Search

Does patient accessible electronic health records (PAEHR) result in increased risk of threats and violence? This study was conducted one year after launching PAEHR in Uppsala to examine whether staff whose patients had gained access to the patient portal perceived greater risks of threats and violence, and were exposed to more threats and violence, than those whose patients had not yet gained access. A total of 174 (35%) professionals responded to a web survey. 83 were from the emergency department, whose patients had online electronic health record access, and 91 were from the psychiatric department, whose patients had not. 40% of all participating professionals believed that risks of threats and violence increase after launch. The results did not support a correlation with more incidents of threats and violence, and only one respondent reported that patient access had played any significant negative role in relation to an incident.

Abstract The upper Tekeze River Basin is facing challenges of widespread deforestation and natural vegetation cover degradation that could exacerbate the water scarcity, food insecurity and extreme poverty in the region. Using remote sensing and GIS, this study quantified the land use land cover change trend in the last three decades and analyzed the current land use / cover statues in the basin. A hybrid classification technique is applied to obtain better classification accuracy. Moreover, for automated cloud and cloud shadow detection the newly developed Mountainous Fmask is used. Using post classification change detection technique, seven major land use/cover classes were identified. These classes remained the dominant classes during the study period, showing marked changes in the area coverage within them. Based on the error matrix statistical indices, the classification accuracies of each class are found to be strong. The overall accuracy and the kappa coefficient for the 2021 map are 91% and 89%, respectively. The techniques used have contributed to improving the accuracy of the classification process and helped the classified images to practically match the ground truths. The analysis revealed settlement expansion by 570.31% in parallel with the expansion of farmland by 52.32% during the period 1991–2021. In contrast, the forestland decreased significantly, by 75.55%. The environmental degradation and unplanned use of land resources could have contributed to why the upper Tekeze basin is experiencing worsening poverty, water scarcity and food insecurity. Thus, land use/cover time series modeling is essential for various purposes, including land use planning and, managing natural resources. In this regards this study provides basic information for implementing sustainable environmental conservation strategies in the area. Furthermore, the applied methodologies may have practical applications in other similar areas.

Our auditory environment is constantly changing and evolving over time, requiring us to rapidly adapt to a complex dynamic sensory input. This adaptive ability of our auditory system can be observed at different levels, from individual cell responses to complex neural mechanisms and behavior, and is essential to achieve successful speech communication, correct orientation in our full environment, and eventually survival. These adaptive processes may differ in individuals with hearing loss, whose auditory system may cope via “readapting” itself over a longer time scale to the changes in sensory input induced by hearing impairment and the compensation provided by hearing devices. These devices themselves are now able to adapt to the listener’s individual environment, attentional state, and behavior. These topics related to auditory adaptation, in the broad sense of the term, were central to the 6th International Symposium on Auditory and Audiological Research held in Nyborg, Denmark, in August 2017. The symposium addressed adaptive processes in hearing from different angles, together with a wide variety of other auditory and audiological topics. The papers in this special issue result from some of the contributions presented at the symposium.

For individuals who form the society to live in harmony, they need to acquire a set of values such as love, respect, tolerance and honesty. To create a society with individuals having these characteristics, value education should be carefully planned and implemented. Students who study in the Distance Learning MA Program on Character and Value Education, are expected to stimulate various feelings, thoughts, values and behaviours in their families, friends, colleagues and immediate environments, starting from themselves. The aim of this qualitative study is to reveal to what extent the students reflected the outcomes they gained in the program to themselves, their families, immediate environments and the society. The participants were 22 students studying in the Distance Learning MA Program on Character and Value Education at Anadolu University, Turkey. The data were collected through a data-collection form consisting of open-ended questions. Descriptive analysis was performed for data analysis. The results of the study showed that the students who attended the Distance Learning MA Program on Character and Value Education gained certain benefits for themselves, which were also reflected to their families and immediate environments as well as the country and the world. Various suggestions were offered in accordance with the results of the study.

Raynaud’s phenomenon (RP) is a condition characterized by episodic, excessive vasoconstriction in the fingers and toes, triggered by cold or stress. This leads to a distinctive sequence of color changes in the digits. Pallor indicates reduced blood flow due to oxygen deprivation, while erythema appears as reperfusion. RP can be primary, with no identifiable underlying cause, or secondary, associated with other conditions. These conditions include autoimmune diseases, most commonly systemic sclerosis, vascular diseases; and neurological conditions. While the exact cause of RP remains unclear, genetic and hormonal (estrogen) factors are likely contributors. The pathogenesis of RP involves a complex interaction between the vascular wall, nerves, hormones, and humoral factors, disrupting the balance between vasoconstriction and vasodilation. In primary RP, the vascular abnormalities are primarily functional. However, in secondary RP, both functional and structural components occur in blood vessels. This explains why digital tissue damage frequently occurs in secondary RP but not primary RP. Diagnosis of RP is primarily clinical. Recent advancements in imaging techniques have aided in diagnosis and monitoring, but nail fold capillaroscopy remains the gold standard for distinguishing between primary and secondary RP. If there are signs of acute ischemic injury, vascular imaging, particularly preoperatively, is crucial to rule out other vaso-occlusive conditions. Management of RP focuses on alleviating symptoms and preventing tissue damage. Vasodilator medications are the first-line treatment when general measures like warmth and stress management are not sufficient. Dihydropyridine calcium channel blockers (CCBs), such as nifedipine, are commonly used for vasodilation. Phosphodiesterase-5 inhibitors and prostaglandin analogs are alternative options for patients who do not respond to CCBs or have ischemic tissue damage. Bosentan, an endothelin-1 receptor antagonist, has shown effectiveness in treating and preventing digital ulcers, especially in patients with multiple ulcers. For severe cases, botulinum toxin injections or sympathectomy surgery can be used to control RP symptoms. However, botulinum toxin injections require repeated administration, and sympathectomy’s long-term effectiveness is uncertain. Fat grafting is a promising surgical therapy for promoting healing and preventing tissue injury.

It is well-established that hearing loss does not only lead to a reduction of hearing sensitivity. Large individual differences are typically observed among listeners with hearing impairment in a wide range of suprathreshold auditory measures. In many cases, audiometric thresholds cannot fully account for such individual differences, which make it challenging to find adequate compensation strategies in hearing devices. How to characterize, model, and compensate for individual hearing loss were the main topics of the fifth International Symposium on Auditory and Audiological Research (ISAAR), held in Nyborg, Denmark, in August 2015. The following collection of papers results from some of the work that was presented and discussed at the symposium.

This study focuses on atmospheric aerosols, especially aerosol optical depth (AOD), over Dire Dawa, Ethiopia, from 2009 to 2020. At first, a correlation between the four satellite sensors and AERONET was made for validation purposes and to determine the sensor that best represents Dire Dawa. Intercomparisons were also made among the four satellite sensors. After all statistical tests, annual, seasonal, and decadal trend analyses were made. The validation results indicated that the AOD of MODIS-terra showed the best correlation with AERONET with R2 (0.78), RMSE (0.03), and MBE of 0.02 and represented the area better than the rest. The inter-comparison of AOD retrieved from multi-spectral satellite sensors showed a positive and satisfactory correlation between MODIS-Terra and OMI. Only MODIS-Aqua showed a linearly increasing mean annual AOD with R2 = 0.43. In three seasons (summer, autumn, and spring), AOD showed linear increments over the 12 years, with R2 ranging between 0.3 and 0.5. The three seasons also had nearly identical AODs of 0.23-0.28. However, winter had the lowest value of 0.2. MODIS-terra, out of the four sensors, exhibited increasing decadal tendency over the 2009-2020 period. Monthly analysis revealed that August had the highest AOD (0.265), and January had the lowest (0.14). The value of AOD obtained from this study over Dire Dawa shows a higher value during all seasons except during winter. Thus, this study gives a glimpse into the use of multi-spectral satellite sensors to monitor air quality over a semi-arid urban region.

Objective: This study aimed to determine the clinical outcomes and risk factors affecting mortality in patients with COVID-19 following hematological malignancy (HM). Methods: Patients diagnosed with HM and hospitalized for COVID-19 were included in this retrospective study. The age, demographic and clinical characteristics, prognosis and treatment of surviving and non-surviving patients were compared. Results: A total of 49 patients were included in this study, 17 (34.6%) of whom died within 28 days of being diagnosed with COVID-19. Older age (p = 0.001), diabetes (p = 0.001), chronic obstructive pulmonary disease (p = 0.002), secondary infection (p < 0.001) and secondary bacterial infection (p = 0.005) were statistically significantly higher in non-survivors. The remission status of HM was higher in surviving patients (p < 0.001). In multivariate regression analysis, age (OR: 1.102, p = 0.035) and secondary infection (OR: 16.677, p = 0.024) were risk factors increasing mortality, the remission status of HM (OR: 0.093, p = 0.047) was a protective factor from mortality. Conclusion: The older age, the remission status of HM and secondary infection due to COVID-19 were determined as prognostic factors predicting mortality in HM patients with following COVID-19.

Objective. Cochlear implant (CI) treatment was introduced to the world in the 1980s and has become a routine treatment for congenital or acquired severe-to-profound hearing loss. CI treatment requires access to a highly skilled team of ear, nose and throat specialists, audiologists and speech-language pathologists for evaluation, surgery and rehabilitation. In particular, children treated with CI are in need of long-term post-operative auditory training and other follow-up support. Design. The study is retrospective with updated information on present performance. Results. Since 2001, a total of 11 Greenlandic patients living in Greenland have been treated with CI, 7 children and 4 adults. Of these children, 4 use oral communication only and are full-time CI-users, 2 with full-time use of CI are still in progress with use of oral communication, and 1 has not acquired oral language yet, but has started auditory and speech training. Six children attend mainstream public school while one child is in kindergarten. Of the adults, only 1 has achieved good speech perception with full-time use of CI while 3 do not use the CI. Discussion. From an epidemiological point of view, approximately 1–3 children below 6 years are in need of a CI every second year in Greenland often due to sequelae from meningitis, which may cause postinfectious deafness. Screening of new-borns for hearing has been started in Greenland establishing the basis for early diagnosis of congenital hearing impairment and subsequent intervention. The logistics and lack of availability of speech therapists in Greenland hampers possibilities for optimal language and speech therapy of CI patients in Greenland. This study aims at describing the results of CI treatment in Greenlanders and the outcome of the CI operations along with the auditory and speech/language outcomes. Finally, we present a suggestion for the future CI treatment and recommendations for an increased effort in the treatment and rehabilitation of implanted patients in Greenland.

A growing number of studies have investigated how land surface temperature (LST) is influenced by a variety of driving factors; however, little effort has been made to identify the dominant ones. The suggested method used the Upper Awash Basin (UAB), Ethiopia, as an example to explore the spatial heterogeneity and factors affecting LST, which is critical for selecting effective mitigation strategies to manage the thermal environment. The study employed two models: ordinary least squares (OLS) and geographically weighted regression (GWR). The OLS model was first used to capture the overall relationship between LST and some biophysical factors. The GWR was then utilized to investigate the spatial non-stationary relationships between LST and its influencing biophysical factors. Although the method was tested in UAB, Ethiopia, it can be applied in similar agroecosystems, to identify the dominant factors that influence LST and develop site-specific LST mitigation strategies. • The OLS and GWR models investigated the spatial heterogeneities of the influencing factors and LST. • Biophysical parameters such as enhanced vegetation index (EVI), modified normalized difference water index (MNDWI), normalized difference built-up index (NDBI), normalized difference bareness index (NDBaI), albedo and elevation were used as potential driving environmental factors of LST • The models performance was computed using the adjusted coefficient of determination (adj. R2), Akaike Information Criterion (AICc), and residual sum of squares (RSS).

Introduction and Objectives: Studies on the societal burden of patients with biopsy-confirmed non-alcoholic fatty liver disease (NAFLD) are sparse. This study examined this question, comparing NAFLD with matched reference groups. Materials and Methods: Nationwide Danish healthcare registers were used to include all patients (≥18 years) diagnosed with biopsy-verified NAFLD (1997–2021). Patients were classified as having simple steatosis or non-alcoholic steatohepatitis (NASH) with or without cirrhosis, and all matched with liver-disease free reference groups. Healthcare costs and labour market outcomes were compared from 5 years before to 11 years after diagnosis. Patients were followed for 25 years to analyse risk of disability insurance and death. Results: 3,712 patients with biopsy-verified NASH (n = 1,030), simple steatosis (n = 1,540) or cirrhosis (n = 1,142) were identified. The average total costs in the year leading up to diagnosis was 4.1-fold higher for NASH patients than the reference group (EUR 6,318), 6.2-fold higher for cirrhosis patients and 3.1-fold higher for simple steatosis patients. In NASH, outpatient hospital contacts were responsible for 49 % of the excess costs (EUR 3,121). NASH patients had statistically significantly lower income than their reference group as early as five years before diagnosis until nine years after diagnosis, and markedly higher risk of becoming disability insurance recipients (HR: 4.37; 95 % CI: 3.17–6.02) and of death (HR: 2.42; 95 % CI: 1.80–3.25). Conclusions: NASH, simple steatosis and cirrhosis are all associated with substantial costs for the individual and the society with excess healthcare costs and poorer labour market outcomes.

The Sudd Wetland, which supports millions of pastoralists and farmers, as well as the internationally renowned Ramsar Wetland, are under pressure from population growth and climate change extremes such as flooding and drought. Using the Climate Hazards Group Infrareds Precipitation with Station (CHIRPS) and Climate Research Unit (CRU-TS4.06) datasets, this study investigates the spatiotemporal trend and variability of precipitation and temperature. As a result, descriptive statistics were used to describe the spatiotemporal behavior of precipitation and temperature. The Rotated Empirical Orthogonal Function (REOF) was used to detect the spatiotemporal variability of precipitation. The Pearson correlation method was used to investigate the relationship between Sea Surface Temperature (SST) and precipitation. The results revealed that Sudd-wetland receives 910 mm mean spatial annual precipitation and experienced 36 °C mean annual temperature with high spatio-temporal variations. It receives the highest precipitation in summer season followed by autumn and spring. The precipitation amount decreases towards the north in all seasons. In both the summer and winter seasons, observed rainfall variability corresponds substantially to ENSO variability, whereas the spring and autumn seasons are more connected with Atlantic and Indian Ocean Sea surface temperature gradients. The Sudd wetland has been affected by prolonged drought and frequent flood events alternatively. The prolonged drought linking with the shrinking of the wetland are potential threats to the farmers and pastoralists to adapt the changing climate. Hence, it is imperative to systematically analyze the wetland ecosystem from different dimensions and adjust the livelihood settings of the people in to less climate sensitive activities. Therefore, we suggest in depth drought and flood risk evaluation and implementation of realistic adaptation strategy to sustain the ecological and economic benefit of the wetland.

Abstract Climate models are basic tools to obtain reliable estimates of future climate change and its effects on the water resources and agriculture in given basin. However, all climate models are not equally valuable for all areas. Therefore, determining the most appropriate climate model for a specific study area is essential. This study examines the performance of 10 CORDEX-AFRICA-220 Regional Climate Models (RCMs), three downscaling institutional based ensembles mean (Reg ensemble, CCLM ensemble and REMOO ensemble) and the multi-model ensemble mean. The models were evaluated based on their ability in replicating the seasonal and annual rainfall, minimum and maximum temperature and inter-annual variability for the period of 1986–2005 using statistical metrics such as BIAS, Root Mean Square Error (RMSE), Pearson correlation coefficient (r), coefficient of variation (CV), Kling Gupta Efficiency (KGE) and Taylor diagram. The findings indicated that HadREMOO, MPI-Reg4-7, HadReg4-7, Reg ensemble, and multi-model ensemble mean performed relatively better in representing the mean annual observed rainfall at the Adiramets, Debarik Ketema, Niguse Maystebri, and Zarima stations, respectively. Whereas, NorESM-CCLM, MPI-CCLM, NorESM-Reg4-7, and NorESM-REMOO exhibited a weak performance in reproducing the observed mean annual rainfall at the Adiramets, Debarik Ketema Niguse, Maystebri, and Zarima stations, respectively. Similarly, RCMs generally capture the mean annual maximum temperature of climatic stationsof Zarima subbasin well. Specifically, the MPI-Reg4-7 simulation performs well in representing the mean annual observed maximum temperature at Adiramets and Maytsebri stations, while the Debarik and Ketema Niguse stations exhibit superior performance in the HadReg4-7 simulation and the Zarima station shows better representation in the CCLM ensemble simulations. The majority of the model simulations exhibit good representation of mean annual minimum temperature at Adiramets, Debarik, and Zarima stations. Specifically, CanESM-RCM, HadReg4-7, REMOOensemble, multi-model ensemble, and Regensemble simulations perform better at Adiramets, Debarik, Ketema niguse, Maystebri and Zarima stations respectively. This suggests that these models may have biases or shortcomings in capturing the temperature values in the subbasin. Furthermore, NorESM-CCLM at Adiramets, Ketema niguse, and Zarima stations, NorESM-REMOO at Debarik station, and HadReg4-7 at Maystebri station demonstrate poor performance in representing the observed mean minimum temprature. Majority of the RCMs, all institutional based ensemble means and the multi-model ensemble mean simulations overestimate the observed mean annual rainfall of the Zarima subbasin with minimum bias of 0.02 mm at Ketema niguse HadReg4-7and maximum bias of 2.81 mm at Maytsebri MPI-CCLM simulation. Similarly, HadReg4-7 simulation of Ketama Niguse MPI-CCLM showed a minimum 0.02 mm and Maytsebri simulation kiremit season mean rainfall showed a maximum bias of and 2.99 mm. Regarding mean annual and kiremit season maximum and minimum temperature of the Zarima subbasin were overestimated by majority of the simulation and the ensemble means. The correlation (r) of observed and model simulated mean annual and kiremit season rainfall was strong (0.60–0.79) and very strong (0.80–0.99) in the majority of the simulations except Ketema niguse station mean annual and kiremit season rainfall simulations of MPI-REMOO, NorESM-Reg4-7; Debarik station kiremit season rainfall of NorESM-CCLM and NorESM-REMOO, MPI-Reg4-7 and MPI-REMOO, which showed moderate correlation. The performance of the RCMs, institutional based ensemble means and multi-model ensemble mean were different in statistical metrics (BIAS, RMSE, r, CV and KGE) and Taylor diagram. Among the simulations and ensemble means, the multi-model ensemble mean was superiors in two or more of statistical metrics at each station of the Zarima subbasin except Maytsebri station kiremit season rainfall, where the CCLM ensemble was better. Consistently, the Taylor diagram showed that the multi-model ensemble was better in the replication of the areal annual and kiremit season rainfall, maximum and minimum temperature of the subbasin. This finding evidenced that selecting the best RCMs and ensemble mean is necessary for climate projection and climate change impact assessment study.

In Sjögren’s disease (SjD), the salivary glandular epithelial cells can induce the chemotaxis of B cells by secreting B-cell chemokines such as C-X-C motif chemokine ligand 13 (CXCL13). Syndecan-1 (SDC-1) is a major transmembrane heparan sulfate proteoglycan (HSPG) predominantly expressed on epithelial cells that binds to and regulates heparan sulfate (HS)-binding molecules, including chemokines. We aimed to determine whether SDC-1 plays a role in the pathogenesis of SjD by acting on the binding of HS to B-cell chemokines. To assess changes in glandular inflammation and SDC-1 concentrations in the submandibular gland (SMG) and blood, female NOD/ShiLtJ and sex- and age-matched C57BL/10 mice were used. In the SMG of NOD/ShiLtJ mice, inflammatory responses were identified at 8 weeks of age, but increased SDC-1 concentrations in the SMG and blood were observed at 6 weeks of age, when inflammation had not yet started. As the inflammation of the SMG worsened, the SDC-1 concentrations in the SMG and blood increased. The expression of the CXCL13 and its receptor C-X-C chemokine receptor type 5 (CXCR5) began to increase in the SMG at 6 weeks of age and continued until 12 weeks of age. Immunofluorescence staining in SMG tissue and normal murine mammary gland cells confirmed the co-localization of SDC-1 and CXCL13, and SDC-1 formed a complex with CXCL13 in an immunoprecipitation assay. Furthermore, NOD/ShiLtJ mice were treated with 5 mg/kg HS intraperitoneally thrice per week for 6–10 weeks of age, and the therapeutic effects in the SMG were assessed at the end of 10 weeks of age. NOD/ShiLtJ mice treated with HS showed attenuated salivary gland inflammation with reduced B-cell infiltration, germinal center formation and CXCR5 expression. These findings suggest that SDC-1 plays a pivotal role in the pathogenesis of SjD by binding to CXCL13 through the HS chain.

This research aims to investigate the effect of teaching the socio-scientific issues, "Global Warming, Sustainable development and Bio-technology" in 8th class, with the case-oriented station technique on the academic achievement of the students and their motivation toward science learning. The study was carried out with 71 students in 8th class in 2 secondary schools of a district with approximately 20.000 population in the Eastern Anatolia Region. The mixed-method, consisting of the data collected as qualitatively and quantitatively, was employed. In the quantitative part of the study, the Socio-scientific issues Achievement Test and the Science Learning Motivation Scale developed by Dede and Yaman (2008) to measure students' motivation to learn were used. Unstructured interview, which is one of the qualitative research methods, was preferred in order to support the study with student opinions and comments. The Socio-scientific Issues Achievement Test and the Science Learning Motivation Scale were applied to the experimental and control groups as pre-test at the beginning and as post-test at the end of the study. Results indicated that teaching the socio-scientific issues with case-oriented station technique positively affected the students' academic achievements and their motivation toward science learning. Besides, the interviews showed that the students found it useful, fun, remarkable and permanent to learn socio-scientific issues using the case-oriented station technique.