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Abstract Background Ethnicity and insurance status have been shown to impact odds of presenting with metastatic cancer, however, the interaction of these two predictors is not well understood. We evaluate the difference in odds of presenting with metastatic disease in minorities compared to white patients despite access to the same insurance across three common cancer types. Methods Using the National Cancer Database, a multilevel logistic regression model that estimated the odds of metastatic disease was fit, adjusting for covariates including year of diagnosis, ethnicity, insurance, income, and region. We included adults diagnosed with metastatic prostate, non–small cell lung cancer (NSCLC), and breast cancer from 2004 to 2015. Results The study cohort consisted of 1 191 241 prostate cancer (PCa), 1 310 986 breast cancer (BCa), and 1 183 029 NSCLC patients. Private insurance was the most protective factor against metastatic presentation. Odds of presenting with metastatic disease were 0.190 [95% CI, 0.182‐0.198], 0.616 [95% CI, 0.602‐0.630], and 0.270 [95% CI, 0.260‐0.279] for PCa, NSCLC, and BCa compared to uninsured patients, respectively. Private insurance provided the most significant benefit to non‐Hispanic White PCa patients with 81% reduction in odds of metastatic presentation and conferred the least benefit to African‐American NSCLC patients at 30.4% reduction in odds of metastatic presentation. Conclusions Insurance status provided the single most protective effect against metastatic presentation. This benefit varied for minorities despite similar insurance. Reducing metastatic disease presentation rates requires addressing social barriers to care independent of insurance.

This study aims at identifying the key agile, lean, resilient and green practices that influence capability of cold supply chain (CSC) using Interpretive Structural Modelling (ISM) technique. Various measures of lean, green, resilient, and agile practices in CSC were identified from previous studies and experts’ opinions. Contextual relationships between practice measures were established via brainstorming session. Measures were then classified based on their driving and dependence powers. The results showed that measures of lean, green, resilient, and agile practices in CSC can be organized in a six-level structural model. Moreover, highly dependent measures at top level in CSC model are operational costs and customer satisfaction, whereas the highly driving at most bottom level of this model are ISO 14001 implementation and government support system for green cold supply chain. Validity of CSC model was assessed in three CSC firms; food, pharmaceutical, and Third Party logistics firms. In conclusion, measures emerging with higher driving power and those with high dependence in ISM hierarchy contribute significantly to enhancing capability of CSC. The proposed ISM may support decision makers in prioritization improvement efforts and achieving effective CSC.

Osteoporosis is a frequently occurring skeletal disease, and osteoporosis-related fractures represent a significant burden for healthcare systems. Dual-Energy X-ray Absorptiometry (DXA) is the most commonly used method for assessing bone mineral density (BMD). Today, particular attention is being directed towards new technologies, especially those that do not use radiation, for the early diagnosis of altered bone status. Radiofrequency Echographic Multi Spectrometry (REMS) is a non-ionizing technology that evaluates the bone status at axial skeletal sites by analyzing raw ultrasound signals. In this review, we evaluated the data on the REMS technique present in the literature. The literature data confirmed diagnostic concordance between BMD values obtained using DXA and REMS. Furthermore, REMS has adequate precision and repeatability characteristics, is able to predict the risk of fragility fractures, and may be able to overcome some of the limitations of DXA. In conclusion, REMS could become the method of choice for the assessment of bone status in children, in women of childbearing age or who are pregnant, and in several secondary osteoporosis conditions due to its good precision and replicability, its transportability, and the absence of ionizing radiation. Finally, REMS may allow qualitative and not just quantitative assessments of bone status.

This study proposed a data mining framework for predicting sequential patterns of maintenance activities. The framework consisted of data collection, prediction of maintenance activities with and without attributes, and then the comparison between prediction results. In data collection, historical data were collected regarding maintenance activities and product attributes. The generalized sequential pattern (GSP) and association rules were then applied to predict maintenance activities with and without attributes to determine the frequent sequential patterns and significant rules of maintenance activities. Finally, a comparison was performed between the sequences of maintenance activities with and without attributes. A real case study of washing machine products was presented to illustrate the developed framework. The results showed that the proposed framework effectively predicted the next maintenance activities and planning preventive maintenance based on product attributes. In conclusion, the data mining approach is found effective in determining the maintenance sequence that reduces downtime and thereby enhancing productivity and availability.

INTRODUCTION:Gastric cancer represents a great challenge for healthcare providers and requires a multidisciplinary treatment approach in which surgery plays a major role. Minimally invasive surgery has been progressively developed, first with the advent of laparoscopy and recently with the spread of robotic surgery, but a number of issues are currently being debated, including the limitations in performing an effective extended lymph node dissection, the real advantages of robotic systems, the role of laparoscopy for Advanced Gastric Cancer, the reproducibility of a total intracorporeal technique and the oncological results achievable during long-term follow-up. METHODS AND ANALYSIS:A multi-institutional international database will be established to evaluate the role of robotic, laparoscopic and open approaches in gastric cancer, comprising of information regarding surgical, clinical and oncological features. A chart review will be conducted to enter data of participants with gastric cancer, previously treated at the participating institutions. The database is the first of its kind, through an international electronic submission system and a HIPPA protected real time data repository from high volume gastric cancer centres. ETHICS AND DISSEMINATION:This study is conducted in compliance with ethical principles originating from the Helsinki Declaration, within the guidelines of Good Clinical Practice and relevant laws/regulations. A multicentre study with a large number of patients will permit further investigation of the safety and efficacy as well as the long-term outcomes of robotic, laparoscopic and open approaches for the management of gastric cancer. TRIAL REGISTRATION NUMBER:NCT02325453; Pre-results.

The research aims to explore the effect of jigsaw strategy on improving academic achievement of students of the Qur’an Sciences at the University of Islamic Sciences.To achieve this goal, an academic achievement test was designed to test students’ performance on Qur’an sciences. The study followed the semi-experimental method; the sample was taken from (58) students registered for Qur’an sciences course for the first semester of the academic year 2019/2020; the students were randomly assigned to two groups. A control group contained (28) students who were taught using the traditional method. The students of the other group (the experimental group) contained (30) students and learned using the jigsaw strategy. A pretest and a posttest were conducted on both groups to measure their achievement. The results showed that there are statistically significant differences at the level (0.05≥α) on the total score of the scale between the mean scores of the control group and that of the experimental group, and on all dimensions in favor of the experimental group. This confirms the effectiveness of using jigsaw strategy for improving academic achievement. The study recommended the need to use the jigsaw strategy in teaching Quranic sciences because of its impact on the development of achievement after training teachers to teach Quranic Sciences according to this strategy

We present analysis of the atmospheres of 70 gaseous extrasolar planets via transit spectroscopy with Hubble’s Wide Field Camera 3 (WFC3). For over half of these, we statistically detect spectral modulation that our retrievals attribute to molecular species. Among these, we use Bayesian hierarchical modeling to search for chemical trends with bulk parameters. We use the extracted water abundance to infer the atmospheric metallicity and compare it to the planet’s mass. We also run chemical equilibrium retrievals, fitting for the atmospheric metallicity directly. However, although previous studies have found evidence of a mass–metallicity trend, we find no such relation within our data. For the hotter planets within our sample, we find evidence for thermal dissociation of dihydrogen and water via the H ^− opacity. We suggest that the general lack of trends seen across this population study could be due to (i) the insufficient spectral coverage offered by the Hubble Space Telescope’s WFC3 G141 band, (ii) the lack of a simple trend across the whole population, (iii) the essentially random nature of the target selection for this study, or (iv) a combination of all the above. We set out how we can learn from this vast data set going forward in an attempt to ensure comparative planetology can be undertaken in the future with facilities such as the JWST, Twinkle, and Ariel. We conclude that a wider simultaneous spectral coverage is required as well as a more structured approach to target selection.

This research developed a framework for electronic planning and management of facility services utilizing blockchain technology. In this framework, an electronic Facility Service Record (eFSR) in blockchain form was developed to manage and control service orders received by its main service center from university facilities via an electronic system. Mathematical models were formulated to determine the optimal schedule and sequence of facility services under probabilistic service order arrivals and stochastic service durations. Each task of a facility service is treated as a block. The scheduling model then assigned blocks (service tasks) to skilled technicians on each scheduling period at a minimal total cost of delay, undertime, and overtime costs, while the sequencing model determined the start and finish times of each block during the planning period. The optimal information of blocks was then confirmed and shared through an electronic network among all relevant facilities and the service center. The developed framework was implemented in university facilities to plan and manage 47 service orders for a total of 140 tasks over a period of twelve days. The results showed that the proposed eFSR is effective in managing optimal service tasks and efficient in improving the utilization and performance of the service center resources. In conclusion, the proposed eFSR with the optimal facility service planning provides real-time assistance and decentralized technology to facilities managers when planning service tasks over multiple periods. These advantages will result in the effective management of facilities and a considerable savings in maintenance resources.

Abstract Background More than 95% of individuals with RTT have mutations in methyl-CpG-binding protein 2 (MECP2), whose protein product modulates gene transcription. The disorder is caused by mutations in a single gene and the disease severity in affected individuals can be quite variable. Specific MECP2 mutations may lead phenotypic variability and different degrees of disease severity. It is known that low bone mass is a frequent and early complication of subjects with Rett syndrome. As a consequence of the low bone mass Rett girls are at an increased risk of fragility fractures. This study aimed to investigate if specific MECP2 mutations may affects the degree of involvement of the bone status in Rett subjects. Methods In 232 women with Rett syndrome (mean age 13.8 ± 8.3 yrs) we measured bone mineral density at whole body and at femur (BMD-FN and BMD-TH) by using a DXA machine (Hologic QDR 4500). QUS parameters were assessed at phalanxes by Bone Profiler-IGEA (amplitude dependent speed of sound: AD-SoS and bone transmission time: BTT). Moreover, ambulation capacity (independent or assisted), fracture history and presence of scoliosis were assessed. We divided the subjects with the most common point mutations in two group based on genotype-phenotype severity; in particular, there has been consensus in recognising that the mutations R106T, R168X, R255X, R270X are considered more severe. Results As aspect, BMD-WB, BMD-FN and BMD-TH were lower in subjects with Rett syndrome that present the most severe mutations with respect to subjects with Rett syndrome with less severe mutations, but the difference was statistically significant only for BMD-FN and BMD-TH (p

FtsZ is a tubulin homolog in bacteria. It forms a Z-ring to recruit other proteins in the process of cell division through its GTPase activity. Amino acid sequence of FtsZ was obtained from uniprot database and used for the determination of primary and secondary structures by several online tools. Homology modeling was carried out by SWISS-MODEL and PHYRE2. The models were evaluated and quality assessment indicated that the model produced by SWISS-MODEL had better quality than PHYRE2. Therefore, SWISS-MODEL was used in docking twenty five natural products by AutoDock 4.2.6. Dunnianol, pebrellin, dalbinol and hederagenin had docking energy higher than the previously used berberine and sanguinarine. Analogs of Dunnianol were sketched by ChemBioOffice Ultra 11.0 and docked. The analogs 2,4 and 7 had higher docking energy than the original compound. These natural products and the analogs obtained in this study could serve as possible inhibitors of this cell division protein, a new target in the development of new antimicrobials.

Rapid advancement of data management and sharing technology has urged organizations to develop effective maintenance management systems. This research, therefore, proposes and implements an Electronic Repair Records (ERR) system for the blockchain of maintenance planning and management. In ERR, this research develops two optimization models for scheduling and sequencing failure repairs from different types over multiple periods. Each failure repair is treated as a block, for which the data, current hash, and previous hash are obtained from failure repair parameters, resources availability information, and the optimal values of the start and finish times of the assigned failure repairs. The scheduling model assigns failure repairs to technicians and in maintenance shops on each scheduling period at a minimal total cost of delay, undertime, and overtime costs, while the sequencing model sequences the assigned failure repairs at minimal total overtime costs and minimum total repair start times. Once the blocks are confirmed, the blockchain is then shared through an electronic network among all maintenance departments. The developed ERR system was implemented to manage the repairs of 36 failures from different failures in six maintenance shops over a period of three days. The results showed that this system is found to be effective in managing optimal repairs and efficient in improving the utilization of available resources in maintenance shops. These advantages may result in significant savings in maintenance costs and better utilization of resources. In conclusion, the developed ERR system including the optimization models can provide in real-time assistance and de-centralized technology to planning engineers when managing maintenance activities over multiple periods in a wide range of business applications.

Production lines are usually subjected to emergent machine failures. Such emergent failures disrupt pre-established maintenance schedules, which challenge maintenance engineers to react to those failures in real time. This research proposes an optimization procedure for optimizing scheduling repairs of emergent failures. Three optimization models are developed. Model I schedules failures in newly idle repair shops with the objective of maximizing the number of scheduled repairs. Model II maximizes the number of assigned repairs to untapped ranges. Model III maximizes both the number of assigned failure repairs and satisfaction on regular and emergency repairs by resequencing regular and emergent failures in the shop that contains the largest free margin. A real case study is provided to illustrate the proposed optimization procedure. Results reveal that the proposed models efficiently scheduled and sequenced emergent failures in the idle maintenance shops, the untapped ranges between repairs of regular failures, and in the maintenance shop with the largest free margin. In conclusions, the proposed models can greatly support maintenance engineers in planning repairs under unexpected failures.

BackgroundPancreatic adenosquamous carcinoma has historically been characterized as having a more aggressive clinical course than ductal adenocarcinoma. The natural history of this disease, however, is essentially unknown.MethodsWe evaluated the clinical characteristics of all patients with pancreatic adenosquamous carcinoma recorded in the California Cancer Registry 2000-2007 and compared them to those of patients with ductal adenocarcinoma.ResultsNinety-five patients with pancreatic adenosquamous carcinoma and 14,746 patients with ductal adenocarcinoma were identified. Demographics were similar between subtypes (p > 0.05). Disease stage at presentation was also similar; over 50% of each diagnostic group presented with metastatic disease (p = 0.62). Surgical resection was more common among patients with locoregional adenosquamous carcinoma than adenocarcinoma (p = 0.0004), but rates of adjuvant therapy administration were similar (p > 0.05). The cohorts' median overall survival durations were similar in a Cox proportional hazards model (p = 0.45); overall survival was also similar when only patients with resected disease were considered (p = 0.65). Early stage, resection and receipt of radiation or chemotherapy were favorable independent prognostic factors among patients with adenosquamous carcinoma. The median overall survival duration of patients with resected adenosquamous carcinoma was 12 months (95% CI, 8-52).ConclusionsAdenosquamous carcinoma has a natural history similar to that of ductal adenocarcinoma when treated with prevalent clinical patterns of care.