In this paper, we study the homogeneous Robin boundary value problem for the Laplacian equation with the nonlocal memory term { u t − △ u = ∫ 0 t g ( t − s ) △ u ( x , s ) ds + a ( x , t ) | u | σ − 2 u + h ( x , t ) , ( x , t ) ∈ Q T = Ω × ( 0 , T ) ∂u ∂η + k ( x , t ) u = 0 , ( x , t ) ∈ ∂ Ω × [ 0 , T ] u ( x , 0 )= u 0 ( x ) in Ω where Ω ⊂ R n ( n ≥ 2 ) is a bounded open domain with sufficiently smooth boundary ∂Ω, T>0, σ is real constant such that σ>1, ∆ is the n dimensional Laplace operator; a( x,t), k( x,t), h( x,t) are given functions, g( s) is a given memory kernel. We show that under appropriate conditions on a, k, σ, g the problem has a global and local in time solution. We established conditions of uniqueness. Lastly, by using the energy method, we obtain sufficient conditions that the solutions of this problem with non-positive initial energy blow up in finite time.

BACKGROUND: Pay for performance (P4P) schemes provide financial incentives or facilities to health workers based on the achievement of predetermined performance goals. Various P4P programs have been implemented around the world. There is a question of which model is suitable for p4p implementation to achieve better results. The purpose of this study is to compare pay for performance models in different countries. METHODS: This is a descriptive-comparative study comparing the P4P model in selected countries in 2022. Data for each country are collected from reliable databases and are tabulated to compare their payment models. the standard framework of the P4P model is used for data analysis. RESULTS: we used the standard P4P model framework to compare pay for performance programs in the primary care sector of selected countries because this framework can demonstrate all the necessary features of payment programs, including performance domains and measures, basis for reward or penalty, nature of the reward or penalty, and data reporting. The results of this study show that although the principles of P4P are almost similar in the selected countries, the biggest difference is in the definition of performance domains and measures. CONCLUSIONS: Designing an effective P4P program is very complex, and its success depends on a variety of factors, from the socioeconomic and cultural context and the healthcare goals of governments to the personal characteristics of the healthcare provider. considering these factors and the general framework of the features of P4P programs are critical to the success of the p4p design and implementation.

We described a 17-year-old male with a large pulmonary hydatid cyst with a spontaneous rupture. He developed acute respiratory distress syndrome (ARDS) requiring mechanical ventilation. He was treated with albendazole, broad-spectrum antibiotics, and corticosteroids. He underwent surgery after discharge. ARDS after rupture of hydatid cyst was rarely reported.

Headwater streams can constitute up to 80% of river channel length and are vulnerable to anthropogenic pressures due to their high connectivity to adjacent land, large relative catchment size and low dilution capacity. In these environments unrestricted cattle access is a potential significant cause of water quality deterioration, resulting from increases in stream bank erosion, riparian damage and sediment deposition among others. Several studies have reported improvements in physico-chemical and hydromorphological conditions of streams following elimination of cattle access; few, however, have focussed on the ecological impacts of such management practices. Here, such impacts are assessed. We look at the short-term effects by comparing habitat condition, sediment deposition, and instream macroinvertebrate communities upstream and downstream of cattle access points prior to, and one year following exclusion via fencing. The long-term effects are also measured by reassessing a small stream catchment entirely fenced off from cattle access in 2008 under a concerted management effort. In the short term, cattle exclusion led to reduction in deposited sediment downstream of cattle access points and a related homogenisation of macroinvertebrate community structure between upstream and downstream sampling points. Increased abundances of specific indicator taxa ( Ancylus fluviatilis, Glossosomatidae and Elmidae) in the fenced catchment following 9 years of exclusion highlight the long-term ecological benefits of such mitigation practices. These findings highlight the importance of incentivised agri-environment schemes in reducing the negative impacts of cattle access to these vulnerable ecosystems.

The bubble size, gas holdup, and interfacial area in a swirling contactor were investigated through experiments and simulations. The interfacial area was obtained for liquids and gases with Reynolds numbers Rel and Reg, respectively. The contactor was divided into 12 subregions. When Reg=23.8 and Rel =20075.4, regions near the side wall and center of the swirl contactor exhibited small bubbles with diameters of 0.33–0.40 and 0.38–0.45 mm, respectively. Rel was negatively related to bubble size, gas holdup, and interfacial area, whereas Reg was positively related. The maximum bubble interfacial area among the 12 subregions was 530 m-1,and for the entire swirling contactor was 196.3 m-1 with a gas–liquid ratio of 0.022. Euler-Euler simulations using the population balance model accurately predicted this area. Larger areas were obtained at lower Rel values. Increasing the liquid velocity is not necessary to achieve larger areas, which indicates a contactor with lower energy consumption.

The sciatic nerve has a neurotrophic activity that plays an important role in the peripheral nervous system (PNS). Compound action potentials (CAPs) is regarded as a physiological/pathological indicator to identify nerve activity in signal transduction of the PNS. Astragaloside (AST) is a small-molecule saponin, which is purified from Astragalus membranaceus. AST has been widely used to treat chronic disease. Nonetheless, the regulating effects of AST on the nerve action potential are not available. Therefore, present investigation was undertaken to study the effect of AST on CAPs of frog sciatic nerve. AST depressed the conduction velocity and amplitude of CAPs in a concentration-dependent way. Notably, the AST-induced responses could be blocked by a Ca2+-free medium as well as applying with all Ca2+ channel antagonists (CdCl2/LaCl3) or L-type Ca2+ channel blockers (nifedipine/diltiazem), but not the T-type and P-type Ca2+ channel antagonist (NiCl2). Taken together, our results suggested that AST may attenuate the CAPs of frog sciatic nerves in vitro via the L-type Ca2+-dependent mechanisms.

Functional connectivity (FC) during sleep has been shown to break down as non-rapid eye movement (NREM) sleep deepens before returning to a state closer to wakefulness during REM sleep. However, the specific spatial and temporal signatures of these fluctuations in connectivity patterns remain poorly understood. The goal of this study was to investigate how frequency-dependent network-level FC fluctuates during nocturnal sleep in healthy young adults using high-density electroencephalography (hdEEG). Specifically, we examined source-localized FC in resting-state networks during NREM2, NREM3, and REM sleep in the first three sleep cycles of 29 participants. Our results showed that FC within and between all resting-state networks decreased from NREM2 to NREM3 sleep in multiple frequency bands and in all sleep cycles. The data also highlighted a complex modulation of connectivity patterns during the transition to REM sleep whereby delta and sigma bands hosted a persistence of the connectivity breakdown in all networks, whereas a reconnection was observed in the default mode (DMN) and the attentional networks in frequency bands characterizing their organization during wake (i.e., alpha and beta bands, respectively). Finally, all network pairs (except the visual network) showed higher gamma-band FC during REM sleep in cycle three compared to earlier cycles during the night. Altogether, our results unravel the spatial and temporal characteristics of the well-known breakdown in connectivity observed as NREM sleep deepens. They also shed light on a complex pattern of connectivity during REM sleep that is consistent with both breakdown and reconnection processes that are network- and frequency-specific.

Objective: This study aims to evaluate the impact of a primary care nurse-practitioner-led clinic model piloted in British Columbia (Canada) on patients' health and care experience. Design: The study relies on a quasi-experimental longitudinal design based on a pre-and-post survey of patients receiving care in NP-Led clinics. The pre-rostering survey (T0) was focused on patients' health status and care experiences preceding being rostered to the NP clinic. One year later, patients were asked to complete a similar survey (T1) focused on the care experiences with the NP clinic. Setting: To solve recurring problems related to poor primary care accessibility, British Columbia opened four pilot NP-led clinics in 2020. Each clinic has the equivalent of approximately six full-time NPs, four other clinicians plus support staff. Clinics are located in four cities ranging from core urban to peri rural. Participants: Recruitment was conducted by the clinic's clerical staff or by their care provider. A total of 437 usable T0 surveys and 254 matched and usable T1 surveys were collected.

Effective vaccines have reduced SARS-CoV-2 morbidity and mortality; however, the elderly remain the most at risk. Understanding how vaccines generate protective immunity, and how these mechanisms change with age is key for informing future vaccine design. Cytotoxic CD8+ T cells are important for killing virally infected cells, and vaccines that induce antigen specific CD8+ T cells in addition to humoral immunity provide an extra layer of immune protection. This is particularly important in cases where antibody titres are sub-optimal, as can occur in older individuals. Here, we show that in aged mice, spike-epitope specific CD8+ T cells are generated in comparable numbers to younger animals after ChAdOx1 nCoV-19 vaccination, although phenotypic differences exist. This demonstrates that ChAdOx1 nCoV-19 elicits a good CD8+ T cell response in older bodies, but that typical age-associated features are evident on these vaccine reactive T cells.

In modern power systems, the impact of random power sources and loads on power systems is increasing, resulting in threatened system frequency security. However, traditional methods are often not comprehensive in modelling randomness, and there is no analytical method to assess the frequency response of power systems under uncertain power disturbances. In this paper, the power disturbance in a power system is regarded as an interval random quantity. Based on a general model of the system frequency response (SFR-G) and the theory of stochastic processes, an analytical prediction method of the power system frequency deviation under uncertain power disturbance is proposed. Through further deduction, the allowable range of power disturbance under the premise of secure frequency deviation can also be defined, which provides a reference for frequency security and accident prevention in power systems. Numerical simulations demonstrate that the proposed analytical method can delimit the response interval of system frequency deviation well, and the backstepping calculation can also delimit the allowable range of power disturbance to ensure the secure operation of the system.

In this paper, we present the results of the MitoEM challenge on mitochondria 3D instance segmentation from electron microscopy images, organized in conjunction with the IEEE-ISBI 2021 conference. Our benchmark dataset consists of two large-scale 3D volumes, one from human and one from rat cortex tissue, which are 1,986 times larger than previously used datasets. At the time of paper submission, 257 participants had registered for the challenge, 14 teams had submitted their results, and six teams participated in the challenge workshop. Here, we present eight top-performing approaches from the challenge participants, along with our own baseline strategies. Posterior to the challenge, annotation errors in the ground truth were corrected without altering the final ranking. Additionally, we present a retrospective evaluation of the scoring system which revealed that (1) the challenge metric was permissive with the false positive predictions and (2) the size-based grouping of instances did not correctly categorize mitochondria of interest. Thus, we propose a new scoring system that better reflects the correctness of the segmentation results. Although several of the top methods are compared favorably to our own baselines, substantial errors remain unsolved for mitochondria with challenging morphologies. Thus, the challenge remains open for submission and automatic evaluation, with all volumes available for download.

Ravi Raj1, Neena Isaac2, Pratibha Warwade31Indian Institute of Technology Delhi, India2Central Water and Power Research Station Pune, India3Central University of Jharkhand Ranchi, IndiaE-mail cez198244@civil.iitd.ac.in

In this issue of the Journal, Kushnir, et al. provide a report of temporal trends in first time ablation at a large academic medical center over a 10 year period. This editorial provides commentary on the report.

Introduction: Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) is a rare inherited disorder usually affecting the right ventricle (RV), characterized by fibro-fatty tissue replacement of the healthy ventricular myocardium. It often predisposes young patients to ventricular tachycardia, heart failure, and / or sudden cardiac death. However, recent studies have suggested predominantly left ventricle (LV) involvement with variable and / or atypical manifestations. Cardiac Magnetic Resonance (CMR) imaging has emerged as the non-invasive gold standard for the diagnosis of ARVC. Case summary: A 21-year-old athletic male with a family history of unknown ventricular arrhythmias, presented with near syncope, chest pain and exertional palpitations. He had an initial work-up that was grossly unremarkable including, electrocardiography (ECG), echocardiography and CMR imaging. Six months later, he presented again with recurrent symptoms during exercise and his ECG demonstrating a new epsilon wave. He had markedly elevated cardiac biomarkers, (troponin I >100 ng/dl, normal value < 0.04 ng/dl). A subsequent coronary angiogram was performed, which was normal. Holter monitoring further showed subsequent episodes of ventricular tachycardia with a right bundle branch morphology. An endomyocardial biopsy was performed, which was negative. A follow-up CMR demonstrated the new development and prominent left ventricular epicardial scar in the lateral wall. The patient underwent familial genetic testing, which confirmed the presence of an isolated JUP gene mutation and showed multiple genes consistent with ARVC in his mother. Thus, he manifested a partial transmission of only one abnormal gene for ARVC and exhibited a markedly different expression in his disease without evidence of typical right-sided heart pathology. A third CMR study was performed, which showed partial improvement in myocardial fibrosis after exercise cessation. Conclusion: We present a case of a young male with a newly diagnosed isolated JUP gene mutation and a genetically diagnosed family history of ARVC. During his course, he demonstrated the progression of a characteristic epsilon wave on ECG and the presence of new, atypical, left ventricular fibrosis on repeat CMR imaging. This case demonstrates a complex interplay between variable genetic penetrance, phenotypical heterogeneity, and lifestyle factors including exercise, in his disease expression and provides insight on the natural course of an isolated JUP mutation. Although rare, clinicians should have a high threshold for the suspicion of ARVC or variants of this disorder even in the absence of classic right sided pathologies and /or an initially normal work-up.

This study aimed to elucidate the damage mechanism of prestressed sandstone under uniaxial compression through the distribution characteristics of meso-structures. Four prestress levels, i.e., 0MPa, 15MPa, 30MPa, and 40MPa were selected. Nuclear Magnetic Resonance and Scanning Electron Microscope techniques were employed to observe the distribution characteristics of meso-structure within rocks and to further its damage mechanism. The results show that, compare with untreated specimens (0MPa), damaged specimens by 15MPa show a more porous meso-structure due to pores/cracks propagation which occurs between skeleton minerals and filler materials. Furthermore, specimens treated by 30MPa and 40MPa show low failure strength because micro-pores/cracks initiation inside skeleton minerals causes high deterioration. By meso-mechanics analysis, particle rotation leads to pores/cracks propagation and slightly modifies the meso-structure under low-prestress conditions. With the increase of the prestress, the transgranular cracks initiation and propagation will transform the skeleton structure of rocks, leading to significant rock deterioration.

In the current state of the art of process industries/manufacturing technologies, computer-instrumented and computer-controlled autonomous techniques are necessary for damage diagnosis and prognosis in operating machinery. From this perspective, the paper addresses the issue of fatigue damage that is one of the most commonly encountered sources of degradation in polycrystalline-alloy structures of machinery components. It is possible to conduct in-situ detection & classification of damage as well as an assessment of the remaining service life through ultrasonic measurements of material degradation and their computer-based analysis. In this paper, tools of machine learning (e.g., convolutional neural networks (CNNs)) are applied to synergistic combinations of ultrasonic measurements and images from a confocal microscope (Alicona) to detect and evaluate the risk of fatigue damage. The database of the confocal microscope has been used to calibrate the ultrasonic database and to provide the ground truth for fatigue damage assessment. The results show that both the ultrasonic data and confocal microscope images are capable of classifying the fatigue damage into their respective classes with considerably high accuracy. However, the ultrasonic CNN model yields better accuracy than the confocal microscope CNN model by almost 9%.

Esophageal cancer (EC) is the tenth most common cancer worldwide and has high morbidity and mortality. Its main subtypes include esophageal squamous cell carcinoma and esophageal adenocarcinoma, which are usually diagnosed in their late stages. The biological defects and inability of preclinical models to summarize completely the etiology of multiple factors, the complexity of the tumor microenvironment, and the genetic heterogeneity of tumors severely limit the clinical treatment of EC. Patient-derived models of EC not only retain the tissue structure, cell morphology, and differentiation characteristics of the original tumor, they also retain tumor heterogeneity. Therefore, compared with other preclinical models, they can better predict the efficacy of candidate drugs, explore novel biomarkers, combine with clinical trials, and effectively improve patient prognosis. This review discusses the methods and animals used to establish patient-derived models, especially patient-derived xenograft models. It also discusses their advantages, applications, and limitations as preclinical experimental research tools to provide an important reference for the precise personalized treatment of EC and improve the prognosis of patients.

Sciatica, a musculoskeletal condition is a common cause of disability and early deaths, affecting millions of people globally. The aim of the study was to evaluate efficacy of different drug combinations for treatment of acute sciatica. It is a single-center, clinical trial with three arms, registered at Clinicaltrials.gov; (NCT05626140). Adults from 18-70 years of age were enrolled (n=130). Patients were placed in three groups each i.e. 40 in diclofenac plus placebo group, 40 in codeine plus diclofenac group and 40 in lacosamide plus diclofenac group and followed up for 15 days for change in mean pain scores using Visual Analog Scale (VAS). Pairwise comparison assessed change from baseline in mean pain scores. The VAS mean pain scores with combination of lacosamide and diclofenac showed significant decrease from 7.785cm to 1.115cm. Codeine with diclofenac displayed a lesser decline of 7.43cm to 2.71cm while diclofenac monotherapy exhibited the least change from 7.50cm to 3.45cm. P value was significant (p < 0.001) for 10th and 15th day of follow up. Adequate analgesia was attained in all the three arms. In conclusion, combination of lacosamide with diclofenac showed clinical superiority in relieving symptoms of acute sciatica compared with diclofenac plus codeine or diclofenac monotherapy.

A document by Nagham Ailabouni. Click on the document to view its contents.

Acute lung injury is a systemic inflammatory response syndrome in the lungs, with a high incidence and fatality rate of 30%–40%. Despite the abundance of research on the pathogenesis of lung injury and the great progress that has been achieved, the various number of cells, cytokines and inflammatory response pathways involved in the pathogenesis of acute lung injury (ALI) and their complex relationships, which together constitute the cell network and inflammatory factor network of ALI inflammatory response, demand more attention. This study reviews the formation of this network in the pathogenesis of acute lung injury

A document by Dr.S. Sugumaran. Click on the document to view its contents.

A 34-year-old woman with breast cancer and the BRCA2: p.Gln3047Ter was treated with olaparib. After tumor progression, cancer genomic profiling testing revealed the BRCA2 p.Gln3047Ter and p.Gln3047Tyr, with 48.9% and 0.37% allele frequency, respectively. These findings shed light on reversion mutation as a resistance mechanism to olaparib in breast cancer.

Cardiac hydatidosis is a relatively rare complication of echinococcosis, with a potentially life-threatening condition. Here, we reported a large interventricular septal hydatid cyst with bulging in the left ventricle accompanied by a huge cervical lamp with recurrent hepatic cysts that underwent cardiac surgery to excise the cyst uneventfully.

Lung cancer can present with unilateral atypical facial pain, a rare symptom due to vagus nerve involvement or paraneoplastic syndrome. This manifestation is usually missed, delaying the diagnosis and prognosis. We discuss a case of a 45-year-old male who presented with right-sided hemifacial pain and with normal neurological investigations.