Multistage Study Research Articles

Post-discharge follow-up system in psychiatric patients: A case study of Farabi Hospital in Isfahan.

Mental illness is one of the most common problems in human societies and the continuation of care and post-discharge follow-up. This study was conducted to define a post-discharge follow-up framework for Farabi Hospital in Isfahan. This was a multistage study, including, interviews literature review, and focus group discussions. Participants included 18 purposefully selected nurses, physicians, and managers, directly involved in the discharge process of Farabi Hospital in Isfahan. The interviews were semi-structured. Data were organized using MAXQDA10 software. The initial framework was set through the extraction of semantic main and secondary codes. The framework was finalized through three several focus group discussion sessions. Results included of 17 sub-categories and seven main categories as "education," organizational arrangement," "team-building," "patient and family participation and trust," "engaging some supportive institutions of community," "process management" and "information management." To implement a post-discharge follow-up system for psychiatric patients in Farabi Hospital of Isfahan must be concentrated to patient and family education, team building, organizational arrangements, participation, and trust of patients and family, while engaging community health centers and notice to information and management and process management.

The use of medicinal plants in the prevention of COVID-19 using the Health Belief Model: A survey based on the Iranian population.

Because of the spread of coronavirus disease 2019 (COVID-19), the preventive measures have increased, such as focusing on the use of medicinal plants in most communities, including Iran. The purpose of this study was to identify the knowledge, attitude, and performance of individuals toward the use of medicinal plants and to identify the predictors of the use of medicinal plants in the prevention of COVID-19. This descriptive-analytical study (February-April 2021) was performed on 3840 Iranian men and women aged 20-70 years selected as a multi-stage cluster study. At the first stage, all provinces were divided into five regions: North, South, East, West, and Center. In the second stage, a provincial center and a city were randomly selected from each region (North: Sari, Babol; South: Bushehr, Bandar Genaveh; East: Mashhad, Sabzevar; West: Hamedan, Toisarkan; Center: Yazd, Ardakan). Data were collected by a researcher-made scale based on the Health Belief Model (HBM). Data analysis was performed applying Pearson correlation coefficient, logistic regression, and linear regression. The results showed that people have relatively high knowledge and positive attitude toward the use of medicinal plants in prevention of COVID-19. The most important reason for positive attitude was the perceived benefits with the mean of 75.06%. Also, half of the people had poor performance. Correlation coefficient showed that the use of medicinal plants with perceived sensitivity (p = 0.000, r = 0.3), perceived benefits (p = 0.012, r = 0.126), perceived barriers (p = 0.000, r = 0.179), and perceived self-efficacy (p = 0.000, r = 0.305) had a significant correlation. The strongest correlation between perceived self-efficacy was observed with the use of herbs in prevention of COVID-19. The HBM constructs can predict 26% of the variance for the use of medicinal plants in the prevention of COVID-19, among which perceived self-efficacy (β = 0.230) was the most powerful predictor. Based on the results, the predictive role of self-efficacy constructs for the use of medicinal plants in prevention of COVID-19 has been confirmed according to the HBM. Therefore, methods of increasing self-efficacy such as training programs and providing appropriate intervention models can be used not only as promoters of using medicinal plants in prevention of COVID-19 but also for improving people's performance in the proper use of medicinal plants.

MEASURING PROFESSIONAL KNOWLEDGE OF LATER LIFE DEPRESSION

Abstract Research linking behavioral health providers’ knowledge of later life depression to their clinical practices and patient outcomes is restricted by outdated measures. A multi-stage study was conducted to ameliorate this gap. Qualitative interviews with geropsychology content experts (N = 5) generated 49 true/false items capturing relevant concepts in later life depression, including brain health concerns. Additional content experts (N = 10) completed the questionnaire and a card sort task placing items into categories (Psychopathology, Assessment/Diagnosis, Treatment, Other) to understand measurement structure. This resulted in retention of 42 items. A random pool of licensed social workers (N=900) were mailed the survey packet with option to complete via return mail or online. This presentation will review scale psychometrics, reliability, and construct validity among MSWs from diverse clinical backgrounds. Associations between participant characteristics and knowledge of cognitive and other depressive symptoms will also be highlighted.

What we think about professional and unprofessional behaviors: differences between the perception of clinical faculty members and medical students

IntroductionDifferences in the viewpoints of clinical faculty members and medical students about prioritizing professional norms accepted by the professional community and lack of alignment of these views can lead to distortion of understanding, problems in learning and assessment of professionalism, and failure in students’ professional identity formation. This study aimed to identify the differences in viewpoints of clinical faculty members and medical students about prioritizing the importance and prevalence of professional and unprofessional behaviors among undergraduate medical students.MethodsA multi-stage qualitative study was conducted at Tehran University of Medical Sciences during 2020–2021. At first, a systematic search was conducted to identify professional and unprofessional behaviors using the directional content analysis method. A panel of experts was formed to check the codes obtained from reviewing the literature and to evaluate its compliance with the context. Then, the modified nominal group technique sessions were held with clinical faculty members and medical students to strengthen the codes extracted from the studies and systematically integrate their views to achieve a comprehensive list of professional and unprofessional behaviors in accordance with the context. Finally, a consensus was made among them about prioritizing the importance and prevalence of these behaviors in undergraduate medical students.ResultsA total of 490 codes of professional behaviors and 595 unprofessional behavior codes were identified in the literature review. In the following sessions of the modified nominal group, 13 clinical faculty members listed 105 codes of professional and unprofessional behaviors, and 51 medical students also listed 313 codes. The results of the modified nominal group technique showed that the faculty members reported the importance of unprofessional behaviors higher than professional ones. At the same time, students rated the importance of professional behaviors higher than unprofessional ones. Both faculty members and students rate the prevalence of professional behaviors as high and the prevalence of unprofessional behaviors as low.ConclusionThe results showed a difference of views between clinical faculty members and medical students about prioritizing professional and unprofessional behaviors. It is essential to align their viewpoints to understand, learn and value professionalism to develop a professional identity.

Factors affecting acceptance of organ donation in mainland China: A national cross-sectional study.

To explore the acceptances and associated influences of organ donation in mainland China. The shortage of organ donors has limited the development of organ transplantation in China. It is important to recognise the target population who has high intention to donate their organs may change the status. We conducted a cross-sectional, multi-stage sampling study collected demographic data and individuals' willingness to accept organ donation. A stepwise linear regression analysis was adopted to evaluate the factors related to the attitudes toward organ donation. We collected 11,031 valid samples for the survey. The willingness to donate organs among Chinese residents averaged 56.93 points. To be specific, males (β=-.03), religious believers (β=-.01) and parents with a different number of children (all: β=-.04) are less willing to donate their organs. Respondents who live in an urban area (β=.03), have higher education level (High school or junior college β=.04, Bachelor degree or above β=.09), feel anxious (mild, moderate β=.02), feel pressured (moderate, severe β=.08), have higher scores of the Short-Form Health Literacy Instrument (HLS-SF12) (β=.31), The Self-Management Scale (SHMS) (β=.16), EuroQol Five Dimensions Questionnaire (EQ-5D) (β=.04) and EuroQol Visual Analogue Scale (EQ-VAS) (β=.24), are more positive to donate. This study firstly discusses the public acceptance of organ donation through a nationwide sample around China. In this study, we discovered that Chinese residents' acceptance level of organ donation and that gender, house, anxiety, pressure, social support and health literacy were the main influencing factors on residents' attitudes. To figure out the Chinese public acceptance and its influencing factors of organ donation can help nurse transplant coordinators to recognise the target population and the obstacles of organ donation. At the phase of collecting data, participants were recruited to fill the questionnaires.

Unmet needs for hypertension diagnosis among older adults in Myanmar: secondary analysis of a multistage sampling study

BackgroundHypertension is a major cause of morbidity among older adults. We investigated older adults’ access to health services in Myanmar by focusing on unmet needs in diagnosing hypertension. This study aims to identify factors associated with the unmet needs for hypertension diagnosis in the study areas of Myanmar.MethodsThis is a secondary data analysis of the survey which is a cross-sectional study conducted with older adults (aged ≥ 60 years) in the Yangon and Bago regions of Myanmar. Objective indicators of health were collected, including blood pressure, height and weight. The diagnosis of hypertension was considered an unmet need when a participant’s blood pressure measurement met the diagnostic criteria for hypertension but the disease had not yet been diagnosed. Bivariate and multivariate analyses using logistic regression were performed to identify factors associated with the unmet need for hypertension diagnosis. Factors related to lifestyle habits and medical-seeking behaviour were selected and put into the multivariate model.ResultsData from 1200 people, 600 from each of the two regions, were analysed. Altogether 483 (40.3%) participants were male, 530 (44.2%) were aged ≥ 70 years, and 857 were diagnosed with hypertension based on their measured blood pressure or diagnostic history, or both, which is a 71.4% prevalence of hypertension. Moreover, 240 (20.0%) participants had never been diagnosed with hypertension. In the multivariate analysis, these unmet needs for hypertension diagnosis were significantly associated with male sex (odds ratio [OR] 1.46, 95% confidence interval [CI] 1.05–2.05), residence in the Bago region (OR 1.64, 95% CI 1.09–2.45) and better self-rated health (OR 1.70, 95% CI 1.24–2.33), but not with education, category on the wealth index or living arrangement.ConclusionsThere are barriers to accessing health services for hypertension diagnosis, as evidenced by the regional disparities found in this study, and charitable clinics may decrease the financial barrier to this diagnosis.

Innovative Business Models in the Context of Organizational Culture Transformation in the COVID-19 Pandemic

The purpose of this article was to establish the interrelations and mutual influence of organizational culture transformation, national culture, and innovative business models’ formation under the COVID-19 pandemic. To achieve the study goal, a multi-stage comprehensive exploratory study based on primary information obtained by expert interviewing was implemented. The developed methodological approach was tested on the example of small and medium-sized enterprises in Russia and China. As a result of the conducted testing, the previously formulated hypotheses were fully proved. H1: the negative shock of the pandemic and the ensuing quarantine restrictions caused critical changes in the business environment, cancelling the relevance of previously effective business models. H2: the new business environment required enterprises to significantly transform their organizational culture. H3: under the conditions of shock changes in the business environment and forced transformation of organizational culture the main condition for the sustainable development of enterprises is innovative business models. Н4: implementation of innovative business models depends on both the business environment and the influence of national culture. The main obstacles to the implementation of innovative business models in small and medium-sized enterprises were also identified. The developed methodological approach can be used in the real sector of the economy by state organizations and non-state funds in the development of programs to assist small and medium-sized businesses in the COVID-19 pandemic. In addition, the study results may be of interest to academic researchers, suggesting empirically determined stable relationships (hypotheses H1, H2, H3, H4) between the transformation of organizational culture, national culture, and innovative business models’ formation to ensure sustainable development of enterprises under the COVID-19 pandemic and opening new promising directions for further research.

An Efficient Quantification Method Based on Feature Selection for High-Dimensional Uncertainties of Multistage Compressors

Abstract Multistage compressors are widely used in aero-engines, gas turbines, and industrial compressors. However, many inevitable geometric/condition uncertainties will lead to low manufacturing qualified rate and severe performance degradation of multistage compressors. There might be hundreds of uncertainty variables simultaneously, so the “curse of dimensionality” problem has seriously constrained the uncertainty quantification (UQ) study in multistage compressors. In this paper, a feature selection method based on interpretable machine learning and bidirectional search is developed to reduce the dimensionality in a multistage compressor UQ study. The method is applied to a three-stage compressor and reduces the uncertainties dimensionality from 292 to 41 and 66 for mass flow rate and efficiency prediction. Consequently, the required sample size is reduced from 1674 to 160 with the model accuracy almost unchanged. For the first time, this study realizes the UQ modeling study on the high dimensional problem of a multistage compressor. In addition, significant stage-by-stage uncertainty propagation is found in the compressor. The last stage has the most significant efficiency deviation, which is significantly affected by the geometric uncertainty of the first two stages. Therefore, traditional studies, which usually simplify the multistage compressor UQ problem to a single cascade/row level, may seriously underestimate the uncertainty effect due to the neglect of stage-by-stage propagation. This study not only reveals the necessity for direct UQ study of multistage compressors but also reduces the computational cost, which lays a foundation for the uncertainty control of multistage compressors in engineering practice.

SARS-CoV-2 seroprevalence, cumulative infections, and immunity to symptomatic infection – A multistage national household survey and modelling study, Dominican Republic, June–October 2021

Population-level SARS-CoV-2 immunological protection is poorly understood but can guide vaccination and non-pharmaceutical intervention priorities. Our objective was to characterise cumulative infections and immunological protection in the Dominican Republic. Household members ≥5 years were enrolled in a three-stage national household cluster serosurvey in the Dominican Republic. We measured pan-immunoglobulin antibodies against the SARS-CoV-2 spike (anti-S) and nucleocapsid glycoproteins, and pseudovirus neutralising activity against the ancestral and B.1.617.2 (Delta) strains. Seroprevalence and cumulative prior infections were weighted and adjusted for assay performance and seroreversion. Binary classification machine learning methods and pseudovirus neutralising correlates of protection were used to estimate 50% and 80% protection against symptomatic infection. Between 30 Jun and 12 Oct 2021 we enrolled 6683 individuals from 3832 households. We estimate that 85.0% (CI 82.1-88.0) of the ≥5 years population had been immunologically exposed and 77.5% (CI 71.3-83) had been previously infected. Protective immunity sufficient to provide at least 50% protection against symptomatic SARS-CoV-2 infection was estimated in 78.1% (CI 74.3-82) and 66.3% (CI 62.8-70) of the population for the ancestral and Delta strains respectively. Younger (5-14 years, OR 0.47 [CI 0.36-0.61]) and older (≥75-years, 0.40 [CI 0.28-0.56]) age, working outdoors (0.53 [0.39-0.73]), smoking (0.66 [0.52-0.84]), urban setting (1.30 [1.14-1.49]), and three vs no vaccine doses (18.41 [10.69-35.04]) were associated with 50% protection against the ancestral strain. Cumulative infections substantially exceeded prior estimates and overall immunological exposure was high. After controlling for confounders, markedly lower immunological protection was observed to the ancestral and Delta strains across certain subgroups, findings that can guide public health interventions and may be generalisable to other settings and viral strains. This study was funded by the US CDC.

Assessing Reproductive Performance to Establish Benchmarks for Small-Holder Beef Cattle Herds in South Africa.

Smallholder beef cattle farms in South Africa have had low reproductive performance, which has been associated with management practices. Considering current farm management practices, a multi-stage selection study was conducted to assess reproductive performance as defined by pregnancy rate, fetal and calf losses, calving interval and days open to benchmark reproductive performance. Data were collected twice, in autumn (March-May) for pregnancy diagnosis and in spring (September-November) for monitoring of confirmed pregnancies. Overall, 3694 cow records from 40 smallholder herds were collected during 2018 and 2019 breeding seasons from five provinces. The preferred 25th quartile described target performance and GLIMMIX procedure determined associations between management practices and performance. Smallholder farms on average recorded 50% pregnancy rate and 12% fetal and calf losses with 304 and 608 days open and calving interval, respectively. The derived target benchmarks for pregnancy rate, fetal and calf losses, days open and calving intervals in smallholder farms were 54%, 1.4%, 152 and 425 days, respectively. Reproductive performance was associated with no knowledge of body condition scoring before breeding, culling of old and non-productive cows, record keeping and low bull to cow ratio (p < 0.05). The performance benchmarks implied that industry averages may be improved if sustainable management services are provided through extension and advisory services.

Factors associated with poor outcomes in SLE patients with COVID-19: Data from ReumaCoV-Brazil register.

ObjectivesTo evaluate factors associated with COVID-19 severity outcomes in patients with systemic lupus erythematosus (SLE).MethodsThis was a cross-sectional analysis of baseline data of a prospective, multi-stage cohort study—“The ReumaCoV Brazil”—designed to monitor patients with immune-mediated rheumatologic disease (IMRD) during the SARS-CoV-2 pandemic. SLE adult patients with COVID-19 were compared with those without COVID-19. SLE activity was evaluated by the patient global assessment (PGA) and SLE Disease Activity Index 2000 (SLEDAI-2K).Results604 SLE patients were included, 317 (52.4%) with COVID-19 and 287 (47.6%) in the control group. SLE COVID-19 patients reported a lower frequency of social isolation and worked more frequently as health professionals. There was no difference in the mean SLEDAI-2K score between groups in the post–COVID-19 period (5.8 [8.6] vs. 4.5 [8.0]; p = 0.190). However, infected patients reported increased SLE activity according to the Patient Global Assessment (PGA) during this period (2.9 [2.9] vs. 2.3 [2.6]; p = 0.031. Arterial hypertension (OR 2.48 [CI 95% 1.04–5.91], p = 0.041), cyclophosphamide (OR 14.32 [CI 95% 2.12–96.77], p = 0.006), dyspnea (OR: 7.10 [CI 95% 3.10–16.23], p < 0.001) and discontinuation of SLE treatment medication during infection (5.38 [CI 95% 1.97–15.48], p = 0.002), were independently associated with a higher chance of hospitalization related to COVID-19. Patients who received telemedicine support presented a 67% lower chance of hospitalization (OR 0.33 [CI 95% 0.12–0.88], p = 0.02).ConclusionHypertension and cyclophosphamide were associated with a severe outcome, and telemedicine can be a useful tool for SLE patients with COVID-19.

Changing the Script: Intergenerational Communication about Sexual and Reproductive Health in Niamey, Niger

ABSTRACT Most strategies to reduce adolescent pregnancies have been designed to educate adolescents directly about family planning (FP), while adolescents often cite peers and parents as their primary sources of sexual health information. Yet parents’ lack of knowledge about sexual and reproductive health (SRH), low self-efficacy to initiate conversations, and adverse social norms act as barriers to open intergenerational communication. To better understand the normative environment influencing communication between parents and youth about FP/SRH in francophone West Africa, the USAID supported Breakthrough RESEARCH project conducted a multi-stage qualitative study in Niger. During Stage 1, the research team developed a screening tool (based on a literature review) to categorize research participants into those who practiced open intergenerational communication about FP/SRH, and those who did not. Stage 2 consisted of 40 in-depth interviews with young people (ages 15–24) and adults (≥25 years old), stratified by whether they practiced open intergenerational communication. Results showed restrictive social norms related to youth SRH and access to information and services. However, particularly among participants classified as open-communicators, there is a hierarchy of norms and normative beliefs, with abstinence as the most virtuous decision for youth, but approving communication about and access to SRH services in order to minimize harm. Participants rely on values such as the protection of youth, protection of family honor and promotion of well-being as means to act in counter-normative ways and communicate about FP/SRH. Implications for the field include demystifying and destigmatizing SRH topics, increasing adults’ communication skills, and changing the “script” to a more life-affirming view of SRH.

Socioeconomic inequality in different phenotypes of childhood obesity and its determinants in Iran: a Blinder-Oaxaca decomposition method

BackgroundChildhood obesity has become a significant public health issue worldwide. Socioeconomic status is among its key determinants. This study examined the socioeconomic inequality in different phenotypes of childhood obesity at the national level in Iran.MethodsThis national, multistage school cross-sectional study was undertaken in 2015 on 14,400 students aged 7–18 years from urban and rural areas of 30 provinces of Iran. Using principal component analysis, socioeconomic status (SES) was categorized into tertiles. SES inequality in different phenotypes of obesity (i.e., generalized obesity", "abdominal obesity", and combined obesity) was estimated using the concentration index. The determinants of this inequality were assessed by the Blinder-Oaxaca decomposition method.ResultsOverall, 14,274 students completed the study (response rate: 99%). The mean age was 12.28 years, 50.6% were boys, and 71.42% lived in urban areas. The prevalence of generalized obesity and abdominal obesity was 20.8% and 11.3%, respectively. The concentration index for different phenotypes of obesity was positive, indicating that inequality is more common amongst the low SES groups. High SES, being male, living in a rural, and having a positive family history of obesity were associated with general obesity. Moderate physical activity and living in a rural area were associated with abdominal obesity. In addition, living in a rural area, having a high SES, being male, and having a positive family history of obesity were associated with combined obesity.ConclusionAccording to the present study findings, all childhood obesity phenotypes were more prevalent in Iranian children with high SES. Therefore, due to obesity and other diseases, it is essential to implement environmental changes in addition to designing macro-educational programs and prevention strategies.

Reconfigurable Fiber Wireless Fronthaul With A-RoF and D-RoF Co-Existence Through a Si3N4 ROADM for Heterogeneous Mmwave 5G C-RANs

Towards enabling bandwidth-hungry 5G applications, a Fiber-Wireless (FiWi) mobile fronthaul architecture is experimentally presented supporting the co-existence of spectrally efficient analog transport formats with Digital Radio over Fiber transport schemes, combined with millimeter wave (mmWave) high-capacity wireless channels. Flexible transport network reconfiguration is proposed by means of a low-loss 1 × 4 Si <sub xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">3</sub> N <sub xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">4</sub> Reconfigurable Optical Add/Drop Multiplexer (ROADM) on TriPleX platform, selectively dropping four FiWi mmWave fronthaul links to four different antenna location. Detailed investigations of the proposed system are reported, including frequency characterization, multi-stage EVM penalty study and analog/digital traffic coexistence PHY layer feasibility. Following, four 10 Gb/s multi-band 16-QAM WDM FiWi analog IFoF links are transmitted through 10km fiber and 1-m directional V-band antennas and flexibly reconfigured by a Si <sub xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">3</sub> N <sub xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">4</sub> ROADM, achieving a record 40 Gb/s wavelength-routed fronthaul capacity for mmWave 5G, while simultaneously meeting multiple 5G Use Cases within 3GPP requirements.

Research Productivity of Academics in Medicine and Allied Health Sciences Disciplines in Nigerian Universities: A Cross-sectional Multi-stage Cluster Study

Background: Research is the act of inquiry to know and is one of the pivotal points and fundamental goals of a university. It is an important part of an academic job and is believed to be the next most valued part of their duty after teaching. Objectives: This study aims to determine the research productivity of Nigerian academics in medicine and allied health sciences disciplines in Nigeria. Methodology: 177 participants completed a 41- items questionnaire that elicits information on sociodemographic, the institution, the program, and research productivity (research papers, conferences attendance and presentation, and book chapters) using a multistage cluster random sampling of Nigerian Universities. Results: Majority of the included participants were male (70.06%), married (79.14%), and below the senior teaching cadre (38.99%). Majority of the academicians do not have any training overseas (67.06%) and have indicated time as a constraint to research productivity (67.06%). Three papers in the past two years is an indication that Nigerian academics in the medical and allied health sciences, on average, may not be deemed to be highly productive. Professors (16.58+27.14) and those in higher ranks (Readers: 11.84+11.22 and senior lectures 12.58+13.53) have published more papers than their counterparts in the junior cadre (lecturer I and II: 4.87+6.58 and 2.69+3.87). Academics in the present study has a median research grant of zero in the past two years. A simple majority of the participants (55.29%) agree on mandating of PhD for promotion and career advancement of academics. There is no difference in the number of papers published (6.04+10.52 and 7.62+13.21) or conferences attended (7.42+19.14 and 4.04 +4.02) between academics in private and public Universities. Conclusion: Apparently low and dismal productivity by these academics in medicine and allied health sciences affirm the need for capacity building on an ongoing basis.

Construction of 3D Ni2+-Al3+-LDH/γ-Fe2O3-Cd2+-Ni2+-Fe3+-LDH structures and multistage recycling treatment of dye and fluoride-containing wastewater

The construction of three-dimensional (3D) Ni2+-Al3+-LDH/γ-Fe2O3-Cd2+-Ni2+-Fe3+-layered double hydroxide (LDH) structures (S1–S6) with magnetic properties and different (γ-Fe2O3-Cd2+-Ni2+-Fe3+-LDH)/(Ni2+-Al3+-LDH) ratios were successfully prepared. The effects of these ratios in these 3D LDH constructions on physicochemical properties were investigated using XRD, SEM, VSM, UV–vis, and BET analyses. The specific surface area and band gap of these materials decreased with increased ratio, while the saturation magnetization increased. The synergistic combination of saturation magnetization, adsorption characteristics, and band gap of six sample types were evaluated. S3 samples were used in a multistage recycling treatment study of dye wastewater and fluoride ion (F−)-containing wastewater, effectively degrading methyl orange (MO) due to its high photocatalytic activity. After this, the memory effect of the calcined product (S3, 300 °C) significantly enhanced the migration and diffusion of F−, resulting in a F− adsorption capacity of 49.25 mg/g. The recycling properties of this composite material for photocatalytic degradation and adsorption capabilities for F− removal were evaluated, showing a reduction in efficiency of only 1 % and 8.6 % for degradation of MO and F− removal respectively, with no significant loss of efficiency after 10 cycles. Adsorption experiments and subsequent sample characterization showed that the F− adsorption mechanism of S3 involved ion exchange mechanism and sorption sites (interlayer, basal, edges and junction sites). The existence of oxygen vacancies and formation of S-scheme heterojunction between γ-Fe2O3-Cd2+-Ni2+-Fe3+-LDH and Ni2+-Al3+-LDH, resulted in the improvement of the photocatalytic activity. The results obtained in this study demonstrated that Ni2+-Al3+-LDH/γ-Fe2O3-Cd2+-Ni2+-Fe3+-LDH composites were a promising adsorbent for degradation of MO and F− removal in practical multilevel utilization due to its simple synthesis, low-cost, recyclability, and high removal capability.

Predictors of chronic COVID-19 symptoms in a community-based cohort of adults.

BackgroundCOVID-19 can cause some individuals to experience chronic symptoms. Rates and predictors of chronic COVID-19 symptoms are not fully elucidated.ObjectiveTo examine occurrence and patterns of post-acute sequelae of SARS-CoV2 infection (PASC) symptomatology and their relationship with demographics, acute COVID-19 symptoms and anti-SARS-CoV-2 IgG antibody responses.MethodsA multi-stage observational study was performed of adults (≥18 years) from 5 US states. Participants completed two rounds of electronic surveys (May-July 2020; April-May 2021) and underwent testing to anti-SARS-CoV-2 nucleocapsid protein IgG antibody testing. Latent Class Analysis was used to identify clusters of chronic COVID-19 symptoms.ResultsOverall, 390 adults (median [25%ile, 75%ile] age: 42 [31, 54] years) with positive SARS-CoV-2 antibodies completed the follow-up survey; 92 (24.7%) had ≥1 chronic COVID-19 symptom, with 11-month median duration of persistent symptoms (range: 1–12 months). The most common chronic COVID-19 symptoms were fatigue (11.3%), change in smell (9.5%) or taste (5.6%), muscle or joint aches (5.4%) and weakness (4.6%). There were significantly higher proportions of ≥1 persistent COVID-19 symptom (31.5% vs. 18.6%; Chi-square, P = 0.004), and particularly fatigue (15.8% vs. 7.3%, P = 0.008) and headaches (5.4% vs. 1.0%, P = 0.011) in females compared to males. Chronic COVID-19 symptoms were also increased in individuals with ≥6 acute COVID-19 symptoms, Latent class analysis revealed 4 classes of symptoms. Latent class-1 (change of smell and taste) was associated with lower anti-SARS-CoV-2 antibody levels; class-2 and 3 (multiple chronic symptoms) were associated with higher anti-SARS-CoV-2 antibody levels and more severe acute COVID-19 infection.LimitationsAmbulatory cohort with less severe acute disease.ConclusionIndividuals with SARS-CoV-2 infection commonly experience chronic symptoms, most commonly fatigue, changes in smell or taste and muscle/joint aches. Female sex, severity of acute COVID-19 infection, and higher anti-SARS-CoV-2 IgG levels were associated with the highest risk of having chronic COVID-19 symptoms.

Scaled-up multistage reverse electrodialysis pilot study with natural waters

A multistage reverse electrodialysis system was studied at the REDstack research facility (the Afsluitdijk, the Netherlands) for over 30 days to describe the performance of such configuration under natural water conditions. The experiments were done with two 0.22 × 0.22 m2 stacks in series comprising 32 cell pairs (3.1 m2 of membrane area) for stage 1 and 64 cell pairs (6.2 m2 membrane area) for stage 2. The total gross power density at the available salinity gradient was stable at around 0.35 W∙m−2. The total net power density, corrected for the initial pressure drop of the stacks, was 0.25 W∙m−2 at an energy efficiency of 37 %. Throughout the operation, due to increased stack pressure drop, the actual total net power density lowered to 0.1 W∙m−2. A distinct behaviour was found for multivalent ions in each stage. For stage 1, Ca2+ and SO42− were transported from the river water to the seawater side, so-called uphill transport. For stage 2, uphill transport was not found, in line with Donnan potential calculations. Stack autopsy revealed microorganisms with sizes ten times larger than the cartridge filter nominal pore size (5 µm) and biofilm covering part of the spacer open area, both contributing to the increasing pressure drop in the stacks. This study showed that stable gross power densities and high energy efficiencies were obtained from feeding natural waters to a multistage reverse electrodialysis system, independent of fouling. In addition, it emphasized the importance of maintaining pumping power losses low for a viable deployment of the technology.

Effect of a Community-Based Holistic Care Package on Physical and Psychosocial Outcomes in People with Lower Limb Disorder Caused by Lymphatic Filariasis, Podoconiosis, and Leprosy in Ethiopia: Results from the EnDPoINT Pilot Cohort Study.

ABSTRACT.Lymphatic filariasis (LF), podoconiosis, and leprosy are highly stigmatized neglected tropical diseases that can cause lower limb swelling and deformity. Simple interventions to support self-care can reduce their physical impacts, but little is known about how to address the psychosocial needs of people living with the diseases, and about how to scale-up morbidity reduction programs. EnDPoINT is a multistage implementation study designed to address these knowledge gaps by developing and evaluating a holistic care package that can be integrated into the Ethiopian health system. This article presents the quantitative results from the EnDPoINT pilot, in which the effectiveness of the care package was assessed in 251 participants from one district in northern Ethiopian using a pre-post design. Reductions 12 months after care package initiation were seen in attacks of acute adenolymphangitis (adjusted odds ratio for attack in last month 0.005; 95% CI 0.001, 0.02; P < 0.001), lower limb and foot circumference (mean difference lower limb circumference −2.0 cm; 95% CI −2.3, −1.8; P < 0.001; foot circumference −2.3 cm; 95% CI −2.5, −2.0; P < 0.001), and lymphedema stage (mean reduction in stage −0.27; 95% CI −0.37, −0.19; P < 0.001). Significant improvements were also observed in scores assessing disability, quality-of-life, depression, stigma, discrimination, and social support. This study thus suggests that the EnDPoINT care package is highly effective in reducing morbidity in people living with LF, podoconiosis, and leprosy in northern Ethiopia.

Multistage epigenome-wide association study identifies highly accurate epigenomic signatures in association with hepatocellular carcinoma: The HCC epigenome score

Multistage epigenome-wide association study identifies highly accurate epigenomic signatures in association with hepatocellular carcinoma: The HCC epigenome score