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.

Synanthropic flora (weeds, spontaneously developed plants) are plants that accompany humans, appearing as a result of anthropopressure as well as after its cessation. The potential of synanthropic flora in shaping green areas usually brings many measurable benefits that depend on land management in cities. The study aimed to determine the preferences and attitudes of adults towards synanthropic flora in settlement units. The article presents survey results from 447 city residents. The obtained results were statistically analyzed using the k-means clustering method to identify segments of respondents with similar attitudes and preferences toward synanthropic flora. Mann-Whitney U tests were employed to determine statistical differences in the demographic variables among the analyzed clusters of respondents. Additionally, multiple regression analysis was performed to identify the opinions and attitudes towards synanthropic flora, that may influence their greater acceptance in the vicinity of residential areas. The results obtained in multiple regression allow for the statement that the respondent’s evaluation of the level of support for the introduction of more synanthropic vegetation into urban greenery (Yw) grows with the increase of acceptance of synanthropic plants occurrence in surroundings. Respondents’ opinions on the subject of the presence of synanthropic plants were studied using such variables concerning: synanthropic vegetation found in turfgrasses has a positive impact on the visual attractiveness of a site (X1), synanthropic plant communities present themselves better than others (X2), presence of synanthropic vegetation in an estate improves the quality of life in that location (X3), introduction of synanthropic flora into estate arrangements is a positive (X4), support for the use of synanthropic flora for educational purposes - as elements of playgrounds or in the form of environmental workshops (X5). Residents’ acceptance of synanthropic flora in green areas is at a relatively high level.

Introduction. Intra-abdominal cystic formations represent heterogeneous pathologies with varied localization and clinical manifestation. The first challenge of a giant intra-abdominal cystic lesion is identifying the organ of origin. The clinical presentation of intra-abdominal cystic lesions varies from acute manifestations to non-specific symptoms or accidental discovery. Case presentation: A 2-year-old girl presents to the emergency unit with a fever of 38.5 Celsius, loss of appetite, and apathy. The investigations showed a gigantic intra-abdominal mass whose organ belonging could not be specified. Postoperatively, a giant mesenteric lymphangioma was evident, which was completely excised. Discussions Giant cystic formations modify the anatomical reports and become space-replacing formations, and the starting point is even more challenging to assess preoperatively. Nevertheless, the careful evaluation of the characteristics of the formation, the effect on the adjacent organs, the age of the patient, and the clinical picture can provide elements of differential diagnosis.

Colours are important features in human and natural environments and are related to several psychological functions. However, a possible relation between colour preferences and personality traits is scarcely investigated. The aim of the present study was to find out whether differences in preferences for colours also reflected differences in Big Five personality traits. The sample consisted of 206 individuals voluntarily recruited from a student sample. The participants chose one of six primary colours (blue, green, red, yellow, black, white) from the Natural Colour System (NCS) as their favorite colour. Personality traits were measured with the Big Five Inventory-44 (BFI-44. Blue and yellow was the most and least preferred chromatic colour, respectively. There were no gender differences in preferences for the chromatic colours, but more women preferred white and men preferred black. Compared to the rest of the sample, the blue group had higher scores on agreeableness and extraversion, and the red group had lower scores on agreeableness. Pairwise comparisons showed that the blue group had higher scores on agreeableness and extraversion than the red group, and higher scores on agreeableness compared to the green group. There were no significant personality differences for the other chromatic and achromatic colour groups.

(1) Background: As part of the Scottish Governments five-year recovery plan to address the backlog in NHS care following the COVID-19 pandemic, community pharmacies in Scotland are planned to provide a Hospital Discharge Medicines Supply and Medicines Reconciliation Service. We aimed to qualitatively explore patients’ experience of this new service; (2) Method: Adult patients (≥18yrs age) who consented to participate in the Community Pharmacy Hospital Dis-charge and Medicines Reconciliation Service were invited for interview within 21 days of dis-charge from hospital. Qualitative, one-to-one, semi-structured, patient interviews were conducted by telephone and audio-recorded using Microsoft Teams®. The interview audio recordings were transcribed verbatim and underwent thematic analysis; (3) Results: 12 patients were inter-viewed, evenly split by sex and with a median age of 62 years (range; 36 to 88 years). Analysis generated main five themes; Patient Engagement, Stakeholder Communication, Practical Factors, Human Factors, and Comparative Experiences. Many of these were interdependent; (4) Con-clusions: Patients appreciated that the service ensured a quicker discharge from hospital. Good stakeholder communication, practical factors (including choice, location, and the realities of ob-taining their medication from the community pharmacy), and a pre-existing and trusted rela-tionship in their usual community pharmacy were the key factors that regulated the patient ex-perience. In the main, patients were positive about the introduction of this new service. However, a lack of previous relationship or trust with a community pharmacy, and previous experiences with medication supply problems were factors which had the potential to negatively impact on patient experiences.

The golden ratio, also known as Phi (ϕ ≈ 1.618034), attracted the interest of mathematicians, artists, and intellectuals for many centuries, probably from when it was discovered in human anthropometry. Even in recent times, researchers found the presence of golden ratio in Renaissance paintings and aesthetic preferences. The reasons behind the fascination with the golden ratio remain unclear, but it has been suggested that stimuli containing this proportion are often perceived as beautiful. However, evidence is conflicting, and the literature struggles to establish the existence of individual preferences for golden ratio. To gain new insights into the nature of these preferences, one hundred participants completed an implicit association task, with either golden ratio or random stimuli presented with positive or negative words. Participants initially categorized the stimuli based on their assigned categories. Then, we assessed their explicit preferences by asking to rate the stimuli in terms of pleasantness and by completing a line bisection task and the Ultimate Game. The results revealed the typical effects observed in implicit association tasks, with improved response times and accuracy when golden ratio stimuli were associated with positive word categories. In contrast, explicit ratings yielded mixed results. We discuss our findings in relation to previous studies that have explored this issue, highlighting the ongoing debate surrounding preferences for the golden ratio.

This paper examines the effect of chronotype on the delinquent credit card payments and stock market participation through preference channels. Using an online survey of 455 individuals who have been working for 3 to 8 years in companies in mainland China, the results reveal that morningness is negatively associated with delinquent credit card payments. Morningness also indirectly predicts delinquent credit card payments through time preference, but this relationship only exists when individuals’ monthly income is at low and average level. On the other hand, financial risk preference accounts for the effect of morningness on stock market participation. Consequently, an additional finding is that morningness is positively associated with financial risk preference, which contradicts previous finding in the literature. Finally, based on the empirical evidence, we discuss the plausible mechanisms that may drive these relationships and the implications for theory and practice. The current study contributes to the literature by examining the links between circadian typology and particular financial behaviours of experienced workers.

The aim of the present study is to investigate both the performance and preferences of males and females Computer Science (CS) graduates. In order to attain the above goal, a quantitative case study was conducted regarding 89 degrees, acquired from 2006 to 2012, from the Department of Computer Science and Technology, University of Peloponnese, Greece. The analysis of the data revealed that in terms of performance, no significant differences between the mean grades of males and females exist, in almost most of the courses included in the curriculum of the aforementioned CS department. Any statistically significant differences in performances were present in almost equal number of courses in favor of males and females. It seems also, that females performed better in the courses they selected more than males. Regarding preferences, in CS courses, it seems that gender differences are existent. Males preferred more than females did core programming courses and advanced topics of Software Systems, computer networks, computer engineering, robotics and mathematics, whereas females preferred more the study of algorithms and security issues, computer fractals, data management, computer architecture, and mobile communication. In addition, females preferred courses in reference with humanities and social sciences, CS terminology, and career opportunities. Yet, females did not select any of programming lab-based courses, computer engineering, computer network issues and robotics.

With the increasingly online exposure of urban public spaces, the new concept of "Internet-celebrity cities" has emerged in China. The online internet-famous sites are the main characteristics of "Internet-celebrity cities". To fully understand online users' preferences in such kind of public spaces, this article took 27 typical riverfront internet-famous sites (RIFS) in Changsha city (China), as an example. Through the online images and review comments on social media platform "Xiaohongshu", the study analyzed users’ perception of RIFS specially on visual and emotional preferences. It revealed the following findings:(1) The popularity of RIFS had a significant head effect and there were far more positive emotions than neutral and negative emotions in review comments. (2) According to 5 different categories of RIFS: modern buildings with river views, restaurants with strong visual impact became the main attractions on commercial RIFS. The art exhibition RIFS attracted visitors to experience traditional culture and highlight their aesthetic pursuits. In the historical and cultural RIFS, people preferred to see the historical buildings with surrounding natural environment, as well as river and mountains views. Ecological Recreational RIFS showed the similar results with the uncultivated RIFS, for the main focus was on the ecological environment, a broader vision and the specific atmosphere. Moreover, the uncultivated RIFS showed more diversified attraction points. This study can provide a new perspective on the waterfront vitality and can offer a targeted and attractive manner for waterfront regeneration that are different from traditional methods.

The supply chain has incorporated products by putting them into hair scarfs. This study introduces the use of mini chips in health and beauty products and can reduce fatigue through enhanced sleep patterns. The mini chip could be placed in the scarf and used as a prototype. RFID technology provides the supply chain with specific information that is used to identify products and make communication easier. (Muhammad, et. al. 2013) This paper presents a new tool herein referred to as a scarf prototype which is developed to analyse EMG (electromyogram), ECG (electrocardiography), EEG (electroencephalogram), and EOG (electro-oculogram) signals that focuses in the area of sleep disorders. The mini chips used can be used to determine a solution for sleep disruption by using automated analytics. This could lead to improvement in our understanding of sleep disruption and overall sleep physiology. Automated technology allows repeated measurements, evaluation of sleep patterns, and provide suggestions to improve a person’s quality of sleep. This analysis compares the use of polysomnography and the scarf prototype. The analytics provide models and shows correlation between variables, such as EMG, ECG, EEG, and EOG. This study shows that the results from the scarf prototype is just as reliable as the original method, polysomnography.

Background. The Stanford Health Assessment Questionnaire-Disability Index (HAQ) is widely used to measure functional ability in persons with Rheumatoid Arthritis (RA). The instrument was developed with limited involvement from persons with RA, and their perception of the instrument has not been studied in depth. The aim of this study was to explore how persons with RA experience the use of the HAQ in care. Methods. Forty persons with RA were purposefully recruited to participate in semi-structured interviews. The interviews were then analyzed qualitatively using thematic analysis. Results. The participants questioned the relevance of the HAQ but nevertheless experienced that the instrument had a profound effect on their understanding of health and how care is delivered. The analysis resulted in three themes: Problems with individual items, meaning of the summative score, and effects on care and health perceptions. Conclusions. To make the HAQ relevant to persons with RA, it needs to be revised or to include an option to select items most meaningful to the respondent. To ensure relevance, the HAQ update should preferably be co-created by researchers, clinicians and persons with RA.

High levels of meat consumption are increasingly being criticised for ethical, environmental, and social reasons. Plant-based meat substitutes have been identified as healthy sources of protein in comparison to meat. This alternative offers several social, environmental and health benefits and may play a role in reducing meat consumption. However, there has been a lack of research on how specific meat substitute attributes can influence consumers to replace or partially replace meat in their diets. Research demonstrates that in many countries consumers are highly attached to meat. They consider it as an essential and integral element of their daily diet. For these consumers which are not interested in vegan or vegetarian alternatives to meat, so-called meathybrids could be a low-threshold option for a more sustainable food consumption behaviour. In meathybrids only a fraction of the meat product (e.g. 20% to 50%) is replaced with plant-based proteins. In this paper, the results of an online survey with 501 Belgium consumers are presented with focus on preferences and attitudes relating to meathyrids. The results show that more than fifty percent of consumers substitute meat at least occasionally. Thus, about half of the respondents reveal an eligible consumption behaviour in respect to sustainability and healthiness to a certain degree. Concerning the determinants of choosing either meathybrid or meat it becomes evident that a strong effect is exerted by the health perception. The healthier meathybrids are perceived, the higher is the choice probability. Thus, this egoistic motive seems to outperform altruistic motives like animal welfare or environmental concerns when it comes to choice for this new product category.

In this article, we present two topics related to mathematical economics. We offer an intriguing proposal for securing cost and production functions in the face of uncertainty and risk. We discuss the relationship between individual and social preferences. This is important because traditional revealed preference theory does not account for such factors.

Iberian ham, a traditional Spanish meat product, is renowned for its unique nutritional and sensory attributes, garnering widespread appreciation both domestically and internationally [1]. It is one of the most outstanding Spanish gastronomic treasures, with very special nutritional and sensory properties that make it highly appreciated throughout the world [2]. Recent trends indicate a notable surge in its consumption, a pattern projected to persist [3]. For an enhanced online shopping experience, understanding the specific characteristics and requirements of various consumer segments is crucial. This study aims to scrutinize national Iberian ham consumption patterns and, through survey methodologies, discern the preferences and needs of online consumers purchasing whole Iberian hams. The subsequent cluster analysis will empower suppliers with insights to pinpoint business prospects and craft segment-specific online marketing strategies.

Background: Over the past decades, efforts have been made to improve the nutritional well-being in people with cystic fibrosis (pwCF). Due to the correlation observed between nutritional indices and lung function, prevailing recommendations consistently advocate for BMI percentile goals at or above the 50th percentile in pwCF. Recent global trends show a notable increase in overweight and obese statuses among pwCF. This study aims to explore the nutritional status of Italian pwCF. Methods: Data from the Italian CF Patient’s Registry were analysed to assess the proportion of individuals categorized as underweight, target weight, overweight, and obese from 2010 to 2021. Patient-level comparison data from 2021 were also examined to identify potential determinants of overweight and obesity. Results: Analysis spanning 2010 to 2021 reveals a decrease of approximately 40% in underweight status among adults, while the proportion of malnourished patients 90, and lower prevalence of Pseudomonas aeruginosa colonization. Conclusions: Our study confirms the evolving nutritional status landscape among Italian adult pwCF, with a significant shift towards overweight and obesity over the past decade. These trends highlight the need for proactive measures within CF standards of care to adapt and address the changing needs of patients.

Dysmenorrhea symptoms are frequent and often self-treated using non-prescription medicines. To further characterize women with dysmenorrhea using a combination of hyoscine butylbromide and paracetamol (PLUS) for self-management of their complaints, we performed a secondary analysis of a published pharmacy-based patient survey. 314 women (mean age 32.3 years) with dysmenorrhea reported a pain and cramps intensity of 7.45 ± 2.13 on a 0-10 Likert scale, which was reduced to 2.86 ± 1.81 upon treatment. Associated impairments of work/daily chores, leisure activities, and sleep were improved by 64.6%, 62.2% and 70.4%, respectively. The onset of symptom relief was within 60 min in 84.7%. Tolerability was rated as very good or good by 97.2%. These findings confirm the efficacy and tolerability data on PLUS from randomized controlled trials in a larger group of women conducting self-management of their dysmenorrhea.

This study investigates optimal decisions in a green supply chain consisting of a manufacturer and a leading retailer considering the green marketing and fairness preferences of member firms. Four Stackelberg game decision models are constructed in which the manufacturer and the re-tailer engage in green marketing separately when the manufacturer has no and has fairness preferences. The impacts of fairness preferences and green marketing on the optimal decision in the green supply chain are comparatively analyzed. The study finds that member firms perform green marketing regardless of the presence or absence of fairness preferences and that such be-havior increases the wholesale price, retail price, and market demand of low-carbon products as well as the profits of member firms and the supply chain. A more interesting finding is that the profit growth of member firms and the supply chain due to the manufacturer’s green marketing is more pronounced than that due to the retailer’s green marketing. When the retailer and the manufacturer engage in conduct green marketing, the manufacturer's fairness preferences have different effects on the wholesale price, retail price, market demand, level of green marketing efforts, member enterprises and profits of supply chain. Therefore, firms should consider the impact of green marketing and fairness preferences to make pricing and performance decisions, so as to achieve efficient operation of the whole supply chain and avoid double marginal effects. Finally, the above conclusions are verified through numerical simulation, providing a reference for the decision-making of member firms in the green supply chain.

Wellness tourism is a growing segment that destinations can rely on to increase tourism flows and revive underdeveloped rural areas. This study elicits tourists' preferences for wellness tourism products and the redevelopment of a wellness destination in a depopulated rural area. The re-search included 595 participants in Central Greece using on-site, face-to-face surveys. The survey data was analyzed using a two-step process. First, conjoint analysis was applied to determine the combination of wellness tourism product attributes that maximize visitors’ utility. In the second step, we elicited visitors' willingness to pay (WTP) for improvements in tourism product attributes using the contingent valuation method. Findings indicate that the combination of attributes that maximizes the preference structure of respondents includes time of visit from September to Oc-tober, duration of visit from 1 to 7 days, wellness tourism as the primary purpose of the visit, and wellness activities that contain both physical activities and training as well as spiritual and emo-tional enhancement. Using binary logistic regression, the analysis indicates that respondents are willing to pay 47.33€ per visit on average further to develop wellness tourism products in the study area. Empirical results confirmed that sustainability issues, quality, and entrepreneurship factors positively impact visitors' WTP for revitalizing wellness products. In contrast, a longer duration of stay in the area and respondents' age negatively impact their WTP. These findings suggest that structuring a customer-driven tourism product will enhance the rural destination's efforts to attract high-yield visitors and advance the rural economy. Furthermore, practical im-plications reveal that Destination Management Organizations will benefit from research results to foster targeted management plans.

With the widespread use of mobile phones, increasing use of mobile applications in different areas of life have gained a large place. Between the reasons of the preference of the rapid increasing number of apps in the application markets of the different platforms, the aesthetic appereance of the icons that apps have perhaps the most important one. In this study, the visual symmetrical side of the icons of the most downloaded apss which are developed for preparing to Public Servant Exam in Turkey is emphasized. Two different types of data are obtained with working on the icons with image processing technique by using Mathworks Matlab program and survey method which is applied on Korkut Ata University students. By comparing the obtained data with the binary logistic regression method, it was determined that the visual symmetry in the apps’ icons partially contributed to the aesthetic appreciation.

Researchers have explored primary colour-geometric shape associations since Kandinsky's correspondence theory. However, there is a gap in the literature regarding interior colour applications on surface shapes. To address this gap, an online study was employed to gather data with one hundred participants who were asked to choose their preferred colours for shapes on bedroom walls with follow-up questions on the colour-shape semantic associations, their preference of colours and shapes on bedroom walls independently in addition to their favourite colour, their favourite shape, and colour-shape pairs without interior context. The results revealed that colour-shape preferences in interiors differ from those found in psychology studies, other colour applications on bedroom walls, and other preferences, indicating that colour preference is context-dependent. Interestingly, the most popular colour for surface shapes on bedroom walls is purple, followed by brown and blue. The study contributes to the existing literature by providing colour charts for bedroom applications for professionals in the industry, their clients/users, and future studies.

This study investigates the cultural dimension in sustainable lighting design to create inclusive environments. India being one of the most culturally and ethnically diverse nations in the world, with a population of almost 18% of the world population, requires attention to include cultural dimension in the design of sustainable environments. With the changing lifestyle and growth in organized retailing, the Indian retail market needs an upgrade to create inclusive environments for shared retail experiences. Lighting is among most influencing atmospheric attribute to create simulating environment for a holistic shopping experience. Preference of lighting conditions vary across the store profiles and users’ cultural background. Very little research has been carried out to understand the lighting preferences of retail customers in India. This study investigated the effects of correlated colour temperature and illuminance levels on spatial impressions and user preferences in mid-range store profile. This study involved ninety-three participants in evaluating high definition visualisations of the sixteen lighting conditions. The observations from this study emphasizes the necessity of similar studies across various states of India to identify the lighting preferences for other functional spaces and cultural backgrounds within the country. The findings may contribute towards providing recommended guidelines in lighting design and include a cultural dimension in the design of sustainable store environments.

The unique qualities of areas with natural landscape features help provide sustainability. Moreover, their different vegetation covers and ecosystems contribute to the preservation of their visual attraction. In recent years, the demand for natural areas has not only been seen at a recreational level, but has also become associated with the conservation and sustainability of those areas. Although the concept of sustainability is expressed from an ecological point of view, studies indicate that the visual aspect is also an important component. Thus, in this study, a visual quality assessment was carried out which considered both objective and subjective evaluations of different habitat types. Efteni lake-wetland and Melen Ağzı dunes (Düzce), Anzer, Ayder, and Çat Düzü highlands (Rize), and Sultanmurat and Taşli highlands (Trabzon) were selected as the study areas. A visual quality analysis was conducted with a total of 43 participants (23 students, 16 local inhabitants and four lecturers) in order establish their preferences in areas with different landscape characteristics. For the determination of the visual qualifications of these areas, a total of 24 photographs showing typical images representing each habitat type (three photographs for each) were employed. Taking perceptual parameters into consideration, assessment of visual quality was made according to the points given to each photo by the participants. Consequently, differences in visual quality were found to be influenced by the demographic status of the participants, differences in habitat types, recreational trends and the conservation status of the habitats.

Diabetic foot ulcers (DFUs) significantly affect the lives of patients and increase the risk of hospital stay and amputation. We suggest a remote-monitoring platform for better DFU care. This system uses digital health metrics (scaled from 0 to 10, where higher scores indicate a greater risk of slow healing) to provide a comprehensive overview through a visual interface. The platform features smart offloading devices that capture behavioral metrics such as offloading adherence, daily steps, and cadence. Coupled with remotely measurable frailty and phenotypic metrics, it offers an in-depth patient profile. Additional demographic data, wound characteristics, and clinical parameters, such as cognitive function, were integrated, contributing to a comprehensive risk factor profile. We evaluated the feasibility of this platform with 124 DFU patients over 12 weeks; 39% experienced unfavorable outcomes such as dropout, adverse events, or non-healing. Digital biomarkers were benchmarked (0-10), categorized into low, medium, and high risk for unfavorable outcomes, and visually represented using color-coded radar plots. The initial results of case reports illustrate the value of this holistic visualization to pinpoint the underlying risk factors for unfavorable outcomes, including a high number of steps, poor adherence, and cognitive impairment. Although future studies are needed to validate the effectiveness of this visualization in personalizing care and improving wound outcomes, early results in identifying risk factors for unfavorable outcomes are promising.

Recent dramatic reductions in the timeframe in which genomic sequencing can deliver results means its application in time-sensitive screening programs such as newborn screening (NBS) is becoming a reality. As genomic NBS (gNBS) programs are developed around the world, there is an increasing need to address the ethical and social issues that such initiatives raise. This study therefore aimed to explore the Australian public’s perspectives and values regarding key gNBS characteristics and preferences for service delivery. We recruited English-speaking members of the Australian public over 18 years of age via social media; 75 people aged 23-72 participated in one of 15 focus groups. Participants were generally supportive of introducing genomic sequencing into newborn screening, with several stating that adoption of such revolutionary and beneficial technology was a moral obligation. Participants consistently highlighted receiving an early diagnosis as the leading benefit, which was frequently linked to the potential for early treatment and intervention, or access to other forms of assistance, such as peer support. Informing parents about the test during pregnancy was considered important. This study provides insights into the Australian public’s views and preferences to inform the delivery of a gNBS program in the Australian context.

This paper aims to understand better how attitudes towards the environment could influence preferences and willingness to pay for the development of sustainable tourism products on the Spanish island of Gran Canaria. A hybrid choice model is estimated to analyse how different latent constructs related to environmental concerns affect individuals’ preferences for a set of sustainable tourism activities. The data used in the analysis is obtained from a discrete choice experiment where different scenarios with nature-based tourism packages are created. A set of measurement indicators allowed us to gain insight into the underlying latent structure regarding the individuals’ attitudes towards the environment. The analysis consists of integrating these attitudes into a choice model, focusing on a market segment primarily comprised of potential customers who are young residents and non-residents. Results reveal significant heterogeneity in preferences and willingness to pay for the various activities under study when attitudinal latent factors are incorporated into the model. Our findings provide valuable insights for researchers, policymakers, and practitioners promoting sustainable tourism products.

Background: Producing, distributing or discussing child sexual abuse materials (CSAM) is often committed through the dark web in order to remain hidden from search engines and regular users. Additionally, on the dark web, the CSAM creators employ various techniques to avoid detection and conceal their activities. The large volume of CSAM on the dark web presents a global social problem and poses a significant challenge for helplines, hotlines and law enforcement agencies. Objective: Identifying CSAM discussions on the dark web and uncovering associated metadata insights into characteristics, behaviours and motivation of CSAM creators. Participants and Setting: We have conducted an analysis of more than 353,000 posts generated by 35,400 distinct users and written in 118 different languages across eight dark web forums in 2022. Out of these, approximately 221,000 posts were written in English and contributed by around 29,500 unique users. Method: We propose a CSAM detection intelligence system. The system uses a manually labelled dataset to train, evaluate and select an efficient CSAM classification model. Once we identify CSAM creators and victims through CSAM posts on the dark web, we proceed to analyze, visualize and uncover information concerning the behaviors of CSAM creators and victims. Result: The CSAM classifier, based on Support Vector Machine model, exhibited good performance, achieving the highest precision of 92.3\%, accuracy of 87.6\% and recall of 84.2\%. Its prediction time is fast, taking only 0.3 milliseconds to process a single post on our laptop. While, the Naive Bayes combination is the best in term of recall, achieving 89\%, and its prediction time is just 0.1 microseconds per post. Across the eight forums in 2022, our Support Vector Machine model detected around 63,000 English CSAM posts and identified near 10,500 English CSAM creators. The analysis of metadata of CSAM posts revealed meaningful information about CSAM creators and their victims, such as: (1) the ages and nationalities of the victims typically mentioned by CSAM creators, (2) forum topics where the CSAM creators assign their posts, and (3) online platforms preferred by CSAM creators for sharing or uploading CSAM. Conclusion: Our CSAM detection system exhibits high performance in precision, recall, and accuracy in real-time when classifying CSAM and non-CSAM posts. Additionally, it can extract and visualize valuable and unique insights about CSAM creators and victims by employing advanced statistical methods. These insights prove beneficial to our partners, i.e. national hotlines and child agencies.

University course scheduling (UCS) is one of the most important and time-consuming issues that all educational institutions face yearly. Most of the existing techniques to model and solve UCS problems have applied approximate methods, which are different in terms of efficiency, performance, and optimization speed. Accordingly, this research aims to apply an exact optimization method to provide an optimal solution to the course scheduling problem. In other words, in this research, an integer programming model is presented to solve the USC problem. In this model, hard and soft constraints include the facilities of classrooms, courses of different levels and compression of students' curriculum, courses outside the faculty and planning for them, and the limited time allocated to the professors. The objective is to maximize the weighted sum of allocating available times to professors based on their preferences in all periods. To evaluate the presented model's feasibility, it is implemented using the GAMS software. Finally, the presented model is solved in a larger dimension using a real data set from a college in China and compared with the current program in the same college. The obtained results show that considering the mathematical model's constraints and objective function, the faculty courses' timetable is reduced from 4 days a week to 3 working days. Moreover, master courses are planned in two days, and the courses in the educational groups do not interfere with each other. Furthermore, by implementing the proposed model for the real case study, the maximum teaching hours of the professors are significantly reduced. The results demonstrate the efficiency of the proposed model and solution method in terms of optimization speed and solution accuracy.

High levels of meat consumption are increasingly being criticised for ethical, environmental, and social reasons. Plant-based meat substitutes have been identified as healthy sources of protein that, in comparison to meat, offer a number of social, environmental and health benefits and may play a role in reducing meat consumption. However, there has been a lack of research on the role they can play in the policy agenda and how specific meat substitute attributes can influence consumers to replace partially replace meat in their diets.

Malaria is a serious infection affecting millions of people in Africa. Our study investigated the personal preferences and applications of antimalarial medicines in Ghana. Based on over 1000 questionnaires distributed in Ghana from January to May 2019, we noticed that although Western medications to fight this disease are widely available, most patients in Ghana prefer treatment with locally produced herbal remedies. This preference appears to be due to a combination of traditional venues for obtaining medicines “on the street” rather than in licensed pharmacies, trust in local and “green” products, extensive advertisement of such local products, and an inherent distrust of imported and synthetic or unnatural medicines. Going local and natural is a trend also observed in other countries across the globe, and adds to the acceptance or rejection of drugs regardless of their activity or toxicity. In fact, adverse side effects associated with herbal remedies, such as general weakness and swollen, sore mouth, do not seem to deter the respondents of this study in Ghana. We propose a combination of (a) increasing public awareness of the benefits of modern medicine and (b) an improvement and control of the quality of herbal remedies to raise the standard of malaria treatment in countries such as Ghana.

Tumor to stroma ratio is a highly debated prognostic factor in the management of several solid tumors and there is no universal agreement on its practicality. In our study we proposed to confirm or dismiss the hypothesis that a simple measurement of stroma quantity is an easy-to-use and strong prognostic tool. We have included 74 consecutive patients with colorectal cancer who underwent primary curative abdominal surgery. The tumors have been grouped into stroma-poor (stroma <10%), medium-stroma (between 10 and 50%) and stroma-rich (over 50%). The proportion of tumor stroma ranged from 5% to 70% with a median of 25%. Very few, only 6.8% of patients had stroma-rich tumors, 4% stroma-poor tumors and 89.2%tumors with a medium quantity of stroma. The proportion of stroma, at any cut-off, had no statistically significant influence on the disease specific survival. This can be explained by the low proportion of stroma-rich tumors in our patient group and the inverse correlation of stroma proportion with tumor grade. The real-life proportion of stroma-rich tumors and the complex nature of the stroma-tumor interaction has to be further elucidated.

Malawi has developed an excellent, nation-wide system for monitoring people infected with HIV and keeping track of key epidemic markers. Their success lies in two things: the focus on simplicity and the use of data collection not only to track the epidemic and identify problems but also to give regular feedback and support to every clinic in the country. This achievement is the more remarkable given that Malawi is one of the poorest countries in the world, ranking 190 out of 194 countries by GDP, but has one of the most severe epidemics of HIV in the world, ranking 9th out of 168 countries by HIV prevalence. We first discuss the current state and likely future epidemic trends in Malawi: unless we know where we are and where we are going we cannot decide what to do or how to do it to in order to achieve a better outcome. We then discuss the history and development of Malawi’s patient monitoring system, as reported in their Integrated HIV Program Reports,ix which have been published quarterly since the beginning of 2004. We consider the current state of patient monitoring and support as reflected in the most recent report for the third quarter (Q3) of 2016 and comment on some of the questions that this raises. Finally, we consider ways in which the current system could be improved by strengthening Malawi’s analytical capacity and making better use of this unique data set. The focus here is on HIV in adultsv because if ART is initiated early in all adults living with HIV this should include testing all pregnant women for HIV and starting them on treatment immediately. However, PMTCT is especially important and care must be given to reducing MTCT and identifying the long-term child survivors of mother-to-child transmission and this demands a complementary assessment. There is an ongoing debate about the relative merits of treatment and prevention in reducing transmission and it should be made clear that the primary reason for starting people on treatment early is that it is in the best interest of the individual patient to start treatment as soon as possible after becoming infected. Allowing a person’s immune system to deteriorate to any degree is not consistent with the clinician’s commitment to ‘first do no harm’ and even those with the highest CD4⁺ cell count are at a substantially increased risk of death. What matters, therefore, is to get as many people as possible onto ART, ensure that they remain virally suppressed, and consider prevention in this context.

A number of decision support tools facilitating the use of Electric Vehicles (EVs) have been recently developed. Due to the EVs’ limited autonomy, routing and path planning are the main challenges treated in such tools. Specifically, determining at which Charging Stations (CSs) to stop, and how much the EV should charge at them is complex. This complexity is further compounded by the fact that charging times depend on the CS technology, the EV characteristics, and follow a nonlinear function. Considering these factors, we propose a path planning methodology for EVs with user preferences, where charging is performed at public CSs. To achieve this, we introduce the Electric Vehicle Shortest Path Problem with time windows and user preferences (EVSPPWP) and propose an efficient solution algorithm for it. Given an origin and a destination, the algorithm prioritizes CSs close to Points of Interest (POIs) that match user inputted preferences, and user-defined time windows are considered for activities such as lunch and spending the night at hotels. The algorithm produces flexible solutions by considering clusters of charging points (CPs) as separate CSs. Furthermore, the algorithm yields resilient paths by ensuring that recommended paths have a minimum number of CSs in their vicinity. The main contributions of our methodology are: modeling user-defined time windows, including user-defined weights for different POI categories, creating CSs based on clusters of CPs with sufficient proximity, using resilient paths, and proposing an efficient algorithm for solving the EVSPPWP. To facilitate the use of our methodology, the algorithm was integrated into a web interface. We illustrate the use of the web interface, giving usage examples and comparing different settings.

Sepsis is a serious disease that can lead to mortality. The etiology of the disease is connected to how the body as a host reacts toward microbes such as bacteria, viruses, and fungi invasion. Current research shows that during sepsis, the reaction toward microbe attacks takes two main phases. The first is known as a cytokine storm, while the second is a vicious cycle of pro-inflammatory responses followed by a strict anti-inflammatory response led by CD4+ Tregs. Various immunomodulatory therapies have been proposed to break the cycle of pro- and anti-inflammatory reactions to sepsis. However, clinical trials did not show promising results, indicating further research into the mechanism that Treg uses to inhibit proinflammatory reactions. We used next-generation sequencing (NGS) analysis of bulk RNA-seq and single-cell RNA-seq data to examine the exact molecular pathways used by Treg to inhibit the immune response in sepsis. Our approach identified ACOD1 (Aconitate Decarboxylase 1) as a primary mediator of Treg suppression of immune cells. We identified and validated CD36 as a downstream target of ACOD1. CD36 is a known metabolite regulator in Tregs. Taken together, our results indicate that targeting ACOD1 could prove valuable in regulating Treg function during sepsis.

In the wake of Portugal's pivotal shift to animal welfare legislation in 2018, where the no-kill policy for population control came into effect, animal shelters have emerged as critical sanctuaries for stray or unwanted animals. Recognising the critical role that adopter preferences play in the successful placement of shelter animals and the pressing need for shelters to expedite adoptions to liberate valuable space to accommodate more animals in need of refuge, this study seeks to investigate the intricate matrix of factors guiding adopters' choices. A descriptive cross-sectional study was performed with a convenience sample of the Portuguese population to assess their preferences and opinions about pet adoption. An online questionnaire was completed by 415 participants from February to October 2021. Among participants selecting attributes for pet adoption, the top preferences were behaviour (52.8%), size (49.6%), vaccination and deworming status (44.3%), and age (36.1%). Conversely, breed (7.2%), sex (6.3%), and animal colour (5.1%) were the least prioritised. Combinations were established based on the most selected attributes. Certain participant characteristics, such as education level and pet ownership history, exhibited distinct preferences in animal attributes. Portuguese people show a marked preference for shelter adoption, prioritising behaviour, size, and health over breed and colour. This insight allows shelters to allocate resources effectively. While promising, the trend towards shelter adoption needs adaptive strategies to align with evolving adopter preferences.

Compared with the traditional bundle pricing strategy with fixed products, this paper proposes a more flexible interactive bundle pricing strategy (IBPS) for agricultural e-retailers. Since more and more consumers tend to buy more environmentally friendly and healthy organic agricultural products, we consider consumers' organic preferences and build a mixed bundle pricing model for organic and inorganic agricultural products. A free shipping strategy is introduced to maximize retailer profit and optimize consumer surplus. Through numerical analysis, we find: (1) Compared with the traditional online retailing method, IBPS can effectively stimulate consumption and higher retailer profit; (2) As the free shipping threshold increases, the total profit shows a trend of first increasing and then decreasing, indicating that a suitable free shipping threshold can optimize the retailer profit; (3) As the consumer green preference increases, the total sales of agricultural products decrease, but the organic sales improve, while total profit rises; (4) The higher the level of consumption, the higher the sales volume of organic products and there is an upward trend in the profits of e-retailers.

This study aimed to investigate the knowledge of patients with hypertension about their condition, adherence to antihypertensive medication, and the factors influencing it. A cross-sectional study was conducted in two cardiology outpatient clinics of two tertiary hospitals, in Greece. The study included 188 patients diagnosed with hypertension. The patient’s knowledge about their disease and adherence to medication were assessed by using the HK-LS and A-14 scales, respectively. Patients had sufficient knowledge levels about their disease, but significantly low levels of adherence to medication. Patients with higher knowledge levels were more adherent to medications [r(188) = 0.885, p < 0.001]. By using multivariate analysis, higher age (p = 0.018), residence in a more populous area (p = 0.041), more years with the disease (p = 0.012), and a lower number of medications (p = 0.03) were associated with higher levels of knowledge. Conversely, younger age (p = 0.036), lower educational levels (p = 0.048), fewer years with the disease (p = 0.001), and a higher number of medications (p = 0.003) were associated with lower adherence to medication. The Greek patients' hypertension knowledge was sufficient, however, adherence to medication was significantly low. Healthcare managers could utilize our findings to design targeted interventions for improving adherence to medication for these patients.

Nowadays, considering the growing tendency of companies towards e-commerce as well as green production, and dual-channel green supply chain management has become particularly important. This paper investigates pricing decisions within a dual-channel green supply chain framework while considering the capital constraints faced by risk-averse manufacturer. Simultaneously, the impact of the degree of risk aversion, consumer green preferences, and channel preferences on the optimal decision-making process of green supply chain members is analyzed. We address the issue of financial constraints faced by manufacturer through bank loans and trade credit financing and compare the two cases. Our findings illustrate that trade credit financing outperforms bank loan financing in the dual-channel green supply chain. Moreover, pricing decisions under different models are influenced by consumer preferences and risk aversion. Specifically, the greenness of the product, wholesale price, and sale price exhibit negative correlations with manufacturers' risk aversion but positive correlations with consumer preferences.

Global degradation of coral reefs is reflected in the destruction of shelters in various environments and threatens the stability of marine ecosystems. Artificial shelters offer an alternative, but their design is challenging due to limited knowledge regarding the shelter characteristics preferences of desired inhabitants. Investigating these preferences is resource-intensive, particularly regarding small shelters that mimic natural reef condition. Further, fish abundance may be too low for statistical analysis in small shelters. We propose a method to characterize the species-specific shelter preferences using low-volume data. During a study conducted from January 2021 to April 2022, round clay artificial shelters (RAS) were deployed on an abandoned oil pier to examine a coral reef fish community. We recorded 92 species from 30 families; grouped them to systematically (families) and functionally (dietary group) classes. Grouping enabled examining each group’s preference while crossing these group preferences revealed species- specific preferences, that matched field observations. This approach proved effective in profiling the shelter preferences of 17 species while having limited resources. These profiles may latter allow the establishment of ecological-oriented artificial reefs.

Ticks are one of the most dominant forced ectoparasites of vertebrates, belonging to the arthropods, which transmit pathogens such as bacteria, viruses, and parasites to humans and animals in Iran and worldwide. Given that, sex ratio factors can affect the epidemiology of vector-borne diseases, this study aimed to identify and determine the ticks' sex ratio and host type (camels, sheep, cattle, dogs, chickens, and pigeons) in different areas of Tehran province. This descriptive cross-sectional study took samples from different animal body parts in four seasons from 20 villages in 2019, in which 685 hard ticks and 121 soft ticks were caught from 1623 studied livestock and poultry. Regarding sex segregation among all caught ticks, 42.01% were male, and 57.99% were female. It is noteworthy that in both mountain and plain environments, R. sanguineus species of hard ticks had the most elevated sex ratio. Most ticks were collected from sheep hosts with 60.04% and the lowest from cattle hosts with 0.62% in tick infestation.

Electric vehicles offer a means to reduce greenhouse gas emissions in passenger transport. The availability of reliable charging infrastructure is crucial for the successful uptake of electric vehicles in dense urban areas. In a pilot project in the city of Hamburg, Germany, public charging infrastructure is equipped with a reservation option providing exclusive access for local residents and businesses. The present paper combines quantitative and qualitative methods to investigate the effects of the newly introduced neighborhood charging concept. We use a methodology combining a quantitative questionnaire survey and qualitative focus group discussions as well as the analyses of charging infrastructure utilization data. Results show that inner-city charging and parking options are of key importance for (potential) users of electric vehicles. Hence, the neighborhood concept is rated very positively. Providing guaranteed charging and parking facilities are therefore likely to increase the stock of EVs. On the other hand, these could to a large extent be additional cars with consequential disadvantages. The study shows that openly accessible infrastructure is presently utilized much more intense than the exclusive option. Consequentially, the concept evaluated should be part of an integrated approach managing parking and supporting efficient concepts like car sharing.

Retail buildings can provide energy flexibility to the grid with the possibility of load shifting and building automation systems. Demand response is a collective innovation in the smart grid domain. Various stakeholders should be involved in the demand response activities to ensure the success. The owners or senior management of retail buildings need to consider the stakeholders who are directly influenced by the demand response participation, e.g. customers and employees. Meanwhile, demand response activities are influenced by various factors, such as energy market structure, policy, etc. Therefore, this paper investigates the demand response readiness for retail buildings with three aspects: energy control preferences, stakeholder engagement, and cross-national differences. A questionnaire is designed and collected with store managers in Denmark (N=51) and the Philippines (N=36). The result shows that: 1) retail stores are much readier to participate in the implicit demand response by manual energy control compared to the utility control or building automation. Meanwhile, store managers have significant concerns about business activities and indoor lighting compared to other aspects; 2) the statistically significant influential factors for retail stores to participate in the demand response are related to whether the DR participation matches the company goals, influences business operation, and whether retail stores are lack of related knowledge; 3) retail stores believe that stakeholders should be informed about the DR activities but not involved in; 4) there are significant differences regarding the energy control preferences and concerns between retail stores in Denmark and the Philippines, but no significant difference regarding the stakeholder engagement.

Obstructive sleep apnea (OSA) may be linked to various factors that narrow the upper airways, such as obesity, adenotonsillar hypertrophy and craniofacial abnormalities. Hypothyroidism has also been described as a risk factor for OSA. However, the implication of goiter independently of thyroid function in the occurrence of OSA remains unclear. We present the case of a 66-year-old patient, with a large compressive multinodular goiter for whom total thyroidectomy was indicated. During the preoperative assessment, the patient showed a body mass index (BMI) of 37.8 kg/m2 with symptoms of OSA. Respiratory polygraphy confirmed the diagnosis of severe OSA (apnea hypopnea index: AHI=32) and treatment with continuous positive airway pressure (CPAP) was initiated prior to thyroid surgery. Surprisingly, after total thyroidectomy, OSA symptoms disappeared and the patient abandoned CPAP therapy. Subsequent respiratory polygraphy after thyroidectomy showed a decrease in AHI to a normal value (AHI < 5). Interestingly, there was no change in BMI or other factors explaining the resolution of OSA, except for thyroidectomy. This case report suggests that goiter can be considered a risk factor for OSA. However, prospective studies are needed to accurately assess the effects of goiter on occurrence of OSA according to its dimensions and local extension.

The goal of this report was to examine the behavioral economic demand for consumer sleep technologies with different levels of validation and endorsement. The value or importance consumers place in different validation methods and the organizations conducting the evaluations was also assessed. Survey data were collected from 113 participants on Amazon mTurk. Participants indicated their likelihood of purchasing devices that varied in level of validation across a series of increasing prices. Demand curves were analyzed to determine the relative value of each watch type. Participants also reported how valuable or important different aspects of device validation were to them. Devices that were both evaluated against laboratory measures and endorsed by sleep researchers had the most value, followed by those only evaluated against laboratory measures, and then those not evaluated against any laboratory measures. The unit price at which there was 50% probability of purchase was increased by $25 or $44 for evaluation or endorsement, respectively. Respondents indicated the most valuable features were a measure of sleep duration, that it was most important that devices were validated against measures of sleep from a laboratory or hospital, and that they would put a high value on sleep tracker endorsements from a university or academic institution. Consumer demand is greatest for a device that has been evaluated by an independent laboratory for accuracy in measuring sleep and is endorsed by an academic, medical, or government institution. These results indicate a role for scientific evaluation and endorsement in consumer preference for sleep trackers.

Due to the tremendous progress in the automotive industry, the growth of the urban population, the number of vehicles is increasing and this creates parking challenges. Intelligent parking management systems offer an optimal solution for finding empty parking space so that drivers can quickly find their car parking space. To solve these problems, it is necessary to design an intelligent parking system, in addition to providing comfort to drivers, which is also economically viable. This paper proposes an intelligent multi-storey car parking system with the help of RFID technology and examining user preferences that can effectively solve car parking problems. The proposed method is a multi-objective decision-making method to reduce the problem of car parking, which is called MODM-RPCP. Therefore, the proposed MODM-RPCP method can allocate the best space for their stopping place by using the decision-making system and based on the priorities considered by the users. The simulation results show that the MODM-RPCP reduces the average booking time more than 19.2% and 27.1%, and decreases the response time of central parking management server more than 20.1% and 29.78% compared to MOGWOLA and ODPP approaches.

High levels ofmeat consumption are increasingly being criticised for ethical, environmental, 2 and social reasons. Plant-based meat substitutes have been identified as healthy sources of protein in 3 comparison to meat. This alternative offers several social, environmental and health benefits and may 4 play a role in reducing meat consumption. However, there has been a lack of research on how specific 5 meat substitute attributes can influence consumers to replace or partially replace meat in their diets. 6 Research demonstrates that in many countries consumers are highly attached to meat.They consider 7 it as an essential and integral element of their daily diet. For these consumers which are not interested 8 in vegan or vegetarian alternatives to meat, so-called meathybrids could be a low-threshold option 9 for a more sustainable food consumption behaviour. In meathybrids only a fraction of the meat 10 product (e.g. 20% to 50%) is replaced with plant-based proteins. In this paper, the results of an online 11 survey with 500 German consumers are presented with focus on preferences and attitudes relating 12 to meathyrids. The results show that more than fifty percent of consumers substitute meat at least 13 occasionally. Thus, about half of the respondents reveal an eligible consumption behaviour in respect 14 to sustainability and healthiness to a certain degree. Concerning the determinants of choosing either 15 meathybrid or meat it becomes evident that the highest effect is exerted by the health perception. The 16 healthier meathybrids are perceived, the higher is the choice probability. Thus, this egoistic motive 17 seems to outperform altruistic motives like animal welfare or environmental concerns when it comes 18 to choice for this new product category.

Aims and Background: People living with mental disorders experience a disproportionately higher burden of tobacco-related disease than the general population. Long-term substitution with less harmful nicotine products could reduce the tobacco-related harm among this population. This study investigated the views and preferences of people with mental health disorders about different nicotine products and their use as long-term substitutes for cigarettes. Methods: Semi-structured focus group discussion followed by a brief questionnaire. The discussion transcripts were analysed for content and themes and quantitative data summarised with descriptive statistics. Results: Twenty-nine participants took part in four focus groups. Vaping devices were the most acceptable nicotine products discussed, however preferences for nicotine products were idiosyncratic and varied along aesthetic, pragmatic, sensory and symbolic dimensions. The concept of tobacco harm reduction was unfamiliar to participants, however they generally agreed with the logic of replacing cigarettes with less harmful nicotine products. Barriers to activating tobacco harm reduction included the symbolism of smoking and quitting; the importance placed on health; the consumer appeal of alternatives; and cost implications. Discussion and Conclusion: Engaging this population in tobacco harm reduction options will require communication that challenges black and white thinking (a conceptual framework in which smoking cigarettes or quitting all nicotine are the only legitimate options) as in practice this serves to support the continuance of smoking. Consumers should be encouraged to trial a range of nicotine products to find the most acceptable alternative to smoking that reduces health harms. Providing incentives to switch to nicotine products could help overcome barriers to using less harmful nicotine products among mental health consumers.

Humification is a promising strategy to reduce the amount of animal waste generated in agriculture. This makes it possible to accumulate products with artificially obtained humic substances (HS) as analogues of natural HS, usually extracted from fossil sources (coal, peat). The review examines the main characteristics of various biological and physical-chemical methods (composting, anaerobic digestion, pyrolysis, hydrothermal carbonation, acid or alkaline hydrolysis, subcritical water ex-traction) used to form HS in animal waste humification products. A comparative analysis of the humification rates and yields of HS in these processes, the characteristics of artificial HS in products (humification index, polymerization index, degree of aromaticity, etc.) is carried out in connection with the use of certain methods of humification and types of animal waste. The main factors (ad-ditives, process conditions, waste pretreatment, etc.) that can increase the efficiency of humification and the properties of HS resources artificially obtained by various methods are highlighted. A generalizing analysis of the content of chemical elements in artificial HS obtained from various animal husbandry wastes in comparison with natural HS was carried out. Based on the results of the chemical composition analysis, the main trends and preferences regarding the most useful ap-plications of humification products as complex biomimetics are discussed.

Background: Public engagement is needed to make sure urban forestry management efforts align with the values of the public being served. Noting this, we determined current and desired urban forest access of Florida (United States) residents using the criteria from the 3-30-300 rule (i.e., 3 trees visible from home, 30% canopy in neighborhood, and a green space within 300 meters of home). Methods: A survey of 1,716 Florida residents was conducted to assess canopy coverage and green space access. Respondents were then asked if this level of urban forest access was sufficient for their needs. We also asked their perceptions of the benefits and drawbacks of urban trees and whether they had any negative interactions with trees in the past. Results: We found that 37.3% of Florida residents met all three criteria of the 3-30-300 rule. Despite this, half the respondents would prefer more trees in their neighborhoods. When asked to name the top benefits provided by trees, the most common responses were shade, beauty, and attracting wildlife. The most common drawbacks to urban trees included risk to property, leaves/debris, and fears regarding storms and hurricanes. Conclusions: Florida residents largely value their urban forest and would like to see it maintained or enhanced. Improving access to greenspaces for recreation is the most pressing concern for urban forest managers in Florida looking to meet the requirements of the 3-30-300 rule. Results from this study can inform and test urban forest management at national and global scales.

Alzheimer’s disease (AD) is an irreversible neurodegenerative disease characterized by progressive cognitive decline. The two cardinal neuropathological hallmarks of AD include buildup of cerebral β amyloid (Aβ) plaques and neurofibrillary tangles of hyperphosphorylated tau. The current disease-modifying treatments are still not effective enough to lower the rate of cognitive decline. The paucity of early detection and disease progression biomarkers also seems to present a major obstacle to AD drug development. The current established readouts based on expression levels of amyloid beta, tau and phospho tau have shown many discrepancies in patient samples when linked to disease progression. There is an urgent need to identify diagnostic and disease progression biomarkers from blood, CSF or other biofluids that can facilitate early detection of the disease and provide pharmacodynamic readouts for new drugs being tested in clinical trials. Advances in proteomic approaches using state-of-the-art mass spectrometry, are now being increasingly applied to study AD disease mechanisms, identify drug targets and novel disease biomarkers. In this report, we describe applications of the quantitative proteomic approaches for understanding AD pathophysiology, summarize the current knowledge gained from proteomic investigations of AD and discuss development and validation of new predictive and diagnostic disease biomarkers.

Gestational Diabetes Mellitus (GDM) is a common medical complication of pregnancy, which is associated with increased risk of future diabetes. mHealth (mobile health, in this paper applica-tions abbreviated to apps) can facilitate health modifications to decrease future risks. This study aims to understand mHealth app use and preferences among women with past GDM and healthcare professionals (HCP) in Australia. An explorative cross-sectional online survey was disseminated via social media, a national diabetes registry, and professional networks. Descrip-tive analyses were conducted on valid responses (women with prior GDM: n=1475; HCP: n=75). One third (33%) of women with prior GDM have used health apps, and a further 80% of non-app users were open to using a health app if recommended by their HCP. Over half (53%) of HCPs supported health information delivery via mHealth, although only 14% had recommended a health app to women post-GDM, and lack of knowledge about mHealth apps was common. Health app users reported that they preferred tracking features, while non-users desired credible health and dietary information and plans. Expanding mHealth app use could facilitate healthy behaviours, but endorsement by HCPs is important to women and currently lacking.

Building on the study by Abdullah et al. (2020), this study aims to analyze the perception of travel, especially in this context of the pandemic, when the measures are alleviated, as well as the citizens' intention and preferences for travel methods during the COVID-19 pandemic. The purpose of the study is to investigate the impact of the COVID-19 pandemic on travel behavior and travel mode preferences in the example of the residents of Bosnia and Herzegovina. Five research questions were defined. A quantitative research approach was applied in this study. The data was collected through a questionnaire (online survey) distributed to respondents via e-mail and the social network Facebook. The convenience sample included 265 respondents. Descriptive analysis, as well as quantitative comparative analysis, were carried out on the collected data. The results show that the COVID-19 pandemic has influenced a change in travel behavior. The primary purpose of travel before and during the COVID-19 pandemic was social activities. The most significant change in the primary purpose of travel before and during the COVID-19 pandemic is reflected in a decrease in social activities and an increase in recreational sports activities. In contrast, other activities remained proportionally the same before and during the COVID-19 pandemic. The average distance traveled for primary outdoor trips before the COVID-19 pandemic is greater than that for primary outdoor trips during the COVID-19 pandemic. This article allows for better organization and planning for the future in the event of another pandemic.

Supply chain flexibility plays a pivotal role in enabling organizations to adapt their marketing strategies to evolving consumer preferences in dynamic market environments. This qualitative study explores how supply chain flexibility dimensions—responsiveness, agility, resilience, and sustainability—impact marketing strategy adaptation. Through semi-structured interviews and document analysis, insights were gathered from industry practitioners across diverse sectors. Key findings highlight that responsive supply chains facilitate quick adjustments in production, distribution, and sourcing to meet changing consumer demands. Agility enables rapid reconfiguration of operations to capitalize on market opportunities and respond to disruptions effectively. Resilient supply chains mitigate risks and maintain continuity during crises, safeguarding customer satisfaction and brand reputation. Integrating sustainability practices not only meets regulatory standards but also aligns with consumer preferences for eco-friendly products, enhancing corporate social responsibility. Technological advancements such as AI, IoT, blockchain, and cloud computing enhance supply chain visibility, optimize decision-making, and support real-time responsiveness. Despite benefits, challenges like legacy systems, organizational silos, resistance to change, and resource constraints hinder effective implementation. Overcoming these barriers requires strategic leadership, cross-functional collaboration, and continuous investment in technology and talent. Embracing supply chain flexibility empowers organizations to navigate complexities, drive innovation, and sustain competitive advantage. By aligning supply chain capabilities with marketing strategies, companies can enhance market responsiveness, customer satisfaction, and long-term growth in today's dynamic business landscape

While it is generally accepted that food habits established during infancy will track into later childhood, longitudinal analysis of children’s food preferences is rare. This paper examines whether maternal-reported child food preferences at five years of age are the same as that reported at two years; and identifies any patterns of change from two- to five- years. Mothers in the Australian NOURISH trial reported child food preferences at two and five years of age. A four point scale was utilised - ‘like’, ‘neither like or dislike’, ‘dislike’, ‘never tried’. The proportion of children having the same preference at the two time points was calculated (95%CI) for 48 foods (cereals, 4; vegetables, 20; fruit, 14; meat/alternatives, 6; dairy, 4). For foods where ≤50% children had consistent preferences, the pattern of food preference change was determined. For 40/48 foods, more than half of the children were reported to have the same preference at two years of age, and three years later, at age five. Foods for which ≤50% children had the same preference at both ages were high-sugar breakfast cereals, zucchini, mushrooms, eggplant, spinach, lettuce, cabbage and celery. Findings reinforce the importance of promoting a consistent message regarding early and frequent exposure to a variety of healthy foods, particularly during the first 2 years of life, as the preferences established in these early years are likely to be maintained over time.

Visual Patient technology is a situation awareness–oriented visualization technology that translates numerical and waveform patient monitoring data into a new user-centered visual language. Vital sign values are converted into colors, shapes, and rhythmic movements—a language humans can easily perceive and interpret—on a patient avatar model in real time. In this review, we summarize the current state of the research on the Visual Patient, including the technology, its history, and its scientific context. We also provide a summary of our primary research and a brief overview of research work on similar user-centered visualizations in medicine. In several computer-based studies under various experimental conditions, Visual Patient transferred more information per unit time, increased perceived diagnostic certainty, and lowered perceived workload. Eye tracking showed the technology worked because of the way it synthesizes and transforms vital sign information into new and logical forms corresponding to the real phenomena. The technology could be particularly useful for improving situation awareness in settings with high cognitive demand or when users must make quick decisions. This comprehensive review of Visual Patient research is the foundation for an evaluation of the technology in clinical applications, starting with a high-fidelity simulation study in early 2020.

There is little understanding of patients' experiences and perceptions with satisfaction by health professionals such as medical and dental clinicians. Furthermore, patient satisfaction is not well understood. The objective of this article is to better understand patients' satisfaction with their medical and dental care. The methods of the current article are based on a narrative review of the literature strategy. Patient satisfaction's multidimensional nature has been established since the perceived reasons for satisfaction varied widely among patients. Many aspects of the treatment influence participant satisfaction at different stages of the intervention's process. An improved understanding of the basis for managing patients' expectations with information reiteratively and efficiently may ultimately reduce patients' potential for negative feelings toward the medical and dental treatment experience. The consumerist method may misrepresent the concept of satisfaction in health service.

Multicriteria decision aid requires a database as a decision matrix, in which two or more alternatives are evaluated according to two or more variables selected as decision criteria. Several problems of this nature use measures by Likert scales. Depending on the method, parameters from these data (e.g. means, modes or medians) are required for calculations. This parameterization of data in ordinal scales has fueled controversy for decades between authors who favor mathematical/statistical rigor and argue against the procedure, stating that ordinal scales should not be parameterized, and scientists from other areas who have shown gains from the process that compensate for this relaxation. The aim of this article is to demonstrate the advantages of the Composition of Probabilistic Preferences (CPP) method in multicriteria problems with data from Likert scales. The CPP is capable of allaying the protests raised and obtaining more accurate results than descriptive statistics or parametric models can bring. The proposed algorithm in R-code involves the use of CPP with empirical distributions and fitting histograms of data measured by Likert scales. Two case studies with simulated datasets having peculiar characteristics and a real case illustrate the advantages of the CPP.

Background: There are limited evidence-based data to guide treatment recommendations for breast cancer (BC) patients ≥ 80 years (P80+). Identifying and addressing unmet needs are critical. Aims: Advocate-BREAST80+ compared the needs of P80+ vs. patients < 80 years (P80-). Methods: In 12/2021, a REDCap survey was circulated electronically to 6,918 persons enrolled in the Mayo Clinic Breast Disease Registry. The survey asked about concerns and satisfaction with multiple aspects of BC care. Results: 2,437 participants responded (35 % response rate); 202 (8.3%) were P80+. P80+ were less likely to undergo local regional and systemic therapies vs. P80- (p

Background: With the rapid improvement of the healthcare technologies, security and privacy of the most sensitive data, health data is at risk. Protecting patient privacy has many components, even though the data are in electronic format. Although patient privacy is thoroughly discussed in the literature, there is no study presenting all components of patient privacy protection. Methods: In this study, a complete evaluation framework is presented, as an evaluation tool, an inventory is developed, reliability and validity of the inventory is examined. Study is conducted in three phases: Conceptual framework development, inventory development and an evaluation case study. In the evaluation, fuzzy conjoint analysis is employed to handle the subjectivity and am-biguity. As the result of the evaluation, the institution is given a patient privacy protection ma-turity grade, between 1 and 5, where 1 is the worst and 5 is the best grade. Results: In the case study, XXX’s biggest hospital, employing 800 nurses, is evaluated. Half of the nurses, 400, have partici-pated in the study. Literature tells healthcare institutions do not invest enough to protect patient privacy, and the study results support this finding. Institution’s maturity grade resulted as level 2, which is bad. Conclusion: The study measures he privacy maturity with many evaluation com-ponents. Result of the evaluation explains to the patients and the public if their data is safe or not. With this maturity grade, patients have an idea about which institution to choose, public can conclude the institutions’ reliability in terms of patient privacy.

Pheochromocytoma is a rare neuroendocrine tumor that affects people in the 4th and 5th decades of life. It can be benign or malignant, and present as isolated tumors or along with other neuroendocrine syndromes. We present a case of an elderly man who underwent laparoscopic adrenalectomy for pheochromocytoma when he was 58 years only to have a recurrence of metastatic malignant pheochromocytoma in his seventies. We also conducted a literature review to understand the epidemiology and presentation of the tumor and to emphasize that there should be a low threshold of suspicion for timely diagnosis and management of recurrent pheochromocytoma.

The EULAR Sjögren's Syndrome Disease Activity Index (ESSDAI), EULAR Sjogren’s Syndrome Patient Reported Index (ESSPRI), and other patient-reported outcomes (PROs), such as the visual analog scale (VAS) for symptoms and EULAR sicca score (ESS), are used to assess the disease activity of primary Sjögren’s syndrome (pSS). Recently, Clinical ESSDAI (ClinESSDAI) and Clinical Trials ESSDAI (ClinTrialsESSDAI) were developed for objective clinical disease activity indexes. However, the relationship of ClinESSDAI and ClinTrialsESSDAI with PROs as well as that between ESSPRI and other PROs and the objective parameters of glandular function in pSS have not been established. Herein, we investigated the correlation of ESSPRI and other PROs with the objective parameters of glandular function and the relationship of PROs with ClinESSDAI and ClinTrialsESSDAI in 66 patients with pSS. Correlations were calculated with Spearman’s correlation coefficient. ClinTrialsESSDAI was correlated with ESSPRI, dryness (ESSPRI-Dryness), fatigue, and pain domains of ESSPRI, VAS for oral dryness (oral-VAS), and patient’s global assessment. Although ESSPRI did not correlate with the objective parameters of glandular function, ESSPRI-Dryness, ESS, and oral- and ocular-VAS did. These results suggest that ESSPRI-Dryness, ESS, and VAS for symptoms, but not ESSPRI, reflect the glandular dysfunction and that ClinTrialsESSDAI correlates with PROs for dryness in pSS.

Diet-related diseases impact populations across the globe. While intertemporal preferences—a fundamental preference for the distribution of benefits across time—have been used to explain low-quality food choices, recent literature proposes another cause: inattention to future implications (or opportunity costs) of the options faced. Food choices tend to become habitual to conserve cognitive resources, rather than carefully modeling future health impacts. Both low discount rates for future benefits and attention to future health impacts predict healthier decisions. While intertemporal preferences are stable, attention may provide an opportunity to intervene in the decision process to promote healthier decisions. In this study, we test the impact of a simple message that highlights health during food choice on the healthiness of foods chosen and on health consideration and intertemporal preferences. Our results show that actively considering health outcomes and lower discount rates lead to healthier food choices. We find that messaging increases the consideration of health outcomes during food choice but does not affect intertemporal preferences, suggesting that simple prompts may be an effective way to promote decisions balancing short and long-term benefits by drawing attention to overlooked opportunity costs of choices.

Crapemyrtle (Lagerstroemia indica L.: Lythraceae) is the most popular summer flowering tree in the U.S. Its total value sold has almost doubled since 1998. Consumers prize crapemyrtles for their beauty and pest resistance. However, current crapemyrtle production and use is being threatened by crapemyrtle bark scale (Acanthococcus lagerstroemiae (Kuwana, 1907)) (CMBS), which has been confirmed in 12 U.S. states after its first sighting in Texas in 2004. Our survey results indicate that producers anticipate a significant decrease in the value of crapemyrtle due to CMBS, in the magnitude of 29.93% and 33.79%, in our 2018 and 2019 surveys respectively. Our findings indicate industry demand for CMBS control. We used a non-parametric test to compare the producers’ responses to several questions regarding CMBS-control, among the different producer categories included in our sample. Incorporated businesses showed the most support, followed by part-nerships, and family/individual operations were the least supportive of science-based CMBS control research. Large businesses predicted a more serious decrease in crapemyrtles’ value as compared to smaller businesses. More businesses with high volume of crapemyrtle-related business considered the benefits of CMBS-control to be higher than its cost, as compared to other businesses. We also used a relative importance index to illustrate the ranking of different attrib-utes of crapemyrtles that producers consider while making decisions about growing/purchasing the plants. Flower color was found to be the most important attribute, followed by disease re-sistance. If the issue of CMBS gets out of control, the industry might need to find potential re-placements to crapemyrtle. The most popular landscape plants that can potentially replace crapemyrtle, in the opinion of producers we surveyed, are vitex (Texas lilac) and magnolia.

The World Health Organization(WHO) in 2016 considered mHealth as: “the use of mobile wireless technologies including smart devices such as smartphones and smartwatches for public health” as an important resource for health services delivery and public health given their ease of use, broad reach and acceptance. WHO emphasizes the potential of this technology to increase access to health information, services and skills as well as promoting positive changes in health behaviors and management of diseases. In this regard, the capability of smartphones and smartwatches for m-health monitoring as well as verification of the patient the signal has become an important component of mHealth system. Most of the smartwatches could extract more than one bioelectrical signal therefore, therefore they provide suitable platform for extracting health data for e-monitoring. The existing approaches have not considered the integrity of data obtained from these smart devices. Therefore, it is important that the integrity of the collected data be verified continuously through user authentication. This could be done using any of the bioelectrical signals extracted and transmitted for e-monitoring. In this article, a smartwatch is used for extracting bioelectrical signal before decomposing the signal into sub-bands of Detail and Approximation Coefficient for user authentication. To select suitable features using biorthogonal wavelet decomposition of signal from a non-intrusive extraction, a detailed experiment is conducted extracting suitable statistical features from the bioelectrical signal from 30 subjects using different biorthogonal wavelet family. Ten features are extracted using Biorthogonal wavelet to decompose the signal into three levels of sub-band Detail and Approximation Coefficient and features extracted from each level the decomposed Detail and Approximation Coefficients. Comparison analysis is done after the classification of the extracted features based on the Equal Error Rate (EER). Using Neural Network (NN) classifier, Biorthogonal Wavelet Detail Coefficient Sub-band level 3 of bior1.1 achieved the best result of EER 13.80% with the fusion of the best sub-band three levels of bior1.1 achieving a better result of 12.42% EER.

South Africa is afflicted with the worst epidemic of HIV in the world a legacy of the system of oscillating migrant labour in the region and the consequent social disruption that was the legacy of Apartheid. The initial response from the national government was slow and ineffective but once the magnitude of the epidemic became apparent the government began to respond. The investment in HIV- and TB-related activities in 2013 was R22 Bn or (US$2.5; 2013 exchange rate) of which the South Africa government contributed 80% and the Presidents Emergency Plan for AIDS Relief (PEPFAR) 17%. South Africa now has the more people on anti-retroviral therapy than any other country and treatment is being started much sooner after infection. Much of the best biomedical, virological, immunological, mathematical and social science around the treatment and prevention of HIV and AIDS and the associated epidemic of TB has been done by South African’s and their international collaborators. If the efforts to control the epidemic are maintained South Africa is on track to meet the UNAIDS 90-90-90target by 2020 and to End AIDS by 2030 in spite of the magnitude of the problem. While individual, patient level data are increasingly available, especially in the Western Cape, much greater efforts need to be made to ensure that the information collected in this way is used to give feedback and support to clinic staff, to ensure that health clinics are providing the best possible service, and to individual patients and people living with HIV to ensure that they are receiving the best possible care and support. South Africa needs to make better use of the rich and detailed data that are being collected from individual clinics and their patients to identify problems or difficulties at the clinic level and to ensure that individual patients are retained on treatment, are virally suppressed and receive the best possible care and support.

INTRODUCTION Recently there has been a significant increase in age in the United States. It is necessary to better understand the physiological and surgical needs of these patients in order to optimize outcomes. The vast majority of procedures performed in adult patients are low-risk operations, such as laparoscopic cholecystectomy. Our aim is to investigate the outcomes, including length of stay, morbidity, mortality, re-admission and discharge disposition of the elderly population (>80) undergoing low-risk operations in our tertiary community hospital. METHODS A retrospective chart review was done at a tertiary community hospital. The time frame utilized was 2011-2015. Patients were excluded only on the basis of their age (< 80) at the time of operation. RESULTS There were a total of 30 patients who underwent laparoscopic cholecystectomy from 2011 to 2015. 21 patients (70%) were female and 9 (30%) were male. No patients were converted to an open procedure. The average age was 86.4 years and average ASA classification prior to surgery was 2.88. Higher ASA class, specifically those that were class III/IV were more likely to have an increased length of stay that was statistically significant. Overall age greater than 80 was an independent risk factor for transfer to a higher level of care upon discharge (SNF, LTAC, etc.), a surrogate marker for physical decompensation following surgery. CONCLUSIONS Routine surgery, such as the laparoscopic cholecystectomy, effects the elderly population in a more substantial way, and early recognition coupled with increased education for physicians regarding geriatric patients can help to reduce length of stay, morbidity, and overall physical and mental deconditioning.

In recent years there has been a clear increase in bottled water consumption, globally which translates to significant health and environmental concerns. This cross-sectional study aims to understand the attitude and preferences of university students in Qatar towards use of bottled and tap water for drinking purposes using an online survey questionnaire. The number of students who responded to the online survey was 14% of the entire student population within the university (n = 688). Overall, majority of the students reported plastic bottled water as the main source of drinking water they preferred to use on campus (n=468; 68.02%), with a higher proportion of females (72.08%) preferring the use of plastic bottled water. Out of the 468 students who preferred plastic bottled water, safety was the most important factor (43.80%) followed by convenience (16.88%) and taste (15.60%). Cost (15.17%), personal/family habits (5.13%), Environmental concerns (2.14%) and minerals (1.28%) were found to be the least important factors. Among the 45 students who preferred tap water over plastic bottled water, cost (46.67%) was the dominant factor followed by convenience (20.00%) and environmental concerns and safety (13.33% each), taste (4.44%), and personal/family habits (2.22%). This study recommends campaigns to focus on attitude and behavior change and not solely emphasize knowledge; 71.7% believed that plastic water bottles are more harmful to the environment, yet the greater majority still resorted to this source. There is an immediate need to further educate students through environmental and health literacy programs on water consumption and quality. Enabling the population to understand the positive and negative aspects of their choices, may be an effective remedy to ensuring a healthy population and healthy environment.

When in doubt, asking a peer can be very helpful. Students learn a lot of social strategies from peers. However, stated preference studies [Newman, 1993] have found that for elementary school students with math questions they prefer to ask the teacher. In this paper, we study revealed preferences instead of stated preferences. We analyze the behavior of fourth-grade students seeking face-to-face assistance while working on an online math platform. Students start by working independently on the platform before the teacher selects two or three tutors from among those who have answered 10 questions correctly. Each student is then able to choose between the teacher or one of these tutors when requesting assistance. We study the students’ preferences over 3 years, involving 88 fourth-grade classes, 2,700 students, 1,209 sessions with classmate tutors, and a total of 16,485 requests for help when there was an option to choose between a teacher or a classmate. We found that students prefer asking classmates for help 3 times more than asking their teachers when given the choice. Furthermore, this gap increases from the first to the second semester. We also found that students prefer to request help from classmates of the same sex and of higher academic performance. In this sense, students from the two highest tertiles sought help from classmates in the same two tertiles, and students from the medium tertile prefer to seek help from students of the highest tertile. However, students in the two lowest tertiles do not prefer asking for help from students from the top tertile more than from their own tertiles.

The article addresses the issue of consumer preferences for types of coffee in Poland (ground coffee, instant coffee, coffee beans, instant coffee mixes and instant cappuccino). The main source of the study is the results of primary research conducted using a structured interview (CAPI—Computer Assisted Personal Interview) on a nationwide sample of 800 coffee consumers. The research was conducted by Grupa IQS Sp. z o.o. from Warsaw in January 2016 for the MOKATE Group based on the assumptions and guidelines developed by the authors of the article. The main purpose of the article is to present the identified coffee consumer preferences in Poland with regard to various kinds of coffee. The results of the research which have been included in the article indicate, among others, ongoing changes in the preferences of Polish consumers regarding their coffee choices. They prove that Polish consumers are drinking ground coffee more and more often. The consumption of instant coffee is decreasing.

After reviewing cancer theories, cancer treatment development histories, randomized clinical trial's performance, cancer treatment strategy, trial follow-up times, and conducting numerous simulations using existing data, the authors found: (1) medical treatments come with three to four lethal factors: treatment side-effects, emotional distress and chronic dress, lack of exercises or physical inactivity, and excessive nutrition in some cases; (2) clinical trial exaggerates the benefits of fast-acting treatments and underestimates the slow-delivering adverse side effects as a result of statistical averaging, interfering effects of personal lifestyle factors, and insufficient follow-up times; (3) the benefits of medical treatments are limited by chain comparison, where surgery sets up a negative standard relative to the best way for resolving cancer; (4) the strategy of destroying the tumor is unworkable; (5) medical treatments can turn natural cancer growth curve into approximately doubly exponential curve; (6) multiple factor non-medical measures are much more powerful than medical treatments in controlling cancer growth and metastasis rates; and (7) cancer early diagnosis and over treatments are bad strategies that have great adverse impacts on cancer patients. Based on huge increases in cancer growth rate constants, substantial of loss of organ functional capacity, and severe systemic aging-like cellular damages, the authors concluded that medical treatments promote cancer growth and metastasis rates and shorten patient lives in most cases, and the claimed benefits are caused by triple biases of clinical trials. The authors believe that the better strategy for ending the global cancer epidemic is abandoning clinical trails as the research model, changing caner treatment strategy from killing cancer cells to slowing down cancer growth rates by using multiple factors optimization approach in personalized medicine.

Systemic inflammation and coronary microvascular endothelial dysfunction are essential pathophysiological factors in heart failure with preserved ejection fraction (HFpEF) that support the use of statins. The pleiotropic properties of statins, such as anti-inflammatory, antihypertrophic, antifibrotic, and antioxidant effects, are generally accepted and may be beneficial in HF, especially in HFpEF. Numerous observational clinical trials have consistently shown a beneficial prognostic effect of statins in patients with HFpEF, while the results of two larger trials in patients with HFrEF have been controversial. Such differences may be related to a more pronounced impact of the pleiotropic properties of statins on the pathophysiology of HFpEF and pro-inflammatory comorbidities (arterial hypertension, diabetes mellitus, obesity, chronic kidney disease) that are more common in HFpEF. This review discusses the potential mechanisms of statin action that may be beneficial for patients with HFpEF, as well as clinical trials that have evaluated the statin effects on left ventricular diastolic function and clinical outcomes in patients with HFpEF.

Aim: The aim of the study is to analyze quantitatively the scientific literature covering nursing studies on patient safety. Method: The Web of Science database is queried in this retrospective bibliometric analysis to identify relevant publications. The study themes, contributing journals, countries, institutions, and authors were evaluated quantitatively. Thus, a total of 5470 publications concerning patient safety in nursing were included and analyzed. Findings: The number of studies conducted increased every year from 1992 to 2023. While the country whose articles receive the most citations (31072) is the United States of America (USA), Turkey is ranked as last with the lowest number of citations (581). Journal of Clinical Nursing, with 338 articles, appeared to have the highest number of publications, Chaboyer W. appeared to have the highest number of citations with a total of 1426 and 45 publications. The countries that have the strongest international cooperation for research in this field are the USA, England, Australia and China. Results: After examining the literature in the field of patient safety in nursing through bibliometric analysis, it is seen that themes such as patient safety, medication errors, nursing care, nursing, education, systematic review, quality care and leadership were emphasized as important considerations.

Patient safety is one of the indicators of the quality of health services in the hospital, for that, it is necessary to have efforts from the hospital to create a system that can minimize the occurrence of errors and unexpected events that can harm patients, nurses as health workers who are the most numerous in the home. sick and with the patient for 24 hours, has an important role in maintaining patient safety. This study aims to explain how the role of nurses and cooperation between health workers in implementing patient safety measures in the hospital. The method used in this study is a literature review by analyzing and exploring relevant articles and focusing on interprofessional collaboration to improve patient safety. The articles used in this study were taken from 3 direct, Proquest, Pubmed science databases published in the last 3 years, namely between 2019-2021, nurses as part of the health team are required to be able to work together with other health professionals in hospitals with various characteristics, including education, gender, age, employment status and length of work, nurses are required to be committed to maintaining patient safety in the hospital.

Implantation of two electrical stimulators of different cranial nerves in one patient is rare. We report the case of a forty-seven-year-old patient already implanted with a trigeminus nerve stimulator. In addition, this patient suffered from hearing problems. In one ear, the patient was deaf. On the other side, the patient wore a bone conduction hearing aid to improve hearing. In this complex situation, we decided to check the possibility of cochlear implantation on the deaf side. Finally, we managed to provide electrical stimulation of the auditory pathway of the deaf ear to improve the patient’s hearing tests. In addition, this case report shows how the trigeminus stimulator interferes with the electrical stimulation in auditory evoked potentials measurements of the auditory brainstem and cortex via EABR (evoked auditory brainstem response) resp. EALR (evoked auditory late response).

A method for generating fluoroscopic (time-varying) volumetric images using patient-specific motion models derived from 4-dimensional cone-beam CT (4D-CBCT) images is developed. 4D-CBCT images acquired immediately prior to treatment have the potential to accurately represent patient anatomy and respiration during treatment. Fluoroscopic 3D image estimation is done in two steps: 1) deriving motion models and 2) optimization. To derive motion models, every phase in a 4D-CBCT set is registered to a reference phase chosen from the same set using deformable image registration (DIR). Principal components analysis (PCA) is used to reduce the dimensionality of the displacement vector fields (DVFs) resulting from DIR into a few vectors representing organ motion found in the DVFs. The PCA motion models are optimized iteratively by comparing a cone-beam CT (CBCT) projection to a simulated projection computed from both the motion model and a reference 4D-CBCT phase, resulting in a sequence of fluoroscopic 3D images. Patient datasets were used to evaluate the method by estimating the tumor location in the generated images compared to manually defined ground truth positions. Experimental results showed that the average tumor mean absolute error (MAE) along the superior-inferior (SI) direction and the 95th percentile in two patient datasets were (2.29 mm and 5.79 mm) for patient 1 and (1.89 mm and 4.82 mm) for patient 2. This study has demonstrated the feasibility of deriving 4D-CBCT-based PCA motion models that have the potential to account for the 3D non-rigid patient motion and localize tumors and other patient anatomical structures on the day of treatment.

Finding an optimal combination of features and classifier is still an open problem in the development of automatic heartbeat classification systems, especially when applications that involve resource-constrained devices are considered. In this paper, a novel study of the selection of informative features and the use of a random forest classifier while following the recommendations of the Association for the Advancement of Medical Instrumentation (AAMI) and an inter-patient division of datasets is presented. Features were selected using a filter method based on the mutual information ranking criterion on the training set. Results showed that normalized R-R intervals and features relative to the width of the QRS complex are the most discriminative among those considered. The best results achieved on the MIT-BIH Arrhythmia Database were an overall accuracy of 96.14% and F1-scores of 97.97%, 73.06%, and 90.85% in the classification of normal beats, supraventricular ectopic beats, and ventricular ectopic beats respectively. In comparison with other state of the art approaches tested under similar constraints, this work represents one of the highest performances reported to date while relying on a very small feature vector.

Patient derived model systems are important tools for studying novel anti-cancer therapies. Patient derived xenografts (PDXs) have gained favor over the last 10 years as newer mouse strains have improved the success rate of establishing PDXs from patient biopsies. PDXs can be engrafted from head and neck cancer (HNC) samples across a wide range of cancer stages, retain the genetic features of their human source, and can be treated with both chemotherapy and radiation, allowing for clinically relevant studies. Not only do PDXs allow for study of patient tissues in an in vivo model, they can also provide a renewable source of cancer cells for organoid cultures. Herein, we review the uses of HNC patient derived models for radiation research including approaches to establishing both orthotopic and heterotopic PDXs, approaches and potential pitfalls to delivering chemotherapy and radiation to these animal models, biological advantages and limitations, and alternatives to animal studies that still use patient-derived tissues.

Mitochondria are involved in many cellular processes and their main role is cellular energy production. They constantly undergo fission and fusion, and these counteracting processes are under strict balance. The cytosolic dynamin-related protein 1, Drp1 or dynamin-1-like protein (DNM1L) mediates mitochondrial and peroxisomal division. Defects in the DNM1L gene results in a complex neurodevelopmental disorder with heterogeneous symptoms affecting multiple organ systems. Currently there is no curative treatment available for this condition. We have previously described a patient with a de novo heterozygous c.1084G>A (p.G362S) DNM1L mutation and studied the effects of a small molecule, Bezafibrate, on mitochondrial functions in this patient’s fibroblasts compared to controls. Bezafibrate normalized growth on glucose-free medium, ATP production, oxygen consumption and s improved mitochondrial morphology in patient’s fibroblasts, albeit concomitantly causing a mild increase ROS production. Further studies would be needed to show the consistency of the response to Bezafibrate, possibly using fibroblasts from patients with different mutations in DNM1L, and this treatment should be confirmed in clinical trials. However, taking into account the favorable effects in our study, we suggest that Bezafibrate could be a possible treatment option for patients with certain DNM1L mutations.

Background and Objectives: Elders’ needs are rarely examined beforehand, and thus, although technology-based tools can enhance self-management, acceptability rates are still low. This study aimed to examine and compare self-reported needs, priorities, and preferences of elders with heart failure (HF), diabetes mellitus (DM), and chronic obstructive pulmonary disease (COPD) toward technology use to enhance self-management. Materials and Methods: A convenience sample of 473 participants over 60s (60.5% females), diagnosed with HF (N=156), DM (N=164), or COPD (N=153) was recruited. They were administered a questionnaire about the usefulness of technology in general and in specific areas of disease management. Results: Most participants (84.7%) admitted that technology is needed for better disease management. This was equally recognized across the three groups both for the overall and specific areas of disease management (in order of priority: ‘Information’, ‘Communication with Physicians &amp; Caregivers’, and ‘Quality of Life &amp; Wellbeing’). Sociodemographic differences were found. Cell phones and PCs were the devices of preference. The four common features prioritized by all three groups were related to ‘information about disease management’ (i.e., monitoring symptoms, reminders for medication intake, management and prevention of complications), whereas the fifth one was related to ‘communication with physicians and caregivers (i.e., in case of abnormal or critical signs). The top disease-specific feature was also monitoring systems (of respiratory rate or blood sugar or blood pressure, oxygen), whereas other disease-specific features followed (i.e., maintaining normal weight for HF patients, adjusting insulin dose for DM patients, and training on breathing exercises for COPD patients). Conclusions: Elders in these three samples seem receptive to technology in disease management. mHealth tools, incorporating both common and disease-specific features and addressing different chronic patients, and being personalized at the same time, could be cost-saving and useful adjuncts in routine clinical care to improve self-management.

A 68-year-old man with malignant metastatic melanoma in complete remission after Pembrolizumab treatment, developed 10 months after Pembrolizumab cessation due a grade 3 diarrhea, confusion, altered mental status, progressive memory loss, gait disturbance. He was admitted to the neurologic department and comprehensive neurological workup, brain magnetic resonance imaging, cerebral fluid analysis, EEG, blood test allowed the diagnosis of autoimmune encephalitis. The patient was treated with plasmapheresis, high dose of intravenous steroids and intravenous immunoglobulins. The patient improved and he is now well with a performance status 1. This case is interesting since the AE developed approximately 10 months after the cessation of immunotherapy, the underlying cancer was in complete remission and the AE showed a good response to the treatment done.

Considering the aging society and budget constraints, a strategy for reforming public transportation welfare policies is essential for sustainability. Among the various transportation welfare policies, fare discount policies are provided to specific age groups, and most countries offer benefits to several public transportation. South Korea provides a fare-free policy limited to subways, and the need for policy modification is emerging due to sustainability problems caused by an aging society. Hence, the scope of the policy should be expanded to all travel modes, but the discount rate should be reduced, or the target group should be reduced in consideration of the budget. This study proposes a travel mode to focus on by city through the preference of the elderly. The latent class model is employed to classfy stated preference data collected from the survey. The estimation results show a significant preference heterogeneity depending on the level of subway supply by region, and a policy focused on subways would be more reasonable in cities with sufficient subway infrastructure. Hence, regarding sustainability, it may be more appropriate to focus on specific means than to provide the same discount policy for all public transport.

There is a need for multimodal strategies to keep research participants informed about study results. Our aim was to characterize preferences of genomic research participants from two institutions along four dimensions of general research result updates: content, timing, mechanism, and frequency. Methods: We conducted a web-based cross-sectional survey that was administered from 6-25-2018 to 12-5-2018. Results: 397 participants completed the survey, most of whom (96%) expressed a desire to receive research updates. Preferences with high endorsement included: update content (brief descriptions of major findings, descriptions of purpose and goals, and educational material); update timing (when the research is completed, when findings are reviewed, when findings are published, and when the study status changes); update mechanism (email with updates, and email newsletter); and update frequency (every three months). Hierarchical cluster analyses based on the four update preferences identified four profiles of participants with similar preference patterns. Very few participants in the largest profile were comfortable with budgeting less money for research activities so that researchers have money to set up services to send research result updates to study participants. Conclusion: This work provides evidence of a need for funders to incentivize researchers to communicate results to participants.

The emergence of three-dimensional human organoids has opened the door for development of patient-derived cancer organoid (PDO) models, which closely recapitulate parental tumor tissue. Mainstays of preclinical cancer modeling include in vitro cell lines and patient-derived xenografts, but these models lack the cellular heterogeneity seen in human tumors. Moreover, xenograft establishment is resource- and time-intensive, rendering these models difficult to use to inform clinical trials and decisions. PDOs, however, can be created efficiently and retain tumor-specific properties such as cellular heterogeneity, cell-cell and cell-stromal interactions, tumor microenvironment, and therapeutic responsiveness. PDO models and drug screening protocols have been described for several solid tumors and, more recently, for gliomas. Since PDOs can be developed in clinically relevant timeframes and share many characteristics of parent tumors, they may enhance the ability to provide precision oncologic care for patients. This review explores the current literature on cancer organoids, highlighting the history of PDO development, organoid models of glioma, and potential clinical applications of PDOs.

Providing patient-centered care to manage chronic pain and opioid use disorder (OUD) is associated with improved health outcomes. However, adopting a holistic approach to providing care is often challenging in rural communities. This study aims to identify and contrast challenges to providing patient-centered care from the perspective of patients and providers. A participatory design approach was adopted to elicit the perceptions of providers and patients with lived experiences of chronic pain and OUD in Jefferson County, Wisconsin. Two focus groups were conducted with each stakeholder group to identify problems that participants face with respect to chronic pain management and OUD and possible solutions. Four interviews were conducted with providers experienced in chronic pain management. Analysis of focus group sessions and interviews show consensus among patients and providers that lack of behavioral health and recovery resources create barriers to effectively manage OUD and chronic pain. However, there was discordance among the two groups about other barriers such as patient and provider attitudes, tapering approach, and access to medications for OUD. This tension among patients and providers can influence patients’ retention in therapy. More efforts are needed to mitigate stigma among providers in rural communities and support psychosocial needs of patients.

Therapeutic patient education (TPE) aims to empower the patients and their caregivers to effectively care for and manage their conditions. Such educational programs have been shown to improve health behaviors, disease outcomes and quality of life among different patient populations. The field of TPE has evolved extensively over decades, owing to interdisciplinary research. No study so far has been done to map this field, to identify the stakeholders and gaps requiring future research. By leveraging the theory of co-citation, Citespace was used to visualize the bibliographic data pertaining to TPE research. A total of 54,533 articles published in English language were analyzed to identify influential funders, regions and institutes contributing to this field. Besides these, important theoretical and empirical work that has shaped this field has also been mapped. Our analysis revealed several important insights. Most of the important theories which helped shape TPE were inspired from the social sciences. Five important themes of research were identified including disorders, study designs utilized in TPE research, scope of the TPE literature, and outcomes, and populations. The research focused on improving perceptions, behaviors, and attitudes for health promotion, reducing stigma as well as self-management and medication adherence. Most of the research was developed in the context of high income countries. The future research should more involve patients and use digital technology. Meta-analytical studies need to be done to identify the specificities of TPE interventions across different disorders. More research should involve low and middle income countries (LMIC) to ensure knowledge and technology transfer.

Arboviruses of medical and veterinary significance have been identified on all 7 continents with every human and animal population at risk for exposure. Like arboviruses, chronic neurodegenerative diseases like Alzheimer’s and Parkinson’s disease are found wherever there are humans. Viral parkinsonism has been documented for a variety of human pathogens though there are few studies that evaluate the effects of viral infection on degenerative neurological diseases. Significant differences in baseline gene and protein expression have been determined between Human Induced Pluripotent Stem Cell lines derived from a non-Parkinson’s disease individual and from an individual with reported Parkinson’s disease. While the organoids generated from each cell line were physically indistinguishable, significant differences were observed in gene and protein expression for neurotransmission and immunity. It was hypothesized that these inherent differences would impact cerebral organoid responses to viral infection. In this preliminary observational study, cerebral organoids from a non-Parkinson’s and Parkinson’s patient were infected with Chikungunya virus and observed for 2 weeks. Parkinson’s organoids lost mass and exhibited a dysfunctional antiviral response. Neurotransmission data from both non-Parkinson’s and Parkinson’s organoids had dysregulation of IL-1, IL-10, IL-6. These cytokines are associated with mood and could be contributing to persistent depression seen in patients following CHIKV infection. Both organoid types had increased expression of CCR5 and CXCL10 which are linked to demyelination, highlighting a potential mechanism for virus-associated parkinsonism. The dysfunctional antiviral response of Parkinson’s organoids highlights the need for more research in neurotropic infections in a neurologically compromised host.

Individuals with low health literacy (HL) are known to have poorer health outcomes and to have higher mortality rates compared to individuals with higher HL: hence, the improvement of HL is a key outcome in modern healthcare systems. Healthcare providers are therefore asked to support patients’ literacy skills by encouraging the implementation of autonomy-supportive patient centered communication (PCC), which in turn requires the enhancement of patient engagement. Our main hypothesis is that the well-known relationship between autonomy-supportive PCC and HL is mediated by patient engagement which is known to play a role in HL promotion and that is related to PCC as well. The purpose of this study was to formulate a hypothetical structural equation model (SEM) linking PCC to patient engagement and HL. A cross-sectional survey design was employed involving 1007 Italian chronic patients. The hypothetical model was tested using SEM to verify the hypothesized mediation of patient engagement between PCC and HL. Results show that the theoretical model has a good fit indexes and that patient engagement fully mediates the relationship between PCC and HL. This finding suggests healthcare systems to implement a new paradigm where patients are supported to play an autonomous role in their own healthcare.

Since the beginning of the year 2020, the global healthcare system has been challenged by the threat of the SARS-COV 2 virus. Molecular, antigen, and antibody testing are the mainstay to identify infected patients and fight the virus. Molecular and antigen tests that detect the presence of the virus are relevant in the acute phase only. Serological assays detect antibodies to the Sars-CoV-2 virus in the recovering and recovered phase. Each testing methodology has its advantages and disadvantages. To evaluate the test methods, sensitivity (percent positive agreement - PPA) and specificity (percent negative agreement – PNA) are the most common metrics utilized, followed by the positive and negative predictive value (PPV and NPV), the probability that a positive or negative test result represents a true positive or negative patient. In this paper, we illustrate how patient risk and clinical costs are driven by false-positive and false-negative results. We demonstrate the value of reporting PFP (probability of false positive results), PFN (probability of false negative results), and costs to patients and healthcare. These risk metrics can be calculated from the risk drivers of PPA and PNA combined with estimates of prevalence, cost, and Reff number (people infected by one positive SARS COV-2).

Cerebral cavernous malformations (CCM) or familial cavernomatosis is a rare, autosomal dominant, inherited disease characterized by the presence of vascular malformations consisting of blood vessels with an abnormal structure in the form of clusters. Based on the altered gene (CCM1/Krit1, CCM2, CCM3) and its origin (spontaneous or familial), different types of this dis-ease can be found. In this work we have isolated and cultivated primary endothelial cells (ECs) from peripheral blood of a type 1 CCM patient. Differential functional and gene expression pro-file of these cells were analyzed and compared to primary ECs from a healthy donor. The muta-tion of the familial index case consisted of a heterozygous point mutation in the position +1 splicing consensus between exons 15 and 16, causing failure in RNA processing and in the final protein. Furthermore, gene expression analysis by quantitative PCR revealed a decreased ex-pression of genes involved in intercellular junction formation, angiogenesis, and vascular ho-meostasis. Cell biology analysis showed that CCM1 ECs were impaired in angiogenesis and cell migration. Taken together, the results obtained suggest that the alterations found in CCM1 ECs are already present in the heterozygous condition, suffering from vascular impairment and someway predisposed to vascular damage.

This paper introduces the AltumView Sentinare smart activity sensor for senior care and patient monitoring. The sensor uses an AI chip and deep learning algorithms to monitor the activity of people, collect activity statistics, and notify caregivers when emergencies such as falls are detected. To protect privacy, only skeleton (stick figure) animations are transmitted instead of videos. The sensor is highly affordable, accessible, and versatile. It was a CES 2021 Innovation Award Honoree, and has been selected by Amazon as one of only three fall detection devices integrated into its Alexa Together urgent response service, and has received very positive reviews from Amazon customers. It has also been used in different senior care settings in about ten different countries. The paper presents the main features of the system, the evidences and lessons learned from its practical applications, and future directions.

Introduction: A dual malignancy with both Ewing Sarcoma and Prostate Adenocarcinoma has not been reported in the English literature. We report a case of simultaneous diagnosis of Ewing sarcoma and prostate adenocarcinoma with profound clinical manifestation. Case presentation: A 53-year-old male with advanced metastatic prostate cancer (Gleason-9) admitted with classical presentation of cauda equina syndrome including incontinence, back pain, and paresis following bilateral nephrostomy insertion for the treatment of bilateral renal hy-dronephrosis. The patient was diagnosed with an epidural abscess at the level of L5-S1 and an emergency surgical spine decompression was performed. No abscess was found, and pathology results showed a concomitant primary Ewing sarcoma in the spine. Conclusions: Very rare occurrences of a dual primary malignancy, in this case, Ewing sarcoma and prostate adenocarcinoma, should be kept in mind in patients suffering from complex clinical course of malignancies.

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a complex disease characterized by profound fatigue, post-exertional malaise (PEM), and neurocognitive dysfunction. Immune dysregulation and gastrointestinal symptoms are commonly observed in ME/CFS patients. Despite affecting approximately 0.89% of the general population, the underlying pathophysiological mechanisms remain poorly understood. This study aimed to elucidate the relationship between immunological characteristics and intestinal barrier function in ME/CFS patients. ME/CFS patients were stratified into two groups based on their immune competence. After documentation of detailed medical records, serum and plasma samples were collected for assessment of inflammatory immune mediators and biomarkers for intestinal barrier integrity by ELISA. We found reduced complement protein C4a levels in immunodeficient ME/CFS patients suggesting a sub-group specific innate immune dysregulation. ME/CFS patients without immunodeficiencies exhibit a mucosal barrier leakage, as indicated by elevated levels of Lipopolysaccharide-binding protein (LBP). Stratifying ME/CFS patients based on immune competence enabled the distinction of two subgroups with different pathophysiological patterns. The study highlights the importance of emphasizing precise patient stratification in ME/CFS, particularly in the context of defining suitable treatment strategies. Given the substantial health and socioeconomic burden associated with ME/CFS, urgent attention and research efforts are needed to define causative treatment approaches.

ABSTRACT Objectives: Typical Diagnostic Reference Levels (DRL) in terms of Computed Tomography Dose Index (CTDI) and patient dose in terms of Effective Dose (ED ) and Size Specific Dose Estimate (SSDE) were estimated in Computed Tomography (CT) guided biopsy procedures. Materials and Methods: A total of 226 CT biopsy procedures - Iliac bone, liver, lung, mediastinum and para-aortic tissue - were retrospectively analyzed and Typical DRL extracted based on ICRP 135 instructions. Results: For helical mode acquisitions, DRLs in terms of CTDIvol were 9.7 mGy for Iliac bone, 8.9 mGy for liver, 8.8 mGy for lung, 7.9 mGy for mediastinal mass and 9 mGy for para-aortic lymph nodes biopsy procedures. For biopsy acquisitions, DRL values were 7.3 mGy, 7.7 mGy, 5.6 mGy, 5.6 mGy and 7.4 mGy respectively. Also, SSDE median values ranged from 7.6 mGy to 10 mGy for biopsy acquisitions and 11,3 mGy to 12,6 mGy for helical acquisitions, as well as the median values for effective dose ranged from 1.6 mSv to 5,7 mSv for biopsy scans and 3.9 to 9.3 mSv for helical scans. Conclusions: The use of DLR as an optimization tool for CT-guided biopsy procedures revealed that helical scans across the entire anatomical region greatly affect radiation dose compared to biopsy acquisitions.

Diabetes mellitus (DM) and chronic kidney disease (CKD) are common in middle aged and elderly individuals. DM may accelerate the aging process, and the age-related declines in the estimated Glomerular Filtration Rate (eGFR), can pose a challenge to diagnose diabetic kidney disease (DKD) using standard diagnostic criteria especially with absence of severe albuminuria among the elderly. In the presence of CKD and DM, elderly patients may need multidisciplinary care due to susceptibility to various health issues e.g., cognitive decline, auditory or visual impairment, various comorbidities, complex medical regimens, and increased sensitivity to medication adverse effects. As a result, it can be challenging to apply recent therapeutic advancements for the general population to the elderly. We review the evidence that the benefits from these newer therapies apply equally to elderly and non-elderly patients and propose a framework for the management of DKD by discussing the nonpharmacological measures and pharmacological management with renin angiotensin system inhibitors (RASi), Sodium Glucose Co-Transporter two inhibitors (SGLT2i), non-steroidal mineralocorticoids receptor antagonists (MRAs), and Glucagon Like Peptide 1 Receptor Agonists (GLP1-RAs).

Background: Poor patient flow can lead to adverse outcomes for patients and organisational inefficiency. Many hospitals have addressed suboptimal patient flow by increasing resourcing, such as bed stock and staffing, however, this is an unsustainable approach. In determining the nature of poor patient flow issues, it is important to collect data from healthcare professionals who manage patient flow on a daily basis. Doing so provides insights into the current state of patient flow management in its entirety, whilst also helping with the development of sustainable solutions.; Methods: Thirteen semi-structured interviews were conducted with clinicians who were directly involved with patient flow at a tertiary care centre in Tasmania, Australia. Results: Through a thematic analysis method, four major themes were developed: managing patient flow, communication for decisions, tools as enablers and barriers and increasing complexity. Conclusions: The findings of this study provide great insights into patient flow issues, with potential solutions identified to address them.

(1) Background: This case presents a rare and challenging clinical scenario involving a 50-year-old female patient diagnosed with Inflammatory Carcinoma, a particularly aggressive and rapidly growing form of breast cancer. The disease is characterized by heat, redness, swelling and noticeable changes in the breast's skin texture, resembling the skin of an orange (peau d'orange). This case is important because it contributes to the limited clinical literature on such aggressive forms of breast cancer.; (2) Methods: The multidisciplinary approach was employed. Diagnostic procedures such as imaging tests, biopsy, and histopathological examination were performed to confirm the diagnosis of Inflammatory Carcinoma and assess the extent of the disease. The presence of the HER2 protein on the tumor cells supported the selection of a combination therapy involving systemic chemotherapy and targeted biological therapy.; (3) Results: The patient responded positively to the combination therapy consisting of systemic chemotherapy and targeted biological therapy. The aggressive nature of Inflammatory Carcinoma, characterized by rapid growth and distinct skin changes, was effectively addressed. The presence of the HER2 protein on the tumor cells indicated the potential efficacy of the combination therapy in aggressive forms of breast cancer.; (4) Conclusions: This case highlights the critical importance of a multidisciplinary approach in managing complex cases of breast cancer, especially rare and aggressive subtypes like Inflammatory Carcinoma. The positive response of the patient to the combination therapy involving systemic chemotherapy and targeted biological therapy demonstrates the potential for favorable outcomes in aggressive disease presentations.

Background The main aim of reconstructive surgery (RS) is to restore the integrity of soft tissues damaged by trauma, surgery, congenital deformity, burns or infection. Microsurgical techniques consist of harvesting tissues that are separated from the vascular sources of the donor site and anastomosed to the vessels of the recipient site. In these procedures, there are some preoperative modifiable factors that have the potential to influence the outcome of the flap transfer and its anastomosis. Methods Chronic inflammatory anaemia (ACD) is a constant condition in patients who have undergone RS and correlates with the perfusion of the free flap. In RS, it is important to maintain good tissue oxyporesis, avoiding blood hyperviscosity. From January 2017 to September 2019, we studied 16 patients (16 males, mean age 38 years) who underwent microsurgical procedures for RS. Haemoglobin (Hb) levels, Corpuscular Indexes, Transferring saturation (TSAT) ferritin concentrations and creatinine clearance have been measured the first day after surgery (T0), after the first week (T1) and after five weeks (T2). At T0 all patients showed low hemoglobin levels (average 7.4 g/dl, STD 0,71range 6,2-7,4 g dL-1), with an MCV of 72, MCH 28, MCHC 33, RDW 16, Sideremy 35, Ferritin 28, Ret% 1,36, TRF 277 and Creatinine Clearance 119. . We assessed all patients for clinical status, medical history and comorbidities before starting therapy. Results. In collaboration between the two departments, we started a therapeutic protocol with erythropoietic stimulating agents (ESAs) (Binocrit 6000 UI/week) and intravenous iron every other day, on the second day after surgery. Thirteen patients received ESAs and FCM (500-1000 mg per session), three patients received ESAs and iron gluconate (1 vial every other day). No patients received blood transfusions. No side effects were observed and, most importantly, no limb or flap rejection. Conclusions Preliminary data from our protocol show an optimal therapeutic response in a surgical setting with limited data in the scientific literature. The enrolment of further patients will allow us to validate this therapeutic protocol with statistically significant data.

Purpose: This study aims to provide a foundational understanding of patient-centric perceptions of telemedicine implementation in rural Minnesota. Methods: This retrospective cohort study utilized a mail questionnaire to assess patient attitudes and behaviors regarding telemedicine during the emergency response to COVID-19. The target population was patients of a Primary Care clinic in eastern Minnesota. Descriptive statistics were used to assess respondents’ level of agreement with survey items scored on a 0-10 scale. Results: A majority of the respondents indicated that they were satisfied with using telemedicine (73.96%); that they gained an additional sense of control over their health condition due to the availability of telemedicine (52.08%); that they would support the use of telemedicine in the future (61.05%); that telemedicine increased access to care (65.63%); telemedicine was preferred over the clinic (61.46%), and that they would purchase new equipment to increase the utility of telemedicine services (54.17%). 51.04% of the respondents indicated a 10/10 level of satisfaction with telemedicine services. 48.96% indicated the strongest level of disagreement related to difficulty using telemedicine or a preference for in-person clinical appointments. Conclusions: Patients were found to have favorable perceptions of telemedicine overall. Though providers continue to recognize the benefit of face-to-face visits, their patients show an increased predilection for virtual care and telemedicine will likely remain an essential tool for providers to reach patients who would otherwise choose not to seek care.

Obsessive-compulsive disorder (OCD) remains, despite significant scientific progress, a pathological condition that is incomprehensible, due toits paradoxical psychological and behavioral symptoms. The presentwork aims at assessing current phenomenological understandings of this pathology. Among the cognitive models used today, post-rationalist cognitivism and cognitive neuropsychological psychotherapy, which both incorporate a phenomenological approach, seem most effective at grasping OCD patients’ experiences of the world, which are typically characterized by hyper-reflexivity, at the expense of "natural evidence." For OCD patients, the emotional sense of the world becomes a set of sterile rules that determine a suffering life.

Left ventricular noncompaction (LVNC) and hypertrophic cardiomyopathy (HCM) commonly occur as separate disorders with distinct clinical and pathoanatomical features. However, these cardiomyopathies may have a similar genetic origin with mutations encoding sarcomeric proteins. The described case demonstrates an example, in which phenotypic expression of both diseases occurs in the same patient.

A 47-year-old physician suddenly noticed a persistent difficulty maintaining attention. He was awake, alert, and oriented. After two hours he developed fever, ageusia, and anosmia. He denied any previous history of psychiatric illness and was hydrated at the time of the subjective attention impairment. On admission, the patient remained oriented. He reported the persistence of attention problems, anosmia, and mild fatigue. The oxygen saturation 99% while he was breathing ambient air. Laboratory tests were unremarkable. A high-resolution computed tomography of the chest was normal. Nasopharyngeal and throat swabs specimens on reverse transcription-polymerase chain reaction analysis tested positive for SARS-CoV2. On illness day 3, the examination was unchanged, but he continued to complain of difficulties to stay focused. Then, he performed an objective attention test. The test demonstrated a moderate attentional impairment. On day 6, the patient reported a subjective worse in his concentration and performed a second test. Although his physical examination remained normal, the attention performance was worse as compared to day 3. Eight hours after worsening of attention impairment, the patient’s oxygen saturation dropped to 94%. From illness days 9 to 14, the patient evolved with clinical improvement. On day 10, a third objective attention test indicated a mild deficit. On day 16, he did not report any other symptom and the attention test was completely normal. Then, the patient returned to work. Neurological symptoms had been previously described in COVID- 19 patients. However, no previous research had investigated early cognitive deficits preceding the traditional symptoms.