Method Of Relief Research Articles

Psychological Effects of Reading on Alleviating Work Stress and Enhancing Job Satisfaction: An Analytical Study

Objectives: It is often hypothesized that reading as a common leisure activity is extolled as an efficacious method for stress relief and is believed to augment individual job satisfaction. There is a lack of a systematic theoretical framework and empirical analysis elucidating this hypothesis. This study aimed to bridge this research gap by constructing a psychological effect regression model and estimating its parameters, thereby delving into the relationship between reading and both work stress and job satisfaction. Methods: Methodologically, this research identifies and addresses endogeneity issues within the model, employing multivariate linear regression to analyze the correlation between reading habits and work stress, as well as job satisfaction. Results: Findings reveal that reading activities significantly and positively influence both the reduction of work stress and the enhancement of job satisfaction. Conclusions: The results offer effective strategic recommendations for individuals and organizations. This work not only enriches theoretical research in relevant fields but also holds substantial significance for practical stress management and career development planning.

Method for Pressure Relief in Deep Coal Mine Roadways Using Borehole Groups and Its Application to Guqiao Coal Mine

Abstract With the increase in the mining depth of coal mines in China, the problem of large deformation of roadways owing to high-ground pressure has become prominent even under enhanced support systems. To reduce the high pressure on the surrounding rock, this study investigates a pressure-relief method for deep roadways using drilling borehole groups. Based on a deep roadway in the Huainan mining area of China, the influences of drilling parameters, such as borehole diameter, length, and arrangement were investigated. The results indicate that the fan-shaped arrangement of the borehole group can compensate for the dilatancy deformation of the surrounding rock. The peak stress of the surrounding rock is reduced and transferred to the inner part of the surrounding rock. Furthermore, a field experiment was conducted on an experimental roadway. The deformation of the roadway was monitored and compared with that of an adjacent roadway that did not apply the pressure-relief method. The monitoring results indicated that the deformation of the experimental roadway was significantly reduced.

Experimental Study on Consolidation Characteristics of Concentrated Full Tailings and Research on Pore Water Relief Methods of Piles

Surface harmless storage of concentrated full tailings (CFTs) involves the technology of adding a curing agent to the tailings slurry discharged from the thickener to realize the modification of the tailings and centralized storage of the tailings on the surface to realize the harmless treatment of the tailings. High water content of tailings is still the key technical problem that restricts the harmless storage of piles at present. Regarding the above problems, we implemented the consolidation test and numerical simulation of seepage-stress coupling consolidation of CFT, clarified the consolidation characteristics and parameters of CFT under different curing ages, and conducted a comparative analysis of pore water pressure in the whole cross-section of piles with different drainage schemes based on the results of the test. In addition, we also clarified the drainage effect of interlayer drainage on reducing the excess pore water pressure of piles and compared the simulation results of the pore water pressure of piles under different permeability coefficients. The results show that as the permeability coefficient of the concentrated tailings material decreases, the pore pressure accumulation inside piles under the same drainage scheme is more serious, and the length of time for consolidation and stabilization becomes longer. Therefore, it is recommended that the excess porous water pressure be relieved by means of increased drainage facilities under a small permeability coefficient.

Comparative assessment between chewing gum, bite wafers, and ibuprofen in pain control following separators placement among orthodontic patients

ObjectiveThis study aimed to evaluate the efficiency of chewing gum and using bite wafers in reducing pain after the placement of separators in orthodontic patients and to compare that efficiency with ibuprofen use. Additionally, this study evaluated the effect of non-pharmacological pain control methods on the frequency of separators falling out. MethodsThe study sample comprised 105 female patients between 15 and 35 years of age. The patients were randomly selected and classified into three groups (35 each). Each group was given either ibuprofen, viscoelastic bite wafers, or chewing gum immediately after the placement of separators and every 8 h for 1 week, as needed. The patients were asked to record their pain perception using a visual analog scale following separator placement at 2 h, 6 h, bedtime, 24 h, and at 2, 3, and 7 days. Analysis of variance testing was used for the data analysis. ResultsAmong the three studied groups, there were no significant differences in pain perception at any time point. The patients experienced significantly higher pain scores at bedtime and 24 h after separator placement. In addition, there were statistically significant findings in pain perception at different time points within each pain relief method (p = 0.000, p < 0.05). ConclusionThe use of chewing gum and bite wafers in alleviating orthodontic pain was beneficial and comparable to ibuprofen use following the placement of separators before orthodontic treatment among orthodontic patients.

Research on cooperative control method of comprehensive pressure relief and anchor grouting reinforcement in deep mining roadways

To address the surrounding rock control problems in high-stressed deep mining roadways, we used Suncun Coal Mine with maximum mining depth in China as the engineering background to analyze failure laws of surrounding rock of gob-side entry driving. Combined with field tests of anchor grouting parameters, we carried out numerical simulation with multi factors. The evolution of surrounding rock stress and displacement under different pressure relief parameters were clarified. On the basis, we proposed an integrated control method for the comprehensive pressure relief for coal and rock mass and anchor grouting reinforcement in deep mining roadway. We used geomechanical model test to compare gob-side entry driving method and this new method. The results showed that this new method can reduce average stress at the working face by 15.8% and peak stress of roadway shoulder by 12.5%. We applied this method in the field, which reduced roadway deformation by 535 mm.

The Performance Analysis of Grouting Repair Effect on the Accuracy of Disturbance Stress Test in Damaged Surrounding Rock Mass.

Disturbance stress assessment is crucial for ensuring the safety of deep engineering projects. Currently, the primary technique for continuously monitoring three-dimensional disturbance stress is the stress relief method, but its accuracy can be compromised by rock damage that occurs after excavation. To mitigate this issue, grouting is employed to repair damaged rock masses and enhance their mechanical properties. However, the impact of grouting techniques on improving the accuracy of disturbance stress testing is challenging to evaluate through laboratory and in situ experiments. To address this problem, numerical simulation technology is employed to investigate disturbance stress testing after the repair of damaged surrounding rock through grouting. The simulation results indicate that grouting repair significantly enhances the accuracy of stress testing. As the depth of damaged rock mass repair increases, the error in stress testing decreases. Achieving complete repair of the initial damage zone during grouting is essential to eliminate errors in stress testing. Expanding on the positive effects of grouting repair on stress testing, a segmented testing method for disturbance stress is proposed. The method involves separately testing the initial stress and stress changes, thereby reducing the stress level within the rock, minimizing rock failure, and enhancing the accuracy of disturbance stress testing. This study provides valuable reference methods, and the outcomes of this research will serve as a foundation for enhancing the accuracy of disturbance stress testing in deep hard rock engineering.

Analysis of Vibratory Stress Relief (VSR) Parameters on Mechanical and Metallurgical Properties of AISI 1008

Analysis of Vibratory Stress Relief (VSR) Parameters on Mechanical and Metallurgical Properties of AISI 1008

Lymph node metastasis prediction and biological pathway associations underlying DCE-MRI deep learning radiomics in invasive breast cancer.

The relationship between the biological pathways related to deep learning radiomics (DLR) and lymph node metastasis (LNM) of breast cancer is still poorly understood. This study explored the value of DLR based on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in LNM of invasive breast cancer. It also analyzed the biological significance of DLR phenotype based on genomics. Two cohorts from the Cancer Imaging Archive project were used, one as the training cohort (TCGA-Breast, n = 88) and one as the validation cohort (Breast-MRI-NACT Pilot, n = 57). Radiomics and deep learning features were extracted from preoperative DCE-MRI. After dual selection by principal components analysis (PCA) and relief methods, radiomics and deep learning models for predicting LNM were constructed by the random forest (RF) method. A post-fusion strategy was used to construct the DLR nomograms (DLRNs) for predicting LNM. The performance of the models was evaluated using the receiver operating characteristic (ROC) curve and Delong test. In the training cohort, transcriptome data were downloaded from the UCSC Xena online database, and biological pathways related to the DLR phenotypes were identified. Finally, hub genes were identified to obtain DLR gene expression (RadDeepGene) scores. DLRNs were based on area under curve (AUC) evaluation (training cohort, AUC = 0.98; validation cohort, AUC = 0.87), which were higher than single radiomics models or GoogLeNet models. The Delong test (radiomics model, P = 0.04; GoogLeNet model, P = 0.01) also validated the above results in the training cohorts, but they were not statistically significant in the validation cohort. The GoogLeNet phenotypes were related to multiple classical tumor signaling pathways, characterizing the biological significance of immune response, signal transduction, and cell death. In all, 20 genes related to GoogLeNet phenotypes were identified, and the RadDeepGene score represented a high risk of LNM (odd ratio = 164.00, P < 0.001). DLRNs combining radiomics and deep learning features of DCE-MRI images improved the preoperative prediction of LNM in breast cancer, and the potential biological characteristics of DLRN were identified through genomics.

Efficacy ofhydroxypropyl-guar dropsin improving tear film index and ocular surface dynamicsusing two treatment methods under a controlled desiccating environment.

This study aimed to assess the efficacy of hp-guar eye drops on tear film index and ocular surface dynamics under desiccating conditions using protection and relief treatment modalities. The 12 normal, non-dry eye participants were subjected to adverse environmental conditions using a Controlled Environment Chamber (CEC) where the relative humidity (RH) was 5% and the ambient temperature was 21°C. The participants were screened for ocular symptoms, tear osmolarity, ocular surface temperature (OST), tear production using the Ocular Surface Disease Index questionnaire (OSDI), OcuSense TearLab Osmometer, FLIR System ThermaCAM P620, and Schirmer strips. Tear production was calculated by the Tear Function Index test (TFI). The mean tear film osmolarity decreased significantly from 296mOsm/L at 40% RH to 285mOsm/L at 5% RH (p = 0.01). Conflicting responses were seen for osmolarity in protection and relief. Mean tear osmolarity was significantly higher in the protection method in comparison to the relief method (p = 0.005). The mean TFI increased from 557 at 40% to 854 at 5% (p = 0.02). A significant increase in TFI was observed in the relief method in comparison with both 40% (p = 0.001) and 5% (p = 0.04). In the relief method, the mean TFI score went up to 1139 when hp-guar was installed. A significant improvement in ocular comfort was experienced in both the protection (p = 0.041) and relief (p = 0.010) methods at 5% RH. The instillation of hp-guar drops in the relief method resulted in a significant reduction in OST. The mean OST dropped to 33.01 ºC, significantly lower than the recorded OST for both normal (p = 0.040) and dry (p = 0.014) environmental conditions. Hp-guar drops significantly improve tear film parameters under a desiccating environment, however, tear film parameters respond differently to the management modalities. In the protection method, tear film osmolarity was protected against a dry environment, while in the relief mode, an improvement in tear production and a decrease in ocular surface temperature were seen. Hp-guar performance could be maximized for the management of exposure to adverse environments by using a treatment protocol that targets the most affected parameters in each group of patients. Using CEC has the potential to provide researchers with a readily available method to evaluate the efficiency of tear supplementation.

Experiences of Menopausal Transition Among Vietnamese Women: A Grounded Theory Analysis.

Background and Purpose: Complaints about menopause vary between cultures, and the experience of menopause changes significantly in women living in different countries. Limited evidence is available regarding the menopausal experience among Asian women. This study aims to explore the menopausal transition experiences of Vietnamese women. Methods: A qualitative inquiry was undertaken using the grounded theory approach. Semi-structured interviews were conducted and analyzed following constructivist grounded theory methods. Results: In the early transition, women's lives underwent many challenges. They had physical manifestations of menopause and difficulty in their sexual life. Later, women identified that their psychosocial impacts were affected, leading to emotional changes and changes in perceptions of others about the menopausal transition. The study also showed that each woman had their own beliefs and religion. Finally, after experiencing physical and mental changes, women found methods for discomfort relief. These methods included seeking information, applying strategies to manage menopausal challenges and consequences, and maintaining balance. Implications for Practice: The diverse perspectives on women's menopausal transition can help nurses and other health care professionals to provide culturally appropriate care for women.

Non-Opioid Analgesics and Adjuvants after Surgery in Adults with Obesity: Systematic Review with Network Meta-Analysis of Randomized Controlled Trials.

Background/Objectives: Managing postoperative pain in patients with obesity is challenging. Although using a combination of pain relief methods is recommended for these patients, the true effectiveness of various intravenous non-opioid analgesics and adjuvants in multimodal anesthesia needs to be better defined. Methods: A systematic review and network meta-analysis was performed to evaluate the efficacy of nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, ketamine, α-2 agonists, lidocaine, magnesium, and oral gabapentinoids in adult surgical patients with obesity. The analysis aimed to compare these treatments to a placebo/no treatment or alternative analgesics, with a primary focus on postoperative pain and secondary endpoints including rescue analgesia, postoperative nausea and vomiting (PONV), and recovery quality. English-language randomized controlled trials across PubMed, Scopus, Web of Science, CINAHL, and EMBASE were considered. Quality and evidence certainty were assessed with the RoB 2 tool and GRADE, and data was analyzed with R software. Results: NSAIDs, along with acetaminophen, lidocaine, α-2 agonists, ketamine, and oral gabapentinoids, effectively reduce early postoperative pain. NSAIDs, particularly ibuprofen, as well as acetaminophen, ketamine, and lidocaine, also show benefits in later postoperative stages. Intravenous non-opioid analgesics and adjuvants show some degree of benefit in reducing PONV and the need for rescue analgesic therapy when using α-2 agonists alone or combined with oral gabapentinoids, notably decreasing the likelihood of PONV. Ketamine, lidocaine, and α-2 agonists are shown to enhance postoperative recovery and care quality. Conclusions: Intravenous non-opioid analgesics and adjuvants are valuable in multimodal anesthesia for pain management in adult surgical patients suffering from obesity.

Adductor Canal Block Versus Femoral Nerve Block in Total Knee Arthroplasty: Network Meta-Analysis.

The quality of postoperative analgesia in total knee arthroplasty is crucial for patient recovery, rehabilitation, and hospital stay duration. In line with the above, а single-shot adductor canal block has been considered as an improved method over continuous femoral nerve block. However, continuous adductor canal block and single-shot femoral nerve block have been not adequately addressed in the discussion. This study aimed to compare the effectiveness of various types of adductor and femoral nerve blocks on clinically relevant outcomes in patients following total knee arthroplasty. A systematic review and network meta-analysis were conducted following "PRISMA-NMA" and Cochrane Handbook guidelines. The eligibility criteria included randomized trials and, where these were lacking for a comparison, nonrandomized studies involving adults undergoing primary total knee arthroplasty, comparing single-shot adductor canal block, continuous adductor canal block, single-shot femoral nerve block, and continuous femoral nerve block. A total of 36 studies involving 3308 patients were included. Single-shot adductor canal block showed higher pain scores and opioid consumption but better functional recovery at 24h compared with continuous femoral nerve block. However, this trend vanishes by the 48h assessment postsurgery. Continuous adductor canal block required higher opioid consumption but better functional recovery and shorter hospital stay compared with continuous femoral nerve block. Single-shot adductor canal block showed higher pain scores but comparable opioid consumption and functional recovery to continuous adductor canal block. The shift from continuous femoral nerve block to single-shot adductor canal block as the preferred method for pain relief after total knee arthroplasty may be premature. While the latter improves mobility, it falls short in pain control and does not shorten hospital stays. Continuous adductor canal block shows promise but is currently underappreciated, and single-shot femoral nerve block is often overshadowed by other techniques in regional anesthesia. Further high-quality, multicenter randomized controlled trials are needed to validate these findings.

METHOD OF MACRO MICROSCOPIC PREPARATION OF SUPERFICIAL VESSELS AND NERVES OF THE FACE

The study of the age-related morphology of the surface structures of the face at the stages of the postnatal period of human ontogenesis under normal conditions allows both morphologists and clinicians to signifi cantly understand several pathological changes, reveal the causality of destructive processes, and propose anatomically based methods of pain relief and surgical interventions. Recently, in connection with the development of maxillofacial surgery, the details of the macromicroscopic preparation of the surface vessels and nerves of the human face are of great interest, which is of important practical importance for establishing the forms of individual anatomical variability.The purpose of the study was to determine the most rational sequence of actions during the preparation of surface vessels and nerves of the face.The study of the fetal anatomy of the superfi cial vessels and nerves of the face was carried out on 18 preparations of human fetuses of 4-10 months using macromicroscopic preparation, injection of vessels, and morphometry without external signs of anatomical deviations or congenital malformations of the structures of the head.The proposed and tested method of dissection of superfi cial vascular- nervous structures of the face in human fetuses ensures the standardization of obtaining data on the typical, individual, and age-related anatomical variability of the branches of the facial and trigeminal nerves and their nerve connections, some branches of the external carotid artery, namely: facial and superfi cial temporal arteries, infl ow of facial, superfi cial temporal and submandibular veins, as well as intra- and intersystem arterial and venous anastomoses. Variants of blood supply and innervation of facial muscles in human fetuses of diff erent ages have been established.The sequence of actions used during the preparation of superfi cial arterial and venous vessels and nerves of the face will help maxillofacial and plastic surgeons to individually choose the most rational method of surgical intervention for the restoration of defects of the head area, as well as the method of analgesia.

Erector spinae plane block as a component of intensive care for acute pancreatitis: a prospective randomized pilot study

BACKGROUND: Analgesia is crucial in the treatment of patients with acute pancreatitis, which includes the increased use of regional analgesia. In recent years, less-invasive and safer methods of pain relief, particularly erector spinae plane block (ESP-block), has drawn attention from the anesthesiological community. However, studies on its use in acute pancreatitis are rare. OBJECTIVE: Our aim was to make a clinical evaluation of bilateral erector spinae plane block in patients with acute pancreatitis. MATERIALS AND METHODS: A pilot prospective randomized study was conducted. The patients were divided into two groups: group 1 (n=7), ESP blockade was used, and group 2 (n=12), epidural analgesia (EA) was used. The primary points were considered to be an assessment of pain syndrome intensity and the need for analgesics. Additional results were liver and kidney function, acid-base condition, inflammatory response level, and the time of onset of peristalsis. RESULTS: The decrease in pain intensity in both groups was unidirectional: after 8 h, it was 3.57±1.98 points to the NRS in group 1 and 2.91±1.97 points to the NRS in group 2, and after 24 h, it was 1.42±1.27 and 1.75±2.3 points to the NRS, respectively. No significant difference was found in pain intensity between the groups (р 0,05). The average consumption of ketorolac was 78.2±16.3 mg in group 2 — 63.28±17.23 mg for 1 patient. The average need for narcotic analgesics, that is, morphine, per patient was 22±8 mg in group 1 and 36.3±17.2 mg in group 2 (р 0,05). During the therapy, blood α-amylase, diuresis rate, creatinine level, and glomerular filtration rate did not have a significant difference between the groups, as well as pH, BE, and blood lactate levels (р 0,05). Peristalsis was noted after 12.49±19.73 h in the ESP-block group and after 16.9±21.3 h in the 2nd group (р 0,05). The ICU length of stay between the groups did not differ and was 62±3 and 62±7 h, respectively (р 0,05). CONCLUSION: Bilateral erector spinae plane block is a simple and safe method that induces analgesic effect and effect on homeostasis in acute pancreatitis, similar to epidural blockade. Further study of the role and location of erector spinae plane block in treating pain in acute pancreatitis is required.

Predicting severe pain after cesarean section: prospective cohort study

BACKGROUND: Severe and unbearable pain after abdominal delivery is recorded in 20% of cases, indicating the limitations of the applied methods of postoperative pain relief and the need for a personalized approach. Tests assessing preoperative pain threshold and anxiety have the greatest sensitivity and specificity as predictors of intense postoperative pain. The informative value of these tests in the Russian obstetric population has not been assessed. OBJECTIVE: This study aimed to determine the optimal method for predicting severe pain after cesarean section (CS). MATERIALS AND METHODS: This prospective cohort study included 212 women who underwent elective CS under spinal anesthesia. The Hospital Anxiety and Depression Scale (HADS) anxiety rating scale, pressure algometry, and cutaneous infiltration anesthesia pain intensity assessment were used as predictors of high-intensity pain. Postoperative pain intensity was assessed using a 10-point Numeric Rating Scale (NRS). The maximum level of pain according to the central pain level at rest (NRSr) and during movement (NRSa) was recorded 24 hour postoperatively. The number of requests for “rescue analgesia” was recorded. The predictive value of the studied methods was determined based on ROC curve analysis. RESULTS: Median (interquartile range) NRSa was 5 [4–5]. Severe pain was recorded in 14% of the patients. The area under the ROC-curve (AUC), reflecting the relationship between severe postoperative pain and pressure-pain threshold, was 0.91±0.03 with 95% confidence interval (CI) of 0.84–0.97 (p 0.001). The relationship between pain intensity during infiltration anesthesia and postoperative pain severity had AUC=0.88 ± 0.04 with 95% CI of 0.81–0.96 (p 0.001). The HADS anxiety score demonstrated the lowest predictive ability (AUC=0.69±0.06; 95% CI, 0.81–0.96; p 0.001). When all three techniques were used together, the AUC was 0.924±0.024 with 95% CI 0.88–0.97 (p=0.001). CONCLUSION: Preoperative pressure-pain threshold and pain severity during infiltration anesthesia are reliable predictors of severe pain after CS. Assessment of preoperative anxiety using HADS has low sensitivity and specificity. However, its use in conjunction with methods for assessing the pain threshold increases the predictive value of the combined model compared with the results of using the methods separately.

Current methods of perioperative analgesia for arthroscopic anterior cruciate ligament reconstruction: a literature review

Arthroscopic knee joint surgery is becoming routine in modern orthopedics. Its advantages include minimal invasiveness, lower infection risk, and early rehabilitation. Despite the minimized surgical trauma, the postoperative period after some arthroscopic operations involving cruciate ligament surgery occurs with relatively severe pain syndrome. This warrants the search for novel pain relief methods for patients that meet all modern trends. This review presents data from randomized clinical studies and meta-analyses on the use of various anesthesias in arthroscopic cruciate ligament repair and discusses methods of prolonged postoperative analgesia. The limited number of studies on this issue and lack of systematic recommendations require prospective studies.

Evaluation of therapeutic efficacy of Emustil drops for ocular discomfort and tear film osmolarity using different treatment management modes under dry environmental conditions

BackgroundWe aimed to check the efficacy of Emustil (oil in water emulsion) drops on tear film index and ocular surface dynamics in dry environments through protection and relief treatment modalities.MethodsThe subjects were exposed to a dry environment using a Controlled Environment Chamber (CEC) where the relative humidity (RH) was 5% and the temperature was 21 °C and screened for ocular symptoms, tear osmolarity, ocular surface temperature (OST) and tear production using ocular Surface Disease Index questionnaire (OSDI), OcuSense TearLab Osmometer, FLIR System ThermaCAM P620 and Schirmer strips/phenol red test respectively. Tear production was calculated by the Tear Function Index test (TFI).ResultsThe mean tear film osmolarity decreased significantly from 296.8 mOsm/l at 40% RH to 291 mOsm/l at 5%. (p = 0.01). Instillation of Emustil resulted in a significant increase in tear osmolarity in the relief method compared with osmolarity seen at 5% RH when no drop was used. The mean PRT value decreased from 26 ± 9 in normal conditions (40% RH) to 22 ± 4 mm in dry conditions (5% RH). Emustil drops did not induce any significant change in tear production in the PRT test. No significant change was found in OST following exposure to 5% RH. OST did not show a statistically significant change with the emulsion when used for relief (p > 0.05). The mean score of ocular discomfort observed was 70 at 5% RH. Still, the instillation of the oil-in-water emulsion (Emustil) resulted in a noticeable decrease in visual discomfort to 37 (p = 0.00) in protection and 59 in relief (p = 0.05). Emustil drops substantially improved tear film parameters under a desiccating environment, however, tear film parameters respond differently to the management modalities. In the protection method, tear film osmolarity was protected against a dry environment, while in the relief mode, tear production was improved.ConclusionCEC allows for a thorough evaluation of tear film parameters and dry eye treatment protocols in labs, providing greater confidence when applying them to patients. In addition, our study showed that Emustil not only provides protection and relief for dry eyes but also helps to maintain ocular homeostasis in desiccating environments. This indicates a promising potential for improving dry eye treatment protocols.

Post-acute COVID-19 syndrome in previously hospitalized patients.

With the prolongation of the COVID-19 pandemic, more individuals are experiencing sequelae after COVID-19 infection, also known as post-acute COVID-19 syndrome (PCS). The aims of this study were to describe the prevalence and characteristics of PCS symptoms such as fatigue, anxiety, and depression and to compare these symptoms according to participant characteristics in patients who had been previously hospitalized due to COVID-19. A descriptive cross-sectional study design was used. We included 114 individuals who had been hospitalized for COVID-19 and were discharged from the hospital at least 4 weeks before. Symptoms were assessed using the Fatigue Severity Scale, the Hospital Anxiety-Depression Scale, and the PCS symptom questionnaire developed by the authors. We used descriptive statistics, the Student's t-test, the Wilcoxon rank-sum test, and the Kruskal-Wallis test for statistical analyses. The most prevalent symptoms were anxiety (66.7%), fatigue (64.0%), headache (57.9%), and concentration or memory difficulties (57.9%). Concentration or memory difficulties and sleep disturbances had the highest mean frequency. Concentration or memory difficulties were rated with the highest mean severity, and cough, loss of taste, and muscle and joint pain had the highest mean distress scores. Female participants, individuals hospitalized for more than 2 weeks, individuals discharged more than 9 months ago, unvaccinated patients, and those who tried at least one symptom relief method reported higher symptom distress. The findings of this investigation into the frequency, severity, and distress of symptoms shed light on the identification of post-COVID symptoms in detail. To objectively evaluate and comprehend the symptom trajectories of PCS, prospective studies about the development of symptom assessment tools and studies with a longitudinal design should be conducted. A substantial number of respondents reported numerous symptoms and expressed symptom distress; therefore, the development of nursing interventions and treatments to alleviate PCS symptoms is crucial.

International double taxation: Interpretation in the Indian context and general mitigation Measures

International Double Taxation poses a complex challenge with diverse interpretations, especially in the Indian context. This paper investigates the nuances of double taxation, focusing on legal principles, double taxation avoidance agreements (DTAAs), and their implications for residents and permanent establishments. It analyzes India's engagement in double taxation treaties, considering monistic and dualistic principles, legislative processes, and recent judicial developments. Case studies from French and Indian courts offer insights into treaty interpretation. The paper examines relief methods such as Exemption, Credit, Tax-sparing, and Expense Deduction, emphasizing their application within Indian tax treaties. Notably, Permanent Establishment (PE) significance in international taxation is explored through relevant case law. Conclusively, the paper underscores the importance of addressing international double taxation in the globalized era. It argues that while various relief methods exist, the Exemption method is most effective in mitigating double taxation, contrasting with the partial relief provided by the Credit method. The choice of relief method varies across nations based on financial considerations. This comprehensive exploration contributes to understanding international double taxation in the Indian context, highlighting legal interpretations, treaty dynamics, and mitigation measures. It advocates for harmonizing global approaches to achieve more effective and equitable solutions in international taxation.

Does Early Initiation of Labor Epidural Analgesia Affect Labor Outcomes? A Randomized Clinical Trial

Background: Although epidural analgesia (EA) is a popular and effective method for pain relief during labor, significant controversy exists in terms of the impact of EA on labor outcomes and the best time for initiation of EA. Here, we aim to explore the effects of early initiation EA on the labor process in nulliparous at-term pregnant women.&#x0D; Methods: A total of 240 nulliparous women enrolled in this study. The early epidural (EE) group (n=120) consisted of women in the latent phase of labor and the late epidural (LE) group (n=120) were in the active phase of labor. Each group received 16 ml of 0.125% preservative-free isobaric bupivacaine with 50 µg fentanyl (total: 17 ml) as a primary bolus dose in the epidural space for labor analgesia and an intermittent bolus of 5-10 ml of the primary solution was administered via a catheter. The length of labor, rate of cesarean section (CS), neonatal well-being, and infant Apgar scores were recorded.&#x0D; Results: There were no statistically significant differences between the two groups regarding the duration of the first (p=.43) and second (p=.54) phases of labor. No statistically significant differences were observed between the two groups in terms of the rate of CS (p=.21), causes for CS (p=.24), and neonatal Apgar scores (p=0.84).&#x0D; Conclusion: Initiation of EA during early labor did not result in increased CS or instrumental vaginal deliveries, and did not prolong labor duration.