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Introduction: Severe COVID-19 is associated with a dysregulated immune response that usually leads to cytokine release syndrome. This study aimed to compare the use of extracorporeal blood purification therapy (Oxiris®) versus standard continuous renal replacement therapy (CRRT) in critically-ill patients with severe COVID-19.Methods: This was a national, multicenter, retrospective study of patients with COVID-19 admitted to the intensive care unit (ICU) between March and October 2020 who required CRRT. Patients were categorized into two groups: Oxiris®CRRT and standard CRRT. The primary outcome was the number of patients alive and ventilator-free at 30-days post-CRRT treatment. Key secondary endpoints included change in inflammatory markers, Sequential Organ Failure Assessment (SOFA) scores, and PaO2/FiO2ratio at 24- and 72-h post Oxiris®initiation.Results: Thirty-five patients received Oxiris®CRRT and 23 patients received standard CRRT. The primary outcome was 31.4% in the Oxiris®group versus 4.3% in the standard CRRT group (adjusted odds ratio 5.97, 95% confidence interval [CI], 0.64–55.6; p= 0.117). In the Oxiris®group, interleukin-6 (IL-6) concentrations significantly decreased at 24 and 72-h (p= 0.033) and PaO2/FiO2ratio significantly increased at 24 and 72 h after Oxiris®initiation (p= 0.001). There was no significant change in SOFA scores at 24- and 72-h after Oxiris®initiation.Conclusion: The number of patients alive and ventilator-free at 30-days was higher in the Oxiris®group than that in the standard CRRT group; however, the difference did not reach statistical significance after adjusting for the baseline severity of illness. There was a significant reduction in IL-6 and significant improvement in PaO2/FiO2ratio after Oxiris®CRRT initiation.

Desalination of brackish groundwater has great potential to alleviate the problem of the limited water resources in Egypt. In this paper, we studied the desalination of brackish water for irrigation purposes using capacitive deionization (CDI) technology. We investigated a modular unit for use in greenhouses (GH). A GH for the production of tomato requires about 3.2 m3/d of water. The target CDI unit has a production capacity of 32 m3/d for irrigation of 10 greenhouses from brackish water. The paper provides an extensive simulation study to illustrate the influence of various design parameters and to unveil the CDI technology pros and cons and its inherent limitations. Although the CDI unit provides comparable energy consumption to typical reverse osmosis units, it does not require frequent replacement of membranes, and the activated carbon can easily be manufactured using local material.

One of the popular area of research for the past decade in the academia as well as in the industry is networked control systems (NCS). Variable time delays induced by the network and data packet dropout during transmission of data are among the problems encountered in these type of systems. Researchers proposed and developed various control strategies over the past years to deal with the above-mentioned problem. Fuzzy logic control (FLC) is a widely used technique for dealing with control problems, and the most commonly used one is type-1 FLC. However, the interval type-2 (IT2) is proven to be better at handling uncertainties compared to the type-1 FLC. In this paper, a nonlinear NCS with delays is considered, and an observer-based IT2 FLC is designed in order to improve the control of NCS due to the presence of uncertainties and delays. The developed scheme includes the design of a state feedback controller based on IT2 FLC, and an observer-based IT2 FLC using Lyapunov–Krasovskii theory. To investigate the effectiveness of the proposed scheme, simulations are performed considering various network delays. Firstly, the results of IT2 FLCs are compared with that of type-1 FLCs and improvement is observed. Secondly, the newly developed observer-based IT2 FLC is compared with the IT2 state feedback FLC developed in the literature. Results show faster and more effective response using the newly developed technique.

Background: Magnetic sphincter augmentation (MSA) is an alternative treatment option to laparoscopic fundoplication (LF) for patients with gastroesophageal reflux disease. To date, over 40,000 devices have been implanted worldwide since first approval in Europe in 2010 and the USA in 2012. Despite this clinical reality, the long-term safety and effectiveness of the procedure continues to be questioned. This study aims to systematically summarize and appraise the currently available evidence for MSA relative to effectiveness, safety, and healthcare resource use.Methods: A systematic literature search was carried out to identify all clinical studies published in English, as of February 15, 2023. Required endpoints were safety, effectiveness, and cost effectiveness.Results: The systematic search identified 212 publications and 14 entries in study registries. After screening and full text analysis, 82 publications were included in qualitative synthesis. One RCT established superiority of MSA compared to twice daily proton-pump inhibitors with respect to the elimination of moderate to severe regurgitation (89% vs 10%, RR 0.11, 95% CI 0.06-0.20, P< 0.001). Eleven cohort studies comparing MSA to LF showed no statistical difference in safety profile and effectiveness measured by post-operative GERD-HRQL score. In addition, patients undergoing MSA significantly retained the ability to belch and vomit when compared to LF. These results were consistent in follow-up out to 7 years.Conclusions: LINX has been shown to provide long lasting relief to patients suffering from persistent GERD while maintaining an acceptable safety profile. As an outpatient day-procedure, MSA is cost effective with short recovery.

IMPORTANCE: Three-dimensional (3-D) volume rendering has been shown to improve visualization in general surgery. Cinematic rendering (CR), a novel 3-D visualization technology for postprocessing of computed tomographaphy (CT) images, provides photorealistic images with the potential to improve visualization of anatomic details. OBJECTIVE: To determine the value of CR for the comprehension of the surgical anatomy. DESIGN, SETTING, AND PARTICIPANTS: This preclinical, randomized, 2-sequence crossover study was conducted from February to November 1, 2018, at University Hospital of Erlangen, Germany. The 40 patient cases were evaluated by 18 resident and attending surgeons using a prepared set of CT and CR images. The patient cases were randomized to 2 assessment sequences (CR-CT and CT-CR). During each assessment period, participants answered 1 question per case that addressed crucial issues of anatomic understanding, preoperative planning, and intraoperative strategies. After a washout period of 2 weeks, case evaluations were crossed over to the respective second image modality. MAIN OUTCOMES AND MEASURES: The primary outcome measure was the correctness of answers. Secondary outcome was the time needed to answer. RESULTS: The mean (SD) interperiod differences for the percentage of correct answers in the CR-CT sequence (8.5% [7.0%]) differed significantly from those in the CT-CR sequence (−13.1% [6.3%]) (P &lt; .001). The mean (SD) interperiod differences for the time spent to answer the questions in the CR-CT sequence (−18.3 [76.9] seconds) also differed significantly from those in the CT-CR sequence (52.4 [88.5] seconds) (P &lt; .001). Subgroup analysis revealed that residents as well as attending physicians benefitted from CR visualization. Analysis of the case assessment questionnaire showed that CR added significant value to the comprehension of the surgical anatomy (overall mean [SD] score, 4.53 [0.75]). No carryover or period effects were observed. CONCLUSIONS AND RELEVANCE: The visualization with CR allowed a more correct and faster comprehension of the surgical anatomy compared with conventional CT imaging, independent of level of surgeon experience. Therefore, CR may assist general surgeons with preoperative preparation and intraoperative guidance.

Boiler is a steam generating device that is used to generate electricity and provide heat in process industry and buildings. The generation of steam is carried out by harnessing thermal energy generated via combustion process. The key challenges that are posed in this process are harmful nitric oxide emissions and the energy losses from the total energy contained in the fuel. It is highly required to reduce these losses to improve boiler efficiency; however, when the operational parameters are adjusted to maximize boiler efficiency, the nitric oxide formation is adversely affected, that is, nitric oxide formation also goes up. Moreover, a little change in demand of steam may cause disturbance in all the dynamics of boiler which may go unstable if not controlled properly. All these issues necessitate measures to be taken to optimize boiler efficiency and nitric oxide as well as to regulate operational parameters like drum pressure and drum level all at the same time. In this work, a detailed study has been carried out to investigate how thermal nitric oxide emissions, combustion process and dynamics of boiler interact with each other. In this respect, dynamic models of nitric oxides, efficiency and other operational variables of boiler have been investigated, and these models have been combined to form a joint model of whole boiler system. This model is then utilized to form an efficient control of boiler variables along with trade-off-based optimization between efficiency and thermal nitric oxide emission. The results have been formed using an experimental input data from a typical package boiler to ensure the practicability of the proposed technique.

Linear accelerometers can be used to retrieve the angular motion of the body they are attached to if their measurements are handled in an appropriate way. In this paper, an 18-accelerometer configuration is used to facilitate angular motion determination. Various measurement models are investigated where each model utilizes different accelerometers’ measurements. These models are used to build linear and nonlinear filters. The filters performances are evaluated and the associated sign ambiguity problem is solved. It is shown that a norm-constrained Kalman filters bank will give the best results. This work can be used within inertial navigation systems as a replacement of the gyroscopes.

Obesity has become a major health problem in the industrialized world. Immune regulation plays an important role in adipose tissue homeostasis; however, the initial events that shift the balance from a noninflammatory homeostatic environment toward inflammation leading to obesity are poorly understood. Here, we report a role for the costimulatory molecule programmed death-ligand 1 (PD-L1) in the limitation of diet-induced obesity. Functional ablation of PD-L1 on dendritic cells (DCs) using conditional knockout mice increased weight gain and metabolic syndrome during diet-induced obesity, whereas PD-L1 expression on type 2 innate lymphoid cells (ILC2s), T cells, and macrophages was dispensable for obesity control. Using in vitro cocultures, DCs interacted with T cells and ILC2s via the PD-L1:PD-1 axis to inhibit T helper type 1 proliferation and promote type 2 polarization, respectively. A role for PD-L1 in adipose tissue regulation was also shown in humans, with a positive correlation between PD-L1 expression in visceral fat of people with obesity and elevated body weight. Thus, we define a mechanism of adipose tissue homeostasis controlled by the expression of PD-L1 by DCs, which may be a clinically relevant finding with regard to immune-related adverse events during immune checkpoint inhibitor therapy.

Steam fraction in riser tubes of boilers is a critical process variable which impacts the life of the tubes and could lead to tube rupture, long boiler down time, and expensive repairs. Unfortunately this parameter is difficult to measure by hardware sensors. This article presents a new neural network softsensor for estimation and monitoring steam mass and volume fractions in riser tubes. First, conventional data were collected from a target industrial boiler. The data are then used to develop a detailed nonlinear simulation model for the two phase flow in the riser tubes and risers and downcomers water circulation. The model output is verified against the collected field data. Next, the boiler nonlinear model is used to generate data covering a wide rage of operating conditions for training and testing the neural network. The input of the neural network includes the heating power, the steam flow rate, the water feed rate, the drum level, and the drum pressure. The neural networks predict the mass steam quality and the steam volume fractions. The softsensor achieves a root mean square error on the test data less than 1.5%. The predicted steam quality is then compared with the critical limits to guide the operators for safe and healthy operation of the boilers. The developed softsensor for estimation of the steam quality has simple structure and can be implemented easily at the operator stations or the application servers.

Phonetic dictionaries are essential components of large-vocabulary speaker-independent speech recognition systems. This paper presents a rule-based technique to generate phonetic dictionaries for a large vocabulary Arabic speech recognition system. The system used conventional Arabic pronunciation rules, common pronunciation rules of Modern Standard Arabic, as well as some common dialectal cases. The paper gives in detail an explanation of these rules as well as their formal mathematical presentation. The rules were used to generate a dictionary for a 5.4 hour corpus of broadcast news. The rules and the phone set were tested and evaluated on an Arabic speech recognition system. The system was trained on 4.3 hours of the 5.4 hours of Arabic broadcast news corpus and tested on the remaining 1.1 hours. The phonetic dictionary contains 23,841 definitions corresponding to about 14232 words. The language model contains both bi-grams and tri-grams. The Word Error Rate (WER) came to 9.0%.

In a multifunction radar, the maximum number of targets that can be managed or tracked is an important performance measure. Interleaving algorithms developed to operate radars exploit the dead-times between the transmitted and the received pulses to allocate new tracking tasks that might involve transmitting or receiving pulses, thus increasing the capacity of the system. The problem of interleaving N targets involves a search among N! possibilities, and suboptimal solutions are usually employed to satisfy the real-time constraints of the radar system. In this paper, we present new tight 0–1 integer programming models for the radar pulse interleaving problem and develop effective solution methods based on Lagrangian relaxation techniques. © 2003 Wiley Periodicals, Inc. Naval Research Logistics, 2004.

Conversion of Arabic script into phonetic rules is one of the major obstacles facing the researchers on Arabic text-to-speech systems and speech recognition. Although Arabic is one of the oldest languages that its sounds and phonological rules were extensively studied and documented (more than 12 centuries ago), these valuable studies need to be compiled from scattered literatures and formulated in a modern mathematical frame work.

Proposes a diphone/sub-syllable method for Arabic Text-to-Speech systems. Examination of the syllabic structure of Arabic language; Methodology; Results and discussion.

Low molecular weight heparins are rarely associated with thrombocytosis. However, the safety of transitioning to unfractionated heparin is unknown.

Recently, the technology of floating photovoltaic panels has demonstrated several advantages over land installations, including faster deployment, less maintenance cost, and higher efficiency. Lake Nasser is the second largest man-made freshwater lake in the world with a surface area of almost 5000 square km. Being in one of the hottest areas in the world, evaporation of water causes loss of very precious and scarce resources: freshwater. Fortunately, the lake is also located in a very rich area in solar energy. This paper presents a study to utilize Lake Nasser’s surface for massive production of solar energy, while significantly reducing the loss of water by evaporation from the lake surface. The project has the potential to be one of the largest producers of low-cost clean electric energy in the world for Europe and the Middle East and North Africa (MENA) region, especially with the ongoing efforts to connect the North African countries with the European super power grid. The study shows that the first phase of the project is expected to deliver about 16% of European need of electricity and save about 3 billion m3 of freshwater. The subsequent phases will provide low-cost green energy to replace the combustible fuels in Europe by 2045, while saving up to 10-12 billion m3 of freshwater lost by evaporation from Lake Nasser.