Related Problems Research Articles

To study the socio-demographic profile and clinical profile of abnormal uterine bleeding cases attending new civil hospital, Surat, Western India

There are so many concerns and worries about menstruation. With the use of advance method of contraception, women are experiencing more menstrual related problems. Now a days, menstrual related complaints are more common in gynaec clinic. So, we had conducted this study to document the sociodemographic and clinical profile among the attendees of gynaec clinic with menstrual related problem. Observational cross-sectional study carried out in western part of India with 100 patients after their written informed consent. Data were collected on pre-designed semi structured questionnaire which consist of sociodemographic and clinical questions. All data were entered in MS excel spreadsheet and analyzed with the help of SPSS V.20. Current study reported 8% of new Gynaec attendees had problem of abnormal uterine bleeding. Majority of patients were belonging to age group 21 years to 40 years (83%) and most of the patients were multipara (75%). Commonest complains among patients were menorrhagia (80%). Most of the patients were reported haemoglobin of less than 12 mg/dl.: Abnormal uterine bleeding is a distressing problem for women in their reproductive age groups especially in 21 years to 40 years.

Is sleep bruxism in obstructive sleep apnea only an oral health related problem?

BackgroundThe etiology of sleep bruxism in obstructive sleep apnea (OSA) patients is not yet fully clarified. This prospective clinical study aimed to investigate the connection between probable sleep bruxism, electromyographic muscle tone, and respiratory sleep patterns recorded during polysomnography.Methods106 patients with OSA (74 males, 31 females, mean age: 56.1 ± 11.4 years) were divided into two groups (sleep bruxism: SB; no sleep bruxism: NSB). Probable SB were based on the AASM criteria: self-report of clenching/grinding, orofacial symptoms upon awakening, abnormal tooth wear and hypertrophy of the masseter muscle. Both groups underwent clinical examination for painful muscle symptoms aligned with Temporomandibular Disorders Diagnostic Criteria (DC/TMD), such as myalgia, myofascial pain, and headache attributed to temporomandibular disorder. Additionally, non-complaint positive muscle palpation and orofacial-related limitations (Jaw Functional Limited Scale-20: JFLS-20) were assessed. A one-night polysomnography with electromyographic masseter muscle tone (EMG) measurement was performed. Descriptive data, inter-group comparisons and multivariate logistic regression were calculated.ResultsOSA patients had a 37.1% prevalence of SB. EMG muscle tone (N1-N3, REM; P = 0.001) and the number of hypopneas (P = 0.042) were significantly higher in the sleep bruxism group. While measures like apnea–hypopnea-index (AHI), respiratory-disturbance-index (RDI), apnea index (AI), hypopnea-index (HI), number of arousals, and heart rate (1/min) were elevated in sleep bruxers, the differences were not statistically significant. There was no difference in sleep efficiency (SE; P = 0.403). Non-complaint masseter muscle palpation (61.5%; P = 0.015) and myalgia (41%; P = 0.010) were significant higher in SB patients. Multivariate logistic regression showed a significant contribution of EMG muscle tone and JFLS-20 to bruxism risk.ConclusionIncreased EMG muscle tone and orofacial limitations can predict sleep bruxism in OSA patients. Besides, SB patients suffer more from sleep disorder breathing. Thus, sleep bruxism seems to be not only an oral health related problem in obstructive apnea. Consequently, interdisciplinary interventions are crucial for effectively treating these patients.Trial registrationThe study was approved by the Ethics Committee of Philipps-University Marburg (reg. no. 13/22—2022) and registered at the “German Clinical Trial Register, DRKS” (DRKS0002959).

Flexural–torsional buckling with enforced axis of twist and related problems

The classical lateral–torsional instability of a cantilever beam with continuous elastic lateral restraint and a transverse point-load applied at the free end is discussed here through the lens of asymptotic simplifications. One of our main goals is to provide analytical approximations for the critical buckling load, as well as its dependence on various key non-dimensional groups. The first part of this study is concerned with a scenario in which a doubly symmetric beam is constrained to rotate about a fixed axis situated at an arbitrary height above the shear centroidal axis. The second part examines a beam that features a continuous elastic lateral restraint spanning its entire length. Assuming that the stiffness of the constraint, [Formula: see text] (say), is finite, the buckling equations in the second case are described by a system of two coupled fourth-order differential equations in the lateral displacement and the angle of twist. We show that as [Formula: see text], the problem discussed in the first part provides an outer solution for the aforementioned system; the relevant boundary conditions for the next-to-leading-order outer approximation are also derived using matched asymptotics. Our theoretical findings are confirmed by comparisons with direct numerical simulations of the full buckling problem.

Spatio-temporal dynamics of agricultural and built-up areas in the Niaye area of Pikine urban wetland (Dakar, Senegal)

The Niaye area of Pikine, a wetland with favorable physical and climatic conditions, is a rich and varied ecosystem that guarantees a supply of water and fertile soil, conducive to market gardening. This plays an important socio-economic role in the Dakar region. However, this sensitive and fragile ecosystem is often affected by poor farming practices. The aim of the study was to analyze the spatial evolution of agricultural areas and built-up areas in order to identify related environmental problems. Interview guides, aerial photographs from 1966 and 1978 and Digital Globe Over view 2 satellite images from 2004 and 2022 were used. The interview guides were used to obtain data on the management of the market gardening activity, and also to identify the environmental problems it generates. Satellite data processing revealed, through cartographic analysis, a progressive market gardening dynamic of +5.07%. In addition, the built-up area around the lake has increased by over 200%, resulting in a 68.4% decline in upland vegetation and a migration of market gardeners to the lake. This situation leads to the destruction of market garden crops in the rainy season as the water rises. What's more, the intensification of market gardening in response to the population's growing demand for vegetables has not failed to encourage bad practices, including the use of pesticides and sewage, which is a public health problem and a threat to the future of this wetland.

Hospital Acquired Infection Revisited: Route of Transmission

Aims: to revisited hospital route of infection transmission in patients under medical care with its related problems and re-focus on some important MDR nosocomial infection agents route of transmission to vulnerable patients. Discussion: Accidental infections acquired in hospitals or hospital acquired infection (HAI) is a global major health condition, and become a major obstacle in the present day era of hospitalization. Increased risk of morbidity with mortality, lengthened hospitalization, massive prescription of antibiotics, and socio-economically become a definite financial burden. Disinfection and sterilization in hospitals is of increasing concern. Besides that, the abuse of antibiotics has led to the prompt wide spread of multidrug-resistant drugs (MDR) microorganisms which is characterized by the ability to quickly adapt to an environment that previously does not support its growth commonly and able to initiate serious life-threatening HAI. The need to understand route of transmission and its associated obstacles will help combating MDR microorganisms. Conclusion: The Global emergence of MDR microorganisms with its difficult route of infections has created a major obstacle to combat the bacterial pathogens, and need serious attention from all stakeholders, throughout the world.

A Layered Learning Approach to Scaling in Learning Classifier Systems for Boolean Problems.

Evolutionary Computation (EC) often throws away learned knowledge as it is reset for each new problem addressed. Conversely, humans can learn from small-scale problems, retain this knowledge (plus functionality) and then successfully reuse them in larger-scale and/or related problems. Linking solutions to problems together has been achieved through layered learning, where an experimenter sets a series of simpler related problems to solve a more complex task. Recent works on Learning Classifier Systems (LCSs) has shown that knowledge reuse through the adoption of Code Fragments, GP-like tree-based programs, is plausible. However, random reuse is inefficient. Thus, the research question is how LCS can adopt a layered-learning framework, such that increasingly complex problems can be solved efficiently? An LCS (named XCSCF*) has been developed to include the required base axioms necessary for learning, refined methods for transfer learning and learning recast as a decomposition into a series of subordinate problems. These subordinate problems can be set as a curriculum by a teacher, but this does not mean that an agent can learn from it. Especially if it only extracts over-fitted knowledge of each problem rather than the underlying scalable patterns and functions. Results show that from a conventional tabula rasa, with only a vague notion of what subordinate problems might be relevant, XCSCF* captures the general logic behind the tested domains and therefore can solve any n-bit Multiplexer, n-bit Carry-one, n-bit Majority-on, and n-bit Even-parity problems. This work demonstrates a step towards continual learning as learned knowledge is effectively reused in subsequent problems.

Error estimates for a mixed finite element method for the Maxwell’s transmission eigenvalue problem

In this paper, we analyze a numerical method combining the Ciarlet-Raviart mixed finite element formulation and an iterative algorithm for the Maxwell’s transmission eigenvalue problem. The eigenvalue problem is first written as a nonlinear quad-curl eigenvalue problem. Then the real transmission eigenvalues are proved to be the roots of a non-linear function. They are the generalized eigenvalues of a related linear self-adjoint quad-curl eigenvalue problem. These generalized eigenvalues are computed by a mixed finite element method. We derive the error estimates using the spectral approximation of compact operators, the theory of mixed finite element method for quad-curl problems, and the derivatives of eigenvalues.

A systematic comparison of deep learning methods for Gleason grading and scoring

Prostate cancer is the second most frequent cancer in men worldwide after lung cancer. Its diagnosis is based on the identification of the Gleason score that evaluates the abnormality of cells in glands through the analysis of the different Gleason patterns within tissue samples. The recent advancements in computational pathology, a domain aiming at developing algorithms to automatically analyze digitized histopathology images, lead to a large variety and availability of datasets and algorithms for Gleason grading and scoring. However, there is no clear consensus on which methods are best suited for each problem in relation to the characteristics of data and labels. This paper provides a systematic comparison on nine datasets with state-of-the-art training approaches for deep neural networks (including fully-supervised learning, weakly-supervised learning, semi-supervised learning, Additive-MIL, Attention-Based MIL, Dual-Stream MIL, TransMIL and CLAM) applied to Gleason grading and scoring tasks. The nine datasets are collected from pathology institutes and openly accessible repositories. The results show that the best methods for Gleason grading and Gleason scoring tasks are fully supervised learning and CLAM, respectively, guiding researchers to the best practice to adopt depending on the task to solve and the labels that are available.

A survey on the implementation of clinical medication reviews in community pharmacies within a multidisciplinary setting

BackgroundPolypharmacy is common in chronic medication users, which increases the risk of drug related problems. A suitable intervention is the clinical medication review (CMR) that was introduced in the Netherlands in 2012, but the effectiveness might be hindered by limited implementation in community pharmacies. Therefore our aim was to describe the current implementation of CMRs in Dutch community pharmacies and to identify barriers to the implementation.MethodsAn online questionnaire was developed based on the Consolidated Framework for Implementation Research (CFIR) and consisted of 58 questions with open ended, multiple choice or Likert-scale answering options. It was sent out to all Dutch community pharmacies (n = 1,953) in January 2021. Descriptive statistics were used.ResultsA total of 289 (14.8%) community pharmacies filled out the questionnaire. Most of the pharmacists agreed that a CMR has a positive effect on the quality of pharmacotherapy (91.3%) and on medication adherence (64.3%). Pharmacists structured CMRs according to available selection criteria or guidelines (92%). Pharmacists (90%) believed that jointly conducting a CMR with a general practitioner (GP) improved their mutual relationship, whereas 21% believed it improved the relationship with a medical specialist. Lack of time was reported by 43% of pharmacists and 80% (fully) agreed conducting CMRs with a medical specialist was complicated. Most pharmacists indicated that pharmacy technicians can assist in performing CMRs, but they rarely do in practice.ConclusionsLack of time and suboptimal collaboration with medical specialists are the most important barriers to the implementation of CMRs.

Colored Unavoidable Patterns and Balanceable Graphs

We study a Turán-type problem on edge-colored complete graphs. We show that for any $r$ and $t$, any sufficiently large $r$-edge-colored complete graph on $n$ vertices with $\Omega(n^{2-1/tr^r})$ edges in each color contains a member from certain finite family $\mathcal{F}_t^r$ of $r$-edge-colored complete graphs. We conjecture that $\Omega(n^{2-1/t})$ edges in each color are sufficient to find a member from ${\mathcal{F}}_t^r$. A result of Girão and Narayanan confirms this conjecture when $r=2$. Next, we study a related problem where the corresponding Turán threshold is linear. We call an edge-coloring of a path $P_{rk}$ balanced if each color appears $k$ times in the coloring. We show that any $3$-edge-coloring of a large complete graph with $kn+o(n)$ edges in each color contains a balanced $P_{3k}$. This is tight up to a constant factor of $2$. For more colors, the problem becomes surprisingly more delicate. Already for $r=7$, we show that even $n^{2-o(1)}$ edges from each color does not guarantee existence of a balanced $P_{7k}$.

Nonlinear optimal control for robotic exoskeletons with electropneumatic actuators

Purpose To provide high torques needed to move a robot’s links, electric actuators are followed by a transmission system with a high transmission rate. For instance, gear ratios of 100:1 are often used in the joints of a robotic manipulator. This results into an actuator with large mechanical impedance (also known as nonback-drivable actuator). This in turn generates high contact forces when collision of the robotic mechanism occur and can cause humans’ injury. Another disadvantage of electric actuators is that they can exhibit overheating when constant torques have to be provided. Comparing to electric actuators, pneumatic actuators have promising properties for robotic applications, due to their low weight, simple mechanical design, low cost and good power-to-weight ratio. Electropneumatically actuated robots usually have better friction properties. Moreover, because of low mechanical impedance, pneumatic robots can provide moderate interaction forces which is important for robotic surgery and rehabilitation tasks. Pneumatic actuators are also well suited for exoskeleton robots. Actuation in exoskeletons should have a fast and accurate response. While electric motors come against high mechanical impedance and the risk of causing injuries, pneumatic actuators exhibit forces and torques which stay within moderate variation ranges. Besides, unlike direct current electric motors, pneumatic actuators have an improved weight-to-power ratio and avoid overheating problems. Design/methodology/approach The aim of this paper is to analyze a nonlinear optimal control method for electropneumatically actuated robots. A two-link robotic exoskeleton with electropneumatic actuators is considered as a case study. The associated nonlinear and multivariable state-space model is formulated and its differential flatness properties are proven. The dynamic model of the electropneumatic robot is linearized at each sampling instance with the use of first-order Taylor series expansion and through the computation of the associated Jacobian matrices. Within each sampling period, the time-varying linearization point is defined by the present value of the robot’s state vector and by the last sampled value of the control inputs vector. An H-infinity controller is designed for the linearized model of the robot aiming at solving the related optimal control problem under model uncertainties and external perturbations. An algebraic Riccati equation is solved at each time-step of the control method to obtain the stabilizing feedback gains of the H-infinity controller. Through Lyapunov stability analysis, it is proven that the robot’s control scheme satisfies the H-infinity tracking performance conditions which indicate the robustness properties of the control method. Moreover, global asymptotic stability is proven for the control loop. The method achieves fast convergence of the robot’s state variables to the associated reference trajectories, and despite strong nonlinearities in the robot’s dynamics, it keeps moderate the variations of the control inputs. Findings In this paper, a novel solution has been proposed for the nonlinear optimal control problem of robotic exoskeletons with electropneumatic actuators. As a case study, the dynamic model of a two-link lower-limb robotic exoskeleton with electropneumatic actuators has been considered. The dynamic model of this robotic system undergoes first approximate linearization at each iteration of the control algorithm around a temporary operating point. Within each sampling period, this linearization point is defined by the present value of the robot’s state vector and by the last sampled value of the control inputs vector. The linearization process relies on first-order Taylor series expansion and on the computation of the associated Jacobian matrices. The modeling error which is due to the truncation of higher-order terms from the Taylor series is considered to be a perturbation which is asymptotically compensated by the robustness of the control algorithm. To stabilize the dynamics of the electropneumatically actuated robot and to achieve precise tracking of reference setpoints, an H-infinity (optimal) feedback controller is designed. Actually, the proposed H-infinity controller for the model of the two-link electropneumatically actuated exoskeleton achieves the solution of the associated optimal control problem under model uncertainty and external disturbances. This controller implements a min-max differential game taking place between: (i) the control inputs which try to minimize a cost function which comprises a quadratic term of the state vector’s tracking error and (ii) the model uncertainty and perturbation inputs which try to maximize this cost function. To select the stabilizing feedback gains of this H-infinity controller, an algebraic Riccati equation is being repetitively solved at each time-step of the control method. The global stability properties of the H-infinity control scheme are proven through Lyapunov analysis. Research limitations/implications Pneumatic actuators are characterized by high nonlinearities which are due to air compressibility, thermodynamics and valves behavior and thus pneumatic robots require elaborated nonlinear control schemes to ensure their fast and precise positioning. Among the control methods which have been applied to pneumatic robots, one can distinguish differential geometric approaches (Lie algebra-based control, differential flatness theory-based control, nonlinear model predictive control [NMPC], sliding-mode control, backstepping control and multiple models-based fuzzy control). Treating nonlinearities and fault tolerance issues in the control problem of robotic manipulators with electropneumatic actuators has been a nontrivial task. Practical implications The novelty of the proposed control method is outlined as follows: preceding results on the use of H-infinity control to nonlinear dynamical systems were limited to the case of affine-in-the-input systems with drift-only dynamics. These results considered that the control inputs gain matrix is not dependent on the values of the system’s state vector. Moreover, in these approaches the linearization was performed around points of the desirable trajectory, whereas in the present paper’s control method the linearization points are related with the value of the state vector at each sampling instance as well as with the last sampled value of the control inputs vector. The Riccati equation which has been proposed for computing the feedback gains of the controller is novel, so is the presented global stability proof through Lyapunov analysis. This paper’s scientific contribution is summarized as follows: (i) the presented nonlinear optimal control method has improved or equally satisfactory performance when compared against other nonlinear control schemes that one can consider for the dynamic model of robots with electropneumatic actuators (such as Lie algebra-based control, differential flatness theory-based control, nonlinear model-based predictive control, sliding-mode control and backstepping control), (ii) it achieves fast and accurate tracking of all reference setpoints, (iii) despite strong nonlinearities in the dynamic model of the robot, it keeps moderate the variations of the control inputs and (iv) unlike the aforementioned alternative control approaches, this paper’s method is the only one that achieves solution of the optimal control problem for electropneumatic robots. Social implications The use of electropneumatic actuation in robots exhibits certain advantages. These can be the improved weight-to-power ratio, the lower mechanical impedance and the avoidance of overheating. At the same time, precise positioning and accurate execution of tasks by electropneumatic robots requires the application of elaborated nonlinear control methods. In this paper, a new nonlinear optimal control method has been developed for electropneumatically actuated robots and has been specifically applied to the dynamic model of a two-link robotic exoskeleton. The benefit from using this paper’s results in industrial and biomedical applications is apparent. Originality/value A comparison of the proposed nonlinear optimal (H-infinity) control method against other linear and nonlinear control schemes for electropneumatically actuated robots shows the following: (1) Unlike global linearization-based control approaches, such as Lie algebra-based control and differential flatness theory-based control, the optimal control approach does not rely on complicated transformations (diffeomorphisms) of the system’s state variables. Besides, the computed control inputs are applied directly on the initial nonlinear model of the electropneumatic robot and not on its linearized equivalent. The inverse transformations which are met in global linearization-based control are avoided and consequently one does not come against the related singularity problems. (2) Unlike model predictive control (MPC) and NMPC, the proposed control method is of proven global stability. It is known that MPC is a linear control approach that if applied to the nonlinear dynamics of the electropneumatic robot, the stability of the control loop will be lost. Besides, in NMPC the convergence of its iterative search for an optimum depends on initialization and parameter values selection and consequently the global stability of this control method cannot be always assured. (3) Unlike sliding-mode control and backstepping control, the proposed optimal control method does not require the state-space description of the system to be found in a specific form. About sliding-mode control, it is known that when the controlled system is not found in the input-output linearized form the definition of the sliding surface can be an intuitive procedure. About backstepping control, it is known that it cannot be directly applied to a dynamical system if the related state-space model is not found in the triangular (backstepping integral) form. (4) Unlike PID control, the proposed nonlinear optimal control method is of proven global stability, the selection of the controller’s parameters does not rely on a heuristic tuning procedure, and the stability of the control loop is assured in the case of changes of operating points. (5) Unlike multiple local models-based control, the nonlinear optimal control method uses only one linearization point and needs the solution of only one Riccati equation so as to compute the stabilizing feedback gains of the controller. Consequently, in terms of computation load the proposed control method for the electropneumatic actuator’s dynamics is much more efficient.

Energy use in residential buildings for sustainable development: The fifth Solar Decathlon Europe revelations

This research focuses on achieving sustainable development in residential buildings with energy use. Under the influence of the energy crisis and related problems, research on residential buildings for less energy use has great potential. The literature review, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses, and including VOSviewer analysis, shows the research is increasing and meaningful. Solar Decathlon buildings are used as the main objects in this research. The fifth Solar Decathlon Europe energy use technologies are examined through onsite investigation and online searching. The Analytic Hierarchy Process method for multi-criteria decision analysis is used for sustainability assessment. Moreover, the Ladybug and ClimateStudio plugins simulated respectively the annual solar radiation and the best angle for receiving it. The main findings show that 34 kinds of technologies used in these buildings can be classified into two categories in three directions. Passive technologies should be applied and prioritized, but generating renewable energy is also important. Some infrequently used technologies are not insignificant. The research shows that the combination of technologies decides sustainability performance, but the quantity used does not. Furthermore, energy use also needs to be balanced and coordinated in combination with architectural aesthetics. This research on energy use in residential buildings is beneficial for achieving sustainable development.

Navigating divergent perspectives on critical habitat designation: Insights from the little bustard (Tetrax tetrax) conservation in Spain

The designation of critical habitats is a conservation tool extensively used worldwide. Although the effectiveness of this tool has been proved globally, its implementation in Spain is scarce, probably due to the ambiguous character of its definition in policy and other related problems. This study provides insight into some of these aspects and how different groups of experts interpret the concept of critical habitat. We used the little bustard (Tetrax tetrax) as a case study of an endangered species for which critical habitats must be designated. We interviewed 47 experts of the species, from researchers to environmental agency technicians, about the objectives that critical habitats should address, and which facilitating and constraining aspects should be considered in such designation. By grouping the answers in different categories and running ordination analyses (Non-Metric Multidimensional Scaling) we found that researchers mainly focused on ecological objectives for critical habitats, compared to the rest of the respondents who also considered socioeconomic aspects as basic objectives for critical habitats. Only 36% of the experts mentioned ecological factors as constraints to such designation, while socioeconomic constraints were mentioned by all but two of the experts (96%). These results suggest differences in the conceptualization of critical habitat between scientists and managers, from pure ecological requirements of the species to the actual implications and socioeconomic constraints of its implementation, respectively. Integrating multiple stakeholders and views will reflect these differences into the operational understanding of critical habitats and will ensure that future critical habitat designations are effective management tools.

Application of machine learning for antibiotic resistance in water and wastewater: A systematic review

Antibiotic resistance (AR) is considered one of the greatest global threats in the current century, which can only be overcome if all interconnected areas of humans, animals and the environment are taken into account as part of the One Health concept proposed by the World Health Organization (WHO). Water and wastewater are among the most important environmental media of AR sources, where the phenomena are generally non-linear. Therefore, the aim of this study was to investigate the application of machine learning-based methods (MLMs) to solve AR-induced problems in water and wastewater. For this purpose, most relevant databases were searched in the period between 1987 and 2023 to systematically analyze and categorize the applications. Accordingly, the results showed that out of 12 applications, 11 (91.6%) were for shallow learning and 1 (8.3%) for deep learning. In shallow learning category, n = 6, 50% of the applications were regression and n = 4, 33.3% were classification, mainly using artificial neural networks, decision trees and Bayesian methods for the following objectives: Predicting the survival of antibiotic-resistant bacteria (ARB), determining the order of influencing parameters on AR-based scores, and identifying the major sources of antibiotic resistance genes (ARGs). In addition, only one study (8.3%) was found for clustering and no study for association. Surprisingly, deep learning had been used in only one study (8.3%) to predict ARGs sequences. Therefore, working on the knowledge gaps of AR, especially using clustering, association and deep learning methods, would be a promising option to analyze more aspects of the related problems. However, there is still a long way to go to consider and apply MLMs as unique approaches to study different aspects of AR in water and wastewater.

Evaluation of drug related problems among hospitalised elderly patients at a secondary hospital in East Borneo

Background: The elderly population often requires increased drug intake (polypharmacy) due to diminished organ function, particularly in the liver and kidneys, responsible for processing medications. Identifying drug-related problems (DRPs) in this demographic is crucial for mitigating morbidity, mortality, and overall drug therapy costs. Objective: This study aimed to identify DRPs and their determinants in hospitalised geriatric patients. Methods: An observational retrospective study was conducted in the Secondary Hospital in East Borneo from January 2019 - December 2021. Data were collected from medication charts, including patients aged 60-79, medical progress notes, and laboratories. DRPs were identified and classified using Pharmaceutical Care Network Europe’s (PCNE) classification V9.0. Results: Of the 614 included patients, 79% were aged 60-69 years, 56.0% were male, and 73% were prescribed ≥ five medications. DRPs were identified in 75.2% of patients, primarily related to treatment effectiveness (27.19%) and treatment safety (53.42%). Causes included inappropriate monitoring (14.5%), improper drug combinations (51.79%), excessive drug dosage (16.61%), and inadequate drug dosage (13.51%). Conclusion: The high frequency of DRPs, specifically concerning treatment effectiveness and safety, highlights the need for enhanced monitoring and prescribing procedures, contributing to preventing and treating future DRPs in the elderly population.

The Student’s Perceptions of Netflix Movies in Learning English to Improve Writing Skills on Vocational High School

This study investigates how students feel about using Netflix as an additional English language learning resource to improve their writing abilities in vocational high schools. The increasing significance of technology in education makes it necessary to understand the positive effects of non-traditional platforms such as Netflix when it comes to language learning. The study employs a qualitative approach, and interviews to gather insights from vocational high school students engaged in English language learning through Netflix. This article aims to investigate students' perceptions of the use of Netflix in the context of English language learning, and to investigate students' How does the use of Netflix contribute in the context of English language learning, particularly in the development of writing skills. The study findings will be the knowledge which can be implemented in the future prospect as the educator, specifically when facing the related problem about The Student Perceptions of Netflix in Learning English to Improve Writing Skills on Vocational High School.

The Effect Of Lavender Aromatherapy On The Intensity Of Menstrual Pain In Adolescent Girls

Until now, dysmenorrhea is still a frightening threat for women, especially young women, when they are approaching menstruation. Pain that occurs during menstruation is a result of excessive uterine contractions caused by the hormone prostaglandin. One non-pharmacological method used to reduce the intensity of pain is by using lavender aromatherapy. Aromatherapy can be given through inhalation or direct application to the skin through massage using inner oil. Aromatherapy is believed to be useful in treating respiratory problems, pain, and mental and emotional problems. The main aim of the research was to see how pain intensity decreased in teenagers before and after being given lavender aromatherapy. This quasi-experimental research used a one group pre-post and post-test approach with samples taken based on purposive sampling according to the specified criteria of 33 people. The results of the Shapiro Wilk test showed that the average pain scale before treatment was 6.52. Then the average pain scale dropped to 4.30 after being given lavender aromatherapy. The calculated Z value is 5.150 and the p-value is 0.000, thus providing significant results that there is an effect of giving lavender aromatherapy on the intensity of menstrual pain in young women at SMA Negeri 1 Perbaungan. In the future, it is hoped that lavender aromatherapy can continue to develop its properties and benefits for teenagers who have problems with pain during menstruation or related health problems.

Estimation of Surge and Swab Pressures While Tripping for Minimizing Excessive Drilling Problems

Surge and swab pressures result from pipe movement upward/downward during drill string reciprocation and tripping. surge and swab create costly drilling concerns such well kick, formation breakage, and lost circulation. This study aims to find the optimum pipe tripping speed to avoid surge and swab issues, particularly in lost circulation zones. Also, to determine how drilling factors and well bore geometry affect surge and swab pressures. Mud rheology, mud properties, hole diameters, drill pipe diameter, and bottom hole assembly (BHA) dimensions were also analyzed. Dynamic surge and swab model was employed to simulate two case studies in Rumaila Iraqi oilfield. The findings indicated that the tripping speed is the most effective variable on surge and swab pressures. Annular clearance and BHA design have also a major effect on the surge and swab pressures. For the first case study, it is found that whenever the mud weight is far from the pore pressure and fracture pressure gradients, the 5" drill pipe can be tripped in/out of lost circulation formation (Shuaibba formation) at optimum tripping speed of (80 ft/min) without surge/ swab related problems. The reason is that the generated surge pressures (6110-6300 psi) are below the fracture pressure (7100-7400 psi). The results also showed that tripping 5" drill pipe within a maximum running speed of 80 ft/min in (8.5") open hole section through Tanuma formation till Rumaila formation causes a surge pressures of (4650-5050 psi) which is still below the fracture pressures of formations (4750-5660 psi). the results of the second case study (S-shaped well) revealed that the optimum tripping speed of the drill string in the (12.25") open hole through Dammam and Hartha formations is (90 ft/min). it is also concluded that pulling out of hole (POOH) process must be carried out more carefully than the running process since the mud density is near the pore pressure gradient. The results of this study can be further used to improve the drilling efficiency in Rumaila oil field with decreasing non-productive time (NPT) by employing the appropriate tripping speed and optimal drilling operations.

Core components of pharmacist-led medication reviews and their relationship to outcomes: a systematic review

Abstract Introduction Medication reviews are a recognised intervention undertaken by healthcare professionals to support patients prescribed multiple medicines or with complex medication regimens. Pharmacist-led medication reviews are now an established intervention in policy and practice. There are different types of medication review, each implemented differently. Huiskes et al. demonstrated that medication reviews undertaken by any professional in any setting had minimal effects on clinical outcomes and that evidence is lacking about their effect on economic outcomes.[1] The implementation of medication reviews in practice was recognised as a factor which may impact outcomes, but this has not been explored further. Aim To develop an initial programme theory that links the core components of pharmacist-led medication reviews to outcomes in different contexts. Methods A systematic review was conducted to identify randomised controlled trials of medication reviews in adults (18+). The review updated that by Huiskes et al. and used the same search strategy in the MEDLINE, EMBASE and Web of Science databases.[1] The search terms used were related to ‘medication review’, ‘pharmacist’ and ‘randomised controlled trial’. Medication review was defined as “a consultation between a pharmacist and a patient to review the patient’s total medicines use with a view to improve patient health outcomes and minimise medicines related problems”. Studies reporting any outcomes were included. Papers not published in English or not available as full texts were excluded. The Cochrane Risk of Bias 2.0 tool was used to assess the studies. Data were extracted using a previously piloted bespoke data collection form. Descriptions of the medication reviews’ core components, implementation and outcomes were narratively synthesised to draw out common themes. The GRADE framework informed the overall assessment of the quality of the evidence from the studies.[2] Results Records screened n=10947, total reports of studies included n=68. Of the 50 individual studies that were identified, 66% were assessed as having a high risk of bias. Narrative synthesis of the data extracted relating to the description and implementation of the medication reviews, and where and how this may have affected outcomes, is presented in our programme theory as core components. Collaborative working may help reduce medicines-related problems and number of medicines prescribed. Patient involvement in goal setting and action planning may improve patients’ ability to take medicines as prescribed and help them achieve their treatment goals. Additional support and follow-up may lead to improved blood pressure, diabetes control, quality of life and a reduction of medicines-related problems. Conclusion This is an extensive systematic review that has explored pharmacist-led medication reviews in all settings and resulted in the production of a draft programme theory. It is best practice for stakeholders to be involved in the development of a programme theory. Providers of medication reviews can evaluate their processes and consider if and how these core components are implemented in their service provision. This initial programme theory will be refined and discussed in future research.

Robot obstacle avoidance optimization by A* and DWA fusion algorithm.

The current robot path planning methods only use global or local methods, which is difficult to meet the real-time and integrity requirements, and can not avoid dynamic obstacles. Based on this, this study will use the improved A-star global planning algorithm to design a hybrid robot obstacle avoidance path planning algorithm that integrates sliding window local planning methods to solve related problems. Specifically, A-star is optimized by evaluation function, sub node selection mode and path smoothness, and fuzzy control is introduced to optimize the sliding window algorithm. The study conducted algorithm validation on the TurtleBot3 mobile robot, with data sourced from experimental data from a certain college. The results showed that hybrid algorithm enabled the planned path to effectively navigate around dynamic obstacles and reach the target point accurately. When compared with traditional methods, path length reduced by 9.6%, path planning time decreased by 29% with an approximate 26.7% increase in the average speed of the robot. Compared with the traditional methods, the research algorithm has greatly improved in avoiding dynamic obstacles, path planning efficiency, model adaptability and so on, which has important value for relevant research. It can be seen that the algorithm proposed in the study has performance advantages, demonstrating the effectiveness and advantages of robot path planning, and can provide reference for robot obstacle avoidance optimization. Research can complete tasks for robots in practical environments, which has certain reference value for the research of robots in path planning and the development of path obstacle avoidance planning.