Purpose/Objectives: To evaluate dosimetric differences between auto-planned Volumetric Modulated Arc Therapy (VMAT) Total Body Irradiation (TBI) technique and 2D AP/PA TBI technique. Methods: Ten pediatric patients treated with VMAT-TBI on Varian c-arm linac were included in this study. VMAT-TBI plans were generated using our in-house developed and publicly shared auto-planning scripts. For each VMAT-TBI plan, a 2D AP/PA plan was created replicating the institution’s clinical setup with the patient positioned at extended SSD with a compensator to account for differences in patient thickness, 50%-transmission daily lung blocks and electron chest-wall boosts prescribed to 50% of the photon prescription. Clinically relevant metrics were analyzed and compared between the VMAT and 2D plans. Results: All VMAT-TBI plans achieved PTV D90%≥100% of prescription. VMAT-TBI PTV D90% significantly increased (6.2%±2.4%, p<0.001) compared to the 2D technique, whereas no differences were observed in global Dmax (p<0.2) and PTV V110% (p<0.4). Compared to the 2D plans, significant decreases in the Dmean to the lungs (-25.6%±11.5%, p<0.001) and lungs-1cm (-34.1%±10.1%, p<0.001) were observed with the VMAT plans. The VMAT technique also provided additional sparing to other organs: for 12Gy prescription, kidneys Dmean of 64.7%±3.3%; for 2Gy prescription, testes/ovaries (Dmean of 31.6%±10.7%), brain (Dmean of 74.8%±1.6%) and thyroid (Dmean of 72.5±3.5%). Conclusions: Superior lung sparing with improved target coverage and similar global Dmax were observed with the VMAT plans as compared to 2D plans. In addition, VMAT-TBI plans provided greater dose reductions in gonads, kidneys, brain, and thyroid.

To alleviate the greenhouse gas emissions by the chemical industry, electrification has been proposed as a solution where electricity from renewable sources is used to power processes. The adoption of renewable energy is complicated by its spatial and temporal variations. To address this challenge, we investigate the potential of distributed manufacturing for electrified chemical processes installed in a microgrid. We propose a multi-scale mixed-integer linear programming model for locating modular electrified plants, renewable-based generating units, and power lines in a microgrid that includes monthly transportation and hourly scheduling decisions. We propose a K-means clustering-based aggregation disaggregation matheuristic to solve the model efficiently. The model and algorithm are tested using a case study with 20 candidate locations in Western Texas. Additionally, we define a new concept, “the Value of the Multi-scale Model”, to demonstrate the additional economic benefits of our model compared with a single-scale model.

Objective: To validate four pretreatment prediction models which were developed based on UK/US population (McLernon 2016 model, Luke model, Dhillon model, and McLernon 2022 model) and compare them with a model developed based on local data. Design: Retrospective development and validation of prediction models. Setting: University-affiliated hospital Patient(s): A total of 26035 Chinese patients underwent OPU cycles between January 2013 and December 2020. Methods: UK/US model performance was externally validated. Local models were established with XGboost, Lasso, and generalized linear model algorithms. Discriminatory power and calibration of the models were compared. Main Outcome Measure(s): The areas under the curves (AUC) of the Receiver Operator Characteristic (ROC) and calibration curves. Result(s): The AUCs for McLernon 2016 model, Luke model, Dhillon model, and McLernon 2022 model were 0.68 (95% CI: 0.675-0.689), 0.67 (95% CI: 0.666-0.68), 0.685((95% CI: 0.678-0.692), and 0.673((95% CI: 0.666-0.68), respectively. The local model yielded an AUC of 0.709(95% CI: 0.702-0.716) with key predictors including age, duration of infertility, and endocrine parameters. All external models suggested underestimation. Among the external models, the rescaled McLernon 2022 model demonstrated the best calibration (slope 1.12, intercept 0.06). Conclusion(s): A patient in China may find the published pretreatment prediction models based on UK/US population provide similar discriminatory power with reasonable AUCs and underestimated predictions.

This paper considers the problem of state observation for nonlinear dynamics. While model-based observer synthesis is difficult due to the need of solving partial differential equations, this work proposes an efficient model-free, data-driven approach based on online learning. Specifically, by considering the observer dynamics as a Chen-Fliess series, the estimation of its coefficients has a least squares formulation. Since the series converges only locally, the coefficients are recursively updated, resulting in an online optimization scheme driven by instantaneous gradients. When the state trajectories are available, the online least squares guarantees an ultimate upper bound of average observation error proportional to the average variation of states. In the realistic situations where the states cannot be measured, the immersed linear dynamics based on the Kazantzis-Kravaris/Luenberger structure is assigned, followed by online kernel principal component analysis for dimensionality reduction. The proposed approach is demonstrated by a limit cycle dynamics and a chaotic system.

The objective of this paper is to determine the transient characteristics and sites of the pre-breakdown (pre-BD) in the spark conditioning under power frequency voltage (PFV) in vacuum. A multi-angle optical path system was built to record the arc of pre-BD at two viewing angles by one camera, realizing the determination of the pre-BD sites in spark conditioning. The recording rate of high-speed camera was 580,000 frames/s. The experimental results indicate that, in the spark conditioning under PFV, the pre-BDs continuously occurred at a random moment. Within several half-waves, the number of the pre-BDs could reach dozens of times, which was the key for the treatment of the electrode surface in conditioning. Under the application of PFV, the single pre-BD occurred at a random moment, in which would last for several microseconds and the peak value of the current would reach several amperes. Moreover, the pre-BD sites randomly distributed in the surface of the electrode and almost covered the whole surface of the electrode. The number of the pre-BDs in edge region of the electrode tent to be more. The pre-BDs took place independently in both time and space.

In today's economic and social conditions where uncertainty is high, the legal and social dimensions of employment policies have gained importance, and it has become even more important to examine the relationship between job security and job performance for employees and organizations. Organizations need high-performing employees to achieve their goals and gain competitive advantage in their industries. Organizational commitment, defined as the employee's sense of belonging to the organization, and the motivation that pushes the individual to act in line with a goal, have psychological effects on the relationship between job security and job performance. The data collected from 582 people working in the banking sectors of Northern Cyprus, the psychological effects of organizational commitment and motivation in the relationship between perceived job security and job performance, are analysed and their positive contributions are observed. The job security provided has a positive effect on organizational outputs.

T α ω n ∗ is the star - like transformation semigroup of the finite set X n . Basic extraction of elements were done using | X n + 1 − λ X n | ≤ | X n − λ X n + 1 | from Full Transformation Semigroup provided n≥1. The five equivalence Green’s relation of star - like semigroup were solved using inline with the general method and definitions were given. The elements of order preserving star-like semigroup in this study were listed from full transformation semigroup, some tables were formed and sequences were created using these tables alongside L ,H, R , J and D equivalence relations. The patterns of the arrangement and tables were examined and also properly generalized .

Hydraulic modeling is the backbone of water system engineering. Understanding “the 3 A’s of hydraulic modeling”—Accuracy, Applicability, and Accessibility—will help you get the most out this important tool.Archived from The Flow, Winter 2021 (Intermountain Section, American Water Works Association)

Studies regarding the deacidification plant process conducted by liquid-liquid extraction for multicomponent mixtures are limited, and no study about the simulation of the deacidification process focused on soybean oil was found in the literature. The objective of this work was to simulate the soybean oil deacidification process by liquid-liquid extraction using ethanol+water (6 wt.%, 12 wt.%, 20 wt.%, 30 wt.%) mixtures as the solvent and evaluate the effect of the mass flow of solvent and the number of stages on the soybean oil yield and final acidity. The process was simulated in a multistage countercurrent liquid-liquid column, and the previously adjusted UNIFAC interaction parameters were used. The sensitivity analysis indicated that no significant difference in the recovery% of soybean oil was observed changing the number of stages, and a higher solvent-to-feed ratio results in a lower free fatty acids(FFA) percentage in the de-acidified oil, while increases in the water% in the solvent are detrimental to the FFA removal. The concentration of FFA in the soybean oil was reduced from 2.54% up to 0.17% at the optimal ratio of 3:1 ethanol + water (20 wt.%) /oil by weight, resulting in an oil recovery higher than 99.0%.

Drug-metabolizing enzymes play an important role in the metabolism of drugs in vivo. Their activity is an important factor affecting the rate of drug metabolism, which directly determines the intensity and persistence of drug action. Patients taking medication can be divided into different metabolic types through detection of CYP2C19 drug-metabolizing enzyme gene polymorphisms, which can then be used for medication guidance for clopidogrel. Here, we describe a detection method based on real-time polymerase chain reaction. This method uses multicolor melting curve analysis to accurately identify different mutation sites and genotypes of CYP2C19 * 2, CYP2C19 * 3, and CYP2C19 * 17. The detection limit of plasmid samples was 1 copies/µl; that of genomic samples was 0.1 ng/µl. The system can detect nine types of CYP2C19 * 2/3/17 at three sites in one tube, quickly achieving detection within 1 h. Combined with the sample release agent, sample extraction was completed in 5 s, achieving rapid diagnosis without extraction for timely diagnosis and treatment. Furthermore, the system is not limited to blood samples and can also be applied to oropharyngeal and saliva samples, increasing sampling diversity and convenience. When using clinical blood samples (n=93), the detection system we established was able to quickly and accurately identify different genotypes, and the accuracy and effectiveness of the detection were confirmed by Sanger sequencing.

Background: Dysphagia is the inability to swallow liquid or solid food due to structural or functional problems. This study aims to help people learn more about dysphagia in head and neck cancer. Design: This research used the PRISMA technique and bibliometric indices to navigate the results of global publication trends regarding dysphagia in head and neck cancer for five years from 2018 to 2022. Furthermore, the paper creates a graphical picture of the bibliographic material by mapping keywords and countries with bibliographic analysis using VOSviewer and NVIVO 12 Plus. Results: A distinct publishing trend was seen in statistics from 137 scientific journal articles published between 2018 and 2022. The United States had the most Scopus-indexed scientific research publications, and 2020 was the year that produced the most publications. The VOSviewer results demonstrated four clusters. According to the NVIVO 12-plus application, this topic was elated to five issues: therapy, neck, radiotherapy, carcinoma, and outcome. Conclusions: Dysphagia in head and neck cancer should not be overlooked, as it may be close to 60% to 70%. This may have both clinical and research implications. We suggest other researchers can develop other topics that we had presented regarding a systematic and comprehensive summary of research on dysphagia in head and neck cancer.

A document by SK Lamichhane. Click on the document to view its contents.

Performing afib ablation combined with the placement of the Watchman device for LAA occlusion has been evaluated before, with results showing evidence of safety and ability to perform (6). This can save time and materials allowing patients to have two procedures simultaneously, preventing repeating exposure to possible risks that come with

AbstractOur patient was a 61-year-old man with dedifferentiated chondrosarcoma (DCS) and a benign thrombus or a tumor thrombus. We diagnosed the patient with a tumor thrombus by angioscopic observation of a smooth-surfaced, white, elevated lesion in the IVC that had invaded the vein wall. Although anticoagulant therapy was discontinued, his condition progressed without an elevation in D-dimer levels or the appearance of new thromboembolism. After one course of chemotherapy, the patient refused to continue the treatment and was treated with palliative care. He died of the underlying disease approximately half a year later. This is the first case of a DCS patient where benign and tumor thrombi was differentiated by angioscopy. Angioscopy is one of the useful tools for this differentiation which can evaluate the color tone and surface properties of an object.

As the COVID-19 pandemic scare fades in early 2022, governments throughout the world are now battling a fear of monkeypox outbreaks in various regions. The human monkeypox virus is a double-strand DNA virus that was first discovered in Africa. The 2022 monkeypox virus can spread from person to person and through infected animals. Nevertheless, the host or carrier for the same has not yet been cleared. The relatively low transmission rate has barred it from attracting attention on a global scale. However, as cases increase, the 2022 monkeypox virus creates a panic. Around 103 countries were affected due to this virus till September 2022. There is currently no global preventive or cure available for this virus. Only two vaccinations that were previously authorized for smallpox are licensed for this virus. Similarly, there is only one drug available for therapy. The article will give comprehensive knowledge regarding available virus epidemiology, morphology, immune invasion prevention, and treatment which help the researcher to come forward and develop a strategy for the disease prevalence.

Background: Long-term musculoskeletal complications represent a growing burden for survivors of childhood acute lymphoblastic leukemia (cALL). This study aimed to describe impairments, activity limitations, and participation restrictions of survivors of cALL at highest risk for late morbidity (PETALE cohort). Procedure: This retrospective study, using cross-sectional observational data from the PETALE cohort, included a subgroup of survivors who presented extreme phenotypes of late effects. Participants completed bilateral hip magnetic resonance imaging (MRI), assessment of maximal isometric muscle strength (MIMS), range of motion (ROM), Near Tandem Balance (NTB), 6-Minute Walk Test (6MWT), Five Time Sit-to-Stand Test (FTSST)), and quality of life (QOL). Descriptive statistics and regression analyses were performed. Results: 97 survivors were included in this study. The selected survivors (24.2 ± 6.7 years old) trended toward lower scores for most outcomes compared to available expected values referenced from a healthy population except for QOL. Thirteen participants (14.6%, 18 hips) had hip ON (53.8% male). Female survivors had hip ON with higher severity score (66.7% female vs. 22.2% male). Survivors with hip ON had reduced hip external rotation ROM compared to those without (p<0.05). Relationships were found between MIMS and ROM outcomes, and with 6MWT. Our multiple linear regression model explained 27.6% of the variance of the 6MWT. Conclusions: Although they reported QOL in the range of healthy peers, long-term cALL survivors at highest risk for late morbidity had clinically significant impairments and activity limitations. These data are in keeping with the frailty phenotype described in childhood cancer survivors.

Treatment of guttural pouch mycosis with salpingopharyngostomyAmanda R Watkins1 and Eric J Parente11University of Pennsylvania New Bolton Center, Kennett Square PAThe case report by Rowe et al (2023) published in this issue describes a case of bilateral guttural pouch mycosis in a 9-month-old thoroughbred colt that was diagnosed due to unusual severe neurologic abnormalities including neck pain and abnormal head carriage. There was no evidence of hemorrhage in this case and therefore the colt was treated with debridement of the mycotic plaques, topical enilconazole, and ultimately a salpingopharyngeal fistula in the dorsal pharyngeal recess to inhibit the growth of the mycosis. The treatments were successful, and the colt went on to race.The guttural pouch is an diverticulum of the auditory tube that is found in ungulates possessing an odd number of toes, including the horse.1 The guttural pouches are susceptible to fungal and bacterial infections and the intimate association of the pouches with major arteries and nerves makes such infections potentially life-threatening. While the purpose of the guttural pouch is an area of speculation among equine researchers it is thought that cooling the blood before it reaches the brain especially during exercise is an important function.1 The cooling of the blood is achieved by a large air filled space separated from the internal carotid artery by only a thin membrane. Therefore, any locally invasive disease within the guttural pouches can have dire consequences.Fungal infection of the guttural pouch occurs rarely but, due to its anatomical position in relation to many neurovascular structures of the head, even mild disease can result in fatal hemorrhage and neurological sequelae.2 Obtaining a positive culture from these cases can be difficult however the most commonly isolated fungal species is Aspergillus fumigatus.2 The warm, dark, and humid environment of the guttural pouch may predispose it as a site of fungal infection. Jukic et al showed that the oxygen and carbon dioxide partial pressures within the guttural pouch vary significantly between horses and that they remain relatively static throughout the respiratory cycle in a normal guttural pouch.3 This inter-horse variation may explain the seemingly random distribution of horses that are affected by guttural pouch mycosis. Additionally the individual differences may contribute to the less aggressive phenotype that resolves without treatment in 15-28 days that is seen in the experimentally induced Aspergillus guttural pouch mycosis model.4 The case described in this report may have been complicated by the mixed infection cultured from the guttural pouch of both Aspergillus fumigatus and Streptococcus equi subsp. zooepidemicus .Salpingopharyngostomy is the creation of a fistula between the pharynx and the guttural pouch and has been described as a treatment for guttural pouch mycosis.3,5–7 The theory behind this procedure is that it opens the guttural pouch to the fluctuating change of respiratory gases and temperatures of the respiratory tract. Jukicet al demonstrated that following salpingopharyngostomy there was no difference in the mean partial pressures of oxygen and carbon dioxide within the guttural pouch however, the variability of the pressures was significantly increased with the partial pressures oscillating with the respiratory pattern.3 This introduction of varying gas levels may change the environment within the guttural pouches making them less hospitable to fungal growth and allowing for faster resolution of the infection. In this case, due to the bilateral nature of the disease the authors created a single salpingopharyngostomy in the dorsal pharyngeal recess to gain access to both guttural pouches simultaneously. Creating a bilateral opening is easily created and can even be made larger and more likely to remain patent by ablating part of the septum between the two pouches.Aspergillus species are highly aerobic and can grow in most oxygen environments. However, they are also capable of growing at low oxygen tension and growth under these conditions may affect their pathogenicity by allowing secretion of virulence factors.8Hyperbaric oxygen treatment of A. fumigatus biofilms in vitro resulted in decreased biofilm proliferation by over 50%, though the effect was transient with growth re-establishing at 6 hours post treatment.9 In human medicine, individuals with invasive fungal infections caused by Aspergillus spp . are routinely treated with hyperbaric oxygen therapy in addition to surgical debridement and anti-fungal medications.10 Though there is a lack of controlled evidence to support this therapeutic in fungal infection, the complications are minimal and it is thought to improve the efficacy of neutrophils and macrophages by meeting their increased oxygen demands when clearing infections.11Additionally increased oxygen may improve the quality of the collagen matrix being created during the healing process.11An additional therapeutic that might have been helpful in this case prior to salpingopharyngeal fistulation is topical oxygen therapy (TOT) which has been recently published by Lepage et al for use as an adjunct treatment in epistaxis cases following transarterial coil embolization (TACE) or as a primary treatment in non-bleeding cases.12 Part of the rationale behind pursuing additional treatment options by this group is the percentage of horses that fail to completely resolve the neurologic sequelae of the disease which has been reported at 50%.13 When examining the issue of recurrent epistaxis following TACE the survival rate is 84% which places this high level of persistent neurological abnormalities into sharp relief. Dysphagia particularly can be severe enough to necessitate euthanasia even in the face of successful hemorrhage management. Certainly, dysphagia can be reversible as in the case published by Whitehead et al that was managed successfully with topical anti-fungals, carotid occlusion and esophagostomy but it can be a lengthy process that not all owners or patients will tolerate.14Guttural pouch mycosis does not lend itself to aggressive surgical debridement given the closely associated vessels and nerves to the mycotic plaques, however the somewhat enclosed environment of the guttural pouch may be an advantage for TOT. Lepage et al treated cases with TOT 4 times per day at 15 L/min for 1-2 weeks by placing an indwelling catheter into the affected guttural pouch and leaving it in place as much as possible for the duration of hospitalization. During treatments the horses were restrained with their heads at the height of the withers to decrease the opening of the guttural pouch orifice to maintain a closed high oxygen environment, though swallowing would still result in transient openings of the orifices.12Following a minimum of two treatments the fungal plaques were seen to begin regressing. Additionally the reported resolution or significant improvement of 10/12 neurologic disorders is encouraging compared to the 9/18 cases of resolution reported in a larger retrospective study on TACE.13It is unlikely TOT and salpingopharyngostomy would have any additive effect if done concurrently since it is unlikely the higher oxygen tension could be achieved with the fistula. The two procedures could be considered in series with the salpingopharyngostomy created after initial TOT. The advantage of the salpingopharyngostomy alone is that it is a single treatment without the need for further treatments or hospitalization. Furthermore, while Jukic et al showed some variations in partial pressures of gas in horses with salpingopharyngostomies there was not significant variation in temperature or humidity. The horses were housed in a controlled environment during short sampling periods in that study and variations may be greater if horses with salpingopharyngostomies are not housed in an environmentally controlled condition.Some of the clinical signs of this case report are difficult to attribute directly to the mycosis infection and there was confounding evidence of bacterial infection and other treatments. Regardless, guttural pouch mycosis can result in severe and possibly fatal disease as it almost did in this case report. Salpingopharyngostomy is an alternative treatment strategy to traditional medical treatment that should be considered in horses with guttural pouch mycosis.References1. Baptiste KE, Naylor JM, Bailey J, Barber EM, Post K, Thornhill J. A function for guttural pouches in the horse. Nature . 2000;403:382-383.2. Ludwig A, Gatineau S, Reynaud MC, Cadoré JL, Bourdoiseau G. Fungal isolation and identification in 21 cases of guttural pouch mycosis in horses (1998–2002). Vet J . 2005;169(3):457-461. doi:10.1016/j.tvjl.2004.06.0053. Jukic CC, Cowling NR, Perkins NR, Eps AW, Ahern BJ. Evaluation of the effect of laser salpingopharyngostomy on the guttural pouch environment in horses. Equine Vet J . 2020;52(5):752-759. doi:10.1111/evj.132214. Greppi MC, Guillot J, Melloul E, Bourdoiseau G, Lepage O, Cadoré JL. Experimental induction of mycotic plaques in the guttural pouches of horses. Med Mycol . Published online October 4, 2016:myw073. doi:10.1093/mmy/myw0735. Koch DW, Ericksen KA, Easley JT, Hackett ES. Clinical outcome of horses with guttural pouch infection following transpharyngeal fenestration. J Am Vet Med Assoc . Published online May 5, 2022:1-5. doi:10.2460/javma.22.01.00416. Koch DW, Easley JT, Nelson BB, Delcambre JJ, McCready EG, Hackett ES. Comparison of two techniques for transpharyngeal endoscopic auditory tube diverticulotomy in the horse. J Vet Sci . 2018;19(6):835. doi:10.4142/jvs.2018.19.6.8357. Watkins AR, Parente EJ. Salpingopharyngeal fistula as a treatment for guttural pouch mycosis in seven horses. Equine Vet J . 2018;50(6):781-786. doi:10.1111/evj.128308. Hall LA, Denning DW. Oxygen requirements of Aspergillus species.J Med Microbiol . 1994;41(5):311-315. doi:10.1099/00222615-41-5-3119. Dhingra S, Buckey JC, Cramer RA. Hyperbaric Oxygen Reduces Aspergillus fumigatus Proliferation In Vitro and InfluencesIn Vivo Disease Outcomes. Antimicrob Agents Chemother . 2018;62(3):e01953-17. doi:10.1128/AAC.01953-1710. Segal E. Hyperbaric Oxygen in the Treatment of Invasive Fungal Infections: A Single-Center Experience. 2007;9.11. Kaufman H, Gurevich M, Tamir E, Keren E, Alexander L, Hayes P. Topical oxygen therapy stimulates healing in difficult, chronic wounds: a tertiary centre experience. J Wound Care . 2018;27(7):426-433. doi:10.12968/jowc.2018.27.7.42612. Lepage OM, Di Francesco P, Moulin N, et al. The Effect of Topical Oxygen Therapy in Horses Affected with Mycosis of the Guttural Pouch: An Experimental Pilot Study and a Case Series. Anim Open Access J MDPI . 2021;11(11):3329. doi:10.3390/ani1111332913. Lepage OM, Piccot-Crézollet C. Transarterial coil embolisation in 31 horses (1999-2002) with guttural pouch mycosis: a 2-year follow-up.Equine Vet J . 2010;37(5):430-434. doi:10.2746/04251640577447996014.Whitehead AE, Whitty J, Scott M, Léguillette R. Reversible dysphagia secondary to guttural pouch mycosis in a gelding treated medically with voriconazole and surgically with carotid occlusion and esophagostomy.Can Vet J . 2018;59(2):165-170.

This article represents the results of couple stress Casson fluid in a microchannel with considering the effects of magnetism, convection, thermal radiation, exponential space and temperature dependent, viscous dissipation, Darcy-Forchheimer condition in presence of multiple slip effect. The well know method Runge Kutta Felhberg is used to resolve the reduced dimensionless equations after apply the dimensionless variables to governing equations. The comparison of the profiles for the presence and absence of couple stress parameter with Casson parameter is plotted for all the parameters and discussed in detail through graphs. It declares that the presence of couple stress which gives better thermal performance as compared with only the presence of Casson parameter.

Maternal mortality remains a health challenge that many developing countries struggle to address. Drawing on 64 key informant interviews, this article shows how Ghana’s most impoverished administrative region, the Upper East, emerged as a bureaucratic ‘pocket of effectiveness’ in reducing maternal mortality in a context where national political settlement dynamics are undermining progress in improving maternal health. At the national level, Ghana’s progress in reducing maternal mortality has been disappointing because public investments are disproportionately directed to reforms that contribute to the short-term political survival of ruling elites. Competitive electoral pressures have contributed to greater elite commitment towards health sector investments with visual impact, while weakening elite incentives for dedicating resources to interventions that are necessary for enhancing the quality of health. In the Upper East Region, the rapid reduction in maternal mortality in recent years has been driven by a hybrid form of accountability that combines top-down pressures from the regional health directorate with horizontal forms of accountability that result in a competitive spirit among health workers. These findings show that even in contexts where resources are limited, the capacity of sub-national leaders in devising local solutions to local problems can lead to improved performance of health systems at the sub-national level. The findings also suggest the need for academic debates to go beyond the binary distinctions regarding the usefulness of top-down versus bottom-up accountability measures and focus on building effective and legitimate forms of accountability that run both top-down and bottom-up when seeking to improve health service delivery.

Casual effects of gut microbiota on the severity of COVID-19: a two-sample Mendelian randomization and a meta-analysisAimin Jiang1†, Zheng Wang1†, Demeng Xia2†, Peng Luo3, Xinxin Gan1, Renqi Yao4,5*, Linhui Wang1*1 Department of Urology, Changhai Hospital, Naval Medical University, Shanghai 200433, China2 Department of Orthopedics, Changhai Hospital, Naval Medical University, Shanghai, China3 Department of Oncology, Zhujiang Hospital, Southern Medical University, Guangzhou 510260, China.4 Translational Medicine Research Center, Fourth Medical Center and Medical Innovation Research Division of the Chinese PLA General Hospital, Beijing 100048, China5 Department of Burn Surgery, Changhai Hospital, Naval Medical University, Shanghai 200433, China† Aimin Jiang, Zheng Wang, and Demeng Xia contributed equally to this work.Correspondence:Linhui Wang, MD, PhD, Department of Urology, Changhai Hospital, No.168 Road, Yangpu District, Shanghai 200433, People’s Republic of China. Tel: (+86) 13901635510; Email:wanglinhui@smmu.edu.cnRenqi Yao, MD, Translational Medicine Research Center, Medical Innovation Research Division and Fourth Medical Center of the Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing 100853, People’s Republic of China. Tel: (+86) 18501689629; Email:yaorenqixx1995@163.com.Keywords:Mendelian randomization, SARS-CoV-2, COVID-19, gut microbiota, infection

A document by Athira Krishnan K.A.. Click on the document to view its contents.

An enveloped double-stranded DNA monkeypox virus (MPXV) is a causative agent of zoonotic viral disease viz. Human monkeypox (HMPX). MPXV belongs to the genus Orthopoxviridae, a family of notorious smallpox viruses, and so it shares similar clinical pathophysiological features. The recent multi-country HMPX outbreak (May 2022 onwards) is recognized as an emerging global public health emergency by WHO, shunting its endemic status as opined over the past few decades. Re-emergence of HMPX raises concern to re-assess the present clinical strategy and therapeutics as its outbreak evolves further. Keeping a check on these developments, here we provide insights into the HMPX epidemiology, pathophysiology, and clinical representation. Weighing on its early prevention, we reviewed the strategies that are being enrolled for HMPX diagnosis. In the line of expanded MPXV prevalence, we further reviewed its clinical management and the diverse employed preventive/ therapeutic strategies, including vaccine (JYNNEOS, ACAM2000, VIGIV) and antiviral drugs/inhibitors (Tecovirimat, Cidofovir, Brincidofovir). Taken together, with a revised perspective of HMPX re-emergence, the present report summarizes new knowledge on its prevalence, pathology, and prevention strategies.

Ovarian cancer seriously threatens women’s health because of its poor prognosis and high mortality. Due to the lack of efficient early detection and screening methods, when patients seek doctors’ help with complaints of abdominal distension, back pain and other nonspecific signs, the clinical results always hint at the widespread metastasis of disease. When referring to the metastasis of this disease, the omentum always takes precedence. The distinguishing feature of the omentum is adipose tissue, which satisfies the energy demand of cancer cells and supplies a more aggressive environment for ovarian cancer cells. In this review, we mainly focus on three important cell types: adipocytes, macrophages and mesenchymal stem cells. Besides, several mechanisms underlying cancer-associated adipocytes (CAA)-facilitated ovarian cancer cell development have been revealed, including their capacities for storing lipids and endocrine function, and the release of hormones, growth factors, and adipokines. Blocking the reciprocity among cancer cells and various cells located on the omentum might contribute to ovarian cancer therapy. The inhibition of hormones, growth factors and adipokines produced by adipocytes will be a novel therapeutic strategy. However, a sufficient number of trials has not been performed. In spite of this, the therapeutic potential of metformin and the roles of exercise in ovarian cancer will be worth mentioning. It’s almost impossible to overcome completely ovarian cancer at the moment. What we can do is trying our best to improve these patients’ prognoses. In this process, adipocytes may bring promising future for the therapy of ovarian cancer.

In this research work, a compact triple-band antenna for WiMAX, WLAN and X-band applications is presented. The proposed antenna has compact size of 18x21.3mm2. The miniaturization of 52.10% is achieved compared with the conventional antenna. For achieving compactness and multiple frequency operation a square patch is loaded with inverted U-shaped slots and partial ground is used and can resonates at 3.26 GHz, 5.95 GHz and 8.83 GHz with a return loss of -29.15 dB, -43.40 dB, -41.14 dB respectively with highest gain of 2.69 dB. The proposed multiband structure yields good impedance matching, acceptable gain, and wide bandwidth.