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Background Benzodiazepines and sedative-hypnotic drugs (BZD/SHD) are commonly utilized in the acute care setting for insomnia and anxiety and are associated with cognitive impairment, falls, and fractures. Interventions to reduce use of BZD/SHD in hospitals are not well characterized. Objective The objective was to conduct a scoping review to identify and characterize interventions to reduce the use of BZD/SHD by adults in the acute care setting. Methods English language studies and abstracts that described an intervention to reduce BZD/SHD in adult hospital patients were included. Six databases (PubMed, EMBASE, CINAHL, PsycINFO, Scopus, and Web of Science) were searched up to July 2018 and updated to February 3, 2021. The grey literature (Opengrey, Grey Matters, Google Advanced) was searched up to July 2018. Titles and abstracts were screened and full-text articles were reviewed and charted by three independent reviewers. Stakeholders were consulted to inform the scoping review and collect perspectives on the findings. Results There were 13,046 records identified and 43 studies included. The most common study designs were uncontrolled before and after (23/43, 53.5%) and randomized controlled trials (7/43, 16.3%). The majority of studies tested a single intervention (32/43, 74.4%) such as education, deprescribing, relaxation training and sleep protocols. Patients were frequently the target of relaxation training and behavior change interventions; while sleep protocols, multifaceted interventions, education and deprescribing were usually directed at healthcare providers, either alone or in combination with patients. Most studies reported positive results in decreasing BZD/SHD use (27/43, 62.8%). Conclusions The scoping review found a variety of interventions to decrease the utilization of BZD/SHD in hospitals. Multifaceted interventions aimed at patients and healthcare providers that include a combination of education, sleep protocols, and deprescribing may support reductions in BZD/SHD use. Stakeholders also recommended policy and system changes such as computer alerts due to feasibility and workload.

Background: Chronic diseases such as Multiple Sclerosis (MS), as one of the hot topics in the literature, have frequently been associated with sexual dysfunction. Objectives: The present study aimed to investigate the effect of mindfulness psycho educational group intervention on improving the sexual function of women with MS. Methods: To this end, 350 women with MS from Isfahan province, who had medical records in Kashani Hospital and Isfahan MS Center, were first screened out by the Female Sexual Function Index (FSFI), among whom the ones scored below 28 were clinically diagnosed with sexual dysfunction. Then 47 patients with sexual dysfunction were randomly assigned to experimental (N=24) and control (N=23) groups using the simple random sampling method. The experimental group received five sessions of Mindfulness-Based Group Psychotherapy; however, the control group received no treatment. The two groups were assessed by a pre-test, post-test, and two follow-ups (one and two months after the end of the intervention, respectively), and MANCOVA was used to analyze the data in SPSS software 16. Results: According to the results, mindfulness-based psycho educational group therapy was effective in improving the sexual function of women with MS in all the six domains (namely desire, arousal, lubrication, orgasm, satisfaction, and pain) and the total FSFI score (p≤.05)). Conclusion: The findings revealed the effectiveness of psycho educational group intervention in improving the sexual function of women with MS. Accordingly, clinicians and therapists working with this group of women are recommended to include mindfulness in their interventions.

Objectives: Cancer affects both patients and their families. Sometimes, the effects of cancer on families are greater than its effects on patients. Family caregivers play significant roles in care for patients with cancer. Nonetheless, the data on the challenges they face in caregiving are limited. The present study explored the perspectives of patients with gastric cancer (GC), their family caregivers, and healthcare providers regarding family caregivers’ challenges in caregiving to patients with GC. Materials and Methods: This descriptive exploratory qualitative study was conducted in 2019–2020. Six GC patients, six family caregivers, three physicians, and five nurses took part for a total of twenty participants. Purposive sampling was performed, and data were collected through semi-structured interviews and continued up to data saturation. Conventional content analysis was used for data analysis. Results: Caregivers’ challenges in caregiving to patients with GC were grouped into five main categories, namely, lengthy process of GC diagnosis, delivery of bad news, management of physical symptoms, altered relationships, and psychological consequences, and 14 subcategories. Conclusion: Educating the public about the primary symptoms of GC and the importance of timely seeking medical care as well as using culturally appropriate protocols for delivering bad news is recommended. Empowering family caregivers for the effective management of GC symptoms and caregiving-related challenges are also recommended to reduce their caregiver burden.

This paper proposes a novel rotational damper, called rotational yielding damper (RYD), for enhancing the seismic behavior of new and existing building structures. In the proposed damper, hourglass-shaped cylindrical steel pins, named hourglass steel pins (HSP), are used as energy dissipating elements, which can be easily replaced in case of failure after severe earthquakes. The earthquake input energy is dissipated through inelastic deformations of HSPs during the loading. The effectiveness of HSP as an energy dissipation element has already been validated numerically and experimentally in various locations of structures. In this paper, a numerical study is performed to evaluate the behavior of the proposed damper and investigate the effects of important damper parameters on the cyclic response of a simple steel frame equipped with it. In addition, the application of the proposed damper in an eccentrically braced frame is also studied. For these purposes, a multi-scale modeling approach in Abaqus software is used to develop numerical models. The results clearly reveal that a properly designed and manufactured RYD has high energy dissipation capacity and equivalent viscous damping as well as high lateral strength and stiffness. Therefore, it can be inferred that RYD can serve as an energy dissipation device in building structures.

Previous investigations have mostly studied an individual methyl donor nutrient in relation to psychological disorders and the findings were inconsistent. We investigated the association of methyl donor micronutrients (folate, B6, B12, choline, betaine, and methionine) with psychological disorders (depression, anxiety, psychological distress) in Iranian adults. In this cross-sectional study, dietary intakes of 3299 adults were collected using a validated food frequency questionnaire. Methyl donor micronutrient score (MDMS) was calculated based on energy-adjusted deciles of each nutrient. Hospital Anxiety and Depression Scale (HADS) and General Health Questionnaire (GHQ), validated for Iranians, have been applied to assess depression, anxiety, and psychological distress. Participants had a mean age of 36.3±7.9 years, of whom 58.5% were women. After considering potential confounders, adults in the top quartile of MDMS, compared to the bottom one, had decreased odds of anxiety (OR: 0.53, 95%CI: 0.37-0.75), depression (OR: 0.75, 95%CI: 0.58-0.97) and psychological distress (OR: 0.61, 95%CI: 0.46-0.80). Stratified analysis revealed that the highest category of MDMS among men was related to a 68% lower odds of anxiety (95%CI: 0.15-0.68). Among women, the top quartile of MDMS was protectively associated with anxiety (OR: 0.60, 95%CI: 0.40-0.90), depression (OR: 0.68, 95%CI: 0.50-0.93) and psychological distress (OR: 0.53, 95%CI: 0.38-0.74). Overweight and obese subjects in the highest quartile of MDMS had a 67%, 35%, and 53% lower odds of anxiety (95%CI: 0.20-0.56), depression (95%CI: 0.44-0.94), and psychological distress (95%CI: 0.31-0.70), respectively. We found that high consumption of methyl donor micronutrients was related to a reduced odds of psychological disorders, especially in women and overweight or obese individuals. Further prospective studies are needed to affirm these findings.

The application of biosecurity in seaweed aquaculture plays an important role in reducing the impact of disease and pest outbreaks. The continuous occurrence of seaweed pests including the macroalgal epiphytes, epi-endophytic filamentous algae and biofilms on Kappaphycus farms may also potentially induce further incidences of the ice-ice syndrome. In this study, on-farm biosecurity management measures were tested on the commercially grown seaweeds Kappaphycus malesianus and Kappaphycus alvarezii during peak ice-ice season at Gallam-Gallam Village, Sabah, Malaysia. The investigation was focused on preventative control measures including the early detection of the ice-ice syndrome and pests through propagule health checks, regular cleaning of the crop thallus and associated long-line ropes and monitoring of the environment. Farm procedures and practices were also assessed in terms of their biosecurity ‘risk’ using the hazard analysis and critical control point (HCCAP) approach. Observations were replicated in two different farm management systems; one system adopted routine biosecurity measures and the other had no biosecurity measures. The results showed that the ice-ice syndrome and pest outbreak was significantly decreased by 60–75% for K. malesianus and 29–71% for K. alvarezii at the farm which adopted the routine biosecurity measures compared with the no biosecurity treatment. The biosecurity measures also significantly improved growth rate and seaweed quality. The infection levels of the epi-endophyte Melanothamnus sp. contributed to the ice-ice syndrome in K. malesianus, whilst the epiphyte coverage was correlated to the ice-ice incidence in K. alvarezii. This study provides the first evidence of biosecurity management measures significantly decreasing the incidence of the ice-ice syndrome and pests on a commercial seaweed farm.

Despite the huge evidence on the link between dietary protein intake and obesity, limited studies have examined the role of individual amino acids in this regard. This study aimed to investigate the association between dietary total and individual BCAAs intake and odds of general and abdominal obesity in a large group of adults. This cross-sectional study was conducted among 8691 adults aged 18–55 years in Isfahan, Iran. Dietary BCAAs were assessed using a validated dish-based 106-item semi-quantitative food frequency questionnaire (DS-FFQ). Information about weight and waist circumference was collected through a self-reported validated questionnaire. General obesity was defined as body mass index (BMI) ≥ 30 kg/m2, and abdominal obesity was defined as waist circumference (WC) ≥ 88 cm for women and ≥ 102 cm for men. Mean age of study participants was 36.8 ± 8.1 years. Prevalence of general obesity was 9.2% in men and 9.7% in women and that of abdominal obesity was 13.3% and 36.2% in men and women, respectively. We found that participants in the top tertile of total BCAAs intake had higher odds of general obesity compared with those in the bottom tertile (OR: 1.42; 95% CI: 1.09–1.84). Such significant association was seen in men (OR: 1.57; 95% CI: 1.05–2.34), but not in women (OR: 1.33; 95% CI: 0.94–1.89) in our stratified analysis. We found no significant association between total BCAAs intake and odds of abdominal obesity. Stratified by sex, no significant association was observed between total BCAAs intake and odds of abdominal obesity [for men: (OR: 1.10; 95% CI: 0.74–1.65) and for women: (OR: 1.08; 95% CI: 0.84–1.38)]. Assessing the association with individual BCAAs, a significant positive association was observed between dietary intake of valine (OR: 1.42; 95% CI: 1.10–1.84), leucine (OR: 1.43; 95% CI: 1.10–1.86), and isoleucine (OR: 1.42; 95% CI: 1.09–1.84) with general obesity. We observed no significant association between dietary intake of individual BCAAs intake and odds of abdominal obesity. Dietary BCAAs intake was associated with an increased odds of general obesity, in particular among men. No significant association was observed between dietary BCAAs and abdominal obesity. Level V, descriptive cross-sectional study.

Purpose. To quantitatively analyze the C2/C3 segments of the spinal cord on magnetic resonance imaging (MRI) scans of neuromyelitis optica spectrum disorder (NMOSD) and relapsing-remitting multiple sclerosis (RRMS) patients in their first five years of the disease and to investigate the intergroup differences regarding markers of spinal cord atrophy and their correlations with expanded disability status scale (EDSS). Materials and Methods. Twenty NMOSD patients and twenty RRMS patients, within their first five years of the disease, were enrolled in this cross-sectional study. All patients underwent spinal cord MR imaging using 1.5 Tesla systems, and C2/C3 portions of the spinal cord were segmented in the obtained scans. C2/C3 anteroposterior diameter (C2/C3 SC-APD), transversal diameter (C2/C3 SC-TD), and cross-sectional area (C2/C3 SC-CSA) were quantitatively measured using Spinal Cord Toolbox v.4.3. Results. Three NMOSD patients were seropositive for anti-AQP4 IgG. The mean C2/C3 SC-CSA in NMOSD patients was significantly lower than in RRMS patients. NMOSD patients had significantly lower C2/C3 SC-TDs than RRMS patients. With the three anti-AQP4+ patients excluded from the analysis, C2/C3 SC-TD was negatively correlated with EDSS. Conclusion. In the early stages of the disease, quantitative evaluation of C2/C3 spinal cord parameters, including cross-sectional area and transversal diameter in NMOSD patients, appears to be of potential diagnostic and prognostic value.

This study was conducted with the aim of involving Clinical Informationists (CI) in the hospital setting. It is fundamental-applied research done in an action research method. The research was cond...

Background: Already at hospital admission, clinicians require simple tools to identify hospitalized COVID-19 patients at high risk of mortality. Such tools can significantly improve resource allocation and patient management within hospitals. From the statistical point of view, extended time-to-event models are required to account for competing risks (discharge from hospital) and censoring so that active cases can also contribute to the analysis. // Methods: We used the hospital-based open Khorshid COVID Cohort (KCC) study with 630 COVID-19 patients from Isfahan, Iran. Competing risk methods are used to develop a death risk chart based on the following variables, which can simply be measured at hospital admission: sex, age, hypertension, oxygen saturation, and Charlson Comorbidity Index. The area under the receiver operator curve was used to assess accuracy concerning discrimination between patients discharged alive and dead. // Results: Cause-specific hazard regression models show that these baseline variables are associated with both death, and discharge hazards. The risk chart reflects the combined results of the two cause-specific hazard regression models. The proposed risk assessment method had a very good accuracy (AUC¿=¿0.872 [CI 95%: 0.835–0.910]). // Conclusions: This study aims to improve and validate a personalized mortality risk calculator based on hospitalized COVID-19 patients. The risk assessment of patient mortality provides physicians with additional guidance for making tough decisions. The research leading to these results has received funding from the European Union's Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No 712949 (TECNIOspring PLUS), and from the Agency for Business Competitiveness of the Government of Catalonia (TECSPR18-1–0017). The TECSPR18-1–0017 project provided the APC. These funders had no role in study design, data collection, analysis, decision to publish, or manuscript preparation.

Background: Schizophrenia is a mental disorder characterized by distortions in thinking, perception, emotions, language, self-sense, and behavior. Recent research suggests that Reactive Oxygen Species (ROS) are involved in the pathophysiology of schizophrenia. Studies have also shown the increased plasma and serum levels of the Trx1 molecule in schizophrenia patients. In the present study, the researchers compared the expression levels of Trx1 mRNA in peripheral blood leukocytes of Iranian schizophrenia patients compared to healthy controls. Methods: First-episode patients (n=35) who met DSM-IV criteria for schizophrenia were recruited from patients referred to psychiatrists in the city of Ilam and Farabi Hospital in Kermanshah. Healthy people were also selected by recruiting people who, according to a psychiatrist, did not have any mental illness. Diagnoses were made for each patient by two independent experienced psychiatrists and confirmed by the Structured Clinical Interview for DSM-IV (SCID). Patients were treated with risperidone for three months and then compared with thirty- five healthy volunteers. Patients were sampled before and after treatment and then by RNA Extraction and DNA synthesis, Trx1 gene expression was performed by real-time PCR method. Results: Comparison of Trx1 gene expression in PBMCs of schizophrenic patients before and after treatment with the control group showed that the expression of Trx1 gene of the “before” treatment group was significantly increased compared with that of the control group (P= 0.0007). Also, Trx1 gene expression in PBMCs of “before” and “after “groups showed that Trx1 gene expression of “after” group was significantly decreased compared to the “before” group (P= 0.014). These results showed that the mean of positive, negative, and general psychopathology was reduced significantly in schizophrenic patients before and after treatment in all three cases (P

The seismic retrofit of existing reinforced concrete (RC) beam-column joints in the case of the interior reinforcement of deformed bars and plain bars, as well as the decision regarding convenient ...

We report a new approach using artificial intelligence (AI) to study and classify the severity of COVID-19 using 1208 chest X-rays (CXRs) of 396 COVID-19 patients obtained through the course of the disease at Emory Healthcare affiliated hospitals (Atlanta, GA, USA). Using a two-stage transfer learning technique to train a convolutional neural network (CNN), we show that the algorithm is able to classify four classes of disease severity (normal, mild, moderate, and severe) with the average Area Under the Curve (AUC) of 0.93. In addition, we show that the outputs of different layers of the CNN under dominant filters provide valuable insight about the subtle patterns in the CXRs, which can improve the accuracy in the reading of CXRs by a radiologist. Finally, we show that our approach can be used for studying the disease progression in a single patient and its influencing factors. The results suggest that our technique can form the foundation of a more concrete clinical model to predict the evolution of COVID-19 severity and the efficacy of different treatments for each patient through using CXRs and clinical data in the early stages of the disease. This use of AI to assess the severity and possibly predicting the future stages of the disease early on, will be essential in dealing with the upcoming waves of COVID-19 and optimizing resource allocation and treatment.

Per- and polyfluoroalkyl substances (PFAS) have been found to be associated with gestational diabetes mellitus (GDM) development, a maternal health disorder in pregnancy with negative effects that can extend beyond pregnancy. Studies that report on this association are difficult to summarize due to weak associations and wide confidence intervals. One way to advance this field is to sharpen the biologic theory on a causal pathway behind this association, and to measure it directly by way of molecular biomarkers. The aim of this review is to summarize the literature that supports a novel pathway between PFAS exposure and GDM development. Epidemiological studies demonstrate a clear association of biomarkers of thyroid hormones and glucose metabolism with GDM development. We report biologic plausibility and epidemiologic evidence that PFAS dysregulation of maternal thyroid hormones and thyrotropin (TSH) may disrupt glucose homeostasis, increasing the risk of GDM. Overall, epidemiological studies demonstrate that PFAS were positively associated with TSH and negatively with triiodothyronine (T3) and thyroxine (T4). PFAS were generally positively associated with glucose and insulin levels in pregnancy. We propose dysregulation of thyroid function and glucose metabolism may be a critical and missing component in the accurate estimation of PFAS on the risk of GDM. Supplementary Information The online version contains supplementary material available at 10.1186/s12940-021-00740-z.

Psychological-related disorders such as obesity are a key contributor to morbidity and mortality.To assess the association between general and abdominal obesity with depression and anxiety among Iranian health-care staff.This cross-sectional study was conducted under the framework of the Study on the Epidemiology of Psychological Alimentary Health and Nutrition. A total of 4361 Iranian health-care staff were analysed for general obesity and 3213 for central obesity. Overweight and obesity was defined as body mass index 25.0-29.9 and ≥ 30.0 kg/m², respectively. Abdominal obesity was defined as waist circumference (WC) ≥ 88 cm for females and ≥ 102 cm for males. The Iranian validated versions of the Hospital Anxiety and Depression Scale and the General Health Questionnaire were used to assess depression and anxiety.Stratified analysis by sex revealed no significant relationship between general obesity, depression and anxiety among males. However, we found an inverse association between abdominal obesity (WC102 cm) and severe depression among males. In females, abdominal obesity was significantly associated with anxiety, before and after taking confounders into account. No significant association was seen between abdominal obesity and psychological distress in either sex after controlling for potential confounders.Abdominal obesity was associated with anxiety in Iranian adult females but not in males. Further studies, particularly prospective research, are required to confirm these findings.العلاقة بين السمنة والاكتئاب والقلق والضائقة النفسية بين العاملين الإيرانيين في مجال الرعاية الصحية.مطهر حيدري-بني، فاطمة سليمان، حامد أفشار، حسين خسروي -بورجيني، عمار كشتيلي، أحمد إسماعيل زاده، بيمان أديبي.تُعتبر الاضطرابات النفسية مثل السمنة من العوامل الرئيسية التي تُسهم في حدوث المراضة والوفيات.هدفت هذه الدراسة إلى تقييم العلاقة بين السمنة العامة وسمنة البطن وبين الاكتئاب والقلق لدى العاملين الإيرانيين في مجال الرعاية الصحية.أُجريت هذه الدراسة المقطعية كجزء من دراسة حول وبائيات الصحة التغذوية النفسية والتغذية. وبلغ مجموع العاملين الإيرانيين في مجال الرعاية الصحية الذين خضعوا لتحليل السمنة العامة والسمنة المركزية 4361 و 3213 شخصاً، على التوالي. وعُرّفت زيادة الوزن والسمنة بأنهما منسب كتلة الجسم الذي يبلغ 25.0–29.9 و≥ 30.0 كجم/م ²، على التوالي. وعُرّفت سمنة البطن على أنها محيط الوسط ≥ 88 سم للنساء، و≥ 102 للرجال. واستُخدمت النسختان الإيرانيتان المُصادق عليهما لمقياس المستشفيات للقلق والاكتئاب والاستبيان الصحي العام لتقييم الاكتئاب والقلق.كشف التحليل الطبقي حسب نوع الجنس عن عدم وجود علاقة وطيدة بين السمنة العامة، والاكتئاب، والقلق بين الرجال. ولكننا وجدنا ارتباطاً عكسياً بين سمنة البطن (محيط الوسط102 سم) والاكتئاب الحاد بين الرجال. وفي النساء، ارتبطت سمنة البطن ارتباطاً كبيراً بالقلق، قبل وبعد أخذ عوامل الإرباك في الاعتبار. ولم تُلاحظ علاقة وطيدة بين سمنة البطن والضائقة النفسية في أي من الجنسين بعد السيطرة على عوامل الإرباك المُحتملة.ارتبطت سمنة البطن بمشاعر القلق في النساء البالغات الإيرانيات ولكن ليس الرجال. كما يلزم إجراء دراسات استباقية خاصة لتأكيد هذه النتائج.Relation entre obésité et dépression, anxiété et détresse psychologique parmi le personnel de santé iranien.Les troubles psychologiques associées à l'obésité constituent un facteur essentiel qui contribue à la morbidité et à la mortalité.Évaluer le lien entre l'obésité générale et abdominale et la dépression et l'anxiété parmi le personnel de santé iranien.La présente étude transversale a été menée dans le cadre de l’étude sur l'épidémiologie de la santé psychologique, alimentaire et nutritionnelle. Au total, 4361 membres du personnel de santé iranien ont été dépistés pour l'obésité générale et 3213 pour l'obésité abdominale. Le surpoids et l'obésité ont été définis respectivement en fonction d’un indice de masse corporelle de 25,0-29,9 et supérieur ou égal à 30,0 kg/m². L'obésité abdominale a été définie par un tour de taille supérieur ou égal à 88 cm pour les femmes et à 102 cm pour les hommes. Les versions iraniennes validées de l'échelle hospitalière d'anxiété et de dépression et du questionnaire général de santé ont été utilisées pour évaluer la dépression et l'anxiété.L'analyse stratifiée par sexe n'a révélé aucune relation significative entre l'obésité générale, la dépression et l'anxiété chez les hommes. Cependant, nous avons trouvé une association inverse entre obésité abdominale (tour de taille102 cm) et dépression sévère chez les hommes. Chez les femmes, l'obésité abdominale était associée de manière significative à l'anxiété, avant et après la prise en compte des facteurs de confusion. Aucune association significative n'a été observée entre l'obésité abdominale et la détresse psychologique dans les deux sexes après contrôle des facteurs de confusion potentiels.L'obésité abdominale était associée à l'anxiété chez les femmes adultes iraniennes, mais pas chez les hommes. Par ailleurs, des études prospectives sont nécessaires pour confirmer ces résultats.

BACKGROUNDThe function of the gestational sac (GS) and the placenta in the closely related processes of embryogenesis and teratogenicity in the first trimester has been minimally described. The prevailing assumption is that direct teratogenic effects are mediated by the critical extraembryonic organ, the placenta, which either blocks or transfers exposures to the foetus. Placental transfer is a dominant mechanism, but there are other paradigms by which the placenta can mediate teratogenic effects. Knowledge of these paradigms and first trimester human developmental biology can be useful to the epidemiologist in the conduct of biomarker-based studies of both maternal and child health.OBJECTIVE AND RATIONALEOur aim is to provide a causal framework for modelling the teratogenic effects of first trimester exposures on child health outcomes mediated by the GS and placenta using biomarker data collected in the first trimester. We initially present first trimester human developmental biology for the sake of informing and strengthening epidemiologic approaches. We then propose analytic approaches of modelling placental mechanisms by way of causal diagrams using classical non-embryolethal teratogens (diethylstilboestrol [DES], folic acid deficiency and cytomegalovirus [CMV]) as illustrative examples. We extend this framework to two chronic exposures of particular current interest, phthalates and maternal adiposity.SEARCH METHODSInformation on teratogens was identified by a non-systematic, narrative review. For each teratogen, we included papers that answered the five following questions: (i) why were these exposures declared teratogens? (ii) is there a consensus on biologic mechanism? (iii) is there reported evidence of a placental mechanism? (iv) can we construct a theoretical model of a placental mechanism? and (v) can this knowledge inform future work on measurement and modelling of placental-foetal teratogenesis? We prioritized literature specific to human development, the organogenesis window in the first trimester and non-embryolethal mechanisms.OUTCOMESAs a result of our review of the literature on five exposures considered harmful in the first trimester, we developed four analytic strategies to address first trimester placental mechanisms in birth cohort studies: placental transfer and direct effects on the foetus (DES and maternal adiposity), indirect effects through targeted placental molecular pathways (DES and phthalates), pre-placental effects through disruptions in embryonic and extraembryonic tissue layer differentiation (folic acid deficiency), and multi-step mechanisms that involve maternal, placental and foetal immune function and inflammation (DES and CMV).WIDER IMPLICATIONSThe significance of this review is to offer a causal approach to classify the large number of potentially harmful exposures in pregnancy when the exposure occurs in the first trimester. Our review will facilitate future research by advancing knowledge of the first trimester mechanisms necessary for researchers to effectively associate environmental exposures with child health outcomes.

Nowadays, increasing the efficiency of the production process and determining the methods of measuring performance is the most significant challenge faced by managers by increasing competition among companies and manufacturing centers. The present study aimed to evaluate the performance of production scenarios. In this regard, the production processes of an automotive industrial plant were simulated by the simulation approach. Then, an integrated approach to optimization methods was applied to optimize the simulation model and reach the efficient production scenario. First, the scenarios were defined using the 2k factorial design. Then, the weight of the response variables and decision variables were determined by the fuzzy step-wise weight assessment ratio analysis method. Further, the efficiency of scenarios was calculated by the fuzzy ratio efficiency dominance model, and the optimal scenario was obtained. This approach was implemented in an automobile manufacturing industry in Iran, and the accurate analysis was applied to the proposed approach. The results indicated that, compared to previous studies, the proposed approach is a practical way for determining the optimal scenario in a complex production system, and can help the managers to make efficient decisions to increase profit and productivity.

This study aims to explore the perceptions of gastric cancer patients, their family caregivers, physicians, and nurses of nutritional challenges. Using a descriptive qualitative method, this study was conducted in 2019–2020. Twenty participants (6 patients, 6 family caregivers, 3 physicians, and 5 nurses) were selected through purposive sampling. Data was collected through in-depth semi-structured interviews and examined using qualitative content analysis. Data analysis revealed three categories, each with two subcategories: eating, an unpleasant experience that contains “a feeling like hyperemesis gravidarum” and “childish food excuses”; flexibility while adhering to a proper diet, which consists of “dietary dos and don’ts” and “nutritional leniency”; and nutrition with distress that contains “patient’s sense of being an extra burden” and “provision of nutrition with suffering in caregivers.” Because of the significant physical and psychological impact of nutritional problems on patients and their caregivers, the need to provide care and education to these patients and their families using a multidisciplinary team is becoming more important.

Background/aims Despite huge evidence on the link between adherence to dietary approaches to stop hypertension (DASH) eating pattern and several metabolic abnormalities, the association of this diet with irritable bowel syndrome (IBS) has not been investigated so far. We aim to examine the association between adherence to the DASH diet and prevalence of IBS symptoms and subtypes in adults. Methods This cross-sectional study was done among 3362 adult people in Isfahan, Iran. Usual dietary intakes were assessed using a validated 106-item dish-based semi-quantitative food frequency questionnaire. To investigate participants' adherence to DASH-style diet, we created DASH score based on 8 main foods and nutrients emphasized or minimized in the DASH diet. Participants were classified into 3 categories according to their DASH-style diet scores. A validated modified Persian version of the Rome III questionnaire was applied for assessment of IBS. Results Totally, 22.2% of study participants were affected by IBS. After adjustment for potential confounding factors, we found that participants in the highest tertile of DASH score had lower odds of IBS (OR, 0.65; 95% CI, 0.50-0.83) compared with those in the lowest tertile. The same findings were also reached for IBS with constipation (OR for the highest vs the lowest tertile of DASH-style diet = 0.56; 95% CI, 0.38-0.85). No significant association was seen between adherence to DASH-style diet and IBS with diarrhea (OR, 1.31; 95% CI, 0.83-2.06). Conclusions We found a significant inverse association between adherence to DASH dietary pattern and odds of IBS and IBS with constipation. Further prospective studies are required to confirm these findings.

International audience; Multimodal learning, also known as multi-view learning, data integration, or data fusion, is an emerging field in signal processing, machine learning, and pattern recognition domains. It aims at building models, learned from several related and complementary modalities, in order to increase the generalization performances of a predictive learning model. Multimodal manifold learning extends spectral or diffusion geometry-aware data analysis to multiple modalities. This can be performed through the definition of undirected graph Laplacian matrices in different modalities. However, finding common eigenbasis of multiple Laplacians is not always a relevant solution for multimodal manifold learning problems. As a matter of fact, the Laplacians of all modalities are not simultaneously diagonalizable in many real-world problems due to the major differences between the different modalities. In this paper, we propose a multimodal manifold learning approach based on intrinsic local tangent spaces of underlying data manifolds in order to discover the local geometrical structure around matching and mismatching samples in different modalities in sparse diagonalization problems. This approach searches for approximate common eigenbasis of Laplacian matrices by expanding the signal of limited existing information about matching and mismatching samples of different modalities to their on-manifold neighbors. Experiments on synthetic and real-world datasets in supervised, unsupervised, and semi-supervised problems demonstrate the superiority of our proposed approach over existing state-of-the-art related methods.

The depth map captured by depth sensors (e.g., the time of flight (ToF) and Kinect) is often prone to low resolution, degradation, noise, and poor quality. This paper proposes a novel model for the robust depth estimation of RGB-D images through local and nonlocal manifold regularizations. The first stage called deep depth prior manifold (DDPM), is inspired partly by the deep depth prior (DDP) model, that is a deep convolutional neural network (CNN) integrated with a local manifold regularization term. The local neighboring relationships between depth pixels and color images are employed to promote smoothing in the results. The Laplacian Eigenmap technique used for local manifold modeling produces over-smooth depth map. To improve the quality of the reconstructed image, a nonlocal manifold modeling stage was suggested, where the similarity between the depth and the corresponding color image is determined by characterizing their matching aspects. These objectives are aggregated within an optimization problem. Moreover, to extract edges better considering visual nonlocal characteristics, the structured low-rank Hankel approximation was adopted to better eliminate depth degradations, and to extract highly promoted edges and sharp points. Three types of the degradations were handling in this work, containing undersampling, ToF-like, and Kinect-like degradations. Experimental results indicate that the proposed method outperformed the state-of-the-art restoration techniques on standard benchmark images, in terms of well-known criteria like PSNR.

PURPOSE OF REVIEW: In this review, we provide essential background knowledge and an analytical framework for the application of placental-fetal molecular biomarkers in fetal origins chronic disease epidemiology. The widely available and highly quantitative placental hormone human chorionic gonadotropin (hCG) is used as an example. hCG is currently used for diagnosing fetal genetic disorders; yet it can and should be expanded to understanding the fetal origins of chronic diseases. We provide justification and methods to do this. RECENT FINDINGS: Ten papers published in the last 5 years were identified with supportive findings relevant to the application of biomarkers of hCG in epidemiologic studies on the developmental origins of health and disease (DOHaD). SUMMARY: There is increasing and consistent evidence that placental-fetal biomarkers may be highly informative in observational studies, as exemplified by hCG, with the correct approaches for measurement and data analysis.

Concrete buildings reinforced by plain bars are one of the special types of old structures generally built before the 1970s. According to the experiences of earthquakes and experimental tests, the ...

Objective Both temporomandibular disorders (TMDs) and sleep bruxism (SB) are known to be destructive to the masticatory system. However, the association between the 2 conditions is poorly understood. The aim of our study was to assess the relationship between TMD and SB through the signs and symptoms in 2 patient groups: TMD only and TMD with SB. Study Design A retrospective chart review was conducted from November 1, 2015, to April 1, 2018, on patients with completed International Network for Orofacial Pain and Related Disorders Methodology history questionnaires and Diagnostic Criteria for Temporomandibular Disorder clinical examinations. Fifty-two patients, including 12 with TMD only and 40 with TMD with SB, met the study criteria. Subjective descriptions and objective measurements of patient symptoms were investigated. The χ2 test and Fisher's exact test were used for statistical analysis. Results The TMD with SB group exhibited increased oral behaviors compared with the TMD-only group (P = .0004). The TMD with SB group also experienced more headaches compared with the TMD-only group (P = .045). Conclusions Our results revealed that patients with jaw pain who self-report increased oral behaviors and/or exhibit temporal headaches should be evaluated for sleep bruxism.

The aim of this study was to compare the accuracy of ultrasonography and magnetic resonance imaging (MR) in the antenatal diagnosis of placenta accreta. We also determined the most relevant sonographic and MR features associated with the diagnosis of placenta accreta. In a prospective observational study approved by the Ethical Board of the Radiology Department, 109 pregnant women who were at high risk for Placenta Accreta were enrolled. The placentas of all cases were scanned using both gray-scale and color Doppler transabdominal sonography. MR was performed when sonographic findings were equivocal or inconclusive. The sonographic and MR features were compared with the final pathologic or clinical findings. The sensitivity and specificity were calculated for both sonography and MR. The role of each sonographic and MR feature was calculated by logistic regression. P < 0.05 was considered as the significance level. The sensitivity and specificity of ultrasonography for the diagnosis of Placenta Accreta spectrum were 87% and 85% (P < 0.001), while those of MR were 100% and 42% (P = 0.1), respectively. In ultrasonography, myometrium thickness ≤ 1 mm with a sensitivity of 83% (95 CI: 0.765, 0.927) and loss of retroplacental clear space with a sensitivity of 81% (95 CI: 0.755, 0.920) had the best sensitivity for the detection of the placental invasion. On MR, the heterogeneous signal intensity of placenta and uterine bulging with a sensitivity of 87% (95 CI: 0.698, 1.04) had the best sensitivity. Placenta accreta can be successfully detected prenatally using ultrasound. MR is useful in equivocal cases.

Limited data are available linking breakfast consumption to Heart Burn Syndrome (HBS). This study was done to investigate to find whether breakfast consumption is associated with HBS. This cross-sectional study was done to investigate the association between breakfast consumption and HBS among Iranian adults. This cross-sectional study was performed among 4763 general adults of Isfahan, Iran. Participants’ patterns of breakfast eating were assessed by asking two questions from them. How often do you eat breakfast in a week?” Participants were able to respond as: "never or 1 day/wk", "2–4 days/wk", "5–6 days/wk", "every day". HBS was defined as the presence of HBS at sometimes, often or always using a Persian version of validated self-administered modified ROME III questionnaire. Totally, 4763 patients with HBS completed this cross-sectional study, where about 32.4% of them intake breakfast less than one time per week. After controlling for potential confounders, participants who consumed breakfast every day had a 43% lower risk for having HBS as compared with those who had breakfast ≤ 1 times/wk (OR 0.57; 95% CI 0.41–0.80). A significant inverse relationship was found between breakfast consumption and frequent than scare HBS (OR 0.57; 95% CI 0.40–0.77) among the whole population, not in patients with HBS. No significant association was observed between breakfast intake and severity of HBS (OR 0.56; 95% CI 0.31–1.04). We found an inverse association between frequency of breakfast consumption and odds of HBS as well as the frequency of HBS among the adult population. Prospective studies are required to confirm these findings. Level V, cross-sectional descriptive study.

The value of early detection and treatment of chronic obstructive pulmonary disease (COPD) is currently unknown. We assessed the cost effectiveness of primary care-based case detection strategies for COPD. A previously validated discrete event simulation model of the general population of COPD patients in Canada was used to assess the cost effectiveness of 16 case detection strategies. In these strategies, eligible patients (based on age, smoking history, or symptoms) received the COPD Diagnostic Questionnaire (CDQ) or screening spirometry, at 3- or 5-year intervals, during routine visits to a primary care physician. Newly diagnosed patients received treatment for smoking cessation and guideline-based inhaler pharmacotherapy. Analyses were conducted over a 20-year time horizon from the healthcare payer perspective. Costs are in 2019 Canadian dollars ($). Key treatment parameters were varied in one-way sensitivity analysis. Compared to no case detection, all 16 case detection scenarios had an incremental cost-effectiveness ratio (ICER) below $50,000/QALY gained. In the most efficient scenario, all patients aged ≥ 40 years received the CDQ at 3-year intervals. This scenario was associated with an incremental cost of $287 and incremental effectiveness of 0.015 QALYs per eligible patient over the 20-year time horizon, resulting in an ICER of $19,632/QALY compared to no case detection. Results were most sensitive to the impact of treatment on the symptoms of newly diagnosed patients. Primary care-based case detection programs for COPD are likely to be cost effective if there is adherence to best-practice recommendations for treatment, which can alleviate symptoms in newly diagnosed patients.

Abstract. Objective: The prevalence of depression and anxiety is increasing worldwide. Diet as a modifiable factor for mental health has received great attention. The aim of the present study was to evaluate the association of vitamin B6 intake with depression and anxiety. Methods: This cross-sectional study was performed among 3362 adults in 2011. Anxiety and depression were evaluated using an Iranian validated version of the Hospital Anxiety and Depression Scale (HADS) questionnaire. Dietary intakes were evaluated by a validated 106 item self-administered Willett-format dish-based semi quantitative food-frequency questionnaire (DFQ). Results: The mean intake of vitamin B6 (mg/day) was significantly lower in anxious (1.93 ± 0.74 vs. 2.0 ± 0.74; P = 0.02) and depressed (1.86 ± 0.72 vs. 1.99 ± 0.74; P = 0.001) people than healthy participants. The lower level of vitamin B6 intake (tertile 1), after adjustment for the impacts of various confounding variables, in total population and women was associated with the higher odds of depression (OR = 1.41; 95% CI: 1.19, 2.31; P

Summary Background Accurate prediction of exacerbation risk enables personalised care for patients with chronic obstructive pulmonary disease (COPD). We developed and validated a generalisable model to predict individualised rate and severity of COPD exacerbations. Methods In this risk modelling study, we pooled data from three COPD trials on patients with a history of exacerbations. We developed a mixed-effect model to predict exacerbations over 1 year. Severe exacerbations were those requiring inpatient care. Predictors were history of exacerbations, age, sex, body-mass index, smoking status, domiciliary oxygen therapy, lung function, symptom burden, and current medication use. Evaluation of COPD Longitudinally to Identify Predictive Surrogate End-points (ECLIPSE), a multicentre cohort study, was used for external validation. Results The development dataset included 2380 patients, 1373 (58%) of whom were men. Mean age was 64·7 years (SD 8·8). Mean exacerbation rate was 1·42 events per year and 0·29 events per year were severe. When validated against all patients with COPD in ECLIPSE (mean exacerbation rate was 1·20 events per year, 0·27 events per year were severe), the area-under-curve (AUC) was 0·81 (95% CI 0·79–0·83) for at least two exacerbations and 0·77 (95% CI 0·74–0·80) for at least one severe exacerbation. Predicted exacerbation and observed exacerbation rates were similar (1·31 events per year for all exacerbations and 0·25 events per year for severe exacerbations vs 1·20 events per year and 0·27 events per year). In ECLIPSE, in patients with previous exacerbation history (mean exacerbation rate was 1·82 events per year, 0·40 events per year were severe), AUC was 0·73 (95% CI 0·70–0·76) for two or more exacerbations and 0·74 (95% CI 0·70–0·78) for at least one severe exacerbation. Calibration was accurate for severe exacerbations (predicted 0·37 events per year vs observed 0·40 events per year) and all exacerbations (predicted 1·80 events per year vs observed 1·82 events per year). Interpretation This model can be used as a decision tool to personalise COPD treatment and prevent exacerbations. Funding Canadian Institutes of Health Research.

Although the regularized over-complete auto-encoders have shown great ability to extract meaningful representation from data and reveal the underlying manifold of them, their unsupervised learning nature prevents the consideration of class distinction in the representations. The present study aimed to learn sparse, robust, and discriminative features through supervised manifold regularized auto-encoders by preserving locality on the manifold directions around each data and enhancing between-class discrimination. The combination of triplet loss manifold regularization with a novel denoising regularizer is injected to the objective function to generate features which are robust against perpendicular perturbation around data manifold and are sensitive enough to variation along the manifold. Also, the sparsity ratio of the obtained representation is adaptive based on the data distribution. The experimental results on 12 real-world classification problems show that the proposed method has better classification performance in comparison with several recently proposed relevant models.

The National Disability Insurance Scheme (NDIS) is considered to be the second greatest reform in healthcare in Australia after the introduction of Medicare in Australia in 1983. This reform was introduced in 2012 in two phases. The first phase as a trial took place for three years. The expectation was that the reform will be rolled out by 2019 or 2020. This article argues that the trial implementation process has achieved very positive outcomes in the lives of a great number of people with disability in Australia. At the same time, NDIS is facing many serious challenges in some areas. One of the obvious challenges is that this reform is a market approached reform. The second challenge relates to meeting the needs of minorities. People with disabilities from Culturally and Linguistically Divers (CALD) backgrounds are one of the five most venerable, underutilised users of NDIS services in Australia. They have no strong voice and negotiable abilities. The main question here is how NDIS is to meet its commitment to satisfy the needs of these vulnerable people in Australia.

Background: Catheter-related bloodstream infection (CRBI) is one of the main causes of mortality and morbidity among hemodialysis patients. Thus, documenting its prevalence and risk factors in each center will help control them and improve patients’ prognosis. Methods: This one-year cross-sectional study was performed in the educational hospitals of Shiraz University of Medical Sciences. Patients were selected using the census method. The included cases aged more than 18 years and had hemodialysis using a double lumen catheter. Finally, data were analyzed by SPSS analytical software. Results: In general, 345 patients with a mean age of 57.90±16.59 were included (192 men and 153 women) in this study. In addition, 138 (40%) patients had the elementary education and 127 (36.8%) study participants were housekeepers. Further, the subclavian vein was the most used site for the catheter (228 cases, 66.10%). Further, 187 (54.20%) cases had CRBI of whom, 181 patients had a previous history of CRBI. Furthermore, fever and chills at the time of hemodialysis were the most prevalent manifestations. Eventually, patients’ age, job, level of education, location of the catheter, previous history of CRBI, hand washing (patient and health-care personnel), use of gloves (health-care personnel), oral administration of antibiotics, use of topical antibiotic ointment, and the pattern of dressing change had a significant impact on the risk of CRBI (P

Association of lifestyle-related factors and mental health has been less studied in Middle Eastern countries. This study aimed to examine the prevalence of two common mental health problems, i.e., depression and anxiety, and their lifestyle determinants in a large sample of Iranian population. This study was conducted within the framework of SEPAHAN population based cross-sectional study (N=4763(. The General Practice Physical Activity Questionnaire (GPPAQ) was used to assess physical activity and the Iranian-validated version of Hospital Anxiety and Depression Scale (HADS) was applied to screen for anxiety and depression. Logistic regression was used as the main statistical method for data analysis by SPSS version 16.0. A P-value The risk of anxiety and depression was 2.5 (OR=2.56,95% CI: 1.97-3.33) and 2.21(1.83-2.67) times higher in women than men, respectively. With every one-year increase in the age, the risk of anxiety decreased by 2% (OR=0.98,95% CI:0.97-0.99). Individuals with higher education had 56% lower risk of anxiety (OR=0.44,95% CI: 0.36-0.55) and 46% depression (OR=0.54,95% CI: 0.46-0.64) than the undergraduate group, and the risk of depression in the inactive (less than one hour of activity per week) group was 27% higher than the active group (OR=1.27,95% CI: 1.06-1.51). The risk of anxiety in the non-smoker group was 65% (OR=0.35,95% CI: 0.20-0.59) and depression was 64% lower than among smokers (OR=0.34,95% CI:0.22-0.53). In the ex-smoker group, the risk of anxiety was 60% (OR=0.40,95% CI:0.19-0.85) and depression was 59% lower than for the smoker group (OR=0.41,95% CI: 0.24-0.73). This current study’s results demonstrated significant associations between unhealthy lifestyle factors and increased risk of anxiety and depression. Hence, special attention must be paid to preventive intervention programmes aiming to enhance healthy lifestyle among at-risk populations.

Challenges with the adoption of mobile banking technologies are best understood by studies on adoption. This however requires understanding the factors that influence its adoption in a given region...

Background Prediction of future lung function will enable the identification of individuals at high risk of developing COPD, but the trajectory of lung function decline varies greatly among individuals. This study involved the development and validation of an individualized prediction model of lung function trajectory and risk of airflow limitation in the general population. Methods Data were obtained from the Framingham Offspring Cohort, which included 4,167 participants ≥ 20 years of age and who had ≥ 2 valid spirometry assessments. The primary outcome was prebronchodilator FEV1; the secondary outcome was the risk of airflow limitation (defined as FEV1/FVC less than the lower limit of normal). Mixed effects regression models were developed for individualized prediction, and a machine learning algorithm was used to determine essential predictors. The model was validated in two large, independent multicenter cohorts (N = 2,075 and 12,913, respectively). Results With 20 common predictors, the model explained 79% of the variation in FEV1 decline in the derivation cohort. In two validation datasets, the model had low error in predicting FEV1 decline (root mean square error range, 0.18-0.22 L) and high discriminative power in predicting risk of airflow limitation (C-statistic range, 0.86-0.87). This model was implemented in a freely accessible website-based application, which allows prediction based on flexible sets of predictors (http://resp.core.ubc.ca/ipress/FraminghamFEV1). Conclusions The individualized predictor is an accurate tool to predict long-term lung function trajectories and risk of airflow limitation in the general population. This model enables identifying individuals at higher risk of COPD, who can then be targeted for preventive therapies.

Introduction Healthcare professionals should seek the necessary resources to improve the quality of care. Given the cultural, social, and economic differences, in every health care system, there are increasing needs for the adapted versions of clinical practice guidelines (CPGs). This study aimed to introduce an innovative CPG adaptation approach for nurses working in a developing country. Methods This study is comprised of three sections: a. An extensive systematic search of the literature, b. The adaptation process, c. Interviews, which were held with stakeholders, users and/or the target population. We applied all of the stages of guideline adaptation process according to Adaptation Resource Toolkit, with the integration of the findings of a systematic literature search and a qualitative content analysis in an "adolopted" new CPG. Results In this study, we applied a mix of three methods namely adoption, adaptation and development (adolopment) of recommendations to save time, cost, and manpower efficiently. Moreover, we integrated the utilized qualitative research method and literature review with the adolopment approach to develop the recommendations. Conclusion Given there is a paucity of nursing clinical practice guidelines (NCPGs) in the nursing management of cancer therapy-induced mucositis and to save time and costs, the findings emerging from the adoption, adaptation, and de novo guideline development by a panel of experts and qualitative content analysis (QCA) method were integrated to achieve a more comprehensive nursing practice guideline.

In this paper, we demonstrate a computationally efficient new approach based on deep learning (DL) techniques for analysis, design and optimization of electromagnetic (EM) nanostructures. We use the strong correlation among features of a generic EM problem to considerably reduce the dimensionality of the problem and thus, the computational complexity, without imposing considerable errors. By employing the dimensionality reduction concept using the more recently demonstrated autoencoder technique, we redefine the conventional many-to-one design problem in EM nanostructures into a one-to-one problem plus a much simpler many-to-one problem, which can be simply solved using an analytic formulation. This approach reduces the computational complexity in solving both the forward problem (i.e., analysis) and the inverse problem (i.e., design) by orders of magnitude compared to conventional approaches. In addition, it provides analytic formulations that, despite their complexity, can be used to obtain intuitive understanding of the physics and dynamics of EM wave interaction with nanostructures with minimal computation requirements. As a proof-of-concept, we applied such an efficacious method to design a new class of on-demand reconfigurable optical metasurfaces based on phase-change materials (PCMs). The experimental results of the fabricated devices are in good agreement with those predicted by the proposed approach. We envision that the integration of such a DL-based technique with full-wave commercial software packages offers a powerful toolkit to facilitate the analysis, design, and optimization of the EM nanostructures as well as explaining, understanding, and predicting the observed responses in such structures. It will thus enable to solve complex design problems that could not be solved with existing techniques.

There has been an increasing prevalence of ad-hoc networks for various purposes and applications. These include Low Power Wide Area Networks (LPWAN) and Wireless Body Area Networks (WBAN) which have emerging applications in health monitoring as well as user location tracking in emergency settings. Further applications can include real-time actuation of IoT equipment, and activation of emergency alarms through the inference of a user's situation using sensors and personal devices through a LPWAN. This has potential benefits for military networks and applications regarding the health of soldiers and field personnel during a mission. Due to the wireless nature of ad-hoc network devices, it is crucial to conserve battery power for sensors and equipment which transmit data to a central server. An inference system can be applied to devices to reduce data size for transfer and subsequently reduce battery consumption, however this could result in compromising accuracy. This paper presents a framework for secure automated messaging and data fusion as a solution to address the challenges of requiring data size reduction whilst maintaining a satisfactory accuracy rate. A Multilayer Inference System (MIS) was used to conserve the battery power of devices such as wearables and sensor devices. The results for this system showed a data reduction of 97.9% whilst maintaining satisfactory accuracy against existing single layer inference methods. Authentication accuracy can be further enhanced with additional biometrics and health data information.

A global shortfall in protein supply from capture fisheries has motivated the Malaysian government to revise its aquaculture strategy, focusing on three commodities: seaweed, fish and marine shrimp. However, the performance of the Malaysian aquaculture sector, particularly seaweed production, is poorly documented. This is the first empirical study to undertake a value chain analysis (VCA) of the Malaysian seaweed sector using stakeholder perceptions and secondary data that encompass members of seaweed farming cooperatives (the Semporna Area Farmers’ Association and the governments’ flagship Seaweed Cluster Project). Fieldwork was conducted between April and June 2015 among seaweed stakeholders involved in the value chain using a mixed methods approach—in-depth interviews with key informants, focus group discussions, household surveys, personal observation and secondary data. Qualitative and quantitative data were collected from both upstream (seaweed farming, marketing structure and the Malaysian Good Aquaculture Practices [MyGAP] certification programme) and downstream (seaweed processing) activities involving farmers, intermediaries/middlemen (buyers), processors and officials. Kappaphycus spp. was sold in two forms: (1) dried seaweed to be used as raw materials in carrageenan processing (approximately 90% of total harvest) and (2) fresh seaweed to be used as a source of seedlings (approximately 10% of total harvest). The value chain ended with the carrageenan form, which is exported to international markets. The price of dried seaweed varied according to a combination of seaweed quality, the strength of farmer’s relationships with intermediaries and processors and in response to demand from the carrageenan industry. The prices obtained by Malaysian farmers for dried seaweed and carrageenan remained low, US$ 0.60 and US$ 4.43 per kg, respectively, despite efforts by the government to enhance the value chain by imposing seaweed standards (via MyGAP) for farm management, dried seaweed and semi-refined carrageenan. The VCA was a useful tool to identify and map the market, with the results providing a better understanding of the seaweed sector, which could be helpful in supporting further aquaculture development in Malaysia.

Data classification with decision tree models is an attractive method in data analysis and data mining. However, compared to other classification methods, the quality of prediction of these models is lower when classic heuristics and local optimization training methods are employed. To improve the performance of these models for single output and multiple outputs data sets, an optimal tree construction method based on the genetic algorithm is presented. The presented bi-level discrete-continues genetic algorithm method is able to select effective features as well as construct optimal tree. For this purpose, new operators of selection, crossover, and mutation are designed in terms of continuous and discrete variables. Comparison of the proposed method with other well-known classification methods for some test data sets and real world data shows that the performance of the decision tree models has been upgraded to the best of prediction methods level.

Sustainably managed wild fisheries support food and nutritional security, livelihoods, and cultures (1). Harmful fisheries subsidies—government payments that incentivize overcapacity and lead to overfishing—undermine these benefits yet are increasing globally (2). World Trade Organization (WTO) members have a unique opportunity at their ministerial meeting in November to reach an agreement that eliminates harmful subsidies (3). We—a group of scientists spanning 46 countries and 6 continents—urge the WTO to make this commitment...

Coupled-mode theory (CMT) has been widely used in optics and photonics design. Despite its popularity, several different formulations of CMT exist in the literature, and their applicable range is not entirely clear, in particular when it comes to high-index-contrast photonics platforms. Here we propose an improved formulation of CMT and demonstrate its superior performance through numerical simulations that compare CMT-derived quantities with supermode calculations and full wave propagation simulations. In particular, application of the improved CMT to asymmetric waveguides reveals a necessary correction in the conventional phase matching condition for high-index-contrast systems, which could lead to more accurate photonic circuit designs involving asymmetric elements.

Statistical constructs such as ROC/AUC do not answer the critical question of how much clinical utility a risk prediction model confers. This paper overviews decision curve analysis, a novel method for quantifying net benefit of a risk prediction model.https://bit.ly/3h1rraX

Providing health care in times of complex emergencies (CEs) is one of the most vital needs of people. CEs are situations in which a large part of the population is affected by social unrest, wars, and food shortages. This systematic review study was conducted to identify the challenges of health-care delivery in CEs. We searched terms related to health-care delivery and CEs in PubMed, Web of Sciences, Science Direct, and Google scholar databases, as well as Persian databases SID and Magiran. The searching keywords included: “Health Care, Complex Crises, War, Humanitarian, Refugees, Displaced Persons, Health Services, and Challenges.” Of 409 records, we selected 6 articles based on the Preferred Reporting Items for Systematic Reviews (PRISMA) checklist. Studies were analyzed through qualitative content analysis. The results show that CEs affect health-care delivery in 4 primary areas: the workforce, infrastructure, information access, and organization of health services. These areas can pose potential threats for health-care providers and planners at times of emergencies. Thus, they should be informed about these challenges to strengthen the health-care system.

Background: Magnetic resonance cholangiopancreatography (MRCP) is a noninvasive method to detect pancreaticobiliary strictures. In this study, we aimed to evaluate the diagnostic performance of MRCP and detect sensitive and specific radiologic features in distinguishing malignant and benign pathologies. Materials and Methods: In this study, 50 patients with biliary obstruction and a confirmed diagnosis using histopathology were included. The pathologies were evaluated using MRCP which were categorized into malignant and benign strictures. The etiology of strictures was detected using histopathology and endoscopic retrograde cholangiopancreatography. The diagnostic performance of MRCP was calculated using SPSS software. P < 0.05 was considered statistically significant. Results: Of 50 patients, 23 patients (46%) had malignant strictures based on MRCP and histopathology. The sensitivity and specificity of MRCP to detect malignancy were 95.7% and 96.3%, respectively. The most sensitive MRCP features to detect malignancy were upstream biliary duct dilation, abrupt tapering, and the presence of a solid mass with sensitivity 100%, 95.7%, and 78.2%, respectively. The malignancy rate was significantly higher in the strictures with length >11.5 mm or wall thickness >2.75 mm (P < 0.05). Conclusion: MRCP is a sensitive method to differentiate malignant lesions from benign pathologies. A long and thick stricture with the presence of a solid mass, upstream biliary duct dilation, and abrupt tapering is highly suggestive of malignancy.

Subwavelength nonlinear optical sources with high efficiency have received extensive attention, although strong dynamic controllability of these sources is still elusive. Germanium antimony telluride (GST) as a well-established phase-change chalcogenide is a promising candidate for the reconfiguration of subwavelength nanostructures due to the strong non-volatile change of the index of refraction between its amorphous and crystalline states. Here, we numerically demonstrate an electromagnetically-induced-transparency-based silicon metasurface actively controlled with a quarter-wave asymmetric Fabry–Perot cavity incorporating GST to modulate the relative phase of incident and reflected pump beams. We demonstrate a giant third-harmonic generation (THG) switch with a modulation depth as high as ∼ 70 d B at the resonant band. We also demonstrate the possibility of multi-level THG amplitude modulation for the fundamental C-band by controlling the crystallization fraction of GST at multiple intermediate states. This study shows the high potential of GST-based fast dynamic nonlinear photonic switches for real-world applications ranging from communications to optical computing.

We present a new platform for integrated photonic sensing, for the first time, using high-Q SiC slot-ring resonators with Qs of 17,400. We experimentally demonstrate device's capability for bulk sensing with a sensitivity of 264 nm/RIU and for biomolecular layer sensing through troponin biomarker detection.

Background Adherence to prescribed medication is essential for glycemic control and to delay the onset of complications. However, information on medication adherence among patients with Type 2 diabetes mellitus is sparse in Bangladesh. This study aimed to determine medication adherence and factors associated with low adherence in patients with Type 2 diabetes in Bangladesh. Methods A cross‐sectional study was conducted among 500 consecutive patients with Type 2 diabetes attending a tertiary hospital in Bangladesh between September 2013 and July 2014. Data were collected on sociodemographic and clinical characteristics, medication use and adherence, and blood tests for glycated hemoglobin. Medication adherence was assessed using the 8‐item Morisky Medication Adherence Scale (score range 0–8), and a score

Positional information is a central concept in developmental biology. In developing organs, positional information can be idealized as a local coordinate system that arises from morphogen gradients controlled by organizers at key locations. This offers a plausible mechanism for the integration of the molecular networks operating in individual cells into the spatially-coordinated multicellular responses necessary for the organization of emergent forms. Understanding how positional cues guide morphogenesis requires the quantification of gene expression and growth dynamics in the context of their underlying coordinate systems. Here we present recent advances in the MorphoGraphX software (Barbier de Reuille et al. eLife 2015;4:e05864) that implement a generalized framework to annotate developing organs with local coordinate systems. These coordinate systems introduce an organ-centric spatial context to microscopy data, allowing gene expression and growth to be quantified and compared in the context of the positional information thought to control them.