A technique for improving readability of Forrester diagram in system dynamics

We describe a three-pass algorithm for improving the readability of Forrester Diagram in system dynamics. The first pass converts Forrester Diagram to recurrent hierarchy. The second pass sorts the vertices on each level, with the goal of minimizing crossings. The third pass is a finite tuning of the layout that determines the horizontal positions of vertices. An illustrative example is given to verify the result.

Women’s satisfaction with maternity experience at a regional hospital in Swaziland: A cross sectional survey

Clinical care during labor and childbirth is important, however understanding women’s preferences and experiences have become more important in assessing quality health care delivery and maternity services utilization. Knowledge on women’s satisfaction will be one of the important steps towards solving maternal and child health problems faced in Swaziland. The aim of the study was to determined maternity experiences and women’s demographic characteristics that affect perceived satisfaction with maternity care at a regional hospital in Swaziland. A cross sectional survey using structured interview questionnaire was used to obtain data from 198 women who had a normal childbirth during their postnatal hospital stay. One-way ANOVA and t-test were used to examine association between variables and stepwise multiple linear regression analysis was conducted to identify predictors of satisfaction. The final model indicated that respecting women’s description of pain/discomfort, staff kindness, gender of birth assistant, never being alone during labor and woman’s education level determined satisfaction with maternity experience, explaining 44.6% of the variation in maternity satisfaction (F= 30.932, p <.001). The study findings show the importance of provider related factors (interpersonal aspect of care, gender of provider) and consideration of woman’s education on satisfaction with care during intrapartum and postpartum.   Les soins cliniques pendant le travail et l'accouchement sont importants, mais la compréhension des préférences et des expériences des femmes est devenue plus importante pour évaluer la qualité de la prestation des soins de santé et l'utilisation des services de maternité. La connaissance de la satisfaction des femmes sera l'une des étapes importantes vers la résolution des problèmes de santé maternelle et infantile rencontrés au Swaziland. L'objectif de l'étude était de déterminer les expériences de maternité et les caractéristiques démographiques des femmes qui affectent la satisfaction perçue à l'égard des soins de maternité dans un hôpital régional du Swaziland. Une enquête transversale utilisant un questionnaire d'entretien structuré a été utilisée pour obtenir des données de 198 femmes qui ont eu un accouchement normal pendant leur séjour à l'hôpital postnatal. Une ANOVA à un facteur et un test t ont été utilisés pour examiner l'association entre les variables et une analyse de régression linéaire multiple par étapes a été menée pour identifier les prédicteurs de la satisfaction. Le modèle final a indiqué que le respect de la description de la douleur/de l'inconfort par les femmes, la gentillesse du personnel, le sexe de l'assistante d'accouchement, le fait de ne jamais être seule pendant le travail et le niveau d'éducation de la femme déterminaient la satisfaction à l'égard de l'expérience de la maternité, expliquant 44,6 % de la variation de la satisfaction de la maternité p <.001). Les résultats de l'étude montrent l'importance des facteurs liés au prestataire (aspect interpersonnel des soins, sexe du prestataire) et la prise en compte de l'éducation de la femme sur la satisfaction des soins pendant l'intrapartum et le post-partum &nbsp

The significance of seizures and other predictive factors during the acute illness for the long-term outcome after bacterial meningitis

SummaryBackgroundSeizures are important neurological complications of bacterial meningitis, but no information about its epidemiology and the outcomes of seizures after community-acquired bacterial meningitis (CABM) in an adult population have been reported.AimsTo determine the frequency, clinical relevance, subtypes of seizures during the acute phase of bacterial meningitis, and the long-term outcomes of seizure complicating adult CABM.MethodsIn this 12-year retrospective study, 117 adult patients were identified with culture-proven CABM. A comparison was made between the clinical data of the patients with and without seizures during hospitalization.ResultsThirty-one patients had seizures during CABM, accounting for 27% (31/117) of the episodes. The time interval between the onset of bacterial meningitis and the seizures was 1–21 days (mean, 4 days). Furthermore, 80% (25/31) of the episodes occurred within 24h of presentation. Ten patients who had seizures progressed to status epilepticus. At follow-up after completing treatment, 10 patients completely recovered and were seizure-free, 19 died of meningitis during the acute stage and the other two progressed to chronic epilepsy.ConclusionA log-rank test demonstrated that the long-term outcome of adult CABM with acute seizures produced worse outcomes than for those who had no seizures, though no difference was noted between focal and generalized seizures. None of our patients without seizures in the acute phase of bacterial meningitis developed late seizures during the follow-up periods. Poor outcome in this study may attribute to neurological complications such as seizure, hydrocephalus, infection itself, or a combination of complications

Cipher Text to Be Transmitted and Cryptanalysis in Network Security

Abstract-In this paper, we propose an encryption algorithm to encrypt plaintext to cipher text. We divide plaintext into numeric and non-numeric fields, also, we pack the numeric fields to produce packed numeric table and combine it with symbol fields to produce the new plaintext. We apply the basic computing operations, e.g., inserting dummy symbols, rotating, transposition, shifting and complement, in the proposed algorithm to encrypt plaintext to cipher text. The produced the cipher text which contains the plaintext, relative data and tables of encryption is transmitted to the receiver through the network. We also propose the cryptanalysis about these algorithms. It can be shown that the proposed algorithm is more secure in network security

Removing Infragravity‐Wave‐Induced Noise from Ocean‐Bottom Seismographs (OBS) Data Deployed Offshore of Taiwan

Vertical ocean‐bottom seismograph (OBS) data at frequencies below 0.05 Hz are contaminated by noise induced by infragravity waves. We constructed the transfer function between pressure and velocity data from OBSs deployed in Taiwan waters to remove the wave pressure‐induced noise from seismic recordings. Data were analyzed from five portable broadband OBSs deployed each for 10 months at water depths from 1740 to 4600 m and from a cabled, shallow‐buried seismograph (EOS1) installed on the seafloor at 300 m depth. Removing long‐period noise from these OBS data improves the identification of teleseismic phases such as P, S, SS, Pdiff, and PKIKP that are otherwise ambiguous or unidentifiable. For EOS1, infragravity‐wave signals completely mask the P and S waveforms in the 10–50 s period band suitable for centroid moment tensor (CMT) solutions for most of the local events. Application of the transfer functions to predict and remove wave deformation yielded clean prominent P and S waveforms at these periods and aided in the CMT determination for small events jointly with land stations. The relative amplitudes of the wavenumber‐normalized transfer function for some of the OBSs are mostly determined by the thickness of the sediment at the OBS site

Impact of cognitive behavior therapy on osteoarthritis-associated pain, insomnia, depression, fatigue, and physical function in patients with knee/hip osteoarthritis: A systematic review and meta-analysis of randomized controlled trials

BackgroundThis meta-analysis aimed at evaluating the efficacy of cognitive behavior therapy (CBT) against osteoarthritis-associated symptoms in patients with knee/hip osteoarthritis.MethodsMedline, PubMed, Cochrane Library, and EMBASE databases were searched from inception to July 2022 to identify randomized controlled trials (RCTs) comparing the efficacy of CBT with other treatment approaches in adults with confirmed knee/hip osteoarthritis. The pain intensity (primary outcome) and the secondary outcomes including insomnia severity, sleep efficiency, physical function as well as the severity of depression and fatigue were assessed at two time points (i.e., immediately after treatment and during the follow-up period). The effect size is expressed as standardized mean difference (SMD) with SMDs of < 0.2, 0.2–0.5, and 0.5–0.8, and > 0.8 representing negligible, small, medium, and large effect sizes, respectively.ResultsFifteen RCTs were included for analysis. Immediately after CBT intervention, meta-analysis showed similar treatment effect in pain severity [SMD = –0.46, 95% confidence interval (CI): –0.95 to 0.04, 11 studies, 1557 participants] and other symptoms including depression (SMD = –0.26, 95% CI: –0.58 to 0.06, five studies, 735 participants), fatigue (SMD = –2.44, 95% CI:–6.53 to 1.65, two RCTs, 511 participants), and physical function (SMD = –0.11, 95% CI:–0.25 to 0.02, five RCTs, 720 participants) between CBT and control groups, while there was an improvement in insomnia severity (SMD = –0.65, 95% CI: –1.06 to –0.24, four RCTs, 639 participants, medium treatment effect) and sleep efficiency (SMD = 0.32, 95% CI: 0.04 to 0.59, three RCTs, 352 patients, small treatment effect). During follow-up, CBT improved pain severity (SMD = –0.52, 95% CI: –1.03 to –0.01, eight studies, 1447 participants, medium treatment effect), insomnia (SMD = –0.43, 95% CI: –0.85 to –0.01, three RCTs, 571 participants, small treatment effect), and depression (SMD = –0.39, 95% CI: –0.59 to –0.18, four RCTs, 791 participants, small treatment effect). Nevertheless, sleep efficiency, fatigue, and physical function were not improved in the follow-up period.ConclusionOur results may suggest the durability of CBT-associated treatment benefits, supporting its role as a potential promising alternative or complementary intervention for patients with knee/hip osteoarthritis, especially against pain and insomnia. Future large-scale investigations are warranted to verify our findings.Systematic review registration[https://www.crd.york.ac.uk/prospero/], identifier [CRD42022331165]

Vascular function in the aging human brain during muscle exertion

: To determine how brain oxygenation is stably maintained during advancing age, cerebral oxygenation and hemoglobin were measured real-time at 10 Hz using near-infrared spectroscopy (NIRS) at rest (30 seconds) and during a 10-repeated handgrip strength test (30 seconds) for 834 adults (M/F = 45/55%) aged 20-88 y. The amplitude of cerebral hemodynamic fluctuation was reflected by converting 300 values of % oxygen saturation and hemoglobin of each 30-second phase to standard deviation as indicatives of brain oxygenation variability (BOV) and brain hemodynamic variability (BHV) for each participant. Both BOV (+21-72%) and BHV (+94-158%) increased during the maximal voluntary muscle exertions for all age levels (α < 0.05), suggesting an increased vascular recruitment to maintain oxygen homeostasis in the brain. Intriguingly, BHV was >100 folds for both resting and challenged conditions (α < 0.001) in >80% of adults aged above 50 y despite similar BOV compared with young age counterparts, indicating a huge cost of amplifying hemodynamic oscillation to maintain a stable oxygenation in the aging brain. Since vascular endothelial cells are short-lived, our results implicate a hemodynamic compensation to emergence of daily deficits in replacing senescent endothelial cells after age 50 y

Mutation and Lineage Analysis of DNMT3A in BCR-ABL1-negative Chronic Myeloproliferative Neoplasms

SummaryIn addition to the JAK2 V617F mutation, somatic mutation in DNMT3A has been described in BCL-ABL1-negative myeloproliferative neoplasms (MPNs). We have screened for DNMT3A exon 23 mutations in 130 adult Taiwanese patients with chronic phase myeloproliferative neoplasms. Only one somatic DNMT3A R882H mutation was identified in one JAK2 V617F mutation-positive essential thrombocythemia patient (1/91, 1%). Both mutations were detected in the CD34+-, CD19+-, peripheral blood mononuclear cell- and granulocyte-enriched fractions, but were not detected in the CD3+-enriched fraction by lineage analysis. Our findings suggest that DNMT3A mutation is not prevalent in MPNs, and further study is needed to clarify its role in the molecular pathogenesis of myeloproliferative neoplasms