With the rise of powerful computational technologies, healthcare systems are going through a paradigm shift to the era of healthcare 5.0, also known as" smart healthcare". This new-age healthcare system not only enhances the life of patients but also aims to reduce healthcare costs significantly. People's health data collected through various means, including various Internet of Things (IoT) devices, is too sensitive to be regulated by particular organisations owing to increasing privacy and security threats. The sheer size of data makes it difficult for centralised bodies to regulate, due to which third-party involvement is introduced, which again poses threats to the privacy of the data holder. Motivated by the abovementioned gaps, we propose a decentralised approach using Ethereum blockchain technology and Oasis protocol. The patient-driven solution approach effectively solves the privacy problem by providing complete control of data to the owner. Along with this, byproducts such as fine-grained access control and on-chain data processing capabilities are also obtained.

Hospital bed shortage is a worldwide concern. Beds unavailability has caused elective surgery cancellations, at our hospital peaking in spring 2016 at over 50%. This is often due to difficult patient step-down from intensive care (ICU) and high-dependency units (HDU). In our general/digestive surgery service admitting approximately 1000 patients yearly, ward rounds were run on a consultant firm basis. We report a quality improvement (ISRCTN13976096) introducing in our service a structured daily multi-disciplinary board round framework (SAFER Surgery R2G) adapted from the “SAFER patient flow bundle” and the "Red to Green days” approaches to enhance flow, comparing the previous year to 2017, when our framework was applied for 12 months.We used a Plan-Do-Study-Act (PDSA) methodology. Our intervention consisted in 1) systematic communication of the key care plan after the afternoon ward rounds to the nurse in charge; 2) 30’ 10AM Monday-to-Friday multidisciplinary board rounds, attended daily by the senior-team and weekly by hospital and site managers, revising the key care plan aiming at safe, early discharges, assessing the appropriateness of each inpatient day and tackling any cause of delay. We measured patient flow by average length of stay (LOS), ICU/HDU step-downs and operation cancellations count, monitoring safety through early 30-day readmissions. Compliance was assessed by board round attendance and staff satisfaction rate surveys.After 12 months (PDSA 2, N=1032), LOS significantly decreased from 7.2(±8.9) to 6.3(±7.4) days (p=0.003); ICU/HDU bed step-down flow increased by 9.3% from 345 to 375 (p=0.197), surgery cancellations dropped from 38 to 15 (p=0.100). 30-day re-admissions increased from 0.9% (N=9) to 1.3% (N=14)(p=0.390). Average cross-specialty attendance was 80%. Satisfaction rates were >75%, regarding enhanced teamwork and faster decisions.The SAFER Surgery R2G framework has shown an increase in patient flow in the context of an enhanced multidisciplinary approach, requiring senior staff commitment to remain sustainable.

Patient group engagement is increasingly used to inform the design, conduct, and dissemination of clinical trials and other medical research activities. However, the priorities of industry sponsors and patient groups differ, and there is currently no framework to help these groups identify mutually beneficial engagement activities. Methods: We conducted 28 qualitative, semi-structured interviews with representatives from research sponsor organizations (n=14) and patient groups (n=14) to determine: 1) how representatives define benefits and investments of patient group engagement in medical product development and, 2) to refine a list of 31 predefined patient group engagement activities. Results: Patient group and sponsor representatives described similar benefits: engagement activities can enhance the quality and efficiency of clinical trials by improving patient recruitment and retention, reduce costs, and help trials meet expectations of regulators and payers. All representatives indicated that investments include both dedicated staff time and expertise, and financial resources. Factors to consider when evaluating benefits and investments were also identified as were suggestions for clarifying the list of engagement activities. Discussion: Using these findings, we refined the 31 engagement activities to 24 unique activities across the medical product development lifecycle. We also developed a web-based prioritization tool (https://prioritizationtool.ctti-clinicaltrials.org/) to help clinical research sponsors and patient groups identify high priority engagement activities. Use of this tools can help sponsors and patient groups identify the engagement activities that they believe will provide the most benefit for the least investment and may lead to more meaningful and mutually beneficial partnerships in medical product development.

In Model-Driven Development (MDD), the models, their generation, and imposing changes on them (model transformation) are used for the development of software. Models provide a framework to start from the imagination and abstraction to create and accomplish the final system. Models create a slow and steady transition from whatness to howness, i.e. from the natural path of the generation of software. For supporting this path, the Logic and Functionality of software must be changeable during its evolution. Here we provide a brief introduction to the concept of Model Driven Development.

Individuals with low health literacy (HL) are known to have poorer health outcomes and to have higher mortality rates compared to individuals with higher HL: hence, the improvement of HL is a key outcome in modern healthcare systems. Healthcare providers are therefore asked to support patients’ literacy skills by encouraging the implementation of autonomy-supportive patient centered communication (PCC), which in turn requires the enhancement of patient engagement. Our main hypothesis is that the well-known relationship between autonomy-supportive PCC and HL is mediated by patient engagement which is known to play a role in HL promotion and that is related to PCC as well. The purpose of this study was to formulate a hypothetical structural equation model (SEM) linking PCC to patient engagement and HL. A cross-sectional survey design was employed involving 1007 Italian chronic patients. The hypothetical model was tested using SEM to verify the hypothesized mediation of patient engagement between PCC and HL. Results show that the theoretical model has a good fit indexes and that patient engagement fully mediates the relationship between PCC and HL. This finding suggests healthcare systems to implement a new paradigm where patients are supported to play an autonomous role in their own healthcare.

Severe asthma patients are at increased risk of major exacerbations and they need to be monitored regularly. The COVID-19 pandemic has impressively impacted on the health care resources. The telemedicine approach applied to the follow-up of asthmatic patients has been proved to be effective in monitoring their disease and adherence to the therapy. The aim of our study was to investigate the satisfaction of severe asthma patients, before the activation of a telemedicine management complemented by a standard of care. An ad hoc questionnaire was developed and sent by e-mail to 180 severe asthma patients. Most of subjects (82%) were confident with the idea of doing self-measurements and self-managing their disease; 77% of subjects favoured to carry out virtual visit and telemedicine. 93% of patients considered easy the self-injection therapy. 94% of subjects felt safe and 93% were not worried while self-administering. Only mild adverse events were reported in 22% subjects after self-administration. Our results showed an agreement between what is considered necessary and practicable by healthcare personnel and what is perceived by the severe asthma patients, in terms of treatment and monitoring of the disease with Telehealth. Biologics have a safety profile and can be easily self-administred at home

Clinicians are key in reclaiming the medical arts ceded to clinically irrelevant technology and thereby aligning patient with fast-changing biological realities. Narrowing the chasm between virtual and real perceptions of health hazards requires: 1) becoming acutely aware of the habitat loss aggravating the pervasive dissemination of chemicals via conventional food, air, and consumer products and the proliferation of non-ionizing radiation; and 2) making strategic use of slow, system 2 thinking so as to respond wisely to the rampant epidemics of chronic low-dose toxicity disregarded or misdiagnosed for half a century. To respond adaptively, take a moment during each patient encounter to add chronic ambient poisoning to the differential diagnosis and investigate subtle symptoms and signs of irritation in vulnerable organ systems. Enacting adaptive response across our profession could ease the suffering of millions, help avert the sixth extinction, and contribute to continuation of evolved life as we know it.

Patients with chronic obstructive pulmonary disease (COPD) often require frequent hospitalization due to worsening symptoms. Preventing prolonged hospital stay and readmission becomes a challenge for healthcare professionals treating patients with COPD. Although the integration of health and social care supports greater collaboration and enhanced patient care, organizational structure and poor leadership may hinder the implementation of patient-oriented goals. This paper presents a case of a 64-year-old chronic smoker with severe COPD who was to be discharged on long-term oxygen therapy (LTOT). It further highlights the healthcare decisions made to ensure the patient’s safety at home and further provides a long-lasting solution to the existing medical and social needs. The goal was accomplished through a discharge plan that reflects multidisciplinary working, efficient leadership, and change management using Havelock’s theory. While COPD is characterized by frequent exacerbation and hospital readmission, it was emphasized that most failed discharges could be attributed to bureaucratic organizational workflow which might not be in the patient’s best interest. It was further demonstrated that healthcare professionals are likely to miss the window of opportunity to apply innovative and long-lasting solutions to the patient’s health condition in an attempt to remedy the immediate symptoms of COPD

In this short note, the described step-by-step derivations of the industrial energy demand function from the production function framework and provided researchers with two specifications. Then we applied these theoretical specifications to the time series data as empirical analysis. We concluded that theories should be considered at the beginning of the empirical analyses but the data also should be allowed to speak freely. Hence, the main suggestion of this short note is that it would be a better strategy to consider the combination of theory-driven and data-driven approaches in the empirical analyses.

Intensive care unit discharge is an important transition which impacts on patient wellbeing. Nurses can play an essential role in this scenario, potentiating patient empowerment. A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA Statement. Embase, PubMed/MEDLINE, CINAHL, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were evaluated in May 2021. Two independent reviewers analyzed the studies, extracted the data, and assessed the quality of evidence. Quality of the studies included was assessed using the Cochrane risk-of-bias tool. Of the 273 articles initially identified, eight randomized controlled trials reported nursing interventions mainly focused on patients’ ICU discharge preparation through information and education. The creation of ICU Nurse-Led and nurses’ involvement in critical care multidisciplinary teams also aimed to support patients during ICU discharge. This systematic review provides an update on clinical practice aimed at improving the patient experience during ICU discharge. The main nursing interventions were based on information and education, as well as the development of new nursing roles. Understanding transitional needs and patient empowerment are key to making the transition easier.

Currently, in the scientific literature there is a great interest on the study of strategies to implement patient-centered care. One of the main tools for this is the therapeutic relationship. Some studies suggest that the perception of the environment in which the physical therapy treatment takes place can influence the perception of its quality. A qualitative study using focus groups was performed. Two researchers conducted the focus groups, using a topic guide with predetermined questions. The focus group discussions were audio-recorded, transcribed verbatim and analyzed thematically using a modified grounded theory approach. The setting was three hospitals and six public health centers located in Spain. The inclusion criteria were patients who had received a minimum of 15 physical therapy sessions and with no communication impairments. Thirty-one participants in four focus groups. Participants described a series of specific experiences relating to the environment, which they felt were influential in the establishment of therapeutic patient-centered relationships, including eight physical factors and five organizational factors. The results of this study highlight environmental factors that affect the quality of the therapeutic patient-centered relationship in physical therapy and emphasize the need for physical therapists and administrators to rethink the situation and propose strategies for improvement.

Oncology clinical pharmacists are uniquely positioned to make interventions to increase patient activation and engagement. To accomplish this goal, pharmacists can target health system-related, provider-related, and patient-related factors to help enhance patient-centered care and drive behavioral health changes. Interventions that pharmacists must tackle include educating team members and patients on the medication acquisition process, communicating urgency of treatment, optimizing workflows, facilitating guideline recommendations, preventing, and managing treatment toxicities, and promoting patient self-advocacy through education and shared decision-making. As crucial members of the healthcare team, oncology clinical pharmacists can simplify highly complex treatment regimens to facilitate and optimize patients’ ownership of their care. This review will focus on the example of venetoclax treatment in acute myeloid leukemia to demonstrate the impact that pharmacists provide that leads to behavioral change of patients and clinicians.

Visual Patient technology is a situation awareness–oriented visualization technology that translates numerical and waveform patient monitoring data into a new user-centered visual language. Vital sign values are converted into colors, shapes, and rhythmic movements—a language humans can easily perceive and interpret—on a patient avatar model in real time. In this review, we summarize the current state of the research on the Visual Patient, including the technology, its history, and its scientific context. We also provide a summary of our primary research and a brief overview of research work on similar user-centered visualizations in medicine. In several computer-based studies under various experimental conditions, Visual Patient transferred more information per unit time, increased perceived diagnostic certainty, and lowered perceived workload. Eye tracking showed the technology worked because of the way it synthesizes and transforms vital sign information into new and logical forms corresponding to the real phenomena. The technology could be particularly useful for improving situation awareness in settings with high cognitive demand or when users must make quick decisions. This comprehensive review of Visual Patient research is the foundation for an evaluation of the technology in clinical applications, starting with a high-fidelity simulation study in early 2020.

Background: Handover is a critical process for ensuring quality and safety in healthcare. Considerable research suggests that poor handover results in significant morbidity, mortality, dissatisfaction, and excess financial costs. Despite this, little formal attention, education, and evaluation has been given to handover. There is also paucity of data on the opinions of practitioners on the safety of handover.Objectives: The aim of this study was to measure the perceived risk, degree of patient harm and the systems used to support handover, and to understand how this varied by care setting, type of clinical practice, location, or level of experience. Methods: An open, anonymous and confidential online questionnaire covering: (a) respondent characteristics; (b) peer-to-peer handover; (c) internal referrals; (d) discharges and transfers between organisations; and (e) leading and improving handover was conducted with healthcare practitioners and managers from various settings. Results: We gathered a total of 432 completed responses from 26 countries. The average reported performance of handover was rated as 3.9 out of 5.For each type of handover, 12 - 14% reported errors occurring more than weekly. Of those that knew the outcome of such errors, between 29% and 34% reported that they had witnessed moderate or severe harm. 12% and 17% of respondents believed that handover was high or very high risk (See table 4). These respondents were more likely to have witnessed moderate or severe harm, or to be more senior.A wide combination of handover systems was utilised by respondents. 28% - 32% relied exclusively on EPRs (with or without face-to-face contact). 21% used Office documents such as Word and Excel for peer-to-peer handover, and over 30% used hand-written or manual systems. Conclusions: This study suggests the need to do more — and go further — to improve communication and reduce risk during all types of handovers. Clinical leaders should find ways to train and support handover with effective systems, with less experienced staff being the primary focus. More research is needed to demonstrate the interventions that improve the safety of handover.

Antennas are crucial elements for wireless technologies, communications and power transfer across the entire spectrum of electromagnetic waves, including radio, microwaves, THz and optics. In this paper, we review our recent achievements in two promising areas: coherently enhanced wireless power transfer (WPT) and superdirective dielectric antennas. We show that the concept of coherently enhanced WPT allows improvement of the antenna receiving efficiency by coherent excitation of the outcoupling waveguide with a backward propagating guided mode with a specific amplitude and phase. Antennas with the superdirectivity effect can increase the WPT systems performance in another way, through tailoring of radiation diagram via engineering antenna multipoles excitation and interference of their radiation. We demonstrate a way to achieving the superdirectivity effect via higher-order multipoles excitation in a subwavelength high-index spherical dielectric resonator supporting electric and magnetic Mie multipoles. Thus, both types of antenna discussed here possess a coherent nature and can be used in modern intelligent antenna systems.

The case for demand-driven research and development has received important considerations among governments, donors and programme implementing partners in development planning and implementation. Addressing demand is believed to be a bottom-top approach for designing and responding to development priorities and is good for achieving development outcomes. In this paper, we discuss the concept and application of demand driven research for development (DDRD) in Africa. We use evidence of six projects implemented under the BiomassWeb Project in Africa. We focus on parameters on level of engagement of stakeholders - whose demand is being articulated, the processes for demand articulation, capacity building and implementation processes, innovativeness of the project, reporting and sustainability of the project. We find that the nature of the institutions involved in articulation and implementation of demand-driven research and development projects and their partnerships influence the impact and reporting of demand-driven projects.

HIV infection invariably attracts the attention of medical staff in complex medical specialties. To achieve the goal of elimination by 2020, various approaches are required, including the establishment of prevention, diagnosis, monitoring, treatment, control measures. These should be supported by statistical studies that report on restricted or extended geographical areas, to the level of social class and age. Such an approach, combing the medical and social science perspectives (medicosocial) can prove useful for developing control measures. Due to the complexity of this immunodeficiency pathology, the condition also attracts comorbidities (most notably tuberculosis). Hence, prospective strategies need to be developed and oriented towards the goal of eradicating HIV infection. This paper presents strategies for consideration.

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

An outbreak caused by coronavirus disease 2019 (COVID-19) occurred in Wuhan City, Hubei Province, China, in December 2019. Up to March 2, 2020, at least 80180 cases have been reported. Most of the patients had a history of visiting Hubei Province or contacting with people who had ever stayed in or passed by Hubei Province, or exposed to symptoms. Some patients got infected only from asymptomatic contacts. This study aimed to report the epidemic features and lab identification of a patient confirmed with COVID-19 infection only from asymptomatic contact.

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

Visual Patient Avatar ICU is an innovative approach to patient monitoring enhancing the user's situation awareness in intensive care settings. It dynamically displays the patient's current vital signs through changes in color, shape and animation. The technology can also indicate patient-inserted devices, such as arterial lines, central lines and urinary catheters, along with their insertion locations. We conducted an international, multi-center study using a sequential qualitative-quantitative design to evaluate users' perception of Visual Patient Avatar ICU among physicians and nurses. Twenty-five nurses and twenty-five physicians from the ICU participated in the structured interviews. Forty of them completed the online survey. Overall, ICU professionals expressed a positive outlook on Visual Patient Avatar ICU. They described Visual Patient Avatar ICU as a simple and intuitive tool that improved information retention and facilitated problem identification. However, a subset of participants expressed concerns about potential information overload and a sense of incompleteness due to missing exact numerical values. These findings provide valuable insights into user perceptions of Visual Patient Avatar ICU and encourage further technology development before clinical implementation.

While nursing is an ethical profession, unethical behavior among nurses is increasing worldwide. This study examined the effects of an ethics seminar on nurses' moral sensitivity and ethical behavior. A total of 37 nurses (17 experimental, 20 control) were recruited. The ethics seminar was held over a 6-month period from May to October, 2018, and comprised six sessions held once a month for two hours. Moral sensitivity and unethical behavior were measured at the start and end of the seminar. Moral sensitivity and unethical behavior showed a negative correlation (r= -.455, p&lt;0.01). After the ethics seminar, the experimental group's moral sensitivity was significantly increased (t = -1.039, p = 0.314). The mean scores of unethical behavior at pre and post-test in the experimental group were 12.59 and 9.47, respectively. This was a statistically significant difference (t = 3.118, p = 0.004). There was no statistically significant difference in the mean score in both moral sensitivity and unethical behavior in the control group. We conclude that ethics seminars can enhance moral sensitivity and reduce the risk of unethical behavior among nurses. Regular ethics seminars and training must be provided to nurses as a matter of policy.

Cable-Driven Parallel Robots (CDPRs) are a special kind of parallel manipulator which use cables to control the position and orientation of the mobile platform or end-effector. The usage of cables instead of rigid links offer some advantages over their conventional rigid counterparts. As cables can only pull, but not push, the number of cables (n) required to command the end-effector is always n+1. This configuration is known as fully-constrained and it is the most extended configuration for CDPRs. Although CDPRs have many advantages, such as their ability to cover large working areas, one of their main problems is that their working area (workspace) is limited in comparison to its frame area (planar case), or frame volume (spatial case), due to the minimum and maximum allowed tensions. Depending of these tensions values the workspace can be notoriously decreased. In order to tackle this problem, lots of works focus on solving kinematics or dynamics problems for cable sagging, i.e., they take into account sagging when modelling the robot kinematic and include these poses inside the usable robot workspace. Taking into account phenomenons like this increases the mathematical complexity of the problem, and much more complex techniques are required. On the other hand, the lack of workspace problem can be tackled by adding active or passive elements to the robot design. In this sense, this paper proposes two mechanical modifications: to add passive carriages to the robot frame and to use a single cable loop to command the end-effector position and orientation. This work presents the kinematic, static and dynamic models of the novel design and shows the gain of workspace for a planar case while taking into account different parameters of the robot.

This paper uses the spatial analysis software GeoDa as a tool, takes GRP (Gross regional product) of Sichuan Province in 2012 and 2018 as the dependent variable, and takes the city (autonomous prefecture) factor-driven, investment-driven and innovation-driven indicators as the dependent variable to explore the impact of innovation activities on regional economic development and the spatial distribution characteristics of regional economy. Through the comparison of the global correlation and local correlation, this paper explores the crux of the regional economic polarization and unbalanced development, and puts forward some measures to solve the existing economic development problems, such as cultivating and improving the regional industrial dependence, accelerating the regional transportation accessibility and convenience, and constructing the regional collaborative innovation system, So as to achieve the strategic goal of the construction of innovative Province in Sichuan Province.

Replacement of fee-for-service with capitation arrangements, forces physicians and institutions to minimize health care costs, while maintaining high-quality care. In this report we describe how patients, their families (and caregivers) can work with members of the medical care team to achieve these twin goals of maintaining (and perhaps improving) high-quality care and minimizing costs. We describe how increased self-management enables patients and their families/caregivers to provide electronic patient-reported outcomes (i.e., symptoms, events) (ePROs) as frequently as the patient or the medical care team consider appropriate. These capabilities also allow greater reliance on the use of mobile technologies (mHealth) to provide ongoing assessments of physiologic measurements/phenomena. Remote surveillance of these communications allows longer intervals between (fewer) visits of patients to the medical-care team when this is appropriate and earlier interventions when that is appropriate. Systems are now available that alert medical care providers to situations when interventions might be needed.

Background: Poor patient flow can lead to adverse outcomes for patients and organisational inefficiency. Many hospitals have addressed suboptimal patient flow by increasing resourcing, such as bed stock and staffing, however, this is an unsustainable approach. In determining the nature of poor patient flow issues, it is important to collect data from healthcare professionals who manage patient flow on a daily basis. Doing so provides insights into the current state of patient flow management in its entirety, whilst also helping with the development of sustainable solutions.; Methods: Thirteen semi-structured interviews were conducted with clinicians who were directly involved with patient flow at a tertiary care centre in Tasmania, Australia. Results: Through a thematic analysis method, four major themes were developed: managing patient flow, communication for decisions, tools as enablers and barriers and increasing complexity. Conclusions: The findings of this study provide great insights into patient flow issues, with potential solutions identified to address them.

Obtaining a proper position for THA’s components is a crucial aspect for the implant perfor-mance and consequently patient outcomes. Patient specific kinematic seems to be a key factor to reach the optimal implant positioning. The aim of this study was to assess the accuracy and safety of a computed dynamic analysis system which through patient specific guides tries to improve implant positioning and functional orientation according to patient’s spinopelvic mobility and anatomy.A total of 100 consecutive patients were prospectively enrolled. All patients received an OPS dynamic hip preoperative planning. A TC scan protocol follow up analysis has done at 6 month after surgery.The mean deviation from the planned acetabular inclination and anteversion was 4.3° e 3.8° respectively. The 98% of cases was within +/- 10° of Lewinnek safe zone both for inclination and anterversion. The height of osteotomy deviated on the average of 1.6mm. The 100% cases were included within 4mm of osteotomy. Patient specific and laser guided instru-mentation is safe and accurately reproduce the dynamic planning in terms of components orien-tation, osteotomy level, leg length and offset.

Background: Falls in hospitalized older patients lead to increased length of stay and poorer discharge outcomes. The Comprehensive Unit-based Safety Program (CUSP) represents a quality improvement intervention for patient safety. Objective: To evaluate CUSP implementation for the prevention of falls at a teaching hospital. Method: An interdisciplinary CUSP team, received a four-hour online module and one-day face-to-face training. The intervention was developed using the WHO implementation science plan-do-study-act framework. Process evaluation was conducted using the UK Medical Research Council framework. The primary outcome measure of patient safety culture was determined using the Safety Attitude Questionnaire (SAQ), while annual fall rates were considered the secondary outcome measure. Results: Safety rounds were conducted during the two-year intervention period, each attended by five to eight HCPs, with nine to 29 patients reviewed each month. Risk factors, plans and actions were administered to individual patients, while local issues were identified and resolved through engagement of senior executives. SAQ domains increased from before (n=39) to after (n=30) the intervention of CUSP. Fall rates reduced from 11.18 per 1,000 bed days pre-implementation to zero falls post-implementation. Conclusion: Improvements in patient safety culture were observed after the implementation of CUSP alongside a reduction in fall rates.

Obsessive-compulsive disorder (OCD) remains, despite significant scientific progress, a pathological condition that is incomprehensible, due toits paradoxical psychological and behavioral symptoms. The presentwork aims at assessing current phenomenological understandings of this pathology. Among the cognitive models used today, post-rationalist cognitivism and cognitive neuropsychological psychotherapy, which both incorporate a phenomenological approach, seem most effective at grasping OCD patients’ experiences of the world, which are typically characterized by hyper-reflexivity, at the expense of "natural evidence." For OCD patients, the emotional sense of the world becomes a set of sterile rules that determine a suffering life.

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

Therapeutic patient education (TPE) aims to empower the patients and their caregivers to effectively care for and manage their conditions. Such educational programs have been shown to improve health behaviors, disease outcomes and quality of life among different patient populations. The field of TPE has evolved extensively over decades, owing to interdisciplinary research. No study so far has been done to map this field, to identify the stakeholders and gaps requiring future research. By leveraging the theory of co-citation, Citespace was used to visualize the bibliographic data pertaining to TPE research. A total of 54,533 articles published in English language were analyzed to identify influential funders, regions and institutes contributing to this field. Besides these, important theoretical and empirical work that has shaped this field has also been mapped. Our analysis revealed several important insights. Most of the important theories which helped shape TPE were inspired from the social sciences. Five important themes of research were identified including disorders, study designs utilized in TPE research, scope of the TPE literature, and outcomes, and populations. The research focused on improving perceptions, behaviors, and attitudes for health promotion, reducing stigma as well as self-management and medication adherence. Most of the research was developed in the context of high income countries. The future research should more involve patients and use digital technology. Meta-analytical studies need to be done to identify the specificities of TPE interventions across different disorders. More research should involve low and middle income countries (LMIC) to ensure knowledge and technology transfer.

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

The aim of the study was to determine the attitude of dentist toward learning communication skills and to recognize the factors influencing attitude toward learning communication skills. A cross-sectional study using a self-administered, 26-item, adapted Communication Skills Attitude Scale (CSAS) was carried out among dentist working in a public sector hospital in Qatar. Overall, two scores could be ascertained from the adapted CSAS: the mean positive attitude score (PAS) and negative attitude score (NAS). Non-parametric tests for statistical significance were utilized to assess relation between PAS and NAS scores and demographics. Fifty-nine dentists completed the survey giving an overall response rate of 53.6%. The mean (SD) PAS and NAS scores were 3.98 (SD=0.54) and 3.26 (SD=0.49) respectively. Female dentist was more positive towards learning communication skills than male. No statistically significant correlation was found between both PAS and NAS scores and respondents’ age. Dentists’ had both positive and negative attitudes towards learning communication skills. Considering the high NAS scores, it is recommended to introduce communication skills formal training sessions

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

Cable interference in cable-driven mechanisms (CDM) is a major challenge in their applications. The wrench closure workspace (WCW) in a fully constrained mechanism may not be realized unless cable interference is considered. This paper classifies all possible types of cable interferences for planar cable-driven mechanisms and presents an analytical solution to find the boundaries of the constant-orientation interference region. It is shown that interference between cables starts and ends when one end of a cable coincides with another cable which can be thought as lying a point on a line segment. This geometrical view is developed and applied to provide a framework for the analysis of cable interference. By subtracting the interference space form WCW, the interference-free workspace is obtained in which the robot is able to operate.

The aim of this study was to compare the effectiveness of propofol-based sedation and midazo-lam sedation in same-day bidirectional endoscopy (BDE) in children. The charts of children (≤15 years old) who had undergone same-day BDE were retrospectively reviewed. Demographic data, indications, sedatives and their dosages, clinical outcomes, endoscopic findings, adverse events, and patient time requirements were compared in cases with propofol-based and midazolam se-dation. A total of 91 children [51 boys, mean age 13 years (range 9-15)] were enrolled. Propofol alone or in combination with midazolam and/or pentazocine was given in 51 (propofol-based sedation group) while midazolam alone or in combination with pentazocine was given in 40 (midazolam sedation group). The mean doses of propofol, midazolam and pentazocine were 96 mg (range 40–145 mg), 4.1 mg (range 3–5 mg) and 7.5 mg in the propofol group while the mean doses of midazolam and pentazocine were 6.2 mg (range 4–10 mg) and 15 mg in the midazolam group, respectively. The total procedure times and endoscopic findings between the two groups were similar, but the median patient time requirement in the propofol group was significantly shorter than that of the midazolam group (7.3 h vs. 8.4 h, P<0.001). No adverse events occurred in either group. Propofol-based sedation shortened patient time requirements in same-day BDE compared with midazolam sedation in children.

This paper presents an OSA patient interactive monitoring system based on the Internet of Things (IoT) framework. This system allows OSA patients to get timely rescue when they are sleepy outside. Because the Beidou position marker has an interactive function, it can reduce the anxiety of the patient while waiting for the rescue. At the same time, if a friend helps the OSA patients to call the doctor, the friend can also report the patient's condition in time. This system uses the popular IoT framework. At the bottom is the data acquisition layer, which uses wearable sensors to collect vital signs from patients, with a focus on ECG and SpO2 signals. The middle layer is the network layer that transmits the collected physiological signals to the Beidou indicator using the Bluetooth Low Energy (BLE) protocol. The top layer is the application layer, and the application layer uses the mature rescue interactive platform of Beidou. Since the GPS indicator has not included the communication satellite, So it has no SMS function. OSA patients can only passively wait for a rescue. Moreover, due to the lack of satellites in Asia and the insufficient density of the ground-enhanced system, the positioning error of OSA patients is large. The Beidou system developed by China itself, the main coverage of the satellite is in Asia, and is equipped with a high-density ground-based augmentation system. Therefore, the Beidou model improves the positioning accuracy and is equipped with a special communication satellite, which increases the short message interaction function. Therefore, patients can report disease progression in time while waiting for a rescue. After our simulation test, the effectiveness of the OSA patient rescue monitoring system based on the Internet of Things framework and the positioning accuracy of OSA patients have been greatly improved. Especially when OSA patients work outdoors, the cell phone base station signal coverage is relatively weak. The satellite signal is well covered, plus the SMS function of the Beidou indicator. Therefore, the system can be used to provide timely patient progress and provide data support for the medical rescue team to provide a more accurate rescue plan. After a comparative trial, the rescue rate of OSA patients using the detection device of this system was increased by 15 percentage points compared with the rescue rate using only GPS satellite phones.

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.

The concept of patient confidentiality is nearly as old as the practice of health professions and, has evolved and transformed over the years, from one jurisdiction to the other. Patient confidentiality can be a fundamental human right, an ethical duty or, a legal duty. The Saudi laws have evolved around its Shari’ah-based legal culture, its history and the international human right laws (IHRLs). These elements have moulded the Saudi Arabia’s unique perspective on patient confidentiality. Its confidentiality laws are found scattered in several legislations. Is the Saudi patient confidentiality law able to adequately deal with the contemporary challenges? The study reviewed the relevant Saudi laws in the light the International Humana Rights Laws. Findings suggest that there are issues bordering on the lack of quality comprehensive data protection laws, on clarity and foreseeability of the existing laws, and on the accessibility of the courts. Furthermore, the lack of a system of law reporting and stare decisis potentially gave the judges a wider latitude of discretion in interpreting the laws. Therefore, the study recommends for a comprehensive data protection law with a clear definition of “confidential information”, of data controllers and their role, and of specific safeguards against potential abuses. Others include defining legitimate purposes for using the patient’s data, and his role, and the extent to which he can control the use of his own data. Consistency in legal interpretations, and an improved law reporting system could positively enhance the overall outcome.

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

Malawi has developed an excellent, nation-wide system for monitoring people infected with HIV and keeping track of key epidemic markers. Their success lies in two things: the focus on simplicity and the use of data collection not only to track the epidemic and identify problems but also to give regular feedback and support to every clinic in the country. This achievement is the more remarkable given that Malawi is one of the poorest countries in the world, ranking 190 out of 194 countries by GDP, but has one of the most severe epidemics of HIV in the world, ranking 9th out of 168 countries by HIV prevalence. We first discuss the current state and likely future epidemic trends in Malawi: unless we know where we are and where we are going we cannot decide what to do or how to do it to in order to achieve a better outcome. We then discuss the history and development of Malawi’s patient monitoring system, as reported in their Integrated HIV Program Reports,ix which have been published quarterly since the beginning of 2004. We consider the current state of patient monitoring and support as reflected in the most recent report for the third quarter (Q3) of 2016 and comment on some of the questions that this raises. Finally, we consider ways in which the current system could be improved by strengthening Malawi’s analytical capacity and making better use of this unique data set. The focus here is on HIV in adultsv because if ART is initiated early in all adults living with HIV this should include testing all pregnant women for HIV and starting them on treatment immediately. However, PMTCT is especially important and care must be given to reducing MTCT and identifying the long-term child survivors of mother-to-child transmission and this demands a complementary assessment. There is an ongoing debate about the relative merits of treatment and prevention in reducing transmission and it should be made clear that the primary reason for starting people on treatment early is that it is in the best interest of the individual patient to start treatment as soon as possible after becoming infected. Allowing a person’s immune system to deteriorate to any degree is not consistent with the clinician’s commitment to ‘first do no harm’ and even those with the highest CD4⁺ cell count are at a substantially increased risk of death. What matters, therefore, is to get as many people as possible onto ART, ensure that they remain virally suppressed, and consider prevention in this context.

Background: MOST-plus is a multicenter, randomized, open-label, adaptive Phase II trial evaluating the clinical benefit of targeted treatments matched to molecular alteration in advanced/metastatic solid tumors. Sorafenib was tested on patients with tumors harboring sorafenib-targeted genes Methods: The MOST-plus trial used a randomized discontinuation design. After 12 weeks of sorafenib (400 mg, po BID), patients with progressive disease dis-continued study, patients with objective response were proposed to continue sorafenib, whereas patients with stable disease (SD) were randomly assigned (1:1) to maintenance or interruption of treatment. Primary endpoint was RE-CIST version 1.1 progression-free rate at 16 weeks after randomization (PFR-16w). Secondary endpoints included progression-free survival (PFS), overall survival (OS), and toxicity. Statistical analyses used a sequential Bayes-ian approach with interim efficacy analyses. The enrolment could be stopped in the case of a 95% probability for the estimated PFR-16w to be higher in the maintenance than in the interruption arm (NCT02029001). Results: 151 patients were included, of whom 35 had SD at 12 weeks of Soraf-enib. For the 35 patients with SD on sorafenib, the PFR-16w was 65% [95% credibility interval 43.4–83.7] in the continuation arm and 25% [7.8–48.1] in the interruption arm. Median PFS and OS were improved in maintenance versus interruption arm (mPFS: 5.6 [95%CI 1.97–6.77] months versus 2.0 [95%CI 1.61–3.91] months (p =0.0231) and mOS : 14.3 [95%CI 8.9–23.8] versus 8.0 months [95%CI 3.5–15.2] (p =0.0857)). Conclusion: Sorafenib showed activity in progressive patients with solid tu-mors harboring somatic genomic alterations in sorafenib-targeted genes. Con-tinuing sorafenib when SD is achieved improves PFR compared to interruption

Plant Factory Transplanter (PFT) is a key component of the plant factory system. Its operation status directly affects the quality and survival rate of planted seedlings, which in turn affects the overall yield and economic efficiency. To monitor the operation status and transplanting quality of a transplanting machine in a timely manner, the primary task is to use a computerized and easy-to-use method to monitor the transplanting units. Inspired by the latest developments in augmented reality and robotics, a DT model-based and data-driven online monitoring method for plant factory transplanting equipment is proposed. First, a data-driven and virtual model approach is combined to construct a multi-domain digital twin of the transplanting equipment. Then, taking the vibration frequency domain signal above the transplanting manipulator and the image features of the transplanting seedling tray as input variables, the evaluation method and configuration method of the PFT digital twin system are proposed. Finally, the effect of the transplanter is evaluated, and the cycle can be repeated to optimize the transplanter to achieve optimal operation parameters. The results show that the digital twin model can effectively use the sensor data to identify the mechanical vibration characteristics and avoid affecting transplanting quality due to mechanical resonance. At a transplanting rate of 3000 plants/h, the transplanting efficiency can be maintained at a high level and the vibration signal of X, Y, Z-axis above the transplanting manipulator is relatively calm. In this case, Combined the optimal threshold method with the traditional Wiener algorithm, the identification rate of healthy potted seedlings can reach 94.3%. Through comprehensively using the optimal threshold method and 3D block matching filtering algorithm for image threshold segmentation and denoising, the recognition rate of healthy seedlings has reached over 96.10%. In addition, the developed digital twin can predict the operational efficiency and optimal timing of the detected transplanter, even if the environmental and sensor data are not included in the training. The proposed digital twin model can be used for damage detection and operational effectiveness assessment of other plant factory equipment structures.

Understanding the flow in urban environments is an increasingly relevant problem due to its significant impact on air quality and thermal effects in cities worldwide. In this review we provide an overview of efforts based on experiments and simulations to gain insight into this complex physical phenomenon. We highlight the relevance of coherent structures in urban flows, which are responsible for the pollutant-dispersion and thermal fields in the city. We also suggest a more widespread use of data-driven methods to characterize flow structures as a way to further understand the dynamics of urban flows, with the aim of tackling the important sustainability challenges associated to them.

The aim of this study is to model hydrodynamic processes of the Istanbul Strait with its stratified flow characteristic and calibrate the most important parameters using local and global search algorithms. For that two open boundary conditions are defined, which are in the North and South part of the Strait. Observed bathymetric, hydrographic, meteorological and water level data are used to set up the Delft3D-FLOW model. First, the sensitivities of model parameters on the numerical model outputs are assessed using PEST toolbox. Then, the model is calibrated based on the objective functions focusing on the flowrates of upper and lower layers. The salinity and temperature profiles of the Strait are only used for model validation. The results show that the calibrated model outputs of Istanbul Strait are reliable and consistent with the in-situ measurements. The sensitivity analysis reveals that the Spatial Low-Pass Filter Coefficient, Horizontal Eddy Viscosity, Prandtl-Schmidt Number, Slope in log-log Spectrum and Manning Roughness Coefficient are most sensitive parameters affecting flowrate performance of the model. The agreement between observed salinity profiles and simulated model outputs is promising whereas the match between observed and simulated temperature profiles is weak showing that the model can be improved particularly for simulating the mixing layer.

The aim of this paper is to develop an intelligent event-driven Electrocardiogram (ECG) processing module in order to achieve an efficient solution for diagnosis of the cardiac diseases. The suggested method acquires the signal with an event-driven A/D converter (EDADC). The output of EDADC is passed through the activity selection and interpolation blocks. It allows focusing only on the important signal parts and resampling it uniformly. Later on, the signal is de-noised. The autoregressive (AR) method is used to extract the classifiable features of the de-noised signal. Afterwards, the output is classified by employing different robust classification techniques such as support vector machines (SVMs), K- Nearest Neighbor (KNN) and Artificial Neural Network (ANN). The event-driven feature enables to adapt the system processing load according to the signal temporal variations. This interesting feature of the devised system aptitudes a drastic reduction in its processing activity and therefore in the power consumption as compared to the traditional ones. A comparison of the performance of different classifiers is also made in terms of accuracy. Results show that the proposed system is a potential candidate for an automatic diagnosis of the cardiac diseases.

Remanufacturing is a viable option to extend the useful life of an end-of-use product or its parts, ensuring sustainable competitive advantages under the current global economic climate. Challenges typical to remanufacturing still persist, despite its many benefits. According to the European Remanufacturing Network a key challenge is lack of accurate, timely and consistent product knowledge as highlighted in a 2015 survey of 188 European remanufacturers. With more data being produced by electric and hybrid vehicles, this adds to the information complexity challenge already experienced in remanufacturing. Therefore, it is difficult to implement real-time and accurate remanufacturing for the shop floor; there are no papers that focus on this within an electric and hybrid vehicle environment. To address this problem this paper attempts to (1) identify the required parameters/ variables needed for fuel cell remanufacturing by means of interviews (2) rank the variables by Pareto analysis (3) develop a casual loop diagram for the identified parameters/ variables to visualise its impact on remanufacturing (4) model a simple stock and flow diagram to simulate and understand data and information-driven schemes in remanufacturing.

Manufacturing organizations shall recognize sustainability as a business occasion to capitalize on, rather than an undesirable pressing situation. Still, empirical evidence shows that this opportunity is hard to capture and communicate in global strategic decisions, through planning by tactical management, to daily operational activities. This paper systematically reviews the modeling challenges at the crossroad of value and sustainability decisions making, spotlighting methods and tools proposed in literature to link sustainability to customer value creation at strategic, tactical and operational level. While statistical results show that the topic of sustainability and value modeling is trending in literature, findings from content analysis reveal that recent attempts to promote a value-based view in the sustainability discussion remain at a strategic level, with most of the proposed indicators being suited for managerial decision-making. The lack of support at operational level points to the opportunity of cross-pollinating sustainability research with value-centered methodologies originating from the aerospace sector. The Value Driven Design framework is proposed as main hub from which to derive models supporting engineers and technology developers in the identification of win-win-win situations, where sustainable improvements are aligned with business advantages.

On 11 March 2020, the COVID-19 emergency was declared and a large number of patients were admitted to the ICUs. Consequently, ICUs had to recruit nurses from other units as well as Nursing students without working experience in critical patients care. Since Critical nursing competence is crucial to avoid medical errors, the aim of this study was, to describe the level of safety and nursing competence in critical patient care of recruited nurses and students, during the COVID-19 pandemic in ICUs. A cross-sectional descriptive study of 66 participants using the validated competency assessment questionnaire for nurses in hospital care (COM-VA©) was performed. Our results showed that the level of safety perceived in critical patients care by the students on placement in ICUs and mentors scored higher than the rest of the participants. Interestingly, whereas the participant’s COM-VA© score indicated a level of competence good enough to work autonomously, the supervisor/mentor’s COM-VA© evaluation showed that only the group of students on placement obtained this level of competency. Altogether, we found that students on placement in ICU possesses a higher level of safety and COM-VA© scores than the rest of participants probably due to the close support of the mentor.

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.

The aim of this single-center, open-label, non-controlled randomized study was to evaluate which formulation of vitamin D between cholecalciferol and calcifediol is most effective in the treatment of hypovitaminosis D in older adults. Demographic characteristics, clinical history and comprehensive geriatric assessment were recorded at admission. Eligible patients randomly received an equivalent vitamin D supplement either with cholecalciferol or calcifediol from hospital admission to three months after discharge. Among the 140 older patients included (mean age 83±6.6, 57.8% females), 69 received cholecalciferol and 71 calcifediol. The mean plasma values of 25OH-Vitamin D3 found at the enrollment were 16.8 ± 9.9 ng/mL in patients receiving cholecalciferol and 18.8 ± 13.3 ng/mL in those treated with calcifediol (p =0.31). At the 3-month follow up, the mean concentration of 25OH-Vitamin D3 was significantly higher in patients treated with calcifediol than in patients treated with cholecalciferol (respectively, 30.7 ± 8.4 vs 45.4 ± 9.8 ng/mL, p &lt;0.001). Supplementation with cholecalciferol or calcifediol results in both cases effective in reaching optimal circulating values of 25OH-VitaminD3 in the older patients suffering from hypovitaminosis D. However, supplementation with calcifediol led to average circulating values of 25OH- VitaminD3 significantly higher (over 50%) than those obtained with cholecalciferol.

Background: Healthcare attention is sometimes considered purely technical, but communication has proven to be closely related to clinical results and patient satisfaction. Therefore, evaluation of communication in the scope of healthcare is a priority. The purpose of this study was to validate and adapt, if necessary, the Spanish version of the Communication Styles Inventory (CSI) in a sample of nursing professionals. (2) Methods: The sample was made up of 2313 nursing professionals selected at random from various medical centers in Spain, and is therefore a sample actively employed at the time data were acquired. We started out from the Communication Style Inventory, a questionnaire for evaluating the predominance of certain individual communication behaviors on six scales (expressiveness, preciseness, verbal aggressiveness, questioningness, emotionality and impression manipulativeness). (3) Results: Confirmatory Factor Analysis of the model proposed showed god fit indices. The reliability of the model shown by the Cronbach’s alpha of α=.81 was adequate, and so was single-level and aggregate consistency. Finally, in the analysis of variance by type of contract, configural, metric and scalar invariance was acceptable, but not strict invariance. (4) Conclusions: This instrument progresses in measuring non-technical attributes, such as communication styles, in nursing personnel.

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.

The modeling and prediction of crop seed yield can be a vital improvement in the precision agriculture industry as it provides reliable assessments of the effectiveness of agro-traits. Here, multiple machine learning (ML) techniques are established for predicting sesame (Sesamum indicum L.) seed yield (SSY) and incorporating agro-morphological features. Models utilized for coupled PCA-ML (Principal component analysis-Machine Learning) methods were compared with original ML models to evaluate predicted efficiency. The Gaussian process regression (GPR) and Radial basis function neural network (RBF-NN) models exhibited the most accurate SSY predictions with determination coefficients or R2 values of 0.99 and 0.91, respectively. The root-mean-square error (RMSE) for the ML models fluctuated between 0 to 0.30 t/ha (metric tons/hectare) for the varied modeling process phases. Estimation of sesame seed yield with coupled PCA-ML models improved performance accuracy. The K-fold process suggested the utilization of datasets with the lowest error rates to ensure the continued accuracy of GPR and RBF models. Sensitivity analysis revealed the capsule number per plant (CPP), seed number per capsule (SPC), and 1000-seed weight (TSW) were the most significant seed yield determinants.

In many countries, governments have implemented non-pharmaceutical techniques to limit COVID-19 transmission. Restricting human mobility is one of the most common interventions, including lockdown, travel restrictions, working from home, etc. However, due to the strong transmission ability of the virus variants, further rounds of interventions, including a strict lockdown, are not considered as effective as expected. The paper aims to understand how the lockdown policy and pandemics changed human mobility in the real scenario. Here we focus on understanding the mobility changes caused by compliance with restrictions and risk perceptions, using the mobility index from the Google report during three strict lockdown periods in Leeds, the largest city in the county of West Yorkshire, England from March 2020 to March 2021. The research proposed the time-varying z-scores and Principal Component Analysis (PCA) to simulate how local people dynamically process and perceive health risk based on multi-dimensional daily COVID-19 reports first. Further modelling highlights exponentially increasing policy non-compliance through the duration of lockdown, probably attributable to factors such as mental anxiety and economic pressures. Finally, the proposed nonlinear regression model examines the mobility changes caused by the population's dynamic risk perceptions and lockdown duration. The case study at Leeds fits data well and shows that the third lockdown policy took effect much slower than the first. At the same time, the negative impact of the epidemic on population mobility decayed 40% in the third lockdown period in contrast with the first lockdown. The risk perception estimation methods could reflect that the local population became increasingly accustomed to the COVID-19 situation, and local people rationally evaluated the risks of COVID in the third lockdown period. The results prove that simulated risk perceptions and policy decay could explain urban mobility behaviour during the mobility well during lockdown periods, which could be a reference for future decision-making processes.

This paper studied the natural convection heat transfer from two equal-sized cylinders of triangular cross-section confined in triangular enclosure. The inner cylinders have hot surfaces and the outer enclosure has a cold surfaces. The annular space between inner cylinders and the outer one was filled with incompressible Newtonian fluid. The work examined the behavior of fluid flow in the process of transferring heat energy. The work was achieved numerically using the commercial code ANSYS-CFX. The adopted initial conditions were selected for these ranges: Prantl number (Pr = 1 to 10³), Rayleigh number (Ra = 10³ to 10⁵). It was found that the increment of Ra number increases the rate of heat transfer. However, the effect of Pr number on heat transfer is almost negligible.

Forest planners have traditionally used expected growth and yield coefficients to predict future merchantable timber volumes. However, because climate change affects forest growth, the typical forest planning methods using expected value of forest growth can lead to sub-optimal harvest decisions. We proposed in this paper to formulate the harvest planning with growth uncertainty due to climate change problem as a multistage stochastic optimization problem and use sample average approximation (SAA) as a tool for finding the best set of forest units that should be harvested in the first period even though we have a limited knowledge of what future climate will be. The objective of the harvest planning model is to maximize the expected value of the net present value (NPV) considering the uncertainty in forest growth and thus in revenues from timber harvest. The proposed model was tested on a small forest with 89 stands and the numerical results showed that the approach allows to have superior solutions in terms of net present value and robustness in face of different climate scenarios compared to the approach using the expected growth and yield. The SAA methods requires to generate samples from the distribution of the random parameter. Our results suggested that a sampling scheme that focuses on generating high number of samples in distant future stages is favorable compared to having large sample sizes for the near future stages. Finally, we demonstrated that, depending on the level of forest growth change, ignoring this uncertainty can negatively affect forest resources sustainability.

We present a class of efficient parametric closure models for 1D stochastic Burgers equations. Casting it as statistical learning of the flow map, we derive the parametric form by representing the unresolved high wavenumber Fourier modes as functionals of the resolved variables’ trajectory. The reduced models are nonlinear autoregression (NAR) time series models, with coefficients estimated from data by least squares. The NAR models can accurately reproduce the energy spectrum, the invariant densities, and the autocorrelations. Taking advantage of the simplicity of the NAR models, we investigate maximal and optimal space-time reduction. Reduction in space dimension is unlimited, and NAR models with two Fourier modes can perform well. The NAR model’s stability limits time reduction, with a maximal time step smaller than that of the K-mode Galerkin system. We report a potential criterion for optimal space-time reduction: the NAR models achieve minimal relative error in the energy spectrum at the time step where the K-mode Galerkin system’s mean CFL number agrees with the full model’s.

Boolean functions and networks are commonly used in the modeling and analysis of complex biological systems, and this paradigm is highly relevant in other important areas in data science and decision making, such as in the medical field and in the finance industry. In a Boolean model, the truth state of a variable is either 0 or 1 at a given time. Despite its apparent simplicity, Boolean networks are surprisingly relevant in many areas of application such as in bioinformatics to model gene expressions and interactions. In the latter case, a gene is either ``on" or ``off" depending on its expression level. Despite the promising utility of Boolean modeling, in most practical applications the Boolean network is not known. Automated learning of a Boolean network and Boolean functions, from data, is a challenging task due in part to the large number of unknowns (including both the structure of the network and the functions) to be estimated, for which a brute force approach would be exponentially complex. In this paper we develop a new information theoretic methodology that we show to be significantly more efficient than previous approaches. Building on the recently developed optimal causation entropy principle (oCSE), that we proved can correctly infer networks distinguishing between direct versus indirect connections, we develop here an efficient algorithm that furthermore infers a Boolean network (including both its structure and function) based on data observed from the evolving states at nodes. We call this new inference method, Boolean optimal causation entropy (BoCSE), which we will show that our method is both computationally efficient and also resilient to noise. Furthermore, it allows for selection of a set of features that best explains the process, a statement that can be described as a networked Boolean function reduced order model. We highlight our method to the feature selection in several real-world examples: (1) diagnosis of urinary diseases, (2) Cardiac SPECT diagnosis, (3) informative positions in the game Tic-Tac-Toe, and (4) risk causality analysis of loans in default status. Our proposed method is effective and efficient in all examples.

Energy storage systems (ESS) are penetrating into various sections of power system through different applications. ESS can be used either as a buffer for intermittent renewable energy sources or as a stand-alone distributed storage for load shifting. ESS use different types of storage devices such as lead-acid batteries, lithium ion batteries, flow batteries, and super-capacitors. Hybrid ESS consisting of few types of storage devices are also common in practice. Determining the load demand of such ESSs at various instances (charging profile) accurately is indispensable in most of the cases. Capacity loss is common phenomenon that occurs in all types of storage devices because of ageing. Capacity loss has to be accounted while determining the charging profile of storage devices for better accuracy. Data-driven modeling is an attractive approach for determining the load demand of ESS due to the availability of valuable data from smart grid technologies. In this paper, the application of different types of data-driven models to predict the current charging profile of the ESS based on previous charging profiles is examined. The proposed method can leverage on the existing data from smart grid and is a black box modeling approach.

There is little understanding of patients' experiences and perceptions with satisfaction by health professionals such as medical and dental clinicians. Furthermore, patient satisfaction is not well understood. The objective of this article is to better understand patients' satisfaction with their medical and dental care. The methods of the current article are based on a narrative review of the literature strategy. Patient satisfaction's multidimensional nature has been established since the perceived reasons for satisfaction varied widely among patients. Many aspects of the treatment influence participant satisfaction at different stages of the intervention's process. An improved understanding of the basis for managing patients' expectations with information reiteratively and efficiently may ultimately reduce patients' potential for negative feelings toward the medical and dental treatment experience. The consumerist method may misrepresent the concept of satisfaction in health service.

The EULAR Sjögren's Syndrome Disease Activity Index (ESSDAI), EULAR Sjogren’s Syndrome Patient Reported Index (ESSPRI), and other patient-reported outcomes (PROs), such as the visual analog scale (VAS) for symptoms and EULAR sicca score (ESS), are used to assess the disease activity of primary Sjögren’s syndrome (pSS). Recently, Clinical ESSDAI (ClinESSDAI) and Clinical Trials ESSDAI (ClinTrialsESSDAI) were developed for objective clinical disease activity indexes. However, the relationship of ClinESSDAI and ClinTrialsESSDAI with PROs as well as that between ESSPRI and other PROs and the objective parameters of glandular function in pSS have not been established. Herein, we investigated the correlation of ESSPRI and other PROs with the objective parameters of glandular function and the relationship of PROs with ClinESSDAI and ClinTrialsESSDAI in 66 patients with pSS. Correlations were calculated with Spearman’s correlation coefficient. ClinTrialsESSDAI was correlated with ESSPRI, dryness (ESSPRI-Dryness), fatigue, and pain domains of ESSPRI, VAS for oral dryness (oral-VAS), and patient’s global assessment. Although ESSPRI did not correlate with the objective parameters of glandular function, ESSPRI-Dryness, ESS, and oral- and ocular-VAS did. These results suggest that ESSPRI-Dryness, ESS, and VAS for symptoms, but not ESSPRI, reflect the glandular dysfunction and that ClinTrialsESSDAI correlates with PROs for dryness in pSS.

This study aimed to translate and psychometrically validate the Neck Outcome Score (NOOS) in the Polish population according to the recommendations of American Academy of Orthopedic Surgeons (AAOS) for the Cross-Cultural Adaptation of Health Status Measures. Participants completed the NOOS, Neck Disability Index (NDI), and Visual Analogue Scale (VAS) for pain assessment. The questionnaires were completed by 57 women and 32 men with cervical spine ailments. A retest was performed in all patients after 48 hours. The analysis confirmed the high internal consistency (Cronbach's alpha of 0.95) of the Polish NOOS. No floor / ceiling effects were observed. The Polish NOOS showed a significant correlation with NDI (0.87; p<0.001) and VAS (0.79; p<0.001). The intraclass correlation coefficient (ICC) for the test-retest was found to be high (0.97). The Polish version of NOOS can be used for clinical and research purposes as an equivalent to the original English version. This study contributes to the area of patient-reported outcome measures available in the Polish language.

Current methodologies for developing patient-derived xenografts (PDX) in humanized mice in preclinical trials to test response to immune-based therapies are limited by graft versus host disease. Here we compared two approaches for establishing PDX tumors in humanized mice: 1) PDX are first established in immune-deficient mice; 2) PDX are initially established in humanized mice, before transplanting established PDX’s to a larger cohort of humanized mice for preclinical trials. With the first approach, there was rapid wasting of PDX-bearing humanized mice with high levels of activated T cells in the circulation and organs, indicating immune-mediated toxicity. In contrast, with the second approach, toxicity was less of an issue and long-term human melanoma tumor growth and maintenance of human chimerism was achieved. Pre-clinical trials from the second approach revealed that rigosertib, but not anti-PD-1, increased CD8/CD4 T cell ratios in spleen and blood and inhibited PDX tumor growth. Resistance to anti-PD-1 was associated with limited infiltration of CD8+ T cell into the tumor. Our findings suggest that it is essential to carefully manage immune editing by first establishing PDX tumors in the presence of human immune cells before expanding PDX tumors into a larger cohort of humanized mice to evaluate therapy response.

High-fidelity patient simulation (HFPS) is widely used in professional training to enhance students’ competence in clinical management. Problem-solving (PS) and clinical reasoning (CR) skills are essential to developing students in professional competence in safe and effective care. These two skills should be initiated at the early training. However, little is known about the effects of HFPS on developing PS and CR skills in first year undergraduate students. Therefore, this pre- and post-experimental study aimed to investigate the effects of HFPS on development of PS and CR skills in first-year nursing students. The students were required to go through four sessions, preparation, pre-briefing and orientation, simulation role-playing, and debriefing, for the HFPS. The study utilized the Problem-Solving Inventory (PSI) and the Nurses Clinical Reasoning Scale (NCRS) to measure problem-solving and clinical reasoning abilities before and after HFPS. Bivariate analysis, one-sample t-test, and independent t-test were performed to evaluate the performance of the PS and CR skills at the two study periods. One hundred eighty-nine students were recruited, with a mean age of 20.56 years, and 73% were female students. The analytic results showed that the PSI, particularly in domains of Problem-Solving Confidence (PSC) (p&lt;0.001) and overall PS (p&lt;0.001), and the CR (p&lt;0.001) had significant improvement after HFPS. The study concluded that HFPS is an effective innovative method to significantly improve students’ problem-solving and clinical reasoning abilities. Nurse educators play an important role in providing explicit learning instructions in a simulation guideline that directs and guides students to learn at each stage of HFPS. Students should take more initiative and engage in their learning through HFPS to enhance their competence in knowledge and higher intellectual skills for personal and professional developments.

Purpose: This study aims to provide a foundational understanding of patient-centric perceptions of telemedicine implementation in rural Minnesota. Methods: This retrospective cohort study utilized a mail questionnaire to assess patient attitudes and behaviors regarding telemedicine during the emergency response to COVID-19. The target population was patients of a Primary Care clinic in eastern Minnesota. Descriptive statistics were used to assess respondents’ level of agreement with survey items scored on a 0-10 scale. Results: A majority of the respondents indicated that they were satisfied with using telemedicine (73.96%); that they gained an additional sense of control over their health condition due to the availability of telemedicine (52.08%); that they would support the use of telemedicine in the future (61.05%); that telemedicine increased access to care (65.63%); telemedicine was preferred over the clinic (61.46%), and that they would purchase new equipment to increase the utility of telemedicine services (54.17%). 51.04% of the respondents indicated a 10/10 level of satisfaction with telemedicine services. 48.96% indicated the strongest level of disagreement related to difficulty using telemedicine or a preference for in-person clinical appointments. Conclusions: Patients were found to have favorable perceptions of telemedicine overall. Though providers continue to recognize the benefit of face-to-face visits, their patients show an increased predilection for virtual care and telemedicine will likely remain an essential tool for providers to reach patients who would otherwise choose not to seek care.

As many as 20-25% of the population experiences harm in outpatient settings, yet these locations are underrepresented in the literature compared to hospitals. We examined results from the Medical Office Survey on Patient Safety Culture designed by the Agency for Healthcare Research and Quality. The survey administered in 2012 gathered perceptions from 23,679 individuals in 934 unique medical offices. We examined associations of organizational patient safety climate composites on frequency of safety and quality issues, overall quality score, and safety rating. We found organizational patient safety composites are all positively and significantly associated with a higher overall quality score and patient safety rating, and fewer safety and quality issues. Office processes and standardization appeared to have the most consistent influence on perceived quality outcomes. Our results indicate it may be advantageous for medical offices to improve on the factors that contribute to positive safety climate.

This study analysed trends of first-time patients visiting the paediatric psychiatry clinic in a university hospital. The medical records from 2009 to 2016 of first-time patients visiting the Kyung Hee university hospital were reviewed, focusing on children in grades 1–12. We analysed the prevalence rate of psychiatric disorders per 100,000 general populations by gender and grade, and the characteristics of patients who sought outpatient care more than three times. The study included 1,467 participants, of which 931 were males (63.5%). The number of male patients per 100,000 populations significantly decreased from 4.14 in 2009 to 2.03 in 2016. While hyperkinetic disorders had the highest prevalence in males, neurotic disorders were most frequent in females. Prevalence of disruptive behaviour disorders in males and mental retardations in females decreased significantly during the study period. The factors affecting continuity were being female, studying in grades 7–12, and diagnosis of depressive, hyperkinetic, and tic disorders. Physicians should consider the new paediatric patients’ gender, grade, and expected diagnosis from their first visit to improve treatment compliance.

Optic nerve sheath diameter (ONSD) can help predict the neurologic outcome of patients with post-cardiac arrest (CA) return of spontaneous circulation (ROSC). We aimed to investigate the effect of ONSD changes before and after CA on neurologic outcomes in patients with ROSC after CA using brain computed tomography (CT). The study included patients hospitalized after CA, who had undergone pre- and post-CA brain CT from January 2001 to September 2020. The patients were divided into good and poor neurologic outcome (GNO and PNO, respectively) groups based on the neurologic outcome at hospital discharge. We performed between-group comparisons of the amount and rate of ONSD changes on brain CT and calculated the area under the curve (AUC) to determine their predictive value for neurologic outcomes. Among the 96 enrolled patients, 25 had GNO. Compared to the GNO group, the PNO group showed significantly higher amount (0.30 vs. 0.63 mm; p=0.030) and rate of change (5.26 vs. 12.29 %; p=0.041). The AUC for predicting PNO was 0.64 (95% CI=0.53–0.73; p=0.04) and patients with a rate of ONSD change &gt;27.2% had PNO with 100% specificity and positive predictive value. Hence, ONSD changes may predict neurologic outcomes in patients with post-CA ROSC.

Irrational use or misuse of antibiotics, particularly by outpatients, increases antibiotic resistance. A lack of public knowledge about ‘Responsible use of antibiotics’ and ‘How to obtain antibiotics’ is a major cause of this. This study aimed to assess the effectiveness of an educational video about antibiotics and antibiotics use to increase outpatient's knowledge in two public hospitals in East Java, Indonesia. A quasi-experimental research setting was used with a one-group pretest-posttest design, carried out from November 2018 to January 2019. The study population consisted of outpatients, to whom antibiotics were prescribed, in two public hospitals in East Java, Indonesia. Participants were selected using a purposive sampling technique; 98 outpatients at MZ General Hospital in S regency and 96 at SG General Hospital in L regency were included. A questionnaire was used to measure the respondents’ knowledge and consisted of five domains, i.e. definition of infections and antibiotics, obtaining the antibiotics, directions of use, storage instructions, antibiotic resistance. The knowledge test score was the total score of the Guttman scale (a dichotomy of ‘yes’ or ‘no’ answers). To determine the significance of the difference in knowledge before and after providing the educational video and in the knowledge score between hospitals, the (paired) Student’s t-test was applied. The educational videos significantly improved outpatients' knowledge, which increased with 41% in MZ General Hospital and 42% in SG General Hospital. An educational video is a useful method to improve the knowledge of the outpatients regarding antibiotics.

(1) Background: Obstetric work requires good communication, which can be trained in interventions targeting health care providers and pregnant women/ patients. This systematic review aims to aggregate the current state of research on communication interventions in obstetrics. (2) Methods: Using the PICOS scheme, studies published in peer-reviewed journals in English or German between 2000 and 2020 were searched. Out of 7,018 results, 71 studies were included in this synthesis and evaluated using the Oxford Level of Evidence Scale. (3) Results: 63 studies, including a communication component, revealed a positive effect on different proximal outcomes (i.e., communication skills). Three studies evaluating the effect of communication training on distal performance indicators (i.e., patient safety) proved to be beneficial to some extent. Most studies included different groups at the same time; those addressing health care providers were more common than those with students (61 vs. 12). Expectant mothers were targeted only in 9 studies. Overall, the evidence level of studies was low (only 11 RCTs), with 24 studies evidence level of I-II, 35 of III, and 10 of IV. (4) Conclusions: Communication training should be applied more often to improve communication of staff, students, and pregnant women, and thereby improve patient safety.

Study background and aims: Laparoscopic cholecystectomy is one of the most frequently performed interventions in departments of general surgery. One of the most important aims in achieving perioperative stability of these patients is diminishing the impact of general anesthesia on the hemodynamic stability and the optimization of anesthetic drug doses based on the individual clinical profile of each patient. The objective of this study is the evaluation of the impact monitoring the depth of anesthesia through Entropy (state entropy – SE and response entropy -RE) has on the hemodynamic stability and on the doses of volatile anesthetic. Material and Methods: This is a prospective, observational, randomized, monocentric study carried out between January 2019 and December 2019 in the Clinic of Anesthesia and Intensive Care from the “Pius Brînzeu” Emergency County Hospital in Timișoara, Romania. The patients included in the study were divided in two study groups; patients in Group A (target group) received multimodal monitoring that included monitoring of standard parameters and of Entropy (SE and RE), while patients in Group B (control group) only received standard monitoring. Anesthetic dose in group A were optimized to achieve a target entropy of 40-60. Results: 68 patients met the inclusion criteria and were allocated to one of the two study groups, Group A (N=43) and Group B (N=25). There were no statistically significant differences identified between the two groups for both demographical and clinical data (p>0.05). Statistically significant differences have been identified for the number of hypotensive episodes (p = 0.011, 95% CI 0.1851 to 0.7042) and for the number of episodes of bradycardia (p < 0.0001, 95% CI 0.3296 to 0.7923). Moreover, there was a significant difference in the Sevoflurane consumption between the two study groups (p = 0.0498, 95% CI -0.3942 to 0.9047). Conclusions: The implementation of the multimodal monitoring protocol that includes the standard parameters and the measurement of Entropy for determining the depth of anesthesia (SE and RE) lead to a considerable improvement in perioperative hemodynamic stability. Optimizing the doses of anesthetic drugs based on the individual clinical profile of each patient leads to a considerable decrease in drug consumption as well as to a lower incidence of hemodynamic side-effects.

The rapid adoption of hydrogen as an eco-friendly energy source has necessitated the development of intelligent power management systems capable of efficiently utilizing hydrogen resources. However, guaranteeing the security and integrity of hydrogen-related data has become a significant challenge. This paper proposes a pioneering approach to ensure secure hydrogen data analysis through the integration of blockchain technology, enhancing trust, transparency, and privacy in handling hydrogen-related information. By combining blockchain with intelligent power management systems, the efficient utilization of hydrogen resources becomes feasible. The utilization of smart contracts and distributed ledger technology facilitates secure data analysis, real-time monitoring, prediction, and optimization of hydrogen-based power systems. The effectiveness and performance of the proposed approach are demonstrated through comprehensive case studies and simulations. Notably, our prediction models, including ABiLSTM, ALSTM, and ARNN, consistently delivered high accuracy with MAE values of approximately 0.154, 0.151, and 0.151, respectively, enhancing the security and efficiency of hydrogen consumption forecasts. The blockchain-based solution offers enhanced security, integrity, and privacy for hydrogen data analysis, thus contributing to the advancement of clean and sustainable energy systems. Additionally, the research identifies existing challenges and outlines potential future directions for further enhancing the proposed system. This study adds to the growing body of research on blockchain applications in the energy sector, with a specific focus on secure hydrogen data analysis and intelligent power management systems.

This study delves into the dynamic intersection of artificial intelligence (AI) and English Language Teaching (ELT) within the post-pandemic educational landscape. Grounded in Constructivism, Connectivism, and Technological Pedagogical Content Knowledge (TPACK), this research explores how AI integration impacts language instruction efficiency, benefits and challenges perceived by St. Michael's College students, differences in learning outcomes, and its potential to address the digital divide. Employing a qualitative approach, the study employs a rigorous method that includes intensive in-depth reviews of literature, maximum purposeful sampling, informal interviews, observation, and thematic analysis. Through these methods, data was collected from 30 participants, leading to the identification of five key themes. Findings suggest that AI enhances instructional efficiency, offers personalized learning experiences, and bridges gaps in remote settings. However, challenges and the importance of pedagogical balance emerged. The study underscores the need for adaptive pedagogical strategies to fully harness AI's potential. Future directions and limitations are discussed, emphasizing the study's implications for shaping the future of ELT.

Water quality assessments are crucial for human health and environmental safeguards. The utilization of a subset of artificial intelligence such as Machine Learning (ML) presents significant impacts to enhance the prediction and classification of water quality. In this research, a set of diverse ML algorithms was evaluated to handle a comprehensive dataset of water quality measurements over an extended period. The aim was to develop a robust approach for accurately forecasting water quality. This approach employed machine learning classifiers such as Logistic Regression (LR), Support Vector Machine (SVM), Stochastic Gradient Descent (SGD), K-Nearest Neighbors (KNN), Gaussian Process Classification (GPC), Gaussian Naive Bayes (GNB), Random Forest (RF), Decision Tree (DT), XGBoost, and Multilayer Perceptron (MLP). The water quality parameters assessed for pH, hardness, solids, chloramines, sulfate, conductivity, organic carbon, trihalomethanes and turbidity. The XGBoost model exhibited the highest accuracy of 89.47% among the classifiers and Stacked Ensemble Classifiers (SEC) improved the prediction further to 92.98%. The findings suggest that XGBoost and the SEC hold promise as reliable approaches for water quality assessments in contrast of artificial intelligence.

Amidst the dynamic landscape of education, this paper embarks on a transformative journey that explores the integration of Artificial Intelligence (AI) in literature and language education. Through a qualitative exploratory approach, purposeful and maximum variation sampling method, the researcher delves into the experiences of educators and learners, unraveling the multifaceted dimensions of AI-driven pedagogy in SMC. Drawing upon a theoretical framework encompassing Constructivism, Connectivism, and Socio-Cultural Theory, the study examines AI's role in reshaping pedagogical landscapes, fostering critical thinking, and expanding access to education. The results resonate with participants' narratives, unveiling AI's potential in fostering personalized learning pathways, enhancing collaborative engagement, and bridging digital divides. Ethical considerations in AI education are explored, leading to the proposition of responsible guidelines. These findings underline the transformative power of AI in education, aligned with the institution's commitment to quality education and innovation. Overall, the study calls for ongoing exploration, emphasizing the qualitative research method's depth and richness, as well as the theoretical framework's guidance in realizing the study's objectives. As AI continues to shape education's frontiers, this research underscores the significance of adaptability, ethical awareness, and holistic engagement for school administrators, educators, learners, and researchers alike.

In econometrics and finance, volatility modelling has long been a specialised field for addressing a variety of issues pertaining to the risk and uncertainties of an asset. This study presents a robust framework, through a step-by-step design, that is relevant for effective Monte Carlo simulation (MCS) with empirical verifications to estimate volatility using the Generalized Autoregressive Score (GAS) model. The framework describes an organised approach to the MCS experiment that includes "background (optional), defining the aim, research questions, method of implementation, and summarised conclusion". The method of implementation is a workflow that consists of writing the code, setting the seed, setting the true parameter a priori, data generation process, and performance assessment through meta-statistics. Among the findings, it is experimentally demonstrated in the study that the GAS model with a lower unconditional shape parameter value can generate a dataset that adequately reflects the behaviour of financial time series data, relevant for volatility estimation. This dynamic framework is intended to help interested users on MCS experiments utilising the GAS model for reliable volatility calculations in finance and other areas.

Modeling is essential to understand better the generative mechanisms responsible for experimental observations gathered from complex systems. In this work, we are using such an approach to analyze the electrocardiogram (ECG). We present a systematic framework to decompose ECG signals into sums of overlapping lognormal components. We used reinforcement learning to train a deep neural network to estimate the modeling parameters from ECG recorded in babies of 1 to 24 months of age. We demonstrate this model-driven approach by showing how the extracted parameters vary with age. After correction for multiple tests, 10 of 24 modeling parameters showed statistical significance below the 0.01 threshold, with absolute Kendall rank correlation coefficients in the [0.27, 0.51] range. We presented a model-driven approach to the analysis of ECG. The impact of this framework on fundamental science and clinical applications is likely to be increased by further refining the modeling of the physiological mechanisms generating the ECG. By improving the physiological interpretability, this approach can provide a window into latent variables important for understanding the heart-beating process and its control by the autonomous nervous system.

River flow prediction is a pivotal task in the field of water resource management during the era of rapid climate change. The highly dynamic and evolving nature of the climatic variables e.g., precipitation has a significant impact on the temporal distribution of the river discharge in recent days making the discharge forecasting even more complicated for diversified water-related issues e.g., flood prediction and irrigation planning. To predict the discharge, various physics-based numerical models are used using numerous hydrologic parameters. Extensive lab-based investigation and calibration are required to reduce the uncertainty involved in those parameters. However, in the age of data-driven predictions, several deep learning algorithms showed satisfactory performance in dealing with sequential data. In this research, Long Short-term Memory (LSTM) neural network regression model is trained using over 80 years of daily data to forecast the discharge time series up to 3 days ahead of time. The performance of the model is found satisfactory through the comparison of the predicted data with the observed data, visualization of the distribution of the errors and Root Mean Squared Error (RMSE) value of 0.09. Higher performance is achieved through the increase in the number of epochs and hyper parameter tuning. This model can be transferred to other locations with proper feature engineering and optimization to perform univariate predictive analysis and potentially be used to perform real-time river discharge prediction.

Health-related data originating from diverse sources are commonly stored in manifold databases and formats, making it difficult to find, access and gather data for research purposes. In addition, so-called secondary use scenarios for health data are usually hindered by local data codes, missing dictionaries and the lack of metadata and context descriptions. Following the FAIR principles (Findable, Accessible, Interoperable and Reusable), we developed a decentralized infrastructure to overcome these hurdles and enable collaborative research by making the meaning of health-related data understandable to both, humans and machines. This infrastructure is currently being implemented in the realm of the Swiss Personalized Health Network (SPHN), a research infrastructure initiative for enabling the use and exchange of health-related data for research in Switzerland. The SPHN ecosystem for FAIR data consists of the SPHN Dataset (semantic definitions), the SPHN RDF Schema (linkage and transport of the semantics in a machine-readable format), a project RDF template, extensive guidelines and conventions on how to generate SPHN RDF schema, a Terminology Service (converter of clinical terminologies in RDF), and a Quality Assurance Framework (automated data validation with SHACLs and SPARQLs). The SPHN ecosystem has been built in a way that it can easily be adapted and extended by any SPHN project to fit individual needs. By providing such a national ecosystem, SPHN supports researchers in generating, processing and sharing FAIR data.

The report details out programming approach for automating warehouse using Answer Set Programming.

The road traffic injuries risk factors such as driving offenses and average speed are concerns for health organizations to reduce the number of injuries. Without any comprehensive view of each road, one cannot decide about the effective policy. In this manner, the data-driven policy will help to improve and assess the decisions. The count data near the road of two airports is surveyed for investigating the time-varying speed zones. The descriptive statistics, ANOVA, and functional data analysis were used. The hourly data of traffic counts for four different locations at the entrance of the two airports, international and domestics, were collected for one the year 2018 to 2019.The hourly pattern of driving offenses for each road was assessed and the to and from airport roads had different peaks (<0.05). The hour, weekdays, type of airport, direction and their interactions were statistically significant (<0.05) for the chance of driving offenses. The speed average during the day was statistically different (<0.5) by the number of different types of vehicles. The traffic count data is a great resource for decision making in safe driving subjects such as driving offenses. With functional data analysis, we can analyze them to get the most of the characteristics of this data. The airports are public places with high traffic demand in all countries that yields the different pattern of traffic transportation, therefore we extract the factors that affect the driving offenses. Finally, we conclude that conducting a time-varying speed zone near the airports seems vital.

Modeling brain dynamics to better understand and control complex behaviors underlying various cognitive brain functions are of interests to engineers, mathematicians, and physicists from the last several decades. With a motivation of developing computationally efficient models of brain dynamics to use in designing control-theoretic neurostimulation strategies, we have developed a novel data-driven approach in a long short-term memory (LSTM) neural network architecture to predict the temporal dynamics of complex systems over an extended long time-horizon in future. In contrast to recent LSTM-based dynamical modeling approaches that make use of multi-layer perceptrons or linear combination layers as output layers, our architecture uses a single fully connected output layer and reversed-order sequence-to-sequence mapping to improve short time-horizon prediction accuracy and to make multi-timestep predictions of dynamical behaviors. We demonstrate the efficacy of our approach in reconstructing the regular spiking to bursting dynamics exhibited by an experimentally-validated 9-dimensional Hodgkin-Huxley model of hippocampal CA1 pyramidal neurons. Through simulations, we show that our LSTM neural network can predict the multi-time scale temporal dynamics underlying various spiking patterns with reasonable accuracy. Moreover, our results show that the predictions improve with increasing predictive time-horizon in the multi-timestep deep LSTM neural network.

In the last decades synthetic jet actuators have gained much interest among the flow control techniques due to their short response time, high jet velocity and absence of traditional piping, that matches the requirements of reduced size and low weight. A synthetic jet is generated by the diaphragm oscillation (generally driven by a piezoelectric element) in a relatively small cavity, producing periodic cavity pressure variations associated with cavity volume changes. The pressured air exhausts through an orifice, converting diaphragm electrodynamic energy into jet kinetic energy. This review paper faces the development of various lumped-element models (LEMs) as practical tools to design and manufacture the actuators. LEMs can quickly predict device performances such as the frequency response in terms of diaphragm displacement, cavity pressure and jet velocity, as well as the efficiency of energy conversion of input Joule power into useful kinetic power of air jet. The actuator performance is analyzed also by varying typical geometric parameters such as cavity height and orifice diameter and length, through a suited dimensionless form of the governing equations. A comprehensive and detailed physical modeling aimed to evaluate the device efficiency is introduced, shedding light on the different stages involved in the process. Overall, the influence of the coupling degree of the two oscillators, the diaphragm and the Helmholtz’s one, on the device performance is discussed throughout the paper.

In the context of the emergence and development of varieties of English around the globe, this paper focuses on Kuwait, where the use of English has greatly increased since the mid-20th century. Drawing on the principles of nativisation and indigenisation, I investigate substrate- and superstrate-derived discourse-pragmatic markers (DPMs) in Kuwaiti English: the Arabic loanwords alhamdulillah and ya'ni and their English equivalents (e.g. I mean and thankfully). Data are drawn from the Kuwaiti English National Corpus, a spoken corpus of almost 800,000 words containing interviews, samples of situated language use, and mediated data (podcasts, TV, radio and YouTube). Keyness and concordance analyses were performed to identify the frequency and functions of the DPMs in Kuwaiti English compared to reference corpora of British and American English. The analysis also takes into account contextual and sociolinguistic information such as the speakers’ social identity. Results show that the Arabic-derived DPMs are abundant in both formal and informal settings, indicating that they have become an integral part of this variety of English. Their English equivalents perform similar roles, but are vastly less common (with the exception of I mean for ya'ni). Both the Arabic- and English-based markers show somewhat narrowed discourse-pragmatic functions and are more likely to be placed in clause-initial position than in ‘native’ contexts. Their use appears to be linked to the social identity of the speakers.

Performing predictive maintenance (PdM) is challenging for many reasons. Dealing with large datasets which may not contain run-to-failure data (R2F) complicates PdM even more. When no R2F data are available, identifying condition indicators (CIs), estimating the health index (HI), and thereafter, calculating a degradation model for predicting the remaining useful lifetime (RUL) are merely impossible using supervised learning. In this paper, a 3 dof delta robot used for pick and place task is studied. In the proposed method, autoencoders (AEs) are used to predict when maintenance is required based on the signal sequence distribution and anomaly detection, which is vital when no R2F data is available. Due to the sequential nature of the data, non-linearity of the system, and correlations between parameter time series, convolutional layers are used for feature extraction. Thereafter, a sigmoid function is used to predict the probability of having an anomaly given CIs acquired from AEs. This function can be manually tuned given the sensitivity of the system or optimized by solving a minimax problem. Moreover, the proposed architecture can be used for fault localization for the specified system. Additionally, the proposed method is capable of calculating RUL using Gaussian process (GP), as a degradation model, given HI values as its input.

The segmentation and de-noising are basic operations, required in every signal processing and classification system. The classical segmentation and de-noising approaches are time-invariant. Consequently, it results in the post processing of an unnecessary information and causes an increase in the system processing activity and power consumption. In this context, an efficient event-driven segmentation and de-noising technique is proposed. It is founded on the principles of level crossing and activity selection. Therefore, it can adapt its sampling frequency, segmentation window length and position along with the filter order by analyzing the input signal local characteristics. As a result, the computational complexity and the power consumption of the proposed system is reduced compared to the counter ones. The suggested system performance is compared with the classical one. It is done for the case of a multi-channel Electroencephalogram (EEG) signals. Results show a noticeable compression gain with an effective adaptation of the de-noising filters order. It aptitudes a significant computational gain, transmission data rate reduction and power consumption reduction of the proposed technique, compared to the counter ones. It shows that the proposed solution is an attractive candidate to embed in the new generation EEG wearables.

There is some evidence that aspects of nurse-doctor communication are associated with the quality of care and treatment patients receive whilst they are in hospital. To date, no studies have examined stakeholder perceptions of how patient care is influenced by clinical communication between nurses and doctors. We conducted a concept mapping study to generate a deep understanding of how clinical communication impacts patient care. Concept mapping has six phases: preparation, idea generation, structuring, representation, interpretation, and utilization. Twenty patients, 21 nurses, and 21 doctors participated in the study. Brainstorming generated 69 discreet statements about how nurse-doctor communication impacts patient care. The structuring (rating and clustering) phase was completed by 48 participants. The data interpretation workshop selected a five-cluster solution: effective communication, trust, patient safety, impediments to patient care, and interpersonal skills. On the final concept map, the five clusters were arranged in a circle around the center of the map. Clusters were relatively equal in size suggesting, each concept makes a broadly equal contribution to how nurse-doctor communication influences patient care. Our study suggests that there are multiple aspects of clinical communication that impact patient care. Candidate interventions to enhance nurse-doctor communication may need to consider the complex nature of interprofessional working. Registration: This study was prospectively registered with the Open Science Framework (OSF) (https://osf.io/9np8v/) prior to recruiting the first participant.

Background: This study aims to investigate the patient safety culture at a sports medicine hospital and explore quality of healthcare and associated factors. Methods: In a cross-sectional study design, the tool Hospital Survey on Patient Safety Culture (HSOPC) was administered online among staff at a sports medicine hospital in Doha, Qatar. About 319 staff participated from 898 staff who received emails (35.5%). Results: The results showed that 49.2% of the staff rated the patient safety grade as excellent and 36.1% as very good, which sums up to 85.3%. Factors associated with better patient safety grade were work climate (OR 10.3 95% CI (3.2 to 33.6); teamwork OR 7.6 95% CI (2.8 to 20.9) and team communication (OR 2.9 95% CI (1.1 to 7.6). Conclusions: Addressing the work climate, enhancing communication, and cohesive work within teams facilitates a culture of trust that improves patient safety grade. Ensuring quick return to play is a team effort involving multiple disciplines, hence a high performance and safety culture can enhance teamwork. Reducing punitive response to error and encouraging staff and supervisors are key areas that can improve safety culture in sports medicine organizations, and efforts should be placed in this area.

Patient value is an important factor in clinical decision-making, but conventionally, it is not incorporated in the decision processes. In this paper, a value-based therapy recommendation comprehensive model is proposed. A literature analysis is conducted to collect value-based evidence. Categorized values and candidate therapies are used in combination as filtering keywords to build this evidence. Then a formalism model is put forward to integrate the value-based evidence with clinical evidence. The relative importance of two evidence can be adjusted dynamically by decision-makers during the decision-making processes. A prototype system was implemented using a case study for breast cancer and validated for feasibility and effectiveness.

Keywords: chronic lymphocytic leukemia; older patient, Bruton tyrosine kinase, BCL2, cost-effectiveness Bruton tyrosine kinase inhibitors (BTKi) and the BCL2 inhibitor venetoclax, with or without the anti CD20 monoclonal antibody Obinutuzumab, represent the preferred options for the first-line therapy of CLL because they are more effective and may improve quality of life. However, pa-tient’s inclusion criteria were heterogeneous across trials designed for older patients and the identification of CLL-specific parameters identifying unfit patients at risk of developing drug-specific adverse events are required to guide treatment choice. Due to inclusion/exclusion criteria in trials, higher discontinuation rates with BTKi were reported in real-world studies and registry analyses provided useful information on factors predicting for earlier discontinuation in a real-world setting. Though targeted agents were shown to be cost-effective treatments in high-income countries, the out-of-pocket expenses may limit accessibility to these drugs and the overall expenditure for new drugs in CLL is projected to increase substantially posing an issue for sustainability. This being said, the choice of a finite duration treatment based on venetoclax containing regimens or treatment until progression with BTKi is today possible in high- income countries and the therapy choice drivers are represented by coexisting medical conditions rather than age, by patient expectations, logistics and sustainability.

Thermoregulation is important for maintaining homeostasis of our body. It can be easily broken under anesthesia. An appropriate method to measure the core body temperature is needed, especially for elderly patients because the efficiency of thermoregulation gradually decreases with age. The aim of this study was to examine the accuracy and feasibility of using of SpotOn® sensor in lower extremity orthopedic surgery in elderly patients aged over 80 years by comparing a SpotOn® sensor with two other reliable minimal-invasive methods: a tympanic membrane thermometer and a bladder thermometer. This study enrolled 45 patients aged over 80 years who were scheduled to undergo a lower extremity surgery. Body temperature was measured using a SpotOn® sensor, tympanic membrane thermometer and bladder thermometer. Agreements between the SpotOn® sensor and the other two methods were assessed using Bland and Altman plots for repeated measures adjusted for unequal numbers of measurements per patient. Compared with TempBladder, bias and limits of agreement for TempZHF were 0.07℃ ± 0.58℃. Compared with TempTympanic, bias and limits of agreement for TempZHF were -0.28℃ ± 0.61℃. 3M SpotOn® sensor using ZHF method for patients aged over 80 years undergoing lower extremity surgery shows feasible measurement value and sensitivity.

In previous clinical studies, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients with cancer has a high risk of aggravation and mortality than in healthy infected individuals. The inoculation with the COVID-19 vaccine reduces the risk of SARS-CoV-2 infection and COVID- 19 severity. However, vaccination-induced production of anti-SARS-CoV-2 antibodies is said to be lower in patients with cancer than in healthy individuals. Additionally, the rationale for why patients with cancer become more severe with COVID-19 is not well understood. Therefore, we examined the infection status of SARS-CoV-2 in primary tumor and micrometastasis tissues of patients with cancer and COVID-19. In this study, angiotensin-converting enzyme 2 (ACE2) expression was observed, and SARS-CoV-2 particles were detected in ovarian tissue cells in contact with the micrometastatic niche of high-grade serous ovarian cancer. We believe that more severe COVID-19 cases in patients with cancer may be attributed to these pathological features.

Today, across the most critical problems faced by hospitals and health centers are those caused by the existence of patients who do not attend their appointments. Among others, this practice generates waste of resources and increases the patients’ waiting list. To handle these problems, hospitals are actively trying to implement methods to reduce the idle time caused by patient no-shows. Many scheduling systems developed require predicting whether a patient will show up for an appointment or not. Although, a challenging problem resides in obtaining these estimates precisely. The goal of this work is to analyze how objective factors influence a patient not to attending their appointment, to identify the main causes that contribute to a patient’s decision, and to be able to predict whether or not the patient will attend the scheduled appointment. As a result, the obtained model is tested on a real dataset collected in a health center linked to the University of Vale do Itajaí (UNIVALI), which includes 25 features and about 5000 samples. The algorithm that produced the best results for the available dataset is the Random Forest classifier. It reveals the best recall rate (0.91), since it measures the ability of a classifier to find all the positive instances and achieves a receiver operating characteristic curve rate of 0.969.

The Acute Cystitis Symptom Score (ACSS) is a patient self-reporting questionnaire for the clinical diagnosis and patient-reported outcome (PRO) in women with acute uncomplicated cystitis (AC). The aim of the current study (part II) was the clinical validation of the Greek ACSS questionnaire. After linguistic validation according to internationally accepted guidelines and cognitive assessment (part I), the clinical validation was performed after ethical approval by using the Greek ACSS study version in 92 evaluable female participants including 53 patients with symptoms suspicious of AC and 39 controls. The clinical outcome using the ACSS questionnaire at different time points after the start of treatment was demonstrated as well. The age (mean±SD) of the 53 patients (44.7±17.0) and 39 controls (49.3±15.9) and their additional conditions at baseline visits, such as menstruation, premenstrual syndrome, pregnancy, menopause, diabetes mellitus, were comparable. There was, however, a significant difference (p&lt;0.001) between patients and controls at baseline visit regarding sum score of the ACSS domains, such as typical symptoms and quality of life. The clinical outcome of up to 7 days showed a fast reduction of the symptom scores and improvement of quality of life. The optimal thresholds for the patient-reported outcome of successful therapy could be established. The linguistically and clinically validated Greek ACSS questionnaire can now be used for clinical or epidemiological studies and also for patient’s self-diagnosis of AC and as a PRO measure tool.

Purpose: "Just culture" is an element of safety culture, and in a broader sense – a part of quality culture. It is the subject of studies, especially in healthcare. This phenomenon is almost unknown in Polish medical facilities. For this reason, the aim of the article is to present the essence and significance of "just culture" in healthcare. The other aim of the research is to present the results of the validation of "just culture" assessment instrument used to recognize the "just culture" maturity level and evaluate the nurses’ beliefs and behaviours in the light of "just culture" criteria. Methodology/Approach: The verified questionnaire consisted of 28 statements in relation to which respondents expressed their opinion on a 5-point Likert scale. The questionnaire was distributed among nurses in one of the largest hospitals in Pomorskie Voivodeship, in Poland. The results based on 68 responses were statistically processed with Statistica 13.1 software. Findings: The obtained results allowed to confirm the reliability of the assessment tool, to recognize the level of „just culture” as wisdom (68%) and to indicate strengths and weaknesses of observed beliefs and behaviours. On this basis, improvement actions were proposed. Originality/Value: We use the original, own prepared questionnaire. This is the first study on "just culture" in healthcare in Poland. There are only few studies devoted to patient safety culture in Poland and no research addressed to "just culture" phenomenon, as well in Poland as in Central Europe. The results in this area allow to recommend the assessment tool for other hospitals and seem to help in understanding the essence of "just culture" implementation.

This paper proposes an optimal trading algorithm based on a novel application of the conventional Control Engineering (CE). We consider a fundamental CE concept, namely, the feedback control and apply it to the Algorithmic Trading (AT). The concrete feedback control strategy is designed in a form of the celebrated Proportional-Integral-Derivative (PID) model. The highly fluctuating nature of the modern financial markets has led to the adoption of a model-free realisation of the generic PID framework. The control theoretical methodology we propose is combined with the advanced statistics for the historical market data. We obtain a specific log-normal probability distribution function (pdf) associated with the specific quantities associated with the available stock data. The empirical log-normal pdf mentioned above makes it possible the necessary PID gains optimization. For this aim, we apply the data-driven optimization approaches and consider the corresponding Monte Carlo solution procedure. The optimized PID trading algorithm we propose is also studied in the Fourier analysis framework. This equivalent frequency domain representation involves a new concept in the financial engineering, namely, the "stock market energy" concept. For the evaluation, we implement the proposed PID optimal trading algorithm and develop a Python based prototype software. We finally apply the corresponding prototype software to a dataset from the Binance BTC / USDT stock market. The experimental result illustrates the implementability of the proposed optimal PID trading scheme and also shows the effectiveness of the proposed CE methods in the modern AT.

Wave buoy measurements were carried out near the north-eastern Black Sea coast at the natural reserve Utrish in 2020-2021. In total, about 11 months of data records were collected during two stages of the experiment at 600 and 1500 meters offshore and depths of 18 and 42 meters. The measured waves propagate almost exclusively from the seaward directions. Generally, the waves do not follow the local wind directions, thus, implying a mixed sea state. Nevertheless, dimensionless wave heights and periods appears to be quite close to the previously established empirical laws for the wind-driven seas. The results of the wave turbulence theory are applied for estimates of spectral energy fluxes and their correspondence to the energy flux from the turbulent wind pulsations. These estimates are consistent with today's understanding of wind-wave interaction. It is shown that the main fraction of the wind energy flux goes to the direct Kolmogorov-Zakharov cascade to high wave frequencies and then to dissipation in small scales. Less than 1% of the wind energy flux is directed to low frequency band (the so-called inverse Kolmogorov-Zakharov cascade), thus, providing wave energy growth.

For the emerging autonomous swarm technology, from the perspective of systems science and systems engineering, there must be some novel elements and methods to aggregate multiple systems into a group, which distinguish with the general components with specific functions, and we expect to provide the presentation of their existence in the swarm development processes. The inspiration of our methodology origins from the integration of swarm ontology, multi-paradigm modeling, multi-agent system, cyber-physical system, etc. Therefore, we choose the model-driven technology as a framework to acquire an approach of model representation across the multiple levels of abstraction and composition. The autonomous strategic mechanism is defined and formed in parallel with ConOps analysis and systems design, so as to effectively solve the cognitive problem of emergence caused by the nonlinear causation among individual and whole behaviors. This approach highlights to use the MBSE processes and their artifacts to embed the meso mechanism to integrate the operational and the functional, and which means to connect the macro and micro aspects in formalism and so to become a whole with its expected goals, and then to verify and validate within a L-V-C simulation environment.