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Background: The primary objective of this research is to propose a new, simple, and effective feature extraction function and to investigate its classification ability using electrocardiogram (ECG) signals., Methods: In this research, we present a new and simple feature extraction function named the minimum and maximum pattern (MinMaxPat). In the proposed MinMaxPat, the signal is divided into overlapping blocks with a length of 16, and the indexes of the minimum and maximum values are identified. Then, using the computed indices, a feature map is calculated in base 16, and the histogram of the generated map is extracted to obtain the feature vector. The length of the generated feature vector is 256. To evaluate the classification ability of this feature extraction function, we present a new feature engineering model with three main phases: (i) feature extraction using MinMaxPat, (ii) cumulative weight-based iterative neighborhood component analysis (CWINCA)-based feature selection, and (iii) classification using a t-algorithm-based k-nearest neighbors (tkNN) classifier., Results: To obtain results, we applied the proposed MinMaxPat-based feature engineering model to a publicly available ECG fibromyalgia dataset. Using this dataset, three cases were analyzed, and the proposed MinMaxPat-based model achieved over 80% classification accuracy with both leave-one-record-out (LORO) cross-validation (CV) and 10-fold CV., Conclusions: These results clearly demonstrate that this simple model achieved high classification performance. Therefore, this model is surprisingly effective for ECG signal classification.

Background: Electrocardiography (ECG) signals are commonly used to detect cardiac disorders, with 12-lead ECGs being the standard method for acquiring these signals. The primary objective of this research is to propose a new feature engineering model that achieves both high classification accuracy and explainable results using ECG signals. To this end, a symbolic language, named Cardioish, has been introduced. Methods: In this research, two publicly available datasets were used: (i) a mental disorder classification dataset and (ii) a myocardial infarction (MI) dataset. These datasets contain ECG beats and include 4 and 11 classes, respectively. To obtain explainable results from these ECG signal datasets, a new explainable feature engineering (XFE) model has been proposed. The Cardioish-based XFE model consists of four main phases: (i) lead transformation and transition table feature extraction, (ii) iterative neighborhood component analysis (INCA) for feature selection, (iii) classification, and (iv) explainable results generation using the recommended Cardioish. In the feature extraction phase, the lead transformer converts ECG signals into lead indexes. To extract features from the transformed signals, a transition table-based feature extractor is applied, resulting in 144 features (12 × 12) from each ECG signal. In the feature selection phase, INCA is used to select the most informative features from the 144 generated, which are then classified using the k-nearest neighbors (kNN) classifier. The final phase is the explainable artificial intelligence (XAI) phase. In this phase, Cardioish symbols are created, forming a Cardioish sentence. By analyzing the extracted sentence, XAI results are obtained. Additionally, these results can be integrated into connectome theory for applications in cardiology. Results: The presented Cardioish-based XFE model achieved over 99% classification accuracy on both datasets. Moreover, the XAI results related to these disorders have been presented in this research. Conclusions: The recommended Cardioish-based XFE model achieved high classification performance for both datasets and provided explainable results. In this regard, our proposal paves a new way for ECG classification and interpretation.

Background and Objectives: Electroencephalography (EEG) signals, often termed the letters of the brain, are one of the most cost-effective methods for gathering valuable information about brain activity. This study presents a new explainable feature engineering (XFE) model designed to classify EEG data for violence detection. The primary objective is to assess the classification capability of the proposed XFE model, which uses a next-generation feature extractor, and to obtain interpretable findings for EEG-based violence and stress detection., Materials and Methods: In this research, two distinct EEG signal datasets were used to obtain classification and explainable results. The recommended XFE model utilizes a channel-based minimum and maximum pattern (ChMinMaxPat) feature extraction function, which generates 15 distinct feature vectors from EEG data. Cumulative weight-based neighborhood component analysis (CWNCA) is employed to select the most informative features from these vectors. Classification is performed by applying an iterative and ensemble t-algorithm-based k-nearest neighbors (tkNN) classifier to each feature vector. Information fusion is achieved through iterative majority voting (IMV), which consolidates the 15 tkNN classification results. Finally, the Directed Lobish (DLob) symbolic language generates interpretable outputs by leveraging the identities of the selected features. Together, the tkNN classifier, IMV-based information fusion, and DLob-based explainable feature extraction transform the model into a self-organizing explainable feature engineering (SOXFE) framework., Results: The ChMinMaxPat-based model achieved over 70% accuracy on both datasets with leave-one-record-out (LORO) cross-validation (CV) and over 90% accuracy with 10-fold CV. For each dataset, 15 DLob strings were generated, providing explainable outputs based on these symbolic representations., Conclusions: The ChMinMaxPat-based SOXFE model demonstrates high classification accuracy and interpretability in detecting violence and stress from EEG signals. This model contributes to both feature engineering and neuroscience by enabling explainable EEG classification, underscoring the potential importance of EEG analysis in clinical and forensic applications.

Background: As primary care is an important infrastructure for the entire health system, the employment structure choices of family physicians-whether to work in a managed care organization or be self-employed, can impact all effectiveness parameters of healthcare: quality, access, health equity, patients' experiences, and cost-effectiveness. The aim of this study is to assess the push and pull factors influencing family physicians' employment choices., Methods: This study employed a qualitative approach to explore the experiences of family physicians (FPs) who choose to work a self-employment practice. We conducted semi-structured interviews with twenty-seven self-employed FPs in Israel, selected through purposive and snowball sampling. The interviews were conducted via Zoom, recorded, and transcribed verbatim. Data analysis followed thematic analysis framework. The analysis yielded 10 themes, which were organized into two categories: pull and push factors., Results: Pull factors, i.e., factors that attract family physicians to become self-employed, included professional self-fulfillment, higher income, professional and business autonomy, working with secretaries according to one's personal choice, designing the space of the clinic, and flexibility in working hours. Push factors, i.e., factors that demotivated family physicians to work under managed care and pushed them to choose self-employment included low control over the work environment, workload, decreased professional and organizational autonomy, managerial pressures on quality measures, engagement in marketing activities, and tensions with non-medical staff in the Health Maintenance Organization., Conclusions: There are obvious implications of this work for Health Maintenance Organizations' policy makers. Balancing managerial pressure and tensions between family physicians and non-medical administration and ensuring suitable working conditions increased physicians' control over the work environment, and professional autonomy may decrease push factors and retain family physicians as Health Maintenance Organization-employed. Understanding pull factors may help to develop a strategy for maximizing cooperation with self-employed family physicians and reinforce physicians' linkage to the healthcare system's treatment objectives.

This article explores the growing prominence of nature-inspired design philosophies in the context of sustainability and human well-being within the built environment and focuses on their application within laboratory buildings. Biomimicry and biophilic design are highlighted as key nature-inspired design approaches, with biomimicry drawing inspiration from nature for innovations and biophilic design promoting human health through enhancing the connection with the surrounding natural elements. This paper further discusses living building strategy as an emerging method for creating dynamic and adaptable spaces by prioritizing user experience through co-creation and focusing on sustainable and regenerative structures. The potential of integrating these approaches is emphasized using laboratory buildings as an example, with nature-inspired and living laboratories serving as models for future built environments that promote both environmental responsibility and a positive human experience. Accordingly, this work aims to investigate the design and construction of laboratory buildings based on nature-inspired design strategies and the living building concept. Moreover, the paper discusses the application of biomimicry and living building concepts within laboratory buildings as a novel contribution to the body of knowledge, and concludes by proposing the Nature-inspired & Living Laboratory (NILL 1.0) TM Building Assessment index to serve as a guideline for the design and construction of laboratory buildings using nature as an inspiration and the analogy of human body systems.

Background: Globally, approximately 1.4% of people have celiac disease (CD), induced by gluten sensitivity. If left untreated, it causes small intestinal inflammation and villous atrophy, which can result in failure to thrive, anemia, osteoporosis, malabsorption, and even malignancy. The only treatment option available is a gluten-free diet (GFD). Few studies have looked at the role and perception of telehealth in relation to CD and selective nutrition both before and after the COVID-19 pandemic., Aim: Our goal was to screen and investigate the research conducted both before and after the COVID-19 pandemic concerning the utilization of telehealth applications and solutions in CD and other GFD-dependent circumstances., Methods: We employed a narrative review approach to explore articles that were published in scholarly journals or organizations between the years 2000 and 2024. Only English-language publications were included. PubMed and Google Scholar searches were mainly conducted using the following keywords: telemedicine, telehealth, telecare, eHealth, m-health, COVID-19, SARS-CoV-2, celiac disease, and gluten-free diet (GFD). Manual searches of the references in the acquired literature were also carried out, along with the authors' own personal contributions of their knowledge and proficiency in this field., Results: Only a few studies conducted prior to the COVID-19 outbreak examined the viewpoints and experiences of adult patients with CD with relation to in-person clinic visits, as well as other options such as telehealth. The majority of patients believed that phone consultations were appropriate and beneficial. Video conferencing and telemedicine became more popular during the COVID-19 pandemic, demonstrating the effectiveness of using these technologies for CD on a global basis. In recent years, urine assays for gluten identification have become accessible for use at home. These tests could be helpful for CD monitoring with telemedicine assistance., Conclusions: The extended knowledge gathered from the COVID-19 pandemic is expected to complement pre-COVID-19 data supporting the usefulness of telemedicine even after the emergent pandemic, encouraging its wider adoption in standard clinical practice. The monitoring and follow-up of CD patients and other GFD-dependent conditions can greatly benefit from telemedicine.

This was a population-based study to determine the impact of COVID-19 on birth outcomes in the Chicago metropolitan area, comparing pre-pandemic (April-September 2019) versus pandemic (April-September 2020) births. Multivariable regression models that adjusted for demographic and neighborhood characteristics were used to estimate the marginal effects of COVID-19 on intrauterine fetal demise (IUFD)/stillbirth, preterm birth, birth hospital designation, and maternal and infant hospital length of stay (LOS). There were no differences in IUFD/stillbirths or preterm births between eras. Commercially insured preterm and term infants were 4.8 percentage points (2.3, 7.4) and 3.4 percentage points (2.5, 4.2) more likely to be born in an academic medical center during the pandemic, while Medicaid-insured preterm and term infants were 3.6 percentage points less likely (-6.5, -0.7) and 1.8 percentage points less likely (-2.8, -0.9) to be born in an academic medical center compared to the pre-pandemic era. Infant LOS decreased from 2.4 to 2.2 days (-0.35, -0.20), maternal LOS for indicated PTBs decreased from 5.6 to 5.0 days (-0.94, -0.19), and term births decreased from 2.5 to 2.3 days (-0.21, -0.17). The pandemic had a significant effect on the location of births that may have exacerbated health inequities that continue into childhood.

Prior studies found reduced incidences of cardiovascular diagnoses and treatments in the initial phase of the COVID-19 pandemic. However, these studies included a limited number of outcomes and did not consider pre-pandemic trends. This study aimed to describe trends in the incidence of cardiovascular diagnoses and treatments over the years 2012-2021 in Israel and to compare the two years of the COVID-19 period with the preceding 8 years. In this retrospective, population-based study, carried out within Clalit Health Services, the incidence rates of cardiovascular outcomes were calculated for individuals aged ≥ 25 (~2.7 million adults per year) during the first (Y1, 3/2020-2/2021) and second (Y2, 3/2021-2/2022) years of COVID-19 and the 8 years prior (3/2012-2/2020). Declines were observed in Y1 compared to 2019 in all diagnoses and treatments: STEMI (-16.3%; 95% CI: -16.6, -16.1), non-STEMI (-16.4%; -16.6, -16.2), AF (-14.1%; -14.2, -14.0), CHF (-7.8%; -7.9, -7.7), CVA (-5.0%; -5.0, -4.9), catheterization (-64.7%; -65.2, -64.2), CABG (-77.7%; -79.2, -76.2), ablation (-21.2%; -22.0, -20.4), pacemaker implantation (-39.3%; -40.7, -37.9), and defibrillator insertion (-12.5%; -13.1, -12.0). Compared with expected rates based on pre-pandemic trends, observed rates were within expected ranges (CHF, CVA, and ablation), less than expected (STEMI, non-STEMI, AF, catheterization, CABG, and pacemaker insertion), or more than expected (defibrillator insertion). In Y2, STEMI, catheterization, and CABG returned to expected rates; non-STEMI and AF were lower than expected; and CHF, CVA, ablation, and pacemaker and defibrillator implantations were higher than expected. Several cardiovascular diagnoses and treatment trends were interrupted by COVID-19. The long-term consequences of these changes should be considered by health policymakers.

Telehealth has accelerated since the outbreak of the COVID-19 virus. As telephone visits become more common, it is important to examine the challenges involved in using this modality of care. In this study, we examined family physicians' and pediatricians' perceptions regarding three aspects of the use of telephone visits: quality of care, safety of care, and physicians' satisfaction. A total of 342 family physicians and pediatricians responded to an online survey. Respondents were asked to rate their degree of agreement with 17 statements inquiring about quality, safety, and satisfaction with telephone visits on a Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). This was followed by in-depth interviews between January and April 2023 with 26 physicians. Participants expressed satisfaction (3.66 ± 0.80) with the use of telephone visits and lower assessments of safety (3.03 ± 0.76) and quality (2.27 ± 0.76) of care using the telephone modality. Eighty percent of the respondents think combining a face-to-face visit with a telephone visit is recommended, and 51% noted that the inability to examine patients closely affects and impedes a physician's decision making. Most interviewees indicated that telephone visits are safe only with former patients they had already seen in the clinic. The findings shed light on the perceptions of family physicians and pediatricians regarding telephone visits. The lower assessments of quality and safety compared to the assessment of satisfaction underscore the need for careful use of telephone visits in healthcare. A proper and balanced selection of patients, implementing technological upgrades to the modality, and performing patient education practices are recommended.

Regular toothbrushing is the primary self-care method to prevent the most common dental diseases and is considered an important public health indicator. This retrospective observational study aimed to examine cross-national time trends in adolescent toothbrushing behaviour and its association with sociodemographic factors between 1994 and 2018. We studied data from 20 countries that conducted seven surveys of the Health Behaviour in School-aged Children (HBSC) study. Adolescents aged 11, 13 and 15 years responded to questions on their toothbrushing frequency, family affluence and structure. Altogether, reports of 691,559 students were analysed using descriptive statistics and binominal logistic regression. The findings showed an overall positive trend in the prevalence of more-than-once-a-day toothbrushing frequency during the entire study period mainly due to a noticeable increase from 1994 to 2010 (except Denmark and Sweden); this trend continued significantly thereafter in 12 of 20 countries. Across all countries, girls and adolescents from more affluent families were more likely to brush their teeth regularly. These relationships remained unchanged throughout the study period, whereas the age-related difference in toothbrushing prevalence decreased noticeably, and the negative relationship between toothbrushing and living in a non-intact family became evident. While the prevalence of regular toothbrushing among adolescents has increased in recent decades, it is still far behind the recommended level of twice-daily brushing for everyone across all countries. The promotion of toothbrushing needs to start at an early age, with a special focus on boys and adolescents from low-affluence and non-intact families.

This study focuses on the concrete role of the presence of a ward's service climate in cultivating nurses' collaboration with family members. Accordingly, this study examined the moderating role of the service climate in the link between nurses' attitudes toward the family and their collaboration with family members in the care process. This is the second article of a series of studies we conducted among health staff in Israeli public hospitals. Relying on the patient- and family-centered care approach and using a cross-sectional study of 179 nurses from 13 internal medicine, surgical and geriatric wards at a large public hospital in Israel, we conducted a multiple regression analysis to test the contribution of all relationship variables to predicting nurses' collaborative behavior with the family in the care process during elderly hospitalization. The findings indicate that service climate had a conditional moderating effect on the relationship between nurses' perception of the family as a burden and their collaboration with the family in nursing care. Namely, in the absence of a targeted service climate, nurses form perceptions about the families as a burden, which in turn affects their distinct non-collaboration, and vice versa.

Introduction: The 'second victim' phenomenon, (SVP) refers to a health professional who was involved in an adverse event (AE) and continues to suffer from the event to the detriment of personal and professional functioning. The second victims' natural history of recovery model predicts stages of the phenomenon from AE occurrence until the 'moving on' stage and serves as a suitable structure for many organizational support programs worldwide., Purpose: Using the second victims' natural history of recovery model to examine the impact of the SVP on Israeli nurses, with a specific focus on the organizational support they felt they required compared with the support they felt that they had received from their organizations., Methods: Fifteen in-depth interviews were conducted, using a semi-structured questionnaire, among nurses who had experienced the SVP. The interviews were recorded subject to the interviewees' consent, transcribed, and analyzed using thematic content analysis., Findings: Throughout all six stages of recovery, all interviewees reported physical and emotional manifestations following exposure to an AE, regardless of the type of event or severity. They also reported difficulty in emotion regulation, as well as damage to functioning and overall quality of life. Most of the nurse interviewees reported a need to share the events with someone, but, despite this desire to receive appropriate support, almost none of them proactively requested help from a professional source, nor did their organizational management initiate proactive support. This lack of referral for further assistance is possibly explained through limited awareness of the SVP as a valid response to an AE, a perceived lack of legitimacy to receive organizational support, and personal barriers that accompany the phenomenon., Conclusions: Appropriate organizational support, offered proximal to an AE as well as over time, is essential for the nurse, the patient, and the organization. Personal barriers, together with limited awareness, may challenge the identification and provision of appropriate assistance. Hence, it is important to address the phenomenon as part of the general organizational policy to improve the quality of care and patient safety.

Introduction : We investigated the association between social distress or toxicity and patients' clinical conditions, demographic characteristics, and social support and networks, and whether this association differs along the distribution of patients' distress levels. This study included 156 patients treated at King Abdulaziz Medical City, Riyadh, Saudi Arabia. Methods : We used the previously validated Social Toxicity Assessment Tool in Cancer (STAT-C) to assess cancer patients' distress. We analyzed distress level, the outcome variable of interest, and covariates to show distribution and identify associations. We then used logistic quantile regression for bounded outcomes to assess the association between social distress or toxicity and patients' clinical conditions, demographic characteristics, and social support and network. As an extension, we examined the interaction between disease status and social support, focusing on the moderating role of social support in attenuating the impact of disease status on social distress. Results : The median age of the patients was 51.2 (SD = 21.4, range 22 to 89), with 48.1% being older than 50 years. Of the 156 cancer patients analyzed, 82 (52.6%) were classified as burdened, and 50% of those with uncontrolled disease status were socially distressed. However, there were more socially distressed patients diagnosed within a year and patients undergoing treatment. There was a greater number of patients who shared their diagnosis with family, colleagues, and neighbors with social distress. The odds of suffering from social distress were higher in younger patients (50 years or younger) than in older patients. Social distress was lower in patients who underwent combined chemotherapy, surgery, and radiation compared with patients who received a single treatment regimen (OR = 0.65, CI, -0.820 to -0.036, p = 0.033). The odds of social distress were 67% higher in patients diagnosed within one year than in patients diagnosed more than one year prior (OR = 1.664, CI, 0.100-0.918, p = 0.015). Patients with uncontrolled disease conditions who shared their diagnosis and treatment with social networks were 48% less likely to experience social distress. Thus, sharing cancer diagnoses with social networks has a statistically significant moderating effect by attenuating the impact of disease status on social distress. Conclusion : Understanding the risk factors for social distress may be important for cancer management. Additionally, identifying the moderating role that patients' sharing of cancer diagnoses in social networks plays in attenuating the impact of disease status on social distress may provide healthcare providers with valuable insights for holistic culture-specific care.

The effects of the phenolic compounds of extra virgin olive oil (EVOO) on AGS cells have never been studied so far, which is the aim of this study. The profiles of the main phenolic components in EVOOs, mainly secoiridoid compounds derived from the transformation of oleuropein during the olive milling process, were evaluated and compared. Oils of different origins were evaluated aiming at verifying whether chemical differences in the phenolic composition of the dry extracts played a role in the metabolism and in maintaining the cellular redox state of AGS cells. The following key enzymes of some metabolic pathways were studied: lactate dehydrogenase, enolase, pyruvate kinase, glucose 6-phosphate dehydrogenase, citrate synthase, 3-Hydroxyacyl-CoA dehydrogenase and hexokinase. As confirmed through PCA analysis, pretreatments with the dry extracts of EVOOs at different concentrations appeared to be able to counteract the enzymatic activity alterations due to oxidative stress induced by H 2 O 2 1 mM and 2 mM. The studied phytocomplexes showed the ability to protect AGS cells from oxidative damage and the secoiridoid derivatives from both oleuropein and ligstroside contributed to the observed effects. The results suggested that EVOOs with medium to high concentrations of phenols can exert this protection.

Globally, the construction sector is regarded as one of the major contributors to greenhouse gas emissions, energy consumption, freshwater usage, resource utilization, and solid waste generation. With a constantly growing population and increased urbanization, this is only predicted to rise. Thus, achieving sustainable development in the construction sector has become an urgent necessity. The adoption of biomimicry in the construction sector is one of the most innovative concepts towards the shift into sustainable practices in construction. However, it has been noticed that the concept of biomimicry is very broad, relatively new, and abstract. Thus, after reviewing previously conducted research on the subject, a noticeable lack of knowledge on the effective implementation of the biomimicry concept was found to be present. Therefore, this research seeks to fill this knowledge gap whereby it aims to explore the development of the biomimicry concept in the field of architecture, building construction, and civil engineering with a systematic review approach of research related to biomimicry in these three fields. This aim is guided by an objective of developing a clear understanding of the application of the biomimicry concept in architecture, building construction, and civil engineering fields. The timeframe considered for this review is between 2000 and 2022. The qualitative exploratory nature of this research focuses on reviewing databases such as Science Direct, ProQuest, Google Scholar, and MDPI, as well as book chapters, editorials, and official websites to extract relevant information using an eligibility criterion of title and abstract review, inclusion of key terms, and detailed review of chosen articles. This study will improve the understanding of the biomimicry concept and how it can be applied in the built environment., Competing Interests: The authors declare no conflict of interest.

The high childhood vaccination coverage in Israel leads to a low rate of morbidity from the diseases against which the vaccination in administered. However, during the COVID-19 pandemic, children's immunization rates declined dramatically due to closures of schools and childcare services, lockdowns, and guidelines for physical distancing. In addition, parents' hesitancy, refusals, and delays in adhering to routine childhood immunizations seem to have increased during the pandemic. A decline in routine pediatric vaccine administration might indicate that the entire population faces increased risks for outbreaks of vaccine-preventable diseases. Throughout history, vaccines have raised questions about their safety, efficacy, and need among adults and parents who feared or hesitated to vaccinate their children. Objections derive from various ideological and religious reasons or concerns about the possible inherent dangers. Mistrust in the government and/or economic or political interests also raise concerns among parents. The importance of providing vaccines to maintain public health, as opposed to the autonomy of the individuals over their body and their children, raises ethical questions. In Israel, there is no legal obligation to get vaccinated. It is imperative to find a decisive solution to this situation without delay. Furthermore, where democratically one's principles are sacred and where one's autonomy over one's body is also unquestionable, such a legal solution would not only be unacceptable but also rather impossible to enforce. It seems that some reasonable balance between the necessity to preserve public health and our democratic principles should apply.

Healthcare resource utilization (HRU) peaks in the last year-of-life, and accounts for a substantial share of healthcare expenditure. We evaluated changes in HRU and costs throughout the last year-of-life among AMI survivors and investigated whether such changes can predict imminent mortality. This retrospective analysis included patients who survived at least one year following an AMI. Mortality and HRU data during the 10-year follow-up period were collected. Analyses were performed according to follow-up years that were classified into mortality years (one year prior to death) and survival years. Overall, 10,992 patients (44,099 patients-years) were investigated. Throughout the follow-up period, 2,885 (26.3%) patients died. The HRU parameters and total costs were strong independent predictors of mortality during a subsequent year. While a direct association between mortality and hospital services (length of in-hospital stay and emergency department visits) was observed, the association with ambulatory services utilization was reversed. The discriminative ability (c-statistics) of a multivariable model including the HRU parameters for predicting the mortality in the subsequent year, was 0.88. In conclusion, throughout the last year of life, hospital-centered HRU and costs of AMI survivors increase while utilization of ambulatory services decrease. HRUs are strong and independent predictors of an imminent mortality year among these patients.

In this research, we consider a deterministic three-stage operating room surgery scheduling problem. The three successive stages are pre-surgery, surgery, and post-surgery. The no-wait constraint is considered among the three stages. Surgeries are known in advance (elective). Multiple resources are considered throughout the surgical process: PHU (preoperative holding unit) beds in the first stage, ORs (operating rooms) in the second stage, and PACU (post-anesthesia care unit) beds in the third stage. The objective is to minimize the makespan. The makespan is defined as the maximum end time of the last activity in stage 3. Minimizing the makespan not only maximizes the utilization of ORs but also improves patient satisfaction by allowing treatments to be delivered to patients in a timely manner. We proposed a genetic algorithm (GA) for solving the operating room scheduling problem. Randomly generated problem instances were tested to evaluate the performance of the proposed GA. The computational results show that overall, the GA deviated from the lower bound (LB) by 3.25% on average, and the average computation time of the GA was 10.71 s. We conclude that the GA can efficiently find near-optimal solutions to the daily three-stage operating room surgery scheduling problem.

In the United States, 10% of infants are born preterm (PT; <37 weeks gestational age) each year and are at higher risk of complications compared to full term infants. The burden of PT birth is borne disproportionately by Black versus non-Black families, with Black mothers significantly more likely to give birth to a PT infant. One proven strategy to improve short- and long-term health outcomes in PT infants is to feed mother's own milk (MOM; breast milk from the mother). However, mothers must make decisions about work and MOM provision following PT birth, and more time spent in paid work may reduce time spent in unpaid activities, including MOM provision. Non-Black PT infants are substantially more likely than Black PT infants to receive MOM during the birth hospitalization, and this disparity is likely to be influenced by the complex decisions mothers of PT infants make about allocating their time between paid and unpaid work. Work is a social determinant of health that provides a source of income and health insurance coverage, and at the same time, has been shown to create disparities through poorer job quality, lower earnings, and more precarious employment in racial and ethnic minority populations. However, little is known about the relationship between work and disparities in MOM provision by mothers of PT infants. This State of the Science review synthesizes the literature on paid and unpaid work and MOM provision, including: (1) the complex decisions that mothers of PT infants make about returning to work, (2) racial and ethnic disparities in paid and unpaid workloads of mothers, and (3) the relationship between components of job quality and duration of MOM provision. Important gaps in the literature and opportunities for future research are summarized, including the generalizability of findings to other countries.

The COVID-19 pandemic has created a sustained state of emergency, causing uncertainty and risk taking. Israeli nurses were required to follow new regulations and safety measures issued by the Israeli Ministry of Health (MOH). This study aimed to examine nurses' compliance with MOH regulations and its association with their risk and threat perceptions and their positive and negative emotions. A cross-sectional online survey was conducted among 346 Israeli nurses. The study model was examined with path analysis. Most nurses reported complying with MOH regulations either fully (49%) or very often (30%). Negative emotions were positively associated with perceptions of both threat and risk, yet only risk perception was positively associated with nurses' compliance. A significant mediated relationship was found between negative emotions and nurses' compliance, with the possible mediator being risk perception. Hence, higher negative emotions were associated with a greater risk perception, which was associated with higher compliance. Health systems leaders must strategize to deal with the wave-like character of the pandemic. Solutions to nursing teams' negative emotions must be provided to keep the balance between feelings of complacency and a situation of high-level, intense negative feelings, which might lead to abstention, burnout, or emotional injury.

Attitudes of healthcare workers (HCWs) toward vaccines are extremely important for increasing vaccination coverage. We conducted a cross-sectional study at the beginning of the fourth COVID-19 vaccination dose campaign among 124 HCWs to evaluate attitudes towards the fourth dose and willingness to get vaccinated. At that time, Israel was the first country to approve the fourth vaccine dose. Most women were unwilling to get the fourth vaccine dose compared to men; 53.9% of physicians were unwilling to get vaccinated compared to 83.3% of nurses and 69% of other HCWs professions. The most frequent concerns regarding the vaccine were its efficacy, benefit, and necessity. The perceived risk and perceived severity of the health risk involved with getting vaccinated with the fourth dose were higher among HCWs who stated that they would not get vaccinated compared to those who were vaccinated or intended to get vaccinated. In contrast, HCWs who were vaccinated with the fourth dose, or those who were planning to get vaccinated, gave higher scores to the perceived benefit of the booster, its advantages, its perceived safety, its ability to protect from severe illness, and the perceived extent of scientific information about the risk associated with the booster. A logistic regression model revealed that perception of the fourth dose's benefits and risk significantly predict the willingness of HCWs to get vaccinated. Willingness to vaccinate their own children, acceptance of a hypothetical annual booster vaccine, and having less severe adverse effects after prior vaccination were also associated with willingness to get the fourth dose. These findings could help policy makers in developing strategies to expand the acceptance and coverage of the COVID-19 booster doses.

Possessing intact mobility in older adults assures their continued independence. The early identification of reduced mobility in older adults with type 2 diabetes (T2DM) is paramount for preventing their future physical deterioration. Hand grip strength (HGS), relative to body size, is associated with mobility in older T2DM patients. This study aims to identify an HGS index that best identifies mobilityintact older T2DM patients, along with its optimal cut-off point. The baseline data are from a cohort of 122 older T2DM patients (59% women) (mean age of 70.2 ± 4.4 years). Three mobility tests encompassing three main mobility domains were measured, including usual gait speed (UGS), timed up and go (TUG), and a two-minute walk test (2MWT). Passing scores were defined as those either above the established cut-off points or above the 25th percentile of population norms. Passing all three tests was considered as possessing intact mobility. Receiver operating characteristic (ROC) curves of the most relevant HGS indices were constructed to determine the area under the curve (AUC) that best identifies patients with intact mobility. In a sample of 122 older adults with T2DM, 63.9% of women and 60% of men were found to possess intact mobility. HGS relative to waist circumference (WC) was found to have the strongest association with intact mobility, presenting the highest AUC in both men (0.78) and women (0.72) for discriminating mobility status, with an optimal cut-off of 0.355 (kg/cm) and 0.245 (kg/cm) in men and women, respectively. HGS relative to WC best differentiated between mobility-intact older adults with T2DM and those with mobility limitations, especially in men. Using HGS/WC as a simple and safe screening mode for mobility in a clinical setting could potentially identify older patients with T2DM that require therapeutic interventions.

To predict and ensure a healthy and high-performing nursing workforce, it is necessary to identify the antecedents that promote work engagement, especially among early-career nurses. To date no study has focused on this. This longitudinal survey, administered to 1204 nurses working in seven general hospitals with 200 or more beds in four prefectures in Japan at two different times in 2019, aims to examine the causal relationship between the personal and professional resources for nurses to work vigorously (PPR-N) and work engagement among nurses in the early stages of their careers, considering time as a key mediating factor. The analysis of structural equation modeling using the cross-lagged effect model supported that PPR-N had significant and positive effects on work engagement after 3 months among early-career nurses with less than 10 years of nursing experience. The PPR-N is a reliable antecedent of work engagement, which is typical of early-career nurses. These results may be provided guidance for managers in overseeing the work environment to ensure a thriving sustainable nursing workforce.

The dynamic nature of intellectual disability (ID) and its many comorbidities necessitate repeated screening and functional diagnosis. However, the existing scales are lengthy and expensive and cannot be implemented at all levels of ID. During phase one of this study (September 2019-September 2020), the functional screening tool (FST-ID) was validated for adults with ID and then used as a clinical tool to collect data for 76 participants from their direct service providers (DSP). Their age ranged from 21 to 71 years (mean = 37.63, SD ± 14.61), and they were diagnosed with severe/profound (N = 16) and moderate (N = 29), and mild (N = 31) levels of ID. The scale was found to hold high psychometric values. During phase two (September 2020-June 2022), the scale was found to be reliable as a continuous, clinical on-going screening tool, enabling the screening of functional and environmental changes experienced by adults with ID during acute times of the pandemic and regular times alike. All 76 adults experienced changes at the senior's daycare center mostly. The new scale may also help in the future to determine whether those changes only relate to post COVID-19 symptoms or other comorbidities as well.

Background: COVID-19 restrictions have led to social isolation affecting youth's health, particularly at-risk youth., Objectives: We examined whether an online mentoring health intervention (OMHI) would strengthen characteristics that can prevent risky behaviors: resilience, perceived social support, psychological distress, and crisis concerns., Methods: Fifty-six secondary-school students participated, 27 in the intervention group and 29 in the control group (mean age 16.18, SD 0.83 vs. 16.62, SD 0.82, respectively). The study took place between March and August 2020., Results: The intervention group was less resilient pre-test, with similar resilience levels as the control group post-test. Intervention group participants presented a significantly higher crisis level pre- and post-test than the control group, as well as an increase in resilience (effect size = 1.88) and social support (effect size = 1.22), while psychological distress significantly decreased (effect size = -1.03). Both groups (intervention vs. control) predicted changes from pre-to-post test for resilience and crisis (adjusted R 2 = 0.33, p = 0.001 and R 2 = 0.49, p = 0.0001 respectively)., Conclusions: OMHI participation was associated with improved resilience and social support, and decreased psychological distress, making it an effective strategy in health promotion for at-risk youth. An online intervention program combining mentoring in physical activity and interpersonal connections may constitute an effective health promotion strategy for at-risk youth, especially in times of crisis.

The original version of the Nurse Managers' Empowering Behavioral Scale for Staff Nurses (NMEB-SN) was both unique and comprehensive. However, it was considered lengthy. Hence, the intention of this particular study was to develop a shortened version of the NMEB-SN comprising 15 items across five subscales. Responses from 1268 staff nurses working at 10 Japanese hospitals were included in the analysis to confirm the validity and reliability of the scale. The results ensured internal consistency, construct and criterion-related validity, and test-retest reliability. The NMEB-SN short version is applicable in the context of practical and efficient nursing management to attract more nurses to the workplace.

Background: Sleep stage classification is a crucial process for the diagnosis of sleep or sleep-related diseases. Currently, this process is based on manual electroencephalogram (EEG) analysis, which is resource-intensive and error-prone. Various machine learning models have been recommended to standardize and automate the analysis process to address these problems., Materials and Methods: The well-known cyclic alternating pattern (CAP) sleep dataset is used to train and test an L-tetrolet pattern-based sleep stage classification model in this research. By using this dataset, the following three cases are created, and they are: Insomnia, Normal, and Fused cases. For each of these cases, the machine learning model is tasked with identifying six sleep stages. The model is structured in terms of feature generation, feature selection, and classification. Feature generation is established with a new L-tetrolet (Tetris letter) function and multiple pooling decomposition for level creation. We fuse ReliefF and iterative neighborhood component analysis (INCA) feature selection using a threshold value. The hybrid and iterative feature selectors are named threshold selection-based ReliefF and INCA (TSRFINCA). The selected features are classified using a cubic support vector machine., Results: The presented L-tetrolet pattern and TSRFINCA-based sleep stage classification model yield 95.43%, 91.05%, and 92.31% accuracies for Insomnia, Normal dataset, and Fused cases, respectively., Conclusion: The recommended L-tetrolet pattern and TSRFINCA-based model push the envelope of current knowledge engineering by accurately classifying sleep stages even in the presence of sleep disorders.

According to the family-centered approach, the involvement of family in the care of hospitalized older patients is a crucial element of quality care. Active involvement of family in care by the nursing staff depends on different factors, including attitudes towards the importance of family in the care and perception of the interactions with the family. This study aims to identify the factors predicting staff behavior of involving the family in the care process. A cross-sectional study was conducted among 179 nursing staff at a hospital, using a self-report questionnaire examining staff attitudes towards the importance of family in care, the perception of the interactions with the family (family behavior, communication and conflicts), and staff behavior toward family involvement. The findings point out the importance that staff attitudes have on their behavior in the active involvement of family in the care of older patients. Staff behavior of family involvement was predicted by their perceptions of the family (as conversational partners and having their own resources), less conflicts with the family, and staff academic education. Staff behavior toward family is influenced by their attitude and staff-family relationships. Educational programs should emphasize the importance of family, as well as dealing with conflicts.

This study examined social characteristics and their relations to healthcare service demand among older adults during the first COVID-19 lockdown in 2020. The sample was based on a cohort of 103,955 adults over the age of 65. A general index of needs was composed based on healthcare service use data and was predicted in a multi-nominal logistic regression. The frequency of the total needs significantly (p < 0.000) declined while supportive community services (4.9%, 2.0%), living in a community framework (27.0%, 15.2%), and living in a private residence (29.7%, 20.1%) were significantly associated (p < 0.000) with less frequent needs compared to the complementary groups. Supportive communities turned out to be an extremely important service for older adults. Policy makers should consider expanding supportive community services for older adults, as it was shown to have a positive correlation with lower healthcare service use, which might be an indicator of better overall health.

Background. Major shifts within the education system have taken place during the COVID-19 pandemic; frontal teaching was often replaced with remote learning, which has affected students in many ways. We investigated the associations and predictors of perceptions of the remote learning experience on well-being (life satisfaction, self-rated health, psychosomatic, and psychological symptoms). Methods. We conducted a cross-sectional research study consisting of 1019 school students in Israel aged 11−18 (53.5% girls, 46.7% boys). Questionnaires were distributed from May−July 2021 during school time. The percentages of participants with various levels of well-being (WB) and remote learning experience were compared. Multiple regression procedures were used to analyze factors predicting wellbeing. Results. All of the remote learning items had statistically significant positive correlations with life satisfaction and self-rated health (i.e., better overall WB was associated with a more positive perception of the remote learning experience). Male gender, high socioeconomic status, greater involvement in lessons in the past year, and connection to the pedagogical team/school and peers predicted better overall WB (F-ratio = 14.03; p < 0.01; adjusted R2 = 0.08). Conclusions. Our results highlight the need for schools to target youths’ coping skills, which may lead to better remote learning experiences. These findings also provide several implications for the need to support children and adolescents through positive activities, relaxation/mindfulness, and cognitive coping to deal with the psychosomatic symptoms during remote learning periods.

This study aims to understand the mechanism whereby the Agile approach works by analyzing the effect of agility on innovativeness, the sequential mediating effect of helping behavior and knowledge sharing, and the moderating effect of customer orientation. Data for 323 Information and Communication Technology (ICT) companies and 964 non-ICT companies were collected and analyzed through online surveys. Bootstrapping analysis using Model No. 83 of the PROCESS macro confirmed that agility increases team members' helping behaviors and strengthens knowledge sharing, which in turn has a positive effect on innovativeness. More specifically, helping behavior and knowledge sharing sequentially mediate the relationship between agility and innovativeness. In addition, the study verified that customer orientation moderates the effect of agility on helping behavior. This study is meaningful in showing that it is important to create a culture that pursues "customer value" while promoting mutually helping behavior and sharing knowledge when introducing Agile methodology., Competing Interests: The authors declare no conflict of interest.

Early diagnosis of COVID-19 is required to provide the best treatment to our patients, to prevent the epidemic from spreading in the community, and to reduce costs associated with the aggravation of the disease. We developed a decision tree model to evaluate the impact of using an artificial intelligence-based chest computed tomography (CT) analysis software (icolung, icometrix) to analyze CT scans for the detection and prognosis of COVID-19 cases. The model compared routine practice where patients receiving a chest CT scan were not screened for COVID-19, with a scenario where icolung was introduced to enable COVID-19 diagnosis. The primary outcome was to evaluate the impact of icolung on the transmission of COVID-19 infection, and the secondary outcome was the in-hospital length of stay. Using EUR 20000 as a willingness-to-pay threshold, icolung is cost-effective in reducing the risk of transmission, with a low prevalence of COVID-19 infections. Concerning the hospitalization cost, icolung is cost-effective at a higher value of COVID-19 prevalence and risk of hospitalization. This model provides a framework for the evaluation of AI-based tools for the early detection of COVID-19 cases. It allows for making decisions regarding their implementation in routine practice, considering both costs and effects.

Israel was among the first countries to initiate adolescent COVID-19 vaccination. As adolescent vaccination requires parental consent, we evaluated the factors associated with parents' willingness to vaccinate their adolescents and their point of view regarding adolescents' involvement in this decision. An online survey was completed by 581 parents of adolescents aged 16-18. The main independent variables included trust in the healthcare system, components of the Health Belief Model (HBM) and adolescents' involvement in the decision, as well as background data, including demographics. Analysis included a multiple logistic regression and mediation examination. Parents reported that 446 adolescents (76.8%) have been or will soon be vaccinated against COVID-19, 12.2% chose not to vaccinate their child and 11% have not yet decided. Vaccination was significantly associated with HBM components and with adolescents' involvement in the decision. The perceived vaccination benefits acted as a mediator in the association between parents' COVID-19 perceived threat and adolescent vaccination, as well as between parents' trust in the healthcare system and adolescent vaccination. Addressing vaccination benefits and barriers is pivotal in the attempt to enhance adolescents' vaccination adherence. Considering the importance of adolescents' involvement in the decision, addressing them directly may also be beneficial in improving vaccination rates.

The Arab ethnic community in Israel is characterized by low social economic status and is at risk due to the typically crowded households. Understanding parents' level of awareness is important to avoid new outbreaks., Objectives: This study seeks to identify predicting factors associated with perceived susceptibility to COVID-19, and barriers to COVID-19 vaccination., Materials and Methods: A survey was conducted through social media, using snowball sampling via social networks. Additionally, t -tests, Chi-square tests, and Z tests were used to evaluate differences between independent proportions. Pearson correlations were calculated for the study variables. Multiple logistic regression examined the extent to which the background variables were related to the intention to vaccinate the child., Results: A total of 2843 Arab parents participated in the study. Older parents, higher socioeconomic status, higher trust in the authorities, vaccinated parents, and low psychological and physical barriers were positively correlated with willingness to vaccinate children. Pandemic fatigue was associated with less positive attitudes and reduced perceived effectiveness toward vaccination., Conclusion: Addressing minorities' poor standards of living and physical and psychological barriers posed by the authorities to minorities' access to vaccination may increase compliance with COVID-19 vaccination and protect the health of the entire population.

Metropolitan Haifa, Israel, has three hospitals: Rambam Health Care Campus, Bnai Zion Medical Center, and Carmel Medical Center. In 2007-2014, the length of stay at RHCC's emergency department increased, while the number of visits decreased. We ask whether the increase in LOS is associated with the falling numbers of visits to other EDs, whether an increase in LOS induces more referrals to competing hospitals in the metropolitan area, and whether it pays to be a crowded ED in mitigating moral hazard. Average LOS at Rambam climbed from 3.5 h in 2000-2007 to 6.4 in 2008-2018. While the number of visits to Rambam decreased significantly, those to Bnai Zion increased significantly and quite linearly. A one-way ANOVA test reveals a statistically significant difference among the three hospitals. In addition, Rambam was significantly different from Carmel but not from Bnai Zion. When LOS stabilized at Rambam from 2016 to 2018 and increased at Bnai Zion, referrals to Rambam went up again. Policymakers should instruct all hospitals to publish LOS data, regulate referrals to EDs, and find an optimal LOS that will reduce competition, non-urgent visits, and moral hazard.

Few studies have examined the simulation of fundamental nursing practices regarding nursing competencies and learning satisfaction via repeated measured methods., Objectives: To evaluate a simulation of fundamental nursing practices on nursing students' competencies and learning satisfaction in three time points: before (T1), immediately after (T2), and one month after simulation (T3), and to examine nursing students' competency predictors to learning satisfaction, immediately after conducting the simulation and one month after., Methods: The study design was a one-group, repeated measures study. Ninety-three undergraduate nursing students were convenience sampled and conducted a simulation of fundamental nursing practices. The students completed a questionnaire at T1, T2, and T3. The Competency Inventory for Registered Nurses questionnaire was distributed, and question about the level of learning satisfaction were asked., Results: All nursing competencies and learning satisfactions increased significantly. Only the legal/ethical practice competency succeeded in predicting the learning satisfaction in T2 and in T3 after conducting simulations., Conclusions: This study has established that a simulation of fundamental nursing practices is effective not just immediately after performing the simulation but also one month after the simulation. Therefore, it is recommended to implement a pedagogical structure of simulations of fundamental nursing practices in other nursing education areas.

(1) Background: The needs of cancer survivors are often not reflected in practice. One of the main barriers of the use of patient-reported outcomes is associated with data collection and the interpretation of patient-reported outcomes (PROs) due to a multitude of instruments and measuring approaches. The aim of the study was to establish an expert consensus on the relevance and key indicators of quality of life in the clinical practice of breast cancer survivors. (2) Methods: Potential indicators of the quality of life of breast cancer survivors were extracted from the established quality of life models, depicting survivors' perspectives. The specific domains and subdomains of quality of life were evaluated in a two-stage online Delphi process, including an international and multidisciplinary panel of experts. (3) Results: The first round of the Delphi process was completed by 57 and the second by 37 participants. A consensus was reached for the Physical and Psychological domains, and on eleven subdomains of quality of life. The results were further supported by the additional ranking of importance of the subdomains in the second round. (4) Conclusions: The current findings can serve to optimize the use of instruments and address the challenges related to data collection and interpretation as the facilitators of the adaption in routine practice.

Background and Purpose: Machine learning models have been used to diagnose schizophrenia. The main purpose of this research is to introduce an effective schizophrenia hand-modeled classification method., Method: A public electroencephalogram (EEG) signal data set was used in this work, and an automated schizophrenia detection model is presented using a cyclic group of prime order with a modulo 17 operator. Therefore, the presented feature extractor was named as the cyclic group of prime order pattern, CGP17Pat. Using the proposed CGP17Pat, a new multilevel feature extraction model is presented. To choose a highly distinctive feature, iterative neighborhood component analysis (INCA) was used, and these features were classified using k-nearest neighbors (kNN) with the 10-fold cross-validation and leave-one-subject-out (LOSO) validation techniques. Finally, iterative hard majority voting was employed in the last phase to obtain channel-wise results, and the general results were calculated., Results: The presented CGP17Pat-based EEG classification model attained 99.91% accuracy employing 10-fold cross-validation and 84.33% accuracy using the LOSO strategy., Conclusions: The findings and results depicted the high classification ability of the presented cryptologic pattern for the data set used.

X-ray angiography is commonly used in the diagnosis and treatment of coronary artery disease with the advantage of visualization of the inside of blood vessels in real-time. However, it has several disadvantages that occur in the acquisition process, which causes inconvenience and difficulty. Here, we propose a novel segmentation and nonrigid registration method to provide useful real-time assistive images and information. A convolutional neural network is used for the segmentation of coronary arteries in 2D X-ray angiography acquired from various angles in real-time. To compensate for errors that occur during the 2D X-ray angiography acquisition process, 3D CT angiography is used to analyze the topological structure. A novel energy function-based 3D deformation and optimization is utilized to implement real-time registration. We evaluated the proposed method for 50 series from 38 patients by comparing the ground truth. The proposed segmentation method showed that Precision, Recall, and F1 score were 0.7563, 0.6922, and 0.7176 for all vessels, 0.8542, 0.6003, and 0.7035 for markers, and 0.8897, 0.6389, and 0.7386 for bifurcation points, respectively. In the nonrigid registration method, the average distance of 0.8705, 1.06, and 1. 5706 mm for all vessels, markers, and bifurcation points was achieved. The overall process execution time was 0.179 s.

(1) Background: Medical teams are at the forefront of the COVID-19 pandemic. Decision making among medical staff is important for promoting and maintaining the health of patients and staff. This study examines factors associated with physicians' decision making and preventive behavior during the COVID-19 pandemic in Israel. (2) Methods: An online survey was conducted among 187 Israeli physicians in April and May 2020 during the COVID-19 pandemic. The questionnaire included the levels of physicians' perceived threat and perceived risk during the epidemic, trust in the health system, emotions, and the degree of compliance with hygiene rules and mandated behaviors. (3) Results: Most physicians reported complying with the rules of hygiene at work (73%) and full compliance with Ministry of Health guidelines (61%). The findings show that higher levels of trust, positive emotions, and threat and risk perceptions were associated with a higher degree of compliance with Ministry of Health guidelines and more careful decision making among physicians. (4) Conclusions: Levels of trust in the health system and positive emotions among healthcare staff during the pandemic are related to careful adherence to guidelines. Taking steps to maintain physical and mental health among healthcare staff is important for their functioning and for maintaining public health.

Brucella melitensis is a key etiological agent of brucellosis and has been increasingly subject to characterization using sequencing methodologies. This study aimed to investigate and compare short-read, long-read, and hybrid assemblies of B. melitensis . Eighteen B. melitensis isolates from Southern Israel were sequenced using Illumina and the Oxford Nanopore (ONP) MinION, and hybrid assemblies were generated with ONP long reads scaffolded on Illumina short reads. Short reads were assembled with INNUca with SPADes, long reads and hybrid with dragonflye. Abricate with the virulence factor database (VFDB) and in silico PCR (for the genes BetB , BPE275 , BSPB , manA , mviN , omp19 , perA , PrpA , VceC , and ureI ) were used for identifying virulence genes, and a total of 61 virulence genes were identified in short-read, long-read, and hybrid assemblies of all 18 isolates. The phylogenetic analysis using long-read assemblies revealed several inconsistencies in cluster assignment as compared to using hybrid and short-read assemblies. Overall, hybrid assembly provided the most comprehensive data, and stand-alone short-read sequencing provided comparable data to stand-alone long-read sequencing regarding virulence genes. For genomic epidemiology studies, stand-alone ONP sequencing may require further refinement in order to be useful in endemic settings.

Background: The adverse events reported from the COVID-19 mRNA vaccines have varied from very mild, such as pain near the vaccination site, to more severe, with occasional anaphylaxis. Details of age-specific gender differences for the adverse effects are not well documented. Methods: Age and gender disaggregated data on reports of adverse events following two or three doses of the Pfizer-BioNTech COVID-19 vaccine were obtained from four cross-sectional studies. The first was from reports submitted to the Israel Ministry of Health national adverse events database (for ages 16 and above). The second was from a national cross-sectional survey based on an internet panel (for ages 30 and above), and the third and fourth were from cross-sectional surveys among employees of a large company (for ages 20-65) using links to a self-completed questionnaire. Results: In all studies, the risks of adverse events were higher following the second dose and consistently higher in females at all ages. The increased risk among females at all ages included local events such as pain at the injection site, systemic events such as fever, and sensory events such as paresthesia in the hands and face. For the combined adverse reactions, for the panel survey the female-to-male risk ratios (RRs) were 1.89 for the first vaccine dose and 1.82 for the second dose. In the cross-sectional workplace studies, the female-to-male RRs for the first, second and third doses exceeded 3.0 for adverse events, such as shivering, muscle pain, fatigue and headaches. Conclusions: The consistent excess in adverse events among females for the mRNA COVID-19 vaccine indicates the need to assess and report vaccine adverse events by gender. Gender differences in adverse events should be taken into account when determining dosing schedules.

Cardiovascular diseases (CVDs) are the number one cause of death globally and are partially due to the inability to control modifiable lifestyle risk factors. The aim of this study was to analyze the profiles of adolescents from seven Mediterranean countries (Greece, Israel, Italy, Macedonia, Malta, Portugal, Spain) according to their modifiable lifestyle risk factors for CVD (overweight/obesity, physical activity, smoking, alcohol consumption). The sample consisted of 26,110 adolescents (52.3% girls) aged 11, 13, and 15 years who participated in the Health Behavior in School-aged Children (HBSC) survey in 2018 across the seven countries. Sociodemographic characteristics (sex, age, country of residence, socioeconomic status) and CVD modifiable lifestyle risk factors (overweight/obesity, physical activity, smoking, alcohol consumption) were recorded. A two-step cluster analysis, one-way analysis of variance, and chi-square test were performed. Four different cluster groups were identified: two low-risk groups (64.46%), with risk among those with low physical activity levels; moderate-risk group (14.83%), with two risk factors (unhealthy weight and low physical activity level); and a high-risk group (20.7%), which presented risk in all modifiable lifestyle risk factors. Older adolescents reported a higher likelihood of being in the high-risk group. Given that the adolescence period constitutes an important time for interventions aimed at CVD prevention, identifying profiles of moderate- and high-risk adolescents is crucial.

This study aimed to develop an inventory for advance care planning implementation for persons with dementia in group homes and to examine the association between inventory implementation and residents' quality of dying. A nationwide cross-sectional study was conducted via questionnaires mailed from 2000 group homes in Japan, selected through stratified random sampling. Participants were managers and care planners who had provided end-of-life care for recently deceased residents. The newly developed inventory was used to assess advance care planning implementation for persons with dementia, and the Quality of Dying in Long-term Care Scale was used to evaluate quality of dying. The valid response rate was 28.5% ( n = 569). The factor structure of the newly developed Advance Care Planning Practice Inventory and the association between its implementation and quality of dying were verified using factor analysis and internal consistency, and logistic regression, respectively. The composite score and the factor score of the newly developed inventory were significantly associated with quality of dying ( p < 0.05). The implementation of advance care planning improves the quality of dying. These findings can be used in development of educational programs, as well as research on advance care planning for care providers.

Sufficient uptake of the COVID-19 vaccine is key to slowing the spread of the coronavirus among the most vulnerable in society, including individuals experiencing homelessness. However, COVID-19 vaccination rates among the Veteran homeless population are currently unknown. This study examines the COVID-19 vaccination rate among homeless Veterans who receive care at the U.S. Department of Veterans Affairs (VA), and the factors that are associated with vaccine uptake. Using VA administrative and clinical data, bivariate and multivariate analyses were conducted to identify the sociodemographic, health-related, and healthcare and housing services utilization factors that influenced COVID-19 vaccine uptake during the first eight months of the vaccine rollout (December 2020-August 2021). Of the 83,528 Veterans experiencing homelessness included in the study, 45.8% were vaccinated for COVID-19. Non-white, older Veterans (65+), females, those who received the seasonal flu vaccine, and Veterans with multiple comorbidities and mental health conditions were more likely to be vaccinated. There was a strong association between COVID-19 vaccination and Veterans who utilized VA healthcare and housing services. VA healthcare and homeless service providers are particularly well-positioned to provide trusted information and overcome access barriers for homeless Veterans to receive the COVID-19 vaccine.

Honest communication between oncologists and patients is important in alleviating the financial burden of cancer care. This study explored patient-relative-oncologist communication regarding the affordability of out-of-pocket (OOP) medication and the extent to which this communication addresses itself to the families' financial burden. A cross-sectional survey was conducted among primary caregivers of deceased cancer patients. About 43% of relatives said that they and/or the patients had paid out of pocket for medications during the last six months of the patient's life. Most (73%) oncologists suggested an OOP medication without asking about financial ability, 43% hardly explained the advantages of an OOP medication, and 52% hardly explained any treatment alternatives. Older age and female gender were related to less communication about an OOP medication, and better education, greater affluence, and having private health insurance were related to more communication. About 56% of relatives said that OOP payment for medications inflicted a very heavy or heavy financial burden on patients and their households. Physicians' interest in financial ability and giving explanation lightened the burden. Given the difficulty of explaining the complex interactions of cost and clinical outcomes, oncologists need to be better educated in skills that would enable them to communicate costs more openly and should consider the cost of a treatment when prescribing it.

Background: This study examined the effectiveness of a birth preparation course on coping with childbirth among primigravid ultra-orthodox Jewish women in Israel. Methods: In total, 130 ultra-orthodox 25-35-week primigravid women were divided into a study ( n = 100, participated in birth preparation courses) and a control ( n = 30, did not participate in the courses) group. A questionnaire was delivered three times: T 1 -before the course/delivery, T 2 -two-three days after delivery, and T 3 -a month after delivery. Results: At T 3 , self-efficacy among the study group was higher than in the control group. Differences in self-efficacy were found over time regardless of the group (F (2,246) = 12.83, p < 0.001), as a time-group interaction effect (F (2,246) = 10.20, p < 0.01). Self-efficacy in the study group (Mean, M = 3.40, Standard deviation, SD = 0.63 at T 1 ) dropped to M = 3.06, SD = 0.76 at T 2 and rose to M = 3.34, SD = 0.64 at T 3 . In the control group, self-efficacy (M = 3.53, SD = 0.56 at T 1 ) dropped to M = 3.26, SD = 0.63 at T 2 and to M = 2.95, SD = 0.76 at T 3 . Discussion: The childbirth preparation course was found to be effective in raising self-efficacy among primigravid ultra-orthodox religious women when compared to the control group.

The widespread outbreak of the novel coronavirus disease COVID-19 has posed an enormous threat to global public health. A different set of policy interventions has been implemented to mitigate the spread in most countries. While the use of personal protective equipment and social distancing has been specifically emphasized, South Korea has deployed massive testing and contact-tracing program from the early stage of the outbreak. This study aims at investigating the effectiveness of testing and contact-tracing to counter the spread of infectious diseases. Based on the SEICR (susceptible-exposed-infectious-confirmed-recovered) model, an agent-based simulation model is developed to represent the behavior of disease spreading with the consideration of testing and contact-tracing in place. Designed experiments are conducted to verify the effects of testing and contact tracing on the peak number of infections. It has been observed that testing combined with contact tracing may lower the peak infections to a great extent, and it can thus be avoided for the hospital bed capacity to be overwhelmed by infected patients. It is implied that an adequate capability of testing and contact-tracing may enable us to become better prepared for an impending risk of infectious diseases.

Many healthcare institutions are interested in reducing costs and in maintaining a good quality of care. The operating room department is typically one of the most costly units in a hospital. Hospital managers are always interested in finding effective ways of using operating rooms to minimize operating costs. In this research, we study the operating room scheduling problem. We consider the use of a weekly surgery schedule with an open scheduling strategy that takes into account the availabilities of surgeons and operating rooms. The objective is to minimize the total operating cost while maximizing the utilization of the operating rooms but also minimizing overtime use. A revised mathematical model is proposed that can provide optimal solutions for a surgery size up to 110 surgical cases. Next, two modified heuristics, based on the earliest due date (EDD) and longest processing time (LPT) rules, are proposed to quickly find feasible solutions to the studied problem. Finally, an artificial bee colony (ABC) algorithm that incorporates the initial solutions, a recovery scheme, local search schemes, and an elitism strategy is proposed. The computational results show that, for a surgery size between 40 and 100 surgical cases, the ABC algorithm found optimal solutions to all of the tested problems. For surgery sizes larger than 110 surgical cases, the ABC algorithm performed significantly better than the two proposed heuristics. The computational results indicate that the proposed ABC is promising and capable of solving large problems.

Antimicrobial resistance (AMR) in Helicobacter pylori is increasing and can result in treatment failure and inappropriate antibiotic usage. This study used whole genome sequencing (WGS) to comprehensively analyze the H. pylori resistome and phylogeny in order to characterize Israeli H. pylori . Israeli H. pylori isolates ( n = 48) underwent antimicrobial susceptibility testing (AST) against five antimicrobials and WGS analysis. Literature review identified 111 mutations reported to correlate with phenotypic resistance to these antimicrobials. Analysis was conducted via our in-house bioinformatics pipeline targeting point mutations in the relevant genes ( pbp1A , 23S rRNA , gyrA, rdxA, frxA , and rpoB ) in order to assess genotype-to-phenotype correlation. Resistance rates of study isolates were as follows: clarithromycin 54%, metronidazole 31%, amoxicillin 10%, rifampicin 4%, and levofloxacin 2%. Genotype-to-phenotype correlation was inconsistent; for every analyzed gene at least one phenotypically susceptible isolate was found to have a mutation previously associated with resistance. This was also observed regarding mutations commonly used in commercial kits to diagnose AMR in H. pylori cases. Furthermore, 11 novel point mutations associated with a resistant phenotype were detected. Analysis of a unique set of H. pylori isolates demonstrates that inferring resistance phenotypes from WGS in H. pylori remains challenging and should be optimized further.