A unified mathematical model of three-phase-lag in a compressed rotating isotropic homogeneous micropolar thermo-viscoelastic medium based on a ramp type thermal shock is developed. An application of this model is carried out to resolve the problem of a perfectly conducting half-space subjected to certain boundary conditions in the presence of an electromagnetic field. Lame's potentials and normal mode analysis techniques are employed to get the general analytical solutions. Specific attention is paid to explore the impact of the rotation, magnetic field, ramp time, as well as initial stress on the distributions of temperature, displacement, stress, and induced electric and magnetic distribution. The findings show that the impact of the rotation, magnetic field, viscous, ramp parameter, initial stress, and phase-lag on the micropolar thermo-viscoelastic medium is noticeable.

Background: Patient safety represents a global issue which leads to potentially avoidable morbidity and mortality. This study aimed to determine the inter-professional differences in patient safety culture in a tertiary university hospital. Method: A cross-sectional study using the Safety Attitude Questionnaire (SAQ) self-administered electronically in the English and Malay languages to evaluate safety culture domains. A positive percentage agreement score of 60% was considered satisfactory. Comparisons were made between clinicians, nurses, allied health professionals, ward attendants and support staff. Results: Of 6562 potential respondents, 5724 (80.4%) completed the questionnaire; 3930 (74.5%) women, 2263 (42.9%) nurses, and 1812 (34.2%) had 6-10 years of working experience. The mean overall positive percentage agreement scores were 66.2 (range=31.1 to 84.7%), with job satisfaction (72.3±21.9%) and stress recognition (58.3±25.6%) representing the highest and lowest mean domain scores respectively. Discussion: Differences were observed between all five job categories. Linear regression analyses revealed that the other four job categories scored lower in teamwork, safety culture, job satisfaction, and working conditions compared to nurses. Conclusions: The overall mean SAQ score was above the satisfactory level, with unsatisfactory percentage agreement scores in the stress recognition domain. Interventions to improve patient safety culture should be developed, focusing on stress management.

Uncertain heat equations are aimed to model the variation of temperature in a given region over time under uncertain influence. Parameter estimation is an important and significant topic in uncertain heat equations because after we construct a uncertain heat equation according to the specific problem to model a dynamic system, it is natural that the uncertain heat equation contains unknown parameters such as the unknown thermal diffusivity and unknown parameters of strength of heat source. For that matter, this paper first employs the moment method to estimate unknown parameters in uncertain heat equations. To show the process of parameter estimation, two numerical examples are given.

Subtilase is a potent cytotoxin that was first described in O113:H21 strain in Australia as a plasmid- encoded cytotoxin (subAB1). Subsequently, chromosomal variants including subAB2-1, subAB2-2, and subAB2-3 were described. In the present study a collection of 101 STECs isolated from various sources in Iran (2009-2016) were analyzed for the detection of different genes encoding the subtilase variants, plasmidic and chromosomal virulence genes, together with the phylogroup and serogroups. Overall, 57 isolates (56.4%) carried at least one variant of subAB. Most strains from small ruminants including 93% of sheep and 96% of caprine isolates carried at least one chromosomally encoded variant (subAB-2). In contrast, 12 cattle isolates (24%) only harbored the plasmid encoded variant (subAB1). STEC strains from other sources including deer, pony and humans were positive for subAB-2-1 and/or subAb2-2. Concerning the virulence markers, some strains showed an association with hosts the bacteria were isolated from. In particular, tia was associated with sheep, goats and pony isolates and astA gene was present in deer, pony and goats and terD was only found in deer and pony isolates. Only cattle STEC carried espP and epeA, the important markers of pO113 plasmid. Some genes were widespread among strain of various sources like ehly, iha and lpfO113 and some genes were not detected such as efa1, toxB and katP. Most strains belonged to phylogenetic group B1 (89.47%), but five strains from cattle, deer, pony and a goat were assigned to A phylogroup. Most cattle strains belonged to O113, while O5 was just detected in ovine isolates, and O128 and O113 were present in caprine strains. In conclusion, the present study reveals the presence of potentially pathogenic genotypes among LEE-negative isolates and some host specificity related to subtilase variants and other virulence markers that may aid in source tracking of STEC during outbreaks.

Objective To evaluate relationships between cycle threshold values and COVID-19 presentations and clinical courses in women presenting for childbirth. Cycle threshold values from polymerase chain reaction (PCR) testing are inversely proportional to viral burden and may be important predictors of disease state and infectivity risk. Design Retrospective cohort study Setting Three Yale-New Haven Health Hospitals between 4/2/2020-5/14/2020 Population Women presenting for childbirth who underwent SARS-CoV-2 PCR testing Methods Electronic health records were reviewed for socio-demographics, medical comorbidities, pregnancy and postpartum course, and COVID-19 symptoms and exposures. Records of SARS-CoV-2 positive women were reviewed for symptom onset, duration, and relation to test timing, disease course, and neonatal SARS-CoV-2 results. Main Outcome Measures SARS-CoV-2 real-time PCR cycle threshold values from positive tests were compared between asymptomatic and symptomatic women and in relation to disease severity. In women with symptomatic COVID-19, cycle threshold values were evaluated as a function of time since symptom onset. Results 1,210 women gave birth during the study period with 84 (6.9%) positive for SARS-CoV-2. Higher cycle threshold values were seen in asymptomatic SARS-CoV-2 positive patients (8/38 (21.1%) of asymptomatic women had cycle threshold <30 compared to 22/32 (68.0%) of symptomatic women, p<0.0001). In symptomatic women, values increased as time from symptom onset increased. Conclusion This study demonstrates higher cycle threshold values in asymptomatic patients and symptomatic patients tested remote from symptom onset, signifying older infections and detection of lower levels of viral RNA. Assessment of standardized cycle threshold values may help to understand disease characteristics and progression.

Empiric broad-spectrum antimicrobials therapy is suggested to be started immediately for sepsis patients. Empiric antimicrobial therapy should be narrowed once pathogen identification and sensitivities are established. However, the detail mechanisms of de-escalation strategy are still unclear. Here we hypothesized neutrophil extracellular trap (NETs) played an essential role and de-escalation strategy might alleviate organs injury through regulation of NETs formation in sepsis. We evaluated the effect of imipenem and ceftriaxone on NETs formation in vitro and examined the role of reactive oxygen species (ROS). Next, we designed de-escalation and escalation strategy based on their effects on NETs formation in CLP model. Organ injury, inflammatory cytokines, NETs levels were compared and evaluated. The in vitro study showed that imipenem and ceftriaxone had opposite effects on NETs formation in activated neutrophils. De-escalation therapy resulted in an evaluated MPO-DNA during early stage and decreased MPO-DNA during late stage, which exerted the reverse effects in escalation therapy sepsis animal model. Inflammatory response and organ injury exacerbated when eliminated NETs with DNAseI during early stage of sepsis (p<0.01). Histopathological analysis showed decreased injury in lung, liver and intestine in de-escalation therapy compared with escalation therapy (p<0.01). De-escalation therapy results in the highest 6-day survival rate compared with the control group (p<0.01), however, no significant difference was found between de-escalation and escalation group (p=0.051). We demonstrate that de-escalation, not escalation, therapy reduces organ injury, decreases inflammatory response by promoting NETs formation in the early stage and inhibiting NETs formation in the late stage of sepsis.

Planting trees is one of the most effective activities in recovering soil organic carbon (SOC) stocks of degraded areas, but we still lack information on how different tree species can influence soil respiration, one of the main sources of dioxide carbon (CO2) to the atmosphere. This study aimed to explore the influence of different forest species on the autotrophic and heterotrophic components of the total soil respiration in a bauxite mining area under reclamation. We analysed the soil CO2 efflux under five treatments: i) monoculture of clonal Eucalyptus; ii) monoculture of Anadenanthera peregrina (L.); iii) a mixed plantation of 16 native forest species (Nat); iv) a mined area without vegetation cover; and v) a natural forest cover. This design allowed exploring the soil CO2 dynamics in a gradient of recovery, from a degraded area to natural vegetation. Additionally, we measured soil temperature, moisture and soil characteristics. Soil CO2 efflux increased with increasing forest species cover in the rainy months. There was no significant change in CO2 efflux among the tree species. Heterotrophic soil respiration contributed to 64% of total soil CO2 efflux and was associated with litter decomposition. Amongst the abiotic variables, increases in soil moisture had the most influence on CO2 efflux. Therefore, these results help to understand the factors that underpin the loss of SOC and can orient management practices to improve soil organic matter and restore soil quality in degraded areas.

The restoration of surface mining is a key to meet the global ecosystem restoration target. With increased data accessibility and computing tool capabilities, it becomes possible to expand mine restoration monitoring from single mine sites to multiple mine sites on a large scale. This study constructed a new index, Mine Landscape Restoration Index (MLRI), by coupling Land Surface Temperature (LST) and Enhanced Vegetation Index (EVI) to simultaneously monitor the restoration of regional multiple mine sites. We analyze historical and future trends of restoration using Mann-Kendall test, Sen’ slope, and Hurst exponent for MLRI time series. The restoration effects of 46 surface coal mine sites located in the northwestern ecologically fragile region of China from 2000 to 2019 were assessed, based on 3675 Landsat images on Google Earth Engine. The results showed that MLRI was effective in identifying restoration areas and processes in surface mine sites, which was validated by high-resolution images and field investigation of mine samples. The restoration area overall percentage was significantly higher in mines started mining before 2000 than after 2000. According to the restoration effects, we clustered the 46 sites into high, medium, and low restoration area percentage clusters with 13, 11, and 22 mine sites, respectively. Individual clusters have aggregation characteristics within each mine region, but are distributed irregularly across the different six mine regions. This study provides a new approach to monitoring the restoration of surface coal mine sites and inform government managers in developing mine restoration programs and sustainable mining development plans.

Firstly described by Lucy Frey in 1923 the “Frey’s syndrome” is characterized by sweating and flushing in direct response to mastication. The mechanism is aberrant regeneration of postganglionic parasympathetic neurons from the auriculotemporal nerve and Acetylcholine secretion by a masticatory stimulus. This entity occurs in up to 65% following lateral parotid resections and less commonly after neck dissection or facelift procedures. This article aims to list possible surgical and non-surgical treatment options of this iatrogenic entity but should focus on the treatment with botulinum toxin A and provide a step by step guide from the Lugol-Iodine-Starch test to the botulinum toxin A (BoNTA-ONA) injection within the affected area.

Aim: This study evaluated the effect of intracavitary levobupivacaine infusion diluted with locally applied isotonic solution for pain control in cystoscopy. Methods: Included in this study are 100 patients who had previously undergone transurethral tumor resection for bladder tumor and were followed up by cystoscopy. The patients were randomized into five groups (n = 20). In the first, second, third, and fourth groups, 4, 6, 8, and 10 mL of levobupivacaine HCl (5.0 mg/mL) were mixed with 26, 24, 22, and 20 mL of isotonic solution, respectively. Hence, the total mixture was 30 mL for each group. The fifth group was the control group. In this group, the standard method commonly used in most clinics was utilized. That is, a gel containing Cathejell-2% lidocaine (25 mg lidocaine) was applied. Cystoscopic interventions were performed with a 17.5 Fr rigid cystoscope and 0°, 30°, and 70° lens. During cystoscopy and 30 min later, the pain status of patients was assessed using the Visual Analogue Scale (VAS), and patient satisfaction was questioned. Results: The mean VAS score during and after the cystoscopy procedure was significantly lower in the levobupivacaine groups compared to the lidocaine group. In addition, patient satisfaction in the levobupivacaine groups was significantly higher than in the lidocaine group. No drug-related side-effects were observed in all groups. Conclusion: Thus, levobupivacaine is a more effective drug than lidocaine alone to control pain during cystoscopy. The use of levobupivacaine is recommended to prevent possible complications of general anesthesia by eliminating the need for the aforementioned as well as its cost-saving advantage.

Growing evidence that individuals of many generalist animals behave as resource specialists has attracted research interest for its ecological and evolutionary implications. Although variation in resource preferences is critical for developing a general theory of individual specialization, it remains to be shown whether diverging preferences can arise among individuals sharing a similar environment and whether these are stable enough to be ecologically relevant. We addressed these issues by means of common garden experiments in feral pigeons (Columba livia), a species known to exhibit resource specialization in the wild. Food-choice experiments on wild-caught pigeons and their captive-bred descendants showed that variation in food preferences can easily arise within a population and that this variation may represent a substantial fraction of the population niche. However, a cross-fostering experiment revealed that the genetic and early common-environment components of food preferences were low, reducing their stability and eroding niche variation in the long-term.

Chronic kidney disease (CKD) is a major cause of disease burden globally. With end-stage renal disease (ESRD), renal replacement therapy via dialysis or kidney transplant can be economically costly. This meta-analysis evaluated the efficacy of AST-120, an oral adsorbent marketed to be able to delay progression of CKD. Outcomes assessed included mortality, ESRD incidence, and doubling of serum creatinine. Databases including Cochrane, PubMed, and Clinicaltrials.gov were searched, and literature-mining from prior publications was also done, yielding a total of 50 non-duplicate citations. Further screening for appropriateness yielded 5 studies included in this meta-analysis. Regarding the effect of AST-120 on all-cause mortality among CKD patients, the pooled data showed a total of 110 events out of 1503 subjects in the interventional group and 116 events out of 1494 subjects in the control group, giving a risk ratio (RR) with 95% confidence interval (CI) of 0.94 [0.74, 1.21]. On the outcome of ESRD incidence, a total of 353 events out of 1524 subjects in the interventional group and 374 events out of 1517 subjects in the control group yielded a RR with 95% CI of 0.94 [0.83, 1.07]. Regarding doubling of serum creatinine, 155 events in both the interventional and control groups, which had 1503 and 1494 subjects, respectively, gave a RR with 95% CI of 0.99 [0.80, 1.22]. In conclusion, AST-120 has no significant clinical benefit over standard treatment in delaying CKD progression. Further studies examining different dosages of AST-120 and its effect on different CKD stages are recommended.

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BJOG Debate

The multi-domain bacterial S1 protein is the largest and most functionally important ribosomal protein of the 30S subunit, which interacts with both mRNA and proteins. The family of ribosomal S1 proteins differs in the classical sense from a protein with tandem repeats and has a “bead-on-string” organization, where each repeat is folded into a globular domain. Based on our recent data, the study of evolutionary relationships for the bacterial phyla will provide evidence for one of the proposed theories of the evolutionary development of proteins with structural repeats: from multiple repeats of assembles to single repeats, or vice versa. In this comparative analysis of 1333 S1 sequences that were identified in 24 different phyla; we demonstrate how such phyla can independently/dependently form during evolution. To our knowledge, this work is the first study of the evolutionary history of bacterial ribosomal S1 proteins. The collected and structured data can be useful to computer biologists as a resource for determining percent identity, amino acid composition and logo motifs, as well as dN/dS ratio in bacterial S1 protein. The obtained research data suggested that the evolutionary development of bacterial ribosomal proteins S1 evolved from multiple assemblies to single repeat. The presented data are integrated into the server, which can be accessed at http://oka.protres.ru:4200.

This is a case of recurrent episodes of headache and cyanosis who has never been diagnosed despite frequent visits to the hospital. After excluding cardiopulmonary causes, methemoglobin levels were found to be high, without exposure to any offending agent. Also, we did a literature review about congenital methemoglobinemia.

This is a unique case describing hydrocephalus to be the primary presenting symptom of neurosarcoidosis. A 49-year-old woman with previous ischemic cerebral events presented with a gait disorder, urinary incontinence and cognitive impairment. Imaging showed obstructive hydrocephalus, progressive white matter abnormalities and basal leptomeningeal enhancement. Further diagnostics suggested sarcoidosis.

Purpose: Central nervous system (CNS) involvement usually confers poor prognosis in cancer. We aimed to estimate prevalence of neurological-complications (NC) in children presenting with non-neurological malignancy and to describe type, aetiology and outcome of such complications Methods: A bidirectional cohort study of children (1 month-15 years) with non-neurological malignancy was conducted at tertiary-care teaching hospital, North India. Prevalence and spectrum of NC was determined. Etiological diagnosis was made using neuroimaging, cerebrospinal-fluid analysis, nerve-conduction velocity, history and clinical examination. Results: A total of 1572 patients (870 with haematological-malignancy; 55.6% and 702 with solid tumours; 44.4%) were enrolled. Most of them presented within 5-10 years of age and were males (72%). Overall frequency of NC was 10.5% (Haematological: 9.4%; solid: 11.8%). Highest proportion of NC was seen in RB (17.2%), followed by Neuroblastoma (16.6%), acute myeloid-leukaemia (AML) (16.6%), Ewing’s sarcoma (16.1%) and Langerhans cell histiocytosis (LCH) (14.2%). Frequent symptoms were seizures (30.9%), headache (18.2%), bilateral lower-limb weakness (13.3%), altered sensorium (9.7%), cranial nerve palsy (9.1%), loss of vision (3.0%), pain in lower-limbs (1.2%), aphasia (0.6%), ataxia (0.6%) and bilateral hearing loss (0.6%). Common aetiologies of NC included CNS metastasis or intracranial extension (in RB, Rhabdomyosarcoma), spinal metastasis (in Neuroblastoma, Ewing’s-sarcoma, germ cell tumour), intracranial bleed (in AML, Hodgkin’s-lymphoma, ALL), CNS relapse (ALL), CNS leukaemia (in Non-Hodgkin’s-lymphoma), cerebral atrophy (Wilm’s-tumor) and Meningo-encephalitis (in LCH). Mortality was high in affected children (80%). Conclusions: Cancer-specific information about NC may be beneficial for early recognition and judicious management in order to prevent neurological or cognitive morbidity.

Purpose: A stable contact force (CF) is correlated with more effective radiofrequency ablation (RFA) lesions and long-term procedural outcomes. Efforts to improve catheter stability include jet ventilation, pacing, steerable sheaths, and CF sensing ablation catheters. This study compares CF stability and effective RF lesions between two commercially available steerable sheaths. Methods: Thirty patients underwent first time RFA at a single center using the Agilis NxT or SureFlex Steerable Sheath. High power short duration RFA was utilized targeting a 10Ω drop. Sheath performance was assessed for the entire procedure and around each pulmonary vein (PV) in terms of mean CF, CF variability, RF time per lesion, and inefficient contact lesions (defined as lesions with CF < 5g for at least 10% of the RF delivery time). Results: Operator-targeted mean CF was achieved using both sheaths; however, overall CF variability was 12.8% lower using the SureFlex sheath (p = 0.08). CF variability was generally 16% greater in the right PVs than the left PVs (p = 0.001), but trended lower with the SureFlex sheath. There were 8% more inefficient contact lesions using Agilis as compared to SureFlex (p = 0.035), especially in the right inferior PV (p = 0.009). RF time per lesion was on average 12% (1.4s) shorter using SureFlex than Agilis (p < 0.05). Conclusion: Choice of steerable sheath may affect catheter stability and potential lesion quality, especially in the right PVs.

Introduction: We sought to clarify the electrocardiographic and electrophysiological characteristics of ventricular arrhythmias (VAs), including idiopathic ventricular tachycardia (VT) and premature ventricular contractions (PVCs), with acute successful radiofrequency catheter ablation (RFCA) at the left ventricle basal inferoseptum near the mitral annulus (LV-BIS-MA). Methods and Results: Twenty-five patients with acute successful RFCA at the LV-BIS-MA were included in this study. The S wave amplitudes on lead III during VAs were 1.54 ± 0.38 mV, significantly larger than that on lead II (0.55 ± 0.19 mV) and aVF (1.04 ± 0.31 mV) (P < 0.01). The RFCA start-to-effect time was 10.2 ± 5.8 seconds (s) in 21 patients (84.0%). In the remaining 4 patients (16.0%), the mean duration of successful RFCA was not well determined due to infrequent nature of clinical VAs during ablation. Trans-septal approach were utilized in all the 25 cases. Intra-cardiac echocardiography (ICE) showed that the ablation catheter tip was underneath the anterior leaflet of the mitral valve via the reversed C‐curve technique. Early (within 3 days) and late (one-year) recurrence rates were 4.0% (one patient) and 12.0% (three patients), respectively. No complications occurred during RFCA or the one-year follow up. CONCLUSION: LV-BIS-MA VAs are a subgroup of idiopathic VAs with distinctive ECG and EP features. RFCA via a transseptal approach using a reversed C curve technique is effective for better identification and targeting the areas of VAs origin and ICE showed that the ablation catheter tip was underneath the anterior leaflet of the mitral valve.

The drainage layer strategy is a common method for improving filtration performance of coalescing filter. In this study, using the commercial glass fibrous filters, the influence of sub-high efficiency drainage layers on high efficiency coalescing filters were investigated experimentally. The efficiency of coalescing filter slight increases, whereas the total wet pressure drop reduces 0.32 kPa after assembling drainage layer. In addition, the influence of pore size, thickness and wettability on performance were evaluated. While the pore size of drainage layer decrease, the wet pressure drop reduces and quality factor increase. Likewise, the thickness of drainage layer also has positive effect on filtration performance. By contrast, the wettability has a weak affect on the filtration performance. As different coalescing filter with the same drainage layer, the improvement in the filtration performance increase with the decrease of pore size difference between the coalescing and drainage layers.

Background: Mast cells play a critical role in tumor-associated immune pathways. We aimed to determine whether the urinary mast cell mediators predict the immune response in patients with non-muscle invasive bladder cancer (NMIBC) treated with Bacillus Calmette-Guérin (BCG) immunotherapy. Methods: Nineteen patients who have received immunotherapy due to NMIBC and 19 healthy participants were enrolled. Urine samples were collected to assay N-methylhistamine, histamine, and tryptase levels immediately before the first BCG instillation, immediately after the third and sixth instillations, and four weeks after the sixth instillation in patients with NMIBC and at a single visit in healthy participants. Cystoscopic examinations were performed on the patient with NMIBC at three-month intervals for two years. The changes in urinary markers due to BCC response, BCG instillation, and the presence of NMIBC were assessed. Results: The average age was 56.1 ± 10.5 years in patients with NMIBC. Fourteen patients had high-grade Ta tumors, and 5 had high-grade T1 tumors. While 12 patients responded, 6 presented with recurrence and 1 with progression. There was no correlation between the levels of mast cell mediators and BCG response. The N-methylhistamine and histamine levels were increased significantly with the onset of immunotherapy, and N-methylhistamine levels were significantly decreased when immunotherapy was terminated. Pre-BCG estimated marginal means of N-methylhistamine were significantly higher in patients with NMIBC than healthy participants. Conclusions: Our study is the first study to identify the changes in mast cell mediators with the onset of immunotherapy and with the presence of bladder cancer. However, these mediators were not found to predict the patients’ response to immunotherapy.

The production of ‘Premium’ olive oil depends in a large part on the quality of the fruit. Small producers see themselves confronted with vast investments and logistic snags when they intend to optimize the harvesting. Today, manual harvesting devices promise less damaged fruit when compared to the traditional methods with nets while the use of a cooling room on the farm is suggested as a solution when the harvesting needs to be stretched out over several days. The use of a manual inverted umbrella during the harvest, together with a storage up to 14 days at 5 °C at a family farm, was studied for three cultivars, ‘Arbequina’, ‘Picual’, and ‘Verdial’. Ten quality parameters of the produced oil were examined in two consecutive years together with an extended sensory analysis in the first year. The results underline the importance of the used harvesting and conservation method on the quality of the extracted oil. The strength of each factor varied in time and according to the cultivar. The ‘Arbequina’ c.v. showed a rapid increase in the importance of the conservation factor, while ‘Picual’ c.v. was the most resistant to deterioration, presenting a lower explanatory value of the conservation factor as compared to the harvesting one. The results indicate that small producers with financial and logistic restrictions can obtain a high-quality product. Either by combining both methods or by choosing the one that guarantees the best results given the cultivar and the specific storage time they need to consider.

This paper aims to establish existence and uniqueness results of weak and strong solution to the three-dimensional periodic magnetization-variables formulation to Navier-Stokes equations with damping term. Authors in precedent works addressed the question as to whether this model and similar ones without damping term possess a weak solution. In this vein, considering a damping term in the magnetization-variable formulation turned to be consequential as it enforces existence and uniqueness results. Energy methods, compactness methods are the main tools.