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Abstract Hydroxyurea is the preferred first‐line cytoreductive treatment for high‐risk essential thrombocythaemia (ET), but many patients are intolerant or refractory to hydroxyurea. Ruxolitinib has been shown to improve symptoms in patients with ET. This post hoc analysis compared the clinical outcomes of patients with ET who received hydroxyurea only with those who switched from hydroxyurea to ruxolitinib due to intolerance/resistance to hydroxyurea. Patients with ET refractory/intolerant to hydroxyurea treated with ruxolitinib in a completed phase 2 study (HU‐RUX) were propensity score matched with patients who received hydroxyurea only in an observational study (HU). Changes in leukocyte and platelet counts were reported at 6‐month intervals during the 48‐month follow‐up. Following propensity score matching, 37 patients were included for analysis in each cohort. Mean (standard deviation [SD]) leukocyte and platelet counts at index were higher for HU‐RUX versus HU (leukocyte: 9.3 [5.1] vs. 6.8 [3.1] × 109/L; platelet: 1027.4 [497.8] vs. 513.9 [154.7] × 109/L), both of which decreased significantly from index to 6 months through to 48 months in HU‐RUX (mean [SD] change from index at 6 months—leukocyte: −1.8 [4.6] × 109/L; platelet: −391.7 [472.9] × 109/L; at 48 months—leukocyte: −3.8 [5.3] × 109/L; platelet: −539.0 [521.8] × 109/L), but remained relatively stable in HU (mean [SD] change from index at 6 months—leukocyte: 0 [1.8] × 109/L; platelet: −5.7 [175.3] × 109/L; at 48 months—leukocyte: −0.1 [2.7] × 109/L; platelet: −6.9 [105.1] × 109/L). In conclusion, these results demonstrate that switching from hydroxyurea to ruxolitinib in patients with ET who are intolerant or refractory to hydroxyurea could improve abnormal haematologic values similar to those who receive first‐line hydroxyurea.

Abstract Heart attack is a life‐threatening condition which is mostly caused due to coronary disease resulting in death in human beings. Detecting the risk of heart diseases is one of the most important problems in medical science that can be prevented and treated with early detection and appropriate medical management; it can also help to predict a large number of medical needs and reduce expenses for treatment. Predicting the occurrence of heart diseases by machine learning (ML) algorithms has become significant work in healthcare industry. This study aims to create a such system that is used for predicting whether a patient is likely to develop heart attacks, by analysing various data sources including electronic health records and clinical diagnosis reports from hospital clinics. ML is used as a process in which computers learn from data in order to make predictions about new datasets. The algorithms created for predictive data analysis are often used for commercial purposes. This paper presents an overview to forecast the likelihood of a heart attack for which many ML methodologies and techniques are applied. In order to improve medical diagnosis, the paper compares various algorithms such as Random Forest, Regression models, K‐nearest neighbour imputation (KNN), Naïve Bayes algorithm etc. It is found that the Random Forest algorithm provides a better accuracy of 88.52% in forecasting heart attack risk, which could herald a revolution in the diagnosis and treatment of cardiovascular illnesses.

Abstract Background Intervertebral disc herniation is widely recognized as the most common cause of myelopathy in dogs older than 2 years; however, the prevalence of various causes of myelopathy in younger dogs has not been reported. Hypothesis/Objectives To describe the prevalence, clinical presentation, and etiology of myelopathy in dogs aged 18 months or less. Secondarily, to investigate which clinical features were associated with each of the most common etiologies. Animals Two hundred twenty‐four dogs aged 18 months or less with myelopathy were included in the study. Methods Retrospective review of clinical records from 4 referral institutions. Multivariable logistic regression analyses assessed which clinical features were associated with each diagnosis. Results French bulldogs (n = 51, 22.8%), pugs (n = 18, 8.0%), crossbreeds (n = 12, 5.4%), and English bulldogs (n = 11, 4.9%) were the most frequently affected breeds. Overall, 31 diagnoses were reached. The 5 most frequent diagnoses were vertebral malformation (VM; n = 42, 18.8%), spinal arachnoid diverticulum (SAD; n = 28, 12.5%), traumatic fracture of the vertebral column (n = 22, 9.8%), atlantoaxial instability (n = 18, 8.0%), and osseous‐associated cervical spondylomyelopathy (n = 17, 7.6%). Intervertebral disc extrusion (IVDE) accounted for 4.5% of cases (n = 10). A final diagnosis of VM was associated with younger, screw‐tailed, and pug breeds with chronic signs of T3‐L3 myelopathy. SAD was associated with screw‐tailed and pug breeds with nonpainful clinical signs. Intervertebral disc extrusion was associated with older, screw‐tailed, and pug breeds with shorter duration of clinical signs. Conclusions and Clinical Importance Prioritization of differential diagnoses for dogs presenting with signs of myelopathy when aged 18 months or less should differ to those for older dogs, with IVDE not the most common cause in the former.

Background Aficamten, a novel cardiac myosin inhibitor, reversibly reduces cardiac hypercontractility in obstructive hypertrophic cardiomyopathy. We present a prespecified analysis of the pharmacokinetics, pharmacodynamics, and safety of aficamten in SEQUOIA‐HCM (Safety, Efficacy, and Quantitative Understanding of Obstruction Impact of Aficamten in HCM). Methods and Results A total of 282 patients with obstructive hypertrophic cardiomyopathy were randomized 1:1 to daily aficamten (5–20 mg) or placebo between February 1, 2022, and May 15, 2023. Aficamten dosing targeted the lowest effective dose for achieving site‐interpreted Valsalva left ventricular outflow tract gradient

Abstract The balance of processes affecting electron density drives the dynamics of upper‐atmospheric electrical events, such as sprites. We examine the detachment of electrons from negatively charged atomic oxygen (O−) via collisions with neutral molecular nitrogen (N2) leading to the formation of nitrous oxide (N2O). Past research posited that this process, even without significant vibrational excitation of N2, strongly impacts the dynamics of sprites. We introduce updated rate coefficients derived from recent experimental measurements which suggest a negligible influence of this reaction on sprite dynamics. Given that previous rates were incompatible with the observed decay of the light emissions from sprite glows, our findings support that glows actually result from electron depletion in sprite columns.

Abstract The accurate classification of power quality disturbances (PQDs) is crucial for advancing real‐time monitoring and classification systems within the modern power grid. The proposed system must ensure dependable, safeguarded, and stable operating conditions amidst diverse power quality issues. This paper presents an approach to classifying power quality disturbances using a deep learning model that synergizes deep convolutional neural networks (DCNN) and Bidirectional Long Short‐Term Memory (BiLSTM). This amalgamation effectively extracts and classifies disturbance signals in real time, grounded on noise levels. The initial feature extraction from the signal is accomplished through a time‐frequency matrix. Subsequently, secondary extraction employs the BiLSTM layer to intricately and significantly classify disturbances in the power signal. This aids in transforming high‐dimensional matrices into a reduced set for enhanced performance. The detailed classification is facilitated by the softmax layer. The simulation results support the power quality evaluations under varied constraints and underscore the substantial classification of power quality disturbances through the DCNN‐BiLSTM algorithm, in comparison to alternative classification algorithms in terms of computational speed and accuracy.

Abstract Background and Aims The environment within prisons, such as overcrowding, lack of access to portable water, poor sanitation, and hygiene predisposes inmates to infections, including intestinal parasitic infections (IPIs). This study therefore determined the prevalence and associated factors of IPIs among prison inmates in Southern Ghana. Methods A cross‐sectional study using the stratified sampling technique was employed. The study recruited 461 prison inmates across three notable prisons, with 50 inmates from Ho Central, 357 inmates from Nsawam Medium Security, and 54 inmates from Sekondi Central Prisons all in Southern Ghana. A structured closed‐ended questionnaire was administered to collect data on sociodemographics, lifestyle/behavioral characteristics, and signs and symptoms of IPIs. In addition, stool samples were collected and analyzed for the presence of various stages of intestinal parasites (trophozoites, cysts, ova, and larva) using formol‐ether concentration, and the modified Ziehl–Neelsen techniques. Results The prevalence of IPIs among inmates of the three selected prisons was 38.2% (95% confidence interval [CI]: 33.72%–42.79%). The prevalence of IPIs among inmates of the three prisons, the Ho Central, Nsawam Medium Security, and Sekondi Central were 46% (95% CI: 31.82%–60.68%), 37.5% (95% CI: 32.49%–42.79%), and 35.2% (95% CI: 22.68%–49.38%), respectively. After adjusting for confounders, the following factors; handwashing after defecation (adjusted odds ratio [AOR]: 0.05 [0.00–0.67]; p = 0.024), trimmed fingernails (AOR: 0.32 [0.13–0.76]; p = 0.011), itchy skin (AOR [95% CI]: 5.99 [3.43–10.43]; p

Abstract Purpose Systematic repurposing of approved medicines for another indication may accelerate drug development in oncology. We present a strategy combining biomarker testing with drug repurposing to identify new treatments for patients with advanced cancer. Methods Tumours were sequenced with the Illumina TruSight Oncology 500 (TSO‐500) platform or the FoundationOne CDx panel. Mutations were screened by two medical oncologists and pathogenic mutations were categorised referencing literature. Variants of unknown significance were classified as potentially pathogenic using plausible mechanisms and computational prediction of pathogenicity. Gain of function (GOF) mutations were evaluated through repurposing databases Probe Miner (PM), Broad Institute Drug Repurposing Hub (Broad Institute DRH) and TOPOGRAPH. GOF mutations were repurposing events if identified in PM, not indexed in TOPOGRAPH and excluding mutations with a known Food and Drug Administration (FDA)‐approved biomarker. The computational repurposing approach was validated by evaluating its ability to identify FDA‐approved biomarkers. The total repurposable genome was identified by evaluating all possible gene‐FDA drug‐approved combinations in the PM dataset. Results The computational repurposing approach was accurate at identifying FDA therapies with known biomarkers (94%). Using next‐generation sequencing molecular reports (n = 94), a meaningful percentage of patients (14%) could have an off‐label therapeutic identified. The frequency of theoretical drug repurposing events in The Cancer Genome Atlas pan‐cancer dataset was 73% of the samples in the cohort. Conclusion A computational drug repurposing approach may assist in identifying novel repurposing events in cancer patients with no access to standard therapies. Further validation is needed to confirm a precision oncology approach using drug repurposing.

Abstract The present research work focused on optimizing the input parameters of the automated TIG welding process of SS304 metal. Since SS304 possesses high inter‐granular toughness and corrosion resistance with increased lifespan in the pressure vessel and automobile sector, SS304 is mainly referred for gas arc welding compared with SS 202. The SS304 workpieces of 60 mm × 40 mm × 4 mm with dimension are utilized in the experiment and the same metal has been used as the filler material. The TIG welding experimental lab‐scale setup utilizes a 2‐axis servo workbench programmed with PLC to perform an automatic trajectory path using Taguchi design of optimization to obtain the optimal welding parameters for the SS304 welding process. To analyze the influence of welding current, welding speed, gas flow rate, and welding arc length on the tensile strength and hardness based on predicted R‐squared, p‐value and co‐efficient of the sum of squares from are verified. From the regression analysis, the predicted model R‐squared value holds 95.78% and 94.83% for the hardness and tensile strength respectively associating with the actual coefficient confirming the model which has maximum precision. Further, it is inferred that on increasing welding current and welding speed, the hardness of the welded joints seems to increase whereas when the minimum gas flow rate is maintained, the tensile strength of the SS304 decreases drastically. Overall, among the four input factors, the welding current is a major influencing parameter on the SS304 which is directly proportional to tensile strength and hardness.

Abstract Many progressed information scientific strategies, particularly Artificial Intelligence (AI) and profound learning methods, have been proposed and tracked down wide applications in our general public. This proposition creates information driven arrangements by utilizing the most recent profound learning and AI innovation, including outfit learning, meta‐learning and move learning, for energy the executives framework issues. Genuine world datasets are tried on proposed models contrasted and best in class plans, which exhibit the predominant presentation of the proposed model. In this proposition, the engineering of the Smart Grid testbed is additionally planned and created by using ML calculations and true remote correspondence frameworks to such an extent that constant plan necessities of Smart Grid testbed is met by this reconfigurable system with stacking of full convention in medium access control (MAC) and physical layers (PHY). The proposed engineering has the reconfiguration property in view of the organization of remote correspondence and trend setting innovations of Information and communication technologies (ICT) which incorporates Artificial Intelligence (AI) calculation. The fundamental plan objectives of the Smart Grid testbed is to make it simple to construct, reconfigure and scale to address the framework level prerequisites and to address the ongoing necessities.

Abstract Aims This study aimed to assess, in patients with cardiogenic shock secondary to unprotected left main coronary artery‐related myocardial infarction (ULMCA‐related AMICS), the incidence and predictors of no recovery of left ventricular function during the admission. Methods and results This was an observational study conducted at two tertiary care centres (2012–20). The main outcome measured was death or requirement for heart transplantation (HT) or left ventricular assist devices (LVAD) during the admission. A total of 70 patients were included. Percutaneous coronary intervention (PCI) was successful in 53/70 patients (75.7%). The combined endpoint of death or requirement of HT or LVAD during the admission occurred in 41/70 patients (58.6%). The highest incidence of the primary endpoint was observed among patients with profound shock and occluded left main coronary artery (LMCA) (20/23, 87%, P

Abstract Access to public transport increases vulnerable people's social mobility, facilitates economic integration and improves general well‐being. This is possible given the low vehicular acquisition and low cost required to enjoy public transport services. Unfortunately, the discourse on the responsiveness of public transport services to the disability community in the Global South has been viewed from users' perspectives, leaving out key stakeholders whose actions impact persons with disability (PWDs') mobility needs. This study seeks to fill the gap by exploring stakeholders' responses to the travel needs of commuters with disability in the Accra Metropolitan Assembly. Employing an exploratory research design, this study purposively engaged five national stakeholders on transport and disability issues. All interviews and transcripts were transcribed using MaxQDA. The qualitative data analysis was iterative as the study adopted a thematic analytical approach to explore participants' opinions. From the data, all stakeholders did not have a disability‐inclined transport agenda or policy despite making various attempts to meet the travel needs of PWDs. Some attempts include the reliance on one's discretion as seen in the case of transport operators, while other stakeholders appeared to offer little support due to financial and administrative bottlenecks. Transport‐oriented stakeholders cared little about PWD while disability‐oriented stakeholders cared little about transport issues. This study recommends a consultative action framework to guide all stakeholders in ensuring the delivery of barrier‐free transport services to the disability community.

Abstract In this paper, we report on a wind observation method based on the movement of hot‐air balloons (HABs). A quality assessment was carried out by comparing against wind observations at the meteorological tower of Cabauw in the Netherlands during May–September 2018, and the obtained standard deviations in error were σu=0.65ms−1 and σv=0.69ms−1 for the measured zonal and meridional wind components, respectively. Subsequent comparison against short‐term forecasts of the HARMONIE‐AROME model showed a standard deviation of 2.5 ms−1 for the wind vector difference. From the HAB observation set, a case was selected with a rapidly changing wind field belonging to a small intensifying depression. The HAB wind observation was applied in data assimilation as a proof of principle for a single‐observation experiment. It is shown that in a complex baroclinic situation, the model state is slightly improved.

Background Baseline stroke severity is probably partly responsible for poor stroke outcomes in sub‐Saharan Africa. However, there is a paucity of information on determinants of stroke severity among indigenous Africans. We sought to identify the factors associated with stroke severity among West Africans in the SIREN (Stroke Investigative Research and Educational Networks) study. Methods and Results Stroke was diagnosed clinically and confirmed with brain neuroimaging. Severe stroke was defined as a Stroke Levity Scale score of ≤5. A multivariate logistic regression model was constructed to identify factors associated with stroke severity at 95% CI and a nominal cutoff of 5% type 1 error. A total of 3660 stroke cases were included. Overall, 50.7%% had severe stroke, including 47.6% of all ischemic strokes and 56.1% of intracerebral hemorrhage. Factors independently associated with severe stroke were meat consumption (adjusted odds ratio [aOR], 1.97 [95% CI, 1.43–2.73]), low vegetable consumption (aOR, 2.45 [95% CI, 1.93–3.12]), and lesion volume, with an aOR of 1.67 (95% CI, 1.03–2.72) for lesion volume of 10 to 30 cm3 and aOR of 3.88 (95% CI, 1.93–7.81) for lesion volume >30 cm3. Severe ischemic stroke was independently associated with total anterior circulation infarction (aOR, 3.1 [95% CI, 1.5–6.9]), posterior circulation infarction (aOR, 2.2 [95% CI, 1.1–4.2]), and partial anterior circulation infarction (aOR, 2.0 [95% CI, 1.2–3.3]) compared with lacunar stroke. Increasing age (aOR, 2.6 [95% CI, 1.3–5.2]) and lesion volume >30 cm3 (aOR, 6.2 [95% CI, 2.0–19.3]) were independently associated with severe intracerebral hemorrhage. Conclusions Severe stroke is common among indigenous West Africans, where modifiable dietary factors are independently associated with it. These factors could be targeted to reduce the burden of severe stroke.

Abstract Background and Aim The COVID‐19 booster dose has been cited as an important supplement for the control of the COVID‐19 pandemic due to reports of waning immunity among fully vaccinated persons. Determining factors that would affect its acceptability is necessary for initiating successful vaccination programs. In this study, we aimed to evaluate the factors associated with the acceptability of the COVID‐19 booster dose in Ghana. Methods We conducted an online cross‐sectional survey among the public. A self‐administered questionnaire was used to collect information on demographic characteristics, willingness to vaccinate, perceptions toward COVID‐19 vaccines, and trust in the government. Participants provided reasons and sources of advice that may affect their willingness to accept a booster dose. Using IBM SPSS and R Statistic; descriptive, univariate, and multivariate analyses were performed. Results Out of 812 respondents, 375 (46.2%) intended to accept the booster dose. Individuals who were males (adjusted odds ratio [aOR] 1.63, 95% confidence interval [CI] 1.07−2.48), had previously received other forms of vaccination twice (aOR 1.96, 95% CI 1.07−3.57) or in most years (aOR 2.51, 95% CI 1.38−4.57), tested positive for COVID‐19 (aOR 3.46, 95% CI 1.23−10.52), have high trust in government (aOR=1.77, 95% CI: 1.15‐2.74) and had positive perceptions regarding COVID‐19 vaccines (OR = 14.24, 95% CI: 9.28−22.44) were more likely to accept a booster dose. Experiencing side effects from the primer dose (aOR 0.12, 95% CI 0.08−0.18) was associated with reduced acceptance. Concerns about vaccine safety and efficacy were the common reasons impeding willingness, while advice from health professionals would be the most considered. Conclusion Low intention to accept the booster dose which is associated with a range of factors including the perception of vaccines and trust in the government, is a cause for concern. Thus, more effort would have to be taken through education and policy interventions to increase booster vaccine acceptability.

Abstract Objective Tau hyperphosphorylation at threonine 217 (pT217) in cerebrospinal fluid (CSF) has recently been linked to early amyloidosis and could serve as a highly sensitive biomarker for Alzheimer’s disease (AD). However, it remains unclear whether other tauopathies induce pT217 modifications. To determine if pT217 modification is specific to AD, CSF pT217 was measured in AD and other tauopathies. Methods Using immunoprecipitation and mass spectrometry methods, we compared CSF T217 phosphorylation occupancy (pT217/T217) and amyloid‐beta (Aβ) 42/40 ratio in cognitively normal individuals and those with symptomatic AD, progressive supranuclear palsy, corticobasal syndrome, and sporadic and familial frontotemporal dementia. Results Individuals with AD had high CSF pT217/T217 and low Aβ42/40. In contrast, cognitively normal individuals and the majority of those with 4R tauopathies had low CSF pT217/T217 and normal Aβ 42/40. We identified a subgroup of individuals with increased CSF pT217/T217 and normal Aβ 42/40 ratio, most of whom were MAPT R406W mutation carriers. Diagnostic accuracies of CSF Aβ 42/40 and CSF pT217/T217, alone and in combination were compared. We show that CSF pT217/T217 × CSF Aβ 42/40 is a sensitive composite biomarker that can separate MAPT R406W carriers from cognitively normal individuals and those with other tauopathies. Interpretation MAPT R406W is a tau mutation that leads to 3R+4R tauopathy similar to AD, but without amyloid neuropathology. These findings suggest that change in CSF pT217/T217 ratio is not specific to AD and might reflect common downstream tau pathophysiology common to 3R+4R tauopathies.

Abstract Though relatively rare in dogs, prostate cancer (PCa) is the most common non‐cutaneous cancer in men. Human and canine prostate glands share many functional, anatomical and physiological features. Due to these similarities, canine PCa has been proposed as a model for PCa in men. PCa is typically androgen‐dependent at diagnosis in men and for this reason, androgen deprivation therapies (ADT) are important treatments for advanced PCa in men. In contrast, there is some evidence that PCa is diagnosed more commonly in castrate dogs, at which point, limited therapeutic options are available. In men, a major limitation of current ADT is that progression to a lethal and incurable form of PCa, termed castrate‐resistant prostate cancer (CRPC), is common. There is, therefore, an urgent need for a better understanding of the mechanism of PCa initiation and progression to CRPC to enable the development of novel therapeutic approaches. This review focuses on the functional, physiological, endocrine and histopathological similarities and differences in the prostate gland of these species. In particular, we focus on common physiological roles for androgen signalling in the prostate of men and dogs, we review the short‐ and longer‐term effects of castration on PCa incidence and progression in the dog and relate how this knowledge may be relevant to understanding the mechanisms of CRPC in men.

Abstract The ubiquitous nature of microplastics in aquatic ecosystems may have serious implications for aquatic biota. While microplastic research in freshwater ecosystems is increasing, very few studies have assessed the physical presence of microplastics among top predators. The Eurasian otter (Lutra lutra), a top predator of aquatic ecosystems, is one of the most widely distributed otter species and has a broad habitat niche. The opportunistic collection of otter spraints (i.e., feces) presents a valuable opportunity to assess pollutants of freshwater ecosystems through noninvasive means. Here, we assessed the prevalence, abundance, and concentration of microplastics (100 μm to 5 mm), as well as dietary remains, in 53 spraint samples collected over eight river catchments spanning three regions of Ireland. We found microplastics present in 57% of spraints at an abundance of 1.2 ± 0.1 microplastics (MPs)/spraint (mean ± SE) and a concentration of 3.8 ± 0.6 MPs/g (dry weight). Fibers were the dominant particle type recovered (85%), followed by film (10%). No significant differences in microplastic concentrations were detected between the three regions assessed, or between spraints collected from areas upstream (i.e., “lower” exposure) or downstream (“higher” exposure) of putative microplastic sources, which were defined using spatial vector data. While microplastic concentrations were not explained by spraint condition (i.e., fresh, drying, or dry), spraints collected in autumn had a significantly higher concentration than spring and summer. Furthermore, microplastic abundance or concentration could not be linked to dietary composition based on the items identified. From a trophic perspective, this study showed that the presence of microplastics in the feces of otter is most likely being obtained through its prey (i.e., secondary ingestion). While there may be limitations associated with using spraints as a biomonitoring tool for microplastics in freshwater systems, particularly with respect to otter home range and dietary niche breadth, they could still be employed for a regional assessment of microplastic levels.

Abstract Hypertension is one of the most important risk factors for stroke and cardiovascular diseases (CVD) globally. Understanding risk factors for hypertension among individuals with matching characteristics with stroke patients may inform primordial/primary prevention of hypertension and stroke among them. This study identified the risk factors for hypertension among community‐dwelling stroke‐free population in Ghana and Nigeria. Data for 4267 community‐dwelling stroke‐free controls subjects in the Stroke Investigative Research and Education Network (SIREN) study in Nigeria and Ghana were used. Participants were comprehensively assessed for sociodemographic, lifestyle and metabolic factors using standard methods. Hypertension was defined as a previous diagnosis by a health professional or use of an anti‐hypertensive drug or mean systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg. Logistic regression analysis was used to estimate adjusted odds ratios (aOR) of hypertension and their 95% confidence intervals (CI) at p

The release of harmful particles from industries is one of the important sources of environmental pollution worldwide. The goal of this study was to determine the amounts of dust deposition and heavy metal pollution in the soils surrounding a cement mill in Konongo, Ghana. Topsoils (0-10 cm) were sampled at the four geographical axes of the factory within a radius of 400 m, while at the same time, about 500 g of cement was sampled with a hand trowel. A Frisbee dust sampler was used to examine the levels of dust depositions at the various geographical axes of the factory. The heavy metals such as cadmium (Cd), chromium (Cr), copper (Cu), zinc (Zn), and lead (Pb) were measured in a total of 20 soil samples using atomic absorption spectroscopy (AAS). The results obtained for climatic elements such as wind speed and direction, temperature, and relative humidity were 2.25, 25.7, and 49.5 m3/s, respectively. The average deposition of dust within the study period using the geographical axis indicated that the southern axis recorded the highest dust accumulation with a mean of 60.2 g/m2 per month. The mean concentrations of metals at the various axes were 1.04 mg/kg, 4.78 mg/kg, 8.95 mg/kg, 9.30 mg/kg, and 18.4 mg/kg for Cd, Cr, Cu, Zn, and Pb, respectively. The concentration of chemical components investigated in the soil was below the WHO/FAO standard, except for Cd. The spatial distribution pattern of the examined heavy metals showed that Cd, Cr, and Cu represent possible sources of soil contaminants. According to the conclusions of this research, this paper suggests an approach to investigate the areas contaminated with heavy metals to call out the attention of local authorities to take action.

Metakaolin is an anhydrous clayey material obtained by the calcination of kaolin. This material has been utilized as a valuable substitute or additive for concrete/cement mixtures and many other applications. The current study is on the production and characterization of metakaolin together with its adsorbent properties for the purification and regeneration of spent lubrication oil. Metakaolin was produced from the calcination of kaolin from Wassa in the Western region of Ghana. The metakaolin was characterized by using X-ray fluorescence (XRF), X-ray diffractometry (XRD), scanning electron microscopy (SEM) coupled with energy dispersive X-ray (EDX), and Fourier transform infra-red (FT-IR). The metakaolin was then used as an adsorbent in the regeneration of the engine lubrication oil, mimicking the acid-clay percolation process. The test results show that the efficiency of metakaolin in removing heavy metals from the used oil using an atomic absorption spectrometer (AAS) was 13.25% for Fe, 25.37% for Cr, 94.36% for Zn, and 33.33% for Cu. The viscosity index of the regenerated oil was 118 compared to that of the virgin oil, which was 115. The regenerated oil had 79% saturates, 6% carbon residues, and 18% aromatics compared to the commercial virgin oil, which contained 84% saturates, 5% carbon residue, and 11% aromatics. This indicated that metakaolin is a better adsorbent for regenerating the used lubrication oil.

Background The clinical significance of conduction disturbances after transcatheter aortic valve implantation has been described; however, little is known about the influence of baseline ECGs in the prognosis of these patients. Our aim was to study the influence of baseline ECG parameters, including interatrial block (IAB), in the prognosis of patients treated with transcatheter aortic valve implantation. Methods and Results The BIT (Baseline Interatrial Block and Transcatheter Aortic Valve Implantation) registry included 2527 patients with aortic stenosis treated with transcatheter aortic valve implantation. A centralized analysis of baseline ECGs was performed. Patients were divided into 4 groups: normal P wave duration (

Background Current electrocardiographic algorithms lack sensitivity to diagnose acute myocardial infarction (AMI) in the presence of left bundle branch block. Methods and Results A multicenter retrospective cohort study including consecutive patients with suspected AMI and left bundle branch block, referred for primary percutaneous coronary intervention between 2009 and 2018. Pre‐2015 patients formed the derivation cohort (n=163, 61 with AMI); patients between 2015 and 2018 formed the validation cohort (n=107, 40 with AMI). A control group of patients without suspected AMI was also studied (n=214). Different electrocardiographic criteria were tested. A total of 484 patients were studied. A new electrocardiographic algorithm (BARCELONA algorithm) was derived and validated. The algorithm is positive in the presence of ST deviation ≥1 mm (0.1 mV) concordant with QRS polarity, in any lead, or ST deviation ≥1 mm (0.1 mV) discordant with the QRS, in leads with max (R|S) voltage (the voltage of the largest deflection of the QRS, ie, R or S wave) ≤6 mm (0.6 mV). In both the derivation and the validation cohort, the BARCELONA algorithm achieved the highest sensitivity (93%–95%), negative predictive value (96%–97%), efficiency (91%–94%) and area under the receiver operating characteristic curve (0.92–0.93), significantly higher than previous electrocardiographic rules (P

Abstract Freshwater systems provide key pathways for microplastic (MP) pollution, and although existing studies have demonstrated the susceptibility of freshwater biota to ingestion, translocation, and trophic transfer, specific challenges pertaining to methodological standardization remain largely unresolved, particularly with respect to isolating, characterizing, and assessing MPs. Here, a critical review is performed outlining the challenges and limitations currently faced by freshwater MP researchers, which may well apply across the MP research spectrum. Recommendations are provided for methodological standardization, particularly in MP characterization, quality assurance, and quality control (QA/QC) procedures as well as reporting. Considerations for the assessment of MPs in freshwater biota as a means of improving comparisons between studies are discussed. Technological advancements, including the improvement of laboratory infrastructure for identifying MPs within the smaller size range as well as methodological standardization are essential in providing policy makers with tools and measures necessary to determine the distribution of MPs within freshwater ecosystems, while also allowing for comparability and providing compliance for future monitoring requirements.

Background. It is estimated that one out of every three Ghanaians has hemoglobin genotype mutation. This change in genetic make-up may result in genotypes such as HbAS, HbSS, and HbSC. Many children in low- and middle-income countries die even before they are diagnosed with sickle cell disease (SCD). In Africa, there are limited data on the incidence and prevalence of SCD and the Volta region of Ghana is no exception. Aim. The aim of this study was to determine the prevalence of SCD and to assess the hemoglobin variants among patients attending Ho Teaching Hospital. Methods. A retrospective study design was used to extract information from the Hospital Administration and Management Systems (HAMS) on the hemoglobin electrophoresis results and corresponding full blood count results of the SCD and sickle cell anemia (SCA) patients as well as patients who were asked to do Hb electrophoresis irrespective of their sickling status. Data were collected for the period January 2016 to December 2018. Sickle cell disease status was determined using the Hb genotypes from the Hb electrophoresis results. The full blood count was used to categorize the severity of anemia based on the hemoglobin concentration in the SCA and SCD patients. Results. A total of 1,523 subjects were included in the study of which the prevalence for sickle cell disease was 16.7%. The SCD genotypes included HbS (6.2%), HbSC (7.9%), and HbSF (2.6%). Hemoglobin C disease (HbCC) constituted 0.3% out of the total prevalence of SCD. The prevalence of anemia was 99.2%, with the severest form in HbS. Also, majority of the SCD patients had severe anemia. Difference in the severity of anemia was found to be significant among both male (P=0.006) and female (P=0.004) participants with SCD. Conclusion. Patients receiving health care at the Ho Teaching Hospital had different hemoglobin variants with HbAS recording the highest prevalence. The high incidence of hemoglobin AS implies the possibility of having an increased population of individuals with sickle cell disease in future if measures are not put in place to improve screening, counseling, and education of the public about the health threat SCD poses.

Background. Hepatitis B virus (HBV) infection has been suggested to play a role in various adverse birth outcomes. The study determined the prevalence as well as knowledge of hepatitis B virus infection among pregnant women in the Ningo-Prampram District of the Greater Accra Region of Ghana. Materials and Methods. A cross-sectional study using simple random sampling technique was used to recruit 213 pregnant women receiving antenatal care in three different health facilities (Prampram Polyclinic (PPC), Dangme Community Hospital (DCH), and Old Ningo Health Center (ONHC)) in the Ningo-Prampram District of Ghana from November 2018 to January 2019. A semi-structured questionnaire was used to collect data which included participants’ HBsAg test results, sociodemographic and gynaecological characteristics, and their level of knowledge on HBV infection. Knowledge of the participants on HBV infection was classified as either excellent, good, or poor based on their cumulative percentage scores from the questionnaire according to Al Rubaish system of classification. Results. Overall low-intermediate prevalence of HBV infection was 3.3%; however, PPC recorded the highest prevalence of 4.0% while DCH and ONHC recorded 2.82% and 2.50%, respectively. Statistically significant association was observed between HBV infection and the health facility. Majority (77.40%) of the study participants had poor knowledge on HBV infection while only 14 (6.57%) had excellent knowledge on HBV. Regarding excellent knowledge, 8 (11.0%) among the participants were demonstrated by the majority of those who received antenatal care from DCH. Generally, knowledge on HBV and the infection was poor among the study participants. Knowledge on HBV infection was found to be associated with residential status (p=0.006), educational level (p

Abstract Background The Janus kinase/signal transducer and activator of transcription (JAK‐STAT) signaling pathway plays a key role in the systemic inflammatory response in many cancers, including colorectal cancer (CRC). This study evaluated the addition of ruxolitinib, a potent JAK1/2 inhibitor, to regorafenib in patients with relapsed/refractory metastatic CRC. Methods In this two‐part, multicenter, phase 2 study, eligible adult patients had metastatic adenocarcinoma of the colon or rectum; an Eastern Cooperative Oncology Group performance status of 0‐2; received fluoropyrimidine, oxaliplatin, and irinotecan‐based chemotherapy, an anti‐vascular endothelial growth factor therapy (if no contraindication); and if KRAS wild‐type (and no contraindication), an anti‐epidermal growth factor receptor therapy; and progressed following the last administration of approved therapy. Patients who received previous treatment with regorafenib, had an established cardiac or gastrointestinal disease, or had an active infection requiring treatment were excluded. The study was conducted in 95 sites in North America, European Union, Asia Pacific, and Israel. After an open‐label, safety run‐in phase (part 1; ruxolitinib 20 mg twice daily [BID] plus regorafenib 160 mg once daily [QD]), the double‐blind, randomized phase (part 2) was conducted wherein patients were randomized 1:1 to receive ruxolitinib 15 mg BID plus regorafenib 160 mg QD [ruxolitinib group] or placebo plus regorafenib 160 mg QD [placebo group]. Part 2 included substudy 1 (patients with high systemic inflammation, ie, C‐reactive protein [CRP] >10 mg/L) and substudy 2 (patients with low systemic inflammation, ie, CRP ≤10 mg/L); the primary endpoint was overall survival (OS). Results The study was terminated early; substudy 1 was terminated for futility at interim analysis and substudy 2 was terminated per sponsor decision. Ruxolitinib 20 mg BID was well tolerated in the safety run‐in (n = 11). Overall, 396 patients were randomized (substudy 1: n = 175 [ruxolitinib group, n = 87; placebo group, n = 88]; substudy 2: n = 221 [ruxolitinib group, n = 110; placebo group, n = 111]). There was no significant difference in OS or progression‐free survival (PFS) between treatments in substudy 1 (OS: hazard ratio [HR] = 1.040 [95% confidence interval: 0.725‐1.492]; PFS: HR = 1.004 [0.724‐1.391]) and substudy 2 (OS: HR = 0.767 [0.478‐1.231]; PFS: HR = 0.787 [0.576‐1.074]). The most common hematologic adverse event was anemia. No new safety signals with ruxolitinib were identified. Conclusions Although addition of ruxolitinib to regorafenib did not show increased safety concerns in patients with relapsed/refractory metastatic CRC, this combination did not improve OS/PFS vs. regorafenib plus placebo.

Background Little is known about the relationship between echocardiographic abnormalities and outcome among patients with acute stroke. We investigated the pattern and association of baseline echocardiographic variables with 1‐month disability and mortality among patients with stroke in the SIREN (Stroke Investigative Research and Education Network) study. Methods and Results We enrolled and followed up consecutive 1020 adult patients with acute stroke with baseline transthoracic echocardiography from west Africa. To explore the relationship between echocardiographic variables and 1‐month disability (using modified Rankin scale >3) and fatality, regression models were fitted. Relative risks were computed with 95% CIs. The participants comprised 60% men with a mean age of 59.2±14.6 years. Ischemic stroke was associated with smaller aortic root diameter (30.2 versus 32.5, P=0.018) and septal (16.8 versus 19.1, P

Background Studies have demonstrated that the current US guidelines based on American College of Cardiology/American Heart Association (ACC/AHA) Pooled Cohort Equations Risk Calculator may underestimate risk of atherosclerotic cardiovascular disease (CVD) in certain high‐risk individuals, therefore missing opportunities for intensive therapy and preventing CVD events. Similarly, the guidelines may overestimate risk in low risk populations resulting in unnecessary statin therapy. We used Machine Learning (ML) to tackle this problem. Methods and Results We developed a ML Risk Calculator based on Support Vector Machines (SVMs) using a 13‐year follow up data set from MESA (the Multi‐Ethnic Study of Atherosclerosis) of 6459 participants who were atherosclerotic CVD‐free at baseline. We provided identical input to both risk calculators and compared their performance. We then used the FLEMENGHO study (the Flemish Study of Environment, Genes and Health Outcomes) to validate the model in an external cohort. ACC/AHA Risk Calculator, based on 7.5% 10‐year risk threshold, recommended statin to 46.0%. Despite this high proportion, 23.8% of the 480 “Hard CVD” events occurred in those not recommended statin, resulting in sensitivity 0.76, specificity 0.56, and AUC 0.71. In contrast, ML Risk Calculator recommended only 11.4% to take statin, and only 14.4% of “Hard CVD” events occurred in those not recommended statin, resulting in sensitivity 0.86, specificity 0.95, and AUC 0.92. Similar results were found for prediction of “All CVD” events. Conclusions The ML Risk Calculator outperformed the ACC/AHA Risk Calculator by recommending less drug therapy, yet missing fewer events. Additional studies are underway to validate the ML model in other cohorts and to explore its ability in short‐term CVD risk prediction.

Background: Cancer cells are able to change the protein expression and behavior of non-cancerous surrounding cells. Exosomes, secreted by prostate cancer (PCa) cells, may have a functional role in cancer metastasis and present a promising source for protein biomarkers. The aim of the present study was to identify which proteins in exosomes can influence non-cancerous cells, and to determine whether we can use urine exosomal proteins to identify high-risk PCa patients. Method: Exosomes were isolated by ultracentrifugation. Migration and invasion were studied by the transwell (invasion) assay. Proteomics was performed by LC-MS/MS and identified proteins were validated by Western blotting. Cellular uptake of fluorescent labeled PKH67-exosomes was measured by FACS. Results: Based on comparative protein profiling by mass spectrometry-based proteomics of LNCaP- and PC3-exosomes, we selected ITGA3 and ITGB1, involved in migration/invasion, for further analyses. Inhibition of exosomal ITGA3 reduced the migration and invasion of non-cancerous prostate epithelial cells (prEC) almost completely. Cellular uptake of exosomes by prEC was higher with PC3-exosomes compared to LNCaP exosomes. Finally, ITGA3 and ITGB1 were more abundant in urine exosomes of metastatic patients (p