Null hypothesis significance testing (NHST) and p-values are widespread in the cardiac surgical literature but are frequently misunderstood and misused. The purpose of the review is to discuss major disadvantages of p-values and suggest alternatives. We describe diagnostic tests, the prosecutor’s fallacy in the courtroom, and NHST, which involve inter-related conditional probabilities, to help clarify the meaning of p-values, and discuss the enormous sampling variability, or unreliability, of p-values. Finally, we use a cardiac surgical database and simulations to explore further issues involving p-values. In clinical studies, p-values provide a poor summary of the observed treatment effect, whereas the three- number summary provided by effect estimates and confidence intervals is more informative and minimises over-interpretation of a “significant” result. P-values are an unreliable measure of strength of evidence; if used at all they give only, at best, a very rough guide to decision making. Researchers should adopt Open Science practices to improve the trustworthiness of research and, where possible, use estimation (three-number summaries) or other better techniques.

Background: This study explores the strategy and effect of emergency surgical treatment for total anomalous pulmonary venous connection (TAPVC). Methods: From March 2009 to February 2020, 78 patients with TAPVC underwent emergency surgical correction. There were 51 males and 27 females. The median age was 39.5 days, and the median weight was 4.0 kg. The preoperative percutaneous oxygen saturation was 80.8±4.5%. Results: Of the cases investigated, seven died during the perioperative period, 16 had delayed chest closure, 19 had early pulmonary vein obstruction, two had secondary tracheal intubation, one had a brain complication, and one had third-degree atrioventricular block. Low weight, younger age, cardiopulmonary bypass time, and aortic cross-clamp time were identified as risk factors for early mortality. During the follow-up from four to 137 months, 12 cases did not respond to follow up. Ten patients died within one to six months after discharge. One patient underwent reoperation due to pulmonary vein obstruction. The longer hospital stays after operation and intensive care unit time were identified as risk factors for late mortality. Conclusions: Emergency surgery for severe TAPVC patients after admission had achieved good results in the near future. Prenatal diagnosis should be strengthened to save more patients. The higher late mortality rate indicates that such patients should strengthen post-discharge management to reduce the occurrence of post-discharge deaths.

Patients with severely calcified aorta undergoing conventional cardiac surgery are at increased risk for postoperative neurologic deficits. Implementation of cerebroprotective devices may substantially reduce or even eliminate the risk of adverse neurologic event, thus enabling surgical therapy, especially when interventional treatment cannot be considered an alternative option.

Objective To investigate urinary/faecal incontinence (UI/FI) prevalence during pregnancy and postpartum, and the main risk and protective factors, in a large Italian population. Design Prospective observational analysis of patient-reported outcome (PRO) measures. Population and setting All pregnant women agreed to participate to the systematic and longitudinal survey on the maternity pathway in Tuscany, Italy. Methods We employed data from four questionnaires completed by women from the beginning of pregnancy until six-months postpartum. Each questionnaire included two PRO measures – the Wexner scale for FI and the International Consultation on Incontinence Questionnaire for UI –, and several questions investigating the socio-demographic and clinical features of respondents. Main outcomes The UI/FI prevalence at each time-point and the related risk and protective factors. Results Among our 6,023 respondents, UI prevalence in the third trimester was 24.3% and almost halved six-months postpartum. Women reporting FI were 6.2% in the third trimester and 4.2% six-months postpartum. Higher UI occurrence and severity were found in highly-educated, aged > 30, and overweight/obese women. Caesarean-section was protective against postpartum UI, while spontaneous tear or episiotomy were risk factors. Protective effects were provided by performing pelvic-floor-muscle-training during pregnancy, mainly for specific risk groups. Furthermore, higher FI prevalence and severity emerged in overweight, aged > 40, highly-educated, non-Italian women and in those undergoing tear. Conclusion PRO measures systematically and longitudinally collected in a large Italian population highlighted the prevalence of pregnancy-related UI/FI and the risk and protective factors. Pelvic-floor-muscle-training may be recommended in women with peculiar socio-demographic and clinical features.

Objective To examine the antenatal imaging features, intrapartum findings and early postpartum course of pregnancies with trisomy 21 (T21). Design Ten-year retrospective review Setting A tertiary hospital in the United Kingdom Population Women with a pregnancy affected by T21, who did not have a termination. Methods Women with pregnancies diagnosed with T21 on: antenatal karyotyping; karyotyping of post-mortem tissue and postnatal karyotype samples, from February 2010-2020. Main Outcome Measures Antenatal imaging findings, fetal growth restriction (FGR), birthweight, mode of delivery, and early neonatal outcomes. Results Seventy-six women with a fetus affected by T21 were identified. There were 6 intrauterine deaths, and 70 livebirths. Thirty-eight (50%) had an antenatal diagnosis and twenty-five (33%) had a suspected diagnosis but declined further testing. The diagnosis was unanticipated in 13 (17%). Cardiac anomalies (n=27) were the most common antenatal anomaly. Doppler abnormalities were apparent in 48/73 (68%). Eighteen (25.7%) had ultrasound evidence of FGR. The majority delivered by Caesarean section, and 21.4% of babies weighed below the 3rd percentile at delivery. Fifty-eight (82%) were admitted to the neonatal unit. Forty-three (61%) required respiratory support and fifty-five (78%) either needed naso-gastric feeding or were nil by mouth. Mean PAPP-A values were significantly lower in cases with abnormal Dopplers, FGR, congenital anomalies and with a birthweight below the 10th percentile. Conclusions Fetuses with T21 have high rates of placental insufficiency. FGR and Doppler abnormalities are common. Postnatally, the majority will require respiratory and feeding support. Antenatal counselling and protocols should reflect these risks. Funding None

We submit this manuscript without an abstract because it is a Letter to the Editor.

Cryptococcosis is an invasive, opportunistic, fungal infection that predominantly effects the respiratory tract and central nervous system in immunocompromised patients. It is classically associated with defects in cellular immunity such as acquired immunodeficiency syndrome. Here we describe a case of life-threatening laryngitis, endobronchitis and pneumonia due to Cryptococcus neoformans in a teenager with hypogammaglobulinaemia. To the best of our knowledge, no previous cases of laryngeal cryptococcosis have been reported in the paediatric population.

This paper is concerned with the asymptotic stability and instability of solutions to a variable coefficient logarithmic wave equation with nonlinear damping and memory term. This model describes wave travelling through nonhomogeneous viscoelastic materials. By choosing appropriate multiplier and using weighted energy method, we prove the exponential decay of the energy. Besides, we also obtain the instability at the infinity of the solutions in the presence of the nonlinear damping.

In this paper, we adopt the optimize-then-discretize approach to solve parabolic optimal Dirichlet boundary control problem. First, we derive the first-order necessary optimality system, which includes the state, co-state equations and the optimality condition. Then, we propose Crank-Nicolson finite difference schemes to discretize the optimality system in 1D and 2D cases, respectively. In order to build the second order spatial approximation, we use the ghost points on the boundary in the schemes. We prove that the proposed schemes are unconditionally stable, compatible and second-order convergent in both time and space. To avoid solving the large coupled schemes directly, we use the iterative method. Finally, we present a numerical example to validate our theoretical analysis.

As cloud computing grows,  the types of computational hardware available in the cloud are diversifying. Field Programmable Gate Arrays (FPGAs) are a relatively new addition to high-performance computing in the cloud, with the ability to accelerate a range of different applications, and the flexibility to offer different cloud computing models. A new and growing configuration is to have the FPGAs directly connected to the network and thus reduce the latency in delivering data to processing elements. We survey the state-of-the-art in FPGAs in the cloud and present the Open Cloud Testbed (OCT), a testbed for research and experimentation into new cloud platforms, which includes network-attached FPGAs in the cloud.  

Crenate broomrape (Orobanche crenata Forsk.) is a serious long-standing parasitic weed problem in Algeria, mainly affecting legumes but also vegetable crops. Unresolved questions for parasitic weeds revolve around the extent to which these plants undergo local adaptation, especially with respect to host specialization, which would be expected to be a strong selective factor for obligate parasitic plants. In the present study, the Genotyping-By-Sequencing (GBS) approach was used to analyze genetic diversity and population structure of 10 Algerian O. crenata populations with different geographical origins and host species (faba bean, pea, chickpea, carrot and tomato). In total, 8,004 high-quality single-nucleotide polymorphisms were obtained and used across the study. Genetic diversity and relationships of 95 individuals from 10 populations were studied using model-based ancestry analysis, principal components analysis, discriminant analysis of principal components, and phylogeny approaches. The genetic differentiation (FST) between pairs of populations was lower between adjacent populations and higher between geographically separated ones, but no support was found for isolation by distance. Further analyses identified four genetic clusters and revealed evidence of structuring among populations and hosts with more evident structuring among hosts than strictly along a geographic gradient. In the most striking example, O. crenata growing on pea had a distinct SNP profile from those growing on faba bean or other crops. These results illustrate the potential of GBS to reveal the dynamics of parasitic weed dispersal and adaptation.

IntroductionHospital-acquired infection with COVID-19 (HAI) has reduced from 14.3% to 4.2% over the last year, but substantial differences still exist between English NHS trusts.MethodsWe assessed rates of HAI, comparing trusts using airborne respiratory protection (RPE, eg FFP3 masks) for all staff, as a marker of measures to reduce airborne spread, against those using mostly droplet precautions (eg surgical masks).Results/DiscussionRPE use was associated with a 33% reduction in HAI odds in the Delta wave, and 21% in the Alpha wave (p<0.00001). We recommend all hospitals make airborne mitigations a priority.

We report a rare and first case of combined cerebral venous sinus thrombosis and posterior internal carotid artery stroke in a 35-year-old female on combined oral contraceptive pills (COCP), presented with headache and vertigo, found to have extensive venous thrombosis and PICA territory ischemic infarct with persistently elevated factor VIII.

Here we present the case of an hepato-splenic-Tγδ-cell lymphoma interestingly occurring in a non-immunocompromised patient, with profuse telangiectasias giving originally misleading orientation towards the diagnosis of B angiotropic lymphoma.

The study is concerned with Al-Aswany’s political opinion articles that have been published since 2011 until 2014. The study investigates whether Al-Aswany persuades or manipulates the reader. Using VanDijk's model, presuppositions as well as the directives in Hyland's model of interaction, the study aims at analyzing how Al-Aswany manipulates the reader. Moreover, the study is set to find out whether a correlation between the use of directives and manipulation exists.  The data used, in this study, are drawn from Al-Aswany’s opinion articles that have been published in Al-Masry Al-Youm newspaper. The researcher has selected two articles from each year: 2011, 2012, 2013, and 2014.

In this paper, we combine the sinc and self-consistent methods to solve a class of non-linear eigenvalue differential equations. Some properties of the self-consistent and sinc methods required for our subsequent development are given and employed. Numerical examples are included to demonstrate the validity and applicability of the introduced technique and a comparison is made with the existing results. The method is easy to implement and yields accurate results. We show that the sinc-self-consistent method can solve the equations on an infinite domain and produces the smallest eigenvalue with the most accuracy

The study is concerned with Al-Aswany’s political opinion articles that have been published since 2011 until 2014. The study is concerned with argumentative persuasion. It aims at examining how the use of argumentative strategies, presuppositions and directives persuade the reader into accepting the proposed arguments and analyzing the degree of persuasion present in the text. Moreover, the study aims at examining whether there is an attempt to manipulate the reader. The data used, in this study, are drawn from Al-Aswany’s opinion articles that have been published in Al-Masry Al-Youm newspaper. The researcher has selected two articles from each year: 2011, 2012, 2013, and 2014. All in all, eight selected articles are gathered for a qualitative analysis. The findings of the study show that his articles are highly persuasive as he, extensively, uses cognitive directives, establishes a common ground through the use of topos of reality and presuppositions, evokes empathy towards the protesters and the revolutions through humanitarianism and justice while raising a feeling of threat/danger from Mubarak’s old regime. Furthermore, even though the texts are highly persuasive, to claim that there is a manipulation from Al-Aswany's part , using these linguistic tools and models, can not be strongly suggested.

Three-dimensional sealing and disinfecting is a very difficult challenge in the canals affected by internal resorption. Hybrid irrigation is a method that takes advantage of both ultrasonic / sonic activations, which has previously proven effective in cleaning the root canals. Also, modern biological materials are suitable to seal these canals.

In this work, the new VIKOR methods are established using the generalized Pythagorean fuzzy soft sets (GPFSSs). For GPFSSs, the distance measures such as Hamming, Euclidean, and generalized are given. Further, the basic characteristics of these distance measures are examined. Fuzzy and soft sets are strong instruments for uncertainty. This strongness has been demonstrated by the GPFSS combining Pythagorean fuzzy sets and soft sets and applied to imprecise and ambiguous information. In this context, new remoteness index-based methods have been proposed, which are dissimilar from available VIKOR methods. The displaced and fixed ideals positive and negative Pythagorean fuzzy values (PFV) were defined. Thus, based on this definition, displaced positive ideal remoteness indices, negative ideal remoteness indices, and fixed positive ideal, negative ideal remoteness indices were discussed. Two different weights are used here: weights based on OF preference information and precise weights calculated with the expectation score function. The VIKOR method given here provides a different way from canonical VIKOR methods: rank candidate alternatives and determining a compromise solution based on different preference structures. The processes principles of the newly defined GPFSSs VIKOR methods are given by four algorithms. An example of these algorithms is given with the behavioral development and cognitive development of the children of Early Childhood children in the COVID-19 quarantine.

Soft actuators and robotic devices have been increasingly applied to the field of rehabilitation and assistance, where safe human and machine interaction is of particular importance. Compared with their widely used rigid counterparts, soft actuators and robotic devices can provide a range of significant advantages; these include safe interaction, a range of complex motions, ease of fabrication and resilience to a variety of environments. In recent decades, significant effort has been invested in the development of soft rehabilitation and assistive devices for improving a range of medical treatments and quality of life. This review provides an overview of the current state-of-the-art in soft actuators and robotic devices for rehabilitation and assistance, in particular systems that achieve actuation by pneumatic and hydraulic fluid-power, electrical motors, chemical reactions and soft active materials such as dielectric elastomers, shape memory alloys, magnetoactive elastomers, liquid crystal elastomers and piezoelectric materials. Current research on soft rehabilitation and assistive devices is in its infancy, and new device designs and control strategies for improved performance and safe human-machine interaction are identified as particularly untapped areas of research. Finally, insights into future research directions are outlined.Corresponding author(s) Email:   mp351@bath.ac.uk, liutao@zju.edu.cn

Derek R. Lovley1,2* Pier-Luc Tremblay3 Xinying Liu2,41Electrobiomaterials Institute, Key Laboratory for Anisotropy and Texture of Materials(Ministry of Education), Northeastern University, Shenyang 110819, China.2Department of Microbiology and Institute for Applied Life Sciences (IALS)University of Massachusetts, Amherst, MA, USA.3School of Chemistry, Chemical Engineering, and Life ScienceWuhan University of Technology, Wuhan 430070, China4College of Environmental Science and Engineering, Beijing Forestry University,Beijing 100083, China*Corresponding author: dlovley@umass.edu

La ricerca di soluzioni ambientalmente sostenibili nel settore edile ha portato la comunità scientifica a studiare la possibilità di riciclo degli elementi in calcestruzzo giunti al fine vita, allo scopo di recuperare gli aggregati che lo compongono. Tale opportunità consente un minore utilizzo di risorse naturali, e riduce la quantità di rifiuti da costruzione e demolizione da smaltire in discarica. La prestazione ambientale del calcestruzzo può essere misurata con uno strumento standardizzato a livello Internazionale, il Life Cycle Assessment (LCA). L'attività sperimentale si focalizza sulla realizzazione di un modello utile all'applicazione del LCA a miscele di calcestruzzo, al fine di realizzare un'analisi comparativa tra le prestazioni ambientali di calcestruzzi convenzionali, e calcestruzzi realizzati con una quota parte di aggregati riciclati derivanti da processi di demolizione. La misura degli indicatori di impatto ambientale definiti dallo Standard ISO 14042 consente di quantificare l'incremento di sostenibilità ottenibile dal recupero degli aggregati, e permette di individuare i processi che incidono maggiormente sulla sostenibilità del prodotto finale.

Abstract Objective: To summarize the risk prediction models of chronic disease in Chinese medicine, describe their performance, and assess suitability of clinical or administrative use. Methods: The China National Knowledge Infrastructure and Wanfang Data were searched through February 2021, and hand searches were performed of the retrieved reference lists. Dual review was conducted to identify studies of prediction models of chronic disease in Chinese medicine. Results: From 399 citations reviewed, 17 studies were included in the analysis. Most of the studies were from single-centers (50%) or did not external validated (81.25%). The sample sizes were smaller and the models’ discrimination were larger compared with studies in fully western medicine. All the models used both laboratory findings and subjective judgements from doctors or patients. 9 models concentrated on diabetes mellitus or cardiovascular disease, and showed better performance and clinical application. Conclusions: The prediction models of chronic disease in Chinese medicine have unique advantages due to their considerations of doctors’ and patients’ subjective judgement. Diabetes mellitus and cardiovascular disease prediction models were in higher quality and clinical usability. Efforts to improve their quality are needed as use becomes more widespread.

A 72-year-old female used the oral phosphate binder lanthanum carbonate for 6 years, before discontinuing it after receiving a pancreas and kidney transplant. Now, 7 years after discontinuation, the patient developed bilious emesis. An upper gastrointestinal endoscopy showed an unspecific gastritis. Biopsies showed subepithelial crystalline deposits consistent with gastric lanthanosis.