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Nur C Bunawan,1 Asghar Rastegar,2 Kathleen P White,3 Nancy E Wang41Alam Sehat Lestari Clinic, West Kalimantan, Borneo, Indonesia; 2Section of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA; 3General Internal Medicine, Yale University School of Medicine, New Haven, CT, USA; 4Department of Surgery and Pediatric Emergency Medicine, Stanford University School of Medicine, Stanford, CA, USAAbstract: Djenkolism is an uncommon but important cause of acute kidney injury. It sporadically occurs after an ingestion of the djenkol bean (Archidendron pauciflorum), which is native to Southeast Asia. The clinical features defining djenkolism include: spasmodic suprapubic and/or flank pain; urinary obstruction; and acute kidney injury. The precise pathogenesis of acute kidney injury following djenkol ingestion remains unknown. However, it is proposed that an interaction between the characteristics of the ingested beans and the host factors causes hypersaturation of djenkolic acid crystals within the urinary system, resulting in subsequent obstructive nephropathy with sludge, stones, or possible spasms. We report a case of djenkolism from our rural clinic in Borneo, Indonesia. Our systematic literature review identified 96 reported cases of djenkolism. The majority of patients recovered with hydration, bicarbonate therapy, and pain medication. Three patients required surgical intervention; one patient required ureteral stenting for the obstructing djenkolic acid stones. Four of the 96 reported patients died from acute kidney failure. We stress the importance of awareness of djenkolism to guide medical practitioners in the treatment of this rare disease in resource-poor areas in Southeast Asia.Keywords: djenkolism, acute renal failure, acute kidney injury, tropical medicine

Background: Despite the substantial burden of asthma-related emergency department (ED) visits, there have been no recent multicenter efforts to characterize this high-risk population. Objective: We aimed to characterize patients with asthma according to their frequency of ED visits and to identify factors associated with frequent ED visits. Methods: A multicenter chart review study of 48 EDs across 23 US states. We identified ED patients ages 18 to 54 years with acute asthma during 2011 and 2012. Primary outcome was frequency of ED visits for acute asthma in the past year, excluding the index ED visit. Results: Of the 1890 enrolled patients, 863 patients (46%) had 1 or more (frequent) ED visits in the past year. Specifically, 28% had 1 to 2 visits, 11% had 3 to 5 visits, and 7% had 6 or more visits. Among frequent ED users, guideline-recommended management was suboptimal. For example, of patients with 6 or more ED visits, 85% lacked evidence of prior evaluation by an asthma specialist, and 43% were not treated with inhaled corticosteroids. In a multivariable model, significant predictors of frequent ED visits were public insurance, no insurance, and markers for chronic asthma severity (all P < .05). Stronger associations were found among those with a higher frequency of asthma-related ED visits (eg, 6 or more ED visits). Conclusion: This multicenter study of US adults with acute asthma demonstrated many frequent ED users and suboptimal preventive management in this high-risk population. Future reductions in asthma morbidity and associated health care utilization will require continued efforts to bridge these majorgaps in asthma care.

We carried out hydraulic fracturing in-situ stress measurements in an 1881-m deep borehole at the Shuiwangzhuang gold deposit and obtained the variation law of deep in-situ stress with depth in the mining area. The measurement results show that the maximum principal stress has an increasing linear trend with depth. The horizontal stress dominates the in-situ stress state within 800 m, and the vertical stress gradually transitions to the maximum principal stress with increasing depth. The maximum horizontal principal stress ranges from 11.22 to 45.69 MPa, the minimum horizontal principal stress from 7.28 to 36.17 MPa, and the vertical principal stress from 8.44 to 48.27 MPa; The direction of the maximum horizontal principal stress is NWW-trending. We analyzed the characteristics of the deep orebody’s in-situ stress according to the stress value and the direction of the maximum horizontal principal stress, which reveals that the deep in-situ stress of the Shuiwangzhuang mining area belongs to the generally low level in the Zhaoyuan–Laizhou area. We discussed the tendency of rockburst in the underground roadway during deep excavation under a high confining pressure environment based on rock mechanics parameters of drill cores, engineering rock grading standards, and elastic strain energy theory of rock bodies. The Shuiwangzhuang gold orebodies generally belong to the rockburst-free strata or strata with weak rockbursts. However, there is a strong rockburst tendency at depths such as 1102.78 m and 1379.40 m. The gold ore body is at a depth of 1680.40~1684.90 m, generally in the rockburst-free area. The above research results can provide an essential scientific basis for deep mine construction and mining design.

In the process of plunge cylindrical grinding, it is difficult to directly measure the contact stiffness between the grinding wheel and the workpiece. In order to solve this problem, a simplified method for qualitatively determining the contact stiffness between the grinding wheel and the workpiece is proposed, and the grinding parameters are optimized. Based on the dynamic model of plunge cylindrical grinding process, the transfer function of grinding process is deduced, and the mathematical model of the time constant and contact stiffness is established. A simplified method for qualitative determination of grinding contact stiffness is proposed. Further, multiple tests are conducted by controlling the wheel feed speed and the workpiece speed. According to the experimental results, the variation of the system time constant and the grinding force with the grinding parameters are analyzed. The relationship model between the contact stiffness and the grinding parameters is established by regression analysis, and the optimal values of the wheel feed speed and the workpiece speed in the specific grinding process are determined under the condition of meeting the machining requirements.

Breast cancer stem cells (CSCs) are a small cluster of highly tumorigenic cell subsets with self-renewal and multi-directional differentiation potential. Accumulating studies have shown that CSCs lead to chemotherapy resistance and recurrence of breast cancer, which is the main reason for the failure of chemotherapy in breast cancer. Autophagy is one of the key mechanisms to protect tumor cells from chemotherapeutic stimulation and other stresses, which contributes to the ultimate survival of CSCs in refractory or recurrent tumors. This study was carried out in terms of multiple strategies such as flow cytometry, stem-like detection, zebrafish tumor xenograft model construction, autophagy lentivirus construction, and western blotting analysis to prove that a natural flavonoid compound diosmetin safely and effectively promoted the tumor-killing effect of chemotherapeutic drug for breast cancer. The involved mechanism was closely related to its ability to reduce HMGB1 expression and subsequently block the autophagy pathway of breast CSCs. This study will provide new ideas and tools for the development of breast cancer drug resistance mechanism and targeted drugs.

Electron cyclotron heating (ECH) breakdown and burn-through assist has been adopted to make the ITER start-up, which uses a low toroidal electric field of about 0.3 V/m, more robust. Related studies have been carried out on many fusion machines such as DIII-D, JT-60U, Tore Supra and FTU. However, the required ECH power to ensure an effective breakdown assist at ITER is not yet clear. Experiment was also performed in J-TEXT to determine the minimum ECH power requirements to assist breakdown and develop a better physics description of the process. The breakdown loop voltage for a successful shot was reduced from 34 to 3.7 V (corresponding to 0.56 V/m) by 300 kW X2-mode ECH power. The critical ECH power to assist the successful formation of a tokamak discharge is about 200kW, and below this value, ionization caused by ECH power is observed, however, the tokamak discharge start-up does not succeed. The effect of different loop voltages and ECH pulse-width on start-up was also studied. As injecting ECH power at a proper time, low ECH power can achieve a similar pre-ionization result as the case with high power. Extremely low breakdown voltage leads to a higher toroidal field later when putting a capacity to continue discharging in J-TEXT. The earlier shutdown of ECH power caused a failed discharge.

Surveillance of children born to women with human immunodeficiency virus (HIV) infection at five pediatric regional centers assessed times and patterns of clinical recognition in these children. Regional HIV seroprevalences among childbearing women were used to assess the proportion of identified children born to HIV-infected women. In total, 415 children with perinatal HIV exposure were identified. Early age at first HIV evaluation was significantly associated with maternal intravenous drug use (3.2 vs. 7.2 months for other or unknown maternal risk, P = .01), birth county with population > 500,000 (3.5 vs. 8.2 months for population < or = 500,000, P = .003), and hospital with routine HIV screening of pregnant women (0.1 vs. 8.8 months for no screening, P = .006). Race did not correlate with age at first evaluation. Using maternal HIV seroprevalence rates for 1988-1991, 34%-50% of the expected number of infants born to HIV-infected women were in clinical care. Perception of increased maternal risk for HIV infection was associated with early clinical recognition of infants of HIV-infected women. [ABSTRACT FROM AUTHOR]

Comprehensive characteristics of a pneumatic underwater launching system were analyzed and the simulation was carried out by simulink. The components of the pneumatic underwater launching system were introduced, and the theoretical calculation formula for the system was derived. A rated pressure of 3.5MPa and 5MPa was offered in the numerical work. Analyses in different piston height show good behaviors: Proper increase of piston-initial accumulator pressure is beneficial to reduce hydrodynamic noise, choose the appropriate pressure of accumulator. The hydrodynamic noise of the system can be significantly reduced by optimizing the structure of the double-acting cylinder, increasing the height of the piston and improving the structure of the piston.

A new AODV based clustering routing protocol（AODV-clustering）was proposed which kept the good features of AODV and also effectively solved its scalability problem.We have implemented it using Java on JiST/SWANS platform,and presenting a simulation-based evaluation,the results confirmed the effectiveness of our design

【Abstract】Objective: To discuss the effect of coupled external fixator and skin flap transposition on exposed and nonunion bones. Methods: The data of 12 cases of infected nonunion and exposed bone following open fracture treated in our hospital during the period of March 1998 to June 2008 were analysed. There were 10 male patients, 2 female patients, whose age were between 19-52 years and averaged 28 years. There were 10 tibial fractures and 2 femoral fractures. The course of diseases lasted for 12-39 months with the mean period of 19 months. All the cases were treated by the coupled external fixator and skin flap transposition. Results: Primary healing were achieved in 10 cases and delayed healing in 2 cases in whom the tibia was exposed due to soft tissue defect and hence local flap transposition was performed. All the 12 cases had bony union within 6-12 months after operation with the average time of 8 months. They were followed up for 1-3 years and all fractures healed up with good function and no infection recurrence. Conclusion: The coupled external fixator and skin flap transposition therapy have shown optimal effects on treating infected, exposed and nonunion bones. Key words: External fixators; Fracture fixation; Infection; Surgical flap

Abstract ZnO nanoparticle array has been fabricated on the Si substrate by a simple thermal chemical vapor transport and condensation without any metal catalysts. This ZnO nanoparticles array is constructed from ZnO quantum dots (QDs), and half-embedded in the amorphous silicon oxide layer on the surface of the Si substrate. The cathodoluminescence measurements showed that there is a pronounced blue-shift of luminescence comparable to those of the bulk counterpart, which is suggested to originate from ZnO QDs with small size where the quantum confinement effect can work well. The fabrication mechanism of the ZnO nanoparticle array constructed from ZnO QDs was proposed, in which the immiscible-like interaction between ZnO nuclei and Si surface play a key role in the ZnO QDs cluster formation. These investigations showed the fabricated nanostructure has potential applications in ultraviolet emitters.

We investigate a power line communications (PLC) scheme that could be used to enhance the HomePlug 1.0 standard, specifically its ROBO mode which provides modest throughput for the worst case PLC channel. The scheme is based on using a low-density parity-check (LDPC) code, in lieu of the concatenated Reed-Solomon and convolutional codes in ROBO mode. The PLC channel is modeled with multipath fading and Middleton's class A noise. Clipping is introduced to mitigate the effect of impulsive noise. A simple and effective method is devised to estimate the variance of the clipped noise for LDPC decoding. Simulation results show that the proposed scheme outperforms the HomePlug 1.0 ROBO mode and has lower computational complexity. The proposed scheme also dispenses with the repetition of information bits in ROBO mode to gain time diversity, resulting in 4-fold increase in physical layer throughput.

We present a novel bandwidth (BW) efficient orthogonal frequency division multiplexing (OFDM) scheme with adaptive zero-padding (AZP-OFDM) for wireless transmission. Redundancy issues in OFDM based on cyclic prefix (CP), zero-padding (ZP), as well as no guard interval (NGI) systems are analyzed. A novel system design criterion based on the channel matrix condition is studied and applied to the design of an AZP-OFDM system. Simulation results have shown that the proposed AZP-OFDM offers performance similar to that of CP-OFDM, complexity similar to that of ZP-OFDM, with BW efficiency higher than that of both CP- and ZP-OFDM in channels with small to moderate delay spread. In channels with large delay spread, AZP scheme adaptively maintains high performance at the expense of BW efficiency. Essentially, AZP-OFDM offers a more flexible tradeoff between symbol recovery, BW efficiency, and complexity.

Objective: Multiple studies have shown that racially minoritized groups had disproportionate COVID-19 mortality relative to non-Hispanic White individuals. However, there is little known regarding mortality by immigrant status nationally in the United States, despite being another vulnerable population., Study Design: This was an observational cross-sectional study using mortality vital statistics system data to calculate proportionate mortality ratios (PMRs) and mortality rates due to COVID-19 as the underlying cause., Methods: Rates were compared by decedents' identified race, ethnicity (Hispanic vs non-Hispanic), and immigrant (immigrants vs US born) status. Asian race was further disaggregated into "Asian Indian," "Chinese," "Filipino," "Japanese," "Korean," and "Vietnamese.", Results: Of the over 3.4 million people who died in 2020, 10.4% of all deaths were attributed to COVID-19 as the underlying cause (n = 351,530). More than double (18.9%, n = 81,815) the percentage of immigrants who died of COVID-19 compared with US-born decedents (9.1%, n = 269,715). PMRs due to COVID-19 were higher among immigrants compared with US-born individuals for non-Hispanic White, non-Hispanic Black, Hispanic, and most disaggregated Asian groups. Among disaggregated Asian immigrants, age- and sex-adjusted PMR due to COVID-19 ranged from 1.58 times greater mortality among Filipino immigrants (95% confidence interval [CI]: 1.53, 1.64) to 0.77 times greater mortality among Japanese immigrants (95% CI: 0.68, 0.86). Age-adjusted mortality rates were also higher among immigrant individuals compared with US-born people., Conclusions: Immigrant individuals experienced greater mortality due to COVID-19 compared with their US-born counterparts. As COVID-19 becomes more endemic, greater clinical and public health efforts are needed to reduce disparities in mortality among immigrants compared with their US-born counterparts., (Copyright © 2024 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Following hydrogen peroxide treatment, ferrous iron (Fe 2+ ) is oxidized to its ferric form (Fe 3+ ), stripping it from and inactivating iron-containing proteins. Many mononuclear iron enzymes can be remetallated by manganese to restore function, while other enzymes specifically utilize manganese as a cofactor, having redundant activities that compensate for iron-depleted counterparts. DNA replication relies on one or more iron-dependent protein(s) as synthesis abates in the presence of hydrogen peroxide and requires manganese in the medium to resume. Here, we show that manganese transporters regulate the ability to resume replication following oxidative challenge in Escherichia coli. The absence of the primary manganese importer, MntH, impairs the ability to resume replication; whereas deleting the manganese exporter, MntP, or transporter regulator, MntR, dramatically increases the rate of recovery. Unregulated manganese import promoted recovery even in the absence of Fur, which maintains iron homeostasis. Similarly, replication was not restored in oxyR mutants, which cannot upregulate manganese import following hydrogen peroxide stress. Taken together, the results define a central role for manganese transport in restoring replication following oxidative stress., (© 2023. The Author(s), under exclusive licence to Springer Nature B.V.)

Introduction: Emergency departments (ED) function as a health and social safety net, regularly taking care of patients with high social risk and need. Few studies have examined ED-based interventions for social risk and need., Methods: Focusing on ED-based interventions, we identified initial research gaps and priorities in the ED using a literature review, topic expert feedback, and consensus-building. Research gaps and priorities were further refined based on moderated, scripted discussions and survey feedback during the 2021 SAEM Consensus Conference. Using these methods, we derived six priorities based on three identified gaps in ED-based social risks and needs interventions: 1) assessment of ED-based interventions; 2) intervention implementation in the ED environment; and 3) intercommunication between patients, EDs, and medical and social systems., Results: Using these methods, we derived six priorities based on three identified gaps in ED-based social risks and needs interventions: 1) assessment of ED-based interventions, 2) intervention implementation in the ED environment, and 3) intercommunication between patients, EDs, and medical and social systems. Assessing intervention effectiveness through patient-centered outcome and risk reduction measures should be high priorities in the future. Also noted was the need to study methods of integrating interventions into the ED environment and to increase collaboration between EDs and their larger health systems, community partners, social services, and local government., Conclusion: The identified research gaps and priorities offer guidance for future work to establish effective interventions and build relationships with community health and social systems to address social risks and needs, thereby improving the health of our patients.

Background: The COVID-19 pandemic has disproportionately impacted racial and ethnic minorities in the United States, including Asian Americans, Native Hawaiians and Pacific Islanders (Asian Americans and NH/PIs). However, few studies have highlighted nor disaggregated these disparities by Asian Americans and NH/PIs ethnic subgroups., Methods: This retrospective, cross-sectional observational study aimed to assess variation of Asian Americans and NH/PIs COVID-19 testing and outcomes compared to non-Hispanic Whites (NHW). The study utilized data from the electronic health records (EHR) and the COVID-19 Universal Registry for Vital Evaluations (CURVE) from all patients tested for SARS-CoV-2 (n = 556,690) at a large, health system in Northern and Central California between February 20, 2020 and March 31, 2021. Chi-square tests were used for testing differences in the severity of COVID-19 (hospitalization, ICU admission, death) and patient demographic and clinical characteristics across the Asian Americans and NH/PIs subgroups and NHW. Unadjusted and adjusted Odds Ratios (ORs) were estimated for measuring effect of race ethnicity on severity of COVID-19 using multivariable logistic regression., Results: Of the entire tested population, 70,564/556,690 (12.7%) tested positive for SARS-CoV-2. SARS-CoV-2 positivity of Asian subgroups varied from 4% in the Chinese and Korean populations, to 11.2%, 13.5%, and 12.5% for Asian Indian, Filipino, and "other Asian" populations respectively. Pacific Islanders had the greatest subgroup test positivity at 20.1%. Among Asian Americans and NH/PIs patients with COVID-19 disease, Vietnamese (OR = 2.06, 95% CI = 1.30-3.25), "Other Asian" (OR = 2.13, 95% CI = 1.79-2.54), Filipino (OR = 1.78, 95% CI = 1.34-2.23), Japanese (OR = 1.78, 95% CI = 1.10-2.88), and Chinese (OR = 1.73, 95% CI = 1.34-2.23) subgroups had almost double the odds of hospitalization compared to NHW. Pacific Islander (OR = 1.58, 95% CI = 1.19-2.10) and mixed race subgroups (OR = 1.55, 95% CI = 1.10-2.20) had more than one and a half times odds of hospitalization compared to NHW. Adjusted odds of ICU admission or death among hospitalized patients by different Asian subgroups varied but were not statistically significant., Conclusions: Variation of COVID-19 testing and hospitalization by Asian subgroups was striking in our study. A focus on the Asian Americans and NH/PIs population with disaggregation of subgroups is crucial to understand nuances of health access, utilization, and outcomes among subgroups to create health equity for these underrepresented populations., (© 2023. The Author(s).)

Background: Pediatric trauma patients undergo fewer computed tomography (CT) scans when evaluated at pediatric trauma centers (PTC) versus adult trauma centers (ATC) with no change in clinical outcome. Factors contributing to this difference are unclear. We sought to identify whether the training background of physicians, specifically emergency medicine (EM) versus pediatric emergency medicine (PEM), affected the CT rate of pediatric trauma patients within one institution., Methods: A single-center retrospective study of CT utilization based on attending physicians' training in trauma patients <18 years between November 2018 and November 2020. Attendings were categorized into two groups: EM residency with no PEM fellowship, or pediatrics/EM residency with PEM fellowship. Primary outcomes measured were the proportion of patients receiving a CT and CT positivity rate., Results: Of 463 study patients, CTs were obtained in 145/228 (64%) patients by EM, and 130/235 (55%) by PEM (p=.07). CT positivity rate was 21% and 19% in EM and PEM, respectively (p=.46). The mean number of CTs per patient in EM was 2.8 compared to 2.1 in PEM (p<.01), and for patients with an injury severity score (ISS) >15, mean number of CTs per patient increased to 4.9 in EM versus 2.4 in PEM (p=.01)., Conclusions: The mean number of CTs ordered per patient was statistically higher for EM attendings. The differences between CT rates highlight future opportunities for ongoing development of pediatric trauma imaging guidelines and radiation exposure reduction., Levels of Evidence: Retrospective Study, Level III., Competing Interests: Declaration of Competing Interest Authors have no disclosures., (Copyright © 2022 Elsevier Inc. All rights reserved.)