Additional Strain Research Articles

The impact of the 2012 student fees increase on the mental health of British graduates: a cohort study

Purpose Financial difficulties are associated with poor student mental health, although the 2012 tuition fees increase for British students had little impact on student mental health in the first two years at university. This study aims to examine the mental health of British graduates before and after this fees increase to determine the impact on mental health several years after graduation. Design/methodology/approach This study conducted an online cohort study with 327 British students who started university before and after the 2012 fees increase. Participants completed measures of current economic hardship and symptoms of depression, anxiety, stress, general mental health and suicidality. Multiple regression was used to examine the impact of cohort (pre- and post-2012 fees increase), tuition fees amount and economic hardship on mental health. Findings Greater economic hardship was positively correlated with all mental health variables. Starting university after the fees increased and/or paying greater fees was associated with increased depression, anxiety, stress and suicidality, with little impact on general mental health. When economic hardship was covaried, the strength of cohort effects reduced but remained significant. Originality/value To the best of the authors’ knowledge, this is the first study to show that the 2012 tuition fees increase for British students increased depression, anxiety, stress and suicidality in graduates many years after graduation, owing to additional financial strain.

Unmet medical needs in otorhinolaryngology

Unfulfilled medical wishes and the resulting disappointments often have infrastructural causes and are the result of inadequate services or limited available resources in amedical practice. As annoying as these might be, they can hardly be influenced by the individual therapeutic competence of the ENT physician. The situation is different in the case of unfulfilled medical wishes of patients who cannot be adequately helped for avariety of reasons, whether because of the severity of their illness or because of the particular, predominantly psychosomatic constellations. This can lead to disappointment and unfulfilled expectations on both sides. This article focuses on diseases for which there are no clear organic findings and therefore no clear treatment options, such as surgery or medication, or in which the organic findings are tangible but do not sufficiently explain the underlying condition. In such cases, the treatment measures initiated are not sufficient and do not satisfy the patient. The patient feels misunderstood, which puts additional strain on the relationship between physician and patient. Abasic psychosomatic understanding of underlying and subjectively dominant organic complaints-by physicians and patients-is helpful here. In this way, the symptom can also be understood and recognized as apossible expression of psychogenic distress in order to pave way to the necessary initiation of causal therapy. The article is intended to reflect on this and make suggestions for dealing with the topic, using the example of tinnitus suffering in particular.

Microstructure and dynamic deformation mechanism of laser powder bed fusion of 316L-containing Ti–6Al–4V with dual-phase heterostructure

In this paper, 316L-containing Ti–6Al–4V alloy was fabricated by laser powder bed fusion (LPBF) through mixing Ti–6Al–4V and 4.5 wt% 316L powders, and the dynamic compressive mechanical properties and deformation mechanism at different strain rates were studied. The results show that the volume fraction of β phase sharply increases from 1.8% (in TC4) to 61.4% (in HST), and micro- and submicron-sized grains coexist in the HST alloy, producing heterostructure in the form of bimodal grain size distribution. The presence of the heterostructure led to superior heterogeneous deformation induced stress, thus facilitating the additional strain hardening and deformation coordinating ability, thus made the HST alloy achieved ultimate compressive stress of ∼1750 MPa and fracture strain of ∼17%, showing excellent comprehensive mechanical properties. Under quasi-static load, the deformation mode of HST alloy is mainly attributed to progressive deformation-induced martensitic transformation. However, at high strain rates, the impact loading inhibited the activation of progressive DIMT, and thus the deformation mode changed to combination of dislocation slipping and deformation twinning.

9.X.1. Protecting the mental health of healthcare workers: evidence, policy and implementation challenges

Abstract Background There is growing evidence that highlights increasing stress levels and declining mental health among the global healthcare workforce, exacerbated by challenges within workplace environments, labour market and policy frameworks. These conditions place additional strain on an already vulnerable healthcare workforce and consequently threaten the stability of health systems as a whole, given the escalating challenges in retaining, recruiting and reactivating healthcare workers. Although the problems are evident, awareness is increasing and international organisations such as the WHO have advanced policy recommendations, comprehensive and context-specific interventions effectively addressing these problems at varying levels are missing. Objectives This innovative workshop offers a platform for bridging the gap between research evidence and policy interventions, stimulating policy learning and knowledge exchange across countries. The session provides an overview of existing knowledge and engages representatives of academia as well as national policymaking, and international organisations to critically discuss challenges as well as good practice experiences with a focus on implementation and problem-solving. The following major questions will be explored: What evidence is available regarding the mental health and wellbeing needs of the healthcare workforce? How are different countries responding to these needs and supporting healthcare workers more effectively? What are some best practice cases focusing on improving mental health support for healthcare workers across various groups, considering diverse needs, gender-inclusiveness, and minority groups? Finally, how can evidence-based policymaking be improved, and how can the implementation of these policies be advanced in a more effective manner? Thesession will encourage critical debate and identify major policy recommendations, focusing on governance and implementation strategies. In the second half of the session, the panel will engage the audience in an interactive discussion to explore novel solutions that prioritise the wellbeing of healthcare workers and effectively address the healthcare workforce crisis in a more person-centred and ‘humanised’ manner. The workshop supports cross-country learning and networking opportunities. Key messages • Mental health and wellbeing of the healthcare workforce is crucial for health system resilience and needs stronger advocacy for coordinated multi-level governance action. • Establish a health system and governance approach together with comprehensive monitoring and qualitative comparative workforce studies to identify transformational policies in contextual settings.

Beyond the illness: a qualitative exploration of the burden of caring for people with tuberculosis on caregivers and their households in South Africa

ABSTRACT Tuberculosis (TB) affects not only the person sick with TB but also their households. Our study aimed for a deeper understanding of the multiplicative impact of TB on households, and more specifically on caregivers of people with TB, as well as factors that influence the burden on caregivers in South Africa. We conducted an exploratory qualitative study focusing on the lived experiences of people providing care to a family member sick with TB. The study found that the burden of caregiving is significant and falls disproportionally on women and poorer households whose resilience has already been compromised by pre-existing multiple stressors and demands, contributing to health inequities and gender inequalities. Having to care for a household member sick with TB imposed an additional strain causing further health, financial and social problems, leaving the household in a worse-off position, and at a higher risk of continued ill health and further poverty. Social support was found to mediate the burden, however, was lacking for many as kinship bonds are weakened by high levels of poverty and unemployment. Support to households is recommended to ensure recovery of the person with TB and their household post-TB illness, and prevent further ill health and poverty.

Respiratory Support for Patients with Chronic Respiratory Failure: the Necessity of a Long-Term Homecare Ventilation Program

Severe respiratory failure, resulting from a wide range of acute and chronic diseases such as chronic obstructive pulmonary diseases, obstructive sleep apnoea, obesity hypoventilation syndrome (Pickwickian syndrome), COVID-19, bilateral pneumonitis, kyphoscoliosis, acute respiratory distress syndrome, amyotrophic lateral sclerosis, Guillain-Barré syndrome, and others, poses a significant challenge for healthcare systems worldwide. Treating severe respiratory failure often requires long-term or lifelong respiratory support, which places a heavy burden on both patients and healthcare systems. Despite the availability of free comprehensive care for patients with chronic kidney failure and heart failure, those requiring long-term respiratory support are often deprived of adequate medical and social assistance. This gap in care leads to frequent hospitalizations, disability, and premature death of patients with severe respiratory failure, further straining healthcare resources and increasing social tension. The solution of the problem is an organisation of ambulatory centre for homecare respiratory support for patients with severe chronic respiratory failure. Homecare respiratory support demonstrated worldwide cost-effectiveness by significantly enhancing patients clinical and social outcomes, restoring their work capacity, and reducing the need for hospitalizations. This article emphasizes the necessity of a comprehensive homecare respiratory support system and highlights how inadequate assistance can result in frequent hospitalizations, increased disability, and premature death, thereby imposing an additional strain on the healthcare system.

Origin of a Kinetically Selective Route for Thermoreversible Valence Tautomerism-Based Photoswitching in O-Heterocycles Containing Conjugated Dienes.

The thermal electrocyclic ring opening of fused cis-cyclobutene to cis,cis-diene is prohibited according to the Woodward-Hoffmann (WH) rules; nonetheless, experiments provide firm evidence for their formation. However, the mechanism, electronic structure, and behavior during the reaction are ambiguous. Herein, we attempt to gain insights into the mechanism of thermal ring opening in four O-heterocycles containing a conjugated diene as the core skeleton. The results emphasize that the reaction initiates with a conrotatory ring opening to produce a cis,trans-diene as a strained transient intermediate following the WH rules but ultimately leads to a forbidden product. The conversion of cis,trans-diene to cis,cis-diene is kinetically preferred through double-bond rotation, involving the formation of a singlet biradicaloid. The expected H-shift is unfavorable because the requirement of suprafacial H transfer incorporates additional strain, while the transfer of other available H is symmetry-forbidden. The increased electrophilicity at O promotes C-O dissociation in the 8-membered cyclic cis,trans-dienes with fused benzene. This enables thermoreversible photoswitching via a two-step mechanism and kinetically refutes the direct disrotatory pathway. These systems can outperform energy storage, and critical insight into their mechanism with the aid of comprehensive electronic structure analysis would assist in their rational design in the future.

Efficacy of potassium schoenite as indigenous source of potassic fertilizer for potato crop grown in Western India

To attain the optimal production and quality, potato (Solanum tuberosum L.) farming requires a large amount of potassium fertilizers. Due to a lack of K mineral reserves, several nations, including India, import potassic fertilizers, which place additional financial strain on the country’s economy. Thus, potassium schoenite produced from sea bittern may present an attractive substitute for potassium nutrition in crop production. The current study examined the relative effect of indigenously produced potassium schoenite (PS) on potato crop. The findings demonstrated that potassium schoenite considerably increased potato growth, yield characteristics, yield, and quality of tuber. With 100% RDK (220 kg/ha K2O) through potassium schoenite + 1% foliar spray of potassium schoenite @ 30 and 45 DAP, the greatest yield attributes, total tuber yield and starch output were achieved which remained at par with 75% RDK (165 kg/ha K2O) through potassium schoenite + 1% foliar spray of potassium schoenite @ 30 and 45 DAP. Furthermore, potassium schoenite saves 25% K2O in potato production as compared to potassium sulfate and muriate of potash. Thus, indigenous potassium sources have been found to be far more effective than imported potassium sulfate and muriate of potash in enhancing potato productivity.

Hydrogen production from non-potable water resources: A techno-economic investment and operation planning approach

The production of hydrogen through water electrolysis facilitates large-scale energy storage, provides ancillary services, and supports the decarbonization of industries with hard-to-reduce emissions. As renewable energy adoption expands, the demand for these applications is increasing. However, water electrolysis currently faces challenges in cost competitiveness compared to other hydrogen production methods. Additionally, its reliance on potable water sources places additional strain on freshwater reserves. This study addresses these issues by exploring the economically optimal investment and operational strategy for hydrogen production using non-potable water sources. The goal is to maximize net profit through mathematical optimization, utilizing three advanced electrolysis technologies: alkaline electrolysis, proton exchange membrane electrolysis, and solid oxide electrolysis. The study examines three non-potable water sources: seawater, urban wastewater effluent, and rainwater. The model takes into account electricity market values from day-ahead and balancing markets, as well as the market values for hydrogen, oxygen, freshwater, and mixed solid salt. Two scenarios are analysed, reflecting varying levels of uncertainty in electricity price forecasts. Each scenario includes nine case studies, representing various combinations of water sources and electrolysis technologies. The results indicate that alkaline electrolysis and proton exchange membrane electrolysis are financially viable technologies, with potential annual net profits of up to 6.4 and 6.2 million euros, respectively. In contrast, solid oxide electrolysis incurs a negative net profit across all scenarios and is not economically viable under the given conditions. The main revenue sources are hydrogen sales and combined up-balancing and down-balancing services in electricity markets. Participation in the balancing market constitutes a significant portion (35 to 61%) of the total revenue in all cases with positive net profits, making it critical for economic viability. Rainwater is identified as the most cost-effective water source for hydrogen production. However, the costs associated with water treatment and brine management are minimal, contributing only 0.7 to 3.7% to the total cost of hydrogen production. Thus, differences in net profit are primarily attributed to the type of electrolysis technology used.

Excellent strength-ductility synergy assisted by dislocation dipole-induced plasticity in Co-free precipitate-strengthened medium-entropy alloy

Precipitation strengthening is one of the most effective approaches for developing advanced structural materials with outstanding strength-ductility combinations. However, most compositional designs of precipitate-strengthened HEAs/MEAs compromise the cost-property tradeoff owing to the addition of expensive Co element. In this study, a Co-free FeCrNi-based precipitate-strengthened medium entropy alloy (denoted as Al0.2Cr0.9FeNi2.2Ti0.2) with a near-equiatomic FeCrNi matrix and a high content (∼ 35 %) L12 nanoprecipitates was designed using a mixing strategy. The microstructural features, mechanical performance, deformation substructure evolution, and strengthening mechanisms were systematically investigated using EBSD, TEM, and APT. Tensile tests indicated that the current alloy aged within a moderate temperature range achieved an exceptional strength-ductility combination compared to existing Co-containing and Co-free HEAs/MEAs. Particularly, the alloy aged at 700 ℃ (denoted as 700A) demonstrated a high ultimate tensile strength of 1606 MPa and a large ductility of 25 %, benefiting from both precipitation hardening and an unusual strain-hardening sustainability. Such anomalous strain-hardening sustainability can be attributed to the dislocation dipole-induced plasticity. High-density dislocation dipoles can simultaneously provide additional strain hardening by reducing the dislocation mean free path and enhance plastic deformation compatibility by acting as stress delocalization origins, thereby contributing to excellent strength-ductility synergy. These findings will not only open a new door for the future development of high-performance Co-free precipitate-strengthened HEAs/MEAs, but also deepen the understanding of the work-hardening mechanisms in these alloys.

Circuit Breaker

In the realm of microservices architecture, ensuring reliability and resilience is paramount due to the distributed nature and interdependencies of services. A key pattern employed to enhance system robustness is the circuit breaker. When a microservice experiences failures, the circuit breaker pattern detects these faults and transitions between three states: closed, open, and half-open. During this period, requests are automatically redirected or fail fast, preventing additional strain on the troubled service. Once the service stabilizes, the circuit breaker transitions to the half-open state, where it allows a limited number of test requests to verify recovery. If these succeed, the circuit breaker closes, restoring normal operation. This abstract explores the implementation, benefits, and challenges of circuit breakers in microservices, emphasizing their role in maintaining high availability and robust performance in modern distributed systems.

Strengthening gold with dispersed nanovoids.

Materials often fail prematurely or catastrophically under load while containing voids, posing a challenge to materials manufacturing. We found that a metal (gold) containing spherical voids with a fraction of up to 10% does not fracture prematurely in tension when the voids are shrunk to the submicron or nanometer scale. Instead, the dispersed nanovoids increase the strength and ductility of the material while simultaneously reducing its weight. Apart from the suppressed stress or strain concentration, such structure provides enormous surface area and promotes surface-dislocation interactions, which enable strengthening and additional strain hardening and thus toughening. Transforming voids from crack-like detrimental defects into a beneficial "ingredient" provides an inexpensive and environmentally friendly approach for the development of a new class of lightweight, high-performance materials.

Current Trends in the Development of Electrochemical Biosensor for Detecting Analytes from Sweat.

The need for wearable bioelectronics continues to grow, and this technology might significantly alter the medical field. In order to diagnose and treat a patient, conventional medicine takes a "reactive" approach and waits for symptoms to appear first. Therefore, it is preferable to progress toward continuous non-invasive wearable biomonitoring, a preventative strategy that may assist individuals in diagnosing or treating illnesses at the earliest stages, sometimes before any outward symptoms have appeared. Wearable physiological sensors, such as the Apple Watch and FitBit, have arrived on the market as a result of technology advances and have quickly become commonplace. However, few devices currently exist that can report directly on these biomarkers of relevance. This is mostly due to the challenges involved in real-time fluid sampling and generating correct readouts utilising extremely selective and sensitive sensors. Sweat is an excretory fluid that is only allowed to be used in order to reduce invasiveness, but this restriction places additional strain on sensors owing to the diluted concentration of the relevant biomarkers and the changes in pH, salinity, and other biophysical parameters that directly influence the read-out of real-time biosensors. Sweat is favoured amid slightly invasive biofluids due to its low concentration of interfering chemicals and the fact that it may be collected without touching the mucosal layers. This review offers a concise outline of the latest advances in sweat-based wearable sensors, their promise in healthcare monitoring, and the problems faced in analysis based on sweat.

Edaphobacter paludis sp. nov., a new acidophilic representative of the Acidobacteriota isolated from fen soils.

Two new strains JP48T and JP55 affiliated with the acidobacterial class Terriglobia have been isolated from fen soil sampled in the Fichtelgebirge Mountains near Bayreuth, Germany. Both strains were Gram-stain-negative, non-motile, non-spore-forming rods that divide by binary fission, segregate exopolysaccharide-like material and form capsules. Strains JP48T and JP55 grew at 4-36 °C (optimum at 27 °C), pH 3.6-7.3 (optimum at pH 4.6-5.5) and with NaCl concentrations of 0-3% (optimum at 1.0%; w/v). Strains JP48T and JP55 grew aerobically on a wide range of organic substrates including mono- and oligosaccharides, amino acids and short-chained fatty acids. MK-8 was identified as the major respiratory quinone. The major fatty acids for strains JP48T and JP55 were iso-C15 : 0, C16 : 1 ω7c, C16 : 0 and iso-diabolic acid. Phosphatidylglycerol, phosphatidylethanolamine, diphosphatidylglycerol, lysophophatidylethanolamine, phosphatidylcholine, unidentified glyco- and glycophospholipids, and unidentified high mass lipid species were the major polar membrane lipids. The G+C content of strains JP48T and JP55 was 57.4 and 57.2 mol%, respectively. The genomes of strains JP48T and JP55 contained nine potential secondary metabolite regions encoding for the compound classes NRPS(-like), T3PKS, terpene, or lanthipeptide class IV. Phylogenetic reconstruction and 16S rRNA gene sequence similarities of 98.3 and 96.9% identified Edaphobacter dinghuensis DHF9T and Edaphobacter lichenicola DSM 104462T as the most closely related type strains to strains JP48T and JP55. Based on their phenotype, phylogeny and chemotaxonomy, we propose the novel species Edaphobacter paludis sp. nov. (type strain JP48T=DSM 109919T=CECT 30269T; additional strain JP55=DSM 109920=CECT 30268) within the class Terriglobia of the phylum Acidobacteriota.

Burnout among intensive care nurses, physicians and leaders during the COVID-19 pandemic: A national longitudinal study.

Burnout is frequent among intensive care unit (ICU) healthcare professionals and may result in medical errors and absenteeism. The COVID-19 pandemic caused additional strain during working hours and also affected off-duty life. The aims of this study were to survey burnout levels among ICU healthcare professionals during the first year of COVID-19, describe those who reported burnout, and analyse demographic and work-related factors associated with burnout. This was a national prospective longitudinal cohort study of 484 nurses, physicians and leaders working in intensive care units with COVID-19 patients in Norway. Burnout was measured at 6- and 12-month follow-up, after a registration of baseline data during the first months of the COVID epidemic. The Copenhagen Burnout Inventory (CBI), was used (range 0-100), burnout caseness defined as CBI ≥50. Bi- and multivariable logistic regression analyses were performed to examine baseline demographic variables and work-related factors associated with burnout caseness at 12 months. At 6 months, the median CBI score was 17, increasing to 21 at 12 months (p = .037), with nurses accounting for most of the increase. Thirty-two per cent had an increase in score of more than 5, whereas 25% had a decrease of more than 5. Ten per cent reported caseness of burnout at 6 months and 14% at 12 months (n.s.). The participants with burnout caseness were of significantly lower age, had fewer years of experience, reported more previous anxiety and/or depression, more moral distress, less perceived hospital recognition, and more fear of infection in the bivariate analyses. Burnout was the single standing most reported type of psychological distress, and 24 out of 41 (59%) with burnout caseness also reported caseness of anxiety, depression and/or post-traumatic stress disorder (PTSD) symptoms. Multivariate analysis showed statistically significant associations of burnout caseness with fewer years of professional experience (p = .041) and borderline significance of perceived support by leader (p = .049). In Norway, a minority of ICU nurses, physicians and leaders reported burnout 1 year into the pandemic. A majority of those with burnout reported anxiety, depression and/or PTSD symptoms combined. Burnout was associated with less years of professional experience.

Systemic aging fuels heart failure: Molecular mechanisms and therapeutic avenues.

Systemic aging influences various physiological processes and contributes to structural and functional decline in cardiac tissue. These alterations include an increased incidence of left ventricular hypertrophy, a decline in left ventricular diastolic function, left atrial dilation, atrial fibrillation, myocardial fibrosis and cardiac amyloidosis, elevating susceptibility to chronic heart failure (HF) in the elderly. Age-related cardiac dysfunction stems from prolonged exposure to genomic, epigenetic, oxidative, autophagic, inflammatory and regenerative stresses, along with the accumulation of senescent cells. Concurrently, age-related structural and functional changes in the vascular system, attributed to endothelial dysfunction, arterial stiffness, impaired angiogenesis, oxidative stress and inflammation, impose additional strain on the heart. Dysregulated mechanosignalling and impaired nitric oxide signalling play critical roles in the age-related vascular dysfunction associated with HF. Metabolic aging drives intricate shifts in glucose and lipid metabolism, leading to insulin resistance, mitochondrial dysfunction and lipid accumulation within cardiomyocytes. These alterations contribute to cardiac hypertrophy, fibrosis and impaired contractility, ultimately propelling HF. Systemic low-grade chronic inflammation, in conjunction with the senescence-associated secretory phenotype, aggravates cardiac dysfunction with age by promoting immune cell infiltration into the myocardium, fostering HF. This is further exacerbated by age-related comorbidities like coronary artery disease (CAD), atherosclerosis, hypertension, obesity, diabetes and chronic kidney disease (CKD). CAD and atherosclerosis induce myocardial ischaemia and adverse remodelling, while hypertension contributes to cardiac hypertrophy and fibrosis. Obesity-associated insulin resistance, inflammation and dyslipidaemia create a profibrotic cardiac environment, whereas diabetes-related metabolic disturbances further impair cardiac function. CKD-related fluid overload, electrolyte imbalances and uraemic toxins exacerbate HF through systemic inflammation and neurohormonal renin-angiotensin-aldosterone system (RAAS) activation. Recognizing aging as a modifiable process has opened avenues to target systemic aging in HF through both lifestyle interventions and therapeutics. Exercise, known for its antioxidant effects, can partly reverse pathological cardiac remodelling in the elderly by countering processes linked to age-related chronic HF, such as mitochondrial dysfunction, inflammation, senescence and declining cardiomyocyte regeneration. Dietary interventions such as plant-based and ketogenic diets, caloric restriction and macronutrient supplementation are instrumental in maintaining energy balance, reducing adiposity and addressing micronutrient and macronutrient imbalances associated with age-related HF. Therapeutic advancements targeting systemic aging in HF are underway. Key approaches include senomorphics and senolytics to limit senescence, antioxidants targeting mitochondrial stress, anti-inflammatory drugs like interleukin (IL)-1β inhibitors, metabolic rejuvenators such as nicotinamide riboside, resveratrol and sirtuin (SIRT) activators and autophagy enhancers like metformin and sodium-glucose cotransporter 2 (SGLT2) inhibitors, all of which offer potential for preserving cardiac function and alleviating the age-related HF burden.

Pandemic Impact, Support Received, and Policies for Health Worker Retention: An Environmental Scan.

The COVID-19 pandemic has brought additional strain to health workers in the Philippines, leading to a significant proportion of them leaving the workforce. The purpose of this study is to explore the impact of the pandemic on health workers, the support that they received and associated challenges; and identify relevant policies for better workplace conditions. An environmental scanning method was utilized. Particularly, a literature review and policy scan that were validated through key informant interviews with administrators and frontline health workers from selected urban and rural sites in the three main islands in the Philippines. These were framed into a background note to springboard the discussions during a national policy dialogue participated by representatives from key government organizations, professional organizations of physicians, nurses, and midwives, professional regulatory bodies, hospital administrators, frontline health workers, and donor agencies in the Philippines. Deaths, burn-out, mental health problems, lack of personal protective equipment and poor allocation of vaccines were reported in the early phases of the pandemic. Support varied across settings but included additional allowance, free meals, accomodation, transportation, training and psychosocial services. Furthermore, pre-pandemic issues such as as low salaries and heavy workload continue to be the main reasons for leaving the workforce or the country. The proposed solutions are as follows: (1) creating policies and strategies for appropriate production, recruitment, and retention of human resources for health; (2) allocating regular permanent positions for both the education and health sector; (3) augmenting and continuation of deployment programs; (3) expanding roles of nurses to push for advanced practice nursing; (4) providing fair compensation along with risk allowances, non-financial incentives, and expanded benefits; (5) supporting mental health wellness by providing an appropriate work-rest balance and safe work environment; (6) providing opportunities for professional development and scholarships with accompanying return-service agreement; and (7) strengthening the reintegration programs for returning overseas health workers. The pandemic has affected the well-being of health workers and disparities in support were reported due to longstanding workplace issues and policy implementation gaps. Stakeholder commitments require sustained monitoring while policies that are in place and yet to be developed demand stronger support from the government, members of Congress, the private sector, and other key decision-makers.

Results of a clinical study of the influenza tetravalent inactivated subunit adjuvant vaccine Grippol Quadrivalent in children aged 6 months to 5 years (inclusive)

The article presents the results of a clinical investigation on the administration of the Grippol Quadrivalent vaccine (influenza tetravalent inactivated subunit adjuvant vaccine) in children from 6 months to 5 years old. The vaccine has demonstrated no less effectiveness in comparison with the Grippol plus vaccine (influenza trivalent inactivated polymer-subunit vaccine).comparable results were obtained for all evaluated indicators of immunological efficacy against matching strains of the influenza virus, while for additional strain B (Yamagata line) there was a statistically significant difference in the increase in the immune response in the Grippol Quadrivalent group. The results of the assessment of the reactogenicity and frequency of systemic adverse events indicated a favorable and comparable safety profile of the vaccines Grippol Quadrivalent and Grippol plus in children from 6 months to 5 years old. The data obtained allowed us to conclude that the immunological efficacy of the Grippol Quadrivalent vaccine is no less when compared to the Grippol plus vaccine, as well as a comparable safety and reactogenicity profile. According to the results of the clinical investigation, on 08/04/2023, the Ministry of Health of the Russian Federation amended the “Instructions for the medical use of the drug”: Grippol Quadrivalent is indicated for children from the age of 6 months.

New design charts for evaluating the damage potential to RC frame buildings adjacent to deep excavations

PurposeUrban excavations are a cause for concern in terms of the probability of damage to nearby structures. In this study, various structural and excavation parameters were investigated to determine the probability of building damage during excavations.Design/methodology/approachFinite-element analysis software was used to develop a set of valid three-dimensional models. Models were developed to assess the effects of structural parameters (building height and position relative to the excavation site) and excavation parameters (depth and support system type) on the responses of the adjacent buildings.FindingsThe new design charts estimated the damage to reinforced concrete frame buildings during excavation by focusing on the angular distortion of the building, additional shear strain on the masonry walls and additional strain and stress on columns. This study showed that the probability of damage decreased as the distance between the building and the excavation increased. By contrast, it increased when the building was located at a distance equal to the excavation depth at its edge. According to this study, the axial stress caused by the excavation of building columns does not exceed 10.9% of the compressive strength of the concrete.Originality/valueThe proposed design charts can replace comparable charts and provide a deeper understanding of damage potential based on key parameters. These charts are more practical than previous charts with limited parameters.

Saturation of Grain Fragmentation upon Severe Plastic Deformation: Fact or Fiction?

There has been general agreement that grain refinement upon severe plastic deformation (SPD) saturates at equivalent strains of 10–20, as a dynamic equilibrium between refinement and coarsening is established. Meanwhile, few reports question such steady state, but suggest another strain hardening regime might be entered for strains >1000. So far, neither an in‐depth analysis nor a general theory for such ultra‐SPD strain hardening has been established. The present work provides clear evidence for additional strain hardening at ultra‐severe strains. Although at this stage the strain hardening rate is awfully weak (≈0.03 MPa), it manifests in noticeable grain refinement and hardness increase. Texture and the existence of subgrains still support dislocation‐based plasticity. Specimens deformed to ultra‐severe strains possess improved thermal stability. Although an unambiguous conclusion regarding the origin of the ultra‐SPD strain hardening is currently not possible, the potential mechanisms are being discussed. While continuous impurity uptake from the anvils could explain the hardening and improved thermal stability, estimation of grain boundary migration rates suggests that a slight but continuous net refinement is also plausible. Together with structural transformations of grain boundaries, this offers an alternative, intrinsic source for ultra‐SPD hardening. It is hoped that this thought‐provoking conclusion stimulates further research into this subject.