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Evidence-based enhanced recovery after surgery (ERAS) programs aim to improve patient outcomes and shorten hospital stays. The objective of this study is to describe the development, implementation, and evolution of an ERAS protocol to optimize the perioperative management for patients undergoing endoscopic skull base surgery for pituitary tumors. A systematic review of the literature was performed, best practices were discussed with stakeholders, and institutional guidelines were established and implemented. Key performance indicators (KPI) were measured and patient-reported outcome surveys were collected. The ERAS protocol was introduced successfully at our institution. We describe the process of initiation of the program and the perioperative management of our patients. We demonstrated the feasibility of integration of ERAS protocols for pituitary tumors with multidisciplinary engagement, with a particular emphasis on the use of data informatics and metrics to monitor outcomes. We expect that this approach will translate to improved quality of care for these often-complex patients.

Purpose: To develop gender-specific operational equations for prediction of cardiorespiratory fitness in female footballers. Method: Forty-eight semiprofessional female footballers performed an intermittent progressive maximal running test for determination of fixed blood lactate concentration (FBLC) thresholds. Relationships between FBLC thresholds and the physiological responses to submaximal running were examined. Developed equations (n = 48) were compared with equations previously obtained in another investigation performed in males (n = 100). Results: Submaximal velocity associated with 90% maximal heart rate was related to FBLC thresholds (r = .76 to .79; P R2 = .82 to .94) of a single blood lactate concentration (BLC) sample measured at 10 or 11.5 km·h−1 was very high. A single BLC sample taken after a 5-minute running bout at 8.5 km·h−1 was related to FBLC thresholds (r = −.71; P P = .15) in the regression lines predicting FBLC thresholds from velocity associated with 90% maximal heart rate was observed between the female and male cohorts. However, regressions estimating FBLC thresholds by a single BLC sample were different (P = .002). Conclusions: Velocity associated with 90% maximal heart rate was robustly related to FBLC thresholds and might serve for mass field testing independently of sex. BLC equations accurately predicted FBLC thresholds. However, these equations are gender-specific. This is the first study reporting operational equations to estimate the FBLC thresholds in female footballers. The use of these equations reduces the burden associated with cardiorespiratory testing. Further cross-validation studies are warranted to validate the proposed equations and establish them for mass field testing.

Objectives This study aims to estimate the prevalence of coronavirus disease 2019 (COVID-19) in the general population of Iran. Methods The target population was all Iranian people aged 6 years and older in the country. A stratified random sampling design was used to select 28 314 people from among the individuals registered in the electronic health record systems used in primary health care in Iran. Venous blood was taken from each participant and tested for the IgG antibody against COVID-19. The prevalence of COVID-19 was estimated at provincial and national levels after adjusting for the measurement error of the laboratory test, non-response bias and sampling design. Results Of the 28 314 Iranians selected, 11 256 (39.75%) participated in the study. Of these, 5406 (48.0%) were male and 6851 (60.9%) lived in urban areas. The mean (standard deviation) participant age was 35.89 (18.61) years. The adjusted prevalence of COVID-19 until 20 August 2020 was estimated as 14.2% (95% uncertainty interval 13.3%–15.2%), which was equal to 11 958 346 (95% CI 11 211 011–12 746 776) individuals. The adjusted prevalences of infection were 14.6%, 13.8%, 16.6%, 11.7% and 19.4% among men, women, urban population, rural population and individuals aged 60 years or more, respectively. Ardabil, Golestan and Khuzestan provinces had the highest prevalence and Alborz, Hormozgan and Kerman provinces had the lowest. Conclusions Based on the study results, a large proportion of the Iranian population had not yet been infected by COVID-19. The observance of hygienic principles and social restrictions should therefore continue until the majority of the population has been vaccinated.

Background Double-blind, placebo-controlled oral food challenges are the gold standard in food allergy diagnosis. Nevertheless, proper masking of peanuts is particularly complex owing to their intense flavor and odor. Thus, it is important to use validated recipes to ensure their adequate masking during oral food challenges. Objective To design and validate recipes containing masked peanuts for double-blind, placebo-controlled oral food challenges. Methods Two types of products (cookies and a custard‑type dessert) containing the masked peanuts and other ingredients with low allergenic potential were designed and validated. For this purpose, of the 24 initial cookie recipes and 12 initial custard recipes developed, those that did not exhibit significant differences in their texture were selected for sensory validation. Results Similarity triangle tests were performed using a panel of 36 selected tasters, enabling the validation of 1 pair of cookie recipes and 1 pair of custard-type dessert recipe, both with low allergenic potential and suitable for those with celiac disease and for vegans. Conclusion The validated recipes are of clinical and research interest because they allow to confirm a peanut allergy and detect a wide range of tolerated threshold doses, which makes it possible to provide specific indications for each patient.

Following the presence of Hegel’s philosophy in Iran from the nineteenth century to the present, this study discusses various interpretations and appropriations of Hegelian philosophy by Iranian ac...

The recent outbreak of COVID-19 has caused disruption all over the world including in the US. It seems that this pandemic is going to stay for a while. Under current circumstances, what matters most is to mitigate its impact to get back to the daily routine as fast as possible. One answer to this challenge is to turn to technology, especially ICT (information and communication technology). Relying on ICT requires a dependable ICT infrastructure that can handle the fast-growing number of users transitioning to online mode. NRI (Network Readiness Index) is a composite index to measure the multi-faceted impact of ICT on society and development. It is a holistic framework measuring the impact of ICT on four fundamental dimensions of society: technology, people, governance, and impact. In this article, a thorough study of the NRI pillars in 2019 is conducted to highlight the strengths and weaknesses of network readiness in the US. The results of the analysis will provide insight into the trend of digital transformation in the USA.

BACKGROUND: Leptomeningeal metastasis (LM) occurs in 3–5% of patients with solid metastatic tumors and often portends a severe prognosis including symptomatic hydrocephalus and intracranial hypertension. Cerebrospinal fluid (CSF) shunting can provide symptomatic relief in this patient subset; however, few studies have examined the role of shunting in the palliation, prognosis and overall oncologic care of these patients. OBJECTIVE: To identify and evaluate risk factors associated with prognosis after CSF diversion and assess surgical, symptomatic and oncologic outcomes in this population. METHODS: A retrospective study was conducted on patients with solid-malignancy LM treated with a shunt at an NCI-designated Comprehensive Cancer Center between 2010–2019. RESULTS: One hundred and ninety patients with metastatic LM underwent CSF diversion. Overall survival was 4.14 months from LM diagnosis (95%CI:3.29–4.70) and 2.43 months (95%CI:2.01–3.09) from shunting. Karnofsky Performance Status (KPS) at time of shunting and brain metastases (BrM) number at LM diagnosis demonstrated significant associations with survival (HR=0.66; 95%CI[0.51–0.86], p=0.002; HR=1.40; 95%CI[1.01–1.93] per 10 BrM, p=0.04, respectively). Eighty-three percent of patients experienced symptomatic relief, and 79% were discharged home or to rehabilitation facilities post-shunting. Post-shunt, 56% of patients received additional systemic therapy or started or completed WBRT. Complications included infection (5%), symptomatic subdural hygroma/hematoma (6.3%), and shunt externalization/removal/repair (8%). Abdominal seeding was not identified. CONCLUSIONS: CSF diversion for LM with hydrocephalus and intracranial hypertension secondary to metastasis can achieve symptomatic relief, hospital discharge, and return to further oncologic therapy, with a complication profile unique to this pathophysiology. However, decision-making in this population must incorporate end-of-life goals of care given limited prognosis.

Systematic HIV program evaluation requires looking at all steps of the HIV cascade of care, from diagnosis to treatment outcomes. Our study was carried out to assess the treatment cascade of people living with HIV (PLWH) in Iran in 2019. We used data from the HIV Case Registry System of Iran through December 2019. We estimated the number of PLWH in 2019 by using Spectrum, and then the proportion of them being diagnosed, linked to care, received antiretroviral treatment and suppressed viral load. We estimated that there are 59,314 (UI: 32,685-125,636) PLWH in Iran, of whom 22,054 people (37% of PLWH) were diagnosed. At the end of 2019, of whom, 14,685 (25% of PLWH) people received antiretroviral therapy. Also, of whom 6338 (11% of PLWH) people had viral load suppression by 2019. Our results showed that about one-third of total PLWH were diagnosed, while this defect is somewhat less in children than adults. To reach the 90.90.90 targets Iran needs to developed the current national HIV care guidelines, which recommend best strategies to scale up the case finding and linkage to care among undiagnosed people specifically those who infected by sexual contact in general and key populations as well.

OBJECTIVE: Radiation therapy is a cornerstone of brain metastasis (BrM) management but carries the risk of radiation necrosis (RN), which can require resection for palliation or diagnosis. We sought to determine the relationship between extent of resection (EOR) of pathologically-confirmed RN and postoperative radiographic and symptomatic outcomes. METHODS: A single-center retrospective review was performed at an NCI-designated Comprehensive Cancer Center to identify all surgically-resected, previously-irradiated necrotic BrM without admixed recurrent malignancy from 2003-2018. Clinical, pathologic and radiographic parameters were collected. Volumetric analysis determined EOR and longitudinally evaluated perilesional T2-FLAIR signal preoperatively, postoperatively, and at 3-, 6-, 12-, and 24-months postoperatively when available. Rates of time to 50% T2-FLAIR reduction was calculated using cumulative incidence in the competing risks setting with last follow-up and death as competing events. The Spearman method was used to calculate correlation coefficients, and continuous variables for T2-FLAIR signal change, including EOR, were compared across groups. RESULTS: Forty-six patients were included. Most underwent prior stereotactic radiosurgery with or without whole-brain irradiation (n=42, 91%). Twenty-seven operations resulted in gross-total resection (59%; GTR). For the full cohort, T2-FLAIR edema decreased by a mean of 78% by 6 months postoperatively that was durable to last follow-up (p

OBJECTIVE The utility and safety of intraoperative MRI (iMRI) for resection of pituitary adenomas is not clearly established in the context of advances in endoscopic approaches. The goal in this study was to evaluate the safety and efficacy of iMRI for pituitary adenoma resection, with endoscopic transsphenoidal (ETS) versus microscopic transsphenoidal (MTS) approaches. METHODS Radiographic and clinical outcomes of all pituitary adenomas resected using iMRI between 2008 and 2017 at a single institution were retrospectively evaluated. RESULTS Of 212 tumors treated, 131 (62%) underwent further resection based on iMRI findings, resulting in a significant increase in gross-total resection on postoperative MRI compared with iMRI (p = 0.0001) in both ETS and MTS groups. iMRI increased rates of gross-total resection for cavernous sinus invasion Knosp grades 1 and 2, but not in Knosp ≥ 3 across treatment groups (p < 0.0001). The extent of resection on postoperative MRI was significantly correlated with increased progression-free survival (p < 0.0001). Initial hormone remission off medical therapy was achieved in 64%, with a significantly higher rate of remission in tumors resected via the ETS approach (81%) compared with the MTS approach (55%) (p = 0.02). The rate of persistent new hormone deficit was low at 8%, including a 2.8% rate of permanent diabetes insipidus, and 45% of patients had improvement in preoperative hormone deficit following surgery. Serious postoperative complications including CSF leaks requiring reoperation were rare at 1%, with no postoperative infections. CONCLUSIONS These results suggest that iMRI is a safe and effective method of increasing the extent of resection for pituitary adenomas while preserving hormone function. When paired with the endoscope, iMRI may offer the ability to tailor more aggressive removal of tumors while optimizing pituitary function, resulting in high rates of secretory hormone remission. Secretory tumors and adenomas with Knosp grade < 3 cavernous sinus invasion may benefit most from the use of iMRI.

Değerleme, en basit şekliyle bir mülkün belirli bir tarihte işleme alınacağı tutarın belirlenmesidir. Değerleme, birçok amaç dahilinde yapılabilir. Bunlar; alım-satım, devir, vergitahakkuku, kamulaştırma, miras dağıtımı, yatırım, finansman ve kredi olarak sıralanabilir. Değerlemenin çok çeşitli yöntemleri vardır. Bu yöntemler geleneksel, istatistiksel ve modern değerleme yöntemleri olarak 3 ana grup altında incelenir. İstatistiksel ve modern yöntemler matematiksel bir modele bağlı olduğu için daha az inisiyatif içermektedir. Çünkü geleneksel değerleme yöntemlerinde değerleme uzmanları, değer hesaplamalarını yalnızca bir fiyat tahmininde bulunarak yapmaya çalışırlar. Oysa değerleme alanının en önemli konularından biri, müşteriye sunulan bilgilerin açık ve net olmasını sağlama ihtiyacıdır. Makalenin amacı, istatistiksel değerleme yöntemlerden biri olan regresyon analizi ile modern değerleme yöntemlerinden biri olan yapay sinir ağları hakkında genel bir bakış sağlamak ve doğruluk değerlerinin karşılaştırılmasıdır. Yapay sinir ağları modellemesi için Matlab, regresyon analizi için Minitab yazılımı kullanılmıştır. Elde edilen değerlerin doğrulukları, ortalama mutlak yüzde hata (MAPE) formülüyle belirlenmiştir.

BACKGROUND Historically, the prognosis for patients who have melanoma brain metastasis (MBM) has been dismal. However, breakthroughs in targeted and immunotherapies have improved long-term survival in those with advanced melanoma. Therefore, MBM presentation, prognosis, and the use of multimodality central nervous system (CNS)-directed treatment were reassessed. METHODS In this retrospective study, the authors evaluated patients with MBM who received treatment at Memorial Sloan Kettering Cancer Center between 2010 and 2019. Kaplan-Meier methodology was used to describe overall survival (OS). Recursive partitioning analysis and time-dependent multivariable Cox modeling were used to assess prognostic variables and to associate CNS-directed treatments with OS. RESULTS Four hundred twenty-five patients with 2488 brain metastases were included. The median OS after an MBM diagnosis was 8.9 months (95% CI, 7.9-11.3 months). Patients who were diagnosed with MBM between 2015 and 2019 experienced longer OS compared to those who were diagnosed between 2010 and 2014 (OS, 13.0 months [95% CI, 10.47-17.06 months] vs 7.0 months [95% CI, 6.1-8.3 months]; P = .0003). Prognostic multivariable modeling significantly associated shortened OS independently with leptomeningeal dissemination (P < .0001), increasing numbers of brain metastases at diagnosis (P < .0001), earlier MBM diagnosis year (P = .0008), higher serum levels of lactate dehydrogenase (P < .0001), receipt of immunotherapy before MBM diagnosis (P = .003), and the presence of extracranial disease (P = .02). The use of different CNS-directed treatment modalities was associated with presenting symptoms, diagnosis year, number and size of brain metastases, and the presence of extracranial disease. Multivariable analysis demonstrated improved survival for patients who underwent craniotomy (P = .01). CONCLUSIONS The prognosis for patients with MBM has improved within the last 5 years, coinciding with the approval of PD-1 immune checkpoint blockade and combined BRAF/MEK targeting. Improving survival reflects and may influence the willingness to use aggressive multimodality treatment for MBM. LAY SUMMARY Historically, melanoma brain metastases (MBM) have carried a poor survival prognosis of 4 to 6 months; however, the introduction of immunotherapy and targeted precision medicines has altered the survival curve for advanced melanoma. In this large, single-institution, contemporary cohort, the authors demonstrate a significant increase in survival of patients with MBM to 13 months within the last 5 years of the study. A worse prognosis for patients with MBM was significantly associated with the number of metastases at diagnosis, previous exposure to immunotherapy, spread of disease to the leptomeningeal compartment, serum lactate dehydrogenase elevation, and the presence of extracranial disease. The current age of systemic treatments has also been accompanied by shifts in the use of central nervous system-directed therapies.

A quadrivalent high-dose inactivated influenza vaccine (IIV4-HD) is licensed for adults ≥65y of age based on immunogenicity and efficacy studies. However, IIV4-HD has not been evaluated in adults aged 60–64y. This study compared immunogenicity and safety of IIV4-HD with a standard-dose quadrivalent influenza vaccine (IIV4-SD) in adults aged ≥60y. This Phase III, randomized, modified double-blind, active-controlled study enrolled 1,528 participants aged ≥60y, randomized 1:1 to a single injection of IIV4-HD or IIV4-SD. Hemagglutination inhibition (HAI) geometric mean titers (GMTs) were measured at baseline and D 28 and seroconversion assessed. Safety was described for 180d after vaccination. The primary immunogenicity objective was superiority of IIV4-HD versus IIV4-SD, for all four influenza strains 28d post vaccination in participants aged 60–64 and ≥65y. IIV4-HD induced a superior immune response versus IIV4-SD in terms of GMTs in participants aged 60–64 y and those aged ≥65y for all four influenza strains. IIV4-HD induced higher GMTs in those aged 60–64 y than those aged ≥65 y. Seroconversion rates were higher for IIV4-HD versus IIV4-SD in each age-group for all influenza strains. Both vaccines were well tolerated in participants ≥60y of age, with no safety concerns identified. More solicited reactions were reported with IIV4-HD than with IIV4-SD. IIV4-HD provided superior immunogenicity versus IIV4-SD and was well tolerated in adults aged ≥60 y. IIV4-HD is assumed to offer improved protection against influenza compared with IIV4-SD in adults aged ≥60 y, as was previously assessed for adults aged ≥65y.

This paper presents the first-ever industrial application of the digital design of a complex, large-scale industrial continuous crystallization network. The aim of the work is to optimize a large-s...

This paper examines the repurposing of Palestinian rural lands for real estate investment. Focusing on Rawabi, the celebrated first Palestinian planned city, this study unsettles the city’s narrati...

A small subset of pituitary adenomas grows despite maximal treatment with standard therapies; namely, surgery and radiotherapy. These aggressive tumors demonstrate 2 patterns of growth: they may be locally aggressive or metastasize distantly, either hematogenously or through the spinal fluid. Further surgery and radiotherapy may be helpful for palliation of symptoms, but they are rarely definitive in the management of these malignant tumors. The only chemotherapy with established activity in the treatment of pituitary tumors is the alkylating agent temozolomide. At most, 50% of patients exhibit an objective response to temozolomide and the median time to progression is short; thus, there remains a significant unmet need for effective treatments within this patient population. Several targeted agents have reported activity in this tumor type—including small molecule inhibitors, checkpoint inhibitors, and other biologics—but remain investigational at this time.

Background Community pharmacist-led anticoagulation management service (CPAMS) offers international normalised ratio point-of-care testing of warfarin in a community pharmacy setting. It has now expanded with 7,344 patients enrolled in the service across 164 pharmacies in New Zealand. The clinical benefit of CPAMS has been shown to be superior, but patient satisfaction with the service has not been fully explored. Objective To develop a questionnaire to assess patient satisfaction with CPAMS and evaluate its psychometric properties. Additionally, to determine the level of patient satisfaction with CPAMS and identify determinants of satisfaction with CPAMS. Settings 1071 patients enrolled in CPAMS across New Zealand invited to take part in the study. Main outcome measure Satisfaction with CPAMS service. Methods Adult patients taking warfarin and currently enrolled in CPAMS were recruited through the national international normalised ratio online system and invited to complete a 36-item survey assessing satisfaction with CPAMS. To identify the most important dimensions of patient satisfaction, exploratory factor analysis was used. Multivariate linear regression models were used to examine the effect of independent variables on patient satisfaction. Results A total of 305 patients completed the survey. The mean overall satisfaction score was 94.5% ± 13.1 out of maximum possible points. Five dimensions of patient satisfaction were identified by factor analysis: patient-centred communication, confidence in pharmacist competence, patient-pharmacist relationship, confidence in CPAMS, and pharmacy environment. Being older and more frequent visits to a pharmacy were positively associated with patient satisfaction. Living more than 1 km away from a pharmacy, and 'poor' self-perceived health status were negative predictors of patient satisfaction. Being Māori or of other ethnic minority was also associated with lower satisfaction scores, exploratory analysis suggests patient-pharmacist relationship is an important driver of these differences. Conclusions The high level of patient satisfaction further supports the effectiveness of CPAMS as a delivery model. Patient satisfaction is affected by age, frequency of pharmacy visits, ethnicity, travel distance to pharmacy, and perceived health status. Policy makers and practitioners should consider the characteristics of patients with low levels of satisfaction to improve and enhance CPAMS engagement.

The occurred damages during the past significant earthquakes have proved that vertical seismic excitation has tremendous effect on bridges. Three-component earthquake excitations are preferred to resemble the earthquakes. In this article, a cable-stayed arch bridge, a new type of bridge with the hybrid system of half-through arch and stay-cables, was analyzed under a set of different earthquake excitations (more than 21 ground motion records). Both vertical and horizontal components of the ground motions were considered to act simultaneously at the bridge supports. By using different three-component earthquake excitations, the dynamic responses of the bridge, including the displacements and accelerations of the main parts of the bridge, were obtained. The effects of various parameters such as soil type, epicentral distance, spatial variation of the ground motions, and dimensional variation of the structure were investigated. The results of the numerical study indicate that the cable-stayed arch bridge subjected to both horizontal and vertical components of earthquakes are more vulnerable than those subjected to horizontal ground motion only.

OBJECTIVE: Intraventricular metastatic brain tumors account for a small but challenging fraction of metastatic brain tumors (0.9–4.5%). Metastases from renal cell carcinoma (RCC) account for a large portion of these intraventricular tumors, and while patient outcomes are assumed to be poor, these have not been reported in a modern series with a multimodality treatment paradigm including radiation, resection and CSF diversion. Here we present the first case series of patients with intraventricular metastatic tumors from renal cell carcinoma. METHODS: This is a single institution retrospective review of patients with intraventricular RCC metastases treated between January 2003 and January 2019. Volumetric analysis was used to delineate tumor size, and the Kaplan-Meier method was used to evaluate survival data. RESULTS: Twenty-two intraventricular RCC metastases were identified in 19 patients with 61.3 patient-years of follow up. The median patient age was 64 years, and the median tumor volume was 2.2 cm(3). Overall, 19 metastases were treated initially with radiation. Of these, 16 received stereotactic body radiotherapy (SBRT) and 3 metastases received whole brain radiotherapy. Three tumors were surgically excised and received adjuvant SBRT in the upfront setting. While five patients presented with obstructive hydrocephalus, none required cerebrospinal fluid (CSF) diversion. Following treatment, 5 metastases progressed, resulting in 1- and 3-year progression free survival (PFS) rates of 81.6% and 68%, respectively. The median overall survival was 2.8 years, with 1- and 5-year overall survival rates of 76.7% and 28.3%, respectively. Leptomeningeal carcinomatosis was not observed. CONCLUSIONS: Despite relatively limited overall survival for this population with metastatic cancer, comparable to contemporary parenchymal brain metastasis cohorts, reasonable local CNS control was achieved in the majority of patients using a paradigm of focal irradiation and resection where indicated. Importantly, CSF diversion was not required even in patients presenting with hydrocephalus.

BACKGROUND: Sinonasal mucosal melanoma (SNMM) is an aggressive cancer with high mortality. Identifying patients at risk of distant metastasis assists with management and prognostication. We aimed to define the relationship between volume, survival, and risk of distant metastases. METHODS: A retrospective review of all patients with SNMM treated at a single institution over a 21-year period was conducted. Tumor volume was calculated using cross-sectional imaging and survival analysis was performed. RESULTS: Sixty-one patients were included. Tumor volume was predictive of local progression free survival (LPFS) (p=0.032), distant metastases free survival (DMFS) (p=0.002), and overall survival (OS) (p=0.022). It was a better predictor than AJCC stage and T-classification. Tumor volume equal to or greater than 5cm(3) was associated with a significantly worse DMFS and OS (p=0.022 and 0.009, respectively). CONCLUSION: Calculation of tumor volume assists in quantifying the risk of distant metastases and death in SNMM.

Asthma is a chronic inflammatory disorder caused by T-cell-mediated inflammation within airways. The prevalence of allergic diseases is rapidly increasing so that knowing allergens (characterization and types) and strategies for asthma management, prevention and treatment are very important. The most strategy is the production of recombinant allergens. Many of the problems associated with using natural allergenic products for allergy diagnosis and treatment can be overcome with the use of genetically engineered recombinant allergens. Various recombinant allergens are now emerging as strong candidates for allergen-specific immunotherapy. Extrinsic asthma (a type of asthma) may respond to immunotherapy such as using recombinant allergens. These exciting novel therapies provide not only the promise of new therapies for asthma but also valuable tools for the investigation of asthma mechanisms. This review describes strategies for asthma management, prevention and treatment, and especially recombinant allergens and also recent progresses in the molecular biology of recombinant allergens and then advantage and disadvantage of these allergens are explained. There are many methods for producing allergens such as extraction of serum, Ro/SS-A anti-Ro/SS-A system, Using the Solid-Phase Immunoadsorption system and finally recombinant technology for producing recombinant allergens. Recombinant allergens can express in many systems such as bacteria, yeast, insect cells, animal cells, and transgenic plant. We describe recombinant allergens produced in these systems. The obtained results hold promise that recombinant allergen–based immunotherapy will improve current immunotherapy practice and may open possibilities for new treatment strategies and possibly even for prophylactic vaccination.

The contemporary embrace of endoscopic technology in the approach to the anterior skull base has altered the perioperative landscape for patients requiring pituitary surgery. Utility of a multi-disciplinary unit in management decisions facilitates the delivery of optimal care. Evolution of technology and surgical expertise in pituitary surgery mandates ongoing review of all components of the care central to these patients. The many areas of potential variability in the pre, intra and post-operative timeline of pituitary surgery are readily identifiable. Core undertakings and contemporary controversies in the peri-operative management of patients undergoing endoscopic transsphenoidal pituitary surgery are assessed against the available literature with a view to providing guidance for the best evidence-based practice.

Vertical or inclined cables which are placed in bridges as a hanger system affect the dynamic performance of bridges. Inclined hangers can be used instead of vertical hangers to improve the stability of the bridge aerodynamically. However, inclined hangers are susceptible to fatigue more than vertical ones. Considerable signs of distress or slackness might be shown by some inclined hangers because of their location on the bridge. In this study, a cable-stayed arch bridge with vertical and inclined hangers has been compared to investigate the effect of hangers on the dynamic performance of the bridge. To reduce the internal cable forces and the probability of fatigue or force fluctuation in hangers, additional horizontal cables are applied on inclined hangers that transfer the tensile load from overstressed hangers to adjacent ones with lower forces. By modification, the results demonstrate the higher stiffness and human comfort level for the bridge that improve the dynamic behavior and control the responses of the bridge.

Al·lèrgia; Diagnòstic molecular; Recomanacions Alergia; Diagnóstico molecular; Recomendaciones Allergy; Molecular diagnosis; Recommendations The introduction of molecular diagnosis into routine clinical practice has substantially improved the diagnosis and management of allergic patients by allowing clinicians to precisely identify the allergenic molecule responsible for immunoglobulin E (IgE)-mediated allergies. However, it can be challenging to accurately interpret the results of molecular assays, partly due to the limited evidence base. In this context, a panel of experts with extensive experience in interpreting in vitro measures of total and serum specific IgE reviewed the available scientific evidence. After this review, the panel selected a series of representative case studies to demonstrate how determination of specific and total IgE values and the relationship between them (ratio analysis) can add value to the diagnostic process by more precisely defining the patient’s sensitization profile. Finally, the experts developed a series of recommendations on the clinical application of ratio analysis to optimize and complement the classical approach to allergy diagnosis.

Alternaria alternata is the most important allergenic fungus, with up to 20% of allergic patients affected. The sensitization profile of patients sensitized to A. alternata and how it changes when treated with immunotherapy is not known. Our objective is to determine the allergen recognition pattern of allergic patients to A. alternata and to study its association to the parameters studied in a clinical trial recently published. Sera of 64 patients from the clinical trial of immunotherapy with native major allergen Alt a 1 were analyzed by immunoblotting, 98. 4% of the patients recognized Alt a 1. The percentage of recognition for Alt a 3, Alt a 4, and/or Alt a 6, Alt a 7, Alt a 8, Alt a 10 and/or Alt a 15 was 1.6%, 21.9%, 12.5%, 12.5%, and 12.5% respectively. Of the 64 patients, 45 (70.3%) only recognized Alt a 1 among the allergens present in the A. alternata extract. Immunotherapy with Alt a 1 desensitizes treated patients, reducing their symptoms and medication consumption through the elimination of Alt a 1 sensitization, which is no longer present in the immunoblotting of some patients. There may be gender differences in the pattern of sensitization to A. alternata allergens, among others.

The main objectives of the present study were to describe the injury incidence and to analyze the anthropometric and physical characteristics of players from three high-level women’s football teams. The present study involved 54 female football players (21.9 ± 4.9 years old) from three different teams competing in the Spanish Reto Iberdrola-Segunda División PRO league. A battery of tests was carried out to determine the anthropometric and physical performance characteristics of the players along with an injury incidence record during a full competitive season. The obtained results showed that there was a high incidence of injury, as 38% of the players suffered some type of injury during the season (range 1–5, 1.75 ± 1.02 injuries per player). Injuries occurred in both matches and during training at a similar percentage (48.6 vs. 51.4%), and the majority of the registered episodes were graded as moderate or severe injury types (60%). Players suffering from an injury accumulated a total of 1587 chronological days off work due to injury during the season, with a recurrence rate of 55%. Considering the high incidence of injury, and the injury burden and the reinjure rate observed in this research, it seems necessary to apply the most efficient prevention and recovery measures possible in these female football teams. These descriptive data could serve athletic trainers and medical staff of female football teams to better understand their own screening procedure-derived data.

OBJECTIVE Stereotactic biopsy is increasingly performed on brain metastases (BrMs) as improving cancer outcomes drive aggressive multimodality treatment, including laser interstitial thermal therapy (LITT). However, the tract recurrence (TR) risk is poorly defined in an era defined by focused-irradiation paradigms. As such, the authors aimed to define indications and adjuvant therapies for this procedure and evaluate the BrM-biopsy TR rate. METHODS In a single-center retrospective review, the authors identified stereotactic BrM biopsies performed from 2002 to 2020. Surgical indications, radiographic characteristics, stereotactic planning, dosimetry, pre- and postoperative CNS-directed and systemic treatments, and clinical courses were collected. Recurrence was evaluated using RANO-BM (Response Assessment in Neuro-Oncology Brain Metastases) criteria. RESULTS In total, 499 patients underwent stereotactic intracranial biopsy for any diagnosis, of whom 25 patients (5.0%) underwent biopsy for pathologically confirmed viable BrM, a proportion that increased over the time period studied. Twelve of the 25 BrM patients had ≥ 3 months of radiographic follow-up, of whom 6 patients (50%) developed new metastatic growth along the tract at a median of 5.0 months post-biopsy (range 2.3–17.1 months). All of the TR cases had undergone pre- or early post-biopsy stereotactic radiosurgery (SRS), and 3 had also undergone LITT at the time of initial biopsy. TRs were treated with resection, reirradiation, or observation/systemic therapy. CONCLUSIONS In this study the authors identified a nontrivial, higher than previously described rate of BrM-biopsy tract recurrence, which often required additional surgery or radiation and justified close radiographic surveillance. As BrMs are commonly treated with SRS limited to enhancing tumor margins, consideration should be made, in cases lacking CNS-active systemic treatments, to include biopsy tracts in adjuvant radiation plans where feasible.

Barrier islands and their backbarrier saltmarshes have a reciprocal relationship: aeolian and storm processes transport sediment from the beaches and dunes to create and build marshes along the landward fringe of the island. In turn, these marshes exert a stabilizing influence on the barrier by widening the barrier system and forming a platform onto which the island migrates, consequently slowing landward barrier migration and inhibiting storm breaching. Here, we present a novel framework for applying these natural interdependencies to managing coastal systems and enhancing barrier-island resilience. Further, we detail application of these principles through a case study of the design of a marsh creation project that showcases the interdisciplinary engagement of scientists, engineers, stakeholders, and policymakers. Specifically, we describe: (1) the ecologic, sedimentologic, stratigraphic, and morphologic data obtained from the southern 4 km of Cedar Island (Virginia, United States) and nearby backbarrier tidal channels, tidal flats, and flood-tidal deltas, and (2) the use of those data to develop an engineering and design plan for the construction of a high (46 ha) and low (42 ha) fringing marsh platform located behind the island, proximal to a former ephemeral inlet. Additionally, we chronicle the process used to narrow five initial alternative designs to the optimal final plan. This process involved balancing best-available existing science and models, considering design and financial constraints, identifying stakeholder preferences, and maximizing restoration benefits of habitat provision and shoreline protection. Construction of this marsh would: (1) provide additional habitat and ecosystem benefits, (2) slow the rapid migration (up to 15 m/yr at present) of the barrier island, and (3) hinder island breaching. Ultimately, this project – presently at the final design and permitting stage – may enhance the storm and sea-level rise resilience of the island, backbarrier marshes and lagoons, and the mainland town community; and provide an example of a novel science-based approach to coastal resilience that could be applied to other global barrier settings.

PURPOSE: To assess automatic sleep staging of three ear-EEG setups with different electrode configurations and compare performance with concurrent polysomnography and wrist-worn actigraphy recordings.METHODS: Automatic sleep staging was performed for single-ear, single-ear with ipsilateral mastoid, and cross-ear electrode configurations, and for actigraphy data. The polysomnography data were manually scored and used as the gold standard. The automatic sleep staging was tested on 80 full-night recordings from 20 healthy subjects. The scoring performance and sleep metrics were determined for all ear-EEG setups and the actigraphy device.RESULTS: The single-ear, the single-ear with ipsilateral mastoid setup, and the cross-ear setup performed five class sleep staging with kappa values 0.36, 0.63, and 0.72, respectively. For the single-ear with mastoid electrode and the cross-ear setup, the performance of the sleep metrics, in terms of mean absolute error, was better than the sleep metrics estimated from the actigraphy device in the current study, and also better than current state-of-the-art actigraphy studies.CONCLUSION: A statistically significant improvement in both accuracy and kappa was observed from single-ear to single-ear with ipsilateral mastoid, and from single-ear with ipsilateral mastoid to cross-ear configurations for both two and five-sleep stage classification. In terms of sleep metrics, the results were more heterogeneous, but in general, actigraphy and single-ear with ipsilateral mastoid configuration were better than the single-ear configuration; and the cross-ear configuration was consistently better than both the actigraphy device and the single-ear configuration.

Objectives Leishmaniosis is a vector-borne disease and in European countries is caused by Leishmania infantum. Cats are considered secondary reservoirs of the infection in endemic areas. The objective of this retrospective study is to describe the clinical findings, diagnosis, treatment and outcome of feline leishmaniosis (FeL) in 16 cats in Spain. Methods Medical records of cats diagnosed with leishmaniosis were retrospectively reviewed for cases that met the following inclusion criteria: identification of Leishmania organisms and/or DNA on cytological and/or histological specimens and/or a high anti- Leishmania antibody titre, compatible clinical findings and pathological abnormalities. Results Sixteen cats met the inclusion criteria, all of which were living in areas endemic for canine leishmaniosis. Systemic signs were present in 11 cases (68.8%). The most common clinical signs on presentation included cutaneous lesions in 12 cats (75%), ocular disease in six cats (37.5%) and anorexia in six cats (37.5%). A polyclonal gammopathy was noted in 12 cats (85.7%). Non-regenerative anaemia and renal abnormalities were present in six (37.5%) and five patients (31.3%), respectively. In nine cats (56.3%), immunosuppressive conditions/comorbidities were identified. The diagnosis was made in eight of the cats (50%) by cytology, but a combination of diagnostic tests was needed for definitive diagnosis in the remaining patients. Twelve cats (75%) were treated specifically for leishmaniosis. Five of the 12 cats (41.7%) did not improve with treatment. The median survival time in the group of patients treated specifically for leishmaniosis was 17 months. Median survival of patients treated with concomitant diseases was 13 months vs 41 months in those without, although this was not statistically significant ( P = 0.557). Conclusions and relevance Presentation of FeL appears to be similar to canine leishmaniosis but with some specific features: ulcerative and nodular skin lesions are the predominant cutaneous signs; cats with immunosuppressive conditions or coexisting diseases were more commonly present than typically seen in dogs (mainly feline immunodeficiency virus). A combination of diagnostic tests may be needed for definitive diagnosis.

International audience; Most of researchers have already studied and discussed the power sharing and synchronization of several generation systems connected to a unique point of common coupling (PCC) to which the loads are also connected. A high penetration rate of distributed generation systems (DGs) based on renewable energies has for logic consequence the development and setting up of networked multi-PCC microgrids. In this paper an improved droop control method for synchronization as well as active and reactive power sharing of different DGs in multiple PCC islanded microgrids is proposed while the real characteristics of the line feeders are taken into account. The simulation results confirm the feasibility and effectiveness of the proposed strategies for synchronization and interconnection of different microgrid DGs, while insuring accurate sharing of the DGs active and reactive powers. 

Radiographic changes of brain metastases after stereotactic radiosurgery (SRS) can signify tumor recurrence and/or radiation necrosis (RN); however, standard imaging modalities cannot easily distinguish between these two entities. We investigated whether 18F-Fluorocholine uptake in surgical samples of the resected lesions correlates with pathologic evidence of recurrent tumor and PET imaging. About 14 patients previously treated with SRS that developed radiographic changes were included. All patients underwent a preoperative 40-min dynamic PET/CT concurrent with 392 ± 11 MBq bolus injection of 18F-Fluorocholine. 18F-Fluorocholine pharmacokinetics were evaluated by standardized uptake value (SUV), graphical analysis (Patlak plot; KiP) and an irreversible two-compartment model (K1, k2, k3, and Ki). 12 out of 14 patients were administered an additional 72 ± 14 MBq injection of 18F-Fluorocholine 95 ± 26 minutes prior to surgical resection. About 113 resected samples from 12 patients were blindly reviewed by a neuropathologist to assess the viable tumor and necrotic content, microvascular proliferation, reactive gliosis, and mono- and polymorphonuclear inflammatory infiltrates. Correlation between these metrics 18F-Fluorocholine SUV was investigated with a linear mixed model. Comparison of survival distributions of two groups of patients (population median split of PET SUVmax) was performed with the log-rank test. Exactly 10 out of 12 patients for which surgical samples were acquired exhibited pathologic recurrence. Strong correlation was observed between SUVmax as measured from a surgically removed sample with highest uptake and by PET (Pearson’s r = 0.66). Patients with 18F-Fluorocholine PET SUVmax > 6 experienced poor survival. Surgical samples with viable tumor had higher 18F-fluorocholine uptake (SUV) than those without tumor (4.5 ± 3.7 and 2.6 ± 3.0; p = 0.01). 18F-fluorocholine count data from surgical samples is driven not only by the percentage viable tumor but also by the degree of inflammation and reactive gliosis (p ≤ 0.02; multivariate regression). 18F-Fluorocholine accumulation is increased in viable tumor; however, inflammation and gliosis may also lead to elevated uptake. Higher 18F-Fluorocholine PET uptake portends worse prognosis. Kinetic analysis of dynamic 18F-Fluorocholine PET imaging supports the adequacy of the simpler static SUV metric.

This study aimed to investigate training-induced fitness changes and their relationship with training-competition load during half a soccer season (18 wks). Training load [heart rate (HR) and ratings of perceived exertion (RPE)] and match time were monitored, including 108 training (3 223 individuals) and 23 match sessions, in 38 youth elite male soccer players. Fitness variables were assessed before and after the study. Yo-Yo intermittent recovery test 1 (Yo-Yo IRT1) improved (P

Background Patients with pituitary metastasis (PM) have a relatively poor prognosis. We describe the presentation, management, and outcomes of patients with PM. Subjects, Materials, and Methods We performed a retrospective review of patients diagnosed with PM at a single institution from 1996 to 2015. Eighty-five patients diagnosed with metastasis to the pituitary or sella turcica by pathology or based on a combination of neuroimaging and clinical findings were included. Univariate and multivariable Cox regressions evaluated associations between clinical factors and overall survival. Results The most frequent sites of primary malignancies resulting in PM were lung (26%) and breast (26%). Median age at diagnosis was 60 years (range, 18–95). The most common complaints at diagnosis included visual deficits (62%), headache (47%), and cranial nerve palsy (31%). Seventy percent of patients had pituitary insufficiency—adrenal insufficiency (59%), hypothyroidism (59%), or diabetes insipidus (28%). Management of PM included radiation therapy (76%), chemotherapy (68%), surgical resection (21%), or combination therapy (71%). Fifty percent and 52% of patients who received surgical treatment and irradiation, respectively, reported symptomatic improvement. Median overall survival (OS) was 16.5 months (95% confidence interval: 10.7–25.4). On multivariable analysis, a primary cancer site other than lung or breast (p = .020), age Conclusion Patients Implications for Practice This study is the largest original series of patients with metastatic disease to the sella. In patients with pituitary metastasis, younger age, primary site other than lung or breast, and metastatic resection may prolong survival. Resection and radiation led to symptomatic improvement in ∼50% of patients. Seventy percent of patients had hypopituitarism. These hormonal deficiencies can be life threatening and can result in substantial morbidity if left untreated. Patients should be treated using a multimodality approach—including a potential role for surgery, radiation, chemotherapy, and hormone replacement—with the goal of improving survival and quality of life.

Sleep is a key phenomenon to both understanding, diagnosing and treatment of many illnesses, as well as for studying health and well being in general. Today, the only widely accepted method for clinically monitoring sleep is the polysomnography (PSG), which is, however, both expensive to perform and influences the sleep. This has led to investigations into light weight electroencephalography (EEG) alternatives. However, there has been a substantial performance gap between proposed alternatives and PSG. Here we show results from an extensive study of 80 full night recordings of healthy participants wearing both PSG equipment and ear-EEG. We obtain automatic sleep scoring with an accuracy close to that achieved by manual scoring of scalp EEG (the current gold standard), using only ear-EEG as input, attaining an average Cohen’s kappa of 0.73. In addition, this high performance is present for all 20 subjects. Finally, 19/20 subjects found that the ear-EEG had little to no negative effect on their sleep, and subjects were generally able to apply the equipment without supervision. This finding marks a turning point on the road to clinical long term sleep monitoring: the question should no longer be whether ear-EEG could ever be used for clinical home sleep monitoring, but rather when it will be.

Background: Weight disorders are highly prevalent at the global level. Vitamin B groups are clearly involved in intracellular mechanisms, energy equation, and weight gain. The present study aims to evaluate the association of dietary vitamin B intake and obesity in a large pediatric population. Methods: This cross-sectional study was conducted among children and adolescents, aged 6-18years, living in urban and rural areas of 30 provinces of Iran. The BMI-for-age classifications were as follow: percentile

Scholars have only recently started to take an interest in the return of highly qualified migrants to their country of origin, especially when it comes to Arab countries. This research, conducted between 2014 and 2016, provides evidence on the Lebanese case, a country where most social scientists have been trained abroad. This article uses a multi-level approach and compares careers paths of social scientists trained in Lebanon and abroad, working in Lebanese public and private universities. If a foreign diploma appears as a significant factor of career differentiation, the analysis undertaken in this article nuances this finding. It reveals to what extent the characteristics of the academic field in origin countries such as Lebanon shape the career paths of academics. Public and, to a lesser extent private universities have become ideological state apparels which are used by the ruling elites to ensure their reproduction, through the revaluation of social capital. However, this reproduction is not made without social actors and their involvement. Lebanese academics develop strategies to accumulate the relevant symbolic capital in order to be recruited or promoted. The activation of the relevant political and sectarian networks is, therefore, one of the key strategies which social scientists mobilise as a first or last resort to acquire university positions.

A time series study of the electrical energy generated by wind turbines and solar cells shows that the energy produced has a lot of fluctuations due to the geographic conditions. These ups and downs have caused not only the share of these sources to be marginal, but also they lead to the volatility of electric power plants. By examining several different data from different countries and regions with the frequency of second and minute, we show that different scale behaviors exist at different time intervals and reveal their other random and nonlinear characteristics. We also compare the non-Gaussian behavior of these regions together, showing that studying the properties of such data helps us to better measure the incidence of these energies

Progressive collapse is a continuous spread of initial local failure from one member to another one, finally causing the collapse of the structure entirely or a disproportionately large part of it. This disproportionate collapse is due to the small initial local failure induced by unpredicted attacks, exhibiting that the structural system cannot resist the development of damage due to the insufficient load carrying capacity. In this study, a typical suspension bridge was modeled and analyzed under explosion load. For this purpose, different scenarios were investigated. Forces and moments of the superstructure, responses and the stability of the structure under the applied loads were studied. Explosion applied on the structure depends on the amount of the load and local effects. Also, by removing one or several elements of structures, the force is distributed in the whole structure. For loading rate on different positions of the structure, it was observed that the critical position would be under the explosion and towers adjacent. Towers adjacent and the middle of the deck were prone to the maximum influences where should be put more attention on and be reinforced to preserve the structure from the total and local failure.

There has been exciting progress in diagnosis and in the treatment of allergic patients. The objective of this review is to summarize the most relevant contributions in the past 10 years with a special focus on the pediatric population allergic to aeroallergens and provide the most relevant references and practical issues for the decision-making. Current guidelines on allergy diagnosis recommend a thorough clinical history as the first step, followed by allergen extract testing using an in vivo prick test and/or an in vitro specific IgE test. Molecular diagnosis is recommended when previous tests are inconclusive. In practice, the most important factors to decide the AIT treatment are the actual intensity and duration of the patient's symptoms and the availability of appropriate AIT products for the patient's sensitization profile at high allergen concentrations and with confirmed efficacy and safety from clinical trials. This document summarizes outstanding references for allergic immunotherapy decision-making and provides summary tables and figures analyzing the most important factors related to the decision for allergen immunotherapy and the safety risks related. The experts concluded that AIT is efficacious and safe for the treatment of allergic patients that is available for the most frequent aeroallergens.What is Known:• The prevalence of allergic asthma and rhinitis in children has increased in recent decades.• The efficacy and safety of allergen immunotherapy has been shown in multiple studies and systematic reviews.What is New:• This document summarizes outstanding references for allergic immunotherapy decision-making and provides summary tables and figures analyzing the most important factors related to the decision for allergen immunotherapy and the safety risks related. Recommendations of expert authors for the decision of the patients more suitable for allergen immunotherapy are included.

The current research seeks to examine the effect of interior architecture on the illuminance of a specific space. Although the existing literature has investigated the effect of the window’s placem...

Context Pituitary adenomas (PA) are often irregularly shaped, particularly posttreatment. There are no standardized radiographic criteria for assessing treatment response, substantially complicating interpretation of prospective outcome data. Existing imaging frameworks for intracranial tumors assume perfectly spherical targets and may be suboptimal. Objective To compare a three-dimensional (3D) volumetric approach against accepted surrogate measurements to assess PA posttreatment response (PTR). Design Retrospective review of patients with available pre- and postradiotherapy (RT) imaging. A neuroradiologist determined tumor sizes in one dimensional (1D) per Response Evaluation in Solid Tumors (RECIST) criteria, two dimensional (2D) per Response Assessment in Neuro-Oncology (RANO) criteria, and 3D estimates assuming a perfect sphere or perfect ellipsoid. Each tumor was manually segmented for 3D volumetric measurements. The Hakon Wadell method was used to calculate sphericity. Setting Tertiary cancer center. Patients or Other Participants Patients (n = 34, median age = 50 years; 50% male) with PA and MRI scans before and after sellar RT. Interventions Patients received sellar RT for intact or surgically resected lesions. Main Outcome Measure(s) Radiographic PTR, defined as percent tumor size change. Results Using 3D volumetrics, mean sphericity = 0.63 pre-RT and 0.60 post-RT. With all approaches, most patients had stable disease on post-RT scan. PTR for 1D, 2D, and 3D spherical measurements were moderately well correlated with 3D volumetrics (e.g., for 1D: 0.66, P < 0.0001) and were superior to 3D ellipsoid. Intraclass correlation coefficient demonstrated moderate to good reliability for 1D, 2D, and 3D sphere (P < 0.001); 3D ellipsoid was inferior (P = 0.009). 3D volumetrics identified more potential partially responding and progressive lesions. Conclusions Although PAs are irregularly shaped, 1D and 2D approaches are adequately correlated with volumetric assessment.

Geometrical variation is the main cause of the aesthetic and functional problems in the product geometry. Variation and disturbances are caused by several sources during the manufacturing process. In the automotive industry, one of the main sources of variation is the spot welding sequence. Optimising this sequence is of combinatorial Nondeterministic Polynomial (NP)-hard problems. In a typical automotive sheet metal assembly, there are a large number of spot welds. Today, if the number of spot welds in a sub-assembly is more than 10, the sequence optimisation will be a challenging and time-consuming task. Therefore, industry is mainly dependent on the experiential approach or simultaneous welding simulations for predicting the geometrical outcome. In this paper, a method is introduced to identify the geometry weld points to reduce the optimisation problem size in a geometry assurance digital twin context. This method is then applied to three automotive body-in-white assemblies and optimisation is performed. The results show that reducing the size of the problem by the proposed approach can help to save a considerable amount of time while getting geometrical outcomes within the satisfactory error levels.

Seasonal influenza causes substantial morbidity and mortality in China, which largely results from limited vaccine accessibility and poor vaccination coverage. Since 2013, Sanofi Pasteur’s facilities in Shenzhen, China have produced a trivalent inactivated influenza vaccine (Shz-IIV3) for each influenza season according to Chinese pharmacopeia requirements. However, the immunogenicity of Shz-IIV3 has not been compared to existing Chinese trivalent inactivated influenza vaccines (IIV3s). Here, we describe the results of a phase IV, observer-blind, randomized study to evaluate whether the immunogenicity of Shz-IIV3 was non-inferior to a comparator IIV3 (Hualan Biological Engineering Inc) also manufactured and licensed in China. Healthy adults aged 18−59 years were randomly assigned in a 1:1 ratio to receive a single 0.5-mL intramuscular injection of the 2017–2018 Northern Hemisphere formulation of Shz-IIV3 (n = 800) or the comparator IIV3 (n = 799). Between baseline and day 28 after vaccination, hemagglutination inhibition titers for the three vaccine strains increased by at least 4-fold and were of similar magnitude in Shz-IIV3 and comparator IIV3 recipients. The rate of seroconversion or significant increase in titers was 62% to 92% in Shz-IIV3 recipients, and 63% to 91% in comparator IIV3 recipients. Post-vaccination hemagglutination inhibition titers and seroconversion rates for Shz-IIV3 were statistically non-inferior to the comparator IIV3 for all three influenza vaccine strains. Rates of solicited and unsolicited vaccine-related adverse events were similar between the two vaccine groups. These results demonstrated that Shz-IIV3 was as immunogenic and safe in adults as a comparator Chinese IIV3, and support the continued use of Shz-IIV3 in China.

Microgrids are designed to operate at a fundamental frequency (50 or 60 Hz). However, certain types of loads generate voltage and/or current harmonics that increase power system heat losses. These harmonic losses reduce system efficiency, cause apparatus overheating and increase power costs. Besides that, the Distributed Generation (DG) is expected to play an important role in future power systems, since it is able to reduce losses, improve power quality to end users. In this paper we propose new harmonic droop controller to compensate the harmonic currents produced by each DG to feed the nonlinear loads. Furthermore, the proposed controller is able to damp the total harmonic distortion of the voltage at the common connection point (PCC). Modeling and simulations incorporate to define the best control parameters for a proper operation. Experimental results are given to show the efficiency of the proposed algorithm.