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Introduction Total knee arthroplasty (TKA) is the treatment of end-stage osteoarthritis in patients who failed to respond to conservative treatment in providing significant pain relief and improving joint function. The medial parapatellar approach (MPP) allows adequate patellar eversion and sufficient knee flexion to expose the knee joint, but the incision through the quadriceps tendon may impair the extensor mechanism of the knee post-operatively. The subvastus approach (SV) completely spares both the quadriceps tendon and muscle and provides adequate exposure of the knee joint for the replacement procedure, SV maintains integrity of the patellar blood supply and reduces post-operative pain resulting in shorter hospital stay. The aim of this prospective study was to compare the results of the medial parapatellar and subvastus approaches in primary total knee arthroplasty (TKA) regarding postoperative pain, recovery of muscle strength, range of knee motion and return to regular daily activities. Materials and Methods Sixty patients underwent TKA at El-Hadara university hospital in Alexandria. The medial parapatellar apphroach (MPP) was performed in 30 patients while the subvastus approach (SV) was used for the other 30 patients. The choice of approach was randomly assigned. Results The statistical analysis of the results at the end of a 6-month follow-up showed that there were no significant differences between the patients in group 1 (MPP) and group 2 (SV) with respect to age, gender, comorbidity, side operated or body mass index (BMI). Regarding the functional knee scores (IKDC, WOMAC), there were no differences at 4 weeks, 3 months and 6 months postoperatively between the two groups. However, we found better outcomes in the SV group regarding the VAS score during the first five postoperative days, earlier quadriceps recovery by assessment of Straight Leg Raising test (SLR), while the operative time was longer in the SV group with less blood collected postoperatively in hemovac drain in the same group. Discussion In our study during the operation via the MPP approach, the index suture positioned at the superomedial border of the patella and the opposite suture on the medial retinacular flap had enabled the surgeon to avoid patellar maltracking during closure of the wound. In the SV group, the L-shaped incision of the medial capsule was considered an efficient landmark for accurate soft tissue closure avoiding the patellar maltracking. Conclusion The subvastus approach offers the advantage of keeping the integrity of quadriceps muscle and the extensor mechanism remains intact post-surgery. It causes less pain and less blood loss postoperatively than the regular parapatellar approach. The patient could recover the knee function in a shorter time with fewer complications, which is greatly in line with the concept of ERAS (Enhanced Recovery After Surgery).

Abstract This article investigates the geodesic structure and deflection angle of charged black holes in the presence of a nonzero vacuum expectation value background of the Kalb–Ramond field. Topics explored include null and timelike geodesics, energy extraction by collisions, and the motion of charged particles. The photon sphere radius is calculated and plotted to examine the effects of both the black hole charge (Q) and the Lorentz-violating parameter (b) on null geodesics. The effective potential for timelike geodesics is analyzed, and second-order analytical orbits are derived. We further show that the combined effects of Lorentz-violating parameter and electric charge can mimic a Kerr black hole spin parameter up to its maximum values, i.e., $$a/M \sim 1$$ a / M ∼ 1 thus suggesting that the current precision of measurements of highly spinning black hole candidates may not rule out the effect of Lorentz-violating parameter. The center of mass energy of colliding particles is also considered, demonstrating a decrease with increasing Lorentz-violating parameter. Circular orbiting particles of charged particles are discovered, with the minimum radius for a stable circular orbit decreasing as both b and Q increase. Results show that this circular orbit is particularly sensitive to changes in the Lorentz-violating parameter. Additionally, a timelike particle trajectory is demonstrated as a consequence of the combined effects of parameters b and Q. Finally, the light deflection angle is analyzed using the weak field limit approach to determine the Lorentz-breaking effect, employing the Gauss–Bonnet theorem for computation. Findings are visualized with appropriate plots and thoroughly discussed.

Abstract The goal of this work is to develop a Machine Learning model to predict the need for both invasive and non‐invasive mechanical ventilation in intensive care unit (ICU) patients. Using the Philips eICU Research Institute (ERI) database, 2.6 million ICU patient data from 2010 to 2019 were analyzed. This data was randomly split into training (63%), validation (27%), and test (10%) sets. Additionally, an external test set from a single hospital from the ERI database was employed to assess the model's generalizability. Model performance was determined by comparing the model probability predictions with the actual incidence of ventilation use, either invasive or non‐invasive. The model demonstrated a prediction performance with an AUC of 0.921 for overall ventilation, 0.937 for invasive, and 0.827 for non‐invasive. Factors such as high Glasgow Coma Scores, younger age, lower BMI, and lower PaCO2 were highlighted as indicators of a lower likelihood for the need for ventilation. The model can serve as a retrospective benchmarking tool for hospitals to assess ICU performance concerning mechanical ventilation necessity. It also enables analysis of ventilation strategy trends and risk‐adjusted comparisons, with potential for future testing as a clinical decision tool for optimizing ICU ventilation management.

Abstract We investigate shadows, deflection angle, quasinormal modes (QNMs), and sparsity of Hawking radiation of the Schwarzschild string cloud black hole’s solution after applying quantum corrections required by the Generalised Uncertainty Principle (GUP). First, we explore the shadow’s behaviour in the presence of a string cloud using three alternative GUP frameworks: linear quadratic GUP (LQGUP), quadratic GUP (QGUP), and linear GUP. We then used the weak field limit approach to determine the effect of the string cloud and GUP parameters on the light deflection angle, with computation based on the Gauss–Bonnet theorem. Next, to compute the quasinormal modes of Schwarzschild string clouds incorporating quantum correction with GUP, we determine the effective potentials generated by perturbing scalar, electromagnetic and fermionic fields, using the sixth-order WKB approach in conjunction with the appropriate numerical analysis. Our investigation indicates that string and linear GUP parameters have distinct and different effects on QNMs. We find that the greybody factor increases due to the presence of string cloud while the linear GUP parameter shows the opposite. We then examine the radiation spectrum and sparsity in the GUP corrected black hole with the cloud of string framework, which provides additional information about the thermal radiation released by black holes. Finally, our inquiries reveal that the influence of the string parameter and the quadratic GUP parameter on various astrophysical observables is comparable, however the impact of the linear GUP parameter is opposite.

Abdulaziz M Al-Garni,1 Hasan S Alamri,1 Waddah M Alalmaei Asiri,1 Abdulaziz Muflih Abudasser,1 Amal Saad Alawashiz,2 Fatima Ahmed Badawi,2 Ghaidaa Abdulrahman Alqahtani,2 Sultan Saad Ali Alnasser,2 Abdulwahab Mufareh Assiri,2 Khalid Talab Salem Alshahrani,2 Osama Ayed Saleh Asiri,2 Ohoud Hussain Moalwi,2 Manar Saeed Alqahtani,2 Reema S Alqhatani2 1Department of Internal Medicine, College of Medicine, King Khalid University, Abha, 61421, Saudi Arabia; 2College of Medicine, King Khalid University, Abha, Saudi ArabiaCorrespondence: Abdulaziz M Al-Garni, Department of Internal Medicine, College of Medicine, King Khalid University, Abha, 61421, Saudi Arabia, Email amoalqarni@kku.edu.saBackground: Use of different social media platforms has increased radically over the past decade, emerging as an important part of adolescents and young people’s everyday life. This might exert potential adverse effects on sleep quality and daytime performance of young adults.Aim of Study: To assess the relation between use of social media platforms and sleep quality among public secondary school students.Methods: A cross-sectional study was conducted on 961 students in Aseer region, Saudi Arabia. Students were asked to fill in a structured interview questionnaire covering personal data, pattern of social media use, sleep quality using The Pittsburgh Sleep Quality Index (PSQI) and their mental health status using the depression, anxiety and stress scale (DASS-21).Results: Students’ ages ranged from 15 to 20 years with a mean age of 16.7 ± 2.1 years old. A total of 570 (59.3%) students were females. Tiktok (80%), Snapchat (77.9%), Instagram (63.8%) and YouTube (58.8%) were the most reported platforms used. Regarding their sleep quality, 34.7% of students were poor sleepers. TikTok use (OR 1.33, 95% CI 1.01– 1.77), hours spent on social media (OR 1.26, 95% CI 1.16– 1.37) and having moderate to severe depressive symptoms (OR 1.69, 95% CI 1.19– 2.40) were significant independent predictors of poor sleep among the studied sample.Conclusion: The present study emphasized the association between prolonged use of social media and poor sleep quality among Saudi adolescents. Awareness and behavioral change strategies and activities concerning the drawbacks of poor sleep and proper use of social media are urgently called for to control mental and physical health consequences of poor sleep and social media addiction.Keywords: adolescents, mental health, Saudi Arabia, screen time, sleep quality, snapchat, social media, students, tiktok

Abstract Background Botulism has not been previously reported in the Kingdom of Saudi Arabia. This rare and sometimes fatal foodborne illness is caused by neurotoxins and primarily results from consuming home-canned fruits, vegetables, dairy, and seafood products & it can lead to paralysis. Objective The purpose of this study was to evaluate the clinical features of patients who developed botulism in Riyadh in 2024 after consuming mayonnaise from a well-known local chain of restaurants in Riyadh, Saudi Arabia. Methods We conducted a retrospective analysis of medical records and interviewed patients or their attendants for all hospitalized cases of foodborne botulism at Riyadh First Health Cluster. For each patient, a standard case report form was completed, containing information on demographics, clinical aspects, botulinum test results, and type of exposure. Descriptive statistics were applied to assess the data. During the outbreak, nineteen patients with foodborne diseases were admitted to Riyadh First Health Cluster Hospitals. Following thorough physical examinations, botulism was suspected in each case. Results Eight of the 19 suspected foodborne illness patients fully satisfied the botulism case definition requirements set forth by the Saudi Arabian Public Health Authority (Weqaya). Among these eight patients, 2 (25%) were male and 6 (75%) were female, with a mean age of 23.25 ± 9.29 years (range: 12–38 years). The incubation period for our patients was 36.25 ± 26.26 h. Notable symptoms included dysphagia in all eight patients (100%), dysarthria, generalized weakness, nausea and vomiting in seven patients (88%), diplopia in four patients (50%), and stomach discomfort in three patients (38%). Of the eight cases, six required intubation, one mimicked brain death, and two were stable. The presence of Clostridium botulinum spores as the cause of the outbreak was confirmed by detecting botulinum spores in contaminated food. Conclusion Diplopia and dysarthria were the most common early sign of botulism. Early manifestations may include respiratory symptoms without any musculoskeletal symptoms. or nausea, vomiting and disorientation.

Abstract Background: Malaria is considered the most deadly and difficult parasitic disease in the world. This study aims to use Markov chains to predict the probability patterns of stability or change in malaria incidence and deaths. Methods: Markov chains were used to analyze the data on malaria incidence and deaths through the Windows Quantitative Systems for Business (WINQSB) program. Data was obtained from the Ministry of Health, Gazira State, Health Information Centre, Sudan. The data is a time series, from 2001 to 2021 per year, according to three cases of decrease, stability, and increase. A transitional matrix is built for the three cases. Results: The results revealed that the probability that malaria incidence and deaths will reach a stable state in one year and in the long run; the probability of transitioning to an increased state was 0.66 of malaria incidence; and the probability of moving to a decreased state was 0.52 of malaria deaths. Conclusion: The results show that the malaria incidence will increase and malaria deaths will decrease in the short and long run from 2022 to 2030 in Gazira State. It is necessary to reinforce means and resources for case management and to investigate the determinants of the situation. Thus, strategies are urgently needed to arrest the unacceptably high incidence and death rates.

Abstract The endoplasmic reticulum (ER) employs stringent quality control mechanisms to ensure the integrity of protein folding, allowing only properly folded, processed and assembled proteins to exit the ER and reach their functional destinations. Mutant proteins unable to attain their correct tertiary conformation or form complexes with their partners are retained in the ER and subsequently degraded through ER-associated protein degradation (ERAD) and associated mechanisms. ER retention contributes to a spectrum of monogenic diseases with diverse modes of inheritance and molecular mechanisms. In autosomal dominant diseases, when mutant proteins get retained in the ER, they can interact with their wild-type counterparts. This interaction may lead to the formation of mixed dimers or aberrant complexes, disrupting their normal trafficking and function in a dominant-negative manner. The combination of ER retention and dominant-negative effects has been frequently documented to cause a significant loss of functional proteins, thereby exacerbating disease severity. This review aims to examine existing literature and provide insights into the impact of dominant-negative effects exerted by mutant proteins retained in the ER in a range of autosomal dominant diseases including skeletal and connective tissue disorders, vascular disorders, neurological disorders, eye disorders and serpinopathies. Most crucially, we aim to emphasize the importance of this area of research, offering substantial potential for understanding the factors influencing phenotypic variability associated with genetic variants. Furthermore, we highlight current and prospective therapeutic approaches targeted at ameliorating the effects of mutations exhibiting dominant-negative effects. These approaches encompass experimental studies exploring treatments and their translation into clinical practice.

Abstract Numerous strategies have been proposed for the detection and prevention of non‐technical electricity losses due to fraudulent activities. Among these, machine learning algorithms and data‐driven techniques have gained prominence over traditional methodologies due to their superior performance, leading to a trend of increasing adoption in recent years. A novel two‐step process is presented for detecting fraudulent Non‐technical losses (NTLs) in smart grids. The first step involves transforming the time‐series data with additional extracted features derived from the publicly available State Grid Corporation of China (SGCC) dataset. The features are extracted after identifying abrupt changes in electricity consumption patterns using the sum of finite differences, the Auto‐Regressive Integrated Moving Average model, and the Holt‐Winters model. Following this, five distinct classification models are used to train and evaluate a fraud detection model using the SGCC dataset. The evaluation results indicate that the most effective model among the five is the Gradient Boosting Machine. This two‐step approach enables the classification models to surpass previously reported high‐performing methods in terms of accuracy, F1‐score, and other relevant metrics for non‐technical loss detection.

Real-world healthcare data sharing is instrumental in constructing broader-based and larger clinical datasets that may improve clinical decision-making research and outcomes. Stakeholders are frequently reluctant to share their data without guaranteed patient privacy, proper protection of their datasets, and control over the usage of their data. Fully homomorphic encryption (FHE) is a cryptographic capability that can address these issues by enabling computation on encrypted data without intermediate decryptions, so the analytics results are obtained without revealing the raw data. This work presents a toolset for collaborative privacy-preserving analysis of oncological data using multiparty FHE. Our toolset supports survival analysis, logistic regression training, and several common descriptive statistics. We demonstrate using oncological datasets that the toolset achieves high accuracy and practical performance, which scales well to larger datasets. As part of this work, we propose a cryptographic protocol for interactive bootstrapping in multiparty FHE, which is of independent interest. The toolset we develop is general-purpose and can be applied to other collaborative medical and healthcare application domains.

Total-body PET/CT images can be rendered to produce images of a subject's face and body. In response to privacy and identifiability concerns when sharing data, we have developed and validated a workflow that obscures (defaces) a subject's face in 3-dimensional volumetric data. Methods: To validate our method, we measured facial identifiability before and after defacing images from 30 healthy subjects who were imaged with both [18F]FDG PET and CT at either 3 or 6 time points. Briefly, facial embeddings were calculated using Google's FaceNet, and an analysis of clustering was used to estimate identifiability. Results: Faces rendered from CT images were correctly matched to CT scans at other time points at a rate of 93%, which decreased to 6% after defacing. Faces rendered from PET images were correctly matched to PET images at other time points at a maximum rate of 64% and to CT images at a maximum rate of 50%, both of which decreased to 7% after defacing. We further demonstrated that defaced CT images can be used for attenuation correction during PET reconstruction, introducing a maximum bias of -3.3% in regions of the cerebral cortex nearest the face. Conclusion: We believe that the proposed method provides a baseline of anonymity and discretion when sharing image data online or between institutions and will help to facilitate collaboration and future regulatory compliance.

Tracer kinetic modeling in dynamic PET has the potential to improve the diagnosis, prognosis, and research of lung diseases. The advent of total-body PET systems with much greater detection sensitivity enables high-temporal-resolution (HTR) dynamic PET imaging of the lungs. However, existing models may become insufficient for modeling the HTR data. In this paper, we investigate the necessity of additional corrections to the input function for HTR lung kinetic modeling. Methods: Dynamic scans with HTR frames of as short as 1 s were performed on 13 healthy subjects with a bolus injection of about [Formula: see text] of 18F-FDG using the uEXPLORER total-body PET/CT system. Three kinetic models with and without time-delay and dispersion corrections were compared for the quality of lung time-activity curve fitting using the Akaike information criterion. The impact on quantification of 18F-FDG delivery rate [Formula: see text], net influx rate [Formula: see text] and fractional blood volume [Formula: see text] was assessed. Parameter identifiability analysis was also performed to evaluate the reliability of kinetic quantification with respect to noise. Correlation of kinetic parameters with age was investigated. Results: HTR dynamic imaging clearly revealed the rapid change in tracer concentration in the lungs and blood supply (i.e., the right ventricle). The uncorrected input function led to poor time-activity curve fitting and biased quantification in HTR kinetic modeling. The fitting was improved by time-delay and dispersion corrections. The proposed model resulted in an approximately 85% decrease in [Formula: see text], an approximately 75% increase in [Formula: see text], and a more reasonable [Formula: see text] (∼0.14) than the uncorrected model (∼0.04). The identifiability analysis showed that the proposed models had good quantification stability for [Formula: see text], [Formula: see text], and [Formula: see text] The [Formula: see text] estimated by the proposed model with simultaneous time-delay and dispersion corrections correlated inversely with age, as would be expected. Conclusion: Corrections to the input function are important for accurate lung kinetic analysis of HTR dynamic PET data. The modeling of both delay and dispersion can improve model fitting and significantly impact quantification of [Formula: see text], [Formula: see text], and [Formula: see text].

The current qualitative and quantitative study methods intend to investigate the quality of electronic examinations and the obstacles of changing the examinations' process from the participants' experiences and perspectives. The study generates feedback to enhance the adoption and improvement of the e. examination process. Due to the COVID-19 pandemic, electronic exams help much during the education interruption. The study employed two tools to answer the study's central question: "To what extent did teachers and students reflect on the quality of electronic examinations' criteria?" They Were distributed among (n=165) undergraduates and (n=24) faculty members during 2020/2021. Findings from the e. questionnaire's SPSS and interview's content analyses indicated that most participants were satisfied with the e. exams' flexibility, ease of use, clarity, fairness in grading, and feasibility in time, efforts, and money. Concerning challenges, few undergraduates complained about the Network problems, e. cheating, and the number of attempts to answer e. exams. Few faculty members have complained that some questions require different preparation methods, e. exams increase students' scores without much effort. On the other hand, it opened the door for malpractices. To conclude, the results revealed that e. examinations are of high quality; they were responsible for undergraduates' high performance, saved effort and time more than the in-class exams. The study recommends future research exploring families, especially parents, about their experience with kids regarding the quality of online examinations during the COVID-19 pandemic. Moreover, research is needed to address how teachers deal with the validity and reliability of the electronic exams.

In this paper, the existence and uniqueness of a specific class of fractional stochastic integro-differential equations considering the stochastic Brownian motion equipped with an appropriate form of a random initial condition is introduced regarding the Hilfer fractional derivative. The proofs of the existence and uniqueness of the solution are presented utilizing sensible constraints upon the deterministic and stochastic coefficients, Schauder's fixed point theorem, and some stochastic theories. Moreover, to get approximations of the exact paths solving such equations we introduce a numerical technique based upon the time-dependent spectral collocation technique considering the shifted Legendre polynomials as a basis. The underlying concept of this technique involves transforming complex equations into a set of algebraic ones by selecting an appropriate set of collocation points within the specified domain where collocation is applied. Herein, the values of the stochastic Brownian motion are calculated using the Mathematica program. For approximating the integrals, the Gauss–Legendre integration scheme is implemented. In addition, we establish the convergence concerning the presented scheme with the error estimate in detail. For this purpose, we present the graphs of maximum errors under the log-log scale. The utilized procedure is leveraged to tackle a variety of stochastic examples encompassing various types to confirm the effectiveness of the obtained theoretical and numerical results. The acquired upshots expose the efficiency and applicability of the presented methodology in the fractional stochastic field.

Objective This study aims to explore the associated impairments of cerebral palsy (CP) and their correlates among children with CP in Vietnam.Design Descriptive cross-sectional study using hospital-based surveillance.Setting National Children’s Hospital, Hanoi, Vietnam between June and November 2017.Participants 765 children with CP were recruited.Outcome measures We assessed clinical characteristics of CP, associated impairments (epilepsy, intellectual, visual, hearing, speech impairments) and their correlates. We performed descriptive analyses (median, IQR and proportion). χ2 test and Fisher’s exact test were used for categorical variables. Univariate logistic regression and multivariate logistic regression models were established and associated impairments were included as independent variables.Results The median age of children was 1.7 years (IQR=2.7). Quadriplegia was the predominant subtype (69.5%) and 46.5% were at Gross Motor Function Classification System level IV–V. Of children, 76.3% had ≥one associated impairment, most commonly speech or intellectual impairments (59.1% and 57.8%, respectively). Severity of motor impairment, type of CP, maternal and perinatal factors (eg, gestational age, perinatal asphyxia, timing of injury causing CP) were associated with greater risk of associated impairments.Conclusion Children with CP have a high burden of associated impairments. Findings from our study will inform the development and implementation of appropriate screening and interventions and reduce the long-term adverse effects of these impairments on individuals with CP and their socioeconomic impact.

This study delves into the efficacy of external strengthening methods in improving the shear behavior of defected reinforced concrete (RC) beams that lack shear stirrups, utilizing both experimental and numerical methodologies. Failure risk of such beams is a potential threat which is mitigated carefully to increase building safety and sustainability to avoid risk of construction failure. Ten RC beams underwent three-point experimental testing to assess the influence of the strengthening scheme and the presence of mechanical anchors. Two beams were designated as control specimens, while eight beams were strengthened with the application of additional strain-hardening cementitious composite (SHCC) layer in various configurations. These configurations encompassed single-sided, two-sided, and strip applications, with the inclusion of mechanical anchors. The study found that employing a single-sided SHCC, incorporating vertically bent bars into the RC beam, is recognized for its efficient alleviation of degradation in shear reinforcement. The incorporation of three SHCC strips to partially reinforce the compromised beams demonstrated a modest impact on the initial stiffness. Nevertheless, noteworthy enhancements of 46% and 42% were observed in both cracking and ultimate loads, respectively. Furthermore, increasing the number of the SHCC strips to four resulted in a more significant improvement in the load–deflection responses. Enhancing the compromised beams by applying four SHCC strips to the beams using bolts offers a feasible alternative to the configuration where SHCC was uniformly attached along the entire defected zone. Moreover, a numerical model was created to simulate the tested beams. The model effectively anticipated the progression of cracks, ultimate capacity, and deflection, indicating excellent agreement with the experimental observations.

This scholarly disquisition furnishes a comprehensive exploration of the burgeoning presence of Chinese private security companies (PSCs) across Latin America and the Caribbean (LAC), delving into the strategic repercussions for regional security architectures and national sovereignty imperatives. Employing a meticulous qualitative methodology encompassing a thorough literature review, policy document analysis, and an examination of Chinese-language sources, the research elucidates the salient drivers catalyzing this phenomenon. These precipitating factors span cultural affinities, economic motivations, geopolitical ambitions, and the exigent security challenges besetting Chinese commercial entities operating within the LAC region. The operational modes of Chinese PSCs are subjected to forensic scrutiny, illuminating their diverse service offerings, geographical permeation across the region, and the obstacles they confront. Furthermore, the inquiry contextualizes the issue within the broader geopolitical milieu, accentuating concerns regarding transparency lacunae, regulatory deficiencies, and potential avenues for Chinese intelligence and military machinations, thereby potentially destabilizing the regional equilibrium. Ultimately, the research culminates in a series of substantive policy prescriptions aimed at mitigating risks, fortifying regional stability, and safeguarding national sovereignty through capacity-building initiatives, constructive engagement with Beijing, enhanced transparency mechanisms, and robust regional cooperation frameworks.

Donald Trump’s tenure as the 45th President of the United States from 2017 to 2021 was marked by a series of controversial policies and rhetoric that significantly impacted both the nation’s international relations and domestic political landscape. This paper provides an in-depth exploration of the multifaceted effects of Trump’s presidency on global affairs and internal political dynamics from 2016 to 2024. Through a comprehensive analysis of his foreign policy actions, economic decisions, and rhetorical strategies, the study aims to elucidate the broader implications of his leadership on the world stage and within the United States. Incorporating a rigorous review of significant policy shifts, international agreements, economic reforms, and public opinion data, the research seeks to assess the lasting influence of Trump’s tumultuous presidency on the country’s global standing and internal cohesion.

Introduction We showed in a phase II randomised controlled trial (RCT) that oral sildenafil citrate in term labour halved operative birth for fetal distress. We outline the protocol for a phase III RCT (can intrapartum SildEnafil safely Avert the Risks of Contraction-induced Hypoxia? (iSEARCH)) of 3200 women in Australia to assess if sildenafil citrate reduces adverse perinatal outcomes related to intrapartum hypoxia.Methods and analysis iSEARCH will enrol 3200 Australian women in term labour to determine whether up to three 50 mg oral doses of sildenafil citrate versus placebo reduce the relative risk of a primary composite end point of 10 perinatal outcomes potentially related to intrapartum hypoxia by 35% (from 7% to 4.55%). Secondary aims are to evaluate reductions in the relative risk of emergency caesarean section or instrumental vaginal birth for fetal distress by 25% (from 20% to 15%) and in healthcare costs. To detect a 35% reduction in the primary outcome for an alpha of 0.05 and power of 80% with 10% dropout in each arm requires 3200 women (1600 in each arm). This sample size will also yield >90% power to detect a 25% reduction for the secondary outcome of any operative birth (caesarean section or instrumental vaginal birth) for fetal distress.Ethics and dissemination Ethical approval for the iSEARCH RCT was granted by the Hunter New England Human Research Ethics Committee (ref no: 2020/ETH02791). Results will be disseminated through websites, peer-reviewed publications, scientific meetings and social media, news outlets, television and radio.Trial registration number ACTRN12621000231842.

Background: The epidemiology of cerebral palsy (CP) is poorly described in Ghana. These data are crucial for evidence-based intervention for children with CP in the country. Objectives: We aimed to describe the epidemiology of CP among children in Ghana. Method: We established the first institution-based register of children with CP in Ghana (Ghana CP Register–GCPR). Children with confirmed CP aged 18 years were registered following a detailed neurodevelopmental assessment. Socio-demographics, risk factors, predominant motor type and topography, gross motor function classification system (GMFCS), associated impairments, education and rehabilitation status were documented. Results: Between October 2018 and February 2020, 455 children were registered (mean [standard deviation {s.d.}] age at assessment: 5.9 [4.1] years). Preterm birth and low birthweight were reported in 52.0% and 21.1% children respectively. Most children (79.6%) had a pre- or perinatally acquired CP and the mean (s.d.) age of CP diagnosis was 22.2 (21.6) months. Overall, 55.9% of children had spastic tri- or quadriplegia, 60.5% had GMFCS level III–V and 70.3% had ≥ 1 associated impairment. However, 20.5% had never received rehabilitation services and 69.6% of school-aged children in the GCPR were not enrolled in schools. Conclusion: The study findings indicate a high burden of severe motor and associated impairment among children with CP in Ghana which highlights the need for tailored interventions to improve health and well-being of children with CP in the country. Contribution: The study highlights the need for interventions to improve functional outcome, health and well-being of children with CP in Ghana.

Introduction Small for gestational age (SGA) infants are at increased risk of fetal distress in labour requiring emergency operative birth (by caesarean section (CS), vacuum or forceps). We have previously shown that maternal oral sildenafil citrate (SC) in labour halves the need for operative birth for suspected fetal distress in women with appropriately grown term infants.Methods and analysis RidStress 2 is a phase III randomised, double-blinded, placebo-controlled trial of 660 women with an SGA or suboptimally grown fetus (estimated fetal weight or abdominal circumference90% power to detect a similar reduction for the secondary outcome of any operative birth (CS or instrumental vaginal birth) for fetal distress.Ethics and dissemination Ethics approval was granted by the Mater Misericordiae Limited Human Research Ethics Committee (EC00332) on 11 September 2020. We plan to disseminate the results of this randomised controlled trial through presentations at scientific meetings and peer-reviewed journals, adhering to all relevant reporting guidelines.Trial registration number RidStress 2 is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12621000354886, 29/03/2021) and the Therapeutic Goods Association of Australia (date registered: 16 March 2021).

Due to the rapid technological advancements of various sectors in recent decades, there has been a growing need for energy, necessitating the development of large-capacity, robust, adaptable, and economical energy storage systems. The most current energy-storage material known as “MXene” is a two-dimensional layered transition metal nitride or carbonitride and carbide. A covalently bonded layer is exfoliated from its parent MAX (Mn + 1AXn) phase by selective chemical etching. MXene commands the highest demand of all the two-dimensional families of materials due to its extraordinary characteristics, which include high conductivity, flexible surface functional groups, excellent mechanical properties, superior hydrophilicity, electrochemical nature, and the thickness of its atomic layers. MXene is used in solid-state supercapacitors, batteries, antimicrobial films, gas and biosensors, water splitting, electromagnetic interference shielding, and photo- and electrocatalysis. Because of MXene’s special qualities, researchers are concentrating on developing the material further, both theoretically and experimentally. Utilizing a variety of microfabrication processes, MXene microelectrodes of micro-sized energy storage devices (MESDs) have been previously created. Distinct methodologies influence not only the apparatus’s arrangement but also the composition of MXene microelectrodes and the electrochemical efficacy of MESDs. ,This review study addresses relevant topics and provides a topical summary of the state-of-the-art regarding MXene-based energy storage devices. The field’s challenges and prospects for the future are discussed in the final part.

Ultrasensitive, high-resolution, extended-field-of-view total-body (TB) PET using the first-of-its-kind 194-cm axial-field-of-view uEXPLORER may facilitate the interrogation of biologic hallmarks of hitherto difficult-to-evaluate low-signal vessel wall pathology in cardiovascular disease. Methods: Healthy volunteers were imaged serially for up to 12 h after a standard dose of 18F-FDG (n = 15) or for up to 3 h after injection of a very low dose (about 5% of a standard dose; n = 15). A cohort undergoing standard 18F-FDG PET (n = 15) on a conventional scanner with a 22-cm axial field of view served as a comparison group. Arterial wall signal, crosstalk with hematopoietic and lymphoid organs, and image quality were analyzed using standardized techniques. Results: TB PET depicted the large vessel walls with excellent quality. The arterial wall could be imaged with high contrast up to 12 h after tracer injection. Ultralow-dose TB 18F-FDG images yielded a vessel wall signal and target-to-background ratio comparable to those of conventional-dose, short-axial-field-of-view PET. Crosstalk between vessel wall and lymphoid organs was identified with better accuracy in both TB PET cohorts than in conventional PET. Conclusion: TB PET enables detailed assessment of in vivo vessel wall biology and its crosstalk with other organs over an extended time window after tracer injection or at an ultralow tracer dose. These initial observations support the feasibility of serial imaging in low-risk populations and will stimulate future mechanistic studies or therapy monitoring in atherosclerosis and other vessel wall pathologies.

Image reconstruction of low-count positron emission tomography (PET) data is challenging. Kernel methods address the challenge by incorporating image prior information in the forward model of iterative PET image reconstruction. The kernelized expectation-maximization (KEM) algorithm has been developed and demonstrated to be effective and easy to implement. A common approach for a further improvement of the kernel method would be adding an explicit regularization, which however leads to a complex optimization problem. In this paper, we propose an implicit regularization for the kernel method by using a deep coefficient prior, which represents the kernel coefficient image in the PET forward model using a convolutional neural-network. To solve the maximum-likelihood neural network-based reconstruction problem, we apply the principle of optimization transfer to derive a neural KEM algorithm. Each iteration of the algorithm consists of two separate steps: a KEM step for image update from the projection data and a deep-learning step in the image domain for updating the kernel coefficient image using the neural network. This optimization algorithm is guaranteed to monotonically increase the data likelihood. The results from computer simulations and real patient data have demonstrated that the neural KEM can outperform existing KEM and deep image prior methods.