Multiple Problems Research Articles

YouTube Videos Are a Moderately Comprehensive, Reliable, and Quality Option to Learn About “Multiple Sclerosis and Sexuality”

Objectives This study aimed to evaluate the performance, comprehensiveness, reliability, and quality of English-language YouTube videos addressing the subject of multiple sclerosis and sexuality. Methods In August 2023, a search was conducted on a computer using the keywords “multiple sclerosis and sexuality,” “multiple sclerosis and sexual health,” “multiple sclerosis and sexual health problems,” and “multiple sclerosis and sexual dysfunction” for this descriptive study. According to predetermined inclusion and exclusion criteria, 38 videos that met the research purpose were examined. The related URLs were recorded. For each video, the following information was collected: content producers, performance with YouTube statistics, comprehensiveness with a form developed by researchers, reliability with Singh’s Reliability Evaluation Form, and quality with Global Quality Scale. Two researchers independently evaluated the videos. Results Eighty-nine and a half percent of the videos contained information presented by professionals. The average number of views was 2699.132 ± 3382.848, the comprehensiveness score was 4.2 ± 1.711, the reliability score was 3.184 ± 1.182, and the quality score was 3.421 ± 1.2. Nearly half (42.2%) contained good and useful information for viewers, and half (50%) had high video quality. The reliability and quality scores of videos containing each item in terms of comprehensiveness were higher compared to videos that did not include that item (p < 0.05). In addition, the videos with higher comprehensiveness scores had higher quality and reliability scores (p < 0.001). Conclusion These results underscore the constrained performance attributes of YouTube videos addressing multiple sclerosis and sexuality, with their content exhibiting a moderate level of comprehensiveness, reliability, and quality. These results may provide a basis for increasing the effectiveness of YouTube videos on multiple sclerosis and sexuality.

Providing optimal care in the neonatal care units in India: How Covid-19 exacerbated existing barriers.

Nearly one quarter (600,000) of all neonatal deaths worldwide per year occur in India. To reduce neonatal mortality, the Indian Ministry of Health and Family Welfare established neonatal care units, including neonatal intensive care units and specialized neonatal care units to provide immediate care at birth, resuscitation for asphyxiation, postnatal care, follow up for high-risk newborns, immunization, and referral for additional or complex healthcare services. Despite these efforts, neonatal mortality remains high, and measures taken to reduce mortality have been severely challenged by multiple problems caused by the Covid-19 pandemic. In this qualitative study, we conducted seven focus group discussions with newborn care unit nurses and pediatric residents and 35 key informant interviews with pediatricians, residents, nurses, annual equipment maintenance contractors, equipment manufacturers, and Ministry personnel in the Vidarbha region of Maharashtra between December 2019 and November 2020. The goal of the study was to understand barriers and facilitators to providing optimal care to neonates, including the challenges imposed by the Covid-19 pandemic. Covid-19 exacerbated existing barriers to providing optimal care to neonates in these newborn care units. As a result of Covid-19, we found the units were even more short-staffed than usual, with trained pediatric nurses and essential equipment diverted from newborn care to attend to patients with Covid-19. Regular training of neonatal nursing staff was also disrupted due to Covid-19, leaving many staff without the skills to provide optimate care to neonates. Infection control was also exacerbated by Covid-19. This study highlights the barriers to providing optimal care for neonates were made even more challenging during Covid-19 because of the diversion of critically important neonatal equipment and staff trained to use that equipment to Covid-19 wards. The barriers at the individual, facility, and systems levels will remain challenging as the Covid-19 pandemic continues.

Accelerating Process Development and Product Formulation.

Currently, the lengthy time needed to bring new drugs to market or to implement postapproval changes causes multiple problems, such as delaying patients access to new lifesaving or life-enhancing medications and slowing the response to emergencies that require new treatments. However, new technologies are available that can help solve these problems. The January 2023 NIPTE pathfinding workshop on accelerating drug product development and approval included a session in which participants considered the current state of product formulation and process development, barriers to acceleration of the development timeline, and opportunities for overcoming these barriers using new technologies. The authors participated in this workshop, and in this article have shared their perspective of some of the ways forward, including advanced manufacturing techniques and adaptive development. In addition, there is a need for paradigm shifts in regulatory processes, increased pre-competitive collaboration, and a shared strategy among regulators, industry, and academia.

Surgical aortic valve replacement in a patient with severe scoliosis

Aortic valve replacement for severe symptomatic Aortic stenosis is a low-risk procedure, but when compounded with coexisting conditions, procedural risk may increase. We present the case of a middle-aged female patient presenting with a constellation of complexities, including oblique sternum, severe dextroscoliosis, severe symptomatic aortic stenosis with bicuspid aortic valve, aortic root distortion, and a relatively rare blood group. Despite multiple problems, she underwent successful surgical aortic valve replacement. This case highlights the importance of a multidisciplinary approach in complex cardiac patients with the utmost need for a heart team concept for patient-centric decision-making.

Multiple Table Models Based on Queuing Theory for Firefighting Traffic Problems

With the development of global urbanization, urban planning has been a hot spot of most concern. Since the traditional urban fire station setting method has been gradually unable to meet the emergency needs of a city. In this paper, a series of methods are developed to achieve the best balance between economic expenditure and reliability. According to the heat maps about emergency calls in a city in recent years, different types of alarm phones have obvious regional distribution characteristics. Inspired by the Queuing Theory algorithm, we abstract this complex problem into a parallel multi-server waiting queuing model to find each average queue length of three kinds of alarm calls and success in converting the multiplicity problem into solving the vehicle number and location problems respectively. Based on this planning problem, new combinations with different numbers of vehicles can be gotten. Then based on the assignment model, the optimal deployment plan can also be different with different numbers and geographical locations of the three kinds of stations. Our method significantly improves the firefighting traffic problems and can be applied in the actual situation.

Development of aids to relieve vulvodynia during the postpartum period.

Postpartum women live with a low quality of life due to pain caused by episiotomy and perineal laceration. In particular, they endure pain when sitting for long periods of time to breastfeed. The purpose of this study is to develop a sitting aid to alleviate postpartum vulvodynia. This study was conducted in the following four phases from July 2017 to May 2019. They are: material selection and molding, cleaning and disinfection testing, pressure distribution measurement testing, and trial testing by postpartum women. The main material was a 100% polypropylene object with a three-dimensional reticular fiber spring structure and fiber density of 3.8 kg/m2. As a result, a sitting aid that withstands washing and disinfection well in the medical field and is breathable. It had moderate resilience and elasticity and reduced pressure on the seating surface for women weighing approximately 45 kg and 55 kg, but we were skeptical about its use for women weighing more than that. The completed sitting aid is noninvasively effective in improving the quality of life of many postpartum women, but the density and thickness of the main material should be reexamined to meet the needs of women in a wider weight range. In addition, a self-administered questionnaire survey of trial users revealed that some women did not experience relief from vulvodynia even after using the sitting aid. Such women also had physical problems such as discomfort in the lower back, difficulty breastfeeding, and difficulty standing up. For women with multiple physical problems, individual causes should be addressed.

A conceptual framework on pre- and post-displacement stressors: the case of Syrian refugees.

Researchers have documented multiple stressors and mental health problems along the journey of refugees as they are displaced to seek refuge in nearby and remote host countries. This article examines published research on Syrian refugees to propose a framework to conceptualize Syrian refugees' pre- and post-stressors and their collective impact on their mental health. The proposed framework provides a comprehensive understanding of the interconnected pathways between pre-displacement stressors, post-displacement stressors, and mental health outcomes for Syrian refugees. Pre-displacement stressors are best captured by the concept of trauma centrality and emotional suppression. Post-displacement stressors, categorized under financial, political, and social themes, have a direct impact on the mental health of the refugees, but could also play a partial mediating role on the impact of pre-displacement stressors on mental health. The framework suggests a direct pathway between the experience of war-related traumatic events and mental health and introduces the country of residence as a potential moderator of the severity of mental health. The latter is primarily influenced by local policies and the host communities' acceptance of refugees. We believe that the proposed framework can guide the work of researchers, policymakers, and practitioners concerned with the mental health and well-being of Syrian refugees. Additionally, although based on the experience of Syrian refugees, it presents a holistic perspective that could be adapted in other refugee settings.

Relationship Between Sleep Problems and Memory Impairment Among Nurses.

Sleep problems are common among nurses and can lead to various health problems. Further, the relationship between multiple sleep problems and memory impairment in clinical nurses remains unknown. Therefore, in this study, we aimed to explore the relationship between sleep problems and memory impairment among nurses. Multistage cluster-stratified random sampling was performed from tertiary hospitals in Shandong, China. Overall, a total of 1833 nurses were included in the final analysis. The Chinese version of the Pittsburgh Sleep Quality Index and prospective and retrospective memory questionnaire were administered to the participants. The sleep quality of the nurses decreased during the normal epidemic prevention and control period compared with that before the epidemic in terms of sleep duration, sleep efficiency, and sleep disturbances. Nurses who reported cumulative or specific sleep problems (e.g., high sleep latency, sleep disturbances, and daytime dysfunction) and those in the "daily disturbances" and "poor sleep quality" groups had a higher risk of memory impairment than the others. Sleep problems might be important for memory impairment among nurses. These findings may help identify nurses at considerable risk of memory impairment in clinical practice.

Modified crayfish optimization algorithm for solving multiple engineering application problems

Crayfish Optimization Algorithm (COA) is innovative and easy to implement, but the crayfish search efficiency decreases in the later stage of the algorithm, and the algorithm is easy to fall into local optimum. To solve these problems, this paper proposes an modified crayfish optimization algorithm (MCOA). Based on the survival habits of crayfish, MCOA proposes an environmental renewal mechanism that uses water quality factors to guide crayfish to seek a better environment. In addition, integrating a learning strategy based on ghost antagonism into MCOA enhances its ability to evade local optimality. To evaluate the performance of MCOA, tests were performed using the IEEE CEC2020 benchmark function and experiments were conducted using four constraint engineering problems and feature selection problems. For constrained engineering problems, MCOA is improved by 11.16%, 1.46%, 0.08% and 0.24%, respectively, compared with COA. For feature selection problems, the average fitness value and accuracy are improved by 55.23% and 10.85%, respectively. MCOA shows better optimization performance in solving complex spatial and practical application problems. The combination of the environment updating mechanism and the learning strategy based on ghost antagonism significantly improves the performance of MCOA. This discovery has important implications for the development of the field of optimization.Graphical

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

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

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

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

Testing the Weak Efficient Market Hypothesis of Chinese Stock Market--Based on the Market Performance of Representative Stock Investment Portfolios in the HS300 Index

Chinas domestic stock market has developed very quickly overall in the more than 30 years since it was established, but information effectiveness in the Chinese stock market still faces multiple problems, so testing the weak efficient market hypothesis of the Chinese stock market is a good way to test its information quality and give investors relevant advice. This article selected representative stocks from the HS300 index, gathered the stocks historical data, used the index model to construct an optimal portfolio, and used another part of historical data to test if the portfolio has continuous excess return compared with the market portfolio and risk-free asset. The article finds excess return for the optimal portfolio during a long period and cannot prove that the Chinese stock market is weak and efficient. This result will provide a certain theoretical basis for investors who use technical analysis for stock investment and may also indicate that many issues still need to be addressed in the Chinese stock market, such as information asymmetry, high transaction costs, and insufficient regulation.

Influence of manipulative skills on quality of life and activities of daily living in multiple sclerosis.

More than 50% of patients diagnosed with multiple sclerosis report problems with manipulative function and impairments in their daily lives due to this disorder. Therefore, the aim of the present study is to determine how pinch strength, prey strength and manipulative dexterity affect the quality of life and personal autonomy of people diagnosed with multiple sclerosis and to study whether there is a difference in these aspects between different types of multiple sclerosis. There was a total sample of 126 participants, of which 57 were controls and 69 cases. All of them were assessed with a Multiple Sclerosis Quality of Life-54 test, Nine-Hole Peg Test and Barthel Index. People with multiple sclerosis have worse pinch strength, prey strenght, manipulative dexterity, performance in basic activities of daily living and quality of life (p < 0.001). Prey strength is a conditioning factor for performance and quality of life in people with multiple sclerosis. As for the type of multiple sclerosis, relapsing-remitting multiple sclerosis presented better values (p < 0.001). The findings of this study point to the fact that patients diagnosed with multiple sclerosis have a decrease in prey strength, pinch strength, manipulative dexterity, quality of life and autonomy in activities of daily living compared to the healthy population.

Connecting student development of use of grouping and mathematical properties

Understanding algebraic properties is a key component of building mathematical thinking across grades K-8, yet less is known about the development of students' use of mathematical properties within their strategies. This article presents results from four conversations with 24 5th-grade students over a school year, that focus on examining the development of students grouping within strategies for multiplication and division problems. Findings add to previous research on student strategies within multiplication and division by detailing some of the nuances in students' use of grouping. Additionally, a focus on student strategies reveals students' progression in more explicit use of grouping underlies the development of more planful use of the distributive and associative properties of multiplication.

Cross-cultural validity of the Dutch sleep-related breathing disorder scale of the Pediatric Sleep Questionnaire in a general population

BackgroundPediatric sleep-disordered breathing is associated with multiple health problems. Polysomnography is the reference standard for identifying this disorder, but availability is limited. Therefore, an alternative screening tool is needed. Globally, the Sleep-Related Breathing Disorder scale of the Pediatric Sleep Questionnaire (PSQ) has proven to be a feasible tool. Consequently, this study aimed to translate and culturally adapt the PSQ into Dutch and then to examine the cultural validity, internal consistency, and test-retest reliability of the Dutch version among a general population visiting oral healthcare centers. MethodsThe translation, review, adaptation, pretest, and documentation approach was used to ensure cross-cultural adaptation of the PSQ. Then, 220 children (2.4–18 years) were sampled for clinimetric evaluation. We estimated the cross-cultural validity by comparing the factor analyses of the original PSQ and the Dutch version. Reliability was assessed using Cronbach's alpha, Spearman's correlation, the intraclass correlation coefficient, the standard error of measurement, and a Bland-Altman plot. ResultsThe factor loading patterns of the Dutch version matched with the original study around the four predetermined factors: breathing, sleepiness, behavior, and other. The internal consistency, with a Cronbach's α of 0.77, was acceptable. The test-retest reliability with an intraclass correlation coefficient and Spearman's correlation of 0.89 and 0.93, respectively, was good to excellent. ConclusionsCultural adaptation was ensured and the results support cross-cultural validity, internal consistency, and test-retest reliability of the Dutch Sleep-Related Breathing Disorder scale of the PSQ. This questionnaire could therefore be a valuable tool for screening disordered breathing in Dutch children.

Development of optimum waste water using network

The present study deals with three case studies are discussed in detail. All cases had been considered as retrofitting problems and solved very precisely considering existing fixed network costs, present cost of power consumption and recent market price of different sizes of pipes. The first case study involves four processes and single contaminant problem and three approaches of water minimization i.e. reuse, recycle reuse, regeneration reuse are applied. The GAMS software using CONOPT was used to mathematical programming. The second case study is identified as a multi contaminant, reuse problem. The results obtained from the present analysis is compared well and validated with the ASPEN WATER and WATER PINCH software's which uses mathematical programming and pinch technology. The third case study is also multiple contaminant problem which involves eight operations and only water reuse approach is applied. The results are also verified with both software's solutions. The initial fresh water consumption is 185 tph and after modification using mathematical programming it reduces to 90 tph (reuse), 90 tph (recycle reuse) and 46 tph (regeneration reuse).

Asymmetric Cryptography Based on the Tropical Jones Matrix

In recent years, the tropical polynomial factorization problem, the tropical matrix decomposition problem, and the tropical multivariate quadratic equation solving problem have been proved to be NP-hard. Some asymmetric cryptographic systems based on tropical semirings have been proposed, but most of them are insecure and have been successfully attacked. In this paper, a new key exchange protocol and a new encryption protocol are proposed based on the difficulty of finding the multiple exponentiation problem of the tropical Jones matrices. The analysis results indicate that our protocol can resist various existing attacks. The complexity of attacking an MEP by adversaries is raised due to the larger number of combinations in the tropical Jones matrices compared to regular matrix polynomials. Furthermore, the index semiring is the non-negative integer cyclic matrix semiring, leading to a higher efficiency in key generation.

Power-Efficient Dispatching of Time-Sensitive Requests in the Fog-Enabled Industrial Internet of Things

Recent advancements in service offerings and the emergence of new application areas have reveal the limitations of cloud computing as a solely solution. One of these new areas is the industrial internet of things, where industrial processes are controlled in a network-based and automated way which brings many new challenges. To solve the challenges, fog computing has been introduced as a complementary paradigm to the cloud. Resource management is one of those challenges need further investigation. The industrial internet of things by its own characteristics has led traditional methods to be inefficient within this evolving ecosystem. Therefore, fully utilizing potential of the new system necessitates effective resource management. This manuscript aims to investigate the problem of resource management in the emerging cloud-fog ecosystem of the industrial internet of things. Considering the dynamic nature of users, this study proposes the algorithms for dynamic resource allocation and provisioning based on deadlines. We formulate the problem as a multiple criteria stochastic problem and introduced an online solution. Our proposed solution takes into account the unique characteristics of Fog computing and the dynamic behavior of users. To effectively handle the scheduling of requests, the research suggests utilizing the Lyapunov optimization method and Lyapunov drift theory. The Lyapunov method helps to merge and measure all the related objectives in terms drift. The objective function is optimized, in each time slot, using a drift-plus-penalty weight parameter. By adopting this approach, the system can operate efficiently while meeting the constraints and performance requirements of IoT applications.

Barriers and facilitators of the reporting by family doctors of cases of domestic violence – a qualitative study across Portugal

BackgroundDomestic violence (DV) is a serious and prevalent public health problem with devastating consequences for the victims and their families. Whilst the number of cases reported to the authorities has risen in recent years, many victims still chose not to present a complaint. In Portugal, to address this, DV became a public crime. As victims of DV present multiple health problems and frequently seek professional help, family doctors are in a privileged position to detect and report cases of DV to the authorities. However, little is known about what motivates these professionals to report or not the DV cases they encounter in their practice to the authorities.MethodsWe conducted semi-structured interviews with family doctors from all regional health administrations of continental Portugal. Interviews occurred between July 2020 and September 2022, were conducted in person or remotely, audio recorded, transcribed, and analysed using thematic analysis. Content analysis was conducted to assess the agreement or disagreement regarding mandatory reporting in each of the themes and subthemes.ResultsFifty-four family doctors took part in this study (n = 39 women, n = 15 men). The main themes that arose from the analysis were: “Barriers related to the physician’s activity,” “Barriers related to the victim or aggressor,” “Facilitators related to the physician’s activity,” “Facilitators related to the victim or aggressor.” Although different barriers were described, most doctors agreed with the mandatory reporting of DV cases.ConclusionsFamily doctors encounter multiple barriers and facilitators when considering reporting a DV case to the authorities. The results of this study can help develop new interventions to address the barriers described by the doctors, increasing their compliance with mandatory reporting, the protection of victims and the just persecution of the aggressor.

Identifying Differences in Frames of Reference That Are Hard to Reconcile During the Process of Normative Integration to Deliver Care for People with Multiple Problems: A Mixed-Method Delphi Study in the Netherlands.

Integrated care is enhanced by integration on system, organizational, professional, and clinical levels including functional and normative integration. Many studies have been done on functional integration on these different levels, less studies focus on how normative integration takes place. In this study, we focus on the question: what differences in frames of refence must be addressed to establish consensus on appropriate care for People with Multiple Problems? A mixed-method Delphi study was carried out in which professionals and managers regularly involved in care for people with multiple problems (PWMPs) worked towards consensus on appropriate care delivery through the assessment of 15 vignettes representing real trajectories of PWMPs. No consensus on appropriate care delivery was reached on any of the 15 vignettes. Five differences in perspective explained the dissensus: 1) an individual versus a systemic perspective on the client; 2) a focus on self-expressed needs of clients or professionally assessed (normative) needs; 3) client-directed or caregiver-directed care; 4) client as victim of circumstances or responsible for circumstances; 5) a focus on barriers or opportunities. In general, panelists agreed that care for PWMPs should be integrated. However, the further integrated care was to be operationalized in practice the greater the dissensus between panelists emerged. To understand how these differences in perspectives may be overcome to provide care for PWMPs normative integration needs to be studied during actual processes of care delivery.