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Aims Healthcare workers’ (HCWs) ability to recognize, classify and manage adverse reactions (ADR) is crucial to ensure patient safety. This study assessed HCWs’ awareness, knowledge, and practice on ADR. Methods This was a cross sectional online questionnaire case-based study, involving clinical HCWs at two tertiary hospitals. Results We recruited 321 respondents with 256 doctors, 58 nurses and seven medical assistants. HCWs with more than five years’ experience and dermatologists had better ADR knowledge. Three-quarter failed to recognize off-target nonimmune mediated non-steroidal anti-inflammatory drugs reactions. About 26% (n=84) could not recognize severe cutaneous adverse drug reactions (SCARs). In those who recognized SCARs, only 76.6% (n=177) will not re-introduce the implicated drugs. Knowledge in managing anaphylaxis and awareness in paradoxical drug-induced reaction was poor. About 18% (n=58) did not use adrenaline in anaphylaxis and 80% (n=259) were unfamiliar with the usefulness of tryptase in anaphylaxis. Nearly 52% were ignorant of succinylated gelatin solution as a hidden allergen. Nearly 90% (n=286) were unfamiliar with utilization of fresh frozen plasma in severe ACE-inhibitor induced angioedema. A significant proportion of respondents understood the reporting pathway for ADRs to medications and vaccines, respectively. Only up to 67.3% (n=216) understood the need to update ADR reporting when a new reaction occurred. Conclusion The overall HCWs knowledge and practice on ADRs is not satisfactory where they lacked awareness on many aspects of ADRs. These findings provide supportive evidence for the incorporation of ADR into the healthcare curricula and plan periodic programs to ensure patient safety.

Background: Intra-abdominal lymphatic malformations are rare entities without a clear consensus on management or prognosis. These malformations are medically and surgically complex and often require a sophisticated, multi-disciplinary approach to treatment. Methods: A single quaternary institutional, retrospective chart review between January 2000-December 2019 was performed on all patients with an initial diagnosis of a non-solid organ intra-abdominal lymphatic malformation. Demographics, presentation, treatment, and outcome were reviewed. Results: 24 patients were identified, 62.5% were male. Median age at time of diagnosis was 2.5 years old, 33% were present at birth, 50% presented before 2 years old, and 29% presented ≥10 years of age. 75% were lymphatic (majority macrocystic), 20.8% were mixed lymphatic-venous malformations (LVM). 54% had other associated lymphatic or vascular malformations including 4 patients with PIK3CA-Related Overgrowth Spectrum (PROS), 3 with Generalized Lymphatic Anomaly, and 2 with Capillary Venous Lymphatic malformation (CVLM). Patients most often presented with abdominal pain (50%). 95.8% required an intervention. 87.5% were managed initially with sclerotherapy. Most interventions were performed for abdominal symptoms either before three years of age or during adolescence. 41.7% underwent laparoscopic or open surgery. 8.3% underwent surgery as their primary therapy. Conclusion: Intra-abdominal lymphatic malformations have a bimodal distribution pattern of presentation; shortly after birth and again at puberty. Most patients present with abdominal symptoms and have other associated vascular anomalies. MRI appears to be the most accurate modality for treatment planning. Interventional procedures such as sclerotherapy and medical therapy with sirolimus are safe and effective and should be considered first line therapies. Surgical resection is often required when the diagnosis is in question or when more conservative therapies are no longer efficacious.

In this article, Sentinel-1 and Sentine-2 data were integrated to mapping wetlands in Yellow River Delta. Given that different wetlands may owning different optimal feature subsets, we propose a multilevel global-to-local feature optimization wetlands hierarchical classification approach. This method constructs classification trees according to the classification difficulty of wetlands and implements wetland classification in three layers. During the process of hierarchical classification, we utilized the effectiveness of random forest algorithm in feature evaluation to select the most suitable feature subset for each classification node of the classification tree for training classifiers and implementing classification. Specifically, this paper uses Stacking method to construct classifiers. Seven sets of comparison experiments were designed to verify the effects of the proposed multilevel global-to-local feature optimization wetlands hierarchical classification approach. Using the proposed method, the overall accuracy and kappa statistic are improved to 90.06% and 0.8768 compared with other classification approach.

Background: The management of aortic arch pathologies represents a great challenge and is associated with high rates of mortality and morbidity. A superior endovascular approach via thoracic endovascular aortic repair (TEVAR) has been introduced to treat arch pathologies with specifically designed endografts. This approach was shown to benefit patients who are deemed ‘high risk’ for undergoing OSR as it is a greatly less invasiveness option and thus, yields lower rates of morbidity and mortality. Aims: This commentary aims to discuss the recent study by Tan et al. which reports original data on the neurological outcomes after endovascular repair of the aortic arch using the RELAY™ Branched device. Methods: We carried out a literature search on multiple electronic databases including PubMed, Ovid, Google Scholar, Scopus and EMBASE in order to collate research evidence on the neurological outcomes of endovascular aortic arch repair with TEVAR. Results: Tan and colleagues showed through their original clinical data that the RELAY™ Branched device has a high rate of technical success and favourable neurological outcomes. There were no reported neurological deficits in patients who received the triple-branched RELAY™ Branched device. Conclusion: The RELAY™ Branched endograft is well-established for candidates for aortic arch endovascular repair with favourable neurological outcomes. Multiple considerations can help control the incidence of stroke following endovascular repair. These include optimization of the supra-aortic vessels’ revascularization, weighting the embolic risk in patients with atheromatous disease, and careful preoperative assessment to select the best candidates for arch endovascular repair

Background: Having good exposure to the mitral apparatus during mitral valve replacement is a vital decision every cardiac surgeon must take. This study was conducted to compare the Simple Transseptal approach and the conventional Left Atrial approach for mitral valve procedures, to evaluate the safety and efficacy of the simple transseptal approach during open-heart mitral valve procedures, as the conventional left atrial approach may not provide optimal exposure, especially in unfavorable anatomical and operative situations. Methods: This is a retrospective chart review cohort study. It has been conducted on 140 patients who were diagnosed with heart diseases that required mitral valve replacement. Surgeries were performed in Cardiothoracic Surgery Department at Assiut University Hospital over the period from January 2016 to June 2021 by one surgeon. Mitral procedure was done through median sternotomy incision under general anesthesia on cardiopulmonary bypass machine with cold antegrade cardioplegia. Demographic data, preoperative diagnosis, intraoperative findings, hospital stay, complications, and mortality were documented and revised. Results: one hundred and forty patients were enrolled in this study with a median age of 39 years, and no significant differences as regards the baseline demographic data as age, sex, and BMI. 68 patients underwent mitral valve replacement through the simple transseptal approach and 72 patients through the conventional left atrial approach. Both studied groups had insignificant differences as regards bypass time, re-operation rate, postoperative complications, hospital stay, and mortality. Conclusion: Simple transseptal approach through the midpoint of fossa ovalis could be a safe and even favorable alternative to the traditional left atriotomy approach in certain difficult operative situations during mitral valve replacement surgery.

The mytilid mussel Bathymodiolus thermophilus lives in the deep-sea hydrothermal vent regions due to its symbiotic relationship with chemosynthetic Gammaproteobacteria species which reside inside specialized gill cells. The symbionts in the gill bacteriocytes oxidize the reduced sulfur amply available in the vent environment. Here we sequenced and assembled the complete genome of a gill symbiont sampled from an individual mussel from the East Pacific Rise (EPR9N), using PacBio sequencing technology. The final symbiont assembly consists of a single contig size of 2.83 Mb, with a GC content of 38.6% and encodes for 2,133 protein-coding genes. CRISPR diversity analysis confirmed this genome originated from a single symbiont strain. Comparative analysis revealed 2,554 core gene clusters were shared with other B. thermophilus thiotrophic gill symbiont genomes, whereas 125 were unique to this EPR9N strain. In addition, we found that EPR9N strain has a unique hydrogenase operon among Bathymodiolus mussels consisting of additional H2-sensing hydrogenase subunits and a histidine kinase gene. Also, we found methylated regions sparsely distributed throughout the EPR9N genome, mainly in the transposases regions and densely present in the rRNA gene regions. Variation in genome size, gene content and genome re-arrangements across individual hosts suggest multiple symbiont strains can associate with B. thermophilus. This complete mussel symbiont genome will be invaluable for further comparative genomic analyses studying structural genome evolution, symbiont population diversity, and symbiont ecology in deep-sea chemosynthetic environments.

MCSE have been gradually applied in clinical practice. However, how to flexibly apply it to the diagnosis and treatment of CAD still needs clinical practice. Herein, we encountered a case of NSTEMI patient, who perform MCSE three times to assist in finding the pathogenesis and guiding medication

Radio frequency (RF) fingerprinting is a challenging and important technique in individual identification of wireless devices. Recent work has used deep learning-based classifiers on ADS-B signal without missing aircraft ID information. However, traditional methods are difficult to obtain well performance accuracy for classical deep learning methods to recognize RF signals. This letter proposes a Gaussian Low-pass Channel Attention Convolution Network (GLCA-Net), where a Gaussian Low-pass Channel Attention module (GLCAM) is designed to extract fingerprint features with low frequency. Particularly, in GLCAM, we design a Frequency-Convolutional Global Average Pooling (F-ConvGAP) module to help channel attention mechanism learn channel weights in frequency domain. Experimental results on the datasets of large-scale real-world ADS-B signals show that our method can achieve an accuracy of 92.08%, which is 6.21% higher than Convolutional Neural Networks.

The Outbreak of Acute hepatitis of unknown etiology has affected children drawing the attention of authorities to investigate the cause. Africa hasn't reported any case yet but isn't guaranteed safety unless there're efforts employed. This work focused on the efforts which would be adapted in Africa prior the outbreak occurs.

In this study, we detected a circular replication-associated protein (Rep)-encoding single-stranded (CRESS) DNA virus in intestinal tissue samples and faecal samples of pigs. Some researchers named po-circo-like (PCL) virus. PCL virus contains a single-stranded DNA genome, and ORF1 encodes the Rep and not the typical capsid protein encoded in PCV. The Rep protein may be responsible for viral genome replication. In addition, PCL virus may be one of the pathogens causing diarrhea symptoms in pigs. We identified four strains of PCL virus in two different pig farms with severe diarrhea outbreaks in Hunan Province, China. The strains in this study share 39.4%–94.9% nucleic acid identity and 85.3%–98.4% amino acid identity with Rep of the reference strains. A multiple sequence alignment of these PCL viruses and Bo-Circo-like CH showed a identity of 93.2% for the Rep protein, and the nucleotide identity was 86.7-89.3%. Moreover, Bo-Circo-like CH and HN75, HN39-01, HN39-02 had similar stem-loop sequences. The PCL virus might therefore be transmitted to non-porcine hosts by cross-species transmission routes. Through Recombination Detection Program (RDP), Simplot and phylogenetic analyses, strong evidence for recombination events was found in China field PCL virus strains. In conclusion, the present study is the first detailed report of the PCL virus in HuNan provinces, which is a potential new virus in pigs that might be involved in cross-species transmission. Further investigation is needed to determine the pathogenesis of this virus and its epidemiologic impact.

The classical eutectic growth models are based on the use of eutectic composition. These models neglect the effect of the primary phase formation and their direct using in the rapid solidification process of off-eutectic (hypoeutectic and hypereutectic) alloys is absent. Combing the effect of the primary phase in the eutectic transformation and an off-eutectic composition, the solidification growth model is derived in the present work. The effect of the model and materials parameters on solidification kinetics is discussed in comparison with experimental data. Computational results on the off-eutectic growth model show that the model agrees well with experimental data on solidification kinetics of Ni-B and Ti-Si alloys.

Traffic safety is one of the essential fundamentals in the field of ‘advanced driver assistance systems (ADAS)’ vehicles. Moreover, these vehicles became popular among many people due to their safety, reliability, and ability to follow traffic rules. Therefore, many car companies seek to improve their safety and intelligence capabilities by conducting experiments in expected and unexpected circumstances. Thus, roads dedicated to these vehicles are being built in many countries to support these industries; However, many of these experiments remain challenging to conduct in certain conditions, especially when various possibilities demand many trials to practice dealing with them. This study uses the ANSYS HFSS algorithm to simulate an ‘ADAS’ scenario. The simulation data will then be extracted and analyzed in MATLAB to determine the ‘direction of arrival (DOA)’ by using the well-known algorithm ‘multiple signal classification (MUSIC)’. After implementing the ‘MUSIC’ algorithm, the results showed high accuracy in determining the ‘DOA’. This research demonstrates that simulation results have a promising potential for accelerating the development of safe autonomous vehicular technology. The same methodology applies to developing new cellular communication technologies such as 5G and 6G antenna beamforming technology.

We study the long time behavior of solutions for time-fractional pseudo-parabolic equation involving time-varying delays and nonlinear pertubations, where the nonlinear term allows to have a superlinear growth. Concerning the associated linear problem, we establish a variation of parameters formula of mild solution and prove some regularity estimates of resolvent operators. In addition, thanks to local estimates on Hilbert scales, fixed point arguments and a new Halanay type inequality, we obtain some results on the global solvability, stability, dissipativity and the existence of decay solutions to our problem.

This paper presents decoupled second-order accurate algorithms based on Crank-Nicolson LeapFrog (CNLF) scheme for the evolution Boussinesq equations. The proposed algorithms deal with the spatial discretization by finite element method and treat the temporal discretization by CNLF method. For the nonlinear term in the Boussinesq equations, the semi-implicit method is used. Unconditional stability and error estimate of the numerical algorithm are proven. Some numerical tests are presented to justify the theoretical analysis.

Background: Given the good prognosis of low-risk papillary thyroid microcarcinomas (lrPTMCs) accurate risk stratification is valuable to optimize management: active surveillance vs. surgery. BRAFV600E testing was associated with increased recurrence risk, hence AS seems reasonable for mutation-negative lrPTMC. However, when considering AS, patient perception is highly important as adherence and emotional aspects are challenging. In this study, we aimed to model the contribution of BRAFV600E testing for the management of PTMCs when tailored to the patient perspective. Methods: We developed a Markovian model to predict the role of BRAFV600E in prioritizing between hemithyroidectomy (HT) and active surveillance (AS) for lrPTMCs. We used a simulated cohort of lrPTMCs, with probabilities of each strategy driven from previous literature. Outcomes were measured as quality-of-life years (QALYs). One- and two-way sensitivity analyses were conducted to ascertain model robustness. Results: We found that the optimal strategy (e.g., that would maximize QALYs) varies according to BRAFV600E status for patients without a preset predilection between AS to HT. Using one-way sensitivity analysis, we found that the two main variables that have the strongest impact on the decision are the utility of AS and the utility of a disease-free state after HT. Two-way sensitivity analysis demonstrated that BRAFV600E status can define the optimal strategy for patients in the middle zone of the utility range (e.g., patients without clear preference). Conclusions: Our model suggests that BRAFV600E status can facilitate decision-making regarding AS vs. HT for patients without preset predilection. Our model supports further real-life studies of BRAFV600E testing for PTMCs.

The Global Methane Pledge declared at the 2021 United Nations climate change conference (COP26) marked the world’s commitment to eradicate methane emissions. Most of these emissions are generated by the oil-gas industry, waste landfills, and agriculture sectors, and are lean in composition. This work explores the use of an intensified reactor that implements the chemical looping principle to handle lean methane emissions. A model-based framework is used to showcase the baseline performance of the proposed reactor in converting methane emissions using nickel-based oxygen carriers. Then, sensitivity analysis of the reactor performance with respect to operating conditions is performed. The reactor is subsequently optimized to minimize the methane emitted, using a dynamic program with safety and operability constraints for the alternating redox process. With the optimal cycle strategy, we demonstrate that near-complete methane conversion can be achieved by the reactor without external heating.

BACKGROUND AND PURPOSE Alcohol-associated liver disease (ALD) caused by chronic alcohol consumption range from simple steatosis to alcoholic hepatitis, fibrosis, and cirrhosis. Physcion is an anthraquinone compound of Rheum palmatum L, a Chinese herbal medicine with possible hepatoprotective properties. This study aimed to investigate the protective effect and associated molecular mechanisms of physcion on chronic alcoholic liver injury. EXPERIMENTAL APPROACH Chronic alcoholic liver injury was induced by placing male C57BL/6 mice on Lieber-DeCarli ethanol-containing diets for 10 days and then administering a single dose of ethanol (5 g/kg body weight) via gavage. Human hepatic stellate cells line, LX-2 cells were pretreated with physcion for 1 h prior to ethanol stimulation. KEY RESULTS Physcion effectively ameliorated ALD-induced serum aminotransferase and triglyceride levels, steatosis, activated SIRT1-AMPK signaling, then inhibited hepatic NLRP3 inflammasome activation and GSDMD relevant in pyroptosis, the same as the hepato-protection of AMPK and SIRT1 agonists. Physcion suppressed ECM accumulation through inhibiting collagen-Ⅰ and α-SMA expression. Moreover, physcion prevented the accumulation of HMGB1 and NF-κB p65 nuclear translocation and release. Importantly, silencing of SIRT1-AMPK signaling eliminates the protective effect of physcion. CONCLUSIONS AND IMPLICATIONS Activation of SIRT1-AMPK signaling is involved in ALD pathogenesis, which alleviated by physcion through inhibiting NLRP3 inflammasome activation, inflammatory response and pyroptosis. Therefore, manipulation of hepatic inflammation and pyroptosis through strategies by targeting SIRT1-AMPK signaling holds great therapeutic potential for ALD.

Abstract There are two simple concrete methods to reduce the dosage of NSAIDs dramatically. An attending physician is suspected of being a fake doctor if the blood test is never performed after administration of the antihyperlipidemic drug. However, the analgesic effects are often not examined after the administration of analgesics. As with antihyperlipidemic drugs, efficacy should be examined after administration of analgesics. Analgesics should not be administered continuously without examining the analgesic effects. One study shows no difference in the analgesic effects between NSAIDs and acetaminophen at the latest 2 weeks after injury or surgery. If NSAIDs are administered for more than 2 weeks, it is necessary to confirm that NSAIDs are more analgesic than acetaminophen. If NSAIDs are more analgesic than acetaminophen, prolonged administration of NSAIDs is acceptable, knowing that they have more adverse effects than acetaminophen. If the analgesic effects of both medicines are comparable, acetaminophen should be administered. These are a matter of course. The two methods reduce the administration of NSAIDs dramatically, reducing the aforementioned adverse effects due to NSAIDs dramatically.

As demand for food increases, agricultural production is poised to increase dramatically. Pesticides are commonly used to maintain high crop yield, though they have several drawbacks, including reduced efficacy over time and harmful effects to human and ecosystem health. Bats are highly effective predators of crop pests and have great potential to reduce crop damage resulting from insects. However, few studies have investigated how pest control by bats might change over large expanses of continuous row crop agriculture, which is common in the Midwest. Agricultural landscapes offer few roosting opportunities and could be difficult for bats to traverse, which might affect the degree of ecosystem services provided by bats. We hypothesized that with increasing distance into uninterrupted row crop agriculture 1) bat activity would decrease and 2) bat species richness would decrease, but that these effects would be buffered when insect pest abundance is high. We deployed 50 acoustic bat detectors over 10 transects in east-central Illinois from July to September 2021. In each transect, we placed detectors on crop field edges at increasing distance from a large riparian corridor assumed to be frequented by bats. Bat activity was high across the landscape but declined by 56% from the forest edge to 4000m into row crop agriculture, while bat diversity decreased by 34%. Pest abundance seemed to decrease overall bat activity but had no effect on bat diversity. These results indicate that bats, although able to have a large effect on crop pest reduction, might not be as efficient in suppressing crop pests in vast uninterrupted agricultural landscapes which offer scant roost availability. Our work will inform recommendations to landowners and private lands managers on ways to increase bat access to roosts and forest cover near agricultural areas, thereby enhancing the potential for bats to provide pest control services.

Running title: Timing of total serum bile acids measurement

Aims Increased LV wall thickness is frequently encountered in transthoracic echocardiography (TTE). While accurate and early diagnosis is clinically important, given the differences in available therapeutic options and prognosis, an extensive workup is often required to establish the diagnosis. We propose the first echo-based, automated deep learning model with a fusion architecture to facilitate the evaluation and diagnosis of increased left ventricular (LV) wall thickness. Methods and Results Patients with an established diagnosis of increased LV wall thickness (hypertrophic cardiomyopathy (HCM), cardiac amyloidosis (CA), and hypertensive heart disease (HTN)/others) between 1/2015 to 11/2019 at Mayo Clinic Arizona were identified. The cohort was divided into 80%/10%/10% for training, validation, and testing sets, respectively. Six baseline TTE views were used to optimize a pre-trained InceptionResnetV2 model. Each model output was used to train a meta-learner under a fusion architecture. Model performance was assessed by multiclass area under the receiver operating characteristic curve (AUROC). A total of 586 patients were used for the final analysis (194 HCM, 201 CA, and 191 HTN/others). The mean age was 55.0 years, and 57.8% were male. Among the individual view-dependent models, the apical 4 chamber model had the best performance (AUROC: HCM: 0.94, CA: 0.73, and HTN/other: 0.87). The final fusion model outperformed all the view-dependent models (AUROC: CA: 0.90, HCM: 0.93, and HTN/other: 0.92). Conclusion The echo-based InceptionResnetV2 fusion model can accurately classify the main etiologies of increased LV wall thickness and can facilitate the process of diagnosis and workup.

Left atrium myxomas are the most frequent heart tumors. Assessment of this phenomenon is largely echocardiographic, since both TTE and TEE provide information on size, shape, and hemodynamic consequences of the tumor. In this publication, we bring forward the similarities between morphological assessment through transillumination echocardiography and pathologic anatomy, highlighting a possible study field for the future.

Wildfires are an increasingly alarming phenomenon that affects forests and agro-ecosystems, generating several cascade effects among which soil erosion is one of the most deleterious. A robust body of data-based evidence on post-fire soil erosion and sediment yield at watershed scale is thus required, especially dealing with areas where wildfires are particularly frequent, such as the Mediterranean Basin. This study analyses the impact of the first rains after a large wildfire in terms of soil erosion and sediment yield at watershed scale in a Mediterranean area, the Pisan Mountains, Central Italy. Here about 1,000 ha of olive groves, maquis, maritime pine and chestnut forests burned. Fire severity was mapped by remote sensing and checked by a field survey. Sediment yield was assessed by sampling the earthy material deposited upstream a check dam at the outlet of the watershed. Finally, a hydrological model was developed in HEC-HMS environment for exploring the relationship between the erosion-deposition events observed in the watershed and the rainfall-induced hydrological processes. The first two post-fire rainy events relocated a high amount of sediments, mostly non-organic, perhaps already in the stream before the fire, while the subsequent four rains deposited materials rich in pyrogenic organic matter. Overall, the soil erosion caused by such six main post-fire rains – the larger of which had a return time of one year – was estimated to amount to 7.85 t ha -1, corresponding to 42% of the watershed average annual potential erosion rate in normal conditions. This value is lower than expected and, overall, moderate if compared to other Mediterranean case studies, possibly because of the nature of soils in the studied watershed, i.e. shallow and quite stony, thus poor in fines prone to erosion.