Face Multiple Problems Research Articles

Crown Ether Electrolyte Induced Li2O2 Amorphization for Low Polarization and Long Lifespan Li‐O2 Batteries

AbstractLithium‐oxygen batteries possess an extremely high theoretical energy density, rendering them a prime candidate for next‐generation secondary batteries. However, they still face multiple problems such as huge charge polarization and poor life, which lay a significant gap between laboratory research and commercial applications. In this work, we adopt 15‐crown‐5 ether (C15) as solvent to regulate the generation of discharge products in lithium‐oxygen batteries. The coronal structure endows C15 with strong affinity to Li+, firmly stabilizes the intermediate LiO2 and discharge product Li2O2. Thus, the crystalline Li2O2 is amorphized into easily decomposable amorphous products. The lithium‐oxygen batteries assembled with 0.5 M C15 electrolyte show an increased discharge capacity from 4.0 mAh cm−2 to 5.7 mAh cm−2 and a low charge overpotential of 0.88 V during the whole lifespan at 0.05 mA cm−2. The batteries with 1 M C15 electrolyte can cycle stably for 140 cycles. Furthermore, the amorphous characteristic of Li2O2 product is preserved when matched with redox mediators such as LiI, with the charge polarization further decreasing to 0.74 V over a cycle life of 190 cycles. This provides new possibilities for electrolyte design to promote Li2O2 amorphization and reduce charge overpotential in lithium‐oxygen batteries.

Crown Ether Electrolyte Induced Li2O2 Amorphization for Low Polarization and Long Lifespan Li-O2 Batteries.

Lithium-oxygen batteries possess an extremely high theoretical energy density, rendering them a prime candidate for next-generation secondary batteries. However, they still face multiple problems such as huge charge polarization and poor life, which lay a significant gap between laboratory research and commercial applications. In this work, we adopt 15-crown-5 ether (C15) as solvent to regulate the generation of discharge products in lithium-oxygen batteries. The coronal structure endows C15 with strong affinity to Li+, firmly stabilizes the intermediate LiO2 and discharge product Li2O2. Thus, the crystalline Li2O2 is amorphized into easily decomposable amorphous products. The lithium-oxygen batteries assembled with 0.5 M C15 electrolyte show an increased discharge capacity from 4.0 mAh cm-2 to 5.7 mAh cm-2 and a low charge overpotential of 0.88 V during the whole lifespan at 0.05 mA cm-2. The batteries with 1 M C15 electrolyte can cycle stably for 140 cycles. Furthermore, the amorphous characteristic of Li2O2 product is preserved when matched with redox mediators such as LiI, with the charge polarization further decreasing to 0.74 V over a cycle life of 190 cycles. This provides new possibilities for electrolyte design to promote Li2O2 amorphization and reduce charge overpotential in lithium-oxygen batteries.

LEADERSHIP CHALLENGES IN DEVELOPING COUNTRIES: A CASE STUDY OF PAKISTANI HIGHER SECONDARY SCHOOLS

The main objective of the research was to explore public school principals’ leadership problems and the techniques they used to overcome those problems. A qualitative research case study was conducted involving 10 public school principals (5 male and 5 female) from district Mardan of Pakistan. The data were gathered through semi-structured interviews and analyzed using the thematic analysis process. The results show that public school principals in Pakistan face multiple problems, including lack of authority, insufficient assistance from higher authorities, lack of resources, and teacher recruitment and retention issues. Additionally, the research also found that public school principals in Pakistan combat their problems with a variety of techniques, including creating a friendly rapport with teachers, engaging the community in the educational process, seeking help from higher authorities, and effectively leveraging resources. Moreover, this research has also examined Pakistani female public school principals’ problems and tactics. The results show that female public-school principals in Pakistan experience typical male principals’ problems, including lack of autonomy, insufficient resources, and support from higher authorities, as well as gender inequity. The results of the study have significant implications for policy and practice as the results of the study can inform specific policies and practices that can help in enlightening public schools’ leadership in Pakistan to improve the quality of education for students.

What Does Leadership Do to the Leader? Using a Pattern-Oriented Approach to Investigate the Association between Daily Leadership Profiles and Daily Leader Well-Being

Leader behavior can vary daily, and leaders face multiple demands and problems in one day. Therefore, studying how leader behaviors interplay on the day-level (i.e., daily leadership profiles) is essential. Building on conservation of resources theory as a meta-theory, we investigated which daily leadership profiles exist and whether profile membership changes across one week. Additionally, we examined whether the leadership profiles are differentially related to leaders' daily well-being (i.e., emotional exhaustion, positive and negative affect), mediated by their daily experienced thriving and time pressure. In a diary study over five workdays (N = 289 leaders), we found three qualitatively different daily leadership profiles: one dominated by passive behaviors (passive), one dominated by transformational and contingent reward behaviors (transformational-rewarding), and one with elevated transformational and all transactional behaviors (comprehensive). The transformational-rewarding and the comprehensive profile showed greater stability across the week than the passive profile. Days in the transformational-rewarding profile were most beneficial for leaders' well-being. In contrast, days in the comprehensive profile seemed to be a double-edged sword for leaders, as indicated by higher experienced thriving and positive affect and simultaneously enhanced experienced time pressure, emotional exhaustion, and negative affect. Taken together, we illuminate the interplay of leadership behaviors on the day-level and the differential associations with leaders' well-being.

Elderly Abuse: the importance of a scientific and a participatory approach

Introduction: The world population of older adults, aged 60 and older, will double from 542 million in 1995 to 1.2 billion in 2025. Despite the fact that many of them are in good health, more and more people will face dementia, multiple problems and elder abuse (WHO, 2021). 
 In this abstract, we will concentrate on elder abuse, which is a complex and multifactorial problem but moreover a taboo subject which needs more community awareness.
 Purpose: Human rights and people’s health of older adults are being violated and this needs to be addressed on a massive scale. Efforts have already been done in developing scientific insights concerning early diagnosis, risk and protective factors as well as evidence-based interventions. 
 The problem is that professionals and organizations in our country often work above, under or next to each other on the subject. Moreover, the voices of older adults are neglected. Therefore we are making a call to cooperate in a participatory way. Integrated care will be the future to prevent elder abuse and to cope with it. We can’t do it alone. 
 Methods: In 2022 we could raise awareness through public involvement as both were invited in two programs on the Belgian Television:
 Canvas TV Documentary ‘Als je eens wist’ – series 3 – Canvas (made by Hilde Van Mieghem) – May 10th 2022: Rating: 189.158. 
 Canvas Contact Webinar ‘Hoe doorbreek je het taboe van ouderenmis(be)handeling’ (Interviewer Joris Hessels) - May 16th 2022: Rating: >100.
 Results: In both programs we raised the importance of breaking the taboo, the need for professional cooperation and the importance to listen to the voices of older adults through storytelling. In the Webinar we also could come in discussion with the audience. So we could address the health demands.
 Afterwards, co-design approach was set up by Odisee Advanced Education in cooperation with Vlaams Ondersteuningscentrum Ouderenmis(be)handeling (VLOCO), organizing an event called ‘Elderly Care is Safe Hands – The Power of Multidisciplinary Cooperation’ – 01st December 2022 – Brussels. Messelis e.a. will present an ‘Intervention Piramide on Elder Abuse’ to involve all kinds of professional organizations on different levels. Also a panel debate will be set up with different organizations and professionals.
 Conclusions: Our insights teach us that a very long way has already been made in terms of attention to elder abuse. Despite the many new insights and impact analyses, the topic of elder abuse remains a taboo and underappreciated problem. Only the tip of the iceberg is ever revealed.
 If we want to tackle the problem, we have to break the taboo and cooperate in a participatory way. Therefore we want to discuss with the international audience to learn other Evidence Based Practices. We also have a wake -up call for the legislator in order to create a clear legal framework. Governments can also do more to prevent and address elder abuse but also to support professional equipment’s and ‘antennas’. We never stand alone.
 

A Study to assess the Correlation between Stress, Body Mass Index and Blood Pressure among adolescents in selected Pre-University Colleges, Mangaluru

Majority of the adolescents undergo stress, whatever the sources may be internal or external, it hampers the major functioning of the body. Most of the youngsters face multiple problems in their life. Each individual has to cope with different kinds of pressure laid down by the society and family. Correlational Descriptive design to assess the Correlation between Stress, Body Mass Index and Blood Pressure among adolescents in selected Pre-University colleges, Mangaluru. The data collection instruments were Demographic proforma, Perceived stress scale and clinical profile. The results of the study revealed regarding level of stress majority 93(77.50%) had moderate level of stress, 16(13.33%) had high level of stress and only 11(9.17%) had low level of stress among adolescents studying in selected pre-university colleges. Majority 73(60.84%) had healthy weight, 46(38.33%) were underweight, one (0.83%) were overweight and none were obese among adolescents studying in selected pre-university colleges. Majority 92(76.67%) had normal blood pressure, 28(23.33%) were prehypertensive and none were in stage 1 and 2 of hypertension among adolescents studying in pre university colleges. Correlation between stress and BMI was weak negative (r= -0.0964) indicating that increase in stress level among adolescents their BMI decreases or vice versa. Correlation between BMI and systolic blood pressure was weak positive (r = 0.0762) indicating increase in BMI among adolescents there is increase in Systolic blood pressure or vice versa. The correlation between BMI and diastolic blood pressure was weak positive (r = 0.0853) indicating increase in BMI among adolescents there is increase in diastolic blood pressure or vice versa. correlation between stress and systolic blood pressure was weak positive (r = 0.023) indicating increase in stress among adolescents there is increase in Systolic blood pressure or vice versa. The correlation between BMI and diastolic blood pressure was weak positive (r = 0.003) indicating increase in stress among adolescents there is increase in diastolic blood pressure or vice versa. Hence, the null hypothesis was rejected H01 and research hypothesis was accepted. There was significant association between stress and in all demographic variables like Age in years, Religion, Class of study, Type of family, Number of siblings, Education of father, Education of mother, Occupation of father, Occupation of mother, Family Income per month and type of food consumed (p<0.05) except in stream of division (p>0.05). There was significant association between BMI and in all demographic variables like Class of study, Type of family, Number of siblings, Education of father, Education of mother, Occupation of father, Occupation of mother, Family Income per month and type of food consumed (p<0.05) except in Age in years, Religion, stream of division (p>0.05).There was significant association between systolic blood pressure and in demographic variables like Age in years, Religion, stream of division, Class of study, Education of father, Education of mother, Occupation of mother, Family Income per month and type of food consumed (p<0.05) except in Number of siblings, Type of family, Occupation of father and type of food consumed (p>0.05). Hence the research hypothesis was accepted and null hypothesis rejected. There was significant association between diastolic blood pressure and in demographic variables like Age in years, Religion, stream of division, Class of study, Number of siblings, Education of father, Education of mother, Occupation of father, Family Income per month and type of food consumed (p<0.05) except in Type of family, Occupation of mother and type of food consumed (p>0.05).

Palliative Care for the Elderly With Heart Diseases in Tertiary Health care: A Concept Analysis.

The increasing incidence of heart failure (HF) in the elderly leads to increased mortality, hospitalization, length of hospital stay, and health care costs. Older adults often face multiple drug treatments, comorbidities, frailty, and cognitive problems, which require early palliative care. However, these patients do not receive adequate palliative care. This concept analysis aimed to develop an in-depth understanding of palliative care for elderly patients with cardiac diseases in tertiary care. The analysis was guided by Walker and Avant's method, and databases were searched using keywords, such as palliative care, tertiary care, elderly, and heart. Covidence was used to review the results using the inclusion and exclusion criteria. The World Health Organisation's definition of palliative care is widely accepted. Palliative care for older adults with heart disease in tertiary care is preceded by chronic illness, polypharmacy, symptom burden, physical and cognitive decline, comorbidities, and psychosocial/spiritual issues. The main attributes of palliative care for this population include health care professionals and patient education, holistic patient/family-centered care, symptom management, shared decision-making, early integration, advanced care planning, and a multidisciplinary approach. Palliative care improves elderly cardiac patients' and their family satisfaction while reducing readmission, hospital stays, and unnecessary invasive procedures. Collaboration between hospitals, community organizations, transitional palliative care services, and research has the potential to improve early palliative care and the well-being of the elderly cardiac population. Advanced Practice Nurses (APNs) competencies play a crucial role in promoting palliative care in the elderly HF population.

Problems of Working Women in Islamabad: A Case of Four Public Organizations

Working women face many problems at the work place. Women workers face more challenges than male workers. For instance, being a working woman they are also house hold women and they have many responsibilities as well as professional responsibilities. They have to maintain balance between her home and career. Different problems such as attitude of society members and prejudice adversely affect the utilization of their talent and working abilities. The objectives of the study were to:(a) Find out the problems faced by the working women (b) Find out the attitude of their families towards working women (c)Check the existing status and security of the women. The study was a survey research type. Design of the study was a quantitative research. All the working women of Islamabad was population of the research study. The simple random sampling technique was used to select working women from various professions. Questionnaire was designed in order to collect data that was comprised of open ended and close ended questions. Population of the study was working women of Islamabad. Data were collected by personal visits. Questionnaires were distributed to a sample of 54 working women in Islamabad and thus data were collected. Data analysis were done through calculating mean score, percentage and frequencies. Result of the study shows that working women face multiple problems at workplace including, harassment, gender discrimination, work family adjustment and lack of support from the family. Study recommended that work organizations should provide a gender discrimination free environment and families might help and support working women to bring productivity and creativity in their work as this will help the families to lessen the financial burden.

A Novel Approach for Improving Guitarists’ Performance Using Motion Capture and Note Frequency Recognition

New guitarists face multiple problems when first starting out, and these mainly stem from a flood of information that they are presented with. Students also typically struggle with proper pitch frequency recognition and accurate left-hand motion. A variety of relevant solutions have been suggested in the existing literature; however, the majority have ultimately settled on two approaches. The first is finger motion capture, wherein researchers focus on extracting finger positions through analyzing images and videos. The second is note frequency recognition, wherein researchers focus on analyzing notes and frequencies from audio recordings. This paper proposes a novel hybrid solution that includes both finger motion capture and note frequency recognition in order to conduct a full assessment and give feedback on a guitarist’s performance. To classify hand positions, several classification algorithms are tested. The random forest algorithm obtained superior results, with an accuracy of 99% for overall hand movement and an average of 97.5% for the classification of each finger. Meanwhile, two algorithms were tested for note recognition, where the harmonic product spectrum (HPS) approach obtained the highest accuracy of 95%.

DE&I Policy as an honest hiring tool: Features of implementation and factors of influence

Aim. The presented study aims to determine factors that influence the quality and efficiency of a transition to the policy of Diversity, Equity & Inclusion (DE&I).Tasks. The authors analyze various aspects affecting the process of introducing the ideology of diversity, equity, and inclusion under modern conditions; identify possible reasons for the gap between the company’s strategy and individual HR decisions, by eliminating which the business will be able to make a step towards achieving the goals associated with the concept of DE&I.Methods. This study uses the methods of logic, analysis, review of literature, documents, and research results on the topic, modeling.Results. Today, a large number of organizations are striving to modernize many business processes as they face multiple social problems. The focus on diversity, equity, and inclusion at work is one such issue. The study examines the issue of companies’ transition to the DE&I (diversity, equity, inclusion) policy. Various aspects affecting the implementation of this ideology under modern conditions are analyzed. Possible reasons for the discrepancy between corporate strategy and individual HR decisions are identified, which can help the business to implement tasks associate with the DE&I concept.Conclusions. Diversity and inclusion contribute to creating an atmosphere where the employees feel confident sharing their ideas and respect the opinions of their co-workers even if they differ from other points of view. The working culture of inclusion and diversity serves as a basis for making the company more competitive in the market. In modern realities, a policy based on diversity, equity, and inclusion is valuable as an important factor in the organization’s success and a source of employee well-being. Therefore, every competent manager should carefully consider every stage in the implementation of DE&I technology.

Planning environmental impact assessment law in China: Status quo, implementation problems and legislative reform

As the primary form of strategic environmental assessment (SEA) mandated by law in China, the planning environmental impact assessment (PEIA) serves to anticipate the likely environmental impacts that may arise out of the proposed plans. In this research, systematic reviews of local practice and major reforms of the PEIA system were conducted to have a comprehensive understanding of the implementation of the PEIA system, so as to clarify the direction and focus of PEIA lawmaking. PEIA documents issued by local governments in China since 2010 were collected to find the development and breakthrough of PEIA laws in local practice. Major reforms of the planning system and environmental governance system in recent years were also examined to find the outdated premises of PEIA laws. The results showed that today the PEIA laws face multiple problems in implementation, including the exclusion of policy EIA, outdated screening and scoping requirements, insufficient guarantee for quality of the review procedure, limited public participation and information disclosure, confusing circumstances for initiating follow-up assessment, and invalid legal liability for participants of the EIA process. To solve these problems through legislative reform, this paper suggests amending the Environmental Impact Assessment Law to extend planning EIA to policy EIA, update the screening and scoping requirements, adjust procedures for review of EIA documents, strengthen public participation and supervision, specify procedures for follow-up assessments, and improve legal liability for violating PEIA obligations.

Multi-omics analysis reveals the host-microbe interactions in aged rhesus macaques.

Aging is a complex multifactorial process that greatly affects animal health. Multi-omics analysis is widely applied in evolutionary biology and biomedical research. However, whether multi-omics can provide sufficient information to reveal comprehensive changes in aged non-human primates remains unclear. Here, we explored changes in host–microbe interactions with aging in Chinese rhesus macaques (Macaca mulatta lasiota, CRs) using multi-omics analysis. Results showed marked changes in the oral and gut microbiomes between young and aged CRs, including significantly reduced probiotic abundance and increased pathogenic bacterial abundance in aged CRs. Notably, the abundance of Lactobacillus, which can metabolize tryptophan to produce aryl hydrocarbon receptor (AhR) ligands, was decreased in aged CRs. Consistently, metabolomics detected a decrease in the plasma levels of AhR ligands. In addition, free fatty acid, acyl carnitine, heparin, 2-(4-hydroxyphenyl) propionic acid, and docosahexaenoic acid ethyl ester levels were increased in aged CRs, which may contribute to abnormal fatty acid metabolism and cardiovascular disease. Transcriptome analysis identified changes in the expression of genes associated with tryptophan metabolism and inflammation. In conclusion, many potential links among different omics were found, suggesting that aged CRs face multiple metabolic problems, immunological disorders, and oral and gut diseases. We determined that tryptophan metabolism is critical for the physiological health of aged CRs. Our findings demonstrate the value of multi-omics analyses in revealing host–microbe interactions in non-human primates and suggest that similar approaches could be applied in evolutionary and ecological research of other species.

Scheduling and Sizing of Campus Microgrid Considering Demand Response and Economic Analysis.

Current energy systems face multiple problems related to inflation in energy prices, reduction of fossil fuels, and greenhouse gas emissions which are disturbing the comfort zone of energy consumers and the affordability of power for large commercial customers. These kinds of problems can be alleviated with the help of optimal planning of demand response policies and with distributed generators in the distribution system. The objective of this article is to give a strategic proposition of an energy management system for a campus microgrid (µG) to minimize the operating costs and to increase the self-consuming energy of the green distributed generators (DGs). To this end, a real-time based campus is considered that currently takes provision of its loads from the utility grid only. According to the proposed given scenario, it will contain solar panels and a wind turbine as non-dispatchable DGs while a diesel generator is considered as a dispatchable DG. It also incorporates an energy storage system with optimal sizing of BESS to tackle the multiple disturbances that arise from solar radiation. The resultant problem of linear mathematics was simulated and plotted in MATLAB with mixed-integer linear programming. Simulation results show that the proposed given model of energy management (EMS) minimizes the grid electricity costs by 668.8 CC/day ($) which is 36.6% of savings for the campus microgrid. The economic prognosis for the campus to give an optimum result for the UET Taxila, Campus was also analyzed. The general effect of a medium-sized solar PV installation on carbon emissions and energy consumption costs was also determined. The substantial environmental and economic benefits compared to the present situation have prompted the campus owners to invest in the DGs and to install large-scale energy storage.

A health service package for residents of informal settlements: A developing country

ABSTRACT The residents of informal settlements lack sufficient access to health services. This has been threatening everyaspect of their lives for years. The aim of the current study was to design a health services package for the residents of such informalsettlements in Iran. This was a qualitative study conducted in 2021 in multiple stages. The needs identified in the previous study wereprovided to experts to reach an agreement by the Delphi method. The expert panel was then used to design a service packageproportional to the health needs of informal settlement residents. Experts agreed on 40 identified health needs, classified incontagious and non-communicable diseases, female health mental and social health and addiction, environmental health, and othercategories. The health service package included five main dimensions: care related to (1) social supports and mental health, (2) economic supports, (3) empowering the community, (4) environmental health, and (5) prevention and health level improvement. A total of 43 services were proposed in this package to improve the health status in such settlements. Informal settlements face multiple diversehealth problems. A multi-dimensional plan is necessary to address identified needs, requiring intersectoral cooperation betweeninvolved organizations and stakeholders.

Comprehensive approach to reintegration of disability benefit recipients with multiple problems (CARm) into the labour market: results of a randomized controlled trial

Purpose Although most clients on work disability benefits face multiple problems, most traditional interventions for (re)integration focus on a single problem. The aim of this study was to evaluate the “Comprehensive Approach to Reintegrate clients with multiple problems” (CARm), which provides a strategy for labour experts to build a relationship with each client in order to support clients in their needs and mobilize their social networks. Methods This study is a stratified, two-armed, non-blinded randomized controlled trial (RCT), with a 12-month follow-up period. Outcome measures were: having paid work, level of functioning, general health, quality of life, and social support. Results We included a total of 207 clients in our study; 97 in the intervention group and 110 in the care as usual (CAU) group. The clients’ mean age was 35.4 years (SD 12.8), 53.1% were female, and 179 (86.5%) reported multiple problems. We found the CARm intervention to have no significant effects superior to those of the CAU group on all outcomes. Conclusion As we found no superior effect of the CARm intervention compared to CAU, we cannot recommend widespread adoption of CARm. A process evaluation will give more insight into possible implementation failure of the intervention. IMPLICATIONS FOR REHABILITATION Most traditional interventions for (re)integration into the labour market are problem-centred, i.e., focusing on a single problem, and have limited effectiveness in persons with multiple problems. A strength-based intervention may be suitable for vocational rehabilitation and disability settings, since it contains many elements (e.g., being strength-based, focused on clients’ wishes and goals, and involving activation of the social environment) also likely to improve chances of re-employment of persons with multiple problems. In this study a strength-based intervention did not show a superior effect on paid employment and functioning within one year follow-up compared to care as usual in people with multiple problems on a work disability benefit.

Inclusive Development of Persons with Disabilities in India: A Situational Analysis

In India around 2.68 Cr persons are disabled which constitutes 2.21% of the total population. Therefore Inclusive development of the disabled persons has been initiated by the government by implementing various welfare and development measures for comprehensive development of persons with disabilities in the country. In international level UN convention of Person with Disabilities indicates that Persons with all types of disabilities must enjoy human rights and fundamental freedom without any barrier. Even SDGs also addresses the issues concerning to disabled persons with its aim of Leaving No One Behind. In spite of many efforts right from Nation to Globe still Persons with disabilities are more vulnerable and they face multiple problems in terms of accessibility of social services, education, health, rehabilitation and support system at community level. Therefore there is an urgent need to take serious calls to strethaning this able population on priority basis. The present paper has been planned with view to discuss the situation of disabled persons in terms of their empowerment and also focuses on various policies and welfare measures related to Inclusive development of Person with disabilities and to suggest proper measures for achieving comprehensive development of Persons with Disabilities.

Depression, Adherence, and Functionality in Patients Undergoing Hemodialysis.

Background Patients undergoing hemodialysis face multiple problems such as difficulties in performing daily activities, low functional capacity, non-adherence to the hemodialysis regimen, and depressive symptoms that lead to poor health outcomes. The present study aimed to assess the levels of depression, adherence, and functionality in patients undergoing hemodialysis, as well as the association between the above variables.Materials and methodsIn this cross-sectional study, 100 patients undergoing hemodialysis from a private hospital in Athens participated. Data were collected via the Zung Self-Rating Depression Scale, the Barthel Scale/Index, and the Greek Simplified Medication Adherence Questionnaire-Hemodialysis for the evaluation of patients’ depression, functionality, and adherence to hemodialysis regimen, respectively. In addition, sociodemographic and clinical characteristics were recorded. The study was conducted during the period of December 2020 to February 2021. IBM SPSS Statistics for Windows, Version 25.0 (Released 2017. IBM Corp., Armonk, New York) was used for the statistical analysis of the data. The statistical significance level was set up at 0.05.ResultsOf the patients, 50% scored < 38 (possible range 20-80) in the scale pof depression, and 25% of patients scored < 34. Regarding adherence, the median value was 7 (IQR: 7-7) while 77% scored 7 (possible range of 0-8). Regarding functionality, mild dependence (score 91-99) was referred by 77% of the participants, moderate dependence (score 61-90) by 17%, and severe dependence (score 21-60) was referred by 6% of the patients. A statistically significant negative association emerged between depression and functionality (r= -0.342, p=0.001) while no significant association arised between depression and adherence (r= 0.021,p=0.836) as well as between adherence and functionality (r = 0.078, p = 0.439). Statistical significantly higher scores of depression were seen in women (β = 3.65, p = 0.001) and elderly >70 years old (β = 3.51, CI=0.09-6.93, p = 0.044). Statistically significantly lower functionality were referred by patients >70 years old (β = -13.58, CI: -21.68-5.49, p = 0.001) and by patients with high depression score (β= -0.62, 95% CI: -1.06-0.20, p = 0.005).ConclusionPatients experienced moderate to low levels of depression and high levels of adherence and functionality. The higher the functionality scores, the lower the depression scores. Demographic characteristics, such as age and gender, seem to be significant predictors of depression and functionality.

Challenges of Developing Novel Vaccines and Large Scale Production Issues

Live attenuated and inactivated pathogens, as well as subunit vaccinations, can give long-term protection against a variety of deadly diseases. Despite this progress, vaccine development for a number of infectious diseases, particularly those that are more capable of evading the adaptive immune response, remains a serious issue. Furthermore, the fundamental impediment to the greatest uptake of virus vaccines isn’t usually the efficacy of conventional procedures, but rather the requirement for more fast research and large-scale manufacture. As a result, the development of more powerful and adaptable vaccine platforms is critical. The complexities of developing the manufacturing process, formulation, and analytical assays, as well as the problem of scientific assay optimization, are the most well-known barriers to vaccine development failures or delays. Scientists argue that the extremely concentrated state of global vaccine manufacturing capacity limits large-scale vaccine production. At the moment, only a few countries have the capacity to make vaccines on their own. Scaling up vaccine production is difficult, and a shortage of manufacturing sites is limiting global vaccine availability. Vaccine manufacturing and the development of breakthrough technologies capable of producing huge quantities of vaccines against known and undiscovered infections are difficult tasks nowadays. Vaccines can be made as suspensions, emulsions, or freeze-dried powders with a variety of adjuvants. However, many of those manufactured vaccines face multiple problems from a pharmaceutical standpoint, including the risk for acute hypersensitivity reactions, the need for extremely cold storage temperatures, and handling and delivery requirements. These requirements should limit vaccine supply to different populations, which has a negative impact on health equity. In the production of vaccines during upstream and downstream processes, new facilities, equipment, and enabling technology may be required, some of which may have an impact on how existing vaccines are manufactured. Despite these advancements, long-standing difficult circumstances will persist or worsen. Despite the fact that the number of individuals required is significantly less than in massive phase 3 studies, pharmacokinetic investigations can be logistically challenging and expensive. Even if there are challenging scenarios for implementing new pharmacokinetic models, there may be significant value in doing so, even in the context of an approved medication. The use of this ethically complex and contentious method for vaccine evaluation would necessitate interdisciplinary, global oversight to ensure that the results are rigorous and justify the potential dangers to participants and their communities.

Effect of a model based on education and teleassistance for the management of obstetric emergencies in 10 rural populations from Colombia.

IntroductionPregnant women and health providers in rural areas of low-income and middle-income countries face multiple problems concerning high-quality obstetric care. This study was performed to identify changes in maternal and perinatal indicators after implementing a model based on education and telecare between a high-complexity hospital in 10 low-complexity hospitals in a southwestern region of Colombia.MethodsA quasiexperimental study with a historic control group and without a pretest was conducted between 2017 and 2019 to make comparisons before and after obstetric emergency care through the use of teleassistance from 10 primary care centers to the referral center (Fundación Valle del Lili, FVL).ResultsA total of 470 patients were treated before teleassistance implementation and 154 patients were treated after teleassistance implementation. After program implementation, the maternal clinical indicators showed a 65% reduction in the number of obstetric patients who were referred with obstetric emergencies. The severity of maternal disease that was measured at the time of admission to level IV through the Modified Early Obstetric Warning System score was observed to decrease.ConclusionThe implementation of a model based on education and teleassistance between low-complexity hospitals and tertiary care centers generated changes in indicators that reflect greater access to rural areas, lower morbidity at the time of admission, and a decrease in the total number of emergency events.

A syndemic examination of injecting drug use, incarceration and multiple drug-related harms in French opioid users.

People who inject drugs (PWID) face multiple health problems, including infectious diseases and drug overdoses. Applying syndemic and risk environment frameworks, this paper aims to examine the co-occurrence and clustering of drug-related harms and their association with incarceration experience with or without in-prison drug injection. The authors used data from a cross-sectional survey conducted in 2015 among 557 active opioid injectors. Self-reported data were collected through face-to-face or online questionnaires. They distinguished three harm categories, namely, viral infections, bacterial infections and overdoses, and built an index variable by summing the number of harm categories experienced, yielding a score from 0 to 3. Association between incarceration experience and co-occurrence of harms was modelled using a multinomial logistic regression. Of the 557 participants, 30% reported lifetime experience of drug-related viral infection, 46% bacterial infection and 22% drug overdose. Multinomial logistic models showed that those who injected drugs during incarceration were more likely to report two (aOR = 2.35, 95% CI: 1.03-5.36) and three (aOR = 9.72, 95% CI: 3.23-29.22) harm categories than those who had never been incarcerated. They were also more likely to report three harm categories than formerly incarcerated respondents who did not inject drugs in prison (aOR = 5.14, 95% CI: 1.71-15.48). This study provides insights of the syndemic nature of drug-related harms and highlights that drug injection during incarceration is associated with co-occurring harms. Public health interventions and policy changes are needed to limit the deleterious impact of prison on PWID.