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Abstract Background Patient navigation (P.N.) is designed to eliminate barriers to care. The objective of this study was to evaluate the impact of a novel P.N. program on timeliness of care in patients with esophageal cancer. Methods This retrospective study compared the timeliness of care for esophageal cancer patients before (January 2014–March 2018) and after the implementation of a novel P.N. program (April 2018–March 2020), called EDAP, at a tertiary care center. The primary outcome was time from biopsy to first treatment; secondary outcomes included time from biopsy to complete staging, biopsy to complete preoperative workup, and referral to the first point of contact. The outcomes were evaluated in the entire cohort and then in a subgroup of patients undergoing curative multimodality therapy. Results There were 96 patients in the pre‐EDAP group and 98 patients in the post‐EDAP group. There was no significant difference between pre‐ and post‐EDAP in the time from biopsy to first treatment and time from biopsy to staging in the overall cohort. In the subgroup of patients undergoing curative multimodality therapy, there was a significant decrease in time from biopsy to first treatment postnavigation (60–51 days, p = 0.02), in addition to a significant decrease in time from biopsy to preoperative workup and time from biopsy to staging. Conclusions This is the first study demonstrating that a novel P.N. program for patients with esophageal cancer improved timeliness of care. The group of patients who benefited most were those undergoing curative multimodality therapy, likely given the extensive coordination of services required by this group.

Abstract Combination of different power cycle scenarios is of prime importance in achieving maximum energy utilization from solar‐driven multigeneration systems. To fulfill such objective, the present article proposes a novel energy distribution system, leveraging a combination of direct‐fed organic Rankine cycle (ORC) and a bottom‐cycled arrangement of Kalina cycle system (KCS) and double‐effect absorption refrigeration cycle (DEARC) within a parabolic trough solar collector powered trigeneration system. The study explores three different ORC configurations: simple ORC; ORC equipped with internal heat exchanger (ORC‐IHE) and regenerative ORC (RORC). It is shown that although higher efficiencies are achievable from a larger portion of PTSC energy absorbed by the ORC, the ORC energy absorption is limited by ORC evaporator temperature differences, and there is unused energy that can be recovered by the KCS, based on the proposed energy system. The results indicate that the addition of bottoming KCS leads to a considerable increase in the exergy efficiency of ORC, ORC‐IHE and RORC‐based systems by 11.7%, 30.7% and 32.6%, respectively. The impact of different ORC configurations, key ORC parameters and various organic working fluids on the energetic/exergetic efficiencies is also examined to find the optimal configuration. In terms of overall energetic/exergetic efficiencies, the highest performance belongs to ORC (78.4%/30.4%) while the lowest energetic and exergetic efficiencies belong to ORC‐IHE and RORC, respectively (56.3% and 25.65%). On the basis of a comparative study with the available literature, these values are higher than what is already reported for similar solar‐driven multigeneration systems. Appropriate thermal match and lower exergy destruction in the KCS, and bottoming cycle arrangement of the DEARC are the main reasons for such enhanced performance. This research not only contributes valuable insights into efficient solar‐driven systems but also sets a new benchmark for performance metrics in the existing literature.

Abstract Background Burkholderia pseudomallei, an environmental saprophyte bacterium, causes melioidosis in humans and animals. It was first discovered in Iran between 1967 and 1976 in small ruminants, equines, environments and humans. No subsequent studies have been conducted to determine the existence and prevalence of this pathogen in the country. Objectives The present study aims to monitor the presence of B. pseudomallei in the ruminant population of the Golestan province of Iran, which largely depends on pastures. The ruminants can serve as sentinels to indicate the presence of the bacteria in the environment and its potential impact on human health in the One Health triad. Methods Liver and lung abscesses from domestic sheep, cattle and goats in three industrial and three conventional slaughterhouses were sampled and analysed using 23S ribosomal DNA polymerase chain reaction (rDNA PCR) with primers CVMP 23‐1 and CVP‐23‐2 for B. pseudomallei, Burkholderia cepacia and Burkholderia vietnamiensis, as well as B. pseudomallei–specific TTS1 real‐time PCR, along with microbiological and biochemical assays. Results Out of the 97 animals sampled, only 14 (15%) tested positive for 23S rDNA PCR. However, the follow‐up evaluation using TTS1 real‐time PCR and microbiological and biochemical assays did not confirm the presence of B. pseudomallei in the samples. Conclusions Although B. pseudomallei was not detected in the current survey, conducting abattoir‐based surveillance of ruminants is a cost‐effective One Health approach to monitor pathogenic Burkholderia. Developing standards of clinical and laboratory good practices for Burkholderia infections is crucial for One Health surveillance.

Key Clinical Message Prompt diagnosis and management of massive pulmonary embolism after bariatric surgery is crucial, but thrombolytic therapy may increase the risk of complications such as anastomotic leakage and bleeding. Individualized management is needed.

Abstract This paper proposes a data‐driven sensor fault detection and isolation approach for the general class of nonlinear systems. The proposed method uses deep neural network architecture to obtain an invariant set of basis functions for the Koopman operator to form a linear predictor for a nonlinear system. Then, the obtained Koopman predictor has been used in a geometric framework for sensor fault detection and isolation purposes without relying on a priori knowledge about the underlying dynamics as well as requiring faulty data, leading to a data‐driven sensor fault detection and isolation framework for nonlinear systems. Finally, the approach's efficacy is demonstrated using simulation case study on a two‐degree of freedom robot arm.

Abstract Intrusion detection in supervisory control and data acquisition (SCADA) systems is integral because of the critical roles of these systems in industries. However, available approaches in the literature lack representative flow‐based datasets and reliable real‐time adaption and evaluation. A publicly available labelled dataset to support flow‐based intrusion detection research specific to SCADA systems is presented. Cyberattacks were carried out against our SCADA system test bed to generate this flow‐based dataset. Moreover, a flow‐based intrusion detection system (IDS) is developed for SCADA systems using a deep learning algorithm. We used the dataset to develop this IDS model for real‐time operations of SCADA systems to detect attacks momentarily after they happen. The results show empirical proof of the model’s adequacy when deployed online to detect cyberattacks in real time.

Abstract The retroperitoneum (RP) might be affected by a variety of infections, inflammations, and tumors, including benign and malignant ones. Although primary malignant tumors are the most prevalent ones in this anatomic area, metastatic and invasive tumors rarely involve the retroperitoneum. Gastrointestinal stromal tumors (GISTs) are considered as the most common tumors that invade the retroperitoneum, but, to the best of our knowledge, it is the first time a surgery team has encountered the appendiceal tumor as a huge retroperitoneal mass. A 68‐year‐old man was referred to the emergency department with abdominal distension and weight loss. In his course of hospitalization, a huge right retroperitoneal mass was detected by a computed tomography (CT) scan; after that, the patient underwent laparotomy, evacuation of massive mucinous tissue located in the right retroperitoneum, and right hemicolectomy due to appendiceal tumor. The histopathological examination showed “mucinous appendiceal neoplasm.” This is the first case study showing the invasion of an appendiceal tumor through the visceral peritoneum into the retroperitoneum, so an invasion of the peritoneal tumor to the retroperitoneum should be considered when a urologist approaches retroperitoneal masses.

Background Percutaneous coronary intervention of calcified lesions was associated with worse outcomes in the era of bare‐metal and first‐generation drug‐eluting stents. Data on percutaneous coronary intervention of calcified lesions with newer‐generation drug‐eluting stents are scarce. Therefore, we investigated the impact of lesion calcification on clinical outcomes in patients undergoing percutaneous coronary intervention with a bioresorbable‐polymer sirolimus‐eluting stent or a durable‐polymer everolimus‐eluting stent. Methods and Results Patients (n=2361) from BIOFLOW II, IV, and V trials were categorized into moderate/severe versus none/mild lesion calcification by a core laboratory. End points were target‐lesion failure (TLF) (cardiac death, target‐vessel myocardial infarction, or target‐lesion revascularization) and probable/definite stent thrombosis at 2 years. The agreement in calcification assessment between the operator and the core laboratory was weak (weighted κ, 0.23). Patients with moderate/severe calcification (n=303; 16%) had higher TLF (13.5% versus 8.4%; P=0.003) and stent thrombosis rates (2.1% versus 0.2%; P

Abstract Aims The risk of HeartMate II (HMII) left ventricular assist device (LVAD) thrombosis has been reported, and serum lactate dehydrogenase (LDH), a biomarker of haemolysis, increases secondary to LVAD thrombosis. This study evaluated longitudinal measurements of LDH post‐LVAD implantation, hypothesizing that LDH trends could timely predict future LVAD thrombosis. Methods and results From October 2004 to October 2014, 350 HMIIs were implanted in 323 patients at Cleveland Clinic. Of these, patients on 339 HMIIs had at least one post‐implant LDH value (7996 total measurements). A two‐step joint model combining longitudinal biomarker data and pump thrombosis events was generated to assess the effect of changing LDH on thrombosis risk. Device‐specific LDH trends were first smoothed using multivariate boosted trees, and then used as a time‐varying covariate function in a multiphase hazard model to analyse time to thrombosis. Pre‐implant variables associated with time‐varying LDH values post‐implant using boostmtree were also investigated. Standardized variable importance for each variable was estimated as the difference between model‐based prediction error of LDH when the variable was randomly permuted and prediction error without permuting the values. The larger this difference, the more important a variable is for predicting the trajectory of post‐implant LDH. Thirty‐five HMIIs (10%) had either confirmed (18) or suspected (17) thrombosis, with 15 (43%) occurring within 3 months of implant. LDH was associated with thrombosis occurring both early and late after implant (P

Inequalities between men and women are common and well-documented. Objective indexes show that men are better positioned than women in societal hierarchies-there is no single country in the world without a gender gap. In contrast, researchers have found that the women-are-wonderful effect-that women are evaluated more positively than men overall-is also common. Cross-cultural studies on gender equality reveal that the more gender egalitarian the society is, the less prevalent explicit gender stereotypes are. Yet, because self-reported gender stereotypes may differ from implicit attitudes towards each gender, we reanalysed data collected across 44 cultures, and (a) confirmed that societal gender egalitarianism reduces the women-are-wonderful effect when it is measured more implicitly (i.e. rating the personality of men and women presented in images) and (b) documented that the social perception of men benefits more from gender egalitarianism than that of women., (© 2017 International Union of Psychological Science.)

Background: It would be clinically advantageous to develop a method of body temperature evaluation in cynomolgus macaques (Macaca fascicularis) that did not require sedation, restraint, surgical manipulation, or expensive equipment., Methods: Body temperatures of 51 cynomolgus macaques were taken with rectal thermometry and non-contact infrared thermometry (NIFT) on the shoulder, face, abdomen, and axillary region., Results and Conclusions: Body temperature measurements from NIFT were statistically different (P < 0.0001) from rectal thermometry. In addition, there was greater between- and within-subject variability in values using NIFT. There was no correlation between any sites of the NIFT and rectal thermometry. It was concluded that NIFT was not a valid alternative to rectal thermometry in cynomolgus macaques.