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Abstract Rapid urbanization has a great impact on avian distribution, ecology, habitat selection, and behavior. Recent avian studies indicated that individuals remain consistent in their behavioral responses to human disturbance across short periods of time. However, there is still little information about keeping consistent behaviors in distinct locations across different stages of the annual cycle. In this study, we aimed to test for long-term consistency in habitat selection with respect to urbanization in a migratory waterbird species, the Eurasian coot Fulica atra. For this purpose, we individually marked ca. 300 coots from four populations that varied in urbanization level and tracked their habitat preferences during the non-breeding season. We found that individuals from urban breeding populations selected habitats with a higher share of artificial areas during the non-breeding season, when compared to non-urban individuals. Also, a comparison of non-breeding sites selected by birds from our study populations with random sites showed that urban birds selected sites with higher urbanization level than resulting from random availability. Finally, we found a seasonal variation in habitat preferences in coots—individuals from all study populations selected more urbanized areas as the non-breeding season progressed. The results indicate that birds are able to remain consistent in habitat preferences not only at a large geographical scale, but also across different seasons. Marked between-population variation in habitat selection across the annual cycle may reflect personality differences of coots from urban and non-urban populations, and it stays in line with the personality-matching habitat choice hypothesis.

Currently, we can see a rapid decline of agricultural land with new uses, especially for construction purposes. This negative trend is evident across Europe, the Czech Republic has the fastest loss of land in the EU. One reason for the significant loss of agricultural land is building industrial zones, which utilises of greenfield areas, and their occupying new areas of agricultural land, often the most the most fertile. The analysis deals with the occupied area (the area of a particular industrial zone), the percentage utilisation of that industrial zone, the number of employees in the industrial zone, and the land quality expressed by means of the agricultural land protection class. The results of the analysis show the low usability of industrial zones, the large occupation of the agricultural land, and the low benefits to the Czech state and Czech citizens. The results also show the poor land use policy in relation to the soil protection. This work is followed by the project Sustainable management of natural resources with an emphasis on non-production and production ability of the soil, the results of which will be included in legislation and be binding for spatial planning.

BackgroundThe use of telehealth technology to improve functional recovery following transcatheter aortic valve implantation (TAVI) has not been investigated. ObjectiveIn this study, we aimed to examine the feasibility of exercise-based cardiac telerehabilitation after TAVI. MethodsThis was a single-center, prospective, nonrandomized study using a mixed methods approach. Data collection included testing, researchers’ observations, logbooks, and individual patient interviews, which were analyzed using a content analysis approach. The intervention lasted 3 weeks and consisted of home-based web-based exercise training, an activity tracker, a TAVI information website, and 1 web-based session with a nurse. ResultsOf the initially included 13 patients, 5 (40%) completed the study and were interviewed; the median age was 82 (range 74-84) years, and the sample comprised 3 men and 2 women. Easy access to supervised exercise training at home with real-time feedback and use of the activity tracker to count daily steps were emphasized by the patients who completed the intervention. Reasons for patients not completing the program included poor data coverage, participants’ limited information technology skills, and a lack of functionality in the systems used. No adverse events were reported. ConclusionsExercise-based telerehabilitation for older people after TAVI, in the population as included in this study, and delivered as a web-based intervention, does not seem feasible, as 60% (8/13) of patients did not complete the study. Those completing the intervention highly appreciated the real-time feedback during the web-based training sessions. Future studies should address aspects that support retention rates and enhance patients’ information technology skills.

Summary: Successful manufacture of specialized human cells requires process understanding of directed differentiation. Here, we apply high-dimensional Design of Experiments (HD-DoE) methodology to identify critical process parameters (CPPs) that govern neural territory patterning from pluripotency—the first stage toward specification of central nervous system (CNS) cell fates. Using computerized experimental design, 7 developmental signaling pathways were simultaneously perturbed in human pluripotent stem cell culture. Regionally specific genes spanning the anterior-posterior and dorsal-ventral axes of the developing embryo were measured after 3 days and mathematical models describing pathway control were developed using regression analysis. High-dimensional models revealed particular combinations of signaling inputs that induce expression profiles consistent with emerging CNS territories and defined CPPs for anterior and posterior neuroectoderm patterning. The results demonstrate the importance of combinatorial control during neural induction and challenge the use of generic neural induction strategies such as dual-SMAD inhibition, when seeking to specify particular lineages from pluripotency.

Summary: MED13L syndrome is a haploinsufficiency developmental disorder characterized by intellectual disability, heart malformation, and hypotonia. MED13L controls transcription by tethering the cyclin C-Cdk8 kinase module (CKM) to the Mediator complex. In addition, cyclin C has CKM-independent roles in the cytoplasm directing stress-induced mitochondrial fragmentation and regulated cell death. Unstressed MED13LS1497F/fs patient fibroblasts exhibited aberrant cytoplasmic cyclin C localization, mitochondrial fragmentation, and a 6-fold reduction in respiration. In addition, the fibroblasts exhibited reduced mtDNA copy number, reduction in mitochondrial membrane integrity, and hypersensitivity to oxidative stress. Finally, transcriptional analysis of MED13L mutant fibroblasts revealed reduced mRNA levels for several genes necessary for normal mitochondrial function. Pharmacological or genetic approaches preventing cyclin C-mitochondrial localization corrected the fragmented mitochondrial phenotype and partially restored organelle function. In conclusion, this study found that mitochondrial dysfunction is an underlying defect in cells harboring the MED13LS1497F/fs allele and identified cyclin C mis-localization as the likely cause. These results provide a new avenue for understanding this disorder.

The paper discusses a new design of a current–mode reconnection–less reconfigurable fractional–order (FO) low–pass filter of various orders. The filtering structure is based on a 4th–order leap–frog topology using operational transconductance amplifiers as basic building blocks. The resulting order of the filter is given by the setting of current gains (allowing the reconnection–less reconfiguration) alongside with the values of the fractional–order capacitors realized by the RC ladder networks. For this purpose, RC ladder networks of orders 0.3, 0.4, 0.5, 0.6 and 0.7 have been designed. The fractional–order form of the filter contains from one up to four FO capacitors (remaining capacitors (if there are any) are of integer–order) allowing to obtain low–pass functions of order of 3 + α, 2 + α, 1 + α, 2 + α + β, 1 + α + β, α + β, 1 + α + β + γ, α + β + γ and α + β + γ + δ. The proposed filter offers a wide variety of possible order combinations with an increasing degree of freedom as the number of fractional–order capacitors within the structure increases. The proposal is supported by the PSpice simulations of magnitude and phase characteristics, pole frequency adjustment and stability analysis. Moreover, the experimental measurements of the implemented filter were carried out and compared with the simulation results. The possibility of the electronic control of the fractional order is also discussed and presented.

Abstract Background The Roma are a European ethnic minority threatened by several recessive diseases. Variants in MANBA cause a rare lysosomal storage disorder named beta-mannosidosis whose clinical manifestation includes deafness and mental retardation. Since 1986, only 23 patients with beta-mannosidosis and biallelic MANBA variants have been described worldwide. Results We now report on further 10 beta-mannosidosis patients of Roma origin from eight families in the Czech and Slovak Republics with hearing loss, mental retardation and homozygous pathogenic variants in MANBA. MANBA variant c.2158-2A>G screening among 345 anonymized normal hearing controls from Roma populations revealed a carrier/heterozygote frequency of 3.77%. This is about 925 times higher than the frequency of this variant in the gnomAD public database and classifies the c.2158-2A>G variant as a prevalent, ethnic-specific variant causing hearing loss and mental retardation in a homozygous state. The frequency of heterozygotes/carriers is similar to another pathogenic variant c.71G>A (p.W24*) in GJB2, regarded as the most frequent variant causing deafness in Roma populations. Conlcusion Beta-mannosidosis, due to a homozygous c.2158-2A>G MANBA variant, is an important and previously unknown cause of hearing loss and mental retardation among Central European Roma.

Abstract Background Early recognition and treatment of sepsis is crucial to prevent detrimental outcomes. General practitioners (GPs) are often the first healthcare providers to encounter seriously ill patients. The aim of this study is to assess the value of clinical information and additional tests to develop a clinical prediction rule to support early diagnosis and management of sepsis by GPs. Methods We will perform a diagnostic study in the setting of out-of-hours home visits in four GP cooperatives in the Netherlands. Acutely ill adult patients suspected of a serious infection will be screened for eligibility by the GP. The following candidate predictors will be prospectively recorded: (1) age, (2) body temperature, (3) systolic blood pressure, (4) heart rate, (5) respiratory rate, (6) peripheral oxygen saturation, (7) mental status, (8) history of rigors, and (9) rate of progression. After clinical assessment by the GP, blood samples will be collected in all patients to measure C-reactive protein, lactate, and procalcitonin. All patients will receive care as usual. The primary outcome is the presence or absence of sepsis within 72 h after inclusion, according to an expert panel. The need for hospital treatment for any indication will be assessed by the expert panel as a secondary outcome. Multivariable logistic regression will be used to design an optimal prediction model first and subsequently derive a simplified clinical prediction rule that enhances feasibility of using the model in daily clinical practice. Bootstrapping will be performed for internal validation of both the optimal model and simplified prediction rule. Performance of both models will be compared to existing clinical prediction rules for sepsis. Discussion This study will enable us to develop a clinical prediction rule for the recognition of sepsis in a high-risk primary care setting to aid in the decision which patients have to be immediately referred to a hospital and who can be safely treated at home. As clinical signs and blood samples will be obtained prospectively, near-complete data will be available for analyses. External validation will be needed before implementation in routine care and to determine in which pre-hospital settings care can be improved using the prediction rule. Trial registration The study is registered in the Netherlands Trial Registry (registration number NTR7026 ).

We use many classical results known for the self-adjoint second-order linear equation and extend them for a three-term even order linear equation with a delay applied to coefficients. We derive several conditions concerning the oscillation and the existence of positive solutions. Our equation for a choice of parameter is diconjugate, and for a different choice can have positive and oscillatory solutions at the same time. However, it is still, in a sense, disconjugate if we use a weaker definition of oscillation.

This paper introduces design of the linearly tunable quadrature voltage-controlled oscillator (VCO) using modern off-the-shelf active elements suitable for the design of electronically adjustable applications. The simplified topology was achieved using non-inertial stabilization of amplitude. It allows targeting adjustability of the oscillation frequency only into lossless integrator part of the topology. This arrangement simplifies the design and the tenability also. Derived symbolical expressions indicate that gain adjustment of used amplifiers (that are still in single path) does not influence amplitude and phase shift ratio of generated waveforms, which is a beneficial feature. The performances of the circuit are tested experimentally in band of units of MHz and results confirmed expected behavior. Initial study of the oscillator with fractional-order capacitors is presented and discussed. Results are supported by laboratory measurements.

In the aftermath of a large Q fever (QF) epidemic in the Netherlands during 2007–2010, new chronic QF (CQF) patients continue to be detected. We developed a health-economic decision model to evaluate the cost-effectiveness of a 1-time screening program for CQF 7 years after the epidemic. The model was parameterized with spatial data on QF notifications for the Netherlands, prevalence data from targeted screening studies, and clinical data from the national QF database. The cost-effectiveness of screening varied substantially among subpopulations and geographic areas. Screening that focused on cardiovascular risk patients in areas with high QF incidence during the epidemic ranged from cost-saving to €31,373 per quality-adjusted life year gained, depending on the method to estimate the prevalence of CQF. The cost per quality-adjusted life year of mass screening of all older adults was €70,000 in the most optimistic scenario.

Abstract Background Widespread use of intraoperative epicardial ultrasonography (ECUS) for quality assessment of coronary artery bypass graft anastomoses during coronary artery bypass grafting (CABG) has not occurred - presumably due to technological and practical challenges including the need to maintain stable and optimal acoustic contact between the ultrasound probe and the target without the risk of distorting the anastomosis. We investigated the feasibility of using a stabilizing device during ultrasound imaging of distal coronary bypass graft anastomoses in patients undergoing on-pump CABG. Imaging was performed in both the longitudinal and transverse planes. Methods Single-centre, observational prospective feasibility study among 51 patients undergoing elective, isolated on-pump CABG. Ultrasonography of peripheral coronary bypass anastomoses was performed using a stabilizing device upon which the ultrasound transducer was connected. Transit-time flow measurement (TTFM) was also performed. Descriptive statistical tests were used. Results Longitudinal and transverse images from the heel, middle and toe were obtained from 134 of 155 coronary anastomoses (86.5%). After the learning curve (15 patients), all six projections were obtained from 100 of 108 anastomoses scanned (93%). Failure to obtain images were typical due to a sequential curved graft with anastomoses that could not be contained in the straight cavity of the stabilizing device, echo artefacts from a Titanium clip located in the roof of the anastomoses, and challenges in interpreting the images during the learning curve. No complications were associated with the ECUS procedure. The combined ECUS and TTFM resulted in immediate revision of five peripheral anastomoses. Conclusions Peroperative use of a stabilizing device during ultrasonography of coronary artery bypass anastomoses in on-pump surgery facilitates imaging and provides surgeons with non-deformed longitudinal and transverse images of all parts of the anastomoses in all coronary territories. Peroperative ECUS in addition to flow measurements has the potential to increase the likelihood of detecting technical errors in constructed anastomoses. Trial registration The study was registered on September 29, 2016, ClinicalTrials.gov ID: NCT02919124.

This paper introduces a novel electronic system for simplex low-bitrate infra-red (IR) communication applications. The transmitter is implemented completely by analog building blocks, formed with the help of a recently fabricated chip that includes active elements allowing various modular interconnections. For the design of this chip, the ON Semiconductor C035 0.35μm I3T25 technology was chosen due to the trade-off between cost, efficiency and obtainable parameters. The designed transmitter operates as a voltageto-duty cycle converter, using pulse width modulation that causes ON/OFF keying of the carrier signal for infra-red (IR) diode. The duty cycle variable between 7% and 83% is modulated by the input voltage (in the range of ±0.8 V) of the transmitter. The use case of the proposed concept in the measurement of illuminance within the range of 30 lx and 550 lx is also presented. The quality of the transmission was evaluated as the error between the transmitted and received values of the duty cycle (kept mostly below 10 %). The maximal power consumption of the transmitter reaches 180 mW.

This paper presents a new concept of a capacitance multiplier using the topology of differential voltage buffer and current conveyor, where the capacitor is connected to the current input terminal. The presented topology overcomes the typical issue known from similar solutions, i.e. creation of an undesired lossy character of the impedance plot. The added feedback path in the structure serves for minimization of the serial parasitic resistance of the current input terminal as well as the output resistance of differential voltage buffer. The electronic driving of the current and voltage internal gains of the active elements allows the adjustment of the capacitance multiplication factor as well as readjustment of the overall capacitance structure between the lossy and lossless modes of operation. The adjustment of the multiplication factor intentionally targets low ranges of gains. Despite that the multiplication factor equals or is less than 1, the range of adjustability is very wide. Simple modifications of the proposed concept leading to the differential-mode operation and enhancement of the multiplication factor are shown and explored. They were experimentally tested in more than 2 decades, from 0.03 to 5.8 nF, and controlled by single DC voltage from 0.1 to 1.0 V. The outputs of experimental measurements meet with the PSpice simulations and confirm the design validity.

ObjectivesTo evaluate the prognostic value of the coefficient of variance of axial light loss of monocytes (cv-ALL of monocytes) for adverse clinical outcomes in patients suspected of infection in the emergency department (ED).MethodsWe performed an observational, retrospective monocenter study including all medical patients ≥18 years admitted to the ED between September 2016 and June 2019 with suspected infection. Adverse clinical outcomes included 30-day mortality and ICU/MCU admission ResultsA total of 3526 of patients were included. The OR for cv-ALL of monocytes alone was 2.21 (1.98-2.47) for 30-day mortality and 2.07 (1.86-2.29) for ICU/MCU admission ConclusionsCv-ALL of monocytes is a readily available biomarker that is useful as prognostic marker to predict 30-day mortality. Furthermore, it can be used to improve routine prediction of adverse clinical outcomes at the ED.Clinical trial registrationRegistered in the Dutch Trial Register (NTR) und number 6916.

BackgroundThe ability to accurately distinguish bacterial from viral infection would help clinicians better target antimicrobial therapy during suspected lower respiratory tract infections (LRTI). Although technological developments make it feasible to rapidly generate patient-specific microbiota profiles, evidence is required to show the clinical value of using microbiota data for infection diagnosis. In this study, we investigated whether adding nasal cavity microbiota profiles to readily available clinical information could improve machine learning classifiers to distinguish bacterial from viral infection in patients with LRTI.ResultsVarious multi-parametric Random Forests classifiers were evaluated on the clinical and microbiota data of 293 LRTI patients for their prediction accuracies to differentiate bacterial from viral infection. The most predictive variable was C-reactive protein (CRP). We observed a marginal prediction improvement when 7 most prevalent nasal microbiota genera were added to the CRP model. In contrast, adding three clinical variables, absolute neutrophil count, consolidation on X-ray, and age group to the CRP model significantly improved the prediction. The best model correctly predicted 85% of the 'bacterial' patients and 82% of the 'viral' patients using 13 clinical and 3 nasal cavity microbiota genera (Staphylococcus, Moraxella, and Streptococcus).ConclusionsWe developed high-accuracy multi-parametric machine learning classifiers to differentiate bacterial from viral infections in LRTI patients of various ages. We demonstrated the predictive value of four easy-to-collect clinical variables which facilitate personalized and accurate clinical decision-making. We observed that nasal cavity microbiota correlate with the clinical variables and thus may not add significant value to diagnostic algorithms that aim to differentiate bacterial from viral infections.

Efficient separation and sensitive identification of pathogenic bacterial strains is essential for a prosperous modern society, with direct applications in medical diagnostics, drug discovery, biodefense, and food safety. We developed a fast and reliable method for antibody-based selective immobilization of bacteria from suspension onto a gold-plated glass surface, followed by detection using strain-specific antibodies linked to gold nanoparticles decorated with a reporter molecule. The reporter molecules are subsequently detected by surface-enhanced Raman spectroscopy (SERS). Such a multi-functionalized nanoparticle is called a SERS-tag. The presented procedure uses widely accessible and cheap materials for manufacturing and functionalization of the nanoparticles and the immobilization surfaces. Here, we exemplify the use of the produced SERS-tags for sensitive single-cell detection of opportunistic pathogen Escherichia coli, and we demonstrate the selectivity of our method using two other bacterial strains, Staphylococcus aureus and Serratia marcescens, as negative controls. We believe that the described approach has a potential to inspire the development of novel medical diagnostic tools for rapid identification of bacterial pathogens.

Abstract Background Sepsis is a potential life threatening dysregulated immune response to an infection, which can result in multi-organ failure and death. Unfortunately, good prognostic markers are lacking in patients with suspected infection to identify those at risk. Red blood cell distribution width (RDW) is a common and inexpensive hematologic laboratory measurement associated with adverse prognosis in multiple diseases. The aim of this study was to determine the prognostic value of RDW for mortality and early clinical deterioration in patients with a suspected infection in the emergency department. Methods In this single center prospective observational cohort study, consecutive patients with suspected infection presenting for internal medicine in the emergency department between September 2016 and March 2018 were included. For prognostic validation of bedside sepsis scores and RDW receiver operating characteristics were generated. Association between RDW and mortality and ICU admission was analyzed univariate and in a multivariate logistic regression model. Results 1046 patients were included. In multivariate analyses, RDW was significantly associated with 30-day mortality (OR 1.15, 95% CI: 1.04–1.28) and early clinical deterioration (OR 1.09, 95% CI: 1.00–1.18). For 30-day mortality RDW had an AUROC of 0.66 (95% CI 0.59–0.72). Optimal cut-off value for RDW 2 was 12.95%. For early clinical deterioration RDW had an AUROC of 0.59 (95% CI 0.54–0.63) with an optimal cut-off value of 14.48%. Conclusions RDW was found to be a significant independent prognostic factor of 30-day mortality and early clinical deterioration in patients with suspected infection.. Therefore it can be a used as an extra marker besides bedside sepsis scores in identifying patients at risk for worse outcome in patients with suspected infection.

Objectives The COVID-19 pandemic pressurised healthcare with increased shortage of care. This resulted in an increase of awareness for code status documentation (ie, whether limitations to specific life-sustaining treatments are in place), both in the medical field and in public media. However, it is unknown whether the increased awareness changed the prevalence and content of code status documentation for COVID-19 patients. We aim to describe differences in code status documentation between infectious patients before the pandemic and COVID-19 patients.Setting University Medical Centre of Utrecht, a tertiary care teaching academic hospital in the Netherlands.Participants A total of 1715 patients were included, 129 in the COVID-19 cohort (a cohort of COVID-19 patients, admitted from March 2020 to June 2020) and 1586 in the pre-COVID-19 cohort (a cohort of patients with (suspected) infections admitted between September 2016 to September 2018).Primary and secondary outcome measures We described frequency of code status documentation, frequency of discussion of this code status with patient and/or family, and content of code status.Results Frequencies of code status documentation (69.8% vs 72.7%, respectively) and discussion (75.6% vs 73.3%, respectively) were similar in both cohorts. More patients in the COVID-19 cohort than in the before COVID-19 cohort had any treatment limitation as opposed to full code (40% vs 25%). Within the treatment limitations, ‘no intensive care admission’ (81% vs 51%) and ‘no intubation’ (69% vs 40%) were more frequently documented in the COVID-19 cohort. A smaller difference was seen in ‘other limitation’ (17% vs 9%), while ‘no resuscitation’ (96% vs 92%) was comparable between both periods.Conclusion We observed no difference in the frequency of code status documentation or discussion in COVID-19 patients opposed to a pre-COVID-19 cohort. However, treatment limitations were more prevalent in patients with COVID-19, especially ‘no intubation’ and ‘no intensive care admission’.

The article presents the results of research on the properties of molding sands in Alphaset technology (alkaline-phenolic). These sands are often used in steel foundries, producing large castings. However, knowledge about them, and especially about the changeability of their properties with the change of environmental conditions (seasons), is still insufficient. Various compositions of molding sand were analyzed based on fresh chromite sand and reclaimed sand. A binder and hardener in various mass ratios were used to prepare the mass. The research methodology included, among others, tests of tensile and bending strength, permeability, abrasion, gas emissivity, and ignition losses. These tests were carried out for summer and winter conditions. The results showed the optimal proportions of resin and hardener, showed the influence of ambient temperature on the properties of the molding sand, and the possible ratio of reclaimed sand in relation to fresh sand. However, you should always remember to verify them under the conditions of a specific foundry.

This paper compares two electronically controllable solutions of triangular and square wave generators benefiting from a single IC package including all necessary active elements (modular cells fabricated in I3T 0.35 µm ON Semiconductor process operating with ±1.65 V supply voltage). Internal cells are used for construction of building blocks of the generator (integrator and Schmitt trigger/comparator). Proposed solutions have adjustable parameters dependent on the values of DC control voltages and currents. Attention is given to the mathematical expressions for the advantageous tunability of these generators. Theoretical mathematical functions comparing the standard linear formula with special expression for the frequency adjustment are evaluated and compared with experimentally obtained results. Mathematical functions prove that the proposed topologies improve efficiency of tunability and reduce overall complexity of both generators. Features of proposed solutions were verified experimentally. Both single-parameter tunable designs target on the operation in bands from tens to hundreds of kHz (from 13 kHz up to 251 kHz for the driving voltage between 0.05 V and 1.0 V for the first solution; from 12 kHz up to 847 kHz for the driving current between 5 µA and 140 µA for the second solution). A comparison with similar solutions indicates beneficial performance of the proposed solutions in tunability ratio vs. driving parameter ratio and also because simplicity of circuitry is low. The qualitative evaluation and comparison of parameters of both circuits is given and confirms theoretical expectations.

Urban sprawl is one of the most common landscape alterations occurring worldwide, and there is a growing list of species that are recognised to have adapted to urban life. To be successful, processes of urban colonization by wildlife require a broad spectrum of phenotypic (e.g., behavioural or physiological) adjustments, but evidence for genetic adaptations is much scarcer. One hypothesis proposes that different pathogen-driven selective pressures between urban and non-urban landscapes leads to adaptations in host immune genes. Here, we examined urbanization-related differentiation at the key pathogen-recognition genes of vertebrate adaptive immunity-the major histocompatibility complex (MHC)-in a common waterbird, the Eurasian coot (Fulica atra). Samples were collected from an old urban population (established before the 1950s), a new urban population (established in the 2000s), and two rural populations from central Poland. We found strong significant divergence (as measured with Jost’s D) at the MHC class II between the old urban population and the remaining (new urban and rural) populations. Also, there was a moderate, but significant divergence at the MHC between the new urban population and two rural populations, while no divergence was found between the two rural populations. The total number of MHC alleles and the number of private (population-specific) MHC alleles was lower in old urban populations, as compared to the rural ones. These patterns of differentiation at the MHC were not consistent with patterns found for neutral genetic markers (microsatellites), which showed few differences between the populations. Our results indicate that MHC allele composition depended on the level of anthropogenic disturbance and the time which passed since urban colonization, possibly due to the processes of genotype sorting and local adaptation. As such, our study contributes to the understanding of genetic mechanisms associated with urbanization processes in wildlife.

The study aimed to analyze the dietary–physical activity patterns (D-PAPs) in the health context of Polish people aged 60+ years. A total of 418 respondents across Poland were recruited; however, the final analysis included 361 women and men aged 60–89 years old. D-PAPs were derived using a principal component analysis (PCA); input variables were the frequency of consumption of 10 food groups and physical activity. Finally, three D-PAPs were identified: ‘Pro-healthy eating and more-active’, ‘Sweets, fried foods and sweetened beverages’, and ‘Juices, fish and sweetened beverages’. We developed the Functional Limitations Score (FLS) using the Mini Nutritional Assessment (MNA®). A logistic regression was applied to verify the association between the D-PAPs and health-condition outcomes. Older adults were more likely to adhere to the upper tertile of the ‘Pro-healthy eating and more-active’ pattern, with good/better self-reported health status in comparison with their peers (OR = 1.86) or with good/very good self-assessed appetite (OR = 2.56), while this was less likely for older adults with malnutrition risk (OR = 0.37) or with a decrease in food intake (OR = 0.46). Subjects with a decrease in food intake (OR = 0.43), who declared a recent weight loss (OR = 0.49), or older adults in the upper tertile of the FLS (OR = 0.34) were less likely to adhere to the upper tertile of the ‘Sweets, fried foods and sweetened beverages’ pattern. The decrease in food intake due to a loss of appetite or chewing or swallowing difficulties was inversely associated with the ‘Pro-healthy eating and more-active’ pattern characterized by a relatively high frequency of consumption of vegetables, fruit, water, dairy, and grains and a high physical activity. In the interest of the good nutritional status and health of older adults, special attention should be paid to removing limitations in meal consumption, including improved appetite.

This work presents a novel methodology to adjust the inductance of real coils (electronically) and to cancel out serial losses (up to tens or even hundreds of Ohms in practice) electronically. This is important in various fields of electromagnetic sensors (inductive sensors), energy harvesting, measurement and especially in the instrumentation of various devices. State-of-the-art methods do not solve the problem of cancellation of real serial resistance, which is the most important parasitic feature in low- and middle-frequency bands. In this case, the employment of serial negative resistance is not possible due to stability issues. To solve this issue, two solutions allowing the cancellation of serial resistance by the value of the passive element and an electronically adjustable parameter are introduced. The operational ranges are between 0.1 and 1 mH and 0.1 and 10 mH, valid in bandwidths from hundreds of Hz up to hundreds of kHz. The proposed concepts are experimentally tested in two applications: an electronically tunable oscillator of LC type and an electronically tunable band-pass RLC filter. The presented methodology offers significant improvements in the process of circuit design employing inductors and can be beneficially used for on-chip design, where serial resistance issues can be very significant.

The authors researched the physical, metallurgical, and mechanical characteristics of A354 alloy (Al-Si-Mg-Cu) reinforced with 5, 10, and 15 wt% of fly ash metal matrix composites. A baseline alloy and three composites were fabricated by a liquid metallurgy route and poured into a permanent mold to obtain cast rods of dimension Φ32 mm × 156 mm. The metallurgical characterization of the developed alloy and metal matrix composites was conducted using energy-dispersive spectroscopy (EDS), field-emission scanning electron microscopy (FESEM), and X-ray diffraction. All the developed composites showed a pore-free nature, but only A354 alloy reinforced with 5 wt% of fly ash (AF5) possessed a homogeneous distribution and perfect bonding of the fly ash with the A354 matrix. Therefore, transmission electron microscopy (TEM) analysis was performed on the sample AF5. All developed alloys and metal matrix composites were subjected to hardness and mechanical property tests. It was observed that the AF5 sample had 170 ± 5.6 HV and tensile strength of 216 ± 2.3 MPa, 18.8% and 24.8% higher than the A354 matrix, but the ductility (6.5 ± 0.43%) was reduced by 23% from the baseline alloy. Finally, the fractography analysis was conducted on all the samples using FESEM to analyze the fracture mode. The fabricated 5 wt% fly ash-based metal matrix composite showed better mechanical performance than other samples. Hence, sample AF5 is suggested for manufacturing components in automotive and structural parts.

This contribution presents and experimentally analyzes the idea how to reach the constant magnitude as well as the phase response in the fractional-order (FO) phase when shifting two-ports. The straightforward method employing the automatic gain control circuit (AGC) in a cascade after so-called constant phase block approximating FO integrator or differentiator is studied. The variable gain amplifier utilized in AGC and simple RC-based FO constant phase elements (approximating capacitors with order alpha = 1/4 and alpha = 1/2 as an example) connected in the feedback of operational amplifier-based integrator are established in the experimental setup. The operation indicated in three decades (between 100 Hz and 100 kHz) is evaluated. The known solutions of the standard FO phase shifting circuits are discussed and generally compared with the features obtained in this paper, together with the supposed effects of AGC on their performances.

A novel solution of reconnection-less electronically reconfigurable filter is introduced in the paper. The filter is designed based on unknown nodal voltages method (MUNV) using operational transconductance amplifiers (OTAs) and variable gain amplifier (VGA). The structure can provide all-pass, band-stop, high-pass 2nd order functions, high-pass function of the 1st order and direct transfer from the same topology without requirement of manual reconnection. The proposed structure also offers the electronic control of the pole frequency. Moreover, fractional-order design of the proposed filter is also provided. The behaviour is verified by simulations using Cadence IC6 (spectre) software.

Abstract Background Intraoperative epicardial ultrasonography of coronary artery bypass graft anastomoses is a procedure used for anatomical quality assessment of peripheral anastomoses during coronary artery bypass grafting. However, it may be difficult to keep the ultrasound transducer in steady contact with the anastomoses on the beating heart without causing any deformation. Furthermore, we are not aware of any sterile ultrasound gel approved for application into the pericardial space. Case presentation We report a method using a stabilizing connecting device for an ultrasound transducer to be used for visualization of coronary anastomoses without application of ultrasound gel during on-pump coronary bypass surgery. Conclusion Use of a stabilizing device and coagulated blood from the patient as an alternative for ultrasound gel facilitates peroperative ultrasonography of coronary anastomoses. The procedure provides surgeons with non-deformed echocardiographic longitudinal and transverse images of all parts of the anastomoses. Trial registration The patient participated in a still ongoing clinical feasibility study: Trial registration: ClinicalTrials.gov ID: NCT02919124; Registered September 29, 2016.

In this paper the authors present a multifunctional reconfigurable fractional-order filter performing a low-pass, high-pass, band-pass and band-reject transfer function. The filter is based on two types of active elements, OTA (Operational Transconductance Amplifier) and ACA (Adjustable Current Amplifier). It provides pole frequency control, depending on the values of the transconductance of the OTA elements. The quality factor is also electronically controlled, depending on the amplification of the ACA element. The order of the filter can be changed by switching the fractional-order capacitor having various values of the order. The circuit was implemented as a PCB (Printed Circuit Board) and measured in laboratory conditions. Measurement results are compared with the simulation results. The behavioural models were used for the purpose of the simulation. DOI: 10.5755/j01.eie.25.1.22732

Abstract Background Guidelines recommend macrolides and fluoroquinolones in patients hospitalized with community-acquired pneumonia (CAP), but their use has been associated with cardiac events. We quantified associations between macrolide and fluoroquinolone use and cardiac events in patients hospitalized with CAP in non-ICU wards. Methods This was a post-hoc analysis of a cluster-randomized trial as a cohort study; including patients with a working diagnosis of CAP admitted to non-ICU wards without a cardiac event on admission. We calculated cause-specific hazard ratio’s (HR’s) for effects of time-dependent macrolide and fluoroquinolone exposure as compared to beta-lactam monotherapy on cardiac events, defined as new or worsening heart failure, arrhythmia, or myocardial ischemia during hospitalization. Results Cardiac events occurred in 146 (6.9%) of 2107 patients, including heart failure (n = 101, 4.8%), arrhythmia (n = 53, 2.5%), and myocardial ischemia (n = 14, 0.7%). These occurred in 11 of 207 (5.3%), 18 of 250 (7.2%), and 31 of 277 (11.2%) patients exposed to azithromycin, clarithromycin, and erythromycin for at least one day, and in 9 of 234 (3.8%), 5 of 194 (2.6%), and 23 of 566 (4.1%) exposed to ciprofloxacin, levofloxacin, and moxifloxacin, respectively. HR’s for erythromycin, compared to beta-lactam monotherapy, on any cardiac event and heart failure were 1.60 (95% CI 1.09;2.36) and 1.89 (95% CI 1.22;2.91), respectively. HR’s for levofloxacin and moxifloxacin, compared to beta-lactam monotherapy, on any cardiac event were 0.40 (95% CI 0.18;0.87)and 0.56 (95% CI 0.36;0.87), respectively. Findings remained consistent after adjustment for confounders and/or in a sensitivity analysis of radiologically confirmed CAP (n = 1604, 76.1%). Conclusions Among patients with CAP hospitalized to non-ICU wards, erythromycin use was associated with a 68% increased risk of hospital-acquired cardiac events, mainly heart failure. Levofloxacin and moxifloxacin were associated with a lower risk of heart failure. Although our study does not fully exclude confounding bias, findings remained largely unchanged in crude, adjusted, and sensitivity analyses. These findings may caution the use of erythromycin as empirical therapy in these patients. Trial registration The original trial was retrospectively registered under ClinicalTrials.gov Identifier NCT01660204 on August 8th, 2012.

This article presents the results of experiments on the optimization of down sprue geometry in the process of pouring sand molds. Theoretical assumptions and computer simulation tests are presented. The starting point was the theory and experience of gas entrapment caused mainly by a poorly designed gating system and the down sprue. Simulations were performed using Magmasoft software. First, initial studies were carried out to determine how the geometry (mainly the channel cross-section) of the sprue affects the problem, and then a detailed experiment was carried out on the so-called ‘short sprue’ version. The air entrapment process was analyzed, as were the parameters of the liquid alloy flow that passes through the analyzed channels. Nine geometric versions of the sprue were proposed and analyzed, and the results allowed us to conclude which sprue geometry is the best from the point of view of minimization of the gas entrapment problem.

Widely used classical angiography with the use of iodine contrast agents is highly problematic, particularly in patients with diabetes mellitus, cardiac and pulmonary diseases, or degree III or IV renal insufficiency. Some patients may be susceptible to allergic reaction to the iodine contrast substance. The intravenous injection of a bolus of CO2 (negative contrast) is an alternative method, which is, however, currently only used for imaging blood vessels of the lower limbs. The aim of our project was to design and test on an animal model a methodology for injecting the CO2 foam which would minimize the possibility of embolization of the brain tissue and heart infarction, leading to their damage. This is important research for the further promotion of the use of CO2, which is increasingly important for endovascular diagnosis and treatment, because carbon-dioxide-related complications are extremely rare. CO2 foam was prepared by the rapid mixing in a 2:1 ratio of CO2 and fetal bovine serum (FBS)-enriched Dulbecco’s Modified Eagle Medium (DMEM). Freshly prepared CO2 foam was administered into the catheterized rat tail vein or cannulated rat abdominal aorta and inferior vena cava (IVC). CO2 foam was compared with commercially available microbubbles (lipid shell/gas core). The rat heart in its parasternal long axis was imaged in B-Mode and Non-linear Contrast Mode before/during and after the contrast administration. Samples of the brain, heart and lungs were collected and subjected to histological examination. The non-linear contrast imaging method enables the imaging of micron-sized gas microbubbles inside a rat heart. The significantly shorter lifetime of the prepared CO2 foam is a benefit for avoiding the local ischemia of tissues.

Numerical prediction of discharge parameters allows design of a pressure-swirl atomizer in a fast and cheap manner, yet it must provide reliable results for a wide range of geometries and operating regimes. Many authors have used different numerical setups for similar cases and often concluded opposite suggestions on numerical setup. This paper compares 2D (two-dimensional) axisymmetric, 3D (three-dimensional) periodic and full 3D numerical models used for estimation of the internal flow characteristics of a pressure-swirl atomizer. The computed results are compared with experimental data in terms of spray cone angle, discharge coefficient (CD), internal air-core dimensions, and velocity profiles. The three-component velocity was experimentally measured using a Laser Doppler Anemometry in a scaled transparent model of the atomizer. The internal air-core was visualized by a high-speed camera with backlit illumination. Tested conditions covered a wide range of the Reynolds numbers within the inlet ports, Re = 1000, 2000, 4000. The flow was treated as both steady and transient flow. The numerical solver used laminar and several turbulence models, represented by k-ε and k-ω models, Reynolds Stress model (RSM) and Large Eddy Simulation (LES). The laminar solver was capable of closely predicting the CD, air-core dimensions and velocity profiles compared with the experimental results in both 2D and 3D simulations. The LES performed similarly to the laminar solver for low Re and was slightly superior for Re = 4000. The two-equation models were sensitive to proper solving of the near wall flow and were not accurate for low Re. Surprisingly, the RSM produced the worst results.

Early recognition of sepsis is essential for improving outcomes and preventing complications such as organ failure, depression, and neurocognitive impairment. The emergency department (ED) plays a key role in the early identification of sepsis, but clinicians lack diagnostic tools. Potentially, biomarkers could be helpful in assisting clinicians in the ED, but no marker has yet been successfully implemented in daily practice with good clinical performance. Pancreatic stone protein (PSP) is a promising biomarker in the context of sepsis, but little is known about the diagnostic performance of PSP in the ED. We prospectively investigated the diagnostic value of PSP in such a population for patients suspected of infection. PSP was compared with currently used biomarkers, including white blood cell count (WBC) and C-reactive protein (CRP). Of the 156 patients included in this study, 74 (47.4%) were diagnosed with uncomplicated infection and 26 (16.7%) patients with sepsis, while 56 (35.9%) eventually had no infection. PSP was significantly higher for sepsis patients compared to patients with no sepsis. In multivariate regression, PSP was a significant predictor for sepsis, with an area under the curve (AUC) of 0.69. Positive and negative predictive values for this model were 100% and 84.4%, respectively. Altogether, these findings show that PSP, measured at the ED of a tertiary hospital, is associated with sepsis but lacks the diagnostic performance to be used as single marker.

All credible and available published records for 17 species of moth flies known so far from Armenia (Phlebotominae 11 species, Psychodinae 6 species) and Azerbaijan (Phlebotominae 18 species) are summarized. The first records of 18 species of Psychodinae (tribes Mormiini, Paramormiini, Psychodini, Pericomaini) from Armenia and 6 new faunistic records (tribes Psychodini, Pericomaini) for the fauna of Azerbaijan are listed. The checklist of recent moth flies from Armenia includes now 35 species, and from Azerbaijan, 24 species.

Objective The quick Sequential Organ Failure Assessment (qSOFA) is developed as a tool to identify patients with infection with increased risk of dying from sepsis in non-intensive care unit settings, like the emergency department (ED). An abnormal score may trigger the initiation of appropriate therapy to reduce that risk. This study assesses the risk of a treatment paradox: the effect of a strong predictor for mortality will be reduced if that predictor also acts as a trigger for initiating treatment to prevent mortality.Design Retrospective analysis on data from a large observational cohort.Setting ED of a tertiary medical centre in the Netherlands.Participants 3178 consecutive patients with suspected infection.Primary outcome To evaluate the existence of a treatment paradox by determining the influence of baseline qSOFA on treatment decisions within the first 24 hours after admission.Results 226 (7.1%) had a qSOFA ≥2, of which 51 (22.6%) died within 30 days. Area under receiver operating characteristics of qSOFA for 30-day mortality was 0.68 (95% CI 0.61 to 0.75). Patients with a qSOFA ≥2 had higher odds of receiving any form of intensive therapy (OR 11.4 (95% CI 7.5 to 17.1)), such as aggressive fluid resuscitation (OR 8.8 95% CI 6.6 to 11.8), fast antibiotic administration (OR 8.5, 95% CI 5.7 to 12.3) or vasopressic therapy (OR 17.3, 95% CI 11.2 to 26.8), compared with patients with qSOFA

Background Acute kidney injury (AKI) is a major health problem associated with considerable mortality and morbidity. Studies on clinical outcomes and mortality of AKI in the emergency department are scarce. The aim of this study is to assess incidence, mortality and renal outcomes after AKI in patients with suspected infection at the emergency department. Methods We used data from the SPACE-cohort (SePsis in the ACutely ill patients in the Emergency department), which included consecutive patients that presented to the emergency department of the internal medicine with suspected infection. Hazard ratios (HR) were assessed using Cox regression to investigate the association between AKI, 30-days mortality and renal function decline up to 1 year after AKI. Survival in patients with and without AKI was assessed using Kaplan-Meier analyses. Results Of the 3105 patients in the SPACE-cohort, we included 1716 patients who fulfilled the inclusion criteria. Of these patients, 10.8% had an AKI episode. Mortality was 12.4% for the AKI group and 4.2% for the non-AKI patients. The adjusted HR for all-cause mortality at 30-days in AKI patients was 2.8 (95% CI 1.7–4.8). Moreover, the cumulative incidence of renal function decline was 69.8% for AKI patients and 39.3% for non-AKI patients. Patients with an episode of AKI had higher risk of developing renal function decline (adjusted HR 3.3, 95% CI 2.4–4.5) at one year after initial AKI-episode at the emergency department. Conclusion Acute kidney injury is common in patients with suspected infection in the emergency department and is significantly associated with 30-days mortality and renal function decline one year after AKI.

Summary: The derivation of endoderm and descendant organs, such as pancreas, liver, and intestine, impacts disease modeling and regenerative medicine. Use of TGF-β signaling agonism is a common method for induction of definitive endoderm from pluripotency. By using a data-driven, High-Dimensional Design of Experiments (HD-DoE)-based methodology to address multifactorial problems in directed differentiation, we found instead that optimal conditions demanded BMP antagonism and retinoid input leading to induction of dorsal foregut endoderm (DFE). We demonstrate that pancreatic identity can be rapidly, and robustly, induced from DFE and that such cells are of dorsal pancreatic identity. The DFE population was highly competent to differentiate into both stomach organoids and pancreatic tissue types and able to generate fetal-type β cells through two subsequent differentiation steps using only small molecules. This alternative, rapid, and low-cost basis for generating pancreatic insulin-producing cells may have impact for the development of cell-based therapies for diabetes.

The nitrogen-vacancy colour centre in diamond is emerging as one of the most important solid-state quantum systems. It has applications to fields including high-precision sensing, quantum computing, single photon communication, metrology, nanoscale magnetic imaging and biosensing. For all of these applications, a high quantum yield of emitted photons is desirable. However, diamond samples engineered to have high densities of nitrogen-vacancy centres show levels of brightness varying significantly within single batches, or even within the same sample. Here we show that nearby nitrogen impurities quench emission of nitrogen-vacancy centres via non-radiative transitions, resulting in a reduced fluorescence quantum yield. We monitored the emission properties of nitrogen-vacancy centre ensembles from synthetic diamond samples with different concentrations of nitrogen impurities. All samples were irradiated with high energy electrons to create high densities of nitrogen-vacancy centres relative to the concentration of nitrogen impurities. While at low nitrogen densities of 1.81 ppm we measured a lifetime of 13.9 ns, we observed a strong reduction in lifetime with increasing nitrogen density. We measure a lifetime as low as 4.4 ns at a nitrogen density of 380 ppm. The change in lifetime matches a reduction in relative fluorescence quantum yield from 77.4% to 32% with an increase in nitrogen density from 88 ppm to 380 ppm, respectively. These results will inform the conditions required to optimise the properties of diamond crystals devices based on the fluorescence of nitrogen-vacancy centres. Furthermore, this work provides insights into the origin of inhomogeneities observed in high-density nitrogen-vacancy ensembles within diamonds and nanodiamonds.