Managing municipal solid waste correctly is critical to the success of a society. Many regions and countries in the world are behind others in the context of solid waste management. In order to compare three such regions within this context, a meta-analysis was conducted in order to develop a decision matrix. Within this decision matrix, the United States, Europe, and Asia were compared to determine which region is managing municipal solid waste the best. This research design allowed for compiling information from many sources to increase the accuracy of data used in the justifications for the decision matrix. Purposive sampling was used to select and evaluate sources that discuss solid waste management to discern which region’s processes are most favorable in many parameters. The decision matrix consists of nine parameters: main management techniques; finances; landfill taxes; jobs created; waste generation; waste composition; waste storage, collection, and transportation; energy recovery; and environmental health. Each was scored on a scale from zero to ten, ten being the best score and zero being the worst. The final score from the decision matrix suggested that Europe had the most favorable municipal solid waste management (MSWM) system, and the United States had a notably close yet lower score. Asia had the lowest score that was hardly comparable to the other two regions.

Aims and objectives: By reporting the use of therapeutic nursing interventions to facilitate the process of change in a depressive elderly caregiver, this paper seeks to underline the importance of fitting interventions to individual clients. Background: In assisting families of chronic illness sufferers, it must be remembered that the perceptions and functions of both clients and families are determined by family members, and that changes, if any, are made by those clients and families, rather than by nurses. However, nurses do play an important role in facilitating the process of change. Design: This is a case report. Methods: A case study of a depressive elderly caregiver is used to examine the use of therapeutic nursing interventions to facilitate the process of change with problem analysis, case conceptualisation and specific skills employed documented. Results: The change from one therapeutic approach (Cognitive-behavioural therapy) to another (Narrative Therapy) facilitates enlisting the caregiver’s unique strengths, resources and competence to overcome the difficulties and challenges identified during the process of change. In dealing with depression in family caregivers, nurses should not only be flexible but also remain sceptical in using different approaches, with heightened awareness of the client’s circumstances.

Environmental impact of a recent oil spill incident in Bonny terminal using soil media was studied using a risk-based modeling approach. The establishment of the presence of contaminants of concern (CoC), evaluation/assessment, modeling spilled volume and ascertaining potential health risk associated with the spill incident was carried out. The Contaminant of Concern (CoC) included Total Petroleum Hydrocarbons (TPH) and Polycyclic Aromatic Hydrocarbons (PAHs). Soils and groundwater were sampled in the vicinity of the spill incident and further away into the surrounding communities. Soils were sampled into the depths (0.1 m, 0.5 m,1.0 m, 1.5 m), and the results of sieve analysis revealed that the area is predominantly silty sand in composition. This study also revealed that TPH concentration at all locations and depths exceeded DPR target value of 50 mg/kg. The TPH model revealed that a total volume of 222,500m3 of the spill area exceeded DPR intervention value of 5000 mg/kg. The results of PAH showed that only BS-1, BS-6, BS-8, BS-9 and BS-10 exceeded DPR target value of 1.0 mg/kg at some depths. All other sample depths and locations were within the target limit. The 3-D grid generated for PAH showed that 563,000m3 of the study area exceeded the DPR target value. The 3-D block models generated for TPH and PAH, along with the cross-sections and extracted time slices all showed that the concentration of the Contaminant of Concern (CoC) generally decreased with depth, and the centre of the spill located at the south-eastern part of the survey area. Based on these models, three spill zones were identified; Zone 1-highly contaminated areas (BS-8, BS-9, BS-10); Zone 2 - moderately contaminated areas (BS-1, BS-2, BS-6, BS-7); and low contaminated areas (BS-3, BS-4, BS-5). The entire soil in the area were contaminated with TPH and 47% of the area contaminated with PAH. This study has shown the effectiveness of the use of a model-based approach in quantifying hydrocarbon contamination volumes in the area. There is therefore the need for continuous monitoring of hydrocarbon spills in the area.

Industrial control systems (ICS) are critical, as in these systems, cyber threats have the potential to affect, disorganize, change their mode of operation, act as an information extraction vehicle, and ultimately turn against itself. Creating risks to the system itself, infrastructure, downtime, leakage of sensitive data, and even loss of human life. Industrial control systems (ICS) are vital to the operation of all the modern automated infrastructure in the western world, such as power plant and power stations. Industrial control systems (ICS) differ from the traditional information systems and infrastructures of organizations and companies, a standard cyber security strategy cannot be implemented but part of it adapting to the real facts and needs of each country, legislation and infrastructure. These systems require continuous operation, reliability and rapid recovery when attacked electronically with automated control, isolation and attack management processes. Incorrect settings and lack of strategic planning can lead to unprotected operation of critical installations, as they do not meet the cyber security requirements. Industrial control systems (ICS) require special protection in their networks, as they should be considered vulnerable in all their areas, they need protection from cyber attacks against ICS, SCADA servers, workstations, PLC automations, etc. Security policies to be implemented should provide protection against cyber threats, and systems recovery without affecting the operation and reliability of operating processes. Security policies such as security assessment, smart reporting, vulnerability and threat simulation, integrity control analysis, apply security policy to shared systems, intrusion detection and prevention, and finally firewall with integrated antivirus and sandbox services should be considered essential entities.

Background: NSU is generally caused by right cerebral hemisphere lesions with a preeminent localization on the frontoparietal lobe. Aim: To assess the correlation between the typology and the brain lesion site and the consensual consent modality of body image modification after an integrated rehabilitative and neuropsychological treatment. Setting: A rehabilitation institute for the treatment of neurological gait disorders and neuropsichological failures. methods: Patients recruited were divided according to the brain lesion site into 3 groups (IG = ischemic group = 5 patients; HG = hemorrhagic group = 4 patients; IG + HG = ischemic + hemorrhagic group = 3 patients) based on CT brain performed in the post-acute phase. At time T0, the patients recruited underwent a systematic review of their current neuroradiological profile (location delineation and type of brain injury) compared with a consensual framing of the neuromotor and neuropsychological profile acquired at the time of taking charge in the ward. At time T1 and after the drafting and implementation of the rehabilitation treatment plan foreseen in the study (1 to 4 months after T0), the patients in our sample underwent a re-evaluation of their neuromotor and neuropsychological profile with controls of the same outcome parameters considered at time T0. Results: A parametrically but not statistically significant modification of the results obtained was observed by measuring the MI ULl, MI LLl and TCT scales in the group with hemorrhagic brain injury; the analysis of variance did not show any statistical significance in the relationship between the type of stroke (ischemic, hemorrhagic or both) and the motor impairment passing from time T0 to time T1. The analysis of variance did not reveal a statistically or parametrically significant relationship between the type (ischemic, hemorrhagic and ischemic + hemorrhagic) of cerebral stroke and the variations of the neuropsychological profile. The T-Student test showed statistically significant changes in the importance of the lesion site in defining the degree of motor disability. In particular, we observed, about the presence of frontal lobe lesions, a statistically significant variation passing from the T0 time to the T1 time for the following motor scales in 9 of 12 recruited patients: MI LLl (26.4 vs. 62, with p < 0.05), TCT (43.6 vs. 80.6, with p < 0.01 for equal variance assumed and p < 0.05 for equal variance not assumed), FAC (0.8 vs. 2.3 with p < 0,01 for equal variance assumed and p < 0.05 for equal variance not assumed). Conclusion: We have confirmed the importance of the anatomical-dysfunctional correlation as a key concept from which to start in any neurorehabilitative treatment approach. Our work has highlighted the basic role of the right frontal lobe in the programming and execution of the gesture and its kinesthetic control as regards the left lower limb and the trunk.

Graphical abstract Biodegradation of implanted gold in human tissue. TEM images reveal markedly biodegradation of implanted gold and re-crystallization of dissolved gold as nanoparticle of different size, shape and crystallinity. Highly crystalline icosahedral Au nanoparticle and the corresponding power spectrum are shown on top. Background: Despite the importance of biodegradation for the durability of metal prosthesis and the widely use of gold implants, there exist a lack of knowledge regarding the stability of pure gold in tissue. Methods: We studied biodegradation of grids of pure gold, nickel, and copper as well as middle ear prosthesis of gold, platinum or titanium. Metals were implanted into rat skin and humans. Dissolution and re-crystallization process of the metals was analysed using SEM, TEM, power spectra as well as elemental analysis by EDX and EELS/ESI. Results: Biodegradation of gold was detected, presumably by solving and re-precipitation of gold around implants. Gold cluster, nanoparticles, and mesostructures were detected, formed by dissolution and re-crystallization process. This process results into a migration of gold into the farer off tissue. Cellular filaments as biomolecular templates facilitate the formation of mesostructures. Loss of function of middle ear prosthesis by biodegradation is caused by chronic inflammation and fibrosis. Indeed, similar processes were detected with platinum, but in a very lower level. Conclusion: Noble metal implants undergo biodegradation in oxidative environment in tissue. The dissolution – recrystallization process can be explained by enzyme catalysed redox processes comprising reactive oxygen species and reduction agents as ascorbic acid present in cells and body tissue. Enymes like myeloperoxidase inside lysosomes of inflammatory cells produce hypochloride ions and H2O2 which can dissolve the gold. General significance: The crucial role of the specific chemical environments of gold implants in tissue for their chemical stability and durability of function has been demonstrated. Due to widely use and importance of gold implants, this finding is of general interes.

Background: In health care systems nursing care documentation is a vital and powerful tool that ensures continuity of care and communication between health personnel for better patient outcomes. Knowledge, attitude and practice of nurses’ towards nursing care documentation affect the quality and coordination of patients’ care. Hence, this study aimed to assess knowledge, attitude, practice and associated factors towards nursing care documentation among nurses in West Gojjam Zone public hospitals, Amhara Ethiopia. Method: Institutional based cross sectional study was conducted among 246 nurses in West Gojjam Zone public hospitals from February to March 8, 2018. The study participants were selected by simple random sampling technique. Data were collected by using pre-tested and validated self-administered structured questionnaire with internal reliability of Cronbach’s Alpha values 0.912, 0.784 and 0.713 for knowledge, attitude and practice questions respectively. Epi data version 3.1 and SPSS version 20 was used for data entry and analysis respectively. Descriptive statistics and binary logistic regression model were used. Result: The overall response rate was 97.56%. Among 240 respondents 54.6% of them had good knowledge, 50% of study participants had favorable attitude and 47.5% of study participants had good nursing care documentation practice. Sex and monthly salary were found to be statistically significant with knowledge of nurses. Work setting, work experiences and knowledge of nurses had significant association with nurses’ attitude towards nursing care documentation. Availability of operational standards, knowledge and attitude of nurses had significant association with nursing care documentation practice. Conclusions and Recommendation: Results of this study showed that knowledge, attitude and practice of West Gojjam zone public hospital nurses on nursing care documentation were poor. Therefore; in order to solve this problem each hospital should recruit nurses until hospitals are saturated enough. It is recommended to avail nursing care documentation standards/guidelines in each hospital and to give training about it and also it is recommended to conduct multisite studies especially qualitative type to increase its quality.

Background: Today’s older adults are often well informed and want to participate in decision-making processes. The coordinated individual planning process offers them active involvement in deciding and owning how their care will be managed. Aim: The aim of the study was to explore active older adults’ knowledge and views regarding coordinated individual planning. Methods: The study has an exploratory inductive approach. Five focus-group discussions were conducted with 40 participants from different organizations and associations. A qualitative interpretive description framework was used, and the analysis resulted in four unique themes. Results: The four themes resulting from the analysis are collaboration and continuity, participation and involvement in decision, individual need for support, and access to information and service. Collaboration between different levels of the healthcare system and between professionals is crucial. Older adults wanted to be participating actors in their healthcare. They worried about the lack of continuity and thought that services were not responsive or did not meet individuals’ needs. Conclusion: Older adults want their views and preferences to be taken into consideration, and they want to be actively engaged in the decision-making process regarding their care.

Healthcare is realizing the importance of health information technology - its applications and devices in play today. Advancing healthcare best practices will rely on up to date data and analysis to provide the most effective forms of therapy. Healthcare is becoming more reliant on patients who are engaging in their own healthcare. With this we are seeing an increase in available health related apps for these devices. This summary reviews various connected health strategies using proven apps and devices to improving the quality of care, promoting patient engagement, and improving outcomes. Here we discuss several trends and the healthcare delivery implications.

Background: The argument on whether extracorporeal shock-wave therapy (ESWT) is beneficial in short- term intervention in adults with plantar fasciitis. It is important and necessary to conduct a meta-analysis to make a comparatively more reliable and overall assessment of the outcomes of ESWT in the less than 6 months. Methods: We conducted a systematic review and meta-analysis of randomized control trials from MEDLINE, EMBASE and CINAHL databases from 2000 to 2020. Randomized trials that evaluated extracorporeal shock wave therapy used to treat plantar heel pain were included. Trials comparing an extra corporeal shock wave therapy with control/placebo were considered for inclusion in the review. We independently applied the inclusion and exclusion criteria to each identified randomized controlled trial, extracted data and assessed the methodological quality of each trial. Results: Four studies involving 645 patients were included. 3 RCTs (n = 605) permitted a pooled estimate of effectiveness based on overall success rate and composite score of visual analogue scales for pain at follow-up 1 (12 weeks). The pooled data showed no significant heterogeneity at the three-month follow-up (p - value of chi-square = 0.61, p = 0.74 and I2 = 0%). The shock wave group had a better success rate than the control group at the three-month follow-up (OR = 2.26, 95% CI = 1.62-3.15, p - < 0.00001). For reduction of pain the pooled data showed no significant heterogeneity (p - value of chi-Square 0.28 and I2 22%). There were significant differences between the ESWT and control groups for all follow-up visits (random-effect model, three trials, MD = 15.14, 95% CI = 13.86 to 16.42, < 0.00001 at three-month). Conclusion: A meta-analysis of data from three randomized-controlled trials that included a total of 605 patients was statistically significant in favor of extracorporeal shock wave therapy at follow-up 1(12 weeks).

Introduction: Physical activity (PA) directly affects Health-related quality of life. The aim of the study was to establish the relationship between physical activity levels of physiotherapists and their physical activity promotion strategies. in Hebron/West Bank. Method: The study relied on cross-section, which included 150 PTs distributed over 42 centers of Hebron areas in Palestine country. The questionnaire is based on Likert scale items pentagonal level, which included several aspects of Health-related quality of life. Statistical analysis was used to test the associations between different categorical variables (p < 0.05). Results: of total 150 participants, most of them were male 56%, their ages ranged from 25-30 years (46%), and holding bachelor’s degrees 78%. About 60% of them are in good physical health. Most participants feel vitality, depression, quit, have energy, and are happy in the most of the time. In addition, most of them believe their health is similar to that of the members of the surrounding community. The study showed there is no relationship between general health and age except in the age group over 40 years, and females are the most exposed group. In addition, there is an influence relationship between physical and psychological with age, and this effect also includes females more than males. Conclusion: Physical functioning of most of the participants was good, while most of the participants had problems with their work and the major effect was on the female category.

Objective: This descriptive study was conducted in order to determine body image perception and life satisfaction of individuals undergoing hemodialysis treatment. Material and methods: The population of the study consisted of individuals who were treated in hemodialysis units in the city center of Kırşehir. Patients. The study was conducted with 135 patients. Questionnaire, multidimensional body-self relations questionnaire, and satisfaction with life scale were used as data collection tool. Results: According to study results, total mean scores of MBSRQ were significantly low in individuals who were older than 65, illiterate, had an extended family, were unemployed, had low income, suffered from disease and underwent hemodialysis treatment for 10 years and longer, had arteriovenous fistula in vascular insertion site, had body mass index within the class of morbid obese, and had no planned transplantation. SWLS mean scores of individuals, who were in the age group of 25-34 years, high school graduate, employed, described their income status as very high, had CRF for 6-12 months, underwent hemodialysis for 6-12 months, were waiting for renal transplantation, were significantly high. As a result of the correlation analysis made between body image and life satisfaction, it was determined that there was a positive, quite significant correlation Conclusion: As a result, it was determined that hemodialysis patients were affected by body image and life satisfaction negatively due to many factors and the total score of body image scale was very low.

This paper is a study of nuclear reactions involving 12c + 12c nuclei carried out with a heavy-ion nucleus-nucleus optical potential derived from a new M3Y-type effective interaction, called B3Y-Fetal, within the framework of optical model at the incident energies of 112, 126.7, 240, 300, 1016 MeV. Folding analyses of the differential cross sections associated with the elastic scattering of the nuclear system, determined at these incident energies with four B3Y-Fetal-based folded potentials constructed from double folding model, have shown the DDB3Y1- and BDB3Y1-Fetal potentials to be the best in excellent agreement with previous work done with the M3Y-Reid. The agreement of the B3Y-Fetal with the famous M3Y-Reid effective interaction, which is also used for folding analysis in this work, is further buttressed and well-established by the findings of this study Herein, the values of the renormalization factor, NR ranging from 1.1117 to 0.8121, obtained with the B3Y-Fetal have been found to be slightly higher, with lower reaction cross sections, aR = 1418 - 1047 millibarns, than NR = 0.9971 - 0.8108 obtained with the M3Y-Reid effective interaction whose accompanying reaction cross sections, being higher, range from 1431 to 1050 millibarns. This depicts the B3Y-Fetal as having a better performance. Additionally, results of folding analyses have shown the best-fit folded potentials, DDB3Y1- and BDB3Y1-Fetal potentials to be in agreement at all incident energies, implying that the cold nuclear matter has an underlying soft equation of state.

Background: Communication is the process of exchanging information or messages from one group to the other through mutually understood verbal or non-verbal ways. Communication barrier is anything that prevents receiving and understanding the messages. poor communication between patients and the nurses’ result in an increased length of stay, wastage of the resource, patient dissatisfaction, absence of confidence, and frustration for both the nurses and the patients. This study will provide basic information on the level of nurses to patients’ communication and perceived barriers in government hospitals of Bahir Dar city. Objective: The objective of this study was to assess the level of the nurse to patient communication and perceived barriers in government hospital of Bahir Dar city, Ethiopia, 2020. Methods: Institution based cross-sectional mixed-methods study was conducted from February 24 – March 9/2020 in government hospitals of Bahir Dar city. A total of 380 nurses were included in the quantitative study by using simple random sampling. For both the quantitative and qualitative study, at the initial stage of data collection and interview; informed consent was obtained from respondents. Data were entered into Epi Data 4.6 and analyzed with a statistical package of social science version 25. Data were mainly analyzed using descriptive statistics and binary logistic regression. For the qualitative study, purposive sampling technique was employed, and 7 participants were interviewed. Thematic analysis was used. Results: From the total participants 36.5% of nurses were found to have poor communication. Variables which have statistically significant associations with the level of communication were educational level, work experience, the unwillingness of nurses, and lack of communication skill. The highest perceived communication barriers were lack of continuous training with 82.7% followed by workload with 80.7% and lack of medical facilities with 79.2% as reported by nurses. All environmental-related barriers were the perceived barriers of the nurse to patient communication. Conclusion: In this study, the communication of nurses to patients is found to low. To enhance communication with the patients; nurses and other stakeholders like the ministry of health, the health bureau, and hospital authorities need to recognize the communication barriers. Giving awareness on the communication barrier for the nurses helps to minimize the barriers and improve the nurses to patients’ communication.

Background: Respiratory muscle strength can be reduced in patients diagnosed with stroke, which reasonably justifies the use of respiratory muscle training in this population. This study determines the comparative efficacy of inspiratory, expiratory, and combined respiratory muscle training on the pulmonary functions and chest expansion in acute stroke survivors. Method: Forty-five acute stroke survivors (15 in each group) completed all protocols of the study. Participants were randomly assigned to any one of three groups. In addition to the conventional exercise therapy, participants received any one of the three respiratory muscle training protocols (inspiratory muscle training, expiratory muscle training or combined respiratory muscle training). Chest expansion was assessed using tape measure and pulmonary function parameters were assessed using a spirometer. Results: Paired t-test analysis showed significant improvements in the chest expansion and the pulmonary function parameters following training in each group. One-way ANOVA showed significant improvements in the pulmonary function parameters across the three groups but not in the chest expansion with p - value = 0.405. Least significant difference (LSD), post-hoc analysis shows that the significant difference for FEV1, FVC and FEV1/FVC lies between inspiratory muscle training group and expiratory muscle training group. Conclusion: When the three training methods were compared, it was found that expiratory muscle training was the most beneficial in improving the pulmonary functions and chest expansion in acute stroke survivors.

In this work the statistical and squeezing properties of light-driven by sub-harmonic generation with two-mode coherent light are studied. With interaction Hamiltonian of both two-mode coherent and sub harmonic generation, we have driven master equation of system under consideration. From the master equation, the solution of the C-number Langevin equation is derived. It helps us to solve quadrature variance, quadrature squeezing, mean, and variance of photon number for light produced by sub-harmonic generation with the two-mode coherent light state. And the result shows that; the squeezing occurs in plus quadrature with the maximum squeezing of 87%. The photon statistics of the system under consideration is subpoissonian in which both mean & variance are increasing as kappa increase.

Plasma stability is the biggest challenge facing the nuclear fusion industry. One of the best methods of stability study is magnetohydrodynamic (MHD) equations, which has two linear and nonlinear states. Usually linear stability analysis is used to describe the MHD state, which is obtained by linearizing nonlinear equations. The reactor under study is the W7-X reactor, which is an optimal example of a stellaratoric system. The question raised in this research is how to create suitable conditions for the formation of plasma and heat transfer produced by the melting reaction. Many efforts have been made in this direction, but still the record holder for plasma state maintenance belongs to the international ITER project and around 1000. However, IPP researchers at the Max Planck Institute in Germany (maker of the W7-X reactor) predicted that by 2020 they would produce a pulse of 30 minutes. The numerical method is used to investigate the stability of the reactor. In this paper, boundary conditions were expressed in terms of resistance wall. With the help of the mathematical Matlab software, magnetic field values ​​were obtained from experimental reports extracted from the Max Planck Institute for various values ​​of β. From the values ​​obtained, it was concluded that the appropriate field value is β = 5 according to the ideal MagnetoHydroDynamic state and the interval defined by the Max Planck Institute.

In the research of steam turbine rotor, start-up optimization is a very key research problem. A series of start-up optimization research can greatly improve the start-up efficiency of steam turbine and the safety performance of the unit. The start-up optimization of steam turbine is inseparable from the analysis of the start-up process of steam turbine and the mathematical model of the startup process of steam turbine unit, because the optimization of steam turbine unit can be regarded as a function to find the optimal solution. This paper analyzes the start-up process of 300 MW steam turbine, analyzes the start-up process of steam turbine unit through the data used in the actual power plant, and gives the mathematical model of cold start-up of steam turbine according to the start-up process of steam turbine, so as to further study the start-up optimization of steam turbine. Finally, the optimization model is determined by several key parameters, which are three weight coefficients α1,α2,α3, the actual damage value Di and damage limit value Dlim, and the start-up time ti and total start-up time t0 of each stage.

Purpose: In an aspect of qualitative treatment, this research gathered lung cancer patients’ actual experiences to understand deeply, such as their expectation for treatment results, their difficulties during treatment, and their various requests to their family and medical teams. Methods: From May to June 2013, semi-structured interviews were conducted with 9 lung cancer patients. Data were collected through a tape-recorded in-depth interview. The analysis of the data was made through the qualitative method. Results: 124 themes regarding the experience were found. From these 35 concepts, 24 subcategories were emerged. The core category was enduring hardship of the treatment with the hope for full recovery. Six categories included ‘Wishing to be cured but concern about recurrence’, ‘Receiving radiation treatment with pleasure and difficult at the same time’. ‘Being sorry for their family’s full support and trying to stand alone‘, ‘Having confidence in their medical team’, ‘regretting for their old days’, and ‘Wanting to live a long life without illness and pain’. Conclusion: The results of this study would help oncology nurses to understand the lung cancer patients receiving concurrent chemo-radiotherapy (CCRT) and to develop a quality of life improvement program for physical, psychosocial, and spiritual aspects of nursing.

Lichen Planopilaris is known as the form of Lichen Planus typical of the scalp. It is classified as a lymphatic disease and is characterized by chronic inflammation which leads to cicatricial alopecia. Its causes are not yet well characterized but its etiology seems to strongly correlates with infection, sensitization and pollution. A clear and objective diagnosis of Lichen Planopilaris is not simple but the evolution and strongly negative outcomes on scalp of people affected by, pose the need of an early diagnosis. In this work we report the case of a 27-year-old male and a 54-year-old female, respectively, in which a correct diagnosis of Lichen Planopilaris, followed the incorrect previous ones, was made by means of dermatoscopy and histopathological analysis, decisive tools for the diagnosis of this kind of pathology.