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This paper presents and examines a newly improved linear technique for solving the equilibrium problem of a pseudomonotone operator and the fixed point problem of a nonexpansive mapping within a real Hilbert space framework. The technique relies two modified mildly inertial methods and the subgradient extragradient approach. In addition, it can be viewed as an advancement over the previously known inertial subgradient extragradient approach. Based on common assumptions, the algorithm's weak convergence has been established. Finally, in order to confirm the efficiency and benefit of the proposed algorithm, we present a few numerical experiments.

This article proposes an iteration algorithm with double inertial extrapolation steps for approximating a common solution of split equilibrium problem, fixed point problem and variational inequity problem in the framework of Hilbert spaces. Unlike several existing methods, our algorithm is designed such that its implementation does not require the knowledge of the norm of the bounded linear operator and the value of the Lipschitz constant. The proposed algorithm does not depend on any line search rule. The method uses a self-adaptive step size which is allowed to increase from iteration to iteration. Furthermore, using some mild assumptions, we establish a strong convergence theorem for the proposed algorithm. Lastly, we present a numerical experiment to show the efficiency and the applicability of our proposed iterative method in comparison with some well-known methods in the literature. Our results unify, extend and generalize so many results in the literature from the setting of the solution set of one problem to the more general setting common solution set of three problems.

Abstract Background Gastrointestinal Stromal Tumour is a rare but potentially curable tumour of the gastrointestinal tract accounting for up to 1% of all gastrointestinal tumours. The discovery of Imatinib mesylate, a novel tyrosine kinase inhibitor has improved the chances even for unresectable, recurrent, or metastatic diseases. Methods This study sought to document the clinical and pathological characteristics of GISTs from two tertiary hospitals in Ghana that have undergone immunohistochemistry confirmation between 2014 and 2021. Results The median age of the subjects was 50 years with most of them (28.0%) being above 61 years. There were more females than males (64.0% vs. 36.0%). Abdominal mass and abdominal pain made up the majority of the clinical presentations. The majority of the subjects had partial gastrectomy (32.0%) which was followed by wedge resection (28.0%). Appendectomy and sleeve gastrectomy were the least performed procedures (8% each). Four of the 25 patients (16.0%) had resections of involved contiguous organs done with splenectomy being the most common procedure. The majority of GISTs were found in the stomach (68.0%) followed by the appendix (12.0%) and small bowel (12.0%). Gastrointestinal bleeding (55.8%) and abdominal pain (38.5%) were the most reported symptoms. Free resection margins were observed in 84.0% of the subjects and only 3/25 (12.0%) experienced tumour recurrence. Conclusion GIST is a potentially curable tumour that once was obscure but currently gaining popularity. Surgical resection offers the hope of a cure for localized disease while targeted therapies is a viable option for recurrent, metastatic, or unresectable tumours.

This study explores the potential of copper-doped nickel oxide (Cu:NiO) as a hole transport layer (HTL) in flexible photovoltaic (PV) devices using a combined first-principles and finite element analysis approach. Density functional theory (DFT) calculations reveal that Cu doping introduces additional states in the valence band of NiO, leading to enhanced charge transport. Notably, Cu:NiO exhibits a direct band gap (reduced from 3.04 eV in NiO to 1.65 eV in the stable supercell structure), facilitating the efficient hole transfer from the active layer. Furthermore, the Fermi level shifts towards the valence band in Cu:NiO, promoting hole mobility. This translates to an improved photovoltaic performance, with Cu:NiO-based HTLs achieving ~18% and ~9% power conversion efficiencies (PCEs) in perovskite and poly 3-hexylthiophene: 1-3-methoxycarbonyl propyl-1-phenyl 6,6 C 61 butyric acid methyl ester (P3HT:PCBM) polymer solar cells, respectively. Finally, a finite element analysis demonstrates the potential of these composite HTLs with Poly 3,4-ethylene dioxythiophene)—polystyrene sulfonate (PEDOT:PSS) in flexible electronics design and the optimization of printing processes. Overall, this work highlights Cu:NiO as a promising candidate for high-performance and flexible organic–inorganic photovoltaic cells.

This research aimed to investigate the mediating function of Green Employee Empowerment (GEE) in the relationship between Green Human Resource Management practices (GHRM) and the environmental performance of small and medium-sized enterprises (SMEs) in Ghana, drawing on the Ability-Motivation-Opportunity (AMO) theory. This study assessed the hypotheses in the established research model using structural equation modeling based on data collected from 320 participants from small and medium-sized firms in Ghana. The study's results revealed that GHRM practices were significantly correlated with the firm's environmental performance. The study found significant GHRM's indirect consequences on environmental performance through GEE in all models examined. These findings suggest that GEE plays a crucial role in translating the impact of GHRM practices into improved environmental performance. The study overlooked other potential mediators or moderators in the relationship between GHRM practices and environmental performance, focusing on GEE. To better understand the complex dynamics behind GHRM techniques' environmental performance, future research might examine business culture, leadership style, and employee sustainability attitudes.

In this paper, we introduce a new type of modified generalized $\alpha$-nonexpansive mapping and establish some fixed point properties and demiclosedness principle for this class of mappings in the framework of uniformly convex Banach spaces. We further propose a new iterative method for approximating a common fixed point of two modified generalized $\alpha$-nonexpansive mappings and present some weak and strong convergence theorems for these mappings in uniformly convex Banach spaces. In addition, we apply our result to solve a convex-constrained minimization problem, variational inequality and split feasibility problem and present some numerical experiments in infinite dimensional spaces to establish the applicability and efficiency of our proposed algorithm. The obtained results in this paper improve and extend some related results in the literature.

Abstract Background HIV-related stigma negatively impacts HIV prevention, treatment, and care, particularly among children and adolescents in sub-Saharan Africa. Interventions that are culturally grounded and relevant for addressing root causes may reduce the stigma experienced by HIV-positive and HIV-affected young people. This study, to be conducted in a post-conflict, rural setting in Omoro District, Uganda, will develop and evaluate a transformative arts-based HIV-related stigma intervention rooted in local cultural knowledge to reduce stigma and improve HIV prevention and care for young people living with HIV. The intervention will be delivered to young people attending school by community Elders, with the support of teachers, through the transfer of local cultural knowledge and practices with the aim of re-establishing the important cultural and social role of Elders within a community that has suffered the loss of intergenerational transfer of cultural knowledge throughout a 25-year civil war. Methods A formative research phase consisting of interviews with students, teachers, and Elders will inform the intervention and provide data for study objectives. Workshops will be delivered to Elders and teachers in participating schools to build capacity for arts-based, educational workshops to be conducted with students in the classroom. The intervention will be evaluated using a stepped-wedge cluster-randomized trial. Government-funded schools in Omoro District will be randomized into three blocks, each comprised of two primary and two secondary schools (n=1800 students). Schools will be randomly assigned to a crossover sequence from control to intervention condition in 8-week intervals. A process evaluation will be implemented throughout the study to evaluate pathways between intervention development, implementation, and effects. Discussion This study will generate comprehensive, in-depth participatory research and evaluation data to inform an effective and sustainable protocol for implementing arts-based HIV stigma interventions for young people in school settings. Findings will have widespread implications in post-conflict settings for HIV prevention, treatment, and care. Trial registration ClinicalTrials.gov NCT04946071 . Registered on 30 June 2021.

Abstract Background and Aim To demonstrate the use of a standard dose of ledipasvir (LDV) and sofosbuvir (SOF), with or without ribavirin, to treat hepatitis C and hepatitis C/HIV co‐infection in Ukraine. Methods Eligible HCV viraemic adults from two clinics in Kyiv were treated with LDV/SOF with or without weight‐based ribavirin for 12 weeks. Clinical assessments were performed at screening and at week 24, and as needed; treatment was dispensed every 4 weeks. The primary outcome was sustained virologic response (SVR) 12 weeks after treatment, with analysis by intention to treat. Cost per patient was estimated in USD (2018) over the 24‐week period. Results Of 868 patients included in the study and initiated on therapy, 482 (55.5%) were co‐infected with HIV. The common genotypes were 1 (74.1%) and 3 (22%). Overall, SVR was achieved in 831 of the 868 patients (95.7%). SVR in patients with hepatitis C alone and hepatitis C/HIV co‐infection was 98.4% and 93.6%, respectively. Adverse events were infrequent and usually mild. Using generic medication, cost per patient was estimated at US$680. Conclusion A standard dose of LDV and SOF, with ribavirin as per protocol, resulted in good outcomes for patients with both hepatitis C alone and co‐infected with hepatitis C/HIV. Program costs in Ukraine were modest using generic medication.

Objectives Identify factors (demographic and clinical) associated with a non-suppressed viral load (VL) of people living with HIV (PLHIV) on antiretroviral therapy (ART) in Nigeria.Design Cross-sectional study.Setting Sixteen US Agency for International Development supported states in Nigeria.Participants 585 632 PLHIV on ART.Primary outcome measures VL non-suppression (defined as having a VL of at least 1000 HIV RNA copies per mL of plasma). χ2 testing and multivariable modified Poisson regression with robust variance estimates were conducted on routinely collected ART programme data.Results Sixty-six per cent of the study population were females. The largest age groups were 25–34 and 35–44, accounting for 32.1% and 31.1%, respectively. Males had a 9% greater likelihood (adjusted prevalence ratio, APR=1.09) of being non-suppressed. The age groups below 60+ (APR=0.67) had a higher likelihood of a non-suppressed VL, with the highest in the 0–14 age group (APR=2.38). Clients enrolled at tertiary and secondary level facilities had the greatest likelihood of a non-suppressed VL. Clients who started ART between 2010 and 2015 had the greatest likelihood of viral non-suppression (APR=6.19). A shorter time on ART (

Infections acquired in a hospital (HAI) often referred to as nosocomial infections are related with increasing morbidity and death among patients that are hospitalised and are predisposed to an elevated risk of infection by health workers (HCWs). The need to maintain an effective infection prevention and control program is therefore essential for quality health care. This study sought to assess the knowledge and compliance of infection control practices of Cardiovascular Perfusionists in theatre at a private healthcare facility in KwaZulu-Natal (KZN) in the city of Durban. We conducted a qualitative study based on in-depth interviews with 12 Cardiovascular Perfusionists (CP) who were purposively selected from private sector. The interviews lasted between 20 to 25 minutes and were transcribed, and then thematic analysis were applied using NVivo. The study found that there is a need for Clinical Technologist specialising in Cardiovascular Perfusion to undergo training in infection control and prevention practices at the higher education and training level. Subsequently, the study reveals that Cardiovascular Perfusionists have a good overall understanding of pathogens and the implications thereof. The study also notes that there is considerable compliance to infection control practices in theatre irrespective of the knowledge pertaining to infection control and prevention policies. We concluded that there is an overall good knowledge and understanding regarding infection control practices, although many felt that there exists an inequitable application of infection control policies due to professional biases.

Abstract Background Patient interruption of antiretroviral therapy (ART) continues to limit HIV programs’ progress toward epidemic control. Multiple factors have been associated with client interruption in treatment (IIT)— including age, gender, CD4 count, and education level. In this paper, we explore the factors associated with IIT in people living with HIV (PLHIV) in United States Agency for International Development (USAID)-supported facilities under the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) program in Nigeria. Methods We conducted cross-sectional analyses on data obtained from Nigeria’s National Data Repository (NDR), representing a summarized record of 573 630 ART clients that received care at 484 PEPFAR/USAID-supported facilities in 16 states from 2000–2020. IIT was defined as no clinical contact for 28 days or more after the last expected clinical contact. Univariate and multivariate logistic regression models were computed to explore the factors associated with IIT. The variables included in the analysis were sex, age group, zone, facility level, regimen line, multi-month dispensing (MMD), and viral load category. Results Of the 573 630 clients analysed in this study, 32% have been recorded as having interrupted treatment. Of the clients investigated, 66% were female (32% had interrupted treatment), 39% were aged 25–34 at their last ART pick-up date (with 32% of them interrupted treatment), 59% received care at secondary level facilities (37% interrupted treatment) and 38% were last receiving between three- to five-month MMD (with 10% of these interrupted treatment). Those less likely to interrupt ART were males (aOR = 0.91), clients on six-month MMD (aOR = 0.01), adults on 2nd line regimen (aOR = 0.09), and paediatrics on salvage regimen (aOR = 0.02). Clients most likely to interrupt ART were located in the South West Zone (aOR = 1.99), received treatment at a tertiary level (aOR = 12.34) or secondary level facilities (aOR = 4.01), and had no viral load (VL) on record (aOR =10.02). Age group was not significantly associated with IIT. Conclusions Sex, zone, facility level, regimen line, MMD, and VL were significantly associated with IIT. MMD of three months and longer (especially six months) had better retention on ART than those on shorter MMD. Not having a VL on record was associated with a considerable risk of IIT.

Objectives: This study was conducted to evaluate the precision of the implant placed using a surgical guide by comparing it with simulated implant position. Methods: Preoperatively cone beam computed tomography scan was taken, which was converted into Digital Imaging and Communication in Medicine files (DICOM). Intraoral scans in form of Standard Tessellation Language (STL) files were taken; both the DICOM and STL files were transferred into 3Shape Implant Studio. After superimposing the data prosthesis was digitally designed and implant simulation was done and surgical guide fabricated. Thereby implants were placed through the guiding hole of the guide. The angular deviation and the linear deviation of the implants at the coronal and the apical end were done by superimposition of the simulated and placed implants in ‘Navident-ClaroNav’ software with closest point algorithm and verified. Result: The mean angular deviation of the implant was 2.73°± 2.05°, the P value for angular deviation was found to be > 0.05. The median lateral deviation of the implant at the coronal end was 0.81 mm.The median lateral deviation of the implant at the apical end was 0.97 mm. Conclusion: The surgical guide designed to reduce the inaccuracies due to manual implant placement has proved to have high accuracy in achieving ideal positioning. The computer aided stereolithographic guide helps in transferring ideal implant position from simulated planning to actual implant site during the surgery, thereby reducing the inaccuracies in its positioning.

Abstract Background The Western-European concept of libertarian rights-based autonomy, which advocates respect for individual rights, may conflict with African cultural values and norms. African communitarian ethics focuses on the interests of the collective whole or community, rather than rugged individualism. Hence collective decision-making processes take precedence over individual autonomy or consent. This apparent conflict may impact informed consent practice during biomedical research in African communities and may hinder ethical principlism in African bioethics. This study explored African biomedical researchers' perspectives regarding informed consent and potential limitations to the principle of respect for autonomy in African communities. Methods We conducted a qualitative study based on in-depth interviews with 12 biomedical researchers, five females and seven males aged 34 to 74 years, currently working at an African university. Interviews lasted 35–40 min each and involved semi-structured open-ended interviews, which allowed participants to offer information about their perceptions and feelings regarding respect for autonomy and informed consent as practised in Africa. Empirical data from the interviews were recorded, transcribed, and analysed using thematic content analysis, together with an interrogation of relevant scientific literature about African communitarian ethics, making evaluations and drawing inferences consistent with the empirical bioethics approach. Results Based on these interviews and analysis of relevant literature, we found that informed consent is difficult to apply in an African context because it derives from a Western conception of libertarian rights-based autonomy. Most respondents pointed out that it was challenging to implement informed consent in the African setting. Furthermore, communalism, customary beliefs, spirituality, and relational autonomy are predominant in most African communities, as exemplified by the African moral philosophies of Ubuntu/Botho and Ukama, which emphasize communitarianism over individual rights. We also found that language, education, poverty, and cultural beliefs are barriers to obtaining proper informed consent in African communities. Conclusions We conclude that there are limitations to applying the principle of respect for autonomy and informed consent in African communities, especially in the context of human biomedical research. We recommend using a more relational approach, such as Ross’s prima facie duties, to implement informed consent in African communities.

Soya bean is an important economic crop for smallholder farming systems in Upper West Region of Ghana. In spite of the introduction of modern and improved soya bean production technologies in Ghana, the productivity of the crop in the region is still low. Given that inefficient use of resources is a potential course of low yields, this study analyses the resource use efficiency of soya bean production. Using cross-sectional data collected from 271 soya bean farmers from the Upper West Region of Ghana, the study employed the Stochastic Frontier Translog Production Function as well as the ratio of Marginal Value Product to Marginal Factor Cost to understand the resource use efficiency of soya bean farmers in the region. The empirical results showed that the estimated coefficients of soya bean seeds, labor and farm size were significant and positively related to soya bean output even though fertilizer input was surprisingly significantly and negatively related to the output of soya bean. Also, resources employed in soya bean production were found not to be efficiently utilized as they were underutilized, indicating that yield and profit could be improved with optimal use of production inputs. Finally, the paper revealed that access to soya bean threshers is the most important constraint faced by farmers in the region. For the region’s soya bean yield to be improved, government and development organizations should assist soya bean farmers by removing major bottlenecks to acquisition of resources required for the production and postharvest handling of the crop.

Pediatric dental procedures are carried out largely to prevent the adverse effects of primary teeth infection on succedaneous teeth (ST). The existing literature on how and when periapical infection (PI) from primary teeth affect ST is conflicted. A series of seven case reports on PI (abscesses and radicular cysts) from primary molars, until the eruption of the premolars, have been illustrated. The resistance of ST to PI based on their developmental stages is also discussed.

To evaluate the effectiveness of reduction of the sphenozygomatic suture in zygomaticomaxillary complex fractures by orbital volume and facial symmetry analysis. 16 patients with severely displaced or comminuted unilateral zygomatic complex fractures were studied. All patients underwent ORIF via hemicoronal incision as fixation of zygomatic arch was deemed necessary. This provided direct visualisation of reduction of the sphenozygomatic suture. The orbital volume and symmetry were analysed using different softwares. Descriptive statistics were computed. Patients were followed up for 3 months. The average reduction in orbital bony volume was 1.8 cc. Comparing the post-operative value with the contralateral normal side an average difference of only 0.5 cc was obtained. Preoperatively average deviation in symmetry was 3.66 ± 1.94 mm. Post-operatively the average deviation in symmetry was reduced to 2.19 ± 0.9 mm. On follow up, the complication noted was only one case of hardware failure was noted in the infraorbital rim. To evaluate the effective reduction of sphenozygomatic suture, restoration of symmetry and orbital volume should be assessed concurrently.

Abstract Background Traditional cost–benefit analysis of soybean production tends to largely focus on financial benefits to farmers, and less so on non-market co-benefits in sustaining smallholder farming systems. Relying solely on the standard financial analysis undermines the actual benefit of soybean production, which often results in ineffectual policy designs. An economic analysis that incorporates key non-pecuniary co-benefits of soybean production provide vital insight that contributes to improving productivity and overall economic well-being of farmers. Cross-sectional data were collected from 271 farmers to estimate the overall economic benefit of soybean that captures both market and non-market attributes in three major producing districts (Sissala-West, Wa-East, and Dafiama-Busie-Issa (DBI)) of Ghana. Results When non-market co-benefits were omitted, soybean production was not profitable (−Gh¢103.10/ha or −US$22.91) in DBI while Sissala-West and Wa-East had modest profit margins. However, the financial analysis changed dramatically when an average non-market value of Gh¢345.69 (US$76.82) was incorporated in the analysis. The soybean system was, therefore, financially viable for all the districts when the non-market attributes of the crop were considered. Conclusions The findings demonstrate the importance of the non-pecuniary benefits of soybean in smallholder farming systems for policy decision-making. For instance, farmers’ motivation for soybean production is closely linked to those ancillary benefits like the biological nitrogen fixed in the soil for cultivation of other crops. Similarly, crop administrators and policy makers’ support for conservation agriculture and green environment is tied to these non-market co-benefits.

Aims and Objectives: The aim of this prospective clinical study was to evaluate the success of one-stage direct (lateral) sinus lift procedure in severely atrophic posterior maxilla. Materials and Methods: One-stage direct (lateral) sinus lift procedure was carried out at 15 sites in 13 patients. All patients included in the study presented with partially edentulous posterior maxilla with one or more missing teeth and residual bone height less than 5 mm. Three months after surgery, patients were evaluated to access increase in residual bone height, density of new bone formed and implant stability. Patients were also evaluated after 3 months of prosthetic placement for the success of implant-supported prosthesis. Results: At 3 months post-operatively, increase in residual bone height was 8.31 ± 1.63 mm and the mean density of the newly formed bone around the implants was 417 ± 66.61 HU. All implants were stable and successfully osseointegrated, except one implant that was lost. The success rate of implant stability was 96.3% during the study period. Conclusion: Single-stage direct (lateral) maxillary sinus floor augmentation is a good treatment option with predictable outcome for patients with deficient alveolar bone in posterior maxilla.

Chronic non-suppurative osteomyelitis, also known as Garre's osteomyelitis is a well-described pathologic entity in dental literature. We present here a case report of a unilateral hard bony swelling of the lower jaw associated with infection. Radiograph revealed the pathognomic feature of 'onion skin' appearance. Surgical recontouring of the lower jaw was performed since there was no evidence of bone remodelling after removal of the infected tooth.

Abstract Background Paucity of data on state-wide maternal mortality in Nigeria hampers planning, monitoring and evaluation of the impact of interventions. The Confidential Enquiry into Maternal Deaths in Ondo State was initiated to overcome this problem. This study aimed to compare trends of maternal mortality ratios, causes of deaths, geographical distribution and other associated factors in 12-monthly reports of the Confidential Enquiry into Maternal Deaths in Ondo State. Methods Notification forms were distributed throughout the State to focal persons and medical records officers at community and facility levels, respectively. Maternal deaths, as defined in the International Classification of Diseases 10th version, were recorded prospectively over 3 years from 1st June 2012 to 30th May, 2015. Forms were submitted, collated and data analysed by a multidisciplinary review committee. Results Reported numbers of maternal deaths (and maternal mortality ratios) were 114 (253 per 100,000 births), 89 (192) and 81 (170), respectively per year, indicating a 33% reduction in maternal mortality ratio over the course of the study period. Assuming that the confidential enquiry process was the only intervention at the time aimed at reducing maternal mortality, simple linear regression with a correlation coefficient of 0.9314, showed a relationship though the difference in the values were not statistically significant (95% CI = − 184.55 to 101.55, p = 0.169). Postpartum haemorrhage and eclampsia were the leading causes of deaths. Conclusion There was a trend of reduction in maternal mortality ratio during the period of study with postpartum haemorrhage as the major cause of death. The positive association between the confidential enquiry reports and maternal mortality ratios make us recommend that our model be adopted in other states and at the federal level.

The economic importance of soybean towards poverty alleviation and food security is gaining wider popularity and common acceptance among smallholder farmers in sub-Sahara Africa, especially in Ghana. Commercial soybean cultivation is relatively new in Ghana; hence it has recently benefited from several productivities enhancing innovation/technologies. However, despite these efforts, productivity has remained low. This paper investigates factors affecting production efficiency among commercial soybean farmers, across the three commercial districts of the Upper West region of Ghana. A cross-sectional data collected from 271 soybean farmers were used to investigate technical efficiency of soybean production. The overall mean technical efficiency estimate is 59% with a scale elasticity of 0.89-indicating a huge scope for efficiency improvement. The result shows that, farmers experience in soybean production heavily influenced technical efficiency of output. With the existing technology and production resources, soybean farmers can improve their current levels of soybean production by 41% through the adoption of best production practices.

Tongue plays an important role in speech and deglutition. It is important to restore the anatomical form to achieve optimum function and aesthetics after ablative cancer resection of tongue lesions. Ideal reconstruction of these defects should be done with a flap that provides adequate bulk and pliable tissue [1]. Usually smaller defects are left to granulate without any reconstruction these may produce unaesthetic anatomical form and speech deformity [2,3]. We describe a technique of primary closure which will restore the anatomical form of the tongue and result in optimal speech.

Gastric infarction is a rare condition often associated with high mortality due to a delay in diagnosis. The stomach which has a rich supply of blood is a rare site for such a condition. Gastric infarction has a long list of etiological factors. We report a case of a patient who was managed successfully following gastric infarction from gastric dilatation. An 18-year-old female student presented with a three-day history of abdominal pain associated with abdominal distension of two days. The abdomen was distended with generalized tenderness, rebound tenderness, and guarding. Bowel sounds were absent. Digital rectal examination was unremarkable, and a pregnancy test was negative. Biochemical tests were all normal. Intraoperatively, two litres of serosanguinous fluid was suctioned from the abdomen. About 300 mL of pus was suctioned from the pelvis. The gangrenous portion was resected, and repair was done in two layers using Conell and Lambert suture techniques. Acute gastric necrosis is a rare surgical condition that requires a high index of suspicion and prompts aggressive resuscitation and surgical intervention to obviate the high mortality rate associated with the condition.

Research in the area of unrelated parallel machine scheduling problem (UPMSP) with sequence-dependent setup times has received little attention from the research community. However, this problem is NP-hard even without considering the setup times, and when sequence-dependent setup times are included, finding optimal solutions becomes very difficult, especially for the problems with large dimension. In this paper, a firefly algorithm (FA) which is refined with a local search solution improvement mechanism is presented to solve this problem, with the objective of reaching a near-optimum solution. Since the classical FA was originally designed for continuous optimization problems, a new solution representation scheme is designed to make the FA suitable for a combinatorial optimization problem such as the UPMSP. Three different popular metaheuristic algorithms are developed in parallel to verify and measure the effectiveness of the proposed algorithm. More so, the success of the novel firefly scheduling method is measured by comparing the quality of its solutions against the best-known methods from the literature. An exhaustive computational and statistical analysis is carried out to show an excellent performance of the new method on a large set of problem instances. The numerical results show that the improved FA is competitive, fast, and efficient and provide good quality solutions for both small and large problem instances.

Torrefaction of selected wood samples of Pinus Carrebea and Leucaena Leucocephala were carried out at temperatures ranging from 200 to 300°C to improve the energy parameters of biomass and to determine the effect of torrefication temperature on the physical and combustion properties of wood selected from Pinus carrebea and Leuceanea leucocephala grown in Nigeria. In this process the biomass hemicellulose is degraded, maintaining its cellulose and lignin content. The samples were dried and heated to 225, 250, 275, and 300°C. Then the torrefied mass was subjected to basic property testing on proximate analysis and heating value was calculated in order to understand the differences between raw material and its torrefied products. Specifically, the wood blocks changed from light brown to black, stemming from the partial carbonization at the wood surface. When the temperature is 225°C, the color of the wood is between dark brown and once the torrefaction temperatures are 250 and 275°C, the colors of the wood become dark and darker respectively. The results of the proximate analysis also showed that increasing of torrefied temperature; volatile fraction was reduced while fixed carbon was increased with increase in temperature from 21.34 to 52.74 and 18.58 to 56.83 for Leucaena leucocephala and Pinus carreabeanus respectively at 225 to 300°C. The volatile content is decreased from 78.58% to 62.76% with increase in temperature. Ash content of were within 1.57-3.41% of torrefied wood. It could be observed that the High calorific value (HCV for pine ranged between 19.80 and 28.06MJ/Kg for the top, 19.93and 24.96MJ/kg for middle with 19.72and 25.96MJ/Kg for base. The values recorded for raw sample and at 275°C been the lowest and highest respectively. The High calorific value (HCV) were found to be on the increase and nose dive at 300°C for the tree parts used in this research. The result revealed that for Leuceana the value increased from raw up to 275°C and at 300°C, a drop in the HHC was experienced. The result also showed that between raw and 250°C the value were statistically not at variance though higher value was recorded at 250°C (22.04MJ/kg). Likewise, between 275°C and 300°C there was no variance statistically, but higher value was observed for 275°C (26.32). It could be observed that the HHC for pine ranged between 19.80 and 28.06MJ/Kg for the top, 19.93 and 24.96MJ/kg for middle with 19.72 and 25.96MJ/Kg for base. The result also showed that between raw and 250 the value were statistically not at variance though higher value was recorded at 250 (22.04MJ/Kg). Likewise, between 275°C and 300°C there was no variance statistically, but higher value was observed for 275°C (26.32MJ/Kg). The proximate analyses revealed that the species are a suitable biomass source for torrefaction process and calorific value increase compared to control raw sample.

Torrefaction of selected wood samples of Pinus Carrebea and Leucaena Leucocephala were carried out at temperatures ranging from 200 to 300°C to improve the energy parameters of biomass and to determine the effect of torrefication temperature on the physical and combustion properties of wood selected from Pinus carrebea and Leuceanea leucocephala grown in Nigeria. In this process the biomass hemicellulose is degraded, maintaining its cellulose and lignin content. The samples were dried and heated to 225, 250, 275, and 300°C. Then the torrefied mass was subjected to basic property testing on proximate analysis and heating value was calculated in order to understand the differences between raw material and its torrefied products. Specifically, the wood blocks changed from light brown to black, stemming from the partial carbonization at the wood surface. When the temperature is 225°C, the color of the wood is between dark brown and once the torrefaction temperatures are 250 and 275°C, the colors of the wood become dark and darker respectively. The results of the proximate analysis also showed that increasing of torrefied temperature; volatile fraction was reduced while fixed carbon was increased with increase in temperature from 21.34 to 52.74 and 18.58 to 56.83 for Leucaena leucocephala and Pinus carreabeanus respectively at 225 to 300°C. The volatile content is decreased from 78.58% to 62.76% with increase in temperature. Ash content of were within 1.57-3.41% of torrefied wood. It could be observed that the High calorific value (HCV for pine ranged between 19.80 and 28.06MJ/Kg for the top, 19.93and 24.96MJ/kg for middle with 19.72and 25.96MJ/Kg for base. The values recorded for raw sample and at 275°C been the lowest and highest respectively. The High calorific value (HCV) were found to be on the increase and nose dive at 300°C for the tree parts used in this research. The result revealed that for Leuceana the value increased from raw up to 275°C and at 300°C, a drop in the HHC was experienced. The result also showed that between raw and 250°C the value were statistically not at variance though higher value was recorded at 250°C (22.04MJ/kg). Likewise, between 275°C and 300°C there was no variance statistically, but higher value was observed for 275°C (26.32). It could be observed that the HHC for pine ranged between 19.80 and 28.06MJ/Kg for the top, 19.93 and 24.96MJ/kg for middle with 19.72 and 25.96MJ/Kg for base. The result also showed that between raw and 250 the value were statistically not at variance though higher value was recorded at 250 (22.04MJ/Kg). Likewise, between 275°C and 300°C there was no variance statistically, but higher value was observed for 275°C (26.32MJ/Kg). The proximate analyses revealed that the species are a suitable biomass source for torrefaction process and calorific value increase compared to control raw sample.

The intelligent water drop algorithm is a swarm-based metaheuristic algorithm, inspired by the characteristics of water drops in the river and the environmental changes resulting from the action of the flowing river. Since its appearance as an alternative stochastic optimization method, the algorithm has found applications in solving a wide range of combinatorial and functional optimization problems. This paper presents an improved intelligent water drop algorithm for solving multi-depot vehicle routing problems. A simulated annealing algorithm was introduced into the proposed algorithm as a local search metaheuristic to prevent the intelligent water drop algorithm from getting trapped into local minima and also improve its solution quality. In addition, some of the potential problematic issues associated with using simulated annealing that include high computational runtime and exponential calculation of the probability of acceptance criteria, are investigated. The exponential calculation of the probability of acceptance criteria for the simulated annealing based techniques is computationally expensive. Therefore, in order to maximize the performance of the intelligent water drop algorithm using simulated annealing, a better way of calculating the probability of acceptance criteria is considered. The performance of the proposed hybrid algorithm is evaluated by using 33 standard test problems, with the results obtained compared with the solutions offered by four well-known techniques from the subject literature. Experimental results and statistical tests show that the new method possesses outstanding performance in terms of solution quality and runtime consumed. In addition, the proposed algorithm is suitable for solving large-scale problems.

Osteoma is a benign tumor which is composed of mature compact or cancellous bone. Osteoma may be periosteal (arising from surface of the bone) or endosteal (develop in the medullary bone) or combination of both. Here, we present a case of unusually large osteoma present on the lingual surface of the mandible in a 40-year-old female patient. The lesion had grown slowly for 15 years and caused intra-oral swelling leading to difficulty in mastication, speech and tongue movements. Under general anesthesia, local complete surgical excision was performed.

The aim was to evaluate treatment outcomes after apicoectomy and apexification in adjacent non-vital maxillary central incisors with large periapical radiolucencies, in a 10-year-old boy. The patient had complained of tenderness in the upper central incisors on mastication and gave a history of trauma to those teeth three years ago. On examination, there were found to be non-vital. Apexification (using Metapex) and apicoectomy (obturation with gutta percha) were performed on 11 and 21, respectively. Radiographical observations were made six months, one year and two years, post-operatively. Apical repair was found to be more favorable after apicoectomy than apexification, for a non-vital maxillary central incisor with an open apex and large periapical radiolucency.

BACKGROUND:The efficacy of intermittent preventive treatment for malaria with sulfadoxine-pyrimethamine (IPTp-SP) in pregnancy is threatened in parts of Africa by the emergence and spread of resistance to SP. Intermittent screening with a rapid diagnostic test (RDT) and treatment of positive women (ISTp) is an alternative approach. METHODS AND FINDINGS:An open, individually randomized, non-inferiority trial of IPTp-SP versus ISTp was conducted in 5,354 primi- or secundigravidae in four West African countries with a low prevalence of resistance to SP (The Gambia, Mali, Burkina Faso and Ghana). Women in the IPTp-SP group received SP on two or three occasions whilst women in the ISTp group were screened two or three times with a RDT and treated if positive for malaria with artemether-lumefantrine (AL). ISTp-AL was non-inferior to IPTp-SP in preventing low birth weight (LBW), anemia and placental malaria, the primary trial endpoints. The prevalence of LBW was 15.1% and 15.6% in the IPTp-SP and ISTp-AL groups respectively (OR = 1.03 [95% CI: 0.88, 1.22]). The mean hemoglobin concentration at the last clinic attendance before delivery was 10.97g/dL and 10.94g/dL in the IPTp-SP and ISTp-AL groups respectively (mean difference: -0.03 g/dL [95% CI: -0.13, +0.06]). Active malaria infection of the placenta was found in 24.5% and in 24.2% of women in the IPTp-SP and ISTp-AL groups respectively (OR = 0.95 [95% CI 0.81, 1.12]). More women in the ISTp-AL than in the IPTp-SP group presented with malaria parasitemia between routine antenatal clinics (310 vs 182 episodes, rate difference: 49.4 per 1,000 pregnancies [95% CI 30.5, 68.3], but the number of hospital admissions for malaria was similar in the two groups. CONCLUSIONS:Despite low levels of resistance to SP in the study areas, ISTp-AL performed as well as IPTp-SP. In the absence of an effective alternative medication to SP for IPTp, ISTp-AL is a potential alternative to IPTp in areas where SP resistance is high. It may also have a role in areas where malaria transmission is low and for the prevention of malaria in HIV positive women receiving cotrimoxazole prophylaxis in whom SP is contraindicated. TRIAL REGISTRATION:ClinicalTrials.gov NCT01084213 Pan African Clinical trials Registry PACT201202000272122.

Systemic inflammation and sequestration of parasitized erythrocytes are central processes in the pathophysiology of severe Plasmodium falciparum childhood malaria. However, it is still not understood why some children are more at risks to develop malaria complications than others. To identify human proteins in plasma related to childhood malaria syndromes, multiplex antibody suspension bead arrays were employed. Out of the 1,015 proteins analyzed in plasma from more than 700 children, 41 differed between malaria infected children and community controls, whereas 13 discriminated uncomplicated malaria from severe malaria syndromes. Markers of oxidative stress were found related to severe malaria anemia while markers of endothelial activation, platelet adhesion and muscular damage were identified in relation to children with cerebral malaria. These findings suggest the presence of generalized vascular inflammation, vascular wall modulations, activation of endothelium and unbalanced glucose metabolism in severe malaria. The increased levels of specific muscle proteins in plasma implicate potential muscle damage and microvasculature lesions during the course of cerebral malaria.

Cerebral malaria (CM) and severe malarial anemia (SMA) are the most serious life-threatening clinical syndromes of Plasmodium falciparum infection in childhood. Therefore it is important to understand the pathology underlying the development of CM and SMA, as opposed to uncomplicated malaria (UM). Different host responses to infection are likely to be reflected in plasma proteome-patterns that associate with clinical status and therefore provide indicators of the pathogenesis of these syndromes.Plasma and comprehensive clinical data for discovery and validation cohorts were obtained as part of a prospective case-control study of severe childhood malaria at the main tertiary hospital of the city of Ibadan, an urban and densely populated holoendemic malaria area in Nigeria. A total of 946 children participated in this study. Plasma was subjected to high-throughput proteomic profiling. Statistical pattern-recognition methods were used to find proteome-patterns that defined disease groups. Plasma proteome-patterns accurately distinguished children with CM and with SMA from those with UM, and from healthy or severely ill malaria-negative children.We report that an accurate definition of the major childhood malaria syndromes can be achieved using plasma proteome-patterns. Our proteomic data can be exploited to understand the pathogenesis of the different childhood severe malaria syndromes.

The Expanded Programme on Immunisation (EPI) provides an effective way of delivering intermittent preventive treatment for malaria (IPT) to infants. However, it is uncertain how IPT can be delivered most effectively to older children. Therefore, we have compared two approaches to the delivery of IPT to Gambian children: distribution by village health workers (VHWs) or through reproductive and child health (RCH) trekking teams. In rural areas, RCH trekking teams provide most of the health care to children under the age of 5 years in the Infant Welfare Clinic, and provide antenatal care for pregnant women.During the 2006 malaria transmission season, the catchment populations of 26 RCH trekking clinics in The Gambia, each with 400-500 children 6 years of age and under, were randomly allocated to receive IPT from an RCH trekking team or from a VHW. Treatment with a single dose of sulfadoxine pyrimethamine (SP) plus three doses of amodiaquine (AQ) were given at monthly intervals during the malaria transmission season. Morbidity from malaria was monitored passively throughout the malaria transmission season in all children, and a random sample of study children from each cluster was examined at the end of the malaria transmission season. The primary study endpoint was the incidence of malaria. Secondary endpoints included coverage of IPTc, mean haemoglobin (Hb) concentration, and the prevalence of asexual malaria parasitaemia at the end of malaria transmission period. Financial and economic costs associated with the two delivery strategies were collected and incremental cost and effects were compared. A nested case-control study was used to estimate efficacy of IPT treatment courses. Treatment with SP plus AQ was safe and well tolerated. There were 49 cases of malaria with parasitaemia above 5,000/µl in the areas where IPT was delivered through RCH clinics and 21 cases in the areas where IPT was delivered by VHWs, (incidence rates 2.8 and 1.2 per 1,000 child months, respectively, rate difference 1.6 [95% confidence interval (CI) -0.24 to 3.5]). Delivery through VHWs achieved a substantially higher coverage level of three courses of IPT than delivery by RCH trekking teams (74% versus 48%, a difference of 27% [95% CI 16%-38%]). For both methods of delivery, coverage was unrelated to indices of wealth, with similar coverage being achieved in the poorest and wealthiest groups. The prevalence of anaemia was low in both arms of the trial at the end of the transmission season. Efficacy of IPTc against malaria during the month after each treatment course was 87% (95% CI 54%-96%). Delivery of IPTc by VHWs was less costly in both economic and financial terms than delivery through RCH trekking teams, resulting in incremental savings of US$872 and US$1,244 respectively. The annual economic cost of delivering at least the first dose of each course of IPTc was US$3.47 and US$1.63 per child using trekking team and VHWs respectively.In this setting in The Gambia, delivery of IPTc to children 6 years of age and under by VHWs is more effective and less costly than delivery through RCH trekking clinics.ClinicalTrials.gov NCT00376155. Please see later in the article for the Editors' Summary.

Results from trials of intermittent preventive treatment (IPT) in infants and children have shown that IPT provides significant protection against clinical malaria. Sulfadoxine-pyrimethamine (SP) given alone or in combination with other drugs has been used for most IPT programmes. However, SP resistance is increasing in many parts of Africa. Thus, we have investigated whether SP plus AQ, SP plus piperaquine (PQ) and dihydroartemisinin (DHA) plus PQ might be equally safe and effective when used for IPT in children in an area of seasonal transmission.During the 2007 malaria transmission season, 1008 Gambian children were individually randomized to receive SP plus amodiaquine (AQ), SP plus piperaquine (PQ) or dihydroartemisinin (DHA) plus PQ at monthly intervals on three occasions during the peak malaria transmission season. To determine the risk of side effects following drug administration, participants in each treatment group were visited at home three days after the start of each round of drug administration and a side effects questionnaire completed. To help establish whether adverse events were drug related, the same questionnaire was administered to 286 age matched control children recruited from adjacent villages. Morbidity was monitored throughout the malaria transmission season and study children were seen at the end of the malaria transmission season.All three treatment regimens showed good safety profiles. No severe adverse event related to IPT was reported. The most frequent adverse events reported were coughing, diarrhoea, vomiting, abdominal pain and loss of appetite. Cough was present in 15.2%, 15.4% and 18.7% of study subjects who received SP plus AQ, DHA plus PQ or SP plus PQ respectively, compared to 19.2% in a control group. The incidence of malaria in the DHA plus PQ, SP plus AQ and SP plus PQ groups were 0.10 cases per child year (95% CI: 0.05, 0.22), 0.06 (95% CI: 0.022, 0.16) and 0.06 (95% CI: 0.02, 0.15) respectively. The incidence of malaria in the control group was 0.79 cases per child year (0.58, 1.08).All the three regimens of IPT in children were safe and highly efficaciousClinicalTrials.gov NCT00561899.

This report has discussed the endodontic and surgical management of a peripheral ossifying fibroma that had occurred in the anterior maxillary anterior region, between a central and a lateral incisor in a 12-year-old child. The lesion was diagnosed to have occurred secondary to a pulpo-periodontal irritation.

Context: The study assesses the apical sealing ability of two obturating materials (resilon and gutta-percha) with their sealants by means of the dye penetration method using India ink. Aims: To compare the resistance to apical dye penetration between resilon (with Epiphany sealer; Epiphany®, Pentron clinical technologies, USA) and gutta-percha (with AH Plus sealer; Dentsply, Maillefer, Germany). It was hypothesized that there would be no difference between the two groups with regard to apical dye penetration. Settings and design: Hundred mandibular first premolars from individuals aged between 20 to 25 years were selected after their lengths were standardized. Materials and Methods: Instrumentation was performed with NiTi hand protaper files (Dentsply, Maillefer) using EDTA paste and copious irrigation with 2.5% sodium hypochlorite. Experimental group 1 consisted of roots that were treated with Epiphany primer and obturated with resilon (with Epiphany sealer). Experimental group 2 consisted of those obturated with gutta-percha using AH Plus sealer. The samples were immersed in blue India Ink and cleared using 5% nitric acid. Dye penetration was assessed under a stereomicroscope. Statistical analysis: Mann-Whitney U test. Results: Roots obturated with resilon core material and Epiphany sealer exhibited lesser mean apical dye penetration (1.281 mm; SD: 0.742) in comparison to those obturated with gutta-percha and AH plus sealer (2.154 mm; SD: 0.814). The difference was found to be highly significant (P

Introduction: Increasing age is known to be associated with increased risk for postoperative morbidity and mortality, however, the goal of this study was to determine if an increase in age correlates to differences in surgical outcomes for elective ventral hernia repair., Methods: Retrospective cohort study using American College of Surgeons NSQIP database from 2016 to 2020. Included diagnosis codes were laparoscopic or open incisional or ventral hernia repairs, categorized into three age groups: 18-64y, 65-74y, and ≥75y. Thirty-day perioperative outcomes analyzed using bivariate χ 2 test and multivariate logistic regression., Results: We identified 116,643 people who had elective ventral or incisional hernia repair. Compared to 18-64y and 65-74y age groups, patients ≥75y were significantly more likely to develop any post-operative complication, be re-admitted post-operatively for any reason, have an extended hospital stay, and require a reoperation., Conclusions: Patients ≥75y have significantly higher rates of perioperative complications after elective hernia repair compared to younger patients., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Competing Interests: There are no conflicts of interest.

Competing Interests: There are no conflicts of interest.

Objective: To compare sustained virologic response 12 weeks post-treatment completion (SVR12) and patient characteristics for older versus younger patients with chronic hepatitis C virus infection (HCV) receiving direct-acting antiviral (DAA) agent therapy., Methods: This retrospective cohort study included patients with chronic HCV who received DAA therapy, between 2015 and 2018, in the largest health system in Rhode Island (N=154). Patient characteristics, comorbid diagnoses, and SVR12 status were compared between older (aged ≥60 years) and younger (<60 years) adults using chi-squared tests., Results: Overall, 94.1% (95% CI: 90.4-97.8) achieved SVR12; response rates were 91.8% (95% CI: 84.9-98.6) for older adults and 95.6% (95% CI: 91.5-99.8) for younger adults (p=0.51)., Conclusions: Our findings refute the historical notion that older adults were a "difficult-to-treat" subpopulation for whom clinicians should expect less treatment success. This is no longer the case with DAA therapy.