High Volume Research Articles

Exploring and identification of road traffic crash hotspots in Kigali-city, Rwanda

Road traffic crashes are on the rise worldwide, particularly in African countries. Rwanda, in this context, faces the challenge of an increasing frequency of crashes each year. Kigali, the capital city of Rwanda, witnesses over three-quarters of the total population as daily road users, leading to high traffic volumes and congestion during peak hours. Identifying dangerous locations and providing insights to transport policymakers is crucial to minimise the severity of crashes in the city. This study focuses on identifying crash hotspots through spatial analysis and explores the various factors contributing to crash severity in the capital city of Rwanda. The study utilises crash data recorded between 2015 and 2022 by the Rwanda National Police, conducting temporal, spatial, and statistical analyses. A multinomial regression model was employed to examine the significance of contributing factors to crash severity. Additionally, six supervised machine learning classifiers were employed to assess their predictive capabilities for accident severity in Kigali city. The findings indicate that the Gasabo district recorded the highest number of crashes among all districts. Time series analysis reveals a decrease in fatal accidents from 2020 to 2022 in Kigali city, while the number of injury and property damage crashes progressively increased from 2019 to 2022. Among the predictive models, the Random Forest model demonstrated strong predictive abilities, achieving an accuracy of 88.11% compared to other models. These results provide valuable insights for road safety policymakers to proactively make decisions and take precautions to prevent crashes before they occur.

Pavement performance and model studies with modified bitumen binder

Flexible pavements experience premature deterioration due to several factors, such as high volumes of traffic, repeated wheel loads, overloading, adverse weather conditions, inferior quality of materials, and other related issues. One of the most commonly found types of distress is rutting, which severely affects pavement performance; hence, the prediction of rutting behaviour is crucial. Research has been done by adding various industrial wastes, chemicals, additives, and modifiers such as rubber, natural rubber, polymers, and waste plastic into the bitumen. These materials are expected to have a substantial impact on enhancing the strength, durability, and performance of pavement while simultaneously reducing the cost of construction. The present research deals with a laboratory investigation of bituminous mixes using both Marshall stability and rutting tests. The performance tests were carried out by Roller Compactor cum Rut Analyzer (RCRA) equipment and Finite Element (FE) analysis in ABAQUS. The experimental findings show that the modified bitumen exhibits 48% greater strength and 20% more resistance to rutting than the conventional bituminous mixes. The model analysis was successfully validated by experimental results. The findings of the research resulted in the development of a mathematical equation that helps to calculate in-service pavement rut depth.

Gambling advertisements in Ontario: exploring the prevalence and regulatory compliance of televised and social media marketing during sports matches

ABSTRACT This paper reports the results of two studies into the prevalence of gambling advertisements exposed during five NHL and two NBA matches broadcast in Ontario, and the social media advertisements posted by ten Ontario-licensed gambling operators on X/Twitter between the 25th and the 29th of October 2023. The studies found a total of 4,119 gambling messages, consisting of 3,537 television-based gambling references and 582 X/Twitter advertisements. Just over half of the television-based references (50.4%) appeared on the playing surface, while references were visible for 21.7% of the entire duration of broadcasts. Despite this high volume of advertising, none of the references breached Ontario-based standards. The X/Twitter advertisements generated 5,687,087 views while featuring mostly males (78.5%) and individuals aged between 25 and 34 (50.5%). Just under half (48.5%) were identified as content marketing, which were found to be breaching advertising standards by concealing the fact that they were advertisements. The studies were observational, and caution should be taken when interpreting the findings against possible impact on behavior. Nonetheless, the findings highlight the need for the further development of standards to ensure the protection of audiences against a high volume of marketing that risks the possible normalization of gambling within sport.

A detailed practical and theoretical study of the adsorptive potential of synthesised ceria impregnated activated graphite for aqueous Se(IV) and Te(IV) removal: Process optimisation, characterisation and mechanistic approach

A cost-effective, simple, and earth friendly nanocomposite adsorbent was synthesized by in - situ penetration of ceria nanocrystals on graphite to remove aqueous selenium (IV) and tellurium (IV). Batch experiments optimize parameters such as pH, temperature, sorbent dosage and equilibration time of 30 minutes. The adsorbent exhibited the maximum adsorption capacities of 144.5 mg/g for Te(IV) and 29.3 mg/g for Se(IV). BET analysis revealed a specific surface area of 16.44 m²/g, an average pore diameter of 4.24 nm, and a high pore volume of 0.0519 cm³/g. The adsorbent was characterized before and after adsorption by SEM-EDX, XRD and FTIR. The sorption data could be well interpreted by the Langmuir model for both Se and Te and by the DR isotherm for Te(IV) at ambient temperature. Kinetic empirical data correlated positively with pseudosecond order for both Se and Te and the Elovich model for Te at room temperature. Kinetics and equilibrium isotherms suggested that the adsorption occurred through surface adsorption using electrostatic bonding along with physisorption involving steady diffusion and accommodation of analyte ions into mesopores and defects of the adsorbent. Chemisorption by electron transfer of the oxyanions of Se/Te with Ce3+/Ce4+ of the cerium impregnated graphite (CIAG) and ion exchange with functional groups on the activated graphite edges were other probable mechanisms. The adsorbent demonstrated the ability to be regenerated and reused over multiple cycles, with minimal interference from coexisting ions emphasizing its selectivity. All measurements were conducted in triplicate with the relative standard deviation (RSD) below 5 %. The optimised method was successfully applied in natural water samples from various sources, demonstrating strong potential for scaling up to field applications.

Optimizing Construction Spoil Reactivity for Cementitious Applications: Effects of Thermal Treatment and Alkaline Activation

Construction spoil (CS), a prevalent type of construction and demolition waste, is characterized by high production volumes and substantial stockpiles. It contaminates water, soil, and air, and it can also trigger natural disasters such as landslides and debris flows. With the advent of alkali activation technology, utilizing CS as a precursor for alkali-activated materials (AAMs) or supplementary cementitious materials (SCMs) presents a novel approach for managing this waste. Currently, the low reactivity of CS remains a significant constraint to its high-value-added resource utilization in the field of construction materials. Researchers have attempted various methods to enhance its reactivity, including grinding, calcination, and the addition of fluxing agents. However, there is no consensus on the optimal calcination temperature and alkali concentration, which significantly limits the large-scale application of CS. This study investigates the effects of the calcination temperature and alkali concentration on the mechanical properties of CS–cement mortar specimens and the ion dissolution performance of CS in alkali solutions. Mortar strength tests and ICP ion dissolution tests are conducted to quantitatively assess the reactivity of CS. The results indicate that, compared to uncalcined CS, the ion dissolution performance of calcined CS is significantly enhanced. The dissolution amounts of active aluminum, silicon, and calcium are increased by up to 420.06%, 195.81%, and 256.00%, respectively. The optimal calcination temperature for CS is determined to be 750 °C, and the most suitable alkali concentration is found to be 6 M. Furthermore, since the Al O bond is weaker and more easily broken than the Si O bond, the dissolution amount and release rate of active aluminum components in calcined CS are substantially higher than those of active silicon components. This finding indicates significant limitations in using CS solely as a precursor, emphasizing that an adequate supply of silicon and calcium sources is essential when preparing CS-dominated AAMs.

User engagement with home blood pressure monitoring: a multinational cohort using real-world data collected with a connected device.

Connected blood pressure (BP) monitors provide reliable data when used properly. Our objective was to analyse the engagement of real-world users with self-measurements. We included adult first-time users of a connected BP monitor from July 2019 to March 2021. They were categorized as persistent users if they continued to use the device between 311 and 400 days after inclusion. We defined a criterion to analyse the timing of self-measurements: at least 12 measurements performed within three consecutive days, at least once every 90 days. Persistent users were clustered by state sequence analysis according to the consistency of their BP monitor measurement timing with this criterion during 1 year of follow-up. Among the 22 177 included users, 11 869 (54%) were persistent during the first year. Their use was consistent with the timing criterion 25% (median) of this time (first and third quartiles: 0%, 50%) and four patterns of use were identified by clustering: 5215 persistent users (44%) only performed occasional sparse measurements, 4054 (34%) complied at the start of follow-up up to eight cumulated months, 1113 (9%) complied at least once during later follow-up up to eight cumulated months, and the remaining 1487 (13%) complied nine or more cumulated months of follow-up. Although connected BP monitors can collect a high volume of data, the real-life timing of self-measurements is far from recommended schedules. We must promote the use of BP monitors as recommended by guidelines and/or learn to analyse more occasional and sparse measurements.

A nationwide analysis of 350 million patient encounters reveals a high volume of mental-health conditions in primary care

How many primary-care encounters are devoted to mental-health conditions compared with physical-health conditions? Here we analyzed Norway’s nationwide administrative primary-care records, extracting all doctor–patient encounters occurring during 14 years (2006–2019) for the population aged 0–100 years. Encounters were recorded according to the International Classification of Primary Care. We compared the volume of mental-health encounters against volumes for conditions in multiple different body systems. A total of 4,875,722 patients generated 354,516,291 encounters. One in 9 encounters (11.7%) involved a mental-health condition. Only musculoskeletal conditions accounted for a greater share of primary-care physicians’ attention. The volume of mental-health encounters in primary care equaled encounters for infections, cardiovascular and respiratory conditions and exceeded encounters for pain, injuries, metabolic, digestive, skin, urological, reproductive and sensory conditions. Primary-care physicians frequently treat complex mental-health conditions in patients of every age. These physicians may have a more important role in preventing the escalation of mental-health problems than heretofore appreciated.

Comparison of the presence of high production volume chemicals in farmed and wild fish highly consumed in catalonia and their risk assessment

The decline in fish populations and the depletion of marine resources have sparked concerns about sustainable fish production, driving the innovation of new aquaculture methods. While some argue that wild fish are healthier than farmed fish due to less exposure to contaminants and pathogens, wild fish can accumulate contaminants from more contaminated water sources. The slower growth of wild fish and their longer exposure to the environment may contribute to higher pollutant levels in fish tissues. In this study, we focus on 25 contaminants considered as high production volume chemicals (HPVCs), such as organophosphate esters (OPEs), benzothiazoles (BTs), benzosulfonamides (BSAs) and phthalates (PAEs). The compounds were extracted from the edible part of the fish using the QuEChERS method and analysed by gas chromatography-tandem mass spectrometry.A total of 74 samples were analysed from three of the most commonly consumed species in Catalonia, Spain (turbot, sea bass and sea bream). Two samples of each species were collected each month, one form farmed and one from wild origin. In general, the compounds were found in all the samples in a wide concentrations range, although no significant differences were observed between the mean concentration of wild and farmed samples. Although similar mean concentrations for the OPEs, BTs and BSAs were found between farmed and wild origin samples, PAEs were more frequently detected in farmed samples. Di-n-octyl phthalate and diethyl phthalate showed the highest concentrations in all fish samples, with values up to 19505 and 17605 ng g−1 (d.w.), in sea bass and sea bream, respectively. Di-(2-ethylexyl)-adipate proved to be the most relevant carcinogenic compound, with no associated health risk. Despite the detection of the studied HPVCs, no health risk was associated with the consumption of these three fish species.

Enhanced microstructures, mechanical properties, and machinability of high performance ADC12/SiC composites fabricated through the integration of a master pellet feeding approach and ultrasonication-assisted stir casting

Integrating ceramic particles into aluminum matrices poses significant challenges due to their limited wettability and high specific volume ratio. This research focused on developing ADC12/SiC aluminum composites with varying SiC concentrations (1.5, 2.5, and 3.5 wt%) through an innovative fabrication process. Initially, ADC12/SiC master pellets containing a high concentration of homogenously dispersed 1-μm SiC particles were produced. Subsequently, these master pellets were introduced into the molten ADC12 alloy, followed by the dispersion of SiC particles via stir casting assisted by ultrasonication. The study assessed the impact of SiC weight fractions on the microstructures, mechanical properties, and machinability of the fabricated composites. The results revealed significant microstructural improvements and a more even distribution of SiC reinforcement inside the ADC12 matrix after the application of this innovative processing method. Increased SiC concentration led to notable refinement of α-aluminum grains and eutectic Si, as well as a more uniform dispersion of intermetallic phases. Additionally, a substantial increase in tensile properties and hardness was observed with the increment of SiC content. Particularly, the ADC12/3.5 wt%SiC composite exhibited a 46.73% increase in hardness and notable enhancements in yield strength, ultimate tensile strength, and elongation, denoted as 201.7 MPa, 241.1 MPa, and 3.40%, respectively, as compared with those of the unreinforced ADC12 alloy. Moreover, the ADC12/SiC composites demonstrated reduced surface roughness compared to the unmodified ADC12 alloy, indicative of a superior surface finish. With the addition of a high SiC content, the chip morphology was observed to change from continuous to discontinuous following a turning operation.

Self-Reported Financial Difficulties Among Patients with Multiple Myeloma and Chronic Lymphocytic Leukemia Treated at U.S. Community Oncology Clinics (Alliance A231602CD).

To estimate the proportion and correlates of self-reported financial difficulty among patients with multiple myeloma (MM) or chronic lymphocytic leukemia (CLL). 23 U.S. community and minority oncology practice sites affiliated with the National Cancer Institute Community Oncology Research Program (NCORP). 521 patients (≥18 years) with MM or CLL were consented and 416 responded to a survey (completion rate=79.8%). Respondents had a MM diagnosis (74.0%), an associate degree or higher (53.4%), were White (89.2%), insured (100%) and treated with clinician-administered drugs (68.0%). Observational, prospective, protocol-based survey administered in 2019-2020. Financial difficulty was assessed using a single-item standard measure, the EORTC QLQC30: "Has your physical condition or medical treatment caused you financial difficulties in the past year?" and using an 'any-or-none' composite measure of 22 items assessing financial difficulty, worries and the use of cost-coping strategies. Multivariable logistic regression models assessed the association between financial difficulty, diagnosis, and socioeconomic and treatment characteristics. 16.8% reported experiencing financial difficulty using the single-item measure and 60.3% using the composite measure. Most frequently endorsed items in the composite measure were financial worry about having to pay large medical bills related to cancer and difficulty paying medical bills. Financial difficulty using the single-item measure was associated with having MM versus CLL (adjusted odds ratio [aOR], 0.34; 95% CI, 0.13-0.84; P=.02), having insurance other than Medicare (aOR, 2.53; 95% CI, 1.37-4.66; P=.003), being non-White (aOR, 2.21; 95% CI, 1.04-4.72; P=.04), and having a high school education or below (aOR, 0.36; 95% CI, 0.21-0.64; P=.001). Financial difficulty using the composite measure was associated with having a high school education or below (aOR, 0.62; 95% CI, 0.41-0.94; P=.03). U.S. patients with blood cancer report financial difficulty, especially those with low socio-economic status. Evidence-based and targeted interventions are needed.

Analisis Pelaksanaan Tugas Ramp Handling dalam Menjaga On Time Performance (OTP) Pada Maskapai Garuda Indonesia di Bandara Soekarno Hatta Cengkareng

Soekarno-Hatta Airport is the main gateway for international and domestic air travel in Indonesia. As one of the busiest airports in Southeast Asia, Soekarno-Hatta Airport handles more than 60 million passengers per year (Soekarno-Hatta Airport Authority, 2023). According to the operational management theory by Suryanto (2020), efficiency in managing all operational processes, including ramp handling, is crucial to ensure smooth and punctual flights. With high traffic volume, the main challenge is to maintain On Time Performance (OTP) to minimize flight delays. This study aims to determine the implementation of ramp handling tasks during pre-flight activities, as well as to determine the obstacles experienced by Ramp Handling officers in pre-flight activities at Soekarno Hatta Cengkareng International Airport and to determine how efforts are made by PT Gapura Angkasa in improving the quality of On Time Performance (OTP) at Soekarno Hatta International Airport, Cengkareng. This study uses a qualitative method, namely through interviews, observations, and documentation of ramp handling personnel units, this study was conducted for 1 month at Soekarno Hatta International Airport The results of this study are that ramp handling officers at Soekarno-Hatta Cengkareng International Airport are responsible for checking the readiness of ground equipment, flight documents, and coordinating with the ground crew team. The use of checklists ensures that all pre-flight steps are carried out correctly and efficiently, which is important for smooth boarding and loading.

A Time-Interval Strategy to Prepare Porous SiO2 Spheres with Adjustable Core-Shell Ratio for Multiple Guest Loading.

Porous microspheres with desired pore size and distribution are in high demand for loading various guest materials, especially various pollutants that are several nanometers in size or stably suspended in liquid. Herein, multilevel porous SiO2 microspheres with arbitrarily adjustable core-shell ratios are prepared by solely regulating the time interval between the start of the hydrolysis reaction and the addition of organic solvent. The core-shell ratio of the SiO2 microspheres increases gradually with prolongation of the addition time interval; meanwhile, the specific surface area can be adjusted from 543.2 m2 g-1 to 992.9 m2 g-1, and the average pore diameter varies from 2.3 to 5.7 nm together with a high pore volume reaching 0.91 cm3 g-1. Moreover, the hierarchical core-shell SiO2 microspheres with an adjustable core-shell ratio, a large specific surface area, and a multilevel pore size could be obtained on a large scale. These SiO2 microspheres demonstrate excellent performance in coloading platinum nanoparticles and various dye molecules, suggesting their great potential in treating various pollutants in printing and dyeing wastewater.

Clinical Outcomes in Relation to Total Hospital Surgical and Transcatheter Aortic Valve Replacement Volumes.

There is a paucity of data regarding the relationship between overall hospital volumes for total aortic valve replacement (AVR; transcatheter AVR [TAVR] or surgical AVR [SAVR]) and patient outcomes. We queried the 2019 Nationwide Readmission Database for patients undergoing AVR. Based on procedural volumes of TAVR or SAVR, we classified hospitals as high (≥50th percentile) or low (<50th percentile) volume centers and categorized hospitals as high TAVR/high SAVR, high TAVR/low SAVR, high SAVR/low TAVR, and low TAVR/low SAVR. Multivariable regression models were employed. The main study outcomes were in-hospital mortality and 30-day readmission after total AVR. Our final analysis included 72 123 patients undergoing AVR at 400 hospitals across the United States. The median (interquartile range) hospital procedural volumes for total AVR, TAVR, and SAVR were 137 (86-210), 82 (50-127), and 56 (31-87) procedures, respectively. There was an inverse correlation between hospital procedural volumes of AVR, TAVR, or SAVR and in-hospital mortality after total AVR but not with 30-day readmission. Using high TAVR/high SAVR hospitals as reference, there was higher in-hospital mortality after total AVR among low TAVR/low SAVR hospitals (adjusted odds ratio [OR], 1.29 [95% CI, 1.07-1.56]) but similar in-hospital mortality among high TAVR/low SAVR hospitals and low TAVR/high SAVR volumes. There was no difference in 30-day readmission rates after total AVR among the 4 hospital categories. Nationwide data revealed that in-hospital mortality after total AVR (SAVR or TAVR) is inversely related to hospital total volumes of AVR. Patients with aortic stenosis have better outcomes if they are managed among experienced centers with high case volumes of both TAVR and SAVR.

Contribution of road transport infrastructure in mitigating the inward–immiserizing growth in Cameroon: An externality approach in computable general equilibrium analysis

The issue of immiserizing growth has been largely discussed in the literature since 1958. It describes a country context contending with high volume of exports relatively to its imports on the international market that benefits from high economic growth but losses in households’ welfare. This study aims to investigate the contribution of transport infrastructure to tackle immiserizing growth in developing countries, focusing on the Cameroon economy, a contending with a significant lack in the development of road transport infrastructure. Further, the study enriches the debate on the wider economic impacts, closely related to immiserizing growth. The loss of welfare is observed upstream to the investigations, as a response to the application of two types of fiscal policies: the import tariff and the capital income tax. Through a dynamic Computable General Equilibrium (CGE) model, the effect of road transport infrastructure is explored, using the externalities approach. This is an innovative methodology recently applied to access the economic impacts of infrastructure investment making a difference between productive and non-productive infrastructure investments. The findings reveal that productive transport infrastructure not only reduces the wider economic impact by improving households’ welfare but also enhances economic growth. A 10 percent increase in road transport infrastructure investment funded by import tariff leads to a welfare improvement of 1.94% and 1.66% in both short and long terms compared to respective losses of 0.58% and 0.15% if the generated financial funds are allocated in non-productive infrastructure such as monuments, defense etc. The similar tendency is observed for the capital income tax funding. Thus, policymakers are recommended to accentuate the road construction, in order to shorten the complex interplay between public decisions and households’ living conditions.

The contingent role of state capacity on the impact of e-government on environmental sustainability in developing countries

E-government is a prominent approach in environmental sustainability as it brings various arrangements that allow for the mitigation of greenhouse gas emissions. The article explores two main objectives. Firstly, the direct impact of e-government on ecological sustainability and secondly, whether e-government enhances environmental sustainability indirectly by improving state capacity. By understanding this nexus, we believe that states in LDCs will seek to explore the maximum potential benefits of ICTs in government operations to establish a more responsive, open, and people-oriented government. The paper utilizes a balanced macro-panel sample of 45 United Nations classified least developed countries from 2003 to 2022. To ensure the reliability of empirical findings, three econometric methods—system generalized methods of moments (GMM), instrumental variable GMM (IV-GMM), and bootstrap ordinary least squares (BOLS) are employed. The results of the entire sample model reveal several key findings. These findings are that e-government development has a direct and positive impact on environmental sustainability, secondly state capacity negatively influences ecological sustainability, and lastly e-government development indirectly affects environmental sustainability by enhancing state capacity. Additionally, intriguing sub-sample findings for least developed countries in Africa and Asia are observed, with notable lessons from the latter, where environmental performance is improving at the expense of a high volume of carbon emissions. However, these overall findings underscore the importance of considering how governments can address environmental sustainability requirements by managing e-government programs and enacting responsible ICT-enabled transformations.

Programmable Merged‐Net Porphyrinic Metal–Organic Frameworks for Water Sorption

AbstractPorous materials have attracted considerable interest as water sorbents due to their potential in a broad range of water sorption‐related applications. Metal–organic frameworks (MOFs) are particularly notable for their high porosity and tunability. However, their limited hydrolytic stability often results in pore collapse, which significantly hinders their water sorption performance. To address this issue, an innovative design strategy based on reticular chemistry is essential to enhance structural stability and ensure efficient water sorption. Herein, a novel synthetic approach for constructing a merged‐net MOF structure using metallolinkers is introduced. Specifically, a porphyrin linker is employed to successfully synthesize a porphyrin‐based merged‐net MOF, UPF‐5. This MOF demonstrates significantly enhanced hydrolytic stability and improved water sorption performance while maintaining high pore volume. Additionally, the structure of UPF‐5 allows for the modification of accessible Zr6 nodes, enabling control over the pore environments and fine‐tuning the water sorption properties. This programmable synthetic strategy for porphyrin‐based merged‐net MOFs not only significantly enhances the structural stability for practical applications, including water sorption, but also advances reticular chemistry by discovering unprecedented topologies in MOF chemistry.

A numerical model for evaluating the long-term migration and phase transition behavior of foam-assisted injection of CO2 in saline aquifers

Geological Carbon Storage (GCS) is a rapidly developing technology with the potential to mitigate the environmental impact of excessive greenhouse gas emissions. Foam-assisted injection of CO2 can effectively alter fluid rheological properties, thereby enhancing sweep efficiency. In this paper, a numerical model to evaluate the long-term migration behavior of foam-assisted injected CO2 in saline aquifers is developed. It is found that foam-assisted injection improves storage efficiency and reduces the plume migration distance compared to direct CO2 injection. This creates higher demands on the injection pressure but minimizes the risk of leakage. The effects of injection strategy, volume fraction of foam, and reservoir heterogeneity were investigated. Modeling results show that the injection strategy with a high foam volume fraction enhances the sweep efficiency and improves the transition rate of injected CO2 to the dissolved state. This can effectively enhance the long-term security of the sequestration. Simulations of layered formations indicates that foams can potentially inhibit the rapid migration of plumes along high-permeability zones. Our study provides insights for foam-assisted injection to enhance reservoir storage efficiency and long-term safety for GCS.

Complexity and Challenges of Cross-Cover Care in Graduate Medical Education: A Qualitative Study.

Cross-cover care (care for hospitalized patients when the primary team is absent) is a common graduate medical education responsibility; however, it may lead to increased preventable adverse events. Despite understanding the difficulties of cross-cover care, medical educators lack comprehensive knowledge of specific challenges that residents face and how they handle these challenges. This study explores the challenges residents experience when providing cross-cover care. The authors conducted 60 semistructured, qualitative interviews with 20 internal medicine and surgery residents at a single academic institution between October 2021 and April 2022. Each resident participated in 3 interviews, 2 immediately after a shift. Working inductively, the authors generated codes for important themes. Study design and data collection were guided by interpretive description, a qualitative approach for health care research focused on experiences and perceptions to develop meaningful findings. To illustrate residents' workflow and aid in quality improvement efforts, the authors created a process map. Seventeen cross-cover challenges were organized into 7 interrelated and overlapping themes: lack of baseline knowledge, inadequate or inaccurate information transfer from the primary team, unfamiliarity with cross-cover patients, high task volume leading to increased interruptions, ill-defined roles leading to unmet expectations from others, perceived decreased access to resources, and fatigue. The process map illustrates 4 cross-cover workflow components: information transfer from the primary team to the cross-cover team, direct handling of cross-cover tasks that are assigned by the primary team or that arise during the time of cross-cover, information transfer back to primary team and other care team members, and responsibilities that residents have overnight that are not directly related to cross-cover. Residents face substantial challenges when providing cross-cover care, which have important implications for patient safety and resident well-being. The medical community should strive to develop educational and structural interventions to improve this process.

Enhanced multidimensional neo-fuzzy classification system and its learning for the video classification task

This research introduces an innovative hybrid neo-fuzzy system for video classification, integrating multidimensional neo-fuzzy components with adjustable synaptic weights and Gaussian membership functions. By combining extended neo-fuzzy neurons (ENFN) and neo-fuzzy units (NFU) with nonlinear activation functions and incorporating extended nonlinear synapses (ENS), the system leverages the neuro-fuzzy Takagi-Sugeno-Kang inference system to enhance traditional models' approximating capabilities. Video classification is complex due to high data volume and variability, especially with moving objects and varying video quality. Traditional models struggle with real-time processing and maintaining accuracy, necessitating advanced techniques for robust performance. The goal is to develop and optimize a hybrid neo-fuzzy system for real-time video stream classification, maintaining high accuracy. Computational experiments demonstrated its robustness, achieving high precision and recall. The proposed optimization algorithm, using cross-entropy learning with one-hot encoding and adaptive δ-rule adjustments, improved learning speed and accuracy. The novelty lies in developing a hybrid neo-fuzzy system with advanced components and a unique optimization algorithm, ensuring robustness and efficiency in complex video classification tasks.

Correspondence between white matter hyperintensities and regional grey matter volumes in Alzheimer's disease.

White matter hyperintensities (WMH) are the most common neuroimaging manifestation of cerebral small vessel disease, and is frequently observed in Alzheimer's disease (AD). This study aimed to investigate the relationship between WMH and cognition and to verify the mediation of grey matter atrophy in this relationship. The diffusion tensor imaging (DTI) technique analyses white matter fiber tract to assess white matter integrity. Voxel-based morphometry was applied to measure the grey matter volume (GMV). A linear regression model was applied to examine the associations between WMH and GMV, and mediation analyses was performed to determine the mediating role of regional GMV in the effect of WMH on cognitive function. Compared to the HC group, AD group have 8 fiber tract fractional anisotropy (FA) decreased and 16 fiber tract mean diffusivity (MD) increased. Compared to AD without WMH, AD with high WMH had 9 fiber tracts FA decreased and 13 fiber tracts MD increased. High WMH volume was negatively correlated with GMV in the frontal-parietal region. Low WMH volume was also negatively correlated with GMV except for the three regions (right angular gyrus, right superior frontal gyrus and right middle/inferior parietal gyrus), where GMV was positively correlated. Mediation analysis showed that the association between WMH and executive function or episodic memory were mediated by GMV in the frontal-parietal region. Damage to white matter integrity was more severe in AD with WMH. Differential changes in DTI metrics may be caused by progressive myelin and axonal damage. There was a negative correlation between WMH and grey matter atrophy in frontal-parietal regions in a volume-dependent manner. This study indicates the correspondence between WMH volume and GMV in cognition, and GMV being a key modulator between WMH and cognition in AD. This result will contribute to understanding the progression of the disease process and applying targeted therapeutic intervention in the earlier stage to delay neurodegenerative changes in frontal-parietal regions to achieve better treatment outcomes and affordability.