Additional Problems Research Articles

Exploring Counting Processes in Early Childhood: A Study on Counting All and Counting on Strategies

This study aimed to describe the counting processes of counting all and counting in early childhood specifically ages 5-6. To achieve this goal, a qualitative method was employed, and the instrument used consisted of three-word problems read by the examiner. These problems were related to counting all, counting all and counting on, and counting on strategies. The study subjects were six 5-6-year-old students from a kindergarten in Malang. The data collection process began with several students being asked to provide answers and reasons regarding the given instrument. Students who provided appropriate reasons were selected as study subjects. The various results obtained included, students using different strategies, such as counting all, counting on, and a combination of counting all and counting on to solve problems. In counting all, subjects counted the quantity of the first number and proceeded with the second. However, this strategy posed difficulties for students when answering addition problems above 10, leading to the use of toes as an additional counting tool. In counting, students remembered the quantity of the first number and continued counting while extending their fingers according to the quantity of the second number. Furthermore, subjects used both strategies in close succession by transitioning from counting all to counting on when solving addition problems of numbers above 5

The application of Erlang model for process simulation of boundary monitoring of ships proceeding through the Kerch-Yenikalsky Strait

This article investigates the peculiarities of the Kerch-Yenikalsky Channel (KEC) passage. The Kerch Strait is one of the most intensively used sea routes in the Russian Federation, which results in a constant flow of ships and requires organized traffic.
 The Kerch Strait throughput capacity was calculated from statistical data on the number of vessels that pass through it on a daily basis. The number of vessels passing through the Kerch Strait increases noticeably every year.
 The increase in the number of vessels passing through the Strait creates additional problems related to safety of navigation and environmental sustainability of the region. For example, an increase in the number of ships can lead to an increased probability of collisions and accidents, as well as to the deterioration of the environmental situation in the area of the strait.
 In this paper, an algorithm is developed and the factors affecting the KEC passage process are analyzed. The Erlang model is used as a model. This model allows to carry out simulation modeling of the process of customs control providing quantitative data. To build the model, statistical processing of data on the passage of customs control was performed. As a result of simulation modeling the following results were obtained:
 1.The maximum throughput capacity of a given control section was determined;
 2.Calculated the optimal composition of the customs control vessels.

A Data-Centric Approach to Loss Mechanisms

Abstract Breaking down the total loss in a turbomachine into a number of low-order, physical models is a powerful way of developing loss models for informing design decisions. Better loss models lead to better design decisions. A problem, however, is that in complex flows, it is often not clear how to break a flow down physically without making assumptions. An additional problem is that the designer often does not know what assumptions should be made to derive the most accurate and general physical models. In practice, this problem often leads to loss models of low accuracy, which only work in a limited part of the overall design space. This paper shows that machine learning can be used to augment a designer in the process of developing loss models for complex flows. It is shown that it is able to help a designer discover new, more accurate and general, physical models, highlighting to a designer what assumptions should be made to retain the physics important to the problem. The paper illustrates the new method using the problem of compressor and turbine profile loss. This problem was chosen because it is well understood and therefore is a good way of validating the new method. However, surprisingly the new method is shown to be able to develop a new profile loss model which is more accurate and general than previous models. This is shown to have been achieved by the machine learning finding a new, more general, underlying model for trailing edge mixing loss.

ICESat-2 noise filtering using a point cloud neural network

The ATLAS sensor onboard the ICESat-2 satellite is a photon-counting lidar (PCL) with a primary mission to map Earth's ice sheets. A secondary goal of the mission is to provide vegetation and terrain elevations, which are essential for calculating the planet's biomass carbon reserves. A drawback of ATLAS is that the sensor does not provide reliable terrain height estimates in dense, high-closure forests because only a few photons reach the ground through the canopy and return to the detector. This low penetration translates into lower accuracy for the resultant terrain model. Tropical forest measurements with ATLAS have an additional problem estimating top of canopy because of frequent atmospheric phenomena such as fog and low clouds that can be misinterpreted as top of the canopy. To alleviate these issues, we propose using a ConvPoint neural network for 3D point clouds and high-density airborne lidar as training data to classify vegetation and terrain returns from ATLAS. The semantic segmentation network provides excellent results and could be used in parallel with the current ATL08 noise filtering algorithms, especially in areas with dense vegetation. We use high-density airborne lidar data acquired along ICESat-2 transects in Central American forests as a ground reference for training the neural network to distinguish between noise photons and photons lying between the terrain and the top of the canopy. Each photon event receives a label (noise or signal) in the test phase, providing automated noise-filtering of the ATL03 data. The terrain and top of canopy elevations are subsequently aggregated in 100 m segments using a series of iterative smoothing filters. We demonstrate improved estimates for both terrain and top of canopy elevations compared to the ATL08 100 m segment estimates. The neural network (NN) noise filtering reliably eliminated outlier top of canopy estimates caused by low clouds, and aggregated root mean square error (RMSE) decreased from 7.7 m for ATL08 to 3.7 m for NN prediction (18 test profiles aggregated). For terrain elevations, RMSE decreased from 5.2 m for ATL08 to 3.3 m for the NN prediction, compared to airborne lidar reference profiles.

Anti-natalism is incompatible with Theory X.

The anti-natalist philosopher David Benatar defends a position asserting that all life is harmful, and that it is, therefore, wrong to have children. In this paper, I critique Benatar's less-discussed claim that his anti-natalism provides solutions to population ethics problems, such as the Non-Identity Problem, the Repugnant Conclusion, and the Mere Addition Problem, all of which are presented in Derek Parfit's Reasons and Persons. Since the publication of his Better Never to Have Been, Benatar has continued to claim that its provision of such solutions strengthens his defense of anti-natalism. Although Benatar's view has received much criticism, this argument has not been discussed at length. I undertake a thorough examination of the argument and identify reasons to reject it. The central point of my critique is that the implications of Benatar's views in determining ranges of wrong and not-wrong cases of procreation are extensionally inadequate when applied to the problems of population ethics.

Efficacy of Pregabalin, Solifenacin, or Combination Therapy for Ureteral Stent Related Symptoms: A Systematic Review and Meta-Analysis

Objective: The Double-J (DJ) ureteral stent is essential in urology but can lead to Ureteral Stent-Related Symptoms (USRS), prompting research into various therapies to enhance patient comfort. The purpose of this study is to assess the efficacy of pregabalin, solifenacin, or combined therapy on ureteral stent-related symptoms. Materials and Methods: We conducted thorough searches in four databases, which included PubMed, Cochrane, EBSCO, and ProQuest. PRISMA Guideline 2020 was applied in this study. The risk of bias was assessed using Newcastle-Ottawa Scale and Cochrane Risk of Bias 2.0. Results: Ten studies consisting of 1477 participants were included in this study. Solifenacin monotherapy could significantly decrease total USSQ (mean difference (MD) -16.62; p=0.001), urinary symptoms (MD -9.16; p=0.002), and sexual matters (MD -0.81; p=0.002). Pregabalin monotherapy could significantly decrease pain (MD -7.29; p<0.00001). Compared to solifenacin monotherapy, combination therapy of pregabalin and solifenacin could significantly decrease total USSQ (MD -12.40; p <0.0001), urinary symptoms (MD -1.88; p=0.007), pain (MD -6.82; p<0.00001), sexual matters (MD -0.77; p <0.00001), and additional problems (MD -1.51; p=0.0007). Conclusion: Combination therapy of pregabalin and solifenacin had the best advantages in lowering USRS, especially urinary symptoms, pain, sexual matters, and some other additional problems.

Chronic Disease Outcomes As Predictors of Quality of Life in Patients with Hemophilia Α: Data from the Real-World AHEAD International Study

Background: Hemophilia A (HA), a genetic disorder caused by deficient or defective factor VIII (FVIII) clotting protein, has a significant impact on patients' quality of life (QoL).The international Antihemophilic factor Hemophilia A outcome Database (AHEAD) study (NCT02078427) is an ongoing prospective, non-interventional, multicenter study evaluating the long-term safety and effectiveness of FVIII replacement in patients with HA receiving either octocog alfa or rurioctocog alfa pegol (ADVATE®; ADYNOVATE® [US] / ADYNOVI™ [Europe]; Baxalta US Inc., a Takeda company Lexington, MA, USA) in routine clinical practice. Aim: This analysis aimed to evaluate the association between chronic disease outcomes and QoL in patients with moderate or severe HA without an active inhibitor and treated with octocog alfa. Methods:Male patients aged ≥18 years with moderate (FVIII 1-≤5%) or severe (FVIII <1%) HA without an active inhibitor and receiving octocog alfa were included in the analysis. Data were included across study years 1 to 5 for patients with all model variables reported in at least one study year. Cut off was set at year 5 as smaller sample sizes in later years did not allow for appropriate statistical modelling due to natural attrition and loss to follow up. The association between chronic disease outcomes and QoL was estimated using a Mixed Effects Model with repeated measures. The model assessed the impact of chronic pain (classified as no pain [used as the reference], mild pain, moderate pain, or severe pain) and number of problem joints (PJs; identified through the reporting of relevant components of the hemophilia joint health score, Gilbert Score and/or Petterson score) on EQ5D 3L index score (calculated using UK value set), controlling for clinical and demographic characteristics (annualized bleeding rate [ABR], HA severity, body mass index [BMI], and age at visit), in addition to individual patient effect, via the random effects component. The random effects component allows the model to control and account for individual patient effects that may not be measured by available independent variables but that may influence the output of the analysis. Results:The final analysis included 175 adult male patients with an average (range) of 2.1 (1-5) study years. The majority (70%) of patients had severe HA. At study year 1, the mean ± SD age was 33.6 ± 12.7 years and the mean ± SD number of PJs was 3.8 ± 2.0, while 47% of patients reported some level of chronic pain, with 20% of patients reporting moderate or severe pain levels. Mean ± SD EQ5D 3L index score was 0.77 ± 0.21 at study year 1. Overall, after controlling for demographic and clinical characteristics, and any individual patient effect, chronic outcomes (chronic pain and number of PJs) were found to have a statistically significant negative association with QoL (Table). The negative association of chronic pain with EQ5D 3L index score was greater with increasing pain level (mild, -0.082; moderate, -0.135; severe -0.169; P≤0.001). Number of PJs was also negatively associated with EQ5D 3L index score (P=0.005) with a decrease of -0.018 for each additional problem joint. Age at visit also showed a negative association with EQ5D 3L index score (-0.004; P=0.002). ABR, HA severity, and BMI did not have a statistically significant association with EQ5D 3L index score. Conclusions: In this Mixed Effects Model, chronic pain level and number of PJs both had a statistically significant negative association with QoL, highlighting the importance of managing these chronic outcomes with effective treatment.

Contextual factors in persistent severe back pain: A longitudinal analysis among German employees.

Chronic back pain in employees compromises participation in social and daily activities, as well as work. To examine the severity of back pain after 2 years and identify factors predicting stagnation at this level of pain. Data were derived from a prospective cohort study with randomized sampling of insurants in the German Pension Insurance using a questionnaire at baseline and follow-up after 2 years. The sample consisted of middle-aged employees (45-59 years) with strong limitations due to back pain (Chronic Pain Grade III or IV), who had not applied for disability pension and did not use medical rehabilitation in the previous 4 years before baseline. Stepwise multivariable logistic regression models with backwards selection were used to identify relevant contextual factors in the stagnation of severe back pain. Of 1208 persons with severe back pain at baseline, 48% had stagnated at that pain level after 2 years. Predictors of persistent severe back pain were older age, poorer general health, more additional disabling conditions, more depressive symptoms, caregiving burden, less pain-related self-efficacy and more fear avoidance beliefs. In a high-risk subgroup with several co-existing conditions, this analysis highlights (mental) health, social and personal (contextual) factors associated with long-term unfavourable back pain progression. Back pain is a condition that often has a chronic or recurrent course, threatening participation in many areas of life. In this study it was found that the unfavourable condition of severe back pain can remain stable for long periods of time in a significant proportion of sufferers. Contextual factors (self-efficacy, fear-avoidance beliefs, caregiving burden) as well as additional health problems should be considered when identifying persons with stagnating pain courses.

Typification of Projects for Development of High-Speed Rail

The emerging demand for improving consumer parameters of rail passenger transport leads to the need to build a dedicated railway infrastructure for passenger trains with speeds exceeding in some sections 250 km/h. The high capital intensity of dedicated infrastructure development projects imposes significant restrictions on their scope and financial feasibility. The geographically determined location of urban agglomerations in European and Asian countries has led to formation of many approaches to the routing of lines for high-speed passenger transportation.The projects for development of dedicated high-speed railways being developed in various countries differ in their technical, technological, and operational characteristics. The use of different approaches has led to different efficiency of the passenger traffic, expressed in the demand of passengers for transportation.A structural analysis of existing high-speed transportation projects allowed revealing general patterns of their development. By the number of operational tasks arising with regard to movement of trains, the phases of traffic development were divided into linear, tree­like and network stages. Thus, when moving from the linear structure of a high-speed rail, an additional problem arises of trains passing from the main track to the secondary one. The transition to the network stage can result in emergence of parallel passages rail tracks between urban agglomerations.To generalise the experience of operating high-speed systems in the world, the article describes the developed method that allows comparing different projects for organising high-speed rail with each other. The comparison is made according to the main characteristics of traffic: travel time between separation points, the traffic speed, the total length of the railway line. Identification of the patterns inherent in various projects for development of high-speed rail will make it possible to compare their technological parameters, to identify the scope of rational use of high-speed lines and areas of competition with other core types of transport.

An investigation comparing various numerical approaches for simulating the behaviour of condensing flows in steam nozzles and turbine cascades

The process of condensation takes place within the low-pressure stages of the steam turbine when undergoing rapid expansion. The dry supercooled steam turns into very tiny liquid droplets, and the resulting wet steam mixture causes additional losses and maintenance problems. Accurate simulation of steam condensing flows helps to obtain accurate information about the thermodynamics of such flows and use this information in the design of highly efficient steam turbine stages. In this study, by using the available numerical models in commercial CFD codes, seven cases are considered for simulating steam condensing flows. The important difference between these cases is the use of different condensation models and different equations of state to calculate the thermodynamic properties of wet steam. The objective of this research is to identify an appropriate model that can be used to simulate the flow of steam condensation effectively. In recent studies, it is still necessary for further improvement of the modelling methods because the numerical results did not fully match the experimental findings, underscoring the persisting uncertainties within this domain. The current study explores various condensation models and equations of state for calculating the thermodynamic properties of wet steam. This diversity of approaches is novel and allows for the comparison of different models to determine the most suitable one for effective flow simulation. The geometries of the IWSEP nozzle (International Wet Steam Experimental Project) and linear cascade of the last-stage rotor blades were considered. To identify the most appropriate model for the simulation of steam condensing flows, the numerical results are validated against in-house experiments. The results indicate that combining the Young droplet growth model with the Vukalovich and Young equations in cases 1 and 2 is not a suitable method for modelling steam condensing flows. However, cases 3 & 4, which are the combination of Gyarmathy and Fuchs-Sutugin droplet growth models with NIST real gas models, are the most appropriate ones. The findings of this research confirm the high sensitivity of the modelling of such flows, and emphasize that the necessary care should be taken in choosing the appropriate numerical model.

NCOG-32. THE SPECIFIC PSYCHOSOCIAL BURDEN OF CAREGIVERS OF ADULT NEURO-ONCOLOGICAL PATIENTS - A PROSPECTIVE STUDY

Abstract OBJECTIVE The diagnosis of a brain tumor represents high burden for the patients’ caregivers (CG). Psychosocial screening tools adapted to the burden profile of CG are urgently required but do not exist. The aim was to develop a problem list for neuro-oncological CGs’ unmet needs for an application in combination to the Distress Thermometer scale. METHODS CG were prospectively assessed regarding changes in everyday life, relationship, social life, emotional, physical problems, and support needs, either via questionnaire (Center A) or by a qualitative interview (center B). A qualitative content analysis was performed by an inductive/deductive approach using MAXQDA® software. RESULTS A total of 50 caregivers were assessed (25 in center A via questionnaire, 25 in center B via interviews) during outpatient visits. Most frequently reported need was the need for psychological support (29/50, 58%). This was true after initial diagnosis (26/50, 52%) as well as in case of clinical deterioration of their loved-one (30/50, 60%). The results leaded to problem categories, congruent to the NCCN distress thermometer categories for cancer patients (practical, social, emotional, physical, and spiritual/existential problems). We detected new topics including “constraints/organization of (medical) appointments” (25/50, 50%) or “constant availability required for partner” (21/50, 42%). Also, 70% (35/50) put their own interests last or adapted their leisure activities. In the qualitative interviews (Center B), further items were identified, e.g., “dealing with psychological problems of the patient” (3/25, 12%), “different coping strategies among patient/caregiver” (4/25, 16%). We defined additional problem categories specifically adapted to CG of neurooncological patients, e.g., “problems due to neurocognitive/neuropsychological symptoms of the loved-one” and “problems with role as a caregiver”. CONCLUSION The interviews reflected the unmet needs of brain tumor caregivers. Our problem list developed for CG of neurooncological patients might allow for the targeted assessment and optimization of care.

Multidimensional Sleep Health Problems Across Middle and Older Adulthood Predict Early Mortality.

Having multiple sleep problems is common in adulthood. Yet, most studies have assessed single sleep variables at one timepoint, potentially misinterpreting health consequences of co-occurring sleep problems that may change over time. We investigated the relationship between multidimensional sleep health across adulthood and mortality. Participants from the Midlife in the United States Study reported sleep characteristics in 2004-2006 (MIDUS-2; M2) and in 2013-2014 (MIDUS-3; M3). We calculated a composite score of sleep health problems across 5 dimensions: Regularity, Satisfaction, Alertness, Efficiency, and Duration (higher = more problems). Two separate models for baseline sleep health (n = 5 140; median follow-up time = 15.3 years) and change in sleep health (n = 2 991; median follow-up time = 6.4 years) to mortality were conducted. Cox regression models controlled for sociodemographics and key health risk factors (body mass index, smoking, depressive symptoms, diabetes, and hypertension). On average, 88% of the sample reported having one or more sleep health problems at M2. Each additional sleep health problem at M2 was associated with 12% greater risk of all-cause mortality (hazard ratio [HR] = 1.12, 95% confidence interval [CI] = 1.04-1.21), but not heart disease-related mortality (HR = 1.14, 95% CI = 0.99-1.31). An increase in sleep health problems from M2 to M3 was associated with 27% greater risk of all-cause mortality (HR = 1.27, 95% CI = 1.005-1.59), and 153% greater risk of heart disease mortality (HR = 2.53, 95% CI = 1.37-4.68). More sleep health problems may increase the risk of early mortality. Sleep health in middle and older adulthood is a vital sign that can be assessed at medical checkups to identify those at greater risk.

A supernumerary tooth: A case report of a mesiodens

Introduction: Mesiodens is an erupted supernumerary tooth located between the maxillary central incisors. Case Report: This report presents a case of a fully erupted mesiodens in a 10-year-old girl causing incisor displacement. The patient presented for a dental checkup with dental caries and a mesiodens visible on clinical exam. Radiographs confirmed eruption of the mesiodens. Extraction was planned to prevent further crowding. Erupted mesiodens can still cause complications like malocclusion and cysts. Extraction is the treatment of choice. Conclusion: Early diagnosis allowed for removal before additional orthodontic problems. Monitoring and restorative care are needed after extraction. This highlights the importance of prompt mesiodens diagnosis and extraction even when fully erupted.

Viability of Living Moss for Indoor Green Walls: A Study on Temperature, Humidity, and Irrigation

There is an increasing demand for green plant walls in indoor environments because of their multifaced benefits, such as aesthetic appeal, indoor air quality improvement, or psychological well-being. Mosses are believed to be excellent for these walls due to their easy application and maintenance. However, so far there is no evidence for their indoor survival. In this study, we tested the moss species Hypnum cupressiforme, Bryachythecium rutabulum, Eurrhynchium angustirete, Thuidium tamariscinum, Streblotrichum convolutum, Syntrichia ruralis, and Ceratodon purpureus for indoor use in living moss walls. We evaluated their vitality through the monitoring of leaf coloration over a twelve month period, subjecting them to varying temperature ranges (14–20 °C), humidity levels (60–100%), and diverse irrigation methods (drip and spray irrigation, 300–1500 mL per day) within controlled climate chambers. Depending on the combination of these variables, mosses survived up to six months. Hypnum cupressiforme and Ceratodon purpureus performed best. However, as the time span of survival was limited, the use of living mosses for indoor purposes at the current stage cannot be recommended. An additional problem is that the requisition of living material such as in the culturing of moss under horticultural conditions is difficult and harvesting from natural environments is detrimental to most habitats.

Clinical Outcomes of Adolescents With Anterior Shoulder Instability and Glenolabral Articular Disruption Lesions Compared With Isolated Bankart Lesions.

Glenolabral articular disruption (GLAD) lesions may occur in adolescents with anterior shoulder instability, resulting in articular cartilage loss and reduced functional glenoid surface area. To compare failure rates and patient-reported outcomes (PROs) between adolescents with versus without GLAD lesions who were treated for anterior shoulder instability with arthroscopic stabilization. It was hypothesized that the comparison would yield no significant differences. Cohort study; Level of evidence, 3. Patients aged ≤18 years who were treated for anterior shoulder instability with arthroscopic stabilization between 2010 and 2021 were retrospectively identified. Those patients with a GLAD lesion identified at the time of surgery were compared with patients with >2 years of retrospective follow-up who were matched to the no-GLAD cohort according to pathology and management. Demographic and patient characteristics including recurrent instability, complications, and reoperations were recorded. All patients in the GLAD cohort were contacted to obtain PRO data, including the Single Assessment Numeric Evaluation; the shortened version of the Disabilities of the Arm, Shoulder, and Hand questionnaire; and the Pediatric Adolescent Shoulder Survey. Patients were also asked about recurrent instability and additional shoulder problems. Of 35 included patients (mean age, 15.4 ± 1.6 years; 80% male), 15 patients (43%) with GLAD lesions and 26 patients without GLAD lesions were identified. Both cohorts had similar patient characteristics, number of anchors, and anchor constructs; the mean follow-up period was significantly different (GLAD vs no-GLAD, 6.9 ± 3.3 vs 3.4 ± 1.2 years, respectively; P < .001). Seven of 15 GLAD patients (46.7%) underwent loose body removal; 4 of 15 GLAD patients (26.6%) and 9 of 26 no-GLAD patients (34.6%) had recurrent subjective instability (P = .7). No significant group differences were found in PRO scores, reoperation rates (15% no-GLAD vs 20% GLAD), or percentage of patients with recurrent instability between cohorts (P > .05). Adolescent patients with and without GLAD lesions treated arthroscopically for anterior shoulder instability had similar PROs and failure rates at intermediate duration of follow-up. GLAD lesions may be managed in a similar surgical manner as isolated Bankart tears in teenagers, with expectations of similar outcomes.

Behavioral Problems in Children with Hearing Loss: A Comparative Analysis with Children with Typical Development and Autism Spectrum Disorder

Research findings on the prevalence and characteristics of behavioral problems of children with hearing loss (HL) are not consistent. The aim of this study was to compare the behavioral problems of children with HL, with typical development (TD) and with autism spectrum disorder (ASD); and to determine the factors affecting behavioral problems in the HL group. Data were collected by using two scales based on the reports of 273 teachers of children with TD, HL and ASD: Child Behavior Checklist-Teacher Report Form (CBCL-TRF) and Social Skills Rating System-Problem Behaviors (SSRS-PB). ANOVA results showed that there was no difference between children with HL and TD, children with ASD had more behavioral problems than the two groups. In the HL group, children using hearing aids exhibited more behavioral problems than children with cochlear implants. Children who had additional problems displayed more behavioral problems than those who had not. Age at onset of hearing aid use and age at implantation were found to be significant predictors of behavioral problems. The findings point to the role of early intervention in preventing behavioral problems in children with HL.

Professional stress and educational training in nursing homes during Covid 19 pandemic in Zagreb

Abstract Background Nursing in nursing homes is considered to be one of the most stressful professions. Additional problems during the Covid 19 pandemic were working in long shifts with highly infectious patients, high mortality, insufficient education and shortage of stuff, work under epidemiological measures. Such situation can be extra stressful and affect nurses health. Objectives During 2020-2022 we did quantitative and qualitative study on sources of work stress and professional burnout. Also we did educational training for nurses. The aim of the research and interventions is acquiring skills to cope with stress, communication skills with different personalities through specific workshops and intervision/ supervision work with nurses implementing by experts: a public health specialist, an epidemiologist, a psychiatrist, a social worker and a nurse. The long-term goals are the protection of nurses health and improvement of care for users. Results Quantitative research was conducted on 135 nurses by validated questionnaires in 12 nursing homes in Zagreb. It was found examined sources of stress are directly related to burnout and also a high degree of emotional exhaustion (62,3%). Basic groups of stress sources were lack of superiors suport, communications problems, excessive work load, unrealistic expectations. High degree of professional burnout was 6%. Also basic topics of a qualitative research were defined. Workshops on coping with stress and communication skills, intervision methodology and supervision interventions were held for representatives of nurses from all nursing homes. Interested nurses attended an 8-week mindfulness course. Conclusions Through research and implementation of the intervention it has been shown that there is a great need for interventions in protecting health of staff in nursing homes in crisis situations. Key messages • Employees who provide health and social care need continuous support in the protection of their mental health, as well as additional support interventions in crisis situations. • Preserving the health of health and social workers improves the quality of care within the health and social system.

Stakeholder engagement to assess the transferability of vaccination interventions in Greece

Abstract Background Due to political instability, poverty and war Greece has been witness, over the last decade, to continuous migrant and refugee flows which enter the country mainly on their way to Northern Europe. Through the RIVER-EU project in Greece we aim to identify and tailor successful interventions that can address health system barriers to MMR/HPV vaccination for this group. Methods RIVER-EU adopts participatory action research (PAR) in order to give voice to all involved groups. The main aim of the focus groups (FGs) and the interviews was to explore transferability. We aimed to discuss how promising interventions could be transferred to the Greek reality and discussed barriers and facilitators. Results FGs were conducted with migrant/refugee parents (mainly mothers), adolescents (boys and girls) and other stakeholders such as health professionals and policy makers. The main challenge in Greece is the diversity of the target group (migrants/refugees), as people who arrive to Greece come from different countries have different cultural and religious backgrounds and have fled their countries for different reasons (war, poverty, financial problems). Possible solutions were discussed such as schools as an intervention site. An additional problem identified was access to vaccination services (for HPV/MMR) and the need to create synergies with local health organizations. Finally, it was evident that adolescents as a group, although from different cultural backgrounds, share common values and norms. Conclusions The RIVER-EU project has implemented an innovative approach to explore barriers and facilitators of transferability and tailor the intervention to the specific circumstances of the situation in Greece. Through the PAR the target groups were able to voice their beliefs about what should be implemented in which way and able to discuss possible solutions. Agreement about the importance of HPV/MMR vaccination for migrants/refugees in Greece was established.

Almost controllable graphs and beyond

An eigenvalue λ of a graph G of order n is a main eigenvalue if its eigenspace is not orthogonal to the all-ones vector jn. In 1978, Cvetković proved that G has exactly one main eigenvalue if and only if G is regular, and posed the following long-standing problem: characterize the graphs with exactly k(2≤k≤n) main eigenvalues. Graphs of order n with n, n−1 main eigenvalues are called controllable, almost controllable, respectively. Cographs, threshold graphs are frequently studied in structural graph theory and computer science. In this paper, all almost controllable cographs, all almost controllable threshold graphs and all almost controllable graphs with second largest eigenvalue less than or equal to 5−12 are characterized. Furthermore, we give some results about cographs with exactly n−2 main eigenvalues, and propose some additional problems for further study.

Evaluation of balance in patients with systemic sclerosis

BackgroundThe aim was to examine static/dynamic balance and proprioception of Systemic Sclerosis by comparing healthy and relationship with demographic and disease-related data. Methods21 Systemic Sclerosis and 19 healthy were included.Berg Balance Scale (functional balance), Sensamove Sensbalance Maxiboard Software (static, dynamic balance:reaction time and travel time and proprioception), Scleroderma Health Assessment Questionnaire/Health Assessment Questionnaire (health status), Medsger's Disease Severity Scale, Modified Rodnan Skin Score were used in evaluation. FindingsComparing the groups, there was significant difference in Berg Balance Scale (p:0.036); Health Assessment Questionnaire/Scleroderma Health Assessment Questionnaire (p:0.001); Static balance-center (p:0.001), front (p:0.001), back (p:0.001), left (p:0.001), right (p:0.021); proprioception-front (p:0.025);Reaction Time-front (p:0.031) and left (p:0.010);Travel Time-front (p:0.041) and left (p:0.014) in favor of healthy group.In Systemic Sclerosis, disease severity had moderate correlation with static balance-back (r:-0.504,p:0.020).Skin thickness had low correlation with Reaction Time-front (r:-0.449,p:0.041).Age had low correlation with Travel time-front (r:0.458,p:0.037) and proprioception-left (r:0.450,p:0.041); moderate with Travel time-back (r:0.515;p:0.017) and proprioception-front (r:0.539,p:0.012). InterpretationCompared to healthy, Systemic Sclerosis had worse health status, functional balance, static/dynamic balance and proprioception.This situation is related to disease severity, skin thickness and age. Evaluations made with objective methods may have the potential to determine the extent of the problem.Clinicians can guide the treatment of patients with SSc by evaluating their static/dynamic balance and proprioception.With early treatment, additional problems that may occur due to worsening of balance and proprioception can be prevented.Proprioception and dynamic balance evaluation can be performed for older patients, static balance when disease activity is high, and dynamic balance when skin thickness score is high.