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.

Dietary supplements are widely embraced by cancer patients seeking complementary and integrative approaches to their care. Unfortunately, many patients do not discuss supplement use with physicians, often due to perceptions of physician indifference or negativity toward supplements. This communication gap exposes patients to unreliable information sources and, potentially, unnecessary risk. As the healthcare landscape evolves, patients increasingly value physicians who recognize their pivotal role in shaping healthcare decisions. This patient-centered perspective emphasizes the provision of evidence-based information tailored to individual needs, open discussions on potential risks, and shared decision-making. It underscores the importance of respecting patient autonomy, offering alternative options, documenting preferences, and ensuring ongoing support while coordinating with the healthcare team. To address these needs, healthcare providers should transform their perspectives and become expert guides who embrace patients as informed, empowered participants. This approach prioritizes open dialogue that considers both facts and uncertainties regarding dietary supplement use, allowing for mutually informed decision-making. Here, we review the literature and present a practical approach emphasizing open discussions, transparency, and respect for patient autonomy. Following this approach, healthcare providers can empower patients to navigate the complexities of dietary supplement use in the context of cancer care, ultimately safeguarding patient safety and well-being.

This paper presents a theoretical framework aimed at improving IoT network cybersecurity by AI-driven anomaly detection in the context of rapid urbanization and the development of smart cities. The framework draws upon the Complex Adaptive Systems Theory, Theory of Planned Behavior, the Technology Acceptance Model, and the Socio-Technical Systems Theory, and intri-cately examines how AI might be integrated into the intricate ecosystem of smart cities to detect and mitigate cyber threats. It emphasizes AI-driven anomaly detection methods as pivotal in-struments that impact cybersecurity enhancement in smart city infrastructures. The proposed framework also highlights the crucial role that human-related factors, including user behavior and adoption, play in determining how effective AI applications are in enhancing cybersecurity in smart cities. It also recognizes the important moderating roles played by outside factors like legislative frameworks, environmental contexts, and technological breakthroughs in the relationship between AI-enabled anomaly detection and enhanced cybersecurity. The goal of this research is to shed light on the interactions between technology and socio-technical dynamics by offering a thorough theoretical understanding of AI's potential in smart city cybersecurity. It highlights the significance of taking into account a variety of contextual aspects when employing AI to strengthen the digital security of urban areas, and provides a strategic direction for future research and practical implementation.

The Genji firefly is a key symbol of the conservation and management of rural environments. The species lives underwater as larvae, in the soil when they pupate, and emerges on the ground as adults. Because of the large differences in habitat conditions between larvae and adults, the habitat requirements of the Genji firefly must be clarified over a wide range, from the instream to the surrounding riparian environment. In this study, we built a habitat suitability model for the Genji firefly by relating local landscape features to the number of individuals surveyed in a small river in an agricultural watershed. For habitat suitability modelling, tree-based machine learning methods, namely Random Forests (RF) and classification and regression trees (CART), are used to model species distributions and extract quantitative information on their ecological characteristics. Because the model performance on the test dataset was poor, we removed noisy absences using model outputs from the RF computation using the entire dataset. As a result, we observed improved model performance, in which there seems to be an optimal level for removing noisy absences. Variable importance and partial dependence plots were then used to visualize the relationship between the local landscape features and habitat suitability of the adult firefly. Detailed information on landscape features extracted using RF and CART is useful for a deeper understanding of the ecology of the Genji fireflies.

This paper argues that popular misrepresentation of the nature of AI has important consequences concerning how it should be regulated. Viewing AI as something that exists in itself, rather than as a set of cognitive technologies whose characteristics – physical, cognitive, and systemic – are quite different from ours (and at times from each other) leads to inefficient approaches to regulation. It limits our ability to anticipate the consequences of its foreseeable developments and social diffusion. It undermines attempts to protect ourselves from the social and political dangers it presents. After a short introduction, section 2 retraces rapidly the history of the idea that intelligence is essentially a quality, one that AI shares with human intelligence and that this resemblance trumps the differences that exist between artificial and natural cognitive systems. Section 3 reviews two approaches to the dangers of AI that reflect the illusion that AI exists in itself. Section 4 turns to the proper understanding of regulations and what is their main goal and purpose. Section 5 analyses three central characteristics of artificial cognitive systems which section six compares with corresponding characteristics of natural cognitive systems. Finally, section 7 draws some conclusions regarding how we should regulate artificial intelligence.

This study presents the manufacturing process driven development of an interlocking metasurface mechanism (ILM) for Fused Filament Fabrication (FFF) with a focus on open-source accessibility. The presented ILM is designed to enable strong contact between to planar surfaces. The mechanism consists of spring elements and locking pins which snap together when forced into contact. The mechanism is designed to optimize mechanical properties, functionality and printability with common FFF printers. The mechanisms is printed from thermoplastic polyurethane (TPU) filament which was selected for its flexibility, crucial for spring element performance and tolerances of the fabrication method. To characterize the designed mechanism a tensile test is carried out to assess the holding force of the ILM. The force-displacement profiles are analyzed and categorized into distinct phases, highlighting the interplay between spring deformation, sliding, and disengagement. The results show variations in holding forces attributed to geometric and material-related factors. The testing results are compared and discussed to a numerical simulation carried out with a frictionless approach with a nonlinear Neo–Hookean material law. The study underscores the importance of meticulous parameter control in 3D printing for consistent and reliable performance of interlocking metasurface mechanisms. The investigation leads to a scalable model of a ILM element pair with a distinct three-phase snapping characteristics ensuring reliable holding capabilities.

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.

Background and Objectives: ACTION-France (Awareness, Care and Treatment In Obesity MaNagement in France) aims to identify the perceptions, attitudes, behaviors, and potential barriers to effective obesity management in France and guide collaborative actions. Methods: ACTION-France is a cross-sectional survey of people with obesity (PwO) and healthcare professionals (HCPs), in France. The PwO and HCP questionnaires ran from 27/09/2022 to 01/02/2023 and from 19/12/2022 to 31/03/2023, respectively. Results: The study, encompassing 1226 PwO and 166 HCPs, reveals a shared recognition of obesity as a chronic condition. However, despite being requested by most PwO, weight-related discussions are surprisingly infrequent, leading to delayed diagnosis and care. PwO and HCPs held different views as to why: HCPs often attributed it to PwO’s lack of motivation or disinterest, whereas PwO avoided them because they felt weight managing was their own responsibility and were uncomfortable discussing it. When weight was discussed, primarily with general practitioners (GPs), discussions mostly focused on physical activity and dietary. However, results identified a strong psychosocial impact of obesity: 42% of respondents reported anxiety-depressive symptoms, and many more hesitated to engage in certain social activities because of their weight. Psychotherapy was only discussed by 55% of HCPs. Pharmaceutical options were also rarely discussed (19.5% of HCPs), though 56.1% of PwO reported they would want to. Conclusions: HCPs’ and PwO’s perceptions differed significantly and need to converge through enhanced communication. A holistic approach, integrating comprehensive training for GPs and psychological comorbidities, would help to bridge perceptual gaps effectively and foster more empathetic and effective patient care.

The literature study delves into novel therapeutic strategies in transplantation medicine, highlighting unique approaches that could revolutionize current practices. It emphasizes novel patterns that have the potential to transform the current landscape. Commencing with a thorough examination of the historical environment, it traces crucial advances and changes in transplantation. The focus is on traditional techniques, emphasizing their limitations and challenges. An extensive examination of contemporary transplantation therapies offers valuable insights into the most recent progress in organ, cellular, and tissue transplantation. This analysis examines the immunological obstacles and outlines the current advancements and constraints. The exploration further navigates into novel models and concepts such as immunomodulation, developments in organ preservation techniques, gene editing, biomaterials, scaffold-based solutions, and the integration of precision medicine, artificial intelligence, and machine learning applications. Each section analyzes the potential for change and current progress in various areas, backed by relevant scientific sources up to 2023. The subsequent sections delve into innovative cellular therapies, biotechnological progress, current clinical trials, and case studies demonstrating effective applications. This examination delves into the ethical and regulatory considerations of innovative therapeutic procedures, emphasizing ethical implications, regulatory frameworks, and the importance of balancing innovation with patient welfare. The literature review concludes by offering a forward-looking perspective, emphasizing potential progress, anticipated challenges, and advocating for collaboration and interdisciplinary approaches to overcome limitations in the field of transplantation medicine.

Background: Mechanical ventilation in preterm neonates aims for synchrony, preventing complications such as lung injury. Neurally Adjusted Ventilatory Assist (NAVA) stands out as a unique mode relying on diaphragmatic electrical signals for synchronization. We attempted to review studies that have explored the long-term consequence of using invasive NAVA in neonates with a specific focus on respiratory outcomes, namely bronchopulmonary dysplasia (BPD). Methods: A systematic review following PRISMA explored invasive NAVA in preterm neonates. Primary objectives compared NAVA to conventional ventilation, assessing BPD incidence, ventilation duration, length of stay, and adverse events. Secondary objectives analyzed ventilator parameters. Results: After screening 282 records, nine studies were included. NAVA showed reduced oxygen requirement at 28 days but no significant differences in oxygen need at 36 weeks postmenstrual age, total length of stay, or ventilator days. Adverse events such as air leak, mortality, patent ductus arteriosus, and intraventricular hemorrhage revealed no substantial variations. Ventilator variables favored NAVA, indicating decreased peak inspiratory pressure, tidal volume, work of breathing, and respiratory severity score. Conclusion: Despite short-term benefits, our study found no significant reduction in BPD with NAVA. Future large-scale trials are essential to comprehensively assess NAVA's impact on preterm infants' long-term outcomes.

Over the past few decades, digitalisation has pushed patient care towards a new era, inducing the evolution of health care delivery and enhancing the overall sustainability of health systems worldwide. Despite the ever-evolving technology leading to a change in health care provision, the uptake of these novel technologies by medical professionals is slow, largely because of concerns about the potential impact on patient care and patient safety, and medico-legal implications. Hence, this research aimed to understand doctors’ perceptions of the adoption of digital virtual consultations in the practice setting.In this survey, an online questionnaire, adapted from the construct by Venkatesh and Bala and based on the Technology Acceptance Model by Davis, was distributed to 886 hospital doctors. Altogether 133 responses were obtained.Results suggest that the respondents perceived digital virtual consultations as adjuncts to face-to-face consultations and as able to diminish time and place barriers. Doctors were willing in principle to utilise these alternatives to traditional methods if the appropriate infrastructure and technology were in place. Feasibility and cost-effectiveness studies are recommended to establish the technology-fit factor and the impact of the technology on the workforce, coupled with a stakeholder analysis to include all the actors involved in such a strategy.

Defects in low-density lipoprotein receptor (LDLR) are associated with familial hypercholesterolemia (FH), manifested by atherosclerosis and cardiovascular disease. Defective LDLR in hepatocytes leads to increased blood cholesterol level that damage vascular cells, especially endothelial cells, through oxidative stress and inflammation. However, the distinctions between endothelial cells from individuals with normal and defective LDLR are not yet fully comprehended. In this study, we obtained and examined endothelial derivatives of induced pluripotent stem cells (iPSC) generated previously from conditionally healthy donors and compound heterozygous FH patients carrying pathogenic LDLR alleles. In normal iPSC-derived endothelial cells (iPSC-EC), we detected the LDLR protein predominantly in its mature form, while iPSC-EC from patients with FH display reduced level of mature LDLR and show abolished low-density lipoprotein uptake. RNA-seq of iPSC-EC with mutant LDLR revealed a unique transcriptome profile comprising downregulated genes related to monocarboxylic acid transport, exocytosis and cell adhesion, as well as upregulated signaling pathways of cell secretion and leukocyte activation. Overall, these findings suggest that LDLR defects increases susceptibility of endothelial cells to inflammation and oxidative stress. This, combined with elevated extrinsic cholesterol levels, may result in accelerated endothelial dysfunction, contributing to early progression of atherosclerosis and other cardiovascular pathologies related to FH.

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.

In the area of dental healthcare services, where patients and professionals deal with multiple auditory stimuli, this cross-sectional study reports on the intricate dynamics of sound preferences, noise obstacles, and the profound impact of music on anxiety reduction within dental office set-tings. The sample comprises of 134 dental patients, primarily females (56.7%), with varying age groups, education levels, and therapy durations in the university clinics of the department of Dentistry, National and Kapodistrian University of Athens and four private dental offices at the metropolitan area of Athens, Greece. Notably, 92.5% of the participants report no hearing loss, and 56.7% exhibit some level of noise sensitivity. The study reveals a moderate to good perceived health status (M=3.84, SD=0.95) among participants, with low perceived noise disturbance in university dental clinics. Preferences for instrumental music, foreign pop, and classical music are prominent during waiting times. Potential irritations include impersonal treatment (44%) and staff behavior (41.8%). Music player usage within the settings of the dental clinic involves radios (49.3%) and headphones (41.0%). Correlations and predictors indicate associations between health status, music preferences, and noise disturbances. More specifically, visiting the university dental clinics (β = .300, p = .005) as well as younger age (β = .300, p = .034) were significant predictors of better perceived health status. Clearer perception of external sounds while using the music player (β = .190, p = .039) was a significant predictor of better perceived health status, while poorer health was predicted by the preference of Greek folk songs (β = -.200, p = .030). Also, the use of smartphones for playing music was related to poorer health (β = -.370, p < .001). Following, younger age (β = -.270, p = .015), lower education (β = -.210, p = .035), higher noise sensitivity (β = .190, p = .027), as well as feelings of anxiety and nervousness due to ambient noise from people and machines (β = .510, p = .027) were significant predictors of noise disturbance from machines. Also, visiting private clinics (β = .240, p = .018), preferences of specific playlist (β = .310, p = .012), no music (β = .280, p = .016) and use of smartphones to play music (β = .230, p = .029) were significant predictors of noise disturbance from patients or staff. Finally, the preference of listening to a specific playlist was related to better health status (r = .190, p < .05). Findings aim to optimize eco-soundscapes in dental offices, con-tributing to enhanced patient well-being. The research underscores the potential of music inter-ventions to alleviate dental anxiety and improve the overall dental experience and quality care.

The variety of risks due to climate change with a potential impact on Cultural Heritage CH requires a multidisciplinary approach and a preliminary overview of the existing methods for risk analysis and assessment in different fields. Thus, the starting point of the research conducted by the Sapienza PNRR working group consists in a systematic literature review of risk assessment approaches, methods and indicators. As a first outcome, the research has designed a multidisciplinary comprehensive framework consisting of the definition of risk categorization, the framework represented by a measurable index and the main target, according to the classification of Cultural Heritage based on the harmonization of European vocabularies definitions and protocols. The risk assessment framework sets the methodological core of a future multi criteria matrix and digital platform for decision focused on the historic built environment and it is functional to the definition of specific operational guidelines connected to each risk for elaborating descriptive/predictive Architectural Heritage’s transformation scenarios to support the development of mitigation and adaptation strategies.

Industrial Control Systems (ICS) are integral to managing and optimizing processes in various industries, including manufacturing, power generation, and more. However, the scarcity of widely adopted ICS datasets hampers research efforts in areas like optimization and security. This scarcity arises due to the substantial cost and technical expertise required to create physical ICS environments. In response to these challenges, this paper presents a groundbreaking approach to generating synthetic ICS data through a data-driven ICS network simulation. We circumvent the need for expensive hardware by recreating the entire ICS environment in software. Moreover, rather than manually replicating the control logic of ICS components, we leverage existing data to autonomously generate control logic. The core of our method involves the stochastic setting of setpoints, which introduces randomness into the generated data. Setpoints serve as target values for controlling the operation of the ICS process. This approach enables us to augment existing ICS datasets and cater to the data requirements of machine learning-based ICS intrusion detection systems and other data-driven applications. Our simulated ICS environment employs virtualized containers to mimic the behavior of real-world PLCs and SCADA systems, while control logic is deduced from publicly available ICS datasets. Setpoints are generated probabilistically to ensure data diversity. Experimental results validate the fidelity of our synthetic data, emphasizing its ability to closely replicate temporal and statistical characteristics of real-world ICS networks. In conclusion, this innovative data-driven ICS network simulation offers a cost-effective and scalable solution for generating synthetic ICS data. It empowers researchers in the field of ICS optimization and security with diverse, realistic datasets, furthering advancements in this critical domain. Future work may involve refining the simulation model and exploring additional applications for synthetic ICS data.

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.

We consider a class of density-driven flow problems. We are particularly interested in the problem of the salinization of coastal aquifers. We consider the Henry saltwater intrusion problem with uncertain porosity, permeability, and recharge parameters as a test case. The reason for the presence of uncertainties is the lack of knowledge, inaccurate measurements, and inability to measure parameters at each spatial or time location. This problem is nonlinear and time-dependent. The solution is the salt mass fraction, which is uncertain and changes in time. Uncertainties in porosity, permeability, recharge, and mass fraction are modeled using random fields. This work investigates the applicability of the well-known multilevel Monte Carlo (MLMC) method for such problems. The MLMC method can reduce the total computational and storage costs. Moreover, the MLMC method runs multiple scenarios on different spatial and time meshes and then estimates the mean value of the mass fraction. The parallelization is performed in both the physical space and stochastic space. To solve every deterministic scenario, we run the parallel multigrid solver ug4 in a black-box fashion. We use the solution obtained from the quasi-Monte Carlo method as a reference solution.

Although Cable driven rehabilitation devices (CDRD) have advantages over traditional link-driven devices, including lightweight, ease of reconfiguration, remote actuation, etc, the majority of existing lower-limb CDRD is limited to rehabilitation in the sagittal plane. In this work, we extend our previous sagittal plane model (2DOF) to accommodate hip motion in the frontal plane (abduction/adduction) toward studying the feasibility of tracking bi-planar motion (combined frontal and sagittal plane motion) via intra-planar cable routing. Two optimization problems have been formulated to estimate an optimal location of the hip cuffs, first to estimate the optimal cuff location at each time step to identify a single ‘averaged’ optimal cuff location and second to calculate a single optimal cuff location for the entire gait cycle. The optimization solutions identified for the 3DOF model revealed that optimization of the location of cuffs on the anterior and posterior side of the hip joint for 4 cable configuration is not sufficient to generate the desired bi-planar motion. For simultaneous tracking of the bi-planar motion, 2 additional cables have been added at hip joints and are routed in an intra-planar manner. The simulation result with the 3DOF model confirmed successful bi-planar trajectory tracking. The various number of cables and cable routings for tracking bi-planar motion will be studied in future work.

Economic expedience of waste heat recovery systems (WHRS), especially for low temperature difference applications, is often questionable due to high capital investments and long pay-back periods. By its simple design isobaric expansion (IE) machines could provide a viable pathway to utilize otherwise unprofitable waste heat streams for power generation and particularly for pumping liquids and compression of gases. Different engine configurations are presented and discussed. A new method of modelling and calculation of the IE process and efficiency is used on IE cycles with various pure and mixtures as a working fluid. Some interesting cases are presented. It is shown in this paper, that the simplest non-regenerative IE engines are efficient at low temperature differences between a heat source and heat sink. Efficiency of non-regenerative IE process with pure working fluid can be very high approaching Carnot efficiency at low pressure and heat source/heat sink temperature differences. Regeneration permits to increase efficiency of the IE-cycle to some extent. Application of mixed working fluids in combination with regeneration permits to significantly increase the range of high efficiencies to much larger temperature and pressure differences.

Ethnobotany has been, for too long, a descriptive discipline. However, ethnobotanists are increasingly calling for a paradigm shift towards the formulation of unifying theories and hypothesis-driven research in ethnobotany. Here, we formulated a theory, termed time-since-introduction theory, to explain the integration of alien plants into local pharmacopoeias in their recipient environment. This theory suggests that the factor time is paramount in determining which alien plants are more likely to be included in the medicinal flora of the areas they are introduced in. The theory relies on three hypotheses, the availability and versatility hypotheses alongside the residence time hypothesis newly proposed in the present study. We tested this theory by fitting a structural equation model to ethnobotanical data collected on South Africa’s alien woody flora. Although residence time is a direct predictor of medicinal status of alien plants, it is a better predictor when mediated through plant versatility. These findings are in support of the theory, and we consequently proposed a framework with which to understand different paths linking all three hypotheses. Collectively, our study shows the value of time in the development of ethnobotanical knowledge and fully responds to the pressing call for paradigm shift in ethnobotany.

Staphylococcus aureus is a high-priority pathogen causing severe infections with high morbidity and mortality worldwide. Many S. aureus strains are methicillin-resistant (MRSA) or even multi-drug resistant. It is one of the most successful and prominent modern pathogens. An effective fight against S. aureus infections requires novel targets for antimicrobial and antistaphylococcal therapies. Recent advances in whole-genome sequencing and high-throughput techniques facilitate the generation of genome-scale metabolic models (GEMs). Among the multiple applications of GEMs is drug-targeting in pathogens. Hence, comprehensive and predictive metabolic reconstructions of S. aureus could facilitate the identification of novel targets for antimicrobial therapies. This review aims at giving an overview of all available GEMs of multiple S. aureus strains. We downloaded all 114 available GEMs of S. aureus for further analysis. The scope of each model was evaluated, including the number of reactions, metabolites, and genes.Furthermore, all models were quality-controlled using Mᴇᴍᴏᴛᴇ, an open-source application with standardized metabolic tests. Growth capabilities and model similarities were examined. This review should lead as a guide for choosing the appropriate GEM for a given research question. With the information about the availability, the format, and the strengths and potentials of each model, one can either choose an existing model or combine several models to create models with even higher predictive values. This facilitates model-driven discoveries of novel antimicrobial targets to fight multi-drug resistant S. aureus strains.

Offshore wind farms are increasingly built in the North Sea and the number of HVDC systems transmitting the wind power to shore increases as well. To connect offshore wind farms to adjacent AC transmission systems, onshore and offshore modular multilevel converters transform the transmitted power from AC to DC and vice versa. Besides, modern wind farms mainly use wind turbines connected to the offshore point of common coupling via voltage source converters. However, converters and their control systems can cause unwanted interactions, referred to as converter-driven stability problems. The resulting instabilities can be predicted by applying an impedance-based analysis in the frequency domain. Considering that the converter models and system data are often confidential and cannot be exchanged in real systems, this paper proposes an enhanced impedance measurement method suitable for black-box applications to investigate the interactions. The proposed method is applied to assess an offshore HVDC system’s converter-driven stability, using impedance measurements of laboratory converters and a wind turbine converter controller replica. The results show that the onshore modular multilevel converter’s interactions with AC grids of moderate short-circuit ratios can lead to instabilities. The offshore system analysis reveals that considering the offshore grid topology is crucial for assessing interactions between the wind turbine controllers and the offshore modular multilevel converter. It is shown that different stability margins result from varying offshore grid layouts.

The unsteady Ekman problem involves finding the response of the near-surface currents to wind stress forcing under linearized dynamics. Its solution can be conveniently framed in the frequency domain in terms of a quantity that is known as the transfer function, the Fourier transform of the impulse response function. In this paper, a theoretical investigation of a fairly general transfer function form is undertaken with the goal of paving the way for future observational studies. Building on earlier work, we consider in detail the transfer function arising from a linearly-varying profile of the vertical eddy viscosity, subject to a no-slip lower boundary condition at a finite depth. The linearized horizontal momentum equations are shown to transform to a modified Bessel’s equation for the transfer function. Two self-similarities, or rescalings that each effectively eliminate one independent variable, are identified, enabling the dependence of the transfer function on its parameters to be more readily assessed. A systematic investigation of asymptotic behaviors of the transfer function is then undertaken, yielding expressions appropriate for eighteen different regimes, and unifying the results from numerous earlier studies. A solution to a numerical overflow problem that arises in the computation of the transfer function is also found. All numerical code associated with this paper is distributed freely for use by the community.

Multiferroics, showing both ferroelectric and magnetic order, are promising candidates for future electronic devices. Especially, the fundamental understanding of ferroelectric switching is of key relevance for further improvements, which however is rarely reported in literature. On a prime example for a spin-driven multiferroic, LiCuVO₄, we present an extensive study of the ferroelectric order and the switching behavior as function of external electric and magnetic fields. From frequency-dependent polarization switching and using the Ishibashi-Orihara theory, we deduce the existence of ferroelectric domains and domain-walls. These have to be related to counterclockwise and clockwise spin-spirals leading to the formation of multiferroic domains. A novel measurement – multiferroic hysteresis loop – is established to analyze the electrical polarization simultaneously as a function of electrical and magnetic fields. This technique allows characterizing the complex coupling between ferroelectric and magnetic order in multiferroic LiCuVO₄.

A three-dimensional, unstructured grid, hydrodynamic and suspended-sediment transport model (i.e., SELFE-SED) was developed to simulate temporal and spatial variations of suspended sediment and was applied to the subtropical subalpine Tsuei-Feng Lake (TFL) of Taiwan. The model was validated with measured water level and suspended‑sediment concentration in 2009, 2010, and 2011. The overall model simulation results are in quantitative agreement with the observational data. The validated model was then applied to explore the most important parameter that affects the suspended-sediment concentration and to investigate the effect of wind stress on the mean current and suspended‑sediment distribution in this shallow lake. Modeling results of sensitivity analysis reveal that the settling velocity is a crucial parameter and erosion rate is less important in the suspended-sediment transport model. Remarkable lake circulation was found based on the strength of wind speed and wind direction. Strong wind would result in higher mean current in the top layer and suspended-sediment distribution in the top and bottom layers. This study demonstrated that the wind stress played a significant influence on mean circulation and suspended-sediment transport in a shallow lake.

The numerical simulation of entropy generation at mixed natural free and forced convection flow in a square lid-driven cavity filled with an eletrically conducting binary fluids saturated porous media in the presence of a magnetic field is performed in this investigation. Both the top and bottom horizontal walls of the cavity are kept at constant and different temperatures while the left and right vertical walls are adiabatic and insulated. The magnetic field is applied in normal direction to the cavity. The Darcy model, including Brinkman term relative to viscous effects and Forchheimer term due to inertial forces, is used for the momentum equations, and the SIMPLER algorithm, based on the control volume finite-element method approach is used to solve the pressure –velocity coupling. The flow pattern and the heat transfer characteristics inside the cavity are presented in the form of isotherms, streamlines and isentropic lines and average Nusselt number trend. The entropy generation rate is determined for various values of Darcy number (10^-3 ≤ Da ≤ 1) and for a range of Hartmann number (0 ≤ Ha ≤ 10²). This study is limited to Pr = 7 which corresponds to water. It is observed that entropy generation is very affected by the variations of dimensionless control parameters considered.

Management of sarcomas in specialist centers delivers significant benefits. In much of the world specialists are not available and development of expertise is identified as a major need. However the terms ‘specialist’ or ‘expert’ center are rarely defined. Our objective is to offer a definition for patient advocates and a tool for healthcare providers to underpin improving the care of people with sarcoma. SPAGN developed a discussion paper for a workshop at the SPAGN 2023 Conference, attended by 75 delegates. A presentation to the Connective Tissue Oncology Society (CTOS) and further discussion led to this paper. Core Principles were identified that underlie specialist sarcoma care. The primary principle is the multi-disciplinary team discussing every patient, at first diagnosis and during treatment. Principles for optimal sarcoma management include accurate diagnosis followed by safe, high-quality treatment, with curative intent. These Principles are supplemented by Features describing areas of healthcare, professional involvement, and service provision and identifying further research and development needs. These allow for variations because of national or local policies and budgets. We propose the term ‘Sarcoma Intelligent Specialist Network’ to recognize expertise wherever it is found in the world. This provides a base for further discussion and local refinement.

Background: Dental education blends theoretical and practical training to prepare students for independent patient care. This study examines the confidence levels of dental students in Umeå regarding independent performance of general dentistry tasks, and whether this confidence changes after clinical training. Methods: Surveys were conducted before and after a summer clinical internship, with s tudents rating their comfort levels on a scale from 0 to 10 for various procedures. Results: Results from 64 initial surveys and 54 follow-up surveys showed no significant difference in confidence before and after the internship. However, confidence levels varied based on whether students had practiced specific tasks during the internship. Students felt least confident in managing acute dental trauma and treating cavities in young children, while they were most confident in tasks like obtaining radiographic surveys and debriding periodontally compromised dentition. Tooth extraction and dental fillings were the most practiced procedures during the internship. Conclusions: The study concludes that the internship between the ninth and tenth semesters does not notably boost students' confidence in specific dental procedures, possibly due to the short duration of the training. Further exploration, including input from clinical supervisors, is suggested to optimize clinical training in dental education.

Background: Gender stereotypes and biases can influence perceptions of competence and suitability for certain medical specialties. Empathy is an important component of an optimal doctor-patient relationship. The scope of our study is to verify the correlation between “empathetic" behavioral style with attention and sensibility to the gender differences of patients of the medical students. Methods: An online survey was conducted using the Jefferson Scale for Empathy (JSE), to measure empathy in the context of health professions education and patient care; and the Nijmegen Gender Awareness in Medicine Scale (N-GAMS), which measures attitudes and assumptions about gender. A total of 234 students (52.1% M; mean age: 22.68±2.48) from Medicine and Surgery at the University of Salerno (Italy) participated, of whom n° 175 were third-year students and n° 59 were fifth-year students. Results: The JSE score shows that male students have higher scores (77.29±12.38) than females (75.91±10.39). Conversely, female students have higher perspective-taking (JSE Factor 1: Male= 51.26±11.84; Female= 52.72±11.88). In addition, third-year students are much more empathetic than their fifth-year colleagues (JSE Score: 3°ys= 77.35±11.46; 5°ys= 74.49±11.33). With reference to the GS, we found that male students have greater sensitivity than their female colleagues (GS: Male= 2.67±0.68; Female= 2.37±0.48); conversely, they have higher scores of gender stereotype towards patients (GRIP: Male= 2±0.88; Female= 1.59±0.61) and doctors (GRID: Male= 1.88±0.89; Female= 1.64±0.63). Also, the third-year students compared to their fifth-year colleagues are characterized by greater gender sensitivity (GS: 3°ys= 2.57±0.62; 5°ys= 2.42±0.57), less bias with respect to patients (GRIP: 3°ys= 1.77±0.79; 5°ys= 1.90±0.78) but, on the other hand, show more stereotypes and prejudices towards doctors (GRID: 3°ys= 1.77±0.81; 5°ys= 1.75±0.74). Conclusions: Humanistic attitudes, including empathy, should be instilled, and evaluated among trainees as an essential part of their postgraduate medical education.

Introduction: In recent years, platelets have been in short supply and high demand. Approximately one in five cardiac surgery patients require platelets. In our safety-net hospital, however, the incidence is over 40%. Renal dysfunction, long cardiopulmonary bypass (CPB) times, and absence of tranexamic acid (TXA) are common risk factors for requiring platelet transfusions. Methods: Our hypothesis was fewer platelets would be transfused within two hours after bypass under these three conditions: creatinine is low, predicted surgery duration is short, and TXA is uniformly administered. Our anesthesia department designed this retrospective before-and-after observational study when the surgery department decided to narrow preoperative criteria respective to these three elements. The Institutional Review Board of Louisiana State University Health Sciences Center Shreveport approved of the protocol and waived individual informed consent. We compared timing of platelet transfusions (within 7 days) in consecutive patients who had CPB during the first ninety days of 2022 to those in 2023 using t-tests in SAS 9.3. Confounders included age, weight, anticoagulants, gender, and the platelet counts and hemoglobin immediately prior to platelet transfusion. Secondary outcomes were postoperative day two creatinine and other components transfused. Results: Preoperatively creatinine tended to be higher in 2022 at 1.5 vs 1.1, reaching significance postoperatively at 1.9 vs 1.1 (p=0.02). Bypass times decreased from 174 to 124 minutes (p=0.06). TXA use increased from 18 of 28 to 26 of 29 patients. Platelet counts increased on bypass from 142 to 173 (p=0.06). Platelet and hemoglobin nadirs were higher (day 3: 8g/dL vs 8.8, p=0.04; 98 vs 138, p=0.005). Platelet units transfused per patient tended to increase (0.75+/-1 vs 0.93+/-1.5); if exposed, patients tended to receive more units (2.1+/-1.3 vs 2.5+/-1.4) sooner. Changes in transfusions for red cells were nonsignificant at 1.97 per patient to 1.21, cryoprecipitate 0.36 to 0.69, and FFP 0.93 to 0.83. Conclusions: This is the first study examining timing of platelet transfusions after bypass. In the present investigation, we measured platelet count during bypass and prothrombin hours after arrival in the intensive care. Platelets were often administered in sets of two because of scarce immediate supply, partly from lack of an agitator table. More importantly, these data support a need for point-of-care thromboelastograms intraoperatively, but the cost has been prohibitive. Some centers’ algorithms list triggers for transfusion by fibrinogen and prothrombin times, available immediately after separation from bypass.

Artificial intelligence (AI) has grown in healthcare in recent years. The UK government recognises AI’s potential to enhance NHS services, yet research on AI in primary care (PC) has received limited attention. AI acceptance presents unique challenges in PC, characterised by fragmented structures, heterogeneous data sources, and multiple government departments. The organisational levels within PC are categorised as macro, meso, and micro levels. Existing research has predominantly focused on micro-level stakeholders. Our online survey addressed this research gap by encom-passing stakeholder perspectives at all levels. The results demonstrate the critical role of me-so-level stakeholders in facilitating AI acceptance. Importantly, a lack of understanding of AI terminology and concepts, concerns over potential job displacement, and the importance of em-pathy in patient care are highlighted as key challenges. Stakeholders also express the need for standardised AI terminology, comprehensive training, and regulatory standards to ensure equi-table and effective AI utilisation. This study lays the foundation for future in-depth interviews and further exploration of AI's role in PC. Observations in secondary care indicate that practitioners have substantial concerns about AI, how it works, and its limitations. Explainable AI can help technologists address such concerns, but first, we need to understand primary care's information needs.

Background: Machine learning can analyze vast amounts of data and make predictions for events in the future. Our group created machine learning models for vital sign predictions. To transport the information of these predictions without numbers and numerical values and make them easily usable for human caregivers, we aimed to integrate them into the Philips Visual-Patient-avatar, an avatar-based visualization of patient monitoring. Methods: We conducted a computer-based simulation study with 70 participants in three European university hospitals. We validated the vital sign prediction visualizations by testing their identification by anesthesiologists and intensivists. Each prediction visualization consisted of a condition (e.g., blood pressure low) and an urgency (a visual indication of the timespan in which the condition is expected to occur). To obtain qualitative user feedback, we also conducted standardised interviews and derived statements that participants later rated in an online survey. Results: The mixed logistic regression model showed 77.9% (95%CI 73.2-82.0%) correct identification of prediction visualizations (i.e. condition and urgency both correctly identified) and 93.8% (95%CI 93.7-93.8%) for conditions only (i.e. without considering urgencies). Forty-nine of 70 participants completed the online survey. The online survey participants agreed that the prediction visualizations were fun to use (32/49, 65.3%), and that they could imagine working with them in the future (30/49, 61.2%). They also agreed that identifying the urgencies was difficult (32/49, 65.3%). Conclusions: This study found that care providers correctly identified >90% of the conditions (i.e. without considering urgencies). The accuracy of identification decreased when considering urgencies in addition to conditions. Therefore, in future development of the technology, we will focus on either only displaying conditions (without urgencies) or improve the visualizations of urgency to enhance usability for human users.

The patient's satisfaction level concerning hospitalization has certain particularities, related to the geographical area, medical/non-medical assistance, the age, incomes, morbidity and mortality of the population. The objective of this study is to emphasize the degree of patients' satisfaction, depending on the specialty of the hospitalization department: surgical, medical, oncological, psychiatry, and to evidence the factors influencing the reliability and accuracy of patients' answers, such as: the patient's health condition upon admission, the duration of the admission, the level of physical pain and the emotional state. Patients and methods: The research was conducted between April and December 2021 on patients hospitalized in two public hospitals from the north-west of Romania, both of them being independent Legal Entities: the Municipal Clinical Hospital of Oradea (MCHO) and the County Clinical Emergency Hospital of Oradea (CCEHO). Results: The lowest score of PSS recorded in these two analyzed public hospitals from the north-western of Romania was appointed for the Pharmaceutical availability of patients medical treatment (2.24), attitude of the staff (2.56) and the quality of nursing care offered (2.58). Conclusions: The hospital management’s focus has been set to improve the communication skills among medical staff, to evidence their compassion, politeness, and to ensure the availability of essential drugs.

Chronic pain is a source of major alterations in quality of life. It represents significant costs for health systems, and reduces the competitiveness of the working population. Vulnerability can drive the incidence of chronic pain, through its influence on modifiable risk factors, and reduced utilization of health care systems. But vulnerability can also be the consequence of a chronic pain: illness can push people into precariousness. We analysed the factors associated with pain intensity among vulnerable persons with a chronic condition, in five European countries (N=1,364). Pain was, among the whole set of variables, the main predictor of sleep problems, fatigue, depression, self-perceived health, physical and mental quality of life. This is in line with other studies showing the major impact of pain on an individual’s health and life. Multivariable analyses, adjusting for the whole set of variables, showed that women had more intense pain, as well as participants with a lower education level. These results confirm the social component in the complex etiology of pain and clearly plaid in favor of integrated care, taking into account individual characteristics and environment.

A human case of dengue virus 2 was detected from a febrile patient living in the Sare yoba, Kolda region (Southern Senegal). Phylogenetic analysis based on the partial sequence of the NS5 gene reveals that the virus belongs to the DENV2 Sylvatic genotype and is closely related to a strain (JF260983/ 98.98% identity) detected in Spain from a tourist who travelled to Guinee Bissau (bordering Kolda region) in 2009. This highlights a potential recent underreported circulation of sylvatic Dengue in the southern part of Senegal and calls for re-enforced integrated surveillance among humans, non-human primates and arboreal mosquitoes throughout a one-health approach.

Diabetes mellitus (DM) and obesity account for the highest burden of non-communicable diseases. There is increasing evidence showing therapeutic patient education (TPE) as a clinically and cost-effective solution to improve biomedical and psychosocial outcomes among people with DM and obesity. The present systematic review and meta-analysis presents a critical synthesis of development of TPE interventions for DM and obesity and the efficacy of these interventions across a range of biomedical, psychosocial and psychological outcomes. A total of 54 of these RCTs were identified among patients with obesity and diabetes and were thus, qualitatively synthesized. Out of these, 47 were included into quantitative synthesis. There was substantial heterogeneity in reporting of these outcomes (I²= 88.35%, Q= 317.64), with significant improvement (SMD=0.36, 95% CI: 0.23 to 0.49) noted in biomedical outcomes in the intervention group. The effect sizes were comparable across interventions delivered by different modes and delivery agents. These interventions can be delivered by allied health staff, doctors or electronically as self-help programs, with similar effectiveness (P < 0.001). These interventions should be implemented in healthcare and community settings to improve health of patients suffering from DM and obesity.

Background: The cumulative number of patients during the COVID-19 pandemic led to a significant shortage of hospital beds. Many patients may not require hospitalization and can be clinically observed in home settings. However, some psychosocial factors are correlated with unsuccessful home isolation (HI), which might negatively affect the transmission control in the community. Therefore, we developed a new psychosocial screening tool (CCPHIET) for assessing HI suitability and examined its validity and reliability.Methods: This cross-sectional descriptive study included COVID-19 patients who were deemed to be medically safe for 14 days of HI. The CCPHIET is comprised of 8 clinical domains pertinent to HI behavioral compliance and risk. We explored its statistical validity and reliability and discussed the potential utility of this tool. Results: A total of 65 COVID-19 patients participated in this study. Most patients (58.5%) were evaluated as good candidates for HI. The CCPHIET has an acceptable content validity (IOC index > 0.5), moderate internal consistency (Cronbach’s alpha = 0.611) and substantial to excellent inter-rater reliability (Intraclass correlation coefficient = 0.944, Cohen’s kappa= 0.627).Conclusions: To compromise between strict and costly absolute institutional quarantine and the potentially unsuccessful absolute HI, the CCPHIET may help to identify good candidates for HI in mild and asymptomatic COVID-19 patients. This psychosocial information would support the physicians in matching each patient to the most suitable setting. Therefore, safe medical care is provided, unnecessary use of medical resources is spared, and local transmission is contained.

Treating a patient with traumatic brain injury requires an interdisciplinary approach because of the pervasive, profound and protean manifestations of this condition. In this review, key aspects of the medical history and review of systems will be described in order to highlight how the role of any provider must evolve to become a better patient advocate. Although this review is written from the vantage point of a vision care provider, it is hoped that patients, caregivers and providers will recognize the need for the team approach; it truly takes a village.

This study was conducted to determine whether overcrowding in the emergency department (ED) affects the occurrence of a return visit (RV) within 72 hours. The crowding indicator of index visit was the average number of total patients, patients under observation, and boarding patients during the first 1 and 4 hours from ED arrival time and the last 1 hour before ED departure. Logistic regression analysis was conducted to determine whether each indicator affects the occurrence of RV and post-RV admission. Of the 87,360 discharged patients, 3,743 (4.3%) returned to the ED within 72 hours. Of the crowding indicators pertaining to total patients, the last 1 hour significantly affected decrease in RV (p=0.0046). Boarding patients were found to increase RV occurrence during the first 1 hour (p=0.0146) and 4 hours (p=0.0326). Crowding indicators that increased the likelihood of admission post-RV were total number of patients during the first 1 hour (p=0.0166) and 4 hours (p=0.0335) and evaluationg patients during the first 1 hour (p=0.0059). Overcrowding in the ED increased the incidence of RV and likelihood of post-RV admission. However, overcrowding at the time of ED departure was related to reduced RV.

Background Critical patients with novel coronavirus pneumonia ( COVID-19) have worse outcome and high mortality. However, the histopathology of critical patient with COVID-19 remains undisclosed. Methods We performed the whole lung biopsy, and described the pathological changes of critical COVID-19 patient done with transplant by HE staining, immunohistochemistry and special staining observed under the microscopy. Findings The whole lungs displayed diffuse congestive appearance and partly haemorrhagic necrosis on gross examination. The haemorrhagic necrosis was prominently present in outer edge of the right lower lung. The cut surfaces of the lung displayed severe congestive and haemorrhagic changes. The main pathological changes showed massive pulmonary interstitial fibrosis, and partly hyaline degeneration, variable degrees of hemorrhagic pulmonary infarction. Small vessels hyperplasia, vessel wall thickening, lumen stenosis, occlusion and microthrombosis formation. Focal monocytes, lymphocytes and plasma cells infiltrating into pulmonary interstitium. Bronchiolitis and alveolitis with proliferation, atrophy, desquamation and squamous metaplasia of epithelial cells. Atrophy, vacuolar degeneration, proliferation, desquamation and squamous metaplasia in alveolar epithelial cells. Alveolar cavity congestion was prominent, and contained mucus, edema fluid, desquamated epithelial cells, and inflammatory cells. We also found several multinucleate giant cells and intracytoplasmic viral inclusion bodies. Special stains including Masson stain, sirius red staining, reticular fibers staining indicated massive pulmonary interstitial fibrosis. Immunohistochemistry showed positive for immunity cells including CD3, CD4, CD8, CD20, CD79a, CD5, CD38 and CD68. Interpretation We demonstrate the pathological findings of critical patient with COVID-19, which might provide a deep insight of the pathogenesis and severity of this disease.

Patient derived model systems are important tools for studying novel anti-cancer therapies. Patient derived xenografts (PDXs) have gained favor over the last 10 years as newer mouse strains have improved the success rate of establishing PDXs from patient biopsies. PDXs can be engrafted from head and neck cancer (HNC) samples across a wide range of cancer stages, retain the genetic features of their human source, and can be treated with both chemotherapy and radiation, allowing for clinically relevant studies. Not only do PDXs allow for study of patient tissues in an in vivo model, they can also provide a renewable source of cancer cells for organoid cultures. Herein, we review the uses of HNC patient derived models for radiation research including approaches to establishing both orthotopic and heterotopic PDXs, approaches and potential pitfalls to delivering chemotherapy and radiation to these animal models, biological advantages and limitations, and alternatives to animal studies that still use patient-derived tissues.

Patient engagement is receiving a growing attention in the healthcare context. However, although worldwide healthcare stakeholders agree that patient engagement is a priority for quality and effective care, no shared recommendations on how to promote patient engagement are currently available. Based on these premises, a Consensus Conference (CC) was promoted to address four main issues: What is the definition of Patient Engagement? How measuring Patient Engagement? What are the most recommended methodologies and the tools to promote Patient Engagement? What is the role of new technologies in promoting of Patient Engagement? The consensus was obtained through an iterative process that began with a systematic synthesis of the available literature in each domain followed by plenary expert discussions. This CC - including the systematic analysis of internationals scientific evidences (2749 sources across the major international scientific databases) together with experiences of a multi-disciplinary consortium of investigators and key stakeholders - attempted to provide the first evidence-based Expert Consensus Statement for the promotion of Patient Engagement in chronic care. These recommendations should be envisaged as inspirational principles to promote a real eco-system of engagement and might orient health services research and interventions.

1) Public health remains a tiny portion of the undergraduate pharmacy curriculum and the material is integrated into other modules. The objective of this study is to describe the UK undergraduate pharmacy curriculum, including its public health content; 2) Methods: A qualitative method (content analysis of websites) was used to describe the UK undergraduate pharmacy curriculum and teaching and learning policy. This involved selecting relevant concepts and then quantifying their presence and the relationships between them. The NVivo software was used to carry out ‘group queries’ and visualisation of results; 3) Results: Public health remains an optional module in the curricula of many UK schools of pharmacy. Several public health-related topics are often integrated into other modules, but UK undergraduate pharmacy curricula are still dominated by traditional pharmacy modules; and 4) Conclusions: Most of the curricula analysed were dominated by traditional pharmacy modules designed to enhance students' knowledge and skills. The skill set of UK pharmacy students with respect to macro-level public health activities needs to be improved in order to enhance pharmacists’ contribution to public health.

Precision medicine seeks to use genomic data to help provide the right treatment to the right patient at the right time. Next-generation sequencing technology allows for the rapid and accurate sequencing of many genes at once. This technology is becoming more common in oncology, though the clinical benefit of incorporating it into precision medicine strategies remains under significant debate. In this manuscript, we discuss the early findings of the impact of next-generation sequencing on cancer patient outcomes. We investigate why not all patients with genomic variants linked to a specific therapy receive that therapy and describe current barriers. Finally, we explore the current state of health insurance coverage for individual genome sequencing and targeted therapies for cancer. Based on our analysis, we recommend increased transparency around the determination of “actionable mutations” and a heightened focus on investigating the variations in health insurance coverage across patients receiving sequencing-matched therapies.

Digital machine intelligence has evolved from its inception in the form of computation of numbers to AI, which is centered around performing cognitive tasks that humans can perform, such as predictive reasoning or complex calculations. The state of the art includes tasks that are easily described by a list of formal, mathematical rules or a sequence of event-driven actions such as modeling, simulation, business workflows, interaction with devices, etc., and also tasks that are easy to do “intuitively”, but are hard to describe formally or as a sequence of event-driven actions such as recognizing spoken words or faces. While these tasks are impressive, they fall short in applying common sense reasoning to new situations, filling in information gaps, or understanding and applying unspoken rules or norms. Human intelligence uses both associative memory and event-driven transaction history to make sense of what they are observing fast enough to do something about it while they are still observing it. In addition to this cognitive ability, all bio-logical systems exhibit autopoiesis and self-regulation. In this paper, we demonstrate how machine intelligence can be enhanced to include both associative memory and event-driven transaction history to create a new class of knowledge-based assistants to augment human intelligence. The digital assistants use global knowledge derived from the Large Language Models to bridge the knowledge gap between various participants interacting with each other. We use the general theory of information and schema-based knowledge representation to create the memory and history of various transactions involved in the interactions.

Responding to changing value creation processes in the sheet metal working sec-tor, where the complexity and interchangeability of products challenge traditional dif-ferentiation strategies, this empirical analysis explores integrating service-oriented and data-driven business models as new paths to ensure competitiveness, especially for small and medium-sized enterprises (SMEs). This study aims to capture the current state and challenges associated with the implementation of these business models in this sector. The research was conducted through semi-structured interviews with SMEs in the industry. The findings indicate that service-oriented and data-driven business models are not yet widely adopted and that manufacturing companies re-quire support in their implementation. Fields of action were identified for the industry. These are "Creating awareness and understanding", "Recognizing added value", "In-creasing company maturity" and "Understanding the change process". Cooperation between science and industry is essential in tackling these fields of action to ensure the successful integration of such business models in manufacturing companies. This pa-per identifies challenges in the fields of action that companies must address through a structured approach promoting awareness, recognizing value, improving organiza-tional maturity, and understanding the change process to successfully implement ser-vice-oriented and data-driven business models.

Eutrophication is a major environmental issue with many negative consequences, such as hypoxia and harmful cyanotoxins production. Monitoring coastal eutrophication is a crucial, especially for island countries like the Republic of Cyprus, which are economically dependent on the touristic sector. Additionally, the open-sea aquaculture industry in Cyprus has been exhibiting an increase in the last decades and environmental monitoring to identify possible signs of eutrophication is mandatory according to the legislation. Therefore, in this modelling study, two different types of Artificial Neural Networks (ANNs) are developed based on in situ-data collected from stations located in the coastal waters of Cyprus. Theses ANNs aim to model the eutrophication phenomenon based on two different data-driven modelling procedures. Firstly, the self-organizing map (SOM) ANN examines several water quality parameters (specifically water temperature, salinity, nitrogen species, ortho-phosphates, dissolved oxygen and electrical conductivity) interactions with the Chlorophyll-a parameter. The SOM model enables us to visualize the monitored parameters relationships and to comprehend complex biological mechanisms related to Chlorophyll-a production. A second feed-forward ANN model is also developed for predicting the Chlorophyll-a levels. Based on this ANN model, several scenarios associated to the eutrophication-related water quality parameters can be extracted. The combination of these two ANNs models is considered a holistic modelling approximation for the identification of eutrophication scenarios, since it enables not only the prediction of the Chlorophyll-a parameter levels, but also the “capturing” of hidden biological mechanisms associated with algal production.

Physics-informed machine learning (PIML) refers to the emerging area of extracting physically relevant solutions to complex multiscale modeling problems and has enjoyed significant interest from the research community. This paper discusses the recent critical advancements in the PIML domain. Novel methods and applications of domain decomposition in physics-informed neural networks (PINN) in particular are highlighted. Additionally, we explore recent Works toward utilizing neural operator learning to intuit relationships in physics systems traditionally modeled by sets of complex governing equations and solved with expensive differentiation techniques. Finally, expansive applications of traditional physics-informed machine learning and potential limitations are discussed. In addition to summarizing recent work, we propose a novel taxonomic structure to catalog physics-informed machine learning based on how the physics-information is derived and injected into the machine learning process. The taxonomy assumes the explicit objectives of facilitating interdisciplinary collaboration in methodology, thereby promoting a wider characterization of what types of physics-problems are served by the physics-informed learning machines, and assisting in identifying apt targets for future work. To summarize, the major twofold goal of this work is to summarize recent advancements and introduce a taxonomic catalog for applications of physics-informed machine learning.

The current paradigm shift in orthodontic treatment planning is based on facially driven diagnostics. This requires an affordable, convenient, and non-invasive solution for face scanning. Therefore, utilization of smartphones` TrueDepth sensors is very tempting. TrueDepth refers to front-facing cameras with a dot projector in Apple devices that provide real-time depth data in addition to visual information. There are several applications that tout themselves as accurate solutions for 3D scanning of the face in dentistry. Their clinical accuracy has been uncertain. This study focuses on evaluating the accuracy of the Bellus3D Dental Pro app, which uses Apple's TrueDepth sensor. The app reconstructs a virtual, high-resolution version of the face, which is available for download as a 3D object. In this paper, sixty TrueDepth scans of the face were compared to sixty corresponding facial surfaces segmented from CBCT. Difference maps were created for each pair and evaluated in specific facial regions. The results confirmed statistically significant differences in some facial regions in amplitudes greater than 3 mm, suggesting that current technology has limited applicability for clinical use. The clinical utilization of facial scanning for orthodontic evaluation, which does not require accuracy in the lip region below 3 mm, can be considered.

Steam Generator Level Control System (SGLCS) is one of the key instrumentations and control subsystems to ensure the safe operation of nuclear power plants. It is highly recommended to perform reliability analysis for SGLCS for making better maintenance strategy. SGLCS is a digital control system with complex redundant configuration and failure\self-diagnosis\repair action, traditional fault tree is not applicable due to its static property, Markov model is not a good choice too because of heavy burden of creating state transition graph for even medium-size system. Boolean Logic Driven Markov Process (BDMP) can describe complex failure-repair state transition via ‘trigger link’ and three kinds of leaf nodes, as well as keep compact and easy-read struct like fault tree. So BDMP is adopted to analysis reliability of SGLCS. Graphical BDMP modeling environment KB3 and Monte Carlo simulator YAMS is used for BDMP modeling and quantitative analysis respectively, and unavailability of SGLCS is obtained. The contribution of three parts of SGLCS to the unavailability of the system is also evaluated, and it is found that the water supply flow control part contributes the most to the failure of SGLCS.

A data-driven analysis method known as dynamic mode decomposition (DMD) approximates the linear Koopman operator on projected space. In the spirit of Johnson-Lindenstrauss Lemma, we will use random projection to estimate the DMD modes in reduced dimensional space. In practical applications, snapshots are in high dimensional observable space and the DMD operator matrix is massive. Hence, computing DMD with the full spectrum is infeasible, so our main computational goal is estimating the eigenvalue and eigenvectors of the DMD operator in a projected domain. We will generalize the current algorithm to estimate a projected DMD operator. We focus on a powerful and simple random projection algorithm that will reduce the computational and storage cost. While clearly, a random projection simplifies the algorithmic complexity of a detailed optimal projection, as we will show, generally the results can be excellent nonetheless, and quality understood through a well-developed theory of random projections. We will demonstrate that modes can be calculated for a low cost by the projected data with sufficient dimension.

The fault diagnosis of safety critical systems such as wind turbine installations includes extremely challenging aspects that motivate the research issues considered in this paper. In fact, the prompt detection and the reliable diagnosis of faults in their earlier occurrence represent the key point especially for offshore installations. For these plants, operation and maintenance procedures in harsh environments would inevitably increase the cost of the energy production. Therefore, this work investigates fault diagnosis solutions that are considered in a viable way and used as advanced techniques for condition monitoring of dynamic processes. To this end, the work proposes the design of fault diagnosis strategies that exploit the estimation of the fault by means of data--driven approaches. This solution leads to the development of effective methods allowing the management of partially unknown information of the system dynamics, while coping with measurement errors, the model--reality mismatch and other disturbance effects. In mode detail, the proposed data--driven methodologies exploit fuzzy systems and neural networks in order to estimate the nonlinear dynamic relations between the input and output measurements of the considered process and the faults. To this end, the fuzzy and neural network structures are integrated with auto--regressive with exogenous input descriptions, thus making them able to approximate unknown nonlinear dynamic functions with arbitrary degree of accuracy. Once these models are estimated from the input and output data measurement acquired from the considered dynamic process, the capabilities of their fault diagnosis capabilities are validated by using a high--fidelity benchmark that simulates the healthy and the faulty behaviour of a wind turbine system. Moreover, at this stage the benchmark is also useful to analyse the robustness and the reliability characteristics of the developed tools in the presence of model--reality mismatch and modelling error effects featured by the wind turbine simulator. On the other hand, a hardware--in--the--loop tool is finally implemented for testing and comparing the performance of the developed fault diagnosis strategies in a more realistic environment and with respect to different fault diagnosis approaches.

Mathematical modelling of bioprocesses has a long and notable history, with eminent contributions from fields including microbiology, ecology, biophysics, chemistry, statistics, control theory and mathematical theory. This richness of ideas and breadth of concepts provide great motivation for inquisitive engineers and intrepid scientists to try their hand at modelling, and this collaboration of disciplines has also delivered significant milestones in the quality and application of models for both theoretical and practical interrogation of engineered biological systems. The focus of this review is the anaerobic digestion process, which, as a technology that has come in and out of fashion, still remains a fundamental process for addressing the global climate emergency. Whether with conventional anaerobic digestion systems, biorefineries, or other anaerobic technologies, mathematical models are important tools that are used to design, monitor, control and optimise the process. Both highly structured, mechanistic models and data-driven approaches have been used extensively over half a decade, but recent advances in computational capacity, scientific understanding and diversity and quality of process data, presents an opportunity for the development of new modelling paradigms, augmentation of existing methods, or even incorporation of tools from other disciplines, to ensure that anaerobic digestion research can remain resilient and relevant in the face of emerging and future challenges.

The origin of the genetic code is the key to revealing the origin of life on Earth, as it is a prerequisite for the existence of life. More than half a century has passed since the discovery of the genetic code, but its origin is still one of the greatest mysteries. Is the origin of the genetic code truly unknowable? Does the code truly require external design? Here, a hypothesis is proposed, according to which ATP is at the origin of the genetic code by its coevolution with the pristine biochemical system. ATP has several properties that make it suitable as a plausible initiator of the genetic code. First, ATP is the only energetic product of photosynthesis. Second, ATP is at the heart of the extant biochemical systems. Third, ATP serves as a carrier of both energy and information. Fourth, ATP could energetically elongate chains of both polynucleotides and polypeptides, thus providing a bridge between these molecules and eventually mediating prebiotic biochemical innovation from energy transformation to informatization. This hypothesis shows how primitive life emerged through a series of processes from energy to information flow mediated by ATP. Informatization (processes for creating and managing information) was inevitably coupled with structuralization (processes for organizing or incorporating cellular structures), cyclizing polynucleotides and polypeptides into a feedback loop of reciprocal causation. The triplet codon might be only for stereochemical handling of amino acids through, e.g., Watson–Crick pairing interactions. It is only the evolutionary completion of the genetic code from RNA to DNA that, contrary to the central dogma, marked the dawn of cellular life, when Darwinian evolution began to operate. The ATP hypothesis sheds light on the origin of life, together with the formation of both photosynthetic and biochemical systems, which remains largely unknown thus far.

This paper proposes a novel approach, based on the adaptive rate processing and analysis, for the isolated speech recognition. The idea is to smartly combine the event-driven signal acquisition and windowing along with adaptive rate processing, analysis and classification for realizing an effective isolated speech recognition. The incoming speech signal is digitized with an event-driven A/D converter (EDADC). The output of EDADC is windowed with an activity selection process. These windows are later on resampled uniformly with an adaptive rate interpolator. The resampled windows are de-noised with an adaptive rate filter and their spectrum are computed with an adaptive resolution short time Fourier transform (ARSTFT). Later on, the magnitude, Delta and Delta-Delta spectral coefficients are extracted. The Dynamic Time Warping (DTW) technique is employed to compare these extracted features with the reference templates. The comparison outcomes are used to make the classification decision. The system functionality is tested for a case study and results are presented. An 8.2 times reduction in acquired number of samples is achieved by the devised approach as compared to the classical one. It aptitudes a significant computational gain and power consumption reduction of the proposed system over the counter classical ones. An average subject dependent isolated speech recognition accuracy of 96.8% is achieved. It shows that the proposed approach is a potential candidate for the automatic speech recognition applications like rehabilitation centers, smart call centers, smart homes, etc.

The out-of-equilibrium dynamics of many body systems has recently received a burst of interest, also due to experimental implementations. The dynamics of both observables, such as magnetization and susceptibilities, and quantum information related quantities, such as concurrence and entanglement entropy, have been investigated under different protocols bringing the system out of equilibrium. In this paper we focus on the entanglement entropy dynamics under a sinusoidal drive of the tranverse magnetic field in the 1D quantum Ising model. We find that the area and the volume law of the entanglement entropy coexist under periodic drive for an initial non-critical ground state. Furthermore, starting from a critical ground state, the entanglement entropy exhibits finite size scaling even under such a periodic drive. This critical-like behaviour of the out-of-equilibrium driven state can persist for arbitrarily long time, provided that the entanglement entropy is evaluated on increasingly subsytem sizes, whereas for smaller sizes a volume law holds. Finally, we give an interpretation of the simultaneous occurrence of critical and non-critical behaviour in terms of the propagation of Floquet quasi-particles.

Power disaggregation aims at determining the appliance-by-appliance electricity consumption leveraging upon a single meter only, which measures the entire power demand. Data-driven procedures based on Factorial Hidden Markov Models have been proven remarkable results on energy disaggregation. Nevertheless, those procedures have various weaknesses: there is a scalability problem as the number of devices to observe raises and the algorithmic complexity of the inference step is severe. DNN architectures, such as Convolutional Neural Networks, have demonstrated to be a viable solution to deal with FHMMs shortcomings. Nonetheless, there are two significant limitations: a complicated and time-consuming training system based on back-propagation has to be employed to estimates the neural architecture parameters, and large amounts of training data covering as many operation conditions as possible need to be collected to attain top performances. In this work, we aim to overcome those limitations by leveraging upon the unique and useful characteristics of the extreme learning machine technique, which is based on a collection of randomly chosen hidden units and analytically defined output weights. Experiment evaluation has been conducted using the UK-DALE corpus. We find that the suggested approach achieves similar performances to recently proposed ANN-based methods and outperforms FHMMs. Besides, our solution generalises well to unseen houses.

Thoracic aortopathy encompasses a spectrum of conditions affecting the aorta, ranging from aneurysms to dissections, posing significant challenges in management and care. In recent years, remote care, facilitated by telemedicine and digital health technologies, has emerged as a promising approach to overcome barriers in delivering timely and efficient healthcare services. This paper explores the practical considerations and challenges associated with implementing remote care strategies in the management of thoracic aortopathy in India with the largest population in the world. By evaluating existing literature and drawing upon clinical experiences, we discuss the potential benefits, limitations, and best practices for incorporating remote care into the management of patients with thoracic aortopathy. Additionally, we address important factors such as patient engagement, technology integration, privacy concerns, and regulatory requirements to optimize the delivery of remote care in this specialized field.

Hepatocellular carcinoma (HCC) results in high mortality due to ineffective systemic therapy. Human immortalized cell lines are commonly used to study anti-tumour effects in the context of new anti-tumour therapies and tumour biology. As immortalized cell lines have limited biological relevance and heterogeneity compared to primary cells, patient-derived tumour tissues and corresponding immune cells are the gold standards for studying the complexity of individual tumour entities. However, culturing primary HCC cells has a low success rate. Here, we aimed to establish a reproducible approach to preserve the patient-derived liver cancer cells for in vitro and in vivo studies. The underlying study aimed to establish an in vitro pre-screening platform to test treatment options' effectivity and dosage, e.g., for new substances, autologous modified immune cells, or combined therapies in HCC. We initially employed 15 surgical resection specimens from patients with different HCC entities for isolation and preservation. The isolated liver cancer cells from four HCC-diagnosed patients were used for orthotopic transplantation into the healthy liver of immunodeficient mice, allowing them to grow for six months before human liver cancer cells were isolated and cultured. As a result, we generated and characterized four new primary-like liver cancer cell lines. Compared to immortalized HCC cell lines, freshly generated liver cancer cells displayed individual morphologies and heterogenous protein-level characteristics. We assessed their ability to proliferate, migrate, form spheroids, and react to common medications compared to immortalized HCC cell lines. All four liver cancer cell lines exhibit strong migration and colony-forming characteristics in vitro, comparable to extensively investigated immortalized HCC cell lines. Moreover, the four etiological different liver cancer cell lines displayed differences in the response to 5-FU, Sorafenib, Axitinib and Interferon-alpha treatment, ranking from non-responders to responders depending on the applicated medication. In sum, we generated individual patient-derived liver cancer cell lines suitable for predictive in vitro drug screenings and moreover for xenograft transplantations to realize the in vivo investigation of drug candidates. We overcame the low cultivation success rate of liver cancer cells derived from patients and analyzed their potential to serve a pre-clinical model.

Background: Retinal diseases such as neovascular age related macular degeneration (nAMD), diabetic macular edema (DME) or branch-/central retinal vein occlusion (B/CRVO) have significant implications for patients' social and psychological well-being. To gain a comprehensive understanding of patients' backgrounds and attitudes, we developed an exploratory questionnaire, the Basic Care and Patient Satisfaction Questionnaire (BPZ-9). Methods: The ALBATROS study aimed to assess the care situation of treatment-naïve patients diagnosed with either nAMD, DME or B/CRVO. The data collection took place at the beginning of treatment and after twelve months of anti-VEGF (vascular endothelial growth factor) therapy. The BPZ-9 instrument comprises nine questions to evaluate patients’ psychological and social situation and their satisfaction with treatment. Results: Data were collected from 1.478 nAMD (mean 78 years), 445 DME (67 years), 233 BRVO (70 years) and 144 CRVO (71 years) patients at 102 study centers throughout Germany. Approximately one third of the patients was living alone and six percent were in organized care. One in four patients had difficulties to walk and one in five needed accompany for treatment. Anxiety to lose vision was present in three out of four patients at the beginning and slightly decreased to two out of three over the 12-month treatment preriod. The distress of having a retinal disease was generally higher than the distress related to treatment. Most patients reported high treatment satisfaction (73%) and felt well informed (81%). Conclusion: Patients receiving anti-VEGF therapy commonly experience impaired mobility, dependency on others, distress and the fear of vision loss.

Outcome of redo-mitral valve replacement in the small mitral annulus with the use of the chimney technology is not well documented. From 2019 to 2020, 77 consecutive patients underwent redo-mitral valve replacement with the use of the chimney technology because of a small mitral annulus. To evaluate heart structural integrity and clinical outcomes, postoperative clinical data and echocardiograms were examined. Mean age was 56.7 ± 15.98 years. All patients underwent mitral valve surgery of which 62 were mitral valve replacements, 7 mitral valve repairs, and 8 double valve replacements. Preoperative Mitral valve mean gradient was 18.07 ± 9.40 mmHg. Postoperative mitral prosthesis size 28.51 ± 1.22 mm. The median increment of mitral size enlargement was 4 (0, 6) valve sizes. Mean mitral gradient coming out of the operating room was 10.34 ± 2.12 mmHg and at follow-up echocardiogram performed at 3 years after the procedure was 10.36 ± 1.70 mmHg. One-year survival was 93.3%, while 4-year survival was 89.3% with no reoperation. Use of the chimney technology in small mitral valve re-mitral valve replacement results in larger valve sizes. Moreover, the mean gradients over the mitral valve are acceptable intraoperatively and over time.

The intensive care unit is characterized by the critical care of the infants and children who access it, as well as the high complexity of care. This implies and requires optimal integration among the various professionals working there and their ability to work as a team. The purpose of the study was to describe how nurses perceive clinical risk and how they relate to it and to identify adverse events and related risk factors. Nine nurses, two moderators and one external observer partici-pated in the focus group. In the qualitative analysis, 9 themes describing the perception of clinical risk in PICU were identified, including teamwork, specific training, time management, team communication, management, individual errors, structural criticality, patient fac-tors/characteristics, and standardization. Safety culture can be fostered by hospital management to involve PICU nurses in promoting patient safety, which could improve breaking down barriers that prevent nurses from fulfilling their roles.

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a common, preventable and treatable disease. The first PREM (Patient Reported Outcome Measure) type questionnaire that has been dedicated to asses experience of care in COPD is the PREM-C9. Aim: To create a Polish version of the PREM-C9 and determine its the psychometric characteristics. Methods: The validation procedure involved forward and back translation and included 42 COPD patients. The psychometric properties were assessed using Cronbach's alpha, Bartlett's test, Kaiser-Meyer-Olkin and Spearman correlation coefficient. The validity of the questionnaire was assessed using Principal Component Analysis for the extracted principal components. The validity of the factor analysis was demonstrated by the Bartlett's sphericity test and the Kaiser-Meyer-Olkin (KMO). Factor analysis was performed using the Oblimin and Varimax rotation. The reliability of the questionnaire was assessed using the Cronbach's alpha. Results: The Polish version of the PREM-C9 questionnaire met all validation criteria: face, translation, psychometric, functional and reconstruction equivalence. The Spearman correlation results between Polish PREM-C9&amp;CAT: rho= 0,44, p=0,003539; HADS-Anxiety: rho= 0.370864, p=0,015612, HADS-Depression: rho= 0,387405, p=0,011253. Conclusion: The developed Polish PREM-C9 questionnaire is a reliable and valid tool that assesses Polish COPD patients' experiences of their disease and the care they receive.

Type 1 diabetes imposes a complex and challenging routine on patients and caregivers. Therefore, considering individual experiences and personal facilitators to promote assertive interventions is crucial. However, no studies have addressed these perspectives in the Brazilian adult population. We aimed to identify psycho-behavioral characteristics perceived as facilitators for coping with the condition. We used a biographical method to conduct semi-structured, face-to-face, in-depth interviews for each participant. Transcripts were analyzed using inductive thematic analysis. Participants (n = 22) were aged 18–57 years (mean: 30.2, standard deviation (SD): 8.7), and the duration since diagnosis was approximately 20.6 years (SD: 4.6). Twelve (54.4%) were women, 13 (59.1%) used insulin pumps, 14 (63.6%) had at least a college degree, and 13 (59.1%) had HbA1C (glycated hemoglobin) levels above 58 mmol/mol (7.5%). Five major themes emerged: 1) peer learning, 2) ownership, 3) welcoming experiences, 4) equity, and 5) reframe the path (P.O.W.E.R.). All themes appeared in the lived experiences shared by participants with HbA1C levels below 58 mmol/mol (7.5%). Improved glycemic control can be achieved, and the challenges encountered in diabetes care within similar socioeconomic contexts can be addressed, by an interdisciplinary care team that takes P.O.W.E.R into consideration when providing person-centered care strategies.

Esophageal cancer is a formidable challenge in the realm of cancer treatment. Conventional methods such as surgery, chemotherapy, and immunotherapy have demonstrated limited success rates in managing this disease. In response, targeted drug therapies have emerged as a promising strategy to improve outcomes for patients. These therapies aim to disrupt specific pathways involved in the growth and development of esophageal cancer cells. This review explores various drugs used to target specific pathways, including cetuximab and monoclonal antibodies (gefitinib) that target the epidermal growth factor receptor (EGFR), trastuzumab that targets human epidermal growth factor receptor 2 (HER-2), drugs targeting the vascular endothelial growth factor receptor (VEGFR), mTOR inhibitors, and cMET inhibitors. Additionally, the article discusses the impact of drug resistance on the effectiveness of these therapies, highlighting factors such as cancer stem cells, cancer-associated fibroblasts, immune-inflammatory cells, cytokines, hypoxia, and growth factors. While drug targeting approaches do not provide a complete cure for esophageal cancer due to drug resistance and associated side effects, they offer potential for improving patient survival rates.

Ketogenic dietary therapies (KDTs) are an effective and safe non-pharmacological treatment for drug-resistant epilepsy, but adherence can be challenging for both patients and caregivers. In Europe, there are no adequate tools to measure it other than monitoring ketosis. This study aimed to adapt and validate the Brazilian adherence questionnaire, Keto-check, into the Italian version: iKetoCheck. Using the Delphi technique, 12 judges validated the contents through agreement rate and the Content Validity Index (CVI). The iKetocheck was self-completed electronically by drug-resistant epilepsy or GLUT1 deficiency patients within an interval of 15 days to measure its reproducibility. Test-retest reliability was evaluated using Pearson correlation and relative significance test. Exploratory and confirmatory factorial analyses were made using Factor software. The final tool, iKetoCheck, consists of 10 questions with 5-point Likert scale answers. It evaluates various aspects such as informing caregivers about the diet, organization of meals, measurement of ketosis, weighing food consumed, diet negligence, use of carbohydrate-free medications, attending follow-up visits, reading food labels, consulting an expert for dietary concerns, and cooking at home. The factorial analysis resulted in three factors: "attention," "organization," and "precision," with satisfactory results for indices in exploratory and confirmatory analyses. Although higher mean values of ketonemia measurement were observed in patients with a higher adherence score, these values were not statistically significant (p=0.284). In conclusion, iKetoCheck is a valid tool for evaluating KDTs' adherence in Italian drug-resistant epilepsy or GLUT1 deficiency patients. It can provide valuable information to improve patient management and optimize the effectiveness of KDTs.

There has been limited research on improving Internet-delivered Cognitive Behavioural Therapy (ICBT) in routine online therapy clinics that serve people from diverse ethnocultural groups (PDEGs). This article describes a patient-oriented adaptation approach used to address this gap in research. A working group consisting of people with lived experience, community stakeholders, ICBT clinicians, managers, and researchers, was formed. The working group examined archival feedback on ICBT from past clients who self-identified as being from diverse ethnocultural back-grounds (N=278) and results of interviews with current patients (N=16), community stakeholders (N=6), and clinicians (N=3). The archival data and interviews revealed the majority of the pa-tients reported being satisfied with and benefitting from ICBT. Suggestions for improvement were not related to the cognitive-behavioural model and techniques, but rather to making treatment materials more inclusive. Consequently, the ICBT adaptation focused on adding content related to cultural influences on mental health, addressing stigma, diversifying case stories, examples and imagery, adding audiovisual introductions, and replacing English idioms with more descriptive language. Moreover, further training was offered to clinicians and efforts were made to improve community outreach. This study demonstrates a process for using patient-oriented research to improve ICBT within routine care serving patients of diverse backgrounds.

Cloud computing appears to be the dreamed vision of the healthcare industry; it refers to means of storing and accessing data and programs over the internet instead of the computer’s hard drive. However, the adoption of cloud computing requires solving several issues and infor-mation privacy is a major one. This work proposes a cloud architecture design for the healthcare information system. The proposed architecture enables for storing and sharing information in a privacy-preserving manner. Patients’ information in the proposed architecture is divided into four categories identified in the case study data analysis. User identity management protocol (U-IDM) is employed for controlling the access to patients’ information, and patients have means of control over who can access their information. A scenario-based instantiation validated the proposed architecture's privacy-preserving patient data exchange. The instantiation proved that the proposed architecture allows sharing healthcare information without violating the privacy of patients.

The COVID-19 pandemic has presented an unprecedented challenge to the healthcare system. Identifying the genomics and clinical biomarkers for effective patient stratification and management is critical to controlling the spread of the disease. Omics datasets provide a wealth of information that can aid in understanding the underlying molecular mechanisms of COVID-19 and identifying potential biomarkers for patient stratification. Artificial intelligence (AI) and machine learning (ML) algorithms have been increasingly used to analyze large-scale omics and clinical datasets for patient stratification. In this manuscript, we demonstrate the recent advances and predictive accuracies in AI and ML-based patient stratification modeling linking omics and clinical biomarker datasets, focusing on COVID-19 patients. Our ML model not only demonstrates that clinical features are enough an indicator of COVID-19 severity and survival but also infers what clinical features are more impactful, which makes our approach a useful guide for clinicians for prioritization of best-fit therapeutics for a given cohort of patients. Moreover, with weighted gene network analysis, we are able to provide insights into gene networks that have a significant association with COVID-19 severity and clinical features. Finally, we have demonstrated the importance of clinical biomarkers in identifying high-risk patients and predicting disease progression.

Denture wearers often complain about jeopardized function and reduced quality of life due to lack of prosthesis’ retention. Implant retained mandibular overdentures, on 2 non-connected implants (2IOD) are well-proven solutions to overcome these issues. We prospectively assessed 69 patients and scrutinized clinical records until at least 7 years of function. Thirty-six were retained on Locator ® Abutments (LA) and thirty-tree on Ball Abutments (BA). Both systems were compared regarding the type, amount and total cost of required maintenance. One implants was lost, yielding 98.7% survival after 7 years. In total 438 technical issues occurred: 121 (27.35%) in BA and 317 (72.4%) in LA. Out of these, 343 events (78%) were solved chairside: 191 (43.6%) were replacements of retention caps, 113 (25.8%) were minor acrylic repairs, in 26 (5.9%) pressure ulcers had to be relieved and 13 (3%) related to abutments. LA required 179 insert replacements compared to 12 in the BA group. The overall initial treatment cost was 3850 euro. The average total maintenance cost in relation to the initial cost for the LA and BA groups was 19.11% (range 0% - 82.24%) and 18.91% (range 0% - 113.26%) respectively (P=0.540). Conclusions: The 7-years maintenance costs for a 2IOD is acceptable when the patient is regularly checked and professionally maintained. Most events are easily solvable chairside, but a few patients required more expensive interventions, regardless of the type of attachment used.

Objectives: The purpose of this systematic review was to ascertain critical care nurses’ understanding and experiences of patient advocacy in adult critical care settings. The specific objectives were to identify how critical care nurses define patient advocacy, to explore the understanding and experiences of critical care nurses regarding patient advocacy, to explore critical care nurses’ role in patient advocacy, and to ascertain the barriers to encouraging advocacy in the critical care setting. Research design: Systematic literature search of CINAHL and Medline databases, Google Scholar, and Cochrane Database of Systematic Reviews, as well as grey literature search, was conducted. Search dates were restricted from January 2005 to 2015 in both CINAHL and Medline. Findings: 62 studies were identified, of which 6 qualitative research papers were included. Nurses gave varied definitions of patient advocacy, which were categorized into three themes: communication, protection, and doing. Nurses perceive advocacy as truly listening to patients and their families. Conclusion: For critical care nurses to be effective advocates, there must be support, collaboration, and improved working relationship between professional groups. Moreover, nurses must be empowered to be able to give power to patients and family.

Patient-derived xenograft (PDX) models are created by engraftment of patients’ tumor tissues into immunocompetent mice. Since PDX model keep the characteristics of primary patient’s tumor such as gene expression profiles and drug sensitivity, it now becomes most reliable in vivo human cancer model. The engraftment rate are increased with the introduction of NOD/Scid based immunocompromised mice, especially, NK cell defective NOD strains such as NOD/Scid/IL2Rγnu (NOG/ NSG) mice and NOD/Scid/Jak3null (NOJ) mice. Success ratio differs from the origin of tumor: Gastrointestinal tumors tend to higher success rate and breast cancer is lower. Subcutaneous transplantation is most popular method to establish PDX, but some tumor needs orthotropic or renal capsule transplantation, and human hormone treatment is needed to establish hormone dependent cancers such as prostate and breast cancer. PDX library with patient’s clinical data, gene-expression patterns, mutational status, drug responsiveness and tumor architecture will be the powerful tool for developing specific biomarker and novel individualized therapy and establishing precision cancer medicine.

Background: Even though a number of studies have verified the positive effect of physical activity (PA) on self-related health (SRH) no previous research has examined this association among pediatric patients with Type 1 diabetes mellitus (T1DM). Objective: The purpose of this study was to investigate the association between regular physical activity (PA) and self-rated health (SRH) in pediatric patients with Type 1 diabetes mellitus (T1DM) who lacked diabetes care. Methods: We conducted a retrospective study among pediatric patients with T1DM who lacked diabetes care and were enrolled in a diabetes education program between January 2011 to January 2015 at the endocrinology clinic of Seoul National University Children’s Hospital in South Korea. The eligible participants for this study were 37 pediatric patients with T1DM aged 9 to 17 years. PA was divided into regular PA and muscle strength exercise to analyze the relationship with SRH using binomial logistic regression analysis. Results: The results showed SRH of pediatric patients with T1DM who did not engage in regular PA was significantly lower than those who did (OR in regular PA = .199 [95% CI: .040, .995]; OR in regular muscle strength exercise = .097 [95% CI: .023, .825]). Conclusions: In conclusion, regular PA and muscle strength exercise in pediatric patients with T1DM who lacked diabetes care were effective in improving their SRH. A systematic plan is required to enhance regular PA for pediatric patients with T1DM.

Background. The Stanford Health Assessment Questionnaire-Disability Index (HAQ) is widely used to measure functional ability in persons with Rheumatoid Arthritis (RA). The instrument was developed with limited involvement from persons with RA, and their perception of the instrument has not been studied in depth. The aim of this study was to explore how persons with RA experience the use of the HAQ in care. Methods. Forty persons with RA were purposefully recruited to participate in semi-structured interviews. The interviews were then analyzed qualitatively using thematic analysis. Results. The participants questioned the relevance of the HAQ but nevertheless experienced that the instrument had a profound effect on their understanding of health and how care is delivered. The analysis resulted in three themes: Problems with individual items, meaning of the summative score, and effects on care and health perceptions. Conclusions. To make the HAQ relevant to persons with RA, it needs to be revised or to include an option to select items most meaningful to the respondent. To ensure relevance, the HAQ update should preferably be co-created by researchers, clinicians and persons with RA.

The purpose of this paper is to examine the role and impact of public governance on European supranational public policies that seek to foster scientific and economic growth within innovation ecosystems (IEs) through the PITCCH initiative. The PITCCH is a European innovation development initiative funded by Horizon 2020 under the 'Innovation in SMEs' measure.The research methodology for this study is based on a 10-month real-time ethnographic field study of the PITCCH project, which allowed for the observation of the project governance and the capture of the perspectives of innovation-driven small and medium enterprises (i-SMEs) in their engagement with IE stakeholders.The findings of this research demonstrate the role of public governance in providing result-oriented practical support to the IE through the lens of i-SMEs, and they contribute to the existing literature on regional economic growth supported by supranational public policies. These findings have both academic and practical applications. They enrich the current literature on this topic and provide insights for policymakers and governing representatives seeking to implement effective public policies.

This work analyzes a new indoor laboratory data set looking at early fire indicators in controlled and realistic experiments representing different incipient fire scenarios. The experiments were performed within the confines of an indoor laboratory setting using multiple distributed sensor nodes on different room positions. Each sensor node collected data of particulate matter (PM), volatile organic compounds (VOC), CO, CO2, H2, UV, air temperature and humidity in terms of a multivariate time series. These data hold immense value for researchers within the machine learning and data science communities who are keen on exploring innovative advanced statistical and machine learning techniques. They serve as a valuable resource for the development of early fire detection systems. The analysis of the collected data was carried out in dependence of the manhattan distance between the fire source and the sensor node. We found that especially larger particles (&gt; 0.5 μm) and VOCs show a significant dependency with respect to the intensity as a function of the manhattan distance to the source. Moreover, we observed differences in the propagation behavior of VOCs, PM, and CO, which are particularly relevant in incipient fire scenarios due to the presence of strand popagation effects.

Variations in groundwater levels that are noticed in different parts of the world are typically the primary focus of research carried out in hydrology. The fluctuating levels of groundwater can be ascribed to several different factors, some of which include an increase in the demand for water, inappropriate irrigation practices, improper management of soil, and unregulated extraction from aquifers. It is necessary to effectively manage groundwater resources to have a trustworthy method of measuring and forecasting groundwater levels. The dynamics of groundwater are inherently uneven and difficult to understand. As a result, applying methods driven by data could potentially yield significant gains in hydrology. In this study, two data-driven models were utilized to estimate groundwater levels at a total of 4 monitoring wells located in Colorado state, USA. These models included ARIMA and ANN. The comparative analysis of the algorithms made use of a data set that had one month's worth of information from each of the years 1980 to 2019. The models were put through their paces, and the results of those tests were statistically and visually assessed. To evaluate the relative accuracy and precision of the models, the mean absolute error (MAE), mean square error (MSE), and root-mean-square error (RMSE) were used. When compared to ARIMA, the analysis demonstrates that ANN can produce the most accurate forecasts of groundwater levels in Colorado state USA.