In the present paper, we study the stochastically-induced behavior of a non-linear volcanic model containing three prognostic variables: the plug velocity $u$, the pressure under the plug, and the conduit volume $V$. The nouvelle phenomena of noise-induced transitions from the equilibrium to the cycle in the bistability parametric zone and noise-induced excitement with the generation of spike oscillations in the monostability zone are found in the presence of N-shaped friction force. To study these phenomena numerically, we used the computations of random solutions, the phase trajectories and time series, the statistics of interspike intervals, and the mean square variations. To study these phenomena analytically, we applied the stochastic sensitivity function technique and the confidence domains method. This approach is used to predict the noise-induced transition from a “dormant volcano” state to the “active volcano” mode. From the physical point of view, the volcano is capable to become active under the influence of external noises in the friction force, which model various compositions and properties of volcanic rocks. What is more, the volcanic plug can pop out when it is slipping heavily, and the volcano can erupt.

Inspired by papers by M.A. Bokhari, A. Qadir, and H. Al-Attas [On Gauss-type quadrature rules, Numer. Funct. Anal. Optim. 31 (2010), 1120-1134] and by M.R. Rapaic, T.B. Sekara, and V. Govedarica [A novel class of fractionally orthogonal quasi-polynomials and new fractional quadrature formulas, Appl. Math. Comput. 245 (2014), 206-219], in this paper we investigate a few types of orthogonal polynomials on finite intervals and derive the corresponding quadrature formulas of Gaussian type for efficient numerical computation of the left and right fractional Riemann-Liouville integrals. Several numerical examples are included to demonstrate the numerical efficiency of the proposed procedure.

By combining variational methods and a Trudinger-Moser-type inequality with weights, we investigate the existence of radial standing waves for a modified Schrödinger equation coupled with the Chern-Simons gauge theory.

This paper deals with the sixth-order boussinesq equation with fourth-order dispersion term. By suitable assumptions on the initial values, the conditions on finite time blow-up of solutions are given. Moreover, the upper and lower bounds of the blow-up time are also investigated

In this paper, the porpuse is to determine an optimal premium in order to increase the insurer's SMR using a control model. For this purpose, First, a stochastic dynamic model is introduced to describe the process of receiving premium and paying claims. Then, the premium variable is introduced as the problem control variable. Next, In order to increase SMR and control the premium, an appropriate objective function is defined for control variables and state variables. In the end, after deterministing and discreting the model, the optimal control problem by using particle swarm is solved.

There is no confirmatory diagnostic test for pulmonary hydatid cyst other than surgical excision and histopathologic confirmation. Imaging is at best suggestive and serology does not have a satisfactory sensitivity. We present a series of children wherein flexible fibreoptic bronchoscopy under conscious-sedation, revealed hydatid membranes in airways. Broncho-alveolar lavage analysis confirmed hydatid in half of them. We propose flexible fibreoptic bronchoscopy with broncho-alveolar lavage as a confirmatory diagnostic test for pulmonary hydatid in children. To the best of our knowledge, this is a completely novel approach to the condition with potential to alter the diagnostic paradigm.

Background: Powered transvenous lead extraction (TLE) tools are commonly required in the removal of the leads that have long implant duration due to fibrotic adhesions. However, the comparative data are lacking among different types of TLE tools. Aim: To compare the efficacy and safety of two different rotational mechanical dilator sheaths in retrospectively analyzed patients who underwent TLE. Methods and results: A total of 566 lead extractions from 302 patients using TightRailTM (333 lead extractions from 169 patients) and Evolution® (233 lead extractions from 133 patients) mechanical dilator sheaths were performed between July 2009 and June 2018. Acute and long term outcomes of study groups were compared. There is no statistically significant difference between Evolution® and TightRailTM groups in procedural success (93.9% vs. 94%), clinical success (99.2% vs. 98%) and major complications (3.8% vs. 1.2%), respectively (p>0.05). In multivariate regression analysis, lead dwell time, number of extracted leads, and baseline leukocyte count were found as independent predictors of procedural success (p<0.05). During the median follow-up of 36.6 (0.2-118) months, all-cause mortality was observed in 73 patients (25.6% in the Evolution® vs. 23.1 in the TightRailTM group, p>0.05). Chronic renal disease, heart failure, and coagulopathy were shown as independent predictors of all-cause mortality in multivariate regression analysis (p<0.05). Conclusions: TLE using TightRailTM or Evoluation® mechanical dilator sheaths is a safe and effective therapeutic option. Both mechanical dilator sheaths showed similar efficacy, safety, and all-cause mortality at acute and long-term follow-up of patients who underwent TLE.

Background: Thromboembolic or hemorrhagic complications related to atrial fibrillation (AF) ablation are rare, and thus, it is difficult to compare their frequency across different direct oral anticoagulants (DOACs). We aimed to compare the intraablation blood coagulability and postprocedural hemoglobin fall as alternatives to those complications across 4 DOACs. Methods: We enrolled AF patients younger than 65 years old in 3 cardiovascular centers who skipped a single dose of apixaban, dabigatran, edoxaban, and rivaroxaban, prior to the ablation. Endpoints included the activated clotting time (ACT), heparin requirement during the ablation, and drop in the hemoglobin level 24 hours after the procedure. Results: The time-course curves of the ACT differed significantly across the patients with apixaban (N=113), dabigatran (N=130), edoxaban (N=144), and rivaroxaban (N=81), with its highest level in the dabigatran group (P <0.001). The average ACT was greater in the dabigatran group than in the other groups (312.3±34, 334.4±44, 308.1±41, and 305.8±34.7 sec; P <0.001). A significant difference was noted in total heparin requirement across the patient groups (3990.2±1167.9, 3890.4±955.3, 4423.8±1051.6, and 3972±978.7 U/m2/h; P <0.001), with its greatest amount in the edoxaban group. The reduction in the hemoglobin level was similar (-0.93±0.92, -0.88±0.79, -0.89±0.97, -0.95±1.23 g/dL; P=0.94). No inter-group difference was noted in the rate of major or minor bleedings (0.9%, 2.3%, 1.4%, and 3.7%; P=0.51), and no thromboembolic events were encountered. Conclusion: A difference in DOACs may have an impact on intraablation anticoagulation, however, it may not on the procedural blood loss in the setting of a single skip.

Multipolar mapping has primarily been studied in complex arrhythmia substrates or re-entrant circuits. Chieng et al. use a Case-Control design to compare multipolar mapping and point-by-point mapping with an ablation catheter for focal atrial and ventricular tachycardias, showing reduced procedure times and earlier electrograms in the multipolar mapping group but no difference in clinical outcomes. It is plausible that faster mapping and better delineation of earliest signals may translate to improved clinical outcomes if studied in a randomized trial in a larger population. Future multipolar mapping systems will guide the operator toward the focus in real-time and may even triangulate the source in three dimensions, giving an estimate of depth within the myocardium or likely focus in the opposite chamber.

A 2-month-old infant Hispanic female with failure to thrive and choking episodes was admitted with progressive worsening of respiratory effort, paroxysmal coughing, and hypoxemia. She required prolonged mechanical ventilation and post-pyloric feeding for concern of aspiration with no marked improvement of chest radiogram or CT findings. Lung biopsy performed and remarkable for lymphocytic infiltration but without a definite diagnosis. Genetic testing identified a unique heterozygous mutation in the COPA gene. She was started on rituximab and azathioprine initially and has weaned off oxygen and the ventilator. We report a unique case of interstitial lung disease secondary to COPA gene mutation without frank pulmonary hemorrhage, renal, or joint involvement upon initial presentation.

The aim of this study is the evaluation of fatigue strength of glass-fibre-reinforced polypropylene composite (PPGF35) by applying both the Risitano Thermographic Method (RTM) and the new static Thermographic Method (STM). Fifteen tensile tests and twenty cyclic tests were carried out to evaluate the fatigue strength of PPGF35 by applying traditional and innovative energy methods. The results show how the energy methods used are very useful for rapid identification of the material’s fatigue strength, saving companies time and money.

Chronic Fatigue Syndrome (CFS), also known as myalgic encephalomyelitis (ME), is a complicated disease characterized by extreme fatigue of at least six months duration. It is necessary to rule out the organic cause of CFS in the paediatric patient in order not to overlook the preventable or the treatable condition. In our case report we present a case of a patient with a surprising origin diagnosed by cardiopulmonary exercise testing.

Droplet impingement of metallic surfaces at high impact velocities results, after some time, in erosion of the surface due to fatigue. By extending our previously published analytical model to enable the use of experimental fatigue data (S-N curves), here, for the first time, a wide range of experimental liquid droplet erosion incubation period test states for both ferrous (stainless steel AISI 316) and non-ferrous (aluminium 6061-T6) engineering metals have been investigated. To achieve this, the developed model includes additional surface hardening and a residual compressive stress state at the surface due to a water drop peening effect. As such, the interrelation of the physical and mechanical properties that follows from the model has been used to identify how changes in selected metal properties might enhance droplet impingement erosion incubation life. Model predictions for both metals, using fatigue data from S-N curves from different literature sources, showed for the droplet impact velocity range of 140 to 400 m/s an excellent agreement with results from a multi-regression equation as determined from an ASTM interlaboratory test program.

The great number of patients presenting to health centers or hospitals during the outbreak of coronavirus disease 2019 (COVID-19) overwhelms the need for critical care support. Early and effective predictors for clinical outcomes are urgently needed for risk stratification. Critically ill patients often develop coagulation disorders, in particular hypercoagulation. Elevated D-dimer is a prominent indicator for the initial coagulopathy of COVID-19. To estimate whether D-dimer is associated with the severity of COVID-19, we performed the analysis of D-dimer abnormalities in patients with COVID-19. The data demonstrated that D-dimer levels were significantly higher in deceased patients than in survivors (weighted mean difference(WMD): 3.70mg/L, 95% confidence interval(CI):1.41–5.98mg/L), and the levels in severe patients were also higher than those in mild cases (WMD: 0.39mg/L, 95% CI: 0.22–0.55mg/L). Therefore, we conclude that elevated D-dimer level is related to the severity and poor prognosis of patients with COVID-19.

Brucellosis remains one of the major zoonotic diseases worldwide and requires a One Health approach for early detection and control. One of the crucial components for brucellosis control and spread is timely and reliable laboratory diagnosis. External quality assessment is a key component of laboratory quality assurance to evaluate performance and identify possible insufficiencies in laboratory practices. Implementation of brucellosis external quality assessment in resource-limited countries are rare and challenging due to logistical and financial difficulties. The aim of this study was to evaluate the stability of dried tube specimens for external quality assessment of brucellosis serological testing that could be used in resource-limited countries to avoid logistical and financial constraints associated with use of sera. Prepared dried tube specimen panels consisted of 5 samples, one negative and 4 positive samples ranging from weak positive to strong positive. It was shown that brucellosis dried tube specimens were stable at room temperature for 105 days (15 weeks). Consistent results were observed for all samples by rose bengal test during weekly stability testing and also at the end of the stability period by complement fixation test, enzyme-linked immunosorbent assays, and fluorescence polarization assay. In conclusion, brucellosis dried tube specimen maintains integrity of serum samples for serological testing of brucella infection and can be a powerful tool for external quality assessment providers, as it decreases huge shipping costs and avoids challenges in maintaining cold chain shipments between the provider and the recipient laboratories. Moreover, it has great prospects for enabling expansion of external quality assessment programs to include lower tier labs in resource-limited countries to monitor and improve the quality and accuracy of brucellosis testing, as well as it could be used for transportation of clinical samples from remote areas without cold chain logistics.

OBJECTIVES: To audit quality of intrapartum care and birth outcomes before and after a restriction in the number of women admitted in childbirth. This restriction policy was implemented as number of births vastly exceeded the pre-dimensioned capacity. DESIGN: A retrospective, comparative criterion-based audit. SETTING: Taiz Houbane Maternal and Child Health Hospital, Yemen. POPULATION: All women giving birth in a high-volume month (August 2017; n=1034) and a low-volume month (November 2017; n=436). METHOD: Criterion-based audit of case files was conducted for all caesarean sections (n=108 and n=82) and for 250 randomly selected vaginal births in each month. Birth outcomes were assessed for all women and newborns. MAIN OUTCOME MEASURES: Prevalence of sub-optimal quality of intrapartum care and adverse birth outcomes (stillbirths, intra-facility newborn deaths, and Apgar score <7). RESULTS: Background characteristics of women were comparable between the months. Rates of labour inductions and caesarean sections increased significantly in the low-volume month (14% vs. 22% (relative risk (RR) 0.62, 95% confidence interval (CI) 0.45-0.87) and 11% vs. 19% (RR 0.55, 95% CI 0.42-0.71), respectively). No other care or birth outcome indicators were significantly different. Structural and human resources remained constant throughout, despite differences in patient volume. CONCLUSIONS: Assumptions regarding quality of care in periods of high demand may be misguiding - resilience to maintain quality of care was strong. We recommend health actors to closely monitor changes in quality of care when implementing resource changes - to enable safe care at birth for as many women as possible. FUNDING: Médecins Sans Frontières

‘Waiting’ and ‘Motion’ are two wastes of the seven wastes considered in the lean manufacturing concept. They both consume valuable operating time and slow down the production cycle. The main goal of this paper is to incorporate 5S, a lean manufacturing method with a view to reducing these two wastes. 5S was implemented to develop a system of organization for blowing Sizers and printing blocks in the work area. 5S derived from five Japanese words, when translated, mean sort, set in order, shine, standardize, and sustain. Research has been carried out in a poly bag manufacturing industry in Bangladesh with the goal of increasing productivity by minimizing non-value - added operational time. The manufacturing of poly bags consists mainly of 3 operations; blowing, printing and sealing. Following the implementation of 5S in these areas, the lead time for blowing operation decreased by 8% and the lead time for printing operation decreased by 18%. The assessment was successfully conducted and established in this study. A scope for improvement has been opened through this research, which may inspire other researchers to consider implementing the 5S tool in their respective research areas as a tool to reduce non-value - added operational time.

With the rapid and large production of biological data (phenotypic traits, genomes, and simulated DNA), traditional statistic-based approaches may not meet the demands of ecological or evolutionary inferences. To mitigate this issue, we propose supervised visual and statistical machine learning approaches to do biological, evolutionary, and demographic inference. We introduce five supervised learning approaches (DAPC, DAKPC, LFDA, LFDAKPC, KLFDA) into ecology and evolution within the same discriminant analysis family, but with different linear and non-linear properties. We tested their performance and expected to find the optimal method for biological, evolutionary, and demographic inference. Applicable examples of such methods include species classification, population structure identification, and demography inference. We applied these five supervised learning techniques to simulated spatially-structured demographic scenarios along with realistic ecological and genetic data to elucidate their power and practicability in pattern inference. LFDA shows the highest discriminatory power in demographic inference. However, KLFDA outperforms other methods in population structure identification. DAPC and DAKPC differentiated species traits well when applied to real datasets. These approaches assess the structure of the data without model assumptions and show the potential to identify complex demographic histories and subtle population structure. We have made the DA package available at https://github.com/xinghuq/DA. We recommend users choose these machine learning approaches appropriately depending on their scientific questions and target data.

Integrating diverse concepts from animal behavior, movement ecology, and machine learning, we develop an overview of the ecology of learning and animal movement. Learning-based movement is clearly relevant to ecological problems, but the subject is rooted firmly in psychology, including a distinct terminology. We contrast this psychological origin of learning with the task-oriented perspective on learning that has emerged from the field of artificial intelligence. We review conceptual frameworks that characterize the role of learning in movement, discuss emerging trends, and summarize recent developments in the analysis of movement data. We also discuss the relative advantages of different modeling approaches for exploring the learning-movement interface, including techniques gleaned from the psychological and machine learning fields. We explore in depth how individual and social modalities of learning can matter to the ecology of animal movement, and highlight how diverse kinds of field studies, ranging from translocation efforts to manipulative experiments, can provide critical insight into the learning process in animal movement.

Difficulties in translating the in vitro potency determined by cellular assays into in vivo efficacy in living organisms complicate the design and development of drugs. However, the residence time of a drug in its molecular target is becoming a key parameter in the design and optimization of new drugs, as recent studies show that residence time can reliably predict drug efficacy in vivo. Experimental approaches to binding kinetics and target ligand complex solutions are currently available, but known bioinformatics databases do not usually report information about the ligand residence time in its molecular target. To extend existing databases we developed the PDBrt database which reports ligand residence time. The PDBrt database is a free, non-commercial repository for 3D protein-ligand complex data, including the measured ligand residence time inside the binding pocket of the specific biological macromolecules as deposited in The Protein Data Bank. The database contains information about both the protein and the ligand separately, as well as the protein-ligand complex and time of the ligand residence inside the protein binding site. The PDBrt database is available at https://pdbrt.polsl.pl.

Letter to the editorTry as we might to make the manuscript selection process as objective as possible, the crapshoot element is unquestionable. Prospective papers are being submitted more frequently than ever, which has broadened the number of reviewers. Medical students and senior faculty alike are being tasked with assessing manuscripts. Different levels of experience, knowledge and variable personal research interests introduce undeniable biases in how papers are ultimately critiqued. We’ve become keenly aware of the importance of evaluating research techniques and the studies themselves for risks of biases; PRISMA, MINORS, MOOSE and ROBINS tools lead a growing list of objective protocols and assessments.1,2,3,4 Have we ever thought of addressing potential biases in how we actually select articles for publication?Obviously, this would be no simple task, but that shouldn’t be a deterrent to making improvements in the process where possible; personal connections come to mind in this regard. Generally speaking, very little is being done to prevent reviewers from being aware of who the authors are and where they’re coming from. Additionally, many submission platforms allow for the selection of preferred reviewers as well as the ability to decline undesired reviewers. While these tendencies are understandable for multiple reasons, their potential to introduce personal biases is noteworthy. For the sake of argument, let’s assign a very simple “risk of personal bias reduction score” for a journal’s manuscript submission platform: One point is given for a) maintaining author confidentiality, b) maintaining institution/location confidentiality and c) avoiding the option to select or decline particular reviewers. As such, the scores range from 0 to 3, with 3 being the most favorable.So how are we doing? Table 1 shows a list of the top 20 otolaryngology journals to date as determined by the h -index, an increasingly popular measure of journal quality based on the number of publication citations.5 Ten of the 19 eligible journals did not take any measures to reduce the potential for personal biases, thus scoring 0. Eight journals earned one point for avoiding the opportunity to select or decline reviewers. Of note, several journals cite this feature as a means of reducing bias; encouraging the submitting author to target “unbiased” reviewers. The value of this is debatable as this feature can easily be used paradoxically. Lastly, one journal scored two points for blinding the reviewers to both the author names and locations.It may seem trivial at first glance, as we’ve grown so accustomed to these aspects of the submission process, but it really isn’t. The notion that editors reviewing manuscripts are immune to biases from prior personal connections and experiences would be extremely shortsighted. Do we really think a given reviewer can assess a submission from a beloved former trainee in a reliably unbiased fashion? How about a manuscript from an institution with which there was a falling out of some kind? These themes are getting increasingly acknowledged in academic publishing, with growing numbers of journals implementing safeguarding measures. At most, there appears to be a nascent interest in addressing these topics within otolaryngology field. With rejection rates at all-time highs, it behooves us to reflect upon what can be done to ensure that the best manuscript wins: Who the authors are, who they know, and where they’re from shouldn’t be significant factors. As it stands currently, our submission platforms leave open avenues for personal connections to have a considerable influence. Reforming these potential biases, or at the very least acknowledging them, is in order.

Objective: to evaluate whether subcutaneous and/ or intraperitoneal analgesia reduce pain after laparoscopy. Design: a double blinded, randomized trial. Setting: A gynecologic surgery unit at a tertiary medical center. Population: Patients who underwent elective laparoscopy for benign indications were randomly assigned to one of four groups: subcutaneous and intraperitoneal analgesia; subcutaneous analgesia and intraperitoneal placebo; subcutaneous placebo and intraperitoneal analgesia; subcutaneous and intraperitoneal placebo. Exclusion criteria were: active infection, pregnancy, known sensitivity to Bupivacaine-Hydrochloride, chronic pelvic pain, surgeries with additional vaginal procedures, conversion to laparotomy, and malignancy. Methods: prior to skin incision, either 9ml Bupivacaine hydrochloride 0.5% or 9ml Sodium Chloride 0.9% (as placebo) were injected subcutaneously to three trocar sites. Upon completion of surgery, either 10ml Bupivacaine hydrochloride 0.5%, diluted with 40ml Sodium Chloride 0.9% (50ml total solution), or 50ml Sodium Chloride 0.9% (as placebo), were instilled intraperitoneally. Main Outcome Measures: the primary outcome was the level of abdominal pain during ambulation at 8 hours following surgery. Secondary outcomes included level of pain felt at rest at 3, 8, and 24 hours, and during ambulation at 24 hours following surgery, and analgesics requirement. Results: one hundred and nineteen women were included in the study. Demographic and interventional characteristics were similar among the groups. The level of postoperative pain, either at rest or with change of position , was not significantly different between the groups, at all time points. Conclusions: Application of subcutaneous and/or intraperitoneal analgesia is not effective in reducing pain after laparoscopy.

Background: Over-resuscitation in post-cardiac patients is associated with significant morbidity and mortality. Accordingly, there is a growing interest in concentrated human albumin and hypertonic saline for resuscitation in cardiac patients following revascularization surgery. In this article, we will review the use of hyperosmolar fluid therapies for resuscitation in post-cardiac surgical patients from the current literature. Methods: A literature search was conducted in MEDLINE (PubMed) utilizing keywords, narrowing publications to 2010-2019. Results: Patients receiving concentrated albumin after cardiac surgery required less fluid bolus therapy, less time on vasopressors and were found to have a less positive fluid balance compared to patients receiving crystalloids. The impact on cardiac output and mean arterial pressure in those given concentrated albumin compared to crystalloid boluses was inconsistent. There was no difference in mortality in those given 20% albumin compared to crystalloids post-revascularization. Hypertonic saline showed some positive immunomodulatory effects in patients post-revascularization. Studies identifying the impact of hypertonic saline on fluid balance and mortality compared to normal saline in patients following revascularization surgery are on-going. Conclusions: In this analysis, publications on resuscitation with hyperoncotic albumin and hypertonic saline in patients post-revascularization surgery were reviewed. While there is data in support of using these alternative fluid therapies in other critically ill patient populations, the limited literature in support of using concentrated albumin and hypertonic saline for resuscitation in following cardiac surgery is equivocal.

BACKGROUND AND PURPOSE CYP2A enzymes metabolically inactivate nicotine and activate tobacco-derived procarcinogens (e.g. NNK, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone). Smoking decreases nicotine clearance, and chronic nicotine reduces hepatic CYP2A activity. However, little is known about the impact of smoking or nicotine on the expression of CYP2A in the lung. We investigated 1) the levels of human lung CYP2A mRNA in smokers versus non-smokers and 2) the impact of daily nicotine treatment on lung CYP2A protein levels in African Green Monkeys (AGM). EXPERIMENTAL APPROACH Lung CYP2A13, CYP2A6 and CYP2A7 (and CYP1A2) mRNA levels in smokers and non-smokers were assessed in Gene Expression Omnibus (GEO) datasets (GSE40364, GSE11874 and GSE103845). The impact of chronic twice daily subcutaneous nicotine at two doses (0.3 and 0.5 mg kg-1), versus vehicle, on lung CYP2A protein levels was assessed. The impact of ethanol self-administration was also investigated, with and without nicotine treatment. KEY RESULTS Smokers, versus non-smokers, had significantly lower levels of lung CYP2A13, CYP2A6 and CYP2A7 (and increased CYP1A2) mRNA in both GEO datasets. Nicotine treatment, at both doses, significantly decreased AGM lung CYP2A protein. Ethanol self-administration had no effect on AGM lung CYP2A protein, and there was no interaction between ethanol and nicotine. CONCLUSIONS AND IMPLICATIONS Smoking was associated with a reduction in human lung CYP2A13, CYP2A6, and CYP2A7 mRNA, consistent with the role of nicotine treatment in reducing AGM lung CYP2A protein. This regulation by smoking/nicotine will increase interindividual variation in lung CYP2A levels that may impact the localized metabolism of inhaled drugs and tobacco smoke procarcinogens.