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Introduction: Obstructive shock results from reduced cardiac output due to physical blockage of blood flow, such as cardiac tamponade. Cardiac tamponade compresses cardiac chambers, particularly the left atrium, causing decreased end-diastolic volume and cardiac output. Rapid fluid accumulation within the pericardial sac is the usual cause. Transesophageal echocardiography provides clearer visualization of these structures than transthoracic ultrasound. This case underlines the impact of esophageal pathology on cardiac output and highlights ultrasound’s dynamic diagnostic utility alongside computed tomography. Case Report: A 64-year-old female with a history of colon cancer and peritoneal metastases status post colostomy presented with altered mental status and urinary symptoms. Laboratory evaluation was notable for leukopenia, hypoglycemia, elevated ammonia, and an abnormal urinalysis that was positive for urinary tract infection. She was initially admitted to the internal medicine service for sepsis secondary to urine as the source of infection. During her hospital stay, she developed hypotension, tachypnea, tachycardia, and complained of chest pressure. Point-of-care echocardiogram revealed compression of the left atrium by distended gastric and esophageal contents. A nasogastric tube was placed and suctioned partially digested food and liquid with improvement of her condition. Follow-up ultrasound showed improvement of compression and cardiac function. Conclusion: In evaluation of acute shock, multiple etiologies must be considered. In this case, the cause of reduced cardiac output was direct compression of the left atrium from an adjacent structure. Even with direct visualization and imaging, immediate history and patient-centered approach are still useful to complete the clinical picture and treat the reversible cause of undifferentiated shock.

Introduction: Osteomyelitis can occur at various osseous locations and commonly presents in the emergency department (ED). The incidence of osteomyelitis is 21.8 cases per 100,000 persons annually.1 Hematogenous osteomyelitis typically occurs in the vertebrae; however, it may seldomly occur in the manubrium. Hematogenous osteomyelitis can be seen in patients with complicated thoracic surgery, radiation, fracture, diabetes, immunosuppression, steroid therapy, and malnutrition.2 Because signs and symptoms of osteomyelitis may be nonspecific, clinicians must have high suspicion based on history and physical. Workup should include identifying the source, imaging, and surgical cultures.Case Report: A 60-year-old male with hypertension and diabetes presented with atraumatic right shoulder and chest pain. The patient presented twice to the ED for clavicle pain five days prior. Computed tomography (CT) of the chest detected osseous infection of the manubrium and upper sternum, right clavicle, and mediastinal phlegmon. A CT of the abdomen and pelvis revealed osteomyelitis and discitis of the 12th thoracic and first lumbar vertebral body with gas at the psoas muscle, as well as sigmoid diverticulitis with colovesicular fistula. The patient was started on broad spectrum antibiotics and 1,500 milliliters of lactated Ringer’s in the ED. After evaluation by cardiothoracic surgery, the patient was taken to the operating room for neck exploration, incision/drainage, manubriectomy, and right sternoclavicular joint resection. Surgical, blood, urine, and respiratory cultures grew Klebsiella pneumoniae. After a 34-day hospital course, the patient was discharged on two weeks of oral levofloxacin and follow-up appointments with cardiothoracic surgery and infectious disease. The patient had good prognosis and recovery.Conclusion: Hematogenous osteomyelitis to the manubrium is rare and may present with only chest pain. It is important to consider other sources that seed in the manubrium and imaging to evaluate multisite infection. Treatment should include intravenous antibiotics and/or surgical intervention for debridement with washout or manubriectomy.

Solid oxide fuel cells (SOFCs) are efficient electrochemical energy device that converts the chemical energy of fuels directly into electricity. It has a high power and energy density and a sustainable source of energy. The electrode (cathode and anode) materials are essential for the efficient operation of SOFCs. Several electrode materials have been studied in the last two decades, mainly perovskite materials. The investigated materials have resulted in improved electrochemical performance of SOFCs, increased commercial viability, and reduced operational costs. However, the sustainability of most of the material compositions (heteroatoms) used as electrodes in SOFCs has never been investigated. The present study examines the recent progress, challenges, and constraints associated with electrode material development in SOFCs from a sustainable perspective. Heteroatoms majorly employed for doping in electrode materials’ long-term availability on the earth’s surface was established. The study also provides an overview on the current state of electrode materials development for symmetrical solid oxide fuel cells. This is intended to address the complexities of different materials development for the anode and cathode.

Introduction: Obstructive shock results from reduced cardiac output due to physical blockage of blood flow, such as cardiac tamponade. Cardiac tamponade compresses cardiac chambers, particularly the left atrium, causing decreased end-diastolic volume and cardiac output. Rapid fluid accumulation within the pericardial sac is the usual cause. Transesophageal echocardiography provides clearer visualization of these structures than transthoracic ultrasound. This case underlines the impact of esophageal pathology on cardiac output and highlights ultrasound’s dynamic diagnostic utility alongside computed tomography. Case Report: A 64-year-old female with a history of colon cancer and peritoneal metastases status post colostomy presented with altered mental status and urinary symptoms. Laboratory evaluation was notable for leukopenia, hypoglycemia, elevated ammonia, and an abnormal urinalysis that was positive for urinary tract infection. She was initially admitted to the internal medicine service for sepsis secondary to urine as the source of infection. During her hospital stay, she developed hypotension, tachypnea, tachycardia, and complained of chest pressure. Point-of-care echocardiogram revealed compression of the left atrium by distended gastric and esophageal contents. A nasogastric tube was placed and suctioned partially digested food and liquid with improvement of her condition. Follow-up ultrasound showed improvement of compression and cardiac function. Conclusion: In evaluation of acute shock, multiple etiologies must be considered. In this case, the cause of reduced cardiac output was direct compression of the left atrium from an adjacent structure. Even with direct visualization and imaging, immediate history and patient-centered approach are still useful to complete the clinical picture and treat the reversible cause of undifferentiated shock.

Purpose – This study aims to evaluate the current educational opportunities available to hermaphrodite (Hijra) students, analyze their difficulties while pursuing academic degrees and suggest potential approaches to address these issues. Design/methodology/approach – This research used a qualitative method to analyze the challenges Hijra individuals face in pursuing education. A total of 20 interviews were conducted with two Hijra groups those who are pursuing an education and those who have abandoned it to collect primary data. The purposive sampling technique was used to identify and choose diverse sources of information. Moreover, the phenomena have been comprehended using the Access Theory and the Gender Stratification Theory. Findings – The findings show that although every Bangladeshi has the right to a decent education, few Hijra youngsters attend schools. Numerous barriers, such as discriminatory views and remarks about third-gender people, physical and mental harassment, a lack of emotional and financial support, family issues, discrimination in the school community and hostility from classmates and teachers, make it difficult for hermaphrodite students to receive a proper education. Originality/value – This research paper fills a gap in the current body of knowledge by presenting empirical evidence regarding young people’s perceptions of the third-gender, the societal barriers faced by Hijra individuals in their pursuit of quality education, their future opportunities, the root causes of these challenges and possible solutions.

Recently, a unique extension of fuzzy sets known as hesitant fuzzy sets has been established to address hesitant cases that previous methods were unable to manage adequately. In this paper, the triangular hesitant fuzzy sets approach has been employed to explore the inherent uncertainty within the parameters of the life distribution. Two essential reliability measures, triangular hesitant fuzzy reliability and the hazard rate function designed for the Pareto Type I life distribution, have been established. Moreover, the triangular hesitant fuzzy reliability measure is utilized to assess the reliability of series and parallel systems. Furthermore, the weighted averaging operator has been used on both the series and parallel systems, making them more reliable and giving much better results than hesitant fuzzy sets. Finally, a numerical example demonstrating the use of these techniques is provided, and the results are presented in tabular and graphical formats.

We are introducing cost effective, easily available brick sand nano-particles (BSNP) (44.208 nm) as an adsorbent in batch process for removal of heavy toxic metals such as Pb, Cd, and Cr from aqueous solution. We used two types of adsorbents, one is acid treated BSNP and other one is untreated BSNP, and investigated adsorbent properties with function of contact time, temperature, and pH. The efficiency or performance of adsorbent was characterized by AAS for percentage of removal from solution, EDS for elemental analysis to confirm the metals adsorption. The Langmuir, Freundlich, Temkin, Hill De Boer, Elovich, and Redlich-Peterson adsorption isotherms were studies to find out the quality of the adsorbent. At 5.68 to 7.6 pH, the maximum removal percentages of Pb, Cd, and Cr were 97% from the aqueous solution. The temperatures at 40℃ to 60℃, the Pb, Cd, and Cr experiments were carried out at their highest possible percentages (98%). The reaction process was pseudo-second order model and several thermodynamic factors, including Intraparticle diffusion, Elovich kinetic model, Boyd kinetic model, activation energy, Gibbs free energy, enthalpy change, and entropy change ensured the adsorbent efficiency of brick sand nanoparticles. The results of present research indicated that Brick Sand Nano-Particles (BSNP) may play a vital role as a cost-effective, efficient, and easily available adsorbent for the removal of Pb, Cd, and Cr from wastewater.

Chinese herbal formula (CHF) has the potential to improve the performance of aged laying hens through integrated regulation of various physiological functions. The present study aimed to investigate the effects of dietary CHF supplementation on the yolk fatty acid profile in aged laying hens. A total of 144 healthy 307-day-old Xinyang black-feather laying hens were randomly allocated into two groups: a control group (CON, fed a basal diet) and a CHF group (fed a basal diet supplemented with 1% CHF; contained 0.30% Leonurus japonicus Houtt., 0.20% Salvia miltiorrhiza Bge., 0.25% Ligustrum lucidum Ait., and 0.25% Taraxacum mongolicum Hand.-Mazz. for 120 days). The fatty acid concentrations in egg yolks were analyzed using a targeted metabolomics technology at days 60 and 120 of the trial. The results showed that dietary CHF supplementation increased (p

This study evaluates the effects of dietary Chinese herb ultrafine powder (CHUP) supplementation in late-phase laying hens on the quality and nutritional values of eggs. A total of 576 Xinyang black-feather laying hens (300-day-old) were randomly allocated into eight groups for a 120-day feeding trial. Each group contained eight replicates with nine hens per replicate. The experimental groups included the control (basal diet) and different levels of CHUP groups (details in ‘Materials and methods’). The results showed that the eggshell strength was increased (p