Problem Areas Research Articles

The Impact of the 2023 Turkey Earthquakes on Glycemic Control and Stress Levels in Children with Type 1 Diabetes: Single-center Experience.

The 2023 earthquake in southeastern Turkey significantly impacted physical and emotional well-being in the region. This study evaluates the earthquake's effects on glycemic control, diabetes management, and stress levels in children with type 1 diabetes (T1D). Seventy-nine pediatric T1D patients were assessed before and after the earthquake. Key parameters included glycated hemoglobin (HbA1c), insulin dosage, and psychological assessments using the Problem Areas in Diabetes Scale-Teen version (PAID-T) and the Post-Traumatic Stress Reaction Scale (PTSRS). Mixed-effects models were used to compare data across time points. Of the 79 participants, 45.6% were male, with a mean age of 143.5 ± 45.0 months. The earthquake disrupted insulin therapy in 36.7% of patients and caused glycemic control issues in 77.2%. HbA1c levels dropped from 9.7 ± 2.7% pre-earthquake to 8.8 ± 2.2% in the first 3 months, rose to 10.6 ± 1.9% in the following 3 months, and stabilized at 9.7 ± 1.9% by the fourth period. A positive correlation was observed between parental stress and children's HbA1c (r = 0.423, p = 0.031). Psychological effects were notable, with 43% reporting distress, and 63.3% experiencing loss of close family or friends. PAID-T scores were 42.0 ± 14.5 for children and 53.7 ± 12.8 for parents, with PTSRS scores of 35.1 ± 17.4. The earthquake significantly affected glycemic control and psychological well-being in children with T1D. Fluctuations in HbA1c levels and the link between parental stress and glycemic outcomes emphasize the need for tailored interventions during crises.

Patient-Reported Outcome Measures in Patients with Diabetes Mellitus: Findings from the Diabetes Landeck Cohort.

Maintaining and optimizing quality of life (QoL) is a central issue and one of the most important goals in therapy for patients with chronic diseases, such as diabetes mellitus (DM). Despite its importance, there is little data on the QoL of patients with DM in Austria. The objective of this study was to extend an established population-based cohort, the Diabetes-Landeck cohort, by including patient-reported outcomes. We performed a survey on quality of life (QoL) and treatment satisfaction in patients from the Diabetes-Landeck cohort using the EQ-5D-5L, the problem areas in diabetes survey (PAID), and the diabetes treatment satisfaction questionnaire (DTSQ). Mean sum scores were calculated and compared between patient characteristic subgroups. In total 58 patients were recruited, with a mean age of 63 years and a mean hemoglobin A1c (HbA1c) of 7.1%. The mean sum score of EQ-5D-5L was 92 (SD=10.6), and that of DTSQ and PAID were 32.2 (SD=6.6) and 10.8 (SD=11.6), respectively. Patients with obesity (body mass index ≥ 30 kg/m2) showed a statistically significant decreased mean sum score of EQ-5D-5L and a statistically significant increased mean sum score of DTSQ. Patients with HbA1c ≥7.5% showed a statistically significant decreased mean sum score of DTSQ. We observed patient-reported outcomes significantly associated with obesity and HbA1c, which could be used for targeted patient monitoring. Limited by small sample size and questions in generalizability, we strongly suggest the rollout of a larger study.

Perceived problems associated with perioperative blood product preparation.

Timely blood product preparation is important for patients undergoing surgery with a high risk of blood loss. However, in circumstances where no blood refrigerators exist in the operating room theatre complex, numerous potential problem sources during blood product preparation may lead to delays, and tense interpersonal interactions between anaesthesia and blood bank personnel can ensue. To evaluate this at our institution, an anonymous online survey was sent to anaesthesia providers and blood bank technologists. The primary outcome was to determine what blood preparation time anaesthesia providers believed was reasonable to expect, compared to the institutional standard of 90 min. Of the 75 (36%) anaesthesia providers surveyed, 94.9% considered <90 min was reasonable for blood to be prepared and 79.7% considered <60 min was reasonable. There were 92 (42%) total survey respondents, with 54.8% reporting problems to occur 'frequently' or 'always'. The perceived frequency of 18 different possible problem sources was identified. Overall, the results suggest problems with perioperative blood product preparation occur frequently and the expectations of the anaesthetic team around preparation time and availability of blood products are not met. Many potential problem areas were identified that warrant further investigation into the ongoing efforts to improve workflow and interdisciplinary interactions.

IMPROVED TECHNIQUES FOR ASSESSING RIDE QUALITY ON CONCRETE PAVEMENTS

Under current procedures used in Australia for testing and interpretation of road profiles it is difficult to identify and isolate pavement sections responsible for unpleasant ride vibration. For the construction of new concrete pavements, in particular, where subsequent correction of profiles is very expensive, there is a need for improved procedures to give early feedback of the ultimate ride quality. To help identify and treat pavement problem areas, numerical models were developed to simulate ride vibration and pavement grinding. The ride and grind simulation models cover four generic vehicle classes – passenger cars, heavy commercial vehicles, offroad recreational and sports utility vehicles and motorcycles – and conventional pavement grinding equipment. A number of vibration response presentation formats were developed to help quantify ride vibration severity, intrinsic unevenness and grind treatment effectiveness. The models and key findings of the study are presented in this paper through contrasting examples of responses from the models to a selection of road profiles before and after virtual (theoretical) remedial grind treatment.

Spanish Validation of the Problem Area in Diabetes-Pediatric Version Survey and Its Weak Association with Metabolic Control Parameters in Pediatric Diabetes: A Cross-Sectional Multicenter Study.

Background: Type 1 diabetes mellitus (T1DM) in pediatric patients often leads to emotional distress, impacting self-management. The PAID-Peds survey measures diabetes-related emotional burden but lacks a validated Spanish version. This study aimed to validate the Spanish PAID-Peds survey in children and adolescents with T1DM and correlate it with diabetic metabolic control parameters. Methods: A cross-sectional study was conducted from October 2022 to December 2023, recruiting 636 patients aged 8-17 years from three Spanish hospitals. Psychometric properties were assessed using Cronbach's alpha for reliability and confirmatory factor analysis for construct validity. Associations between PAID-Peds scores and clinical measures, such as HbA1c, were examined. Results: The final sample consisted of 538 participants (84.59% response rate). The PAID-Peds survey showed high internal consistency (Cronbach's alpha = 0.90). The confirmatory factor analysis indicated a satisfactory model fit (χ2 = 812.28, p < 0.001; RMSEA = 0.08). Weak correlations were found between PAID-Peds scores and HbA1c (r = 0.14, p < 0.001). Conclusions: The Spanish PAID-Peds survey is a reliable tool for assessing emotional burden in pediatric T1DM patients. Integrating it into clinical practice may improve early identification of emotional distress, aiding in better diabetes management. Further research should explore its application over time and in intervention studies.

Effect of Early Postoperative Physical Therapy and Educational Program on Wound Recurrence in Diabetic Foot Ulcers: A Randomized Controlled Trial.

Objective: This study aimed to examine the impact of early postoperative physical therapy combined with an educational program on wound recurrence and quality of life in patients with foot ulcers. Methods: Forty-eight postoperative patients with diabetic foot ulcers were randomly assigned to either an intervention group, which received both physical therapy and an educational program (n = 25), or a control group, which received physical therapy only (n = 23). Each intervention was initiated on the day after surgery in both groups. The intervention group participated in physical therapy sessions, followed by a 15 min disease education program conducted five times per week. The primary endpoint was the rate of wound recurrence six months after hospital discharge. Secondary endpoints included ankle dorsiflexion range of motion, knee extension strength, gait functional independence measure scores, problem areas in diabetes scores, and EuroQol-5 dimensions-5 levels scores. Results: The intervention group demonstrated a significantly lower rate of wound recurrence within six months after discharge (10.5%) compared with the control group (27.7%). Conclusions: The combined use of early postoperative physical therapy and educational programs was an effective intervention strategy, contributing to reduced wound recurrence rates in patients with diabetic foot ulcers.

Continuous Glucose Monitors and Programmed Shared Medical Appointments in Managing Type 2 Diabetes Mellitus Among First Nation Women in Australia: A Co-Designed Feasibility Study.

First Nations women in Australia diagnosed with type 2 diabetes, co-designed and attended a programmed shared medical appointment that included continuous glucose monitors and culturally responsive food appreciation activities over 8 weekly sessions to improve glycaemic control. The project was a single site, longitudinal change from baseline, mixed methods, feasibility study using HbA1c as the primary outcome measure. Secondary outcome measures included, weight, metabolic health-related blood panels, CGM, Blood Glucose Levels (BGL) time-in-range percentage, Patient Activation Measure (PAM) and Problem Areas In Diabetes (PAID) tools and client satisfaction survey and semi focussed interviews. Forty participants commenced and twenty-five participants completed the program (62,5%). Of the completing participants the mean HbA1c had an absolute reduction of 0.7 percentage points ( from baseline to program completion, P = .013). Eighteen (75%) reduced HbA1c and maintained some reduction for 12 months. Seven (28%) achieved remission, HbA1c <6.4% (46mmol/l) maintained for 12 months. There were statistically significant improvements in weight, systolic blood pressure, liver enzymes, BGL time-in-range, PAM and PAID scores. It is feasible to use programmed shared medical appointments incorporating CGM aiming to improve glycaemic control and other metabolic measures of health among First Nations women in Australia. Trial Registration: The project was registered with the Australian and New Zealand Clinical Trial Registry ACTRN12622000650796. The trial web page = https://www.anzctr.org.au/ACTRN12622000650796.aspx.

A Multi-Level Task Framework for Event Sequence Analysis.

Despite the development of numerous visual analytics tools for event sequence data across various domains, including but not limited to healthcare, digital marketing, and user behavior analysis, comparing these domain-specific investigations and transferring the results to new datasets and problem areas remain challenging. Task abstractions can help us go beyond domain-specific details, but existing visualization task abstractions are insufficient for event sequence visual analytics because they primarily focus on multivariate datasets and often overlook automated analytical techniques. To address this gap, we propose a domain-agnostic multi-level task framework for event sequence analytics, derived from an analysis of 58 papers that present event sequence visualization systems. Our framework consists of four levels: objective, intent, strategy, and technique. Overall objectives identify the main goals of analysis. Intents comprises five high-level approaches adopted at each analysis step: augment data, simplify data, configure data, configure visualization, and manage provenance. Each intent is accomplished through a number of strategies, for instance, data simplification can be achieved through aggregation, summarization, or segmentation. Finally, each strategy can be implemented by a set of techniques depending on the input and output components. We further show that each technique can be expressed through a quartet of action-input-output-criteria. We demonstrate the framework's descriptive power through case studies and discuss its similarities and differences with previous event sequence task taxonomies.

Methodology for assessing the state of transport services for the population of the subject of the Russian Federation on the example of the Omsk region

Introduction. Within the framework of the transformation of the passenger transportation industry of the Russian Federation, the relevance of assessing the current state of the public transport service system in the subjects of the Russian Federation is determined on the basis of the parameters laid down in current and prospective regulatory legal acts.Materials and Methods. The research uses current regulatory legal acts of the federal and regional levels in the field of public transport services, data from the administrative-territorial division of the subject of the Russian Federation, current registers of inter-municipal and municipal routes, up-to-date statistical information on the population. The following research methods were used: analysis, survey, formalization.Results. The research presents a methodology developed by the authors for rapid assessment of the current state of the public transport service system in the subject of the Russian Federation, including an algorithm for its application. The methodology is based on the assessment of six criteria, which are aggregated indicators of the parameters of public transport services in the areas of accessibility, safety, reliability and comfort. The results of the testing of the technique in the Omsk region are presented.Discussion and conclusions. The results obtained allow us to identify problem areas for which it is necessary to develop and implement measures to improve the quality of public transport services in the short term. The proposed methodology is not a substitute for the methods approved by the current regulatory legal acts, and can be used at the initial stage of development and updating of transport planning documents of the subject of the Russian Federation.

Glycemic and Psychosocial Outcomes of Advanced Hybrid Closed-Loop Therapy in Youth With High HbA1c: A Randomized Clinical Trial.

To determine the efficacy of advanced hybrid closed-loop (AHCL) therapy in a high-risk cohort of youth on continuous subcutaneous insulin infusion (CSII) with or without continuous glucose monitoring (CGM) with suboptimal glycemia. In a 6-month multicenter clinical trial, youth with type 1 diabetes with mean and most recent HbA1c >8.5% (65 mmol/mol) were randomly assigned 1:1 to AHCL or treatment as usual (CSII ± CGM). The primary outcome was the 24-week between-group difference in HbA1c. Secondary outcomes included CGM metrics from masked CGM and psychological measures (youth-reported problem areas in diabetes [PAID], quality of life, anxiety, depression, and hypoglycemia fear) assessed using validated questionnaires. A total of 42 participants were randomized (mean [SD] age 16.2 [2.5] years, HbA1c 9.8 [1.1]% or 84 [12] mmol/mol, PAID score 50.3 [19.8]). At study end, the mean (SD) HbA1c was 8.8 (1.1)% or 73 (12) mmol/mol with AHCL and 9.9 (1.2)% or 85 (13.1) mmol/mol with CSII ± CGM, with mean adjusted group difference of -0.77% (95% CI -1.45 to -0.09) or -8.4 mmol/mol (-15.8 to -1.0); P = 0.027. AHCL increased time in range 70-180 mg/dL (difference 19.1%; 95% CI 11.1 to 27.1), reduced time >180 mg/dL (difference -17.7%; 95% CI -26.6 to -8.8), with no increase in time spent <70 mg/dL (difference -0.8%; 95% CI -2.7 to 0.6). There was no evidence for difference in psychosocial outcomes between the two groups at study end. AHCL should be encouraged in youth with suboptimal glycemia, as AHCL improves glycemia. However, psychological support remains vital, as technology alone may not be able to reduce the burden of diabetes care in this subgroup.

МОТИВАЦИЯ ТРУДА ПЕРСОНАЛА В УСЛОВИЯХ ЦИФРОВИЗАЦИИ: ХОЛИСТИЧЕСКИЙ ПОДХОД

Employee engagement has always been and remains a key factor determining the development of any organization, regardless of its size, form of ownership, complexity, and operating conditions. The proposed article is devoted to the relationship between the factors of employee motivation with different levels of qualification and job title with the development of digitalization, especially artificial intelligence, as well as their impact on the efficiency of the company. A methodology for holistic assessment of the motivational level of a company is proposed based on determining the degree of consistency of the main interests of employees, mutual support of their goals and the company's mission, as well as the team's commitment to self-development to achieve the strategic goals of the company. Problem areas in the motivational system of a specific organization are identified, among which the following must be highlighted: partial imbalance between the main goals and mission of the company; the need to integrate motivational incentives around such indicators as growth in service volumes, increased collection of payments for services rendered and customer satisfaction with the quality and timeliness of services rendered, etc. To improve the motivational system, various measures are recommended to improve the motivational system of the company, as well as improvement in the direction of integrating the value system of the team of key employees using artificial intelligence.

Participatory Action Research for Professional Development

The sudden shift to online education during the Covid-19 Pandemic resulted in uncertainty and stress among teachers. This study investigates the role of Participatory Action Research [PAR] in supporting teachers’ professional development in times of pandemic-induced chaos and how effective PAR is in tackling challenges that emerge. The study involved fourteen in-service teachers of English and 267 students at a Turkish state university. Through three cycles of PAR, professional development support was provided for the newly established English preparatory school. Data were collected through observations, reflections, interviews, and questionnaires. The qualitative findings revealed that PAR contributed to teachers’ professional development and in-class practices. The quantitative analysis of the questionnaire findings resulted in a positive reflection of PAR in teachers’ in-class practices. The cyclical nature of PAR will continue with the fourth cycle for the problem areas that still need improvement.

DIFFERENTIAL METHOD FOR ASSESSING THE EVENNESS OF THE ROAD SURFACE OF THE STREET AND ROAD NETWORK BY THE IRI INDEX

The article investigates the use of the IRI index to assess the condition of the pavement of streets of different types within a settlement: main city and district roads, residential and industrial. The possibility of applying a differential system for assessing the evenness of the road surface is considered, which makes it possible to more accurately determine its condition in five gradations – from excellent to critical. Based on the results, a map of the district was built, which clearly demonstrates the distribution of the technical condition of its street and road network. This allowed us to identify problem areas, which will make it easier to optimize the planning of repair work and ensure efficient use of resources. The research provides a more comprehensive understanding of the factors contributing to pavement deterioration. Furthermore, the use of modern technologies, such as GIS systems and remote sensing data, facilitated the development of a dynamic model for monitoring road conditions in real-time.

Investigation of caregiver burden, quality of life, and occupational performance of primary caregivers of individuals having experienced a stroke with and without aphasia

ABSTRACT Background Individuals having experienced a stroke need the help of an individual to perform their activities of daily living. Therefore, the disease affects not only patients but also their caregivers. Objectives This study aimed to investigate how aphasia affects caregivers’ burden of care, quality of life, and occupational performance. Methods This cross-sectional study involved Group 1, (n=51) the caregivers of individuals having experienced a stroke with aphasia, and Group 2 (n = 51), the caregivers of individuals having experienced a stroke without aphasia. The caregivers were evaluated using the sociodemographic information form, the Zarit Caregiver Burden Scale, the SF-36 Short Form, and Canadian Occupational Performance Measure tests. Results Our study found that the caregiver burden in Group 1 was higher than in Group 2 (t = 3.8, p = 0.01). Caregivers in Group 1 also had higher pain levels (t = –2.21, p = 0.029) and lower social functions than those in Group 2 (t = –2.54, p = 0.013). There was no statistically significant difference between the other sub-parameters of quality of life (p > 0.05). It was observed that the occupational performance (t = –3.31, p = 0.001) and satisfaction levels (t = –3.57, p = 0.001) of the caregivers in Group 1 were lower than those of the caregivers in Group 2. Conclusions Occupational therapy evaluation and intervention programs for caregivers should consider the occupational performance of caregivers of individuals with aphasia and include approaches to problem areas.

Advancing healthcare transformation: AI-driven precision medicine and scalable innovations through data analytics

Artificial intelligence and data fusion technologies are being used to incorporate the technology into healthcare systems worldwide. This work focuses on the idea and investigates how the AI-based Data Fusion Centre affects precision medicine, organizational and patient-centric models. In understanding how practice, diagnostics, and general efficiency of the healthcare system may benefit from AI, this article provides a great example. In this way, the approach is extended comprehensively by providing an analysis of techniques and illustrations. A unique case surveillance at Cleveland Clinic made it possible for the authors to record the influence of data fusion centers. Data fusion integrates as needed multiple data originating from various data fusion centers and provides a coherent and inclusive health status for a given patient. Some examples are genetics databases, electronic health records databases, wearable sensors in real-time databases. Contemporary diagnostic tools’ feasibility and efficacy are explained through methodologies based on machine learning and deep learning. These studies have helped in early diagnosis of the illness signals and cost parameters minimization. Analyzing this article one can observe that the growing ethical considerations to be met are to allow intelligent machines to work in full efficiency. The problem area that has come up in relation to GCP is data privacy, which is viewed as a major concern, second to algorithmic bias and integration. The results of the study show that it is expected that Data Fusion Center offers pro and post progressively effective and fair president, especially on the health of the clients.

The role of self-efficacy in managing type 2 diabetes and emotional well-being: a cross sectional study

BackgroundManaging chronic conditions like Type 2 diabetes presents significant challenges, with self-efficacy—one’s belief in their ability to manage their health—playing a crucial role. This study investigates the influence of self-efficacy on emotional distress and health outcomes among Type 2 diabetes patients.MethodsWe conducted a cross-sectional study in Damascus with 336 Type 2 diabetes patients from three healthcare facilities. Data were collected through face-to-face interviews using validated questionnaires: the Diabetes Management Self-Efficacy Scale (DMSES), Problem Areas in Diabetes (PAID-5), and the World Health Organization-Five Well-being Index (WHO-5).ResultsAnalysis revealed that female gender and older age are significant factors influencing diabetes distress, with higher levels of distress observed in females and older patients. A negative correlation was found between self-efficacy and age, indicating reduced confidence in diabetes management among older individuals. Treatment modalities, such as oral hypoglycemic agents, were positively associated with higher self-efficacy. Significant associations were found between diabetes duration, age, and diabetes distress (PAID-5 scores), while self-efficacy (DMSES scores) varied based on treatment types.ConclusionsDespite high levels of diabetes distress and low psychological well-being, patients demonstrated commendable self-efficacy in managing their diabetes. Targeted interventions should address the needs of elderly female patients and those undergoing specific treatments to improve care outcomes. This study highlights the importance of tailored support and a holistic approach to diabetes management.

Innovative Environment of Pedagogical University Technology Park as a Factor for Study the Cognitive Activity of Students

This paper presents a new result of comprehension of literary sources related to the issues and architectonics of technoparks’ environment in pedagogical universities. Based on research analysis, the author identified blank spaces in the conditions of forming the cognitive activity by means of a foreign language for chemistry and biology students of non-linguistic training profiles. Cognitive activity is pointed out as a problem area, which can be influenced by the risks present during the training of students in Natural Sciences majors and profiles. The genesis of Technoparks of Universal Pedagogical Competencies is traced through a retrospective of the typology of Science and Technology Parks in their classic sense. The research context of this paper is in new and creative paradigm of the educational environment, which noted by modern scientists. It correlates with updated approaches and the sphere of concepts rethought by the author in the pedagogical and technological field, related to the realization of learning activities in the technopark of the pedagogical institution.

Surgery of premature infants-Perspectives and limitations

The continuous improvement in the quality of modern perinatology, sociodemographic changes and the increasing spread of reproductive medicine have resulted in an increasing number of premature infants to be treated. The treatment of preterm infants (< 37thweek of pregnancy) and especially extremely premature infants (< 28thweek of pregnancy) is challenging due to immature organ development, which differs considerably from that of other age groups. While the fate of premature infants and especially extremely premature infants was unfavorable 100 years ago, the survival of premature infants > 1000 g has now shifted to survival in over 80% of cases [30]. The main medical problem areas of immature patients are afetal proinflammatory immune system, an immature gastrointestinal tract with reduced transport capability, an incompletely developed intestinal barrier and adeveloping intestinal flora (microbiome) as well as immature lungs, which was significantly limiting for the survival of premature infants before the development of synthetic pulmonary surfactants. Furthermore, the central nervous system (CNS), which is far from being fully developed in preterm infants, is particularly vulnerable to exogenous factors, such as inflammation, toxins and medications. In addition, the CNS requires an environment appropriate to the developmental stage of the neonate to ensure normal physiological psychomotor development in the future. The article presents the special aspects of surgery on premature infants, the indications, complications and outcome, taking the special general problems of prematurity into account. Finally, the ethical conflicts associated with the care of extremely premature infants are briefly discussed.

Comprehensive Examination of Health Technology Assessment in Policy Formulation and Implementation

Health Technology Assessment, or HTA, is conceived as a key instrument to assess the clinical efficacy or efficiency and social impact of specific health technologies for policy purposes. This paper discusses incorporating HTA information in formulating and implementing policies focusing on the rational use of resources in healthcare systems. This study provides an understanding of the global case studies of HTA to outline the problem areas, advantages, and developments in the context of decision-making for health. The paper underscores seven evidence-based ways stakeholder involvement, methodological practices, and intersectoral cooperation create value in HTA.

Education in an Inclusive School: Limitations and Risks

In the article, the author raises the question of the specifics of the organization of education in an inclusive school, defines the limitations and risks of this process. Based on domestic legislation, domestic and foreign authors, the article formulates a set of features of an inclusive school. The lack of consideration of the risks of education in an inclusive school can lead to undesirable consequences in the educational process not only for children with disabilities, but also for other students. The purpose of the article. The purpose of the article is to identify problem areas, risk situations and limitations in the organization of the educational process in an inclusive school. Methodology and methods of research. The article examines the issues of education in an inclusive school from the standpoint of socio-pedagogical and inclusive approaches. Some issues of the organization of an inclusive educational system are based on concepts about the educational space, the way of school, and the culture of the educational organization. In the course of the research, methods of theoretical analysis, synthesis, collection of empirical material through observation, pedagogical reflection, etc. were used. The results of the study. The author characterizes the limitations of education in an inclusive school, which are systemic, but are not defined or difficult to determine in the process of introspection of an educational organization. Among them are the peculiarities of the nosology of students, the substitution of the upbringing of children with disabilities only with correctional and developmental activities, the specifics of the inclusion of children with disabilities in the school team. The characterization of restrictions allows us to identify the risks of education in an inclusive school, which, in turn, create conditions for changing the nature of education to an inappropriate inclusive approach, that is, excluding students with disabilities from certain types of activities. Conclusion. In conclusion, conclusions are drawn about the results of the analysis of education in an inclusive school.