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Motion Estimation (ME) and the two-dimensional (2D) discrete cosine transform (2D-DCT) are both computationally expensive parts of HEVC standard, therefore real-time performance of the HEVC may not be free from glitches. To address this issue, this study deploys the graphics processing units (GPUs) to perform the ME and 2D-DCT tasks. In this concern, authors probed into four levels of parallelism (i.e., frame, macroblock, search area, and sum of the absolute difference (SAD) levels) existing in ME. For comparative analysis, authors involved full search (FS), test zone search (TZS) of HEVC, and hierarchical diamond search (EHDS) ME algorithms. Similarly, two levels of parallelism (i.e., macroblock and sub-macroblock) are also explored in 2D-DCT. Notably, the least computationally complex multithreaded Loeffler DCT algorithm is utilized for computing 2D-DCT. Experimental results show that ME processing task corresponding to 25 frames, with each frame of size (3840×2160) pixels, is accomplished in 0.15 seconds on the NVIDIA GeForce GTX 1080, whereas the 2D-DCT task along with the image reconstruction and differencing corresponding to 25 frames took 0.1 seconds. Collectively, both ME and 2D-DCT tasks are processed in 0.25 seconds, which still leaves enough room for the encoder's remaining parts to be executed within one second. Due to this enhancement, the resultant encoder can safely be used in real-time applications. [ABSTRACT FROM AUTHOR]

Metal organic frameworks (MOFs) have garnered significant attention in the development of stretchable and wearable conductive hydrogels for flexible transducers. However, MOFs used in hydrogel networks have been hampered by low mechanical performance and poor dispersibility in aqueous solutions, which affect the performance of hydrogels, including low toughness, limited self-recovery, short working ranges, low conductivity, and prolonged response–recovery times. To address these shortcomings, a novel approach was adopted in which micelle co-polymerization was used for the ex situ synthesis of Zn-MOF-based hydrogels with exceptional stretchability, robust toughness, anti-fatigue properties, and commendable conductivity. This breakthrough involved the ex situ integration of Zn-MOFs into hydrophobically cross-linked polymer chains. Here the micelles of EHDDAB had two functions, first they uniformly dispersed the Zn-MOFs and secondly they dynamically cross-linked the polymer chains, profoundly influencing the mechanical characteristics of the hydrogels. The non-covalent synergistic interactions introduced by Zn-MOFs endowed the hydrogels with the capacity for high stretchability, high stress, rapid self-recovery, anti-fatigue properties, and conductivity, all achieved without external stimuli. Furthermore, hydrogels based on Zn-MOFs can serve as durable and highly sensitive flexible transducers, adept at detecting diverse mechanical deformations with swift response–recovery times and high gauge factor values. Consequently, these hydrogels can be tailored to function as wearable strain sensors capable of sensing significant human joint movements, such as wrist bending, and motions involving the wrist, fingers, and elbows. Similarly, they excel at monitoring subtle human motions, such as speech pronunciation, distinguishing between different words, as well as detecting swallowing and larynx vibrations during various activities. Beyond these applications, the hydrogels exhibit proficiency in distinguishing and reproducing various written words with reliability. The Zn-MOF-based hydrogels hold promising potential for development in electronic skin, medical monitoring, soft robotics, and flexible touch panels. [ABSTRACT FROM AUTHOR]

Grass carp (Ctenopharyngodon idella) was exposed to nanoparticles of different concentrations, i.e., copper oxide nanoparticles (CuO-NPs), silver nanoparticles (Ag-NPs), and green synthetic gold nanoparticles (Au-NPs).The administered doses of the three concentration groups were 20mg L−1, 30 mg L−1, and 40mg L−1 each for a period of 14 and 28 days, respectively. The DNA damage in the erythrocytes of grass carp was detected through a comet assay technique. The values of total comet score (TCS) were noted for the exposed concentrations with a significant increasing trend (p < 0.05) and ordered as CuO-NPs > Ag-NPs > Au-NPs. The highest TCS value of the exposed erythrocytes was recorded for CuO-NPs at 40 mg L−1 after 14 days of exposition period. Comparatively, TCS values of erythrocytes exposed to green synthetic Au-NPs at all the concentrations and exposed time were less as compared to the Ag-NPs and CuO-NPs. The study confirmed the adverse effects of nanoparticles on the genetic material of fish cells. [ABSTRACT FROM AUTHOR]

Accurate wind power forecasting is critical for system integration and stability as renewable energy reliance grows. Traditional approaches frequently struggle with complex data and non-linear connections. This article presents a novel approach for hybrid ensemble learning that is based on rigorous requirements engineering concepts. The approach finds significant parameters influencing forecasting accuracy by evaluating real-time Modern-Era Retrospective Analysis for Research and Applications (MERRA2) data from several European Wind farms using in-depth stakeholder research and requirements elicitation. Ensemble learning is used to develop a robust model, while a temporal convolutional network handles time-series complexities and data gaps. The ensemble-temporal neural network is enhanced by providing different input parameters including training layers, hidden and dropout layers along with activation and loss functions. The proposed framework is further analyzed by comparing stateof- the-art forecasting models in terms of Root Mean Squared Error (RMSE) and Mean Absolute Error (MAE), respectively. The energy efficiency performance indicators showed that the proposed model demonstrates error reduction percentages of approximately 16.67%, 28.57%, and 81.92% for MAE, and 38.46%, 17.65%, and 90.78% for RMSE for MERRAWind farms 1, 2, and 3, respectively, compared to other existingmethods. These quantitative results show the effectiveness of our proposed model with MAE values ranging from 0.0010 to 0.0156 and RMSE values ranging from 0.0014 to 0.0174. This work highlights the effectiveness of requirements engineering in wind power forecasting, leading to enhanced forecast accuracy and grid stability, ultimately paving the way for more sustainable energy solutions. [ABSTRACT FROM AUTHOR]

A brompheniramine taste‐masked pediatric formulation was developed as part of the National Institutes of Health Pediatric Formulation Initiative to help address low patient compliance caused by the bitter taste of many adult formulations. To confirm that the taste‐masked formulation can provide a similar pharmacological effect to the previous marketed adult formulations, a juvenile porcine model was used to screen the model pediatric formulation to compare the bioavailability between the marketed brompheniramine maleate and the taste‐masked maleate/tannate formulation. Pigs were dosed orally with both formulations and blood samples were obtained from 0 to 48 h. Plasma samples were prepared and extracted using solid‐phase extraction. The mass spectrometer was operated under selected ion monitoring mode. The selected ion monitoring channels were set to m/z 319.1 for brompheniramine and m/z 275.2 for the internal standard chlorpheniramine. Calibration curves were linear over the analytical range 0.2–20 ng/ml (r2 > 0.995) for brompheniramine in plasma. The intra‐ and inter‐day accuracies were between 98.0 and 105% with 5.73% RSD precision. The bioanalytical method was successfully applied to a preclinical bioavailability study. The bioavailability profiles were not significantly different between the two formulations, which demonstrates that taste‐masking with tannic acid is a promising approach for formulation modification for pediatric patients. [ABSTRACT FROM AUTHOR]

Purpose: Products formulated for intramammary (IMM) infusion are intended for the delivery of therapeutic moieties directly into the udder through the teat canal to maximize drug exposure at the targeted clinical site, the mammary gland, with little to no systemic drug exposure. Currently, to our knowledge, there has been no in-vitro matrix system available to differentiate between IMM formulations. Our goal is to develop A custom tailored in-vitro "Matrix of Chemistry, Manufacturing and Control" (MoCMC) System to be a promising future tool for identifying inequivalent IMM formulations. MoCMC can detect inter and intra batch variabilities, thereby identifying potential generics versus brand product similarities or differences with a single numeric value and a specific & distinctive fingerprint. Methods: The FDA-approved IMM formulation, SPECTRAMASTⓇ LC, was selected as the reference product for the MoCMC. Twelve in-house test formulations containing ceftiofur hydrochloride were formulated and characterized. The MoCMC was developed to include six input parameters and three output parameters. The MoCMC system was used to evaluate and compare SPECTRAMASTⓇ LC with its in-house formulations. Results: Based on the MoCMC generated parameters, the distinctive fingerprints of MoCMC for each IMM formulations, and the statistical analyses of MCI and PPI values, in-house formulations, F-01 and F-02 showed consistency while the rest of in-house formulations (F-03-F-12) were significantly different as compared to SPECTRAMASTⓇ LC. Conclusion: This research showed that the MoCMC approach can be used as a tool for intra batch variabilities, generics versus brand products comparisons, post-approval formulations changes, manufacturing changes, and formulation variabilities. [ABSTRACT FROM AUTHOR]

The accuracy of photovoltaic (PV) power forecasting techniques relies not only on high-quality spatiotemporal data but also on an efficient feature-mining methodology. In this study, a spatiotemporal power forecasting model based on the broad learning system (BLS) and the improved backtracking search optimization algorithm (IBSOA) is proposed. The objective is to enhance the accuracy of PV power predictions while reducing the time-intensive training process associated with an extensive set of broad learning system parameters. The spatiotemporal attributes of historical data from multiple PV sites are clustered using a self-organizing map. The clustering analysis explores the spatiotemporal correlation among five photovoltaic (PV) power stations for each season between 2017 and 2018. Subsequently, the IBSOA is employed to optimize the hyperparameters of the BLS model, particularly the mapping and enhancement nodes. By utilizing hyperparameter optimization, a BSOA-based broad learning model is introduced to achieve superior accuracy. The results are assessed using the proposed method in comparison with three popular optimization algorithms: 1) genetic algorithm (GA), 2) bird swarm algorithm (BSA), and 3) backtracking search optimization algorithm (BSOA). All scenarios are validated and compared using PV plant data from the DKA center in Australia. The root-mean-square error (RMSE) indicators of the proposed prediction method are consistently lower than the worst-case scenario in each season, decreasing by 3.2283 kW in spring, 3.9159 kW in summer, 1.3425 kW in autumn, and 1.4058 kW in winter. Similarly, the mean absolute percentage error (MAPE) exhibits a reduction compared to the worst case, with a decreases of 0.882% in spring, 1.2399% in summer, 1.803% in autumn, and 1.087% in winter. The comprehensive results affirm that the proposed method surpasses alternative optimization techniques, delivering high-quality power forecasts for the given case study. [ABSTRACT FROM AUTHOR]

Emergency Resuscitative Thoracotomy (ERT) is a lifesaving procedure in selected patients. Outcome mostly in blunt trauma is believed to be poor. The primary aim of this study was to determine the predictors of postoperative mortality following ERT. We retrospectively reviewed 34 patients ≥ 18 years who underwent ERT at San Camillo—Forlanini Hospital (Rome, Italy) between January 2009 and December 2022 with traumatic arrest for blunt or penetrating injuries. Of 34 ERT, 28 (82.4%) were for blunt trauma and 6 (17.6%) were for penetrating trauma. Injury Severity Score (p-value 0.014), positive E-FAST (p-value 0.023), Systolic Blood Pressure (p-value 0.001), lactate arterial blood (p-value 0.012), pH arterial blood (p-value 0.007), and bicarbonate arterial blood (p-value < 0.001) were significantly associated with postoperative mortality in a univariate model. After adjustment, the only independent predictor of postoperative mortality was Injury Severity Score (p-value 0.048). Our experience suggests that ERT is a technique that should be utilized for patients with critical penetrating injuries and blunt trauma in patients in extremis. Our study highlights as negative prognostic factors high values of ISS and lactate arterial blood, a positive E-FAST, and low values of Systolic Blood Pressure, pH arterial blood and bicarbonate arterial blood. [ABSTRACT FROM AUTHOR]

Background Textbook outcomes are composite outcome measures that reflect the ideal overall experience for patients. There are many of these in the elective surgery literature but no textbook outcomes have been proposed for patients following emergency laparotomy. The aim was to achieve international consensus amongst experts and patients for the best Textbook Outcomes for non-trauma and trauma emergency laparotomy. Methods A modified Delphi exercise was undertaken with three planned rounds to achieve consensus regarding the best Textbook Outcomes based on the category, number and importance (Likert scale of 1–5) of individual outcome measures. There were separate questions for non-trauma and trauma. A patient engagement exercise was undertaken after round 2 to inform the final round. Results A total of 337 participants from 53 countries participated in all three rounds of the exercise. The final Textbook Outcomes were divided into 'early' and 'longer-term'. For non-trauma patients the proposed early Textbook Outcome was 'Discharged from hospital without serious postoperative complications (Clavien–Dindo ≥ grade III; including intra-abdominal sepsis, organ failure, unplanned re-operation or death). For trauma patients it was 'Discharged from hospital without unexpected transfusion after haemostasis, and no serious postoperative complications (adapted Clavien–Dindo for trauma ≥ grade III; including intra-abdominal sepsis, organ failure, unplanned re-operation on or death)'. The longer-term Textbook Outcome for both non-trauma and trauma was 'Achieved the early Textbook Outcome, and restoration of baseline quality of life at 1 year'. Conclusion Early and longer-term Textbook Outcomes have been agreed by an international consensus of experts for non-trauma and trauma emergency laparotomy. These now require clinical validation with patient data. [ABSTRACT FROM AUTHOR]

Here is reported the synthesis of a magnetic phosphorus-containing adsorbent decorated with poly(N-isopropylacrylamide) (PNIPAM) brushes via surface-initiated atom transfer radical polymerization (SI-ATRP) and its application for vortex assisted solid phase extraction of lead in water, cigarettes and soil. The adsorbent was characterized using Fourier-transform infrared spectroscopy (FT-IR) and energy dispersive x-ray (EDX) spectroscopy. A high-resolution continuum source flame atomic absorption spectrometer (HR-CS FAAS) was used for the quantification of lead. All factors affecting the extraction efficiency including the solution pH, adsorbent dose, sample volume, vortex time, and elution protocols were optimized. The limits of detection (LOD) and quantification (LOQ) were determined to be 0.05 µg L−1 and 0.18 µg L−1, respectively. The preconcentration and enhancement factors were 20 and 18. Validation was performed using TMDA 64.3 fortified water and INCT-OBTL-5 tobacco leaves certified reference materials with satisfactory recoveries. The method was shown to be sensitive, efficient and reproducible. [ABSTRACT FROM AUTHOR]

Background and Objective: A thorough insight into the management of hand injuries can shape the approach of a surgeon in order to achieve optimal outcomes for the patients. The aim of this study was to share our experience in reconstruction of the hand and establishing an algorithm for classification and treatment of hand injuries. Methods: This is a descriptive cross sectional study and was conducted from January 2020 to August 2022 at Burns and Plastic Surgery center, Peshawar. Data was collected from medical records about the patient demographics, mechanism of injury and type of procedures done. Defect size was classified into small (<5cm), medium (5cm to 10 cm) and large (>10cm). The defect site and size was cross tabulated against the method of soft tissue reconstruction in order to make the algorithm for reconstruction of hand injuries. Data was analyzed using SPSS. Results: The study population included 41 (75.9%) male and 13 (24.1%) female patients, mean age 31.56±14.1. Machine injuries (33.3%) and electric burns (24.1%) were the most common cause of hand soft tissue defects. The most commonly performed flap was Posterior introsseous artery (PIA) flap, followed by First dorsal metacarpal artery (FDMA) flap. Flap necrosis was observed in three cases (5.6%). Conclusion: This treatment algorithm for coverage of soft tissue defects in hand injuries will help with the decision making process of hand reconstruction and has didactic value for novice surgeons. It will also form the foundation for further work on this aspect of hand injuries. [ABSTRACT FROM AUTHOR]

The aim of this paper was to investigate the effects of formulation parameters on the physicochemical and pharmacokinetic (PK) behavior of amorphous printlets of lopinavir (LPV) manufactured by selective laser sintering 3D printing method (SLS). The formulation variables investigated were disintegrants (magnesium aluminum silicate at 5–10%, microcrystalline cellulose at 10–20%) and the polymer (Kollicoat® IR at 42–57%), while keeping printing parameters constant. Differential scanning calorimetry, X-ray powder diffraction, and Fourier-transform infrared analysis confirmed the transformation of the crystalline drug into an amorphous form. A direct correlation was found between the disintegrant concentration and dissolution. The dissolved drug ranged from 71.1 ± 5.7% to 99.3 ± 2.7% within 120 min. A comparative PK study in rabbits showed significant differences in the rate and extent of absorption between printlets and compressed tablets. The values for Tmax, Cmax, and AUC were 4 times faster, and 2.5 and 1.7 times higher in the printlets compared to the compressed tablets, respectively. In conclusion, the SLS printing method can be used to create an amorphous delivery system through a single continuous process. [ABSTRACT FROM AUTHOR]

Between February 2020 and January 2022, the Food and Drug Administration (FDA) recalled 281 metformin extended-release products due to the presence of N-nitrosodimethylamine (NDMA) above the acceptable daily intake (ADI, 96 ng/day). Our previous studies indicated presence of NDMA levels above ADI in both metformin immediate and extended-release products. When metformin products have NDMA impurities, it is indispensable to check for the same impurities in metformin combination products. Therefore, the objective of the present study was to evaluate in-use stability of commercial metformin combination products for NDMA. For this purpose, metformin products in combination with glyburide (GB1-GB12), glipizide (GP1-GP8), pioglitazone (P1-P3), alogliptin (A1, A2), and linagliptin (L1, L2) were repacked in pharmacy vials, stored at 30°C/75% RH for 3 months, and monitored for NDMA impurity. The NDMA level varied from 0 to 156.8 ± 32.8 ng/tablet initially and increased to 25.4 ± 5.1 to 455.0 ± 28.4 ng/tablet after 3 months of exposure to in-use condition. Initially, 18 products have NDMA level below ADI limit before exposure which decreased to 7 products (GB5, GP3, GP5, A1, A2, L1, and L2) meeting specification. In conclusion, in-use stability study provides quality and safety risk assessment of drug products where nitroso impurities are detected in the probable condition of use. [ABSTRACT FROM AUTHOR]

Purpose: Intramammary (IMM) formulations are locally acting and delivered intracisternally into the udder. No pharmacopeial in-vitro release method is available to differentiate between the IMM formulations. Our research aim is to develop in-vitro release methods that discriminate different IMM formulations (SPECTRAMAST® LC and in-house formulations). Methodology: Different in-house formulations were developed to simulate SPECTRAMAST® LC generics. SPECTRAMAST® LC and the in-house formulations were characterized for physicochemical attributes, such as particle size, rheology, drug content, sedimentation rate, and flocculation rate. The in-vitro release method was optimized by evaluating drug release using USP apparatuses 1, 2 (with and without enhancer/customized cells), and 4. Various test parameters, including medium effect (whole homogenized bovine milk versus aqueous buffer), medium volume (200–900 mL), and rotational speed (50–200 rpm) were investigated. Results: Two potential in-vitro systems can be used as discriminatory methods for IMM formulations: USP apparatus 2 with the IMM formulation loaded into two containers a) customized formulation container (83.1 cm in height and 56.4 cm in width) or b) enhancer cells with their top adapted with mesh #40 (rotation speed:125 rpm and 900 mL of whole homogenized bovine milk). The release profile of SPECTRAMAST® LC at 1 h (99.8%) was not significantly different from formulations with similar physicochemical characteristics F-01 (99.1%) and F-02 (100.5%). Formulation with different physicochemical characteristics F-03 (44.3%) and F-04 (57.2%) showed slower release (1 h) than SPECTRAMAST® LC (98.8%). Conclusion: The developed in-vitro release methods can be used as a potential tool for in-vitro comparability evaluations for IMM formulations. [ABSTRACT FROM AUTHOR]

This work investigates substrate leakage in Capacitive Micromachined Ultrasonic Transducers, (CMUTs) having thin backings. CMUTs produced with solid or rigid substrates have a high Q resonance with flat baseline. However, if the operating wavelength of CMUT becomes larger than the thickness of substrate the real part of cell impedance shows elevated baselines with more leakage at DC than at higher frequencies. When a clamped CMUT membrane is excited harmonically the vibrations produced are counterbalanced by the backing medium. Hence some of the energy is coupled to substrate as loss resulting in a lower mechanical Q of resonance. We first derive this energy coupled to the backing medium using FEA analysis considering the velocity field and associated tensile stresses in a thin backing. Substrate impedance is found numerically from isotropic damping of dispersive elastic waves in the backing. This backing impedance is introduced as a shunt mechanical loss across the transduction force in equivalent circuit model. We characterize the measured impedance of CMUT cells with both FEMs and linear circuit models. Simulations results closely agree with the measured impedance levels, frequency and bandwidth of resonance. [ABSTRACT FROM AUTHOR]

Aim: The aim of this article is to share our experience of thumb reconstruction based on the defect and irrespective of the aetiology, and to work towards standardising the treatment for thumb defects. Material and method: This study was conducted at the Burns and Plastic Surgery Centre at Hayatabad Medical Complex from 2018 to 2021. Thumb defects were divided into small (<3 cm), medium (4–8 cm) and large defects (>9 cm). Patients were evaluated for complications post-operatively. The data for defect size and defect site was cross-tabulated for reconstructive options with the help of SPSS. Different flaps were performed depending on the site and size of the defect, which were arranged in a schema to develop an algorithm. Results: After scrutinising the data, 35 patients qualified for the study, comprising 71.4% (25) males and 28.6% (10) females. The mean age (and SD) was 31.17 +15.8 years. The right thumb was affected in the majority of the study sample (57.1%), and the majority were affected by machine injury or post-traumatic contractures, affecting 25.7% (n = 9) and 22.9% (n = 8), respectively. Injuries to the first web space and distal to the IPJ of the thumb were the most common, accounting for 28.6% (n = 10) each. A first dorsal metacarpal artery flap was the most common flap, followed by retrograde posterior interosseous artery flap, observed in 11 (31.4%) and 6 (17.1%) cases. The most common complication observed in the study population was flap congestion (n = 2, 5.7%) with a complete flap loss in 1 patient (2.9%). Based on the cross-tabulation of flaps against the size and location of defects, an algorithm was developed to help standardise reconstruction of thumb defects. Conclusion: Thumb reconstruction is critical in restoring the patient’s hand function. This classification-based, structured approach for thumb reconstruction will help hand surgeons in taking decisions and selecting effective coverage options with minimal complications. Most of these defects can be covered with local, simple flaps without the need for a microvascular reconstruction. [ABSTRACT FROM AUTHOR]

Background: Achilles tendon tenotomy is an integral part of the Ponseti method, aimed at correcting residual equinus and lack of dorsiflexion after correction of the adductus deformity in clubfoot. Percutaneous tenotomy using a number 15 scalpel blade is considered the gold standard, resulting in excellent results with minimal complications. The use of a large-bore needle to perform Achilles tendon tenotomies has been described in literature, but a large-scale randomized controlled trial is currently lacking. In this trial, we aim to show the non-inferiority of the needle tenotomy technique compared to the gold standard blade tenotomy technique. Methods: We will randomize 244 feet into group A: needle tenotomy or group B: blade tenotomy. Randomization will be done using a block randomization with random block sizes and applying a 1:1 allocation to achieve an intervention and control group of the exact same size. Children will be evaluated at 3 weeks and 3 months post-tenotomy for primary and secondary clinical outcomes. The primary clinical outcome will be the range of dorsiflexion obtained the secondary clinical outcomes will be frequency of minor and major complications and Pirani score. The non-inferiority margin was set at 4°, and thus, the null hypothesis of inferiority of the needle technique will be rejected if the mean difference between both techniques is less than 4°. The statistical analysis will use a multi-level mixed effects linear regression model for the primary outcomes and a multi-level mixed effects logistic regression model for the secondary clinical outcomes. The physician performing the evaluations post-tenotomy will be the only one blinded to group allocation. Trial registration: This trial was registered prospectively with ClinicalTrials.gov registration number: NCT04897100 on 21 May 2021. [ABSTRACT FROM AUTHOR]

Water contamination is increasing globally by heavy metals, dyes, and cyanides day by day. Heavy metals are very toxic even if present in a small amount in water. Here, we have synthesized a novel type of self-healable, ultra-thin with high mechanical strength, and pH-responsive poly-(acrylic acid)@Fe/Ni (PAA@Fe/Ni) hybrid hydrogel membrane using filter paper as a substrate. Acrylic acid was polymerized on the surface and in pores of the filter paper by free radical addition polymerization reaction using NMBA as a cross-linker, iron ions as an accelerant, and persulfate radicals as initiator. The iron ions were subsequently converted to metal particles by coating with nickel particles to enhance their stability and act as an antifouling agent. The membrane was characterized by FTIR, SEM, EDX, and AFM techniques. The abundant carboxylic acid (–COOH) groups and iron ions present inside the polymer network provide self-healing ability to the membrane. The pore size of the filter paper was reduced from 2.5 to 1.04 μm and thus improving the rejection capability of the membrane. The results demonstrated that the membrane is efficient enough for the complete rejection of Cr(VI) from model water and industrial wastewater under different environmental stimuli (pH and concentration) up to 100 ppm. The self-healing behavior, ultra-thin with high mechanical stability, and responsive nature of the PAA@Fe/Ni hybrid hydrogel membrane are the significantly advanced features of the synthesized membrane. [ABSTRACT FROM AUTHOR]

The aim of this work was to design pediatric-friendly, dose-flexible orally disintegrating drug delivery systems (printlets) of the antiviral drug tenofovir disoproxil fumarate (TDF) by selective laser sintering (SLS) for potential use in hospitals along with other antiviral drugs. In order to obtain a consistent quality of printlets with desired properties, it is important to understand certain critical quality attributes for their main and interactions effect. The printlets were optimized by Box-Behnken’s design of the experiment by varying process variables while keeping the composition constant. The composition contained 16.3% TDF, 72.7% polyvinyl pyrrolidone K16-18, 8% magnesium aluminum silicate, 3% Candurin® NXT Ruby Red, and 0.3% colloidal silicon dioxide. The process variables studied were surface (X1), chamber temperatures (X2), and laser scanning speed (X3). The range of variable levels was 75–85°C for X1, 50–70°C for X2, and 200–240 mm/s for X3, respectively. The responses studied were hardness, disintegration time, dissolution, physiochemical, and pharmacokinetic characterization. X-ray powder diffraction indicated partial or complete conversion of the crystalline drug into amorphous form in the printlets. Comparative pharmacokinetics between Viread® (generic) and printlets in rats were superimposable. Pharmacokinetic parameters showed statistically insignificant differences between the two formulations in terms of Tmax, Cmax, and AUC of (p > 0.05). Printlets were bioequivalent to Viread® as per FDA bioequivalence criteria. Thus, the SLS printing method showed the fabrication of dose-flexible printlets with quality, and in vivo performance equivalent to commercial tablets. [ABSTRACT FROM AUTHOR]

Photocatalysis is a promising technology for the degradation of recalcitrant organic pollutants in water. In this study, superparamagnetic zinc ferrite nanoparticles (ZnFe2O4) were synthesized and characterized using scanning electron microscopy, X-ray diffraction, energy dispersive X-ray and Fourier transform infrared spectroscopy. The synthesized nanoparticles (NPs) of ZnFe2O4 were observed to have a photosensitive nature and showed characteristic visible-light-induced activation that was used for the photocatalytic degradation of a textile dye, Remazol brilliant violet 5R (RBV-5R). The effect of different operational parameters such as pH, H2O2, catalyst dosage, concentration of RBV-5R and the reusability of ZnFe2O4 as well as scavengers were investigated under visible irradiation. The almost complete degradation (99.9%) of RBV-5R was observed at pH 10, 0.1 g of ZnFe2O4 and 6 mM of H2O2 in 30 min. The photocatalytic degradation of RBV-5R followed pseudo-first-order kinetics. The mineralization was calculated from total organic carbon (TOC) that was represented by 82% TOC removal in 30 min. The results revealed that visible-light-induced ZnFe2O4 photocatalysis may be a promising technology for the elimination of toxic organic dyes, such as RBV-5R, from water resources. [ABSTRACT FROM AUTHOR]

Objective: To share our experience with nasal reconstruction and to give a standardized algorithm for nasal reconstruction. Study Design: Descriptive cross sectional. Setting: Burns and Plastic Surgery Center, Peshawar. Period: January 2019 to December 2022. Material & Methods: Data was obtained from patient records after approval from IREB. Patients with multiple co-morbidities and small defects (<1.5cm) were excluded from this study. Defects were classified based on anatomic areas of radix, dorsum, sidewall, alar and lower third nasal defects. Cases were cross tabulated regarding site for the reconstructive options to generate the treatment algorithm. Results: A total of 51 cases were included in the study including 30 (58.8%) male patients. Mean age of patients was 48.12+21.89SD. Skin malignancies were the most common (n=35, 68.6%). Nasal ala was the most common site reconstructed in our study (25.5%) followed by nasal dorsum and sidewalls. Medium size (41.2%) was the most common. In 64.8% (n=33) cases, forehead based flaps were used to reconstruct the nasal defects (Table-I). In 5.9% cases we observed flap congestion. In 19 (37.25%) cases, patients presented with additional soft tissue defects which needed reconstruction (Table-II). Reconstructive options are presented as an algorithm based on the defect site (Figure-1). Conclusion: In this study we shared our experience with the readers regarding reconstruction of the nasal detects. We have formulated an algorithm for reconstruction of these defects that will simplify reconstruction in such cases. [ABSTRACT FROM AUTHOR]

Heavy metal-based pollutants are one of the most alarming health hazards causing multiple diseases including cancer, hepatotoxicity, brain hemorrhage, kidney and heart failures, etc. In this study, we report an ecofriendly, low cost, and simple synthesis of silver nanoparticles (AgNPs) mediated by Nannorrhops ritchiana leaf-based biomolecular extract as a key biosensor for the mercury(II) heavy metal. The formation of AgNPs was confirmed by using different characterization techniques including UV–visible spectroscopy, energy-dispersive X-ray analysis, Fourier transform infrared spectroscopy, and scanning electron microscopy. The synthesized AgNPs are yellowish-brown and exhibit the surface plasmon resonance around 435 nm. The various functional groups responsible for reduction of Ag+ to Ag0 and capping agents present in the leaf extract were confirmed by infrared spectroscopy. Energy-dispersive X-ray and scanning electron microscopic analysis were used to confirm the presence of silver and surface morphology of the nanoparticles, respectively. X-ray diffraction data suggested crystalline nature of the prepared nanoparticles. The AgNPs were successfully applied as a sensitive and selective platform for sensing of mercury(II) ions. Various parameters including nanoparticles loading, concentration of Hg+2, pH, and reaction time were optimized. The platform demonstrates a low limit of detection (4.8 × 10–7 M) and limit of quantification (4.8 × 10–7 M) with an R2 value of 0.999. The SS-DNA interaction with the AgNPs, studied by UV–Vis spectroscopy revealed intercalative mode of binding with a binding constant of 1.04 × 104 units. Importantly, this AgNPs platform also demonstrated good antibacterial efficacy against Proteus mirabilis, Shigella flexneria, Escherichia coli, and Staphylococcus aureus. [ABSTRACT FROM AUTHOR]

Hydrogen peroxide (H2O2) is a by-product of oxidase-catalyzed reactions that serves as a signaling molecule and can cause DNA and protein damage. This leads to an increase in our susceptibility toward various kinds of diseases including diabetes mellitus and hypertension, The novelty of this work lies in the synergistic effect of all three components of the Ag-Fe2O3-IL composite for the colorimetric detection of H2O2. Silver-doped iron oxide nanostructures (Ag-Fe2O3 NS) were synthesized and then coated with ionic liquid (IL) having peculiar characteristics of aromaticity and conductivity to enhance their properties. The prepared Ag-Fe2O3 nanoparticles were characterized through spectroscopic techniques namely FTIR, XRD, SEM and EDX. The characterized Ag-Fe2O3 NS and 3, 3', 5, 5' Tetramethylbenzidine (TMB) solutions were employed for the colorimetric sensing of H2O2. To optimize the proposed sensor different reaction conditions including (a) amount of Ag-Fe2O3NS/IL (b) TMB, (c) pH, (d) H2O2 concentration and (e) incubation time were optimized. At optimum conditions, the desired sensor showed a wide linear range 1 × 10−9–3.2 × 10−7 M, a lower limit of quantification 3.20 × 10−7 M, and a limit of detection 1.07 × 10−8 M with a 0.9996 R2 value. The selectivity of the proposed sensor was compared with the potential interfering species and the incubation time was just 5 min. Additionally, the sensor was effectively applied for detecting hydrogen peroxide in the urine samples of diabetes mellitus patients. [ABSTRACT FROM AUTHOR]

The focus of the present work was to develop co-amorphous dispersion (CAD) formulations of tacrolimus (TAC) using sucrose acetate isobutyrate as a carrier, evaluate by in vitro and in vivo methods and compare its performance with hydroxypropyl methylcellulose (HPMC) based amorphous solid dispersion (ASD) formulation. CAD and ASD formulations were prepared by solvent evaporation method followed by characterization by Fourier transformed infrared spectroscopy, X-ray powder diffraction (XRPD), differential scanning calorimetry (DSC), dissolution, stability, and pharmacokinetics. XRPD and DSC indicated amorphous phase transformation of the drug in the CAD and ASD formulations, and dissolved more than 85% of the drug in 90 min. No drug crystallization was observed in the thermogram and diffractogram of the formulations after storage at 25 °C/60% RH and 40 °C/75% RH. No significant change in the dissolution profile was observed after and before storage. SAIB-based CAD and HPMC-based ASD formulations were bioequivalent as they met 90% confidence of 90–11.1% for Cmax and AUC. The CAD and ASD formulations exhibited Cmax and AUC 1.7–1.8 and 1.5–1.8 folds of tablet formulations containing the drug's crystalline phase. In conclusion, the stability, dissolution, and pharmacokinetic performance of SAIB-based CAD and HPMC-based ASD formulations were similar, and thus clinical performance would be similar. [ABSTRACT FROM AUTHOR]

Mercury (Hg) is a toxic heavy metal discharged into the environment by many human and natural sources. Therefore, the precise and accurate determination of trace mercury in samples is of immense importance. In this regard, a spectrophotometric method has been developed for the quantification of Hg (II) in water, hair, and fish using deep eutectic (choline chloride, ChCl + decanol) solvent-based liquid-liquid microextraction (DES-LLME). All of the relevant parameters, including pH (9), volume of 1-(2-pyridylazo)-2-naphthol (PAN) (300 µL), ratio of choline chloride and decanol (1:1), volume of DES (400 µL), volume of tetrahydrofuran (THF) (400 µL), and sample volume (40 mL) were optimized. The low limits of detection (LOD) (0.09 µg L−1) and quantification (LOQ) (0.325 µg L−1) demonstrate that the developed approach is highly sensitive. High preconcentration (PF) and enhancement factors (EF) of 50 show that the developed protocol is highly efficient. The relative standard deviation (RSD) is 6.32%, indicating that the method is reproducible. The method was validated by the analysis of TMDA-53.3 water and NCSZC81002B hair certified reference materials with high recoveries of 97% and 93%, respectively. The method was also employed for the analysis of tap water, dam water, river water, hair, and tuna fish with satisfactory recoveries from 95% to 102%. The developed approach was compared with literature methods on the basis of the limit of detection. [ABSTRACT FROM AUTHOR]

Objective: To share our experience with reconstruction of the head and neck defects and to standardize the reconstruction options for such defects. Study Design: Descriptive Cross Sectional study. Setting: Burns and Plastic Surgery Center, Peshawar. Period: November 2018 to December 2022. Material & Methods: Data was collected from medical records about the patient demographics, mechanism of injury and type of procedures done. Defect size was classified into small (< 3 cm), medium (4 cm to 8 cm) and large (> 8 cm). Data was analyzed using SPSS. Results: Over the study period, 112 (70%) male and 48 (30%) female patients, with mean age of 44.36 + 21.35, were operated. The main cause of head and neck defects, were malignant lesions; 60% (n=96) cases. The most common site of was nose, either alone or in combination with surrounding areas. In 54 (33.4%) cases, the reconstructed defects were of medium size, followed by large defects (n=52, 32.5%). In 79 (49.4%) cases, the defects were reconstructed with local flaps, followed by pedicled flaps; 70 (43.8%) cases. Free flap reconstruction was performed in 11 (6.9%) cases. The most common free flap was fibula based (n=4). Complications were observed in 4.4% cases. Conclusion: The most common defects in head and neck region are on nose. In most cases the etiology is lesion excision. Other common defects encountered are scalp, eyelids and ear. Most of the defects can be covered with local flaps with very low complication rate. [ABSTRACT FROM AUTHOR]

Hydrogen peroxide acts as a byproduct of oxidative metabolism, and oxidative stress caused by its excess amount, causes different types of cancer. Thus, fast and cost-friendly analytical methods need to be developed for H2O2. Ionic liquid (IL)-coated cobalt (Co)-doped cerium oxide (CeO2)/activated carbon (C) nanocomposite has been used to assess the peroxidase-like activity for the colorimetric detection of H2O2. Both activated C and IL have a synergistic effect on the electrical conductivity of the nanocomposites to catalyze the oxidation of 3,3′,5,5′-tetramethylbenzidine (TMB). The Co-doped CeO2/activated C nanocomposite has been synthesized by the co-precipitation method and characterized by UV–Vis spectrophotometry, FTIR, SEM, EDX, Raman spectroscopy, and XRD. The prepared nanocomposite was functionalized with IL to avoid agglomeration. H2O2 concentration, incubation time, pH, TMB concentration, and quantity of the capped nanocomposite were tuned. The proposed sensing probe gave a limit of detection of 1.3 × 10−8 M, a limit of quantification of 1.4 × 10−8 M, and an R2 of 0.999. The sensor gave a colorimetric response within 2 min at pH 6 at room temperature. The co-existing species did not show any interference during the sensing probe. The proposed sensor showed high sensitivity and selectivity and was used to detect H2O2 in cancer patients' urine samples. [ABSTRACT FROM AUTHOR]

Background: Radiology trainees were uncomfortable going to the CT scanner to review trauma panscans and interacting with trauma surgeons. Objective: This study aims to determine if radiology residents can be trained to accurately identify injuries requiring immediate surgical attention at the CT scanner. Methods: A high-fidelity simulation model was created to provide an immersive training experience. Between February 2015 and April 2017, 62 class 1 trauma panscans were read at the CT scanner by 11 PGY-3 radiology residents. Findings made at the scanner were compared to resident preliminary and attending radiology reports and correlated with clinical outcomes. Timestamps were recorded and analyzed. Surveys were administered to assess the impact of training on radiology residents' self-confidence and to assess trauma surgeons' preference for radiology at the scanner. Significance level was set at p < 0.05. Results: The mean time to provide results at the CT scanner was 11.1 min. Mean time for the preliminary report for CT head and cervical spine was 24.4 ± 9.8 min, and for the CT chest, abdomen, and pelvis was 16.3 ± 6.9 min. 53 traumatic findings on 62 panscans were identified at the scanner and confirmed at preliminary and final reports, for a concordance rate of 85%, compared to 72% for the control group. Radiology residents agreed or strongly agreed the training prepared them for trauma panscan reporting. Trauma surgeons shifted in favor of radiology presence at the scanner. Conclusion: Radiology residents can be trained to accurately and rapidly identify injuries requiring immediate surgical attention at the CT scanner. Clinical impact: These findings support the value-added of an in-person radiologist at the CT scanner for whole-body trauma panscans to facilitate timely detection of life-threatening injuries and improve professional relations between radiologists and trauma surgeons. [ABSTRACT FROM AUTHOR]

Chronic use of antihistamines can induce abnormalities in lipid absorption with potential excessive accumulation of lipids in the mesentery that can lead to the development of obesity and a metabolic syndrome. The focus of the present work was to develop a transdermal gel formulation of desloratadine (DES) to prevent/reduce obesity and metabolic syndromes. Nine formulations were prepared to contain hydroxypropyl methylcellulose (2–3%), DES (2.5–5.0%), and Transcutol® (15–20%). The formulations were evaluated for cohesive and adhesive properties, viscosity, drug diffusion through synthetic and pig ear skin, and pharmacokinetics in New Zealand white rabbits. Drug permeation was faster through the skin compared to synthetic membranes. The drug had good permeation, as indicated by very short lag time (0.08–0.47 h) and high flux (59.3–230.7 μg/cm2.h). The maximum plasma concentration (Cmax) and area under the curve (AUC) of transdermal gel formulations were 2.4 and 3.2 fold that of the Clarinex tablet formulation. In conclusion, as indicated by the higher bioavailability, transdermal gel formulation of DES may decrease the dose of the drug, compared to commercial formulation. It has the potential to reduce or eliminate metabolic syndromes associated with oral antihistamine therapy. [ABSTRACT FROM AUTHOR]

Many nitrosamines have been recognized to be carcinogenic for many decades. Despite the fact that several nitrosamine precursors are frequently used in the manufacturing of pharmaceutical products, their potential presence in pharmaceutical products has previously been overlooked due to a lack of understanding on how they form during the manufacturing process. From the risk assessment, it is clear that nitrosamines or their precursors may be present in any component of the finished dosage form. As a risk mitigation strategy, components with a high potential to form nitrosamine should be avoided. In the absence of suitable alternatives, sufficient measures to maintain nitrosamines below acceptable intake levels must be applied. Excipient manufacturing pathways must be extensively studied in order to identify probable excipient components that may contribute to nitrosamine formation. The manufacturers must not solely rely on pharmacopeial specifications for APIs and excipients, rather, they should also develop and implement additional strategies to control nitrosamine impurities. The formulation can be supplemented with nitrosating inhibitors, such as vitamin C, to stop the generation of nitrosamine. The purpose of this review is to identify key risk factors with regard to nitrosamine formation in pharmaceutical dosage forms and provide an effective control strategy to contain them below acceptable daily intake limits. [ABSTRACT FROM AUTHOR]

Biologics have changed the landscape for the management of many debilitating chronic diseases but account for a significant expenditure of medications globally. Fortunately, advances in technology paved the way for the introduction of biosimilars, which are highly similar to the originator biologics. In the quest to reduce the budget impact of biologics, organizations have begun to adopt biosimilars. Institutions evaluating biosimilars for inclusion in the hospital formulary must make informed formulary decisions by conducting a thorough review of key elements for evaluation of biosimilars and address the multidimensional aspects during the selection process of different biosimilar products. Therefore, we aim to present an institutional guide of these elements to inform formulary decisions. These key elements include biosimilar evaluation for formulary addition; regulatory approval; substitution, interchangeability, and switching; extrapolation; product characteristics, manufacturing, and supply chain issues; pharmacoeconomic evaluations; traceability, nomenclature, and coding; education; and pharmacovigilance. [ABSTRACT FROM AUTHOR]

This study estimated, for Saudi Arabia, the cost-efficiency of converting patients from reference Neupogen and Neulastim to one of two filgrastim biosimilars (Nivestim, Zarzio); the budget-neutral expanded access to supportive care with biosimilar filgrastim and therapeutic care to ado-trastuzumab emtansine thus afforded; and the number-needed-to-convert (NNC) to provide supportive or therapeutic treatment to one patient. Replicating prior studies, we modeled the cost-efficiencies gained from converting varying proportions of a hypothetical panel of 4,000 patients undergoing six cycles of cancer treatment from Neupogen or Neulastim to one of the two biosimilar G-CSF formulations, using national cost inputs. Cost-savings in USD were used to estimate the additional doses of biosimilar G-CSF and expanded access to ado-trastuzumab emtansine on a budget-neutral basis, and NNC to purchase one additional dose of supportive or therapeutic treatment. Savings from conversion from reference to a biosimilar filgrastim were $3,086,400 (Nivestim) and $3,460,800 (Zarzio). With reference pegfilgrastim, savings from conversion were $11,712,240 (Nivestim) and $12,086,640 (Zarzio). Biosimilar conversion from reference to biosimilar filgrastim enabled expanded access to ado-trastuzumab emtansine ranging from 61 patients (5 days, Nivestim) to 191 patients (14 days, Zarzio). For supportive care, biosimilar conversion enabled expanded access ranging from 8,244 patients (5 days, Nivestim) to 25,882 patients (14 days, Zarzio). For biosimilar conversion from daily filgrastim, the NNC for treatment with ado-trastuzumab emtansine decreased as days of injections increased [5 days: 395 (Nivestim), 352 (Zarzio); 14 days: 141(Nivestim), 126 (Zarzio)]. Alternately, for biosimilar conversion from single-injection pegfilgrastim to daily biosimilar filgrastim, the NNC for treatment with ado-trastuzumab emtansine rose as days of injections increased, being highest under the 14-day scenario (146, Nivestim; 130, Zarzio). This simulation study demonstrated significant potential cost-savings from biosimilar conversion. These savings provide budget-neutral increased access to supportive and therapeutic cancer care. [ABSTRACT FROM AUTHOR]

Background: Cancer treatments have gradually evolved into targeted molecular therapies characterized by a unique mechanism of action instead of non-specific cytotoxic chemotherapies. However, they have unique safety concerns. For instance, endocrinopathies, which are defined as unfavorable metabolic alterations including thyroid disorders, hyperglycemia, dyslipidemia, and adrenal insufficiency necessitate additional monitoring. The aim of this study was to assess the prevalence of monitoring errors and develop strategies for monitoring cancer patients who receive targeted therapies. Method: A retrospective chart review was used to assess the prevalence of monitoring errors of endocrinopathies among cancer patients who received targeted therapies over one year. All of the adult cancer patients diagnosed with a solid tumor who received targeted therapies were included. The primary outcome was to determine the prevalence of monitoring errors of endocrinopathies. The secondary outcomes were to assess the incidences of endocrinopathies and referral practice to endocrinology services. Results: A total of 128 adult patients with solid tumors were involved. The primary outcome revealed a total of 148 monitoring errors of endocrinopathies. Monitoring errors of the lipid profile and thyroid functions were the most common error types in 94% and 92.6% of the patients treated with novel targeted therapies, respectively. Subsequently, 57% of the monitoring errors in the blood glucose measures were identified. Targeted therapies caused 63 events of endocrinopathies, hyperglycemia in 32% of the patients, thyroid disorders in 15.6% of them and dyslipidemia in 1.5% of the patients. Conclusion: Our study showed a high prevalence of monitoring errors among the cancer patients who received targeted therapies which led to endocrinopathies. It emphasizes the importance of adhering to monitoring strategies and following up on the appropriate referral process. [ABSTRACT FROM AUTHOR]

With the introduction of 4G/5G Internet and the increase in the number of users, the malicious cyberattacks on computing devices have been increased making them vulnerable to external threats. High availability windows servers are designed to ensure delivery of consistent services such as business activities and e-services to their customers without any interruption. At the same time, a cyberattack on any of the clustered computer can put servers and customer devices in danger. A memory dump mechanism can capture the contents of memory in the event of a system or device crash such as corrupted files, damaged hardware, or irregular CPU power consumption. In this paper, we present a smart memory forensics scheme to recognize malicious attacks over high availability servers by capturing the memory dump of suspicious processes in the form of RGB visual images. Second, the local and global properties of malware images are captured using local binary patterns (LBP) and gray-level co-occurrence matrices (GLCM). A state-of-the-art t-distributed stochastic neighbor embedding scheme (t-SNE) is applied to reduce data dimensionality and improve the detection time of unknown malwares and their variants. An optimized CNN model is designed to predict malicious files harming servers or user devices. Throughout this study, we employed public data set of 4294 malicious samples covering malware variants and benign executables. A baseline is prepared to compare the performance of proposed model with state-of-the-art malware detection methods. The combined LBP + GLCM feature extraction along with t-SNE dimensionality reduction scheme further improved the detection accuracy by 98%, whereas the detection time is also increased by 73x. The overall performance shows that memory forensics is more effective for malware detection in terms accuracy and response time. [ABSTRACT FROM AUTHOR]

Objectives: To describe the demographics, reconstructive options for different area and defect sizes and the functional outcome of upper extremity reconstruction. Study design: Descriptive study Setting: Burns and Plastic Surgery Center, Hayatabad Medical Complex, Peshawar Duration: 6-years Material and Methods: This study was performed from 2018 to 2021 in the department of Burns and Plastic Surgery. All the patients with upper extremity defects, for which reconstruction was performed, were included in the study after informed consent. The data was collected from hospital record and functional outcome was assessed based on the Toronto Extremity Salvage Score (TESS) questionnaire after 6-months of reconstruction. All the data was organized and evaluated with the help of statistical soft ware. Results: A total of 67 patients were included in the study including 51(76.1%) male and 16(23.9%) female patients with age ranging from 5 weeks to 65 weeks (mean 30.27+14.9 SD). Right upper extremity was affected in 61.2 % (n=41). The main cause of injury was electric burns and machine injuries, accounting for 26.9% each. Hand was the mainly affected region. The most commonly performed flap in our series was retrograde posterior interosseous artery flap (n=14, 20.9). Insignificant partial flap necrosis was observed in 3 (4.5%). Post-operative TESS score ranged from 40% to 99% with a mean of 85.4+14.9SD. Conclusion: There are multitude of options available for upper limb reconstruction. Functional outcome should be assessed using standardized tools like Toronto Extremity Salvage Score (TESS). This will lead to standardization of treatment modalities in such patients. [ABSTRACT FROM AUTHOR]

Purpose: Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) represents a minimally invasive technique of aortic occlusion (AO). It has been demonstrated to be safe and effective with appropriate training in traumatic hemorrhage with hemodynamic instability; however, its indications are still debated. The aim of this systematic review and meta-analysis is to assess the impact of REBOA on mortality in torso trauma patient with severe non-compressible hemorrhage compared to other temporizing hemostatic techniques. Study design: The primary outcome is represented by 24-h, and in-hospital mortality. Secondary outcomes are post-procedural hemodynamic improvement (systolic blood pressure—SBP), mean injury severity score (ISS) differences, treatment-related morbidity, transfusional requirements and identification of prognostic factors. Results: A significant survival benefit at 24 h (RR 0.46; 95% CI 0.27–0.79; I2: 55%; p = 0.005) was highlighted in patients undergoing REBOA. Regarding in-hospital mortality (RR 0.99; 95% CI 0.75–1.32; I2: 73%; p = 0.98) no differences in risk of death were noticed. A hemodynamic improvement—although not significant—was highlighted, with 55.8 mmHg post-AO SBP mean difference between REBOA and control groups. A significantly lower mean number of packed Red Blood Cells (pRBCs) was noticed for REBOA patients (mean difference: − 3.02; 95% CI − 5.79 to − 0.25; p = 0.033). Nevertheless, an increased risk of post-procedural complications (RR 1.66; 95% CI 0.39–7.14; p = 0.496) was noticed in the REBOA group. Conclusions: REBOA may represent a valid tool in the initial treatment of multiple sites subdiaphragmatic hemorrhage with refractory hemodynamic instability. However, due to several important limitations of the present study, our findings should be interpreted with caution. Level of evidence: Level III according to ELIS (SR/MA with up to two negative criteria). [ABSTRACT FROM AUTHOR]

Collaboration with local emergency services: Establishing relationships with local first responders and ensure that they are familiar with the layout of the event venue and that they are adequately staffed to respond to emergencies during sporting events. With large groups of spectators watching potentially dangerous sporting events, it is essential to consider the safety of all involved in these mass attendance events and to have a plan for all types of disasters, despite them luckily being rare events. Keywords: crowd; disaster; emergency; planning; sporting event EN crowd disaster emergency planning sporting event S1 S3 3 06/30/23 20230503 NES 230503 Sports disasters refer to a variety of events including accidents, injuries, or acts of violence that occur during sporting events. [Extracted from the article]

With large groups of spectators watching potentially dangerous sporting events, it is essential to consider the safety of all involved in these mass attendance events and to have a plan for all types of disasters, despite them luckily being rare events. Keywords: crowd; disaster; emergency; planning; sporting event EN crowd disaster emergency planning sporting event S1 S3 3 05/18/23 20230502 NES 230502 Sports disasters refer to a variety of events including accidents, injuries, or acts of violence that occur during sporting events. Collaboration with local emergency services: Establishing relationships with local first responders and ensure that they are familiar with the layout of the event venue and that they are adequately staffed to respond to emergencies during sporting events. [Extracted from the article]

This work offers an overview of the effective communication techniques for space exploration of ground, aerial, and underwater vehicles. We not only comprehensively summarize the trajectory planning, space exploration, optimization, and other challenges encountered but also present the possible directions for future work. Because a detailed study like this is uncommon in the literature, an attempt has been made to fill the gap for readers interested in path planning. This paper also includes optimization strategies that can be used to implement terrestrial, underwater, and airborne applications. This study addresses numerical, bio-inspired, and hybrid methodologies for each dimension described. Throughout this study, we endeavored to establish a centralized platform in which a wealth of research on autonomous vehicles (on the land and their trajectory optimizations), airborne vehicles, and underwater vehicles, is published. [ABSTRACT FROM AUTHOR]

Antimony (Sb) is highly hazardous to human health even in minute concentration. Therefore, its accurate and precise determination in the real environmental samples is of immense importance. In this work for the first time, UV–Vis spectrophotometric method was developed for the quantification of Sb(III) from water samples using supramolecular solvent (undecanol-tetrahydrofuran)–based extraction. The maximum absorption wavelength for antomony-diathizone complex was found to be 590 nm having molar absorptivity of 3.1 × 104 L.mol.cm−1. Factors affecting extraction efficiency like solution sample volume, amount of chelating agent, pH, matrix effect, and type and volume of supramolecular solvent were determined and optimized. Analytical parameters like limit of detection (0.19 µg L−1), limit of quantification (0.62 µg L−1), pre-concentration factor (15), enhancement factor (15), and relative standard deviation for 8 successive analysis (0.8%) were calculated under optimized experimental conditions. The method was applied to real water samples like tap water of laboratory, waste water from Kohat hospitals, and dam water (Tanda dam Kohat) with quantitative addition recovery (94–100%). [ABSTRACT FROM AUTHOR]

This occurred despite the fact that the patients in the prehospital transfusion group had a higher admission mean hemoglobin (Hb) concentration than the patients in the control arm (133 g/L vs. 118 g/L, respectively; I p i < 0.001), a small and nearly identical fraction of patients in both groups had an admission INR >1.5 (described above), and the patients in both groups had identical mean admission systolic blood pressures (114 mmHg; I p i = 0.74). It is clear from these three trials that some trauma patients derive lifesaving benefit from prehospital transfusions, and the design of future studies and sub-analyses should be further refined to more clearly elucidate those patients who might benefit. Keywords: COMBAT; emergency medical service; mortality; outcome; PAMPer; prehospital transfusion; randomized trial; red blood cell; RePHILL; trauma EN COMBAT emergency medical service mortality outcome PAMPer prehospital transfusion randomized trial red blood cell RePHILL trauma 1671 1679 9 08/09/22 20220801 NES 220801 Abbreviations BP blood pressure ED emergency department GCS Glasgow coma scale LTOWB low titer group O whole blood RBC red blood cell RCT randomized controlled trial For with much wisdom comes much sorrow, and as knowledge grows, grief increases. Similarly, recognizing patients with unsurvivable injuries (i.e., injuries leading to nonpreventable death) and excluding them from future studies will also help to better establish those patients who might benefit from prehospital transfusions.31-33 These should be major areas of future research to optimize patient care and to help steward the inventory of precious blood products. [Extracted from the article]

Objective: To determine the pattern of partial edentulism and the cast removable dental prosthesis design in relation to the Classes recorded. Study Design: Cross-sectional study. Place and Duration of Study: Department of Prosthodontics, Armed Forces Institute of Dentistry (AFID), Rawalpindi Pakistan, from Apr to Sep 2021. Methodology: A total of 67 partially dentate male and female patients presenting to the Prosthodontics Department requiring partial cast dentures were included in the study. Visual inspection of the master casts and partial denture frameworks was carried out in the laboratory. Kennedy's Classification, modification areas, type of major connector, direct retainer, rest and use of indirect retention were recorded. Results: The most prevalent Class of partially dentate arch was Kennedy Class-II in maxilla 10 (45.5%) and Class-I and III in mandible 15 (33.3%) each. Major connectors most frequently encountered were anteroposterior palatal strap (59.1%) and lingual bar (57.8%). Circumferential clasp (35.8%) was the most used retainer type in Classes II and III, whereas RPI was mostly found in Classes I and II (32.1%). Occlusal rests were most commonly used (72.4%). Indirect retention was mostly used in Class-I and II denture frameworks (95.9%). Conclusion: The most commonly encountered partial edentulism pattern was Kennedy's Class I and II. Following basic principles of RPD design can help elevate the standards of removable denture treatment. [ABSTRACT FROM AUTHOR]

Objective: We aim to look at the epidemiology of lower limb trauma and study the post-operative functional outcome. Study Design: Descriptive study Sett ing: Burns and Plastic Surgery Center, Hayatabad Medical Complex, Peshawar Duration: six years Material and Methods: After approval from the ethical board, data was collected from hospital records. Data regarding patient demographics, site, anatomic location of injury, and type of reconstructive procedure done was collected. Complications including partial (significant or insignificant) or complete necrosis was documented. Toronto extremity Salvage (TESS) score was calculated. Results: A total of 73 patients underwent lower limb reconstruction with mean age of 28.7+12.5 SD. Road traffic accidents (RTA) were the main cause of lower limb trauma (45.2%). There were 54.8% defects with associated fractures, most commonly tibia. The mean duration of presentation for reconstruction was 5.3 week +10.23SD. Total of 81 flaps were performed (68 pedicled and 13 free micro-vascular flaps). 35-patients required bony stabilization. Infection (8.2%) was the most common complication. Partial Flap necrosis was observed in 4(5.5%) cases, out of which 3(4.1%) were significant partial necrosis. Mean Toronto Extremity Salvage Score (TESS) was 84.8+13.6 SD. Discussion: Mostly younger male population are involved with lower limb trauma. Most patients had delayed presentation due to under developed infra-structure in the tribal areas and issues with timely referral from peripheral health care facilities. Most of the small and medium defects can be closed with local flaps. However large defects with bone involvement required free microvascular flaps. Post-operative outcome was good using TESS score. Conclusion: Robust referral system and single stage orthoplastic procedures should be adopted. Multi-center studies need to be conducted and liaison with orthopedic department is paramount to improve outcomes. [ABSTRACT FROM AUTHOR]