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The glaucoma is an eye disease that causes blindness when it progresses in an advanced stage. Early glaucoma diagnosis is essential to prevent the vision loss. However, early detection is not covered due to the lack of ophthalmologists and the limited accessibility to retinal image capture devices. In this paper, we present an automated method for glaucoma screening dedicated for Smartphone Captured Fundus Images (SCFIs). The implementation of the method into a smartphone associated to an optical lens for retina capturing leads to a mobile aided screening system for glaucoma. The challenge consists in insuring higher performance detection despite the moderate quality of SCFIs, with a reduced execution time to be adequate for the clinical use. The main idea consists in deducing glaucoma based on the vessel displacement inside the Optic Disk (OD), where the vessel tree remains sufficiently modeled on SCFIs. Within this objective, our major contribution consists in proposing: (1) a robust processing for locating vessel centroids in order to adequately model the vessel distribution, and (2) a feature vector that relevantly reflect two main glaucoma biomarkers in terms of vessel displacement. Furthermore, all processing steps are carefully chosen based on lower complexity, to be suitable for fast clinical screening. A first evaluation of our method is performed using the two public DRISHTI-DB and DRIONS-DB databases, where 99% and 95% accuracy, 96.77% and 97,5% specificity and 100% and 95% sensitivity are respectively achieved. Thereafter, the method is evaluated using two fundus image databases respectively captured through a smartphone and retinograph for the same persons. We achieve 100% accuracy using both databases which assesses the robustness of our method. In addition, the detection is performed on 0.027 and 0.029 second when executed respectively on the Samsung-M51 on the Samsung-A70 smartphone devices. Our proposed smartphone app provides a cost-effective and widely accessible mobile platform for early screening of glaucoma in remote clinics or areas with limited access to fundus cameras and ophthalmologists.

Background This study evaluates the safety and feasibility of combined resection for patients with synchronous pulmonary and esophageal cancer. Methods Patients undergoing esophagectomy between 1997 and 2019 were identified from prospectively collected databases at three tertiary referral centers, and those with combined anatomic lung resection at the same setting were identified. This cohort was then matched in a 1:3 ratio to esophagectomy alone cases, based on age, sex, pathologic stage, neoadjuvant therapy, and surgical procedure. Demographic data, peri-operative data, post-operative complications were compared. Statistical analysis included unpaired t-test, Fisher’s exact or chi-squared test and Gehan-Breslow analysis. Results Of 4729 esophagectomies, combined anatomic lung resection was performed in 18 patients with discrete pulmonary lesions. Matching yielded 49 patients who underwent esophagectomy only and was statistically similar compared to patients undergoing combined resections. Ivor Lewis esophagectomy and lobectomy were the most frequent procedures. Combined resections did not have a higher overall complication rate than esophagectomy alone, rather these patients had fewer overall complications (56% vs 84%; p=0.02). Specifically, there was not difference in anastomotic leak (17% vs. 18%) or pulmonary complications (39% vs. 33%) between combined resection and esophagectomy alone. No post-operative mortality was identified, and median overall survival was 4.1 years versus 6.5 years (p=0.10). Conclusions Patients with synchronous localized lung and esophageal cancer, although rare, should not be biased towards non-surgical therapy, as the morbidity associated with combined esophagectomy and anatomic lung resection does not differ significantly from esophagectomy alone in this highly selected group of patients.

Africa, like the rest of the world, has been impacted by the coronavirus disease 2019 (COVID-19) pandemic. However, only a few studies covering this subject in Africa have been published.We conducted a retrospective study of critically ill adult COVID-19 patients-all of whom had a confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection- admitted to the intensive care unit (ICU) of Habib Bourguiba University Hospital (Sfax, Tunisia).A total of 96 patients were admitted into our ICU for respiratory distress due to COVID-19 infection. Mean age was 62.4±12.8 years and median age was 64 years. Mean arterial oxygen tension (PaO2)/fractional inspired oxygen (FiO2) ratio was 105±60 and ≤300 in all cases but one. Oxygen support was required for all patients (100%) and invasive mechanical ventilation for 38 (40%). Prone positioning was applied in 67 patients (70%). Within the study period, 47 of the 96 patients died (49%). Multivariate analysis showed that the factors associated with poor outcome were the development of acute renal failure (odds ratio [OR], 6.7; 95% confidence interval [CI], 1.75-25.9), the use of mechanical ventilation (OR, 5.8; 95% CI, 1.54-22.0), and serum cholinesterase (SChE) activity lower than 5,000 UI/L (OR, 5.0; 95% CI, 1.34-19).In this retrospective cohort study of critically ill patients admitted to the ICU in Sfax, Tunisia, for acute respiratory failure following COVID-19 infection, the mortality rate was high. The development of acute renal failure, the use of mechanical ventilation, and SChE activity lower than 5,000 UI/L were associated with a poor outcome.

PURPOSE Therapeutic drug monitoring (TDM) of anti-infective drugs is an increasingly complex field, given that in addition to the patient and drug as two usual determinants, its success is driven by the pathogen. Pharmacodynamics is related both to the patient (toxicity) and bacterium (efficacy or antibiotic susceptibility). The specifics of TDM of antimicrobial drugs stress the need for multidisciplinary knowledge and expertise, as in any other field. The role and responsibility of the laboratory in this interplay are both central and multifaceted. This narrative review highlights the role of the clinical laboratory in the TDM process. METHODS A literature search was conducted in PubMed and Google Scholar, focusing on the last five years (studies published since 2016) to limit redundancy with previously published review articles. Furthermore, the references cited in identified publications of interest were screened for additional relevant studies and articles. RESULTS The authors addressed microbiological methods to determine antibiotic susceptibility, immunochemical and chromatographic methods to measure drug concentrations (primarily in blood samples), and endogenous clinical laboratory biomarkers to monitor treatment efficacy and toxicity. The advantages and disadvantages of these methods are critically discussed, along with existing gaps and future perspectives on strategies to provide clinicians with as reliable and useful results as possible.. CONCLUSIONS Although interest in the field has been the driver for certain progress in analytical technology and quality in recent years, laboratory professionals and commercial providers persistently encounter numerous unresolved challenges. The main tasks that need tackling include broadly and continuously available, easily operated, and cost-effective tests that offer short turnaround times, combined with reliable and easy-to-interpret results. Various fields of research are currently addressing these features.

Highlights • Cutaneous toxicities are frequent with targeted therapies. • Managing cutaneous toxicities is critical for life-saving treatment continuation. • Dermatologists can provide a key input in preventing and managing these toxicities., With the development of molecular targeted therapies, a wide array of dermatologic toxicities is appearing. Their prevention, recognition, and management by dermatologists is critical to ensure antineoplastic treatment continuation. The objective of this study was to provide a literature review of the most common dermatologic toxicities due to targeted therapies in oncologic patients, including their clinical presentation, prevention, and management.

In this paper, we present an energy-efficient joint machine learning based beam-user selection and low complexity hybrid beamforming for the multiuser massive multiple-input multiple-output (MIMO) downlink system. Massive MIMO system is a key enabler of 5th generation (5G) technology which is being used in vehicle-to-everything (V2X) communications and other Internet-of-Things (IoT). The large number of antennas at the base-station side causes high power consumption in the radio frequency (RF) chain. Hybrid beamforming techniques are used to reduce the number of RF chains with minimal performance loss. This paper proposes a low complexity orthogonal hybrid beamforming design with the aid of a machine learning based beam-user selection scheme. The Householder (HH) reflectors are used to generate the orthogonal analog beamforming (ABF) matrix. We use a feedforward neural network (FFNN) beam-user selection scheme. The proposed HH ABF+FFNN scheme provides better energy-efficiency (EE) performance in the ill-conditioned massive MIMO channel. It has been shown that the green SE-EE point (41.35b/s/Hz,0.8b/Hz/J) can be obtained by the proposed HH ABF+FFNN scheme as compared to the (33.77b/s/Hz,0.63b/Hz/J) from the state-of-the-art Discrete Fourier transform based techniques.

Background Although congenital adrenal hyperplasia (CAH) is known to be associated with adrenal crises (AC), its association with patient- or clinician-reported sick day episodes (SDE) is less clear. Methods Data on children with classic 21-hydroxylase deficiency CAH from 34 centers in 18 countries, of which 7 were Low or Middle Income Countries (LMIC) and 11 were High Income (HIC), were collected from the International CAH Registry and analyzed to examine the clinical factors associated with SDE and AC. Results A total of 518 children—with a median of 11 children (range 1, 53) per center—had 5388 visits evaluated over a total of 2300 patient-years. The median number of AC and SDE per patient-year per center was 0 (0, 3) and 0.4 (0.0, 13.3), respectively. Of the 1544 SDE, an AC was reported in 62 (4%), with no fatalities. Infectious illness was the most frequent precipitating event, reported in 1105 (72%) and 29 (47%) of SDE and AC, respectively. On comparing cases from LMIC and HIC, the median SDE per patient-year was 0.75 (0, 13.3) vs 0.11 (0, 12.0) (P Conclusions The real-world data that are collected within the I-CAH Registry show wide variability in the reported occurrence of adrenal insufficiency–related adverse events. As these data become increasingly used as a clinical benchmark in CAH care, there is a need for further research to improve and standardize the definition of SDE.

PurposeThis paper investigates the impact of bridging social capital on the financial and non-financial performance of family businesses and explores the mediation role of social skills in the context of family succession.Design/methodology/approachA quantitative study, through questionnaires, was conducted among 105 Tunisian family firms that have experienced a family succession for at least one year. The PLS-SEM analysis method was used to test the research hypothesis.FindingsResults show that an increase in external social capital is positively associated with financial performance and family-centred non-economic goals, whereas social skills mediate this positive relationship.Originality/valueThe proposed model aims to test the direct effect of bridging social capital on family firms' performance and exploring the mediation role of the successor's social skills.

Over the course of this year, more than a billion people have been afflicted by the COVID-19 outbreak. As long as individuals maintain their social distance, they should all be secure at this period. Because of this, there has been a rise in the usage of different online technologies, but at the same time, there has also been a rise in the likelihood of different cyber-attacks. A DDoS assault, the most prevalent and deadly of them all, impairs an online resource for its users. Thus, in this paper, we have proposed a filtering approach that can work efficiently in the COVID-19 scenario and detect the DDoS attack. We base our proposed approach on statistical methods like packet score and entropy variation for the identification of DDoS attack traffic. We have implemented our proposed approach on Omnet++ and for testing its efficiency we have checked it with different test cases. Our proposed approach detects the DDoS attack traffic with 96% accuracy and can also clearly have differentiated the DDoS attack traffic from the flash crowd.

This paper studies the influence of degraded connections on dynamic characteristics, seismic response, and seismic fragility behaviors of traditional Chinese timber-framed buildings. Numerical mode...

Cirebon has 18 rivers that flow into the Java Sea. The Cirebon rivers play an important role in several sectors such as industrial, agriculture, household, and also aquaculture. The increasing anthropogenic activities, may have affected the health and quality of the Cirebon rivers and the surrounding area. This study aimed to determine the water pollution level of Cirebon rivers based on the Storage and Retrieval (STORET) and Pollution Index approaches. The study was conducted at seven different rivers located in the districts (kabupaten) and municipals (kotamadya) of Cirebon. The observation was performed during the end of the west monsoon (March 2019) as well as the beginning (July 2019) and the end of the east monsoon (November 2019). The STORET score of the Cirebon district rivers were between -10 and -20, which is categorized as lightly to moderately polluted. Similarly, most of the Cirebon municipal rivers were moderately contaminated throughout the year (-18 to -30). In contrast, the Pollution Index (PI) values of all observed rivers were between 1.0 to 5.0 which are categorized as lightly polluted.

Objective Brucella prosthetic valve endocarditis is a rare but a life-threatening complication of brucellosis. It remains a diagnostic challenge. Optimal treatment of Brucella prosthetic valve endocarditis is debated. Available data is limited to case reports or small case series. The purpose of this study was to systematically review all published cases of Brucella prosthetic valve endocarditis in the literature. Method A systematic review of PubMed database, Google, Google Scholar, and Scopus (From January 1974 to the present) for studies providing epidemiological, clinical and microbiological data as well as data on treatment and outcomes of Brucella prosthetic valve endocarditis was performed. Results A total of 51 reported cases were reviewed. Brucella melitensis (45%) and Brucella abortus (11.7%) were the most frequently isolated species. Most common type of prosthesis valve was mechanical prothesis (84.3%) and ten patients had double valve prosthesis (19.6%). Fever and dyspnea were present in 100% and 37.2% of the cases, respectively. The diagnosis was set with echocardiographic finding in 30 cases (93.7%), which revealed vegetation in 27 cases (84.3%). Most used antibiotics were rifampicin, doxycycline and aminoglycoside or cotrimoxazole. No deaths were noted in patients treated by combined medical and surgical treatment, but mortality was noted in 27.7% of the cases treated by antibiotics alone (p = 0.006). Conclusion This systematic review highlights diagnostic challenges and demonstrates that surgery improved outcome by reducing mortality in patients treated with the combined surgical and medical treatment option. Brucellosis should be considered in the differential diagnosis of prosthetic valve endocarditis in patients residing in or traveling to areas of endemicity.

Early detection of chordae tendineae state through medical imaging has a significant impact in reducing the clinical progression of mitral valve disease. This study proposes two methods for trackin...

The right ventricular assessment is crucial to heart disease diagnosis. Unfortunately, its segmentation is quite challenging due to its intricate shape, ill‐defined thin edges, large variability among patients, and pathologies. Besides, it is a very laborious and time‐consuming task to be done manually. Therefore, automated segmentation techniques are very suitable to reduce the strain on the expert. Here, it is attempted to review the taxonomy of the current RV segmentation approaches adopted to handle the afore‐mentioned issues. Enhanced by our expert's interpretation, the results of over forty research papers were evaluated based on several metrics such as the dice metric and the Hausdorff distance. Synthetic tables and charts were also used to discuss the reviewed approaches. The following study shows that none of the existing methods has proved accurate enough to meet all the RV challenging issues. Many misestimated results were reported for several cases. Eventually, global guidance is outlined, which supports combining different methods to enhance the expected results during the MRI short‐axis slice processing.

The world has now been facing the coronavirus disease 2019 (COVID-19) pandemic due to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) since over a year. If most of clinical presentations are benign, fragile patients are at greater risk of developing severe or fatal lung disease. Many therapies have been explored with very low impact on mortality. In this context, Kirkby et Mackenzie have published in April 2020 a report reminding the anti-inflammatory properties of low-dose radiotherapy (delivering less than 1Gy) and its use in the treatment of viral and bacterial pneumopathies before antibiotics era. Large in vivo and in vitro data have demonstrated the biological rationale and anti-inflammatory activity of low-dose radiotherapy in many pathologies. Over the past year, three phase I/II clinical trials have been published, as well as one randomized controlled trial, reporting the feasibility and the clinical and biological improvement of a 0.5 to 1Gy treatment dose to the entire lung. 13 other studies, including a randomized phase III trial, are currently ongoing worldwide. These studies may provide data in the effect of low-dose radiotherapy in the treatment of SARS-CoV-2 pneumonia. This article explains biological rationale of low-dose radiotherapy, and reports already published or ongoing studies on low-dose radiotherapy for SARS-CoV-2 pneumonia.

This paper reveals an automatic approach for macular diagnostic by the use of Optical Coherence Tomography (OCT) in the evaluation process. At preliminary behaviour levels, the evaluation of macula...

Objectives To determine trends in clinical practice for individuals with DSD requiring gonadectomy. Design Retrospective cohort study. Methods Information regarding age at gonadectomy according to diagnosis; reported sex; time of presentation to specialist centre; and location of centre from cases reported to the International DSD Registry and who were over 16 years old in January 2019. Results Data regarding gonadectomy were available in 668 (88%) individuals from 44 centres. Of these, 248 (37%) (median age (range) 24 (17, 75) years) were male and 420 (63%) (median age (range) 26 (16, 86) years) were female. Gonadectomy was reported from 36 centres in 351/668 cases (53%). Females were more likely to undergo gonadectomy (n = 311, P < 0.0001). The indication for gonadectomy was reported in 268 (76%). The most common indication was mitigation of tumour risk in 172 (64%). Variations in the practice of gonadectomy were observed; of the 351 cases from 36 centres, 17 (5%) at 9 centres had undergone gonadectomy before their first presentation to the specialist centre. Median age at gonadectomy of cases from high-income countries and low-/middle-income countries (LMIC) was 13.0 years (0.1, 68) years and 16.5 years (1, 28), respectively (P < 0.0001) with the likelihood of long-term retention of gonads being higher in LMIC countries. Conclusions The likelihood of gonadectomy depends on the underlying diagnosis, sex of rearing and the geographical setting. Clinical benchmarks, which can be studied across all forms of DSD will allow a better understanding of the variation in the practice of gonadectomy.

Hospital effluent (HE) is one of the most important sources of pharmaceuticals released into the environment. This kind of pollution is a recognized problem for both human health and aquatic life. Consequently, in the present study, we assessed the effects of untreated hospital effluent on mice via biochemical and histopathological determinations. Female mice were given free access to water bottles containing untreated HE at different dilutions for 21 days. Then clinical biochemistry and histopathology evaluation were conducted. Serum biochemistry analysis showed the presence of significant increase in cholesterol, triglycerides, glycaemia and total bilirubin. However, phosphatase alkaline and urea activities have been significantly decreased compared to the control group. No significant variation was observed for the rest of the studied parameters (high-density lipoproteins; low-density lipoproteins and uric acid). Additionally, multiple alterations, including cellular necrosis, leucocyte infiltration and congestion, were observed in different tissues of mice exposed to the tested HE. HIGHLIGHTS Hospital effluent (HE) exposure did not influence the total body weight of mice.; Sub-chronic exposure to the HE disturbed biochemical parameters in mice.; Histological abnormalities were observed in mice liver, kidney and heart sections.; Effluent toxicology.; Water contamination.

International audience; The succession process can be a traumatic event in the life cycle of a family firm and is usually characterised by an increased interest towards the firm of the successor accompanied by a progressive disengagement of the predecessor. Drawing on five longitudinal case studies of Tunisian family firms examined from 2016 to 2019, we investigated the sequential and dynamic nature of this process, focusing on the conflicts among family members involved in the process. The main findings suggest that professional and family-related conflicts can lead to excessive tensions between the involved parties, which can result in failure of the succession process. Moreover, specific contingency factors, such as tragic events, can positively or negatively trigger deviation from the succession process path.

The extensive research on microplastics (MPs) in the last years has shown that it is not just an environmental problem anymore. As it can also be found in human food, it poses a potential risk for human health and food safety. Especially sea salt, which is produced by the evaporation of seawater, including its microplastic contamination, has been reported with different levels of MP contamination. Therefore, in this preliminary study, we investigated if different solar evaporation methods (traditional, geomembrane, and tunnel) influence the concentration of microplastic particles in sea salt production in Indonesia, one of the countries with the highest estimated level of plastic waste input into the ocean. The results show a significantly higher MP contamination in sea salt produced traditionally compared to the geomembrane and tunnel methods.

BackgroundBovine mastitis, an inflammatory disease of the mammary gland, is classified as subclinical or clinical. Circulating neutrophils are recruited to the udder to combat infection. We compared the transcriptomic profiles in circulating leukocytes between healthy cows and those with naturally occurring subclinical or clinical mastitis.Methods and ResultsHolstein Friesian dairy cows from six farms in EU countries were recruited. Based on milk somatic cell count and clinical records, cows were classified as healthy (n = 144), subclinically (n = 48) or clinically mastitic (n = 22). Circulating leukocyte RNA was sequenced with Illumina NextSeq single end reads (30 M). Differentially expressed genes (DEGs) between the groups were identified using a DESeq2 package, followed by GO enrichment analysis. Both subclinical and clinical mastitis caused significant changes in the leukocyte transcriptome, with more intensive changes attributed to clinical mastitis. We detected 491 DEGs between clinical and healthy groups, 350 DEGs between subclinical and healthy groups and 170 DEGs between clinical and subclinical groups. Most DEGs were associated with cell killing and immune processes. Many upregulated DEGs in clinical mastitis encoded antimicrobial peptides (AZU1, CAMP, CATHL1, CATHL2, CATHL4, CATHL5, CATHL6, DEFB1, DEFB10, DEFB4A, DEFB7, LCN2, PGLYRP1, S100A9, TF and LTF) which were not upregulated in subclinical mastitis. This suggests that the leukocytes may have greater killing capacity in cows with clinical mastitis.ConclusionWe have, for the first time, described circulating leukocyte transcriptomic profiles in naturally occurring subclinical mastitis and assessed their differences from healthy cows and those with clinical mastitis.

Gonadal dysfunction is an adverse outcome in patients with congenital adrenal hyperplasia (CAH), which may become apparent already during puberty. Clinical consequences of gonadal dysfunction include menstrual disturbances in females and hypogonadism and impaired fertility in males and females. In males, gonadal dysfunction can be caused by primary gonadal failure due to testicular adrenal rest tumours (TART), and by secondary gonadal failure due to poor hormonal control. In females, gonadal dysfunction can result from an overproduction of adrenal androgens including 11-oxygenated C-19 androgens and progestins, and rarely from ovarian adrenal rest tumours. In all patients with CAH, optimal hormonal control is the key for adequate gonadal function. Therefore, regular measurements of adrenal steroids and/or their metabolites should be performed. In addition, markers of the hypothalamus–pituitary–gonadal axis need to be assessed. In females, the regularity of the menstrual cycle should be evaluated. In males, regular evaluation for TART using ultrasonography is recommended from the start of puberty or even earlier when poor hormonal control is present. When TART is present, counselling on cryopreservation of semen should be offered.

This paper studies the effect of performance degradation and infilled walls on the seismic fragility of a traditional Chinese timber-frame structure. The Yihe Hall was chosen as the archetype build...

The use of formaldehyde for fish preservation is common in developing countries like Indonesia, even though there are rules for food safety practices. Law enforcement has not been successfully impl...

Contains fulltext : 230038pub.pdf (Publisher’s version ) (Open Access) Intersex/DSD and transgender healthcare for children and adolescents has increasingly become a topic for public and academic debate. Key contestations concern early healthcare interventions in intersex/DSD care and ‘cautious gatekeeping’ in transgender care. With this article, which is based on an integrative literature review and expert interviews, we offer more insight into these debates, by mapping and comparing the arguments used by different stakeholders in both fields. Our analytical comparison of the debates reveals that contradictory perceptions of gender, the malleability of bodies and the autonomy of children/adolescents guide the arguments. While medical and psychological research may provide valuable input to further the debates, they remain inherently ethical and interwoven with gendered norms and expectations. This necessitates critical inter- and multidisciplinary conversations both in healthcare and in academic research. 14 p.

The present work develops a novel hybrid method for ocular and muscular artifact removal from electroencephalography (EEG) signals, EFICA-TQWT. It is a combination of efficient fast independent component analysis (EFICA) method with the tunable Q-factor wavelet transform (TQWT). The main contribution of this paper is to apply the 3D interpolation method in the filtering system. Three EEG datasets are used in this work, two healthy and one epileptic. The choice of subjects for each dataset is made with the help of an expert in physiology. The selection criterion adopted is the presence of muscular and ocular artifacts in the processed recordings. First, a noisy channel automatic classification is performed by the support vector machine (SVM) with radial basis function in order to delete the signal(s) corresponding to the noisiest channel(s) from each EEG recording. The results of the automatic classification by the SVM were compared with those found by the expert’s classification. An accuracy of 97.45%, a sensitivity of 86.66% and a 100% specificity are provided by the SVM classification. The hybrid method of artifact removal will be applied on the rest of the EEG channels of international 10/20 system for each subject. Then, a reconstruction of the eliminated channel signal(s) will be performed in order to obtain a well-filtered signal. The proposed filtering process is evaluated by calculating the mean squared error (MSE) and the signal to noise ratio (SNR). Both for the healthy and pathological EEG datasets, a comparative study of the proposed method (EFICA-TQWT) and other filtering techniques (Fast-ICA, DWT, TQWT and EFICA) is generated. The EFICA-TQWT method gave the best results with a minimum of MSE and a maximum of SNR, more particularly in the case of the application of the 3D interpolation method. Besides, in order to optimize the computing time of the proposed system, a parallel implementation of this filtering system is developed based on graphical processing units using compute unified device architecture.

The most outstanding feature of face is the nose which is in furthering than any other feature to facial characteristics. Furthermore, the appealing aspects of the nose is an essential olfactory organ. Over and beyond the aesthetic and functional aspects the client's reaction to his/her own nose as well as the reaction of the people around to it impacts to the psychic characteristics. A non-probability purposive sample of this cross - sectional descriptive study was consisted of 100 young male and female in Kurdish ethnicity, their ages ranged between 21-25 years. The main objective of the study is conducted to assess the cosmetic factors, contribute to Rhinoplasty among both genders at Raparin District. The data collecting period were during the (December 15th, 2019 to January 5th, 2020). A self-administration questionnaire was used for data collection and it was designed according guidelines, literatures, and articles concerning Rhinoplasty; which consisted of 26 variables. Data were analyzed using SPSS Version 23. The study results revealed that most of participants (67%) were female when only (17%) of them were married, however, more than half (67%) were students. Whenever, they about (56%) were barely sufficient in their monthly income. Moreover, about (61%) of participants interested to surgically alter the appearance of their nose, closely two-third (74%) of participants wanted to surgically change the function of their nose. Therefore, almost (87%) of participant relatives have been operated with Rhinoplasty. Also, the study demonstrated there is a statistically significant relationship between cosmetic factors contributing to Rhinoplasty with age (p=0.035) and occupation (p=0.037). When, there were strongly statistically significant association between cosmetic un-functional factors contributing to Rhinoplasty with level of education (p=0.003). The study recommended to plastic surgeons evaluate patients carefully before Rhinoplasty surgery to get rid of unnecessary surgeries because there are lots of complications related to Rhinoplasty and the psychological needs of the patients who undergo Rhinoplasty should be considered.

Gender incongruence (GI) is defined as a condition in which the gender identity of a person does not align with the gender assigned at birth. Awareness and more social acceptance have paved the way for early medical intervention about two decades ago and are now part of good clinical practice although much robust data is lacking. Medical and mental treatment in adolescents with GI is complex and is recommended to take place within a team of mental health professionals, psychiatrists, endocrinologists, and other healthcare providers. The somatic treatment generally consists of the use of GnRH analogues to prevent the progression of biological puberty and subsequently gender-affirming hormonal treatment to develop sex characteristics of the self-identified gender and surgical procedures. However to optimize treatment regimens, long-term follow-up and additional studies are still needed. What is known• The prevalence of gender dysphoria increased significantly in the past years and can lead to significant complaints and burdens especially during puberty.• Pubertal suppression and gender-affirmed treatment can be effectively used in adolescence with gender dysphoria.What is new• Transgender mental and medical healthcare is a long-lasting process during which not only the child/adolescent with GI but also their parents/family have to be counseled in making choices about their social, medical, and legal transitions.• There are an increasing number of transgender persons defining as nonbinary. Therefore, an individualized approach by an experienced team is necessary.

The main objective of this study is to empirically test whether there exist short run and long run causality between, Residential Electricity Consumption (REC), Industrial Electricity Consumption (IEC) and economic growth in Kingdom of Saudi Arabia (KSA). Time series data for this study spans from 1990 to 2019. The study adopts granger causality and co. Integration analysis to estimate a Vector Error Correction Model (VECM). Results from error correction model show that there exist long run co. integration relationship between targeted variables. In addition, VECM results indicates that, industrial electricity consumption is inelastic to the changes in electricity prices with respect to economic growth, while residential electricity consumption shows elastic relationship. Granger causality test indicates there is unidirectional relationship, running from economic growth to industrial electricity consumption, which lead to accept, proactive (conservative) hypothesis. In this case, energy conservative policy will have little or no effect on economic growth. Nevertheless, results proof acceptance of neutrality hypothesis in the case of residential electricity consumption and economic growth. The study therefore, recommends that in Saudi Arabia, policy makers should consider expanding their energy-mix alternatives, in order to cope with the future industrial electricity demand arising from increased economic growth.Keywords: electricity consumption, GDP growth, co. integration and causality.JEL Classifications: O3, O4DOI: https://doi.org/10.32479/ijeep.10488

Electroencephalography (EEG) is one of the most signals used for studying and demonstrating the electrical activity of the brain due to the absence of side effects, its noninvasive nature and its well temporal resolution. Indeed, it provides real-time information, so it can be easily suitable for predicting drivers’ vigilance states. The classification of these states through this signal requires sophisticated approaches in order to achieve the best prediction performance. Furthermore, deep learning (DL) approaches have shown a good performance in learning the high-level features of the EEG signal and in resolving classification issues. In this paper, we will predict individuals’ states of vigilance based on the study of their brain activity by analyzing EEG signals using DL architectures. In fact, we propose two types of networks: (i) a 1D-UNet model, which is composed only of deep one-dimensional convolutional neural network (1D-CNN) layers and (ii) 1D-UNet-long short-term memory (1D-UNet-LSTM) that combines the proposed 1D-UNet architecture with the LSTM recurrent model. The experimental results reveal that the suggested models can stabilize the training model, well recognize the subject vigilance states and compete with the state of art on multiple performance metrics. The per-class average of precision and recall can be, respectively, up to 86% with 1D-UNet and 85% with 1D-UNet-LSTM, hence the effectiveness of the proposed methods. In order to complete our virtual prototyping and to get a real evaluation of our alert equipment, these proposed DL models are implemented also on a Raspberry Pi3 device allowing measuring the execution time necessary for predicting the state vigilance in real time.

This paper presents an automatic approach for macular degeneration diagnostic by adding pertinent features in the evaluation process. In macular abnormality identification, the manual assessment of...

In this study, we aim to explore the value of procalcitonin (PCT), C-reactive protein (CRP), and serum cholinesterase (SChE) activity kinetics as useful predictors of mortality in patients with septic shock admitted to the intensive care unit (ICU).We conducted a prospective single-blinded study in the ICU of a university hospital during a period of 1 year. Were included all patients 18 years of age or older, with confirmed septic shock. For all included patients, blood samples of septic biomarkers (PCT, SChE activity, and CRP) were obtained. Serum was collected at the day of ICU admission (day 0), the day of septic shock (day 1), then 3 and 5 days after the septic shock development.During the study period, 60 patients were included. The mean age (± SD) was 47.7 ± 19 years. There were 46 male (74%) and 14 female (26%) patients. Mean SAPSII on ICU admission was 40.7 ± 16 (median: 37), and mean SOFA score on ICU admission was 16 ± 4 (median: 7). During their ICU stay, out of the 60 included patients, 37 patients died (61%). The comparison between the 2 groups (deaths and survivors) showed that the factors associated with poor outcome were age, SOFA score on ICU admission, and the need for invasive mechanical ventilation. The day of septic shock, there was no difference in the mean concentrations in those of plasma SChE activity or in the PCT and CRP plasma between survivors and non-survivors. However, the comparison of mean plasma SChE activity, and PCT and CRP plasma concentrations (on day 3 and day 5) between survivors and non-survivors, showed a significant difference between the 2 groups.Our study suggests that, in a group of critically ill patients with severe septic shock, a rise or no change in procalcitonin and/or CRP level, and/or a decrease or no change in SChE activity should warn the clinician about the insufficiency and/or inadequacy of the therapy. However, a fall in procalcitonin and/or CRP levels, and/or a rise in SChE activity were associated with a favourable prognosis. Based on our study and some other data detailed above, we recommend that an estimation of SChE acti-vity, procalcitonin, and CRP on the day of septic shock, followed by estimation within the next 72-120 h, could help the prognostic assessment of critically ill patients with septic shock. Further studies are needed to define the critical values related to mortality.

International audience; The NATURE-HF registry was aimed to describe clinical epidemiology and 1-year outcomes of outpatients and inpatients with heart failure (HF). This is a prospective, multicenter, observational survey conducted in Tunisian Cardiology centers. A total of 2040 patients were included in the study. Of these, 1632 (80%) were outpatients with chronic HF (CHF). The mean hospital stay was 8.7 ± 8.2 days. The mortality rate during the initial hospitalization event for AHF was 7.4%. The all-cause 1-year mortality rate was 22.8% among AHF patients and 10.6% among CHF patients. Among CHF patients, the older age, diabetes, anemia, reduced EF, ischemic etiology, residual congestion and the absence of ACEI/ ARBs treatment were independent predictors of 1-year cumulative rates of rehospitalization and mortality. The female sex and the functional status were independent predictors of 1-year all-cause mortality and rehospitalization in AHF patients. This study confirmed that acute HF is still associated with a poor prognosis, while the mid-term outcomes in patients with chronic HF seems to be improved. Some differences across countries may be due to different clinical characteristics and differences in healthcare systems.

Background: Childhood pneumonia is a significant cause of mortality and morbidity in developing countries. About 7-13% of childhood pneumonia present with very severe pneumonia with a high risk of mortality. Identification of risk factors is necessary for early intervention and better management. Methods: Analytic observational study with a cross-sectional approach was conducted with subjects of pneumonia patients aged 2-59 months admitted in Respirology Ward and PICU Department of Pediatrics Dr. Soetomo Surabaya from January 2017 to December 2018. Results: A total of 253 were roled in this study. Group with very severe pneumonia are 140 patients and 113 patients with severe pneumonia. Independent risk factors were analysed by chi-square test and Continuity Correction. Independent risk factors that intluence the incidence of very severe pneumonia in infants and children are patient's age (PR=1.365;P=0.009;95% confidence interval (CI)=1.089-1.712), low birth weight (PR=1.380;P=0.010;95% CI=1.115-1,708), prematurity (PR=1,412;P=0.007;95% CI=1,141-1,747), exclusive breastfeeding (PR=1,434;P=0.007;95% CI=1,093-1,880), nutritional status (PR=2,412;P

Vertigo is a common sign related to a problem with the brain or vestibular system. Detection of ocular nystagmus can be a support indicator to distinguish different vestibular disorders. In order to get reliable and accurate real time measurements from nystagmus response, video-oculography (VOG) plays an important role in the daily clinical examination. However, vestibular diseases present a large diversity in their characteristics that leads to many complications for usual analysis. In this paper, we propose a novel automated approach to achieve both selection and classification of nystagmus parameters using four tests and a pupil tracking procedure in order to give reliable evaluation and standardized indicators of frequent vestibular dysfunction that will assist clinicians in their diagnoses. Indeed, traditional tests (head impulse, caloric, kinetic and saccadic tests) are applied to obtain clinical parameters that highlight the type of vertigo (peripheral or central vertigo). Then, a pupil tracking method is used to extract temporal and frequency nystagmus features in caloric and kinetic sequences. Finally, all extracted features from the tests are reduced according to their high characterization degree by linear discriminant analysis, and classified into three vestibular disorders and normal cases using sparse representation. The proposed methodology is tested on a database containing 90 vertiginous subjects affected by vestibular Neuritis, Meniere's disease and Migraines. The presented technique highly reduces labor-intensive workloads of clinicians by producing the discriminant features for each vestibular disease which will significantly speed up the vertigo diagnosis and provides possibility for fully computerized vestibular disorder evaluation.

Aim of the work: To assess the bone turnover markers and bone mineral density (BMD) in ankylosing spondylitis (AS) patients and to evaluate their association with clinical variables. Patients and methods: Forty-seven AS patients were compared with 47 matched control. Clinical features and inflammatory parameters were assessed. C-terminal telopeptide fragments of type I collagen (CTX), alkaline phosphatases (ALP), N-terminal propeptide of type I procollagen (PINP) serum levels, and BMD of the lumbar spine and femoral neck were evaluated. The Bath AS disease activity and functional indices (BASDAI and BASFI) were assessed. Results: Mean serum levels of C-reactive protein, ALP and CTX were higher in AS patients than control (p = 0.001, p = 0.001 and p = 0.027 respectively). Osteopenia and osteoporosis were significantly more frequent in AS patients (57.4%) than control (21.3%) (p

In 2015, the Indonesian government issued regulations to accelerate the implementation of integrated Light-Rail Transit (LRT) in the capital region and its surroundings. In order to ensure its operational safety, experimental work is required to test components’ strength of the manufactured LRT structures. Following the JIS 7105 standard test method, the strain and deflection of the structures were measured by vertical load, compression, rotation, and three-point load support test. The critical area estimated in the railroad structure were conducted according to the finite element method, in which strain gauges are installed in areas where the stress concentration exceeds nominal pressure, namely notches, bends, and junction areas. The result shows that the maximum stress on the LRT train structure occurs at the door, where maximum compressive strain value is -1082 μe » -75.74 MPa on the left and the maximum tensile strain value is 597 μe » 41.79 MPa at the right door. The results of fatigue load analysis represent the average stress (σm) and voltage amplitude (σa) at the coordinate system located in the Søderberg triangle. Meanwhile, the camber value with the full vertical load still has a positive value of 3.03 mm, which indicates a safe limit.

BACKGROUD AND OBJECTIVE: The control of clinical manifestation of vestibular system relies on an optimal diagnosis. This study aims to develop and test a new automated diagnostic scheme for vestibular disorder recognition. METHODS: In this study we stratify the Ellipse-fitting technique using the Video Nysta Gmographic (VNG) sequence to obtain the segmented pupil region. Furthermore, the proposed methodology enabled us to select the most optimum VNG features to effectively conduct quantitative evaluation of nystagmus signal. The proposed scheme using a multilayer neural network classifier (MNN) was tested using a dataset involving 98 patients affected by VD and 41 normal subjects. RESULTS: The new MNN scheme uses only five temporal and frequency parameters selected out of initial thirteen parameters. The scheme generated results reached 94% of classification accuracy. CONCLUSIONS: The developed expert system is promising in solving the problem of VNG analysis and achieving accurate results of vestibular disorder recognition or diagnosis comparing to other methods or classifiers.

This study aims to determine the compliance of amil zakat institutions in financial management (accountability) in terms of the background of the financial manager. The research method uses descriptive qualitative analysis with a multiple case study model of national amilzakat institutions that have zakat distribution in Madiun and are members of the Madiun Regional Zakat Organization Forum (FOZDA), namely BAZNAS, LMI, LAZISMU, Yatim Mandiri, BMH, Global Zakat, Nurul Hayat and Dompet Duafa. Data collection using in-depth interviews, observation and documentation to informants at each institution. The results of this study indicate that the understanding of accounting, financial reports and the applicable standards of the financial staff of the amilzakat institution is different, which is due to the educational background, years of service and position of the institution in Madiun, whether as a branch office, unit or outlet. However, office governance, finance, management and human resources in institutions can work together, so that the compliance of the amilzakat institution in carrying out accounting (accounting) which produces output in the form of financial reports can run well, as a form of transparency and accountability to donors.

Disaster response requires the cooperation of multiple emergency responder organizations (EROs). However, after‐action reports relating to large‐scale disasters identity communication difficulties among EROs as a major hindrance to collaboration. On the one hand, the use of two‐radio communication, based on multiple orthogonal frequencies and uneven coverage, has been shown to degrade inter‐organization communication. On the other hand, because they reflect different areas of expertise, EROs use differing terminologies, which are difficult to reconcile. These issues lead to ambiguities, misunderstandings, and inefficient exchange of data and information among those involved, which can impede the response process and slow decision making. We, therefore, hypothesize that promoting semantic interoperability across ERO information systems might improve information exchange among stakeholders and thereby allow a more coherent response to the disaster. We propose an ontology‐based messaging service on the basis of the Emergency Data Exchange Language (EDXL) standards. The parties involved will continue to use the terminologies to which they are accustomed, but the system will resolve inconsistencies and thereby enhance mutual understanding among EROs by ensuring semantic translation of the exchanged information. The evaluation of the semantic translation demonstrated the effectiveness and accuracy of the proposed service.

Deep Learning is part of the scientific field of Machine Learning and Machine Learning is part of Artificial Intelligence science. Deep Learning has extraordinary capabilities by using a hardware Graphical Processing Unit (GPU) so that the artificial requirement network can run faster than using a Personal Computer Unit (CPU). Especially in terms of object classification in images using existing methods in the Convolutional Neural Network (CNN). The method used in this research is Preprocessing and Processing of Input Data, Training Process in which CNN is trained to obtain high accuracy from the classification carried out and the Testing Process which is a classification process using weights and bias from the results of the training process. This type of research is a pre experimental design (pre experimental design). The results of the object image classification test with different levels of confusion in the Concrete database with the Mix Design K-125, K-150, K-250 and K-300 produce an average accuracy value. This is also relevant to measuring the failure rate of concrete or slump.

The Vestibulo-ocular response VOR is characterized by a smooth pursuit eye movements in one direction, called slow phase of ocular nystagmus, interrupted by resetting saccades fast phase of nystagm...

PurposeThe purpose of this paper is to analyze cloud reviews according to the end-user context and requirements.Design/methodology/approachpropose a comprehensive knowledge base composed of interconnected Web Ontology Language, namely, modular ontology for cloud service opinion analysis (SOPA). The SOPA knowledge base will be the basis of context-aware cloud service analysis using consumers' reviews. Moreover, the authors provide a framework to evaluate cloud services based on consumers' reviews opinions.FindingsThe findings show that there is a positive impact of personalizing the cloud service analysis by considering the reviewers' contexts in the performance of the framework. The authors also proved that the SOPA-based framework outperforms the available cloud review sites in term of precision, recall and F-measure.Research limitations/implicationsLimited information has been provided in the semantic web literature about the relationships between the different domains and the details on how that can be used to evaluate cloud service through consumer reviews and latent opinions. Furthermore, existing approaches are lacking lightweight and modular mechanisms which can be utilized to effectively exploit information existing in social media.Practical implicationsThe SOPA-based framework facilitates the opinion based service evaluation through a large number of consumer's reviews and assists the end-users in analyzing services as per their requirements and their own context.Originality/valueThe SOPA ontology is capable of representing the content of a product/service as well as its related opinions, which are extracted from the customer's reviews written in a specific context. Furthermore, the SOPA-based framework facilitates the opinion based service evaluation through a large number of consumer's reviews and assists the end-users in analyzing services as per their requirements and their own context.