We introduce a fully differentiable end-to-end audio transformation network designed to convert the style of one audio sample to another. This method offers three significant advantages: (a) it operates without the need for parallel utterances, transcriptions, or time alignment processes; (b) it utilizes a global conditioning mechanism, making it vocabulary agnostic and capable of transforming audio styles regardless of the target identity; and (c) it performs one-shot audio transformations without intermediate phonetic representations, thus eliminating the necessity for phonetic alignments and speaker-independent ASR networks. We assess our method against existing approaches in voice conversion and musical style transfer tasks. Subjective evaluations demonstrate the superiority of our approach. The network employs an encoder-decoder architecture that integrates neural network models known for their explainability in natural language processing tasks.

Aiming at the problem of model error and tracking dependence in the process of intelligent vehicle motion planning, an intelligent vehicle model transfer trajectory planning method based on deep reinforcement learning is proposed, which obtain an effective control action sequence directly. Firstly, an abstract model of the real environment is extracted. On this basis, Deep Deterministic Policy Gradient (DDPG) and vehicle dynamic model are adopted to jointly train a reinforcement learning model, and to decide the optimal intelligent driving maneuver. Secondly, the actual scene is transferred to equivalent virtual abstract scene by transfer model, furthermore, the control action and trajectory sequences are calculated according to trained deep reinforcement learning model. Thirdly, the optimal trajectory sequence is selected according to evaluation function in the real environment. Finally, the results demonstrate that the proposed method can deal with the problem of intelligent vehicle trajectory planning for continuous input and continuous output. The model transfer method improves the model generalization performance. Compared with the traditional trajectory planning, the proposed method output continuous rotation angle control sequence, meanwhile, the lateral control error is also reduced.

The phenomenon of seat occupancy in university libraries is a prevalent issue. However, existing solutions, such as software-based seat reservations and sensors-based occupancy detection, have proven to be inadequate in effectively addressing this problem. In this study, we propose a novel approach: a serial dual-channel object detection model based on Faster RCNN. Furthermore, we develop a user-friendly web interface and mobile APP to create a computer vision-based platform for library seat occupancy detection. To construct our dataset, we combine real-world data collection with UE5 virtual reality. The results of our tests also demonstrate that the utilization of personalized virtual dataset significantly enhances the performance of the convolutional neural network (CNN) in dedicated scenarios. The serial dual-channel detection model comprises three essential steps. Firstly, we employ Faster RCNN algorithm to determine whether a seat is occupied by an individual. Subsequently, we utilize an object classification algorithm based on transfer learning, to classify and identify images of unoccupied seats. This eliminates the need for manual judgment regarding whether a person is suspected of occupying a seat. Lastly, the web interface and APP provide seat information to librarians and students respectively, enabling comprehensive services. By leveraging deep learning methodologies, this research effectively addresses the issue of seat occupancy in library systems. It significantly enhances the accuracy of seat occupancy recognition, reduces the computational resources required for training CNNs, and greatly improves the efficiency of library seat management.

Classification of pre-processed fMRI dataset using the functional connectivity(FC) based features is considered a challenging task due to high dimensional FC features set and smaller dataset size. To tackle this specific FC high dimensional features set and a smaller dataset size , We have proposed here a GAN based dataset augmenter to firstly train the GAN on the NYU Connectivity Features dataset and used the trained GAN to generate synthetic features per category and after getting sufficient number of features per category , A multi-head attention mechanism was used as a head for the classification . We name our proposed approach as "ASD-GANNet" which is End-To-End and does not require hand-crafted features as the multi-head attention mechanism focuses on the features that are more relevant . Moreover , We compared our results with the 06 available state-of-the-art techniques from the literature and Our proposed approach results using "NYU" site as a training set for generating GAN based synthetic dataset are promising. We achieved an overall 10-fold cross validation based accuracy of 82% ,sensitivity 82% and specificity 81% outperforming the available state-of-the art approaches. Sitewise comparison of our proposed approach also outperformed the the available state-of-the-art as out of the 17 sites our proposed approach has better results in the 10 sites.

Autonomous driving navigation relies on diverse approaches, each with advantages and limitations depending on various factors. For HD maps, modular systems excel, while end-to-end methods dominate mapless scenarios. However, few leverage the strengths of both. This paper innovates by proposing a hybrid architecture that seamlessly integrates modular perception and control modules with data-driven path planning. This innovative design leverages the strengths of both approaches, enabling a clear understanding and debugging of individual components while simultaneously harnessing the learning power of end-to-end approaches. Our proposed architecture achieved 1st and 2nd place in the 2023 CARLA Autonomous Driving Challenge’s SENSORS and MAP tracks, respectively. These results demonstrate the architecture’s effectiveness in both map-based and mapless navigation.

Speech recognition, or automatic speech recognition (ASR), is a technology designed to convert spoken language into text using software. However, conventional ASR methods involve several distinct components, including language, acoustic, and pronunciation models with dictionaries. This modular approach can be time-consuming and may influence performance. In this study, we propose a method that streamlines the speech recognition process by incorporating a unified recurrent neural network (RNN) architecture. Our architecture integrates a convolutional neural network (CNN) with an RNN and employs a connectionist temporal classification (CTC) loss function. Key experiments were carried out using a dataset comprising 576,656 valid sentences, using erosion techniques. Evaluation of the model performance, measured by the word error rate (WER) metric, demonstrated remarkable results, achieving a WER of 2%. This approach has significant implications for the realm of speech recognition, as it alleviates the need for labor-intensive dictionary creation, enhancing the efficiency and accuracy of ASR systems, and making them more applicable to real-world scenarios. For future enhancements, we recommend the inclusion of dialectal and spontaneous data in the dataset to broaden the model's adaptability. Additionally, fine-tuning the model for specific tasks can optimize its performance for targeted objectives or domains, further enhancing its effectiveness in those areas.

As an emerging building solution, cross-laminated timber (CLT) floors have been increasingly used in mass timber construction. The current vibration design of CLT floors is conservative due to the assumption of simple support conditions in the floor-to-wall connections. It is noted that end fixity occurs as a result of clamping action at the ends, arising from the gravity load applied by the structure above the floor and by the mechanical fasteners. In this paper, the semi-rigid floor-to-wall connections are treated as elastically restrained edges against rotations to account for the effect of partial constraint. A rotational end-fixity factor was first defined to reflect the relative bending stiffness between CLT floors and elastic restraints at the edges. Then, for the design of vibration serviceability of CLT floors as per the Canadian Standard for Engineering Design in Wood (CSA O86), restraint coefficients were defined and their analytical expressions were derived for natural frequencies and the mid-span deflection under a concentrated load, respectively. In particular, a simplified formula of the restraint coefficient for the fundamental frequency was developed to assist engineers in practical design. At last, by comparing with reported experimental data, the proposed design formula showed excellent agreement with test results. In the end, the proposed end fixity factor with their corresponding restraint coefficients is recommended as an effective mechanics-based approach to account for the effect of end support conditions of CLT floors.

Speech recognition, also known as automatic speech recognition (ASR), is a technology that enables software to transcribe spoken language into text. However, existing Amharic ASR methods require multiple separate blocks, such as language, acoustic, and pronunciation models with dictionaries, which can be time-consuming and influence performance. This study proposes an approach that replaces much of the speech pipeline with a single recurrent neural network (RNN) architecture. Our proposed architecture is based on a hybrid approach that combines a convolutional neural network (CNN) with a recurrent neural network (RNN) and a connectionist temporal classification (CTC) loss function. We conducted several experiments with noisy audio data that contain 20,000 valid sentences. The model was evaluated using the word error rate (WER) metric, achieving impressive results of 7% WER on noisy data. This approach has significant implications for the field of speech recognition, as it reduces the human effort required to create dictionaries and improves the efficiency and accuracy of ASR systems, making them more practical for real-world applications.

Tanzania like any other developing countries is depending on uncertain rainfall for their subsistence and commercial agriculture. In this paper the start and end of rains for Mbeya Meteorological Station in Tanzania Mainland was analyzed and critically examined. Data were kindly given by Tanzania Meteorological Agency (TMA) during face to face Statistics in Applied Climatology (fSIAC) workshop which was held at Sokoine University of Agriculture (SUA) the year 2013 prior to online Course on Statistics in Applied climatology (eSIAC). In this study data were analyzed using Instat (for windows version 3.3.7) package developed by the Statistical Services Centre of the University of Reading. The analysis showed that much of rains start early December all the way to May. There is also 50 percent chance of having below and above the mean for both total annual rainfall and number of rains, in other word one in two years the total rains are below means likewise the number of rain days.

To evaluate the used and End-of-Life tyre management chains, both direct observation and interviews with approximately 200 used-tyre dealers were conducted. The study revealed that while the used tyre business is well-organized, End-of-Life tyre treatment is nearly non-existent, often involving dumping, open burning for metal recovery, or use in meat processing, causing environmental and health risks. To address these challenges, an 8 t/hr capacity tyre recycling plant is planned, based on estimated tyre availability and development opportunities for sustainable recycling in Togo.

Background: Type 2 diabetes mellitus (T2DM) affects over 500 million people worldwide, and over 50% of this group experience the most common complication, diabetic peripheral neuropathy (DPN). The presence of advanced glycation end-products (AGEs) have been linked with the development of DPN. The present study assessed for AGE levels in participants with type 2 diabetes, and explored the hypothesis that there may be increased AGE levels in more severe DPN. Methods: 124 participants with T2DM were consecutively recruited, and underwent skin autofluorescence, clinical assessment for peripheral neuropathy, peripheral nerve ultrasound, nerve conduction studies and axonal excitability assessment. Results: Elevated levels of AGE did not correlate with higher clinical neuropathy scores, sural sensory nerve amplitude, median or tibial nerve cross-sectional area or measures of axonal excitability. While higher AGE readings correlated with diabetic kidney disease, these recordings were not associated with more severe peripheral neuropathy outcomes on multiple regression analysis. Conclusion: The present study suggests that accumulation of AGE is not associated with clinical, electrophysiological and morphological measures of neuropathy in T2DM.

Biotechnological potential of Thermoanaerobacter strain AK15 to produce ethanol and valuable alcohols from carbohydrates and amino acids were evaluated in present study. The strain is highly ethanologenic, producing a maximum of 1.57 mol ethanol per mol of glucose degraded at high liquid-gas phase ratios. The strain degrades most of the sugars tested as well as starch and pretreated hydrolysates of biopolymers (Whatman paper, newspaper, Timothy grass, Rhubarb leaves, and several macroalgae species) to ethanol mainly. The strains degraded serine and threonine when used as a single substrate, producing mainly acetate and ethanol as end products, and the branched-chain amino acids (leucine, isoleucine, valine) when cultivated in the presence of thiosulfate. The main end products from branched-chain amino acids were a mixture of their corresponding branched-chain fatty acids and alcohols. Finally, the strain was also shown to use butyrate as an electron sink during glucose degradation resulting in the reduced product butanol in addition to end products produced from glucose. Thus, strain AK15 is a promising candidate for ethanol and fine chemical production from a range of lignocellulosic and algal biomass.

Abstract: Like other plants, every PV power plant will one day reach the end of its service life. Calculations show that 20,400 tons of PV waste will be generated worldwide by 2030 and 60.2 million tons by 2050, not including the mass of the support structure. Such large amounts of waste pose a potential threat to the environment and people if not properly managed. The paper analysed the options for dealing with PV waste, namely reuse, recycling and landfilling. For recycling as the best option in terms of environmental protection and circular economy, an overview of recycling technologies and the percentage of achievable recycling for the materials contained in each PV system component is given. In addition, the current situation of legislation and recycling of PV modules in Europe was examined with special reference to the Balkan countries. There are a small number of factories for recycling PV modules in Europe, but none in the Balkan countries. The main reason for this is the small amount of PV waste in these countries and consequently the economic unprofitability. For this reason, PV modules (after dismantling the aluminum frame and cables) are mostly disposed of as non-hazardous waste in landfills in these countries. Finally, the main barriers to faster implementation of PV module reuse and recycling are listed, along with guidelines for their removal. The cost of recycling Si modules is about ten times higher than the cost of disposal. To change this ratio in favor of recycling, cheaper recycling methods need to be developed and taxes on landfill disposal need to be increased.

Doppler findings of persistent reverse end-diastolic flow (PREDF) in a fetal middle cerebral artery (MCA) are a very rare sonographic finding and are a marker of poor fetal condition. This finding often leads to intrauterine fetal death or early neonatal death. The reverse end-diastolic flow in the middle cerebral artery is the terminal hemodynamic event. Fetal cerebral circulation normally has a high impedance; in the event of fetal hypoxemia, impedance decreases, resulting in the central redistribution of blood flow to vital organs, which maintains the oxygen delivery to the brain. Reverse flow in the middle cerebral arteries describes the loss of this autoregulatory process. PREDF is a sequence happening due to increased extracranial or intracranial pressure. Previous case reports mentioned intracranial hemorrhage, intrauterine growth restriction (IUGR), fetal anemia, and fetal hepatic abnormalities as leading problems to PREDF. This condition presumably arises due to cerebral edema associated with severe hypoxemia. We reported Doppler findings of PREDF MCA in a 33-year-old female at 30 weeks gestation who was referred to the hospital with severe preeclampsia accompanied by IUGR and oligohydramnios. A cesarean section was performed due to severe preeclampsia and a low bishop score. Hypotheses on various etiologies and their association with intrauterine/neonatal death as well as the best management still require further investigation.

Utility perceived by individuals is believed to be different from the utility experienced by that individual. System dynamicists implicitly categorize this phenomenon as a form of bounded rationality and traditionally employ a simple smoothing function to capture it. We challenge this generalization by testing it against an alternative formulation of utility perception that is suggested by modern theories of behavioral economics. In particular, the traditional smoothing formulation is compared with the peak-end rule in a simple theoretical model as well as in a medium-size model of electronic health record implementation. Experimentation with the models reveals that the way utility perception is formulated is important and might affect behavior and policy implications of system dynamics models.

Introduction: Obstructive sleep apnea (OSA) is the most common sleep-breathing disorder. OSA is associated with cardiovascular diseases such as coronary artery disease (CAD) and arrhythmias with an increased risk of sudden cardiac death. Some changes in ECG markers are seen as an indicator of arrhythmogenicity, especially ventricular arrhythmias. The goal of this study was to investigate if OSA patients with CAD have QT dispersion and T peak to T end (TpTe) changes as a surrogate of arrhythmogenicity. Methods: We studied 75 patients with CAD who underwent polysomnographic studies. Patients were categorized into mild, moderate, and severe OSA according to the Apnea hypopnea index (AHI). Baseline ECG and echocardiography for assessing LV function and valvular heart disease were done for all of them. Results: Results showed that in patients with moderate and severe sleep apnea QT dispersion was higher in a group with more involvement of coronary artery disease, reduced ejection fraction, and a history of old MI. However, we didn’t find any significant statistical relationship between OSA and TpTe marker. Conclusion: Our results showed a positive relation between ECG arrhythmic indices such as QT dispersion and OSA severity in patients with CAD.

Background: Male factors contribute to approximately 50% of infertile couples. However, obvious causes remain unknown in many cases. This observational study aimed to investigate the associations of clinical and lifestyle parameters with sperm parameters. Materials and Methods: This study enrolled 41 men of infertile couples without obvious causes for male infertility from July 2023 to April 2024. Semen samples were evaluated for sperm number, motility, DNA fragmentation, and oxidative stress (OS) marker oxidation-reduction potential (ORP). Blood samples were analyzed for biochemical parameters, including advanced glycation end products (AGEs) and systemic OS marker diacron-reactive oxygen metabolites (d-ROMs). Skin-accumulated AGEs levels were identified with an autofluorescence method. Lifestyle factors were assessed with a lifestyle questionnaire. Results: Most of the participants were under 40 years old and non-obese with normal clinical and sperm parameters. Multiple regression analyses revealed that body mass index, serum d-ROMs, and semen ORP levels were independently associated with decreased sperm number. Additionally, serum zinc and semen ORP levels were associated with sperm motility. Furthermore, serum zinc and high-density lipoprotein-cholesterol levels were associated with sperm progressive motility and DNA fragmentation, respectively. The rest of the clinical and lifestyle factors, including skin-accumulated and serum AGE levels were not correlated with any sperm parameters. Furthermore, serum d-ROMs and semen ORP levels were not correlated with each other or any of the clinical and lifestyle factors. Conclusions: Our present study indicates that both systemic and local OS may be independently involved in sperm abnormality of healthy men without obvious causes for male infertility.

With a recent advance in photonic integrated circuits (PIC), a new field of frequency agile coherent radar systems is being thoroughly researched. In contrast to the traditional all-electronics radiofrequency (RF) radar techniques, a fully photonics-based system does not suffer from bandwidth limitation and noise degradation when switching from S to X or K-band and can achieve excellent phase noise even at frequencies exceeding 20 GHz. However, recent state-of-the-art PICs still exhibit high processing losses in the optical domain, which must be addressed in the electrical part of the RF domain. This study presents a comprehensive analysis of the challenges in designing RF front-end amplifier chains for microwave photonic radars, particularly in maintaining stability, minimizing noise, and reducing intermodulation distortion. Furthermore, a comprehensive demonstration of the RF front-end, encompassing both the optical generation of RF signals and experimental measurements of a rotor blade's Doppler fingerprint to validate the system's performance is presented.

In this work, we introduce the design a 16-channel in-pixel neural analog front-end which employs a current-based summing approach to establish a common-mode feedback loop. The primary aim of this novel structure is to enhance both the system common-mode rejection ratio (SCMRR) and the common-mode interference (CMI) range. Compared to more conventional designs, the hereby proposed front-end utilizes DC-coupled inverter-based main amplifiers, which significantly reduce the occupied on-chip area. Additionally, the current-based implementation of the CMFB loop obviates the need for voltage buffers, replacing them with simple common-gate transistors and in turn decreasing both area occupancy and power consumption. The proposed architecture is further examined from an analytical standpoint, providing a comprehensive evaluation through design equations of its performance in terms of gain, common-mode rejection and noise power. A 50μm×65μm compact layout of the pixel amplifiers that make up the recording channels of the front-end was designd in a 180 nm CMOS process. Simulations conducted in Cadence Virtuoso reveal an SCMRR of 80.5 dB and a PSRR of 72.58 dB, with a differential gain of 44 dB and a bandwidth that fully encompasses the frequency range of the bio-signals that can be theoretically captured by the neural probe. The noise integrated in the range between 1 Hz and 7.5 kHz results in an IRN of 4.04 μVrms. Power consumption is also tested, with a measured value of 3.77 μW per channel, corresponding to an overall consumpution of about 60 μW. To test its robustness with respect to PVT and mismatch variations, the front-end is evaluated by means of extensive parametric simulations and Monte Carlo simulations, revealing favorable results.

IgA nephropathy (IgAN) is the most common primary glomerulonephritis worldwide. IgAN causes end-stage kidney disease (ESKD) in 20–40% of all cases. The activation of the complement system by pathological circulating IgAs, which is often associated with low serum C3 levels (LowC3), seems to play a crucial role. Previous studies have shown an association between histological evidence of TMA, which is the result of alternative complement activation, and poor outcome. However, it is not known to what extent the decrease in serum C3 levels reflects ongoing TMA injury. Our study aimed at assessing the association of LowC3 and ESKD and whether this association reflects ongoing TMA. We enrolled all patients with biopsy-proven IgAN and followed-up patients until last visit, ESKD or death. Of the 56 patients included in the study, 12 (21%) presented low serum C3 (LowC3) at the time of renal biopsy. TMA was significantly more frequent in the LowC3 group [7/12 (58%) vs 9/44 (20%), p=0.02]. After adjusting for potential confounders, LowC3 was strongly associated with an increased hazard of ESKD (hazard ratio [HR]: 5.84 [95%CI: 1.69,20.15; P=0.005). The association was not affected by adjusting for TMA. The estimated overall proportion of the relation between C3 and ESKD mediated by TMA was low and not statistically significant. Our study provides evidence that C3 hypocomplementemia is associated with an increased risk of ESKD with mechanisms that are largely independent from TMA.

To study the coupling mechanism and dynamic response of the end-face movable gear trans-mission system under complex excitation, a specific configuration of end-meshing movable gear reduction mechanism was used to achieve predetermined rigid thrust transmission and mis-matched gear meshing functions, which solved the inherent defects of traditional harmonic gear mechanism thin-wall flexible wheel easy to be damaged by fatigue. Considering the phenomenon of elastic deformation of live teeth accompanied by significant changes in meshing characteristics in the transmission process of end-meshing harmonic reducer, the influence of dynamic meshing parameters, live tooth deformation, time-varying stiffness of tooth meshing, and time-varying backlash on nonlinear dynamic performance was explored, as well as the mechanism of mul-ti-parameter coupling on transmission performance. The nonlinear dynamics model of the end-meshing harmonic reducer is established to solve the chattering prediction problem. Finally, a comprehensive test bed for the transmission system of harmonic reducer with meshing type with adjustable characteristic end was built to verify the correctness of the theoretical model and provide the theoretical and technical basis for exploring the optimal parameter selection of pas-sive vibration suppression problem.

The recycling of wastes to obtain value-added products is a great challenge in the sustainable economy. In our studies, a mixed precursor containing aluminium scrap from end – of – life vehicles and TiO2 Degussa P25 was used to prepare TiO2 modified Al photocatalyst through solid state reaction. Al scrap and TiO2 Degussa P25 in the ration of n(Ti) / n(Al) = x (x = 0.0 - 2.5%), and acetylacetonate and Tween 80 was mixed under magnetic stirring and sintered using a con-ventional furnance at 550°C. DTA – TG – DTG, X – ray diffraction, Fourier – transform infrared, UV – Vis and photoluminescence spectroscopies were assed to investigate the thermal, structural, optical properties and photocatalytic activity. The effect of aluminium concentration on the characteristics of TiO2 Degussa P25 depending on the above instruments are studied. XRD revealed that the materials have crystal structure of anatase TiO2, rutile TiO2 and aluminium. The opto-electronic properties show that Al addition shifted the absorption spectra toward the visible range. The photocatalytic performance of Al – TiO2 composites was quantified by the degradation of Allura Red solution under a visible condition. The highest photocatalytic activity (79.99%) was achieved for the sample containing 0.5% Al and a higher concentration of Al particles shields the active centres of the semiconductor, thus reducing its photocatalytic activity. Aluminium scrap from end-of-life vehicles can be a source of raw material to be considered in semiconductor production. The spin-trapping technique evidenced that •O2- was the main species generated responsible for the Allura Red degradation.

Background: The UNHLM pledged to enroll 30 million in TB preventive treatment (TPT) by 2022, necessitating TPT expansion to all at TB risk. We assessed uptake and completion of a 12-dose, weekly isoniazid-rifapentine (3HP) TPT regimen. Methods: Between February 2018 - March 2019 in Dhaka, community-based TPT using 3HP targeted household contacts of 883 confirmed drug-sensitive pulmonary TB patients. Adhering to WHO guidelines, contacts underwent active TB screening before TPT initiation. Results: Of 3,193 contacts who advised health facility visits for screening, 67% (n=2,149) complied. Among these, 1,804 (84%) received chest X-rays. Active TB was diagnosed in 39 (2%) contacts; they commenced TB treatment. Over 97% of 1,216 contacts began 3HP TPT, with completion rates higher among females, those with more education and income, non-slum residents, and those without 3HP-related adverse events. Adverse events, mainly mild, occurred in 5% of participants. Conclusions: The 3HP weekly regimen, with its short duration, self-administered option, and minimal side effects, achieved satisfactory completion rates. A community-focused 3HP TPT approach is feasible, scalable nationally, and aligns with UNHLM targets.

Recent literature has seen a rapid expansion in the reference to front-end forensics as an indication of the untapped value of forensic science. While some of these contributions have centered on development of forensic intelligence from a single area of investigation, others call for a more fundamental change in the relationship between crime laboratories and policing, particularly relating early laboratory analysis with big datasets to provide leads to investigators. We highlight several recently implemented tactical strategies of crime laboratories that contribute to the body of forensic intelligence. Beyond the scientific gains from these tactical applications, the corresponding details on associated efficiencies, costs, time savings, and quality improvements offer insights towards patterns of success for the community of crime laboratories. Further details expand an interpretation of what constitutes success with an eye on the contributions of the crime laboratory towards public health, safety, and protection of the innocent in addition to societal gains from conviction of the guilty. The economic interpretation of the value provided by the forensic laboratory assists in the cost-benefit review of strategic and tactical decisions and supports the justification for laboratory public funding with measures of the return on investment from public support of the forensic laboratory

Introduction: Advanced glycation end-products (AGEs) may play a relevant role as inducers in the chronic inflammatory pathway present in immune-mediated diseases, such as systemic lupus erythematosus (SLE). AGEs concentrations have been associated, with discrepant results to date, with some parameters such as disease activity or accrual damage, suggesting their potential usefulness as biomarkers of the disease. Objectives: To confirm differences in AGEs levels measured by cutaneous autofluorescence between SLE patients and healthy controls (HC) and study their correlation with various disease parameters. Methods: Cross-sectional study, where AGEs levels were measured by skin autofluorescence, and SLE patients’ data were compared with those of sex- and age-matched HC in a 1:3 proportion through a multiple linear regression model. Correlations of AGEs levels with demographic and clinical data were analyzed through ANOVA tests. Both analyses were adjusted for confounders. Results: AGEs levels in SLE patients were significantly higher than in HC (p<0.001). We found statistically significant positive correlation with SLE disease activity index (SLEDAI) and damage index (SDI), physician and patient global assessment, C-reactive protein, leukocyturia, complement C4, IL6 and oral ulcers. We also found a negative statistically significant correlation with current positivity of anti-nuclear and anti-Ro60 antibodies. Conclusions: AGEs seem to have a role in LES pathophysiology, becoming a new management and prognosis biomarker in this disease. The association with specific antibodies and disease manifestations may indicate a specific clinical phenotype related to higher AGEs levels.

The LED light source is an important light source for indoor visible light communication. It has the characteristics of a large divergence angle and a high transmission rate. Therefore, using LED as the light source for visible light full-duplex communication can not only satisfy the lighting requirements but also transmit information at high speed. To analyze the factors that affect the optical power of the indoor single-light source visible light communication uplink receiving end, an indoor visible light communication model was established, and mathematical calculation formulas were derived based on the model establishment, and the maximum movable range formula of the retroreflective end under specific conditions was derived; The reliability of the formula was verified with the help of Zemax simulation software. Theoretical analysis and experimental results show that increasing the movement range of the retroreflective end can be achieved by increasing the lens diameter, reducing the focal length, and increasing the link distance.

There is a pressing need for more precise biomarkers of chronic kidney disease (CKD). Plasma samples from 820 subjects [231 with CKD, 325 with end-stage kidney disease (ESKD) and 264 controls] were analyzed by LC-MS/MS to determine a metabolic profile of 28 aminoacids (AA) and biogenic amines to test their value as markers of CKD risk and progression. The Kynurenine/Tryptophan ratio showed the strongest correlation with estimated glomerular filtration rate values (coefficient=-0.731, P&lt;0.0001). Models created with Orthogonal Partial Least Squares-Discriminant Analysis (OPLS-DA) containing the metabolic signature showed high goodness of fit and predictability for controls/CKD (R2X:0.73;R2Y:0.92;Q2:0.92) and lower for CDK/ESKD (R2X:0.56;R2Y:0.59;Q2:0.55). Based on generated VIP scores, the most relevant markers for segregating samples into control/CKD or CKD/ESKD groups were citrulline (1.67) and tryptophan (1.59), respectively. ROC analysis showed that the addition of the metabolic profile to a model including CKD classic risk factors improved AUC from 86.7% (83.6-89.9) to 100% (100-100) for CKD risk (P&lt;0.0001), and from 63.0% (58.2-67.8) to 96.5% (95.3-97.8) for the risk of progression from CKD to ESKD (P&lt;0.0001). Plasma concentrations of AA and related amines may be useful as diagnostic biomarkers of kidney disease, both for CKD risk and for progression of CKD patients to ESKD.

The right to live with dignity during the final stages of existence, enshrined in national and supranational Charters of Rights, represents a significant step towards humanizing medicine and is integral to the right to health. Palliative Care, rooted in health, dignity, and therapeutic self-determination, has emerged as a fundamental human right and a moral imperative within health systems. It seeks to alleviate suffering, emphasizing the holistic well-being of patients with life-limiting illnesses. This paper provides a comprehensive global perspective on Palliative Care, with special attention to its implementation in Italy. Palliative Care is a crucial dimension of care, designed to enhance the quality of life for patients suffering from progressive and incurable diseases. Despite its growing need due to an aging population and increased prevalence of chronic illnesses, still remains a significant disparity in access to these essential services worldwide. Insufficient resources, legislative constraints, and limited training for healthcare providers pose challenges to the widespread adoption of Palliative Care. In Italy, although laws have been enacted to ensure the provision of Palliative Care, its availability remains inconsistent across different regions. Financial constraints and insufficient support hinder the comprehensive dissemination of these services. Recognizing the significance of Palliative Care, the Catholic Church also endorses its implementation as a response to human suffering and an approach to end-of-life care. Efforts to strengthen Palliative Care are critical to meeting the rising demand and ensuring access to compassionate and dignified care for all individuals in need. Through legislative advancements and adequate resources, Italy can make significant strides in advancing the provision of Palliative Care.

Introduction: The treatment of peritoneal dialysis in end-stage renal disease is increasing in clinical practice. The main purpose of this study was to evaluate the effect of far-infrared radiation therapy on inflammation and the cellular immunity of patients undergoing peritoneal dialysis. Materials and Methods: We recruited 56 patients undergoing peritoneal dialysis, and we included 32 patients from the experimental group and 24 patients from the control group in the final analysis. The experimental evaluation in our study was as follows: (1) We used abdominal computed tomography to measure the diameter and degree of hardening of the abdominal veins and large blood vessels to explore the changes in abdominal blood vessels. (2) The study compared the effects of peritoneal dialysis using albumin, blood urea nitrogen, creatinine, white blood cell, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, erythrocyte sedimentation rate, Hs-CRP clearance rate, and HBAlC. (3) We compared the cytokine concentration of blood between the two groups while controlling for GM-CSF, IL-2, IFN-γ, IL-6, IL-18, IL-4, IL-5, IL-13, IL-12p70, TNF-α, and IL-1β. Results and Discussion: (1) There was no significant difference in the abdominal blood vessels of the experimental group relative to the control group according to abdominal CT measured over 6 months. (2) Our study demonstrates the statistically significant effect of FIR therapy on the following parameters: albumin (p = 0.048*), creatinine (p = 0.039*), and Hs-CRP (p < 0.001**) decreased significantly, and glomerular filtration rate (eGFR, p = 0.043*) and glucose (p < 0.001**) increased significantly. Our study found that, in the experimental group, albumin and creatinine decreased significantly due to FIR therapy for 6 months. However, our study also found that, in the experimental group, glucose (p < 0.001**) increased significantly due to FIR therapy for 6 months. Peritoneal dialysis combined with FIR can reduce the side effects of glucose in dialysis buffer, which interferes with peritoneal inflammation and peritoneal mesothelial cell fibrosis. In addition, we also found that, in the experimental group, Hs-CRP (p < 0.001**) decreased significantly due to FIR therapy for 6 months. (3) No statistical significance in the inflammatory cytokines related to FIR therapy differences was observed in our study. IFN-γ (p = 0.124), IL-12p70 (p = 0.093), IL-18 (p = 0.213), and TNF-α (p = 0.254) did not exhibit significant improvements in peritoneal dialysis with FIR treatment over 6 months. IFN-γ and IL-18 in the plasma of patients in the experimental group and the control group were higher in the third month than in the first month. Conclusion: We found that the effect of peritoneal dialysis improved significantly with FIR therapy, and significant improvements in the peritoneal permeability and inflammatory response were observed. end-stage renal disease; peritoneal dialysis; far-infrared therapy (FIR)

Packaging of the eukaryotic DNA genome with histone and other proteins forms a chromatin structure that regulates the outcome of all DNA mediated processes. The cellular pathways that ensure genomic stability detect and repair DNA damage through mechanisms which are critically dependent upon chromatin structures established by histones and, particularly, transient histone post-translational modifications . Though subject to a range of modifications, histone methylation is especially crucial for DNA damage repair as the methylated histones often form platforms for subsequent repair protein binding at damaged sites. In this review, we highlight and discuss how histone methylation impacts the maintenance of genome integrity through effects related to DNA repair and repair pathway choice.

Short stature has been associated with increased various disease and all-cause death, but no reliable data exist the association between height and end-stage renal disease (ESRD) in diabetic patients. We investigated the relationship between short stature, development of ESRD, and mortality in type 2 diabetes. This study analyzed clinical data using the National Health Insurance Database in Korea. Height was stratified by five groups according to age and sex. Risk of ESRD and all-cause mortality was analyzed with Cox proportional hazards models. During a 6.9-year follow-up period, 220,457 subjects (8.4%) died and 28,704 subjects (1.1%) started dialysis. Short stature significantly increased the incidence of ESRD and all-cause mortality in the overall cohort analysis. In multivariable analysis, hazard ratios (HR) for development of ESRD comparing the highest versus lowest quartiles of adult height were 0.86 (95% confidence interval (CI), 0.83–0.89). All-cause mortality also decreased with highest height compared to patients with lowest height after fully adjusting for confounding variables (HR 0.79, 95% CI, 0.78–0.81). Adult height had an inverse relationship with newly diagnosed ESRD and all-cause in both males and females. Short stature is strongly associated with an increased risk of ESRD and all-cause mortality in type 2 diabetes.

Health information and communication are key elements that allow patients and family members to make decisions about end-of-life process and guarantee a death with dignity. Objective: To understand carers’ experiences regarding health information and communication during the illness and death of family members. Methods: This qualitative study was conducted in Andalusia based on the paradigm of hermeneutic phenomenology. Participants were carers who had accompanied a family member at the end of life for over 2 months and less than 2 years. Five nominal groups and 5 discussion groups were established, and 41 in-depth interviews with 123 participants were conducted. Atlas.ti 7.0 software was used to analyse the discourses. Results: Four dimensions of the dying process emerged: differences in carers’ perceptions of information and communication, a conspiracy of silence, consequences of the absence or presence of information, and the need for a culture change. Conclusions: Poor management of health information and communication at the end of life suffering and discomfort patients and their families. The culture of denying and avoiding death is still present today. A change in education about death would better enable health professionals to care for patients at the end of life.

Parallel manipulators with multiple end-effectors bring us interesting advantages over conventional parallel manipulators such as improved manipulability, workspace and avoidance of singularities. In this work the kinematics of a five-bar planar parallel manipulator equipped with two end-effectors is approached by means of the theory of screws. As an intermediate step the displacement analysis of the robot is also investigated. The input-output equations of velocity and acceleration are systematically obtained by resorting to reciprocal-screw theory. In that regard the Klein form of the Lie algebra se(3) of the Euclidean group SE(3) plays a central role. In order to exemplify the method of kinematic analysis, a case study is included. Furthermore, the numerical results obtained by means of the theory of screws are confirmed with the aid of special software like ADAMS.^TM

Obesity is one of the most prevalent and damaging metabolic conditions and is a risk factor for the development of other disorders that define the metabolic syndrome. Recent studies have identified a significant role of AGE accumulation and RAGE signaling pathways in the underlying mechanisms that cause the chronic inflammatory response present in obesity which, ultimately, leads to adipose tissue dysfunction. Given the current interest and increasing evidence on possible therapeutic opportunities in the AGE-RAGE axis, the purpose of this work is to review the key findings on new small molecules and bioactive compounds that act as AGE or RAGE inhibitors and their effects on metabolic parameters of people with obesity. The search queries were defined according to the following PICO question: “What are the effects of AGE-RAGE antagonism on adipose tissue metabolism and other metabolic parameters of people with obesity? “. Article search was performed in three online databases: PubMed, Scopus, and Web of Science. In the end, 20 studies were selected for this review. Overall, the reviewed molecules showed beneficial effects on body weight, glucose tolerance, insulin resistance, inflammatory profile, and adipose tissue metabolism in mice models with obesity. There are still very few studies on human application of these molecules, but the ones that were reviewed revealed controversial data when compared to animal studies. Therefore, further human clinical trials should be performed to retrieve more conclusive data.

Background: This study aimed to investigate the effects of intradialytic concurrent (resistance-endurance) training combined with melatonin (MEL) supplementation on oxidative stress, inflammation, and cellular damage in hemodialysis (HD) patients. Methods: Thirty-two hemodialysis (HD) patients were randomly assigned to three groups: Exercise (EX)-MEL, EX-Placebo (PLA), and Control (C)-PLA. Participants in the EX-MEL and EX-PLA groups underwent 12 weeks of concurrent training. Before nocturnal sleep, they ingested either 3 mg of MEL (EX-MEL) or a placebo (EX-PLA and C-PLA). Blood samples were collected at baseline and after 12 weeks of intervention to assess lipid peroxidation [malondialdehyde (MDA)], antioxidant biomarkers [ferric reducing antioxidant power (FRAP), reduced glutathione (GSH), total thiol (THIOL)], total bilirubin (TBIL), uric acid (UA), biomarkers of muscle and liver damage [aspartate aminotransferase (ASAT), alanine aminotransferase (ALAT), creatine kinase (CK), lactate dehydrogenase (LDH), Gamma-glutamyltransferase (Gamma-GT)], and inflammation [C-reactive protein (CRP)]. Results: EX-MEL demonstrated a decrease of MDA (p

This paper reviews the ethical issues involved and argues that each of the usual policies for handling conscientious refusals faces serious challenges. Healthcare providers who refuse to provide medical services should be expected to explain their reasons, make prompt referrals, and bear some of the resulting costs or burdens.

Steel fibre reinforced concrete (SFRC) consists of short hooked steel fibres randomly distributed and oriented within the cementitious matrix. The contribution of fibre in bridging cracks to provide the stress transfer required relies upon the orientation of the fibre in the concrete. Bridging fibre aligned with a crack are less effective than those inclined to it. Therefore, understanding the pull-out behaviour of misaligned fibre is a key factor to quantify and optimize the design of SFRC in the structural applications. In the laboratory a single oriented fibre embedded in a solid cylinder of concrete is subjected to a pull-out test where the axis of a tensile force is aligned with the axis of the cylinder. Based upon the observed behaviour this paper presents a new analytical bounding approach to capture the pull-out response of misaligned hooked-end steel fibre embedded in a concrete matrix. The analysis is based upon a transversely isotropic condition assumed for the plasticity that occurs in the cold drawn fibre. The model accounts for the influence of fibre diameter and the combined strengths of the steel and concrete. The model predictions have also been compared with other experimental results published in the literature. The results showed that the model can predict pull-out loads reasonably for different fibre orientations between bounds of failure derived from the strengths of the two constituents. A critical orientation is observed at maximum strength. Therein, an understanding of the pull-out behaviour of misaligned, hooked-end fibres is necessary to optimize the strength of concrete from this method of reinforcement.

Advanced glycation end-products (AGEs) form through non-enzymatic glycation of various proteins. Optic nerve degeneration is a frequent complication of diabetes, and retinal AGEs accumulation is strongly linked to diabetic retinopathy development. Type 2 diabetes mellitus (T2DM) is a major risk factor for Alzheimer's disease (AD), with patients often exhibiting optic axon degeneration in the nerve fiber layer. Notably, a gap exists in our understanding of how AGEs contribute to neuronal degeneration in the optic nerve within the context of both diabetes and AD. Our previous work demonstrated that glyceraldehyde (GA)-derived toxic advanced glycation end-products (TAGE) disrupt neurite outgrowth through TAGE-β-tubulin aggregation and tau phosphorylation in neural cultures. In this study, we further illustrated GA-induced suppression of optic nerve axonal elongation via abnormal β-tubulin aggregation in mouse retinas. Elucidating this optic nerve degeneration mechanism holds promise for bridging the knowledge gap regarding vision loss associated with DM and AD.

Breeding for low hydrogen cyanide (HCN) varieties is a major objective of programmes targeting boiled cassava food product. To enhance breeding for low HCN, knowledge on genetic variation and trait heritability is essential. In this study, 64 cassava clones established across four locations and evaluated for HCN using three HCN assessment methods; 1 to 9 scale, 0 ppm to 800 ppm scale and a quantitative assay based on spectrophotometer readings (HCN_Spec). Data were also collected on the weather variables precipitation, relative humidity, and temperature. Significant differences were observed among clones (P &lt; 0.001) and locations (p &lt; 0.001). There were also significant (p &lt; 0. 001) clone by environment interactions. Locations Arua and Serere posted higher HCN scores among clones and were associated with significantly higher (p &lt; 0.001) mean daily temperature (K) and lower relative humidity (%) across 12-hour and 18-hour intervals. Within locations HCN broad sense heritability estimates ranged 0.22 – 0.64 while combined location heritability estimates ranged 0.14 to 0.32. Relationships between the methods were positive and strong (R2 = 0.75 – 0.92). It is expected that the information herein will accelerate efforts towards breeding for low HCN cassava varieties.

Chronic hemodialysis (HD) patients have very high cardiovascular risk. Acute vascular changes during dialysis mediated by factors of the endothelium may have a crucial role in this. Aim: To study acute vascular changes during HD. In 29 consecutive chronic HD patients (age: 65.6±10.4 years) pre-, mid-, and post-HD plasma syndecan-1 (SDC-1) and endothelin-1 (ET-1) levels were measured. Applanation tonometry was performed before HD. SDC-1 levels increased during HD (p=0.004). Males had higher ET-1 levels. Patients were divided into 2 groups based on pulse wave velocity (PWV): PWV≥12 m/s and PWV<12 m/s. Pre-HD and mid-HD SDC-1 levels were higher in the group with PWV≥12 m/s (10.174±2.568 vs. 7.928±1.794 ng/ml, p=0.013, and 10.319±3.482 vs. 8.248±1.793 ng/ml, p=0.044, respectively). Post-HD ET-1 levels were higher in the patient group having PWV≥12 m/s (10.88±3.00 vs. 8.05±3.48 pg/l, p=0.027). Patients having PWV≥12 m/s had higher pre-HD peripheral and aortic systolic blood pressure (p<0.05). Total cholesterol correlated with the SDC-1 decrease during HD (r=0.539; p=0.008). Pre-, mid-, and post-HD SDC-1 correlated with the ultrafiltration (r=0.432, p=0.019; r=0.377, p=0.044; and r=0.401, p=0.012, respectively). SDC-1 and ET-1 contribute to vascular changes observed during HD, and they have correlations with some cardiovascular risk factors.

Hundreds of thousands of kilometers of communication and power (umbilical) cables and flowlines lie undersea worldwide. Most of these offshore cables and flowlines have reached or will soon be nearing the end of their service life, necessitating the need for a viable recycling approach to recover some valuable material, e.g., copper. However, separation into constituent materials has proven very challenging due to the highly robust design of the composite cables (and flowlines) to withstand service conditions and the tough external plastic sheaths that protect against seawater corrosion. Here, we summarize the findings of the cryogenic comminution of subsea cables and flowlines for an effective separation and recovery of component materials. Heat transfer analyses of complex multilayer flowlines and umbilicals were conducted to evaluate the time required for these structures to reach their respective critical brittle-transition temperatures. Subsequently, the time was used as a guide to crush the flowline and umbilical cables under cryogenic conditions. The results show that the flowlines and umbilical cables will reach the brittle-transition temperature after approximately 1000s (i.e., 17 min) of submergence in liquid nitrogen (LN). Comminution of the materials at temperatures near the brittle-transition temperature was proven relatively efficient compared to room-temperature processing. The present evaluation of heat transfer and lab-scale crushing will afford accurate process modelling and design of a pilot cryogenic comminution of decommissioned flowlines in an LN-doped atmosphere.

Diabetic nephropathy (DN), one of the primary consequences of diabetes mellitus, affecting many people worldwide. Diabetes affects yearly 463 million adults globally between the ages of 20 and 79, and is the main cause of death under the age of 60. ROS production rises during hyperglycemia and is crucial to the development of diabetic complications. Advanced glycation end products (AGEs) are produced excessively in a diabetic state and accumulate in the kidney, where they change renal architecture and impair renal function. Another important targeted pathway for the formation of DN includes NF-B, Nrf2, NLRP3, Akt/mTOR, and autophagy. About 40% of individuals with diabetes eventually acquire diabetic kidney disease and end stage renal disease that needs hemodialysis, peritoneal dialysis, or kidney transplantation, to survive. The current state of acceptable therapy for this kidney ailment is limited. The studies revealed that some naturally occurring bioactive substances might shield the kidney by controlling oxidative stress, renal fibrosis, inflammation, and autophagy. In order to provide new potential therapeutic lead bioactive compounds for contemporary drug discovery and clinical management of DN, this review was designed to examine the various mechanistic pathways by which current conventional plants derive phytocompounds that are effective for the control and treatment of DN.

Regular exercise can reduce depression. However, the uptake of exercise is limited in patients with end-stage renal disease undergoing hemodialysis. To address the gap, we designed a gamified non-weight-bearing exercise program (Exergame), which can be executed during hemodialysis treatment. The Exergame is virtually supervised based on its interactive feedback via wearable sensors attached on lower extremities. We examined the effectiveness of this program to reduce depression symptom compared to supervised exercise in 73 hemodialysis patients (age=64.5±8.7years, BMI=31.6±7.6kg/m2). Participants were randomized into an Exergame group (EG) or a Supervised-exercise group (SG). Both groups received similar exercise tasks for 4-week, 3-session per week, 30-min per session, during hemodialysis treatment. Depression symptom was assessed at baseline and 4-week using Center for Epidemiologic Studies Depression (CES-D). Both groups showed significant reduction in depression score (37%, p<0.001, Cohen’s effect size d=0.69 in EG vs. 41%, p<0.001, d=0.65 in SG) with no between-group difference for the observed effect (p>0.050). The EG expressed a positive exercise experience including fun, safety, and helpfulness of sensor-feedback. Together, results suggested that the virtually-supervised low-intensity Exergame is feasible during routine hemodialysis treatment. It is as effective as supervised-exercise to reduce depression symptom, while reducing burden of administrating exercise in dialysis clinics.

Pit lakes can represent significant liabilities at mine closure. However, pit lakes also present opportunities to provide significant regional benefit and address residual closure risks of both their own and overall project closure, and even offset the environmental costs of mining by creating new end uses. Unfortunately, many pit lakes have continued to be abandoned without repurposing for an end use. We reviewed published pit lake repurposing case studies of abandoned mine pit lakes. We found beneficial end use type and outcome varied dependent upon climate and commodity; but equally important social and political dynamics that manifest as mining company commitments or regulatory requirements. Many end uses have been realized: passive and active recreation, nature conservation, fishery and aquaculture, drinking and industrial water storage, greenhouse carbon fixation, flood protection and waterway remediation, disposal of mine and other waste, mine water treatment and containment, and education and research. Common attributes and reasons that led to successful repurposing of abandoned pit lakes as beneficial end uses are discussed. Recommendations are given for all stages of mine closure planning to prevent pit lake abandonment and to achieve successful pit lake closure with beneficial end uses.

Filamentous fungi such as Aspergillus spp. are opportunistic pathogens, which cause highly invasive infections, especially in immunocompromised individuals. Control of such fungal pathogens is increasingly problematic due to the small number of effective drugs available for treatment. Moreover, the increased incidence of fungal resistance to antifungal agents makes this problem a global human health issue. The cell wall integrity system of fungi is the target of antimycotic drugs echinocandins, such as caspofungin (CAS). However, echinocandins cannot completely inhibit the growth of filamentous fungal pathogens, which results in survival/escape of fungi during treatment. Chemosensitization was developed as an alternative intervention strategy, where co-application of CAS with the intervention catalyst octyl gallate (OG; chemosensitizer) greatly enhanced CAS efficacy, thus achieved ≥ 99.9% elimination of filamentous fungi in vitro. Based on hypersensitive responses of Aspergillus antioxidant mutants to OG, it is hypothesized that, besides destabilizing cell wall integrity, the redox-active characteristic of OG may further debilitate fungal antioxidant system.

In this paper, the active front-end (AFE) converter topology for the total harmonic distortion (THD) reduction in a wind energy system (WES) is used. A higher THD results in serious pulsations in the wind turbine (WT) output power and in several power losses at the WES. The AFE converter topology improves capability, efficiency and reliability in the energy conversion devices; by modifying a conventional back-to-back converter, from using a single voltage source converter (VSC) to use pVSC connected in parallel the AFE converter is generated. The THD reduction is done by applying a different phase shift angle at the carrier of digital sinusoidal pulse width modulation (DSPWM) switching signals of each VSC. To verify the functionality of the proposed methodology, the WES simulation in Matlab-Simulink® is analyzed, and the experimental laboratory tests using the concept of rapid control prototyping and the real-time simulator Opal-RT® Technologies is achieved. The obtained results show a type-4 WT with total output power of 6MVA, generating a THD reduction up to 5.5 times at the WES.

Objective: To examine variations in end-of-life care for breast cancer, heart failure, and dementia patients. Data and methods: Data from four Norwegian health registries were linked using a personal identification number. Longitudinal trends over 365 days and the type of care on the final day of life were analyzed using descriptive techniques and logistic regression analysis. Results: Patients with dementia were most commonly placed in nursing homes, while patients with heart failure and breast cancer were more frequently hospitalized. Breast cancer and heart failure patients had a higher likelihood of dying at home. The presence of general practitioners increased the probability of home-based end-of-life care for cancer patients, while non-physician healthcare workers increased the likelihood of home-based care for the other patient groups. Conclusion: Diagnoses, individual characteristics, and service availability are all associated with the place of death in end-of-life care.

Heat using behavior has a large impact on in heating energy in heat metering system, and therefore a better understanding can assist in behavior guidance to reduce energy. To understand the current situation of indoor thermal environment and heat using behavior for heat metering households in northern China, including adjusting heating end valves and operating windows, 30 households were measured and surveyed. The factors influencing heat using behavior, including outdoor and indoor environmental parameters and time of the day, were analyzed. The results are :1) Thermal neutral temperature for heat metering households is relatively high, up to 24.5℃; 2) The heat using behavior of households is lack of rationality: low proportion of active households; high indoor temperature setting; more frequency of window opening. Improving indoor comfort is the main reason for households to adjust the heating end valve, and only 7.15% of households have considered the economic benefits brought by adjusting the valve. " Thermostat control valve does not work" is the main reason for households without adjustment; 3) Time of the day and indoor temperature affect active households’ willingness to adjusting heating end valve. Time of the day, indoor temperature and outdoor temperature have impacts on opening window during heating period.

Traditional end-effector robots for arm rehabilitation are usually attached a­t the hand, primarily focusing on coordinated multi-joint training. Therapy at an individual joint level of the arm for severely impaired stroke survivors is not always possible with existing end-effector robots. The Arm Rehabilitation Robot (AREBO)—an end-effector robot—was designed to provide both single and multi-joint assisted training while retaining the advantages of traditional end-effector robots, such as ease of use and cost-effectiveness (compared to exoskeletons). This work presents the design, optimization, and characterization of AREBO for training single-joint movements of the arm. The AREBO has three actuated and three unactuated degrees of freedom, allowing it to apply forces in any arbitrary direction at its endpoint and self-align to arbitrary orientations within its workspace. The AREBO’s link lengths were optimized to maximize its workspace and manipulability. The AREBO provides single-joint training in both unassisted and adaptive weight support modes using a human arm model to estimate the human arm's kinematics and dynamics without using additional sensors. The characterization of the robot’s controller and the algorithm for estimating the human arm parameters were performed using a two degrees of freedom mechatronic model of the human shoulder joint. The results demonstrate that: (a) the movements of the human arm can be estimated using a model of the human arm and robot’s kinematics, (b) the AREBO has similar transparency to that of existing arm therapy robots in the literature, and (c) the adaptive weight support mode control can adapt to different levels of impairment in the arm. This work demonstrates how an appropriately designed end-effector robot can be used for single-joint training, which can be easily extended to multi-joint training. Future work will focus on the evaluation of the system on patients with any neurological condition requiring arm training.

Background. There is limited evidence on the relationship between chronic kidney disease (CKD) and frailty in older people in Vietnam. This study aimed to examine the prevalence of frailty and its impact on mortality in older patients with end-stage renal disease. Method. This is a prospective, observational study at two large Dialysis Centres in Vietnam from November 2020 to June 2021. Consecutive older patients diagnosed with end-stage renal disease and on dialysis were recruited. Participants’ frailty status was defined by the Clinical Frailty Scale (CFS). The study outcome was all-cause mortality at 6th month. Results. A total of 175 participants were recruited (mean age 72.4 years, 58.9% female). Using the cut-point of CFS ≥4, 87.4% of the participants were frail. Mortality at 6th month was 14.9%, 31.9% in participants with CFS ≥7, 12.8% in participants with CFS=6, 7.5% in participants with CFS from 4 to 5, and 4.5% in participants with CFS ≤3 (p=0.001). Cox regression analysis showed that compared to the non-frail participants, the probability of death over 6 months was nearly 2-fold higher in the mildly frail, 3-fold higher in the moderately frail, and 9-fold higher in the severely frail participants. Conclusion. This study demonstrated a very high prevalence of frailty in older patients with end-stage renal disease and dialysis and the significant impact of frailty severity on mortality. Healthcare providers should consider incorporating frailty screening into routine care for older patients with end-stage renal disease and dialysis.

Digital health research is an emerging discipline that requires easy-to-understand theoretical frameworks and implementation models for digital health providers in health and social care settings. The COVID-19 pandemic has heightened demand for digital health discipline-specific instruction on ‘how to’ manage evidence-based digital health transformation. Access to the use of these models guarantees that digital health providers can investigate phenomena using safe and suitable approaches and methods to conduct research and identify answers to challenges and problems that arise in health and social care settings. The COMPASS theory is designed to aid transformation of health and social care environments. A navigational rose of primary quadrants is divided by four main compass points, with person-centred care being central to the philosophy. Two axes produce Cartesian planes that intersect to form a box plot, which can be used to discover human and physical resource weightings to augment digital health research design and implementation. A third continuum highlights stakeholders' capabilities, critical for any multidisciplinary study. The COMPASS mnemonic guides end-users through the process of design, development, implementation, evaluation, and communication of digital health transformations. The theory's foundations are presented and explained in context of the 'new normal' of health and social care delivery.

Background: Membranous glomerulonephritis (MGN) is one of the most common causes of nephrotic syndrome in non-diabetic adults, accounting for up to one-third of biopsy diagnostics in some regions. A watchful waiting strategy has been adopted to accurately assess the success of MGN. In this study, we predict prognostic risk factors for primary MGN patients for effective intervention and prognosis. Materials and Methods: This is a retrospective study design involving 125 biopsy-proven MGN subjects on follow-up from January 2012 to October 2019 in Hospital Serdang and Hospital Kuala Lumpur, Malaysia. Result and Conclusion: After the median follow-up of 36 (15.0-57.0) months, 26 (20.8%) consisting of 17 (13.6%) primary MGN and 9 (7.2%) secondary MGN subjects achieved complete remission while 17 (13.6%) and 10 (8.0%) of primary and secondary MGN subjects respectively achieved spontaneous remission. Subjects with nephrotic range proteinuria have 2.917 odds more at risk of primary MGN while subjects with hypertension have 2.417 odds risk of primary MGN compared to those with no hypertension at presentation. Multiple logistic regression models retained only factors directly associated with MGN with only nephrotic range proteinuria associated with primary MGN. Those with nephrotic range proteinuria were 3.04 times the odds of primary MGN when compared with those without nephrotic syndrome (95% C. I = 1.089, 8.472). The nephrotic syndrome could be used to determine the prognosis in patients with primary MGN especially those at risk of end-stage kidney disease.

Initially, retinol-binding protein (RBP), was thought to be a biomarker for proximal convoluted tubule dysfunction could be important in chronic kidney diseases (CKD). Membranous glomerulonephritis (MGN) is an important cause of CKD and end-stage renal disease (ESRD). Therefore, monitoring MGN patients using urinary RBP is important in effective treatment decision making and prognostication of MGN patients. Enzyme-linked immunosorbent assay (ELISA) technique was used to detect the RBP in the urine samples of 69 MGN patients comprising 47 primary and 22 secondary MGN, at the end of the follow-up period. The test for the urinary biomarker gave the following results: urinary RBP was detected in 27 (39.1%) and 6 (8.7%) of the primary and secondary MGN patients, respectively. The correlation analysis demonstrated a significant relationship between urinary RBP and renal function test parameters, in addition to a logistic regression analysis that proved urinary RBP as a prognostic non-invasive biomarker for primary MGN. Therefore, urinary RBP could be employed to monitor and provide effective prognosis and early treatment decisions in primary MGN.

This work assesses sea-level rise using three different models created on Free and Open-Source Software for Geographic Information System (FOSS4GIS). Based on regional projections of Special Report on Climate Change and Oceans and Cryosphere (SROCC) of the Intergovernmental Panel on Climate Change (IPCC), the models were applied to a case of study on Rio Grande do Sul coast – Brazil under different sea-level rise scenarios by the end of this century. The End Point Rate for QGIS (EPR4Q), calculates a shoreline projection using End Point Rate method. The Uncertainty Bathtub Model (uBTM), analyses the sea-level rise impact by the uncertainty of sea-level projec-tions and vertical error of the Digital Elevation/Terrain Model (DEM/DTM). The Bruun Rule for Google Earth Engine Model (BRGM) predicts the shoreline position with sea-level rise, using topographic and bathymetric data from Unmanned Aerial Vehicles (UAV) and Coastal Modelling System (SMC – Brazil), respectively. The results indicated a maximum shoreline retreat for 2100 of -502 m and -1727 m using EPR4Q and BRGM, correspondingly. The uBTM using the land-use of Mapbiomas showed a maximum of 44.57 km2 of urban area impacted by the sea-level flood. This research highlights the possibility of performing coastal management analysis in GIS environ-ment using non-commercial software.

Critically the paper argues that a truly people-centered technology supported chronic care system can only be designed by understanding and responding to the needs, attributes and capabilities of the most vulnerable in society. The paper suggests innovative ways of supporting interactions with these ‘end-users’ and highlights how reflection on these approaches can contribute to emancipating both the health system to move towards more socially inclusive e-health solutions.

Abstract The aim of this research is to conduct a systematic review analysing the role of the physiotherapy interventions in palliative care. PRISMA as a critical appraisal tool was utilised for the selection of the research articles. The inclusion criteria were based on the year of publication, ease of availability, language, geographical location, and study type. To ensure the credibility, databases such as Elsevier, Proquest, and EBSCO Host were used to filter the grey content. Data published in the past ten years (2009-onwards) was only included to ensure the selection of the most recent interventions used by the physiotherapists. A total of 11 articles were selected which determined that physiotherapy interventions involving breathing exercises, aerobic exercises, manual therapies, and educational awareness were critical to promoting the functional capability and empower the patients.

The urbanisation phenomenon and related cities expansion and transport networks entail preventing the increase of population exposed to environmental pollution. Regarding noise exposure, the Environmental Noise Directive demands on main metropolis to produce noise maps. While based on standard methods, these latter are usually generated by proprietary software and require numerous input data concerning, for example, the buildings, land use, transportation network and traffic. The present work describes an open source implementation of a noise mapping tool fully implemented in a Geographic Information System compliant with the Open Geospatial Consortium standards. This integration makes easier at once the formatting and harvesting of noise model input data, cartographic rendering and output data linkage with population data. An application is given for a French city, which consists in estimating the impact of road traffic-related scenarios in terms of population exposure to noise levels both in relation to a threshold value and level classes.

Advanced Glycation End Products (AGEs) represent a set of substances that contribute directly to the triggering and/or aggravation of pathologies associated with ageing. AGEs are produced by the reaction between reducing sugars (or α-dicarbonyl compounds) proteins and amino acid residues. Current methodologies require an incubation period of 1-3 weeks to generate AGEs. In this study the reaction time for the formation of AGEs (48 and 3 hours) is significantly reduced by coupling and adapting procedures already existing in the literature to the free radical generation system called the hypoxanthine/xanthine oxidase assay. The capacity of different classes and chemical compounds (aminoguanidine, chlorogenic acid, rutin, extracts of Hancornia speciosa Gomes) were evaluated to inhibit the protein glycation process, acting as capturing agents of α-dicarbonyl species. Aminoguanidine, rutin and the leaf extracts of Hancornia speciosa Gomes show a high capacity to act as α-dicarbonyl compound scavengers (RCS-trapping) and resulting in the inhibition of AGEs formation.

This study proposes self-calibration of capacitor mismatch errors for high-resolution pipeline analog-to-digital converters (ADCs). The proposed calibration circuit recursively amplifies the capacitor mismatch error by re-utilizing a multiplying digital-to-analog converter in a pipeline stage without increasing the circuit complexity, and the amplified error voltage is converted into digital code by utilizing the remaining pipeline stages. Error correction is performed by subtracting the digital code from the ADC output during normal operation. A prototype of a 12-bit pipeline ADC is fabricated in a 0.18 µm standard CMOS process. The ADC comprises eight 1.5-bit stages, followed by a 4-bit flash ADC as the final stage; the capacitor mismatch errors in the first two pipeline stages are corrected by utilizing the proposed self-calibration technique. At a sampling rate of 30 MS/s, the measured differential and integral nonlinearities improve from +0.82/-0.75 and +1.12/-1.79 to +0.45/-0.41 and +0.47/-0.91 after calibration, respectively. Further, the measured dynamic performances improve significantly with calibration. For an input frequency of 2.09 MHz, the ADC achieves a spurious-free dynamic range (SFDR) and signal-to-noise and distortion ratios (SNDR) of 69.3dB and 63.9dB before calibration, respectively. After calibration, the SFDR and SNDR increase to 84.1dB and 68.9dB, respectively, and the effective number of bits is approximately 11.1bit. The power consumption of the ADC is 35mW under 1.8V supply, and the resulting figure of merit is 514fJ/conversion step.

Pipeline conflicts arising from data dependencies are a common issue encountered in the hardware implementation of layered QC-LDPC decoders. This paper proposes an efficient layered decoding architecture to reduce pipeline conflicts without introducing stall cycles, by reordering the processing order offline and using the patch method based on variable-to-check message. The experimental results on the LDPC code of the IEEE802.16 standard in the OFDM-PON system demonstrate that the proposed architecture has a sensitivity improvement of 0.125 dBm and 0.375 dBm, respectively, compared with our previous work and the method described in the other work.

The concept of Palliative Care (PC) is more and more known in medicine and the need for this type of approach is growing in a world with great longevity and exponentially increasing chronic diseases. More and more cases from internal medicine, gastroenterology or cardiology wards could benefit from a better care if their medical team would align with the PC concept and principles. In this sense we try to present the specifical needs for Romanian patients in accordance with the current standards of care and how they must be adapted to the reality of the medical system in which they are cared for. We consider also that for medical staff from chronic disease wards it may be necessary to recapitulate the most important principles that govern medical practice of palliation, emphasizing some important aspects of applicability in daily clinical activity.

This study innovatively assesses the Mun River flow components in Thailand, integrating Artificial Neural Networks (ANN) and Isotopic (18O) End-Member Mixing Analysis (IEMMA). It quantifies the contributions of the Upper Mun River (UMR) and Chi River (CR) to the overall flow, revealing a discrepancy in their estimated contributions. ANN predicts the UMR and CR contribute approximately 70.1% and 29.5% respectively, while IEMMA indicates a more pronounced disparity with 84% from UMR and 16% from CR. This divergence highlights the distinct perspectives of ANN, focusing on hydrological data patterns, and IEMMA, emphasizing isotopic signatures. Despite discrepancies, both methods validate UMR as a significant contributor to the overall flow, highlighting their utility in hydrological research. The findings underscore the complexity of river systems and advocate for an integrated approach of river flow analysis for a comprehensive understanding, crucial for effective water resource management and planning.

Dielectric elastomer actuators (DEAs) offer robust, high energy density solutions for soft robotics. The proposed end effector consists of three spring roll configuration DEAs, each acting as a robotic finger, using a 3M VHB-F9473PC adhesive membrane. The lateral force, bending angle and response time of the actuator are measured experimentally and compared with the predictions of an analytical model. The cylindrical actuator measures 70 mm in length and 15 mm in diameter and achieved a lateral force of 30 mN, a bending angle of 6.8 ° and a response time of ≈ 1 s. Spring roll configuration DEAs are shown to reduce the effects of viscoelasticity seen in the membrane, making the actuator more controllable at higher voltages. The dielectric constant of the membrane is shown to be a limiting factor of actuation, with a decrease in dielectric constant resulting in larger actuation. The end effector successfully gripped numerous light objects for extended periods, showing the applicability of spring roll DEAs for soft end effectors.

This paper discusses a MEMS switch that can be fabricated using low temperature (<100^oC) deposition and patterning techniques suitable for the back-end-of-the-line integration with CMOS. The resulting cross-bar switches can be used for electrostatic discharge protection, FPGA implementation, chip security assessment and lock-down, and circuit block power management. We discuss platinum and iron switch with turn-on voltages of ~ 1.8 V. In the case of the iron switches, we also show that they can be magnetized to have “memory” and stay on when turned on. Platinum switch cycling of up to 1000 times did not show any changes in their turn-on voltage and their contact resistance was unchanged. The 10-100 nm switch airgaps were formed using low temperature sputtered sacrificial polysilicon and XeF₂ etching. XeF₂ does not attack any of the metals used in CMOS enabling fabrication of cross-bar switches with any of these metals. Once activated, it takes ∿ 6 to mechanically turn on the switch that can be decreased to ~1 ns by optimizing the device structure. Interestingly, the nm-scale gaps can be used as spark gap as a fast plasma switch to discharge first followed by the activation of the MEMS switch.

For older adults, approaching end-of-life (EOL) brings unique transitions related to family relationships. Unfortunately, most families greatly underestimate the need to discuss these difficult issues. For example, parents approaching EOL issues often struggle with receiving assistance from others, avoiding family conflict, and maintaining their sense of personhood. In addition, discussions of EOL issues force family members to face their parents’ mortality, which can be particularly difficult for the adult children to process emotionally. This study explored aging issues identified by aging parents and their families as they traverse these impending EOL changes. Ten focus groups of seniors (n = 65) were conducted. Focus groups were organized according to race (African American/Caucasian), gender, and whether the older adult was living independently or in an assisted care facility. When asked open-ended questions about discussing aging and EOL issues with family members, participants revealed tensions that led us to consider Relational Dialectics Theory as a framework for analysis. The predominant tension highlighted in this report was certainty versus uncertainty, with the two sub-themes of sustained life versus sustained personhood and confronting versus avoiding EOL issues. For these data, there were more similarities than differences as a result of gender, race, or living situation than one might expect, although culture and financial status were found to be influential in the avoidance of EOL discussions. The results of this study help to provide additional insight into relational dialectics related to aging, EOL, and the importance of communication in facilitating family coping.

This paper presents a study of the 2D roughness profiles on a flat surface generated on a steel work piece, by ball nose end milling, with linear equidistant tool paths (pick-intervals). The milled surface exploration with a surface roughness tester (on pick and feed directions) produces usually 2D roughness profiles having periodical evolutions. These evolutions can be seen as time-dependent signals, describable as a sum of sinusoidal components (the wavelength of each component being regarded as a period). In order to detect a well approximated description of these components, two appropriate signal processing techniques are used in this work: first technique provides a direct mathematical (analytical) description and is based on computer aided curve (signal) fitting (more accurate), the second technique (providing an indirect and incomplete description) is based on the spectrum generated by fast Fourier transform (less accurate). This study can be seen as a way for a better understanding the interaction between the tool and the work piece or to achieve a mathematical description of the machined surface microgeometry in terms of roughness (e. g. its description being a collection of closely spaced 2D roughness profiles).

This study introduces a fruit harvesting mechanism powered by a single motor, designed for integration with unmanned aerial vehicles (UAVs). The mechanism performs reciprocating motion by converting linear motion into rotational motion. Consequently, the end-effector can execute multi-dimensional kinematic trajectories, including biaxial and rotational movements, synchronized with the motor's position. These axial and rotational motions facilitate the gripper's ability to reach, retrieve, and detach fruit from branches during the harvesting process. Notably, a critical consideration in designing this fruit harvesting mechanism is to generate the necessary torque at the end-effector while minimizing reaction forces and torque that could destabilize the UAV during flight. With these considerations in mind, this preliminary study aimed to harvest a Fuji apple and conducted dynamic analysis. We constructed a prototype of the single motor-driven fruit harvesting mechanism using a suitable servo motor. To assess its mechanical performance and evaluate its impact on the hexacopter, we developed both a specific test platform featuring a six-spherical-prismatic-spherical parallel structure and a virtual environmental flight simulator. Overall, the results demonstrate the successful harvesting of a Fuji apple weighing approximately 300 g by the single motor-driven fruit harvesting mechanism, with no adverse effects observed on the hexacopter's operation.

In contrast to some low molar-mass per- and polyfluoroalkyl substances (PFASs), well-established to be toxic, persistent, bioaccumulative and mobile, fluoropolymers (FPs) are water insoluble, safe, bio-inert, durable niche high performance polymers which fulfil the 13 polymer of low concern (PLC) criteria in their recommended conditions of use. In addition, more recent innovations (e.g., the use of non-fluorinated surfactants in aqueous radical (co)polymerization of fluoroalkenes) from industrial manufacturers of FPs are highlighted. This review also aims at showing how these specialty polymers endowed with outstanding properties are essential (even irreplaceable since hydrocarbon polymer alternatives used in similar conditions fail) for our daily life (electronics, Energy, optics, internet of things, transportation, etc) and constitute a special family a part from other “conventional” C1-C10 PFASs found everywhere on the Earth and Oceans. Furthermore, some information reports the recycling (e.g. the unzipping depolymerization of polytetrafluoroethylene, PTFE, into TFE), end of life of FPs, their risk assessment, circular economy and regulations. Various researches are devoted to Environment involving FPs, though they represent a niche volume (with a yearly production of 330,300 tonnes) compared to all plastics (with 460 million tonnes). Complementary to other reviews on PFASs, which lack of such above data, this review presents both fundamental and applied strategies as evidenced by major FP producers.

(1) Background: This article reviews the available scientific literature on drug-related problems and negative outcomes associated with medications identified by medication review with follow-up for end-stage renal disease and discussed with the physicians; (2) Methods: A systematic review was conducted of the scientific literature retrieved from the following databases: MEDLINE (via PubMed), Web of Science, SCOPUS, Cochrane Library: The Cochrane Central Register and Control Trials (CENTRAL) and Literatura Latinoamericana y del Caribe (LILACS), Medicina en Español (MEDES), and the SciELO bibliographic database (collection of scientific journals). The following terms were used as descriptors and searched in free text: "end-stage renal disease", "medication review", and "drug-related problems” and “negative outcomes associated with medication". The following limits were applied: "humans" and "adults (more than 18 years)”; (3) Results: A total of 59 references were recovered and after applying inclusion/exclusion criteria, 16 articles were selected. Of these selected articles, 15 provided information on drug-related problems and only 1 on negative outcomes associated with medications; (4) Conclusions: It can be concluded that drug-related problems and negative outcomes associated with medication affect patients with end-stage renal disease, mainly those receiving renal replacement therapy. More evidence is needed, especially on negative outcomes associated with medication.

Industrial data scarcity is one of the largest factors holding back the widespread use of machine learning in manufacturing. To overcome this problem, the concept of transfer learning was developed and it achieved high attention in recent industrial research. Our paper focuses on the problem of time series segmentation and presents the first in-depth research about transfer learning for deep-learning based time series segmentation on the example of industrial end-of-line pump testing. In particularly, we investigate if the performance of deep learning models can be increased by pretraining the network with data from other domains. Three different scenarios are analyzed: source and target data being closely related, source and target data being distantly related, and source and target data being non-related. The results demonstrate that transfer learning can enhance the performance of time series segmentation models in respect to accuracy and training speed. The benefit is most clearly seen in scenarios where source and training data are closely related and the number of target training data samples is lowest. However, in the scenario of non-related datasets, cases of negative Transfer Learning were observed as well. Thus, the research emphasizes the potential, but also the challenges of industrial Transfer Learning.

Patients living with cancer often experience serious adverse events due to their condition or its treatments. Those events may lead to a critical care unit admission or even result in death. One of the most important but challenging part of care is to build a caring plan according to the patient’s wishes, meeting his goals and values. Advance directives (ADs) allow everyone to give their preferences in advance regarding life sustaining treatments, continuation, and withdrawal or withholding of treatments in case one is not able to speak his mind anymore. While the absence of ADs is associated with a greater probability of receiving unwanted intensive care around the end of his life, their existence correlates with the respect of the patient’s desires and his greater satisfaction. Although progress has been made to promote ADs’ completion, they are still scarcely used among cancer patients in many countries. Several limitations to their acceptation and use can be detected. Efforts should be made to provide tailored solutions for the identified hindrances. This narrative review aims to depict the situation of ADs in the oncology context, and to highlight the future areas of improvement.

In the paper, a coordinated control methodology of single-phase (1-P) end-users switching oper-ations on the phases of an active electric distribution network (AEDN) has been proposed to ob-tain a minimum unbalance degree at the coupling common point (CCP) level with the main dis-tribution system. The phase load balancing (PLB) process considers the smart devices that switch from one phase to another phase the 1-P end-users (consumers and prosumers) to compensate for the phase load unbalance. The proposed methodology has been tested successfully in an AEDN belonging to a Romanian Distribution Network Operator (DNO) containing 114 end-users (104 consumers/10 prosumers) integrated into the Smart Metering System (SMS). The op-timal solution leads to a value of the objective function by 1.00004, represented by the unbalance factor, very close to the ideal target, 1.00. A comparative analysis was conducted considering other possible PLB cases (the consumer-level PLB and prosumer-level PLB), obtaining similar values of the UF (1.027 vs. 1.028), slightly higher than in the hybrid-level PLB. Also, the signifi-cant technical benefits were quantified through an energy-saving of 58.73% and decreasing the phase voltage unbalance rate by 91 % compared to the initial case (without PLB). These results emphasized the positive impact of the proposed coordinated control methodology on the PLB process and evidenced its effectiveness and applicability in the AEDNs.

Background. Pregnancy rates in women on dialysis have increased in the last decades, thus making it a topic of growing interest. The rarity of this event is predominantly due to fertility problems and to the high rates of pregnancy failure including stillbirth, fetal and neonatal deaths [1]. Methods. We conducted a narrative review of existent literature in order to analyse the major issues about pregnancy on dialysis to give the reader a full updated prospective about this topic which, even if not common, is becoming more and more frequent. Results. Even if recently acquired knowledge has improved diagnosis and treatment of dialysis pregnancies focusing on several aspects, pregnancy on dialysis remains a great challenge for obstetricians and should be managed by a multidisciplinary expertise team. Conclusion. Dialysis in pregnancy may be necessary for women previously affected by end stage renal disease (ESRD) becoming pregnant, or in case of acute renal injury presenting for the first time during gestation or, again in case of existent renal pathology worsening during pregnancy and requiring dialysis. Although some evidence suggests that more intensive dialysis regimens are correlated with better obstetric outcomes, the optimal therapeutic protocol still remains to be established.

Recently, significant events took place that added immensely to the sociotechnical pressure for developing sustainable composite recycling solutions, namely (1) a ban on composite landfilling in Germany in 2009, (2) the first major wave of composite wind turbines reaching their End-of-Life (EoL) and being decommissioned in 2019-2020, (3) the acceleration of aircraft decommissioning due to the COVID-19 pandemic, and (4) the increase of composites in mass production cars, thanks to the development of high volume technologies based on thermoplastic composites. Such sociotechnical pressure will only grow in the upcoming decade of 2020s as other countries are to follow Germany by limiting and banning landfill options, and by the ever-growing number of expired composites EoL waste. The recycling of composite materials will therefore play an important role in the future, in particular for the wind energy, but also for aerospace, automotive, construction and marine sectors to reduce environmental impacts and to meet the demand. The scope of this manuscript is a clear and condensed yet full state-of-the-art overview of the available composite recycling technologies of both low and high Technology Readiness Levels (TRL). TRL is a framework that has been used in many variations across industries to provide a measurement of technology maturity from idea generation (basic principles) to commercialization. In other words, this work should be treated as a technology review providing guidelines for the sustainable development of the industry that will benefit the society. The authors propose that one of the key aspects for the development of sustainable recycling technology is to identify the optimal recycling methods for different types of composites. Why is that the case can be answered with a simple price comparison of E-glass fibers (~2 $/kg) versus a typical carbon fiber on the market (~20 $/kg) – which of the two is more valuable to recover? However, the answer is more complicated than that – the glass fiber constitutes about 90% of the modern reinforcement market, and it is clear that different technologies are needed. Therefore, this work aims to provide clear guidelines for economically and environmentally sustainable End-of-Life (EoL) solutions and development of the composite material recycling.

Not a lot is known about either death or the dying process. Politicians and many in the medical profession in the UK tend to shy away from interfering with it by not allowing euthanasia as an end of life option for the patient. This is the first paper in a series of two, comparing the situation in human medicine and veterinary medicine, in which euthanasia is well practiced for relieving suffering at the end of an animal’s life. This first part takes the form of a literature review including best practice around end of life care, its deficiencies and the need for assisted dying. Veterinary surgeons are well trained in the ethics of euthanasia and put it to good use in the best interest of their animal patients. In countries which have legalized physician assisted suicide for the terminally ill reporting indicates that it works well, without increases in involuntary euthanasia and most importantly without intimidation of the vulnerable. However, there is still an ever increasing tendency to overuse sedation and opioids at the end of life, which merits further investigation. With advances in medical science able to significantly prolong the dying process, patient autonomy demands a review of the law in the UK.

The rapid increase in metabolic diseases occurred in the last three decades in both industrialized and developing countries has been related to the rise in sugar-added foods and sweetened beverages consumption. An emerging topic in the pathogenesis of metabolic diseases related to modern nutrition is the role of Advanced Glycation Endproducts (AGEs). AGEs can be ingested with high temperature processed foods, but also endogenously formed as consequence of a high dietary sugars intake. Animal models of high sugars consumption, in particular fructose, have reported AGEs accumulation in different tissues in association with peripheral insulin resistance and lipid metabolism alterations. The in vitro observation that fructose is one of the most rapid and effective glycating agent when compared to other sugars has prompted the investigation of the in vivo fructose-induced glycation. In particular, the widespread employment of fructose as sweetener has been ascribed by many experimental and observational studies for the enhancement of lipogenesis and intracellular lipid deposition. Indeed, diet-derived AGEs have been demonstrated to interfere with many cell functions such as lipid synthesis, inflammation, antioxidant defences, and mitochondrial metabolism. Moreover, emerging evidences also in humans suggest that this impact of dietary AGEs on different signalling pathways can contribute to the onset of organ damage in liver, skeletal and cardiac muscle, and brain, affecting not only metabolic control, but global health. Indeed, the here reviewed most recent reports on the effects of high sugars consumption and diet-derived AGEs on human health suggest the need to limit the dietary sources of AGEs, including added sugars, to prevent the development of metabolic diseases and related comorbidities.

As the number of end-of-life vehicles continues to grow, the field of separation technology for broken copper and aluminium parts of end-of-life vehicles has emerged as a significant area of research. As a key technology for the separation of non-magnetic non-ferrous metals, such as copper and aluminium, eddy current separation can achieve efficient separation of non-magnetic non-ferrous metals according to their differing conductivity and density. Nevertheless, further research is required in the separation of large-scale broken copper and aluminium parts of end-of-life vehicles. This paper presents a novel magnetic roller model comprising circumferential and axial periodic arrangements of permanent magnets. A single permanent magnet was constructed as an equivalent current model, and the magnetic scalar potential equations were solved using simulation tools. This allowed the distribution of the magnetic field outside the magnetic roller to be studied. The results demonstrate that the novel permanent magnet array magnetic roller can enhance the magnetic field intensity and action distance of the external magnetic field, which is more conducive to the separation of large-scale broken copper and aluminium parts of scrap cars. The findings of this research provide a theoretical foundation for the separation of scrap car broken copper and aluminium parts.

Toxic advanced glycation end-products (TAGE), formed by glyceraldehyde (GA) as an intermediate in the non-enzymatic reaction with intracellular proteins, are highly cytotoxic and have been implicated in the pathogenesis of various diseases. However, the mechanisms underlying the degradation and removal of TAGE remain largely unknown. In the present study, we identified the checkpoint kinase-1 (CHK1) mutant, d270KD, which was rapidly degraded intracellularly by GA, and showed that its degradation was mainly mediated by the ubiquitin-proteasome pathway. The high-molecular-weight complexes formed by the GA stimulation of d270KD were abundant in the RIPA-insoluble fraction, which also contained high levels of TAGE. The knockdown of p62/SQSTM1 reduced the amount of high-molecular-weight complexes in the RIPA-insoluble fraction, indicating its involvement in the formation of TAGE aggregates. The present results suggest that the ubiquitin-proteasome pathway and p62 play a role in the degradation and aggregation of intracellular TAGE formed by GA. This study provides new insights into the mechanisms underlying TAGE metabolism and may lead to the development of novel therapeutic strategies for diseases associated with TAGE accumulation.

We report the first case of Daratumumab interference of allogeneic crossmatch tests repeatedly causing aberrant false-positive results, which inadvertently delayed transplant for a waitlisted renal patient with multiple myeloma. Daratumumab is an IgG1κ human monoclonal antibody commonly used to treat multiple myeloma, characterized by cancerous plasma cells and often leads to renal failure requiring kidney transplant, by depleting CD38-expressing plasma cells. In this case study, the patient had end-stage renal disease secondary to multiple myeloma and was continuously receiving Daratumumab infusions. The patient did not have any detectable antibodies to human leukocyte antigens but repeatedly had unexpected positive crossmatch by the flow cytometry-based method with 26 of the 27 potential deceased organ donors, implying donor-recipient immunological incompatibility. However, further review and analysis suggested that the positive crossmatches were likely false-positive as a result of interference from Daratumumab binding to donor cell surface CD38 as opposed to the presence of donor-specific antibodies. The observed intensity of the false-positive crossmatches was also highly variable, potentially due to donor- and/or cell-dependent expression of CD38. The variability of CD38 expression was, therefore, for the first time, characterized on the T and B cells isolated from various tissues and peripheral blood of 78 individuals. Overall, T cells were found to have a lower CD38 expression profile than the B cells, and no significant difference was observed between deceased and living individuals. Finally, we show that a simple cell treatment by dithiothreitol can effectively mitigate Daratumumab interference thus preserving the utility of pre-transplant crossmatch in multiple myeloma patients awaiting kidney transplant.

：An effective technology for predicting the end-point phosphorous content of basic oxygen furnace (BOF) can provide theoretical instruction to improve the quality of steel via controlling the hardness and toughness. Given the slightly inadequate prediction accuracy in the existing prediction model, a novel hybrid method was suggested to more accurately predict the end-point phosphorus content by integrating an enhanced sparrow search algorithm (ESSA) and a multi-strategy with a deep extreme learning machine (DELM) as ESSA-DELM in this study. To begin with, the input weights and hidden biases of DELM were randomly selected, resulting in that DELM inevitably had a set of non-optimal or unnecessary weights and biases. Therefore, the ESSA was used to optimize the DELM in this work. For the ESSA, the Trigonometric substitution mechanism and Cauchy mutation were introduced to avoid trapping in local optima and improve the global exploration capacity in SSA. Finally, to evaluate the prediction efficiency of ESSSA-DELM, the proposed model was tested on process data of the converter from the Baogang steel plant. The efficacy of ESSA-DELM was more superior to that of other DELM-based hybrid prediction models and conventional models. The result demonstrated that the hit rate of end-point phosphorus content within ±0.003%, ±0.002%, and ±0.001% was 91.67%, 83.33%, and 63.55%, respectively. The proposed ESSA-DELM model could possess better prediction accuracy compared with other models, which could guide field operations.

SETMAR is a protein lysine methyltransferase that is involved in several DNA processes, including DNA repair via the non-homologous end joining (NHEJ) pathway, regulation of gene expression, illegitimate DNA integration, and DNA decatenation. However, SETMAR is an atypical protein lysine methyltransferase since in anthropoid primates, the SET domain is fused to an inactive DNA transposase. The presence of the DNA transposase domain confers to SETMAR a DNA binding activity towards the remnants of its transposable element, which has resulted in the emergence of a gene regulatory function. Both the SET and the DNA transposase domains are involved in the different cellular roles of SETMAR, indicating the presence of novel and specific functions in anthropoid primates. In addition, SETMAR is dysregulated in different types of cancer, indicating a potential pathological role. While some light has been shed on SETMAR functions, more research and new tools are needed to better understand the cellular activities of SETMAR and to investigate the therapeutic potential of SETMAR.

Neonatal palliative care (NPC) is an integrated and holistic approach that is an integral part of the contemporary neonatal treatment delivery paradigm. It is the highest fulfillment of the notion of beneficence (doing or creating 'good') that has otherwise been neglected/underestimated by the focus of modern medicine on technology and instrumental treatments by its commitment to alleviating patient pain and quality of life. For decades, the Double-Effect Doctrine (DDE) has been used to consider and address a range of ethically questionable circumstances, often at the end of life, including euthanasia, termination of pregnancy to save maternal life, and morally justified warfare. The theory has continued to be mired in controversy as ethicists, legal scholars, theologians, and philosophers discuss the abstract concepts of moral reasoning, purpose, foresight, and other underlying moral theories. In this paper, the moral theory of DDE is discussed in its clinical application to the ethical decision-making process in neonatal palliative and end-of-life treatment, specifically 1) the administration of opioids as required for symptom control and 2) the use of palliative sedation for intractable symptom care.

Skin involvement is an overlooked aspect in the management of paediatric patients with type 1 diabetes. A comprehensive search of published literature using the PubMed database was carried out using the following key terms: “children”, “pediatric/paediatric patients”, “skin”, “skin disorders”, “type 1 diabetes”. Dermatological side effects are frequently observed among diabetic children and adolescents. Insulin-induced lipodystrophies and allergic contact dermatitis caused by insulin pumps or glycaemic sensors are the most common skin reactions in these patients. Furthermore, several diabetes-associated skin diseases such as necrobiosis lipoidica, granuloma annulare, vitiligo, and bullosis diabeticorum may already be present in paediatric age. Paediatric diabetes specialists should pay attention to their patients’ skin so as to recognize these disorders, identify the potential causes, and choose the most suitable treatment. Finally, the evaluation of skin concentrations of advanced glycation end-products using non-invasive diagnostic techniques may be used to assess the risk of chronic complications of diabetes as early as adolescence.

This paper reports the findings from a pilot study designed to explore the barriers, facilitators and similarities with the delivery and implementation of two distinct models of Advance Care Planning (ACP) documentation for older adults in their last year of life used by health care professionals in their clinical practice. PACe (Proactive Anticipatory Care Plan): a GP led model and PEACE (Proactive Elderly Persons’ Advisory CarE): a nurse led model with community geriatrician oversight were used by participants in their clinical practice. Telephone interviews were conducted with general practitioners (GPs) to explore their views of using the PACe tool. Hospital admission avoidance matrons took part in face to face interviews and care staff employed in private residential care homes took part in individual telephone interviews to explore their views of using the PEACE tool. GPs and admission avoidance matrons were employed by Clinical Commissioning Groups (CCGs) and all study participants were recruited from the South East of England where data collection took place in 2015. Nine telephone interviews and two face-to-face interviews (one joint and one individual) were conducted with twelve participants. The data was analysed thematically. Participants highlighted the similarity of both tools in providing focus to ACP discussions to inform individual end-of-life care preferences. The importance of relationships was a pivotal theme-established, trusting inter-professional relationships to enable multidisciplinary teamwork and a prior relationship with the older person (or their proxy in the case of cognitive impairment) to enable conversations of this nature. Using both tools enabled participants to think critically and reflect on their own practice was another theme identified. Notwithstanding participants’ views to improve the layout of both tools, using a paper-based approach to deliver streamlined ACP and end-of-life care was a theme to emerge as a barrier which focused on the problems with access to paper-based documentation, accuracy and care co-ordination in the context of multidisciplinary team working. The value of technology in overcoming this barrier and underpin ACP as a means to help simplify service provision, promote integrated professional practice and provide seamless care was put forward as the solution.

This paper aims to study the surface homogenization and integrity of Ti-6Al-4V alloy by longitudinal-torsional coupled ultrasonic vibration assisted ball-end milling. A method of continuous processing between the flat surface and freeform surface connection is proposed by using ultrasonic vibration assisted ball-end precision milling, during this process, it is not necessary to exchange the cutting tool. The way has been explored for changing the homogenization of surface on Ti-6Al-4V by ultrasonic vibration-assisted milling (UVAM). Cutting experiments employing three parameters, cutting speed, feed rate and depth of cut and two types of machining forms using ball-end milling with UVAM and conventional milling (CM) respectively. The high frequency cutting force, finished surface roughness, topography and residual stresses on the surface and tool wear have been measured by advanced instruments. Particularly, adopting the high frequency cutting force measurement system, it is concluded cutting force in ball-end milling decreased significantly using UVAM as against CM. Moreover, the surface roughness by UVAM with ball-end milling is much better than the CM at a high cutting speed. However, an opposite trend is observed at a low cutting speed. Especially, there is a steep decrease from Ra 0.828 μm average value at 4000 rpm to Ra 0.129 μm average value at 5000 rpm. At the same time, the homogenization of surface roughness and residual stresses decrease significantly in UVAM as compared to which in CM when taking the transversal-longitudinal ratio into consideration. Cutting experiments and measuring results are demonstrated the validity and feasibility of UVAM with ball-end milling, and this method enjoys significant advantages compared to CM process.

Globally, the importance of sustainable forest is increasing. The forest culture (FC) products are consumed from the perspective of value consumption unlike general products. The benefits contributed by FC products differ in terms of their impact on individuals and society. In this study, we investigated how the expected benefit of FC affects pursued values (PVs) and preferred activities (PAs) from the perspective of value consumption. We (1) determined the indicators of the expected benefit of PVs and PAs in FC and (2) examined the causal relationship among these factors using Means-End Chain theory. We also reviewed relevant literature and surveyed 1,700 Koreans to explore how FC benefits, values, and activities relate to consumer behavior. Factor analysis divided 11 and 19 indicators of PVs and PAs of FC, respectively, into three factors: “symbolic, social, and consumption value” and “tourism-exploration, cultural-artistic, and living-leisure activity.” The contributing characteristics of FC affect the PVs and, in turn, the PAs of FC. In other words, the concrete attitudes of consumers toward FC were categorized by abstract concepts and influenced their practical and behavioral attitudes. In conclusion, FC products should be developed with a focus on value consumption.

Introduction. The management of anemia in chronic kidney disease (CKD-An) presents significant challenges for nephrologists due to variable responsiveness to erythropoietin-stimulating agents (ESA), hemoglobin (Hb) cycling, and multiple clinical factors affecting erythropoiesis. The Anemia Control Model (ACM) is a decision support system designed to personalize anemia treatment, which has shown improvements in achieving Hb targets, reducing ESA doses, and maintaining Hb stability. This study aimed at evaluating the association between ACM-guided anemia management with hospitalizations and survival in a large cohort of hemodialysis patients. Methods. This mul-ti-center, retrospective cohort study evaluated adult hemodialysis patients within the European Fresenius Medical Care NephroCare network from 2014 to 2019. Patients treated according to ACM recommendations were compared to those from centers without ACM. Data on demographics, comorbidities, and dialysis treatment were used to compute a propensity score estimating the like-lihood of receiving ACM-guided care. The primary endpoint was hospitalizations during follow-up; the secondary endpoint was survival. A 1:1 propensity score-matched design was used to minimize confounding bias. Results. A total of 20,209 eligible patients were considered (reference group: 17,101; ACM adherent group: 3,108). Before matching, the mean age was 65.3±14.5 years, with 59.2% men. Propensity score matching resulted in two groups of 1,950 patients each. Matched ACM adherent and non-ACM patients showed negligible differences in baseline characteristics. Hospi-talization rates were lower in the ACM group both before matching (71.3 vs. 82.6 per 100 per-son-years, p<0.001) and after matching (74.3 vs. 86.7 per 100 person-years, p<0.001). During fol-low-up, 385 patients died, showing no significant survival benefit for ACM-guided care (hazard ratio = 0.93; p=0.51). Conclusions: ACM-guided anemia management was associated with a sig-nificant reduction in hospitalization risk among hemodialysis patients. These results further support the utility of ACM as a decision support tool enhancing anemia management in clinical practice.

Active front-end (AFE) rectifiers have been becoming widely employed in power systems to achieve unity power factor and harmonic mitigations. The typical modeling approaches applied for AFE rectifiers in the literature mostly relied on two baselines named the detailed model and the time average model. The former approach deals with the switching element model (SEM) leads to significant harmonics in currents with distorted waveforms. The latter approach uses the average-value model (AVM) to overcome the currents’ harmonics as well as provide fast responses. However, even the AVM baseline has contained problems during the starting stage (lack of control signals) and over the dead-time periods which causes serious issues in the implementation process. This paper presents an improved dynamic AVM for AFE rectifiers by precisely considering the issues mentioned above along with the practical starting procedure and desirable initialization. The studied AFE rectifier is developed using the voltage-oriented control (VOC) technique based on the different modeling methodologies including SEM, Conventional AVM, and the proposed AVM. The performance of all models is analyzed and compared using simulation results with MATLAB/Simulink R2023a Function blocks for all the algorithm parts and SimScape elements for the electrical circuit model. The simulation results illustrate that the performance of the proposed AVM approach can closely resemble the behavior of the SEM baseline with low harmonic distortion.

Chronic oxidative stress in long-distance runners adversely affects conditioning. Therefore, it is important to objectively assess and monitor oxidative stress but measuring oxidative stress can be invasive or require skill to measure. Therefore, this study aimed to verify whether skin autofluorescence (SAF), a noninvasive, rapid, and easily calculable metric for calculating advanced glycation end products (AGEs), is useful as an oxidative stress biomarker. The subjects were 50 young Japanese male long-distance runners (aged 20.2 ± 1.2 years); 35 average male university students (aged 19.8 ± 1.1 years) served as controls. The interactions and relationships between SAF and plasma pentosidine and oxidative stress markers (reactive oxygen metabolite-derived compounds [d-ROMs], biological antioxidant potential [BAP], and the BAP/d-ROMs ratio) in runners were examined, and SAF in the runners and controls was compared. The results suggest that plasma pentosidine in runners is associated with oxidative stress markers and that plasma pentosidine can assess oxidative stress. However, SAF was not validated as an oxidative stress marker because it was not associated with oxidative stress marker. In future, clarifying the factors affecting SAF may clarify the relationship between SAF, plasma pentosidine, and oxidative stress markers.

Motor functions are deteriorated by aging. Some conditions may magnify this deterioration. To examine whether hemodialysis (HD) process would negatively impact gait and balance beyond diabetes condition among mid-age adults (48-64 years) and older adults (65+ years). One hundred and ninety-six subjects (age=66.2±9.1 years, body-mass-index=30.1±6.4 kg/m², female=56%) in 5 groups were recruited: mid-age adults with diabetes undergoing HD (Mid-age HD+, n=38) and without HD (Mid-age HD-, n=40); older adults with diabetes undergoing HD (Older HD+, n=36) and without HD (Older HD-, n=37); and non-diabetic older adults (Older DM-, n=45). Gait parameters (stride velocity, stride length, gait cycle time, and double support) and balance parameters (ankle, hip, and center of mass sways) were quantified using validated wearable platforms. Groups with diabetes had overall poorer gait and balance compared to the non-diabetic group (p<0.050). Among people with diabetes, the HD+ had significantly worsened gait and balance when comparing to the HD- (Cohen’s effect size d=0.63-2.32, p<0.050). Between-group difference was more pronounced among older adults with the largest effect size observed for stride length (d=2.32, p<0.001). Results suggested that deterioration in gait speed among the HD+ was correlated with age (r=-0.440, p<0.001), while this correlation was diminished among the HD-. Interestingly, results also suggested that poor gait in the Older HD- related to poor balance, while no correlation was observed between poor balance and poor gait among the Older HD+. Using objective assessments, results confirmed that the presence of diabetes can deteriorate gait and balance, and this deterioration can be magnified by HD process. Among non-HD people with diabetes, poor static balance described poor gait. However, among people with diabetes undergoing HD, age was a dominate factor describing poor gait irrespective of static balance. Results also suggested feasibility of using wearable platforms to quantify motor performance during routine dialysis clinic visits. These objective assessments may assist in identifying early deterioration in motor function, which in turn may promote timely intervention.

This is the second of a series of two papers comparing the end of life issues in human and veterinary medicine. We outline the main differences between human and animal patients such as patient communication, finance and ‘conflicts of interest’ between animal, owner and veterinarian. We discuss striking similarities between human and veterinary issues such as assessing quality of life and the primary role of the attending veterinarian or doctor being the welfare and care of the patient. This paper takes the form of an ethical argument in favour of allowing euthanasia in human medicine, by providing insights into end of life issues for humans from an independent veterinary perspective. Veterinary surgeons are well trained in the ethics of euthanasia and put it to good use in the best interest of their animal patients. Doctors in the UK are limited and unwilling to put forward a case for the option of euthanasia for those patients who face a slow and agonizing death. With advances in medical science being able to significantly prolong the dying process, autonomy for the patient demands a review of the law regarding patient choice in the UK.

Background: Bloodstream infections (BSIs) pose a major health risk to hemodialysis patients, significantly contributing to morbidity and mortality. This study aimed to identify the bacterial pathogens responsible for BSIs in this population, analyze clinical and laboratory profiles, and identify risk factors associated with poor outcomes. Methods: This retrospective study was conducted at Sohar Hospital, Oman, analyzing cases from January 2018 to December 2022. Data were obtained from e-health records, focusing on patient demographics, bacterial etiology, antibiotic susceptibility, and clinical outcomes. Statistical analysis included t-tests, Mann-Whitney tests, chi-square, and Fisher’s exact tests, with univariate odds ratios calculated for mortality associations using the R package GTSUMMARY. Results: Among 1332 hemodialysis patients, 148 (11.1%) developed a BSI, with an average age of 60.43±14.46 years. Infections were more common among females (54%) and those over 60 years. The predominant comorbidities were hypertension (86%) and diabetes mellitus (74%). The main causative agents were coagulase-negative staphylococci (29.7%), Staphylococcus aureus (20.3%), Pseudomonas aeruginosa (12.2%), and Klebsiella pneumoniae (8.8%). Gram-negative bacteria showed high susceptibility (80-100%) to carbapenems and piperacillin-tazobactam, while Gram-positive bacteria exhibited 80-100% susceptibility to amoxicillin-clavulanic acid and universal sensitivity to linezolid and vancomycin. Conclusions: BSIs in hemodialysis patients at Sohar Hospital are associated with high morbidity and mortality rates, underscoring the need for prompt empirical antibiotic therapy and targeted treatment adjustments based on culture results. This study highlights critical mortality-associated factors, offering valuable insights for improving patient management and survival outcomes in this vulnerable population.

We evaluated the inhibitory effects of our developed Chol-PEG2000 micelles and Chol-PEG500 vesicles on amyloid-β (Aβ) aggregation, a key factor in Alzheimer's disease. ThT assay proved that Chol-PEG2000 delayed Aβ fibril elongation by 17 hours and Chol-PEG500 by 40 hours at 10-times molar ratio against Aβ40 peptide. At 50-times molar ratio, both Chol-PEG2000 and Chol-PEG500 significantly inhibited Aβ aggregation, as shown by minimal fluorescence intensity increase over 48 hours.

In the context of modern healthcare, the concept of patient-centered care (PCC) has emerged as a crucial aspect, prompting the need for innovative frameworks to empower patients and enhance healthcare outcomes. This paper introduces the Patient-Oriented Medical Ontology Conceptual Framework (POMOCF), a powerful framework aimed at giving patients control over their personal and healthcare information. It prioritizes patient independence by allowing for direct control of electronic health records (EHRs) and facilitates the gathering of information through document upload or scanning. In the POMOCF front-end framework, we propose to maintain scalability, along with robust authorization, authentication, and secure data protocols, all of which are detailed within the framework. This approach enhances data accuracy and security, improving data management efficiency. As part of our ongoing development, we are planning to implement an innovative inference system that will automatically analyze and extract relevant details from the uploaded authorized document, provide real-time updates, and maintain data accuracy. This approach further strengthens data accuracy and prevents unauthorized modifications, thereby making the data management process more efficient. POMOCF leverages medical ontology principles to ensure standardized clinical concepts and improved semantic interoperability. Our integration plans involve integrating genotypic data for personalized medicine initiatives and strengthening the front-end infrastructure. By linking front-end interfaces with advanced technological solutions, we aim to provide effective healthcare delivery, promoting personalized care and enhancing patient outcomes.

Patients with chronic kidney disease (CKD), particularly those with end-stage kidney disease (ESKD) undergoing dialysis or kidney transplantation, face ongoing challenges in relation to the risk of COVID-19. In addition to their underlying condition, factors such as immune-evasive variants, immunosuppressive therapies, and the need for dialysis contribute to poor COVID-19 outcomes in this population. Severe COVID-19 can lead to the deterioration of CKD/ESKD, resulting in acute kidney injury, septic shock, and respiratory failure. Moreover, patients with CKD/ESKD have shown impaired response to COVID-19 vaccination, with seroconversion failures associated with the burden of immunosuppressive treatments, further heightening their vulnerability to severe disease. Despite the current endemic, it is crucial to acknowledge the ongoing significance of COVID-19 as a serious threat to patients burdened with chronic diseases like CKD and ESRD. Understanding the impact of COVID-19 on these patients is essential, as they remain at risk of severe disease progression. This paper presents the results of a literature review to enhance our understanding of COVID-19-related risks in patients with CKD/ESKD. Expert insights and illustrative scenarios provide practical perspectives and highlight the importance of risk stratification based on clinical factors for guiding targeted measures and treatments to mitigate COVID-19 risks in these vulnerable patients.

Reassessment of the fatigue life for wind turbines structural components is typically performed using deterministic methods with the same partial safety factors as used for the original design. However, in relation to life extension, the conditions are generally different from the assumptions used for calibration of partial safety factors; and using a deterministic assessment method with these partial safety factors might not lead to optimal decisions. In this paper, the deterministic assessment method is compared to probabilistic and risk-based approaches, and the economic feasibility is assessed for a case wind farm. Using the models also used for calibration of partial safety factors in IEC61400-1 ed. 4 it is found that the probabilistic assessment generally leads to longer additional fatigue life than the deterministic assessment method. The longer duration of the extended life can make life extension feasible in more situations. The risk-based model is applied to include the risk of failure directly in the economic feasibility assessment and it is found that the reliability can be much lower than the target for new turbines, without compromising the economic feasibility.

Healthy life style is associated with decreased risk of chronic kidney disease (CKD) and mortality in the general population. However, there is no definitive evidence on the benefits of physical activity and other health-related behaviors in the early-stage CKD. This study aimed to explore the association between health-related behaviors and end-stage renal disease (ESRD) and mortality in the early stages of CKD. The National Health Insurance Service (NHIS) database from January 1st, 2009 to December 31st, 2016 was used to screen 83,470 subjects with early stage CKD. Cox proportional hazard regression analysis was used to evaluate the association between health-related behaviors and ESRD and death. Kaplan-Meier curves for mortality and ESRD were plotted according to the physical activity, smoking status and alcohol consumption pattern. Risk of death decreased significantly in subjects who engaged in sufficient physical activity (adjusted Hazard Ratio (HR) 0.73; 95% CI: 0.64-0.83; p < 0.001). Risk of ESRD and death increased significantly in the current smoker with adjusted HR of 1.44 (95% CI: 1.06-1.95; p < 0.02) and 1.61 (95% CI: 1.44-1.80; p < 0.001) respectively. Therefore, systematic interventions to encourage physical activity and smoking cessation need to be actively considered in the early stages of CKD.

The heavy demand of water resources from the Zarqa River Basin (ZRB) has resulted in a base-flow reduction of the River from 5m³/s to less than 1m³/s. This paper aims at predicting Curve Numbers (CN) as a baseline scenario and proposing restoration scenarios for ZRB. The method includes classifying the soil type and land use, predicting CNs, and proposing CN restoration scenarios. Prediction of existing CNs will be in parallel with the runoff prediction using the US Army Corps of Engineers HEC-1 Model, and Rainfall-Runoff Model (RRM). The models have been set up at the land use distribution of 0.3% water body, 9.3% forest and orchard, 71% mixture of grass, weeds, and desert shrubs, 7.0% crops, 4.0% urban areas, and 8.4% bare soil. The results show that CN under dry condition are 59, 78 under a normal condition and 89 under a wet condition. During vegetation period, CN are 52, 72 and 86 for the dry, normal and wet condition respectively. The restoration scenarios; CN decreases runoff, and increases soil moisture when using the contours, terraces and crop residues. Analyzing results of CN scenarios will be a fundamental tool to support end-users related to their targets to achieve watershed restoration.

This paper designs and fabricates a small-type permanent-magnet linear motor and driver for automation applications. It covers structural design, magnetic circuit analysis, control strategies, and hardware development. Magnetic circuit analysis software JMAG is used for flux density distribution, back electromotive force(back-EMF), and electromagnetic force analysis. To address end effects and cogging force, auxiliary core structures and control strategies are proposed. The motor has a three-phase, six-coil, seven-pole configuration, achieving a peak phase voltage of 3.621 V at 1.0 m/s with a total harmonic distortion(THD) of 0.49 % and the voltages of each phase are balancing a phase voltage error of -0.002 V. The average electromagnetic force is 5.46 N/A. The driver uses a three-phase inverter with voltage space vector pulse width modulation(VSVPWM), dq-axes current closed-loop control, electromagnetic force control, and S-curve motion trajectory control. Simulations with JMAG-RT models in MATLAB/Simulink verify the control strategies. A microcontroller (TMS320F280045) serves as the control core, and a magnetic encoder with a 488 nm resolution provides position feedback. Each phase winding has an equivalent resistance of approximately 3.0 Ω and an inductance of approximately 1.98 mH. The S-curve motion trajectory control achieves a maximum position error of approximately 5.0 μm and a speed ripple of approximately 0.03 m/s at steady speed. With cogging force improvement, the maximum electromagnetic force is 4.90 N, and the q-axis current compensates around 1.05 A based on mover position. S-curve motion trajectory control results in highly stable and responsive performance. Practical tests show that the designed small-type permanent-magnet linear motor and its driver provide efficient, stable, and high-precision solutions for automation applications.

Falls are extremely damaging to the elderly. The number of elderly who have experienced falls has increased over the years, several of the elderly stay alone or in in badly maintained elderly homes. This makes a low-cost fall detection system a necessity. There has been huge improvements in terms of IoT systems, ML algorithms. Varied data sets have been collected across the world for fall detection. These data sets have a very little in common among them, in terms of user demographics, sensors used, the ADL and Fall activities Hence in this paper we present a data set that has wide user demographics, we used various sensors – such as accelerometer, gyroscope, magnetometer and hear rate. We used wrist worn sensors to collect data. In this paper we present a detailed analysis of the data set we collected using common ML algorithms such as – Naïve Bayes (NB), K Nearest Neighbor (KNN), Logistic Regression (LR), Random Forest (RF) and Support Vector Machines (SVM). We analyzed the performance of these algorithms for variations in accuracy with respect to age, gender, height, weight and health issues and we have identified outliers by analyzing each incorrect prediction. This paper provides the complete details of the data collection methodology, The methods used for analysis and presents the results of analysis in complete detail.