Special Settings Research Articles

Global solutions to the tangential Peskin problem in 2-D

We introduce and study the tangential Peskin problem in 2D, which is a scalar drift-diffusion equation with a nonlocal drift. It is derived with a new Eulerian perspective from a special setting of the 2D Peskin problem where an infinitely long and straight 1D elastic string deforms tangentially in the Stokes flow induced by itself in the plane. For initial datum in the energy class satisfying natural weak assumptions, we prove existence of its global solutions. This is considered as a super-critical problem in the existing analysis of the Peskin problem based on Lagrangian formulations. Regularity and long-time behaviour of the constructed solution is established. Uniqueness of the solution is proved under additional assumptions.

Healthcare professionals' experience regarding competencies in specialized and primary stroke units: A qualitative study

AimTo describe healthcare professionals’ experience of needed competence in patient stroke care within specialist and primary healthcare. BackgroundHealthcare professionals who provide stroke care need multifaceted, multi-professional skills; ongoing training is important for competent stroke care. DesignA descriptive qualitative study. MethodsSix focus group interviews with semi-structured interviews were conducted in October and November 2020. Healthcare professionals (n = 25) working in stroke care units in both specialist and primary healthcare settings were interviewed. The interviews were recorded, transcribed and analyzed inductively by content analysis. The study was conducted, and results were reported according to the Consolidated Criteria for Reporting Qualitative Research. ResultsFive main categories were identified: clinical competence; multiprofessional networking competence; competence in interaction skills; emotional and psychoeducational support competence; and self-management and development competence. ConclusionCompetence in stroke care includes both in-depth and wide-ranging professional competences that require ongoing development. Utilizing various education models and collaborative learning approaches can help meet the requirements for developing competence in stroke care. Patient or public contributionNo patient or public contribution

Evaluation of ChatGPT pathology knowledge using board-style questions.

ChatGPT is an artificial intelligence chatbot developed by OpenAI. Its extensive knowledge and unique interactive capabilities enable its use in various innovative ways in the medical field, such as writing clinical notes and simplifying radiology reports. Through this study, we aimed to analyze the pathology knowledge of ChatGPT to advocate its role in transforming pathology education. The American Society for Clinical Pathology Resident Question Bank 2022 was used to test ChatGPT, version 4. Practice tests were created in each subcategory and answered based on the input that ChatGPT provided. Questions that required interpretation of images were excluded. We analyzed ChatGPT performance and compared it with average peer performance. The overall performance of ChatGPT was 56.98%, lower than that of the average peer performance of 62.81%. ChatGPT performed better on clinical pathology (60.42%) than on anatomic pathology (54.94%). Furthermore, its performance was better on easy questions (68.47%) than on intermediate (52.88%) and difficult questions (37.21%). ChatGPT has the potential to be a valuable resource in pathology education if trained on a larger, specialized medical data set. Those relying on it (in its current form) solely for the purpose of pathology training should be cautious.

Administrator Perspectives on Teacher Leadership for Teaching Students with Extensive Support Needs Across Settings

ABSTRACT While often understated, the role of teachers of students with extensive support needs (ESN) requires many activities associated with the concept of teacher leadership. Administrators play a key role in supporting teachers as they perform these essential leadership-oriented activities. In this study, researchers surveyed the engagement and perspectives of administrators in general and special education settings on six teacher leader competencies (TLCs) related to teaching students with ESN. Overall, special and general education administrators reported high confidence in their own ability to supervise teachers in the TLCs as well as in their teachers’ ability to implement four of the six TLCs. While no significant differences were found between the two administrator groups, some differences were noted between the type of professional development received and the levels of expectation for the following TLCs: implementing inclusive practices, supervising paraprofessionals, and adapting and developing individualized curricula. Given that administrator support has an important impact on teacher job satisfaction and retention, this study provides discussion regarding the findings and potential implications for the field.

특수학교에서의 긍정적 행동지원 운영 사례에 대한 연구

Research Objective: This study aims to explore practical knowledge essential for the effective implementation of positive behavior support in special schools, using a case study of a school with a focus on positive behavior support operated by the C Education Office. The intention is to understand the practical knowledge required and to identify support strategies for the successful execution of positive behavior support in special education settings. Research Method: The study involved five head teachers responsible for the operation of five schools emphasizing positive behavior support in special education. The qualitative level of the operation of positive behavior support in these schools was assessed using an evaluation checklist. Based on the evaluation results, interviews were conducted to understand the specific implementation situations of the schools. The interview data were analyzed through keyword extraction, categorization, and classification. Research Findings: The qualitative level of positive behavior support in the operation of schools emphasizing positive behavior support in special education was evaluated as very high, with an average score of 82.73 across the five schools. The analysis of interview data revealed key themes related to people, systems, and culture in the actual operational situations of schools emphasizing positive behavior support. Discussion and Recommendations: The case of operating schools with a focus on positive behavior support in the C Education Office's special education provides a practical example for problem-solving in other special schools operated by the C Education Office and in different regions implementing positive behavior support.

Specific educational program for adolescent anemia prevention (Progres MIRA) to adolescent girls in remote areas of Bengkulu, Indonesia

Background: Anemia prevalence worldwide ranges from 30-50%, mostly occurring in developing countries, predominantly affecting adolescent groups. In Indonesia, the prevalence of anemia in females aged ≥15 years is 22.7%. Cases in Indonesia include 45% in Denpasar City and 62% in Bengkulu Province. Generally, adolescent girls are vulnerable to anemia due to significant blood loss during menstruation, posing risks of Low Birth Weight (LBW) and stunting during childbirth.Purpose: To determine the effectiveness of Progres MIRA (Specific Education Program for Anemia Prevention in Adolescents) on compliance with iron supplement consumption and hemoglobin levels in adolescent girls on Enggano Island, North Bengkulu Regency in 2023.Method: This study used a quasi-experimental post-test only method with a control group. The Progres MIRA research intervention involved a specific education program for anemia prevention in a special classroom setting. The independent variable was Progres MIRA, the dependent variables were hemoglobin levels and compliance with consuming iron supplement tablets, and external variables included menstrual duration, menstrual cycle, nutrient intake, and economic status.Results: The research findings showed that 82.9% of adolescent girls had a menstrual duration of >6 days, which influenced the amount of iron supplement tablet consumption among them. The menarche age among adolescent girls in the Progres MIRA group was 28.6% at an age <12 years. Compliance levels in treatment related to the menstrual duration variable obtained a ρ-value= 0.01, menarche age obtained a ρ-value= 0.57, malnutrition deficiency index obtained a ρ-value= 0.04, and MUAC obtained a ρ-value= 0.10. This indicates that Progres MIRA effectively increases compliance with iron supplement tablet consumption among adolescent girls.Conclusion: Progres MIRA is effective in improving compliance with iron supplement tablet consumption among adolescent girls. Recommended Dietary Allowance (RDA) significantly affects compliance with iron supplement tablet consumption among adolescent girls.

The Construction of Precursor Models in the Thinking of Young Children: The Case of Expansion and Contraction of Metals

The aim of the current study is to examine how preschool children overcome their difficulties regarding thermal expansion and contraction and construct in their minds a precursor model; that is, an entity compatible with school knowledge. Having investigated these difficulties through a pretest, a teaching intervention was implemented based on both the telling of a fairy tale and the carrying out of experimental activities. Finally, the changes in children’s thinking were studied with a posttest. The study involved 36 children aged 4–6 years who voluntarily participated in individual semistructured interviews conducted by three researchers in a special kindergarten setting. The results of the study revealed statistically significant progress in children’s responses between pre- and posttests. Furthermore, the finding of almost 1/3 of children’s responses being compatible with school knowledge indicates that (a) it is possible for children of that age to construct a precursor model for thermal expansion and contraction and (b) the combination of storytelling along with experimental activities is probably an appropriate teaching strategy.

Associations between Rheumatoid Arthritis and Various Comorbid Conditions in Germany—A Retrospective Cohort Study

Aims: The aim of the present study was to estimate the prevalence of physical and mental health comorbidities in patients with rheumatoid arthritis (RA) in Germany, in order to better understand the complex clinical picture and its consequences. Methods: This retrospective cohort study was based on data from the IQVIA Disease Analyzer database and included individuals aged ≥ 16 years with an initial documented diagnosis of RA between 2015 and 2021 (index date). RA patients were matched 1:1 with non-RA individuals using nearest neighbor propensity score matching. The study investigated associations between RA and various disorders documented within 365 days after the index date. The cumulative incidence of defined disorders was calculated for individuals with and without RA. Multivariable logistic regression models were used to study these associations. Results: Data were available for a total of 49,713 patients with and 49,713 patients without RA (mean age: 60.4 (SD: 15.5) years; 66.7% female). A significant and clinically relevant positive association was observed between RA and seven disorders: soft tissue disorders (Odds Ratio (OR): 1.47; 95% Confidence Interval (CI): 1.42–1.52), renal failure (OR: 1.36; 95% CI: 1.26–1.47), anemia (OR: 1.32; 95% CI: 1.24–1.40), liver diseases (OR: 1.32, 95% CI: 1.23–1.41), osteopathies and chondropathies (OR: 1.28; 95% CI: 1.22–1.3), diseases of the esophagus, stomach and duodenum (OR: 1.18; 95% CI: 1.14–1.22), and nutritional deficiencies (OR: 1.17; 95% CI: 1.10–1.24). Conclusions: We observed significant associations between RA and several comorbidities, which have clinical relevance for the care of RA patients not only in general practices but also in specialist settings.

Proposal of a diagnostic algorithm for radiation-induced dropped head syndrome in long-term childhood cancer survivors based on a prospective study in a specialized clinical setting and a review of the literature

PurposeTo prospectively assess the incidence of Dropped Head Syndrome (DHS) in childhood cancer survivors (CCS) and to develop and evaluate a diagnostic algorithm for DHS.MethodsA systematic literature search for DHS in combination with neck radiotherapy (RT) exposure was performed. Analyses and a combination of the most common examination methods were integrated into a diagnostic algorithm. Almost all CCSs visiting the local late effects clinic between May 2020 and April 2022 were included in the study. CCS exposed to neck RT with doses ≥ 19 Gy received standardized clinical and neurological assessment and, in case of abnormal results, an MRI scan to confirm muscle atrophy.ResultsTwo hundred and five CCS were included of whom 41 received RT to the neck with ≥ 19 Gy. In the entire cohort and in the subgroup receiving RT, 2.4% and 12% of CCS were affected by DHS, respectively. Results of clinical and neurological assessment correlated well with MRI results. Neck circumference and neck/thigh ratio were lower after neck RT. Over 50% of CCS experienced neck disability and pain.ConclusionsA relevant proportion of CCS exposed to neck RT is affected by DHS. High concordance of MRI results with the neurological examination supports the clinical value of the diagnostic algorithm. Measurement of neck circumference might be an easy tool for assessment of neck muscle atrophy in survivors at risk.Implications for cancer survivorsIntegration of a diagnostic algorithm for DHS in standard long-term follow-up care facilitates diagnosis as well as initiation of early treatment and obviates the need for invasive examinations.

Portuguese translation, cultural adaptation, and validation of the Person-Centred Practice Inventory - Staff (PCPI-S).

Aiming to translate, culturally adapt, and psychometrically evaluate the Person-centred Practice Inventory - Staff (PCPI-S) for Portuguese healthcare professionals, this methodological study was conducted sequentially in two phases. Phase I followed the 10-steps recommendations from the ISPOR taskforce for translation and cultural adaptation of patient reported outcome measures. Phase II comprised a quantitative cross-sectional virtual survey of the translated PCPI-S with healthcare professionals, who were reached through snowball sampling from both primary and specialized care settings. The psychometric properties of the PCPI-S were determined by assessing reliability and construct validity. A sample of 304 healthcare professionals participated in Phase II. Ceiling effects were found. The overall internal consistency was excellent (> 0.9). The confirmatory factor analysis showed a good model fit after minor modifications, revealing construct validity, and supporting the theoretical framework. In conclusion, the three-factorial model of PCPI-S adjusted to the studied sample is a valid and reliable instrument to assess the perceptions of healthcare professionals on person-centred practice in various Portuguese clinical contexts. Considering the ceiling effects, the effect of social desirability should be explored.

Hospital pharmacist experience in a multidisciplinary team in special care settings

The COVID-19 pandemic is placing huge strain on health systems and professionals. Emergency departments and their pharmacy services have been the first to face this challenge before any other pharmacy units. This article provides a description of the experience of two public hospitals located in the Autonomous Community of Madrid, Spain.Team working and reciprocal trust have made it possible to meet the unprecedented demand for health services and has facilitated rapid decision making. Strategies have been developed to guarantee the availability, distribution and safe use of medications. Other strategies have included favoring communication within Emergency Departments pharmacy services, and between these services and Emergency Departments during the pandemic.Multidisciplinary cooperation and information sharing have traditionally formed the base for efficient and quality work, along with solid technologies that guarantee a safe use of medications. The crucial role of information and communication technologies during the pandemic may give rise to a new model of pharmaceutical care, which should not replace face-to-face Emergency Department pharmacist support and advice. Promoting the re-humanization of healthcare and pharmacy services is essential. An adequate technical training and the development of abilities such as flexibility, planning and coordination skills, and an assertive communication and management of emotions will be key to the successful management of unimaginable settings in the future.

Nasal sprays: commonly used medications that are often misunderstood.

Sinonasal inflammatory disease is very common and all clinicians who care for these patients should understand the topical treatment options available. This article reviews the utility and application of steroidal, saline, decongestant, antihistamine and anticholinergic preparations for the treatment of sinonasal disease, with a particular focus on evidence-based guidelines for use in both specialist and non-specialist healthcare settings.

Patient pathways for rare diseases in Europe: ataxia as an example

BackgroundProgressive ataxias are rare and complex neurological disorders that represent a challenge for the clinicians to diagnose and manage them. This study explored the patient pathways of individuals attending specialist ataxia centres (SAC) compared with non–specialist settings. We investigated specifically how diagnosis was reached, the access to healthcare services, treatments, and care satisfaction. The focus of this study was on early intervention, coordination of treatment to understand the care provision in different countries.MethodsA patient survey was done in the UK, Germany and Italy to gather information about diagnosis and management of the ataxias in specialist (SAC) and non-specialist settings, utilisation of other primary and secondary health care services, and patients’ satisfaction of received treatment.ResultsPatients gave positive feedback about the role of SAC in understanding their condition, ways to manage their ataxia (p < 0.001; UK) and delivering care adapted to their needs (p < 0.001; UK), in coordinating referrals to other healthcare specialists, and in offering opportunities to take part in research studies. Similar barriers for patients were identified in accessing the SACs among the selected countries, UK, Germany, and Italy.ConclusionsThis study provides crucial information about the ataxia patients care pathways in three European countries. Overall, the results showed a trend in patients’ satisfaction being better in SAC compared to non-SAC. The outcomes can be used now for policy recommendations on how to improve treatment and care for people with these very rare and complex neurological diseases across Europe.

Dynamical effects of memristive electromagnetic induction on a 2D Wilson neuron model.

Electromagnetic induction plays a crucial impact on the firing activity of biological neurons, since it exists along with the mutual effect between membrane potential and ions transport. Flux-controlled memristor is an available candidate in characterizing the electromagnetic induction effect. Different from the previously reported literature, a non-ideal flux-controlled memristor with cosine mem-conductance function is employed to determine the periodic magnetization and leakage flux processes in neurons. Thereafter, a three-dimensional (3D) memristive Wilson (m-Wilson) neuron model is constructed under the consideration of this kind of electromagnetic induction. Numerical simulations are performed by multiple numerical tools, which demonstrate that the 3D m-Wilson neuron model can generate abundant firing activities. Interestingly, coexisting firing activities, antimonotonicity, and firing frequency regulation are discovered under special parameter settings. Furthermore, a PCB-based analog circuit is designed and hardware measurements are executed to verify the numerical simulations. These explorations in numerical and hardware surveys might provide insights to regulate the firing activities by appropriate electromagnetic induction.

Automation of ultrasonographic optic nerve sheath diameter measurement using convolutional neural networks.

Ultrasonographic optic nerve sheath (ONS) diameter is a noninvasive intracranial pressure (ICP) surrogate. ICP is monitored invasively in specialized intensive care units. Noninvasive ICP monitoring is important in less specialized settings. However, noninvasive ICP monitoring using ONS diameter (ONSD) is limited by the need for experts to obtain and perform measurements. We aim to automate ONSD measurements using a deep convolutional neural network (CNN) with a novel masking technique. We trained a CNN to reproduce masks that mark the ONS. The edges of the mask are defined by an expert. Eight models were trained with 1000 epochs per model. The Dice-similarity-coefficient-weighted averaged outputs of the eight models yielded the final predicted mask. Eight hundred and seventy-three images were obtained from 52 transorbital cine-ultrasonography sessions, performed on 46 patients with brain injuries. Eight hundred and fourteen images from 48 scanning sessions were used for training and validation and 59 images from four sessions for testing. Bland-Altman and Pearson linear correlation analyses were used to evaluate the agreement between CNN and expert measurements. Expert ONSD measurements and CNN-derived ONSD estimates had strong agreement (r = 0.7, p < .0001). The expert mean ONSD (standard deviation) is 5.27mm (0.43) compared to CNN mean estimate of 5.46mm (0.37). Mean difference (95% confidence interval, p value) is 0.19mm (0.10-0.27mm, p = .0011), and root mean square error is 0.27mm. A CNN can learn ONSD measurement using masking without image segmentation or landmark detection.

Registered Nurses' beliefs about end-of-life care: A mixed method study.

To examine registered nurses' (RNs) behavioural, normative and control beliefs about end-of-life care for patients who are diagnosed with advanced and life-limiting illnesses; and to identify the barriers and facilitators they experience when providing end-of-life care. A sequential explanatory mixed methods study. An online cross-sectional survey was conducted using the Care for Terminally Ill Patient tool among 1293 RNs working across five hospitals in the Kingdom of Saudi Arabia. Online individual semi-structured interviews with a subgroup of survey respondents were then undertaken. Data were collected between October 2020 to February 2021. A total of 415 RNs completed the online survey, with 16 of them participating in individual interviews. Over half of the participants expressed the belief that end-of-life care is most efficiently delivered through multidisciplinary team collaboration. The majority of participants also believed that discussing end-of-life care with patients or families leads to feelings of hopelessness. Paradoxically, the study revealed that more than half of the participants held the negative belief that patients at the end of life should optimally receive a combination of both curative and palliative care services. The results showed that nurses' beliefs were significantly associated with their age, religion, ward type, level of education and frequency of providing end-of-life care. Data from the qualitative interviews identified four themes that explored RNs' beliefs and its related factors. The four themes were 'holistic care', 'diversity of beliefs', 'dynamics of truth-telling' and 'experiences of providing end-of-life care.' Wherever possible, patients at the end-of-life should be cared for in specialist settings by multidisciplinary teams to ensure effective, high-quality care. Where this is not possible, organisations should ensure that teams of multidisciplinary staff, including nurses, receive education and resources to support end-of-life care in non-specialist settings. Hospitals that employ foreign-trained nurses should consider providing targeted education to enhance their cultural competence and reduce the impact of different beliefs on end-of-life care.

Construction of learning environments: A multiple case study in special education settings

AbstractEducation in segregated settings for pupils with intellectual disability (ID) has often been portrayed as a unified form of schooling. There is a risk of providing a simplified picture of these settings and of what pupils with ID need to learn. This is generally stipulated in policy documents, leaving room for staff in school to interpret curricula and form learning environments. The aim of this study is to explore how four different learning environments are constructed in segregated settings where pupils with ID are educated in Sweden. The study was conducted as a multiple case study, using observations and interviews with teachers and pupils in four special classes for pupils with ID (SCIDs). Drawing on curriculum theory, the four learning environments, in the results named as Alpha, Beta, Gamma and Delta class, respectively, appeared to be characterized by different ideas of schooling, labelled as knowledge‐mediating, socializing, functional life skills and caring as well as teacher‐centred classrooms. The study contributes to a deepened understanding of the complexity of education for pupils with ID in segregated settings.

A Comprehensive Review on Third-Generation Photovoltaic Technologies

The renewable energy industry has revolutionized due to photovoltaic (PV) technologies, which offer a clean and sustainable alternative to conventional energy sources. Third-generation photovoltaic technologies refer to a group of emerging PV technologies aiming to surpass the efficiency and cost-effectiveness of traditional silicon-based solar cells. Different ceramic materials have also been investigated for use in these advanced PV technologies. This review examines the science, current state, and advancements of third-generation PV systems for wide-scale implementation. The first section of this study provides an overview of the development of PV technologies from the first to the third generation, highlighting the most significant novel developments made at each step. Organic photovoltaic (OPV) cells, dye-sensitized solar cells (DSSCs), and perovskite solar cells (PSCs) are discussed here as a few new technologies that constitute the third generation, also known as the next generation of advanced PV. This review presents how these devices can be used in specialized settings, including indoor and low-light environments, thereby expanding the range of energy harvesting potential. The brief history of these emerging technologies, their current status, future developments, and key challenges are discussed in this review paper.

Evaluation of photobiomodulation therapy (117 and 90s) on pain, regeneration, and epigenetic factors (HDAC 2, DNMT3a) expression following spinal cord injury in a rat model.

Photobiomodulation therapy (PBMT), due to its anti-inflammatory, analgesic effects, and most importantly as a non-invasive procedure, has currently gained a special setting in pain relief and the treatment of Spinal cord injuries (SCI). However, the mechanism of action of the PBM is not yet completely understood. In this study, SCI is induced by an aneurysm clip, and PBM therapy was applied by a continuous-wave (CW) laser with a wavelength of 660nm. Adult male rats were divided into four groups: Control, SCI, SCI + PBMT 90s, and SCI + PBMT 117s. After 7weeks, hyperalgesia, allodynia, and functional recovery were assessed. Fibroblasts infiltrating the spinal cord were counted after H&E staining. The expression of epigenetic factors (HDAC2, DNMT3a), protein relevant for pain (GAD65), and astrocytes marker (GFAP) after 4weeks of daily PBMT (90 and 117s) was probed by western blotting. Both PBMTs (90 and 117s) significantly improved the pain and ability to move and fibroblast invasion was reduced. SCI + PBMT 90s, increased GAD65, HDAC2, and DNMT3a expression. However, PBMT 117s decreased GFAP, HDAC2, and DNMT3a. PBMT 90 and 117s improved the pain, and functional recovery equally. The regulation of epigenetic mechanisms appears to be a significant effect of PBMT117s, which emphasizes on impact of radiation duration and accumulative energy.

Public-Key Encryption With Tester Verifiable Equality Test for Cloud Computing

Public-key encryption with equality test (PKEET) provides cloud servers with an effective way to check the equality of outsourced encrypted data without decryption. This enables PKEET to attract much attention and be widely researched in cloud computing. However, we claim that the existing PKEET schemes suffer from an inherited problem, called message-consistency unverifiability of testers (MCUT). Applying the MCUT problem, outsourcers can fool cloud servers into outputting incorrect testing results of encrypted data, which negates the practicability of PKEET in cloud computing. We investigate the PKEET literature and find the main reason for the MCUT problem is the independence between the messages inserted in the decryption and testing modules in their ciphertexts. To bridge the technical gap between PKEET and its practical applications, we present a new notion, called PKE with tester verifiable equality test (PKE-TVET), which solves the MCUT problem by allowing testers to verify the message consistency in two modules. We then instantiate the PKE-TVET and give a specific construction in the standard model. In our PKE-TVET scheme, the testing module is integrated into the decryption module so that there is only one message inserted in the ciphertext for both decryption and testing. This special setting lets our scheme directly get rid of the MCUT problem. For better applications in actual scenarios, we further extend the scheme to support authorization and tester designation. Finally, we analyze the tradeoff of parameter sizes and computation costs for the security against MCUT attacks in our PKE-TVET scheme.