Understanding the dynamics of teamwork and communication among healthcare professionals is crucial in the face of evolving healthcare challenges. This study assessed relational coordination among healthcare professionals in the South Tyrolean healthcare system in Italy, focusing on communication and teamwork dynamics in a cross-sectional survey. Using the validated Relational Coordination Survey (RCS) instrument and 525 completed online responses, the questionnaire aimed to understand the implications of different levels of relational coordination ratings by general practitioners, hospital physicians, nurses, and administrative personnel (response rate 26%). The demographics of the participants revealed a predominance of female professionals (64%), with an average age of 50 and 18 years of service. The resulting RCS scores varied significantly across professional groups, with nurses reporting the highest within-group scores, indicating moderate coordination, and administrators reporting the lowest scores, reflecting areas of weak coordination. Between-group relational coordination was generally perceived as weak across professional groups, with the least weakness observed between general practitioners and nurses. German or Italian language and health district affiliation emerged as significant factors influencing relational coordination ratings, highlighting the need for differentiated understanding and strategies in multilingual and diverse regional settings. Assessments of interdisciplinary feedback and referral practices highlight the variation in teamwork and communication weaknesses and underscore the need for targeted interventions to improve relational coordination. This study provides insights into the complexity of relational dynamics in health care settings. It suggests that improving relational coordination through tailored strategies could significantly improve team effectiveness, quality of patient care, and overall system efficiency.

Service-Learning (SL) is a methodology that links students directly with reality. It strengthens the development of different competencies in students as they participate in activities associated with community service. The objective of this work is to analyze the SL methodology as an effective pedagogical practice to promote the development of generic competencies in university students. This research is a systematic review. The articles were selected according to the Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and the eligibility criteria proposed by the PICOS strategy (population, interventions, comparators, outcomes and study design) based on 71 records of scientifically identified articles in the Web of Science (WoS) Journal Citation Report databases. Publications between 1999 and 2022 were considered. The literature review allowed the selection of seven articles showing the results of qualitative, quantitative and mixed research. The results reveal that the application of SL enhances the learning of professional and transversal competencies such as teamwork, appreciation and respect for diversity and multiculturalism, ethical commitment, critical and self-critical capacity, social responsibility, among others. It is concluded that this pedagogical practice effectively consolidates the development of these competencies, and that the success of its application depends on the commitment of teachers, students and community partners.

Introduction: It has long been accepted that trauma is one of the most important and frequent predisposing factors for onychomycoses . However, the role of direct trauma in the pathogenesis of fungal nail infections was only recently been elucidated in a series of 32 cases of post-traumatic single-digit onychomycosis. The importance of repeated trauma due to foot and toe abnormalities was rarely investigated.Aim of the study: This is a multicenter single-author observational study over a period of 6 years performed at a specialized nail clinic in three countries. All patient photographs taken by the author during this period were screened for toenail alterations and all toe onychomycosis cases were checked whether they contained enough information to evaluate potential foot and toe abnormalities. Particular attention was paid to the presence of hallux valgus, hallux valgus interphalangeus, hallux erectus, inward rotation of the big toe and outward rotation of the little toe, as well as splay foot. Only cases with unequivocal proof of fungal nail infection by either histopathology, mycologic culture or polymerase chain reaction (PCR) were accepted.Results: Of 1653 cases, 185 were onychomycoses proven by mycologic culture, PCR or histopathology. Of these, 179 involved at least one big toenail, 6 affected one or more lesser toenails. Three patients consulted us for another toenail disease and the onychomycosis was diagnosed as a second disease. Eight patients had a pronounced tinea pedum. Relatively few patients had a normal big toe position (n = 9). Most of the cases had a mild to marked hallux valgus (HV) (105) and a hallux valgus interphalangeus (HVI) (143), hallux erectus was observed in 43 patients, the combination of HV and HVI was observed 83 times. Discussion: The very high percentage of foot and toe deformations was surprising. It may be hypothesized that this is not only a pathogenetically important factor but may also play an important role for the localization of the fungal infection as no marked hallux deviation was noted in onychomycoses that affected the lesser toes only. As the management of onychomycoses is a complex procedure involving the exact diagnosis with determination of the pathogenic fungus, the nail growth rate, the type of onychomycosis, its duration and predisposing factors, anomalies of the toe position may be important. Among the most commonly mentioned predisposing factors are peripheral circulatory insufficiency, venous stasis, peripheral neuropathy, immune deficiency and iatrogenic immunosuppression whereas foot problems are not given enough attention. Unfortunately, many of these predisposing and aggravating factors are difficult to treat or to correct. Generally, when explaining the treatment of onychomycoses to the patients, the importance of these orthopedic alterations is not or only insufficiently discussed. In view of the problems encountered with the treatment of toenail mycoses, this attitude should be changed in order to make the patient understand why there is such a low cure rate despite excellent minimal inhibitory drug concentrations in the laboratory.

Hard tissue apposition along the root canal walls is a slow, normally occurring physiological aging process. In response to tooth wear, local deposition of hard tissue may also occur in the pulp at a slow pace. Sometimes, the rate of hard tissue deposition acceleration may seem to be uncontrolled after dental trauma, autotransplantation, and orthodontic therapy, leading to rapid partial or total obliteration of the root canal space. This situation is called calcific metamorphosis (CM) or pulp canal obliteration (PCO). Although the incidence of pulpal necrosis in these teeth is believed to be infrequent, conventional endodontic therapy in severely calcified canals poses extreme difficulties and a higher risk for procedural accidents. This article aims to review the available approaches for the predictable negotiation of calcified canals and to introduce the buckling resistance activation test (BRAT) technique.

Monitoring of clients living with HIV encompasses a specific array of activities that routinely check on various aspects of ART following its initiation depending on the availability of resources in that particular state, among other factors as per guidelines from the World Health Organisation. This is a significant practice as it promotes positive health outcomes for patients and efficient utilisation of ART regimens to reduce resistance to the medication – hence it is a measure to guard avoidable costs. It also forms a basis on which decisions are made from. It can be done clinically by assessing for signs e.g., skin rash and symptoms e.g., nausea and vomiting, checking vital organ function and measuring weights across all populations, or can be also be done by assessing specimens for their respective viral loads, white blood cell count, pregnancy status or other infections such as hepatitis B. There have not been any special indications required for one to be eligible for monitoring during ART in developing countries; all qualify for routine monitoring even though some may be more frequent than others in cases of comorbidities such as renal failure where medications can be attributed to exacerbating the condition.

The emphasis in the automotive industry towards sustainable mobility has led to a significant interest in hybrid-electric propulsion systems with high energy density batteries. Addressing the needs of this strategy, the battery market is exploring new technologies to improve the safety and lifespan of electric vehicles. To this end, there is a focus on the all-solid-state battery (ASSB) technology for its cycle capabilities. Filling the current void in the literature pertaining to accurate ageing models for ASSBs, in this work, we present an enhanced version of the numerical ageing model, originally developed for liquid electrolyte based batteries, to forecast the development of the solid electrolyte interface layer that is the major cause of battery capacity fading. The model has been tested on prototype batteries and reveals an accuracy of 99%. The capacity fade in ASSBs has been investigated under different conditions, and the enhanced ageing model has been validated using experimental data from these batteries. The findings suggest that there is potential for solid-state batteries to be commercialized, although significant work is needed to match the manufacturing level of lithium-ion batteries with liquid electrolytes.

This study investigates how digital alchemy can enhance literature and language teaching through a combination of online and face-to-face learning. It uses constructivist learning theory and the SAMR model to examine how digital tools and resources can transform learner engagement, critical thinking, and creativity. The study gathered data from interviews, focus groups, and document analysis with 30 participants from private HEI schools. The results show that digital alchemy through blended learning allows learners to personalize and collaborate in their exploration of various literary texts. However, the study also identifies some challenges related to resource availability and educator training. The study emphasizes the importance of using digital alchemy in literature and language teaching and suggests some ways for educators, administrators, and policymakers to effectively use digital tools and resources for student-centered teaching methods in the digital era.

The sudden outbreak of the COVID-19 pandemic challenged education systems worldwide to quickly pivot their teaching-learning processes from in-person to virtual modes in order to control the spread of the virus. In a short period of time, teachers were forced to adopt new remote teaching methods to ensure the continuation of education. This paper examines how teachers in Pakistan leveraged mobile technology as an alternative teaching strategy to provide access to education during these unprecedented times. Through in-depth individual interviews with selected teachers, the study explores the potential of mobile technology to transform traditional teaching methods into interactive learning environments. The findings highlight the importance of embracing new pedagogical possibilities offered by mobile technology and the need for effective teacher professional development in the post-pandemic era. The study offers valuable insights into how mobile technology can be effectively utilized in education, even in the most challenging circumstances.

Background: Patients with thromboembolic disease, prosthetic valves, or coagulation issues are commonly prescribed anticoagulants and antiplatelets. Although common professional oral hygiene might not represent a health concern for these patients, anticoagulant and antiplatelet medication might constitute a challenge for dentists and dental hygienists since possible prolonged bleeding might interfere with dental procedures. The aim of the present study was to investigate the bleeding time of different anticoagulants and antiplatelets during a professional hygiene session adapting the Ivy test to the oral environment; Methods: 93 consecutive patients undergoing professional oral hygiene were recruited. Debridement during oral hygiene was performed using ultrasonic mechanical instrumentation, and bleeding sites were assessed and treated with gentle pressure using sterile gauzes. The time for bleeding cessation was recorded. Patients were categorized into six groups based on their drug intake, Control: no anticoagulants or antiplatelets DTI: direct thrombin inhibitors (dabigatran) AntiXa: directa factor Xa inhibitors (endoxaban, apixaban, rivaroxaban) VKA: vitamin K antagonists (warfarin, acenocoumarol) SAPT: single anti-platelet therapy (acetylsalicylic acid or clopidogrel) DAPT: dual anti-platelet therapy (acetylsalicylic acid and clopidogrel). Bleeding time was measured in seconds and mean values were assessed among the different groups. Differences between groups were investigated with Kruskal-Wallis test followed by Dunn’s post-hoc correction for multiple comparisons or two-way ANOVA followed by Dunnett post-hoc; Results: Control patients presented the lowest bleeding time 50 sec, followed by AntiXa (98), SAPT (105), DTI (120), DAPT (190) and VKA (203). A statistically significant difference was present among control and DTI (p=0.004), VKA (p<0.001), DAPT (p<0.001). Conclusions: Based on the present outcomes, an increased risk of prolonged bleeding emerged in patients taking VKA and DAPT. However, bleeding did not interfere with the oral hygiene ses-sion The optimal period for dental treatment of these patients should be 2-3 hours before the next dose, without the need to temporarily suspend the medication.

(1) Background: The aim of the research was to present and emphasize the importance of magnetic resonance imaging (MRI) in diagnosing Achilles tendon (AT) ruptures by presenting case reports. (2) Materials and Methods: The sample of respondents included 7 patients (4 males and 3 females, 2 athletes and 5 non-athletes), aged 25 to 58 years, with AT injuries, who were examined and treated at the Institute for Treatment and Rehabilitation "Niška Banja", Niš, Serbia. Ankle examinations with MRI were conducted using the Esaote O-scan 0.3 T machine. The examinations were performed without the application of a paramagnetic contrast agent and without the use of anesthesia. Results: The MRI method's sensitivity and overall diagnostic accuracy were excellent, with 100% true positives. In our study, the method accurately detected the presence, location, and severity of AT injuries in all cases. MRI is an important and reliable method for detecting AT injuries, classifying them, monitoring the course of recovery, and assessing the effects of therapy. Conclusions: An unrecognized or delayed diagnosis of an AT injury can lead to chronic changes. Timely diagnosis (clinical examination, ultrasonography, magnetic resonance imaging) and appropriate treatment (conservative or operative) enable patients to return to normal activities, including sports. Unfortunately, the use of MRI is limited by restricted access and the cost of the examination.

Brain hemispheres develop rather symmetrically except in the case of pathology or intense training. As school experience is a form of training, the current study tested the influence of pedagogy on morphological development through the cortical thickness (CTh) asymmetry index (AI). First, we compared CTh AI of 111 students aged 4 to 18 with 77 adults aged > 20. Second, we investigated CTh AI in the students, as a function of schooling background (Montessori or traditional). At the whole-brain level, CTh AI was not different between the adult and student groups, even when controlling for age. However, the pedagogical experience was found to impact CTh AI in the temporal lobe, within the parahippocampal (PHC) region. The PHC has a functional lateralization, with the right PHC having a stronger involvement in spatiotemporal context encoding, while the left PHC is involved in semantic encoding. We observed CTh asymmetry toward the left PHC for participants enrolled in Montessori schools and toward the right for participants enrolled in traditional schools. As these participants were matched on age, intelligence, home life, and socioeconomic conditions, we interpret this effect found in memory-related brain regions to reflect differences in learning strategies. Pedagogy modulates how new concepts are encoded, with possible long-term effects on knowledge transfer.

In this paper, a distinction is first made between environmental, sustainable and green chemistry; the last two are then examined in relation to the more general problem of the environmental education. A brief historical digression on the STS (Science, Technology and Society) movement tries to dissect the reasons why chemistry is seen by the general public as a problem, not as a decisive resource for the realization of the ecological transition. Although sustainable and green chemistry can be decisive in overcoming the insularity of chemical disciplines in the high school, it fails to effectively embed itself in educational practices. Specific operational goals, supporting a real scientifical and technological literacy in sustainable and green chemistry, can help chemical educators. They are provided at the end of an examination of the founding axes of sustainable and green chemistry, according to the criteria of scientific and technological literacy.

The importance of personalized medicine is growing, since there is an urged need to avoid unnecessary and expensive treatments. In nuclear medicine, the theranostic approach is an established tool for a specific molecular targeting in means of diagnostics and therapy. The visualisation of potential targets can help to predict if a patient would benefit from a particular treatment or not. Thanks to the quick development of radiopharmaceuticals and diagnostic techniques, the use of theranostic agents is constantly rising. In this article important milestones of nuclear therapies and diagnostics in the context of theranostics are highlighted. It begins with the well-known radioiodine therapy in patients with thyroid cancer and then guides through different approaches for the treatment of advanced cancer with targeted therapies. The aim of this review is to provide a summary of background knowledge, current applications and advantages of targeted therapies and imaging in nuclear medicine practice.

Educators' subject-matter knowledge and their understanding of the many ways in which technology may be used to enhance student learning can both benefit from the usage of pedagogical technology, which is the primary goal of this kind of technology. The goal of this study is to determine the extent to which kids with special needs might benefit academically by adopting various forms of technology into their daily routines. This work makes use of descriptive qualitative research together with the methodology and processes that come with case study research. The emphasis of this study was placed on three institutions that welcome students of all abilities. According to the results of the qualitative research, inclusive schools do not universally possess the resources necessary to successfully incorporate technology into the classroom. The results suggest that this teacher occupies a position that is about equivalent to the center of the acceptable range. This displays the instructor's existing proficiency in the use of technology to enhance the results for their students.

In this empirical article, we argue that, while emergency remote teaching (ERT) may have achieved its goal of saving the academic years during the COVID-19 pandemic, it also constructed unintended pedagogical consequences that were possibly overlooked at the time of advocating it. The research question that the article attempted to answer is, what unintended pedagogical consequences did students and lecturers suffer because of the move to ERT at rural-based universities (RBUs) in South Africa? Drawing on students' and lecturers’ lived experiences of ERT, this article foregrounds unintended pedagogical consequences that arose at one RBU in South Africa during the transition from face-to-face teaching to ERT. Underpinned by the tenets of critical realism philosophy, as well as student integration theory, in-depth interviews with three lecturers and six students were conducted. The findings of the study indicate that home conditions, individual characteristics, pre-COVID-19 blended learning experiences, university training and support, and teaching, learning, and assessment practices and policies altogether contributed to the construction of unintended pedagogical consequences of ERT presented in this article. These consequences include (1) exclusion of low-income students in active teaching and learning, (2) equipping middle-class students with better chances of success than working-class students. (3) distressing female students and lecturers more than their male counterparts, and (4) unproductive assessment practices. This study may be beneficial to academics and policymakers from similar contexts in their plight to continue with remote teaching and assessment (RTA) beyond the pandemic.

This study examined how practice distribution schedules influenced accuracy and efficacy in the tennis serve. 24 recreational players were randomized into two experimental groups. Both groups carried out 4 series of 10 services per session during 12 sessions. Massed practice group did not rested between services and rested 10 seconds between series. Distributed practice group rested 10 seconds between services and 30 seconds between series. The accuracy and efficacy were registered and computed based on the 2D digitalization. The learning and retention were tested in a post-test and retention test. The learning program increased the efficacy in the post-test in both groups (p =.001 massed group; p =.015 distributed group). On the retest, the group of massed practice decreased efficacy (p =.021). In accuracy, the group of massed practice reduced its performance in the post-test (p =.015). The effects of the program on the accuracy in the retention test were not observed. It is concluded that this type of sports learning programs, applied at a recreational level, can provide a rigorous approach that contributes with guarantees to the learning of tennis.

(1) Background: Cardiorespiratory fitness (CRF) is a prognostic factor regarding long time morbidity and mortality. To assess CRF the well-known gold standard is cardiopulmonary exercise testing (CPET), which is a time consuming and expensive test. Therefore, alternative methods for routine evaluation of CRF are needed for the general population as well as for specific patient groups such as children and young adults with congenital heart disease. The Stair Climbing Test (SCT) is a simple and resource saving test reported in the current literature. This test is used in various settings to assess different health associated risk factors including cardiorespiratory fitness, muscular resilience, therapy effectiveness or pre- and postoperative morbidity and mortality.

A significant part of the literature on innovative practice in medicine relates to seizing opportunities and curbing harms for patients in desperate situations. Unfortunately, the term innovation has multiple meanings and a rich rhetorical flourish that adds confusion and misunderstanding to an already difficult debate. This paper aims to enhance the current definition of innovative practice for medicine. First, we replace the term innovation with the more literal of new non-validated practice. To identify this meaning, we analyse the traditional research ethics’ distinction between research, validated practice, and innovation in the Belmont Report. Second, we propose the following explicit definition of new non-validated practice: the first or recent use of diagnostic, therapeutic or preventive interventions that introduce a significant change, with an insufficient level of evidence of safety or efficacy for regular healthcare, and with the main aim to benefit individual patients. This definition is a promising conceptual tool to inform empirical research, ethicists, and the harmonization of its regulation and legislation (e.g. right-to-try laws).

Biological nanoparticles (NPs), such as extracellular vesicles (EVs), exosome-mimetic nanovesicles (EMNVs) and nanoghosts (NGs), are perspective non-viral delivery vehicles for all types of therapeutic cargo. Biological NPs are renowned for their exceptional biocompatibility and safety, alongside their ease of functionalization, but a significant challenge arises when attempting to load therapeutic payloads, such as nucleic acids (NAs). One effective strategy involves fusing biological NPs with liposomes loaded with NAs, resulting in hybrid carriers that offer the benefits of both biological NPs and the capacity for high cargo loads. Despite their unique parameters, one of the major issues of virtually any nanoformulation is the ability to escape degradation in the compartment of endosomes and lysosomes which determines the overall efficiency of nanotherapeutics. In this study, we fabricated all major types of biological and hybrid NPs and studied their response to acidic environment observed in endolysosomal compartment. In this study, we show that EMNVs display increased protonation and swelling relative to EVs and NGs in an acidic environment. Furthermore, the hybrid NPs exhibit an even greater response compared to EMNVs. Short-term incubation of EMNVs in acidic pH corresponding to late endosomes and lysosomes again induces protonation and swelling, whereas hybrid NPs are ruptured, resulting in the decline of their quantities. Our findings demonstrate that in an acidic environment, there is enhanced rupture and release of vesicular cargo observed in hybrid EMNVs that are fused with liposomes compared to EMNVs alone. This was confirmed through PAGE electrophoresis analysis of mCherry protein loaded into nanoparticles. In vitro analysis of NPs colocalization with lysosomes in HepG2 cells demonstrated that EMNVs mostly avoid endolysosomal compartment whereas hybrid NPs escape it over time. To conclude, (1) hybrid biological NPs fused with liposomes appear more efficient in the endolysosomal escape via the mechanism of proton sponge associated with scavenging of protons by NPs, influx of counterions and water, and rupture of endo/lysosomes, but (2) EMNVs are much more efficient than hybrid NPs in actually avoiding endolysosomal compartment in human cells. These results reveal biochemical differences across four major types of biological and hybrid NPs, and indicate that EMNVs are more efficient in escaping or avoiding endolysosomal compartment.

Two major sample configurations are adopted in all the instruments for fabric hand measurement, flat sample as in KES and FAST types machines, and wrinkled sample as in PhabrOmeter. This paper compares the two sample types to examine which one if any offers a better coverage and reflection of the fabric sensory attributes. Fabrics have unique behaviors of drape, wrinkle and tactile sense which are entirely due to the simultaneous occurrence of both in-plane membrane deformation and out-of-plane bending deformation in multiple curvature. Such singular deformation mode cannot be detected by any machines using flat sample, whereas during a PhabrOmeter test, the fabric sample genuinely produces drape, wrinkle in addition to other related deformations. This paper then introduced the theoretical research pertaining to the measurement. Then a split sample experiment is conducted to demonstrate the importance of the internal connections in fabric during drape and wrinkle processes. As such fabric interconnection will be barely disclosed during tests using flat samples, another important advantage of PhabrOmeter is hence clearly shown.

The aim of this study was to develop a valid and reliable questionnaire to assess vitamin D-related knowledge, attitude and practice (KAP) in Iranian adults who may be at increased risk of vitamin D deficiency. This study was conducted on 527 subjects, aged ≥20 years from Public health care centers in Tehran, Iran. Based on results of literature review and in-depth interviews, the 38-item vitamin D-related KAP questionnaire with four subscale was developed: 1) general knowledge; 2) nutritional knowledge; 3) attitudes; 4) behaviors. Validity of the developed vitamin D-KAP questionnaire was assessed, utilizing face, content, and construct validity methods. Internal consistency was calculated to assess reliability of the current developed questionnaire. A total of 572 (54.1% female) adults, aged 30.2±7.9 years, participated in the study. All items were perceived as relevant and comprehendible by participants. Content validity was confirmed by the panel of experts. The internal consistency, as measured by Cronbach’s alpha coefficients, exceeded the minimum reliability standard of 0.60 for four subscales. The EFA suggested a four-factor construct and the results of the CFA indicated acceptable fit indices for the proposed model. No ceiling effects were observed except for general knowledge (1.2%). Floor effects detected were 0, 1.1, 2.4, and 8.7% for practice, attitude, general knowledge, and nutrition knowledge, respectively. General knowledge had the highest score (79.59±14.52) and nutrition knowledge, the lowest score (42.58±20.40) among the four sub-scales. Results confirm the initial validity and reliability of the vitamin D-related knowledge, attitude and practice questionnaire. Further investigations in different urban and rural population are recommended.

The diversity and inclusion discussion permeates many sectors of society. Within this dialogue, science and scientists are acutely aware of the value of diversity and the need for inclusion. While demographic diversity in science has received considerable recent attention, very little research and understanding exists on inclusion. Our study presents empirical data on the meaning of inclusion using a crowdsourcing approach that sought responses to the question “What does inclusion mean to you?”. The most prominent concepts were those of empathy, warmth, support, love, acceptance and curiosity; diverse perspectives; and participation. We clustered conceptual elements of inclusion into four themes: access and participation, embracing diverse perspectives, a welcome environment, and team belonging. On the basis of these data, we theorize a conceptual framework model from which inclusion may be put into practice. Our model suggests a dynamic process of inclusion operating from principal structural elements of 1) a foundation that involves place, access and participation, and space; 2) reciprocal engagement as an engine for inclusion; and 3) expression of inclusion as culture. The framework model demonstrates a means by which the practice of diversity can be more than shifts in demographic statistics, and instead promote the full expression of benefits derived when the many dimensions of diversity are truly included.

Education on native tree species using indigenous knowledge systems is crucial in elementary school environmental education because it sensitizes learners on the significant roles played by the native trees and their interconnections with their culture and existence. Unfortunately in Ghana, there is no pedagogical model that would aid elementary school teachers in carrying out such education.This study was aimed at developing, implementing and evaluating an indigenous knowledge inspired pedagogical model for native tree education among elementary school learners in Ghana. The convergent parallel mixed methods design that aimed at collecting quantitative and qualitative datasets on the development and evaluation of the developed pedagogical model. The results show that the pedagogical model was deemed very satisfactory in all its aspects for native tree education among elementary school learners in Ghana. The model was able to assist in developing the sustainability consciousness and competence of elementary school learners toward caring for native trees through tree planting, making of nurseries and gardens, and engaging in native tree conservation campaigns. The study recommends that the Ministry of Education should adopt, improve and widely disseminate the pedagogical model and help in its broader implementation in various elementary schools across the country.

RAxML-NG is a new phylogentic inference tool that replaces the widely-used RAxML and ExaMLtree inference codes. Compared to its predecessors, RAxML-NG offers improvements in accur-acy, flexibility, speed, scalability, and user-friendliness. In this chapter, we provide practicalrecommendations for the most common use cases of RAxML-NG: tree inference, branch supportestimation via non-parametric bootstrapping, and parameter optimization on a fixed tree topo-logy. We also describe best practices for achieving optimal performance with RAxML-NG, inparticular, with respect to parallel tree inferences on computer clusters and supercomputers. AsRAxML-NG is continuously updated, the most up-to-date version of the tutorial described inthis chapter is available online at: https://cme.h-its.org/exelixis/raxml-ng/tutorial .

Paleoclimatic and paleoceanographic studies routinely rely on the usage of foraminiferal calcite through faunal, morphometric and physico-chemical proxies. The application of such proxies presupposes the extraction and cleaning of these biomineralized components from ocean sediments in the most efficient way, a process which is often labor intensive and time consuming. In this respect, in this study we performed a systematic experiment for planktonic foraminiferal specimen cleaning using different chemical treatments and evaluated the resulting data of a Late Quaternary gravity core sample from the Aegean Sea. All cleaning procedures adopted here were made on the basis of their minimum potential bias upon foraminiferal proxies, such as the faunal assemblages, degree of fragmentation, stable isotope composition (δ18O and δ13C) and/or Mg/Ca ratios that are frequently used as proxies for surface-ocean climate parameters (e.g., sea surface temperature, sea surface salinity). Six different protocols were tested, involving washing, sieving, and chemical treatment of the samples with hydrogen peroxide and/or sodium hexametaphosphate (Calgon ®). Single species foraminifera shell weighing was combined with high-resolution Scanning Electron Microscopy (SEM) and synchrotron X-ray Microtomography (SμCT) of the material processed by each of the cleaning protocols, in order to assess the decontamination degree of specimen’s ultrastructure and interior. It appeared that a good compromise between time and cleaning efficiency is the simultaneous treatment of samples with a mixed hydrogen peroxide and Calgon solution, while the most effective way for an almost complete decontaminate of the calcareous components from undesirable sedimentary material is a two-step treatment - initially with hydrogen peroxide and subsequently with Calgon solutions.

IntroductionParamedicine is a domain of practice and health profession that specialises in the provision of health and social care across a range of settings including, but not limited to, emergency and primary care. Paramedics work in a variety of clinical settings such as paramedics services, hospitals, and clinics, in the community as well as non-clinical roles, such as education, leadership, policy work, public health and research. A previous competency framework for paramedics in Canada had become increasingly poorly aligned with contemporary practice. We sought to develop a competency framework that represents contemporary paramedic practice in Canada. MethodsThis project was guided by a conceptual framework informed by systems thinking and used a six-step model for developing competency frameworks. We engaged paramedics from across Canada in working groups to explore various contexts of paramedic practice. We gathered data using multiple methods and coded this data into activity statements. We grouped these statements and developed or expanded corresponding professional activities through five drafts of the framework from 2022 to 2024. A technical committee reviewed and edited the draft framework throughout the process, culminating in a public review period from January to March 2024, and a subsequent final version of the National Competency Framework for Paramedics (NCFP). ResultsThe National Competency Framework for Paramedics reflects contemporary paramedic practice in Canada. It describes the professional activities of paramedics organised under five domains - Person-Centred Care; Collaborative Care; Safe Care; Self-Care; and Professional Care. Paramedics perform these activities across multiple contexts of practice by enacting a variety of roles depending on the event. Discussion and conclusion By exploring the variety of practice contexts and the expectations of paramedics across Canada, the NCFP provides a holistic, contemporary description of paramedic practice in Canada, providing a foundation for professional practice in a variety of settings. The five domains provide a comprehensive representation of paramedic practice helping to ensure care is ultimately and sufficiently aligned with the needs of the community and settings in which paramedics can practice. The NCFP can be used to inform education programs to better prepare paramedics for complex, interprofessional health and social care practice now and as practice continues to evolve.

Background: The enduring psychological effects of the COVID-19 pandemic continue to affect individuals long after the immediate health concerns have subsided. This research aims to identify specific groups within the Romanian population who are at a higher risk of experiencing mental health challenges that can interfere with everyday life and may lead to more serious mental health disorders. Methods: Conducted as a cross-sectional survey, this study evaluated the prevalence and intensity of psychological distress using the DASS-21 questionnaire. An online survey distributed via Google Forms also gathered socio-demographic data and COVID-19-specific information. Statistical analyses included the Shapiro-Wilk test, Fisher's exact test, and Z-tests with Bonferroni correction. Quantitative independent variables that lacked a normal distribution were compared between groups using either the Mann-Whitney U test or the Kruskal-Wallis H test. Results: Analysis of 521 questionnaires, filled out by a predominantly middle-aged cohort of 320 women and 201 men, revealed that 63.72% of participants worked outside the healthcare field. Those unemployed or retired reported significantly higher anxiety levels than individuals in other sectors. Moreover, living alone, experiencing the loss of close relatives (6.14%) or friends (33.59%), and undergoing hospitalization or reinfection due to COVID-19 were linked to significantly elevated distress scores. Conclusion. By identifying the segments of the population most vulnerable to psychological distress, as evidenced by higher scores among the unemployed, retirees, individuals living alone, and those directly affected by COVID-19 through personal health or loss, targeted initiatives for psychological screening and therapy can be established. Such measures are essential for enhancing the post-pandemic mental well-being of Romanians, addressing the specific needs uncovered in this study.

Effective sports training should be attuned to the athlete's specific conditionings and characteristics. In motor learning research, two often neglected factors that influence this resonance are the learner's athletic background and the structural diversity of exercises (e.g., relative similarity). This study examines the effects of three learning approaches (i.e., contextual interference (CI), differential learning (DL), and free-play control condition (CO)) on the parallel learning of Handball (HB), Volleyball (VB), and Basketball (BB) skills, considering participants' prior sport backgrounds. Forty-five males (15 HB, 15 VB, and 15 BB players) with a mean age of 22±1.4 years and at least 6 years of experience in the mastered discipline voluntarily participated in this study. A pre-post-retention test design including a 6-week-intervention program was employed. In terms of short-term (pre-post) gain, only the DL- group significantly improved their performance in both non-mastered disciplines (p=0.03 for the BB free-throw and p=0.05 for the HB shooting tests), with a trend (ES=0.53) towards an improvement in the performance of the mastered VB underarm-pass skill. In terms of relatively permanent gains, the CI group significantly improved their performances from pre- to retention-test only in the non-mastered BB free-throw skill (p=0.018). In contrast, the DL group significantly improved their performance at retention compared to the pre-test in both non-mastered BB (p=0.004) and HB (p=0.003) skills, with a trend (ES=0.4) towards improvement in the mastered VB test. In both short, and relatively permanent terms, higher composite score gains were observed in DL compared to CI (p=0.001 and 0.002) and CO (p=0.001 and <0.0001). In conclusion, the present findings provide additional support for the potential advantages of the DL model over those of CI. These findings can serve as the basis for tailored training and intervention strategies and provide a new perspective for addressing various issues related to individual and situational learning.

The practice of teaching and scientific research on cadaveric material remains crucial for medical education, especially in surgical disciplines. However, in Italy, this practice has been neglected due to legislative insufficiency and financial constraints. Although innovative methods and tools like simulators and e-learning have been adopted, direct hands-on experience with human cadavers remains irreplaceable for medical and surgical education. The absence of clear legislation governing cadaveric dissection has limited availability for teaching and research, resulting in economic burdens for universities and individuals seeking proper surgical training. To address this issue, the Law No. 10/2020 and the recent implementing decree were introduced in Italy, providing detailed legislation on the donation of bodies for educational and research purposes. The law emphasizes the importance of respecting the donor's specific choices and aligns with constitutional principles promoting culture, research, and health protection. However, some critical issues related to consent procedures, duration of body availability, and preservation of anatomical parts remain. Additionally, the law's dissemination among the population needs improvement. Future optimization could include allowing donors to choose the timing of body donation and considering different timeframes for body availability. Furthermore, the implementation of consent procedures could be simplified to increase donations. The law should also address the need for appropriate reception centers and allocate resources for effective dissemination. Despite these challenges, Law No. 10/2020 represents a significant step forward in enhancing medical-surgical training, scientific research, and the overall quality of patient care in Italy.

Background: Previous investigations have found a correlation between abnormal curvatures and a variety of patient complaints such as cervical pain and disability. However, no study has shown that loss of the cervical curve is a direct result of exposure to a motor vehicle collision (MVC). This investigation presents a retrospective consecutive case series of patients with both a pre-injury cervical lateral radiograph (CLR) and a post-injury CLR after exposure to a MVC. Computer analysis of digitized vertebral body corners on CLRs was performed to investigate the possible alterations in the geometric alignment of the sagittal cervical curve. Methods: Three spine clinic records were reviewed, over a 2-year period, looking for patients where both an initial lateral cervical x-ray and an examination were performed prior to the patient being exposed to a MVC; afterwards an additional exam and radiographic analysis were required. A total of 41 patients met the inclusion criteria. Examination records of pain intensity on numerical pain rating scores (NPRS) and neck disability index (NDI), if available, were analyzed. The CLRs were digitized and modeled in the sagittal plane using curve fitting and the least squares error approach. Radiographic variables included total cervical curve (ARA C2-C7), Chamberlain’s line to horizontal (skull flexion), horizontal translation of C2 relative to C7, segmental translations (retrolisthesis and anterolisthesis), and circular modelling radii. Results: There were 15 males and 26 females with an age range of 8-65 years. Most participants were drivers (28) involved in rear end impacts (30). The pre-injury NPRS was 2.7 while the post injury was 5.0; p &lt; 0.001. The NDI was available on 24 /41 (58.5%) patients and was found to increase following exposure to the MVC: 15.7% to 32.8%, p &lt; 0.001. An altered cervical curvature was identified following exposure to MVC, characterized by an increase in radius of curvature and an approximate 8° reduction of lordosis from C2-C7; p &lt; 0.001. The mid cervical spine (C3-C5) showed the greatest curve reduction with localized mild kyphosis at these levels on average. Several participants developed segmental translations that approached the instability value of translation &gt; 3.5mm. Conclusions: Abnormalities of cervical lordosis occurred following exposure to a MVC. The average loss of cervical curvature was 8° from C2-C7, with mild flexion of the mid cervical segments. Snap through type or dynamic buckling during the MVC may explain our findings. The primary contribution of this study to the motor vehicle collision literature is that altered cervical lordosis may result from MVC exposures and the consequences of an altered cervical alignment, in turn, may lead to future pain, disability and decreased health-related quality of life.

The onset of the Coronavirus 2019 (COVID-19) pandemic has challenged the worldwide healthcare sector, including dentistry. The highly infectious nature of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus and risk of transmission through aerosol generating procedures has profoundly impacted the delivery of dental care services globally for months causing prioritization of critical dental needs and suspension of routine dental procedures. As dental practices with strengthened infection control strategies and preventive measures are re-opening in the “new normal” period, it is the responsibility of healthcare professionals to constantly analyze new data and limit the spread of COVID-19 in dental care settings. With the new variants of SARS-CoV-2 rapidly emerging in different geographic locations, a definite need to comply more than ever with the rigorous public health measures to mitigate COVID -19 transmission exists. The aim of this article is to provide dental clinicians with essential information regarding both the spread of SARS-CoV-2 virus and protective measures against COVID-19 transmission in dental facilities. By compiling guidance and standard protocols recommended by credible national and international organizations, this article serves as an aid to navigating through this unprecedented time with ease. Much to learn about COVID-19 exists and because of constant ongoing research, we are not aware of all of the newly found information. However, in this paper, we reviewed the available literature recommended for the best current practices that must be taken for a dental office to function safely and successfully.

Additive manufacturing (AM) provides opportunities to design objects differently than traditional manufacturing methods allow, but only if designers understand the possibilities AM presents. In this study, we examined whether an AM workshop combined with an idea generation session could inspire engineering professionals to use AM solutions to solve current technical problems they face. All subjects were employees at an organization that will be referred to as Company X, a multinational commercial organization based in North America. During the study, we collected ideas for 24 projects generated before and after a training workshop focused on design for AM. In the workshop, we provided three hours of instruction about design for two metal-based AM processes. The participants’ ideas were assessed using four specific metrics: (1) cost, (2) time,(3) completeness of solution, and (4) quality, which was a function of feasibility, usefulness, and novelty. Using these data, we explored whether the workshop was effective in inspiring the participants to use AM methods and techniques from AM research in their concept generation and whether participants’ AM solutions showed improvement in cost, implementation time, and quality over non-AM designs generated before the workshop.

This article aims to discuss the activities developed through the Pedagogical Residency Program for literacy of the Pedagogy course at UFF (Universidade Federal Fluminense) at INFES (Northwest Fluminense Institute of Higher Education) located in Santo Antônio de Pádua/Rio de Janeiro/Brazil, which due to the COVID-19 Pandemic, it started to be carried out remotely, in a virtual context, using digital technologies. We will describe the context and activities that were carried out within this new reality.

A relatively loud sound is audible when a vibrator is attached to the aural cartilage. This form of conduction is referred to as cartilage conduction (CC). In Japan, a new type of hearing aid has been developed using CC and is available in clinical practice since 2017. A clinical study conducted prior to its launch demonstrated its benefits, particularly in patients with aural atresia who were unable to use air-conduction hearing aids. Several studies have been published on the benefits of CC hearing aids since their introduction in clinical practice. Most of the patients included in these studies had canal stenosis or aural atresia, and the purchase rates of CC hearing aids in these patients were relatively high. However, the number of patients with open ears was small, with overall poor results in the trials, with the exception in patients with continuous otorrhea. CC hearing aids are considered a good option for compensating hearing loss in ears with canal stenosis or atresia in both bilateral and unilateral cases. However, CC hearing aids are not currently considered the first choice for patients with an open ear,.

This study examined the status of Education for Sustainable Development (ESD) practices and the understanding of Sustainable Development (SD) among Saudi kindergarten teachers in a specific governorate. Two hundred twenty-seven kindergarten teachers participated, and data was collected through a questionnaire. The results indicated that most kindergarten teachers (89.9%) were unaware of SD. The overall status of ESD practices among the participating teachers was weak, with an average score of 2.60 out of 4. Among the different dimensions, values (2.74), competencies (2.69), and practice (2.65) obtained relatively higher scores, while the content dimension (2.49) received the lowest score. Significant differences were found in the mean scores of ESD practices based on teachers’ qualifications and the type of school. However, no differences were observed based on experience. The lack of awareness regarding SD emerged as the primary barrier to implementing ESD in kindergarten institutions. Expanding teacher training was identified as the most crucial step in promoting ESD in kindergartens. The findings highlight the importance of raising awareness among Saudi kindergarten teachers about SD, providing professional development opportunities to enhance ESD implementation in classrooms, and creating teaching materials aligned with ESD principles.

Fish and fish products are very appreciated in the human diet because of high quality proteins and other important nutrients, such as minerals and polyunsaturated fatty acids. Maintaining freshness, quality and safety is essential in the fish supply chain, starting from on board vessels where the product must be carefully checked and protected from any source of contamination. Safe fishing and handling of fish are very important to reduce the risk of foodborne diseases caused by pathogenic microorganisms such as Salmonella spp., Vibrio spp., Listeria monocytogenes, Clostridium botulinum type E, viruses, and parasites. The inspection of raw material, use of good quality ice and water, high standards of personnel hygiene and cleanliness of equipment and fa-cilities as well as proper storage temperature are the most effective measures to ensure safety of fish and fish products for consumers. This review describes the good hygiene practice to be ap-plied on ships to preserve both fish products and public health.

Introduction: Parents’ behavior and practices affect many aspects of family life, including health, and many studies have proven that children's bad habits are associated with parents’ behavior and practices. Objectives: This study aimed to identify parents’ negative behaviors that might affect their families’ health and social development. Methodology: A descriptive cross-sectional study was conducted to examine the influence of parents’ behavior and practices on their family health, in which 192 respondents participated. Results: The results clarified the influence of parents on family health in several aspects. On the behavioral side, approximately 90% of the participants agreed that the behavior of parents may affect the behavior of their families, and the social and educational side results clarified the relationship between parents' illiteracy and support for the cognitive and social health of the family. Discussion: This study clarified that there is a significant relationship between illiterate parents and their ability to support their families, illustrating that the majority of participants thought that the development of the cognitive and social health of families depends on the presence of supportive parents, which has many implications for family social and psychological health. Conclusion: Parental behaviors and practices have a strong effect on their family’s health, which affects the development of the families’ cognitive and social health. Recommendation: The study recommends the need for supportive, friendly hospitals for family social health and the provision of specialized programs that support the family’s social and psychological health.

Malaysia is a developing country and agro-industries contribute country’s economy. However, it is largely unknown the scenarios of agricultural practice and food supply over the years. To understand the fact, this study was designed to explore the agricultural land use changes and domestic food supply for last 50 years in Malaysia. The result showed that oil palm plantation area and yield, both are increased by folds, conforming “oil palm” mono-culture practice. Rice cultivation area remained almost unchanged but the yield increased. However, both area of plantation and yield in case of rubber, coca and coconut were decreased. When, it comes to domestic food supply, in 1973 food grain (Rice, Wheat, Maize) import was lower than domestic production. However, the import increased more than 3 times than the domestic production in 2013. Domestic production of vegetables and vegetables import was almost 50:50. Fruits import increased almost 3 times of domestic production, though domestic production was increased. In conclusion, it is understood that Malaysian agriculture economy is standing on “oil palm” wearers domestic food supply is import dependent. It is high time to reshuffle the policy for sustainable development and achieving food sovereignty.

The article deals with issues related to social and moral education and development of preschool children. The theoretical understanding of the current state of this field is reflected in the modern normative documents "On education in the Russian Federation", the state educational standards. Analysis of theoretical and practice-oriented research in this area shows that the phrase "moral education" today is gradually replaced by "social and moral education", "social and moral development". This trend is found in preschool pedagogy (work L. V. Abramova, R. S. Bure, S. M. Zyryanova, N.A. Karataeva, G. M. Kiseleva, I. F. Sleptsova, etc.). It is the study of social and moral representations of preschool children that many relevant diagnostic methods are aimed at: to explain the actions of children, their relationship with each other and adults, to assess these actions (i.e. to correlate the situation with the moral norm). The presented research was based on the method of research of moral representations of children of senior preschool age, developed by G. A. Uruntaeva and Yu.A. Afon'kina. The analysis of the results showed that children of senior preschool age willingly included in the retelling of the actions described in the situation, but find it difficult to assess what is happening from a moral point of view. It is obvious that psychological and pedagogical work is necessary in this direction, taking into account the age characteristics of children, as well as social and moral guidelines relevant to the current situation of development of society.

Taking into account Bar-On’s postulations about social-emotional intelligence, the aim of the current work is to find out the differences in the five dimensions of this intelligence between children that practice organized sport and those children that do not practice it at elementary school level, to show that an increasing in the number of hours per day performing this activity causes differences in some of these dimensions. Hence, a sample of 940 children from elementary schools, ranging in age from 6 to 12 years old, attending different schools from the Autonomous Community of Extremadura (Spain), was used. Results showed that children who practiced organized sport had better coping abilities for stress, adaptability, and mood states, and that they are more emotionally intelligent than those who did not. Moreover, children who practiced for fewer hours daily (up to 2 hours) had better stress coping than those who practiced more. To conclude, it is important to promote the sport federative practice in elementary education, in order to ensure that children learn to better regulate and manage their emotions, without increasing it to an excessive number of hours per day, which may generate greater stress that might be difficult to control.

Background/Objectives: Concurrent opioid (OPI) and benzodiazepine (BZD) use may exacerbate falls/fractures risk compared to no use or use alone. Yet, patients may need concurrent OPI-BZD use for co-occurring conditions (e.g., pain and anxiety). Therefore, we examined the association between longitudinal OPI-BZD dosing patterns and subsequent injurious falls risk. Methods: We conducted a retrospective cohort study including non-cancer fee-for-service Medicare beneficiaries initiating OPI and/or BZD in 2016-2018. We identified OPI-BZD use patterns during the 3 months following OPI and/or BZD initiation (i.e., trajectory period) using group-based multi-trajectory models. We estimated time to first injurious fall within 3 months post-trajectory period using inverse-probability-of-treatment-weighted Cox proportional hazards models. Results: Among 622,588 beneficiaries (age≥65=84.6%, female=58.1%, White=82.7%; having injurious falls=0.45%), we identified 13 distinct OPI-BZD trajectories: Group(A):Very-low OPI-only (early discontinuation)(44.9% of the cohort); (B):Low OPI-only (rapid decline)(15.1%); (C):Very-low OPI-only (late discontinuation)(7.7%); (D):Low OPI-only (gradual decline)(4.0%); (E):Moderate OPI-only (rapid decline)(2.3%); (F):Very-low BZD-only (late discontinuation)(11.5%); (G):Low BZD-only (rapid decline)(4.5%); (H):Low BZD-only (stable) (3.1%); (I):Moderate BZD-only (gradual decline)(2.1%); (J):Very-low OPI (rapid decline)/Very-low BZD (late discontinuation)(2.9%); (K):Very-low OPI (rapid decline)/Very-low BZD (increasing)(0.9%); (L):Very-low OPI (stable)/Low BZD (stable)(0.6%); and (M):Low OPI (gradual decline)/Low BZD (gradual decline)(0.6%). Compared with Group(A), 6 trajectories had increased 3-month injurious fall risks: (C): HR, 95%CI=1.78, 1.58-2.01; (D): 2.24, 1.93-2.59; (E): 2.60, 2.18-3.09; (H): 2.02, 1.70-2.40; (L): 2.73, 1.98-3.76; and (M): 1.96, 1.32-2.91. Conclusions: Our findings suggest that 3-month injurious fall risk varied across OPI-BZD trajectories, highlighting the importance of considering both dose and duration when assessing fall risks of OPI-BZD use among older adults.

Background: Dermatophytosis, commonly known as tinea, poses a significant public health concern worldwide, especially in environments with poor hygiene and overcrowding, such as prisons. Despite its prevalence and impact on quality of life, there is a lack of research on the knowledge and hygiene practices regarding dermatophytosis among prisoners, particularly in Nepal. Objective: The study aimed to assess prisoners' knowledge, hygiene practice and infection status regarding dermatophytosis in Central Prison, Nepal. Methods: A descriptive cross-sectional study with a sample size of 184 respondents was designed to collect data using a validated pre-tested questionnaire from September 2023 to January 2024. The collected data was then analysed using IBM SPSS version 21. Knowledge and hygiene practices were measured on an eight and 11-point scale and rated as poor (≤4) and sound (>4), bad (≤6), and good (>6), respectively. Summary data were presented by descriptive, while Chi-square and logistic regression were used for inferential statistics at P < 0.05. Results: The findings revealed moderate knowledge among prisoners regarding dermatophytosis, with significant gaps in understanding its spread and prevention. While most prisoners recognised the importance of treatment, there were misconceptions about the inevitability of contracting dermatophytosis and the role of personal hygiene. Conclusions: Despite good knowledge levels, adherence to recommended hygiene practices was suboptimal, highlighting the need for targeted interventions. The study underscores the importance of addressing knowledge gaps, changing attitudes, and promoting hygienic practices to mitigate the burden of dermatophytosis among prisoners.

In this digital world, organisations are facing global competition as well as manpower pressures leading towards knowledge economy, which heavily impacts on their local and international businesses. The trend is to foster collaboration and knowledge sharing to cope with these problems. With the advancement of technologies and social engineering that can connect people in virtual world across time and distance, several organisations are embarking on knowledge management (KM) systems, implementing community of practice (CoP) approach. However, virtual communities are relatively new paradigms, and there are several challenges to their successful implementation from an organisation’s point of interest. There is lack of CoP implementation framework that can cater to today’s dynamic business and sustainability requirements. To fill the gap in literature, this paper develops a practical framework for a CoP implementation with a view to align KM strategy with business strategy of an organization. It explores the different steps of building, sharing and using tacit and explicit knowledge in CoPs by applying Wiig KM cycle. It proposes a practical CoP implementation framework that adopts the Benefits-Tools-Organisation-People-Process (BTOPP) model in addressing the key questions surrounding each of the BTOPP elements with a structured approach. Finally, it identifies key challenges such as organizational culture and performance measurements, and provides practical recommendations to overcome them for a successful CoP implementation.

Reflection in healthcare education is an emergent topic with many studies and reviews being published. The purpose of the present review is to map the literature in this field by performing a systematic review of reviews (umbrella review) and to explore which definitions and models are currently in use, how reflection impacts on design, evaluation and assessment and future challenges. Nineteen reviews were identified that satisfied inclusion criteria. Emerging themes were: reflection is currently portrayed as self-reflection and critical reflection with the epistemology-of-practice notion not being as much as expected in tandem with the evidence-based-medicine paradigm modern science advocates. Reflective techniques were recognised in multiple settings (e.g. summative, formative, group vs individual etc.) and have been associated with learning but assessment remains a research topic with issues of validity, reliability and replicability. Future challenges involve the epistemology of reflection in healthcare education and how to practice and assess reflection without losing its theoretical background.

Throughout its history Western science has tended to treat complexity as a problem to be avoided or solved. A philosophy of simplification achieved significant improvements in human life and prevails as a model for achieving societal good. However, misplaced efforts to control complexity worsen our sustainability challenges. Effective responses to modern day dilemmas such as floods and climate change require ways of thinking that are more congruent with the complexity of the world. Further, governmental programs to reduce flood risk depend on the support of an informed and engaged public. It has proven difficult to communicate risk in ways that align scientific and technical expertise based on an objective worldview, with communal and individual under-standings of risk based on subjective experiences and perspectives. I introduce Paul Cilliers’ philosophy of critical complexity as the basis of a new conceptual framework that values and balances complexity and simplicity. This paper shows how objective strategies that rely on analytic and probabilistic thinking can be integrated with subjective approaches that draw on the experiential and possibilistic. An example depicts how the problematic framing of the “100-year flood” can be replaced by a model of the data that covers a range of possibilities within an experiential time frame. Cilliers’ work opens an ethical dimension in which we make more intentional choices and acknowledge our limitations. Complexability – understanding how to live with complexity rather than aiming to simplify it – is a vital component of sustainability communication and education.

Multi-morbidity and polypharmacy are common in older people and pose a challenge for health and social care systems especially in context of global population ageing. They are complex and interrelated concepts in the care of older people that require early detection and patient centred decision making that are underpinned by the principles of multidisciplinary led comprehensive geriatric assessment (CGA). Personalised care plans need to remain responsive and adaptable to the needs of a patient, enabling an individual to maintain their independence.

During the Renaissance, Leonardo Da Vinci was the first person to successfully detail the anatomy of the aortic root and its adjacent structures. Ever since, novel insights into morphology, function and their interplay have accumulated resulting in advanced knowledge on complex functional characteristics of the aortic valve (AV) and root. This shifted the vision from the AV as being a static structure towards that of a dynamic interconnected apparatus within the aortic root as a functional unit, exhibiting a complex interplay with adjacent structures via both humoral and mechanical stimuli. This paradigm shift has stimulated surgical treatment strategies of valvular disease that seek to recapitulate healthy AV function, whereby AV disease can no longer be seen as an isolated morphological pathology which needs to be replaced. As prostheses still cannot reproduce the complexity of human nature, treatment of diseased AVs, whether stenotic or insufficient, has tremendously evolved with a similar shift towards treatments options that are more hemodynamically centered such as the Ross procedure and valve-conserving surgery. Native AV and root components allow for an efficient Venturi effect over the valve to allow for optimal opening during the cardiac cycle, while also alleviating the left ventricle. Next to that, several receptors are present on native AV leaflets, enabling messenger pathways based on their interaction with blood and other shear-stress related stimuli. Many of these physiological and hemodynamical processes are under acknowledged but may hold important clues for innovative treatment strategies, or as potential novel targets for therapeutic agents that halt or reverse the process of valve degeneration. A structured overview of these pathways and their implications for cardiothoracic surgeons and cardiologists is lacking. As such, we provide an overview on embryology, hemodynamics, and messenger pathways of the healthy and diseased AV and its implications for clinical practice, by relating this knowledge to current treatment alternatives and clinical decision-making.

In the interaction of the rolling stock and the upper structure of the railway track, intense dynamic loads occur. They have a destructive effect both on the parts of the rolling stock and on the elements of the superstructure of the track. In order to develop a durable, rational and reliably functioning design of cars and locomotives with good dynamic properties and good indicators of the impact of rolling stock on the railway track, along with theoretical computational studies, experimental studies are also required, which are usually the final stage in the design and implementation of rolling stock or modernization of existing ones. Locomotives and wagons in order to improve their strength and dynamic performance. The article presents the results of field tests to determine the dynamic performance of the type CKD6e diesel locomotive. The description of the preparation of the CKD6e shunting locomotive for testing is given. An analysis of the dynamic performance of a diesel locomotive during the passage of turnouts, on a straight section of the track and in a curve with a radius of 400 m, was carried out. The studies performed showed that the minimum value of the stability factor against wheel derailment on a straight section of the track is significantly higher than the standard value. The experimentally obtained ratio of frame forces to the static load from the wheelset on the rails, the coefficients of vertical dynamics of the first and second stages of suspension and the coefficient of stability against derailment of the wheel from the rail, registered on the track section in a curve with a radius of 400 m) meet the current requirements. A calculation scheme and equations of vertical oscillations are proposed, an analysis is carried out according to the graphs of movements of bogies and a locomotive body when moving along irregularities of different lengths at different speeds.

There are several pathologies that can change the anatomy of the otic capsule and that can distort the bone density of the bony structures of the inner ear, but otosclerosis is one of the most frequent. Similar behavior has been shown in patients affected by osteogenesis imperfecta (OI), a genetic disease due to a mutation in the genes coding for type I (pro) collagen. In particular, we note that otosclerosis and OI can lead to bone resorption creating pericochlear cavitations in contact with the internal auditory canal (IAC). In this regard, in our experience we have collected 5 cases presenting this characteristic and their audiological data and clinical history were analyzed. This feature can be defined as a potential cause of a third-window effect, because it causes an energy loss during the transmission of sound waves from the OW away from the basilar membrane.

Digital dentistry, including CAD/CAM dentistry, is perhaps the most disruptive innovation in dentistry to date. The rapid development of digital dentistry technologies over the past several decades has enabled clinicians to improve patient care by significantly reducing the time necessary for the restorative phase of treatment. Advancements in intra-oral scanning and computer-aided design and manufacturing (CAD/CAM), in conjunction with new dental CAD/CAM ceramic materials, have simplified patient care and made same-day dentistry a reality. This review aims to present the most recent advancements described in current literature as well as to document the successful implementation of digital dentistry into a predoctoral program. The overall process of CAD/CAM same-day dentistry and the accompanying advancements in software and materials were presented and discussed. Implementation of technology and personnel requirements were reviewed. CAD/CAM dentistry has been influential in shaping and improving dental practice and education, and this influence will only continue with time.

Existing implementations of game design patterns have largely been confined to theoretical or research settings. Weaknesses in these implementations have prevented game design patterns from being properly evaluated as an educational and practical development tool. This paper examines these weaknesses, describes a method of developing and applying patterns that overcome the weaknesses, and evaluates use of the method for game design education and practice. Weaknesses in existing pattern implementations are: omission of design problems, presumption of functional completeness at the level of pattern languages, narrow topical focus, and lack of a concise, repeatable method for pattern production. Several features of the proposed method were specifically built to address these weaknesses, namely the pattern template, the process for connecting patterns into a language and assessing the language’s scope, a rubric for assessing pattern confidence and interconnectivity confidence, and pattern-building exercises. This method was applied in a classroom setting. Results, as assessed by the evaluation of student work, suggest that creating patterns/pattern languages is an effective pedagogical approach. De-signs produced using designer-created patterns closely align with existing design theory and are clearly understood by students. The above results may indicate that the path to gaining wider acceptance of pattern theory as a design framework within game design is not to produce a universal pattern language but to facilitate the creation of case-specific languages, by students and professional designers, that use a shared ontology and thus can be combined easily to solve the diverse sets of problems faced by these groups.

The balance between theory and practice in architectural education is a permanent element of the discussion on teaching architecture. The article discusses the method of implementation of practical knowledge of the architectural profession at Poland’s largest department of architecture – Cracow University of Technology. Showing the subsequent stages of the education process on the way to obtaining authorization to independent design in Poland. Against this background, the didactic methods used in the initially experimental subject and now regular one taught at the Faculty of Architecture of the Technical University of Cracow together with the Chamber of Architects of the Republic of Poland since 2018 are discussed. The results of this collaboration and the didactic effects are discussed. The experience of adapting methods for remote education in connection with the pandemic of Covid-19 is also presented. In conclusion, because of the obtained results in response to the legal changes introduced by the State, the proposed new model of professional practice is discussed which, in the coming years, will cover all architecture universities in Poland.

The Sustainable Development Goals (SDGs) is a global strategy that aims to obtain a more equitable and just world. These objectives are organized in 17 SDGs, which are detailed in 169 targets. Different international institutions have emphasized education's relevance to developing citizens who contribute to the SDGs' achievement for 2030. However, a review focused on Physical Education exclusively has not been performed yet. Therefore, the objective of this work is double. First, to analyze and select the specific goals of the SDGs that can be implemented in the subject of Physical Education. And second, to relate these specific goals to the different models based on Physical Education practices. This review showed how three institutional documents have previously related sport, physical exercise and physical education to the specific goals of the SDGs. Based on the search done, this document selects those goals that could be integrated into the educational context through Physical Education. The bibliographic and narrative analysis carried out in this research shows that of the 169 specific goals proposed in the SDGs, only 24 could be worked on in Physical Education. In addition, after this previous analysis, a proposal for the relationship between the practice-based models and these 24 goals is presented. The contributions made in this paper will allow teachers to establish links between PE sessions and SDGs while raising awareness to develop students who contribute to a more sustainable world.

The coal mine underground reservoir is an appropriate solution between coal mining and groundwater resource protection and utilization. By calculating the storage capacity of a groundwater reservoir, the storage coefficient has been proved to be always an empirical value. Based on the mathematical derivation of the vertical fracture area ratio and the horizontal fracture area rate of the collapse zone and the fissure zone in the goaf area of the coal seam, the mathematical models of tem are derived, and the model for calculating the water storage coefficient is derived. The water storage coefficient derived from the theoretical model had more basis and more advanced than the traditional empirical value. By using this method, the practical calculation of No.1 underground reservoir of the DaLliuta Coalmine in Shenhua Shendong, has got a perfect matching with the actual groundwater storage capacity.

Pharmacists must acquire the necessary knowledge to provide better drug therapy to patients. In other words, educational programs need to facilitate behavioral changes among pharmacists. Therefore, this study aimed to evaluate how the behavior of pharmacists changed after attending a palliative care educational program. We conducted a web-based questionnaire survey examining the behavior of pharmacists regarding palliative care before participating in the program, two months after participating in the program, and eight months after participating in the program, to determine the behavior and changes over time. For all questions, scores were higher at two and eight months after attending the program than before attending the program (P &lt;0.05). In addition, no significant difference was observed between two and eight months after attending the program for all questions (P =0.504-1.000). The knowledge gained from the educational program was used to repeatedly intervene with patients with cancer, to address the various symptoms they experienced and maintain their behavior. The proven effectiveness of this program serves as a stepping stone for a nationwide rollout across Japan’s 47 prefectures.

The aim of this study was to examine the post-injury psychological impact looking for to avoid sources of health issues. We have analyzed differences in the stress, anxiety and depression levels between male and female football players who have suffered at least one injury during the last season played respect to similar players who have not been injured. A descriptive cross-sectional design was used. The participants were 187 football players and data on the player’s injuries were collected. A Self-reported Questionnaire collected number, type and severity of injuries sustained during the previous sports season (twelve months), and also the player’s current situation being injured or not injured. To evaluate the psychological variables, the DASS-21 questionnaire was used. Results indicated that the male injured players presented anxiety levels higher than those who were non-injured. When we observe the female players’ data, the stress levels of the non-injured ones are higher than those of the injured players. Regarding the non-injured athletes, results showed that the female non-injured players presented values in anxiety higher than those corresponding to the non-injured male players. Thus, sport injury affects mental health issues such as anxiety and stress, and in a different way regarding gender.

Type 2 diabetes (T2DM) presents an enormous global healthcare challenge, especially among rural communities due to limited access. To overcome this, many low- and middle-income countries are resorting to task shifting, using community health workers (CHWs) for diabetes management. However, its successful implementation depends on the practice behaviours and knowledge of these workers. This cross-sectional study from rural South India aimed to evaluate the proficiency of 275 CHWs in diabetes screening and management. A customized questionnaire, developed through experts and government was used to evaluate the practice behaviours and knowledge. Analytical methodologies consisted of descriptive statistics, logistic regression, and mosaic plots for comprehensive data interpretation. Results showed significant deficiencies of mean correct practice behaviours at 48 and 50% respectively. The identified gaps included diabetes diagnosis, HbA1c testing, diet, self-management, complications screening and risk assessment. In several areas, correct practice behaviour was reported by a relatively large number of CHWs despite incorrect answers to the related knowledge questions such as referral to the health centres, self-management and calculation of diabetes risk assessment. Addressing these deficiencies requires a thorough needs assessment and tailored training for improved diabetes management by CHWs. Training of CHWs, should not only identify prior knowledge and/or behaviour but also their interrelationship to help create a robust and flexible set of practice behaviours.

Zoos are increasingly putting in place formalized animal welfare assessment programs to allow monitoring of welfare over time, as well as to aid in resource prioritization. These programs tend to rely on assessment tools that incorporate resource-based and observational animal- focused measures since it is rarely feasible to obtain measures of physiology in zoo-housed animals. A range of assessment tools are available which commonly have a basis in the Five Domains framework. A comprehensive review of the literature was conducted to bring together recent studies examining welfare assessment methods in zoo animals. A summary of these methods is provided with advantages and limitations of the approach es presented. We then highlight practical considerations with respect to implementation of these tools into practice, for example scoring schemes, weighting of criteria, and innate animal factors for consideration. It is concluded that would be value in standardizing guidelines for development of welfare assessment tools since zoo accreditation bodies rarely prescribe these. There is also a need to develop taxon or species- specific assessment tools to inform welfare management.

This paper investigates how Islamic tolerance contributes to solve religious conflict today that has impacted on various aspects such as economic collapse, insecurity in life, lack of professional society, academic retrogressions, and so on. Knowledge of these issues has become an urgent to build a community that is full of peace, harmony and unity. The paper suggests that Quranic views on tolerance should be understood and practiced in order to avoid disunity in society which is due to failure to appreciate tolerance values in association. The paper concludes problems or misunderstandings always occur in different religious societies, since every religion has its own teachings and principles, as well as each of them is interpreted in different ways.

This work provides an update to the Erasmus Plus TEALEAF project The outcomes of a week-long EU-funded / Irish Government-recognized teacher course in July 2016 is described within the context of a qualitative small scale study investigating teachers' progress in the course. The explicit aim of the teacher course was to equip a diverse group of teachers with the initial tools to work to produce simple digital apps for learning about biodiversity in their respective domains. A community of practice seeks to establish a new concept of the pre-existing generalised collective conscience through triangulated conversation between the generalised and particularised collective and individual consciences. In particular to revise the generalised collective conscience that teachers can program apps for learning about biodiversity. A number of features of teaching and learning were selected in general and their relationship to constructivism delineated. The teachers were prompted for their responses to each day of the course through a self evaluation tool and the responses were ranked according the the rubric. The data was analyzed using multidimensional scaling - ASCAL procedure - in SPSS 23TM and within the repertory grid domain according to the RepSocio tool in Rep 5TM. The plots show a gradual development throughout the week in terms of specific features becoming 'stronger' or exerting more influence towards the middle of the course and fragmenting after that. Analyses were able to show which participants correlated most closely with the hypothetical IDEAL within the community of practice. Concerning this community of practice, one determine the interrelationships within the community are determined using a social mapping exercise moving from the individual consciences to a particularised collective conscience.

The purpose of this study is to assess the solid waste management status and practice in Sendafa town, Oromia regional state residents. In order to achieve this goal, the researcher intends to employ both primary and secondary data from the Sendafa town municipality. With the aid of multi-cluster sampling and a purposive sampling method, the researchers chose a sample size of 398 people and 10 interview responders. To utilize a systematic sampling technique at intervals of residences, individual samples were chosen. Quantitative data was cleaned and analysed using STATA software. A multiple linear regression model and logistic regression other descriptive statistics methods were then used to change the results. The qualitative data were imported, coded, and thematised using ATLAS.ti.9 in order to prepare respondents' interviews for analysis. The findings indicate that residents' poor solid waste management practices are a result of a lack of awareness, low family income transportation issues, issues with waste collectors, a lack of a sense of responsibility and belonging, and a failure to enforce current solid waste management laws. Solid waste accumulates near roads, bridges, and residential areas that are close to landfills, contaminating the area and leading to diseases like TB and Asthma (and other related health issues in children and adults who live there). Thus, researcher recommends that to have sustainable solid waste management the town administrators should have plan to develop awareness creation symposium or panel of discussion, resolve transportation issues, monitor and guide the routine activities of waste collectors, develop sense of belongingness for themselves and for the community, develop integrated solid waste land fill projects and working with all stakeholders like NGO and health institution will minimize the adverse effect of improper solid waste management. Keywords: Solid Waste, Status of Solid Waste Management, Land fill site suitability

Positive Health (PH) has been described as a promising transformative innovation to address the challenges of promoting well-being and reducing the burden of disease. The aim of this study is to review the current state of knowledge about PH as introduced by Huber et al. (2016) within the available scientific literature. A rapid review of the literature following the Cochrane Rapid Review recommendations. Three databases were searched (PubMed, Google Scholar, and CINAHL). Data were extracted and synthesized using a narrative approach. A total of 55 articles were included. Initial evaluation studies reveal promising results both at individual and collective levels. However, a need is expressed in several articles for further refinement of the conceptualization of PH and ways to make the effects of the PH approach more measurable. Professionals also expressed a desire for a more informed application and elaboration of the PH method across various settings and populations to enhance its effectiveness in practice. This rapid review highlights the transformative potential of PH in shifting from a disease-focused to a health-oriented paradigm of healthcare. It underscores the need for continued research regarding further development of the concept and its practical method, along with the necessity for methodological innovation.

Biodiversity conservation is a key factor in meeting sustainable development goals. This is even more important in cities, where green spaces are becoming increasingly scarce. This study analyzes the Kinshasa's proliferating ornamental plant nurseries, known as informal horticultural sites (IHS). The analysis focused on characterizing the profile of horticulturists, their production conditions and the ornamental species produced. Fifteen IHSs were sampled using the "snowball" technique, and 178 horticulturists were surveyed. Based on the socio-professional profile of the horticulturists, five groups of IHS are distinguished after a hierarchical classification on principal components. We found that IHSs exclusively employed men, most of whom were new to the trade, from all levels of education, and most of whom ranged from 19 to 45 years old. Production conditions are relatively similar from one site to another. However, all IHS are characterized by permanent land insecurity, the use of phytosanitary products, plant conditioning methods that are not very diversified and calibrated to growers' investment capacities, and diversified seed acquisition methods. A total of 139 ornamental species, most of them exotic, were identified. Of these, 37% are phanerophytes and 24% are considered potentially invasive. We suggest ways of professionalizing the activity and protecting the urban environment.

Background and Objectives: In Libya, prescription medicines can easily be dispensed without a prescription, as self-medication with the subsequent of potential misuse and unnecessary risk for patients. This systematic review and meta-analysis explored the prevalence of self-medication among citizens in Libya. Methods: We systematically searched PubMed, ISI Web of Knowledge, EMBASE, Medline, Scopus, google scholar and ResearchGate databases for studies published in Libya reporting the prevalence of non-prescription use of medicines in community pharmacies, targeting studies published from Jan 2008 until Dec 2019. A random meta-analysis was performed to analyze pooled estimates of non-prescription usage of medicines. Results: Out of 63 articles identified, a total of 13 papers from 7 cities were met the inclusion criteria and involved a total of 4741 subjects. The overall pooled proportion of self-medication of drugs was 53.6% (95% CI: 0.93% - 1.08%), with low heterogeneity and the P-value of the whole population tasted was found to be = 1.000 (df = 12). Seven out of the 13 studies reported data on self-medication for antibiotics without prescription. The records ranged from 15.3% (95% CI 0.61–1.65) in Misurata to 76.6% (95% CI 0.80–1.25) in Tripoli. Conclusion: Self-medication use of medicines among Libyan population is a common phenomenon involving a high proportion use of antibiotics. This misuse of medications could enhance the development and spread of antibiotic resistance.

In 2014, the International Union for Conservation of Nature adopted the Red List of Ecosystems (IUCN RLE) criteria as the global standard for assessing risks to terrestrial, marine, and freshwater ecosystems. Identifying and quantifying the impacts of biodiversity assessments on the status of nature is key to justifying continued investment in assessments and enabling strategic planning to maximize future impact. In this policy perspective, we use an established impact evaluation framework to identify the impacts of the IUCN RLE since its inception. To date, 1,397 ecosystem units in 100 countries have been assessed following the IUCN RLE protocol. Systematic assessments are complete or underway in more than 25 countries and two continental regions (the Americas and Europe). Countries with established ecosystem red lists have already used them to inform legislation, land-use planning, protected area expansion, monitoring and reporting, and ecosystem management. IUCN RLE indices based on systematic assessments have high potential to inform global biodiversity reporting for the Aichi Targets and the United Nations Sustainable Development Goals. Expanding the coverage of IUCN RLE assessments, building capacity to undertake them, and establishing stronger policy instruments to manage red-listed ecosystems will be key to maximizing conservation impacts over the coming decades.

Fire accidents are common accidents amongst residential house occupants in Libya. Some of the factors that can mitigate fire accidents in Libyan residential houses include fire safety awareness and knowledge. This study investigated the level of awareness and knowledge of fire safety amongst residential house occupants in Libya. The possibility and consequences of fire hazards and risk existing in residential houses in Libya were also studied. Experimental data obtained for 1.5 m/s and 3.5 m/s as walking and running evacuation time, respectively amongst residential house occupants in Libya were also compared. The sample consist of 90 respondents with instruments of fire safety awareness and knowledge, fire hazard and consequences, and the involvement of residential house occupants in fire emergency. Statistical analysis was performed at p < 0.05 to determine the levels of residential awareness and knowledge regarding fire safety and the hazard and consequences. The findings illustrated that the items were highly reliable (α > 0.7) and normally distributed. Also, the results illustrated that the majority of residential house occupants in Libya have fair level of fire safety awareness and knowledge with overall percentage of 80% and 90%, respectively. On the other hand, the results further showed that majority of residential house occupants have good level of fire emergency involvement with 90%. This paper proposes a fire safety assessment method which may form the basis of future fire safety practice in Libya.

Background: Obesity among pregnant women is common, and their offspring are predisposed to obesity, insulin resistance, and diabetes. Circulating metabolites that are related to insulin resistance and are associated with this decreased tissue-specific uptake are unknown. Here, we assessed metabolite profiles in elderly women and who were either female offspring from obese mothers (OOM) or offspring of lean mothers (OLM). Metabolic changes were tested for associations with metrics for insulin resistance. Methods: 37 elderly women were separated into an elderly offspring from obese mothers (OOM; n = 17) and elderly offspring from lean/normal weight mothers (OLM; n = 20) groups. We measured plasma metabolites using 1H-NMR and also insulin-dependent tissue specific glucose uptake in skeletal muscle were assessed. Associations were made between metabolites and glucose uptake. Results: Compared to the OLM group, we found that the 22:6 docosahexaenoic acid percentage of the total long chain n-3 fatty acids (DHA/FA) was significantly lower in OOM (P = 0.015). DHA/FA associated significantly to skeletal muscle GU (P = 0.031) and M-value in the OLM group only (P = 0.050). Conclusions: DHA/FA is associated with insulin-dependent skeletal muscle glucose uptake and that this association is significantly weakened in the offspring of obese mothers.

Background: Dental professions are at high risk of contracting novel corona virus (COVID-19) infections during the dental procedure due to the droplets and aerosols generated during various dental procedures on infected patients. To prevent and avoid the cross-infection of the infection to dental professionals or the patients attending the dental clinic, good knowledge of the infection and its prevention mechanisms is mandatory among the professionals. Until to date, there is no pooled estimate on the knowledge,attitude and practice (KAP) of dental professionals to COVID-19 in the globe. Hence, this study aimed to determine the pooled estimate of KAP of dental professionals in this pandemic disease. Methods: Article search was done electronically using Medline, Scopus, Web of Science, EMBASE, SciELO and Google Scholar from June 1, 2020 to August 20, 2020. All studies that assessed the KAP of dental professionals to COVID-19 were searched and included in this review after passing the inclusion criteria. The pooled analysis of their knowledge (sign and symptom, mode of transmission and prevention mechanisms), attitude (their concern, intention to treat suspected patients) and practice (face mask usage, hand washing and alcohol based hand rub usage, handshaking practice, deferred procedures and checkup of patients temperature) was computed using RevMan 5.3 and random effect model was used. The presence of publication bias was assessed using the funnel plot. Results: Twelve articles with a total of 5,362 study participants were included in this study. The pooled estimate revealed that 59.91% of the dental professionals had good knowledge of the signs and symptoms of COVID-19. Two-third of dental professionals know the prevention mechanisms of the infection, and 70.13% had enough knowledge of the transmission modalities of the infection. The professional attitude revealed that only 36.43% of the participants had intention to treat a patient with cough or suspected COVID-19 (36.43%, 95%CI: 8.57, 64.29). Moreover, 47.85% of the dentists were concerned about their life, and the fate of their profession due to this pandemic disease (47.85%, 95%CI: 26.74, 68.97). The pooled analysis showed only 50.86% (95%CI: 18.64, 83.09) of the study participants worn face mask and 52.63% (95%CI: 10.54, 94.71) had avoided handshaking practice during this pandemic period. Non-emergency dental procedures were canceled by 83.98%. Conclusion: The dental professional KAP is not optimal. Thus, dental professionals should be aware of the recently updated knowledge about COVID-19 and practice according to the standards of treatment guidelines, and the recommended infection control measures in dental settings. Moreover, as saliva and droplets are the major sources of infection, dentists should follow essential protocols to regulate droplet and aerosol contamination in the dental practice

Abstract: Background: Irreversible electroporation (IRE) is a form of non-thermal ablation that delivers pulses of high voltage electrical current between electrodes. The role of IRE in the treatment of colorectal hepatic metastases is unestablished. This study is an international ques-tionnaire survey of the use of IRE for colorectal hepatic metastases. Methods: A questionnaire addressing views on the use of IRE for colorectal liver metastases was circulated to clinicians with an interest and/or expertise in this technique. Results: 64 clinicians from 17 different countries replied to the questionnaire. Thirty-six (56%) had experience of treating patients with colorectal liver metastases with IRE. The preferred mode of delivery of IRE was percutaneous treatment under CT guidance. Thirty-three (70% respondents) used IRE exclusively for lesions in proximity to inflow or outflow structures. Twenty (43% respondents) used IRE as their sole ablative treat-ment whilst 19 (40% respondents) used IRE in combination with thermal ablation. The maximum number of lesions that could be treated by IRE was two and preferred size of lesion was

Probiotics are now being looked at as a possible addition to cancer treatments in both study and clinical settings. This study tries to give an overview of probiotic research as it relates to cancer, with a focus on how it might help avoid cancer, treat it, and improve the health of cancer patients. We look at developmental studies that use cell culture and animal models to look at how well probiotics work in cancer. We focus on how probiotics change the immune system, inflammation, and gut bacteria. The results of clinical studies that looked at probiotics as an add-on therapy for cancer patients are looked at to see how they affected the treatment success, side effects, and quality of life of the patients. We look at the possible benefits of probiotics for certain types of cancer, such as colorectal cancer, breast cancer, and stomach tumors. We also find the best probiotic strains for each type of cancer. We also look at the synergistic benefits of combining probiotics with standard cancer treatments like chemotherapy, radiation therapy, and immunotherapy to improve the effectiveness of treatment and lower side effects. Lastly, we talk about the present problems and future directions of probiotic research for cancer. We focus on personalized methods, ideal doses and treatment plans, finding signs of treatment success, and making probiotic-based therapies. By learning more about how probiotics could be used to treat cancer, we can create personalized, successful, and well-tolerated probiotic treatments to improve cancer outcomes.

Tooth bud removal called Ibyinyo is the practice of removing the developing tooth buds, usually done on an infant, typically performed by traditional healers who believe that this practice will reduce fever and diarrhea in children. This practice is most prevalent in East-African countries, including Rwanda. These procedures are mostly performed in non-sterile conditions using basic sharp instruments. We will discuss the case of a 10-year-old female patient who was presented at the dental clinic, with two malformed permanent canine teeth. Clinical examination revealed malformed enamel and elongated permanent right maxillary canine tooth left mandibular canine tooth with crown malformation. She was also presented with retained (primary) left maxillary lateral incisor tooth and missing left maxillary canine tooth. In addition, the ectopic eruption of left maxillary central incisor tooth and missing permanent right mandibular canine tooth were noted. All these complications resulted from tooth bud removal that the patient had experienced in her early childhood. Her malformed right maxillary and left lower mandibular canine teeth were reshaped, using composite filling materials, to improve her appearance aesthetically. Ibyinyo is preventable damage, done out of ignorance and superstitious practices that can be stopped by growing social awareness. Therefore, educating parents through community-based campaigns on the detrimental consequences of early childhood tooth bud removal through Ibyinyo practice might be helpful to eradicate this harmful and unnecessary practice.

From the moment the World Health Organization (WHO) declared COVID-19 to be a pandemic disease, COVID-19 began to affect the lives of many healthcare providers worldwide. In response to this pandemic, urology departments and training residency programs implemented urgent measures to reduce outpatient clinics, adopted the use of telemedicine, regulated emergency and outpatient urological procedures, promoted the use of operating theatres, and developed the use of sustainable e-learning alternatives to traditional urology resident/staff educational activities. Here, we review the response of urologists in Saudi Arabia to the COVID-19 pandemic and how they applied both for the patients and for the healthcare of urologist personnel.

For more than eighty years the standard interpretation (SI) has dominated quantum physics. Perspectives that have tried to challenge this domination have been remarkably unsuccessful. As a result, quantum theory (QT) has remained remarkably stagnant. The article offers a critical examination of SI and provides an explanation for its continued domination. It also uses Bohmian mechanics—a theoretical perspective advanced by American physicist David Bohm—as a case study for why alternative interpretations have failed to displace SI. The article sees the main reason for the failure to achieve much progress beyond SI in the unresolved philosophical problem of subject-object relation that continues to plague our study of physics. The article sketches a path to a possible solution and outlines a new science practice that this solution will require.

Introduction: Blood transfusion involves the transfer of blood from donors to patients. A blood transfusion is carried out every 2 seconds in the US. It is made up of about 29000 units of red blood cells and is transfused every day in the US. When blood transfusion is done correctly, it can result in the saving of lives and the improvement of healthcare. However, it may also lead to immediate, late, delayed, and chronic complications. No previous studies have been conducted in Qatar to address this issue. Methods: This is a cross-sectional study intended to determine the knowledge, attitude, and practice toward blood transfusion among healthcare providers at Hamad Medical Corporation (HMC), which is the principal healthcare provider in Qatar. Participants between 18 and 25 years of age were selected for the research study. A 10-item online questionnaire that people can fill out on their own will be used to get the data needed for the analysis and meet the study's goals. Results: the analysis has indicated that facing negative reactions after blood transfusion and being worried about getting affected by any infection have a small positive association, with the specific values coming in at r = 0.317, p = 0.000. Fever after blood transfusion and feeling like refusing blood transfusion have a significant and moderate positive correlation, with the specific values coming in at r = 0.630 and p = 0.000. Conclusion: The findings of this study have helped us figure out how healthcare providers feel, what they know, and what they do during a blood transfusion.

Understanding the strength of the associations between perceived risk and individuals’ behavioral intentions to protect their health is important for determining appropriate risk communication strategies in communities impacted by lead contamination. We conducted a survey within communities of northern Idaho, USA (n = 306) near a Superfund megasite with legacy mining contamination. We empirically test a theoretical model based on the Health Belief Model. Survey respondents had higher intentions to practice health protective behaviors when they perceived the risk of lead contamination as severe, recognized the benefits of health protective behaviors, and considered the risks of lead contamination. Women reported higher behavioral intentions than men, but age and mining affiliation did not have an association. Survey comments indicated that perceptions about the long-term environmental remediation in the region influenced risk perceptions. Understanding risk perceptions, behavioral intentions, and related factors can aid public health agencies in tailoring risk communication for increasing protective behaviors in mining-impacted communities internationally.

A strategy to propose solutions to health-related problems recognizes that people, animals, and the environment are interconnected. Fusarium and Neocosmospora are an example of this interaction due to the capable of infecting plants, animals, and human. This review provides information on various aspects of these relations and proposes how to approach fusariosis with a One Health methodology. Here we give a framework to understand infection pathogenesis, through the epidemiological triad and explain how the broad utilization of fungicides in agriculture may play a role in the treatment of human fusariosis. We assess how plumbing systems and hospital environments might play a role as a reservoir for animal and human infections. We explain the role of antifungal resistance mechanism in both humans and agriculture. Our review emphasizes the importance of developing interdisciplinarity research studies where aquatic animals, plants, and human disease interactions can be explored through coordination and collaborative actions.

Apart from their obvious educational mission, public schools provide health, psychological, emotional, and social development grounding for students. Thus, the educational system is special in that it combines multiple integrated responsibilities and duties beyond the scope of any other social welfare program. As such, social workers are a very important constituent of this system, and they ostensibly serve to attend to the wellbeing of students while ensuring educational system performance. In light of this extremely steep set of demands, this work assesses and compares social workers’ authentic roles in UAE schools during and after the COVID-19 pandemic so that we may contribute to the improvement of educational systems worldwide. The results are nuanced and will better illuminate the important capabilities of social workers in the continually changing educational system, as well as the challenges they face and ameliorate during emergency scenarios.

This paper explores the concept of feminist architecture and its potential to challenge gender norms and stereotypes in urban design. Women face specific challenges in urban spaces, including safety concerns, lack of accessibility, and discrimination. Feminist architecture offers a potential solution to these challenges by providing a framework that prioritizes the needs and experiences of marginalized groups, including women. The study employs a mixed-methods approach to conduct a review of relevant literature, case studies, and examples of feminist architecture from around the world to address research questions related to barriers and benefits of implementing feminist architecture in mainstream design practices. After identifying obstacles, this paper offers concrete strategies to overcome these barriers and the findings suggest that by prioritizing inclusivity, accessibility, sustainability, and democracy, feminist architecture principles offer a framework for designing urban environments that are just, equitable, and empowering for all individuals. However, despite the potential gains of incorporating feminist architecture into the design process, there are several barriers and limitations that designers may face. Therefore, to overcome these barriers and limitations, implementing feminist architecture principles require a commitment to understanding how gender operates in society, financial support, policy advocacy, and collaborative approaches among designers. By creating inclusive, gender-neutral, and supportive spaces and promoting diversity and inclusion within learning and practice, feminist architecture has the capacity to transform the built environment and make it more inclusive, equitable, and just for everyone.

Background: Traumatic events adversely affect the clinical course of obsessive-compulsive disorder (OCD). Our investigation explores the correlation between prolonged interpersonal trauma and the severity of symptoms related to obsessive-compulsive and anxiety disorders. Methods: The study follows a cross-sectional and observational design, employing the International Trauma Questionnaire (ITQ) to examine areas linked to interpersonal trauma, the Hamilton Anxiety Rating Scale (HAM-A), and the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) to assess anxious and obsessive-compulsive symptoms, respectively. Descriptive analysis, analysis of variance (ANOVA), and logistic regression analyses were conducted. Results: We recruited 107 OCD-diagnosed patients, categorizing them into subgroups based on the presence or absence of complex post-traumatic stress disorder (cPTSD). The ANOVA revealed statistically significant differences between the two groups in the onset age of OCD (p=0.083), psychiatric familial history (p=0.023), HAM-A, and Y-BOCS (p=0.000). Logistic regression indicated a statistically significant association between the presence of cPTSD and Y-BOCS scores (p=0.000). Conclusion: The coexistence of cPTSD in OCD exacerbates obsessive-compulsive symptoms and increases the burden of anxiety. Further advancements in this field are crucial for mitigating the impact of early trauma on the trajectory of OCD and associated anxious symptoms.

In the context of the Education-2030 Framework for Action, an important goal for initial STEM teacher education is to provide professional development on equality and gender awareness. This study explored whether STEM prospective secondary teachers are prepared to implement a sustainable gender-sensitive practice upon graduation. To this end, we cross-culturally validated the TEGEP (Teacher Self-Efficacy for Gender Equality practice) scale and compared STEM student teachers’ perceptions of self-efficacy by country and sex. Participants were 205 STEM (science, technology, engineering, and mathematics) secondary school student teachers (136 Greek and 69 Spanish) drawn from seven public universities (six Greek, one Spanish). Statistical analysis confirmed the structure and factor invariance of the TEGEP across country and between sexes showing evidence that gender equality self-efficacy level is only moderate and that perceived competence in gender knowledge was significantly higher in Greek than in Spanish STEM student teachers, while the latter felt more competent than the Greek in developing values and attitudes in regards to gender. The study provides a cross-validated instrument to measure gender equality self-efficacy in STEM teacher education and evaluate sustainable changes after planned interventions.

Fashion industry is the second most polluting industry in the world representing a 2 trillion dollars and growing valuation (Pal, 2017). This dual context makes its challenges hard to address. From one side, fashion design education and practice systems have been perpetuating an industrial-focused approach which relies mostly in the economic improvement through fast cycles of product development (Pal, 2017). On the other side, fashion industry has also been closed to either multidisciplinary and transdisciplinary initiatives outside the scope of the artistic disciplines. Therefore, innovative approaches are needed to solve fashion industrial challenges. One of the most promising fields to tackle fashion current environment and technological problems is microbiology (Mazzoto et al., 2021). During the past 50 years, microbiology has played a vital role in solving human grand challenges in health, agriculture, food, and waste management sectors, and it also represents an opportunity for fashion industry as well. Microbiology biotechnological potential for the fashion industry relies mostly on the improvement of toxic waste bioremediation and the development of novel biomaterials and biomolecules. Moreover, the emergent field of synthetic biology is expanding the tools and approaches available, and they can already be seen in the development of engineered living materials that have functional properties (Mazzoto et al., 2021). Despite the urgent need for change, there is still a long way until a more sustainable fashion industry is achieved. Therefore, microbiological research and innovation need maturation to be able to scale-up and reach a global impact for tackling fashion industrial problems.

Health and wellness tourism should be particularly valued in the post-pandemic phase, as a stra-tegic product to enhance the population's well-being and quality of life indicators, at social, phys-ical, and environmental dimensions, with different proposals for specialized experiences that complement the destination's offer, positioning regions as health and wellness destinations. Thermal tourism should be encouraged, as a specific product, due to the innovation and diversi-fication observed in the services made available and the benefits recognized at different age levels of tourists and destinations communities. Considering the relevance of thermal springs and thermal tourists for tourism destinations image, positioning, and development, this research aims to identify the specific motivations of tourists to the practice of thermal tourism, to understand how the benefits that thermal tourists search for, and their sociodemographic profile influence the motivations, and how the motivations determine the travel characteristics. This research was de-veloped on the North and Centre of Portugal, for their relevance in the context of thermal springs and related tourism activities. To achieve the research objectives, a questionnaire survey was ap-plied to thermal tourists, through a non-probability by convenience sampling, using bivariate tests, such as Pearson’s chi-squared test, one-way ANOVA, and t-student. The results highlight that most respondents practiced thermal tourism due to leisure and relaxation benefits, such as the escape from daily stress, spend time with family, and being "pampered"; relaxation is the most valued motivation, followed by the search for psychological and physical wellbeing. The research found relations between the benefits expected by thermal tourists, and their travel characteristics such as the composition of the group, the general travel motivation, the thermal destination cho-sen, and the number of nights spent. In thermal tourism, new challenges emerge, demanding the development of strategies, products, and services responding to the needs of specific market segments.

This study was aimed to identify perception, knowledge, attitude and nursing practice toward use of physical restraints among clinical nurses, and further examined the factors associated with nursing practice toward use of physical restraints. The research participants were 180 nurses from a urban general hospital located in Korea. Data were collected using self-report questionnaires and analyzed using t-test, ANOVA, Pearson correlation coefficients, and multiple regression. There were significant negative relationships attitudes towards the use of physical restraints with knowledge (r = -.32, p &lt; .001) and nursing practice (r = -.12, p = .107). Knowledge showed a positive correlation with nursing practice (r = .28, p &lt; .001). Factors affecting nursing practice of clinical nurses were identified as knowledge (β= .23), education experiences (Yes) (β= .18), and work unit (ICU) (β= .43). The explanation power of this regression model was 22% and it was statistically significant (F=7.45, p&lt;.001). The findings from this study suggest that knowledge, education experiences and work unit were the strongest predictor on nursing practice toward use of physical restraints. Thus, we propose that developing and applying evidence-based educational intervention programs by work unit to reduce the inappropriate use of physical restraints in hospitals are required.

This paper provides a comprehensive overview of the potential applications of dual energy CT (DECT) in improving image quality and diagnostic capabilities of CT arthrography (CTA) in clinical practice. The paper covers the use of virtual non contrast (VNC) images, in which the injected contrast medium is reduced from the articular cavity, in order to better analyze 2D and 3D images of the bone. Moreover , virtual monoenergetic imaging (VMI) applications and their potential use for the reduction of metal artifacts and improving image contrast are reviewed. The role of virtual non calcium (VNCa) in detecting bone marrow edema surrounding the imaged joint will be discussed. Furthermore , the role of iodine map to enhance the contrast between soft tissues, optimizing the visualization of contrast material, and to distinguish contrast material from calcifications is described. Finally, a case series including different joints is provided to underline the additional advantages of high spatial resolution dual energy CT reconstructed images.

The WHO European Region defined the role of a new central professional for primary care, the Family and Community Nurse (FCN). The introduction of FCN in the framework of health policies highlight a key role of nurses in addressing the families’ and communities’ needs. A scoping review was conducted in order to identify and describe the available tools which has been adopted for the assessment of the community health needs by FNC. A comprehensive literature review on Embase, Cochrane Library, PubMed, CINAHL, Scopus and PsycInfo databases was conducted including all studies up to May 2021. A total of 1563 studies were identified and 36 of them were included. The literature review had made possible to identify studies employing twelve different community assessment's tools or modalities. Referring the WHO framework proposed in 2001 some common themes have been identified with an uneven distribution, as profiling the population, deciding on priorities for action and public healthcare programmes, implementing the planned activities, evaluation of health outcomes, multidisciplinary activity, flexibility and involving the community. To the best of our knowledge, this work is the first attempt to provide an overview of community assessment tools, keeping the guidance provided by the WHO as a reference.

Edcraft, a recycling and upcycling event for Malaysian secondary school students, particularly in the Klang Valley area in 2020. The event's goal was to look into gamified solutions to encourage recycling and upcycling among the students’ age group. Lectures, talks, practical exercises and games were used to teach students about climate change and environmental preservation. According to a post-event survey, the percentage of participants who recycle has climbed significantly: 76% now recycle, compared to only 24% previously. The study discovered that gamification-based activities could effectively facilitate recycling and upcycling behaviours. Such solutions can be applied to encourage behavioural changes in different contexts. By interviewing 15 Edcraft students in a focus group study setting, researchers could better understand the motivations. Themes such as 'social connections are vital', 'convenience and rewards are significant motivators', 'gamified activities help attract and engage teens' and 'environmental knowledge is crucial to prolonging recycling' emerged from the thematic analysis. This manuscript proposes gamified activities to induce a behavioural change in upcycling, and the findings yield helpful insights to fuel pro-environmental behaviours.

The combination of statistical learning technologies with large databases of psychophysiological data has appropriately generated enthusiastic interest in future clinical applicability. It is argued here that this enthusiasm should be tempered with the understanding that significant obstacles must be overcome before the systematic introduction of psychophysiological measures into neuropsychiatric practice becomes possible. The nonspecificity of psychophysiological measures complicates their use in diagnosis. Low test-retest reliability complicates use in longitudinal assessment, and quantitative psychophysiological measures can normalize in response to placebo intervention. Ten cautionary observations are introduced and, in some instances, possible directions for remediation are suggested.

Cross-field innovation in faba bean breeding has added significant value to the traditional faba bean planting industry by allowing for the selection of faba bean varieties with a dual purpose as ornaments and food. In order to improve the selection efficiency, we determined 17 phenotypes related to ‘dual purpose’ faba beans and evaluated 37 new breeding lines, which were bred for 10 years by our team, and two traditional faba bean varieties by means of an Analytic Hierarchy Process. The lines and varieties were evaluated and sorted into five grades, from which two breeding lines with excellent comprehensive phenotypes and dual ornamental and food functions were selected. The new line GS5 passed the identification of Crop Identification Committee of Chongqing Seed Industry Association on November 25, 2021 and was renamed "Doumei 1 hao" with the identification number of " 202111". The results confirmed that the comprehensive evaluation system constructed in this study can be used for the effective selection of dual-purpose faba bean lines, providing an empirical approach for strategic decision-making by breeders.

Objectives: The aim of this study was to assess the knowledge, attitude and practice of healthcare professionals regarding adverse drug reaction [ADR] monitoring and pharmacovigilance [PV] in India. Materials and Methods: It was a questionnaire based cross sectional observational study. Data was collected with the help of data collection Google form that included the demographics and twenty two survey based questions. Data were analysed by using Microsoft Excel sheet, further analysed for results, including frequency, percentage, mean and standard deviation. Result: The questionnaire was filled by two hundred ten healthcare professionals in which 52.9 % were male and 47.10% of female. Most of the respondents were pharm d students (50.47%). Out of the total 91.4% responded to the definition of pharmacovigilance correctly. 87.6% participants said all ADR should be reported. 86.20% participants think Pharmacovigilance should be taught in detail to healthcare professionals. Most of the respondents (43.8%) always informed the patients about ADR while prescribing the medicines. Conclusion: Study revealed most of the participants have good knowledge about ADR and pharmacovigilance. Difficult to decide whether ADR occur or not and extra work load being major factors responsible for under reporting.

It is widely acknowledged that the integration of BIM and GIS data is a crucial step forward for future 3D city modelling, but most of the research conducted so far has covered only the semantic aspects of GIS-BIM integration. We present here the results of the GeoBIM project, in which we tackled three integration problems focussing instead on aspects involving geometry processing: (i) the automated processing of complex architectural IFC models, (ii) the integration of existing GIS subsoil data in BIM, and (iii) the georeferencing of BIM models for their use in GIS software. All the problems have been studied using real world models and existing datasets made and used by practitioners in the Netherlands. For each problem, we expose in detail the issues we faced, our proposed solutions, and our recommendations for a more successful integration.

Quality evidence-based decisions and strategies are critical and valuable tools in strengthening health systems policies, strategic priorities action plans and comprehensive care delivery management. Our finding showed that there is scarcity of local/national and internal effective evidence-based and management strategies for informed decision making based on the disease or health epidemics nature, extend, ecological and geo-location of pandemics and epidemics crises burden and impacts. Evidence-based programs or projects are crucial in evolving pandemics and/or (Ebola, meningitis, Cholera and influenza) epidemics persistent morbidity and mortality/ case fatality reduction or prevention; as well as on poverty and inequity alleviation within the vulnerable population and citizenry over time. This paper assesses implications of evidence-based on health systems surveillance and monitoring systems, preparedness and emergency response gaps and needs in improving care delivery uptake and usefulness, coverage and effectiveness in Africa. Furthermore, the article advocates for quality, access to and uptake of knowledge-based policy-decision making and practice improvements in building efficient and standardized surveillance, preparedness and response approaches. Also, in enriching data sharing and inclusiveness through understanding the links between poverty, poor health and inequited related emerging infectious diseases epidemics in Africa. Leveraging on cumulative lessons learnt experiences and innovations in integrating participatory knowledge-based policies and approaches is paramount in fostering vulnerable population awareness and engagement, skills empowerment collaborative productivity and sustainable healthy solutions and measures. Strengthening new partnerships, alliances, and networks requires collaborative and quality evidence policy decisions, appropriate and reliable monitoring and evaluation systems approaches and strategies in improving local preparedness and emergency response capabilities against future emerging infectious diseases epidemics and fast-tracking poverty alleviation knowledge-based livelihoods and health solutions for impact. Furthermore, integrated, participative partnerships and collaborative responsibilities, cost effective and reliable evidence health financing and budget allocation, and targeted capacity development aiming at reducing and averting the burden of poverty related emerging threats and epidemics preparedness and response programs in African countries.

Abstract: Background: The practice of menstrual hygiene(MH) is a public health issue and depends on various factors. Taboos and incorrect MH practices can lead to health hazards. This study aimed at assessing the Knowledge, Attitude, and Practice of MH among the female students and faculty of Medical and Health Sciences University. Materials and methods: This cross-sectional questionnaire survey between February and June 2023 using consecutive sampling. Univariate analysis and comparisons were done with a significant p-value <.05. Results: A total of 253 women participated in the study. The knowledge and practices of MH were good. There were significantly more irregular and painful periods in younger females (p=.005,.0001). 89% of women used disposable pads and least used menstrual cups. Younger women were unaware of menstrual cloth. The attitude towards menses varied, with younger females feeling annoyed (p=.002), and older females embarrassed (p=.0001) at menarche. About 1/3rd of participants perceived menstrual blood as unhygienic. Younger women were more open about talking about menses (p=.005). Conclusion: There was good knowledge and practices of MH among participants. There were differences in menstrual history and attitude among older and younger women. The attitude and beliefs vary among the participants, due to sociocultural factors and age differences.

Improving the quality and access to healthcare services in rural areas is fundamental to develop sustainable healthcare systems. This research aims to explore the motivations of healthcare professionals to work and settle in rural island areas of Greece with limited access to secondary and tertiary care. The study suggests practical ways to encourage self-motivation and attract more health workers in rural areas. An exploratory qualitative research approach was employed, involving semi-structured interviews with 16 healthcare professionals working in primary care units that lack direct hospital or hospital-health center access. The research was conducted specifically in the rural islands of Cyclades. Thematic analysis was conducted to identify common themes and unique insights from the participants. The analysis revealed three thematic categories. Τhe «attraction» thematic was influenced by personal factors, random selection, origin, accommodation factors, professional factors and obligatoriness. The «recruitment» thematic was associated with understaffing, special care issues, unstable working environment, educational and organizational aspects, and insular lifestyle. The thematic of «retention» highlighted personal issues, accommodation difficulties, economic and work-related issues, and unique challenges posed by an insular lifestyle. This research provides valuable insights into the motivations that drive healthcare professionals to settle, work, and remain in remote island units, as well as the challenges they encounter in making this decision. The study proposes strategies to motivate and attract more healthcare professionals to rural areas. These findings should be considered when formulating or reviewing primary healthcare empowerment policies to ensure equitable healthcare access for all individuals.

Heat waves are a significant consequence of climate change threatening public health by increased morbidity and mortality. The aim of this study was to estimate individuals’ knowledge, attitudes and practice related to heat waves. We conducted an exploratory cross-sectional study in Greece during September 2023. We employed a convenience sample of 1055 participants. We used the heat wave knowledge, awareness, practice and behavior scale (HWKAPBS) to measure our outcome. We measured several socio-demographic variables, such as gender, age, educational level, etc. as potential determinants. Mean scores for the knowledge, awareness, practice and behavior factors were 12.5, 22.7, 22.2 and 12.1 respectively. Females had higher scores on the four factors compared with males. We found a positive relationship between self-perceived health status and awareness, practice and behavior about heat waves. Similarly, we identified a positive relationship between self-perceived financial status and awareness and behavior about heat waves. Increased age was associated with increased practice score, while increased educational level was associated with increased knowledge score. Additionally, behavior score was higher among participants in urban areas than those in rural areas. We found statistically significant positive correlations between the four factors. Levels of knowledge, awareness, practice and behavior about heat waves were high in our sample. Several socio-demographic variables affect participants’ knowledge, awareness, practice and behavior concerning heat waves.

Wide-field (WF) retinal imaging is becoming a standard diagnostic tool for diseases involving the retinal periphery. Technological progress elicited the advent of wide-field optical coherence tomography (WF-OCT) and WF-OCT angiography (WF-OCTA) examinations. This review presents the results of studies that analyzed the implementation of these procedures in clinical practice and refers to them as traditional and ultra-wide-field fluorescein angiography (UWF-FA). The PUBMED search was performed using the terms WF-OCT OR WF-OCTA OR UWF-FA AND the specific clinical entity, including diabetic retinopathy (DR), retinal vein occlusion (RVO), Coats disease, peripheral retinal telangiectasia, peripheral retinal degeneration, lattice degeneration, and posterior vitreous detachment. The analysis only included the studies in which the analyzed field of view for the OCT or OCTA exam was larger than 55 degrees. The evaluation of the extracted studies indicates that WF imaging with OCT and OCTA provides substantial information on retinal disorders involving the retinal periphery. Vascular diseases, such as DR or RVO, can be reliably evaluated using WF-OCTA with results superior to standard-field fluorescein angiography. Nevertheless, UWF-FA provides a larger field of view and still has advantages over WF-OCTA concerning the evaluation of areas of non-perfusion and peripheral neovascularization. Detailed information on the vascular morphology of peripheral changes should be obtained via WF-OCTA, not angiographic examinations. WF-OCT can serve as a valuable tool for the detection and evaluation of vitreoretinal traction, posterior vitreous detachment, and peripheral retinal degeneration, and guide therapeutic decisions on a patient’s eligibility for surgical procedures.

Computed tomography (CT) is a widely employed imaging modality with diverse clinical applications in pediatric and adult populations, offering numerous advantages. Despite several alternatives to imaging modalities with ionising radiation, CT scans have demonstrated persistent global popularity, contributing to a substantial amount of effective radiation doses for patients. This exposure results in hazards, including stochastic effects that amplify the radiation-induced cancer risk proportionally to the radiation dose received. CT-related radiation comprises a substantial portion of cumulative effective doses within diagnostic radiology, specifically impacting younger patient cohorts undergoing repeated investigations for chronic diseases over time. Scientific literature over recent decades has explored various methods to mitigate radiation doses during medical imaging. One notable strategy involves implementing low-dose and ultralow-dose CT protocols, maintaining diagnostic efficacy in acute and non-acute medical and surgical conditions. Utilising innovative image reconstruction algorithms, such as iterative reconstruction and emerging deep-learning algorithms based on artificial intelligence, plays a pivotal role in achieving an approximately 80% reduction in patient radiation compared to standard doses. This review article discusses the significance of low-dose protocols across a spectrum of acute and chronic medical conditions affecting different body systems.

Long-span steel structure trusses are widely used in factory buildings, but with the growth of service time and the increase of dynamic load fatigue, a considerable part of the long-span truss with dynamic load appears serious transverse cracks at the bottom of the middle span and oblique deformation of the abdomen in the operation process. The U-shaped cracks at the bottom and belly, as well as the mid-span down deflection of the main truss, reduced the functional function of the factory building truss structure, and had to limit the original crane load, which affected the normal safety and durability of the structure. Therefore, the application principle of the variable axial force cable system in the long-span factory building truss structure and 3D3S software modeling [1] were used. Analyzing and studying the reinforcement method of large-span powerhouse truss can provide practical experience for subsequent similar projects. In view of the above phenomenon, the large-span powerhouse trusses of Hongcheng Powerhouse 1 and No.2 located in Tonglu, Zhejiang Province are used as the research object, and the variable axial force cable method is proposed to strengthen and lift the load. Considering the span of large-span powerhouse truss, the cable system with 22m controlling force of 400kN is proposed to be selected for powerhouse 1, and the cable system with variable axial force of 24m is proposed to be selected for Powerhouse 2. The force model of large-span truss is established by using the finite element method commonly used to analyze the force of truss. Under two working conditions, The influence of reinforcement effect is analyzed and compared from three aspects: stiffness, bearing capacity and stability. And the phenomenon of uneven stress distribution is analyzed. The stress distribution characteristics of each node are understood by simulating the most disadvantageous node plates with the greatest internal force before and after reinforcement.

Quantitative dynamic strain measurements of the ground would be useful for engineering scale problems such as monitoring for natural hazards, soil-structure interaction studies and non-invasive site investigation using full waveform inversion (FWI). Distributed Acoustic Sensing (DAS), a promising technology for these purposes, needs to be better understood in terms of its directional sensitivity, spatial position, and amplitude for application to engineering-scale problems. This study investigates whether the physical measurements made using DAS are consistent with the theoretical reception patterns and experimental measurements of ground strain made by geophones. Results show that DAS and geophone measurements are consistent in both phase and amplitude for broadband (10s of Hz), high amplitude (10s of microstrain) and complex wavefields originating from different positions around the array when: (1) the DAS channels and geophone locations are properly aligned, (2) the DAS cable provides good deformation coupling to the internal optical fiber, (3) the cable is coupled to the ground through direct burial and compaction, and (4) laser phase noise is mitigated in the DAS measurements. The theoretical relationship between DAS-measured and point-wise strain for vertical and horizontal active sources is introduced using 3D elastic finite-difference simulations. The implications of using DAS strain measurements are discussed including directionality and magnitude differences between the actual and DAS-measured strain fields. A method for spatially aligning the DAS channels with the geophone locations at tolerances less than the spatial resolution of the DAS system is proposed.

The Wester coastal Delta zone of the Netherlands is the relatively more crowded area of the country where ten of the seventeen million people live. The governmental prognosis is that this number of people will increase steadily in the coming decennia, unless the threat of climate-change seawater level rising. This is the picture in more Delta zones globally what makes the topic of resiliency for these delta-areas of importance. Approaches of resiliency are often dominated by governmental rescue planning and believe in technology solutions, while in the process the behaviour of people can make the difference in overcoming climate-change impact disasters. In the struggle against high water storming and flooding, the Dutch people prove this by developing societal resilient behaviour in a broad spectrum of activities. Post-PhD research on Dutch resilient behaviour in the in 1016-flooded Zaanstreek-Waterland area near the city of Amsterdam confirms that. Recently research by questionnaire among citizens in this region shows that people have favour for shared responsibility with government and related professional organizations. The Dutch examples of societal resiliency carried by people also show a action-learning perspective intertwined with governmental contingency planning. Therewith the Dutch practice shows a positive cross-fertilization of practice and knowledge development.

Introduction: Despite its high prevalence and impact on health, metabolic dysfunction-associated steatotic liver disease (MASLD) is inadequately addressed in European primary care (PC), with a large proportion of cases going undiagnosed or diagnosed too late. A multi-country European re-search consortium led a project to design and evaluate a patient-centered, integrated model for MASLD screening, diagnosis and linkage to specialty care for European PC settings. Aim: Based on the lessons from this project, the latest research evidence and existing guidelines for the management of MASLD, we sought to develop a set of practice recommendations for screening, referral and management of MASLD in PC. Methods: The Rand/UCLA modified Delphi panel method, with two rounds, was used to reach consensus on practice recommendations. The international panel consisted of experts from six countries, representing family medicine, gastroenterology, hepatology, cardiology and public health. Initially, fifteen statements were drafted based on a synthesis of evidence from the literature and earlier findings from our consortium. Prior to the consensus meeting, the statements were rated by the experts in a first round. Then, in a hybrid meeting, the experts discussed findings of round one, adjusted the statements and reassessed the updated recommendations in a second round. Results: In round one, there was already a high level of consensus on 10 out of 15 statements. After round 2, there were fourteen statements with a high agreement (>90%). One statement was not endorsed. The approved recommendations addressed the following practice areas: risk screening and diagnosis, management of MASLD – Lifestyle interventions, pharmacological treatment of MASLD/MASH, pharmacological treatment for co-morbidity, integrated care, surgical management and other referrals to specialists. Conclusion: The final set of 14 recommendations focuses on increasing comprehensive care for MASLD in PC. The recommendations provide practical evidence-based guidance tailored to PC practitioners. We expect that these recommendations will contribute to the ongoing discussion on systematic approaches to tackle MASLD and support European PC providers by integrating the latest evidence into practice.