Study on the concentration, distribution, and persistence of health spending for the contributory scheme in Colombia.

Colombia is among the countries with the most robust financial protection against personal health spending in the world, with out-of-pocket spending ranking lowest across OECD countries. We investigate the evolution, distribution, and persistence of health spending by age group, sex, health care setting, health condition and geographic region for over 19 million users of Colombia's health system between 2013 and 2021 (contributory scheme). We use average patient-level expenditure data from the Health-Promoting Entities of the Ministry of Health and Social Protection. We applied multivariate statistical techniques such as multiple correspondence analysis, factor maps and correlations. For both sexes, average health expenditure increases gradually with age until 60 years, accelerating thereafter abruptly. Health conditions with the highest percentage of expenditure were those related to neoplasms, blood diseases, circulatory system, pregnancy, puerperium and perinatal period. We found that home-based care in Amazonía-Orinoquía is almost non-existent, and that outpatient care represents a high proportion in all age groups (over 65%) compared to the other regions. There is a strong persistence of expenditure from one year to the next (i.e. they can provide relevant information for prediction), especially in areas with a larger supply of health services such as Bogotá-Cundinamarca. To the authors' knowledge, this is the most comprehensive and detailed micro-analysis of health spending that has been developed for a Latin American country to date.

Novel characterisation of sheep flocks in Wales: A description of principal flock typologies and antimicrobial use patterns.

There is increasing pressure to reduce and refine antimicrobial use (AMU) in farmed livestock, to slow the development of antimicrobial resistance (AMR) and preserve the efficacy of antimicrobials (AMs) in both humans and animals. Developing strategies to help drive the prudent use of AMs requires an understanding of the direct and indirect factors influencing the between-farm variation in AMU typically observed. Given limited evidence of risk factors in sheep, this exploratory study aimed to investigate whether sheep flocks could be classified into farm types based on farm characteristics, health parameters and management practices, and whether important differences existed in AMU between these flock types. This study was conducted on 22 sheep flocks in Wales, United Kingdom as part of a wider longitudinal study on AMU and AMR. Comprehensive surveys were administered to flocks where 147 variables regarding farm characteristics, flock health parameters and management practices were captured. AMU data for each flock were also collated. A Multiple Correspondence Analysis (MCA), followed by a Hierarchical Clustering on Principal Components (HCPC) analysis, were used to classify the flocks. The top 10 dimensions yielded by MCA explained 67.4 % of the total variance. Nine partitions of relatively homogeneous flocks, derived from three typologies produced from the first three cut-points of the HCPC dendrogram, were visualised and described. These nine partitions were characterised by 70 variable categories, principally the implementation or neglect of best-practice lameness management practices. Partitions of flocks that neglected best-practice lameness managements - characterised by delayed treatments of lame sheep, footbathing and bleeding when foot trimming - reported higher lameness prevalence and fewer lame ewes recovering within five days of treatment. These flocks had higher total AMU (mg/PCU) and used a higher mass of injectable AMs than other partitions of flocks. Flock traits, lambing practices, disease challenges and other management factors also described partitions derived in later dendrogram cuts. Findings from this study confirm good AM stewardship in sheep flocks to be a complex picture, given the typologies of flocks described and the range of factors likely to influence AMU. Opportunities for targeted strategies for sustainable reductions in AMU can be directed towards specific flock types identified, specifically within the context of lameness treatment and control. We highlight the importance of understanding flock heterogeneity, through the construction of typologies, as a means to fine-tune appropriate interventions to specific flock types in order to help drive more prudent use of AMs.

Study on the differentiation of sensory quality of mainstream Jiang-flavor baijiu in the Chinese market based on Pivot Profile.

Jiang-flavor baijiu (JFB) is a prominent type of Chinese baijiu, known for its unique flavor attributes, sensory experience, and high tasting value. Previous research has mainly focused on the detection and identification of its flavor substances, but in-depth studies on the precise sensory description and differentiation of its flavor qualities are still lacking. In this study, a rapid sensory analysis method, Pivot Profile (PP), was applied to 30 mainstream JFBs in the Chinese market, generating 91 sensory attributes with independent definitions, from which 29 main sensory attributes were established that were easy to perceive and descriptive, as well as convenient for transmitting their sensory qualities and distinguishing differences in price and production region, including color (one descriptor), aroma (21 descriptors), taste, and mouthfeel (seven descriptors). The nine key sensory attributes that distinguish JFB quality are as follows: Jiang, Grain, Chen, Qu, Rancid, Acid, Sweet, Fullness, and Harmony. It was found that price was positively correlated with sensory quality, with greater variation in the quality of samples within the medium price range (RMB 500-1000). All samples from MTCQ1 (the core production area of Maotai Town) performed better in sensory quality. In addition, salted vegetable showed a high degree of regional characteristics, concentrated in most of the production regions of Guizhou Province. Aroma attributes were more suitable than taste and mouthfeel as sensory indicators for distinguishing production regions. This study has opened the direction of systematic construction of sensory description of JFB and provided a successful case for the evaluation of Chinese baijiu using novel sensory analysis techniques.

Assessing the relationship between river water pollution and the LULC composition of a basin in the Isthmus of Tehuantepec in Oaxaca, Mexico.

Water pollution originating from land use and land cover (LULC) can disrupt river ecosystems, posing a threat to public health, safety, and socioeconomic sustainability. Although the interactions between terrestrial and aquatic systems have been investigated for decades, the scale at which land use practices, whether in the entire basin or separately in parts, significantly impact water quality still needs to be determined. In this research, we used multitemporal data (field measurements, Sentinel 2 images, and elevation data) to investigate how the LULC composition in the catchment area (CA) of each water pollution measurement station located in the river course of the Los Perros Basin affects water pollution indicators (WPIs). We examined whether the CAs form a sequential runoff aggregation system for certain pollutants from the highest to the lowest part of the basin. Our research applied statistical (correlation, time series analysis, and canonical correspondence analysis) and geo-visual analyses to identify relationships at the CA level between satellite-based LULC composition and WPI concentrations. We observed that pollutants such as nitrogen, phosphorus, coliforms, and water temperature form a sequential runoff aggregation system from the highest to the lowest part of the basin. We concluded that the observed decrease in natural cover and increase in built-up and agricultural cover in the upper CAs of the study basin between the study period (2016 to 2020) are related to elevated WPI values for suspended solids and coliforms, which exceeded the allowed limits on all CAs and measured dates.

Comprehensive Statistical Approach to Investigate the Risk Factors Affecting the Occurrences of Cellulitis Episodes among Patients with Lymphedema.

Background: Cellulitis is an infection of the skin and the tissues just under the skin. As any disease, cellulitis has various physiological and physical effects that deteriorate a patient's quality of life. Luckily, cellulitis can be treated when dealt with in a timely fashion. Nonetheless, some patients may experience more than one episode of cellulitis or a recurrence of cellulitis that was previously cured. In fact, the occurrences of cellulitis episodes are believed to follow a statistical distribution. The frequency distribution of cellulitis episodes is scrutinized herein. We aimed to investigate the risk factors that affect the number of cellulitis episodes and the pattern of association between cancer types and cellulitis episodes by using analytical and visual approaches.Methods: A statistical approach applying a two-part count regression model was used instead of the traditional one-part count model. Moreover, multiple correspondence analysis was used to support the finding of count regression models.Results: The results of analysis of the sample from the National Cheng Kung University hospital in Taiwan revealed the mean age of patients was 58.7 ± 14.31 years old. The two-part regression model is conceptually and numerically better than the one-part regression model when examining the risks factors that affect cellulitis episodes. Particularly, we found the significant factors based on the best model are cellulitis history ([Formula: see text]; P value < 0.001), clinical stage of cancer (3) ([Formula: see text]; P value < 0.001), no cancer ([Formula: see text]; P value < 0.05), cancer of female reproductive organs ([Formula: see text]; P value < 0.05), breast cancer ([Formula: see text]; P value < 0.05), and age ≥ 60 years ([Formula: see text]; P value < 0.05). Multiple correspondence analysis approach found cancer types (breast and female reproductive organ), age ≥ 60 years, and cellulitis history were more likely to link to excess zero cellulitis or one cellulitis episode.

Shaping the future research agenda of Cancer Nursing in Italy: Insights and strategic directions.

This report analyzes the evolution of cancer nursing research in Italy, focusing on 207 publications from nursing journals indexed in MEDLINE. Using Latent Dirichlet Allocation, we identified four primary research topics from the included abstracts: Patient-Centered Care, Clinical Nursing Practice, Healthcare Institutions and Systems, and Research and Data Analysis. The temporal trends reveal a shift from foundational studies on healthcare systems in the late 1990s to more recent emphases on patient-centered care and clinical practice. This progression underscores the growing importance of personalized healthcare approaches. Our findings highlight the need for continued investment in innovative nursing interventions and advanced technologies, such as telehealth, to enhance patient outcomes. Research priorities need to investigate how to tailor nursing interventions to individual patient characteristics, such as their cultural background, lifestyle, and personal values, in the area of clinical nursing practice, which is less represented in the literature thus far. The limited publications regarding clinical nursing practice in the Italian context might reflect the need to strengthen cancer nursing as a specialization in Italy to trigger research and practice that address unmet patient needs. The current analysis provides a foundation for future comprehensive studies and strategic development of a research agenda for cancer nursing research in Italy, led by the Italian Association of Cancer Nursing.

Imbalance between Employees and the Organisational Context: A Catalyst for Workplace Bullying Behaviours in Both Targets and Perpetrators.

Research on workplace bullying from the perpetrators' perspective is limited, leading to few interventions tailored to them. This gap stems from insufficient understanding of how organisational conditions and individual dispositions trigger or amplify perpetrator behaviour. To develop effective interventions in preventing bullying, perceived organisational factors were examined. This study, guided by the Job Demands-Resources (JD-R) model and the three-way model of workplace bullying (WB), aims to explore the effects of perceived (im)balances in the task or employee focus, social atmosphere (positive or negative), and hierarchical structure (high or low) in organisations on the incidence of WB, both in terms of perpetrator and target experiences. The research involved 1044 employees from multiple Spanish organisations and sectors: 51.7% in services, 24.6% in education, 14.5% in wholesale and retail trade, and 9.2% in manufacturing. The average age of participants was 35.43 years (SD = 10.9), with a female majority of 61.3%. Using a cross-sectional study design, the experiences of being a target and perpetrator were quantitatively assessed through validated WB target and perpetrator scales. Additionally, the study qualitatively examined employees' perceptions of their organisational context through free descriptions, using adjectives to depict their views. Correspondence analysis was employed to test the hypotheses, and the results affirmed them. The study found that perceived imbalances in organisational focus, social atmosphere, and hierarchy correlate with higher WB target and perpetrator reports, whereas balanced atmospheres correlate with no WB. This research underscores the significance of balanced organisational contexts in mitigating WB. It highlights a gap in the current literature regarding the broader organisational factors that influence bullying and advocates for a more in-depth understanding of these dynamics. Furthermore, it contributes to the existing body of knowledge by offering a comprehensive and harmonised approach to preventing WB, transcending isolated interventions.

Depositional Environment and Ecological Response of Bioconstructions: A Case Study of Southern China (Guizhou Province) in Moscovian-Gzhelian.

From the late Carboniferous to the early Permian, multiple pulses of glaciation and deglaciation have been caused by the LPIA. The Pennsylvanian period experienced phases of recovery, proliferation, and decline, ultimately forming a reef system distinctly different from that of the Mississippian period. During the late Bashkirian to Moscovian, the metazoan reef experienced a limited resurgence, with reef predominantly formed by chaetetid developing in the United States, northern China, and Japan. During the Kasimovian to Gzhelian, the phylloid algal reef dominated the global reef systems. In the late Pennsylvanian, bioconstruction cases and paleoenvironmental proxies in southern Guizhou Province were studied to investigate the composition, recovery, and evolutionary processes of the bioconstructions as well as their response to environmental variations during this period. Several bioconstructions have been reported in the Lumazhai section of Houchang Town, Guizhou Province, southern China, from the Moscovian to the Gzhelian. The upper Carboniferous strata are well-preserved and continuously exposed. The continuous strata, abundant fossils, and diverse bioconstructions provide excellent research materials for exploring the mutual constraints between organisms and their environment. This study identified ten microfacies, whose vertical evolution indicated significant changes in the depositional environment related to relative sea-level fluctuations. Skeletal grains are widely present in these facies. Among them, foraminifera, algae, bryozoans, crinoids, and Tubiphytes are the most common and exhibit distinct distribution characteristics in various environments. Quantitative statistics, CCA and theoretical ecospace have been utilized to examine and interpret environmental impact factors. Quantitative analysis of their relative abundance and distribution patterns provides insights into the complex interactions between organisms and environmental factors. The relative abundances of different organisms and factors controlling their bioconstructions are influenced by relative sea-level changes. CCA analysis reveal that hydrodynamic conditions are the primary influencing factor. Variation trends in average tiering and motility reveal the characteristics of biological communities during environmental changes in phylloid algae and microbial bioconstructions. These bioconstructions are not directly correlated with changes in environmental factors, and the biological communities in phylloid algae mounds and biostromes exhibit similar organism compositions and ecological niches across different environments.

Exploring the Impact of a Structured Educational Approach on Peristomal Skin Complications: An Interim Analysis.

This study, employing an interim analysis, investigates the effects of the Dermamecum protocol, a structured educational and tailored approach that stratifies ostomy patients into risk paths (green, yellow, red) based on pre-operative and post-operative characteristics. The green path indicates a low risk of peristomal skin complications (PSCs), focusing on sustaining healthy behaviours and basic stoma care. The yellow path represents a moderate risk, emphasizing the need for patients to self-monitor and recognize early signs of complications. The red path corresponds to high risk, requiring stringent monitoring and immediate access to healthcare support. The study aims to reduce PSCs and improve patient outcomes. Methods include the stratification of 226 patients, with significant differences in gender distribution, BMI categories, and stoma types across the paths. Results show an occurrence rate of PSCs of 5.9% in all risk paths (5.7% green path, 4.7% yellow path, and 7.9% red path, p = 0.685), significantly lower than the median rate of 35% reported in the literature. Multiple correspondence analysis validated the stratification, with distinct clusters for each path. Poisson regression models in the exploratory framework of an interim analysis identified male gender as the only significant predictor of PSCs, indicating the need for gender-specific interventions. The findings suggest that the Dermamecum protocol effectively reduces early PSCs, providing a foundation for further research.

Relationships between benthic macroinvertebrates and environmental variables of Nyamuhinga River, Lake Kivu southwest basin, Sud-Kivu, Democratic Republic of the Congo.

Benthic macroinvertebrate abundance and taxa richness associated with environmental variables were monitored monthly from September 2015 to August 2016 in the Nyamuhinga River. The benthic macroinvertebrate samples were collected using a D-frame aquatic net employing the man-time method. Environmental variables including pH, temperature, conductivity, and total dissolved solids (TDS) were measured using a Combo HI 98129 and GREISIN-GER 020 multimeters, and water flow was assessed using the Float Method procedure. The Shannon-Wiener and equitability indices were then calculated to assess diversity and richness, facilitating the comparison of diversity within sites or stations. A total of 35,142 macroinvertebrate individuals were collected from the 12 sampling sites belonging to 29 genera, 27 families, and 9 orders. Diptera were the most abundant (71.83%) followed by Odonata (9.13%) and Ephemeroptera (7.11%). The findings showed that taxa richness decreased from upstream to downstream. At the same time, absolute abundance increased from downstream to upstream due to riparian vegetation, substrate type, plant debris, and organic matter which are habitats for benthic macroinvertebrates in the river. Environmental variables such as flow, pH, temperature, conductivity, and TDS varied between sites and stations because of habitat disturbances, contaminant discharges into the catchment, and inflow of tributary waters into the river. The canonical correspondence analysis (CCA) results displayed that Eristalis and Chironomus were strongly associated with the flow, conductivity, TDS, temperature, and pH at the downstream sites related to anthropogenic activities from the catchment. From our results, the Nyamuhinga River needs conservation master plan/guidelines and increased awareness to reduce environmental impacts in Bukavu River catchments in the Lake Kivu basin.

Cross-Sectional Study Assessing Management Practices and Udder Health in California Sheep Flocks and Seroprevalence of Small Ruminant Lentivirus.

(1) Background: Information is lacking on small ruminant lentivirus (SRLV) status, prevalence, risk factors, and control measures for mastitis in California ewes. The goal of this survey was to outline characteristics of the sheep industry in California related to udder health and mastitis management. (2) Methods: An online survey consisting of 48 questions was completed by respondents between April 2022 and February 2023. Descriptive analysis and chi-squared tests were conducted to evaluate associations between variables. A multiple correspondence analysis (MCA) of general management practices, udder health management, and flock demographics was performed to assess clustering. A subset of respondents (20) participated in SRLV serology testing. (3) Results: Seventy-one completed surveys were submitted. The MCA showed two clusters. Larger flock sizes, the use of breeding ewes for meat or wool production or contract grazing, and extensive management practices were more closely related to >5% udder abnormalities per lactation and ≥5% orphan lambs. The flock-level seroprevalence of SRLV was 75% (15/20), and ewe-level seroprevalence was 14.1% (183/1106). (4) Conclusions: The results of this study highlight areas that need further research, such as exploring differences in mastitis and SRLV incidences among management systems, the efficacy of mastitis treatments, and education on critical timepoints for mastitis diagnosis and control.

Patterns and Drivers of Bumblebee Diversity in Gansu.

Understanding the influence of factors responsible for shaping community assemblage is crucial for biodiversity management and conservation. Gansu is one of the richest regions for bumblebee species in the world. We explored the distribution data of 52 bumblebee species collected in Gansu and its surroundings between 2002 and 2022, predicting habitat suitability based on 17 environmental variables using MaxEnt. The factors influencing community assemblage were assessed using canonical correspondence analysis. Net primary productivity, water vapor pressure, temperature seasonality, annual precipitation, and precipitation seasonality were some of the most influential drivers of species distributions. Based on Ward's agglomerative cluster analysis, four biogeographic zones are described: the Southern humid zone, the Western Qilian snow mountain zone, the Eastern Loess plateau zone, and the Western dry mountain zone. In the clusters of grid cells based on beta diversity values, the Southern humid zone comprised 42.5% of the grid cells, followed by the Eastern Loess plateau zone (32.5%), the Western dry mountain zone (20%), and the Western Qilian snow mountain zone (5%). Almost all the environmental factors showed a significant contribution to the assemblages of bumblebees of different groups. Our findings highlight the need for better data to understand species biogeography and diversity patterns, and they provide key baseline data for refining conservation strategies.

Self-purification in tropical upland rivers as affected by environmental factors: the case of Balili River in Benguet, Philippines.

A major data gap in tropical river ecology is the limited documentation of natural water purification of upstream rivers. This study documented the improvement of water quality of downstream Balili River as affected by environmental factors and macrophyte diversity using a mixed-method approach (water quality assessment, plant inventory, field observation, canonical correspondence analysis, community interview). Results showed that the distance from pollution plays a significant role in the self-purification of the river while the floral diversity maintains the riparian from further contaminating the water and at the same time absorbing air pollutants. Generally, the pollution reduction and %change is exponential at 2 and 3 km from point source then taper at 4 and 5 km. At 3 km from the point source, 30% improvement in TDS, BOD and salinity, 25% for EC, 20% in TSS, 35% in WQI, 36% in CPI, and 50% for DO were noted. Key factors that influence the self-purification process in the river were distance from pollution source, elevation, human disturbance (as indicated by %tree canopy) and temperature. These findings highlight the importance of distance from pollution sources and floral diversity in driving water quality improvements, with implications for sustainable water resource management in tropical regions.

This study documented the improvement of water quality of downstream Balili River as affected by environmental factors and macrophyte diversity ­ as contribution to the major data gap in tropical river ecology which currently has limited documentation on natural water purification of upstream rivers. The study also shows the mosaic interplay of water quality, plant diversity, distance from pollution, human disturbance, and air quality in understudied tropical river. Further, this study is unique in documenting the downstream of Balili River since majority of the previous studies were concentrated in the upstream portion of the river.

An investigation on the prevalence and patterns of multi-morbidity among a group of slum-dwelling older women of Kolkata, India.

BACKGROUND: Multi-morbidity is a pervasive and growing issue worldwide. The prevalence of multi-morbidity varies across different populations and settings, but it is particularly common among older adults. It poses substantial physical, psychological, and socio-economic burdens on individuals, caregivers and healthcare systems. In this context, the present study aims to provide an insight on the prevalence and degree of multi-morbidity; and also, on the relationship between level of multi-morbidity and morbid conditions among a group of slum-dwelling older women. METHODS: This community based cross-sectional study was conducted in the slum areas of urban Kolkata, West Bengal, India. It includes total 500 older women, aged 60 years or above. Pre-tested schedules on so-demographic and morbidity profile have canvassed to obtain the information by door-to-door survey. To determine the relationship between the level of multi-morbidity and morbid conditions, correspondence analysis has performed. RESULTS: The study revealed three most prevalent morbid conditions- back and/or joint pain, dental caries/cavity and hypertension. The overall prevalence of multi-morbidity was 95.8% in this group of older women. It was highly over-represented by the oldest-old age group (80 years and above). Majority were found to suffer from five simultaneous morbid conditions that accounted for 15.2% of the total respondents. All of the oldest-old women of this study reported to suffer from more than two medical conditions simultaneously. Three distinct groups were formed based on the inter-relationship between level of multi-morbidity and morbid conditions. The group 1 and 2 represents only 27.8% and 18% of the total sample. Whereas, group 3 comprises the highest level of morbidities (≥ 6) and 52.8% of total sample, and strongly related with general debilities, cardiac problems, asthma/COPD, gastrointestinal, musculoskeletal problems, neurological disorders, hypothyroidism and oral health issues. CONCLUSION: The findings confirmed the assertion that multi-morbidity in slum living older adults is a problem with high prevalence and complexity. This study proposes an easily replicable approach of understanding complex interaction of morbidities that can help further in identifying the healthcare needs of older adults to provide them with healthy and more productive life expectancy.

Clinical Study and Serological Diagnosis of Vector-Borne Pathogens in Sardinian Dogs.

Canine vector-borne diseases (CVBDs) comprise a group of infectious diseases caused by a wide range of pathogens transmitted by arthropod vectors. Clinical signs commonly involve symptoms such as fever, anorexia, weight loss, blood disorders, hepatosplenomegaly, and others that can lead to death in dogs with comorbidities. Some pathogens responsible for CVBDs constitute a serious threat to human health due to their zoonotic transmission. This study aimed to determine the prevalence of zoonotic vector-borne diseases (Rickettsia rickettsii, Anaplasma phagocytophilum, Ehrlichia canis, Bartonella henselae, and Leishmania infantum) in domestic Sardinian dogs with and without clinical signs of these pathogens. Blood serum samples were collected from 142 dogs and examined through serological analysis. Clinical signs suggestive of these pathogens were also evaluated. The results obtained showed that 33 (33/140; 23.6%), 22 (22/134; 16.4%), 14 (14/142; 9.9%), 20 (20/66; 30.3%), and 26 (26/108; 24.1%) dogs were seropositive for Rickettsia sp., Anaplasma sp., Ehrlichia sp., Bartonella sp., and Leishmania sp. antibodies, respectively. Among these dogs, 12 dogs presented with at least one clinical sign (8.5%), while 18 (12.7%) showed more than two symptoms at the same time. Furthermore, among the asymptomatic dogs (93/142; 65.5%), 13% (n = 12) tested positive for A. phagocytophilum, 12% (n = 11) tested positive for B. henselae, 9% (n = 8) tested positive for E. canis, 12% (n = 11) tested positive for L. infantum, and 19% (n = 18) tested positive for R. rickettsii. This survey represents the first study assessing different canine vector-borne pathogens in dogs from North Sardinia. Since the pathogens detected here represent emerging zoonotic diseases, these results highlight the need to undertake further studies to increase the knowledge of these under-reported vector-borne pathogens in Sardinia.

From percentages to narratives: Giving silence a voice in child sexual abuse within the Portuguese Catholic Church, 1950-2022.

BACKGROUND: Over the last two decades, several studies have examined the extent and expression of child sexual abuse (CSA) in religious institutions. In 2021, following new Vatican guidelines and under intense public pressure, the Portuguese Episcopal Conference commissioned a study on CSA in Portugal by members of the Portuguese Catholic Church (PCC) and others associated with it (from 1950 to 2022). OBJECTIVE AND METHODS: The study draws on a web-based survey and a respondent driven sample. The questionnaire included categorical questions about victims, abusers, types of abuse, and open-ended questions. We characterized victims and abusers and developed a social cartography of abuse using Correspondence Analysis. Victims' narratives are also part of the model of analysis. RESULTS: We validated 512 of CSA by members of the PCC. Boys were more frequently abused (57.2 % vs. 42.2 %); male abusers predominate (96.7 %); most victims were abused more than once (57 %); the average age of victims when the first abuse occurred was 11.2 years. More invasive forms of abuse predominate (80 % manipulation of sexual organs or penetration; only 20 % had no body touching). There are patterns of abuse, and space plays a pivotal role in understanding the forms that CSA takes within Catholic environments. The richness of individual narratives was an unexpected outcome that enables us to better understand the organisational and symbolical power structures in which abuse takes place. CONCLUSION: Given the characteristics of our sample, these cases are the tip of the iceberg, with CSA within the PCC likely involved thousands of children. Further research should strive to consider victims' narratives.

Investigating the effect of prescribing status and patient characteristics on the therapeutic outcomes in patients with diabetes using a leftover drug adjustment protocol.

Treatment for diabetes includes anti-diabetic medication in addition to lifestyle improvements through diet and exercise. In Japan, protocol-based pharmacotherapy management allows drug treatment to be provided through cooperation between physicians and pharmacists, based on a protocol that is prepared and agreed upon in advance. However, there are no studies to clarify the relationship between patient characteristics and therapeutic effects after pharmacist intervention in protocol-based pharmacotherapy management for patients with diabetes. Therefore, this study aimed to use protocol-based reports from pharmacies to understand the status of outpatient diabetes medication compliance. We classified patients with diabetes on the basis of patient characteristics that can be collected in pharmacies and investigated the characteristics that impacted diabetes treatment. Patients were prescribed oral anti-diabetic drugs at outpatient clinics of Hitachinaka General Hospital, Hitachi, Ltd., from April 2016 to March 2021. Survey items included patient characteristics (sex, age, number of drugs used, observed number of years of anti-diabetic drug prescription, number of anti-diabetic drug prescription days, and presence or absence of leftover anti-diabetic drugs) and HbA1c levels. Graphical analyses indicated the relationship between each categorised patient characteristic using multiple correspondence analyses. Subsequently, the patients were clustered using K-means cluster analysis based on the coordinates obtained for each patient. Patient characteristics and HbA1c values were compared between the groups for each cluster. A total of 1,910 patients were included and classified into three clusters, with clusters 1, 2, and 3 containing 625, 703, and 582 patients, respectively. Patient characteristics strongly associated with Cluster 1 were ages between 65 and 74 years, use of three or more anti-diabetic drugs, use of 3 years or more of anti-diabetic drugs, and leftover anti-diabetic drugs. Furthermore, Cluster 1 had the highest number of patients with worsening HbA1c levels compared with other clusters. Using the leftover drug adjustment protocol, we clarified the patient characteristics that affected the treatment course. We anticipate that through targeted interventions in patients exhibiting these characteristics, we can identify those who are irresponsibly continuing with drug treatment, are not responding well to therapy, or both. This could substantially improve the efficacy of their anti-diabetic care.

Causal Forest Machine Learning Analysis of Parkinson's Disease in Resting-State Functional Magnetic Resonance Imaging.

In recent years, Artificial Intelligence has been used to assist healthcare professionals in detecting and diagnosing neurodegenerative diseases. In this study, we propose a methodology to analyze functional Magnetic Resonance Imaging signals and perform classification between Parkinson's disease patients and healthy participants using Machine Learning algorithms. In addition, the proposed approach provides insights into the brain regions affected by the disease. The functional Magnetic Resonance Imaging from the PPMI and 1000-FCP datasets were pre-processed to extract time series from 200 brain regions per participant, resulting in 11,600 features. Causal Forest and Wrapper Feature Subset Selection algorithms were used for dimensionality reduction, resulting in a subset of features based on their heterogeneity and association with the disease. We utilized Logistic Regression and XGBoost algorithms to perform PD detection, achieving 97.6% accuracy, 97.5% F1 score, 97.9% precision, and 97.7%recall by analyzing sets with fewer than 300 features in a population including men and women. Finally, Multiple Correspondence Analysis was employed to visualize the relationships between brain regions and each group (women with Parkinson, female controls, men with Parkinson, male controls). Associations between the Unified Parkinson's Disease Rating Scale questionnaire results and affected brain regions in different groups were also obtained to show another use case of the methodology. This work proposes a methodology to (1) classify patients and controls with Machine Learning and Causal Forest algorithm and (2) visualize associations between brain regions and groups, providing high-accuracy classification and enhanced interpretability of the correlation between specific brain regions and the disease across different groups.

Generation of nighttime pedestrian fatal precrash scenarios at junctions in Tamil Nadu, India, using cluster correspondence analysis.

OBJECTIVE: Modern transportation amenities and lifestyles have changed people's behavioral patterns while using the road, specifically at nighttime. Pedestrian and driver maneuver behaviors change based on their exposure to the environment. Pedestrians are more vulnerable to fatal injuries at junctions due to increased conflict points with vehicles. Generation of precrash scenarios allows drivers and pedestrians to understand errors on the road during driver maneuvering and pedestrian walking/crossing. This study aims to generate precrash scenarios using comprehensive nighttime fatal pedestrian crashes at junctions in Tamil Nadu, India. METHODS: Though numerous studies were available on identifying pedestrian crash patterns, only some focused on identifying crash patterns at junctions at night. We used cluster correspondence analysis (CCA) to address this research gap to identify the patterns in nighttime pedestrian fatal crashes at junctions. Further, high-risk precrash scenarios were generated based on the positive residual means available in each cluster. This study used crash data from the Road Accident Database Management System of Tamil Nadu State in India from 2009 to 2018. Characteristics of pedestrians, drivers, vehicles, crashes, light, and roads were input to the CCA to find optimal clusters using the average silhouette width, Calinski-Harabasz measure, and objective values. RESULTS: CCA found 4 clusters with 2 dimensions as optimal clusters, with an objective value of 3.3618 and a valence criteria ratio of 80.03%. Results from the analysis distinctly clustered the pedestrian precrash behaviors: Clusters 1 and 2 on pedestrian walking behaviors and clusters 3 and 4 on crossing behaviors. Moreover, a hidden pattern was observed in cluster 4, such as transgender drivers involved in fatal pedestrian crashes at junctions at night. CONCLUSION: The generated precrash scenarios may be used to train drivers (novice and inexperienced for nighttime driving), test scenario creation for developing advanced driver/rider assistance systems, hypothesis creation for researchers, and planning of effective strategic interventions for engineers and policymakers to change pedestrian and driver behaviors toward sustainable safety on Indian roads.

Altitudinal Impact on Phytochemical Composition and Mycorrhizal Diversity of Taxus Contorta Griff in the Temperate Forest of Shimla District.

Taxus contorta (family Taxaceae) is a native plant of temperate region of western Himalaya. The current study investigated the effect of altitude on the phytochemical composition and mycorrhizal diversity, associated with distribution of T. contorta in Shimla district, Himachal Pradesh, India. Quantitative phytochemical analysis of the leaf extracts indicated that alkaloid levels decreased with altitude, with the highest value in Himri's methanol extracts (72.79 ± 1.08 mg/g) while phenol content increased with altitude, peaking in Nankhari's methanol extracts (118.83 ± 5.90 mg/g). Saponin content was higher in methanol extracts (78.13 ± 1.66 mg/g in Nankhari, 68.06 ± 1.92 mg/g in Pabbas, and 56.32 ± 1.93 mg/g in Himri). Flavonoid levels were notably higher in chloroform extracts, particularly in Nankhari (219.97 ± 2.99 mg/g), and positively correlated with altitude. Terpenoids were higher in chloroform extracts at Himri (11.34 ± 0.10 mg/g) and decreased with altitude. Taxol content showed minimal variation between solvents and altitudes (4.53-6.98 ppm), while rutin was only detected in methanol extracts (1.31-1.46 ppm). Mycorrhizal spore counts in T. contorta's rhizosphere varied with altitude: highest at Himri (77.83 ± 2.20 spores/50 g soil), decreasing to Pabbas (68.06 ± 1.96 spores/50 g soil) and lowest at Nankhari (66.00 ± 2.77 spores/50 g soil), with 17 AMF species identified overall, showing significant altitudinal influence on spore density. The rhizosphere of T. contorta was shown to be dominated by the Glomus species. The rhizospheric soil of the plant was found to be slightly acidic. Organic carbon and available potassium content decreased contrasting with increasing available nitrogen and phosphorus with altitude. Correlation data showed strong negative links between organic carbon (-0.83), moderate positive for nitrogen (0.46) and phosphorus (0.414), and moderate negative for potassium (-0.56) with the altitude. This study provides a comprehensive insight into changes in phytochemical constituents, mycorrhizal diversity and soil composition of T. contorta along a range of altitude.