bluuebunny/crossref_metadata_2025 huggingface dataset:
Radiation-hygienic situation in the area of sublimate production waste storage of JSC “AECC”
Authors: Zozul Yu. N. , Kiselev S. M. , Shlygin V. V. , Akhromeev S. V. , Malakhova A. N. , Gimadova T. I. , Belskikh Yu. S. , Archakova Yu. V. , Galitskaya L. N.
Published: April 2024

In accordance with the fundamentals of state policy in the field of ensuring nuclear and radiation safety, State Corporation «Rosatom» carries out the remediation of JSC “AECC” nuclear legacy sites. The article presents the results of environmental impact assessment carried out in 2021-2023 in the vicinity of sublimation waste storage facilities that are being decommissioned. Health physics studies involved ambient dose rate measurements, sampling (soil, groundwater) and analysis of radiological and non radiological environmental pollutants. The external gamma dose rate, as well as content of natural and artificial radionuclides in soil, don’t exceed background levels. While uranium presence in groundwater is found to be 10 times and higher then background level. The data obtained indicate that the accumulated wastes of sludge sumps (bottom sediments, pulp) сome into contact with natural water. Flooded storage facilities form a plume of contamination spreading out in the direction of groundwater flow. Given the current situation optimization of the existing environmental monitoring programs in the JSC “AECC” health protection zone is recommended and reference levels of uranium proposed.
Current status of reference location in the basic model for assessment of external radiation doses to the population living in radioactively contaminated areas after the Chernobyl accident
Authors: Barkovsky A. N. , Ramzaev V. P.
Published: April 2024

An open plot of virgin land is the reference location in the basic model used to date to estimate the effective dose of external exposure to the population living in a radioactively contaminated area. As our field observations in the Bryansk region of Russia have shown, at present it is very difficult to find truly reference plots of virgin land due to the fact that many virgin meadows were plowed or reclaimed for more than 30 years after the Chernobyl accident. Without special instrumental survey, such disturbed meadow areas can easily be confused with areas of virgin soil. Therefore, the situation with the use of open areas of virgin soil as the reference location has changed dramatically since the first years after the Chernobyl accident. It requires a change in the approach to choosing such a location for the model and/or some revision of the structure of the model itself. Firstly, we propose and justify the use of a permanently cultivated kitchengarden plot as the reference location. The second way to resolve the current difficult situation with the presence of a sufficient number of the virgin soil sites could be excluding the very concept of “reference location” from the model. In this case, when calculating the effective dose of external radiation, it is proposed to directly use the values of the gamma radiation dose rate in the air normalized to the 137Cs contamination density of soil. The values of the normalized dose rate should be experimentally determined in the required time period for each of the locations taken into account in the model.
Experience of using the portable gamma spectrometer MKS AT6101D for in situ measurements of the density of 137Cs soil contamination in the Bryansk region of Russia
Authors: Ramzaev V. P. , Barkovsky A. N.
Published: April 2024

We have tested applicability of the commercially available portable spectrometer-dosimeter MKS AT6101D (the manufacturer: ATOMTEX, Belarus) to measure the density of 137Cs soil contamination (inventory of 137Cs in soil) in situ. The study was performed in 2015–2020 at the territories of the Bryansk region of Russia contaminated due to the Chernobyl accident. The in situ measurements were performed in the 17 ground plots (7 grasslands and 10 kitchengargens) for which the 137Cs inventory and the mean migration depth of the radionuclide in soil was available from laboratory (ex situ) measurements of soil samples. It was found that the in situ data obtained with the method that was provided by the manufacturer of the instrument required additional correction on the vertical distribution of 137Cs in the soil. The correction procedure was developed; in 2020–2021, it has been successfully tested in 114 kitchengarden plots located at the settlements in the zones of radioactive contamination in the Bryansk region.
Fatores sociodemográficos e de saúde associados ao risco de sarcopenia, medo de cair e nível de atividade física de idosos
Authors: Nogueira Greicequerli , Do Nascimento Júnior José Roberto Andrade , Fidelix Yara Lucy , De Oliveira Daniel Vicentini
Published: April 2024

Objetivo: analisar os fatores sociodemográficos e de saúde associados ao indicativo de sarcopenia, medo de cair e nível de atividade física de idosos da região sul e sudeste do Brasil. Métodos: estudo transversal realizado com 116 idosos. Foi utilizado um questionário com questões sociodemográficas e de saúde, o Questionário Internacional de Atividade Física, a Escala de Eficácia de Quedas e o SARC-f. A análise dos dados foi realizada por meio do teste Qui-quadrado de Pearson (p<0,05). Resultados: percebe-se maior frequência de idosos com ausência de risco de sarcopenia, sem medo de cair e fisicamente ativos na faixa etária de 60 a 70 anos, renda mensal acima de três salários-mínimos, com percepção de saúde boa e que se percebem com saúde melhor do que idosos da mesma idade (p<0,05). Conclusão: conclui-se que alguns fatores sociodemográficos, como a idade mais joven e maior renda, e fatores de saúde, como a melhor percepção de saúde, estão associados ao risco de sarcopenia, medo de cair e ao nível de atividade física de idosos.
Conjunctive management of groundwater and surface water resources using a hybrid simulation–optimization method
Authors: Hashemi Seyed Abolfazl , Robati Amir , Momeni Raghabadi Mehdi , Kazerooni Sadi Mohammadali
Published: April 2024

This study aimed to determine the optimal conjunctive utilization of groundwater and surface water resources in the Halil River basin, one of the most significant study regions in Kerman Province (Iran). Multi-verse optimizer (MVO) and the ANFIS (adaptive neuro-fuzzy inference systems) simulation model, known as the MVO–ANFIS simulation–optimization model, were used for this purpose. Moreover, the optimal exploitation policy for the studied basin was presented. The ANFIS model yielded a coefficient of determination greater than 0.99 in Baft, Rabor, and Jiroft. This model had a high capability to simulate groundwater levels in these three regions. Therefore, the ANFIS model was adopted as the simulation model to predict the aquifer water table in these regions. Regarding the conjunctive utilization of groundwater and surface water resources, the exploitation policy resulting from the MVO–ANFIS simulation–optimization model had a desirable performance by supplying 91.70, 87.75, and 97.58% of the total demands of Baft, Rabor, and Jiroft, respectively. Moreover, results of water system performance indicators, including reliability (82.96, 72.65, 95.07), resiliency (70, 53.47, 80), vulnerability (29.54, 25.64, 17.02), and sustainability (74.24%, 66.10%, 85.78%) in the mentioned regions, respectively, showed the appropriate performance of the proposed model for the simulation–optimization problem.
Effects of climate variability and/or land use dynamics on the hydrological balance of the Cavally river catchment at Toulepleu, West Africa
Authors: Yao Blé Anouma Fhorest , Soro Gneneyougo Emile , Larbi Isaac , Limantol Andrew Manoba , Goula Bi Tié Albert
Published: April 2024

The study focuses on assessing the individual and combined impacts of climate variability and land use change on hydrological responses. The results indicate that the basin, urban area, cropland, degraded forest, and open forest shows an increasing trend, while gallery forest shows a decreasing trend over the period 1992–2015. Climatic variability is marked by two climatic periods (a wet one from 1980 to 1996 and a dry one from 1997 to 2016) with a 35% decrease in rainfall. Regardless of the state of the landcover used, the simulated mean annual runoff decreases by 67.92% between the wet and dry climate periods. Changes in land use between 1992 and 2015 reduce mean annual runoff by 4.71%. Analysis of the joint effect of climatic and LU variation shows a 68.96% reduction in runoff. In this catchment. The joint impact has a clearly greater effect on runoff than the climatic impact, which is greater than that of human activities. There is a need for policymakers to prioritise sustainable land use practices and integrated water resource management strategies in the area to mitigate the combined effects of climate variability and anthropogenic activities, ensuring the long-term resilience of the ecosystem and water availability for local communities.
Impacts of land use/land cover on water quality: a contemporary review for researchers and policymakers
Authors: Locke Kent Anson
Published: April 2024

Few factors are as important in determining water quality as land use/land cover (LULC). Many land use activities, including agriculture, urban development, mining, and commercial forestry, tend to be sources of diffuse pollution. By contrast, indigenous vegetation can act as a sink, thus providing some protection from diffuse anthropogenic contamination. Notwithstanding the large body of research demonstrating these facts, decision-makers require clear and accessible information to assist them in developing effective management plans that are fully cognisant of the manifold impacts of LULC on water resources. Reviewing the available literature, this article, therefore, offers a critical overview of the typical impacts of LULC on water quality. An important strategy for managing water quality highlighted in this article is the maintenance of a sufficient amount of unfragmented natural vegetation, not only within riparian zones but also across catchment areas. However, knowledge gaps identified in this review indicate that further context-specific research is required to determine not only the types and minimum amount of vegetative cover required to protect water resources from diffuse pollution but also the potential impact of landscape fragmentation on the ability of natural vegetation to protect water resources. A critical discussion of these factors is therefore provided.
Will the European Regulation for water reuse for agricultural irrigation foster this practice in the European Union?
Authors: McLennan Cameron , Rudi Gabrielle , Altchenko Yvan , Ait-Mouheb Nassim
Published: April 2024

The development of the water reuse sector within the European Union (EU) varies considerably. In 2020, Portugal, Spain, Italy, Greece, France and Cyprus had the most comprehensive regulations for the reuse of reclaimed water for agriculture. The approval of a common regulation by the EU Parliament and the Council in May 2020 (which came into effect in June 2023) elicits the question of how each country will comply with it. This review compares (i) national regulations to the 2020 European Regulation, (ii) existing projects with respect to their performance in terms of water quality and (iii) raises a debate about the role of the EU Regulation in fostering water reuse at the EU level. The European Regulation will probably strengthen consumer confidence as common minimum requirements are now required. However, the issues related to micropollutants, disinfection by-products or possible changes in the water quality downstream of the compliance point are not fully considered by the EU Regulation. Moreover, other techno-economic obstacles to be overcome include the distance between the production of treated water and agricultural needs, the low economic competitiveness of reclaimed water and the implementation of the multi-barrier approach.
Mitigation of tunnel support design risks for hydropower projects within high tectonic stress regimes – an empirical analysis
Authors: Hameed Aamir , Soomro Mairaj , Huang Yaoying , Akram Mian Sohail , Sanaullah Muhammad , Ahmed Luqman , Khan Muhammad Jehangir
Published: April 2024

The study for the design of tunnels in similar geological settings, providing insights into potential challenges that may arise during excavation and offering strategies for mitigating risks in District Kalam on the Ushu River, Khyber Pakhtunkhwa, Pakistan. The methodology involved geological mapping, rock sampling, discontinuity surveys, and laboratory testing for empirical analysis of tunnel parameters at the Weir House, Powerhouse, and tunnel alignment locations. Empirical analysis of tunnel parameters using three rock classification systems, rock mass rating (RMR), rock quality tunneling index, and rock mass index (RMi). Based on the classification, the rock quality was found to be fair, indicating favorable rock properties. The Q-system rated the rock as poor to fair, suggesting low discontinuity intensity, medium rock strength, or medium deformation modulus. According to the RMi, rock was rated as medium to strong, indicating low discontinuity intensity, high rock strength, or low deformability. The support design for the tunnel is based on empirical analysis, it recommends support design for the tunnel reinforcement elements such as rock bolts, wire mesh, and shotcrete lining. Overall, the tunnel is stable and does not have complex structure and weak zones.
Demarcation of groundwater potential zones in Ponnai sub-basin, Southern India using remote sensing, GIS and fuzzy-AHP approaches
Authors: Loganathan Sankar , Sathiyamoorthy Mahenthiran
Published: April 2024

Groundwater is an essential source for household, irrigation and industry needs. The amount of groundwater and its quality are rapidly declining because of urbanization and industrialization. Groundwater resources in hard rock regions should be handled properly to maximize their utilization. This work aims to demarcate the Groundwater Potential Zones (GWPZ) in a part of the Palar River Basin (Ponnai sub-basin) by combining Remote Sensing (RS), Geographic Information System (GIS) and Fuzzy-Analytical Hierarchy Process (FAHP). The factors which influence the groundwater like geology, land use/land cover (LULC), geomorphology, slope, soil, rainfall, lineament density (LD), drainage density (DD), normalized difference vegetation index (NDVI), topographic wetness index (TWI) and topographic position index (TPI) are considered for mapping of GWPZ. The weightage is allocated to these parameters on the basis of the FAHP technique and the obtained groundwater potential map was classified as, very poor (13.5%), poor (21.76%), moderate (31.5%), good (20.66%) and very good (8.54%). The GWPZ map was validated with the actual well yield of the Ponnai sub-basin. The research work will serve as a guideline for the effective use of groundwater and long-term sustainable management of the aquifer in the Ponnai sub-basin.
Remdesivir: A Quick Review of Pharmacotherapy
Authors: Tolou-Ghamari Zahra
Published: April 2024

Background::

In the year 2009, Remdesivir or Veklury was discovered by Gilead Sciences for the management of hepatitis C, Ebola and Marburg virus disease
through injection into a vein and then a few years later, 22nd Oct 2020 (United States), the drug was recommended for the management of
COVID-19 under a provisional guideline.

Objective::

The aim of this systematic review was to address pharmacotherapy approaches associated with the efficacy and side effects of remdesivir for the
treatment of viral infections.

Methods::

This is a focused, in-depth consequent guide approach and literature search, with a methodical assessment associated with the terms “Remdesivir,”
“ Remdesivir Bioavailability,” “Remdesivir and Disease,” “ Remdesivir and COVID-19” that was done through Pubmed, Scopus, and Web of
Science from their inception to 2023.

Results::

105 studies included in silico, in-vivo, and in-vitro experiments to test remdesivir therapeutic efficacy were selected based on the current,
knowledgeable, and high-quality topics of manuscripts. Regarding efficacy, in addition to COVID-19, remdesivir shows therapeutic efficacy in
other virus infections, such as hepatitis C, Ebola, and Marburg. In patients with COVID-19, remdesivir shortens the time to recovery, lowering
progression to mechanical ventilation and decreasing hospital resources. Combination with dexamethasone in selected patients who need minimal
conventional oxygen but are at high risk of severe COVID-19 was reported beneficial. Combination with chloroquine or hydroxychloroquine may
cause a decrease in the antiviral activity of remdesivir, but dexamatason reported minimal or no reduction in drug exposure. However, synergistic
effects were reported in combination with favipiravir, but methotrexate toxicity needs to be evaluated. Significant improvement in 'patients'
conditions was reported in combination with methylprednisolone pulse therapy. Infusion-related reactions such as nausea, elevated liver enzymes,
sweating, and hypotension are the most common side effects.

Conclusion::

Different studies showed that with remdesivir pharmacotherapy, in addition to significant improvement in the recovery rate in those with
COVID-19, the risk of adverse effects was significantly lower than in the control groups. To verify efficacy and side effects, besides attentive
consideration of kidney and liver function, further evidence-based pharmacotherapy studies of remdesivir seem advantageous.
Expression and Purification of His-Tagged Variants of Human Hepatitis A
Virus 3C Protease
Authors: Karaseva Maria A. , Gramma Vladislav A. , Safina Dina R. , Lunina Natalia A. , Komissarov Alexey A. , Kostrov Sergey V. , Demidyuk Ilya V.
Published: April 2024

Background:

Protease 3C (3Cpro) is the only protease encoded in the human hepatitis
A virus genome and is considered as a potential target for antiviral drugs due to its critical role in
the viral life cycle. Additionally, 3Cpro has been identified as a potent inducer of ferroptosis, a
newly described type of cell death. Therefore, studying the molecular mechanism of 3Cpro functioning
can provide new insights into viral-host interaction and the biological role of ferroptosis.
However, such studies require a reliable technique for producing the functionally active recombinant
enzyme.

Objective:

Here, we expressed different modified forms of 3Cpro with a hexahistidine tag on the
N- or C-terminus to investigate the applicability of Immobilized Metal Ion Affinity Chromatography
(IMAC) for producing 3Cpro.

Methods:

We expressed the proteins in Escherichia coli and purified them using IMAC, followed
by gel permeation chromatography. The enzymatic activity of the produced proteins was assayed
using a specific chromogenic substrate.

Results:

Our findings showed that the introduction and position of the hexahistidine tag did not affect
the activity of the enzyme. However, the yield of the target protein was highest for the variant
with seven C-terminal residues replaced by a hexahistidine sequence.

Conclusion:

We demonstrated the applicability of our approach for producing recombinant, enzymatically
active 3Cpro.
Construction of GPC3-modified Lipopolymer SiRNA Delivery System
Authors: Sun Dandan , Li Xiaoyu , Liu Yaru , Quan Jishan , Jin Guangyu
Published: April 2024

Background:

Gene therapy has been widely concerned because of its unique therapeutic mechanism.
However, due to the lack of safe and effective carries, it has not been widely used in clinical practice.
Glypican 3 (GPC3) is a highly specific proteoglycan for hepatocellular carcinoma and is a potential diagnostic
and therapeutic target for hepatocellular carcinoma. Herein, to monitor the effect of gene therapy and enhance
the transfection efficiency of gene carriers, GPC3-modified lipid polyethyleneimine-modified superparamagnetic
nanoparticle (GLPS), a type of visualized carrier for siRNA (small-interfering RNA) targeting the liver,
was prepared.

Methods:

We performed in vitro gene silencing, cytotoxicity, and agarose gel electrophoresis to identify the
optimal GLPS formulation. In vitro MRI and Prussian blue staining verified the liver-targeting function of
GLPS. We also analyzed the biocompatibility of GLPS by co-culturing with rabbit red blood cells. Morphological
changes were evaluated using HE staining.

Results:

The GLPS optimal formulation consisted of LPS and siRNA at a mass ratio of 25:1 and LPS and
DSPE-PEG-GPC3 at a molar ratio of 2:3. GLPS exhibited evident liver-targeting function. In vitro, we did not
observe morphological changes in red blood cells or hemolysis after co-culture. In vivo, routine blood analysis
revealed no abnormalities after GLPS injection. Moreover, the tissue morphology of the kidney, spleen, and
liver was normal without injury or inflammation.

Conclusion:

GLPS could potentially serve as an effective carrier for liver-targeted MRI monitoring and siRNA
delivery.
COVID-19 Study: A New Principle Discovery
Authors: Lu Da-Yong , Lu Ting-Ren
Published: April 2024

The impact and burden of coronavirus outbreak (COVID-19, SARS-CoV-2) still exists
worldwide. Different knowledge, opinions, and techniques determine the various outcomes and potency
of preventive and therapeutic strategies. COVID-19 infections, long COVID, and the complexity
of treatment variability are challenging issues for therapeutic promotion and cost-effective consideration.
To speed up global efforts against COVID-19, clinical diagnosis, therapeutic selections,
and drug combination studies should be optimized in different ways. The epidemic condition, vaccination,
techniques, and therapeutic options are open to new expeditions. To target infectious and
therapeutic variability, biomedical mechanisms and pathways should be understood. Facilitating and
enhancing new global machinery and roadmap against viral-induced social damages and potential
epidemics should be established for biological and pharmaceutical purposes. Thus, in this study, the
ways of medical translation for COVID-19 treatment are discussed.
Vigilance Needed in Treating a Child with Disseminated TB: A Case Report
Authors: Velmurugan Hemasri , Neelambaram Krishnapriya , Gurunthalingam Meenalotchini Prakash , Chouhan Dushyant , Thangaraju Pugazhenthan , Keshari Kar Bikram , Gaikwad Nitin Rewaram
Published: April 2024

Background:

Tuberculosis is still one of the biggest causes of infection-related death around the world. Disseminated tuberculosis is a potentially fatal disease caused by the haematogenous spread of Mycobacterium tuberculosis. First-line anti-tuberculosis drugs in-clude isoniazid, rifampicin, pyrazinamide, and ethambutol. The first three drugs are known to cause hepatotoxicity.

Case Presentation:

We have, herein, reported a case of Drug-induced Liver Injury (DILI) due to anti-tuberculosis therapy in a one-year-old male child with disseminated tuberculosis. He was started on a fixed-dose combination of Anti-tuberculosis Therapy (ATT; isoniazid 50 mg, rifampicin 75 mg, and pyrazinamide 150 mg) and pyridoxine 10 mg orally. Initially, liver pa-rameters were normal, but later on with the course of the treatment, there was a rapid rise in liver enzymes, suggesting liver injury.

Discussion:

The association between liver injury and anti-tuberculosis therapy has been con-firmed by applying various causality association scales. It is obvious that proper treatment of disseminated tuberculosis can avoid the development of drug-resistant strains that can be harm-ful, worsening the prognosis as there are fewer therapeutic alternatives available. At the same time, there is a need to monitor the patient with ATT-induced DILI.

Conclusion:

The diagnosis of tuberculosis in children is difficult because of the mild, nonspe-cific clinical presentation, which usually reflects the implicated underlying organ. In addition to prompt diagnosis and treatment of disseminated TB, careful monitoring is equally important.
Selected Non-communicable Disease Risk Factors and Mental Health of South African Durban-based Refugees: A Cross-sectional Study
Authors: Thabana Mateisi Wailer , Grace Jeanne Martin
Published: April 2024

Background

Non-communicable diseases (NCDs) are the leading contributor to mortality and morbidity worldwide, with refugees considered more susceptible to NCDs. Refugees often encounter difficulties in accessing healthcare, resulting in delayed diagnostic assessment and treatment of mental disorders and NCDs, leading to the deterioration of the condition. The study aimed to ascertain the prevalence of risk factors for NCDs and mental health among South African Durban-based refugees.

Methods

This cross-sectional study was conducted among 121 randomly selected South African Durban-based refugees. Data on the metabolic risk factors for NCDs were collected using a modified version of the World Health Organisation (WHO) STEPwise approach to (NCDs) surveillance (STEPS) instrument. Participants' mental health disorders were determined with a Global Mental Health Assessment Tool-Primary Care Version questionnaire.

Results

A significant 38.80% of participants had normal BMI [x2 (5, n=47) = 82.55, p<.001], 24.0% were overweight [x2 (5, n=29) = 82.55, p<.001], 25.6% were obese class l [x2 (5, n=31) = 82.55, p<.001]. A significant 77.1% [x2 (2, n=64) = 76.79, p<.001] of the participants had desirable cholesterol levels, and 62.3% [x2 (2, n=71) = 44.57, p<.001] had normal fasting glucose levels. A significant 26.1% [x2 (4, n=31) = 64.82, p<.001] and 46.2% [x2 (4, n=55) = 64.82, p<.001] were classified as having hypertension stage I and II, respectively. A non-significant 32.2% and 25.0% experienced depression and anxiety.

Conclusions

The prevalence of hypertension and high BMI levels combined with mental disorders underscores the importance of healthcare service delivery to this vulnerable population in SA.
High-frequency Resonance Suppression of Railway Traction Power Supply
System Based on the Combination of Single-tuned and C-type Filters
Authors: Zhang Haigang , Yin Ming , Zhou Haoqiang , Zeng Song , Wang Zizhuo , Xu Junpeng , Wang Bulai , Zou Jinbai
Published: April 2024

Background:

Railroad transportation in the actual operation process, there are also
many dangerous accidents caused by resonance, which greatly affect the safety of railroad transportation.
A comprehensive examination of the operational dynamics within the power branch of a
traction substation is imperative for sustaining system equilibrium. Discrepancies between these
facets pose a potential threat to the safety of railway transport. Thus, a meticulous analysis of highfrequency
resonance characteristics and the formulation of effective suppression techniques
become paramount.

Objective:

Harmonics from grid-side locomotive traction braking are scrutinized under different
operational scenarios and different train runs. The aim is to develop an effective harmonic management
strategy to normalize the THD and thus maintain the traction power supply system to
become more stable.

Methods:

This study investigates the high-frequency harmonic resonance characteristics using a
control variable approach. Harmonics and negative sequences generated during locomotive traction
braking under different operating conditions are investigated by means of extensive analysis. These
challenges require the implementation of a harmonic management method. This method uses a
combination of two monotonic filters and a C filter in parallel. This method applies to different operating
conditions and can dynamically adapt harmonics to changes in the number of trains, which
is related to the actual dynamics of the traction power system closely.

Results:

A comparative evaluation of seven operating conditions shows that the filter in this patent
exceeds the efficiency of existing methods. The filter reduces the fluctuations during spectral
changes, and the voltage distortion rate decreases from the previous 2.33% to 0.55%, making it
more adaptable and promising effective harmonic management in high voltage and high current
situations.

Conclusion:

Through multiple simulation tests, a synergistic configuration involving the C-type
filter and two single-tuned parallel connections under regenerative braking conditions emerges.
This refined, patented filter design not only mitigates the impact of negative sequence during the
filtration process but also substantially diminishes high harmonics and THD.
Healthcare Sector Fraud and Corruption
Authors: Shahid Amina , Fatima Mariam , Malik Shiza
Published: April 2024

Health sector corruption and fraud are rising not only in developing
countries but also in well-developed countries. Up-coding of bills, identity theft, and
quackery are some of the major kinds of fraud in this sector. In this chapter, major
causes and types of healthcare fraud have been discussed, and how they are affecting
the society, with special reference to Pakistan’s conditions. Moreover, a gist of
methods to reduce this issue has been proposed. The data suggests that the foremost
issue conducive to the poor impact of public investments in the healthcare sector seems
to be corruption and an observation system based on butcherly. The need is to
overcome the dilemma through diverse approaches that necessitate collaboration and
mutual work among politicians, citizens, policymakers, and every person within the
community. Only then the cults of health sector fraud and corruption could be
curtailed.
Physician-Assisted Suicide - The Ethical Insights
Authors: Farzeen Aiman , Mubashir Areeba , Malik Shiza
Published: April 2024

PAS is opted for when the patient is terminally ill and he/she no longer
wants to continue life-supporting treatments that are often excruciating, financially
unaffordable and offer no hope for survival to terminally ill patients. This chapter talks
about the ethical concern of physician-assisted suicide (PAS), which is one of the
perennial ethical problems of medicine, how it can be distinguished from euthanasia,
and what are the different types of practices that constitute end-of-life procedures. It
talks about the factors that make PAS a legal and ethical issue. Furthermore, PAS’s
prevalence across the world, especially in Pakistan, is discussed, and also the causative
factors leading to PAS have been shed light upon. Moreover, the influence it has on
individuals and society and the ways by which we can address issues encountered as a
result of physician-assisted suicide are made part of this discussion.
Covid-19 Pandemic and Ethics of Mandatory Vaccinations
Authors: Aslam Sanaa Masood , Waheed Yasir
Published: April 2024

In recent years, vaccines have been found to be the most effective tool for
mass protection of people against infectious communicable diseases. Despite
technological advancements, the obligation of these essential preventive healthcare
treatments, to date, remains a subject of debate and, to an extent, opposition arising
from vaccine hesitancy and/or vaccine opposition. The COVID-19 pandemic
exacerbated shortages in resources and personnel owing to its rapid spread globally.
With little known about this uncommon disease, efforts for early development of
vaccines to achieve herd immunity, control disease transmission and reduce morbidity
and mortality were undertaken. The emergence and administration of vaccines raised
ethical concerns about loss of liberty and autonomy under mandatory provisions. This
chapter aims to highlight the processes through which an infectious disease such as
COVID-19 is politicized and securitized in the global policy arena, driving the
development and administration of vaccines as specific protection. It further discusses
the ways in which COVID-19 vaccine sufficed ethical standards for mandatory
vaccination programs.
Ethical Dilemmas in Journalism and their Impacts on Mental Health of the Society
Authors: Swaiba Umme , Siddique Zoya , Malik Shiza
Published: April 2024

Journalists all across the world regularly violate journalistic ethics, which
has a detrimental effect on societal peace and order. Due to unrestricted and
independent media, there is a serious problem with journalists misreporting, making up
news, inventing facts, and revealing improper material. The frequency, probable
causes, and effects of this situation are all covered in detail in this chapter, along with
international instances of poor journalism. There are also some recommendations in
this chapter for addressing this problem at the individual and organizational levels.
Evaluation of Prompts to Simplify Cardiovascular Disease Information Generated Using a Large Language Model: Cross-Sectional Study (Preprint)
Authors: Mishra Vishala , Sarraju Ashish , Kalwani Neil M , Dexter Joseph P
Published: April 2024

UNSTRUCTURED

In this cross-sectional study, we evaluated the completeness, readability, and syntactic complexity of cardiovascular disease prevention information produced by GPT-4 in response to 4 kinds of prompts.
A Model of Trust in Online COVID-19 Information and Advice: Cross-Sectional Questionnaire Study (Preprint)
Authors: Sillence Elizabeth , Branley-Bell Dawn , Moss Mark , Briggs Pam
Published: April 2024

BACKGROUND

During the COVID-19 pandemic, many people sought information from websites and social media. Understanding the extent to which these sources were trusted is important in relation to health communication.

OBJECTIVE

This study aims to identify the key factors influencing UK citizens’ trust and intention to act on advice about COVID-19 found via digital resources and to test whether an existing model of trust in eHealth provided a good fit for COVID-19–related information seeking online. We also wished to identify any differences between the evaluation of general information and information relating specifically to COVID-19 vaccines.

METHODS

In total, 525 people completed an online survey in January 2022 encompassing a general web trust questionnaire, measures of information corroboration, coping perceptions, and intention to act. Data were analyzed using principal component analysis and structural equation modeling. The evaluation responses of general information and COVID-19 vaccine information were also compared.

RESULTS

The principal component analysis revealed 5 trust factors: (1) credibility and impartiality, (2) familiarity, (3) privacy, (4) usability, and (5) personal experiences. In the final structural equation modeling model, trust had a significant direct effect on intention to act (β=.65; P<.001). Of the trust factors, credibility and impartiality had a significant positive direct effect on trust (β=.82; P<.001). People searching for vaccination information felt less at risk, less anxious, and more optimistic after reading the information. We noted that most people sought information from “official” sources. Finally, in the context of COVID-19, “credibility and impartiality” remain a key predictor of trust in eHealth resources, but in comparison with previous models of trust in online health information, checking and corroborating information did not form a significant part of trust evaluations.

CONCLUSIONS

In times of uncertainty, when faced with a global emergent health concern, people place their trust in familiar websites and rely on the perceived credibility and impartiality of those digital sources above other trust factors.
Virtual therapeutic assistants in outpatient aftercare - Expectations of patients and health care professionals: A survey (Preprint)
Authors: Immel Diana , Hilpert Bernhard , Schwarz Patricia , Hein Andreas , Gebhard Patrick , Barton Simon , Hurlemann René
Published: April 2024

BACKGROUND

To explore the expectations of patients with depression and healthcare professionals towards a socially interactive agent as a virtual therapeutic assistant in outpatient aftercare, a qualitative survey was conducted.

OBJECTIVE

The current analysis focus on research questions covered the appearance and role of the assistant, assistant-patient interaction (time of interaction, skills and abilities of the assistant, ways of interacting) and therapist-assistant interaction.

METHODS

A two-part qualitative study was conducted to explore the perspectives of the two groups (patients and care providers). As a first step, care providers (N=30) were recruited during a regional offline meeting. After a brief lecture, they were given a link and asked to take part in a semi-structured online questionnaire. Secondly patients (N=20) were recruited in a clinic and interviewed in a semi-structured face-to-face interview.

RESULTS

Findings included the following: The assistant should be a multimodal communicator (voice, facial expressions, gestures) and counteract negative self-evaluation. The gender of the assistant should be female or optional. However, only male was rejected due to negative associations. The assistant is seen as proactive and the patient as a passive recipient of information in terms of patient-assistant interaction. Gaps in aftercare can be filled by the assistant`s unlimited availability. However, the assistant should train the patient's autonomy to avoid dependency. Health status monitoring was viewed positively by both groups. In order to detect early warning signs of illness, a biofeedback function is desired. When appropriate to the situation, humor in the assistant is considered desirable. With regard to the desired skills of the assistant, these can be summarized in terms of providing structure and emotional support, especially warmth and competence in order to build trust. Consistency is important for the assistant to appear authentic. In terms of care providers-assisted therapist-assistant interaction, an objective measure of the patient's health status, an emergency system for suicide prevention, as well as an information tool and decision support for health care professionals (psychiatrists, psychotherapists, nurses and social workers) were identified as crucial.

CONCLUSIONS

Overall, the survey conducted provides innovative guidelines for developing a virtual therapeutic assistant to fill the gaps in patient aftercare.
How Patients With Cancer Use the Internet to Search for Health Information: Scenario-Based Think-Aloud Study (Preprint)
Authors: Huijgens Fiorella , Kwakman Pascale , Hillen Marij , van Weert Julia , Jaspers Monique , Smets Ellen , Linn Annemiek
Published: April 2024

BACKGROUND

Patients with cancer increasingly use the internet to seek health information. However, thus far, research treats web-based health information seeking (WHIS) behavior in a rather dichotomous manner (ie, approaching or avoiding) and fails to capture the dynamic nature and evolving motivations that patients experience when engaging in WHIS throughout their disease trajectory. Insights can be used to support effective patient-provider communication about WHIS and can lead to better designed web-based health platforms.

OBJECTIVE

This study explored patterns of motivations and emotions behind the web-based information seeking of patients with cancer at various stages of their disease trajectory, as well as the cognitive and emotional responses evoked by WHIS via a scenario-based, think-aloud approach.

METHODS

In total, 15 analog patients were recruited, representing patients with cancer, survivors, and informal caregivers. Imagining themselves in 3 scenarios—prediagnosis phase (5/15, 33%), treatment phase (5/15, 33%), and survivor phase (5/15, 33%)—patients were asked to search for web-based health information while being prompted to verbalize their thoughts. In total, 2 researchers independently coded the sessions, categorizing the codes into broader themes to comprehend analog patients’ experiences during WHIS.

RESULTS

Overarching motives for WHIS included reducing uncertainty, seeking reassurance, and gaining empowerment. At the beginning of the disease trajectory, patients mainly showed cognitive needs, whereas this shifted more toward affective needs in the subsequent disease stages. Analog patients’ WHIS approaches varied from exploratory to focused or a combination of both. They adapted their search strategy when faced with challenging cognitive or emotional content. WHIS triggered diverse emotions, fluctuating throughout the search. Complex, confrontational, and unexpected information mainly induced negative emotions.

CONCLUSIONS

This study provides valuable insights into the motivations of patients with cancer underlying WHIS and the emotions experienced at various stages of the disease trajectory. Understanding patients’ search patterns is pivotal in optimizing web-based health platforms to cater to specific needs. In addition, these findings can guide clinicians in accommodating patients’ specific needs and directing patients toward reliable sources of web-based health information.
An Electronic Medical Record–Based Prognostic Model for Inpatient Falls: Development and Internal-External Cross-Validation (Preprint)
Authors: Parsons Rex , Blythe Robin , Cramb Susanna , Abdel-Hafez Ahmad , McPhail Steven
Published: April 2024

BACKGROUND

Effective fall prevention interventions in hospitals require appropriate allocation of resources early in admission. To address this, fall risk prediction tools and models have been developed with the aim to provide fall prevention strategies to patients at high risk. However, fall risk assessment tools have typically been inaccurate for prediction, ineffective in prevention, and time-consuming to complete. Accurate, dynamic, individualized estimates of fall risk for admitted patients using routinely recorded data may assist in prioritizing fall prevention efforts.

OBJECTIVE

The objective of this study was to develop and validate an accurate and dynamic prognostic model for inpatient falls among a cohort of patients using routinely recorded electronic medical record data.

METHODS

We used routinely recorded data from 5 Australian hospitals to develop and internally-externally validate a prediction model for inpatient falls using a Cox proportional hazards model with time-varying covariates. The study cohort included patients admitted during 2018-2021 to any ward, with no age restriction. Predictors used in the model included admission-related administrative data, length of stay, and number of previous falls during the admission (updated every 12 hours up to 14 days after admission). Model calibration was assessed using Poisson regression and discrimination using the area under the time-dependent receiver operating characteristic curve.

RESULTS

There were 1,107,556 inpatient admissions, 6004 falls, and 5341 unique fallers. The area under the time-dependent receiver operating characteristic curve was 0.899 (95% CI 0.88-0.91) at 24 hours after admission and declined throughout admission (eg, 0.765, 95% CI 0.75-0.78 on the seventh day after admission). Site-dependent overestimation and underestimation of risk was observed on the calibration plots.

CONCLUSIONS

Using a large dataset from multiple hospitals and robust methods to model development and validation, we developed a prognostic model for inpatient falls. It had high discrimination, suggesting the model has the potential for operationalization in clinical decision support for prioritizing inpatients for fall prevention. Performance was site dependent, and model recalibration may lead to improved performance.
Artificial Intelligence and Medical School Admissions: Envisioning Holistic, Applicant-responsive, and Dynamic Selection (Preprint)
Authors: Sugumar Vijithan , Bhatt Nitish , Kulasegaram Kulamakan , Hanson Mark
Published: April 2024

UNSTRUCTURED

There has been tremendous technological change in the medical admissions processes in recent years with a transition to online engagement and recruitment strategies and virtual medical school admissions assessments. Technology is now key to most medical schools’ admissions processes. Moreover, a spotlight has specifically been placed on the shortcomings of the medical school admissions system when it comes to implementing holistic admissions which may contribute to persisting socioeconomic disparities in matriculants.

Simultaneously, in the past decade witnessed the disruptive power of artificial intelligence (AI) and the societal changes that have been catalyzed by its rapid development. AI innovations are already in widespread use in private sector recruitment and when employed strategically have improved efficacy and efficiency of hiring practices. This raises the question of how undergraduate medical admissions will be able to leverage this emerging technology to improve the current admissions workflow.

In this article, authors explore the potential uses for AI and machine learning technology within the undergraduate medical admissions process. We follow the journey of the medical school applicant through the various common phases of the application process, and suggest AI solutions to improve on commonly noted shortcomings. We also consider how to deliberately design AI for medical admissions with a focus on the applicant experience, logistical considerations for medical schools, and the global societal interest in the medical education field.
Improving Neurological Health in Aging Via Neuroplasticity-Based Computerized Exercise: Protocol for a Randomized Controlled Trial (Preprint)
Authors: Attarha Mouna , de Figueiredo Pelegrino Ana Carolina , Toussaint Paule-Joanne , Grant Sarah-Jane , Van Vleet Thomas , de Villers-Sidani Etienne
Published: April 2024

BACKGROUND

Our current understanding of how computerized brain training drives cognitive and functional benefits remains incomplete. This paper describes the protocol for Improving Neurological Health in Aging via Neuroplasticity-based Computerized Exercise (INHANCE), a randomized controlled trial in healthy older adults designed to evaluate whether brain training improves cholinergic signaling.

OBJECTIVE

INHANCE evaluates whether 2 computerized training programs alter acetylcholine binding using the vesicular acetylcholine transporter ligand [18F] fluoroethoxybenzovesamicol ([18F] FEOBV) and positron emission tomography (PET).

METHODS

In this phase IIb, prospective, double-blind, parallel-arm, active-controlled randomized trial, a minimum of 92 community-dwelling healthy adults aged 65 years and older are randomly assigned to a brain training program designed using the principles of neuroplasticity (BrainHQ by Posit Science) or to an active control program of computer games designed for entertainment (eg, Solitaire). Both programs consist of 30-minute sessions, 7 times per week for 10 weeks (35 total hours), completed remotely at home using either loaned or personal devices. The primary outcome is the change in FEOBV binding in the anterior cingulate cortex, assessed at baseline and posttest. Exploratory cognitive and behavioral outcomes sensitive to acetylcholine are evaluated before, immediately after, and 3 months following the intervention to assess the maintenance of observed effects.

RESULTS

The trial was funded in September 2019. The study received approval from the Western Institutional Review Board in October 2020 with Research Ethics Board of McGill University Health Centre and Health Canada approvals in June 2021. The trial is currently ongoing. The first participant was enrolled in July 2021, enrollment closed when 93 participants were randomized in December 2023, and the trial will conclude in June 2024. The study team will be unblinded to conduct analyses after the final participant exits the study. We expect to publish the results in the fourth quarter of 2024.

CONCLUSIONS

There remains a critical need to identify effective and scalable nonpharmaceutical interventions to enhance cognition in older adults. This trial contributes to our understanding of brain training by providing a potential neurochemical explanation of cognitive benefit.

CLINICALTRIAL

ClinicalTrials.gov NCT04149457; https://clinicaltrials.gov/ct2/show/NCT04149457

INTERNATIONAL REGISTERED REPORT

DERR1-10.2196/59705