Effect of Diabetes Self-Management Education on Glycaemic Control in Sudanese Adults with Type 2 Diabetes

Research Background: The high prevalence of diabetes in Sudan, estimated at 16%, highlights the importance of effective health education in diabetes management. Diabetes self-management education has been identified as a crucial tool in enhancing the knowledge, attitudes, and abilities necessary for self-management among individuals with diabetes. Aim: To assess the impact of diabetes self-management education on medication adherence and glycemic control in Sudanese adults with type 2 diabetes before and 3 months after the DSME intervention. Method: The study was conducted in Sudan between September 2022 and March 2023, it was an interventional, one-group, pre- and post-test study that aimed to assess the impact of diabetes self-management education (DSME) on medication adherence and diabetes control in Sudanese adults with type 2 diabetes. The research was conducted in primary health care centers in six cities in Sudan and involved 244 participants. The data entry and statistical analysis were conducted using the Statistical Package for Social Sciences version 27.0. A paired t test was used for analysis. Results: The study included 244 participants, 67% of whom were males. The age mean ± SD was 48.6 ± 9.3 years, and 85.3% of participants were married. Age at onset of diabetes mean ± SD was 40.60 ± 7.81 years;44.6% had diabetes for less than 5 years;and 84.1% had a positive family history of diabetes mellitus. The levels of poor, low, and partial adherence to medication decreased by 8.2%, 4%, and 20.6%, respectively, after the intervention. The levels of good and high medication regime adherence increased by 13% and 19.8%, respectively;BMI decreased by 1.1 ± 0.73 kg/m2 (p = 0.005). The fasting blood sugar decreased by 69 ± 32.9 mg/dl (p = 0.049), and the glycated hemoglobin decreased by 1.21 ± 0.28% (p = 0.001). Conclusions: The findings of this study reinforce the importance of patient education in improving glycemic control and enhancing self-management behaviors. Patient education plays a critical role in enhancing glycemic control and self-management behaviors. It is essential for healthcare providers to adopt a patient-centered approach, taking into account the individual's beliefs, attitudes, and knowledge about their illness and treatment. Overcoming these challenges necessitates a comprehensive approach, including enhancing healthcare professionals’ knowledge and communication skills, offering accessible and culturally sensitive diabetes education programs, and addressing barriers to resources and support for self-management.

Factors related to self-management behavior among persons with mild-to-moderate chronic obstructive pulmonary disease in Wenzhou,China

Objective:To describe the self-management(SM)behavior among persons with mild-to-moderate chronic obstructive pulmonary disease(COPD),and it examines the correlation between COPD knowledge,self-efficacy,perceived social support,and SM behavior among persons with mild-to-moderate COPD in Wenzhou,China.Methods:A simple random sampling technique was used to recruit 121 persons with mild-to-moderate COPD who visited the respiratory outpatient department of the First Affiliated Hospital of Wenzhou Medical University in Wenzhou,China.Research instruments include a demographic data questionnaire,COPD SM scale,COPD knowledge questionnaire,6-item chronic disease self-efficacy scale,and perceived social suppor t scale.Descriptive statistics and Pearson's Correlation were used for data analysis.Results:The findings show that the mean score of COPD SM scale was 2.70(SD=0.45).The Pearson correlation analysis revealed that the COPD knowledge(r=0.47,P<0.001),self-efficacy(r=0.28,P=0.001),and perceived social support(r=0.48,P<0.001)were positively correlated to the COPD SM behavior among persons with mild-to-moderate COPD in Wenzhou,China.Conclusions:The findings indicate that disease knowledge,self-efficacy,and perceived social support were related to SM behavior in persons with mild-to-moderate COPD,which provides a theoretical basis for developing SM interventions for persons with mildto-moderate COPD and improving this population's SM behavior.

Water, Sanitation and Hygiene in Lower-Level Health Care Facilities of Dar es Salaam Region in Tanzania: Status towards Achieving the Sustainable Development Goals and Way Forward

Background: Improving Water, Sanitation and Hygiene in health care settings is a critical prerequisite for achieving national health goals and Sustainable Development Goals (SDGs). The World Health Organization (WHO) has set a target for each United Nations member state to reach by 2030. Each member state is required to reach by 2022, 2025 and 2030 at least 60%, 80% and 100%, respectively of basic level of service of the five elements which are water, sanitation, hygiene, waste management and environmental cleaning. Methods: This study aimed to evaluate and document the current state of basic water, sanitation, and hygiene services in all lower-level health care facilities in the Dar es Salaam region of Tanzania as of July 2022. A cross-sectional study was conducted in 99 public dispensaries in the Dar es Salaam region’s five councils: Ubungo, Kigamboni, Kinondoni and Temeke Municipalities, and Ilala City. The interviewee form and observational checklists were both digitalized using the Kobo tool software. The respondents were health care facility in-charges or nurse in-charges. Data were downloaded, validated, and imported to Stata version 15 for analysis. Results: The basic WASH level per JMP is far below the target in 2022. Each member state by 2022 is required to reach at least 60% of the basic level of service of each element. We found a low coverage of basic WASH in the 99 dispensaries included in this study. The basic WASH coverage was met in only 10 (10.1%) of the dispensaries, while the remaining 89 (89.9%) dispensaries fall on limited WASH services. Conclusion: This study revealed lower coverage of basic WASH services in dispensaries. An urgent need is required to improve the status of WASH in all the dispensaries and facilitate the provision of quality health care services, patient safety and reduce health care associated infections.

Dynamics of information diffusion and disease transmission in time-varying multiplex networks with asymmetric activity levels

While the interaction between information and disease in static networks has been extensively investigated,many studies have ignored the characteristics of network evolution.In this study,we construct a new two-layer coupling model to explore the interactions between information and disease.The upper layer describes the diffusion of disease-related information,and the lower layer represents the disease transmission.We then use power-law distributions to examine the influence of asymmetric activity levels on dynamic propagation,revealing a mapping relationship characterizing the interconnected propagation of information and diseases among partial nodes within the network.Subsequently,we derive the disease outbreak threshold by using the microscopic Markov-chain approach(MMCA).Finally,we perform extensive Monte Carlo(MC)numerical simulations to verify the accuracy of our theoretical results.Our findings indicate that the activity levels of individuals in the disease transmission layer have a more significant influence on disease transmission compared with the individual activity levels in the information diffusion layer.Moreover,reducing the damping factor can delay disease outbreaks and suppress disease transmission,while improving individual quarantine measures can contribute positively to disease control.This study provides valuable insights into policymakers for developing outbreak prevention and control strategies.

Monitoring absolute vertical land motions and absolute sea-level changes from GPS and tide gauges data over French Polynesia

In this study,we estimate the absolute vertical land motions at three tidal stations with collocated Global Navigation Satellite System(GNSS)receivers over French Polynesia during the period 2007-2020,and obtain,as ancillary results,estimates of the absolute changes in sea level at the same locations.To verify our processing approach to determining vertical motion,we first modeled vertical motion at the International GNSS Service(IGS)THTI station located in the capital island of Tahiti and compared our estimate with previous independent determinations,with a good agreement.We obtained the following estimates for the vertical land motions at the tide gauges:Tubuai island,Austral Archipelago-0.92±0.17 mm/yr,Vairao village,Tahiti Iti:-0.49±0.39 mm/yr,Rikitea,Gambier Archipelago-0.43±0.17 mm/yr.The absolute variations of the sea level are:Tubuai island,Austral Archipelago 5.25±0.60 mm/yr,Vairao village,Tahiti Iti:3.62±0.52 mm/yr,Rikitea,Gambier Archipelago 1.52±0.23 mm/yr.We discuss these absolute values in light of the values obtained from altimetric measurements and other means in French Polynesia.

Effects of the self-management training program on self-management behavior and blood pressure levels among elderly people with hypertension

Objective:To determine the effects of the Self-Management Training Program on self-management behavior and blood pressure(BP)levels among elderly people with hypertension(HT).Methods:This study was based on a quasi-experimental design using sampling groups composed of elderly residents of Pathum Thani Province with HT.Simple random sampling was applied to two sampling groups,an experimental group and a control group.However,the experimental group had been on the Self-Management Training Program based on the Creer concept.The Program’s contents included small-group health-education sessions and the patients’manual,Self-Management Training Skills for Self-Management Behavior.Small group discussions were held for self-reflection,to stimulate follow-up for self-management behavior training during home visits.The Self-Management Training Program was compared with programs involving the more usual care.Data were collected using the Self-Management Behavior for Hypertension Control Questionnaire and BP assessment tests.Data were analyzed using a descriptive statistic,chi-square test,pair t-test,repeated-measures Analysis of Variance(ANOVA),and repeated-measures Analysis Covariance(ANCOVA).Results:It was found that at 13 weeks after entering the program,the experimental group demonstrated a significantly lower systolic and diastolic BP with a baseline statistical significance(P<0.005),and that at the 4th week and the 13th week,there was a decrease in BP in the experimental group.The experimental group also had above-baseline self-management behavior scores that were higher than in the control group(P<0.01).Conclusions:Results from this study show that the Self-Management Program was useful for BP control and promoted sustainable self-management behavior.

Methodology for local correction of the heights of global geoid models to improve the accuracy of GNSS leveling

At present,one of the methods used to determine the height of points on the Earth’s surface is Global Navigation Satellite System(GNSS)leveling.It is possible to determine the orthometric or normal height by this method only if there is a geoid or quasi-geoid height model available.This paper proposes the methodology for local correction of the heights of high-order global geoid models such as EGM08,EIGEN-6C4,GECO,and XGM2019e_2159.This methodology was tested in different areas of the research field,covering various relief forms.The dependence of the change in corrected height accuracy on the input data was analyzed,and the correction was also conducted for model heights in three tidal systems:"tide free","mean tide",and"zero tide".The results show that the heights of EIGEN-6C4 model can be corrected with an accuracy of up to 1 cm for flat and foothill terrains with the dimensionality of 1°×1°,2°×2°,and 3°×3°.The EGM08 model presents an almost identical result.The EIGEN-6C4 model is best suited for mountainous relief and provides an accuracy of 1.5 cm on the 1°×1°area.The height correction accuracy of GECO and XGM2019e_2159 models is slightly poor,which has fuzziness in terms of numerical fluctuation.

Abnormal Thyroid Stimulating Hormone Level and Heavy Menstrual Bleeding

Heavy Menstrual Bleeding is one of the common Gynaecological issues. There are several causes. Some of the women presented with these issues found to have underling thyroid abnormality which was not discovered earlier. This research tries to find the prevalence of the Thyroid Disorder among the women present with Heavy menstrual bleeding in Sri Lankan women.

The Impact of Sea Level Rise on Roadway Design and Evacuation Routes in Delaware

As the global temperature continues to increase, the sea level continues to rise at a rapid rate that has never been seen before. This becomes an issue for many facets of life but one of the most impacted is the transportation infrastructure. Many people living in low elevation coastal areas can become trapped by flooding with no way in or out. With Delaware being a coastal state, this would affect a large portion of the population and will have detrimental effects over time if nothing is done to combat sea level rise. The issue with sea level rise in transportation is that once the roads become flooded, they become virtually unusable and detour routes would be needed. If all the roads in a coastal area were to be affected by sea level rise, the options for detours would become limited. This article looks at direct solutions to combat sea level rise and indirect solutions that would specifically help transportation infrastructure and evacuation routes in Delaware. There is not one solution that can fix every problem, so many solutions are laid out to see what is applicable to each affected area. Some solutions include defense structures that would be put close to the coast, raising the elevation of vulnerable roads throughout the state and including pumping stations to drain the water on the surface of the road. With an understanding of all these solutions around the world, the ultimate conclusion came in the form of a six-step plan that Delaware should take in order to best design against sea level rise in these coastal areas.

Buckling Optimization of Curved Grid Stiffeners through the Level Set Based Density Method

Stiffened structures have great potential for improvingmechanical performance,and the study of their stability is of great interest.In this paper,the optimization of the critical buckling load factor for curved grid stiffeners is solved by using the level set based density method,where the shape and cross section(including thickness and width)of the stiffeners can be optimized simultaneously.The grid stiffeners are a combination ofmany single stiffenerswhich are projected by the corresponding level set functions.The thickness and width of each stiffener are designed to be independent variables in the projection applied to each level set function.Besides,the path of each single stiffener is described by the zero iso-contour of the level set function.All the single stiffeners are combined together by using the p-norm method to obtain the stiffener grid.The proposed method is validated by several numerical examples to optimize the critical buckling load factor.

Core level excitation spectra of La and Mn ions in LaMnO3

Manganese-based perovskite is popular for research on ferromagnetic materials,and its spectroscopic studies are essential for understanding its electronic structure,dielectric,electrical,and magnetic properties.In this paper,the M-edge spectra of La ions and the M-edge,L-edge,and K-edge spectra of Mn ions in LaMnO3 are calculated by considering both the free-ion multiplet calculation and the crystal field effects.We analyze spectral shapes,identify peak origins,and estimate the oxidation states of La and Mn ions in LaMnO3 theoretically.It is concluded that La ions in LaMnO3 predominantly exist in the trivalent state,while Mn ions exist primarily in the trivalent state with a minor presence of tetravalent ions.Furthermore,the calculated spectra are in better conformity with the experimental spectra when the proportion of Mn3+is 90%and Mn4+is 10%.This article enhances our comprehension of the oxidation states of La and Mn within the crystal and also provides a valuable guidance for spectroscopic investigations of other manganates.

Emission and capture characteristics of deep hole trap in n-GaN by optical deep level transient spectroscopy

Emission and capture characteristics of a deep hole trap(H1)in n-GaN Schottky barrier diodes(SBDs)have been investigated by optical deep level transient spectroscopy(ODLTS).Activation energy(Eemi)and capture cross-section(σ_(p))of H1 are determined to be 0.75 eV and 4.67×10^(−15)cm^(2),respectively.Distribution of apparent trap concentration in space charge region is demonstrated.Temperature-enhanced emission process is revealed by decrease of emission time constant.Electricfield-boosted trap emission kinetics are analyzed by the Poole−Frenkel emission(PFE)model.In addition,H1 shows point defect capture properties and temperature-enhanced capture kinetics.Taking both hole capture and emission processes into account during laser beam incidence,H1 features a trap concentration of 2.67×10^(15)cm^(−3).The method and obtained results may facilitate understanding of minority carrier trap properties in wide bandgap semiconductor material and can be applied for device reliability assessment.

Levels of evidence and grades of recommendation supporting European society for medical oncology clinical practice guidelines

Background:The European Society for Medical Oncology(ESMO)guidelines are among the most comprehensive and widely used clinical practice guidelines(CPGs)globally.However,the level of scientific evidence supporting ESMO CPG recommendations has not been systematically investigated.This study assessed ESMO CPG levels of evidence(LOE)and grades of recommendations(GOR),as well as their trends over time across various cancer settings.Methods:We manually extracted every recommendation with the Infectious Diseases Society of America(IDSA)classification from each CPG.We examined the distribution of LOE and GOR in all available ESMO CPG guidelines across different topics and cancer types.Results:Among the 1,823 recommendations in the current CPG,30%were classified as LOEⅠ,and 43%were classified as GOR A.Overall,there was a slight decrease in LOEⅠ(−2%)and an increase in the proportion of GOR A(+1%)in the current CPG compared to previous versions.The proportion of GOR A recommendations based on higher levels of evidence such as randomized trials(LOEⅠ–Ⅱ)shows a decrease(71%vs.63%,p=0.009)while recommendations based on lower levels of evidence(LOEⅢ–Ⅴ)show an increase(29%vs.37%,p=0.01)between previous and current version.In the current versions,the highest proportion of LOEⅠ(42%)was found in recommendations related to pharmacotherapy,while the highest proportion of GOR A recommendations was found in the areas of pathology(50%)and diagnostic(50%)recommendations.Significant variability in LOEⅠand GOR A recommendations and their changes over time was observed across different cancer types.Conclusion:One-third of the current ESMO CPG recommendations are supported by the highest level of evidence.More well-designed randomized clinical trials are needed to increase the proportion of LOEⅠand GOR A recommendations,ultimately leading to improved outcomes for cancer patients.

A hybrid CNN-LSTM model for diagnosing rice nutrient levels at the rice panicle initiation stage

Nitrogen(N)and potassium(K)are two key mineral nutrient elements involved in rice growth.Accurate diagnosis of N and K status is very important for the rational application of fertilizers at a specific rice growth stage.Therefore,we propose a hybrid model for diagnosing rice nutrient levels at the early panicle initiation stage(EPIS),which combines a convolutional neural network(CNN)with an attention mechanism and a long short-term memory network(LSTM).The model was validated on a large set of sequential images collected by an unmanned aerial vehicle(UAV)from rice canopies at different growth stages during a two-year experiment.Compared with VGG16,AlexNet,GoogleNet,DenseNet,and inceptionV3,ResNet101 combined with LSTM obtained the highest average accuracy of 83.81%on the dataset of Huanghuazhan(HHZ,an indica cultivar).When tested on the datasets of HHZ and Xiushui 134(XS134,a japonica rice variety)in 2021,the ResNet101-LSTM model enhanced with the squeeze-and-excitation(SE)block achieved the highest accuracies of 85.38 and 88.38%,respectively.Through the cross-dataset method,the average accuracies on the HHZ and XS134 datasets tested in 2022 were 81.25 and 82.50%,respectively,showing a good generalization.Our proposed model works with the dynamic information of different rice growth stages and can efficiently diagnose different rice nutrient status levels at EPIS,which are helpful for making practical decisions regarding rational fertilization treatments at the panicle initiation stage.

Exploring Variability in Sea Level at a Tide Gauge Station through Control Charts

Monitoring temporal changes in sea level is important in assessing coastal risk.Sea level anomalies at a tide gauge station,if kinematically conceived,include systematic variations such as trend,acceleration,periodic oscillations,and random disturbances.Among them,the non-stationary nature of the random sea level variations of known or unknown origin at coastal regions has been long recognized by the sea level community.This study proposes the analyses of subgroups of random residual statistics of a rigorously formulated kinematic model solution of tide gauge variations using X-bar and S control charts.The approach is demonstrated using Key West,Florida tide gauge records.The mean and standard errors of 5-year-long subgroups of the residuals revealed that sea level changes at this location have been progressively intensifying from 1913 to the present.Increasing oscillations in sea level at this locality may be attributed partly to the thermal expansion of seawater with increasing temperatures causing larger buoyancy-related sea level fluctuations as well as the intensification of atmospheric events including wind patterns and the impact of changes in inverted barometer effects that will alter coastal risk assessments for the future.

Research on the Digital Economy's Impact on China's Economic Growth:Based on the Variations in Urbanization Levels Across China's Eastern,Central,and Western Regions and Sectoral Heterogeneity

This paper uses inter-provincial panel data from 2011 to 2017,a linear regression model,and a threshold model to conduct empirical analyses of the impact of the digital economy on China's overall economic growth and the three main sectors of industry.The paper then investigates the impact and effects the digital economy has had on the economic growth of the three main sectors of industry in China's eastern,central,and western regions.Finally,the paper investigates the most significant differences among the various regions and the threshold effects of urbanization levels on the relationship between the digital economy and economic growth.The findings indicate a significantly positive correlation between the digital economy and regional economic growth.Moreover,geographical factors notably influence this correlation.The digital economy exerts a positive effect on all sectors of industry.It may not substantially impact industrial development in regions with highly developed infrastructure.Regarding the other regions,the digital economy exhibits varying degrees of impact due to the differences in the specific indicators.The conclusion drawn by the threshold model is that the magnitude of the threshold effect correlates with geographic factors.No threshold effect was observed in the eastern region,while the threshold effect occurred in the central region when the urbanization levels for the provinces were below 0.6645.Similarly,the threshold effect was noted in the western region when the urbanization level was below 0.3931.Considering all of this,the study also offers policy recommendations that will help balance the regional development of digital economies,accelerate the digital transformation of traditional industries,enhance digital infrastructure construction,refine the formulation and implementation of data policy,and establish relevant incentive mechanisms.

Cumulative effects of excess high-normal alanine aminotransferase levels in relation to new-onset metabolic dysfunction-associated fatty liver disease in China

BACKGROUND Within the normal range,elevated alanine aminotransferase(ALT)levels are associated with an increased risk of metabolic dysfunction-associated fatty liver disease(MAFLD).AIM To investigate the associations between repeated high-normal ALT measurements and the risk of new-onset MAFLD prospectively.METHODS A cohort of 3553 participants followed for four consecutive health examinations over 4 years was selected.The incidence rate,cumulative times,and equally and unequally weighted cumulative effects of excess high-normal ALT levels(ehALT)were measured.Cox proportional hazards regression was used to analyse the association between the cumulative effects of ehALT and the risk of new-onset MAFLD.RESULTS A total of 83.13%of participants with MAFLD had normal ALT levels.The incidence rate of MAFLD showed a linear increasing trend in the cumulative ehALT group.Compared with those in the low-normal ALT group,the multivariate adjusted hazard ratios of the equally and unequally weighted cumulative effects of ehALT were 1.651[95%confidence interval(CI):1.199-2.273]and 1.535(95%CI:1.119-2.106)in the third quartile and 1.616(95%CI:1.162-2.246)and 1.580(95%CI:1.155-2.162)in the fourth quartile,respectively.CONCLUSION Most participants with MAFLD had normal ALT levels.Long-term high-normal ALT levels were associated with a cumulative increased risk of new-onset MAFLD.

Lightning in a Forest (Wild) Fire: Mechanism at the Molecular Level

The mechanism of lightning that ignites a forest fire and the lightning that occurs above a forest fire are explained at the molecular level. It is based on two phenomena, namely, internal charge separation inside the atmospheric cloud particles and the existence of a layer of positively charged hydrogen atoms sticking out of the surface of the liquid layer of water on the surface of rimers. Strong turbulence-driven collisions of the ice particles and water droplets with the rimers give rise to breakups of the ice particles and water droplets into positively and negatively charged fragments leading to charge separation. Hot weather in a forest contributes to the updraft of hot and humid air, which follows the same physical/chemical processes of normal lightning proposed and explained recently[1]. Lightning would have a high probability of lighting up and burning the dry biological materials in the ground of the forest, leading to a forest (wild) fire. The burning of trees and other plants would release a lot of heat and moisture together with a lot of smoke particles (aerosols) becoming a strong updraft. The condition for creating lightning is again satisfied which would result in further lightning high above the forest wild fire.

Nested Levels of Hybrid Cryptographical Technique for Secure Information Exchange

Data security is a very important part of data transmission over insecure channels connected through high-speed networks. Due to COVID-19, the use of data transmission over insecure channels has increased in an exponential manner. Hybrid cryptography provides a better solution than a single type of cryptographical technique. In this paper, nested levels of hybrid cryptographical techniques are investigated with the help of Deoxyribonucleic Acid (DNA) and Paillier cryptographical techniques. In the first level, information will be encrypted by DNA and at the second level, the ciphertext of DNA will be encrypted by Paillier cryptography. At the decryption time, firstly Paillier cryptography will be processed, and then DAN cryptography will be processed to get the original text. The proposed algorithm follows the concept of Last Encryption First Decryption (LEFD) at the time of decryption. The computed results are depicted in terms of tables and graphs.

Change in self-image pressure level before and after autologous fat breast augmentation and its effect on social adaptability

BACKGROUND There is an increasingly strong demand for appearance and physical beauty in social life,marriage,and other aspects with the development of society and the improvement of material living standards.An increasing number of people have improved their appearance and physical shape through aesthetic plastic surgery.The female breast plays a significant role in physical beauty,and droopy or atrophied breasts can frequently lead to psychological inferiority and lack of confidence in women.This,in turn,can affect their mental health and quality of life.AIM To analyze preoperative and postoperative self-image pressure-level changes of autologous fat breast augmentation patients and their impact on social adaptability.METHODS We selected 160 patients who underwent autologous fat breast augmentation at the First Affiliated Hospital of Xinxiang Medical University from January 2020 to December 2022 using random sampling method.The general information,selfimage pressure level,and social adaptability of the patients were investigated using a basic information survey,body image self-assessment scale,and social adaptability scale.The self-image pressure-level changes and their effects on the social adaptability of patients before and after autologous fat breast augmentation were analyzed.RESULTS We collected 142 valid questionnaires.The single-factor analysis results showed no statistically significant difference in the self-image pressure level and social adaptability score of patients with different ages,marital status,and monthly income.However,there were significant differences in social adaptability among patients with different education levels and employment statuses.The correlation analysis results revealed a significant correlation between the self-image pressure level and social adaptability score before and after surgery.Multiple factors analysis results showed that the degree of concern caused by appearance in selfimage pressure,the degree of possible behavioral intervention,the related distress caused by body image,and the influence of body image on social life influenced the social adaptability of autologous fat breast augmentation patients.CONCLUSION The self-image pressure on autologous fat breast augmentation patients is inversely proportional to their social adaptability.