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Abstract Introduction Intravenous vitamin C was administered following hematopoietic stem cell transplant to mitigate nonrelapse mortality (NRM) in a Phase II clinical trial. Methods Patients with advanced hematologic malignancies received IV vitamin C, 50 mg/kg/day, in three divided doses on days 1–14 after HSCT, followed by 500 mg bid oral until 6 months. Results All patients enrolled (55) were deficient in vitamin C at day 0 and had restoration to normal levels. Vitamin C recipients had a trend for lower nonrelapse mortality (NRM, 11% vs. 25%, p‐value = 0.07) compared with propensity score‐matched historical controls. A similar trend toward improved survival was observed (82% vs. 62% p = 0.06), with no attributable grade 3 and 4 toxicities to vitamin C. Conclusion In patients undergoing allogeneic HSCT, repletion of vitamin C is feasible and may reduce NRM and improve overall survival. Randomized trials in large uniform cohorts of patients are needed to confirm the utility of this easily available and inexpensive therapy.

Abstract Background Small songbirds respond and adapt to various geographical barriers during their annual migration. Global flyways reveal the diverse migration strategies in response to different geographical barriers, among which are high-elevation plateaus. However, few studies have been focused on the largest and highest plateau in the world, the Qinghai–Tibet Plateau (QTP) which poses a significant barrier to migratory passerines. The present study explored the annual migration routes and strategies of a population of Siberian Rubythroats (Calliope calliope) that breed on the north-eastern edge of the QTP. Methods Over the period from 2021 to 2023, we applied light-level geolocators (13 deployed, seven recollected), archival GPS tags (45 deployed, 17 recollected), and CAnMove multi-sensor loggers (with barometer, accelerometer, thermometer, and light sensor, 20 deployed, six recollected) to adult males from the breeding population of Siberian Rubythroat on the QTP. Here we describe the migratory routes and phenology extracted or inferred from the GPS and multi-sensor logger data, and used a combination of accelerometric and barometric data to describe the elevational migration pattern, flight altitude, and flight duration. All light-level geolocators failed to collect suitable data. Results Both GPS locations and positions derived from pressure-based inference revealed that during autumn, the migration route detoured from the bee-line between breeding and wintering grounds, leading to a gradual elevational decrease. The spring route was more direct, with more flights over mountainous areas in western China. This different migration route during spring probably reflects a strategy for faster migration, which corresponds with more frequent long nocturnal migration flights and shorter stopovers during spring migration than in autumn. The average flight altitude (1856 ± 781 m above sea level) was correlated with ground elevation but did not differ between the seasons. Conclusions Our finding indicates strong, season-dependent impact of the Qinghai–Tibet Plateau on shaping passerine migration strategies. We hereby call for more attention to the unexplored central-China flyway to extend our knowledge on the environment-migration interaction among small passerines.

Despite decades of Inuit accessing services in Manitoba, Inuit-centric services remain scant and have only begun to emerge. This article reports on Inuit utilisation of mental health services in Manitoba. In this study, we focused on two interrelated cohorts: Inuit living in Manitoba and Inuit from the Kivalliq region who come to Winnipeg to access specialised services. We used administrative data routinely collected by Manitoban agencies. The study was conducted in partnership with the Manitoba Inuit Association, and Inuit Elders from Nunavut and Manitoba. Our results show that mental health-related consults represent between 1 in 5 and 1 in 3 of all consults made by Inuit in Manitoba. Rates of hospitalisation for mental health conditions are considerably lower than those of residents from the Manitoba northern health authority. Given that Nunavut has the highest rate of suicide in the world, our results suggest underserved needs rather than lower needs. Kivalliq and Manitoba Inuit utilise mental health services in Manitoba extensively, yet these services for the most part remain western-centric. Epistemological accommodations in the provision of mental health services have yet to be implemented. This is now the focus of our work.

Inuit youth face challenges in maintaining their wellbeing, stemming from continued impacts of colonisation. Recent work documented that urban centres, such as Winnipeg Canada, have large Inuit populations comprised of a high proportion of youth. However, youth lack culturally appropriate health and wellbeing services. This review aimed to scan peer-reviewed and grey literature on Inuit youth health and wellbeing programming in Canada. This review is to serve as an initial phase in the development of Inuit-centric youth programming for the Qanuinngitsiarutiksait program of research. Findings will support further work of this program of research, including the development of culturally congruent Inuit-youth centric programming in Winnipeg. We conducted an environmental scan and used an assessment criteria to assess the effectiveness of the identified programs. Results showed that identified programs had Inuit involvement in creation framing programming through Inuit knowledge and mostly informed by the culture as treatment approach. Evaluation of programs was diffcult to locate, and it was hard to discren between programming, pilots or explorative studies. Despite the growing urban population, more non-urban programming was found. Overall, research contributes to the development of effective strategies to enhance the health and wellbeing of Inuit youth living in Canada.

Background: Clinician teachers (CT) have historically felt undervalued and underappreciated. One technology used to increase motivation is gamification: the process of inserting elements of game-playing into activities that are not usually associated with games. We developed a mobile application that rewards CTs using in-app gamification techniques to increase CTs motivation. This program was implemented specifically in a regional campus setting, Mississauga, Ontario. Methods: A cross-platform application that rewards physicians for their clinical teaching hours was created. This consisted of a star grading criteria where each physician was awarded depending on the number of hours completed. End-user perceptions of the application were evaluated using a survey with a Likert scale and open-ended questions. Survey results were collated with descriptive statistics and thematic analysis. Results: The TutorTracker application was developed implementing a live gamification algorithm. It allows physicians to view their hours completed, rewards obtained, and add additional hours. The majority of CTs agreed or strongly agreed that the application was user-friendly, easy to navigate and enjoyed the rewards provided. Major themes that emerged were regarding additional features and full integration of such an application for rewarding teaching efforts. Conclusions: Gamification principles have been implemented in a cross-platform application allowing CTs to be rewarded for their teaching. The next steps would be to formally quantify the effects and advantages of using the application to increase the motivation of tutors.

Abstract Background The genetic basis of type 2 diabetes (T2D) is under-investigated in the Middle East, despite the rapidly growing disease prevalence. We aimed to define the genetic determinants of T2D in Qatar. Methods Using whole genome sequencing of 11,436 participants (2765 T2D cases and 8671 controls) from the population-based Qatar Biobank (QBB), we conducted a genome-wide association study (GWAS) of T2D with and without body mass index (BMI) adjustment. Results We replicated 93 known T2D-associated loci in a BMI-unadjusted model, while 96 known loci were replicated in a BMI-adjusted model. The effect sizes and allele frequencies of replicated SNPs in the Qatari population generally concurred with those from European populations. We identified a locus specific to our cohort located between the APOBEC3H and CBX7 genes in the BMI-unadjusted model. Also, we performed a transethnic meta-analysis of our cohort with a previous GWAS on T2D in multi-ancestry individuals (180,834 T2D cases and 1,159,055 controls). One locus in DYNC2H1 gene reached genome-wide significance in the meta-analysis. Assessing polygenic risk scores derived from European- and multi-ancestries in the Qatari population showed higher predictive performance of the multi-ancestry panel compared to the European panel. Conclusion Our study provides new insights into the genetic architecture of T2D in a Middle Eastern population and identifies genes that may be explored further for their involvement in T2D pathogenesis.

Abstract Objective This study compares clinical pain outcomes between patients in a pain treatment program that received a Fitbit, to patients that did not. We also explored: (1) cognitive, emotional, and psychological factors that may have impacted the decision to opt in to receiving a Fitbit; and (2) whether the choice to receive a Fitbit impacted changes in cognitive, emotional, and psychological factors following treatment. Methods Among 58 patients in a multidisciplinary pain treatment program at a Veterans Affairs Healthcare System hospital, 31 patients opted to receive a Fitbit as adjunct treatment, while 27 did not. This study utilized patient-reported and practitioner-collected data from the pain treatment program. Results Compared to the non-Fitbit group, the Fitbit group displayed a significant decrease in average pain intensity, however showed no correlation between Fitbit activity and average pain intensity. Additionally, treatment satisfaction was the only predictor of treatment group, when modeling pre- and post-treatment outcomes changes. Conclusion The implementation of a Fitbit may lead to improved pain intensity. Initial evidence suggests that opting to receive a Fitbit during a pain treatment program indicates treatment engagement leading to greater treatment satisfaction. Future work is needed to verify and expand upon this potential mechanism.

IntroductionChronic low back pain (cLBP) poses significant challenges, often addressed through avoidance or distraction. Emerging evidence suggests that mind-body interventions, like our novel Mind Your Pain (MyP) smartphone mobile application, may offer relief. We conducted a single-arm, mixed-methods neuroimaging study to assess the degree to which treatment response to our 8-week intervention, as measured by the reduction in the Pain, Enjoyment of Life and General Activity Scale (PEG), was associated with enhanced pain-related insula activation over time.MethodsTwenty-nine individuals with cLBP completed patient-reported assessments, qualitative sensory testing (QST) measures, and neuroimaging pre- and post-MyP. Functional MRI data during experimental heat pain on the left forearm were collected and analyzed, comparing responders (≥50% reduction in PEG scores) and non-responders.ResultsMyP led to significant decreases in PEG scores overall. Furthermore, MyP responders exhibited increased pain-related activation in key brain regions, including the contralateral posterior insula, bilateral ventral anterior insula, ventral anterior cingulate, dorsolateral prefrontal cortex, and nucleus accumbens. Although baseline behavioral and sensory measures did not differ between the two responder groups, baseline neural differences related to the impact of the endogenous back pain were observed.DiscussionMyP appears to modify pain response and underlying neural circuitry, suggesting neural changes in interoception may serve as biomarkers for mind-body interventions in cLBP. This study highlights the potential of MyP as a novel approach for cLBP management, warranting further investigation.

The escalating environmental concerns associated with plastic waste have intensified the search for sustainable waste management solutions. Plastic dispersion in the environment poses severe threats to ecosystems, human well-being, and agriculture. Consequently, addressing plastic pollution stands as a pressing ecological concern. In contrast, the adoption of sustainable solar energy is harnessed for the production of HHO (Oxy-Hydrogen) gas, offering a promising avenue for clean energy generation. Gas production is achieved through the process of electrolysis, utilizing solar panels as the primary energy source. To address storage challenges, a spiral pipe configuration is employed for the interim containment of the generated HHO gas. Given the highly flammable nature of HHO gas, stringent safety protocols are imperative throughout the production and storage phases. To ensure the safe handling of HHO gas, a sophisticated MQ-8 Sensor is employed for real-time leak detection within the gas containment system. This sensor plays a critical role in maintaining operational safety by promptly identifying and addressing any potential gas leaks that may arise within the tubing infrastructure. The HHO gas, generated through the electrolysis process, serves as the primary fuel for the pyrolysis of plastic. This optimization is crucial to maximize the efficiency of the pyrolysis process. As a result of the pyrolysis process, crude oil is produced as an intermediary product. This crude oil holds the potential for subsequent refinement, offering versatility for various applications and end uses. Hence, the integration of solar energy-driven HHO gas in the pyrolysis of plastic demonstrates a promising avenue for mitigating plastic waste and contributing to environmental cleanliness. The intricate technological aspects, ranging from gas production through electrolysis, leak detection, optimized combustion, to crude oil production and refinement, collectively establish a comprehensive framework for sustainable waste management and resource recovery.

Hydrothermal liquefaction (HTL) is an emerging technology for bio-crude production but faces challenges in determining the optimal temperature for feedstocks depending on the process mode. In this study, three feedstocks—wood, microalgae spirulina (Algae Sp.), and hydrolysis lignin were tested for sub-supercritical HTL at 350 and 400 °C through six batch-scale experiments. An alkali catalyst (K2CO3) was used with wood and hydrolysis lignin, while e (Algae Sp.) was liquefied without catalyst. Further, two experiments were conducted on wood in a Continuous Stirred Tank Reactor (CSTR) at 350 and 400 °C which provided a batch versus continuous comparison. Results showed Algae Sp. had higher bio-crude yields, followed by wood and lignin. The subcritical temperature of 350 °C yielded more biocrude from all feedstocks than the supercritical range. At 400 °C, a significant change occurred in lignin, with the maximum percentage of solids. Additionally, the supercritical state gave higher values for Higher Heating Values (HHVs) and a greater amount of volatile matter in bio-crude. Gas Chromatography and Mass Spectrometry (GCMS) analysis revealed that phenols dominated the composition of bio-crude derived from wood and hydrolysis lignin, whereas Algae Sp. bio-crude exhibited higher percentages of N-heterocycles and amides. The aqueous phase analysis showed a Total Organic Carbon (TOC) range from 7 to 22 g/L, with Algae Sp. displaying a higher Total Nitrogen (TN) content, ranging from 11 to 13 g/L. The pH levels of all samples were consistently within the alkaline range, except for Wood Cont. 350. In a broader perspective, the subcritical temperature range proved to be advantageous for enhancing bio-crude yield, while the supercritical state improved the quality of the bio-crude.

Soil management approaches have been advocated to modify the soil fertility parameters for higher agricultural production through different land systems. The present review examines the influence of organic/inorganic fertilizers and tillage practices through transformations in regulating the nutrient status, microbial components, and soil organic carbon. Fertilization along with different tillage practices have been found to affect the available plant nutrient content including macronutrients, secondary nutrients, and micronutrients. The review investigation also showed that, compared to inorganic fertilizers (INF), application of compost enhanced plant available macronutrients (N, P, K), micronutrients (Zn, Cu, Fe, Mn) and soil organic carbon (SOC) with different tillage practices. Through different land systems, transformation of the plant available macronutrients, micronutrients and microbial compositions showed their enhancement. Microbial parameters viz. microbial biodiversity, microbial biomass carbon (MBC), potentially mineralizable nitrogen (PMN), microbial biomass nitrogen (MBN) and microbial respiration reported increase. Soil organic carbon and aggregate distribution in the soil and the aggregate-associated organic carbon and physical fractions of SOC have also been reviewed. Among different tillage systems, the reduced tillage with residue incorporation and no-tillage (zero tillage) with residue mulching, significantly enhanced carbon sequestration in soil aggregates in comparison to conventional tillage with residue removal treatments. The practice of zero tillage improved dissolved organic carbon and MBC in light and heavy fractions of carbon in the upper layers of soil.

Knowledge of nutrient surpluses in soils is critical to optimize nutrient management and minimize adverse environmental effects. We investigated the nutrient surpluses in soils in two regions over 25 years (1992 to 2017) in the south Loess Plateau, China. One region has cereals as the main crop, whereas in the other region, the main cereal crops was changed to kiwi orchards. The inputs of nitrogen (N), phosphorus (P), and potassium (K) increased rapidly (by 74%, 77%, and 103% from 1992 to 2017 in the cereal region; and by 91%, 204%, and 368% in the kiwifruit region), while the nutrient outputs were relatively stable, which resulted in increasing nutrient surpluses (the annual averaged surpluses of N, P, and K were 178, 62, and 12 kg ha−1 y−1 for the cereal region; and 486, 96, and 153 kg ha−1 y−1 for the kiwifruit region) and lower nutrient use efficiency (NUE). The higher N surplus in the orchard-dominated region caused high nitrate N accumulation (3071 kg N ha−1 of 0–5 m in 11–20 y in the kiwifruit orchard) in deeper soil profiles. Similarly, high P and K surpluses in the orchard-dominated region increased soil available P and K. This highlights that comprehensive measures should be taken to control nutrient surpluses, which will help balance nutrient inputs and outputs and minimize nutrient losses in intensive horticultural crop systems.

Insulin resistance (IR) and beta cell dysfunction are the major drivers of type 2 diabetes (T2D). Genome-Wide Association Studies (GWAS) on IR have been predominantly conducted in European populations, while Middle Eastern populations remain largely underrepresented. We conducted a GWAS on the indices of IR (HOMA2-IR) and beta cell function (HOMA2-%B) in 6,217 non-diabetic individuals from the Qatar Biobank (QBB; Discovery cohort; n = 2170, Replication cohort; n = 4047) with and without body mass index (BMI) adjustment. We also developed polygenic scores (PGS) for HOMA2-IR and compared their performance with a previously derived PGS for HOMA-IR (PGS003470). We replicated 11 loci that have been previously associated with HOMA-IR and 24 loci that have been associated with HOMA-%B, at nominal statistical significance. We also identified a novel locus associated with beta cell function near VEGFC gene, tagged by rs61552983 (P = 4.38 × 10-8). Moreover, our best performing PGS (Q-PGS4; Adj R2 = 0.233 ± 0.014; P = 1.55 x 10-3) performed better than PGS003470 (Adj R2 = 0.194 ± 0.014; P = 5.45 x 10-2) in predicting HOMA2-IR in our dataset. This is the first GWAS on HOMA2 and the first GWAS conducted in the Middle East focusing on IR and beta cell function. Herein, we report a novel locus in VEGFC that is implicated in beta cell dysfunction. Inclusion of under-represented populations in GWAS has potentials to provide important insights into the genetic architecture of IR and beta cell function.

Chronic pulmonary aspergillosis is a lung disorder characterized by the presence of single or multiple cavities with or without an aspergilloma or nodules on chest imaging, with mycological evidence of and/or demonstration of immunological response to Aspergillus spp. The affected patient should manifest relevant symptoms for at least 3 months. Chronic cavitary pulmonary aspergillosis is the most common subset of chronic pulmonary aspergillosis, which is often reported in patients previously treated for pulmonary tuberculosis, having residual cavities in their lungs. We present a case of a 55-year-old male patient treated for pulmonary tuberculosis 2 years back, now presenting with fever, shortness of breath, and hemoptysis with overt radiological changes from the baseline, positive direct microscopy, and serology for Aspergillus spp. and thus meeting the criteria for chronic cavitary pulmonary aspergillosis. Treatment with oral antifungal was initiated, but the follow-up data are unavailable due to patient noncompliance and lack of resources. We aim to emphasize the radiological and microbiological features of this condition to aid the early diagnosis and prompt treatment, as this may mimic similar pulmonary disorders and pose a significant challenge in the diagnosis and management outcomes.

In the realm of advertising, the utilization of diverse linguistic techniques has become pivotal in captivating audiences across varying cultural and linguistic landscapes. This paper delves into the nuanced strategies employed by advertisers, specifically focusing on the incorporation of code-mixing and code-switching in advertisements to resonate with diverse demographic segments. Employing a qualitative research methodology, this study aims to elucidate the intricate mechanisms through which advertisers leverage linguistic diversity to garner attention and engagement from heterogeneous audiences. Through a meticulous analysis of advertisements, this research uncovers the multifaceted nature of language manipulation in advertising campaigns. By intertwining elements of different languages and cultural representations, advertisers effectively navigate the linguistic tapestry of a multicultural society, thereby enhancing the relatability and appeal of their messaging to broader consumer bases. Furthermore, this study sheds light on the inherent power of language in shaping consumer perceptions and behaviors, emphasizing its role as a potent tool for audience engagement and brand communication. The findings of this study underscore the significance of linguistic diversity as a strategic asset in contemporary advertising practices. By harnessing the synergistic potential of code-mixing and code-switching techniques, advertisers can transcend linguistic barriers and forge meaningful connections with diverse audiences. Ultimately, this research contributes to a deeper understanding of the symbiotic relationship between language, culture, and consumer behavior, highlighting the pivotal role of language in shaping advertising effectiveness and consumer engagement on a mass scale.

Background: The need for palliative care is rising globally with 76% of those who are in need living in low- and middle-income countries (LMICs). Digital health interventions (DHIs) have been identified as a means of making palliative care more widely accessible. This review summarizes the range and characteristics of DHIs used to deliver palliative care in LMICs and sought to identify factors that influence their implementation and utilization. Objectives: This review aims to summarize the range and characteristics of DHIs used to deliver palliative care in LMICs and identify factors that influence their implementation and utilization. Design: Mixed-method systematic review incorporating both quantitative and qualitative data. Data sources and methods: All studies focusing on DHIs for patients who need palliative care (adults/children) and their caregivers (patient and caregiver centred) in LMICs and published in English were identified through a systematic search of MEDLINE, EMBASE, PsycINFO and CINAHL databases. Data synthesis and analysis were carried out following the convergent integrated approach based on the Joanna Briggs Institute (JBI) methodology for mixed-methods systematic reviews. Results: Fifteen studies were included (three qualitative, four mixed-methods and eight quantitative studies). Telemedicine/mHealth was the most reported DHI utilized in LMICs in delivering palliative care. Patients and caregivers benefited from using DHIs in many ways including increased access to care with reduced discomfort, travel time and risk of health care-associated infections. Health care providers also reported that using DHI such as telemedicine enables them to provide care in a more effective and efficient way. Four factors were identified as the main barriers to implementation: resource constraints; literacy, training and skills; governance, operational and communication issues and technical issues. Conclusion: DHIs, such as telemedicine, have the potential to enhance accessibility to palliative care in LMICs, particularly in rural areas. Comprehensive strategies for their use are required to address the identified barriers.

Abstract The conformational landscapes of peptide/human leucocyte antigen (pHLA) protein complexes encompassing tumor neoantigens provide a rationale for target selection towards autologous T cell, vaccine, and antibody-based therapeutic modalities. Here, using complementary biophysical and computational methods, we characterize recurrent RAS55-64 Q61 neoepitopes presented by the common HLA-A*01:01 allotype. We integrate sparse NMR restraints with Rosetta docking to determine the solution structure of NRASQ61K/HLA-A*01:01, which enables modeling of other common RAS55-64 neoepitopes. Hydrogen/deuterium exchange mass spectrometry experiments alongside molecular dynamics simulations reveal differences in solvent accessibility and conformational plasticity across a panel of common Q61 neoepitopes that are relevant for recognition by immunoreceptors. Finally, we predict binding and provide structural models of NRASQ61K antigens spanning the entire HLA allelic landscape, together with in vitro validation for HLA-A*01:191, HLA-B*15:01, and HLA-C*08:02. Our work provides a basis to delineate the solution surface features and immunogenicity of clinically relevant neoepitope/HLA targets for cancer therapy.

Abstract Introduction Frail older patients are at risk for many complications when admitted to the hospital. Multidisciplinary regional transmural agreements (RTA) in which guidelines were set concerning the information transfer of frail older patients might improve outcomes. We aim to investigate the effect of implementation of the RTA on the completeness of the information transfer of frail older patients when admitted to and discharged from the hospital. Methods This is a retrospective cohort study in which we collected data from 400 randomly selected hospitalized frail older patients (70+) before the implementation of the RTA, January through March 2021, and after, October through December 2021. The cohort was split up into four groups, which determined what correspondence would be checked (referral letter by General Practitioner (GP) and three groups of ‘hospital letters’: ED letter upon admittance, clinical discharge letter to the elderly care physician and clinical discharge letter to the GP. We assessed for mention of frailty, a medication list and mention of resuscitation orders. Results In the period before implementation the mean age of patients was 82.6 years (SD 7.4) and 101 were female (50.5%), after implementation mean age was 82.3 (SD 6.9) and 112 were female (56.0%). Frailty was mentioned in hospital letters in 12.7% before and 15.3% after implementation (p = 0.09). More GP referral letters were present after implementation (32.0% vs. 54.0%, p = 0.03), however frailty was mentioned only in 12.5% before and 7.4% after (p = 0.58). There was a good handover of medication lists from the hospital (89.3% before, 94% after, p = 0.20) and even better from the GP (93.8% before, 100% after, p = 0.19). Resuscitation orders were mentioned in 59.3% of letters from the hospital before implementation and 57.3% after (p = 0.77), which is higher than in the referral letters (18.8% before and 22.2% after (p = 0.91). Discussion The implementation of RTA improved the number of GP referral letters present; however, it did not lead to other significant improvements in communication between the hospital and the GP’s. Frailty and resuscitation orders are still frequently not mentioned in the reports. After a successful reimplementation, the improvements of outcomes could be investigated.

Hassaam S Choudhry,1 Usman Toor,1 Alexandra J Sanchez,1 Shahzad I Mian2 1Rutgers New Jersey Medical School, Newark, NJ, USA; 2University of Michigan Medical School, Ann Arbor, MI, USACorrespondence: Shahzad I Mian, University of Michigan Medical School, 1000 Wall Street, University of Michigan Medical School, Ann Arbor, MI, 48105, USA, Email smian@umich.eduPurpose: In the past few years, there has been remarkable progress in accessibility of open-source artificial intelligence (AI) image generators, developed to help humans understand how AI sees our world. Here, we characterize perception of racial and sex diversity in ophthalmology by AI.Methods: OpenAI’s open-source DALL E-2 AI was used for image generation of ophthalmologists with queries that all included “American” and “portrait photo”. Factors used for queries contained categories of following: “Positive Characteristic”, “Negative Characteristic”, “Finances”, “Region”, “Experience”, “Academic Rank”, and “Subspecialty”. The first 40 faces for each search were categorized on the basis of race and sex by two independent reviewers. If race or sex was not agreed upon, a third reviewer independently provided a classification, or if still indeterminate, the image was labeled as such. Images that did not adequately show facial features were excluded from categorization.Results: A total of 1560 images were included in the analysis. Control search queries specifying solely ophthalmologist sex and/or race outputted (100%) accurate images validating the tool. The query “American ophthalmologist, portrait photo” portrayed the majority of ophthalmologists as White (75%) and male (77.5%). Young/inexperienced/amateur ophthalmologists were perceived to have greater non-White racial diversity (27.5%) and female representation (28.3%) relative to old/experienced/mature ophthalmologists (23.3% non-White and 18.3% female). Ophthalmology department chairs (25%) had slightly more racial diversity compared to residents (22.5%), but residents had greater female representation (30%) compared to chairs (15%).Conclusion: Our results suggest the DALL E-2 AI may perceive a trend of increasing racial and sex diversity in younger, newer ophthalmologists compared to more senior ophthalmologists. Future investigations should attempt to validate how AI may be used as a tool to evaluate ophthalmology’s progress towards becoming more inclusive of increasingly diverse ophthalmologists.Keywords: artificial intelligence, race, sex

The electrochemical performance of in-house developed, spark plasma-sintered, Aluminum metal–matrix composites (MMCs) was evaluated using different electrochemical techniques. X-ray diffraction (XRD) and Raman spectra were used to characterize the nanocomposites along with FE-SEM and EDS for morphological, structural, and elemental analysis, respectively. The highest charge transfer resistance (Rct), lowest corrosion current density, lowest electrochemical potential noise (EPN), and electrochemical current noise (ECN) were observed for GO-reinforced Al-MMC. The addition of honeycomb-like structure in the Al matrix assisted in blocking the diffusion of Cl− or SO4−2. However, poor wettability in between Al matrix and Al2O3 reinforcement resulted in the formation of porous interface regions, leading to a degradation in the corrosion resistance of the composite. Post-corrosion surface analysis by optical profilometer indicated that, unlike its counterparts, the lowest surface roughness (Ra) was provided by GO-reinforced MMC.

Dengue is amongst the most prevalent viral diseases which globally affects millions of individuals annually and renders billions at risk, particularly in tropical and sub-tropical nations. WHO estimated 100–400 million infections each year and reported 4.2 million active cases in 2019 worldwide. The infection is caused by arthropod-transmitted dengue virus which is known to have 5 serotypes (DENV1-5). Most of the cases show mild clinical symptoms; though others may develop severe forms viz; dengue hemorrhagic fever and dengue shock syndrome. Though limited literature suggests the population-specific genetic influence on susceptibility and the clinical course of dengue; the genetic propensity of dengue is largely unknown in most ethnicities. In this context, the human leukocyte antigen (HLA) system represents the most polymorphic region of the human genome and is crucial for the initiation of an appropriate immune response. In most of the genome-wide association studies, the HLA complex is the most significantly linked genetic region with susceptibility or protection towards various infectious and noninfectious diseases. Killer immunoglobulin-like receptors represent another highly variable system present on the surface of natural killer (NK) cells which regulate the activity of NK cells through interactions with their cognate HLA ligands. It is conceivable that the interaction of HLA-Killer immunoglobulin-like receptors systems influences the host susceptibility towards dengue infection as well the disease outcome. Here we attempt to review these parameters in dengue infection and disease outcome. Further detailed investigations are warranted towards the identification of novel susceptibility markers and targeted therapeutic interventions.

Objective: Smart insufflation (SI) techniques relying on valve and membrane-free insufflation are increasing in usage. Although considerable literature exists demonstrating the benefits of SI on procedural ease and patient outcomes, there remains a paucity describing the financial impact of these devices. The purpose of this study was to determine the financial and efficiency impact of these devices on the operating room and inpatient wards of a hospital. Methods: A discrete event simulation model representing a typical mid-sized North American hospital comparing SI to traditional insufflation (TI) was generated. The National Surgical Quality Improvement database from 2015 to 2019 was used to populate the model with data supplemented from the literature. Outcomes included length of stay (LOS), duration of surgery (DOS), annual procedure volume, profit, return on investment (ROI), and gross profit margin (GPM). From the literature review, DOS savings were 10–32 minutes/case, while LOS savings were 0–3 days/case. Results: Implementation of an SI led to an increase in annual throughput of 42–346 (4.4%–36.6%) cases for all procedures and 38 to 297 (4.3%–33.3%) cases for complex procedures. LOS was found to be decreased by 175–614 (18.3%–64.2%) days for all procedures and 231 to 614 (35.6%–77.9%) cases for complex procedures with the implementation of an SI. Together, this resulted in an increase in net profit of $104,685 per annum. The ROI of SI over the TI device was >1000%, and the GPM for the TI was 90.0%, while the GPM for the SI was 71.7%. Conclusion: Despite the initial financial investment being greater, the implementation of SI offsets these expenses and yields significant financial benefits. Our study demonstrates the financial benefits of SI over TI and illustrates how granular operational and financial analyses of technologies are essential to aid in sound healthcare procurement decision making.

Novel Fe–Cr SS alloys were fabricated by alloying with 0, 0.10 and 0.20 wt-% Sn respectively to investigate the effect of the Sn addition on the microstructure, passive characteristics and localized corrosion behavior in chloride medium at room temperature. The advanced scanning micro-electrochemical techniques along with the traditional electrochemical methods were used for in-depth investigations. Potentiodynamic and potentiostatic test results exhibited that the addition of Sn in SS alloys increased the resistance against pitting corrosion in NaCl medium. The acquired dynamic impedance data confirmed the effective electrochemical stability of the alloy SS3 (SS with 0.20 wt-% Sn) at applied anodic potential, suggesting the presence of a compact and stable passive film in Sn containing alloys, which contributed to their improved localized corrosion resistance in chloride solution. The scanning electrochemical microscopic results corroborated that the alloy SS3 remained stable even after 24 h of exposure and displayed no noticeable surface heterogeneity. A reduced anodic current density in scanning vibrative electrode technique mapping images was observed even after 24-h of exposure in alloy SS3 compared to other samples, indicating that the anodic metal dissolution was successfully obstructed by forming a compact and dense passive film on this alloy.

Abstract With the ongoing evolution of the SARS-CoV-2 virus updated vaccines may be needed. We fitted a model linking immunity levels and protection to vaccine effectiveness data from England for three vaccines (Oxford/AstraZeneca AZD1222, Pfizer-BioNTech BNT162b2, Moderna mRNA-1273) and two variants (Delta, Omicron). Our model reproduces the observed sustained protection against hospitalisation and death from the Omicron variant over the first six months following dose 3 with the ancestral vaccines but projects a gradual waning to moderate protection after 1 year. Switching the fourth dose to a variant-matched vaccine against Omicron BA.1/2 is projected to prevent nearly twice as many hospitalisations and deaths over a 1-year period compared to administering the ancestral vaccine. This result is sensitive to the degree to which immunogenicity data can be used to predict vaccine effectiveness and uncertainty regarding the impact that infection-induced immunity (not captured here) may play in modifying future vaccine effectiveness.

Aim: To determine whether horizontal fusional vergences are comparable when measured using a prism bar and synoptophore. Methods: Thirty two participants (18–23 years) had their blur, break, and recovery points measured for convergence and divergence amplitudes using a prism bar (6 m) and synoptophore. All participants had VA of 0.1 LogMAR or better in either eye, were heterophoric or orthophoric and had binocular single vision. The prism bar target was a 0.2 LogMAR letter. The synoptophore target was the foveal ‘rabbit’ fusion slides. The prism bar was placed over the dominant eye and the testing speed was two seconds per two prism dioptres (Δ), increasing to five seconds per 5Δ when the increments began to increase in 5Δ. Synoptophore testing speed was two seconds per degree. Results: The synoptophore measured significantly higher convergence break points than the prism bar (Z = 3.37, p = 0.001). No significant differences were found between both tests for divergence break points (Z = 0.99, p = 0.32). However, both tests displayed wide limits of agreement (LoA) when measuring convergence (–24Δ to + 49.59Δ) and divergence break points (–7.70Δ to + 10.19Δ). Differences when measuring convergence and divergence blur and recovery points were not statistically significant. Conclusion: There was a statistically and clinically significant difference when measuring convergence break points using the prism bar and synoptophore but no significant difference when measuring divergence break points. However, both tests displayed wide LoA when measuring convergence and divergence break points, indicating they should not be used interchangeably in clinic to measure horizontal fusional vergences.

Objective: To explore the perception regarding skin colour and decline in mental health due to an increased obsession with fair complexion among young adults, specifically in Pakistan. Study Design: Exploratory study. Place and Duration of Study: Public and Private Universities of Islamabad/Rawalpindi Pakistan, from Jun to Aug 2022. Methodology: Three independent focus group discussions were carried out with young adults (aged 18-35). Focus group discussions were recorded and transcribed by keeping in mind the ethical consideration. Moreover, two interviews, one with the dermatologist and the other with the beautician, were also conducted to gain more information. The data was gathered and transcribed and then, themes emerged by using Thematic Analysis. Inter-rater reliability of themes was computed by four independent raters which were found to be substantial for focus groups and each interview. Results: The results reveal major themes that emerged from the present study, which influenced young adults' perception regarding skin colour and damaged their mental health. New dimensions were revealed in which both males and females were studied, which had not previously been explored in Pakistan. Conclusion: This study identifies those factors contributing to the deteriorating mental health of a person related to skin colour and mental health professionals. The Young adults of Pakistan are dissatisfied and preoccupied with the notion of perfect skin colour, which leads them to opt for different unhealthy means to beautify themselves and damaging their mental health.

Mild Cognitive Impairment (MCI) is the primary stage of acute Alzheimer's disease, and early detection is crucial for the person and those around him. It is difficult to recognize since this mild stage does not have clear clinical signs, and its symptoms are between normal aging and severe dementia. Here, we propose a tensor decomposition-based scheme for automatically diagnosing MCI using Electroencephalogram (EEG) signals. A new projection is proposed, which preserves the spatial information of the electrodes to construct a data tensor. Then, using parallel factor analysis (PARAFAC) tensor decomposition, the features are extracted, and a support vector machine (SVM) is used to discriminate MCI from normal subjects. The proposed scheme was tested on two different datasets. The results showed that the tensor-based method outperformed conventional methods in diagnosing MCI with an average classification accuracy of 93.96% and 78.65% for the first and second datasets, respectively. Therefore, it seems that maintaining the spatial topology of the signals plays a vital role in the processing of EEG signals.

Laser thermal ablation has become a prominent neurosurgical treatment approach, but in epilepsy patients it cannot currently be safely implemented with intracranial recording electrodes that are used to study interictal or epileptiform activity. There is a pressing need for computational models of laser interstitial thermal therapy (LITT) with and without intracranial electrodes to enhance the efficacy and safety of optical neurotherapies. In this paper, we aimed to build a biophysical bioheat and ray optics model to study the effects of laser heating in the brain, with and without intracranial electrodes in the vicinity of the ablation zone during the LITT procedure. COMSOL Multiphysics finite element method (FEM) solver software was used to create a bioheat thermal model of brain tissue, with and without blood flow incorporation via Penne's model, to model neural tissue response to laser heating. We report that the close placement of intracranial electrodes can increase the maximum temperature of the brain tissue volume as well as impact the necrosis region volume if the electrodes are placed too closely to the laser coupled diffuse fiber tip. The model shows that an electrode displacement of 4 mm could be considered a safe distance of intracranial electrode placement away from the LITT probe treatment area. This work, for the first time, models the impact of intracranially implanted recording electrodes during LITT, which could improve the understanding of the LITT treatment procedure on the brain's neural networks a sufficient safe distance to the implanted intracranial recording electrodes. We recommend modeling safe distances for placing the electrodes with respect to the infrared laser coupled diffuse fiber tip.

Background Nintedanib slows progression of lung function decline in patients with progressive fibrosing (PF) interstitial lung disease (ILD) and was recommended for this indication within the United Kingdom (UK) National Health Service in Scotland in June 2021 and in England, Wales and Northern Ireland in November 2021. To date, there has been no national evaluation of the use of nintedanib for PF-ILD in a real-world setting. Methods 26 UK centres were invited to take part in a national service evaluation between 17 November 2021 and 30 September 2022. Summary data regarding underlying diagnosis, pulmonary function tests, diagnostic criteria, radiological appearance, concurrent immunosuppressive therapy and drug tolerability were collected via electronic survey. Results 24 UK prescribing centres responded to the service evaluation invitation. Between 17 November 2021 and 30 September 2022, 1120 patients received a multidisciplinary team recommendation to commence nintedanib for PF-ILD. The most common underlying diagnoses were hypersensitivity pneumonitis (298 out of 1120, 26.6%), connective tissue disease associated ILD (197 out of 1120, 17.6%), rheumatoid arthritis associated ILD (180 out of 1120, 16.0%), idiopathic nonspecific interstitial pneumonia (125 out of 1120, 11.1%) and unclassifiable ILD (100 out of 1120, 8.9%). Of these, 54.4% (609 out of 1120) were receiving concomitant corticosteroids, 355 (31.7%) out of 1120 were receiving concomitant mycophenolate mofetil and 340 (30.3%) out of 1120 were receiving another immunosuppressive/modulatory therapy. Radiological progression of ILD combined with worsening respiratory symptoms was the most common reason for the diagnosis of PF-ILD. Conclusion We have demonstrated the use of nintedanib for the treatment of PF-ILD across a broad range of underlying conditions. Nintedanib is frequently co-prescribed alongside immunosuppressive and immunomodulatory therapy. The use of nintedanib for the treatment of PF-ILD has demonstrated acceptable tolerability in a real-world setting.

IntroductionPatients with chronic vestibular hypofunction typically suffer from dizziness, imbalance and oscillopsia (blurred vision); symptoms that pose challenges to everyday life. Currently, advice on how to deal with such challenges is mainly provided by health care professionals (i.e., ENT-surgeons, neurologists, physiotherapists and psychologists). However, fellow patients with a similar condition and a true appreciation of the lived experiences, are likely to provide valuable support and advice as well. The purpose of this study, therefore, was to collect tips and advice from patients with chronic vestibular hypofunction.MethodsAn exploratory survey was designed to collect tips from fellow chronic vestibular hypofunction patients on how to cope with disease-related challenges in everyday life. The survey was distributed both online and in person. The list of tips was coded and analyzed thematically and deductively, by using the international classification of functioning, disability, and health (ICF) model.ResultsIn total, 425 tips were obtained from the 179 participants. Most tips were coded under “environmental factors” (46%) and “activities and participation” (39%). The remaining tips were categorized as “body functions” (15%). No tips were about “body structures.” The participants coped with their daily struggles by investing in assistive products and technology, like adapted bikes, special footwear, walking frames. They described the importance of ensuring minimal light intensity for visibility (i.e., installing light sources in dark places). During activities, participants gave the advice to avoid bumpy roads and obstacles, and highlighted the necessity of adequate visual fixation to maintain balance. To ensure optimal activity, participants emphasized the importance of managing energy and taking sufficient rest.DiscussionThis study gives insight into how patients with chronic vestibular hypofunction cope with everyday struggles due to their symptoms. These tips can expand advice given by healthcare professionals. Knowing that fellow patients experience similar struggles and learned to deal with their struggles in adequate ways, might offer support and help patients focus on possibilities rather than on disabilities. Further research should investigate the effect of sharing tips to see whether improvement in (mental) health can be achieved in patients with chronic vestibular hypofunction.

Abstract Background In-office needle arthroscopy (IONA) has been described as a diagnostic alternative to magnetic resonance imaging (MRI) for intra-articular pathology. However, few studies have analyzed its impact on cost and wait times when used as a therapeutic intervention. The purpose of this study was to investigate the impact on cost and wait times associated with offering IONA for partial medial meniscectomy as an alternative to traditional operating room (OR) arthroscopy for patients with irreparable medial meniscus tears on MRI. Methods Two models were created comparing the existing care pathway (current state) to a proposed future state utilizing IONA. Data sources were accounting data from an academically affiliated hospital in Canada and supplemented with literature values. A Monte Carlo simulation combined with DuPont analysis running 10,000 simulations was conducted to calculate the revenue, expenses, profits, and effect on surgical waitlists (i.e., throughput) between the states. Sensitivity analyses examined the influence of patient preference and revision rates on profit and throughput. Two-sample Student’s t test was performed (p

Introduction. Electrical burns are one of the most common causes of burns besides flame burns and scalds. High tension electrical burns lead to greater morbidity and mortality. Active management strategies are required to manage high tension electrical burns. Common epidemiological features and surgical management of wounds are described. Role of high ligation in high tension electrical burns has been described.Purpose. To describe the epidemiology, main features of the presentation and acute management of high tension electrical burns.Materials and methods. This study was done for the duration of 2 months. All patients who were admitted with high tension electrical burns were included in the study. Patients’ demographics, mode of injury, % age of burn areas involved, entry-exit wounds were recorded on the day of admission. Emergency fasciotomy was done in cases of impending gangrenous changes inlimbs to prevent compartment syndrome and peripheral neuropathy. Reconstructive surgeries were done depending on thelocation and depth of burns. Results. 64% patients were below 30 years. The majority of the patients who sustained electric burns were males (82.3%). All the patients were from low and middle socioeconomic status according to the modified kuppuswamy scale. The majority of patients sustained electric contact burns (55.8%). The majority of the patients were unskilled workers working in the fields (94.2%). Surgical treatment of all patients includes fasciotomies in 15 patients, debridement/ amputation in 32 patients, reconstructive surgeries in 42 patients.Conclusion. High tension electrical burns are one of the most common causes of burns, especially in rural areas. Public awareness and compliance with safety standards as well as respect for the potentially deleterious effects of electricity are of utmost essential for avoiding these deadly injuries.

An intuitionistic hesitant fuzzy set is an extension of the fuzzy set which deals with uncertain information and vague environments. Multiple-attribute decision-making problems (MADM) are one of the emerging topics and an aggregation operator plays a vital role in the aggregate of different preferences to a single number. The Aczel-Alsina norm operations are significant terms that handle the impreciseness and undetermined data. In this paper, we build some novel aggregation operators for the different pairs of the intuitionistic hesitant fuzzy sets (IHFSs), namely as Aczel-Alsina average and geometric operators. Several characteristics of the proposed operators are also described in detail. Based on these operators, a multi-attribute decision-making algorithm is stated to solve the decision-making problems. A numerical example has been taken to display and validate the approach. A feasibility and comparative analysis with existing studies are performed to show its superiority.

In this study, hydrothermal co-liquefaction of restaurant waste for biocrude production was conducted. The feedstock was resembled using the organic fraction of restaurant waste and low-density polyethylene, polypropylene, polystyrene, and polyethylene terephthalate, four plastic types commonly present in municipal solid waste. Using design of experiment and a face-centered central composite design, three factors (feedstock plastic fraction, temperature, time) were varied at three levels each: feedstock plastic fraction (0, 0.25, 0.5), temperature (290 °C, 330 °C, 370 °C), and reaction time (0 min, 30 min, 60 min). The literature reports positive synergistic interactions in hydrothermal co-liquefaction of biomass and plastics; however, in this work, only negative synergistic interactions could be observed. A reason could be the high thermal stability of produced fatty acids that give little room for interactions with plastics. At the same time, mass might transfer to other product phases.

The use of agricultural chemicals has adversely affected soil health and the environment. Organic farming practices, particularly vermicompost (VC), are gaining attention for their potential to improve soil fertility and crop productivity. This study investigated VC rate applications on lettuce growth, yield, soil fertility, nutrient dynamics, enzyme activity, biological parameters, and biochemical aspects under greenhouse conditions in Samsun, Turkey during 2022–2023. Experimentally, VC was applied at rates of V1: 1%, V2: 2%, and V3: 4% w/w, with a control group without VC application, V0: 0% w/w. Batavia lettuce, which is sensitive to environmental conditions and nutrient deficiency, was subjected to these treatments in a randomized complete block design, replicated thrice. Results showed consistent improvements in plant dry weight across all VC treatments, with the 2% application rate (V2) yielding the highest increase in lettuce yield (56.43%). Soil pH varied across treatments, with V1 being slightly alkaline and V3 showing high electrical conductivity and increased nitrogen content. Phosphorus content increased in all treatments, while potassium varied, with V3 having the highest values. Soil enzyme activities increased with VC concentrations, with V3 showing the highest urease activity. Pearson correlations confirmed positive associations with growth parameters and soil enzymatic activity. These findings highlight vermicompost as a sustainable solution for lettuce production and soil improvement.

Objective: To determine the depression, suicidal ideation, and future concerns among domestic violence spectators. Study Design: Exploratory study design. Place and Duration of Study: Shelter Homes and Community Centres, in Rawalpindi/Islamabad Pakistan, from Aug to Nov 2022. Methodology: In-depth interviews with 30 participants aged 12 to 17 years were conducted to assess the future apprehensions and worries of domestic violence spectators. Interviews were recorded and transcribed for thematic analysis. Transcribed data were critically reviewed, and themes were identified. Inter-rater reliability was calculated with the help of Cohen Kappa and was found to be in substantial agreement. Results: The study findings identified major themes related to psychological issues and future apprehensions among participants who witnessed domestic violence. Maladaptive relationships with parents and intensification of social problems such as isolation, self-harm, social withdrawal, suicidal ideation, difficulty in making friends, and apprehensions about the future relationship with a partner were also perceived as serious future concerns among domestic violence spectators. Conclusion: Domestic violence takes a toll on the mental and physical well-being of not only its victims but also its spectators. Early detection and prevention of violent exposure are essential to mitigate its long-term psychological impact.

BackgroundVaccines have reduced severe disease and death from Coronavirus Disease 2019 (COVID-19). However, with evidence of waning efficacy coupled with continued evolution of the virus, health programmes need to evaluate the requirement for regular booster doses, considering their impact and cost-effectiveness in the face of ongoing transmission and substantial infection-induced immunity.Methods and findingsWe developed a combined immunological-transmission model parameterised with data on transmissibility, severity, and vaccine effectiveness. We simulated Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) transmission and vaccine rollout in characteristic global settings with different population age-structures, contact patterns, health system capacities, prior transmission, and vaccine uptake. We quantified the impact of future vaccine booster dose strategies with both ancestral and variant-adapted vaccine products, while considering the potential future emergence of new variants with modified transmission, immune escape, and severity properties. We found that regular boosting of the oldest age group (75+) is an efficient strategy, although large numbers of hospitalisations and deaths could be averted by extending vaccination to younger age groups. In countries with low vaccine coverage and high infection-derived immunity, boosting older at-risk groups was more effective than continuing primary vaccination into younger ages in our model. Our study is limited by uncertainty in key parameters, including the long-term durability of vaccine and infection-induced immunity as well as uncertainty in the future evolution of the virus.ConclusionsOur modelling suggests that regular boosting of the high-risk population remains an important tool to reduce morbidity and mortality from current and future SARS-CoV-2 variants. Our results suggest that focusing vaccination in the highest-risk cohorts will be the most efficient (and hence cost-effective) strategy to reduce morbidity and mortality.

ObjectiveMost of the work in terms of liquid biopsies in patients with solid tumors is focused on circulating tumor DNA (ctDNA). Our aim was to evaluate the feasibility of using circulating tumor cells (CTCs) in peripheral blood samples from patients with advanced or metastatic gastrointestinal (GI) cancers.MethodsIn this prospective study, blood samples were collected from each patient in 2 AccuCyte® blood collection tubes and each tube underwent CTC analysis performed utilizing the RareCyte® platform. The results from both tubes were averaged and a total of 150 draws were done, with 281 unique reported results. The cadence of sampling was based on convenience sampling and piggybacked onto days of actual clinical follow-ups and treatment visits. The CTC results were correlated with patient- and tumor-related variables.ResultsData from a total of 59 unique patients were included in this study. Patients had a median age of 58 years, with males representing 69% of the study population. More than 57% had received treatment prior to taking blood samples. The type of GI malignancy varied, with more than half the patients having colorectal cancer (CRC, 54%) followed by esophageal/gastric cancer (17%). The least common cancer was cholangiocarcinoma (9%). The greatest number of CTCs were found in patients with colorectal cancer (Mean: 15.8 per 7.5 ml; Median: 7.5 per 7.5 ml). In comparison, patients with pancreatic cancer (PC) had considerably fewer CTCs (Mean: 4.2 per 7.5 ml; Median: 3 per 7.5 ml). Additionally, we found that patients receiving treatment had significantly fewer CTCs than patients who were not receiving treatment (Median 2.7 versus 0.7). CTC numbers showed noteworthy disparities between patients with responding/stable disease in comparison to those with untreated/progressive disease (Median of 2.7 versus 0). When CTCs were present, biomarker analyses of the four markers human epidermal growth factor receptor 2 (HER2)/programmed death-ligand 1 (PD-L1)/Kiel 67 (Ki-67)/epidermal growth factor receptor (EGFR) was feasible. Single cell sequencing confirmed the tumor of origin.ConclusionOur study is one of the first prospective real-time studies evaluating CTCs in patients with GI malignancies. While ctDNA-based analyses are more common in clinical trials and practice, CTC analysis provides complementary information from a liquid biopsy perspective that is of value and worthy of continued research.

Background Postoperative atrial fibrillation (POAF) is the most frequent complication of cardiac surgery. Despite clinical and economic implications, ample variability in POAF assessment method and definition exist across studies. We performed a study‐level meta‐analysis to evaluate the influence of POAF assessment method and definition on its incidence and association with clinical outcomes. Methods and Results A systematic literature search was conducted to identify studies comparing the outcomes of patients with and without POAF after cardiac surgery that also reported POAF assessment method. The primary outcome was POAF incidence. The secondary outcomes were in‐hospital mortality, stroke, intensive care unit length of stay, and postoperative length of stay. Fifty‐nine studies totaling 197 774 patients were included. POAF cumulative incidence was 26% (range: 7.3%–53.1%). There were no differences in POAF incidence among assessment methods (27%, [range: 7.3%–53.1%] for continuous telemetry, 27% [range: 7.9%–50%] for telemetry plus daily ECG, and 19% [range: 7.8%–42.4%] for daily ECG only; P>0.05 for all comparisons). No differences in in‐hospital mortality, stroke, intensive care unit length of stay, and postoperative length of stay were found between assessment methods. No differences in POAF incidence or any other outcomes were found between POAF definitions. Continuous telemetry and telemetry plus daily ECG were associated with higher POAF incidence compared with daily ECG in studies including only patients undergoing isolated coronary artery bypass grafting. Conclusions POAF incidence after cardiac surgery remains high, and detection rates are variable among studies. POAF incidence and its association with adverse outcomes are not influenced by the assessment method and definition used, except in patients undergoing isolated coronary artery bypass grafting.

The effect of specimen width and incorporation of a circular hole on the tensile behaviour of commercially available aluminium alloy AA 1100 was studied using finite element analysis (FEA) for convergence with the already published experimental work of other researchers. Static structural analysis was conducted to simulate tensile loading of Japanese industrial standard (JIS) specimen JIS Z 2201 No. 13B and No. 5 until the point of the ultimate tensile strength (UTS) was reached. A strain rate of 0.25 mm/s was used for both the neat specimen and the one bearing a circular hole of 8 mm in diameter at the centre of the specimen. The numerical results exhibited a good agreement with the experimental work by comparison of the percentage elongation for numerical and experimental data. The normal stresses calculated using analytical and numerical approaches also reflected a good convergence. For neat specimens of JIS Z 2201 No. 13B and No. 5, a 100 % increase in specimen width enhanced the load required to reach UTS by 100 %, while elongation was increased by 30 %. On the other hand, for specimens of JIS Z 2201 No. 13B and No. 5, bearing an 8 mm circular hole reduced the load required to reach UTS by 300 %, while elongation was only increased by 25 %. The 200 % decrease in load required to reach UTS and 57 % reduction in elongation was observed by incorporating an 8 mm circular hole in the neat specimens.

The dominance-based rough set approach is crucial to the advancement of rough set theory. It gives a more thorough and adaptable framework for knowledge acquisition, information analysis, and DM. It is a means of expressing discrepancies resulting from the examination of the domains with specified preference rankings of the characteristics. This work seeks to extend the Rough set approach utilizing dominance relationships to a Pythagorean fuzzy setting. The lower and upper approximations of Pythagorean fuzzy dominance-based rough set are determined by using the constructive technique. Next, we examine the basic characteristics for the rough estimations relying on the Pythagorean fuzzy dominance. By combining Approximate Distribution Reductions with a Pythagorean fuzzy dominance-based rough set, reductions are prescribed in four distinct manners. Additionally, the discernibility matrices and theorems connected to these reductions are produced. Such findings are all Pythagorean fuzzy generalizations or extensions of the conventional rough set method relying on dominance. Finally, the conceptual ideas are supported with a numerical example.

Although the concepts of imprecision are captured by both rough sets and intuitionistic fuzzy sets, investigations combining these two ideas and their applications in incompletely ordered information systems are scarce. The semantics of many kinds of missing information still lacks consensus on a global level. Rule extraction is also an important task in a sort of decision system in which condition attributes are treated as intuitionistic fuzzy values and decision attributes are crisp ones. The main goal of this paper is to address semantic issues related to incomplete information. This paper contributes to the following aspects: First, four types of incomplete information are classified (i.e., “do-not-care value”, “partially-known value”, “class-specific value” and “non-applicable value”), and then a complete information system is introduced using novel semantics, followed by a ranking approach to create each object’s neighborhood using intuitionistic fuzzy values for condition attributes. Further, a dominance-based intuitionistic fuzzy decision table is proposed. Second, the lower and upper approximation sets of an object and crisp classes validated by decision attributes are determined by comparing their relationships. Third, the rule extraction approach is developed using the discernibility matrix and discernibility function to collect knowledge from existing dominance intuitionistic fuzzy decision tables. Finally, the provided approach is used for the estimation of inflation rates in LDCs with inadequate data.

The paper describes the corrosion based degradation of aluminium alloys using an analytical and numerical framework. The corrosion rate was calculated using analytical equations for aluminium sheets subjected to a corrodent. Parametric analysis for the pit morphology, diameter, depth and distribution on the plate was conducted using finite element analysis. A comparison between elliptical and circular pits of the same area was also made for stress magnification using numerical analysis. It was observed that the stress generated at constant load when a specimen corrodes due to pitting is directly proportional to the pit diameter and pit depth. Zigzag pit morphologies due to the combined effect of mechanical degradation and corrosion have the highest stress at the corners of the pattern, while circular pits have the highest stress at the centre of the pit. The zigzag pit morphology has more detrimental effects than circular pits. For multiple distributed pits, the pits closer to the specimen edges exhibit higher stress values than those near the centre of the specimen. The effect of multiple or quantitatively increased number of pits having smaller geometric properties has a more detrimental effect than a single pit with larger geometric attributes.

Dog bites injuries are a significant cause of morbidity and mortality. Conventionally, it was suggested to leave the wounds open due to probable increased risk of infections and occurrence of rabies with suturing.Recent publications indicate that primary closure does not necessarily affect the chances of infection but definitely helps in improving the quality of scar. We are presenting our experience and protocol for primary closure of all dog bite wounds. From March 2020 to February 2021, 10 consecutive patients of all ages coming to the emergency of our hospital with category 3 dog bite that penetrated the epidermis and dermis and presenting within 48 hours of injury were included. Every patient was administered first dose of anti rabies vaccine (ARV) (zero dose) for active immunisation and was also given injection tetanus intramuscularly. Mean age of patients in our study was 20.9 with range from 2 years to 90 years. Only 2/10 patients developed infections which were managed conservatively with drainage of abscess and antibiotics. Rest all patients recovered without complications. Primary closure of dog bite wounds when associated with debridement, sufficient irrigation, povidine iodine cleansing and antibiotic administration resulted in improved cosmetic appearance without increase in the rate of infection.

In the present study, clover-grass press cake was treated by liquid hot water at temperatures of 180–200 °C for a reaction time of 5–10 min. Evaluation of pretreatments was based on the monosaccharide yield after enzymatic hydrolysis of the pretreated slurry and solid fraction, respectively. Extraction of up to 48% hemicellulose and 4% cellulose was observed during pretreatment. The optimal pretreatment conditions were identified as 190 °C and 10 min resulting in monosaccharide yields of 90% and 73% of the theoretical maximum by slurry and solid conversion, respectively. At optimal conditions, the C6 monosaccharide yield (83–90%) was fairly equal compared to the C5 monosaccharide yield (56–89%), which increased by slurry conversion due to near-complete monomerization of soluble xylo-oligosaccharides. In this study, we showed that clover-grass press cake possesses considerable potential as feedstock for production of fermentable sugars in a biorefinery context.

This research paper has used a three-dimensional approach that combines Finite Element Analysis, the famous three-factor Design of Experiments by Taguchi, with the third dimension. An idea to optimize a Lithium (Li) and Lead (Pb) based Toroid is presented as they are known hazardous materials. The approach emphasized generating different run orders by a parametric variation of outer diameter, thickness, and base metal on the minimum and maximum specifications. Based on the Design of Experiments, the calculated run orders were modelled and simulated under the specified loading conditions to select the best combination of parameters. The analytical stresses generated in the combinations were compared with the numerical counterparts for model validation. On-Mises stress and deformation results from the simulation were analyzed to select the optimized design of Toroid structure and the final shape was modelled accordingly. The analytical and numerical stresses also showed good agreement with each other, supporting the validity of the presented approach. The method effectively models such specimens before fabrication, so that all material and geometric aspects can be finalized before risking physical contact with the actual worker.

Pediatric chronic myeloid leukemia (CML) is rare and has a worse prognosis compared to adult CML. Median age of diagnosis in pediatric age group is 14 years with most cases occurring in children above 12 years of age in India. We report a case of a 22-month-old female child who presented with fever and reduced appetite of 15-day duration and was diagnosed as a case of CML. The patient was started on imatinib. However, she presented with blast crisis at 8 months of initiation of therapy. She was started on second-generation tyrosine kinase inhibitors with normalization of blood counts within 3 weeks of initiation of therapy. An exhaustive literature search has shown that this is the youngest patient to present with CML.

Abstract Highly pathogenic avian influenza (HPAI) viruses of the A/Goose/Guangdong/1/1996 lineage (GsGd), which threaten the health of poultry, wildlife and humans, are spreading across Asia, Europe, Africa and North America but are currently absent from South America and Oceania. In December 2021, H5N1 HPAI viruses were detected in poultry and a free-living gull in St. John’s, Newfoundland and Labrador, Canada. Our phylogenetic analysis showed that these viruses were most closely related to HPAI GsGd viruses circulating in northwestern Europe in spring 2021. Our analysis of wild bird migration suggested that these viruses may have been carried across the Atlantic via Iceland, Greenland/Arctic or pelagic routes. The here documented incursion of HPAI GsGd viruses into North America raises concern for further virus spread across the Americas by wild bird migration.