The “leaky pipeline” concept in surgery refers to the phenomenon of losing capable individuals at various stages of surgical training due to systemic structural barriers and workplace culture. Despite growing numbers of women entering medical schools, the pipeline to surgical leadership remains predominantly male-dominated. Sexual harassment, bullying, and discrimination against women are pervasive, making it difficult for female surgeons to thrive. Moreover, surgical training is notoriously inflexible, with long working hours and high demands on personal time, disproportionately affecting women. In response, Women in Surgery network and the Women in ENT group have been established to provide mentorship opportunities, access to networking events and educational resources, and create a more inclusive and equitable workplace culture. The Royal College of Surgeons of England has commissioned the Kennedy report on diversity in surgery, which includes recommendations addressing the attrition of women in surgery. These initiatives have led to a rise in female ENT surgeons over the last decade, with an increase in female ENT surgical trainees from 32% to approximately 48%, and growth among women serving as ENT consultants, increasing from 10% to 18%. While the progress made by these initiatives towards increasing gender diversity in surgery is commendable, progress has been slow, and more comprehensive and multifaceted approaches are needed. The article argues that active participation of all stakeholders, including the Colleges, organizations responsible for surgical training, and surgeons is required to change this culture and fix the leaky pipeline.

In most animals, nests primarily aim to protect offspring, and are presumably shaped by nat- ural selection. In some species, however, nests are conspicuous and elaborate, thereby visible to predators. One hypothesis to explain this apparent paradox is that nests could also evolve through sexual selection. Here, we tested this hypothesis by studying nest weaves across the weaver family (Aves: Ploceidae). We hypothesized that scale-invariance, a measure of vi- sual regularity of the weave, reflects the quality of the nest builder or activates pre-existing preferences exploiting a sensory bias in the receiver. We predicted a link between weave scale- invariance and two proxies of the intensity of sexual selection: mating system and sexual size dimorphism. Our results reveal that species under stronger sexual selection produce more scale-invariant weaves. These results suggest a previously unnoticed sexually selected signal associated with the evolution of some of the most spectacular constructions observed in the animal kingdom.

This study explores the benefits of employing bifacial solar cells instead of conventional silicon solar cells. When compared to conventional solar cells, bifacial solar cells are more advantageous since they can absorb light from both sides. The albedo from the surface where the solar cell is attached is used by the solar cell's back side. A single bifacial solar module at lab scale is intended to investigate its properties. A potato slicing device is created that uses solar energy as a practical use of the bifacial solar cell. The bifacial solar cell is used to absorb solar energy and charge batteries because it is better than directly connecting a solar cell to a machine since the current will not be stable. The battery is directly attached to the device in order to provide non-fluctuating current. The process of cutting potatoes into slices requires mechanical power, which takes more time to complete. With the development of solar powered potato slicer, this process is now possible. The potato slicer that runs on solar power uses less time than one that runs on mechanical power, and the voltage regulator can regulate the machine's speed. The bifacial solar cells can also be used for more laboratory applications.

Objective: The healthcare resource allocation efficiency of individual provinces in Western China was analyzed to provide a reference for optimizing regional health resource allocation. Methods: A comprehensive analysis of grassroots healthcare resource allocation efficiency by province in Western China from 2012 to 2021 was conducted using the data envelopment analysis (DEA)-Malmquist model combined with rank-sum ratio analysis. Results: 1) Five DEA regions were robustly effective in 2021. Four non-DEA effective regions had different degrees of input redundancy and output deficiency. 2) The mean total factor value productivity of primary healthcare resources in Western China from 2012 to 2021 was 0.96, showing a decreasing trend. 3) Chongqing and Sichuan were ranked third, indicating the highest efficiency of health resource allocation. Conclusion: The overall efficiency of resource allocation of primary healthcare institutions in Western China is declining. Furthermore, technological progress is generally low and varies significantly by region. Therefore, developing multifaceted and innovative efficiency improvement strategies according to regional characteristics in a targeted manner is required.

Pyroptosis is a novel type of programmed cell death associated with the pathogenesis of many inflammatory diseases. Studies have shown that the Millettia speciosa Champ polysaccharide(MSP)has anti-inflammatory effects, but there is no report on whether the MSP has an effect on pyroptosis from the anti-inflammatory mechanism. This study aims to investigate the inhibitory effects of a water-soluble polysaccharide was obtained from Millettia Speciosa Champ(MSP-1)on the pyroptosis of RAW264.7 cells induced bylipopolysaccharide(LPS)/adenosine triphosphate(ATP). The results showed that MSP-1 significantly inhibited the pyroptosis of RAW264.7 macrophages. MSP-1 inhibited the secretions of IL-6, IL-1β, IL-18, nitric oxide (NO), and lactic dehydrogenase(LDH)and reduced caspase-1, cleaved IL-1β, and cleaved gasdermin D(GSDMD) activation of the cleaved protein levels. MSP-1 ameliorated the scorching of RAW264.7 macrophages by a mechanism that may be related to the downregulation of each of the caspase-1/IL-1β/GSDMD signaling pathways. In addition, the structure of MSP-1 was characterized in this study. MSP-1 consisted of only glucose with an average molecular weight of 50.2 kDa. Moreover, the infrared spectroscopy, methylation, and nuclear magnetic resonance (NMR) results showed that MSP-1 consisted of →4)-α-D-Glcp-(1→, →4, 6)-α-D-Glcp-(1→and T-α-Glcp.

In this paper, we consider the Dirichlet problem of the fractional Helmholtz equation with dissipation, as well as study the inverse problem of determining the source function, potential function and dissipation of the equation by Dirichlet to Neumann (DtN) map and Runge approximation. We prove the global uniqueness of the three functions of the equation under low-frequency conditions. As the main result, it implies that one can use the external data to uniquely recover the unknown function of the equation in low-frequency case, and will be of important significance in photoacoustic tomography and thermoacoustic tomography.

This paper deals with the unique solvability of some inverse problems for nonlinear Navier-Stokes-Voigt (Kelvin-Voigt) system with memory that governs the flow of incompressible viscoelastic non-Newtonian fluids. The inverse problems that study here, consist of determining a time dependent intensity of the density of external forces, along with a velocity and a pressure of fluids. As an additional information, two types of integral overdetermination conditions over space domain are considered. The system supplemented also with an initial and one of the boundary conditions: stick and slip boundary conditions. For all inverse problems, under suitable assumptions on the data, the global and local in time existence and uniqueness of weak and strong solutions were established.

Objective To evaluate the long-term efficacy of fibroid devascularization with ultrasound-guided high-intensity focused ultrasound (USgHIFU). Design A retrospective study. Setting A specialized hospital and two general hospitals in China. Population 117 patients with uterine fibroids Methods Treatment cells were arranged to cover the targeted vessels and then sonicated through steering the HIFU focal spots. Fibroid devascularization was assessed with the Adler grade obtained by color Doppler flow imaging (CDFI) and power Doppler imaging. The patients were followed up at 1-month, 3-month, 6-month, 1-year, 2-year and 3-year after treatment. Main outcome measures The non-perfusion volume rate (NPVR), fibroid volume shrinkage rate (FVSR), Adler Grade, symptom severity score (SSS) and uterine fibroid symptom and quality of life (UFS-QOL) were evaluated. Adverse events were recorded. Results NPVR Significant difference was observed in Adler grade, FV, FVSR, SSS and UFS-QOL before and after treatment ( p<0.001). The SSSs were reduced by 33.42% at 1-year, 42.32% at 2-year and 52.46% at 3-year after treatment. Conclusions USgHIFU-induced devascularization is a practical non-invasive treatment option for patients with uterine fibroid. Also, it can sustain long-term symptom improvements and could be attractive for patients who plan to become pregnant.

For high-value utilization of low temperature EDA/urea pretreated lignin (EUL), its physicochemical structure characteristics and biological activities were demonstrated. After pretreatment, the UV absorption of lignin was dramatically improved, indicating stronger UV resistance potential. Molecular weight and polydispersity index of EUL were significantly reduced from 2318 to 1421 g/mol and 1.44 to 1.20, respectively. The ester bond in lignin was broken due to EDA reaction with lignin carbonyl group and the C-H stretching vibration absorption strength of hydrophobic alkane in aromatic methoxy group and methyl and methylene in side chain was increased at 2852 and 2923 cm-1, suggesting that the hydrophobicity of lignin was improved. EUL exhibited the highest DPPH scavenging activity and Staphylococcus aureus inhibitory properties. It is speculated to be applied as novel UV protection, antioxidant and antibacterial agent in daily life. This research will lay a theoretical foundation for high-value utilization of low temperature EDA/urea pretreated lignin.

Currently, the main drivers for developing Li-ion batteries for efficient enery applications include energy density, cost, calendar life, and safety. The high energy/capacity anodes and cathodes needed for these applications is hindered by challengers like: 1) aging and degradation; 2) improved safety; 3) material costs, and 4) recyclability. The present begins by summarising the progress made from early Li-metal anode-based batteries to current commercial Li-ion batteries. Then discusses the recent progress made in studying and developing various types of materials for both anode and cathode electrodes, as well the various types of electrolytes and separator materials developed specifically for Li-ion battery operation. Battery management, handling and safety are also discussed at length. Also, as a consequence of the exponentially growth in the production of Li-ion batteries over the last ten years, the review identifies the challenge of dealing with the ever-increasing quantities of spent batteries. The review identifies the economic value of metals like Co and Ni contained with batteries and the extremely large numbers of batteries produced to date and the extremely large numbers that are expected to be manufactured in the next ten years. Thus, highlighting the need to develop effective recycling strategies to reduce the levels of mining for raw materials and prevents harmful products from entering the environment through landfill disposal.

In this paper, a wideband cylindrical conformal microstrip antenna array employing a proximity-coupled feeding mechanism with a cavity-backed configuration is designed and fabricated. Compared with other conformal microstrip patch antennas by using linear subarrays assembled piecewise, this design uses Teflon instead of traditional dielectric layers, and makes it possible to process the whole conformal array without splicing, obtaining the freedom in unit size and array radius adjustment except ease of manufacturing and assemblage. Combined with the optimization of the cavity size, an array with 44 elements is obtained which has a bandwidth of 40% from 8 to 12GHz and a gain of 16.4 dB.

Ecological speciation within the mormyrid genus Campylomormyrus resulted in sympatric species exhibiting divergence in their feeding apparatus and electric organ discharge (EOD). This study documents the overall diet of the genus Campylomormyrus and examines the hypothesis that Campylomormyrus radiation is caused by an adaptation to different food sources. We performed diet assessment of five sympatric Campylomormyrus species (C. alces, C. compressirostris, C. curvirostris, C. tshokwe, C. numenius) and their sister taxon Gnathonemus petersii with markedly different snout morphologies and EODs using hybrid capture/HTS DNA metabarcoding of their stomach contents. Our approach allowed for high taxonomic resolution of prey items, including benthic invertebrates, allochthonous invertebrates, and vegetation. Comparisons of the diet compositions using quantitative measures and diet overlap indices revealed that all species are able to exploit multiple food niches in their habitats, i.e., fauna at the bottom, the water surface, and the water column. Major part of the diet is larvae of aquatic insects, such as dipterans, coleopterans, and trichopterans, known to occur in holes and interstitial spaces of the substrate. The results showed that different snout morphologies and the associated divergence in the EOD translate into different prey spectra. This suggests that the diversification in EOD and the morphology of the feeding apparatus is under functional adaptation.

Intelligent reflecting surface is a new technology reconfigure the wireless propagation environment through intelligent signal reflection. In recent years, many studies have been done on the use of this technology in the wireless communication. In this article, we investigate one of the important points in the field of using this technology, which has been neglected until now. Since most of the times the signal sent in wireless and radar applications has modulation, it makes it difficult to create a signal with a desired phase at the receiver location. Because the reflected signal from the IRS may have a different delay than the signal received through the transmitter, and therefore the signal received from the transmitter and reflected from the intelligent surface have a different nature, so, strengthening or weakening the desired signal at the receiver location comes with difficulty. In this paper, we investigate this issue and suggest an innovative solution for the location of the intelligent reflecting surfaces in the environment to solve this problem in some applications.

Background: A proportion of the convalescent SARS-CoV-2 pediatric population presents nonspecific symptoms, mental health problems and a reduction in quality of life similar to myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and long COVID-19 symptomatic. However, data regarding its clinical manifestation and immune mechanisms are currently scarce. Methods: In this study, we perform a comprehensive clinical and immunological profiling of 17 convalescent COVID-19 children with post-acute COVID-19 sequelae (PASC) manifestation and 13 convalescent children without PASC manifestation. A detailed medical history, blood and instrumental tests and physical examination were obtained from all patients. SARS-CoV-2 reactive T cell response was analyzed via multiparametric flowcytometry and the humoral immunity was addressed via pseudovirus neutralization and ELISA assay. Results: The most common PASC symptoms were shortness of breath/exercise intolerance, paresthesia, smell/taste disturbance, chest pain, dyspnea, headache and lack of concentration. Blood count and clinical chemistry showed no statistical differences among the study groups. We detected higher frequencies of spike (S) reactive CD4+ and CD8+ T cells among the PASC study group, characterized by TNFα and IFNγ production and low functional avidity. CRP levels are positively correlated with IFNγ producing reactive CD8+ T cells. Conclusions: Our data might indicate a possible involvement of a persistent cellular inflammatory response triggered by SARS-CoV-2 in the development of the observed sequelae in pediatric PASC. These results may have implications on future therapeutic and prevention strategies.

AbstractSuccessful pregnancy is a rare phenomenon in women with Wilson’s disease (WD).  We report a case of a primigravid 19 -years old woman who presented with hemolytic anemia and was later diagnosed with Wilson’s disease for the first time during pregnancy. With prompt treatment, she delivered a healthy albeit pre-term child.IntroductionWilson’s disease, also known as hepatolenticular degeneration, is an autosomal recessive disorder of defect in copper transport due to a mutation in the adenosinetriphosphatase copper transporting beta (ATP7B) gene. Impaired copper transport results in the accumulation of copper in the liver, brain, and cornea, thereby causing symptoms. It presents as liver disease, neurological, neuropsychiatric symptoms, and non-immune hemolytic anemia [1]. Kinnier Wilson first described the disease in 1912. It affects between 1 in 30000 individuals to 1 in 100,000 individuals [1,2]. The mean age at diagnosis is 13.2 years [3]. The diagnosis may be overlooked owing to its numerous presentations of non-specific symptoms of fever, fatigue, and change in behavior to fulminant hepatic failure. Kayser-Fleischer ring is found more commonly with the neurological presentation, up to 95 % of cases [4]. Hemolytic anemia, which may be seen as a distinctive clinical feature with jaundice or acute liver failure in Wilson disease, is a rare presentation in isolation [5]. The diagnosis is often based on the constellation of clinical findings, serum ceruloplasmin, urinary copper excretion, Coombs negative hemolytic anemia, and liver biopsy [5].We report a case of a 19 years old pregnant lady who presented for the first time in her life with Coombs negative hemolytic anemia in the third trimester of pregnancy. Jaundice, as a presentation in pregnancy, can be due to hemolysis with or without hepatitis secondary to Wilson’s disease.Case PresentationA 19-year-old normotensive primigravida from a rural area presented to our center in the third trimester at 30 weeks of gestation with a history of fever, yellowish discoloration of eyes and urine, malaise, generalized weakness, and fatigue for ten days. She also had moderate pain in the upper abdomen, more localized on the right side, decreased appetite, and a few vomiting episodes. She received symptomatic care as she was treated with the diagnosis of acute viral hepatitis in her local hospital initially. However, she did not have clinical improvement. She did not have a history of altered sensorium, itching, pale-colored stools, or bluish patches on the body. She never had any similar illness in the past. Movement disorders, behavioral and personality changes were not noted in the past. She had uneventful home delivery and childhood. She was good at her academic performance and there was no history of any known liver or neurological disorders in  family members.On examination, she had pallor and icterus with no palpable lymph nodes. She had a fever of the recorded temperature of 101 degree Fahrenheit with a blood pressure of 100/60 mmHg on bilateral arms . A firm, tender liver with regular margin and surface, with a distinct border, was palpable 4 cm below the right subcostal margin. The fundal height of the patient corresponded to 28 weeks of gestation. Fetal heart sound was audible, and the rest of the systemic examinations had normal findings. Her hemoglobin was 5 g/dl on the initial presentation at the district hospital, where she was transfused 2 pints of fresh blood. Peripheral blood smear showed a microcytic hypochromic picture with anisocytosis and poikilocytosis. Liver function test (LFT) was abnormal with unconjugated hyperbilirubinemia, transaminitis but a normal prothrombin time and international normalized ratio (PT/INR), with the platelet count always in the normal range. Her viral serology profile was send and was found to be negative . She had a high lactate dehydrogenase (LDH) value and a negative Direct-Coomb’s test. Her lab reports are mentioned in the table 1.Table 1

We present a case of a young male who presented in urosepsis and developed ventricular fibrillation with cardiac arrest. Work-up revealed a hemodynamically significant anomalous aortic origin of the right-coronary artery. Patient underwent revascularization with percutaneous coronary intervention. Herein, we introduce the case and decision making in our interventional approach.

This survey paper offers a comprehensive review of the recent advances and applications of Machine Learning (ML) approaches in the interdisciplinary field of bioengineering, specifically in the realm of biosignal processing. Biosignals, including electroencephalograms (EEG), electrocardiograms (ECG), and electromyograms (EMG), are inherently complex, presenting significant challenges such as noise, artifacts, variability, and nonlinearity in their processing. However, ML has shown promise in overcoming these hurdles, enabling the extraction of useful features and insights from these signals. The paper outlines how ML is leveraged for processing, analyzing, classifying, and interpreting biosignals for various applications, such as diagnosis, monitoring, rehabilitation, and brain-computer interfaces. Additionally, it discusses the ongoing challenges and potential future directions of ML applications in this field. Through this review, we aim to highlight the critical role of ML in enabling adaptive, personalized, and intelligent systems that interact with biosignals in real-time, with potential implications for improving patient outcomes in various medical conditions.

Abstract This paper concentrates on the robust fractional sliding mode control for fractional uncertain time-varying delay systems in order (0,1). By providing a novel Lyapunov–Krasovskii function, some novel conditions considering interval mismatch are derived to obtain a linear quadratic regulator (LQR) based fractional sliding mode control (SMC) strategy. Based on a fractional order integral matrix inequality and linear matrix inequality (LMI) approach, the conditions are less conservative and easy to solve. The control law is designed by using hyperbolic tangent function to reduce chattering phenomenon. The proposed conditions can be solved using some standard numerical packages. Two examples are provided to verify the effectiveness of the introduced theoretical formulation.

A document by Rajan Bhandari. Click on the document to view its contents.

A document by Marco Radaelli. Click on the document to view its contents.

In the present day, most people who experience a traumatic or distressing event are prone to the development of Post-Traumatic Stress Disorder (PTSD). Currently, the FDA-approved medications for this condition include selective serotonin reuptake inhibitors such as sertraline and paroxetine, in addition to antidepressants. If taken for an extended period, these medications can have negative side effects and are only effective against certain symptoms. The limited treatment options available are a result of the limited understanding of PTSD pathophysiology. In this section, we discuss the novel pathophysiology of PTSD in greater detail. This review highlights various animal models that can be employed to evaluate drugs in a translational manner for human studies. Further, this review covers the current treatment of PTSD, drugs that are being tested in clinical trials, drugs that have failed in clinical trials, and a discussion of drugs targeting new targets, such as melatonin agonists, Neurokinin-1 antagonists, neuropeptide-Y agonists, and orexinergic antagonists. Recently, antikindling medications and psychedelics have become widely discussed. Psychological interventions, such as cognitive-behavioral therapy and prolonged exposure therapy, are often prescribed as supplementary treatments or even as initial treatments due to their lack of side effects and their ability to help the individual grow emotionally and personally. Fortunately, some of the drugs are being tested in phase 4 clinical trials, such as oxytocin and suvorexant, which involve a set of symptoms; thus, comprehensive research on combined approaches could give us a better comprehension of pharmacotherapy for PTSD.

Background and Purpose: The holotoxin A1, isolated from Apostichopus japonicus, has shown potent antifungal activities with unclear mechanism and efficacy against candidiasis. This study aimed to reveal the antifungal effects and mechanism of holotoxin A1 against Candida albicans in vitro and in candidiasis murine models for the first time. Experimental Approach: The antifungal effect of holotoxin A1 against C. albicans was tested in vitro. To explore the antifungal mechanism of holotoxin A1, the transcriptome, ROS levels, and mitochondrial function of C. albicans was evaluated. The oropharyngeal and intra-abdominal candidiasis mouse models were used to verify the effectiveness and systematic toxicity in vivo. Key Results: Holotoxin A1 was a potent fungicide against C. albicans SC5314, clinical strains and drug-resistant strains. Holotoxin A1 inhibited the oxidative phosphorylation and induced oxidative damage by increasing intracellular accumulation of ROS in C. albicans. Holotoxin A1 caused the disfunction of mitochondria by depolarizing the mitochondrial membrane potential and reducing the production of ATP. Holotoxin A1 directly inhibited the enzymatic activity of mitochondrial complex I (CI) and antagonized with the rotenone, an inhibitor of CI, against C. albicans. Meanwhile, the CI subunit NDH51 null mutants showed the decreased susceptibility to holotoxin A1. Furthermore, holotoxin A1 significantly reduced fungal burden and infections with no significant systemic toxicity in oropharyngeal and intra-abdominal candidiasis murine models. Conclusions and Implications: Holotoxin A1 was a promising candidate for the development of novel antifungal drug against both oropharyngeal and intra-abdominal candidiasis, especially caused by the drug resistant strains.

A secondary amine-controlled 4-step cascade aldimine condensation/intramolecular Mannich-type cyclization/aromatization/amination or oxidation process, using biaryls aldehydes and secondary amines as substrates, has been developed to divergently assemble naphtho-fused 2-aminoindolines and naphthoxindoles in a one-pot reaction.

A document by Patrizia Pisanu. Click on the document to view its contents.