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Abstract Defect detection in pharmaceutical blister packages is the most challenging task to get an accurate result in detecting defects that arise in tablets while manufacturing. Conventional defect detection methods include human intervention to check the quality of tablets within the blister packages, which is inefficient, time-consuming, and increases labor costs. To mitigate this issue, the YOLO family is primarily used in many industries for real-time defect detection in continuous production. To enhance the feature extraction capability and reduce the computational overhead in a real-time environment, the CBS-YOLOv8 is proposed by enhancing the YOLOv8 model. In the proposed CBS-YOLOv8, coordinate attention is introduced to improve the feature extraction capability by capturing the spatial and cross-channel information and also maintaining the long-range dependencies. The BiFPN (weighted bi-directional feature pyramid network) is also introduced in YOLOv8 to enhance the feature fusion at each convolution layer to avoid more precise information loss. The model's efficiency is enhanced through the implementation of SimSPPF (simple spatial pyramid pooling fast), which reduces computational demands and model complexity, resulting in improved speed. A custom dataset containing defective tablet images is used to train the proposed model. The performance of the CBS-YOLOv8 model is then evaluated by comparing it with various other models. Experimental results on the custom dataset reveal that the CBS-YOLOv8 model achieves a mAP of 97.4% and an inference speed of 79.25 FPS, outperforming other models. The proposed model is also evaluated on SESOVERA-ST saline bottle fill level monitoring dataset achieved the mAP50 of 99.3%. This demonstrates that CBS-YOLOv8 provides an optimized inspection process, enabling prompt detection and correction of defects, thus bolstering quality assurance practices in manufacturing settings.

Abstract Geographic atrophy (GA) is an advanced form of dry age-related macular degeneration (AMD) that leads to progressive and irreversible vision loss. Identifying patients with greatest risk of GA progression is important for targeted utilization of emerging therapies. This study aimed to comprehensively evaluate the role of shape-based fractal dimension features ( $${F}_{fd}$$ F fd ) of sub-retinal pigment epithelium (sub-RPE) compartment and texture-based radiomics features ( $${F}_{t}$$ F t ) of Ellipsoid Zone (EZ)-RPE and sub-RPE compartments for risk stratification for subfoveal GA (sfGA) progression. This was a retrospective study of 137 dry AMD subjects with a 5-year follow-up. Based on sfGA status at year 5, eyes were categorized as Progressors and Non-progressors. A total of 15 shape-based $${F}_{fd}$$ F fd of sub-RPE surface and 494 $${F}_{t}$$ F t from each of sub-RPE and EZ-RPE compartments were extracted from baseline spectral domain-optical coherence tomography scans. The top nine features were identified from $${F}_{fd}$$ F fd and $${F}_{t}$$ F t feature pool separately using minimum Redundancy maximum Relevance feature selection and used to train a Random Forest (RF) classifier independently using three-fold cross validation on the training set ( $${S}_{t}$$ S t , N = 90) to distinguish between sfGA Progressors and Non-progressors. Combined $${F}_{fd}$$ F fd and $${F}_{t}$$ F t was also evaluated in predicting risk of sfGA progression. The RF classifier yielded AUC of 0.85, 0.79 and 0.89 on independent test set ( $${S}_{v}$$ S v , N = 47) using $${F}_{fd}$$ F fd , $${F}_{t}$$ F t , and their combination, respectively. Using combined $${F}_{fd}$$ F fd and $${F}_{t}$$ F t , the improvement in AUC was statistically significant on $${S}_{v}$$ S v with p-values of 0.032 and 0.04 compared to using only $${F}_{fd}$$ F fd and only $${F}_{t}$$ F t , respectively. Combined $${F}_{fd}$$ F fd and $${F}_{t}$$ F t appears to identify high-risk patients. Our results show that FD and texture features could be potentially used for predicting risk of sfGA progression and future therapeutic response.

The development and evaluation of a mild steel permanent mould were conducted with considerations based on materials availability, cost efficiency, and national economic development. The design, material selection, and fabrication strategy were all carefully chosen to meet these objectives. Geometric modelling of the mould design was carried out using Pro/Engineer® software, generating various views and parameters of the mould with and without components. Mild steel was chosen for mould production due to its strength, rigidity, availability, high melting temperature, surface finish, and machinability. Fabrication of the mould utilized basic machine tools such as a lathe machine and drilling machine. To evaluate the performance of the developed mould, an aluminium alloy pulley was produced using the mould and aluminium scraps. Microstructural analysis and hardness tests were performed on mould samples before and after casting. The results indicate that the heated mould sample, after casting, exhibits a fine-induced dendritic structure comprised of smaller grains, whereas the microstructure of the unheated mould displayed larger grain sizes. The maximum hardness number recorded was 204 HV for the mould sample after casting, indicating the ability of the mould material to withstand fatigue stresses and wear generated during casting.

During anatomy dissection, the release of formaldehyde (FA) from cadavers and embalming fluids can negatively affect the well-being of students and staff. The exposure of students, staff, and technicians to FA in the dissection hall is a concern. To address this issue, a study measured the FA and air quality (CO 2 and Total Volatile Organic Compounds- TVOC) with different ventilation setups: natural, fan-based, and air-conditioned. The FA levels and the indoor air quality at the breathing zone were estimated using an air conditioning (AC), fan-based, and naturally ventilated setup. The FA, CO 2 , and TVOC levels were calculated at the cadavers’ head and toe ends, in the pathway, and between the dissection tables. The FA, CO 2 , and TVOC levels were higher near the cadaver and lower in the pathway and between the tables, regardless of the type of ventilation used. Fan-based ventilation had the lowest mean FA, CO 2 , and TVOC levels compared to AC and natural ventilation. However, there was no significant difference in these levels between the ventilation types, except for the toe-ends of the cadavers ( P

This report discusses the occurrence of tumor-to-tumor metastasis—an atypical phenomenon in oncology where a secondary malignancy develops within an existing primary tumor. The case of a 64-year-old woman is presented, who, with a history of stage II invasive ductal carcinoma of the breast treated with mastectomy and chemoradiotherapy, developed neurological symptoms indicative of a secondary brain tumor. MRI and subsequent histopathological analysis post-craniotomy confirmed a meningioma with a metastatic breast carcinoma, demonstrating the clinical importance of considering tumor-to-tumor metastasis in similar patient histories.

**Background:** Postoperative urinary retention (POUR) is a common and distressing surgical complication that may be associated with the pharmacological reversal technique of neuromuscular blockade (NMB). **Objective:** This study aimed to investigate the impact that POUR has on medical charges. **Methods:** This was a retrospective observational study of adult patients undergoing select surgeries who were administered neuromuscular blockade agent (NMBA), which was pharmacologically reversed between February 2017 and November 2021 using data from the PINC-AI™ Healthcare Database. Patients were divided into 2 groups: those experiencing POUR (composite of retention of urine, insertion of temporary indwelling bladder catheter, insertion of non-indwelling bladder catheter) during index hospitalization following surgery and those without POUR. Surgeries in inpatient and outpatient settings were analyzed separately. A cross-sectional comparison was performed to report total hospital charges for the 2 groups. Furthermore, patients experiencing subsequent POUR events within three days after discharge from index hospitalization were studied. **Results:** A total of 330 838 inpatients and 437 063 outpatients were included. POUR developed in 13 020 inpatients and 2756 outpatients. Unadjusted results showed that POUR was associated with greater charges in both inpatient ($92 529 with POUR vs $78 556 without POUR, _p_

Objective Estimations of the treatment effect on overall survival (OS) may be influenced by post-progression therapies (PPTs). It is unclear how often OS analyses account for PPT effects. The purpose of this cross-sectional analysis was to determine the prevalence of OS analyses accounting for PPT effects in phase III oncology trials.Methods and analysis We screened two-arm, superiority design, phase III, randomised, oncology trials reporting OS from ClinicalTrials.gov. The primary outcome was the frequency of OS analyses adjusting for PPT confounding. Logistic regressions computed ORs for the association between trial-level covariates and the outcome.Results A total of 334 phase III trials enrolling 265 310 patients were included, with publications between 2004 and 2020. PPTs were reported in 47% of trials (157 of 334), and an analysis accounting for PPTs was performed in only 12% of trials (N=41). PPT adjustments were often prespecified (N=23, 56%), and appeared to be more likely in cross-over studies (OR 5.04, 95% CI 2.42 to 10.38) and studies with discordant surrogate-OS findings (OR 2.26, 95% CI 1.16 to 4.38). In key subgroup analyses, PPT analyses were infrequent, including 8% of trials among those studying locoregional/first-line therapy and 11% of trials among those powered for OS.Conclusions Although time on PPTs is an important component of OS, PPTs are rarely considered in OS analyses, which may introduce confounding on estimates of the treatment effect on OS. PPTs and methods to account for their effects on OS estimates should be considered at the time of trial design and reporting.

Background: Left ventricular thrombus (LVT) is a significant complication in STEMI. Previous studies were conducted prior to modern timely percutaneous reperfusion networks. Current expert opinion suggests incidence in the current era has decreased. We conducted a systematic review and meta-analysis to better understand the incidence and diagnosis of LVT in patients with STEMI treated with timely percutaneous techniques as assessed by multimodality imaging. Methods: Cochrane, EMBASE, LILACS, and MEDLINE were searched over the last 10 years only including studies using contemporary techniques. The primary outcome was detection of LVT in patients via echocardiogram with or without contrast or Cardiac MRI (cMRI) following STEMI (both anterior and any territory) treated with PCI. Data was pooled across studies and statistical analysis was conducted via random effects model. Results: 31 studies were included. 18 studies included data on any territory STEMI, totaling 14,172 patients, and an incidence of 5.6% [95% CI 4.3–7.0]. 18 studies were included in analysis for anterior STEMI, totaling 7382 patients and incidence of 12.7% [95% CI 9.8–15.6]. Relative to cMRI as a gold standard, the sensitivity of non-contrast echocardiography to detect LVT was 58.2% [95% CI 46.6–69.2] with a specificity of 97.8% [95% CI 96.3–98.8]. Conclusions: Incidence of LVT in STEMI patients treated with contemporary timely percutaneous revascularization is in keeping with historical data and remains significant, suggesting this remains an ongoing issue for further investigation. Numerically, both cMRI and contrast echo detected more LVT compared to non-contrast echo in any-territory STEMI patients.

We report the case of a 77-year-old woman presenting with an asymptomatic internal carotid artery (ICA) aneurysm arising at the skull base. The distal right extracranial ICA aneurysm presented as a challenging case due to difficulty in obtaining adequate surgical exposure and preserving the facial nerves present near the ICA aneurysm. Transcervical open repair with a team of vascular and otolaryngology surgeons was completed successfully. In this report, we detail the operative steps needed to complete this exposure and our perioperative management.

Automatic product recognition is crucial in advancing economic and social fronts due to its superior reliability and time-saving nature compared to manual operations. The precise organization of products on store shelves is essential for boosting sales and ensuring customer satisfaction. However, verifying that the physical arrangement aligns with the ideal plan is a costly and time-consuming task for store personnel. In the computer vision domain, detecting products in scene images poses a considerable challenge, particularly when dealing with grocery items displayed on store shelves. The arrangement of products often presents crowded environments with numerous identical objects placed closely together. This study illustrates the ongoing challenge of identifying specific objects in complex situations despite using advanced object detection systems. The proposed framework consists of a three-stage pipeline. The initial stage incorporates a cutting-edge product detection algorithm, YOLOv5, to locate multiple grocery objects. The proposed OD-Refiner layer in the second stage identifies the missed retail object and rectifies overlapping bounding boxes of YOLOv5. The OCR-based object recognizer called Batch Normalization Free Rigorous Feature Flow Neural Network (BNFRNN) is proposed in the final stage of the pipeline. The performance of the proposed framework was evaluated using a benchmark dataset, WebMarket. The proposed framework outperforms current state-of-the-art approaches by achieving a precision score of 92.56%, recall of 85.64%, and F-score of 88.97%.

Background As the population is aging and indications are expanding, shoulder arthroplasty is becoming more frequent, especially bilateral staged replacement. However, surgeons are hesitant to use bilateral reverse prostheses due to potential limitations on activities of daily living. Methods This meta-analysis was conducted to compare bilateral anatomic to bilateral reverse shoulder implants. PubMed, Cochrane, and Google Scholar (pages 1–20) were searched until April 2023. The clinical outcomes consisted of postoperative functional scores (American Shoulder and Elbow Surgeons [ASES], Single Assessment Numeric Evaluation [SANE], Physical Component Score [PCS], Mental Component Score, and Simple Shoulder Test), pain, and range of motion (external rotation and forward elevation). Three studies were included in this meta-analysis. Results Bilateral anatomic implants had better postoperative functional outcomes and range of motion, but no significant difference was seen in postoperative pain when compared to the reverse prosthesis. Better ASES score, SANE score, and PCS as well as better external rotation and forward elevation were seen in the bilateral anatomic shoulder replacement group, but no significant difference in pain levels was seen between the two groups. Conclusions These results may be explained by the lower baseline seen in the reverse prosthesis group, which may be due to an older population and different indications. Nevertheless, more randomized controlled studies are needed to confirm these findings. Level of evidenceIII.

The utilization of Ordinary Portland Cement as the primary material of choice in the construction industry has had its drawbacks due to the large amounts of pollution Portland cement’s production causes. Significant findings have been discovered, and alkali-activated materials have been implemented as an alternative cementitious material to the traditional concrete of today. Alkali-activated materials can be formulated using industrial wastes, making them eco-friendly and a more sustainable replacement for concrete. This study aims to assess whether alkali-activated materials can be implemented in infrastructural fields and seeks to evaluate the possibility of alkali-activated materials acting as pavement-quality concrete in infrastructural applications. This review presents the results of various studies, demonstrating that alkali-activated materials can meet the requirements for pavement-quality concrete with the proper incorporation of industrial wastes. This outlines the viability of alkali-activated materials (AAMs) as a green alternative for pavement applications as most AAMs attain required mechanical properties, mostly reaching compressive strength values higher than the required 40 MPa, all while simultaneously adhering to the needed durability, workability, drying shrinkage, and abrasion resistance attributes. Using industrial waste-based alkali-activated materials renders the material eco-friendly and sustainable, all while enhancing the material’s characteristics and properties necessary for large-scale infrastructural applications. This review highlights AAMs’ suitability as a durable and eco-friendly solution for pavement construction.

Chylothorax caused by superior vena cava (SVC) syndrome is a rare but potentially life-threatening complication requiring a multidisciplinary diagnosis and management approach. We present a case of a 27-year-old female with end-stage renal disease who developed chylothorax secondary to SVC syndrome caused by venous stenosis from a tunneled hemodialysis (HD) catheter. The patient had a history of ongoing hemodialysis through a tunneled catheter placed in the right internal jugular vein approximately seven months before presentation. She presented with dyspnea, chest pain, and a large left-sided pleural effusion. A multidisciplinary diagnostic workup and management included 2 thoracentesis, pleural fluid studies, serial radiological tests, right and left heart catheterizations, and blood serum studies with flow cytometry. They revealed that SVC stenosis around the hemodialysis catheter was causing the patient's pathology. The patient underwent veno-plasty of the right SVC and brachiocephalic veins and replacement of HD catheter leading to the resolution of the chylothorax and significant improvement in respiratory symptoms. This report will highlight the approach to diagnosing and managing chylothorax and a review of existing medical literature.

The widespread availability and diversity of open-source microcontrollers paired with off-the-shelf electronics and 3D printed technology has led to the creation of a wide range of low-cost scientific instruments, including microscopes, spectrometers, sensors, data loggers, and other tools that can be used for research, education, and experimentation. These devices can be used to explore a wide range of scientific topics, from biology and chemistry to physics and engineering. In this study, we designed and built a multifunction fluorescent open source in vivo/in vitro imaging system (openIVIS) system that integrates a Raspberry Pi with commercial cameras and LEDs with 3D printed structures combined with an acrylic housing. Our openIVIS provides three excitation wavelengths of 460 nm, 520 nm, and 630 nm integrated with Python control software to enable fluorescent measurements across the full visible light spectrum. To demonstrate the potential applications of our system, we tested its performance against a diverse set of experiments including laboratory assays (measuring fluorescent dyes, using optical nanosensors, and DNA gel electrophoresis) to potentially fieldable applications (plant and mineral imaging). We also tested the potential use for a high school biology environment by imaging small animals and tracking their development over the course of ten days. Our system demonstrated its ability to measure a wide dynamic range fluorescent response from millimolar to picomolar concentrations in the same sample while measuring responses across visible wavelengths. These results demonstrate the power and flexibility of open-source hardware and software and how it can be integrated with customizable manufacturing to create low-cost scientific instruments with a wide range of applications. Our study provides a promising model for the development of low-cost instruments that can be used in both research and education.

Introduction: Police personnel perform untiring duties to maintain law and order. The objectives of this study were to assess the physical and mental health status of police personnel in a selected rural subdivision of Bengaluru District. Methods: A cross-sectional study was conducted among 142 police personnel in 7 police stations of the selected rural subdivision using a universal sampling technique. A structured interview schedule was used, which included socio-demographic details, occupational details, anthropometry, blood pressure and blood sugar measurements, Patient Health Questionnaire-9 (PHQ-9) to screen for depression and Perceived Stress Scale (PSS) to identify stress. Results: The mean age of the police personnel was 40.28±10.97 years. Most of the workforce were males (83%). About 68.3% of the studied group were obese. High random blood sugar and high blood pressure values were observed in 5.6% and 48.6% of the personnel who had no previous history of diabetes mellitus and hypertension. The prevalence of mild to severe depression was found to be 36% and that of high stress was 83.1%. Conclusion: The high prevalence of increased blood pressure, obesity, depression and perceived stress warrants the need for routine screening and application of various levels of prevention. Health promotion and improved working conditions can improve their health status.

Background: Total shoulder arthroplasty has been effective in treating primary glenohumeral arthritis surgically. However, the subscapularis (SSC) tendon must be released as part of the surgery's conventional approach, which could lead to postoperative problems and later tendon failure. Using a procedure that spares the tendon, Lafosse et al reported improved postoperative SSC performance. This meta-analysis will compare this approach to the standard one. Methods: PubMed, Cochrane, and Google Scholar (pages 1-20) were searched till October 2022. The clinical outcomes consisted of the postoperative pain, adverse events, and range of motion. Results: Only 3 studies were included in this meta-analysis. The subscapularis sparing approach tended to have better postoperative internal rotation (P = .06) and shoulder elevation (P = .1); however, the results were marginally statistically insignificant. Conclusion: This is the first meta-analysis to compare the subscapularis sparing to the standard approach in total shoulder arthroplasty. Showing better postoperative range of motion (elevation and internal rotation), the SSC approach might be considered as a good substitute to the standard one. However, it is limited by the potentially limited exposure making it harder to use in muscular and obese patients. More randomized clinical trials are needed to reach more significant results and establish clearer indications of this approach.

Background: Patients with premenopausal breast cancer (PMBC) have been historically excluded from some clinical trials because of the limitations of using endocrine therapy (ET) in this population. We analyzed breast cancer randomized clinical trials (RCTs) to determine the rates of and factors associated with inclusion of PMBC patients to provide a benchmark for PMBC inclusion in RCTs moving forward. Methods: Using ClinicalTrials.Gov, we identified breast cancer phase III RCTs and extracted inclusion criteria and patient enrollment information. Multiple binary logistic regression modeling was used to assess trial-related factors that were associated with PMBC patient inclusion. Results: Of 170 breast cancer RCTs identified, 131 (77.1%) included PMBC patients. Sixty-five (38.2%) trials analyzed patients with hormone-receptor-positive (HR+) and HER2-negative (HER2-) breast cancer, of which 31 (47.7%) allowed for enrollment of PMBC patients. Lower rates of PMBC inclusion were seen in trials that studied HR+/HER2-patients (47.7% PMBC inclusion in HR+/HER2-trials vs. 94.3% in non-HR+/HER2-trials, aOR 0.07 [95% CI: 0.02–0.19], p

Renewed call for the replacement of conventional materials with carbon fibre reinforced plastics (CFRPs) in many high-performance applications is responsible for the current wave of research on minimum quantity lubrication (MQL) strategy in machining. Due to their competitive advantages over conventional materials, polymer matrix composites (PMCs) are now attracting the attention, of researchers, especially in the field of machining. Although most manufacturing methods require less machining, precision machining like milling and drilling call for more research inputs. For this purpose, this review article assesses various aspects of nanofluid preparation and its application in CFRPs. Recent scientific reports on nanofluids with a focus on properties, preparation, and application (including respective methodologies) were analyzed, to contribute to the growing database for future research in this field. This review article shows that cutting temperature and cutting force remain the key determinants of surface finish, while tool wear constitutes a major parameter that machining scientists would like to keep under full control by the use of appropriate cutting fluids. Uncertainties around the quality of nanofluids which is scarcely discussed in the literature is raised in this review, while advocating for more research to unravel it. Furthermore, this review article sheds more light on the machining operations of carbon fiber-reinforced plastics using nanoparticle-laden fluids for a safe and sustainable machining experience. Finally, this review assesses the possibility of achieving excellent CFRP processing using a sustainable approach to fill existing gaps identified in literature like wasted cutting liquids, environmental pollution, and exposure of operators to health hazards.

Purpose: To determine the dosimetric limitations of daily online adaptive pancreas stereotactic body radiation treatment by using an automated dose escalation approach. Methods and Materials: We collected 108 planning and daily computed tomography (CT) scans from 18 patients (18 patients × 6 CT scans) who received 5-fraction pancreas stereotactic body radiation treatment at MD Anderson Cancer Center. Dose metrics from the original non-dose-escalated clinical plan (non-DE), the dose-escalated plan created on the original planning CT (DE-ORI), and the dose-escalated plan created on daily adaptive radiation therapy CT (DE-ART) were analyzed. We developed a dose-escalation planning algorithm within the radiation treatment planning system to automate the dose-escalation planning process for efficiency and consistency. In this algorithm, the prescription dose of the dose-escalation plan was escalated before violating any organ-at-risk (OAR) dose constraint. Dose metrics for 3 targets (gross target volume [GTV], tumor vessel interface [TVI], and dose-escalated planning target volume [DE-PTV]) and 9 OARs (duodenum, large bowel, small bowel, stomach, spinal cord, kidneys, liver, and skin) for the 3 plans were compared. Furthermore, we evaluated the effectiveness of the online adaptive dose-escalation planning process by quantifying the effect of the interfractional dose distribution variations among the DE-ART plans. Results: The median D95% dose to the GTV/TVI/DE-PTV was 33.1/36.2/32.4 Gy, 48.5/50.9/40.4 Gy, and 53.7/58.2/44.8 Gy for non-DE, DE-ORI, and DE-ART, respectively. Most OAR dose constraints were not violated for the non-DE and DE-ART plans, while OAR constraints were violated for the majority of the DE-ORI patients due to interfractional motion and lack of adaptation. The maximum difference per fraction in D95%, due to interfractional motion, was 2.5 ± 2.7 Gy, 3.0 ± 2.9 Gy, and 2.0 ± 1.8 Gy for the TVI, GTV, and DE-PTV, respectively. Conclusions: Most patients require daily adaptation of the radiation planning process to maximally escalate delivered dose to the pancreatic tumor without exceeding OAR constraints. Using our automated approach, patients can receive higher target dose than standard of care without violating OAR constraints.

Typically the rampdown phase of a shot consists of a decrease in current and injected power and optionally a change in shape, but there is considerable flexibility in the rate, sequencing, and duration of these changes. On the next generation of tokamaks it is essential that this is done safely as the device could be damaged by the stored thermal and electromagnetic energy present in the plasma. This works presents a procedure for automatically choosing experimental rampdown designs to rapidly converge to an effective rampdown trajectory. This procedure uses probabilistic machine learning methods paired with acquisition functions taken from Bayesian optimization. In a set of 2022 experiments at DIII-D, the rampdown designs produced by our method maintained plasma control down to substantially lower current and energy levels than are typically observed. The actions predicted by the model significantly improved as the model was able to explore over the course of the experimental campaign.

A first of its kind fully data-driven system has been developed and implemented into the DIII-D plasma control system to detect and control Alfvén eigenmodes (AE) in real-time. Susceptibility to fast ion-induced AE is a challenge in fully non-inductive tokamak operation, which significantly reduces fast-particle confinement and results in degraded fusion gain. Controlling AEs in real-time to improve fast-ion confinement is, hence, important for future advanced tokamak fusion reactors. The models were implemented and tested in experiments which showed that neural networks (NN) are highly effective in detecting 5 types of AE (BAE, EAE, LFM, RSAE, TAE) using high resolution ECE. To estimate the neutron deficit, a NN has been trained that outputs the classical neutron rate using similar inputs to NUBEAM. Also a preliminary ML-based proportional control has been designed and gone through initial testing in experiment to use feedback-control on the neutral beam power to achieve desired amplitude of AE modes and neutron deficits. The effect of AEs on fast-ion confinement is measured by analysing the gap in classical neutron rate from the proposed NN-based NUBEAM and the measured neutron rate.

Introduction Transradial access (TRA) has rapidly emerged as the preferred vascular access site for coronary angiography and percutaneous coronary intervention. Radial artery occlusion (RAO) remains as an important complication of TRA as it precludes future ipsilateral transradial procedures. While intraprocedural anticoagulation has been studied extensively, the definitive role of postprocedural anticoagulation has not yet been established.Methods and analysis The Rivaroxaban Post-Transradial Access for the Prevention of Radial Artery Occlusion trial is a multicentre, prospective, randomised, open-label, blinded-endpoint design study investigating the efficacy and safety of rivaroxaban to reduce the incidence of RAO. Eligible patients will undergo randomisation to receive either rivaroxaban 15 mg once daily for 7 days or to no additional postprocedural anticoagulation. Doppler ultrasound to assess radial artery patency will be performed at 30 days.Ethics and dissemination The study protocol has been approved by the Ottawa Health Science Network Research Ethics Board (approval number 20180319-01H). The study results will be disseminated via conference presentations and peer-reviewed publications.Trial registration number NCT03630055.

Since its emergence, the COVID-19 pandemic had a dramatic impact on the public health worldwide and it scarred the medical, economical, and social determinants of health. Even after the significant vaccination advances, the disease of SARS-CoV-2 can manifest in severe presentations with life-threatening thromboembolic and multi-organ complications leading to notable morbidity and mortality. Clinicians and researchers are on continuous pursuit of investigating different approaches in the attempt to prevent the infection and minimize its severity. Although the COVID-19’s pathophysiology remains relatively unclear, it is well established now that coagulopathy, systemic thrombotic propensity, and a robust immunoinflammatory response are some of the most important determinants of its morbidity and mortality. Accordingly, research efforts have focused on addressing the inflammatory and hematological cascades using available agents to avoid thromboembolic events. Several studies and investigators have emphasized the importance of Low molecular weight heparin (LMWH), namely, Lovenox, in addressing these sequelae of the COVID-19 disease, either prophylactically or therapeutically. This review explores the benefits and concerns of employing LMWH, a widely used anticoagulant, in COVID-19 disease. It delves into Enoxaparin as a molecule, along with its pharmacology, mechanism of action, and clinical uses. It also reviews the current high-quality clinical evidence that highlight the role of enoxaparin in SARS-CoV-2 infection.

Abstract Background Drugs and alcohol can cause significant harm to individuals, families and communities. Young offenders represent an important population group, which often sport many characteristics that make them highly vulnerable to experiencing harm from drug use. For decades, research has shown the complexity of health behaviours and the need to consider consumer perspectives to respond and support different populations effectively. Methods This study utilised qualitative inquiry to explore young offenders’ (aged 13 to 18 years) experiences with drug use. The study sought to discern the pathways to drug dependencies for young people and to understand how community organisations can better support young people involved with the justice system. Results Three themes were identified in the data. First, the clear lack of knowledge about how to reduce harm from drug use among young offenders. Second, the structural and environmental influences on drug use and the need to develop personal skills and knowledge, alongside advocating for supportive environments for good health. Third, the power and hope that a youth advocate with lived experience can bring to the harm prevention and health promotion field. Conclusions Community services have an integral role in ensuring drug and alcohol education is accessible for different youth populations. Importantly, health promotion organisations should raise awareness about the environmental influences on drug use behaviours, and work deliberately to include consumer perspectives in the design and planning of prevention and harm reduction strategies.

Effective use of noninvasive ventilation in patients with chronic obstructive pulmonary disease is well-known. However, noninvasive ventilation in patients presenting with altered sensorium and severe acidosis (pH

Abstract Background Both modified FOLFIRINOX (mFFX) and gemcitabine/nab-paclitaxel chemotherapy regimens have been shown to improve clinical outcomes in patients with pancreatic cancer, and are often used interchangeably as the standard of care. Preclinical studies often do not use these regimens, since administering these multiagent approaches can be difficult. In this study, we assessed the feasibility of administering these two chemotherapy regimens in spontaneous pancreatic tumors using KPC mice with the ultimate goal of advancing preclinical studies. Methods KPC mice were created by breeding Kras LSL−G12D/+ to Trp53 fl/fl ;Ptf1α Cre/+, resulting in Kras LSL−G12D/+ ;p53 fl/+ ;Ptf1α Cre/+ mice. At 14 weeks of age, mice were palpated for spontaneous tumor growth that was verified using ultrasounds. Mice with tumors under 15 mm in diameter were used. The mice were assigned to one of seven treatment regimens: 1 cycle of mFFX (FFX X1), 2 cycles of mFFX (FFX X2), 1 cycle of mFFXwith 40 Gy SBRT (FFX SBRT), 1 cycle of gemcitabine/nab-paclitaxel (GEM/AB X1), 2 cycles of gemcitabine/nab-paclitaxel (GEM/AB X2), 2 cycles of gemcitabine/nab-paclitaxel with 40 Gy SBRT (GEM/AB SBRT), or saline only (control). Results In total, 92 mice were included. The median OS in the FFX X2 group was slightly longer that the median OS in the FFX X1 group (15 days vs 11 days, P = 0.003). Mice in the GEM/AB X2 group had longer OS when compared to mice in the GEM/AB X1 group (33.5 vs 13 days, P = 0.001). Mice treated with chemotherapy survived longer than untreated control animals (median OS: 6.5 days, P

Purpose: The application of radiotherapy to the treatment of cancer requires the knowledge of photon interaction coefficients such as mass attenuation (μm) and mass energy-absorption coefficients (μen/ρ). Although these coefficients have been determined for different tissues, it is lacking for the colorectal cancer (CRC) tissue in the literature. This study determines the μm and μen/ρ for the CRC tissue within the radiotherapy energy range. Materials and Methods: The CRC tissue from autopsy patients was freeze-dried, grounded into a fine powder, and made into pellets of 1 cm thickness. The elements detected in the CRC tissue using Rutherford backscattering spectrometry were used in XCOM to determine the theoretical values of μm and μen/ρ. The CRC tissue was again exposed to X-rays of energies of 6 and 15MV, respectively, to determine its experimental values of μm and μen/ρ. Results: Elements detected included carbon, oxygen and nitrogen making up 96.67%, high atomic number and trace elements making up the remaining 3.33% fraction of the CRC tissue. Conclusion: The theoretical and experimental μm and μen/ρ values showed a good agreement of about 2% difference between them. These values can be used to simulate the CRC tissue with respect to μm and μen/ρ.

Scene Text Recognition (STR) has become a popular and long-standing research problem in computer vision communities. Almost all the existing approaches mainly adopt the connectionist temporal classification (CTC) technique. However, these existing approaches are not much effective for irregular STR. In this research article, we introduced a new encoder-decoder framework to identify both regular and irregular natural scene text, which is developed based on the transformer framework. The proposed framework is divided into four main modules: Image Transformation, Visual Feature Extraction (VFE), Encoder and Decoder. Firstly, we employ a Thin Plate Spline (TPS) transformation in the image transformation module to normalize the original input image to reduce the burden of subsequent feature extraction. Secondly, in the VFE module, we use ResNet as the Convolutional Neural Network (CNN) backbone to retrieve text image features maps from the rectified word image. However, the VFE module generates one-dimensional feature maps that are not suitable for locating a multi-oriented text on two-dimensional word images. We proposed 2D Positional Encoding (2DPE) to preserve the sequential information. Thirdly, the feature aggregation and feature transformation are carried out simultaneously in the encoder module. We replace the original scaled dot-product attention model as in the standard transformer framework with an Optimal Adaptive Threshold-based Self-Attention (OATSA) model to filter noisy information effectively and focus on the most contributive text regions. Finally, we introduce a new architectural level bi-directional decoding approach in the decoder module to generate a more accurate character sequence. Eventually, We evaluate the effectiveness and robustness of the proposed framework in both horizontal and arbitrary text recognition through extensive experiments on seven public benchmarks including IIIT5K-Words, SVT, ICDAR 2003, ICDAR 2013, ICDAR 2015, SVT-P and CUTE80 datasets. We also demonstrate that our proposed framework outperforms most of the existing approaches by a substantial margin.

IntroductionKidney stone disease (KS) is a complicated disease with an increasing global incidence. It was shown that Bushen Huashi decoction (BSHS) is a classic Chinese medicine formula that has therapeutic benefits for patients with KS. However, its pharmacological profile and mechanism of action are yet to be elucidated.MethodsThe present study used a network pharmacology approach to characterize the mechanism by which BSHS affects KS. Compounds were retrieved from corresponding databases, and active compounds were selected based on their oral bioavailability (≥30) and drug-likeness index (≥0.18). BSHS potential proteins were obtained from the Traditional Chinese Medicine Systems Pharmacology (TCMSP) database, whereas KS potential genes were obtained from GeneCards and OMIM, TTD, and DisGeNET. Gene ontology and pathway enrichment analysis were used to determine potential pathways associated with genes. The ingredients of BSHS extract were identified by the ultra‐high‐performance liquid chromatography coupled with quadrupole orbitrap mass spectrometry (UHPLC-Q/Orbitrap MS). The network pharmacology analyses predicted the potential underlying action mechanisms of BSHS on KS, which were further validated experimentally in the rat model of calcium oxalate kidney stones.ResultsOur study found that BSHS reduced renal crystal deposition and improved renal function in ethylene glycol(EG)+ammonium chloride(AC)-induced rats, and also reversed oxidative stress levels and inhibited renal tubular epithelial cell apoptosis in rats. BSHS upregulated protein and mRNA expression of E2, ESR1, ESR2, BCL2, NRF2, and HO-1 in EG+AC-induced rat kidney while downregulating BAX protein and mRNA expression, consistent with the network pharmacology results.DiscussionThis study provides evidence that BSHS plays a critical role in anti-KS via regulation of E2/ESR1/2, NRF2/HO-1, and BCL2/BAX signaling pathways, indicating that BSHS is a candidate herbal drug for further investigation in treating KS.

Nose masks are widely worn for protection against respiratory pathogens, including SARS-CoV-2. They have been reported as possible substrates for viral sampling and testing for COVID-19 but, evaluations have so far been purposive; involving individuals known to have the infection and using improved materials on the nose masks to trap the virus. We investigated the feasibility of using the regular 3-ply surgical masks and, voluntary coughing as a mode of particle expulsion for detecting SARS-CoV-2 infections in a cross-sectional study at Ghana's first COVID-19 testing reference laboratory, the Noguchi Memorial Institute for Medical Research, University of Ghana. Paired samples of naso-oropharyngeal swabs and nose masks already worn by 103 consenting adult participants (retro masks) were collected. Participants were also required to produce three strong coughs into a newly supplied sterile surgical nose mask. Pre-wetted swabs in Viral Transport Media (VTM) were used in swabbing the inner lining of each nose mask. The swabs used were then stored in VTM to maintain the integrity of the samples. PCR results of SARS-CoV-2 detection from the nose masks were compared to those from naso-oropharyngeal swabs ('gold-standard'). Out of the 103 participants tested with all three methods, 66 individuals sampled with naso-oropharyngeal swabs were detected as positive, and the retro and new masks matched 9 and 4, respectively. Only 3 individuals were positive across all three sampling methods accessed. The retro nose masks performed better in matching the gold-standard results than the new mask + coughing method, with 90% vs 80% sensitivity, positive predictive value of 13.6% vs 6%, and a weak but significant linear relationship (adj. R2 = 0.1; P = 0.0004). Importantly, we also show that the nose masks would work for sampling whether individuals are symptomatic or asymptomatic since gold-standard PCR cycling threshold (Ct) values for positive individuals did not differ between the two groups (P< 0.05). We recommend including features such as talking during participant engagement, use of a spontaneous cough inducer and increased coughing bouts > 3, to improve the performance of sterile nose masks for SARS-CoV-2 detection.

Background: In patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI), selecting an antithrombotic regimen requires balancing risks of ischemic cardiac events, stroke, and bleeding. Methods: We studied 467 patients with AF undergoing PCI in the time period from December 2015 to July 2018 identified via a chart audit by 47 Canadian cardiologists in the CONNECT AF+PCI (the Coordinated National Network to Engage Interventional Cardiologists in the Antithrombotic Treatment of Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention) study, to determine patterns of initial antithrombotic therapy selection. Results: The median (25th, 75th percentile) CHADS2 score was 2 (1, 3), and PCI was performed in the setting of acute coronary syndrome in 62.1%. Triple antithrombotic therapy (TAT) was the initial treatment in 62.7%, dual-pathway therapy in 25.7%, and dual antiplatelet therapy in 11.6%, with a temporal increase in use of dual-pathway therapy during the course of the study; median intended TAT duration was 1 (1, 3) month. Compared with patients selected for TAT, patients selected for dual-pathway therapy were less likely to have prior myocardial infarction (35.8% vs 25.8%, P = 0.045) and prior PCI (33.8% vs 23.3%, P = 0.03), and they received shorter total length of stents (38 [23, 56] vs 30 [20, 46] mm, P = 0.03). Patients selected for dual-pathway therapy had a higher prevalence of prior stroke/transient ischemic attack (13.0% vs 23.3%, P = 0.01). There was no difference in prevalence of anemia (21.5% vs 25.8%, P = 0.30). Use of dual-pathway therapy was similar among patients with acute coronary syndrome and those with stable disease (24.1% vs 28.2%, P = 0.32). Conclusions: Approximately one-quarter of AF patients undergoing PCI are treated with dual-pathway therapy in Canadian practice, with its use increasing during the studied period. Patients selected for dual-pathway therapy have less-complex coronary disease history and intervention. Résumé: Introduction: Les patients atteints de fibrillation auriculaire (FA) qui subissent une intervention coronarienne percutanée (ICP) et choisissent un schéma posologique antithrombotique ont besoin de peser les risques d’événements cardiaques d’origine ischémique, d’accidents vasculaires cérébraux et d’hémorragies. Méthodes: Les 467 patients atteints de FA ayant subi une ICP de décembre 2015 à juillet 2018 qui ont fait l’objet de notre étude ont été trouvés lors de la vérification des dossiers par 47 cardiologues canadiens de l’étude CONNECT AF+PCI (Coordinated National Network to Engage Interventional Cardiologists in the Antithrombotic Treatment of Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention) pour déterminer les schémas de sélection du traitement antithrombotique initial. Résultats: Le score CHADS2 médian (25e, 75e percentile) était de 2 (1, 3), et l’ICP avait été réalisée dans le cadre du syndrome coronarien aigu chez 62,1 % des patients. La trithérapie antithrombotique (TTA) était le traitement initial chez 62,7 % des patients, la bithérapie, chez 25,7 % des patients, et la bithérapie antiplaquettaire, chez 11,6 % des patients, mais il y avait une augmentation temporelle dans l’utilisation de la bithérapie durant l’étude; la durée médiane prévue de la TTA était de 1 (1, 3) mois. Comparativement aux patients sélectionnés pour la TTA, les patients sélectionnés pour la bithérapie étaient moins susceptibles d’avoir eu un infarctus du myocarde précédent (35,8 % vs 25,8 %, P = 0,045) et une ICP précédente (33,8 % vs 23,3 %, P = 0,03), et recevaient des endoprothèses de longueur totale plus courte (38 [23, 56] vs 30 [20, 46] mm, P = 0,03). Les patients sélectionnés pour la bithérapie montraient une prévalence plus élevée d’accidents vasculaires cérébraux/accidents ischémiques transitoires (13,0 % vs 23,3 %, P = 0,01). Il n’existait aucune différence dans la prévalence de l’anémie (21,5 % vs 25,8 %, P = 0,30). L’utilisation de la bithérapie était similaire chez les patients atteints d’un syndrome coronarien aigu et chez les patients dont la maladie était stable (24,1 % vs 28,2 %, P = 0,32). Conclusions: Dans la pratique canadienne, environ le quart des patients atteints de FA qui subissent une ICP sont traités par bithérapie, mais durant la période étudiée, son utilisation avait augmenté. Les patients sélectionnés pour la bithérapie ont des antécédents et des interventions liées aux maladies coronariennes moins complexes.

This study examines consumers' willingness to pay a higher price premium for quail products using the price of chicken as a benchmark. A double-bounded dichotomous choice contingent valuation was used to elicit the data, and the factors influencing consumers’ willingness to pay (WTP) were identified using the ordered logit regression model. Results revealed that on the average consumers were willing to pay a higher price premium for quail products, with the mean WTP of GH¢ 27.46 ($5.66), representing 196.14% price premium and GH¢26.34 ($5.43) representing 196.03% price premium per crate of eggs and 1kg of quail meat, respectively. These findings are crucial for the development of the products as well as formulating marketing strategies for its promotion in the African food markets.

Social capital concept has become popular over the past decades. What is not known in literature and worth investigating is the network designs and nature that enhance the development of new learning ideas and knowledge creation. The aim of the paper is to examine network structure dimensions, namely centrality (bonding) and structural holes (bridging or looser ties) of social capital formed within higher education networks that stimulate the development of new ideas and knowledge creation of the participants in the networks across multiple domains of science. This study employs negative binomial regression on a sample of participants within a higher education network to predict the development of new ideas and knowledge creation. The results show that the different features of social capital dimensions influence the development of new ideas and knowledge creation of the participants in the networks differently. Specifically, the study reveals that the brokerage network appears to be more relevant than cohesion in the Ghanaian higher education institution networks. When knowledge creation is decomposed into different fields of science, Health Science is found to be the most productive. The decomposing of the knowledge creation into different fields of science remains a value of this study.

COVID-19,which is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is one of the worst pandemics in recent history. The identification of patients suspected to be infected with COVID-19 is becoming crucial to reduce its spread. We aimed to validate and test a deep learning model to detect COVID-19 based on chest X-rays. The recent deep convolutional neural network (CNN) RegNetX032 was adapted for detecting COVID-19 from chest X-ray (CXR) images using polymerase chain reaction (RT-PCR) as a reference. The model was customized and trained on five datasets containing more than 15,000 CXR images (including 4148COVID-19-positive cases) and then tested on 321 images (150 COVID-19-positive) from Montfort Hospital. Twenty percent of the data from the five datasets were used as validation data for hyperparameter optimization. Each CXR image was processed by the model to detect COVID-19. Multi-binary classifications were proposed, such as: COVID-19 vs. normal, COVID-19 + pneumonia vs. normal, and pneumonia vs. normal. The performance results were based on the area under the curve (AUC), sensitivity, and specificity. In addition, an explainability model was developed that demonstrated the high performance and high generalization degree of the proposed model in detecting and highlighting the signs of the disease. The fine-tuned RegNetX032 model achieved an overall accuracy score of 96.0%, with an AUC score of 99.1%. The model showed a superior sensitivity of 98.0% in detecting signs from CXR images of COVID-19 patients, and a specificity of 93.0% in detecting healthy CXR images. A second scenario compared COVID-19 + pneumonia vs. normal (healthy X-ray) patients. The model achieved an overall score of 99.1% (AUC) with a sensitivity of 96.0% and specificity of 93.0% on the Montfort dataset. For the validation set, the model achieved an average accuracy of 98.6%, an AUC score of 98.0%, a sensitivity of 98.0%, and a specificity of 96.0% for detection (COVID-19 patients vs. healthy patients). The second scenario compared COVID-19 + pneumonia vs. normal patients. The model achieved an overall score of 98.8% (AUC) with a sensitivity of 97.0% and a specificity of 96.0%. This robust deep learning model demonstrated excellent performance in detecting COVID-19 from chest X-rays. This model could be used to automate the detection of COVID-19 and improve decision making for patient triage and isolation in hospital settings. This could also be used as a complementary aid for radiologists or clinicians when differentiating to make smart decisions.

Abstract Background Phase 3 oncologic randomized clinical trials (RCTs) can lead to Food and Drug Administration (FDA) approvals. In this study, we aim to identify trial-related factors associated with trials leading to subsequent FDA drug approvals. Methods We performed a database query through the ClinicalTrials.gov registry to search for oncologic phase 3 RCTs on February 2020. We screened all trials for therapeutic, cancer-specific, phase 3, randomized, multi-arm trials. We then identified whether a trial was used for subsequent FDA drug approval through screening of FDA approval announcements. Results In total, 790 trials were included in our study, with 225 trials (28.4%) generating data that were subsequently used for FDA approvals. Of the 225 FDA approvals identified, 65 (28.9%) were based on trials assessing overall survival (OS) as a primary endpoint (PEP), two (0.9%) were based on trials with a quality of life (QoL) PEP, and 158 approvals (70.2%) were based on trials with other PEP (P = 0.01). FDA approvals were more common among industry funded-trials (219, 97.3%; P

Purpose: Various pathways and cytokines are implicated in pathogenesis of diabetic macular edema (DME). Computational imaging biomarkers (CIBs) of vessel tortuosity from ultra-widefield fluorescein angiography (UWFA) and texture patterns from OCT images have been associated with anti–vascular endothelial growth factor (VEGF) therapy treatment response in DME. This analysis was a radiogenomic assessment of the association between underlying cytokines, UWFA, and OCT-based DME CIBs. Design: Biclustering analysis based on UWFA and OCT CIBs to identify a common imaging phenotype across patients with subsequent assessment of underlying cytokine signatures and treatment response attributes. Participants: The IMAGINE DME study was a post hoc study of cytokine expressions that included 24 eyes with sufficient baseline aqueous humor samples and an in-depth assessment of the imaging studies obtained during the phase I/II DmeAntiVEgf study (DAVE) that measured different cytokine expressions. Methods: A total of 151 graph or morphologic features quantifying leakage shape, size, density, interobject distance, and architecture of leakage spots and 5 vessel tortuosity features were extracted from the baseline UWFA scans, and 494 texture-based radiomics features were extracted from each of the fluid and retinal tissue compartments of OCT images. Biclustering enables simultaneous clustering of patients and features and was used to aggregate patients in terms of their commonality of phenotypes (based on similar imaging attributes) and to identify commonality in terms of cytokine expression and treatment response to anti-VEGF therapy. Main Outcome Measures: Identification of eyes with similar imaging phenotypes to evaluate commonalities of patterns and underlying cytokine expression. Results: Strong correlations between VEGF and 7 UWFA leakage morphologic features (Pearson correlation coefficient [PCC], 0.45–0.51; P < 0.05), 1 vascular tortuosity-based UWFA feature (PCC, 0.45; P = 0.00016), and 2 OCT-derived intraretinal fluid texture features (PCC, 0.58–0.63; P < 0.05) were identified. Strong correlation between intraretinal fluid features and other cytokines (PCC, 0.41–0.59; P < 0.05) were also observed. Conclusions: This study identified groups of eyes with similar imaging phenotypes as defined by UWFA and OCT CIBs that demonstrated similar treatment response patterns and cytokine expression, including a strong association between VEGF with UWFA-derived leakage morphologic and vessel tortuosity features.

Excessive scar formation is a hallmark of localized and systemic fibrotic disorders. Despite extensive studies to define valid anti-fibrotic targets and develop effective therapeutics, progressive fibrosis remains a significant medical problem. Regardless of the injury type or location of wounded tissue, excessive production and accumulation of collagen-rich extracellular matrix is the common denominator of all fibrotic disorders. A long-standing dogma was that anti-fibrotic approaches should focus on overall intracellular processes that drive fibrotic scarring. Because of the poor outcomes of these approaches, scientific efforts now focus on regulating the extracellular components of fibrotic tissues. Crucial extracellular players include cellular receptors of matrix components, macromolecules that form the matrix architecture, auxiliary proteins that facilitate the formation of stiff scar tissue, matricellular proteins, and extracellular vesicles that modulate matrix homeostasis. This review summarizes studies targeting the extracellular aspects of fibrotic tissue synthesis, presents the rationale for these studies, and discusses the progress and limitations of current extracellular approaches to limit fibrotic healing.

Introduction: Tumor-related liver failure (TRLF) is the most common cause of death in patients with intrahepatic cholangiocarcinoma (ICC). Though we previously showed that liver radiotherapy (L-RT) for locally advanced ICC is associated with less frequent TRLF and longer overall survival (OS), the role of L-RT for patients with extrahepatic metastatic disease (M1) remains undefined. We sought to compare outcomes for M1 ICC patients treated with and without L-RT. Methods: We reviewed ICC patients found to have M1 disease at initial diagnosis at a single institution between 2010 and 2021 who received L-RT, matching them with an institutional cohort by propensity score and a National Cancer Database (NCDB) cohort by frequency technique. The median biologically effective dose (BED10) was 98 Gy (interquartile range [IQR] 80.5-97.9 Gy) for L-RT. Patients treated with other local therapies or supportive care alone were excluded. We analyzed survival with Cox proportional hazards modeling. Results: We identified 61 patients who received L-RT and 220 who received chemotherapy alone. At median follow up of 11 months after diagnosis, median OS was 9 months (95% confidence interval [CI] 8-11) and 21 months (CI 17-26) for patients receiving chemotherapy alone and L-RT, respectively. TRLF was the cause of death more often in the patients who received chemotherapy alone compared to those who received L-RT (82% vs. 47%; P=0.001). On multivariable propensity-score matched analysis, associations with lower risk of death included duration of upfront chemotherapy (hazard ratio [HR] 0.82; P=0.005) and receipt of L-RT (HR 0.40; P=0.002). The median OS from diagnosis for NCDB chemotherapy alone cohort was shorter than that of the institutional L-RT cohort (9 vs. 22 months; P

Background: Medical education in India always relied on the traditional classroom method of teaching. The current COVID pandemic brought a situation where online classes have taken precedence over the traditional classroom teaching. Here we attempt to see from the students' perspective whether online classes can replace the traditional classroom teaching. Aims and objectives: We aimed to study the advantages and disadvantages of online learning. Materials and methods: Online live streamed classes using Free Conference Call app were held in the Department of Anatomy, AIIMS Raipur. Live streaming, pre-recorded lecture videos were supplemented by cadaveric dissection videos, assignments etc posted in Google Classroom. Feedback regarding the online classes were obtained from first year undergraduate medical students using Google Forms. Results: A total of 72 students responded to the survey. 57 students used mobile phones to access the classes. 10 students preferred the online classes with chalk and board lecture, 23 students preferred lecture with PowerPoint presentation while the rest preferred online classes with chalk and board lecture followed by PowerPoint presentation. Out of the total (n=72) respondents, majority of them experienced technical issues which hampered their online learning experience. Owing to this reason, 43 students showed preference for pre-recorded videos over online live classes. 41.7% of the students opined that online classes should be included as a part of MBBS anatomy curriculum. Conclusion: Online learning in the form of live classes and recorded videos can be included as a part of routine Anatomy curriculum but it can never be a substitute for interactive face to face classroom learning and practical session.

Background: Globally, reverse shoulder arthroplasty (RSA) has moved away from the Grammont design to modern prosthesis designs. The purpose of this study was to provide a focused, updated systematic review for each of the most common complications of RSA by limiting each search to publications after 2010. In this part II, the following were examined: (1) instability, (2) humerus/glenoid fracture, (3) acromial/scapular spine fractures (AF/SSF), and (4) problems/miscellaneous. Methods: Four separate PubMed database searches were performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Overall, 137 studies for instability, 94 for humerus/glenoid fracture, 120 for AF/SSF, and 74 for problems/miscellaneous were included in each review, respectively. Univariate analysis was performed with chi-square and Fisher exact tests. Results: The Grammont design had a higher instability rate vs. all other designs combined (4.0%, 1.3%; P < .001), and the onlay humerus design had a lower rate than the lateralized glenoid design (0.9%, 2.0%; P = .02). The rate for intraoperative humerus fracture was 1.8%; intraoperative glenoid fracture, 0.3%; postoperative humerus fracture, 1.2%; and postoperative glenoid fracture, 0.1%. The rate of AF/SSF was 2.6% (371/14235). The rate for complex regional pain syndrome was 0.4%; deltoid injury, 0.1%; hematoma, 0.3%; and heterotopic ossification, 0.8%. Conclusions: Focused systematic reviews of recent literature with a large volume of shoulders demonstrate that using non-Grammont modern prosthesis designs, complications including instability, intraoperative humerus and glenoid fractures, and hematoma are significantly reduced compared with previous studies. As the indications continue to expand for RSA, it is imperative to accurately track the rate and types of complications in order to justify its cost and increased indications.

Background: Globally, reverse shoulder arthroplasty (RSA) has moved away from the Grammont design to modern prosthesis designs. The purpose of this 2-part study was to systematically review each of the most common complications of RSA, limiting each search to publications in 2010 or later. In this part (part I), we examined (1) scapular notching (SN), (2) periprosthetic infection (PJI), (3) mechanical failure (glenoid or humeral component), and (4) neurologic injury (NI). Methods: Four separate PubMed database searches were performed following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Overall, 113 studies on SN, 62 on PJI, 34 on mechanical failure, and 48 on NI were included in our reviews. Univariate analysis was performed with the χ2 or Fisher exact test. Results: The Grammont design had a higher SN rate vs. all other designs combined (42.5% vs. 12.3%, P < .001). The onlay humeral design had a lower rate than the lateralized glenoid design (10.5% vs. 14.8%, P < .001). The PJI rate was 2.4% for primary RSA and 2.6% for revision RSA. The incidence of glenoid and humeral component loosening was 2.3% and 1.4%, respectively. The Grammont design had an increased NI rate vs. all other designs combined (0.9% vs. 0.1%, P = .04). Conclusions: Focused systematic reviews of the recent literature with a large volume of RSAs demonstrate that with the use of non-Grammont modern prosthesis designs, complications including SN, PJI, glenoid component loosening, and NI are significantly reduced compared with previous studies. As the indications for RSA continue to expand, it is imperative to accurately track the rates and types of complications to justify its cost and increased indications.

Background The effects of aortic occlusion (AO) on brain injury are not well defined. We examined the impact of AO by resuscitative endovascular balloon occlusion of the aorta (REBOA) and resuscitative thoracotomy (RT) on outcomes in the setting of traumatic brain injury (TBI).Methods Patients sustaining TBI who underwent RT or REBOA in zone 1 (thoracic aorta) from September 2013 to December 2018 were identified. The indication for REBOA or RT was hemodynamic collapse due to hemorrhage below the diaphragm. Primary outcomes included mortality and systemic complications.Results 282 patients underwent REBOA or RT. Of these, 76 had mild TBI (40 REBOA, 36 RT) and 206 sustained severe TBI (107 REBOA, 99 RT). Overall, the mean (±SD) age was 42±17 years, with an Injury Severity Score (ISS) of 40±17 and mean systolic blood pressure (SBP) at the time of REBOA or RT of 81±34 mm Hg. REBOA patients had a mean SBP at the time of AO of 78.39±29.45 mm Hg, whereas RT patients had a mean SBP of 83.18±37.87 mm Hg at the time of AO (p=0.24). 55% had ongoing cardiopulmonary resuscitation (CPR) at the time of AO, and the in-hospital mortality was 86%. Binomial logistic regression controlling for TBI severity, age, ISS, SBP at the time of AO, crystalloid infusion, and CPR during AO demonstrated that the odds of mortality are 3.1 times higher for RT compared with REBOA. No significant differences were found in systemic complications between RT and REBOA.Discussion Patients with TBI who receive REBOA may have improved survival, but no difference in systemic complications, compared with patients who receive RT for the same indication. Although some patients are receiving RT prior to arrest for extrathoracic hemorrhagic shock, these results suggest that REBOA should be considered as an alternative to RT when RT is chosen for the sole purpose of resuscitation in the setting of TBI.Level of evidence 4.

Abstract Background The first live birth after uterus transplantation took place in Sweden in 2014. It was the first ever cure for absolute uterine factor infertility. We report the surgery, assisted reproduction, and pregnancy behind the first live birth after uterus transplantation in the Middle East, North Africa, and Turkey (MENAT) region. A 24-year old woman with congenital absence of the uterus underwent transplantation of the uterus donated by her 50-year-old multiparous mother. In vitro fertilization was performed to cryopreserve embryos. Both graft retrieval and transplantation were performed by laparotomy. Donor surgery included isolation of the uterus, together with major uterine arteries and veins on segments of the internal iliac vessels bilaterally, the round ligaments, and the sacrouterine ligaments, as well as with bladder peritoneum. Recipient surgery included preparation of the vaginal vault, end-to-side anastomosis to the external iliac arteries and veins on each side, and then fixation of the uterus. Results One in vitro fertilization cycle prior to transplantation resulted in 11 cryopreserved embryos. Surgical time of the donor was 608 min, and blood loss was 900 mL. Cold ischemia time was 85 min. Recipient surgical time was 363 min, and blood loss was 700 mL. Anastomosis time was 105 min. Hospital stay was 7 days for both patients. Ten months after the transplantation, one previously cryopreserved blastocyst was transferred which resulted in viable pregnancy, which proceeded normally (except for one episode of minor vaginal bleeding in the 1st trimester) until cesarean section at 35 + 1 weeks due to premature contractions and shortened cervix. A healthy girl (Apgar 9-10-10) weighing 2620 g was born in January 2020, and her development has been normal during the first 6 months. Conclusions This is the first report of a healthy live birth after uterus transplantation in the MENAT region. We hope that this will motivate further progress and additional clinical trials in this area in the Middle East Region, where the first uterus transplantation attempt ever, however unsuccessful, was performed already three decades ago.

Abstract Background This study aimed at detecting PfHRP2 and pLDH malaria antigens in urine and salivary specimens of suspected malaria patients using RDT kits, and identifying factors influencing the detection of these antigens. Methods Malaria rapid test kit (SD Bioline RDT kit) was used to detect malaria antigens, PfHRP2 and pLDH, in blood, urine and saliva samples received from patients suspected of malaria. Subsequently, malaria parasitaemia was determined. From the same patients, body temperature readings and haemoglobin concentrations were recorded. Also, micro-haematuria and saliva occult blood were determined. Relative to blood, the sensitivities and the performance of urine and saliva as alternative samples were evaluated. Results A total of 706 suspected malaria patients provided all three specimens. Prevalence of malaria by microscopy and RDT was 44.2% and 53.9%, respectively. Compared to blood, the sensitivities of urine and saliva were 35.2% and 57.0% respectively. Haemoglobin concentration 38.7 °C and occult blood influenced the detection of malaria antigens in both urine and saliva. Furthermore, the antigens were not detected in urine and saliva when parasitaemia was 60,000 parasites/µL and samples contaminated with blood.

Radiation therapy to treat cancer has evolved significantly since the discovery of x-rays. Yet, radiation therapy still has room for improvement in reducing side effects and improving control of cancer. Safer and more effective delivery of radiation has led us to novel techniques and use of biomaterials. Biomaterials in combination with radiation and chemotherapy have started to appear in pre-clinical explorations and clinical applications, with many more on the horizon. Biomaterials have revolutionized the field of diagnostic imaging, and now are being cultivated into the field of theranostics, combination therapy, and tissue protection. This review summarizes recent development of biomaterials in radiation therapy in several application areas.

Nutrients use efficiency of plants could be affected by the antagonistic or synergistic effects of two or more elements in the soil leading to decreased or increased yield. Field experiments were conducted in 2017 and 2018 cropping seasons at the Landmark University Teaching and Research farm, Omu-Aran, Nigeria, to determine the interaction between zinc (Zn) and phosphate (P) fertilizers on growth, yield, nutrient elements and some heavy metals composition of groundnut grown on an Alfisol. Treatments consisted of four levels of phosphorus (0, 40, 80 and 120 kg P ha-1) and three levels of zinc (0, 4 and 8 kg Zn ha-1). The experiment was laid out in a Randomized Complete Block Design (RCBD), replicated four times. The following parameters were taken: plant height, plant spread, total biomass, number of pods/plot, weight of pods/plot, number of seeds/plot, weight of seeds/plot. Laboratory analysis of some chemical constituents of groundnut seed was carried out to determine the nutrient and heavy metals composition. Results indicated that application of 8 kg Zn ha-1 and 120 kg P ha-1 had a synergistic effect on the growth parameters and antagonistic effect on the yield, yield parameters, some nutrient elements and beneficial heavy metals. Application of 8 kg Zn and 80 kg P ha-1 is therefore recommended on an Alfisol without necessarily increasing the concentration of non-beneficial heavy metals in groundnut seed.

Kinetic equilibrium reconstruction plays a vital role in the physical analysis of plasma stability and control in fusion tokamaks. However, the traditional approach is subjective and prone to human biases. To address this, the consistent automatic kinetic equilibrium reconstruction (CAKE) method was introduced, providing objective results. Nonetheless, its offline nature limits its application in real-time plasma control systems (PCSs). To address this limitation, we present RTCAKENN, a machine learning model that approximates 7 CAKE-level output profiles, namely pressure, inverse q , toroidal current density, electron temperature and density, carbon ion impurity temperature and rotation profiles, using real-time available inputs. The deep neural network consists of an encoder layer, where the scalars and interdependent inputs such as plasma boundary coordinates and motional Stark effect data are encoded using multi-layer perceptrons (MLPs), while profile inputs are encoded by 1D convolutional layers. The encoded data is passed through a MLP for latent feature extraction, before being decoded in the decoding layers, which consist of upsampling and convolutional layers. RTCAKENN has been implemented in the DIII-D PCS and our model achieves accuracy comparable to CAKE and surpasses existing real-time alternatives. Through clever dropout training, RTCAKENN exhibits robustness and can operate even in the absence of Thomson scattering data or charge exchange recombination data. It executes in under 8 ms in the real-time environment, enabling future application in real-time control and analysis.

Purpose: Patients with pancreatic cancer often receive radiation therapy before undergoing surgical resection. We compared the clinical outcomes differences between stereotactic body radiation therapy (SBRT) and 3-dimensional (3D)/intensity-modulated radiation therapy (IMRT). Methods and Materials: We retrospectively collected data from the University of Texas MD Anderson Cancer Center. Patients with borderline resectable/potentially resectable or locally advanced pancreatic cancer receiving neoadjuvant SBRT (median, 36.0 Gy/5fx), 3D conformal radiation (median, 50.4 Gy/28 fx) or IMRT (median, 50.4 Gy/28 fx) were included. Overall survival (OS) and progression-free survival were analyzed using Cox regression. Results: In total, 104 patients were included in our study. Fifty-seven patients (54.8%) were treated with SBRT, and 47 patients (45.2%) were treated with 3D/IMRT. Patients in the SBRT group were slightly older (median age: 70.3 vs 62.7 in the 3D/IMRT group). Both groups had similar proportions of patients with locally advanced pancreatic cancer (SBRT: 30, 52.6%; 3D/IMRT: 24, 51.1%). All patients were treated with chemotherapy. Patients in the SBRT group underwent more surgical resection compared with the 3D/IMRT group (38.6% vs 23.4%, respectively). At a median follow-up of 22 months, a total of 60 patients (57.7%) died: 25 (25/57, 43.9%) in the SBRT group, and 35 (35/47, 74.5%) in the 3D/IMRT group. Median OS was slightly higher in the SBRT group (29.6 months vs 24.1 months in the 3D/IMRT group). On multivariable Cox regression, the choice of radiation therapy technique was not associated with differences in OS (adjusted hazard ratios [aHR] = 0.5; 95% confidence interval [CI], 0.2%-1.3%, P = .18). Moreover, patients that underwent surgical resection had better OS (aHR = 0.3, 95% CI, 0.1%-0.8%, P = .01). Furthermore, progression-free survival was also similar between patients treated with SBRT and those treated with 3D/IMRT (aHR = 0.9, 95% CI, 0.5%-1.8%, P = .81) Conclusions: SBRT was associated with similar clinical outcomes compared with conventional radiation techniques, despite being delivered over a shorter period of time which would spare patients prolonged treatment burden. Future prospective data are still needed to better assess the role of SBRT in patients with pancreatic cancer.