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Authors: Farbod Behnaminia, Saeed Samet

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The COVID-19 pandemic has paralyzed many lives until a vaccine was available, which caused the so-called “new normal.” According to the World Health Organization (WHO), COVID-19 is an infectious disease. It can cause significant illness or death in anyone. Governments and health officials tried to impose rules and regulations to avoid and slow down transmission. Therefore, software engineers worldwide developed applications to trace and track patients’ movements and notify others, mainly using Bluetooth. In this way, everyone could be informed whether they come in close contact with someone who has COVID-19 and takes proper safety precautions. Because most of the applications use technologies that can potentially reveal the user’s identity and location, researchers have debated privacy preservation and how to improve user privacy during such pandemics. Thanks to Distributed Ledger Technology (DLT), there have been some proposed methods to develop privacy-preserving Patient Tracking Systems in the last two years. As an instance of the DLT, Blockchain is like a decentralized peer-to-peer database that maintains a record of transactions. Transactions are immutable, transparent, and anonymous in this system. We conducted a comprehensive evaluation of the literature by looking for papers in the relevant field and dividing them into pre- and post-pandemic systems. Additionally, we discussed the many uses of blockchain technology in pandemic control. We found that two major obstacles facing blockchain implementation across many healthcare systems are scalability and privacy. The Polkadot platform is presented, along with a review of its efficacy in tackling current concerns. A more scalable healthcare system is achievable in the near future using Polkadot as well as a much more privacy-preserving environment.

Keywords: blockchain, electronic record management, EHR, privacy-preserving, patient tracking, COVID-19, trust and confidence, Polkadot

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Authors: Essam Mansour

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The purpose of this study is to explore the potential role of South Valley University (SVU) libraries’ manpower, collections and services in the fight against terrorism in the Upper Egypt. A quantitative research methodology was used in the form of a survey sent to 127 library staff at the SVU. The survey was undertaken from June to July 2015 with a response rate 73.2%. Printed materials were the most adequate collections in the SVU libraries. Other materials, such as CDs/DVDs, audiovisual materials, microfilm and microfiche, online resources and electronic materials respectively were inadequate at SVU libraries. Few of the services provided by SVU libraries were characterized as adequate services, some are inadequate and other services do not exist. The average of the facilities provided by SVU libraries was somewhat adequate. Activities, such as holding social field trips, holding training workshops and holding academic field trip were, at least, somewhat adequate to SVU libraries. SVU libraries had no a significant role in fighting terrorism in the Upper Egypt. There is no a relationship between the SVU library staff’s professional characteristics and the potential role that their libraries may play in the fight against this phenomenon. As a result of the lack of SVU libraries’ collections, services, facilities and activities, this study concluded that that such role could not be achieved. Almost all the library staff admitted that this severe lack has affected the provision of library patrons and members of the library community to these collections and services, which help in countering the threat of terrorism. Despite the significance of all these problems faced by SVU libraries in the fight against terrorism, it was found that the inadequacy of the library opening hours is significantly correlated with the professional characteristics of the library staff, particularly their job title and work experience.

Keywords: terrorism, national security, university libraries, south valley university, Egypt, survey

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Authors: Deepak Deshpande, Vikas Minchekar

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Day by day in modern India communal forces became stronger and stronger. Each and every caste group trying to show their strength through massive marches. Such kind of marches or ralliesruinous national integrity in India. To test this assumption present investigation has been carried out. This research was undertaken by using survey techniques. The study has been carried out in two phases. In the first stage, the students’ attitudes were collected while in the second phase the views of the members of the historical association were collected. The social dominance orientation scale and sources of social dominance inventory have been administered on 200 college students belonging to Maratha caste. Analyzed data revealed ahigh level of social dominance in Maratha caste students. Approximately, 80 percent students have reported that they have learned such dominance from the medieval history. The other sources disappear very less prominent. These results and present Indian social situation have been communicated with the members of the historical association of India. The majority members of this association agreed with this reality. The consensus also received on that Maratha caste person experiencing dominance due to the misinterpretation of the King Shivaji Empire; synchronize by politicians. The survey monkey app was used through electronic mail to collect the views on ‘The attitude towards the modification of curricula questionnaire’. The maximum number of members of the historical association agreed to employ to teach the medieval Indian history accordingly the secular perspectives.

Keywords: social dominance orientation, secular perceptive, national integrity, Maratha caste and medieval Indian history

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Authors: Selam Mulugeta, Barkot Milkias, Mesfin Araya, Abel Worku, Eyasu Mulugeta

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In Ethiopia, there is inadequate information on non-adherence to antidepressant treatment in patients with depressive disorders. Having awareness of the pattern of adherence is important in future prognosis, quality of life, and functionality in these patients. This hospital-based cross-sectional quantitative study was done on a sample of 216 consecutive outpatients with depressive disorders. Data were collected using questionnaires through in-person and phone call interviews. The 8-item Morisky scale was used to assess the pattern of medication adherence. Other specially developed tools were used to obtain sociodemographic and clinical information from electronic medical records and patient interviews. Data were analyzed using the Statistical Package for the Social Sciences Version - 25. Univariate and multivariable analyses were carried out to assess factors associated with non-adherence. 90% of the participants had a primary diagnosis of major depressive disorder. Based on the 8-item Morisky Medication Adherence Scale, the prevalence of non-adherence was found to be 84.7%. Living distance between 11 to 50 km from the hospital (AOR= 11, 95% CI (29,46.6)), post-secondary level of education (AOR= 8.3, 95% CI (1, 64.4)) and taking multiple medications (AOR= 6.1, 95% CI (1, 34.9)) were found to have significantly increased odds of non-adherence. Non-adherence was significantly associated with factors such as increased living distance from the hospital, relatively higher educational level, and polypharmacy. Proper and patient-centered psychoeducation, addressing the communication gap between patients and doctors, adherence to prescribing guidelines, avoiding polypharmacy unless indicated & working on accessibility of treatment is essential to decrease non-adherence.

Keywords: depressive disorders, Ethiopia, medication adherence, Addis Ababa

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Authors: Insook Lee, Heeseung Choi, Kyung-Sook Bang, Sungjae Kim, Minkyung Song, Buhyun Lee

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Backgrounds: A clearer and comprehensive understanding of the effects of forest therapy on depression is needed for further refinements of forest therapy programs. The purpose of this study was to review the literature on forest therapy programs designed to decrease the level of depression among adults to evaluate current forest therapy programs. Methods: This literature review was conducted using various databases including PubMed, EMBASE, CINAHL, PsycArticle, KISS, RISS, and DBpia to identify relevant studies published up to January 2016. The two authors independently screened the full text articles using the following criteria: 1) intervention studies assessing the effects of forest therapy on depression among healthy adults ages 18 and over; 2) including at least one control group or condition; 3) being peer-reviewed; and 4) being published either in English. The Scottish Intercollegiate Guideline Network (SIGN) measurement tool was used to assess the risk of bias in each trial. Results: After screening current literature, a total of 14 articles (English: 6, Korean: 8) were included in the present review. None of the studies used randomized controlled (RCT) study design and the sample size ranged from 11 to 300. Walking in the forest and experiencing the forest using the five senses was the key component of the forest therapy that was included in all studies. The majority of studies used one-time intervention that usually lasted a few hours or half-day. The most widely used measure for depression was Profile of Mood States (POMS). Most studies used self-reported, paper-and-pencil tests, and only 5 studies used both paper-and-pencil tests and physiological measures. Regarding the quality assessment based on the SIGN criteria, only 3 articles were rated ‘acceptable’ and the rest of the 14 articles were rated ‘low quality.’ Regardless of the diversity in format and contents of forest therapies, most studies showed a significant effect of forest therapy in curing depression. Discussions: This systematic review showed that forest therapy is one of the emerging and effective intervention approaches for decreasing the level of depression among adults. Limitations of the current programs identified from the review were as follows; 1) small sample size; 2) a lack of objective and comprehensive measures for depression; and 3) inadequate information about research process. Futures studies assessing the long-term effect of forest therapy on depression using rigorous study designs are needed.

Keywords: forest therapy, systematic review, depression, adult

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Authors: Ying Shi, June Zhang, Lu Shao, Xiyan Xie, Aidi Lao, Zhangan Wang

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Background: Low levels of physical activity are associated with poorer health outcomes, and this situation is more critical in older adults living in long‐term care facilities. Objectives: To systematically identify, appraise, and synthesize current qualitative research evidence regarding the barriers and facilitators to physical activity as reported by older adults and care staff in long‐term care facilities. Design: This is a systematic review with qualitative evidence synthesis adhering to PRISMA guidelines. Methods: We conducted a systematic search on PubMed, Science Citation Index Expanded, Social Sciences Citation Index, EMBASE, CINAHL, and PsychInfo databases from inception until 30 June 2023. Thematic synthesis was undertaken to identify the barriers and facilitators relating to physical activity. Then, we mapped them onto the Capability, Opportunity, Motivation, and Behavior model and Theoretical Domains Framework. Methodological quality was assessed using the CASP Qualitative Studies Checklist, and confidence in review findings was assessed using the GRADE-CERQual approach. Results: We included 32 studies after screening 10496 citations and 177 full texts. Seven themes and 17 subthemes were identified relating to barriers and facilitators influencing physical activity in elderly residents. The main themes were mapped onto COM-B) model-Capability (physical activity knowledge gaps and individual health issues), Opportunity (social support and macro-level resources) and Motivation (health beliefs, fear of falling or injury, and personal and social incentives to physical activity). Most subthemes were graded as high (n = 9) or moderate (n = 3) confidence. Conclusions and Implications: Our comprehensive synthesis of 32 studies provides a wealth of knowledge of barriers and facilitators to physical activity from both residents and care staff’s perspectives. Intervention components were also suggested within the context of long‐term care facilities. End users such as older residents, care staff, and researchers can have confidence in our findings when formulating policies and guidance on promoting physical activity among elderly residents in long‐term care facilities.

Keywords: long‐term care, older adults, physical activity, qualitative, systematic review

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Authors: Sanaz Mosadeghsedghi, Mathew Hudder, Mohammad Ali Baghbanzadeh, Charbel Atallah, Seyedeh Laleh Dashtban Kenari, Konstantin Volchek

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Lithium has recently been extensively used in lithium-ion batteries (LIBs) for electric vehicles and portable electronic devices. The conventional evaporative approach to recover and concentrate lithium is extremely slow and may take 10-24 months to concentrate lithium from dilute sources, such as geothermal brines. To response to the increasing industrial lithium demand, alternative extraction and concentration technologies should be developed to recover lithium from brines with low concentrations. In this study, a combination of electrocoagulation (EC) and electrodialysis (ED) was evaluated for the recovery of lithium from geothermal brines. The brine samples in this study, collected in Western Canada, had lithium concentrations of 50-75 mg/L on a background of much higher (over 10,000 times) concentrations of sodium. This very high sodium-to-lithium ratio poses challenges to the conventional direct-lithium extraction processes which employ lithium-selective adsorbents. EC was used to co-precipitate lithium using a sacrificial aluminium electrode. The precipitate was then dissolved, and the leachate was treated using ED to separate and concentrate lithium from other ions. The focus of this paper is on the study of ED, including a two-step ED process that included a mono-valent selective stage to separate lithium from multi-valent cations followed by a bipolar ED stage to convert lithium chloride (LiCl) to LiOH product. Eventually, the ED cell was reconfigured using mono-valent cation exchange with the bipolar membranes to combine the two ED steps in one. Using this process at optimum conditions, over 95% of the co-existing cations were removed and the purity of lithium increased to over 90% in the final product.

Keywords: electrochemical separation, electrocoagulation, electrodialysis, lithium extraction

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Authors: Hatem Diaf, Patrice Melinon, Antonio Pereira, Bernard Moine, Nicholas Blanchard, Florent Bourquard, Florence Garrelie, Christophe Donnet

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Glassy carbon exhibits excellent biological compatibility with live tissues meaning it has high potential for applications in life science. Moreover, glassy carbon has interesting properties including 'high temperature resistance', hardness, low density, low electrical resistance, low friction, and low thermal resistance. The structure of glassy carbon has long been a subject of debate. It is now admitted that glassy carbon is 100% sp2. This term is a little bit confusing as long sp2 hybridization defined from quantum chemistry is related to both properties: threefold configuration and pi bonding (parallel pz orbitals). Using plasma laser deposition of carbon clusters combined with pulsed nano/femto laser annealing, we are able to synthesize thin films of glassy carbon of good quality (probed by G band/ D disorder band ratio in Raman spectroscopy) without thermal post annealing. A careful inspecting of Raman signal, plasmon losses and structure performed by HRTEM (High Resolution Transmission Electron Microscopy) reveals that both properties (threefold and pi orbitals) cannot coexist together. The structure of the films is compared to models including schwarzites based from negatively curved surfaces at the opposite of onions or fullerene-like structures with positively curved surfaces. This study shows that a huge collection of porous carbon named vitreous carbon with different structures can coexist.

Keywords: glassy carbon, cluster deposition, coating, electronic structure

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Authors: Qingyu Zhang, Helin Ma, Lili Weng, Mei Cao

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Green supply chain management has been an important organizational strategy to reduce environmental risks and improve financial performance. Firms have to adopt green supply chain practices to meet the official regulations and reduce peer pressure in China. This paper exhibits an empirical study of the drivers of green supply chain management practices and the environmental and economic performance of green supply chain management implementation in Chinese firms. While China is the fastest-growing emerging economy, it has paid a high ecological price. It is reported that China hosts 7 of the world’s 10 most polluted cities. The continued environmental deterioration and the resultant heightened regulatory control and public scrutiny have posed new operating challenges to firms conducting business in China. These challenges make the country an ideal setting to conduct the present study. A research questionnaire was developed to gather data in China. The questionnaire targeted managers and employees in Chinese companies. The data were collected in the last quarter of 2015, involving industries such as electronic & communicational equipment, textile & clothing, pharmaceutical & healthcare, and so on. This study confirms and validates that (1) both internal and external drivers play a significant role in the implementation of green supply chain management practices; (2) green purchase and investment recovery have a significant impact on firms’ environmental and economic performance; (3) with the improvement of the firms’ environmental performance, their economic performance will improve.

Keywords: economic performance, environmental performance, external driver, green supply chain management

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Authors: Daniel Nigusse Tollosa, Erica James, Alexis Hurre, Meredith Tavener

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Introduction: Lifestyle behaviours such as healthy diet, regular physical activity and maintaining a healthy weight are essential for cancer survivors to improve the quality of life and longevity. However, there is no study that synthesis cancer survivor’s adherence to healthy lifestyle recommendations. The purpose of this review was to collate existing data on the prevalence of adherence to healthy behaviours and produce the pooled estimate among adult cancer survivors. Method: Multiple databases (Embase, Medline, Scopus, Web of Science and Google Scholar) were searched for relevant articles published since 2007, reporting cancer survivors adherence to more than two lifestyle behaviours based on the WCRF/AICR recommendations. The pooled prevalence of adherence to single and multiple behaviours (operationalized as adherence to more than 75% (3/4) of health behaviours included in a particular study) was calculated using a random effects model. Subgroup analysis adherence to multiple behaviours was undertaken corresponding to the mean survival years and year of publication. Results: A total of 3322 articles were generated through our search strategies. Of these, 51 studies matched our inclusion criteria, which presenting data from 2,620,586 adult cancer survivors. The highest prevalence of adherence was observed for smoking (pooled estimate: 87%, 95% CI: 85%, 88%) and alcohol intake (pooled estimate 83%, 95% CI: 81%, 86%), and the lowest was for fiber intake (pooled estimate: 31%, 95% CI: 21%, 40%). Thirteen studies were reported the proportion of cancer survivors (all used a simple summative index method) to multiple healthy behaviours, whereby the prevalence of adherence was ranged from 7% to 40% (pooled estimate 23%, 95% CI: 17% to 30%). Subgroup analysis suggest that short-term survivors ( < 5 years survival time) had relatively a better adherence to multiple behaviours (pooled estimate: 31%, 95% CI: 27%, 35%) than long-term ( > 5 years survival time) cancer survivors (pooled estimate: 25%, 95% CI: 14%, 36%). Pooling of estimates according to the year of publication (since 2007) also suggests an increasing trend of adherence to multiple behaviours over time. Conclusion: Overall, the adherence to multiple lifestyle behaviors was poor (not satisfactory), and relatively, it is a major concern for long-term than the short-term cancer survivor. Cancer survivors need to obey with healthy lifestyle recommendations related to physical activity, fruit and vegetable, fiber, red/processed meat and sodium intake.

Keywords: adherence, lifestyle behaviours, cancer survivors, WCRF/AICR

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Authors: J. Iqbal, Z. Zara

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Five new Acceptor-Donor-Acceptor (A-D-A) type small donor molecules (M1-M5) namely; dimethyl cyanoacetate terthiophene di(methylthiophene) dibenzosilole (DMCAO3TBS) (M1), dimelononitrile terthiophene di(methylthiophene) dibenzosilole (DMCNTBS) (M2), dimethyl rhodanine terthiophene di(methylthiophene) dibenzosilole (DMRTBS) (M3), dimelanonitrile terthiophene di(methylthiophene) methyl fluorene (DMCNTF) (M4) and dimethyl rhodanine terthiophene di(methylthiophene) methyl fluorine (DMRTF) (M5) were designed and theoretically explored their electronic, photophysical and geometrical properties via DFT best functional MPW1PW91/6-311G (d,p) level of theory with respect to reference molecules dioctyl cyanoacetate terthiophene di(octylthiophene) dioctylfluorene (DCAO3TF) (Ra) and dioctyl cyanoacetate terthiophene di(octylthiophene) octylcarbazole (DCAO3TCz) (Rb). Among the designed donor molecules (M1-M5), M2 and M4 represented lowest band gap value (2.480 eV and 2.47 eV) with distinctive broad absorption peak at 598 and 601 nm in chloroform due to the presence of stronger electron withdrawing acceptor molecule which pulls the λmax value towards red shift. Theoretically estimated reorganization energies of these molecules recommended excellent property of charge mobility. The designed donor molecules M1-M5, demonstrated lower λe value with reference to their λh, showing that these molecules could be ideal candidates for the transfer of electron with and M2, M4 are best among these as champion molecules with having lowest λe (0.006 D and 0.005 D respectively). Additionally, the Voc of M2 and M4 are 2.01 eV and 1.85 eV respectively with reference respect to PCBM. Thus, our present investigation suggested that our designed donor molecules (M1-M5) are suitable candidates for the solar cell and proposed for high and better performance for the small molecule based solar cell devices.

Keywords: dibenzisilol, donor materials, hole mobility, organic solar cells

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Authors: Ahmed A. Abd El Rahim, Mohamed M. M. Essa, Magdy M. A. Shabana, Said A. Mohamed, Mohamed Ibrahim Mabrouk

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Background: Sacroiliac joint (SIJ) dysfunction is considered the main cause of pregnancy-related back pain, which may continue to persist postnatally. Myofascial release technique (MFR) is an application of low-intensity, prolonged stretch to myofascial structures to improve function by increasing the sliding properties of restricted myofascial tissues. Purpose: This study was designed to investigate the effect of MFR on postnatal SIJ hypo-mobility. Materials and Methods: Fifty postnatal women complaining of SIJ hypo-mobility participated in this study. Their ages ranged from 26 to 35 yrs., and their body mass index (BMI) didn`t exceed 30 kg/m2. They were randomly assigned to two equal groups, group A (Gr. A) and group B (Gr. B). Both groups received three sessions per week for eight successive weeks. Gr. A received a traditional physical therapy program, while Gr. B received a traditional physical therapy program in addition to MFR. Doppler imaging of vibration was utilized to measure SIJ mobility pre- and post-intervention, and an electronic digital goniometer was used to measure back flexion and extension Range of motion. Results: Findings revealed a statistical improvement in post-intervention values of SIJ mobility in addition to trunk flexion and extension ROM in Gr. B compared to Gr. A (P<0.001). Conclusion: Adding MFR to traditional physical therapy programs is highly recommended in the treatment of SIJ hypo-mobility in postnatal women.

Keywords: sacroiliac hypo-mobility, sacroiliac dysfunction, myofascial release technique, traditional physical therapy, postnatal

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Authors: Abdolghani Ebrahimi, Diego Klabjan, Chenxi Ge, Daniela Ladner, Parker Stride

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In this work, we use machine learning and novel data analysis techniques to predict the one-year mortality of cirrhotic patients. Data from 2,322 patients with liver cirrhosis are collected at a single medical center. Different machine learning models are applied to predict one-year mortality. A comprehensive feature space including demographic information, comorbidity, clinical procedure and laboratory tests is being analyzed. A temporal pattern mining technic called Frequent Subgraph Mining (FSM) is being used. Model for End-stage liver disease (MELD) prediction of mortality is used as a comparator. All of our models statistically significantly outperform the MELD-score model and show an average 10% improvement of the area under the curve (AUC). The FSM technic itself does not improve the model significantly, but FSM, together with a machine learning technique called an ensemble, further improves the model performance. With the abundance of data available in healthcare through electronic health records (EHR), existing predictive models can be refined to identify and treat patients at risk for higher mortality. However, due to the sparsity of the temporal information needed by FSM, the FSM model does not yield significant improvements. To the best of our knowledge, this is the first work to apply modern machine learning algorithms and data analysis methods on predicting one-year mortality of cirrhotic patients and builds a model that predicts one-year mortality significantly more accurate than the MELD score. We have also tested the potential of FSM and provided a new perspective of the importance of clinical features.

Keywords: machine learning, liver cirrhosis, subgraph mining, supervised learning

Procedia PDF Downloads 127

Authors: Scott Cavinder

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Surgical site infections (SSI) are a known complication to any surgical procedure and are one of the most common nosocomial infections. Globally it is estimated 300 million surgical procedures take place annually, with an incidence of SSI’s estimated to be 11 of 100 surgical patients developing an infection within 30 days after surgery. The specific purpose of the project is to address the PICOT (Problem, Intervention, Comparison, Outcome, Time) question: In patients who have undergone cardiothoracic or vascular surgery (P), does implementation of a post-operative care bundle based on current EBP (I) as compared to current clinical agency practice standards (C) result in a decrease of SSI (O) over a 12-week period (T)? Synthesis of Supporting Evidence: A literature search of five databases, including citation chasing, was performed, which yielded fourteen pieces of evidence ranging from high to good quality. Four common themes were identified for the prevention of SSI’s including use and removal of surgical dressings; use of topical antibiotics and antiseptics; implementation of evidence-based care bundles, and implementation of surveillance through auditing and feedback. The Iowa Model was selected as the framework to help guide this project as it is a multiphase change process which encourages clinicians to recognize opportunities for improvement in healthcare practice. Practice/Implementation: The process for this project will include recruiting postsurgical participants who have undergone cardiovascular or thoracic surgery prior to discharge at a Northwest Indiana Hospital. The patients will receive education, verbal instruction, and return demonstration. The patients will be followed for 12 weeks, and wounds assessed utilizing the National Healthcare Safety Network//Centers for Disease Control (NHSN/CDC) assessment tool and compared to the SSI rate of 2021. Key stakeholders will include two cardiovascular surgeons, four physician assistants, two advance practice nurses, medical assistant and patients. Method of Evaluation: Chi Square analysis will be utilized to establish statistical significance and similarities between the two groups. Main Results/Outcomes: The proposed outcome is the prevention of SSIs in the post-op cardiothoracic and vascular patient. Implication/Recommendation(s): Implementation of standardized post operative care bundles in the prevention of SSI in cardiovascular and thoracic surgical patients.

Keywords: cardiovascular, evidence based practice, infection, post-operative, prevention, thoracic, surgery

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Authors: Yi-Fung Lin, Shiow-Ching Shun, Wen-Yu Hu

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Background: A skill mix model is regarded as one of the most effective methods of reducing nursing shortages, as well as easing nursing staff workloads and labor costs. Although this model shows several benefits for the health workforce, the relationship between the optimal model of skill mix and the patient mortality rate remains to be discovered. Objectives: This review aimed to explore the relationship between the skill mix model and patient mortality rate in acute care hospitals. Data Sources: A systematic search of the PubMed, Web of Science, Embase, and Cochrane Library databases and researchers retrieved studies published between January 1986 and March 2022. Review methods: Two independent reviewers screened the titles and abstracts based on selection criteria, extracted the data, and performed critical appraisals using the STROBE checklist of each included study. The studies focused on adult patients in acute care hospitals, and the skill mix model and patient mortality rate were included in the analysis. Results: Six included studies were conducted in the USA, Canada, Italy, Taiwan, and European countries (Belgium, England, Finland, Ireland, Spain, and Switzerland), including patients in medical, surgical, and intensive care units. There were both nurses and nursing assistants in their skill mix team. This main finding is that three studies (324,592 participants) show evidence of fewer mortality rates associated with hospitals with a higher percentage of registered nurse staff (range percentage of registered nurse staff 36.1%-100%), but three articles (1,122,270 participants) did not find the same result (range of percentage of registered nurse staff 46%-96%). However, based on appraisal findings, those showing a significant association all meet good quality standards, but only one-third of their counterparts. Conclusions: In light of the limited amount and quality of published research in this review, it is prudent to treat the findings with caution. Although the evidence is not insufficient certainty to draw conclusions about the relationship between nurse staffing level and patients' mortality, this review lights the direction of relevant studies in the future. The limitation of this article is the variation in skill mix models among countries and institutions, making it impossible to do a meta-analysis to compare them further.

Keywords: nurse staffing level, nursing assistants, mortality, skill mix

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Authors: Palash Kumar Mollick, Leire Olazar, Laura Santamaria, Pablo Comendador, Manomita Mollick, Gartzen Lopez, Martin Olazar

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The entire world is skeptical towards a silver line technology of converting plastic waste into valuable synthetic gas. At this junction, besides an adequately studied conventional catalytic process for steam reforming, a non-thermal plasma is being introduced. Organic volatiles are produced in the first step, pyrolysing the plastic materials. Resultant lightweight olefins and carbon monoxide are the major components that undergo a steam reforming process to achieve syngas. A non-thermal plasma consists of ionized gases and free electrons with an electronic temperature as high as 10³ K. Organic volatiles are, in general, endorganics inactive and thus demand huge bond-breaking energy. Conventional catalyst is incapable of providing the required activation energy, leading to poor thermodynamic equilibrium, whereas a non-thermal plasma can actively collide with reactants to produce a rich mix of reactive species, including vibrationally or electronically excited molecules, radicals, atoms, and ions. In addition, non-thermal plasma provides nonequilibrium conditions leading to electric discharge only in certain degrees of freedom without affecting the intrinsic chemical conditions of the participating reactants and products. In this work, we report thermodynamic and kinetic aspects of the conversion of organic volatiles into syngas using a non-thermal plasma. Detailed characteristics of plasma and its effect on the overall yield of the process will be presented.

Keywords: non thermal plasma, plasma catalysis, steam reforming, syngas, plastic waste, green energy

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Authors: Malizgani Paul Chavula

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Background: Comprehensive sexuality education (CSE) plays a critical role in promoting youth and adolescents’ sexual and reproductive health and well-being. However, little is known about the enablers and barriers affecting the integration of CSE into educational programmes. The aim of this review is to explore positive and negative factors influencing the integration of CSE into national curricula and educational systems in low- and middle-income countries. Methods: We conducted a systematic literature review (January 2010 to August 2022). The results accord with the Preferred Reporting Items for Systematic Reviews and Meta-analysis standards for systematic reviews. Data were retrieved from the PubMed, Cochrane, Google Scholar, and Web of Hinari databases. The search yielded 431 publications, of which 23 met the inclusion criteria for full-text screening. The review is guided by an established conceptual framework that incorporates the integration of health innovations into health systems. Data were analyzed using a thematic synthesis approach. Results: The magnitude of the problem is evidenced by sexual and reproductive health challenges such as high teenage pregnancies, early marriages, and sexually transmitted infections. Awareness of these challenges can facilitate the development of interventions and the implementation and integration of CSE. Reported aspects of the interventions include core CSE content, delivery methods, training materials and resources, and various teacher-training factors. Reasons for adoption include perceived benefits of CSE, experiences and characteristics of both teachers and learners, and religious, social, and cultural factors. Broad system characteristics include strengthening links between schools and health facilities, school and community-based collaboration, coordination of CSE implementation, and the monitoring and evaluation of CSE. Ultimately, the availability of resources, national policies and laws, international agendas, and political commitment will impact upon the extent and level of integration. Conclusion: Social, economic, cultural, political, legal, and financial contextual factors influence the implementation and integration of CSE into national curricula and educational systems. Stakeholder collaboration and involvement in the design and appropriateness of interventions is critical.

Keywords: comprehensive sexuality education, factors, integration, sexual reproductive health rights

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Authors: Malihe Aliasgari, Yousef Nejatbakhsh

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The era of Big Data and the immensity of real-life datasets compels computation tasks to be performed in a distributed fashion, where the data is dispersed among many servers that operate in parallel. However, massive parallelization leads to computational bottlenecks due to faulty servers and stragglers. Stragglers refer to a few slow or delay-prone processors that can bottleneck the entire computation because one has to wait for all the parallel nodes to finish. The problem of straggling processors, has been well studied in the context of distributed computing. Recently, it has been pointed out that, for the important case of linear functions, it is possible to improve over repetition strategies in terms of the tradeoff between performance and latency by carrying out linear precoding of the data prior to processing. The key idea is that, by employing suitable linear codes operating over fractions of the original data, a function may be completed as soon as enough number of processors, depending on the minimum distance of the code, have completed their operations. The problem of matrix-matrix multiplication in the presence of practically big sized of data sets faced with computational and memory related difficulties, which makes such operations are carried out using distributed computing platforms. In this work, we study the problem of distributed matrix-matrix multiplication W = XY under storage constraints, i.e., when each server is allowed to store a fixed fraction of each of the matrices X and Y, which is a fundamental building of many science and engineering fields such as machine learning, image and signal processing, wireless communication, optimization. Non-secure and secure matrix multiplication are studied. We want to study the setup, in which the identity of the matrix of interest should be kept private from the workers and then obtain the recovery threshold of the colluding model, that is, the number of workers that need to complete their task before the master server can recover the product W. The problem of secure and private distributed matrix multiplication W = XY which the matrix X is confidential, while matrix Y is selected in a private manner from a library of public matrices. We present the best currently known trade-off between communication load and recovery threshold. On the other words, we design an achievable PSGPD scheme for any arbitrary privacy level by trivially concatenating a robust PIR scheme for arbitrary colluding workers and private databases and the proposed SGPD code that provides a smaller computational complexity at the workers.

Keywords: coded distributed computation, private information retrieval, secret sharing, stragglers

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Authors: Rong Sun, Laihong Shen

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La-based perovskite oxygen carriers, especially the doped-La(M)FeO₃, showed excellent performances during chemical looping processes. However, the mechanisms of the undoped and doped La(M)FeO₃ are not clear at present, making the mechanisms clear may help the development of chemical looping technologies. In this paper, the method based on the density function theory (DFT) was used to analysis the influence of Ca, Sr, and Ba doping of La on the electronic structure, while the CO oxidation mechanisms on the surface of LaFeO₃ and Ca-doped LaFeO₃ oxygen carriers were also analyzed. The results showed that the band gap was decreased by the doping of low valence. While the doping of low valence element Ca, Sr, and Ba at La site simultaneously resulted to the moving of the valence band toward high energy and made the valence band cross the Fermi energy level. This was resulted from the holes generated by divalent ion substitution. The holes can change the total magnetization from antiferromagnet to weakly ferromagnetism. The calculation results about the formation of oxygen vacancy showed that substitutions of Ca, Sr, and Ba caused a large drop in oxygen vacancy formation energy, indicating that the bulk oxygen transport was improved. Based on the optimized bulk of the undoped and Ca-doped LaFeO₃(010) surface, the CO adsorption was analyzed. The results indicated that the adsorption energy increased by divalent ion substitution, meaning that the adsorption stability decreased. The results can provide a certain theoretical basis for the development of perovskite oxides in chemical looping technologies.

Keywords: chemical looping technologies, lanthanum ferrate (LaFeO₃), divalent ion substitution, CO oxidation

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Authors: Cristian Pauna

Abstract:

Trading the financial markets is a widespread activity today. A large number of investors, companies, public of private funds are buying and selling every day in order to make profit. Algorithmic trading is the prevalent method to make the trade decisions after the electronic trading release. The orders are sent almost instantly by computers using mathematical models. This paper will present a price prediction methodology based on a multi-dimensional neural network. Using the Fisher transform, the neural network will be instructed for a low-latency auto-adaptive process in order to predict the price evolution for the next period of time. The model is designed especially for algorithmic trading and uses the real-time price series. It was found that the characteristics of the Fisher function applied at the nodes scale level can generate reliable trading signals using the neural network methodology. After real time tests it was found that this method can be applied in any timeframe to trade the financial markets. The paper will also include the steps to implement the presented methodology into an automated trading system. Real trading results will be displayed and analyzed in order to qualify the model. As conclusion, the compared results will reveal that the neural network methodology applied together with the Fisher transform at the nodes level can generate a good price prediction and can build reliable trading signals for algorithmic trading.

Keywords: algorithmic trading, automated trading systems, financial markets, high-frequency trading, neural network

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Authors: Francisco Pedroza-Montero, Jesús Naín Pedroza-Montero, Diego Soto-Puebla, Osiris Alvarez-Bajo, Beatriz Castaneda, Sofía Navarro-Espinoza, Martín Pedroza-Montero

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Nanodiamonds have been widely studied for their physical properties, including chemical inertness, biocompatibility, optical transparency from the ultraviolet to the infrared region, high thermal conductivity, and mechanical strength. In this work, we studied how the fluorescence spectrum of nanodiamonds quenches concerning the concentration in aqueous solutions systematically ranging from 0.1 to 10 mg/mL. Our results demonstrated a non-linear fluorescence quenching as the concentration increases for both of the NV zero-phonon lines; the 5 mg/mL concentration shows the maximum fluorescence emission. Furthermore, this behaviour is theoretically explained as an electronic recombination process that modulates the intensity in the NV centres. Finally, to gain more insight, the FRET methodology is used to determine the fluorescence efficiency in terms of the fluorophores' separation distance. Thus, the concentration level is simulated as follows, a small distance between nanodiamonds would be considered a highly concentrated system, whereas a large distance would mean a low concentrated one. Although the 5 mg/mL concentration shows the maximum intensity, our main interest is focused on the concentration of 0.5 mg/mL, which our studies demonstrate the optimal human cell viability (99%). In this respect, this concentration has the feature of being as biocompatible as water giving the possibility to internalize it in cells without harming the living media. To this end, not only can we track nanodiamonds on the surface or inside the cell with excellent precision due to their fluorescent intensity, but also, we can perform thermometry tests transforming a fluorescence contrast image into a temperature contrast image.

Keywords: nanodiamonds, fluorescence spectroscopy, concentration, bioimaging, thermometry

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Authors: Saeid Mehvari, Yolanda Sanchez-Vicente, Sergio González Sánchez, Khalid Lafdi

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Abstract- Materials with a combination of transparency, electrical conductivity, and flexibility are required in the ‎growing electronic sector. In this research, electrically conductive and flexible films have been prepared. These ‎composite films consist of dispersing micro-copper particles into polyurethane (PU) matrix. Two sets of samples were ‎made using both spin coating technique (sample thickness lower than 30 μm) and materials casting (sample thickness ‎lower than 100 μm). Copper concentrations in the PU matrix varied from 0.5 to 20% by volume. The dispersion of ‎micro-copper particles into polyurethane (PU) matrix were characterised using optical microscope and scanning electron ‎microscope. The electrical conductivity measurement was carried out using home-made multimeter set up under ‎pressures from 1 to 20 kPa through thickness and in plane direction. It seems that samples made by casting were not ‎conductive. However, the sample made by spin coating shows through-thickness conductivity when they are under ‎pressure. The results showed that spin-coated films with higher concentration of 2 vol. % of copper displayed a ‎significant increase in the conductivity value, known as percolation threshold. The maximum conductivity of 7.2 × 10-1 ‎S∙m-1 was reached at concentrations of filler with 20 vol. % at 20kPa. A semi-empirical model with adjustable ‎coefficients was used to fit and predict the electrical behaviour of composites. For the first time, the finite element ‎method based on the representative volume element (FE-RVE) was successfully used to predict their electrical ‎behaviour under applied pressures. ‎

Keywords: electrical conductivity, micro copper, numerical simulation, percolation threshold, polyurethane, RVE model

Procedia PDF Downloads 181

Authors: Debananda Mohapatra, Subramanya Badrayyana, Smrutiranjan Parida

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Recognizing the upcoming era of carbon nanostructures and their revolutionary applications, we investigated the formation and supercapacitor application of highly pure and hydrophilic carbon nano-onions (CNOs) by economical one-step flame-synthesis procedure. The facile and scalable method uses easily available organic carbon source such as clarified butter, restricting the use of any catalyst, sophisticated instrumentation, high vacuum and post processing purification procedure. The active material was conformally coated onto a locally available cotton wipe by “sonicating and drying” process to obtain novel, lightweight, inexpensive, flexible, binder-free electrodes with strong adhesion between nanoparticles and porous wipe. This interesting electrode with CNO as the active material delivers a specific capacitance of 102.16 F/g, the energy density of 14.18 Wh/kg and power density of 2448 W/kg which are the highest values reported so far in symmetrical two electrode cell configuration with 1M Na2SO4 as an electrolyte. Incorporation of CuO nanoparticles to these functionalized CNOs by one-step hydrothermal method add up to a significant specific capacitance of 420 F/g with deliverable energy and power density at 58.33 Wh/kg and 4228 W/kg, respectively. The free standing CNOs, as well as CNO-CuO composite electrode, showed an excellent cyclic performance and stability retaining 95 and 90% initial capacitance even after 5000 charge-discharge cycles at a current density of 5 A/g. This work presents a new platform for high performance supercapacitors for next generation wearable electronic devices.

Keywords: binder-free, flame synthesis, flexible, carbon nano-onion

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Authors: Kamran Dastafkan, Chuan Zhao

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Improving surface chemistry is a promising approach in addition to the rational alteration in the catalyst composition to advance water electrolysis. Here, we demonstrate an evident enhancement of oxygen evolution on an iron-nickel vanadate catalyst synthesized by a facile successive ionic adsorption and reaction method. The vanadate-modified catalyst demonstrates a highly efficient oxygen evolution in 1 M KOH by requiring low overpotentials of 274 and 310 mV for delivering large current densities of 100 and 400 mA cm⁻², respectively where vigorous gas bubble evolution occurs. Vanadate modification augments the OER activity from three aspects. (i) Both the electrochemical surface area (47.1 cm²) and intrinsic activity (318 mV to deliver 10 mA cm⁻² per unit ECSA) of the catalytic sites are improved. (ii) The amorphous and roughened nanoparticle-comprised catalyst film exhibits a high surface wettability and a low-gas bubble-adhesion, which is beneficial for the accelerated mass transport and gas bubble dissipation at large current densities. The gas bubble dissipation behavior is studied by operando dynamic specific resistance measurements where a significant change in the variation of the interfacial resistance during the OER is detected for the vanadate-modified catalyst. (iii) The introduced vanadate poly-oxo-anions with high charge density have electronic interplay with Fe and Ni catalytic centers. Raman study reveals the structural evolution of β-NiOOH and γ-FeOOH phases during the OER through the vanadate-active site synergistic interactions. Achievement of a high catalytic turnover of 0.12 s⁻¹ put the developed FeNi vanadate among the best recent catalysts for water oxidation.

Keywords: gas bubble dissipation, iron-nickel vanadate, low-gas bubble-adhesion catalyst, oxygen evolution reaction

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Authors: Nashed Atef Nashed Farag

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Introduction: Reporting adverse events following vaccination remains a challenge. WHO has mandated pharmacovigilance centers around the world to submit Adverse Events Following Immunization (AEFI) reports from different countries to a large electronic database of adverse drug event data called Vigibase. Despite sufficient information about AEFIs on Vigibase, they are not available to the general public. However, the WHO has an alternative website called VigiAccess, an open-access website that serves as an archive for reported adverse reactions and AEFIs. The aim of the study was to establish a reporting model for a number of commonly used vaccines in the VigiAccess system. Methods: On February 5, 2018, VigiAccess comprehensively searched for ESSI reports on the measles vaccine, oral polio vaccine (OPV), yellow fever vaccine, pneumococcal vaccine, rotavirus vaccine, meningococcal vaccine, tetanus vaccine, and tuberculosis vaccine (BCG). These are reports from all pharmacovigilance centers around the world since they joined the WHO Drug Monitoring Program. Results: After an extensive search, VigiAccess found 9,062 AEFIs from the measles vaccine, 185,829 AEFIs from the OPV vaccine, 24,577 AEFIs from the yellow fever vaccine, 317,208 AEFIs from the pneumococcal vaccine, 73,513 AEFIs from the rotavirus vaccine, and 145,447 AEFIs from meningococcal cal vaccine, 22,781 EI FI vaccines against tetanus and 35,556 BCG vaccines against AEFI. Conclusion: The study found that among the eight vaccines examined, pneumococcal vaccines were associated with the highest number of AEFIs, while measles vaccines were associated with the fewest AEFIs.

Keywords: surgical approach, anatomical approach, decompression, axillary nerve, quadrangular space adverse events following immunization, cameroon, COVID-19 vaccines, nOPV, ODK vaccines, adverse reactions, VigiAccess, adverse event reporting

Procedia PDF Downloads 53

Authors: Perpetual Onyejelem, Kenichi Matsui

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Solid waste management is one essential area for urban administration to achieve environmental sustainability. Proper solid waste management (SWM) improves the environment by reducing diseases and increasing public health. On the other way, improper SWM practices negatively impact public health and environmental sustainability. This article evaluates SWM in Port Harcourt, Nigeria, with the goal of determining the current solid waste management practices and their health implications. This study used secondary data, which relies on existing published literature and official documents. The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement and its four-stage inclusion/exclusion criteria were utilized as part of a systematic literature review technique to locate the literature that concerns SWM practices and the implementation of solid waste management policies between 2014-2023 in PortHarcourt and its health effects from specific databases (Scopus and Google Scholar). The results found that despite the existence and implementation of the Rivers State Waste Management Policy and the formulation of the National Policy on Solid Waste Management in Port Harcourt, residents continued to dump waste in drainages. They were unaware of waste sorting and dumped waste haphazardly. This trend has persisted due to a lack of political commitment to the effective implementation and monitoring of policies and strategies and a lack of training provided to waste collectors regarding the SWM approach, which involves sorting and separating waste. In addition, inadequate remuneration for waste collectors, the absence of community participation in policy formulation, and insufficient awareness among residents regarding the 3R approach are also contributory factors. This caused the emergence of vector-borne diseases such as malaria, lassa fever, and cholera in Port Harcourt, increasing the expense of healthcare for locals, particularly low-income households. The study urges the government to prioritize protecting the health of its citizens by studying the methods other nations have taken to address the problem of solid waste management and adopting those that work best for their region. The bottom-up strategy should be used to include locals in developing solutions. However, citizens who are always the most impacted by this issue should launch initiatives to address it and put pressure on the government to assist them when they have limitations.

Keywords: health effects, solid waste management practices, environmental pollution, Port-Harcourt

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Authors: Abdalla Mansour, Dan Brown, Adel Helmy, Rikin Trivedi, Mathew Guilfoyle

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Introduction: Diagnosing delayed cerebral ischaemia (DCI) following aneurysmal subarachnoid haemorrhage (SAH) can be challenging, particularly in poor-grade patients. Objectives: This study sought to assess the value of routine CTP in identifying (or excluding) DCI and in guiding management. Methods: Eight-year retrospective neuroimaging study at a large UK neurosurgical centre. Subjects included a random sample of adult patients with confirmed aneurysmal SAH that had a CTP scan during their inpatient stay, over a 8-year period (May 2014 - May 2022). Data collected through electronic patient record and PACS. Variables included age, WFNS scale, aneurysm site, treatment, the timing of CTP, radiologist report, and DCI management. Results: Over eight years, 916 patients were treated for aneurysmal SAH; this study focused on 466 patients that were randomly selected. Of this sample, 181 (38.84%) had one or more CTP scans following brain aneurysm treatment (Total 318). The first CTP scan in each patient was performed at 1-20 days following ictus (median 4 days). There was radiological evidence of DCI in 83, and no reversible ischaemia was found in 80. Findings were equivocal in the remaining 18. Of the 103 patients treated with clipping, 49 had DCI radiological evidence, in comparison to 31 of 69 patients treated with endovascular embolization. The remaining 9 patients are either unsecured aneurysms or non-aneurysmal SAH. Of the patients with radiological evidence of DCI, 65 had a treatment change following the CTP directed at improving cerebral perfusion. In contrast, treatment was not changed for (61) patients without radiological evidence of DCI. Conclusion: CTP is a useful adjunct to clinical assessment in the diagnosis of DCI and is helpful in identifying patients that may benefit from intensive therapy and those in whom it is unlikely to be effective.

Keywords: SAH, vasospasm, aneurysm, delayed cerebral ischemia

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Authors: Tzu-Hao Li, Yen-Ying Kung, Chang-Youh Tsai

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Oral dryness is a common chief complaint among patients with Sjőgren syndrome (SS), which is a disorder currently known as autoantibodies production; however, to author’s best knowledge, there has been no satisfying pharmacy to relieve the associated symptoms. Hence the effectiveness of other non-pharmacological interventions such as acupuncture should be accessed. We conducted a meta-analysis of randomized clinical trials (RCTs) which evaluated the effectiveness of xerostomia in SS. PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Chongqing Weipu Database (CQVIP), China Academic Journals Full-text Database, AiritiLibrary, Chinese Electronic Periodicals Service (CEPS), China National Knowledge Infrastructure (CNKI) Database were searches through May 12, 2018 to select studies. Data for evaluation of subjective and objective xerostomia was extracted and was assessed with random-effects meta-analysis. After searching, a total of 541 references were yielded and five RCTs were included, covering 340 patients dry mouth resulted from SS, among whom 169 patients received acupuncture and 171 patients were control group. Acupuncture group was associated with higher subjective response rate (odds ratio 3.036, 95% confidence interval [CI] 1.828 – 5.042, P < 0.001) and increased salivary flow rate (weighted mean difference [WMD] 3.066, 95% CI 2.969 – 3.164, P < 0.001), as an objective marker. In addition, two studies examined IgG levels, which were lower in the acupuncture group (WMD -166.857, 95% CI -233.138 - -100.576, P < 0.001). Therefore, in the present meta-analysis, acupuncture improves both subjective and objective markers of dry mouth with autoantibodies reduction in patients with SS and is considered as an option of non-pharmacological treatment for SS.

Keywords: acupuncture, meta-analysis, Sjogren syndrome, xerostomia

Procedia PDF Downloads 111

Authors: Hassan Bohra, Mingfeng Wang

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Conjugated porous polymers (CPPs) are amorphous, insoluble and highly robust organic semiconductors that have been largely synthesized by traditional transition-metal catalyzed reactions. The distinguishing feature of CPP materials is that they combine microporosity and high surface areas with extended conjugation, making them ideal for versatile applications such as separation, catalysis and energy storage. By applying a modular approach to synthesis, chemical and electronic properties of CPPs can be tailored for specific applications making these materials economical alternatives to inorganic semiconductors. Direct arylation - an environmentally benign alternative to traditional polymerization reactions – is one such reaction that extensively over the last decade for the synthesis of linear p-conjugated polymers. In this report, we present the synthesis and characterization of a new series of robust conjugated porous polymers synthesized by facile direct arylation polymerization of thiophene-flanked acceptor building blocks with multi-brominated aryls with different geometries. We observed that the porosities and morphologies of the polymers are determined by the chemical structure of the aryl bromide used. Moreover, good control of the optical bandgap in the range 2.53 - 1.3 eV could be obtained by using different building blocks. Structure-property relationships demonstrated in this study suggest that direct arylation polymerization is an attractive synthetic tool for the rational design of porous organic materials with tunable photo-physical properties for applications in photocatalysis, energy storage and conversion.

Keywords: direct arylation, conjugated porous polymers, triazine, photocatalysis

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Authors: Raad Nari, Maura Moriaty, Maha T. Barakat

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Introduction: Sodium-glucose co-transporter-2 (SGLT2) inhibitors are a new class of oral anti-diabetic drugs with a unique mechanism of action. They are used to improve glycaemic control in adults with type 2 diabetes by enhancing urinary glucose excretion. In the UAE, there has been certainly an increased use of these medications. As with any new medication, there are safety considerations related to their use in patients with type two diabetes. A retrospective study was conducted at the three main centres of the Imperial College London Diabetes Centre. Methodology: All patients in electronic database (Diamond) from October 2014 to October 2017 were included with a minimum of six months usage of sodium glucose co-transporter inhibitors that comprise canagliflozin, dapagliflozin and empagliflozin. There were 15 paired sample biochemical and clinical correlations. The analysis was done at the start of the study, three months and six months apart. SPSS version 24 was used for this study. Conclusion: This study of sodium glucose co-transporter-2 inhibitors used showed significant reductions in weight, glycated haemoglobin A1C, systolic and diastolic blood pressures. As the case with systematic reviews, there were similar changes in liver enzymes, raised total cholesterol, low density lipopoptein and high density lipoprotein. There was slight improvement in estimated glomerular filtration rate too. Our analysis also showed that they increased in the incidence of urinary tract symptoms and incidence of urinary tract infections.

Keywords: SGLT2 inhibitors dapagliflozin empagliflozin canagliflozin, adverse effects, amputation diabetic ketoacidosis DKA, urinary tract infection

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