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Abstract The disease dynamics affect the human life. When one person is affected with a disease and if it is not treated well, it can weaken the immune system of the body. Human Immunodeficiency Virus (HIV) is a virus that attacks the immune system, of the body which is the defense line against diseases. If it is not treated well then HIV progresses to its advanced stages and it is known as Acquired Immunodeficiency Syndrome (AIDS). HIV is typically a disease that can transferred from one person to another in several ways such as through blood, breastfeeding, sharing needles or syringes, and many others. So, the need of the hour is to consider such important disease dynamics and that will help mankind to save them from such severe disease. For the said purpose the reaction-diffusion HIV CD4 $$^{+}$$ + T cell model with drug therapy under the stochastic environment is considered. The underlying model is numerically investigated with two time-efficient schemes and the effects of various parameters used in the model are analyzed and explained in a real-life scenario. Additionally, the obtained results will help the decision-makers to avoid such diseases. The random version of the HIV model is numerically investigated under the influence of time noise in It $${\hat{o}}$$ o ^ sense. The proposed stochastic backward Euler (SBE) scheme and proposed stochastic Implicit finite difference (SIFD) scheme are developed for the computational study of the underlying model. The consistency of the schemes is proven in the mean square sense and the given system of equations is compatible with both schemes. The stability analysis proves that both schemes and schemes are unconditionally stable. The given system of equations has two equilibria, one is disease-free equilibrium (DFE) and the other is endemic equilibrium. The simulations are drawn for the different values of the parameters. The proposed SBE scheme showed the convergent behavior towards the equilibria for the given values of the parameters but also showed negative behavior that is not biological. The proposed SIFD scheme showed better results as compared with the stochastic SBE scheme. This scheme has convergent and positive behavior towards the equilibria points for the given values of the parameters. The effect of various parameters is also analyzed. Simulations are drawn to evaluate the efficacy of the schemes.

الملخص: أهداف البحث: شهد نظام الرعاية الصحية في المملكة العربية السعودية تحولات كبيرة كجزء من رؤية 2030. وكجزء من هذا التحول، تم تنفيذ نظام الوصفات الطبية الإلكتروني (وصفتي) لتمكين المرضى من تلقي الوصفات الطبية من صيدليات المجتمع. قامت هذه الدراسة بتقييم رضى المرضى عن خدمات صيدليات المجتمع ونظام وصفتي. طرق البحث: استخدمت دراسة رصدية مقطعية بيانات موجودة من برنامج تجربة المرضى التابع لوزارة الصحة السعودية. تم جمع البيانات من مرضى أعمارهم أكبر من 15 سنة، والذين زاروا مراكز الرعاية الأولية الحكومية خلال النصف الأول من عام 2022. وتم إجراء إحصاءات تلخيصية، وتحليلات الانحدار اللوجستي متعدد المتغيرات، لتقييم ومقارنة الرضى بين مجموعات المرضى. النتائج: شملت العينة 66,541 مريضاُ. وكان أكثر من 70% من المرضى راضين عن خدمات صيدليات المجتمع ونظام وصفتي. أظهر التقدم في السن والإناث ارتباطا إيجابيًا بالرضى عن العديد من الخدمات. في حين أظهر المرضى الذين زاروا العيادات الوقائية احتمالات أعلى للرضى عن توافر الأدوية ووقت الانتظار، بينما كان مرضى عيادات الأمراض المزمنة أقل رضى عن توافر الأدوية. كان لدى المرضى السعوديين احتمالات أقل للرضى عن الخدمات المتعددة. الاستنتاجات: قد تشير مستويات الرضى المرتفعة بشكل عام بين المرضى إلى نجاح نظام وصفتي في تلبية احتياجات المرضى وتوقعاتهم. ومع ذلك، لا تزال هناك مجالات للتحسين لزيادة رضى المرضى، مثل معالجة نقص الأدوية وضمان التواصل الواضح بين المريض والصيدلي. تسلط النتائج الضوء على أهمية المراقبة والتقييم المستمرة لدعم تجربة المريض مع خدمات الصيدلة التي قد تحسن تجربة∖رحلة المريض، والالتزام بالدواء، ونتائج الرعاية الصحية الشاملة. Abstract: Introduction: The healthcare system in KSA has been substantially transformed as part of Vision 2030, including implementation of an electronic prescribing system, called Wasfaty, to enable patients to receive their prescriptions from community pharmacies (CPs). This study assessed patient satisfaction with CPs and the Wasfaty system. Methods: This cross-sectional observational study used existing data from the Saudi Ministry of Health's patient experience program. Data were collected from patients (≥15 years of age) visiting governmental primary care clinics in 2022. Summary statistics were determined and multivariable logistic regression analyses were conducted. Results: The sample included 66,541 patients. More than 70% of patients were satisfied with the services of the CPs and the Wasfaty system. Being older and being female consistently showed a positive association with satisfaction across several services. Whereas patients in preventive clinics had higher odds of satisfaction with medication availability (OR: 1.19, 95% CI: 1.03–1.37) and waiting time (OR: 1.23; 95% CI: 1.03–1.47), patients in chronic disease clinics had lower satisfaction with medication availability (OR: 0.92, 95% CI: 0.85–0.99). Saudi patients had lower odds of being satisfied with multiple services. Conclusions: The overall high satisfaction among patients suggested the success of the Wasfaty system in meeting patient needs and expectations. However, areas for improvement exist to increase patient satisfaction, such as addressing medication shortages and ensuring clear patient–pharmacist communication. The results highlight the importance of continued monitoring and evaluation to support the patient experience with pharmacy services, and to improve patients' journeys, medication adherence, and overall healthcare outcomes.

Badan Meteorologi, Klimatologi, and Geofisika (BMKG): For weather and climate observations, the Meteorology, Climatology, and Geophysics Agency operates 1,285 digital and automated instruments across Indonesia. These instruments need regular calibration as required by Law No. 31 of 2009 on Meteorology, Climatology, and Geophysics. BMKG maintains a calibration laboratorylaboratory in Medan, North Sumatra, complying with ISO/IEC 17025:2017 standards, which ensure the quality of measChamber inhomogeneity, which affects temperature stability, is an important factor in calibration. ibration. To address this, a study designed an IoT-based temperature monitoring system using nine DHT22 sensors to measure chamber temperature inhomogeneity. The IoT system measured an inhomogeneity value of 0.9 0.9 °C, matching standard results using Aqara sensors. The designed system measured inhomogeneity at 0°C through the T6 sensor, while the standard system did so at 2°C with the Aqara 6 sensor, both placed consistently in the upper left rear section. The IoT system improved efficiency, offering real-time monitoring via the ThinkSpeak platform and reducing sampling time to 20 seconds from the standard 30 minutes.

The application of nanofluids in heat transfer systems is widely recognized for enhancing thermal efficiency compared to conventional fluids, representing a pivotal advancement in energy-saving strategies across a range of commercial applications. However, the selection of nanofluid concentration often lacks a systematic approach, with decisions made independently of specific application requirements, type of nanofluid, cost considerations, and economic factors such as energy cost and system lifetime. This article explores the optimization of nanoparticle concentrations in the immersion cooling system of a data center server, utilizing three distinct nanofluids (Al₂O₃-water, TiO₂-water, and CuO-water). The Iceotope immersion cooling designs were examined across various flow conditions. The investigation involved calculating heat transfer rates and pressure drops through the server by simulating a model using Computational Fluid Dynamics (CFD), Finite Element (FE), and COMSOL Multiphysics® Modeling software for varying volume fractions of nanoparticles. The study proposes a novel methodology to assess potential economic trade-offs associated with nanofluid utilization in immersed liquid-cooled data centers. This approach aims to identify the lowest overall cost within the data center and the maximum viable volume fraction of a nanofluid. Results indicate that Al2O3-water nanofluid exhibits superior thermal efficiency due to its higher thermal conductivity, while TiO₂-water and CuO-water are evaluated for comparative performance. However, it also presents challenges, such as higher viscosity leading to increased pressure drop and pumping costs. Economic considerations reveal that, despite its thermal advantages, the most cost-effective fluid is the conventional fluid (pure water). The server incurs a cost of $706.15. These findings underscore the importance of considering both thermal performance and economic factors when determining the optimal nanofluid concentration for practical application.

Rice is a major cereal crop which ensure food security to more than half of the global population. Several biotic factors impact rice grain quality and its final production. White stripe disease, caused by pathogen Stenotrophomonas maltophilia is considered among the major limiting factor for reducing rice yields and quality. Present study was performed to understand the white stripe disease, which has been frequently misdiagnosed as bacterial leaf blight (BLB) due to similar symptoms. A survey was carried out based on accessibility and farmer participation to monitor incidence and sample collection. The survey was conducted in districts Faisalabad, Gujranwala, Sialkot, Sheikhupura, and Hafizabad, these districts were selected for their importance for rice cultivation in Pakistan. The total sample size was around 500 leaves distributed evenly throughout each study area. The results of study indicated presence of new pathogen of rice. These isolates were biochemically identified and confirmed by gram staining negative, 3% KOH positive, 5% salt tolerance positive, oxidase test negative, catalase test positive, starch hydrolysis test negative, nitrate reductase test positive, indole test negative, lactose test positive, maltose test positive, methyl red test negative, Voges-prokauer test negative and urea hydrolysis test negative. The pathogenicity test was confirmed that pathogen and the Sialkot isolate were the most aggressive isolate among the five isolates collected form the studied areas. The molecular characterization was accomplished by PCR and sequencing. The results of the phylogenetic study indicate that this pathogen belongs to a distinct group, as it is distantly related to Xanthomonas oryzae pv. oryzae (Xoo). This study provides important findings into a novel clade of pathogen causing white stripe disease in rice.

Abstract Background Intracranial hemorrhage accounts for 10–20% of stroke etiologies annually. Basal ganglia is the most common site for intracranial hemorrhage accounting for 50% of all cases. Bilateral spontaneous basal ganglia hemorrhages (BGH) are rare with few reported cases. Case presentation We report an unusual case of a 69-year-old female who presented with a spontaneous bilateral basal ganglia hemorrhage secondary to a right BGH with contralateral extension through the anterior commissure (AC) utilizing the Canal of Gratiolet. Clinical course and imaging findings are discussed. Conclusions To our knowledge, this is the first case to specifically detail the extension of spontaneous hemorrhage across the AC via the Canal of Gratiolet, and imaging findings provide a novel depiction of AC anatomy and fiber distribution in a clinical context. These findings may explain the mechanism behind this rare clinical entity.

Introduction There is increasing literature to support the efficacy of middle meningeal artery (MMA) embolization in the treatment of chronic subdural hematomas (cSDH). Techniques for optimal embolization of the MMA are yet to be elucidated. We hypothesized utilization of a novel 046” intermediate catheter within the proximal MMA trunk carry procedural advantages for multiple pedicle embolizations and ease of navigation to distal MMA vasculature. Methods We retrospectively reviewed and analyzed a prospectively maintained IRB‐approved database of the senior authors. Results Twenty‐one (21) consecutive cases of Vecta46 utilization with MMA embolization were identified (2023), in patients 69±13 years (range 49‐83 years), 4 (19%) women. Four (19%) patients were on antiplatelet/anticoagulants. At presentation, recurrent cSDH in 9 patients (43%) were previously managed with burr holes (n=2, 22%), craniotomy (n=3, 33%), or without drainage (n=4, 44%). Average admission cSDH thickness was 8.8±1.6mm, midline shift of 3±0.7mm. Access was performed through a 5‐ or 6‐French arteriotomy. Both anterior and posterior MMA branches were embolized in 16 (76%) cases, and adjunctive coiling of the proximal MMA trunk was performed in all cases. Vecta46 was successfully placed in the proximal MMA trunk in all cases. There were no vessel irregularities, vasospasm, or dissection noted along the course of the MMA Vecta46 placement. No immediate procedural complications were noted and all cases achieved complete distal MMA occlusion. Figure 1: (A) Ophthalmic (black) and petrous (white) collaterals off the anterior and posterior MMA branches, respectively. (B) Contralateral (green) and falx (orange) penetration of the MMA branches. (C) Proximal coiling of the anterior and posterior MMA branches (black). Conclusion The Vecta46 intermediate catheter is a powerful tool for MMA embolization that allows the safe and effective placement of an intermediate catheter in the proximal MMA trunk. This allows for simple catheter exchange for multiple liquid embolic pedicle embolizations and significant support for navigating microcatheters to distal MMA branches.

Introduction Middle meningeal artery (MMA) embolization for the treatment of chronic subdural hematomas (cSDH) is becoming an alternative to surgical intervention. Recent literature suggests distal embolic penetration beyond visible MMA branches achieves optimal cSDH devascularization. Here, we report the mid‐term radiographic follow‐up of a hyper‐dilution glue technique for enhanced embolization of non‐visible dural vasculature. Methods A prospectively maintained IRB‐approved institutional database of the senior authors was retrospectively reviewed to identify and analyze cSDHs managed with 10:1 glue hyper‐dilution (TRUFILLTM n‐BCA liquid embolic) paradigm. Results Over a 5‐month study period (September 2022 to February 2023), 46 cases of 10:1 glue hyper‐dilution for MMA embolization were identified in 23 patients. 56% of the cases were female with an average age of 70±1.59 years. Average admission cSDH thickness was 9.3±0.8 mm with an average midline shift of 3.5±0.5 mm. Bilateral embolization was performed in 91% (n=21) of patients. Technical success was achieved in all cases without need for periprocedural rescue surgery. One postprocedural complication (2.2%), a unilateral partial facial nerve palsy (House‐Brackmann 2), was identified. All patients were discharged at their mRS baseline. Nine patients (40%) had radiographic follow‐up (mean 42±6.7 days; range 1 to 194 days). Complete resolution of the cSDH was achieved in 67% of those with follow‐up imaging (n=9) cases. In those with residual cSDH, average followup thickness was 7.2±0.8mm. Conclusion Mid‐term radiographic results of 10:1 glue hyper‐dilution for MMA embolization for enhanced non‐visible dural vasculature demonstrates a favorable safety profile compatible with the literature and encouraging resolution of cSDH. Further follow‐up and comparative studies are warranted.

Introduction The latest FDA‐approved intermediate guide catheter, Vecta46, allows for a unique, mini‐triaxial access platform. The size of this catheter allows for 058” guide compatibility, intraluminal accommodation of an 027” microcatheter for flow diverter delivery, and angiographic procedural injections in an 070” guide catheter. Methods We retrospectively identified and analyzed patients who underwent Surpass Evolve flow diversion treatment utilizing the Vecta46 across the senior authors’ institutions. Results The use of the Vecta46 was identified for treatment of 9 aneurysms treated with the Surpass Evolve Flow Diverter (March to April 2023), in patient’s aged 61±3.5 years (range 40‐74 years) with 89% (n=8) female. Aneurysm average size of 4.3±0.47mm, aneurysms originating along the internal carotid artery (n=6) and MCA branches (n=4). Preoperative PRU measured 92 ± 21. Radial access was utilized in 2 cases. Mean Surpass Evolve utilized was 4.4±0.17mm (diameter) by 15.7±0.88mm (length). An 071” guide catheter (Armadillo, Q’Appel Medical) was used in 8 cases. Vecta46 was safely navigated to the supraclinoid ICA segment in all cases. Average fluoroscopy time was 24±3.1 minutes, radiation exposure was 756±259mGy, and verapamil was used in all cases. Technical success was achieved in all cases with adequate vessel wall apposition verified. There were no hemorrhagic complications nor parent vessel wall dissection or vasospasm in the region of the Vecta46 catheter on final control angiography in all 9 cases. Conclusion The new low‐profile Vecta46 intermediate catheter can be safely and effectively utilized in a 6‐French mini‐triaxial system for flow diverter delivery without compromising injection quality, support, or trackability.

Introduction Middle meningeal artery (MMA) embolization has emerged as an adjunctive treatment in the management of chronic subdural hematomas (cSDH). After surgical cSDH evacuation, embolization offers enhanced resorption of cSDH fluid by infarcting the neomembranes at the capillary level. MMA embolization is typically performed on the side ipsilateral to the cSDH, but in the setting of recent surgical evacuation, the ipsilateral meningeal circulation is oftentimes disrupted and/or collateralized. In this situation, penetration of the membranes via an over‐the‐top contralateral injection may provide additional MMA occlusion and efficacy. Methods Consecutive cases of unilateral cSDH surgery with contralateral liquid embolic injection were retrospectively identified from a prospectively maintained database of the senior authors. Results Eight consecutive cases of recurrent cSDH after surgery were identified (average age = 76±3.5 years, all male). Five subjects (63%) had a previous craniotomy and 3 (38%) had previous burr holes. All subjects had a contralateral MMA embolization in addition to an ipsilateral MMA embolization with regards to their previous index surgery. Average recurrent cSDH thickness was 9.8±1.4mm, midline shift of 1.8±0.9mm. MMA branches embolized included both anterior and posterior (n=5, 63%) anterior only (n=2, 25%), and posterior only (n=1, 12.5%). The falx was penetrated in the contralateral MMA embolization in 3 (38%) cases. Injection of glue across the midline to previously non‐penetrated dura on the index surgery side was successfully achieved in all 8 cases. There were no periprocedural complications encountered. Conclusion The addition of contralateral MMA embolization for recurrent cSDH after previous surgery is a safe and potentially additive therapy that may increase the overall efficacy of MMA embolization in these challenging cases.

Introduction Placement of 088” aspiration catheters in the internal carotid artery (ICA) for aspiration in mechanical thrombectomy (MT) has been previously described. However, the use and safety of 088” aspiration catheters beyond the ICA has not been established. Here, we report the utilization and early safety outcomes of 088” catheter placement in the M1 segment for MT. Methods We reviewed a prospectively maintained IRB‐approved database of the senior author to identify consecutive cases where the 088” catheter was navigated to the MCA for use in mechanical thrombectomy. Results We identified 13 cases with placement of an 088” aspiration catheter in the MCA segment (all cases performed in 2023). Average patient age was 71±4 years (range 56‐97 years), with 10 (77%) females, presenting NIHSS was 12±2.1, and 3 (23%) patients received tPA. Location of the thrombus includes 7 (54%) in the M1 and 6 (46%) in the M2. In 13 (100%) cases, the Zoom88 (OD = 2.7 mm, Imperative Care, Campbell, CA) catheter was advanced to at least the M1 segment, and it was used with a coaxial Zoom71 catheter. The average M1 diameter prior to MT was 2.5±0.2mm, 2.3±0.2mm, and 2.2±0.1 in the proximal, mid, and distal M1‐segment, respectively. After MT, the average M1 diameter was 2.4±0.1mm, 2.2±0.1mm, and 2.1±0.2mm in the proximal, mid, and distal M1‐segment, respectively. 85% (n=11) of cases used one or more stentrievers including a Tigertriever, Solitaire, and Trevo. Average number of passes was 1.9±0.2. There were no vessel perforations, catheter‐related dissections, or hemorrhagic complications noted in any case. TICI 2C/3 recanalization was achieved in 100% of cases. The average mRS on discharge was 1.2±0.4. Figure 1. (A) AP angiography demonstrating an M1 branch occlusion (orange). (B) Native view, 088” catheter under aspiration in the MCA (green). (C) Post‐thrombectomy final angiography demonstrating TICI 3 reperfusion. Conclusion The use of large‐bore 088” aspiration catheters in the MCA may offer a safe strategy for direct clot ingestion during mechanical thrombectomy in MCA vasculature that is smaller than the 8‐Fr aspiration catheter.

Introduction Recent literature continues to demonstrate the successful role large‐bore aspiration catheters have in thrombus ingestion during mechanical thrombectomy. However, the ledge gap, or step off, between the catheter and the microwire can make navigating to distal vasculature difficult. A new 035” micro‐guidewire reduces the step off for 035” aspiration catheters (Aristotle 35 Colossus Guidewire, Scientia Vascular, West Vale City, UT) while maintaining torquability and softness. We report here our early experience in 6 mechanical thrombectomy cases. Methods We reviewed and analyzed a prospectively maintained database of the senior authors to identify cases utilizing a 035” micro‐guidewire with 035” aspiration catheters in mechanical thrombectomy. Results Six consecutive cases of 035” microwire use for mechanical thrombectomy were identified. Four (67%) patients were female with an average age of 77±5.3 years (range 56‐97). Average presenting NIHSS was 11±3. Thrombus locations included 50% (n=3) in the M2, 33% (n=2) in the M1, and 17% (n=1) in the P1. Radial access was performed in 1 case (17%), with remaining via femoral access (n=5, 83%). An 088” ID aspiration catheter was navigated to at least the M1 segment in all anterior circulation cases and the basilar in the posterior circulation case. The 035” wire was placed proximal to the occlusion in all cases allowing coaxial 035” and 071” catheter aspiration passes. The average number of passes was 2±0.3. TICI 2C/3 was achieved in 83% of cases (5/6) and 2b in the remaining case. There were no catheter‐related dissections, perforations, or hemorrhagic complications noted for the cases. Figure 1. (A) AP angiography demonstrating a thrombus in the right M2 superior division (white). (B) 035” (yellow), 071” (orange), and 088” (red) aspiration catheters over the Colossus 35 micro‐guidewire (black) at the level of the thrombus without crossing it. Conclusion The Colossus 035” micro‐guidewire may offer advantages over its narrower counterparts by reducing ledge effect and the need to cross the thrombus. Further comparative studies against currently available microwires are needed in various anatomies to confirm this perceived performance advantage.

Abstract In this article, the ratio-dependent prey-predator system perturbed with time noise is numerically investigated. It relates to the population densities of the prey and predator in an ecological system. The initial prey-predator models only depend on the time and a couple of the differential equations. We are considering a model where the prey-predator interaction is influenced by both space and time and the need for a coupled nonlinear partial differential equation with the effect of the random behavior of the environment. The existence of the solutions is guaranteed by using Schauder’s fixed point theorem. The computation of the underlying model is carried out by two schemes. The proposed stochastic forward Euler scheme is conditionally stable and consistent with the system of the equations. The proposed stochastic non-standard finite difference scheme is unconditionally stable and consistent with the system of the equations. The graphical behavior of a test problem for different values of the parameters is shown which depicts the efficacy of the schemes. Our numerical results will help the researchers to consider the effect of the noise on the prey-predator model.

This article deals with coupled nonlinear stochastic partial differential equations. It is a reaction-diffusion system, known as the stochastic Gray-Scott model. The numerical approximation of the stochastic Gray-Scott model is discussed with the proposed stochastic forward Euler (SFE) scheme and the proposed stochastic non-standard finite difference (NSFD) scheme. Both schemes are consistent with the given system of equations. The linear stability analysis is discussed. The proposed SFE scheme is conditionally stable and the proposed stochastic NSFD is unconditionally stable. The convergence of the schemes is also discussed in the mean square sense. The simulations of the numerical solution have been obtained by using the MATLAB package for the various values of the parameters. The effects of randomness are discussed. Regarding the graphical behavior of the stochastic Gray-Scott model, self-replicating behavior is observed.

Rapid shallow landslides are a significant hillslope erosion mechanism and limited understanding of their initiation and development results in persistent risk to infrastructure. Here, we analyse the slope above the strategic A83 Rest and be Thankful road in the west of Scotland. An inventory of 70 landslides (2003–2020) shows three types of shallow landslide, debris flows, creep deformation, and debris falls. Debris flows dominate and account for 5,350 m3 (98%) of shallow-landslide source volume across the site. We use novel time-lapse vector tracking to detect and quantify slope instabilities, whilst seismometers demonstrate the potential for live detection and location of debris flows. Using on-slope rainfall data, we show that shallow-landslides are typically triggered by abrupt changes in the rainfall trend, characterised by high-intensity, long duration rainstorms, sometimes part of larger seasonal rainfall changes. We derive empirical antecedent precipitation (>62 mm) and intensity-duration (>10 h) thresholds over which shallow-landslides occur. Analysis shows the new thresholds are more effective at raising hazard alerts than the current management plan. The low-cost sensors provide vital notification of increasing hazard, the initiation of movement, and final failure. This approach offers considerable advances to support operational decision-making for infrastructure threatened by complex slope hazards.

Introduction and Objectives: Clinical data for older patients with advanced liver disease are limited. This post hoc analysis evaluated the efficacy and safety of terlipressin in patients aged ≥65 years with hepatorenal syndrome using data from 3 Phase III, randomized, placebo-controlled studies (OT-0401, REVERSE, CONFIRM). Patients and Methods: The pooled population of patients aged ≥65 years (terlipressin, n = 54; placebo, n = 36) was evaluated for hepatorenal syndrome reversal—defined as a serum creatinine level ≤1.5 mg/dL (≤132.6 μmol/L) while receiving terlipressin or placebo, without renal replacement therapy, liver transplantation, or death—and the incidence of renal replacement therapy (RRT). Safety analyses included an assessment of adverse events. Results: Hepatorenal syndrome reversal was almost 2-times higher in terlipressin-treated patients compared with patients who received placebo (31.5% vs 16.7%; P = 0.143). Among surviving patients, the need for RRT was significantly reduced in the terlipressin group, with an almost 3-times lower incidence of RRT versus the placebo group (Day 90: 25.0% vs 70.6%; P = 0.005). Among 23 liver-transplant-listed patients, significantly fewer patients in the terlipressin versus placebo group needed RRT by Days 30 and 60 (P = 0.027 each). Fewer patients in the terlipressin group needed RRT post-transplant (P = 0.011). More terlipressin-treated patients who were listed for and received a liver transplant were alive and RRT-free by Day 90. No new safety signals were revealed in the older subpopulation compared with previously published data. Conclusions: Terlipressin therapy may lead to clinical improvements in highly vulnerable patients aged ≥65 years with hepatorenal syndrome. Clinical trial numbers: OT-0401, NCT00089570; REVERSE, NCT01143246; CONFIRM, NCT02770716

Gait recognition provides the opportunity to identify different walking styles of people without physical intervention. However, covariates such as changing clothes and carrying conditions may influence recognition accuracy. Our objective was to identify the walking patterns of people for different covariates through analyzing images from publicly available data set CASIA-B on gait. On the dataset, the proposed method was evaluated by using GEI (gait energy image) as inputs for normal walking, changing clothes, and carrying conditions in a multi-view environment. A support vector machine (SVM) and a histogram of oriented gradients (HOG) were applied to classify images of the human gait in order to meet the objectives. Observations show that, under consideration of the mean of the individual accuracies, the accuracy of recognition is in the following order: clothing > normal walk > carrying at a 90° angle. Measurement accuracy of 87.9% was achieved for the coat-wearing people and measurement accuracy of 83.33% was achieved for all the mentioned covariates. The accuracy of the clothing covariate stated as 87.9% is a useful for people especially for different season like winter.

Di beberapa daerah di Indonesia, malaria masih merupakan salah satu penyakit endemik dan termasuk ke dalam kategori penyakit menular dengan vektor nyamuk Anopheles. Penurunan jumlah mortalitas penderita malaria ini telah menjadi program Pemerintah Indonesia dan World Health Organization. Salah satu hal penting yang dapat dilakukan adalah menyediakan alat diagnosis malaria yang cepat dan akurat berbantukan komputer. Oleh karena itu, pada studi ini dikembangkan sebuah metode deteksi malaria berbasis segmentasi warna citra yang dikombinasikan dengan metode pencacahan objek citra dan pembelajaran mesin berbasis Convolutional Neural Network. Pada studi ini, segmentasi citra dilakukan dengan menetapkan suatu nilai ambas batas tertentu (thresholding) pada model warna HSV. Nilai ambang batas untuk masing-masing kanal warna ditetapkan sebagai berikut: H = 100-175, S = 100-250, dan V = 60-190. Terdapat tiga skema pembelajaran mesin yang digunakan, yaitu citra asli menggunakan RMSProp optimizer, citra tersegmentasi menggunakan RMSProp dan Adam optimizer. Akurasi pelatihan dan validasi CNN tertinggi diperoleh dengan skema citra tersegmentasi menggunakan RMSProp optimizer, yaitu sebesar 92,77% dan 94,38%. Sementara, deteksi malaria berbasis pencacahan objek memiliki akurasi sebesar 93,78%. Meskipun deteksi malaria berbasis pencacahan objek memiliki akurasi 93,78%, tetapi sumber daya komputasi dan waktu yang diperlukan jauh lebih rendah. Abstract Malaria is still one of the endemic diseases in several regions of Indonesia. Reducing the malaria mortality rate has become a notable programme, not only does the Government of the Republic of Indonesia project it, but also the World Health Organization has a similar plan to tackle this disease. One of the prominent concerns to properly promote this programme is providing a rapid and accurate malaria diagnosis tool by applying the computer-aided diagnostics to minimize human errors. The aim of this study is to develop a colour microscopic image-based malaria detection using object counting and CNN-based machine learning. In this research, the HSV colour model with threshold values of H: 100-175, S: 100-250, and V: 60-190 was used to remove the image background. There are three machine learning schemes implemented in this study, i.e. original image using RMSProp optimizer, segmented image using RMSProp and Adam optimizer. The highest training and validation accuracy of CNN were obtained using a segmented image scheme by the RMSProp optimizer, 0.9277 and 0.9438. On the contrary, object-based malaria detection has an accuracy of 93.78%. Furthermore, there are several considerations to determine the malaria detection method, i.e. accuracy, computational resources, and time. Even though malaria detection using object counting has an accuracy of 93.78%, lower than the accuracy of CNN validation, the computational resources and time required are much lower and faster. Therefore, this detection method is suitable for smartphone-based devices with low-middle end specifications.

Background: Outbreak investigations typically focus their efforts on identifying cases that present at healthcare facilities. However, these cases rarely represent all cases in the wider community. In this context, community-based investigations may provide additional insight into key risk factors for infection, however, the benefits of these more laborious data collection strategies remains unclear. Methods: We used different subsets of the data from a comprehensive outbreak investigation to compare the inferences we make in alternative investigation strategies. Results: The outbreak investigation team interviewed 1,933 individuals from 460 homes. 364 (18%) of individuals had symptoms consistent with chikungunya. A theoretical clinic-based study would have identified 26% of the cases. Adding in community-based cases provided an overall estimate of the attack rate in the community. Comparison with controls from the same household revealed that those with at least secondary education had a reduced risk. Finally, enrolling residents from households across the community allowed us to characterize spatial heterogeneity of risk and identify the type of clothing usually worn and travel history as risk factors. This also revealed that household-level use of mosquito control was not associated with infection. Conclusions: These findings highlight that while clinic-based studies may be easier to conduct, they only provide limited insight into the burden and risk factors for disease. Enrolling people who escaped from infection, both in the household and in the community allows a step change in our understanding of the spread of a pathogen and maximizes opportunities for control.

Abstract Background Methyltransferases (MTFs) are broad range of enzymes, which are ubiquitously expressed in diverse organisms ranging from bacteria to animals. MTFs proteins have been associated with various biological/cellular processes including transcriptional regulation, subcellular protein and RNA localization, signal transduction and DNA-damage repair. However, the role of MTFs in immune mechanism during host–parasite interaction has not been addressed yet. Results An open reading frame (764 bp) of methyltransferase-type 12 gene of H. contortus denoted as HcMTF-12, was successfully cloned using reverse transcriptase-polymerase chain reaction (RT-PCR) followed by prokaryotic expression in Escherichia coli BL21 (DE3 strain). The recombinant HcMTF-12 protein (rHcMTF-12) was about 47 kDa along with a fusion vector protein of 18 kDa. Immunoblot results identified the native protein MTF-12 with antibodies produced in rats against rHcMT-12, whereas rHcMTF-12 protein was recognized with sera of goat experimentally infected with H. contortus. Immunohistochemical analysis revealed that the native MTF-12 protein was mainly located in the periphery (cuticle) of parasite sections as well as within the pharynx and intestinal region. An immunofluorescence assay validated that rHcMTF-12 attached to the surface of goat PBMCs. Furthermore, the cytokines transcription of IL-2, IFN-γ and IL-4 transcripts of PBMCs incubated with rHcMTF-12 were enhanced in a dose-dependent manner. The secretion of TGF-β1 and IL-10 was significantly decreased. However, IL-6 production was not significantly different as compared to the control groups. Moreover, the migration activity and nitric oxide (NO) production by PBMCs were induced considerably, whereas the proliferation of PBMCs cells was negatively affected when incubated with the rHcMTF-12 protein. Conclusions Our findings suggest that HcMTF-12 significantly mediated the functions of PBMCs, and it might be a potential candidate for therapeutic interventions against haemonchosis.

This article deals with the Fitzhugh–Nagumo equation in the presence of stochastic function. A numerical scheme has been developed for the solution of such equations which preserves the certain structure of the unknown functions, also we have given the stability analysis, consistency of the problem, and explicitly optimal a priori estimates for the existence of solutions of such equations. A unique solution has been guaranteed. The corresponding explicit estimates in the function spaces are formulated in the form of theorems. Lastly, one important feature of the article is the simulation of the proposed numerical scheme in the form of the 2D and 3D plots which shows the efficacy of the stochastic analysis of such nonlinear partial differential equations.

Lactococcus garvieae is a pathogen typically acquired from the consumption of raw seafood or unpasteurized dairy products. Here, we present the unique case of a middle-aged gentleman who presented with back pain, originally thought to be muscle spasms due to poor posture and heavy lifting. Initial radiological imaging showed evidence of a lumbar epidural abscess and lung nodule. Upon further work-up, L. garvieae was isolated in blood and abscess cultures. It was later hypothesized that the L. garvieae bacteremia might have an association with adenocarcinoma of the lung.

Molecular germplasm characterization is essential for gathering information on favorable attributes and varietal improvement. The current study evaluated the genetic divergence and population structure of 80 potato genotypes collected from Punjab, Pakistan, using polymorphic retrotransposon-DNA-based markers (iPBS). A total of 11 iPBS primers generated 787 alleles with a mean value of 8.9 alleles per primer, of which ~95% were polymorphic across the 80 genotypes. Different variation attributes, such as mean expected heterozygosity (H = 0.21), mean unbiased expected heterozygosity (µHe = 0.22), and mean Shannon’s information index (I = 0.32), showed the existence of sufficient genetic diversity in the studied potato genotypes. Analysis of molecular variance (AMOVA) showed that genetic variation within the population was higher (84%) than between populations (16%). A neighbor-joining tree was constructed based on the distance matrices that arranged the 80 genotypes into five distinct groups, and the genotypes FD61-3 and potato 2 had the highest genetic distance. A STRUCTURE analysis corroborated the dendrogram results and distributed the 80 genotypes also into five clusters. Our results determined that retrotransposon-based markers are highly polymorphic and could be used to evaluate genetic diversity between local and exotic potato genotypes. The genotypic data and population structure dissection analysis reported in this study will enhance potato varietal improvement and development.

Background: Even though literature revealed the problem of nurses' knowledge deficit regarding the care of chest drain in general, no study that investigated the prevalence of chest drains in ICUs and nurses' knowledge of chest drain among Jordanian nurses was found in the literature. This study aims were to describe the prevalence rate of chest drain insertion in Jordanian ICUs, and to evaluate Jordanian nurses’ level of knowledge regarding chest drain care. Methods: Anon-experimental descriptive design using cross-sectional survey was used for evaluating nurses’ knowledge utilizing researchers-developed instrument. In addition, a retrospective chart review for patients who had chest drain in the previous three months to assess the prevalence rate of chest drain insertion. Data was analysis using the Statistical Package for Social Sciences (SPSS) program. Results: The 3-month period prevalence of chest drain insertion was 8%. The most common indication for chest drains insertion was cardiac surgery (84.8%, n = 134) followed by pleural effusion (6.3%, n = 10). The results revealed that the mean score for nurses’ knowledge regarding care of chest drain was 15.7 out of 30 (52.3%), with the majority had insufficient or intermediate level of knowledge (47.6%, n = 107 vs. 51.1%, n = 115). The areas with least level of knowledge were in the troubleshooting (31.9%), and removal (39.5%). Nurses from private hospitals had significantly higher (M = 16, SD ± 2.77) level of knowledge (F[2, 222] = 8.467, p < .001) than nurses from other sectors. Conclusions: Chest drain is prevalent in Jordanian ICUs, which requires nurses to know how to care for patients with this critical intervention. However, they seemed to lack the needed knowledge for the appropriate care. Developing, implementing and continuous monitoring of guidelines regarding chest drain care for nurses and physicians are recommended.

Background: Whole genome sequencing has revolutionized epidemiological investigations of multidrug-resistant pathogenic bacteria worldwide. Aim of this study was to perform comprehensive characterization of ESBL-positive isolates of Escherichia coli obtained from clinical samples at the King Abdulaziz University Hospital utilizing whole genome sequencing. Methods: Isolates were identified by MALDI-TOF mass spectrometry. Genome sequencing was performed using a paired-end strategy on the MiSeq platform. Results: Nineteen isolates were clustered into different clades in a phylogenetic tree based on single nucleotide polymorphisms in core genomes. Seventeen sequence types were identified in the extended-spectrum β-lactamase (ESBL)-positive isolates, and 11 subtypes were identified based on distinct types of fimH alleles. Forty-one acquired resistance genes were found in the 19 genomes. The blaCTX-M-15 gene, which encodes ESBL, was found in 15 isolates and was the most predominant resistance gene. Other antimicrobial resistance genes (ARGs) found in the isolates were associated with resistance to tetracycline (tetA), aminoglycoside [aph(3″)-Ib, and aph(6)-Id], and sulfonamide (sul1, and sul2). Nonsynonymous chromosomal mutations in the housekeeping genes parC and gyrA were commonly found in several genomes. Conclusion: Several other ARGs were found in CTX-M-positive E. coli isolates confer resistance to clinically important antibiotics used to treat infections caused by Gram-negative bacteria. Keywords: Genome, Antimicrobial resistance gene, Virulence gene, Insertion sequences, Escherichia coli, Saudi Arabia

The spin Hall effect and the inverse spin Hall effect are important spin-charge conversion mechanisms. The direct spin Hall effect induces a surface spin accumulation from a transverse charge current due to spin-orbit coupling even in nonmagnetic conductors. However, most detection schemes involve additional interfaces, leading to large scattering in reported data. Here we perform interface-free x-ray spectroscopy measurements at the Cu L_{3,2} absorption edges of highly Bi-doped Cu (Cu_{95}Bi_{5}). The detected x-ray magnetic circular dichroism signal corresponds to an induced magnetic moment of (2.2±0.5)×10^{−12} μ_{B} A^{−1} cm^{2} per Cu atom averaged over the probing depth, which is of the same order of magnitude as found for Pt measured by magneto-optics. The results highlight the importance of interface-free measurements to assess material parameters and the potential of CuBi for spin-charge conversion applications.

Oat husks are produced during the milling process of oats. Oat husks are a lignocellulosic material that have the potential for valorization thereby improving the circular economy of agricultural by-products. However, due to the high lignocellulosic content, there are limited valorization pathways for oat husks. To improve the anaerobic digestibility of oat husks, pre-treatment was investigated as a method to aid valorization. A novel extrusion process was used in an attempt to fragment the lignocellulosic structure of oat husks prior to anaerobic digestion. The extrusion pre-treatment was investigated to determine the effect it may have on altering the methane yield and digestibility of oat husks. Biochemical methane potential assays were undertaken using oat husks with no pre-treatment and extruded oat husks. These assays demonstrated that extruded oat husks produced a significantly higher methane yield of 264 ml/gVS fed, which was 27% greater than the methane yield produced from the untreated oat husks. Similarly, the total solids degradation was also significantly higher for extruded oat husks treatment compared to the untreated oat husks. Overall, the extrusion process demonstrated an increased methane yield for oat husks compared to previously published data. The biomethane potential tests suggest that extruded oat husks would be a feedstock suitable for anaerobic digestion.

Although many studies discussed evidence-based practice among general nurses, few studies were found by the researchers among intensive care unit nurses. Also, no study has been conducted to investigate the predictors of evidence-based practice among intensive care unit nurses in Jordan. Therefore, this study aims to identify the predictors of evidence-based practice among intensive care unit nurses in Jordan. A descriptive cross-sectional design was used to conveniently recruit 132 participants. Self-reported questionnaires were utilized including the Evidence-Based Practice Questionnaire and Evidence-Based Practice barrier scale. Participants’ rate of evidence-based practice was 60% (M = 4.2/7), which was significantly correlated with their knowledge ( r = 0.739, P < .01) and attitudes ( r = 0.564, P < .01) of evidence-based practice. The results revealed a 2-predictor model that explained 62.2% of the variance in evidence-based practice among intensive care unit nurses. The 2 variables were attitude (β = 0.245) and knowledge (β = 0.563). The outcomes of this study added new information regarding the prediction of evidence-based practice among intensive care unit nurses. An educational program for nurses regarding this issue is crucial to improve their practice aiming at enhancing nursing care. Also, nursing schools should update their curricula to explain the importance of evidence-based practice and to enhance students’ competencies in research utilization and statistical skills.

The proper conceptus elongation in ruminants is critical for the successful placentation and establishment of pregnancy. We have previously shown that the trophectoderm-specific knockdown of LIN28A/B in day 9 ovine blastocysts resulted in increased let-7 miRNAs and reduced conceptus elongation at day 16 of gestation. In this current study, by transcriptome analysis of LIN28A knockdown (AKD) or LIN28B knockdown (BKD) trophectoderm (TE), we explored the downstream target genes of the LIN28-let-7 axis and their roles in the placental and fetal development. We identified 449 differentially expressed genes (DEGs) in AKD TE and 1214 DEGs in BKD TE compared to non-targeting control (NTC). Our analysis further revealed that 210 downregulated genes in AKD TE and 562 downregulated genes in BKD TE were the potential targets of let-7 miRNAs. Moreover, 16 downregulated genes in AKD TE and 57 downregulated and 7 upregulated genes in BKD TE were transcription factors. The DEGs in AKD and BKD TE showed enrichment in the biological processes and pathways critical for placental development and function, and fetal development and growth. The results of this study suggest the potential roles of the LIN28-let-7 axis in placental and fetal development beyond its involvement in trophoblast proliferation and conceptus elongation.

Hydrothermal treatment (HTT) is recognized as one of the promising thermochemical pre-treatments for biomass energy. It provides a low energy requirement and an elimination of pre-drying. Furthermore, a water washing method for the treated biomass is employed. One of the most promising biofuel candidates is empty fruit bunch (EFB) due to the large yearly production in Indonesia. In this study, the quality of hydrochars derived from EFB was assessed for its quality as a solid fuel. Raw EFB is thermochemically treated by employing HTT, and its characteristics in regard to grindability are studied. The study suggested that commercial-scale HTT produces a solid fuel with a high heating value (HHV) with a value similar to Indonesian coal. In addition, it has lower ash content than the parent biomass, which reduces the probability of slagging and fouling in boilers. Furthermore, the particle size distribution profile suggested better characteristics than the parent biomass and some types of coal.

How corticostriatal connections of different pyramidal cell types are organized, particularly in convergent circuits, has not been evaluated in detail. Here, cell type-specific Cre-driver mice reveal that pyramidal tract-type corticostriatal projections, though broadly similar to intratelencephalic-type projections from the same cortical region, are generally more restricted and variable in their topographic termination patterns.

The present study evaluated the effects of 4 typical subtropical forages on ruminal microbial community composition to formulate a better diet for buffalo. Corn straw silage, elephant grass, cassava residues and sugarcane tail silage were used as substrates for in vitro fermentation. Eight replicates were set up for every substrate, and fermentation was carried out in a 100-mL glass syringe, using buffalo rumen inoculum. Every replicate was anaerobically dispensed with 10 mL of rumen inoculum, 20 mL of McDougall's buffer and 200 mg of dried substrate, and placed in a water bath at 39 °C. Gas production was recorded at 0, 2, 6, 12, 24, 36, 48 and 72 h of incubation. After 24 h, fermentation was ceased for 4 replicates and samples were collected. Volatile fatty acids (VFA) concentrations were measured using gas chromatography. Microbial populations were quantified using quantitative real-time PCR (qRT-PCR), and microbial community was analyzed using high throughput sequencing technology. The results showed, cassava residues as substrate had the highest gas production, acetate, propionate and total VFA concentrations (P

Delayed brain development in perinatally HIV-infected children may affect the functional brain activity and subsequently cognitive function. The current study evaluated the functional brain activity in HIV-infected children by quantifying the amplitude of low frequency fluctuations (ALFF) and functional connectivity (FC). Additionally, correlation of ALFF and FC with cognitive measures was performed. Twenty-six HIV-infected children and 20 control children underwent neuropsychological (NP) assessment and resting-state functional magnetic resonance imaging (rs-fMRI). ALFF and FC maps were generated and group differences were analyzed using two-sample t-test. Furthermore, ALFF and FC showing significant group differences were correlated with NP scores using Pearson's correlation. Significantly lower ALFF in the left middle temporal gyrus, precentral and post central gyrus was observed in HIV-infected children compared to controls. FC was significantly reduced in the right inferior parietal, vermis, middle temporal and left postcentral regions, and significantly increased in the right precuneus, superior parietal and left middle frontal regions in HIV-infected children as compared to control. HIV-infected children showed significantly lower NP scores in various domains including closure, exclusion, memory, verbal meaning, quantity and hidden figure than controls. These waning cognitive functions were significantly associated with changes in ALFF and FC in HIV-infected children. The findings suggest that abnormal ALFF and FC may responsible for cognitive deficits in HIV-infected children. ALFF and FC in association with cognitive evaluation may provide a clinical biomarker to evaluate functional brain activity and to plan neurocognitive intervention in HIV-infected children undergoing standard treatment. Keywords: Human immunodeficiency virus, Resting-state functional imaging, Magnetic resonance imaging, Amplitude of low frequency fluctuations, Functional connectivity

Assessment of global longitudinal systolic strain (GLS) and longitudinal systolic strain of the basal segments (BLS) has shown prognostic value in cardiac disorders. However, strain is reduced with increased afterload. We assessed the prognostic value of GLS and BLS adjusted for afterload. GLS and BLS were determined in 272 subjects with normal ejection fraction and no known coronary disease, or significant valve disease. Systolic blood pressure (SP) and diastolic blood pressure (DP) obtained at the time of echocardiography were used to adjust GLS and BLS as follows: strain × SP (mmHg)/120 mmHg and strain × DP (mmHg)/80 mmHg. Patients were followed for cardiac events and mortality. The mean age was 53 ± 15 years and 53% had hypertension. There were 19 cardiac events and 70 deaths over a mean follow-up of 26 ± 14 months. Cox analysis showed that left ventricular mass index (P = 0.001), BLS (P < 0.001), and DP-adjusted BLS (P < 0.001) were independent predictors of cardiac events. DP-adjusted BLS added incremental value (P < 0.001) to the other two predictors and had an area under the curve of 0.838 for events. DP (P = 0.001), age (P = 0.001), ACE inhibitor use (P = 0.017), and SP-adjusted BLS (P = 0.012) were independent predictors of mortality. SP-adjusted BLS added incremental value (P = 0.014) to the other independent predictors. In conclusion, DP-adjusted BLS and SP-adjusted BLS were independent predictors of cardiac events and mortality, respectively. Blood pressure-adjusted strain added incremental prognostic value to other predictors of outcome. Introduction Assessment of global longitudinal systolic strain (GLS) and basal longitudinal systolic strain (BLS) have shown utility for prediction of prognosis in various cardiac disorders (1, 2, 3, 4). In some studies, longitudinal strain has been shown to be a more sensitive indicator of left ventricular (LV) systolic dysfunction than traditional measures of function (5, 6). The detection of early abnormalities in myocardial function by strain assessment likely accounts for the superior ability of the technique to predict outcome in some cardiac disorders (3, 4, 7). However, longitudinal strain is similar to many other measures of systolic function in that it is influenced by loading conditions (8, 9). Both experimental and clinical studies have shown that increased afterload reduces longitudinal strain. The early improvement in longitudinal strain occurring in patients with aortic stenosis undergoing valve

The present study considers evaporative cooling and desiccant unit-based air-conditioning (AC) options for livestock AC application. In this regard, proposed systems are investigated by means of experiments and thermodynamic investigations. Air-conditioning requirements for animals are theoretically investigated and temperature-humidity index (THI) is estimated. A lab-scale heat mass exchanger based on the Maisotsenko-cycle evaporative cooling conception (MEC) is set up and its performance is evaluated at different ambient air conditions. In addition, a desiccant-based air-conditioning (DAC) unit is thermodynamically evaluated using a steady-state model available in the literature. The study focuses on the ambient conditions of Multan which is the 5th largest city of Pakistan and is assumed to be a typical hot city of southern Punjab. The study proposed three kinds of AC combination i.e., (i) stand-alone MEC, (ii) stand-alone desiccant AC, and (iii) M-cycle based desiccant AC systems. Wet bulb effectiveness of the stand-alone MEC unit resulted in being from 64% to 78% whereas the coefficient of performance for stand-alone desiccant AC and M-cycle based desiccant AC system was found to be 0.51 and 0.62, respectively. Results showed that the stand-alone MEC and M-cycle based desiccant AC systems can achieve the animals’ thermal comfort for the months of March to June and March to September, respectively, whereas, stand-alone desiccant AC is not found to be feasible in any month. In addition, the ambient situations of winter months (October to February) are already within the range of animal thermal comfort.

Biomass co-firing into the existing pulverized coal boilers has economic and environmental advantages, such as reduced slagging inside the furnace and lower GHG emissions. Compared to other pre-treatments, hydrothermal treatment has high conversion efficiency, capability to eliminate the energy-intensive drying process, and relatively low operating temperatures. In this study, a simulation study using computational fluid dynamics (CFD) has been performed to explore the potential of coal co-firing with hydrothermally treated empty fruit bunch (HT-EFB) into an existing coal power plant. In the co-firing process, it is important to predict the combustion performance for all stages of the combustion. Furthermore, an empirical investigation is performed to clarify the result of simulations. In the findings, an HT-EFB mass fraction in the range of 10–25 % seems to be the most preferable co-firing condition.

One of the strategies to improve environmentally friendly energy harvesting can be realized by using biomass as a primary energy source for generating electricity and H2. In addition, high energy efficiency can be achieved by minimizing the exergy loss through process integration and exergy recovery. As an implementation, this study proposes a cogeneration system for black liquor (BL) to co-produce electricity and H2. The system primarily comprises of BL drying, circulating fluidized bed gasification, syngas chemical looping (SCL), and power generation. The Aspen Plus V8.8 software package is used for modelling and performing calculations of the proposed integrated system. Furthermore, thermodynamic analysis of gasification is performed by employing Gibbs energy minimization. The effects of target solid content on the required total work and compressor outlet pressure during drying and gasification with different steam-to-fuel ratios are evaluated. Moreover, the SCL process adopts three reactors, namely, the reducer, oxidizer, and combustor. Compared to the conventional processes, the integrated drying-gasification-SCL processes are significantly cleaner and more energy efficient. The proposed integrated system can achieve a net energy efficiency of about 70 %, with almost 100 % carbon capture.

Introduction. Shared Decision-Making may facilitate information exchange, deliberation, and effective decision-making, but no decision aids currently exist for difficult decisions in neurocritical care patients. The International Patient Decision Aid Standards, a framework for the creation of high-quality decision aids (DA), recommends the presentation of numeric outcome and risk estimates. Efforts are underway to create a goals-of-care DA in critically-ill traumatic brain injury (ciTBI) patients. To inform its content, we examined physicians’ perceptions, and use of the IMPACT-model, the most widely validated ciTBI outcome model, and explored physicians’ preferences for communicating prognostic information towards families. Methods. We conducted a qualitative study using semi-structured interviews in 20 attending physicians (neurosurgery,neurocritical care,trauma,palliative care) at 7 U.S. academic medical centers. We used performed qualitative content analysis of transcribed interviews to identify major themes. Results. Only 12 physicians (60%) expressed awareness of the IMPACT-model; two stated that they “barely” knew the model. Seven physicians indicated using the model at least some of the time in clinical practice, although none used it exclusively to derive a patient’s prognosis. Four major themes emerged: the IMPACT-model is intended for research but should not be applied to individual patients; mistrust in the IMPACT-model derivation data; the IMPACT-model is helpful in reducing prognostic variability among physicians; concern that statistical models may mislead families about a patient’s prognosis. Discussion: Our study identified significant variability of the awareness, perception, and use of the IMPACT-model among physicians. While many physicians prefer to avoid conveying numeric prognostic estimates with families using the IMPACT-model, several physicians thought that they “ground” them and reduce prognostic variability among physicians. These findings may factor into the creation and implementation of future ciTBI-related DAs.

The aim of this work focuses on the relationship among the Dark Triad (psychopathy, narcissism, and Machiavellianism), perceptions of organizational politics, political skills, and counterproductive work behavior. This study empirically tests the mediating role of perceptions of organizational politics in the relationship between the Dark Triad and counterproductive work behavior. Furthermore, the study investigates the moderating role of political skills in strengthening the link between the Dark Triad and the perceptions of organizational politics. A sample of 149 participants was randomly selected. To analyze the data of the present work, we employed a structural equation model using partial least square and PROCESS. From empirical findings, we imply an inference that perception of organizational politics partially mediates the Dark Triad's influence on the counterproductive work behavior. Moreover, the results identify the moderating role of political skills in strengthening the link between the Dark Triad and the perceptions of organizational politics. Empirical findings suggest important policy implications for the hospitality industry.

Background: Self-Management is a crucial regimen for patients with diabetes mellitus. Many factors have affected patients' self-management practice including psychosocial factors. Literature revealed contradictory results concerning the psychosocial correlates of patients' self-management practices. Therefore, this study assessed the psychosocial correlates of diabetes self-management practices among Jordanian diabetic patients. Methods: A descriptive, cross-sectional, correlational design was utilized to collect data (conducted in the middle region of Jordan in 2015) from 341 Jordanian outpatients with diabetes using self-reported questionnaires (Social Support Scale, CES-D, and Summary of Diabetes Self-Care Activities) and chart review. Results: Participants reported practice rate of 2.85/ 7 (SD=1.3), with diet practice the most (M=3.66, SD=1.5) and exercise the least (M=1.53, SD=2.1). Participants reported receiving social support (M=3.23, SD=1.3) less than needed (M=3.39, SD=1.3). High levels of depressive symptoms were reported (M=17.1, SD= 11.4). Diet practices had significant positive correlation with family support attitude (r= .266, P= .000) and negative correlation with depressive symptoms (r= - .114, P= .037). Testing blood sugar significantly correlated with both support needed (r= .144, P= .008) and support received (r= .166, P= .002). Conclusion: Jordanian DM patients were found to practice less than optimum DM self-management practices, and to consider diet practices than exercise practices. This study confirmed that the subcategories of DM self-care management should be considered rather than considering the general plan.

Background/Aim: We aimed to assess the influence of Helicobacter pylori and its virulent factors, cytotoxin associated gene (cag) A and E, on portal hypertensive gastropathy (PHG) and the levels of interleukin (IL)-8, IL-10, and tumor necrosis factor-alpha (TNF-α). Patients and Methods: The patients with cirrhosis underwent screening endoscopy and the lesions related to PHG were graded. Biopsies were obtained for histology, and polymerase chain reaction (PCR) of H. pylori 16S rRNA, cagA, cagE, and tissue cytokine levels was carried out. Absent or mild PHG was compared with moderate to severe PHG. Results: One hundred and forty patients with cirrhosis were studied; males numbered 92 and the mean age of the patients was 50.3 ± 12.0 years, H. pylori positivity in 87 (62.1%) patients was associated with male gender (P = 0.032), younger age (P = 0.029), hepatitis D etiology (P = 0.005), higher serum albumin (0.000), lower Child Pugh score (P = 0.001), and lower portal vein diameter (P = 0.001). There was no significant difference in the levels of TNF-α and IL-8. However, a decrease in the anti-inflammatory cytokine IL-10 was noted with moderate to severe gastropathy. Four H. pylori strains were positive for both cagA and cagE, while four were positive for cagA only. All the four patients with both virulent factors had mild gastropathy only. Conclusion: The presence of H. pylori infection neither affected the severity of PHG nor augmented the IL-8 and TNF-α levels. There was a decline of virulent H. pylori strains and IL-10 levels in patients with advanced PHG.

Background/Aim: Helicobacter pylori is a Gram-negative bacteria, which is associated with development of gastroduodenal diseases. The prevalence of H. pylori and the virulence markers cytotoxin-associated gene A and E (cagA, cagE) and vacuolating-associated cytotoxin gene (vacA) alleles varies in different parts of the world. H. pylori virulence markers cagA, cagE, and vacA alleles in local and Afghan nationals with H. pylori-associated gastroduodenal diseases were studied. Patients and Methods: Two hundred and ten patients with upper gastrointestinal symptoms and positive for H. pylori by the urease test and histology were included. One hundred and nineteen were local nationals and 91 were Afghans. The cagA, cagE, and vacA allelic status was determined by polymerase chain reaction. Results: The nonulcer dyspepsia (NUD) was common in the Afghan patients (P = 0.025). In Afghan H. pylori strains, cagA was positive in 14 (82%) with gastric carcinoma (GC) compared with 29 (45%) with NUD (P = 0.006), whereas cagE was positive in 11 (65%) with GC and 4 (67%) with duodenal ulcer (DU) compared with 12 (18%) with NUD (P < 0.001 and 0.021, respectively). The vacA s1a/b1was positive in 10 (59%) of GC compared with 20 (31%) in NUD (P = 0.033). In Pakistani strains, cagE was positive in 12 (60%) with GC, 7 (58%) with GU, 12 (60%) with DU compared with 11 (16%) with NUD (P < 0.001, 0.004, and < 0.001, respectively). In Pakistani strains, cagA/s1a/m1 was 39 (33%) compared with Afghans in 17 (19%) (P = 0.022). Moderate to severe mucosal inflammation was present in 51 (43%) Pakistani patients compared with 26 (28%) (P = 0.033) in Afghans. It was also associated with grade 1 lymphoid aggregate development in Pakistani patients 67 (56%) compared with 36 (40%) (P = 0.016) in Afghans. Conclusion: Distribution of H. pylori virulence marker cagE with DU was similar in Afghan and Pakistan H. pylori strains. Chronic active inflammation was significantly associated with Pakistani H. pylori strains.

Lung cancer is the primary cause of cancer-related mortality worldwide and although improvements in treatment have been achieved over the last few years, long-term survival rates for lung cancer patients remain poor. Therefore, there is an imperative need for molecularly targeted agents that will achieve long-term disease control. Numerous downstream molecular pathways, such as EGF/RAS/RAF/MEK/ERK and PI3K/AKT/mTOR are identified as having a key role in the pathogenesis of various forms of human cancer, including lung cancer. PI3K/AKT/mTOR signal pathway is an important intracellular signal transduction pathway with a significant role in cell proliferation, growth, survival, vesicle trafficking, glucose transport, and cytoskeletal organization. Aberrations in many primary and secondary messenger molecules of this pathway, including mutations and amplifications, are accounted for tumor cell proliferation, inhibition of apoptosis, angiogenesis, metastasis and resistance to chemotherapy-radiotherapy. In this review article, we investigate thoroughly the biological role of PI3K pathway in lung cancer and its contribution in the development of future therapeutic strategies.

In the original version of this Article, support provided during initiation of the project was not fully acknowledged. The PDF and HTML versions of the Article have now been corrected to include support from Karel Svoboda, members of the Svoboda lab, and members of Janelia’s Vivarium staff.

Background and study aims: Colorectal cancer can be prevented through the use of colonoscopy with polypectomy. Most colon polyps are benign or low grade adenomas. However, currently all lesions need histopathologic analysis, which increases diagnostic costs and delays the final diagnosis. Confocal laser endomicroscopy (CLE) is a new technology that enables real-time endomicroscopy. However, there are challenges to maintaining a stable image with currently available systems. We conducted a small study to obtain a preliminary assessment of whether the use of an endoscopic distal attachment cap may enhance image quality of CLE in comparison with images obtained with free-hand acquisition. Patients and methods: Forty outpatients underwent colonoscopy for evaluation of colon polyps in a single academic medical center. Patients were assigned randomly to 1 of 2 study arms on the basis of whether an endoscopic distal attachment cap was used (n = 21, Cap Used) or not used (n = 19, No Cap) in the procedure. The quality of confocal images and probe stabilization was summarized. Results: A total of 81 polyps were identified. The proportion of polyps with images of high quality was 74 % (28/38) in the Cap Used group and 79 % (30/38) in the No Cap arm. Image stability was also similar with and without a cap. Diagnostic accuracy was estimated to be slightly higher in the Cap Used group for probe-based confocal laser endomicroscopy (pCLE; 78 % vs 70 %). This was also true for white-light and narrow-band imaging. Conclusions: This preliminary study did not yield any evidence to support that the use of an endoscopic distal attachment cap improves the quality of images obtained during CLE.

Localisation in wireless networks faces challenges such as high levels of signal attenuation and unknown path-loss exponents, especially in urban environments. In response to these challenges, this paper proposes solutions to localisation problems in noisy environments. A new observation model for localisation of static nodes is developed based on hybrid measurements, namely angle of arrival and received signal strength data. An approach for localisation of sensor nodes is proposed as a weighted linear least squares algorithm. The unknown path-loss exponent associated with the received signal strength is estimated jointly with the coordinates of the sensor nodes via the generalised pattern search method. The algorithm’s performance validation is conducted both theoretically and by simulation. A theoretical mean square error expression is derived, followed by the derivation of the linear Cramer-Rao bound which serves as a benchmark for the proposed location estimators. Accurate results are demonstrated with 25%–30% improvement in estimation accuracy with a weighted linear least squares algorithm as compared to linear least squares solution.

Sorafenib is an oral angiogenetic multikinase inhibitor approved in the treatment of renal and hepatocellular carcinoma. Bleeding and venous thrombotic events have been described with angiogenetic agents but cerebrovascular accidents are rarely reported. We report two cases of patients with hepatocellular carcinoma who developed a cerebrovascular accident while on sorafenib. Neither patient had any risk factors for the cerebrovascular events apart from gender and age in the second patient. Laboratory data were noncontributory. The head CT scan did not reveal acute abnormalities. No hemodynamically significant stenosis was visible in the carotid ultrasound, and the echocardiogram showed normal size of the heart chambers and normal systolic function of the left ventricle. Sorafenib was discontinued in both cases. Physicians should monitor patients receiving sorafenib for neurologic symptoms, and in the absence of other etiology, prompt discontinuation of this drug should be considered.

Pancreatic cancer is a malignancy of poor prognosis which is mostly diagnosed at advanced stages. Current treatment modalities are very limited creating great interest for novel preventive and therapeutic options. Vitamin D seems to have a protective effect against pancreatic cancer by participating in numerous proapoptotic, antiangiogenic, anti-inflammatory, prodifferentiating, and immunomodulating mechanisms. 25-hydroxyvitamin D [25(OH)D] serum concentrations are currently the best indicator of vitamin D status. There are three main sources of vitamin D: sun exposure, diet,and dietary supplements. Sun exposure has been associated with lower incidence of pancreatic cancer in ecological studies. Increased vitamin D levels seem to protect against pancreatic cancer, but caution is needed as excessive dietary intake may have opposite results. Future studies will verify the role of vitamin D in the prevention and therapy of pancreatic cancer and will lead to guidelines on adequate sun exposure and vitamin D dietary intake.