The article presents an experience based on the design of DIY materials (Do-It-Yourself) as a phenomenon that contributes to the circular economy, making use of household waste and organic binders. The development context is the southernmost Industrial Design School in Latin America, where students are educated through the transfer of knowledge emphasized on the experimentation and territory assessment. Methodology corresponds to the traditional industrial design process, inserting DIY design of materials in the strategic stage. Objective and subjective variables are determined applied in the definition of new materials, being able to determine a range of proposals based on household waste. Citrus × Sinensis, Peperomia caperata (Piperaceae), Radiata pine veneers, among them, which are conceived by students to be self-produced at the user level. The results are materials elaborated based on household waste, exemplified with three types based on organic husks. Beyond findings associated to technique, compatibilities between residual materials and results expressed in materials and catalogs, it is possible to educate future designers on the innovative theme, with the potential to improve life quality of people and their environments.

Cyber Physical Systems (CPS) has been a popular research area in the last decade. The dependability of CPS is still a critical issue, and rare survey has been published in this domain. CPS is a dynamic complex system, which involves various multidisciplinary technologies. To avoid human error and to simplify management, self-management CPS (SCPS) is a wise choice. And to achieve dependable self-management, systematic solution is necessary to verify the design and to guarantee the safety of self-adaptation decision, as well as to maintain the health of SCPS. This survey first recalls the concepts of dependability, and proposes a generic environment-in-loop processing flow of self-management CPS, and then analyzes the error sources and challenges of self-management through the formal feedback flow. Focus on reducing the complexity, we first survey the self-adaptive architecture approaches and applied dependability means; then we introduce a hybrid multi-role self-adaptive architecture, and discuss the supporting technologies for dependable self-management at the architecture level. Focus on dependable environment-centered adaption, we investigate the verification and validation (V&V) methods for making safe self-adaptation decision and the solutions for processing decision dependably. For system-centered adaption, the comprehensive self-healing methods are summarized. Finally, we analyze the missing pieces of the technology puzzle and the future directions. In this survey, the technical trends for dependable CPS design and maintenance are discussed, an all-in-one solution is proposed to integrate these technologies and build a dependable organic SCPS. To the best of our knowledge, this is the first comprehensive survey on dependable SCPS building and evaluation.

Hospital-acquired infections (HAIs) contribute to increased length of hospital stay, high mortality and higher health-care costs. Prevention and control of HAIs is a critical public health concern. We conducted a cross-sectional survey of 213 hospital health-care workers in Qassim, Saudi Arabia. We assessed Knowledge, Attitude and Practice (KAP) of standard infection control precautions using a structured questionnaire. Predictors of KAP were investigated using multivaraible logistic regression analyses and independent sample t tests. Prevalence of good (≥80% correct response) knowledge, attitude and practice were 67.6%, 61.5% and 73.2%, respectively. Predictors of good knowledge included age over 34 years (adjusted odds ratio: 30.5, p<0.001), and receiving training (13.3, p<0.001). Predictor of positive attitude was having >6 years of experience (5.5, p<0.001). While, the predictors of good practice were having >6 years of experience (2.9, p<0.01), previous exposure to HAIs (2.5, p<0.05) and training (3.5, p<0.01). However, being female (0.22, p<0.001) and older (>34 years) (0.34, p<0.01) were negatively associated with knowledge. Results indicate that older academic programs might not have adequately covered infection crontrol. Arranging training for HCWs might be useful in improving their knowledge of standard infection control precautions and is also expected to facilitate positive attitude and practice.

The recommendations of the panel of experts on the further development of the ‘High-Tech Strategy’ of the Government of the Federal Republic of Germany designate the biologization of economic processes along with digitization as the central driver of societal change. Various fields such as the 'biologization of materials research' were then defined in the 'Bio-Agenda' in order to walk the path from biology to innovation. In view of this perspective, we describe how the use of biological materials and mechanisms can lead to resource conservation, the production of intelligent materials and new technological and medical applications. Our strategy, based on research on ‘Biointerfaces in Technology and Medicine’, aims at the development of modular biohybrid systems that could be used as 'biofactories of the future' for sustainable production processes. To achieve this goal, in a first phase already known technologies have to be further refined and integrated in order to obtain and apply compartmentalized reaction systems on different length and time scales. In a second phase, the resulting functional units will be employed to develop dissipative systems useful for biomedical applications and advanced production processes. From a technical point of view, future success in creating 'something entirely new' will depend crucially on robust and complementary research capabilities. Since the close connection of engineering and life sciences at KIT provides an excellent basis for this endeavor, we consider the above perspectives to be feasible.

Infant malnutrition remains as an important cause of death and disability, Haiti has the highest prevalence in America, so preventive strategies are needed. Our objective was to assess infant and young children malnutrition in Haiti and to study an association to World Health Organization (WHO) recommended feeding practices adherence. Cross-sectional study of children younger than 2 years old, recruited at Saint Espri Health Center, Port Au Prince (August to September 2014). We registered feeding practices, social and demographic data, and performed anthropometry (WHO-2006 standard). We evaluated 278 infants and young children, 8.08 ± 6.5 months old, 53.2% female. 18.35% had underweight; 13.31% were stunted and 13.67% had moderate or severe wasting. Malnutrition was associated to male gender, older age, lower education of mothers and higher number of siblings. The adherence to WHO recommended practices for breastfeeding was from 11.8 to 97.9% and was related to a lower prevalence of malnutrition. For complementary food, adherence was 9.7 to 90.3%, also associated to lower malnutrition. Conclusion: Prevalence of infant and young children malnutrition in this Haitian Health Center population was high, related to some risk factors. The adherence to WHO recommended feeding practices was associated to a better nutritional status.

The current coronavirus disease 2019 (COVID-19) pandemic is largely driven by community transmission, after 2019 novel Coronavirus (2019-nCoV or SARS-CoV-2) crosses the borders. To stop the spread, rapid testing is required at community clinics and hospitals. These rapid tests should be comparable with the standard PCR technology. Isothermal amplification technology provides an excellent alternative that is highly amenable to resource limited settings, where expertise and infrastructure to support PCR are not available. In this review, we provide a brief description of isothermal amplification technology, its potential and the gaps that need to be considered for SARS-CoV-2 detection. Among this emerging technology, loop mediated amplification (LAMP) and recombinase polymerase amplification (RPA) technologies have been identified as potential platforms that could be implemented at community level, without samples referral to a centralised laboratory and prolonged turn-around-time associated with the standard COVID-19 RT-PCR test. LAMP, for example, has recently been shown to be comparable with PCR and could be performed in less than 30 min by non-laboratory staff, without RNA extractions commonly associated with PCR. More so, it is cost effective and could easily be scaled up to resource limited settings. Diagnostics developers, scientific community and commercial companies could consider this alternative method to help stop the spread of COVID-19.

The runtime environment is an important concern for self-adaptive systems (SASs). Although researchers have proposed many approaches for developing SASs that address the issue of uncertain runtime environments, the understanding of these environments varies depending on the objectives, perspectives, and assumptions of the research. Thus, the current understanding of the environment in SAS development is ambiguous and abstract. To make this understanding more concrete, we describe the landscape in this area through a systematic literature review (SLR). We examined 128 primary studies and 14 unique environment models. We investigated concepts of the environment depicted in the primary studies and the proposed environment models based on their ability to aid in understanding. This illustrates the characteristics of the SAS environment, the associated emerging environmental uncertainties, and what is expressed in the existing environment models. This paper makes explicit the implicit understanding about the environment made by the SAS research community and organizes and visualizes them.

This article describes the use of the PI ProcessBook software tool for visualization and indirect monitoring of occupancy of SHC rooms from the measured operational and technical quantities for monitoring of daily living activities for support of independent life of elderly persons. The proposed method for data processing (predicting the CO₂ course using neural networks from the measured temperature indoor T_i (°C), temperature outdoor T_o (°C) and the relative humidity indoor rHi (%)) was implemented, verified and compared in MATLAB SW tool and IBM SPSS SW tool with IoT platform connectivity. Within the proposed method, the Stationary Wavelet Transform de noising algorithm was used to remove the noise of the resulting predicted course. In order to verify the method, two long-term experiments were performed, (specifically from February 8 to February 15, 2015, from June 8 to June 15, 2015) and two short-term experiments (from February 8, 2015 and from June 8, 2015). For the best results of the trained ANN BRM within the prediction of CO₂, the correlation coefficient R for the proposed method was up to 90%. The verification of the proposed method confirmed the possibility to use the presence of persons of the monitored SHC premises for rooms ADL monitoring.

Hand gestures may play an important role in medical applications for health care of elderly people, where providing a natural interaction for different requests can be executed by making specific gestures. In this study we explored three different scenarios using a Microsoft Kinect V2 depth sensor then evaluated the effectiveness of the outcomes. The first scenario utilized the default system embedded in the Kinect V2 sensor, which depth metadata gives 11 parameters related to the tracked body with five gestures for each hand. The second scenario used joint tracking provided by Kinect depth metadata and depth threshold together to enhance hand segmentation and efficiently recognize the number of fingers extended. The third scenario used a simple convolutional neural network with joint tracking by depth metadata to recognize five categories of gestures. In this study, deaf-mute elderly people execute five different hand gestures to indicate a specific request, such as needing water, meal, toilet, help and medicine. Then, the requests were sent to the care provider’s smartphone because elderly people could not execute any activity independently. The system transferred these requests as a message through the global system for mobile communication (GSM) using a microcontroller.

Importance: Because of the high prevalence of myopia in Taiwan, understanding the risk factors for its development and progression is important to public health. Background: This study investigated the risk factors for myopia and their influence on the progression of myopia in schoolchildren in Taiwan. Design: Patients’ clinical records were obtained retrospectively from ophthalmologists. Questionnaires were given to collect demographic information, family background, hours spent on daily activities, myopia progression, and treatment methods. Participants: A total of 522 schoolchildren with myopia from a regional medical hospital in northern Taiwan participated the study. Written informed consent was obtained from the participants of legal age or the parents or legal guardians. Methods: Multivariable regression analyses were performed. Myopia measured in dioptres was analysed, controlling for patients’ family and demographic information as well as their daily behaviours. Main Outcome Results: Children with high myopic parents were more myopic. Earlier onset age of myopia was associated with a higher level of myopia and greater annual myopic progression. Children reporting more near work activities had higher levels of myopia and greater progression of myopia. Lower levels of myopia were associated with more exercise, longer periods of sleep, and better vision care knowledge in children and parents. Intake of food supplements had no effect on myopia. Conclusions and Relevance: In addition to genetics, education, environment, and near work activity can influence the development of myopia. Health policies for schoolchildren should promote protective activities and vision care knowledge in order to protect the eyesight of schoolchildren.

Background: Low-level physical activity (PA) among Chronic Low Back Pain (cLBP) is associated with various biopsychosocial factors. This research aimed to study the predictors of PA behavior among cLBP patients. Methods: In the present study 300 eligible patients with cLBP who referred to comprehensive health service centers in the Shahid Beheshti University of Medical Sciences (SBUMS) in Tehran, Iran were random selected.To diagnose the predictors of PA behavior, all the Theory of Reasoned Action (TRA) constructs were examined as risk factors to see if they influence on the probability of PA behavior occurrence and were interpreted through odds ratio (OR). SPSS version 19 was used to analyze the data. Results: Totally 280 cLBP patients with mean age of 57.07 ±13.09 years old participated in the study. This study showed that motivation to comply significant predictor the cLBP patients for subjective norm OR (%95CI): 2.095(0.116-2.792), p-value<0.001), intention was significant predictor for perform the PA behavior OR (%95CI): 1.431(0.138-1.538), p-value <0.001), behavior beliefs could predictor for attitude OR (%95CI): 1.276(0.106-1.355), p-value= 0.002). attitude, normative beliefs, subjective norm ,and evaluation outcome behavior could predictors the cLBP patients for intention to perform the PA behavior OR (%95CI): 1.188(0.032-1.312), p-value<0.001)., OR (%95CI): 1.158(0.076-2.208), p-value=0.003) ., OR (%95CI): 1.104(0.076-1.128), p-value<0.001) ., OR (%95CI): 0.814(0.301-1.440), p-value=0.007). Conclusions: This study showed that the cLBP patients who were normative beliefs and evaluation regarding PA behavior could effect on the intention to engage in greater PA than those via other constructs (attitude and subjective norm). This study showed that the cLBP patients who were normative beliefs and evaluation regarding PA behavior could effect on the intention to engage in greater PA than those via other constructs (attitude and subjective norm). This study showed that the cLBP patients who were normative beliefs and evaluation regarding PA behavior could effect on the intention to engage in greater PA than those via other constructs (attitude and subjective norm).

UAVNs (unmanned aerial vehicle networks) may become vulnerable to threats and attacks due to their characteristic features such as high mobility, highly dynamic network topology, and open-air wireless environments. Since previous work has focused on classical and metaheuristic-based approaches, none of these approaches have a self-adaptive approach. In this article, we examine the challenges of cyber detection methods to secure UAVNs and review exiting security schemes proposed in the current literature. Furthermore, we propose an agent-based self-protective method (ASP-UAVN) for UAVNs that is based on the Human Immune System (HIS). In ASP-UAS, the safest route from the source UAV to the destination UAV is chosen according to a self-protective system. In this method, a multi-agent system using an Artificial Immune System (AIS) is employed to detect the attacking UAV and choose the safest route. In the proposed ASP-UAVN, the route request packet (RREQ) is initially transmitted from the source UAV to the destination UAV to detect the existing routes. Then, once the route reply packet (RREP) is received, a self-protective method using agents and the knowledge base is employed to choose the safest route and detect the attacking UAVs. The method is evaluated here via extensive simulations carried out in the NS-3 environment. The experimental results of four scenarios demonstrated that the ASP-UAS increases the Packet Delivery Rate (PDR) by more than 17.4, 20.8, and 25.91%, and detection rate by more than 17.2, 23.1, and 29.3%, and decreases the Packet Loss Rate (PLR) by more than 14.4, 16.8, and 20.21%, the false-positive and false-negative rate by more than 16.5, 25.3, and 31.21% those of SUAS-HIS, SFA and BRUIDS methods, respectively.

The role of vitamin D in the prevention and treatment of non-skeletal health issues has received significant media and research attention in recent years. Costs associated with clinical management of low vitamin D (LVD) have increased exponentially. However, no clear evidence supports vitamin D screening to improve health outcomes. Authoritative bodies and professional societies recommend against population-wide vitamin D screening in community-dwelling adults who are asymptomatic or at low risk of LVD. In order to assess patterns of physician management of LVD in this conflicting environment, we conducted a scoping review of three electronic databases and gray literature. Thirty-eight records met inclusion criteria and were summarized in an evidence table. Results from seven countries showed a consistent increase in vitamin D lab tests and related costs. Many vitamin D testing patterns reflected screening rather than targeted testing for individuals at high risk of vitamin D deficiency or insufficiency. Interventions aimed at managing inappropriate clinical practices related to LVD were effective in the short term. Variability and controversy were pervasive in many aspects of vitamin D management, shining light on physician practices in the face of uncertainty. Future research is needed is needed to inform better clinical guidelines and to assess implementation practices that encourage evidence-based management of LVD in adult populations.

Anomaly detection and segmentation aim at distinguishing abnormal images from normal images and further localizing the anomalous regions. Feature reconstruction based method has become one of the mainstream methods for this task. This kind of method has two assumptions: (1) The features extracted by neural network is a good representation of the image. (2) The autoencoder solely trained on the features of normal images cannot reconstruct the features of anomalous regions well. But these two assumptions are hard to meet. In this paper, we propose a new anomaly segmentation method based on feature reconstruction. Our approach mainly consists of two parts: (1) We use a pretrained vision transformer (ViT) to extract the features of the input image. (2) We design a self-attention autoencoder to reconstruct the features. We regard that the self-attention operation which has a global receptive field is beneficial to the methods based on feature reconstruction both in feature extraction and reconstruction. The experiments show that our method outperforms the state-of-the-art approaches for anomaly segmentation on the MVTec dataset. It is both effective and time-efficient.

The Voronoi entropy is a mathematical tool for quantitative characterization of the orderliness of points distributed on a surface. The tool is useful to study various surface self-assembly processes. We provide the historical background, from Kepler and Descartes to our days, and discuss topological properties of the Voronoi tessellation, upon which the entropy concept is based, and its scaling properties, known as the Lewis and Aboav-Weaire laws. The Voronoi entropy has been successfully applied to recently discovered self-assembled structures, such as patterned micro-porous polymer surfaces obtained by the breath figure method and levitating ordered water micro-droplet clusters.

The term dehumanisation refers to the ways in which a person is perceived to be less than human or treated as if they are less than human. It involves treating a person as if they are a child or infant, like an animal or non-living object, or as if they are dead, or any other way in which someone fails to be treated like a human being with an adult identity. Dehumanisation is widespread in dementia care; it is a major obstacle to person-centred care and has poor outcomes for people with dementia. This article proposes a new model of dehumanisation. The New Model presents a new way of describing dehumanisation that has been synthesised from current understanding about the phenomenon and reflects what is presently known about the subject. The model aims to summarise existing theories and models of dehumanisation and make dehumanisation theory accessible to students and trainees in healthcare. This article describes the new model, discusses existing models and theories in the literature, and explores the potential role of the new model in solutions for reducing dehumanisation in dementia care.

The work shows a single case intervention based on the motivational coaching model the “Cantón’s Giraffe”, theoretically and experimentally proven in a 20-years-old dancesport practitioner, who considered improving her execution with her dance partner. Methodological triangulation was used [34], combining a test-retest quantitative measure (Using Ryff Psychological Wellbeing Scales; the Rosenberg Self-Esteem Questionnaire and an ad-hoc instrument for the motivational force assessment) and subjective analysis of the responses from the interviews conducted. A three-phase intervention protocol was used [33]: identification, intervention, and follow-up. The results show an improvement in reevaluation scores, an increase in the subjective evaluation, and participant satisfaction and perceived resources raised at the end of the intervention. These results are in line with previous similar studies.

This article takes an approach to explaining the behavioral manifestations of the decision making in US companies’ offer of health insurance that is grounded not only on their cost minimizing behavior, but also in a humanness dimension based on the African concept of Ubuntu. In this way, we define an Ubuntu based Random Utility modeling framework, describing the choice process as a tripartite decision making, and implemented using a nationally representative random sample of 1,061 American companies from the Dunn and Bradstreet Business data, supplied by Survey Sampling International to the Associated Press-NORC Center for Public Affairs Research. The results from the three sequentially implemented specifications showed that the relationship between management culture and health plan offering strategy is dependent on other relevant co-variates, which when left out, leads to the problem of omitted variables bias. However, when all variables are included but assumed to enter the relationship exogenously, this results in management culture not having any statistically significant effect on companies' decisions about scope of health plan offering. When the exogeneity assumption is relaxed through a recursively Bivariate Probit model, the system of two equations produces a highly significant management culture effect. In fact, in this later case we see that companies with groups and formal committee management culture are 1.58 times less likely to choose a multiple plan strategy over a single plan strategy, hence failing to show the more wholesome plan offering that would theoretically prevail under Ubuntu style management.

Afghanistan is overwhelmed with food insecurity that is a large percentage of the population lacks reliable access to food supplies. Grains play a vital role in the country's food security due to their importance in terms of consumption and production quantity. This paper estimates cereal self-sufficiency and then makes a food balance forecast of the three major food crops cultivated in Afghanistan over six-decades. Descriptive statistics and coarse metric techniques were employed to determine cereal self-sufficiency and food balance forecast. The econometric analysis demonstrated that (1) Afghanistan is not yet self-sufficient in meeting grain consumption, and the production and consumption ratio declined from 0.9 to 0.55 from 1979 to 2030. (2) The gap of theoretical food imbalance will increase, and by the year 2030, cereal production will likely be sufficient for only 49.8 percentage of inhabitants, leaving a high shortage equivalent to the amount required by 24.4 million people. By evaluating the quantitative food balance and the growing population change, this study presents an analysis of the emerging threat to Afghanistan's food security and suggests a solution for food security, should increase the size of public agricultural expenditure, improve the level of agriculture infrastructure, and continue to introduce a policy to achieve higher yield.

Personal health data is acquired, processed, stored, and accessed using a variety of different devices, applications, and services. These are often complex and highly connected. Therefore, use or misuse of the data is hard to detect for people, if they are not capable to understand the trace (i.e., the provenance) of that data. We present a visualization technique for personal health data provenance using comics strips. Each strip of the comic represents a certain activity, such as entering data using a smartphone application, storing or retrieving data on a cloud service, or generating a diagram from the data. The comic strips are generated automatically using recorded provenance graphs. The easy-to-understand comics enable all people to notice crucial points regarding their data such as, for example, privacy violations.

Objective: To recommend how physicians can best respond to families whose hopes for a miracle via divine intervention influence their medical decisions, like, for example, making them not want to withdraw ventilatory support in cases of poor neurologic prognosis because they are still hoping for God to intervene. Methods: Auto-ethnographic analysis of chaplaincy experience in this clinical context yields a nuanced 90-second, point-of-care spiritual intervention physicians can use to address the religious aspect of families who base medical decisions on their hopes for a miracle via divine intervention. Explanation of how spiritual intervention dovetails with existing physician communication protocol for responding to families hoping for a miracle. Results: Spiritual intervention for religious aspect of miracle-hoping families is integrated into existing physician communication protocol for responding to families hoping for a miracle with recommendations for utilization of existing communication technology when necessary. Conclusion: Properly addressing the religious dimension of families hoping for a miracle may be helpful for physicians interested in decreasing their own stress levels, improving outcomes for this clinical context, and ensuring that unintentional discrimination does not perpetuate racial disparities in end-of-life care.

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

Tinnitus is a complex and heterogeneous psycho-physiological disorder responsible for causing a phantom ringing or buzzing sound albeit the absence of an external sound source. It has a direct influence on affecting the quality of life of its sufferers. Despite being around for a while, there hasn’t been a cure for tinnitus, and the usual course of action for its treatment involves use of tinnitus retaining and sound therapy, or Cognitive Behavioral Therapy (CBT). One positive aspect about these therapies is that they can be administered face-to-face as well as delivered via internet or smartphone. Smartphones are especially helpful as they are highly personalized devices, and offer a well-established ecosystem of apps, accessible via respective marketplaces of differing mobile platforms. Note that current therapeutic treatments such as CBT have shown to be effective in suppressing the tinnitus symptoms when administered face-to-face, their effectiveness when being delivered using smartphones is not known so far. A quick search on the prominent market places of popular mobile platforms (Android and iOS) yielded roughly 250 smartphone apps offering tinnitus-related therapies and tinnitus management. As this number is expected to steadily increase due to high interest in smartphone app development, a contemporary review of such apps is crucial. In this paper, we aim to review scientific studies validating the smartphone apps, particularly to test their effectiveness in tinnitus management and treatment. We use the PRISMA guidelines for systematic identification of studies on major scientific literature sources and delineate the outcomes of identified studies.

Very little is known about laboratory confirmed blood stream infections (LCBIs) in neonatal intensive care units (NICUs) in resource-limited settings. The aim of this cohort study was to determine the incidence, risk factors, and causative agents of LCBIs in a level-2 NICU in India. The diagnosis of LCBIs was established using the Centre for Disease Control, USA criteria. A predesigned questionnaire containing risk factors associated with LCBIs was filled-in. A total of 150 neonates (43% preterm) were included in the study. The overall incidence of LCBIs was 31%. The independent risk factors for LCBIs were: preterm neonates (relative risk (RR) 2.23), duration of NICU stay more than 14 days (RR 1.75), chorioamnionitis in the mother (RR 3.18), premature rupture of membrane in mothers (RR 2.32), neonate born through meconium-stained amniotic fluid (RR 2.32), malpresentation (RR 3.05), endotracheal intubation (RR 3.41), umbilical catheterization (RR 4.18), and ventilator-associated pneumonia (RR 3.17). The initiation of minimal enteral nutrition was protective from LCBIs (RR 0.22). The predominant causative organisms were gram-negative pathogens (58%). The results of the present study can be used to design antibiotic interventions to reduce LCBIs in resource-limited settings.

This review describes major advances in the use of functionalized molecular metal oxides (polyoxometalates, POMs) as water oxidation catalysts under electrochemical conditions. The fundamentals of POM-based water oxidation are described together with a brief overview of general approaches to designing POM water oxidation catalysts. Next, the use of POMs for homogeneous, solution-phase water oxidation is described together with a summary of theoretical studies shedding light on the POM-WOC mechanism. This is followed by a discussion of heterogenization of POMs on electrically conductive substrates for technologically more relevant application studies. Stability of POM water oxidation catalysts are discussed on selected examples where detailed data is already available. The review finishes with an outlook on future perspective and emerging themes in electrocatalytic polyoxometalate-based water oxidation research.

The intensive care units in North West London are part of one of the oldest critical carenetworks in the UK, forming a mature and established strategic alliance to shareresources, experience and knowledge for the benefit of its patients. North WestLondon saw an early surge in COVID-19 admissions, which urgently threatened thecapacity of some of its intensive care units even before the UK government announcedlockdown. The pre-existing relationships and culture within the network allowed itsmembers to unite and work rapidly to develop agile and innovative solutions, protectingany individual unit from becoming overwhelmed, and ultimately protecting its patients.Within a short 50-day period 223 patients were transferred within the network todistribute pressures. This unprecedented number of critical care transfers, combinedwith the creation of extra capacity and new pathways, allowed the region to continue tooffer timely and unrationed access to critical care for all patients who would benefitfrom admission. This extraordinary response is a testament to the power and benefitsof a regionally networked approach to critical care, and the lessons learned maybenefit other healthcare providers, managers and policy makers, especially in regionscurrently facing new outbreaks of COVID-19.

Burning Man is probably the most famous art festival in the world. What started as a bonfire ritual for a small group of friends held on San Francisco beach in 1986, has evolved into an iconic event. Held annually for one week before the Labor Day weekend, the festival attracts over 60,000 participants each year and yields over $8 million in tickets and contributions.This preprint reveals some preliminary results from the economic analysis of Burning Man that is based on the unique data from over 500 surveys collected during several Burning Man events between 2012 and 2018.The paper’s main findings demonstrate that Burning Man is not some hippie get-together with lots of booze and drugs. Instead, it is a lucrative and exclusive event that is attended by bright, wealthy and well-educated people, both from the United States and abroad. A typical Burner is a 32-old childless male with a college degree and an average annual income above $100,000 who attended Burning Man at least two times before and who spends between $5,000 and $6,000 on tickets, fares, gear, and supplies.

Context: A clinical video telehealth (CVT) program was implemented improve access and quality of dementia care to patients and their caregivers in rural areas. The program was offered as part of an established dementia clinic/geriatric primary care clinic in collaboration with five community-based outpatient clinics (CBOC’s) affiliated with the Tennessee Valley Healthcare System (TVHS) in middle Tennessee. Telehealth support was provided by a physician – social worker team visit. Methods: Telehealth training and equipment were provided to clinic personnel, functioning part-time with other collateral clinical duties. Patients and caregivers were referred by primary care providers and had an average of 1 to 2 CVT encounters originating at their local CBOC lasting 20 to 30 minutes. Clinical characteristics and outcomes of patients and caregivers receiving CVT support were collected by retrospective electronic medical record (EMR) review. Results: Over a 3-year period 45 CVT encounters were performed on patient-caregiver pairs, followed for a mean of 15 (1-36) months. Some 80% patients had dementia confirmed and 89% of these had serious medical comorbidities, took an average of 8 medications, and resided at a distance of 103 (76-148) miles from the medical center. Dementia patients included 33% with late stage dementia, 25% received additional care from a mental health provider, 23% took antipsychotic medications, 19% transitioned to a higher level of care, and 19% expired an average of 10.2 months following consultation. Caregiver distress was present in 47% of family members. Consult recommendations included 64% community-based long-term care services and supports (LTSS), 36% medications, and 22% further diagnostic testing. Acceptance of the CVT encounter was 98%, with 8770 travel miles saved. Conclusion: CVT is well received and may be helpful in providing dementia care and supporting dementia caregivers to obtain LTSS for high-need older adults in rural areas.

Teacher burnout has been revealed to be one of the most common negative consequence of the COVID-19 pandemic The purpose of this study was to identify distinct psychological resources and burnout risk profiles of teachers and to examine their association with Kolb’s Educator Roles and the professional experience. Methods: The survey data were collected from 330 preschool and primary school (84 males, Mage = 38.3, SD = 9.14) teachers using a convenience sampling method. Results: The two-step cluster analysis revealed two distinct profiles. The first profile, ‘High psychological resources, no burnout risk’, was characterised by absent symptoms of burnout and increased levels of well-being, self-control, and positive emotionality. The second profile, ‘Moderate psychological resources, mild burnout’, was associated with medium levels of well-being, self-control and positive emotionality accompanied by mild burnout. Our findings highlighted that cluster 1 had a significantly higher score for the Facilitator role and cluster 2 for the Expert and Coach roles. In addition, teachers with less professional experience were more likely to belong to cluster 1, taking into account their good skills on digital literacy. Conclusions: These findings help to provide new insights into the explanation of teacher burnout and the design of intervention programmes.

In recent years, Lassa fever has been announced as an infectious disease in the world, a few imported cases have been accounted for in various pieces of the world and there are developing worries of the possibilities of Lassa fever Virus as an organic weapon. Regardless of its assaulting impact, no substantial arrangement has been created to reduce the hazard of the ailment, about a large portion of 10 years after identifying it. A Review based on the documents from the literature search on PubMed, Scopus, Goggle Scholar and Science direct. Out of these, the final 16 articles that met the criteria were selected. Relevant information on epidemiology, the burden of management and control were obtained. Timely and effective containment of the Lassa fever disease in Lassa village four decades ago could have minimized the devastating effect and threats posed by this illness in the West African sub-region and indeed the entire globe. That was a hard lesson calling for much more proactive measures towards the eradication of the illness at primary, secondary, and tertiary levels of health care. Hence, the paper is aimed at appraising the threats associated with Lassa fever disease; its demands on curtailing the menace of the epidemic, and recommendations on important focal points.

We propose a novel transfer learning method for speech emotion recognition allowing us to obtain promising results when only few training data is available. With as low as 125 examples per emotion class, we were able to reach a higher accuracy than a strong baseline trained on 8 times more data. Our method leverages knowledge contained in pre-trained speech representations extracted from models trained on a more general self-supervised task which doesn’t require human annotations, such as the wav2vec model. We provide detailed insights on the benefits of our approach by varying the training data size, which can help labeling teams to work more efficiently. We compare performance with other popular methods on the IEMOCAP dataset, a well-benchmarked dataset among the Speech Emotion Recognition (SER) research community. Furthermore, we demonstrate that results can be greatly improved by combining acoustic and linguistic knowledge from transfer learning. We align acoustic pre-trained representations with semantic representations from the BERT model through an attention-based recurrent neural network. Performance improves significantly when combining both modalities and scales with the amount of data. When trained on the full IEMOCAP dataset, we reach a new state-of-the-art of 73.9% unweighted accuracy (UA).

This paper presents a study of different types of parametric signals with application to underwater acoustic communications. In all the signals, the carrier frequency is 200 kHz, which corresponds to the resonance frequency of the transducer under study and different modulations are presented and compared. In this sense, we study modulations with parametric sine sweeps (4 to 40 kHz) that represent binary codes (zeros and ones), getting closer to the application in acoustic communications. The different properties of the transmitting signals in terms of bit rate, directivity, efficiency and power needed are discussed as well.

This study explores individual and contextual risk factors for the onset of work interfering with private life (WIL) and private life interfering with work (LIW) among self-employed men and women across European countries. It also studies the relationship between interference (LIW and WIL) and wellbeing among self-employed men and women and the effect of macro level risk factors. Data from the fifth round of European Working Conditions Survey was utilized and a sample of self-employed men and women with active businesses was extracted. Applying multilevel regressions, results show that though business characteristics are important for level of WIL, time demand is the most evident risk factor for WIL and LIW. There is a relationship between wellbeing and WIL and LIW respectively, and time demands is the most important factor in this relationship. Gender equality on the labor market did not relate to level of interference, nor did it mediate the relationship between interference and wellbeing. However, the main and most important risk factor for experiencing WIL and LIW and for how interference relate to wellbeing is gender relation processes in work and life, both on individual and contextual level.

The COVID-19 pandemic has exposed the inadequacies of the current healthcare system and needs a paradigm change, which is holistic, and community based illustrated by the healing wheel. The present paper proposes that existential positive psychology (PP 2.0) represents a promising approach to meet the rising needs in palliative care. This framework has a twofold emphasis on (a) How to transcend and transform suffering as the foundation for wellbeing, and (b) how to cultivate our spiritual and existential capabilities to achieve personal growth and flourishing. We propose that these objectives can be achieved simultaneously through dialectical palliative counselling, as illustrated by Wong’s integrative meaning therapy (Wong, 2020) and Lo’s Conceptual Model of CALM Therapy in palliative care (Lo et al., 2014). We then discuss existential suffering in general and at the last stage of life in particular; we also review recent research and interventions on existential suffering in palliative patients. Finally, we outline the objectives and the strategies of IMT in providing palliative counselling for palliative care and hospice patients.

Type 1 diabetes affects millions of people globally and requires careful management to avoid serious long-term complications, including heart and kidney disease, stroke, and loss of sight. The present standard-of-care for type 1 diabetes is exogenic insulin substitutional therapy. The most advanced stretegies in this area is the development of hybrid-closed loop system and the producing of long-acting insulins. Progresses in stem cell therapies have started to revolutionize the care of patients with type 1 diabetes; however, significant challenges remain including the limited islets availability, difficulties in maintaining the viability, the heterogeneity within a complex pathology and in patients’ responses to treatment. On the way, a considerable amount of efforts in maximizing the islet transplantation effectiveness by controlling the advantageous of different stem cell approaches. With the availability and the use of big data, the concept of precision medicine is gaining wide attention worldwide and could bring the dream of “presonlaized” therapies as a reality in the near future. Here we review the current range of treatments available as well as recent pre-clinical breakthroughs in the field of personlaized medicine for type 1 diabetes.

Chitosan is a cationic polysaccharide usually obtained by alkaline deacetylation of chitin poly(N-acetylglucosamine). It is biocompatible, biodegradable, mucoadhesive and non-toxic. These excellent biological properties make chitosan a good candidate for a platform in developing drug delivery systems having improved biodistribution, increased specificity and sensitivity, and reduced pharmacological toxicity. In particular, chitosan nanoparticles are found to be appropriate for non-invasive routes of drug administration: oral, nasal, pulmonary and ocular routes. These applications are facilitated by the absorption-enhancing effect of chitosan. Many procedures for obtaining chitosan nanoparticles have been proposed. Particularly, the introduction of hydrophobic moieties into chitosan molecules by grafting to generate a hydrophobic-hydrophilic balance promoting self-assembly is a current and appealing approach. The grafting agent can be a hydrophobic moiety forming micelles that can entrap lipophilic drugs or it can be the drug itself. Another suitable way to generate self-assembled chitosan nanoparticles is through the formation of polyelectrolyte complexes with polyanions. This paper reviews the main approaches for preparing chitosan nanoparticles by self-assembly through both procedures and illustrates the state of the art of their application in drug delivery.

In this work, we develop a self-consistent physical model of bubbles in a gas solid two-phase flow. Using the Peng-Robonson state equation and a detailed specific heat ratio equation of bubbles, we obtain the kinetic equations of the bubbles on the basis of the Ergun equation, thermodynamic equations, and kinetic equations. It is found that the specific heat ratio of bubbles in such systems strongly depends on bubble pressures and temperatures, which play an important role in the characteristics of the bubbles. The theoretical studies show that with increasing height in the systems, the gas flow rate shows a downward trend. Moreover, the larger particles in the gas solid flows are, the greater the gas velocity is. The bubble sizes increase with the increasing heights of the gas solid systems, and then decrease. The bubble velocity is affected by the gas velocity and the bubble size, which gradually increase and eventually quasi-stabilize. This shows that gas and solid phases in a gas solid two-phase flow interact with each other and a self-consistent system comes into being. The theoretical results have exhibited important value as a guide for understanding the properties and effects of bubbles in gas solid two-phase flows.

Considering the significant advancements in autonomous vehicle technology, research in this field is of interest to researchers. To drive vehicles autonomously, controlling steer angle, gas hatch, and brakes need to be learned. The behavioral cloning method is used to imitate humans’ driving behavior. We created a dataset of driving in different routes and conditions and using the designed model, the output used for controlling the vehicle is obtained. In this paper, the Learning of Self-driving Vehicles Based on Real Driving Behavior Using Deep Neural Network Techniques (LSV-DNN) is proposed. We designed a convolutional network which uses the real driving data obtained through the vehicle’s camera and computer. The response of the driver is during driving is recorded in different situations and by converting the real driver’s driving video to images and transferring the data to an excel file, obstacle detection is carried out with the best accuracy and speed using the Yolo algorithm version 3. This way, the network learns the response of the driver to obstacles in different locations and the network is trained with the Yolo algorithm version 3 and the output of obstacle detection. Then, it outputs the steer angle and amount of brake, gas, and vehicle acceleration. The LSV-DNN is evaluated here via extensive simulations carried out in Python and TensorFlow environment. We evaluated the network error using the loss function. By comparing other methods which were conducted on the simulator’s data, we obtained good performance results for the designed network on the data from KITTI benchmark, the data collected using a private vehicle, and the data we collected.

Background: Maternal mortality (MM) is a matter of serious concern in low income developing countries (LDCs). Perspective: A great reduction has been observed regarding the maternal deaths globally after huge efforts since 1990 todate. However, the situation continues to be either stagnant or worsening in developing countries, suggesting that the efforts to cope with this issue are either insufficient or not properly implemented. We need to first diagnose the problem areas that are a great hurdle in the road to success towards the reduction of MM. Postpartum haemorrhage and preeclampsia are one of the most common causes of MM. Malnutrition, neurological dysfunction and cancer are among the non-obstetric causes. Trained medical and paramedical staff can be of great help in this regard by increasing awareness among masses at grass root level. Target set by Millennium Development goal has minimized the MM by 44%. But it has not met the target set by Millenium Development Goals 5 and a lot of measures need to be taken in this regard. Conclusions: Majority of the MDs are preventable and can be avoided by adopting appropriate frameworks, linked data sets, surveillance, birth attendants training, preparation for births, etc. Delay in decision to get healthcare, access to healthcare center and receiving these facilities are the main factors in MM.

The critical changes in physical appearance during adolescence can considerably influence the self-appraisal of body image. The purpose of this study is to analyze body self-image gender differences in Mediterranean adolescents, and his relationships to the anthropometric characteristics of this population in different phases of the adolescence. Participants were 809 Mediterranean teenagers (396 females) aged 11 to 17. A relative low prevalence of dissatisfaction with body image was observed among healthy urban Mediterranean adolescents (boys 17.3%; girls 22.7%). Girls showed statistically significantly higher mean BSQ scores than boys (M = 61.7, SD = 26.6 versus M = 56.3, SD = 27.1; p < 0.001). Girls in the late adolescence were more often classified as being dissatisfied (31%) in comparison to those in the early adolescent group (19.1%; p < 0.05). There was a good correlation of BSQ scores with all the anthropometric variables in males but not in females.

In Rwanda, more than 90% of the population is insured for health care. Despite the comprehensiveness of health insurance coverage in Rwanda, some health services at partner institutions are not available, causing insured patients to pay unintended cost. We aimed to analyze the effect of health insurance on health care utilization and factors associated with the use of health care services in Rwanda. This is an analysis of secondary data from the Rwanda integrated living condition survey 2016-2017. The survey gathered data from 14580 households, and decision tree and multilevel logistic regression models were applied. Among 14580 households only (20%) used health services. Heads of households aged between [56-65] years (AOR=1.28, 95% CI:1.02-1.61), aged between [66-75] years (AOR=1.52, 95% CI: 1.193-1.947), aged over 76 years (AOR=1.48, 95% CI:1.137-1.947), households with health insurance (AOR=4.57, 95% CI: 3.97-5.27) displayed a significant increase in the use of health services. This study shows evidence of the effect of health insurance on health care utilization in Rwanda: a significant increase of 4.57 times greater adjusted odds of using health services compared to those not insured. The findings from our research will guide policymakers and provide useful insights within the Rwanda context as well as for other countries that are considering moving towards universal health coverage through similar models.

Objective: The study investigated the benefit of practicing the art of bonsai and the well-being of practitioners. The art promotes relaxation, focus and art therapy that can have personal and emotional value in a self-help setting. When the bonsai tree is used as a healing object, it may improve the ability of the bonsai practitioner to adapt to adverse and stressful life events, such as the present global COVID-19 pandemic. Method: International bonsai artists (n = 255) participated in a study that examined the effect their bonsai had on their mental well-being. Semi-structured interviews were conducted with bonsai artists answering the question: “How has bonsai helped you?”. Results: Most participants acknowledged that being able to take care of their bonsais affected their mood in a positive manner. Discussion: Although the participants did not report overall improved mental health, participants expressed an improvement in their mood when being able to work on a bonsai tree. Conclusion: These findings are significant in that it can be useful in as a preventative and restorative manner in the mental well-being of people who practice the art.

Machine learning has become an increasingly ubiquitous technology, as big data continues to inform and influence everyday life and decision-making. Currently in healthcare, as well as in most other industries, the two most prevalent machine learning paradigms are supervised learning and transfer learning. Both practices rely on large-scale, manually annotated datasets to train increasingly complex models. However, the requirement of data to be manually labeled leaves an excess of unused, unlabeled data available in both public and private data repositories. Self-supervised learning (SSL) is a growing area of machine learning that has the ability to take advantage of unlabeled data. Contrary to other machine learning paradigms, SSL algorithms create artificial supervisory signals from unlabeled data and pretrain algorithms on these signals. The aim of this review is two-fold: firstly, we provide a formal definition of SSL, divide SSL algorithms into their four unique subsets, and review the state-of-the-art published in each of those subsets between the years of 2014-2020. Second, this work surveys recent SSL algorithms published in healthcare, in order to provide medical experts with a clearer picture of how they can integrate SSL into their research, with the objective of leveraging unlabeled data.

Comprehensive geriatric assessment, defined as an interdisciplinary assessment and development of an overall plan of treatment and follow-up, has become a fundamental part of clinical geriatric care. Since the 1970s, the Veterans Administration has encouraged the development of geriatric evaluation and management programs. Evolution of geriatric evaluation and management has occurred over time and many VA medical centers have transferred inpatient geriatric evaluation programs to long-term care Community Living Centers (CLC) and outpatient settings. Availability of resources and trained personnel across the continuum of care as well as administrative facilitation of collaboration between care components are critical to the efficient utilization of geriatric services. Facilities may need to prioritize their resources and utilize the most effective and relevant elements of geriatric evaluation and management according to patient population needs, available space, resources, and institutional priorities.

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.

Frequent employee resistance to innovation is one of the main barriers of change failure in a health care organization and one of the negative stimuli of employment relationships. Identifying the reasons of resistance is a topical issue for every organization, as the speed of change can affect their competitiveness. Consequently, it is helpful not only to know the causes of potential resistance but also to be ready to control any implicit opposition. The organizational climate and the attitude of the staff play an important role in understanding and accepting innovation. Purpose of the study is to develop a model, which would facilitate the choice of an appropriate strategy necessary to enable the health care organization to eliminate or at least to reduce resistance to often essential innovative changes. The article analyses the root causes of resistance and identifies strategies that help to mitigate or eliminate staff resistance for innovation. Use of suggested model can make easier reducing staff resistance to change processes and thus speed up the implementation of innovations. This methodology can be used to eliminate the reasons for staff resistance to change in health care institutions of different countries, but it was tested in Lithuania and achieved good enough results.

In Kenya, millions of children have limited access to nurturing care. With the COVID-19 pandemic, it is anticipated that vulnerable children will bear the biggest brunt of the direct and indirect impacts of the pandemic. This review aimed to deepen understanding of the effects of COVID-19 on nurturing care from conception to four years of age, a period where the care of children is often delivered through caregivers or other informal platforms. The review has drawn upon the empirical evidence from previous pandemics and epidemics, and anecdotal and emerging evidence from the ongoing COVID-19 crisis. Multifactorial impacts fall into five key domains: direct health; health and nutrition systems, economic, social and child protection, and child development and early learning. The review proposes program and policy strategies to guide the re-orientation of nurturing care, prevent the detrimental effects associated with deteriorating nurturing care environments, and support the optimal development of the youngest and most vulnerable children. These include the provision of cash transfers and essential supplies for vulnerable households, and strengthening of community-based platforms for nurturing care. Further research on COVID-19 and the ability of children’s ecology to provide nurturing care is needed, as is further testing of new ideas.

Objectives: This study was performed to estimate diagnostic accuracy of the two commercially available point-of-care tests to identify poor glycemic control defined by HbA1c levels, with HPLC as a reference. Settings: The study was carried at two locations, general medical out-patient department of a teaching medical college in Bhopal (urban), and a primary health care centre in rural area in the state of Madhya Pradesh, India.Participants: All individuals with diabetes mellitus who presented to the health care facility for assessment of glycemic control. We excluded participants who denied a written informed consent. No other exclusions were used. We compared HbA1c estimated from two index tests (Hemocue Hb501, Sweden; SD Biosensor, South Korea) from capillary blood samples with HPLC performed from venous blood, as a reference standard. Primary and secondary outcome measures: Diagnostic properties of index tests such as sensitivity, specificity, positive and negative predictive value and diagnostic accuracy for identifying poor glycemic control were primary outcome measures. Lin’s concordance correlation coefficient (CCC) was secondary outcome measure.Results: Out of 114 patients, all received reference standard, 103-Hemocue A1C test, and 110- SD Biosensor test. Overall both the index-tests had similar diagnostic accuracy estimates. The area under the Receiver Operating Curve for SDA1c device was 0.935 (95%CI 0.886-0.983), and for Hemocue device was 0.938 (95%CI 0.893-0.984). The Hemocue device HbA1c value of above 7.0 (positive) correctly predicted poor glycemic control 92% times (81.58% for SD device). There were 4 vs. 11 device failures and 14 vs. 12 failures with SD and Hemocue respectively. Ambient air temperatures were no different for the device test failures.Conclusions: Commercially available point-of-care tests evaluated in this study are comparable and an acceptable alternative to HPLC based measurements for assessment of glycemic control. Tests and device failure rates of both the index tests are similar.

The purpose of this study is to examine the self-esteem levels of visually handicapped individuals who do sports and do’t do sports. There were 106 sportsmen and 94 persons with visual handicapped (200 in total) who participated in the research clubs in the province of Izmir. As the sub-problems, the relationship between the genders of participant who visually handicapped and not visually handicapped was investigated. The study consists of two parts. In the first part, the demographic characteristics of the participants were determined; in the second part Rosenberg Self Value scale consisting of 10 questions was used. Data were analyzed with SPSS 18.00 package program. T test, correlation analysis, descriptive statistics were applied to test hypotheses of the study. The research found that there is a significant difference between the self-esteem levels of individuals with and without visually handicapped sports (P <0.05). No statistically significant difference was found between the self-esteem levels of the sportsmen and the sportswomen (P> 0,05). There was no significant difference in the self-esteem levels of visually handicapped individuals who played individual sports and team sports (P> 0,05). As a result, it has been seen that sports have a positive effect on self-esteem in visually handicapped individuals and they contribute and hold to life more meaningful.

Africa was the only continent not to achieve the 2015 Millennium Development Goal of 50% poverty reduction. This paper asks whether Africa will fare better in meeting Sustainable Development Goals (SDGs) addressing poverty and hunger by 2030. To answer this question we examine literature, including our field research published over the last thirteen years. We find that ‘sustainable development’ is a failed concept immersed in the contemporary global economic system that favors growth over ecosystem stability and patriarchal systems of governance that undervalue women’s capacity for sustainability in their care-work as food providers. We examine barriers to women’s farming (climate change, gender bias, limited access to land, technology, finance) and provide examples of women’s innovative strategies for overcoming these barriers in their care practices toward family and community well-being and ecosystem health. We conclude that sustainability is only possible through transformation of thinking away from approaches that value profit over people and ecosystems and toward gender-based approaches for achieving the goals laid out in the SDGs through holistic, integrative systems of ecosystem fit.

The increasing number of registered road crashes involving cyclists during the last decade, and the high proportion of road crashes resulting in severe injuries and fatalities among cyclists constitutes a global issue for community health, urban development, and sustainability. Nowadays, the incidence of many risk factors for road crashes of cyclists remains largely unexplained. Given the importance of this issue, the present study has been conducted with the aim of determining relationships between infrastructural, human factors and safety outcomes of cyclists. Objectives: This study aimed, first, to examine the relationship between key infrastructural and human factors present in cycling, bicycle-user characteristics, and their self-reported experience with road crashes. And second, to determine whether a set of key infrastructural and human factors may predict their self-reported road crashes. Methods: For this cross-sectional study, a total of 1064 cyclists (38.8% women, 61.2% men; M = 32.8 years of age) from 20 different countries across Europe, South America and North America, participated in an online survey composed of four sections: demographic data and cycling-related factors, human factors, perceptions on infrastructural factors, and road crashes suffered. Results: The results of this study showed significant associations between human factors, infrastructural conditions and self-reported road crashes. Also, a logistic regression model found that self-reported road crashes of cyclists could be predicted through variables such as age, riding intensity, risky behaviors, and problematic user/infrastructure interactions. Conclusions: The results of this study suggest that self-reported road crashes of cyclists are influenced by features related to the user and their interaction with infrastructural characteristics of the road.

Background: This study investigated the prevalence of worsening problems using Post Stroke Checklist (PSC) at 3, 6, and 12 months post-stroke and their associations with health-related quality of life. Methods: In stroke patients admitted between June 2014 and December 2015, PSC and EuroQol-5Dthree level (EQ-5D-3L) were assessed at post-stroke 3 (n=181), 6 (n=175), and 12months (n=89). The prevalence of worsening problems and its association withEQ-5D-3L at post-stroke 3 and 6months were analyzed. Results: An average of 0.59 (range 0–12), 1.47 (range 0–12), and 1.00 (range 0–10) worsening problems per patient was identified at 3, 6, and 12months after stroke, respectively. The most frequently and continuously identified worsening problems were mood disturbances (reported by 8.8%, 16.0% and13.5% of patients at 3, 6, and 12 months post-stroke, respectively). Worsening mobility was significantly associated with worse EQ-5D index at post-stroke 3 months (β,-0.583; 95% CI, -1.045 to -0.120). The worsening of mobility and communication was significantly associated with worse EQ-5D index at post-stroke 6 months (mobility: β,-0.170; 95% CI, -0.305 to -0.034, communication: β,-0.164; 95% CI, -0.309 to -0.020). Conclusions: PSC may be useful for the detection of various subjective worsening problems during serial clinical follow-up after stroke. Appropriate rehabilitation and management strategy to solve the identified problems could improve the quality of life in stroke survivors.

Hydrogels incorporated with hydrophobic motifs have received considerable attention to recapitulate the cellular microenvironments, specifically for the bio-mineralization of a 3D matrix. Introduction of hydrophobic motifs into a hydrogel often results in irregular arrangement of the motifs, and further phase separation of hydrophobic domains, but limited efforts have been made to resolve this challenge in the hydrophobically-modified hydrogel. Therefore, this study presents an advanced integrative strategy to incorporate hydrophobic domains regularly in a hydrogel by self-assembling of polymer cross-linkers, building blocks of a hydrogel. Self-assemblies between polymer cross-linkers were examined as micro-domains to incorporate hydrophobic motifs in a hydrogel. The self-assembled structures in a pre-gelled solution were confirmed with the fluorescence analysis and the hydrophobicity of a hydrogel could be tuned by incorporating the motifs in a controlled manner. Overall, the results of this study would greatly serve to tuning performance of a wide array of hydrophobically-modified hydrogels in drug delivery, cell therapies and tissue engineering.

Background: Nursing services provided by nurses are based on knowledge and competence in the field of nursing science developed in accordance with Client needs, scientific developments, and the demands of globalization. These health services include nursing services that are carried out responsibly, accountably, with quality, and safely by nurses who have obtained registration and permission to practice. Nursepreneur is innovation and courage to take risks and is ready to work hard to achieve goals with optimism. Which has important components namely: 1) quality, 2) role, 3) option and success. The post-pandemic new world, especially in the health care system, continues to grapple with the demands of costs to provide patient care and safety. By using the application of the nursing theory model. Purpose :. Assessing scientific studies on the application of evidence-based intervention in wound care using nursing theory, identifying the important role of telenursing in improving nursing services in Nerspreneurship, Method: literature study Conclusion: Telenursing in nursing focuses on providing nursing care through information technology, such as telephone, computers, and the Internet that can be used to improve treatment outcomes among older people, especially those with low literacy skills and low financial status (Esmaeilpour-BandBoni et al., 2020). The statement from the results of the study refutes that Telenursing is intended for patients who have higher education and middle and upper economic states.

In this study, 6 residents of a long-term care facility were asked to try on Virtual Reality glasses and report their first experiences with Virtual Reality. The results show that Virtual Reality is of great interest to elderly residents of in-patient long-term care facilities. The wearing period was longer than expected and no symptoms of cyber sickness occurred. For the residents it was exciting to explore the virtual environments. Austrian destinations, nature scenes in the mountains and forests but also trips to the zoo, the museum, in churches or even densely populated areas like shopping streets or train stations would be places for the residents, they would like to explore virtually. Far-off destinations such as Rio de Janeiro or the Caribbean are more of an exception. Biographically relevant places such as the parental home or the location of their wedding were not named. Concerning the usability, an adjustment of the VR glasses is necessary for a longer-term use in any case.

Green public space immensely provides ecological soundness (ES), social resilience, social inclusiveness, mental health, self-esteem, and cultural prosperity from privileged class to lower ones. This research aims at estimating the effect of social services, safety, and infrastructural amenity in green space (parks) on mental health building self-esteem for elderly population. Data were collected from four parks out of 21 in Dhaka selected by systematic random sampling. Two-hundred and three elderly participants were picked up for survey using snowball sampling. The survey was conducted in a pre-structured questionnaire consisted of 40 close-ended questions. Data was analyzed applying ordinal logistic model, multivariate regression analysis, and Partial Least Square (PLS) -Path Modeling. The study explored several key findings-1) Infrastructural amenities impacted social services of parks; 2) Social services contributed positively to mental health boosting up self-esteem for elderly population. 3) Likewise, mental health for elderly population was affected by safety measure of green space. Dhaka requires constructing age-friendly parks to promote elderly mental health.

(1)Background: When the COVID-19 pandemic arrived, changes had to be made to several management aspects at our Pediatric Oncology Center. We investigated how the families per-ceived these changes. (2) Methods: Two questionnaires were developed at the Pediatric Oncology Unit of the Istituto Nazionale dei Tumori in Milan, to explore how the pandemic has affected the experience of patients who had been or were being treated at our hospital, and their families. These were administered to three samples of individuals. (3) Results: Between July and October 2020, 120 questionnaires were administered to parents of patients. The impact of school closures and the impossibility of attending sports and social activities outside the hospital were regarded as im-portant. 77.5% of parents judged the social distancing to have affected their children. Regarding the changes introduced in the management of the ward and outpatient clinic, most parents’ opinions were positive. Differences in the opinions expressed by Groups 2 and 3 were statistically significant on the topic of relationships on the ward and staff workload. The aspect most negatively affected by the pandemic was the support that patients’ parents were able to give each other. Regardless of whether patients were treated before the pandemic or after the first lockdown, their parents of all indicated a strong degree of satisfaction with the care received, and with the organizational ar-rangements. (4) Conclusions: The results of our study point us in the right direction to further improve our daily work and better respond to the needs of our patients and their families.

The resonance spectra of neutral silver indicate self-absorption for the studied Ag I lines at the wavelengths of 327.9 nm and 338.2 nm. The center dip is associated with self-reversal due to self-absorption in the plasma. The Q-switched radiation of 355 nm, 532 nm, or 1064 nm from a Nd:YAG laser device generates the plasma at the surface of silver nano-material targets, with experiments conducted in standard ambient temperature and pressure laboratory air. Procedures for recovery of the spectral line shapes confirm that over and above the effects of self-reversal, line shape distortion are important in the analysis. The work discusses parameters describing self-absorption when using fluence levels of 2 to 33 J/cm² to generate the plasma. Furthermore, subsidiary calibration efforts that utilize the hydrogen alpha line of the Balmer series show that the Ag I lines at 827.35 nm and 768.7 nm are optically thin.

Hierarchical honeycomb patterns were manufactured with the breath-figures self-assembly by drop-casting on the silicone-oil lubricated glass substrates. Silicone oil promoted spreading of the polymer solutions. The process was carried out with the industrial grade polystyrene and polystyrene with the molecular weight Mw=35.000. Both of polymers gave rise to the patterns, built from micro- and nano-scaled pores. Ordering of the pores was quantified with the Voronoi tessellations and calculating the Voronoi entropy. Measurement of the apparent contact angles evidenced the Cassie - Baxter wetting regime of the porous films.

Hip fractures are an important socio-economic problem in western countries. Over the past 60 years orthogeriatric care has improved the management of older patients admitted to hospital after suffering hip fractures. Orthogeriatric co-management units have increased quality of care, reducing adverse events during acute admission, length of stay, both in-hospital and mid-term mortality, as well as healthcare and social costs. Nevertheless, a large number of areas of controversy regarding the clinical management of older adults admitted due to hip fracture remain to be clarified. This narrative review, centered in the last 5 years, combined the search terms “hip fracture”, “geriatric assessment”, “second hip fracture”, “surgery”, “perioperative management” and “orthogeriatric care”, in order to summarise the state of the art of some questions such as the optimum analgesic protocol, the best approach for treating anemia, the surgical options recommendable for each type of fracture and the efficiency of orthogeriatric co-management and functional recovery.

This study is framed on the Information Theory as a constructive criterion to generate probabilistic distributions –through the elaboration of Bayesian Networks- and to reduce the uncertainty in the occurrence and relationship between two key psychological variables associated with the sports’ performance: Self-Determined Motivation and Competitive Anxiety. We analyzed 674 universitary students/athletes who competed in the 2017 Universitary Games (Universiade) in México, from 44 universities, with an average age of 21 years old (SD = 2.07), and with a sportive experience of 8.61 years of average (SD = 5.15). Methods: Regarding the data analysis, first of all a CHAID algorithm was carried out for to know the independence links among variables, and then two Bayesian networks (BN) were elaborated. The validation of the BN revealed AUC values ranging from 0.5 to 0.92. Subsequently, various instantations were carried out with hypothetical values applied to the “bottom” variables. Results showed two probability trees that have Extrinisic Motivation and Amotivation at the top, while the anxiety/activation due to the worry for performance was at the bottom of probabilities. The instantiations carried out support the existence of these probabilistic relationships, demonstrating the little influence on the competition anxiety generated by the intrinsic motivation. In conclusion, the reduction of the uncertainty made up by the restricted BN may aloe to re-introduce Information Theory principles in psychosocial studies, allowing authors to obtain useful probabilities values upon target psychological variables related with sportive performance.

Resuscitation plans (RP) are an important clinical indicator relating to care at the end of life in pediatrics. A retrospective review of the medical records of children who had been referred to the Royal Children’s Hospital, Brisbane, Australia who died in the calendar year 2011 was performed. Of 62 records available, 40 patients (65%) had a life limiting condition and 43 medical records (69%) contained a documented (RP). This study demonstrated that both the underlying condition (life-limiting or life-threatening) and the setting of care (PICU or home) influenced the development of resuscitation plans. Patients referred to the paediatric palliative care (PPC) service had a significantly longer time interval from documentation of a resuscitation plan to death and were more likely to die at home. All of the patients who died in the paediatric intensive care unit (PICU) had a RP which was documented within the last 48 hours of life. Most RPs were not easy to locate. Documentation of discussions related to resuscitation planning should accommodate patient and family centered care based on individual needs. With varied diagnoses and settings of care, it is important that there is inter-professional collaboration (particularly involving PICU and PPC services) in developing protocols of how to manage this difficult but inevitable clinical scenario.

Advanced coatings are essential to modern technologies, as they optimise surface characteristics for different application scenarios. Transparent and self-cleaning coatings are increasingly used as protective coatings for various applications, such as foldable touchscreens, windows, and solar panels. Moreover, incorporating other functionalities such as high hardness, wear resistance, and flexibility into transparent and self-cleaning coatings is important for broadening the use cases. Although many kinds of multifunctional coatings have been developed, it is still difficult to embody several properties in one coating adequately, as some properties, such as hardness and flexibility, are inherently contrastive. This review first describes basic principles, including wetting ability, photocatalytic reactions, photo-induced hydrophilic phenomena, and the implication of self-cleaning. The desired properties of multifunctional coatings are then listed, and methods for evaluating different properties are used. Recent progress in various preparation methods for multifunctional coatings, including the sol-gel, dip/spin, and chemical vapour deposition (CVD) methods, are also presented. Magnetron sputtering (MS) technology is widely used in coating preparation. Compared with chemosynthesis and CVD, MS is time-saving, suitable for industrial production, and environmentally friendly. Coatings prepared by MS usually possess excellent mechanical properties. Thus, we highlight the current research status of MS technology in multifunctional coating preparation. Moreover, according to the multilayer design structure of coatings, their optical and mechanical properties and self-cleaning ability can be controlled by combining the characteristics of different materials. Finally, combining photocatalytic materials such as TiO2 with other materials through a multilayer structure to obtain a multifunctional coating with excellent overall properties is discussed.

Polymers in highly confined geometries can display complex morphologies including ordered phases. A basic component of a theoretical analysis of their phase behavior in confined geometries is the knowledge of the number of possible single-chain conformations compatible with the geometrical restrictions and the established crystalline morphology. While the statistical properties of unrestricted self-avoiding random walks (SAWs) both on and off-lattice are very well known, the same is not true for SAWs in confined geometries. The purpose of this contribution is a) to enumerate the number of SAWs on the simple cubic (SC) and face-centered cubic (FCC) lattices under confinement for moderate SAW lengths, and b) to obtain an approximate expression for their behavior as a function of chain length, type of lattice, and degree of confinement. This information is an essential requirement for the understanding and prediction of entropy-driven phase transitions of model polymer chains under confinement. In addition, a simple geometric argument is presented that explains, to first order, the dependence of the number of restricted SAWs on the type of SAW origin.

This study uses data from the pilot project "Community Monitoring for Better Health and Education Services Delivery Project'' in Burkina Faso, to model the joint impact of generic essential drugs and nursing staff supplies constraints on access to primary health care in the country. The results show that statistical endogeneity of supply side constraints are present in the standard univariate probit specification of access to care. However, when accounted for, the resulting Trivariate Probit model shows that although shortages of generic essential drugs supply do not seem to constitute a significant barrier to access in Burkina Faso, shortages in nursing staff supply do. In fact, the likelihood of primary care access is reduced by 85.5% among those that reported having experienced a shortage in nursing staff, while paradoxically increasing by 60.3% among those that reported having experienced a shortage in generic essential drugs. A potential explanation for these findings is that overall the health care needs in the three surveyed regions in the country were more linked to primary health care services consumption from nurses, although further research would be important to clearly elucidate the position of health goods such as generic essential drugs.

By manipulating the various physico-chemical properties of amino acids, design of peptides with specific self-assembling properties has been emerging since more than a decade. In this context, short peptides possessing detergent properties (so-called “peptergents”) have been developed to self-assemble into well-ordered nanostructures that can stabilize membrane proteins for crystallization. In this study, the peptide with “peptergency” properties, called ADA8 extensively described by Zhang et al., is studied by molecular dynamics for its self-assembling properties in different conditions. In water, it spontaneously forms beta sheets with a β barrel-like structure. We next simulated the interaction of this peptide with a membrane protein, the bacteriorhodopsin, in the presence or absence of a micelle of dodecylphosphocholine. According to the literature, the peptergent ADA8 is thought to generate a belt of β structures around the hydrophobic helical domain that could help stabilize purified membrane proteins. Molecular dynamics is here used to challenge this view and to provide further molecular details for the replacement of detergent molecules around the protein. To our best knowledge, this is the first molecular mechanism proposed for ''peptergency''. In addition, our calculation approach should serve as a predicting tool for the design of beta peptergent with diverse amphipathic properties.

The synthesis these past few years of novel organic molecules that spontaneously self-assemble into a large variety of molecular architecture, particularly generating organogels, has opened up new horizons for preparing functional materials. Here, we present an original preparation path of such materials through the making of hybrid gels of these molecules together with covalent polymers. Three types of systems are described: i) intermingled gels where a polymer gel and an organogel pervade one another; ii) encapsulation of self-assembled filaments in polymer fibrils, which provides a system with unusual magnetic properties; iii) the reverse situation where self-assembled nanotubes sheathe polymer fibrils. Here two covalent polymers are considered: a neutral polymer, namely stereoregular polystyrene (isotactic or syndiotactic), and a semi-conducting polymer, P3BT. In the latter case, semi-conducting nanowires are obtained.

Objective: This study assessed hearing aid benefits for people with a normal audiogram but hearing-in-noise problems in everyday listening situations. Design: Exploratory double-blinded case control study whereby participants completed retrospective questionnaires, ecological momentary assessments, speech-in-noise testing, and mental effort testing with and without hearing aids. Twenty-seven adults reporting speech-in-noise problems but normal air-conduction pure-tone audiometry took part in the study. They were randomly separated into an experimental group who trialled mild-gain hearing aids with advanced directional processing and a control group fitted with hearing aids with no gain or directionality. Results: Self-reports showed mild-gain hearing aids reduce hearing-in-noise difficulties and provide a better hearing experience (i.e., improved understanding, participation, and mood). Despite the self-reported benefits, the laboratory tests did not reveal a benefit from the mild-gain hearing aids, with no group differences on speech-in-noise tests or mental effort measures. Further, participants found the elevated cost of hearing aids to be a barrier for their adoption. Conclusions: Hearing aids benefit the listening experience in some listening situations for people with normal audiogram who report hearing difficulties in noise. Decreasing the price of hearing aids may lead to greater accessibility to those seeking remediation for their communication needs.

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

There are many criterion to generalize the concept of numerical radius; one of the most recent interesting generalization is what so called the generalized Euclidean operator radius. Simply, it is the numerical radius of multivariable operators. In this work, several new inequalities, refinements and generalizations are established for this kind of numerical radius.

The threat of antimicrobial resistance to society is compounded by a relative lack of new clinically effective licensed therapies reaching patients over the past three decades. This has been particularly problematic within antifungal drug development leading to a rise in fungal infection rates and associated mortality. This paper highlights the potential of an ultrashort peptide, (naphthalene-2-ly)-acetyl-diphenylalanine-dilysine-OH (NapFFKK-OH), encompassing hydrogel-forming and antifungal properties within a single peptide motif, thus overcoming formulation (e.g. solubility, drug loading) issues associated with many current employed highly hydrophobic antifungals. A range of fungal susceptibility (colony counts) and cell cytotoxicity (MTS cell viability, LIVE/DEAD staining® with fluorescent microscopy, haemolysis) assays were employed. Scanning electron microscopy confirmed the nanofibrous architecture of our self-assembling peptide, existing as a hydrogel at concentrations of 1% w/v and above. Broad-spectrum activity was demonstrated against a range of fungi clinically relevant to infection (Aspergillus niger, Candida glabrata, Candida albicans, Candida parapsilosis and Candida dubliniensis) with greater than 4 log10 CFU/mL reduction at concentrations of 0.5% w/v and above. We hypothesise antifungal activity is due to targeting of anionic components present within fungal cell membranes resulting in membrane disruption and cell lysis. NapFFKK-OH demonstrated reduced toxicity against mammalian cells (NCTC 929, ARPE-19) suggesting increased selectivity for fungal cells. However, further studies relating to safety for systemic administration is required, given the challenges toxicity has presented in the wider context of antimicrobial peptide drug development. Overall this study highlights the promise of NapFFKK-OH hydrogels, particularly as a topical formulation for the treatment of fungal infections relating to the skin and eyes, or as a hydrogel coating for the prevention of biomaterial related infection.

A significant part of the literature on innovative practice in medicine relates to seizing opportunities and curbing harms for patients in desperate situations. Unfortunately, the term innovation has multiple meanings and a rich rhetorical flourish that adds confusion and misunderstanding to an already difficult debate. This paper aims to enhance the current definition of innovative practice for medicine. First, we replace the term innovation with the more literal of new non-validated practice. To identify this meaning, we analyse the traditional research ethics’ distinction between research, validated practice, and innovation in the Belmont Report. Second, we propose the following explicit definition of new non-validated practice: the first or recent use of diagnostic, therapeutic or preventive interventions that introduce a significant change, with an insufficient level of evidence of safety or efficacy for regular healthcare, and with the main aim to benefit individual patients. This definition is a promising conceptual tool to inform empirical research, ethicists, and the harmonization of its regulation and legislation (e.g. right-to-try laws).

Nanoparticle (NP)–surfactants formed by the self-assembly of NPs and end-functionalized polymers at the hydrophilic/hydrophobic interface have a wide range of applications in many fields. In this study, the influence of density of amino groups, NPs dimension and pH on the interaction between end-functionalized polymers and NPs were extensively investigated. Single amino-terminated polystyrene (PS-NH2, Mw ≈ 0.6k, 2.5k, 3.5k, 3.9k) and diamino-terminated polystyrene (H2N-PS-NH2, Mw ≈ 1.1k, 2.8k) were prepared using reversible addition–fragmentation chain transfer polymerization and atom transfer radical polymerization. NPs with different dimensions (zero-dimensional carbon dots with sulfonate groups, one-dimensional cellulose nanocrystals with sulfate groups and two-dimensional graphene with sulfonate groups) in the aqueous phase were added into the toluene phase containing the aminated PS. The influence of pH and the molecular weight of amino-terminated PS on the interfacial tension between two phases were investigated. The results indicate that aminated PS exhibited the strongest interfacial activity after compounding with sulfonated NPs at a pH of 3. Terminating PS with amino groups on both ends leads to better performance in in reducing the water/toluene interfacial tension than modifying the molecular structure of PS on a single end. The dimension of sulfonated NPs also contributed significantly to the reduction of the water/toluene interfacial tension. The minimal interfacial tension was 4.49 mN/m after compounding PS-NH2 with sulfonated zero-dimensional carbon dots. Molecular dynamics simulation on the evolution of the water/toluene interface in the presence of sulfonated carbon dots and H2N-PS-NH2 revealed that these opposite charged substances moved towards the interface in an extreme short time and orderly assembled in a thermodynamic equilibrium.

Objectives: A wealth of literature has established risk factors for social isolation among older people, however much of this research has focused on community-dwelling populations. Relatively little is known about how risk of social isolation is experienced among those living in long-term care (LTC) homes. We conducted a scoping review to identify possible risk factors for social isolation among older adults living in LTC homes. Methods: A systematic search of five online databases retrieved 1535 unique articles. Eight studies met the inclusion criteria. Results: Thematic analyses revealed that possible risk factors exist at three levels: individual (e.g., communication barriers), systems (e.g., location of LTC facility), and structural factors (e.g., discrimination). Discussion: Our review identified several risk factors for social isolation that have been previously documented in literature, in addition to several risks that may be unique to those living in LTC homes. Results highlight several scholarly and practical implications.

This paper addresses the development of knowledge and assessment-centered learning approaches within a reflective learning framework in a first year physics class in a university faculty. The quality of students’ reflections was scored using a Self-reporting Reflective Learning Appraisal Questionnaire at the end of each learning approach. The results showed the differences between the approaches based on reflections on the learning control through self-knowledge, by connecting experience and knowledge, as well as through self-reflection and self-regulation. Assessment-centered activities fundamentally help students identify aspects of their attitudes towards, as well as regulate, their sustainability learning education.

Not only does this paper present a novel type-2 fuzzy system for identification and behavior prognostication of an experimental solar cell set and a wind turbine, but also it brings forward an exquisite technique to acquire an optimal number of membership functions and the corresponding rules. It proposes a seven-layered NCPRT2FS. For fuzzification in the first two layers, Gaussian type-2 fuzzy membership functions with uncertainty in the mean, are exploited. The third layer comprises rule definition and the forth one embeds fulfillment of type reduction. The three last remained layers are the ones in which resultant left–right firing points, two end-points and output all get assessed correspondingly. It should not be neglected off the nutshell that recurrent feedback at the fifth layer exerts delayed outputs ameliorating efficiency of the suggested NCPRT2FS. Later in the paper, a modern structural learning, established on type-2 fuzzy clustering, is held forth. An adaptively rated learning back-propagation algorithm is extended to adjust the parameters ensuring the convergence as well. Eventually, solar cell photo-voltaic and wind turbine are deemed as case studies. The experimental data are exploited and the consequent yields emerge so persuasive.

Hospital-based programs democratize mRNA therapeutics by facilitating the processes to translate a novel RNA idea from the bench to the clinic. Because mRNA is essentially biological software, therapeutic RNA constructs can be rapidly developed. The generation of small batches of clinical grade mRNA to support IND applications and first-in-man clinical trials, as well as personalized mRNA therapeutics delivered at the point-of-care, is feasible at a modest scale of cGMP manufacturing. Advances in mRNA manufacturing science and innovations in mRNA biology, are increasing the scope of mRNA clinical applications.

Managing blood cholesterol levels is important for the treatment and prevention of diabetes, cardiovascular disease, and obesity. An easy-to-use, portable cholesterol blood test will accelerate more frequent testing by patients and at-risk populations. We aim to evaluate the performance of smartphone-based point-of-care cholesterol blood tests as compared to that of hospital-grade laboratory tests. We used smartphone systems that are already familiar to many people. Because smartphone systems can be carried around everywhere, blood can be measured easily and frequently. We compared the results of cholesterol tests with those of existing clinical diagnostic laboratory methods. We found that smartphone-based point-of-care lipid blood tests are as accurate as hospital-grade laboratory tests (N=116, R>0.97, P<0.001 for all 3 cholesterol blood tests: total cholesterol, high density lipoprotein, and triglyceride). Our system will be useful for those who need to manage blood cholesterol levels to motivate them to track and control their behavior.

In light of the self-simulation hypothesis, a simple form implementation of the principle of efficient language is discussed in a self-referential geometric quasicrystalline state sum model in three dimensions. Emergence is discussed in context of geometric state sum models.

The interest on the use of renewable energy resources is increasing, especially towards wind and hydro powers, which should be efficiently converted into electric energy via suitable technology tools. To this aim, self--tuning control techniques represent viable strategies that can be employed for this purpose, due to the features of these nonlinear dynamic processes working over a wide range of operating conditions, driven by stochastic inputs, excitations and disturbances. Some of the considered methods were already verified on wind turbine systems, and important advantages may thus derive from the appropriate implementation of the same control schemes for hydroelectric plants. This represents the key point of the work, which provides some guidelines on the design and the application of these control strategies to these energy conversion systems. In fact, it seems that investigations related with both wind and hydraulic energies present a reduced number of common aspects, thus leading to little exchange and share of possible common points. This consideration is particularly valid with reference to the more established wind area when compared to hydroelectric systems. In this way, this work recalls the models of wind turbine and hydroelectric system, and investigates the application of different control solutions. The scope is to analyse common points in the control objectives and the achievable results from the application of different solutions. Another important point of this investigation regards the analysis of the exploited benchmark models, their control objectives, and the development of the control solutions. The working conditions of these energy conversion systems will be also taken into account in order to highlight the reliability and robustness characteristics of the developed control strategies, especially interesting for remote and relatively inaccessible location of many installations.

Motivated by the theoretical model of health insurance choice with Flexible Spending Accounts (FSAs) presented in Cardon 2012, this study investigates the determinants of optional coverage (SSP) and flexible spending accounts (FSA) enrollment, among the privately insured in post-affordable-care-act (ACA) USA. To this end, we rely on semi-parametric bi-variate probit methods, along with a pooled cross-section of the 2015-2016 National Health Interview Surveys. As predicted by the theoretical model, we find that SSP and FSA are complement health solutions with a positive correlation. Our results emphasize that the most important trigger factors influencing the joint probability of SSP and FSA adoption include not only insurance premium cost, but also age, education, marital status, number of work hours, region of residency, citizenship status, and annual health expenditure level. We find that controlling for these latter factors, health status is not significant especially for FSA adoption. In addition, despite the fact that the relative frequency of individuals with FSA rises with increasing levels of medical expenditure, ACA restrictions on FSA tax exclusion to an annual adjusted maximum of $2600 (in 2017 $s) seems to adversely burden individuals with greater medical expenditure, thereby reducing their likelihood of FSA enrollment in post-ACA USA. Understanding these factors is very crucial to US health care market's stakeholders, including insurance companies, firms looking to design their health insurance offerings, but also policy-makers interested in providing new tailored health solutions for reducing health risks.

Remotely Piloted Aircraft Systems (RPAS) are increasingly becoming relevant actors flying through the airspace and will assume much more importance in the future perspective. In order to allow their safe integration with manned conventional traffic in non-segregated airspaces, in accordance with the overall Air Traffic Management (ATM) paradigm, specific enabling technologies are needed. As well known, among the enabling technologies identified as crucial for RPAS integration into the overall ATM system, the Detect and Avoid (DAA) technology is fundamental. In the meantime, to support extended surveillance, the universal introduction on-board of aircraft of cooperative Automatic Dependent Surveillance – Broadcast (ADS-B) is increasingly implemented, having the potential to allow coverage of the whole airspace also in remote areas not usually covered by conventional radar surveillance. In this paper, the experimental results are presented and discussed that have been obtained through the real-time validation, with hardware and human in the loop (RTS-HIL) simulations, of an automatic ADS-B based Separation Assurance and Collision Avoidance System aimed to support RPAS automatic operations as well as remote pilot decision making. In the paper, after an introductory outline of the Concept of Operations (ConOps) of the system and of its architectural organization, while also providing basic information about the main system functionalities, the description is reported of the tests that have been carried out and the obtained results are described and discussed, in order to emphasize the performances and limitations of the proposed system. In particular, not only the quantitative performances obtained are reported and commented but also the feedbacks received by the pilots in order to improve the system are described, for instance in terms of preferred typology of conflict resolution manoeuver elaborated by the system.

Vitrimers are covalent network materials, comparable in structure to classical thermosets. Unlike normal thermosets, they possess a chemical bond swap mechanism that makes their structure dynamic and suitable for activated welding and even autonomous self-healing. The central question in designing such materials is the trade-off between autonomy and material stability: The swap mechanism facilitates the healing but it also facilitates creep, which makes the perfectly stable self-healing solid a hard goal to reach. Here, we address this question for the case of self-healing vitrimers made from star polymers. Using coarse-grained molecular dynamics simulations, we study the adhesion of two vitrimer samples and find that they bond together on timescales that are much shorter than the stress relaxation time. We show that the swap mechanism allows the star polymers to diffuse through the material through coordinated swap events, but the healing process is much faster and does not depend on this mobility.

Levels of synthetic musk fragrances (SMFs) and various personal care products (PCPs) were measured in the Han River and its tributaries in Seoul, Korea. The most abundant SMF in all river and PCP samples was 4,6,6,7,8,8-hexamethyl-1,3,4,7-tetrahydrocyclopenta[g]isochromene (HHCB), followed by 1-(3,5,5,6,8,8-hexamethyl-6,7-dihydronaphthalen-2-yl)ethanone (AHTN), musk ketone (MK), and 1,1,2,3,3-pentamethyl-2,5,6,7-tetrahydroinden-4-one (DPMI). There was a significant correlation between the SMF concentration in the PCPs and the Han River samples. Moving from upstream to downstream in the Han River, the median SMF concentration was 6.756, 2.945, 0.304, and 0.141 μg/L in the sewage treatment plant (STP) influent, effluent, tributaries, and mainstream, respectively, implying that effective SMF removal was achieved during the sewage treatment process, followed by dilution in the receiving water. Four STPs using advanced biological treatment processes had removal efficiencies of 55.8%, 50.6%, 43.3% for HHCB, AHTN, and MK, respectively. The highest SMF concentrations in the tributaries were observed at locations close to the STPs. Our study confirmed that the main source of SMFs in the receiving water were sewage effluent containing untreated SMFs, which are largely originated from household PCPs, especially hair care products (e.g., shampoo) and perfumes.

Introduction: Type 2 diabetes (T2D) is a major driver of health care costs, thus treatments enabling T2D reversal may reduce expenditures. We examined the impact of a T2D continuous care intervention (CCI) on health care utilization. Previous research documented that CCI, including individualized nutrition supported by remote care, simultaneously reduced hemoglobin A1c and medication use and improved cardiovascular status after two years; however, the impact on utilization is unknown. Methods: This study used four years of data (two years pre-intervention, two years post-intervention) from the Indiana Network for Patient Care (INPC) health record. Two methods estimated the impact of CCI on utilization. First, an interrupted time series (ITS) including only CCI participants (n=193) compared post-intervention utilization to expected utilization had the pre-intervention trend persisted. Deviation from the trend was estimated non-parametrically for each 6-month interval after the implementation of CCI . Second, a 1:3 matched comparator group (n=579) was constructed and used for a difference-in-differences (DiD) analysis. The primary outcome was annualized outpatient encounters. Secondary outcomes included emergency encounters and hospitalizations. Results: In two years prior to intervention, CCI participants had a mean of 5.77 annualized encounters (5.62 outpatient, 0.04 hospitalizations, 0.11 emergency). The CCI group showed a reduction in outpatient utilization after intervention. In ITS analysis, 1.6 to 1.9 fewer annualized outpatient encounters occurred in each 6-month interval post-intervention relative to expected utilization based on pre-intervention trends (p<0.01 each 6-month period; 28-33% reduction). The DiD analysis suggested a larger reduction; 5 fewer annualized outpatient encounters in the quarter after intervention, diminishing to 2.5 fewer after 2 years (p<0.01 each quarter). The study was underpowered to draw conclusions about hospitalization and emergency encounters due to the limited number of CCI patients and the rarity of encounters. Conclusions: Outpatient encounters were significantly reduced for a T2D patient population up to 2 years after receiving an individualized intervention supporting nutrition and behavior change through remote care.

The Covid-19 pandemic is a tragedy for those who have been hard hit worldwide. At the same time, it is also a test of concepts and practices of what good care is and requires, and how quality of care can be accounted for. In this paper, we present our Care-Ethical Model of Quality (CEMQ) and apply it to the case of residential care for older people in the Netherlands during the Covid-19 pandemic. Instead of thinking about care in healthcare and social welfare as a set of separate care acts, we think about care as a complex practice of relational caring, crossed by other practices. Instead of thinking about professional caregivers as functionaries obeying external rules, we think about them as practically wise professionals. Instead of thinking about developing external quality criteria and systems, we think about cultivating (self-)reflective quality awareness. Instead of abstracting from societal forces that make care possible but also limit it, we acknowledge them and find ways to deal with them. Based on these critical insights, the CEMQ model can be helpful to describe, interrogate, evaluate, and improve existing care practices. It has four entries: (i) the care receiver considered from their humanness, (ii) the caregiver considered from their solicitude, (iii) the care facility considered from its habitability and (iv) the societal, institutional and scholarly context considered from the perspective of the good life, justice and decency. The crux is enabling all these different entries with all their different aspects to be taken into account. In Corona times this turns out to be more crucial than ever.

In remote sensing applications, one of the key points is the acquisition, real-time pre-processing and storage of information. Due to the large amount of information present in the form of images or videos, compression of this data is necessary. Compressed sensing (CS) is an efficient technique to meet this challenge. It consists in acquiring a signal, assuming that it can have a sparse representation, using a minimal number of non-adaptive linear measurements. After this CS process, a reconstruction of the original signal must be performed at the receiver. Reconstruction techniques are often unable to preserve the texture of the image and tend to smooth out its details. To overcome this problem, we propose in this work, a CS reconstruction method that combines the total variation regularization and the non-local self-similarity constraint. The optimization of this method is performed by the augmented Lagrangian which avoids the difficult problem of non-linearity and non-differentiability of the regularization terms. The proposed algorithm, called denoising compressed sensing by regularizations terms (DCSR), will not only perform image reconstruction but also denoising. To evaluate the performance of the proposed algorithm, we compare its performance with state-of-the-art methods, such as Nesterov's algorithm, group-based sparse representation and wavelet-based methods, in terms of denoising, and preservation of edges, texture and image details, as well as from the point of view of computational complexity. Our approach allows to gain up to 25% in terms of denoising efficiency, and visual quality using two metrics: PSNR and SSIM.

COVID-19, the disease caused by the new coronavirus, SARS-CoV-2, has caused significant human and economic burden. Of the three major methods to mitigate the effect of the virus, diagnostics have become the focal point because vaccines and therapeutics, despite the intense effort of scientists worldwide, will take months to develop, test for safety and efficacy, scaleup and distribute to millions. This perspective aims to clarify some of the issues related to COVID-19 diagnostics and highlights some of the challenges key stakeholders including policymakers, businesses, managers, scientists and individuals face during this evolving pandemic.

Based on a measuring system to determine levels of spatial organization in 2D polygons (homogeneous or heterogeneous partition of defined areas) lying on principles of regularity, we propose the entropy term linked to the concept of “information”, from the “information theory field”, in order to obtain an information measurement regarding a quantity of or amount of information in the architecture of complex 2D biological organizations. The term “quantity” does not refer to the amount of data (size), but to the probability of a geometrical basic pattern within a set of possible statistical configurations regarding levels of homogeneity and heterogeneity. It is this notion of information that is important in information theory, and measures of information in units of bits, what we propose to use for measuring quantities of organization in the architecture of complex geometrical systems. Two complex systems are tested, biological and non biological in order to obtain experimental results, which are verified with the evaluation criteria “entropy”. Experimental results show that the lowest levels of information and entropy, in addition with low rates of heterogeneity and high rates of homogeneity are particular features of geometrical organizations in biological systems.

Body-Esteem Scale is an assessment tool for adolescents and adults that evaluate three dimensions of self-evaluations of one’s body. Body-Esteem Scale has been translated and validated in some countries since America down to Europe. Lack of translation and reliability evidence in Portugal was detected. This study aimed to translate and test the validity and reliability of the Body Esteem Scale for Adolescents and Adults (BESAA) in students in the context of Portuguese higher educa-tion. A total of 173 students (60.7% are female) with a mean age of 19.7 (standard deviation = 2.2) years participated. Categorical Principal Component Analysis was used to assess the underlying dimensions of BESAA. Construct validity was evaluated through correlation with the Appearance Schemas Inventory – Revised and a three-factor model (“Appearance”, ‘‘Weight’’ and “Attribu-tion’’) was established. Confirmatory factor analysis was performed to verify the construct validity of the instrument. Items that had factor weights (λ)<.40 were removed, as well as those that were considered redundant by the modification indices estimated by the Lagrange Multipliers (LM) method (LM>11, p<.001). We observed high correlations between theoretically similar factors, and low correlations between different factors. The Portuguese BESAA showed adequate validity and reliability.

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

Mass insect rearing can have a range of applications, for example in biological control of insects. Since the performance of released biological control agents determines efficacy, the competitive fitness of insects post release is a key variable. Here, we tested whether inoculation with a gut symbiont, Enterobacter cloacae, and gnotobiotic rearing of larvae could improve insect growth and male competitive fitness of a transgenic diamondback moth, which has shown variation in fitness when reared in different insectaries. All larvae were readily infected with the focal symbiont. Under gnotobiotic rearing pupal weights were reduced and there was a marginal reduction in larval survival. However, gnotobiotic rearing substantially improved the fitness of transgenic males. In addition, in gnotobiotic conditions, inoculation with the gut symbiont increased pupal weights and male fitness, increasing the proportion of transgenic progeny from 20 to 30% relative to symbiont-free insects. Gnotobiotic conditions may improve the fitness of transgenic males by excluding microbial contaminants, while symbiont inoculation could further improve fitness by providing additional protection against infections, or by normalizing insect physiology. The simple innovation of incorporating antibiotic into diet, and inoculating insects with symbiotic bacteria that are resistant to that antibiotic, could provide a readily transferable tool for other insect rearing systems.

We obtain two generalizations of a known theorem of A. Alam and M. Imdad (Fixed Point Theory Appl. 17 (2015) 693–702) showing that some standard proofs can be obtained involving only Cauchy sequences of the successive approximations instead of the usual successive approximations sequences. Suitable examples prove the effective generalization of our results in metric spaces not necessarily complete.

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

(RADA)4 nanoscaffolds are excellent candidates for use as peptide delivery vehicles: they are relatively easy to synthesize with custom bio-functionality, and assemble in situ to allow a focal point of release. This enables (RADA)4 to be utilized in multiple release strategies by embedding a variety of bioactive molecules in an all-in-one ‘construct’. One novel strategy focuses on the local, on-demand release of peptides triggered via proteolysis of tethered peptide sequences. However, the spatial-temporal morphology of self-assembling nanoscaffolds may greatly influence the ability for enzymes to both diffuse into as well as actively cleave substrates. Fine structure and its impact on overall affect on peptide release is poorly understood. In addition, fractal networks observed in nanoscaffolds are linked to the fractal nature of diffusion in these systems. Therefore, matrix morphology and fractal dimension of virgin (RADA)4 and mixtures of (RADA)4 and matrix metalloproteinase 2 (MMP-2) cleavable substrate modified (RADA)4 were characterized over time. Sites of high (GPQG+IASQ, CP1) and low (GPQG+PAGQ, CP2) cleavage activity were chosen. Fine structure was visualized using established according to established methods. After 2 hrs of incubation, nanofiber networks showed an established fractal nature, however nanofibers continued to bundle in all cases as incubation times increased. It was observed that despite extensive nanofiber bundling after 24 hrs of incubation time, the CP1 and CP2 nanoscaffolds were susceptible to MMP-2 cleavage. The properties of these engineered nanoscaffolds characterized herein illustrate that they are an excellent candidate as an enzymatically initiated peptide delivery platform.

A custom-designed series of unsymmetrical spiroalkanedithiols having tailgroups comprised of a terminally fluorinated chain and a hydrocarbon chain of varying lengths were synthesized and used to prepare self-assembled monolayers (SAMs) on gold substrates. The specific structure of the adsorbates was of the form [CH₃(CH₂)_n][CF₃(CF₂)₇(CH₂)₈]C[CH₂SH]₂, where n = 7, 9, and 12 (designated as F8H10-C10, F8H10-C12, and F8H10-C18, respectively). The influence of the length of the hydrocarbon chain in the bidentate dithiol on the structure and interfacial properties of the monolayer was explored. A structurally analogous partially fluorinated monodentate alkanethiol and the corresponding normal alkanethiols were used to generate appropriate SAMs as reference systems. Ellipsometric thickness measurements showed an unexpectedly low film thickness for the SAMs derived from the bidentate adsorbates, possibly due to disruptions in interchain packing caused by the fluorocarbon chains (i.e., phase-incompatible fluorocarbon-hydrocarbon interactions), ultimately giving rise to loosely packed and disordered films. Analysis by X-ray photoelectron spectroscopy (XPS) were also consistent with a model in which the films were loosely packed; additionally, the XPS spectra confirmed the attachment of the sulfur headgroups of the bidentate adsorbates onto the gold substrates. Studies of the SAMs by polarization modulation-infrared reflection-adsorption spectroscopy (PM-IRRAS) suggested that as the length of the hydrocarbon chain in the adsorbates was extended, a more ordered surface was achieved by reducing the tilt of the fluorocarbon segment. The wettability data indicated that the adsorbates with longer alkyl chains were less wettable than those with shorter alkyl chains, likely due to an increase in interchain van der Waals forces in the former.

In quantum field theory (QFT), it is well known that when Feynman diagrams containing loops are evaluated to account for self interactions, probability amplitude comes out to be infinite which is physically not admissible. So, to make the QFT convergent, various renormalization methods are conventionally followed in which an additional (infinite) counter term is postulated which neutralizes the original infinity generated by diagram. The resulting finite values of amplitudes have agreed with experiments with surprising accuracy. However, proponents of renormalization methods acknowledged that this ad-hoc procedure of subtraction of infinity from infinity to reach at a finite value is not at all satisfactory and there is no physical basis for bringing in the counter term. So, it is desirable to establish a method in QFT which does not generate any infinite term (thus not requiring renormalization), but which predicts same results as conventional methods do. In this paper, we describe such a technique taking self interaction quantum electrodynamics diagram representing electron or photon self energy. In our method, no problem of infinity arises and hence renormalization is not necessary. Still, the dependence of calculated probability amplitude on physical variables in our technique comes out to be same as conventional methods. Using similar procedure, we hope, the problem of non-renormalizability of quantum gravity may be solved in future.

Quantitative differential phase contrast (qDPC) imaging has become an important method of optical measurement and life science research in microscopy because of its high reconstruction resolution and non-invasive, high-contrast and quantitative imaging of biological samples. Despite the continuous development of the principle and algorithm, the frame rate of the existing qDPC algorithm is still much lower than that of camera acquisition, so it is hardly applied to real-time image the fast-moving biological samples. In this paper, based on color-coded multiplexing strategy, a compact real-time quantitative phase imaging system is designed to realize multi-mode imaging. The system employs a programmable LED array to illuminate directly, and the phase reconstruction algorithm is deployed in the graphics processing unit (GPU) of the laptop to accelerate the calculation. The system can achieve high-speed quantitative phase imaging of non-stained biological samples, and the frame rate can reach 60fps. The device has the advantages of compact structure, low cost and portability. Thus, it is suitable for mobile medical applications.

User experience and user requirements are two independent approaches. User requirements address the customer's requirements and expectations for the solution, whereas user experience encompasses all aspects of how the user interacts with and uses the software. The software product should be easy to use and has usable features. Moreover, the additional value for the software is if the product has an attractive design or working environment that is in line with user behaviors, it can occur if integrate software requirements and user experience. Integration escalates developer productivity by focusing on features that meet the user's needs and expectations. That integration improves efficiency in software development by identifying and addressing problems that may arise during the development process, saving developer time and effort in developing software. The usage context of integration of user experience and user requirements in UX Journey contributes increase developer productivity and self-efficacy in developing software by focusing development on features that match the user needs, as well as increasing efficiency in overcoming problems that arise during the development process. UX Journey makes developers feel more confident in their ability to develop quality software.

This paper reports the findings from a pilot study designed to explore the barriers, facilitators and similarities with the delivery and implementation of two distinct models of Advance Care Planning (ACP) documentation for older adults in their last year of life used by health care professionals in their clinical practice. PACe (Proactive Anticipatory Care Plan): a GP led model and PEACE (Proactive Elderly Persons’ Advisory CarE): a nurse led model with community geriatrician oversight were used by participants in their clinical practice. Telephone interviews were conducted with general practitioners (GPs) to explore their views of using the PACe tool. Hospital admission avoidance matrons took part in face to face interviews and care staff employed in private residential care homes took part in individual telephone interviews to explore their views of using the PEACE tool. GPs and admission avoidance matrons were employed by Clinical Commissioning Groups (CCGs) and all study participants were recruited from the South East of England where data collection took place in 2015. Nine telephone interviews and two face-to-face interviews (one joint and one individual) were conducted with twelve participants. The data was analysed thematically. Participants highlighted the similarity of both tools in providing focus to ACP discussions to inform individual end-of-life care preferences. The importance of relationships was a pivotal theme-established, trusting inter-professional relationships to enable multidisciplinary teamwork and a prior relationship with the older person (or their proxy in the case of cognitive impairment) to enable conversations of this nature. Using both tools enabled participants to think critically and reflect on their own practice was another theme identified. Notwithstanding participants’ views to improve the layout of both tools, using a paper-based approach to deliver streamlined ACP and end-of-life care was a theme to emerge as a barrier which focused on the problems with access to paper-based documentation, accuracy and care co-ordination in the context of multidisciplinary team working. The value of technology in overcoming this barrier and underpin ACP as a means to help simplify service provision, promote integrated professional practice and provide seamless care was put forward as the solution.