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Abstract The global crisis of the COVID-19 pandemic has highlighted the need for mathematical models to inform public health strategies. The present study introduces a novel six-compartment epidemiological model that uniquely incorporates a higher isolation rate for unreported symptomatic cases of COVID-19 compared to reported cases, aiming to enhance prediction accuracy and address the challenge of initial underreporting. Additionally, we employ optimal control theory to assess the cost-effectiveness of interventions and adapt these strategies to specific epidemiological scenarios, such as varying transmission rates and the presence of asymptomatic carriers. By applying this model to COVID-19 data from India (30 January 2020 to 24 November 2020), chosen to capture the initial outbreak and subsequent waves, we calculate a basic reproduction number of 2.147, indicating the high transmissibility of the virus during this period in India. A sensitivity analysis reveals the critical impact of detection rates and isolation measures on disease progression, showing the robustness of our model in estimating the basic reproduction number. Through optimal control simulations, we demonstrate that increasing isolation rates for unreported cases and enhancing detection reduces the spread of COVID-19. Furthermore, our cost-effectiveness analysis establishes that a combined strategy of isolation and treatment is both more effective and economically viable. This research offers novel insights into the efficacy of non-pharmaceutical interventions, providing a tool for strategizing public health interventions and advancing our understanding of infectious disease dynamics.

In applied and computational mathematics, quaternions are fundamental in representing three-dimensional rotations. However, specific types of quaternionic linear matrix equations remain few explored. This study introduces new quaternionic linear matrix equations and their necessary and sufficient conditions for solvability. We employ a methodology involving lemmas and ranks of coefficient matrices to develop a novel algorithm. This algorithm is validated through numerical examples, showing its applications in advanced fields. In control theory, these equations are used for analyzing control systems, particularly for spacecraft attitude control in aerospace engineering and for control of arms in robotics. In quantum computing, quaternionic equations model quantum gates and transformations, which are important for algorithms and error correction, contributing to the development of fault-tolerant quantum computers. In signal processing, these equations enhance multidimensional signal filtering and noise reduction, with applications in color image processing and radar signal analysis. We extend our study to include cases of $ \eta $-Hermitian and i-Hermitian solutions. Our work represents an advancement in applied mathematics, providing computational methods for solving quaternionic matrix equations and expanding their practical applications.

Abstract Background Respiratory health problems are one of the main causes of morbidity and mortality in adult people with cerebral palsy (CP). The influence of respiratory muscle training has not yet been studied in this population group. The objective of the study was to evaluate and compare the efficacy of two protocols with inspiratory muscle training (IMT), low intensity and high intensity, to improve respiratory strength and pulmonary function in adults with CP. Methods The study was a controlled, randomized, double‐blind trial with allocation concealment. Twenty‐seven institutionalized CP patients were recruited and randomly distributed in the high‐intensity training group (HIT) or low‐intensity training group (LIT). Over 8 weeks, an IMT protocol was followed 5 days/week, 10 series of 1 min with 1 min rest between them. HIT trained with a load of 40% of the maximum inspiratory pressure (MIP) and LIT with 20%. Respiratory strength and pulmonary function were evaluated. Results After IMT intervention, MIP, maximum expiratory pressure, forced expiratory volume in 1 s (FEV1) and peak expiratory flow increased in both groups; in HIT 29%, 19%, 13%, and 8%, respectively (p = 0.000, p = 0.000, p = 0.002, p = 0.001) and in LIT 17%, 7%, 3%, and 4%, respectively (p = 0.000, p = 0.000, p = 0.049, p = 0.113). All the improvements were significantly higher in HIT than in LIT. Conclusion Inspiratory muscle training improved respiratory muscle strength and pulmonary function in adults with CP. Training with a 40% MIP load improved all the evaluated parameters and was the most effective treatment for adults with CP.

IntroductionMycobacteria are known to exert a range of heterologous effects on the immune system. The mycobacteria-based Freund’s Complete Adjuvant is a potent non-specific stimulator of the immune response used in immunization protocols promoting antibody production, and Mycobacterium bovis Bacille Calmette Guérin (BCG) vaccination has been linked with decreased morbidity and mortality beyond the specific protection it provides against tuberculosis (TB) in some populations and age groups. The role of heterologous antibodies in this phenomenon, if any, remains unclear and under-studied.MethodsWe set out to evaluate antibody responses to a range of unrelated pathogens following infection with Mycobacterium tuberculosis (M.tb) and vaccination with BCG or a candidate TB vaccine, MTBVAC, in non-human primates.ResultsWe demonstrate a significant increase in the titer of antibodies against SARS-CoV-2, cytomegalovirus, Epstein-Barr virus, tetanus toxoid, and respiratory syncytial virus antigens following low-dose aerosol infection with M.tb. The magnitude of some of these responses correlated with TB disease severity. However, vaccination with BCG administered by the intradermal, intravenous or aerosol routes, or intradermal delivery of MTBVAC, did not increase antibody responses against unrelated pathogens.DiscussionOur findings suggest that it is unlikely that heterologous antibodies contribute to the non-specific effects of these vaccines. The apparent dysregulation of B cell responses associated with TB disease warrants further investigation, with potential implications for risk of B cell cancers and novel therapeutic strategies.

In this study the novel garnet-type Y2.47Na0.5Ln0.03Al5O12, Y2.97Ln0.03Al4.95V0.05O12, Y2.92Na0.05Ln0.03Al4.9833V0.0167O12 (Ln = Ce3+, Tb3+, Eu3+) phosphors were successfully synthesized by the sol-gel method for the first time. The structural, morphological and optical properties were characterized by using multiple characterization techniques. The XRD and FTIR results confirmed that all obtained phosphors are monophasic yttrium aluminium garnet compounds, i.e. the doping of Ce3+, Tb3+, Eu3+, Na+, V5+ ions does not induce any impurity phases, indicating the successful incorporation of these dopants into the YAG host. The formation of novel garnets was probed using 27Al, 51V, 23Na MAS NMR techniques. SEM micrographs revealed that almost in all cases, the surface of the obtained luminophores is porous and consists of homogeneously distributed irregular sphere-like shape particles, which tend to form larger agglomerates. The optical properties of obtained compounds were also investigated by recording their excitation and emission spectra and calculating the colour coordinates in the CIE 1931 colour space.

La inclusión financiera en el Perú está en aumento, pues ya el 56 % de los adultos tiene productos financieros. Esto ha incrementado el uso de cajeros automáticos y los riesgos asociados a ellos, como el shoulder surfing. Buscando mitigar el riesgo de este ataque, se hizo una prueba de concepto de interfaz touchless que permite a los usuarios ingresar su PIN de manera segura, proponiendo un ejemplo para que sea usado por entidades bancarias o fabricantes de cajeros automáticos. Para esto, se generaron secuencias desordenadas aleatoriamente con los números del 0 al 9 sin que estos se repitan. Luego, se implementan sensores infrarrojos para ingresar los números del PIN. Se realizaron pruebas de mitigación y usabilidad con un grupo de 16 personas. La primera prueba mostró resultados alentadores, pues a los atacantes se le dificulta identificar los dígitos ingresados por los usuarios y solo lograron registrar el 25 % correctamente. Asimismo, en las pruebas de usabilidad se obtuvo un promedio general de usabilidad de 78.4375, situando a la interfaz en un rango B +, por encima del umbral de 68 puntos. Considerando esto, se concluye que la propuesta cumple con el objetivo de permitir al usuario ingresar su PIN de manera segura ante ataques de shoulder surfing.

Selecting the right actuator for a portable exoskeleton involves a comprehensive evaluation of various design characteristics. In this study, we introduce a methodology for actuator selection based on specific tasks, enhancing the practical adoption of portable exoskeletons. By examining a range of candidate actuators designed for lower limb exoskeletons, our objective is to engineer a system that is both lightweight and power-efficient. These candidate actuators, developed by integrating diverse motors and transmission systems, were rigorously tested against defined tasks. Our methodology, applied to an assistive exoskeleton catered to the elderly, showed its potential in tailoring an efficient system with matching capabilities. The obtained results indicated that the ideal configuration achieved reductions in weight and power requirements by 35% and 80%, respectively. The present research delineates a strategic approach for actuator selection in portable exoskeletons, contributing to the evolution of high-performing assistive devices.

Este trabajo se interroga respecto al rol y desenvolvimiento de la agencia estatal encargada del turismo en Salta durante los años peronistas. Se analiza la evolución, funciones, capacidades y límites del Estado a “ras de suelo” en un espacio escasamente explorado por la historiografía del turismo. A partir de ello se demostró que la organización del turismo se llevó a cabo mediante la acción autónoma y descentralizada de la dependencia subnacional, con escasa o nula coordinación nacional y caracterizada por la fragmentariedad, los obstáculos, las marchas y las contramarchas.

Decision-making in real-world scenarios faces uncertainty. Fuzzy theory has been a means to represent such uncertainty. In this study, we propose an approach that incorporates bipolarity into multi-criteria decision-making processes applied to digital marketing. The proposal considers both the positive and negative dimensions of data, leading to better-informed decisions. Our contribution integrates bipolarity into Pythagorean fuzzy matrices, a framework that broadens the utility of bipolar fuzzy theory. Through computational experimentation, we identify the most effective strategy for digital marketing platforms. When compared to existing techniques, our approach shows advantages, underlining its potential to improve decision-making in uncertain scenarios and offering insights for businesses that refine their digital marketing strategies.

Background: Colorectal cancer is a leading cause of morbidity and mortality worldwide, with chemotherapy being a crucial treatment despite its significant side effects, such as chemotherapy-induced peripheral neuropathy (CIPN). Physical exercise has shown potential benefits in mitigating these side effects and improving patients’ overall well-being. Objective: This study aims to evaluate the efficacy of a strength exercise program in reducing CIPN in patients with colorectal cancer undergoing chemotherapy, along with secondary objectives including impacts on quality of life, body mass index, oxygen consumption, anxiety and depression, fatigue, sleep quality, and various analytical parameters. Methods: A double-blind randomized controlled trial was conducted with 44 participants, divided into an intervention group (supervised resistance training twice a week and home exercises) and a control group (home exercises only). The primary outcome measure was CIPN, assessed using the EORTC QLQ-CIPN20 questionnaire. Secondary outcomes included assessments using the EORTC QLQ-C30, the 6-minute walk test, HADS, FACT-F, and MISS, along with various blood parameters. Results and Conclusions: The study will provide insights into the effectiveness of physical exercise in managing CIPN and improving various health parameters in colorectal cancer patients. By developing tailored exercise protocols, this research aims to enhance patient quality of life, optimize treatment outcomes, and reduce the incidence of debilitating side effects, thereby supporting the integration of physical exercise into standard oncological care.

Despite the advantages of surgical handrub in terms of the ease of application and effectiveness, chlorhexidine (CHG)-based hand scrubbing remains the preferred method for surgical hand preparation. However, it does not systematically meet the non-inferiority requirement of the European norm (EN) 12791 with respect to n-propanol (the reference product) and does not provide the sustained efficacy expected for these long-lasting agents. Commercially available alcohol-based products have also failed to demonstrate sustained efficacy according to EN 12791. Multi-step protocols enhance the efficacy of hand scrubbing, yet their extended disinfection duration might diminish their allure for healthcare professionals. In this study, we show that hand scrubbing with CHG 4% followed by a 1 min rubbing with the novel formulation of ethanol (Et) 70%/CHG 3% plus 0.3% potassium sorbate food additive (PS) meets the non-inferiority requirement and demonstrates sustained efficacy when tested according to EN 12791. The immediate and 3 h effect of this protocol was significantly higher than that of n-propanol and the homologous disinfection protocol without PS (CHG 4% hand scrub plus Et 70%/CHG 3% rub), demonstrating that the inclusion of PS confers a notable residual effect. We speculate that this non-volatile ingredient acts synergistically with CHG. This promising combination represents an alternative method for the development of new disinfection strategies.

Los desarrollos en la teoría de la argumentación jurídica han impactado de manera notable en la reconstrucción de la teoría jurídica, la epistemología jurídica y el razonamiento probatorio. Algunos de los conceptos centrales de la misma son la distinción entre “caso fácil” y “caso difícil” así como la correlativa necesidad de realizar una justificación interna y externa de las premisas. El objetivo de nuestro trabajo consiste en analizar la fecundidad de la epistemología del desacuerdo, para clarificar la noción de caso difícil y principalmente para dar cuenta del alcance de la obligación de motivar la sentencia. La exploración implica de alguna manera extender el campo de aplicación de nociones como la “desacuerdo entre pares epistémicos” no solo a la disposición para revisar las creencias de los juzgadores sino también para evaluar el alcance de la obligación de realizar la justificación externa de las premisas. Para el abordaje de la temática iniciamos describiendo los aspectos centrales de la argumentación jurídica para posteriormente ensayar una reconstrucción de las alternativas del concepto de “caso difícil” en términos de desacuerdo, y ensayar la aplicación de una noción de “desacuerdo posible entre pares” para analizar el campo de las alternativas disponibles y evaluarla a partir de su capacidad de dar cuenta de cierto aspectos centrales de la práctica de la justificación jurídica en los procesos, principalmente de las decisiones jurisdiccionales y como al mismo cumplimentar los ideales normativos del sistema.

Many studies have been performed in different regions of the world as a result of the COVID-19 pandemic. In this work, we perform a statistical study related to the number of vaccinated cases and the number of deaths due to COVID-19 in ten South American countries. Our objective is to group countries according to the aforementioned variables. Once the groups of countries are built, they are characterized based on common properties of countries in the same group and differences between countries that are in different groups. Countries are grouped using principal component analysis and K-means analysis. These methods are combined in a single procedure that we propose for the classification of the countries. Regarding both variables, the countries were classified into three groups. Political decisions, availability of resources, bargaining power with suppliers and health infrastructure among others are some of the factors that can affect both the vaccination process and the timely care of infected people to avoid death. In general, the countries acted in a timely manner in relation to the vaccination of their citizens with the exception of two countries. Regarding the number of deaths, all countries reached peaks at some point in the study period.

In this study, an internet of things (IoT)-enabled fuzzy intelligent system is introduced for the remote monitoring, diagnosis, and prescription of treatment for patients with COVID-19. The main objective of the present study is to develop an integrated tool that combines IoT and fuzzy logic to provide timely healthcare and diagnosis within a smart framework. This system tracks patients' health by utilizing an Arduino microcontroller, a small and affordable computer that reads data from various sensors, to gather data. Once collected, the data are processed, analyzed, and transmitted to a web page for remote access via an IoT-compatible Wi-Fi module. In cases of emergencies, such as abnormal blood pressure, cardiac issues, glucose levels, or temperature, immediate action can be taken to monitor the health of critical COVID-19 patients in isolation. The system employs fuzzy logic to recommend medical treatments for patients. Sudden changes in these medical conditions are remotely reported through a web page to healthcare providers, relatives, or friends. This intelligent system assists healthcare professionals in making informed decisions based on the patient's condition.

ObjectivesTo assess the feasibility of extracting radiomics signal intensity based features from the myocardium using cardiovascular magnetic resonance (CMR) imaging stress perfusion sequences. Furthermore, to compare the diagnostic performance of radiomics models against standard-of-care qualitative visual assessment of stress perfusion images, with the ground truth stenosis label being defined by invasive Fractional Flow Reserve (FFR) and quantitative coronary angiography.MethodsWe used the Dan-NICAD 1 dataset, a multi-centre study with coronary computed tomography angiography, 1,5 T CMR stress perfusion, and invasive FFR available for a subset of 148 patients with suspected coronary artery disease. Image segmentation was performed by two independent readers. We used the Pyradiomics platform to extract radiomics first-order (n = 14) and texture (n = 75) features from the LV myocardium (basal, mid, apical) in rest and stress perfusion images.ResultsOverall, 92 patients (mean age 62 years, 56 men) were included in the study, 39 with positive FFR. We double-cross validated the model and, in each inner fold, we trained and validated a per territory model. The conventional analysis results reported sensitivity of 41% and specificity of 84%. Our final radiomics model demonstrated an improvement on these results with an average sensitivity of 53% and specificity of 86%.ConclusionIn this proof-of-concept study from the Dan-NICAD dataset, we demonstrate the feasibility of radiomics analysis applied to CMR perfusion images with a suggestion of superior diagnostic performance of radiomics models over conventional visual analysis of perfusion images in picking up perfusion defects defined by invasive coronary angiography.

Abstract Atrial fibrillation (AF) is the most common cardiac arrhythmia. It is associated with a higher risk of important adverse health outcomes such as stroke and death. AF is linked to distinct electro-anatomic alterations. The main tool for AF diagnosis is the Electrocardiogram (ECG). However, an ECG recorded at a single time point may not detect individuals with paroxysmal AF. In this study, we developed machine learning models for discrimination of prevalent AF using a combination of image-derived radiomics phenotypes and ECG features. Thus, we characterize the phenotypes of prevalent AF in terms of ECG and imaging alterations. Moreover, we explore sex-differential remodelling by building sex-specific models. Our integrative model including radiomics and ECG together resulted in a better performance than ECG alone, particularly in women. ECG had a lower performance in women than men (AUC: 0.77 vs 0.88, p

IntroductionCigarette smoking is a significant public health problem, and it is essential to work actively with young people to limit the incorporation of this addiction. This study aimed to identify characteristics associated with tobacco use in adolescents in a real setting.MethodsEpidemiologic, cross-sectional study including secondary school students aged 12–17 years in the 1st, 2nd, and 3rd grades of “Joan Fuster High School” in the city of Sueca, Valencia (Spain). An anonymous, self-administered questionnaire was used to collect data on demographics, cigarette smoking history, alcohol consumption, nicotine dependence, and exposure to parental cigarette smoking.ResultsThe final sample of individuals surveyed included 306 students (50.6% females) with a median age of 13 years. The prevalence of cigarette smoking was 11.8% (13.5% in females and 9.9% in males). The mean age of cigarette smoking onset was 12.7 ± 1.6 years. Ninety-three students (30.4%) were repeaters, and 114 (37.3%) reported alcohol consumption. Significant factors associated with tobacco use were being a repeater (odds ratio [OR] 4.19, 95% confidence interval [CI] 1.75–10.55, p = 0.002), alcohol consumption (OR 4.06, 95% CI 1.75–10.15, p = 0.002) and parental cigarette smoking (OR 3.76, 95% CI 1.52–10.74, p = 0.007).DiscussionAn operational profile of features associated with tobacco consumption was identified in the presence of parental cigarette smoking, alcohol consumption, and poor academic performance. Consideration of these factors could be useful in the operational design of cigarette smoking cessation interventions for young people in a context where there is a great need for better prevention and control of cigarette smoking.

Abstract Background Prolonged sedentary time is associated with an increased incidence of chronic disease including type 2 diabetes mellitus (DM2). Given that occupational sedentary time contributes significantly to the total amount of daily sedentariness, incorporating programmes to reduce occupational sedentary time in patients with chronic disease would allow for physical, mental and productivity benefits. The aim of this study is to evaluate the short-, medium- and long-term effectiveness of a mHealth programme for sitting less and moving more at work on habitual and occupational sedentary behaviour and physical activity in office staff with DM2. Secondary aims. To evaluate the effectiveness on glycaemic control and lipid profile at 6- and 12-month follow-up; anthropometric profile, blood pressure, mental well-being and work-related post-intervention outcomes at 3, 6 and 12 months. Methods Multicentre randomized controlled trial. A sample size of 220 patients will be randomly allocated into a control (n = 110) or intervention group (n = 110), with post-intervention follow-ups at 6 and 12 months. Health professionals from Spanish Primary Health Care units will randomly invite patients (18–65 years of age) diagnosed with DM2, who have sedentary office desk-based jobs. The control group will receive usual healthcare and information on the health benefits of sitting less and moving more. The intervention group will receive, through a smartphone app and website, strategies and real-time feedback for 13 weeks to change occupational sedentary behaviour. Variables: (1) Subjective and objective habitual and occupational sedentary behaviour and physical activity (Workforce Sitting Questionnaire, Brief Physical Activity Assessment Tool, activPAL3TM); 2) Glucose, HbA1c; 3) Weight, height, waist circumference; 4) Total, HDL and LDL cholesterol, triglycerides; (5) Systolic, diastolic blood pressure; (6) Mental well-being (Warwick-Edinburgh Mental Well-being); (7) Presenteeism (Work Limitations Questionnaire); (8) Impact of work on employees´ health, sickness absence (6th European Working Conditions Survey); (9) Job-related mental strain (Job Content Questionnaire). Differences between groups pre- and post- intervention on the average value of the variables will be analysed. Discussion If the mHealth intervention is effective in reducing sedentary time and increasing physical activity in office employees with DM2, health professionals would have a low-cost tool for the control of patients with chronic disease. Trial Registration ClinicalTrials.gov NCT04092738. Registered September 17, 2019.

Objective: the superior attachment of the uncinate process (SAUP) is highly variable. Lateral types of SAUP are associated with frontal rhinosinusitis. SAUP in the middle turbinate is more common when the middle turbinate is aerated. We aim to refine these findings by studying the relationship between the SAUP type and the different subtypes of pneumatization of the middle turbinate. Methods: 200 CT sinonasal scans were analyzed by an otolaryngologist and a radiologist. All CT scans were analyzed to study the type of the middle turbinate concha bullosa and lamellar cell and the type of SAUP. Results: 379 sides were analyzed. The prevalence of the various types of SAUP were: Type I: 43.80%, Type II: 22.16%, Type III: 16.36%, Type IV: 3.69%, Type V: 9.76%, and Type VI: 4.22%. When studying the pneumatization of the middle turbinate and the SAUP types, we only found a statistically significant association between the lateral attachment of the uncinate process and the presence of a lamellar cell (p = 0.029). Conclusion: lateral types of SAUP are more likely in the presence of a lamellar cell. This finding, therefore, renders checking for lateral SAUP types in the presence of a lamellar cell even more relevant than when studying the pre-surgical CT scan. In those cases, it is advisable to perform a careful and complete uncinectomy.

Background: Acute appendicitis is a frequently encountered surgical emergency. Despite several scoring systems, the possibility of delayed diagnosis persists. In addition, a delayed diagnosis leads to an increased risk of complicated appendicitis. Hence, there is a need to identify biological markers to help clinicians rapidly and accurately diagnose and prognosticate acute appendicitis with a high sensitivity and specificity. Although several markers have been evaluated, the pressing concern is still the low specificity of these markers. One such marker is serum ischemia-modified albumin (IMA), which can be a novel biomarker for accurately diagnosing and prognosticating acute appendicitis. Methods: The authors conducted a systematic search of the PubMed, EMBASE, Web of Science, and Scopus databases through February 2023 as per the PRISMA guidelines. The difference in the levels of IMA between patients with acute appendicitis vs. healthy controls, and the difference in the levels of IMA between patients with complicated vs. non-complicated acute appendicitis were taken as the outcome measures. Statistical analysis was performed using a random effects model and mean difference (MD) was calculated. The methodological quality of the studies was assessed by utilizing the Newcastle–Ottawa scale. Results: A total of six prospective comparative studies were included in the meta-analysis. The analysis revealed that the mean level of serum IMA was significantly raised in the acute appendicitis group (MD 0.21, 95% CI 0.05 to 0.37, p = 0.01). Similarly, the mean serum IMA levels were also raised in the complicated appendicitis group compared to the non-complicated appendicitis group (MD 0.05, 95% CI 0.01 to 0.10, p = 0.02). Three of the studies included were, however, of poor methodological quality. Conclusions: Serum IMA is a viable potential marker for diagnosing and prognosticating acute appendicitis. However, due to the limited methodological quality of available studies, further prospectively designed and adequately powered studies are needed.

In this article, we build a repetitive magic square by multiplying four elements. This square is a matrix with its corresponding elements. The elements of this matrix that take different values allow us to obtain Ramanujan's number 1729 as its multiplicative magic constant. The additive magic constant of the square is the number 40. The elements of these magic constants form an arithmetic progression. An algorithm to build magic squares is also proposed.

Abstract Interferon lambda 4 (IFNλ4) has shown antiviral activity against RNA viruses, including some coronaviruses. Besides, genetic variants of IFNL4 can be predictive of the clearance of RNA viruses. However, little is known about the effect of these genetic variants on SARS-CoV-2 infection. In this study, we investigated whether there was a relationship of the rs12979860 polymorphism of IFNL4 with COVID-19. We found that the T allele of rs12979860 was overexpressed in COVID-19 patients with regard to the general population without this disease (36.16% vs. 26.40%, p = 6.4 × 10–4; OR 0.633 C vs T; 95% CI 0.487, 0.824), suggesting that this allele could be a risk factor for COVID-19. Accordingly, the CC genotype was significantly lower in COVID-19 patients compared to controls (37.85% vs. 55.51%, p = 8 × 10–5; OR 0.488; 95% CI 0.342, 0.698). These results were not affected by sex, age, and disease severity in patients with COVID-19. Our findings suggest that, like other infectious diseases caused by RNA viruses, genetic variants of IFNL4 can predispose to COVID-19. Confirmation of our results may contribute to better understanding the mechanisms of this disease.

Petrochemical and dairy industries, waste management, and paper manufacturing fall under the category of process industries where flow and liquid control are essential. Even when liquids are mixed or chemically treated in interconnected tanks, the fluid and flow should constantly be observed and controlled, especially when dealing with nonlinearity and imperfect plant models. In this study, we propose a nonlinear dynamic multiple-input multiple-output (MIMO) plant model. This model is then transformed through linearization, a technique frequently utilized in the analysis and modeling of fractional processes, and decoupling for decentralized fixed-structure H-infinity robust control design. Simulation tests based on MATLAB and SIMULINK are subsequently executed. Numerous assessments are conducted to evaluate tracking performance, external disturbance rejection, and plant parameter fluctuations to gauge the effectiveness of the proposed model. The objective of this work is to provide a framework that anticipates potential outcomes, paving the way for implementing a reliable controller synthesis for MIMO-connected tanks in real-world scenarios.

The extraction of bioactive compounds and cellulose saccharification are potential directions for the valorization of spent mushroom substrate (SMS). Therefore, investigating the suitability of different extraction methods for recovering bioactive compounds from SMS and how the extraction affects the enzymatic saccharification is of uppermost relevance. In this work, bioactive compounds were extracted from Pleurotus spp. SMS using four extraction methods. For Soxhlet extraction (SoE), a 40:60 ethanol/water mixture gave the highest extraction efficiency (EE) (69.9–71.1%) among the seven solvent systems assayed. Reflux extraction with 40:60 ethanol/water increased the extraction yield and EE compared to SoE. A shorter reflux time yielded a higher extraction of carbohydrates than SoE, while a longer time was more effective for extracting phenolics. The extracts from 240 min of reflux had comparable antioxidant activity (0.3–0.5 mM GAE) with that achieved for SoE. Ultrasound-assisted extraction (UAE) at 65 °C for 60 min allowed an EE (~82%) higher than that achieved by either reflux for up to 150 min or SoE. Subcritical water extraction (SWE) at 150 °C resulted in the best extraction parameters among all the tested methods. Vanillic acid and chlorogenic acid were the primary phenolic acids identified in the extracts. A good correlation between the concentration of caffeic acid and the antioxidant activity of the extracts was found. Saccharification tests revealed an enhancement of the enzymatic digestibility of SMS cellulose after the extraction of bioactive compounds. The findings of this initial study provide indications on new research directions for maximizing the recovery of bioactive compounds and fermentable sugars from SMS.

The continuous Bernoulli distribution is defined on the unit interval and has a unique property related to fractiles. A fractile is a position on a probability density function where the corresponding surface is a fixed proportion. This article presents the derivation of properties of the continuous Bernoulli distribution and formulates a fractile or quantile regression model for a unit response using the exponentiated continuous Bernoulli distribution. Monte Carlo simulation studies evaluate the performance of point and interval estimators for both the continuous Bernoulli distribution and the fractile regression model. Real-world datasets from science and education are analyzed to illustrate the modeling abilities of the continuous Bernoulli distribution and the exponentiated continuous Bernoulli quantile regression model.

In this paper, we introduce a SIVR model using the Laplace Adomian decomposition. This model focuses on a new trend in mathematical epidemiology dedicated to studying the characteristics of vaccination of infected communities. We analyze the epidemiological parameters using equilibrium stability and numerical analysis techniques. New mathematical strategies are also applied to establish our epidemic model, which is a pandemic model as well. In addition, we mathematically establish the chance for the next wave of any pandemic disease and show that a consistent vaccination strategy could control it. Our proposal is the first model introducing a vaccination strategy to actively infected cases. We are sure this work will serve as the basis for future research on COVID-19 and pandemic diseases since our study also considers the vaccinated population.

Resumen: Introducción: El cribado neonatal de fibrosis quística (FQ) ha permitido el diagnóstico precoz de la enfermedad, siendo determinante en el aumento de supervivencia de estos pacientes. Su principal inconveniente es su baja especificidad y elevado número de falsos positivos. El objetivo fue analizar las diferencias de tripsina inmunorreactiva (TIR) entre los diferentes grupos de recién nacidos (RN) con cribado neonatal positivo según fueran sanos, portadores sanos, afectos de FQ o Cystic Fibrosis Screen Positive, Inconclusive Diagnosis (CFSPID). Material: Estudio retrospectivo analítico de las concentraciones de TIR en RN con cribado neonatal positivo para FQ nacidos en un hospital de tercer nivel durante 8 años. Resultados: Se analizaron 790 RN con cribado neonatal positivo para FQ, 86,3% a término, 53% niñas y 11,8% ingresados. El valor medio de TIR fue 79,16 ng/ml (rango 60-367). Se encontraron concentraciones significativamente más elevadas de TIR en afectos de FQ con respecto a los otros grupos (p

Introduction: Neonatal cystic fibrosis (CF) screening has enabled the disease to be diagnosed early, and is a determining factor in the increase in survival of these patients. Its main disadvantage is its low specificity and elevated number of false positives. The aim of this study is to analyse the differences in immunoreactive trypsin (IRT) between the different groups of newborns (NB) with a positive neonatal screen depending on whether they were healthy, healthy carriers, affected by CF, or CFSPID (Cystic Fibrosis Screen Positive, Inconclusive Diagnosis). Material: Retrospective analytical study of the concentrations of IRT in NB with a positive neonatal screen for CF born in a tertiary hospital during an 8-year period. Results: A total of 790 NB with a positive neonatal screen for CF were analysed. Of these 86.3% were term, 53% girls, and 11.8% were admitted. The mean IRT value was 79.16 ng/mL (range 60–367). Significantly higher concentrations of IRT were found in those affected by CF compared to the other groups (P

In genes related to drug pharmacokinetics, molecular variations determine interindividual variability in the therapeutic efficacy and adverse drug reactions. The assessment of single-nucleotide variants (SNVs) is used with growing frequency in pharmacogenetic practice, and recently, high-throughput genomic analyses obtained through next-generation sequencing (NGS) have been recognized as powerful tools to identify common, rare and novel variants. These genetic profiles remain underexplored in Latin-American populations, including Colombia. In this study, we investigated the variability of 35 genes included in the ADME core panel (absorption, distribution, metabolism, and excretion) by whole-exome sequencing (WES) of 509 unrelated Colombian individuals with no previous reports of adverse drug reactions. Rare variants were filtered according to the minor allele frequencies (MAF)

In this article, we propose a comparative study between two models that can be used by researchers for the analysis of survival data: (i) the Weibull regression model and (ii) the random survival forest (RSF) model. The models are compared considering the error rate, the performance of the model through the Harrell C-index, and the identification of the relevant variables for survival prediction. A statistical analysis of a data set from the Heart Institute of the University of São Paulo, Brazil, has been carried out. In the study, the length of stay of patients undergoing cardiac surgery, within the operating room, was used as the response variable. The obtained results show that the RSF model has less error rate for the training and testing data sets, at 23.55% and 20.31%, respectively, than the Weibull model, which has an error rate of 23.82%. Regarding the Harrell C-index, we obtain the values 0.76, 0.79, and 0.76, for the RSF and Weibull models, respectively. After the selection procedure, the Weibull model contains variables associated with the type of protocol and type of patient being statistically significant at 5%. The RSF model chooses age, type of patient, and type of protocol as relevant variables for prediction. We employ the randomForestSRC package of the R software to perform our data analysis and computational experiments. The proposal that we present has many applications in biology and medicine, which are discussed in the conclusions of this work.

Abstract A single intradermal vaccination with MTBVAC given to adult rhesus macaques was well tolerated and conferred a significant improvement in outcome following aerosol exposure to M. tuberculosis compared to that provided by a single BCG vaccination. Vaccination with MTBVAC resulted in a significant reduction in M. tuberculosis infection-induced disease pathology measured using in vivo medical imaging, in gross pathology lesion counts and pathology scores recorded at necropsy, the frequency and severity of pulmonary granulomas and the frequency of recovery of viable M. tuberculosis from extrapulmonary tissues following challenge. The immune profiles induced following immunisation with MTBVAC reflect those identified in human clinical trials of MTBVAC. Evaluation of MTBVAC- and TB peptide-pool-specific T-cell cytokine production revealed a predominantly Th1 response from poly- (IFN-γ+TNF-α+IL2+) and multi-(IFN-γ+TNF-α+) functional CD4 T cells, while only low levels of Th22, Th17 and cytokine-producing CD8 T-cell populations were detected together with low-level, but significant, increases in CFP10-specific IFN-γ secreting cells. In this report, we describe concordance between immune profiles measured in clinical trials and a macaque pre-clinical study demonstrating significantly improved outcome after M. tuberculosis challenge as evidence to support the continued development of MTBVAC as an effective prophylactic vaccine for TB vaccination campaigns.

Background: Periprosthetic bone remodeling, which is a phenomenon observed in all femoral stems, has a multifactorial origin as it depends on factors related to the patient, the surgical technique, and the design of the implant. To determine the pattern of remodeling produced by 2 models of anatomic cementless implants, we quantified the changes in bone mineral density (BMD) in the 7 areas of Gruen observed at different moments after surgery during the first postoperative year. Methods: A prospective, comparative, controlled, 1-year follow-up densitometric study was carried out in 2 groups of patients suffering from primary unilateral hip osteoarthritis. In the first group, with 68 patients, an ABG-II stem was implanted. In the second, with 66 patients, the ANATO stem was used. The contralateral, healthy hip was taken as a control. Results: Both groups showed a decrease in BMD at 3 months in all the areas, which recovered at the end of the study, except in zone 7: there was a 17.7% decrease in the ABG-II group and a 5.9% decrease in the ANATO group. In zones 2 and 6, where more loads are transmitted, conservation of BMD is observed in response to Wolff's law. The differences in the pattern of remodeling between groups were maintained despite the age, gender, and BMI of the patients or the size of the implants. Conclusions: The ANATO stem achieved a more efficient transmission of loads at the metaphyseal level, which promotes bone preservation at the proximal femur, than the ABG-II stem.

Objective: In this study we conducted an economic evaluation of a surveillance programme to prevent hip dislocation in children with cerebral palsy. Method: We developed a model that compared costs and health outcomes of children with cerebral palsy with and without a surveillance programme. Information from a number of sources was combined into a decision analytical model, primarily based on data from a comparative study with a 20-year follow-up. Effectiveness was measured using Quality-Adjusted Life Years (QALYs). The analysis took the perspective of the Spanish National Health Service. We undertook extensive sensitivity analyses including a probabilistic sensitivity analysis. Results: The surveillance programme led to higher QALYs and higher health care costs, with an estimated incremental cost per QALY gained of 12,282€. The results were robust to model assumptions. The probability that the programme was cost-effective was estimated to be over 80% at the threshold of 25.000€/QALY recommended in Spain. Conclusion: This study indicates that surveillance programmes to prevent hip dislocation in children with cerebral palsy are likely to be cost-effective. Resumen: Objetivo: En este estudio se realiza una evaluación económica de un programa de vigilancia para prevenir la luxación de cadera en niños y niñas con parálisis cerebral. Método: Se desarrolló un modelo que comparó los costes y los resultados en salud de niños y niñas con parálisis cerebral incluidas y no incluidas en un programa de vigilancia. Se combinó la información proveniente de diversas fuentes en un modelo analítico de decisión, principalmente basado en datos de un estudio comparativo con 20 años de seguimiento. La efectividad se midió empleando los años de vida ajustados por calidad (AVAC). El análisis tomó la perspectiva del Sistema Nacional de Salud de España. Se realizó un extenso análisis de sensibilidad, incluyendo un análisis de sensibilidad probabilístico. Resultados: El programa de vigilancia estuvo asociado a más AVAC y mayores costes sanitarios, con un coste incremental por AVAC ganado estimado en 12.282 €. Los resultados fueron robustos a los supuestos del modelo. La probabilidad de que el programa fuera coste-efectivo se estimó en un valor por encima del 80% para el umbral de 25.000 € por AVAC recomendado en España. Conclusión: Este estudio indica que es probable que los programas de vigilancia para prevenir la luxación de cadera en niños y niñas con parálisis cerebral sean coste-efectivos.

Abstract Purpose To evaluate the clinical outcomes, MRI imaging and histological characteristics of biopsy samples of the tendon from patients in whom rotator cuff repair was previously performed with a bioinductive type I bovine collagen implants. Methods Prospective study of 30 patients with partial or complete rotator cuff tears who underwent arthroscopic repair and augmentation with a resorbable type I bovine collagen implant. Preoperatively and at 6 and 12 months after surgery, the VAS, ASES and Constant‐Murley scores were evaluated and an MRI study was performed. At 6 months, biopsies of the resulting tissue were obtained and examined histologically. Results Patients experienced statistically significant and sustained improvement from baseline for all scores and the mean tendon thickness increased by 1.84 mm. Magnetic resonance imaging evidence of complete healing was found in 27 patients and a considerable reduction in defect size, greater than 50%, was shown in 3. In all samples obtained, the new tissue generated had the histological appearance of a tendon, and was indistinguishable from the native tendon. There was no evidence of any remaining collagen implant. Conclusions Biopsies of tissue formed from bioinductive type I bovine collagen implants showed, six months after surgery, the generation of a neotendon indistinguishable from the native one. Histology and MRI imaging, revealed complete integration of the implant and absence of inflammatory or foreign body reactions. The clinical parameters, thickness and MRI signal of the tendon improved significantly at 6 months, regardless of the type and size of the tear, and remained unchanged until 12 months. Level of evidence Level IV, case series.

Source coding maps elements from an information source to a sequence of alphabetic symbols. Then, the source symbols can be recovered exactly from the binary units. In this paper, we derive an approach that includes information variation in the source coding. The approach is more realistic than its standard version. We employ the Shannon entropy for coding the sequences of a source. Our approach is also helpful for short sequences when the central limit theorem does not apply. We rely on a quantifier of the information variation as a source. This quantifier corresponds to the second central moment of a random variable that measures the information content of a source symbol; that is, considering the standard deviation. An interpretation of typical sequences is also provided through this approach. We show how to use a binary memoryless source as an example. In addition, Monte Carlo simulation studies are conducted to evaluate the performance of our approach. We apply this approach to two real datasets related to purity and wheat prices in Brazil.

The focus on renewable energy is increasing globally to lessen reliance on conventional sources and fossil fuels. For renewable energy systems to work at their best and produce the desired results, precise feedback control is required. Microbial electrochemical cells (MEC) are a relatively new technology for renewable energy. In this study, we design and implement a model-based robust controller for a continuous MEC reactor. We compare its performance with those of traditional methods involving a proportional integral derivative (PID), H-infinity (H∞) controller and PID controller tuned by intelligent genetic algorithms. Recently, a dynamic model of a MEC continuous reactor was proposed, which describes the complex dynamics of MEC through a set of nonlinear differential equations. Until now, no model-based control approaches for MEC have been proposed. For optimal and robust output control of a continuous-reactor MEC system, we linearize the model to state a linear time-invariant (LTI) state-space representation at the nominal operating point. The LTI model is used to design four different types of controllers. The designed controllers and systems are simulated, and their performances are evaluated and compared for various operating conditions. Our findings show that a structured linear fractional transformation (LFT)-based H∞ control approach is much better than the other approaches against various performance parameters. The study provides numerous possibilities for control applications of continuous MEC reactor processes.

Direct current (DC) servo motors are central to many complex systems, such as electrical, electro-mechanical, and electro-hydraulic frameworks. In practice, these systems can have nonlinear characteristics and parameter variations. Accurate model representation and position tracking of DC motors are the main issues in many real systems, such as twin rotors, aircraft, airships, and robot manipulators. The precise position tracking of these systems has already been achieved using conventional H-infinity (H∞) controllers. However, the order and structure become more intricate when employing complex weights to shape the closed-loop system, which limits the current proposals. To overcome the above-mentioned limitations, in this article, we provide a precise angular position tracking of a DC servo motor utilizing an intelligent, robust linear controller based on a fixed-structure linear fractional transformation. The conventional H∞ controllers are based on the minimization of an unstructured linear fractional transformation objective function that leads to a complex design of these controllers. The main advantage of the proposed intelligent H∞ synthesis is the fixed and simple structure that increases its practical implementation. The methodology is formulated in the MATLAB software for the robust design of the proposed synthesis based on an intelligent fixed-structure H∞ optimization. Simulation results are compared with conventional H∞ and proportional-integral-derivative controllers. The results are also validated experimentally.

In diverse branches of mathematics, several inequalities have been studied and applied. In this article, we improve Furuta’s inequality. Subsequently, we apply this improvement to obtain new radius inequalities that not been reported in the current literature. Numerical examples illustrate the main findings.

Left Ventricular (LV) Non-compaction (LVNC), Hypertrophic Cardiomyopathy (HCM), and Dilated Cardiomyopathy (DCM) share morphological and functional traits that increase the diagnosis complexity. Additional clinical information, besides imaging data such as cardiovascular magnetic resonance (CMR), is usually required to reach a definitive diagnosis, including electrocardiography (ECG), family history, and genetics. Alternatively, indices of hypertrabeculation have been introduced, but they require tedious and time-consuming delineations of the trabeculae on the CMR images. In this paper, we propose a radiomics approach to automatically encode differences in the underlying shape, gray-scale and textural information in the myocardium and its trabeculae, which may enhance the capacity to differentiate between these overlapping conditions. A total of 118 subjects, including 35 patients with LVNC, 25 with HCM, 37 with DCM, as well as 21 healthy volunteers (NOR), underwent CMR imaging. A comprehensive radiomics characterization was applied to LV short-axis images to quantify shape, first-order, co-occurrence matrix, run-length matrix, and local binary patterns. Conventional CMR indices (LV volumes, mass, wall thickness, LV ejection fraction—LVEF—), as well as hypertrabeculation indices by Petersen and Jacquier, were also analyzed. State-of-the-art Machine Learning (ML) models (one-vs.-rest Support Vector Machine—SVM—, Logistic Regression—LR—, and Random Forest Classifier—RF—) were used for one-vs.-rest classification tasks. The use of radiomics models for the automated diagnosis of LVNC, HCM, and DCM resulted in excellent one-vs.-rest ROC-AUC values of 0.95 while generating these results without the need for the delineation of the trabeculae. First-order and texture features resulted to be among the most discriminative features in the obtained radiomics signatures, indicating their added value for quantifying relevant tissue patterns in cardiomyopathy differential diagnosis.

RT-PCR tests have become the gold standard for detecting the SARS-CoV-2 virus in the context of the COVID-19 pandemic. Because of the extreme number of cases in periodic waves of infection, there is a severe financial and logistical strain on diagnostic laboratories. For this reason, alternative implementations and validations of academic protocols that employ the lowest cost and the most widely available equipment and reagents found in different regions are essential. In this study, we report an alternative implementation of the EUA 2019-nCoV CDC assay which uses a previously characterized duplex PCR reaction for the N1 and RNAse P target regions and an additional uniplex reaction for the N2 target region. Taking advantage of the Abbott m2000 Sample Preparation System and NEB Luna Universal Probe One-Step RT-qPCR kit, some of the most widely available and inexpensive nucleic acid extraction and amplification platforms, this modified test shows state-of-the-art analytical and clinical sensitivities and specificities when compared with the Seegene Allplex-SARS-CoV-2 assay. This implementation has the potential to be verified and implemented by diagnostic laboratories around the world to guarantee low-cost RT-PCR tests that can take advantage of widely available equipment and reagents.

One of the ingredients used for brewing is barley, which should be malted; it is considered the most polluting agricultural input. On the other hand, food wastage is today a widespread problem that causes significant environmental damage and also generates large economic losses worldwide. One of the most wasted food products is bread; it is estimated that hundreds of tons of bread are wasted every day worldwide. In this study, the brewing of ale beers with bread was carried out. For this purpose, up to 50% of the malt weight was replaced by different types of bread: wheat bread, whole wheat bread, rye bread, and corn bread. A physicochemical and sensory comparison was made with 100% malt ale beer. All beers brewed with bread had an alcoholic strength similar to that of the control beer, except the corn beer. Beers brewed with whole grain bread showed a higher antioxidant capacity and a higher total polyphenol content. The sensory analysis presented different profiles depending on the type of bread; in general, the addition of bread created a greater olfactory intensity in nose. Thus, it was found that it is possible to brew beer with bread substituting up to 50% of the malt. In addition, it was also shown that the beer brewed with whole wheat bread had similar characteristics to the control beer, even improving some beneficial health properties, representing a great advantage for the brewing industry all over the world.

Determining success factors for managing supply chains is a relevant aspect for companies. Then, modeling the relationship between inventory cost savings and supply chain success factors is a route for stating such a determination. This is particularly important in pharmacies and food nutrition services (FNS), where the advances made on this topic are still scarce. In this article, we propose and formulate a robust compromise (RoCo) multi-criteria model based on non-linear programming and time-dependent demand. The novelty of our proposal is in defining a score that allows us to measure the mentioned success factors in a simple way, in meeting together all three elements (RoCo multi-criteria, non-linear programming, and time-dependent demand) to state a new model, and in applying it to pharmacies and FNS. This model relates inventory cost savings for pharmacy/FNS and success factors across their supply chains. Savings of inventory costs are predicted by lot sizes to be purchased and computed by comparing optimal and true inventory costs. We utilize a system that records the movements and costs of products to collect the data. Factors, such as purchasing organization, economies of scale, and synchronized supply, are assumed using the purchase system, with these factors ranked on a Likert scale. We consider multilevel relationships between savings obtained for 79 pharmacy/FNS products, and success factor scores according to these products. To deal with the endogeneity bias of the relationships proposed, internal instrumental variables are employed by utilizing generalized statistical moments. Among our main conclusions, we state that the greatest cost savings obtained from inventory models are directly associated with low-success supply chain factors. In this association, the success factors operate as endogenous variables, with respect to inventory cost savings, given the simultaneity of their relationship with cost savings when inventory decision-making.

Different types of mathematical inequalities have been largely analyzed and employed. In this paper, we introduce improvements to some Ostrowski type inequalities and present their corresponding proofs. The presented proofs are based on applying the celebrated Hayashi inequality to certain functions. We provide examples that show these improvements. Illustrations of the obtained results are stated in a probability framework.

In this paper, we study a type of disease that unknowingly spreads for a long time, but by default, spreads only to a minimal population. This disease is not usually fatal and often goes unnoticed. We propose and derive a novel epidemic mathematical model to describe such a disease, utilizing a fractional differential system under the Atangana–Baleanu–Caputo derivative. This model deals with the transmission between susceptible, exposed, infected, and recovered classes. After formulating the model, equilibrium points as well as stability and feasibility analyses are stated. Then, we present results concerning the existence of positivity in the solutions and a sensitivity analysis. Consequently, computational experiments are conducted and discussed via proper criteria. From our experimental results, we find that the loss and regain of immunity result in the gain and loss of infections. Epidemic models can be linked to symmetry and asymmetry from distinct points of view. By using our novel approach, much research may be expected in epidemiology and other areas, particularly concerning COVID-19, to state how immunity develops after being infected by this virus.

Objective: The aim of this study was to analyze the outcomes and complications in children treated with elastic stable intramedullary nailing (ESIN) for tibial fractures. Methods: The study included 132 patients (92 males) with a median age of 11 years (IQR 10, 15) treated with ESIN for displaced tibial shaft fractures or dia-metaphyseal distal tibial fractures from March 2002 to March 2022. The median follow-up was 118.5 months (IQR 74.5, 170). The primary outcome was success rate, while secondary outcomes were the time of bone healing, length of hospital stay, and associated injuries. Demographic data, type and nature of fracture, indication for surgery, healing time, operative time, complications of treatment, and time to implant removal were recorded. Results: Complete radiographic healing was achieved at a median of 7 weeks (IQR 6, 9). Most of the patients (n = 111; 84.1%) had fractures localized in the shaft of the tibia. The most common injuries were acquired by road traffic accidents (n = 42) and by a fall in the same level (n = 29), followed by injuries from sport activities (n = 21) or motorbike accidents (n = 18). Associated injuries were reported in 37 (28%) children. Fractures were closed in the majority of the children (n = 100; 76%), while 32 (24%) children presented with an open fracture. Children with open fractures were significantly older than children with closed fractures (13.5 years (IQR 10, 15) vs. 11 years (IQR 8.5, 14.5); p = 0.031). Furthermore, children with open fractures had a significantly longer hospital stay (7 days (IQR 5, 9) vs. 3 days (IQR 3, 6); p = 0.001), a higher rate of associated injuries (n = 14 (43.7%) vs. n = 23 (23%); p = 0.022), and a higher rate of postoperative complications (n = 7 (21.9%) vs. n = 8 (8%); p = 0.031). No intraoperative complications were recorded. A total of 15 (11.4%) postoperative complications were recorded. Most complications (60%) were minor complications, mostly related to the wound at the nail insertion site and were managed conservatively. A total of six (4.5%) patients required reoperation due to angulation of the fragments (n = 5) or refracture (n = 1). Conclusion: ESIN is a minimally invasive bone surgery technique and is a highly effective treatment for pediatric tibial unstable fractures with a low rate of complications. Based on the given results, surgical stabilization of the tibial fractures using titanium intramedullary nailing can be safely performed without casting with early physiotherapy.

Despite the increasing amount of research on social media, there are few studies on the use of WhatsApp to assess academic performance. Surprisingly, students use social media during lectures, causing a problem. According to the literature, students utilize WhatsApp throughout academic activities where it is prohibited. Researchers and policymakers must pay attention to this problem to understand its impact on academic achievement. In this paper, by using multivariate statistical methods, we investigate the impact of WhatsApp use on academic performance. We construct a questionnaire for this investigation and apply it to a case study based on a sample of 258 students of management from India. We determine the prevalence of WhatsApp employment among these students and note that many of them utilize the app for academic purposes. We found a positive association between time spent on WhatsApp and students’ grade point average (GPA) based on factor, principal component, correlation, and chi-square analyses. Answering questions on the app in class is related to the program’s ability to help students learn. More use of the app in class leads to a lower GPA. However, sometimes, using the app might help students learn and perform better. We identify that many students disseminate materials through the app for academic purposes, contributing to their academic performance. Furthermore, this app is utilized for communicating with their teachers. Computations were carried out with the R and SPSS software.

Governments must consider different issues when deciding on the location of healthcare centers. In addition to the costs of opening such centers, three further elements should be addressed: accessibility, demand, and equity. Such locations must be chosen to meet the corresponding demand, so that they guarantee a socially equitable distribution, and to ensure that they are accessible to a sufficient degree. The location of the centers must be chosen from a set of possible facilities to guarantee certain minimum standards for the operational viability of the centers. Since the set of potential locations does not necessarily cover the demand of all geographical zones, the efficiency criterion must be maximized. However, the efficient distribution of resources does not necessarily meet the equity criterion. Thus, decision-makers must consider the trade-off between these two criteria: efficiency and equity. The described problem corresponds to the challenge that governments face in seeking to minimize the impact of the pandemic on citizens, where healthcare centers may be either public hospitals that care for COVID-19 patients or vaccination points. In this paper, we focus on the problem of a zone-divided region requiring the localization of healthcare centers. We propose a non-linear programming model to solve this problem based on a coverage formula using the Gini index to measure equity and accessibility. Then, we consider an approach using epsilon constraints that makes this problem solvable with mixed integer linear computations at each iteration. A simulation algorithm is also considered to generate problem instances, while computational experiments are carried out to show the potential use of the proposed mathematical programming model. The results show that the spatial distribution influences the coverage level of the healthcare system. Nevertheless, this distribution does not reduce inequity at accessible healthcare centers, as the distribution of the supply of health centers must be incorporated into the decision-making process.

In this paper, we propose a new privatization mechanism based on a naive theory of a perturbation on a probability using wavelets, such as a noise perturbs the signal of a digital image sensor. Wavelets are employed to extract information from a wide range of types of data, including audio signals and images often related to sensors, as unstructured data. Specifically, the cumulative wavelet integral function is defined to build the perturbation on a probability with the help of this function. We show that an arbitrary distribution function additively perturbed is still a distribution function, which can be seen as a privatized distribution, with the privatization mechanism being a wavelet function. Thus, we offer a mathematical method for choosing a suitable probability distribution for data by starting from some guessed initial distribution. Examples of the proposed method are discussed. Computational experiments were carried out using a database-sensor and two related algorithms. Several knowledge areas can benefit from the new approach proposed in this investigation. The areas of artificial intelligence, machine learning, and deep learning constantly need techniques for data fitting, whose areas are closely related to sensors. Therefore, we believe that the proposed privatization mechanism is an important contribution to increasing the spectrum of existing techniques.

Background: The Bacillus Calmette-Guérin (BCG), the only vaccine against tuberculosis (TB) currently in use, has shown beneficial effects against unrelated infections and to enhance immune responses to vaccines. However, there is little evidence regarding the influence of BCG vaccination on pertussis. Methods: Here, we studied the ability of BCG to improve the immune responses to diphtheria, tetanus, and acellular (DTaP) or whole-cell pertussis (DTwP) vaccination in a mouse model. We included MTBVAC, an experimental live-attenuated vaccine derived from Mycobacterium tuberculosis, in our studies to explore if it presents similar heterologous immunity as BCG. Furthermore, we explored the potential effect of routine BCG vaccination on pertussis incidence worldwide. Findings: We found that both BCG and MTBVAC when administered before DTaP, triggered Th1 immune responses against diphtheria, tetanus, and pertussis in mice. Immunization with DTaP alone failed to trigger a Th1 response, as measured by the production of IFN-γ. Humoral responses against DTaP antigens were also enhanced by previous immunization with BCG or MTBVAC. Furthermore, exploration of human epidemiological data showed that pertussis incidence was 10-fold lower in countries that use DTaP and BCG compared to countries that use only DTaP. Interpretation: BCG vaccination may have a beneficial impact on the protection against pertussis conferred by DTaP. Further randomized controlled trials are needed to properly define the impact of BCG on pertussis incidence in a controlled setting. This could be a major finding that would support changes in immunization policies. Funding: This work was supported by the Ministry of “Economía y Competitividad”; European Commission H2020 program, “Gobierno de Aragón”; CIBERES; “Fundação Butantan”; Instituto de Salud Carlos III and “Fondo FEDER”.