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Introduction:Sexuality is an important part of women's physical & psychological health. Female sexual function is affected during pregnancy. Aim: we aimed to assess and compare sexual function & related endocrinological & psychological aspects in pregnant and non-pregnant women. Methods: A total of sexually active 40 women included two groups: 20 pregnant women and 20 non- pregnant women who served as controls. Sexual function (using Female Sexual Function Index), the psychological status (using Depression, Anxiety and Stress Scale) and Serum total testosterone & estradiol levels were assessed. Results: The studied women’s age ranged from 19 to 35years. The mean of desire, arousal, orgasm, and total score domains in pregnant women (2.97±0.98, 3.00±0.82, 3.53±0.93, 21.77±3.89 respectively) were significantly lower when compared to non- pregnant women (p < 0.05).In pregnant women,the depression & stress axis showed significant negative correlations with desire, satisfaction, and total score domains (p < 0.05). Bothaxes showed also significant negative correlations with total testosterone in both pregnant & non-pregnant women(p < 0.05).There were negative correlations between satisfaction in pregnant women and each of female age, husbands’ age, duration of marriage and parity (r=-0.6 p=.00.5, r=-0.59 p=.006, r=-0.72 p=.001, r=-0.59, p=.005 respectively). Conclusions: Sexual function is affected in pregnant women more than non- pregnant women. Hormonal changes, depression and stress are interrelated factors along with other factors such as age, husband’s age and duration of marriage affect the sexual function in pregnant women. So, when evaluating pregnant women, sexual function along with all these factors should be considered and assessed.

Objective: We had previously shown that long-acting cabotegravir (CAB-LA) injections fully protected macaques from vaginal simian HIV (SHIV) infection. Here, we reassessed CAB-LA efficacy in the presence of depot medroxyprogesterone acetate and multiple sexually transmitted infections (STIs) that are known to increase HIV susceptibility in women. Design: Two macaque models of increasing vaginal STI severity were used for efficacy assessment. Methods: The first study (n = 11) used a double STI model that had repeated exposures to two vaginal STI, Chlamydia trachomatis and Trichomonas vaginalis. Six animals were CAB-LA treated and five were controls. The second study (n = 9) included a triple STI model with repeated exposures to C. trachomatis, T. vaginalis and syphilis, and the contraceptive, depot medroxyprogesterone acetate (DMPA). Six animals were CAB-LA treated and three were controls. All animals received up to 14 vaginal SHIV challenges. A survival analysis was performed to compare the number of SHIV challenges to infection in the drug-treated group compared with untreated controls over time. Results: All six CAB-LA treated animals in both models, the double STI or the triple STI-DMPA model, remained protected after 14 SHIV vaginal challenges, while the untreated animals became SHIV-infected after a median of two challenges (log-rank P

For the last 20 years, undergraduate medical education has seen a major curricular reform movement toward integration of basic and clinical sciences. The rationale for integrated medical school curricula focuses on the application of knowledge in a clinical context and the early ability to practice key skills such as critical thinking and clinical problem-solving. The method and extent of discipline integration can vary widely from single sessions to entire programs. A challenge for integrated curricula is the design of appropriate assessments. The goal of this review is to provide a framework for clinical anatomy educators with definitions of integration, examples of existing integration models, strategies, and instructional methods that promote integration of basic and clinical sciences.

Background/Aim: The current study aimed to evaluate the impact of sustained virological response (SVR) after two sofosbuvir (SOF) containing regimens on the clinical outcomes, non invasive markers of hepatic fibrosis and liver stiffness. Patients and Methods: The study included 200 patients with compensated HCV cirrhosis. Group 1: received SOF and Ribavirin (RBV) for 6 months, Group 2: received SOF, Daclatsvir (DAC) and RBV for 3 months. Hepatitis C Virus Ribonucleic Acid (HCV RNA) by Polymerase Chain Reaction (PCR) was done at baseline, end of treatment (EOT), SVR12, SVR48. Model for end stage liver disease (MELD) score was calculated, the aspartate aminotransferase to platelet ratio index (APRI) and Fibrosis-4 (FIB-4) scores were done. FibroScan was done at baseline and SVR48. Results: SVR12 occured in 75% and 96% in group 1 and 2, respectively. There was improvement in both of APRI and FIB-4 scores at EOT in the two groups, and maintained to SVR48. A significant improvement in mean liver stiffness (LS) occurred at SVR48 compared to baseline in the study groups. Improvement in LS was observed more in group 2. There was a significant decrease in the mean value of MELD score in group 2 and non-significant decrease in group 1 at SVR48 in comparison to pre-treatment mean value. Conclusion: SOF/DAC/RBV was effective treatment regimen in compensated liver cirrhosis. This regimen resulted in significant improvement in MELD score, and liver stiffness at SVR48.

Identification of cadaveric structures during anatomy summative practical examinations is a challenge for first-year medical students. To assist in cultivating this skill, we offered 12 formative laboratory activities (anatomy boot camps [ABCs]) that approximated the summative practical examination format using reciprocal and near-peer teaching. Students assisted in crafting the formative practical examination, then engaged in a self-review by scoring their individual answer sheets. Students performing below designated thresholds (≤60%) were offered laboratory review sessions led by medical student upperclassmen. Mann-Whitney U tests were used to compare the performance of participants who attended the ABC sessions leading up to each summative examination. Correlation analysis was utilized to examine the relationship between student participation in ABCs summative examinations. Voluntary surveys were administered to assess the perceived value of the experience. Mann-Whitney U tests indicated students who attended the ABC review preceding three of the four summative practical and two of the four written examinations scored consistently higher on these examinations than students who chose not to attend. Correlation analysis revealed that as the overall frequency of ABC attendance increased, students' performance on the summative practical and written examinations increased significantly (P < 0.001). These findings suggest that the provision of supplemental learning experiences, such as the ABCs, contributes to improved student learning outcomes. This sentiment was echoed in student surveys. This activity, which combines multiple peer teaching approaches, appears to be an effective strategy for guiding and enhancing student success in the anatomy practical examinations. Clin. Anat. 33:286-292, 2020. © 2019 Wiley Periodicals, Inc.

The emissions pledges of the US and China as outlined in their November 2014 agreement and in the Paris Climate Accord are key aspects of global efforts to reduce greenhouse gas emissions. A number of major US states are still pursuing emissions goals aligned with these targets even though the Trump Administration has withdrawn the US from the Paris Accord. China has also reaffirmed its commitment to its targets. This raises the question of what would be the optimal mix of energy resources each nation should deploy in order to meet its respective target. We examine this question using the Combined Energy and Geoengineering Optimization Model (CEAGOM). Our analysis shows that both nations would need to make significant but achievable adjustments to their respective energy mixes in order to meet their targets.

Objectives This retrospective cohort study examines incidence, risk factors, and clinical outcomes of acute myocardial infarction (AMI) and acute ischemic stroke (AIS) within one year of gram-negative bloodstream infection (GN-BSI) based on predefined clinical criteria. Methods Hospitalized adults with GN-BSI at Prisma Health-Midlands hospitals in South Carolina, USA from 2010 through 2015 were identified. Kaplan-Meier analysis was used to determine incidence of AMI and AIS within one year after GN-BSI. Multivariate Cox proportional hazards regression models were used to examine risk factors for AMI or AIS and impact on 1-year mortality. Results Among 1292 patients with GN-BSI, 263 and 17 developed AMI and AIS within 1-year with incidences of 23.4% and 1.9%, respectively. Majority of AMI were type 2 (164; 62%); 99 patients had type 1 AMI with incidence of 8.9%. Age >65 years (hazard ratio [HR] 1.52, 95% CI: 1.17–1.99), prior coronary artery disease or stroke (HR 1.74, 95% CI: 1.34–2.25), hypertension (HR 1.55, 95% CI: 1.13–2.15), end-stage renal disease (HR 1.52, 95% CI: 1.09–2.08), and quick Pitt bacteremia score (HR 1.55 per point, 95% CI: 1.40–1.72) were predictors of AMI/AIS. Development of type 1 AMI or AIS after GN-BSI was independently associated with increased 1-year mortality (HR 1.47, 95% CI: 1.03–2.07). Conclusions AMI and AIS occur frequently within one year of GN-BSI and have negative impact on 1-year survival. Future randomized clinical trials are needed to determine the most effective clinical interventions for prevention of AMI/AIS following BSI in high risk patients and improve survival after these events.

The study was conducted from May -November 2019 among 114 dacryocystitis patients attending toophthalmology department of Al-Yarmuk central hospital in Baghdad city. From of 114 patients withdacryocystitis, 90 (79%) patients had bacterial dacryocystitis, 24 (21%) with fungal dacryocystitis. Accordingto the results 83(73%) recorded with chronic dacryocystitis and 31(27%) with acute dacryocystitis. The highpercentage was bacterial dacryocystitis (32%), fungal dacryocystitis (38%) were at age of 74±0.3 y and thelow percentage of bacterial was (11%) at 63±0.5 y and with fungal dacryocystitis (8%) at age of 42±0.3y.Patients with bacterial dacryocystitis had diabetes mellitus (56 %),arthritis and hypertension (28%,16 %)while the DM with fungal dacryocystitis (46%), arthritis, hypertension (38 %,16 %), S.aureus 23(26%),S.epidermidis 18 (20%),Streptococcus spp. 14 (16%), Pseudomonas spp. 11 (12%), E. coli 10 (11%),Enterobacter spp 9 (10%) finally Proteus spp. 5 (6%), while Aspergillus flavus represented 9 (37%) ascausing fungal dacryocystitis, Aspergillus fumigates 7 (29%), Aspergillus niger 4 (17%)and Candida spp 4(17%) . The antibiotic susceptibility tests revealed that S. aureus isolates were sensitive to Chloramphenicol(83%),. S.epidermidis isolates showed sensitivity to Gentamycin and Tetracycline (88%), Streptococcusspp showed the susceptibility to Erythromycin (93%), Ciprofloxacin (86%) respectively,Pseudomonas sppisolates considered highly sensitive to Tetracycline and Chloramphenicol (91%), E.coli isolates were alsosusceptible to Chloramphenicol (90%), Enterobacter spp were sensetive to Tetracycline and Gentamicin(78%),Proteus spp isolates seems sensitive to Chloramphenicol and Tetracycline (100%), Aspergillus spp.and Candida spp. isolates remain sensitive to Itraconazole, Voriconazole .

Aim : This study aimed to evaluate the efficacy/safety of Sofosbuvir/Ribavirin and Sofosbuvir/Daclatasvir/Ribavirin in Egyptian cirrhotic HCV patients, and to demonstrate the effects on the haematological and biochemical profile. Patients and Methods: A Prospective study was done on 200 HCV cirrhotic patients. They were allocated into two Groups, Group 1: received Sofosbuvir (SOF) and Ribavirin (RBV) for 24 weeks, Group 2: received SOF, Daclatasvir (DAC) and RBV for 12 weeks. Results : Sustained virological response was achieved in 75 (75%) and 96 (96%) patients in Group 1, 2 respectively. The mean value of Hb and Platelet count decreased in a significant manner at treatment end in both Groups, and the percentage of drop was significantly higher in Group 1 in comparision to Group 2. The mean values of albumin, ALT, and AST decreased in a significant manner at treatment end in both Groups. There was a significant increase in total bilirubin mean value in both Groups at treatment end. The percent of the increase in the indirect bilurubin mean value was significantly higher in Group 2. There was improvement in FIB-4 score at treatment end in both Groups. This improvement was maintained to SVR 12 in both Groups. Conclusion: Cirrhotic patients received SOF, DAC and RBV for 12 weeks had a significantly higher SVR12 rate when compared to those received SOF and RBV for 24 weeks. In patients who achieved sustained virological response, there was improvement in liver function parameters, and FIB4 at the time of SVR12 in comparison to baseline values.

Background Lumbar interbody fusion is a recognized surgical technique in treatment of degenerative lumbar instability. Interbody fusion supplemented with pedicle screw fixation has several advantages over posterolateral fusion and has been advocated to improve fusion rates and clinical outcomes. Interbody fusion places the bone graft in the loadbearing position of the anterior and middle spinal columns thereby enhancing the potential for fusion. In addition, the interbody space has more vascularity than the posterolateral space, also increasing the potential for a solid fusion mass to form. Aim of the Work to assess safety and efficacy of unilateral pedicle screw fixation associated with interbody fusion in Lumbar spine degenerative diseases and to evaluate and compare outcomes of unilateral versus bilateral pedicle screw fixation associated with interbody fusion in lumbar spine degenerative diseases, as regard the operation time, bleeding, postoperative stay, cost, and the clinical and biomechanical results. Material & Methods This observational prospective comparative study of the 2 groups who were operated either unilateral (Group A /25 patients) or bilateral (Group B/25 patients) pedicle screw fixation with interbody fusion was done. Patients were followed up for 1, 6, 12 months. This study occurred at Ain Shams University hospitals. Results No differences were observed between the two groups with respect to demographic data. The patients of the two groups had significant improvement in functional outcome compared to preoperatively, except in early postoperative VAS back and ODI in unilateral group which is better than bilateral group. However, no significant difference noticed in the further follow up. There was no significant difference comparing fusion rate, complication rate and duration of hospital stay between the two groups at postoperative follow-up. There was significantly less blood loss, shorter postoperative pain killer use and significantly shorter operation time in the unilateral PS fixation group as compared with the bilateral PS fixation group in our study. Conclusion Our study suggested TLIF with unilateral PS fixation was as safe and effective as that with bilateral PS fixation. Unilateral PS fixation may significantly reduce the intraoperative blood loss and shorten the operation time, somewhat improve the clinical outcome scores of ODI and VAS Back without significant difference comparing fusion rate, complication rate and duration of hospital stay between the two groups at postoperative follow-up. BPSF with TLIF likely causes more degeneration at the cranial adjacent segment compared with UPSF techniques. However, the long-term follow up is required to demonstrate the impact of these findings.

In this paper, the performance of a small centrifugal compressor of an UAV at design and off-design operational conditions is estimated by way of advanced commercial CFD code, ANSYS-CFX-16. Then, the gained performance is compared with published predicted performance using approximate method[1, 2]. The engine used is JetCat P200-sx, which is a single spool turbojet. Considered off-design regimes include centrifugal compressor operations at 73%, 80%, 85%, 90%, 100% and 103% of the design point rotational speed. Commercial CFD code CFX-16, is used for compressor performance prediction at design and off- design operating conditions. The computational grid is created using Turbo-Grid for compressor parts impeller and vanned diffuser. While for both intake device and vaneless diffuser an unstructured tetrahedral mesh with prism layers along the wall surfaces using ANSYS-ICEM CFD mesh is used to resolve the near-wall boundary layer. To gain a reduction in the computational analysis cost, only one passage is considered as a portion of the computational domain and the model is simulated as a steady state problem. Finally, to detect the surge point at each rotational speed the unsteady simulation on performance predictions of centrifugal compressor is investigated. It is a common practice to use compressor characteristics available in graphical form. These plots can be transformed into empirical equations that can be used in automatic calculation. Such approach was done to predict the same compressor performance[13]. The CFD detailed compressor performance is compared with the mentioned published one. The numerical CFD results illustrate good agreement with the analytical model.

The study included 234 patients attended to Iben AL-Haithem hospital of ophthalmology in Baghdad city having microbial keratitis , at age of (18-81) years for the period from September 2017- April 2018 . there were 147 ( 63% ) patients with bacterial keratitis and 87 (37%) with fungal keratitis . Men with bacterial keratitis represented 60% (88) and women 40% (59) ,while men with fungal keratitis were 61% (53) and women 39% (34), the number of the patients with bacterial keratitis were 82(56%) and 51(59%) with fungal keratitis from Baghdad while the internally displaced were 62(44%) with bacterial and 36(41%) with fungal keratitis , the percentage of patients with bacterial keratitis and fungal keratitis were both (34%) at mean age of 73 ± 2.3 y . Most patients with bacterial keratitis recorded having diabetes mellitus(39%) while the diabetic with fungal keratitis represented (41%) , The results revealed that gram positive bacteria was 102 (69%) and gram negative 45 ( 31%) , S.aureus was the most common cause of bacterial keratitis42(29%), followed by S.epidermidis 36(24%) then Streptococcus spp. 24(16%) , Pseudomonas spp. 17 (12%) , Proteus, spp. 13 (9%) , Escherichia coli 9(6%) and Enterobacter spp 6(4%) while Aspergillus fumigates represented 26(30%) as the most common cause of fungal keratitis , Aspergillus flavus 19(22%) , Aspergillus niger 16(18%) , Pencillium spp 11(13%) , Fusarium oxysporium. 8(9%) , Fusarium solani 5(6%) and Candida spp 2(2%) . S. aureus isolates were susceptible to Cloramphenicol and Ciprofloxacin (83%) while they were resistant to Clindamycin (57%) . S.epidermidis isolates were susceptible to Cloramphenicol and Amikacin (86%) ,Streptococcus spp were susceptible to Tetracycline and Clindamycin (88% ,83%) , Pseudomonas spp showed their high susceptibility to Tetracycline(96%) followed by Cloramphenicol and Ciprofloxacin (88%) both each, Enterobacter spp were susceptible to Tetracycline and Gentamicin (100%) while E.coli were susceptible to Cloramphenicol (100%) followed by Ciprofloxacin and Gentamicin (89%) both, fungal isolates were susceptible to all types of antibiotics used in the study as (98%) of Aspergillus spp isolates were sensitive to Itraconazole (98%) Voriconazole, Amphotericin B and Natamycin (95%,93% ,92%) respectively, Pencillium spp. were sensitive to Amphotericin B (100%) then Natamycin and Itraconazole (91%) both, Fusarium spp were sensitive to Natamycin and Itraconazole (100%) , Candida isolates were sensitive (100%) to Amphotericin B, Natamycin and Voriconazole.

Background: Exosomes are microvesicles that are recently discovered in intercellular communication especially between tumor cells as lung cancer that are important for tumor development and progression. Objectives: Examine the diagnostic role of serum exosomal LncRNA in lung cancer among Egyptian population. Methods: Lung cancer characteristic exosomal RNA-based biomarker Lnc-RNA-RP11-510M2.10 was selected based on bioinformatic methods, followed by RT-qPCR validation of their expression in serum of 20 patients with lung cancer and 10 healthy volunteers. Results: serum exosomal Lnc-RNA-RP11-510M2.10 showed a significant negative association with lung cancer patients in comparison to patients with healthy persons (p

Addressing greenhouse gas emissions and the associated global temperature rise will be one of the key issues of the 21st century. The supply and use of energy is the single largest contributor to anthropogenic greenhouse gas emissions through the burning of fossil fuels. Given the role fossil fuel use plays in the global economy, curtailing their use in order to mitigate climate change will be very difficult. This has led to proposals to deploy various types of geoengineering as a means of mitigating the global temperature increase. Current integrated assessment models (IAMs) do not readily incorporate geoengineering options. They are also complex to set up and run. This has led the authors to develop the Combined Energy and Geoengineering Optimization Model (CEAGOM)©. CEAGOM provides an easy to use software platform that explicitly includes geoengineering as potential options as part of the optimization of the energy resource mix for meeting a specified energy demand while still meeting specified climate targets. This paper describes the CEAGOM model and shows that its results compare quite favorably with those from a more complex IAM.

Blended learning is the integration of different learning approaches, new technologies, and activities that combine traditional face-to-face teaching methods with authentic online methodologies. Although advances in educational technology have helped to expand the selection of different pedagogies, the teaching of anatomical sciences has been challenged by implementation difficulties and other limitations. These challenges are reported to include lack of time, costs, and lack of qualified teachers. Easy access to online information and advances in technology make it possible to resolve these limitations by adopting blended learning approaches. Blended learning strategies have been shown to improve students' academic performance, motivation, attitude, and satisfaction, and to provide convenient and flexible learning. Implementation of blended learning strategies has also proved cost effective. This article provides a theoretical foundation for blended learning and proposes a validated framework for the design of blended learning activities in the teaching and learning of anatomical sciences. Clin. Anat. 31:323-329, 2018. © 2018 Wiley Periodicals, Inc.

This survey was applied on the pa- ranasal sinuses of the Buffalo in Egypt (Bos bubalis L.) and its surgi- cal approach. Ten adult buffaloe heads of ages ranging between 2 -7 years were used. Six of these heads were used for dry skull preparation while the other four were used for radiography and cross sections. The study concluded that, in addition to sinuses conchales, four paranasal sinuses have been found to occur in adult buffalo comprising the sinus frontalis, sinus maxillaris, sinus palatinus and sinus lacrimalis. The anatomical and radiographic description of these paranasal sinuses as well as its dimensions and communications has been mentioned. Two sites for trephination of the frontal sinus could be indicated.Trephining the rostral frontal sinus through was indicated at the middle of a transverse line extending between the caudal margins of the orbital rim to the median plane while trephination site to gain the caudal frontal sinus was indicated at the middle of another transverse line extending from the middle of the base the horn to the median plane. Surgical approach of the maxillary sinus for trephining could be indicated on a vertical line extending upward from the caudal margin of the 2nd premolar for about 4.0-4.5 cm.

This paper presents a lightly weighted hydraulic actuator that is designed mainly for robotic applications. This hydraulic cylinder will be used as the main actuator for the hydraulic humanoid robot HYDROïD. For implementation, the knee joint is taken as an example in order to execute the necessary steps to build the actuator from carbon fiber composite material. An optimization process is used to minimize the total weight of the actuator and satisfy its constraints. Meanwhile, the mechanical design with the integrated sensors is shown. In addition, results are discussed on the spot of the weight minimization and actuator performance. Finally, experimental testing is carried out to monitor the pressure and the position readings of the hydraulic cylinder.

Introduction: Healthcare professional schools across the world are implementing near-peer tutoring (NPT) programs owing to numerous benefits to both tutors and tutees. This study determined whether higher attendance at NPT sessions led to improvements in course grades for high and low performing students. Methods: Fourth-year medical students used the USMLE Step 1 question format to tutor first-year medical students during the second half of the Structure and Function (SF) module, i.e., SF2. Attendance was recorded and students were accordingly divided into three groups: high, moderate, and low-no attendance. Students' performances in SF1 and SF2 were compared using Student's t-test. Differences among the three groups were analyzed using ANOVA and Scheffe post hoc test (P< 0.05). Students who earned 70-79% (C) in SF1 were further examined on the basis of their attendance rate and performance in SF2. Those who attended three or more sessions completed a survey evaluating the NPT program. Results: Course grades were significantly higher in SF2 than SF1 for all students, regardless of attendance rate. However, students who received a C grade in SF1 and had high or moderate attendance improved significantly in their SF2 course grade. Most students agreed that the NPT program was valuable and they evaluated the tutors highly. They also agreed that NPT prepared them for course exams and Step 1, but did not reduce anxiety and stress about Step 1. Conclusions: The positive effect of the NPT program resulted in its expansion to include all first-year modules. This article is protected by copyright. All rights reserved.

High-gain observers play an important role in the design of feedback control for nonlinear systems. This article overviews the essentials of this technique, starting with motivating examples that illustrate the main features of highgain observers, with emphasis on the peaking phenomenon and the role of control saturation in dealing with it. The observer design for single-output and multi-output systems is presented along with the use of the observer in feedback control. A nonlinear separation principle is discussed, and the use of an extended high-gain observer as a disturbance estimator is covered. The most serious challenge in implementing high-gain observers is the effect of measurement noise, which is covered next. The article ends by presenting an experimental application of the extended high-gain observer to speed control of a permanent magnet synchronous motor (PMSM).

Background and Aims Nonvariceal upper GI hemorrhage (NVUGIH) is a feared adverse event after percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI). We aimed to determine the incidence of NVUGIH after PCI for AMI and its impact on mortality, morbidity, and health care resource utilization over 11 months. Methods We used the Nationwide Readmission Database 2014. Inclusion criteria were (1) a principal diagnosis of ST or non-ST-elevation myocardial infarction, (2) in-hospital PCI, and (3) admission in January. Exclusion criteria were age less than 18 years and elective admission. The primary outcome was the 11-month incidence of NVUGIH. Secondary outcomes were 11-month mortality rate, prolonged mechanical ventilation, shock, upper endoscopy, length of stay, and total hospitalization costs and charges. Independent risk factors for NVUGIH were identified using multivariate logistic regression analysis. Results A total of 22,669 patients were included in the study. The mean age was 63.8 years (range, 63.4-64.1 years), and 31.7% of patients were female. The 11-month incidence of NVUGIH was 1.6%. The onset of NVUGIH was associated with an increase in the 11-month mortality rate (adjusted odds ratio, 1.94; 95% confidence interval, 1.01-3.72; P =.04). The upper endoscopy, shock, and prolonged mechanical ventilation rates were 72%, 6.2%, and 1.9%, respectively. In total, 26,532 days were associated with NVUGIH, with a total health care in-hospital economic burden of U.S.$17.6 million. Independent predictors of NVUGIH were female gender, Charlson comorbidity score, and length of stay. Conclusions The 11-month incidence of NVUGIH among patients who undergo PCI for AMI is 1.6%. NVUGIH has a substantial impact on mortality, morbidity, and in-hospital health care resource utilization.

This chapter explores the voice as palimpsest through the experience of Stylianos Floikos, one of the few remaining cantors (or psaltes) at the Ecumenical Patriarchate of Constantinople in Istanbul, Turkey. Stylianos, like other psaltes, while interpreting melodies either from neumatic scores or from memory, creates inaudible yet profoundly affective resonance with his own previous interpretations and those of other psaltes. Through this process, both he and those listening experience the act of realizing a melody as a dialogue with past voices rendered present. This multilayered, polyphonic experience of voice forms the context through which both personal and cultural identity are apprehended and renegotiated.

A real-time and calibration-free lane departure warning system algorithm is proposed. The pre-processing stage of the lane departure algorithm is carried out using Gaussian pyramid to smooth the image and reduce its dimensions, which decrease the unnecessary details in the image. A lane detection stage is then developed based on Edge Drawing Lines (EDLines) algorithm that is a real-time line segment detector, which has false detection control. The reference-counting technique is used to track the lane boundaries and predict the missing ones. Experimental results show that the proposed algorithm has accuracy of 99.36% and average processing time of 80 fps (frame per second). The proposed algorithm is efficient to be used in the self-driving systems in the Original Equipment Manufacturers (OEMs) cars.

Treatment of arrhythmias by catheter ablation targeting the anatomical foci of arrhythmias by radiofrequency has evolved dramatically in recent years. A road map for the relevant heart structures is an important asset for the success of the procedure and should be obtained before the intervention. This can be achieved by intra-cardiac echocardiography, conventional angiographic methods, multidetector CT, or MRI. The electrophysiological technique comprises a diagnostic procedure and an interventional – therapeutic – procedure. Electrocardiographic-gated multidetector CT is important in the diagnostic session to evaluate the anatomical details in combination with electric activity mapping. This combined protocol provides a unique view of the propagation of electrical activity, either normal or abnormal, over cardiac structures and allows a precise functional and anatomical evaluation to be obtained. In this review, we evaluate the role of electrocardiographic-gated multidetector CT in roadmapping arrhythmias in the paediatric age group, focussing on its strengths; we also evaluated some additional aspects that need further improvement in the future.

Functional electrical stimulation cycling is a common clinical treatment for individuals with spinal cord injury and other paralytic conditions, however, the long term effects of home-based functional electrical stimulation cycling remains unreported.To determine the effectiveness of a long-term home-based functional electrical stimulation lower extremities cycling (FES-LEC) program on body composition.An adult male 52.7 years of age at pre-intervention and 57.3 years of age at post-intervention with chronic C4 spinal cord injury and American Spinal Injury Association Impairment Scale C.Dual-energy X-ray absorptiometry scans were performed on the participant before and after the FES cycling program to determine body composition changes. An RT300 FES cycle was issued to the participant with the recommendation to cycle three times per week for general conditioning and the maintenance of physical health.Total body lean mass (LM) increased from 39.13 kg to 46.35 kg, an 18.5% increase while total body fat mass (FM) increased by just 3.7% from 20.85 kg to 21.64 kg. Legs LM increased by 10.9% (10.93 kg to 12.12 kg). There was a negligible decrease in total body bone mineral content (BMC) with a pre-training measure of 2.09 kg compared to a post-training measure of 1.98 kg. Lower extremities FM increased by less than 1% from 3.51 kg to 3.54 kg.Natural limitations of a single subject case report disallow a causal conclusion. However, for this particular older adult with chronic tetraplegia, home-based FES-LEC appears to have resulted in cardio-metabolic protective body composition changes.

Observations of atmospheric methane (CH4) since the late 1970s and measurements of CH4 trapped in ice and snow reveal a meteoric rise in concentration during much of the twentieth century. Since 1750, levels of atmospheric CH4 have more than doubled to current globally averaged concentration near 1,800 ppb. During the late 1980s and 1990s, the CH4 growth rate slowed substantially and was near or at zero between 1999 and 2006. There is no scientific consensus on the drivers of this slowdown. Here, we report measurements of the stable isotopic composition of atmospheric CH4 ((13)C/(12)C and D/H) from a rare air archive dating from 1977 to 1998. Together with more modern records of isotopic atmospheric CH4, we performed a time-dependent retrieval of methane fluxes spanning 25 y (1984-2009) using a 3D chemical transport model. This inversion results in a 24 [18, 27] Tg y(-1) CH4 increase in fugitive fossil fuel emissions since 1984 with most of this growth occurring after year 2000. This result is consistent with some bottom-up emissions inventories but not with recent estimates based on atmospheric ethane. In fact, when forced with decreasing emissions from fossil fuel sources our inversion estimates unreasonably high emissions in other sources. Further, the inversion estimates a decrease in biomass-burning emissions that could explain falling ethane abundance. A range of sensitivity tests suggests that these results are robust.

Extra-hepatic compartments might contribute to hepatitis C virus (HCV) persistence and extra-hepatic manifestations. Therefore, we investigated HCV infection in colonic tissue in patients with chronic hepatitis C (CHC) and its relationship with HCV pathogenesis. Colonic biopsies were collected from three groups with CHC infection: treatment naïve (TN; n=12), non-responders (NR; n=10) to anti-HCV therapy (pegylated interferon-α and ribavirin) and sustained virologic response (SVR; n=10) and from a fourth healthy control group (n=10). Liver biopsies were examined to assess inflammation and fibrosis. HCV infection and colonic T regulatory (Treg) frequency were detected by immunohistochemistry. HCV core and NS3 proteins were detected in B cells and macrophage/monocytes of 42 % and 25 % of TN and 50 % and 30 % of NR, respectively, but not in SVR or control group. The numbers of cells expressing HCV proteins were positively correlated with both HCV viral load and colonic Treg frequency. A significant negative correlation between HCV-expressing cells with both liver inflammation and fibrosis was identified. Our study provides evidence that HCV can infect B cells and macrophages of the colon. The correlations between HCV infection in colonic tissue and HCV viral load and liver pathology underline the significance of this extra-hepatic infection in HCV pathogenesis and response to therapy.

We propose an output-feedback tracking controller for uncertain, nonaffine, nonlinear systems. The output feedback controller results in a closed-loop system with a three-time-scale structure; an extended high-gain observer estimates unmeasured states and uncertainties in the fastest time scale and dynamic inversion is used to deal with nonaffine inputs and input uncertainties in the intermediate time scale while the plant dynamics evolves in the slowest time scale. The dynamic inversion algorithm is based on sector conditions and results in exponential convergence of the inputs. Together with the extended high-gain observer, dynamic inversion results in performance recovery of a target system. The singular perturbation method is used to analyze the stability and performance of the system and numerical simulations are used to demonstrate the effectiveness of the control design.

High-gain observers play an important role in the design of feedback control for nonlinear systems. One challenge in the use of high-gain observers is the effect of measurement noise. It is shown in the literature that the presence of measurement noise puts a constraint on how high the observer gain could be, which forces a trade-off between the fast convergence of state estimates and the error due to measurement noise. A number of techniques have been proposed in the literature to attenuate the effects of measurement noise on systems utilizing a high-gain observer. In experimental applications of high-gain observers, it is quite common to use a low-pass filter to filter out the high-frequency components of the noise before feeding the measurement into the observer. In this paper we analyze effect of measurement noise on high-gain observers when low pass filters are used.

Underactuated dynamic systems typically have multiple isolated equilibria, and therefore, a stabilizing controller is effective only in the region of attraction of the equilibrium. An impulsive control method is proposed for enlarging the region of attraction of stabilized equilibria of underactuated systems. The method relies on obtaining an estimate of the region of attraction and intersection of this region with the impulse manifold. The efficacy of the method is demonstrated through simulations and experiments.

Background and Aim Forkhead box protein P3 (FoxP3)+ regulatory T (Treg) cells play a fundamental role in maintaining the balance between the tissue-damaging and protective immune response to chronic hepatitis C (CHC) infection. Herein, we investigated the frequency of Treg cells in the colon and their potential relationship to the various CHC outcomes and hepatic histopathology. Methods Colonic biopsies were collected from three groups with CHC: treatment naive (TN; n = 20), non-responders (NR; n = 20), sustained virologic response (SVR; n = 20), and a fourth healthy control group (n = 10). The plasma viral loads and cytokines levels were determined by quantitative real-time polymerase chain reaction, and ELISA, respectively. Liver biopsies were examined to assess inflammatory score and fibrosis stage. Colonic Treg frequency was estimated by immunohistochemistry using confocal microscopy. Results A significant increase in the frequency of colonic Treg was found in TN, and NR groups compared with the control and SVR group. The frequency of colonic Treg, plasma interleukin (IL)-10 and IL-4 levels were significantly positively correlated with viral load and negatively correlated with METAVIR inflammatory score, and fibrosis stages. Conclusion Colonic Treg cells are negatively correlated with liver inflammation and hepatitis C virus (HCV) viral load, which suggests a strong linkage between gut-derived Treg cell populations and HCV infection.

In recent years, mono-propellant propulsion has attracted widespread attention in space due to excessive benefits of safety, low cost, simplicity, clean exhaust and high reliability. A 5N monopropellant Hydrogen Peroxide (H2O2) thruster is selected to be utilized with remote sensing (RS) satellites for attitude control and orbit correction. In the present paper, comprehensive theoretical analysis and design parameters are investigated. The effects of change in various design parameters are studied, such as operating pressures (7-16 bar), H2O2 concentration (70-95%) and initial temperature (25-70℃). The crucial design performance of thruster has been carried out by using thermo-chemical software package. A conceptual design was conducted to determine the dimensions of the thruster prototype including the injector plate, catalytic bed, retainer and nozzle part. 70℃ H2O2 preheating temperature might be needed for catalytic bed fast response. The results are described in the form of graphs and tables for the quick and easy analysis.

An output feedback controller is proposed for stabilization of the inverted pendulum on a cart in the presence of uncertainties. The output feedback controller has a multi-time-scale structure in which Extended High-Gain Observers are used to estimate system states and uncertainties in the first and fastest time scale; dynamic inversion is used to deal with uncertain input coefficients in the second time scale; the pendulum converges to a reference trajectory in the third time scale; and finally, the reference trajectory is designed such that both the pendulum and the cart converge to the desired equilibrium in the fourth and slowest time scale. The multi-time-scale structure allows independent analysis of the dynamics in each time scale and singular perturbation methods are effectively utilized to establish exponential stability of the equilibrium. Simulation results indicate that the output feedback controller provides a large region of attraction and experimental results establish the feasibility of practical implementation.

The miniaturization of electronic devices with high processing components is promoting the rapid increase in heat generation of devices/systems. Synthetic jet cooling flexible thin device has major advantages in order to suit the device miniaturization and compactness. Diaphragm motion is the main component in the device that generate fluid motion for cooling application. In this paper, the synthetic jet diaphragm has been characterized using Laser Doppler to record the motion to determine the motion type. Based on the recorded motion, a User Define Function coding has been develop to imitate the motion in Computational Fluid Dynamic (CFD) software in order to simulate the fluid motion based from the actual diaphragm motion. The diaphragm motion showed a dome shape motion as the laser tracking result were plotted at three points across the diaphragm diameter. Results show that the diaphragm has sinusoidal motion which produce maximum amplitude at 500Hz driving frequency. The UDF program for diaphragm motion has been able to mimic the experimental result.The miniaturization of electronic devices with high processing components is promoting the rapid increase in heat generation of devices/systems. Synthetic jet cooling flexible thin device has major advantages in order to suit the device miniaturization and compactness. Diaphragm motion is the main component in the device that generate fluid motion for cooling application. In this paper, the synthetic jet diaphragm has been characterized using Laser Doppler to record the motion to determine the motion type. Based on the recorded motion, a User Define Function coding has been develop to imitate the motion in Computational Fluid Dynamic (CFD) software in order to simulate the fluid motion based from the actual diaphragm motion. The diaphragm motion showed a dome shape motion as the laser tracking result were plotted at three points across the diaphragm diameter. Results show that the diaphragm has sinusoidal motion which produce maximum amplitude at 500Hz driving frequency. The UDF program for diaphragm moti...

Integrated framework to simulate electronic system (including digital and analog devices) with the mechanical parts of a heterogeneous automotive system is presented. The electronic system, consisting of many Electronic Control Units (ECUs), is modeled to simulate the mechatronic system functionality. The recently developed Functional Mock-up standard approach is used to have a model for a complex cyber-physical automotive system. The framework simulates real system including the Hardware (HW) and the Software (SW) to run on the ECUs. It allows Co-development of the automotive system SW and HW while the mechanical system is in the loop. Hardware and Software debugging is demonstrated using the developed methodology. The development cycle for the automotive mechatronic system could be greatly shortened using the proposed framework.

The paper addresses the high-gain observer design for nonlinear systems in the presence of sensor nonlinearities. It is shown that the properties of high-gain observers with linear outputs will hold with nonlinear outputs, provided the nonlinear output function is incrementally inside the sector [β, ∞] for some β > 0 and the observer eigenvalues are chosen to be real.

Recently, academic health professionals have been increasing collaboration with peers at a distance for activities such as research, scholarship, and faculty development. Novel virtual technologies enable academic professional teams to overcome time and distance barriers to facilitate collaboration, but little research is available to guide academicians on how to effectively organize and manage virtual collaborative teams using these technologies. Based upon a literature review and six years of experience as a virtual collaborative team, the authors use Boyer’s Scholarship of Integration paradigm to identify and critique four models for virtual collaboration. The literature search devised from the four identified models found references that had a theoretical foundation for peer virtual collaboration and have been adopted in some professional context. The authors present a review of this literature, describe the benefits for adapting these models to academic health profession contexts, and provide a reflective critique about the challenges for their adaptation in these contexts. They also provide a hypothetical scenario to exemplify the application of these models for health-care professionals along with important considerations and tips when forming new virtual peer collaborative teams or problem-solving teams who are not optimally functioning.

In the present study, we describe the innovative use of the National Board of Medical Examiners (NBME) Comprehensive Basic Science Examination (CBSE) as a progress test during the preclerkship medical curriculum. The main aim of this study was to provide external validation of internally developed multiple-choice assessments in a new medical school. The CBSE is a practice exam for the United States Medical Licensing Examination (USMLE) Step 1 and is purchased directly from the NBME. We administered the CBSE five times during the first 2 yr of medical school. Student scores were compared with scores on newly created internal summative exams and to the USMLE Step 1. Significant correlations were observed between almost all our internal exams and CBSE scores over time as well as with USMLE Step 1 scores. The strength of correlations of internal exams to the CBSE and USMLE Step 1 broadly increased over time during the curriculum. Student scores on courses that have strong emphasis on physiology and pathophysiology correlated particularly well with USMLE Step 1 scores. Student progress, as measured by the CBSE, was found to be linear across time, and test performance fell behind the anticipated level by the end of the formal curriculum. These findings are discussed with respect to student learning behaviors. In conclusion, the CBSE was found to have good utility as a progress test and provided external validation of our new internally developed multiple-choice assessments. The data also provide performance benchmarks both for our future students to formatively assess their own progress and for other medical schools to compare learning progression patterns in different curricular models.

This is a reflective essay based on the experience of developing a structure and function module within a new integrated medical curriculum. Our hope is that the insights we gained during a 4-yr journey in a new medical school will be transferable to others engaged with curriculum development. Here, we present an interpretive analysis of our personal experiences together with some original research data and a synthesis of the literature. We will argue that a focus on teaching faculty is the key to successful curriculum integration and suggest an agenda for faculty development. Our essay begins by exploring what curriculum integration really means and what its purpose might be. Our case study explores the challenges of building a shared understanding among stakeholders and of negotiating learning outcomes and methods of teaching as well as the process of developing content and assessment. We feel that many of our experiences in the new medical school are applicable in other settings, such as curriculum reform in established schools and for developers of competency-based premedical curricula. We conclude with recommendations to assist other curriculum planners and teachers by offering some benefits of hindsight.

Diet and exercise are cornerstones in the management of obesity and associated metabolic complications, including insulin resistance, type 2 diabetes, and disturbances in the lipid profile. However, the role of exercise in managing body composition adaptations and metabolic disorders after spinal cord injury (SCI) is not well established. The current review summarizes evidence about the efficacy of using neuromuscular electrical stimulation or functional electrical stimulation in exercising the paralytic lower extremities to improve body composition and metabolic profile after SCI. There are a number of trials that investigated the effects on muscle cross-sectional area, fat-free mass, and glucose/lipid metabolism. The duration of the intervention in these trials varied from 6 weeks to 24 months. Training frequency ranged from 2 to 5 days/week. Most studies documented significant increases in muscle size but no noticeable changes in adipose tissue. While increases in skeletal muscle size after twice weekly training were greater than those trials that used 3 or 5 days/week, other factors such as differences in the training mode, i.e. resistance versus cycling exercise and pattern of muscle activation may be responsible for this observation. Loading to evoke muscle hypertrophy is a key component in neuromuscular training after SCI. The overall effects on lean mass were modest and did not exceed 10% and the effects of training on trunk or pelvic muscles remain unestablished. Most studies reported improvement in glucose metabolism with the enhancement of insulin sensitivity being the major factor following training. The effect on lipid profile is unclear and warrants further investigation.

For many reasons, electrical propulsion systems are the most expected in space; they are suitable for researchers because they are effective, easy to design and applicable in space. One of the most important parameters that could assess the performance of the propulsion system is the problem of measuring the very low thrust of pulsed plasma thrusters (PPTs). Various test beds, including indirect designs of measuring systems such as pendulums and optical measuring systems, can measure the thrust with very high precision, but it is very complicated. This paper presents the firing test of a new designed coaxial pulsed plasma thruster for proofing the concept and then the thrust is measured by a new simple test bed using a rod in accordance with a loading cell (0-100 gf.) which can measure thrust accurately after good calibration up to μgf. In a medium-sized vacuum chamber (VC) (10−5 bar, D= 1 m and L= 1.4 m), a coaxial PPT is designed and tested under environmental conditions in space. Four proofs of concept took place until the experiment was adjusted and six experiments were carried out to measure the thrust using the new test bed under various operating conditions. Evaluation of the system is presented too and the maximum thrust obtained is 0.68mN at the discharge voltage equals 7kV and the 12kV voltage of the spark plug initiator and the efficiency equals 10%. The steps of fabrication of the coaxial PPT and steps of measuring the thrust is presented in the paper beside the result charts of the thrust under different operating conditions.

An integrated framework for Virtual Verification and Validation (VVV) for a complete automotive system is proposed. The framework can simulate/emulate the system on three levels: System on Chip (SoC), Electronic control unit (ECU) and system level. The framework emulates the real system including hardware (HW) and software (SW). It enhances the automotive V-cycle and allows co-development of the automotive system SW and HW. The procedure for debugging AUTOSAR application on the virtual platform (VP) is shown. SW and HW profiling is feasible with the presented methodology. Verification and validation of automotive embedded SW is also presented. The proposed methodology is efficient as the system complexity increases which shortens the development cycle of automotive system. It also provides fault injection capability. With HW emulation, co-debugging mechanism is demonstrated. A case study covering the framework capability is presented. The case study demonstrates the proposed framework and methodology to design, simulate, trace, profile and debug AUTOSAR SW using VPs.