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Most cancer vaccines target peptide antigens, necessitating personalization owing to the vast inter-individual diversity in major histocompatibility complex (MHC) molecules that present peptides to T cells. Furthermore, tumours frequently escape T cell-mediated immunity through mechanisms that interfere with peptide presentation

Ammonia is one of the most important industrial chemicals which is prepared by the traditional Haber–Bosch process. Haber–Bosch process is an expensive process requiring higher temperature, pressure, and a lot of energy. Electrocatalytic nitrogen reduction reactions (NRR) have gained a lot of interest as the alternate method for the production of ammonia. For obtaining a higher yield, higher Faradic efficiency (PE), inhibition of side reactions e.g., hydrogen evolution reaction (HER), and reducing the production cost for ammonia by NRR, selection of appropriate catalysts, cell layout, and electrolyte selection are important controlling parameters for the NRR. Non-metallic catalysts are preferred over noble metallic catalysts due to their lower cost, more resources, and characteristic dorbital electron but have the issue of low selectivity due to the higher HER. The selectivity for the NRR can be improved by employing the catalysts with higher absorption of N2. PEM-type cells and the back-to-back cells are used to inhibit the HER. Apart from these factors, NRR is also dependent on other factors to obtain better experimental results e.g., no nitrides, removing the ammonia from contaminants sites, and controlling the experiment time.

Evaluating a resident's development as a bedside educator in the emergency department (ED) is challenging. Teaching consults, where trainees are observed and assessed in their teaching skills, have been used to improve bedside teaching. Within emergency medicine, there are a few assessment tools to evaluate a clinician's bedside teaching, with the majority focusing on faculty. A user-friendly assessment tool adapted to the ED that emphasizes behaviorally anchored, milestone-based evaluations for residents has yet to be developed. We sought to develop such an assessment tool for evaluating residents' bedside teaching in the ED. Using a nominal-group consensus-building technique, we derived the bedside teaching assessment tool. The consensus-building panel was composed of clinician-educators with extensive experience in resident education. The teaching consult process consisted of the consultant, a faculty member with a focus in medical education, directly observing a resident's bedside teaching throughout their shift while filling out the evaluation form based on observed behaviors. A total of 35 consults were provided to 30 individual residents. The mean (±SD) scores for the 35 consults for the learning climate, content teaching, supervision, feedback and evaluation, and self-assessment were 3.84 (±0.75), 3.56 (±0.58), 3.70 (±0.60), 3.64 (±0.77), and 3.92 (±0.45), respectively. The median scores for the above domains were 4, 3.5, 4, 3.5, and 4, respectively. The tool has acceptable internal consistency with a Cronbach's alpha of 0.723 (95% CI 0.469-0.839). Eleven of 13 (85%) residents who provided feedback agreed or strongly agreed that the quantitative feedback provided by the assessment tool was useful. Twelve of 13 (92%) residents found the consultation process to be unobtrusive to their clinical performance. In conclusion, this novel behaviorally anchored assessment tool for bedside teaching can serve as a useful adjunct to a teaching consult and provide useful feedback for the development of residents' bedside teaching skills.

Most bacterial vaccines work for a subset of bacterial strains or require the modification of the antigen or isolation of the pathogen before vaccine development. Here we report injectable biomaterial vaccines that trigger potent humoral and T-cell responses to bacterial antigens by recruiting, reprogramming and releasing dendritic cells. The vaccines are assembled from regulatorily approved products and consist of a scaffold with absorbed granulocyte-macrophage colony-stimulating factor and CpG-rich oligonucleotides incorporating superparamagnetic microbeads coated with the broad-spectrum opsonin Fc-mannose-binding lectin for the magnetic capture of pathogen-associated molecular patterns from inactivated bacterial-cell-wall lysates. The vaccines protect mice against skin infection with methicillin-resistant Staphylococcus aureus, mice and pigs against septic shock from a lethal Escherichia coli challenge and, when loaded with pathogen-associated molecular patterns isolated from infected animals, uninfected animals against a challenge with different E. coli serotypes. The strong immunogenicity and low incidence of adverse events, a modular manufacturing process, and the use of components compatible with current good manufacturing practice could make this vaccine technology suitable for responding to bacterial pandemics and biothreats.

In Vehicular Ad-hoc Networks (VANETs), fast and reliable dissemination of safety messages is a key step toward improving the overall road safety. In a highly dynamic VANET environment, safety message dissemination in a multi-hop manner is a challenging and complex problem that has gained significant attention recently. Many protocols and schemes have been proposed to efficiently share safety messages among vehicles. However, most existing techniques do not perform well under real-world traffic conditions, or perform adequately only under very limited scenarios and traffic conditions. This research proposes a highly efficient and reliable multi-hop broadcasting protocol, Intelligent Forwarding Protocol (IFP), that exploits handshake-less communication, ACK Decoupling, and an efficient collision resolution mechanism. In this research, IFP has been extensively studied and evaluated to establish its robustness and superiority over existing schemes. A key contribution of this paper is to present an in-depth analysis and optimization of IFP using theoretical modeling, thorough simulations, and extensive real-world experimentation. With IFP, the message propagation delay is significantly reduced and packet delivery ratio is drastically improved.

The coronavirus disease 2019 (COVID‐19) pandemic demonstrates the importance of generating safe and efficacious vaccines that can be rapidly deployed against emerging pathogens. Subunit vaccines are considered among the safest, but proteins used in these typically lack strong immunogenicity, leading to poor immune responses. Here, a biomaterial COVID‐19 vaccine based on a mesoporous silica rods (MSRs) platform is described. MSRs loaded with granulocyte‐macrophage colony‐stimulating factor (GM‐CSF), the toll‐like receptor 4 (TLR‐4) agonist monophosphoryl lipid A (MPLA), and SARS‐CoV‐2 viral protein antigens slowly release their cargo and form subcutaneous scaffolds that locally recruit and activate antigen‐presenting cells (APCs) for the generation of adaptive immunity. MSR‐based vaccines generate robust and durable cellular and humoral responses against SARS‐CoV‐2 antigens, including the poorly immunogenic receptor binding domain (RBD) of the spike (S) protein. Persistent antibodies over the course of 8 months are found in all vaccine configurations tested and robust in vitro viral neutralization is observed both in a prime‐boost and a single‐dose regimen. These vaccines can be fully formulated ahead of time or stored lyophilized and reconstituted with an antigen mixture moments before injection, which can facilitate its rapid deployment against emerging SARS‐CoV‐2 variants or new pathogens. Together, the data show a promising COVID‐19 vaccine candidate and a generally adaptable vaccine platform against infectious pathogens., Mesoporous silica rods (MSRs) scaffolds are used as a platform to induce adaptive immunity against SARS‐CoV‐2 antigens. Sustained delivery of GM‐CSF, MPLA, and a variety of SARS‐CoV‐2 subunit immunogens from the MSR vaccine recruite immune cells into the scaffolds and consistently induce antigen‐specific long‐lasting antibodies, cytotoxic T lymphocyte responses (CTL), and viral neutralization in vitro.

Tissue adhesives capable of achieving strong and tough adhesion in permeable wet environments are useful in many biomedical applications. However, adhesion generated through covalent bond formation directly with the functional groups of tissues (i.e., COOH and NH

Most bacterial vaccines work for a subset of bacterial strains or require the modification of the antigen or isolation of the pathogen before vaccine development. Here we report injectable biomaterial vaccines that trigger potent humoral and T-cell responses to bacterial antigens by recruiting, reprogramming and releasing dendritic cells. The vaccines are assembled from regulatorily approved products and consist of a scaffold with absorbed granulocyte-macrophage colony-stimulating factor and CpG-rich oligonucleotides incorporating superparamagnetic microbeads coated with the broad-spectrum opsonin Fc-mannose-binding lectin for the magnetic capture of pathogen-associated molecular patterns from inactivated bacterial-cell-wall lysates. The vaccines protect mice against skin infection with methicillin-resistant Staphylococcus aureus, mice and pigs against septic shock from a lethal Escherichia coli challenge and, when loaded with pathogen-associated molecular patterns isolated from infected animals, uninfected animals against a challenge with different E. coli serotypes. The strong immunogenicity and low incidence of adverse events, a modular manufacturing process, and the use of components compatible with current good manufacturing practice could make this vaccine technology suitable for responding to bacterial pandemics and biothreats.

In this paper, we developed a simple two-step route to prepare a PdO/SnO2 heterostructure with the diameter of the SnO2 and PdO nanoparticles at about 15 nm and 3 nm, respectively. In the evaluation temperature window between 80 °C and 340 °C, PdO/SnO2 shows the best response to 100 ppm of CO at 100 °C with fast response time (14 s) and recovery time (8 s). Furthermore, the PdO/SnO2 nanoparticles exhibit a low detection limit and good selectivity to CO against interfering gases as well as rarely-seen low-temperature stability and reversibility. Such enhanced gas sensing performance could be attributed to both the ultrafine structure of PdO and the synergy between PdO and SnO2. The results clearly indicate the application of PdO/SnO2 as a pratical low-temperature sensing material for CO.

Background Shared decision-making (SDM) has been studied in the emergency department (ED) in relation to hospital admissions but not for CT scan utilization. CT scans are a common imaging modality with high accuracy that emit considerable ionizing radiation. This study has three aims: to measure provider and patient preference for SDM; to evaluate patient involvement in the decision to order a CT scan; and to determine the association between patient involvement and CT utilization. Methods In this prospective study, stable ED patients with abdominal pain with CT imaging as a likely diagnostic tool, were screened and consented. The Control Preferences Scale assessed patient and provider baseline decision-making preference. Using the OPTION-5 tool, providers were assessed in each encounter for the extent to which they engaged patients in discussions. The association between the Control Preferences Scale, the OPTION-5 score and ultimate CT utilization was evaluated. Results Twenty-nine encounters were observed. CT was considered in 70% (n = 20) of encounters and ordered in 55% (n = 16). 62% of patients and 59% of providers reported that they prefer “shared responsibility” when making treatment decisions. In >80% of encounters, provider's showed no or minimal effort when discussing whether to perform a CT scan. Provider or patient preference was not associated with patient involvement. Patient involvement was not associated with CT utilization. Conclusions High rates of provider and patient preference to use SDM for treatment plans were reported but providers were rarely observed engaging patients with abdominal pain in the decision to order a CT scan.

The use of fuel cells is one of the most promising renewable energy strategies, but they still suffer from many limitations. The high mass enthalpy of hydrogen as a fuel comes at the cost of inconveniences and risks associated with storage, transportation and utilization, while the high performance of Pt catalysts in commercial fuel cells is limited by their high cost, low earth abundance, and poor stability as a result of CO intermediate poisoning. To circumvent these dilemmas, direct methanol fuel cells (DMFCs) were developed, using methanol as a fuel and Ni as the anode catalyst. Thanks to the condensed form of the fuel, DMFCs are considered as the most promising fuel-cell solution for portable electronic devices. Usually, other elements have to be introduced into Ni-based catalysts to modify the active sites to provide better alternatives to pristine Ni metal in terms of activity and stability. In this study, we provide a mild synthetic method for the preparation of CuNi alloy nanoparticles. The proper alloying ratio leads to the suitable modification of the electronic structure of Ni, which promotes the MOR catalytic reaction on the NiCu alloy. The NiCu alloy catalyst exhibits a mass current density of 1028 mA mgmetal-1 for the MOR at 1.55 V (vs. RHE), which is among the best values obtained from similarly prepared Ni-based catalysts.

The issues related to setup downtime, raw material waste, and the quality defects are inevitable in the flexographic printing business. To enable sustainable continuous process improvements within the printing process, lean manufacturing methodologies, such as Value Stream Mapping, (VSM), can be a competitive management approach. Therefore, this study explores how the systematic application of VSM in a flexographic printing process can foster further the process improvement when combined with other lean activities, such as, 5S, single minute exchange of die (SMED), and kaizen etc. To assess the contribution of this lean approach, the Overall Equipment Effectiveness, (OEE), and manufacturing costs are taken as performance metrics. The results demonstrate that when integrated with 5-why root cause analysis and kaizen, VSM improved OEE by 24.31% and reduced manufacturing costs from US$0.762 million to US$0.6 million. Hence, the significance of the proposed combined lean approach for continuous improvement is reached.

In this paper, we developed a simple two-step route to prepare a PdO/SnO

Objectives Small bowel obstructions (SBOs) occur 300,000 times annually leading to $1.3 billion in cost. Approximately 20% of patients require a laparotomy to manage the obstruction and either prevent or treat intestinal ischemia. Early management may play a role in reducing these complications. Nasogastric decompression is commonly used for early management. Our primary objective was to determine if NGD was associated with lower rates of surgery, bowel ischemia or length of stay. Methods We retrospectively enrolled 181 ED patients with SBO from 9/2013 to 9/2015 in order to determine if nasogastric decompression was associated with a reduction in rates of surgery, bowel ischemia or hospital length of stay. Results Our subject population was 46% female, median age of 60.27% of patients received surgery. Nasogastric decompression was used in 51% of patients. There was no association with a reduction in rates of surgery ( p = 0.20) or bowel resection ( p = 0.41) with patients receiving Nasogastric decompression, and no difference in baseline characteristics. Nasogastric decompression was associated with a two-day increase in hospital length of stay. Factors that were significantly associated with surgical exploration of SBO were: female (OR 2.32 (95% CI: 1.01–5.31)) and “definite SBO” on CT (OR 3.29 (95% CI: 1.18–9.20)). Abnormal vital signs, obstipation, and lab values were not predictors of surgery. Conclusion Nasogastric decompression is not associated with a reduction in need for surgery or bowel resection, but is associated with a 2-day increase in median LOS. Women were more likely to receive surgery than men.

The primary objective of this study was to compare Emergency Department patients with first-time versus recurrent acute pancreatitis.This study was a retrospective chart review of patients with a diagnosis of acute pancreatitis who presented to a single academic urban emergency department from 2012 to 2016. Criteria for inclusion were clinical symptoms of pancreatitis, age greater than or equal to 18 years, ED diagnosis of acute pancreatitis, and an abdominal CT scan within 24 h of triage. Exclusion criteria were traumatic mechanism and pregnancy. Charts were reviewed by a minimum of two trained abstractors using structured data collection sheets and discrepancies were resolved by a third abstractor. Patients with first time acute pancreatitis versus recurrent acute pancreatitis were compared to determine differences in characteristics, management and disposition.250 patients were included in the study. Of these, 165 patients had first-time acute pancreatitis and 85 patients had recurrent acute pancreatitis. Demographics, vital signs and initial lab values were the same in both groups. Patients with recurrent acute pancreatitis were more likely to have significant findings on CT (Modified CT Severity Index, 2.09 versus 1.43, p 0.05), more likely to require IV opiates (96% versus 75%, p 0.001) and less likely to need ICU admission (8% versus 19%, p = 0.03).ED patients with recurrent acute pancreatitis demonstrated more significant findings on CT compared to patients with first-time acute pancreatitis but were less likely to require ICU admission.

Hanging is one of the most common causes of suicide world-wide, more prevalent in developing countries. There are no established protocols for early management of near-hanging patients who present to the emergency department (ED). The use of early intubation, strict blood pressure control and targeted temperature management has shown promise in small studies.To detect changes in mortality and neurological deficits in near-hanging patients before and after implementation of a novel early management protocol in a tertiary care hospital in India.Prospective cohort study conducted at a tertiary-care hospital in Tamil Nadu, India from August 2014-July 2016. For first year of study (pre-implementation), near-hanging patients were treated without a structured protocol. For second year of study (post-implementation), near-hanging patients were treated per a protocol including early intubation, strict blood pressure control and targeted temperature management. Primary outcomes included: (1) in-hospital mortality and (2) hospital discharge without neurological deficit.65 patients were included (27 in the pre-implementation phase and 38 in the post-implementation phase.) At presentation, there was no difference between the two groups in mean heart rate, mean arterial pressure, mean oxygen saturation, Glasgow coma score, or mean respiratory rate. Protocol implementation decreased mortality (10/27 (37%) versus 2/38 (5%), P 0.05) and increased the number of patients discharged without neurological deficit (10/27 (37%) versus 35/38 (92%), P 0.05).This novel early management protocol reduced mortality and increased the number discharged without neurological deficit in near-hanging patients in a single tertiary care center in India.

The western segment of hygrocins A–B has been synthesized through the coupling of a chiral C5–C13 synthon with the sterically demanding hexasubstituted naphthalenic core. The C5–C13 chiral fragment has been assembled via a stereoselective Johnson orthoester rearrangement of an optically pure allylic alcohol derived from d-glucose. Our studies lay the platform for the determination of the absolute configuration of the unassigned C8-stereocenter of the title compounds in addition to the completion of the total synthesis of the unique ansamacrolides hygrocins A and B.

One of the most significant challenges in wide-scale Wireless Sensor Networks (WSNs) is to achieve energy efficiency in order to increase their lifetime and ensuring responsiveness. A very widely applied approach in this regard is to overload the region with numerous low-cost sensing devices that can communicate with each other wirelessly and coordinate amongst themselves in developing schedules for being asleep or active. The literature has numerous research works in this regard which aim to develop efficient sleep scheduling schemes. In this paper, we present an implementation of a grid-topology based cooperative Rank Based Sleep Scheduling (RBSS) protocol in which the nodes of every cell coordinate in a distributive manner, the decision making process of selecting the nodes that should stay active, while others sleep. The proposed protocol guarantees the WSN connectivity as well as the required coverage. Finally, we implement RBSS on a small scale grid using TelosB motes.

Sharing emergency messages amongst vehicles on the road can greatly reduce traffic accidents. In Vehicular Ad Hoc Networks (VANETs) to share these emergency messages, fast and reliable message dissemination is the key objective in a highly dynamic VANET environment. This research proposes a novel broadcasting protocol to achieve these goals by introducing handshake-less broadcasting, ACK Decoupling and efficient collision resolution mechanism. A key contribution of this paper is to analyze and optimize the broadcasting algorithm using thorough mathematical modeling with extensive simulations. With the suggested optimization process, the message propagation delay can be significantly reduced.

Compound (I) is successfully synthesized, which represents the western segment of the title compounds.

Vehicular Ad Hoc Networks (VANETs) is an extension of Mobile Ad Hoc Networks (MANETs) to share traffic information and emergency alerts amongst vehicles on the road. To support many applications in VANETs, most studies use GPS to find the furthest node with ACK to ensure successful message reception. However, this ACK procedure can be removed if a channel between the sender and receiver is clear such that the sender can overhear the broadcasted messages from the receiver. If the sender fails, nodes closer to the sender inform the sender of successful rebroadcasting, which serves as an ACK to the sender. This process will either entirely remove costly ACKing processes or at least decouple the messages propagation from ACKing to the sender, which will significantly improve the speed of message propagation. In this paper, we use Signal-to-Noise Ratio (SNR) with ACK decoupling to ensure fast message propagation with reliable message recovery. Detailed simulation results show that the proposed SNR based approach with ACK decoupling outperforms the Smart Broadcast (SB) by 200% in average throughput and per hop delay, while ensuring the reliable dissemination of emergency messages in typical VANETs environments.

In modern day world, time has become a precious resource. Therefore, different strategies and techniques are constantly being employed in all fields of life to save every bit of time. Increasingly many of such applications involve wireless sensor networks. A highly potential system that can be made significantly more efficient using WSNs is an elevator system. There have been numerous attempts to improve the serving efficiency of the elevator system over the course of time. This paper proposes to utilize the elevator system in a more productive manner so that more number of people can be served in a lesser time. Hence, people will be able to spend this valuable time on other important and crucial matters rather than waiting for the elevator and wasting their time in vain. To achieve this goal, we implement the elevator system based on a wireless adhoc network of intelligent floors (equipped with sensors) which can communicate with each other in a multi-hop fashion. In this way, every floor is aware of the traffic conditions, i.e., the number of upward/downward requesting-passengers, waiting at every other floor and the elevator positions in real-time and hence can make efficient decisions of where to direct/stop the elevator.

This paper presents the concept and design of exhaustive-parallel search algorithm for Network-on-Chip. The proposed parallel algorithm searches minimal path between source and destination in a forward-wave-propagation manner. The algorithm guarantees setup latency if the setup path exists. A high performance switch is designed to support exhaustive-parallel search algorithm. The NoC fabric is designed for 8×8 mesh architecture and its performance is evaluated.