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Increased intracranial pressure (ICP) is encountered in numerous traumatic and non-traumatic medical situations, and it requires immediate recognition and attention. Clinically, ICP typically presents with a headache that is most severe in the morning, aggravated by Valsalva-like maneuvers, and associated with nausea or vomiting. Papilledema is a well-recognized sign of increased ICP; however, emergency physicians often find it difficult to visualize the optic disc using ophthalmoscopy or to accurately interpret digital fundus photographs when using a non-mydriatic retinal camera. Emergency ultrasound can evaluate the optic nerve sheath diameter (ONSD) and optic disc elevation to determine whether increased ICP is present, however, the studies have been small with different definitions and measurements of the ONSD. The ONSD threshold values for increased ICP have been reported anywhere from 4.8 to 6.3 millimeters. Neuroimaging is the next step in the evaluation of patients with papilledema or high clinical suspicion of increased ICP, as it can identify most structural causes or typical radiological patterns of increased ICP. Neuroradiographic signs of increased ICP can be helpful in suggesting idiopathic intracranial hypertension (IIH), especially when papilledema is absent. Patients with papilledema and normal neuroimaging may undergo lumbar puncture as part of their clinical workup. The cerebrospinal fluid (CSF) opening pressure remains one of the most important investigations to establish the diagnosis of IIH. A CSF evaluation is also required to exclude other etiologies of elevated ICP such as infectious, inflammatory, and neoplastic meningitis. Invasive ICP measurement remains the standard to measure and monitor this condition.

BackgroundNon-sputum-based triage tests for tuberculosis are a priority for ending tuberculosis. We aimed to evaluate the diagnostic accuracy of the late-prototype Xpert MTB Host Response (Xpert HR) blood-based assay.MethodsWe conducted a prospective diagnostic accuracy study among outpatients with presumed tuberculosis in outpatient clinics in Viet Nam, India, the Philippines, Uganda, and South Africa. Eligible participants were aged 18 years or older and reported cough lasting at least 2 weeks. We excluded those receiving tuberculosis treatment in the preceding 12 months and those who were unwilling to consent. Xpert HR was performed on capillary or venous blood. Reference standard testing included sputum Xpert MTB/RIF Ultra and mycobacterial culture. We performed receiver operating characteristic (ROC) analysis to identify the optimal cutoff value for the Xpert HR to achieve the target sensitivity of 90% or more while maximising specificity, then calculated diagnostic accuracy using this cutoff value. This study was prospectively registered with ClinicalTrials.gov, NCT04923958.FindingsBetween July 13, 2021, and Aug 15, 2022, 2046 adults with at least 2 weeks of cough were identified, of whom 1499 adults (686 [45·8%] females and 813 [54·2%] males) had valid Xpert HR and reference standard results. 329 (21·9%) had microbiologically confirmed tuberculosis. Xpert HR had an area under the ROC curve of 0·89 (95% CI 0·86-0·91). The optimal cutoff value was less than or equal to -1·25, giving a sensitivity of 90·3% (95% CI 86·5-93·3; 297 of 329) and a specificity of 62·6% (95% CI 59·7-65·3; 732 of 1170). Sensitivity was similar across countries, by sex, and by subgroups, although specificity was lower in people living with HIV (45·1%, 95% CI 37·8-52·6) than in those not living with HIV (65·9%, 62·8-68·8; difference of 20·8%, 95% CI 13·0-28·6; p

Metaheuristics are optimization algorithms that efficiently solve a variety of complex combinatorial problems. In psychological research, metaheuristics have been applied in short-scale construction and model specification search. In the present study, we propose a bee swarm optimization (BSO) algorithm to explore the structure underlying a psychological measurement instrument. The algorithm assigns items to an unknown number of nested factors in a confirmatory bifactor model, while simultaneously selecting items for the final scale. To achieve this, the algorithm follows the biological template of bees' foraging behavior: Scout bees explore new food sources, whereas onlooker bees search in the vicinity of previously explored, promising food sources. Analogously, scout bees in BSO introduce major changes to a model specification (e.g., adding or removing a specific factor), whereas onlooker bees only make minor changes (e.g., adding an item to a factor or swapping items between specific factors). Through this division of labor in an artificial bee colony, the algorithm aims to strike a balance between two opposing strategies diversification (or exploration) versus intensification (or exploitation). We demonstrate the usefulness of the algorithm to find the underlying structure in two empirical data sets (Holzinger-Swineford and short dark triad questionnaire, SDQ3). Furthermore, we illustrate the influence of relevant hyperparameters such as the number of bees in the hive, the percentage of scouts to onlookers, and the number of top solutions to be followed. Finally, useful applications of the new algorithm are discussed, as well as limitations and possible future research opportunities.

Despite the value of sense of purpose during older adulthood, this construct often declines with age. With some older adults reconsidering the relevance of purpose later in life, the measurement of purpose may suffer from variance issues with age. The current study investigated whether sense of purpose functions similarly across ages and evaluated if the predictive power of purpose on mental, physical, cognitive, and financial outcomes changes when accounting for a less age-affected measurement structure. Utilizing data from two nationwide panel studies (Health and Retirement Study: n = 14,481; Midlife in the United States: n = 4,030), the current study conducted local structural equation modeling and found two factors for the positively and negatively valenced purpose items in the Purpose in Life subscale (Ryff, 1989), deemed the purposeful and purposeless factor. These factors become less associated with each other at higher ages. When reproducing past findings with this two-factor structure, the current study found that the purposeful and purposeless factors predicted these outcomes in the same direction as would be suggested by past research, but the magnitude of these effects differed for some outcomes. The discussion focuses on the implications of what this means for our understanding of sense of purpose across the lifespan.

Congenitally corrected transposition of the great arteries (ccTGA) is a rare congenital anomaly defined by double discordance – atrioventricular and ventricular-arterial. ccTGA frequently has associated lesions, which influence long-term survival.

Summary: Background: Clinical severity scores can identify patients at risk of severe disease and death, and improve patient management. The modified early warning score (MEWS), the quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA), and the Universal Vital Assessment (UVA) were developed as risk-stratification tools, but they have not been fully validated in low-resource settings where fever and infectious diseases are frequent reasons for health care seeking. We assessed the performance of MEWS, qSOFA, and UVA in predicting mortality among febrile patients in the Lao PDR, Malawi, Mozambique, and Zimbabwe. Methods: We prospectively enrolled in- and outpatients aged ≥ 15 years who presented with fever (≥37.5 °C) from June 2018–March 2021. We collected clinical data to calculate each severity score. The primary outcome was mortality 28 days after enrolment. The predictive performance of each score was determined using area under the receiver operating curve (AUC). Findings: A total of 2797 participants were included in this analysis. The median (IQR) age was 32 (24–43) years, 38% were inpatients, and 60% (1684/2797) were female. By the time of follow-up, 7% (185/2797) had died. The AUC (95% CI) for MEWS, qSOFA and UVA were 0.67 (0.63–0.71), 0.68 (0.64–0.72), and 0.82 (0.79–0.85), respectively. The AUC comparison found UVA outperformed both MEWS (p

The genus Scutellaria L. comprises about 400 - 500 species, some of which are of practical value due to their biological activities. To prevent misidentification and contamination of plant material harvested from species of this genus, knowledge of the morphological and micromorphological characters of the seeds has proved useful. The present paper aims to perform a morphological and micromorphological characterization of seeds belonging to 12 taxa of the genus Scutellaria L., with the idea of completing the literature data and discussing the importance of these characters. The seeds of the analysed taxa showed different colours (yellow, black, brown) and ornamentations (generated by the arrangement and shape of the epidermal papillae). In some taxa, the seeds were glabrous (Scutellaria baicalensis Georgi, S. resinosa Torr., S. suffrutescens S. Watson., S. incana Spreng., S. integrifolia L.), others showed tector hairs concentrated in the apical region of the epidermal papillae (S. altissima L.) or distributed over the entire surface (S. orientalis L., S. supina L., S. orientalis L. var. pinnatifida Rchb.), covering the whole or part (S. pontica K. Koch.) of the seed surface. Sessile glands were observed in S. galericulata L., among the papillae, whereas S. alpina L., presented stellate hairs. Seed sizes also varied between the taxa. The results obtained confirm the taxonomic importance of the analysed features but indicate that the correct identification of Scutellaria species cannot be performed based only on seed characteristics, requiring additional research and observations.

Radial artery occlusion (RAO), Forearm Hematoma (FH), and compartmental syndrome are three well-recognized complications associated with radial artery (RA) access to percutaneous coronary intervention (PCI). There are disparate ways the RA can be damaged, from multiple needling attempts to adverse interactions between the radial sheath, exchange wire, and diagnostic or guiding catheter with the artery.

Abstract Pulmonary hypertension (PH) is a progressive and invalidating condition despite available therapy. Addressing complications such as left main coronary artery compression (LMCo) due to the dilated pulmonary artery (PA) may improve symptoms and survival. Nevertheless, clear recommendations are lacking. The aim of this study is to analyze the prevalence, characteristics, predictive factors and impact of LMCo in a heterogenous precapillary PH population in a single referral center. Two hundred sixty‐five adults with various etiologies of precapillary PH at catheterization were reviewed. Coronary angiography (CA) was performed for LMCo suspicion. Revascularization was performed in selected cases. Outcomes were assessed at a mean follow‐up of 3.9 years. LMCo was suspected in 125 patients and confirmed in 39 (31.2%), of whom 21 (16.8%) had 50%–90% stenoses. Nine revascularizations were performed, with clinical improvement. The only periprocedural complication was a stent migration. LMCo was associated with PH etiology (p 0.003), occuring more frequently in congenital heart disease‐associated PH (61.5% of all LMCo cases, 66.6% of LMCo ≥ 50%). Predictors of LMCo ≥50% were PA ≥ 37.5 mm (Sn 81%, Sp 74%) and PA‐to‐aorta ≥1.24 (Sn 81%, Sp 69%), with increased discrimination when considering RV end‐diastolic area. LMCo ≥ 50% without revascularization presented clinical deterioration and worse survival (p 0.019). This analysis of a heterogeneous pre‐capillary PH population provides LMCo prevalence estimation, predictive factors (PA size, PA‐to‐aorta, RV end‐diastolic area and PH etiology) and long‐term impact. While LMCo impact on survival is inconclusive, untreated LMCo ≥ 50% has worse prognosis. LMCo revascularization may be performed safely and with good outcomes.

Objectives: The exact mechanisms of deep brain stimulation (DBS) are still an active area of investigation, in spite of its clinical successes. This is due in part to the lack of understanding of the effects of stimulation on neuronal rhythms. Entrainment of brain oscillations has been hypothesised as a potential mechanism of neuromodulation. A better understanding of entrainment might further inform existing methods of continuous DBS, and help refine algorithms for adaptive methods. The purpose of this study is to develop and test a theoretical framework to predict entrainment of cortical rhythms to DBS across a wide range of stimulation parameters. Materials and Methods: We fit a model of interacting neural populations to selected features characterising PD patients' off-stimulation finely-tuned gamma rhythm recorded through electrocorticography. Using the fitted models, we predict basal ganglia DBS parameters that would result in 1:2 entrainment, a special case of sub-harmonic entrainment observed in patients and predicted by theory. Results: We show that the neural circuit models fitted to patient data exhibit 1:2 entrainment when stimulation is provided across a range of stimulation parameters. Furthermore, we verify key features of the region of 1:2 entrainment in the stimulation frequency/amplitude space with follow-up recordings from the same patients, such as the loss of 1:2 entrainment above certain stimulation amplitudes. Conclusion: Our results reveal that continuous, constant frequency DBS in patients may lead to nonlinear patterns of neuronal entrainment across stimulation parameters, and that these responses can be predicted by modelling. Should entrainment prove to be an important mechanism of therapeutic stimulation, our modelling framework may reduce the parameter space that clinicians must consider when programming devices for optimal benefit.

ABSTRACT: Objectives: To identify and summarize existing global knowledge gaps on antimicrobial resistance (AMR) in human health, focusing on the World Health Organization (WHO) bacterial priority pathogens, Mycobacterium tuberculosis, and selected fungi. Methods: We conducted a scoping review of gray and peer-reviewed literature, published in English from January 2012 through December 2021, that reported on the prevention, diagnosis, treatment, and care of drug-resistant infections. We extracted relevant knowledge gaps and, through an iterative process, consolidated those into thematic research questions. Results: Of 8409 publications screened, 1156 were included, including 225 (19.5%) from low- and middle-income countries. A total of 2340 knowledge gaps were extracted, in the following areas: antimicrobial research and development, AMR burden and drivers, resistant tuberculosis, antimicrobial stewardship, diagnostics, infection prevention and control, antimicrobial consumption and use data, immunization, sexually transmitted infections, AMR awareness and education, policies and regulations, fungi, water sanitation and hygiene, and foodborne diseases. The knowledge gaps were consolidated into 177 research questions, including 78 (44.1%) specifically relevant to low- and middle-income countries and 65 (36.7%) targeting vulnerable populations. Conclusion: This scoping review presents the most comprehensive compilation of AMR-related knowledge gaps to date, informing a priority-setting exercise to develop the WHO Global AMR Research Agenda for the human health sector.

The surgical interventions performed to treat oral cancer can cause important psychological manifestations, but also eating disorders, deglutition disorders, intense pain, sometimes severe depression or anxiety. That is why it is very important to understand as completely as possible the psychological and social deficiencies that patients diagnosed with oral cancer may encounter, in order to help them throughout the treatment, and throughout their survival. The implementation of measures to ensure the psychosocial adaptation to everything that involves a surgical intervention for the treatment of oral cancer needs to be done as early as possible. The goals of these interventions can be represented by the reduction of isolation, the feeling of alienation, anxiety, lack of hope and optimism regarding the future and the clarification or reinterpretation of erroneous information and thoughts about the disease and treatment. Accordingly, this work aims to highlight those measures that can be used to reduce the psychosocial consequences determined by the complex treatment and especially by the surgical intervention specific to oral cancer.

Oral cancer is one of the most common malignancies in the world, Squamous Cell Carcinoma being the most common form at lips’ level. The treatment of oral cancer still remains a challenge for both doctors and patients. The quality of a person’s life is also influenced by oral health through the role that the oral cavity has in speech, nutrition, facial aesthetics and social acceptance. This paper aims to highlight the need for the involvement of a multidisciplinary team in the diagnosis and treatment of oral cancer, with the achievement of a complex assessment, including in terms of anxiety, social stressors, personality traits, coping resources or the diagnosis of even some possible mental disorders. Thus, the psychiatric evaluation of patients with oral cancer aims to coordinate and involve a psychiatric therapy in the complex oncological and surgical treatment of these patients.

Background and Objectives: Ovarian cancer, including tubal and peritoneal cancer, is the third most common gynecological cancer and the leading cause of death from gynecological malignancies in developed countries. This study explores the prognostic value of the neutrophil-to-lymphocyte ratio (NLR) in determining the optimal duration of neoadjuvant chemotherapy (NACT) for advanced ovarian cancer. It also investigates the correlation between NLR dynamics and the KELIM score, a chemosensitivity marker, to enhance individualized therapeutic strategies. Materials and Methods: A total of 79 patients underwent NACT followed by interval debulking surgery (IDS) or palliative care. The data collected included demographic information, tumor characteristics, treatment modalities, and laboratory parameters. The baseline NLR (NLR-T0) and post-therapeutic NLR (NLR-T1) were calculated, and their variation (NLR∆) was analyzed. The KELIM score was determined using CA-125 values. Results: Patients with a high baseline NLR (≥2.5) had significantly worse progression-free survival (PFS) and overall survival (OS) compared to those with a low NLR (Conclusions: The NLR is a valuable prognostic marker for assessing treatment response and guiding NACT duration in advanced ovarian cancer.

Skin-friendly textile materials were obtained by applying oil-in-water emulsions based on palmarosa essential oil, chamomile, and calendula tinctures onto cotton fabrics. Different formulations based on these bioactive principles incorporated in collagen as polymeric matrices were prepared and immobilized on a plain weave textile structure from 100% cotton. The functionalized textile materials were characterized in terms of physicochemical, mechanical, antibacterial, and biocompatibility points of view. The pH values of the prepared emulsions were in the range of 4.81–5.23 and showed no significant differences after 4 h of storage. Moreover, the addition of a higher quantity of active principles (palmarosa essential oil and plant tinctures) caused slightly lower values of acidic pH. The electrical conductivity of the obtained emulsions increased with the decrease in the oil phases in the system. The highest values were obtained for the emulsion developed with the smallest volume fraction of active principle—palmarosa essential oil and plant tinctures. The emulsion that contained the least amount of collagen and the highest number of active principles exhibited the lowest stability. The textile materials treated with synthesized emulsions exerted antibacterial effects against S. aureus and E. coli strains and did not affect keratinocyte growth, spreading, and organization, highlighting the biocompatibility of these developed skin-friendly textiles.

Xerosis cutis represents one of the most common dermatological diagnoses, which, when untreated, can be the trigger for open wounds, infections, and other skin diseases. Plant extracts are a valuable option for long-term treatments for xerosis due to their phytocompounds, especially polyphenols, flavonoids, triterpenes, and polysaccharides, with antioxidant, anti-inflammatory, antimicrobial, moisturizing, and reparatory effects. Active substances have different mechanisms; therefore, evaluating the effects on the cells can be a key indicator, providing valuable information in terms of both cytotoxicity and efficacy. The in vitro and in vivo toxicity tests performed for Betulae extractum, Liquiritiae extractum, and Avenae extractum highlighted potential toxic effects at higher concentrations in a dose-dependent relationship, but at lower levels they can be considered safe (12.5 µg/mL for birch and licorice extracts, 50 µg/mL for oat extract). Concerning the re-epithelialization process, the results revealed that all three dry extracts effectively stimulate skin cell migration, highlighting a potential anti-inflammatory effect by increasing the cell migration rate in conditions of induced inflammation associated with oxidative stress. Among the tested concentrations with a potential contribution to wound healing, the following standout: are birch bark extract 3 μg/mL, licorice root extract 7.5 µg/mL, and oat herb (harvested before flowering) extract 7.5 µg/mL.

Currently, some parts made from workpieces in the form of sheets or strips are obtained by applying piercing processes. In the research whose results are presented in the article, square-shaped holes were made to evaluate the piercing accuracy of the surfaces generated by piercing in sheets of three different metal materials (carbon steel 1.033, aluminum alloy AlMg3, and stainless steel X5CrNi18-10) with different thicknesses. Apart from the nature of the material, the thickness of the sheet, the size of the clearance between the puncher and the die, and the average speed of the puncher were considered as input factors in the piercing process. The output parameters tracked were the size of the side of the square-shaped hole and the height of the burr generated by the cut. The experimental results were mathematically processed using special software, obtaining empirical mathematical models that highlight the influence of the input factors considered on the deviation of the side size of the square-shaped hole and the burr height. The analysis of the results showed that the intended size of the square hole side exerts the strongest influence on the piercing accuracy. The factor with the most significant influence on the height of the burr is the clearance between the puncher and the die.

Phytoestrogens, natural compounds with structural similarity to 17-β-estradiol, are known to have potential health benefits, including in hormone-dependent malignancies. The therapeutic interest and some safety concerns observed triggered the need to develop accurate methods to assess their level in different matrices. This narrative review examines the existing analytical methods used to isolate, quantify, and characterize phytoestrogens and their metabolites in plants, foods, and biological samples. Different conventional and modern extraction techniques, such as ultrasonication-assisted extraction, supercritical fluid extraction, or enzyme-assisted extraction, were presented and compared. The advantages and limitations of the existing analytical methods, such as high-performance liquid chromatography using different sensitive detectors, gas chromatography often coupled with mass spectrometry, and immunoassay methods, are highlighted, along with the need for ongoing research to improve the sensitivity and selectivity of the analysis.

We face significant environmental pollution problems due to various industries, such as the aluminum industry, which generates large amounts of red mud (RM) waste, or agriculture, in which case the use of pesticides creates huge water pollution problems. In this context, the present study offers a better perspective to originally solve both environmental issues. Thus, the main target of the study referred to using RM waste as a filler for preparing composite copolymer beads. Thereafter, this can achieve significant removal of water pollutants due to their adsorption/oxidation characteristics. As evidenced by the changes in chemical structure and composition, thermal stability, morphology, and porosity, RM was homogenously incorporated in poly(acrylonitrile-co-acrylic acid) beads prepared by wet phase inversion. The final assessment for the removal of pesticides by adsorption and oxidation processes was proven successful. In this regard, 2,4-dichlorophenoxyacetic acid was chosen as a model pollutant, for which an adsorption capacity of 16.08 mg/g composite beads was achieved.

Lipid metabolism dysregulation can lead to dyslipidemia and obesity, which are major causes of cardiovascular disease and associated mortality worldwide. The purpose of the study was to obtain and characterize six plant extracts (ACE—Allii cepae extractum; RSE—Rosmarini extractum; CHE—Cichorii extractum; CE—Cynarae extractum; AGE—Apii graveolentis extractum; CGE—Crataegi extractum) as promising adjuvant therapies for the prevention and treatment of dyslipidemia and its related metabolic diseases. Phytochemical screening revealed that RSE was the richest extract in total polyphenols (39.62 ± 13.16 g tannic acid/100 g dry extract) and phenolcarboxylic acids (22.05 ± 1.31 g chlorogenic acid/100 g dry extract). Moreover, the spectrophotometric chemical profile highlighted a significant concentration of flavones for CGE (5.32 ± 0.26 g rutoside/100 g dry extract), in contrast to the other extracts. UHPLC-MS quantification detected considerable amounts of phenolic constituents, especially chlorogenic acid in CGE (187.435 ± 1.96 mg/g extract) and rosmarinic acid in RSE (317.100 ± 2.70 mg/g extract). Rosemary and hawthorn extracts showed significantly stronger free radical scavenging activity compared to the other plant extracts (p < 0.05). Pearson correlation analysis and the heatmap correlation matrix indicated significant correlations between phytochemical contents and in vitro antioxidant activities. Computational studies were performed to investigate the potential anti-obesity mechanism of the studied extracts using target prediction, homology modeling, molecular docking, and molecular dynamics approaches. Our study revealed that rosmarinic acid (RA) and chlorogenic acid (CGA) can form stable complexes with the active site of carbonic anhydrase 5A by either interacting with the zinc-bound catalytic water molecule or by directly binding Zn2+. Further studies are warranted to experimentally validate the predicted CA5A inhibitory activities of RA and CGA and to investigate the hypolipidemic and antioxidant activities of the proposed plant extracts in animal models of dyslipidemia and obesity.

To make wind power more competitive, it is necessary to reduce turbine downtime and reduce costs associated with wind turbine operation and maintenance (O&M). Incorporating machine learning in the development of condition-based predictive maintenance methodologies for wind turbines can enhance their efficiency and reliability. This paper presents a monitoring method that utilizes Density Based Support Vector Machines (DBSVM) and the evolutionary Fourier spectra of vibrations. This method allows for the smart monitoring of the function evolution of the turbine. A complex optimal function (FO) for 5-degree order has been developed that will be the boundary function of the DBSVM to be timely determined from the Fourier spectrum through the magnitude–frequency and place of the failure occurring in the wind turbine drivetrains. The trend of the failure was constructed with the maximal values of the optimal frequency function for both yesthe cases of the upwind and downwind parts of the gearbox.