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Knowledge of hazard conditions due to mass movements is one of the non-structural measures for risk management, urban planning, and protection of natural resources. To obtain this type of mapping, a spatial construction was started by correlating the historical movements with the inherent variables of the terrain by means of the bivariate statistical method, which assigns densities or weights of evidence to estimate the degree of susceptibility. This model was combined with the triggering factors (rainfall and earthquake) to determine the spatiotemporal conditions (hazard). From this procedure, it was obtained that the susceptibility model presents 34% (32.33 km2) of the total area in the high and very high categories, especially in the regions of Mount Siradella and Mount Faro. The validation of the present model obtained a value of 0.945 with the ROC curve. For the hazard condition, 34.1% (32.06 km2) of the study area was found to be in the high and very high category, especially in the municipalities of El Grove, Sanxenxo, and A Illa de Arousa, which have the greatest extension. The present evaluation is an advance in the knowledge of the risk and the actions that can be derived, as in turn, this type of study is an easy tool to obtain due to its low cost and information processing.

Introduction: Differentiating between migraine and COVID-19 headaches is essential for better treatment. Evidence-based research during the COVID-19 pandemic has found that university students are more likely to experience migraine. Migraine can affect academic performance, sleep pattern, social and emotional well-being if left untreated or misdiagnosed. This study aimed to determine the prevalence of migraine symptoms and the association of triggers, coping strategies and clinical characteristics with COVID-19 diagnosis. Methods: This cross-sectional study was conducted across higher educational institutions in Peninsular Malaysia. Convenience sampling was applied to recruit full-time university students. A reliable and validated instrument was used to evaluate demographic data, migraine symptoms, triggers, coping strategies and clinical characteristics of migraine (frequency, intensity, severity and duration) during COVID-19 diagnosis. Results: The response rate was 98.3%, where 485 out of 493 responses were analysed. The prevalence of migraine was 35.9% (n=174). None of the triggers, coping strategies and clinical characteristics of migraine were significantly associated with COVID-19 diagnosis. Conclusion: The university students in Peninsular Malaysia showed a considerable prevalence of migraine symptoms. During the pandemic, the common triggers for existing symptoms were stress and a lack of sleep (combined triggers). The coping strategy adopted by most of the university students was lifestyle changes and in the COVID-19 positive group maladaptive coping strategies were adopted indicating the need for further investigation.

BackgroundDuring pregnancy and early motherhood, risks of relapse and worsening are high for women with a history of eating disorders (EDs), as are adverse sequelae for their babies. However, systematic descriptions of the processes that these women undergo through pregnancy, birth, and early motherhood are lacking, as are good descriptions of the various trajectories these women follow through pregnancy and early motherhood. This study addresses both these knowledge gaps.MethodsWe used a longitudinal research interview design, recruiting a non-clinical sample of 24 women with a history of severe EDs from routine pregnancy controls in five public, local, family health care centers in Norway. The participants were interviewed twice, first during pregnancy and then 4–6 months after delivery. Data were analyzed according to grounded theory. The focus was on modeling the trajectories of EDs through pregnancy, birth, and early motherhood. All the participants were diagnosed (DSM-5) using the Eating Disorder Examination and then completed the Eating Disorder Examination Questionnaire.ResultsFive perceived trajectories through pregnancy and early motherhood were identified: “The mastering mother,” in which an ED pathology seems to be absent through pregnancy and early motherhood; “The inadequate mother,” in which the ED pathology worsens before pregnancy, through pregnancy, and early motherhood; “The overwhelmed mother,” in which the ED worsens during pregnancy and early motherhood; “The depressed mother,” in which the ED is put on hold during pregnancy, but worsens in early motherhood; and “The succeeding mother,” in which the ED worsens during pregnancy, but reduces in early motherhood.DiscussionED trajectories through pregnancy and early motherhood vary greatly among women with a history of EDs. This may indicate different psychological dynamics through these phases. A model with five trajectories captures a large degree of the variation. The model may help clinicians’ preparedness when dealing with these patients.

BackgroundFreezing of Gait (FOG) is a motor symptom frequently observed in advanced Parkinson’s disease. However, due to its paroxysmal nature and diverse presentation, assessing FOG in a clinical setting can be challenging. Before FOG can be fully investigated, it is critical that a reliable experimental setting is established in which FOG can be evoked in a standardized manner, but the efficacy of various gait tasks and triggers for eliciting FOG remains unclear.ObjectivesThis study aimed to conduct a systematic review of the existing literature and evaluate the available evidence for the relationship between specific motor tasks, triggers, and FOG episodes in individuals with Parkinson’s disease (PwPD).MethodsWe conducted a literature search on four online databases (PubMed, Web of Science, EMBASE, and Cochrane Library) using the keywords “Parkinson’s disease,” “Freezing of Gait”, “triggers” and “tasks”. A total of 128 articles met the inclusion criteria and were included in our analysis.ResultsThe review found that a wide range of gait tasks were employed in studies assessing FOG among PD patients. However, three tasks (turning, dual tasking, and straight walking) emerged as the most frequently used. Turning (28%) appears to be the most effective trigger for eliciting FOG in PwPD, followed by walking through a doorway (14%) and dual tasking (10%).ConclusionThis review thereby supports the utilisation of turning, especially a 360-degree turn, as a reliable trigger for FOG in PwPD. This finding could be beneficial to clinicians conducting clinical evaluations and researchers aiming to assess FOG in a laboratory environment.

The aim of the study was to investigate the relationship between body mass index (BMI) and clinical and anamnestic data in patients with bronchial asthma (BA). Material and methods. 553 patients with BA and 95 apparently healthy individuals without medical or family history of asthma, allergy or atopy symptoms were examined. Patients were divided into three groups depending on BMI: Group I included 152 patients with normal body weight (NBW), II - 206 overweight patients, III - 195 with obesity. BA control was assessed by using the ACQ-5 questionnaire, and the AQLQ was used to assess quality of life. The study was approved by the Bioethics Commission of the Medical Institute of Sumy State University. Statistical analysis of the obtained results was carried out using the SPSS-17 program. Results. There were no significant sex- and age-related differences (p > 0.05) between clinical groups. Complaints, medical history, clinical and instrumental indicators, disease severity, control, and quality of life of patients were analyzed to identify features of BA associated with obesity. The study has found that BA patients with obesity experienced a higher frequency of positive family history (p = 0.004), exacerbations during the cold season (p = 0.001), sensitivity to weather changes (p = 0.001), acute respiratory diseases (p = 0.001), stress (p = 0.001), and a combination of non-specific triggers (p = 0.001) which could result in exacerbations compared to patients with NBW. Exacerbations caused by flowering plants were more common in BA patients with NBW (55.3 %) compared to those with obesity (43.1 %). When comparing BA in individuals with obesity to those with NBW, there were several distinctive features. These included a higher frequency of symptoms such as cough and shortness of breath at rest or with minor physical exertion, weakness, fatigue, sleep disturbances, heartburn; night and day symptoms when using salbutamol, a severe and uncontrolled course with more pronounced obstructive disorders and lower reversibility, pneumonia, exacerbation episodes, and lower quality of life. Conclusions. BA with obesity compared to BA with NBW is characterized by a number of differences such as non-allergic factors as triggers, more severe course, lower level of control and quality of life, pain, pronounced bronchial obstruction with lower reversibility. [ABSTRACT FROM AUTHOR]

Phenomenology is the unity of principles and methods employed for investigating the essence of things. The present paper is a brief review of the series of publications that these authors carried out over the past decade. The general thrust of these publications consists in the idea that phenomenological ideas of physics are used to analyze earthquakes. One conspicuous example of a phenomenological theory is thermodynamics. Maxwell's electrodynamics is also a perfect example of a phenomenological theory. The phenomenology of earthquakes is still far from reaching that high level of excellence. A look at the rational knowledge of geodynamics shows that we have so far reached a preliminary stage where we are aware of the subject-matter, methods, and problems faced by the future phenomenological theory of earthquakes. Nevertheless, we already clearly see that our approach to the construction of such a theory has promise. We are using concrete examples to show that phenomenological concepts of general physics are helpful in the search for the principles of the theory, in the processing and analysis of concrete manifestations of seismicity. [ABSTRACT FROM AUTHOR]

Controlled ovarian hyperstimulation (COH) is a crucial component of assisted reproductive technologies like intrauterine insemination (IUI) and in vitro fertilization (IVF). Triggers in COH play a pivotal role in maturation of the follicles in their final stages and optimizing the timing of egg retrieval, which is very important for the collection of maximum eggs and for a good success rate. Human chorionic gonadotropin (hCG) is used as a standard method for the final follicular maturation and ovulation. HCG has the similar effect as luteinizing hormone (LH) with a half-life of 5-7 days. Now a days, gonadotropin-releasing hormone agonist (GnRH-a) trigger has been used with the target to reduce OHSS for the induction of final follicular maturation and ovulation. Based on the results of various studies, using the GnRH-a trigger leads to defects in the luteal phase resulting in reduced implantation and clinical pregnancy rates and also increasing abortion rates in fresh embryo transfer cycles compared to the routine IVF cycle with hCG triggering. In this review, we examined the benefits, problems and also ways to reform various triggers used for ovulation. [ABSTRACT FROM AUTHOR]

Intelligent responsive packaging provides informative feedback or control the release of active substances like antimicrobial agents in response to stimuli in food or the environment to ensure food safety. This paper provides an overview of two types of intelligent packaging, information-responsive and intelligent controlled-release, focusing on the recent research progress of intelligent controlled-release antimicrobial packaging with enzyme, pH, relative humidity, temperature, and light as triggering factors. It also summarizes the current status of application in different food categories, as well as the challenges and future prospects. Intelligent controlled-release technology aims to optimize the antimicrobial effect and ensure the quality of food products by synchronizing the release of active substances with food preservation needs through sensing stimuli, which is an innovative and challenging packaging technology. The paper seeks to provide a reference for the research and industrial development of responsive intelligent packaging and controlled-release packaging applications in food. [ABSTRACT FROM AUTHOR]

Migraine is a complex neurological disorder that affects a significant portion of the population. Conventional therapies for migraines have limitations and drawbacks, necessitating the exploration of novel therapeutic strategies. This review paper provides an overview of emerging therapeutic approaches for migraines, focusing on both pharmacological and non-pharmacological interventions. The review begins with an introduction that highlights the background and significance of the topic. It emphasizes the need for advancements in migraine treatment and the potential impact of emerging therapeutic strategies on patient care. The pathophysiology of migraines is discussed, providing a brief overview of the underlying mechanisms, key neurochemicals, and pathways involved. Additionally, the current understanding of migraine triggers is explored, shedding light on factors that can initiate or exacerbate migraine attacks. The paper then delves into the conventional therapies used for migraine management. An overview of commonly used treatments is provided, along with a discussion of their limitations and drawbacks. The need for the development of novel therapeutic strategies is emphasized, considering the challenges faced by existing therapies. Recent advances in migraine research are reviewed, highlighting the scientific advancements in the field. Novel insights into the pathophysiology of migraines are discussed, along with the identification of potential therapeutic targets. These advancements have the potential to reshape our understanding of migraines and guide the development of more targeted and effective treatments. Non-pharmacological approaches for migraine management are explored, including a comprehensive review of complementary and alternative therapies. The evidence-based review highlights the potential benefits of lifestyle modifications, such as dietary changes, sleep optimization, and exercise, in reducing migraine frequency and severity. Emerging pharmacological therapies are examined, focusing on the overview of novel pharmacological agents under investigation. The analysis of clinical trials and their outcomes provides insights into the efficacy and safety of these emerging therapies. The discussion also encompasses emerging drug classes and their mechanisms of action, shedding light on the potential of targeted treatments for migraines. The review concludes with a discussion of the future perspectives and challenges in migraine research. The potential implications of personalized medicine approaches are explored, considering the role of genetics and biomarkers in guiding treatment decisions and optimizing therapeutic interventions. The recommendations for future research and development highlight the need for further investigations into the underlying mechanisms of migraines, prospective studies evaluating combination therapies, and the ethical considerations associated with personalized medicine approaches. In summary, this review paper provides a comprehensive overview of the emerging therapeutic strategies for migraines. It highlights the advancements in understanding the pathophysiology of migraines, the potential of non-pharmacological interventions, and the promise of emerging pharmacological therapies. The paper emphasizes the importance of personalized medicine approaches in guiding treatment decisions and optimizing patient outcomes. The insights and recommendations provided in this review can contribute to the advancement of migraine research and improve patient care in the future. [ABSTRACT FROM AUTHOR]

Slope movements are one of the most widespread geomorphic processes and can cause material damage due to their rapid and unpredictable action. The structural-geological conditions of the slope can play an important role in the resulting activity of landslide movements, and their type and mechanism. The environments in which slopes with different structural-geological structures regularly occur are cuesta. In order to define landslide activity on slopes with different structures, it is necessary to know their detailed historical behaviour. In this study, dendrogeomorphic methods were used to spatio-temporally reconstruct the activity of two landslides on slopes with contrasting structural-geological structure (bedding planes slope and escarpment slope) in the Hřebečský hřbet (Czech Republic) cuesta area. A total of 174 individuals of common spruce (Picea abies (L.) Karst.) were sampled using 348 increment cores. The internal structure and depth of the landslides on both slopes were analyzed using ERT (electrical resistivity tomography) geophysical measurements. The escarpment slope was affected by a rotational landslide that transitioned to a shallow plastic front at the base. Activity on this front was very high, which can be attributed to its heavy waterlogging, as confirmed by ERT measurements. Moreover, the chronological occurrence of landslide activity on this slope corresponded very well with the occurrence of above-average 3-day rainfall. In contrast, the slope on bedding planes was affected by rotational-translational landslide, which activity was significantly lower (four dated events in the last 80 years). Moreover, these events did not correspond to the occurrence of any pattern of above-average rainfall events. Thus, in this case, dendrogeomorphological analysis revealed distinct landslide behaviour on slopes with contrasting structural-geological conditions. [ABSTRACT FROM AUTHOR]

In recent years, the role of emotions in digital games has gained prominence. Studies confirm emotions' substantial impact on gaming, influencing interactions, effectiveness, efficiency, and satisfaction. Combining gaming dynamics, Virtual Reality (VR) and the immersive Escape Room genre offers a potent avenue through which to evoke emotions and create a captivating player experience. The primary objective of this study is to explore VR game design specifically for the elicitation of emotions, in combination with the Escape Room genre. We also seek to understand how players perceive and respond to emotional stimuli within the game. Our study involved two distinct groups of participants: Nursing and Games. We employed a questionnaire to collect data on emotions experienced by participants, the game elements triggering these emotions, and their overall user experience. This study demonstrates the potential of VR technology and the Escape Room genre as a powerful means of eliciting emotions in players. "Escape VR: The Guilt" serves as a successful example of how immersive VR gaming can evoke emotions and captivate players. [ABSTRACT FROM AUTHOR]

Objective Measures of diagnostic performance in cancer are underdeveloped. Electronic clinical quality measures (eCQMs) to assess quality of cancer diagnosis could help quantify and improve diagnostic performance. Materials and Methods We developed 2 eCQMs to assess diagnostic evaluation of red-flag clinical findings for colorectal (CRC; based on abnormal stool-based cancer screening tests or labs suggestive of iron deficiency anemia) and lung (abnormal chest imaging) cancer. The 2 eCQMs quantified rates of red-flag follow-up in CRC and lung cancer using electronic health record data repositories at 2 large healthcare systems. Each measure used clinical data to identify abnormal results, evidence of appropriate follow-up, and exclusions that signified follow-up was unnecessary. Clinicians reviewed 100 positive and 20 negative randomly selected records for each eCQM at each site to validate accuracy and categorized missed opportunities related to system, provider, or patient factors. Results We implemented the CRC eCQM at both sites, while the lung cancer eCQM was only implemented at the VA due to lack of structured data indicating level of cancer suspicion on most chest imaging results at Geisinger. For the CRC eCQM, the rate of appropriate follow-up was 36.0% (26 746/74 314 patients) in the VA after removing clinical exclusions and 41.1% at Geisinger (1009/2461 patients; P  < .001). Similarly, the rate of appropriate evaluation for lung cancer in the VA was 61.5% (25 166/40 924 patients). Reviewers most frequently attributed missed opportunities at both sites to provider factors (84 of 157). Conclusions We implemented 2 eCQMs to evaluate the diagnostic process in cancer at 2 large health systems. Health care organizations can use these eCQMs to monitor diagnostic performance related to cancer. [ABSTRACT FROM AUTHOR]

This study expands on prior studies on wireless telecommunication generations by examining the technological differences and evolutional triggers that characterise each Generation (from 1G to 5G). Based on a systematic literature review approach, this study examines fifty (50) articles to enhance our understanding of wireless generation evolution. Specifically, this study analyses i) the triggers that necessitated the evolution of wireless telecommunication generations and ii) makes a case regarding why it is imperative to look beyond the fifth Generation (5G) network technologies. The authors propose areas for future research.

Objective: This study aims to extend the Theory of Planned Behavior with Triggers (TPBT) to improve the prediction of physical activity (PA) behavior using the TPB model. Methods: Questionnaires, including the TPB scale, PA rating scale (PARS-3), and triggers scale, were administered to 596 Chinese college students, and the data were analyzed using SPSS 23.0 and AMOS 24.0. Results: Subjective norm (SN), attitude (AT), and perceived behavioral control (PBC) all significantly and positively affected behavioral intention (BI). The path coefficient of PA behavior was significantly influenced by the interaction term of three types of triggers and BI, and the TPB with Triggers (TPBT) model improved the explanation rate of PA behavior. Conclusion: Triggers have a moderating effect on the relationship between BI and PA behavior, and the TPBT model better explains college students’ PA behavior. Among the three dimensions of triggers, people are more receptive to facilitator and signal triggers than spark triggers. This has practical implications for practitioners designing interventions to promote PA among college students.

Equine headshaking syndrome is a poorly understood neuropathic pain condition presenting as uncontrollable shaking, flicking, or striking of the head. Therapeutic options are limited, and treatments are only partially successful. Currently, epidemiological information on headshaking in the Southern Hemisphere is lacking. An online survey was circulated to Australian owners of headshaking horses to collect information on triggers, symptoms, seasonality, treatments, and perceived treatment efficacy. The responses (n = 216) showed the mean age at symptom onset as 9.6 (±4.7) years. More geldings were affected than mares (76% vs. 24%), and symptom onset occurred later in geldings compared to mares (10.1 ± 4.7 vs. 7.9 ± 4.0 years; p < 0.01). Bright sunlight, wind, and high pollen were the most commonly reported triggers (61%, 46% and 40%, respectively), and seasonal onset of symptoms was reported by 54% of respondents. In total, 71% of respondents reported using two or more treatments. The most common treatments were supplements (68%), nose nets (63%), light-blocking masks (48%), bodywork (48%) and pharmaceutical compounds (38%). Overall, treatments were considered ineffective by 33% of respondents. The findings were in agreement with surveys from the Northern Hemisphere. Of note was the perception of bright light as a primary trigger, alongside the reported low treatment efficacy of light-blocking masks. Seasonal intensification of symptoms and its relationship to day length merits further exploration.

Epilepsy is one of the most common chronic neurological syndromes in dogs and has serious implications for the quality of life of both the dogs and owners. Seizure-precipitating factors (SPFs) (also termed “triggers” or “provocative factors”) have been studied and reported in both humans and dogs with idiopathic epilepsy. In dogs stress, hormones, sleep deprivation, and the weather have been reported as SPFs. The Border Collie (BC) is a breed of dog that is predisposed to idiopathic epilepsy, and the outcome is often poor. BC is described as a very sensitive dog with a strong focus on their owners, and this may have an influence on their and their owners' stress level. In this article, we described six unrelated BCs with idiopathic epilepsy in which several remarkable SPFs were identified, and avoiding them improved the outcome of these dogs. The possible SPFs were different for each dog. The SPFs were, among others, the other dog in the family, the lack of intellectual challenge, the presence of an autistic child, a busy street, the relation with the owner, and throwing a ball at the beach. These cases illustrate that recognizing the SPF(s) and taking measures with regard to management can lead to a reduction in epileptic seizure frequency or even achieving seizure freedom.

The Fogg Behaviour Model suggests that for behaviour to occur, motivation, ability and a trigger must interact at the same time. Using this framing, this paper investigates and reflects on the triggers of energy use behaviour amongst low-income urban households in Kumasi, the second largest city in Ghana within the broader framing of sustainable energy transition. The research adopted the transdisciplinary approach. Selected households voluntarily participated in the research project implemented over a period of 2 years. Households were grouped into full-treatment, partial-treatment, and control groups. A co-designed intervention was introduced to the full treatment group. This paper observes and reflects on the energy behaviour of the full treatment group before, during and after the intervention using the Fogg Behaviour Model. The paper concludes that ‘saving money’ is a key trigger toward electricity use efficiency amongst low-income urban households. Consequently, an energy transition programme amongst low-income households might be effective if designed around this theme.

The occurrence of gastroesophageal reflux disease (GERD) and symptom onset are closely associated with diet. We aimed to compare the dietary and lifestyle triggers between non-erosive reflux disease (NERD) and reflux esophagitis (RE) in Chinese patients and to provide evidence for development of practical dietary modifications for GERD. A multicenter cross-sectional survey was conducted. A total of 396 GERD patients with typical gastroesophageal reflux symptoms who received upper endoscopy in the previous month were enrolled, including 203 cases of NERD patients and 193 cases of RE patients. All participants completed questionnaires including demographic data, reflux symptoms, previous management, dietary and lifestyle habits, triggers of reflux symptoms, psychological status, and quality of life. There were no significant differences in GERD symptom scores between NERD and RE. RE patients had a higher male proportion and smoking/drinking and overeating rates than NERD patients. In the NERD group, more patients reported that fruits, dairy products, yogurt, bean products, cold food, and carbonated beverages sometimes and often induced reflux symptoms and had more triggers compared to RE patients. The number of triggers was positively correlated to GERD symptom score and GERD-HRQL score in both NERD and RE patients. However, 74.0% of GERD patients still often consumed the triggering foods, even those foods that sometimes and often induced their reflux symptoms, which might be related to the reflux relapse after PPI withdrawal considering NERD and RE patients had similar GERD symptom severity. There were some differences in terms of dietary habits, dietary and lifestyle triggers, and related quality of life between NERD and RE, and these results may provide evidence of different approaches toward the dietary modification of NERD and RE patients. [ABSTRACT FROM AUTHOR]

Based on the current research trends and academic applications, which suggest that emotional intelligence can be learned and enhanced through education and training, this academic project coded and analyzed the emotional patterns of 46 undergraduate students who attended an 18-week academic course on emotional management. A paired-sample t-test showed a significant increase from pre-course to post-course emotional intelligence scores, suggesting the importance of designing an academic course in formal educational settings. Analysis of students' emotions journals indicated a total of 18 negative emotions, with the emotion of irritability occurring most frequently, followed by anger and anxiety. Loneliness, impatience, and guilt were some of the least felt negative emotions. The triggers for the arousal of negative emotions spanned family matters, interpersonal relations, academics, and communication skills, among others. The majority of the students used cognitive-behavioral and family systems theories in understanding and analyzing their emotional patterns. Students used various strategies to deal with the negative emotions, including developing communication skills, talking with family and friends, better time management, improving self-efficacy, cultivating a positive attitude, engaging in physical activities, etc. These results are discussed in this paper and the possible implications for practical purposes and further research are suggested. [ABSTRACT FROM AUTHOR]

Introduction: Localized bullous pemphigoid (LBP) is an infrequent bullous pemphigoid (BP) variant restricted to a body region. According to the most compelling evidence, LBP occurs in patients with pre-existent serum antibodies against the basement membrane zone, which occasionally acquire the capacity to induce disease after the influence of different local factors acting as triggers. Methods: We hereby present a multicenter cohort of 7 patients with LBP developed after local triggers: radiotherapy, thermal burns, surgery, rosacea, edema and a paretic leg. In addition, we conducted a review of the literature, and we propose a set of diagnostic criteria for LBP, also based on our case series and the 2022 BP guidelines from the European Academy of Dermatology and Venereology. Results: During follow-up, three of the patients from our series evolved to a generalized BP, with only one requiring hospitalization. Our literature search retrieved 47 articles including a total of 108 patients with LBP, with a 63% with a potential local precipitating factor previous to their diagnosis. LBP mostly affected older females, and a subsequent generalized progression occurred in 16.7% of the cases. The most frequently involved areas were the lower limbs. Radiation therapy and surgery were responsible for the inducement of nearly 2 in 3 cases of LBP. We observed a significantly higher risk of generalization in cases where the trigger led to the developing of LBP earlier (p=0.016). Our statistical analysis did not detect any other prognosis factor for generalization when assessing direct immunofluorescence, histological and serological results, or other patient related factors. Conclusion: LBP should be suspected in patients with recurrent localized bullous eruptions. The presence of a trauma history in the same anatomic area is reported in most cases. [ABSTRACT FROM AUTHOR]

This paper explores the triggers and consequences of sustainability reporting in the developing economy of Pakistan. Moreover, the study examines whether the corporate factors have any indirect and conditional indirect effects on financial performance through sustainability reporting where sector-affiliation acts as a moderator. An explanatory sequential mixed-methods approach has been applied for the data collection and analysis. The study uses secondary data collected from annual reports of 178 companies listed on the Pakistan Stock Exchange for 2010–2018. The quantitative results reveal that size, age, leverage, earnings, sustainability awards, CEO duality, and board independence significantly influence sustainability reporting. In contrast, foreign ownership, ownership concentration, women on board, and media visibility do not determine sustainability reporting. Mediation results indicate significant indirect effects of each corporate factor on financial performance through sustainability reporting. Similarly, except for a few, conditional indirect effects in all the models were also seen to exist. Subsequently, interviews with prominent players in the field helped validate and understand the quantitative results. This study has implications for regulators, corporate managers, investors, NGOs, and academic researchers. [ABSTRACT FROM AUTHOR]

Atrial fibrillation (AF) is a very common arrhythmia that mainly affects older individuals. The mechanism of atrial fibrillation is complex and is related to the pathogenesis of trigger activation and the perpetuation of arrhythmia. The pulmonary veins in the left atrium arei confirm that onfirm the most common triggers due to their distinct anatomical and electrophysiological properties. As a result, their electrical isolation by ablation is the cornerstone of invasive AF treatment. Multiple factors and comorbidities affect the atrial tissue and lead to myocardial stretch. Several neurohormonal and structural changes occur, leading to inflammation and oxidative stress and, consequently, a fibrotic substrate created by myofibroblasts, which encourages AF perpetuation. Several mechanisms are implemented into daily clinical practice in both interventions in and the medical treatment of atrial fibrillation. [ABSTRACT FROM AUTHOR]

Despite the initial understanding of the word 'triggered' as relating to the clinical phenomenon of post‐traumatic stress disorder (PTSD), this language has become a common part of the vernacular today, used by many people to apply to a wide variety of experiences and events. Counselling students are particularly sensitised to trauma, as well as identity politics, and are familiar with trigger warnings at college. They themselves have experienced trauma at high rates. Therefore, we were interested to understand how they might be using the word and interpreting the experience of being 'triggered', whether different sources of being triggered are related to emotional reactions, and whether a discourse analysis might indicate how and why the term has become useful and for what other experiences it might be serving as a stand‐in. In this mixed‐methods study, 79 counselling students from around the country shared their definitions and experiences of being 'triggered'. Participants completed surveys and wrote narratives, which, via thematic qualitative analysis, were coded into five themes. The quantitative analysis focused on the relationship of feelings to themes and the relationship between anger suppression and coping with each theme. Discourse analysis explored how individuals wrote about responsibility and anger. It was discovered that those who wrote about being triggered from a past sexual assault did not discuss anger, nor the responsibility of others to protect them (as those who wrote about microaggressions did), but positioned themselves as overreactors. Results are discussed with regard to training and practice. [ABSTRACT FROM AUTHOR]

In the setting of the coronavirus disease 2019 (COVID-19) pandemic, new strategies are needed to address the unique and significant palliative care (PC) needs of patients with COVID-19 and their families, particularly when health systems are stressed by patient surges. Many PC teams rely on referral-based consultation methods that can result in needs going unidentified and/or unmet. Here, we describe a novel system to proactively identify and meet the PC needs of all patients with COVID-19 being cared for in our hospital's intensive care units. Patients were screened through a combination of chart review and brief provider interview, and PC consultations were provided via telemedicine for those with unmet needs identified. In the first six weeks of operation, our pilot program of proactive screening and outreach resulted in PC consultation for 12 of the 29 (41%) adult patients admitted to the intensive care unit with COVID-19 at our institution. Consultations were most commonly for patient and family support as well as for goals of care and advance care planning, consistent with identified PC needs within this unique patient population.

Anti N-methyl D-aspartate receptor encephalitis (NMDAR-E) though rare, is currently considered as the commonest antibody mediated encephalitis in the world. No review on perspectives of NMDAR-E from India is available. The aim of the study was to review all the cases of NMDAR-E reported from India until June 2021 in terms of clinical features, diagnosis, and treatment, and perform a comparison of adult and paediatric cases. A literature review of NMDAR-E case reports/case series published from India till June 2021 was done. Demography, clinical profile, triggers, electroencephalography (EEG), neuroimaging, treatment details and outcomes were analysed. Sixteen case series and 35 case reports with a total of 249 cases were analysed. 82% of cases were from paediatric age group. The female to male ratio was 3:1. Psychiatric deficits, movement disorders, seizures, and language abnormalities were the most common clinical features. MRI brain abnormalities were seen in 45% patients. Electroencephalographic abnormalities were seen in 85% of patients. Infective triggers (herpes simplex virus and various other agents) were reported in 11% of the cases. Pediatric patients as compared with adults had more encephalopathy, autonomic dysfunctions, and normal imaging whereas the latter had more cognitive dysfunctions and delta brush pattern in electroencephalography (p

Background: Migraine is one of the most common neurological disorders worldwide. Clinical characteristics of migraine may be somewhat different across ethnic groups. Although factors such as stress, lack of sleep, and fasting are known as migraine triggers, the discussion about geographical differences of migraine triggers in Asia is lacking. Methods: In this study, we performed a narrative review on migraine triggers in Asia. We searched PubMed for relevant papers published between January 2000 and February 2022. Results: Forty-two papers from 13 Asian countries were included. Stress and sleep are the most frequently reported migraine triggers in Asia. There were some differences in migraine triggers in Asian countries: fatigue and weather common in Eastern Asia and fasting common in Western Asia. Conclusion: Majority of the common triggers reported by patients with migraine in Asia were stress and sleep, similar to those reported globally, thus showing they are universally important. Some triggers linked to internal homeostasis are influenced by culture (e.g., alcohol, food/eating habit), and triggers related to environmental homeostasis, such as weather, are highly heterogenous between regions. [ABSTRACT FROM AUTHOR]

One of the aims of environmental management is to achieve good ecosystem state. Assessing the state needs to be informed by thresholds above which state is defined as "good" for both the quality that defines good state, and the extent of the habitat that needs to be in such a quality. Operationalizing such thresholds has been carried out using a wide variety of approaches, with, often, haphazard and subjective outcomes. Here, we review approaches for setting "good-state" thresholds and evaluate their strengths and weaknesses for application to marine seabed ecosystems. Only two approaches defined a current ecologically meaningful good state and estimated thresholds quantitatively from data, while two other approaches ("avoid collapse" and "allow recovery") would result in a state that could recover to good in the future. Other methods were subjective in the choice of threshold or based on statistically detectable thresholds rather than thresholds between good and not good or degraded state. We argue that the most objective method for setting a good-state threshold is based on maintaining the state within the range of natural variation in undisturbed systems. Preliminary time-series analyses of marine seabed community biomass suggest this threshold is located between 54 and 79% of the undisturbed state. [ABSTRACT FROM AUTHOR]

Background: The role of triggers in the occurrence of appropriate implantable cardioverter‐defibrillator (ICD) shocks due to ventricular tachyarrhythmias is not well known. The aim of the study was to assess the prevalence of trigger factors in appropriate ICD shocks and to analyze their prognostic impact on clinical outcome. Methods: A total of 710 consecutive patients of a prospective single‐center ICD‐registry who received a first appropriate ICD shock between 2000 and 9/2021 were analyzed. Results: In 35% of ICD patients with first ICD shock, at least one of the following triggers was found: Ischemia (22%), Compliance (9%), Decompensation (38%), Stress (12%), Technical (5%), Electrolyte/endocrinological disorder (22%) and Medication side effects (4%). The trigger factors can be summarized under the acronym ICD‐STEMi. The prospective application of the ICD‐STEMi scheme increased the rate of identified triggers from 32% to 56% (p <.001). Patients with triggered first ICD shock had an increased 5‐year mortality rate (50% vs. 38%, p <.001). Patients with triggers did not show different mortality outcomes or recurrent ICD shocks whether they received arrhythmia therapy or not. Conclusions: The evaluation of trigger factors after the occurrence of ICD shocks is mandatory and can be systematically evaluated using the acronym ICD‐STEMi. Systematic evaluation of triggers using the ICD‐STEMi scheme can identify triggers in about half of ICD patients with first appropriate ICD shock. Patients with triggered ICD shock have a 12% higher 5‐year mortality rate. [ABSTRACT FROM AUTHOR]

After the termination of a relationship, people can experience post-relationship grief (PRG). The bereaved can encounter grief intrusions: unexpected encounters that trigger memories and feelings of their lost loved one. Grief intrusions can help (or force) people to oscillate between the active work of grief and the active work of restoration. Guided by the Dual Process Model of Grief, this study sought to identify grief triggers after the end of a romantic relationship and how participants make sense of those triggers. Surprisingly, some participants admitted to purposely seeking out these triggers in order to experience the emotions of PRG. [ABSTRACT FROM AUTHOR]

Although past research has addressed why civilians are targeted, we know less about why non-state actors escalate violence against civilians at particular times. This article seeks to identify the events that trigger spikes in violence against civilians committed by non-state actors. We employ an innovative method to identify twenty-four such escalations in Africa committed by twenty different non-state groups between 1989 and 2015. Rigorous case studies reveal three major types of triggers, including situations in which (1) groups lose relative power, (2) groups gain relative power, and (3) opponents attack civilians. Specifically, we find that opponent military advances—which results in a relative loss of power for the non-state actor—are the most common trigger. More broadly, 75 percent of all escalations are tied to a group's relative loss in power. These results improve understandings of civilian targeting by non-state actors and may inform efforts to forecast such violence before it occurs. [ABSTRACT FROM AUTHOR]

The actual impact of landslides in Pakistan is highly underestimated and has not been addressed to its full extent. This study focuses on the impact which landslides had in the last 17 years, with focus on mortality, gender of deceased, main triggers (landslides and fatal landslides), and regional identification of the hotspots in Pakistan. Our study identified 1089 landslides (including rockfalls, rockslides, mudslides, mudflows, debris flows) out of which 180 landslides were fatal and claimed lives of 1072 people. We found that rain (rainfall and heavy rainfall)-related landslides were the deadliest over the entire study period. The main trigger of landslides in Pakistan is heavy rainfall which comprises over 50% of the triggers for the landslide, and combined with normal rainfall, this rate climbs to over 63%. The second main reason for landslide occurrence is spontaneous (due to rock instability, erosion, climate change, and other geological elements) with landslides accounting for 22.3% of all the landslides. Landslides caused by rain-related events amounted to 41.67% of the fatalities, whereas spontaneous landslides caused 29.44% of the deaths and the human induced events accounted for 25.5% of the fatalities. The fatal landslides accounted for 19.53% deaths of the children. Our study also found that more than 48% of the deadly landslides occurred between the months of January to April, whereas the least fatal landslides occurred in the month of June which accounted for only 3% of all the fatal landslides in Pakistan. [ABSTRACT FROM AUTHOR]

BackgroundDespite the recent expansion of treatment options in atopic dermatitis (AD), most management responsibilities fall on the patient and/or caregivers. Disease control often requires vigilance about and avoidance of common exposures, however the concerns for patients and caregivers living with AD have not been well enumerated.MethodsAn IRB approved survey was distributed to the public to evaluate the patient and caregiver concerns for topical exposures and potential triggers.Results323 people accessed the link to the survey with 259 providing response to at least one section of questions (response rate 80.2%). Results indicated that temperature and other weather related changes were the most common trigger. Nearly all respondents avoided at least one topical ingredient, with fragrances being the most common. Steroid exposure was common, however respondents expressed concerns about overall steroid exposure.ConclusionsOur results attempt to enumerate the daily topical exposure concerns for patients and caregivers living with AD. While our online survey is both limited and without mechanistic insights, our results provide insight to providers by highlighting the role of temperature in AD symptoms; identifying commonly perceived triggers; indicating the value of provider insight for topical product selection; and indicating that no specific aspect of topical corticosteroid exposure may alleviate the general steroid concerns for patients or caregivers.

ObjectiveWe describe the characteristics and outcomes of pediatric rapid response team (RRT) events within a single institution, categorized by reason for RRT activation (RRT triggers). We hypothesized that events with multiple triggers are associated with worse outcomes.Patients and MethodsRetrospective 3-year study at a high-volume tertiary academic pediatric hospital. We included all patients with index RRT events during the study period.ResultsAssociation of patient and RRT event characteristics with outcomes including transfers to ICU, need for advanced cardiopulmonary support, ICU and hospital length of stay (LOS), and mortality were studied. We reviewed 2,267 RRT events from 2,088 patients. Most (59%) were males with a median age of 2 years and 57% had complex chronic conditions. RRT triggers were: respiratory (36%) and multiple (35%). Transfer to the ICU occurred after 1,468 events (70%). Median hospital and ICU LOS were 11 and 1 days. Need for advanced cardiopulmonary support was noted in 291 events (14%). Overall mortality was 85 (4.1%), with 61 (2.9%) of patients having cardiopulmonary arrest (CPA). Multiple RRT trigger events were associated with transfer to the ICU (559 events; OR 1.48; p

IntroductionLocalized bullous pemphigoid (LBP) is an infrequent bullous pemphigoid (BP) variant restricted to a body region. According to the most compelling evidence, LBP occurs in patients with pre-existent serum antibodies against the basement membrane zone, which occasionally acquire the capacity to induce disease after the influence of different local factors acting as triggers.MethodsWe hereby present a multicenter cohort of 7 patients with LBP developed after local triggers: radiotherapy, thermal burns, surgery, rosacea, edema and a paretic leg. In addition, we conducted a review of the literature, and we propose a set of diagnostic criteria for LBP, also based on our case series and the 2022 BP guidelines from the European Academy of Dermatology and Venereology.ResultsDuring follow-up, three of the patients from our series evolved to a generalized BP, with only one requiring hospitalization. Our literature search retrieved 47 articles including a total of 108 patients with LBP, with a 63% with a potential local precipitating factor previous to their diagnosis. LBP mostly affected older females, and a subsequent generalized progression occurred in 16.7% of the cases. The most frequently involved areas were the lower limbs. Radiation therapy and surgery were responsible for the inducement of nearly 2 in 3 cases of LBP. We observed a significantly higher risk of generalization in cases where the trigger led to the developing of LBP earlier (p=0.016). Our statistical analysis did not detect any other prognosis factor for generalization when assessing direct immunofluorescence, histological and serological results, or other patient related factors.ConclusionLBP should be suspected in patients with recurrent localized bullous eruptions. The presence of a trauma history in the same anatomic area is reported in most cases.

Background: Given the lack of previous studies on adverse events (AEs) in the area of occupational healthcare in Spain, it is very important to begin to understand this phenomenon in order to act on it. The objective was to accurately quantify AE occurring in occupational healthcare in MC Mutual during May 2021. Methods: We conducted a review of a representative random sample of 250 clinical records to identify AEs through an active search audit, focused on the frequency, type, severity, and preventability of these events, categorized using standardized scales. Results: We detected seven AEs in the sample of clinical records, representing 3% AEs per clinical record, while in the APEAS Spanish Study, they were detected in 10% of patients. The most frequent AE type was postoperative, followed by medication and diagnostic delay. The AEs were of intermediate severity and high severity and with a variable degree of being preventable. Conclusions: The detection of AEs has been useful in the development of projects and action plans such as specific training courses, safety patient newsletters, ambulatory risk maps, and treatment plans framed in the official certification of patient safety. These results should be evaluated in other companies similar to MC Mutual.

Introduction Although most patients with fibromyalgia describe periods of exacerbation of their symptomatology, there are very few studies describing its characteristics. Material and methods We recruited a total of 124 patients from our outpatient clinics who agreed to a follow-up of at least 6 months. All of them were asked to note and describe whether they had had any worsening of their symptoms during that time. Results Sixty-nine patients (75%) reported at least one flare, with a mean of 2 flares per patient. The mean duration of flares was 11 weeks. The most frequent triggers were: continuous stress (56%), intense stress (39%), physical overexertion (37%) and climatic changes (36%). The most common actions taken by patients were rest and medication. Conclusions Two-thirds of fibromyalgia patients experienced flares within 6 months. The symptoms and measures taken are similar to those patients usually take when they notice a worsening of symptoms.

A fundamental goal of population ecologists is to identify drivers responsible for temporal variation in abundance. Understanding whether variation is associated with environmental stochasticity or anthropogenic disturbances, which are more amenable to management action, is crucial yet difficult to achieve. Here, we present a hierarchical monitoring framework that models rates of change in abundance from spatially structured populations and identifies when local declines fall out of synchrony with trends at larger spatial scales. Importantly, the framework provides signals that alert managers to the categorical significance of observed declines while avoiding signals where declines result from drivers operating at larger spatial scales (e.g., periodic reductions in primary productivity owing to drought). We demonstrate utility through application to a rapidly declining sagebrush (Artemisia spp.) indicator species (greater sage-grouse; Centrocercus urophasianus) using 30 years (1990–2019) of count data collected from greater than 4,400 leks (habitual breeding sites) distributed across the western United States. Results revealed population declines, immediately preceding triggers (2–4-year period), ranging between 58 and 68%. Conversely, population trends unassociated with triggers showed little-to-no sign of decline. Retrospective application of the monitoring framework indicated an average annual rate of 1.7% of leks or 1.3% of neighborhood clusters (lek aggregations) would have required management intervention to reverse range-wide declines and stabilize the U.S. population as a whole.

Background: Anaphylaxis is a very dynamic issue with its incidence and trigger profile changing over the years. We aimed to compile the characteristics of anaphylaxis cases diagnosed in our clinic prospectively and to make a comparison between diagnostic criteria proposed by National Institute of Allergy and Infectious Diseases/Food Allergy and Anaphylaxis Network (NIAID/FAAN) and World Allergy Organization (WAO). Method: Three-item diagnostic criteria recommended by NIAID/FAAN (2006) were used in the diagnosis of anaphylaxis. The clinical features of the cases, risk factors, etiologies, severity of anaphylaxis, and treatment approach were determined. The same patients were also classified by current WAO diagnostic criteria. Results: A total of 204 patients (158F/46 M, median age 45.3 years) were included. Drugs (65.2%), venom (9.8%) and food allergies (9.3%) were the top 3 etiologies. Among drug triggers, chemotherapeutics were the most common (17.7%), followed by antibiotics (15.3%) and non-steroidal anti-inflammatory drugs (14.2%). The patients were mostly diagnosed with the second criterion (84.8%), followed by the first criterion (11.8%) and the third criterion (3.4%) of the NIAID/FAAN criteria. In terms of WAO criteria, 82.8% of the patients were diagnosed with the first criterion, and 14.3% with the second criterion while 2.9% of the patients did not meet the WAO criteria. The severity of anaphylaxis was evaluated as grade-2, 3 and 4 in 30.9%, 64.2%, and 4.9% of the patients, respectively. Adrenaline was administered to 31.9% of the patients especially who had angioedema and bronchospasm (p = 0.04). Conclusion: Our data suggest that covering more details in patient's history may prevent possible underdiagnosis and WAO diagnostic criteria seem to be insufficient in some patients. We believe that our results will contribute to the literature on anaphylaxis and would be groundwork for future studies.