Initial Action Research Articles

Veterans Affairs' Whole Health System of Care for Transitioning Service Members and Veterans.

The Department of Veterans Affairs (VA) has launched an organization-wide transformation to a Whole Health System of Care that will ideally begin at the time of transition from active duty through the end of a Veteran's life. A brief history and overview of the Whole Health approach are provided along with selected evaluation results and planned initial actions as a result of the Total Force Fitness-Whole Health Summit held in March 2022. More work is required to strengthen the natural linkages between the Department of Defense's Total Force Fitness and Veterans Affairs' Whole Health approach to care. The Total Force Fitness-Whole Health collaboration is a model of whole-person care for the nation.

Pelatihan Baca Tulis Al-Qur’an (BTQ) Pada Anak-Anak KP.Golat Desa Pangkalan

It is hoped that the results of this paper will become insights as well as initial discourse and action to develop BTQ learning in Islamic educational institutions or in the community. An introduction to reading and writing the Koran to children in this community service activity discussing the introduction of BTQ to children. The purpose of this community service activity is to provide an introduction to the procedures for reading and writing the Qur'an to reveal the effectiveness of implementing the BTQ program at kp.Golat desa. Pangkalan Kab. Pandeglang Banten. The demand for the ability to read and write the Koran has become a widespread phenomenon. Therefore a BTQ program was created for children at kp.Golat desa.pangkalan kab.pandeglang banten. So that with this activity it is hoped that it can improve children's reading and writing of the Koran at kp.Golat desa.pangkalan kab.pandeglang banten, with a variety of BTQ methods provided that can adapt to the needs and characteristics of the children. The diversity of these methods is considered to be able to complement each other's shortcomings with one another. This paper attempts to describe the development of BTQ learning in Sobang Pandeglang with a variety of methods. The results of this paper are attempted to become insights as well as discourse and initial action to develop BTQ learning in Islamic educational institutions or in the community.

Restoring Consumer Trust in a Home Improvement Service Provider with Negative Reviews

With the growth in technology, the use of digital information to learn about a product or a service has increased substantially. Generally, users tend to trust a service provider until they find negative information. However, when their trust is violated, it becomes difficult to rebuild it. This study focused on the type of response that a service provider can provide to restore a user’s trust. We recruited 400 participants through Qualtrics Research Services for a 2*5 between subjects study. The findings suggest that irrespective of the type of accusation, i.e., morality- or competence-based, both an elaborate apology and denial restore the trust in the service provider. However, these ratings fell within the average range, suggesting that both are only an initial action and additional information is needed to regain the trust lost due to an accusation.

Robust Control of Voltage Source Converters: A Tube-Based Model Predictive Approach

Finite control set-model predictive control (FCS-MPC) operates based on the assumption that optimal control responses executed on a prediction model match closely an actual system. Thus, model uncertainties and external disturbances affect the controller’s performance. To weaken the impact of uncertainties, this brief proposes a tube-based FCS-MPC to control the output voltage of a voltage source converter (VSC). The proposed controller is composed of two FCS-MPCs. The first one generates an initial control action and a prediction of the output voltage based on a system, including no uncertainties. This control action and the output voltage are then sent to the second FCS-MPC, together with the output voltage of the uncertainty-involved system, to choose the best switching states of the VSC. Simulation and experimental validations demonstrate the proposed method’s effectiveness and robustness compared to a conventional FCS-MPC.

Does screening for PTSD lead to VA mental health care? Identifying the spectrum of initial VA screening actions.

Despite the active posttraumatic stress disorder (PTSD) screening program in Department of Veterans Affairs (VA) primary care clinics and the availability of empirically supported treatments for PTSD at VA, many veterans for whom screening suggests treatment may be indicated do not gain access to VA-based mental health care. To determine where we may be losing veterans to follow-up, we need to begin by identifying the initial action taken in response to a positive PTSD screen in primary care. Using VA administrative data and chart review, we identified the spectrum of initial actions taken after veterans screened positive for PTSD in VA primary care clinics nationwide between October 2017 and September 2018 (N = 41,570). We collapsed actions into those that could lead to VA-based mental health care (e.g., consult placed to a VA mental health clinic) versus not (e.g., veteran declined care), and then examined the association between these categories of actions and contextual- and individual-level variables. More than 61% of veterans with positive PTSD screens had evidence that an initial action toward VA-based mental health care was taken. Urban-dwelling and female veterans were significantly more likely to have evidence of these initial actions, whereas White and Vietnam-era veterans were significantly less likely to have this evidence. Our findings suggest that most veterans screening positive for PTSD in VA primary care clinics have evidence of initial actions taken toward VA-based mental health care; however, a substantial minority do not, making them unlikely to receive follow-up care. Findings highlight the potential benefit of targeted primary care-based access interventions. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Study on Preparation of Slow-release Polycarboxylate Superplasticizer by Macromonomer EPEG at Room Temperature

Slow-release polycarboxylate superplasticizer was synthetic under room-temperature conditions, a free radical copolymerization reaction occurred under the action of a redox initiator, and the optimal preparation process and temperature effect were discussed in detail. The results show that the best preparation process (EP-15) is: acid-to-ether ratio is 1.89, the amount of NaH2PO2 is 2.27%, the appropriate reaction temperature is 15-25°C, and the suitable macromonomer is EPEG-3000 of OXIRANCHEM. Tests have verified that compared to a commercially available slow-release polycarboxylate superplasticizer (PCE-1), EP-15’s dispersion retention performance and the strength growth of concrete in 3 d, 7 d, and 28 d are significantly better.

DECEPTION BASED TECHNIQUES AGAINST RANSOMWARES: A SYSTEMATIC REVIEW

Ransomware is the most prevalent emerging business risk nowadays. It seriously affects business continuity and operations. According to Deloitte Cyber Security Landscape 2022, up to 4000 ransomware attacks occur daily, while the average number of days an organization takes to identify a breach is 191. Sophisticated cyber-attacks such as ransomware typically must go through multiple consecutive phases (initial foothold, network propagation, and action on objectives) before accomplishing its final objective. This study analyzed decoy-based solutions as an approach (detection, prevention, or mitigation) to overcome ransomware. A systematic literature review was conducted, in which the result has shown that deception-based techniques have given effective and significant performance against ransomware with minimal resources. It is also identified that contrary to general belief, deception techniques mainly involved in passive approaches (i.e., prevention, detection) possess other active capabilities such as ransomware traceback and obstruction (thwarting), file decryption, and decryption key recovery. Based on the literature review, several evaluation methods are also analyzed to measure the effectiveness of these deception-based techniques during the implementation process.

Fiber Optic Acoustic Sensing to Understand and Affect the Rhythm of the Cities: Proof-of-Concept to Create Data-Driven Urban Mobility Models

In the framework of massive sensing and smart sustainable cities, this work presents an urban distributed acoustic sensing testbed in the vicinity of the School of Technology and Telecommunication Engineering of the University of Granada, Spain. After positioning the sensing technology and the state of the art of similar existing approaches, the results of the monitoring experiment are described. Details of the sensing scenario, basic types of events automatically distinguishable, initial noise removal actions and frequency and signal complexity analysis are provided. The experiment, used as a proof-of-concept, shows the enormous potential of the sensing technology to generate data-driven urban mobility models. In order to support this fact, examples of preliminary density of traffic analysis and average speed calculation for buses, cars and pedestrians in the testbed’s neighborhood are exposed, together with the accidental presence of a local earthquake. Challenges, benefits and future research directions of this sensing technology are pointed out.

Failures of urge suppression in obsessive-compulsive disorder: Behavioral modeling using a blink suppression task

Many individuals with obsessive-compulsive disorder (OCD) report sensory-based urges (e.g. ‘not-just-right experiences’) in addition to, or instead of, concrete fear-based obsessions. These sensations may be comparable to normative “urges-for-action” (UFA), such as the urge to blink. While research has identified altered functioning of brain regions related to UFA in OCD, little is known about behavioral patterns of urge suppression in the disorder. Using an urge-to-blink task as a model for sensory-based urges, this study compared failures of urge suppression between OCD patients and controls by measuring eyeblinks during 60-s blocks of instructed blink suppression. Cox shared frailty models estimated the hazard of first blinks during each 60-s block and recurrent blinks following each initial erroneous blink. OCD patients demonstrated a higher hazard of first and recurrent blinks compared to controls, suggesting greater difficulty resisting repetitive sensory-based urges. Within OCD, relationships between task outcomes and symptom severity were inconsistent. Findings provide support for a deficit in delaying initial urge-induced actions and terminating subsequent actions in OCD, which is not clearly related to clinical heterogeneity. Elucidating the nature of behavioral resistance to urges is relevant for informing conceptualizations of obsessive-compulsive psychopathology and optimizing treatment outcomes.

What the Fire Has Left Behind: Views and Perspectives of Resin Tappers in Central Greece

Resin tapping has long been an important traditional economic activity in less advantaged areas that serves as a source for income to local populations as well as an important management tool intricately linked with ecosystem services. In Greece, the majority of the remaining resin tappers are located in communities close to Pinus halepensis stands in the northern part of Evia Island. However, on 3 August 2021, a wildfire burned more than 50,000 Ha in the region, bringing the remaining resin tappers to a standstill. This paper aims to examine the views of 89 resin tappers in N. Evia and their perspectives on their profession as expressed during personal interviews. According to the participants’ replies, resin production is expected to bounce back to pre-fire levels in 40 years. A considerable portion of those interviewed (39.3%) were forced to work in other professions near their communities during the period that followed the fire. They were very dissatisfied by the fire management and initial mitigation actions, and fairly satisfied by the ecosystem recovery works that followed. However, they have high expectations for employment in a seven-year long government-funded support program which will allow them to continue living in their communities, and in this context they are willing to make a professional shift to forest operations work. In this context, the role of state authorities is expected to be crucial. The provision of vocational training and financial incentives could be decisive in preventing them from transitioning to alternative production sectors.

The Reign of Raffles in Java in 1811-1816

Not long after the handover of Java, Lord Minto, governor of India, appointed Thomas Stamford Raffles as lieutenant-governor of Java. Coincidentally, in keeping with his feelings for the Dutch, he began his career on the island of Penang, where the British established a trading station (1786) against the trade monopoly exercised by the Dutch forces in Malacca through sea patrols. Raffles may well be regarded as a staunch hater against the Dutch who were constantly trying to destroy them before, during and after his rule in Java. The initial action of Raffles and Minto was to place the important influence attached to the administration of the domestic government in British hands. This was done through changes in the European government bureaucratic system and indigenous governments as well as changes in the administrative system of the residency area. Besides, Raffles introduced the land rental system or what is more commonly called the "land tax system", the "British system" or the "national system". The period of Raffles' rule in Java, which was relatively short, brought about a lot of changes and developments in Java.

Navigating how to choose an oncologist as part of the cancer journey.

e18877 Background: Being diagnosed with cancer and having to navigate what to do next is overwhelming. One of the initial actions that needs to be taken is choosing an oncologist. It is essential that each patient finds an oncologist they trust and who will work with them through their diagnosis and treatment. CVS Health conducted this study to gain insight into 1) how cancer patients select an oncologist and what factors weigh into choosing an oncologist and 2) treatment cost concerns. Methods: In August 2022, we conducted an online survey with consumers selected from a national online panel. Patients (n = 126) were included if they had cancer, employer health insurance and currently undergoing or having completed chemotherapy infusion, oral chemotherapy, hormone therapy or immunotherapy. Patients answered a series of questions designed to understand how they selected their oncologist. Descriptive statistics and percentages are reported. Results: Oncology diagnoses included breast (48%), colon or rectal (8%), leukemia (8%), melanoma (7%), basal cell (6%), ovarian (6%), endometrial (6%), testicular (6%), prostate (5%), lung (4%) and < 3% of other cancers (patients could choose multiple diagnoses). Most (79%) patients completed treatment; 75% received or were receiving chemotherapy infusion, 63% surgery, 60% radiation therapy, 29% hormone therapy and 22% oral chemotherapy. 68% of patients responded that someone suggested/referred them to their oncologist. Of these patients, 43% stated a specialist (other than an oncologist) referred them to their oncologist, 34% said their primary care physician (PCP) referred them, while hospital/treatment center, family member/friend, insurance company and other made up the rest. 38% of respondents received a second opinion. Most (89%) patients remained with the same oncologist throughout their treatment. When selecting an oncologist, most patients identified experience (93%), being a respected oncologist (90%), reputation (86%), being in network (77%), quality measures (74%) and treatment recommendations (73%) as “Very Important” factors when choosing an oncologist. 38% of patients began to worry about medical bills when diagnosed; however, 30% were never concerned. Over half (56%) of patients reported treatment cost as the most concerning bill. 82% of patients reached their deductible during treatment, with half (54%) expecting to hit their deductible less than 3 months into treatment. 75% of respondents reported hitting their out-of-pocket maximum; 39% hit it less than 3 months into treatment. Conclusions: Specialists and PCPs are integral in referring patients to oncologists. While patients are less likely to choose their oncologists directly, they report that experience, reputation, and quality of care are essential qualities in an oncologist. Cost was not an important factor when choosing an oncologist, however, patients are concerned with medical bills, specifically treatment costs.

Proof-of-concept study of artificial intelligence-assisted review of CBCT image guidance.

Automation and computer assistance can support quality assurance tasks in radiotherapy. Retrospective image review requires significant human resources, and automation of image review remains a noteworthy missing element in previous work. Here, we present initial findings from a proof-of-concept clinical implementation of an AI-assisted review of CBCT registrations used for patient setup. An automated pipeline was developed and executed nightly, utilizing python scripts to interact with the clinical database through DICOM networking protocol and automate data retrieval and analysis. A previously developed artificial intelligence (AI) algorithm scored CBCT setup registrations based on misalignment likelihood, using a scale from 0 (most unlikely) through 1 (most likely). Over a 45-day period, 1357 pre-treatment CBCT registrations from 197 patients were retrieved and analyzed by the pipeline. Daily summary reports of the previous day's registrations were produced. Initial action levels targeted 10% of cases to highlight for in-depth physics review. A validation subset of 100 cases was scored by three independent observers to characterize AI-model performance. Following an ROC analysis, a global threshold for model predictions of 0.87 was determined, with a sensitivity of 100% and specificity of 82%. Inspecting the observer scores for the stratified validation dataset showed a statistically significant correlation between observer scores and model predictions. In this work, we describe the implementation of an automated AI-analysis pipeline for daily quantitative analysis of CBCT-guided patient setup registrations. The AI-model was validated against independent expert observers, and appropriate action levels were determined to minimize false positives without sacrificing sensitivity. Case studies demonstrate the potential benefits of such a pipeline to bolster quality and safety programs in radiotherapy. To the authors' knowledge, there are no previous works performing AI-assisted assessment of pre-treatment CBCT-based patient alignment.

Dipeptide Nitrile CD34 with Curcumin: A New Improved Combination Strategy to Synergistically Inhibit Rhodesain of Trypanosoma brucei rhodesiense.

Rhodesain is the main cysteine protease of Trypanosoma brucei rhodesiense, the parasite causing the acute lethal form of Human African Trypanosomiasis. Starting from the dipeptide nitrile CD24, the further introduction of a fluorine atom in the meta position of the phenyl ring spanning in the P3 site and the switch of the P2 leucine with a phenylalanine led to CD34, a synthetic inhibitor that shows a nanomolar binding affinity towards rhodesain (Ki = 27 nM) and an improved target selectivity with respect to the parent dipeptide nitrile CD24. In the present work, following the Chou and Talalay method, we carried out a combination study of CD34 with curcumin, a nutraceutical obtained from Curcuma longa L. Starting from an affected fraction (fa) of rhodesain inhibition of 0.5 (i.e., the IC50), we observed an initial moderate synergistic action, which became a synergism for fa values ranging from 0.6 to 0.7 (i.e., 60-70% inhibition of the trypanosomal protease). Interestingly, at 80-90% inhibition of rhodesain proteolytic activity, we observed a strong synergism, resulting in 100% enzyme inhibition. Overall, in addition to the improved target selectivity of CD34 with respect to CD24, the combination of CD34 + curcumin resulted in an increased synergistic action with respect to CD24 + curcumin, thus suggesting that it is desirable to use CD34 and curcumin in combination.

Pott Puffy Tumor : Case Report

Pott puffy tumor (PPT) is an abscess of the subperiosteal os, frontalis. Frontalis subperiosteal abscess is often found in cranial osteomyelitis. Cranial osteomyelitis is an inflammatory process of the cranial bones, mainly caused by pyogenic organisms. The most common cause of cranial osteomyelitis in developing countries is paranasal sinusitis. One of the causes of PPT is an infection of the frontal sinus. Intracranial complications are the most common complications of PPT, one of which is a cerebral abscess in the frontal lobe. In this case report, the patient complained of forehead swelling that spread to both upper eyelids. There is a history of boils on the left side of the forehead since 3 weeks ago but was not treated medically. On physical examination, there was no neurological deficit. In the initial action, aspiration of the swelling results in the form of pus. Based on the results of a plain head CT scan and 3D skull bones, the results obtained were an appearance of an abscess in the subperiosteal frontal bone and osteomyelitis of the frontal bone. The patient underwent debridement craniectomy and further therapy in the form of intravenous antibiotics. As a follow-up examination, an examination of pus culture and examination of anatomical pathology were carried out, and obtained cranial osteomyelitis results but found no pathogenic germs.

Evaluating the Effect of Brief Disaster Education on Emergency Department Staff: Can Short, Low-cost Education Improve Disaster Readiness of Non-DMAT Healthcare Personnel?

Introduction:Some incidents require early deployment of emergency department personnel not designated as disaster medical assistance team (DMAT). Although not as trained as DMAT members, they should be aware of basic disaster response concepts and knowledge. Educating disaster readiness to every healthcare staff in emergency departments would be ideal but it is very costly in both time and expense. To overcome this problem, we tried to evaluate the effectiveness of teaching basic concept and knowledge to non-designated personnel in a short-session and measure the effect.Method:This study is a before-and-after comparison study. From July 2020 to July 2022, a two-hour education was given to volunteers among doctors, nurses, paramedics and administrative staff working in emergency departments across four hospitals in Korea. Educational sessions consisted of basic disaster concept, pre-deployment DMAT preparations, initial actions required on incident site, key elements of incident response (command, control, safety, communication), and triage. Attendees were given a pretest before the session and another test after the session. Chi-square test and Wilcoxon rank test were used to compare the results.Results:Total of 105 volunteers participated in the study. Participants were mostly nurses (62.9%) followed by paramedics (23.8%). Overall knowledge level reported to be increased, including knowledge regarding DMAT deployment (29.5% to 93.3%, p<0.001), DMAT personnel (26.7% to 94.3%, p<0.001), DMAT-designated equipment (23.8% to 60.0%, p<0.001), initial response (27.6% to 69.5%, p<0.001) and patient transport priority (74.3% to 94.3%, p<0.001). Questions testing triage and rate of participants answering every question showed improvement with post-test median score of 67% and rate of 1.0% to post-test median score of 100% and rate of 35.2%, respectively (both p<0.001).Conclusion:Educating non-DMAT personnel in emergency departments with a short session showed significant improvement in basic knowledge of disaster response. It may help institutions with limited resources.

Community participation in management program in the Waranggui mangrove forest

The results of the research showed that community participation in the management of the Waranggui mangrove forest includes all elements of society (leader elements 3 respondents, interest elements 3 respondents and family heads, women and youth elements every 18 respondents) dominated by family heads, women elements, and youth elements. Community participation in the management of the Waranggui mangrove forest did not include the function of management participation. The highest form of community participation was in the implementation participation function with a total of 34 respondents (56.7%). with the highest participation function in carrying out activities (implementation) and the intensity of participation in initiating activities (initiation action) with the highest level of participation was quite inactive on the element of the head of the family.

Novel simultaneous determination of alliin and allicin in Allium sp. using digital subtraction HPTLC

Allicin is a major thiosulfinate found in garlic and other Allium sp. and it is responsible for their pungent aroma. It is formed during the tissue lysis of garlic, by the initial action of alliinase upon alliin, the major cysteine sulfoxide. Simultaneous detection of these two analytes is usually performed using HPLC. Contrary to the most important phytoconstituents in other samples, allicin is scarcely detected using the simple HPTLC technique, due to challenges caused by its unique structure, despite its simplicity and high needs in the analytical monitoring of the Allium sp. In this work, a cost-effective, simple, sensitive and accurate method was developed for the determination of allicin together with alliin, using HPTLC. Allicin is quickly pre-derivatised with cysteine in excess to the stable S-allylmercaptocysteine that is then simultaneously detected with alliin, using ninhydrin reagent. The method was validated in terms of accuracy (recoveries of 90–120 %), precision (RSD% of 4–12 %), selectivity, robustness, peak purity and limit of detection (LOD = 0.05 μg/band for allicin and LOD = 0.10 μg/band for alliin). The method was successfully applied using real Allium sp. samples and the results were in good agreement with HPLC data.

Myelin sheath injury and repairment after subarachnoid hemorrhage.

Subarachnoid hemorrhage (SAH) can lead to damage to the myelin sheath in white matter. Through classification and analysis of relevant research results, the discussion in this paper provides a deeper understanding of the spatiotemporal change characteristics, pathophysiological mechanisms and treatment strategies of myelin sheath injury after SAH. The research progress for this condition was also systematically reviewed and compared related to myelin sheath in other fields. Serious deficiencies were identified in the research on myelin sheath injury and treatment after SAH. It is necessary to focus on the overall situation and actively explore different treatment methods based on the spatiotemporal changes in the characteristics of the myelin sheath, as well as the initiation, intersection and common action point of the pathophysiological mechanism, to finally achieve accurate treatment. We hope that this article can help researchers in this field to further clarify the challenges and opportunities in the current research on myelin sheath injury and treatment after SAH.

The ACGME Framework for Medically Underserved Areas and Populations and Graduate Medical Education

The ACGME Framework for Medically Underserved Areas and Populations and Graduate Medical Education