Mini-commentary on BJOG-20-1841.R1: Cervical dilatation and preparation prior to outpatient hysteroscopy: A systematic-review and meta-analysis

Papillary muscle rupture is one of the rare and potentially life-threatening complication usually following acute myocardial infarction (AMI). Acute papillary muscle rupture (PMR) results in severe mitral regurgitation rapidly progressing to florid pulmonary edema and cardiogenic shock. Without emergent surgical intervention, the mortality is extremely high. The management of STEMI patients in COVID 19 pandemic is difficult and challenging. We present an unusual case of 56 years old male who presented with acute inferior wall myocardial infarction (IWMI), underwent successful thrombolysis, developed reinfarction 5 days later complicated by acute postero-medial papillary muscle rupture (PPMR) leading to severe acute mitral regurgitation.

Anthropogenically-driven climate warming is a hypothesized driver of animal body size reductions. Less understood are effects of other human-caused disturbances on body size, such as urbanization. We compiled 140,499 body size records of over 100 North American mammals to test how climate and urbanization, and their interactions with species traits, impact body size. We tested three hypotheses of body size change across urbanization gradients; urban heat island effects, fragmentation, and resource availability. Our results unexpectedly demonstrate urbanization is more tightly linked with body size changes than temperature, most often leading to larger individuals, thus supporting the resource availability hypothesis. In addition, life history traits, such as thermal buffering, activity time, and average body size play critical roles in mediating the effects of both climate and urbanization on intraspecific body size trends. This work highlights the value of using digitized, natural history data to track how human disturbance drives morphological change.

Assuming that the game emerged with the existence of humanity, it can be argued that in the historical process, adults' view of the child, economic and social conditions, natural disasters, war and similar disasters shaped with different perspectives. The game, which was considered as important as work in the preparation of young generations to life by the people of the First Age, was accepted as an occupation that helps both children and adults to gain skills, relax and get to know the world in the Middle Ages. Since the 18th century and especially in the 19th century, social consciousness has developed, and childhood and play have begun to be viewed as an important and different aspect of development (Oktay, 2013). In the 21st century, time will show how industrialization and digitalization that started in all aspects of life will affect the child and the game.Bardak, M. (2018). Play Based Learning. in A. Gürol (Eds.), Learning Approachs in Early Childhood (s. 207-230). İstanbul: Efe Akademi Publishing. ISBN: 978-65-230-847-9 (https://openaccess.izu.edu.tr/xmlui/handle/20.500.12436/1309#sthash.o0zfa6AC.dpbs)

The field of optogenetics is rapidly growing in relevance and number of developed tools. Amongst other things, the optogenetic repertoire includes light-responsive ion channels and methods for gene regulation. This review will be confined to the optogenetic control of gene expression in mammalian cells as suitable models for clinical applications. Here optogenetic gene regulation might offer an excellent method for spatially and timely regulated gene and protein expression in cell therapeutic approaches. Well-known systems for gene regulation, such as the LOV-, CRY2/CIB-, PhyB/PIF-systems, as well as other, in mammalian cells not yet fully established systems will be described. Advantages and disadvantages with regard to clinical applications are outlined in detail. Among the many unanswered questions concerning the application of optogenetics, we discuss items such as the use of exogenous chromophores and their effects on the biology of the cells and methods for a gentle, but effective gene transfection method for optogenetic tools for in vivo applications.

Plant biomass constitutes the main resource of renewable carbon in the planet and its valorization has traditionally been focused on the use of cellulose, although hemicellulose is the second most abundant group of polysaccharides on earth. Enzymes involved in its degradation are usually glycosyl hydrolases and filamentous fungi are good producers of these enzymes. In this study, a new strain of Aspergillus niger was utilized for hemicellulase production under solid state fermentation using wheat straw as a single carbon source. Physicochemical parameters for production of an endoxylanase were optimized by using one factor at a time approach and response surface methodology (RSM). Maximum xylanase yield after RSM optimization was increased 3-fold. The enzyme was purified by ultrafiltration and ion-exchange chromatography1.41-fold, with 6.2 % yield. Highest xylanase activity was observed at 50 °C and pH 6. A high pH and thermal stability were found, greater than 90% residual activity between pH 3.0-9.0 and between 30-40°C, after 24 h of incubation, presenting half-lives of 30 min at 50 and 60°C. Enzyme was mostly active for wheat arabinoxylan, and displayed the following kinetic parameters Km of 26.06 mg•ml-1 and Vmax of 5,647 U•mg-1min-1.Wheat straw xylan hydrolysis with the purified β-1,4 endoxylanase showed that it was able to release xylooligosaccharides, making it suitable for different applications in food technology.

Habitat structure is a key determinant of variation in biodiversity. The effects of increased vertical and horizontal vegetation structure can result in marked shifts in animal communities. This is particularly true for ants in response to woody thickening, with predicted negative impacts on ant diversity. We used pitfall traps to study the response of epigeic ants in two co-occurring dominant habitats (closed and open) of an African savanna biome experiencing extensive woody thickening. Although species richness was higher in open habitats, evenness was significantly lower. Thickening explained significant amounts of variation in ant composition, but site-specific characteristics and seasonality were more important. These site-specific characteristics were largely linked to Anoplolepis custodiens, a species that were locally abundant in open habitats with clayey soils, where they often accounted for more than 90% of all ant activity. As A. custodiens also responds positively to disturbance, indiscriminate bush clearing could lead to knock on effects associated with the numerical and behavioural dominance of this species.

Farmlands contamination with heavy metals (HMs) can be considered as a global issue especially in developing countries. The current study investigates the various pollution indices, potential ecological risk index (PERI) and human health risk caused by HMs in some selected regions of Punjab Province, Pakistan. Farmlands soil samples were collected, acid extracted and analyzed via ICP-MS (Agilent 7500c) for selected HMs. All the HMs were found within permissible limits set by worldwide regulatory authorities except Cd which exceeded its limit in 68% agricultural soils of the study area. The CF values for Cd showed high (CF≥6) degree of contamination to considerable contamination (3≤CF≤6). The CD values indicated low (CD≤6) contamination to moderate (6dermal>inhalation. Furthermore, the RI values were observed higher than 1.0×10–4 for Cd (Lahore and Faisalabad regions) and Cr (Multan and Faisalabad regions) in children working in farmlands and likely exposed to high cancer risk. So, minimization of pollutants must be the top priority of the state to reduce contaminants inputs and immobilization in soil through environmental protection laws and regulations

Objective: To investigate concordance in perceptions of communication among participants in family discussions and assess the importance of different domains of communication in a neurocritical care unit. Methods: Prospective observational study conducted in a neurocritical care unit. Our study involved family discussions regarding plan of care for patients admitted to the unit. All participants completed a survey. The first 4 questions rated understanding of the discussion and general satisfaction; the remaining questions were open-ended to assess quality of communication by the physician leading the discussion. Responses were scored and compared among participants using a Likert scale. A difference of < 1 in scores among participants was rated as concordance, while > 2 was designated as discordance. All open-ended responses were classified into six domains. Results: We observed 35 family discussions. Questions 1-3 yielded 99 cross-comparisons per question (total of 297 compared responses). Most responses were either “Strongly Agree” or “Agree”; with “Neutral” or “Disagree” responses being more prevalent in Question 2. Overall concordance of responses between participants was 88%. Education was the most frequently cited domain of communication in response to open-ended questions. Among family and neutral observers, empathy was frequently listed, while providers more often listed family engagement. Conclusion: Overall, satisfaction was high among providers, families, and the observer regarding quality of communication during family discussions in the unit. Perceptual differences emerged over whether this communication impacted healthcare decision-making during that encounter.

Introduction: Referrals for OE have increased but the reasons for this remain unclear. We characterise referrals to inform primary secondary care interface improvements. Methods: Questionnaire study from dedicated consultant-led research clinic for OE referrals. Results: 62 patients responded; 63% female, mean age 54 years. One was excluded (not OE). Most had multiple primary care visits before referral (average 4 GP; 2 practice nurse). 60% had received oral antibiotics (16% multiple classes). 18% had never had ear drops. 39% were not advised to keep ears dry. 21% had dermatitis; 13% contact allergy, 30% systemic allergy, 5% diabetes. <10% had narrow canals. 36% had active discharge but <7% needed a wick. Conclusion: OE occurs most commonly in women - often with associated risk factors. Lifestyle advice and ototopical drops are frequently overlooked; instead often inappropriately treated with oral antibiotics. Most ear were anatomically normal and community aural care clinics may have a role in reducing referrals.

Graph energy is a measurement of determining the structural information content of graphs. In this paper we determine the Quasi-Laplacian energy of classes of composite graphs based on R -graphs.

In this paper, we address the problem of global asymptotic stability and strong passivity analysis of nonlinear and nonautonomous systems controlled by second-order vector differential equations. First, we construct this system or the differential equation from a nonlinear time varying network of the circuit theory. Our system and with its real energy function generalize and improve upon some well-known studies in the literature. This system and its special forms have ample applications in many scientific investigations. We realized that most of the first- and second-order ordinary differential equations can be represented by LRC circuits. So, the energy (Lyapunov) functions of the systems can be constructed directly without much trial and error. By this way, the application of Lyapunov’s direct method may become a standard technique for physical systems. We illuminate this idea with many applications and improvements. We also compare the Lyapunov stability theory with Hamiltonian and Lagrangian systems in the sense of conservative and dissipative systems. Then, we provide new explicit stability and passivity results with minimum criteria.

Through reducing the problem to rational orthogonal system (Takenaka-Malmquist system), this note gives a proof for existence of n-best rational approximation to functions in the Hardy H^2(D) space by using pseudohyperbolic distance.

Rationale, Aims and Objectives: Alignment between patients’ treatment choices and treatments received is acknowledged as an important outcome of shared decision-making (SDM), yet recent research suggests that patients’ choices do not always align with their actual treatment trajectories. This paper explores the alignment of patient-expressed treatment choices (for surgery or medical management) after exposure to decision aids and treatments received among patients with hip or knee osteoarthritis within High Value Healthcare Collaborative (HVHC) systems as the collaborative integrating decision aids intended to support SDM into routine clinical practice. Method: This retrospective cohort study examines data from adult (>18 years) patients with hip or knee osteoarthritis who received decision aids as part of orthopedic consultations within HVHC systems between 2012-2015. Multivariate logistic regression explored the association between patient-level characteristics with the odds of treatment choice-receipt alignment. Results: The majority of patients with knee osteoarthritis (68.3%) and hip osteoarthritis (71.9%) received treatments aligned with their choices following exposure to decision aids, but analyses reveal important differences in the odds of such alignment across patient characteristics. In adjusted models, African American patients with knee osteoarthritis had 50% lower odds of receiving treatment aligned with their choices compared with white patients (OR = 0.52, p<0.05). Medicare- or Medicaid-insured knee patients had 49% and 59% lower odds (respectively) of receiving choice-aligned treatments relative to privately insured patients. Patients with knee (OR = 0.40, p<0.01) or hip (OR = 0.75, p<0.05) osteoarthritis at earlier decision-making stages had lower odds of receiving treatments congruent with their choices. Conclusion: This work elucidates the odds of treatment choice-aligned care for patients within health care systems attempting to routinely integrate decision aids to support SDM into clinical practice and underscores the gaps in achieving this alignment among African American patients, those with public insurance and those at early decision-making stages.

Recently He et al. \cite{He2019} derived an analytical solution of the system of Lane-Emden equations by using the Taylor series method and computed a closed-form solution of the system of Lane-Emden equations subject to given initial conditions. In this work, this method is further explored and extended to a class of nonlinear ODEs, PDEs, a system of Nonlinear ODEs and PDEs subject to certain Initial conditions and boundary conditions. In some cases, we could find exact solutions and if that is not possible then we compute approximate solutions. We have compared these solutions with other existing techniques and showed that the method is simple and superior to other existing iterative techniques. We have also provided Mathematica codes which user may find useful and can compute solutions as per their need.

We in this paper improve a method of establishing the existence of finite time blow-up solutions, and then apply it to study the finite time blow-up, the blow-up time and the blow-up rate of the weak solutions on the initial boundary problem of u_t - \Delta u_{t} - \Delta u_{t} = |u|^{p - 1}u. By applying this improved method, we prove that I(u_{0}) < 0 is a sufficient condition of the existence of the finite time blow-up solutions and \frac{2(p - 1)^{-1}\|u_{0}\|_{H_{0}^{1}}^{2}}{(p - 1) \|\nabla u_{0}\|_{2}^{2} - 2(p + 1)J(u_{0})} is an upper bound for the blow-up time, which generalize the blow-up results of the predecessors in the sense of the variation. Moreover, we estimate the upper blow-up rate of the blow-up solutions, too.

Giant cell arteritis (GCA) is rarely associated with cancer. The association paraneoplastic vasculitis and tumors appears to be more frequent with hematologic cancers. The authors report the case of 83-years-old Caucasian man, diagnosed with prostatic adenocarcinoma who developed a paraneoplastic GCA responsive to corticosteroids associated with disease progression.

In this paper first we present some new identities by using the notions of quantum integrals and derivatives which allows us to obtain new quantum Simpson’s and quantum Newton’s type inequalities for differentiable convex functions by using the q_{x}-quantum integral and q^{y}-quantum integral. In particular, this paper generalises and extends previous results obtained by the various authors in the field of quantum and classical integral inequalities.

The centrifugal fan blades of the high-speed train ventilation and cooling system are subjected to cyclic loading which will shorten the life of fan blades. It could cause an accident of the high-speed-train in service. In this study, a modified method based on the nominal stress method was proposed and developed for the fatigue life prediction of centrifugal fan blades. The finite element model was firstly used to analyze the mode and the stress of fan blades based on the typical material property. The fatigue life was predicted based on the physical curve, using the Miner's cumulative damage rule to calculate total damage. In order to verify the effectiveness of this method, the experimental tests were conducted on fan blades using a fatigue bench system, which were the typical structure of the ventilation cooling system of the high-speed-train. The damage mechanisms of blades was deduced from the fracture fractographs. The ventilation good correlation was achieved between the prediction model and the actual experimental results, testifying the practicability and effectiveness of this proposed method. Thus, the research result can reduce the probability of accidents caused by the fan blade damage and improve the reliability of the ventilation cooling system of the high-speed train.

The main aim of the current study is to evaluate the compressive quasi-static and fatigue properties of titanium alloy (Ti6Al4V) cellular materials, with different topologies, manufactured via Laser Powder Bed Fusion (LPBF) process. The topologies herein considered are lattice based regular and irregular configurations of cubic, star and cross shaped unit cell along with trabecular based topology. The results have indicated that the effective stiffness of all configurations are in the range of 0.3 – 20 GPa, which is desirable for implant applications. The morphological irregularities in the structures induce bending dominated behavior affecting more the topologies with vertical struts. The S – N curves normalized with respect to the yield stress indicate that the behavior of star regular structures is between purely stretching dominated cubic and purely bending dominated cross based structures. Trabecular structures have shown desirable quasi-static and fatigue properties despite the random distribution of struts.

Forage grasses, such as Panicum maximum, are important alternatives of lignocellulosic biomass for bioethanol production. Thus, this study investigates whether future climate conditions could influence P. maximum cell wall structure and hydrolytic performance. A combined temperature-free air controlled and a free-air carbon dioxide enrichment (Trop-T-FACE) facility was used to investigated the isolated and combined effect of elevated atmospheric CO2 concentration (eC) (600 μmol.mol-1) and elevated temperature (eT) by 2˚C more than the ambient temperature, on cell wall composition, cellulose crystallinity, accessibility, and hydrolysis yields. The elevated temperature treatments (eT and eT+eC) exhibited the most pronounced effects. Warming reduced starch content and crystallinity index (CI) of cellulose while increased cellulose content. The fluorescent protein-tagged carbohydrate-binding modules analysis demonstrated that warming led to improvement in the total cellulose surface exposure/accessibility in eT and eT+eC by 181% and 132%, respectively. Consequently, glucan conversion yields were improved by 7.07 and 5.37%, showing that warming led to lower recalcitrance in P. maximum biomass, which positively affect its use in biorefineries. Therefore, this work provides important information from an ecological and economic point of view, and might assist in the selection of tropical forage grasses efficiently adapted to climate changes with positive effect on bioenergy production.

The forgotten topological index of a graph $G$, denoted by $F(G)$, is defined as the sum of weights $d(u)^{2}+d(v)^{2}$ over all edges $uv$ of $G$, where $d(u)$ denotes the degree of a vertex $u$. In this paper, we give sharp upper bounds of the F-index (forgotten topological index) over bicyclic graphs, in terms of the order and maximum degree.

The growing use of new generation sequencing technologies on genetic diagnosis has produced an exponential increase in the number of Variants of Uncertain Significance (VUS). In this manuscript we compare three machine learning methods to classify VUS as Pathogenic or No pathogenic, implementing a Random Forest (RF), a Support Vector Machine (SVM), and a Multilayer Perceptron (MLP). To train the models, we extracted 82,463 high quality variants from ClinVar, using 9 conservation scores, the loss of function tool and allele frequencies. For the RF and SVM models, hyperparameters were tuned using cross validation with a grid search. The three models were tested on a set of 5,537 variants that had been classified as VUS any time along the last three years but had been reclassified in august 2020. The three models yielded superior accuracy on this set compared to the benchmarked tools. The RF based model yielded the best performance across different variant types and was used to create VusPrize, an open source software tool for prioritization of variants of uncertain significance. We believe that our model can improve the process of genetic diagnosis on research and clinical settings.

Cooperative breeding, which is commonly characterized by non-breeding individuals that assist others with reproduction, is common in avian species. However, few accounts have been reported in Charadriiformes, particularly island-nesting species. We present observations of cooperative breeding behaviors in Hawaiian Stilts during the 2012-2020 nesting seasons on the Hawaiian islands of O‘ahu and Moloka‘i. We describe three different behaviors that indicate cooperative breeding: (1) nest sharing; (2) helper at the nest; (3) cooperative chick rearing. Our observations suggest an ideal opportunity to examine the evolution of cooperative breeding behaviors in the order Charadriiformes.