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Background This paper attempts to evaluate the primary health care system by evaluating health centres in Greece. Methods Malmquist Index Data Envelopment Analysis is applied to study the total productivity of 155 health centres in Greece during 2016–2018. The data were collected from the Ministry of Health and submitted to quality tests to ensure validity and avoid bias. Results This paper measures the productivity of each of the 155 health centres in Greece and how it shifted during 2016–2018. In addition, the overall productivity change of the 155 health centres over time is calculated and analysed as being due to technical efficiency or technological efficiency. The analysis of the mean values showed a decrease of 0.9% in the overall productivity factor from 2016 to 2017 and a decrease of 5.2% from 2017 to 2018. The overall decrease in the productivity of the 155 health centres was 3.1%. From 2016 to 2018, 59 health centres changed their productivity mainly due to technological change and 91 changed mainly due to technical efficiency change. One health centre showed regression to its total productivity due to equal regression of its technical efficiency and technology. Conclusions The method used is nonparametric data envelopment analysis along with the Malmquist index to include panel data in the analysis. Meaningful results were extracted by indicating the number of health centres that improved their productivity, regressed in productivity, or remained constant through the period 2016–2018. This paper may contribute to improving health centres’ efficiency and productivity. Furthermore, valuable results can be extracted for the National Health Care System to match available resources that correspond to each health centre’s needs, as well as for manager planners and stakeholders in primary health care.

Objective: To propose a deep-learning network for the diagnosis of two corneal diseases: Fuchs’ endothlelial dystrophy and keratoconus, based on optical coherence tomography (OCT) images of the cornea. Methods: In this paper, we propose a novel network with parallel resolution-specific encoders and composite classification features to directly diagnose Fuchs’ endothelial dystrophy and keratoconus using OCT images. Our proposed network consists of a multi-resolution input, multiple parallel encoders, and a composite of convolutional and dense features for classification. The purpose of using parallel resolution-specific encoders is to perform multi-resolution feature fusion. Also, using composite classification features enhances the dense feature learning. We implemented other related networks for comparison with our network and performed k-fold cross-validation on a dataset of 16,721 OCT images. We used saliency maps and sensitivity analysis to visualize our proposed network. Results: The proposed network outperformed other networks with an image classification accuracy of 0.91 and a scan classification accuracy of 0.94. The visualizations show that our network learned better features than other networks. Significance: The proposed methods can potentially be a step towards the early diagnosis of corneal diseases, which is necessary to prevent their progression, hence, prevent loss of vision.

Key summary points Aim To investigate the association between psychotropic drug use and handgrip strength in older hospitalized patients. Findings Psychotropic drug use was linearly associated with handgrip strength, with the greatest reduction in handgrip strength between zero and two psychotropic drugs. Message Psychotropic drug use should be kept as low as possible in treatment of older patients. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-021-00511-6., Purpose Handgrip strength is an indicator of frailty and longevity in older adults. The association between psychotropic drug use and handgrip strength in older hospitalized patients was investigated in this study. Methods A total of 488 patients were included in this retrospective cross-sectional study, 333 women and 155 men, from two different cohorts of older (mean age 84 years) hospitalized in-patients. We used multiple linear regression models to explore the association between psychotropic drug use and handgrip strength. We adjusted for factors known to affect handgrip strength: Age, gender, body mass index (BMI) and comorbidity (Charlson comorbidity index). Results Both unadjusted and adjusted analyses showed that psychotropic drug use was associated with handgrip strength (β = − 0.183, p

Introduction/Aims Mean retirement age for UK doctors is 59.6 years giving the average OMFS consultant approximately 20 years of practice. Current pension tax regulations, new consultant posts having 10 sessions (40 hours), increasing proportions of consultants working less than full time (LTFT) all combined with the backlog of elective care created by COVID-19 will create a significant gap between workforce capacity and clinical demand. Materials and Methods The age of current OMFS consultants was estimated using the date of their primary medical/dental qualification. Changes in job plans were estimated using data from the BAOMS Workforce Census and from recently advertised posts. Reports of unfilled posts were collated by OMFS Regional Specialty Professional Advisors (RSPAs). Results First degree dates were identified for 476 OMFS substantive consultant posts. Estimated current average age was 52.7 years (minimum 35.9, maximum 72.1), 75th centile age 59.0 with 23% of the current consultant workforce above the average retirement age for doctors. New consultant posts consisted of 10 sessions (40 hours), whereas existing consultants average 12.1 sessions (48.4 hours). Unfilled consultant posts in Great Britain are 13 % of total compared to 20% in Northern Ireland and Ireland. Conclusions Many (23%) of the OMFS consultant workforce are above average retirement age. Forty-hour contracts; new consultants working LTFT; and early loss of senior colleagues because of pension pressure will reduce NHS’ capacity to treat OMFS disorders and injuries. This paper suggests increasing consultant posts, increasing trainee numbers and actively retaining senior surgeons to maintain capacity.

This paper investigates the Impact of relative humidity, varying the concentrations of water-soluble aerosol particle concentrations (WASO), Mineral Nuclei Mode Aerosols Particle Concentration (MINN), mineral accumulation mode, nonspherical (MIAN) aerosol particles concentrations and Mineral Coarse Mode Aerosols Particle Concentration (MICN) on the visibility and particles size distribution of desert aerosols based on microphysical properties of desert aerosols. The microphysical properties (the extinction coefficients, volume mix ratios, dry mode radii and wet mode radii) were extracted from Optical Properties of Aerosols and Clouds (OPAC 4.0) at eight relative humidities, RHs (00 to 99%) and at the spectral visible range of 0.4-0.8mm, the concentrations were varied to obtain five different models for each above-mentioned component. Regression analysis of some standard equations were used to determine the Angstrom exponent (α), the turbidity coefficient (β), the curvature (α2), humidification factor (), the mean exponent of aerosol growth curve (µ) and the mean exponent of aerosol size distributions (n). The values of angstrom exponent (α) were observed to be less than 1 throughout the five models at all RHs for the four studied components, and this signifies the dominance of coarse mode particles over fine mode particles. But the magnitude of the angstrom exponent (α) fluctuates all through the studied components except for WASO which increased with the increase in RH across the models and this also signifies the dominance of coarse mode particles with some traces of fine mode particles. The investigation also revealed that the curvature (α2) has both monomodal (negative signs) and bimodal (positive signs) types of distributions all through the five models and this also signifies the dominance of coarse mode particles with some traces of fine mode particles across the individual models for all the studied components. it was also found that the visibility decreased with the increase in RH and increased with the increase in wavelength. The investigation further revealed that the turbidity coefficient (β) fluctuates with the increase in RH and the particles concentrations, and this might be due to major coagulation and sedimentation. The analysis further found that there is a direct inverse power relation between the humidification factor and the mean exponent of aerosols size distribution with the mean exponent of aerosols growth curve. It was also found that as the magnitude of µ increased for MIAN, MINN and MICN, the effective hygroscopic growth decreased. For WASO, it was found that as the magnitude of µ decreased, the effective hygroscopic growth increased with the increase in particles concentrations and RH. The decreased in the magnitude of µ for WASO might be due to the fact that as we increase the non-hygroscopic particles, we decrease the deliquescence. The mean exponent of aerosol size distribution (n) being less than 3 shows foggy condition of the desert atmosphere the four investigated components and five studied models.

In 1948, Elliott Carter penned an analysis of his Piano Sonata for Edgard Varèse. His analysis of the first movement, in particular, makes one ask why Carter did not subsume its recurrent two-tempo structure under “first group” of its sonata form. Given Carter’s sophistication, was he experiencing a moment of music historical “agnosia,” since two-tempo expositions inform familiar Beethoven works such as Piano Sonata, op.31, no.2 and String Quartet in Bb, op.130. This paper explores Carter’s “agnosia” by way of internal and external evidence. Internally, it revisits the thematic chart he attached to the 1948 analysis and goes on to posit the idea that the work’s quintal neo-tonality so saturates its thematic network themes as to distort the composer’s analysis of the form, historical precedents irrespective. Externally, the paper compares three works by Beethoven to Carter’s Sonata as regards its two-tempo structure, using concepts borrowed from Hepokoski and Darcy’s Elements of Sonata Theory (1999). Finally, the author revisits writings of Carter and his circle that may explain why his analysis downplayed historical precedents to the Piano Sonata.

Bisphenol A is an extremely high-volume chemical widely used in polycarbonate plastics, the linings of food and beverage tins, and shopping receipts. Canadians are ubiquitously exposed to bisphenol A and research shows that exposure at environmentally relevant doses causes endocrine disruption. Recent risk assessments and exposure estimates by the European Food Safety Authority have guided increased restrictions around the use of bisphenol A and established a lower tolerable daily intake, while the CLARITY-BPA program in the United States identified several adverse effects below this exposure level. Within the context of bisphenol toxicity and international regulation, this paper describes the need for revised bisphenol A risk assessments in Canada. Completed in 2008, the most recent bisphenol A risk assessment conducted by Health Canada does not include risks from alternative bisphenols or non-dietary exposure. It also does not account for the additive effects caused by simultaneous exposure to multiple endocrine-disrupting chemicals.

Objective: To evaluate the Microimplant-assisted Rapid Palatal Expansion (MARPE), considered an alternative to surgical interventions for disjunction of the midpalatal suture in adolescent patients and young adults with maxillary transverse deficiency. The stage of ossification of the midpalatal suture, bone quality and adequate activation protocols are factors that can influence the quantity and quality of the orthopedic separation. Methodology: This paper demonstrates the application of MARPE in an unfavorable case report, of an adult patient with total crossbite, in an advanced stage of fusion of the palatine and maxillary processes, with poverty in the posterior bone volume, in comparison with the same therapy in an adolescent at an earlier stage of sutural maturation. In both cases, after tomographic examinations and oral scanning, the installations and recommended activation protocol were performed. These were not sufficient in the case of the adult patient, and generated side effects that, to be overcome, required changes in activations and additional maneuvers. Results: The application of MARPE may require clinical versatility to adopt differentiated protocols in relation to chronological age, bone thickness and sutural ossification stage. Conclusion: In the end, new computer tomography scans and a clinical examination showed satisfactory results in both patients. In the unfavorable case, the opening of the midpalatal suture occurred at more modest levels, but it was sufficient to correct the posterior crossbite. Objetivo: evaluar la expansión palatina rápida asistida por microimplantes (MARPE), considerada una alternativa a las intervenciones quirúrgicas para la disyunción de la sutura palatina media en pacientes adolescentes y adultos jóvenes con deficiencia transversal maxilar. El estadio de osificación de la sutura mediopalatina, la calidad ósea y los protocolos de activación adecuados son factores que pueden influir en la cantidad y calidad de la separación ortopédica. Metodología: Este trabajo demuestra la aplicación de MARPE en un reporte de caso desfavorable de un paciente adulto con mordida cruzada total, en etapa avanzada de fusión de los procesos palatino y maxilar, con pobre volumen óseo posterior, en comparación con la misma terapia en un adolescente de una etapa más temprana de maduración de la sutura. En ambos casos, tras la TC y la exploración oral, se realizaron las instalaciones y el protocolo de activación recomendado. Esto no fue suficiente en el caso del paciente adulto y generó efectos secundarios que, para ser superados, requirieron cambios en las activaciones y maniobras adicionales. Resultados: La aplicación de MARPE puede requerir versatilidad clínica para adoptar protocolos diferenciados con relación a la edad cronológica, grosor óseo y estadio de osificación de la sutura. Conclusión: Al final, la nueva tomografía computarizada y el examen clínico mostraron resultados satisfactorios en ambos pacientes. En el caso desfavorable, la apertura de la sutura mediopalatina se produjo a niveles más modestos, pero fue suficiente para corregir la mordida cruzada posterior. Objetivo: Avaliar a Expansão Palatal Rápida Assistida por Microimplantes (MARPE), considerada uma alternativa às intervenções cirúrgicas para disjunção da sutura palatina mediana em pacientes adolescentes e adultos jovens com deficiência transversa maxilar. O estágio de ossificação da sutura palatina mediana, a qualidade óssea e os protocolos de ativação adequados são fatores que podem influenciar na quantidade e na qualidade da separação ortopédica. Metodologia: Este trabalho demonstra a aplicação do MARPE em um relato de caso desfavorável, de uma paciente adulta com mordida cruzada total, em estágio avançado de fusão dos processos palatino e maxilar, com pobreza no volume ósseo posterior, em comparação com a mesma terapia em uma adolescente em um estágio anterior de maturação sutural. Em ambos os casos, após os exames tomográficos e escaneamento oral, foram realizados as instalações e o protocolo de ativação recomendado. Isso não foi suficiente no caso do paciente adulto e gerou efeitos colaterais que, para serem superados, exigiram mudanças nas ativações e manobras adicionais. Resultados: A aplicação do MARPE pode exigir versatilidade clínica para adoção de protocolos diferenciados em relação à idade cronológica, espessura óssea e estágio de ossificação sutural. Conclusão: Ao final, novas tomografias computadorizadas e exame clínico mostraram resultados satisfatórios em ambos os pacientes. No caso desfavorável, a abertura da sutura palatina mediana ocorreu em níveis mais modestos, mas foi suficiente para corrigir a mordida cruzada posterior.

Introduction: in the last few years, a significant number of premature children have been born in Brazil, associated with this information are the risk conditions of neonatal morbi mortality wich is occurring during the first year of life. The importance of the thought about medical assistance for the premature child during its very first years is essential, and have the purpose of minimizing the social and biological risks and the consequent child development to which the infant is exposed, this shows the relevance in the measuring the motor development of the premature child, with respect to the corrected gestation age. The analysis of previous paper published that used as instrument of evaluation of triage infant motor development Alberta Motor Scale (AIMS) for premature infants. Methodology: It is an article of the type of literature research, whose source comes from: PubMed, SciELO, LILACS and academic Google, there were selected sixteen published papers from the 2010-2021. Sixteen articles were selected for the construction of the current study, of these, ten were chosen for the construction of the current study, in which two axes of discussion emerged: Low socioeconomic conditions and delayed motor development; and the prolonged length of stay in the NICU and motor performance. Conclusion: The results have shown that the Alberta infant Motor Scale (AIMS) is considered as an screening instrument of the gross motor development with reliability in its application to premature babies, also is an evidence of the socioeconomic conditions, as well as the time spent in the UTIN are risk factors for the child motor development.

Pilot ignited high pressure direct injection natural gas engines have a lower tendency of end-wall gas formation owing to the fuel introduction method. Thus, this type of engines are adaptable to high compression ratios and have the potential to achieve low emission levels. In this paper, numerical investigations concerning underexpanded gas jets and in-cylinder working process of pilot ignited high pressure direct injection natural gas engines are involved. The different numerical models adopted in the previous studies are systematically evaluated, giving guidance for the selection of numerical methods during the development of pilot ignited natural gas engines. The results indicate that analytical models could predict jet penetration with high accuracy while Mach disk height and diameter could be well reproduced by empirical correlations. Computational fluid dynamic models could provide more detailed information of jet flow fluid compared to analytical models and empirical correlations. Among all the computational fluid dynamic models, RANS models are considered as the most computational efficient ones while DNS is the most time consuming choice. If only the macro parameters are concerned, RANS models are the best choices. However, if near-field detailed structures are emphasized, using LES models is a better solution. When conducting three-dimensional simulations of the engine working process, RANS models are the most efficient choices for the modeling of in-cylinder flow field while reduced dual fuel mechanism coupled with phenomenological soot models could capture the in-cylinder combustion and emission formation processes with high-precision.

The association between the Dietary Inflammatory Index (DII) and breast cancer risk has been widely reported in recent years, but there is still controversy about whether a pro-inflammatory diet is a risk factor for breast cancer. We conducted a meta-analysis to investigate the relationship between the DII and breast cancer risk in pre-menopausal and post-menopausal women. We comprehensively searched PubMed, Embase and the Cochrane Library in January 2021 to identify articles reporting an association between the DII and breast cancer risk. A pooled analysis was conducted with 14 studies covering 312,885 participants. Overall, women in the most pro-inflammatory diet category were at greater risk for breast cancer than those in the most anti-inflammatory category (relative risk [RR]=1.37, 95% confidence interval [CI] 1.17-1.60, P

Introduction: Chondroectodermal dysplasia (Ellis–van Creveld syndrome (EVC)) (OMIM: #225500) is a rare skeletal dysplasia with unknown exact prevalence. EVC patients may have abnormal skeletal and extra skeletal symptoms. We report a case of EVC patient and review previous cases reported in Iran.Materials and methods: The patient was a 30 years old woman referred to our hand clinic for an extra finger in both hands. She was born to a consanguineous marriage. The patient had a history of bilateral valgus deformity of the knees, for which she underwent proximal tibial and distal femoral osteotomy. Upon examination, the patient had bilateral polydactyly and brachymetacarpia with hypotrophic fingernails. She was about 120 cm tall and had acromesomelic type dwarfism. Oral examination revealed serrated incisal margins, dental transposition, a diastema, conical teeth and, enamel hypoplasia. In the radiographic examination of upper extremity, postaxial polydactyly and polymetacarpia, enlarged distal radius, and fusion of capitate and hamate were seen. We searched online databases (Pubmed, Scopus, Google Scholar) and found 14 Iranian papers with 21 reported patients (there was no time limit). We reviewed available clinical and genetic data and the geographic origins of patients.Results: 14 articles reporting 22 EVC patients (including our patient) from Iran have been published in Persian and English (7 in Persian and 7 in English). All patients presented with characteristic EVC symptoms but were diagnosed at a relatively late age, 18 patients were born to consanguineous marriages.Conclusions: It seems that based on these studies, it is possible to identify some families with this genetic mutation. We can warn such families of the dangers of consanguineous marriage through genetic counseling before marriage. In addition, by identifying families with such problems, we can detect such anomalies in the baby earlier with more careful prenatal care.

Background A skilled health workforce is instrumental for the delivery of multidisciplinary cancer care and in turn a critical component of the health systems. There is, however, a paucity of data on the vast inequalities in cancer workforce distribution, globally. The aim of this study is to describe the global distribution and density of the health care workforce involved in multidisciplinary cancer management. Methods We carried out a systematic review of the literature to determine ratios of health workers in each occupation involved in cancer care per 100 000 population and per 100 cancer patients (PROSPERO: protocol CRD42018095414). Results We identified 33 eligible papers; a majority were cross-sectional surveys (n = 16). The analysis of the ratios of health providers per population and per patients revealed deep gaps across the income areas, with gradients of workforce density, highest in high-income countries versus low-income areas. Benchmark estimates of optimal workforce availability were provided in a secondary research analysis: mainly high-income countries reported workforce capacities closer to benchmark estimates. A paucity of literature was defined for critical health providers, including for pediatric oncology, surgical oncology, and cancer nurses. Conclusion The availability and distribution of the cancer workforce is heterogeneous, and wide gaps are described worldwide. This is the first systematic review on this topic. These results can inform policy formulation and modelling for capacity building and scaleup., Highlights • Workforce is an essential component of the health systems. • Stark inequalities are reported for the distribution of health workforce worldwide, but data are limited. • We aimed at portraying the first global figure of the comprehensive cancer workforce for cancer management. • Inequalities in density and distribution of the workforce regard all the key health personnel involved in cancer management. • These data will inform the development of evidence-informed policies for the workforce in low- and middle-income countries.

Aicardi-Goutières syndrome (AGS) is a rare genetic neuroinflammatory disorder caused by abnormal upregulation of type 1 interferon signalling. Opsoclonus-myoclonus syndrome is a rare autoimmune phenotype demonstrating a disturbance in the humoral immune response mostly seen in the context of paraneoplastic or postinfectious states, although its pathophysiology is incompletely understood. We report the first three children described with AGS demonstrating transient opsoclonus and myoclonus after irritability and/or developmental regression, suggesting a pathological association. We describe the presentation, clinical features, progress, cerebrospinal fluid (CSF) inflammatory markers, electroencephalogram (EEG), and magnetic resonance imaging (MRI) findings in these children. Two patients had developmental regression but demonstrated a positive response to JAK1/2 inhibition clinically and on serial examination of CSF inflammatory markers. These findings suggest that AGS should be considered in children presenting with opsoclonus-myoclonus, and that the association between AGS and opsoclonus-myoclonus further supports the role of immune dysregulation as causal in the rare neurological phenomenon opsoclonus and myoclonus. What this paper adds There is a phenotypic association between opsoclonus-myoclonus syndrome and Aicardi-Goutières syndrome. There is clinical evidence of immune dysregulation in the pathogenesis of opsoclonus and myoclonus.

Available literature contains limited data on the correlation between epicardial adipose tissue and post-infarction myocardial remodeling with regard to diagnosis and prognosis. Objective. The aim of the paper is to study the correlation between epicardial adipose tissue thickness and structural and functional heart parameters in patients with myocardial infarction and percutaneous coronary intervention. Materials and Methods. The study involved 94 patients with myocardial infarction and subsequent ad-hoc percutaneous coronary intervention. All the patients underwent stress echocardiography 6 weeks after coronary stenting. Student’s t-test, Mann–Whitney U-test, and sign test were used for statistical data processing. Results. The authors revealed significant differences in the parameters of the ejection fraction and the shortening fraction while assessing the systolic function of the left ventricle (LV). Patients whose epicardial adipose tissue thickness (EATT) was more than 3.5 mm demonstrated lower parameters. Assessment of the correlation between diastolic function and EATT showed that patients with EATT (>3.5 mm) had a longer time of LV isovolumetric relaxation (p3.5 mm compared with those with EATT3.5 mm demonstrated an increase in the end-diastolic LV dimension from 53.8 to 55.9 mm (p3.5 mm) in patients with percutaneous coronary intervention is associated with higher values of LV end-diastolic dimension, indexed left atrial volume and LV myocardial mass associated with lower values of LV ejection fraction and shortening fraction. Epicardial adipose tissue (>3.5 mm) in patients with post-infarction myocardial remodeling is associated with post-load increase in the LV end-diastolic dimension. Keywords: epicardial adipose tissue, post-infarction remodeling, myocardial dysfunction, stress testing. В доступной литературе имеются ограниченные данные о связи эпикардиального ожирения с постинфарктным ремоделированием миокарда с позиций диагностики и прогноза. Цель. Изучение связи толщины эпикардиального жира (ТЭЖ) со структурно-функциональными параметрами сердца у пациентов с инфарктом миокарда, подвергнутых чрескожному коронарному вмешательству. Материалы и методы. В исследовании приняли участие 94 пациента с инфарктом миокарда и последующим стентированием коронарных артерий ad hoc, которым через 6 нед. после чрескожного коронарного вмешательства проводилась стресс-эхоКГ. Статистическая обработка данных осуществлялась с помощь t-критерия Стьюдента, U-критерия Манна–Уитни, критерия знаков. Результаты. При оценке систолической функции левого желудочка (ЛЖ) выявлены достоверные различия параметров фракции выброса и фракции укорочения, которые характеризовались более низкими значениями у пациентов с ТЭЖ более 3,5 мм. Оценка связи диастолической функции с ТЭЖ показала, что пациенты с ТЭЖ более 3,5 мм имеют более длительное время изоволюметрического расслабления ЛЖ (p

Focal boost to dominant intraprostatic lesions (DILs) has recently been proposed for prostate radiation therapy. Accurate and fast delineation of the prostate and DILs is thus required during treatment planning. In this paper, we develop a learning-based method using positron emission tomography (PET)/computed tomography (CT) images to automatically segment the prostate and its DILs. To enable end-to-end segmentation, a deep learning-based method, called cascaded regional-Net, is utilized. The first network, referred to as dual attention network, is used to segment the prostate via extracting comprehensive features from both PET and CT images. A second network, referred to as mask scoring regional convolutional neural network (MSR-CNN), is used to segment the DILs from the PET and CT within the prostate region. Scoring strategy is used to diminish the misclassification of the DILs. For DIL segmentation, the proposed cascaded regional-Net uses two steps to remove normal tissue regions, with the first step cropping images based on prostate segmentation and the second step using MSR-CNN to further locate the DILs. The binary masks of DILs and prostates of testing patients are generated on the PET/CT images by the trained model. For evaluation, we retrospectively investigated 49 prostate cancer patients with PET/CT images acquired. The prostate and DILs of each patient were contoured by radiation oncologists and set as the ground truths and targets. We used five-fold cross-validation and a hold-out test to train and evaluate our method. The mean surface distance and DSC values were 0.666 ± 0.696 mm and 0.932 ± 0.059 for the prostate and 0.814 ± 1.002 mm and 0.801 ± 0.178 for the DILs among all 49 patients. The proposed method has shown promise for facilitating prostate and DIL delineation for DIL focal boost prostate radiation therapy.

Cardiovascular diseases are a major component of non-communicable diseases and death, with thrombosis constituting the most common underlying pathosis of the three major cardiovascular disorders: ischaemic heart disease (acute coronary syndrome), stroke and venous thromboembolism (VTE). The introduction of direct oral anticoagulants (DOACs) in recent years has necessitated a more complex approach to periprocedural and perioperative anticoagulation management and the need for revised management strategies and protocols. Currently, patients taking classic oral anticoagulants are advised to stop taking the drugs and have their INR values checked 72 h prior to dental surgery (e.g., apical surgery, tooth extraction, and periodontal surgery) and checked again 24 h prior to the procedure to ensure it is within the therapeutic range. However, the current incorporation of these novel DOACs in routine medical practice requires changes in the way patients are managed preoperatively in dentistry, and specifically in endodontic surgery. The methodology applied in this review included searching for relevant articles in the PubMed database using keywords listed in the Entree Terms databases. Articles published on human blood clotting mechanism, antithrombotic drugs, as well as treatment guidelines and recommendations for dentistry were retrieved. In addition, textbooks and guidelines that may not have surfaced in the online search were searched manually. The aim of this paper was to review the mechanisms of action of classic and novel antithrombotic medications and their impact on endodontic treatment and the management of local haemostasis in endodontics.

Objective Identify and evaluate palliative care interventions used in peripheral vascular disease (PVD). Background PVD encompasses conditions with poor outcome and severe suffering, both mentally and physically, yet utilisation and research into palliative care interventions remain sparse. Method A systematic review of all study designs published between January 1991 and January 2020 in which people with PVD received palliative care interventions and at least one patient reported outcome was recorded. Results A total of eight studies involving 87037 unique patients met inclusion criteria (four cohort studies and four cross sectional studies). There were no randomised controlled studies; The small number of studies and study heterogeneity precluded meta-analysis. Only two papers recorded patient reported outcomes. Five papers found an association between palliative care and reduction in health care utilisation. Most of the studies reported that palliative care was likely underused. Only two of the studies included non-hospital patients. The methodological quality of the papers ranged from low to moderate. Conclusions Despite high mortality and morbidity associated with PVD, evidence of the effectiveness of palliative care in this group of patients is lacking. There are only a handful of papers on palliative care in vascular surgery and the majority are small, methodologically flawed and lack patient reported outcomes. Randomised controlled trials of palliative care interventions in patients with PVD are needed to determine optimal treatment outcomes.

Background Most of the countries in the world adopted isolation measures during the COVID-19 pandemic. According to Kola L. et. al (2021), “in most settings in low and middle-income countries (LMICs), ongoing in-person mental health services have been disrupted and patients with severe mental conditions and substance abuse disorders are often unable to obtain medications, attend to treatment centres, or receive social services”. The aim of this paper is to describe the effects of the COVID-19 pandemic on the demand for attention in a mental health service as reported by healthcare workers. Methods A quantitative cross-sectional descriptive study was conducted and a survey designed by the Secretaría de Políticas Integrales sobre Drogas de la Nación Argentina was applied to a total of 29 healthcare workers of a mental health centre in the Province of Córdoba, Argentina, during the month of November, 2020. Results The perception of healthcare workers towards the demand for attention shows that the 3 main reasons for consultation during the first three months of isolation measures were drug abuse (50%), request for treatment (10.3%), and order for medication (10.3%). During the three subsequent months, the reasons for consultation were drug abuse (62.1%), request for treatment (44.8%) and remote treatment modality (24.1%). Healthcare workers state that drug abuse consultations increased 65.5% and the self-inflicted violence consultations increased 44.8%. Conclusions The isolation measures generate a change in the demand for attention. There are differences between various phases of the isolation measures, where an increase in the drug abuse consultations and remote treatment modality could be observed. Key messages To develop predictability according to the variations in the demand for attention produced during public health crisis. To train healthcare workers in order to make interventions in public health crisis.

The global pandemic caused by the 2019 coronavirus (COVID-19) has led to a dramatic increase in medical waste worldwide. This tremendous increase in medical waste is an important transmission medium for the virus and thus poses new and serious challenges to urban medical waste management. This study investigates the response of medical waste management to the COVID-19 pandemic and subsequent changes in Wuhan City based on the most detailed data available, including waste generation, storage, transportation, and disposal. The results show that despite a 5-fold increase in the demand for daily medical waste disposal in the peak period, the quick responses in the storage, transportation, and disposal sectors during the pandemic ensured that all medical waste was disposed of within 24 hours of generation. Furthermore, this paper discusses medical waste management during future emergencies in Wuhan. The ability of the medical waste management system in Wuhan to successfully cope with the rapid increase in medical waste caused by major public health emergencies has important implications for other cities suffering from the pandemic and demonstrates the need to establish resilient medical emergency systems in urban areas.

This paper presents the development and preliminary evaluation of a non-invasive brain-computer interface (BCI) based on motor imagery (MI) aimed at lower limb stroke rehabilitation. The BCI considers the subject’s ability, concentration, and motivation through a classification threshold adapted by the operator. It presents realistic visual feedback, which consisted of an avatar that mimics foot dorsiflexion. Ten healthy and three chronic stroke volunteers participated in one session of use; all were naive regarding BCI. Two evaluations were performed. The first one considered the area under the curve (AUC) in the receiver operating characteristics (ROC) space to assess user’s ability to modulate his/her sensorimotor rhythms. The second evaluation addressed the MI-BCI operation and computed the accuracy (ACC), the true positive rate (TPR), and false positive rate (FPR). These last two metrics were represented in the ROC space. The outcomes for healthy subjects (AUC = 0.66 ± 0.12, ACC = 64.4 ± 6.9%) resulted to be above the chance level. In stroke subjects, the results could have been affected by the brain injury (AUC = 0.53 ± 0.03, ACC = 54 ± 6%). The results of TPR and FPR for healthy (TPR = 58 ± 10%, FPR = 29 ± 18%)and stroke (TPR = 51 ± 21%, FPR = 45 ± 28%) subjects suggested a difficulty inherent to the idle state identification. It was shown that the developed MI-BCI aimed at motor recovery could adapt to the SMR modulation of the user-patient and enable to control avatar dorsiflexion despite subjects’ inexperience or stroke sequelae in a single session of use.

This paper aims to make simple the evaluation of the main veins related to the brainstem and cerebellum. Posterior fossa venous drainage is best understood in context with its three main collectors: superior: toward the Vein of Galen; posterior: toward the torcular complex; and anterior: toward the superior petrosal sinus. A fourth possible drainage path, often harder to distinguish, is directed toward the inferior petrosal sinus. Veins of these four systems are frequently connected to one another. Despite traditionally being considered less regular than its arterial disposition, posterior fossa venous anatomy follows specific patterns that are easy to identify. The three more representative veins of each venous confluent have been selected, to help in recognizing them angiographically. Since pial large veins are primarily located over the surface of the encephalon, most related anatomical structures can be confidently identified. This is of special interest when angiographic 2D or 3D studies are evaluated and provide fundamental assistance in locating precise structures. To better aid in understanding venous disposition, an overview of embryologic and fetal development is also discussed.

A correction to this paper has been published: https://doi.org/10.1007/s00590-021-03026-9

The concept of cesarean section in the last 10 years. The paper addresses a period of 10 years in terms of the evolution of the number and percentage of cesarean operations in total births and their impact on perinatal outcomes. The results of the study showed with certainty that the widening of indications for abdominal births with increasing their incidence contributes to improving indicators of perinatal mortality

Purpose Posterior capsular contracture causes stiffness during knee extension in knee osteoarthritis. Furthermore, in posterior-stabilized total knee arthroplasty (PS-TKA), a unique design such as the cam mechanism could conflict with the posterior capsule (PC) causing flexion contracture (FC). However, few studies have focused on the anatomical aspects of the PC. This study aimed to investigate the anatomical site and forms of posterior capsular attachment to the femoral cortex, and to evaluate the efficacy of posterior capsular release for FC by assessing changes in knee extension angles using a navigation system. Methods Attachment sites of the PC were investigated in 10 cadaveric knees using computed tomography. PS-TKA was performed in six cadaveric knees using a navigation system to evaluate the efficacy of posterior capsular release for FC. Posterior capsular release was performed stepwise at each part of the femoral condyle. Results The gastrocnemius tendon and PC were integrally attached to the femoral cortex at the medial and lateral condyles, whereas the PC at the intercondylar fossa was independently attached directly to the femoral cortex. Moreover, the PC at the intercondylar fossa was attached most distally among each femoral condyle. Posterior capsular release at the intercondylar fossa allowed 11.4° ± 2.8° improvement in knee extension. This angle was further improved by 5.5° ± 1.3°, after subsequent capsular release at the medial and lateral condyles. Conclusion The forms and sites of posterior capsular attachment differed based on the part of the femoral condyle. Stepwise posterior capsular release was effective for FC in PS-TKA. Level of evidence III.

Background Participating in clinical trials is a metric of high-quality cancer care and improves survival. However, Black individuals with cancer are less likely to be enrolled in clinical trials and experience a disproportionate burden of cancer mortality compared to Whites. Patient-engaged research is one potential strategy to address racial inequities in clinical trials, but little is known about best practices for engaging Black individuals and communities impacted by cancer in research partnerships. Methods We used a community engaged research approach to establish a patient advisory council (PAC) representative of the patient population served by a safety net hospital cancer center. We outline the process of establishing the PAC and the lessons learned. Results The inaugural PAC included 7 members representative of the cancer center’s patient demographics. PAC members developed a patient centered vision, mission and action plan. PAC and community-academic research partners experienced the transformative power of centering the lived experiences of patients of color to promote health equity in cancer research. Conclusion Establishing a patient advisory council at a safety net hospital cancer care center provided a platform for engaging a hardly reached population in patient centered research. Supplementary Information The online version contains supplementary material available at 10.1186/s40900-021-00317-7., Plain English summary Participating in clinical trials is an important measure of high-quality cancer care and improves survival. However, Black individuals with cancer are less likely to participate in clinical trials and are more likely to die from cancer compared to Whites. Including Black patients as research partners is one way to improve racial equity in clinical trial participation. We established a patient advisory council (PAC) including patients and caregivers with similar racial demographics as the patients receiving care at a safety net hospital cancer center. PAC members partnered with the research team to develop a vision, mission, and action plan to improve research participation among patients of color. PAC members used their lived experiences and training from the research team to help develop a strategy to improve representation of patients of color in cancer research. This paper is focused on the PAC development process. Supplementary Information The online version contains supplementary material available at 10.1186/s40900-021-00317-7.

LINE1 retrotransposons, which are thought to be the remnants of ancient integrations of retrovirus-like elements, are aberrantly (re)activated in many cancer cells. Due to LINE1-induced alterations in target gene expression and/or chromosomal rearrangements, they may be important drivers of tumorigenesis. Moreover, LINE1 encoded proteins, Open Reading Frame (ORF)1 and ORF2, may have pro-oncogenic potential through inductors of oncogenic transcription factors or inhibitors of cell cycle suppressors. The current study therefore aimed to investigate in vitro and in vivo anti-tumorigenic effects of two well-known antiretroviral drugs, zidovudine, a nucleoside analogue inhibitor of RT (NRTI), and efavirenz, a non-nucleoside RT inhibitor (NNRTI). Our data demonstrate that both drugs in clinically relevant doses significantly reduced the proliferation of murine and human cancer cell lines, as well as growth of tumors in a murine subcutaneous model. Intriguingly, we found that the combination of both zidovudine and efavirenz almost entirely blocked tumorigenesis in vivo. Because both drugs are FDA-approved agents and the combination was very well tolerated in mice, the combination therapy as presented in our paper might be an opportunity to treat colorectal tumors and metastasis to the liver in an inexpensive way.

Vasovagal syncope (VVS) refers to fainting of people with a drop in blood flow to the brain more serious disease in paraplegia patients. Precognitive diagnoses are characterized by lightheadedness, nausea, severe fatigue, and an elevated heart rate. As a result, it’s important to seek care as soon as possible after experiencing syncope. Since receiving a correct diagnosis and appropriate care, the majority of patients may avoid complications with syncope. Syncope appears to be a sign of COVID 19 in people with coronary artery disease. Furthermore, a sudden heart attack might result in acute syncope. In a few circumstances, machine learning classification techniques may not be precise. For paraplegia patients, prediction vasovagal syncope needs more precise results in order to save their lives. The aim of this paper is to use the ensemble technique to improve the accuracy of conventional machine learning algorithms. EEG (ElectroEncephaloGram) brainwave dataset from kaggle is used to implement it. The accuracy of the proposed AWET algorithm is 82%. It improves the accuracy by 17% compare to Support Vector Machine, Random Forest, Naive Bayes, and MultiLayer Perceptron classifiers. © 2021 River Publishers

The aim of this paper was to empirically analyze the relationship between public health expenditure and health outcomes among EU developing countries. Using regression analysis and factor analysis, we documented that public health expenditure and health outcomes are in a long-run equilibrium relationship and the status of health expenditure can improve life expectancy and reduce infant mortality. Secondarily, we studied how the status of good governance, health care system performance, and socioeconomic vulnerabilities affect the public health’s outcomes in the selected countries. We found that the effectiveness of health and the way to reduce infant mortality or to improve life quality is directed conditioned by good governance status. Moreover, the consolidation of health care system performance directly improves the quality of life among EU developing countries, which indicates that public policymakers should intervene and provide political and financial support through policy mixes.

Machine learning models are gaining popularity for its application on a wide range of medical diagnosis tasks. It is essential to make accurate predictions for such tasks as decisions have the potential to make a huge impact for the patient, even reducing fatality. In this paper, we have focused on increasing the accuracy as well as efficiency of prediction of heart disease using feature selection techniques. We have implemented a wrapper based sequential forward selection algorithm to identify optimum sets of features significant for the prediction of coronary artery disease. Our proposed feature selection technique was able to increase the accuracy of prediction by a maximum of 9.7% as opposed to not performing feature selection, and has the potential to be an effective and efficient tool in heart disease prediction.

Boarding schools, by definition, house students in residence either on campus or close by in residential facilities - where the sleep environment is likely to differ from their home environment. For boarders, being in the boarding environment occurs alongside a convergence of psychosocial and physiological factors likely to impact adolescent sleep. This paper comprises a review of the literature on sleep and boarding students in the Australian context. We also propose recommendations aligned with the scientific evidence base that can be used to promote healthy sleep in Australian boarding school students, focusing on staff training and sleep knowledge, daily routines, sleeping arrangements, and student mental health and wellbeing. It must be noted that these recommendations should be considered interim recommendations until further research is performed in the area. Further, we suggest the development of standardised practice guidelines, to ensure that student sleep is supported appropriately within the Australian boarding context.

Background: Generalized anxiety disorder (GAD) is one of the most common types of anxiety disorders with unclear pathogenesis. Our team’s previous research found that extensive neuronal apoptosis and neuronal regeneration disorders occur in the hippocampus of GAD rats. Danzhi Xiaoyao (DZXYS) Powder can improve the anxiety behavior of rats, but its molecular mechanism is not well understood.Objective: This paper discusses whether the pathogenesis of GAD is related to the abnormal expression of Notch signal pathway, and whether the anti-anxiety effect of DZXYS promotes nerve regeneration in the hippocampus by regulating the Notch signaling pathway.Methods: The animal model of GAD was developed by the chronic restraint stress and uncertain empty bottle stimulation method. After the model was successfully established, the rats in the model preparation group were divided into the buspirone, DZXYS, DZXYS + DAPT, and model groups, and were administered the corresponding drug intervention. The changes in body weight and food intake of rats were continuously monitored throughout the process. The changes in anxiety behavior of rats were measured by open field experiment and elevated plus-maze test, and morphological changes and regeneration of neurons in the rat hippocampus were observed by HE staining and double immunofluorescence staining. Changes in the expression of key targets of the Notch signaling pathway in the hippocampus were monitored by real-time fluorescence quantitative PCR and western blotting.Results: In this study, we verified that the GAD model was stable and reliable, and found that the key targets of the Notch signaling pathway (Notch1, Hes1, Hes5, etc.) in the hippocampus of GAD rats were significantly upregulated, leading to the increased proliferation of neural stem cells in the hippocampus and increased differentiation into astrocytes, resulting in neuronal regeneration. DZXYS intervention in GAD rats can improve appetite, promote weight growth, and significantly reverse the anxiety behavior of GAD rats, which can inhibit the upregulation of key targets of the Notch signaling pathway, promote the differentiation of neural stem cells in the hippocampus into neurons, and inhibit their differentiation into astrocytes, thus alleviating anxiety behavior.Conclusion: The occurrence of GAD is closely related to the upregulation of the Notch signaling pathway, which hinders the regeneration of normal neurons in the hippocampus, while DZXYS can downregulate the Notch signaling pathway and promote neuronal regeneration in the hippocampus, thereby relieving anxiety behavior.

Prevalence of non-alcoholic fatty liver disease (NAFLD) increases in line with obesity and type 2 diabetes, and there is no approved drug therapy. Polyunsaturated fatty acids of n-3 series (omega-3) are known for their hypolipidaemic and anti-inflammatory effects. Existing clinical trials suggest varying effectiveness of triacylglycerol- or ethyl ester-bound omega-3 in the treatment of NAFLD, without affecting advanced stages such as non-alcoholic steatohepatitis. Preclinical studies suggest that the lipid class used to supplement omega-3 may determine the extent and nature of their effects on metabolism. Phospholipids of marine origin represent an alternative source of omega-3. The aim of this review is to summarise the available evidence on the use of omega-3 phospholipids, primarily in obesity-related NAFLD, and to outline perspectives of their use in the prevention/treatment of NAFLD. A PubMed literature search was conducted in May 2021. In total, 1088 articles were identified, but based on selection criteria, 38 original papers were included in the review. Selected articles describing the potential mechanisms of action of omega-3 phospholipids have also been included. Preclinical evidence clearly indicates that omega-3 phospholipids have strong antisteatotic effects in the liver, which are stronger compared to omega-3 administered as triacylglycerols. Multiple mechanisms are likely involved in the overall antisteatotic effects, involving not only the liver but also adipose tissue and the gut. Robust preclinical evidence for strong antisteatotic effects of omega-3 phospholipids in the liver should be confirmed in clinical trials. Further research is needed on the possible effects of omega-3 phospholipids on advanced NAFLD.

Blood cancer or leukemia is the cancer which leads to abnormal formation of white blood cells in the blood by the blood marrow; it can be fatal disease if not diagnosed early. It can be detected and diagnosed at the earliest by using the image processing of microscopic images of blood cell. This method is cheap and very fast and accurate. This technique is currently being used in the hospitals to detect blood cancer of all types. In this paper, a method is prepared in which the white blood cells are separated from blood and its color, textural, geometrical features are extracted and fed into different types of classifiers like SVM, LDA, etc. These classifiers are used to detect whether cells are healthy or cancerous. To improve the accuracy of detection, we have checked the detection without principal component analysis (PCA) and also with PCA. Further, if cancer is detected, then KNN classifier is used to detect the type of the cancer. The counting of white blood cells is also done to make the method more accurate. This automated method is found to be highly accurate, fast, and cheap as compared to manual detection.

Parkinson's disease (PD), the typical neurodegenerative disease, is characterized by the progressive loss of dopaminergic neurons in the substantia nigra (SN). However, no therapeutic agent used currently could slow down neuronal cell loss so as to decelerate or halt the progression of PD. Traditional Chinese medicine (TCM) has been utilized to treat the dysfunction of the autonomic nervous system. Wen-Shen-Yang-Gan decoction (WSYGD) has a good effect on the clinical treatment of PD with constipation. However, it is not clear which ingredients and what mechanism are responsible for the therapeutic effect. In this study, the pharmacodynamic study of WSYGD in PD mice was applied. Concurrently, a novel method for the identification of metabolic profiles of WSYGD has been developed. Finally, we found that WSYGD could protect the PD mice induced by rotenone. The underlying mechanism of the protective effect may be related to the reduction of the DA neurons apoptosis via reducing inflammatory reaction. By virtue of UPLC-MS and chemoinformatics method, 35 prototype compounds and 27 metabolites were filtered out and tentatively characterized. In conclusion, this study provides an insight into the metabolism of WSYGD in vivo to enable understanding of the metabolic process and therapeutic mechanism of PD.

Coastal communities have received little attention in the public health literature, perhaps because our mental maps tend to associate socio-economic deprivation and health inequalities with inner cities. Mapping a range of key health indicators at small area level, this paper reveals a distinct core-periphery pattern in disease prevalence, with coastal communities experiencing a high burden of ill health across almost all conditions included in the Quality and Outcomes Framework dataset. Other sources suggest poor outcomes for children and young people living in coastal areas. Low rates of participation in higher education contrast with high rates of hospitalisation for self-harm, alcohol and substance use. Reflecting a shift in the distribution of children living in poverty since the 1990s, this may be an early indicator of a future public health crisis in these communities. Exploring reasons for the health challenges facing the periphery, this perspective piece calls for more public health research that can accommodate the complex and interlinked problems facing coastal communities and a more concerted effort to align public health with economic, education, local government and transport policies at the national level.

In the USA, the COVID-19 pandemic has created challenges beyond the direct consequences of the infection. Because of shifting resources in response to need, many domains within the healthcare sector unrelated to COVID-19 have had interrupted abilities to provide care. In the current study, we focus on preventative sexual health care during the pandemic. In a sample of 511 (mean age = 27.7) people, we examined quantitative data regarding continuation and discontinuation of birth control and PrEP during the pandemic, along with qualitative data illustrating the underlying reasons for participants' (dis)continuation. Results showed that most (92.5%) of birth control users reported continuation of their birth control, with the predominant reasons reported being use for health reasons, long-acting reversible contraceptive use, access to remote healthcare services, and increased vigilance over pregnancy prevention. Conversely, around half (52.6%) of PrEP-using participants reported already discontinuing or planning to discontinue their PrEP regimen. Temporary abstinence and concerns about accessing in-person health care were the predominant reasons for PrEP discontinuation. These results have implications for both researchers and sexual healthcare providers. Disruptions to preventative sexual health care should be considered in ongoing research about patient needs, and healthcare providers may wish to consider particular challenges faced by PrEP users concerning re-start and continuation.

Chimeric Antigen Receptor (CAR) T-cell therapy has demonstrated high rates of response in recurrent B-cell Acute Lymphoblastic Leukemia in children and young adults. Despite this success, a fraction of patients' experience relapse after treatment. Relapse is often preceded by recovery of healthy B cells, which suggests loss or dysfunction of CAR T-cells in bone marrow. This site is harder to access, and thus is not monitored as frequently as peripheral blood. Understanding the interplay between B cells, leukemic cells, and CAR T-cells in bone marrow is paramount in ascertaining the causes of lack of response. In this paper, we put forward a mathematical model representing the interaction between constantly renewing B cells, CAR T-cells, and leukemic cells in the bone marrow. Our model accounts for the maturation dynamics of B cells and incorporates effector and memory CAR T-cells. The model provides a plausible description of the dynamics of the various cellular compartments in bone marrow after CAR T infusion. After exploration of the parameter space, we found that the dynamics of CAR T product and disease were independent of the dose injected, initial B-cell load, and leukemia burden. We also show theoretically the importance of CAR T product attributes in determining therapy outcome, and have studied a variety of possible response scenarios, including second dosage schemes. We conclude by setting out ideas for the refinement of the model., This work was partially supported by the Fundacion Espanola para la Ciencia y la Tecnologia (UCA PR214), the Asociacion Pablo Ugarte (APU, Spain), Junta de Comunidades de Castilla-La Mancha (SBPLY/17/180501/000154), Ministry of Science and Technology, Spain (PID2019110895RB-I00), and Inversion Territorial Integrada de la Provincia de Cadiz (ITI-0038-2019).

Purpose of the study: to analyze characteristics of cancer-testis antigens (Ctas) as potential biomarkers for dissemination of primary human skin melanoma (sm).Material and Methods. Recent publications from Pubmed, scopus and elibrary databases were analyzed for the available appropriate literature review. In total, 176 papers reported the description of Ctas and encoding genes and their potential for prognosis of primary sm dissemination. The authors included 52 of them in the given review.Results. Two sections of the paper comprise clinically significant characteristics of Ctas and their genes, including overexpression, which is selective for the heterogeneous tumor cell populations and mediated by humoral and/or cellular immune reactions; the association of tumor process and activation of Cta genes by demethylation of promotor sites, which is correlated with tumor progression; and the conditions required for effective immunotherapy involving Ctas and/or their genes.Conclusion. At present, there are no standards or clinical recommendations for the Cta-based prognosis of the early dissemination of primary skin melanoma. Therefore, it is important to study and analyze the Cta and encoding gene characteristics that reveal the connection between primary sm progression and tumor genesis including the role of circulating tumor cells (ctc), similar to stem cells, which have epithelial-mesenchymal transition (emt) phenotype, for clinical diagnostics of early sm dissemination. As a result of the study, the following Ctas could be considered as significant biomarkers of the early sm dissemination: mage-a1, mage-a4 and ny-eso-1, which expression correlates with the clinical pathological description of the disease progression, as well as with the relapse-free period and overall survival of the patients; magea3, which expression correlates with spag5 activation and Cd8+ t-cell abundance; ssx, a marker for stem cell migration including identification of the cells with emt and/or ctcs; and prame, signaling marker for dissemination of the uveal melanoma.

Variation in material properties leads to variation in stiffness, or displacement response, of structural systems. This paper presents an efficient method to calculate the variability in stiffness of a three-layer Cross Laminated Timber (CLT) panel as a result of heterogeneous elastic properties in the constituent lumber. Typically, problems involving stochastic material properties are solved by Monte Carlo simulations, which is computationally expensive for complex systems. The Variability Response Function is a well-established concept for efficient evaluation of the variance of stochastic systems where properties are modeled by random fields. A new method to study the variation in CLT panel stiffness is developed by applying the Variability Response Function to CLT geometry. Using this method, novel CLT panel layups can efficiently be studied, increasing opportunities for traditionally low-value species to be used in CLT panels. Three case studies are provided to demonstrate the application and utility of the developed method.

Background Falls are a major health burden for older adults with Parkinson’s disease (PD), but there is currently no reliable questionnaire to capture the circumstances and consequences of falls in older adults with PD. This study aimed to develop a PD-specific falls questionnaire and to evaluate its test-retest reliability in older adults with PD. Methods A novel PD-specific falls questionnaire (PDF-Q) was developed in two modes (online and paper-based version) and used to assess falls and near-falls events over the past 12-months. Questions were agreed upon by an expert group, with the domains based on previous falls-related questionnaires. The questions included the number and circumstances (activities, location and direction) of falls and near-falls, and consequences (injuries and medical treatment) of falls. The PDF-Q was distributed to 46 older adults with PD (online n = 30, paper n = 16), who completed the questionnaire twice, 4 weeks apart. Kappa (κ) statistics were used to establish test-retest reliability of the questionnaire items. Results Pooled results from both questionnaires for all participants were used to assess the overall test-retest reliability of the questionnaire. Questions assessing the number of falls (κ = 0.41) and the number of near-falls (κ = 0.51) in the previous 12-months demonstrated weak agreement, while questions on the location of falls (κ = 0.89) and near-falls (κ = 1.0) demonstrated strong to almost perfect agreement. Questions on the number of indoor (κ = 0.86) and outdoor (κ = 0.75) falls demonstrated moderate to strong agreement, though questions related to the number of indoor (κ = 0.47) and outdoor (κ = 0.56) near-falls demonstrated weak agreement. Moderate to strong agreement scores were observed for the most recent fall and near-fall in terms of the direction (indoor fall κ = 0.80; outdoor fall κ = 0.81; near-fall κ = 0.54), activity (indoor fall κ = 0.70; outdoor fall κ = 0.82; near-fall κ = 0.65) and cause (indoor fall κ = 0.75; outdoor fall κ = 0.62; near-fall κ = 0.56). Conclusions The new PDF-Q developed in this study was found to be reliable for capturing the circumstances and consequences of recent falls and near-falls in older adults with PD.

The aim of this paper is to develop 10-year cardiovascular disease (CVD) risk prediction models for the contemporary Chinese populations based on the Guangzhou Biobank Cohort Study (GBCS) and to compare its performance with models based on Framingham’s general cardiovascular risk profile and the Prediction for Atherosclerotic CVD Risk in China (China-PAR) project. Subjects were randomly classified into the training (n = 15,000) and validation (n = 12,721) sets. During an average of 12.0 years’ follow-up, 3,732 CVD events occurred. A 10-year sex-specific CVD risk prediction model including age, systolic blood pressure, use of antihypertensive medication, smoking, and diabetes was developed. Compared with the Framingham and China-PAR models, the GBCS model had a better discrimination in both women (c-statistic 0.72, 95% CI 0.71–0.73) and men (c-statistic 0.68, 95% CI 0.67–0.70), and the risk predicted was closer to the actual risk. This prediction model would be useful for identifying individuals at higher risks of CVD in contemporary Chinese populations.

Background Numerous pathologies result in multiple-organ failure, which is thought to be a direct consequence of compromised cellular bioenergetic status. Neither the nature of this phenotype nor its relevance to survival are well understood, limiting the efficacy of modern life-support. Methods To explore the hypothesis that survival from critical illness relates to changes in cellular bioenergetics, we combined assessment of mitochondrial respiration with metabolomic, lipidomic and redox profiling in skeletal muscle and blood, at multiple timepoints, in 21 critically ill patients and 12 reference patients. Results We demonstrate an end-organ cellular phenotype in critical illness, characterized by preserved total energetic capacity, greater coupling efficiency and selectively lower capacity for complex I and fatty acid oxidation (FAO)-supported respiration in skeletal muscle, compared to health. In survivors, complex I capacity at 48 h was 27% lower than in non-survivors (p = 0.01), but tended to increase by day 7, with no such recovery observed in non-survivors. By day 7, survivors’ FAO enzyme activity was double that of non-survivors (p = 0.048), in whom plasma triacylglycerol accumulated. Increases in both cellular oxidative stress and reductive drive were evident in early critical illness compared to health. Initially, non-survivors demonstrated greater plasma total antioxidant capacity but ultimately higher lipid peroxidation compared to survivors. These alterations were mirrored by greater levels of circulating total free thiol and nitrosated species, consistent with greater reductive stress and vascular inflammation, in non-survivors compared to survivors. In contrast, no clear differences in systemic inflammatory markers were observed between the two groups. Conclusion Critical illness is associated with rapid, specific and coordinated alterations in the cellular respiratory machinery, intermediary metabolism and redox response, with different trajectories in survivors and non-survivors. Unravelling the cellular and molecular foundation of human resilience may enable the development of more effective life-support strategies., Graphical abstract Image 1

Physical human-robot interaction (pHRI) interfaces are responsible for ensuring safe, comfortable, and effective force transfer between wearable devices and their users. However, analysis is often oversimplified by treating the human-robot attachment as a rigid connection and using gross load measurements. As a result, information about the distribution of forces across the human-robot contact surface is lost. In this paper, we present an analysis method to predict distributed loading across a pHRI interface based on a model with discretized elastic elements that account for compliance from human soft tissue and the robot attachment. Stiffness properties of a proxy upper arm are measured with an indenter and used in the pHRI interface model. The analysis is performed assuming a rigid arm model, consistent with the underlying assumption in literature, and repeated using the proposed compliant arm model with measured elastic properties. The distributed loading predicted by the pHRI interface model is validated with measurements from a sensorized upper arm cuff on the Harmony exoskeleton. Our results reveal that a model incorporating compliance at the human-robot attachment is necessary to improve prediction of distributed interface loads. This motivates the need for human-centered analysis which can enable finer control of interaction forces and help design more ergonomic attachment interfaces.

ObjectiveThis systematic review aims to explore and synthesise existing literature on the direct and indirect costs from road traffic injuries (RTIs) in sub-Saharan Africa (SSA), the quality of existing evidence, methods used to estimate and report these costs, and the factors that drive the costs.MethodologyMEDLINE, SCOPUS, ProQuest Central, Web of Science, Global Index Medicus, Embase, World Bank Group e-Library, Econlit, Google Scholar and WHO webpages were searched for relevant literature. References of selected papers were also examined for related articles. Screening was done following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Articles were included in this review if they were published by March 2019, written in English, conducted in SSA and reported original findings on the cost of illness or economic burden of RTIs. The results were systematically examined, and the quality assessed by two reviewers using a modified Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist.ResultsEleven studies met the inclusion criteria. RTIs can cost between INT$119 and 178 634 per injury and INT$486 and 12 845 per hospitalisation. Findings show variability in costing methods and inadequacies in the quality of existing evidence. Prolonged hospital stays, surgical sundries and severity of injury were the most common factors associated with cost.ConclusionWhile available data are limited, evidence shows that the economic burden of RTIs in SSA is high. Poor quality of existing evidence and heterogeneity in costing methods limit the generalisability of costs reported.

Aim: Design Analysis of 7.5KW Stand-alone Solar Photovoltaic Power System for an Intermediate Household. Methodology: A design analysis of standalone 7.5KW PV system was carried out using PV modeling equations based on load estimated. The analyzed data of the solar photovoltaic components was used to determine the estimated output power of 7.5KW. Therefore, a number of modeling equations and methodologies for designing a PV system based on application have been developed and simplified in order to ensure the optimum performance of the system. The analyzed solar powered 7.5KW system was achieved by designing 24 solar panels of 335W each, 16 deep cycle battery of 200A each, and a pulse width modulation (PWM) charge controller of 60A to monitor the output of the battery for safety operation. The battery will be connected to the inverter circuit (DC-AC) to generate 220V alternating current in its output via a step-up transformer. In this paper, design analysis of a standalone PV system enables of producing power to a household with approximate consumption of 7.5KW was conducted. Results: The standalone PV system along with the cost implications was analysed and designed. In this analysis a sequential design plan of an independent standalone solar powered photovoltaic structure was analysed and overviewed to supply continuous and uninterrupted power to a typical utility with maximum power consumption of 7500W (7.5KVA). The calculated/computed values of all the components yield a result that can serve the purpose. Based on the design analysis, the result implies that the estimate consumption of 7.5KW in a day requires 24 PV panels of 335 Watts each, 16 (12V, 200Ah) batteries, 10KW inverter, (12V, 60A) charge controller and copper wire of cross-sectional area (1.688mm2) for installation. Conclusion: In Nigeria, to generate a solar power of 7.5KVA requires almost $15,585.70 which is equivalent to N 5,965,426.66.

Early classification of coronavirus disease (COVID-19) has a vital role in controlling the rapid spread of this disease and saving patients’ lives. The fast spread of COVID-19 increased the diagnostic encumbrance of radiologists. Computed tomography (CT) imaging is an effective tool to detect COVID-19 but requires a radiology expert and takes a large time. The machine learning (ML) based models are considered as one of the important ways to analyze the CT images to detect the COVID-19 cases. Therefore, this paper has been focused on finding a suitable machine learning algorithm that can automatically analyze CT images to extract and detect COVID-19 pneumonia features with higher accuracy. This research used classifiers as the Artificial Neural Network (ANN), Support Vector Machine (SVM), Decision tree (DT) to classify CT images into COVID-19 and NonCOVID-19. This paper also designed an Adaptive Neuro-Fuzzy Inference System (ANFIS) based model to achieve a fast and accurate diagnosis of Covid-19. The CT exams of other lung diseases were included in the dataset to improve the model performance. So, the NonCOVID-19 results of the proposed models include the other lung diseases. Confusion matrices and ROC analyses of the proposed models are analyzed using 5-fold cross-validation. During the study and testing of several proposed models, the experimental results showed that the performance of the ANFIS proposed model achieved the best performance with an accuracy of 98.63% and 0.02 s testing time. In the main purpose of this study is to shed light on the ML-based COVID-19 detection models for researchers working with ML techniques and help avoid proven failures, especially for small imprecise datasets.

AimsSchizophrenia is a highly heritable disorder, sharing genetic roots with other psychiatric disorders from both common and rare genetic variants. Copy number variants (CNVs) are one of the rare causes which increase the risk of a variety of psychiatric, medical and physical phenotypes. The role of schizophrenia-associated CNVs is becoming of increasingly scientific and clinical importance in the field of psychiatry, with new CNV-phenotype relationships opening perspectives for understanding the aetiology of psychiatric disorders. This paper aims to investigate whether 13 schizophrenia (SZ)-associated CNVs or any SZ-CNV-carrier status increase the risk for 9 psychiatric phenotypes, reduce levels of happiness, change duration of sleep, and increase the index of multiple deprivation.MethodThe study includes 421,268 participants of British or Irish descent (aged 40–69 years), containing 418,036 controls and 3232 schizophrenia-associated CNV carriers. The data are secondary from the UK Biobank, an online resource containing data on array-genotyped participants with their specific phenotypic information. Prior to analysis, CNV selection led to the exclusion of any CNV with less than 5 hits in the UK Biobank population. Incidence of each phenotype was based on self-reported diagnoses, questionnaires or hospital ICD-10 diagnoses, with a minimum of 500 cases. Both binary logistic and linear regression were used to assess the incidence of these phenotypes in relation to the CNVs, adjusted for age, sex, and ethnicity as potential cofounders.ResultOverall, 12/13 CNVs were nominally associated with at least one phenotype, including 114/168 possible associations and 54 undetectable associations as not every CNV carrier displayed one of the chosen phenotypes. 41 associations were statistically significant (p < 0.05) and 13 survived Bonferroni Correction (p < 2.98 × 10-4). All significant associations met the expected change except 15q11.2 deletion and any CNV carrier status which showed a decrease in likelihood of addiction.ConclusionThese findings suggest schizophrenia-associated CNV can affect range of psychiatric phenotypes. By building on existing reports, understanding the widespread effects of CNVs in the aetiology and pathogenicty of psychiatric disorders may overtime aid in strengthening our search for more targetted, effective treatments.Many thanks to Professor George Kirov for supervising and supporting this project.

In a railway vehicle air brake system, a brake pipe is used to connect all related elements, for example, the air source system, brake control device, and brake valve. The brake pipe has a significant impact on the safety and reliability of trains. This paper presents a fracture analysis of a brake pipe installed on the bogie of a metro train running on one metro line in China. The analysis was conducted using a brake pipe modal test in a depot, a bogie vibration test, and a brake pipe dynamic stress measurement applied at the field site. The field experiment results indicate that the main cause of a brake pipe fracture is the coupling resonance between the first-order lateral bending eigenmode of the brake pipe (74 Hz) and the eigenmode of the reverse yawing of two side beams of the bogie frame (73 Hz). The wheel out-of-roundness is the main excitation source. To solve the pipe fracture problem, a dynamic stress analysis method that considers the frequency and time domains is presented to assess the possible measures. The measures investigated in this study are the pipe wall thickness, pipe clamp stiffness (elastic modulus), and pipe clamp numbers. The simulation results and on-track tests show that doubling the pipe wall thickness and decreasing the elastic modulus of the pipe clamp by 5.67 fold can reduce the dynamic stress amplitude of the pipe by approximately 60%. If a pipe clamp is added at the middle position between the two pipe clamps on the pipe, the dynamic stress amplitude of the pipe will decrease by 94% compared to the present pipe structure. This is because the additional pipe clamp alters the frequency of the first-order lateral bending eigenmode of the brake pipe to avoid being equal to the eigenfrequency of the reverse yawing of the two side beams of the bogie frame. After the metro corporation added a pipe clamp and applied a regular wheel re-profiling, no brake pipe fracture occurred on the investigated metro line.

Introduction Several drugs of abuse (DOA) are capable of modulating neurohypophysial hormones, such as oxytocin (OT) and vasopressin (VP), potentially resulting in the development of psychological abnormalities, such as cognitive dysfunction, psychoses, and affective disorders. Efavirenz (EFV), widely used in Africa and globally to treat HIV, induces diverse neuropsychiatric side effects while its abuse has become a global concern. The actions of EFV may involve neurohypophysial system (NS) disruption like that of known DOA. This study investigated whether sub-chronic EFV exposure, at a previously-determined rewarding dose, alters peripheral OT and VP levels versus that of a control, ∆9-tetrahydrocannabinol (∆9-THC), methamphetamine (MA) and cocaine. Materials and methods To simulate the conditions under which reward-driven behavior had previously been established for EFV, male Sprague Dawley rats (n = 16/exposure) received intraperitoneal vehicle (control) or drug administration across an alternating sixteen-day dosing protocol. Control administration (saline/olive oil; 0.2 ml) occurred on odd-numbered and drug administration (EFV: 5 mg/kg, ∆9-THC: 0.75 mg/kg, MA: 1 mg/kg, or cocaine: 20 mg/kg) on even-numbered days followed by euthanasia, trunk blood collection and plasma extraction for neuropeptide assay. Effect of drug exposure on peripheral OT and VP levels was assessed versus controls and quantified using specific ELISA kits. Statistical significance was determined by Kruskal-Wallis ANOVA, with p, Highlights • Efavirenz alters rat plasma neuropeptide levels in a similar manner to illicit drugs. • Opposed to cocaine, methamphetamine reduces plasma vasopressin rather than oxytocin. • Efavirenz and ∆−9-tetrahydrocannabinol comparably affect peripheral neuropeptides. • Efavirenz reduces vasopressin more than oxytocin versus ∆−9-tetrahydrocannabinol.