This paper aims to explore the use of computer-based simulation teaching combined with PBL in colorectal tumor bleeding.  The outpatient department organized 21 nursing staffs to conduct computer simulation combined with PBL teaching, compared emergency theory and skill scores, and investigated the recognition of computer simulation teaching combined with PBL.  The scores of theoretical knowledge examination before training were (84.31 ± 6.39) and (92.59 ± 2.93) after training; the scores of treatment skills examination were (85.69 ± 6.15) and (95.43 ± 2.88) after training; the scores of comprehensive treatment skills before training were (76.6 ± 6.31) and (91.43 ± 2.3) after training. The results of the questionnaires showed that the nurses were more agreeable to the new teaching methods and were able to complete the tasks in strict accordance with the requirements, ultimately achieving a level of satisfaction with their progress.  Computer simulation teaching combined with PBL can deepen general practitioners' understanding of knowledge, improve practical ability, and provide a clinical basis for improving patient resuscitation in specialized oncology hospitals. First-aid skills are the most important means of rescuing patients with acute illnesses, and every medical personnel should be proficient in them, but for general practitioners, they usually resuscitate less and do not have enough clinical experience , and traIt has been more than 20 years since PBL was launched in Shanghai Second Medical University and Xi'an Medical University in 1986, and some higher medical schools in China have also started to try PBL teaching.The learning community in traditional PBL has only nurses in the classroom, so the homogeneity of group members' thinking is high, and the overall thinking level of the learning group can hardly reach a high level, which makes the design of problem solutions lack high innovation; the group of teachers is also limited to the lecturers of the course, who lack the necessary skills and motivation to participate.The problems in PBL come from real, complex, and ill-structured problems in life. However, teachers in traditional PBL still use text and video to represent problem situations, which cannot give nurses an immersive feeling and make it difficult to empathize with the environment emotionally and psychologically to achieve effective transfer of knowledge.Traditional PBL requires a large number of small classrooms for group discussions, and each small classroom must be equipped with sufficient teaching tools, learning resources, and instructors. However, with the continuous expansion of Chinese universities, schools are faced with the contradiction of more nurses and fewer instructors, shortage of teaching resources such as classrooms and libraries, and tight education funding. This has led to schools implementing PBL in the form of large class discussions, where over 100 nurses are divided into small groups in a large classroom and a lead teacher leads the discussion, which is not true PBL in the true sense.In traditional PBL, nurses' problem-solving process is mainly accomplished by consulting relevant textual materials and having face-to-face discussions, exchanges, and consultations with group members. Communication among nurses and between nurses and teachers is mainly focused on the classroom, but since they are at the same level of learning and have basically similar levels of thinking, there may be some difficulties in not developing nurses' critical thinking and creative thinking skills.In teaching, if PBL is used alone, the knowledge gained gives a feeling of lack of depth and systematization, and a lot of time is wasted in group discussions. The knowledge acquired by nurses in traditional PBL teaching is sufficient for solving a selected clinical problem, but it is not broad and deep enough for mastering the systematic knowledge of a discipline, especially in some basic medical courses, because PBL breaks the integrity of basic theoretical knowledge, some contents may be missed, so it is not as deep and systematic as the theoretical learning emphasized in the traditional teaching mode, which will cause nurses to accumulate insufficient knowledge thickness of a discipline.One reason for the resistance to the implementation of PBL cannot be overlooked: the lack of appropriate textbooks. Many schools implementing PBL have found that existing textbooks for basic medicine and clinical phases are not suitable for PBL and need to be rewritten, which is a challenge for both teachers and nurses with poor clinical reasoning and self-learning skills. The continuous cross-pollination between disciplines and the deepening of medical teaching reform, medical PBL is bound to change accordingly. We believe that the online virtual classroom and online virtual clinical skills center constructed by computer technology will provide a teaching platform for remote PBL and develop nurses' problem-solving skills and that telemedicine PBL will become an important development direction of PBL.Our medical theoretical knowledge and the extensive use of high-tech top our instruments require nurses to have a more comprehensive knowledge structure and be able to skillfully apply our commonly used technologies. In recent years, the number of outpatients in our hospital has increased rapidly, and there are often difficult and critical patients from overseas. In addition to the 13 busy nursing work, inpatient nurses undertake the task of our care for outpatients. Although the number of emergency cases is small compared to that of general hospitals, the condition is aggressive, with many comorbidities, poor predictability, and serious consequences. In order to ensure the medical safety of outpatients, the outpatient department regularly organizes standardized training for nursing staff on theoretical knowledge of treatment and treatment skills and other comprehensive abilities of our care and has achieved remarkable results.PBL states that medical education should study not only the biological process of disease but also its connection with social groups, psychology, environment, and behavioral patterns; the purpose of education is to promote nurses to become self-motivated lifelong learners who can continuously update their knowledge.PBL is a learning method for acquiring and synthesizing new knowledge through problem orientation , 6. It uTraditional PBL (or classroom PBL) emphasizes that the teacher distributes the problem (or case) to be learned to the nurses before or during the class, and the nurses collect information related to the problem through various means around the problem or (case) and analyze and organize the collected information. In the first discussion, the instructor divides the learners into learning groups, one for every five to six nurses, and gives the nurses a certain amount of time in class to discuss and divide their learning. Nurses can then look up the information again with the questions that arose from the discussion session. In the second discussion, nurses participate in the study group again with the knowledge they have developed and the problems they have identified during the learning process. For problems that exist, the nurse needs to again continue to search in depth for information about the problem, analyze, organize, and synthesize new information with old information to form a hypothesis for the final solution. At the group discussion, the whole class submits the final problem solution reached through the discussion, and finally, the teacher gives a summary and feedback.PBL is a new teaching method that has been rapidly developing worldwide. Since its introduction by McMaster University in Canada in 1969, PBL has been used mainly in medical and vocational schools and certain other educational fields, such as life sciences, nursing, dentistry, pharmacy, veterinary medicine, public health, architecture, business, law, engineering, forestry, and sociology , 11.In just a few decades, PBL has been continuously explored and introduced into practice teaching all over the world, which must have its own indelible advantages. The main manifestations are. The PBL approach is consistent with today's philosophical view of education. PBL is based on some of today's learning theories, such as constructivist theory, contextual cognitive theory, and so on. And it is also consistent with the idea of lifelong education.Since PBL embodies certain learning principles, it (1) enhances the spontaneity of nurses' learning. The survey found that nurses who use PBL learning are more willing to participate in teaching and learning and have more positive attitudes than those in traditional teaching methods. Nurses find PBL to be a more interesting, stimulating, and enjoyable way to learn. In PBL, nurses are more likely to become spontaneous and independent learners because they are less restricted by the teacher and more independent, which provides a solid foundation for lifelong learning.In real life, social skills are an important element in the workplace. PBL is done in a collaborative group format, which motivates group members to cooperate in solving relevant problems. Thus, the dynamic process of collaborative learning, evaluating peers, and presenting and defending one's plan to other members of the group led to significant improvements in the nurses' interpersonal skills. All nurses do not have to follow the same pattern of learning; nurses are able to learn in the way they prefer. Stimulates student autonomy in learning. Nurses must set their own learning goals and standards to test whether they are meeting expectations, which increases their sense of responsibility for their own learning and gives them a higher degree of autonomy than traditional nurses. Teachers can give timely feedback on nurses' questions and performance to help nurses plan their next steps in learning. Combining student self-assessment, peer assessment, and teacher assessment allows nurses to become more fully aware of what is wrong with their learning. We provide an environment where nurses feel competent to learn and encourage and support them to develop their own learning interests. This interactivity is not limited to the classroom but is achieved in various forms of interaction between nurses and teachers inside and outside the classroom.Because the process from problem identification to problem-solving in PBL is a cognitive process, and the answer to the problem in PBL is not unique, there are multiple solutions, so the nurse can only find a feasible solution in various ways to achieve the set goal or the desired effect.Establish a training group with the head nurse as the leader and select senior nurses with rich experience in treatment and training as instructors. Each person undertakes several projects to organize training.Formulate training plan. ①The training team will formulate outpatient treatment skills training plan and corresponding our treatment plan according to the annual nurse training plan of nursing department, combined with the characteristics of oncology outpatients and our situations that are prone to occur, such as cardiac arrest, hemorrhage , drug allergy events, and sudden syncope, fall and suicide, etc., our treatment plan and resuscitation workflow, etc. ②The training team develops training programs and content to be focused on according to the outpatient treatment skills training plan, such as oxygen inhalation method, electric suction method, indwelling gastric tube, urinary catheterization, use of cardiac monitor and simple respirator, as well as cardiopulmonary resuscitation, cardiac defibrillation. ③ Training for nurses' comprehensive treatment ability includes the ability to identify and solve problems, our operation skills and critical care record writing ability, etc., old. Conduct training.The implementation of training treatment skills training is arranged by the chief nurse, and the instructor conducts centralized training for all inpatient nurses. The training method adopts a combination of scenario simulation method and instructor operation demonstration method, and the scenario simulation method is used for key training contents, such as resuscitation of patients in cardiac arrest and hemorrhagic shock. After the training, the trainees are assessed, and the chief nurse randomly checks the assessment every month, and the assessment results are linked to the performance.Effectiveness evaluation assessment is divided into three parts: theoretical knowledge of our nursing, skill operation, and comprehensive our application ability of nurses. The theoretical examination questions combined with the theoretical knowledge learned, unified questions, ≥80 points to pass; skills operation reference 55 clinical nursing technical operation scoring standards for assessment, ≥90 points to pass; nurses comprehensive our ability assessment for resuscitation of patients after the end of the assessment, including the ability of nurses to identify and solve problems, resuscitation equipment operation proficiency, oral medical advice implementation, and critical care records The assessment of writing ability is conducted, and ≥80 is qualified.Nurses from Shanghai Second Medical University and Xi'an Medical University participated in the study. Before starting the medical internship in our oncology, theoretical and practical skills examinations were conducted for common diseases in our oncology such as superior vena cava compression syndrome, acute spinal cord compression, malignant pleural effusion, pericardial effusion, and malignant colorectal tumor combined with cardiopulmonary resuscitation cases, and then a case was designed by the instructor for each disease. The operation of the SimMan4000 integrated simulator from Laerdal, Norway, was used for training. The teacher created a case of superior vena cava compression syndrome, acute spinal cord compression, malignant pleural effusion, pericardial effusion, and malignant colorectal tumor combined with CPR according to the teaching content. Then, according to the problems raised by the nurses, summarized into a number of several focused problems, each student chooses a few or a problem to find information, self-study ; a few days later, focused discussion, each student report what they have prepared, and then discussion, the first hypothesis to argue, when nurses encounter more difficult. When nurses encounter more difficult problems or discussions, the teacher provides the necessary guidance and conducts a mutual aid course with nurses, the last class is summarized by the teacher, and finally a theory exam is given. The computer simulation teaching uses SimMan4000 integrated simulator for CPR skills training and assessment, the problems encountered in the computer simulation training nurses can discuss again or consult the information, and get the answers and repeatedly verify on the computer simulator to come up with the correct answers. Questionnaires were distributed to nurses' evaluation of the PBL combined with computer simulation teaching method. There were 89 questionnaires distributed and 89 questionnaires were collected, with a 100% recovery rate.The results of clinical medicine undergraduates before and after the internship were significantly better than those before the internship, with significant differences (about 0.05), see In total, 98.9% of the nurses liked the teaching method combining computer simulation and PBL, 97.6% of the nurses thought that this teaching method deepened their understanding and memory and improved their practical ability, and 96.6% of the nurses thought that the teaching method combining computer simulation and PBL could cultivate both team spirit and problem-solving ability.Before training, 16 nurses passed the treatment theory knowledge examination, with a passing rate of 76.1%, and after training, 21 nurses passed, with a passing rate of 100%; before training, 15 nurses passed the treatment skills examination, with a passing rate of 71.5%, and after training, 20 nurses passed, with a passing rate of 95.1%; before training, 16 nurses passed the treatment comprehensive ability examination, with a passing rate of 76.3%, and after training, 20 nurses passed, with a passing rate of 95.3%. After the training, 20 nurses passed the comprehensive treatment ability test, with a pass rate of 76.3%, and the pass rate was 95.3%. After the training, the nurses' treatment theory knowledge, treatment skills assessment, and treatment comprehensive ability assessment scores are significantly improved  loses consciousness, determines whether it is cardiac arrest, starts our colorectal tumor hemorrhage, and at the same time notifies the doctor, cardiac monitoring, opens the venous. One person will direct the resuscitation, two people will be responsible for chest compressions and artificial ventilation, one person will be responsible for defibrillation and one person will be responsible for intravenous drug administration, and each person will rotate different roles after proficiency. Then, there is group discussion for the teacher to review. With the help of the video, the nurses and the instructor analyzed the resuscitation process and pointed out the merits of the nurses and the aspects that needed further improvement, such as theoretical knowledge, resuscitation techniques, communication skills, and psychological status.The teaching effectiveness was evaluated as follows:Nurses in both groups were given the same difficulty of theoretical closed-book test and applied SimMan4000 integrated simulator for skill examination with computer scoring. The theoretical test scores and operational skills test scores of nurses in the experimental group for our colorectal tumor hemorrhage were significantly higher see .l clinical levels were improved. The results of the questionnaire survey are shown in After the examination, questionnaires were distributed to the nurses of both groups, which included the evaluation of the responsibility of the instructors, the approval of the teaching methods of the instructors and the evaluation of whether their theoretical and Since no universities in China have adopted multiple computer technologies to reform traditional medical PBL methods, it is difficult for us to conduct an empirical investigation study on the effects of computer technologies on reforming traditional medical PBL at this stage. In 2002, a university medical school was the first in China to establish an advanced clinical skills center using multiple technologies, including simulation and virtual technologies. At the same time, a university medical school also applied the PBL method to teaching various disciplines and achieved certain experience and effectiveness.In the following, we will analyze the results of the questionnaire of the 2003 undergraduate clinical skills training of a university medical school and the statistical table of the questionnaire of microbiology “PBL” of a university medical school to explore the expected effect of using various computer technologies to reform the traditional medical PBL method.The results of the 2003 undergraduate clinical skills training questionnaire at a university medical school are as follows:The survey was conducted mainly for the participation of 2003 undergraduate nurses in clinical skills training. 104 questionnaires were distributed, 64 in the 2003 undergraduate class, and 40 in the diagnostic class. A total of 85 questionnaires were returned, and the results are shown in Tables 5The comparison of the effectiveness of teaching with or without simulation is shown in Figures 1P < 0.05). During the experiment, the interns in the laboratory group were satisfied with the teaching work and performed differently (P < 0.05)(Tables The experimental results showed that the practical and theoretical scores of interns in the experimental group were significantly higher than those in the control group (A comparison of the changes in the condition of the two groups of patients after our 0 h and 12 h is shown in The comparison of mortality rates between the two groups of patients at 7 and 21 days after surgery is shown in Computer simulation technology has created a fully functional clinical simulation teaching environment, providing medical students with a new practical experience. Compared with traditional medical education, simulated medical education has a better training effect and has been widely used in the medical field , 12. ThrPBL encourages students to learn actively, and the most obvious advantage of PBL compared with traditional lecture method is that it emphasizes and encourages students to learn actively, encourages students to broaden their ideas and learn creatively, and requires the integration and convergence of basic and clinical expertise in various medical disciplines , 16. StuThe combination of computer simulation teaching and PBL enhances the attractiveness of classroom teaching and students' learning ability, stimulates the enthusiasm of operation and practice, and deepens the understanding and memory of knowledge, thus completely changing the previous situation of emphasizing knowledge transfer but not ability cultivation, teacher teaching but not student participation in the teaching process , 20. PBLThis study showed that the application of computer simulation combined with PBL in CPR teaching significantly improved students' performance, and 96.8% of students liked computer simulation combined with PBL, which fully demonstrated the advantages of this teaching method , 25. SevWith the development of new surgical procedures, improved surgeon techniques and the widespread use of broad-spectrum antibiotics, the incidence of fatal bleeding has become less common, but when this complication does occur, it is often critical, clinically difficult to treat, and highly lethal. The first few minutes of treatment when bleeding occurs are critical, and correct and timely treatment by the first caregiver on the scene may save the patient's life. Therefore, it is critical for nursing staff to have the correct treatment measures in place to take accurate and effective measures to stop the bleeding and improve the success rate of resuscitation.This study showed that the application of computer simulation teaching combined with PBL for colorectal tumor bleeding significantly improved the learning performance of nurses, and the questionnaire results showed that nurses were more agreeable to the new teaching method and were able to complete the tasks strictly in accordance with the requirements, and eventually reached a level of satisfaction with their progress. This fully reflects the advantages of computer simulation teaching combined with PBL teaching method.In summary, PBL teaching on computer simulation system can overcome the real problem of “few practice opportunities” for medical nurses by simulating real clinical scenes and expand their clinical thinking ability through “problem-centered” heuristic teaching. The problem of low practice opportunities for medical nurses can be overcome by simulating real clinical scenarios. Through the perfect combination of teaching methods and teaching methods, it provides an important guarantee for the overall improvement of clinical practice skills of medical and nursing staff.


Migration has become one of the challenging global issues of the twenty-first century. Therefore, analyzing the intention to migrate is essential to develop clear strategies to manage actual migration. This research aimed to investigate emigration intention predictors  and the interaction effect of social networks between those predictors and migration intention. A sample of 701 high school students participated in the research. Exploratory Factor Analysis and Confirmatory Factor Analysis were employed to explore the dimension and loading of items respectively. To test the moderation effect of social networks on migration intention and the predictor variables, structural equation modeling was employed using Amos version 27. The findings indicated that Attitude, National pride, subjective social norm, and perceived behavioral control predict youths' emigration intention. The result also revealed that social network strengthens the negative correlation between place attachment and intention to migrate only if the individuals have a high social network. The social network also moderates the relationship between attitude and emigration intention. Migration has become one of the challenging global issues of the twenty-first century. Though it is as old as human beings, research findings showed that its magnitude, complexion, and its aversive consequences have been increasing from time to time. It is stated that migration dynamics are continually evolving and new migration flows develop due to different push and pull factors like economic, social, and political structures in host and sending countries , 2,133 , and 483  returnees were registered at Jama, Kelela, and Mekedela woredas, respectively, in 2015 only  to process their migration. If this money is properly managed and invested, it could have enabled them to start their businesses in their own country where they live with their close families, relatives, and friends. Therefore, their intention to migrate and their behavior of migration seem to be beyond economic issues. This condition requires further research to investigate the social-psychological determinants of migration and migration intention in Ethiopia in addition to the economic factor which is over-examined.In general, since the nature of migration is complex, it is unlikely that limited theories and disciplines can address all the issues it contains. It can be better understood if there is a synergy of a variety of disciplines or interdisciplinary studies concerning the nature of migration to deal with a range of variables associated with it. It appears that only the economic factor has been addressed as a determinant of migration and migration intention. However, focusing on economic factors might result in poor management of migration and migration intention. Therefore, it is time for psychology in general and social psychology, in particular, to come up with possible explanations concerning the nature and determinants of migration in Ethiopia.Therefore, this study is designed to answer the following basic research questions:Do subjective social norms, attitude, national pride, place attachment, and perceived behavioral control predict the intention of high school students in South Wollo to migrate abroad?Does one's social network moderate the relationship between high school students' intention to migrate abroad and subjective social norms, attitude, national pride, place attachment, and perceived behavioral control?The specific objective of this study was intended to:Identify if perceived behavioral control, subjective norms, national pride, place attachment, and attitude predict cross-border migration intention of high school students;Examine whether one's social network moderates the relationship between high school students' intention to migrate abroad and subjective social norms, attitude, national pride, place attachment, and perceived behavioral control.To accomplish this research, the theory of planned behavior is used as a theoretical framework. Several investigators showed the application of the theory of planned behavior in their attempts to predict and understand people's intentions to engage in various activities. The theory of planned behavior is very important to incorporate both individual and social factors in determining individuals' behavior, and it has been promoted by different researchers in studying the interaction effect of the social and psychological aspects on individuals' behavior. The theory can accommodate different theoretical constructs by including individual and social factors into the same model and has the capacity to predict a range of behaviors and intentions in numerous domains . At the onset, the names of the woredas were written on the paper. Then the pieces of paper were rolled and put in the hat. A student at Wollo University drew two pieces of paper with the names of the Mekdela and Tenta woredas on them. Once the woredas were selected, similar techniques applied to select woredas were applied to select the schools to draw the sample sections. With this sampling technique, Adjibar and Mekdela High Schools were selected.To select participants of the research for item validation, a multistage cluster sampling technique was employed. First, Once the schools were selected using a simple random sampling technique (lottery method), information about the average number of students per class was collected from the principals of the schools. Since there was item validation, these gave a clue about the number of sections that would be included in the study as the number of participants for instrument validation should be >300  were written on the pieces of paper and rolled. Teachers at these schools drew the sections that would participate in the study.*41) which were 164 and similarly, sample students from Adjibar (4*54) were 216. But the exact number of participants that were taken from the two schools was 165 and 214 from Mekdela and Adjibar High Schools, respectively. Therefore, the total number of participants in this research study was 379.Four sections were taken from each school. The approximate total samples that ought to be taken from Mekdela High School were sample sections times average students per class  to 4 (there are very much) for social networks and 1 (strongly disagree) to 5 (strongly agree) for intention, place attachment, subjective social norms, attitude, national pride, and perceived behavioral control.The intention of individuals to migrate abroad was measured using the intention scale developed by Chan-Hoong and Soon  and had The attitude of individuals toward migration was measured using the scales developed by previous researchers. The attitude measuring instrument has social status and socio-economic security items in it. The social status having two items has a Cronbach's alpha of 0.6 and the socioeconomic scale with ten items has a reliability of 0.79 , structural equation modeling was employed using Amos version 26.As the initial versions of the instruments were in English, the first step was to translate them into the Amharic language. Translation to Amharic was done by a language expert and psychologist. The language expert was an assistant professor in the Amharic language at Wollo University. In addition, to evaluate the translation from the perspective of psychological essence, an assistant professor in developmental psychology from the psychology department participated. Subsequently, backward translation from Amharic to English was made by other language experts and psychologists. This was made to verify if the translated items are similar to the original ones. To check the content validity of the instrument, a panel discussion was conducted. Four teachers (two assistant professors and two lecturers) from the psychology department at Wollo University were the panelists to evaluate if the instruments contained relevant content concerning the issues under investigation. The panelists evaluated if the measuring instruments have adequate coverage of the topics under investigation. Moreover, judgment was given about the cultural relevance and translation of the instruments.Exploratory factor analysis (EFA) was used to uncover dimensions of the underlying data set or examine which of the items have the strongest association with the latent variable  and supported the factorability of the items. Using the Maximum Likelihood (ML) extraction method, the instruments of the seven variables  had 71 total items that were subjected to SPSS version 23. The analysis revealed the presence of seven components with eigenvalues exceeding 1, explaining 28.10, 12.94, 7.14, 4.6, 3.45, 2.79, and 1.87% of the variance, respectively. The seven components solution explained a total of 61% of the variance. In addition, factor analysis was also conducted for each scale to investigate if there are dimensions for each latent variable independently. The results indicated that there were no dimensions for all of the scales of the latent variable used in this study. The reliability of tools is indicated in The Kaiser–Meyer–Olkin test score (KMO), which is 0.95, confirmed the adequacy of the sample and Barlett's Test of Sphericity was significant  = 1.071, the Comparative Fit Index (CFI) = 0.99, the Standardized Root Mean Square Residual (SRMR) = 0.038, the Root Mean Square Error of Approximation (RMSEA) = 0.014, and P-CLOSE = 1. Moreover, all the loadings of the items were significant and above 0.5, which indicated that more than 50% of the variance is explained by latent factors. Concerning the ethics of the research, the participants were told that they have the right to quit at any time or not to participate if they were not interested in it. Moreover, they were told that their information about the issue under study would be kept confidential. There were no personal identifiers used, just codes assigned for each questionnaire. In general, the research was conducted by taking the social and psychological well-being of the participants into account.In this section, the collected data are presented and analyzed. The results began by describing the demographic characteristics of the participants of the study. Next to this, path analyses of variances were presented in line with the objectives of the study.A total of 747 high school students from different grade levels participated in the current research. The return rate of the questionnaire was 93.84% as 701 students filled correctly and returned it. Forty-six students, i.e., 6.16% of the total participants, either did not properly fill out or did not return the questionnaire and were not included in the analysis. The frequency and percentage of the sample in terms of school grade level and sex who responded correctly are presented in p < 0.001) predictor of an intention to migrate abroad of all other predictors. The result also indicated that national pride is the second strongest predictor  compared to the rest of the other independent variables. Attitude , and subjective social norms  also predicted an intention to migrate abroad. As was presented in the result, place attachment did not significantly  predict an intention to migrate abroad.As it is portrayed in To examine the interaction (moderation) effect of social networks on attitude, place attachment, subjective social norms, perceived behavioral control, and national pride on an intention to migrate abroad, a path analysis was conducted.p < 0.01) strengthened the relationship between attitude and an intention to migrate. However, the mere presence of social networks did not play role in strengthening the relationship between migration intention and attitude. It was indicated that low social networks did not have a moderation effect between the variables. But the relationship between attitude and migration intention was strengthened only when there was a high social network. As it is portrayed in P < 0.01) strengthened the negative relationship between place attachment and an intention to migrate abroad. But the moderation effect of social networks between place attachment and an intention to migrate was significant when the individuals' social network was high. However, when the social network was low, the interaction effect of social networks between the predictor and criterion variable was not significant. The result of path analysis also indicated that social networks significantly  predicted the migration intention of high school students. This finding is similar to the findings of other researchers. For example, Gödri and Feleky  and the outcome variable (migration intention), the result indicated that the moderation effect of social network is revealed only in two predictors and migration intention. It moderated and strengthened the positive relationship between attitude and migration intention. But the moderation effect was significant when adolescents have a high social network. On the contrary, when the adolescents' social network was low, its moderation effect was not significant.Among the different means, attitude is formed is through social learning. Social learning is one of the mechanisms to form an attitude. People learn a behavior and behavioral intention through vicarious learning and make cognitive inferences based on what they experience from others Bandura, . In lineThe result of path analysis also indicated that social networks significantly strengthened the negative relationship between place attachment and migration intention. But the moderation effect of social networks between place attachment and migration intention was significant when the adolescents' social network was high. On the contrary, when the social network was low, the interaction effect of social networks between the predictor and the criterion variable was not significant. When adolescents have a low place attachment and have a high social network, their migration intention will be high. This could be justified because if they have a high social network, they might think that previously migrated individuals facilitate their migration process. The previously migrated members of the society serve as social capital for those who intend to migrate abroad in search of jobs, providing them with accommodation, giving information, and delivering psychological support. In addition to getting information about the existing jobs and conditions in the destination country, the social Network serves as a safety net by providing them with material and social support Chi, .Massey et al.  found thAs migration is one of the critical issues with far-reaching positive and negative impacts for Ethiopia, interdisciplinary research is required. In line with this view, this research was conducted to explain migration from a social-psychological perspective. Previous studies focused on the economic dimension. The present research focused on some social-psychological variables to identify if they predict migration intention. Accordingly, attitude, place attachment, perceived behavioral control, subjective social norms, and national pride were considered to investigate whether they determine the migration intention of adolescents. The results indicate that all the above variables, except place attachment, predict migration intention. Perceived behavioral control was found to be the top predictor. This is conceptually meaningful as self-efficacy is a core psychological variable that shapes intention and action. The fact that place attachment failed to predict migration intention can be linked to the overweighting power of unemployment and the consequent desperation and desire for change. In other words, the adolescents were becoming pragmatic and realistic in that remaining at one loved origin place without a job and hope does not make them productive.Moreover, this research identified the moderation effect of social networks between the criterion variable (migration intention) and the predictor social psychological variables. The result indicated that social networks positively moderated the relationship between attitude and migration intention. On the other hand, social networks strengthened the negative relationship between place attachment and migration intention when individuals have a high social network. What is interesting here is that a social network's capability to moderate is significant when the social network is high. When the social network is high, the support or distraction that adolescents receive from the network is high, thereby having a profound positive or negative impact on their social behavior. Currently, we have not found a significant moderation effect of social networks between the three predictor variables  and the criterion variable, migration intention, implying the need for further study in other settings.Finally, the current research hints that it is not only economic issues that determine migration intention. Social psychological issues are one of the important determinants of migration intention. Therefore, more interdisciplinary research is required to better understand migration and migration intention to develop a policy for the management of migration. For example, an anthropological study on the impact of culture on migration intention would be useful.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The studies involving human participants were reviewed and approved by Ethical Committee of Psychology Department. Written informed consent to participate in this study was provided by the participants' legal guardian/next of kin.Both authors listed have made a substantial, direct, and intellectual contribution to the work and approved it for publication.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


This project aimed to retrospectively obtain, review, and extract key safety data from medical records of participants enrolled in RAMPART, the NIH-supported Rapid Anticonvulsant Medication Prior to ARrival Trial of intramuscular midazolam versus intravenous lorazepam for pre-hospital treatment of status epilepticus, to support a US new drug application (NDA) for intramuscular midazolam.A collaborative partnership was established between the NDA sponsor, the RAMPART trial lead academic institution, US government agencies, and contract research organizations to retrieve, review, and extract relevant safety data from the medical records of RAMPART participants and summarize those data to include in an NDA submitted to the US Food and Drug Administration (FDA).Key data in the medical records of 890 RAMPART trial participants  were reviewed and extracted into a project database. Safety events occurred in 771 (86.6%) participants, and included additional information not collected in the RAMPART trial. This database also enabled subgroup analyses based on medical history and prior/concurrent medications, building upon previous analyses according to age, sex, and race. No previously unrecognized safety patterns were identified, and no association was observed between efficacy and medical history or medication usage.The use of unstructured real-world retrospective medical record data can effectively support an NDA submission in place of conducting another interventional clinical trial. This retrospective medical records review and extraction of additional safety data contributed to the FDA approval of intramuscular midazolam for the pre-hospital treatment of status epilepticus in 2018.NCT00809146. Midazolam is a short-acting hypnotic-sedative drug of the benzodiazepine class approved in the US since the 1980s for the treatment of insomnia and as a sedative-hypnotic for use in anesthesia . The ranStatus epilepticus represents a medical emergency that can lead to permanent brain damage or death, and immediate treatment is critical to improve outcomes . AlthougThe new drug application (NDA) submission included key safety and efficacy data from RAMPART. RAMPART enrolled patients from 33 emergency medical services agencies associated with 79 US hospitals and demonstrated that intramuscular midazolam administered via autoinjector was more effective than the standard of care, intravenous lorazepam, for the treatment of status epilepticus in children and adults when administered by emergency medical personnel in the pre-hospital setting. RAMPART also showed comparable safety of midazolam and lorazepam, including the incidence of serious adverse events (SAEs) . The triThe successful efficacy results from RAMPART were pivotal to the NDA submission; however, the FDA advised that more comprehensive safety, clinical, and other relevant data would be required to support the safety of midazolam for this new use and recommended that comprehensive safety information be extracted from the medical records of RAMPART participants and presented using MedDRA.Real-world data (RWD) have typically been used for post-marketing surveillance but this situation has changed in recent years, with some instances of RWD providing support for successful NDAs , 8. In 2This medical records project involved a public–private partnership that developed a detailed project plan to collect unstructured, retrospective, RWD from the medical records of RAMPART participants. The intent was to comprehensively identify and extract all safety, clinical, and other relevant data requested by the FDA and create an analyzable database to support NDA review. The medical records data were intended to complement and supplement the information from the prospective, interventional RAMPART clinical trial. However, comprehensive collection of all safety information from a patient’s medical record, rather than the focused collection of more proximate AEs and pre-specified safety outcomes, was unprecedented and required the development of a suitable methodology  that included the detailed processes and procedures that would be needed. Furthermore, as the FDA anticipated that further questions could arise during NDA review, they recommended gathering other potentially useful clinical data, beyond safety events; for example, vital signs, laboratory tests, imaging results, bioelectrical signals, blood gases, and blood cultures. This early communication with the FDA regarding study design and data collection is in line with their recent Guidance for Industry documents , 11.Therefore, the objective of this midazolam RAMPART medical records project (MRP) was to retrospectively obtain and review the medical records of all RAMPART participants to comprehensively identify and extract safety and other clinical data, including renal and hepatic events, into an analyzable database to support NDA review of a new indication for midazolam.A collaborative partnership was established between the NDA sponsor , the academic institution that coordinated RAMPART (UM), US government agencies , and multiple contract research organizations . Each partner organization had a defined role under the program plan Fig. .Fig. 1MeThis MRP was not classified as a clinical trial and had no testable hypothesis but was considered to more closely align with a non-interventional, retrospective chart review study. It was a unique program that was not aligned with any previously conducted internal studies or projects and therefore had had no specific internal processes and procedures to follow. As such, a dedicated program plan was developed, analogous to a clinical study protocol, which described the rationale, methodology, processes, procedures, and guidelines related to the implementation of the MRP. Where applicable, relevant aspects of the sponsor’s internal standard operating procedures for a non-interventional retrospective chart review study were leveraged, to ensure that the MRP was conducted in a robust manner, in order to support regulatory submission of the results. The program plan and subsequent amendments were reviewed and approved by an Institutional Review Board.UM retrieved the medical records of all RAMPART participants from the 79 participating US hospitals and assessed the completeness of each record. The initial review of each record (to ensure information required for patient enrollment was complete) was conducted by a clinical research professional supervised by a board-certified emergency physician. Any missing components were obtained by the respective hospital, if available.UM also performed a complete redaction of personal information from each medical record prior to transferring the medical record to the sponsor. To ensure participant confidentiality, this redaction was performed by a dedicated team at UM in accordance with the Health Insurance Portability and Accountability Act requirements for a Limited Data Set. The redacted medical records, some of which exceeded 1000 pages, were transferred from UM to the NIH, and then to the sponsor and the CRO that conducted the data review, extraction, and databasing of the data, according to the project plan.All sections of each medical record were then fully reviewed by a CRO (conducted by licensed nurses and overseen by board-certified physicians) to identify the required data to be extracted, including all pertinent information recorded in the ambulance, in the ED, and during the entire in-patient hospitalization , including the discharge summary. A case report form was created to collect the required medical record data to be extracted.Data were extracted from the medical records according to the requirements pre-specified in the Program Plan Table . Data weFour CROs were contracted to undertake different aspects of data extraction and the sponsor conducted extensive training with the personnel at each CRO on the required processes, procedures, and requirements of the MRP. The first CRO reviewed and extracted data from medical records into a secure electronic database, which was developed and validated via user acceptance testing procedures. If unredacted personal information was encountered in a medical record during review, the extraction was stopped immediately, the medical record was removed from the CRO’s internal medical record repository, and the sponsor was notified. The sponsor also removed the medical record in question from their internal medical record repository and immediately notified UM’s medical record redaction team. The medical record was then re-reviewed by UM’s medical record redaction team, as well as by a second CRO, to ensure that the medical record was fully redacted before data extraction was resumed.The data extraction started with the date of the RAMPART participant’s enrollment and continued until the day the participant either withdrew consent, was discharged from the ED/hospital, or died. Electronic edit checks were created and defined in a data management plan, to ensure data quality. Data to be captured included safety-related events on Days 0, 1, and 2 of RAMPART, as that duration spans at least six half-lives for midazolam and lorazepam. Day 0 was defined as the day of the participant’s ED arrival. Events beginning after Day 2 through discharge (or death) were not considered temporally related to the administration of midazolam or lorazepam due to the short half-lives of these drugs. No clinical judgment, interpretation, or inference was made regarding the nature of the safety events captured from the medical records; only objective information documented in healthcare provider (HCP) notes was extracted.Since the MRP was not a clinical trial, the safety events extracted from the medical records were not aligned with the standard definition of an AE, in contrast to the safety events that had been prospectively reported by the investigators during the RAMPART study. Safety data captured for the MRP were termed safety events (SEs) and serious safety events (SSEs) instead of AEs and SAEs. Despite this difference in terminology, and for consistency, the principles used to categorize safety data captured in the MRP database were based on the International Conference on Harmonisation (ICH) guideline definitions for AEs and SAEs Table . In addiThe seriousness of an SE extracted from the medical records was determined based on the standard ICH guideline criteria for identifying SAEs. The severity of an SE  was captured only if severity was explicitly stated in the medical record. For example, if the medical record stated ‘skin rash,’ with no documented indication of severity, then the SE would be captured as ‘skin rash’ and the severity would be recorded as ‘not available in the medical record.’ In general, the unavailability of data points was prospectively noted in the MRP database so that any subsequent requests for the data, from the FDA or other bodies, could be properly addressed.The outcome of each SE was collected only if it was clearly documented in the medical record; otherwise, it was recorded as ‘not available in the medical record.’ No assessments of causal relationship to the study treatment were performed for individual SEs; if a relationship to drug was explicitly documented in the medical record, then that relationship was captured. If the SE was treated , then the details were recorded, when documented in the medical record. For each SE, the verbatim term was captured and then coded according to MedDRA version 18.1.Preexisting medical conditions at the time of randomization were captured as medical history. However, if any preexisting condition was explicitly documented as having worsened in severity after randomization and study treatment administration, then that worsening was captured as an SE. Other pre-specified clinical information from each participant’s medical record was captured and stored in the database Table .Table 3PThe program plan specified the laboratory tests that were relevant to the pre-defined SEOIs previously described. These were collected in the MRP database, from Day 0 through ED/hospital discharge or withdrawal of consent, whenever the value had an identifiable unit documented in the medical records Table . Local hThe database constructed for the MRP was used to summarize SEs and SSEs and, in conjunction with efficacy data from the RAMPART clinical study database, was used to perform additional analyses of pre-specified subpopulations.The primary analysis population for summarizing the safety data collected from the RAMPART medical records included all participants randomized to midazolam or lorazepam (intent-to-treat population). In RAMPART and in the MRP, randomization was defined as occurring at the time the autoinjector was applied to the participant, prior to ED arrival. Participants were included in the primary analysis population even if study drug administration was not successful.Due to the emergency setting in which RAMPART was conducted , some participants were enrolled in the trial more than once (repeat enrollment). In these cases, data were extracted from the medical record for each separate enrollment.The relationship between the primary efficacy outcome  and study drug dose was determined by fitting a linear logistic regression model and modelling the log as a function of study drug dose (mg/kg). The relationships between the primary efficacy outcome and medical history and concomitant medications were qualitatively assessed by dividing participants into medical history and medication subgroups and comparing the percentage of participants achieving response between those who were and were not in each subgroup. For medical history, the subgroups were defined as patients with renal, respiratory, or hepatic impairment/disease history, or history of seizure. For concomitant medications, the subgroups were defined as patients who were taking opioids, benzodiazepines, enzyme inducers, enzyme inhibitors, enzyme inhibitors exclusive of inducers, and enzyme inducers exclusive of inhibitors.For the primary analysis of SEs and SSEs, only the first enrollment was used for each participant. Additional analyses of SEs and SSEs were performed by (i) including only enrollments after the first, and (ii) by including all enrollments for each participant. SEs and SSEs were summarized according to treatment group with the denominator for each treatment group reflecting the number of participants who were randomized at least once to that treatment .Medical records abstracts were reviewed for 1020 hospitalizations of 890 individual RAMPART study participants  experienced an SE, and 495 (55.6%) had an SSE  and other factors including temporal relationship of the event to the drug. The MRP analysis concluded that one death was possibly related to study drug.Based on analysis of the MRP safety database, no previously unrecognized adverse drug effects were identified for either midazolam or lorazepam. There was no significant relationship between the primary efficacy outcome  and study drug dose; and no association was observed between treatment success and any of the medical history or concomitant medication subgroups.This MRP used unstructured, RWD from medical records to complement existing clinical trial data and facilitate FDA review and approval of an NDA, in September 2018, of intramuscular midazolam for the treatment of status epilepticus. The methods presented here may provide useful insights for others involved in drug development and attempting to meet similar regulatory submission requests.This project involved a complex collaborative partnership between industry, academic, and government entities. The execution and success of the MRP was facilitated by the development and implementation of a comprehensive and robust strategy that clearly outlined the methodology, procedures, guidelines, communication, and mitigation strategies to be utilized.In a typical non-interventional retrospective medical records review, the protocol targets a limited number of specific safety outcomes of interest. By contrast, this MRP project attempted to comprehensively capture, retrospectively, all relevant safety information from medical records in much the same way that a Phase 3 pivotal clinical trial aims to comprehensively capture all relevant AEs prospectively. This approach resulted in capturing a very large volume of safety and other data from the 1020 medical records reviewed from the RAMPART study, with the number of SEs and SSEs captured in the MRP project exceeding the number of AEs reported in the RAMPART trial, with the variance likely attributable to differing reporting windows and thresholds, and inability to clarify data with the investigators in the MRP as in the clinical trial database.Moreover, an interventional clinical trial has an Investigator overseeing the care of the patient who will decide if a sign or symptom meets the definition of an AE and needs to be captured. The data reported to the clinical study database are organized and reviewed by the Principal Investigator prior to being submitted to a study sponsor, thus ensuring that the information is complete and internally consistent. A study sponsor can then query the investigator regarding potential data errors, missing data, or discrepancies identified during data review, and the investigator can resolve these data issues.In the retrospective setting, that is not the case. Determining when an SE or SSE is, or is not, present in a medical record requires detailed rules to govern inference and instructions to aid the data extractors who will be reviewing and extracting the data from the medical records. In a retrospective review of medical records, there is no pathway to query an investigator or HCP involved in the patient’s care, in order to resolve data discrepancies or other issues, which can be limiting to the analysis. RWD does also have its limitations, which needs to be considered when designing a study. Per the FDA, to use RWD studies in support of regulatory decisions, these studies must still meet the legal requirements of an “adequate and well-controlled study” . This inWith the recent increase in acceptance of RWD in support of regulatory decisions and the historic use of RWD for safety surveillance post-marketing, we believe that this MRP was an appropriate safety study to support the NDA and that other programs needing to supplement clinical trial data with additional safety data can utilize a similar process. However, the MRP differs from previously reported real-world studies. The hybrid model of data collection required for this project was highly complex, involving retrieval, review, and extraction of complete safety data from over 1000 medical records from 79 US hospitals. With no known precedent for this type of unstructured comprehensive data collection, this project required the development and implementation of a program plan to describe the detailed processes and procedures that would need to be followed to achieve the required deliverables.The MRP conducted for the RAMPART study represents a novel use of unstructured data collection from medical records to provide necessary supplemental safety information for FDA review of an NDA. During the initial stages of creating this study, FDA provided input in the data collection, verification, and analysis processes that was essential in designing this MRP study. The learnings from this project may be useful to others undertaking similar projects and/or studies that utilize RWD. Creative use of unstructured real-world retrospective medical record data can be considerably more efficient than conducting clinical trials, provided that the methodology includes well-designed processes, procedures, and guidelines for the comprehensive review, extraction, and analysis of the safety data in order to ensure acceptable quality, consistency, and robustness of the data and results. Finally, this MRP demonstrated that a collaborative partnership between pharmaceutical industry sponsors, academic institutions, US government agencies, and CROs can be effective and successful.


It was concluded that juice content had a significant positive impact on physicochemical parameters such as volume, color, acidity, as well as the antioxidant activity of breads. The carrot and beetroot juices were the most efficient in terms of shaping wheat bread properties, especially in terms of antioxidant activity.Bakery products, including bread, are important components of the diet of people all over the world. One of the food industry’s goals is to improve its quality in the context of healthiness and physical parameters. Consumers’ perception of sensory quality is an important aspect of food choice. Thus, the study aimed to enhance nutritional parameters  together with maintaining or increasing bread quality . Among vegetable juices, tomato, beetroot and carrot were selected, as they are easily accessible in Europe and are inexpensive. At the same time, those juices are known to be high in antioxidants. In this study, the effect of substituting recipe water with tomato, beetroot and carrot juices (replacement level: 15, 30, 50%  Tritium aestivum L.) bread is a staple food consumed all over the world, we decided to include vegetable juices in the bread making process and evaluate their effect on product quality. Bread may be a good carrier of bioactive compounds as it is a highly accepted, convenient food. However, vegetables added to baked products significantly change the physical and chemical characteristics  ,31 30,31Studies of pH and titratable acidity show that with the appropriate addition of juice to the dough, these two parameters can be shaped in wheat bread. Consequently, this affects the organoleptic perception of the bread.It is well known that polyphenols are beneficial for health, due to their antioxidant properties, which act as free radical scavengers and reduce oxidative stress in the human body. Fruits, vegetables and juices pressed from them are particularly rich in polyphenols ,33. TherThe addition of vegetable juices to wheat bread affected the content of phenolic compounds . HoweverThe antioxidant activity of bread supplemented with vegetable juices, measured by ABTS and DPPH assays, shows the positive effect of the baking process on this type of attribute. Antioxidant capacity increased in all bread variants tested compared to the control sample. The smallest effect of the addition of juice was observed in samples with carrot juice. A slightly better effect was obtained with tomato juice and a significant, several-fold increase in the antioxidant activity of the bread was found when beetroot juice was added. However, the degree of increase in antioxidant capacity was not the same when we compared the values measured by the ABTS and DPPH methods. The DPPH method was more sensitive to changes in juice shares in wheat bread. Another study seems to confirm our finding , but othThe addition of tomato juice did not significantly change the sensory characteristics of the bread according to the evaluation panel . HoweverA PCA chemometric analysis was conducted to evaluate and demonstrate changes in wheat breads, as influenced by the type and level of vegetable juice addition. The first two principal components explained 75.32% of the total variability. The attributes that most differentiated the samples of bread with tomato juice were the total color difference (ΔE*), ABTS and DPPH values, and taste scores . As the Samples of wheat breads with beetroot or carrot juice additives were grouped into their respective subgroups, far from the control sample. In the case of breads with beetroot juice, the samples differed the most in antioxidant properties and TPC value, followed by organoleptic properties. The high content of bioactive compounds, which additionally act as colorants, caused significant positive changes in crust colour, crumb porosity, and flavour. Based on Based on the experiment results, it was concluded that carrot and beetroot juices contributed to more active fermentation resulted as increased bread volumes. The active and potential acidity of the bread crumbs was also significantly affected by the juices. By obtaining an intense color of bread with the addition of carrot and beetroot juice, it is possible to use them as natural food colorants in bakery products. Most importantly, the addition of vegetable juices proved to be a very good way to increase the antioxidant activity of wheat bread. PCA analyses revealed that carrot and beetroot juice are the most efficient in terms of shaping wheat bread properties. A 30% or 50% substitution of water for juice in a recipe increases the organoleptic value of baked goods, especially in terms of color and taste. The research showed that the addition of vegetable juices may be used in the bread production technology, creating a new assortment to meet consumers’ needs for food with high organoleptic and nutritional qualities.


Adolescent idiopathic scoliosis (AIS) is a structural deformity of the spine involving all three planes of the space and arises in otherwise healthy children at or around puberty . It is aThe diagnosis of AIS is made both with clinical examination and specific radiological exams. The clinical evaluation includes a determination of the asymmetry of the shoulder and of the chest, and of pelvic obliquity, with the Adam forward-bending test used to detect the hump. The radiographic examination includes the use of a long cassette AP, an LL X-ray and a bending test to detect the curve flexibility. Additionally, whole-spine MRI is routinely used in the detection of AIS .A delay in AIS treatment can be cause of faster progression of the deformity and consequent back pain, spinal decompensation, pulmonary function alterations and worsening of physical appearance . UntreatThere is no consensus on AIS treatment and there is a great variety of therapeutic strategies used in different countries. In skeletally immature patients, observation, followed by bracing if the curve progresses to greater than 25°, is the standard of care in North America. In Europe, especially in France, Germany and Spain, brace treatment is always accompanied by physical therapy . PhysicaStudies reported a complication rate of 6.3% for AIS surgery, with a mortality rate of 0.014 to 0.02 ,16 The rThe complexity of AIS aetiology, natural history and treatment widely, underlined in medical literature, should play a central role in surgeons’ indications and in the preoperative counselling with patients. Additionally, specific psychological and clinical support has to be provided to the patients during the entire treatment time.In conclusion, many question remain still open on AIS aetiopathogenesis and natural history, a knowledge gap which inevitably negatively affect the possibility of a progression prediction and slows the development of targeted approaches. At the present day, the treatment of this disease has as its goal the prevention or correction of spinal deformities. More research is required to truly improve AIS prevention and management.The issues raised in this editorial may help to give a clear view of the present situation of the spinal deformity pathology in adolescent patients and provide input for further innovations.JCM team for their precious help. Finally, a special thanks to the authors for their considerable contribution.I would like to thank the reviewers in advance for their careful job and the


Cryptocurrency, often known as virtual or digital currency, is a safe platform and a key component of the blockchain that has recently attracted much interest. Utilizing blockchain technology, bitcoin transactions are recorded in blocks that provide detailed information on all financial transactions. Artificial intelligence (AI) has significant applicability in several industries because of the abundance and processing capacity of large data. One of the main issues is the absence of explanations for AI algorithms in the current decision-making standards. For instance, there is no deep-learning-based reasoning or control for the system’s input or output processes. More particularly, the bias for adversarial attacks on the process interface and learning characterizes existing AI systems. This study suggests an AI-based trustworthy architecture that uses decentralized blockchain characteristics such as smart contracts and trust oracles. The decentralized consensuses of AI predictors are also decided by this system using AI, enabling secure cryptocurrency transactions, and utilizing the blockchain technology and transactional network analysis. By utilizing AI for a thorough examination of a network, this system’s primary objective is to improve the performance of the bitcoin network in terms of transactions and security. In comparison to other state-of-the-art systems, the results demonstrate that the proposed system can achieve very accurate output. Blockchain and AI integration has emerged as one of the disruptive technologies that directly influence human lives. One of the key forces behind global innovation is these technologies. In recent years, the globe has had to deal with a brand-new tradable system called cryptocurrencies. For the purposes of conducting transactions through this network, this system is built on a distributed, decentralized blockchain network. In relation to the rapid advancement of blockchain technology, cryptocurrencies have also acquired notoriety and interest. Nearly 7000 different types of cryptocurrencies were traded frequently in the second quarter of 2020, with a market valuation of over USD 300 billion. Artificial-intelligence technology has a versatile impact on a variety of sectors and industries. The intricate design of AI demonstrates the findings of more than 70 years of research and study in an area that has numerous ethical and security concerns ,2,3,4. AProof of Work (PoW): PoW is one of the blockchain’s consensus methods for adding new transactions to the ledger. Verifying transactions and adding new blocks to the chain are the first objectives. PoW initiates the process of participants completing transactions into the network and receiving rewards. Individuals are identified as miners, and mining as the activity. Digital tokens are sent between miners over the network, and in a decentralized network, all transactions are collected in a block. The purpose of this entire procedure is to arrange the blocks, verify the transactions, and reach minor consensus.Proof of Stake (PoS): The consensus protocol for addressing the issue of energy usage is called PoS. A blockchain network’s stakeholders can produce new blocks thanks to this protocol. The protocol chooses the validators on the basis of different criteria such as delegated validators and high-frequency transacting validators. In addition to being more energy-efficient than PoW, PoS also addresses some security issues by avoiding the allocation of validators who own blockchain-native money. The generation of new blocks is delayed if validation fails. When it comes to detecting changes and data streaming, PoS offers the possibility of delay tolerance in AI applications.The revolution of the digital currency is mentioned in ,10,11. DThe network modeling classification of semantic edges and nodes, and the network creation of transactional information for various purposes.Presenting a network summary based on network evaluation, properties, and market effects.Presenting an overview of AI in the context of cryptocurrencies and a thorough examination of the transactional network.The techniques used in blockchain and AI approaches include entity recognition, activity detection, and transactional tracing, delivering reliable records for the performance assessment of the network.The following is a summary of this paper’s significant contributions:The remainder of this paper is organized as follows: The state of the art in knowledge discovery and AI through the blockchain architecture is briefly described in this section. There are two distinct sections: Blockchain for AI, and cryptocurrency-based exchange security.According to ,20, the On the basis of the sender’s private key that determines the type of money, transactions using cryptocurrencies transmit a pervasive message to the blockchain network, which is addressed in . No one One of the most important recent research papers ,48,49 foThe primary goal of this research is knowledge discovery on blockchain-based and AI-based cryptocurrency systems to improve the security and dependability of any exchanges over this network. The knowledge discovery method reveals information and architecture that are hidden from the user’s view. The proposed system’s intricate architecture, which employs a combined method in cryptocurrencies, is shown in An overview of knowledge discovery utilizing AI within the blockchain framework is provided by the designed architecture. This commitment, which offers a secure knowledge discovery process, involves two key elements. The blockchain framework includes a customized consensus algorithm linked to blocks with ordered nodes and smart contracts to maintain the system’s transactional records.https://coinmarketcap.com/ website, which contains all information related to the cryptocurrencies, market caps, volumes, etc. The comprehensive information and records related to the blockchain dataset are available online for unheard network transactional analysis. In this process, we collected the dataset from the The decentralized autonomous organization (DAO) is a model organizational structure built on blockchain technology that stands out for its openness and independence. The DAO automates and independently creates management decisions by using coded and programmed smart contracts to break down complex management functions into a variety of computer words. Crypto management adopts distributed ownership using DAO as the organizational form and management structure, making all members the organization’s owners and decision makers. In DAO, crypto management is heavily reliant on distributed collaboration and collective intelligence, which can circumvent the limitations of hierarchical management structures and individual-dependent decision-making models, thus improving intelligence and dependability. The independence of crypto administration is built on concepts that can be effectively created and dynamically performed. They typically outline the complicated interactions between people and organizations, the method for managing and allocating resources, and the objectives and limitations of stakeholders. DAO uses multiparty negotiation, games, and even votes to obtain the ultimate consensus. The terminology used to describe various organizational management functions may be translated into contract rules using a set of standardized standards, and many interactive rules can be combined to fully specify complicated management rules. As a result, under the established DAO principles, crypto administration can work freely and efficiently. To give organizational management a different collective decision framework and system of governance, crypto management leverages the DAO. The DAO’s governance framework must be created to meet the objectives of fairness, efficiency, collaboration, security, cost-effectiveness, and other aspects of crypto administration. The two key components are collaboration mode, which directs any nodes to participate actively in proposals, and decision mode, which controls all nodes to reach the agreed-upon outcome. Particularly when a conflict emerges, an efficient dispute resolution process is required to prevent self-serving suggestions and criminal collaboration, protecting both individual interests and communal security. Individual intelligence blockages at every stage impact the outcomes in traditional top–down and bottom–up hierarchical organizational decision-making frameworks, causing some innovative and advantageous decisions to be mistakenly abandoned. This also impairs the organization’s management effectiveness and capacity for growth. Through the blockchain-based DAO, crypto management enables multiparty nodes to collaborate on voting and proposition processes for decisions. It is by definition a democratic form of governance where the entire community participates. Throughout this procedure, it is important to select a voting mechanism that is acceptable for the governance framework in place. This management framework outlines how to gain voting qualifications and how to use them to voice opinions on organizational management. Regarding the latest deep-learning (DL) models, classification and detection processes can achieve inimitable performance among ML models. DL models are difficult to certify, debug, and interpret, and they are not able to give proper descriptions for validating models. From another point of view, AI changes the system concept into symbols or rules, e.g., knowledge graphs, which are easy to present.The security and trustworthiness of the information are two of the main challenges of the users during this decade due to much illegal online processing. In this system, the main focus is to discover trustworthy knowledge from a blockchain framework. The blockchain is one of the secure platforms that contain various consensus protocols and different architectures such as multiledgers, simple ledgers, and interprobability.The suggested framework was utilized to ascertain and establish what occurred in cases where there was disagreement regarding who was responsible for an incident. The integrity of the data that are accessible must be guaranteed by the company handling a claim or a law enforcement official responding to an incident. Once data integrity is confirmed, it is possible to conclusively identify the responsible party. Using our architecture as a framework, the investigator or agent begins by gaining access to the relevant forensic data that are kept in the data center. Then, they must compile the supplied transactions that include the data hashed for the first-level blockchain systems, along with their associated hashed root values and hashed routes. The investigator or agent could confirm that the data center provided authorities with valid/tamperproof IoT hash data if the quantity is indeed saved in the blockchain and the computed hashed root match. Additionally, numerous multichain miners have independently verified the existence of the transaction on the blockchain, and that significant PoW/computational time has been set aside to guarantee the integrity of hash data in a multichain system.This section discusses key blockchain concepts in AI applications. There are five key concepts in blockchain AI integrated systems: consensus protocols, decentralized infrastructures, decentralized AI operations, types, and decentralized AI applications.One of the decentralized AI applications is the knowledge management and discovery process, which is very famous in modern AI applications for managing a huge number of data. This process offers the benefits of systemwide and application-wide intelligence for customizing knowledge patterns in special applications, users, and devices. The decentralization of knowledge management and discovery provides knowledge patterns based on personalized information regarding the stakeholders’ needs. A blockchain framework provides a secure knowledge-transfer tracing process between an AI system and application stakeholders.The learning process is the most important part of knowledge discovery, and it solves the various machine-learning problems such as regression, classification, clustering, and pattern mining. Moreover, the blockchain provides unalterable high-security learning models based on historical data. Another aspect of AI is logic programming, which is very important for developing the rules for reasoning and generalizing the application’s components. During this process, the blockchain framework comes with distributed reasoning for facilitating a personal reasoning strategy. Similarly, smart contracts ensure the availability of unforgettable reasoning for future processes in this strategy.This section provides the development environment of the proposed knowledge discovery in the blockchain framework. The main concept of this research is the integration of AI into the blockchain to overcome the trustworthiness issue in cryptocurrency. To have enough data storage, there is a need to manage the dataset on the basis of AI applications that can achieve a relevant and high level of accuracy, and the dataset must be collected from trustworthy sources. AI applications mainly focus on managing centralized data to execute the nodes from the underlying network. This process contains data filtration, segmentation, routing, and data storage in intelligent data management. The presented system aims to extract information from the blockchain framework and focuses on the trustworthiness of this system based on AI for decentralized network decision making. Equations  and 2)  2) preseEquation  shows thOn the basis of the blockchain operation, we assessed the proposed architecture’s overall complexity. The blockchain process added extra overhead to the suggested architecture in comparison to centralized and distributed structures. As depicted in The proposed approach was designed on the basis of integrating AI and the blockchain for knowledge discovery in various cryptocurrency frameworks. The designed system focuses on reasoning, learning, and knowledge management, which directly affect the process of the system to extract the hidden part of a transactional process. The system’s effectiveness was analyzed on the basis of a real-time dynamic network to represent the system’s effectiveness. The blockchain-based system uses knowledge monetization for the confidentiality of knowledge, and automatically provides quality as a reward to the client. The results showed that the system could achieve affordable performance.Furthermore, the taxonomy and implementation comparison for AI operations with the blockchain infrastructure and protocols were discussed. According to the findings of our evaluation, the suggested decentralized security architecture performed better than the centralized and distributed architectures. Our research also indicated that the architecture could be used in conjunction with the IoT ecosystem as a security detection component that monitors and analyzes the traffic data of the entire IoT ecosystem in order to identify and prevent potential attacks.The analysis of the cryptocurrency transaction network and network modeling give the ability to abstract the transnational data of a cryptocurrency regarding the objects of specific nodes and the relationship between edges and objects. There are various ways of organizing the cryptocurrencies’ transnational data with different structures, and abstracted networks change a lot. Similarly, there are different methods of modeling the network, for which a suitable model for various cryptocurrencies is adaptive low-information loss modeling, which gives identical notifications to downstream tasks. Possible future directions in this field are network modeling based on compatible transactions, information complementation based on practical networks, online learning, and network analysis based on dynamic transactions, which should be considered for further progress in this field. The blockchain technology is one of the approaches for reforming the mode of traditional industries. The growth of data is one of the aspects of this technique. Due to cryptocurrency network analysis, transactions still do not meet the requirements of practical applications, which is the main problem of the multidata source structure of the blockchain.