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We present Orbit, a unified and modular framework for robot learning powered by Nvidia Isaac Sim. It offers a modular design to easily and efficiently create robotic environments with photo-realistic scenes and high-fidelity rigid and deformable body simulation. With Orbit, we provide a suite of benchmark tasks of varying difficulty- from single-stage cabinet opening and cloth folding to multi-stage tasks such as room reorganization. To support working with diverse observations and action spaces, we include fixed-arm and mobile manipulators with different physically-based sensors and motion generators. Orbit allows training reinforcement learning policies and collecting large demonstration datasets from hand-crafted or expert solutions in a matter of minutes by leveraging GPU-based parallelization. In summary, we offer an open-sourced framework that readily comes with 16 robotic platforms, 4 sensor modalities, 10 motion generators, more than 20 benchmark tasks, and wrappers to 4 learning libraries. With this framework, we aim to support various research areas, including representation learning, reinforcement learning, imitation learning, and task and motion planning. We hope it helps establish interdisciplinary collaborations in these communities, and its modularity makes it easily extensible for more tasks and applications in the future. ISSN:2377-3766

This study is conducted to investigate the effect of contrast polarity towards eye fixation patterns when reading text on a smartphone in bright and dark conditions involving the effects when reading on a smartphone such as in real-life situations. The number of fixations and duration of fixation showed no statistically significant difference (p=0.160 and 0.099 respectively). However, emmetropic subjects showed a higher result in bright conditions compared to myopic subjects (p=0.046). This concludes that emmetropic eye movement efficiency seems superior, possibly due to lower spherical order aberration as pupil size decreases in bright illumination. Keywords: Contrast Polarity; Fixation Rates; Eye Tracking; Light conditions eISSN: 2398-4287 © 2023. The Authors. Published for AMER & cE-Bs by e-International Publishing House, Ltd., UK. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer–review under responsibility of AMER (Association of Malaysian Environment-Behaviour Researchers), and cE-Bs (Centre for Environment-Behaviour Studies), College of Built Environment, Universiti Teknologi MARA, Malaysia DOI: https://doi.org/10.21834/ebpj.v8i24.4680

While regulatory T (Treg) cells are traditionally viewed as professional suppressors of antigen presenting cells and effector T cells in both autoimmunity and cancer, recent findings of distinct Treg cell functions in tissue maintenance suggest that their regulatory purview extends to a wider range of cells and is broader than previously assumed. To elucidate tumoral Treg cell ‘connectivity’ to diverse tumor-supporting accessory cell types, we explored immediate early changes in their single-cell transcriptomes upon punctual Treg cell depletion in experimental lung cancer and injury-induced inflammation. Before any notable T cell activation and inflammation, fibroblasts, endothelial and myeloid cells exhibited pronounced changes in their gene expression in both cancer and injury settings. Factor analysis revealed shared Treg cell-dependent gene programs, foremost, prominent upregulation of VEGF and CCR2 signaling-related genes upon Treg cell deprivation in either setting, as well as in Treg cell-poor versus Treg cell-rich human lung adenocarcinomas. Accordingly, punctual Treg cell depletion combined with short-term VEGF blockade showed markedly improved control of PD-1 blockade-resistant lung adenocarcinoma progression in mice compared to the corresponding monotherapies, highlighting a promising factor-based querying approach to elucidating new rational combination treatments of solid organ cancers.

Preferred first-line treatment for patients with metastatic EGFR-mutant lung cancer is osimertinib, yet it is not known if patient outcomes may be improved by identifying and intervening upon molecular markers associated with therapeutic resistance.All patients with metastatic EGFR-mutant lung cancer treated with first-line osimertinib at Memorial Sloan Kettering Cancer Center (n=327) were identified. Available pre-treatment and post-progression tumor samples underwent targeted gene panel sequencing and mutational signature analysis using SigMA algorithm. Progression-free and overall survival were estimated using Kaplan Meier methods.Using multivariate analysis, baseline atypical EGFR (mPFS 5.8 mo, p0.001) and concurrent TP53/RB1 alterations (mPFS 10.5 mo, p=0.015) were associated with shorter progression-free survival on first-line osimertinib. Of 95 patients with post-progression biopsies, acquired resistance mechanisms were identified in 52% (off-target n=24, histological transformation n=14, on-target n=12), with MET amplification (n=9), small cell lung transformation (n=7) and acquired EGFR amplification (n=7) the most frequently identified mechanisms. While there was no difference in post-progression survival based on identified resistance (p=0.07), patients with subsequent second-line therapy tailored to post-progression biopsy results had improved post-progression survival (HR 0.09, p=0.006). Paired post-progression tumors had higher tumor mutational burden (p=0.008) and further dominant APOBEC mutational signatures (p=0.07) compared to pre-treatment samples.Patients with EGFR-mutant lung cancer treated with first-line osimertinib have improved survival with treatment adaptation based on identified mechanisms of resistance at time of progression using tissue-based genomic analysis. Further survival gains may be achieved using risk-based treatment adaptation of pre-treatment genomic alterations.

To investigate potential associations between B cell-related immunological changes and development of inflammatory arthritis (IA) after treatment with immune checkpoint inhibitors (ICI).Patients who developed IA (ICI-IA) and patients who did not develop immune-related adverse events (non-irAE) after receiving ICI due to metastatic melanoma were consecutively recruited. Blood samples were collected at the time of ICI-IA occurrence and at different timepoints during treatment. Peripheral blood B cell subsets during ICI treatment were analyzed by flow cytometry. Rheumatoid factor, autoantibodies against citrullinated peptides and against joint-related proteins were measured.Proportions of CD19Development of ICI-IA is accompanied by an increase in transitional B cells and by production of autoantibodies to joint-related proteins. Monitoring of B cell-driven abnormalities upon ICI treatment may help earlier recognition of ICI-IA. This article is protected by copyright. All rights reserved.

Background: We assessed the efficacy and safety of mechanical thrombectomy (MT) in adult stroke patients with anterior circulation large vessel occlusion presenting in the late time window not fulfilling the DEFUSE-3 (Thrombectomy for Stroke at 6 to 16 Hours With Selection by Perfusion Imaging trial) and DAWN (Thrombectomy 6 to 24 Hours After Stroke With a Mismatch Between Deficit and Infarct trial) inclusion criteria. Methods: Cohort study of adults with anterior circulation large vessel occlusion admitted between 6 and 24 hours after last-seen-well at 5 participating Swiss stroke centers between 2014 and 2021. Mismatch was assessed by computer tomography or magnetic resonance imaging perfusion with automated software (RAPID or OLEA). We excluded patients meeting DEFUSE-3 and DAWN inclusion criteria and compared those who underwent MT with those receiving best medical treatment alone by inverse probability of treatment weighting using the propensity score. The primary efficacy end point was a favorable functional outcome at 90 days, defined as a modified Rankin Scale score shift toward lower categories. The primary safety end point was symptomatic intracranial hemorrhage within 7 days of stroke onset; the secondary was all-cause mortality within 90 days. Results: Among 278 patients with anterior circulation large vessel occlusion presenting in the late time window, 190 (68%) did not meet the DEFUSE-3 and DAWN inclusion criteria and thus were included in the analyses. Of those, 102 (54%) received MT. In the inverse probability of treatment weighting analysis, patients in the MT group had higher odds of favorable outcomes compared with the best medical treatment alone group (modified Rankin Scale shift: acOR, 1.46 [1.02–2.10]; P =0.04) and lower odds of all-cause mortality within 90 days (aOR, 0.59 [0.37–0.93]; P =0.02). There were no significant differences in symptomatic intracranial hemorrhage (MT versus best medical treatment alone: 5% versus 2%, P =0.63). Conclusions: Two out of 3 patients with anterior circulation large vessel occlusion presenting in the late time window did not meet the DEFUSE-3 and DAWN inclusion criteria. In these patients, MT was associated with higher odds of favorable functional outcomes without increased rates of symptomatic intracranial hemorrhage. These findings support the enrollment of patients into ongoing randomized trials on MT in the late window with more permissive inclusion criteria.

Background: Maternal hypotension is an unwanted consequence of the physiologic onset of spinal blockade, and causes both maternal and fetal effects. Maternal symptoms include nausea, vomiting, and a sense of ‘‘impending doom’’ from inadequate cerebral perfusion. Inadequate treatment of hypotension can ultimately end with the loss of consciousness and cardiovascular collapse. Materials and methods: We included 80 full term parturient (ASA I or II) with uncomplicated pregnancies. The patients were prospectively randomized into two groups. 80 patients received 1000 mL NaCl 0,9 % solution before the initiation of spinal anesthesia. Maternal systolic blood pressure was measured every 1 minutes (for first 10 minutes) and then every 3 minutes. One group received ephedrine infusion (1 mg/min) with rescue ephedrine boluses (10 mg), (usually defined as a maternal blood pressure ˂ 30% above baseline), (40 patients) and the other received rescue boluses alone (10 mg) , (usually defined as a maternal blood pressure ˂ 30% above baseline), (40 patients). Results: Gr 1 (Ephedrine infusion with rescue ephedrine boluses). The incidence of hypotension was at 8 patients (8/40 [20%]),(when an absolute value of less than 90 mmHg). Gr 2 (rescue boluses ephedrine alone). The incidence of hypotension was at 32 patients (32/40 [80%]), (when an absolute value of less than 90 mmHg). Group 2 had a higher incidence of hypotension compared with group 1 (32/40 [80%]) vs (8/40 [20%]). Neonatal outcomes were not different between the 2 groups. Conclusion: Prophylactic variable rate ephedrine infusion and rescue ephedrine bolus dosing is more effective than relying on rescue ephedrine bolus dosing with respect to limiting clinician workload and maternal symptoms during spinal anesthesia for cesarean delivery.Maternal hypotension

Introduction. The choice of surgical treatment with kidney stone disease directly depends on the size of the kidney stones. According to clinical guidelines for the treatment of urolithiasis in children, the size of a kidney stone in adult patients is used to determine tactics. Normally, the longitudinal size of the kidney of a child, for example, 1-3 years old, is 2 times smaller than that of an adult, and the width of the child's ureter is 37% less than the width of the adult's ureter. But anatomical and age differences in children (infant, preschool, school and adolescence) are not taken into account. Existing prognostic nomograms for urolithiasis (Dogan, Onal, CMUN, SKS, Guy's Stone Score, S.T.O.N.E, and CROES) that are validated for use in children also do not take this into account. Thus, the size of a kidney stone, as a criterion for choosing an effective and safe method of surgical treatment, needs to be clarified. The purpose of the study: to define the concept of a large kidney stone in children of different age groups. Materials and methods. We analyzed clinical guidelines, domestic and foreign publications on the use of «kidney stone size» in children of different ages and the principles of substantiation of the term large kidney stone. 320 histories of percutaneous nephrolitholopaxy (PNL) from 2008-2019 were retrospectively and perspectively analyzed. aged from 1 to 17 years, the average age of patients is 6.6 years. The average calculus size was 26 (15-58) mm. Number of patients in different age groups: toddlers 1-3 y/o – 73, pre-school child 3-5 y/o. – 71, school child 6-12 y/o – 79, adoloscents 12-18 y/o – 97. By type of calculus: single –125 (39.1%), multiple – 68 (21.3%), K1, K2 – 46 (14.3%), K3, K4 – 81 (25.3%). The weight of the patients ranged from 8–94 kg, the average weight was 21 kg, the height was from 73–180 cm, and the average height was 120 cm. The length of the child's kidney depends on his age, the formula for calculating the length of the kidney (cm) = 6.79 + 0.22 x age (g)) Result. KSS-CDA: Kidney stone size in children different ages was proposed: KSS-CDA = (stone size (mm)/the kidney length (mm))*100%. KSS-CDA makes the interpretation of the size of kidney stones in children from different age groups objective. The definition of "Large" kidney stone is used if the size of the stone is 20% or more of the longitudinal size of the kidney in children. For example, a child is 1 year 7 months old, the stone is 15 mm, the length of the kidney is 69 mm. The SSEF is 21.74%, this kidney stone can be described as «large». The «medium» stone size is 10-20% (6-14 mm), small

BACKGROUND: Fat embolism syndrome is a life challenge syndrome. Early diagnosing and treatment can significantly improve the patient’s prognosis and likelihood of success. This syndrome occurs mainly after long bones fractures or orthopedic surgery up to 95% of diagnosed cases, but in unusual situation can be faced as well. These rare situations include diabetes mellitus, video-assisted thoracoscopies, fatty liver, and fat injection in plastic and cosmetic procedures. The likelihood of this syndrome can be increased if multiplex long bones fractures occur in the same patient simultaneously. This syndrome is usually manifested with respiratory changes (hypoxemia and ARDS), neurological focal symptoms (confusion, headache, aphasia, and hemiplegia), and skin abnormalities (petechias, and rush in conjunctiva and oral mucosa). The clinical scenario begins typically after 24−72 h of injury, and mainly, respiratory changes are the first, followed by neurological abnormalities and finally petechias as the most significant sign. CASE REPORT: In this case, we report a rare case of unexpected fat embolism syndrome after soft-tissue minimal trauma. This is the first case that we faced according to literature, and the aim of reporting this case is to emphasize that fat syndrome embolism can happen perhaps in every trauma patient even in minor soft-tissue trauma in absence of bone fractures. CONCLUSION: We strongly suggest that this case should make the physicians taking in consideration fat embolism syndrome even if bone fracture missed, to early diagnosing and adequately treating the patient, and optimizing his chances to survive.

After a three-year quarantine from the deadliest global pandemic of the last century, ASTES is organizing to gather all health professionals in Tirana, The 6th Albanian Congress of Trauma and Emergency Surgery(ACTES 2022) on 11-12 November 2022, with the topic Trauma & Emergency Surgery and not only...with the aim of providing high quality, the best standards, and the best results, for our patients ...ACTES 2022 is the largest event that ASTES (Albanian Society for Trauma and Emergency Surgery) has organized so far with 230 presentations, and 67 foreign lecturers with enviable geography, making it the largest national and wider scientific event.The scientific program is as strong as ever, thanks to the inclusiveness, where all the participants with a mix of foreign and local lecturers, select the best of the moment in medical science, innovation, and observation.The scientific committee has selected all the presentations so that the participants of each medical discipline will have something to learn, discuss, debate, and agree with updated methods, techniques, and protocols.I hope you will join us on Friday morning, and continue the journey of our two-day event together.

The potential condition of fishery sector is indeed quite large in Central Bangka Regency. The majority of fishermen in Central Bangka Regency still use traditional fishing gear and simple fishing technology. The number of fishing units used in Central Bangka Regency consists of 370 units of lift net, 1,085 units of gillnets, 129 units of bubu, 60 units of sero, 125 units of fishing rods and 4 beach seines with a fleet of 1,767 (DKP Central Bangka Regency 2019). These types of fishing gear need to be assessed for performance and selected for superior fishing units as a form of optimizing to find out the strategy for developing appropriate and superior fishing units for the fisheries sector in the mining sector in Central Bangka Regency. The method of collecting data on fishing units was carried out by accidental sampling. The number of samples taken according to the category of fishing units were 20 units of lift net, 58 units of gill nets, 8 units of bubu, 3 units of sero, 10 units of fishing rods and 1 beach seines. Based on the results of standardization of technical aspects, environmental aspects, social aspects and economic aspects, the analysis of fishing gear gillnets is the most appropriate fishing gear to be developed in Central Bangka Regency with VA = 13.26 which makes gillnets gear priority I. Priority fishing gear II is a fishing rod with VA = 12.87 and priority III is a lift net with VA = 11.56. Keywords: superior fishing gear, sustainable fishing, Central Bangka Regency

Epididymal cysts in children are rare, and, as a rule, their detection is an incidental finding, the course is asymptomatic, the surgical treatment is not carried out. Isolated torsion of these cysts is extremely rare in both children and adults, causing acute pain syndrome and swelling of the scrotum. Due to its rarity and lack of specificity of clinical and echographic manifestations, this condition leads to a delay in the accurate diagnosis of the disease, which is carried out only intraoperatively. The rare case of combined testicular torsion and torsion of a large appendage cyst in a 12-year-old teenager is presented in the publication.

Inaccessibility to eye-care services may have a negative impact on the quality of life. Financial constraints and a shortage of professional eye care practitioners are among the main hindrances to implementing comprehensive eye care in most countries. Vision screening is commonly used to identify those who may have undetected vision problems. However, the existing instrument-based vision screening is also less than ideal. Online Eye Screening: Questionnaire and Vision Tests (OES:QVT) is developed as a new alternative vision screening when existing vision screening is impractical due to the time-cost-labour practicality challenge of equipment-based vision screening. There were three phases of the OES:QVT innovation process: (1) idea generation to enhance eye care accessibility for underprivileged communities; (2) problem-solving tactic to remove the dependency on instruments in existing vision screening style; (3) implementation – by substituting inconvenient instrument-based vision screening with a hybrid of the questionnaire and online vision tests. OES:QVT harnesses both benefits of questionnaires and simple vision tests to cover major vision problems for wide-ranging age groups. OES: QVT consists of three versions – adult version, paediatric version and people with intellectual disabilities version. OES:QVT displays good consistency and accuracy of vision screening via solid content and criteria validation. OES:QVT lessens the burden of expensive equipment-based vision screening by forming a hybrid between questionnaires and online vision tests. OES:QVT offers an alternative option when an ideal sophisticated vision screening program and full eye examination are not feasible.

Small cell lung cancer (SCLC) is characterized by morphologic, epigenetic and transcriptomic heterogeneity. Subtypes based upon predominant transcription factor expression have been defined that, in mouse models and cell lines, exhibit potential differential therapeutic vulnerabilities, with epigenetically distinct SCLC subtypes also described. The clinical relevance of these subtypes is unclear, due in part to challenges in obtaining tumor biopsies for reliable profiling. Here we describe a robust workflow for genome-wide DNA methylation profiling applied to both patient-derived models and to patients’ circulating cell-free DNA (cfDNA). Tumor-specific methylation patterns were readily detected in cfDNA samples from patients with SCLC and were correlated with survival outcomes. cfDNA methylation also discriminated between the transcription factor SCLC subtypes, a precedent for a liquid biopsy cfDNA-methylation approach to molecularly subtype SCLC. Our data reveal the potential clinical utility of cfDNA methylation profiling as a universally applicable liquid biopsy approach for the sensitive detection, monitoring and molecular subtyping of patients with SCLC.

Purpose: RB1 mutations and loss of retinoblastoma (Rb) expression represent consistent but not entirely invariable hallmarks of small cell lung cancer (SCLC). The prevalence and characteristics of SCLC retaining wild-type Rb are not well-established. Furthermore, the performance of targeted next-generation sequencing (NGS) versus immunohistochemistry for Rb assessment is not well-defined. Experimental Design: A total of 208 clinical SCLC samples were analyzed by comprehensive targeted NGS, covering all exons of RB1, and Rb IHC. On the basis of established coordination of Rb/p16/cyclinD1 expression, p16-high/cyclinD1-low profile was used as a marker of constitutive Rb deficiency. Results: Fourteen of 208 (6%) SCLC expressed wild-type Rb, accompanied by a unique p16-low/cyclinD1-high profile supporting Rb proficiency. Rb-proficient SCLC was associated with neuroendocrine-low phenotype, combined SCLC with non-SCLC (NSCLC) histology and aggressive behavior. These tumors exclusively harbored CCND1 amplification (29%), and were markedly enriched in CDKN2A mutations (50%) and NSCLC-type alterations (KEAP1, STK11, FGFR1). The remaining 194 of 208 SCLC were Rb-deficient (p16-high/cyclinD1-low), including 184 cases with Rb loss (of which 29% lacked detectable RB1 alterations by clinical NGS pipeline), and 10 cases with mutated but expressed Rb. Conclusions: This is the largest study to date to concurrently analyze Rb by NGS and IHC in SCLC, identifying a 6% rate of Rb proficiency. Pathologic-genomic data implicate NSCLC-related progenitors as a putative source of Rb-proficient SCLC. Consistent upstream Rb inactivation via CDKN2A/p16↓ and CCND1/cyclinD1↑ suggests the potential utility of CDK4/6 inhibitors in this aggressive SCLC subset. The study also clarifies technical aspects of Rb status determination in clinical practice, highlighting the limitations of exon-only sequencing for RB1 interrogation. See related commentary by Mahadevan and Sholl, p. 4603

Purpose: Clinical patterns and the associated optimal management of acquired resistance to PD-(L)1 blockade are poorly understood. Experimental Design: All cases of metastatic lung cancer treated with PD-(L)1 blockade at Memorial Sloan Kettering were reviewed. In acquired resistance (complete/partial response per RECIST, followed by progression), clinical patterns were distinguished as oligo (OligoAR ≤ 3 lesions of disease progression) or systemic (sAR). We analyzed the relationships between patient characteristics, burden/location of disease, outcomes, and efficacy of therapeutic interventions. Results: Of 1,536 patients, 312 (20%) had an initial response and 143 developed AR (9% overall, 46% of responders). OligoAR was the most common pattern (80/143, 56%). Baseline tumor mutational burden, depth of response, and duration of response were significantly increased in oligoAR compared with sAR (P < 0.001, P = 0.03, P = 0.04, respectively), whereas baseline PD-L1 and tumor burden were similar. Post-progression, oligoAR was associated with improved overall survival (median 28 months vs. 10 months, P < 0.001) compared with sAR. Within oligoAR, post-progression survival was greater among patients treated with locally-directed therapy (e.g., radiation, surgery; HR, 0.41; P = 0.039). Fifty-eight percent of patients with oligoAR treated with locally-directed therapy alone are progression-free at last follow-up (median 16 months), including 13 patients who are progression-free more than 2 years after local therapy. Conclusions: OligoAR is a common and distinct pattern of acquired resistance to PD-(L)1 blockade compared with sAR. OligoAR is associated with improved post-progression survival and some cases can be effectively managed with local therapies with durable benefit.

The purpose of this research is to learn about the concept of the Balagan Method which is applied in the Al-Jihad Islamic Boarding School, and to find out how to apply the Balagan method to achieve the goal of teaching grammar rules (Al-qowa'id An-nahwiyah) as well as exploring the advantages and disadvantages. and his shortcomings through the book Syarh Ibnu 'Aqil' Alal Alfiyah at the Al-Jihad Islamic Boarding School, West Bandung. This research uses descriptive qualitative method, namely by means of data collection, observation, interviews, and documents. Namely the data analysis method sugested by Meles Huberman. This research proves the existence of a method in teaching grammar rules (Al-qowa'id An-nahwiyah) and exploring its strengths and weaknesses through the book Syarh Ibnu 'Aqil' Alal Alfiyah at Al-Jihad Islamic Boarding School, West Bandung. And also this method is the suggested method to be applied in learning grammar (Al-qowa'id An-nahwiyah). Abstrak Tujuan dari penelitian ini adalah untuk mempelajari tentang konsep Metode Balagan yang diterapkan di Pondok Pesantren Al-Jihad, dan untuk mengetahui bagaimana menerapkan metode Balagan ntuk mencapai tujuan dalam mengajarkan aturan tata bahasa (Al-qowa’id An-nahwiyah) Serta menggali kelebihan dan kekurangan-Nya melalui buku Syarh Ibnu ‘Aqil ‘Alal Alfiyah di Pondok Pesantren Al-Jihad Bandung Barat. Penelitian ini menggunakan metode deskriptif kualitatif yaitu dengan cara pengumpulan data, observasi, wawancara, dan dokumen. Yaitu Metode analisis data menurut Meles Huberman. Penelitian tersebut membuktikan adanya metode dalam mengajarkan aturan tata bahasa (Al-qowa’id An-nahwiyah) Serta menggali kelebihan dan kekurangan-Nya melalui buku Syarh Ibnu ‘Aqil ‘Alal Alfiyah di Pondok Pesantren Al-Jihad Bandung Barat. Dan juga metode ini metode yang diasarankan untuk duterapkan dalam pembelajaran tata bahasa (Al-qowa’id An-nahwiyah). ملخص البحث الأهداف من هذه الدراسة هي التعرف على مفهوم طريقة بلاغان المطبق في معهد الجهاد، ولمعرفة كيفية تنفيذ طريقة بلاغان لتحقيق الأهداف في تعليم القواعد النحوية من خلال كتاب شرح ابن عقيل على الألفية بمعهد الجهاد باندونج الغربية، والكشف على المزايا والعيوب الموجودة في تعليم القواعد النحوية من خلال كتاب شرح ابن عقيل على الألفية باستخدام طريقة بلاغان. هذه الدراسة تسلك منهج الوصف التحليلي، وهو المنهج النوعي والطرق الوصفية النوعية بطريقة جمع البيانات، والملاحظة، والمقابلة، والوثيقة. وكان أسلوب تحليل البيانات على ما يقترحها ميلس حوبرمان. أثبتت الدراسة وجود الطريقة في تعليم القواعد النحوية من خلال كتاب شرح ابن عقيل على الألفية بمعهد الجهاد بندونج الغربية. وأيضا من الطرق المقترحة للاستفادة في التعليم. وذلك بأن يجعل هذه الطريقة مطبقة في سير التعليم القواعد النحوية

Latar Belakang: Perkembangan teknologi informasi yang pesat mempengaruhi dunia bisnis, salah satu fungsi internet yang menjadi fokus penelitian ini adalah kemampuannya dalam melakukan kegiatan pemasaran baik produk dan brand image secara online bagi siapapun yang membutuhkan dan terhubung dengan media internet. Hal inilah yang disebut dengan e-marketing. Tujuan: Penelitian ini bertujuan untuk mengetahui gambaran tentang harga, kepercayaan, e-service quality dan keputusan konsumen membeli barang secara online pada masyarakat Desa Lembontonara Kabupaten Morowali Utara. Metode: Penelitian yang digunakan adalah jenis penelitian deskriptif dan verifikatif. Pengumpulan data menggunakan teknik penelitian melalui kuesioner dan studi pustaka. Analisis data yang digunakan dalam penelitian ini menggunakan analisis deskriptif, selain itu penelitian ini juga menggunakan analisis regresi linear berganda, uji asumsi klasik, uji normalitas, uji multikolinearitas, uji heteroskedastisitas dan uji hipotesis yang mencangkup uji simultan (uji F), Uji Persial (uji t) dan Koefesien Determinasi (uji R2). Hasil: Penelitian ini menunjukkan bahwa harga kepercayaan dan e-service quality berpengaruh signifikan terhadap Keputusan pembelian di desa Lembontonara. Selanjutnya harga berpengaruh signifikan terhadap keputusan pembelian di desa Lembontonara sebesar 17,4%. Kemudian kepercayaan berpengaruh signifikan terhadap keputusan pembelian di desa Lembontonara sebesar 41,7%. Dan E-Service quality berpengaruh signifikan terhadap keputusan pembelian di desa Lembontonara sebesar 58,4%. Kesimpulan: Penelitian ini menyimpulkan bahwa harga kepercayaan dan e-service, keputusan, berpengaruh signifikan terhadap Keputusan pembelian di desa Lembontonara.

INTRODUCTION Penile glans amputation during circumcision is a rare but potentially devastating complication. The mechanism and causes are poorly understood and incomprehensible. It is important to identify the causes of these complications, to suggest a mechanism and to propose prevention measures. MATERIALS Between 2005 and 2019, six patients with penile glans amputationafter circumcision were analyzed. All were operated without medical evidence, for religious reasons. THE RESULTS The operations were performed by local anesthesia, at home - in 5 patients, in 1 child - at polyclinic. All children were circumcised by scalpel with guillotine method, without visualization of glans. Partial amputation of penile glans was observed in 2 children (33.3%). Complete cut-off of the glans at the level of the coronal sulcus was revealed in 4 boys (66.6%). Meatoplasty with urethral mobilizations was performed 2 patients (33.3%) with partial amputation. The tops of corpus cavernous was covered of with the remnants of the skin of penile shaft in two boys (33.3%). Glansplasty was performed in 2 other patients (33/3%), using a labial mucosa graft to reconstruct the shape of glans and glanular groove. The follow up have showed meatostenosis in two boys (33.3%) in the first 2 months after surgery. One child required repeated meatoplasty (16.6%), another had a recovery of normal urine flow rates after urethral dilatation and stenting (4 weeks). CONCLUSION Visual control of the glans position during circumcision will prevent the amputation. "Guillotine" techniques including, Mogen clamp-type devices, are considered potentially dangerous. Circumcision in newborns, without general anesthesia, in the presence of swelling of the foreskin have an increased risk of glans damage. Preliminary examination of the glans and adequate release of preputial adhesions help to prevent complication of circumcision and to identify combined malformations (hypospadia, epispadia, concealed penis.).

Introduction: While acute Coronavirus disease 2019 (COVID-19) affects the cardiovascular (CV) system according to recent data, an increased CV risk has been reported also during long-term follow-up (FU). In addition to other CV pathologies in COVID-19 survivors, an enhanced risk for arrhythmic events and sudden cardiac death (SCD) has been observed. While recommendations on post-discharge thromboprophylaxis are conflicting in this population, prophylactic short-term rivaroxaban therapy after hospital discharge showed promising results. However, the impact of this regimen on the incidence of cardiac arrhythmias has not been evaluated to date.Methods: To investigate the efficacy of this therapy, we conducted a single center, retrospective analysis of 1804 consecutive, hospitalized COVID-19 survivors between April and December 2020. Patients received either a 30-day post-discharge thromboprophylaxis treatment regimen using rivaroxaban 10 mg every day (QD) (Rivaroxaban group (Riva); n = 996) or no thromboprophylaxis (Control group (Ctrl); n = 808). Hospitalization for new atrial fibrillation (AF), new higher-degree Atrioventricular-block (AVB) as well as incidence of SCD were investigated in 12-month FU [FU: 347 (310/449) days].Results: No differences in baseline characteristics (Ctrl vs Riva: age: 59.0 (48.9/66.8) vs 57 (46.5/64.9) years, p = n.s.; male: 41.5% vs 43.7%, p = n.s.) and in the history of relevant CV-disease were observed between the two groups. While hospitalizations for AVB were not reported in either group, relevant rates of hospitalizations for new AF (0.99%, n = 8/808) as well as a high rate of SCD events (2.35%, n = 19/808) were seen in the Ctrl. These cardiac events were attenuated by early post-discharge prophylactic rivaroxaban therapy (AF: n = 2/996, 0.20%, p = 0.026 and SCD: n = 3/996, 0.30%, p < 0.001) which was also observed after applying a logistic regression model for propensity score matching (AF: χ2-statistics = 6.45, p = 0.013 and SCD: χ2-statistics = 9.33, p = 0.002). Of note, no major bleeding complications were observed in either group.Conclusion: Atrial arrhythmic and SCD events are present during the first 12 months after hospitalization for COVID-19. Extended prophylactic Rivaroxaban therapy after hospital discharge could reduce new onset of AF and SCD in hospitalized COVID-19 survivors.

N,N-dimethyltryptamine (DMT) is distinct among classic serotonergic psychedelics because of its short-lasting effects when administered intravenously. Despite growing interest in the experimental and therapeutic use of intravenous DMT, data are lacking on its clinical pharmacology. We conducted a double-blind, randomized, placebo-controlled crossover trial in 27 healthy participants to test different intravenous DMT administration regimens: placebo, low infusion (0.6 mg/min), high infusion (1 mg/min), low bolus + low infusion (15 mg + 0.6 mg/min), and high bolus + high infusion (25 mg + 1 mg/min). Study sessions lasted for 5 h and were separated by at least 1 week. Participant’s lifetime use of psychedelics was ≤20 times. Outcome measures included subjective, autonomic, and adverse effects, pharmacokinetics of DMT, and plasma levels of brain-derived neurotropic factor (BDNF) and oxytocin. Low (15 mg) and high (25 mg) DMT bolus doses rapidly induced very intense psychedelic effects that peaked within 2 min. DMT infusions (0.6 or 1 mg/min) without a bolus induced slowly increasing and dose-dependent psychedelic effects that reached plateaus after 30 min. Both bolus doses produced more negative subjective effects and anxiety than infusions. After stopping the infusion, all drug effects rapidly decreased and completely subsided within 15 min, consistent with a short early plasma elimination half-life (t1/2α) of 5.0–5.8 min, followed by longer late elimination (t1/2β = 14–16 min) after 15–20 min. Subjective effects of DMT were stable from 30 to 90 min, despite further increasing plasma concentrations, thus indicating acute tolerance to continuous DMT administration. Intravenous DMT, particularly when administered as an infusion, is a promising tool for the controlled induction of a psychedelic state that can be tailored to the specific needs of patients and therapeutic sessions.Trial registration: ClinicalTrials.gov identifier: NCT04353024

Objective: To assess a multi-pronged strategy using primarily digital methods to equitably recruit asthma patients into a clinical trial of a digital health intervention. Methods: We approached eligible patients using at least one of eight recruitment strategies. We recorded approach dates and the strategy that led to completion of a web-based eligibility questionnaire that was reported during the verbal consent phone call. Study team members conducted monthly sessions using a structured guide to identify recruitment barriers and facilitators. The proportion of participants who reported being recruited by a portal or non-portal strategy was measured as our outcomes. We used Fisher’s Exact test to compare outcomes by equity variable, and multivariable logistic regression to control for each covariate and adjust effect size estimates. Using grounded theory, we coded and extracted themes regarding recruitment barriers and facilitators. Results: The majority (84.4%) of patients who met study inclusion criteria were patient portal enrollees. Of 6366 eligible patients who were approached, 627 completed the eligibility questionnaire and were less frequently Hispanic, less frequently Spanish-speaking, and more frequently patient portal enrollees. Of 445 patients who consented to participate, 241 (54.2%) reported completing the eligibility questionnaire after being contacted by a patient portal message. In adjusted analysis, only race (OR 0.46 [(0.28, 0.77)], p=0.003) and college education (OR 0.60, 95% CI [0.39, 0.91], p = 0.016) remained significant. Key recruitment barriers included technology issues (e.g., lack of email access) and facilitators included bilingual study staff, Spanish-language recruitment materials, targeted phone calls, and clinician-initiated “1-click” referrals. Discussion/Conclusion: A primarily digital strategy to recruit patients into a digital health trial is unlikely to achieve equitable participation, even in a population overrepresented by patient portal enrollees. Non-digital recruitment methods that address racial and educational disparities and less active portal enrollees are necessary to ensure equity in clinical trial enrollment.

Objective We examined undergraduates' concerns about returning to campus and online learning from home. Participants Undergraduates majoring in STEM (Science, Technology, Engineering, and Mathematics) at US universities/colleges. Methods Participants completed an online survey in July 2020. We content-analyzed responses to open-ended questions about concerns about fall 2020. Results Students (N = 64) were 52% women, 47% low socioeconomic status (SES), and 27% non-Hispanic white. Concerns about returning to campus included student noncompliance with university COVID-19 prevention guidelines (28%), infection risk (28%), poor instructional quality (26%), inadequate university plans for preventing/handling outbreaks (25%), negative impacts on social interactions (11%), and transportation/commuting (11%). Concerns about learning from home included difficulty focusing on schoolwork (58%), lack of hands-on/experiential learning (24%), negative impacts on social interactions (19%), family/home environment (15%), concerns that online learning wastes time/money (10%), and inadequate technology/Internet access (5%). Conclusions Universities should address student concerns and provide resources to overcome barriers to effective learning.

IntroductionWhile in the CASTLE-AF trial, in patients with atrial fibrillation and heart failure with reduced ejection fraction, interventional therapy using pulmonary vein isolation was associated with outcome improvement, data on cavotricuspid isthmus ablation (CTIA) in atrial flutter (AFL) in the elderly is rare.MethodsWe included 96 patients between 60 and 85 years with typical AFL and heart failure with reduced or mildly reduced ejection fraction (HFrEF/HFmrEF) treated in two medical centers. 48 patients underwent an electrophysiological study with CTIA, whereas 48 patients received rate or rhythm control and guideline-compliant heart failure therapy. Patients were followed up for 2 years, with emphasis on left ventricular ejection fraction (LVEF) over time. Primary endpoints were cardiovascular mortality and hospitalization for cardiac causes.ResultsPatients with CTIA showed a significant increase in LVEF after 1 (p p p = 0.003). In the multivariate regression analysis, CTIA remained the relevant factor associated with LVEF improvement (HR: 2.845 CI:95% 1.044–7.755; p = 0.041). Elderly patients (≥ 70 years) further benefited from CTIA, since they showed a significantly reduced rehospitalization (p = 0.042) and mortality rate after 2 years (p = 0.013).ConclusionsCTIA in patients with typical AFL and HFrEF/HFmrEF was associated with significant improvement of LVEF and reduced mortality rates after 2 years. Patient age should not be a primary exclusion criterion for CTIA, since patients ≥70 years also seem to benefit from intervention in terms of mortality and hospitalization.

Supplementary Figures related to Figures 1-6

Processed data for bulk RNA-seq of primary tumors isolated from KP, KPS-HET and KPS animals

Processed data for bulk ATAC-seq of isogenic SMARCA4-WT and -KO cell lines

Mutations and copy number alterations in PDX models used in this study