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The management of greywater and sanitation in South Africa's urban informal settlements is a pressing concern. This review critically examines the legal framework that governs greywater management in South Africa's informal settlements, aiming to shed light on the existing regulations, gaps, and opportunities for sustainable greywater reuse. By scrutinizing the legal framework, the review identifies gaps and challenges in the regulatory environment, including inconsistencies, lack of clarity, and limited enforcement mechanisms. It explores the potential for international best practices to inform possible amendments to the existing legal framework. This was a quantitative research design utilizing a cross sectional survey model. Questionnaires were administered electronically to a sample of 17 municipal leaders from the City of Tshwane, City of Johannesburg and Buffalo City municipalities whose responsibilities were on water management. Descriptive statistics were employed in analysis of the data. Outcomes were reviewed against the alignment or the lack thereof with the SANS 1732:201x standards. This paper underscores the critical need for a coherent and robust legal framework to support responsible greywater management in South Africa's informal settlements. The paper's insights contribute to the ongoing discourse on water governance, shedding light on the pathways toward a more equitable water future. [ABSTRACT FROM AUTHOR]

Background: Cough is one of the most common presenting problems for patients in primary care and is largely managed in primary care clinical settings. Family physicians' familiarity with chronic cough guidelines and the extent to which these guidelines translate into everyday practice have not been well described. The objective of this study was to characterize current diagnosis, treatment, and referral practices among family physicians and to identify potentially impactful strategies to optimize chronic cough management in primary care. Methods: We conducted a cross-sectional survey of 5,000 family physicians to explore diagnosis, treatment, and referral practices related to chronic cough management in adults in primary care. Respondents completed the survey via paper or online. The outcome measures were self-reported numeric ratings and responses related to the survey elements. Results: 588 surveys were completed (11.8% response rate). About half (49.6%) of respondents defined chronic cough in a manner consistent with the American College of Chest Physicians (ACCP) chronic cough guidelines, with the rest differing in opinion primarily regarding duration of symptom presentation. Respondents reported trying to rule out most common causes of chronic cough themselves before referring (mean 3.41 on a 4-point scale where 4 is "describes me completely") and indicated a desire for more resources to help them manage and treat chronic cough. Years in practice and rural/urban setting influenced diagnosis and referral practices. Conclusions: Family physicians see chronic cough as a complicated condition that can be and is often diagnosed and treated entirely in a primary care setting. They also value the ability to refer in complex cases. Our results support that family physicians provide evidence-based management of chronic cough. [ABSTRACT FROM AUTHOR]

Background: Gender dysphoria among transgender adolescents has predominantly been examined in relation to body dissatisfaction. While in adult transgender samples, body dissatisfaction is higher than in cisgender controls, this has so far rarely been investigated for adolescents. In the context of a cisnormative society, the impact of influences from the social environment on body dissatisfaction and gender dysphoria has been neglected in research. Therefore, this study aimed to (1) provide a detailed analysis of body dissatisfaction among young transgender people and (2) investigate whether body dissatisfaction and gender dysphoria are associated with experiences of minority stress such as trans hostility and poor peer relations (PPR). Methods: The paper presents a cross-sectional study among a sample of transgender adolescents, presenting at a specialized outpatient counseling clinic (N = 99; age M = 15.36, SD = 1.85). First, body dissatisfaction (assessed by the Body-Image-Scale; BIS), was explored and compared to data from a population-based control group of cisgender peers (N = 527; age M = 14.43, SD = 0.97). Second, within a clinic-referred transgender subsample (n = 74), associations between body dissatisfaction and gender dysphoria (measured by Utrecht Gender Dysphoria Scale; UGDS), PPR (measured by the Youth-Self-Report; YSR-R), and trans hostile experiences (assessed in clinical interview) were examined by correlations, t-tests and multivariate regression. Results: Transgender adolescents reported more body dissatisfaction than cisgender peers. The dissatisfaction with sex characteristics, non-hormonal reactive body regions and the total score for body dissatisfaction were positively related with gender dysphoria. The majority had experienced trans hostility in the present and/or past (54.1%) and PPR (63.5%). More body dissatisfaction was correlated with more PPR regarding visible body parts i.e., hair, overall appearance and muscles, whilst PPR and gender dysphoria were not associated. Transgender adolescents who experienced trans hostility showed higher gender dysphoria and PPR, but not more body dissatisfaction. In multiple regression, trans hostility predicted gender dysphoria, whilst age and PPR predicted body dissatisfaction. Discussion: Experiences of minority-stress differentially interact with body dissatisfaction and gender dysphoria among transgender adolescents. Social correlates of body dissatisfaction and gender dysphoria must be considered when working with young transgender people. [ABSTRACT FROM AUTHOR]

Introduction: Telepractice service delivery of allied health interventions to people with disability can potentially reduce access barriers and improve service equity. However, questions remain regarding telepractice functionality for people with disability. This study addressed questions related to how allied health clinicians and managers perceive telepractice as functioning in the provision of therapy services to people with disability. Methods: Thirteen interviews of allied health clinicians and managers from across Australia were conducted between 21 November and 22 February via MS teams. Qualitative methodology and critical realist theoretical paradigm underpin the study. Data analysis was completed using a reflective thematic analysis method and five themes were generated and described utilising an analytic metaphor. Results: The study themes were described in relation to a shopping for shoes analytic metaphor and the five themes included (1) a shoe for every foot, (2) planned purchases, (3) shoe on the other foot, (4) you need both shoes and (5) help choosing their shoes. In summary, the function of telepractice fits differently for each individual, similar to pairs of shoes. Conclusions: Telepractice has its own strengths and weaknesses and isn't a direct substitute for in‐person sessions, much like left and right shoes are similar but not the same. The results support participant perceptions that telepractice functions best as an adjunct to in‐person sessions through a flexible hybrid delivery model in the provision of therapy services to people with a disability. A strategy for improving perceived usefulness may involve positioning telepractice as unique with strengths and weaknesses, not replacing in‐person care. Patient or Public Contribution: The paper forms part of a larger codesign process which included customer and carer participants throughout the design and planning of the project, inclusion of a peer researcher, and the selection of the analytic metaphor including in the findings of this article production. [ABSTRACT FROM AUTHOR]

Background: Metabotropic glutamate receptors 2/3 (mGluR2/3) and 5 (mGluR5) are novel therapeutic targets for major depression (MD), bipolar disorder (BD) and schizophrenia. We aimed to determine whether mGluR2/3 and mGluR5 binding in the anterior cingulate cortex (ACC), a brain region essential for the regulation of mood, cognition and emotion, were differentially altered in these pathologies. Methods: Using postmortem human brains derived from 2 cohorts, [3H]LY341495 binding to mGluR2/3 and [3H]MPEP binding to mGluR5 were measured by receptor autoradiography in the ACC. The first cohort comprised samples from individuals who had MD with psychosis (MDP), MD without psychosis (MDNP) and matched controls (n = 11-12 per group). The second cohort comprised samples from individuals who had MDNP, BD, schizophrenia and matched controls (n = 15 per group). Results: No differences in mGluR2/3 or mGluR5 binding were observed in the MDP, MDNP, BD or schizophrenia groups compared with the control group (all p > 0.05). Importantly, there were also no differences in binding densities between the psychiatric disorders (p > 0.05). We did, however, observe age-related effects, with consistent negative associations between mGluR2/3 and age in the control group (r < -0.575, p < 0.025) and the psychotic disorder groups (MDP and schizophrenia: r = -0.765 to -0.515, p < 0.05), but not in the mood disorder groups (MDNP, BD). Limitations: Replication in larger independent cohorts and medication-naive individuals would strengthen these findings. Conclusion: Our findings suggest that mGluRs are unaltered in the ACC; however, the presence of altered receptor function cannot be discounted and requires further investigation. Taken together with previous studies, which report differential changes in mGluR2, 3 and 5 across these disorders, we suggest mGluRs may be affected in a brain region-specific manner. [ABSTRACT FROM AUTHOR]

Background: Brain imaging studies suggest that volume reductions and compromised white matter integrity occur in schizophrenia and bipolar disorder (BD). However, the cellular correlates have not yet been identified. To address this issue we assessed oligodendrocyte, astrocyte and microglial populations in postmortem white matter from schizophrenia, BD and nonpsychiatric control samples. Methods: The density, areal fraction and spatial distribution of glial fibrillary acidic protein (GFAP)-expressing astrocytes and ionized calciumbinding adaptor molecule-1 (IBA-1)-expressing microglia as well as the density, nuclear size and spatial distribution of Nissl-stained oligodendrocytes were quantified in postmortem white matter adjacent to the dorsolateral prefrontal cortex (Brodmann area 9) in schizophrenia, BD and control samples (n = 20). In addition, the oligodendrocyte-associated proteins myelin basic protein and 2′,3′-cyclic-nucleotide 3′-phosphodiesterase (CNPase) were quantified in the same samples by enzyme-linked immunosorbent assay and immunoblotting. Results: Oligodendrocyte density (p = 0.012) and CNPase protein levels (p = 0.038) differed between groups, being increased in BD compared with control samples. The GFAP area fraction (p = 0.05) and astrocyte spatial distribution (p = 0.040) also differed between groups, reflecting decreased area fraction and increased cell clustering in both schizophrenia and BD samples. Limitations: Oligodendrocytes were identified using morphological criteria. Conclusion: This study provides evidence for glial pathology in prefrontal white matter in schizophrenia and BD. Changes in oligodendrocyte and astrocyte populations in white matter in the major psychiatric disorders may reflect disruptions in structural or metabolic support of axons. [ABSTRACT FROM AUTHOR]

BACKGROUND: Although previous study has demonstrated that brain-derived neurotrophic factor (BDNF) is involved in the antidepressant-like effect of oleanolic acid, there is little information regarding the details of the molecular mechanism involved in this effect. METHODS: We used a chronic unpredictable mild stress (CUMS) model to test the antidepressant-like effect of oleanolic acid on depressant-like behaviour, miR-132 expression and synaptic protein expression in the male mouse hippocampus. Furthermore, we explored the possible signalling pathways associated with miR-132 expression that mediate the effect of oleanolic acid on neuronal proliferation. RESULTS: The results demonstrated that a 3-week treatment with oleanolic acid ameliorated CUMS-induced anhedonic and anxiogenic behaviours. Furthermore, we found that oleanolic acid led to the BDNF-related phosphorylation and activation of extracellular signal-regulated kinases (ERK) and cyclic adenosine monophosphate response element binding protein (CREB), which was associated with the upregulation of miR-132 and hippocampal neuronal proliferation. Moreover, experiments with an miR-132 antagomir revealed that targeting miR-132 led to inhibition of neuronal proliferation and the postsynaptic density protein 95, but did not affect presynaptic protein synapsin I. LIMITATIONS: Several other stimuli can also induce CREB phosphorylation in the hippocampus. Thus, regulation of miR-132 may not be restricted to neurotrophic signalling. CONCLUSION: Our results show that oleanolic acid induces the upregulation of miR-132, which serves as an important regulator of neurotrophic actions, mainly through the activation of the hippocampal BDNF-ERK-CREB signalling pathways. [ABSTRACT FROM AUTHOR]

BACKGROUND: Dysfunctional reward processing is present in individuals with schizophrenia-spectrum disorders (SSD) and may confer vulnerability to addiction. Our objective was to identify a deficit in patients with SSD on response to rewarding stimuli and determine whether this deficit predicts cannabis use. METHODS: We divided a group of patients with SSD and nonpsychotic controls into cannabis users and nonusers. Response to emotional and cannabis-associated visual stimuli was assessed using self-report, event-related potentials (using the late positive potential [LPP]), facial electromyography and skin-conductance response. RESULTS: Our sample comprised 35 patients with SSD and 35 nonpsychotic controls. Compared with controls, the patients with SSD showed blunted LPP response to pleasant stimuli (p = 0.003). Across measures, cannabis-using controls showed greater response to pleasant stimuli than to cannabis stimuli whereas cannabis-using patients showed little bias toward pleasant stimuli. Reduced LPP response to pleasant stimuli was predictive of more frequent subsequent cannabis use (β = -0.24, p = 0.034). LIMITATIONS: It is not clear if the deficit associated with cannabis use is specific to rewarding stimuli or nonspecific to any kind of emotionally salient stimuli. CONCLUSION: The LPP captures a reward-processing deficit in patients with SSD and shows potential as a biomarker for identifying patients at risk of heavy cannabis use. [ABSTRACT FROM AUTHOR]

BACKGROUND: Obsessive-compulsive disorder (OCD) is a common, heritable neuropsychiatric disorder, hypothetically underpinned by dysfunction of brain cortical-striatal-thalamic-cortical (CSTC) circuits; however, the extent of brain functional abnormalities in individuals with OCD is unclear, and the genetic basis of this disorder is poorly understood. We determined the whole brain functional connectivity patterns in patients with OCD and their healthy first-degree relatives. METHODS: We used resting-state fMRI to measure functional connectivity strength in patients with OCD, their healthy first-degree relatives and healthy controls. Whole brain functional networks were constructed by measuring the temporal correlations of all brain voxel pairs and further analyzed using a graph theory approach. RESULTS: We enrolled 39 patients with OCD, 20 healthy first-degree relatives and 39 healthy controls in our study. Compared with healthy controls, patients with OCD showed increased functional connectivity primarily within the CSTC circuits and decreased functional connectivity in the occipital cortex, temporal cortex and cerebellum. Moreover, patients with OCD and their first-degree relatives exhibited overlapping increased functional connectivity strength in the bilateral caudate nucleus, left orbitofrontal cortex (OFC) and left middle temporal gyrus. LIMITATIONS: Potential confounding factors, such as medication use, heterogeneity in symptom clusters and comorbid disorders, may have impacted our findings. CONCLUSION: Our preliminary results suggest that patients with OCD have abnormal resting-state functional connectivity that is not limited to CSTC circuits and involves abnormalities in additional large-scale brain systems, especially the limbic system. Moreover, resting-state functional connectivity strength abnormalities in the left OFC, bilateral caudate nucleus and left middle temporal gyrus may be neuroimaging endophenotypes for OCD. [ABSTRACT FROM AUTHOR]

In the present school-based study, a convenience sample of 477 students in grades 6-9 and second year in high school from a city and a smaller town recorded daily occurrence and intensity of headaches in a standard paper diary during a 3-week period. Total headache activity (headache sum), number of headache days, intensity level and duration for weekly headaches were estimated. Approximately 85% of the adolescents had experienced headache of any intensity level during the 3-week recording period. On the average, they reported 2.5 headache days per week and a mean intensity level for headache episodes of 1.7. Our estimates for headache of any intensity level (1-5) occurring at least once a week was surprisingly high (73.8%). For the highest intensity level across the whole 3-week period, almost identical proportions of mild and moderate headaches were reported by students (22.3-22.5%), while about twice as many (40.7%) had experienced severe headaches. Girls consistently reported more headaches than boys, in particular of the moderate and severe intensity types. Students in the city also reported more frequent and intense headaches than those in the town. Peak headache activity was observed at noon and in the afternoon and in the days from the middle of the week until weekend. The use of prospective recordings in diaries will further advance our knowledge on the prevalence and characteristics of recurrent headaches among children and adolescents in community samples. [ABSTRACT FROM AUTHOR]

Objective: To examine whether personal psychological resources safeguard hospital nurses against adverse workplace consequences, particularly job burnout and the desire to leave the profession. Background: Nursing research has extensively documented the adverse effects of job burnout and staff turnover. With the current nursing shortage, it is imperative to identify resources and strategies that can mitigate adverse workplace outcomes. However, the role of personal psychological resources, or psychological capital, in aiding nurses to perform effectively in their work environment remains relatively unexplored. Study design and methods: This study adopted a cross-sectional survey design. The survey assessed nurses' experienced burnout (MBI-HSS), psychological capital (PCQ-24), and intentions to leave nursing. Hospital nurses (n= 258) from six states of Australia responded to an online anonymous survey between June and November 2022. Results: Respondents indicated a high degree of experienced burnout: 68.6% experienced high emotional exhaustion, 31.8% had high depersonalisation, and 31.8% had low personal accomplishment. Additionally, 38.8% had high intentions to leave the profession. Emotional exhaustion (p<.001, b=.56) and personal accomplishment (p=.006, b=-.15) were significant predictors of turnover intentions. Higher psychological capital was significantly associated with lower emotional exhaustion (p<.001, b=-.42), lower depersonalisation (p<.001, b=-.29), higher personal accomplishment (p<.001, b=.60), and lower turnover intentions (p<.001, b=.44). Discussion: Much of the nursing burnout and intent to leave literature focuses on negative rather than positive aspects of the work environment. Positive responses to workplace stimuli promote positive attitudes such as empowerment, job satisfaction, and organisational commitment that have a tangible impact on personal and occupational wellbeing. This may explain why nurses with stronger personal psychological resources experienced less burnout and voiced fewer intentions to leave the profession. Conclusion: The health and wellbeing of nurses should be a priority for healthcare organisations; the working conditions nurses face in Australian hospitals cause many to be negatively impacted by work stress. Implications for Research, Policy, and Practice: Nurses would benefit from initiatives to enhance their psychological resources. Targeted interventions to develop psychological capital should be examined in a nursing population. This can change policy, thereby benefitting the healthcare system. What is already known about the topic? • Australia is currently facing a shortage of qualified nurses. • Hospital nurses often experience job burnout and high levels of turnover due to the challenging nature of their work environment. • Personal psychological resources have been linked to positive workplace outcomes, such as job satisfaction and organisational commitment, in various settings. What this paper adds: • It demonstrates that nurses possessing greater personal psychological resources experience lower levels of burnout and are less likely to consider leaving the profession. • The paper suggests that implementing targeted interventions designed to enhance nurses' personal psychological resources could be a viable approach for mitigating burnout and turnover intentions (TI). [ABSTRACT FROM AUTHOR]

Background: Bushmeat is a resource exploited by thousands of people around the world, especially in tropical and neotropical regions, constituting an important source of protein and income. But what is known, so far, about the consumption and trade of wild vertebrate meat (hereinafter "bushmeat") in a megadiverse country like Brazil? This question was answered through a systematic survey of publications on the consumption and trade of wild vertebrate meat made in Brazil between 2011 and 2021. Methods: We selected 63 scientific articles available on "Google Scholar," "Science Direct," "Scopus," " Web of Science" and "Portal de Periódico da CAPES." The articles were categorized as: exclusive to (1) consumption or (2) bushmeat trade, totals of 54 and three articles, respectively; both (3) consumption and trade bushmeat, totaling six articles. We applied a nonparametric Spearman's correlation analysis to verify the association between the number of papers and the species richness of wild vertebrates cited for consumption by Brazilian state. Results: The results revealed that the publications were concentrated in the Northeast (36), North (26) and Southeast (1) regions, distributed across 16 states of the federation. These data reinforce the need for more researches in states and other regions of the country. Our research hypothesis was confirmed, since the richness of species cited for meat consumption was positively associated with the amount of work carried out by the states of the federation. We identified a total of 321 species of wild vertebrates mentioned in the categories involving the consumption of bushmeat. We had a greater bird species richness mentioned for consumption (170) to the detriment of mammals (107), reptiles (40) and amphibians (4). Furthermore, in the articles involving the bushmeat trade categories we had 57 species of vertebrates mentioned, with mammals being the most representative in terms of species richness (29), to the detriment of birds (20) and reptiles (8). These data reinforce that birds and mammals have been the groups most used both for consumption and trade in bushmeat in the country's regions, and it is necessary to mitigate the hunting exploitation of these groups. We recorded that socioeconomic, biological, environmental and sociocultural factors were the most cited predictors of the consumption and trade of bushmeat in the articles. We identified that the bushmeat trade chain is dynamic and ramified, made up of several actors, including specialized and diversified hunters, intermediaries, market sellers, market vendors, restaurant owners and final customers. Public markets and open-air fairs were the most cited places for buying and selling wild meat in commerce. Conclusions: In general, our results indicate that we have made significant advances in publications on the consumption and trade of bushmeat in Brazil over the last few years. However, we highlight the need to better understand the patterns of consumption and trade of bushmeat in different regions of the country, as well as the factors associated with the dynamics of the trade chain and uses of wildlife by local communities. We emphasized that a multidimensional understanding of hunting activities is important to face socio-ecological problems and improve the conservation of target species which have continually been explored for uses by populations in different regions of the world. [ABSTRACT FROM AUTHOR]

Background: Given India's high patient load on the existing healthcare setup, as well as political, social, and organizational challenges, the nursing sector is facing various problems, therefore leading to substandard nursing experiences leading to poor patient care at the parallel healthcare setups, specifically homecare. This paper presents self-managed organizations (SMOs) characterized by a horizontal management structure as an effective alternative to existing hierarchical management structures overladen with bureaucracy. Therefore, we are exploring the strategies at self-managed homecare organizations that can make nursing a better and more productive experience. Method: This study utilized Constructivist Grounded Theory (CGT), employing semi-structured interviews to explore nursing dynamics in horizontal organizational structures. It delved into crucial aspects like finances, organizational structure, value systems, information flow, and conflict resolution within SMOs. The methodology involved theoretical sampling, prioritizing expert self-management knowledge over mere representativeness. Seven nurses, twelve management members, and fifteen patients from self-managed homecare organizations contributed to the examination of nursing experiences. Constant comparative analysis of data led to the identification of the Qualitative Success Enablers (QSEs), revealing three themes: Insightfulness, Enhancing Nursing Experience through Job Enrichment, and Autonomy-Enabled Intrapreneurship. Results: The findings indicate that the horizontal management structure represented by the studied organization in India has shown considerable success in times laden with uncertainties during the COVID-19 pandemic, especially during the delta wave, which revealed the frailty of existing healthcare infrastructure. The organization successfully maintained a better nursing experience and gained patient and employee satisfaction, as revealed by in-depth semi-structured interviews and constant comparative analysis. Conclusion: In a world of unique challenges, we stand on the brink of significant transformations. SMOs are vital in India's homecare sector for enhancing nursing experiences and overall organizational performance. Fostering a trust-based environment within SMOs is integral to delivering effective services. The autonomy to design nursing jobs, insightfulness, and innovativeness in the nursing job through suitable training activities, various job enrichment methods, and finding meaningfulness in a job through softer aspects of caregiving result in an enhanced nursing experience at SMOs. This groundbreaking approach can be extended to other homecare organizations in India, relieving the strain on the existing healthcare system. [ABSTRACT FROM AUTHOR]

Background: Task-shared care is a demonstrated approach for integrating mental health into maternal and child healthcare (MCH) services. Training and continued support for frontline providers is key to the success of task sharing initiatives. In most settings this is provided by mental health specialists. However, in resource constrained settings where specialists are in short supply, there is a need to explore alternative models for providing training and supportive supervision to frontline maternal care providers. This paper reports on the impact of a cascade training (train-the-trainers) approach in improving the knowledge and attitudes of primary healthcare workers (PHCW) to perinatal depression. Methods: Senior primary health care providers selected from across participating local government areas were trained to provide training to other PHCWs. The training sessions facilitated by these trainers were observed and rated for fidelity by specialist trainers, while the trainees provided their impression of and satisfaction with the training sessions using predesigned assessment forms. Training outcomes assessed included knowledge of depression (using mhGAP training questions and knowledge of depression questionnaire) and attitude towards providing care for depression (revised depression attitude questionnaire (R-DAQ)) measured pre and post training as well as six months after training. Results: Trainees were 198 PHCWs (94.4% female), who routinely provide MCH services in 28 selected primary care clinics and had between 6- and 34-years' experience. Training was provided by 11 trained trainers who were general physicians or senior nurses. Training sessions were rated high in fidelity and on training style. Sessions were rated excellent by 77.8% of the trainees with the trainers described as knowledgeable, effective and engaging. Knowledge of depression mean score improved from a pre-training level of 12.3 ± 3.5 to 15.4 ± 3.7, immediately post-training and 14.7 ± 3.2, six months post-training (both comparisons: p < 0.001). The proportion of PHCW workers endorsing statements indicative of positive attitudes on the professional confidence and the generalist perspective modules of the R-DAQ also increased with training. Conclusion: Our findings suggest that cascade training can be an effective model for rapidly providing training and upskilling frontline PHCWs to deliver care for women with perinatal depression in resource limited settings. Trial registration: This study was retrospectively registered 03 December 2019. https://doi.org/10.1186/ISRCTN 94,230,307. [ABSTRACT FROM AUTHOR]

Simple Summary: We have shown that a confocal Raman imaging provides an excellent tool to extend our knowledge on the redox status of iron ion of heme proteins inside specific organelles of bronchial normal epithelial lung (BEpC) and lung cancer (A549) cells. The role of retinoic acid in regulating respiration, apoptosis processes, and reactive oxygen species production has been discussed. We showed that retinoic acid plays a key role in the oscillations between reduced (Fe2+) and oxidized (Fe3+) form of cytochrome c in the electron transport chain that can activate or inhibit these physiological functions. The redox status of cytochrome c regulated by retinoic acid becomes a target for further development of robust therapeutic approaches. The multiple functions of cytochrome c (cyt c) and their regulation in life and death decisions of the mammalian cell go beyond respiration, apoptosis, ROS scavenging, and oxidation of cardiolipine. It has become increasingly evident that cyt c is involved in the propagation of mitogenic signals. It has been proposed that the mitogenic signals occur via the PKCδ-retinoic acid signal complex comprising the protein kinase Cδ, the adapter protein Src homologous collagen homolog (p66Shc), and cyt c. We showed the importance of retinoic acid in regulating cellular processes monitored by the Raman bands of cyt c. To understand the role of retinoids in regulating redox status of cyt c, we recorded the Raman spectra and images of cells receiving redox stimuli by retinoic acid at in vitro cell cultures. For these purposes, we incubated bronchial normal epithelial lung (BEpC) and lung cancer cells (A549) with retinoic acid at concentrations of 1, 10, and 50 µM for 24 and 48 h of incubations. The new role of retinoic acid in a change of the redox status of iron ion in the heme group of cyt c from oxidized Fe3+ to reduced Fe2+ form may have serious consequences on ATPase effectiveness and aborting the activation of the conventional mitochondrial signaling protein-dependent pathways, lack of triggering programmed cell death through apoptosis, and lack of cytokine induction. To explain the effect of retinoids on the redox status of cyt c in the electron transfer chain, we used the quantum chemistry models of retinoid biology. It has been proposed that retinol catalyzes resonance energy transfer (RET) reactions in cyt c. The paper suggests that RET is pivotally important for mitochondrial energy homeostasis by controlling oxidative phosphorylation by switching between activation and inactivation of glycolysis and regulation of electron flux in the electron transport chain. The key role in this process is played by protein kinase C δ (PKCδ), which triggers a signal to the pyruvate dehydrogenase complex. The PKCδ-retinoic acid complex reversibly (at normal physiological conditions) or irreversibly (cancer) responds to the redox potential of cyt c that changes with the electron transfer chain flux. [ABSTRACT FROM AUTHOR]

Simple Summary: Cancer research has been increasingly focusing on identifying genes and molecular pathways that drive the disease. In this context, protein–protein interaction networks, which provide insights into the interactions among proteins within a cell, have proven particularly useful. However, the effectiveness of existing approaches can be influenced by the specific network used, as different networks can have different topological structures. In addition, newer context-specific networks often come with incomplete structures, which complicates the analysis. To address these challenges, we propose a new method, called MultiFDRnet, that can identify driver genes and pathways using multiple protein–protein interaction (PPI) networks. Here, the false discovery rate (FDR) refers to the proportion of non-cancer genes within identified subnetworks. Our method, tested on both simulated and real cancer data, has been able to identify important subnetworks that are supported by multiple PPI networks and reveal novel modular structures in context-specific PPI networks. The software that we developed to implement this method is freely available for other researchers to use. Background: The identification of cancer driver genes and key molecular pathways has been the focus of large-scale cancer genome studies. Network-based methods detect significantly perturbed subnetworks as putative cancer pathways by incorporating genomics data with the topological information of PPI networks. However, commonly used PPI networks have distinct topological structures, making the results of the same method vary widely when applied to different networks. Furthermore, emerging context-specific PPI networks often have incomplete topological structures, which pose serious challenges for existing subnetwork detection algorithms. Methods: In this paper, we propose a novel method, referred to as MultiFDRnet, to address the above issues. The basic idea is to model a set of PPI networks as a multiplex network to preserve the topological structure of individual networks, while introducing dependencies among them, and, then, to detect significantly perturbed subnetworks on the modeled multiplex network using all the structural information simultaneously. Results: To illustrate the effectiveness of the proposed approach, an extensive benchmark analysis was conducted on both simulated and real cancer data. The experimental results showed that the proposed method is able to detect significantly perturbed subnetworks jointly supported by multiple PPI networks and to identify novel modular structures in context-specific PPI networks. [ABSTRACT FROM AUTHOR]

Background: Interrupted time series (ITS) analysis is a time series regression model that aims to evaluate the effect of an intervention on an outcome of interest. ITS analysis is a quasi-experimental study design instrumental in situations where natural experiments occur, gaining popularity, particularly due to the Covid-19 pandemic. However, challenges, including the lack of a control group, have impeded the quantification of the effect size in ITS. The current paper proposes a method and develops a user-friendly R package to quantify the effect size of an ITS regression model for continuous and count outcomes, with or without seasonal adjustment. Results: The effect size presented in this work, together with its corresponding 95% confidence interval (CI) and P-value, is based on the ITS model-based fitted values and the predicted counterfactual (the exposed period had the intervention not occurred) values. A user-friendly R package to fit an ITS and estimate the effect size was developed and accompanies this paper. To illustrate, we implemented a nation population-based ITS study from January 2001 to May 2021 covering the all-cause mortality of Israel (n = 9,350 thousand) to quantify the effect size of Covid-19 exposure on mortality rates. In the period unexposed to the Covid-19 pandemic, the mortality rate decreased over time and was expected to continue decreasing had Covid-19 not occurred. In contrast, the period exposed to the Covid-19 pandemic was associated with an increased all-cause mortality rate (relative risk = 1.11, 95% CI = 1.04, 1.18, P < 0.001). Conclusion: For the first time, the effect size in ITS: was quantified, can be estimated by end-users with an R package we developed, and was demonstrated with data showing an increase in mortality following the Covid-19 pandemic. ITS effect size reporting can assist public health policy makers in assessing the magnitude of the entire intervention effect using a single, readily understood measure. [ABSTRACT FROM AUTHOR]

This paper constructs a platform framework for extensive data analysis of college students' psychological quality with the help of the thinking mode of big data and related technologies and proposes the construction principles, data sources, data processing methods, data platform construction, and platform application of big data analysis platform for college students' psychological quality assessment. This paper combines the application methods of big data technology, collects the management data related to the psychological quality assessment of college students, saves them into the system database with certain storage logic, and realizes the function of psychological quality assessment through the design of selected psychological quality assessment data, data management and data resource management and other parts based on the data results of extensive data analysis. This study provides some insights into the psychological quality assessment of college students. The strength of association between the variables of psychological quality assessment of college students changes over time, but the overall psychological structure is more stable. This stable psychological structure characteristic is conducive to constructing the policy of constant psychological education in large universities. [ABSTRACT FROM AUTHOR]

This paper aims to investigate the impact of the exchange rate on stock market indices of four main sectors in Turkey. For this purpose, the paper uses monthly data spanning the period between 06/2008-11/2020 and employs the panel GMM estimation method. This method instrumentalizes the past observation values of the dependent variable to control the endogeneity and provides efficient results. Considering that firms operating in many sectors in Turkey are affected by the volatility of the exchange rate, the paper takes initiative in understanding how stock market indices of four sectors react to the fluctuation in USD and Euro prices. This study contributes to the current literature, performing the panel GMM estimation method, unlike studies that only examine the causality relationship on the link between exchange rate and the stock market. The results show that there is unidirectional causality from the exchange rate to stock market indices. According to our findings, the USD/TRY exchange rate negatively affects stock market indices, and the Euro/TRY exchange rate positively affects stock market indices. The findings obtained from the analysis results confirm prior knowledge acquired from Turkey's foreign trade structure. [ABSTRACT FROM AUTHOR]

Objective: To investigate the psychosocial effects of the COVID-19 pandemic on nurses and midwives working in acute care settings, specifically psychological distress, self-reported concerns, and perceived impact on their work and personal lives. Background: Little is known about the psychosocial impact of the pandemic on nurses and midwives in Australia, a country with a substantially lower number of COVID-19 cases and deaths than many others. Few studies investigating the prevalence of psychological distress among nurses during the pandemic have been conducted in more than one setting, especially in the Australian context. Study design and methods: Cross-sectional survey design (STROBE checklist). Nurses and midwives (n=1,611) at four metropolitan tertiary health services in Melbourne, Australia completed an anonymous online survey between 15 May and 31 August 2020, which assessed symptoms of depression, anxiety and stress (DASS-21); concerns related to COVID-19; and other effects of COVID-19. Space was provided for free-text comments. Results: Approximately one fifth of respondents reported moderate to extremely severe symptoms of depression, anxiety and stress. Fewer years of clinical experience were significantly associated with higher levels of psychological distress. More than half of the respondents were extremely/very concerned about passing COVID-19 on to family members and about their family's health, and almost half were concerned about caring for a patient who had confirmed or suspected COVID-19. Respondents reported that certain precautionary measures such as personal protective equipment (PPE) interfered with their ability to provide optimal patient care. Positive aspects of the pandemic were also reported including a sense of togetherness and cooperation among staff. Conclusion: The COVID-19 pandemic has had a considerable impact on the psychological wellbeing and work and personal lives of nurses and midwives working in acute care settings in Melbourne, Australia, particularly those with less clinical experience. Implications for nursing and health services research, policy and practice: Nurses and midwives, particularly those with less clinical experience, would benefit from additional, targeted wellbeing and support initiatives. For those with less experience, initiatives could include being partnered with more experienced colleagues and educators who can provide practical and emotional support and monitor their stress levels. What is already known about the topic? * Nurses and midwives have experienced more psychological distress than other healthcare workers during the COVID-19 pandemic. * Most studies about the psychosocial impact of the COVID-19 pandemic on nurses and midwives have been conducted in a single health service. * Few studies have concurrently investigated the experiences of nurses and midwives from different health services during the COVID-19 pandemic especially in the Australian context. What this paper adds * Despite the relatively low number of COVID-19 cases and deaths in Australia, the COVID-19 pandemic has had a considerable impact on the psychological wellbeing and work and personal lives of Australian nurses and midwives. * About one in five of the nurses and midwives surveyed reported moderate to extremely severe symptoms of depression, anxiety and stress during the first wave of the pandemic. * Nurses and midwives with fewer years of clinical experience experienced higher levels of psychological distress than those with more experience. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate the training and implementation of the gravimetric method for estimating postpartum blood loss in clinical practice in Indonesian midwife-led birth centres. Background: Postpartum haemorrhage remains a leading cause of maternal death, particularly in low-resource settings. There is no gold standard for assessing blood loss volume during labour and childbirth. Studies recommended using a gravimetric method to measure blood loss in low-resource settings due to its relative accuracy and simplicity. Study design and methods: An online training module for the use of the gravimetric method was developed. All participants undertook the training and were asked to implement the method in clinical practice. A pre/post-test study design was used to examine midwives' understanding of the gravimetric method; their implementation experience was explored using a structured questionnaire. Knowledge was assessed pre-training. The training consisted of both theoretical and practical elements and the opportunity for participants to ask questions. Post-training tests were administered, followed by a one-month period of implementation and an evaluation of their experience of using the method in practice. Results: Two hundred and eighty-five midwives from 17 health facilities were recruited to the study, and a total of 101 midwives from 12 health facilities completed all elements. The participants' understanding of the gravimetric method improved significantly following the training. Although a number of challenges were identified regarding the implementation of the gravimetric method in practice, the participants were generally positive about its use, and 89% said that they would recommend this method to colleagues. Conclusion: A three-hour online training effectively improved participants' understanding of the gravimetric method for assessing blood loss volume. This study identified midwives' positive experiences with the gravimetric method and identified areas to improve practitioner experience of implementation in practice. Implications for research, policy, and practice: A three-hour online training followed by a onemonth implementation period could be an effective and efficient approach to developing midwives' understanding and use of the gravimetric method of blood loss estimation postpartum. What is already known about the topic? * The gravimetric method estimates the blood loss volume by weighing sanitary materials used during the labour process (i.e., gauze, sheets, swabs, pads, etc.) before and after being contaminated by the blood. * In clinical practice, the weight difference (in grams) is considered as 'blood loss volume' for ease of measurement and reported in millilitres without any formal conversion of units of weight to volume. * The benefits of the gravimetric method have been reported previously. However, there is limited evidence on the evaluation of this method to train midwives regarding implementation of the gravimetric method in clinical practice. What this paper adds * An online training programme is effective in increasing midwives' knowledge and awareness of the gravimetric method for postpartum blood loss assessment. * The midwives found the gravimetric method simple to adopt in clinical practice, which increased their confidence in detecting postpartum haemorrhage. * The midwives encountered some barriers while implementing the gravimetric method and provided strategies to mitigate the issues raised. [ABSTRACT FROM AUTHOR]

Simple Summary: Hyperthermia, a limited increase in tumor tissue temperature up to a maximum of 45 °C, has long been used in cancer treatment, either as a stand-alone therapy or in conjunction with chemo-/radiotherapy. Among the different physical procedures used, a particularly promising technique is magnetic fluid hyperthermia (MFH): this consists of the local administration of magnetic nanoparticles, followed by the application of alternating magnetic fields. One concern with this technique is the possibility of damage to healthy peritumoral tissue. The present study investigates innovative nanoparticles with self-regulating temperature, which should reduce this risk and thus mark a significant step forward in MFH. In an experimental model of aggressive breast cancer, we demonstrated a substantial reduction of tumor growth rate by using an experimental MFH protocol, transferable to clinical practice. These innovative nanomaterials present the added advantage of allowing non-invasive monitoring of temperature, by magnetic resonance imaging (MRI) and magnetic particle imaging (MPI). This paper reports a comprehensive investigation of a magnetic nanoparticle (MNP), named M55, which belongs to a class of innovative doped ferrite nanomaterials, characterized by a self-limiting temperature. M55 is obtained from M48, an MNP previously described by our group, by implementing an additional purification step in the synthesis. M55, after citrate and glucose coating, is named G-M55. The present study aimed to demonstrate the properties of G-M55 as a diagnostic contrast agent for MRI and magnetic particle imaging (MPI), and as an antitumoral agent in magnetic fluid hyperthermia (MFH). Similar specific absorption rate values were obtained by standard MFH and by an MPI apparatus. This result is of interest in relation to the application of localized MFH by MPI apparatus. We demonstrated the biocompatibility of G-M55 in a triple-negative human breast cancer line (MDA-MB-231), and its efficacy as an MFH agent in the same cell line. We also demonstrated the efficacy of MFH treatment with G-M55 in an experimental model of breast cancer. Overall, our results pave the way for the clinical application of G-M55 as an MFH agent in breast cancer therapy, allowing not only efficient treatment by both standard MFH apparatus and MPI but also temperature monitoring. [ABSTRACT FROM AUTHOR]

At present, percutaneous nephrolithotomy has become an option for hospitals increasingly to treat calculus. However, due to the certain risk of percutaneous nephrolithotomy, it may lead to postoperative complications. Analyzing the preoperative factors of septic shock after percutaneous nephrolithotomy can provide guidance for reducing the incidence of septic shock after PCNL. This article establishes a logistic regression model based on preoperative factors, uses statistical methods, and uses the professional statistical software SPSS to create a database and analyze the data. The method of classification data analysis was used to determine various influencing factors including patient factors, stone factor, and preoperative factors and combined B-ultrasound guidance and percutaneous nephrolithotomy to reduce the risk of surgery. The experimental results found that the percutaneous nephroscope laser lithotripsy guided by the smart Internet of Things can effectively perform lithotripsy; in this paper, the preoperative data of different complications are obtained, and the risk of surgery is closely related to the operation time. The operation time exceeds 90 minutes and causes the risk of severe bleeding after PCNL. It is twice the operation time of less than 90 minutes and 5 times the operation time of less than 60 minutes. [ABSTRACT FROM AUTHOR]

This paper introduces a novel, temporally sensitive analytical method for qualitative researchers, which is simultaneously timely and necessary given increasing recognition of the fundamental role that time plays in organizational life and scholarship. As a result of this recognition, research designs considering temporality have substantially increased over the past decade. However, while methods for qualitative data collection using longitudinal and 'shortitudinal' designs, in particular qualitative diary methods, have become increasingly common, analytical methods capable of fully exploiting the temporal nature of such data have lagged behind their quantitative counter‐parts, where we see marked progression in analytical methods and procedures. In this paper, we argue that this lack of progression in approaches for analysing qualitative diary data hinders our knowledge and theoretical development when it comes to incorporating temporality, particularly in the exploration of phenomena at individual‐/micro‐levels, arguably most salient to organizational psychology researchers. We respond to these challenges by introducing a novel, step‐by‐step analytical approach that facilitates rigorous incorporation of temporality into the analysis and theorization of micro‐level, qualitative diary data, termed Thematic Trajectory Analysis (TTA). Practitioner points: Existing qualitative analytical methods have limitations when applied to qualitative diary data and have thereby limited the questions that may be explored, and understood, through qualitative data.Offers an alternative, step‐by‐step, analytical approach for researchers and practitioners seeking to understand within‐person changes and dynamism in organizations.Enables the benefits of qualitative diaries to be better exploited by both researchers and practitioners and thereby lead to better understanding of how organizational processes unfold, and in turn, lead to stronger intervention mechanisms.Demonstrates the utility of combing textual and visualized data outputs in understanding complex and dynamic phenomena in organizations. [ABSTRACT FROM AUTHOR]

Multiple sclerosis (MS) is an inflammatory disease damaging the myelin sheath in the central and peripheral nervous system in the brain and spinal cord. Optic Neuritis (ON) is one of the most prevalent ocular demonstrations of MS. The current diagnosis protocol for MS is MRI, but newer modalities like Optical Coherence Tomography (OCT) are already of interest in early detection and progression analysis. OCT reveals the symptoms of MS in the Central Nervous System (CNS) through cross-sectional images from neural retinal layers. Previous works on OCT were mostly focused on the thickness of retinal layers; however, texture features seem also to have information in this regard. In this research, we introduce a new pipeline that constructs layer-stacked (LS) images containing data from each specific layer. A variety of texture features are then extracted from LS images to differentiate between healthy controls and ON/None-ON MS cases. Furthermore, the definition of texture extraction methods is tailored for this application. After performing a vast survey on available texture analysis methods, a treasury of powerful features is collected in this paper. As a primary work, this paper shows the ability of such features in the diagnosis of HC and MS (ON and None-ON) cases. Our findings show that the texture features are powerful to diagnose MS cases. Furthermore, adding information of conventional thickness values to texture features improves considerably the discrimination between most of the target groups including HC vs. MS, HC vs. MS-None-ON, and HC vs. MS-ON. [ABSTRACT FROM AUTHOR]

Simple Summary: Although the deep inferior epigastric perforator flap (DIEP) has become the most frequent autologous flap in breast reconstruction, it remains unclear whether reconstruction should be performed at the same time as the mastectomy or delayed. Therefore, we conducted a meta-analysis to offer an overview of recipient site postoperative complications and help guide practicians toward the ideal timing for breast reconstruction. A pooled analysis using the Mantel and Haenszel methods with a fixed effect model provided results as an odd ratio with a 95% confidence interval. Among most complications including hematoma, infection, fat necrosis, and flap loss, no significant differences were observed. However, delayed wound healing was significantly higher for patients who underwent delayed breast reconstruction. This paper offers evidence that both surgical timings offer similar outcomes and are, therefore, valid surgical strategies. Purpose: The setting regarding the ideal timing for deep inferior epigastric perforator flap (DIEP) reconstruction remains unclear. Immediate breast reconstruction (IBR) is performed at the same time as mastectomy, while delayed breast reconstruction (DBR) is performed at any time after mastectomy except immediately. We compared both strategies to assess whether IBR or DBR should be performed to reduce postoperative adverse events. Methods: A systematic review of PubMed, Embase, Medline, Cochrane, and Web of Science was conducted, aiming at articles comparing the recipient site outcomes of IBR versus DBR with DIEP. We used the Mantel–Haenszel method with a fixed effects model. Results were expressed as the OR with a 95% CI. Results: Two retrospective and two prospective studies were identified involving 5784 DIEPs (1744 immediate and 4040 delayed). We showed a significant difference in favor of IBR for wound healing issues (OR = 0.57, 95% CI 0.41, 0.77; p = 0.0003). However, no significant differences for hematoma, infection, fat necrosis, partial flap loss, and total flap loss rate were seen. Conclusions: Despite variability in the choice of the ideal time for breast reconstruction and outcomes reported among studies, immediate DIEP surgery appears to be a reliable setting with less delayed healing issues. [ABSTRACT FROM AUTHOR]

Objective. The purpose of this paper is to analyse the correlation between cardiac ultrasound-related indicators and cardiac function in patients with coronary heart disease and heart failure. Methods. In this experiment, a total of 160 patients with coronary heart disease and heart failure who were diagnosed and treated in our hospital from June 2019 to March 2021 were recruited as the study group. All were examined by colour Doppler ultrasound instrument, SPSS statistical software was used to analyse the data obtained, and Spearman correlation was used to analyse the correlation between cardiac ultrasound-related indicators and cardiac function in patients with coronary heart disease and heart failure. Results. In the study group, there were 68 patients with grade II cardiac function, accounting for 42.50%; 74 patients with grade III, accounting for 46.25%; and 18 patients with grade IV, accounting for 11.25%. The ultrasound parameters of the patients in the study group were profiled and calculated, and then statistically analysed with cardiac function grading. Cardiac function classification was significantly positively correlated with LVMI, LAD, and LVEDd (r = 0.689/0.915/0.928, P = 0.001) and significantly negatively correlated with CI, LVFS, and LVEF (r = −0.689/−0.878/−0.912), P = 0.001). Conclusion. Cardiac ultrasound-related indicators are associated with patients with coronary heart disease and heart failure. With the decline of cardiac function in patients with coronary heart disease and heart failure, the patient's condition is aggravated. Therefore, cardiac ultrasound-related indicators play a major role in the diagnosis of clinical disease progression. [ABSTRACT FROM AUTHOR]

The goal of the present paper is to systematically review the use of the Operationalized Portage Inventory (OPI) instrument to measure children's development from 0-6 years, in Brazilian publications. Using the PRISMA-P methodology, databases were assessed in Portuguese (Capes, BVS-Psychology, BVS-Bireme, Redalyc, Google Scholar) from 2002 to 2016. Forty-two studies were analyzed in terms of goals, procedures, design, results and limitations. Twelve papers were characterized as descriptive, 14 were correlational, and 16 involved intervention assessment. Studies suggested the OPI to be useful in describing and/or evaluating repertoires of 976 children with 19 different syndromes and 7 diverse risk conditions. More methodological rigor is recommended in future studies using the OPI. [ABSTRACT FROM AUTHOR]

Background: This paper is a follow‐up study continuing the COVISTRESS network previous research regarding health‐related determinants. Objective: The aim was to identify the main consequences of COVID‐19 lockdown on Body MassIndex and Perceived Fragility, related to Physical Activity (PA), for different categories of populations, worldwide. Design: The study design included an online survey, during the first wave of COVID‐19 lockdown, across different world regions. Setting and participants: The research was carried out on 10 121 participants from 67 countries. The recruitment of participants was achieved using snowball sampling techniques via social networks, with no exclusion criteria other than social media access. Main outcome measures: Body MassIndex, Physical Activity, Perceived Fragility and risk of getting infected items were analysed. SPSS software, v20, was used. Significance was set at P <.05. Results: Body MassIndex significantly increased during lockdown. For youth and young adults (18‐35 years), PA decreased by 31.25%, for adults (36‐65 years) by 26.05% and for the elderly (over 65 years) by 30.27%. There was a high level of Perceived Fragility and risk of getting infected for female participants and the elderly. Correlations between BMI, Perceived Fragility and PA were identified. Discussion and Conclusions: The research results extend and confirm evidence that the elderly are more likely to be at risk, by experiencing weight gain, physical inactivity and enhanced Perceived Fragility. As a consequence, populations need to counteract the constraints imposed by the lockdown by being physically active. [ABSTRACT FROM AUTHOR]

Research background: Accounting records provide a wide range of data necessary for decisions of the management as well as for users of a company's financial statements. IFRS represents one of the widely accepted accounting principles, often mentioned in relation to the preparation of high-quality financial statements. Purpose of the article: The aim of this paper is to identify the factors contributing to the occurrence of misstatements when preparing financial statements under IFRS. The subsequent goal is to identify the possible influences of such misstatements on the users of the financial statements. Methods: The research itself focuses on perceived problems in IFRS application in the Czech Republic. The total tested population is 193 Czech companies preparing their financial statements under IFRS. Descriptive statistics, the chi-square test of independence along with proportional tests, are used for the statistical data analysis. Findings & Value added: The results indicate that, while misstatements in accounting do not occur regularly, a statistical dependence can be shown be-tween the frequency of misstatements occurrence and the average size of mis-statements. The frequency of the subsequently identified misstatements is also proven to be statistically dependent on the average size of misstatements. The IFRS themselves are not proven to influence misstatement occurrences in financial statements, which is in contrast with previous studies. Managerial pressures, similarly to other studies, are proven by the research to be affecting the quality of accounting information. This paper broadens the literature on the factors influencing the quality of financial statements prepared under IFRS and simultaneously reaches conclusions disproving the frequently noted bene-fits of IFRS implementation. [ABSTRACT FROM AUTHOR]

Objective: To describe the roles that Australian nurses play, the breadth of skills that they deploy, and the range of contexts in which they practice. Study design and methods: This cross-sectional study used a descriptive survey where data were collected online using Qualtrics©. Survey respondents were nurses whose primary role was caring for people with intellectual and developmental disability. In addition to demographic data, the main outcome measures were: nursing roles, practice and context. Results: Complete responses were collected from 101 nurses; 78 females and 22 males completed the survey, the majority of whom (n=70) were from New South Wales. The major focus of care was direct assessment and care, followed by supervision of support workers, education, and advocacy for people with intellectual and developmental disability. Physical healthcare was consistent across body systems, as it was for all adaptive behaviour domains. Support for mental illness was more likely to be for depression and anxiety. Nurses liaise with a multitude of health and social agencies as part of their nursing practice. Discussion: This is the first study to capture the roles, practice and contexts of these Australian nurses. Nurses caring for people with IDD play a variety of roles and engage in a vast array of practice related to the physical and social needs of people with intellectual and developmental disability across the whole of the lifespan and in multiple, disparate contexts. Conclusion: It is important for the ongoing care of people with intellectual and developmental disability that the value added by this nursing workforce not be overlooked as disability and health policies evolve. Implications for research, policy and practice: This cross sectional study lays the groundwork for further research about these Australian nurses, in particular more focussed research about the economic benefits of disability services employing nurses, description and effect of nursing interventions specific to people with intellectual and developmental disability, as well as theoretical work to conceptualise new, National Disability Insurance Scheme-ready, models of nursing care for people with intellectual and developmental disability. What is already known about the topic? * In the Australian context, little is known about the contemporary roles and practice of nurses who care for people with intellectual and developmental disability. What this paper adds: * This paper offers a detailed and modern insight into the roles and nursing practice of this marginalised group of nurses. Although all nurses offer physical nursing care, unique to these nurses is the breadth and depth of social, behavioural, emotional and adaptive behaviour support across the lifespan. [ABSTRACT FROM AUTHOR]

This exploratory paper describes associations between neonatal clinical data and behavioral outcomes among infants born with very low birth weight (VLBW) at 4 years of age. Statistical analysis of 24 VLBW infants was conducted using principal factor analysis (PFA). Multiple linear regressions were calculated to explore the relationship between identified risk factors (demographic and clinical data) and behavioral measures: the Battelle Developmental Inventory (2nd ed.) Screening Test (BDI-2 ST) and the Achenbach Child Behavior Checklist (CBCL). Gestational age was controlled for in the model. Exploratory PFA results indicated that two factors had greater ability to explain observed variations within the sample. The first factor significantly associated high-level neonatal care with aggressive behaviors (β = -0.7477, p < 0.05). The first factor was also predictive of lower personal-social, communication, and cognitive scores. The second factor significantly associated cardiopulmonary complications with pervasive developmental problems (attention deficit hyperactivity disorder, anxiety, depression, and oppositional defiant disorder) (β = 0.1977, p < 0.05). These results showed that behavioral consequences at 4 years of age were found among children born VLBW due to the severity of illness, the need of high-level care, and cardiopulmonary complications during the neonatal period. These findings suggest VLBW infants experience longer term effects from trauma early in life and warrant further study. [ABSTRACT FROM AUTHOR]

The article presents a study which examined the organization and developmental sequences of macro-structure components of the written narratives of 44 students aged 7-11 years old in Japan who are deaf or hard of hearing (DHH). Based on the results, the students successfully completed the elements of action, sequence, orientation and climax of their oral paper puppet plays. Also cited is the definition of narrative as an extension of discourse.

The growing use of digital technologies (DTs) has a myriad of implications to socio-technical systems, which are not yet fully recognised. This paper investigates the contributions and drawbacks of DTs to resilient performance (RP), an aspect that so far has received less attention in comparison to others such as efficiency. To this end, a survey questionnaire was applied to 79 academics and practitioners linked to resilience engineering. Data analysis involved descriptive statistics and a thematic analysis of the open-text responses to the survey. Mixed impacts were identified, with 10 themes related to contributions and 16 to drawbacks. Regarding the contributions, the results highlighted the use of DTs for monitoring and anticipating system performance. Machine learning seems to be the most promising approach for this purpose. A key drawback is the need for developing new skills across the workforce so that they can make sense of the outputs of DTs and are aware of their strengths and weaknesses. The human role is expected to remain crucial for RP, which makes the current coordination difficulties with DTs even more important to address. A research agenda composed of five topics is proposed, encompassing description, prescription, and assessment. The agenda emphasizes the need for mapping the attributes or functionalities of DTs onto resilience concepts, models, and frameworks. [ABSTRACT FROM AUTHOR]

Background: Adverse visual symptoms with electronic devices have been reported, but causes have yet to be clearly defined. Previous studies have neither equated stimulus luminance across devices nor studied subjects with verified normal accommodation prior to testing. Pupil size during device use also has not been explored. We compared pupil sizes and accommodative responses to targets of similar size displayed with ink on paper, an e-ink reader, and an LCD device in young, healthy adults with normal accommodation. Methods: Subjects were 42 healthy adults, aged 22 to 33 years, with near acuity 20/20 (6/6) or better in the tested eye. Normal accommodation was verified with accommodative amplitude and facility (+/-2.00 flippers) tests. The reading text was presented at 40 cm, and text size and device luminance were matched across devices. While the subject read the passage aloud, pupil size was measured. Accommodative responses were obtained twice with near retinoscopy and twice with an open-field autorefractor for each device. Results: One-way ANOVA for correlated samples and Tukey's HSD test were used to compare mean pupil size and mean accommodative response across devices. The differences in mean pupil size for paper versus e-ink (5.1 ± 0.9 vs. 5.5 ± 0.8, p<0.01) and LCD versus e-ink (5.1 ± 0.9 vs 5.5 ± 0.8, p<0.01) were significant. By retinoscopy, the difference in mean accommodative response was significant only for e-ink and LCD (1.48 ± 0.76 D vs. 1.78 ± 1.26 D, p<0.01). By autorefraction, no significant differences in mean accommodative response were found across device type. Linear regression showed that accommodative response was not predicted by pupil size for any of the devices. Conclusions: In this group of young adults with normal accommodation, accommodative response was not significantly different for ink on paper, e-ink, or LCD devices of matched luminance. Pupil size did not predict accommodative response for any device. [ABSTRACT FROM AUTHOR]

This study is aimed at modeling biodigestion systems as a function of the most influencing parameters to generate two robust algorithms on the basis of the machine learning algorithms, including adaptive network-based fuzzy inference system (ANFIS) and least square support vector machine (LSSVM). The models are assessed utilizing multiple statistical analyses for the actual values and model outcomes. Results from the suggested models indicate their great capability of predicting biogas production from vegetable food, fruits, and wastes for a variety of ranges of input parameters. The values that are calculated for the mean relative error (MRE %) and mean squared error (MSE) were 29.318 and 0.0039 for ANFIS, and 2.951 and 0.0001 for LSSVM which shows that the latter model has a better ability to predict the target data. Finally, in order to have additional certainty, two analyses of outlier identification and sensitivity were performed on the input parameter data that proved the proposed model in this paper has higher reliability in assessing output values compared with the previous model. [ABSTRACT FROM AUTHOR]

Background: The shift towards integrated care (IC) represents a global trend towards more comprehensive and coordinated systems of care, particularly for vulnerable populations, such as the elderly. When health systems face fiscal constraints, integrated care has been advanced as a potential solution by simultaneously improving health service effectiveness and efficiency. This paper addresses the latter. There are three study objectives: first, to compare efficiency differences between IC and non-IC hospitals in China; second, to examine variations in efficiency among different types of IC hospitals; and finally, to explore whether the implementation of IC impacts hospital efficiency. Methods: This study uses Data Envelopment Analysis (DEA) to calculate efficiency scores among a sample of 200 hospitals in H Province, China. Tobit regression analysis was performed to explore the influence of IC implementation on hospital efficiency scores after adjustment for potential confounding. Moreover, the association between various input and output variables and the implementation of IC was investigated using regression techniques. Results: The study has four principal findings: first, IC hospitals, on average, are shown to be more efficient than non-IC hospitals after adjustment for covariates. Holding output constant, IC hospitals are shown to reduce their current input mix by 12% and 4% to achieve optimal efficiency under constant and variable returns-to-scale, respectively, while non-IC hospitals have to reduce their input mix by 26 and 20% to achieve the same level of efficiency; second, with respect to the efficiency of each type of IC, we show that higher efficiency scores are achieved by administrative and virtual IC models over a contractual IC model; third, we demonstrate that IC influences hospitals efficiency by impacting various input and output variables, such as length of stay, inpatient admissions, and staffing; fourth, while bed density per nurse was positively associated with hospital efficiency, the opposite was shown for bed density per physician. Conclusions: IC has the potential to promote hospital efficiency by influencing an array of input and output variables. Policies designed to facilitate the implementation of IC in hospitals need to be cognizant of the complex way IC impacts hospital efficiency. [ABSTRACT FROM AUTHOR]

Objective: To shorten the Patient Engagement In Research Scale (PEIRS) to its most essential items and evaluate its measurement properties for assessing the degree of patients' and family caregivers' meaningful engagement as partners in research projects. Methods: A prospective cross‐sectional web‐based survey in Canada and the USA, and also paper‐based in Canada. Participants were patients or family caregivers who had engaged in research projects within the last 3 years, were ≥17 years old, and communicated in English. Extensive psychometric analyses were conducted. Results: 119 participants: 99 from Canada, 74 female, 51 aged 17‐35 years and 50 aged 36‐65 years, 60 had post‐secondary education, and 74 were Caucasian/white. The original 37‐item PEIRS was shortened to 22 items (PEIRS‐22), mainly because of low inter‐item correlations. PEIRS‐22 had a single dominant construct that accounted for 55% of explained variance. Analysis of PEIRS‐22 scores revealed the following: (1) acceptable floor and ceiling effects (<15%), (2) internal consistency (ordinal alpha = 0.96), (3) structural validity by fit to a Rasch measurement model, (4) construct validity by moderate correlations with the Public and Patient Engagement Evaluation Tool, (5) good test‐retest reliability (ICC2,1 = 0.86) and (6) interpretability demonstrated by significant differences among PEIRS‐22 scores across three levels of global meaningful engagement in research. Conclusions: The shortened PEIRS is valid and reliable for assessing the degree of meaningful patient and family caregiver engagement in research. It enables standardized assessment of engagement in research across various contexts. Patient or public contribution: A researcher‐initiated collaboration, patient partners contributed from study conception to manuscript write‐up. [ABSTRACT FROM AUTHOR]

Purpose. The potential of UV-mediated photofunctionalization to enhance the resin-based luting agent bonding performance to aged materials was investigated. Methods. Sixty samples of each material were prepared. Yttria-stabilized zirconia (YZr) and Pd-Au alloy (Pd-Au) plates were fabricated and sandblasted. Lithium disilicate glass-ceramic (LDS) was CAD-CAM prepared and ground with #800 SiC paper. Half of the specimens were immersed in machine oil for 24 h to simulate the carbon adsorption. Then, all of the specimens (noncarbon- and carbon-adsorbed) were submitted to UV-mediated photofunctionalization with a 15 W UV-LED (265 nm, 300 mA, 7692 μW/cm2) for 0 (control groups), 5, and 15 min and subjected to contact angle (Ɵ) measurement and bonded using a resin cement (Panavia™ V5, Kuraray Noritake, Japan). The tensile bond strength (TBS) test was performed after 24 h. The Ɵ (°) and TBS (MPa) data were statistically analyzed using two-way ANOVA and Bonferroni correction tests (α = 0.05). Results. In the carbon-adsorbed groups, UV-mediated photofunctionalization for 5 min significantly decreased Ɵ of all materials and increased TBS of YZr, and UV for 15 min significantly increased the TBS of LDS and Pd-Au. In noncarbon-adsorbed groups, UV-photofunctionalization did not significantly change the Ɵ or TBS except YZr specimens UV-photofunctionalized for 15 min. Conclusion. UV-mediated photofunctionalization might have removed the adsorbed hydrocarbon molecules from the materials' surfaces and enhanced bond strengths of Panavia™ V5 to YZr, LDS, and Pd-Au. Additionally, UV-mediated photofunctionalization improved the overall TBS of YZr. Further investigation on the optimum conditions of UV photofunctionalization on indirect restorative materials should be conducted. [ABSTRACT FROM AUTHOR]

Supplemental digital content is available in the text. Introduction: The ability to self-manage and problem solve effectively is an important component of managing chronic conditions. For individuals with limb loss, problem solving the fit of their prosthetic socket is crucial to being able to functionally ambulate with a prosthetic leg. This study evaluates and compares two innovative problem-solving tools designed to empower prosthesis wearers in self-managing their socket fit. Materials and Methods: Fourteen paper-based problem-solving decision trees were integrated into a mobile health app displayed on an iPad. Thirty prosthesis wearers performed a total of six trials split between the two conditions (paper-based and mobile app).Technical effectiveness, efficiency, and acceptability were assessed during and after participants used each tool to problem solve real-life scenarios. Technical effectiveness was a measure of the number of errors, whereas efficiency was a measure of the amount of time needed to complete each trial. Acceptability was measured using Likert-like questionnaires and semistructured interviews. Results: Results demonstrated significantly better efficiency (paper-based = 124.22 seconds on average, app = 108.76 seconds; P = 0.0076) and technical effectiveness (paper-based = 0.66 errors on average, app = 0.2 errors; P < 0.001) for the app. Age and education were correlated with the outcomes. Conclusions: The mobile app demonstrated significantly better outcomes as compared with the paper-based decision trees. Both the mobile app and paper-based tool had high acceptability; however, the mobile app was found to be significantly easier to use and less confusing than the paper-based version of the decision trees. Further study is required to assess the efficacy of the decision trees to manage a prosthetic fit issue in an individual who is currently having difficult managing a prosthetic socket fit issue. [ABSTRACT FROM AUTHOR]

This paper studies the problem of estimating the covariance of a collection of vectors using only highly compressed measurements of each vector. An estimator based on back-projections of these compressive samples is proposed and analyzed. A distribution-free analysis shows that by observing just a single linear measurement of each vector, one can consistently estimate the covariance matrix, in both infinity and spectral norm, and this analysis leads to precise rates of convergence in both norms. Through information-theoretic techniques, lower bounds showing that this estimator is minimax-optimal for both infinity and spectral norm estimation problems are established. These results are also specialized to give matching upper and lower bounds for estimating the population covariance of a collection of Gaussian vectors, again in the compressive measurement model. The analysis conducted in this paper shows that the effective sample complexity for this problem is scaled by a factor of $m^{2}/d^{2}$ , where $m$ is the compression dimension and $d$ is the ambient dimension. Applications to subspace learning (principal components analysis) and learning over distributed sensor networks are also discussed. [ABSTRACT FROM AUTHOR]

Purpose. Thyroid hormones play an important role in growth, development, and physiology of the kidney. The kidney plays a key role in the metabolism, degradation, and excretion of thyroid hormones and its metabolites. The aim of this study is to investigate the prevalence of disease states of thyroid-kidney organs and detecting the correlation between thyroid and kidney function abnormalities. Materials and Methods. In this retrospective study, a total of forty-five patients with thyroid and kidney dysfunction were investigated. Clinical features, laboratory data at initial presentation, management, and outcomes were collected. The paper has been written based on searching PubMed and Google Scholar to identify potentially relevant articles or abstracts. Median, percentage, mean ± standard deviation (SD), and the two-tailed t-test were used for statistical analyses. The correlation between variables was assessed by Pearson's, Spearman's correlation tests and regression analyses. Results. The mean ± SD of age of study patients was 48.2 ± 22.93 years (ranging from 1 to 90 years). There was no correlation between serum thyroid-stimulating hormone, free thyroxine levels with estimated glomerular filtration rate, and proteinuria. No association between antimicrosomal antibodies with estimated glomerular filtration rate was seen. Cardiovascular disease was the most common complication of overt hypothyroidism in kidney dysfunction patients. Conclusion. The present study showed more prevalence of primary hypothyroidism in comparison with other thyroid dysfunctions in patients with kidney dysfunction. Reduced mean values of thyroid function profiles after treatment suggest that this thyroid disease should be considered and ameliorated with thyroid hormone replacement therapy in patients with kidney disease. [ABSTRACT FROM AUTHOR]

Background: Comparative optimism, the belief that negative events are more likely to happen to others rather than to oneself, is well established in health risk research. It is unknown, however, whether comparative optimism also permeates people's health expectations and potentially behaviour during the COVID‐19 pandemic. Objectives: Data were collected through an international survey (N = 6485) exploring people's thoughts and psychosocial behaviours relating to COVID‐19. This paper reports UK data on comparative optimism. In particular, we examine the belief that negative events surrounding risk and recovery from COVID‐19 are perceived as more likely to happen to others rather than to oneself. Methods: Using online snowball sampling through social media, anonymous UK survey data were collected from N = 645 adults during weeks 5‐8 of the UK COVID‐19 lockdown. The sample was normally distributed in terms of age and reflected the UK ethnic and disability profile. Findings: Respondents demonstrated comparative optimism where they believed that as compared to others of the same age and gender, they were unlikely to experience a range of controllable (eg accidentally infect/ be infected) and uncontrollable (eg need hospitalization/ intensive care treatment if infected) COVID‐19‐related risks in the short term (P <.001). They were comparatively pessimistic (ie thinking they were more at risk than others for developing COVID‐19‐related infection or symptoms) when thinking about the next year. Discussion: This is one of the first ever studies to report compelling comparative biases in UK adults' thinking about COVID‐19. [ABSTRACT FROM AUTHOR]

• A single cryolipolysis session has no effect on abdominal adipose tissue in healthy women. • Randomized controlled trial with blind assessor. • Ultrassonography was used as a method of evaluating the outcome. To analyze the effects of cryolipolysis on the fat thickness of the lower abdomen of healthy women and patient's satisfaction. Design and setting : a randomized controlled trial, with concealed allocation and blinded assessor. Participants: 34 healthy women between 18 and 48 years, skinfold in the lower abdomen ≥3 cm, BMI between 18.5 and 27 kg/m2, low level of physical activity, and no contraindication to cryolipolysis were allocated to intervention group (IG, n = 17) or control group (CG, n = 17). Interventions: The IG received one session of cryolipolysis with −10 °C of temperature for 50 min. The CG was not submitted to any kind of intervention. Both groups did the evaluation protocols at baseline, 30, 60 and 90 days after the intervention. Main outcome measures: fat thickness was measured by ultrasonography (US), skinfold (SF) and abdominal circumference (AC1 and AC2). No significant differences between the IG and CG were demonstrated at any evaluation at any time of follow up for the variables US (30 days: 0.05 cm (95%CI: −0.12; 0.22), 60 days: 0.05 cm (95%CI: −0.11; 0.20) and 90 days: 0.04 cm (95%CI: −0.7; 0.25)), SF (30 days: −0.09 cm (95%CI: −0.25; 0.08), 60 days: −0.14 cm (95%CI: −0.36; 0.09) and 90 days: −0.001 cm (95%CI: −0.237; 0.234)), AC1 (30 days: 0.42 cm (95%CI: −1.1; 1.9), 60 days: −0.1 cm (95%CI: −1.74; 1.54) and 90 days: −0.007 cm (−1.9; 1.9)) and AC2 (30 days: 0.183 cm (95%CI: −0.84; 1.20), 60 days: −0.13 cm (95%CI: −1.61; 1.35) and 90 days: −0.31 cm (95%CI: −1.61; 1.00)). The current study showed that a single application of the utilized protocol of cryolipolysis does not produce any significant effect on fat thickness of the lower abdomen of healthy women. Clinical Trial Registration number: NCT03160976 (https://clinicaltrials.gov/ct2/show/NCT03160976). Contribution of the Paper : the study is one of the first studies in the literature with methodological rigor to report an unfavorable result for localized abdominal fat treatment with a single session of cryolipolysis. [ABSTRACT FROM AUTHOR]

Background: The abundance of easy and accessible information and the rapid development of social networking sites (SNSs) have proven that the world is small and within reach. The great implication of this interconnectivity is attributable to the change in the learning and sharing environment, which for the most part is something that classrooms are lacking. Considering the potential implications of SNSs in nursing education reveals the benefits of SNSs in allowing students to communicate and interact with a wider audience and beyond the classroom. The aim of this study is to identify the extent of SNS utilization, the perceived benefits of SNSs and the potential of SNSs for improving the study habits of nursing students in five countries (Israel, Iraq, Oman, the Philippines and Turkey). Methods: This study is a quantitative cross-sectional study that determined the relationship between the utilization of SNSs, the perceived benefits of SNSs, and the potential of SNSs for improving the study habits of nursing students in the five participating countries (Israel, Iraq, Oman, the Philippines, and Turkey). This paper is based on carefully analysing the survey responses of a sample of 1137 students from an online hosting site. The online instrument focuses on the extent of the utilization and benefits of SNSs according to their accessibility, usability, efficiency and reliability. Results: Based on the Pearson correlation coefficient (r) our findings, reveal a significant positive correlation between the extent of a possible improvement in study habits and the extent of SNS utilization in terms of the four domains, namely, accessibility (r = 0.246), usability (r = 0.377), reliability (r = 0.287) and efficiency (r = 0.387). Conclusion: It can be concluded that there is a significant positive correlation between students' study habits and the extent of SNS utilization, meaning that the more students devote themselves to their study habits, the higher the level of SNS utilization. The use of SNSs by nursing students has positive and negative implications, and there is greater potential for further improving approaches to nursing education through the adaptation of curricula based on the proper utilization of SNSs. [ABSTRACT FROM AUTHOR]

BACKGROUND: Globally, nearly 3 billion people rely on solid fuels for cooking and heating, the vast majority residing in low- and middle-income countries (LMICs). The resulting household air pollution (HAP) is a leading environmental risk factor, accounting for an estimated 1.6 million premature deaths annually. Previous interventions of cleaner stoves have often failed to reduce exposure to levels that produce meaningful health improvements. There have been no multicountry field trials with liquefied petroleum gas (LPG) stoves, likely the cleanest scalable intervention. OBJECTIVE: This paper describes the design and methods of an ongoing randomized controlled trial (RCT) of LPG stove and fuel distribution in 3,200 households in 4 LMICs (India, Guatemala, Peru, and Rwanda). METHODS: We are enrolling 800 pregnant women at each of the 4 international research centers from households using biomass fuels. We are randomly assigning households to receive LPG stoves, an 18-month supply of free LPG, and behavioral reinforcements to the control arm. The mother is being followed along with her child until the child is 1 year old. Older adult women (40 to <80 years of age) living in the same households are also enrolled and followed during the same period. Primary health outcomes are low birth weight, severe pneumonia incidence, stunting in the child, and high blood pressure (BP) in the older adult woman. Secondary health outcomes are also being assessed. We are assessing stove and fuel use, conducting repeated personal and kitchen exposure assessments of fine particulate matter with aerodynamic diameter =2.5 ηm (PM2.5), carbon monoxide (CO), and black carbon (BC), and collecting dried blood spots (DBS) and urinary samples for biomarker analysis. Enrollment and data collection began in May 2018 and will continue through August 2021. The trial is registered with ClinicalTrials.gov (NCT02944682). CONCLUSIONS: This study will provide evidence to inform national and global policies on scaling up LPG stove use among vulnerable populations. [ABSTRACT FROM AUTHOR]

BACKGROUND: In spring 2013, groundwater of a vast area of the Veneto Region (northeastern Italy) was found to be contaminated by perfluoroalkyl substances (PFAS) from a PFAS manufacturing plant active since the late 1960s. Residents were exposed to high concentrations of PFAS, particularly perfluorooctanoic acid (PFOA), through drinking water until autumn 2013. A publicly funded health surveillance program is under way to aid in the prevention, early diagnosis, and treatment of chronic disorders possibly associated with PFAS exposure. OBJECTIVES: The objectives of this paper are: a) to describe the organization of the health surveillance program, b) to report serum PFAS concentrations in adolescents and young adults, and c) to identify predictors of serum PFAS concentrations in the studied population. METHODS: The health surveillance program offered to residents of municipalities supplied by contaminated waterworks includes a structured interview, routine blood and urine tests, and measurement of 12 PFAS in serum by high-performance liquid chromatography–tandem mass spectrometry. We studied 18,345 participants born between 1978 and 2002, 14–39 years of age at recruitment. Multivariable linear regression was used to identify sociodemographic, lifestyle, dietary, and reproductive predictors of serum PFAS concentrations. RESULTS: The PFAS with the highest serum concentrations were PFOA [median 44.4 ng/mL, interquartile range (IQR) 19.3–84.9], perfluorohexanesulfonic acid (PFHxS) (median 3.9 ng/mL, IQR 1.9–7.4), and perfluorooctanesulfonic acid (PFOS) (median 3.9 ng/mL, IQR 2.6–5.8). The major predictors of serum levels were gender, municipality, duration of residence in the affected area, and number of deliveries. Overall, the regression models explained 37%, 23%, and 43% of the variance of PFOA, PFOS, and PFHxS, respectively. CONCLUSIONS: Serum PFOA concentrations were high relative to concentrations in populations with background residential exposures only. Interindividual variation of serum PFAS levels was partially explained by the considered predictors. [ABSTRACT FROM AUTHOR]

Background: Major trauma patients experience a 20% mortality rate overall, and many survivors remain permanently disabled. In order to monitor the quality of trauma care in the Trauma System, outcomes assessment is essential. Quality indicators on outcome can be expressed as quality of life, functional outcome, and others. The trauma follow-up system was created within the Romagna Trauma System (Italy) in order to monitor the trauma network and assess its long-term outcomes. The aim of this paper is firstly to evaluate the existence of correlations between epidemiological data, severity of injury, and clinical assessment characterizing the acute phase and the long-term outcomes in trauma patients and secondly, to explore the association between outcome variables have been modified. Methods: We conducted a cross-sectional study over a 10-year period, including patients with severe trauma who survived and were discharged from the intensive care unit. The outcome measures were assessed with the use of the Extended Glasgow Outcome Scale and the Euro Quality of Life scale 5 dimension. Demographic data and clinical severity descriptors versus functional outcome were tested in a binary logistic regression model. Results: In all, 428 major trauma patients participated in the study. At 1 year, 50.8% of trauma patients included had a good recovery and 49.2% had some degree of disability. The median value of quality of life was 0.725. At the multivariate analysis, variables showing significant impact on functional outcome were age (p = 0.052, OR 1.025), injury severity score (p = 0.001, OR 1.025), and Glasgow coma scale ≤ 8 (p = 0.001, OR 3.509) The Spearman's Rank correlation coefficient showed a strong correlation between the global level of function variables and quality of life at one year (Spearman's Rho Correlation Coefficient 0.760 (p < 0.0001)). Conclusions: Increased age, increased injury severity score, and severe traumatic brain injury are predictors of long-term disability. Most of these trauma patients show impairments that affect not only the level of functional state but also the quality of life. The degree of functional independence has the greatest positive impact on quality of life. According to our results, after the recovery a prompt recognition of physical and psychological problems with systematic follow-up screening programs can help patients and doctors in defining specific therapeutic-rehabilitation pathways tailored to meet individual requirements. [ABSTRACT FROM AUTHOR]

Cluster analysis is widely used in data analysis. Statistical data analysis is generally performed on the linear data. If the data has directional structure, classical statistical methods cannot be applied directly to it. This study aims to improve a new directional clustering algorithm which is based on trigonometric approximation. The trigonometric approximation is used for both descriptive statistics and clustering of directional data. In this paper, the fuzzy clustering algorithms (FCD and FCM4DD) improved for directional data and the proposed method are carried out on some numerical and real data examples, and the simulation results are presented. Consequently, these results indicate that the fuzzy c-means directional clustering algorithm gives the better results from the points of the mean square error and the standard deviation for cluster centers. [ABSTRACT FROM AUTHOR]