High Dependence Research Articles

Molecular engineering design of twisted-backbone pure Type-I organic photosensitizers for hypoxic photodynamic therapy.

Photodynamic therapy (PDT), an emerging tumor therapeutic strategy has received tremendous attention. Enslaved by the high dependence of oxygen, Type-II photosensitizers (PSs) mediated PDT is restricted by the hypoxic environment of tumors. By transferring electrons to water or other substrates instead of oxygen, Type-I PSs hold the promise of achieving an ideal therapeutic effect under hypoxic conditions. In this study, three twisted-backbone PSs (CBz-TQs-1, CBz-TQs-2 and CBz-TQs-3) are synthesized and studied. Owing to different substituent effects, the ROS generation mechanism transfers from pure Type-II of their prototype PSs (TQs-1, TQs-2 and TQs-3) to mixed Type-I/II of CBz-TQs-1 and CBz-TQs-2 to pure Type-I of CBz-TQs-3. Moreover, CBz-TQs-3 exhibits an ultra-high ROS quantum yield (∼1.0). The in vitro and in vivo PDT effects of water-dissolvable nanoparticles (NPs) of CBz-TQs-3 are investigated. The results show that the phototoxicity of CBz-TQs-3 is not affected by hypoxic environments. In addition, a remarkable tumor ablation can be found after CBz-TQs-3 NPs mediated PDT on Balb/c mice with xenograft tumors. It proves that a twisted backbone strategy is beneficial for designing pure Type-I PSs with high-efficient hypoxic PDT.

Health-Related Quality of Life in severely injured patients in Finland: an observational cohort study of 325 patients with 1-year follow-up

BackgroundMajor trauma has a significant effect on Health-Related Quality of Life (HR-QoL). It is unclear, however, which factors most affect HR-QoL. This study aims to evaluate HR-QoL after severe injury in Finland and determine how different injury patterns and patient-related factors, such as level of education and socioeconomic group, are associated with HR-QoL. We also assess how well different injury scoring systems associate with HR-QoL.MethodsWe retrospectively analyzed 325 severely injured trauma patients (aged ≥ 18 years, New Injury Severity Score, (NISS) ≥ 16, and alive at 1 year after injury) treated in the Intensive Care Unit (ICU) or High Dependence Unit (HDU) of Tampere University Hospital (TAUH) from 2013 through 2016. HR-QoL was assessed with the EQ-5D-3L questionnaire completed during ICU stay and 1 year after injury. HR-QOL index values and reported problems were further compared with Finnish population norms.ResultsThe severity of the injury (measured by ISS and NISS) had no significant association with the decrease in HR-QoL. Length of ICU stay had a weak negative correlation with post-injury HR-QoL and a weak positive correlation with the change in HR-QoL. The largest mean decrease in HR-QoL occurred in patients with spinal cord injury (Spine AIS ≥ 4) (-0.338 (SD 0.136)), spine injury in general (Spine AIS ≥ 2 (-0.201 (SD 0.279)), and a lower level of education (-0.157 (SD 0.231)). Patient’s age, sex, or socioeconomic status did not seem to associate with smaller or greater changes in HR-QoL.ConclusionsAfter serious injury, many patients have permanent disabilities which reduce HR-QoL. Injury scoring systems intended for assessing the risk for death did not seem to associate with HR-QoL and are not, therefore, a meaningful way to predict the future HR-QoL of a severely injured patient. Recovery from the injury seems to be weaker in poorer educated patients and patients with spinal cord injury, and these patients may benefit from targeted additional measures. Although there were significant differences in baseline HR-QoL levels between different socioeconomic groups, recovery from injury appears to be similar, which is likely due to equal access to high-quality trauma care.

Analysis of postural stability using foam posturography in patients with persistent postural-perceptual dizziness.

Persistent postural-perceptual dizziness (PPPD) is worsened in a standing posture, or by body movement, or visual stimulation. We aimed to evaluate postural stability in PPPD patients using foam posturography and to investigate the dependence on visual and somatosensory input in the standing posture. Foam posturography was performed on 53 PPPD patients, and data from the PPPD patients were compared with the data from an age- and sex-matched healthy controls. The PPPD patients were divided into four groups based on the findings of vestibular function tests and the effect of vestibular function on posturographic data was examined. Romberg's ratios were significantly higher in PPPD patients than in controls. The median Romberg's ratios in PPPD patients with normal vestibular function were also higher than those in controls. However, foam ratio was significantly lower in PPPD patients than in controls. The median foam ratios in PPPD patients with vestibular dysfunction were also lower than those in controls. In a standing posture, PPPD patients may be more dependent on visual input and less dependent on somatosensory input than healthy subjects. Higher dependence on visual and lower dependence on somatosensory input in PPPD may be a feature unaffected by vestibular function.

Characterization and mid-term outcomes of current out-of-hospital cardiac arrest patients admitted to intensive cardiovascular care units

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Consell Català de Resuscitació. Background Out-of-hospital cardiac arrest (OHCA) accounts the 50% of cardiovascular deaths. Being aware of characteristics and outcomes of our OHCA population is important in order to apply measures in the weaker areas to improve the results of the process. Purpose To investigate current outcomes, at 6-month follow-up, of patients admitted to an Intensive Cardiac Care Unit (ICCU) in a mediterranean area during the 2020s. Current characteristics, prehospital management and factors related to outcomes were also analyzed. Methods PCR-Cat was a prospective observational multicentre registry. OHCA patients admitted to the ICCU of 8 hospitals were included from October/2020 to December/2021. Those who survived with good neurological status, no disabilities, and remained independent for usual life activities, were classified as Good Outcome (GO). Those patients who died or had a poor neurological status, with high dependency or rested in permanent vegetative status were classified as Poor Outcome (PO). A multinomial logistic regression was done to analyze the factors independently related to PO. Results 288 patients were included, only 50 (17.36%) were women. At 6-month follow-up, 48.95% of patients had GO. Most events happened in the first month (Figure 1). The cause of death was neurological in 72.9%. Patients with PO were significantly older (63.74 vs. 58.88, p=0.003) and had more comorbidities (Table 1A). The most frequent location was on a public space (54.84%) and most were witnessed (88.93%). Cardiopulmonary resuscitation maneuvers were initiated by a bystander in 69.18% until EMS arrival, being only 20.79% done by an experienced bystander. The medium no-flow time was low (2 min) but total time until ROSC was of 28 min. First rhythm was shockable in 80%, but an automatic external defibrillator was only used in 58% of cases. Statistically significant lower values of first pH and higher values of first lactate, glucose and creatinine were related to PO (Table 1B). Patients with PO had a higher APACHE II (26 vs. 20, p<0.001) and SOFA (10.39 vs. 7.14, p<0.001) scores at admission, and required a longer time on mechanical ventilation (6 vs. 3.5 days, p=0.001). The main cause of the OHCA was acute coronary syndrome (53.82%), followed by chronic coronary syndrome (7.64%) and dilated myocardiopathy (7.64%). In the multinomial logistic regression, older age (p=0.005), male sex (p=0.016), previous stroke (p=0.046), longer ROSC time (p<0.001) and non-shockable first rhythm (p<0.001) were independently related to PO. Receiving cardiopulmonary resuscitation maneuvers by an experienced bystander was related to a reduction of 17 min of ROSC (p=0.001). Conclusions Less than a half of patients admitted to an ICCU because of an OHCA had GO at 6-month follow-up. Age, male sex, previous stroke, longer ROSC time and non-shockable first rhythm were factors independently related to PO. Interventions addressed to reduce ROSC time are urgently needed.

Navigating the uncommon: a case of caesarean section associated with exercise-induced anaphylaxis

Exercise-induced anaphylaxis (EIA) and food-dependent exercise-induced anaphylaxis (FDEIA) are rare but serious conditions where physical activity triggers severe allergic reactions. These are rarely reported in pregnant women undergoing caesarean section. We present the case of a 33-year-old woman with a history of EIA, scheduled for a caesarean section at 37 weeks of gestation. To manage the planned caesarean section, a multidisciplinary team strategy was devised to mitigate anaphylaxis risks. The surgery proceeded without complications under spinal anaesthesia, and the patient did not exhibit any anaphylactic reactions. The patient was monitored in the high dependency unit (HDU) and was discharged two days later. This case highlights the importance of individualized anaesthesia planning, multidisciplinary collaboration, and detailed preparation to ensure the safety of pregnant patients with EIA undergoing caesarean section.

Evaluation of Knowledge among Nurses about Pressure Ulcer in a Tertiary Care Hospital, Lahore

Background: Pressure ulcers are a prevalent issue in healthcare settings, leading to significant morbidity and increased healthcare costs. Nurses play a crucial role in the prevention and management of these conditions, yet gaps in knowledge can affect patient outcomes. The study aimed to assess the knowledge of nurses at a tertiary care hospital in Lahore, Pakistan, a setting where pressure ulcer management is critical yet understudied. Objective: This study aimed to evaluate the current level of knowledge among nurses regarding pressure ulcer prevention and management, and to identify any significant differences in knowledge across various critical care settings within the hospital. Methods: A cross-sectional descriptive study was conducted at Shalamar Hospital, Lahore, involving 125 staff nurses and nursing interns selected via simple random sampling. Participants were required to have at least six months of experience in general wards. Data were collected using a validated questionnaire, assessing knowledge of pressure ulcer management. Ethical approval was obtained from the Shalamar College of Nursing's ethical committee. Data analysis was performed using SPSS version 25 and Microsoft Excel, applying descriptive and inferential statistics, including the Chi-square test, with a significance level set at p<0.05. Results: The study revealed that 68.8% (86/125) of nurses had average knowledge, 29.6% (37/125) demonstrated good knowledge, and only 1.6% (2/125) exhibited poor knowledge regarding pressure ulcer management. Notably, nurses in the Surgical Intensive Care Unit (SICU) and High Dependency Unit (HDU) displayed the highest levels of knowledge, whereas those in the Medical Intensive Care Unit (MICU), Cardiac Care Unit (CCU), and Emergency Room (ER) had comparatively lower knowledge levels. Conclusion: The majority of nurses at Shalamar Hospital possessed an average level of knowledge concerning pressure ulcer management. There is a critical need for targeted educational interventions to enhance knowledge and practices, particularly in units where nurses showed lower knowledge levels. Improving nurse education in pressure ulcer management could significantly impact the quality of patient care and reduce the prevalence of these injuries.

Utilization of Waste Marble and Bi2O3-NPs as a Sustainable Replacement for Lead Materials for Radiation Shielding Applications

In an attempt to reutilize marble waste, a new approach is presented in the current study to promote its use in the field of shielding against ionizing radiation. In this study, we aimed to develop a novel and sustainable/eco-friendly lead-free radiation shielding material by improving artificial marble (AM) produced from marble waste combined with polyester by reinforcing it with bismuth oxide (Bi2O3) nanoparticles. Six samples of AM samples doped with different concentrations (0%, 5%, 10%, 15%, 20%, and 25%) of Bi2O3 nanoparticles were prepared. The linear attenuation coefficient (LAC) values were measured experimentally through the narrow beam method at different energies (0.0595 MeV, 0.6617 MeV, 1.1730 MeV, and 1.330 MeV) for all samples with various concentrations of Bi2O3. Radiological shielding parameters such as half value layer (HVL), tenth-value layer (TVL), and radiation shielding efficiency (RSE) were estimated and compared for all the different samples. The results prove that increasing the concentration of Bi2O3 leads to the enhancement of the radiation shielding properties of the AM as a shielding material. It was observed that as the energy increases, the efficiency of the samples falls. High energy dependence was found when calculating the HVL and TVL values of the samples, which increased with increases in the energy of the incident photons. A comparison between the sample with the most efficient gamma radiation attenuation capability (AM-25%), concrete, and lead was conducted, and a discussion regarding their radiation shielding properties is presented herein. The results show that the AM-25% sample is superior to the ordinary concrete over all the studied energy ranges, as evidenced by its significantly lower HVLs. On the contrary, lead is superior to the AM-25% sample over all the studied energy ranges owing to its unbeatable density as a shielding material. Overall, this new type of artificial marble has the potential to be used as a radiation shielding material at low- to medium-gamma energy regions, specifically in medical imaging and radiation therapy.

A new era for African health systems: Market shaping and the African Continental Free Trade Area (AfCFTA)

AbstractThe COVID‐19 pandemic has forced a reflection on the origins of supplies in African healthcare market and underscored the need for an increase in local manufacturing of medical supplies. Several African countries’ health markets have been heavily reliant on imports. First, this article demonstrates how the African healthcare market has had a high import dependency and the role that the African Continental Free Trade Area (AfCFTA) could play to reverse this. It is estimated that African countries import between 80% and 94% of medical supplies, 75% of testing kits, between 70% and 95% of pharmaceuticals, and 99% of vaccines. Second, during the COVID‐19 pandemic, countries imposed export restrictions which impacted the flow of medical supplies to African countries. This finding highlighted the limited production capabilities on the African continent and reiterated the need to strengthen continental value chains and local manufacturing capacity to establish the continent's New Public Health Order. Third, there was the emergence of local innovations seeking to minimize the impact of these supply chain disruptions. Using case studies on the local production of COVID‐19 testing kits and personal protective equipment, the article highlights progress made toward health market reform. It calls attention to the implementation of the AfCFTA to strengthen the supply, manufacturing, and trade of medical resources. Fourth, this article highlights countries that have African‐made pharmaceuticals and vaccinations and the importance of regional hubs to expand these products in African healthcare markets. It concludes by discussing investments made to expand local manufacturing of health products.

Clinical Spectrum and Fetomaternal Outcomes in Near Miss Patients Presenting to a Tertiary Care Hospital

Background and Objectives: Maternal near miss events are life threatening obstetric conditions which need urgent medical help in order to prevent maternal death. Audit of near miss events is a surveillance tool which is used to assess the quality of antenatal care in a setting and help in identifying causes to improve the maternal outcome. The objective was to find out the frequency, clinical spectrum and fetomaternal outcome in near miss patients presenting to a tertiary care hospital.Methods: This was case-series observational study, conducted in Lady Willingdon Hospital, Lahore from January 2022 to December 2022. Eighty women were included. Each case was analyzed regarding age, gestational age, parity, examination findings, laboratory diagnosis, management plan, feto-maternal outcome, level of post-operative care, number of blood transfusions and complications.Results: Most patient's were from age bracket 30-40 years, gestational age 28-36 weeks, parity P2-P4. The leading causes of near miss events were hemorrhage (48.75%), followed by hypertensive disorders (31.25%), viral hepatitis (8.75%), uterine rupture (6.25%), sepsis (5%) and ruptured ectopic pregnancy (3.75%). As maternal outcome, there were four deaths. Our fifty-eight patients (72.5%) required regular level-1 care, eighteen patients (22.5%) required high dependency unit level-2 care and four patients (5%) required intensive care unit level-3 care. Seventy-one babies were delivered. Sixty-one were born alive while ten were still born. Neonatal ICU admissions were twenty-seven, out of these twenty-two were discharged from nursery and early neonatal deaths were five.Conclusion: Near miss events, if treated timely at well-equipped facility may prevent progression to life threatening situations.Keyword: Near miss events, hemorrhage, hypertension, antenatal care

Cross-talk between leukemic and immune cells at the tumor microenvironment in chronic lymphocytic leukemia: An update review.

Chronic lymphocytic leukemia (CLL) is a mature-type B cell malignancy correlated with significant changes and defects in both the innate and adaptive arms of the immune system, together with a high dependency on the tumor microenvironment. Overall, the tumor microenvironment (TME) in CLL provides a supportive niche for leukemic cells to grow and survive, and interactions between CLL cells and the TME can contribute to disease progression and treatment resistance. Therefore, the increasing knowledge of the complicated interaction between immune cells and tumor cells, which is responsible for immune evasion and cancer progression, has provided an opportunity for the development of new therapeutic approaches. In this review, we outline tumor microenvironment-driven contributions to the licensing of immune escape mechanisms in CLL patients.

Abstract PO3-07-02: Radiomics Models for B-mode Breast Ultrasound and Strain Elastography to improve Breast Cancer Diagnosis (INSPiRED 005): An International, Multicenter Analysis

Abstract Background: Breast Elastography, a technique that quantifies tissue stiffness, has been evaluated to objectify and improve the performance of B-mode breast ultrasound. However, large prospective trials showed benefits in BI-RADS 4a breast masses only and a high operator dependency. Modern Artificial Intelligence techniques for automated image processing like radiomics, a technique where quantified features are extracted from images, may overcome these limitations. We aimed to develop and validate radiomics models based on B-mode and Strain Elastography (SE) images for patients with BI-RADS 3 or 4 breast masses and compare their performance to the respective human experts. Methods: This is a secondary analysis of an international, multicenter trial (NCT02638935), evaluating the performance of SE in women with BI-RADS 3 or 4 breast masses. Women were recruited at 12 institutions in 7 countries and underwent B-mode breast ultrasound as well as SE. B-mode images were saved and re-assed by three ultrasound readers ( >10 years of experience), resulting in three independent assessments and a final consensus assessment. SE was interpreted using the E-/B ratio. B-mode and strain images were manually segmented and quantitative radiomics features were extracted using pyradiomics. We used 10-fold cross-validation to build machine learning models (XGBoostTree, MARS) based on data of 11 of 12 study sites. The data of the 12th (largest) study site was used as external validation set. Performance metrics included sensitivity, specificity and area under the receiver operator characteristic curve (AUROC). Results: The study included a total of 1288 patients, 1206 with evaluable B-mode images and 1190 with evaluable Strain images. Mean age was 46.6 years (SD 16.02) and a total number of 29.0% (350 of 1206) and 28.9% (344 of 1190) breast masses were malignant in the B-mode and Strain cohort, respectively. Distribution of BI-RADS categories was 33.0%, 34.5%, 14.5%, and 18.0% for BI-RADS 3, 4a, 4b, and 4c, respectively. In the external validation set (n = 342), the B-mode radiomics model (XGBoostTree) achieved an AUROC of 0.86 (95% CI 0.82 to 0.90), with a sensitivity of 97.4% (95% CI 0.93 to 1.00, 113 of 116) and a specificity of 27.0% (95% CI 0.21 to 0.33, 61 of 226). The model showed equivalent performance compared to the three ultrasound readers (P = 0.133); see also Table 1. In the external validation set (n = 333), the Strain radiomics model (MARS) achieved an AUROC of 0.84 (95% CI 0.79 to 0.88), with a sensitivity of 100% (95% CI 47.0 to 58.0, 115 of 115) and a specificity of 25.5% (95% CI 0.22 to 0.34, 60 of 218). The model showed equivalent performance compared to the three ultrasound readers (P = 0.696) and performed significantly better compared to SE (P = 0.002); see also Table 1. Sensitivity of the strain model was descriptively higher (100% vs. 97.4%, see Table 1). Both models were well-calibrated. Conclusion: This is the largest development and validation study for radiomics models based on B-mode breast ultrasound and SE, to date. The radiomics models performed on par with human readers, with the strain radiomics model showing potential to identify initially missed carcinomas in BI-RADS 3 breast masses. Future implementation studies may evaluate the performance of these image analysis algorithms in clinical routine and their integration into the multi-modal breast cancer diagnostics process, including mammography and MRI. Table 1. Diagnostic performance metrics Citation Format: André Pfob, Tanja He, Lie Cai, Richard G. Barr, Volker Duda, Zaher Alwafai, Corinne Balleyguier, Dirk-André Clevert, Sarah Fastner, Christina Gomez, Manuela Goncalo, Ines Gruber, Markus Hahn, André Hennigs, Panagiotis Kapetas, Sheng-Chieh Lu, Juliane Nees, Ralf Ohlinger, Fabian Riedel, Matthieu Rutten, Benedikt Schaefgen, Anne Stieber, Riku Togawa, Mitsuhiro Tozaki, Sebastian Wojcinski, Cai Xu, Geraldine Rauch, Jörg Heil, Chris Sidey-Gibbons, Michael Golatta. Radiomics Models for B-mode Breast Ultrasound and Strain Elastography to improve Breast Cancer Diagnosis (INSPiRED 005): An International, Multicenter Analysis [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-07-02.

Synergizing Battery-Powered Permanent Magnet Synchronous Motor Control with Integrated Modular Multilevel Converter Systems

This proposed work presents a comprehensive examination of a modular multilevel converter (MMC) combined with a permanent magnet synchronous motor (PMSM) for battery energy management in applications. In order to provide effective energy transfer and dynamic control, the Modular Multilevel Converter serves as a bridge between the battery system and the Permanent Magnet Synchronous Motor drive. By cleverly controlling energy flow and minimizing losses during charging and discharging cycles, the combination of MMC with PMSM seeks to increase energy efficiency and prolong battery life. Since the energy source provides all of the power for the motor, it runs at a constant pace. When the accelerating mode finishes, the energy storage receives just enough power to maintain a steady voltage. The energy storage system utilizes the majority of the renewable power generated by the electric motor when it is in deceleration mode to raise the voltage in the system. During the subsequent acceleration mode, the stored energy might be released the MMC-BESS, which combines a modular multilevel converter with a battery energy storage system, is gaining popularity due to its high adaptability and dependability. This system integrates batteries into a sub module. Sub-modular capacitor voltage fluctuations are caused by the significant reactive power that is generated through the workings of modular multilevel converters. To reduce the fluctuation, large capacitance capacitors is required, which would significantly increase the system's capacity. The proposed approach means to upgrade energy proficiency and execution in electric vehicle applications. By joining the benefits of battery power with the flexibility of MMC frameworks, the arrangement offers upgraded control accuracy, decreased misfortunes, and further developed adaptation to non-critical failure. This combination works with consistent power the executives, guaranteeing ideal use of assets while meeting severe execution prerequisites. Through exhaustive examination and recreation, the adequacy of this incorporated framework is illustrated, displaying propelling the field of electric vehicle impetus and power conversion potential.

Back Propagation Artificial Neural Network Based DC Bus Capacitance Identification Method in Three-Phase PWM Rectifier for Charging System of EVs

In order to improve the performance and reliability of the three-phase PWM rectifier in electric vehicle (EV) charging system, it is important to focus on the identification of the DC bus capacitance. The existing methods have the disadvantages such as a low identification accuracy, a high hardware dependency, and high costs. Therefore, the development of new identification methodologies could be the way out of the aforementioned disadvantages, in terms of advanced algorithms. In this paper, a DC bus capacitance identification method based on back propagation (BP) artificial neural network (ANN) algorithm is proposed. The capacitance can be accurately identified in the diode rectification stage, by training the neural network to extract the potential laws in the data, which only includes the Phase-a voltage and current, as well as the DC bus voltage ripple. The regression response is 0.99991. Finally, the experimental results show the accuracy and effectiveness of the proposed method. A simple and effective BP ANN is designed, and it can identify the capacitance at different grid voltages and DC bus loads. It has a high identification accuracy that the maximum identification error is less than 4.5%.

6274094 An audit of obstetric admissions to a high dependency unit, in a tertiary maternity hospital

6274094 An audit of obstetric admissions to a high dependency unit, in a tertiary maternity hospital

"Fabrication of cutting inserts with chromium-molybdenum steel for turning operations using material extrusion technology"

In this study, cutting inserts for turning were produced using metal 3D printing's material extrusion technology. The primary focus was on optimizing cutting parameters. An experimental plan was devised involving rounds of cutting tests based on a design of experiments and analysis of variance. Inserts were manufactured by printing bound metal powder filament, a combination of chromium-molybdenum tool steel with a polymeric binder. After printing, green parts underwent debinding to eliminate the binder, eventually resulting in full metal parts via sintering. These inserts underwent machining tests on aluminum-copper EN AW-2030 alloy specimens. Results indicated that the inserts could function within cutting speeds (Vc) ranging from 40 to 260 m/min, feed rates (f) from 0.05 to 0.25 mm/r, and radial pass depths (ap) from 0.1 to 2.4 mm. Optimal technological conditions were determined as Vc = 160–200 m/min, f = 0.20–0.25 mm/r, and ap = 1.2 mm. Analysis revealed that cutting speed was less significant than feed rate or depth of cut on tool wear. Feed rate minimized wear within the 0.15–0.25 mm/r range, while pass depth proved most influential on wear, with optimal values between 0.8 and 1.2 mm. Surface finish, assessed through mean roughness Ra, showed high dependence on pass depth, improving for low ap values and relatively high Vc values. These findings demonstrate that inserts fabricated via material extrusion can operate within a technological range like commercial inserts, presenting an advanced approach for customizing design and manufacturing while surpassing conventional insert limitations.

The Relationship Between Eye Distance To The Computer And Computer Vision Syndrome (CVS) Complaints

The use of computers is now commonplace among individuals, ranging from students to professionals. Computers offer numerous advantages, leading to a high dependency on them, particularly among office workers, who incorporate computer usage into their daily activities. In general, the occupational setting necessitates prolonged computer usage, thereby leading to inadvertent exposure to the computer screen/monitor and subsequent development of eye-related complaints, including Computer Vision Syndrome (CVS). This study aimed to investigate the correlation between eye distance to the computer and the occurrence of CVS symptoms. This research employs an analytical observational study design with a cross-sectional approach. The study sample consists of employees from the Middle Type Customs and Excise Service Office (KPPBC TMC) in Malang. The sample selection was based on the prolonged duration of computer usage, averaging 6 hours per working day. The study findings indicated a significant correlation between the viewing distance to the computer screen and the occurrence of CVS complaints among the respondents. Among the total of 65 respondents, 66.2% experienced CVS complaints, with the most predominant symptom being tired eyes at 53.8%. A higher proportion of respondents (53.8%) had an eye distance from the computer of less than 50 cm, compared to those with an eye distance of more than 50 cm (46.2%). The majority of respondents in this study were in the age range of 25-29 years, comprising 40% of the sample. Among them, the majority were male, accounting for 57.7% of the respondents.

Assessing Household Catastrophic Healthcare Expenditure and its Associated Factors: A Study in a North-Eastern State of India

Background: Out-of-pocket expenses (OOPE) are the primary means of funding healthcare costs in developing nations, and when the cost is too high, it leads to catastrophic healthcare expenditures (CHE). Aim & Objective: This study aimed to assess the proportion of households that faced CHE and also examined the associated factors that determine CHE at the household level. Methods and Material: Between September 2020 and February 2021, a cross-sectional study covering a sample of 771 households was conducted in four districts of Assam. A multistage sampling design was employed to select the sample households. Statistical analysis used: Binary logistic regression analysis has been performed to ascertain the factors that could determine household CHE. Results: 23% households had experienced CHE, high dependence on the private healthcare system. Monthly household income, duration of illness, presence of children under five years of age and elderly members, education of household head, and health insurance were the significant factors influencing CHE. Conclusions: The study identified the growing use of private healthcare services as a major concern that contributes to the prevalence of CHE. To make all healthcare services accessible and affordable and to lower OOP on healthcare, it is also crucial to improve the infrastructure and quality of the public healthcare system in rural and remote locations.

Water Footprint Flow and Vulnerability of China’s Provincial Energy Sector

Water and energy are mutually reinforcing elements in production and consumption activities, forming an inseparable relationship. This study, conducted at the provincial level, investigates the intricate connections between energy water footprint flow, water shortage, and water pollution. It aims to elucidate the vulnerability of provincial energy sectors to water use, fostering regional coordinated management for sustainable energy and water development. Utilizing a multi-regional input–output model, the research analyzes both the quantity and quality of water resources. The water footprint of China’s provincial energy sector is quantified and scrutinized. Furthermore, an evaluation index system is constructed based on the water footprint concept. The entropy weight TOPSIS method is then applied to assess the vulnerability of inter-provincial energy sector water footprints. The key findings are as follows: (1) The energy water footprint has shifted from water resource-deficient areas, such as the northwest, North China, and northeast, to economically developed regions with relatively abundant water resources, such as East China and South China. This reveals that the transfer of water footprints in economic activities does not entirely alleviate water shortages in China and may even exacerbate shortages in certain water-deficient areas. (2) The graywater footprint of the energy sector is significantly larger than the blue water footprint and water shortage footprint. (3) The production and supply departments of power and heat emerge as the largest contributors to the transfer of energy and water footprints from water shortage areas to water-rich areas, followed by coal mining and dressing departments. (4) Top 10 Vulnerable Provinces: Tibet, Zhejiang, Ningxia, Tianjin, Jiangsu, Henan, Hunan, Beijing, Chongqing, and Hebei are identified as the top 10 provinces vulnerable to water footprints in the energy sector. This vulnerability closely correlates with the energy sector’s dependence on water footprints and production leverage. Recommendations include optimizing the energy mix and establishing stable external water footprint supply channels for provinces with high water footprint dependence. Provinces with high production leverage are advised to accelerate innovation and application of water-saving technologies in key energy sectors, increase the utilization of clean energy, and enhance resource recycling. National government departments should focus on controlling and reducing water pollutants in the energy sector across regions, addressing water shortages by purifying water bodies and improving water quality.

Analysis of small-scale soil CO2 fluxes in an orange orchard under irrigation and soil conservative practices

The quantification of soil carbon dioxide (CO2) flux represents an indicator of the agro-ecosystems sustainability. However, the monitoring of these fluxes is quite challenging due to their high spatially-temporally variability and dependence on environmental variables and soil management practices.In this study, soil CO2 fluxes were measured using a low-cost accumulation chamber, that was realized ad hoc for the surveys, in an orange orchard managed under different soil management (SM, bare versus mulched soils) and water regime (WR, full irrigation versus regulated deficit irrigation) strategies. In particular, the soil CO2 flux measurements were acquired in discontinuous and continuous modes, together with ancillary agrometeorological and soil-related information, and then compared to the agrosystem scale CO2 fluxes measured by the eddy covariance (EC) technique.Overall significant differences were obtained for the soil CO2 discontinuous fluxes as function of the WR (0.16 ± 0.01 and 0.14 ± 0.01 mg m−2 s−1 under full irrigation and regulated deficit irrigation, respectively). For the continuous soil CO2 measurements, the response observed for the SM factor varied from year to year, indicating for the overall reference period 2022-23 higher soil CO2 flux under the mulched soils (0.24 ± 0.01 mg m−2 s−1) than under bare soil conditions (0.15 ± 0.00 mg m−2 s−1). Inter-annual variations were also observed as function of the day-of-year (DOY), the SM and their interactions, resulting in higher soil CO2 flux under the mulched soils (0.24 ± 0.02 mg m−2 s−1) than under bare soil (0.15 ± 0.01 mg m−2 s−1) in certain periods of the years, according to the environmental conditions. Resultssuggest the importance of integrating soil CO2 flux measurements with ancillary variables that explain the variability of the agrosystem and the need to conduct the measurements using different operational modalities, also providing for night-time monitoring of CO2. In addition, the study underlines that the small-scale chamber measurements can be used to estimate soil CO2 fluxes at orchard scale if fluxes are properly scaled.

Illuminating sustainable household well-being and natural resource dependence in the case of disaster resettlement in rural China.

In order to transform rural development, the implementation of disaster resettlement projects should not only reduce environmental hazards, but also improve the sustainability of natural resources and household well-being. This article assesses sustainable household well-being (SHWB) and natural resource dependence using a quantitative survey of rural China. It identifies four classes of relationship between SHWB and natural resource dependence and explores the impact of disaster resettlement on these classes. The result shows that rural households that participate in disaster resettlement as well as in voluntary relocation, centralized relocation, and new-stage relocation are more likely to achieve "high well-being and low dependence." However, the overall SHWB level of the relocated households is lower than that of the non-relocated households, and disaster resettlement also has a significant positive impact on the "low well-being and low dependence" class. It is recommended that governments implement measures to address these issues. The findings in this article could shed light on the impact of resettlement programs on rural households elsewhere.