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As a first, the paper proposes modelling and learning of specific behaviors for dynamic obstacle avoidance in end-to-end motion planning. In the literature many end-to-end methods have been used in simulators to drive a car and to apply the learnt strategies to avoid the obstacles using the lane changing, following the vehicle as per the traffic rules, driving in-between the lane boundaries, and many more behaviors. The proposed method is designed to avoid obstacles in the scenarios where a dynamic obstacle is headed directly towards the robot from different directions. To avoid the critical encounter of the dynamic obstacles, we trained a novel deep neural network (DNN) with two specific behavioral obstacle avoidance strategies, namely “head-on collision avoidance” and “stop and move”. These two strategies of obstacle avoidance come from the human behavior of obstacle avoidance. Looking at the current frame only, for a very similar visual display of the scenario, the two strategies have contrasting outputs and overall outcomes that makes learning very difficult. A random data recording over general simulations is unlikely to record the corner cases of both behaviors that rarely occur, and a behavior-specific training used in this paper intensifies the same cases for a better learning of the robot in such corner cases. We calculate the intention of the obstacle, whether it will move or not. This proposed method is compared with three state-of-the-art methods of motion planning, namely Timed-Elastic Band, Dynamic Window Approach and Nonlinear Probabilistic Velocity Obstacle. The proposed method beats all the state-of-the-art methods used for comparisons.

Coastal region of Bangladesh possesses a fragile ecosystem and is exposed to hazards like cyclones, floods, storm surges, and water-logging. A detail understanding on the impact of water-logging due to various natural, man-made and climate change scenarios is still lacking. Considering this research gap, the present research is aimed to study impacts of these scenarios inside polders-24 and 25 which are situated on the western part of the coastal region. In this Study as natural scenario, sedimentation in the Hari River; as man-made scenario, new polders in the south-central region and as SLR scenario, an extreme sea level rise of 1.48m are considered. Long-term satellite images are analyzed, and numerical model is applied in the study area. The result shows that water-logging is more acute inside polder-25 compared to polder-24. Sedimentation in Hari River aggravates the water-logging condition. Dredging in Hari River does improve the situation. Journal of Engineering Science 12(3), 2021, 73-83

Understanding of the Everglades’ ecological vulnerabilities and restoration needs has advanced over the past decade but has not been applied in an integrated manner. To address this need, we developed the Everglades Vulnerability Analysis (EVA), a decision support tool that uses modular Bayesian networks to predict the ecological outcomes of a subset of the ecosystem’s health indicators. This tool takes advantage of the extensive modeling work already done in the Everglades and synthesizes information across indicators of ecosystem health to forecast long-term, landscape-scale changes. In addition, the tool can predict indicator vulnerability through comparison to user-defined ideal system states that can vary in the level of certainty of outcomes. An integrated understanding of the Everglades system is essential for evaluation of trade-offs at local, regional, and system-wide scales. Through EVA, Everglades restoration decision makers can provide effective guidance during restoration planning and implementation processes to mitigate unintended consequences that could result in further damage to the Everglades system.

Biodiversity conservation under a changing climate is a challenging endeavor. Landscapes are shifting as a result of climate change and sea level rise but plant communities in particular may not keep up with the pace of change. Predictive ecological models can help decision makers understand how species are likely to respond to change and then adjust management actions to align with desired future conditions. Florida’s Everglades is a wetland ecosystem that is host to many species, including a large number of endangered and endemic species. Everglades ecosystem restoration has been ongoing for decades, but consideration of sea level rise impacts in restoration planning is more recent. Incorporating potential impacts from sea level rise into restoration planning should benefit species and their coastal habitats, most notably at the southern Florida peninsula. The endangered Cape Sable seaside sparrow (Ammospiza maritima mirabilis) occurs in marl prairie habitat at the southern end of the Everglades. The locations of three of its six subpopulations are proximate to the coast. We used a spatially explicit predictive model, EverSparrow, to estimate probability of sparrow presence considering both hydrologic change from restoration and sea level rise. We found that the probability of sparrow presence decreased with increasing sea level rise. Within approximately 50 years, probability of presence significantly decreased for all three coastal subpopulation areas, with areas above 40% probability increasingly limited. Given the exceptionally low dispersal ability of this species and the geographic restrictions for habitat expansion, our results highlight the importance of freshwater flow into the southern Everglades marl prairie for habitat conservation.

Purpose: Strabismus is a condition in which the eyes are misaligned causing double vision. While it primarily affects pediatric patients, adults may also present with strabismus due to various etiologies, but the occurrence of these are not well-established. This study aims to elucidate the prevalence of adult strabismus and its clinical risk factors. Methods: This retrospective study reviewed charts of 1705 adult patient seen by the Indiana University School of Medicine Department of Ophthalmology between June 2016 and October 2020 for potential strabismus. Exclusion criteria included no diagnosis of strabismus or diplopia (n=42), not an adult patient (n=3), no charts available for review (n=105), and personal relation with a patient (n=3). Patient demographic, co-morbidity, ophthalmologic risk factor, and strabismus characteristic data was collected. Prevalence was calculated for each subclassification of strabismus, and clinical characteristics were discovered through calculation of odds ratios (OR). Results: 1551 patient charts were included. The prevalence of esotropia (ET), exotropia (XT), and hypertropia (HT) was found to be 42.41%, 43.8%, and 44.04%, respectively. Combined vertical and horizontal strabismus was seen in 29.91% of patients. Patients 65 years and older had increased odds of having ET and HT (OR 1.67, 95% confidence interval (CI) (1.35, 2.05); OR 1.79, CI (1.45, 2.20)) but lower odds of having XT than their younger counterparts (OR 0.40, CI (0.32, 0.50)). Women had reduced odds of having ET compared to men (OR 0.63, CI (0.51,0.78)). Patients with low visual acuity (logMAR≥1) had much lower odds of having ET and HT (OR 0.43, CI (0.24, 0.78); OR 0.06, CI (0.02, 0.20)) but over four times greater odds of having XT (OR 4.34, CI (2.41, 7.84)). Hypertension, diabetes, and hyperlipidemia also affected the odds of having strabismus. Conclusion: Adult strabismus remains a poorly understood condition; further research is necessary to facilitate individualization of care.

The recycling of organic waste products (e.g. sewage sludge, SS) is currently being promoted as a substitute for mineral fertilizers for agricultural lands. The spreading of SS allows the recycling of the nutrients and organic matter it contains. SS contains various pollutants such as volatile organic compounds (VOCs) that adversely affect the ecosystem and human health through ozone production and serve as critical precursors of atmospheric secondary organic aerosols. There are very few studies quantifying the gaseous compounds emitted from SS, and those studies primarily address their odorant properties for identifying suitable odour abatement techniques. There is an urgent need for more comprehensive quantitative information on VOCs emitted from SS as aerosol precursors. In this context, an experimental study was performed on SS samples taken from a wastewater treatment plant located in France. Undigested SS (UDSS), digested SS (DSS) and SS with 30% and 60% dryness were collected from different stages of treatment sequence and analyzed using atmospheric simulation chambers coupled to proton-transfer-reaction quadrupole ion-guide time-of-flight mass spectrometer. Our study revealed that SS samples emitted a large spectrum of VOCs. 380 compounds were detected, quantified and classified into different chemical groups. The VOC emissions increased with the increase in the dryness of the sample; the highest being in SS 60%, followed by SS 30%, UDSS and DSS. OVOCs were dominant in SS 60%. The statistical analysis showed that the anaerobic digestion and the dewatering to 60% of dryness decreased the emissions of sulphuric compounds. Aromatic compounds and indoles (e.g. skatole) were emitted significantly from the UDSS. Some of these VOCs can serve as precursor gases for atmospheric aerosol formation. The experimental dataset obtained in this study provides an accurate inventory reference for the VOC emissions from SS samples and shows the impacts of the treatment on emission characteristics of VOCs.

Background: Chronic hepatitis C is a common entity which is frequently associated with depression. Aim: To determine the frequency of depression in patients of chronic hepatitis C who had not yet received treatment. Settings: Department of Gastroenterology and Medicine at Fatima Memorial Hospital Lahore, Pakistan. Study design: Cross sectional Descriptive study Methods: Total 217 patients were enrolled. Each patient was interviewed and then marked down by the doctor himself. Patient Health Questionnaire (PHQ 9) (annexure 2 attached) was applied to determine the presence of depression. Depression was managed as per hospital protocol. The study was conducted from 10th April, 2018 to 9th October, 2018 Results: In this study mean age was 45 years with standard deviation ± 11.33. 62% patients were male, 38% patients were female. More over 57% patients had depression while 43% patients didn’t have depression. Conclusion: Our study concluded that there was a significant association between depression and chronic hepatitis C patients before they have started their treatment, in tertiary care hospital. Keywords: Depression, chronic, hepatitis C

Background: Spontaneous bacterial peritonitis (SBP) is an acute infection of otherwise sterile ascitic fluid in patients with decompensated liver cirrhosis. Gram negative bacteria are considered the main causative microorganisms of SBP. However, widespread use of antibiotics in cirrhotic patients has changed the microbial spectrum and the sensitivity patterns. Aim: To determine the frequency of different microorganisms and their sensitivity patterns in ascitic fluid of cirrhotic patients with spontaneous bacterial peritonitis and to see the impact of age, gender and duration of SBP on these patterns. Study design and duration: It was a prospective observational study conducted at Fatima Memorial Hospital, Lahore from December 2015 to December 2016. Methods: A total of 200 patients with clinical suspicion of SBP were enrolled in the study. Ascitic fluid sample was obtained within 6 hours of hospitalization and was sent to hospital laboratory. Culture reports were reviewed to determine the frequency of different microorganism as well as their sensitivity patterns to different antibiotics. Results: Out of 200 patients, the culture was positive in 113(56.53%) patients. Escherichia coli was seen in 35 (31.2%) patients, Acinobacter Spp was present in 18 (15.3%), Streptococcus in 15 (13.4%), Enterococcus in 14 (12.1%), Staphylococcus aureus in 13 (11.4%), MRSA in 12 (10.8%), and K. Pneumonia in 6 (5.7%) patients. Ceftazidime was sensitive in 73 (64.9%) cases, Cefotaxime was sensitive in 55 (49%), Ceftriaxone was sensitive in 50 (43.9%), Ciprofloxacin was sensitive in 49 (43.3%), Amikacin was sensitive in 36 (31.8%) Conclusion: The most frequent organism in ascitic fluid of SBP patients was E Coli, and the most sensitive antibiotic was ceftazidime. Keywords: Microbial Spectrum, Sensitivity Pattern,Spontaneous Bacterial Peritonitis (SBP), Ascitic Fluid

This study was aimed to grow the local isolates yeast Candida tropicalis on locally prepared sawdust powder hydrolysate as a basal medium and carbon source with respect to single cell protein (SCP) production. The saw dust powder was treated with 10% H2SO4 for one hour at 100 0C. After cooling the supernatant containing the isolated sugar separated from debris by filtration and used as a carbon source and basal medium for yeast growth and SCP production. A high amount of SCP was achieved after five days of incubation, the percentage of the produced SCP 39.05% of the biomass dry weight, which is equivalent to 3.07g/l. SCP formation biosynthesis was affected by the level of nitrogen present in the medium; a high amount of protein being achieved in fermentation medium containing 0.3% urea in which the percentage of the yielded SCP was increased to 42.54%, (3.71g/l) of the biomass dry weight. The effect of varying nitrogen sources on SCP accumulation was also assayed. Medium containing ammonium phosphate greatly stimulated protein production in which the produced SCP was increased to reach 5.90 g/l. The produced amount equivalent to (48.22%) of the biomass dry weight. Conversely, a medium containing sodium nitrate had a suppressive effect on SCP production. This evidence clearly suggests that the metabolic versatility of Candida tropicalis may be employed in the conversion of low-grade material into high SCP product.

OBJECTIVE: This study evaluates the 24 month follow up for the NICHD Neonatal Research Network (NRN) Inositol for Retinopathy Trial. STUDY DESIGN: Bayley Scales of Infants Development-III and a standardized neurosensory examination were performed in infants enrolled in the main trial. Moderate/severe NDI was defined as BSID-III Cognitive or Motor composite score

Background Coronary artery disease (CAD) is associated with celiac disease (CD) with limited evidence. However, the common risk factors linking CD and CAD are still lacking in the literature. Known CAD risk factors include hypertension, hyperlipidemia, type 2 diabetes, obesity, and tobacco use. Common risk factors linking CD and CAD are poorly documented. Objective There are three objectives: Firstly, to evaluate potential demographic differences between CD patients with CAD and without CAD. Secondly, to analyze the risk factors of CAD in CD patients. Lastly, to compare CD-CAD and matched non-CD CAD to determine whether there are additional CAD risks in individuals with CD. Methods The study is a nationwide retrospective case-control study. The National Inpatient Sample (NIS) database was used to identify patients admitted between 2016 and 2018 with a principal or secondary diagnosis of CD. We analyzed sociodemographic and clinical risk factors of CAD in CD patients and compared the CD-CAD population with the matched non-CD CAD cohort. Results Out of 23,441 hospitalizations with CD in 2016-2018, 4244 (18%) were found to have CAD. Established CAD risk factors identified in CD patients included hypertension, hyperlipidemia, type 2 diabetes, and a family history of CAD. In contrast, tobacco use is not a CAD risk factor in CD patients. Female patients with CD had 55% lesser odds of CAD than male patients. The odds of CAD in CD patients with hyperlipidemia were five times higher, 1.2 times higher with essential hypertension, and two times higher with type 2 diabetes. Patients with CAD had a higher prevalence of iron deficiency anemia (9.33% CD-CAD and 8.28% non-CAD CD Vs. 7.32% non-CD CAD). Conclusions Our study confirms that, as with non-CD individuals, males and the White race are at increased CAD risk in the CD population. CD-CAD patients have a higher hyperlipidemia prevalence than non-CD CAD patients. CD patients with type 1 diabetes have an early diagnosis of CAD compared to CD patients with type 2 diabetes. Iron deficiency anemia is a statistically significant risk factor for CAD in CD patients.

Hereditary hemochromatosis (HH) has an increased risk of hepatocellular cancer (HCC) both due to genetic risks and iron overload as iron overload can be carcinogenic; HH impacts the increasing risk of HCC, not only through the development of cirrhosis but concerning hepatic iron deposition, which has been studied further recently.To evaluate HH yearly trends, patient demographics, symptoms, comorbidities, and hospital outcomes. The secondary aim sheds light on the risk of iron overload for developing HCC in HH patients, independent of liver cirrhosis complications. The study investigated HH (without cirrhosis) as an independent risk factor for HCC.We analyzed data from National Inpatient Sample (NIS) Database, the largest national inpatient data collection in the United States, and selected HH and HCC cohorts. HH was first defined in 2011 International Classification of Disease - 9During the 2011-2019 period, a total of 18031 hospitalizations with a primary or secondary diagnosis of HH (excluding liver diseases) were recorded in the NIS database. We analyzed different patients' characteristics, and we found increments in inpatient population trend with a Ptrend0.001 and total hospital cost of care trend from $42957 in 2011 to $66152 in 2019 with a Ptrend0.001 despite no change in Length of Stay over the last decade. The multivariate analyses showed that HH without cirrhosis (aOR, 28.8; 95%CI, 10.4-80.1;Our study showed an increasing trend of in-hospital admissions of HH patients in the last decade. These trends were likely related to advances in diagnostic approach, which can lead to increased hospital utilization and cost increments. Still, the length of stay remained the same, likely due to a big part of management being done in outpatient settings. Another vital part of our study is the significant result that HH without cirrhosis is an independent risk factor for HCC with adjusting all known risk factors. More prospective and retrospective large studies are needed to re-evaluate the HH independent risk in developing HCC.

Funder: RCUK | Medical Research Council (MRC); doi: https://doi.org/10.13039/501100000265, Funder: Alzheimer's Society; doi: https://doi.org/10.13039/501100000320, Funder: Alzheimer's Research UK (ARUK); doi: https://doi.org/10.13039/501100002283, Soluble aggregates of the microtubule-associated protein tau have been challenging to assemble and characterize, despite their important role in the development of tauopathies. We found that sequential hyperphosphorylation by protein kinase A in conjugation with either glycogen synthase kinase 3β or stress activated protein kinase 4 enabled recombinant wild-type tau of isoform 0N4R to spontaneously polymerize into small amorphous aggregates in vitro. We employed tandem mass spectrometry to determine the phosphorylation sites, high-resolution native mass spectrometry to measure the degree of phosphorylation, and super-resolution microscopy and electron microscopy to characterize the morphology of aggregates formed. Functionally, compared with the unmodified aggregates, which require heparin induction to assemble, these self-assembled hyperphosphorylated tau aggregates more efficiently disrupt membrane bilayers and induce Toll-like receptor 4-dependent responses in human macrophages. Together, our results demonstrate that hyperphosphorylated tau aggregates are potentially damaging to cells, suggesting a mechanism for how hyperphosphorylation could drive neuroinflammation in tauopathies.

This work was an attempt to propose a model to set up for newly establishment of Nuclear Medicine facility. Medical physicist should establish a major guideline to set up a model of a new nuclear medicine facility; draw the fundamental structure and calculate the corresponding shielding. The various layouts such as the diagnostic (In-Vivo and In-Vitro) and therapeutic layouts of fundamental structure were been made on the primacies as controlled, supervised and non-supervised area according to radiation exposure rate. Some shielding calculations of various facilities such as the diagnostic and therapeutic facility have to provide on instrumentation and radiation safety with the required layout according to maximum activity of radionuclide into the controlled area. Bangladesh Journal of Physics, 26(2), 41-49, December 2019

Breast cancer is the greatest challenging health complexities that medical science is facing. Most cases can be prevented by early detection and diagnosis which are the best way to cure breast cancer to decrease the mortality rate. The aim of this research is to obtain a method for enhancing the mammography images by using the proposed method which is incorporating the Local Contrast with Contrast Limited Adaptive Histogram Equalization (LC-CLAHE) to improve the appearance and to increase the contrast of the image and then de-noised by 2D wiener filter techniques. To extract the region of interest (tumor), we used region growing technique for the segmentation process. The standard Mammographic Image Analysis Society (MIAS) database images are considered for the evaluation. Efficiency is measured by Root Mean Square Error (RMSE) and Peak Signal to Noise Ratio (PSNR). It is observed that the proposed method with wiener filter gives higher (PSNR) and lower (RMSE), with a significant filter mask [3 3].

Background: An estimated 5·1 million stillbirths and neonatal deaths occur annually. Household surveys, most notably the Demographic and Health Survey (DHS), run in more than 90 countries and are the main data source from the highest burden regions, but data-quality concerns remain. We aimed to compare two questionnaires: a full birth history module with additional questions on pregnancy losses (FBH+; the current DHS standard) and a full pregnancy history module (FPH), which collects information on all livebirths, stillbirths, miscarriages, and neonatal deaths. Methods: Women residing in five Health and Demographic Surveillance System sites within the INDEPTH Network (Bandim in Guinea-Bissau, Dabat in Ethiopia, IgangaMayuge in Uganda, Matlab in Bangladesh, and Kintampo in Ghana) were randomly assigned (individually) to be interviewed using either FBH+ or FPH between July 28, 2017, and Aug 13, 2018. The primary outcomes were stillbirths and neonatal deaths in the 5 years before the survey interview (measured by stillbirth rate [SBR] and neonatal mortality rate [NMR]) and mean time taken to complete the maternity history section of the questionnaire. We also assessed between-site heterogeneity. This study is registered with the Research Registry, 4720. Findings: 69 176 women were allocated to be interviewed by either FBH+ (n=34 805) or FPH (n=34 371). The mean time taken to complete FPH (10·5 min) was longer than for FBH+ (9·1 min; p2=80·9%; p2=0·7%; p=0·40). Interpretation: FPH takes an average of 1·4 min longer to complete than does FBH+, but has the potential to increase reporting of stillbirths in high burden contexts. The between-site heterogeneity we found might reflect variations in interviewer training and survey implementation, emphasising the importance of interviewer skills, training, and consistent implementation in data quality. Funding: Children's Investment Fund Foundation.

As urban development continues to encroach into natural systems, these ecosystems experience increasing degradation to their form and function. Changing climatic conditions further compound the losses in biodiversity and ecosystem function. The state of Florida is known for its biodiversity but has experienced declines in species populations and habitats because of urbanization and sea level rise. Because Florida benefits from a multibillion-dollar income from natural resources tourism, these declines challenge the state's economy. In this study, we assessed the potential future impacts of urbanization and sea level rise on a suite of conservation targets that have been set for the state. We developed six scenarios of all combinations of intermediate and high sea level rise paired with two types of urbanization, sprawling and compact, in both 2040 and 2070 to examine the potential future threats to conservation targets in High Pine and Scrub, Coastal Uplands, and Freshwater Aquatics ecosystems. Our results show projected decreases in extent and area of these priority ecosystems into the future. Under Florida's current trends in urbanization practices, projections indicate a greater impact on conservation targets than if sprawl reduction practices are implemented. Projections indicate that Coastal Uplands will experience the greatest loss in area, at up to 47%. Conservation-focused urban planning and climate adaptation strategies can help protect Florida's natural resources with benefits to Florida's tourism economy as well as critical ecosystem functions and services such as coastal flood protection and storm surge risk reduction.

Aim: The main objective is to incorporate the major foetal parameters – biparietal diameter, head circumference, abdominal circumference and femur length for prediction of gestational age through ultrasonography between 10th and 42nd weeks of gestation and try to do a simultaneous comparative study with gestational age predicted by last menstrual period. Methods: The study has been conducted particularly on the population of Bangladesh. It has been done on 229 Bangladeshi women who had usual singleton foetuses, with evidence of menstrual dates by sonography before fourteen weeks of gestation. Foetal anatomical structures have been scanned and measured at the time of sonographic inspection. For each patient, in addition to the four foetal parameters such as Biparietal Diameter (BPD), Head Circumference (HC), Abdominal Circumference (AC) and Femur Length (FL), the other parameters like Gestational Age (GA) by Last Menstrual Period (LMP) as well as by Ultrasonography (USG) have been recorded. Here we have adopted non-linear regression models in order to predict the response on gestational age. Usually, different modelling methods have been used for this purpose. Results: The logarithmic models normally presented better results if gestational age was predicted based on a single parameter than polynomial models whereas if all predictor variables were considered together, then Nernst model may turn out to be the best one. Also, it was seen that the accuracy level of gestational age predicted by ultrasonography was slightly more accurate than that determined by last menstrual period. Conclusions: There is a high degree of association among the different foetal parameters. Further, there is a high degree of association between the gestational ages by LMP and that by USG. Prediction of gestational ages by USG technique gives a good degree of accuracy and hence can be a reliable technique for estimation of gestational ages.

Given limited funding, natural resources decision making is riddled with tradeoffs, including which species or landscapes to prioritize for management action. Florida’s Everglades wetland is home to numerous indicator species, some of which are endangered. But with a multitude of species comes differing hydrologic requirements to yield appropriate foraging and breeding conditions for each. The Everglades ecosystem is highly managed, with water being moved across the landscape to meet the habitat and reproductive needs of species of concern. Predictive modeling can help water managers understand potential consequences to targeted water conditions. EverForecast is a novel spatially explicit, hydrologic, and ecological operational forecast developed to inform conservation management decisions. Not only does EverForecast provide probable near-term water conditions, but also predicted species responses to those hydrologic conditions. Using examples from two focal regions of the Everglades, we show the magnitude of impacts to a suite of species and an almost 70% decline in suitable conditions for one species when prioritizing water management to meet the needs of another species. Although EverForecast is a relatively new decision support tool, its hydrologic outputs are already commonly used to make water management recommendations because it provides near-term hydrologic forecasts that scientists and managers need for water operations decision making. Because species management decisions have historically been made to target a single species at a time, it may take longer for full utility of EverForecast’s ability to quantify tradeoffs among species to become integrated into decision making.

Background More patients with functioning single ventricle are living into adulthood due to improved survival with the Fontan procedure. Therefore, screening and detection of late-stage complications such as Fontan Associated Liver Disease (FALD) has become increasingly important to improve outcomes. The role of hematologic abnormalities as a marker of cirrhosis in this population is evolving. Purpose We aimed to evaluate the value of hematologic parameters in predicting the presence of cirrhosis in the context of FALD. Methods This was a retrospective study of patients after Fontan completion who underwent liver biopsy between 2007 and 2019 at our institution. Biopsy slides were evaluated for the presence of cirrhosis by a single pathologist. Laboratory testing was recorded within 12 months of the liver biopsy. Univariable analysis was conducted with an alpha level of 0.05 for hypothesis testing. Results A total of 31 Fontan patients with liver biopsies were identified, of whom 7 patients were found to have cirrhosis (Table 1). Compared to patients with no cirrhosis on biopsy, cirrhotic patients tended to have lower hematologic counts including absolute lymphocyte count (0.78 vs 1.02, p=0.019), hemoglobin (12.5 vs 15.1, p=0.018), and platelets (131 vs 194, p=0.025). Notably, the MELD-XI score (Model for End-stage Liver Disease excluding INR) as well as its individual components, creatinine and total bilirubin, were not different between the groups. Conclusion Our data suggests that hematologic parameters including absolute lymphocyte count might be of value in predicting cirrhosis on liver biopsy following Fontan completion. Further research to validate these findings in other cohorts is warranted. Funding Acknowledgement Type of funding sources: None.

The effects of the magnetic field, plasma rotation and different parameters on the nonlinear natures of dust-ion-acoustic solitary waves have been investigated theoretically. The contemplated dusty plasma system is three-dimensional and homogeneously magnetized through which solitary waves of small amplitude propagate obliquely. The plasma consists of trapped negatively charged lighter ions, stationary dust particles with arbitrary charges, Maxwellian distributed electrons and mobile positively charged heavier ions. In this article, at the outset, we have derived the nonlinear modified Zakharov-Kuznetsov (mZK) equation by the reductive perturbation method, and then the equation is examined by a suggested mathematical technique. Therefore, advanced and typical wave solutions have been computed to analyze the dust-ion-acoustic solitary waves which propagate in the magnetorotating plasma. The effects of the magnetic field, the Coriolis force, and different plasma constituents on wave characteristics have been thoroughly investigated and it is found that they have a significant role in changing the amplitude and width of the dust-ion-acoustic solitary waves. Furthermore, the electric field and the soliton energy have also been calculated. These results might be significant to illustrate astrophysical and fusion devices, cosmic phenomena, pulsar radiations, rotating plasma waves, etc.

Total productive maintenance (TPM) is at the forefront of the maintenance strategies which brought about a paradigm shift from repair-maintenance strategy to proactive maintenance. The philosophy of TPM entails the facets of cost reduction and increased productivity. However, it has been observed that many manufacturing enterprises have made unsuccessful attempts at its adoption. In order to detect and overcome a qualitative research methodology has been employed and a survey has been carried out identifying the barriers and categorizing them to strategic, managerial, departmental, financial, and social regimes through rigorous data analysis. It was observed that strategic constraints are primarily detrimental to the success of TPM due to the lack of defined strategies for workers by management. Moreover, the departmental constraints are present due to misalignment between TPM and departmental objectives, in addition to the lack of training for workers in the system for TPM implementation. Moreover, there are managerial and financial constraints due to the lack of information visibility and finances, social constraints due to gap between top management authorization and worker mentality. Finally, a proper strategy has been proposed to address the issues affecting TPM implementation.

Background/Objective: Retinopathy of Prematurity (ROP) is a leading causes of childhood blindness. It affects 15,000 surviving US preterm infants annually, with 1,400 infants developing severe ROP and 500 infants developing legal blindness. The pathogenesis of ROP involves 2 phases: During phase 1, the immature retinal vascularization is obliterated due to hyperoxia. During phase 2 (>4 weeks postnatally), abnormal neovascularization occurs due to hypoxia, sometimes requiring surgical intervention. We retrospectively evaluated the impact of late supplemental oxygen (>4 weeks postnatally) on ROP progression in infants born stage 2 ROP admitted to the Riley Hospital for Children Neonatal Intensive Care Unit (NICU) from 7/2017- 12/2019 were included. Nine patients treated with supplemental oxygen therapy were compared to a control cohort managed by a standard protocol after the diagnosis of stage 2 ROP. The primary outcome was the need for surgical intervention with either laser or bevacizumab treatment. Continuous data was analyzed using unpaired t-test, and categorical data was analyzed using fishers exact test. Results: There was no statistical difference in regard to clinical variables contributing to risk of severe ROP (sex, race, birthweight necrotizing enterocolitis, bronchopulmonary dysplasia or length of stay) between the two study cohorts. There was a statistically significant decrease in need for treatments (laser or bevacizumab) in patients receiving supplemental oxygen (control: 35/83 patients treated, late O2: 0/9 patients treated, p=0.012). Conclusion and Implications: Supplemental oxygen therapy seems to have a protective effect on the development of treatable ROP (type I). Limiting surgical intervention (laser or bevacizumab) would directly benefit the babies by decreasing the need for sedation and any inherent risks of surgery. This initial data suggests the need for future studies with a higher sample size to validate the efficacy of late supplemental O2 in ROP. Study Group Control Number (Mean) % (SD) Number (Mean) % (SD) p-value Population (N) 9 - 83 - Sex Male 2 22.2% 35 42.2% N.S. Female 7 77.8% 48 57.8% N.S. Race Caucasian 5 55.6% 44 53.0% N.S. Non-Caucasian 4 44.4% 39 47.0% N.S. Birthweight (grams) 698 145.26 721 197.09 N.S. Gestational Age (Weeks) 24.94 1.19 25.32 1.72 N.S. Length of Stay (Days) 129.22 27.13 148.58 67.97 N.S. Necrotizing Enterocolitis Yes 3 33.3% 21 25.3% N.S. No 6 66.7% 62 74.7% N.S. Sepsis Yes 6 66.7% 41 49.4% N.S. No 3 33.3% 42 50.6% N.S. Bronchopulmonary Dysplasia Yes 9 100.0% 80 96.4% N.S. No 0 0.0% 2 2.4% N.S. Need for Additional Treatment (Inpatient) Yes 0 0.0% 35 42.2% N.S. No 9 100.0% 48 57.8% N.S. Need for Additional Treatment (Outpatient) Yes 0 0.0% 35 42.2% 0.012 No 9 100.0% 48 57.8%

Background Senior–Loken syndrome is a rare genetic disorder that presents with nephronophthisis and retinal degeneration, leading to end‐stage renal disease and progressive blindness. The most frequent cause of juvenile nephronophthisis is a mutation in the nephronophthisis type 1 (NPHP1) gene. NPHP1 encodes the protein nephrocystin‐1, which functions at the transition zone (TZ) of primary cilia. Methods We report a 9‐year‐old Senior–Loken syndrome boy with NPHP1 deletion, who presents with bilateral vision decrease and cystic renal disease. Renal function deteriorated to require bilateral nephrectomy and renal transplant. We performed immunohistochemistry, H&E staining, and electron microscopy on the renal sample to determine the subcellular distribution of ciliary proteins in the absence of NPHP1. Results Immunohistochemistry and electron microscopy of the resected kidney showed disorganized cystic structures with loss of cilia in renal tubules. Phosphoinositides have been recently recognized as critical components of the ciliary membrane and immunostaining of kidney sections for phosphoinositide 5‐phosphatase, INPP5E, showed loss of staining compared to healthy control. Ophthalmic examination showed decreased electroretinogram consistent with early retinal degeneration. Conclusion The decreased expression of INPP5E specifically in the primary cilium, coupled with disorganized cilia morphology, suggests a novel role of NPHP1 that it is involved in regulating ciliary phosphoinositide composition in the ciliary membrane of renal tubular cells., In this study, we report a 9‐year‐old Senior‐Loken syndrome patient with NPHP1 deletion. We found the decreased expression of INPP5E specifically in the primary cilium, coupled with disorganized cilia morphology, suggests a novel role of NPHP1 in regulating ciliary phosphoinositide composition in the ciliary membrane of renal tubular cells.

Background Rising trends in takotsubo syndrome (TTS)-related complications warrant data to identify the rate, causes and predictors of readmission on a large scale. We conducted the first-ever meta-analysis to evaluate the pooled rate of short-term and long-term readmissions after index TTS admissions. Methods PubMed/Medline, EMBASE and SCOPUS databases were systematically reviewed to find studies through October 2019 reporting rates and causes of readmission following index TTS admissions. Random effects models were used to estimate pooled rates and causes of readmissions and I2 statistics were used to report inter-study heterogeneity. Results A total of 16 cohorts with 118,941 TTS index admissions (mean age 65–75 yrs; female >85%, median follow-up 272.5 days) revealed a 16.6% [95% CI-13.2%-20.3%, I2=99%] pooled rate of readmission. Short-term and long-term pooled readmission rates are displayed in Fig.1. The readmission rate was higher in cohorts with young patients (70 yrs), smaller sample size (n100) and single-centres vs. multicentres. Studies published from the USA (16.4% vs. 14.9%) had a higher readmission rate as compared to Italy. The most frequent causes were cardiac (40.6%), respiratory (15.7%) and renal (7.0%). Among readmissions with cardiac diagnoses, heart failure was most common (40.1%). Conclusions This global meta-analysis revealed that the pooled rate of readmission following index TTS admissions was ∼17% and causes were mainly cardiac or respiratory. Funding Acknowledgement Type of funding source: None