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Problem: HRD and HRM can sometimes operate in silos or at cross-purposes. The increasingly FRAGILE world order confronting business (i.e., Fragmenting boundaries; Resurgent populism; Accelerated digitalisation; Growing inequality; Inverted populations; Loss of Trust; and the Ecological crisis) mandates greater collaborative engagement across HRD and HRM. Solution: Following a detailed review of the skills-based implications of the FRAGILE world order, the article unpacks the nascent skills-based agenda, detailing the transition from traditional job to task-based understanding, and outlining some examples of what it can look like in practice. Ultimately, to effectively navigate the FRAGILE world order organizations must have a clear understanding of both their current skill demands and deficiencies, and equally skills required of the future. Stakeholders: This conceptual article will be of interest to HRD and HRM professionals, but equally hold broader insights for organizations and policy makers engaged in navigating the FRAGILE world order through a skills-based agenda. [ABSTRACT FROM AUTHOR]

Abstract Aim To evaluate emergency obstetric care education and training within a medical assistant training program, being delivered in a remote, fragile region of Southeast Asia. This will aid in the identification of potential areas of enhancement to improve the management of obstetric emergencies. Design An ethnographic study, adopting a multi‐methods approach. Methods Emergency obstetric care education and training will be assessed through documentary analysis and interviews (online or face‐to‐face) with educators and trainers (N ~ 6–7). Student experiences will be explored using in‐person focus groups, facilitated by an external trainer involved in delivering the program (N ~ 10–12). A reflective field diary will provide insight into the lived experience of postgraduate students (N ~ 4–5). Data will be collected between May 2022 and May 2023. The full data set will be triangulated and analysed using the READ approach; (1) ready your materials, (2) extract data, (3) analyse data and (4) distil your findings. Institutional ethical approval was obtained from a university in October 2021, and inter‐country regional access was gained following adherence to their local ethical requirements. Implications for the Profession and Patient Care The findings from this study may help to inform the future design of the medical assistant training program. It is anticipated that the knowledge gained from this study will enhance the education and training of mid‐level health providers at local, national, and international levels. This work intends to contribute to addressing Sustainable Development Goal 3, Target 1 of reducing maternal mortality to 70:100,000 live births in low‐income countries. Reporting Method This protocol adhered to the Standards for Reporting Qualitative Research (SRQR) checklist. Patient or Public Contribution No formal PPI has been undertaken; however, stakeholders involved in delivering the education and training have been consulted.

Aim The Epibloc elastic-dynamic fixation has been applied for many years at several hand surgery centres in Italy. This technique has been considered safe and reliable in the treatment of distal meta- epiphyseal fractures of the radius with dorsal displacement. The aim of this study was to evaluate an alternative use of this method in the treatment of volar displaced wrist fractures in cases where an internal fixation could not be recommended. Methods The procedure consisted of two flexible pins with a trocar tip and an external plate for locking fixation with compression. The surgical technique was derived from the original procedure, modifying the placement of the pins and performing small surgical accesses to preserve the neuro-vascular structures of the volar aspect of the wrist. To achieve and preserve the reduction of the volar fragment, a third pin was inserted into the fracture with a similar procedure to Kapandji's reduction technique. Results At three-month follow-up, most patients did not experience any pain. In 14 cases, the strength grip was recovered between 75% and 90%, compared to the contralateral hand (Jamar test). In 15 patients, the wrist range of motion was restored with values greater than 100. In 17 cases, forearm pronation-supination was restored to more than 120°. Conclusion In cases of non-comminuted, one or two fragments volar displaced wrist fractures, the elastic-dynamic fixation associated with an intrafocal pinning reduction may be proposed as an alternative to open reduction and internal fixation in elderly patients. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Political Sciences is the property of Republic of Iraq Ministry of Higher Education & Scientific Research (MOHESR) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aim: To evaluate emergency obstetric care education and training within a medical assistant training program, being delivered in a remote, fragile region of Southeast Asia. This will aid in the identification of potential areas of enhancement to improve the management of obstetric emergencies. Design: An ethnographic study, adopting a multi‐methods approach. Methods: Emergency obstetric care education and training will be assessed through documentary analysis and interviews (online or face‐to‐face) with educators and trainers (N ~ 6–7). Student experiences will be explored using in‐person focus groups, facilitated by an external trainer involved in delivering the program (N ~ 10–12). A reflective field diary will provide insight into the lived experience of postgraduate students (N ~ 4–5). Data will be collected between May 2022 and May 2023. The full data set will be triangulated and analysed using the READ approach; (1) ready your materials, (2) extract data, (3) analyse data and (4) distil your findings. Institutional ethical approval was obtained from a university in October 2021, and inter‐country regional access was gained following adherence to their local ethical requirements. Implications for the Profession and Patient Care: The findings from this study may help to inform the future design of the medical assistant training program. It is anticipated that the knowledge gained from this study will enhance the education and training of mid‐level health providers at local, national, and international levels. This work intends to contribute to addressing Sustainable Development Goal 3, Target 1 of reducing maternal mortality to 70:100,000 live births in low‐income countries. Reporting Method: This protocol adhered to the Standards for Reporting Qualitative Research (SRQR) checklist. Patient or Public Contribution: No formal PPI has been undertaken; however, stakeholders involved in delivering the education and training have been consulted. [ABSTRACT FROM AUTHOR]

Ductility is the ability of a material to deform without suffering brittle failure under stresses. Once the load ceases, the acquired deformation maintains over time. On the contrary, a stone is fragile when, subjected to a load, it deforms but, if the load continues, it suddenly breaks. The ductile or fragile facets are homogeneous and isotropic in the stones, but they can mainly vary according to the operating load and temperature. At low temperatures, particularly in polar and subpolar climates, limestone used as a building material and in stone heritage presents an increase in the yield stress. The fragile behavior at lower temperature is higher than at room temperature (20 °C). In this research, the mechanical performance of the Portuguese Blue limestone in dry and saturated conditions and different operating temperatures was accessed in three steps of −20 °C, 0 °C, and + 20 °C. A series of mechanical properties (e.g., uniaxial compressive and flexural strengths, point load strengths index, abrasion resistance, anchorage rupture load, impact resistance, hardness, and abrasion resistance) have been estimated. The results evidence a general progressive increase of the stone’s strengths at low temperature. This is due to a stone decrease in thermal energy and associated reduction in atomic or molecular motion. The reduced motion results in a decrease in internal friction, and it allows the solid to become more rigid, leading to increased mechanical strength. Studying the mechanical properties at various steps of temperatures supports the correct selection of stone materials proper for specific environmental conditions and intended application. [ABSTRACT FROM AUTHOR]

ABSTRACTScience currently faces major external and internal threats. External threats include persistent anti-science attacks, the post-pandemic politicization of public health, and chronic underfunding. Internal threats include a proliferation of low-quality studies, an epidemic of retractions, and questions regarding the reproducibility of important research findings. These threats occur just as humanity faces an unprecedented onslaught of existential challenges including climate change, a failing green revolution, pandemics, and severe environmental degradation of the planet, each of which will require scientific solutions. History shows that science is fragile and vulnerable to theocratic, ideological, and authoritarian forces. In this moment of crisis, it is important for all scientists to become foot soldiers in the defense of science.

Abstract A health system has three key stakeholders, the State—at national and subnational levels—the health service providers and the citizens. In most settings and especially in peacetime, these stakeholders are typically well-defined. In contrast, during conflict and crisis as well as during ceasefire and post-conflict peacebuilding, stakeholders in the health system are often more diverse and contested. Health systems in such settings tend to be more decentralised, de facto—often in addition to de jure decentralisation. Despite much debate on the potential benefits of decentralisation, assessing its impact on health system performance remains difficult and its effect is open to dispute in the literature. This narrative synthesis aims to support efforts to assess and make sense of how decentralisation impacts health system performance in fragile and post-conflict countries—by synthesising evidence on the impact of decentralisation on health system performance from six country case studies: Papua New Guinea, the Philippines, Indonesia, Pakistan, Myanmar and Nepal. The impact of decentralisation on health system performance is optimised when combining centralisation (e.g., the benefits of central coordination in improving efficiency) with decentralisation (e.g., the benefits of local decision making in improving equity and resilience). The findings may inform efforts to think through what to centralise or decentralise, the impacts of those choices, and how the impact may change over time as countries go through and emerge from conflict—and as they go through and recover from the Covid-19 pandemic and prepare for future pandemics.

Background: The elderly population is expanding globally. This gives numerous challenges especially regarding hip fracture patients. In the US alone over 300.000 hip fracture patients are treated each year, and a large amount of those develop opoid addiction. Hip fractures require surgical intervention within 24 h and is associated with significant pain even at rest. Postoperative analgesic treatment need to be optimized to ensure adequate pain relief and to prevent subsequent opioid addiction. Previous studies have shown that methadone effectively decreases post-operative opioid consumption but the studies focused on younger patients undergoing elective surgery. This study focus on the use of methadone on the elderly, fragile patients undergoing acute surgery, by first determining the maximal tolerable dose.The hypothesis is the maximal tolerable doses of these hip-fracture patients lies between 0.10 mg/kg and 0.20 mg/kg. This trial aims to estimate the maximum tolerable dose of methadone when administered to elderly patients undergoing surgery for a hip fracture. Method: This project is an adaptive dose-finding trial. The continuous reassessment method will estimate the maximum tolerable dose of methadone. The primary outcome will be respiratory depression. The statistical analysis plan will be published a priori to the closure of patient recruitment and statistical analysis of database results. Conclusion: The results of this study will give valuable information about the maximally tolerated dose of methadone for postoperative pain relief for elderly patients with hip fractures and potential adverse events.This trial is registered on clinicaltrials.gov with trial registration: NCT05581901. Registered 17 October 2022, https://www.clinicaltrials.gov/ct2/show/NCT05581901?term=methadone&cond = hip&draw = 2&rank = 1.

Attacks on health have become a significant concern for non-belligerents of war, including healthcare personnel and facilities, as witnessed in the ongoing Sudan conflict. About 1.5 billion people in fragile and conflict-affected settings (FCAS) have a heightened need for essential health services. Conflicts often lead to the disruption of the building blocks of health systems, a lack of access to health facilities, the failure of essential medical supply chains, the collapse of political, social and economic systems, the migration of health care workers, and upsurges in illness. While health indicators often decline in conflict, health can also bring peace and harmony among communities. An investment in building resilient health systems and health diplomacy is a neutral starting point for mitigating the repercussions of conflicts. The international commitment towards Sustainable Development Goals (SDGs) provides the impetus to emphasise the relationship between health and peace with the amalgamation of SDG 3, SDG 16, and SDG 17. The inspection of how health diplomacy should be used as a 'tool for peace' and not as leverage in conflict settings must be reiterated by the international community. [ABSTRACT FROM AUTHOR]

Background The pre-sarcopenia is a preclinical state of sarcopenia; which was identified as an age associated muscle disease detected by low muscle mass only and normal muscle function. It can predict the subsequent functional decline. Objective To estimate the prevalence of presarcopenia in Iraqi sample aged =60 years old and determines some socio-demographic factors that may be related. Methods A descriptive cross-sectional community dwelling study. The data obtained from a questionnaire (socio-demographic and behavioral data) in addition to anthropometry and muscle strength measurements. The muscle mass was estimated by anthropometry equation and cutoff points were derived from The European Working Group on Sarcopenia in Older People 2019. Results The result revealed that near quarter of the sample was pre-sarcopenia; 38.3% male and 8.2% female. It was significantly associated with male, single, retirement, smokers, alcoholic, diabetic and normal body mass index elderly, it negatively related to age and fall history and positively with schooling and physically activate. Conclusion Pre-sarcopenia, which is an age associated condition was presented as a considerable prevalence among a sample of older age participants from Baghdad and association with all independent variables. [ABSTRACT FROM AUTHOR]

Copyright of Tropelías: Revista de Teoría de la Literatura y Literatura Comparada is the property of Prensas Universitarias de Zaragoza and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

A health system has three key stakeholders, the State—at national and subnational levels—the health service providers and the citizens. In most settings and especially in peacetime, these stakeholders are typically well-defined. In contrast, during conflict and crisis as well as during ceasefire and post-conflict peacebuilding, stakeholders in the health system are often more diverse and contested. Health systems in such settings tend to be more decentralised, de facto—often in addition to de jure decentralisation. Despite much debate on the potential benefits of decentralisation, assessing its impact on health system performance remains difficult and its effect is open to dispute in the literature. This narrative synthesis aims to support efforts to assess and make sense of how decentralisation impacts health system performance in fragile and post-conflict countries—by synthesising evidence on the impact of decentralisation on health system performance from six country case studies: Papua New Guinea, the Philippines, Indonesia, Pakistan, Myanmar and Nepal. The impact of decentralisation on health system performance is optimised when combining centralisation (e.g., the benefits of central coordination in improving efficiency) with decentralisation (e.g., the benefits of local decision making in improving equity and resilience). The findings may inform efforts to think through what to centralise or decentralise, the impacts of those choices, and how the impact may change over time as countries go through and emerge from conflict—and as they go through and recover from the Covid-19 pandemic and prepare for future pandemics. [ABSTRACT FROM AUTHOR]

Abstract Understanding how health systems respond to shocks has become a pressing need to strengthen response efforts. With already fragmented and disrupted health services, fragile and conflict affected [FCA] countries are more vulnerable to shocks. Previous studies have focused more on conceptualizing health system resilience rather than how health systems [especially in FCA countries] respond to or are resilient to acute shocks. To understand how health systems in FCA countries respond to the shocks and what influence their responses, we conducted a review of the literature published between January 2011 and September 2021 on health system responses to acute shocks in FCA countries. We searched Medline, Embase, Scopus, Jester and Google Scholar – 60 empirical studies in FCA countries on response to sudden, extreme, and unanticipated shocks were included in the review. We found that health systems in FCA countries responded to acute shock using absorptive, adaptive, or transformative capacities. These capacities were mediated by four dimensions of context; knowledge, uncertainties, interdependence, and legitimacy. In addition, we identified the cross-cutting role of community involvement [and its self-evolving nature], frontline workers, and leadership capacity. To our knowledge, this is among the first reviews that focus on FCA country health systems responses to acute shock. By highlighting enabling and constraining factors to each type of capacity, this study provides important lessons and practical strategies from FCA countries on how to absorb, adapt and transform in response to acute shocks – thus promoting health system resilience globally.

Background: Abortion-related complications are one of the five main causes of maternal mortality. However, research about abortion is very limited in fragile and conflict-affected settings. Our study aims to describe the magnitude and severity of abortion-related complications in two referral hospitals supported by Médecins Sans Frontières and located in such settings in northern Nigeria and Central African Republic (CAR). Methods: We used a methodology similar to the World Health Organization (WHO) near-miss approach adapted in the WHO multi-country study on abortion (WHO-MCS-A). We conducted a cross-sectional study in the two hospitals providing comprehensive emergency obstetric care. We used prospective medical records' reviews of women presenting with abortion-related complications between November 2019 and July 2021. We used descriptive analysis and categorized complications into four mutually exclusive categories of increasing severity. Results: We analyzed data from 520 and 548 women respectively in Nigerian and CAR hospitals. Abortion complications represented 4.2% (Nigerian hospital) and 19.9% (CAR hospital) of all pregnancy-related admissions. The severity of abortion complications was high: 103 (19.8%) and 34 (6.2%) women were classified as having severe maternal outcomes (near-miss cases and deaths), 245 (47.1%) and 244 (44.5%) potentially life-threatening, 39 (7.5%) and 93 (17.0%) moderate, and 133 (25.6%) and 177 (32.3%) mild complications, respectively in Nigerian and CAR hospitals. Severe bleeding/hemorrhage was the main type of complication in both settings (71.9% in the Nigerian hospital, 57.8% in the CAR hospital), followed by infection (18.7% in the Nigerian hospital, 27.0% in the CAR hospital). Among the 146 women (Nigerian hospital) and 231 women (CAR hospital) who did not report severe bleeding or hemorrhage before or during admission, anemia was more frequent in the Nigerian hospital (66.7%) compared to the CAR hospital (37.6%). Conclusion: Our data suggests high severity of abortion-related complications in these two referral facilities of fragile and conflict-affected settings. Factors that could contribute to this high severity in these contexts include greater delays in accessing post-abortion care, decreased access to contraceptive and safe abortion care that result in increased unsafe abortions; as well as increased food insecurity leading to iron-deficiencies and chronic anaemia. The results highlight the need for better access to safe abortion care, contraception, and high quality postabortion care to prevent and manage complications of abortion in fragile and conflict-affected settings. [ABSTRACT FROM AUTHOR]

Early treatment with antivirals against SARS-CoV-2 infection can prevent the onset of severe COVID-19 in fragile and immunocompromised patients. In this real-life, prospective, observational study, we evaluated efficacy and safety of a 3-day early treatment with remdesivir in adult and fragile patients with a diagnosis of SARS-CoV-2 infection who referred to the COVID-19 early treatment service of Infectious Diseases Unit of University of Naples Federico from 10 January 2022 to 31 March 2022. The included patients could be treated with either remdesivir alone or with remdesivir plus a monoclonal antibody with activity against SARS-CoV-2. Among the 62 included patients, we showed low rates of hospitalization (8%), increase in oxygen supplementation (3.2%), ICU admission (1.6%) and death (1.6%). The rate of disease progression was 8% and it was similar in patients treated with remdesivir alone or in combination with monoclonal antibodies (6.7% and 9.4%, respectively; p = 0.531). The rate of adverse drug reaction was low and similar in the two groups (13.3% in patients treated with remdesivir, 15.6% in patients treated with the combination; p = 0.543). Most common adverse events were headache and fever. In conclusion, in our cohort of patients at a high risk of worse COVID-19 outcomes, an early course of remdesivir showed low rates of disease progression and adverse drug reactions. [ABSTRACT FROM AUTHOR]

Understanding how health systems respond to shocks has become a pressing need to strengthen response efforts. With already fragmented and disrupted health services, fragile and conflict affected [FCA] countries are more vulnerable to shocks. Previous studies have focused more on conceptualizing health system resilience rather than how health systems [especially in FCA countries] respond to or are resilient to acute shocks. To understand how health systems in FCA countries respond to the shocks and what influence their responses, we conducted a review of the literature published between January 2011 and September 2021 on health system responses to acute shocks in FCA countries. We searched Medline, Embase, Scopus, Jester and Google Scholar – 60 empirical studies in FCA countries on response to sudden, extreme, and unanticipated shocks were included in the review. We found that health systems in FCA countries responded to acute shock using absorptive, adaptive, or transformative capacities. These capacities were mediated by four dimensions of context; knowledge, uncertainties, interdependence, and legitimacy. In addition, we identified the cross-cutting role of community involvement [and its self-evolving nature], frontline workers, and leadership capacity. To our knowledge, this is among the first reviews that focus on FCA country health systems responses to acute shock. By highlighting enabling and constraining factors to each type of capacity, this study provides important lessons and practical strategies from FCA countries on how to absorb, adapt and transform in response to acute shocks – thus promoting health system resilience globally. [ABSTRACT FROM AUTHOR]

Background: Dignity is an important ideal in the nursing of older women who need municipal care. Dignity can be challenged when health is impaired by feeling grief and suffering associated with bodily changes and impaired functions. Aim and research questions: The study aimed to deepen the understanding of the meaning of dignity in the life of fragile older women who daily needed help from municipal care service. The research questions are: What is older women's experience of dignity, and what is it not to be met with dignity when needing service from municipality care? Research design: The study has a qualitative design, and the methodology is based on Gadamer's ontological hermeneutics. Ten women receiving municipal care, aged from 66 to 91 were interviewed in their home environments. Kvale and Brinkmanns' three levels of interpretation were applied in the analysis of the interviews: self-understanding, a critical understanding based on common sense, and theoretical understanding. Ethical considerations: The study follows the guidelines for good scientific practice according to the Declaration of Helsinki and was approved by the Norwegian Centre for Research Data. Results: The interviews revealed fragments of the women's unique life history. Two themes emerged from the interpretation: Confirming encounters provide human dignity; and Not being confirmed as a human being violates human dignity. Conclusions: For the women, dignity is about feeling seen and understood by the individual nurse and this takes place both in conversation and in bodily care. Not being seen or confirmed gives rise to suffering. The reason for this seems to be lack of competence on the part of the staff or little continuity. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Temporary COVID-19 hotels have been established in Italy to assist the homeless people that test positive for SARSCoV-2 and require isolation. This observational study aimed to investigate the characteristics of the subjects who were isolated at the Casa tra Noi COVID-19 hotel in Rome between October 2020 and May 2021 and to estimate the duration of SARSCoV-2 positivity according to their main socio-demographic, behavioural and clinical features. SUBJECTS AND METHODS: Socio-demographic data, clinical history, and anamnestic data of guests were collected by the clinicians reviewing the medical documentation and face-to-face interviewing. Nasopharyngeal swabs were performed every 7 days and the presence of SARS-CoV-2 was assessed by RT-PCR. Median duration of SARSCoV-2 positivity according to socio-demographic, behavioral factors and clinical condition was calculated. RESULTS: The 196 guests (161 males, 82.1%) had a median age of 41 years (IQR: 30-53), and were mostly African (87, 44.4%). Only asymptomatic/paucisymptomatic infections were observed. Almost half of the individuals (84, 42.9%) were affected by at least one co-morbidity, the frequency of which was higher among women (57.1% vs. 39.8%, p=0.06). The date of the negative SARS-CoV-2 molecular test was known for 144 guests (73.5%). Among these, the median duration of positivity was 21 days (IQR: 14-26) and did not significantly vary with age, country of origin, smoking status, alcohol or drug abuse. Among the co-morbidities, only infectious diseases significantly modified the duration of positivity, which increased from 21 to 34 days (p=0.013). CONCLUSIONS: Hotel guests were frequently affected by physical/mental co-morbidities. Duration of SARS-CoV-2 positivity was significantly prolonged only in individuals affected by an infectious disease. [ABSTRACT FROM AUTHOR]

Resumen: La fractura femoral distal (FFD) compleja en el paciente anciano es infrecuente, pero su manejo es un desafío. En estos pacientes frágiles, la FFD se asocia a un elevado riesgo de complicaciones médicas y mortalidad. Su tratamiento óptimo sigue siendo controvertido. El objetivo del estudio es proponer nuestro tratamiento estándar, describir nuestros resultados y discutir su relevancia clínica. Reportamos 3 casos de pacientes ancianas y frágiles con múltiples comorbilidades que presentaron una FFD compleja a causa de un traumatismo de baja energía. Fueron tratadas con éxito mediante un reemplazo femoral distal. Las 3 pacientes presentaron una movilización precoz con carga completa (la media hasta la primera deambulación fue de 5 días), buenos resultados funcionales (la media de rango de movimiento de la rodilla fue de 103̊) y una estancia hospitalaria breve (media de 10 días). Según nuestra experiencia, la artroplastia primaria podría ser una buena elección terapéutica para las FFD complejas en los pacientes ancianos. Abstract: Complex distal femoral fracture (DFF) in the elderly patient is an infrequent but challenging scenario. In these fragile patients, DFF is associated with a high rate of medical complications and mortality. The optimum treatment remains controversial. Our aim is to propose our standard treatment, describe our results and discuss its clinical relevance. We describe 3 cases of elderly and fragile patients with multiple comorbidities who suffered a complex DFF after low energy trauma. They were successfully treated through a primary arthroplasty with distal femoral replacement. All the 3 patients presented early full weight-bearing mobilization (average time to first ambulation was 5 days), good functional outcome (mean knee range of motion was 103°) and short hospital length of stay (mean of 10 days). According to our experience, primary arthroplasty with distal femoral replacement could be a good therapeutic option for complex DFF in elderly patients.

As an effective means to content authentication and privacy protection, reversible data hiding (RDH) permits us to hide a payload such as authentication data in a media file. The resulting marked content will not introduce noticeable artifacts. In order to achieve superior payload-distortion performance, the conventional RDH algorithms often exploit the smooth content for data embedding. Since RDH allows both the embedded payload and the raw content to be perfectly reconstructed, it is required that, the altered smooth regions within the cover should be identified without error by a data receiver. Therefore, a core work in RDH is to design an efficient content-aware algorithm that can enable a data hider to take advantages of the smooth cover elements as much as possible while the detection procedure for the marked elements should be invertible to a data receiver. This has motivated the authors to present a novel patch-level selection and breadth-first prediction strategy for efficient RDH in this paper. However, different from many conventional RDH works, the proposed approach allows a data hider to preferentially and simultaneously use adjacent smooth elements as many as possible, which can benefit data embedding procedure a lot. Experiments show that our work significantly outperforms a part of advanced RDH algorithms in terms of the payload-distortion performance, which has demonstrated the superiority and applicability.

Early treatment with antivirals against SARS-CoV-2 infection can prevent the onset of severe COVID-19 in fragile and immunocompromised patients. In this real-life, prospective, observational study, we evaluated efficacy and safety of a 3-day early treatment with remdesivir in adult and fragile patients with a diagnosis of SARS-CoV-2 infection who referred to the COVID-19 early treatment service of Infectious Diseases Unit of University of Naples Federico from 10 January 2022 to 31 March 2022. The included patients could be treated with either remdesivir alone or with remdesivir plus a monoclonal antibody with activity against SARS-CoV-2. Among the 62 included patients, we showed low rates of hospitalization (8%), increase in oxygen supplementation (3.2%), ICU admission (1.6%) and death (1.6%). The rate of disease progression was 8% and it was similar in patients treated with remdesivir alone or in combination with monoclonal antibodies (6.7% and 9.4%, respectively; p = 0.531). The rate of adverse drug reaction was low and similar in the two groups (13.3% in patients treated with remdesivir, 15.6% in patients treated with the combination; p = 0.543). Most common adverse events were headache and fever. In conclusion, in our cohort of patients at a high risk of worse COVID-19 outcomes, an early course of remdesivir showed low rates of disease progression and adverse drug reactions.

We investigated the movement strategies of young, healthy participants (7 men/7 women) during the movement of a fragile object using nonlinear analysis. The kinematic variables of position, velocity, and acceleration were quantified using largest Lyapunov exponent (LyE) and approximate entropy (ApEn) analysis to identify the structure of their movement variability and movement predictability, respectively. Subjects performed a total of 15 discrete trials of an upper extremity movement task without crushing the object at each fragility condition, using each hand (left/right). We tested four fragility conditions hypothesizing that an increase in fragility would result in higher movement predictability and decreased temporal variability. Comparisons between the structure of movement variability and movement predictability were based on fragility condition, handedness, and kinematic measures. In this specific population, object fragility and participant handedness did not significantly impact the structure of movement variability (LyE) in the primary direction of movement (Z direction), although some effects were observed in the anterior/posterior directions. ApEn values were minimized across conditions, showing increased movement predictability, and is suggested for the analysis of discrete kinematic movements. In healthy populations, the results of this study suggest minimal effects on task performance and movement predictability as a result of object fragility. [ABSTRACT FROM AUTHOR]

Background: Co-production has been widely recognised as a potential means to reduce the dissatisfaction of citizens, the inefficacy of service providers, and conflicts in relations between the former and the latter. However, the benefits of co-production has begun to be questioned: co-production has often been taken for granted, and its effects may not be effective. To understand and prevent unsuccessful citizen and provider collaboration, the recent literature has begun to focus on the causes of co-destruction. This paper investigates how the barriers that may arise during the co-production of a new social service with family carers can be identified and interpreted. Methods: To investigate this topic, we undertook a single case study - a longitudinal project (Place4Carers (Graffigna et al., BMJ Open 10:e037570, 2020)) intended to co-produce a new social care service with and for the family carers of elderly patients living in rural and remote areas. We organised collaborative co-assessment workshops and semi-structured interviews to collect the views of family carers and service providers on the co-production process. A reflexive approach was used in the analysis for collecting the opinions of the research team that participated in the co-production process. Results: The analysis revealed four main co-production barriers: lack of trust, lack of effectiveness of engagement, participants' inability (or impossibility) to change and the lack of a cohesive partnership among partners. Despite these findings, the project increases carers' satisfaction, competence and trust in service providers by demonstrating the positive effects of co-production. Conclusions: Our article confirms that co-creation and co-destruction processes may coexist. The role of researchers and service providers is to prevent or remedy co-destruction effects. To this end, we suggest that in co-production projects, more time should be spent co-assessing the project before, during and after the co-production process. This approach would facilitate the adoption of adjustment actions such as creating mutual trust through conviviality among participants and fostering collaborative research between academia and organisations that are not used to working together. [ABSTRACT FROM AUTHOR]

This paper offers a comprehensive treatment of the question as to whether a binary relation can be consistent (transitive) without being decisive (complete), or decisive without being consistent, or simultaneously inconsistent or indecisive, in the presence of a continuity hypothesis that is, in principle, non-testable. It identifies topological connectedness of the (choice) set over which the continuous binary relation is defined as being crucial to this question. Referring to the two-way relationship as the Eilenberg–Sonnenschein (ES) research program, it presents four synthetic, and complete, characterizations of connectedness and its natural extensions and two consequences that stem from it. The six theorems make connections that have eluded decision theory and thereby generalize the pioneering work of Eilenberg, Sonnenschein, Schmeidler and Sen. We draw the relevance to several applied contexts, as well as to ongoing theoretical work. [ABSTRACT FROM AUTHOR]

The World is going through a tough situation and that is a pandemic caused by the Novel Corona virus which originated in the Wuhan Province of China in December 2019. During this tough and critical situation, the only saviors of humanity are our health care professionals, who restore the faith and trust in humanity and ensure the safety of each individual suffering from this COVID-19 disease. The cherry on the cake is the additional health support provided by the staff of Emergency Medical Services who help the health care workers in treating the patients in hospital, by giving the pre-requisite or the initial treatment during this emergency situation. So to tackle this pandemic, it is important to meet up to the increasing demand of Emergency Medical Services so that the situation remains under control and there is a decrease in mortality. The fragile and fragmented healthcare system of India needs to be upgraded and emphasis needs to be put on developing the Emergency Medical Services so as to strengthen the healthcare system as a whole and to make living better. [ABSTRACT FROM AUTHOR]

Copyright of Revista de Medicina y Cine / Journal of Medicine & Movies is the property of Ediciones Universidad de Salamanca and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Evidence for international first aid guidelines predominantly comes from studies conducted in western contexts during peacetime and/or healthcare settings. Yet, internationally the burden of trauma falls on low- and middle-income countries where lay responders might have to act in fragile contexts, where first aid and healthcare resources are limited or not available. This study focuses on the principles and practices that govern first aid education (FAE), versus clinical evidence of first aid interventions. Accepting that application of first aid may vary according to context, we sought to understand educational principles according to contextual resources of fragile and non-fragile environments. We interviewed educators, from six countries where conflict, geography or resources deemed them to be fragile, to explore which educational approaches were used and found effective in educating potential lay responders. Through qualitative analysis, we identified educational approaches and themes including: The need to take a basic (de-medicalized) approach; Context adaptation; Consideration of the types of injuries and emergencies that learners were likely to face; Engaging learners through active learning approaches; and A focus on critical thinking. We connected a similar set of educational approaches in non-fragile contexts, as reflected in the International First Aid and Resuscitation Guidelines 2016. Recognizing common educational approaches provides educators with a common base on which to develop their educational approach and build future recommendations with global applicability. This also allows for mutual research and application between FAE in fragile and non-fragile environments. Adaptación de la educación en primeros auxilios a contextos frágiles: estudio cualitativo. La evidencia para las guías internacionales de primeros auxilios proviene principalmente de estudios desarrollados en contextos occidentales en tiempos de paz y/o entornos sanitarios. Sin embargo, a nivel internacional la carga del trauma recae en los países con bajos y medianos ingresos, donde los socorristas legos podrían tener que actuar en contextos frágiles, en los que los primeros auxilios y los recursos sanitarios son limitados o no están disponibles. Este estudio se enfoca en los principios y prácticas que rigen la educación en primeros auxilios (EPA), versus la evidencia clínica de las intervenciones en primeros auxilios. Aceptando que la aplicación de los primeros auxilios puede variar según el contexto, buscamos comprender los principios educativos acordes al contexto de los recursos en entornos frágiles y no frágiles. Entrevistamos educadores de seis países que por el conflicto, la geografía o los recursos se consideraban frágiles, con el fin de explorar cuáles enfoques educativos se usaban y eran efectivos para formar a los potenciales socorristas legos. Mediante un análisis cualitativo, identificamos los enfoques educativos y temas incluyendo: La necesidad de un enfoque básico (no medicalizado) Adaptación al contexto. Consideraciones sobre los tipos de lesiones y emergencias que los participantes probablemente enfrentarán. Involucrar a los participantes mediante enfoques de aprendizaje activo; y Un enfoque en pensamiento crítico. Conectamos un conjunto similar de enfoques educativos en contextos no frágiles, como se refleja en las Directrices Internacionales de Primeros Auxilios y Reanimación 2016. Reconocer enfoques educativos comunes les proporciona a los educadores una base común sobre la cual desarrollar su propio enfoque educativo y construir futuras recomendaciones con aplicabilidad global. Esto también permite la investigación y aplicación mutuas entre EPA en entornos frágiles y no frágiles.

We suggest that a measure of a correlation's fragility is the minimum number of items that, when replaced with the group median, result in a nonsignificant correlation on reanalysis. Between January 2000 and July 2021, there were 1769 significant correlations reported in 142 papers published in this journal, and only 51 correlations (2.9%) had available data (scatter plots from which we could digitize the raw data). Twenty-six of these 51 correlations were fragile at 4 or fewer replacements. Five of the reported significant correlations were not significant when we replicated the analysis from the extracted data. [ABSTRACT FROM AUTHOR]

The efficacy and safety of the direct oral anticoagulants (DOACs) in fragile patients (age ≥ 75 years and/or creatinine clearance [CrCl] levels ≤50 mL/min and/or body weight ≤50kg) with venous thromboembolism (VTE) have not been consistently compared. We used the RIETE database to compare the rates of the composite of VTE recurrences or major bleeding during anticoagulation in fragile patients with VTE, according to the use of rivaroxaban or apixaban for initial and long-term therapy. From January 2013 to October 2019, 36,889 patients were recruited, of whom 14,831 (40%) were fragile. Overall, 999 fragile patients (15%) received DOACs starting within the first 48 h: rivaroxaban 711 and apixaban 288. Median duration of therapy was: 113 vs. 111 days. A substantial amount of patients in both subgroups (25% vs. 40%) received non-recommended doses of DOACs. During anticoagulation, 13 patients developed VTE recurrences, 18 had major bleeding and 36 died. When only considering patients receiving recommended doses (n = 705), there were no differences between drugs in the rate of the composite outcome (rate ratio [RR]: 1.08; 95%CI: 0.35–3.30) or all-cause death (RR: 0.99; 95%CI: 0.32–3.08). On multivariable analysis, patients receiving rivaroxaban or apixaban at recommended doses had a similar risk for the composite outcome (hazard ratio: 1.34; 95%CI: 0.35–5.06). The use of rivaroxaban or apixaban at recommended doses in fragile patients with VTE was associated with a similar risk for VTE recurrences or major bleeding. • Fragile patients with VTE are at increased risk for bleeding during anticoagulation. • The use of DOACs in fragile patients with VTE is associated with better outcomes than standard therapy. • Rivaroxaban or apixaban at recommended doses was associated with a similar risk for VTE recurrences or major bleeding. • A substantial amount of patients using DOACs were prescribed non-recommended doses. [ABSTRACT FROM AUTHOR]