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Biomechanical risk factors for rotator cuff syndrome in high-risk occupations: A prospective study protocol
Background Rotator cuff syndrome (RCS) is the most common upper limb musculoskeletal disorder worldwide. RCS negatively impacts quality of life and comes with high costs to the individual and society through time loss of work or healthcare usage. Identifying modifiable risk factors for RCS is a critical avenue for exploration to improve prevention and treatment of RCS. Objective The overarching goal of this research is to explore the connection between shoulder kinematics and RCS in high-risk occupations and determine if pre-injury shoulder kinematics during a standardized overhead reaching motion are a risk factor for symptomatic RCS. Methods A prospective cohort design will be used to assess 292 individuals who work in high-risk occupations, such as construction, farming, and healthcare. Workers without any shoulder pain or disorders will be asked to attend an in-laboratory baseline testing session. First participants will complete questionnaires about their baseline symptoms, personal characteristics, and work exposures. They will then perform a standardized functional reaching task while their shoulder movement is tracked with optical motion capture. Participants will be surveyed every 3 months for two years; individuals with any indications of shoulder symptoms that develop during the study period will be further assessed with clinical impingement tests. Logistic regression and survival analyses will be performed to determine if scapular kinematics pre-injury, combined with several individual and work-related factors, are a risk factor for development of RCS. Proposed Results These findings will provide empirical evidence to clarify the contribution of biomechanics to injury development. Specifically, it is expected that scapular kinematics at the baseline assessment will be a risk factor for the development of RCS. Conclusions This research represents a crucial step for understanding shoulder musculoskeletal health. This information is foundational for development of innovative, evidence-based treatment and prevention strategies.
Shopping festival atmospherics of China’s singles day shopping festival and participants’ perception: Scale development and validation
China’s Singles Day Shopping Festivals (SDSFs) have continuously attracted consumers in recent years. As large-scale online sales events, their atmospherics have not yet been systematically analyzed. The present study aims to develop a measurement scale named “shopping festival atmospherics” (SFA) to capture the major dimensions of the atmospherics created by SDSFs. Following a rigorous procedure, both qualitative and quantitative approaches are employed to develop the measurement scale. Finally, three dimensions (cultural cues, social cues, and online cues) that contain eighteen attributes are extracted. The present study also identifies several novel shopping atmospheric cues that have not been mentioned in the literature. The happily crowded environment (“Renao” in the Chinese language) is a positive atmospheric cue for Chinese participants. A fair shopping environment is also a positive atmospherics cue as participants worry about price scams. Finally, the limitations and suggestions for future research are presented at the end of the paper.
Cognitive emotion regulation questionnaire: Evidence of internal structure through confirmatory factor modeling and exploratory structural equation modeling
The Cognitive Emotion Regulation Questionnaire is one of the most widely used instruments to measure cognitive emotion regulation, and its psychometric properties have been evaluated in various studies and cultural contexts. However, the 9-factor internal structure originally proposed for the scale measures does not present consistent evidence in the literature. The exclusive use of the confirmatory factor modeling in previous literature may largely explain this inconsistency. In the present research, we propose to estimate innovative measurement models for this questionnaire, the exploratory structural equation modeling. For this purpose, we worked with a large sample of Argentines of 6881 Argentine adults aged between 18 and 81 (M = 27.14, SD = 9.86; 69.6% female; 86.4% not being in psychological or psychiatric treatment) and compared the fit of the models. The results favored the exploratory structural equation model (χ2 = 4092.89, df = 342, CFI = .982, SRMR = .013, RMSEA = .04), indicating that we are not observing indicators that reflect simple factorial structures. Based on the results of the present study, it can be concluded that the simple 9-factor structure traditionally proposed for the CERQ does not exhibit adequate model fit. This finding suggests the need for caution among applied psychologists and clinical researchers who interpret scale scores as if they reflect distinct, unidimensional factors. The common practice of generating summed scores across items associated with each of the originally proposed factors may therefore be questionable. A more nuanced understanding of the questionnaire’s internal structure may ultimately enhance the reliability and interpretability of CERQ scores in both clinical and applied settings, thereby improving the quality of psychological assessment and intervention outcomes.
Design of Polyether sulfone flat-sheet membranes for multi-layered hemodiafiltration devices
Multilayered hemodialysis devices enable blood flow without the need for an external pump, whereas hollow fiber-type devices require a pump due to significant pressure loss across the fibers. This highlights a key advantage of multilayered devices for implantable applications, where a simpler and lighter system reduces the burden on patients. This study investigates the mechanical strength and dialysis efficiency of polyether sulfone (PES) flat-sheet membranes for multilayered devices. PES membranes, with thicknesses ranging from 40 to 160 µm, were prepared using the liquid inversion method, with thickness controlled via spin coating. The mechanical strength of the membranes was tested following the ISO 8637–1:2017 protocol, and membranes thicker than 80 µm were experimentally verified to withstand pressures of up to 500 mmHg, making them suitable for dialysis applications. Furthermore, the study demonstrates the successful use of 80 µm membranes in both in vitro and ex vivo experiments with rats, identifying this thickness as optimal for multilayered dialysis devices.
The social organization of the Asian weaver ant colonies: A natural enemy novel sub-castes worker’s functional activity findings
An arboreal ant species by nature, the Asian weaver ant Oecophylla smaragdina F., (Hymenoptera: Formicidae) colony’s social structure composition was investigated in depth. Brood and barrack nests were collected from the African oil palm (Elaeis guineensis) canopies and Limau kasturi (Citrus microcarpa) orchards, and dissected. All caste’s morphological traits were examined stereo-microscopically. The workers’ width and length measurements of the separately dissected head, thorax, frontal view, abdomen, and body full side view sizes were recorded. All colonies comprise a founding queen laying thousands of eggs stored in a protective yellowish, unknown sticky substance (shining reflection), with reproductive winged green and newly emerged yellow queens, adult drone males, and wingless workers along their immature pupae and larvae arranged in woven, solid silken chambers (brood nests exclusively). Besides the traditionally known caste of minor and major workers, five polymorphic individuals comprising two unidentified novel sub-castes of intermediate workers and one sub-caste of major workers were described. The full body and abdomen lengths are proposed as dominant predicting factors differentiating among the five sub-castes. The discovery of a multimodal size frequency distribution model contrasts with the classical archetypical bimodal systems in ants. Intermediate workers foraging outside the nest revealed reconnaissance autonomy and aggressive behaviors that aided larger workers in securing the territorial perimeter. Bigger workers occupied the first defensive layers of the colony’s territorial frontier, while the intermediate workers maintained their stance at a closer nest distance. Major workers systematically acted as leaders-supervisors by removing individuals of smaller size during overheating exposure. Due to their short lifespan and segregated nests, it is difficult to collect adult males in wide plantations. A stable and average mature three-year-old colony produces several reproductive individuals monthly. The mean number of emerging queens is higher in older colonies (scarcity of males) and lower for younger colonies (queens-males averages are correlated). The queen production increases with higher rainfall and relative humidity. This study identified three novel worker sub-castes: one major intermediate, two intermediate in size. These findings contribute to a better understanding of the overall worker’s functional activity. The Asian weaver ant demonstrates adaptive measures in response to challenging abiotic factors (temperature), defying classical labor division rules.
Development of a methodology for measuring the quality of statutory social workers’ complex decision-making
Registered social workers in English Local Authorities are required to have an expertise in the complex decision-making needed to promote well-being when an adult’s own judgement about their well-being and wishes about how to promote it might, in the circumstances, put their well-being at risk. Such circumstances are complex partly because core professional values – promoting autonomy and protecting from harm – can come into conflict. Given the consequential nature of social workers’ decisions, it is essential to be able to evaluate the quality of social workers’ decision-making. In this paper, we set out the systematic development, in collaboration with expert social workers, of a bespoke methodology to measure decision-making quality and investigate underpinning cognitive processes. Central to our methodology was social workers’ consideration of key legal principles. First, we reviewed the research literature to identify existing measurement schemes aspects of which might be suitable for incorporating into our methodology. No existing measurement schemes were found, but we identified a factorial survey vignette-based scheme which seemed promising as the basis for our own methodology. Second, by reviewing statute and case law, we identified 40 key legal principles which social workers should consider in their decision-making. Next, based on these principles, we developed four hypothetical case vignettes to activate decision-making. Finally, we developed four scoring templates, one for each vignette, setting out exemplar judgements and decisions against which practitioners’ judgements and decisions could be compared and scored. Our new methodology provides a means of assessing the quality of social workers’ decision-making and, as prior- and post-intervention quality can be measured, has the potential to generate evidence of the impact of policy and practice interventions on decision-making.
TENS alone or combined with low-level laser therapy photobiomodulation for pain, functional capacity, and cardiorespiratory physiological variables after cesarean section: protocol for a randomized clinical trial
Introduction Women undergoing cesarean section frequently report postpartum pain from the surgical procedure, which may be related to functional mobility and cardiorespiratory physiological variables. Transcutaneous electrical nerve stimulation (TENS) and low-level laser therapy (LLLT) photobiomodulation are electrophysical agents used for analgesic purposes in post-cesarean. However, the combined effect of these interventions and their impact on functional performance and cardiorespiratory physiological variables in this population is not known. This study aims to evaluate the effect of TENS combined with LLLT photobiomodulation on pain, functional performance, and behavior of cardiorespiratory variables and compare it with the effects of TENS alone in women during postpartum after cesarean section. Methods This is a protocol of a randomized clinical trial that will be conducted at Divino Amor Maternity Hospital (Rio Grande do Norte, Brazil). A total of 88 patients undergoing cesarean section will be distributed in four groups: TENS combined with LLLT photobiomodulation, TENS alone, placebo, and control. The patients included in the study will be evaluated at three time-points: assessment 1 (8–12 hours postpartum), assessment 2 (20–24 hours postpartum), and assessment 3 (44–48 hours postpartum). Data will encompass sociodemographic and clinical information, pain assessment, functional performance, and cardiorespiratory physiological variables (systemic arterial pressure, heart and respiratory rates, and oxygen saturation). The combined intervention group will follow the protocol of two sessions with low-intensity TENS (30 min, 100 Hz, and 75 µs), with electrodes above and below the cesarean incision, and LLLT photobiomodulation (660 nm, 2 J per point, and 100 mW), without touching the cesarean incision. The TENS alone group will follow the same low-intensity TENS protocol used in the combined intervention. Interventions (combined and isolated) will be delivered after completion of assessments 1 and 2. Brazilian Registry of Clinical Trials number RBR-9pjd2n3.
Modeling and analysis of 100 kW two-stage three-phase grid-connected PV generation system under absurd atmospheric and grid disturbances
The sustainable growth of renewable energy sources, especially photovoltaic (PV) driven electricity generation, is expected to grow exponentially over the next few years. The extraction of grid parameters such as the line voltage’s magnitude, phase angle, and phase sequence, are crucial for the effective control of PV-grid synchronization. The existing grid synchronization technique such as a conventional phase-locked loop (PLL) is unable to provide an accurate fundamental frequency positive sequence under various types of grid fault conditions. Therefore, the main purpose of this article is to model and analyze the introduction of cascaded delay signal cancelation (CDSC) for a 100 kW two-stage three-phase grid-connected PV generation system under absurd atmospheric and various grid disturbances. The performance of the CDSC is benchmarked with a conventional structure of PLL as well as a double second-order generalized integrator (DSOGI). The modeling and analyses of these selected grid synchronizers were performed in a Matlab-Simulink (R2020b) environment.
Shedding light on the effects of conflict management training: A multi-rater assessment shines a spotlight on medical students’ skills
Background Medical students are repeatedly exposed to challenging situations while working with healthcare teams, so acquiring conflict management skills is necessary. This study aimed to investigate the effect of an educational intervention on the conflict management skills of medical students using self- and observer-assessment. Methods This educational intervention with a pre-and post-test design was conducted in 2022–2023. Second-year medical students of Tehran University of Medical Sciences volunteered to participate in a randomized study with a control group. The participants were divided into two intervention (12 groups of 4 each, n = 48) and control groups (12 groups of 4 each, n = 48). The intervention group was educated based on the Fogg model, and the control group was trained using conventional method. Student conflict management skills were evaluated using a self-assessment checklist and observer-assessment. Results The findings of observer-assessment revealed that the post-test rating in the intervention group was significantly higher than the control group, while the pre-test score in the two groups did not indicate a significant difference (P = 0.03; ES = 0.44 and P = 0.30; ES = 0.18, respectively). Moreover, the comparison between pre-test and post-test in the two intervention and control groups also showed that the educational intervention significantly increased the mean score of the post-test in both the intervention and control groups (P ≤ 0.001; ES = 0.97 and P ≤ 0.001; ES = 1.34, respectively). The comparison between pre-test and post-test in the two intervention and control groups via self-assessment showed that the skill score increased only in the intervention group (P = 0.02; ES = 0.48 and P = 0.98; ES = 0.004, respectively). Conclusion This study found that using the Fogg model in e-learning platforms enhances medical students’ conflict management skills, highlighting the effectiveness of well-designed, creative, and active model-based teaching methods.
In Silico molecular docking and molecular dynamic simulation of transferrin coated Phenytoin loaded SLNs with molecular targets of epilepsy
Epilepsy is a chronic neurological disorder characterized by recurrent seizures, affecting millions of people worldwide. Phenytoin is a widely used antiepileptic drug, but its therapeutic efficacy is limited by poor brain penetration and undesirable side effects. We have investigated the drug against the selected candidate’s protein target using Insilco analysis to check the mode of action in real time system. This makes Phenytoin a promising therapeutic drug for the management of different targets involved in Epilepsy disease. Considering this, using a wide range of computer aided drug-designing approaches, high interactions with the protein targets have been inferred against drug molecule Phenytoin. Eight receptors against Phenytoin molecules showed binding interactions during molecular docking but the top four i.e. Bcl-2, BDNF, IL-1β and Caspase showed high binding affinities with docking score of 7.8 kcal/mol, 7.7. kcal/mol. 7.4 kcal/mol and 7.1 kcal/mol respectively. The compound Phenytoin interacts with several important active side residues in the active domain of all the receptors which was further validated via molecular dynamic simulations for 100 ns time intervals. Furthermore, the complexes of Phenytoin reveal very stable dynamics with average RMSD, RMSF and ROG values with stable carbon-alpha atoms confirmation at different intervals. In conclusion, these molecules are promising and require experimental validation to prove them as epilepsy inhibitors.
Association of pulmonary artery bifurcation angle shift with contralateral stenosis after post-arterial switch in the pediatric transposition of great artery patients
Background The arterial switch operation (ASO) is the standard surgical treatment for transposition of the great arteries (TGA). Postoperative complications such as branch pulmonary artery (PA) stenosis are commonly observed. This study aimed to investigate the possible potential anatomical mechanisms contributing to isolated branch PA stenosis using cardiac computed tomography (CCT). Methods A retrospective, single-center study was conducted on pediatric patients under 18 years of age diagnosed with TGA, with or without ventricular septal defect (VSD), who underwent ASO and cardiac CCT between January 2004 and October 2022. Baseline characteristics, echocardiographic data, and CCT findings were compared between patients with and without isolated branch PA stenosis. Special attention was given to the angle between the PA bifurcation and the ascending aorta (AAO). Results Among 30 patients enrolled, 46.67% (14/30) had isolated branch PA stenosis, while 53.33% (16/30) had no stenosis. Baseline and echocardiographic variables showed no significant differences between groups, except for the PA bifurcation angle relative to the AAO. Patients with isolated right PA (RPA) stenosis demonstrated significantly greater leftward angulation (median angle: 25° [IQR: 24, 30]) compared to the no-stenosis group (median angle: −2° [IQR: −8, 6.5]). Similarly, isolated left PA (LPA) stenosis was associated with greater rightward angulation (median angle: −22° [IQR: −32, −20]) compared to the no-stenosis group (P = 0.042). Conclusion Alterations in the PA bifurcation angle relative to the AAO may contribute to the development of isolated branch PA stenosis following ASO. Preoperative planning to optimize the PA bifurcation angle to within ±20 degrees may help reduce the risk of postoperative stenosis. A larger study incorporating advanced cardiac imaging into routine ASO follow-up is warranted.
Nano formulation development and antibacterial activity of cinnamon bark extract-chitosan composites against Burkholderia Glumae the causative agent of Bacterial Panicle Blight in rice
Bacterial panicle blight (BPB) disease, caused by Burkholderia glumae , poses a significant threat to rice production. Conventional chemical control methods contribute to environmental concerns and resistance issues, necessitating the development of sustainable alternatives. This study aimed to formulate and evaluate cinnamon bark extract-chitosan (CBE- CS) nano formulations for antibacterial efficacy against Burkholderia glumae . First, the antibacterial activity of cinnamon bark extract (CBE) was assessed, revealing a minimum inhibitory concentration (MIC) of 6.25 μg/mL and a minimum bactericidal concentration (MBC) of 12.5 μg/mL. Morphological analysis using scanning electron microscopy (SEM), confocal laser scanning microscopy (CLSM), and transmission electron microscopy (TEM) showed significant bacterial cell wall damage, cytoplasmic leakage, and structural degradation after treatment. Chemical characterization of CBE using gas chromatography-mass spectrometry (GC-MS) and Fourier transform infrared spectroscopy (FTIR) identified key active compounds, with (Z)-3- phenylacryldehyde as the major component (51.24%). Next, nano formulations of CBE-CS were developed, and their physicochemical properties were characterized, including particle size, zeta potential, encapsulation efficiency (33.9%), and loading capacity (48.78%). Antibacterial assessments demonstrated that the nano formulations effectively inhibited Burkholderia. glumae . Finally, greenhouse trials on rice seedlings confirmed the efficacy of these nano formulations in controlling BPB disease, showing significant bacterial suppression and improved plant health. These findings suggest that CBE-CS nanoparticles offer a promising, eco-friendly alternative for managing bacterial blight in rice, providing both effective antibacterial activity and enhanced plant protection.
Active peptides of TSP-1 inhibit retinal angiogenesis through the CD36 pathway in a rat model of choroidal neovascularization
Background Choroidal neovascularization (CNV) is a key manifestation of intraocular neovascularization, and it is considered one of the main causes of blindness in ophthalmology. Additionally, multiple anti-vascular endothelial growth factor (VEGF) drugs have been used as first-line treatment for CNV. However, several issues posed challenges to the anti-VEGF drugs, which were mainly composed of short duration of action, requirement for repeated injections, and complications. Thrombospondin-1 (TSP-1) is an endogenous protein that was found to regulate multiple biological processes within the body, and it has been proven to exhibit an inhibitory effect on neovascularization. Besides, the function of TSP-1 during the inhibition of neovascularization was currently considered to mainly focus on its type Ⅰ repeats (TSRs), which was attributed to the large molecular weight, complex structure, and possible unknown functions of TSP-1. Therefore, TSRs can be applied as targets and research directions for the further development and exploration of potential therapeutic drugs. Objectives Based on the type I repeats (TSRs) of thrombospondin-1 (TSP-1), amino acid sequences of different lengths were designed and synthesized in this study, named as VR-9 VR-10、VR-11、VR-12、VR-13. The objective was to explore the effects of the above five peptides on angiogenesis in Chori-retinal neovascularization, alongside the screening of the best peptides and the deep exploration into the underlying mechanism, aimed to provide a basis for the development and application of peptide drugs in the treatment of CNV. Methods Wound healing, CCK-8, and 5-ethynyl-2′-deoxyuridine (EdU) assays were employed to evaluate the proliferation and migration ability of cells. CRISPR-Cas9 technology was utilized to establish CD36 knockdown cell lines, alongside the conduction of qPCR to verify the efficiency of gene knockdown. The expression levels of VEGF and CD31 in RF/6A cells and rats were assessed by Western blot. Additionally, Hematoxylin and eosin (HE) staining was performed to examine the structural integrity of the rat retina, while Fluorescein Isothiocyanate-Dextran Cardiac Perfusion (FITC) labeling was used to observe the occurrence and development of choroidal neovascularization (CNV). Results According to the wound-healing and CCK-8 assays, VR-13 was the most effective in inhibiting the proliferation and migration of endothelial cells. Furthermore, VR-13 peptide effectively inhibited the pathological development of CNV without the detection of retinal toxicity in the rat CNV model. Conclusions Overall, it was found that VR-13 exhibit significant effects on the inducing of apoptosis and the inhibition of the progression of angiogenesis by regulating the expression of VEGF and CD31 via CD36 signaling pathway.
Women’s economic independence and physical intimate partner violence (IPV) during separation
A growing number of studies have addressed the issue of intimate partner violence (IPV). While some studies have shown that women’s economic independence reduces the risk of physical IPV, the empirical evidence is still inconclusive. In particular, little is known about the factors that are associated with the likelihood of experiencing physical IPV during the immediate separation process. We use data from the German Family Panel (pairfam) for the years 2009–2022. The analytical sample consists of women who went through a separation since the last interview (n = 786 person-years). We use logistic regression models to examine the determinants of physical IPV during separation. We find that mothers with minor children have significantly higher odds of experiencing physical IPV during separation than women who do not have minor children (OR=1.96, p=.006), controlling for key sociodemographic characteristics. Low education as well as non-employment are associated with higher risks of physical IPV during separation for both women with and without minor children. However, non-employment is a particular risk factor for mothers with lower levels of education. Divorce and separation, especially when minor children are involved, can be a highly stressful time when partner conflict escalates and, in some cases, culminates in violence against the partner. This paper highlights the importance of maternal labor market integration and economic independence as a lever to potentially reduce physical IPV and conflict during separation.
SARS-CoV-2 survival on skin and its transfer from contaminated surfaces
Understanding the transmission dynamics of SARS-CoV-2, particularly its transfer from contaminated surfaces (fomites) to human skin, is crucial for mitigating the spread of COVID-19. While extensive research has examined the persistence of SARS-CoV-2 on various surfaces, there is limited understanding of how efficiently it transfers to human skin, and how long it survives on the skin. This study investigates two key aspects of SARS-CoV-2 transmission: (1) the transfer efficiency of SARS-CoV-2 from non-porous (plastic and metal) and porous (cardboard) surfaces to a 3D human skin model (LabSkin), and (2) the survival of SARS-CoV-2 on the skin under different temperature conditions. First, we validated LabSkin as a suitable surrogate for human skin by comparing the transfer efficiency of the bacteriophage Phi 6 from surfaces to LabSkin and to human volunteers’ fingers. No significant differences were observed, confirming LabSkin’s suitability for these studies. Subsequently, the transfer of SARS-CoV-2 from surfaces to LabSkin was assessed, showing that plastic and metal surfaces had similar transfer efficiencies (~13%), while no transfer occurred from cardboard once the inoculum had dried on the surface. Finally, the survival of SARS-CoV-2 on skin was assessed, showing a rapid decay at higher temperatures, with a half-life ranging from 2.8 to 17.8 hours depending on the temperature. These findings enhance our understanding of viral transmission via fomites and inform public health strategies to reduce the risk of SARS-CoV-2 transmission through surface contact.
Desiccation tolerant yet short-lived seeds: A conundrum for post-harvest handling of a high restoration value bunchgrass?
The successful preservation of seeds for future use depends on factors that maintain or limit seed viability. Yet, seed biology knowledge that would facilitate seed storage of most wild species used in ecosystem restoration is absent. This study characterized changes in seed water content, germination, desiccation tolerance, and relative storage longevity of Aristida beyrichiana (wiregrass), a focal restoration species, with respect to habitat of collection. We collected mature seeds from mesic and xeric habitats over two years then exposed these to desiccation stress sufficient for germplasm storage and aging stress (60% relative humidity, 45°C). We followed each method with germination assays at simulated seasonal temperatures. We analyzed germination responses along with production of normal and abnormal seedlings. We then modeled potential seed longevity and compared this against longevity of reference species. We found that wiregrass seeds display sufficient desiccation tolerance for ex situ storage and germinate preferentially under spring or fall and summer temperature conditions. The negligible to small effects of ecotype on these responses do not support the hypothesis that habitat of occurrence represents an adequate predictor of desiccation tolerance or germination response. However, seeds from both xeric and mesic habitats are estimated to be short-lived in storage. The contradiction between high desiccation tolerance yet short-lived nature of seeds implies that proper post-harvest seed handling, particularly regarding seed moisture management, is critical for maintaining seed viability. Further implications of this interesting seed physiology are discussed in the context of restoration.
A systemic approach to accident prevention: How control factors influence accident severity and losses across industries
Accidents are often attributed to frontline operator errors, overshadowing higher-level organizational and regulatory factors. This study integrates Systems-Theoretic Accident Model and Processes (STAMP) with fuzzy-set Qualitative Comparative Analysis (fsQCA) and Necessary Condition Analysis (NCA) – a configurational approach – to examine 80 major accident investigation reports from five high-risk Chinese industries (chemical, construction, transportation, coal mining, firefighting) spanning 2010–2022. Four systemic control elements (control activities errors, feedback errors, controller failures, controlled process errors) were assessed against three severity indicators (fatalities, injuries, direct economic losses). Results reveal distinct yet overlapping causal pathways. In chemical accidents, feedback errors are crucial for high fatalities. Construction and coal mining often link early controller/control activity failures to severe outcomes. Transportation highlights control activity errors for injuries, while firefighting points to the combination of control activity errors and controller failures. NCA corroborates key factors like feedback errors and controller failures as necessary conditions (effect sizes d > 0.1, p < 0.05). While supplementary statistical analysis confirmed these factors’ general importance, it faced data limitations (small N, collinearity); the fsQCA/NCA approach provided more robust insights into combinatorial pathways and necessity. Bottleneck analyses further indicate that even modest increments in key errors can trigger disproportionately large losses. These findings underscore the need for multi-level interventions—strengthening feedback loops, organizational oversight, and control processes—to mitigate accident severity in complex socio-technical systems, demonstrating the utility of configurational methods for understanding systemic failures.
A scoping review of racism and anti-racist solutions in the health care of people who have experienced trafficking
Racial minorities are disproportionately affected by human trafficking, with African Americans making up over 30% of trafficking cases in the United States despite being only 14% of the national population. Health care providers play a crucial role in identifying and supporting survivors of trafficking as roughly two-thirds of individuals who have been trafficked encounter a healthcare professional. However, discrimination against trafficked patients of color in health care, a key setting for frontline service provision, remains unexplored. We undertook a scoping review to identify the effects of racial and ethnic discrimination in the healthcare of individuals who have experienced human trafficking, with the aim of informing anti-racist practice, treatments, interventions, and research. Following the PRISMA extension for scoping reviews (PRISMA-ScR), we identified 41 sources comprising quantitative and qualitative studies, case reports, grey literature, and text and opinion pieces. Quantitative studies indicated that there are significant gaps in service availability for Black, Indigenous, and People of Color (BIPOC) survivors in the midwestern United States. Our remaining sources suggested that healthcare provider bias and discrimination emerged through victim blaming, adultification, criminalization, or invisibility of BIPOC survivors. Racism was also perpetuated structurally through lack of culturally relevant training, fear of punishment from police or immigration enforcement, and sociocultural barriers to accessing healthcare. Furthermore, we identified best practices for future anti-trafficking efforts in health care on several levels including treatment, research, intervention design and evaluation, community partnerships, coalition-building, and political advocacy. Ultimately, healthcare providers have a unique opportunity to respond to human trafficking, but to do so effectively will require comprehensively addressing critical gaps in care for BIPOC populations across individual, interpersonal, and structural levels.
Implementation of early warning, alert and response: An experience from the Marburg virus disease outbreak response in Kagera, Tanzania, March to May 2023
Introduction Tanzania declared a Marburg Virus Disease (MVD) outbreak on March 21, 2023, reporting nine cases and six deaths (case fatality rate (CFR) 66.7%). Detection began when a Community Health Worker (CHW) reported unexplained illness via the electronic EBS (e-EBS) system, triggering a national outbreak response. This study documents the Early Warning, Alert and Response (EWAR) interventions carried out during the MVD outbreak response in the Kagera region to identify strengths and bottlenecks for strengthening future outbreak preparedness and response efforts. Method We documented EWAR interventions using retrospective surveillance document review. MVD outbreak detection and reporting timeliness were compared with Tanzania’s EBS indicators and the 7-1-7 target. Surveillance interventions included additional staff deployment, equipment addition, and tool adoption. Community sensitization efforts utilized Swahili-translated informational cards to facilitate early detection and reporting of signals through multiple channels, including the 199-hotline number, EBS desk numbers and via e-EBS and verified using the standard case definition (SCD). Signals were compiled in Microsoft Excel, where descriptive analysis using frequencies to show trends was conducted. Suspected MVD cases were sent for laboratory confirmation. Findings On March 15, 2023, a CHW reported a signal in the e-EBS system within 24 hours. However, a community member and HCWs missed unusual signs of the MVD index case. Five additional members were deployed to support data management using the equipment provided, including three laptops, ten smartphones, and adapted tools. A total of 6,260 informational cards were distributed during community sensitization; 176 MVD signals were reported, where 48 (27.3%) met the SCD, and 37 were sent for laboratory confirmation, of which 2.7% tested positive for the virus. Most signals, 107 (60.8%), were reported in April. Conclusions and recommendations The government should adopt the 7-1-7 target and strengthen community and health facility EBS through ongoing mentorship for EWAR.
Solid breast tumors phantom emulating oxy and deoxyhemoglobin concentrations for near infrared imaging
Significance: Continuous-wave near-infrared spectroscopy (CW-NIRS) is a valuable, inexpensive and non-invasive tool for complementary diagnose breast cancer. The use of phantoms has proven to be a very powerful way to evaluate different experimental approaches as well as to test possible diagnostics equipment. The phantoms developed in this work can properly emulate either benign or malignant tumors and, in contrast to those constructed with actual biological chromophores, require no special storage, being thus stable in time. Aim: In this work we study the feasibility of employing two artificial absorbents as a replacement for oxygenated and deoxygenated hemoglobin concentrations in breast tumors, allowing discrimination benign from malignant tumors in CW transmittance NIRS experiments. Approach: Tumor phantoms were made of epoxy resin containing two kinds of absorbents to emulate the absorption curves of the hemoglobins in concentrations that reproduce those of benign and malignant tumors (fibroadenoma and adenocarcinoma respectively). CW transmittance NIRS experiments were carried out to evaluate the approach which was also compared with Monte Carlo (MC) simulations. Results: Results show that the constructed tumor phantoms are feasible to reproduce the desired targets. Additionally, the retrieved concentrations agree with the proposed ones. Thus, it is possible to construct a phantom containing inclusions emulating a fibroadenoma and/or an adenocarcinoma suitable for testing mammography algorithms or equipment. Conclusions: We have successfully designed, constructed, and validated tumor phantoms emulating both benign and malignant breast tumors. The transmittance experiments carried out agree very well with MC simulations. In addition, it was possible to obtain a map of absorbent concentrations recovered from the diffuse imaging experiments.