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Pulmonary alveolar proteinosis (PAP) is a syndrome that results from the accumulation of lipoproteinaceous material in the alveolar space. According to the underlying pathogenetic mechanisms, three different forms have been identified, namely primary, secondary and congenital. Primary PAP is caused by disruption of granulocyte−macrophage colony-stimulating factor (GM-CSF) signalling due to the presence of neutralising autoantibodies (autoimmune PAP) or GM-CSF receptor genetic defects (hereditary PAP), which results in dysfunctional alveolar macrophages with reduced phagocytic clearance of particles, cholesterol and surfactant. The serum level of GM-CSF autoantibody is the only disease-specific biomarker of autoimmune PAP, although it does not correlate with disease severity. In PAP patients with normal serum GM-CSF autoantibody levels, elevated serum GM-CSF levels is highly suspicious for hereditary PAP. Several biomarkers have been correlated with disease severity, although they are not specific for PAP. These include lactate dehydrogenase, cytokeratin 19 fragment 21.1, carcinoembryonic antigen, neuron-specific enolase, surfactant proteins, Krebs von Lungen 6, chitinase-3-like protein 1 and monocyte chemotactic proteins. Finally, increased awareness of the disease mechanisms has led to the development of pathogenesis-based treatments, such as GM-CSF augmentation and cholesterol-targeting therapies.

This paper introduces a novel energy management strategy incorporating stochastic elements designed for off-grid photovoltaic (PV) systems supplying multiple loads in environments marked by unpredictable power usage. In these PV microgrid applications, unpredictable power consumption can lead to discrepancies between energy supply and demand, compromising system reliability and efficiency. This issue is especially pertinent in providing reliable electricity to remote or rural areas where conventional grid infrastructure is not available or reliable. To overcome this challenge, this paper addresses the random variability in load consumption by modeling it as a Markov decision process (MDP). The MDP framework facilitates the development of an effective decision-making process, accounting for the probabilistic nature of energy consumption patterns. Furthermore, by integrating MDP-based load consumption prediction into the energy management system, real-time optimization of both PV power and battery charging and discharging within the microgrid is achieved. This integration balances energy production and consumption, enhancing overall system efficiency. Three scenarios were examined to evaluate the effectiveness of the suggested strategy in enhancing the real-time operation of off-grid PV systems: standard test conditions, time-varying climatic profiles, and real-time weather situations. The findings indicate that the proposed strategy can adapt to dynamic load profiles, ensuring efficient energy utilization while maintaining microgrid stability.

This paper presents an innovative scheme to enhance the efficiency of power extraction from wind energy conversion systems (WECSs) under random loads. The study investigates how stochastic load consumption, modeled and predicted using a Markov chain process, impacts WECS efficiency. The suggested approach regulates the rectifier voltage rather than the rotor speed, making it a sensorless and reliable method for small-scale WECSs. Nonlinear WECS dynamics are represented using Takagi–Sugeno (TS) fuzzy modeling. Furthermore, the closed-loop system’s stochastic stability and recursive feasibility are guaranteed regardless of random load changes. The performance of the suggested controller is compared with the traditional perturb-and-observe (P&O) algorithm under varying wind speeds and random load variations. Simulation results show that the proposed approach outperforms the traditional P&O algorithm, demonstrating higher tracking efficiency, rapid convergence to the maximum power point (MPP), reduced steady-state oscillations, and lower error indices. Enhancing WECS efficiency under unpredictable load conditions is the primary contribution, with simulation results indicating that the tracking efficiency increases to 99.93%.

Summary: Symbiotic interactions between Symbiodiniaceae and bacteria are still poorly explored, especially those in hospite. Here, we adapted a technique that allows for the enrichment of intact and metabolically active in hospite Symbiodiniaceae cells (ihSC) and their associated bacteria from the tissue of the model coral Pocillopora damicornis, using a discontinuous gradient of solution of isotonic Percoll (SIP). The ihSC were concentrated in the 50% SIP fraction, as determined by microscopy. The presence of bacteria associated with ihSC was confirmed by fluorescence in situ hybridization, while microbiome analysis indicated that bacteria of the families Halieaceae, Flavobacteriaceae, and Alcanivoraceae are significantly associated with ihSC. Extracellular vesicles that could be exuding molecules were detected on the symbiosome membranes. Our technique and data contribute to elucidate ihSC-bacteria interactions.

Difficult-to-treat and severe asthma are challenging clinical entities. In the face of suboptimal asthma control, the temptation for clinicians is to reflexively escalate asthma-directed therapy, including increasing exposure to corticosteroids and commencement of costly but potent biologic therapies. However, asthma control is objectively and subjectively assessed based on measurable parameters (such as exacerbations or variability in pulmonary physiology), symptoms and patient histories. Crucially, these features can be confounded by common untreated comorbidities, affecting clinicians’ assessment of asthma treatment efficacy.

This paper presents an innovative scheme to enhance the efficiency of power extraction from wind energy conversion systems (WECSs) under random loads. The study investigates how stochastic load consumption, modeled and predicted using a Markov chain process, impacts WECS efficiency. The suggested approach regulates the rectifier voltage rather than the rotor speed, making it a sensorless and reliable method for small-scale WECSs. Nonlinear WECS dynamics are represented using Takagi–Sugeno (TS) fuzzy modeling. Furthermore, the closed-loop system's stochastic stability and recursive feasibility are guaranteed regardless of random load changes. The performance of the suggested controller is compared with the traditional perturb-and-observe (P&O) algorithm under varying wind speeds and random load variations. Simulation results show that the proposed approach outperforms the traditional P&O algorithm, demonstrating higher tracking efficiency, rapid convergence to the maximum power point (MPP), reduced steady-state oscillations, and lower error indices. Enhancing WECS efficiency under unpredictable load conditions is the primary contribution, with simulation results indicating that the tracking efficiency increases to  99.93 % . [ABSTRACT FROM AUTHOR]

Background People living with cystic fibrosis have an increased risk of lung infection with nontuberculous mycobacteria (NTM), the prevalence of which is reportedly increasing. We conducted a systematic review of the literature to estimate the burden (prevalence and incidence) of NTM in the cystic fibrosis population. Methods Electronic databases, registries and grey literature sources were searched for cohort and cross-sectional studies reporting epidemiological measures (incidence and prevalence) of NTM infection or NTM pulmonary disease in cystic fibrosis. The last search was conducted in September 2021; we included reports published since database creation and registry reports published since 2010. The methodological quality of studies was appraised with the Joanna Briggs Institute tool. A random effects meta-analysis was conducted to summarise the prevalence of NTM infection, and the remaining results are presented in a narrative synthesis. Results This review included 95 studies. All 95 studies reported on NTM infection, and 14 of these also reported on NTM pulmonary disease. The pooled estimate for the point prevalence of NTM infection was 7.9% (95% CI 5.1–12.0%). In meta-regression, sample size and geographical location of the study modified the estimate. Longitudinal analysis of registry reports showed an increasing trend in NTM infection prevalence between 2010 and 2019. Conclusions The overall prevalence of NTM infection in cystic fibrosis is 7.9% and is increasing over time based on international registry reports. Future studies should report screening frequency, microbial identification methods and incidence rates of progression from NTM infection to pulmonary disease.

Background Increasing awareness of milder presentations of cystic fibrosis (CF) and greater interest in non-CF bronchiectasis are likely to lead to more CF screening by respiratory clinicians. As a result, adults who may not strictly fulfil CF diagnostic criteria yet display evidence of abnormal CF transmembrane conductance regulator (CFTR) function are being identified. The degree of agreement on diagnosis and care needs in these cases between CF clinicians remains unknown, and has implications for patient care, including access to CFTR modulator therapies. Methods We surveyed adult CF physicians in Canada, the USA, the UK and Ireland, and presented them with anonymised vignettes of adult patients referred for assessment of possible CF. Diagnostic inter-rater agreement over diagnosis, ease of classifying cases and appropriate follow-up was assessed using Krippendorff's reliability coefficient (α). Results Agreement over diagnosis (α=0.282), ease of classification (α= −0.01) and recommended follow-up (α=0.054) was weak. Clinician experience (>10 and 5–10 years versus

Urban-population growth model has attracted attention over the last few decades due to its usefulness in representing population dynamics, virus dynamics, and epidemics. Researchers have included stochastic perturbation in the urban-population growth model to improve the model, attempting to capture the random nature of real-time dynamics. When doing so, researchers have presented conditions to ensure that the corresponding stochastic solution is both positive and unique (in probability). This paper advances that knowledge by showing that the stochastic diffusion constant can be both positive and negative—previous results in the literature have required that such a constant be positive only. A numerical simulation illustrates the paper's findings.

Abstract This paper shows a result for the load frequency control with event‐triggering mechanism under deception attacks. Specifically, the event‐triggering mechanism and deception attacks are considered in the dynamic model of power systems. The event‐triggering is used to reduce the frequency of controller update and communication between nodes. The H∞ controller is designed and the stability of the system is guaranteed by utilising the Lyapunov–Krasovskii functional method and truncated Bessel–Legendre inequality. Finally, a three‐area interconnected networked power system is given and the simulated results are presented to show the effectiveness of the developed theoretical results.

Pulmonary alveolar proteinosis (PAP) is a syndrome that results from the accumulation of lipoproteinaceous material in the alveolar space. According to the underlying pathogenetic mechanisms, three different forms have been identified, namely primary, secondary and congenital. Primary PAP is caused by disruption of granulocyte−macrophage colony-stimulating factor (GM-CSF) signalling due to the presence of neutralising autoantibodies (autoimmune PAP) or GM-CSF receptor genetic defects (hereditary PAP), which results in dysfunctional alveolar macrophages with reduced phagocytic clearance of particles, cholesterol and surfactant. The serum level of GM-CSF autoantibody is the only disease-specific biomarker of autoimmune PAP, although it does not correlate with disease severity. In PAP patients with normal serum GM-CSF autoantibody levels, elevated serum GM-CSF levels is highly suspicious for hereditary PAP. Several biomarkers have been correlated with disease severity, although they are not specific for PAP. These include lactate dehydrogenase, cytokeratin 19 fragment 21.1, carcinoembryonic antigen, neuron-specific enolase, surfactant proteins, Krebs von Lungen 6, chitinase-3-like protein 1 and monocyte chemotactic proteins. Finally, increased awareness of the disease mechanisms has led to the development of pathogenesis-based treatments, such as GM-CSF augmentation and cholesterol-targeting therapies. [ABSTRACT FROM AUTHOR]

BackgroundIndividuals with cystic fibrosis have an elevated lifetime risk of colonization, infection, and disease caused by nontuberculous mycobacteria. A prior study involving non-cystic fibrosis individuals reported a gene expression signature associated with susceptibility to nontuberculous mycobacteria pulmonary disease (NTM-PD). In this study, we determined whether people living with cystic fibrosis who progress to NTM-PD have a gene expression pattern similar to the one seen in the non-cystic fibrosis population.MethodsWe evaluated whole blood transcriptomics using bulk RNA-seq in a cohort of cystic fibrosis patients with samples collected closest in timing to the first isolation of nontuberculous mycobacteria. The study population included patients who did (n = 12) and did not (n = 30) develop NTM-PD following the first mycobacterial growth. Progression to NTM-PD was defined by a consensus of two expert clinicians based on reviewing clinical, microbiological, and radiological information. Differential gene expression was determined by DESeq2.ResultsNo differences in demographics or composition of white blood cell populations between groups were identified at baseline. Out of 213 genes associated with NTM-PD in the non-CF population, only two were significantly different in our cystic fibrosis NTM-PD cohort. Gene set enrichment analysis of the differential expression results showed that CF individuals who developed NTM-PD had higher expression levels of genes involved in the interferon (α and γ), tumor necrosis factor, and IL6-STAT3-JAK pathways.ConclusionIn contrast to the non-cystic fibrosis population, the gene expression signature of patients with cystic fibrosis who develop NTM-PD is characterized by increased innate immune responses.

We present a patient with cystic fibrosis who used nebulized levofloxacin off-label to suppress chronic Burkholderia cenocepacia pulmonary infection. The patient was initially using tobramycin inhalation powder (TIP) off-label continuously for suppression of chronic B. cenocepacia; this was changed to alternating months of nebulized levofloxacin and TIP. Following initiation of nebulized levofloxacin, the patient had significant improvement in respiratory symptom burden and lung function (as measured by forced expiratory volume in 1 second [FEV1]), and a decrease in the frequency of pulmonary exacerbations. Further research is necessary to determine whether the benefits observed with nebulized levofloxacin in our patient translate to a larger population of patients with chronic Burkholderia spp. pulmonary infection.

Objectives: Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) occurs due to abnormal proliferation of pulmonary neuroendocrine cells. We hypothesized that performing a quantitative analysis of airway features on chest CT may reveal differences to matched controls, which could ultimately help provide an imaging biomarker. Methods: A retrospective quantitative analysis of chest CTs in patients with DIPNECH and age matched controls was carried out using semi-automated post-processing software. Paired segmental airway and artery diameters were measured for each bronchopulmonary segment, and the airway:artery (AA) ratio, airway wall thickness:artery ratio (AWTA ratio) and wall area percentage (WAP) calculated. Nodule number, size, shape and location was recorded. Correlation between CT measurements and pulmonary function testing was performed. Results: 16 DIPNECH and 16 control subjects were analysed (all female, mean age 61.7 +/− 11.8 years), a combined total of 425 bronchopulmonary segments. The mean AwtA ratio, AA ratio and WAP for the DIPNECH group was 0.57, 1.18 and 68.8%, respectively, compared with 0.38, 1.03 and 58.3% in controls (p < 0.001, p = 0.03). AA ratio correlated with FVC (R2 = 0.47, p = 0.02). A multivariable model incorporating nodule number, AA ratio and AWTA-ratio demonstrated good performance for discriminating DIPNECH and controls (AUC 0.971; 95% CI: 0.925–1.0). Conclusions: Quantitative CT airway analysis in patients with DIPNECH demonstrates increased airway wall thickness and airway:artery ratio compared to controls. Advances in knowledge: Quantitative CT measurement of airway wall thickening offers a potential imaging biomarker for treatment response.

The COVID-19 pandemic hit hard society, strongly affecting the emotions of the people and wellbeing. It is difficult to measure how the pandemic has affected the sentiment of the people, not to mention how people responded to the dramatic events that took place during the pandemic. This study contributes to this discussion by showing that the negative perception of the people of the COVID-19 pandemic is dropping. By negative perception, we mean the number of negative words the users of Twitter, a social media platform, employ in their online posts. Seen as aggregate, Twitter users are using less and less negative words as the pandemic evolves. The conclusion that the negative perception is dropping comes from a careful analysis we made in the contents of the COVID-19 Twitter chatter dataset, a comprehensive database accounting for more than 1 billion posts generated during the pandemic. We explore why the negativity of the people decreases, making connections with psychological traits such as psychophysical numbing, reappraisal, suppression, and resilience. In particular, we show that the negative perception decreased intensively when the vaccination campaign started in the USA, Canada, and the UK and has remained to decrease steadily since then. This finding led us to conclude that vaccination plays a key role in dropping the negativity of the people, thus promoting their psychological wellbeing.

The article presents a case study of an 85-year-old woman with unexplained hypoxia. Topics include her medical history, presentation in the emergency department with shortness of breath, and initial treatment. The article also discusses the findings of laboratory investigations, including arterial blood sampling and viral respiratory swab testing, as well as the management of her condition with intravenous diuretic agents and continuous positive airway pressure therapy.

This paper details how to construct a small-scale shaking table attached to a magnetorheological (MR) damper. The motivation for this construction relies on the increasing interest in modeling the dynamics of MR dampers—MR dampers have been used in structures for safety reasons. To model the MR damper, we use the so-called ‘Dahl model’, which is useful to represent systems with a hysteresis. The Dahl model, validated through experimental data collected in a laboratory, was combined with a linear model to represent a two-story building. This two-story building model allows us to simulate the dynamics of that building when its floors are attached to MR dampers. By doing so, we can assess—through simulation—to what extent MR dampers can protect structures from vibrations. Using data from the ‘El Centro’ earthquake (1940), we can conclude that MR dampers have the potential to reduce the impact of earthquakes upon structures. This finding emphasizes the potential benefits of MR dampers for the safety of structures, which is a conclusion taken from the apparatus detailed in this paper.