Notes

Blueprint in Remote-Controlled Medicine Shipping and delivery: In the Service provider Style to Clinical studies.
The coronavirus disease 2019 (COVID-19) pandemic incited substantial changes to acute care delivery, including the rapid scale-up of telehealth and numerous changes to in-person care. This study explored health system changes associated with the COVID-19 pandemic and their influences on pediatric acute care delivery and quality of care.
We conducted 38 semistructured interviews May-November 2020 with families and clinicians from 3 US regions, eliciting their perspectives and experiences regarding changes to acute care delivery during the pandemic. Interviews were analyzed using a general inductive approach to identify relationships between clinical care infrastructure, care processes, and healthcare quality.

Emerging knowledge of COVID-19 epidemiology and associated restrictions influenced care-seeking behaviors and clinical infrastructure and processes. Infrastructure changes included the closure of some clinics, limited "sick visit" hours and locations, and increased resources for telehealth. Modified caes and decision aids describing diagnoses, populations, and procedures best-suited to telehealth may improve the quality of acute care delivery.Traditional quality improvement (QI) strategies to describe workflow processes rely primarily upon qualitative methods or human-driven observations. These methods may be limited in scope and accuracy when applied to time-based workflow processes. This study sought to evaluate the utility of integrating objective time measurements to augment traditional QI strategies using procedural sedation workflow in a pediatric emergency department as an archetype.
We applied the FOCUS-Plan-Do-Check-Act framework to reduce the time from arrival to sedation for long-bone fractures. First, we added supplementary framework-defining steps to repeat the Clarifying and Understanding steps. We then extracted objective time-based data from an electronic health record (EHR) system and a real-time locating system (RTLS). We then compared and contrasted the findings of traditional surveys with analyses of timed steps within the sedation workflow.

When identifying the source of delays, traditional survey techniques yielded ambiguous and even conflicting results based on clinical roles. The timestamps supported 5 measurable clinical role of subworkflows. By measuring the time to completion for 54 sedation cases, workflow patterns and significant bottlenecks were identified.

Analyzing the time to complete individual tasks provided a more nuanced description of workflow delays and clarity when traditional survey results conflicted. Augmenting traditional QI process maps with EHR and RTLS timestamps better explained workflow bottlenecks, informing the QI team when selecting targets for subsequent Plan-Do-Check-Act work.
Analyzing the time to complete individual tasks provided a more nuanced description of workflow delays and clarity when traditional survey results conflicted. Augmenting traditional QI process maps with EHR and RTLS timestamps better explained workflow bottlenecks, informing the QI team when selecting targets for subsequent Plan-Do-Check-Act work.Herein, we assess the cost-effectiveness of a multidisciplinary clinic for children with urinary stones. The clinic's primary goals were to decrease unnecessary visits, imaging, and costs while optimizing the quality of care.
Between October 2012 and January 2016, children with complex stone disease, previously treated in urology and/or nephrology clinics, were seen at a triannual pediatric combined stone clinic. We compared the number and cost of ultrasounds, emergency room (ER) visits, and stone surgeries performed before and after each patient's initial evaluation. All patients received satisfaction surveys.

Among the 79 patients, 27 were seen at least twice in the combined clinic and followed multiple times in either urology or nephrology clinics. The mean number of ER visits per patient per year significantly decreased from 0.29 ± 0.36 to 0.10 ± 0.15 (
= 0.002). The mean cost of ER visits went from CAD$ 23.44 ± 28.80 to CAD$ 4.14 ± 12.18 (
= 0.002). Likewise, the mean annual number and cost of stone-related surgeries significantly decreased [(0.38 ± 0.63 versus 0.20 ± 0.32 after the MSC started (
= 0.026) and mean annual cost of surgeries went from CAD$ 182.97 ± 301.49 to CAD$ 41.59 ± 110.97 (
= 0.022)]. Among the survey responses returned, 75% of families believed the clinic was time-saving.

Despite a small sample size, the number of ER visits and stone-related operations significantly decreased after the initial combined clinic intervention. Longer-term data will hopefully confirm if the positive findings continue.
Despite a small sample size, the number of ER visits and stone-related operations significantly decreased after the initial combined clinic intervention. Longer-term data will hopefully confirm if the positive findings continue.Improving the discharge process is an area of focus throughout healthcare organizations. Capacity constraints, efficiency improvement, patient safety, and quality care are driving forces for many discharge process workgroups.
Following the Pareto principle, we focused on improving the discharge process on the medical-surgical units that received the most patients admitted from the emergency department. Increased demand for medical-surgical beds, renovations, and diminished bed capacity made it imperative to improve efficiency using quality improvement techniques. A core team of frontline staff decreased the time between computer entry of discharge orders and patient's departure from the unit to less than 60 minutes, with 80% compliance. The team developed a daily dashboard that detailed the process and outcome measures to create situational awareness and daily visual management. Additional observations of staff workflow uncovered excessive walking for printer use. Printers were placed at the point of use to reduce transport times. Next, using survey results provided by patients on discharge quality, a Treasure Map that aided with teach-back and Team Discharge were implemented to level the staff's workload. Finally, physicians discharged patients earlier in the day. They standardized their discharge criteria to remove subjectivity from the discharge process and enable better team involvement.

After implementing 4 interventions, the average time between computer entry of discharge orders and patient's departure from the unit decreased (94.26 versus 65.98 minutes;
< 0.001), simultaneously reducing our average length of stay from 5.62 to 4.81 days (
< 0.001).

In conclusion, hardwiring proven interventions and complementing them with daily visual management led to significant, sustained results.
In conclusion, hardwiring proven interventions and complementing them with daily visual management led to significant, sustained results.Multiple clinic models for Down syndrome exist; one model is the multidisciplinary, specialty clinic, such as the Massachusetts General Hospital Down Syndrome Program (MGH DSP).
Intrateam communication was identified as an area for improvement. Our team developed an intervention, the Passport, a paper-based communication tool passed by parents between clinical teams who evaluated the same patients in different locations. Metrics included an electronic survey of parents and clinicians and tracking the frequency of Passport use. The analysis included the use of Statistical Process Control charts and rules.

The parental suggestions for communication-based interactions improved from 54% (32/60) to 17% (3/18) (
0.01). Communication scores within the MGH DSP team and between the team and parents were high at 86% and 96%, respectively. Overall satisfaction with the MGH DSP remained consistently high during our project, with a mean score of 6.49 out of 7. The MGH DSP team members reported communication scores with a mean of 85 out of 100.

Implementation of a paper Passport tool incorporated parents in the real-time, intraclinic communication between our MGH DSP teams, leading to improved communication suggestions and high marks on the other metrics followed. Such a tool could be useful for other multidisciplinary clinics where team members evaluate the same patients at different locations on the same day.
Implementation of a paper Passport tool incorporated parents in the real-time, intraclinic communication between our MGH DSP teams, leading to improved communication suggestions and high marks on the other metrics followed. Such a tool could be useful for other multidisciplinary clinics where team members evaluate the same patients at different locations on the same day.The preprocedure time-out is an important safety measure to verify patient identity and accuracy of a planned procedure. The time-out is an institutional and Joint Commission requirement. However, physicians in our emergency departments (EDs) document it inconsistently. We aimed to improve physician preprocedure time-out documentation for deep sedation (ketamine and/or propofol) from 75% to 90%, and separately for cutaneous abscess incision and drainage (I&D) from 94% to 98% by June 2020.
We analyzed 1 year of baseline data and weekly electronic medical record (EMR) reports from November 2019 through June 2020. Our outcome measures were the rate of physician time-out documentation for deep sedation and I&D, respectively; our process measure was physician engagement. Our interventions included education, monthly reminders and updates, individualized feedback for insufficient documentation, EMR deep sedation, and I&D procedure note optimization, and academic and financial incentives. We used statistica potential harm through these safety checks. Future studies may quantify patient safety effects and examine the efficacy of similar interventions for other procedures.Theoretically, the application of reliability principles in healthcare can improve patient safety outcomes by informing process design. As preventable harm continues to be a widespread concern in healthcare, evaluating the association between integrating high-reliability practices and patient harms will inform a patient safety strategy across the healthcare landscape. This study evaluated the association between high-reliability practices and hospital-acquired conditions.
Twenty-five pediatric organizations participating in the Children's Hospitals Solutions for patient safety collaborative participated in this nonexperimental design study. A survey utilizing the high-reliability healthcare maturity model assessed the extent of implementing high-reliability practices at each participating site. We analyzed responses for each component and a composite score of high reliability against an aggregate measure of hospital-acquired conditions.

Of the 95 invited sites, 49 responded and 25 were included in the finainciples into healthcare.Long bone fractures are a common cause of pain in the pediatric emergency department (PED), and ensuring timely delivery of analgesic medications is essential for these children. We aimed to decrease the median time to the first dose of analgesic for long bone fracture-associated pain in our PED to 36 minutes or less by July 1, 2015.
A series of 4 initiatives were implemented in successive "plan, do, study, act" rapid cycles. Initiatives consisted of educational interventions for staff regarding Emergency Severity Index procedures for triaging pain, transition to in-room triage, enhanced communication about quality goals using a "quality board," and ongoing staff educational sessions on outlier cases as well as biases and barriers to quality.

We implemented the initiatives from April through July of 2015. The monthly median time to analgesic delivery for long bone fracture-associated pain in the PED decreased from 72 minutes in April to 33.5 minutes in July of 2015. For 12 months following the first intervention, the average monthly median time to the first analgesic dose was 48.5 versus 66.3 minutes for the prior 12 months.

A series of 4 interventions led to a decrease in the median time to the first dose of analgesic for long bone fracture-associated pain in the PED.
A series of 4 interventions led to a decrease in the median time to the first dose of analgesic for long bone fracture-associated pain in the PED.
Chronic back pain is the leading cause of disability in the United States. Based on the hypothesis that nonspecific back pain may be rooted in a psychophysiologic etiology, we propose a new approach to chronic back pain.

A pilot study was conducted to assess whether psychophysiologic symptom relief therapy (PSRT) can reduce disability and back pain bothersomeness for patients with chronic back pain.

This was a three-armed, randomized trial for adults with nonspecific chronic back pain that compared PSRT with usual care and an active comparator (mindfulness-based stress reduction [MBSR]). Psychophysiologic symptom relief therapy-randomized participants received a 12-week (36 hours) course based on the psychophysiological model of pain. All groups were administered validated questionnaires at baseline and at 4, 8, 13, and 26 weeks. The primary outcome was the reduction in pain disability measured by the Roland-Morris Disability Questionnaire.

The mean Roland-Morris Disability Questionnaire score for the PSRT group (n = 11) decreased from 9.5 (±4.3 SDs) to 3.3 (±5.1) after 26 weeks which was statistically significant compared with both MBSR (n = 12) (
= 0.04) and usual care (n = 12) (
= 0.03). Pain bothersomeness scores and pain-related anxiety decreased significantly over 26 weeks in PSRT compared with MBSR and usual care (data in manuscript). At 26 weeks, 63.6% of the PSRT arm reported being pain free (0/10 pain) compared with 25.0% and 16.7% in MBSR and usual care arms, respectively. Psychophysiologic symptom relief therapy attendance was 76%, and there was 100% follow-up of all groups.

Psychophysiologic symptom relief therapy is a feasible and potentially highly beneficial treatment for patients with nonspecific back pain.
Psychophysiologic symptom relief therapy is a feasible and potentially highly beneficial treatment for patients with nonspecific back pain.
The unknown and uncontrollable situation of the coronavirus disease 2019 (COVID-19) pandemic may have triggered changes in pain, anxiety, and depression along with a perception of nonspecific COVID-19 symptoms.

We determined how anxiety, depression, and pain outcomes varied during the "Stay-at-Home" order compared with the prepandemic period and whether nonspecific COVID-19 symptoms would occur.

We conducted an online survey to opportunistically reassess clinical anxiety, depression, pain intensity, and pain interference while controlling for somatic symptom severity during the prepandemic and Stay-at-Home order period. During the Stay-at-Home period, anxiety, depression, pain intensity, and pain interference were reassessed. Coping strategies were assessed as a critical factor influencing pain behaviors. In addition, we explored the occurrence of nonspecific COVID-19 symptoms with an ad hoc survey referencing the Centers for Disease Control and Prevention publicly available COVID-19 symptoms.

We observed a significant increase in depression and anxiety levels during the Stay-at-Home period. Coping strategy changes (eg, increased exercise) were linked to lower pain severity and interference which improved overall. Participants who self-reported nonspecific COVID-19 symptoms had higher prepandemic depression. Among the 72 participants not diagnosed with COVID-19, 70.8% of the participants experienced symptoms resembling those associated with COVID-19.

We suggest the parallel between pain outcome improvement and worsening anxiety and depression during the Stay-at-Home order might reflect a shift in symptoms, indicating that those patients with underlying mood disorders may require more help than they did before the pandemic.
We suggest the parallel between pain outcome improvement and worsening anxiety and depression during the Stay-at-Home order might reflect a shift in symptoms, indicating that those patients with underlying mood disorders may require more help than they did before the pandemic.In assessments of cancer risk from atmospheric polycyclic aromatic hydrocarbons (PAHs), scientists and regulators rarely consider the complex mixture of emitted compounds and degradation products, and they often represent the entire mixture using a single emitted compound-benzo[a]pyrene. Here, we show that benzo[a]pyrene is a poor indicator of PAH risk distribution and management nearly 90% of cancer risk worldwide results from other PAHs, including unregulated degradation products of emitted PAHs. We develop and apply a global-scale atmospheric model and conduct health impact analyses to estimate human cancer risk from 16 PAHs and several of their N-PAH degradation products. We find that benzo[a]pyrene is a minor contributor to the total cancer risks of PAHs (11%); the remaining risk comes from other directly emitted PAHs (72%) and N-PAHs (17%). We show that assessment and policy-making that relies solely on benzo[a]pyrene exposure provides misleading estimates of risk distribution, the importance of chemical processes, and the prospects for risk mitigation. We conclude that researchers and decision-makers should consider additional PAHs as well as degradation products.We explore in general relativity the survival time of neutron stars that host an endoparasitic, possibly primordial, black hole at their center. Corresponding to the minimum steady-state Bondi accretion rate for adiabatic flow that we found earlier for stiff nuclear equations of state (EOSs), we derive analytically the maximum survival time after which the entire star will be consumed by the black hole. We also show that this maximum survival time depends only weakly on the stiffness for polytropic EOSs with Γ ≥ 5/3, so that this survival time assumes a nearly universal value that depends on the initial black-hole mass alone. Establishing such a value is important for constraining the contribution of primordial black holes in the mass range 10-16 M ⊙ ≲ M ≲ 10-10 M ⊙ to the dark-matter content of the Universe.The paper focuses on collection of information on recent multifaceted usage of biomass materials with critical examination on its sustainability. The use of biomass is becoming popular, with wide global acceptance as it is considered as green technology. The use of biomass products across industrial parallels, the material combination and production processes were elucidated in this paper. Biomass materials are seen as affordable alternative to conventional materials for domestic and industrial applications. The multifaceted use of biomass, which includes, energy generation, metallurgical applications, construction purposes, reinforcement in metal matrix composite, microelectromechanical system, biochemical and traditional medicine were discussed. This underscores the need to develop a sustainable plan to meet with its diverse usage to be beyond laboratory efforts. This paper examined whether the availability of biomass can sustain its multifaceted usage or not. It also examined the modalities to ensure sustainable use of biomass. Different policies were highlighted and discussed in line with continuous multifaceted use of biomass.Awash River basin (ARB) as a system is in a state of continuous change that requires successive studies to discern the changes or trends of climatic elements through time due to climate change/variability, and other socio-economical developmental activities in the basin. The livelihood of communities in the ARB is primarily based on rainfall-dependent agriculture. Effects of rainfall anomalies such as reduction of agricultural productivity, water scarcity, and food insecurity are becoming more prevalent in this area. In recent years, ARB has been experiencing more frequent rainfall anomalies that change-point detection test and trend analyses of basin rainfall associated with sea surface temperature is crucial in providing guidance to improve agricultural productivity in ARB. Change-point detection tests such as Pettit's, the von Neumann ratio (VNR), Buishand's range (BR) and standard normal homogeneity (SNH) plus trend analysis Mann-Kendall (MK) test of rainfall and temperature data from 29 meteorological stablished, especially in the downstream areas. Moreover, early detection of El Niño episodes would provide invaluable warning of impending rainfall anomalies in the ARB and would enable better preparations to mitigate its negative effects.Measuring the trends of growth and variability in agricultural production is important to understand how outputs change over time. Ethiopia is the largest producer of coffee in Africa and the fifth in the world. Despite the abundant opportunities and continuous efforts made to enhance its production, it is often said that the productivity of Ethiopian coffee remains far below its potential. Yet, empirical data on the status of coffee production over time in Ethiopia is scant. We, thus, analyzed the trend, instability, and decomposition of coffee production in Ethiopia for three periods, i.e., the entire period (1993-2019), the pre-Agricultural Growth Program period (1993-2010), and the Agricultural Growth Program period (2011-2019). In all three periods, harvested area and production showed an increasing trend while productivity showed a cyclical decreasing trend. The compound growth rates of harvested area (8.14%) and production (6.68%) in the 1993-2019 period were positive and significant at 1% level, whereas that of productivity (-0.45%) was not significant. Similarly, the compound growth rates of harvested area and production during pre-AGP (6.02 and 6.06%) and AGP (6.43 and 3.57%) were positive, but only significant during AGP, and that of productivity in both pre-AGP and AGP (0.19 and -1.6%) were not significant. Productivity was, however, more stable than harvested area and production during the entire and pre-AGP periods, while harvested area and production were more stable in AGP than in the other two periods. Besides, the harvested area effect on production differentials was substantial in all three periods, while productivity and productivity-harvested area interaction effects declined production during the entire and AGP periods. Overall, the results demonstrate that to enhance and sustain coffee production in Ethiopia, using improved varieties and agronomic practices can be a better option than expanding the cultivation area since land is scarce and fixed in supply.d-Allulose, a C-3 epimer of d-fructose, is a rare sugar that has no calories. Although d-allulose has been reported to have several health benefits, such as anti-obesity and anti-diabetic effects, there have been no reports evaluating the effects of d-allulose on insulin resistance using a hyperinsulinemic-euglycemic clamp (HE-clamp). Therefore, we investigated the effects of d-allulose on a high-sucrose diet (HSD)-induced insulin resistance model. Wistar rats were randomly divided into three dietary groups HSD containing 5% cellulose (HSC), 5% d-allulose (HSA), and a commercial diet. The insulin tolerance test (ITT) and HE-clamp were performed after administration of the diets for 4 and 7 weeks. After 7 weeks, the muscle and adipose tissues of rats were obtained to analyze Akt signaling via western blotting, and plasma adipocytokine levels were measured. ITT revealed that d-allulose ameliorated systemic insulin resistance. Furthermore, the results of the 2-step HE-clamp procedure indicated that d-allulose reversed systemic and muscular insulin resistance. d-Allulose reversed the insulin-induced suppression of Akt phosphorylation in the soleus muscle and epididymal fat tissues and reduced plasma TNF-α levels. This study is the first to show that d-allulose improves systemic and muscle insulin sensitivity in conscious rats.In recent years, the world has shown considerable concerns about environmental degradation accompanied by urban expansion. In terms of size, Bogura is equivalent to most of the major cities in Bangladesh, yet no thermal and ecological assessment has ever been conducted here. This study uses multitemporal Landsat satellite images between 2001 and 2020 to investigate the thermal and ecological conditions of Bogura Sadar (sub-district). Land surface temperature (LST) is obtained from Landsat images using the widely used radiative transfer equation. The thermal and ecological conditions are evaluated by computing urban heat island (UHI) and urban thermal field variance index (UTFVI) from LST data. The influence of vegetation, built-area, water-body, and bare soil on LST are examined using land cover indices through pixel-level multivariate linear regression analysis. According to the findings of this sub-district-scale (urban and rural areas) study, the mean LST has increased by 0.62 °C in the last 20 years. As per local administrative-wise findings, LST has increased in most areas, regardless of their urban or rural function. The difference between the urban area and the rest of the surroundings was significant (1.74 °C) in 2020. In 2001, UHI affected area was 5.65 km2, which expanded to 8.84 km2 in 2020. Thermal and ecological conditions are worse in urban areas than its surrounding areas. The regression models of the LST and land cover indices could explain more than half (R2 0.66 to 0.73) of LST variation over the years. Land cover could explain the LST in 2020 to the least extent implying that anthropogenic activities have greater influence than earlier. Land cover could explain less than half of the LST variation in the urban area.The purpose of this study was to explore the stability and toxicity of the herbicides and their degradation byproduct after exposure to different environmental factors. Triazines (atrazine, propazine, simazine) and chloroacetanilides (acetochlor, alachlor, metolachlor) which are commonly used herbicides were evaluated for cytotoxicity in different UV (254 nm and 365 nm) and temperature (4 °C, 23 °C, and 40 °C) conditions as well as degradation rates. Atrazine with the highest LD50 (4.23 μg mL-1) was less toxic than the other tested triazine herbicides Chloroacetanilides tested were more toxic than tested triazines, with LD50 0.08-1.42 μg mL-1 vs 1.44-4.23 μg mL-1, respectively. Alachlor with LD50 0.08 μg mL-1 showed the strongest toxic response as compared with other tested herbicides. Temperatures only did not alter cytotoxicity of the tested herbicides, except for acetochlor and alachlor showing about 45 % more cell death after exposure to 40 °C for 2 h. At all 3 tested temperatures, 2 h of UV treatments did not affect cytotoxic effects of the tested herbicides, except for acetochlor and alachlor. At 4 °C, acetochlor toxicity was attenuated about 63 % after UV 365 nm exposure; but alachlor toxicity was enhanced after either UV 254 or 365 nm exposure for about 40 % and 24 %, respectively. At 23 °C, acetochlor toxicity was enhanced about 35 % after UV 254 nm exposure, but attenuated about 48 % after UV 365 nm exposure. Alachlor toxicity was enhanced about 34 % after UV 254 nm and 23 °C exposure. In combination of UV 254 nm and 40 °C, acetochlor toxicity was lowered by 63 % and alachlor toxicity was no change as compared with 4 °C, no UV group. After co-treatment with UV 365 nm and 40 °C both acetochlor and alachlor toxicity was enhanced 55 % and 80 %, respectively. Through degradation analysis by LC-MS/MS, alachlor showed the most dramatic degradation (only 0.58 %-10.58 % remaining) after heat and UV treatments.The study investigated the effect of institutional mechanisms of micropension saving (MPS) schemes in extending coverage to informal economy workers. We used mixed methods as the research approach, and collected both quantitative and qualitative data for analysis. Using principal component analysis, multiple regression analysis and interpretative approaches that yielded themes, we concluded that more access provision, incentives and security result in increased informal economy workers' participation in MPS. However, general form of financial information to informal economy workers was found to demotivate enrolment onto the scheme. Consequently, we recommended that corporate pension trustees should create institutional structures like pension education campaigns on national television and radio to promote the culture of pension saving.The alkaline hydrogen peroxide (AHP) pretreatment of cladodes of cactus (Opuntia ficus-indica) for biogas production was evaluated based on the delignification of cladodes of cactus. The effects of alkaline hydrogen peroxide concentration (30% w/w solution) and the pretreatment time (3, 6, 9, and 12 h) were evaluated at pH 11.5, temperature of 30 °C, and 180 rpm for removal of lignin. A batch of anaerobic digestion experiments were conducted at mesophilic temperature conditions (37 ± 1 °C) with the pretreated biomass. The feed stock (cladodes of cactus) used in this study contained 12.51 ± 1.25 cellulose, 16.34 ± 2.93% hemicellulose, and 10.45 ± 2.31% lignin, and the balance were (carbohydrate, protein, lipid, and ash). After AHP pretreatment, the lignocellulosic content of the feed stock was changed to 12.50 ± 1.84%, 13.63 ± 3.23%, and 7.49 ± 3.05% for cellulose, hemicellulose, and lignin respectively. The AHP pretreatment of cladodes of cactus highly affected the lignin structure relative to cellulose and hemicellulose. The alkaline hydrogen peroxide pretreatment resulted in a higher amount of biogas produced from 877.9 ± 15.12 ml biogas/g VS to 1613.5 ± 10.76 ml biogas/g VS which is an 83.4% increment and decreased after 9 h treatment to 1398.8 ± 17.8 ml biogas/g VS. In addition, the measured methane yields range from 302.48 ± 0.33 to 602.65 ± 3.24 ml CH4/g VS. The results showed that alkaline hydrogen peroxide pretreatment of cladodes of cactus is an effective strategy for enhance biogas yield.In recent years, there has been an increase in demand for bioactive techniques in the food packaging industry. Although edible packaging is popular, it has yet to be effectively implemented into the market. Packaging made of plastics and chemicals is widely employed in the market today, posing a threat to the environment and living creatures. This research attempts to show current breakthroughs and progress in the field of biodegradable packaging. When compared to ancient packaging materials, bio-based packaging materials are safer. Sustainable biodegradable packaging materials can be made from edible films, coatings, and other bio food packaging techniques made from various biological resources. This paper discusses the important qualities and advantages of several bio-based packing materials. It is highlighted the advantages of bio-based packaging materials over synthetic packaging materials. It has been debated the importance of employing bio-based packaging to mitigate the environmental risks associated with traditional packaging technologies. Many researchers may be prompted by this study to focus on packaging reformulation options. Thus, we can attain food packing materials by considering customer's economic and sustainability aspects.
Alzheimer's disease (AD) is one of the most common NDs leading to cognitive dysfunctions and dementia which are progressively worsen with age. Cell therapy is currently of particular interest in treatment of neurodegenerative disease (ND) such as AD. However, the effective treatment for AD is yet to be found.

In this study, the possible roles of human umbilical mesnchymal stromal cord (hUMSCs) and adipose mesenchymal stem cells (hAD-MSCs) in neurogenesis and synaptic function were investigated using a β-amyloid 1-42 (β A42)-induced AD rat model.

hUMSCs and hAD-MSCs were isolated from umbilical cord stroma and adipose tissue, respectively. The expression of Mesenchymal (CD73, CD90 and CD105) and hematopoietic (CD45 and CD133) markers of hUMSCs and hAD-MSCs were confirmed by flow cytometry. Alzheimer's rat model was created by β-amyloid 1-42 injection into the hippocampus and confirmed by Morris Water Maze and immunohistochemical staining. hUMSCs and hAD-MSCs were injected in Alzheimer's rat model, intravection of both applied SCs could improve learning and cognitive impairment induced by β A42 injection.The number of English Language Learners (ELLs) has been growing worldwide. ELLs are at risk for reading disabilities due to dual difficulties with linguistic and cultural factors. This raises the need for finding practical and efficient reading interventions for ELLs to improve their literacy development and English reading skills. The purpose of this study is to examine the evidence-based reading interventions for English Language Learners to identify the components that create the most effective and efficient interventions. This article reviewed literature published between January 2008 and March 2018 that examined the effectiveness of reading interventions for ELLs. We analyzed the effect sizes of reading intervention programs for ELLs and explored the variables that affect reading interventions using a multilevel meta-analysis. We examined moderator variables such as student-related variables (grades, exceptionality, SES), measurement-related variables (standardization, reliability), intervention-related variables (contents of interventions, intervention types), and implementation-related variables (instructor, group size). The results showed medium effect sizes for interventions targeting basic reading skills for ELLs. Medium-size group interventions and strategy-embedded interventions were more important for ELLs who were at risk for reading disabilities. These findings suggested that we should consider the reading problems of ELLs and apply the Tier 2 approach for ELLs with reading problems.The present study investigates the lump, one-stripe, lump-stripe, and breather wave solutions to the (2+1)-dimensional Sawada-Kotera equation using the Hirota bilinear method. For lump and lump-stripe solutions, a quadratic polynomial function, and a quadratic polynomial function in conjunction with an exponential term are assumed for the unknown function f giving the solution to the mentioned equation, respectively. On the other hand, only an exponential function is considered for one-stripe solutions. Besides, the homoclinic test approach is adopted for constructing breather wave solutions. The propagations of the attained lump, lump-stripe, and breather wave solutions are shown through some graphical illustrations. The graphical outputs demonstrate that the lump wave moves along the straight line y = - x and exponentially decreases away from the origin of the spatial domain. On the other hand, lump-kink solutions illustrate the fission and fusion interaction behaviors upon the selection of the free parameters. Fission and fusion processes show that the stripe soliton splits into a stripe soliton and a lump soliton, and then the lump soliton merges into one stripe soliton. In addition, the achieved breather waves illustrate the periodic behaviors in the xy-plane. The outcomes of the study can be useful for a better understanding of the physical nature of long waves in shallow water under gravity.Nondestructive estimation of fruit properties during their ripening stages ensures the best value for producers and vendors. Among common quality measurement methods, spectroscopy is popular and enables physicochemical properties to be nondestructively estimated. The current study aims to nondestructively predict tissue firmness (kgf/cm), acidity (pH level) and starch content index (%) in apples (Malus M. pumila) samples (Fuji var.) at various ripening stages using visible/near infrared (Vis-NIR) spectral data in 400-1000 nm wavelength range. Results show that non-linear regression done by an artificial neural network-cultural algorithm (ANN-CA) was able to properly estimate the investigated fruit properties. Moreover, the performance of the proposed method was evaluated for Vis-NIR data based on optimal NIR wavelength values selected by a genetic optimization tool. Regression coefficients ( R ) in estimated acidity, tissue firmness, and starch content properties were R = 0.930 ± 0.014 , R = 0.851 ± 0.014 , and R = 0.974 ± 0.006 , respectively, using only the three most effective wavelengths from the acquired spectra.In this study, we present a low-profile dual-spectrum split-ring monopole that operates at industrial, scientific and medical (ISM) (2.45 GHz) band and ultrawideband (UWB) spectrum (3.1-10.6 GHz). We optimised the design for dual-band operations by using circular split-ring radiators. The coupling between both rings drives the structure to achieve quasi-resonance frequencies in the UWB spectrum. A small stub combines the two radiators and both behave as a single element that enables the antenna to resonate at ISM band 2.45 GHz. The antenna achieves the desired characteristics in terms of good impedance matching, radiation properties as well as other physical and practical requirements such as compact geometry, planar profile and easy fabrication. The very good agreement between the simulated and measured results show that the proposed antenna has the potential for dual-band application.
In selected breast cancer patients, radiation treatment (RT) lowers the recurrence risk, with minor or no improvement of survival. In these patients, the choice to undergo RT is considered a preference-sensitive decision. To facilitate shared decision-making (SDM) for this choice, a patient decision aid was made. We aimed to evaluate the effect of the PtDA on decisional conflict.

We performed a multi-center pre- and post-intervention study (BRASA-trial). The first 214 patients made a choice without support of the PtDA; the subsequent 189 patients received a link to the PtDA. The primary endpoint was decisional conflict; secondary endpoints were perceived SDM and knowledge on treatment options. Patients filled out questionnaires immediately after, and three months after their decision. Data were analyzed with multi-level regression analysis.

After correcting for the difference in age and educational level, the mean (±SD) decisional conflict for the intervention group (27.3±11.4) was similar to the control group (26.8±11.4; difference=0.86, 95%CI 1.67,3.36) three months after their decision. This also applied to perceived SDM. Patients exposed to the PtDA pursued additional treatment less often (45% vs 56%, odds ratio 0.59, 95%CI 0.37,0.95) and scored significantly higher on the knowledge test (7.4±2.5 vs 6.1±2.7, corrected difference=1.0, 95%CI 0.50,1.49). There was no significant increase in consultation time.

Handing out the PtDA was not associated with improved scores in decisional conflict or perceived SDM, but it was associated with a choice for less additional treatment and better knowledge about the treatment options.
Handing out the PtDA was not associated with improved scores in decisional conflict or perceived SDM, but it was associated with a choice for less additional treatment and better knowledge about the treatment options.
Prostate specific membrane antigen positron emission tomography imaging (PSMA-PET) has demonstrated potential for intra-prostatic lesion localization. We leveraged our existing database of co-registered PSMA-PET imaging with cross sectional digitized pathology to model dose coverage of histologically-defined prostate cancer when tailoring brachytherapy dose escalation based on PSMA-PET imaging.

Using a previously-developed automated approach, we created segmentation volumes delineating underlying dominant intraprostatic lesions for ten men with co-registered pathology-imaging datasets. To simulate realistic high-dose-rate brachytherapy (HDR-BT) treatments, we registered the PSMA-PET-defined segmentation volumes and underlying cancer to 3D trans-rectal ultrasound images of HDR-BT cases where 15 Gray (Gy) was delivered. We applied dose/volume optimization to focally target the dominant intraprostatic lesion identified on PSMA-PET. We then compared histopathology dose for all high-grade cancer within whole-gland treatment plans versus PSMA-PET-targeted plans. Histopathology dose was analyzed for all clinically significant cancer with a Gleason score of 7or greater.

The standard whole-gland plans achieved a median [interquartile range] D98 of 15.2 [13.8-16.4] Gy to the histologically-defined cancer, while the targeted plans achieved a significantly higher D98 of 16.5 [15.0-19.0] Gy (p=0.007).

This study is the first to use digital histology to confirm the effectiveness of PSMA-PET HDR-BT dose escalation using automatically generated contours. Based on the findings of this study, PSMA-PET lesiondose escalation can lead to increased dose to the ground truth histologically defined cancer.
This study is the first to use digital histology to confirm the effectiveness of PSMA-PET HDR-BT dose escalation using automatically generated contours. Based on the findings of this study, PSMA-PET lesion dose escalation can lead to increased dose to the ground truth histologically defined cancer.We aimed to determine the functional role of the miRNA, which affects drug sensitivity to 5-FU in oral squamous cell carcinoma (OSCC), using two types of 5-FU-resistant and parental OSCC cell lines. MiRNA microarray data showed that miR-30a was significantly upregulated in two resistant cell lines. Therefore, we investigated the effects and molecular mechanism of miR-30a on 5-FU sensitivity. Stable overexpression of miR-30a in parental OSCC cells decreased cell proliferation and attenuated drug sensitivity to 5-FU. Cell cycle analysis indicated that miR-30a overexpression increased the proportion of G1 phase cells and decreased the proportion of S phase cells. MiR-30a knockdown using siRNA reversed the effects of miR-30a overexpression. DNA microarray analysis using miR-30a-overexpressing cell lines and a TargetScan database search showed that cyclin E2 (CCNE2) is a target of miR-30a. A luciferase reporter assay confirmed that a miR-30a mimic interacted with the specific binding site in the 3' UTR of CCNE2. CCNE2 knockdown with siRNA in OSCC cells yielded decreased drug sensitivity to 5-FU, similar to miR-30a overexpressing cells. These findings suggest that miR-30a in OSCC may be a novel biomarker of 5-FU-resistant tumors, as well as a therapeutic target for combating resistance.
Australians who are Not in Employment, Education or Training (NEET) and receive income support span a wide spectrum of working ages. Australian research has concentrated on NEETs aged 15-29 years, in line with international standards. This paper investigates extending the NEET concept to include all working age persons 15-64 years and the value added to welfare policy through analysis of a new linked dataset.

An observational study design was implemented with individuals aged 15-64 years recorded as receiving Department of Social Services (DSS) income support payments from September 2011 being linked with Australian Bureau of Statistics (ABS) Census data from August 2011 to create a linked dataset for analysis. Descriptive analyses were undertaken of NEET status by Census socio-demographic characteristics, and we modelled the adjusted likelihood of NEET status by Census demographics.

Some 1.37 million or 45.2% of linked DSS payment recipients qualified as NEET. Of NEETs, more than twice as many were femsights, these results have implications for welfare policy, and indicate a wider range of demographics should be considered under the NEET classification. This may also have implications for Organisation for Economic Co-operation and Development (OECD) reporting.
Goal attainment scaling (GAS) has been widely applied to chronic conditions; however, only recently has it been used for patients with low back pain (LBP). The objectives of this systematic review were to (a) examine the characteristics and rigor of published studies of GAS in the rehabilitation of patients with LBP, (b) describe how GAS has been applied in patients with LBP, and (c) evaluate the responsiveness and validity of GAS as an outcome measure in patients with LBP.

A systematic search of the CINAHL, PubMed, and MEDLINE databases was performed (1968 and 1 September 2020) in addition to hand searching. Studies including GAS procedures in patients with LBP during rehabilitation were included in the review. Two authors independently selected studies for inclusion and determined levels of evidence using the Oxford Levels of Evidence and rated each study for quality using the Newcastle-Ottawa scale and reporting transparency using the STROBE statement checklist.

Six Level IV and one Level III/IV stud been inadequately developed and validated for use during rehabilitation in patients with LBP.
Silicosis is a neglected and widely prevalent occupational disease in India and several other countries such as China, South Africa, Brazil, etc. It is an irreversible, incurable, and progressive disease with high morbidity and mortality, which is mostly caused by occupational exposure to silica dusts. Silicosis is usually detected at an advanced stage, when effective intervention is not possible. But early detection appears to be a cost-effective way to control it. There is a need for some suitable biomarker, which could detect silicosis at an early stage for further necessary intervention. This study aimed to estimate the lung damage in silicotic subjects and its relationship with serum CC16 as a proxy marker. The ultimate objective was to explore whether CC16 could be used as a screening tool for early detection of silicosis.

Radiographs of 117 workers having radiological evidences of silicosis were evaluated in accordance with International Labour Organisation (ILO) Classification of chest radiographsdary prevention. It may be viewed as a new approach toward control of silicosis, and an appropriate policy may be adopted.
A number of epidemiological studies were performed to know the prevalence of and the risk factors for hypertension. However, these studies reported inconsistent results. As a result, this systematic review and meta-analysis were planned to generate representative data on the prevalence of and risk factors for hypertension among the Ethiopian adult population.

Five electronic databases, namely, PubMed, Science Direct, Google Scholar, Hinari, and African Journals Online, were searched for studies published in English from 1 January 2010 to 31 August 2020. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument and Newcastle-Ottawa scale were used for data extraction and quality assessment for this review. Stata version 14 statistical software was used for the analysis, and due to high heterogeneity a random effects model was used for meta-analysis at 95% confidence interval (CI).

In this review, 35 observational studies were included. The pooled prevalence of hypertension in E
The pooled prevalence of hypertension is relatively higher as compared to the previous reports in Ethiopia. Older age, urban residence, lower educational coverage, family history of hypertension, DM, BMI ≥25, alcohol consumption, and central obesity were the risk factors for hypertension. The governments and stakeholders should design an appropriate strategy to prevent and control the disease in the Ethiopian population.Green hydrogen, i.e., produced from renewable resources, is attracting attention as an alternative fuel for the future of heavy road transport and long-distance driving. However, the benefits linked to zero pollution at the usage stage can be overturned when considering the upstream processes linked to the raw materials and energy requirements. To better understand the global environmental implications of fuelling heavy transport with hydrogen, we quantified the environmental impacts over the full life cycle of hydrogen use in the context of the Planetary Boundaries (PBs). The scenarios assessed cover hydrogen from biomass gasification (with and without carbon capture and storage [CCS]) and electrolysis powered by wind, solar, bioenergy with CCS, nuclear, and grid electricity. Our results show that the current diesel-based-heavy transport sector is unsustainable due to the transgression of the climate change-related PBs (exceeding standalone by two times the global climate-change budget). Hydrogen-fuelled heavy transport would reduce the global pressure on the climate change-related PBs helping the transport sector to stay within the safe operating space (i.e., below one-third of the global ecological budget in all the scenarios analysed). However, the best scenarios in terms of climate change, which are biomass-based, would shift burdens to the biosphere integrity and nitrogen flow PBs. In contrast, burden shifting in the electrolytic scenarios would be negligible, with hydrogen from wind electricity emerging as an appealing technology despite attaining higher carbon emissions than the biomass routes.MicroRNAs are involved in the pathogenesis of various human malignant tumors. This study aims to explore the role of miR-513b-5p in the malignant proliferation of retinoblastoma (RB) cells and its potential molecular mechanisms. The function-gain and function-loss experiments were performed in Weri-RB1 cells using miR-513b-5 mimics and inhibitors. miR-513b-5p mimics inhibited the proliferation and clone formation and promoted apoptosis of Weri-RB1 cells. In contrast, the miR-513b-5p inhibitor promoted the proliferation and clone formation of Weri-RB1 cells and inhibited cell apoptosis. miR-513b-5p can directly bind to the 3'UTR region of TRIB1 mRNA, and inhibit its protein expression. Overexpression of TRIB1 promoted the proliferation and cloning of Weri-RB1 cells but inhibited their apoptosis. The knockdown of TRIB1 inhibited the proliferation and clone formation of Weri-RB1 cells and promoted cell apoptosis. In addition, miR-513b-5p mimics neutralized the effects of TRIB1 overexpression on the proliferation and apoptosis of Weri-RB1 cells. Finally, miR-513b-5p can inhibit the phosphorylation level of AKT, mTOR, and p70, while TRIB1 played the opposite role. miR-513b-5p inhibits the malignant proliferation of Weri-RB1 cells by repressing the expression of TRIB1. miR-513b-5p and TRIB1 may be the biomarkers and/or key targets for clinical diagnosis and treatment of RB.Peritoneal loose body (PLB) is a rare clinical entity. It is generally agreed that the most common origin of the loose bodies is appendix epiploica. We here report a case of PLB that looks like a "boiled egg," which was misdiagnosed preoperatively as a lesion of hepatic origin and was confirmed by operation and postoperative pathology. PLBs are rare entities, a good understanding of their specific imaging features can help prevent misdiagnosis, but sometimes an accurate preoperative diagnosis is still difficult to achieve. Exploratory laparoscopy is a recommended method for management of PLBs.
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