Barriers to blockchain adoption in the seaport industry: A fuzzy DEMATEL analysis.

Blockchain technology, marked as a disruptive force across various sectors, including seaport logistics, faces challenges and obstacles that impede its effective adoption. We aim to empirically identify the significant barriers impeding blockchain adoption in the seaport industry and elucidate the interconnected relationships between these impediments. Utilizing the Fuzzy Decision-Making Trial and Evaluation Laboratory Analysis (Fuzzy DEMATEL) technique, we quantify the cause-and-effect relationships between various barriers to blockchain adoption. Structured interviews involving 18 experts were conducted, collecting both qualitative interview data and quantitative data. The nature of ports and the maritime industry did not seem to be accurately reflected in the literature about blockchain adoption, presenting several new findings in this study. Four primary obstacles were identified: 1) Lack of management support and commitment. 2) Issues in supply chain collaboration, communication and coordination. 3) Resistance from and lack of involvement of external stakeholders. 4) The high cost. Furthermore, cost was reaffirmed as a significant factor influencing blockchain adoption. We enhance existing literature by revealing the interdependencies among identified barriers and offers insights for policymakers and industry practitioners. We aim to foster successful blockchain integration in the seaport industry, improving its sustainability performance. During this research, it has been acknowledged by the business sector that the effective employment of business process re-engineering (BPR) and the strategic implementation of blockchain technology are crucial strategies to surmount the obstacles that have impeded the extensive integration of blockchain within port operations.

Blockchain-Based Frameworks for Food Traceability: A Systematic Review.

With the rise of globalization and technological competition, the food supply chain has grown more complex due to the multiple players and factors involved in the chain. Traditional systems fail to offer effective and reliable traceability solutions considering the increasing requirement for accountability and transparency in the food supply chain. Blockchain technology has been claimed to offer the food industry a transformative future. The inherent features of blockchain, including immutability and transparency, create a dependable and secure system for tracking food products across the whole supply chain, ensuring total control over their traceability from the origin to the final consumer. This research offers a comprehensive overview of multiple models to understand how the integration of blockchain and other digital technologies has transformed the food supply chain. This comprehensive systematic review of blockchain-based food-supply-chain frameworks aimed to uncover the capability of blockchain technology to revolutionize the industry and examined the current landscape of blockchain-based food traceability solutions to identify areas for improvement. Furthermore, the research investigates recent advancements and investigates how blockchain aligns with other emerging technologies of Industry 4.0 and Web 3.0. Blockchain technology plays an important role in improving food traceability and supply-chain operations. Potential synergies between blockchain and other emerging technologies of Industry 4.0 and Web 3.0 are digitizing food supply chains, which results in better management, automation, efficiencies, sustainability, verifiability, auditability, accountability, traceability, transparency, tracking, monitoring, response times and provenance across food supply chains.

Early and intensive Motor Training for people with spinal cord injuries (the SCI-MT Trial): description of the intervention.

STUDY DESIGN: Descriptive. OBJECTIVES: The primary objective is to describe the intervention that will be provided in a large multi-centre randomised controlled trial titled: Early and Intensive Motor Training for people with Spinal Cord Injuries (the SCI-MT Trial). The secondary objective is to describe the strategies that will be used to operationalise and standardise the Motor Training provided to participants while keeping the intervention person-centred. METHODS: The paper focuses on the rationale and principles of Motor Training for people with spinal cord injuries (SCI). The description of the intervention is based on the Template for Intervention Description and Replication (TIDieR) checklist. Specifically, it addresses the following 6 criteria of the TIDieR checklist: why the effectiveness of Motor Training is being examined; what, how, where and when the Motor Training will be administered; and how much Motor Training will be provided. RESULTS: A detailed intervention manual has been developed to help standardise the delivery of the intervention. CONCLUSIONS: This paper describes the details of a complex intervention administered as part of a large randomised controlled trial. It will facilitate the subsequent interpretation of the trial results and enable the intervention to be reproduced in clinical practice and future trials.

Challenges and opportunities for educating health professionals after the COVID-19 pandemic.

The education of health professionals substantially changed before, during, and after the COVID-19 pandemic. A 2010 Lancet Commission examined the 100-year history of health-professional education, beginning with the 1910 Flexner report. Since the publication of the Lancet Commission, several transformative developments have happened, including in competency-based education, interprofessional education, and the large-scale application of information technology to education. Although the COVID-19 pandemic did not initiate these developments, it increased their implementation, and they are likely to have a long-term effect on health-professional education. They converge with other societal changes, such as globalisation of health care and increasing concerns of health disparities across the world, that were exacerbated by the pandemic. In this Health Policy, we list institutional and instructional reforms to assess what has happened to health-professional education since the publication of the Lancet Commission and how the COVID-19 pandemic altered the education process.

Genomic surveillance of SARS-CoV-2 Omicron variants on a university campus.

Novel variants continue to emerge in the SARS-CoV-2 pandemic. University testing programs may provide timely epidemiologic and genomic surveillance data to inform public health responses. We conducted testing from September 2021 to February 2022 in a university population under vaccination and indoor mask mandates. A total of 3,048 of 24,393 individuals tested positive for SARS-CoV-2 by RT-PCR; whole genome sequencing identified 209 Delta and 1,730 Omicron genomes of the 1,939 total sequenced. Compared to Delta, Omicron had a shorter median serial interval between genetically identical, symptomatic infections within households (2 versus 6 days, P = 0.021). Omicron also demonstrated a greater peak reproductive number (2.4 versus 1.8), and a 1.07 (95% confidence interval: 0.58, 1.57; P < 0.0001) higher mean cycle threshold value. Despite near universal vaccination and stringent mitigation measures, Omicron rapidly displaced the Delta variant to become the predominant viral strain and led to a surge in cases in a university population.

Characterization of Buriti (Mauritia flexuosa) Pulp Oil and the Effect of Its Supplementation in an In Vivo Experimental Model.

Mauritia flexuosa (Buriti) pulp oil contains bioactive substances and lipids that are protective against cardiovascular and inflammatory diseases. We performed physical and chemical analyses to verify its quality and stability. Buriti oil was stable according to the Rancimat test, presenting an induction period of 6.6 h. We evaluated the effect of supplementation with crude buriti oil and olive oil on metabolic parameters in 108 Swiss mice for 90 days. We investigated six groups: extra virgin olive oil (EVOO) 1 and 2 (1000 and 2000 mg/kg), buriti oil (BO) 1 and 2 (1000 and 2000 mg/kg), synergic (S) (BO1 + EVOO1), and control (water dose 1000 mg/kg). The animals were euthanized to examine their blood, livers, and fats. The supplementation did not interfere with food consumption, weight gain, and histological alterations in the liver. Group S showed the strongest relationship with the fractions HDL-c and non-HDL-c, indicating a possible cardioprotective effect. Moreover, we observed significantly higher IL-6 levels in the control, EVOO2, and BO1 groups than in the EVOO1 group. Resistin was also significantly higher for the synergic treatment than for the control. We conclude that BO combined with EVOO could be an excellent food supplement for human consumption.

Transportation capacity shortage influence on logistics performance: evidence from the driver shortage.

The study aims to provide an in-depth analysis of a transportation capacity shortage issue affecting Australian logistics service providers. Transportation capacity shortage is an important issue in all transportation modes. In this study, the driver shortage is viewed as an antecedent variable to estimate the impact of transportation capacity shortage on logistics performance. This study investigates the underlying relationships between driver shortage, logistics capability, and logistics performance according to resource-based theory. Structural equation modeling (SEM) was used to analyze the measurement models and structural model. The empirical results illustrate that driver shortage indirectly influences logistics performance, the logistics capability is a mediator factor in the relationship between driver shortage and logistics performance in logistics service providers. We argue that this provides valuable insights for transportation capacity shortage management.

Pareidolia in a Built Environment as a Complex Phenomenological Ambiguous Stimuli.

Pareidolia is a kind of misperception caused by meaningless, ambiguous stimuli perceived with meaning. Pareidolia in a built environment may trigger the emotions of residents, and the most frequently observed pareidolian images are human faces. Through a pilot experiment and an in-depth questionnaire survey, this research aims to compare built environmental pareidolian phenomena at different time points (6 a.m., 12 p.m., 2 a.m.) and to determine people's sensitivity and reactions towards pareidolia in the built environment. Our findings indicate that the differences in stress level do not influence the sensitivity and reactions towards pareidolia in the built environment; however, age does, and the age of 40 seems to be a watershed. Females are more likely to identify pareidolian faces than males. Smokers, topers, and long-term medicine users are more sensitive to pareidolian images in the built environment. An unexpected finding is that most pareidolian images in built environments are much more easily detected in the early morning and at midnight but remain much less able to be perceived at midday. The results help architects better understand people's reactions to pareidolia in the built environment, thus allowing them to decide whether to incorporate it appropriately or avoid it consciously in building design.

Mapping the emergence of SARS-CoV-2 Omicron variants on a university campus

Novel variants continue to emerge in the SARS-CoV-2 pandemic. University testing programs may provide timely epidemiologic and genomic surveillance data to inform public health responses. We conducted testing from September 2021 to February 2022 in a university population under vaccination and indoor mask mandates. A total of 3,048 of 24,393 individuals tested positive for SARS-CoV-2 by RT-PCR; whole genome sequencing identified 209 Delta and 1,730 Omicron genomes of the 1,939 total sequenced. Compared to Delta, Omicron had a shorter median serial interval between genetically identical, symptomatic infections within households (2 versus 6 days, P=0.021). Omicron also demonstrated a greater peak reproductive number (2.4 versus 1.8) and a 1.07 (95% confidence interval: 0.58, 1.57; P<0.0001) higher mean cycle threshold value. Despite near universal vaccination and stringent mitigation measures, Omicron rapidly displaced the Delta variant to become the predominant viral strain and led to a surge in cases in a university population.

Evaluating factors associated with the cancellation and delay of elective surgical procedures: a systematic review.

BACKGROUND: Elective surgery cancellation is considered a fundamental problem in health care services-it causes considerable disruption to patient flow, further eroding often already stretched operating capacity, and consequentially reduces both hospital performance and patient satisfaction. This research presents a systematic review (SR) of the reasons for surgery cancellation among different hospitals and countries. By highlighting these causes, we identify how to reduce cancellations, thereby improving the use of surgical capacity and resources and creating a more predicable patient flow. METHODS: An SR was performed on elective surgery cancellation in compliance with the Preferred Reporting Items for Systematic Review and Meta-Analysis and by assessing the methodological quality of SR with Measurement Tool to Assess Systematic Reviews guidelines. RESULTS: There are different reasons for surgery cancellation that vary between hospitals. This SR demonstrates that hospital-related causes (e.g. unavailable operation room time, inappropriate scheduling policy and lack of beds) are the primary reason for surgery cancellation, followed by work-up related causes (e.g. medically unfit and changes in the treatment plan) and patient-related causes (e.g. absence of a patient and patient refusal). CONCLUSION: This review demonstrates that the main causes for surgery cancellation can be controlled by hospital managers, who can aim to improve areas such as patient flow and capacity management. Ultimately, this will improve the quality of healthcare delivered by hospitals.

Acoustic Reflexes in Aural Atresia Patients: Evidence of an Intact Efferent System?

OBJECTIVE: To record crossed acoustic reflex thresholds (xART's) postoperatively from patients after surgical repair of unilateral congenital aural atresia (CAA). To seek explanations for when xARTs can and cannot be recorded. We hope to understand the implications for this central auditory reflex despite early afferent deprivation. METHODS: Patients who underwent surgery to correct unilateral CAA at a tertiary academic medical were prospectively enrolled to evaluate for the presence of xART. Preoperative ARTs in the normal (non-atretic) ear, and postoperative ipsilateral ARTs (stimulus in the normal ear) and contralateral ARTs (stimulus in the newly reconstructed atretic ear; record in the normal ear) were measured at 500, 1000, and 2000 Hz. RESULTS: Four of 11 patients with normal ipsilateral reflex thresholds preoperatively demonstrated crossed acoustic reflexes postoperatively (stimulus in reconstructed ear; record from normal ear). Four other patients demonstrated normal ipsilateral thresholds preoperatively but did not have crossed reflexes postoperatively. No reflexes (pre- or postoperatively) could be recorded in 3 patients. Crossed reflex threshold is significantly correlated with the postoperative audiometric threshold. There was no correlation between ipsilateral and contralateral reflex thresholds. CONCLUSION: Crossed acoustic reflexes can be recorded from some but not all postoperative atresia patients, and the thresholds for those reflexes correlate with the postoperative pure tone threshold. The presence of acoustic reflexes implies an intact CN VIII-to-opposite CN VII central reflex arc despite early unilateral sound deprivation.

A stochastic variational framework for Recurrent Gaussian Processes models.

Gaussian Processes (GPs) models have been successfully applied to the problem of learning from sequential observations. In such context, the family of Recurrent Gaussian Processes (RGPs) have been recently introduced with a specifically designed structure to handle dynamical data. However, RGPs present a limitation shared by most GP approaches: they become computationally infeasible when facing very large datasets. In the present work, with the aim of improving scalability, we modify the original variational approach used with RGPs in order to enable inference via stochastic mini-batch optimization, giving rise to the Stochastic Recurrent Variational Bayes (S-REVARB) framework. We review recent related literature and comprehensively contextualize it with our approach. Moreover, we propose two learning procedures, the Local and Global S-REVARB algorithms, which prevent computational costs from scaling with the number of training samples. The global variant permits even greater scalability by also preventing the number of variational parameters from increasing with the training set, through the use of neural networks as sequential recognition models. The proposed framework is evaluated in the task of dynamical system identification for large scale datasets, a scenario not readily supported by the standard batch inference for RGPs. The promising results indicate that the S-REVARB framework opens up the possibility of applying powerful hierarchical recurrent GP-based models to massive sequential data.

Quantification of Head Acceleration during Vestibular Rehabilitation Exercises.

PURPOSE: Vestibular rehabilitation exercises have been proven to reduce symptoms and diminish the risk of falls in those with dizziness and balance impairments. The first purpose of this study is to investigate a new method of measuring head movements during habituation vestibular rehabilitation exercises. The second is to explore the relationship between head acceleration measurements during select traditional vestibular rehabilitation exercises and the variables of age, dizziness, and poor balance confidence. RESEARCH DESIGN: A descriptive, cross-sectional study, in a university setting. STUDY SAMPLE: Fifty-two participants, ranging in age from 20 to 96 yr. All were volunteers, with the majority (34) reporting no history of dizziness or balance confidence. DATA COLLECTION: Head accelerations were calculated from linear and angular displacements as measured by magnetometry. RESULTS: Head accelerations decreased with increasing age, dizziness, and low balance confidence during four habituation exercises. CONCLUSIONS: Head acceleration varies as a function of age, dizziness, and low balance confidence during head movement-based vestibular and balance rehabilitation therapy (habituation) exercises. The magnetometry measurement method used could be applied across the course of treatment to establish predictive measures based on change in acceleration over time. More diverse participant sampling is needed to create normative data.

Coordinated Plasticity of Synapses and Astrocytes Underlies Practice-Driven Functional Vicariation in Peri-Infarct Motor Cortex.

Motor rehabilitative training after stroke can improve motor function and promote topographical reorganization of remaining motor cortical movement representations, but this reorganization follows behavioral improvements. A more detailed understanding of the neural bases of rehabilitation efficacy is needed to inform therapeutic efforts to improve it. Using a rat model of upper extremity impairments after ischemic stroke, we examined effects of motor rehabilitative training at the ultrastructural level in peri-infarct motor cortex. Extensive training in a skilled reaching task promoted improved performance and recovery of more normal movements. This was linked with greater axodendritic synapse density and ultrastructural characteristics of enhanced synaptic efficacy that were coordinated with changes in perisynaptic astrocytic processes in the border region between head and forelimb areas of peri-infarct motor cortex. Disrupting synapses and motor maps by infusions of anisomycin (ANI) into anatomically reorganized motor, but not posterior parietal, cortex eliminated behavioral gains from rehabilitative training. In contrast, ANI infusion in the equivalent cortical region of intact animals had no effect on reaching skills. These results suggest that rehabilitative training efficacy for improving manual skills is mediated by synaptic plasticity in a region of motor cortex that, before lesions, is not essential for manual skills, but becomes so as a result of the training. These findings support that experience-driven synaptic structural reorganization underlies functional vicariation in residual motor cortex after motor cortical infarcts.SIGNIFICANCE STATEMENT Stroke is a leading cause of long-term disability. Motor rehabilitation, the main treatment for physical disability, is of variable efficacy. A better understanding of neural mechanisms underlying effective motor rehabilitation would inform strategies for improving it. Here, we reveal synaptic underpinnings of effective motor rehabilitation. Rehabilitative training improved manual skill in the paretic forelimb and induced the formation of special synapse subtypes in coordination with structural changes in astrocytes, a glial cell that influences neural communication. These changes were found in a region that is nonessential for manual skill in intact animals, but came to mediate this skill due to training after stroke. Therefore, motor rehabilitation efficacy depends on synaptic changes that enable remaining brain regions to assume new functions.

Effect of Buffer Conditions and Organic Cosolvents on the Rate of Strain-Promoted Azide-Alkyne Cycloaddition.

We investigate the effect of buffer identity, ionic strength, pH, and organic cosolvents on the rate of strain-promoted azide-alkyne cycloaddition with the widely used DIBAC cyclooctyne. The rate of reaction between DIBAC and a hydrophilic azide is highly tolerant to changes in buffer conditions but is impacted by organic cosolvents. Thus, bioconjugation reactions using DIBAC can be carried out in the buffer that is most compatible with the biomolecules being labeled, but the use of organic cosolvents should be carefully considered.

Emergence of Binaural Summation After Surgical Correction of Unilateral Congenital Aural Atresia.

OBJECTIVE: To investigate the emergence of binaural summation in patients with unilateral congenital aural atresia undergoing surgical correction. STUDY DESIGN: Preoperative and postoperative audiometric testing in a prospective cohort of 10 patients with unilateral congenital aural atresia. SETTING: University-based tertiary care center. PATIENTS: Ten patients (ages 6-53) with an average 69 dB (±9 dB sd) unilateral conductive hearing loss, normal hearing in the nonatretic ear, and normal bone conduction in the atretic ear. INTERVENTIONS: Pre- and postoperative hearing in noise test in quiet and in noise. MAIN OUTCOME MEASURES: Levels of sentences presented from a single central speaker were adaptively varied to determine a speech reception threshold (SRT), first in quiet and then with simultaneous multitalker babble at 65 dB SPL from the same speaker. RESULTS: Preoperative SRT was worse than normal controls in both quiet (p = 0.001) and in noise (p = 0.05), as expected. Postoperative SRT in quiet improved 3.5 dB (marginally significant with one-tailed p value of 0.05); thresholds in noise improved an insignificant 0.8 dB (one-tailed p = 0.2). Converting results to dB-worse-than normal, atresia patients did better in noise (relative to normal) than in quiet (p = 0.008). CONCLUSION: The expected summation effect (3 dB) occurs after atresia surgery in quiet but not in noise. Relative to normal, these patients performed better in noise than quiet, perhaps because these patients develop skills attending to threshold-level speech in noise during their years without binaural benefit.

Synthesis and characterization of TiO2 and TiO2/Ag for use in photodegradation of methylviologen, with kinetic study by laser flash photolysis.

This paper reports the synthesis, characterization, and application of TiO2 and TiO2/Ag nanoparticles for use in photocatalysis, employing the herbicide methylviologen (MV) as a substrate for photocatalytic activity testing. At suitable metal to oxide ratios, increases in silver surface coating on TiO2 enhanced the efficiency of heterogeneous photocatalysis by increasing the electron transfer constant. The sol-gel method was used for TiO2 synthesis. P25 TiO2 was the control material. Both oxides were subjected to the same silver incorporation process. The materials were characterized by conventional spectroscopy, SEM micrography, X-ray diffraction, calculation of surface area per mass of catalyst, and thermogravimetry. Also, electron transfers between TiO2 or TiO2/Ag and MV in the absence and presence of sodium formate were investigated using laser flash photolysis. Oxides synthesized with 2.0 % silver exhibited superior photocatalytic activity for MV degradation.

The Bangladesh paradox: exceptional health achievement despite economic poverty.

Bangladesh, the eighth most populous country in the world with about 153 million people, has recently been applauded as an exceptional health performer. In the first paper in this Series, we present evidence to show that Bangladesh has achieved substantial health advances, but the country's success cannot be captured simplistically because health in Bangladesh has the paradox of steep and sustained reductions in birth rate and mortality alongside continued burdens of morbidity. Exceptional performance might be attributed to a pluralistic health system that has many stakeholders pursuing women-centred, gender-equity-oriented, highly focused health programmes in family planning, immunisation, oral rehydration therapy, maternal and child health, tuberculosis, vitamin A supplementation, and other activities, through the work of widely deployed community health workers reaching all households. Government and non-governmental organisations have pioneered many innovations that have been scaled up nationally. However, these remarkable achievements in equity and coverage are counterbalanced by the persistence of child and maternal malnutrition and the low use of maternity-related services. The Bangladesh paradox shows the net outcome of successful direct health action in both positive and negative social determinants of health--ie, positives such as women's empowerment, widespread education, and mitigation of the effect of natural disasters; and negatives such as low gross domestic product, pervasive poverty, and the persistence of income inequality. Bangladesh offers lessons such as how gender equity can improve health outcomes, how health innovations can be scaled up, and how direct health interventions can partly overcome socioeconomic constraints.