Global warming increases forest wildfire risks to the economy, environment, and human safety. Continuous satellite monitoring offers accurate wildfire predictions and data-driven decision support. Earth Observation Satellite Constellations(EOSC) enable periodic wildfire tracking through revisit observations. Efficient scheduling of these tasks is crucial for optimal constellation operation in wildfire management. However, the existing EOSC scheduling algorithms rarely concentrates on the scheduling of revisit tasks. In this paper, the revisit task scheduling problem of the EOSC is expressed as a multi-objective model. A time-driven multi-objective optimization method(TDMO) is designed to optimize the constellation scheduling process of wildfire observation tasks. TDMO has a time-driven feature and coupled with revisit time in the task, experiments on different scheduling scenarios show this method is effective in scheduling revisit tasks towards wildfire targets.

Railway transportation hub faces the challenge of low utilization of negative sequence (NS) and regenerative braking energy (RBE). This paper proposes a modular multilevel three-port energy router (MM-TER) with integrated energy storage, including back-to-back modular multilevel converter, energy storage system and isolated DC-DC converter. On this basis, a coordinated operation control strategy of MM-TER is proposed. The upper layer determines the operation mode and calculates the reference power of each port. The lower layer realizes the fast tracking of the reference power and the rapid response of the mode switching. Finally, the case analysis shows that the MM-TER proposed in this paper significantly improves the utilization rate of RBE and NS compensation.

Background: Nonsteroidal anti-inflammatory drug hypersensitivity (NSAID-H) is often seen in children. Little is known about the natural history of pediatric NSAID-H. The aim of this prospective study was to evaluate tolerance development in pediatric patients with confirmed, immediate NSAID-H and to determine the risk factors for NSAID-H persistence. Methods: Children with a confirmed diagnosis of NSAID-H were assessed for tolerance by drug provacation test (DPT) at least three years after diagnosis. Factors associated with developing tolerance in NSAID-H were investigated. Results: Of the 34 cases with confirmed NSAID-H diagnosis, 23 (67.65%) were included. The median (range) age at the last DPT was 16.5 (13.2-20.4) years. Tolerance developed in 12 (52.1%). Kaplan-Meier survival analysis showed that median duration to develop tolerance was 6.16 years from the initial reaction (SE=18.6). ROC analysis gave a cut-off value for initial reaction age as ≤11.75 years in predicting NSAID-H tolerance with specificity 83.3%, sensitivity 81.8%, (AUC=0.830, 95%CI 0.616-0,952, p<0.001). Univariate logistic regression analysis showed that the risk of persistence of NSAID-H was 1.3-fold higher with each additional year from the initial reaction [1/Odds Ratio(OR)] (OR=0.754, 95%CI 0.964-0.590; p=0.024). At the diagnostic DPT, in the tolerant group, urticaria (42.7%) was more common ( p=0.006) and the persistent group reacted at a significantly lower cumulative dose ( p=0.044). Conclusion: Half of the patients with NSAID-H developed tolerance, around six years after the initial reaction. The probability of tolerance rises if the initial reaction occurs before the age of 11.75 years and if urticaria was observed at presentation. Reaction at low doses on diagnostic DPT may be a predictor of persistence.

Background: Point of care Lung ultrasound (POC-LUS) is a rapid and simple method to evaluate neonates with respiratory distress. POC-LUS has lately been reported as a predictor of need for NICU admission in late preterm and term babies born with respiratory distress in the transition period. Objectives: The Primary objective was to determine whether the POC-LUS score is a good predictor for need for NICU admission in late preterm and term babies born with respiratory distress when performed within the first 2 hours of life. The secondary objective was to find a correlation between the LUS score and the clinical respiratory distress severity score during this transition period. Methods: A prospective observational study was carried out in a tertiary care neonatal unit (Level III-B) over 1 year on 97 late preterm and term neonates having respiratory distress at birth. POC-LUS was performed in a transition nursery area within 2 hours of birth and LUS Score was recorded as per a pre-validated LUS scoring system. The decision for NICU admission was independently taken by the medical team based on clinical criteria, and blinded to the LUS findings. A receiver operating characteristic (ROC) curve was generated to predict NICU admission based on the LUS score. LUS score was also analyzed for correlation with clinical respiratory distress severity scoring i.e Silverman Anderson Score (SA score) during transition. Results: The mean gestational age of the babies in the study was 37.45 weeks ± 1.88 weeks. 43 percent of neonates in the studied population needed admission to the NICU. LUS Score >5/18 within 2 hours after birth as a ‘cut-off’ was determined to be an excellent predictor of NICU admission in late preterm and term babies who are born with respiratory distress. (Area under ROC Curve 0.903, sensitivity 64%, specificity 98%, positive likelihood ratio 35 and p-value <0.001). LUS score also had a positive correlation with the SA score in the study population (Pearson correlation, r = 0.325; p-value = 0.001). Conclusion: The study predicted an optimal LUS score cutoff of 5/18 in deciding the need for NICU admission of late preterm and term neonates with respiratory distress at birth and also has a positive correlation with clinical respiratory distress score.

Background: Premature neonates are a high-risk group of developmental problems. Improvements in technology in the Neonatal Intensive Care Unit (NICU) have led to improved survival of preterm neonates. This study was aimed to evaluate the growth, development, behavioral, immunization completion and long-term outcome of preterm infants. Methods: A cohort study of preterm infant’s post-discharged from NICU of Dr. Cipto Mangunkusumo National Central Public Hospital (CMNCPH) will be done at Developmental Behavioral – Community Pediatrics (DB-CP) clinic of CMNCPH. Developmental screening and assessment using the Ages and Stages Questionnaire 3rd edition and Bayley Scales of Infant and Toddler Development 3rd edition (BSID-3) will be performed at the corrected age of age 9-12 months, 18-24 months, 30-36 months, and 48-54 months. Screening for autism spectrum disorders (ASD) and attention deficit hyperactivity disorders (ADHD) will be performed at 18-24 month and 36 months of age respectively. Discussion: Our study is a prospective cohort study focusing on growth, development, behavioral, immunization completion and long-term outcome of preterm infants. With a follow up until 54 months, this study may provide early detection, early diagnosis, and early intervention of growth, developmental and behavioral impairment and ensuring the optimum outcomes and quality of life for surviving neonates.

This paper presents an AI-based framework designed for learning and regenerating analog circuits from academic papers. The framework comprises four distinct modules: circuit extractor, table extractor, text extractor, and simulation executor. The circuit extractor module utilizes deep learning object detection to identify devices and their associated textual descriptions while extracting interconnections between devices. The table extractor module handles textual and image-based tables, extracting device parameters and simulation data. The text extractor module leverages Optical Character Recognition (OCR) and AI models to extract supplementary information. The simulation executor employs this information to conduct simulations and optimize circuit performance. In our experiments, our method effectively extracts multimodal circuit design information, achieving an average accuracy of up to 97% in target detection within the circuit extractor module. The improved performance during the simulation process further validates the effectiveness of our framework.

Biodiversity offers diverse ecosystem services responsible for increasing human well-being and moving financial capital around the world. Therefore, given the natural and human causes of biodiversity reduction, we need to use conservation prioritization methods that not only show where to find high species richness, but also low economic cost. In this paper, we suggest priority areas, on a global scale, for the conservation of terrestrial and flying mammals and the Serpentes, an endothermic group. We do that by finding high potential for providing ecosystem services (measured here by Species Richness) and correlating it with Economic Cost (measured as Land Acquisition Cost). To achieve this goal, we first developed the ‘bivariatemaps’ package, using it to plot bivariate maps that integrate the Species Richness with the Land Cost for each of the three studied groups. We observe that more attention should be paid to tropical countries, which have high species richness, but low land acquisition cost. We note that more attention should be paid to the Indomalayan region, which has a high richness of species low-cost sites for the conservation of species. Bivariate maps have been published in studies since the 70s, but only in the 2010s they became more used by the general public, including scientists from low-profit universities. We hope that this paper (and the ‘bivariatemaps’ package) helps to generate works planned globally and regionally in the face of natural and anthropogenic processes responsible for the loss of biodiversity that can bring us socio-economic benefits.

Title: Lin-CD117+CD34+FceRI+ progenitor cells are elevated in atopic dermatitisTo the Editor, We recently demonstrated that Lin-CD117+CD34+FcεRI+progenitor cells predict treatment response to omalizumab in chronic spontaneous urticaria (CSU) (1). These heterogenous myeloid progenitors acquired FcεRI expression with advancing maturity and a phenotype previously described as mast cell progenitors (2). A growing body of research suggests that inflammation drives the egress of myeloid and mast cell progenitors from the bone marrow (1, 3). Atopic dermatitis (AD) is a common inflammatory skin disorder characterised by recurrent eczematous lesions with the dominant symptom of intense itch (4). While the role of T-cell mediated type 2 inflammation is integral to the pathogenesis of AD, mast cells and the pre-formed pruritogens they release have an important role. We sought to measure Lin-CD117+CD34+FcεRI+progenitor cells in the peripheral blood of 10 individuals with a clinical diagnosis of AD and 10 healthy controls. Ethical approval was granted by the Joint Research Ethics Committee in Tallaght University Hospital and St. James’s Hospital in Ireland. Informed consent was obtained. Healthy control subjects had no diagnosis of atopic disease which we defined as the absence of self-reported AD, allergic rhinitis, asthma, food allergy, eosinophilic oesophagitis or CSU. We excluded patients with AD who were in receipt of any systemic treatment. Peripheral blood mononuclear cells (PBMC) were incubated in PBS, pH 7.4 with 2% heat‐inactivated foetal calf serum with the following fluorescent‐labelled antibodies; V500 CD4 (RPA‐T4), V500 CD8 (RPA‐T8), PerCP-Cy5.5 CD14 (M5E2), V500 CD19 (HIB19), PE CD34 (581), APC CD117 (104D2) and BV421 FcεRI (AER‐37). Absolute numbers of cells per ml were calculated using BD Biosciences Liquid Counting Beads. Sample acquisition was performed on a FACSCanto II flow cytometer (BD Biosciences). Data analysis was performed using FlowJo (v10, BD Biosciences). Fluorescence minus one (FMO) controls were used to confirm CD34, CD117 and FcεRI positivity. We categorised progenitor cells according to whether they were Lin-CD34+CD117+FcεRI-(hereafter, FcεRI- progenitors), Lin-CD34+CD117+Fc εRI+ (hereafter, FcεRI+ progenitors), and Lin-CD34+CD117+Fc εRIhi( hereafter, FcεRIhi progenitors) (See Supplemental Figure 1). FcεRIhi progenitors represent an extremely rare cell type with the phenotype of true mast cell precursors (2).Baseline characteristics are illustrated in Table 1.CD34+CD117+Fc εRI+cells were elevated in individuals with AD when compared with healthy controls (n=10; p = 0.0067) (Figure 1). There was no difference in FcεRI- or FcεRIhiprogenitors between individuals with AD and healthy controls (p = 0.356; p = 0.276 respectively). In keeping with findings observed in CSU, mean total serum IgE was not correlated with the number of myeloid progenitors in peripheral blood in individuals with AD (r = 0.486, p = 0.223) or in healthy controls (r = -0.267, p = 0.522). The mean number of circulating FcεRI+ progenitors in males with AD (n=6) was 413.3 per mL of peripheral blood compared to 212.8 per mL in females but this was not statistically significant (p = 0.102). Although myeloid progenitors have been found to predict treatment response in CSU, CSU differs from AD in primarily being a mast cell driven disease. In contrast, mast cell activation in AD represents an adjacent process to the more pivotal role of Th2 polarisation. Our findings therefore propose an intriguing difference in FcεRI+ myeloid progenitors in AD and suggest that the bone marrow may be engaged in myeloid cell replenishment. This phenomenon may provide supportive evidence for the potential efficacy of Bruton Tyrosine Kinase inhibitors or MRGPRX2 targeted therapies in AD (5, 6). Paired analyses of individuals off and on systemic treatment modalities in AD may provide additional insights into the triggers of progenitor egress. 1. Ridge K, Moran B, Alvarado-Vazquez PA, Hallgren J, Little MA, Irvine AD, et al. Lin. Allergy. 2024.2. Dahlin JS, Malinovschi A, Öhrvik H, Sandelin M, Janson C, Alving K, et al. Lin- CD34hi CD117int/hi FcεRI+ cells in human blood constitute a rare population of mast cell progenitors. Blood. 2016;127(4):383-91.3. Lei Y, Guo X, Luo Y, Niu X, Xi Y, Xiao L, et al. Synovial microenvironment-influenced mast cells promote the progression of rheumatoid arthritis. Nat Commun. 2024;15(1):113.4. Langan SM, Irvine AD, Weidinger S. Atopic dermatitis. Lancet. 2020;396(10247):345-60.5. Robak E, Robak T. Bruton’s Kinase Inhibitors for the Treatment of Immunological Diseases: Current Status and Perspectives. J Clin Med. 2022;11(10).6. Wollam J, Solomon M, Villescaz C, Lanier M, Evans S, Bacon C, et al. Inhibition of Mast Cell Degranulation by Novel Small Molecule MRGPRX2 Antagonists. J Allergy Clin Immunol. 2024.

Background: Worldwide data on epidemiology of anaphylaxis are limited, mostly due to the difficult recording of all cases. The aims of the study are to determine anaphylaxis frequence to a general E.D. before and during COVID-19 pandemic, its association with demographic and clinical characteristics. Methods: This is a retrospective study analysing clinical records from a general E.D. of Milan in two periods before (2018-2019) and during the COVID-19 pandemic (2020-2021). The analysis regarded demographic data, comorbidities, chronic therapies, causes, severity and adrenaline use. Globally data were assessed to find predictive risk factors for a severe reaction. Results: The frequence of anaphylaxis remained stable, (120/104129 = 0.12% in 2018-2019 and 72/66720 = 0.1% in 2020-2021). No differences in the occurrence of anaphylaxis were found in sex and in the mean age. The main causes of anaphylaxis were food (2018-2019: 53% vs 2020-2021: 51%) and drugs (2018-2019: 27% vs 2020-2021: 33%). Hymenoptera stings had a low occurrence and unidentified trigger was about 15% in each period. The severity of anaphylaxis had a similar distribution in the two-year periods. Gender, cardiovascular diseases, food allergy, drug allergy and Hymenoptera venom allergy did not influence the severity. A positive correlation was found with an increase in the mean age, especially in patients aged 50 or more (p<0.001). Angiotensin II receptors blockers, β-blockers, diuretics and proton pump inhibitors were associated with increasing severity (p<0.01). Conclusion: The anaphylaxis frequency in E.D. was not affected by the COVID-19 pandemic. Food anaphylaxis remained the most important cause of admission to the E.D. in our urban area. More studies are necessary to estimate the real incidence of all anaphylactic reactions.

This study compared the established MaxEnt and a more novel deep learning approach for modelling the distribution of humpback whales (Megaptera novaeangliae) in north Iceland. It examined the mechanisms, structures, and optimisation techniques of both approaches, highlighting their differences and similarities. For this, monthly distribution models for Skjálfandi Bay were created, spanning from 2018 until 2021, using presence-only sighting data and satellite remote sensing data. Additionally, the trained models were used to create distribution projections for the year 2022, solely based on the available environmental data. The results were compared by using the established Area Under the Curve value. The findings indicate that both approaches have their limitations and advantages. MaxEnt does not allow continuous updating within a time series, yet it mitigates the risk of overfitting by employing the maximum entropy principle. The deep learning model is more likely to overfit, but the larger weight network increased the model’s capability to capture complex relationships and patterns. Ultimately, the results indicate that the deep learning model had a higher predictive performance in modelling both current and future humpback whale distributions. Both modelling approaches have inherent limitations, such as the low resolution of the input data, spatial biases, and the inability to fully capture the complexity of all natural processes. Despite this, deep learning in particular showed promising results in modelling the distribution of humpback whales and prompts further research in different study areas and applications for other mobile animal species.

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Methods for personalizing medical treatment are the focal point of contemporary biomedical research. In cancer care, we can analyze the effects of therapies at the level of individual cells. Quantitative characterization of treatment efficacy and evaluation of why some individuals respond to specific regimens, whereas others do not, requires additional approaches to genetic sequencing at single time points. Methods for the analysis of changes in phenotype, such as in vivo and ex vivo morphology and localization of cellular proteins and organelles can provide important insights into patient treatment options. Novel therapies are needed to extend survival in metastatic castration-resistant prostate cancer (mCRPC). Prostate-specific membrane antigen (PSMA), a cell surface glycoprotein that is commonly overexpressed by prostate cancer (PC) cells relative to normal prostate cells, provides a validated target. We developed a software for image analysis designed to identify PSMA expression on the surface of epithelial cells in order to extract prognostic metrics. In addition, our software can deliver predictive information and inform clinicians regarding the efficacy of PC therapy. We can envisage additional applications of our software system, beyond PC, as PSMA is expressed in a variety of tissues. Our method is based on image denoising, topologic partitioning, and edge detection. These three steps allow to segment the area of each PSMA spot in an image of a coverslip with epithelial cells. Our objective has been to present the community with an integrated, easy to use by all, tool for resolving the complex cytoskeletal organization and it is our goal to have such software system approved for use in the clinical practice.

With the vigorous development of the electric vehicle (EV) industry, the demand for charging has surged. However, the relative lag in the construction of charging infrastructure has led to a series of problems for drivers, such as difficulty in finding available charging stations and long waiting times for charging. To address this, this paper proposes an EV charging guidance framework based on an Informer network and Multi-Agent Reinforcement Learning (MARL), aiming at achieving efficient EV charging guidance. Firstly, this paper regards charging stations as independent agents, integrating information from vehicles, charging stations, and traffic, transforming the multi-objective optimization problem of EV charging guidance into a multi-agent reinforcement learning task. Then, an Actor-Critic algorithm combined with the Informer is designed, utilizing the Informer in the Critic network to model the interactions between different charging stations, thereby reducing the complexity of policy learning and enhancing coordination among agents. Subsequently, after calculating the advantage function for the agents, the Actor network is updated to improve learning efficiency. The proposed algorithm was simulated and validated in two different EV charging scenarios. The simulation results show that compared with several state-of-the-art methods, our algorithm achieved the best results in multi-objective optimization, demonstrating its superiority and practicality of our proposed algorithm.

The complex network relationship between leaf traits and their multiple traits is closely related to the environment, and is the result of interactions between various environmental factors such as climate and soil. Based on previous work, we selected 20 P. euphratica trees along the desert riparian forest of the main stream of the Tarim River for leaf sample collection and habitat survey. We used 27 leaf traits of P. euphratica to visualize the leaf trait network (LTN). Through network structure parameters, such as edge density, diameter, average path length, and average clustering coefficient, the spatial pattern of the LTN and its relationship with 11 soil factors and 19 climatic factors were discussed using principal component analysis and correlation analysis. The results showed that: (1) there were significant differences in the parameters of the leaf trait network of P. euphratica along the main stream of the Tarim River. The variation coefficients of the diameter and average path length were the largest, respectively, whereas that of the average clustering coefficient was the smallest. (2) There were both positive and negative correlations between each parameter and soil factors, such as soil water content, soil total potassium, and soil organic matter, and climatic factors, such as isothermality, minimum temperature of the coldest month, and precipitation of the wettest month. (3) The explanatory power of climate alone on the leaf traits of P. euphratica was generally higher than that of soil factors, indicating that climatic conditions play a more decisive role in shaping the network structure of leaf traits of P. euphratica. However, regarding the influence of network modularity, the contribution of soil factors was significant, indicating that the influence of soil conditions on some LTN parameters cannot be ignored.

Objective: This study aims to compare the labor performance, complications and postpartum sexual function of Type 3 Female Genital Mutilation/Cutting (FGM/C) pregnant women undergoing deinfibulation with Type 3 FGM/C patients without deinfibulation. Design: Prospective cohort study Setting: Sudan-Turkish Training and Research Hospital Population: Each group consisted of 150 pregnant women diagnosed with Type 3 FGM/C (with and without deinfibulation). Methods: Type 3 FGM/C patients who underwent deinfibulation were compared with Type 3 FGM/C patients who did not undergo deinfibulation in terms of age, parity, obstetric and neonatal outcomes and FSFI scores at three months. Main Outcome Measures: The labor performance, complications and postpartum sexual function of Type 3 FGM/C pregnant women undergoing deinfibulation with Type 3 FGM/C patients without deinfibulation. Results: In our homogeneous Type 3 FGM/C group mainly consisting of primiparous women, it was found that more episiotomy procedures were performed, the second stage of labor was significantly prolonged, and perineal damage was more in the group without deinfibulation. In addition, postpartum hemorrhage and hospitalization of mother and baby were longer in the group without deinfibulation. In the second part of our study, in which we compared the FSFI scores of deinfibulation in the episiotomized subgroup, higher scores were found in all scores in the deinfibulation group. Conclusion: Type 3 FGM/C is definitely associated with poor obstetric and sexual outcomes. Funding information: The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

In the constantly evolving cybersecurity landscape, effectively categorizing cyber-threat actors based on attack patterns is critical for establishing effective defense systems. Cyberattack detection and categorization are crucial for effective threat attribution. This study proposes a novel methodology for categorizing attack patterns based on distinct attack attributes to improve cyber-threat actor (CTA) attribution. The system uses advanced machine learning techniques to analyze a large dataset of cyber-attacks, detecting unique patterns and attributes associated with different threat actors. This study employs a dataset containing a variety of attack features. It aims to categorize cyber-attacks like ransomware, phishing, spoofing, dictionary attacks, and man-in-the-middle attacks (MITM), among others from the dataset. This study aims to identify trends in attack vectors, allowing for a more exact categorization of cyber-threat actors based on attack patterns. Experimental results show that the framework accurately categorizes threats and has the potential to improve response times and precision in cyber threat attribution.

Background: Infraorbital ethmoidal (Haller) air cells (IOEAc) are ethmoidal cells which pneumatizes inferior to the orbital floor and lateral to a line parallel with the lamina papyracea. Studies have shown considerable anatomical variation with different extensions in humans. Objectives: To identify and categorize the anatomical variations of the IOEAc creating a new, comprehensive variation classification system/ Patients and methods: All included 1260 computed tomography (CT) of the nose and paranasal sinuses were reviewed to detect the presence or absence of IOEAc. All cases with IOEAc were evaluated for: bilaterality, multiplicity and shape and categorized according to its extensions to the maxillary infundibulum and its relations to all the length of the inferior orbital wall. Results: IOEAc were identified in 173 (13.7%) scans. Bilaterality was observed in 99 patients (57.2%), while 50 patients (28.9%) had right unilateral air cells and 24 patients (13.9%) had left unilateral air cells. The classification system categorized 5 large groups’ I-V and subtypes. With 173 cases distributed as 26%, 17.9%, 3.5%, 9.8%, 24.9%, 10.4%, 2.3%, 1.7%, and 3.5% among the five categories respectively. Conclusions: The new classification system provides a comprehensive classification of the described anatomical variations of the IOEAc. It allows the description and categorization of variants identified in past and future studies. It is applicable to current clinical practice.

Objective: To investigate the effect of traditional Mindfulness-Based Stress Reduction (MBSR) program in infertility patients. Design, setting and population : A feasibility Randomized Controlled Trial (RCT) using an effectiveness-implementation type-II hybrid design was conducted with patients seeking infertility consultation in Canada. Methods: Participants were recruited at initial consultation and block randomized into standard treatment or a virtual Mindfulness Based Stress Reduction (MBSR) course. Main outcome measures: MBSR program completion rate and the effect of MBSR program on mental health and QOL measures Results: Of 155 patients that met inclusion criteria, 45 completed the intake survey, 34 met study criteria, 24 proceeded with randomization. Among those randomized to the MBSR group, 73% started the course and 64% completed >50% of the program. Of participants randomized into the MBSR arm, 82%, 45%, and 27% completed the first, second, and third survey, respectively. This compared to 77%, 69%, and 69% in the control group. Secondary outcomes, measuring mental health and QOL outcomes, pregnancy rates, and initiation of treatment, showed no significant differences. Conclusion: We identified challenges implementing intensive mindfulness interventions in this population and how these may be addressed in future studies. A large-scale RCT is required to evaluate the impact of MBSR on pursuing fertility treatment and mental health outcomes.

Objective To investigate the predictors of severe postpartum hemorrhage (sPPH) in patients with placenta accreta spectrum disorders (PAS) without a history of cesarean delivery (CD). Design Retrospective case-control study. Setting A referral center for high-risk obstetrical patients in China. Population Patients with PAS (the 2019 International Federation of Gynecology and Obstetrics clinical diagnostic criteria) without a history of CD. Methods Patients were categorized into the sPPH and non-sPPH groups based on whether the postpartum bleeding volume within 24 hours after delivery exceeded 1500 mL. Univariate, multivariate and decision tree analyses were performed to identify predictors of sPPH in PAS without a history of CD. Main Outcome Measures Postpartum bleeding volume within 24 hours after delivery. Results This study included 348 patients without a history of CD, 60 of whom experienced sPPH. Multivariate analysis identified vaginal delivery (adjusted odds ratio [aOR] 15.486, 95% confidence interval [CI] 4.013–59.767), placenta previa (aOR 3.215, 95% CI 1.257–8.222), a history of three or more intrauterine procedures (aOR 2.433, 95% CI 1.129–5.244), and multiparity (aOR 2.120, 95% CI 1.070–4.202) as independent predictors of sPPH in this patient population. Conclusion Patients with PAS without a history of CD have distinctive predictors of sPPH. Besides placenta previa, a history of three or more intrauterine procedures and multiparity warrant close monitoring to prevent sPPH. Vaginal delivery should be discouraged in patients with PAS without a history of CD.

For free propagation from a focus the Hermite-Gauss wave functions of optics spread in space. In quantum mechanics the Hermite-Gauss functions are referred to as the harmonic oscillator eigen- functions. These functions are used here to describe the interference of wave packets. It has been shown that when transformed to a frame moving with the normal to the wave front trajectories, the Hermite-Gauss functions are constant up to a phase factor which is the Gouy phase. The Gouy phase itself assumes the role of proper space or time coordinate. Along the whole of such a trajectory, the space wave function is proportional to the wave number function. An arbitrary normalisable wave packet can be expanded using the Hermite-Gauss functions as a basis. As example, it is shown that in the co-moving frame, a displaced Gaussian does not spread but rather becomes a coherent state. This allows a particularly simple representation of the Young's interference pattern from two or more slits.

Aim Recording the indication for a medicine in the prescription supports communication. In May 2023 our district hospitals made the free-text indication field in prescriptions compulsory for all medicines in the inpatient prescribing system. This study aimed to evaluate the effect of introducing a compulsory indication field in an inpatient prescribing system. Methods Text in the indication field was manually classified as an indication, ‘other text’, ‘rubbish text’, ‘to be determined’, and ‘blank’. Prescribing data were extracted from the district data warehouse. The change in proportion of prescriptions with an indication was compared for eight-weeks after introduction of a compulsory indication field to an equivalent eight-weeks in 2022. Secondary outcomes included patient outcomes, medication cessation, and indication recording before discharge. Results We analysed 81,634 prescriptions before and 82,726 after indications were made compulsory. The proportion of prescriptions with an indication increased from 29.2% to 75.6%. ‘Rubbish text’ increased from 0% to 2.3%, ‘other text’ from 2.5% to 14.7%, and ‘to be determined’ from 0.0% to 6.6%. Of 5,557 prescriptions with ‘to be determined’ initially, 18.1% were ceased and 2.7% had an indication before discharge. There was minimal change in patient outcomes. Conclusion Introducing a compulsory indication field increased the proportion of medicines with an indication from 29% to 76%, with only a small increase in ‘rubbish text’. The carefully selected compulsory field improved information quality but did not alter medicine use or patient outcomes. Compulsory fields should be combined with improvements in other components of care to improve medicine use.

Chalcones are α,β-unsaturated ketones, naturally produced as flavonoids and isoflavonoids precursors. Their privileged chemical structure enables their conjugation with different groups, aiming to improve their chemical properties and biological activities. Chalcone-sulfonamide hybrids display a range of biological activities and have been widely investigated for their anticancer potential, being considered promising molecules for cancer treatment. This systematic review aimed to summarize the information available in the literature about the anticancer potential of chalcones-sulfonamides in vitro and in vivo and their mechanisms of action. An electronic search was performed across scientific databases (PubMed, Web of Science, Emabase, and Scopus), and two blinded authors selected the studies according to the inclusion and exclusion criteria. The search yielded 1,467 articles, of which 18 were considered eligible for the review. Our analysis demonstrated that chalcones-sulfonamides are mainly obtained by Claisen-Schmidt condensation and can receive several functional groups, directly affecting their activity. Chemical substitutions often involve the addition of methoxy or chlorine groups at different positions of the molecule. Chalcones-sulfonamides demonstrated relevant cytotoxic potential in vitro and reduced tumor growth in vivo. The mechanisms underlying these effects involve oxidative stress, increased intracellular Reactive Oxygen Species (ROS), and DNA damage. The oxidative stress induced by chalcones-sulfonamides also seems to contribute to the inhibition of Carbonic Anhydrase, which is frequently overexpressed in cancer cells. Altogether, chalcones-sulfonamides may lead to cell death by different pathways, predominantly via apoptosis or necroptosis.

Sierra Leone and neighbouring countries are prone to the proliferation of illicit drugs due to porous borders, weak regulatory frameworks, and the activities of transnational criminal syndicates. Among the emerging drug threats in the region is the synthetic cannabinoid known as "Kush," which has gained immense popularity. The use of this drug has surged in recent years, particularly among Sierra Leonean youths, leading to the declaration of a national state of emergency by the government. The Ministry of Health and Sanitation has been tasked with establishing a National Task Force on drugs and substance abuse to identify treatment and mitigation measures to combat Kush addiction among affected individuals. This commentary highlights the current situation of Kush abuse among youths, its usage patterns, and socioeconomic implications for Sierra Leone and the surrounding countries with key recommendations that will inform strategies for prevention, treatment, and regulation.

Background: The duration for COVID-19 patients to achieve a negative nucleic acid test result is influenced by various factors. This study aimed to explore the influences of clinical symptoms of COVID-19 on the time required for nucleic acid test results to become negative. Methods: The retrospective study enrolled a total of 486 participants infected with COVID-19 who were aged ≥18 years and hospitalized at Shanghai Lingang Make-shift Hospital between April 10, 2022, and May 20, 2022. The clinical data included patient demographics, clinical symptoms, and the time of nucleic acid conversion to negative, all assessed using a cross-sectional study method. Results: This study included COVID-19 patients with a median age of 38, comprising 66.0% males and 34.0% females. Multiple linear regression analyses demonstrated a significant positive correlation between the time of nucleic acid conversion to negative and the clinical symptoms of throat pain among patients with COVID-19 ( β=0.845, 95% CI: 0.123–1.567, P≤0.05). Logistic regression analysis showed that throat pain had a significant negative effect on the 7-day negative nucleic acid conversion rate (OR=0.586, 95%CI:0.390-0.880, P≤0.01), as did diarrhea（OR = 0.541, 95%CI=0.295-0.989,P≤0.05）. Conclusion: The varying clinical symptoms influence the time to negative nucleic acid test results in COVID-19 patients, indicating that these symptoms should receive special attention in clinical treatment to optimize therapy and shorten recovery time.