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A high-throughput (105.5 g/h) passive four-stage asymmetric oscillating feedback microreactor using chaotic mixing mechanism was developed to prepare aggregated BaSO4 particles of high primary nanoparticle size uniformity. Three-dimensional unsteady simulations showed that chaotic mixing could be induced by three unique secondary flows (i.e., vortex, recirculation, and oscillation), and the fluid oscillation mechanism was examined in detail. Simulations and Villermaux-Dushman experiments indicate that almost complete mixing down to molecular level can be achieved and the prepared BaSO4 nanoparticles were with narrow primary particle size distribution (PSD) having geometric standard deviation, σg, less than 1.43 when the total volumetric flow rate Qtotal was larger than 10 mL/min. By selecting Qtotal and reactant concentrations, average primary particle size can be controlled from 23 to 109 nm as determined by microscopy. An average size of 26 nm with narrow primary PSD (σg = 1.22) could be achieved at Qtotal of 160 mL/min.

In this study, a new electrolyte system consisting of tetrabutylphosphonium 4-(methoxycarbonyl) phenol ([P4444][4-MF-PhO]) ionic liquid and acetonitrile (AcN) was developed as CO2 electroreduction electrolyte to produce oxalate, and the mechanism was studied. The results showed that using the new ionic liquid-based electrolyte, the reduction system exhibits 93.8% Faradaic efficiency and 12.6 mA cm-2 partial current density of oxalate at -2.6 V (vs. Ag/Ag+). The formation rate of oxalate is 234.4 μmol cm-2 h-1, which is better than that reported in the literature. The mechanism study using density functional theory (DFT) calculation revealed for the first time that [P4444][4-MF-PhO] IL can effectively activate CO2 molecules through ester and phenoxy double active sites, stabilize the reaction intermediate. The potential barriers of the key intermediates *CO2- and *C2O42- formation by induced electric-field was reduced in the phosphonium-based ionic environment, which greatly facilitates the activation and conversion of CO2 molecules to oxalate.

The stress ratio ( R) effect, especially at elevated temperatures, is associated with the fatigue crack growth (FCG) prediction in aero-engine hot-end components under complex operation conditions. The FCG experiments with three R were conducted on Ni-based superalloy GH4169 at room temperature (RT), 550 °C, and 700 °C. The results indicate that the R-effect on the FCG of GH4196 is temperature-dependent. Therefore, efforts were made to identify the R-effect at various temperatures to describe the FCG. The concept of the crack-closure or the two-driving-force was examined to quantify the R-effect considering the temperature influence. Fractographic analyses on the fracture surface were performed to discuss the underlying mechanism responsible for the temperature influence. The study can contribute to the R-dependent FCG modeling at various temperatures.

COVID-19, TB and HIV are infectious diseases of global public health concern. Triple Co-infection with these diseases can create a diagnostic and therapeutic dilemma. We present a case of a young Cameroonian woman with SARS-CoV-2 -- HIV-TB triple co-infection. Early diagnosis and appropriate management yielded an excellent outcome.

We herein report the cases of three patients with chest symptoms or fever and diffuse wall thickening of the trachea and main bronchi on chest CT. They were diagnosed with various causes of inflammations of the trachea and main bronchi using bronchial or tracheal biopsy specimens and flexible bronchoscopy.

Over the past decade, there has been significant improvement in the treatment of diseases of the conduction system and symptomatic bradyarrhythmias with the development of leadless pacemaker systems. The Micra transcatheter pacemaker system has been shown to mitigate a lot of the complications associated with traditional pacing systems, which are notably skin pocket and lead-related complications. Numerous studies have shown the low complication rates associated with Micra procedure; however, there have been no specific guidelines or recommendations surrounding periprocedural anticoagulant therapy. This is important because a significant percentage of patients requiring pacemaker therapy have an indication for anticoagulation therapy as well. Multiple studies have shown the safety of uninterrupted anticoagulation during Micra implant, however, there is insufficient high-quality data to recommend periprocedural systemic use of anticoagulation. In this paper, we review the available data surrounding anticoagulation therapy in patients undergoing Micra implantation and the potential bleeding risks associated with this procedure.

In this paper, a homogeneous diffusive system of plant-herbivore interactions with toxin-determined functional responses is considered. We are mainly interested in studying the existence of global steady state bifurcations of the diffusive system. In particular, we also consider the case when the bifurcation parameter, one of the diffusion rates, tends to infinity. The corresponding system is called shadow system. By using time-mapping methods, we can show the existence of the positive non-constant steady state solutions. The results tend to describe the mechanism of the spatial pattern formations for this particular system of plant-herbivore interactions.

Objective: The aim of the study was to evaluate the feasibility and potential of the Global Trigger Tool (GTT) for identifying the adverse drug events (ADEs) in patients with depression. Methods: In this study, the trigger items for antidepressants were developed base on the ‘Institute for Healthcare Improvement (IHI) GTT for Measuring Adverse Events’ . Trigger detection of the medical records was carried out in 200 patients diagnosed with depression in a specialized hospital. Each medical record with the presence of any of the triggers was reviewed by two researchers respectively to determine whether it was an ADE, if so, ADE should be classified in severity, and involved system and primary suspected drug were identified. Logistic regression was performed to investigate risk factors associated with ADEs, and ADE detection rate and positive predictive value (PPV) were calculated to evaluate the sensitivity and specificity of the triggers. Results: Triggers were detected for 162 times in 159 cases (79.5%), and 69 ADEs in 61 patients were identified by record reviewing. the PPV of the trigger tool was 42.59%. 79.7% were classified as category E, and 20.30% category F. ADEs were most likely to involve metabolic system (34.78%), manifested as hypokalemia, pathoglycemia and hypercholesterolemia. venlafaxine was most likely to cause AEs (32.56%), followed by paroxetine (22.09%). Risk factors for ADEs included the number of administrated antidepressants (p=0.008) and the number of concomitant drugs (p=0.014). Conclusion: The GTT is a feasible and effective tool for detecting ADEs of antidepressants for inpatients.

Methotrexate (MTX) has been shown to impair neurocognitive outcomes. Because the cumulative dose of MTX used in the standard treatment of osteosarcoma is higher compared to the treatment of other childhood cancers, we analyzed the neurocognitive performance among 12 survivors of childhood osteosarcoma exposed to high-dose MTX at our institution. Prospective longitudinal evaluations of neurocognitive functioning using the Japanese Wechsler Intelligence Scale for Children-4th Edition were performed. As a result, we observed age-appropriate development of neurocognitive performance among osteosarcoma survivors. In conclusion, cognitive development was not adversely affected in this cohort of childhood osteosarcoma survivors treated with HD-MTX.

In this paper, we have developed a mathematical technique for solving delay differential equations(DDES) which is based on the Taylor wavelets with the collocation method. And applying the convergence analysis, convergence and error analysis of the proposed technique of Taylor wavelets is worked out and it is shown to converge uniformly on it. We derive numerical solutions to DDES equations with various parameters using the Taylor wavelet technique (TWTS). And also the obtained TWTS based numerical solutions have been compared with the analytical solutions and existing methods of solutions. The error analysis in the obtained solutions shows the competence and consistency of the proposed method. It is predicted that the proposed method can be set up expansively and appropriate for the solution of a diverse classes of DDES arising in science and engineering.

A Riemann-Liouville fractional Robin boundary-value problem is proposed to describe the fast heat transfer law both within isotropic materials and through the boundary of the materials in high temperature environment. The variational formulation of the fractional model is given, and further the energy estimation of the weak solution is deduced. The uniqueness theorem of weak solution is proved. A valid finite difference scheme is developed for the fractional model and numerical experiment is implemented. Numerical results indicate that the fractional model is applicable to discover the thermal superdiffusion in the thermal protective clothing(TPC) system and numerical algorithms are effective to improve the intelligence of TPC design.

Introduction Thoracic endovascular aortic repair (TEVAR) became the standard of care for treating type B aortic dissections and descending thoracic aortic aneurysms. We aimed to describe the racial/ethnic differences in TEVAR utilization and outcomes. Methods The National Inpatient Sample was reviewed for all TEVARs performed between 2010 and 2017 for Type B aortic dissection and descending thoracic aortic aneurysm (DTAA). We compared groups stratifying by their racial/ethnicity background in whites, black, Hispanic, and others. A mixed-effects logistic regression was performed to assess the relationship between race/ethnicity and the primary outcome, in-hospital mortality. Results A total of 25,260 admissions for TEVAR during 2010–2017 were identified. Of those, 52.74% (n= 13,322) were performed for aneurysm and 47.2% (n= 11,938) were performed for type B dissection. 68.1% were white, 19.6% were black, 5.7% Hispanic, and 6.5% were classified as others. White patients were the oldest (median age 71 years; <0.001), with TEVAR being performed electively more often for aortic aneurysm (58.8% vs. 34% vs. 48.3% vs. 48.2%; p<0.001). In contrast, TEVAR was more likely urgent or emergent for type B dissection in black patients (65.6% vs 41.1% vs 51.6% vs 51.7%; p<0.001). Finally, the black population showed a relative increase in the incidence rate of TEVAR over time. The adjusted multivariable model showed that race/ethnicity was not associated with in-hospital mortality. Conclusion Although there is a differential distribution of thoracic indication and comorbidities between race/ethnicity in TEVAR, racial disparities do not appear to be associated with in-hospital mortality after adjusting for covariates.

A 62-year-old man presents to the Cardiology Department with a two years history of angina on exertion. Invasive coronary angiography revealed a severe three vessels coronary artery disease. The “Hybrid Heart Team” successfully performed a fully robotically-assisted hybrid revascularization combining RE-MIDCAB on the LAD and R-PCI on non-LAD lesions.

Venous thrombosis associated with pacemaker implant is a known phenomenon. We present a clinical video emphasizing on an important physical exam finding suggesting propagation of thrombus in Internal Jugular vein secondary to pacemaker insertion, which would be educational and help readers visualize the Sign on Physical Exam

TITLE: Letter to the Editor: Anatomical reasons for failure of dual‐filter cerebral embolic protection application in TAVR: A CT‐based analysisARTICLE TYPE: letter to the editorCORRESPONDENCE: 1. Muhammad Ali MuzammilContact; +92 3313657590 Email; muzammil200077@gmail.comInstitute: Dow University of Health Sciences, karachiAddress: A-49 Street No.8 Block:2 Chapal Sun city near kiran Hospital Scheme#33 Gulzar-e-hijriCo-Authors ; 2. Rahat Ahmed MemonEmail: rahatahmed227@yahoo.com Contact: +12677091949Institute: Abington Memorial Hospital

In long-lived species, reproductive skipping is a common strategy whereby sexually mature animals skip a breeding season, potentially reducing population growth. This may be an adaptive decision to protect survival, or a non-adaptive decision driven by individual-specific constraints. Understanding the presence and drivers of this behaviour is key to effective population management, yet in many species such as the endangered African penguin (Spheniscus demersus), these factors remain unknown. This study uses multistate mark-recapture methods to estimate African penguin survival and breeding probabilities at two colonies between 2013 and 2020. Overall, survival was higher at Stony Point (0.82) than Robben Island (0.77). Inter-colony differences were linked to food availability; under decreasing sardine (Sardinops sagax) abundance, survival decreased at Robben Island and increased at Stony Point. Additionally, reproductive skipping was evident across both colonies; at Robben Island ~22% of breeding individuals skipped reproduction each year, versus ~10% at Stony Point. Penguins skipping reproduction had a lower probability of future breeding than breeding individuals; this lack of adaptive benefit suggests reproductive skipping is driven by individual-specific constraints. Lower survival and breeding propensity at Robben Island places this colony in greater need of conservation action. However, further research on the drivers of inter-colony differences is needed.

In light of ongoing climate change, it is increasingly important to know how nutritional requirements of ectotherms are affected by changing temperatures. Here, we analyse the wide thermal response of phosphorus (P) requirements via elemental gross growth efficiencies of Carbon (C) and P, and the Threshold Elemental Ratios in different aquatic invertebrate ectotherms such as the freshwater model species Daphnia magna, the marine copepod Acartia tonsa, the marine heterotrophic dinoflagellate Oxyrrhis marina, and larvae of two populations of the marine crab Carcinus maenas. We show that they all share a non-linear cubic thermal response of nutrient requirements. Phosphorus requirements decrease from low to intermediate temperatures, increase at higher temperatures, and decrease again when temperature is excessive. This universality in the thermal response of nutrient requirements is of great importance if we aim to understand or even predict how ectotherm communities will react to global warming and nutrient-driven eutrophication.

Protein-based condensates have been proposed to accelerate biochemical reactions by enriching reactants and enzymes simultaneously. Here, we engineered those condensates into a Photo-Activated Switch in E. coli (PhASE) to regulate enzymatic reactions via tuning the spatial correlation of enzymes and substrates. In this system, scaffold proteins undergo liquid-liquid phase separation (LLPS) to form light-responsive compartments. Tethered with a light-responsive protein, enzymes of interest (EOIs) can be recruited by those compartments from cytosol within only a few seconds after a pulse of light induction and fully released in 15 minutes. Furthermore, we managed to enrich small molecular substrates simultaneously with enzymes in the compartments and achieved the acceleration of luciferin and catechol oxidation by 2.3 folds and 1.6 folds, respectively. We also developed a quantitative model to guide the further optimization of this de-mixed regulatory system. Our tool can thus be used to study the rapid redistribution of proteins, and reversibly regulate enzymatic reactions in E. coli.

Asthma 17q21 Polymorphism Associates with COVID-19 in Children

Electric circuit analysis under non-sinusoidal, non-linear situations has been a hot topic for a long time. Many scientific communities hold opposing viewpoints on the additional analysis tool and domain, resulting in a variety of standards and definitions. With the advent of Power Electronic equipment, converters, and Renewable Energy sources, the electric power system has become increasingly sophisticated since its inception. Electronic equipment has transformed the electrical system and provided a slew of advantages to industrial applications. Unfortunately, this comes at the expense of power system distortion (voltage and current). Understanding power flow in non-sinusoidal linear and non-linear circuit circumstances is required for this. As a result, a novel mathematical framework to analyze the circuit in such an environment is always required. Finally, in non-sinusoidal conditions, a consensus can be reached on norms that comply with well-known, established standards. The work provided here compares the use of harmonic domain and geometric algebra in circuits with disturbances for sinusoidal and non-sinusoidal excitations in order to demonstrate the accuracy of geometrical algebra in power flow calculations.

Children with cancer who develop fever in the setting of chemotherapy-induced neutropenia are treated empirically for bacteremia. Viral etiologies are most common and there remains no consensus about anticipatory guidance that should be provided to patients regarding community-acquired infections. Using COVID-19 positivity as a surrogate for a community acquired infectious exposure, we performed a retrospective chart review of pediatric oncology patients diagnosed with COVID-19 during the Omicron (B.1.1.529) surge at The Children’s Hospital at Montefiore. No patients in our cohort developed bacteremia, or serious respiratory illness. Future studies will aid in understanding the relationship between bacteremia and community acquired infections in order to provide evidence-based recommendations about environmental exposures and guide optimal care for our patients.

Aim: Deprescribing interventions may reduce inappropriate polypharmacy and the associated negative clinical consequences. This systematic review examined current research on the effectiveness of deprescribing interventions implemented within specialist outpatient clinics. Methods: This systematic review was informed by a literature search on 18/10/21 of publications from January 1990 in PubMed and Embase. Studies were included if they focused on patients ≥60 years and measured change in medication burden (defined by number of medications or number of inappropriate medications) as result of an intervention conducted within a specialist outpatient clinic. Methodological quality was assessed by 2 authors using the revised Cochrane risk-of-bias tools. Due to significant heterogeneity between trials, a qualitative synthesis was completed. The primary outcome reviewed was change in medication count or potentially inappropriate medication. Secondary outcomes were maintenance of deprescription and clinical benefits. Results: 19 studies were included for review that included 10,914 participants. They included geriatric outpatient clinics, oncology/haematology clinics, haemodialysis clinics and designated polypharmacy/multimorbidity clinics. Seven RCTs were identified. Other studies included retrospective evaluations and prospective/pilot studies. Four RCTs reported statistically significant reduction of medication burden with intervention, however all studies were assessed as having a high risk of bias. The studies could be grouped into those where the deprescribing intervention was physician-led and implemented, delivered from a multidisciplinary team, or pharmacist-led and physician implemented. Conclusion: The evidence for deprescribing interventions in outpatient clinics is very limited and further research is recommended. The addition of a pharmacist and validated medication assessment tools appear to be enablers.

Iliac bone involvement is an exceptional location for hydatidosis. The clinical evolution is insidious and the appearance of clinical signs is late after rupture of the cortical bone and invasion of the soft tissues, making its management cumbersome and difficult.