Background and Objectives: Effective strategy to cardiopulmonary resuscitation should be based on tissue perfusion. Our primary aim was to determine the association between capillary lactate values and initial rhythm as well as probability of return of spontaneous circulation in out-of-hospital cardiac arrest patients. Materials and Methods: This prospective observational cohort study included all patients with non-traumatic out-of-hospital cardiac arrest, older than 18 years, resuscitated by a prehospital emergency medical team between April 2020 and June 2021. Capillary lactate samples were collected at the time of arrival and every 10 minutes after first measurement until the time of return of spontaneous circulation (ROSC) or if ROSC was not achieved at time of declaring death on scene. Results: 83 patients were enrolled in the study. ROSC was achieved in 28 patients (33,7%), 21 were admitted to the hospital (26,3%) and 6 (7,23%) of them were discharged from the hospital. At discharge all patients had Cerebral Performance Category Scale 1 or 2. Initial capillary lactate values were significantly higher in patients with non-shockable rhythm compared to the group with shockable rhythm (9,19 +/- 4,6 versus 6,43 +/- 3,81; p = 0.037). A significant difference persisted also in a second value taken 10 minutes after in-itial value (10,03 +/- 5,19 versus 5,18 +/- 3,47; p = 0.019). Capillary lactate values were higher in the ROSC group and non-ROSC group at the time of restored circulation (11,10 +/- 6,59 and 6,77 +/- 4,23, respectively; p = 0,047). Conclusions: Capillary lactate values are significantly lower in patients with a shockable first rhythm in OHCA. There is also a significant connection between a rise in capillary lactate level and ROSC.

The objective of this study was to identify the key elements used by prehospital emergency physicians (EP) to decide whether or not to attempt advanced life support (ALS) in asystolic out-of-hospital cardiac arrest (OHCA). From 01.01.2009 to 01.01.2017, all adult victims of asystolic OHCA in Geneva, Switzerland, were retrospectively included. Patients with signs of "obvious death" or with a Do-Not-Attempt-Resuscitation order were excluded. Patients were categorized as having received ALS if this was mentioned in the medical record, or, failing that, if at least one dose of adrenaline had been administered during cardio-pulmonary resuscitation (CPR). Prognostic factors known at the time of EP's decision were included in a multivariable logistic regression model. 784 patients were included. Factors favourably influencing the decision to provide ALS were witnessed OHCA (OR=2.14, 95%CI1.43–3.20) and bystander CPR (OR=4.10, 95%CI2.28–7.39). Traumatic aetiology (OR=0.04, 95%CI0.02–0.08), age >80 years (OR=0.14, 95%CI0.09–0.24) and a Charlson comorbidity index greater than 5 (OR=0.12, 95%CI0.06–0.27) were the factors most strongly associated with the decision not to attempt ALS. Factors influencing the EP’s decision to attempt ALS in asystolic OHCA are the relatively young age of the patients, few comorbidities, presumed medical aetiology, witnessed OHCA and bystander CPR.

Background Out-of-pocket costs are key expenses that many individuals incur in order to receive health services. They have been identified as a key access barrier for vulnerable populations, in particular for populations affected by neglected diseases with a chronic progression, such as Chagas disease. It is important to understand the costs of accessing healthcare services that are borne by patients with T. cruzi infection. Methodology We prepared a structured survey for patients with T. cruzi infection/Chagas disease who were all treated by the healthcare system in endemic municipalities in Colombia. The results were analyzed according to three categories: 1. the socioeconomic profiling of the patients; 2. the costs of and time spent on transportation; and 3. the opportunity costs (money that was not earned) related to treatment at the local primary care hospital or at the high-complexity reference hospital. Main findings Ninety-one patients answered the survey voluntarily. The data revealed that, when treated at the specialized reference hospital, patients spent 5.5 times more on food and accommodation, transportation costs were five times higher, and the loss of earnings was three times higher than when they were treated at the local primary care hospital. Moreover, the amount of time spent on transportation was 4 times higher at the reference hospital. Conclusions Providing comprehensive healthcare services for Chagas management at local primary healthcare hospitals would allow the most vulnerable patients to save on expenses related to medical and non-medical costs (out-of-pocket costs), in turn leading to higher adhesion to treatment thus benefiting the health system as a whole. These findings are in alignment with the WHO’s World Health Assembly 2010 Resolution on the importance of treating Chagas at local primary care hospitals, thereby saving patients time and money, allowing for timely care, and promoting access to healthcare.

Background: In recent years, the assessment and guidance of cardiopulmonary resuscitation (CPR) quality using noninvasive and invasive monitoring techniques have been increasingly recommended. In this study, we introduce a new physiological monitoring system that simultaneously measures arterial pressure (AP), venous pressure (VP), and cerebral tissue oxygen saturation (SctO2) during CPR. Methods: This prospective observational study was conducted at a single center (Kagoshima City Hospital). Adult out-of-hospital patients aged ≥18 years with an intravenous femoral arterial line, venous line, and SctO2 monitor were included. We measured femoral arterial pressure (FAP) and femoral venous pressure (FVP) invasively if catheters were immediately inserted into the femoral artery and vein for potential candidates who require interventions such as extracorporeal cardiopulmonary resuscitation but did not receive such interventions as a result. Results: We observed several representative cases that provided the following insights: We presented several cases, including two patients with significant increases in FVP and low SctO2 values, and in both cases, return of spontaneous circulation (ROSC) was not achieved. In contrast, we also presented two cases in which CPR resulted in higher FAP compared to FVP and an upward trend in SctO2 values was observed, and both instances achieved ROSC. Conclusion: We presented a simultaneous physiological monitoring system that can monitor AP, VP, and SctO2 during CPR. Further case accumulations will be necessary to assess the variations in hemodynamic status during CPR and the association between each hemodynamic status and outcomes after cardiac arrest.

The underlying physical concept of computing out-of-time-ordered correlation (OTOC) is a significant new tool within the framework of quantum field theory, which now-a-days is treated as a measure of random fluctuations. In this paper, by following the canonical quantization technique we demonstrate a computational method to quantify the two different types of Cosmological auto-correlated OTO functions during the epoch when the non-equilibrium features dominates in Primordial Cosmology. In this formulation, two distinct dynamical time scales are involved to define the quantum mechanical operators arising from cosmological perturbation scenario. We have provided detailed explanation regarding the necessity of this new formalism to quantify any random events generated from quantum fluctuations in Primordial Cosmology. We have performed an elaborative computation for the two types of two-point and four-point auto-correlated OTO functions in terms of the cosmological perturbation field variables and its canonically conjugate momenta to quantify random auto-correlations in the non-equilibrium regime. For both the cases we found significantly distinguishable non-chaotic, but random behaviour in the OTO auto-correlations, which was not pointed before in this type of studies. Finally, we have also demonstrated the classical limiting behaviour of the mentioned two types of auto-correlated OTOC functions from the thermally weighted phase space averaged Poisson Brackets, which we found exactly matches with the large time limiting behaviour of the auto-correlations in the super-horizon regime of the cosmological scalar mode fluctuation.

Quantum turbulence is characterized by many degrees of freedom interacting non-linearly to produce disordered states, both in space and time. The advances in trapping, cooling, and tuning the interparticle interactions in atomic Bose-Einstein condensates (BECs) make them excellent candidates for studying quantum turbulence. In this work, we investigate the decaying regime of quantum turbulence in a trapped BEC. Although much progress has been made in understanding quantum turbulence, other strategies are needed to overcome some intrinsic difficulties. We present an alternative way of investigating this phenomenon by defining and computing a characteristic length scale, which possesses relevant characteristics to study the establishment of the quantum turbulent regime. One intrinsic difficulty related to these systems is that absorption images of BECs are projected to a plane, thus eliminating some of the information present in the original momentum distribution. We overcome this difficulty by exploring the symmetry of the cloud, which allows us to reconstruct the three-dimensional momentum distributions with the inverse Abel transform. We present our analysis with both the two- and three-dimensional momentum distributions, discussing their similarities and differences. We argue that the characteristic length allows us to visualize the time evolution of the turbulent state intuitively.

The concept of out-of-time-ordered correlation (OTOC) function is treated as a very strong theoretical probe of quantum randomness, using which one can study both chaotic and non-chaotic phenomena in the context of quantum statistical mechanics. In this paper, we define a general class of OTOC, which can perfectly capture quantum randomness phenomena in a better way. Further we demonstrate an equivalent formalism of computation using a general time independent Hamiltonian having well defined eigenstate representation for integrable supersymmetric quantum systems. We found that one needs to consider two new correlators apart from the usual one to have a complete quantum description. To visualize the impact of the given formalism we consider the two well known models viz. Harmonic Oscillator and one dimensional potential well within the framework of supersymmetry. For the Harmonic Oscillator case we obtain similar periodic time dependence but dissimilar parameter dependences compared to the results obtained from both microcanonical and canonical ensembles in quantum mechanics without supersymmetry. On the other hand, for one dimensional potential well problem we found significantly different time scale and the other parameter dependence compared to the results obtained from non-supersymmetric quantum mechanics. Finally, to establish the consistency of the prescribed formalism in the classical limit, we demonstrate the phase space averaged version of the classical version of OTOCs from a model independent Hamiltonian along with the previously mentioned these well cited models.

This study aims to introduce out of school activities (OSA) to high school PJOK teachers in Padang Pariaman District, West Sumatra Province, Indonesia. As is known, OSA is an alternative for students in fulfilling their movement needs, especially during the COVID 19 pandemic. Currently, students mostly stay at home, such as studying from home, to doing activities from home. So that there is minimal possibility of carrying out the movement activities recommended by WHO. The research method used is action research. This method gets a problem, then arranges problem-solving, conducts treatment, and finally evaluates. The research results show no teachers who have ever carried out of school activities (OSA); understanding, implementation, and evaluation are also not understood by the teachers. After being given the treatment, the teachers became more aware and understood about out of school activities, starting from understanding, implementing to evaluating what had to be done.

Adaptable or adapted? Whether it is a question of physical, biological or even economic systems, this problem arises when all these systems are the location of matter and energy conversion. To this interdisciplinary question we propose a theoretical framework based on the two principles of thermodynamics. Considering a finite time linear thermodynamic approach, we show that non-equilibrium systems operating in quasi-static regime are quite deterministic as long as boundary conditions are correctly defined. The Novikov-Curzon-Ahlborn approach [1,2] applied to non-endoreversible systems then makes it possible to precisely determine the conditions for obtaining characteristic operating points. As a result, power maximization principle (MPP), entropy minimization principle(mEP), efficiency maximization, or waste minimization states are only specific modalities of system operation. We show that boundary conditions play a major role in defining operating points because they define the intensity of the feedback that ultimately characterizes the operation. Armed with these thermodynamic foundations, we show that the intrinsically most efficient systems are also the most constrained in terms of controlling the entropy and dissipation production. In particular, we show that the best figure of merit necessarily leads to a vanishing production of power. On the other hand, a class of systems emerges which, although they do not offer extreme efficiency or power, have a wide range of use and therefore marked robustness. It therefore appears that the number of degrees of freedom of the system leads to an optimization of the allocation of entropy production.

Quantum turbulence deals with the phenomenon of turbulence in quantum fluids, such as superfluid helium and trapped Bose-Einstein condensates (BECs). Although much progress has been made in understanding quantum turbulence, several fundamental questions remain to be answered. In this work, we investigated the entropy of a trapped BEC in several regimes, including equilibrium, small excitations, the onset of turbulence, and a turbulent state. We considered the time evolution when the system is perturbed and let to evolve after the external excitation is turned off. We derived an expression for the entropy consistent with the accessible experimental data, that is, using the assumption that the momentum distribution is well-known. We related the excitation amplitude to different stages of the perturbed system, and we found distinct features of the entropy in each of them. In particular, we observed a sudden increase in the entropy following the establishment of a particle cascade. We argue that entropy and related quantities can be used to investigate and characterize quantum turbulence.

This study have uniquely mad use of Box-Jenkins ARIMA models to address the core of the threes objectives set out in view of the focus to add meaningful value to knowledge exploration. The outcome of the research have testify the achievements of this through successful nine months out-of-sample forecasts produced from the program codes, with indicating best model choices from the empirical estimation. In addition, the results also provide description of risks produced from the uncertainty Fan Chart, which clearly outlined possible downside and upside risks to tourist visitations in the country. In the conclusion, it was suggested that downside risks to the low level tourist arrival can be managed through collaboration between authorities concerned with the management of tourist arrivals in the country.

Hospitals are perpetually challenged by the dual requirements of concurrently improving the quality of healthcare and maintaining financial solvency. Both issues are among the top concerns for hospital executives across the United States, yet some have questioned if the efforts to enhance quality are financially sustainable. led us to examine if improving quality in the hospital setting impacts revenue. Using multivariate regression, we assessed if numerous quality measures were associated with our targeted measure of hospital profitability: the net patient revenue per adjusted discharge. The independent variables included the HCAHPS Summary Star Rating, Hospital Compare Overall Rating, All-Cause hospital-wide Readmission Rate, Total Performance Score, Clinical Outcomes Domain Score, Safety Domain Score, Person and Community Engagement Domain Score, and the Efficiency and Cost Reduction Score. Our results indicated that improving quality was significantly associated with improved net patient revenue per adjusted discharge for seven of the eight of these quality measures at the hospital level. It is clear that failing to address quality and patient safety issues is costly for US hospitals, thus we believe our findings support the premise that increased attention to the quality of care delivered as well as patients’ perceptions of care may allow hospitals to accentuate profitability and advance a hospital’s financial position.

We investigate numerically the interactions of in-phase Airy beams modulated by a fundamental Gaussian beam and fourth-order diffraction in Kerr nonlinear media. Directly numerical simulations show that normal (anomalous) fourth-order diffractions and in-phase (out-of-phase) Gaussian beam affect the interactions of solitons generated from Airy beams in unique manners. Different from previous results that interactions between in-phase (out-of-phase) conventional beams are always attractive (repulsive), many anomalous interactions of Airy beams are obtained. Stable bound states of breathing Airy soliton pairs can be formed with the help of fourth-order diffraction and fundamental Gaussian beam.

This paper intends to examine whether a company’s policy of dividend would impact or influence the price fluctuation of respective common stock in the designated stock market particularly in Hong Kong. Hence, there are 354 companies in Hong Kong which are all listed company on the Stock Exchange of Hong Kong (HKEX), were chosen as sample data for analysis with their audited financial information ranged from 2001 to 2020. Two proxies, the yield and the ratio of pay-out of dividend were widely adopted for the measurement of the effect of dividend policy and the possible influence on the volatility of respective common stock price by employing two statistical models, which are the model of fixed and random effects to provide accurate regression coefficients. With the results from the model of fixed effects, the yield and the pay-out ratio of dividend have been found statistically associated to the price volatilization of respective common stock in Hong Kong. The statical results in this study also find the yield and the ratio of pay-out of dividend are apparently and negatively associated to the price volatilization of respective common stock in Hong Kong. The research outcomes will be a reference for further study on different variables may have effects or volatilize the price of common stock price particularly in Hong Kong capital market.

Since the start of the COVID-19 pandemic, the world has witnessed a digital revolution that has transformed the way information are broadcast and consumed. This rapid evolution was accompanied by an “infodemic” (Beaulieu, 2019), a transformation of workplaces (Lulli LG, 2021)and difficulties in managing information flows (Bendahan & Nader, 2020). In this scientific article, we examine the communication strategies adopted by hospital structures as they are perceived by staff, highlighting their psychological and professional experiences throughout the crisis period. The results of the study carried out among hospital staff (n=200) demonstrate that the perception of communication strategies is generally positive for 78.56% of participants (M=1.85). The assessments of the staff interviewed as for the effect of this communication on the psychological experience and on the management of professional tasks have a positive trend respectively (M=2.15) and (M=1.86)

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

Pneumonia is the leading cause of hospitalization in pediatric patients. Disease severity greatly influences pneumonia progression and adverse health outcomes such as hospital readmission. Hospital readmissions have become a measure of healthcare quality to reduce excess expenditures. The aim of this study was to examine 30-day all-cause readmission rates and evaluate the association between pneumonia severity and readmission among pediatric pneumonia hospitalizations. Using 2018 Nationwide Readmissions Database (NRD), we conducted a cross-sectional study of pediatric hospitalizations for pneumonia. Pneumonia severity was defined by the presence of respiratory failure, sepsis, mechanical ventilation, dependence on long-term supplemental oxygen, and/or respiratory intubation. Outcomes of interest were 30-day all-cause readmission, length of stay, and cost. The rate of 30-day readmission for the total sample was 5.9%, 4.7% for non-severe pneumonia, and 8.7% for severe pneumonia (p<0.01). Among those who were readmitted, hospitalizations for severe pneumonia had a longer length of stay (6.5 vs. 5.4 days, p<0.01) and higher daily cost ($3,246 vs. $2,679, p<0.01) than admissions for non-severe pneumonia. Factors associated with 30-day readmission were pneumonia severity, immunosuppressive conditions, length of stay, and hospital case volume. To reduce potentially preventable readmissions, clinical interventions to improve the disease course and hospital system interventions are necessary.

The use of the Google Scholar produces about 278 hits on the term ‘‘inertial propulsion.’’ If patents are also included, the number of hits increases to 536. This paper discusses, in a critical way, some characteristic aspects of this controversial topic. The review starts with the halteres of athletes in the Olympic games of ancient times and then continues with some typical devices which were developed or/and patented from the second fourth of the twentieth century till today.

This paper elucidates the impact of uncertainty on the Markowitz asset allocation and how it performs. The findings imply that when evaluated out-of-sample, estimation errors in parameters might significantly affect how well an allocation performs. Numerous publications that address this ambiguity have been highlighted to emphasize our findings further. In our work, we compare these approaches to alternative allocation strategies and explain their performance in both expected and real out-of-sample events. We find that the Markowitz framework can be improved by using tactics that take uncertainty into account. Longer sample numbers, however, may not always translate into better outcomes. Applying a short-sale constraint can also enhance the initial portfolio. Finally, we find that even more basic approaches to asset allocation, such as equally weighted allocation, perform reasonably well.

As is well known, the main contribution of the FRP strips to the strength of load-bearing walls is an improvement in the in-plane strength. This paper deals with the possibility of applying the FRP strips in way to modify the strengthening mechanism of the FRP reinforcing system, from an in-plane to an out-of-plane strengthening mechanism. In order to achieve this goal, a second reinforcement system – derived from the CAM system (Active Confinement of Masonry) – provides connections between the FRP strips placed on the opposite sides of the wall. This new strengthening technique – called the straps/strips technique – establishes a stiffness constraint that forces the opposing FRP strips to behave like two flanges of an FRP I-beam embedded in the wall. Consequently, the use of FRP strips also improves the flexural strength of the wall. The present paper briefly summarizes the results obtained in previous works with the straps/strips technique and proposes an improvement of this strengthening technique, based on some weak-points emerged in the early experimentations. The paper also shows the results of a further experimental test, performed with the improved straps/strips technique. Finally, the similarity between FRP strips with transversal connection and concrete wythes of a sandwich panel with flexible connectors leads to interpret the behavior of the ideal I-beam in terms of composite action established between the FRP strips. This paves the way for analytical modeling of the straps/strips technique.

Multiple studies have shown that hospital settings are poorly cleaned during terminal cleaning. The adequacy of these cleaning methods has been undermined by presence of multi drug resistant bacteria on hospital surfaces. This case is even more serious in developing countries leading to health care- associated infections that pose a great threat to patients, visitors and health care providers in hospital settings.This study used various microbiological techniques to test for antibiotic susceptibility profiles of bacteria present at Thika Level 5 Hospital surfaces, Kenya. A simple random cross sectional study was performed, with a total of 85 samples being collected from five different sites. The sites included male and female wards, health care personnel offices, latrine, and kitchen surfaces. Samples were collected using sterile swabs, dipped in normal saline, and transported to the laboratory within 2Hours for processing.Of the 85 plates cultured, 47 plates showed bacterial growth (55%) on selective media with a significant P value of 0.0357. Seven different species of bacteria were identified biochemically from all sites, Escherichia coli was the most abundant species (28%), and the least was Salmonella typhii (5%). Multiple drug resistance was common in the different bacteria identified. All isolates were resistant to chloramphenical and susceptible to gentamycin. The most resistant microorganism was Staphylococcus aureus (50%), and the least resistant microorganism was Klebsiella pneumoniae (12.5%). The antimicrobial resistant bacterial species identified in this study have been documented to cause serious health care associated infections. These results present a significant public health concern because there is a possibility of patients, staff and visitors contacting nosocomial infections when they come into contact with surfaces at Thika Level 5 Hospital surfaces, Kenya.

The purpose of this study was to assess the extent to which self-esteem and depression mediated the influence of internalized stigma on life satisfaction among Korean out-of-school youths. Cross-sectional data on 318 youths provided information on perceived stigma, self-esteem, depression, life satisfaction, and personal characteristics. A multinomial logistic regression analysis was followed by structured path analysis to investigate the mediation effects. Internalized stigma was negatively associated with life satisfaction. Self-esteem significantly mediated the influence of stigma on depression and the influence of depression on life satisfaction. Further, stigma directly and significantly influenced depression. This study demonstrated that self-esteem and depression were important to the relationship between internalized stigma and life satisfaction. Implications for possible policies and programs with the aim of helping out-of-school youths to integrate and lead successful satisfying lives are discussed.

In view of the increasing age of cardiac surgery patients, questions arise about the expected postoperative quality of life and the hoped-for prolonged life expectancy. Little is known so far about this weighting by the patients concerned. This study aims to obtain information on the patient’s preferences. Between 2015 and 2017, data from 1349 consecutive patients from seven heart centers in Germany undergoing cardiac surgery were analyzed. Baseline data regarding the patient’s situation as well as a questionnaire regrading quality of life versus lifespan were taken preoperatively. Patients were divided by age into 4 groups: below 60, 60-70, 70-80, and above 80 years. As a result, if one had to decide between quality of life and length of life, about 60% of the male patients decided for quality of life, independent of their age. On the other hand, female patient’s decision for quality of life increased significantly with age, from 51% in the group below sixty to 76% in the group above eighty years. This finding suggests that the female patients adapt their preferences with age whereas male patients do not. This should impact further treatment decisions of elderly patients in cardiac surgery within a shared decision-making process.

Covid-19 is a disease caused by SARS-CoV-2, which has spread worldwide since the beginning of 2020. Several pharmaceutical and non-pharmaceutical strategies were proposed to contain the virus dissemination, including vaccination and lockdowns. One of the consequences of the pandemic was the denial or delay of access to convenient health care services, but also potentially the increase of adverse events within those services, like the number of hospital infections. Therefore, the main question here is: What happened to the performance and sustainability of hospitals? The main goal of this work was to test if the Portuguese public hospitals' performance has been affected by the SARS-CoV-2 pandemic. We used the Benefit-of-Doubt method integrated with the Malmquist Index to analyze the performance evolution over time. Then, we employed a multiple regression model to test whether some pandemic-related variables could explain the performance results. We considered a database of 40 Portuguese public hospitals evaluated from January 2017 to May 2022. The period 2017 to 2019 corresponds to the baseline (pre-pandemic), against which the remaining period will be compared (during the pandemic). We also considered fourteen variables characterizing hospital quality, divided into three main performance definitions (efficiency and productivity; access; safety and care appropriateness). As potential explanatory variables, we consider seven dimensions, including vaccination rate and the need for intensive care for Covid-19 infected people. Results suggest that Covid-19 pandemic features help explain the drop on access after 2020, but not the evolution of safety and appropriateness of care, which surpris-ingly increased the whole time.

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

The fear of missing out (FoMO) is characterized in the literature as a fear that others are having rewarding experiences while one is missing out, and a constant need to keep connected with one’s social network. Driven by Social Determination Theory (SDT) FoMO has been linked with Problematic Social Networking Sites use (PSNSU), negative affectivity (NA), self-esteem (SE) and sleep disturbances. The present study reports findings from 512 individuals (79.1% women, mean age 30.5 years, SD= 8.61). Structural equation modelling (SEM) suggests that the duration of SNSs use and the numbers of SNSs platforms actively used partially mediated the relationship between FoMO and PSNSU. In turns, PSNSU partially mediated the relationship between FoMO and NA. Furthermore, the present study has extended the literature by incorporating the Vulnerability Model in the FoMO concept, identifying that SE partially mediated the relationship between FoMO and NA, while NA fully mediated the relationship between FoMO and sleeping disturbances. Accordingly, the present has extended previous research findings in showing exercise as a potential protective factor to prevent against FoMO. Practical and theoretical implications are discussed.

Communication, compression of information, transmission of information through noisy channels, interconnecting different information systems, cryptography, gate construction –– these areas all depend on classical information theory. We show that, in classical terms, semantic aspects of communication are not at all irrelevant to the engineering problem, contrary to Shannon, and affect the message intended to be transmitted. This is revisited and captured by an analogy to trust, in that they are essential to the channel (for proper use), but cannot be transferred (under risk of flaws) through that same channel. Information is also described by, at least, a tri-state system — not by binary logic. The trust analogy semantics can be coded as the Curry-Howard relationship, connecting computer code with structural logic, by way of different categories. Two-state and Boolean logic (aka Shannon semantics) was used classically before, with Shannon theory, but without trust analogy semantics – found to be a sine qua non condition. This is now familiar in classical gate construction with physical systems with, e.g., Verilog and SystemVerilog. The applications to computation and quantum theory are further explored. The most fundamental entity in today`s theory of information is proposed to use at least three logical states, not bits, in all applications, including: cyber-physical systems, devices, in computation, and in quantum theory.

The efficiency of cold sheet and strip rolling of steels and non-ferrous metals in the main depends on the quality of the technological lubricant and its cost. In this regard, it is important to develop new compositions of effective metal-working coolants (MWC) having low cost and providing the maximum reduction in the friction coefficient. We developed and tested the new compositions of the MWC on basis of chicken fat, and mono- and diglycerides and their esters of boric acid synthesized from the wastes of sunflower oil production. The MWC were tested in DSEA on laboratory rolling mill 100x100 with a roll diameter of 260 mm during steel 08Kp rolling. The efficiency of the coolants was determined by the factor of metal stretch forming λ and the coefficient of friction μ in the deformation zone which was found by forward slip method. We found the metal-working coolant with 100 % concentration of boric acid esters of mono- and diglycerides is the most effective in steel rolling. Thus the new MWC on basis of boric acid esters of mono- and diglycerides synthesized from the wastes of sunflower oil production can be recommended for use in rolling of structural steels on account of availability, high efficiency, and a low cost.

This paper provides a new discovery that adds to the contemporary theory of modelling of non-stationary queues, by capturing analytically the behavior of the root parameter, for the G1/M/1 PSFFA model of non-stationary Ek/M/1 queue. Additionally, it has been also revealed that the resulting root parameter reduces to the PSFFA model of non-stationary queue. Potential applications of PSFFA to Computer engineering are provided. Some challenging open problems are addressed combined with closing remarks and future research directions.

In this paper, we concentrate on the study of the properties of residual Tsallis entropy for order statistics. Order statistics have an important role in reliability structural engineering for example for modelling lifetimes of series and parallel systems. The residual Tsallis entropy of ith order statistic from a continuous distribution function and its deviation from the residual Tsallis entropy of ith order statistics from a uniform distribution is investigated. In a mathematical framework, a method to express the residual Tsallis entropy of the ith order statistic from a continuous distribution in terms of the residual Tsallis entropy of the ith order statistic from a uniform distribution is provided. This approach may provide insight into the behavior and properties of the residual Tsallis entropy for order statistics. Further, we study the monotonicity properties of the residual Tsallis entropy of order statistics under dierent conditions. By studying these properties, deeper understanding of the relationship between the position of order statistics and the resulting residual Tsallis entropy is gained.

E-commerce platforms created to meet the needs of digital consumers, who are the leading actors of digital-oriented consumption, are increasing rapidly. Revolutionizing our daily lives by offering the digital equivalent of real-world experiences, e-commerce now offers a comfortable shopping experience that transcends the limitations of time and space. This phenomenon has been embraced by individuals spanning all age groups, from young children to the elderly. Structural equation modeling was used in this study, in which the factors affecting online shopping addiction were determined. In this direction, the causal and correlational relationships between the variables of fear of missing out (FoMO), cognitive load, personality types, some socio-demographic characteristics (gender and monthly shopping amount) and online shopping addiction in online shopping were revealed structurally. Since the purposive sampling was used, the study was carried out on 488 people. The goodness-of-fit indices included in the created model were found at an “acceptable” level (χ2/df= 2.248, p=0.000; RMSEA=0.051; GFI=0.878; AGFI=0.856; CFI=0.950; NFI=0.914). These results show that the final version of the model meets the necessary criteria for a good fit, its validity and accuracy. The study revealed the causal and correlational relationship between online shopping addiction and cognitive load, personality types, FoMO, gender, and monthly online shopping amount.

In this article we study the presence of chaos in supersymmetric(SUSY) quantum mechanics. For that purpose we present a form of 4-point out of time order correlator(OTOC) for SUSY quantum mechanical systems using tensor product formalism. We calculate the 4-point OTOC for SUSY 1D harmonic oscillator and find that the OTOC is exactly equal to that of 1D bosonic harmonic oscillator system. In similar manner using the eigenstate representation of supersymmetric systems we calculate the generalized higher order out of time order correlator. The higher order OTOC is a more sensitive measure of chaos than the usual 4-point correlator used in literature. Finally, we calculate the generalized 2N-point OTOC for SUSY 1D harmonic oscillator.

Clinical pharmacists are employed at many hospital departments in Denmark, but not yet on the Faroe Islands. The purpose of this study was to test feasibility of a clinical pharmacist-led medication review service at the surgical ward of the National Hospital on the Faroe Islands. Hospitalised surgical patients were offered a medication review service by a clinical pharmacist. Identified drug related problems (DRPs) were classified according to the Pharmaceutical Care Network Europe (PCNE) model. The qualitative inputs from the ward’s staff were collected. In total, 42 patients with 171 identified DRPs were included. The majority of the DRPs concerned suboptimal effect and the safety of the drug treatment. The 49.6 % of the proposed medication changes were accepted by the ward physicians. According to the qualitative inputs, the interest for the service was greater among the younger physicians compared to the older ones, and among nurses compared to physicians. Identified barriers for the optimal service implementation were an absence of medication ordinations and poor visibility of pharmacist’s notes in electronic health records. For a successful implementation of the service, work on the physicians’ interest in an interdisciplinary cooperation and optimization of the electronic health records are warranted.

The Ministry of Health evaluates hospital management in accordance with the standard of quality of service. The concept of Shariah hospitals offers management services that exceed the standard of quality of hospital care. The study aims to illustrate the concept of Shariah hospitals in Indonesia. We collect related literature from various media via online search with the keywords “Shariah hospitals,” “implementation of Shariah hospitals,” and “application of Shariah hospitals.” Main findings: The study finds that the Shariah hospitals built by the philosophy of Islam are willing to provide the best health-care services to patients. A code of conduct must be fulfilled by the hospital management in Shariah hospitals: (1) general liability, (2) obligations to society and the environment, (3) obligations to patients, (4) obligations to the leaders, staff, and employees, and (4) relationships with related institutions. The foremost challenges include the improvement of health personnel performance and the quality of services in addition to perceptions that are not inclusive of the system of Shariah hospitals. This implementation should run consistently and with the commitment of all parties. Such insight, in turn, can be counted as an input to an approach to health services, particularly in increasing the performance rates, such as hospital. This study is the first to provide new insight into discussion about shariah hospital by presenting its focuses on Islamic approaches in meeting the quality standards of health services in hospitals so as to obtain more value. However, exclusive principles—Islamization, heterogeneity, and the performance of health workers—challenge the implementation of this hospital system.

Objectives: To evaluate the effectiveness of hydrogen peroxide (HP) use in the hospital water network disinfection to control Legionella spp. colonization. Methods: Following the detection of high levels of Legionella contamination in a 136-bed general hospital water network, an HP treatment of the hot water (25 mg/L) was adopted. During a period of 34 months, the effectiveness of HP on Legionella colonization was assessed. Legionella was isolated in accordance with ISO-11731 and identification was carried out by sequencing of the mip gene. Results: Before HP treatment L.pneumophila sg 2-15 was isolated in all sites with a mean count of 9950±8279 CFU/L. After one month of HP-treatment, we observed the disappearance of L. pneumophila 2-15, however other Legionella species never cultured before appeared; Legionella pneumophila 1 was isolated in 1 out of 4 sampling sites (2,000 CFU/L) and other non-pneumophila species in all sites (mean load 3,000 ±2887 CFU/L). Starting from September 2013, HP-treatment was modified adding food-grade polyphosphates and in the following months we observed a progressive reduction of the mean load of all species (p<0.05), until to a substantial disappearing of Legionella colonization. Conclusion: Hydrogen peroxide demonstrated a good efficacy in controlling Legionella. Although in the initial phases of treatment it seemed unable to eliminate all the species, by keeping HP levels to 25 mg/L and adding food-grade polyphosphates, a progressive and complete control of colonisation was obtained.

Phenotypic complementation of gene knock-outs is an essential step in establishing function. Here we describe a simple strategy for ‘gold standard’ complementation in which the mutant allele is replaced in situ with a wild type (WT) allele in a procedure that exploits CRISPR/Cas9. The method relies on the prior incorporation of a unique 24 nucleotide (nt) ‘bookmark’ sequence into the mutant allele to act as a guide RNA target during its Cas9-mediated replacement with the WT allele. The bookmark comprises a 23 nt Cas9 target sequence plus an additional nt to ensure the deletion is in-frame. Here, bookmarks are tailored to Streptococcus pyogenes CRISPR/Cas9, but could be designed for any CRISPR/Cas system. For proof of concept, 9 bookmarks were tested in Clostridium autoethanogenum. Complementation efficiencies reached 91%. As complemented strains are indistinguishable from their progenitors, concerns over contamination may be satisfied by incorporation of ‘watermark’ sequences into the complementing genes.

Background: Patients with infectious complications related to the presence of cardiac implantable electronic devices (CIED) constitute a heterogeneous group, including local pocket infection (PI) and lead related infectious endocarditis (LRIE). The diagnosis of CIED-related infection is often difficult and requires complex imaging and microbiological tests. The aim of the current study was to evaluate the usefulness of new simple hematological parameters in detecting infectious complications in patients with CIED and assessing their extent. Methods: The retrospective analysis of clinical data of 2909 patients (36.37% with CIED-related infections), undergoing transvenous lead extraction (TLE) procedures in three high-volume centres in the years 2006-2020, was conducted. The sensitivity and specificity of new hematological markers were evaluated: the neutrophil to lymphocyte ratio (NLR), neutrophil to platelet ratio (NPR), and lymphocyte to platelet ratio (LPR) in the diagnosis of infectious complications, assessment of the spread of the infectious process and differentiation of additional structures related to the presence of leads. Results: In patients with CIED infections, compared to the non-infectious group, high inflammatory parameters were confirmed, and the highest specificity of the new markers in detecting the infectious process was demonstrated. (79.47% for NPR and 72.82% for NLR). Analysis of laboratory parameters in infectious and non-infectious patients with the presence of additional lead-related masses showed the highest specificity of NPR (82,78%) in predicting the diagnosis of vegetation. Comparison of laboratory parameters in patients with LRIE and PI showed higher NLR % (4.24 vs 2.56; p<0.001, area under curve (AUC) in a receiver operating characteristic (ROC) curve: 0.67 and 0.78 respectively) and higher NPR (0.03 vs 0.02; p<0.001; AUC: 0,51 and 0,55) in patients with LRIE. The highest sensitivity in the detection of coexistence LRIE with PI has been demonstrated for NLR (87.33%). Conclusions: Novel hematological markers may be helpful in the recognition of the inflammatory process in patients with CIED, differentiation of vegetation and vegetation-like masses, and the extent of infection in patients with PI.

The out-of-time-ordered correlation (OTOC) function is an important new probe in quantum field theory which is treated as a significant measure of random quantum correlations. In this paper, with the slogan "Cosmology meets Condensed Matter Physics" we demonstrate a formalism using which for the first time we compute the Cosmological OTOC during the stochastic particle production during inflation and reheating following canonical quantization technique. In this computation, two dynamical time scales are involved, out of them at one time scale the cosmological perturbation variable and for the other the canonically conjugate momentum is defined, which is the strict requirement to define time scale separated quantum operators for OTOC and perfectly consistent with the general definition of OTOC. Most importantly, using the present formalism not only one can study the quantum correlation during stochastic inflation and reheating, but also study quantum correlation for any random events in Cosmology. Next, using the late time exponential decay of cosmological OTOC with respect to the dynamical time scale of our universe which is associated with the canonically conjugate momentum operator in this formalism we study the phenomena of quantum chaos by computing the expression for {\it Lyapunov spectrum}. Further, using the well known Maldacena Shenker Stanford (MSS) bound, on Lyapunov exponent, λ≤2π/β, we propose a lower bound on the equilibrium temperature, T=1/β, at the very late time scale of the universe. On the other hand, with respect to the other time scale with which the perturbation variable is associated, we find decreasing but not exponentially decaying behaviour, which quantifies the random correlation at out-of-equilibrium. Finally, we have studied the classical limit of the OTOC to check the consistency with the large time limiting behaviour.

The purpose of this study is to improve the performance of walls under out-of-plane loads, particularly when subjected to the hammering action of the floors. The idea behind the paper is to provide the masonry walls with a device that behaves like a buttress, without having to build a traditional buttress. The solution presented here consists of a mechanical coupling between the three-dimensional net of steel ribbons of the CAM system and the CFRP strips. Since the steel ribbons of the CAM system have a pre-tension, the mechanical coupling allows the steel ribbons to establish a semi-rigid transverse link between the CFRP strips bonded on two opposite sides of a wall. Therefore, two vertical CFRP strips tied by the steel ribbons behave like the flanges of an I-beam and the flexural strength of the ideal I-beam counteracts the out-of-plane displacements of the wall. The experimental results showed that the combined technique inherits the strong points of both constituent techniques: the delamination load is comparable to that of the specimens reinforced with the CFRP strips and the overall behavior is ductile as for the specimens reinforced with the CAM system. They also allowed us to design a more performing combined technique.

The single set of electron transporters of the cardiac mitochondrial respiratory chain is organized into three separate supercomplexes. Two of them contain complex I, a dimer of complex III, and two dimers of complex IV. The third supercomplex contains a dimer of complex III and two dimers of complex IV. We also considered two important discoveries. First, the enzymes of β-oxidation of fatty acids are physically associated with respirasome. Second, β-oxidation of fatty acids creates the highest level of QH2 and reverses the flow of electrons from QH2 through complex II, reducing fumarate to succinate. We argue that the respirasome is uniquely adapted for the β-oxidation of fatty acids. The acyl-CoA dehydrogenase complex reduces the membrane’s pool of ubiquinone to QH2, which is instantly oxidized by the 2complex III-4complex IV supercomplex, generating high energization of mitochondria and reversing the electrons flow through the complex II, which reverses the electrons flow through the complex I increasing the NADH/NAD+ ratio in the matrix. The mitochondrial nicotinamide nucleotide transhydrogenase catalyzes a hydride (H-, a proton plus two electrons) transfer across the inner mitochondrial membrane, reducing the cytosolic pool of NADP(H), thus providing the heart with ATP for muscle contraction and energy and reducing equivalents for the housekeeping processes.

Introduction: CT scan of the skull in patients with head trauma play an important role in identifying patients' injuries; In moderate to severe brain injury; CT scans are arguably the best way to get information about the intracranial complications of a head injury. Researchers have cited a number of reasons for why doctors are increasingly asking for CT scans of patients. In this study; pathological findings in CT scan of patients with mild cranial trauma and level of consciousness 13-15 are examined. Method: In this study, the treatment process of 445 patients who had referred to the emergency department due to skull trauma was examined as research units; and samples were taken by simple random sampling among patients for whom CT scan of the brain was requested. In this study; the reasons for requesting a CT scan of the skull from the requesting physician were questioned through an interview at the time of request. Results: According to the tables; it can be seen that most of the patients referred to the hospital due to skull trauma for CT scan were men and were discharged in less than the first 24 hours. The age group of 21 to 30 years had the highest and the age group over 70 years had the lowest frequency and the highest percentage of request for CT scan was by doctor and the biggest injury that caused patients with mild cranial trauma to go to hospital was fall. Conclusion Based on the findings of this study, cranial trauma is one of the life-threatening factors that can cause minor or severe injuries Its range varies from superficial injuries to hematoma and intracranial hemorrhage, which is a reason to perform CT scans of patients with skull trauma. In order to carefully examine the extent of the damage to the patient and to avoid possible risks and to take the necessary measures for treatment. On the other hand, the lack of clear protocols as well as the lack of clarity and certainty of physicians in their diagnoses to perform graphs of qualified people has increased the number of unnecessary CT scans

(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.

Infection control among patients is critical for diseases like COVID-19. The concentration of patients in a few facilities burdens healthcare providers and the healthcare system. This study examined the operations of an extended anteroom in a dedicated COVID-19 hospital. It presents issues to consider in the deployment and operation of an extended anteroom through discussions by expert working groups. The subjects covered included efficient space, staffing, equipment management, and education. The process involved wearing personal protective equipment (PPE; in this case, Level D), and if necessary, wearing additional powered air purification respirators (PAPR), after moving from the preparation room to the dressing room, and when entering the hospital through the entrance passage. When leaving the hospital, personnel used a mandatory exit-only passage; in the dressing room, they undressed, and then went outside, in this order. The efficient spatial composition of the anteroom facilitated entry and exit and the separation of contaminated areas and non-contaminated areas using colors and lines. It is necessary to develop operational guidelines for hospitals that treat infectious diseases and conduct research to improve care. The study indicated the need to develop educational programs and use educational simulations to address regionally spread infectious diseases

Introduction: The management performance of hospitals in emergency departments in coping with clinical hazards is necessary for their success in providing quality services. The purpose of this study is to provide an optimization procedure and applying management performance in health and medical emergency on the rate of emergency preparedness of the suburb city hospitals. Research method: A semi-experimental and interventional descriptive study in the emergency department of Shahid Motahari Hospital in 2015-2016. Data was collected through the standard checklist of hospital emergency responsiveness test to WHO disasters with 90 questions in 9 domains which is codified by the World Health Organization, in the form of interviews and observing evidences , and if necessary a numerical analysis. Initially, the situation was measured according to this checklist. In the next stage, a set of solutions was developed and then the solutions were implemented according to the obtained information. Data analysis before and after proposing the procedure and its application in order to improve the quality of health management performance and emergency preparedness was performed using central indices, and for describing and presenting the survey results, tables and graphs were used. Results: The highest and lowest emergency preparedness rates for disasters and emergencies before the proposed procedure were the Communication Factor (%77/8) and Human resource factor (%2/8) respectively. The degree of preparedness of the medical center was measured in the management performance according to the model (WHO) before proposing the procedure (%77.98). The researcher's procedure provided and applied based on the information obtained from survey environment, location and type of hospital structure. After providing the procedure, the maximum and minimum rates were the continuity of service factor (%58.3) and post-accident rebuilding factor (%100), respectively. Generally, the rate of emergency preparedness of studied medical center in management performance for coping with disasters and medical emergencies was measured (%97.2) according to hospital emergency responsiveness test for accidents and (WHO). The significance level is less than 0.05, so we can say that the effectiveness with confidence (95%) was effective. Conclusion: According to the statistics of accidents and disasters in the suburb cities, the results of the research and the importance of the role of emergency departments in interurban hospitals in controlling accidents, the need for planning and implementation of practical measures such as conducting training courses on health management in disasters and emergencies, having an estimate of critical and essential resources, changing the structure, providing manpower (emergency management) in order to more precise control and ease of service, maintenance and repair of equipment, timely triage and retrofitting of hospitals were effective in improving their preparedness.

Nurses focus more on curative aspects rather than health promotion and disease prevention, thus weakening primary health care and lessening engagement with the community. Providing a learning environment that can support the professional growth of nurses through engagement with local communities and educational institutions would strengthen primary health care in the community; however, this poses challenges due to the traditional mindset of nurses towards primary health care. This integrative review aimed to explore key features of the potential of the nursing center model as a contracting-out approach to strengthen primary health care services. This integrative review provides lessons for implementing the Nursing Centre model for any country, mainly where nurses are not fully utilized for health promotion and disease prevention.

Vaccination is the key infection control measure against Coronavirus Disease 2019 (COVID-19). Most municipalities in Japan have adopted an opt-in system for COVID-19 vaccination, but its background information is limited. We, therefore, aimed to examine the differences in vaccination coverages and their cancellation rates between opt-in and opt-out settings for COVID-19 vaccination in 10 cities in A prefecture, Japan. 10 cities in A Prefecture were surveyed by email as of 10 October 2021 on the vaccination coverage by age group (12 years and older) and the cancellation rate on the day of vaccination. We also checked on the complaints received in the opt-out group. Opt-out was adopted in one of the ten cities in which vaccination was designed for all household members aged 15-64, thus serving as the opt-out group. Vaccination coverage in the opt-out group was 88.2%-89.2% for the first dose and 84.9%-86.0% for the second dose at 95% confidence intervals in the comparable 20–64-year age group. In contrast, the overall opt-in group (nine cities, one of which did not have an identified vaccination rate) was 51.3%-83.6% for the first dose and 63.5%-74.8% for the second dose in the same age group. For the opt-out group, the cancellation rate on the day was 11.3% for the first dose and 3.7% for the second dose, which had a lower cancellation rate than that of the opt-out on influenza vaccines in previous studies, 71%. Meanwhile, the opt-in group did not monitor them. There were no complaints about default changes in the opt-out group. While there is room for further research, such as understanding the reasons for accepting the default change by residents in the opt-out group, it was suggested that making opt-out the default would promote COVID-19 vaccination.

The Centers for Disease Control and Prevention recommends everyone between 13-64 years be tested for HIV at least once as a routine procedure. HIV routine screening is reimbursable by Medicare, Medicaid, expanded Medicaid, and most commercial insurance plans. Yet, scaling-up HIV routine screening remains a challenge. We conducted a scoping review for studies on financial benefits and barriers associated with HIV screening in clinical settings in the U.S. to inform an evidence-based strategy to scale-up HIV routine screening. We searched Ovid MEDLINE®, Cochrane, and Scopus for studies published between 2006 - 2020 in English. The search identified 383 Citations; we screened 220 and excluded 163 (outside the time limit, irrelevant, or outside the U.S.). Of the 220 screened articles, we included 35 and disqualified 155 (did not meet the eligibility criteria). We organized eligible articles under two themes: financial benefits/barriers in healthcare settings (9 articles); and Cost-effectiveness in healthcare settings (26 articles). The review concluded recommendations in three areas: (1) Finance: Incentivize healthcare providers/systems for implementing HIV routine screening and/or separate its reimbursement from bundle payments; (2) Personnel: Encourage nurse-initiated HIV screening programs in primary care settings and educate providers on CDC recommendations; and (3) Approach: Use opt-out approach.

As professionals, social workers have a special position in relation to considering the needs of children with cancer and their families. Hence, it is important to recognize the experiences and challenges of social workers to improve care of their clients. This study was a qualitative content analysis that aimed to determine a comprehensive understanding of 19 pediatric oncology social workers’ experiences in Iran. Data were collected using semi structured interviews and field observations, analyzed through face content analysis. Concepts extracted from social workers’ experiences consisted of the nature of oncology work, lack of professional competence, low organizational support and professional inferiority that were related to main concept of "exhausting and stressful service". The results indicated that social workers' involvement in stressful and emotionally demanding situations and professional and organizational challenges caused personal exhaustion. In addition to explaining the social workers’ experiences and related factors, the results emphasize the importance of taking care of service providers to prevent them becoming stressed and exhausted. It is also important to protect patients from the consequences of stressed and exhausted care providers so further research is recommended to develop specific intervention.

Background: Suicide is a major health problem. The aim of this study was a comparative study of the causes and methods of completed suicide referred to legal Medicine Organization in Bushehr Province during the years 2006- 2015. Methods: This consideration has been done as a retrospective cross-sectional study; the data were collected by the check list. After coordination to the medico legal 343 cases of completed suicide lead to death over a ten year period from 2006 to 2015 were extracted and the data were analyses by SPSS software. Results: The rate of completed suicide was 2.43 and 1.12 suicides per 100,000 people in male and female, respectively. The mean age were 29.25 and 27.61 years in male and female, respectively p>0.05. A higher completed suicide rate was found among single people. The most common ways of a suicide among people who live in Bushehr were hanging out 184(53.6%), self-Immolation 83(24.2%) and firearms 37(10.8%). Motive of suicide was psychological disorders, Physical disease, Conflict with family and substance abuse. 43(12.5%) people smoking and 22(6.4%) people were both smoking and opioid. During the ten year period of studied, throughout the all years that frequency of hanging out has been higher than others. Conclusion: Due to the high incidence of completed suicide in young people and unmarried individuals also hanging out in male and self-burning in females are prevalent. So determination of preventive measures appears to be necessary. Social factors such as psychological disorders and family conflicts have a noticeable role from .Bushehr people.

This study examines the relationship of fear of missing out (FOMO) with heavy social networking among Turkish university students (aged 17 - 55). The perception of the possible role of parental supervision on online activities is also investigated. Factor analysis of FOMO scale led us to evaluate the construct under two dimensions as (1) fear of missing experience and (2) fear of missing activity. The results revealed that fear of missing activity increases social media intrusion while fear of missing experience is found to have no significant effect. The reverse relationship is also valid: an urge to use social media predicts fear of missing out (activity and experience). Fear of missing experience is associated with problematic social media use (PSMU) and a high desire to use social media. The results additionally demonstrate that students aged 30 and older believe more in the requirement of parental control than those aged 17-22.

The present paper deals with an improvement of the strengthening technique consisting in the combined use of straps—made of stainless steel ribbons—and CFRP strips, to increase the out-of-plane strength of masonry walls. The straps of both the previous and the new combined technique pass from one face to the opposite face of the masonry wall through some holes made along the thickness, giving rise to a three-dimensional net of loop-shaped straps, closed on themselves. The new technique replaces the stainless steel ribbons with steel wire ropes, which form closed loops around the masonry units and the CFRP strips as in the previous technique. A turnbuckle for each steel wire rope allows the closure of the loops and provides the desired pre-tension to the straps. The mechanical coupling—given by the frictional forces—between the straps and the CFRP strips placed on the two faces of the masonry wall gives rise to an I-beam behavior of the facing CFRP strips, which begin to resist the load as if they were the two flanges of the same I-beam. Even the previous combined technique exploits the ideal I-beam mechanism, but the greater stiffness of the steel wire ropes compared to the stiffness of the steel ribbons makes the constraint between the facing CFRP strips stiffer. This gives the reinforced structural element greater stiffness and delamination load. In particular, the experimental results show that the maximum load achievable with the second combined technique is much greater than the maximum load provided by the CFRP strips. Even the ultimate displacement turns out to be increased, allowing us to state that the second combined technique improves both strength and ductility. Since the CFRP strips of the combined technique run along the vertical direction of the wall, the ideal I-beam mechanism is particularly useful to counteract the hammering actions provided by the floors on the perimeter walls, during an earthquake. Lastly, after the building went out of service, the box-type behavior offered by the three-dimensional net of straps prevents the building from collapsing, acting as a device for safeguarding life.

The lay-up of cross laminated timber (CLT) leads to significant differences in properties over its cross-section. Particularly the out-of-plane shear behavior of CLT is effected by the changes in shear moduli over the cross-section. Results from laboratory shear tests are used to evaluate the shear stiffness of 3- and 5-layer CLT panels in their major and minor strength direction. The results are compared to calculated shear stiffness values on evaluated single-layer properties as well as commonly used property ratios using the Timoshenko beam theory and the shear analogy method. Differences between the two calculation approaches are pointed out. The shear stiffness is highly sensitive to the ratio of the shear modulus parallel to the grain to the shear modulus perpendicular to the grain. The stiffness values determined from two test measurements are compared with the calculated results. The level of agreement is dependent on the number of layers in CLT and the property axis of the CLT panels.

(1) Background: In patients suffering from heart failure, the main causes of death are either he-modynamic failure, or ventricular arrhythmias. The only tool to significantly reduce arrhythmic sudden death is the implantable cardioverter defibrillator (ICD), but not all patients benefit to the same extend of these devices. (2) Methods: The primary outcome of this single center study was defined as cardiovascular death in patients with ischemic and non-ischemic heart failure who have benefited from ICD therapy. The secondary outcomes were death from any cause, sudden cardiac death, ICD-related therapies (appropriate antitachycardia pacing or shock therapy for ventricular tachycardia or fi-brillation) and recurrences of ventricular tachyarrhythmias. (3) Results: A total of 403 consecutive ICD recipients – symptomatic heart failure patients with ICD for the primary prevention of sudden cardiac death – were included retrospectively: 59% is-chemic cardiomyopathy (ICMP) and 41% non-ischemic cardiomyopathy (NICMP). Within a median follow-up period of 36 months, the incidence of cardiovascular mortality was not signif-icantly different in patients with NICMP and ICMP: the primary outcome had occurred in 9 pa-tients (5.4%) in the NICMP group and in 14 patients (5.9%) in the ICMP group (hazard ratio 1; 95%confidence interval [CI] 0.45 to 2.28; p =0.97). All-cause mortality occurred in 14 of 166 pa-tients (8.4%) in NICMP group and 18 of 237 patients (7.6%) in ICMP group. Sudden cardiac death occurred in 2 patients (1.2%) in the NICMP group and in 4 patients (1.7%) in the ICMP group (hazard ratio 0.71; 95% CI, 0.13 to 3.88; P=0.69). The rate of appropriate device therapies was comparable in both groups. (4) Conclusion: In this study, ICD implantation for primary prevention of sudden cardiac death in patients with symptomatic systolic heart failure was associated with similar rates of cardiovas-cular and all-cause mortality in patients with ischemic heart disease, and in patients with heart failure from other causes. NICMP and ICMP showed comparable rates of recurrent ventricular tachyarrhythmias and appropriate ICD therapies.

Background: Misconceptions and knowledge gaps about antibiotic use contribute to inappropriate antibiotic use and antimicrobial resistance. Aim: Identifying and prioritizing misconceptions and knowledge gaps about antibiotic use from a healthcare professionals’ perspective. Methods: A modified Delphi study of two rounds with an expert meeting. A literature search was conducted to create statements about misconceptions and knowledge gaps about antibiotic use. These were rated by healthcare professionals from five EU countries representing general practice, out-of-hour services, nursing homes, and pharmacies. Consensus was achieved if ≥80% of the participants rated 4+ on a five-point Likert scale during the second Delphi round. Results. In total, 44 misconceptions were identified through the literature search within four themes: 1) antimicrobial resistance in general, 2) use of antibiotics in general, 3) use of antibiotics for respiratory tract infections, and 4) use of antibiotics for urinary tract infections. Consensus was reached for more than half of the statements within each setting. Conclusions. Experts from different settings and nationalities acknowledge that multiple misconceptions and knowledge gaps can contribute to inappropriate use of antibiotics in the community. These results provide valuable information to use in educational campaigns for patients and healthcare professionals to improve the use of antibiotics.

Confined masonry (CM) is a construction system which consists of masonry wall panels enclosed by vertical and horizontal reinforced concrete confining elements. The presence of these confining elements distinguishes CM from unreinforced masonry system and makes this technology suitable for construction of structures in regions subjected to intense seismic or wind actions. CM construction has been used in many countries and regions, and has performed well in past earthquakes. The purpose of the paper is to review past research studies related to the seismic in-plane and out-of-plane behaviour of CM structures. The authors have identified the key design and construction parameters which were considered in past research studies and have performed statistical analyses to establish their influence on the seismic performance of CM buildings. For the purpose of this study the authors have compiled databases of previous experimental studies on CM wall specimens which were used for statistical analyses. Finally, the paper discusses research gaps and needs for future research studies which would contribute to the understanding of seismic behaviour and failure mechanisms of CM walls.

Keywords: Post-Stroke; Hyperbaric oxygen therapy; Sequelae; Feasibility; Out-patient.

Auto checkout has received more and more attention in recent years and this system automatically generates a shopping bill by identifying the picture of the products purchased by the customers. However, the system is challenged by the domain adaptation problem, where each image of the training set contains only one commodity, whereas the test set is a collection of multiple commodities. The existing solution to this problem is to resynthesize the training images to enhance the training set. Then the composite images are rendered using CycleGAN to make the image distribution of the training set and the test set more similar. However, we find that the detection boxes given by the ground truth of the common dataset contain a large part of the background area, the area will affect the training process as noise. To solve this problem, we propose a mask data priming method. Specifically, we redo the large scale Retail Product Checkout (RPC) dataset and add segmentation annotation information to each item in the training set image based on the original dataset using pixel-level annotation. Secondly, a new network structure is proposed in which we train the network using joint learning of detectors and counters, and fine-tune the detection network by filtering out suitable images from the test set. Experiments on the RPC dataset have shown that our method yields better results. we used an approach that reached 81.87% compared to 56.68% for the baseline approach which demonstrates that pixel-level information helps to improve the detection results of the network.

In this work, the apparent shear strength at the interface between a bamboo fiber and the surrounding poly(lactic acid) (PLA) matrix is quantified. A method for processing pull-out test samples within a controlled embedded length is proposed and the details of the test procedure are presented, along with a critical discussion of the results. Two series of samples are considered: untreated and mercerized bamboo fibers from the same batch, embedded in the same polyester matrix. Electron and optical microscopy are used to observe the fiber-matrix interface before and after the test, and to identify the failure mode of each sample, especially as regards the occurrence of fibrillation in the fiber bundles. The values of apparent interfacial shear strength are calculated only for regular fibers successfully pulled out from the matrix, and reported with their statistical variations. Mercerization, whose efficiency was proven by Fourier Transform InfraRed (FTIR) spectroscopy, did not appear though to improve the quality of the interface (τ_app = 7.0 ± 3.1 MPa for untreated fibers and τ_app = 5.3 ± 2.4 MPa for treated fibers).

Background: Trans-septal endocardial left ventricle lead placement is an alternative technique used capture the left ventricular endocardially but it is use is limited due lack of evidence, practice uptake and clinical trials. we evaluated the efficiency of the procedure, post procedural complication rate, rate of thromboembolic events as well as changes in echocardiographic parameters, brain natriuretic peptide (BNP) level and the New York Heart Association (NYHA) class. Results: TSLV lead implant is safe, improves ejection fraction, LVEDV, LVESV, LVIDd. Significantly reduces NTproBNP levels and NYHA class. Stroke rate was reported only in one patient (9%), noticeably, this particular patient was on DOAC rather than anti-vitamin K antagonists. In this group, patients, who were on Warfarin , were not reported to have any thrombo-embolic events. Discussion: Trans-septal endocardial LV lead implant in patients with a failed CS approach remains a viable alternative however, there is a higher risk of stroke amongst these patients, as well as more procedure related risk of complications compared to conventional CRT. The data analysis demonstrates that patients undergoing a TSLV lead implant due to a failed trans-venous approach have more advanced heart failure, defined by their higher NYHA class compared to conventional trans-venous CRT implant groups. Their pre TSLV implant, echocardiographic parameters are also worse compared to trans-venous CRT implant group

This study delves into hospital mobility, understood as an indicator of perceived service quality, across the Italian regions of Apulia and Emilia Romagna, utilizing logistic regression among machine learning techniques. The focus is on how structural, operational, and clinical variables impact patient perceptions of service quality, influencing their healthcare choices. Through the analysis of mobility trends with machine learning, significant differences between regions were uncovered, highlighting the influence of regional context on perceived quality. The integration of SHAP (SHapley Additive exPlanations) values into our analysis provided deeper insights into the logistic regression model, elucidating the specific contribution of each variable to perceived healthcare quality. This incorporation of SHAP values underscores the study's commitment to employing advanced, explainable AI techniques to enhance the interpretability and fairness of healthcare service evaluations. The choice of logistic regression elucidated the impact of specific variables on quality perception, offering essential insights for optimizing healthcare resource distribution and underscoring the importance of data-driven strategies to foster more equitable, efficient, and patient-centred healthcare systems. Contributing to the understanding of perceived quality dynamics within the healthcare context, the research paves the way for further investigations into enhancing accessibility and service quality, leveraging machine learning as a tool for improving healthcare services efficiency in diverse regional settings.

Coronavirus disease-19 (COVID-19) has disproportionately affected certain demographics in England, exacerbating existing health disparities. Effective therapeutics are a critical line of defence against COVID-19, particularly for patients at elevated risk for severe disease. Surveillance systems were established to monitor usage of COVID-19 therapeutics in hospital and community settings and inform stewardship. Three antiviral therapies: nirmatrelvir plus ritonavir (Paxlovid®), remdesivir (Veklury®), and molnupiravir (Lagevrio®); and two neutralising monoclonal antibody therapies (nMAbs): sotrovimab (Xevudy®) and casirivimab with imdevimab (Ronapreve®); were in use in England between July 2020 to April 2023. This paper aims to illuminate trends in the utilisation of COVID-19 therapeutics treatment in both hospital and community settings, stratified by the Index of Multiple Deprivation (IMD) in England. Chapter 3 of the English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR) report 2022 to 2023 also discusses the epidemiological surveillance of these five directly-acting antiviral COVID-19 therapeutics use in England between 2022 to 2023.

(1) Background: As part of the Scottish Governments five-year recovery plan to address the backlog in NHS care following the COVID-19 pandemic, community pharmacies in Scotland are planned to provide a Hospital Discharge Medicines Supply and Medicines Reconciliation Service. We aimed to qualitatively explore patients’ experience of this new service; (2) Method: Adult patients (≥18yrs age) who consented to participate in the Community Pharmacy Hospital Dis-charge and Medicines Reconciliation Service were invited for interview within 21 days of dis-charge from hospital. Qualitative, one-to-one, semi-structured, patient interviews were conducted by telephone and audio-recorded using Microsoft Teams®. The interview audio recordings were transcribed verbatim and underwent thematic analysis; (3) Results: 12 patients were inter-viewed, evenly split by sex and with a median age of 62 years (range; 36 to 88 years). Analysis generated main five themes; Patient Engagement, Stakeholder Communication, Practical Factors, Human Factors, and Comparative Experiences. Many of these were interdependent; (4) Con-clusions: Patients appreciated that the service ensured a quicker discharge from hospital. Good stakeholder communication, practical factors (including choice, location, and the realities of ob-taining their medication from the community pharmacy), and a pre-existing and trusted rela-tionship in their usual community pharmacy were the key factors that regulated the patient ex-perience. In the main, patients were positive about the introduction of this new service. However, a lack of previous relationship or trust with a community pharmacy, and previous experiences with medication supply problems were factors which had the potential to negatively impact on patient experiences.

Public health is an important aspect of community activities, making research on health necessary because it is a crucial field in maintaining and improving the quality of life in society as a whole. Research in public health allows for a deeper understanding of the health problems faced by a population, including disease prevalence, risk factors and other determinants of health. This work aims to explore the potential of hospital patient data analysis as a valuable tool for understanding community implications and deriving insights for effective community health interventions. The study recognises the significance of harnessing the vast amount of data generated within hospital settings to inform population-level health strategies. The methodology employed in this study involves the collection and analysis of deidentified patient data from a representative sample of a hospital in Indonesia. Various data analysis techniques, such as statistical modelling, data mining and machine learning algorithms, are utilised to identify patterns, trends and associations within the data. A program written in Python is used to analyse patient data in a hospital for five years from 2018 to 2022. These findings are then interpreted within the context of public health implications, considering factors such as disease prevalence, socioeconomic determinants and healthcare utilisation patterns. The results of the data analysis provide valuable insights into the public health implications of hospital patient data. The research also covers prediction for the patient data to the hospital based on disease, age and geographical residence. The research prediction shows that in 2023, the number of patients was not considerably affected, but in in March to April 2024, the number significantly increased to 10,000 patients. These recommendations encompass targeted prevention strategies, improved healthcare delivery models and community engagement initiatives. The research emphasises the importance of collaboration between healthcare providers, policymakers and community stakeholders in implementing and evaluating these interventions.

The study aims to evaluate the rate of readmission in patients affected by diabetic foot ulcers (DFUs), causes and the outcomes of patients requiring a new hospitalization. This study is a retrospective observational study including consecutive patients requiring hospitalization since January 2019 to September 2022 due to a DFU. Once they were discharged, patients were regularly followed as outpatients. After 6 months of follow-up, the rate of hospital readmission for a diabetic foot problem was recorded. According to the readmission or not, patients were divided in two groups, readmitted and not readmitted patients respectively. Hence, all patients were followed for six months more and outcomes for the two groups were analyzed and compared. The mean age was 6812yrs, with a prevalence of male (72.6%); the majority of patients were affected by type 2 diabetes (>90%) with a mean diabetes duration of approximately 20yrs. After 6 months of follow-up, 68 (21.9%) patients were readmitted. The main reason of hospital readmission were the presence of critical limb ischaemia (CLI) in the contralateral limb (6.1%), the recurrence of CLI in the previous treated limb (4.5%) and the onset of new infected DFU in the contralateral foot (4.5%). Readmitted patients reported lower rate of healing (51.5vs89.2%,p<0.0001) and higher rate of major amputation (10.3vs4.5%,p=0.04) in comparison to not readmitted patients. CLI and dialysis resulted independent predictors of hospital readmission. Hospital readmission is frequent issue among patients with DFUs, increasing the risk of non-healing and major amputation. CLI resulted the main cause of new hospitalization.

Aims: Primary AIM of the study was to evaluate effect of prolonged hospital stay on Surgical site infections We also evaluated effect of prolonged hospital stay on overall morbidity in Gastrointestinal and Hepatobiliary Surgery as secondary outcome. Methods: We retrospectively analysed all the patients who underwent gastrointestinal and hepatobiliary surgery between April 2017 to March 2020. On our analysis we found mean hospital stay in patient who did not develop SSI and/or morbidity was 4 days (Total hospital stay) vs 6 days who developed morbidity (hospital stay before diagnosis of SSI or diagnosis or morbid event). Based on this to avoid selection bias, we did 1:1 propensity score analysis between patients who had 4 or less than hospital stay vs patients who had 5 or more hospital stay before diagnosis of surgical site infection and/or morbid event. We took all the preoperative and intraoperative factors like Age, sex, malignant disease, ASA score, CDC grade of surgery, open or laparoscopic surgery, HPB surgeries, colorectal surgeries, Upper Gastrointestinal surgeries and small intestinal surgeries as covariates. We used nearest neighbor matching protocol with a calipher of 0.2. Cases were not reusable after matching. Statistical analysis was done using SPSS version 23. Results: We included 348 patients operated between April 2017 and March 2020 in our analysis. After 1:1 propensity score matching 58 patients included in study arm (prevent hospital stay more than 4 days) and 56 patients in control arm. Both groups were comparable with regard to Age, Sex, Surgery for malignant disease, ASA score, CDC grade of surgery, HPB surgeries, Small intestinal surgeries, Colorectal surgeries, upper gastrointestinal surgeries, intraoperative blood product requirement, intraoperative hypotension or any other event, operative time. Prolonged hospital stay (> 4 days) was significantly associated with surgical site infections (p<0.0001), morbidity (p=0.001). Open surgeries were associated with prolonged hospital stay. (p=0.032). Conclusion: Prolonged Hospital stay is associated with increase surgical site infection and morbidity in Gastrointestinal and Hepatobiliary Surgery.

While obesity is recognized as a key global public health issue, there has been no research to date on the perceptions of care for people with this condition held by individuals in positions of organizational power. The aim of this study was therefore to describe the perceptions and experiences of clinical leaders and managers of providing care to inpatients with obesity at a metropolitan public health service. This study applied an interpretative phenomenological analysis (IPA) approach to qualitative research, conducting interviews with 17 participants. Their perceptions of care for inpatients with obesity encompassed both their personal understanding as an individual, and their observations about the organizational, patient and carer perspectives. Three overall themes were identified: 1) The problem of inpatients with obesity, 2) Inpatients with obesity as sources of risk and 3) Personal and professional perceptions of inpatients with obesity. While clinical leaders and managers were aware of potential impact of stigma and weight bias on the care given to this cohort, elements of implicit bias, stereotyping, ‘othering’ and ambivalence were frequently present in the data. Ongoing efforts to improve care for patients with obesity must therefore include efforts to address perceptions and attitudes at all organisational levels of the workforce.

In this four-month-long study (from April 1, 2020 to August 1, 2020), we have collected, modeled, and analyzed COVID-19 data from the top five most infected counties per top six most infected states in the United States (30 counties total). More specifically, we collected data on each state’s total COVID-19 cases, deaths, tests conducted, and their counties’ population, density, percentage of seniors, number of hospitals, total COVID-19 cases, and total COVID-19 related deaths. In this study, we have models illustrating the growth of COVID-19 cases and deaths per county, growth of COVID-19 cases and deaths per state (which is really the sum of our chosen five counties), and growth of COVID-19 tests conducted per state. In addition, our study also contains models illustrating the statistics of several variables that might have affected a county’s COVID-19 data, which has been mentioned above: population, density, percentage of seniors, and number of hospitals. An interesting finding we have noticed upon modeling the 30 counties’ density and total COVID-19 cases as an xy scatter plot is that there is a considerably strong relationship between the two variables. Los Angeles County (which was an extreme outlier), in particular, supports the idea that a county’s most populous city can greatly affect its entire county’s COVID-19 cases; if the largest city is extremely dense, it appears that the entire county has a greater total COVID-19 case count.

Background: Chronic lower limb ulcers (CLLU) have an important burden to the individual and the healthcare system. However, there is a lack of information about the cost of CLLU in Argentina.Objective: To determinate the number and cost of consultation and hospitalization associated to CLLU in a public hospital in Argentina. Methods: Retrospective observational study. Cost estimation were calculated based on days of stay, treatments and laboratory tests in a inpatient population and the number of consultations, treatments and laboratory tests, in a outpatient population. Results: In 2013 and 2014, the overall number of consultation with ICD-10 codes was 7,224 and the number of inpatient was 359. The mean age for male and female outpatient consultations was 59.53(±13.06) years and 59.04(±10.93), respectively. For CLLU male and female inpatient, the mean age was 63.9(±10.4) years and 54.5(±8.6) years, respectively. The length of stay was 22.88 days. There was a mean of 0.41 surgeries per patient where 25% were amputations. The mean annual cost in a single public hospital was US$4,053.65 per inpatient and US$3,589.24 per outpatient. Conclusion: Cost information allows new public health policies to reduce socioeconomic burden due to CLLU.

An understanding of the cultural conditions that determine the factors affecting nurses’ intention to leave is important for countries suffering from nurse shortage. Aim: to examine factors influencing intention to leave among female hospital nurses in a large Japanese sample, classified into four generations by age considering economic conditions. Methods: a cross-sectional survey with convenience sampling was conducted. Anonymous self-administered questionnaires were distributed to all nurses in 30 hospitals. To assess intention to leave, basic attributes, life conditions, work characteristics, and factors of psychosocial work environment were addressed. After classifying data into four generations based on age cohorts, we conducted multivariate logistic regression analysis using the completed data (N = 5,074, mean age = 36.24). Results: regardless of generational characteristics influenced by economic conditions, effort and monetary reward were generation-common factors. Over-commitment, social support, and the presence of a role model were generation-common factors in three generations. While having children increased intention to leave in the generation born 1965–1979, having family members in need of caregiving other than children decreased the risk in the generation born in the 1980s. Conclusion: generational countermeasures considering factors of psychosocial work environment and life conditions are needed to avert female nurse turnover.

We consider the maximum entropy Markov chain inference approach to characterize the collective statistics of neuronal spike trains, focusing on the statistical properties of the inferred model. We review large deviations techniques useful in this context to describe properties of accuracy and convergence in terms of sampling size. We use these results to study the statistical fluctuation of correlations, distinguishability and irreversibility of maximum entropy Markov chains. We illustrate these applications using simple examples where the large deviation rate function is explicitly obtained for maximum entropy models of relevance in this field.

In this work, we focus on investigating electrothermal flow in a rotating electric field (ROT-ETF), with primary attention paid to the horizontal traveling-wave electrothermal (TWET) vortex induced at the center of the electric field. The frequency-dependent flow profiles in the microdevice are analyzed using different heat transfer models. Accordingly, we address in particular the importance of electrode cooling in ROT-ETF as metal electrodes of high thermal conductivity while substrate material of low heat dissipation capability are employed to develop such microfluidic chips. Under this circumstance, cooling of electrode array due to external natural convection on millimeter-scale electrode pads for external wire connection occurs and makes the internal temperature maxima shift from the electrode plane to a bit of distance right above the cross-shaped interelectrode gaps, giving rise to reversal of flow rotation from a typical repulsion-type to attraction-type induction vortex, which is in good accordance with our experimental observations of co-field TWET streaming at frequencies on the order of reciprocal charge relaxation time of the bulk fluid. These results point out a way to make a correct interpretation of out-of-phase electrothermal streaming behavior, which holds great potential for handing high-conductivity analytes in modern microfluidic systems.

The EU has planned the phase-out of new vehicles based on internal combustion engines in favour of high efficiency electric cars by 2035 (Fit for 55 package). However, many doubts remain about the effectiveness of this choice for each Country of the Union in terms of CO2 emissions reduction, as each State is characterized by a different carbon intensity related to the production of electricity needed to manufacture and recharge vehicles. This study seeks to explore the Italian case. To this aim, carbon intensities related to the electricity production were calculated considering both the Italian electricity mix production at 2021 and those at 2035, envisaged considering two scenarios based on different introductions of renewable sources (RES). Afterwards, the values obtained were adopted for determining the CO2 emissions related to the whole production process of battery systems in Italy (emissions from mining and refining, scrap materials and final assembly included) by comparing some of the most up-to-date Life-Cycle Assessment (LCA) analysis related to the manufacturing cycle of the batteries. Finally, the results were adopted to calculate the starting carbon debit for A, B, C and M car segments for Mild Hybrid, Full Hybrid and Full Electric powertrains. At the same time, statistical road fuel/electricity consumption data were collected and overall CO2 emissions were calculated for the same vehicles for a defined mileage, so to determine break-even points with respect to the cumulative (i.e., from battery and road) carbon emissions. The results showed that advantages related to electric vehicles are significant only if a low carbon intensity related to electricity production is reached by means of a very high introduction of RES, thus keeping the door open for innovative powertrain technologies (plug-in), if fed with low carbon fuels.

The switching game Lights Out and its variants were studied extensively as recreational mathematics problems. The game board of the ordinary Lights Out is a rectangular grid of lights, where each light is either on or off. By clicking a light, the clicked light and its adjacent rectilinear neighbors are toggled. Given an arbitrary initial configuration of lights, the final mission is to “solve” this game by switching off all the lights. Most studies on Lights Out and its variants focused on the solvability of given games or the number of solvable games, but when the game is viewed in a coding-theoretical perspective, more interesting questions with special meanings in coding theory will naturally pop up, such as finding the minimal number of lit lights among all solvable games except the solved game, or finding the minimal number of lit lights that the player can achieve from a given unsolvable game, etc. However, these problems are usually hard to be solved in general in terms of algorithmic complexity. This study considers a natural extension of the Lights Out game, which enlarges the toggle pattern in a way that all the lights in the same row and those in the same column of the clicked light are toggled. This variant of Lights Out is a two-state version of a switching game called Alien Tiles. In this paper, we investigate the properties of the two-state Alien Tiles, and discuss several coding-theoretical problems about this game. Then, we apply this game as an error correction code and investigate its optimality. We also give a brief overview on algorithmic complexity and coding theory for readers who are not familiar with these topics. The purpose of this paper is to propose ways of playing switching games in a think-outside-the-box manner, which benefit the recreational mathematics community.

An analysis of the performance of Automatic Dependent Surveillance-Broadcast (ADS-B) data received from the Grand Forks, North Dakota International Airport was carried out in this study. The purpose was to understand the vulnerabilities of Universal Access Transceiver (UAT) ADS-B system and recognize the effects on present and future Air Traffic Control (ATC) operation. The Federal Aviation Administration (FAA) mandated all the General Aviation aircraft to be equipped with ADS-B. The aircraft flying within United States and below the transition altitude (18,000 feet) are more likely to install an UAT ADS-B. At present unmanned aircraft systems (UAS) and autonomous air traffic control (ATC) towers are being integrated into the aviation industry and UAT ADS-B is a basic sensor for both class 1 and class 2 Detect and Avoid (DAA) systems. As a fundamental component of future surveillance system, the anomalies and vulnerabilities of ADS-B system need to be identified to enable a fully utilized airspace with enhanced situational awareness. The data received was archived in GDL-90 format, which was parsed into readable data. The anomaly detection of ADS-B messages was based on the FAA ADS-B performance assessment report. The data investigation revealed ADS-B message suffered from different anomalies including drop out; missing payload; data jump; low confident data and altitude discrepancy. Among those studied, the most severe was drop out and 32.49% of messages suffered from this anomaly. Dropout is an incident where ADS-B failed to update within a specified rate. Considering the potential danger being imposed, an in-depth analysis was carried out to characterize message dropout. Three flight parameters were selected to investigate their effect on drop out. Statistical analysis was carried out and Friedman Statistical Test identified that altitude affected drop out more than any other flight parameters.

This work analyzes the severity and risk associated with Automatic Dependent Surveillance-Broadcast (ADS-B) message drop out in Detect and Avoid (DAA) function of Unmanned Aircraft System (UAS). Performance assessment of the Universal Access Transceiver (UAT) ADS-B message implies that in some cases ADS-B fails to update within a specified update interval, which is referred to as drop out in this work. ADS-B is a fundamental surveillance sensor for both class 1 and class 2 DAA systems. Message loss or drop out has been found as one of the common limitations of the ADS-B system. The key feature of this study is incorporating the update rate of real ADS-B data transmitted from the manned aircraft. The data were received from the Grand Forks International Airport, North Dakota. Monte Carlo method has been adopted to resolve encounter scenarios in the presence of drop out. The change in the alert triggered by the UAS DAA in the presence of ADS-B drop out has been investigated. Furthermore, the risk matrices are created to quantify the associated risk with drop out affected alerts. Simulation results depict that both the duration of drop out and DAA look-ahead time affect the alert-triggering function of UAS. With a small look- ahead window and longer duration of drop out, the number of warning alerts increases. Also, alerts are affected more during an overtaking encounter than that of a head-to-head encounter. A system-level analysis is also carried out to recognize the potential reasons behind the ADS-B drop out.

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.

Background: Hospital-acquired infections (HAI) pose a significant danger to global public health, mainly because their numbers are growing exponentially each year. Additionally, the rise of bacterial strains resistant to current treatment options further exacerbates this threat. The study aimed to examine the occurrences of HAIs identified in public hospitals at the county level. Methods: We conducted a cross-sectional study utilizing data provided to the Mures Public Health Directorate from all the public hospitals within this county. We examined HAIs reported during the period spanning from 2017 to 2021, which amounted to a total of 4603 cases. Results: The medical departments reported the highest prevalence of HAIs at 48.25%. The most common infections in-cluded enterocolitis with Clostridioides difficile (32.61%), COVID-19 (19.83%), bronchopneumonia (16.90%), sepsis, surgical wound infections, and urinary tract infections. The five most frequently identified pathogens were Clostridioides difficile (32.61%), SARS-CoV-2 (19.83%), Acinetobacter baumannii (11.82%), Klebsiella pneumoniae (9.58%), and Pseudomonas aeruginosa (7.95%). Acinetobacter baumannii was the predominant agent causing bronchopneumonia, while Klebsiella pneumoniae was the leading cause of sepsis cases. Escherichia coli was the primary agent behind urinary tract infec-tions, and Staphylococcus aureus MRSA was identified as the main etiology for wound infections and central catheter infections. Throughout the study period, there was a significant rise in Clostridioides difficile cases, accounting for 40.36% of all reported HAIs in 2021. Conclusions: The study identifies Clostridioides difficile increase in HAI cases during COVID-19, highlighting the need for careful antibiotic use, and emphasizing the growing challenge of multi-resistant strains in post-pandemic state hospitals.

The violence against women is a theme that extrapolates health issues, since after a victim seek for a health care, there is the notification of the act [1]. In Brazil, many times, these women are first assisted by mobile urgency services (SAMU/SIATE) and, as far as we have concern, there are no other studies with specific data about these assistance. The present paper aimed to analyze SAMU/SIATE assistance to abused women. Qualitative and retrospective epidemiological study of assistance to assaulted women carried out by SIATE and SAMU Maringá/Norte Novo between 2011 and 2020. Women between 20 and 39 years old, non-pregnant, were the main victims, and 19,52% of them have used some kind of drug. The (ex)partner figured as the perpetrator in 17,35%, but there were no information about this variable in 73,75% of the records. The Qui-square test shows a mortality rate superior to 70% among the severe traumatized victims. This is one of the first studies to analyze this kind of care provided by SAMU/SIATE, and reveals some gaps in its “modus-operandi” that can limitate an extrapolation of the results to bigger spheres. More researches in mobile urgency care services, in other provinces also, are needed to propose strategies to fight against this epidemic.

Overcrowding in the emergency department is a problem that generates several implications for bed management, which is deemed one of a hospital's most critical processes. Effective management of hospital production capacity includes bed management processes, which can be improved in order to leverage hospital performance. Thus, this study sought to understand how bed management works and identify the main factors that influence its management. The study was performed through a case study, with data collected from semi-structured interviews and bibliographic research, which were triangulated. Thematic content analysis of the interviews and cross-analysis were performed. As a result, the main factors that influence hospital Bed management were identified: communication between teams and units; definition of performance goals; decisions shared between units; occupation and discharge planning by the teams; length of stay; the role of the nurses; and COVID-19. The greatest difficulties in the management process are related to these factors. Additionally, suggestions are provided to mitigate such reported difficulties.

Patients satisfaction with fast and high-quality services is the most important in the healthcare settings and specially in outpatient departments and private clinics. High quality services on health sector are indicated by continuous quality improvement (CQI). CQI is a progressive incremental process focused on safety of all participants, outcomes, systematic process, regulated and improved working environment at the later than earlier stages. Among the various suggested strategies, we adopted the patents feedback to improve the quality of services our clinic. All of the patient visited hospital were sent a massage on mobile and requested to provide their feedback on our services. Roughly around 5% of all visitors responded and filled up questionnaire. Majority of them were satisfied with the services in various department. However, they provided us some suggestions to identify the further gaps and improve the services in improving patients experience at our clinic. We considered their feedback, identified problems, redesigned the policies and implemented. After implementation of new strategies, we preliminary again evaluated the patients’ feedback on our services. Patients feedback explores that optimized methods of services for the has considerably increased the patients’ satisfaction. Taken together, our this shows that patients’ feedback is very important factor to improve patients’ experience at outpatient clinics using continuous quality improvement tools. For that reason, this study would serve as reference for public health stack holders, administrators and researchers.

Background: Anaemia in pregnancy have been a cause of serious concern and burden as it contributes significantly to high maternal mortality worldwide. This study aims to explore how big the burden of anaemia in pregnant women is, how it can be reduced during antenatal clinic in order to minimize risks and complications of anaemia among pregnant women. Method: An analytical cross-sectional study design used, involved 560 pregnant women attending antenatal clinic at three regional referral hospitals in Dar es Salaam region, Tanzania, from January to June 2022. Those willing to participate and met inclusion criteria were included in the study. Data was collected by interview through a structured questionnaire. Analysis of data was done using SPSS v25.0, (p<0.001) considered statistical significant. Results: A total of 560 pregnant women were interviewed. The prevalence of anaemia in pregnancy is high about 70.9% whereby 61.2% participants had mild anaemia, 33.2% participants had moderate anaemia and 25.6% participants had severe anaemia. Significant associations were found between age, education level, marital status, Less ANC attendance (<3 visit), lack of health insurance and lack of employment among pregnant women. Conclusion: Prevalence of anaemia in pregnancy women is still high and its predictors highly affect its control. Hence the ministry of health in collaboration with other stakeholders should develop policies, educating community on the importance of antenatal visit for early detection and treatment of anaemia and impacting knowledge to medical personnel in management of anaemia in pregnancy and associated complications in order to decrease maternal mortality rate.

Background: Malnutrition has negative consequences in hospitals, like poor disease recovery, increased mortality, length of hospitalization, readmission, and health care costs.Aims: This review was designed to determine malnutrition prevalence in hospitals located in eastern Mediterranean region (EMR).Study design: To conduct this systematic review, papers, including original articles, related references and conference proceedings on the prevalence of malnutrition in adult hospitalized patients published in international journals and scientific databases from 1 Jan 2017 to 31 Jan 2022 will be included. The following keywords and their alternatives will be used in the literature search: malnutrition, patient, and EMR. The protocol has been registered at PROSPERO (code: CRD42022339426).Methods: After initial screening based on inclusion and exclusion criteria, the full text articles will be read carefully and eligible documents will be selected according to the defined objectives. Afterward, the selected papers will be reviewed for methodological quality and the required information will be extracted. Finally, in case of sufficient data, a meta-analysis will be performed. Screening, selection, quality assessment, and data extraction will be done by at least two independent reviewers.Results: This review is ongoing and will be completed until the end of year 2023.Conclusion: This review aims to provide comprehensive evidence about the prevalence of malnutrition among adult inpatients in EMR hospitals. This can provide regional authorities, health managers and policy makers good information regarding current status to make appropriate decisions for promoting the health status in hospitals.

Chronic obstructive pulmonary disease (COPD) is a multifactorial lung inflammatory disease affecting 174 million people worldwide, with a recently reported increased incidence in female patients. Patients with COPD are especially vulnerable to the detrimental effects of environmental exposures, especially from air particulate and gaseous pollutants. Exposure to air pollution severely influences COPD outcomes, resulting in acute exacerbations, hospitalizations, and death. In the current study, we conducted a review of the literature addressing air pollution induced acute exacerbations of COPD (AECOPD) in order to determine whether air pollution affects COPD patients in a sex-specific manner. We found that while the majority of studies enrolled both male and female patients, only a few reported results disaggregated by sex. Most studies had a higher enrollment of male patients, only four compared AECOPD outcomes between sexes, and only one study identified sex differences in AECOPD, with females displaying higher rates. Overall, our analysis of the literature confirmed that air pollution exposure is a trigger for AECOPD hospitalizations and revealed a significant gap in our knowledge of sex-specific effects of air pollutants on COPD outcomes, highlighting the need for more studies considering sex as a biological variable.

Sink waste traps and drains are a reservoir for multi-drug resistant Gram-negative bacteria in the hospital environment. It has been suggested that these bacteria can migrate through hospital plumbing. Hospital waste traps were installed in a laboratory model system where sinks were connected through a common wastewater pipe. Enterobacterales populations were monitored using selective culture, MALDI-TOF identification and antibiotic resistance profiling before and after a wastewater backflow event. When transfer between sinks was suspected, isolates were compared using whole-genome sequencing. Immediately after the wastewater backflow, two KPC-producing Enterobacter cloacae were recovered from a waste trap in which Carbapenemase-producing Enterobacterales (CPE) had not been detected previously. The isolates belonged to ST501 and ST31 and were genetically indistinguishable to those colonising sinks elsewhere in the system. Following inter-sink transfer, KPC-producing E. cloacae ST501 successfully integrated into the microbiome of the recipient sink and was detected in the waste trap water at least six months after the backflow event. Seven weeks and three months after the backflow, other inter-sink transfers involving Escherichia coli ST5295 and KPC-producing E. cloacae ST501 were also observed.

One of the special trends in health care is the increasing availability of data and services to the cloud, especially for convenience (for example, providing a complete patient medical record without interruption) and savings (for example, economic issues). Management of health care data). However, there are limitations to using common cryptographic prototypes and access control models to address security and privacy concerns in an increasingly cloudy environment. In this paper, we explore the potential and capacity of using China's Blockchain technology to protect health care data hosted in the cloud. We also explain the real challenges of such an approach and further research is needed. Health care is a highly data-dependent domain, with large amounts of data being created, published, stored and accessed daily. For example, data are created when a patient undergoes a number of examinations (such as computed tomography or computed tomography scans) and the data need to be sent to the radiologist and then to a physician. The visit results are then stored in the hospital, and then need to be accessed later by another physician at another hospital within the network. It is clear that technology can play an important role in improving the quality of care for patients (for example, using data analytics to make informed medical decisions) and potentially costing more by allocating resources more efficiently in terms of personnel, equipment, etc. , Reduce. For example, paper-based data extraction is difficult to extract into systems (for example, it is costly and may involve data entry errors), archiving them and accessing them as needed is costly. These challenges may cause medical decisions to be incomplete, requiring repeated tests for missing information or missing data stored in another hospital in another state or country (at the expense of increased costs and no convenience). (For patients) and so on. Because of the nature of the industry, it is important to ensure the security, privacy and integrity of health care data. As a result, there is definitely a need for a secure and secure data management system.

Watching the international COVID-19 epidemics unfold during February and early March 2020, we began to highlight how outbreaks in care homes were inevitable, given the vulnerable patients in close proximity, and pressures on social care to help relieve pressure on the NHS. We suggested public health measures would significantly impact on care homes. Specifically we felt all homes would have multiple individuals isolated within days of introduction of guidance requiring isolation of new cough (or fever), and that a clear definition of an outbreak would be needed that differentiated COVID19 from influenza. We share the experiences of a GP practice looking after 900 nursing or dual registration care homes in the London Borough of Ealing in the early stages of the COVID19 Pandemic 2020. We believe that the altered presentation of cases of COVID19 in care homes contributed to the size of outbreaks, and that keeping COVID19 out of homes is the only way to manage this disease, with early isolation and complete segregation of positive and negative cases. We have seen over 300 suspected cases resulting in four fold (n=175) average monthly death rates, three fold usual issue of anticipatory medications, and approximately 32% mortality rate (up to 43% in over 90’s). Discharge pathways from hospital and admissions to care homes must be clear and robust. COVID19 naïve patients should not be admitted to units with outbreaks and COVID19 positive patients should not be admitted to anything other than a designated “hot” home until risk of contagion is passed. Some patients are testing positive at over 30 days since initial mild symptoms.

Introduction: The attitudes of doctors and nurses toward patient safety is a significant factor in hospital safety climates and medical error rates. Yet, there are very few studies of patient safety attitudes in Saudi hospitals and none conducted in hospital emergency departments. Aims: The current study aims to investigate the discrepancy between the patient safety attitudes of doctors and nurses in a Saudi hospital emergency department. Materials and Method: The study employed a qualitative research designvia semi-structured interviews with Saudi and non-Saudi doctors and nurses working in a Saudi hospital emergency department to determine their attitudes and experiences about the patient safety climate. Results: The findings showed doctors and nurse held some similar safety attitudes, however, nurses reported issues with doctors with respect to their teamwork, communication, and patient safety attitudes. Moreover, several barriers to the patient safety climate were identified such as limits to resources, teamwork, communication, and incident reporting. Conclusion: The findings provide one of the few research contributions to knowledge on the differential patient safety attitudes of Saudi and non-Saudi doctors and nurses and suggest the application of such knowledge would enhance positive patient outcomes in emergency departments.

Objective. To describe patient satisfaction with pre-hospital emergency knowledge and determine if patients and professionals share a common vision on the satisfaction predictors. Methods. A qualitative study conducted in two phases. First, a systematic review following the PRISMA protocol was carried out searching publications between January 2000 and July 2016 in Medline, Scopus, and Cochrane. Second, three focus groups involving professionals (advisers and healthcare providers) and a total of 79 semi-structured interviews involving patients were conducted to obtain information about what dimensions of care were a priority for patients. Results. Thirty-three relevant studies were identified. A majority conducted in Europe using questionnaires. They pointed out a very high level of satisfaction of callers and patients. Delay with the assistance and the ability for resolution of the case are the elements that overlap in fostering satisfaction. The published studies neither reviewed the overall care process nor related the measurement of the real time in responding to an emergency with the satisfaction. The patients and professionals concurred in their assessments about the most relevant elements for patient satisfaction, although safety was not a predictive factor for patients. Response capacity and perceived capacity for resolving the situation were crucial factors for satisfaction. This qualitative approach yielded assistance targets to be improved. Conclusions. Published studies have assessed similar dimensions of satisfaction. Furthermore, despite the fact that few explanations may be given due to the no face to face attention, taking into account the patient’s emotional needs or maintaining contact with the patient until the emergency services arrive are high predictors of the satisfaction.

One of the most rapidly advancing areas of deep learning research aims at creating models that learn to disentangle the latent factors of variation from a data distribution. However, modeling joint probability mass functions is usually prohibitive, which motivates the use of conditional models assuming that some information is given as input. In the domain of numerical cognition, deep learning architectures have successfully demonstrated that approximate numerosity representations can emerge in multi-layer networks that build latent representations of a set of images with a varying number of items. However, existing models have focused on tasks requiring to conditionally estimate numerosity information from a given image. Here we focus on a set of much more challenging tasks, which require to conditionally generate synthetic images containing a given number of items. We show that attention-based architectures operating at the pixel level can learn to produce well-formed images approximately containing a specific number of items, even when the target numerosity was not present in the training distribution.

Background: The manifestations, severity, and mortality of COVID-19 are considered to be associated with the changes in various hematological parameters and in immunity. Associations of immunoglobulin G antibodies against severe acute respiratory syndrome-linked coronavirus (IgG-SARS)-positive status with cardiac function and hematological and biochemical parameters in apparently health subjects are poorly understood. Methods: The present cross-sectional study included 307 healthy volunteers (24-69 years of age; 44.8±8.6 years; 80.4% men) and was initiated in 2019 before the COVID-19 pandemic. COVID-19 episodes were confirmed by detection of IgG-SARS against SARS-CoV-2 S1 RBD to reveal 70 IgG-SARS-positive and 237 negative participants. Numerous ultrasound characteristics were assessed by echocardiography, and 15 hematological and biochemical parameters were assayed in the blood. Descriptive and comparative analysis was based on the IgG-SARS status of the participants. Results: The left ventricular mass index, mitral ratio of peak early to late diastolic filling velocity or flow velocity across the mitral valve, and deceleration time of early mitral inflow were decreased (P<0.05) in IgG-SARS-positive participants versus those in IgG-SARS-negative participants according to multivariate logistic regression analysis. Erythrocyte sedimentation rate and platelet count were slightly increased, and blood hemoglobin was decreased in IgG-SARS-positive participants compared with those in IgG-SARS-negative participants. Conclusions: LV filling, inflammation, blood coagulation, and hemoglobin appear to be influenced by COVID-19 infection in healthy participants. These observations contribute to the development of a population recovery strategy after the episodes of COVID-19.

Safe water is a global public health concern amid increasing scarcity and pollution. Bottled water production and consumption contribute to these problems. This study examines tap water consumption in Italy, assessing associated sociodemographic factors and related health outcomes such as obesity and self-perceived health status. Data from the Italian National Statistics Institute's "Aspects of daily life" survey (N=45,597) were analyzed. Covariates included education, age, gender, economic status, region, concerns about waste and climate change, consumption of carbonated drinks excluding water, alcohol consumption, consumption of vegetables, consumption of snacks, body mass index, and self-perceived health status. Bivariate analyses and mixed-effect logistic regression models explored the associations. People who drink tap water were 19,674 with a higher prevalence in people aged 45 to 59 old, people with a graduate/post-graduate degree diploma, with optimal economic resources, and concerned about waste production and climate change, coming from the North-East regions of Italy. Underweight people showed a higher prevalence of TW assumption as well as those who drink less than occasionally carbonated drinks, drink alcohol, consume vegetables more than once a day, and snacks less than once a week with a satisfying level perceived health status. Regressions showed that all age classes are less likely to drink tap water than people younger than 20 years old. The category with “inadequate” economic resources is more likely to consume tap water. Low educational classes show a low likelihood of consuming tap water as well as Islands. A concern about waste production and climate change is associated with an increased likelihood of assuming tap water. Tap water consumption was negatively associate with obesity but not with a satisfactory Self-perceived health status. Insights from this study can inform public health strategies.

The sustainable development of mines has been the focus of attention in recent years, in China, there are a large number of untreated mined-out areas, and a series of disasters caused by instability of the goaf will bring heavy blows to people’s safety and financial resources. Mined-out areas management is an important part that cannot be ignored in mine sustainable development, and filling management is one of the most effective ways to solve the hidden danger of mined-out areas. Among them, cemented filling with tailings and the ultra-high-water backfilling are commonly used in mining enterprises. However, filling treatment will lead to increasing cost and the decreasing profits, which seriously depresses the motivation of mining enterprises and even leads to mor-al hazard. Therefore, the analysis of the economic benefits of goaf control plays a vital role in the sustainable construction and long-term development of mines. This paper proposed the mine-out area treatment economic model, the proposed method employs the guiding philosophy of news-boy model to create a mathematical economy model that provides the basis of goaf management mode for mine. The following research results are achieved: (1) The economic model of mined-out area backfilling treatment is constructed, and which is classified three different modes. (2) Com-bined with mathematical derivation and simulation, the influence of relevant variable parameters on each type of filling mode is discussed. (3) Various types of goaf filling treatment mode are com-pared with non-filling scheme (benchmark mode), so as to provide theoretical support for mining enterprises to choose the appropriate filling scheme. The results shows that the economic model of mined-out area management provides the optimal mode for mined-out area filling, the balance of tailings and ultra-high water filling materials procurement is realized, to making maximum profits. In this paper, the use of economic thinking has an important impact on the sustainable development of safety goaf management. To evaluate the sustainable development of goaf management by building economic models. It has important theoretical basis and practical guiding significance for the development and exploration of mined-out area management by combining economy with sustainable development.

Ciliopathies are genetic syndromes that link skeletal dysplasias to dysfunction of primary cilia. Primary cilia are sensory organelles synthesized by intraflagellar transport (IFT) - A and B complexes, which traffic protein cargo along a microtubular core. We have reported that deletion of IFT-A gene, Thm2, together with a null allele of its paralog, Thm1, causes a small skeleton with small mandible or micrognathia in juvenile mice. Using micro-computed tomography, here we quantify the craniofacial defects of Thm2^-/-;Thm1^aln/- triple allele mutant mice. At postnatal day 14, triple allele mutant mice exhibit micrognathia, maxillary hypoplasia, and a decreased facial angle due to shortened maxilla, premaxilla, and nasal bones, reflecting altered development of facial anterior-posterior elements. In contrast, other ciliopathy-related craniofacial defects, such as cleft lip and/or palate, hypo-/hypertelorism, broad nasal bridge, craniosynostosis, and facial asymmetry, were not observed, suggesting development of the facial transverse dimension is intact. Calvarial-derived osteoblasts of triple allele mutant mice showed reduced bone formation in vitro that was ameliorated by Hedgehog agonist, SAG. Together, these data indicate that Thm2 and Thm1 genetically interact to regulate bone formation and sculpting of the postnatal face. The triple allele mutant mice present as a novel model to study craniofacial bone development.

This article focuses on the issue of motor oils used in the engines of off-road mobile machinery (NRMM), more specifically tractors. The primary goal of the paper is to determine the appropriate replacement interval for these oils. The physical properties of the examined samples were first determined by conventional instruments. Furthermore, the concentration of abrasive metals, contaminants, and additive elements were measured using an optical emission spectrometer. Lastly, the content of water, fuel, glycol, and the products of oxidation, nitration, and sulphation were determined by using infrared spectrometry. The measured values were compared to the limit values. Based on the processing and evaluation of these analyses, the overall condition of the oils was assessed and subsequently the optimal exchange interval of the examined oils was determined. In addition, a risk analysis of the outage was performed. Due to the high yields of crops, farmers can lose a significant amount of product when a tractor is not functioning during the harvest period. This loss for calculated in the paper.

Biomarkers have the potential to aid in the study of Alzheimer’s disease (AD); unfortunately, AD biomarker values often have a high degree of overlap between healthy and AD individuals. This study investigates the potential utility of a series of novel AD biomarkers, the sixty second ¹²⁹Xe retention time, and the xenon washout parameter, based on the washout of hyperpolarized ¹²⁹Xe from the brain of AD participants following inhalation. The xenon washout parameter is influenced by cerebral perfusion, T1 relaxation of xenon, and the xenon partition coefficient, all factors influenced by AD. Participants with Alzheimer’s disease (n=4) and healthy volunteers (n=4) were imaged using hyperpolarized ¹²⁹Xe magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) to determine the amount of retain xenon in the brain. At 60 sec post breath hold, AD patients retained significantly higher amounts of ¹²⁹Xe compared to healthy controls. Data was fit to a pharmacokinetic model and the xenon washout parameter was extracted. Xenon washout in white and grey matter occurs at a slower rate in Alzheimer’s participants (¹²⁹Xe half-life time of 42s and 43s, respectively) relative to controls (20s and 16s, respectively). Following larger scale clinical trials for validation, the xenon washout parameter has the potential to become a useful biomarker for the support of an AD diagnosis.

This paper analyzes the causal effect between domestic private investment, public investment, foreign direct investment and economic growth in Tanzania during the 1970-2014 period. The modified neo-classical growth model is used to estimate the ieffect of investment on economic growth. Also, the economic growth models based on Phetsavong and Ichihashi (2012) [1], and Le and Suruga (2005) [2]are used to estimate the crowding out effect of public investment on domestic private investment on one hand and foreign direct investment on the other hand. In the same way, the crowding out effect of foreign direct investment on domestic private investment is estimated. A correlation test is applied to check the correlation among independent variables, and the results show that there is very low correlation suggesting that multicollinearity is not a serious problem. Moreover, the diagnostic tests including RESET regression errors specification test, Breusch-Godfrey serial correlation LM test, Jacque-Bera-normality test and white heteroskedasticity test reveal that the model has no signs of misspecification and that, the residuals are serially uncorrelated, normally distributed and homoskedastic. Broadly, the empirical results show that the domestic private investment and foreign direct investment play an important role in economic growth in Tanzania. Besides, a revealed negative, albeit weak, association between public and private investment suggests that the positive effect of domestic private investment on economic growth becomes smaller when public investment-to-GDP ratio exceeds 8-10 percent. Similarly, foreign direct investment tends to marginally reduce the impact of domestic private investment on growth. These results suggest that public investment and foreign direct investment need to be considered carefully in order to avoid a reduced positive impact of domestic private investment on growth. Domestic saving may be promoted to encourage domestic investment for economic growth.

In recent years, pedestrian re-identification has gained a lot of interest due to its importance for many purposes such as security and safety. Many types of solutions have been proposed to solve this problem, where the majority are based on a features extraction such Convolution Neural Networks (CNNs). These approaches assume that only the identities that are in the training data can be recognized. The pedestrians in the training data are called In distribution (ID). However, in real world scenarios, new pedestrians and objects can appear in the scene and the model should detect them as Out Of Distribution (OOD). In our previous study , we proposed a pedestrian re-identification based on von-Mises Fisher (vMF) distribution. Each identity is embedded in the unit sphere as a compact vMF distribution far from other identities distributions. The embedding is done through a base CNN. Recently, proposed a framework called Virtual Outlier Synthetic (VOS), that detects OOD based on synthesising virtual outlier in the embedding space in an online manner. Their approach assumes that the samples from the same object maps to a compact space. This assumption aligns with the vMF based approach. Therefore, in this paper, we revisited the vMF approach and merged with VOS in order to detect OOD data points. We present our approach to merge both frameworks. We conducted several experiments to evaluate our proposed framework. Results showed that our framework was able to detect new pedestrian that do not exist in the training data in the inference phase. It also slightly helped to improve the re-identification performance.

The aim of this prospective study was to examine the issues of these items to evaluate the possibility of their application to clinical practice. This prospective survey was performed on pharmacists of 14 hospitals. The number of confirmation items was 345 and 375 items in the control group and recommended item group, respectively. The mean time required for completing a regimen check (±standard deviation) was 4 minutes and 14 seconds (±1 minute and 50 seconds) and 6 minutes and 18 seconds (±1 minute and 7 seconds) in the control group and recommended item group, respectively. Among the recommended items, the mean number of items that pharmacists confirmed was 12.4 and 18.6 in the control and recommended items, respectively. The number of doubt inquiries was higher in the recommended item group than in the control group (41 vs. 27 cases). The number of doubt inquiries related to dosage, premedication, urinalysis, and a history of hepatitis B virus was higher in the recommended item group than in the control group. In the present study, we created 19 items that should be confirmed in regimen checks and examined the possibility of their application to clinical practice.

The sustainable management of public hospitals is usually threatened by long-period operating deficit, especially during the pandemic of COVID-19. This study aims at quantitatively decomposing the historical changes in the annual operating costs of public hospitals in Japan to identify the main driving forces responsible for a worsening imbalance between operating costs and income over the past two decades. A dataset of the annual operating costs of public hospitals in Japan is compiled, in which influencing factors are redefined to make the data amenable to the application of a decomposition method referred to as the Logarithmic Mean Divisia Index (LMDI). Using the LMDI method, the contribution of each influencing factor to the changes in public hospital operating costs was quantitatively determined. The results indicate an overall positive effect arising out of the national reform of public hospitals that aimed to reduce the operating costs of these institutions, but the rapid increase in the prices of medicines in recent years made a major contribution to the increasing operating costs. The pandemic reveals a damage on public hospitals’ financial balance but the city-wide lockdown offset part of the increased medical expense. Both long-term and short-term pricing policies are required for the sustainable management of public hospitals.

(1) Background: The usage of digital technologies in hospital nursing provides potential solutions to the shortage of qualified nurses and current pandemic challenges. The process involves changes and requires willingness to learn. In this respect, leaders can motivate nurses. Therefore, this vignette study examined which motives and values leaders must address in order to promote nurses’ motivation to use different digital technologies. (2) Methods: We asked hospital nurses in an online vignette study to assess fictitious situations about the imminent introduction of a digital technology. The situations differed regarding the devices (tablet/smart glasses), addressed motives (extrinsic/intrinsic), and values (efficiency/patient orientation). (3) Results: We included 299 responses in the analysis. The tablet vignettes caused especially high motivation, more than the vignettes of the smart glasses (Z = -6.653, p = <0.001). The leader was more motivating when emphasizing effi-ciency rather than patient orientation (Z = -2.995, p =0.003). The dataset did not give significant re-sults regarding extrinsic and intrinsic motives. (4) Conclusions: The results suggest efficiency as a motive for using known digital technologies. Management actions can provide the structural framework and training so that responsible leaders can ensure their staff’s engagement to also use unknown devices.