Search

José Maria Pereira de Godoy1, Lina MO Azoubel2, Maria de Fátima Guerreiro Godoy2,31Department of Cardiology and Cardiovascular Surgery, Medicine School of São Jose do Rio Preto-FAMERP, Brazil; 2Godoy Clinic, Lymphovenous Rehabilitation, Medicine School, São José do Rio Preto-FAMERP, Brazil; 3CAPES (Coordination of improvement of Personal of Superior Level), Rio de Janeiro, BrazilAbstract: The aim of the current study is to report on the minimal surgical treatment of elephantiasis of the feet to facilitate the use of compression mechanisms. The cases of two patients with congenital lymphedema that evolved to elephantiasis involving the feet are reported. Intensive treatment of the lymphedema was performed with a significant reduction in size thus allowing a better identification of the limits of tissue masses for the surgical approach. This reduction enabled primary suturing of the lesions to be carried out and fast healing of the wounds. The surgery greatly improved large deformities of the toes and feet and facilitated further treatment of the lymphedema using bandaging. Thus, the skin was preserved, there was a reduction in the size of the feet, and the patients were able to start wearing shoes.Keywords: elephantiasis, surgical treatment, feet, lymphedema

Abstract The impact of Bariatric Surgery (BS) on maternal and neonatal outcomes among pregnant women is not fully understood, especially in comparison to different weight categories. The primary aim of this study is to assess the factors associated to women who have undergone BS. The study also investigates the maternal and neonatal outcomes amongst this group in comparison to the three Body Mass Index (BMI) groups (women with obesity, overweight and normal weight). A 12-month population-based retrospective study was conducted using registry data from the PEARL-Peristat Study at the Women's Wellness and Research Center (WWRC) in Qatar from January 1, 2017, through December 31, 2017. Both univariate and multivariable regression analyses were employed to scrutinize risk factors and maternal and neonatal outcomes. The study included 6212 parturient women, of which 315 had a history of BS, while 5897 with no BS history. Qatari women, aged 35 and higher, with parity > 1, diabetes, and hypertension were more likely to be in the post-BS group. Women in the post-BS group were found to be more likely to have a cesarean delivery (37.5% vs. 24%, Adjusted Odds Ratio (aOR) = 1.59, CI 1.18–2.14), preterm babies (10% vs. 7%, aOR = 1.66, CI 1.06–2.59), and stillbirth (1.6% vs. 0.4%, aOR = 4.53, CI 1.33–15.50) compared to the normal weight women group. Moreover, post-BS women had a higher risk of low-birth-weight neonates than women with obesity (15% vs. 8%, aOR = 1.77, CI 1.153–2.73), overweight (15% vs. 7%, aOR = 1.63, CI 1.09–2.43), and normal weight (15% vs. 8%, aOR = 1.838, CI 1.23–2.75). Finally, women in the post-BS group were more likely to have low-birth-weight neonates amongst term babies than women with obesity and overweight. Pregnancies with post-BS should be considered a high-risk group for certain medical outcomes and should be monitored closely. These findings may guide the future clinical decisions of antenatal and postnatal follow-up for post-BS women.

Abstract Abuse of the highly toxic compound fentanyl and its analogues is increasing, raising serious public health concerns due to their potency and availability. Therefore, there is a need for decontamination methodologies to safely remove fentanyl to avoid harmful exposure. In this study, the efficacy of commercial and in-house synthesized decontamination agents (Dahlgren Decon, RSDL (Reactive Skin Decontamination Lotion), FAST-ACT (First applied sorbent treatment against chemical threats), GDS2000, alldecont MED, bleach, Domestos Spray Bleach, Effekt Klor, MgO, TiO2-nanodiamond, and CeO2) were evaluated for the degradation of fentanyl and carfentanil under controlled laboratory conditions and on wooden floor surfaces. Liquid chromatography/mass spectrometry analysis showed that oxidative decontamination agents were the most effective, with N-oxides identified as major degradation products. The physiological effects of these N-oxides were also investigated regarding their ability to activate the µ-opioid receptor and their metabolism in human liver microsomes. The results provide empirical evidence that complements prior research findings on the degradation of fentanyl and carfentanil using a variety of decontamination agents.

Introduction A proportion of people develop Long Covid after acute COVID-19, but with most studies concentrated in high-income countries (HICs), the global burden is largely unknown. Our study aims to characterise long-term COVID-19 sequelae in populations globally and compare the prevalence of reported symptoms in HICs and low-income and middle-income countries (LMICs).Methods A prospective, observational study in 17 countries in Africa, Asia, Europe and South America, including adults with confirmed COVID-19 assessed at 2 to

IntroductionEngagement in public health policy development is critical to forward-thinking public health policy. There is a robust empirical case to support the prospect of the engagement of young adults in civic and research efforts. However, the literature is limited in conceptualizing the mechanisms of engagement in health policy development from the perspective of young adults. This study applied the concepts and methods of cognitive anthropology to identify the mechanisms of engagement in health policy development from the perspective of young people.MethodsOnline elicitation and cognitive domain analysis were applied to collect and analyze the data. Students enrolled in a public health leadership class at a large United States southeastern university were invited to participate in an online discussion. Saturation was achieved after the eighth submission. Data were analyzed qualitatively for repetition and recurrence and quantitatively to assess their cultural saliency.ResultsThirty-two students submitted 147 individual engagement ideas. The analysis resulted in 24 unique mechanisms organized into 10 clusters. The most prominent engagement mechanisms included education, peer activities, advocacy, direct involvement, and activism.DiscussionIn the dynamic landscape of public health, active involvement in health policy development presents a crucial pathway for leadership among young professionals. The application of cognitive anthropology methods contributes to the emerging science of engagement and allows to identify and measure consensus around the pathways for engagement in health policy development among young professionals.

Abstract Background Case analysis is a dynamic and interactive teaching and learning strategy that improves critical thinking and problem-solving skills. However, there is limited evidence about its efficacy as an assessment strategy in nursing education. Objectives This study aimed to explore nursing students’ perceived efficacy of case analysis as an assessment method for clinical competencies in nursing education. Methods This study used a mixed methods design. Students filled out a 13-item study-advised questionnaire, and qualitative data from the four focus groups was collected. The setting of the study was the College of Nursing at Sultan Qaboos University, Oman. Descriptive and independent t-test analysis was used for the quantitative data, and the framework analysis method was used for the qualitative data. Results The descriptive analysis of 67 participants showed that the mean value of the perceived efficacy of case analysis as an assessment method was 3.20 (SD = 0.53), demonstrating an 80% agreement rate. Further analysis indicated that 78.5% of the students concurred with the acceptability of case analysis as an assessment method (mean = 3.14, SD = 0.58), and 80.3% assented its association with clinical competencies as reflected by knowledge and cognitive skills (m = 3.21, SD = 0.60). No significant difference in the perceived efficacy between students with lower and higher GPAs (t [61] = 0.05, p > 0.05) was identified Three qualitative findings were discerned: case analysis is a preferred assessment method for students when compared to MCQs, case analysis assesses students’ knowledge, and case analysis assesses students’ cognitive skills. Conclusions This study adds a potential for the case analysis to be acceptable and relevant to the clinical competencies when used as an assessment method. Future research is needed to validate the effectiveness of case analysis exams in other nursing clinical courses and examine their effects on academic and clinical performance.

ABSTRACT Background Contraceptive counselling and utilization for kidney transplant patients is a vital component of their kidney transplant care. The use of standardized information on contraceptive methods to prevent unplanned post‐transplant pregnancies in Africa in general is less studied. This study aimed to describe contraceptive counselling and uptake among kidney transplant recipients at a kidney transplant centre in Ethiopia. Methods A descriptive study on contraceptive counselling and uptake among female Ethiopian kidney transplant recipients was conducted at St. Paul's Hospital Millennium Medical College (Ethiopia) from April 15 to July 15, 2023. Data on women's sociodemographic, renal transplantation and contraceptive counselling and use were collected through interviewing the participants using a structured questionnaire. Data were analyzed on SPSS 23 using simple descriptive analysis. Percentages and frequencies were used to present the results. Results A total of 60 participants were included in the final analysis. The mean age of the participants was 33.7 ± 8.4 years. The median duration from the time of renal transplant was 19 months. Most (49/60, 81.7%) of the participants reported that they did not receive family planning counselling on contraceptive methods in the early post‐transplant phase. The rate of contraceptive uptake was 8.3% (5/60) with two patients being copper IUD users, and Implanon, tubal ligation and combined oral contraceptives each utilized by a single kidney transplant patient. Conclusion Contraceptive counselling and uptake rates among female kidney transplant recipients in this study were very low, which is consistent with findings from previous studies. Increasing female kidney transplant patients’ awareness on safe and effective contraceptive use through adequate contraceptive counselling is essential.

This study aimed to assess the prevalence and factors associated with lipid profile abnormalities of children aged 6 to 42 months in a Central-West Brazilian capital city. This cross-sectional study used data from the baseline of a cluster-randomized clinical trial conducted in parallel. It evaluated the lipid profile, usual nutrients intake (direct food-weighing method and 24-hour dietary recall), anthropometric parameters, and socioeconomic aspects of 169 children from early childhood education centers. Poisson regression with robust variance analysis was conducted. Of the total sample, 85% had dyslipidemia, 72% had high-density lipoproteins (HDL-c) levels below the desired range, 49% had increased triglycerides (TG), 17% exhibited elevated low-density lipoproteins (LDL-c), and 15% showed high total cholesterol (TC). An increase in the body mass index (BMI) for age z-score was associated with a higher prevalence of increased TG (PR = 1.22; 95%CI: 1.05-1.41; p = 0.009). Higher age in children was associated with an increased prevalence of high LDL-c (PR = 1.037; 95%CI: 1.01-1.07; p = 0.022) and TC (PR = 1.036; 95%CI: 1.00-1.07; p = 0.037), however it was a protective factor against low HDL-c (PR = 0.991; 95%CI: 0.98-1.00; p = 0.042). High energy intake was associated with low HDL-c (PR = 1.001; 95%CI: 1.00-1.00; p = 0.023). A higher prevalence of increased LDL-c (PR = 1.005; 95%CI: 1.00-1.01; p = 0.006) and decreased HDL-c (PR = 1.002; 95%CI: 1.00-1.00; p < 0.001) were associated with dietary cholesterol intake. Most of the children presented at least one alteration in serum lipids. Lipid profile abnormalities were associated with higher BMI, older age, and increased caloric and cholesterol intake.

Abstract Objective: To estimate the economic burden associated with COVID-19 in Córdoba, Colombia, 2020 and 2021. Methods: Economic burden study. Direct costs were analyzed from the third-party payer perspective using healthcare administrative databases and interviews from a cohort of confirmed COVID-19 cases from Córdoba. Costing aggregation was performed by the bottom-up method. Indirect costs were estimated using the productivity loss approach. Contrast tests and statistical models were estimated at 5% significance. Results: We studied 1,800 COVID-19 cases. The average economic cost of COVID-19 per episode was estimated at US$ 2,519 (95%CI 1,980;3,047). The direct medical cost component accounted for 92.9% of the total; out-of-pocket and indirect costs accounted for 2% and 5.1%, respectively. Conclusion: COVID-19 economic cost was mainly due to direct medical costs. This study provided evidence of the economic burden faced by households due to COVID-19, with the most vulnerable households bearing much of the burden on their income.

Infectious disease outbreaks are associated with substantial stigma, which can have negative effects on affected persons and communities and on outbreak control. Thus, measuring stigma in a standardized and validated manner early in an outbreak is critical to disease control. We reviewed existing scales used to assess stigma during outbreaks. Our findings show that many different scales have been developed, but few have been used more than once, have been adequately validated, or have been tested in different disease and geographic contexts. We found that scales were usually developed too slowly to be informative early during an outbreak and were published a median of 2 years after the first case of an outbreak. A rigorously developed, transferable stigma scale is needed to assess and direct responses to stigma during infectious disease outbreaks.

This paper presents a single-element linearly polarized (LP) patch antenna characterized by a wide impedance bandwidth and low profile, optimized for 5G V2X applications. By inserting air gaps into the LP patch antenna structure, a circularly polarized (CP) antenna is generated. Moreover, a cross-stubs technique is employed to generate CP from LP, thereby enhancing the axial ratio (AR) bandwidth. In this work, we consider both linear and circular polarization patch antennas designed to operate suitable for V2X applications. The resonating structure for both antennas is designed on a 0.787 mm Rogers RT-duroid 5880 substrate with a relative permittivity of 2.2. The proposed design demonstrates resonance within the frequency range of 24 to 34 GHz and an AR bandwidth from 26.4 to 32.1 GHz. Additionally, the proposed design achieves a realized gain of 5.5 dBi along with a radiation efficiency of 94%. To extend the antenna’s gain capabilities, the single-element CP antenna is transformed into a series-fed 9-element array, achieving a maximum realized gain reaching 15.2 dBi and sidelobe levels (SLL) exceeding -17 dB. All proposed antennas are simulated, followed by fabrication and measurements, with the results demonstrating a good level of agreement between simulation and measurement. The proposed antennas’ low profile, wideband performance, and fabrication simplicity position them as ideal candidates for enhancing connectivity in next-generation V2X communications within the millimeter wave (mmWave) band.

In power-constrained wireless networks, extending network lifespan can be achieved through effective energy harvesting techniques. Developing energy-efficient routing protocols in such networks is complex due to the unstable and unpredictable harvested energy. In this regard, reconfigurable Intelligent Surfaces (RIS), capable of manipulating the RF signals, offer enhanced energy harvesting, which in turn minimizes the nodes’ battery recharging time (BRT). Our study presents a novel RIS-assisted routing protocol for multi-hop energy harvesting-based wireless networks. The protocol assigns channels to each hop on the chosen path. It incorporates a rate calculation algorithm that takes into consideration the harvested power, BRT, and channel conditions. More specifically, it assigns a specific rate to every available channel, taking into account the energy available at each node, the estimated time required for battery recharging, and the link status between nodes. By selecting the highest rate per hop, the protocol enhances network throughput while considering energy limits and channel quality. The proposed approach is evaluated and compared with the benchmark, the Min hop scheme, using MATLAB simulations, demonstrating its superior performance.

Heterogeneous wireless networks (HWNs) are essential in modern communication systems, as they seamlessly integrate various radio access technologies (RATs). In this context, network selection (NS) emerges as a pivotal element, responsible for selecting the most appropriate network for user equipment (UE) during transitions between RATs. Conventional NS mechanisms, such as the multi-attribute decision-making (MADM) methods, are commonly employed for their fast ranking of RATs, real-time support, and flexibility. However, they suffer from three primary limitations; the rank reversal problem (RRP), overlooking specific user/service requirements while favouring the highest-ranking RAT, and the associated frequent handovers. To address these limitations, in this paper, we first employ one of the most recent and effective MADM approaches, known as the measurement of alternatives and ranking according to the compromise solution (MARCOS), to model and solve the NS problem (MARCOS-NS) for the first time in the literature. We then propose novel sigmoid utility functions to assess the quality of each RAT attribute within the HWNs environment, taking into account user/application requirements. Further, we enhance MARCOS-NS by replacing its original normalization technique with the proposed sigmoid utility functions to overcome its limitation, creating a new MADM approach called MARCOS-Utility. Our results demonstrate the superiority of MARCOS-Utility over conventional MADM approaches as it completely eliminates the RRP, reduces vertical handover occurrences by an average of 33.1%, and achieves a balance between data rate and packet loss ratio for the streaming traffic class.

The continuous growth of urban populations has led to the persistent problem of traffic congestion, which imposes adverse effects on quality of life, such as commute times, road safety, and the local air quality. Advancements in Internet of Things (IoT) sensor technology have contributed to a plethora of new data streams regarding traffic conditions. Therefore, the recognition and prediction of traffic congestion patterns utilizing such data have become crucial. To that end, the integration of Machine Learning (ML) algorithms can further enhance Intelligent Transportation Systems (ITS), contributing to the smart management of transportation systems and effectively tackling traffic congestion in cities. This study seeks to assess a wide range of models as potential solutions for an ML-based multi-step forecasting approach intended to improve traffic congestion prediction, particularly in areas with limited historical data. Various interpretable predictive algorithms, suitable for handling the complexity and spatiotemporal characteristics of urban traffic flow, were tested and eventually shortlisted based on their predictive performance. The forecasting approach selects the optimal model in each step to maximize the accuracy. The findings demonstrate that, in a 24 h step prediction, variating Ensemble Tree-Based (ETB) regressors like the Light Gradient Boosting Machine (LGBM) exhibit superior performances compared to traditional Deep Learning (DL) methods. Our work provides a valuable contribution to short-term traffic congestion predictions and can enable more efficient scheduling of daily urban transportation.

BackgroundThe high number of unnecessary alarms in intensive care settings leads to alarm fatigue among staff and threatens patient safety. To develop and implement effective and sustainable solutions for alarm management in intensive care units (ICUs), an understanding of staff interactions with the patient monitoring system and alarm management practices is essential. ObjectiveThis study investigated the interaction of nurses and physicians with the patient monitoring system, their perceptions of alarm management, and smart alarm management solutions. MethodsThis explorative qualitative study with an ethnographic, multimethods approach was conducted in an ICU of a German university hospital. Using triangulation in data collection, 102 hours of field observations, 12 semistructured interviews with ICU staff members, and the results of a participatory task were analyzed. The data analysis followed an inductive, grounded theory approach. ResultsNurses and physicians reported interacting with the continuous vital sign monitoring system for most of their work time and tasks. There were no established standards for alarm management; instead, nurses and physicians stated that alarms were addressed through ad hoc reactions, a practice they viewed as problematic. Staff members’ perceptions of intelligent alarm management varied, but they highlighted the importance of understandable and traceable suggestions to increase trust and cognitive ease. ConclusionsStaff members’ interactions with the omnipresent patient monitoring system and its alarms are essential parts of ICU workflows and clinical decision-making. Alarm management standards and workflows have been shown to be deficient. Our observations, as well as staff feedback, suggest that changes are warranted. Solutions for alarm management should be designed and implemented with users, workflows, and real-world data at the core.

Background: COVID-19 is primarily known as a respiratory illness; however, many patients present to hospital without respiratory symptoms. The association between non-respiratory presentations of COVID-19 and outcomes remains unclear. We investigated risk factors and clinical outcomes in patients with no respiratory symptoms (NRS) and respiratory symptoms (RS) at hospital admission. Methods: This study describes clinical features, physiological parameters, and outcomes of hospitalised COVID-19 patients, stratified by the presence or absence of respiratory symptoms at hospital admission. RS patients had one or more of: cough, shortness of breath, sore throat, runny nose or wheezing; while NRS patients did not. Results: Of 178,640 patients in the study, 86.4 % presented with RS, while 13.6 % had NRS. NRS patients were older (median age: NRS: 74 vs RS: 65) and less likely to be admitted to the ICU (NRS: 36.7 % vs RS: 37.5 %). NRS patients had a higher crude in-hospital case-fatality ratio (NRS 41.1 % vs. RS 32.0 %), but a lower risk of death after adjusting for confounders (HR 0.88 [0.83–0.93]). Conclusion: Approximately one in seven COVID-19 patients presented at hospital admission without respiratory symptoms. These patients were older, had lower ICU admission rates, and had a lower risk of in-hospital mortality after adjusting for confounders.

Alzheimer's disease (AD) is the most common cause of dementia worldwide. Fifty million people today are affected by this disease globally. AD has had a tremendous impact on the affected individual, caregiver, and society, in both developed and developing nations. Donepezil—chitosan-gold nanocomposite (Donz-CS-AuNPs) was prepared by co-precipitation technique. Placket-Burman experimental design was used in this work to estimate the effect of the three independent variables (concentration of chitosan, gold, and donepezil) on the dependent variables (loading efficiency, and particle size) by using Minitab 18.1 software. The quantities for the independent variables used were: 10 and 40 mg of donepezil, 24.6 and 73.8 mg of gold, and 500 and 1500 mg of chitosan. The Donz-CS-AuNPs were characterized using energy dispersive X-ray (EDX) analysis, X-ray diffraction (XRD), scanning electron microscopy (SEM), Fourier transform infrared spectroscopy (FTIR), UV-Vis spectroscopy and release study. The results of EDX showed strong signals of Au (1.5–2, 2–2.5 and 9.5–10 keV), which confirmed the specific gold peaks from the Donz-CS-AuNPs. The XRD pattern of Donz-CS-AuNPs nanocomposites showed the existence of AuNPs peak at 2θ= 38.2°, 43.8° and 64.5°. The SEM images demonstrated spherical shapes of the AuNPs. In the in vitro release study, the release increased steeply and reached 75% after 1440 min.

Shunt is a flexible tube called a catheter implanted inside the brain where cerebrospinal fluid (CSF) is produced. Existing treatments rely on passive implantable shunts with differential pressure valves. The authors defined, designed, and programmed an intelligent wireless hydrocephalus shunting system. The shunting system was designed, simulated, and tested to carry out many tasks such as regulating the mechatronic valve, collecting Injection Control Pressure (ICP) readings, analyzing these readings, responding to all emergency cases, and diagnosing the whole shunting system. Nowadays, many challenges face clinical trials for new medical devices. Clinical trials are complex and require following several rules and regulations to ensure compliance with different standards. Due to the difficulty of using medical trials, an urgent need for a physical framework for implementing a virtual model of intracranial pressure and cerebrospinal fluid dynamics in hydrocephalus mechatronic shunt testing. Such a physical framework will play a vital role in assessing the functioning of the whole mechatronic shunting system. A framework of a mechatronic shunting system (implanted and external) is illustrated and integrated with embedded management and diagnosis software. Such a framework will help assess, test, and evaluate the main functions of the proposed shunting system.

Abstract Payments for Ecosystem Services (PES) provide conditional incentives for forest conservation. PES short-term effects on deforestation are well-documented, but we know less about program effectiveness when participation is sustained over time. Here, we assess the impact of consecutive renewals of PES contracts on deforestation and forest degradation in three municipalities of the Selva Lacandona (Chiapas, Mexico). PES reduced deforestation both after a single 5-year contract and after two consecutive contracts, but the impacts are only detectable in higher deforestation-risk parcels. Enrollment duration increases PES impact in these parcels, which suggests a positive cumulative effect over time. These findings suggest that improved spatial targeting and longer-term enrollment are key enabling factors to improve forest conservation outcomes in agricultural frontiers.

Abstract Background A manual approach to case investigation and contact tracing can introduce delays in response and challenges for field teams. Go.Data, an outbreak response tool developed by the World Health Organization (WHO) in collaboration with the Global Outbreak Alert and Response Network, streamlines data collection and analysis during outbreaks. This study aimed to characterize Go.Data use during COVID-19, elicit shared benefits and challenges, and highlight key opportunities for enhancement. Methods This study utilized mixed methods through qualitative interviews and a quantitative survey with Go.Data implementors on their experiences during COVID-19. Survey data was analyzed for basic univariate statistics. Interview data were coded using deductive and inductive reasoning and thematic analysis of categories. Overarching themes were triangulated with survey data to clarify key findings. Results From April to June 2022, the research team conducted 33 interviews and collected 41 survey responses. Participants were distributed across all six WHO regions and 28 countries. While most implementations represented government actors at national or subnational levels, additional inputs were collected from United Nations agencies and universities. Results highlighted WHO endorsement, accessibility, adaptability, and flexible support modalities as main enabling factors. Formalization and standardization of data systems and people processes to prepare for future outbreaks were a welcomed byproduct of implementation, as 76% used paper-based reporting prior and benefited from increased coordination around a shared platform. Several challenges surfaced, including shortage of the appropriate personnel and skill-mix within teams to ensure smooth implementation. Among opportunities for enhancements were improved product documentation and features to improve usability with large data volumes. Conclusions This study was the first to provide a comprehensive picture of Go.Data implementations during COVID-19 and what joint lessons could be learned. It ultimately demonstrated that Go.Data was a useful complement to responses across diverse contexts, and helped set a reproducible foundation for future outbreaks. Concerted preparedness efforts across the domains of workforce composition, data architecture and political sensitization should be prioritized as key ingredients for future Go.Data implementations. While major developments in Go.Data functionality have addressed some key gaps highlighted during the pandemic, continued dialogue between WHO and implementors, including cross-country experience sharing, is needed ensure the tool is reactive to evolving user needs.

Abstract Background Congenital airway malformations affect the quality of life and increase the family burden. The care of children who have these lesions requires considerable expenditures of time and other resources within a tertiary care center. Aim This work aims to determine the incidence of congenital airway malformations in children with airway-related manifestations detected by flexible fiberoptic bronchoscopy at the bronchoscopy unit of Alexandria University Children Hospital during the period from 1st of January 2019 to 31st of December 2019. Patients and methods This retrospective study includes symptomatic children who underwent flexible fiberoptic bronchoscopy from 1st of January 2019 to 31st of December 2019. Results The incidence of congenital airway malformations in the studied population was 32%. The mean age of patients at time of diagnosis was 7 months and the most common congenital anomaly was laryngomalacia. Conclusion We concluded that congenital airway malformations are not uncommon in newborns and their early detection can be beneficial for optimum management.

Abstract Background High rates of clinical alarms in the intensive care unit can result in alarm fatigue among staff. Individualization of alarm thresholds is regarded as one measure to reduce non-actionable alarms. The aim of this study was to investigate staff’s perceptions of alarm threshold individualization according to patient characteristics and disease status. Methods This is a cross-sectional survey study (February-July 2020). Intensive care nurses and physicians were sampled by convenience. Data was collected using an online questionnaire. Results Staff view the individualization of alarm thresholds in the monitoring of vital signs as important. The extent to which alarm thresholds are adapted from the normal range varies depending on the vital sign monitored, the reason for clinical deterioration, and the professional group asked. Vital signs used for hemodynamic monitoring (heart rate and blood pressure) were most subject to alarm individualizations. Staff are ambivalent regarding the integration of novel technological features into alarm management. Conclusions All relevant stakeholders, including clinicians, hospital management, and industry, must collaborate to establish a “standard for individualization,” moving away from ad hoc alarm management to an intelligent, data-driven alarm management. Making alarms meaningful and trustworthy again has the potential to mitigate alarm fatigue – a major cause of stress in clinical staff and considerable hazard to patient safety. Trial registration The study was registered at ClinicalTrials.gov (NCT03514173) on 02/05/2018.

The 2013-2016 Ebola Virus Disease (EVD) epidemic in West Africa was the deadliest in history, with over 28,000 cases. Numerous physical and mental health symptoms have been reported in EVD survivors, although there is limited prior research on how the health of survivors compares to the general population. We conducted a survey of EVD survivors in Kenema District, Sierra Leone and a population-based sample of community members who lived in EVD-affected areas but were not diagnosed with EVD, and compared resulting data about self-reported symptoms, duration, and severity between EVD survivors and community members through multivariate regression models. This study found that more than six years after the epidemic, survivors were significantly more likely to experience both physical and mental health symptoms than community members, with respective adjusted incidence rate ratios (IRRs) of 2.65 (95% CI, 2.28-3.09), p < 0.001, and 11.95 (95% CI, 6.58-21.71), p < 0.001. The most highly reported physical health symptoms experienced by EVD survivors were joint pain (75.5%), headaches (67.3%), and vision problems (44.5%), and the most prevalent psychological symptoms were spells of terror and panic (25.5%) and difficulty falling asleep or staying asleep (20.0%). EVD survivors were significantly more likely than community members to report the symptoms as lasting for a longer period, a median of 6.0 (3.0-7.0) years, and with higher severity. The results indicated that six years after the epidemic, EVD survivors in Kenema District, Sierra Leone are experiencing worse physical and mental health than their peers. These findings of the long-term, debilitating health issues following EVD infection should be considered when designing and implementing future epidemic responses.

AIM: To evaluate the efficacy and safety of intrastromal transplantation of adipose-derived stem cells (ASCs) in keratoconus patients. METHODS: This study was conducted on 8 eyes of 8 patients with moderate to severe keratoconus. In the patients, ophthalmic assessments including visual acuity, refraction, slit lamp examination, fundoscopy, corneal topography, and confocal microscopy were performed. Autologous stem cells were used. The isolated stem cells were injected into the corneal stroma by using femtosecond laser. Surgical procedure was similar to intracorneal ring implantation. All patients were re-assessed 1, 3, and 6mo after surgery. RESULTS: The baseline mean visual acuity was 0.48±0.18 and improved to 0.66±0.17 after surgery and final acuity increased by 1.85±0.80 lines (P=0.001). The mean spherical refraction of patients improved 0.34±0.35 D (P=0.039), and the mean cylindrical refraction of patients improved 0.84±0.23 D (P=0.016). The mean flat keratometry decreased 0.78±0.71 D (P=0.017), and the mean steep keratometry decreased 0.59±0.68 D (P=0.023). The mean central corneal thickness of patients improved of 6.29±4.47 μm (P=0.03). The mean keratocyte density at the anterior and middle stroma of cornea increased (P

The Church followed the doctrine of asceticism and distance from the use of precious materials in construction. The research addresses the concept of Romanesque art, the symbolic connotations, and meanings of Christianity in ecclesiastical architectural design by reviewing several images from different countries of Romanesque architectural elements such as church planning in the form of a Latin cross, which symbolizes the redemptithe on of Christ, and analyzing the reasons for the direction of most churches to the East according to the Gospel and in the interpretations of the early church fathers. Religious symbolism is limited not only to Romanesque art but also to Christian arts in general.The symbol is not time-bound and is not limited to a place. The symbol is signs and signs used within a particular culture, civilization, or religion, and how individuals deal with these connotations, whether culturally or religiously. These symbols are rich and study-rich and powerful in terms of impact on the recipient and viewer.Some symbols of Romanesque art are derived from ancient civilizations (civilizations of the Near and the Far East) and some Greek mythology, adding a new vision of his faith with the main aspects of religion.

This quality improvement report details how Sultan Bin Abdulaziz Humanitarian City (The City), the largest rehabilitation facility within Middle East with a capacity of 511 beds and more than 20 nursing in-patient units improved the quality and patient safety culture in nursing services after successfully adopting and implementing the zero harm programme.In healthcare settings, the idea of zero harm including zero incidents, zero injuries and injury-free are commonly used to highlight the importance of patient safety. Patient injuries and deaths resulting from hospital-acquired illnesses such as medication administration errors, falls, central line-associated bloodstream infections, hospital-acquired pressure injuries and catheter-associated urinary tract infection are largely preventable and grossly unacceptable occurrences. Achieving zero incidents of such critical measures can significantly impact treatment plan and enhance patient experience.The projects’ purpose was to build a new culture of safety by implementing innovative strategy designed to protect patients from preventable harm while maintaining an extraordinary high standard of quality patient care. Additionally, the programme was established with the aim of instilling a sense of commitment to every nurse working in this organisation to anticipate potential harms and to be vigilant to prevent it before it reaches the patient.This document also describes a set of initiatives aimed at mitigating preventable incidents and ultimately achieving zero harm on our organisation. The result showed a significant increase by 95% between the percentage of nursing units that had 365 days of zero harm in 2020 and 2021. This improvement indicates that the concept of zero harm had been successfully inculcated among nursing units and had motivated nursing staff to uphold a higher culture of patient safety. Furthermore, by incorporating the Just Culture model into the electronic reporting system, the reporting rate of occurrences in the zero-harm programme was supported and sustained.

الأهداف: هدفت الدراسة إلى استقصاء مبادئ سيادة القانون المتضمنة في كتب الدراسات الاجتماعية ( الجغرافيا، التاريخ، التربية الوطنية والمدنية) للمرحلة الأساسية العليا ( الصف الثامن والتاسع والعاشر) في الأردن. المنهجية: تم استخدام المنهج الوصفي التحليلي باستخدام أسلوب تحليل المحتوى، بالاستناد إلى قائمة محكمة تكونت من خمسة مجالات لسيادة القانون وهي: ( الشرعية، الضمان القانوني، الوقاية من سوء استخدام السلطة، المساواة أمام القانون وعدم التمييز، الوصول إلى العدالة). واشتمل كل مجال على عدد من مبادئ سيادة القانون والتي بلغت (54) مبدأ. وتكونت عينة الدراسة من (18) كتاباً. وجرى التحقق من صدق الأداة وثباتها. النتائج: أظهرت نتائج الدراسة أن المجال الأول (الشرعية) هو الأكثر تكراراً، وأقل المجالات تكراراً كان المجال الثالث (الوقاية من سوء استخدام السلطة). وأكثر المبادئ تكراراً كان المبدأ (14) " يشير المحتوى أن القوانين تدعم الحصول على الحقوق المختلفة" وكان في كتاب التربية الوطنية والمدنية للصف التاسع الأساسي. ولم تتضمن كتب الدراسات الاجتماعية لعينة الدراسة (11) مبدأ وهي المبادئ( 19، 20، 24، 26، 32، 37، 45، 47، 48، 53، 54 )، وبينت النتائج أن أكبر نسبة مساحة تتضمن مبادئ سيادة القانون كانت في كتب الدراسات الاجتماعية للصف العاشر، وأقل نسبة مساحة في كتب الدراسات الاجتماعية للصف الثامن. الخلاصة: توصي الدراسة بزيادة تضمين مبادئ سيادة القانون في المجال الثالث في كتب الدراسات الاجتماعية من قبل مطوري ومصممي المناهج.

Summary: Cleft palate (CP) is one of the most common craniofacial birth defects; however, there are relatively few established genetic risk factors associated with its occurrence despite high heritability. Historically, CP has been studied as a single phenotype, although it manifests across a spectrum of defects involving the hard and/or soft palate. We performed a genome-wide association study using transmission disequilibrium tests of 435 case-parent trios to evaluate broad risks for any cleft palate (ACP) (n = 435), and subtype-specific risks for any cleft soft palate (CSP), (n = 259) and any cleft hard palate (CHP) (n = 125). We identified a single genome-wide significant locus at 9q33.3 (lead SNP rs7035976, p = 4.24 × 10−8) associated with CHP. One gene at this locus, angiopoietin-like 2 (ANGPTL2), plays a role in osteoblast differentiation. It is expressed both in craniofacial tissue of human embryos and developing mouse palatal shelves. We found 19 additional loci reaching suggestive significance (p

Abstract Using reconfigurable intelligent surfaces (RISs) to improve the coverage and the data rate of future wireless networks is a viable option. These surfaces are constituted of a significant number of passive and nearly passive components that interact with incident signals in a smart way, such as by reflecting them, to increase the wireless system's performance as a result of which the notion of a smart radio environment comes to fruition. In this survey, a study review of RIS‐assisted wireless communication is supplied starting with the principles of RIS which include the hardware architecture, the control mechanisms, and the discussions of previously held views about the channel model and pathloss; then the performance analysis considering different performance parameters, analytical approaches and metrics are presented to describe the RIS‐assisted wireless network performance improvements. Despite its enormous promise, RIS confronts new hurdles in integrating into wireless networks efficiently due to its passive nature. Consequently, the channel estimation for, both full and nearly passive RIS and the RIS deployments are compared under various wireless communication models and for single and multi‐users. Lastly, the challenges and potential future study areas for the RIS aided wireless communication systems are proposed.

Abstract Dental practitioners may be at risk for exposure to severe acute respiratory syndrome corona virus 2 when performing aerosol generating procedures. Though recent evidence suggests that coronavirus may be transmitted through aerosol generating procedures, it is unknown whether common procedures performed in dental clinics generate aerosol. The aim of this study was to simultaneously quantify airborne concentrations of the bacteriophage MS2 near the oral cavity of a dental mannequin and behind personal protective equipment (i.e., face shield) of the practitioner during a simulated orthodontic debanding procedure. A deband was performed eight times on a dental mannequin. Optical particle counters and SKC Biosamplers were used to measure particle concentration and to collect virus aerosol generated during the procedure, both near the oral cavity and behind the orthodontists face shield. A plaque assay was used to determine the viable virus airborne concentration. When comparing the two measuring locations, near the oral cavity and behind the clinician’s face shield, there was no statistically significant difference of virus concentrations or particle size distribution. This study suggests that debanding under these conditions generates live virus aerosol and a face shield does not provide increased protection from virus aerosol, but does provide some protection against splatter during the procedure.

Unmanned aerial vehicles (UAVs) have recently established their capacity to provide cost-effective and credible solutions for various real-world scenarios. UAVs provide an immense variety of services due to their autonomy, mobility, adaptability, and communications interoperability. Despite the expansive use of UAVs to support ground communications, data exchanges in those networks are susceptible to security threats because most communication is through radio or Wi-Fi signals, which are easy to hack. While several techniques exist to protect against cyberattacks. Recently emerging technology blockchain could be one of promising ways to enhance data security and user privacy in peer-to-peer UAV networks. Borrowing the superiorities of blockchain, multiple entities can communicate securely, decentralized, and equitably. This article comprehensively overviews privacy and security integration in blockchain-assisted UAV communication. For this goal, we present a set of fundamental analyses and critical requirements that can help build privacy and security models for blockchain and help manage and support decentralized data storage systems. The UAV communication system's security requirements and objectives, including availability, authentication, authorization, confidentiality, integrity, privacy, and non-repudiation, are thoroughly examined to provide a deeper insight. We wrap up with a discussion of open research challenges, the constraints of current UAV standards, and potential future research directions.

The emergence of new disruptive technologies is paving the way towards shaping the upcoming sixth generation (6G) of wireless networks, which are envisioned to enable a large number of innovative applications over a ubiquitous, secure, unified, self-sustainable, and fully intelligent platform. These technologies include but are not limited to, virtual/augmented/mixed reality services, haptics, flying vehicles, brain-machine interface, and telepresence, to name a few. The successful operation of their associated functionalities is subject to meeting stringent network requirements, such as extremely high data rates, ultra-low latency, low complexity, uniquely small-sized designs, and high energy and spectral efficiencies. Therefore, the evolution of 6G networks will be accompanied by diverse novel technological trends, including artificial intelligence, data mining, cloud and edge computing, wireless mobile caching, network slicing, network function virtualization, as well as centralized and decentralized deep learning. While 6G wireless paradigms are envisaged to support the realization of self sustaining, self optimized networks with personalized user experience, privacy and security remain a predominant concern due to the centralized and decentralized data exchange, storage, and process, needed for the successful operation of 6G networks.

Ultra-reliable and low-latency communications (URLLC) is one of the cornerstone services of fifth-generation and beyond (B5G) wireless networks. The URLLC use cases demand strict block error probability and very low-latency targets, and thus even a small 32 byte of payload corruption could be detrimental to the user experience and the overall system performance. Ideally, the current heterogeneous network model and innovative technologies have paved the way for the seamless optimization of B5G URLLC applications. Yet, unprecedented interference issues due to the uncoordinated nature of modern wireless networks, innovative radio access techniques, and frequency reuse methods can significantly affect the performance of the URLLC systems. Therefore, understanding and mitigation of all types of interference associated with each URLLC technology, deployment scenario, and wireless transmission mode are prudent. In this regard, many authors have recently presented interpretative and analytical studies on the management of interference issues; however, the discussion was limited to application-centric approaches and earlier research trends. In this review article, we primarily discuss different types of interference challenges related to the URLLC systems using contemporary designs, frameworks, access modes, and enabling technologies for B5G and sixth-generation (6G) communication networks. We present state-of-the-art research work, in-depth analysis of interference problems, and guidance on the futuristic 6G URLLC technologies and communication networks. This study intends to provide a holistic vision of B5G/6G URLLC systems, their empirical aspects, limitations, essential techniques, and an outlook toward future research avenues.

The Bologna Plan adopted by European universities ended the hegemony of an evaluation system exclusively based on the performance of traditional examinations. In this area, with a view to revitalizing grading models in university education, a wide range of evaluation mechanisms has been developed in recent years. Using them, teachers may evaluate the learning levels of their students, including both the specific competences of the taught subject and the transversal competences that help students further develop their professional careers. This article presents a methodology based on a multi-criteria procedure through which students could be evaluated from different points of view, based on different types of evaluation mechanisms that are diversely weighted. Therefore, their levels of learning could be assessed more objectively. This article shows a practical case of applying this methodology, which has been used for the last five years in a course on energy markets taught as part of the Degree in Energy Engineering at the UPV.

Introduction: The coronavirus disease 2019 (COVID-19) was originally identified in the city of Wuhan, China, in December 2019. Current evidence indicates that the COVID-19-causing virus is transmitted person-to-person through direct contact and droplets. Objective: To estimate Sars-CoV-2 virus infection rate in hospital employees according to their job responsibilities. Materials and methods: Retrospective cohort study to detect Sars-CoV-2 infection in hospital employees, carried out between February 2020 and October 2021. The Kaplan Meier procedure was carried out to estimate the virus infection rate based on variables such as gender, age and job description. Results: There was a difference in infection rate between young and older adult age groups (Log Rank=18.6 gl=1 p=

Selenium is an indispensable trace element for all living organisms. It is an essential structural component of several selenium-dependent enzymes, which support the human body’s defense mechanism. Recently, the significance of selenium in preventing/treating COVID-19 has been documented in the literature. This review highlights the clinical studies, compositions, and patent literature on selenium to prevent/treat COVID-19. Selenium exerts its anti-COVID-19 action by reducing oxidative stress, declining the expression of the ACE-2 receptor, lowering the discharge of pro-inflammatory substances, and inhibiting the 3CLPro (main protease) and PLpro enzyme of SARS-CoV-2. The data of clinical studies, inventive compositions, and patent literature revealed that selenium monotherapy and its compositions with other nutritional supplements/drugs (vitamin, iron, zinc, copper, ferulic acid, resveratrol, spirulina, N-acetylcysteine, fish oil, many herbs, doxycycline, azithromycin, curcumin, quercetin, etc.,) might be practical to prevent/treat COVID-19. The studies have also suggested a correlation between COVID-19 and selenium deficiency. This indicates that adequate selenium supplementation may provide promising treatment outcomes in COVID-19 patients. The authors foresee the development and commercialization of Selenium-based compositions and dosage forms (spray, inhalers, control release dosage forms, etc.) to battle COVID-19. We also trust that numerous selenium-based compositions are yet to be explored. Accordingly, there is good scope for scientists to work on developing novel and inventive selenium-based compositions to fight against COVID-19. However, there is also a need to consider the narrow therapeutic window and chemical interaction of selenium before developing selenium-based compositions.