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Smart ports, utilizing advanced and hybrid technologies, are gaining increasing attention for application in the maritime industry, with driver assistance and autonomous driving being pivotal in container-terminal operations. This study introduces a novel approach for enhancing object detection and distance estimation, focusing principally on decision support for reach stacker container handlers in port terminals by integrating generative and deep learning models. The EfficientDet model, enriched with integrated k-means clustering, is developed to detect and classify objects using a practical dataset of labeled images based on visual features. Moreover, generative models, specifically the diffusion model and generative adversarial network, are utilized to generate depth scenes for estimating object distances. Experimental results indicate that the proposed approach yields superior object detection and distance estimation outcomes in port terminal operations, characterized by high accuracy and reduced computational cost. The proposed method exhibits potential for application across various industries, including transportation, logistics, and security, where precise object detection and distance estimation are vital for efficient and secure operations. • Computer vision technique assists safe operations of a reach stacker in port terminals. • GAN and diffusion models generate depth frames without costly stereo cameras. • Adversarial environments in a dataset improve the robustness of the detection model. • With distance estimation, a depth frame supports a 3D map for remote surveillance. • A novel algorithm with computer vision and machine learning guarantees accuracy and efficiency. [ABSTRACT FROM AUTHOR]

This paper investigates the effectiveness of phishing awareness methods amidst the rising tide of cyberattacks. A quantitative analysis of 115 participants was conducted to assess individual vulnerability to phishing and evaluate the impact of various awareness strategies. Descriptive and inferential statistics were used to explore the influence of demographic variables on susceptibility to phishing. The findings indicate that traditional courses and interactive games are beneficial but require continuous re-evaluation. Machine learning models, including Logistic Regression and Random Forest, were developed based on these findings to predict phishing vulnerability. The analysis highlights the importance of age and field of activity in predicting vulnerability, while gender shows a less significant impact. This research underscores the shortcomings of current approaches and suggests improvements for more inclusive and adaptive strategies to counter evolving phishing threats. Future research should explore real user behaviors influenced by psychological factors and ensure balanced participant distribution to enhance the understanding of phishing vulnerability and defense mechanisms. [ABSTRACT FROM AUTHOR]

Upon implantation into a patient, any biomaterial induces a cascade of immune responses that influences the outcome of that device. This cascade depends upon several factors, including the composition of the material itself and the location in which the material is implanted. There is still significant uncertainty around the role of different tissue microenvironments in the immune response to biomaterials and how that may alter downstream scaffold remodeling and integration. In this study, we present a study evaluating the immune response to decellularized extracellular matrix materials within the intraperitoneal cavity, the subcutaneous space, and in a traumatic skeletal muscle injury microenvironment. All different locations induced robust cellular recruitment, specifically of macrophages and eosinophils. The latter was most prominent in the subcutaneous space. Intraperitoneal implants uniquely recruited B cells that may alter downstream reactivity as adaptive immunity has been strongly implicated in the outcome of scaffold remodeling. These data suggest that the location of tissue implants should be taken together with the composition of the material itself when designing devices for downline therapeutics. Different tissue locations have unique immune microenvironments, which can influence the immune response to biomaterial implants. By considering the specific immune profiles of the target tissue, researchers can develop implant materials that promote better integration, reduce complications, and improve the overall outcome of the implantation process. [Display omitted] [ABSTRACT FROM AUTHOR]

Within the context of the opioid epidemic, changes needed to be made in the prescription and administration of analgesics. The purpose of this paper is to describe the development and implementation of a project that utilized a holistic pain assessment framework and introduced new order sets to guide the integration of nonopioid, opioid, and co-analgesics in a quaternary care medical center. An interdisciplinary team updated policies and procedures for pain assessment and opioid administration and created new analgesic order sets for both adult and pediatric patients. Following requisite approvals, these order sets were integrated into the electronic health record. Education of clinicians, patients, and caregivers was provided to facilitate implementation of these new clinical practices. Prescribers' levels of adherence with the use of the pain order sets ranged from 80% to 90% and no adverse effects were reported. Education of nursing staff was incorporated into hospital orientation. Ongoing evaluations are providing insights into how the new policies and procedures can be optimized to ensure reliable, safe, and effective pain management. Since the implementation of the opioid optimization project, adherence with the tiered, multimodal approach to analgesic prescribing is high. Next steps include both qualitative and quantitative evaluations of the benefits and challenges associated with this practice change. For example, systems will be developed to monitor nurses' adherence with the implementation of the pain order sets and the use of both pharmacologic and nonpharmacologic pain management interventions. [ABSTRACT FROM AUTHOR]

• Nursing students are expected to assist in managing anaphylaxis on clinical placement. • Nursing students anaphylaxis treatment knowledge is relatively low. • Experiential learning via simulation is recommended to enhance anaphylaxis knowledge. Anaphylaxis is a life-threatening condition. Evidence appertaining to anaphylaxis knowledge amongst Vietnamese nursing students is limited which questions their preparedness to respond to clinical deterioration. To examine anaphylaxis knowledge amongst Vietnamese nursing students. A cross-sectional survey design of third and fourth-year nursing students. A total of 140 nursing students participated. Eighty-nine (63.6%) students possessed good, generalized knowledge however, only 67 (47.9%) had good knowledge of anaphylaxis treatment. More than half (n=86, 61,4%) identified epinephrine as the first line treatment, but 55.7% (n=78) and 52.1% (n=73) of students incorrectly answered anaphylaxis treatment procedures and epinephrine dose for children, respectively. Knowledge of anaphylaxis varied between third- and fourth-year students. Despite showcasing a general good level of knowledge, some knowledge aspects require improvement. Recommendations include enhancing experiential learning opportunities to support student knowledge and reasoning to ensure effective translation of learning to practice. [ABSTRACT FROM AUTHOR]

Single-stage microtia auricular reconstruction is becoming more relevant. The determining factor is a temporoparietal fascia flap (TPF) with both branches of the superficial temporal artery (STA). There are not many studies regarding vascular branching in people with microtia. We conducted an anatomical study on the TPF flap harvested during single-stage endoscopic-assisted microtia auricular reconstruction from May 2018 to July 2021. We observed the flaps under endoscopic and surgical microscopes to determine several variables (vascular size, number of frontal/parietal branches, distance from the branching location to the estimated external ear canal, distance from the frontal artery to projected course of facial nerve's frontal branch, etc.). The study included 55 flaps from 54 patients. Of the 55 flaps, 50 (90.9%) had a parietal branch, and all 55 (100%) had a frontal branch with a mean diameter of 0.98 and 0.91 mm, respectively. Regarding the frontal artery, 1.8%, 25.5%, 50.9%, 16.35% and 5.45% had 0–4 traverse frontal branch(es), respectively. The mean distance from the frontal artery to the estimated course of the frontal nerve was 10.56 mm. Parietal artery absence is more likely in patients with severe hemifacial microsomia or STA trunk go under the auricular cartilage remnants (p < 0.05). Either frontal or parietal artery absence or small diameter can cause necrosis. Frontal arteries travelling near the frontal nerve may result in post-operative nerve palsy. Microtia auricular reconstructive surgery is always a big challenge for plastic surgeons. Anatomical variants are common. A detailed anatomical description of the STA, with the help of microsurgery and endoscopy, allows arterial-based flap designing and harvest, which tremendously improves surgical success rate by diminishing flap necrosis and nerve damage. Therapeutic, IV. [ABSTRACT FROM AUTHOR]

The evolution and functioning of various tropical ecosystems is poorly understood due to a lack of quantitative techniques to characterize the physicochemical composition of soils and sediment. Here, a detailed multi-method study of lithological changes is provided from a core taken from the silted-up Dibi subsidence lake (central Cameroon). To unravel the provenance of sediment, mineral constituents, and organic matter sources, an array of tools are applied including a spectrophotometer, a laser particle sizer, Rock-Eval pyrolysis, X-ray diffractometer (XRD), a portable X-ray fluorescence (XRF) spectrometry, and an inductively coupled plasma-atomic emission spectroscopy (ICP-AES) instruments. The studied core consists of light-colored deposits at the base (Unit 1) overlain by dark humic deposits (Unit 2). The sediment is very well graded (grading index Sd < 0.35Ф), indicative of bottom suspended to rolling transport. Unit 1 is characterized by relatively low values of total organic carbon (TOC: 2%–5%) whereas the dark Unit 2 has high contents of TOC (10%–33%). The core shows a high oxygen index (OI) value (average = 207 mg carbon dioxide (CO 2)/g TOC) and a low hydrogen index (HI) value (average = 107 mg hydrocarbon (HC)/g TOC). This indicates highly altered organic matter (OM), likely from decomposed terrestrial plants. The chlorophyll-α fingerprint (peak around 675 nm) also reveals an autochtonous primary production of organic matter. The mineralogical assemblage of Unit 2 comprises kaolinite, quartz, feldspars, montmorillonite, ilmenite, siderite, gibbsite, rutile, and anatase whereas that of Unit 1 is similar but differs with the presence of illite and the absence of gibbsite. The high titanium dioxide (TiO 2) and zirconium (Zr) contents confirm that the source rocks also are comprised of granites, and gneiss without volcanic rocks, such as basalts and trachytes. The source rocks have been intensively weathered using some parameters such as ln(Al 2 O 3 /Na 2 O), K 2 O/Rb, K/Al, and weathering indices, where Al 2 O 3 denotes aluminum oxide, Na 2 O denotes sodium oxide, K 2 O denotes potassium oxide, Rb denotes rubidium, K denotes potassium, and Al denotes aluminum. The enrichment factors (EF) of redox-sensitive trace elements and their relation with TOC, the negative values of manganese/iron ratio (Mn∗) associated to three elemental ratios (cupper/zinc (Cu/Zn), thorium/uranium (Th/U), and vanadium/chromium (V/Cr)) attest to the predominance of sub-oxic to anoxic bottom waters in Dibi lake during sediment deposition. The data also show low primary productivity at the base of the core, followed by an increase towards the top, linked to the intensification of weathering and facilitated by humid climatic conditions, usually increase terrestrial input and palaeoproductivity. The petrological data show a generally warm and humid palaeoclimate. This climatic variation has contributed to the large spread of the savannah and disappearance of the forest. This study sheds light on the late Pleistocene to Holocene palaeoenvironment evolution of the Adamawa region which could be integrated into the context of the Pleistocene to Present regional evolution of the tropical palaeoenvironment. • The lacustrine deposit suggests a dual origin of the OM (terrestrial and lacustrine). • Environmental conditions suggest anoxic to sub-oxic medium in freshwater. • The Adamawa region has been going through a hot and humid climate for more than 2,500 cal years BP. [ABSTRACT FROM AUTHOR]

Late gadolinium enhancement (LGE) scar burden by cardiac magnetic resonance is a major risk factor for sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM). However, there is currently limited data on the incremental prognostic value of integrating myocardial LGE radiomics (ie, shape and texture features) into SCD risk stratification models. The purpose of this study was to investigate the incremental prognostic value of myocardial LGE radiomics beyond current European Society of Cardiology (ESC) and American College of Cardiology (ACC)/American Heart Association (AHA) models for SCD risk prediction in HCM. A total of 1,229 HCM patients (62% men; age 52 ± 16 years) from 3 medical centers were included. Left ventricular myocardial radiomic features were calculated from LGE images. Principal component analysis was used to reduce the radiomic features and calculate 3 principal radiomics (PrinRads). Cox and logistic regression analyses were then used to evaluate the significance of the extracted PrinRads of LGE images, alone or in combination with ESC or ACC/AHA models, to predict SCD risk. The ACC/AHA risk markers include LGE burden using a dichotomized 15% threshold of LV scar. SCD events occurred in 30 (2.4%) patients over a follow-up period of 49 ± 28 months. Risk prediction using PrinRads resulted in higher c-statistics than the ESC (0.69 vs 0.57; P = 0.02) and the ACC/AHA (0.69 vs 0.67; P = 0.75) models. Risk predictions were improved by combining the 3 PrinRads with ESC (0.73 vs 0.57; P < 0.01) or ACC/AHA (0.76 vs 0.67; P < 0.01) risk scores. The net reclassification index was improved by combining the PrinRads with ESC (0.25 [95% CI: 0.08-0.43]; P = 0.005) or ACC/AHA (0.05 [95% CI: −0.07 to 0.16]; P = 0.42) models. One PrinRad was a significant predictor of SCD risk (HR: 0.57 [95% CI: 0.39-0.84]; P = 0.01). LGE heterogeneity was a major component of PrinRads and a significant predictor of SCD risk (HR: 0.07 [95% CI: 0.01-0.75]; P = 0.03). Myocardial LGE radiomics are strongly associated with SCD risk in HCM and provide incremental risk stratification beyond current ESC or AHA/ACC risk models. Our proof-of-concept study warrants further validation. [Display omitted] [ABSTRACT FROM AUTHOR]

OBJECTIVE: The COVID-19 pandemic resulted in training programs restructuring their curricula. Fellowship programs are required to monitor each fellow's training progress through a combination of formal evaluations, competency tracking, and measures of knowledge acquisition. The American Board of Pediatrics administers subspecialty in-training examinations (SITE) to pediatric fellowship trainees annually and board certification exams at the completion of the fellowship. The objective of this study was to compare SITE scores and certification exam passing rates before and during the pandemic. METHODS: In this retrospective observational study, we collected summative data on SITE scores and certification exam passing rates for all pediatric subspecialties from 2018 to 2022. Trends over time were assessed using analysis of variance (ANOVA) analysis to test for trends across years within one group and t-test analysis to compare groups before and during the pandemic. RESULTS: Data were obtained from 14 pediatric subspecialties. Comparing prepandemic to pandemic scores, Infectious Diseases, Cardiology, and Critical Care Medicine saw statistically significant decreases in SITE scores. Conversely, Child Abuse and Emergency Medicine saw increases in SITE scores. Emergency Medicine saw a statistically significant increase in certification exam passing rates, while Gastroenterology and Pulmonology saw decreases in exam passing rates. CONCLUSIONS: The COVID-19 pandemic resulted in restructuring didactics and clinical care based on the needs of the hospital. There were also societal changes affecting patients and trainees. Subspecialty programs with declining scores and certification exam passing rates may need to assess their educational and clinical programs and adapt to the needs of trainees' learning edges. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Taibah University Medical Sciences is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Anastomotic strictures (AS) after esophageal atresia (EA) repair are common. While most respond to endoscopic therapy, some become refractory and require surgical intervention, for which the outcomes are not well established. All EA children with AS who were treated surgically at two institutions (2011–2022) were retrospectively reviewed. Surgical repair was performed for those with AS that were either refractory to endoscopic therapy or clinically symptomatic and undergoing surgery for another indication. Anastomotic leak, need for repeat stricture resection, and esophageal replacement were considered poor outcomes. 139 patients (median age: 12 months, range 1.5 months–20 years; median weight: 8.1 kg) underwent 148 anastomotic stricture repairs (100 refractory, 48 non-refractory) in the form of stricturoplasty (n = 43), segmental stricture resection with primary anastomosis (n = 96), or stricture resection with a delayed anastomosis after traction-induced lengthening (n = 9). With a median follow-up of 38 months, most children (92%) preserved their esophagus, and the majority (83%) of stricture repairs were free of poor outcomes. Only one anastomotic leak occurred in a non-refractory stricture. Of the refractory stricture repairs (n = 100), 10% developed a leak, 9% required repeat stricture resection, and 13% required esophageal replacement. On multivariable analysis, significant risk factors for any type of poor outcome included anastomotic leak, stricture length, hiatal hernia, and patient's weight. Surgery for refractory AS is associated with inherent yet low morbidity and high rates of esophageal preservation. Surgical repair of non-refractory symptomatic AS at the time of another thoracic operation is associated with excellent outcomes. Level III. • Surgical treatment for refractory strictures can achieve a high rate of esophageal preservation; however, this carries an inherent but low risk of anastomotic leak, need for repeat stricture resection, or eventual esophageal replacement. • Children with co-existent refractory stricture and a hiatal hernia are at an increased risk of poor anastomotic outcomes. [ABSTRACT FROM AUTHOR]

Studies have documented diverse adverse effects of the COVID-19 pandemic on young people's lives—for instance on mental health, education/employment prospects, and intrafamily violence. We sought to generate much-needed evidence regarding whether, and which, young people are experiencing multiple intersecting effects. Data come from cross-sectional surveys with young people ages 15–25 years in Mexico (nationwide, n = 55,692), Kenya (four counties, n = 2,750), and India (two states, n = 3,537), collected from late 2020 to early 2022. We used latent class analysis to identify subgroups based on multiple adverse effects, then examined associations between these subgroups and COVID-19 infections/family deaths, and sociodemographic characteristics. We found prevalent adverse impacts overall and two distinct subgroups in each country—one experiencing higher levels of all impacts, such as on mental health (44%–78% across countries), education/employment (22%–84%), intrafamily violence (22%–49%), and friendships (66%–86%). This subgroup comprised 40% of the sample in Mexico, 25% in Kenya, and 35% in India. In multivariate analyses, this group consistently had greater odds of experiencing COVID-19-related infections and deaths of loved ones. They were more likely socioeconomically disadvantaged, older, urban residents. Associations with other characteristics were country-specific. This study provides novel cross-country evidence that a subgroup of young people has experienced intersecting adverse impacts of COVID-19 on their lives. Findings also confirm prior evidence of multiple elevated vulnerabilities in general. Expanded provision of multiple layers of support is required, particularly for the most vulnerable subgroup, as are multi-sectoral policies and interventions to prevent intersectional effects in future times of crisis. [ABSTRACT FROM AUTHOR]

Repetitive Transcranial Magnetic Stimulation (rTMS) is an effective treatment for Major Depressive Disorder (MDD). Two common rTMS protocols, 10 Hz and intermittent theta burst stimulation (iTBS), have comparable rates of efficacy in groups of patients. Recent evidence suggests that some individuals may be more likely to benefit from one form of stimulation than the other. The pretreatment pupillary light reflex (PLR) is significantly associated with response to a full course of rTMS using heterogeneous stimulation protocols. To test whether the relationship between pretreatment PLR and early symptom improvement differed between subjects treated with iTBS or 10 Hz stimulation. PLR was measured in 52 subjects who received solely 10 Hz (n = 35) or iTBS (n = 17) to left dorsolateral prefrontal cortex (DLPFC) for the first ten sessions of their treatment course. Primary outcome measure was the percent change of Inventory of Depressive Symptomatology – Self Report (IDS-SR) from session 1 to session 10. There was a positive association between normalized maximum constriction velocity (nMCV) and early improvement in subjects receiving 10 Hz stimulation (R = 0.48, p = 0.004) and a negative association in subjects receiving iTBS (R = −0.52, p = 0.03). ANOVA revealed a significant interaction between nMCV and the type of initial stimulation (p = 0.001). Among subjects with low nMCV, those initially treated with iTBS showed 2.6 times greater improvement after 10 sessions (p = 0.01) than subjects initially receiving 10 Hz stimulation. nMCV may detect physiologic differences between those likely to benefit from 10 Hz or iTBS treatment. Future studies should examine whether PLR could guide prospective treatment selection. • We examined the pupillary light reflex in MDD subjects treated with 10 Hz rTMS or intermittent theta-burst stimulation. • Pupillometry may detect baseline differences between subjects more likely to show early response to 10 Hz or iTBS treatment. • The utility of the PLR in guiding prospective treatment assignment should be assessed in randomized controlled studies. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To describe the process of identifying and reporting inpatient safety concerns from the perspective of parents of children with medical complexity (CMC). METHODS: We conducted a secondary analysis of qualitative data from semi-structured interviews with 31 English and Spanish-speaking parents of CMC at two tertiary children's hospitals. Interviews lasted 45--60 minutes and were audio-recorded, translated, and transcribed. Three researchers inductively and deductively coded transcripts using an iteratively refined codebook with validation by a fourth researcher. Thematic analysis was used to develop a conceptual model of the process of inpatient parent safety reporting. RESULTS: We identified four steps illustrating the process of inpatient parent safety concern reporting 1) parent recognizing concern, 2) parent reporting concern, 3) staff/hospital response continuum, and 4) parent feelings of validation/invalidation. Many parents endorsed that they were the first to catch a safety concern and were identified as unique reporters of safety information. Parents typically described reporting their concerns verbally and in real-time to the person they felt could quickly remedy the situation. There was a spectrum of validation. Some parents reported their concerns were not acknowledged and addressed, which led them to feel overlooked, disregarded, or judged. Others reported their concerns were acknowledged and addressed, resulting in parents feeling heard and seen and often leading to changes in clinical care. CONCLUSIONS: Parents described a multi-step process of reporting safety concerns during hospitalization and a spectrum of staff response and validation. These findings can inform family-centered interventions that support safety concern reporting in the inpatient setting. [ABSTRACT FROM AUTHOR]

Copyright of Proges en Urologie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Two new neolignans, plagraneolignans A-B (1 - 2), in addition to eight known compounds, platycodin D (3), platycodin J (4), platycodin D 3 (5), platyconic acid A (6), platycoside E (7), chlorogenic acid (8), hexyl β -sophoroside (9) and tryptophan (10), were isolated from the roots of Platycodon grandiflorus. Their structures were elucidated by means of comprehensive spectroscopic analysis, including 1D, 2D and HRESIMS, as well as though comparison with published data. The antioxidant and hypolipidemic effects of all isolated compounds were evaluated. Compounds 1 - 2 , 8 and 10 exhibited the DPPH radical scavenging activity with IC 50 values ranging from 40.4 to 54.9 µM and the capacity of reducing intracellular lipid levels on the HepG2 cell line in the range of 21.79–32.40%. [Display omitted] • Two new neolignans, plagraneolignans A-B (1 - 2) were isolated from the roots of Platycodon grandiflorus. • Their structures were successfully determined by spectroscopic evidence. • Compounds 1 - 2 showed the antioxidant and hypolipidemic effects. [ABSTRACT FROM AUTHOR]

[Display omitted] • Sedimentary rocks from northwestern Vietnam experienced Triassic metamorphism. • Metasedimentary rocks were sourced from the western Yangtze Block and the northwestern Vietnam. • The JASSZ records Paleo-Tethyan ocean-continent subduction-collision orogenic processes. Metasedimentary rocks in the Son La area of northwestern Vietnam provide unique geochronological and metamorphic evidence for constraining Paleo-Tethys evolution. In this study, detrital zircons from the metasedimentary rocks in the Nam Co Complex were dated and yield ages between 2787 and 618 Ma. Their maximum depositional ages are constrained to ca. 870 Ma and ca. 835 Ma for the lower and upper formations, respectively. Similarly, the ages of detrital zircons from metasedimentary rocks in the Ta Khoa antiform cluster from 3280 to 749 Ma. The depositional ages of the metasandstone and gneisses are constrained at ca. 800 Ma and ca. 760 Ma, respectively. The age patterns and Hf isotope compositions of the Nam Co Complex and the Ta Khoa antiform are similar to those of the western Yangtze Block, suggesting that the metasedimentary rocks in northwestern Vietnam represent the southeastern extent of the western Yangtze Block. Metamorphic zircon and monazite from metasedimentary rocks in northwestern Vietnam constrain Triassic tectonic events at 247–240 Ma. The P-T conditions of the metasedimentary rocks from the Ta Khoa antiform were defined at P = ca. 7.0–7.5 kbar and T = ca. 685 °C. Additionally, mineral chemical analyses indicate that phengites occur in Grt-Ph schists from the Nam Co Complex. The phengites have high Si contents (up to 3.542p.f.u.), indicating that the Grt-Ph schist experienced a high-pressure metamorphic event. Previous studies have also reported that eclogites and granulites in the Jinshajiang, Ailaoshan, and Song Ma zones record Triassic high-pressure metamorphism with a clockwise P-T-t path. These results suggest that the Jinshajiang-Ailaoshan-Song Ma suture zone (JASSZ) is a Paleo-Tethyan ocean-continent subduction-collision orogenic belt. The spatial distribution and tectonic evolution of the metasedimentary rocks in the Son La area support the hypothesis of west-dipping subduction of the Yangtze Block beneath the Indochina Block along the JASSZ. [ABSTRACT FROM AUTHOR]

• In this pilot study, we found independent-living older adults to be moderately lonely and use digital technology as an instrument for social connection and life administration. • We assessed virtual tourism as a potential facilitator to increasing social connectedness, finding the potential exists, but further research is required. • It is essential to consider barriers and facilitators to increasing social connectedness through digital technology in older adult populations, including user experience, user interface, and ergonomics of products. • Older adults experience enjoyment, nostalgia, and interest in using virtual tourism. • Future research must consider users from diverse populations, particularly in revisiting places of shared interest virtually and the feasibility of these advanced digital devices and use. The present pilot study explored the research aim of understanding how independent-living older adults experience social isolation and loneliness and whether virtual tour digital technology can increase social connectedness (N = 10). Through triangulation of interviews, experiences, and feedback, this study contributes to the knowledge base on the well-being of our ageing populations and how digital technologies, specifically virtual tourism, can aid in this process. The key findings reveal that the participants in our study were moderately lonely but were open to embracing more digital technology, sharing how it is instrumental in facilitating social connection and life administration. Participating in virtual tour experiences was well accepted as participants expressed enjoyment, nostalgia, and interest in future use. However, its contribution to increasing social connections needs to be clarified and requires further investigation. Several future research and education directions are provided. [ABSTRACT FROM AUTHOR]

• We assessed perampanel outcomes for pediatric Japanese patients from study 311. • Adjunctive perampanel for FOS was generally safe and well tolerated. • Perampanel was efficacious regardless of seizure types or EIASM status. • Perampanel is an effective treatment option in Japanese pediatric patients with FOS. To evaluate the safety and tolerability of adjunctive perampanel in a Japanese subpopulation of Study 311 (NCT02849626), which was a global, multicenter, open-label, single-arm study of children (aged 4 to <12 years) with inadequately controlled focal-onset seizures (FOS), with or without focal to bilateral tonic-clonic seizures (FBTCS) or generalized tonic-clonic seizures (GTCS). Study 311 comprised a Core Study, Extension A, and Extension B; this report focuses on the Japanese patient subgroup in the Core Study only. In the Core Study, Japanese patients (FOS only) received adjunctive perampanel ≤12 mg/day in a 23-week Treatment Phase. Endpoints included safety/tolerability (primary) and median percent change in seizure frequency per 28 days from baseline. Patients were stratified by age and concomitant enzyme-inducing anti-seizure medication (EIASM) use. Of 65 enrolled Japanese patients, 56 completed the Core Study and nine withdrew. The most common reason for discontinuation was adverse events (AEs) (n = 4 [6.2%]). The mean (standard deviation) daily dose of perampanel in Japanese FOS patients was 5.8 (2.2) mg/day. During the Core Study, treatment-emergent AEs (TEAEs) were reported by 89% of Japanese patients, most commonly nasopharyngitis (28%) and somnolence (28%). The median percent reduction in seizure frequency per 28 days from baseline was 37% and the lower limit of the 95% CI was greater than 10.5%, satisfying the pre-defined efficacy criteria. Perampanel was effective regardless of age or concomitant EIASM use. Perampanel as adjunctive therapy is generally safe, well-tolerated, and efficacious in Japanese children aged 4 to <12 years with FOS (with/without FBTCS). [ABSTRACT FROM AUTHOR]

Lateral cervical lymph node metastases (LNM) for pediatric patients with papillary thyroid cancer (PTC) is a poor prognostic factor. We aimed to identify risk factors for lateral LNM. This retrospective study had included 48 pediatric patients with papillary thyroid cancer underwent total thyroidectomy and central cervical lymphadenectomy at K hospital from 2016 to 2020. The number of patients in each T stage was as follows: 24 (50.0%) in stage 1, 9 (18.7%) in Stage 2, 8 (16.7%) in Stage 3, and 7 (14.6%) in Stage 4. Most of the patients had LNM with N1a and N1b rates of 83.3% and 62.5%, respectively. Lung metastases were observed at presentation in three patients (6.3%). Univariate analysis revealed that age (p = 0.021), male (p = 0.011), tumor size > 10 mm (p = 0.002), multifocality (p < 0.001), extrathyroidal extension (p = 0.001) and central LNM (p < 0.001) were factors that increase the risk of metastasis to lateral LNM. Approximately 62.5% of pediatric patients with PTC exhibited lateral LNM at the time of diagnosis. Our study confirmed that multifocality, maximum tumor diameter, extrathyroidal extension and central LNM were independent risk factors for lateral LNM in pediatric PTC. Level IV. [ABSTRACT FROM AUTHOR]

• Indocyanine green is used to evaluate perfusion in a variety of surgical disciplines such as colorectal surgery, vascular surgery, and plastic surgery. • We defined qualitative features of indocyanine green fluorescence angiography of esophageal anastomoses in children, and created an anastomotic scorecard that indicates risk of a poor outcome. Indocyanine green (ICG) is commonly used to assess perfusion, but quality defining features are lacking. We sought to establish qualitative features of esophageal ICG perfusion assessments, and develop an esophageal anastomotic scorecard to risk-stratify anastomotic outcomes. Single institution, retrospective analysis of children with an intraoperative ICG perfusion assessment of an esophageal anastomosis. Qualitative perfusion features were defined and a perfusion score developed. Associations between perfusion and clinical features with poor anastomotic outcomes (PAO, leak or refractory stricture) were evaluated with logistic and time-to-event analyses. Combining significant features, we developed and tested an esophageal anastomotic scorecard to stratify PAO risk. From 2019 to 2021, 53 children (median age 7.4 months) underwent 55 esophageal anastomoses. Median (IQR) follow-up was 14 (10–19.9) months; mean (SD) perfusion score was 13.2 (3.4). Fifteen (27.3%) anastomoses experienced a PAO and had significantly lower mean perfusion scores (11.3 (3.3) vs 14.0 (3.2), p = 0.007). Unique ICG perfusion features, severe tension, and primary or rescue traction-induced esophageal lengthening [Foker] procedures were significantly associated with PAO on both logistic and Cox regression. The scorecard (range 0–7) included any Foker (+2), severe tension (+1), no arborization on either segment (+1), suture line hypoperfusion >twice expected width (+2), and segmental or global areas of hypoperfusion (+1). A scorecard cut-off >3 yielded a sensitivity of 73% and specificity of 93% (AUC 0.878 [95%CI 0.777 to 0.978]) in identifying a PAO. A scoring system comprised of qualitative ICG perfusion features, tissue quality, and anastomotic tension can help risk-stratify esophageal anastomotic outcomes accurately. Diagnostic - II [Display omitted] [ABSTRACT FROM AUTHOR]

In this paper, sensorless robust speed control with nonlinear lumped mismatched disturbance observers for a permanent magnet type axial gap bearingless motor (AGBM) is designed. Multistage anti-windup-based dynamic surface control combined with integral backstepping control is proposed to control the motor's axial displacement and rotor speed. The approach is against parameter uncertainties and external disturbances, improving steady-state accuracy, eliminating the derivative explosion phenomenon, no chattering problem, and reducing the magnitude of the control system when current saturation occurs. In addition, a novel nonlinear lumped mismatched disturbance observer is proposed to improve the approach under unmodeled dynamics and external disturbances. To obtain high-accuracy tracking control, the control system includes the robust controller combined with the disturbance observers and anticipatory activation of anti-windup (AW) compensation, which means the controller is more complex. Then, to design a sensorless robust speed control for the motor, the rotor position and speed observer require higher accuracy. High-gain back-EMF observer combined with an improved phase-locked loop is proposed to estimate rotor angular position and speed even when the motor speed is reversed. Overall stability of closed-loop system control, including a sensorless speed control approach for motors using back-EMF estimation combined with saturation of the currents and lumped disturbance observers, is mathematically proven. Finally, the simulation results under measurement noise show that the proposed control system are obtained the effectiveness, feasibility, and robustness. [Display omitted] [ABSTRACT FROM AUTHOR]

To evaluate the outcomes of adult patients with spermatic cord sarcoma (SCS). All consecutive patients with SCS managed by the French Sarcoma Group from 1980 to 2017 were analysed retrospectively. Multivariate analysis (MVA) was used to identify independent correlates of overall survival (OS), metastasis-free survival (MFS), and local relapse-free survival (LRFS). A total of 224 patients were recorded. The median age was 65.1 years. Forty-one (20.1%) SCSs were discovered unexpectedly during inguinal hernia surgery. The most common subtypes were liposarcoma (LPS) (73%) and leiomyosarcoma (LMS) (12.5%). The initial treatment was surgery for 218 (97.3%) patients. Forty-two patients (18.8%) received radiotherapy, 17 patients (7.6%) received chemotherapy. The median follow-up was 5.1 years. The median OS was 13.9 years. In MVA, OS decreased significantly with histology (HR, well-differentiated LPS versus others = 0.096; p = 0.0224), high grade (HR, 3 versus 1–2 = 2.7; p = 0.0111), previous cancer and metastasis at diagnosis (HR = 6.8; p = 0.0006). The five-year MFS was 85.9% [95% CI: 79.3–90.6]. In MVA, significant factors associated with MFS were LMS subtype (HR = 4.517; p < 10-4) and grade 3 (HR = 3.664; p < 10-3). The five-year LRFS survival rate was 67.9% [95% CI: 59.6–74.9]. In MVA, significant factors associated with local relapse were margins and wide reresection (WRR) after incomplete resection. OS was not significantly different between patients with initial R0/R1 resection and R2 patients who underwent WRR. Unplanned surgery affected 20.1% of SCSs. A nonreducible painless inguinal lump should suggest a sarcoma. WRR with R0 resection achieved similar OS to patients with correct surgery upfront. [ABSTRACT FROM AUTHOR]

Artificial Intelligence (AI) can optimize treatment approaches in dental healthcare due to its high level of accuracy and wide range of applications. This study seeks to propose a new deep learning (DL) ensemble model based on deep Convolutional Neural Network (CNN) algorithms to predict tooth position, detect shape, detect remaining interproximal bone level, and detect radiographic bone loss (RBL) using periapical and bitewing radiographs. 270 patients from January 2015 to December 2020, and all images were deidentified without private information for this study. A total of 8000 periapical radiographs with 27,964 teeth were included for our model. AI algorithms utilizing the YOLOv5 model and VIA labeling platform, including VGG-16 and U-Net architecture, were created as a novel ensemble model. Results of AI analysis were compared with clinicians' assessments. DL-trained ensemble model accuracy was approximately 90% for periapical radiographs. Accuracy for tooth position detection was 88.8%, tooth shape detection 86.3%, periodontal bone level detection 92.61% and radiographic bone loss detection 97.0%. AI models were superior to mean accuracy values from 76% to 78% when detection was performed by dentists. The proposed DL-trained ensemble model provides a critical cornerstone for radiographic detection and a valuable adjunct to periodontal diagnosis. High accuracy and reliability indicate model's strong potential to enhance clinical professional performance and build more efficient dental health services. [ABSTRACT FROM AUTHOR]

Bioaccumulation of heavy metals in mangrove crabs has been reported and most of them are toxic to animals and potential human carcinogens. Given that the land crab Cardisoma armatum Herklots, 1951 is more consumed by surrounding populations, this study aimed to quantify the levels of metals in its tissues and to assess the human health risks. Soft tissues were isolated in adult crabs and frozen then; samples were dried, crushed and handled following the standard procedures. Human health risks were evaluated using some indices. Heavy metal levels in each tissue were shown in decreasing order: Fe > Zn > Al > Cu > Cd > Pb. Cadmium, lead and copper metals were in upper levels in the hepatopancreas (0.35, 0.19 and 7.88 mg/kg) whereas iron, aluminium and zinc were higher in muscles (129.30, 15.96 and 82.83 mg/kg). Most EDI values were apparently below the PTDI and CR Lim values signifying that the consumption of C. armatum remains safe for consumers although, a limit in intake frequency might be required for children. For all metals, THQ and HI values were below the standard value 1 indicating no health risks in consumers due to the intake of single or several metals. Also, the carcinogenic risks for Cd and Pb metals are considered to be negligible because they are lower than 10−6. Overall, regarding the results, consumption of C. armatum seems harmless for human health in the study area. [ABSTRACT FROM AUTHOR]

Centrally administered insulin stimulates the reward system to reduce appetite in response to food intake in animal studies. In humans, studies have shown conflicting results, with some studies suggesting that intranasal insulin (INI) in relatively high doses may decrease appetite, body fat, and weight in various populations. These hypotheses have not been tested in a large longitudinal placebo-controlled study. Participants in the Memory Advancement with Intranasal Insulin in Type 2 Diabetes (MemAID) trial were enrolled in this study. This study on energy homeostasis enrolled 89 participants who completed baseline and at least 1 intervention visit (42 women; age 65 ± 9 years; 46 INI, 38 with type 2 diabetes) and 76 completed treatment (16 women, age 64 ± 9; 38 INI, 34 with type 2 diabetes). The primary outcome was the INI effect on food intake. Secondary outcomes included the effect of INI on appetite and anthropometric measures, including body weight and body composition. In exploratory analyses, we tested the interaction of treatment with gender, body mass index (BMI), and diagnosis of type 2 diabetes. There was no INI effect on food intake or any of the secondary outcomes. INI also showed no differential effect on primary and secondary outcomes when considering gender, BMI, and type 2 diabetes. INI did not alter appetite or hunger nor cause weight loss when used at 40 I.U. intranasally daily for 24 weeks in older adults with and without type 2 diabetes. [ABSTRACT FROM AUTHOR]

This article presents the implementation of a multi-criteria decision support method in the management of multi-source switching systems. We implement the Analytic Hierarchy Process (AHP) in order to solve problems relating to multi-source switching systems. This method reduces undesired multiple switchings bothering the output signal and perceived as electrical perturbations for sensitive charges. The advantage of this approach is that it makes it possible to compare several criteria that are difficultly customisable, using a sole optimisation function. As solution to curb issues relating to the implementation of AHP in real time as descrribed in the literature, we propose an algorithm for aggregating criteria, sub-criteria and alternatives, of which the ultimate goal is to switch to the alternative source offering the best compromise amongst a variety of contradictory. To approve the proposed AHP method, we implement an expert source management system in a Labview environment, which reproduces the same switching conditions in real time. [ABSTRACT FROM AUTHOR]

Hospital onset Clostridioides difficile infection (CDI) causes significant disease burden and is associated with increased patient mortality. A nurse-driven CDI test order set had been implemented to reduce hospital-onset CDI, yet the order set was not being used. We employed a humble inquiry interview method to identify barriers to using the CDI test order set. The humble inquiry approach uncovered unexpected barriers and may be a robust method to identify additional infection prevention evidence-to-practice gaps. • The Humble inquiry interview method may be useful in infection prevention. • Humble inquiry allows for open ended responses. • The study found unexpected barriers to utilizing a nurse driven C.diff order set. • Patient modesty was a barrier to nurse-patient communication regarding bowel habits. [ABSTRACT FROM AUTHOR]

Combination of liver stiffness measurement and platelets count is a tool to safely rule out varices needing treatment (VNT) in patients with compensated advanced chronic liver disease (cACLD). Aims: to evaluate 4-year liver-related complications and survival in low-risk patients according to Baveno VI criteria. we conducted a monocentric retrospective analysis of prospectively collected data of all consecutive patients, with cirrhosis (LSM≥12.5 kPa) and without previous complication, evaluated between 2012 and 2015. Liver-related complications and survival were compared between 2 groups of patients: favourable (LSM< 20 kPa and platelet count>150.000/mm3) and unfavourable Baveno VI status patients (LSM ≥ 20 kPa or platelet count ≤150.000/mm3). 455 patients with cACLD were analysed. Two hundred patients had favourable Baveno VI criteria, 3.6% with VNT. The 4-year probability of being free of acute decompensation was higher in low-risk patients (94.4 ± 1.8% vs. 85.7%±2.6%, p = 0.018). Unfavourable Baveno status was independently associated with acute decompensation. The probability of being free of HCC was significantly higher in low-risk patients (94.2 ± 1.8% vs. 87.6 ± 2.4%, p = 0.048). Liver-related mortality was not different between the 2 groups (p = 0.56). The Baveno VI criteria could predict clinical outcome in cACLD. [ABSTRACT FROM AUTHOR]

Upper limb balance is one of the important physical fitness parameters for all populations, especially overhead athletes like swimmers. Upper extremity star excursion balance test (UESEBT) is a comprehensive dynamic balance assessment, this study aims to explore the reliability and validity of UESEBT among adolescent swimmers. This cross-sectional study recruited 70 adolescent swimmers. All participants were required to complete UESEBT, upper quarter Y-balance test (UQYBT), maximal isometric strength (MIS) tests in upper limb, closed kinetic chain upper extremity stability test (CKCUEST), trunk flexor endurance test (TFET) and lateral trunk endurance test (LTET). The intra- and inter-operator reliability and the correlation of UESEBT with other physical performances were conducted. For reliability, the intra- and inter-operator reliability of all directions and composite score were high-to-excellent (ICC = 0.706−1.000) among all participants. For validity, the UESEBT has a moderate-to-strong correlation with UQYBT (r = 0.42−0.72, p < 0.001), and a weak-to moderate one with CKCUEST (r = 0.25−0.42, p < 0.05). Furthermore, the UESEBT performance showed weak-to-moderate correlations with MIS (r = 0.24−0.44, p < 0.05). UESEBT was correlated to LTET (r = 0.24−0.33, p < 0.05) whereas no relationship was found with TFET. UESEBT was a reliable and valid tool to screen upper extremity dynamic balance among adolescent swimmers. UESEBT provides more detailed information in eight directions to assess the upper limb sport performance. Further study should explore the prediction ability of UESEBT for injury. [ABSTRACT FROM AUTHOR]

Isolation studies on the leaves of Tabernaemontana penduliflora afforded two undescribed indole alkaloids, 7,10-dihydroxyindolenine (1a) and pendulifloramine (2), together with four known compounds, 10-hydroxyheyneanine (4), 10-hydroxycoronaridine (5), vobasine (6), and voacristine (7). The structures 1a and 2 were determined based on NMR and mass spectra, together with database mining and computer-assisted structure elucidation. Their absolute and relative configurations were deduced by comparison of their CD spectra with those of known compounds and of the ab initio calculated spectra. Compounds 1a and 2 displayed moderate radical-trapping activity towards 2,2-diphenyl-1-picrylhydrazyl (DPPH) with 50 % scavenging capacity activity (SC 50) values of 34 µg/mL and 46 µg/mL, respectively, and good ability to reduce the TPTZ-Fe(III) complex to TPTZ-Fe(II) (TPTZ = 2,4,6-Tri-(2-pyridyl)- s -triazin) with 133 µg EGA/mg and 186 µg EGA/mg of dry weight, respectively. Both compounds also have anti-inflammatory activity with IC 50 values of 9 µg/mL and 5 µg/mL for 1a and 2 , respectively. [Display omitted] • Phytochemical studies have been done on the leaves of Tabernaemontana penduliflora. • Two new compounds (1a - 2) were isolated from the enriched alkaloids extract. • Compounds 1a and 2 showed anti-inflammatory activity and antioxidative properties. • The IC 50 values of compounds 1a and 2 were 9 µg/mL and 5 µg/mL, respectively. • The SC 50 values were 133 µg EGA/mg and 186 µg EGA/mg, respectively. [ABSTRACT FROM AUTHOR]

Left-sided repair for long gap esophageal atresia (LGEA) has been described for patients with a large leftward upper pouch, no thoracic tracheoesophageal fistula (TEF) nor tracheobronchomalacia (TBM), or as salvage plan after prior failed right-sided repair. We describe our experience with left-sided MIS traction induced growth process. We retrospectively reviewed patients who underwent Foker process for LGEA at two institutions between December 2016 and November 2021. Patient characteristics, surgical techniques, and outcomes were reviewed. 71 patients underwent Foker process. Of 34 MIS cases, 28 patients (82%) underwent left-sided repair (median gap length 5 cm) at median age 4 months with median 3 (range 2–8) operations and median 13.5 (IQR 11–21) days on traction until esophageal anastomosis. 9 patients (32%) underwent completely MIS approach, whereas 5 patients (18%) converted to open at first operation and 14 patients (50%) converted to open later in the traction process. Traction was internal in 68%, external in 11%, and combination in 21%. Median follow-up was 15.4 (IQR 7.5–31.7) months after anastomosis. 14% had anastomotic leak managed with antibiotics and/or esophageal vacuum therapy. Median number of esophageal dilations was 3.5 (range 0–13). 18% required stricture resection. 39% underwent Nissen fundoplication. None have needed esophageal replacement. For multiple reasons including the tendency of both esophageal pouches to have a leftward bias, less tracheal compression by upper pouch, and clean field of surgery for reoperative cases, we now more commonly use left-sided approach for MIS LGEA repair compared to right side, regardless of left aortic arch. Level IV Treatment Study. [ABSTRACT FROM AUTHOR]

The purpose of this study was to analyze the management and outcomes of primary button battery ingestions and their sequelae at a single high-volume center, and to propose a risk score to predict the likelihood of a severe outcome. The medical record was queried for all patients under 21 years old evaluated at our institution for button battery ingestion from 2008 to 2021. A severe outcome was defined as having at least one of the following: deep/circumferential mucosal erosion, perforation, mediastinitis, vascular or airway injury/fistula, or development of esophageal stricture. From a selection of clinically relevant factors, logistic regression determined predictors of a severe outcome, which were incorporated into a risk model. 143 patients evaluated for button battery ingestion were analyzed. 24 (17%) had a severe outcome. The independent predictors of a severe outcome in multivariate analysis were location of battery in the esophagus on imaging (96%), battery size >/ = 2 cm (95%), and presence of any symptoms on presentation (96%), with P < 0.001 in all cases. Predicted probability of a severe outcome ranged from 88% when all three risk factors were observed, to 0.3% when none were present. We report the presentation, management, and complication profiles of a large cohort of BB ingestions treated at a single institution. A risk score to predict severe outcomes may be used by providers initially evaluating patients with button battery ingestion in order to allocate resources and expedite transfer to a center with pediatric endoscopic and surgical capabilities. Level IV. Clinical Research Paper. [ABSTRACT FROM AUTHOR]

Enhanced recovery pathways (ERPs) and recommendations have become widely accepted for metabolic and bariatric surgery, including recommendations for preoperative carbohydrate loading and duration of fasting status. There is still a lack of consensus regarding such protocols and the underlying issues of gastric emptying time, resting gastric volume and pH, and risk of aspiration in patients with severe obesity and in patients undergoing bariatric surgery. The goal of this position statement by the International Society for the Perioperative Care of Patients with Obesity (ISPCOP) is to provide an analysis of available data on preoperative fasting and loading with oral complex clear carbohydrate drinks as well its potential effects on perioperative risk of aspiration in the context of Enhanced Recovery Pathways for Metabolic and Bariatric Surgery (ERAMBS). [ABSTRACT FROM AUTHOR]

Breast cancer care has been affected by the COVID-19 pandemic. This systematic review aims to describe the observed pandemic-related changes in clinical and health services outcomes for breast screening and diagnosis. Seven databases (January 2020–March 2021) were searched to identify studies of breast cancer screening or diagnosis that reported observed outcomes before and related to the pandemic. Findings were presented using a descriptive and narrative approach. Seventy-four studies were included in this systematic review; all compared periods before and after (or fluctuations during) the pandemic. None were assessed as being at low risk of bias. A reduction in screening volumes during the pandemic was found with over half of studies reporting reductions of ≥49%. A majority (66%) of studies reported reductions of ≥25% in the number of breast cancer diagnoses, and there was a higher proportion of symptomatic than screen-detected cancers. The distribution of cancer stage at diagnosis during the pandemic showed lower proportions of early-stage (stage 0–1/I-II, or Tis and T1) and higher proportions of relatively more advanced cases than that in the pre-pandemic period, however population rates were generally not reported. Evidence of substantial reductions in screening volume and number of diagnosed breast cancers, and higher proportions of advanced stage cancer at diagnosis were found during the pandemic. However, these findings reflect short term outcomes, and higher-quality research examining the long-term impact of the pandemic is needed. • Comprehensive review of COVID-19 impacts on breast cancer screening and diagnosis. • Consistent evidence of substantial reductions in screening volume globally. • Reductions in number of diagnosed breast cancers were found. • Higher stage cancers comprised a higher proportion of breast cancers. • Ongoing, high-quality research examining longer-term pandemic impacts is needed. [ABSTRACT FROM AUTHOR]

To determine if the administration of norepinephrine to patients recovering from on-pump cardiac surgery is associated with changes in urinary oxygen tension (PO 2), an indirect index of renal medullary oxygenation. Single center, prospective observational study. Surgical intensive care unit (ICU). A nonconsecutive sample of 93 patients recovering from on-pump cardiac surgery. In the ICU, norepinephrine was the most commonly used vasopressor agent (90% of patients, 84/93), with fewer patients receiving epinephrine (48%, 45/93) or vasopressin (4%, 4/93). During the 30-to-60-minute period after increasing the infused dose of norepinephrine (n = 89 instances), urinary PO 2 decreased by (least squares mean ± SEM) 1.8 ± 0.5 mmHg from its baseline level of 25.1 ± 1.1 mmHg. Conversely, during the 30-to-60-minute period after the dose of norepinephrine was decreased (n = 134 instances), urinary PO 2 increased by 2.6 ± 0.5 mmHg from its baseline level of 22.7 ± 1.2 mmHg. No significant change in urinary PO 2 was detected when the dose of epinephrine was decreased (n = 21). There were insufficient observations to assess the effects of increasing the dose of epinephrine (n = 11) or of changing the dose of vasopressin (n <4). In patients recovering from on-pump cardiac surgery, changes in norepinephrine dose are associated with reciprocal changes in urinary PO 2 , potentially reflecting an effect of norepinephrine on renal medullary oxygenation. [ABSTRACT FROM AUTHOR]

• State-led resettlement is increasingly justified on environmental grounds. • A mixed-methods approach captures people's lived experience after resettlement. • Structural and proximate forces shape people's livelihoods after resettlement. • Inequalities are apparent in the way many are not able to recover and adapt in-place. • Increased out-migration after resettlement represents a form of double displacement. Migration is an expression of shifting human-environment relations in response to changing risks and opportunities. Under modernist development regimes, the perceived environmental qualities of a locality have been used to justify state-led initiatives to encourage people to settle in particular places, in order to exploit favourable conditions and resources. In more recent decades, as the environmental consequences of modernist development intensify, environmental risks increasingly form part of the justification for state-led resettlement schemes to protect people or, purportedly, to protect the environment from people. The success of such resettlement schemes, in terms of contributing to improved livelihood outcomes for affected people, is greatly undermined however by the lack of large-scale support required to recover livelihoods. This paper looks at the complex relations between environmental change, resettlement and migration. It is based on research of two resettlement schemes in the Mekong Delta, Vietnam undertaken in the 2000s, that sought to reduce people's exposure to environment risks. Subsequent environmental deterioration in the resettlement areas, together with key agrarian changes, has undermined the capacity of people to recover from the disruption of resettlement and adapt their livelihoods to new risks and opportunities, resulting in increased outmigration. We argue that whilst large-scale, state-led resettlement schemes are often designed in response to life-threatening risks, without supporting the capacity of people to adapt to the everyday risks of deteriorating environmental conditions, reduced access to resources and limited employment opportunities, then livelihood precarity will persist resulting in a kind of double displacement. As such the increased out-migration from resettlement sites should not be seen as indicative of new adaptation pathways but, due to the largely involuntary nature of such migration, it should rather be understood as an expression of the limits of adaptation in the new localities. The underestimation of the level of support required for people to recover and adapt following resettlement reflects the technocratic way in which resettlement is approached and the failure to appreciate the scale of disruption associated with the cumulative and combined effect of slow-onset environmental deterioration. [ABSTRACT FROM AUTHOR]

Basal cell carcinoma is the most common non-melanoma skin cancer, tightly connected to ultraviolet exposure, and typically occurs on sun-exposed areas, including the nose. Reconstructing defects in the nasal tip following the removal of basal cell carcinoma lesions presents significant challenges, requiring a balance between completely removing the cancerous cells and achieving an optimal aesthetic result, especially since this area is central to the face. We present the case of a 62-year-old male patient with a 2 × 3 cm tumor located at the nasal tip, initially diagnosed as a benign vascular tumor based on clinical examination and imaging results. The tumor had been progressively growing over the past three years, interfering with the patient's daily activities, and prompting his desire for its removal. A surgical excision of the tumor was performed, using a local flap incorporating Burrow's triangles to minimize skin tension and optimize aesthetic outcomes. The patient made a good recovery, and the wound healed well. However, histopathological analysis revealed residual tumor cells at the resection margin. Reconstructing defects after excising basal cell carcinoma from the nasal tip is challenging and tumor removal must ensure complete cancer excision while preserving the nasal structure. Local flap reconstruction is often preferred for better cosmetic results. Careful planning and wide excision margins are crucial, as basal cell carcinoma can resemble benign lesions, as shown in our case. • Basal cell carcinoma can sometimes present with atypical clinical features, resembling benign lesions • Surgeons should cautiously excise benign tumors with adequate margins to avoid positive resection edges • Random-pattern local flaps remain a viable option for reconstructing large defects in the nasal tip area. [ABSTRACT FROM AUTHOR]

Blockchain systems have always faced the challenge of performance bottlenecks, and sharding technology is considered a promising mainstream on-chain scalability solution to solve this problem. Due to the complexity and high cost of the cross-shard transaction processing mechanism in the sharding blockchain system, as well as the high proportion of cross-shard transactions, it becomes challenging for the sharding blockchain system to reach the ideal theoretical performance upper limit. Therefore, this paper aims to reduce the proportion of cross-shard transactions by dividing accounts with frequent transactions into the same shard, thereby improving system throughput. This paper builds a hypergraph based on historical transaction data to represent the diverse transaction relationships between accounts, and formulates the account division problem in the blockchain as a community discovery problem on the hypergraph structure. A time-aware community detection algorithm is proposed to partition accounts by considering the sustainability of transaction relationships between accounts. This also solves the problem of community detection algorithms tending to partition into larger shards. In addition, this paper builds a local Ethereum test network and implements the proposed algorithm on a real transaction dataset. Experimental results show that this algorithm can reduce the proportion of cross-shard transactions from about 95% to about 10%. Furthermore, it shows superior performance in terms of transaction throughput and latency compared with other community detection-based account partitioning algorithms. • Redefine the account partitioning in blockchain as community detection on graph. • Combine a transaction stability measure that considers the temporal aspect. • Build and implement an Ethereum test network on real account trading datasets. [ABSTRACT FROM AUTHOR]

Organic pollutants (OPs) discharged via wastewater can severely impact public health, natural habitat, and environment in long term. The microalgae-bacteria consortia (MBC) demonstrates its potential as a sustainable bioremediation method for organic pollutants remediation from wastewater. The overarching goal of this study is to review (i) the formation of microalgae and bacteria consortia, (ii) the mechanism of MBC in OCs removal, (iii) the effects of operating conditions on the treatment efficiency, and (iv) the omics approach of MBC for removing OCs in wastewater. The review provides further insights into the application of omics techniques to identify microalgae-bacteria interaction in the consortia. Transcriptomics and metabolomics have elucidated the response of MBC to the impact of culturing conditions and presence of OCs in wastewater. Metagenomics identifies the four dominating-algal strains and observing microbial dynamics during ciprofloxacin treatment. The data of omics approach provide a strong support for upscaling MBC for OCs remediation in wastewater. [Display omitted] • The MBC presents in three main forms: commensalism, mutualism, and parasitism. • Short-term contact with OPs enhances protoplasmic responses of MBC cells. • Long-term contact alters the whole MBC structure. • The MBC removes OPs higher than 90 %. • Omics reveal removal mechanisms, bacterial diversity, and interaction in MBC. [ABSTRACT FROM AUTHOR]