Primary System Research Articles

Microstructure evolution in laser powder bed fusion melted 2205 duplex stainless steel using in-situ EBSD during uniaxial tensile testing

Compared to duplex stainless steels (DSSs) prepared by traditional methods, specimens produced through laser powder bed fusion (LPBF) exhibit excellent yield strength but lower elongation. To improve elongation, understanding microstructure evolution during uniaxial tensile testing is crucial. This study investigates the slip behavior, grain boundary evolution, and phase transformation of LPBF 2205 duplex stainless steel during tensile deformation using in-situ electron backscatter diffraction (EBSD). Results show the formation of slip bands, which increase in number as loading stress rises. The primary slip systems activated are {110}<111> in ferrite and {111}<110> in austenite. In the ferrite phase, slip dislocations accumulate and generate low-angle grain boundaries (LAGBs), which evolve into high-angle grain boundaries (HAGBs), refining the grain structure. Numerous Σ3 annealing twins form in the austenite phase, but detwinning and twinning reduce Σ3 content as deformation processes. Ferrite and austenite exhibit good stability during the initial stages of tensile deformation. However, some austenite transforms into martensite through the transformation-induced plasticity (TRIP) effect at the final stages of deformation, which helps relieve stress concentration and delays material fracture. This study provides valuable insights for optimizing microstructure to improve the mechanical properties of LPBF materials.

Reducing strain on primary healthcare systems through innovative models of care: the impact of direct access physiotherapy for musculoskeletal conditions—an interrupted time series analysis

ObjectivesTo evaluate the longitudinal impact of introducing a national, direct access physiotherapy model of care on the rates of primary and secondary care consultations for musculoskeletal (MSK) conditions.DesignInterrupted time series...

Role of mixed healthcare providers networks in strengthening primary care systems: a case study of a rural primary care site

IntroductionService delivery networks, also called healthcare providers networks (HCPNs) have been used to address health inequities and promote universal healthcare (UHC). This study described the effect of instituting a mixed...

The primary systemic vasculitis associated optic neuritis: a retrospective analysis in a single center over 10 years

ObjectivesTo investigate the clinical and image characteristics of primary systemic vasculitis-associated optic neuritis patients.MethodsThis is a retrospective study. The patients clinically diagnosed with primary system vasculitis-induced optic neuritis were recruited from March 2013 to December 2023. All cases received orbital magnetic resonance imaging scans were analyzed. The ocular findings, systemic manifestations, laboratory data and prognosis were reviewed retrospectively. In addition, the related literature was reviewed.ResultsFourteen patients (21 eyes), including 10 men and 4 women, were enrolled in this study. The ages ranged from 30 to 86 years in this cohort. Orbits MRI detects the enlargement and/or enhancement of the optic nerve. Cases 1–5 reported a confirmed diagnosis of Takayasu’s arteritis, and cases 6–8 had giant cell arteritis. Cases 9–13 were antineutrophil cytoplasmic antibody-associated vasculitis. Case 14 was Cogan’s syndrome. Mult organs and tissues, such as the kidneys, heart, paranasal sinuses, meninges, and respiratory system, were involved. In all of the 14 involved patients, the disease onset was either during the fall or winter season. There were no or only slight improvements in visual activity after conventional therapies.ConclusionsThe autoantibodies’ attack on the optic nerve, ischemic damage, or destruction of the blood–brain barrier may be the potential pathogenesis of vasculitis-associated optic neuritis. Even with prompt and aggressive clinical interventions, the prognosis remains unsatisfactory.

Neurolymphomatosis mimicking a Guillain–Barré syndrome triggered by COVID‐19 vaccination

Guillain–Barré syndrome (GBS) is an acute disorder of the peripheral nervous system, causing flaccid paralysis, areflexia, and variable sensory involvement. Proximal as well distal muscles of the limbs can be involved, and in most severe and advanced cases progresses to respiratory failure and death. GBS is considered an autoimmune disease, and at the basis of the attack at the peripheral nervous system different mechanisms have been recognized, in particular viral infections or other immune stimulations. Cranial nerve involvement in patients with diffuse large B‐cell lymphoma (DLBCL) and primary central nervous system lymphoma are rare conditions that could present with similar clinical features. Here we present a case of a 36‐year‐old man hospitalized for acute polyradiculoneuritis of the cranial nerves and lumbar roots that arose a 14 days after severe acute respiratory syndrome COVID‐19 2 (Sars‐CoV‐2) vaccination. Most of the main criteria for the diagnosis of GBS were met, including clinical and electrophysiological criteria. Albuminocytologic dissociation and high protein level in cerebrospinal fluid were also found. Therefore, the patient was treated with a cycle of intravenous immunoglobulin (IVIG) with notable improvement of symptoms and gradual recovery of motility. A five months later, following SARS‐CoV‐2 infection, the patient presented with worsening of neurological symptoms and was readmitted to the hospital. He underwent instrumental tests again and was treated with repeated cycles of IVIG and then with a cycle of plasmapheresis without any improvement. In the following 10 days he developed very serious conditions; he was transferred to intensive care unit and deceased after 6 days. The cause of the neurological syndrome was determined only after autoptic analysis, which revealed the presence of primary peripheral nervous system (PNS) DLBCL. The reported case highlights that GBS‐like presentation always requires a careful differential diagnosis, and physicians should also consider the possibility of an occult cancer.

What if … there were no special schools?

AbstractInclusive education is a human right that involves restructuring the school system and closing special schools. However, there is uncertainty about whether all or only some students in an inclusive system should attend regular primary schools and whether all or only some special schools should be closed. This question is usually only discussed in terms of the best possible care and education and the challenge of transportation to school and travel distances is neglected. This article attempts to take both into account. The federal state of Bavaria in Germany does not yet have a fully developed inclusive school system. Using school statistics data for the entire Bavarian primary school population in 2020 (N &gt; 445,000) and geographical data, we simulate deterministically what the Bavarian primary school system could look like with various underlying inclusion models. We analyse the resulting student numbers, support rates of primary schools and school travel distances of former special school students in an urban-rural comparison in four different simulated inclusion models. The results show that all models are potentially feasible. The student numbers at each primary school resulting from the closure of special schools would in most cases not change significantly, whereas the support rate (i.e., the percentage of students with SEN per primary school) would. Schooling close to home favours students in rural areas in particular and significantly reduces their journeys to school by up to 30 km, while for students in urban areas, all inclusive models would be possible. The pedagogical and systemic consequences of the simulated inclusion models are discussed.

Performance evaluation of cognitive radio to limit interference on primary system

Performance evaluation of cognitive radio to limit interference on primary system

Investigating patient revisit intention in community health centres: a mediational study

Purpose Community health centres (CHCs) play a vital role in healthcare service delivery in rural India and act as a crucial link between the primary and tertiary healthcare systems. The rural population in the union territory of Jammu and Kashmir primarily depends on CHCs for healthcare services due to the scarcity of private healthcare infrastructure and the lack of access to tertiary hospitals. The purpose of this study is to analyse the impact of management capability, staff competence, waiting time and patient satisfaction on revisit intention among patients visiting CHCs for care needs. It further examines the mediational role of patient satisfaction between antecedents of patient satisfaction and revisit intention. Design/methodology/approach A survey by questionnaire was used to collect data from 318 inpatients and outpatients visiting CHCs. Partial least square-structural equation modelling was performed with the help of SmartPLS 3 software to evaluate the causal relationships between variables. Findings The findings of the study ascertain that staff competence and waiting time are strong predictors of patient satisfaction while management capability was reported as an insignificant factor. Patient satisfaction significantly affects revisit intention and successfully mediates the impact of management capability, staff competence and waiting time on revisit intention. Originality/value CHCs play a significant role in bridging the gap between primary healthcare and tertiary healthcare and in delivering healthcare services to the vast rural population in India. This study necessitates the active participation of management to ensure the smooth functioning of CHCs. There is a need to provide adequate staff and necessary infrastructural facilities to reduce the treatment waiting time.

The changes in cardiovascular disease risk factors after the implementation of the package of essential non-communicable disease control.

The Package of Essential Non-Communicable (PEN) Disease Control was implemented in the primary healthcare system to manage cardiovascular disease (CVD) risk factors in Iran. This study aimed to evaluate the status of CVD risk factor control following the implementation of the PEN. This historical cohort study was conducted among 60-65-year-old residents to compare hypertension (HTN) control via mean systolic blood pressure (SBP) and diastolic blood pressure (DBP), diabetes mellitus (DM) control via fasting blood sugar (FBS) and HbA1C tests, hyperlipidemia control via serum cholesterol and triglyceride levels, and overweight and obesity via body mass index (BMI) measurement in 2016 (before the implementation of the PEN project) and 2021 (after 5 years). A total of 1,583 residents with a mean age of 62.32±1.70 years were included in the study. In 2021, compared to 2016, there was a significant decrease in the relative frequency of residents with high SBP from 13.7% to 9.3%, high DBP from 11.3% to 3.4%, FBS≥126 mg/dL from 25.6% to 19.7%, and BMI≥30 from 25.7% to 23.4%. Additionally, the mean DBP and the mean serum levels of FBS among all participants decreased significantly. However, the relative frequency of residents with total cholesterol≥200 mg/dL increased significantly from 11.5% to 14.2%. Following the implementation of the PEN, the control of HTN, DM, and obesity improved among 60-65-year-old residents. However, the control of hypercholesterolemia did not improve.

Protección sísmica de estructuras civiles mediante dispositivo INERTER en la provincia de Huancayo

This research work proposes the use of a Tuned-Mass-Damper-Inerter (TMDI), which combines a new configuration of passive vibration control using an “Inerter”. This two-terminal mechanical flywheel device, based on the well-known Tuned-Mass-Damper (TMD), generates resistance forces proportional to the relative acceleration of its terminals. TMDI takes advantage of the “mass amplification effect” of Inerter to improve performance compared to TMD. For harmonically excited primary linear systems, closed-form analytical software is modeled to obtain optimal design and tuning parameters of the TMDI, using established methods. It is observed that, with proper distribution of the dampers, the TMDI system is more effective in suppressing vibrations close to the natural frequency of the uncontrolled primary system and is more resistant to the effects of detuning and misdistribution. Furthermore, the results of the modeled structures show the effectiveness of the TMDI, modeled as a classical damper, in suppressing the fundamental mode of vibration for linear MDOF structures. The incorporation of the Inerter in the proposed TMDI configuration can replace part of the vibrating mass, achieving lightweight passive vibration control solutions or improving structural performance. The solution proposed and modeled with traditional dampers behaves linearly, in line with current performance trends for minimally damaged structures protected by passive control devices. Additionally, optimized TMDI is applied for vibration suppression and displacement control, offering optimal seismic protection.

Text mining of verbal autopsy narratives to extract mortality causes and most prevalent diseases using natural language processing

Verbal autopsy (VA) narratives play a crucial role in understanding and documenting the causes of mortality, especially in regions lacking robust medical infrastructure. In this study, we propose a comprehensive approach to extract mortality causes and identify prevalent diseases from VA narratives utilizing advanced text mining techniques, so as to better understand the underlying health issues leading to mortality. Our methodology integrates n-gram-based language processing, Latent Dirichlet Allocation (LDA), and BERTopic, offering a multi-faceted analysis to enhance the accuracy and depth of information extraction. This is a retrospective study that uses secondary data analysis. We used data from the Agincourt Health and Demographic Surveillance Site (HDSS), which had 16338 observations collected between 1993 and 2015. Our text mining steps entailed data acquisition, pre-processing, feature extraction, topic segmentation, and discovered knowledge. The results suggest that the HDSS population may have died from mortality causes such as vomiting, chest/stomach pain, fever, coughing, loss of weight, low energy, headache. Additionally, we discovered that the most prevalent diseases entailed human immunodeficiency virus (HIV), tuberculosis (TB), diarrhoea, cancer, neurological disorders, malaria, diabetes, high blood pressure, chronic ailments (kidney, heart, lung, liver), maternal and accident related deaths. This study is relevant in that it avails valuable insights regarding mortality causes and most prevalent diseases using novel text mining approaches. These results can be integrated in the diagnosis pipeline for ease of human annotation and interpretation. As such, this will help with effective informed intervention programmes that can improve primary health care systems and chronic based delivery, thus increasing life expectancy.

Evolution of interface voids and columnar grains of the FeCrAl/RAFMs HIP bonding joint

Hot Isostatic Pressing (HIP) diffusion bonding of FeCrAl and reduced-activation ferritic/martensitic steels (RAFMs) is a novel method for preparing the tritium permeation barrier (TPB) in nuclear fusion reactors. This study primarily investigates the formation mechanisms and evolution of interfacial voids and columnar grains under different bonding temperatures and post-welding heat treatment (PWHT) conditions. It is found that increasing bonding temperature facilitates element diffusion, leading to the closure of interfacial voids. Decarbonization of RAFMs and the increase in Cr content facilitates the formation of interfacial columnar grains, with C playing a crucial role in this process due to its lower diffusion activation energy than Cr. Although appropriate PWHT can reduce the size of interfacial columnar grains, it cannot entirely diminish them. The FeCrAl/IPFs joint effectively prevents the formation of brittle (Cr, C) compounds and interfacial AlN defects. After HIP (1050 °C) + PWHT (750 °C), the joint achieves high tensile strength and ductility both at room temperature and 300 °C. The enhancement in ductility is primarily attributed to the high Schmid factor of interfacial columnar grains, which facilitated the activation of the primary slip system under tensile load, resulting in a high elongation of joints.

CCL5 is essential for axonogenesis and neuronal restoration after brain injury

BackgroundTraumatic brain injury (TBI) causes axon tearing and synapse degradation, resulting in multiple neurological dysfunctions and exacerbation of early neurodegeneration; the repair of axonal and synaptic structures is critical for restoring neuronal function. C-C Motif Chemokine Ligand 5 (CCL5) shows many neuroprotective activities.MethodA close-head weight-drop system was used to induce mild brain trauma in C57BL/6 (wild-type, WT) and CCL5 knockout (CCL5-KO) mice. The mNSS score, rotarod, beam walking, and sticker removal tests were used to assay neurological function after mTBI in different groups of mice. The restoration of motor and sensory functions was impaired in CCL5-KO mice after one month of injury, with swelling of axons and synapses from Golgi staining and reduced synaptic proteins-synaptophysin and PSD95. Administration of recombinant CCL5 (Pre-treatment: 300 pg/g once before injury; or post-treatment: 30 pg/g every 2 days, since 3 days after injury for 1 month) through intranasal delivery into mouse brain improved the motor and sensory neurological dysfunctions in CCL5-KO TBI mice.ResultsProteomic analysis using LC-MS/MS identified that the “Nervous system development and function”-related proteins, including axonogenesis, synaptogenesis, and myelination signaling pathways, were reduced in injured cortex of CCL5-KO mice; both pre-treatment and post-treatment with CCL5 augmented those pathways. Immunostaining and western blot analysis confirmed axonogenesis and synaptogenesis related Semaphorin, Ephrin, p70S6/mTOR signaling, and myelination-related Neuregulin/ErbB and FGF/FAK signaling pathways were up-regulated in the cortical tissue by CCL5 after brain injury. We also noticed cortex redevelopment after long-term administration of CCL5 after brain injury with increased Reelin positive Cajal-Rerzius Cells and CXCR4 expression. CCL5 enhanced the growth of cone filopodia in a primary neuron culture system; blocking CCL5’s receptor CCR5 by Maraviroc reduced the intensity of filopodia in growth cone and also CCL5 mediated mTOR and Rho signalling activation. Inhibiting mTOR and Rho signaling abolished CCL5 induced growth cone formation.ConclusionsCCL5 plays a critical role in starting the intrinsic neuronal regeneration system following TBI, which includes growth cone formation, axonogenesis and synaptogensis, remyelination, and the subsequent proper wiring of cortical circuits. Our study underscores the potential of CCL5 as a robust therapeutic stratagem in treating axonal injury and degeneration during the chronic phase after mild brain injury.Graphical

Socio-Demographic and Clinical Profile of Admitted Patients for Psychiatric Illness in a Tertiary Care Military Hospital in Bangladesh

Background: Mental health problems are becoming a public health issue in all countries around the world. It’s often ignored and unnoticed by patients, their relatives and society as well. Treatments for all these disorders are as available as efficacious. The purpose of this study was to assess the socio-demographic and clinical profile of admitted patients for psychiatric illness in a tertiary care military hospital. Materials and methods: This hospital based retrospective study was performed by analyzing the medical records of admitted psychiatric patients, carried out in the Department of Psychiatry at Combined Military Hospital (CMH), Chattogram from 01 July 2022 to 31 December 2022. For this purpose, 41admitted patients in psychiatry ward of CMH Chattogram were enrolled in the study. Psychiatric diagnoses of the patients were assigned by the consultant psychiatrist as per International Classification of Diseases (ICD) 10th Revision diagnostic criteria. Statistical analyses were carried out by using the Statistical Package for Social Sciences (SPSS)-version 16. The quantitative observations were indicated by frequencies and percentages. Ethical issues were maintained all through the study. Results: The results showed that more than half of (56.09%) patients were in 19-35 years of age with male preponderance (63.41%) and most of the cases reported from urban area (58.53%). The most common psychiatric morbidity among the patients were major depressive disorder (26.82%) followed by Anxiety disorder (17.07%) and Obsessive- compulsive disorders (17.07%). In this study majority of patients stayed 15-28 days (80.48%) on an average of 21.5 days. Conclusion: Neurotic cases were predominant in psychiatric admission. Results of this study may help in the planning for better mental health service integrated with primary healthcare system of our country. Findings of this study will also act as an eye-opener for psychiatrists regarding a wide range of psychiatric diagnoses as well future research in psychiatric fraternity. IAHS Medical Journal Vol 6(2), December 2023; 19-23

Expanding the roles of malaria post workers in Thailand: A qualitative study of stakeholder perspectives.

In Thailand, since the 2000s, malaria post (MP) workers have been tasked with promptly detecting and treating all malaria cases to prevent onward transmission in the communities. Expanding their roles to provide health services beyond malaria has been proposed as a strategy to sustain their activities until elimination is reached. This article examines the perspectives of stakeholders on community-based malaria care to assess prospects for expanding the role of MPs. The study incorporated in-depth interviews (IDIs) and focus group discussions (FGDs). In forested communities and local health facilities in northeast Thailand bordering Lao PDR and Cambodia, where malaria transmission is low, IDIs were conducted with 13 MPs and 23 community members. An additional 14 policymakers and implementers across the health sector in Thailand were interviewed. The respondents highlighted how in these border areas population groups most at risk of malaria, namely forest goers and migrants, are reluctant to visit public health facilities. In these areas, MP workers are well integrated in their communities and remain relevant although the communities no longer see malaria as spriority. Common conditions such as dengue, diabetes, insect bites, diarrhea, mental illness and substance abuse, were identified as local health concerns needing potential add-on services from MP workers. Although challenges in terms of training, supervision, and financing were raised, opportunities included additional funds from local administrative offices to maintain and integrate malaria activities with other health programmes. Changes to the roles of MPs should be adapted to changing local needs, some of which were identified in this study, should avoid duplication and potential tensions with other local health programmes, and need to build on the capacity of the community and primary care system. These enabling factors are worthy of consideration by any malaria programmes looking into maintaining their village malaria workers in the Greater Mekong Subregion.

Adult auditory brain responses to nestling begging calls in seasonal songbirds: an fMRI study in non-parenting male and female starlings (Sturnus vulgaris).

The present study aims to investigate whether begging calls elicit specific auditory responses in non-parenting birds, whether these responses are influenced by the hormonal status of the bird, and whether they reflect biparental care for offspring in the European starling (Sturnus vulgaris). An fMRI experiment was conducted to expose non-parenting male and female European starlings to recordings of conspecific nestling begging calls during both artificially induced breeding and non-breeding seasons. This response was compared with their reaction to conspecific individual warbling song motifs and artificial pure tones, serving as social species-specific and artificial control stimuli, respectively. Our findings reveal that begging calls evoke a response in non-parenting male and female starlings, with significantly higher responsiveness observed in the right Field L and the Caudomedial Nidopallium (NCM), regardless of season or sex. Moreover, a significant seasonal variation in auditory brain responses was elicited in both sexes exclusively by begging calls, not by the applied control stimuli, within a ventral midsagittal region of NCM. This heightened response to begging calls, even in non-parenting birds, in the right primary auditory system (Field L), and the photoperiod induced hormonal neuromodulation of auditory responses to offspring's begging calls in the secondary auditory system (NCM), bears resemblance to mammalian responses to hunger calls. This suggests a convergent evolution aimed at facilitating swift adult responses to such calls crucial for offspring survival.

Exploring the relationship between climate change events and migration decisions: Evidence from a choice experiment in Bangladesh

Bangladesh is a low-lying deltaic nation with high vulnerability to climate-related hazards. Hatiya Island is located in Southern Bangladesh, and residents rely significantly on fishing and agriculture for their livelihoods. However, the island's primary production systems face a threat from intense and frequent sudden onset environmental hazards such as river erosion, cyclones, and flooding, as well as slow onset environmental hazards like saline intrusion, tidal inundation, and rising temperatures. Little is known about the effect sudden onset and slow onset hazards have on the migration patterns of Hatiya's residents. The aim of this study is to investigate the relationship between climatic events and the migration decisions of residents on Hatiya Island. To explore this link, we collected empirical data from 337 respondents on Hatiya Island using a choice experiment survey. The five attributes were used to construct migration scenarios, including climate events at Hatiya Island, the distance of migration, the migration type, the social network at the potential destination, and the difference in income between Hatiya Island and the potential destination. The findings from the mixed logit model indicated that climate events at Hatiya, migration distance, and income gap affected residents' migration decisions. Extreme slow onset change and extreme sudden onset change were less likely to induce migration compared to the moderate level of slow and sudden onset change. However, residents were more likely to migrate as the income difference between Hatiya and the prospective destination increased. Residents were willing to migrate at a 9.4 % increase in income for extreme sudden onset change, while residents required a 14.19 % increase in income to migrate in response to extreme slow onset change. As such, policies are needed to support migrants in receiving areas through improved social protection systems, to support migrant-sending households' transformative adaptation in origin areas, and to bolster community-driven adaptation initiatives in Hatiya. The findings from this study can contribute to the existing literature on the relationship between environmental hazards and mobility and inform policymakers on how to design policies that support vulnerable populations.

The Ultramorphology and Sexual Dimorphism of Antennae and Sensilla in the Pale Grass Blue, Pseudozizeeria maha (Lepidoptera: Lycaenidae).

The pale grass blue, Pseudozizeeria maha, is a small lycaenid butterfly widely distributed across Asia. Due to its exclusively diurnal lifestyle and conspicuous sexual dimorphism in wing coloration, vision has traditionally been regarded as the primary sensory system driving various behaviors. However, non-visual sensory systems related to sex-specific behavioral responses, such as antennae, have received far less attention. This study investigated the morphological characteristics and sensilla types of the antennae in adult P. maha using scanning electron microscopy, with a focus on potential sexual dimorphism. The antennae of adult P. maha are clavate, with no significant sexual differences in overall morphology. Six types of antennal sensilla were identified: Böhm bristles, sensilla squamiformia, sensilla trichodea, sensilla chaetica, sensilla basiconica, and sensilla coeloconica, with no sexual dimorphism observed in their morphological types or dimensions. Remarkably, the sensilla coeloconica exhibit significant sexual dimorphism, with a more prominent presence in females. This finding suggests that female P. maha may rely more on olfactory cues for some sex-specific behaviors, such as oviposition site selection.

Palliative Care in Turkey: Insights from experts through key informant interviews

BackgroundThe rising demand for palliative-care (PC) in Turkey, driven by cancer, has prompted increased attention since the national PC policy in 2010. Despite this, the healthcare system predominantly focuses on curative care, lacking PC integration. This is due to combination of administrative obstacles, fragmented coordination, education and training scarcity. Thus urgent strategies are required to address the growing PC gap. This qualitative study explores the perspectives of PC professionals and policymakers, providing valuable insights for national policy and program development. Material and methodThis study employed an exploratory approach using key informant interviews. Interviews were conducted using semi-structured questionnaire. It sought to collect relevant contextual information in order to achieve its aim. Thematic content analysis was employed to examine and interpret the data. ResultTwenty-one participants, comprising nurses, specialists, and oncologists, were interviewed. The findings are encompassed by eight themes. 1) Integrated Care, highlights the importance of cohesive collaboration among diverse healthcare providers, social care services, and primary care systems to ensure comprehensive and effective care. 2) Meeting social care needs underscores significance of addressing a wide spectrum of patient requirements, including psychosocial support. 3) PC education emphasizes necessity of equipping healthcare professionals with the requisite skills and knowledge through comprehensive training. 4) Legalizing do-notresuscitate orders draws attention to the critical discussion surrounding end-of-life decisions. 5) Empowering communities recognizes bridging knowledge gaps among patients and caregivers. 6) Decision-Making underscores the importance of informed and collaborative decision-making processes. 7) Cultural considerations urge the adoption of culturally sensitive approaches. 8) Ongoing challenges shed light on persistent issues such as provider attitudes, and administrative hurdles. ConclusionThis study highlights essential factors for establishing an integrated PC program for cancer patients in Turkey. The existing healthcare system in Turkey offers opportunities for advanced PC. Successful implementation demands strategic actions to facilitate meaningful transformation.

The role of the somatosensory system in the feeling of emotions: a neurostimulation study.

Emotional experiences deeply impact our bodily states, such as when we feel 'anger', our fists close and our face burns. Recent studies have shown that emotions can be mapped onto specific body areas, suggesting a possible role of the primary somatosensory system (S1) in emotion processing. To date, however, the causal role of S1 in emotion generation remains unclear. To address this question, we applied transcranial alternating current stimulation (tACS) on the S1 at different frequencies (beta, theta, and sham) while participants saw emotional stimuli with different degrees of pleasantness and levels of arousal. Results showed that modulation of S1 influenced subjective emotional ratings as a function of the frequency applied. While theta and beta-tACS made participants rate the emotional images as more pleasant (higher valence), only theta-tACS lowered the subjective arousal ratings (more calming). Skin conductance responses recorded throughout the experiment confirmed a different arousal for pleasant versus unpleasant stimuli. Our study revealed that S1 has a causal role in the feeling of emotions, adding new insight into the embodied nature of emotions. Importantly, we provided causal evidence that beta and theta frequencies contribute differently to the modulation of two dimensions of emotions-arousal and valence-corroborating the view of a dissociation between these two dimensions of emotions.