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Introduction: Inappropriate use of direct oral anticoagulants (DOACs) is common, affecting up to 30% of atrial fibrillation (AF) population receiving treatment for stroke prevention. This study assessed appropriateness of anticoagulation in anticoagulation-naive AF patients treated with DOACs during a 12-month prospective follow-up., Methods: This prospective cohort study included all anticoagulation-naive AF patients referred for anticoagulation for stroke prevention at a tertiary cardiovascular center. Participants were prospectively followed through phone call interviews by a dedicated nurse at 1, 3, 6, 9, and 12 months after enrollment., Results: Of 403 anticoagulation-naive AF patients, rivaroxaban was prescribed for 325 patients (80.7%) and apixaban for 78 (19.3%). Inappropriate therapy was observed in 23% (76/325) and 46% (36/78) of patients treated with rivaroxaban and apixaban, respectively. Undertreatment was predominant scenario for both drugs, detected in 78.5% (78/112) of patients treated inappropriately, and was more frequently observed with apixaban versus rivaroxaban (44.8% vs 16.3%). During 12 months, inappropriate treatment was corrected in only 13% of all patients. The multivariate regression model identified creatinine clearance ≤ 49 mL/min (odds ratio [OR], 2.17; 95% confidence interval [CI], 1.12 to 4.21), female sex (OR, 1.81; 95% CI, 1.11 to 2.97), and age ≥ 80 years (OR, 1.85; 95% CI, 1.22 to 2.83) as independent covariates associated with inappropriate dosing., Conclusions: Inappropriate therapy with DOACs for stroke prevention in patients with AF is common, and the dosage were corrected in few patients during the 12-month follow-up. Our findings highlight the persistent lack of knowledge regarding appropriate DOAC dosage and need for continuous education., Competing Interests: Declarations. Competing interests: Dr. Lip is a consultant and speaker for BMS/Pfizer, Boehringer Ingelheim, Daiichi-Sankyo, Anthos. No fees are received personally.  He is a National Institute for Health and Care Research (NIHR) Senior Investigator and co-principal investigator of the AFFIRMO project on multi morbidity in AF, which has received funding from the European Union’s Horizon 2020 research and innovation program me under grant agreement No 899871., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Noise is one of the harmful health factors in industrial sites. Hearing impairments are one of the most common occupational diseases in a wide range of industries. The aim of this study is to determine the general prevalence of noise-induced hearing disorders among industrial workers and to homogenize the results of different studies in this field. In this systematic review and meta-analysis study, the keywords of Occupational Noise, Hearing Impairment, Workers, Industry in Science Direct, PubMed, Scopus, Web of Science and Google Scholar databases without any lower time limit and until March 2022. Details of the identified studies were then transferred into the EndNote reference management software. Subsequently, duplicate studies were eliminated, and the remaining studies were evaluated in accordance with the inclusion and exclusion criteria and through the three remaining phases of PRISMA i.e., screening, eligibility, and inclusion. To analyze the eligible studies, the random effects model was used, and the heterogeneity of the studies was assessed using the I 2 index. In a review of 69 studies with a sample size of 3,552,888 people, the overall prevalence of hearing impairment among industrial workers was 28.8% (95% CI 26.2%-31.6%). The highest prevalence of hearing impairments was reported among agricultural and fishery workers with 45.7% (95% CI 35.1%-56.7%), and the highest prevalence of hearing impairment among industrial workers was found in the continent of Africa with 46.2% (95% CI 37.4%-55.2%). Due to the higher prevalence of hearing impairments among men, the elderly and in developing countries, it is necessary to establish pertinent laws and regulations in order for workers to use appropriate personal protective equipment (PPE) and mandate employers to provide hearing protection programs., Competing Interests: Conflict of InterestThe authors declare that they have no conflict of interest., (© Association of Otolaryngologists of India 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Purpose: The aim was to compare the use of different tools within the ImageJ program (polygon vs. segmented line) and their impact on the calculation of muscle area and echo intensity (EI) values in ultrasound imaging of the vastus lateralis muscle., Methods: Thirteen volunteers participated in this study. Ultrasound images of the vastus lateralis muscle were acquired using 2D B-mode ultrasonography and analyzed using both the polygon and segmented line tools by the same evaluator. The intraclass correlation coefficient (ICC) and coefficient of variation (CV) assessed the tools' reliability. Bland-Altman plots were employed to verify the agreement between measurements, and linear regression analysis determined proportional bias. A paired t-test was conducted to analyze differences between the tools., Results: The reliability between tools for muscle area calculation was weak (r = 0.000; CV = 138.03 ± 0.34%), while it was excellent for EI (r = 0.871; CV = 15.19 ± 2.96%). The Bland-Altman plots indicated a large bias for muscle area (d = 195.2%) with a proportional bias (p < 0.001). For EI, the bias was (d = 15.2) with proportional bias (p = 0.028). The paired t-test revealed significant differences between the tools for area (p < 0.001) but not for EI (p = 0.060)., Conclusion: The study found significant differences in measurements obtained with the polygon and segmented line tools in ImageJ, with the polygon tool showing higher values for muscle area and lower values for EI., (© 2024. Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB).)

Petroleum hydrocarbons and their derivatives constitute the leading group of environmental pollutants worldwide. In the present global scenario, petroleum and natural gas production, exploration, petroleum refining, and other anthropogenic activities produce huge amounts of hazardous petroleum wastes that accumulate in the terrestrial and marine environment. Due to their carcinogenic, neurotoxic, and mutagenic characteristics, petroleum pollutants pose severe risks to human health and exert ecotoxicological effects on the ecosystems. To mitigate petroleum hydrocarbons (PHs) contamination, implementing "green technologies" for effective cleanup and restoration of an affected environment is considered as a pragmatic approach. This review provides a comprehensive outline of newly emerging bioremediation technologies, for instance; nanobioremediation, electrokinetic bioremediation, vermiremediation, multifunctional and sustainably implemented on-site applied biotechnologies such as; natural attenuation, biostimulation, bioaugmentation, bioventing, phytoremediation and multi-process hybrid technologies. Additionally, the scope of the effectiveness and limitations of individual technologies in treating the petroleum hydrocarbon polluted sites are also evaluated., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Community Mental Health Centers (CMHCs) offer affordable mental health services in a less stigmatized environment, in a domiciliary setting. This study aimed to shed light on the epidemiological factors of patients attending CMHCs of Mashhad, their referral status, and treatment., Methods: This study was conducted over the medical records of patients seen by psychiatrists between January 2014 and December 2021 in Mashhad's CMHC, the northeast of Iran. A detailed questionnaire was used to extract data from medical records about the epidemiological characteristics, diagnosed mental illnesses, referral status, and how often they visited the psychiatrist. The association between epidemiological findings and patient referral (referral system or self-referral) as well as the association between epidemiological findings and the number of psychiatric revisits were examined using the Chi-square test., Results: Out of 662 patients, 472 (71%) were female and 190 (29%) were male, with an average age of 29 years. Among the 475 adult patients, 367 (77.3%) were married, with the majority being homemakers (56.4%). Major Depression Disorder (MDD) (32%) and Generalized Anxiety Disorder (GAD) (18.3%) were the most prevalent mental health conditions among patients. The majority of patients (74.9%) were referred to the CMHC of Mashhad from Primary Healthcare centers (PHCs) and psychiatric hospitals. Furthermore, female gender and patients with lower level of education were associated with more referral through from referral system. Of note, 431 patients (65.1%) did not return for a second visit, the ratio of treatment dropout was higher for patients with lower education levels., Conclusions: Referral system should be more practical in Iran to enhance health services in CMHCs. It is recommended that PHCs undergo certain modifications to enhance the referral process for patients with mental health conditions, focusing on common mental disorders and individuals with low socioeconomic level., (© 2024. The Author(s).)

Tissue engineering holds promise for developing therapeutic applications using viscous materials e.g. hydrogels. However, assessing the cytotoxicity of such materials with conventional assays can be challenging due to non-specific interactions. To address this, we optimized a live/dead staining method for quantitative evaluation and compared it with the conventional CCK8 assay. Our MicroDrop method involved seeding droplets containing 5000 cells in 10 µl medium on 12-well plates. After allowing them to adhere for 4 h, various viscous samples were applied to the cells and measurements were conducted using a fluorescence microscope immediately and at daily intervals up to 72 h. A sodium dodecyl sulfate (SDS) dilution series compared the MicroDrop with the CCK8 assay. The findings revealed a cell-type specific pattern for 10 mg/ml hyaluronic acid (HA), wherein MC3T3-E1 cells maintained 95% viability until 72 h, while L929 cells experienced a gradual decline to 17%. 2 mg/ml HA exhibited consistent viability above 90% across all time points and cell lines. Similarly, fibrin demonstrated 90% viability across dilutions and time points, except for undiluted samples showing a decrease from 85% to 20%. Gelatin-methacrylol sustained viability above 70% across all time points at both 5% and 10% concentrations. The comparison of the SDS dilution series between viability (MicroDrop) and metabolic activity (CCK8) assay showed a correlation coefficient of 0.95. The study validates the feasibility of the established assay, providing researchers with an efficient tool for assessing cytotoxicity in viscous materials. Additionally, it holds the potential to yield more precise data on well-known hydrogels., (© 2024. The Author(s).)

Purpose: To synthesize the effect of exercise training on functional capacity, muscle strength, exercise capacity, dialysis efficacy, and quality of life (QOL) in children and adolescents with CKD., Methods: PubMed/Medline, Scopus, PEDro, Web of Science, CINAHL, Cochrane, and Embase were searched from inception to September 30, 2023. Randomized control trials (RCTs) and clinical trials that assessed the effect of exercise training programs on functional capacity, muscle strength, exercise capacity, dialysis efficacy, and QOL in children and adolescents with CKD were included. Random effect model and meta-regression were used for the meta-analysis., Results: Four clinical trials and three RCTs were included. The results showed that exercise training improves strength, but meta-analysis did not show a significant effect of exercise on functional capacity (WMD: 1.02; 95% CI: - 0.14 to 2.18; p = 0.083) and QOL (WMD: 8.00; 95% CI: - 3.90 to 19.91; p = 0.187). Subgroup analysis revealed that more than 25 sessions and 45 min per session of intervention, a PEDro score of more than 5, and being younger than 12 years of age had a large effect on functional capacity and QOL results. Due to the limited number of studies that reported the effect of exercise on dialysis efficacy and exercise capacity, the findings were inconclusive., Conclusion: Exercise training could benefit children and adolescents with CKD by increasing their strength. Longer exercise interventions may be beneficial for improving functional capacity and QOL. Future well-designed RCTs should overcome the existing limitations using adequate sample sizes and longer exercise durations., (© 2023. The Author(s), under exclusive licence to Springer Nature B.V.)

Simple and sensitive electrochemical sensors were fabricated from cerium oxide (CeO 2 ) and copper-benzene tricarboxylic acid-modified cerium oxide (CeO 2 -Cu-BTC) materials for differential pulse voltammetric analysis of toxic cadmium (Cd) ions in aqueous solutions. The materials were prepared by hydrothermal method and structurally characterized by Fourier transform infrared spectroscopy (FTIR), scanning electron microscopy with energy-dispersive X-ray (SEM-EDX), thermogravimetric analysis (TGA), and X-ray diffraction analysis (XRD). The CeO 2 -modified carbon paste electrode (CeCPE) and the CeO 2 -Cu-BTC-modified carbon paste electrode (CeBCPE) were electrochemically characterized by their cyclic voltammetry and electrochemical impedance study in standard K 3 [Fe(CN) 6 ] single-electron redox process. Their electrochemical surface areas, electrode surface coverages, and charge transfer resistances were calculated to be 1.46 cm 2 , 2.338 × 10 -5 mol∙cm -2 , and 2790 Ω and 5.48 cm 2 , 2.476 × 10 -5 mol∙cm -2 , and 1254.65 Ω for CeCPE and CeBCPE, respectively. These fabricated electrodes were used as electrochemical sensors for cadmium ion estimation by optimizing the experimental parameters through differential pulse voltammetry. The optimized conditions included 10% modifier for CeCPE and 5% modifier for CeBCPE in 0.12 M HCl solution of pH 5 as supporting electrolyte at - 1.2 V deposition for 30 s in 0.01 to 10 mg L -1 linear cadmium solution range. Under these conditions, the limit of quantification (LOQ) of 0.368 mg L -1 and 0.005 mg L -1 was calculated for CeCPE and CeBCPE electrodes, respectively. The limit of detection (LOD) was calculated to be 0.121 mg L -1 and 0.002 mg L -1 for CeCPE and CeBCPE, respectively. All the experimental results indicated that electrodes fabricated from CeO 2 -Cu-BTC show better performance as compared to CeO 2 -based electrodes. Both these types of electrochemical sensors presented good repeatability and performance in the presence of interfering ions as well. From these findings, it can also be inferred that these electrochemical sensors can provide a simple and very sensitive method for approximation of toxic cadmium ions in aqueous solutions., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Adipose tissue, including white adipose tissue (WAT), brown adipose tissue (BAT), and beige adipose tissue, is vital in modulating whole-body energy metabolism. While WAT primarily stores energy, BAT dissipates energy as heat for thermoregulation. Beige adipose tissue is a hybrid form of adipose tissue that shares characteristics with WAT and BAT. Dysregulation of adipose tissue metabolism is linked to various disorders, including obesity, type 2 diabetes, cardiovascular diseases, cancer, and infertility. Both brown and beige adipocytes secrete multiple molecules, such as batokines, packaged in extracellular vesicles or as soluble signaling molecules that play autocrine, paracrine, and endocrine roles. A greater understanding of the adipocyte secretome is essential for identifying novel molecular targets in treating metabolic disorders. Additionally, microRNAs show crucial roles in regulating adipose tissue differentiation and function, highlighting their potential as biomarkers for metabolic disorders. The browning of WAT has emerged as a promising therapeutic approach in treating obesity and associated metabolic disorders. Many browning agents have been identified, and nanotechnology-based drug delivery systems have been developed to enhance their efficacy. This review scrutinizes the characteristics of and differences between white, brown, and beige adipose tissues, the molecular mechanisms involved in the development of the adipocytes, the significant roles of batokines, and regulatory microRNAs active in different adipose tissues. Finally, the potential of WAT browning in treating obesity and atherosclerosis, the relationship of BAT with cancer and fertility disorders, and the crosstalk between adipose tissue with circadian system and circadian disorders are also investigated., (© 2023. The Author(s).)

Teratomas are rare neoplasms that arise from totipotent stem cells. Teratomas of the head and neck are extremely rare, constituting about 10% of all cases and usually present in the neonatal period. Extensive literature search has shown that there are only two cases reportedof teratoma of the ethmoid sinus; one as a mature teratoma in a neonate and another was histologically immature teratoma in an adult male (Mwang'ombe et al. in East Afr Med J 79(2):106-107, 2002; Aggarwal et al. in J Postgrad Med 59(2):138-141, 2013). We hereby report the second case of immature teratoma of ethmoid sinus origin in an adult male., Competing Interests: Conflict of interestThe authors declare that manuscript has been read and approved by all the authors, the requirements for authorship have been met, and that each author believes that the manuscript represents honest work., (© Association of Otolaryngologists of India 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Key Message: Mapping and fine mapping of bean anthracnose resistance genes is a continuous process. We report fine mapping of anthracnose resistance gene Co-18 which is the first anthracnose gene mapped to Pv10. The discovery of resistance gene is a major gain in the bean anthracnose pathosystem research. Among the Indian common bean landraces, KRC-5 exhibit high levels of resistance to the bean anthracnose pathogen Colletotrichum lindemuthianum. To precisely map the anthracnose resistance gene, we used a Recombinant Inbred Line (F 2:9 RIL) population (KRC-5 × Jawala). The inheritance test revealed that KRC-5 carries a dominant resistance gene temporarily designated as Co-18. We discovered two RAPD markers linked to Co-18 among 287 RAPD markers. These RAPD markers were eventually developed into SCARs (Sc-OPR15 and Sc-OPF6) and flank Co-18 on chromosome Pv10 at a distance of 5.3 and 4.2 cM, respectively. At 4.0-4.1 Mb on Pv10, we detected a SNP (single-nucleotide polymorphism) signal. We synthesized 58 SSRs and 83 InDels from a pool of 135 SSRs and 1134 InDels, respectively. Five SSRs, four InDels, and two SCARs were used to generate the high-density linkage map, which led to the identification of two SSRs (SSR24 and SSR36) that are tightly linked to Co-18. These two SSRs flank the Co-18 to 178 kb genomic region with 13 candidate genes including five NLR (nucleotide-binding and leucine-rich repeat) genes. The closely linked markers SSR24 and SSR36 will be used in cloning and pyramiding of the Co-18 gene with other R genes to develop durable resistant bean varieties., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Stroke is a leading cause of disability and death worldwide. Ivermectin is a broad-spectrum anti-parasitic agent with potential anti-bacterial, anti-viral, and anti-cancer effects. However, the effects of ivermectin on the brain are poorly described. This study examined the effects of ivermectin on cerebral ischemia-reperfusion (IR) in rats. A rat model of transient global IR was induced by bilateral carotid artery occlusion for 20 min. Rats received ivermectin (2 mg/kg/day, ip) one hour after inducing cerebral IR for three consecutive days at 24-h intervals. Next, we examined the effects of ivermectin on brain infarction, histopathology, malondialdehyde levels, myeloperoxidase activity, spatial learning and memory, and phospho-AMPK protein levels. The results showed that ivermectin reduced brain infarct size (P < 0.001) and histopathological changes such as cerebral leukocyte accumulation and edema (P < 0.05) compared to untreated rats with IR. Treatment with ivermectin also decreased myeloperoxidase activity (P < 0.01) and malondialdehyde levels (P < 0.05) while increasing AMPK activity (P < 0.001), memory, and learning compared to the untreated IR group. Overall, we show for the first time that ivermectin conferred neuroprotective effects in a rat model of cerebral IR. Our results indicate that three days of treatment with ivermectin reduced brain infarct size, lipid peroxidation, and myeloperoxidase activity and improved memory and learning in rats with cerebral IR. These effects likely occurred via AMPK-dependent mechanisms., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Introduction and Hypothesis: Postpartum lumbopelvic pain (PLPP) is common among women. Abdominal, diaphragm, and pelvic floor muscles (PFMs) modulate intraabdominal pressure as a part of the force closure mechanism. These muscles are exposed to changes during pregnancy that compromise the force closure mechanism. It was hypothesized that abdominal and PFMs activity, the direction of bladder base displacement, diaphragm thickness, and excursion might differ between women with and without PLPP during respiratory and postural tasks., Methods: Thirty women with and 30 women without PLPP participated in this case-control study. Ultrasound imaging was used to assess the abdominal, diaphragm, and PFMs during rest, active straight leg raising (ASLR) with and without a pelvic belt, and deep respiration., Results: The bladder base descent was significantly greater in the PLPP group than in the controls during deep respiration and ASLR without a belt (p = 0.026; Chi-squared = 6.40). No significant differences were observed between the groups in the abdominal muscles activity and diaphragm muscle thickness. There was a significant interaction effect of the group and the task for diaphragm excursion (F (2, 116) = 6.08; p = 0.00) and PFM activity (F (2, 116) = 5.22; p = 0.00). In the PLPP group, wearing a belt compromised altered PFM activation and direction of bladder base displacement., Conclusion: The PFM activity, direction of bladder base displacement, and diaphragm excursion differed between groups during postural and respiratory tasks. Therefore, it is recommended to involve retraining of the PFMs and diaphragm muscle in the rehabilitation of women with PLPP., (© 2023. The International Urogynecological Association.)

Purpose: Major histocompatibility complex class II (MHC-II) deficiency is a rare inborn error of immunity (IEI). Impaired antigen presentation to CD4 + T cells results in combined immunodeficiency (CID). Patients typically present with severe respiratory and gastrointestinal tract infections at early ages. Hematopoietic stem cell transplantation (HSCT) is the only curative therapy., Methods: We describe the clinical, immunologic, and genetic features of eighteen unrelated Iranian patients with MHC-II deficiency., Results: Consanguinity was present in all affected families. The median age at the initial presentation was 5.5 months (range 7 days to 18 years). The main symptoms included failure to thrive, persistent diarrhea, and pneumonia. Autoimmune and neurologic features were also documented in about one-third of the patients, respectively. Thirteen patients carried RFXANK gene mutations, two carried RFX5 gene mutations, and three carried a RFXAP gene mutation. Six patients shared the same RFXANK founder mutation (c.162delG); limited to the Iranian population and dated to approximately 1296 years ago. Four of the patients underwent HSCT; three of them are alive. On the other hand, nine of the fourteen patients who did not undergo HSCT had a poor prognosis and died., Conclusion: MHC-II deficiency is not rare in Iran, with a high rate of consanguinity. It should be considered in the differential diagnosis of CID at any age. With the limited access to HSCT and its variable results in MHC-II deficiency, implementing genetic counseling and family planning for the affected families are mandatory. We are better determined to study the c.162delG RFXANK heterozygous mutation frequency in the Iranian population., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Children with developmental disabilities (DD) exhibit feeding and swallowing difficulties, which can have an impact on nutritional, developmental, and psychological aspects. The existing tools assess the nature of feeding problems and behaviors only. The present study aimed to assess the physical, functional, and emotional domains in children with DD with feeding issues using Feeding handicap index for children (FHI-C). For clinical validation, FHI-C was administered on the parents/caregivers of 60 children with cerebral palsy, 61 with autism spectrum disorder, 59 with intellectual disability and 60 typically developing children in the age range of 2 to 10 years. The results revealed that the mean scores (Total FHI-C and FHI-C domain scores) were significantly higher for all three clinical groups than for the control group, which revealed good clinical validity. Also, FHI-C was found to have significantly high test-retest reliability. The study presents a valid and reliable tool for assessing the psychosocial handicapping effects of feeding problems in children with DD. FHI-C provides a holistic picture about the psychosocial impact of feeding problems in children with DD and will assist the clinicians in prioritizing the goals for feeding therapy. The scores obtained can be used as reference for pre and post therapy comparison purposes., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Sleep disorders are conditions that have long-term effects on health, quality of sexual function, productivity at work, and overall quality of life. Considering that reports on menopausal sleep disorders are heterogeneous, the aim of this research was to determine the global prevalence of sleep disorders during menopause by meta-analysis., Methods: PubMed, Google Scholar, Scopus, WoS, ScienceDirect, and Embase databases were checked with suitable keywords. All screening stages of articles were reviewed based on PRISMA and their quality was determined based on STROBE. Data analysis, examination of heterogeneity, and publication bias of factors affecting heterogeneity were performed in CMA software., Results: The overall prevalence of sleep disorders among postmenopausal women was 51.6% (95% CI: 44.6-58.5%). The upper prevalence of sleep disorders was among postmenopausal women at 54.7% (95% CI: 47.2-62.1%). The upper prevalence of sleep disorders in the same population category was related to restless legs syndrome with a prevalence of 63.8% (95% CI: 10.6-96.3%)., Conclusion: In this meta-analysis, sleep disorders during menopause were found to be common and significant. Therefore, it is recommended that health policymakers offer pertinent interventions in relation to the health and hygiene of sleep for women in menopause., (© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Immediate access to the patient in crisis situations, such as cardiac arrest during robotic surgery, can be challenging. We aimed to present a full immersion simulation module to train robotic surgical teams to manage a crisis scenario, enhance teamwork, establish clear lines of communication, improve coordination and speed of response. Start time of cardiopulmonary resuscitation (CPR), first defibrillator shock and robotic de-docking time from the first 'cardiac arrest call' were recorded. Observational Teamwork Assessment for Surgery (OTAS) scores were used in control and test simulations to assess performance along with a participant survey. Repeat scenarios and assessment were conducted at a 6-month interval for the same team to validate knowledge retention and an additional scenario was run with a new anaesthetic team to validate modular design. OTAS scores improved across all specialty teams after training with emergency algorithm and at retention validity re-test (p = 0.0181; p = 0.0063). There was an overall reduction in time to CPR (101-48 s), first defibrillator shock (> 302 s to 86 s) and robot de dock time (86-25 s) Improvement remained constant at retention validity re-test. Replacing the anaesthetic team showed improvement in time to CPR, first shock and robotic de-dock times and did not affect OTAS scores (p = 0.1588). The module was rated highly for realism and crisis training by all teams. This high-fidelity simulation training module is realistic and feasible to deliver. Its modular design allows for efficient assessment and feedback, optimising staff training time and making it a valuable addition to robotic team training., (© 2023. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.)

The Svalbard archipelago is a glacial environment bestowed with various lakes that act as a natural archive for understanding environmental conditions. The accumulation of sediments in lake basins and their distribution are affected by different mechanisms. Therefore, to understand the distribution of sediments, factors controlling the transport and metal enrichment in the lake environment, core sediments were studied from four lakes (L-A, L-1, L-2 and L-3). Also, the potential ecological risk index (PERI) was computed to determine the impact of metal enrichment on the sediment-associated biota. The results obtained showed that the distribution of trace elements was mainly controlled by the major elements like Al, Ti, Fe, and Mn attributed to their lithogenic origin. Index of geoaccumulation (I geo ) of all four lakes showed a moderate level of enrichment of metals like Cr and Cd indicating an enhanced supply of these metals probably from the catchment rocks and anthropogenic activities. A comparison of metals with Arctic Sediment Quality Guidelines (ASQGs) showed that Cd, Cr and Cu were enriched in the sediments of all the cores indicating the occurrence of adverse biological effects. Furthermore, a potential ecological risk index (PERI) revealed high Cd indicating considerable potential ecological risk to the sediment-associated biota. Thus, trace element influx to the lakes needs to be monitored with due emphasis on Cd contamination., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Virtual dissection provides a digital experience of medical images to visualize anatomy on touchscreen tables. This study aimed to integrate the virtual dissection table (VDT) into the gastrointestinal anatomy course and assess medical students' intended learning outcomes and satisfaction with this educational technology., Methods: This quasi-experimental study enrolled second-year undergraduate medical students who studied anatomical sciences in the autumn semester of 2021-2022 at a single medical school. In the intervention and control groups, the participants were randomized to study anatomy by VDT or topographical anatomy textbooks. The knowledge tests evaluated the students' learning outcomes of gastrointestinal anatomy, and following the course, students completed a satisfaction survey., Results: The findings indicated that a significant gain occurred, and instructional intervention during which the learning environment was enriched with virtual dissection could enhance the students' learning ( F  = 13.33, df = 2, P  < 0.01, partial η 2  = 0.20) and satisfaction ( T  < 0.01, Cohen's P  < 0.01, Cohen's d  = 1.63, CI 95%  = 1.02-2.23)., Conclusions: This study demonstrates the potential for virtual dissection to augment anatomical science education. Further research is required to consider the contributing features and apply this educational technology to enhance students' anatomy learning., Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-023-01867-z., Competing Interests: Conflict of InterestThe authors declare no conflict of interests., (© The Author(s) under exclusive licence to International Association of Medical Science Educators 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Background: Abstracting cerebrovascular disease (CeVD) from inpatient electronic medical records (EMRs) through natural language processing (NLP) is pivotal for automated disease surveillance and improving patient outcomes. Existing methods rely on coders' abstraction, which has time delays and under-coding issues. This study sought to develop an NLP-based method to detect CeVD using EMR clinical notes., Methods: CeVD status was confirmed through a chart review on randomly selected hospitalized patients who were 18 years or older and discharged from 3 hospitals in Calgary, Alberta, Canada, between January 1 and June 30, 2015. These patients' chart data were linked to administrative discharge abstract database (DAD) and Sunrise ™ Clinical Manager (SCM) EMR database records by Personal Health Number (a unique lifetime identifier) and admission date. We trained multiple natural language processing (NLP) predictive models by combining two clinical concept extraction methods and two supervised machine learning (ML) methods: random forest and XGBoost. Using chart review as the reference standard, we compared the model performances with those of the commonly applied International Classification of Diseases (ICD-10-CA) codes, on the metrics of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV)., Result: Of the study sample (n = 3036), the prevalence of CeVD was 11.8% (n = 360); the median patient age was 63; and females accounted for 50.3% (n = 1528) based on chart data. Among 49 extracted clinical documents from the EMR, four document types were identified as the most influential text sources for identifying CeVD disease ("nursing transfer report," "discharge summary," "nursing notes," and "inpatient consultation."). The best performing NLP model was XGBoost, combining the Unified Medical Language System concepts extracted by cTAKES (e.g., top-ranked concepts, "Cerebrovascular accident" and "Transient ischemic attack"), and the term frequency-inverse document frequency vectorizer. Compared with ICD codes, the model achieved higher validity overall, such as sensitivity (25.0% vs 70.0%), specificity (99.3% vs 99.1%), PPV (82.6 vs. 87.8%), and NPV (90.8% vs 97.1%)., Conclusion: The NLP algorithm developed in this study performed better than the ICD code algorithm in detecting CeVD. The NLP models could result in an automated EMR tool for identifying CeVD cases and be applied for future studies such as surveillance, and longitudinal studies., (© 2023. Springer-Verlag GmbH Germany, part of Springer Nature.)

Background and Objective: Constipation is one of the most common functional disorders of the gastrointestinal tract in older adults. To date, no systematic review or previous meta-analysis has estimated the global prevalence of constipation in older adults. The prevalence of this disorder has been reported differently in different studies; therefore, this study aims to systematically review the publications and to perform a meta-analysis of the prevalence of constipation in older adults., Methods: The electronic databases PubMed, Google Scholar, Scopus, Web of Science, and ScienceDirect were systematically searched for studies reporting the prevalence of constipation in older adults up to February 2022. To perform the analysis, the random effects model was used, and heterogeneity was assessed by Cochran's Q test and expressed as I 2 ., Results: Out of 5341 evaluated publications, 36 met the eligibility criteria. These studies included 58,405 older adults aged 60-93 years. The overall prevalence of constipation in older adults was 18.9% (95% confidence interval [95% CI]: 14.7-23.9%). The prevalence of constipation in older adults according to Rome II criteria was 16.2% (95% CI: 6.8-33.7), based on Rome III criteria was 19.2% (95% CI: 12.6-28.1), and based on Rome IV criteria was 10.3% (95% CI: 5.8-17.7). The highest prevalence of constipation was found in older adults in Africa at 32.3% (95% CI: 21.5-45.4), and the lowest in Asia at 13.6% (95% CI: 9.1-19.9). Concerning diagnostic tools, the highest prevalence of constipation was found if a self-reporting tool was applied with a value of 19.7% (95% CI: 15.8-24.3)., Conclusion: The results suggest that health policymakers should pay more attention to the prevention of constipation in older adults, including raising public awareness to the importance of nutrition and diet and physical activity in older adults., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature.)

Introduction and Hypothesis: This study synthesized the effects of supervised and unsupervised pelvic floor muscle training (PFMT) programs on outcomes relevant to women's urinary incontinence (UI)., Methods: Five databases were searched from inception to December 2021, and the search was updated until June 28, 2022. Randomized and non-randomized control trials (RCTs and NRCTs) comparing supervised and unsupervised PFMT in women with UI and reported urinary symptoms, quality of life (QoL), pelvic floor muscles (PFM) function/ strength, the severity of UI, and patient satisfaction outcomes were included. Risk of bias assessment of eligible studies was performed by two authors through Cochrane risk of bias assessment tools. The meta-analysis was conducted using a random effects model with the mean difference or standardized mean difference., Results: Six RCTs and one NRCT study were included. All RCTs were assessed as "high risk of bias", and the NRCT study was rated as "serious risk of bias" for almost all domains. The results showed that supervised PFMT is better than unsupervised for QoL and PFM function of women with UI. There was no difference between supervised and unsupervised PFMT for urinary symptoms and improvement of the severity of UI. Results of patient satisfaction were inconclusive due to the sparse literature. However, supervised and unsupervised PFMT with thorough education and regular reassessment showed better results than those for unsupervised PFMT without educating patients about correct PFM contractions., Conclusions: Supervised and unsupervised PFMT programs can both be effective in treating women's UI if training sessions and regular reassessments are provided., (© 2023. The International Urogynecological Association.)

There is currently no causal treatment available for Parkinson's disease (PD). However, the use of glial cell line-derived neurotrophic factor (GDNF) to provide regenerative effects for neurons is promising. Such approaches require translational delivery systems that are functional in diseased tissue. To do so, we used a non-viral Sleeping Beauty (SB) transposon system to overexpress GDNF in adipose tissue-derived mesenchymal stromal cells (adMSCs). Entrapment of cells in fibrin hydrogel was used to boost potential neurorestorative effects. Functional GDNF-adMSCs were able to secrete 1066.8 ± 169.4 ng GDNF/120,000 cells in vitro. The GDNF-adMSCs were detectable for up to 1 month after transplantation in a mild 6-hydroxydopamine (6-OHDA) hemiparkinson male rat model. Entrapment of GDNF-adMSCs enabled GDNF secretion in surrounding tissue in a more concentrated manner, also tending to prolong GDNF secretion relatively. GDNF-adMSCs entrapped in hydrogel also led to positive immunomodulatory effects via an 83% reduction of regional IL-1β levels compared to the non-entrapped GDNF-adMSC group after 1 month. Furthermore, GDNF-adMSC-treated groups showed higher recovery of tyrosine hydroxylase (TH)-expressing cells, indicating a neuroprotective function, although this was not strong enough to show significant improvement in motor performance. Our findings establish a promising GDNF treatment system in a PD model. Entrapment of GDNF-adMSCs mediated positive immunomodulatory effects. Although the durability of the hydrogel needs to be extended to unlock its full potential for motor improvements, the neuroprotective effects of GDNF were evident and safe. Further motor behavioral tests and other disease models are necessary to evaluate this treatment option adequately., (© 2023. The Author(s).)

This study examined the modelling and optimisation of the electrocoagulation-flocculation (ECF) recovery of aquaculture effluent (AQE) using aluminium electrodes. The response surface methodology (RSM), artificial neural network (ANN), and adaptive neuro-fuzzy inference system (ANFIS) were used for the modelling, while the optimisation tools were the numerical RSM and genetic algorithm (GA). Furthermore, the kinetics of the ECF process was studied to provide insight into the mechanism governing the ECF of AQE. The experimental design was performed using the central composite design (CCD) of the RSM. The ANFIS modelling was accomplished via the Grid Partition (GP) of the data set, while the ANN used the multi-layer perceptron (MLP) based feed-forward system. Statistically, the prediction accuracy of the models followed the order: ANFIS (R 2 : 0.9990), ANN (R 2 : 0.9807), and RSM (R 2 : 0.9790). The process optimisation gave optimal turbidity (TD) removal efficiencies of 98.98, 97.81, and 96.01% for ANFIS-GA, ANN-GA, and RSM optimisation techniques, respectively. The ANFIS-GA gave the best optimization result at optimum conditions of pH 4, current intensity (3 A), electrolysis time (7.2 min), settling time (23 min), and temperature (43.8 °C). In the kinetics study, the experimental data was analysed using pseudo-first-order (0.8787), pseudo-second-order (0.9395), and Elovich (R 2 : 0.9979) kinetic models; the Elovich model gave the best correlation with the experimental data showing that the process is governed by electrostatic interaction mechanism. This study effectively demonstrated that ECF recovery of AQE can effectively be modelled using RSM, ANN, and ANFIS and be optimised using RSM, ANN-GA, and ANFIS-GA techniques, and the order of performance is ANFIS > ANN > RSM and ANFIS-GA > ANN-GA > RSM, respectively., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Testicular heat stress leads to impairment of spermatogenesis in mammals. Involved mechanism in this vulnerability to heat-induced injury remains unclear, and research is being conducted to find an approach to reverse spermatogenesis arrest caused by hyperthermia. Recently, different studies have utilized photobiomodulation therapy (PBMT) therapy for the improvement of sperm criteria and fertility. This study aimed at evaluating the effect of PBMT on the improvement of spermatogenesis in mouse models of hyperthermia-induced azoospermia. A total of 32 male NMRI mice were equally divided into four groups consisting of control, hyperthermia, hyperthermia + Laser 0.03 J/cm 2 , and hyperthermia + Laser 0.2 J/cm 2 . To induce scrotal hyperthermia, mice were anesthetized and placed in a hot water bath at 43 °C for 20 min for 5 weeks. Then, PBMT was operated for 21 days using 0.03 J/cm 2 and 0.2 J/cm 2 laser energy densities in the Laser 0.03 and Laser 0.2 groups, respectively. Results revealed that PBMT with lower intensity (0.03 J/cm 2 ) increased succinate dehydrogenase (SDH) activity and glutathione (GSH)/oxidized glutathione (GSSG) ratio in hyperthermia-induced azoospermia mice. At the same time, low-level PBMT reduced reactive oxygen species (ROS), mitochondrial membrane potential, and lipid peroxidation levels in the azoospermia model. These alterations accompanied the restoration of spermatogenesis manifested by the elevated number of testicular cells, increased volume and length of seminiferous tubules, and production of mature spermatozoa. After conducting experiments and analyzing the results, it has been revealed that the use of PBMT at a dosage of 0.03 J/cm 2 has shown remarkable healing effects in the heat-induced azoospermia mouse model., (© 2023. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.)

In the domain of neuroergonomics, cognitive workload estimation has taken a significant concern among the researchers. This is because the knowledge gathered from its estimation is useful for distributing tasks among the operators, understanding human capability and intervening operators at times of havoc. Brain signals give a promising prospective for understanding cognitive workload. For this, electroencephalography (EEG) is by far the most efficient modality in interpreting the covert information arising in the brain. The present work explores the feasibility of EEG rhythms for monitoring continuous change occurring in a person's cognitive workload. This continuous monitoring is achieved by graphicallyinterpreting the cumulative effect of changes in EEG rhythms observed in the current instance and the former instance based on the hysteresis effect. In this work, classification is done to predict the data class label using an artificial neural network (ANN) architecture. The proposed model gives a classification accuracy of 98.66%., (© The Author(s), under exclusive licence to Springer Nature B.V. 2022.)

A U-shaped contraction pattern was shown to be associated with a better Cardiac resynchronization therapy (CRT) response. The main goal of this study is to automatically recognize left ventricular contractile patterns using machine learning algorithms trained on conventional quantitative features (ConQuaFea) and radiomic features extracted from Gated single-photon emission computed tomography myocardial perfusion imaging (GSPECT MPI). Among 98 patients with standard resting GSPECT MPI included in this study, 29 received CRT therapy and 69 did not (also had CRT inclusion criteria but did not receive treatment yet at the time of data collection, or refused treatment). A total of 69 non-CRT patients were employed for training, and the 29 were employed for testing. The models were built utilizing features from three distinct feature sets (ConQuaFea, radiomics, and ConQuaFea + radiomics (combined)), which were chosen using Recursive feature elimination (RFE) feature selection (FS), and then trained using seven different machine learning (ML) classifiers. In addition, CRT outcome prediction was assessed by different treatment inclusion criteria as the study's final phase. The MLP classifier had the highest performance among ConQuaFea models (AUC, SEN, SPE = 0.80, 0.85, 0.76). RF achieved the best performance in terms of AUC, SEN, and SPE with values of 0.65, 0.62, and 0.68, respectively, among radiomic models. GB and RF approaches achieved the best AUC, SEN, and SPE values of 0.78, 0.92, and 0.63 and 0.74, 0.93, and 0.56, respectively, among the combined models. A promising outcome was obtained when using radiomic and ConQuaFea from GSPECT MPI to detect left ventricular contractile patterns by machine learning., (© 2022. The Author(s).)

In this study, the new synthesized magnetic nanoparticles based on amorphous carbon have been used as a sorbent in magnetic dispersive solid-phase extraction prior to dispersive liquid-liquid micro-extraction. The developed method was applied for analysis of ten pesticides from different fruit juice samples by gas chromatography-flame ionization detection. In this work, a few mg of the sorbent is added into an aqueous solution containing the analytes. Adsorption and desorption of the compounds of interest are accelerated by vortexing and sonication, respectively. To achieve high enrichment factors, a suitable organic solvent (iso-propanol) is used to elute the target analytes from the nanosorbent. The obtained iso-propanol is phased and 1,1,2-trichloroethane are employed as the disperser and extraction solvents, respectively, in the following micro-extraction procedure. The synthesized magnetic nanoparticles were characterized by scanning electron microscope, X-ray diffraction, vibrating sample magnetometer, and Fourier-transform infrared spectrophotometer. To achieve the high extraction efficiency and optimum conditions, all parameters that could affect the extraction yield were investigated. Under optimum conditions, the method had broad linear ranges with a proper linearity (r 2  ≥ 0.9987). Limits of detection and quantification for analysis of the selected pesticides were found in the ranges of 0.5-1.0 and 1.7-3.3 µg L -1 , respectively. High enrichment factors and extraction recoveries were obtained in the ranges of 321-438 and 64-88%, respectively. To evaluate repeatability of the method, it was performed on two sets of standard solutions at the concentrations of 10 and 50 µg L -1 (each analyte). Relative standard deviations varied in the ranges of 2-6% and 4-7% for intra- (n = 6) and inter-day (n = 5) precisions, respectively., (© 2022. The Author(s), under exclusive licence to The Japan Society for Analytical Chemistry.)

Introduction: Emergency department (ED) flow impacts patient safety, quality of care and ED provider satisfaction. Throughput interventions have been shown to improve flow, yet few studies have reported the impact of ED physician leadership roles on patient flow and provider experiences. The study objective was to evaluate the impacts of the emergency physician lead role on ED flow metrics and provider experiences., Methods: Quantitative data about patient flow metrics were collected from ED information systems in two tertiary hospital EDs and analyzed to compare ED length of stay, EMS hallway length of stay, physician initial assessment time, 72-h readmission and left without being seen rates three months before and following emergency physician lead role implementation. ED flow metrics for adult patients at each site were analyzed independently using descriptive and inferential statistics, t tests and multivariable regression analysis. Qualitative data were collected via surveys from ED providers (physicians, nurses, and EMS) about their experiences working with the emergency physician leads and analyzed for themes about emergency physician leads impact., Results: The number of ED visits was relatively stable pre-post at the Peter Lougheed Centre (Lougheed) but increased pre-post at the Foothills Medical Centre (Foothills). Post-intervention at Lougheed median ED length of stay decreased by 18 min (p < 0.001) and at Foothills ED length of stay increased by 8 min (p < 0.001). EMS length of stay at Lougheed decreased by 20 min (p < 0.001), and at Foothills length of stay increased by 17 min (p < 0.001). Themes in provider feedback were that emergency physician leads (1) facilitated patient flow, (2) impacted provider workload, and (3) supported patient flow and safety with early assessments, treatments and investigations., Conclusion: In this study, the emergency physician lead impacted ED flow metrics variably at different sites, but important learnings from provider experiences can guide future emergency physician lead implementation., (© 2023. The Author(s), under exclusive licence to Canadian Association of Emergency Physicians (CAEP)/ Association Canadienne de Médecine d'Urgence (ACMU).)

In this study, different K-nearest neighbors (KNN), support vector regression (SVR), decision tree (DT), and random forest (RF) algorithms integrated with the Bayesian optimization algorithm (BOP) have been applied as novel hybrid modeling/optimization tools to predict the total nitrogen in treated wastewater of Southern Tehran Wastewater Treatment Plant (STWWTP). In order to enhance the outcomes of hybrid models, the chosen sub-models (the best and least correlated hybrid models) were used to generate voting average and stacked regression ensemble models. Throughout the preprocessing step, two alternative scenarios were used to handle missing values from the samples, including elimination versus estimation via linear interpolation. The results of this research demonstrated that ensemble models were better than individual hybrid models, although not all ensemble models were superior to single models. The results also revealed that the stacking regression ensemble model using KNN-BOP and SVR-BOP as sub-models was the most superior model among the developed models, with the coefficient of determination (R 2 ) = 0.640, root mean squared error (RMSE) = 2.378, and mean absolute error (MAE) = 1.838 on the test data. The best hybrid ensemble model that can accurately predict the concentration of total nitrogen (TN) in the effluent can give people a heads-up about water pollution caused by eutrophication before it gets bad., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Aim: This study aimed at exploring the perception and experiences with regard to the COVID-19 pandemic among Bangladeshi urban young adults., Subject and Methods: Using a mixed-method approach, an online cross-sectional survey among 315 participants and in-depth interviews (IDI) among 20 young adults were conducted from May 1 to May 25, 2020. Descriptive statistics and chi-square tests were performed for quantitative data, along with the thematic analysis for qualitative data., Results: The mean (± SD) age of the participants was 26.54 (± 3.05), and the majority were male (54.9%). About 81.6% of the participants reported COVID-19 as a viral disease, transmitted through droplets of sneezing and coughing, and close contact with another person (90.8%). Nearly 40% of participants reported news channels as a reliable source of information for COVID-19. Participants who were male were less likely to be aware than females in terms of mode of transmission of COVID-19 such as going outside of the home (82.7% male vs 90.8% female; p <  0.05). Male participants thought they were perfectly healthy and more reluctant to agree with maintaining social distance compared to female participants (72.8% male vs 90.1% female; p  < 0.001). Participant's satisfaction level with services provided by the government was also significantly different and higher among females than male participants (39.9% male vs 53.5% female; p  < 0.05). The majority of the participants reported suffering due to financial uncertainty, psychological distress, and inadequate health facilities. Dissatisfaction was reported with the existing health services as creating several misconceptions, lacking testing facilities, and debasement by the health professionals., Conclusion: This study found a better perception regarding COVID-19 among the young adults, but they had poor preventive practices. Health education intervention with the rapid response should be implemented targeting this vulnerable group to improve their preventive practices., Competing Interests: Competing interestsThe authors have no competing interests to declare., (© The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2021.)

In this qualitative study, we aimed to explore the challenges of providing services and supports for children with autism spectrum disorders (ASD) and their families from the perceptions of professionals and parents of children with ASD. We classified the results of the study into three key categories including shortcomings in the management of children with ASD; shortcomings of supportive programs and facilities for children with ASD and their families; and organizational challenges in providing services for these children. We analyzed data using the content analysis method. The results showed that there is a wide range of challenges in providing sufficient and high-quality services for children with ASD and empowerment programs for their parents., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose: Despite the importance of patient flow to emergency department (ED) management, there is a need to strengthen and expand training in flow strategies for practicing ED staff. To date, there has been limited academic inquiry into the skills and training that ED staff require to improve patient flow. As part of a quality improvement initiative, our team aimed to identify the topics and training methods that should be included in flow training for ED staff., Methods: We conducted an integrative review and modified Delphi. For the integrative review, we sought to identify appropriate skills, training strategies, and training modalities to include in a curriculum for ED staff. The findings from the review were compiled and distributed to Canadian experts in ED efficiency through a modified Delphi, including physicians, nurses, and nurse practitioners., Results: Our literature search retrieved 8359 articles, of which 46 were included in the review. We identified 19 skills, 9 training strategies, and 12 training modalities used to improve ED efficiency in the literature. For the modified Delphi, we received responses from 39 participants in round one and 28 in round two, with response rates of 57% and 41%, respectively. The topics chosen by the most respondents were: "flow decisions," "teamwork," "backlog and surge management," "leadership," and "situational awareness.", Conclusion: Our findings suggest that flow training should teach ED staff how to make decisions that improve flow, work more effectively as a team, manage patient backlog and surge, improve leadership skills, and develop situational awareness. These findings add to a gap in the academic literature regarding the training ED staff require to improve patient flow., (© 2022. The Author(s).)

Acoustic Voice Quality Index and Dysphonia Severity Index are the two most widely used multiparametric objective measures that can successfully quantify voice quality. Latoszek et al. (2019) reported that gender had no influence on both AVQI and DSI in Dutch population. However, there is a lack of research focussed on investigating the gender effect on both DSI and AVQI and on investigating the relationship between DSI and AVQI in the Indian adult population. The present study is aimed to investigate the effect of gender on DSI and AVQI and to explore the relation between the two in the Indian adult population. 138 normophonic individuals (74 females and 64 males) were considered as participants. The phonation of /a/ and reading samples were considered as stimuli for extracting AVQI analysed using AVQI script version 02.03. The raw values of MPT, highest frequency, lowest intensity, and Jitter% were obtained from VRP module and MDVP module of Computerized Speech Lab to calculate the DSI. The results revealed that gender has significant effect on CPPs, HNR and TiltLTAS, ShimLocal, ShimdB, MPT, F0-High and Jitter%. While the overall AVQI, DSI, SlopeLTAS and I-Low were independent of gender effect. To conclude, the present study provides the reference data for AVQI v.2.03 and DSI for healthy Indian adults and discusses the influence of gender on AVQI, DSI and their constituent parameters., (© Association of Otolaryngologists of India 2021.)

The idea of the circular economy (CE) has gained prominence in the policies of the European Union (EU), commerce, and academic studies. Basically, CE is capable of achieving the best value and resolving many of the systemic challenges in the society and commerce of a country, thus leading to sustainable development and preventing irreparable damage to the environment. Medical waste management has proved a daunting challenge with the increase in the global population and the demand for medical services. Fuzzy multi-criteria decision-making approaches try to cover the different and uncertain views of decision-makers (DMs). The present study suggests a novel strategy based on multi-objective optimization using the ratio analysis (MOORA) in the area of spherical fuzzy sets (SFSs) to counterbalance the disadvantages of the failure modes and effects analysis (FMEA) method, such as the lack of weight assignment for risk factors and consideration of uncertainty. In the proposed method, first, the barriers are identified using the FMEA method, and the risk factors are given values. Then, the barriers identified using MOORA are prioritized in the spherical fuzzy (SF) area. The computational procedure of the proposed methodology is established through a case study of the barriers to circular economy implementation in designing sustainable medical waste management systems problems under an SF environment. The proposed approach was compared with IF-MOORA and was found that the results are more reliable using the proposed method, also the ranking in the MOORA method was compared with the TOPSIS method in terms of degree of correlation., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

This current study review provides a brief review of a natural bee product known as propolis and its relevance toward combating SARS-CoV viruses. Propolis has been utilized in medicinal products for centuries due to its excellent biological properties. These include anti-oxidant, immunomodulatory, anti-inflammatory, anti-viral, anti-fungal, and bactericidal activities. Furthermore, studies on molecular simulations show that flavonoids in propolis may reduce viral replication. While further research is needed to validate this theory, it has been observed that COVID-19 patients receiving propolis show earlier viral clearance, enhanced symptom recovery, quicker discharge from hospitals, and a reduced mortality rate relative to other patients. As a result, it appears that propolis could probably be useful in the treatment of SARS-CoV-2-infected patients. Therefore, this review sought to explore the natural properties of propolis and further evaluated past studies that investigated propolis as an alternative product for the treatment of COVID-19 symptoms. In addition, the review also highlights the possible mode of propolis action as well as molecular simulations of propolis compounds that may interact with the SARS-CoV-2 virus. The activity of propolis compounds in decreasing the impact of COVID-19-related comorbidities, the possible roles of such compounds as COVID-19 vaccine adjuvants, and the use of nutraceuticals in COVID-19 treatment, instead of pharmaceuticals, has also been discussed., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Alfalfa is a major forage crop in Iran. To quantify the impact of climate change on its yield and water application for irrigation in Iran, the SSM-iCrop2 simulation model and two GCMs of IPSL and HadGEM were used under RCP4.5 and RCP8.5 for the 2050s. Despite increased temperatures, alfalfa forage yield will increase in most of the regions across the country due to acceleration of spring regrowth, a higher number of cuttings, increased incident and received photosynthetically active radiation because of increased growing season length due to increased temperatures, and positive effect of CO 2 on photosynthesis and radiation use efficiency. Changes in climatic conditions have had a significant impact on alfalfa net irrigation water, and the sum of net irrigation water has a direct relationship with alfalfa yield. Due to increased temperature, changes in rainfall, and improved concentration of atmospheric CO 2 , the forage yield of alfalfa will fluctuate highly under all climatic scenarios. The highest increase and decrease in the average yield using the HadGEM model under RCP8.5 was 32 and - 33%, respectively. The average net irrigation water of alfalfa increased by 36% in the HadGEM model under RCP8.5 and decreased by - 41% in the IPSL model under RCP8.5. Therefore, to improve alfalfa yield in Iran in the future, strategies compatible such as high temperature-tolerant cultivars may be the most reasonable approaches., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: The purpose of this paper is to present a method for registration of 3D computed tomography to 2D single-plane fluoroscopy knee images to provide 3D motion information for knee joints. This 3D kinematic information has unique utility for examining joint kinematics in conditions such as ligament injury, osteoarthritis and after joint replacement., Methods: We proposed a non-invasive rigid body image registration method which is based on two different multimodal similarity measures. This hybrid registration method helps to achieve a trade-off among different challenges including, time complexity and accuracy., Results: We performed a number of experiments to evaluate the performance of the proposed method. The experimental results show that the proposed method is as accurate as one of the most recent registration methods while it is several times faster than that method., Conclusion: The proposed method is a non-invasive, fast and accurate registration method, which can provide 3D information for knee joint kinematic measurements. This information can be very helpful in improving the accuracy of diagnosis and providing targeted treatment., (© 2022. The Author(s).)

Background: Anatomic extent of ductal carcinoma in situ (DCIS) may be uncertain in spite of clinical, pathologic, and imaging data. Consequently close/positive margins are common with lumpectomy for DCIS and often lead to a challenge in deciding whether to perform a re-excision or mastectomy., Patients and Methods: From a single health system, we identified cases of lumpectomy for DCIS with close/positive margins who underwent re-excision for the purpose of constructing a nomogram. In total, 289 patients were available for analysis. The patients were randomly divided into two sets allocating 70% to the modeling and 30% to the validation set. A multivariable logistic regression model was used to estimate the probability of overall positive margin status using multiple clinicopathologic predictors. Nomogram validation included internal tenfold cross-validation, internal bootstrap validation, and external validation for which a concordance index was calculated to assess the external validity., Results: Significant predictors of persistent positive margins from regression modeling included necrosis at diagnosis (non-comedo or comedo); DCIS not associated with calcifications on core biopsy; high-grade DCIS; progesterone receptor positivity; and number of positive margins at initial surgery. When subjected to internal validation, the nomogram achieved an uncorrected concordance index of 0.7332, a tenfold cross-validation concordance index of 0.6795, and a bootstrap-corrected concordance index of 0.6881. External validation yielded an estimated concordance index of 0.7095., Conclusion: Using clinical and pathologic variables from initial diagnosis and surgery for DCIS, this nomogram predicts persistent positive margins with margin re-excision, and may be a valuable tool in surgical decision-making., (© 2022. This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply.)

Cervical cancer remains a significant disease burden and contributes to prominent cancer-related mortality among women. This study aimed to assess awareness and knowledge of cervical cancer and attitude towards HPV vaccination among rural women in Bangladesh. A cross-sectional study was carried out from September 2019 to January 2020 involving 600 women selected using multi-stage sampling from six rural areas of Bangladesh. Face-to-face interviews were conducted using a semi-structured questionnaire consisting of socio-demographic information, knowledge (20-items) and, attitudes (5-items). Most of the participants (71.8%) were aware of cervical cancer. Women's awareness was significantly associated with marital status, education level, employment status, and internet/social media use (p < 0.05). Mass media was the main source of information and 2.3% of the women had previously undergone cervical cancer screening. Knowledge regarding symptoms, risk factors, and preventive measures was limited with a mean knowledge score of 8.73 (SD: 2.68). Only 5.3% of women had vaccinated against HPV, but the willingness to receive the HPV vaccine was high (76.6%) among those who were not vaccinated. The cost of the HPV vaccine (40.1%) and lack of adequate knowledge (34.3%) were the main reasons behind women's unwillingness to receive the vaccine. Higher odds of willingness to receive the HPV vaccine were found among women aged 15-29 years (aOR: 1.92, CI = 1.21-3.04, p = 0.006), had high education (aOR: 1.93, CI = 1.25-4.42, p = 0.005), and internet/social media users (aOR: 2.32, CI: 1.51-3.56, p < 0.001). These results highlight the urgent need for educational intervention on cervical cancer and the institution of national policies providing HPV vaccination coverage., (© 2020. American Association for Cancer Education.)

Food demand of growing population can only be met by finding solutions for sustaining the crop yield. The understanding of basic mechanisms employed by microorganisms for the establishment of parasitic relationship with plants is a complex phenomenon. Symbionts and biotrophs are dependent on living hosts for completing their life cycle, whereas necrotrophs utilize dead cells for their growth and establishment. Hemibiotrophs as compared to other microbes associate themselves with plants in two phase's, viz. early bio-phase and later necro-phase. Plants and microbes interact with each other using receptors present on host cell surface and elicitors (PAMPs and effectors) produced by microbes. Plant-microbe interaction either leads to compatible or incompatible reaction. In response to various biotic and abiotic stress factors, plant undergoes programmed cell death which restricts the growth of biotrophs or hemibiotrophs while necrotrophs as an opportunist starts growing on dead tissue for their own benefit. PCD regulation is an outcome of plant-microbe crosstalk which entirely depends on various biochemical events like generation of reactive oxygen species, nitric oxide, ionic efflux/influx, CLPs, biosynthesis of phytohormones, phytoalexins, polyamines and certain pathogenesis-related proteins. This phenomenon mostly occurs in resistant and non-host plants during invasion of pathogenic microbes. The compatible or incompatible host-pathogen interaction depends upon the presence or absence of host plant resistance and pathogenic race. In addition to host-pathogen interaction, the defense induction by beneficial microbes must also be explored and used to the best of its potential. This review highlights the mechanism of microbe- or symbiont-mediated PCD along with defense induction in plants towards symbionts, biotrophs, necrotrophs and hemibiotrophs. Here we have also discussed the possible use of beneficial microbes in inducing systemic resistance in plants against pathogenic microbes., Competing Interests: Conflict of interestThere is no conflict of interest regarding the publication of this article., (© King Abdulaziz City for Science and Technology 2022.)

In this study, we evaluate the geochemistry of macro- (Fe, P, Ca, S, K, Na, Mg) and micronutrients (Mo, Cu, Pb, Zn, Co, Mn, Cd, Sr, Cr, Hg, Se), along with possible health risks of heavy metals contamination in agricultural soils and vegetables of the Mahshahr industrial port in Iran. Calculation of geochemical coefficients revealed the low pollution load of Mahshahr agricultural soils. Most of the investigated elements exhibited lower concentrations in soil than international standards. Element concentrations in plant samples were far below the permissible values set by environmental agencies. Based on permissible values, there was deficiency of several soil elements, including Cu, in vegetables because they are mostly present in the soil residual phase. An exception was Mn, which is the most mobile element in soil. The transfer factor (TF) of elements showed the following trend: K > Na > P > S > Mo > Hg > Se > Zn > Cd > Cu > Mg > Mn > Ca > Cr > Co ≈ Fe = Pb. There was high transfer of major elements from soil to plants, and lower values for micronutrients and heavy metals. The calculated daily intake (DIM) and health risk index (HRI) for ten plant species for adults were < 1, while the HRI was larger than 1 for Mn via radish consumption. According to geochemical investigations and statistical tests such as principal component analysis, Kruskal-Wallis, and correlation coefficient calculations, plant species play the most important role in elemental uptake by plants., (© 2022. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Structural engineering of the recombinant thrombolytic drug, Reteplase, and its cost-effective production are important goals in the pharmaceutical industry. In this study, a single-point mutant of the protein was rationally designed and evaluated in terms of physicochemical characteristics, enzymatic activity, as well as large-scale production settings. An accurate homology model of Reteplase was used as the input to appropriate tools to identify the aggregation-prone sites, while considering the structural stability. Selected variants underwent extensive molecular dynamic simulations (total 540 ns) to assess their solvation profile and their thermal stability. The Reteplase-fibrin interaction was investigated by docking. The best variant was expressed in E. coli, and Box-Behnken design was used through response surface methodology to optimize its expression conditions. M72R mutant demonstrated appropriate stability, enhanced enzymatic activity (p < 0.05), and strengthened binding to fibrin, compared to the wild type. The optimal conditions for the variant's production in a bioreactor was shown to be 37 ºC, induction with 0.5 mM IPTG, for 2 h of incubation. Under these conditions, the final amount of the produced enzyme was increased by about 23 mg/L compared to the wild type, with an increase in the enzymatic activity by about 2 IU/mL. This study thus offered a new Reteplase variant with nearly all favorable properties, except solubility. The impact of temperature and incubation time on its large-scale production were underlined as well., (© 2021. The Author(s), under exclusive licence to Springer Nature B.V.)

About 50% of infertility is caused by men. This study aimed to investigate the efficiency of photobiomodulation on spermatogenesis in a busulfan-induced infertile mouse as a testicular degeneration treatment. Thirty-two adult NMRI male mice were divided into 4 groups: control, busulfan, PBMT 0.03 J/cm 2 , and laser 0.2 J/cm 2 . In the study, azoospermia was induced by busulfan as a testicular degeneration, and then, they were treated using photobiomodulation therapy at 0.03 J/cm2 and 0.2 J/cm 2 energy densities. Sperm parameters, stereological analysis, serum testosterone levels, together with SDH activity, MDA production oxidized as a marker for lipid peroxidation, glutathione (GSSG) and glutathione (GSH), mitochondrial membrane permeability (MMP), reactive oxygen species (ROS) production, and ATP production as well as TUNEL assay were assessed. Photobiomodulation therapy with 0.03 J/cm 2 energy densities group revealed a significant increase the testosterone hormone level and spermatogenic cells with the reduction of apoptotic cells and marked increase in GSH, ATP, and SDH levels and decrease the levels of MDA and ROS production in the busulfan-induced mice when compared with the control and sham groups. In conclusion, the photobiomodulation therapy (0.03 J/cm 2 energy density) may provide benefits on the spermatogenesis following busulfan injection and might be an alternative treatment to the patients with oligospermia and azoospermia in a dose-dependent manner., (© 2021. Society for Reproductive Investigation.)

Inflammatory bowel diseases (IBDs) are chronic and relapsing disorders that affect the quality of life in many individuals around the world. Over the past few years, the prevalence of IBDs is substantially rising which might pose a considerable social and economic burden on health systems. Progresses in the management of chronic inflammatory diseases lead to prolonged remission phase and decreased hospitalization rate. However, during treatment, many patients become refractory to conventional therapies. Recently, advanced approaches using somatic cell therapy medicinal products (SCTMPs) including immune and stem cell-based therapies have drawn many researchers' attentions. Promising results from recent trials, alongside with the emerging market indicated that these therapeutic approaches could be an alternative and promising treatment to conventional therapies. In this review, we will discuss recent advances in cell-based therapies, which have been developed for treatment of IBDs. In addition, the global emerging market and the novel products in this field are highlighted., (© 2021. Japan Human Cell Society.)

Objectives: Clinical decision support may facilitate evidence-based imaging, but most studies to date examining the impact of decision support have used non-randomized designs which limit the conclusions that can be drawn from them. This randomized trial examines if decision support can reduce computed tomography (CT) utilization for patients with mild traumatic brain injuries and suspected pulmonary embolism in the emergency department. This study was funded by a competitive public research grant and registered on ClinicalTrials.gov (NCT02410941)., Methods: Emergency physicians at five urban sites were assigned to voluntary decision support for CT imaging of patients with either head injuries or suspected pulmonary embolism using a cluster-randomized design over a 1-year intervention period. The co-primary outcomes were CT head and CT pulmonary angiography utilization. CT pulmonary angiography diagnostic yield (proportion of studies diagnostic for acute pulmonary embolism) was a secondary outcome., Results: A total of 225 physicians were randomized and studied over a 2-year baseline and 1-year intervention period. Physicians interacted with the decision support in 38.0% and 45.0% of eligible head injury and suspected pulmonary embolism cases, respectively. A mixed effects logistic regression model demonstrated no significant impact of decision support on head CT utilization (OR 0.93, 95% CI 0.79-1.10, p = 0.31), CT pulmonary angiography utilization (OR 0.98, 95% CI 0.88-1.11, p = 0.74) or diagnostic yield (OR 1.23, 95% CI 0.96-1.65, p = 0.10). However, overall CT pulmonary diagnostic yield (17.7%) was almost three times higher than that reported by a recent large US study, suggesting that selective imaging was already being employed., Conclusion: Voluntary decision support addressing many commonly cited barriers to evidence-based imaging did not significantly reduce CT utilization or improve diagnostic yield but was limited by low rates of participation and high baseline rates of selective imaging. Demonstrating value to clinicians through interventions that improve workflow is likely necessary to meaningfully change imaging practices., (© 2021. The Author(s), under exclusive licence to Canadian Association of Emergency Physicians (CAEP)/ Association Canadienne de Médecine d'Urgence (ACMU).)

To evaluate the incidence of apoptosis within the testes of patients who died from severe acute respiratory syndrome coronavirus 2 (COVID-19) complications, testis tissue was collected from autopsies of COVID-19 positive (n = 6) and negative men (n = 6). They were then taken for histopathological experiments, and RNA extraction, to examine the expression of angiotensin-converting enzyme 2 (ACE2), transmembrane protease, serine 2 (TMPRSS2), BAX, BCL2 and Caspase3 genes. Reactive oxygen species (ROS) production and glutathione disulfide (GSH) activity were also thoroughly examined. Autopsied testicular specimens of COVID-19 showed that COVID-19 infection significantly decreased the seminiferous tubule length, interstitial tissue and seminiferous tubule volume, as well as the number of testicular cells. An analysis of the results showed that the Johnsen expressed a reduction in the COVID-19 group when compared to the control group. Our data showed that the expression of ACE2, BAX and Caspase3 were remarkably increased as well as a decrease in the expression of BCL2 in COVID-19 cases. Although, no significant difference was found for TMPRSS2. Furthermore, the results signified an increase in the formation of ROS and suppression of the GSH activity as oxidative stress biomarkers. The results of immunohistochemistry and TUNEL assay showed that the expression of ACE2 and the number of apoptotic cells significantly increased in the COVID-19 group. Overall, this study suggests that COVID-19 infection causes spermatogenesis disruption, probably through the oxidative stress pathway and subsequently induces apoptosis., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)