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Cognitive relay network is a spectrum dynamic paradigm that exploits the unused portions of the licensed spectrum. This is based on merging both cooperative relaying techniques and cognitive radio network to achieve spectrum efficiency and enhance the overall system performance. In this paper, the presence of mobile users at the destination node is considered. Here, the end users can navigate at relatively fast vehicular velocities causing dynamic multipath fading and high Doppler shift. which can be fairly modeled using Nakagami-m fading channel (i.e., m < 1). In a spectrum scarcity environment, a secondary user must deploy an optimal power allocation policy to get higher transmission rates while the overall interference affecting the primary user (PU) is kept below a certain threshold value. In particular, the outage probability performance is studied over the mixed Rayleigh and Nakagami-m fading channels for different scenarios based on the statistical characteristics of signal-to-noise ratio. The first scenario is the cognitive dual hop amplify and forward relay network over independent and non-identical (i.n.i.d) distributed mixed fading channels. In the second scenario, the cognitive relay network consists of a single amplify and forward relay in addition to the direct link transmission with a selection combining at the destination over i.n.i.d distributed mixed fading channels. Numerical results are presented to evaluate the impact of the fading parameter, m, the maximum aggregated intrusion constraint, and the locations of the primary users (PUs) on different channel scenarios at high vehicular speeds.

Background Diabetes mellitus is a chronic progressive metabolic disorder characterized by high blood sugar affecting the whole body resulting in a significant impact on the quality of life for the patients and their families. Diabetes mellitus complications lead to morbidity, disability, and mortality and represent a serious global health issue threatening the health system worldwide and resulting in a critical economic impact for all countries, especially epidemic ones. Objective The objective of this study was to assess the level of knowledge and awareness regarding diabetic foot and related behaviour among diabetic patients and their relatives, as well as healthcare workers in Saudi Arabia. Methods A cross-sectional analytic study was conducted in 2022 on healthcare workers, diabetic patients, and their relatives above the age of 18 in Saudi Arabia by using a valid, pretested structured questionnaire. The collected data were analyzed using IBM SPSS Statistics for Windows, Version 26 (Released 2019; IBM Corp., Armonk, New York, United States). Results In this study, there was no correlation between the healthcare workers' attitude and knowledge. A total of 131 healthcare workers were involved, and a majority of them had good knowledge regarding the predisposing factors of diabetic foot ulcers, and 63 (48.1%) had good knowledge regarding diabetes foot care. On the other hand, there was poor knowledge regarding the characteristics and complications of diabetes ulcers. This study showed various attitudes among healthcare workers regarding diabetic ulcer care. For example, they prioritized the prevention of ulcers over treatment (N=67, 51.1%), the majority of healthcare workers were very keen to wound care (N=77, 58.8%), and they believed that it was their responsibility to educate their patients about reducing re-ulceration (N=86; 65.7%). However, 52 participants (39.7%) considered management of diabetic foot ulcer time-consuming, 54 (41.2%) mentioned that if they had the opportunity, they would like to avoid taking care of the diabetic wound, and 51 (38.9%) reported non-satisfaction with diabetic wound care. One hundred diabetic patients and 117 relatives also were involved, and only 41.3% of participants (patients and relatives) had good knowledge regarding diabetes mellitus. However, our findings also revealed that 91.65% of the participants had good knowledge and a favourable attitude towards diabetes mellitus and diabetic foot care. Nevertheless, even though the participants had good knowledge regarding foot care, they had poor practice, with 56.55% scoring poor on the assessment questionnaire. Conclusion Our study shows that most of the participants had good knowledge and attitudes but poor practices. This highlights the need for more efforts to educate the Saudi population about diabetes and its complications.

Objectives: Cardiac magnetic resonance (CMR) imaging is a key test in the diagnosis of cardiac amyloidosis (CA). Extracardiac involvement is common in light chain (AL) amyloidosis and MRI findings may assist in its diagnosis. We sought to investigate the utility of splenic CMR parameters for the diagnosis of CA. Methods: Thirty-four patients with AL amyloidosis and 32 patients with severe left ventricular hypertrophy in the setting of aortic stenosis (LVH-AS) who completed 3T cardiac MRI at the time of their diagnosis of AL or LVH-AS were assessed with T1, T2 (modified Look-Locker inversion recovery), extracellular volume (ECV) mapping, and late gadolinium enhancement (LGE) imaging of the heart and spleen. Results: Age, left ventricular mass index, wall thickness, ejection fraction, and splenic dimensions did not differ significantly between groups. All AL patients had cardiac involvement. T1 and T2 spleen mapping did not differ significantly between groups but AL patients had higher median ECV in the spleen than in LVH-AS (AL 46.9%, LVH-AS: 31%, p < 0.001), and significantly lower short tau inversion recovery ratio (AL: 1.7, LVH-AS: 2.7, p < 0.001) both with very good diagnostic performance to diagnose AL. We identified 16 AL patients with spleen involvement and 16 without. Spleen ECV and “normalized” spleen ratio, defined as the ratio of spleen LGE to muscle values exhibited strong correlation and had excellent diagnostic performance to discriminate those with spleen involvement. Conclusion: Our findings show that spleen CMR parameters can identify spleen involvement in AL patients and differentiate them from those without AL amyloidosis. © 2022, The Author(s).

Congenital heart diseases (CHD) are considered to be the second leading cause of death during infancy and childhood. However, due to advanced imaging techniques, more than 90% of children with complex CHD survive into adulthood, increasing the prevalence of CHD in the population. Tetralogy of Fallot (ToF) is considered to be the most common, complex, cyanotic CHD. Health is an important determinant of a patient's quality of life and this drove physicians to examine ToF patient's health related quality of life (HRQOL), in order to improve medical and surgical interventions. The purpose of this narrative review was to identify parameters derived through modalities, such as cardiovascular magnetic resonance, echocardiography and cardiopulmonary exercise testing and correlate them with repaired ToF (rToF) patient's perceived HRQOL. It is widely proven that rToF patients have worse physical capabilities than healthy population and this can be safely attributed to their cardiac condition. Unfortunately, rToF population is relatively small, making most of the included trials reliable and unable to uniformly agree to the same results. Further investigation is mandatory in order to discover those parameters that will allow physicians to better understand HRQOL in this population, leading to better medical management and rehabilitation. © 2022 Elsevier Inc.

Ligation of the left innominate vein (LIV) expands the surgeon’s surgical field for ascending aorta and aortic arch procedures. Although it is considered a safe technique by most surgeons in that it is associated with only minor drawbacks, conflicting views exist regarding this method. We herein describe a 70-year-old woman who underwent ascending aorta replacement due to an aneurysm with subsequent cerebral dysfunction caused by extended brain edema, possibly related to LIV ligation, leading to her death. © 2022 Tehran University of Medical Sciences.

Background Burnout is defined as a syndrome resulting from chronic workplace stress that has not been successfully managed. It is characterised by feelings of energy depletion or exhaustion, increased mental distance from one’s job and reduced professional efficacy. The COVID-19 pandemic has created unexpected demands on healthcare systems worldwide and they have experienced numerous stressors. As the coping is one of the stressors management strategies that may affect burnout, this is a descriptive cross-sectional study aimed to estimate the frequency and level of burnout and its association with coping strategies among physicians and nurses in Saudi Arabia during the COVID-19 Pandemic using Copenhagen Burnout Inventory and Brief-COPE. Results Overall, 403 healthcare providers were recruited (85 physicians, 318 nurses). Personal, work-related and client-related burnout were detected among 67.5%, 68% and 58.3% of the respondents, respectively. The mean score for adaptive coping was (27.6 ± 10.3, median: 29 IQR: 14.0) out of 48, and the mean score for maladaptive coping was (14.2 ± 6.81, median: 14 IQR: 8.0) out of 36. Some factors associated with burnout were participants’ age group, professional position, number of family members and years of experience in the medical field. The personal, work-related and client-related burnout had inverse correlations with the overall adaptive coping category. Conclusion The frequency of burnout during the COVID-19 pandemic, particularly among nurses, was significant. Burnout was also frequent among both the younger age group and those with fewer years of experience. Some predictors were identified as having a close person infected with COVID-19, being assigned to treat COVID-19 patients, longer working hours, having sleeping hours affected by the pandemic and experiencing verbal or physical abuse from patients. In addition to a significant correlation between the adaptive coping category and the three burnout dimensions.

Over the last few years, the number of precision farming projects has increased specifically in harvesting robots and many of which have made continued progress from identifying crops to grasping the desired fruit or vegetable. One of the most common issues found in precision farming projects is that successful application is heavily dependent not just on identifying the fruit but also on ensuring that localisation allows for accurate navigation. These issues become significant factors when the robot is not operating in a prearranged environment, or when vegetation becomes too thick, thus covering crop. Moreover, running a state-of-the-art deep learning algorithm on an embedded platform is also very challenging, resulting most of the times in low frame rates. This paper proposes using the You Only Look Once version 3 (YOLOv3) Convo-lutional Neural Network (CNN) in combination with utilising image processing techniques for the application of precision farming robots targeting strawberry detection, accelerated on a heterogeneous multiprocessor platform. The results show a performance acceleration by five times when implemented on a Field-Programmable Gate Array (FPGA) when compared with the same algorithm running on the processor side with an accuracy of 78.3% over the test set comprised of 146 images.

Despite a number of attempts over the past two decades, research into reliable, controlled induction of long term evoked responses, mimicking low level learning and memory in dissociated cell cultures remains challenging. In addition, a full understanding of the stimulus-response relationships that underlie synaptic plasticity has not yet been achieved, and many of the underlying principles remain largely unknown. Plasticity studies have been predominantly limited to low density Multi/Micro Electrode Arrays (MEAs). With the advent of complementary metal-oxide-semiconductor (CMOS) based High-Density (HD) MEAs, unprecedented spatial and temporal resolution is now possible. In this thesis, an attempt to bridge the gap between studies of neural plasticity and the use of CMOS based HD-MEAs with thousands of electrodes, is reported. Additionally, since such HD-MEAs generate a large volume of data and require advanced analytics to efficiently process and analyse recordings, computational tools and novel algorithms to infer connectivity during plasticity have been developed. \ud \ud The study showed that the responsiveness, stability and initial firing rate of neuronal cultures are the deciding factors to reliably induce evoked responses. With multi-site stimulation, sustained long term potentiation was achieved, which was validated both by evoked response plots and overall firing rates measured at five different time points - before and after repeated stimulation, and at a three day time points. In contrast, while depression responses were observed, it was found that the effects were not sustained over many days. The findings of the study suggest that appropriate selection of neuronal cultures is crucial for inducing desired evoked responses and criteria for this have been developed. Furthermore, it is concluded that the initial responses to test stimuli can be used to determine whether potentiated or depressed responses are to be expected. \ud \ud To analyse the recordings, pipeline of computational tools was developed. Firstly, neuronal synchrony metrics were adapted for the first time for large HD-MEA recordings and shown to correspond effectively to the firing dynamics. To analyse functional connectivity, an information theoretic approach, Transfer Entropy(TE), was utilised. The method showed accurate estimation of functional connectivity with mid 80th percentile accuracy on simulated data. A superimposition method was proposed to enhance confidence in the connectivity estimation. To statistically evaluate connectivity estimation, a new surrogate method, based on ISI distribution approach, was proposed and validated with a simulated Izhikevich network. The method achieved improved accuracy, compared to the existing ISI shuffling method. This newly developed method was later utilised to infer connectivity and refine connections during the learning process of real neuronal cultures over many days of stimulation. The connectivity inference corresponded accurately to both the spontaneous and stimulated networks during evoked responses and the proposed method permitted observation of the evolution of connections for the potentiated network.

Disseminated intravascular coagulopathy (DIC) is a very rare outcome post endovascular repair of aortic aneurysm dissections. We present a case of a 70-year-old male who presented with DIC post a thoracic endovascular aortic repair (TEVAR) procedure due to a type 1A endoleak. Initially, the patient was treated with red blood cells and blood products; however, when failing to improve, he underwent a hybrid arch replacement. In this study, we will analyze the management of DIC post TEVAR and look at its presentation more extensively, as it is currently a topic that is poorly studied. © 2020 Wiley Periodicals LLC

Nowadays cellulite, or gynoid lipodystrophy (GLD) is the most concerning and displeasing skin problem. It is a condition in which the skin appears dimpled, bumpy and "orange peel-like." It's caused by changes in the structure of the connective tissues and fat cells that lie underneath the skin's surface [1]. This article aimed at reviewing the classification, pathophysiology and treatment in general, as well as the management of cellulite with non-invasive body countering.

Noninvasive skin tightening is a technology done to lift the skin without even minimal penetration to skin layers. Therefore, cosmetic surgeons can effectively tighten moderately lax or creepy skin on the face, neck, and body, helping patients improve their appearance without surgical intervention. It works on stimulating collagen reproduction by inducing heat to the deep layers of the skin. There are two types of skin tightening technology; MFU (Microfocused ultrasound) and Non-Ablative Radiofrequency. This article focus on MFU, its efficacy, safety, complication and patients who are suitable for MFU.

In this paper, an upper bound expression of the outage probability (OP) under interference power constraint is derived for cognitive amplify-and-forward (AF) relay network with best relay selection (BRS) scheme. In the proposed model, the destination moves at high speed, more than 100km/h and the channels that connected with destination are modeled as Nakagami-m fading channels, m < 1 whereas the other communication links are modeled by Rayleigh distribution. Analytical results are presented to evaluate the impact of the number of secondary relays, primary user (PU) location, and the severity parameter m on the performance of the cognitive relay network. Analytical results show that the Nakagami-m fading model can more accurately model conditions in vehicular environment.

In this paper, closed form outage probability is derived for cognitive amplify-and-forward (AF) relaying system in a spectrum sharing environment for a moving end mobile users. The end users can move at high vehicular speeds which cause dynamic multipath fading and a high Doppler shift. The transmit power of the secondary network is governed by the maximum interference power that the primary network's receiver can tolerate. In the proposed model, the channel between relay to destination is modeled as Nakagami-m fading channel, m < 1 that is most suitable for modeling channel fading at high mobility scenarios whereas the other communication links are modeled by Rayleigh distribution. The impact of the PU location on the OP performance is studied also.

During the past two and a half decades, community-based conservation has been introduced in Nepal under the influence of global biodiversity and conservation policies. This develop - ment was spurred by the emergence of ‘Indigenous Peoples’ and Community Conserved Territories and Areas (ICCA)’ (see Dudley, 2008; Borrini-Feyerabend et al., 2010; IUCN/ CEESP, 2010) and urged to take actions for the recognition and promotion of Sacred Natural Sites (SNS) (see Schaaf, 2003; Wild and McLeod, 2008; Verschuuren et al., 2010). Both gained legitimacy through various international decisions and programmes that helped create the legal foundations for the recognition of diverse conservation practices in Nepal (see IUCN, 2003a, 2003b, 2004, 2008a, 2008b, 2012, CBD, 2004, 2009, 2010).