ment in the ideal 3D position. Different biomaterials and techniques that allow bone regeneration are described in the literature, each with its advantages and disadvantages. This clinical case with 18 months of follow-up shows the enucleation of an odontogenic cyst fol-lowing the guide bone regeneration with fence technique. After 6 months 2, dental implants were placed at the region of tooth 11 and 21, being rehabilitated nine weeks after. The fence technique allowed the recovery of the bone morphology and the placement of the dental implants in the 3D ideal position.

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.

probiotics. However, these bacteria caused rare infections mostly in diabetic and immunocompromised subjects in presence of risk factors such as prosthetic hearth valves and dental procedures or caries. The scope of this survey was re-assessing the pathogenic potential of lactobacilli based on the infection case reports published in the last three years. In 2019, 2020 and 2021 17, 15 and 16 cases, respective-ly,.including endocarditis, bacteremia and other infections, were reported. These annual numbers are higher than observed previously. Lacticaseibacillus rhamnosus (13 cases), comprising strain GG (ATCC 53103) with established applications in healthcare, L. paracasei (7 cases), Lactobacillus acidophilus (5 cas-es), L. jensenii (5 cases), Lactiplantibacillus plantarum (3 cases), L. paraplantarum, L. delbrueckii subsp. del-brueckii, L. gasseri, L. paragasseri, Limosilactobacillus fermentum and L. reuteri (1 case each) were involved. Virulence characterization of two strains that caused infections, a derivative of L. rhamnosus GG and L.paracasei LP10266, indicated that increased biofilm forming capacity favors pathogenicity and it is determined by variable genetic traits. This survey highlighted that strains of lactobacilli able to cause infections were little characterized genet-ically. Instead, to avoid that these bacteria become a hazard, genetic stability should be periodically re-evaluated by whole genome sequencing (WGS) to ensure that only non-pathogenic variants are ad-ministered to vulnerable individuals.

Background: Although persistent systemic inflammation is considered to be predictive for future cardiovascular events, it remains unclear whether or not C-reactive protein (CrP) plays an active role in coronary-plaque instability. Here, we report a case of a patient with failed and super-infected renal allograft as a source for systemic inflammation presenting with repeat acute coronary syndromes. Case presentation: A 52-years-old male type-2 diabetic with a failed kidney transplant who was hospitalized for acute urinary-tract infection. In the presence of other, classic cardiovascular risk factors, peak values of CrP coincided with episodes of unstable angina treated by percutaneous coronary interventions. Besides pyelonephritis, the histological examination of the kidney transplant revealed signs of chronic rejection and the presence of a renal cell carcinoma in situ. Once the renal allograft has been removed, systemic inflammation was attenuated, the patient was not re-hospitalized for acute-coronary syndrome within the next 12 months. Conclusion: In this case, systemic inflammation was paralleled by instability of coronary plaques as documented by repeat percutaneous coronary interventions.

This paper aims to provide the reader with an organic view of the eyewear sector considering both market and quality aspects and evaluating the role of Industry 4.0 in process and product innovation for managing consumer health, analyzing a case study of a leading multinational company in the eyewear and ophthalmic lenses sector. The research has been developed with a qualitative approach. The study is a conceptual development and it uses an exploratory interview to create a single case study. The case study was developed with the realization by the researcher of a semi-structured interview. The selected interlocutor was the Innovation Manager of Alpha Optics. it has been decided to focus the attention on this figure, as it was responsible for the realization and introduction into the company of Industry 4.0 enabling technologies for developing health innovations. From this case study it was possible to observe how the connection with the trends that influence the demand for eyeglasses is a driving factor for product innovation. Products increasingly adapted to the needs of young people and the use of digital devices seem to be the ones on which the greatest number of innovations are concentrated.

In this retrospective report we present five cases of critically ill pregnant or newly delivered women positive for Covid-19 admitted to our obstetrical departments at Karolinska University Hospital. They compose 6% of eighty-three pregnant women that tested positive for SARS-CoV-2 during the period March 25 to May 4, 2020. Three patients were at the time of admission in gestational week between 21+4 to 22+5 and treated during their antenatal period, meanwhile the other two were admitted within 1 week postpartum. All of them were in a need of intensive care, one was treated with high flow oxygen therapy, the other four with invasive mechanical ventilation (three with endotracheal intubation and one with extra corporeal membrane oxygenation). Age above thirty, overweight and gestational diabetes are notable factors in the cases presented. At the time of admission, they all presented with symptoms as fever, cough and dyspnea. Chest imaging with computer tomography scan was performed in each case and demonstrated multifocal pneumonic infiltrates in all of them but no pulmonary embolism was confirmed in any. Neither did the echocardiogram indicates any cardiomyopathy. Four of the patients have been discharged from the hospital, with an average of 20 hospital days. One antenatal pregnant woman needed prolonged ECMO therapy, in gestational week 27+3 she went into cardiac arrest, resulting in an urgent c-section on maternal indication. At the time of writing she is still hospitalized. In coherence with other published reports our cases indicate that critically ill pregnant women infected by SARS-Cov-2 may develop severe respiratory distress syndrome requiring prolonged intensive care. The material is limited for conclusions to be taken, more detailed information on symptoms, treatment, and outcomes for pregnant and postpartum women managed in intensive care is therefore needed.

The prevalence and case fatality rates of Pediatric Lassa fever disease (LFD) are not well documented. This study was aimed at determining the prevalence, pattern and outcome of Pediatric LFD. It was a prospective observational study. A total of 183 subjects that met the criteria for LFD suspects were recruited consecutively and subjected to Lassa virus PCR test. Structured questionnaire was used to collect information. Of the 183 children recruited, 24 tested positive to Lassa virus PCR, giving a positivity rate of 13.1%. Mean duration of illness at presentation was 8.54 ± 3.83 days. Fever, abdominal pain and vomiting were the three highest presenting complaints. Seven out of 24 children died giving a case fatality rate (CFR) of 29.2%. Subjects with bleeding, poor urine output, convulsions and unconsciousness were more likely to die of LFD. Positivity and CFR of LFD are high. Improved case finding and prompt treatment is advocated.

The purpose of this study is to assess the concentration-response relations between conjunctivitis and exposure to ambient ozone. This retrospective study includes emergency department (ED) visits for conjunctivitis in Edmonton, Canada, for the period April 1992–March 2002. Daily average levels of ozone (range: 1.2–50.9, ppb), of temperature, and of relative humidity were estimated and used for the period of the study. For each of the considered exposure lags, (from 0 to 9 days), six different models were fitted to estimate the concentration-response function. The goodness of fit was assessed using the Akaike information criterion. During the period of the study, 17,211 ED visits for conjunctivitis were recorded and used. For all subjects together, a positive statistically significant association was obtained for the exposure lagged by 5 days. For female subjects, lags 1, 3, and 9 had positive statistically significant associations (lag 2 had negative associations). For male subjects, only lag 5 had a positive statistically significant association. The estimated non-linear concentration-response functions for the considered groups (all, males, females) and lags, revealed the associations along the exposure levels. The fitted shapes are described by algebraic functions and may have various forms. The estimated functions are useful to determine the risk associated with exposure to ground-level ozone.

Introduction: Neonatal mortality has declined in Cambodia but remains a key contributor to under-five deaths. The aim of this study was to further understanding of potential factors contributing to high neonatal mortality rates in Cambodia through assessment of verbal autopsies collected following newborn deaths. The study team analyzed verbal autopsies of perinatal deaths in order to describe timing and causes of neonatal deaths, demographic data, and factors potentially related to mortality. Methods: The case series data derive from 13 verbal autopsy reports collected in rural southern Cambodia. The mortality review was nested within a trial of a behavioral intervention to improve newborn survival, and was conducted after the close of the trial. The study examined all neonatal deaths occurring to infants born at 16 health centers between in the study site of Takeo province. The World Health Organization standardized definition of neonatal mortality was employed, and two pediatricians independently reviewed data collected from each event to assign a cause of death. Results: Thirteen newborn deaths of infants born at a health facility were reported during the time period February 2015–November 2016. Ten out of the 13 deaths (76.92%) were early neonatal deaths, two (15.38%) were late neonatal deaths, and one was a stillbirth. Five out of 13 deaths (38.46%) occurred within the first day of life, indicating death was likely due to an intrapartum event. The largest single contributor to mortality was neonatal sepsis; six of 13 deaths (46.15%) were attributed to some form of sepsis. Twenty-three percent of the deaths were attributed to asphyxia. Other causes of death included stillbirth and prematurity. Eight deaths (61.54%) occurred within the control group of the larger intervention study. Conclusion: The study highlights the continuing need to improve both intrapartum and postnatal quality of care and infection prevention and control, and to fully address causes of sepsis, in order to effectively reduce mortality in the newborn period.

Sustainability addresses environmental and social issues affecting this and future generations. When family businesses perceive that the community is disrupted, recognize an environmental problem and respond by implementing new environmental policies or regulations, the family business’s socio-emotional values press to transition to a more sustainable production system, such as the ‘Circular Economy.’ Drawing on the Dubin (1978) methodology—a paradigm for building models through deduction—we design a sustainable model, which shows family businesses’ responses to changes in the environment. It explains the reasons why family firms transition to the Circular Economy, based on the theory of Socio-Emotional Wealth (SEW). We check the model through the case study of the food retail leader in the Spanish market—Mercadona—which applies policies about energy, resources and waste to become a Circular Economy business model. Because of the strong family character of Mercadona, this case can be useful for the decision-making of other family businesses.

Pancreatic cancer is one of the most fatal common cancers affecting both men and women, representing about 3 percent of all new cancer cases in the United States. In this study, we aimed to investigate the association of pancreatic cancer risk with alcohol consumption as well as folate intake. We performed a case-control study of 384 patients diagnosed with pancreatic cancer from May 2004 to December 2009 and 983 primary care healthy controls. Our findings showed no significant association between risk of pancreatic cancer and either overall alcohol consumption or type of alcohol consumed (drinks/day). Our study showed dietary folate intake was modestly but significantly inversely associated with pancreatic cancer (OR=0.99, P <.0001). The current study supports the hypothesis that pancreatic cancer risk is reduced with higher food-based folate intake.

Background. Ovarian cysts are common in premenopausal women but can present with vague, non-specific symptoms, making discovery more challenging. Most are benign and resolve spontaneously; however, they can present, as in this case, as ovarian torsions, which is a gynecological emergency. Case presentation. A twenty-year-old female had presented over 3–4 times per year for the last 6 years to her primary doctor citing intermittent abdominal pain, irregular menstruation, dyspnea, and an enlarging abdomen circumference. The doctor stated, she was “just fat” and could, benefit from a “special camp to lose weight”, so she stopped mentioning her concerns. Upon presenting to the emergency department with acute onset abdominal pain, a computed tomography scan showed a large cyst lesion filling the abdominal and pelvic cavity. Its origin appeared to be from the left adnexa. Surgery was performed, and an acute ovarian torsion caused by a 36 cm craniocaudal left ovarian cyst was found and removed along with the left fallopian tube and 16 L of fluid. Conclusions. The value of respecting the “third presentation” rule indicates to health care providers that any patient who presents with any /or other symptoms or complaint needs to be thoroughly investigated. In this case the patient presented recurring pelvic/abdominal concerns, irregular menstruation, which warranted further investigation to safeguard fertility and prevent errors of omission. It is important to consider the differentials and be aware of vague symptoms that may lead to early recognition and effective management to prevent adverse consequences, complications, or even death.

Neovascular age-related macular degeneration (nAMD) leads to visual impairment if not treated timely. Intravitreal anti-VEGF drugs have revolutionized nAMD treatment in two decades. We evaluated visual outcomes of anti-VEGF treatment in nAMD. A real-life population-based cohort study. Data included parameters for age, sex, age at the diagnosis, laterality, chronicity, symptoms, visual outcomes, lens status, and history of intravitreal injections. A total of 1088 eyes (827 patients) with nAMD were included. Visual acuity was stable or improved in 984 eyes (90%) after an average 36±25 months follow-up. Bevacitzumab was the first-line drug in 1083 (99.5%) eyes. Vision improved ≥15 ETDRS letters in 377 (35%), > 5 ETDRS letters in 309 (28%) and was stable (±5 ETDRS letters) in 298 (27%) eyes after anti-VEGF treatment. The loss of 5-<15 ETDRS letters in 44 (4%) and ≥15 ETDRS letters in 60 (6%) eyes was noted. At the diagnosis of nAMD, 110 out of 827 patients (13%) fulfilled the criteria of visual impairment, whereas 179 patients (22%) were visually impaired after the follow-up. Improvement or stabilization in vision was noted in 90% of the anti-VEGF-treated eyes with nAMD. In addition, anti-VEGF agents are crucial in diminishing nAMD-related visual impairment.

The COVID-19 pandemic has profoundly changed the world and human society in various ways. Infection-related figures are key indicators of the direct impact of the pandemic. In addition to the virus, many vulnerable populations (e.g. patients with complex health conditions) have suffered direct or indirect health impacts, such as delayed treatment or diagnosis of cancer and severe mental illness due to stay-at-home restrictions, or financial issues. Studying these kinds of impacts can provide the community with insights and understanding of how the pandemic has affected patients with health conditions and help inform decision-makers design policies that support various vulnerable populations. This paper surveys analytical work conducted on how COVID-19 has impacted patients with complex health conditions. We categorise vulnerable populations into three specific cohorts: patients with chronic disease, patients with cancer and patients with end-of-life care. We then investigate how each of these cohorts has been impacted by the pandemic. We also identify each cohort from an analytics perspective by leveraging various data collection strategies and analytical methods. The goals of this paper are to provide evidence on how to improve the quality of life for vulnerable populations and to inform a national response strategy for future pandemics, which seems inevitable in a highly globalised economy.

Most vulnerable individuals are particularly affected by the COVID-19 pandemic. This study takes place in a large city in France. The aim of this study is to describe the mobility of the homeless population at the begin-ning of the health crisis and to analyze its impact in terms of COVID-19 prevalence. From June to August 2020 and September to December 2020, 1272 homeless people were invited to be tested for SARS-CoV-2 antibodies and virus in and completed questionnaires. Our data show that homeless populations are sociologically dif-ferent depending on where they live. We show that people living on the street were most likely to be relocated to emergency shelters than other inhabitants. Some neighborhoods are points of attraction for homeless peo-ple in the city while others emptied during the health crisis, which had consequences for virus circulation. People with a greater number of different dwellings reported became more infected. This first study of the mo-bility and epidemiology of homeless people in time of pandemic provides unique information about mobility mapping, sociological factors of this mobility, mobility at different scales and epidemiological consequences. We suggest that homeless policies need to be radically transformed since actual model exposes people to infection in emergency.

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

The Sustainable Development Goals (SDGs) raise quality employability, gender equity in access to employment and increase coverage in education, however, in Colombia, high unemployment rates and informality of young people are risks of fulfilling these objectives. This is verified by a study with cohorts on access to employment, labor mobility and entry to quality occupations, through the use of probabilistic models. This study found that young people are less likely to be employed than adults, education has increased in the new generations and allowing them to enter a higher quality occupation, job segmentation and lack of experience of young people are the main cause of unemployment and Women are less likely to be employed than men and to do so in quality jobs. To comply with the SDGs, you must increase coverage in education, make a differential gender policy and expand programs as learners and insert dual education.

The aim of the article is to verify differences in the perception of selected factors of sustainability among small and medium-sized enterprises (SMEs) in Central Europe. The subjects of analysis are factors such as corporate social responsibility (CSR), business risk sources (market, financial, personnel, and operational), reputation and social media, national support, social changes, and crisis events in business. The questionnaire was completed by 1,090 SMEs from the business environments of Visegrad Group countries. Statistical hypotheses were verified using Z-scores for two population properties. The most negatively perceived factors among owners and managers in the SME segment are national support and legislative changes. The most positively perceived factor is reputation and social media. The country of doing business is a significant factor. The perception of crisis events in business is most negative among Czech SMEs. More than 80% of Hungarian SMEs perceive their companies as sustainable. In comparison with Slovak and Polish SMEs, Hungarian perceptions are more positive in the context of sustainability. The country of doing business is the strongest factor in evaluating CSR indicators. The positive perception of CSR in Czech SMEs (43.9%) is lower than in other countries.

As part of a comprehensive research on eco-friendly processing techniques, the influence of heat treatment environment on the case-hardening of AISI 1018 steel using pulverized cassava leaf was studied. The process was carried out at two different temperatures (850˚C and 950˚C) and under three environmental conditions: (Process 1) the control experiment, was carried out in air only, (Process 2) the medium comprised of pulverized cassava leaves, and (Process 3) the combination of pulverized cassava leaves plus barium carbonate (BaCO3) as an energizer (CBC mixture). Vickers microhardness testing and scanning electron microscopy were used to evaluate the effect of processing environment on case hardening of the steel. As expected, regardless of the processing temperature, Process 1 resulted in little or no hardening of the steel surface. However, notable case hardening occurred when steel specimens were subjected to either Process 2 or Process 3. Furthermore, the inclusion of barium carbonate in Process 3 significantly enhanced the case hardening effectiveness of the cassava leaf as it pertains to rate and maximum hardness achieved. Maximum enhancement was observed at 950oC. After 1 hour, the increase in hardness were 160% and 280%, for Process 2 and Process 3, respectively. Upon increasing the processing time to 5 hours, the increase in hardness due to Process 2 was raised to 254%, while that of Process 3 remained at approximately 280%. Diffusivity of AISI 1018 was calculated using the microhardness data. Diffusivity was highest in Process 2 samples with values of 1.568 x 10-9 m2/s at 850°C and 1.893 x 10-9 m2/s at 950 °C.

We used a mixed-method single-case experimental research design to examine the effect of modelling (peer versus non-peer) on exercise self-efficacy in stroke survivors who participated in a community-based exercise program. Quantitative data were obtained using a ABCA design: (A1) no model/baseline 1 (3 weeks); (B) peer model (6 weeks); (C) non-peer model (6 weeks); and (A2) no model/baseline 2 (3 weeks). Four participants completed self-efficacy questionnaires after each weekly session. Qualitative data were obtained using researcher diaries and two semi-structured interviews: after B and A2. Based on quantitative and qualitative results, participants reported higher exercise self-efficacy in the model conditions, with ratings appearing highest for the non-peer model. This finding could be due to a lack of full integration of the peer model and low feelings of similarity. Modelling in general could help people recovering from a stroke increase their exercise self-efficacy, but non-peer models may not be most advantageous.

This study examines the Health Silk Road (HSR) as a critical component of China's Belt and Road Initiative (BRI) and its implications for global health and international relations. The HSR aims to enhance public health and foster international cooperation in the healthcare sector, with objectives including strengthening healthcare infrastructure, expanding China's global health leadership, and enhancing international health cooperation. Through an in-depth analysis of the China-Pakistan collaboration on healthcare under the China-Pakistan Economic Corridor (CPEC) as a case study, this research explores the motives, implications, and potential concerns associated with the HSR. This research posits that the HSR has a mix of positive and negative implications, making it challenging to categorize the initiative as simply good or bad. While the HSR contributes to improved healthcare services, infrastructure, and capacity-building in participating countries, it also raises concerns about debt sustainability, transparency, and China's geopolitical influence. This research contributes to a nuanced understanding of the HSR's multifaceted impacts and underscores the importance of open dialogue, cooperation, and the sharing of best practices among stakeholders in order to maximize the initiative's benefits and minimize potential negative consequences. By assessing the motives, implications, and concerns of the HSR, this study offers valuable insights for policymakers, global health practitioners, and scholars, highlighting the significance of international collaboration in addressing shared health challenges and promoting sustainable development.

Since 2012, the northeast of Tunisia has been experiencing an emergence of dog rabies. Published data revealed that the disease is widespread in the north of Tunisia. Even with studies on rabies, lacking knowledge on the associated risk factors was highlighted. Therefore, we conducted a case-control study on dog rabies in northeast Tunisia to identify potential risk factors for dog rabies occurrence. The cases group (n=77) included positive dog rabies confirmed at the referral laboratory using Fluorescent Antibody Test (FAT) in 2014 and 2018. The controls group (n=77) involved all negative cases received at the laboratory and 15-days quarantine dogs that received a certificate of absence of rabies after the observation period. Univariate and multivariate logistic regression was conducted to explore the risk factors (age, sex, breed, confinement, vaccination status, presence of bites, owned or not and origin of dogs, sector, presence of rabies cases, and slaughterhouses, etc.…) related to the occurrence of rabies. The final logistic regression model revealed that unconfined dogs were almost twice as likely to be affected as confined dogs (OR=1.9; 95% CI: 1.17 to 3.27). The odds of rabies occurrence were 25 times higher in areas where rabies cases have been reported between 3 months and 1 year compared to the uninfected areas (25.7; 95% CI: 3.02-219.14). Similarly, the risk of rabies is significantly higher in dogs born in the home to the owner bitch (OR=2.41; 95% CI: 1.14-5.13). Living in areas with rabies cases in the last three months increases by 2.8 times the risk of getting rabies (2.8; 95% CI: 1.16-6.77). However, vaccination reduces by 1.6 times the risk of contracting rabies (0.6; 95% CI: 0.38-0.97). Our findings provide reliable data on dog rabies that will be very useful for decision-makers and could contribute to improving the ongoing national control program of rabies.

There are two contrary opinions regarding the risk if mainland China (MC) moves away from its zero-COVID policy. Some experts think the risk shall be much lower than influenza as per MC’s own COVID-19 case fatality rate (CFR), while some other experts think the risk shall be much higher than influenza as per the COVID-19 CFRs of other regions. We elucidate here that this and multiple other striking differences in the CFR between various scenarios all support and substantially resulted from the view that good IDM is highly powerful to mitigate COVID-19, where IDM (isolation-disinfection-maintenance) means isolation of COVID-19 cases from other people, disinfection of their living environments, and health maintenance (e.g., rest, nutrition, breathing). The high effect of good IDM is also supported by the theoretic functions of IDM in minimizing co-infections and maintaining body functions, and the fact that all the 505 COVID-19 deaths reported in MC in 2022 before May 5 died directly of severe underlying diseases with COVID-19. Although it is tough for people in poverty to obtain good IDM, good IDM can be feasible at home for the most mild cases and in hospitals for the most severe cases. Therefore, good IDM can be crucial to mitigating COVID-19 worldwide. It also suggests that the risk for China to end its zero-COVID policy depends on China’s control policies or measures. Based on the effect of IDM, the cautious co-existence policy was proposed for COVID-19 control. This policy could reduce the whole death toll in MC because good IDM is non-specific and can reduce deaths of various other diseases. The cautious co-existence policy (non-specific) and the vaccination policy (specific) aid each other to mitigate COVID-19, and they cannot replace each other. Those who are qualified in health for vaccination should be vaccinated against COVID-19 timely.

This study examines the relation between ambient air pollution and emergency department (ED) visits due to certain infectious diseases in Toronto, Canada. The National Ambulatory Care Reporting System database was used to draw the corresponding health cases. Daily data on ED visits, ambient air pollution concentration levels, and weather conditions during the period from April 2004 to December 2015 (4,292 days in total) were linked together and used in statistical models. Six air pollutants (fine particulate matter PM2.5, CO, NO2, SO2, ozone O3 as a daily average, and ozone O3-8 hour ozone, as a maximum eight hour average) were investigated. In addition, the Air Quality Health Index (combining NO2, O3, and PM2.5) was also considered. The time-stratified case-crossover technique was applied in the study design. Conditional Poisson models were created using the daily counts of ED visit data. The considered factors, air pollutants and weather, were lagged by the same number of days, from 0 to 14. In the period of the study 339,644 ED visits were identified; 177,619 for females and 162,025 for males. For each air pollutant 270 models were realized (15 lags x 18 strata). Ambient air pollution concentrations lagged by 2, 3, and 5 days have the highest impact on ED visits, with 34, 32, and 35 positive associations, respectively. For all patients and an increase in a one interquartile range (IQR=1.2 ppb) of sulphur dioxide, the following values of the relative risks (RR) were estimated: RR=1.005 (95% confidence interval: 0.998, 1.013), 1.008 (1.001, 1.016), 1.009 (1.001, 1.016), 1.011 (1.004, 1.019), 1.007 (0.987, 1.028), and 1.009 (1.002, 1.016) for lags from 0 to 5, respectively. The results suggest that exposures for certain air pollutants (mainly CO, O3, and SO2) in urban environment affect the number of ED visits related to infectious diseases.

Psychotherapy is one of the evidence-based clinical interventions for the treatment of depression in older adults with dementia. Randomized Controlled Trials are often the first methodological choice to gain evidence, yet they are not applicable to a wide range of humanistic psychotherapies. Amongst all, the efficacy of the Gestalt therapy (GT) is under-investigated. The purpose of this paper is to present a research protocol aiming to assess the effects of a GT-based intervention on people with dementia (PWD) and the indirect influence on their family carers. The study implements the Single-Case Experimental Design with Time-Series Analysis that will be carried out in Italy and Mexico. Ten people in each country, who received a diagnosis of dementia and present depressive symptoms, will be recruited. Eight or more GT sessions will be provided whose fidelity will be assessed by the GT Fidelity Scale. Quantitative outcome measures are foreseen for monitoring participants’ depression, anxiety, quality of life, carers’ burden, and the caregiving dyad mutuality, at baseline and follow-up. The advantages and limitations of the research design are considered. If GT will result effective in the treatment of depression in PWD, it could enrich the range of evidence-based interventions provided by healthcare services.

The chemical graph theory is a subfield of mathematical chemistry which applies classic graph theory to chemical entities and phenomena. Chemical graphs are main data structures to represent chemical structures in cheminformatics. Computable properties of graphs lay the foundation for (quantitative) structure activity and structure property predictions - a core discipline of cheminformatics. It has a historic relevance for natural sciences, such as chemistry, biochemistry and biology, and is in the heart of modern disciplines, such as cheminformatics and bioinformatics. This review first covers the history of chemical graph theory, then provides an overview of its various techniques and applications for CASE, and finally summarises modern tools using chemical graph theory for CASE.

Clearly policy makers should consider the impacts of any decisions they might make before making them. Science can provide estimates of various economic, ecologic, environmental, and even social impacts of alternative policies, impacts that determine how effective any particular policy will be. These impact estimates can be used to compare and evaluate alternative policies in the search for identifying the best one to implement. Among all scientists providing inputs to policy making processes are analysts who develop and apply models that provide these estimated impacts and, possibly, their probabilities of occurrence. But just producing them is not a guarantee that they will be considered by policy makers. This paper discusses ways scientists, including systems analysts, can effectively contribute to and inform those involved in making water management decisions. Brief descriptions of a variety of past and on-going water management policy making processes illustrate both some successes and failures of science informing policy.

This research article reports the results of a qualitative case study that correlates academic literature with five Industry 4.0 cyber trends, seven cyber risk frameworks and two cyber risk models. While there is a strong interest in industry and academia to standardise existing cyber risk frameworks, models and methodologies, an attempt to combine these approaches has not been done until present. We apply the grounded theory approach to derive with integration criteria for the reviewed frameworks, models and methodologies. Then, we propose a new architecture for the integration of the reviewed frameworks, models and methodologies. We therefore advance the efforts of integrating standards and governance into Industry 4.0 and offer a better understanding of a holistic economic impact assessment model for IoT cyber risk.