effort based

In this study, a new type of multi-arch tunnel construction method is proposed. This effort is undertaken due to the many disadvantages of the traditional multi-arch tunnel construction method. Furthermore, this method omits the construction of a middle pilot tunnel, and it has the advantages of safety, high efficiency, and being economical. When using the method of continuous arch tunneling without a middle pilot tunnel, the blasting of the first tunnel and the following tunnel has a greater impact on the surrounding rock damage, as well as on the supporting structure of the same cross-section...

Targeted efforts to better understand the barriers and facilitators of stakeholders and healthcare settings to implementation of exercise and education self-management programmes for osteoarthritis (OA) are needed. This study aimed to explore the barriers and facilitators to the implementation of Good Life with osteoArthritis in Denmark (GLA:D), a supervised group guideline-based OA programme, across Irish public and private healthcare settings. Interviews with 10 physiotherapists (PTs; 8 public) and 9 people with hip and knee OA (PwOA; 4 public) were coded by the Consolidated Framework for Implementation Research (CFIR) constructs in a case memo (summary, rationale, quotes)...

Fundamental knowledge of wet clutches' drag loss behavior is essential for designing low-loss clutch systems. In contrast to the widely investigated injection lubrication, more comprehensive knowledge is needed on the drag loss behavior of dip-lubricated wet clutches. In the development phase, data-driven models allow drag loss predictions with low computational effort and, at the same time, sufficient accuracy. Therefore, this study aimed to deepen and expand knowledge of the drag loss behavior of dip-lubricated wet clutches based on experimental investigations...

Purpose The relative newness of Post-COVID Conditions (PCC) has revealed a void in assessment protocols and treatment guidelines for dental settings. Providing oral health care practitioners with an assessment and treatment protocol could facilitate the delivery of comprehensive oral health care. The purpose of this study was to test a protocol for assessing and treating patients with PCC in dental practice settings. Methods A qualitative exploratory research design was used to conduct the study. A PCC assessment and treatment protocol (ATP) was developed and was used by dental hygienists in clinical practice in California for a period of 6 weeks...

This article responds to Coope's call for the medical humanities to address the climate crisis as a health issue. Coope proposes three areas for progress towards ecological thinking in healthcare, with a focus on ecological mental health. The article emphasises the need to understand the cultural dimensions of mental health and proposes an interdisciplinary approach that integrates insights from the arts and humanities. It examines the impact of climate change on mental health, drawing on The Rockefeller Foundation - Lancet Commission on Planetary Health and recent studies...

IMPORTANCE: The Practical Guide to Implementing PROMs in Gender-Affirming Care (PG-PROM-GAC) is an evidence-based resource, which was developed in response to international calls for improved patient-reported outcome measure (PROM) implementation in gender-affirming care. The PG-PROM-GAC has the potential to improve PROM implementation; however, its real-world effectiveness has not yet been investigated. OBJECTIVE: Investigate effectiveness and fidelity of three implementation strategies from the PG-PROM-GAC in a real-world gender clinic setting...

Three years after the start of the SARS-CoV-2 virus (COVID-19) pandemic, its effects continue to affect society and COVID-19 vaccination campaigns continue to be a topic of controversy and inconsistent practice. After experiencing spikes in COVID-19 cases, our University of California Davis Health Division of Hospital Medicine sought to understand the reasons underlying the low COVID-19 vaccination rates in our county and find approaches to improve the number of vaccinations among adults admitted to the inpatient setting...

Diet shift is an opportunity to mitigate the impacts of food systems, which are responsible for about a third of greenhouse gas (GHG) emissions globally and exert various environmental pressures on ecosystems. This study evaluates the mitigation potential of both global and local environmental impacts through dietary changes within the Brazilian context. Furthermore, the study aims to identify the potential benefits and trade-offs that may arise from these dietary transitions, thus providing a comprehensive analysis of the overall environmental implications...

Per- and polyfluoroalkyl substances (PFAS) are a class of man-made contaminants of human health concern due to their resistance to degradation, widespread environmental occurrence, bioaccumulation in living organisms, and potential negative health impacts. Private drinking water supplies may be uniquely vulnerable to PFAS contamination in impacted areas, as these systems are not protected under federal regulations and often include limited treatment or remediation, if contaminated, prior to use. The goal of this study was to determine the incidence of PFAS contamination in private drinking water supplies in two counties in Southwest Virginia, USA (Floyd and Roanoke) that share similar bedrock geologies, are representative of different state Department of Health risk categories, and to examine the potential for reliance on citizen-science based strategies for sample collection in subsequent efforts...

Close contact between lactating rodent mothers and their infants is essential for effective nursing. Whether the mother's effort to retrieve the infants to their nest requires the vasopressin-signaling via V1b receptor has not been fully defined. To address this question, V1b receptor knockout (V1bKO) and control mice were analyzed in pup retrieval test. Because an exploring mother in a new test cage randomly accessed to multiple infants in changing backgrounds over time, a computer vision-based deep learning analysis was applied to continuously calculate the distances between the mother and the infants as a parameter of their relationship...

Following the approval of the first antibody-drug conjugates (ADCs) in the early 2000s, development has increased dramatically, with 14 ADCs now approved and >100 in clinical development. In lung cancer, trastuzumab deruxtecan (T-DXd) is approved in human epidermal growth factor receptor 2 (HER2)-mutated, unresectable or metastatic non-small cell lung cancer, with ADCs targeting HER3 (patritumab deruxtecan), trophoblast cell-surface antigen 2 (datopotamab deruxtecan and sacituzumab govitecan [SG]) and mesenchymal-epithelial transition factor (telisotuzumab vedotin) in late-stage clinical development...

BACKGROUND: Information on the causes of deaths from diarrhoea in children younger than 5 years is needed to design improved preventive and therapeutic approaches. We aimed to conduct a systematic analysis of studies to report estimates of the causes of deaths from diarrhoea in children younger than 5 years at global and regional levels during 2000-21. METHODS: For this systematic review and Bayesian multinomial analysis, we included 12 pathogens with the highest attributable incidence in the Global Enteric Multicenter Study...

Photon-counting detector (PCD) CT enables routine virtual-monoenergetic image (VMI) reconstruction. We evaluated the performance of an automatic VMI energy level (keV) selection tool on a clinical PCD-CT system in comparison to an automatic tube potential (kV) selection tool from an energy-integrating-detector (EID) CT system from the same manufacturer. 
Approach: Four torso-shaped phantoms (20-50 cm width) containing iodine (2, 5, and 10-mg/cc) and calcium (100 mg/cc) were scanned on PCD-CT and EID-CT...

BACKGROUND & AIMS: Celiac disease (CD) is a chronic inflammatory disease of the small intestine induced and maintained by gluten ingestion in susceptible individuals. Current treatment consists of strict adherence to a lifelong gluten-free diet (GFD) which is considered safe and effective in the large majority of patients. However, since adherence to a GFD is difficult and has a negative impact on quality of life, an increasing interest in other treatment options has emerged. Moreover, in some individuals a GFD is not sufficiently effective, necessitating alternative treatments...

The American Nurses Association Enterprise (ANA Enterprise) Research Advisory Council plays a vital role in bringing nursing voices together and shaping the dynamic landscape of nursing research. Historically, its priorities have revolved around 4 pivotal research priorities: advancing research capacity, promoting interprofessional collaboration, enhancing data structures and governance, and propelling practice-based nursing research. In a remarkable transition, the 2024 Research Priorities of the ANA Enterprise Research Advisory Council align with the vision and strategic goals of the ANA Enterprise...

Vulnerability to adversarial attacks is one of the principal hurdles to the adoption of deep learning in safety-critical applications. Despite significant efforts, both practical and theoretical, training deep learning models robust to adversarial attacks is still an open problem. In this article, we analyse the geometry of adversarial attacks in the over-parameterized limit for Bayesian neural networks (BNNs). We show that, in the limit, vulnerability to gradient-based attacks arises as a result of degeneracy in the data distribution, i...

Pollution from heavy metals in estuaries poses potential risks to the aquatic environment and public health. The complexity of the estuarine water environment limits the accurate understanding of its pollution prediction. Field observations were conducted at seven sampling sites along the Yangtze River Estuary (YRE) during summer, autumn, and winter 2021 to analyze the concentrations of seven heavy metals (As, Cd, Cr, Pb, Cu, Ni, Zn) in water and surface sediments. The order of heavy metal concentrations in water samples from highest to lowest was Zn > As > Cu > Ni > Cr > Pb > Cd, while that in surface sediments samples was Zn > Cr > As > Ni > Pb > Cu > Cd...

In modern times, medicine is predominantly based on evidence-based practices, whereas in ancient times, indigenous people relied on plant-based medicines with factual evidence documented in ancient books or folklore that demonstrated their effectiveness against specific infections. Plants and microbes account for 70% of drugs approved by the USFDA (U.S. Food and Drug Administration). Stilbenes, polyphenolic compounds synthesized by plants under stress conditions, have garnered significant attention for their therapeutic potential, bridging ancient wisdom with modern healthcare...

PURPOSE: In 2020, one million women aged < 55 years were diagnosed with breast cancer globally. The impact of breast cancer and its treatments on these women's ability to work and need for social benefits may differ by social characteristics. We evaluated social benefit use following breast cancer by education and cohabitation. METHODS: We conducted a nationwide population-based cohort study, including women aged 18-55 years diagnosed with stage I-III breast cancer in Denmark during 2002-2011...

Neurodegenerative diseases (NDs) are one of the prominent health challenges facing contemporary society, and many efforts have been made to overcome and (or) control it. In this research paper, we described a practical one-pot two-step three-component reaction between 3,4-dihydronaphthalen-1(2 H )-one ( 1 ), aryl(or heteroaryl)glyoxal monohydrates ( 2a - h ), and hydrazine monohydrate (NH2 NH2 •H2 O) for the regioselective preparation of some 3-aryl(or heteroaryl)-5,6-dihydrobenzo[ h ]cinnoline derivatives ( 3a - h )...