Nutrition is at the center of interactions between organisms and their environment. During this time of unprecedented anthropogenic environmental change, biological indicators of nutritional changes and their effects on ecosystems are crucial if we are to understand and mitigate these changes. In this study, we developed a qPCR assay to examine nutritional responsiveness of ten genes identified as potential indicators of nutritional state in the freshwater zooplankton Daphnia pulex. We grew animals in six ecologically relevant treatments: nutrient replete, low carbon (food), low phosphorus, low nitrogen, low calcium, and high Cyanobacteria. We measured the growth rate and elemental composition of these animals and extracted their RNA. We then selected ten nutrient sensitive genes, two per limiting nutrient, and two reference genes from an RNA sequencing dataset of Daphnia pulex grown under the same six nutritional treatments. We then designed and validated qPCR primers for the ten indicator and two reference genes. We ran qPCR using these primers on cDNA from our experimental animals and found that the differential expression patterns of these genes could discriminate between our six nutritional states with high levels of accuracy. These results represent a compelling proof of concept for the use of gene-based nutritional biomarkers, paving the way for the use of genetically based nutritional state biomarkers in the study of ecology

Developing high-yielding varieties of sunflower as oilseed staple crops requires knowledge of physiologic and molecular mechanisms involved in yield formation. Source strength, sink demand, and their interactions play crucial roles in the yield formation of sunflowers. The persistence of assimilate flux to the developing grains mainly determines sink demand. There was no information on the molecular mechanism for assimilate flux to the sink organ of sunflowers. To shed light on molecular events engaging in assimilate flux to sink organs, two experiments were carried out on five sunflower inbred lines differing in their grain yields. Source-related parameters (such as leaf biomass, area, and number) and sink-associated attributes (such as floret number as the first anthesis and capitulum biomass and diameter, in addition to changes in biomass of capitulum and stem, as the first anthesis with those at physiological maturity) were evaluated across all the inbred lines. The invertase gene expression level was measured on the receptacle base of three inbred lines, showing discrepancies in the source, sink, and grain yield performances. The results showed that while no significant correlation was found between source strength and sink demand with grain yield, higher grain yield was likely attributed to the persistence of assimilate flux to the capitulum base during grain filling. This phenomenon was discussed to be due to higher invertase activity in the receptacle base.

Introduction Viral infections are associated with pulmonary exacerbations in children with Cystic Fibrosis (cwCF), but after 3 years of SARS-CoV-2 pandemic, whether cwCF are at higher risk of developing COVID-19 or its adverse consequences remains controversial. Methods We conducted an observational, multicenter, cross-sectional study of cwCF infected by SARS-CoV-2 between March 2020 and June 2022, (1 st to 6 th COVID-19 pandemic waves) in Spain. The study aimed to describe patients’ basal characteristics, SARS-CoV-2 clinical manifestations and outcomes, and whether there were differences across the pandemic waves. Results During study time, 351 SARS-CoV2 infections were reported among 341 cwCF. Median age was 8.5 years (range 0-17) and 51% were female. Cases were unevenly distributed across the pandemic, with most cases (82%) clustered between November 2021 and June 2022 (6 th wave, also known as Omicron Wave due to the higher prevalence of this strain in that period in Spain). Most cwCF were asymptomatic (24.8%) or presented with mild Covid-19 symptoms (72.9%). Among symptomatic, most prevalent symptoms were fever (62%) and increased cough (53%). No multisystem inflammatory syndrome (MIS-C), persisting symptoms, long-term sequelae or deaths were reported. Conclusions Spanish current data indicate that cwCF do not experience higher risks of SARS-CoV-2 infection nor worse health outcomes or sequelae. Changes in patients’ basal characteristics, clinical courses and outcomes were detected across waves. While the pandemic continues, and new SARS-CoV-2 variants are being identified, a worldwide monitoring of COVID-19 in pediatric CF patients is needed.

Objective: To evaluate the frequency and burden of disease of SARS-CoV-2 and other respiratory viruses in children under the age of 2 months. Methods: A retrospective, cross-sectional, single-center study was conducted between March 2021, and February 2022. All children under the age of 2 months and tested for SARS-CoV-2 were included. The frequency of SARS-CoV-2, of other respiratory viruses and the burden of disease caused by SARS-CoV-2 and other respiratory viruses were evaluated. Results: 727 children with an RT-PCR test for SARS-CoV-2 were included (mean age: 0.9 months (±0.6); boys: 57%); 514 (71%) in the emergency room and 213 (29%) in hospital. Among them, 62 (8.5%) had a positive RT-PCR test for SARS-CoV-2, more often in the Omicron period (23%) than in the Alpha period (4%). Of the 565 (78%) with a multiplex RT-PCR test for other viruses, 325 (58%) were positive. Children with a positive SARS-CoV-2 were less likely to have required respiratory support (p=.001), enteral nutrition (p=.03), or intensive care admission (p=.01) and had a shorter hospital stay than children with other respiratory viruses (5d vs. 7d, p=.007). Conclusion: In this young population of children, SARS-CoV-2 infection was less frequent and less severe than other viral respiratory infections.

INTRODUCTIONMerkel Cell Carcinoma (MCC) is a rare, life-threatening tumor with neuroendocrine features. Due of its extremely low occurrence worldwide, epidemiological data on the disease is limited. (1). Commonly recognized risk factors include fair skin, history of skin cancer, old age, chronic immunosuppression, chronic ultraviolet (UV) light exposure, and Merkel cell polyomavirus (MCPyV) infection (2). Amongst these factors, MCPyV and UV exposure play a fundamental role with synergistic effects in the pathophysiology of MCC (3). Despite being a part of normal skin flora in most individuals, MCPyV DNA can clonally combine with the genome of neoplastic cell precursors at the initial phases of carcinogenesis (4, 5). Concurrently, UV exposure elicits antigen-presenting dendritic cells to produce inflammatory cytokines, leading to local immunosuppression and creating an ideal environment for tumoral growth (6). Moreover, immune hypersensitivity from UV exposure facilitates the viral tumorigenic process (2).Merkel cells cannot be derived from the MCC because they lack the ability to proliferate. Merkel cell precursors (perhaps generated from epidermal stem cells or hair follicle stem cells) and pre- and pro-B cells appear to have histopathology, genetics, and molecular characteristics with malignant cells instead (7).MCC often presents as a single, asymptomatic erythematous or violaceous nodule, often mistaken for cysts or abscesses. It usually originates from the head or neck and generally spares the extremities (8). Immunohistochemical (IHC) staining is required to validate histopathological findings of small round cells that infiltrate cutaneous or subcutaneous area. (7). Although MCC responds to the combination of excisional surgery, radiotherapy, and chemotherapy, it requires continuous follow-ups within the first year of diagnosis due to the high recurrence rate (9).Here, we present a 32-year-old Iranian (non-Caucasian) immunocompetent female with a small nodule on her left arm at the disease onset finally diagnosed as MCC. In this report, we aim to emphasize the significance of early diagnosis and management of this cancer and highlight the complications that a late diagnosis would entail for these patients.

Cardiofaciocutaneous syndrome is a rare genetic disorder. It is characterized by craniofacial dysmorphism, congenital heart disease, ectodermal abnormalities, developmental delay, and central nervous system disorders. We discuss the case of an 11-year-old boy with cardiofaciocutaneous syndrome presenting with ulerythema ophryogenes and phenotypic features similar to Noonan syndrome.

Tandem solar cells are a key technology to exceed the theoretical efficiency limit of single-junction cells. One of the most promising combinations is the silicon-perovskite tandem cells, considering their potential for high efficiency, large-area fabrication, and low cost. Whereas most research focuses on improvements in each subcell, another key challenge relies on the tunnel junction that connects subcells and affects overall cell characteristics. Here, the first demonstration of tunnel junctions using a stack of p+/n+ polysilicon deposited directly on the passivating tunnel oxide are shown to overcome the drawbacks of conventional metal oxide-based tunnel junctions including low tunneling efficiency and sputter damage. Furthermore, using Random Forest analysis, high implied open circuit voltages over 700 mV in the bottom cell with the polysilicon tunnel junction are achieved. Their contact resistivities are as low as 500 mΩ·cm2, suggesting FF losses of less than 1 %abs for the operating conditions of a tandem cell.

Less Invasive Surfactant Administration (LISA) is a growing method for treatment of respiratory distress syndrome. Although it has become standard of care in parts of Europe[1], its adoption in North America remains slow[2], but with increased interest. Many centers are developing their own guidelines and procedures[3, 4]. This study in Pediatric Pulmonology directly compares two different techniques for administration of surfactant via thin catheter (LISA). Studies like this highlight the importance of fine-tuning techniques for common procedures using an evidence-based approach; allowing new therapies to reach our patient population.Prospective trials of LISA were first performed by Verder et all[5]. A thin, flexible catheter is guided into the trachea and surfactant is administered. The thin catheter does not occlude the airway, allowing the infant to remain on non-invasive respiratory support. While comparable to Intubate-Surfactant-Extubate (INSURE), the use of an endotracheal tube occludes the infant’s airway and nessecitates the use of positive pressure ventilation (PPV). The avoidance of PPV prevents volutrauma and the subsequent inflammatory cascade that is associated with chronic lung disease of prematurity or bronchopulmonary dysplasia[6, 7]. Randomized control trials and subsequent meta-analyses demonstrated that LISA reduced rates of bronchopulmonary dysplasia and death compared to the CPAP, surfactant and mechanical ventilation and the standard of care, INSURE [8-11].Thin catheter administration of surfactant is one of the most popular ways to administer surfactant. Two main techniques have emerged over the past decade. Both techniques require direct visualization of the airway. The first technique is insertion of a rigid catheter (such as the off-label use of an Angiocath) using direct manipulation. The second technique involves the use of Magill forceps to guide a more flexible catheter (such as a feeding tube) into the airway for instillation of surfactant. Both techniques require a highly skilled operator who is familiar with direct visualization of the airway. The study shared in this issue of Pediatric Pulmonology compares the two techniques and demonstrated decreased time to placement and increased success at first attempt with a rigid vs. soft catheter. As this practice was refined most institutions have reappropriated instruments and devices intended for another purpose to successfully implement this practice. Quality improvement initiatives have been helpful in streamlining this process and guiding implementation at individual institutions [3]. It is important for each institution to identify the target patient population, standardize the instruments used for the procedure, and adequately train staff on the procedure.In recent years, some manufacturers have recognized the need for specialized equipment for this procedure. There are three devices that have been specifically designed for surfactant administration, including Surfcath™ (Vygon, Ecouen, France), LISAcath® (Chiesi, Parma, Italy), and Neofact® (Lyomark Pharma, Oberhaching, Germany). Surfcath™ has added benefits over an Angiocath, including a centimeter marking to guide insertion. The distal tip of the device is a blunt black tip of 2 cm, bent at 30 degrees which allows ease of use for insertion. It can be manipulated into the desired shape more easily than an Angiocath. LISAcath® is very similar including a rounded, soft tip at the distal edge and printed markings on the outer surface. One multi-center study surveyed neonatologists and found that they preferred the LISAcath® for ease of use and safety compared to an Angiocath[12]. LISAcath® is currently no longer being produced. Neofact® is an application device with a tracheal catheter. It has an angled applicator tip which allows for positioning directly in front of the glottis. This facilitates the use of a flexible catheter without the use of Magill forceps. This device was studied in a feasibility study and found to be successful in 19 of 20 infants, with a median of 2 attempts[13]. These devices are not available for use in the United States at the time of this publication.Ultimately, direct laryngoscopy remains a noxious procedure for neonates despite incremental improvements over intubation. Alternative approaches continue to be tested including techniques such as surfactant administration via laryngeal or supraglottic airways. These techniques allow for administration of surfactant without direct visualization of the airway. This could be especially helpful in settings where a provider skilled in airway manipulation is not available[14]. Meanwhile, the search for a nebulized surfactant product with similar efficacy continues as a method for truly non-invasive surfactant administration to treat respiratory distress syndrome.1. Klotz, D., et al., European perspective on less invasive surfactant administration—a survey. European journal of pediatrics, 2017. 176 : p. 147-154.2. Kurepa, D., et al., The use of less invasive surfactant administration (LISA) in the United States with review of the literature. Journal of Perinatology, 2019. 39 (3): p. 426-432.3. Conlon, S.M., et al., Introducing less-invasive surfactant administration into a level IV NICU: a quality improvement initiative.Children, 2021. 8 (7): p. 580.4. Williamson, S.L., H. McDermott, and H. Gowda, Implementing less invasive surfactant administration on a neonatal unit. Archives of Disease in Childhood-Education and Practice, 2022. 107 (4): p. 298-301.5. Verder, H., et al., Surfactant treatment of newborn infants with respiratory distress syndrome primarily treated with nasal continuous positive air pressure. A pilot study. Ugeskrift for laeger, 1992. 154 (31): p. 2136-2139.6. Keszler, M. and G. Sant’Anna, Mechanical ventilation and bronchopulmonary dysplasia. Clinics in perinatology, 2015.42 (4): p. 781-796.7. Walsh, M.C., et al., Impact of a physiologic definition on bronchopulmonary dysplasia rates. Pediatrics, 2004. 114 (5): p. 1305-1311.8. Rigo, V., C. Lefebvre, and I. Broux, Surfactant instillation in spontaneously breathing preterm infants: a systematic review and meta-analysis. European journal of pediatrics, 2016. 175 : p. 1933-1942.9. Mehler, K., et al., Developmental outcome of extremely preterm infants is improved after less invasive surfactant application: developmental outcome after LISA. Acta Paediatrica, 2021.110 (3): p. 818-825.10. Göpel, W., et al., Less invasive surfactant administration is associated with improved pulmonary outcomes in spontaneously breathing preterm infants. Acta paediatrica, 2015. 104 (3): p. 241-246.11. Göpel, W., et al., Avoidance of mechanical ventilation by surfactant treatment of spontaneously breathing preterm infants (AMV): an open-label, randomised, controlled trial. The Lancet, 2011.378 (9803): p. 1627-1634.12. Fabbri, L., et al., Five‐country manikin study found that neonatologists preferred using the LISA cath rather than the Angiocath for less invasive surfactant administration. Acta Paediatrica, 2018.107 (5): p. 780-783.13. Maiwald, C.A., et al., Clinical evaluation of an application aid for less-invasive surfactant administration (LISA). Archives of Disease in Childhood-Fetal and Neonatal Edition, 2021. 106 (2): p. 211-214.14. Zapata, H.A., et al., Surfactant administration through laryngeal or supraglottic airways (SALSA): A viable method for low-income and middle-income countries. Frontiers in Pediatrics, 2022.10 .

Objective: Asthma is a chronic obstructive disease that is common in children worldwide. This study aims to examine the effects of a digital game designed for respiratory training in childhood asthma. Methods: Fifteen children aged 8-14 years with asthma were included in the study. There were two groups a digital game group (n=9) and a control group (n=6). Demographic information of the children was recorded. Pulmonary function test (PFT) was evaluated with a portable spirometer (Spirobank MIR), the quality of life of the children was evaluated with the Paediatric Asthma Quality of Life Questionnaire and psychological status was evaluated with the child depression scale. Respiratory training was given to the digital game group with a digital game. The control group was followed with medication. Both groups were evaluated at baseline and after 3 weeks. Results: In the digital game group; It was observed that there was an increase in PFT, sub-parameters of the PAQLQ questionnaire, and the total score after the treatment (p<0.05). In addition, it was determined that there was a significant decrease after the treatment according to the questionnaire used for the change in the psychological status of the children (p<0.05). Conclusion: It was determined that respiratory training given with digital games had a positive effect on children’s psychological state, pulmonary function test, and quality of life.

Morocco has a long history of domesticating cannabis and refuges a local Beldia population, which lacks detailed information on genetic diversity. In this study, the genetic diversity of cannabis grown in four Moroccan regions was assessed with six genomic SSR markers involving two cannabis populations: the local Beldia and the introduced Critical variety. A total of 111 alleles were detected, with an average of 18.5 alleles /locus. Several genetic diversity indices were measured for both populations and showed the superiority of Beldia with a high genetic diversity compared to Critical. The analysis of molecular variance showed that genetic variability was remarkably observed within individuals (65%) and, to a less extent, within and among populations (19% and 16%, respectively). Principle coordinates analysis, unrooted neighbor-joining tree, and genetic structure profiles confirmed that Beldia and Critical are genetically distant and belong to two different gene pools. The gene flow revealed the presence of a genetic exchange between the two populations, thus highlighting the need to protect the local genetic heritage of Morocco from potential genetic erosion.

Introduction The currently available evidence states that 12 months after kidney transplantation (KT), more than half of the patients have severe cardiac structural and functional abnormalities. Objective To assess the cardiac reverse remodeling using echocardiography in the long-term after KT and its association with fibroblast growth factor-23 (FGF-23), carboxy-terminal propeptide of procollagen type I (PIP), and parathyroid hormone (PTH). Methods Fifty-three patients with end-stage renal disease were assessed before and 28 months after KT by echocardiography and serum quantification of FGF-23, PIP, and PTH. Results Thirty men and 23 women, with a mean age of 34±11 years, were included in the study. At 28 months after KT, an increase in functional capacity, complete resolution of the left ventricle (LV) hypertrophy (LV mass:121 ± 48 vs. 65 ± 14 gr/m2), reduction in left atrial volume (46 vs. 30 ml/m2), improvement in LV ejection fraction (53 vs. 63 %), global longitudinal strain (-15.9 vs.-19.4 %), and diastolic function were observed. Multivariate analysis showed that pre-KT LV mass, graft function, hypertension, and post-KT PIP predicted post-KT LV mass (R2=0.65, F=12.1, p=0.001). Logistic regression showed that the pre-KT FGF-23 concentration was the only variable related to hypertension after KT (X2=12.1, R2=0.3, p=0.032). PTH levels were not associated with LV hypertrophy. Conclusions Long-term follow-up after KT demonstrated that type 4 cardiorenal syndrome is reversible. Myocardial interstitial expansion is a minor component of absolute LV mass and is dominated by cardiomyocyte hypertrophy. FGF-23 plays an important role in persistent hypertension after KT.

In this paper, an adaptive anti-disturbance switching (AADS) control strategy is proposed for switched Takagi-Sugeno fuzzy systems (ST-SFSs) subject to multi-source disturbances. The disturbances consist of two parts: the available unmodeled disturbance and the disturbance modeled by dynamic neural network. Firstly, a novel adaptive disturbance observer is designed to approximate the dynamic neural network modeled disturbance. Secondly, the attenuation performance from the output to the available disturbance is analyzed by the L 2 gain index. Thirdly, a controller based on the adaptive disturbance observer is constructed for the ST-SFS under the average dwell time switching signal limitation. Further, under the designed adaptive disturbance observer, and the controller, a sufficient condition is established for the ST-SFS to realize multi-source disturbance suppression (DS). Finally, a mass-spring-damping simulation example is given to verify the rationality of the established AADS control scheme.

A novel shock life model is proposed for ball grid array (BGA) solder joints to evaluate its life under shock loads based on the evolutionary power spectral density (EPSD). Considering the bandwidth and non-Gaussian features of the stress signals during different stages, the shock stress response was treated as a non-stationary and non-Gaussian stochastic process. EPSD of the shock stress response is derived in matrix form based on wavelet transforms. The weight coefficient and non-Gaussian damage factor are proposed to describe the influence of the bandwidth and non-Gaussian characteristics of shock response on damage, respectively. The damage values of different stress stages were calculated by weight coefficient and corrected using non-Gaussian damage factor. Then the shock life model is proposed based on damage accumulation theory. Tests for the BGA solder joints shock life were conducted, and the result shows the proposed model is feasible.

In this paper, we formulate a deterministic mathematical model SEAIRB to study the dynamics behavior of COVID-19 pandemic. The model incorporates the impact of two strategies, health education and public sanitation, on the spread of the epidemic. Firstly, by using Routh-Hurwitz criteria, the disease-free equilibrium is locally asymptotically stable when the basic reproduction number does not exceed 1. Further, by using the comparison theorem, the global asymptotic stability of the disease-free equilibrium is obtained. Finally, numerical simulations are performed to verify the theoretical analysis and analyze the impact of different control strategies on the spread of the epidemic.

Due to unambiguous applications of bulk service vacation queues with set up time in various fields such as pharmaceutical, aerospace engineering, automobile industries etc., in this article, we analyze an infinite-buffer batch-size-dependent bulk service queue with single and multiple vacations, N-policy and set up time. Customers/packets/units are served by a single server according to general bulk service ( a,b) rule. The service time of a batch dynamically vary with the batch-size and follows the general type of distribution which covers a large scale of distributions. Firstly, we generate the steady-state system equations. The main intend of this study is to obtain the complete joint distribution of queue-length and server content at service completion epoch, for which the bivariate probability generating function has been derived. We extract the joint distribution which is presented in a quite simple form and using those we find the joint distribution at arbitrary epoch beside some marginal distributions and performance measures. Finally, several numerical examples along with graphical sketches have been provided to verify the analytical results and to provide inner feeling to the system designers.

Summary — Large Low Earth Orbit satellite constellations require Machine Learning methods for enabling autonomy in health keeping of the satellites. Autonomy in health keeping entail’s fault detection, isolation and reconfiguration. However, prior to building model building, it becomes imperative to conduct Exploratory Data Analysis of the data to gain an intuition of data and to decide the best model. Univariate Exploratory data analysis has been carried out on a BUS CURRENT sensor of Electrical Power System of a Low Earth Orbit Satellite to gain an understanding of data. Various aspects of data like presence of outliers, sampling frequency, missing values, comparison of imputation methods to fill missing values seasonality and trend analysis, stationarity test on data, rolling mean, and auto correlation and partial auto correlation plots have been made and a detailed statistical analysis of results has been conducted.

Introduction Central venous catheter (CVC) placement is commonly performed in children. We aim to develop simple formulas to predict CVC intravascular length to minimise radiation exposure associated with the procedure. Methods 124 paediatric patients who received tunnelled neck CVCs and subsequent CT thorax at Hong Kong Children’s Hospital from January 2020 to July 2022 were reviewed retrospectively. Formula development cohorts were subdivided by insertion sites – 39 right external jugular vein (REJV), 41 right internal jugular vein (RIJV), 14 left external jugular vein (LEJV), 10 left internal jugular vein (LIJV). Using measurements from CT by two radiologists, formulas predicting the CVC intravascular length based on height and insertion sites were developed using a linear regression model. These formulas were tested with validation cohorts (10 randomly selected cases in REJV and RIJV groups respectively). Validation cohorts were not available for LEJV and LIJV groups due to small sample sizes. Result The goodness-of-fit (R^2) of all formulas are above 0.8. In the validation cohorts, the REJV formula was predictive of intravascular CVC length within 1cm in 70% of CVC with mean absolute difference of 0.63cm (SD 0.48cm), and the RIJV formula was predictive of intravascular CVC length within 1cm in 80% of CVC with mean absolute difference of 0.67cm (SD 0.53cm). Conclusion Intravascular CVC length can be estimated using simple formulas based on height and insertion sites. Further prospective validation of the LEJV and LIJV formulas is needed.

A document by Priyanka Samal. Click on the document to view its contents.

Two-dimensional (2D) membranes have demonstrated potential for molecular separation; however, their applicability for Li/Mg ion separation has been restricted by their negatively-charged and easily-swellable properties in water. Moreover, their practical application has been hindered by the challenge of producing significant quantities of single-layer nanosheets. To overcome these challenges, we have developed a scalable method for synthesizing micro-sized nitrate ZnAl layered double hydroxide (LDH) and subsequent exfoliating to yield monolayer nanosheets for the construction of 2D membranes. The sub-nanometer channels of the LDH membrane is positively charged, which prevents the passage of magnesium ions. These channels also impede the flow of magnesium ions that are more difficult to dehydrate. As a result, the LDH membranes exhibit robust lithium-magnesium separation ability, with a separation ratio of 6 (Li/Mg). This work provides a method for producing high-quality LDH nanosheets and validates the enormous potential of LDH membranes in the field of lithium-magnesium separation.

Objective Effect on patient outcomes when introducing a novice robotic surgeon, trained in accordance with a structured learning curriculum, to an experienced robotic surgery team. Design Observational cohort study. Setting Tertiary referral centre. Population Patients with early-stage cervical cancer who were treated with primary robot-assisted surgery between 2007 and 2019. In addition to the 165 patients included in a former analysis, we included a further 61 consecutively treated patients and divided all patients over three groups: early learning phase of 61 procedures (group 1), experienced phase of the 104 procedures thereafter (group 2), and the final 61 procedures during introduction of a novice with structured training (group 3). Methods Risk-adjusted cumulative sum (RA-CUSUM) analysis was performed and patient outcomes between groups were compared. Main Outcome Measures Surgical proficiency based on recurrence, surgical and oncological outcomes. Results Based on RA-CUSUM analysis, no learning curve effect was observed for group 3. Regarding surgical outcomes, mean operation time in group 3 was significantly shorter than group 1 ( p<0.001) and similar to group 2 ( p=0.96). Proportions of intraoperative and postoperative adverse events in group 3 were not significantly different from the experienced group (group 2). Regarding oncological outcomes, the 5-year disease-free survival, disease-specific survival, and overall survival in group 3 were not significantly different from the experienced group. Conclusions Introducing a novice robotic surgeon, who was trained in accordance with a structured learning curriculum, resulted in similar patient outcomes as by experienced surgeons suggesting novices can progress through a learning phase without compromising outcomes of cervical cancer patients.

The power-electronics-based renewable power plants are currently experiencing rapid growth in various power systems. Their variable control strategies have altered the power transmission line fault characteristics, which leads to problems for the protections that rely on a linear estimation of the power frequency fault information, even to the point of the refused operation risk of protection. Therefore, this paper proposes a new protection algorithm based on a current energy ratio for the transmission line connecting to renewable power plants. The current fault characteristics are investigated in detail, and their energy relationship is adopted to fully distinguish internal and external faults. When an internal fault occurs, there are large differences in energy ratio of transient current on both sides. Energy ratio can be used to measure the degree of variation to distinguish the faults inside and outside the line. Simulation results show that faults of different fault resistances can be distinguished within 10 ms. Moreover, the proposed method requires a conventional sampling frequency and a computation speed that can be met by most protection devices. Thus, the proposed algorithm provides a better solution to the transmission line protection problem. These features make the proposed method a good choice for industrial application.

This paper analyzes the government R&D subsidy strategies at different stages, considering cost efficiency differences and subsidy rate as endogenous variables, and extends the subsidy from symmetric to asymmetric cases. We find that although subsidies in the R&D stage bring greater innovation output, they may lead to a deadweight loss of social welfare, while choosing the optimal subsidy rate in the output stage can maximize social welfare. It’s usually difficult for governments to pursue both maximum social welfare and innovation output. The cost efficiency of R&D and the symmetry of subsidies will also influence the strategies of government subsidy policies.

This research examines the impact of two-by-two interactions between three content creation strategy on cloud tourists' evaluation of vicarious tourism experience. Results indicated that the content creation strategies of out-group identity or third-perspective, out-group or objectifying-information, and third-perspective or objectifying-information will make cloud tourists pay more attention to high construal-level features. Conversely, cloud tourists focus on low construal-level traits while employing in-group identity and first-perspective, in-group identity and personalizing-information, and first-perspective and personalizing information strategies. In addition to having substantial theoretical implications, our findings provide novel insights regarding ways for practitioners to maximize their strengths while hide the weaknesses.

Objectives: Perinatal psychopathology can be damaging. This study examined the strength of the associations between risk factors and all perinatal mood and anxiety disorder symptoms while assessing the mediating effect of experiential avoidance. Method: Participants ( N =246) completed assessments during pregnancy (28-32 weeks) and the postpartum (6-8 weeks). Structural equation modeling (SEM) was used to examine associations between risk factors and latent factors: Distress (composed of depression, generalized anxiety, irritability, and panic symptoms); Fear (social anxiety, agoraphobia, specific phobia, and obsessive-compulsive); and Bipolar (mania and obsessive-compulsive). Results: During pregnancy, past psychiatric history, anxiety sensitivity, maladaptive coping, and age were significant risk factors. In the postpartum, negative maternal attitudes and past psychiatric history were only risk factors for symptoms that composed Distress. Experiential avoidance mediated the relation between maladaptive coping and symptoms that composed Fear. Conclusion: It is important to assess for psychological risk factors starting in pregnancy. This study identified critical risk factors that are associated with the underlying commonality among perinatal mood and anxiety symptoms. Some of the risk factors as well as the mediator are malleable (negative maternal attitudes, experiential avoidance), creating new possibilities for prevention and treatment of perinatal mood and anxiety disorder symptoms.