In this paper, a numerical scheme based on quintic B-spline collocation method using the Strang splitting technique is presented for the solution of the generalized Rosenau-RLW equation given by appropriate initial-boundary values. For our purpose, firstly the problem is split into two subproblems such that each one includes the derivative in the direction of time. Secondly, each subproblem using collocation finite element method with quintic B-splines for spatial integration is reduced to a system of ordinary differential equations (ODEs). Then, the resulting ODEs for time integration are solved using the Strang time-splitting technique with the second order via the usual Runge-Kutta (RK-4) algorithm with the fourth order. To measure the accuracy and efficiency of the present scheme, a model problem with an exact solution is taken into consideration and investigated for various values of the parameter p. The L₂ and L_{∞} errors with the invariants of discrete mass Q and discrete energy E have been computed and given a comparison with other ones found in the literature. The convergence order of the present numerical scheme has also been computed. Furthermore, the stability analysis of the scheme is numerically examined.

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The multi-dimensional hyperviscous magnetohydrodynamics equation is considered in this paper. The well-posedness of the multi-dimensional hyperviscous magnetohydrodynamics equation is proved. Global attractor of the multi-dimensional hyperviscous magnetohydrodynamics equations is proved in Η1/2+n/4×Η1/2+n/4 and Η1+n/2×Η1+n/2.

Lo scarico di acque reflue trattate nei corpi idrici ricettori o il loro riutilizzo rende necessari sia gli interventi sugli impianti di depurazione esistenti sia lo sviluppo di nuove tecnologie innovative ed ecosostenibili in modo da assicurare maggiori efficienze depurative e rimuovere i contaminanti emergenti intercettati nelle acque reflue. Questi “contaminanti emergenti” si possono classificare secondo il loro uso e/o scopo; tra questi, quelli maggiormente intercettati nelle acque reflue sono i farmaci come antibiotici, antinfiammatori, ormoni naturali e sintetici. Gli attuali impianti di depurazione, purtroppo, non sono in grado di rimuovere questi composti e, quindi, vengono immessi nell’ambiente attraverso differenti modi come gli effluenti dei depuratori. Per ridurre al massimo l’impatto causato dai contaminanti emergenti, facciamo riferimento a delle moderne tecnologie: i bioreattori a membrana MBR, che derivano dalla combinazione dei processi di degradazione biologica a fanghi attivi e di filtrazione su membrana; i bioreattori a membrana elettricamente potenziati eMBR, che combinano i processi di biodegradazione, i processi elettrochimici e la filtrazione su membrana in un unico sistema, che permette di ottenere un effluente di qualità maggiore rispetto ai tradizionali MBR. 

Il nuovo COVID-19 è stato identificato come la causa di malattie respiratorie ed è stato rilevato per la prima volta a Wuhan, in Cina, nel dicembre 2019. Poiché il virus ha già iniziato a diffondersi in tutto il mondo, è importante che i professionisti del settore idrico siano informati sulle attribuzioni di questo virus e su qualsiasi misura necessaria per proteggere sia i lavoratori che la salute pubblica in generale. I coronavirus insieme ad altri patogeni sono presenti nelle acque reflue e gli impianti di depurazione sono in gene in grado di abbattere in modo significativo la carica patogena. In generale i sistemi di disinfezione delle acque sono progettati per ridurre al minimo il rischio di epidemie e malattie causato dalla possibile presenza di virus e batteri.

Erosion leading to sedimentation in surface water may deliver sediment-bound nutrients that contribute to eutrophication. Loss of native vegetation driven by land use changes have accelerated the naturally high rates of erosion in New Zealand and increased sedimentation in streams and lakes. Water quality in Lake Rotorua, in the Bay of Plenty region, New Zealand, has declined since the 1960’s due to land use developments contributing to nutrient loading and eutrophication. Anthropogenic P loads delivered to the lake are 17-19 t P y-1, 71-79% of which are sediment-bound. Lake sediments release an estimated 48% of the total annual P load. Detainment bunds (DBs) were first implemented in the Lake Rotorua catchment in 2010 as a strategy to address P losses from pastoral agriculture. Detainment bund are 1.5-2 m high earthen stormwater retention structures, constructed on productive pasture across the flow path of targeted low-order ephemeral streams. The current DB design protocol recommends a minimum pond volume of 120 m3 ha-1 of contributing catchment with a maximum pond storage capacity of 10,000 m3. No previous study has investigated the ability of DBs to decrease annual suspended sediment (SS) loads leaving pastoral catchments. Annual SS yields delivered to 2 DBs, with 20 ha and 55 ha catchments, during this 12-month study, were 109 kg SS ha-1 and 28 kg SS ha-1, respectively. Results suggest that the DB strategy decreased annual SS loads discharged from the DB catchments by 1280 kg (59%) and 789 kg (51%) as a result of the bunds’ ability to impede stormflow and facilitate soil infiltration and sedimentation. The results of this study highlight the DB strategy’s ability to consistently decrease SS loads leaving pastures in runoff, even during rare, high magnitude storm events, and suggests DBs are likely able to reduce P loading in Lake Rotorua.

The stability of positronium negative ion embedded in non-ideal classical plasmas has been investigated theoretically within the framework of Rayleigh-Ritz variational method by computing its ground state energy quite accurately. A pseudopotential, derived from a solution of Bogolyubov's hierarchy equations, has been used to describe interactions among the charged particles in plasma. A large basis set is utilized to compute accurately various quantities, such as binding energy, cusp values, annihilation rate, associated with the ground state of the ion. A detailed study has been made on the effects of non-ideality of plasma on those quantities. In particular, special emphasis is given to determine the ranges of plasma screening parameters within which the ion remains stable.

Objective: Climate change coupled with anthropogenic events can alter the distribution of biological groups and affect the reorganization, structure, dynamics and functioning of ecosystems and their services. Despite this, predictions of impacts on Brazilian savannas are scarce. This study estimated the potential effects of climate change on peripheral plant diversity by predicting the distribution of species from Cerrado. Site: Northern Brazilian Cerrado (NBC). Methods: Ecological niche modeling was used to provide present and future projections of responses in terms of occurrence of ten woody species based on four algorithms and four future climate change scenarios for the year 2050. Potential refuge areas for conservation actions were identified, and evidence of the vulnerability of the flora was demonstrated based on the disparity between potential areas of climate stability amid current protected areas (Conservation Units - CUs). Results: The results suggested a lack of pattern between the scenarios and an idiosyncratic response of the species, indicating different impacts on plant communities and the existence of unequal stable alternative conditions, which could bring consequences to the ecological relationships and functionality of the floras. Even in the most pessimistic scenarios, most species presented an expansion of potential occurrence areas, suppressing or cohabiting with species of adjacent biomes. Typically marginal plants were the most sensitive. Key findings: Overlapping adequate habitats are concentrated in the NBC. The analysis of habitats in relation to anthropized areas and CUs demonstrate low future effectiveness in the protection of these savannas, indicating the need to create CUs that consider the potential effects of climate change.

IntroduzioneAlla luce della recente  situazione di emergenza sanitaria  di sanità pubblica come dichiarato dall'OMS il 30 gennaio 2020\cite{2019-ncov} in merito alla diffusione dei casi di SARS-CoV-2 più comunemente noto come Coronavirus, considerato la notevole rilevanza sociale e  contagiosità della patologia Covid-19, si è reso indispensabile visto l'eziopatogenesi, l'andamento geografico e temporale fornire ai professionisti sanitari tutti gli strumenti procedurali per fronteggiare al meglio questa sfida sanitaria. Gli operatori  sanitari, primi i colleghi cinesi e successivamente molti altri a livello internazionale  si sono trovati in prima linea, quasi inconsapevolmente in prima battuta ad affrontare casi di sospetti quadri clinici con interessamento delle vie respiratorie senza i dispositivi di protezione individuale adeguate. Questo breve articolo vuole fornire indicazioni chiare ed esemplificative attraverso la creazione di una procedura ad hoc, per consentire :L'autoprotezione dei professionisti sanitari durante il prelievo di materiale biologico indispensabile per la diagnosi di Covid-19.La riduzione della trasmissione dell'infezioni da sanitari ad altri pazienti e a tutta la popolazione generaleCon il fine prioritario di tutelare la salute del professionista sanitario e indirettamente  della popolazione generale.I coronavirus umani si trasmettono da una persona infetta principalmente per via aerea e tramite contatti diretti. La sintomatologia include:Cefalea, rinorrea, tosse, faringite, piressia e una sensazione generale di malessere  tra le complicanze vi sono la polmonite e bronchite in modo marcato nelle persone con comorbidità a carico del apparato cardiocircolatorio e del tratto  respiratorio \cite{diagnosi}. I  sintomi sono simili all'influenza, aspecifici, pertanto la diagnosi laboratoriale\cite{sars} e strumentale\cite{news} è indispensabile al fine di trattare al meglio i pazienti critici in strutture sanitarie e collocare i pazienti paucisintomatici/asintomatici in isolamento. GUIDA     EFFETTUAZIONE DEL TAMPONE RINO-FARINGEO PER SARS-CoV-2Ove possibile eseguire l'attività “pre-tampone” prima di arrivare nella zona tampone al fine di ridurre la possibilità di contaminazione.Attività Pre-tamponeIl personale sanitario:esegue l’accettazione telefonicamente compilando specifico foglio di notifica con relativa etichettaraccomanda all’utente, ove possibile, di presentarsi a digiuno, senza aver lavato i denti e senza l’uso di colluttori orali\cite{sanit}raccomanda al paziente di presentarsi nel posto e all'orario stabilito munito di mascherina chirurgica, con mezzo di trasporto proprio e preferibilmente senza accompagnatori.   controlla la checklist tampone controllando la presenza di tutti i materiali necessari per la buona riuscita del  prelievo del campione biologico

Introduction: Exercise is beneficial for improving general health, wellbeing and specific medical conditions. In musculoskeletal conditions such as chronic low back and neck pain, prescribed exercise has been found to be moderately effective in decreasing pain and improving function. Osteopaths are primary contact health professionals who manage predominantly musculoskeletal complaints. This work presents a secondary data analysis of the Australian osteopathy practice-based research network and profiles the characteristics of osteopaths who often use exercise prescription in patient care. Methodology: Secondary analysis of a cross-sectional survey of 992 osteopaths registered with the Osteopathy Research and Innovation Network, an Australian practice-based research network. Demographic, practice and treatment characteristics of Australian osteopaths who ‘often’ use exercise prescription in patient care were examined. Results: Seven-hundred and thirty-three Australian osteopaths (74%) indicated they use exercise prescription ‘often’ in patient care. Australian osteopaths who often use exercise prescription are more likely to be co-located with another osteopath (ORa 1.54), and send referrals to an exercise physiologist; (ORa 1.94). Those osteopaths who often use exercise prescription were also more likely to discuss physical activity (ORa 5.61), and nutrition (ORa 1.90). Australian osteopaths who use exercise prescription often were more likely to treat patients with sports injuries (ORa 2.43), and use soft tissue techniques (ORa 1.92), trigger point techniques (ORa 2.72) and sports taping (ORa 1.78). Conclusion: Osteopaths who utilise exercise prescription were more likely to discuss physical activity, diet and nutrition, and utilise referral networks with specialist medical practitioners and exercise physiologists. Australian osteopaths who often use exercise prescription were also more likely to treat sport injury patients. The results support the conclusion that Australian osteopaths use exercise prescription and have referral networks with other health professionals for patient management. Further work is required to explore the type of exercise prescription used and for what conditions.

The use of heuristic methods is one of the main advances in research in general since these techniques are capable of adapting themselves to problems for which it is almost impossible to obtain a suitable mathematical model. However, its use in the context of power systems is still in its initial stage, and in this work an application has been presented for the solution of a problem related to the dynamic behaviour of the electrical networks. An effective way of solving the problem of voltage control in electrical power systems is through the injection of reactive power at strategic points in the network. We present a brief description of the problem and the most appropriate measures for its solution. It is concluded that an effective way of attacking the problem is by means of FACTS devices and particularly with the inclusion of the Static VAR Compensator (SVC) and the Thyristor Controlled Series Compensator (TCSC). Because these devices have convenient features for voltage control, in addition to being flexible and allows to incorporate tasks such as damping power oscillations. The inclusion of FACT devices in power system has been presented by using SVC and TCSC to elaborate an appropriate strategy for its implementation in real systems. The optimal sizing and location of SVC and TCSC is carried out on the basis of Grey Wolf Optimization (GWO) having an end goal of loss minimization. The proposed GWO based method validates using IEEE-30 and IEEE-57 bus systems.

Background: Pregnancy related acute kidney injury (PRAKI) is still a common serious problem in developing countries. Insulin-like growth factor-binding protein 7 (IGFBP7) and tissue inhibitor metalloproteinases-2 (TIMP-2) can identify critically ill patients at risk for the development of severe AKI. Objectives: To identify main causes and timing of PRAKI and to study the G1 cell cycle arrest biomarkers in cases diagnosed with (PRAKI) as a diagnostic tool. Methods: 80 pregnant women diagnosed with PRAKI were recruited from a single hospital as well as 30 age-matched pregnant women with normal pregnancy participated in this study. A urine specimen was collected from all study participants with established AKI within 24 hours of ICU admission to measure IGFBP7*TIMP-2. Results: The incidence of PRAKI was 1.1%. The most common cause of PRAKI is preeclampsia/eclampsia spectrum (61%). Most of the cases occur in the third trimester (60%) and postpartum period (23%). At a cutoff 0.33 ng/mL, the estimated sensitivity and specificity of urinary [TIMP-2]*[IGFBP7] in predicting PRAKI is 100% (95% CI) with NPV and PPV are 100%. Conclusions: Urinary [TIMP-2]*[IGFBP7] serves as a sensitive and specific biomarker in the diagnosis of PRAKI.

Coral reef fish larvae are tiny, exceedingly numerous, and hard to track. They are also highly capable, equipped with swimming and sensory abilities that may influence their dispersal trajectories. Despite the importance of larval input to the dynamics of a population, we remain reliant on indirect insights to the processes influencing larval behaviour and transport. Here, we used genetic data (300 independent single nucleotide polymorphisms) derived from a light trap sample of a single recruitment event of Dascyllus abudafur in the Red Sea (N=168 settlers). We analysed the genetic composition of the larvae and assessed whether kinship among these was significantly different from random as evidence for cohesive dispersal during the larval phase. We simulated many iterations of similar-sized recruitment cohorts to compare the expected kinship composition relative to our empirical data. The high number of siblings within the empirical cohort strongly suggests cohesive dispersal among larvae. This work highlights the utility of kinship analysis as a means of inferring dynamics during the pelagic larval phase.

An understanding of the influence of competition on bumble bees’ foraging strategy is essential to understand the coexistence of multiple bee species in the context of pollinator declines, but remains unclear. We conducted a field survey in an isolated meadow in eastern Himalaya with10 bumble bee species and more than 55 flowering plants they visited. In 2018 and 2019 we measured abundance of the three dominant bumble bees (one mainly foraging for pollen and two for nectar) and recorded the identity and frequency of flowering plants they visited. The intensity of competition of species pairs was evaluated by niche overlap. A composite index of flower depth of plants visited by each bumble bee was calculated on each sampling day. Results indicated that foraging strategies of the three bee species shifted differentially in response to increasing competition; the pollen-seeking bee was forced to forage for more nectar while the nectar-seeking bees were impelled to change target flowers in order to match proboscis length and flower depth. The coexistence of multiple bumble bee species in a community can thus be achieved by adjusting foraging strategy in response to intensity of competition for floral resources.

Most plant species are rare and only a few are common, but whether species success is associated with functional traits is debated. We measured five root traits and seed mass on 242 Central European grassland species, and extracted their specific leaf area, height and bud-bank size from databases. Then we tested if trait values are associated with commonness at seven spatial scales from 16m² grassland plots to worldwide naturalization success. At every scale, success was associated with at least four traits, and they explained the highest proportions of variance for naturalization success (41%) and abundance in grassland plots (37%). Low root tissue density characterized successful species at every scale, whereas other traits showed directional changes depending on the scale. Across scales, belowground traits explained overall more variance in species success (18.1%) than aboveground traits (12.5%). So, belowground traits are at least as important as aboveground traits for species success.

Abstract Background and Purpose: Galbanic acid (GBA), a sesquiterpene coumarin compound isolated from Ferula species, has noticeable anti-cancer effects. In current research, we investigated effects of GBA in combination with arsenic trioxide (ATO) on MT-2 cells, an Adult T cell leukemia (ATL) cell line. ATL is a malignancy caused by human T cell leukemia virus type 1 (HTLV-1). Experimental Approach: The MT-2 cells were treated with each agent alone at various concentrations. After determination of IC50 values, MT-2 cells were treated with 20 µM GBA combined with 4 µM ATO. The viability of MT-2 cells was evaluated by alamar blue assay and cell cycle distribution was assessed by PI staining. Furthermore, the activity of P-glycoprotein (P-gp) in the presence of GBA was studied by mitoxantrone efflux assay. To understand the molecular mechanisms of GBA+ATO treatment in MT-2 cells, the mRNA expression of RelA, p53, CDK4, c-MYC, c-FLIPL, and c-FLIPS was measured by real-time PCR. Key Results: GBA+ATO synergistically inhibited proliferation of MT-2 cells and induced apoptotic cell death. GBA and ATO also synergized to induce cell cycle arrest with an apparent sub-G1 cells accumulation. Rate of mitoxantrone accumulation in MT-2 cells was enhanced in the presence of GBA, indicating GBA has inhibitory effects on the functionality of the P-gp efflux pump. The real-time PCR analysis revealed that GBA+ATO combination downregulated the expression of p53, CDK4, c-FLIPL, and c-FLIPS. Statistical analysis revealed a significant relation between p53 expression and c-FLIPS. Conclusion and Implications: The GBA+ATO combination could be considered as a new therapeutic approach for ATL patients.

Joints in medium has a significant influence on transmission of blasting stress waves and expansion of blast-caused cracks. This paper first carries out an experiment on crack expansion in PMMA medium with vertically filled joints under blasting load by using the Digital Laser Dynamic Caustics testing system (DLDC), makes an analysis on beginning, expanding and ending of wing cracks, studies variation of dynamic stress intensity factor and crack expansion velocity on crack tip. Then it makes an effective inversion to stress wave transmission and crack expansion in the test by using the Distinct Lattice Spring Model(DLSM), makes a comparison on stress variation at center points on wave heading side, back side and endpoints of the joint, makes an analysis on characteristics of stress wave impact. Finally it compares and analyzes expansion velocity/acceleration difference of wing cracks with different joint characteristics(filled, open, closed, bedding).

Shewanella oneidensis MR-1, a model strain of exoelectrogenic bacteria (EEB), plays a key role in environmental bioremediation and bioelectrochemical systems because of its unique respiration capacity. However, only a narrow range of substrates can be utilized by S. oneidensis MR-1 as carbon sources, resulting in its limited applications. In this work, a rapid, highly efficient and easily manipulated base editing system pCBEso was developed by fusing a Cas9 nickase (Cas9n (D10A)) with the cytidine deaminase rAPOBEC1 in S. oneidensis MR-1. The C-to-T conversion of suitable C within the base editing window could be readily and efficiently achieved by the pCBEso system without requiring double strand break or repair templates. Moreover, double-locus simultaneous editing was successfully accomplished with an efficiency of 87.5. With this tool, the roles of the key genes involving in N-acetyl-glucosamine (GlcNAc) or glucose metabolism in S. oneidensis MR-1 were identified. Furthermore, an engineered strain with expanded carbon source utilization spectra was constructed and exhibited a higher degradation rate for multiple organic pollutants (i.e., azo dyes and organoarsenic compounds) than the wild type when glucose or GlcNAc was used as the sole carbon source. Such a base editing system could be readily applied to other EEB. This work not only enhances the substrate utilization and pollutant degradation capacities of S. oneidensis MR-1, but also accelerates the robust construction of engineered strains for environmental bioremediation.

The occurrence of atmospheric precipitation and runoff is not at the same time, and a certain lag in time, and its lagged time and intensity are affected by the water storage capacities, which is related to the occurrence of droughts. This paper will develop the lagging index (LI) based on the measured data of 56 rainfall stations and 11 hydrological stations in the Central Guizhou of China, and analyze the spatio-temporal evolution characteristics of rainfall-runoff. The studies show that (1) the lagged effect of runoff to rainfall in the Central Guizhou of China mainly shows the lagged 3 periods with the lagged distribution areas accounting for more than 80% of the total areas. (2) The order of spatio-temporal distribution differences of the lagged intensities is the lagged period 2（Cv=0.62）

Land degradation, desertification (LDD) and climate change are increasing in the Near East and North Africa (NENA) region, impacting the livelihoods of about 410 million people, food security and migration. Agriculture is a vital socio-economic sector, contributing on average 14 percent of the Gross Domestic Product (GDP) (excluding oil producing countries) and providing jobs and incomes for 38 percent of the region’s economically active population. However, most NENA countries import at least 50 percent of the calories they consume. It is estimated that the total areas desertified or vulnerable to desertification cover 9.84 million km2 or about 86.7 percent of the total NENA region. Soil erosion by water and wind and sand and dust storms (SDS) causes losses of about USD 13 billion in GDP each year. But there are also opportunities to reverse these negative trends. Proper land use planning, prioritization of target areas for restoration and adoption of sustainable land and water management (SLWM) could reverse the situation. This paper analyses the inter-linkages between LDD resource base management and food security under different scenarios and offers mitigation and remediation options. These include knowledge management and sharing; establishment of a regional platform to facilitate dialogue; public and private investment opportunities; provision of tools to scale-out sustainable land and water options; and creation of a conducive enabling environment supported by policies and strategies.

ABSTRACT Background: Domperidone and metoclopramide are the most commonly prescribed galactogogues for enhancing milk production, but evidence supporting their efficacy and safety is contradictory. Objectives: To evaluate the efficacy and safety of domperidone and metoclopramide use by breastfeeding women. Search strategy: A systematic literature retrieval of Medline, Embase, Cochrane Library, PubMed, EBSCO, Web of Science, ClinicalTrials.gov and additional bibliography was conducted without time restriction. Selection criteria: Randomised controlled trials exploring the effects of domperidone and metoclopramide in breastfeeding women were included. The primary outcomes were the difference in human milk volume and maternal and neonatal side effects. Data collection and analysis: Two reviewers screened, extracted and assessed the eligible trials independently. Effect size with 95% confidence intervals were presented using random effect model. Main results: Fifteen studies were included. Pooled results demonstrated a low to moderate increase in daily human milk volume of 90.54 mL/day (95%CI 65.69, 115.39), 0.04 mL/day (95%CI 28.85, 28.93) with the use of domperidone and metoclopramide, respectively. No differences were noted in the incidence of maternal side effects with domperidone (RR1.20, 95%CI 0.74, 1.97) or metoclopramide (RR1.23, 95%CI 0.51, 2.94). Additionally, there were no significant differences in the volume of human milk and maternal side effects between the domperidone and metoclopramide group. Conclusions: Domperidone demonstrated a modest increase of 90.54 mL/day in milk production, and had a lower risk of side effects in mothers and infants, which could be considered as a suitable choice for breastfeeding women. Keywords: domperidone; metoclopramide; galactogogues; human milk; side effects

Objective: The purpose of the current study was to determine the difference in intestinal microbiota after delivery between healthy fetuses and fetuses with hyperechogenic bowel during the second trimester and the relationship between fetal echogenic bowel and microbiota. Design: Prospective cohort study. Setting: The Second Affiliated Hospital Of Fujian Medical University，Quan zhou, China. Population: 34 single pregnant women and their fetuses. Methods: Fourteen healthy fetuses (control group), 13 fetuses with echogenic bowel (EB group), and 7 fetuses with echogenic bowel and other abnormalities (C-EB group) were selected. The first meconium after delivery was collected for 16s rRNA sequencing. Results: A total of 69,222 operation classification units were obtained by clustering all high-quality sequences with 97% similarity. There was no significant difference in the Shannon, Simpson, and Chao 1 indices among the three groups. At the phylum level, the intestinal microflora of the three groups were similar.At the genus level, the abundance of Escherichia coli/Shigella in the EB、C-EBgroup was significantly lower than the control group, while the abundance of Staphylococcus, Methylobactrium, and Curvibacter in the EB group was significantly higher than the other groups. There was a difference in abundance of Gammaproteobacteria, Fusobacteria, Enterobacteriaceae, and E. coli in the EB and C-EB groups. Conclusion: The intestinal flora may be related to fetal echogenic bowel via mucus secretion and intestinal gas production.

Objective: To introduce an innovative laparoscopic knot tying technique, designed to be ergonomically more suitable, easier to learn and safer for patient and surgeon, than traditional knot tying techniques for minimally invasive surgery. Design: A qualitative, explanatory research design is used to describe a new technique of laparoscopic knot tying. Method: Various knot tying techniques (laparoscopic knots, surgical knots, knitting knots, fishing knots, and sailor’s knots) were reviewed Conclusion: Radfar’s laparoscopic knot tying technique is introduced taking into consideration: • Improve ergonomics • Accurate Knot reproducible • Knot security • Decrease trauma to patient and surgeon • decrease foreign-body reaction

After being collected for patient care, Observational Health Data (OHD) can further benefit patient well-being by sustaining the development of health informatics and medical research. Vast potential is unexploited because of the fiercely private nature of patient-related data and regulation about its distribution. Generative Adversarial Networks (GANs) have recently emerged as a groundbreaking approach to learn generative models efficiently that produce realistic Synthetic Data (SD). They have revolutionized practices in multiple domains such as self-driving cars, fraud detection, simulations in the and marketing industrial sectors known as digital twins, and medical imaging. The digital twin concept could readily apply to modelling and quantifying disease progression. In addition, GANs posses a multitude of capabilities relevant to common problems in the healthcare: augmenting small dataset, correcting class imbalance, domain translation for rare diseases, let alone preserving privacy. Unlocking open access to privacy-preserving OHD could be transformative for scientific research. In the COVID-19’s midst, the healthcare system is facing unprecedented challenges, many of which of are data related and could be alleviated by the capabilities of GANs. Considering these facts, publications concerning the development of GAN applied to OHD seemed to be severely lacking. To uncover the reasons for the slow adoption ofGANs for OHD, we broadly reviewed the published literature on the subject. Our findings show that the properties of OHD and eval-uating the SD were initially challenging for the existing GAN algorithms (unlike medical imaging, for which state-of-the-art model were directly transferable) and the choice of metrics ambiguous. We find many publications on the subject, starting slowly in 2017and since then being published at an increasing rate. The difficulties of OHD remain, and we discuss issues relating to evaluation,consistency, benchmarking, data modeling, and reproducibility.