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Background: A combination of fractional CO2 laser and subcision is usually employed for the treatment of post‐acne atrophic scars. However, the efficacy and safety of both simultaneous and sequential combination therapies should be explored. Aims: To compare the efficacy and safety of simultaneous and sequential fractional CO2 laser and subcision combination therapies for post‐acne atrophic scars. Patients and Methods: This single‐blind, split‐face clinical trial included 34 patients with post‐acne atrophic scars at our institution. Each patient underwent three sessions of subcision combined with fractional CO2 laser, with a 1‐month interval between each session. The left side of the face was treated with simultaneous combination therapy, whereas the right side was treated with sequential combination therapy. Treatment efficacy was assessed at 4, 8, and 12 weeks; and 3 and 6 months after the last session. Results: Simultaneous and sequential treatments demonstrated comparable efficacy. Regarding the adverse events, the side of the face undergoing simultaneous treatment experienced longer swelling duration, higher pain levels during laser treatment, and shorter downtime. Conclusions: Despite the longer swelling time and higher pain levels during laser treatment in the simultaneous treatment side, the effectiveness and satisfaction level of the CO2 fractional laser and subcision for treatment of the acne scars were comparable between the two combinations, with a shorter downtime for the simultaneous than for the sequential combination therapy. [ABSTRACT FROM AUTHOR]

This paper examines a hitherto unreported use of the Gã Perfect gram termed the 'sequential perfect'. The sequential perfect represents a late stage of grammaticalization as it no longer conveys any aspectual information on its own, instead deriving its semantics from verbal categories in the prior discourse. It is primarily modal, being used for irrealis, habitual and iterative situations. It occurs in the non-initial clause of multiclausal constructions and signals that the event it marks is temporally posterior to another event. It also imparts the epistemic modal meanings of inevitability and certainty. I propose that these newer functions are developed from the core semantic components of change-of-state and completion. This involves grammaticalization via domain extension, where change-of-state within an event is extended to change between events. The investigation introduces a new pathway for grammaticalization of the perfect, which has implications for studies of the perfect and grammaticalization generally. [ABSTRACT FROM AUTHOR]

Objective response rate (ORR), overall survival (OS), and progression-free survival (PFS); and safety was assessed using the frequency of key adverse events (AEs). Results: Among the 76 patients included, the median maximum tumor diameter was 12.4 cm (range, 7.0– 23.4 cm). The overall ORRs based on mRECIST and RECIST 1.1 criteria were 94.1% and 51.5%, respectively. The median OS was 28.1 months (95% CI, 22.7– 33.4), and the median PFS was 11.7 months (95% CI, 7.7– 15.8). All patients experienced AEs, but only 18.4% experienced grade 3 or 4 AEs, there was no treatment-related mortality. Conclusion: In this single-center, retrospective study, our results suggested that FOLFOX-HAIC with sequential DEB-TACE demonstrated promising efficacy and safety for patients with unresectable HCC with a maximum tumor diameter of ≥ 7 cm. [ABSTRACT FROM AUTHOR]

This study introduces an innovative hybrid approach for personalized trip recommendations, aiming to enhance existing recommender systems by leveraging multidimensional data. Our proposed method integrates user preferences and diverse contextual factors to address challenges related to data sparsity effectively. To overcome this hurdle, our methodology employs a clustering approach, streamlining the extraction of Points of Interest (PoI) and reducing computational complexity. The framework comprises three key components: I) a unique strategy for context assessment, achieved by combining contextual information in vector form through the Term-Frequency-Inverse-Document-Frequency technique, II) the incorporation of tourist demographic information to alleviate the Cold Start problem, and III) the implementation of an asymmetric schema that elevates the traditional similarity paradigm. Moreover, our approach utilizes personalized PoIs in consecutive travel patterns, enabling the retrieval and ranking of an optimal list of potential routes. The experimental results based on Flickr and Yelp datasets reveal that the proposed method surpasses prior work on all three metrics, achieving a significant 8% increase in precision and an 11% increase in F-Score, thereby enhancing the quality metrics of personalized trip recommendations. [ABSTRACT FROM AUTHOR]

This study proposes a compact, low-profile, four-port dual-band monopole multiple-input-multiple-output (MIMO) antenna array for unmanned aerial vehicle (UAV) communication systems. Each monopole antenna of the array features a modified T-shaped radiator configuration and is printed on a Rogers RT5880 substrate with compact dimensions of 134.96 mm × 134.96 mm × 0.8 mm. A four-element square MIMO configuration with sequential 0°, 90°, 180°, and 270° rotations was integrated smoothly into the UAV body. A prototype of the MIMO array was fabricated and experimentally evaluated, with measured results showing a close correlation to simulated results. The proposed dual-band monopole antenna demonstrated one of the widest impedance bandwidths of 46.15% at 2.4 GHz (2.04 to 3.25 GHz) IEEE 802.11b and 31.85% at 5.8 GHz (5.37 to 7.38 GHz) IEEE 802.11a on a thin 0.0064 λo substrate while achieving high transmission efficiency. The isolation of the proposed four-port MIMO design was measured at 23 dB at 2.4 GHz and 19 dB at 5.8 GHz. The MIMO array's total efficiency of each monopole antenna was measured at 96% at 2.4 GHz and 89% at 5.8 GHz. The design has measured diversity parameters such as an ECC below 0.01 and a DG of approximately 10. Based on these results, the proposed design suits the UAV communication system. [ABSTRACT FROM AUTHOR]

Objectives: To comprehensively examine the characteristics and prognosis of bilateral sudden sensorineural hearing loss (BSSHL) and its subtypes compared to unilateral sudden sensorineural hearing loss (USSHL). Data Sources: PubMed, Scopus, and CINAHL. Review Methods: Databases were searched from inception to December 5, 2023, for studies reporting patient characteristics and audiometric outcomes for BSSHL and its simultaneous (Si‐BSSHL) and sequential (Se‐BSSHL) subtypes. Meta‐analysis of continuous measures, proportions (%), mean differences (Δ), and odds ratio (OR) were performed. Results: Eleven studies were included, consisting of 368 patients with BSSHL and 2,705 patients with USSHL. The pooled prevalence among all SSHL cases was 88.1% (95% CI: 81.2%–93.6%) for USSHL and 11.9% (95% CI: 6.4% to 18.8%) for BSSHL. PTA improvement following treatment with steroids was significantly worse in patients with BSSHL (Δ15.3 dB; 95% CI: 14.6 to 15.9; p < 0.0001) compared to patients with USSHL. There was no significant difference in post‐treatment PTA improvement between the BSSHL subtypes. Patients with Si‐BSSHL were significantly less likely to have an idiopathic etiology (OR: 0.4; 95% CI: 0.2 to 0.8; p = 0.01) and significantly more likely to have an autoimmune disease etiology (OR: 27.4; 95% CI: 2.2 to 336.1; p = 0.01), comorbid cardiovascular disease (OR: 2.3; 95% CI: 1.1 to 5.1; p = 0.03), and comorbid hypertension (OR: 2.5; 95% CI: 1.6 to 3.8; p < 0.0001) compared to patients with USSHL. Conclusions: BSSHL is a considerably rarer form of SSHL with worse prognosis compared to USSHL. BSSHL, and Si‐BSSHL in particular, has significantly greater associations with systemic pathologies compared to USSHL. Laryngoscope, 134:3883–3891, 2024 [ABSTRACT FROM AUTHOR]

Peiyu Xing,1,&ast; Yucheng Zhang,2,&ast; Yong Zhang,1 Shaowei Wang,2 Xiaojia Hu,1 Meihua Wang,1 Fan Xia,1 Yang Zhao,1 Wei Qu,2 Bo Meng2 1Department of Ophthalmology, China Medical University the Fourth People’s Hospital of Shenyang, Shenyang, People’s Republic of China; 2Department of Ophthalmology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Bo Meng, Department of Ophthalmology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China, Email m18204507737@163.comPurpose: The objective of this research was to assess the effectiveness and safety of using Conbercept injection and dexamethasone implant (DEX I) in sequence for treating refractory macular edema (ME) caused by central retinal vein occlusion (CRVO) in patients.Methods: A study was conducted on 34 patients with persistent macular edema caused by central retinal vein occlusion, reviewing their medical history and interventions performed. Sequential implantation of DEX I was performed 1 week after the Conbercept injection. OCTA images were used to measure central retinal thickness (CRT), best-corrected visual acuity (BCVA), intraocular pressure (IOP), and pre- and post-treatment vessel density of the superficial capillary plexus (SCP) and deep capillary plexus (DCP), with a 1-year follow-up period.Results: At the 12-month follow-up, participants demonstrated notable improvements in central retinal thickness and intraocular pressure (p < 0.05). Throughout the monitoring period, no significant differences were found in BCVA improvement or vessel density reduction (p > 0.05). Two patients required topical treatment to lower their intraocular pressure during the study period.Conclusion: In conclusion, patients experiencing persistent ME due to secondary CRVO may benefit from transitioning to a treatment regimen involving Conbercept and DEX I, potentially resulting in a reduction in CRT. However, no significant improvement was observed in BCVA or deep and superficial capillary plexus vessel density.Keywords: macular edema, sequential, central retinal thickness, best corrected visual acuity

Eradication of Helicobacter pylori (H. pylori) infection in children is challenging due to increased antibiotic resistance and decreased effectiveness of the current therapeutic choices, especially in developing countries. The purpose of this study is to compare the efficacy and safety of triple therapy (TT), sequential therapy (ST), hybrid therapy (HT), concomitant therapy (CT), and ciprofloxacin-based triple therapy (CTT) as an empirical therapy for H. pylori eradication in children. In this randomized controlled trial, 200 children (aged between 3 and 16 years) with both positive rapid urease test and histopathology for H. pylori infection were included. Patients were randomly assigned to receive either TT, ST, HT, CT, or CTT. The eradication status was evaluated using a stool antigen test (SAT) 4 weeks after stoppage of antibiotic therapy and 2 weeks after stoppage of proton pump inhibitors. SAT was performed using an ELISA monoclonal antibody-based kit. The most common presenting symptom was epigastric pain (79%). The most common endoscopic findings were gastric antral erythema (98%) and antral nodularity (54.5%). All gastric biopsies showed superficial lamina propria infiltration with plasma cells and lymphocytes. Active gastritis with neutrophils infiltration was seen in 75% of the cases. Gastric atrophy and intestinal metaplasia were uncommon histopathological findings (8.5% and 1%, respectively). The eradication rates for TT, ST, HT, CT, and CTT were 70%, 77.5%, 80%, 85%, and 90%, respectively, with the latter achieving a statistically significant difference when compared with TT (p = 0.025). The rate of occurrence of adverse effects among different regimens was not statistically different. Conclusion: As an empirical treatment for children with H. pylori infection, CTT is safe and provides the highest eradication rate. HT, ST, and CT might not be superior to TT. Trial registration: This study was registered at the Pan African Clinical Trials Registry, Cochrane South Africa, under the identifier PACTR202201686010590. Date of registration: 04 January 2022. What is Known: • Triple therapy has been the standard eradication regimen for pediatric H. pylori infection. The efficacy of triple therapy has decreased in many countries due to increased antibiotic resistance. What is New: • This randomized controlled trial is the first to compare triple therapy, sequential therapy, hybrid therapy, concomitant therapy, and ciprofloxacin-based triple therapy for the eradication of pediatric H. pylori infection. Triple therapy exhibited the lowest eradication rate among the studied regimens, suggesting it may not be an adequate therapeutic option for infected children. Ciprofloxacin-based triple therapy appears to be a safe and effective therapeutic choice for pediatric H. pylori infection. Additionally, this study provides the first reported eradication rate of hybrid therapy in pediatric H. pylori infection. [ABSTRACT FROM AUTHOR]

Markov Decision Process (MDP) is a popular mathematical framework for modeling stochastic sequential problems under uncertainty. These models appear in many applications, such as computer science, engineering, telecommunications, and finance, among others. One of the most challenging goals is to deal with complexity reduction in the case of large MDP. In this paper; we propose an optimal strategy deals with large MDP under discount reward. The proposed approach is based on an intelligent combination of a decomposition technique and an efficient parallel strategy. The global MDP is splitting into several 'sub-MDPs', subsequently, these MDPs are classified by level following the strongly connected components principle. A master-slave strategy base on Message Passing Interface (MPI) is proposed to solve the obtained problem. The performance of the proposed approach is shown in terms of scalability, cost, and execution speed. [ABSTRACT FROM AUTHOR]

The fundamental question of "what is the transport path of electrons through proteins?" initially introduced while studying long-range electron transfer between localized redox centers in proteins in vivo is also highly relevant to the transport properties of solid-state, dry metal-protein-metal junctions. Here, we report conductance measurements of such junctions, Au-(Azurin monolayer ensemble)-Bismuth (Bi) ones, with well-defined nanopore geometry and ~103 proteins/pore. Our results can be understood as follows. (1) Transport is via two interacting conducting channels, characterized by different spatial and time scales. The slow and spatially localized channel is associated with the Cu center of Azurin and the fast delocalized one with the protein's polypeptide matrix. Transport via the slow channel is by a sequential (noncoherent) process and in the second one by direct, off-resonant tunneling. (2) The two channels are capacitively coupled. Thus, with a change in charge occupation of the weakly coupled (metal center) channel, the broad energy level manifold, responsible for off-resonance tunneling, shifts, relative to the electrodes' Fermi levels. In this process, the off-resonance (fast) channel dominates transport, and the slow (redox) channel, while contributing only negligibly directly, significantly affects transport by intramolecular gating. [ABSTRACT FROM AUTHOR]

Pollinating fig wasps are believed to adjust their sex ratios according to standard local mate competition (LMC) theory.Standard LMC theory assumes that all mothers ovipositing in a patch or fig does so simultaneously. However, it has been shown that fig wasps can oviposit sequentially.We counted the number of figs containing dead and living mothers in figs where mothers entered naturally to estimate the incidence of sequential and simultaneous oviposition.Single mothers were the norm in two wasp species, and multiple mothers the norm in the other two. However, contrary to LMC theory, in all four species, when multiple mothers occurred, sequential oviposition seems to occur more frequently than simultaneous oviposition.The sex allocation problem fig wasp mothers face is thus more complicated than the widely assumed simultaneous ovipositing situation, and it leads to several expectations. Single mother's sex ratios should increase as the probability of additional mothers increases. Naturally founded multi‐mother figs should have more female‐biased sex ratios than the standard LMC model predicts for the final number of mothers. This is because early‐arriving mothers underestimate the number of mothers and lay more daughters than the final number of mothers would require and later‐arriving mothers can lay fewer sons to be competitive against the first mothers' too female‐biased clutches.Mothers must produce sex ratios that are optimised across a probabilistic range of foundress densities they experience. [ABSTRACT FROM AUTHOR]

Background/Aim: Rapamycin inhibits the mTOR protein kinase. Methioninase (rMETase), by degrading methionine, targets the methionine addiction of cancer cells and has been shown to improve the efficacy of chemotherapy drugs, reducing their effective doses. Our previous study demonstrated that rapamycin and rMETase work synergistically against colorectal-cancer cells, but not on normal cells, when administered simultaneously in vitro. In the present study, we aimed to further our previous findings by exploring whether synergy exists between rapamycin and rMETase when used sequentially against HCT-116 colorectal-carcinoma cells, compared to simultaneous administration, in vitro. Materials and Methods: The half-maximal inhibitory concentrations (IC50) of rapamycin alone and rMETase alone against the HCT-116 human colorectal-cancer cell line were previously determined using the CCK-8 cell viability assay (11). We then examined the efficacy of rapamycin and rMETase, both at their IC50, administered simultaneously or sequentially on the HCT-116 cell line, with rapamycin administered before rMETase and vice versa. Results: The IC50 for rapamycin and rMETase, determined from previous experiments (11), was 1.38 nM and 0.39 U/ml, respectively, of HCT-116 cells. When rMETase was administered four days before rapamycin, both at the IC50, there was a 30.46% inhibition of HCT-116 cells. When rapamycin was administered four days before rMETase, both at the IC50, there was an inhibition of 41.13%. When both rapamycin and rMETase were simultaneously administered, both at the IC50, there was a 71.03% inhibition. Conclusion: Rapamycin and rMETase have synergistic efficacy against colorectal-cancer cells in vitro when administered simultaneously, but not sequentially. [ABSTRACT FROM AUTHOR]

Background and Aim: There is no consensus on the appropriate use of mixtures of local anaesthetic drugs in various combinations for nerve blocks. We intended to compare short-acting lignocaine and long-acting ropivacaine as a mixture versus undiluted sequential injections on block characteristics of ultrasound-guided (USG) supraclavicular brachial plexus block for upper limb surgeries. Methods: A double-blinded randomised study was conducted on 64 adult patients scheduled for upper limb surgery who received 15 mL each of 2% lignocaine with adrenaline and 0.75% ropivacaine as a 1:1 mixture in the mixed group (Group M) or sequential injections in the sequential group (Group S) by using a USG technique. The primary outcome was the percentage of participants with complete four nerve sensory blocks at 10 minutes post block injection. Secondary outcomes were sensory and motor block characteristics till 30 minutes, total duration of analgesia, sensory and motor block, and complications. Results: Demographic characteristics and time taken for the procedure were similar. The percentage of participants with a complete four-nerve sensory block at 10 minutes was higher in Group S (69%) versus Group M (41%) (P = 0.04). Complete sensory and motor block rates were similar at 30 minutes. The block procedure time, total duration of analgesia, and sensory and motor block were similar in both groups. There were no major complications. Conclusion: Sequential lignocaine-ropivacaine, compared to the mixed injection technique, has a higher initial rate of sensory and motor block onset with a similar total block duration. [ABSTRACT FROM AUTHOR]

Once hailed as a ‘wonder material'’ for its low cost, durability, lightweight, flexibility, and water resistance, plastics have now become one of the potent threats to human civilization. Imperatively, light and microbes could play significant roles in plastic degradation. Plastic–semiconductor composites enhance photodegradation, whereas the presence of biodegradable compound in composites may facilitate their degradation by soil microbes. In this work, composite films of polyvinyl chloride (PVC) and zinc oxide semiconductor (ZnO) are synthesized in various combinations and subjected to sequential photo- and biodegradation. The photodegradation was exclusively solar, whereas polycaprolactone (PCL) was apprehensively added to the composite for enhancing the biodegradability. The process sequence was also altered to investigate the possible effects. Sequential photocatalytic degradation under sunlight and biodegradation by bacteria isolated from soil could decrease the original weight of a photo-bio degradable polymer composite film comprising of PVC, PCL and ZnO in less than a month. The isolated microbe was later identified as Bacillus altitudinis by 16S rRNA gene sequencing. Identification and isolation of enzymes involved in PVC degradation by the isolated strain may be included in future work. Maximum 26.8 w% degradation was observed within 25 days in case of PVC–ZnO composite. The role of PCL was found to be insignificant in biodegradation especially in presence of ZnO. The solar photodegradation was modelled based on a proposed mechanism that finally led to two parallel reaction pathways following first- and zero-order kinetics, respectively. Biodegradation, on the other hand, was noted to be fairly consistent with the Michaelis–Menten kinetics.Article Highlights: Polymer composite is degraded by sunlight and microbes. Sequences of photo and bio degradation are altered Kinetic data are modelled for both photo and bio degradation Natural degradation of polymer composite is enhanced [ABSTRACT FROM AUTHOR]

Purpose: Concurrent chemoradiation is the standard of care for the treatment of anal cancer. Radiation can be delivered by sequential or simultaneous integrated boost (SIB) approach. The present study was conducted to compare the treatment outcomes and toxicity profile of patients with anal cancer treated with sequential boost and SIB approach. Methods: A single-institution retrospective analysis of patients with squamous cell carcinoma of the anal canal treated between 2019 and 2022 with radical chemoradiation was performed. The sequential boost schedule consisted of 45 Gy in 25 fractions (1.8 Gy daily) to the gross tumor, nodes, and elective nodal volume, followed by a 9 Gy in five fractions boost to the gross disease. Patients receiving SIB were treated as per RTOG 0529 protocol. In both the groups, patients were treated with volumetric modulated arc therapy (VMAT). The two groups were compared in terms of overall survival (OS), colostomy-free survival (CFS), relapse-free survival (RFS), and acute toxicity profile. p-values < 0.05 were considered statistically significant. Results: The patient and disease characteristics in both treatment arms were comparable. The only difference was a significantly longer overall treatment time of ≥ 50 days in the sequential arm (77.8% vs 43.8%, p = 0.04). The median follow-up was 18 months. The 2-year CFS was 80% in sequential vs 87.5% at 2 years for the SIB arm, 2-year OS 83.3% vs 58.6%, and 2-year RFS was 38.9% vs 41.7%, respectively. A total of 14 (77.8%) in sequential and 8 (50%) in the SIB arm had disease relapse. On univariate analysis, the involved pelvic lymph node significantly affected OS (HR 10.45, p = 0.03) while inguinal lymph node involvement adversely affected RFS (HR 6.16, p = 0.02). The most common acute toxicity was radiation-induced dermatitis, 15 (83.4%; 5 grade II, 10 grade III) in sequential vs 7 (43.8%; 3 each grade II and III) in the SIB group followed by hematological (61.1% vs 68.75%). However, the incidence of overall acute toxicities was significantly less in the SIB arm (p = 0.006). Conclusion: Our study showed that concurrent chemoradiation with the SIB-VMAT approach is well tolerated in patients of anal carcinoma and resulted in lesser treatment interruptions and comparable outcomes as compared to the sequential approach. Our results warrant further evaluation in a prospective study. [ABSTRACT FROM AUTHOR]

IntroductionMucosal deficiency is one of the most challenging conditions in patients with acute severe ulcerative colitis (ASUC). Intravenous corticosteroids (CS) are the first-line treatment, with infliximab (IFX) used as a rescue therapy. However, the efficacy remains unsatisfactory. We investigated whether CS combined with IFX as first-line therapy would improve outcomes in patients with ASUC with mucosal deficiency.MethodsA retrospective study was performed at a tertiary inflammatory bowel disease center. The primary outcomes included clinical remission, endoscopic improvement, and endoscopic remission at week 14. The secondary outcomes included the colectomy rate within 90 days and durable clinical remission.ResultsA total of 43 patients with ASUC with mucosal deficiency were included in the analysis (25 in the CS combined with the IFX group and 18 in the CS sequential IFX group). At week 14, endoscopic improvement was observed in 21 of 25 patients (84.0%) receiving the CS combined with the IFX regimen, compared to 9 of 18 (50.0%) patients receiving the CS sequential IFX regimen (p = 0.017). Durable clinical remission rates were significantly higher in the combined group than in the sequential group (85.7% vs. 35.7%, p = 0.004). There was no statistically significant difference between the two groups in terms of clinical and endoscopic remission at week 14 or colectomy rate within 90 days. Multivariate analysis confirmed that the CS combined with the IFX regimen was an independent predictive factor for a higher endoscopic improvement rate at week 14 (odds ratio (OR) 8.428, 95%confidence interval (CI) 1.539–46.153, p = 0.014) and a higher durable clinical remission rate (OR 10.800, 95%CI 2.095–55.666, p = 0.004).ConclusionCS combined with IFX as first-line therapy may be an effective induction strategy in patients with ASUC with mucosal deficiency. Further large-scale, multicenter prospective studies are needed.

Mechanical metamaterials signify a groundbreaking leap in material science and engineering. The intricate and experience-dependent design process poses a challenge in uncovering architectural material sequences with exceptional mechanical properties. This study introduces inverse-designed 3D sequential metamaterials with outstanding mechanical attributes, achieved through a novel computational framework. The explored sequences based on Schoen's I-graph–wrapped package (IWP) and Schwarz Primitive (Schwarz P) surpass the Hashin-Shtrikman upper bound of Young's modulus at relative densities of 0.24 and 0.43, outperforming previous records. Optimized Body-Centered-Cubic (BCC) truss-based sets outperform traditional ones by 72.7%. This innovative approach can be extended for metamaterial customization, involving the optimization of multi-directional Young's modulus, total stiffness, and the addition of isotropy constraints. The paper explores the characteristics and implications of this innovation, emphasizing the impact of geometric and topological variations on mechanical performance. These metamaterial sequences offer unparalleled adaptability, and hold significant potential in structural engineering and adaptive mechanical systems, opening avenues for technological advancements.

AbstractTherapist responsiveness denotes that therapists provide therapeutic interventions within an emerging context of client manifestations and moment-by-moment internal and external changes. So far, psychotherapy research on explaining how therapy works falls short of operationalizing the sequence of events constituted by therapist responsiveness. The present special section of Psychotherapy Research addresses this conceptual and methodological gap and proposes six original contributions, using several validated assessment protocols, both from a quantitative and qualitative viewpoint, to study therapist responsiveness in psychotherapy. It aims at providing a rigorous conceptual and methodological basis for studying a core principle of change in psychotherapy for the future. [ABSTRACT FROM AUTHOR]

Background and Aim: There is no consensus on the appropriate use of mixtures of local anaesthetic drugs in various combinations for nerve blocks. We intended to compare short-acting lignocaine and long-acting ropivacaine as a mixture versus undiluted sequential injections on block characteristics of ultrasound-guided (USG) supraclavicular brachial plexus block for upper limb surgeries. Methods: A double-blinded randomised study was conducted on 64 adult patients scheduled for upper limb surgery who received 15 mL each of 2% lignocaine with adrenaline and 0.75% ropivacaine as a 1:1 mixture in the mixed group (Group M) or sequential injections in the sequential group (Group S) by using a USG technique. The primary outcome was the percentage of participants with complete four nerve sensory blocks at 10 minutes post block injection. Secondary outcomes were sensory and motor block characteristics till 30 minutes, total duration of analgesia, sensory and motor block, and complications. Results: Demographic characteristics and time taken for the procedure were similar. The percentage of participants with a complete four-nerve sensory block at 10 minutes was higher in Group S (69%) versus Group M (41%) (P = 0.04). Complete sensory and motor block rates were similar at 30 minutes. The block procedure time, total duration of analgesia, and sensory and motor block were similar in both groups. There were no major complications. Conclusion: Sequential lignocaine-ropivacaine, compared to the mixed injection technique, has a higher initial rate of sensory and motor block onset with a similar total block duration.

A significant proportion of the world's population has no access to grid-based electricity and so relies on off-grid lighting solutions. Rechargeable lamp technology is gaining popularity as an alternative off-grid lighting model in developing countries. In this paper, we explore consumer behavior and the operational inefficiencies that result under this model. Specifically, we are interested in (i) measuring the impact of inconvenience (of traveling to recharge the lamp) along with the impact of liquidity constraints (because of poverty) on lamp usage and (ii) evaluating the efficacy of strategies that address these factors. We build a structural model of consumers' recharge decisions that incorporates several operational features of the low-income regions. We conducted large-scale field experiments in Rwanda in partnership with a local rechargeable lamp operator and use the resultant data to estimate and test our model. We find that the complete removal of inconvenience and liquidity constraints from the current business model results in 73% and 126% increases in both recharges and revenue, thereby suggesting that these constraints are major sources of inefficiency. By implementing simple operations-based strategies—such as starting more recharge centers, visiting consumers periodically to collect their lamps for recharge, and allowing consumers to partially recharge their lamps and pay flexibly for the recharge—more than half the benefit of completely eliminating the inefficiencies can be attained. By contrast, the price- and capacity-based strategies that vary the economic variables (i.e., the amount paid per recharge and the amount of light obtained in return) but not the operational model perform far worse than the aforementioned strategies. Overall, our analysis emphasizes the importance of managing operations effectively even in markets with cash-constrained consumers, in which firms may have a natural tendency to focus more on reducing prices. This paper was accepted by Vishal Gaur, operations management. Funding: This work was supported by the International Growth Centre; Wharton School, University of Pennsylvania; and Institut Européen d'Administration des Affaires; The Environment and Energy Partnership; Grand Challenges Canada (Stars in Global Health); INSEAD's Emerging Markets Institute; INSEAD's Randomized Controlled Trials Laboratory; the INSEAD–Wharton Alliance, and International Growth Centre. Supplemental Material: The online appendix and data are available at https://doi.org/10.1287/mnsc.2023.4844. [ABSTRACT FROM AUTHOR]

Trabecular bone score (TBS) is a grayscale textural assessment resulting from a computed evaluation of pixel gray-level variations in previously obtained lumbar spine DXA images. It is an index of bone microarchitecture correlated with parameters of bone strength. Higher values of TBS indicate a better microarchitecture, whereas lower values indicate a degraded microarchitecture. TBS can be used alongside Fracture Risk Assessment tool "FRAX" and bone mineral density (BMD) to enhance the assessment of fracture risk and to inform treatment initiation and monitoring. A systematic review was carried out aiming to update the evidence on the clinical use of the TBS in the management of both primary and secondary osteoporosis. Results revealed that in both primary and secondary osteoporosis, TBS enhances the prediction of fracture risk, and when adjust with BMD and clinical risk factors, it is able to inform the decision-making process regarding initiating osteoporosis therapy and the choice of anti-osteoporosis medication. Evidence also implies that TBS provides valuable adjunctive information in monitoring osteoporosis therapy. In conclusion, this work provides an up-to-date evidence-based review and recommendations which informs the utility of trabecular bone score in standard clinical practice. [ABSTRACT FROM AUTHOR]

An innovative ultrasonic-assisted enzymatic aqueous two-phase extraction (UAE-ATPE) method was applied to enhance the yield from Strobilanthes crispus leaves, exploring both sequential and simultaneous approaches. Comparative analysis included assessing total phenolic content (TPC), total flavonoid content (TFC), partition coefficient (k) and recovery (R). Liquid chromatography-mass spectrometry and scanning electron microscopy evaluated extracts from both techniques. Simultaneous UAE-ATPE demonstrated significantly higher TPC (5.7±0.1 mg GAE/g dry leaves) and TFC (3.3±0.1 mg QE/g dry leaves) compared to sequential extraction, where TPC and TFC measured 4.5±0.3 mg GAE/g dry leaves and 1.7±0.1 mg QE/g dry leaves. Additionally, simultaneous UAE-ATPE yielded higher k and R values for phenolic and flavonoid compounds. Notably, it identified 32.4% of the area corresponding to 6 compounds, surpassing the 25.3% area identified sequentially with 13 compounds. A collaborative effect of enzymatic hydrolysis and ultrasonic extraction was observed in simultaneous UAE-ATPE. In the inhibition test on the HMG-CoA reductase enzyme, simultaneous UAE-ATPE extract (200 µg/mL) exhibited exceptional results, achieving superior inhibition of 66.1% compared to the sequential method's inhibition of 39.4%. This underscores the efficacy of simultaneous UAE-ATPE in producing concentrated anti-cholesterol compounds. The study strongly emphasizes the superiority of simultaneous UAE-ATPE over the sequential approach. [ABSTRACT FROM AUTHOR]

Background: This study compared rapid and slow intrathecal fentanyl injection followed by a slow injection of bupivacaine to estimate the duration of postoperative analgesia in lower-segment caesarean sections (LSCS). Methods: The study was performed on 60 parturient aged 18-35 years undergoing LSCS and was divided equally into two groups. Group A (Normal Sequential) received slow sequential intrathecal injections of fentanyl and hyperbaric bupivacaine and Group B (Rapid Sequential) received a rapid intrathecal injection of fentanyl followed by a slow injection of hyperbaric bupivacaine. We compared the duration of postoperative analgesia, time of onset of sensory and motor block attained, the highest level of sensory block attained, duration of motor block, Visual Analogue Scale (VAS) scores, spinal anaesthesia-related complications and haemodynamic parameters between both the groups. Results: The duration of postoperative analgesia was longer (P < 0.001) in group B (3.22 ± 0.66 hrs) as compared to group A (2.53 ± 0.41 hrs.) The onset of sensory block was faster (P < 0.001) in group B (1.01 ± 0.29 min) as compared to group A (1.32 ± 0.08 min). More patients in group B achieved higher levels of sensory blockade as compared to group A (5 patients in group A and 12 patients ofgroup B achieved a sensory block up to the T2 dermatome). VAS scores and the requirement of rescue analgesia were significantly lower (10 in group B and 19 in group A). Conclusion: Rapid sequential intrathecal injection of fentanyl and hyperbaric bupivacaine provided better anaesthesia and postoperative analgesia than the normal group.

This study proposes a compact, low-profile, four-port dual-band monopole multiple-input-multiple-output (MIMO) antenna array for unmanned aerial vehicle (UAV) communication systems. Each monopole antenna of the array features a modified T-shaped radiator configuration and is printed on a Rogers RT5880 substrate with compact dimensions of 134.96 mm × 134.96 mm × 0.8 mm. A four-element square MIMO configuration with sequential 0°, 90°, 180°, and 270° rotations was integrated smoothly into the UAV body. A prototype of the MIMO array was fabricated and experimentally evaluated, with measured results showing a close correlation to simulated results. The proposed dual-band monopole antenna demonstrated one of the widest impedance bandwidths of 46.15% at 2.4 GHz (2.04 to 3.25 GHz) IEEE 802.11b and 31.85% at 5.8 GHz (5.37 to 7.38 GHz) IEEE 802.11a on a thin 0.0064 λo substrate while achieving high transmission efficiency. The isolation of the proposed four-port MIMO design was measured at 23 dB at 2.4 GHz and 19 dB at 5.8 GHz. The MIMO array’s total efficiency of each monopole antenna was measured at 96% at 2.4 GHz and 89% at 5.8 GHz. The design has measured diversity parameters such as an ECC below 0.01 and a DG of approximately 10. Based on these results, the proposed design suits the UAV communication system.

To compare the outcomes of Descemet membrane endothelial keratoplasty (DMEK) performed after phacoemulsification and intraocular lens (IOL) implantation (sequential DMEK) and DMEK combined with phacoemulsification and IOL implantation (combined DMEK) in patients with Fuchs endothelial corneal dystrophy (FECD) and cataract. Systematic literature review and meta‐analysis performed according to the PRISMA guidelines and registered in PROSPERO. Literature searches were conducted in Medline and Scopus. Comparative studies reporting sequential DMEK and combined DMEK in FECD patients were included. The main outcome measure of the study was the corrected distance visual acuity (CDVA) improvement. Secondary outcomes were postoperative endothelial cell density (ECD), rebubbling rate and primary graft failure rate. Bias risk was assessed and a quality appraisal of the body of evidence was completed using the Cochrane Robin‐I tool. A total of 667 eyes (5 studies) were included in this review, 292 eyes (43.77%) underwent a combined DMEK, while 375 (56.22%) eyes underwent a sequential DMEK surgery. We found no evidence of a difference between the two groups (mean difference, 95% CI) regarding: (1) CDVA improvement (−0.06; −0.14, 0.03 LogMAR; 3 studies, I2: 0%; p = 0.86); (2) postoperative ECD (−62; −190, 67 cells/mm2; 4 studies, I2: 67%; p = 0.35); (3) rebubbling (risks ratio: 1.04; 0.59, 1.85; 4 studies, I2: 48%; p = 0.89); and primary graft failure rate (risks ratio: 0.91; 0.32, 2.57; 3 studies, I2: 0%; p = 0.86). Of all the 5 non‐randomized studies, all (100%) were graded as low quality. The overall quality of the analysed studies was low. Randomized controlled trials are needed to confirm no difference or superiority of one approach in terms of CDVA, endothelial cell count and postoperative complication rate between the two arms. [ABSTRACT FROM AUTHOR]

Safety-critical systems used in applications that demand high levels of dependability, efficiency, and fault-tolerance often use sequential logic circuits in its design and implementation. The safety-critical digital system typically uses latches, flip-flops, and other memory elements, which are prone to the effects of natural faults and single event upsets (SEUs) caused by radiation-induced effects. The faults can lead to subsystem failures due to the continuous advancement in the realization of the small size transistor. To design a reliable digital-based system, it is essential to develop new faulttolerance approaches that are integrated into the design of sequential logic circuits. This work proposes a novel fault-tolerant approach based on the redundancy of sequential logic circuit, which consists of a variety of design components, D flip-flop storage elements linked to a fault injection unit, a duplicate modular redundancy, and data monitoring units with a switching circuit. The experimental simulation results using a five-state Markov chain analysis model prove that the proposed fault-tolerant system can achieve 0.99999998 for reliability of the fault detection coverage (C) which equal to 0.99999. Finally, we believe that using this new approach of fault-tolerance and redundancy would improve the dependability and reliability of next generation safety-critical applications. [ABSTRACT FROM AUTHOR]

Background: Treating Helicobacter pylori is becoming increasingly difficult with the development of bacterial resistance to many established treatment regimens. As a result, researchers are constantly looking for novel and effective treatments. This trial aims to establish the efficacy of levofloxacin-based sequential treatment regimen and concomitant levofloxacin-based regimen as empirical first-line therapy in the Syrian population. Method: This is an open-label, prospective, single-center, parallel, active-controlled, superiority, randomized clinical trial. The recruitment will target Helicobacter pylori-positive males and females between the ages of 18 and 65 to evaluate the efficacy of empirical first-line therapy in the Syrian population. We are planning to recruit up to 300 patients which is twice the required sample size. One hundred fifty individuals will be randomly assigned to undergo either a sequential levofloxacin-based treatment regimen or a concomitant levofloxacin-based regimen. High-dose dual therapy (proton-pump inhibitor and amoxicillin) will be the rescue therapy in the event of first-line failure. The first-line eradication rate in both groups is the primary outcome, and one of the secondary outcomes is the overall eradication rate of high-dose dual therapy in the event of first-line treatment protocol failure. Intention-to-treat analysis and per-protocol analysis will be used to evaluate the eradication rates of Helicobacter pylori for first-line treatment protocols. Discussion: For the first time in the Syrian population, this randomized controlled trial will provide objective and accurate evidence about the efficacy of a sequential levofloxacin-based treatment regimen. Trial registration: ClinicalTrials.gov NCT06065267. Registered on October 3, 2023. Prospective registered. Enrollment of the first participant has not started yet. [ABSTRACT FROM AUTHOR]

Background: More understanding of the physiological needs of the embryo during its growth from the zygote to the blastocyst stage, as well as the composition of the uterine andfallopian tubal secretions, has led to the development of single-step or sequential culture media. Objectives: The present study aimed to investigate the utilization of mCR2aa culture medium as a sequential culture medium for embryo development, supplemented with platelet lysate (PL) to decrease the concentration of fetal bovine serum (FBS) in the embryo culture medium. Methods: After maturation and fertilization of sheep oocytes obtained from a slaughterhouse, potential zygotes were cultured in mCR2aa medium without FBS for two days (C1, 1 - 3 days of culture). In the second two days of culture (C2, 3 - 5 days of culture), 2.5% or 5% of FBS and 5% or 10% of PL were used. In the remaining days of culture (C3, 5 - 9 days of culture), 2.5%, 5%, or 10% of FBS, and 0%, 2.5%, 5%, or 10% of PL were used. These percentages were compared to the commercial BO-IVC™ medium and mCR2aa medium, both of which contained 10% of FBS. Results: No significant difference was observed in the number of produced blastocysts between different treatments and the control. However, the number of hatched blastocysts in BO-IVC™, as a single-step culture medium, significantly differed from that of the other treatments. The number of hatched blastocysts in the sequential culture medium was higher in media supplemented with 2.5% FBS and 10% PL in the C2 mCR2aa medium, and 2.5% FBS without PL in the C3 mCR2aa medium, but no significant difference was observed in other treatments. However, increasing the concentration of FBS and PL in the C3 mCR2aa medium significantly decreased the number of hatched blastocysts. Conclusions: An increase in the percentage of PL to 10% necessitated a decrease in FBS to 2.5% in the C2 mCR2aa medium, while PL in the C3 mCR2aa medium was not required in the presence of 2.5% FBS. [ABSTRACT FROM AUTHOR]

Background: This study compared rapid and slow intrathecal fentanyl injection followed by a slow injection of bupivacaine to estimate the duration of postoperative analgesia in lower-segment caesarean sections (LSCS). Methods: The study was performed on 60 parturient aged 18-35 years undergoing LSCS and was divided equally into two groups. Group A (Normal Sequential) received slow sequential intrathecal injections of fentanyl and hyperbaric bupivacaine and Group B (Rapid Sequential) received a rapid intrathecal injection of fentanyl followed by a slow injection of hyperbaric bupivacaine. We compared the duration of postoperative analgesia, time of onset of sensory and motor block attained, the highest level of sensory block attained, duration of motor block, Visual Analogue Scale (VAS) scores, spinal anaesthesia-related complications and haemodynamic parameters between both the groups. Results: The duration of postoperative analgesia was longer (P < 0.001) in group B (3.22 ± 0.66 hrs) as compared to group A (2.53 ± 0.41 hrs.) The onset of sensory block was faster (P < 0.001) in group B (1.01 ± 0.29 min) as compared to group A (1.32 ± 0.08 min). More patients in group B achieved higher levels of sensory blockade as compared to group A (5 patients in group A and 12 patients ofgroup B achieved a sensory block up to the T2 dermatome). VAS scores and the requirement of rescue analgesia were significantly lower (10 in group B and 19 in group A). Conclusion: Rapid sequential intrathecal injection of fentanyl and hyperbaric bupivacaine provided better anaesthesia and postoperative analgesia than the normal group. [ABSTRACT FROM AUTHOR]

Backgrounds and Aims: This controlled randomized clinical trial was designed to compare effectiveness, side effects, and severity of symptoms before and after therapy between quadruple (QT) and sequential regimens (SQ) for Helicobacter Pylori (H. pylori). Methods: Patients were randomly allocated into two groups. Group A received a 14‐day QT including pantoprazole 40 mg q12 h, bismuth subcitrate 240 mg q12 h, clarithromycin 500 mg q12 h, and amoxicillin 1000 mg q12 h and group B received ST including pantoprazole 40 mg q12 h and amoxicillin 1000 mg q12 h for the initial 5 days followed by pantoprazole 40 mg q12 h, clarithromycin 500 mg q12 h and tinidazole 500 mg q12 h for the next 5 days. Adverse drug reactions and patients' compliance were assessed after finishing the treatment course and also 4 weeks after. All patients were naive, therefore ST and QT were first‐line therapies. To evaluate severity of symptoms we used Short‐Form Leeds Dyspepsia Questionnaire (SF‐LDQ) before taking the first dose of regimens, at the end of therapy, and also 4 weeks after (follow‐up). Results: The mean age in Group A (n = 83) was 48.55 ± 12.56 and 47.24 ± 12.78 in Group B (n = 79). No statistically significant differences were observed between the two groups regarding age, gender, endoscopic findings, and also eradication rate. The analysis demonstrated a significant decrease in SF‐LDQ score between baseline and after therapy and baseline and follow‐up in both regimen groups. Both regimens were well tolerated by the majority of patients, and there were no significant differences between the two groups in terms of adverse drug reactions Conclusion: This study showed that ST can be used as an alternative first‐line therapy to QT in patients with H. pylori infection. [ABSTRACT FROM AUTHOR]

Computing the solution of the Caputo fractional differential equation plays an important role in using the order of the fractional derivative as a parameter to enhance the model. In this work, we developed a power series solution method to solve a linear Caputo fractional differential equation of the order q , 0 < q < 1 , and this solution matches with the integer solution for q = 1 . In addition, we also developed a series solution method for a linear sequential Caputo fractional differential equation with constant coefficients of order 2 q , which is sequential for order q with Caputo fractional initial conditions. The advantage of our method is that the fractional order q can be used as a parameter to enhance the mathematical model, compared with the integer model. The methods developed here, namely, the series solution method for solving Caputo fractional differential equations of constant coefficients, can be extended to Caputo sequential differential equation with variable coefficients, such as fractional Bessel's equation with fractional initial conditions. [ABSTRACT FROM AUTHOR]

Study data from World Health Organization indicate that 2.8% of the disease around the world is caused by micronutrient insufficiency due to improper consumption of a balanced diet. The micronutrient deficiency is detected from the individual's blood sample which is an invasive technique. Such techniques are quite in comfort for the persons and also painful. This proposed method involves the micronutrient deficiency identification using the non-invasive method of image processing. In this work, images of the anterior conjunctiva of eye, tongue and nail bed are used to detect the deficiency. Convolutional neural network models are used in the proposed deep learning model to extract the features of the parts of eye, nail and tongue. CNN-LSTM and CNN-GRU architectures are used to predict the deficiency in the images by extracting the features and perform the classification. A collection of 140 images were used as a dataset in this system. The real-time images are used to train the model, which is then validated with sample images for increased accuracy. The simulation of the CNN network with CNN-GRU has very low MSEs with 0.22%, results show that the proposed system achieved an accuracy of 99.6%, specificity of 99.7% and sensitivity of 99.4%. [ABSTRACT FROM AUTHOR]

Abstract Background Germline genetic testing is recommended by the National Comprehensive Cancer Network (NCCN) for individuals including, but not limited to, those with a personal history of ovarian cancer, young-onset (

Computing the solution of the Caputo fractional differential equation plays an important role in using the order of the fractional derivative as a parameter to enhance the model. In this work, we developed a power series solution method to solve a linear Caputo fractional differential equation of the order q,0

In this paper, by assuming certain assumptions, we study a novel class of sequential Caputo fractional differential equations (FDE) Consist of antiperiodic and Riemann-Liouville (R-L) fractional integral boundary conditions. The existence and uniqueness of the solution to the proposed class of problems utilizing the fixed point theory and some new equalities of norm form are investigated. At the end of the paper, two specific examples of the study results are offered to demonstrate its performance and effectiveness.

Summary: Background: The sequential anti-osteoporotic treatment for women with postmenopausal osteoporosis (PMO) is important, but the order in which different types of drugs are used is confusing and controversial. Therefore, we performed a network meta-analysis to compare the efficacy and safety of available sequential treatments to explore the most efficacious strategy for long-term management of osteoporosis. Methods: In this network meta-analysis, we searched the PubMed, EMBASE, Web of Science, the Cochrane Library, and ClinicalTrials.gov from inception to September 19, 2023 to identify randomised controlled trials comparing sequential treatments for women with PMO. The identified trials were screened by reading the title and abstract, and only randomised clinical trials involving sequential anti-osteoporotic treatments and reported relevant outcomes for PMO were included. The main outcomes included vertebral fracture risk, the percentage change in bone mineral density (BMD) in different body parts, and all safety indicators in the stage after switching treatment. A frequentist network meta-analysis was performed using the multivariate random effects method and evaluated using the surface under the cumulative ranking curve (SUCRA). Certainty of evidence was assessed using the Confidence in the Network Meta-Analysis (CINeMA) framework. This study is registered with PROSPERO: CRD42022360236. Findings: A total of 19 trials comprising 18,416 participants were included in the study. Five different sequential treatments were investigated as the main interventions and compared to the corresponding control groups. The intervention groups in this study comprised the following treatment switch protocols: switching from an anabolic agent (AB) to an anti-resorptive agent (AR) (ABtAR), transitioning from one AR to another AR (ARtAAR), shifting from an AR to an AB (ARtAB), switching from an AB to a combined treatment of AB and AR (ABtC), and transitioning from an AR to a combined treatment (ARtC). A significant reduction in the incidence of vertebral fractures was observed in ARtC, ABtAR and ARtAB in the second stage, and ARtC had the lowest incidence with 81.5% SUCRA. ARtAAR and ABtAR were two effective strategies for preventing fractures and improving BMD in other body parts. Especially, ARtAAR could improve total hip BMD with the highest 96.1% SUCRA, and ABtAR could decrease the risk of total fractures with the highest 94.3% SUCRA. Almost no difference was observed in safety outcomes in other comparisons. Interpretation: Our findings suggested that the ARtAAR and ABtAR strategy are the effective and safe sequential treatment for preventing fracture and improving BMD for PMO. ARtC is more effective in preventing vertebral fractures. Funding: The National Natural Science Foundation of China (82170900, 81970762), the Hunan Administration of Traditional Chinese Medicine, and the Hunan Province High-level Health Talents ''225'' Project.

A simple, inexpensive, and efficient synthesis of 1,4-dihydropyridines in good yield in the presence of an organocatalyst N-(phenylsulfonyl)benzene sulfonamide in an eco-friendly solvent at 75 °C is described. The key advantages of the present method are high yields, short reaction time, easy workup, catalyst recycling, and reusability, which gives economic and ecological rewards at a mild temperature.

Abstract Backgrounds and Aims This controlled randomized clinical trial was designed to compare effectiveness, side effects, and severity of symptoms before and after therapy between quadruple (QT) and sequential regimens (SQ) for Helicobacter Pylori (H. pylori). Methods Patients were randomly allocated into two groups. Group A received a 14‐day QT including pantoprazole 40 mg q12 h, bismuth subcitrate 240 mg q12 h, clarithromycin 500 mg q12 h, and amoxicillin 1000 mg q12 h and group B received ST including pantoprazole 40 mg q12 h and amoxicillin 1000 mg q12 h for the initial 5 days followed by pantoprazole 40 mg q12 h, clarithromycin 500 mg q12 h and tinidazole 500 mg q12 h for the next 5 days. Adverse drug reactions and patients' compliance were assessed after finishing the treatment course and also 4 weeks after. All patients were naive, therefore ST and QT were first‐line therapies. To evaluate severity of symptoms we used Short‐Form Leeds Dyspepsia Questionnaire (SF‐LDQ) before taking the first dose of regimens, at the end of therapy, and also 4 weeks after (follow‐up). Results The mean age in Group A (n = 83) was 48.55 ± 12.56 and 47.24 ± 12.78 in Group B (n = 79). No statistically significant differences were observed between the two groups regarding age, gender, endoscopic findings, and also eradication rate. The analysis demonstrated a significant decrease in SF‐LDQ score between baseline and after therapy and baseline and follow‐up in both regimen groups. Both regimens were well tolerated by the majority of patients, and there were no significant differences between the two groups in terms of adverse drug reactions Conclusion This study showed that ST can be used as an alternative first‐line therapy to QT in patients with H. pylori infection.

Background: Germline genetic testing is recommended by the National Comprehensive Cancer Network (NCCN) for individuals including, but not limited to, those with a personal history of ovarian cancer, young-onset (< 50 years) breast cancer, and a family history of ovarian cancer or male breast cancer. Genetic testing is underused overall, and rates are consistently lower among Black and Hispanic populations. Behavioral economics-informed implementation strategies, or nudges, directed towards patients and clinicians may increase the use of this evidence-based clinical practice. Methods: Patients meeting eligibility for germline genetic testing for breast and ovarian cancer will be identified using electronic phenotyping algorithms. A pragmatic cohort study will test three sequential strategies to promote genetic testing, two directed at patients and one directed at clinicians, deployed in the electronic health record (EHR) for patients in OB-GYN clinics across a diverse academic medical center. We will use rapid cycle approaches informed by relevant clinician and patient experiences, health equity, and behavioral economics to optimize and de-risk our strategies and methods before trial initiation. Step 1 will send patients messages through the health system patient portal. For non-responders, step 2 will reach out to patients via text message. For non-responders, Step 3 will contact patients' clinicians using a novel "pend and send" tool in the EHR. The primary implementation outcome is engagement with germline genetic testing for breast and ovarian cancer predisposition, defined as a scheduled genetic counseling appointment. Patient data collected through the EHR (e.g., race/ethnicity, geocoded address) will be examined as moderators of the impact of the strategies. Discussion: This study will be one of the first to sequentially examine the effects of patient- and clinician-directed strategies informed by behavioral economics on engagement with breast and ovarian cancer genetic testing. The pragmatic and sequential design will facilitate a large and diverse patient sample, allow for the assessment of incremental gains from different implementation strategies, and permit the assessment of moderators of strategy effectiveness. The findings may help determine the impact of low-cost, highly transportable implementation strategies that can be integrated into healthcare systems to improve the use of genomic medicine. Trial registration: ClinicalTrials.gov. NCT05721326. Registered February 10, 2023. https://www.clinicaltrials.gov/study/NCT05721326 [ABSTRACT FROM AUTHOR]

The eradication rates for Helicobacter pylori globally are decreasing with a dramatic increase in the prevalence of antibiotic resistant bacteria all over the world, including Saudi Arabia. There is no current consensus on the management of H. pylori in Saudi Arabia. The Saudi Gastroenterology Association developed these practice guidelines after reviewing the local and regional studies on the management of H. pylori. The aim was to establish recommendations to guide healthcare providers in managing H. pylori in Saudi Arabia. Experts in the areas of H. pylori management and microbiology were invited to write these guidelines. A literature search was performed, and all authors participated in writing and reviewing the guidelines. In addition, international guidelines and consensus reports were reviewed to bridge the gap in knowledge when local and regional data were unavailable. There is limited local data on treatment of H. pylori. The rate of clarithromycin and metronidazole resistance is high; therefore, standard triple therapy for 10–14 days is no longer recommended in the treatment of H. pylori unless antimicrobial susceptibility testing was performed. Based on the available data, bismuth quadruple therapy for 10–14 days is considered the best first-line and second-line therapy. Culture and antimicrobial susceptibility testing should be considered following two treatment failures. These recommendations are intended to provide the most relevant evidence-based guidelines for the management of H. pylori infection in Saudi Arabia. The working group recommends further studies to explore more therapeutic options to eradicate H. pylori. [ABSTRACT FROM AUTHOR]

A commingled production scheme, where wells are simultaneously completed in multiple reservoir units, offers a cost-effective alternative worldwide. However, their behavior can be more complex than single-unit wells in sequential production. Limited completion studies exist for the unique Paleogene Gulf of Mexico fields. To aid decision-making, we conducted a numerical study using geological and reservoir models of Lower and Upper Wilcox units, based on publicly available data. Results show that commingled production maximizes per-well oil production compared to sequential schemes. Over 30 years, it provides 61% more oil recovery, and over 50 years, it yields 21% more. One-factor-at-a-time design of experiments sensitivity analysis identifies that key reservoir properties influencing oil recovery in both schemes are upper and lower unit thicknesses, facies proportion of the upper unit. Additionally, average permeability of the lower unit plays a significant role in sequential production schemes. [ABSTRACT FROM AUTHOR]

Purpose: Bilateral cochlear implantation is an effective treatment for patients with bilateral profound hearing loss. In contrast to children, adults mostly choose a sequential surgery. This study addresses whether simultaneous bilateral CI is associated with higher rates of complications compared to sequential implantation. Methods: 169 bilateral CI surgeries were analyzed retrospectively. 34 of the patients were implanted simultaneously (group 1), whereas 135 patients were implanted sequentially (group 2). The duration of surgery, the incidence of minor and major complications and the duration of hospitalization of both groups were compared. Results: In group 1, the total operating room time was significantly shorter. The incidences of minor and major surgical complications showed no statistically significant differences. A fatal non-surgical complication in group 1 was particularly extensively reappraised without evidence of a causal relationship to the chosen mode of care. The duration of hospitalization was 0.7 days longer than in unilateral implantation but 2.8 days shorter than the combined two hospital stays in group 2. Conclusion: In the synopsis of all considered complications and complication-relevant factors, equivalence of simultaneous and sequential cochlear implantation in adults in terms of safety was found. However, potential side effects related to longer surgical time in simultaneous surgery must be considered individually. Careful patient selection with special consideration to existing comorbidities and preoperative anesthesiologic evaluation is essential. [ABSTRACT FROM AUTHOR]

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Birds are excellent bioindicators, playing a vital role in maintaining the delicate balance of ecosystems. Identifying species from bird vocalization is arduous but has high research gain. The paper focuses on the detection of multiple bird vocalizations from recordings. The proposed work uses a deep convolutional neural network (DCNN) and a recurrent neural network (RNN) architecture to learn the bird's vocalization from mel-spectrogram and mel-frequency cepstral coefficient (MFCC), respectively. We adopted a sequential aggregation strategy to make a decision on an audio file. We normalized the aggregated sigmoid probabilities and considered the nodes with the highest scores to be the target species. We evaluated the proposed methods on the Xeno-canto bird sound database, which comprises ten species. We compared the performance of our approach to that of transfer learning and Vanilla-DNN methods. Notably, the proposed DCNN and VGG-16 models achieved average F1 metrics of 0.75 and 0.65, respectively, outperforming the acoustic cue-based Vanilla-DNN approach. [ABSTRACT FROM AUTHOR]

As informational leakages become a common occurrence in economic and business settings, the impact of observability on behavior in adversarial situations assumes increased importance. Consider a two-player contest where there is a probabilistic information leak about one player's action and the recipient of the information has the ability to revise his contest expenditure in response to the leaked rival choice. How does the ability to revise and resubmit affect each contestant's behavior? We design a laboratory experiment to study this question for two well-known contest games: the lottery contest and the all-pay auction. Equilibrium predicts that compared to simultaneous moves, the strategic asymmetry arising from the ability to revise has no effect on expected expenditure in the lottery contest. In contrast, in the all-pay auction expected expenditure is decreasing in the probability of informational leakage. Experimental data support these predictions despite overexpenditure relative to equilibrium. Furthermore, the potential observability of the rival's action confers an advantage on the informed player not only in the all-pay auction, as theory predicts, but also in the lottery contest if the probability of leakage is high. [ABSTRACT FROM AUTHOR]

Solid-phase microextraction (SPME) is a simple and effective sample-preparation technique for the analysis of real-world samples. However, there is a phenomenon that a swelling or saturation of available sorption sites on the solid SPME coating can be caused by compounds with high affinities towards the solid coating present in matrices with low level binding matrix, thus resulting in the displacement of lower-affinity compounds. This phenomenon, known as the displacement effect, can make the quantitative analysis of polar analytes rather challenging. This work attempts to mitigate the impact of displacement effects by combining sequential SPME with an autosampler system. To apply the appropriate thin-film (TF) SPME membranes in the autosampler system, two special TF-SPME holders are designed to enable sampling in headspace (HS) or direct immersion (DI) mode. Next, two automated sequential SPME strategies are proposed to minimize the impact of displacement: the application of a PDMS-coated thin film in HS or DI mode (keeping the thin film in the vial without pausing the automated sequential SPME after the first round of extraction), and the use of a DVB/CAR/PDMS-coated fiber in DI mode. The results indicate that the proposed sequential SPME strategy enables the extraction of greater amounts of polar compounds, as the use of the PDMS-coated thin film in step 1 reduces the concentration of nonpolar compounds in the sample, and thus, the displacement of polar compounds on the sorbent. Finally, the proposed automated sequential method is applied to address displacement effects in the quantification of polar compounds in environmental analysis. The results of these assays clearly demonstrate that the proposed sequential SPME method not only effectively minimizes displacement effects, but it also successfully achieves full automation through its use of an autosampler system.

A vital aspect of Indian classical music (ICM) is rāga, which serves as a melodic framework for compositions and improvisations for both traditions of classical music. In this work, we propose a CNN-based sliding window analysis on mel-spectrogram and modgdgram for rāga recognition in Carnatic music. The important contribution of the work is that the proposed method neither requires pitch extraction nor metadata for the estimation of rāga. CNN learns the representation of rāga from the patterns in the mel-spectrogram/modgdgram during training through a sliding-window analysis. We train and test the network on the sliced-mel-spectrogram/modgdgram of the original audio while the final inference is performed on the audio as a whole. The performance is evaluated on 15 rāgas from the CompMusic dataset. Two fusion paradigms, namely multi-channel and multi-modal frameworks, have been implemented to identify the potential of two feature representations. Out of the two approaches, multi-modal architecture reports a macro-F1 measure of 0.72, which is at par with the performance of the baseline sequence classification model. The performance is also compared with that of a transfer learning approach. [ABSTRACT FROM AUTHOR]