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Abstract This paper presents a non‐isolated DC‐DC converter designed to validate ultra‐high voltage gain using a modified double boost mode. The objective is to achieve exceptionally high voltage gain by integrating a modified triple boost technique (MTBT), interleaved with second main and auxiliary third MOSFETs, and a modified switched inductor‐capacitor (MSLC), effectively doubling the voltage transfer gain. Furthermore, MSLC is combined with the auxiliary third and double main MOSFET to double the voltage gain while concurrently mitigating voltage stress on the auxiliary MOSFET and diodes in the proposed converter (the PC). Additionally, all diodes in the MTBT operate under zero current switching (ZCS) and the double main and auxiliary third MOSFET face very low current stress at ultra‐high voltage gain. The input current of the PC remains steady without pulsating at a low duty ratio, making the PC more suitable for renewable energy systems. The PC offers numerous advantages, exhibiting high efficiency and ensuring minimal voltage stress on power devices with low current stress on the power switches. Notably, PC aims to elevate input voltages from 30 V to a variable output range of 335 to 600 V, delivering 440 watts at 96.1% efficiency.

Conclusions: Our results suggested that a diet with a higher PI score may contribute to an increase in the odds of NAFLD independent of common confounders.

Conclusion: Our findings emphasize the importance of promoting healthy eating and regular physical activity during Ramadan.

ABSTRACT Left ventricular assist devices (LVADs) have been used as a bridge to transplantation in patients with advanced heart failure. In this case, LVAD therapy was used as a destination therapy for 16 years, representing the longest documented and continuously ongoing support with the original implanted device.

ABSTRACT We report a rare case of a 29‐year old woman presenting with abdominal pain, whose initial examination failed to identify intrauterine contraceptive device (IUCD) threads. IUCD migration was confirmed by CT scan and subsequent single‐port laparoscopic retrieval alleviated her symptoms.

Background Multiple studies have highlighted the importance of carotid artery stenting (CAS) operator's experiences. However, fellowship‐trained neurointerventionalists remain an under‐represented specialty in the literature. We aim to report the complication rate of CAS performed exclusively by neurointerventionalists. Methods Retrospective cohort study regarding stenting symptomatic and asymptomatic carotid stenosis was collected at multiple comprehensive stroke centers. The primary outcome included a composite of the 30‐day periprocedural mortality, symptomatic ischemic stroke, symptomatic intracranial hemorrhage, and myocardial infarction. The secondary outcomes included other complications. Chi‐squared tests were performed for categorical variables, and Welch's t‐test was used for continuous variables. Cutoffs in continuous variables were estimated using grid search optimization. Sensitivity analyses were performed for missing data. Results Between 2018 and 2022, 1445 CAS procedures were performed by 38 neurointerventionalists. We have 30‐day outcome data on 1281 patients. Patients were predominantly symptomatic (93.01%), male (65.79%), White (70.36%), and had a median age of 69. The primary outcomes occurred in 26 (1.8%) cases, with 13 (0.9%) death, 8 (0.55%) symptomatic ischemic stroke, 4 (0.28%) symptomatic intracranial hemorrhage, and 1 (0.07%) myocardial infarction. A statistically significant increase in all outcomes correlated with advanced age (P = 0.001), women (P = 0.013), aortic arch type 3 (P = 0.01), and higher preprocedural modified Rankin score (P = 0.006). Secondary outcomes were higher in Hispanic and Black patients (P = 0.007) and those with low diastolic blood pressure at stenting (P = 0.04). Conclusion CAS, conducted by fellowship‐trained neurointerventionalist physicians in comprehensive stroke centers, demonstrates a lower complication rate than what was previously reported in CAS, carotid endarterectomy, and transcarotid artery revascularization literature. Physician training, higher frequency, and standardized stroke care in a comprehensive stroke center may contribute to this low complication rate.

New epoxy (EP)-based sandwich composites have enhanced mechanical performance and optimized cost-effectiveness, as a result of composites’ increasing popularity. This study aims to develop composites with 3, 5, and 7 layers of woven carbon fibers (WCFs) layered on 3D rayon-based graphite felt (3D RGF) as the core of the sandwich composites. Using WCFs as face sheet layers increases flexural strength and modulus. Flexural strength increases to 226.92 MPa, and modulus increases to 15.18 GPa with 3 WCFs layers. Five layers increase modulus to 25.43 GPa and flexural strength to 370.21 MPa. Seven layers provide the highest modulus of 31.38 GPa and flexural strength of 405.07 MPa. Diverse concentrations of nanosilica (0.01, 0.1, 0.5, and 0.8 wt%) were embedded within the core to bolster its mechanical properties. Using an in situ casting method, an EP resin solution was infused into the structure, forming a bicontinuous composite. This method significantly enhances the toughness and adhesion between the fibers and the EP resin, resulting in superior mechanical properties. EP alone has 57-MPa tensile strength, but three layers of WCFs increase it to 531.38 MPa, five layers increase it to 647.24 MPa, and seven layers increase it to 764.40 MPa. The minimum tensile modulus of EP is 2.75 ± 0.5 GPa. The modulus increases significantly when layers of WCFs are added, reaching 9.75 GPa with three layers, 14.96 GPa with five layers, and a maximum value of 23.44 GPa with seven layers. When a little amount of nanosilica was added, the flexural properties of composites were significantly affected. Among all concentrations, 0. 5 wt% nano-SiO2 yielded the highest enhancement of flexural strength and modulus. At 0.1 wt% nanosilica, the flexural strength and modulus of the sandwich composites increase to 493.5 MPa and 30.5 GPa (23.4% and 24.5%). The peak occurs at 0.5 wt%, reaching 645.7 MPa and 41.5 GPa (61.4% and 69.4%). However, at 0.8 wt%, values drop to 560.1 MPa and 30.4 GPa, still showing 40.0% and 24.1% improvements. This study provides a new solution for reinforcing the mechanical properties of EP sandwich composites. Increasing the performance with nanofiller concentrations is also emphasized.

Abstract Objective To predict one‐year seizure freedom, using a combination of relevant clinical variables, following stereotactic laser amygdalohippocampotomy for mesial temporal lobe epilepsy in a series of 101 patients. Methods Eight predictors of seizure freedom were selected based on their association with medial temporal lobe epilepsy: (1) MRI evidence of mesial temporal sclerosis (MTS); (2) unitemporal interictal epileptiform discharges; (3) absence of generalized tonic–clonic seizures; (4) history of febrile seizures; (5) onset of epilepsy ≤16 years; (6) absence of an auditory, visual, or vertiginous aura; and (7) unitemporal ictal onset; (8) unitemporal PET hypometabolism. We compared four multivariate models: “MTS,” using just evidence of MTS; “FULL,” using all eight binary predictors; “AIC” using backwards selection of variables; and “SCORE,” using a 0‐to‐8‐point ordinal score awarding one point for each binary predictor. Results In univariate analysis, significant predictors for seizure freedom were evidence of mesial temporal sclerosis (p = 0.011, Fisher exact) and unitemporal interictal discharges (p = 0.005). For multivariate prediction (using leave one‐out cross‐validation), the ordinal SCORE model had a significantly higher area under the curve (AUC 0.70) than the other three models: MTS (AUC 0.54, p = 0.002, Delong's test), FULL (AUC 0.62, p = 0.003), or AIC (AUC 0.53, p

Abstract Objective Neurofilament heavy‐chain gene (NEFH) variants are associated with multiple neurodegenerative diseases, however, their relationship with ALS has not been robustly explored. Still, NEFH is commonly included in genetic screening panels worldwide. We therefore aimed to determine if NEFH variants modify ALS risk. Methods Genetic data of 11,130 people with ALS and 7,416 controls from the literature and Project MinE were analysed. We performed meta‐analyses of published case–control studies reporting NEFH variants, and variant analysis of NEFH in Project MinE whole‐genome sequencing data. Results Fixed‐effects meta‐analysis found that rare (MAF

Abstract Type 2 diabetes (T2D) is a chronic metabolic disorder caused by defective insulin signaling, insulin resistance, and impairment of insulin secretion. Autophagy is a conserved lysosomal‐dependent catabolic cellular pathway involved in the pathogenesis of T2D and its complications. Basal autophagy regulates pancreatic β‐cell function by enhancing insulin release and peripheral insulin sensitivity. Therefore, defective autophagy is associated with impairment of pancreatic β‐cell function and the development of insulin rersistance (IR). However, over‐activated autophagy increases apoptosis of pancreatic β‐cells leading to pancreatic β‐cell dysfunction. Hence, autophagy plays a double‐edged sword role in T2D. Therefore, the use of autophagy modulators including inhibitors and activators may affect the pathogenesis of T2D. Hence, this review aims to clarify the potential role of autophagy inhibitors and activators in T2D.

ABSTRACT Background and Aims Despite its prioritization by the World Health Organization, improving access to cervical cancer screening remains a challenge in Ethiopia. Educated individuals, particularly teachers, are viewed as key influencers in promoting healthy lifestyles among youth and can significantly contribute to cervical cancer prevention. However, there is a notable gap in research regarding cervical cancer screening practices among female educators in the studied region. This study aimed to assess the cervical cancer screening practices and associated factors among female school teachers in Bahir Dar, Ethiopia, 2024. Methods A school‐based cross‐sectional study was conducted from May 27 to June 28, 2024, involving 561 female school teachers in Bahir Dar City, using a stratified multistage sampling method. Data were gathered through a pretested structured questionnaire, entered in Epi‐data version‐4.6, and analyzed with SPSS version‐23. Bi‐variable and multivariable binary logistic regression analyses were performed, considering variables with p values

Abstract According to the United Nations, around 53 million metric tons of electronic waste is produced every year, worldwide, the big majority of which goes unprocessed. With the rapid advances in AI technologies and adoption of smart gadgets, the demand for powerful logic and memory chips is expected to boom. Therefore, the development of green electronics is crucial to minimizing the impact of the alarmingly increasing e‐waste. Here, it is shown the application of a green synthesized, chemically stable, carbonyl‐decorated 2D organic, and biocompatible polymer as an active layer in a memristor device, sandwiched between potentially fully recyclable electrodes. The 2D polymer's ultramicro channels, decorated with C═O and O─H groups, efficiently promote the formation of copper nanofilaments. As a result, the device shows excellent bipolar resistive switching behavior with the potential to mimic synaptic plasticity. A large resistive switching window (103), low SET/RESET voltage of ≈0.5/−1.5 V), excellent device‐to‐device stability and synaptic features are demonstrated. Leveraging the device's synaptic characteristics, its applications in image denoising and edge detection is examined. The results show a reduction in power consumption by a factor of 103 compared to a traditional Tesla P40 graphics processing unit, indicating great promise for future sustainable AI‐based applications.

Abstract The widespread use and circulation of industrial emulsifiers pose significant health risks, compounded by their limited availability and high cost. Consequently, there is growing interest in exploring the potential of natural sources, such as microorganisms like yeast, for emulsifier production. In this study, 25 strains of Saccharomyces cerevisiae were isolated from 17 distinct local sources. The yeasts were characterized based on cell shape, size, and colony morphology using yeast malt agar, followed by morphological, microscopic, and biochemical analyzes. Among the isolates, AC1 from a vinegar starter demonstrated superior bioemulsifier production. Emulsification efficiency tests revealed that AC1 exhibited values of 7.1 cm, 0.71 nm, and 34.50%, outperforming other isolates. The biomass yield was approximately 4.35 g/L. This strain was registered in the gene bank as JZT351 (OR115510) after a 100% match with S. cerevisiae. Optimal bioemulsifier production conditions for JZT351 were identified using a liquid yeast extract peptone dextrose medium, with date juice replacing 75% of the glucose, at pH 5.5, 30°C, and 72 h. The resulting emulsification activity, index, and oil displacement were 8.69 cm, 0.95 nm, and 39.7%, respectively. Fourier‐transform infrared spectroscopy (FTIR) compared the functional groups of the bioemulsifier with those of conventional emulsifiers. Molecular characterization was confirmed by 1H NMR. FTIR spectra revealed bioemulsifier bands at 3443.28, 2929.34, 1656.559, 1534.09, 807.06, and 1656.55 cm−1. At 0.5–5 ppm, signals and spectral frequencies corresponded to a mannoprotein structure. The bioemulsifier exhibited 58.09% antioxidant activity at 10 mg/mL, as assessed by DPPH scavenging. It showed the highest inhibition against Pseudomonas aeruginosa and the least against Candida albicans.

Abstract Nephrotoxicity occurs when the body is exposed to certain drugs or toxins. When kidney damage occurs, the kidney fails to eliminate excess urine and waste. Solanesol (C45H74O) is a tri‐sesquiterpenoid alcohol first isolated from tobacco, and it is widely distributed in plants of the Solanaceae family. Solanesol (SNL) is an intermediate in the synthesis of coenzyme Q10 (CoQ10), an antioxidant which protects nerve cells. This study investigated the protective effect of SNL at doses of 30 and 60 mg/kg in gentamicin‐induced nephrotoxicity in Wistar albino rats. Animals were distributed into six groups and administered 100 mg/kg gentamicin‐intraperitoneal injection for 14 days. Biochemical assessments were performed on kidney homogenate, blood, and serum. Treatment with SNL was shown as lower serum levels of creatinine, blood urea nitrogen (BUN), thiobarbituric acid reactive substances (TBARS), and Tumor necrosis factor alpha)TNF‐α ((p

Abstract The overall objective was to determine how no extracellular glucose and/or low glycogen content affect fatigue kinetics in mouse flexor digitorum brevis (FDB) single muscle fibers. High glycogen content (Hi GLY), near normal in situ level, was obtained by incubating fibers in culture medium containing glucose and insulin while low glycogen content (Lo GLY), at about 19% of normal in situ level, was achieved by incubating fibers without glucose. Neither Lo GLY nor the absence of extracellular glucose (0GLU) affected tetanic [Ca2+]i prior to fatigue. The number of contracting unfatigued fibers versus stimulus strength relationship of Lo GLY‐0GLU fibers was shifted to higher voltages compared to Hi GLY fibers exposed to 5.5 mM glucose (5GLU). The relationship for Lo GLY‐0GLU fibers was shifted back toward that of Hi GLY‐5GLU fibers when glucose was reintroduced, whereas the removal of glucose from Hi GLY‐5GLU fibers had no effect. Fatigue was elicited with one 200 ms long tetanic contraction every s for 3 min. Both Lo GLY and 0GLU increased the rate at which intracellular tetanic concentration ([Ca2+]i) declined and unstimulated [Ca2+]i increased during fatigue in the order of the least fatigue resistant > mid fatigue resistant > the most fatigue resistant fibers.

Abstract Background The objective of this study was to evaluate the impact of dysglycemia on perioperative outcomes, in patients with and without diabetes, and how prior glycemic control modifies these relationships. Methods Consecutive surgical patients admitted to six South Australian tertiary hospitals between 2017 and 2023 were included. Blood glucose levels within 48 h pre‐ and post‐operatively were assessed in an adjusted analyses against a priori selected covariates. Dysglycemia metrics were hyperglycemia (>10.0 mmol/L), hypoglycemia (1.7 mmol/L), and stress hyperglycemic ratio (SHR). The primary outcome was hospital mortality. Results Of 52 145 patients, 7490 (14.4%) had recognized diabetes. Inpatient mortality was observed in 787 patients (1.5%), of which 150 (19.1%) had diabetes mellitus. Hyperglycemia was associated with increased mortality in patients with diabetes (odds ratio [OR] = 2.99, 95% CI: 1.63–5.67, p = 0.004) but not in non‐diabetics, who instead had an increased odds of intensive care unit (ICU) admission if hyperglycemic (OR = 1.95, 95% CI: 1.40–2.72, p

Abstract Neuromodulation via Responsive Neurostimulation (RNS) or Deep Brain Stimulation (DBS) is an emerging treatment strategy for pediatric drug‐resistant epilepsy (DRE). Knowledge gaps exist in patient selection, surgical technique, and perioperative care. Here, we use an expert survey to clarify practices. Thirty‐two members of the Pediatric Epilepsy Research Consortium were surveyed using REDCap. Respondents were from 17 pediatric epilepsy centers (missing data in one): Four centers implant RNS only while 13 implant both RNS and DBS. Thirteen RNS programs commenced in or before 2020, and 10 of 12 DBS programs began thereafter. The busiest six centers implant 6–10 new RNS devices per year; all DBS programs implant 50%) was reported by 81% (13/16) of centers. RNS and DBS are rapidly evolving treatment modalities for safe and effective treatment of pediatric DRE. There is increasing interest in multicenter collaboration to gain knowledge and facilitate dialogue. Plain language summary We surveyed 32 pediatric epilepsy centers in USA to highlight current practices of intracranial neuromodulation. Of the 17 that replied, we found that most centers are implanting thalamic targets in pediatric drug‐resistant epilepsy using the RNS device. DBS device is starting to be used in pediatric epilepsy, especially after 2020. Different strategies for target identification are enumerated. This study serves as a starting point for future collaborative research.

Key Clinical Message Topical papaverine is an effective vasodilator that can be used for dilating small veins to accept venous couplers for thumb replantation. This technique corrects size mismatches for successful venous anastomosis and minimizes postoperative complications. Abstract Thumb replantation is a complex microsurgical procedure used to restore function and appearance after amputation. A successful venous anastomosis is essential in replantations; however, venous couplers can mismatch the size of veins and lead to obstacles. A 26‐year‐old male presented with a left thumb amputation caused by an electric saw injury. The amputated thumb was preserved and replantation surgery was performed 9 h post‐injury. The digital artery and veins were repaired but a size mismatch was found between the only salvageable superficial vein (0.7 mm) and the smallest available venous coupler (1 mm). The vein was dilated to accept the coupler by a series of applications of topical papaverine (1 mg/mL). This allowed venous anastomosis to be accomplished in 25 min. Postoperative follow‐up showed good thumb function, sensation, and circulation. Venous anastomosis is vital in thumb replantation to avoid venous congestion hence survival of the replanted thumb. Venous couplers shorten operative time and decrease the risk of postoperative complications. Papaverine is a vasodilator and facilitates venous anastomosis when veins and couplers are mismatched. This case demonstrates how papaverine, a vasodilator, may be used to improve surgical outcome during thumb replantation when small veins prevent venous coupler use.

Abstract Background The use of prophylactic drainage after laparoscopic cholecystectomy has been a routine practice for many years. However, the debate surrounding using it stems from conflicting evidence regarding its potential benefits and risks. Methods Patients who underwent laparoscopic cholecystectomy from February 1, 2022, to November 30, 2022, at Aleppo University Hospital were enrolled according to our previously registered protocol (NCT05267860). Results This study included 232 patients (117 in the drainage group [DG], and 115 in the non‐drainage group [NDG]). There was no statistical difference in the patients' main characteristics, comorbidities, and laboratory findings. The duration of the surgical operation in NDG (mean = 44.92, SD = 1.85) was shorter than in DG (mean 55.14, SD = 2.14), with (p = 0.039) statistically significant, which indicates that the use of the drainage led to a prolongation of the surgical operation. The total number of complicated cases reached 22 (9.48%) cases (DG = 9 vs. NDG = 13, p = 0.348) as follows: bleeding (n = 1) (DG = 1 vs. NDG = 0; p = 0.320), bile leak with no established bile duct injury (n = 1) (DG = 1 vs. NDG = 0; p = 0.320), wound infection (n = 12) (DG = 4 vs. NDG = 8; p = 0.443), urinary tract infection (n = 3) (DG = 0 vs. NDG = 3; p = 0.079), prolonged shoulder pain (n = 2) (DG = 0 vs. NDG = 2; p = 0.152), and acute pancreatitis (n = 1) (DG = 1 vs. NDG = 0; p = 0.144). Conclusion Based on the results of our study, the use of prophylactic drainage was safe, but ineffective, as it did not improve the outcomes statistically significantly or worsen them, which is consistent with previous studies highlighting the need for personalized patient care in this setting.

ABSTRACT Objective The aim of this study was to evaluate the effectiveness of a novel biomaterial (FG) for alveolar ridge preservation compared to CTG in terms of soft tissue thickness and bone dimensional changes. Materials and Methods A randomized clinical trial was conducted on 30 patients who required extraction of 30 hopeless mandibular posterior teeth. All patients went through atraumatic tooth extraction, and then, they were randomly allocated to either a CTG, an FG, or a spontaneous healing (SH) group (1:1:1). All patients received a dental implant placed 6 months postoperatively. The soft tissue thickness and bone dimensional changes were measured before and 6 months after the procedure. Results The study's analysis revealed statistically significant differences in buccal gingival thickness and dimensional bone changes across the three examined groups after 6 months (p

Abstract For the past few years, the addition of renewable energy sources has been on the rise, but the unregulated addition of these sources can cause severe harm to the grid. Therefore, it is necessary to have a predefined limit for a grid, beyond which no further addition of renewables should be allowed without reinforcement. That limit is called the hosting capacity (HC), which is addressed in the literature by search‐based methods with heavy computational burdens. This manuscript first presents a framework to find the HC for a grid. The same framework is then applied to 503 different simulated but realistic LV distribution feeders in Finland to find their HCs and the most effective network parameters in defining a network specific HC. Next, different machine learning models, that is, Decision Tree (DT), Random Forest (RF), Linear Regression (LR), K nearest neighbours (KNN), Logistic Regression, and Support Vector Machine (SVM) are implemented on the generated data. For the classification case, the accuracy values for logistic regression, KNN, and SVM were 0.89, 0.84, and 0.81, respectively. The findings demonstrate that the developed machine learning based technique will enable distribution network operators in finding the HC without applying any deterministic or probabilistic approaches.

Abstract Background Among youth, symptoms of depression, anxiety, and alcohol use are associated with considerable illness and disability. Youth face many personal and health system barriers in accessing mental health care. Mobile applications (apps) offer youth potentially accessible, scalable, and anonymous therapy and other support. Recent systematic reviews on apps to reduce mental health symptoms among youth have reported uncertain effectiveness, but analyses based on the type of app‐delivered therapy are limited. Objectives We conducted this systematic review with youth co‐researchers to ensure that this review addressed the questions that were most important to them. The objective of this review is to synthesize the best available evidence on the effectiveness of mobile apps for the reduction of depressive symptoms (depression, generalized anxiety, psychological distress) and alcohol use among youth. Search Methods We conducted electronic searches of the following bibliographic databases for studies published between January 1, 2008, and July 1, 2022: MEDLINE (via Ovid), Embase (via Ovid), PsycINFO (via Ovid), CINAHL (via EBSCOHost), and CENTRAL (via the Cochrane Library). The search used a combination of indexed terms, free text words, and MeSH headings. We manually screened the references of relevant systematic reviews and included randomized controlled trials (RCTs) for additional eligible studies, and contacted authors for full reports of identified trial registries or protocols. Selection Criteria We included RCTs conducted among youth aged 15–24 years from any setting. We did not exclude populations on the basis of gender, socioeconomic status, geographic location or other personal characteristics. We included studies which assessed the effectiveness of app‐delivered mental health support or therapy interventions that targeted the management of depressive disorders and/or alcohol use disorders. We excluded apps that targeted general wellness, apps which focused on prevention of psychological disorders and apps that targeted bipolar disorder, psychosis, post‐traumatic stress disorder, attention‐deficit hyperactivity disorder, substance use disorders (aside from alcohol), and sleep disorders. Eligible comparisons included usual care, no intervention, wait‐list control, alternative or controlled mobile applications. We included studies which reported outcomes on depressive symptoms, anxiety symptoms, alcohol use and psychological distress over any follow‐up period. Data Collection and Analysis We standardized the PICO definitions (population, intervention, comparison, and outcome) of each included study and grouped studies by the type of therapy or support offered by the app. Whenever app design and clinical homogeneity allowed, we meta‐analyzed outcomes using a random‐effects model. Outcome data measured using categorical scales were synthesized using odds ratios. Outcome data measured using continuous scales were synthesized as the standardized mean difference. We assessed the methodological quality of each included study using the Cochrane Risk of Bias 2.0 tool and we assessed certainty of the evidence using the GRADE approach. Main Results From 5280 unique citations, we included 36 RCTs published in 37 reports and conducted in 15 different countries (7984 participants). Among the 36 included trials, we assessed two with an overall low risk of bias, 8 trials with some concern regarding risk of bias, and 26 trials with a high risk of bias. Interventions varied in the type of therapy or supports offered. The most common intervention designs employed mindfulness training, cognitive behavioral therapy (CBT), or a combination of the two (mindfulness + CBT). However, other interventions also included self‐monitoring, medication reminders, cognitive bias modification or positive stimulation, dialectical behavioral therapy, gamified health promotion, or social skill building. Mindfulness apps led to short term improvements in depressive symptoms when compared to a withheld control (SMD = −0.36; 95% CI [−0.63, −0.10]; p = 0.007, n = 3 RCTs, GRADE: very low certainty) and when compared to an active control (SMD = −0.27; 95% CI [−0.53, −0.01]; p = 0.04, n = 2 RCTs, GRADE: very low). Apps delivering this type of support also significantly improved symptoms of anxiety when compared to a withheld control (SMD = −0.35; 95% CI [−0.60, −0.09]; p = 0.008, n = 3 RCTs, GRADE: very low) but not when compared to an active control (SMD = −0.24; 95% CI [−0.50, 0.02]; p = 0.07, n = 2 RCTs, GRADE: very low). Mindfulness apps showed improvements in psychological stress that approached statistical significance among participants receiving the mindfulness mobile apps compared to those in the withheld control (SMD = −0.27; 95% CI [−0.56, 0.03]; p = .07, n = 4 RCTs, GRADE: very low). CBT apps also led to short‐term improvements in depressive symptoms when compared to a withheld control (SMD = −0.40; 95% CI [−0.80, 0.01]; p = 0.05, n = 2 RCTs, GRADE: very low) and when compared to an active control (SMD = −0.59; 95% CI [−0.98, −0.19]; p = 0.003, n = 2 RCTs, GRADE: very low). CBT‐based apps also improved symptoms of anxiety compared to a withheld control (SMD = −0.51; 95% CI [−0.94, −0.09]; p = 0.02, n = 3 RCTs, GRADE: very low) but not when compared to an active control (SMD = −0.26; 95% CI [−1.11, 0.59]; p = 0.55, n = 3 RCTs, GRADE: very low). Apps which combined mindfulness and CBT did not significantly improve symptoms of depression (SMD = −0.20; 95% CI [−0.42, 0.02]; p = 0.07, n = 2 RCTs, GRADE: very low) or anxiety (SMD = −0.21; 95% CI [−0.49, 0.07]; p = 0.14, n = 2 RCTs, GRADE: very low). However, these apps did improve psychological distress (SMD = −0.43; 95% CI [−0.74, −0.12]; p = 0.006, n = 2 RCTs, GRADE: very low). The results of trials on apps to reduce alcohol use were inconsistent. We did not identify any harms associated with the use of apps to manage mental health concerns. All effectiveness results had a very low certainty of evidence rating using the GRADE approach, meaning that apps which deliver therapy or other mental health support may reduce symptoms of depression, anxiety and psychological distress but the evidence is very uncertain. Authors' Conclusions We reviewed evidence from 36 trials conducted among youth. According to our meta‐analyses, the evidence is very uncertain about the effect of apps on depression, anxiety, psychological distress, and alcohol use. Very few effects were interpreted to be of clinical importance. Most of the RCTs were small studies focusing on efficacy for youth at risk for depressive symptoms. Larger trials are needed to evaluate effectiveness and allow for further analysis of subgroup differences. Longer trials are also needed to better estimate the clinical importance of these apps over the long term.

Key Clinical Message A case of major aphthous‐like ulcer was described in a 50‐year‐old patient. The patient showed the main signs of aphthous stomatitis painful ulcer, 1–2 cm in diameter, located on the ventral of the tongue, buccal mucosa, and the palate. These ulcers persisted for more than 3 weeks. The patient's self‐administration of a nonsteroidal anti‐inflammatory drug (NSAID) was suggested as the leading cause of aphthous‐like ulcers in this case. ulcers were treated with dexamethasone mouthwash and low‐level laser therapy (LLLT).

Key Clinical Message Tuberculosis (TB) pericarditis, while uncommon, should be considered in patients with pericardial masses and effusion. Timely recognition and treatment with anti‐TB medications are crucial for a successful outcome. Abstract TB pericarditis presenting as a pericardial mass is an unusual and rare manifestation of this disease. We report a 59‐year‐old South Asian male who presented with a 1‐week history of dyspnea and cough. He was found to have a hemorrhagic pericardial mass with a massive pericardial effusion. Pleural fluid analysis was positive for TB. The patient was successfully treated with anti‐TB medications. Although rare, tuberculous pericardial involvement should be suspected in patients presenting with symptoms of pericardial masses and effusion.

Key Clinical Message Secondary hematocolpos is a rare but serious complication after cystocele repair. This warrants multidisciplinary management (gynecology and urology) to optimize outcomes & minimize iatrogenic risks. Abstract Hematocolpos is the term used for the accumulation of menstrual blood in the vagina. It is most commonly seen in adolescent girls but can also occur in elderly women as a result of gynecological conditions. We present the case of a 48‐year‐old female who presented with amenorrhea and abdominal pain following surgical repair of a cystocele. Investigation revealed secondary hematocolpos due to surgical trauma. Surgical drainage and correction of the uterus were performed, resulting in immediate pain relief. This case underscores the importance of considering hematocolpos in patients with post‐surgical amenorrhea, and further research is needed to better understand its causes, risk factors, and optimal management strategies.

Abstract The global economy has been dramatically impacted by COVID‐19, which has spread to be a pandemic. COVID‐19 virus affects the respiratory system, causing difficulty breathing in the patient. It is crucial to identify and treat infections as soon as possible. Traditional diagnostic reverse transcription‐polymerase chain reaction (RT‐PCR) methods require more time to find the infection. A high infection rate, slow laboratory analysis, and delayed test results caused the widespread and uncontrolled spread of the disease. This study aims to diagnose the COVID‐19 epidemic by leveraging a modified convolutional neural network (CNN) to quickly and safely predict the disease's appearance from computed tomography (CT) scan images and a laboratory and physiological parameters dataset. A dataset representing 500 patients was used to train, test, and validate the CNN model with results in detecting COVID‐19 having an accuracy, sensitivity, specificity, and F1‐score of 99.33%, 99.09%, 99.52%, and 99.24%, respectively. These experimental results suggest that our strategy performs better than previously published approaches.

Abstract Introduction Children with chronic conditions have greater health care needs than the general paediatric population but may not receive care that centres their needs and preferences as identified by their families. Clinicians and researchers are interested in developing interventions to improve family‐centred care need information about the characteristics of existing interventions, their development and the domains of family‐centred care that they address. We conducted a scoping review that aimed to identify and characterize recent family‐centred interventions designed to improve experiences with care for children with chronic conditions. Methods We searched Medline, Embase, PsycInfo and Cochrane databases, and grey literature sources for relevant articles or documents published between 1 January 2019 and 11 August 2020 (databases) or 7–20 October 2020 (grey literature). Primary studies with ≥10 participants, clinical practice guidelines and theoretical articles describing family‐centred interventions that aimed to improve experiences with care for children with chronic conditions were eligible. Following citation and full‐text screening by two reviewers working independently, we charted data covering study characteristics and interventions from eligible reports and synthesized interventions by domains of family‐centred care. Results Our search identified 2882 citations, from which 63 articles describing 61 unique interventions met the eligibility criteria and were included in this review. The most common study designs were quasiexperimental studies (n = 18), randomized controlled trials (n = 11) and qualitative and mixed‐methods studies (n = 9 each). The most frequently addressed domains of family‐centred care were communication and information provision (n = 45), family involvement in care (n = 37) and access to care (n = 30). Conclusion This review, which identified 61 unique interventions aimed at improving family‐centred care for children with chronic conditions across a range of settings, is a concrete resource for researchers, health care providers and administrators interested in improving care for this high‐needs population. Patient or Public Contribution This study was co‐developed with three patient partner co‐investigators, all of whom are individuals with lived experiences of rare chronic diseases as parents and/or patients and have prior experience in patient engagement in research (I. J., N. P., M. S.). These patient partner co‐investigators contributed to this study at all stages, from conceptualization to dissemination.

This paper investigates the existence and controllability of second-order functional differential equations with infinite delay, incorporating random operators. The existence of solutions is established using the Schauder fixed point theorem, ensuring that solutions exist under specified conditions. Additionally, the controllability of the system is analyzed using fixed point theory, demonstrating that the solutions can be controlled under specific criteria. An example is included to illustrate the application of the theoretical results.

Conclusion: The findings suggest that TachoSil sealant effectively reduces early postoperative lymphatic drainage volume and maintains lower drainage rates up to 10 days following axillary dissection in breast cancer patients. The use of TachoSil sealant may have potential benefits in reducing the incidence of complications associated with lymphatic drainage and improving patient outcomes.

This study demonstrated the impact of formic acid (FAc), a common reactive impurity in pharmaceutical excipients, on the stability of mirabegron (MB). The investigation of MB-excipient compatibility tests revealed the formation of a new degradation product, FAc-DP, at 0.2% after 7 days of isothermal stress at 55°C. FAc-DP was synthesized and characterized as N-formyl MB using liquid chromatography–mass spectrometry (LC-MS) and both 1D and 2D nuclear magnetic resonance spectroscopy (NMR).

Background In acute ischemic stroke caused by large‐vessel occlusion, tissue viability is dependent on the blood supply from leptomeningeal collaterals until reperfusion is achieved. Rapid and accurate evaluation of baseline collateral status is a key marker of eligibility for endovascular therapy but can be challenging to interpret using source images of the computed tomography angiography (SI‐CTA). Our objective was to assess whether the use of thick maximum‐intensity projection computed tomography angiography (MIP‐CTA) improves interrater agreement for evaluation of baseline collaterals status between stroke trainees and an expert stroke neurologist. Methods An expert stroke neurologist and 2 stroke trainees independently reviewed images from 40 brain CTA scans with anterior circulation large‐vessel occlusion and assessed collateral status using the Tan collateral scoring system using SI‐CTA in the first reading and then using MIP‐CTA in the second reading. We calculated interrater agreement and recorded the total time needed in each reading. Results Interrater agreement was fair between the 2 stroke fellows and stroke expert when using SI‐CTA (κ=0.45 with 52.5% agreement). After using MIP‐CTA, interrater agreement improved to moderate (κ=0.69 with 70% agreement). The median reading time was 1.89 minutes per scan using SI‐CTA and 1.00 minute per scan using MIP‐CTA (P

Conclusions: Cirrhotic patients aged ≥ 65 years have significantly poor survival compared to younger patients. A prospective study is needed to further investigate the effect of age and obesity on survival and disease progression in older adult patients with cirrhosis.

The single-valued neutrosophic set (SVNS) is a more common platform for representing the degree of truth, indeterminacy, and falsity memberships. Indeterminacy is an important aspect of SVNS, and the score function (SF) is important in ranking alternatives in decision-making scenarios. When the score and accuracy values for different SVNNs were equal, existing SFs were unable to rank the alternatives. To address the limitations, this paper introduces the perfect score function (PSF) as a solution for ranking single-valued neutrosophic numbers (SVNNs) without any errors and presents the concepts of strong and weak SVNSs. This article has emphasized the drawbacks of the existing SF in SVNNs. Additionally, we propose an optimized weighted geometric operator (OWGO) for SVNNs, and its properties such as idempotency, boundedness, monotonicity, and commutativity are explored. Furthermore, the decision-making approach has been depicted based on the proposed score function and OWGO to select the finest faculty for a university.

Accurate lung cancer detection is vital for timely diagnosis and treatment. This study evaluates the performance of six convolutional neural network (CNN) architectures, ResNet-50, VGG-16, ResNet-101, VGG-19, DenseNet-201, and EfficientNet-B4, using the LIDC-IDRI dataset. Models were assessed both in their base forms and with transfer learning. The dataset consisted of 460 × 460 × 3 pixel images categorized into squamous cell carcinoma (SCC), normal benign, large cell carcinoma (LCC), and adenocarcinoma (ADC). Performance metrics were computed, including accuracy (99.47% for the custom CNN), precision (99.50%), recall (98.37%), AUC (99.98%), and F1-score (98.98%) during training. However, overfitting was observed in the validation phases. Transfer learning models showed better generalization, with DenseNet-201 achieving a top validation accuracy of 96.88% and EfficientNet-B4 of 96.53%. Hyperparameter tuning improved the models’ generalization capabilities, maintaining high accuracy while reducing overfitting. This study highlights the effectiveness of transfer learning, particularly DenseNet-201, in enhancing automated lung cancer detection systems. Future work will focus on expanding datasets and exploring additional augmentation techniques to further refine model performance in clinical settings.

Background. Celiac disease (CD) is an immune-mediated enteropathy that has been associated with other immune-related gastrointestinal disorders, such as eosinophilic esophagitis (EoE) and lymphocytic gastritis (LG). To our knowledge, this is the first study in Saudi Arabia that has described such an association. Aim. To evaluate the prevalence of EoE and LG in children and adolescents with CD. Methods. This was a retrospective cross-sectional study of all pediatric patients (aged 0–18 years) with CD following up at King Abdulaziz University Hospital, between January, 2014, and December, 2021. The study examined clinical, demographic, endoscopic, and histopathological data. Results. Seventy-five patients with CD were included in the analysis. The median age was 12 years (range, 2–18 years). Male constituted 54.7% of the overall cohort (n = 41). The most common clinical symptoms were short stature (54.7%), weight loss (34.7%), abdominal pain (33.3%), abdominal distension (29.3%), anorexia (29.3%), diarrhea (24%), and vomiting (21.3%). The esophageal biopsy results reported were basal cell hyperplasia in 24 patients (32.9%), esophageal eosinophilia in 23 patients (31.5%), and EoE in 3 patients (4.1%). The gastric biopsy results were normal in 40 patients (53.3%). The most common abnormality was chronic inactive gastritis with no Helicobacter pylori (HP) infection (16%). LG was found in 3 patients (4%). Conclusions. The prevalence of EoE in this cohort of patients with CD was lower than the prevalence recorded in a number of other studies. Further studies are needed to determine the effects of a gluten-free diet (GFD) on EOE and LG.

Background. For orthodontic treatment to be effective, bracket placement must be precise to make the finishing stage easier, leading to an ideal occlusion with minimal intervention. This study aimed to evaluate the accuracy of manual and digital bracket positioning techniques utilizing computer-aided design and computer-aided manufacturing (CAD/CAM) jigs, 3D-printed indirect bonding trays (IBT), and double-layer vacuum-formed thermoplastic IBT. Methods.This study was done by scanning the dental arch of 30 orthodontic patients. The virtual setup and bracket positioning were performed with the Insignia™ system for ten patients, and 3D Maestro® software was used for the virtual setup of the remaining 20 patients. At the same time, the bracket positioning of 10 patients was done digitally by the 3D Maestro® software and the remaining 10 patients manually through the Ray Set® device. IBT were fabricated by CAD/CAM system, 3D printer, and vacuum-formed thermoplastic machine. A virtual bracket position was compared to the actual bracket position using the best-fit method of 3D digital superimposition in Geomagic® Control X™ (CX) software to determine how accurate it was in terms of linear and angular accuracy. Statistical analyses using SPSS 26.0 including Bland–Altman plots were used to assess the intra-examiner reproducibility. Shapiro–Wilk test was used to measure normality distribution. Wilcoxon matched-pairs signed rank test was used to analyze the differences between bracket positions within each group. Results. Although there were obvious positional discrepancies between several readings, they were still within clinically acceptable ranges. Conclusions. All types of IBT would translate the planned position of the bracket from the digital and manual techniques to the teeth of patients with accepted precision in both linear and angular measurements; in addition, the error rate is about the same for all types of IBT. This trial is registered with NCT05549089.

This paper focuses on solving the challenge of observer-based exponential control (O-BC) regarding conformable fuzzy polynomial models with time delay. In this work, polynomial matrices with unmeasurable states are considered to enhance the practicality of the model in the design problem. The proposed approach guarantees the existence of the polynomial controller and observer gains by satisfying sufficient conditions based on the sum-of-squares (S-O-S) approach. The stability conditions of the addressed system are solved using MATLAB SOSTOOLS, and the effectiveness of the proposed control scheme is evaluated through the presentation of simulation results from a numerical example and a mass-spring-damper system.

Abstract Connected and Autonomous Vehicles (CAVs) can receive various information from surrounding vehicles through Vehicle‐to‐Everything (V2X) communication technologies and adjust their car‐following behaviour accordingly. Although several studies have evaluated the impact of CAVs on traffic flow stability in a small segment of networks, most approaches are focused on their specific applications considering the trajectory information, and there is a lack of studies analyzing the impact of CAVs on a large‐scale network. This paper proposes a novel viscous continuum traffic model considering the anticipation of space headway, the throttle angle, and brake torque information during cooperative car‐following. The methods employed to develop the new car‐following model and its counterpart continuum traffic model have been described. The linear and non‐linear stability analyses of the newly developed model have been conducted to obtain the critical stability factors in small perturbations. Numerical simulations have been carried out to investigate the effect of the anticipation, the throttle angle, and brake torque information on traffic stability, fuel consumption, and exhaust emissions. The numerical results reveal that the anticipation of space headway and the transmission of the throttle angle and brake torque information during cooperative car‐following manoeuvres can improve the traffic flow stability and reduce fuel consumption and emissions.

Abstract This article describes a technique for improving the performance of an offshore wind farm (OWF), which includes a permanent magnet synchronous generator (PMSG) driven by a variable‐speed wind turbine (VSWT) and connected to the grid through a high‐voltage direct current transmission system (HVDC). Under various network disturbances, the gorilla tropical optimization (GTO) metaheuristic method is used to fine‐tune the proportional‐integral (PI) controller gains for VSC‐based PMSG‐VSWT and VSC‐based HVDC transmission systems. This study compares several strategies for extracting the maximum power from a system while maintaining stability under symmetrical and unsymmetrical fault circumstances. Compared to different algorithms, GTO provides better results and improves system recovery and stability after disturbances. As a consequence, dynamic and transient stability may be enhanced. MATLAB/Simulink is used to implement the control mechanism.

Abstract For the past few years, the world has seen a great shift toward renewable energy resources from conventional ones. But the ever‐increasing integration of distributed generation (DG) to the electrical network leads to integration limiting constraints like overvoltage, under voltage, harmonics, equipment ampacity violations, and failure of protection schemes. Therefore, an extensive investigation of the methodologies in which DGs can be incorporated into the electrical network is presented in this manuscript. This article provides an extensive review of all the hosting capacity (HC) terms, references, limiting constraints of the studied networks, geographical segregation, and their determination methodologies. Moreover, the factors defining the HCs of various networks and the architectures employed to increase them, are also explained briefly in the conducted review study.

Abstract Hydroxychloroquine (HCQ) was initially promoted as an oral therapy for early treatment of coronavirus disease 2019 (COVID‐19). Conventional meta‐analyses cannot fully address the heterogeneity of different designs and outcomes of randomized controlled trials (RCTs) assessing the efficacy of HCQ in outpatients with mild COVID‐19. We conducted a pooled analysis of individual participant data from RCTs that evaluated the effect of HCQ on hospitalization and viral load reduction in outpatients with confirmed COVID‐19. We evaluated the overall treatment group effect by log‐likelihood ratio test (−2LL) from a generalized linear mixed model to accommodate correlated longitudinal binary data. The analysis included data from 11 RCTs. The outcome of virological effect, assessed in 1560 participants (N = 795 HCQ, N = 765 control), did not differ significantly between the two treatment groups (−2LL = 7.66; p = 0.18) when adjusting for cohort, duration of symptoms, and comorbidities. The decline in polymerase chain reaction positive tests from day 1 to 7 was 42.0 and 41.6 percentage points in the HCQ and control groups, respectively. Among the 2037 participants evaluable for hospitalization (N = 1058 HCQ, N = 979 control), we found no significant differences in hospitalization rate between participants receiving HCQ and controls (odds ratio 0.995; 95% confidence interval 0.614–1.610; −2LL = 0.0; p = 0.98) when adjusting for cohort, duration of symptoms, and comorbidities. This individual participant data meta‐analysis of 11 HCQ trials that evaluated severe acute respiratory syndrome‐coronavirus 2 viral clearance and COVID‐19 hospitalization did not show a clinical benefit of HCQ. Our meta‐analysis provides evidence to support the interruption in the use of HCQ in mild COVID‐19 outpatients to reduce progression to severe disease.

Abstract Background We performed an integrated biomarker evaluation in pembrolizumab‐treated patients with R/M HNSCC enrolled in KEYNOTE‐012 or KEYNOTE‐055. The relationship between biomarkers and HPV status was explored. Methods We evaluated PD‐L1 (combined positive score [CPS]), TMB, T‐cell‐inflamed gene expression profile (TcellinfGEP), and HPV status. Associations between biomarkers were evaluated by logistic regression (ORR) and Cox regression (PFS, OS). Results Two hundred and fifty‐seven patients (KEYNOTE‐012, n = 106; KEYNOTE‐055, n = 151) had TMB data available; of these, 254 had PD‐L1 and 236 had TcellinfGEP. TMB, PD‐L1, and TcellinfGEP were each significantly associated with ORR (p

Abstract This study offers a comprehensive analysis of the distribution, evolution, and driving factors of CO2 emissions from 1990 to 2016 at multiple spatial scales. Utilizing 26 indicators encompassing various facets of CO2 emissions, it is employed principal component analysis (PCA) and empirical orthogonal functions (EOFs) to identify the dominant characteristics of global CO2 emissions. This model retained three core components, accounting for 93% of the global CO2 variation, reflecting emission trajectories and associated economic metrics, such as Gross domestic product (GDP). The analysis differentiated the effects of these components based on countries' economic standings. Using a novel aggregated index, significant national contributors to global CO2 emissions are pinpointed. Notably, the leading contributors are found among developed nations (e.g., the United States, Canada, Japan), Gulf states (e.g., Saudi Arabia, Qatar), and emerging economies (e.g., China, Brazil, Mexico). Furthermore, these results highlight that shifts in global CO2 emissions over the past 30 years are predominantly influenced by factors like industrial emissions and GDP. Results also demonstrate a distinct relationship between a country's CO2 emissions and its physical and socioeconomic factors. Specifically, the nation's coastline length, population density in coastal regions, and the diversity of its climatic conditions significantly influence its carbon footprint.

Abstract Background Nutritional counseling, which includes two‐way interactive education, has been hypothesized to improve the health and nutritional status of pregnant women, but little is known about the impact such practice of care might have on maternal and infant health and behavioral outcomes of pregnant women living in low income, low‐middle income, and upper‐middle‐income countries (LMIC)s. Objectives We conducted a systematic review to appraise the effectiveness and impact on health equity of two‐way nutritional counseling practices in LMICs on maternal and infant behavioral, nutritional, and health outcomes. Search Methods We conducted electronic searches for relevant studies on Medline, Embase, CINAHL, PsychInfo, and the Cochrane CENTRAL for randomized and non‐randomized trials on the effectiveness of two‐way interactive nutritional counseling among pregnant women from the date of database inception up to June 22, 2021. In addition, we searched references of included studies in systematic reviews, gray literature resources, and unpublished studies or reports that satisfied our eligibility criteria using a focused Google search. Selection Criteria We included randomized and non‐randomized controlled studies (NRS), controlled before and after, and interrupted time series that assessed the effectiveness of two‐way interactive nutrition counseling targeting pregnant women in LMICs. Data Collection and Analysis Data extraction and risk of bias were conducted in duplicate. The risk of bias (ROB) for randomized trials (RCT) was assessed according to the Cochrane Handbook of Systematic Reviews, and ROB for NRS was assessed using the Newcastle‐Ottawa scale (NOS). RCT and NRS were meta‐analyzed separately. Main Results Our search identified 6418 records and 52 studies met our inclusion criteria, but only 28 were used in the quantitative analysis. Twenty‐eight studies were conducted in Asia, the most in Iran. Eight studies were conducted in Africa. Two‐way interactive nutritional counseling during pregnancy may improve dietary caloric intake (mean difference [MD]: 81.65 calories, 95% confidence interval [CI], 15.37–147.93, three RCTs; I2 = 42%; moderate certainty of evidence using GRADE assessment), may reduce hemorrhage (relative risk [RR]: 0.63; 95% CI, 0.25–1.54, two RCTs; I2 = 40%; very low certainty of evidence using GRADE assessment), may improve protein (MD: 10.44 g, 95% CI, 1.83–19.05, two RCTs; I2 = 95%; high certainty of evidence using GRADE assessment), fat intake (MD: 3.42 g, 95% CI, −0.20 to 7.04, two RCTs; I2 = 0%; high certainty of evidence using GRADE assessment), and may improve gestational weight gain within recommendations (RR: 1.84; 95% CI, 1.10–3.09, three RCTs; I2 = 69%). Nutrition counseling probably leads to the initiation of breastfeeding immediately after birth (RR: 1.72; 95% CI, 1.42–2.09, one RCT). There was little to no effect on reducing anemia (RR: 0.77; 95% CI, 0.50–1.20, three RCTs; I2 = 67%; very low certainty of evidence using GRADE assessment) risk of stillbirths (RR: 0.81; 95% CI, 0.52–1.27, three RCTs; I2 = 0%; moderate certainty of evidence using GRADE assessment) and risk of cesarean section delivery (RR: 0.96; 95% CI, 0.76–1.20, four RCTs; I2 = 36%; moderate certainty of evidence using GRADE assessment). Authors’ Conclusions Our review highlights improvements in maternal behavioral and health outcomes through interactive nutrition counseling during pregnancy. However, we are uncertain about the effects of nutrition counseling due to the low certainty of evidence and a low number of studies for some key outcomes. Moreover, the effects on health equity remain unknown. More methodologically rigorous trials that focus on a precise selection of outcomes driven by the theory of change of nutrition counseling to improve maternal and infant behavioral and health outcomes and consider equity are required.

Abstract Background Silent or unrecognized myocardial infarction (UMI) diagnosed by surveillance electrocardiography (ECG) carries similarly poor prognosis as recognized MI (RMI) for poorly understood reasons. Methods This study included 5430 consecutive patients who presented to the nuclear laboratory and underwent 2‐day stress and rest Tc‐99m sestamibi and ECG studies between March 1991 and June 1999. UMI was diagnosed if ECG showed Q‐wave MI in the absence of a history of RMI. We measured infarct size (% defect size as compared with the entire left ventricular sestamibi uptake), ejection fraction (EF, %), and summed difference score (SDS, sestamibi uptake by myocardium in stress minus sestamibi uptake in rest images as a marker of ischemia). Survival was determined by follow‐up survey (median 6 years). Results We identified 346 UMIs, 628 RMIs, and 4456 subjects without MI (No MI). As compared with RMI, UMI patients had lesser abnormalities on nuclear scans (p

Introduction Flow diversion (FD) is commonly used for the treatment of aneurysms involving the ophthalmic segment of the carotid artery (COA). The origin of the ophthalmic artery (OA) in relation to the aneurysm sac can affect recurrence and complications. We studied the effects of COA treatment with FD alone or in combination with coil embolization, based on the origin of the ophthalmic artery in‐relation to the aneurysm sac. Methods Retrospective analysis of a prospectively collected tertiary center database. Based on the ophthalmic artery origin, four types of carotid ophthalmic aneurysms were previously described and implemented in this study: OA originates from Type A. directly from the aneurysm fundus, B. aneurysm neck, C. inner curve of the carotid siphon, and D. OA separate from the aneurysm. Imaging outcomes were aneurysm occlusion and OA patency at 1‐year, determined by Digital Subtraction Angiography (DSA) or MRA. Clinical outcome was treatment‐related visual complications. Results A total of 60 patients treated at our tertiary center between January 2017 and November 2019 were reviewed. 4 patients were lost to follow up. Clinical and angiographic data of 59 COAs treated with FD +/‐ coil embolization were available. FD alone was used in 44 (75%) aneurysms, the rest had adjunct coiling. Median age was 55. Ten (17%) patients were men. Thirty two aneurysms (55%) were Type D, 22 (37%) Type B, 5 (8%) Type A. No Type C aneurysms were identified. Overall complete occlusion rate was 82%; 94% vs 71% for adjunct coiling vs FD only, respectively. Residual filling was seen in 4 (12%) Type D aneurysms, 8 (35%) Type B aneurysms, and 1 (20%) Type A aneurysm. The ophthalmic artery was occluded at follow up in all but one patient in Type A aneurysm group (80%), 2 (7.1%) in Type D, and 6 (27%) in Type B. 6/15 (40%) of patients in the adjunct coiling group had transient and short‐lasting disturbing visual symptoms, vs 7/44 (16%) in the FD only group. No patient had long‐term visual complications. A total of 10 patients showed OA occlusion at follow up, 4 of them in the adjunct coiling group (26%). There was 1 patient (2%) with a non‐disabling stroke due to antiplatelet therapy interruption and in‐stent thrombosis. Conclusion Flow diversion appears safe and effective for COA treatment. Adjunct coil embolization increased COA occlusion 1 year after FD treatment without significant increase in long‐term visual complications. Adjunct coiling and ophthalmic artery origin location appear to have a significant effect on treatment result, and should be considered at treatment planning.

Introduction Ticagrelor use has become more prominent in acute ischemic stroke management in the presence of clopidogrel resistance(1‐2). This study compares the effectiveness of aspirin plus ticagrelor at different doses versus clopidogrel in reducing the risk of recurrent stroke and other thrombotic events without increasing the risk of bleeding. Methods We performed a retrospective chart review of patients diagnosed with acute ischemic stroke at a large academic comprehensive stroke center from September 1, 2020, to July 1, 2022. A total of 3 separate groups, low‐dose ticagrelor (45 mg or 60 mg twice a day), full‐dose ticagrelor (90 mg twice a day) and clopidogrel (75 mg daily) were created. We compared baseline characteristics and completed a one‐way ANOVA to analyze for outcome measures such as in‐hospital mortality, 90‐day mortality, favorable functional outcome defined as modified Rankin Score (mRS) of 0‐2, at 90 days, symptomatic intracranial hemorrhage (sICH) and asymptomatic hemorrhage (aICH) between groups. All data was analyzed via IBM SPSS v28.0. Results A total of 445 patients were included in our study. The mean age was 66.1 ± 12.8 years and the majority of patients were female (52.9%). The most common ethnicity was African American (82.9%). Sixty patients were discharged on low‐dose ticagrelor, 39 on full dose ticagrelor and 351 on clopidogrel. A total of 162/433 (36.0%) had a presumed stroke etiology of intracranial atherosclerotic disease (ICAD). Only 24 patients received intravenous thrombolytics (5.3%) and 47 had stent placement (10.4%). Out of 445 patients, 288 were on aspirin 81 mg at time of discharge. Of that group, 228 were on both aspirin and clopidogrel, 60 were on aspirin and low‐dose ticagrelor and 39 were on aspirin and full‐dose ticagrelor. There was no statistical significance for new or recurrent ischemic stroke between groups (low‐dose vs full‐dose vs clopidogrel) determined by one‐way ANOVA (10.0% vs. 17.9% vs. 7.8%, F(2,103) = 0.01, p=0.99). Symptomatic ICH was also similar between the groups (3.3% vs. 2.6% vs. 1.1%, F(2,101) = 0.68, p=0.51). There was no significance for favorable functional outcomes and mortality as well (26.7% vs. 23.1% vs. 24.2%, F(2,173) = 0.62, p=0.54; 80.0% vs. 79.5% vs. 81.5%, F(2,150) = 1.5, p=0.22). Conclusion These findings suggest that a lower dose of ticagrelor may be a safe and effective alternative to full dose ticagrelor or clopidogrel for the prevention of recurrent ischemic stroke without increasing hemorrhagic complications. Larger randomized trials are necessary to further evaluate these findings.

Introduction Ruptured aneurysmal SAH accounts up to 80% of nontraumatic SAH, with more than 80% located in the anterior circulation and a mortality rate upwards of 50%.1‐3 Endovascular treatment (EVT) of ruptured intracranial aneurysms (rIA) is increasingly being recognized as a standard treatment that may result in better early outcomes and independency when compared with open neurosurgical clipping in cases of appropriate equipoise.1,2,4–6 Despite this, EVT of intracranial aneurysms has its own risk of complications including intraoperative rupture and thromboembolic events.7 The complication rate is found to be higher in cases of rIA than that seen in cases of unruptured intracranial aneurysms.8 The use of somatosensory evoked potentials (SSEP) and electroencephalography (EEG) intraoperative neuromonitoring (IONM) have proven their efficacy in identifying iatrogenic neurological complications in vascular surgeries including carotid endarterectomy 9–11, EVT and microsurgical treatment of intracranial aneurysms. 11,12 rIA have their own unique challenges due to preoperative neurological deficits and perioperative vasospasm making it more difficult to identify new neurological deficits after the procedure. They are also associated with decreased vasoreactivity secondary to bleeding, and a higher rate of procedural complications that can alter the IONM signals.13,14 IONM in the form of SSEP and EEG can be utilized in anesthetized patients to indirectly monitor intraoperative cerebral perfusion as well as central and peripheral neuronal integrity.15,16 Changes in one or both modalities indicate a change in cerebral perfusion that can be related to EVT directly, for example, aneurysm perforation or coil herniation and embolism, or indirectly secondary to anesthesia and hemodynamic changes.17 (Figure1) Methods We reviewed the medical records of 323 patients who underwent EVT of ruptured aneurysms with IONM utilizing SSEP and EEG. We included all patients who had endovascular management of ruptured aneurysm and completed IONM records until the end of the procedure and excluded those with no IONM records or incomplete records. Patients were divided into 2 groups, one group with postprocedural neurological deficits (PPND) and one group without PPND. Results Total of 323 patients undergoing EVT, significant IONM changes were noted in 71 patients (21.98%) and 46 (14.24%) who experienced PPND. 22 out of 71 (30.98%) patients who had significant IONM changes experienced PPND. Univariable analysis demonstrated that persistent changes in SSEP and EEG were associated with PPND (p‐values: