A new approach is proposed to analysis the non-Gaussian random vibration of hyperbolic tangential package. Firstly, the non-Gaussian vibration noise of specified mean, variance, skewness and kurtosis is developed by Hermite polynomial, and verified by Gaussian mixture model (GMM) theory. Secondly, next to analyzing an analytical and numerical response of the two degrees of freedom (TDOF) linear package, the acceleration response of the TDOF hyperbolic tangential package system (HTPS) under non-Gaussian vibration excitation is obtained though the Hermite polynomial and Runge-Kutta method, and the effects of the external excitation and system parameters are investigated. Finally, on the basis of the first-passage probability of the acceleration response, the reliability analysis method is introduced. The analysis provides a guidance to the vibration reliability analysis and packaging optimization design.

This article is devoted to the study of the relativistic Vlasov-Klein-Gordon system in space dimension three. The dynamical model describes a collisionless ensemble of classical particles coupled with a Klein-Gordon field. By combining the Fourier method and smoothing effect of low velocity particles, we prove a higher regularity of the field, which is widely used for the study of Vlasov equation.

This study focuses on the comprehensive analysis of thermal characterization of an electrically conducting nanofluid flow containing TiO2 nanoparticles dissolved in two different common liquids (H2O and C2H6O2) and contained within a continuously extending disk. The heat and concentration formulation are modified by incorporating the standard interpretations of the Joule heating, energy source, dissipation, and modified activation energy with binary chemical reactions. The Darcy-Forchheimer addition are used to highlight the significance of porous media. The Brownian dispersion’s effects are clearly discernible in the current investigation. Furthermore, as a novelty, special thermophysical models of viscosity and thermal conductivity are included. The obtained differential formulations are tackled through analytical procedure HAM. The veracity of finding is verified through numerical scheme (ND-solve technique). Using several graphs and charts, the perception trends of model factors are evaluated. The influence of and are estimated based on flow characteristics. The drag force and heat transmission rate are shown to optimize with as well as in the pictorial simulations produced from the existing model. The can also be strengthened by the presence of a high degree . The outcomes are validated by previous studies and a good degree of consistency is revealed.

A theorem on the maximum regularity of solutions of the nonlinear Sturm-Liouville equation with greatly growing and rapidly oscillating potential in the space $L_2(R)\,(R=(-\infty,\infty))$ is proved in this paper. Two-sided estimates of the Kolmogorov widths of the sets associated with solutions of the nonlinear Sturm-Liouville equation are also obtained. As is known, the obtained estimates given the opportunity to choose approximation apparatus that guarantees the maximum possible error.

Motivated by important applications in materials science and biology, we consider a non-stationary coagulation equation with in-flux and out-flux of particles (cargo). An exact analytical solution to this integrodifferential equation is found in a parametric form. This solution behaves as a decaying exponent with respect to the particle volume (fluorescence intensity in the case of coagulation of endosomes). We demonstrate that our exact solution substantially depends on coagulation kernels (fusion and fission rates) as well as the in-flux and out-flux processes of cargo.

The main objective of this case report is to critically evaluate the difficulties associated with the diagnosis and treatment of a rare endogenous intestinal perforation, represented by an impacted gallbladder stone; thus increasing the awareness of jejunal perforation and small bowel diverticula.

In this work, a dynamic S-box is designed based on the chaotic neural network using the memristor model of LiNbO3 (LNO) single crystalline thin film. The LNO memristor, which shows good repeatability and the characteristic of gradual resistance change, is used as the self-feedback weight in the Transient Chaotic Neural Network (TCNN) model to form a chaotic neural network. Double pseudo-random digits are generated for dynamically adjusting the S-box elements according to the weight function. The experimental results show that the proposed design can achieve physical unclonability and has better nonlinearity and differential uniformity.

Self-rectifying memristor has no need for selector devices, but possess the one-way transmission behavior and multi-level non-volatile memory characteristics, which makes it promising candidate for electronic synapse. In this letter, we propose a novel self-rectifying memristor based on Pt/Hf0.5Zr0.5O2/TiN structure. The devices show large memory window (104) and high rectifying ratio (104), which can block the sneak current in passive crossbar array without any additional hardware overhead. Moreover, the devices demonstrate excellent multi-level states modulation capability, low power consumption, high endurance and long retention. The final benchmark demonstrates that the proposed Pt/Hf0.5Zr0.5O2/TiN self-rectifying memristor is a promising candidate for electronic synapse application.

Objective: To investigate the compatibility of oxytocin and tranexamic acid injection products when mixed for the purpose of co-administration by intravenous infusion. Population or Sample: Oxytocin and tranexamic acid were collected from hospitals taking part in a multicentre postpartum haemorrhage treatment (E-MOTIVE) trial in Kenya, Nigeria, Tanzania, and South Africa. Methods: The compatibility of two sentinel products of oxytocin injection and tranexamic acid injection in 200mL infusion bags of both 0.9%w/v saline and Ringer’s Lactate was assessed. We analysed all tranexamic acid -oxytocin combinations, and each evaluation was conducted for up to 6hrs. Subsequently, the compatibility of multiple tranexamic acid products with reference oxytocins products when mixed in 0.9%w/v saline over a period of 1 hour was investigated. Results: We found a significant interaction between certain oxytocin and tranexamic acid products after mixing them in vitro and observing for 1 hour. The interaction substantially impacted oxytocin content leading to reduction in concentration (14.8% - 29.0%) immediately on mixing (t=0 minutes). In some combinations, the concentration continued to decline throughout the stability assessment period. Oxytocin loss was observed in 7 out of 22 (32%) combinations tested. Conclusions: In a clinical setting, mixing oxytocin and tranexamic acid may result in an underdosing of oxytocin, compromising care in an emergency life-threatening situation. The mixing of oxytocin and tranexamic acid injection products for co-administration with IV infusion fluids should be avoided until the exact nature of the interaction and its implications are understood.

Sexual selection has long been thought to promote speciation, but evidence is inconclusive. In Odonata - which includes dragonflies and damselflies-, wing pigmentation has been found to be influenced by sexual selection. Past evidence shows that wing pigmentation in males is a driver of speciation in damselflies. However, whether sexual dimorphism per se is associated with species diversification rates has not been tested. Here we test whether wing pigmentation sexual dimorphism influences diversification rates in a supertree of 1,239 species, the most comprehensive phylogeny inferred for the group. We find that wing pigmentation among dimorphic males is associated with higher species diversification rates in damselflies but not in dragonflies.  This study presents the first evidence of the role of species sexual dimorphism in species diversification in a clade identified as a marker of habitat quality. In the face of accelerating biodiversity loss, uncovering diversification drivers is of pressing importance.

Objective: Nasal septum perforation is an anatomical defect located in the nasal septal cartilage/bone and mucosa. The most common cause of nasal septal perforations is septoplasty. Repair of nasal septal perforations is difficult regardless of the surgical technique due to its location and health of the surrounding tissues. Currently, no technique has been defined to be used for closure of all nasal septal perforations. We aimed to present our bipediculated crescent-shaped unilateral slide flap technique, which we designed and used as a novel technique for closure of nasal septal perforations, and its surgical results. Design: Retrospective study. Settings: Single-center patients with nasal septum perforation. Participants: 36 patients who underwent nasal septum perforation repair in our clinic between 2018-2022. All patients underwent surgical procedure with the same technique by the same surgeon. Main Outcome Measures: Nasal septum perforation closure success at 6th month follow-up. Results: Thirty-six patients, including 20 males and 16 females, were included in the study. The mean age of the patients was 35,58±9,6. The most common cause of nasal septal perforation was previous septal surgeries. The septal perforation dimensions of the patients were between 5-23 mm and the mean was 13,86±5,4 mm. Septal perforation closure rate was determined as 94.4% in the 6 months follow-up results after surgery. Conclusion: Bipediculated crescent shaped unilateral sliding flap is an effective, easy and novel technique in the repair of nasal septal perforations.

Little is known about morbidity due to drug-related hyponatraemia, despite hyponatraemia being a common side effect of frequently prescribed medicines. We conducted a 12-month retrospective service evaluation of hospital admissions due to drug-related hyponatraemia to determine what drugs are contributing factors, describe patient demographics and burden of morbidity. This was undertaken at a large acute UK hospital and drug-related hyponatraemia was defined by admissions where hyponatraemia was coded as the principal diagnosis and specific medication(s) were recorded as either contributory factor(s) or the principal cause of hyponatraemia and these medication(s) were discontinued. Of 131 hyponatraemia admissions, 71 (54%) were drug-related. Angiotensin converting enzyme inhibitors/ angiotensin receptor blockers, proton pump inhibitors and thiazide diuretics were drug classes most commonly associated. 61% of patients were women, median age 81 (IQR15.5) years, 61% were on more than 2 implicated drugs. The median length of stay was 4 (2-9 days IQR). This study highlights that elderly woman on more than 2 drugs that can cause hyponatraemia, constituted the majority of patients admitted to hospital with drug-related hyponatraemia.

The effect of antenatal depressive and anxious symptoms on the rate of physiological birthsA comment on the recently published article by Hulsbosch et al:Association between high levels of comorbid anxiety and depressive symptoms and decreased likelihood of birth without intervention: A longitudinal prospective cohort study

Acute liver injury with special clinical phenotype after use of herbal Runzaozhiyang capsulesRunning Head: Liver injury caused by Runzaozhiyang capsulesJiabing WangTaizhou Municipal Hospital, Zhejiang, Taizhou 318000, ChinaE-mail address: wangjiabing9205@163.comKeywords: Runzaozhiyang capsules; Acute liver injury; Herbal; Case report

Hemorrhagic cystitis is a common complication following the use of cyclophosphamide. Associated dysuria can be painful and there are few good options to relive pain. Phenazopyridine has historically been utilized for dysuria and is available over the counter. However, it is associated with hematologic side effects with prolonged use.

An accurate medication history prevents medication errors during transitions of care, whereas an inaccurate medication history may lead to unnecessary tests or prolonged hospitalization. We describe the case of a patient with chronic hypothyroidism who presented to the hospital with severe hypothyroidism and reported strict adherence to her home levothyroxine.

Anssi H Manninen, Research & Development, Dominus Nutrition Oy, Raahe, Finland.Corresponding author: Anssi H Manninen, Dominus Nutrition Oy, Ylipäätie 438, FIN-92220, Raahe, Finland. Email: anssi@dominusnutrition.fi

Organic memristors are promising candidates for the flexible synaptic components of wearable intelligent systems. With heightened concerns for the environment, considerable effort has been made to develop organic transient memristors to realize eco-friendly flexible neural networks. However, in the transient neural networks, achieving flexible memristors with bio-realistic synaptic plasticity for energy efficient learning processes is still challenging. Here, we demonstrate a biodegradable and flexible polymer based memristor, suitable for the spike-dependent learning process. An electrochemical metallization phenomenon for the conductive nanofilament growth in a polymer medium of poly (vinyl alcohol) (PVA) is analyzed and a PVA based transient and flexible artificial synapse is developed. The developed device exhibits superior biodegradability and stable mechanical flexibility due to the high water solubility and excellent tensile strength of the PVA film, respectively. In addition, the developed flexible memristor is operated as a reliable synaptic device with optimized synaptic plasticity, which is ideal for artificial neural networks with the spike-dependent operations. The developed device is found to be effectively served as a reliable synaptic component with high energy efficiency in practical neural networks. This novel strategy for developing transient and flexible artificial synapses can be a fundamental platform for realizing eco-friendly wearable intelligent systems.Corresponding author(s) Email:   sinhlee@knu.ac.kr 

Acute Lymphoblastic Leukemia of the Central Nervous System Presenting with Rapid Weight GainConnor P. Hall1 and Alan D. Friedman11Division of Pediatric Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USACorrespondence: Alan D. Friedman, MDJohns Hopkins UniversityCRB I, Rm. 253 1650 Orleans St. Baltimore, Maryland 21231 Phone: 410-955-2095; Fax: 410-955-8897 Email: afriedm2@jhmi.eduWord Count: 863Number of Figures: 1Running Title: Rapid Weight Gain in ALLKey Words: acute lymphoblastic leukemia/ relapse/ weight gain/ central nervous systemAbbreviations:

Biodiversity patterns are the sum of multiple overlapping species distributions. Their analysis therefore requires proper species inference. DNA-based species delimitation has become increasingly popular for such assessments and their robustness is often measured by congruence of multiple delimitation approaches. We explore how contrasting results of different species delimitations translate into conclusions of synecological studies, exemplified by assemblages of phytophagous scarab beetles in Sri Lanka from different elevations and forest types. Particularly, we compared estimates based on complete assemblages and on cumulated species inventories inferred from individually analysed subclades. These patterns of assemblage similarity were analysed across different spatial scales with reference to morphospecies and haplotypes. Method-related ambiguity of species estimates, which also included subclade inferences, affected severely the certainty of apparent biodiversity patterns at most spatial scales. In this case study of tropical beetle, haplotypes only provided very little explanatory information, since genetically highly diverse populations widely lacked shared haplotypes.

Wolves (Canis lupus) can exert top-down pressure and shape ecological communities through selective predation of ungulates and beavers (Castor Canadensis). Considering their ability to shape communities through predation, understanding wolf foraging decisions is critical to predicting their ecosystem level effects. Specifically, if wolves are optimal foragers, consumers that optimize tradeoffs between cost and benefits of prey acquisition, changes in these factors may lead to prey switching or negative-density dependent selection with potential consequences for community stability. For wolves, factors affecting cost and benefits include prey vulnerability, risk, reward, and availability which can vary temporally. We described wolf diet in by frequency of occurrence and percent biomass and characterized diet in relation to optimal foraging using prey remains found in wolf scats on Isle Royale National Park, Michigan, USA during May–October 2019–2020. We used logistic regression to estimate prey consumption over time. We predicted prey with temporal variation in cost (vulnerability and/or availability) such as adult and calf moose (Alces alces) and beaver to vary in wolves’ diet. We analyzed 206 scats and identified 62% of remains as beaver, 26% as and moose, and 12% as other (birds, smaller mammals, and wolves). Adult moose were more likely to occur in wolf scat in May, when moose are in poor condition following winter. Similarly, the occurrence of moose calves peaked June–mid July following parturition but before their vulnerability declined as they matured. In contrast, beaver occurrence in wolf scat did not change over time, possibly reflecting the importance of low handling cost prey items for recently introduced lone or paired wolves. Our results demonstrate that wolf diet is plastic and responsive to temporal changes in prey acquisition cost as predicted by optimal foraging theory. Temporal fluctuation in diet may influence wolves’ ecological role if prey respond to increased predation risk by altering their foraging or breeding behavior.

Background: Splenic dysfunction in children with sickle cell disease (SCD) increases the risk of serious bacterial infections; therefore, families are instructed to seek medical care in the presence of fever. Recurrent hospital admissions of patients with SCD cause financial and resource burdens on caregivers and the healthcare system, contributing to a lower quality of life in this patient population. Recent studies have documented a reduction of the incidence of bacterial infections among these patients managed on an outpatient basis with no association of increased morbidity and mortality. We decided to establish a partnership between our pediatric hematology/oncology division and pediatric emergency medicine division to initiate an algorithm to identify low risk patients eligible for outpatient management. Procedure: We conducted a retrospective review of patients with SCD less than 18 years of age, followed at the Comprehensive Care Sickle Cell Center at the Medical University of South Carolina (MUSC), who presented to our Pediatric Emergency Department (ED) with a temperature ≥ 101°F from July 1st 2018 to June 30th 2020. Results: Mean length of stay and age at admission were nearly equal between pre- and post-implementation of the algorithm. The admission rates from the study for were 55.2% and 43.6% pre- and post-implementation, respectively. Patients revisited the ED within 72 hours in 6.7% of patients in pre-implementation and 5.9% of patients in post-implementation. There were no patient deaths. Conclusions: Our pathway helps to standardize the treatment of febrile pediatric patients with SCD and safely decreases hospital admissions.

The objective of the study was to simulate New Zealand’s foot-and-mouth disease (FMD) operational plan to determine personnel requirements for a FMD response and understand how the numbers of frontline staff available could affect the size and duration of FMD outbreaks, when using stamping-out (SO) measures with or without vaccination. The model utilized a national dataset of all known livestock farms. Each simulation randomly seeded infection into a single farm. Transmission mechanisms included direct and indirect contacts, local and airborne spread. Prior to each simulation, the numbers of personnel for front-line tasks were set randomly. In a random subset of simulations, vaccination was allowed to be deployed as an adjunct to SO. Front-line tasks included contact tracing, surveillance of at-risk farms, depopulation and vaccination using teams comprising personnel of the different types required by New Zealand’s operational plans. The effect of personnel numbers on the size and duration of epidemics were explored using machine learning methods. In the second stage of the study, using a subset of iterations where numbers of personnel were unconstrained, the number of personnel used each day were quantified. When personnel resources were unconstrained, the 95 th percentile and maximum number of infected places (IPs) were 78 and 462 respectively, and the 95 th percentile and maximum duration were 69 and 217 days respectively. However, severe constraints on personnel resources allowed some outbreaks to exceed the size of the UK 2001 FMD epidemic which had 2026 IPs. The number of veterinarians available had a major influence on the size and duration of outbreaks, while the availability of other personnel types did not. A shortage of veterinarians was associated with an increase in time to detect and depopulate IPs, allowing for continued transmission. Emergency vaccination placed a short-term demand for additional staff at the start of the vaccination programme, but the overall number of person days used were similar to SO-only strategies. This study determined the optimal numbers of front-line personnel required to implement the current operational plans to support an FMD response in New Zealand. A shortage of veterinarians was identified as the most influential factor to impact disease control outcomes. Emergency vaccination led to earlier control of an FMD outbreak, but also resulted in a short-term spike in demand for personnel. A successful response needs to have access to sufficient personnel, particularly veterinarians, trained in response roles and available at short notice.

In this paper, after a continuous predator-prey model incorporating Allee effect and cannibalism is simplified, its discrete system is derived by using semidiscretization method. Not only the existence and local stability of fixed points of the discret system are investigated, but also, what's more important, the sufficient conditions for the occurrence of its period-doubling bifurcation and Neimark-Sacker bifurcation are also obtained by using the center manifold theorem and bifurcation theory. Finally some numerical simulations are given to illustrate the existence of Neimark-Sacker bifurcation.