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Background Traumatic brain injuries (TBI) are a significant cause of mortality and morbidity for children globally. Adherence to evidence-based treatment guidelines have been shown to improve TBI outcomes. To inform the creation of a pediatric TBI management guideline for a low and middle income country context, we assessed the quality of available clinical practice guidelines (CPGs) for the acute management pediatric TBI. Methods Articles were identified and retrieved from MEDLINE, EMBASE, Cochrane Library, LILACS, Africa-Wide Information and Global Index Medicus. These articles were screened by four reviewers independently. Based on the eligibility criteria, with the exception of literature reviews, opinion papers and editor’s letters, articles published from 1995 to November 11, 2016 which covered clinical recommendations, clinical practice or treatment guidelines for the acute management of pediatric TBI (within 24 hours) were included for review. A reference and citation analysis was performed. Seven independent reviewers from low, middle and high income clinical settings with knowledge of pediatric TBI management appraised the guidelines using the AGREE II instrument. Scores for the CPGs were aggregated by domain and overall assessment was determined. Results We screened 2372 articles of which 17 were retained for data extraction and guideline appraisal. Except for one CPG from a middle income country, the majority (16/17) of the guidelines were developed in high income countries. Seven guidelines were developed specifically for the pediatric population, while the remaining CPGs addressed the acute management of TBI in both adult and pediatric populations. The New Zealand Guideline Group (NZGG, 2006) received the highest overall assessment score of 46/49 (93.88%) followed by the Scandinavian Neurotrauma Committee (SNC, 2016) with a score of 45/49 (91.84%) followed by the Scottish Intercollegiate Guideline Network (SIGN, 2009) and Brain Trauma Foundation (BTF 2012) both with scores of 44/49 (89.80%). CPGs from Cincinnati Children’s Hospital (CCH 2006) and Sao Paulo Medical School Hospital/Brazilian Society of Neurosurgery (USP/BSN, 2001) received the lowest score of 27/49 (55.10%) subsequently followed by the Appropriateness Criteria (ACR, 2015) with 29/49 (59.18%). The domains for scope and purpose and clarity of presentation received the highest scores across the CPGs, while applicability and editorial independence domains had the lowest scores with a wider variability in score range for rigor of development and stakeholder involvement. Conclusions To our knowledge, this is the first systematic review and guideline appraisal for pediatric CPGs concerning the acute management of TBI. Targeted guideline creation specific to the pediatric population has the potential to improve the quality of acute TBI CPGs. Furthermore, it is crucial to address the applicability of a guideline to translate the CPG from a published manuscript into clinically relevant local practice tools and for resource limited practice settings.

Background Decision impact studies have become increasingly prevalent in genomic medicine, particularly in cancer research. Such studies are designed to provide evidence of clinical utility for genomic tests by evaluating their impact on clinical decision-making. This paper offers insights into understanding of the origins and intentions of these studies through an analysis of the actors and institutions responsible for the production of this new type of evidence. Methods We conducted bibliometric and funding analyses of decision impact studies in genomic medicine research. We searched databases from inception to June 2022. The datasets used were primarily from Web of Science. Biblioshiny, additional R-based applications, and Microsoft Excel were used for publication, co-authorship and co-word analyses. Results 163 publications were included for the bibliometric analysis; a subset of 125 studies were included for the funding analysis. Included publications started in 2010 and increased steadily over time. Decision impact studies were primarily produced for proprietary genomic assays for use in cancer care. The author and affiliate analyses reveal that these studies were produced by ‘invisible colleges’ of researchers and industry actors with collaborations focused on producing evidence for proprietary assays. Most authors had an industry affiliation, and the majority of studies were funded by industry. While studies were conducted in 22 countries, the majority had at least one author from the USA. Discussion This study is a critical step in understanding the role of industry in the production of new types of research. Based on the data collected, we conclude that decision impact studies are industry-conceived and -produced evidence. The findings of this study demonstrate the depth of industry involvement and highlight a need for further research into the use of these studies in decision-making for coverage and reimbursement.

Funder: Evans Fund, Department of Social Anthropology, University of Cambridge, Raw material analyses of prehistoric stone tool assemblages can reveal insight into mobility and exchange patterns in hunter-gatherer populations by reconstructing the circulation of stone throughout ancient landscapes. In Pleistocene Southeast Asia, stone tools are generally thought to have been fashioned from easily accessible local raw materials. However, despite the consistent presence of stone tools made of igneous raw material at prehistoric sites throughout the Tràng An Landscape Complex in northern Vietnam, there are no sources of igneous raw material in the immediate vicinity. This paper presents the results of geochemical sourcing analysis of late Pleistocene igneous stone tools from Tràng An: the first analysis of its type in mainland Southeast Asia. The results shed light on mobility and raw material provisioning strategies in Pleistocene mainland Southeast Asian hunter-gatherer populations and raise questions surrounding the relationship between technological organization, raw material, and expediency in Southeast Asian stone tool assemblages.

Under the background of high-energy penetration of new energy into the power grid, this paper takes the ancillary service capability of photovoltaic energy integrated into the grid as the starting point and builds a photovoltaic system reactive power service impact evaluation model on the grid energy efficiency. This is based on the multi-temporal and spatial scale operation mode, in order to study the supporting principles of photovoltaic system reactive power services on the energy efficiency of grid operation and the law of influence on system energy efficiency changes. In this way, the space for power system energy efficiency improvement and the reactive power service market value of renewable energy are explored to improve the renewable energy auxiliary services participation in the theoretical system of electric power spot market transactions. The research conclusions can provide a decision-making reference for system dynamic energy efficiency management and can assist relevant market entities to make optimal decisions in spot market transactions, and provide empirical data for improving the theory of renewable energy participation in auxiliary service market transactions.

The control system designing of Unmanned Wave Glider (UWG) is challenging since the control system is weak maneuvering, large time-lag and large disturbance, which is difficult to establish accurate mathematical model. Meanwhile, to complete marine environment monitoring in long time scale and large spatial scale autonomously, UWG asks high requirements of intelligence and reliability. This paper focuses on the “Ocean Rambler” UWG. First, the intelligent control system architecture is designed based on the cerebrum basic function combination zone theory and hierarchic control method. The hardware and software designing of the embedded motion control system are mainly discussed. A motion control system based on rational behavior model of four layers is proposed. Then, combining with the line-of sight method(LOS), a self-adapting PID guidance law is proposed to compensate the steady state error in path following of UWG caused by marine environment disturbance especially current. Based on S-surface control method, an improved S-surface heading controller is proposed to solve the heading control problem of the weak maneuvering carrier under large disturbance. Finally, the simulation experiments were carried out and the UWG completed autonomous path following and marine environment monitoring in sea trials. The simulation experiments and sea trial results prove that the proposed intelligent control system, guidance law, controller have favorable control performance, and the feasibility and reliability of the designed intelligent control system of UWG are verified.

The 3D High Efficiency Video Coding (3D-HEVC) standard aims to code 3D videos that usually contain multi-view texture videos and its corresponding depth information. It inherits the same quadtree prediction structure of HEVC to code both texture videos and depth maps. Each coding unit (CU) allows recursively splitting into four equal sub-CUs. At each CU depth level, it enables 10 types of inter modes and 35 types of intra modes in inter frames. Furthermore, the inter-view prediction tools are applied to each view in the test model of 3D-HEVC (HTM), which uses variable size disparity-compensated prediction to exploit inter-view correlation within neighbor views. It also exploits redundancies between a texture video and its associated depth using inter-component coding tools. These achieve the highest coding efficiency to code 3D videos but require a very high computational complexity. In this paper, we propose a context-adaptive based fast CU processing algorithm to jointly optimize the most complex components of HTM including CU depth level decision, mode decision, motion estimation (ME) and disparity estimation (DE) processes. It is based on the hypothesis that the optimal CU depth level, prediction mode and motion vector of a CU are correlated with those from spatiotemporal, inter-view and inter-component neighboring CUs. We analyze the video content based on coding information from neighboring CUs and early predict each CU into one of five categories i.e., DE-omitted CU, ME-DE-omitted CU, SPLIT CU, Non-SPLIT CU and normal CU, and then each type of CU adaptively adopts different processing strategies. Experimental results show that the proposed algorithm saves 70% encoder runtime on average with only a 0.1% BD-rate increase on coded views and 0.8% BD-rate increase on synthesized views. Our algorithm outperforms the state-of-the-art algorithms in terms of coding time saving or with better RD performance.

BackgroundIn 2016, Kenya conducted a study of missed opportunities for vaccination (MOV)-when eligible children have contact with the health system but are not fully vaccinated-to explore some of the reasons for persistent low vaccination coverage. This paper details the qualitative findings from that assessment.MethodsUsing the World Health Organization MOV methodology, teams conducted focus group discussions among caregivers and health workers and in-depth interviews of key informants in 10 counties in Kenya. Caregivers of children ResultsSix focus group discussions with caregivers, eight focus group discussions with health workers, and 35 in-depth interviews with key informants were completed. In general, caregivers had positive attitudes toward healthcare and vaccination services, but expressed a desire for increased education surrounding vaccination. In order to standardize vaccination checks at all health facility visits, health workers and key informants emphasized the need for additional trainings for all staff members on immunization. Health workers and key informants also highlighted the negative impact of significant understaffing in health facilities, and the persistent challenge of stock-outs of vaccines and vaccination-related supplies.ConclusionsIdentified factors that could contribute to MOV include a lack of knowledge surrounding vaccination among caregivers and health workers, inadequate number of health workers, and stock-outs of vaccines or vaccination-related materials. In addition, vaccination checks outside of vaccination visits lacked consistency, leading to MOV in non-vaccinating departments. Qualitative assessments could provide a starting point for understanding and developing interventions to address MOV in other countries.

With the development of recent years, the field of deep learning has made great progress. Compared with the traditional machine learning algorithm, deep learning can better find the rules in the data and achieve better fitting effect. In this paper, we propose a hybrid stock forecasting model based on Feature Selection, Convolutional Neural Network and Bidirectional Gated Recurrent Unit (FS-CNN-BGRU). Feature Selection (FS) can select the data with better performance for the results as the input data after data normalization. Convolutional Neural Network (CNN) is responsible for feature extraction. It can extract the local features of the data, pay attention to more local information, and reduce the amount of calculation. The Bidirectional Gated Recurrent Unit (BGRU) can process the data with time series, so that it can have better performance for the data with time series attributes. In the experiment, we used single CNN, LSTM and GRU models and mixed models CNN-LSTM, CNN-GRU and FS-CNN-BGRU (the model used in this manuscript). The results show that the performance of the hybrid model (FS-CNN-BGRU) is better than other single models, which has a certain reference value.

Icy bridge deck in winter has tremendous consequences for expressway traffic safety, which is closely related to the bridge pavement temperature. In this paper, the critical meteorological conditions of icy bridge deck were predicted by multiple linear regression and BP neural network respectively. Firstly, the main parameters affecting the bridge pavement temperature were determined by Pearson partial correlation analysis based on the three-year winter meteorological data of the traffic meteorological monitoring station on the bridge in Shandong province. Secondly, the bridge pavement temperature is selected as the dependent variable, while air temperature, wind speed, relative humidity, dew point temperature, wet bulb temperature and wind cold temperature were selected as independent variables, and the bridge pavement temperature prediction models of linear regression and 5-layer hidden layer classical BP neural network regression were established respectively based on whether the variables are linear or not. Finally, the prediction accuracy of the above models was compared by using the measured data. The results show that the linear regression model could be established only with air temperature, relative humidity and wind speed, owing to collinearity problem. Compared with multiple linear regression model, the predicted value of the BP neural network has a higher degree of fitting with the measured data, and the coefficient of determination reaches 0.7929. Using multiple linear regression and BP neural network, the critical meteorological conditions of bridge deck icing in winter can be effectively predicted even when the sample size is insufficient.

Context Candida-related infections are nowadays a serious Public Health Problem emerging multidrug-resistant strains. Candida biofilm also leads bloodstream infections to invasive systemic infections. Objective The present meta-analysis aimed to analyze Candida biofilm rate, type, and antifungal resistance among hospitalized patients between 1995 and 2020. Data sources Web of Science, Scopus, PubMed, and Google Scholar databases were searched for English papers using the following medical subject heading terms (MESH): “invasive candidiasis”; “bloodstream infections”; “biofilm formation”; “biofilm-related infections”; “mortality”; and “prevalence”. Study selection The major inclusion criteria included reporting the rate of biofilm formation and the prevalence of biofilm-related to Candida species, including observational studies (more exactly, cohort, retrospective, and case-control studies). Furthermore, data regarding the mortality rate, the geographical location of the study set, and the use of anti-fungal agents in clinical isolates were also extracted from the studies. Data extraction Independent extraction of articles by 2 authors using predefined data fields, including study quality indicators. Data synthesis A total of 31 studies from publicly available databases met our inclusion criteria. The biofilm formation in the data set varied greatly from 16 to 100% in blood samples. Most of the studies belonged to Europe (17/31) and Asia (9/31). Forest plot showed a pooled rate of biofilm formation of 80.0% (CI: 67–90), with high heterogeneity (Q = 2567.45, I2 = 98.83, τ2 = 0.150) in random effects model (p < 0.001). The funnel plot and Egger’s linear regression test failed to find publication bias (p = 0.896). The mortality rate in Candida-related bloodstream infections was 37.9% of which 70.0% were from biofilm-associated infections. Furthermore, Candida isolates were also characterized in low, intermediate, or high biofilm formers through their level of biofilm mass (crystal violet staining or XTT assays) after a 24h growth. When comparing between countries, statistical differences were obtained (p = 0.0074), showing the lower and higher biofilm prevalence values in Italy and Spain, respectively. The prevalence of low, intermediate, and high biofilms were 36.2, 18.9, and 35.0% (p < 0.0001), respectively. C. tropicalis was the prevalent species in high biofilm formation (67.5%) showing statistically significant differences when compared to other Candida species, except for C. krusei and C. glabrata. Finally, the rates of antifungal resistance to fluconazole, voriconazole, and caspofungin related to biofilm were 70.5, 67.9 and 72.8% (p < 0.001), respectively. Conclusions Early detection of biofilms and a better characterization of Candida spp. bloodstream infections should be considered, which eventually will help preserve public health resources and ultimately diminish mortality among patients.

This paper explores the potential of combining different isotope systems from different tissues to improve resolution when reconstructing breastfeeding and weaning practices (BWP) in archaeology. Additionally, we tested whether changes in diet can be detected in deciduous teeth. Rib collagen samples from 22 infants/children from the archaeological site of Bacuranao I (Mayabeque, Cuba) were processed for nitrogen (δ15N) and carbon (δ13Cco) stable isotopes and assessed using a Bayesian model (WARN). In addition, enamel of 48 teeth from 30 infants/children were analyzed for oxygen (δ18Oen) and carbon (δ13Cen) stable isotopes. Data revealed that the timing of weaning cannot be characterized precisely by analyzing either δ18O or δ15N. While a depletion in both δ15N and δ13Cco is only evident after one year, the WARN model suggested that the weaning process started at around 3 months and ended around 1.7 years. Most teeth were enriched in δ18Oen compared to deciduous incisors, suggesting a breastfeeding signal. However, a high variability in δ18O was found between similar teeth from the same individuals. Higher enrichment in δ18Oen, and variability, was observed in tissues formed during the first six months of life. A δ13C enrichment of 1.0‰ was observed among deciduous teeth and ribs. While most individuals enriched in δ15N showed enrichment in δ13C, the δ18O values were more variable. Our data suggests that stable isotopes of deciduous teeth, especially δ13Cen, can be used to detect changes in diet during the weaning process. It is also possible that the δ18O enrichment observed in M1 is influenced by the effects of cooking techniques on weaning foods. The combination of multiple isotope systems and tissues overcome some of the limitations posed by single tissue approaches.

Complex IT outsourcing relationships aptitude several benefits such as increased cost likelihood and lowered costs, higher scalability and flexibility upon demand. However, by virtue of its complexity, the complex outsourcing typically necessitates the interactions among various stakeholders from diverse regions and cultures, making it significantly more challenging to manage than traditional outsourcing. Furthermore, when compared to other types of outsourcing, complex outsourcing is extremely difficult because it necessitates a variety of control and coordination mechanisms for project management, which proportionally increases the risk of project failure. In order to overcome the failure of projects in complex outsourcing relationships, there is a need of robust systematic research to identify the key challenges and practices in this area. Therefore, this research implements systematic literature review as a research method and works as a pioneer attempt to accomplish the aforementioned objectives. Upon furnishing the SLR results, the authors identified 11 major challenges with 67 practices in hand from a total of 85 papers. Based on these findings, the authors intend to construct a comprehensive framework in the future by incorporating robust methodologies such as AHP and fuzzy logic, among others. Qatar National Library and Qatar University - grant No. IRCC- 2021-010.

Vehicle-tree collisions are the most common type of road crash with fixed obstacle in Czech Republic. Based on the literature review and using real world in-depth crash data, this paper aims to define factors, which significantly influence the injury severity of single vehicle-tree crashes. In-depth data provide a comprehensive view to the failure on the system infrastructure—human—vehicle related to crash, the in-depth crash database include very detailed information related to infrastructure, vehicle, human failure and crash participants characteristics and their medical condition and also crash reconstruction. Multinomial logistic regression and generalized linear mixed model were used to determine the individual effect of each predictor. The statistically significant variables were the day period, trunk diameter and impact speed. Using multinomial logistic regression shows also vehicle age as statistically significant. Obtained results can help to efficiently direct countermeasures not only on the road infrastructure—e.g. speed reduction in selected locations with specified tree character. However, the emphasis should be also focused on driver behaviour.

Men are underrepresented in family planning (FP) research, and despite the widespread promotion of FP through mass media, there is no systematic evaluation on how mass media exposure influences their FP knowledge, attitudes and behavior. Using Demographic and Health Survey (DHS) data from 31 countries in Sub-Saharan Africa (SSA), collected between 2010 and 2019, this paper examines the associations between three types of traditional mass media (radio, television and print) with FP knowledge, attitudes and method choices among reproductive age men in SSA, relative to other socio-cultural factors. Estimates to quantify the relative contribution of each type of mass media, relative to other evidence-based socio-cultural influences on FP outcomes, were derived using the Shorrocks-Shapley decomposition. Radio exposure had the largest impact on FP knowledge, attitudes and method choice, accounting for 26.1% of the variance in FP knowledge, followed by Television (21.4%) and education attainment (20.7%). Mass media exposure had relatively minimal impact on FP method choice, and between the three types of mass media, television (8%) had the largest influence on FP method choice. Print media had comparatively lesser impact on FP knowledge (8%), attitudes (6.2%) and method choice (3.2%). Findings suggest that mass media exposure has positive influences on FP knowledge, attitudes and method choice but its influence on FP knowledge, attitudes and method choice is smaller relative to other socio-cultural factors such as education, household wealth and marital status. As such, efforts to increase FP uptake in Sub-Saharan Africa should take into consideration the impact of these socio-cultural economic factors.

The recognition and classification of White Blood Cell (WBC) play a remarkable role in blood-related diseases (i.e., leukemia, infections) diagnosis. For the highly similar morphology of different WBC subtypes, it is too confused to classify the WBC effectively and accurately for visual observation of blood cell smears. This paper proposes a Deep Convolutional Neural Network (DCNN) with feature fusion strategies, named WBC-AMNet, for automatically classifying WBC subtypes based on focalized attention mechanism. To obtain more localized attention of CNN, the fusion features of the first and the last convolutional layer are extracted by focalized attention mechanism combining Squeeze-and-Excitation (SE) and Gather-Excite (GE) modules. The new method performs successfully in classifying monocytes, neutrophils, lymphocytes, and eosinophils on the complex background with an overall accuracy of 95.66%, better than that of general CNNs. The multi-classification accuracy of WBC-AMNet with the background segmentation is over 98% in all cases. In addition, Gradient-weighted Class Activation Mapping (Grad-CAM) is employed to visualize the attention heatmaps of different feature maps.

Background As the world’s largest coal producer, China was accounted for about 46% of global coal production. Among present coal mining risks, methane gas (called gas in this paper) explosion or ignition in an underground mine remains ever-present. Although many techniques have been used, gas accidents associated with the complex elements of underground gassy mines need more robust monitoring or warning systems to identify risks. This paper aimed to determine which single method between the PCA and Entropy methods better establishes a responsive weighted indexing measurement to improve coal mining safety. Methods Qualitative and quantitative mixed research methodologies were adopted for this research, including analysis of two case studies, correlation analysis, and comparative analysis. The literature reviewed the most-used multi-criteria decision making (MCDM) methods, including subjective methods and objective methods. The advantages and disadvantages of each MCDM method were briefly discussed. One more round literature review was conducted to search publications between 2017 and 2019 in CNKI. Followed two case studies, correlation analysis and comparative analysis were then conducted. Research ethics was approved by the Shanxi Coking Coal Group Research Committee. Results The literature searched a total of 25,831publications and found that the PCA method was the predominant method adopted, and the Entropy method was the second most widely adopted method. Two weighting methods were compared using two case studies. For the comparative analysis of Case Study 1, the PCA method appeared to be more responsive than the Entropy. For Case Study 2, the Entropy method is more responsive than the PCA. As a result, both methods were adopted for different cases in the case study mine and finally deployed for user acceptance testing on 5 November 2020. Conclusions The findings and suggestions were provided as further scopes for further research. This research indicated that no single method could be adopted as the better option for establishing indexing measurement in all cases. The practical implication suggests that comparative analysis should always be conducted on each case and determine the appropriate weighting method to the relevant case. This research recommended that the PCA method was a dimension reduction technique that could be handy for identifying the critical variables or factors and effectively used in hazard, risk, and emergency assessment. The PCA method might also be well-applied for developing predicting and forecasting systems as it was sensitive to outliers. The Entropy method might be suitable for all the cases requiring the MCDM. There is also a need to conduct further research to probe the causal reasons why the PCA and Entropy methods were applied to each case and not the other way round. This research found that the Entropy method provides higher accuracy than the PCA method. This research also found that the Entropy method demonstrated to assess the weights of the higher dimension dataset was higher sensitivity than the lower dimensions. Finally, the comprehensive analysis indicates a need to explore a more responsive method for establishing a weighted indexing measurement for warning applications in hazard, risk, and emergency assessments.

Emotions at work have long been identified as critical signals of work motivations, status, and attitudes, and as predictors of various work-related outcomes. When more and more employees work remotely, these emotional signals of workers become harder to observe through daily, face-to-face communications. The use of online platforms to communicate and collaborate at work provides an alternative channel to monitor the emotions of workers. This paper studies how emojis, as non-verbal cues in online communications, can be used for such purposes and how the emotional signals in emoji usage can be used to predict future behavior of workers. In particular, we present how the developers on GitHub use emojis in their work-related activities. We show that developers have diverse patterns of emoji usage, which can be related to their working status including activity levels, types of work, types of communications, time management, and other behavioral patterns. Developers who use emojis in their posts are significantly less likely to dropout from the online work platform. Surprisingly, solely using emoji usage as features, standard machine learning models can predict future dropouts of developers at a satisfactory accuracy. Features related to the general use and the emotions of emojis appear to be important factors, while they do not rule out paths through other purposes of emoji use.

The combination of blockchain and the sports industry is bound to be a trend in terms of innovation and the development of sports industry in the near future. Therefore, after analyzing the problems existing in the current business model of the sports industry, this paper takes 200 innovation indicators of 50 listed companies in the sports industry, among which 15 use blockchain and 35 do not use, as research samples and uses a three-stage DEA model to calculate their innovation efficiency. The results show that sports companies that use blockchain have better performance in terms of innovation efficiency than do those that do not, which illustrates the necessity of blockchain-based business model innovation. Then, by focusing on the internal structure and the case of the "vSport blockchain", this work shows that this business model innovation is feasible. The article first proposes a blockchain-based sports industry business model and then uses a combination of empirical and case studies to prove the necessity and feasibility of sports industry business model innovation.

The accurate segmentation of retinal vessels images can not only be used to evaluate and monitor various ophthalmic diseases, but also timely reflect systemic diseases such as diabetes and blood diseases. Therefore, the study on segmentation of retinal vessels images is of great significance for the diagnosis of visually threatening diseases. In recent years, especially the convolutional neural networks (CNN) based on UNet and its variant have been widely used in various medical image tasks. However, although CNN has achieved excellent performance, it cannot learn global and long-distance semantic information interaction well due to the local computing characteristics of convolution operation, which limits the development of medical image segmentation tasks. Transformer, currently popular in computer vision, has global computing features, but due to the lack of low-level details, local feature information extraction is insufficient. In this paper, we propose Patches Convolution Attention based Transformer UNet (PCAT-UNet), which is a U-shaped network based on Transformer with a Convolution branch. We use skip connection to fuse the deep and shallow features of both sides. By taking advantage of the complementary advantages of both sides, we can effectively capture the global dependence relationship and the details of the underlying feature space, thus improving the current problems of insufficient extraction of retinal micro vessels feature information and low sensitivity caused by easily predicting of pixels as background. In addition, our method enables end-to-end training and rapid inference. Finally, three publicly available retinal vessels datasets (DRIVE, STARE and CHASE_DB1) were used to evaluate PCAT-UNet. The experimental results show that the proposed PCAT-UNET method achieves good retinal vessel segmentation performance on these three datasets, and is superior to other architectures in terms of AUC, Accuracy and Sensitivity performance indicators. AUC reached 0.9872, 0.9953 and 0.9925, Accuracy reached 0.9622, 0.9796 and 0.9812, Sensitivity reached 0.8576, 0.8703 and 0.8493, respectively. In addition, PCAT-UNET also achieved good results in two other F1-Score and Specificity indicators.

The COVID-19 epidemic appears to have a catastrophic impact on global well-being and public health. More than 10 million confirmed cases have been reported worldwide until now. Due to the growing number of confirmed cases, timely and accurate classification of healthy and infected patients is essential to control and treat COVID-19. To this end, in this paper, we aim to develop a deep learning-based system for the persuasive classification and reliable detection of COVID-19 using chest radiography. Firstly, we evaluate the performance of various state-of-the-art convolutional neural networks (CNNs) proposed over recent years for medical image classification. Secondly, we develop and train CNN from scratch. In both cases, we use a recently published public X-Ray dataset for training and validation purposes. For transfer learning, we obtain 100% accuracy for binary classification (i.e., Normal/COVID-19) and 87.50% accuracy for tertiary classification (Normal/COVID-19/Pneumonia). With the CNN trained from scratch, we achieve 93.75% accuracy for tertiary classification. We observe, in the case of transfer learning, the classification accuracy drops with an increased number of classes. Our comprehensive ROC and confusion metric analysis with 10-fold cross-validation strongly underpin our findings.

Containers have emerged as a more portable and efficient solution than virtual machines for cloud infrastructure providing both a flexible way to build and deploy applications. The quality of service, security, performance, energy consumption, among others, are essential aspects of their deployment, management, and orchestration. Inappropriate resource allocation can lead to resource contention, entailing reduced performance, poor energy efficiency, and other potentially damaging effects. In this paper, we present a set of online job allocation strategies to optimize quality of service, energy savings, and completion time, considering contention for shared on-chip resources. We consider the job allocation as the multilevel dynamic bin-packing problem that provides a lightweight runtime solution that minimizes contention and energy consumption while maximizing utilization. The proposed strategies are based on two and three levels of scheduling policies with container selection, capacity distribution, and contention-aware allocation. The energy model considers joint execution of applications of different types on shared resources generalized by the job concentration paradigm. We provide an experimental analysis of eighty-six scheduling heuristics with scientific workloads of memory and CPU-intensive jobs. The proposed techniques outperform classical solutions in terms of quality of service, energy savings, and completion time by 21.73–43.44%, 44.06–92.11%, and 16.38–24.17%, respectively, leading to a cost-efficient resource allocation for cloud infrastructures.

In quantum computing, the variational quantum algorithms (VQAs) are well suited for finding optimal combinations of things in specific applications ranging from chemistry all the way to finance. The training of VQAs with gradient descent optimization algorithm has shown a good convergence. At an early stage, the simulation of variational quantum circuits on noisy intermediate-scale quantum (NISQ) devices suffers from noisy outputs. Just like classical deep learning, it also suffers from vanishing gradient problems. It is a realistic goal to study the topology of loss landscape, to visualize the curvature information and trainability of these circuits in the existence of vanishing gradients. In this paper, we calculate the Hessian and visualize the loss landscape of variational quantum classifiers at different points in parameter space. The curvature information of variational quantum classifiers (VQC) is interpreted and the loss function's convergence is shown. It helps us better understand the behavior of variational quantum circuits to tackle optimization problems efficiently. We investigated the variational quantum classifiers via Hessian on quantum computers, starting with a simple 4-bit parity problem to gain insight into the practical behavior of Hessian, then thoroughly analyzed the behavior of Hessian's eigenvalues on training the variational quantum classifier for the Diabetes dataset. Finally, we show how the adaptive Hessian learning rate can influence the convergence while training the variational circuits., Comment: 13 pages, 9 figures

Hand gesture recognition tasks based on surface electromyography (sEMG) are vital in human-computer interaction, speech detection, robot control, and rehabilitation applications. However, existing models, whether traditional machine learnings (ML) or other state-of-the-arts, are limited in the number of movements. Targeting a large number of gesture classes, more data features such as temporal information should be persisted as much as possible. In the field of sEMG-based recognitions, the recurrent convolutional neural network (RCNN) is an advanced method due to the sequential characteristic of sEMG signals. However, the invariance of the pooling layer damages important temporal information. In the all convolutional neural network (ACNN), because of the feature-mixing convolution operation, a same output can be received from completely different inputs. This paper proposes a concatenate feature fusion (CFF) strategy and a novel concatenate feature fusion recurrent convolutional neural network (CFF-RCNN). In CFF-RCNN, a max-pooling layer and a 2-stride convolutional layer are concatenated together to replace the conventional simple dimensionality reduction layer. The featurewise pooling operation serves as a signal amplitude detector without using any parameter. The feature-mixing convolution operation calculates the contextual information. Complete evaluations are made on both the accuracy and convergence speed of the CFF-RCNN. Experiments are conducted using three sEMG benchmark databases named DB1, DB2 and DB4 from the NinaPro database. With more than 50 gestures, the classification accuracies of the CFF-RCNN are 88.87% on DB1, 99.51% on DB2, and 99.29% on DB4. These accuracies are the highest compared with reported accuracies of machine learnings and other state-of-the-art methods. To achieve accuracies of 86%, 99% and 98% for the RCNN, the training time are 2353.686 s, 816.173 s and 731.771 s, respectively. However, for the CFF-RCNN to reach the same accuracies, it needs only 1727.415 s, 542.245 s and 576.734 s, corresponding to a reduction of 26.61%, 33.56% and 21.19% in training time. We concluded that the CFF-RCNN is an improved method when classifying a large number of hand gestures. The CFF strategy significantly improved model performance with higher accuracy and faster convergence as compared to traditional RCNN.

In this paper, a general class of estimators is proposed for estimating the finite population mean for sensitive variable, in the presence of measurement error and non-response in simple random sampling. Expressions for bias and mean square error up to first order of approximation, are derived. Impact of measurement errors is examined using real data sets, including the survey conducted at Quaid-i-Azam University, Islamabad. Simulated data sets are also used to observe the performance of the proposed estimators in comparison to some other estimators. We obtain the empirical bias and MSE values for the proposed and the competing estimators.

British supermarket-panel data suggest no increases in overall sales and purchases of alcohol following COVID-19 lockdowns, yet survey and mortality data suggest otherwise. This paper attempts to unravel the paradox. Based on purchase data of 79,417 British households from Kantar Worldpanel, we undertake controlled interrupted time series analysis of the impact of COVID-19 confinement introduced on 23rd March 2020, and variably applied during 2020, compared to purchases during 2015 to 2019 as controls. We also undertook Poisson regression analyses to estimate if changes in purchases differed by household socio-demographic and economic factors. Excess off-trade household alcohol purchases (expressed as grams of ethanol) following the introduction of confinement, were 29.2% higher (95% CI = 25.8% to 32.5%) for the post-confinement months of 2020, being larger until mid-July 2020 (37.5%, 95%CI = 33.9 to 41.26%) when pubs re-opened with restrictions, and smaller (24.6%, 95%CI = 21.6 to 27.7) thereafter. During the time of complete pub closures, and fully adjusting for no on-trade purchases, household purchases of alcohol did not change when compared with the same time period during 2015–2019 (coefficient = -0.9%, 95%CI = -5.6 to 3.8). Excess purchases from 23rd March to 31st December 2020 varied by region of Great Britain, being higher in the north of England, and lower in Scotland and Wales. Excess purchases were greater in the most deprived households, compared with the least deprived households. Excess purchases increased substantially as the amount of alcohol normally purchased by a household increased, with the top one fifth of households that normally bought the most alcohol increasing their purchases more than 17 times than the bottom one fifth of households that bought the least alcohol. That the heaviest buyers of alcohol increased their purchases the most, with some independent impact of socio-economic disadvantage, might explain why reported alcohol problems and recent alcohol-related death rates might have increased. A conclusion of this is that alcohol policy to reduce high consumption of alcohol, and the availability of help and treatment to reduce alcohol consumption become more important during extraordinary times, such as COVID lockdowns.

This paper sought to understand the extent to which, and how individuals use personal or collective language when asked to articulate sense of place from a collective perspective. Understanding a collective sense of place could illuminate place-based connections in natural resource industries, where it is as groups or as institutions that organizations interact with the environment rather than as individuals. While there are well known methods for collecting information about sense of place at the individual level, there is a gap in understanding the best method to collect information at a collective level. We examined the use of key-informant interviews as a method to understand collective sense of place. In Bocas del Toro, Panama, ecotourism and environmentally based organizations are becoming more prolific due to abundant natural resources, making it an interesting case study for understanding sense of place from an organizational perspective. The use of personal and collective language is examined though in-depth semi-structured interviews from 15 environmentally-oriented organizations with a total of 17 interviews. This study specifically examined whether and how key informants, when prompted to speak for their organization, spoke collectively, reflecting a collective perspective versus their own. Methods included both quantitative analysis of personal versus collective language use frequency, and qualitative examinations of how individuals used personal versus collective language. Our results indicated no difference in the frequency with which individuals use personal versus collective language. We found that how individuals situated their perspectives into an organization reflects a complex personal and collective point of view reflecting five themes of personal versus collective language use: 1) sole personal perspective, 2) sole collective perspective, 3) distinction between collective and personal perspective; 4) organization perspective with insertion of “I think”; and 5) personal and collective perspective about organization and greater community. Our research identifies a previously undiscussed potential bias of key informant interviews. These findings have implications for how researchers approach collecting information beyond the individual level.

Aim/Goal/Purpose Population surveys underrepresent people with severe mental ill health. This paper aims to use multiple regression analyses to explore perceived social support, loneliness and factor associations from self-report survey data collected during the Covid-19 pandemic in a sample of individuals with severe mental ill health. Design/Methodology/Approach We sampled an already existing cohort of people with severe mental ill health. Researchers contacted participants by phone or by post to invite them to take part in a survey about how the pandemic restrictions had impacted health, Covid-19 experiences, perceived social support, employment and loneliness. Loneliness was measured by the three item UCLA loneliness scale. Findings In the pandemic sub-cohort, 367 adults with a severe mental ill health diagnosis completed a remote survey. 29–34% of participants reported being lonely. Loneliness was associated with being younger in age (adjusted OR = -.98, p = .02), living alone (adjusted OR = 2.04, p = .01), high levels of social and economic deprivation (adjusted OR = 2.49, p = .04), and lower perceived social support (B = -5.86, p < .001). Living alone was associated with lower perceived social support. Being lonely was associated with a self-reported deterioration in mental health during the pandemic (adjusted OR = 3.46, 95%CI 2.03–5.91). Practical implications Intervention strategies to tackle loneliness in the severe mental ill health population are needed. Further research is needed to follow-up the severe mental ill health population after pandemic restrictions are lifted to understand perceived social support and loneliness trends. Originality Loneliness was a substantial problem for the severe mental ill health population before the Covid-19 pandemic but there is limited evidence to understand perceived social support and loneliness trends during the pandemic.

The global impact of coronavirus disease 2019 (COVID-19) is unprecedented, and many control and prevention measures have been implemented to test for and trace COVID-19. However, invisible-spreaders, who are associated with nucleic acid detection and asymptomatic infections, have received insufficient attention in the current COVID-19 control efforts. In this paper, we analyze the time series infection data for Italy, Germany, Brazil, India and Sweden since the first wave outbreak to address the following issues through a series of experiments. We conclude that: 1) As of June 1, 2020, the proportion of invisible-spreaders is close to 0.4% in Sweden, 0.8% in early Italy and Germany, and 0.4% in the middle and late stages. However, in Brazil and India, the proportion still shows a gradual upward trend; 2) During the spread of this pandemic, even a slight increase in the proportion of invisible-spreaders could have large implications for the health of the community; and 3) On resuming work, the pandemic intervention measures will be relaxed, and invisible-spreaders will cause a new round of outbreaks.

Metastatic castration resistant prostate cancer (mCRPC) is commonly treated by androgen deprivation therapy (ADT) in combination with chemotherapy. Immune therapy by checkpoint inhibitors, has become a powerful new tool in the treatment of melanoma and lung cancer, and it is currently being used in clinical trials in other cancers, including mCRPC. However, so far, clinical trials with PD-1 and CTLA-4 inhibitors have been disappointing. In the present paper we develop a mathematical model to assess the efficacy of any combination of ADT with cancer vaccine, PD-1 inhibitor, and CTLA-4 inhibitor. The model is represented by a system of partial differential equations (PDEs) for cells, cytokines and drugs whose density/concentration evolves in time within the tumor. Efficacy of treatment is determined by the reduction in tumor volume at the endpoint of treatment. In mice experiments with ADT and various combinations of PD-1 and CTLA-4 inhibitors, tumor volume at day 30 was always larger than the initial tumor. Our model, however, shows that we can decrease tumor volume with large enough dose; for example, with 10 fold increase in the dose of anti-PD-1, initial tumor volume will decrease by 60%. Although the treatment with ADT in combination with PD-1 inhibitor or CTLA-4 inhibitor has been disappointing in clinical trials, our simulations suggest that, disregarding negative effects, combinations of ADT with checkpoint inhibitors can be effective in reducing tumor volume if larger doses are used. This points to the need for determining the optimal combination and amounts of dose for individual patients.

Introduction Quality antenatal care is a window of opportunity for improving maternal and neonatal outcomes. Numerous studies have shown a positive effect of women empowerment on improved coverage of maternal and reproductive health services, including antenatal care (ANC). However, there is scarce evidence on the association between women’s empowerment and improved ANC services both in terms of coverage and quality. Addressing this gap, this paper examines the relationship between multi-dimensional measures of women empowerment on utilization of quality ANC (service coverage and consultation) in Pakistan. Methods We used Pakistan Demographic and Health Survey 2017–18 (PDHS) data which comprises of 6,602 currently married women aged between 15–49 years who had a live birth in the past five years preceding the survey. Our exposure variables were three-dimensional measures of women empowerment (social independence, decision making, and attitude towards domestic violence), and our outcome variables were quality of antenatal coverage [i.e. a composite binary measure based on skilled ANC (trained professional), timeliness (1st ANC visit during first trimester), sufficiency of ANC visits (4 or more)] and quality of ANC consultation (i.e. receiving at least 7 or more essential antenatal components out of 8). Data were analysed in Stata 16.0 software. Descriptive statistics were used to describe sample characteristics and binary logistic regression was employed to assess the association between empowerment and quality of antenatal care. Results We found that 41.4% of the women received quality ANC coverage and 30.6% received quality ANC consultations during pregnancy. After controlling for a number of socio-economic and demographic factors, all three measures of women’s empowerment independently showed a positive relationship with both outcomes. Women with high autonomy (i.e. strongly opposed the notion of violence) in the domain of attitude to violence are 1.66 (95% CI 1.30–2.10) and 1.45 (95% CI 1.19–1.75) and times more likely to receive antenatal coverage and quality ANC consultations respectively, compared with women who ranked low on attitude to violence. Women who enjoy high social independence had 1.87 (95% CI 1.44–2.43) and 2.78 (95% CI 2.04–3.79) higher odds of quality antenatal coverage and consultations respectively, as compared with their counterparts. Similarly, women who had high autonomy in household decision making 1.98 (95% CI 1.60–2.44) and 1.56 (95% CI 2.17–1.91) were more likely to receive quality antenatal coverage and consultation respectively, as compared to women who possess low autonomy in household decision making. Conclusion The quality of ANC coverage and consultation with service provider is considerably low in Pakistan. Women’s empowerment related to social independence, gendered beliefs about violence, and decision-making have an independent positive association with the utilisation of quality antenatal care. Thus, efforts directed towards empowering women could be an effective strategy to improve utilisation of quality antenatal care in Pakistan.

Objective This study aimed to elucidate the effects of cholecystectomy on the risk of colorectal cancer (CRC) by conducting a meta-analysis of 10 cohort studies. Methods The eligible cohort studies were selected by searching the PubMed and EMBASE databases from their origination to June 30, 2016, as well as by consulting the reference lists of the selected articles. Two authors individually collected the data from the 10 papers. When the data showed marked heterogeneity, we used a random-effects model to estimate the overall pooled risk; otherwise, a fixed effects model was employed. Results The final analysis included ten cohort studies. According to the Newcastle-Ottawa Scale (NOS), nine papers were considered high quality. After the data of these 9 studies were combined, an increased risk of CRC was found among the individuals who had undergone cholecystectomy (risk ratio (RR) 1.22; 95% confidence interval (CI) 1.08–1.38). In addition, we also found a promising increased risk for colon cancer (CC) (RR 1.30, 95% CI 1.07–1.58), but no relationship between cholecystectomy and rectum cancer (RC) (RR 1.09; 95% CI 0.89–1.34) was observed. Additionally, in the sub-group analysis of the tumor location in the colon, a positive risk for ascending colon cancer (ACC) was found (RR 1.18, 95% CI 1.11–1.26). After combining the ACC, transverse colon cancer (TCC), sigmoid colon cancer (SCC) and descending colon cancer (DCC) patients, we found a positive relationship with cholecystectomy (RR 1.18, 95% CI 1.11–1.26). Furthermore, after combining the ACC and DCC patients, we also found a positive relationship with cholecystectomy (RR 1.28; 95% CI 1.11–1.26) in the sub-group analysis. In an additional sub-group analysis of patients from Western countries, there was a positive relationship between cholecystectomy and the risk of CRC (RR 1.20; 95% CI 1.05–1.36). Furthermore, a positive relationship between female gender and CRC was also found (RR 1.17; 95% CI 1.03–1.34). However, there was no relationship between gender and CC or RC. Furthermore, no publication bias was observed, and the sensitivity analysis indicated stable results. Conclusions This meta-analysis of 10 cohort studies revealed that cholecystectomy is associated with an increased risk for CRC, CC and ACC, particularly in Western countries. No relationship between cholecystectomy and RC was observed. There was no relationship between gender and either CC or RC, but a positive relationship between female gender and CRC was observed.

In the paper the costs of Polish county hospitals in 2015–2018 are studied using behavioral cost function. The set of variables combines hospitals’ characteristics which may determine their level of costs, such as the form of ownership, bed turnover rate, number of patient-days and share of beds in emergency department with environment characteristics which may influence both outsourcing costs and patients’ health. In 2017 the system of basic hospital service provision (hospital network) was introduced in Poland. Dummy variables included in the model represent the category of hospital in the system. The results show that the costs may be described using fixed effect panel model. Positive impact of percentage of emergency department patients transferred to other departments and of wages is found. Higher ratio of residents and interns to doctors is found to decrease costs. Dummy variable for the period after the introduction of hospital network assumed a negative sign with costs, but the parameter remained insignificant.

Background Coronavirus (COVID-19) has severely impacted lifestyles worldwide. Responses to COVID-19 have intentionally restricted the factors that encourage regular and frequent PA; opportunity, capability and motivation. However, the effects of these restrictions are likely to have differed by gender and age and different intensities of PA. This rapid review builds on previous evidence by synthesising the global impact of COVID-19 on adult PA through specific intensities and types of PA and evaluating this by gender and age. Methods A rapid systematic search of seven electronic databases (PubMed, MEDLINE, CINAHL, SPORTDiscus, Academic Search Complete, APA PsycInfo, and APA PsycArticles) was performed from December 2019 to January 2021. Studies investigating adult change in PA, exercise or sedentary behaviour due to COVID-19 were included. Results From an initial database search identifying 3,863 articles, 66 remained for synthesis after applying eligibility criteria. Results demonstrate decreases among all intensities and types of PA—walking (6 out of 7 papers), moderate-only (5 out of 6 papers), vigorous-only (5 out of 6 papers) and MVPA (4 out of 5 papers); as well as overall PA (14–72% participants reported a decrease). Reflecting that COVID-19 responses were designed to have universal effects, they also achieved whole-society decreases in PA behaviour, accented in older age groups. Conclusion There is a universal need to address the low levels of PA post-COVID-19. The consequences of decreased PA across all intensities has powerful, potentially recoverable, impacts. Universal declines have implications for public health officials and PA advocates for post-COVID-19 initiatives to promote PA.

Extensive research shows that residential segregation has severe health consequences for racial and ethnic minorities. Most research to date has operationalized segregation in terms of either poverty or race/ethnicity rather than a synergy of these factors. A novel version of the Index of Concentration at the Extremes (ICERace-Income) specifically assesses racialized economic segregation in terms of spatial concentrations of racial and economic privilege (e.g., wealthy white people) versus disadvantage (e.g., poor Black people) within a given area. This multidimensional measure advances a more comprehensive understanding of residential segregation and its consequences for racial and ethnic minorities. The aim of this paper is to critically review the evidence on the association between ICERace-Income and health outcomes. We implemented the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to conduct a rigorous search of academic databases for papers linking ICERace-Income with health. Twenty articles were included in the review. Studies focused on the association of ICERace-Income with adverse birth outcomes, cancer, premature and all-cause mortality, and communicable diseases. Most of the evidence indicates a strong association between ICERace-Income and each health outcome, underscoring income as a key mechanism by which segregation produces health inequality along racial and ethnic lines. Two of the reviewed studies examined racial disparities in comorbidities and health care access as potential explanatory factors underlying this relationship. We discuss our findings in the context of the extant literature on segregation and health and propose new directions for future research and applications of the ICERace-Income measure.

Active Queue Management (AQM) is recommended by Internet Engineering Task Force to mitigate the bufferbloat phenomenon in the Internet. In this paper, we show the results of comprehensive measurements carried out in our university network, in which a device with an AQM algorithm, designed and programmed for this purpose, was running. The implemented AQM algorithm was based on the dropping function, i.e. arriving packets were dropped randomly, with the probability being a function of the queue length. Several different dropping function forms, proposed in the networking literature, were used, in addition to the classic FIFO queue (no AQM). The experiment lasted over a month, during which the state of the network was measured and recorded several thousand times. This made the results independent of the natural fluctuations of the users’ behavior and the network load. Conclusions on the general performance improvement offered by the implemented AQM, as well as the differences in the performance between particular forms of the dropping function, were reached. Some of these conclusions differ from those drawn previously from simulations. This underlines the need for carrying measurements of new AQMs in real, operating networks, with complex, natural traffic.

Made available in DSpace on 2022-04-28T19:49:42Z (GMT). No. of bitstreams: 0 Previous issue date: 2022-01-01 Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Several studies have reported the relationship of deforestation with increased incidence of infectious diseases, mainly due to the deregulation caused in these environments. The purpose of this study was to answer the following questions: a) is increased loss of vegetation related to dengue cases in the Brazilian Cerrado? b) how do different regions of the tropical savanna biome present distinct patterns for total dengue cases and vegetation loss? c) what is the projection of a future scenario of deforestation and an increased number of dengue cases in 2030? Thus, this study aimed to assess the relationship between loss of native vegetation in the Cerrado and dengue infection. In this paper, we quantify the entire deforested area and dengue infection cases from 2001 to 2019. For data analyses, we used Poisson generalized linear model, descriptive statistics, cluster analysis, non-parametric statistics, and autoregressive integrated moving average (ARIMA) models to predict loss of vegetation and fever dengue cases for the next decade. Cluster analysis revealed the formation of four clusters among the states. Our results showed significant increases in loss of native vegetation in all states, with the exception of Piauí. As for dengue cases, there were increases in the states of Minas Gerais, São Paulo, and Mato Grosso. Based on projections for 2030, Minas Gerais will register about 4,000 dengue cases per 100,000 inhabitants, São Paulo 750 dengue cases per 100,000 inhabitants, and Mato Grosso 500 dengue cases per 100,000 inhabitants. To reduce these projections, Brazil will need to control deforestation and implement public health, environmental and social policies, requiring a joint effort from all spheres of society. Graduate Program in Agronomy–Cropping Systems São Paulo State University (Unesp), SP Graduate Program in Geography São Paulo State University (Unesp) School of Technology and Sciences, SP Federal University of Mato Grosso do Sul (UFMS), Chapadão do Sul, MS Federal University of Acre (UFAC) Graduate Program in Agronomy State University of Londrina (Uel), PR Graduate Program in Sciences—Nuclear Energy in Agriculture Centro de Energia Nuclear na Agricultura São Paulo University São Paulo State University (Unesp) Engineering School, SP Graduate Program in Geography Federal University of Mato Grosso do Sul (UFMS), Três Lagoas, MS Graduate Program in Agronomy–Cropping Systems São Paulo State University (Unesp), SP Graduate Program in Geography São Paulo State University (Unesp) School of Technology and Sciences, SP São Paulo State University (Unesp) Engineering School, SP CNPq: 303767/2020-0

High Flow Nasal Oxygen (HFNO) therapy offers a proven means of delivering respiratory support to critically ill patients suffering from viral illness such as COVID-19. However, the therapy has the potential to modify aerosol generation and dispersion patterns during exhalation and thereby put healthcare workers at increased risk of disease transmission. Fundamentally, a gap exists in the literature with regards to the effect of the therapy on the fluid dynamics of the exhalation jet which is essential in understanding the dispersion of aerosols and hence quantifying the disease transmission risk posed by the therapy. In this paper, a multi-faceted approach was taken to studying the aerosol-laden exhalation jet. Schlieren imaging was used to visualise the flow field for a range of expiratory activities for three healthy human volunteers receiving HFNO therapy at flow rates of 0—60 L/min. A RANS turbulence model was implemented using the CFD software OpenFOAM and used to perform a parametric study on the influence of exhalation velocity and duration on the dispersion patterns of non-evaporating droplets in a room environment. A dramatic increase in the turbulence of the exhalation jet was observed when HFNO was applied. Quantitative analysis indicated that the mean exhalation velocity was increased by 2.2—3.9 and 2.3—3 times that for unassisted breathing and coughing, respectively. A 1—2 second increase was found in the exhalation duration. The CFD model showed that small droplets (10—40 μm) were most greatly affected, where a 1 m/s increase in velocity and 1 s increase in duration caused an 80% increase in axial travel distance.

The highly contagious nature of SARS-CoV-2 has led to several studies on the transmission of the virus. A little studied potential fomite of great concern in the community is currency, which has been shown to harbor microbial pathogens in several studies. Since the onset of the COVID-19 pandemic, many businesses in the United States have limited the use of banknotes in favor of credit cards. However, SARS-CoV-2 has shown greater stability on plastic in several studies. Herein, the stability of SARS-CoV-2 at room temperature on banknotes, money cards and coins was investigated. In vitro studies with live virus suggested SARS-CoV-2 was highly unstable on banknotes, showing an initial rapid reduction in viable virus and no viral detection by 24 hours. In contrast, SARS-CoV-2 displayed increased stability on money cards with live virus detected after 48 hours. Environmental swabbing of currency and money cards on and near the campus of Brigham Young University supported these results, with no detection of SARS-CoV-2 RNA on banknotes, and a low level on money cards. However, no viable virus was detected on either. These preliminary results suggest that the use of money cards over banknotes in order to slow the spread of this virus may be ill-advised. These findings should be investigated further through larger environmental studies involving more locations.

Economic globalization has swept the whole world. To focus on their main business, enterprises that are referred to as original equipment manufacturers (OEMs) outsource non-core production activities to contract manufacturers (CMs). By constructing a two-level supply chain consisting of two competing OEMs and one upstream CM, the strategic interaction of the OEMs between outsourcing and purchasing is studied. Specifically, the CM can offer custom- and predefined modes of original equipment manufacturing (namely, CO mode and PO mode, respectively). The former mode enables OEMs to determine product quality, while the latter only allows them to purchase from several quality configurations. The results show that, first, since the CO mode allows the adopter to lead the product design, whether to choose this mode depends on the required R&D cost. Interestingly, however, a lower R&D cost does not necessarily result in the adoption of the CO mode if the product quality difference is small under the PO mode. Second, the optimal purchasing strategy of an OEM is indifferent to the outsourcing mode (CO and PO) of its rival but significantly affected by the quality cost. However, compared to the PO mode, choosing the CO mode would cause the competitor to suffer more profit losses. Third, differing from the prior literature, this paper finds that when the downstream OEM can make quality decisions, although this may lead to profit loss of the contract manufacturer in some channels, it could benefit the CM overall.

BackgroundThe hospitalization of children during the COVID-19 pandemic has affected their physical and mental health. Pediatric nurses have faced challenges in providing high-quality nursing care for children and their families. However, the pediatric nursing care recommendations for COVID-19 patients in the hospital setting remain unclear. The current scoping review provides recommendations for nursing interventions for pediatric COVID-19 patients in the hospital setting.Methods and findingsThe selected articles containing management and nursing recommendations for COVID-19 that have occurred in pediatric patients ages 0–19 years old. A search strategy was developed and implemented in seven databases. We included peer-reviewed articles that reported observational or interventional studies, as well as policy papers, guides or guidelines, letters and editorials, and web articles. A total of 134 articles and other documents relevant to this review were included. We categorized the results based on The Nursing Intervention Classification (NIC) taxonomy which consists of six domains (e.g., Physiological: Basic); eleven classes (e.g., Nutrition Support); and eighteen intervention themes (e.g., Positioning, Family Presence Facilitation, Family Support, and Discharge Planning).ConclusionApart from the intervention of physical problems, there is a need to promote patient- and family-centered care, play therapy, and discharge planning to help children and families cope with their new situation.

Background mHealth innovations have been proposed as an effective solution to improving adolescent access to and use of Sexual and Reproductive Health (SRH) services; particularly in regions with deeply entrenched traditional social norms. However, research demonstrating the effectiveness and theoretical basis of the interventions is lacking. Aim Our aim was to describe mHealth intervention components, assesses their effectiveness, acceptability, and cost in improving adolescent’s uptake of SRH services in Sub-Saharan Africa (SSA). Methods This paper is based on a systematic review. Twenty bibliographic databases and repositories including MEDLINE, EMBASE, and CINAHL, were searched using pre-defined search terms. Of the 10, 990 records screened, only 10 studies met the inclusion criteria. The mERA checklist was used to critically assess the transparency and completeness in reporting of mHealth intervention studies. The behaviour change components of mHealth interventions were coded using the taxonomy of Behaviour Change Techniques (BCTs). The protocol was registered in the ‘International Prospective Register for Systematic Reviews’ (PROSPERO-CRD42020179051). Results The results showed that mHealth interventions were effective and improved adolescent’s uptake of SRH services across a wide range of services. The evidence was strongest for contraceptive use. Interventions with two-way interactive functions and more behaviour change techniques embedded in the interventions improved adolescent uptake of SRH services to greater extent. Findings suggest that mHealth interventions promoting prevention or treatment adherence for HIV for individuals at risk of or living with HIV are acceptable to adolescents, and are feasible to deliver in SSA. Limited data from two studies reported interventions were inexpensive, however, none of the studies evaluated cost-effectiveness. Conclusion There is a need to develop mHealth interventions tailored for adolescents which are theoretically informed and incorporate effective behaviour change techniques. Such interventions, if low cost, have the potential to be a cost-effective means to improve the sexual and reproductive health outcomes in SSA.

In order to establish natural social synchrony between two humans, two requirements need to be fulfilled. First, the coupling must be bi-directional. The two humans react to each other’s actions. Second, natural social bodily synchronization has to be intentional or unintentional. Assuming that these essential aspects of human-human interactions are present, the present paper investigates whether similar bodily synchrony emerges between an interacting human and an artificial agent such as a robot. More precisely, we investigate whether the same human unintentional rhythmic entrainment and synchronization is present in Human Robot Interaction (HRI). We also evaluate which model (e.g., an adaptive vs non adaptive robot) better reproduces such unintentional entrainment. And finally, we compare interagent coordination stability of the HRI under 1) unidirectional (robot with fixed frequency) versus bidirectional (robot with adaptive frequency) rhythmic entrainment and 2) human intentional versus unintentional coupling. Fifteen young adults made vertical arm movements in front of the NAO robot under five different conditions of intentional/unintentional and unidirectional/bidirectional interactions. Consistent with prior research investigating human-human interpersonal coordination, when humans interact with our robot, (i) unintentional entrainment was present, (ii) bi-directional coupling produced more stable in-phase un-intentional and intentional coordination, (iii) and intentional coordination was more stable than unintentional coordination. To conclude, this study provides a foundation for modeling future social robots involving unintentional and bidirectional synchronization—aspects which seem to enhance humans’ willingness to interact with robots.

Anthropometry is a Greek word that consists of the two words “Anthropo” meaning human species and “metery” meaning measurement. It is a science that deals with the size of the body including the dimensions of different parts, the field of motion and the strength of the muscles of the body. Specific individual dimensions such as heights, widths, depths, distances, environments and curvatures are usually measured. In this article, we investigate the anthropometric characteristics of patients with chronic diseases (diabetes, hypertension, cardiovascular disease, heart attacks and strokes) and find the factors affecting these diseases and the extent of the impact of each to make the necessary planning. We have focused on cohort studies for 10047 qualified participants from Ravansar County. Machine learning provides opportunities to improve discrimination through the analysis of complex interactions between broad variables. Among the chronic diseases in this cohort study, we have used three deep neural network models for diagnosis and prognosis of the risk of type 2 diabetes mellitus (T2DM) as a case study. Usually in Artificial Intelligence for medicine tasks, Imbalanced data is an important issue in learning and ignoring that leads to false evaluation results. Also, the accuracy evaluation criterion was not appropriate for this task, because a simple model that is labeling all samples negatively has high accuracy. So, the evaluation criteria of precession, recall, AUC, and AUPRC were considered. Then, the importance of variables in general was examined to determine which features are more important in the risk of T2DM. Finally, personality feature was added, in which individual feature importance was examined. Performing by Shapley Values, the model is tuned for each patient so that it can be used for prognosis of T2DM risk for that patient. In this paper, we have focused and implemented a full pipeline of Data Creation, Data Preprocessing, Handling Imbalanced Data, Deep Learning model, true Evaluation method, Feature Importance and Individual Feature Importance. Through the results, the pipeline demonstrated competence in improving the Diagnosis and Prognosis the risk of T2DM with personalization capability.

The symport of lactose and H+ is an important physiological process in E. coli, for it is closely related to cellular energy supply. In this paper, the symport of H+ and lactose by E. coli LacY protein is computationally simulated using a newly proposed cotransport model that takes the "leakage" phenomenon (uncoupled sugar translocation) into account and also satisfies the static head equilibrium condition. Then, we study the equilibrium properties of this cotransport process including equilibrium solution and the time required to reach equilibrium state, when varying the parameters of the initial state of cotransport system. It can be found that in the presence of leakage, H+ and lactose will reach their equilibrium state separately, but the intensity of "leakage" has almost no effect on the equilibrium solution, while the stronger leakage is, the shorter the time required for H+ and lactose to reach equilibrium. For E. coli cells with different periplasm and cytoplasm volumes, when cotransport is performed at constant initial particle concentration, the time for cytoplasm pH to be stabilized increases monotonically with the periplasm to cytoplasm volume ratio. For a certain E. coli cell, as it continues to lose water and contract, the time for cytoplasm pH to be stabilized by cotransport also increases monotonically when the cell survives. The above phenomena and other findings in this paper may help us to not only further validate or improve the model, but also deepen our understanding of the cotransport process of E. coli LacY protein., 10 figures

Recent developments in dental implant have heightened the urgent need to natural tissue adhesives estrogenic materials with ability of promoting the proliferation and osteoblastic differentiation in human dental pulp-derived stem cells, to provide better integration of tissue for dentistry. Up to now, far little attention has been paid to adhesives extract of the root of Ferula sp. which contains biomaterial compounds with estrogenic activities. Prior to undertaking the investigation, analysis of the extract of the root of F. ovina revealed a novel terpenoid, and we identified it as Fenoferin. So far, this paper has focused on Fenoferin compared to Ferutinin and root extract to determine if Fenoferin caused changes in craniofacial cartilage, bone (ceratohyal) and tooth mineralization. Following the purpose of study, we used zebrafish as a well-developed model system for studying bone development, so the developing zebrafish larvae were exposed to various concentration of compounds at 2dpf, and the histological analyses were performed at 6dpf. The result of the current study highlights the importance of F. ovina in studies related to dental regenerative medicine.

China is still one of the countries dominated by thermal power generation. In order to generate more efficient, stable and clean power, it is necessary to evaluate thermal power generation units (TPGU). Firstly, a comprehensive evaluation index system for TPGU with 20 secondary indicators was established from four aspects: reliability indicators, economic indicators, technical supervision indicators, and major operating indicators. Secondly, the entropy weight method can be used to calculate the weight of each second-level index. Mahalanobis Distance improved Technique for Order Preference by Similarity to an Ideal Solution (TOPSIS) method is coupled with the Grey Relational Analysis (GRA), and the comprehensive evaluation values of 5 units (600MW) are respectively 0.4516, 0.5247, 0.3551, 0.5589 and 0.6168 from both vertical and horizontal dimensions. Finally, by comparing and analyzing this method with the above research methods, it is found that the results obtained by this method which re-establishes the coordinate system based on the data set are more accurate. In addition, this method can effectively evaluate the operation of TPGU, which is of great significance for cleaner production while generating electricity. In conclusion, some suggestions on clean production of TPGU are put forward, and the innovation points and limitations of this paper are pointed out.

The increasing energy demand and the target to reduce environmental pollution make it essential to use efficient and environment-friendly renewable energy systems. One of these systems is the Photovoltaic (PV) system which generates energy subject to variation in environmental conditions such as temperature and solar radiations. In the presence of these variations, it is necessary to extract the maximum power via the maximum power point tracking (MPPT) controller. This paper presents a nonlinear generalized global sliding mode controller (GGSMC) to harvest maximum power from a PV array using a DC-DC buck-boost converter. A feed-forward neural network (FFNN) is used to provide a reference voltage. A GGSMC is designed to track the FFNN generated reference subject to varying temperature and sunlight. The proposed control strategy, along with a modified sliding mode control, eliminates the reaching phase so that the sliding mode exists throughout the time. The system response observes no chattering and harmonic distortions. Finally, the simulation results using MATLAB/Simulink environment demonstrate the effectiveness, accuracy, and rapid tracking of the proposed control strategy. The results are compared with standard results of the nonlinear backstepping controller under abrupt changes in environmental conditions for further validation.

Online virtual museum tours combine museum authority and an academic approach with the diversity and interactivity of online resources; such tours have become an essential resource for online scientific research and education. Many important museums around the world are developing this type of online service. Comprehensive evaluation of such tours is, however, urgently needed to ensure effectiveness. This paper establishes a heuristic evaluation scale based on the literature. Taking the online virtual tour of the Exhibition of Architecture of the Forbidden City as a case study, confirmatory factor analysis was then carried out to improve the scale. Interviews were conducted to discuss and analyze the research results. The developed evaluation scale has four dimensions: authenticity, interaction, navigation, and learning. The results from the case study showed, first, that the exhibition had visual authenticity, but the behavioral authenticity was insufficient; second, the exhibition was generally interactive, but this aspect could be improved by enriching the links; third, the lack of effective navigation design for the exhibit was the main factor affecting experience quality. Fourth, the exhibition was informative and supported learning, but needs further improvement to the quantity and quality of information provided. Finally, the interviews revealed that the online exhibition did not entirely support people of different ages and abilities, so it needs further improvement to be wholly inclusive.

ImportanceGiven the overwhelming worldwide rate of infection and the disappointing pace of vaccination, addressing reinfection is critical. Understanding reinfection, including protection longevity after natural infection, will allow us to better know the prospect of herd immunity, which hinges on the assumption that natural infection generates sufficient, protective immunity. The primary aim of this paper is to provide data on SARS-CoV-2 reinfection over a 10-month period.ObjectiveThe primary objective of this study is to establish the incidence of reinfection of COVID-19 among healthcare employees who experienced a prior COVID-19 infection.DesignThis observational cohort study followed a convenience sample of 2,625 participants who experienced a COVID-19 infection for subsequent COVID-19 infection.SettingHealthcare employees were recruited across a large Midwestern healthcare system. Positive PCR test results were administered and recorded by the system-affiliated lab serving Illinois and Wisconsin.ParticipantsAdult healthcare system employees who enrolled in a research study focused on SARS-CoV-2 antibodies (N = 16,357) and had at least one positive PCR test result between March 1, 2020 and January 10, 2021 were included (N = 2,625).ExposurePositive PCR test for SARS-CoV-2Main Outcome(s) and Measure(s)The primary outcome is incidence of COVID-19 reinfection, defined by current CDC guidelines (i.e. subsequent COVID-19 infection ≥ 90 days from prior infection). COVID-19 recurrence, defined as subsequent COVID-19 infection after prior infection irrespective of time, is also described.ResultsOf 2,625 participants who experienced at least one COVID-19 infection during the 10-month study period, 156 (5.94%) experienced reinfection and 540 (20.57%) experienced recurrence after prior infection. Median days were 126.50 (105.50-171.00) to reinfection and 31.50 (10.00-72.00) to recurrence. Incidence rate of COVID-19 reinfection was 0.35 cases per 1,000 person-days, with participants working in COVID-clinical and clinical units experiencing 3.77 and 3.57 times, respectively, greater risk of reinfection relative to those working in non-clinical units. Incidence rate of COVID-19 recurrence was 1.47 cases per 1,000 person-days.Conclusions and RelevanceThis study supports the consensus that COVID-19 reinfection, defined as subsequent infection ≥ 90 days after prior infection, is rare, even among a sample of healthcare workers with frequent exposure.

Assessing and selecting the most viable embryos for transfer is an essential part of in vitro fertilization (IVF). In recent years, several approaches have been made to improve and automate the procedure using artificial intelligence (AI) and deep learning. Based on images of embryos with known implantation data (KID), AI models have been trained to automatically score embryos related to their chance of achieving a successful implantation. However, as of now, only limited research has been conducted to evaluate how embryo selection models generalize to new clinics and how they perform in subgroup analyses across various conditions. In this paper, we investigate how a deep learning-based embryo selection model using only time-lapse image sequences performs across different patient ages and clinical conditions, and how it correlates with traditional morphokinetic parameters. The model was trained and evaluated based on a large dataset from 18 IVF centers consisting of 115,832 embryos, of which 14,644 embryos were transferred KID embryos. In an independent test set, the AI model sorted KID embryos with an area under the curve (AUC) of a receiver operating characteristic curve of 0.67 and all embryos with an AUC of 0.95. A clinic hold-out test showed that the model generalized to new clinics with an AUC range of 0.60–0.75 for KID embryos. Across different subgroups of age, insemination method, incubation time, and transfer protocol, the AUC ranged between 0.63 and 0.69. Furthermore, model predictions correlated positively with blastocyst grading and negatively with direct cleavages. The fully automated iDAScore v1.0 model was shown to perform at least as good as a state-of-the-art manual embryo selection model. Moreover, full automatization of embryo scoring implies fewer manual evaluations and eliminates biases due to inter- and intraobserver variation.