Introduction: The reduced implementation of surveillance programs and limited bedside infectious diseases consultations due to the pressure of COVID-19 pandemic in healthcare systems led to increased rates of irrational use of antimicrobials and incidence of infections by multidrug-resistant microorganisms. The aim of the present study is to evaluate the incidence of antimicrobial resistance and the management of bloodstream infections before and during COVID-19 pandemic at the University General Hospital of Alexandroupolis (Greece). Material-Methods: This is a retrospective study conducted from January 2018 to December 2022. Data were collected from the University Microbiology Laboratory per semester regarding the isolated strains of Gram positive and negative bacteria in blood cultures and respiratory samples in hospitalized patients in medical and surgical wards and in the Intensive Care Unit (ICU). Additionally, bloodstream infections with requested infectious diseases consultation were reported (n=400), determining whether these were carried out via telephone contact or at the patient's bedside. Demographic data, comorbidities, focus of infection, antimicrobial regimen, duration of treatment, length of hospitalization and clinical outcome were analysed. Results: A total of 4569 strains of Gram positive and negative bacteria were isolated. An increasing trend was reported compared to the pre-pandemic period in the incidence of resistant Gram-negative bacteria, particularly in ICUs. Prior antimicrobial use and the rate of hospital-acquired infections were increased significantly during the pandemic. In the pre-pandemic period 2018-2019, a total of 246 infectious diseases consultations were carried out, while during the period 2020-2022 154, with the percentage of telephone consultations 15% and 76% respectively. Detection of the source of infection and timely administration of appropriate antimicrobial agents were more frequently recorded before the pandemic and 28-day mortality was significantly reduced in cases with bedside consultations. Conclusion: Empowering of infectious diseases surveillance programs and committees, rational use of antimicrobials agents and bedside infectious diseases consultations are vital in order to reduce the impact of infections caused by multidrug-resistant strains.

Recently, many independent research project focus on the study of the molecular basis of aging processes. I parallel, the different progression of many diseaes between sex is a hot topic research area. These studies require many data, models and tools for inferring aging and sex specific molecular machinaries. Among the others, the Genotype-Tissue Expression (GTEx) database is one of the preminent resources for the analysis of expression data related to tissues, sex and age. The current version of the database has a lot of querying interface that enable many analysis centered on the expression of genes on tissues. Despite this the database lacks on the analysis at sex/age level, thus the researcher has to download data and then write queries by hand. Nevertheless it lacks on the integration with existing protein interaction data. Therefore, the need for the introduction of tools enabling easy access and powerful analysis capabilities (i.e. state of the art network based analysis and integration), arises. We here present NOMA-DB a framework for the analysis of age related genes based on the GTEx database that enable easy querying at sex/age level, network based analysis. The framework is based on wrapping the GTEx database and on building an application logic level on top of existing data. The current version enables the analysis of genes by tissue, gene and age, thus it may be used in potentially future directions of analysis towards better comprehension of aging/sex-related molecular machineries based on the analysis of expression dat

Acute low back pain (LBP) stands as a leading cause of activity limitation and work absenteeism, and its associated healthcare expenditures are expected to become substantial when acute LBP develops into a chronic and even refractory condition. Therefore, early intervention is crucial to prevent progression to chronic pain whose management is particularly challenging and for which the most effective pharmacological therapy is still controversial. Current guideline treatment recommendations vary and are mostly driven by expertise with opinion differing across different interventions. Thus, it is difficult to formulate evidence-based guidance when relatively few randomized clinical trials did explore the diagnosis and management of LBP while employing different selection criteria, statistical analyses, and outcome measurements. This narrative review aims to provide a critical appraisal of current acute LBP management by discussing the unmet needs and areas of improvement from bench-to-bedside and proposes multimodal analgesia as the way forward to attain an effective and prolonged pain relief and functional recovery in patients with acute LBP.

Introduction Hydroxychloroquine (HCQ) is an antimalarial agent that has been tried out in the treatment of COVID-19, however, evidence of efficacy remains limited. Although Hydroxychloroquine overdose is not common, growing cases of poisoning with HCQ have been reported during recent years. HCQ toxicity is characterized by life-threatening symptoms which require immediate medical intervention. This report presents a suicide attempt in a hyperglycemic patient, massive ingestion of HCQ manifested by hypokalemia and acidosis.Case summaryA 47-year-old man presented at the hospital hours after massive ingestion of HCQ (100 tablets), with generalized weakness and dizziness which had led to a fall. He was drowsy and had experienced episodes of nausea/vomiting. His past medical history was remarkable for uncontrolled diabetes mellitus, confirmed by the blood glucose of 345 mg/dL, and a previous history of hospitalization a few months ago, due to a suicide attempt. He developed marked hypokalemia accompanied by acidosis, plasma potassium of 2.8 mmol/L and pH 7.34, and hypotension, blood pressure of 80/51 mm Hg, but survived with close cardiac monitoring and immediate intervention including aggressive potassium replacement, bicarbonate infusion, and charcoal administration. ConclusionConsidering the significantly increased off-label use of HCQ during the COVID-19 pandemic, this report alerts the potential for HCQ to be associated with severe electrolyte disorders, especially in predisposing conditions like diabetes. Clinicians should keep in mind the possibility of hypoglycemia in diabetic patients under hypoglycemic medications and concurrent use of chloroquine/HCQ. This therapeutic approach also suggests the benefit of even a delayed activated charcoal administration in the treatment of HCQ poisoning.

Electric Vehicles (EVs) are the need of the hour due to growing climate change problems linked with the transportation sector. Battery Thermal Management System (BTMS), which is accountable for certifying safety and performance of lithium-ion batteries (LiB), is the most vital part of an EV. LiB has auspicious gravimetric energy density but the heat generation due to chemical reactions inside a LiB during charging and discharging causes temperature rise which has a direct effect on LiB performance and safety. This study specifically focuses on aircooled BTMS, defines different types of air-cooled BTMS (active and Passive), discusses limitations associated with air-cooled BTMS, and investigates different optimization techniques and parameters to improve performance of air-cooled BTMS. Maintaining temperature within optimum range and uniform temperature distribution between cells of a battery pack are the major design parameters for improving the performance and efficiency of air-cooled BTMS. Various optimization techniques including cell arrangement with a battery pack, air-flow channel optimization, and air inlet/outlet position variations are discussed and each technique is thoroughly reviewed. Finally, it’s noted that passive air-cooled BTMS is not that effective for long-distance vehicles so most researchers shifted their focus toward active air-cooled BTMS. Active air-cooled BTMS requires a lot of power for effective performance. Lastly, the most recent field of air-cooled BTMS technology which is Air-Hybrid BTMS is discussed and declared a very promising solution for overcoming major limitations associated with air-cooled BTMS.

The River Basin Management Plan (RBMP) is an essential component of the European Union Water Framework Directive that details an integrated approach required to protect, improve and sustainably manage water resources. RBMP were intended to be produced for the periods 2009-2015, 2016-2021 and 2022-2027. However, after two years of delays in the development processes, the Republic of Ireland produced its first RBMP in 2010. The second RBMP cycle was also implemented in 2018 and is expected to run until the end of 2021 to give way to the third RBMP, whose consultation processes have been ongoing since December 2019. This paper contributes to the forthcoming RBMP by assessing stakeholders’ perspectives on the second RBMP through a desk-based review and by conducting interviews with nine institutions (14 interviewees). The qualitatively analysed interviews reveal a broad spectrum of actors associated with water management and governance in the Republic of Ireland through a three-tier governance structure that has been delivered (with amendment) through the first two RBMPs. Organisations such as the An Fóram Uisce|The Water Forum, the Environmental Protection Agency, the Local Authority Waters, and the Agricultural Sustainability Support and Advisory Programme have responsibilities designated in the RBMPs to deliver improved water quality, integrated catchment management, community engagement and awareness-raising. Trust has also been building up among these organisations and other agencies in the water sector. Despite these responsibilities and progress, the interviews identified communication lapses, ineffective collaboration and coordination among stakeholders and late implementation to be hampering the successful delivery of the second RBMP, in addition to significant pressures acting on water bodies from agricultural activities and urban wastewater treatment. Towards the third RBMP, the paper concludes that optimised water sector finance, enhanced and well-resourced communications, and improved stakeholder collaboration are needed to foster effective and efficient water services delivery and quality. More so, given the cross-cutting impact of the Sustainable Development Goals on water resources and the interconnected relations among the goals, the paper further recommends the integration of the SDGs in the various plans of actions and a co-benefits approach to derive the triple benefits from biodiversity, climate change initiatives and water quality measures.

Novel Coronavirus (2019-nCOV) causes inflammatory response with worsening symptoms. Classification of potential anti-viral and anti-inflammatory drugs in managing the symptoms of the COVID-19 and reducing morbidity is important. The objective of this study is to identify a group of drugs, best suited for COVID-19 treatment based on recent developments in clinical trials, FDA drug evaluation, directions and developments and from drug therapies globally. Online literature search was done on Medline, PubMed and google scholar databases for studies on various treatments and drug therapies for COVID-19 and relevant studies were identified and the identified drugs are described in detail as per their Pharmacological, pharmaceutical properties of the drugs, mechanism of action, current COVID-19 drug therapy, contraindications and drug-drug interactions Certain drugs can inhibit action against viral infection and protect lungs from severe inflammatory response. This article summarizes several drugs like Hydroxychloroquine, Chloroquine, Remdesivir, Favipiravir, Lopinavir, Ritonavir, Dexamethasone, Ivermectin, Baricitinib, Casirivimab / imdevimab, Bamlanivimab along with auxiliary treatment like convalescent plasma transfusion. Remdesivir is first drug approved by FDA. Hydroxychloroquine, dexamethasone and remdesivir are showing results against COVID-19 but it is important to test the efficacy and safety of such drugs though some drugs have shown remarkable results.

The targeted application of plant growth promoting rhizobacteria (PGPR) provides the key for a future sustainable agriculture with reduced pesticide application. PGPR interaction with the indigenous microbiota is poorly understood but essential to develop reliable applications. Therefore, Stenotrophomonas rhizophila SPA-P69 was applied as seed coating and in combination with a fungicide based on the active ingredients fludioxonil, metalaxyl-M, captan and ziram. Plant performance and rhizosphere composition of treated and non-treated maize plants of two field trials were analyzed. Plant health was significantly increased by treatment; however overall corn yield was not changed. By applying high-throughput amplicon sequencing of the 16S rRNA and the ITS genes, the bacterial and fungal changes in the rhizosphere due to different treatments were determined. Despite treatments had a significant impact on the rhizosphere microbiota (9- 12%), the field site was identified as main driver (27- 37%). Soil microbiota composition from each site was significantly different, which explains the site-specific effects. In this study we were able to show first indications how PGPR treatments increase plant health via microbiome shifts in a site-specific manner. This way first steps towards a detailed understanding of PGPRs and developments of consistently efficient applications in diverse environments are set.

The aim of this study was to assess the best timing to perform arthrocentesis in the management of temporomandibular disorders with regards to conservative treatment. A systematic search based on PRISMA guidelines, including a computer search with specific keywords, reference list search, and manual search was done. Relevant articles were selected after 3 search rounds for final review based on 6 predefined inclusion criteria, followed by a round of critical appraisal. Eleven publications, including 5 randomized controlled trials and 6 prospective clinical studies informed this review. The studies were divided into 3 groups based on the timing of arthrocentesis: 1). Arthrocentesis as the initial treatment, 2). Early arthrocentesis, and 3). Late arthrocentesis. Meta-analyses compared the efficacy of improvement in mouth opening and pain reduction in the 3 groups. The results were statistically significant and favoured early arthrocentesis, followed by late arthrocentesis in terms of both improvements in mouth opening and pain reduction. All 3 groups showed improvement in mouth opening and pain reduction. We conclude that early arthrocentesis may be able to produce the best clinical results, while arthrocentesis before attempting conservative treatment may produce less favourable outcomes.

This paper is focused on the analysis of methods used to assess effectiveness and efficiency of the occupational safety and health management system (OSHMS) in a company. It reviews current Russian and international occupational safety and health standards. The paper details the method outlined in International Standard GOST 12.0.230.3-2016 “Occupational safety standards system. Management systems for occupational safety. Evaluation of effectiveness and efficiency” based on the data collected during the external audit of OSHMS function efficiency in a Russian mining company. Effectiveness and efficiency indicators were determined, and a generalized desirability coefficient was calculated. Weaknesses of the method proposed in GOST 12.0.230.3-2016 were identified and mathematical and linguistic solutions were proposed to improve it. Harrington function was used to determine a numerical and linguistic score. The performed calculation demonstrated that the company needed strategic management decisions to improve the current situation. Practical approaches were offered to enhance the company's systems-based occupational safety and health performance..

Nerve hydrodissection (HD), a technique used when treating nerve entrapments, involves using an anesthetic or solution such as saline or 5% dextrose solution to separate the nerve from the surrounding tissue, fascia, or adjacent structures. This technique aims to treat neuropathic pain, or pain caused by the nerve. Ultrasound-guided HD of peripheral nerves has gained significant attention in the medical profession and pain management fields in recent years. This is due to a number of high impact publications of randomized control trials demonstrating the efficacy and safety of this technique for the treatment of carpal tunnel syndrome. Even the 20th edition of Harrison’s Principles of Internal Medicine textbook lists injection of 5% dextrose as an alternative local treatment that does not have the side effects of corticosteroids. At present, there is no review of the current literature on this technique. This manuscript will summarize and discuss the following: 1) the different approaches to doing ultrasound-guided HD of nervous structures, 2) its usages in different clinical situations, 3) its clinical pearls, 4) the solution used, and 5) the postulated mechanisms of action.

Detection of PLA2R and THSD7A among primary membranous glomerulonephritis (MGN) patients transformed the diagnosis, treatment monitoring and prognosis. Anti-PLA2R can be detected in 70-90% of primary MGN patients while anti-THSD7A in 2-3% of anti-PLA2R negative primary MGN patients depending on the technique used. Serum and urine samples are less invasive and non-invasive respectively and can detect the presence of anti-PLA2R and anti-THSD7A with higher sensitivity and specificity, significant in patients’ monitoring and prognosis better than exposing patients to frequent biopsy which is an invasive procedure. Different techniques of detection of PLA2R and THSD7A in patients’ urine and sera were reviewed with the aim of providing newer and alternative techniques. We proposed the use of biomarkers (PLA2R and THSD7A) in making the diagnosis, treatment decision and follow up of patients with primary MGN. We also reviewed other prognostic renal biomarkers like retinol binding protein (RBP) and beta-2 microglobulin in order to detect progression of renal damage for early intervention.

Water supply is a mandatory service for Tanzanians from respective legal public water utilities, and their sustainability reflects implementations of best management strategies at a local level. The objective of this study was to assess current approaches used in water quality and quantity management in Tanzania. This was achieved through secondary water data tends, on-site water quality assessments, visits of respective water supply and sanitation authorities, and assessment of their performances. It was observed that water supplied in rural-based authorities was quite different from that supplied in an urban setting as far as quality and quantity is concerned, urban-based supplies being of assistance to users over rural ones. A new strategy on water management is presented for sustainable water supply in Tanzania; it is based on controlling groundwater abstractions and preference of surface water in public water supplies. Rural water supply management must learn several practices realized at urban supplies for the betterment of respective majority water users.

Acute pancreatitis (AP) is an inflammatory condition of the pancreas and is one of the most common ailments of the gastrointestinal system that results in significant morbidity and mortality. The main etiologic causes of AP are alcohol consumption, gallstones, hypertriglyceridemia, and biliary stones. The clinical signs and symptoms, and diagnostic criteria of AP are well established in the literature and multiple studies. Multiple scoring systems have been used to predict the severity, prognosis, and mortality associated with AP. The present review of the literature brings to light the significant and recent contributions in the etiology, risk factors, epidemiology, diagnosis, complications, prognosis and newest modalities in treatment that could be beneficial in the management of AP.

Knowledge management gains space within the school organization and can contribute satisfactorily to the quality of teaching. In everyday life the school manager intuitively uses knowledge management practices without exploiting the potentials they offer or allow. In this context, the purpose of this work is to identify the level of implementation of knowledge management practices aimed at structuring the organizational processes used by the public school manager. The methodology adopted was exploratory, with a qualitative and quantitative approach. For data collection, an already validated instrument with twenty-seven questions was used. Respondents to the questionnaires, one hundred and eleven managers of the basic education schools that make up the public school system in a city in the northwestern region of Paraná, Southern Brazil. In analyzing the results, it was only at this point that we investigated only those practices that were related to the structuring of organizational processes. This decision is justified because of the responsibilities of the school manager in the execution of his work. The results indicated that the school in its daily life, makes use of practices of Knowledge Management related to the structuring of the organizational processes and that many are already applied by the managers.

Lean is one of the systematic approach to achieve higher value for organizations through eliminate non-value-added activities. It is an integrated set of tools, techniques, and principles designed to optimize cost, quality and delivery while improving safety. In Vietnam, industry waste management and treatment has become serious issue. The aim of this research is to present the effective of Lean application for industrial wastes collecting and delivery improvement. Through a case study, this paper showed the way of Lean tools and principles applied for wastes management and treatment such as Value Stream Mapping, Pull system, Visual Control, and Andon.... to get benefit on both economic and environment. In addition, the results introduced a good experience for Vietnamese enterprises in cost saving and sustainable development in waste management.

The alteration of the delicate balance that regulates the secretion and distribution of the tear film determines the dry eye (DE) syndrome, because the tear film represents the interface between the eye and the environment. Despite having a multifactorial origin, the main risk factors for the emergence of the ocular disease are female gender and advanced age. Likewise, morphological changes in several glands and in chemical composition of their secretions such as proteins, mucins, lipidics, aqueous tears, and salinity, are highly relevant factors to maintain a condition of good health of the ocular anterior segment. Another key factor of recurrence and onset of the disease is the presence of local and/or systemic infiammation that reflex on the ocular surface. However, it is one of the most commonly encountered disease in clinical practice and many other causes related to daily life and to lengthen the average life will contribute to the beginning. This review will consider how and what disorders of the ocular surface are responsible for a widespread pathology so. In the end, the most appropriate and new therapies will be briefly exposed according to the specific pathology.

Distribution System Operators (DSOs) are adapting to changing energy demands and the shift toward renewable and decentralized energy. Circularity is increasingly relevant for DSOs as their distribution systems age and need replacing. Taking circular action, however, is generally regarded as challenging as the current circular economy (CE) landscape is highly fragmented and rarely touches the implementation level. A longitudinal case study at Dutch DSO Liander on the circu-larity of distribution transformers was used to understand empirical success factors for taking circular action and to generate prescriptive knowledge on the operationalization of circularity. Six design propositions for circular action were formulated that suggest to 1) initiate small-scale cir-cularity experiments, 2) involve technical and strategic experts, 3) synergize circularity with more urgent, primary goals 4) translate circular initiatives bottom-up and top-down, 5) collaborate with other DSOs, and 6) create multidisciplinary teams. At DSO Liander, selecting the right interventions depending on the changing context contributed to operationalizing circularity for distribution transformers and achieving circularity targets. The generalizable design propositions could assist other DSOs in optimizing their strategy toward circular action.

Whole genome duplication (WGD) or polyploidization can occur at the cellular, tissue, and organismal levels. At the cellular level, tetraploidization has been proposed as a driver of aneuploidy and genome instability, and correlates strongly with cancer progression, metastasis, and development of drugs resistance[1–6]. WGD is also a key developmental strategy for regulating cell size, metabolism, and cellular function[1,7–10]. In specific tissues, WGD is involved in normal development (e.g. organogenesis), tissue homeostasis, wound healing, and regeneration[10–17]. At the organismal level, WGD propels evolutionary processes such as adaptation[18], speciation[19], and crop domestication[20]. An essential strategy to further our understanding of the mechanisms promoting WGD and its effects is to compare isogenic strains that differ only in their ploidy. Caenorhabditis elegans (C. elegans) is emerging as an animal model for these comparisons, in part because relatively stable and fertile tetraploid strains can be produced rapidly from nearly any diploid strain[7]. Here we review the use of Caenorhabditis polyploids as tools to understand important developmental processes (e.g. sex determination, dosage compensation, and allometric relationships)[21–27] and cellular processes (e.g. cell cycle regulation, chromosome dynamics during meiosis)[28–32]. We also discuss how the unique characteristics of the C. elegans WGD model will enable significant advances in our understanding of mechanisms of polyploidization and its role in development and disease.

Pigeonpea (Cajanus cajan) is one of the important grain legume crops cultivated in the semi-arid tropics, playing a crucial role in the economic well-being of subsistence farmers. India is the major producer of pigeonpea, accounting for over 75 per cent of the world's production. Sterility mosaic disease (SMD), caused by Pigeonpea sterility mosaic virus (PPSMV) and transmitted by the eriophyid mite (Aceria cajani), is a major constraint to pigeonpea cultivation in the Indian subcontinent, leading to potential yield losses of up to 100 per cent. The recent characterization of another Emaravirus associated with SMD has further complicated the etiology of this challenging viral disease. This review focuses on critical areas, including the current status of the disease, transmission and host-range, rapid phenotyping techniques, as well as available disease management strategies. The review concludes with insights into the future prospects, offering an overview and direction for further research and management strategies.

The forage fish, a crucial source of nutrition in developing countries, are unfortunately primarily used for fishmeal and aquafeed production for aquaculture that mainly serves consumers in developed countries. Industrial fish use leaves a meager portion of the catch for direct human consumption in the fish-producing countries, leading to inflated fish prices locally. Overfishing forage fish necessary to support the fish reduction industry disrupts the ecosystem, diminishes the catch of larger fish, such as mackerel, and marginalizes local artisanal fishermen. This article appraises roughly the financial and nutritional impacts of elevated fish prices on low-income consumers in forage fish-producing countries, drawing attention to the ethical implications of this situation. A hypothetical 10% boost in the annual supply of fresh forage fish to the current global supply of 5 million MT markets could save consumers hundreds of millions of US dollars globally, tens of mil-lions of US dollars nationally, and several dollars for a family while improving the nutrition of families that depend on forage fish. The numbers suggest that even a modest boost to the supply of forage fish in fresh fish markets could significantly benefit the fish-producing nations' consumers and the fish-producing nations. In some countries, such as South Africa, the orders of magnitude of these sums approach that of the entire local fish reduction industries' value. The increased fish prices could be considered involuntary subsidies by low-income consumers to the aquafeed and aquaculture industries. In summary, the reduction industry's and aquaculture's current use of captured forage fish warrants further scrutiny, as it inadvertently burdens disadvantaged societies financially and nutritionally. The article proposes alternative protein sources and cultivating non-carnivorous fish among several optional measures to ensure equitable distribution of forage fish resources.

Credit business is a vital part of the bank's core business, which has an extremely important impact on the bank's income and development. In the operation of credit business, credit risk assessment is particularly crucial, and accurate risk assessment can minimize risks while maximizing the bank's returns. We propose a method to optimize credit risk assessment using machine learning techniques. In this work, we employ a random forest machine learning model to process and analyze large amounts of loan application data. By using correlation analysis, information enrichment, etc., the characteristics that have the most impact on credit risk assessment are screened. Subsequently, the model was constructed using a random forest algorithm. Random forests improve the generalization ability and accuracy of the model by building multiple decision trees and introducing randomness between these trees. In the experimental analysis part, we compare the performance of various models on the German credit dataset, and the results show that the deep learning model outperforms the traditional machine learning model in most indicators, verifying the effectiveness of our method.

Introduction: This population-based retrospective cohort study assesses rates of adverse events (AEs) involving cerebral thromboembolism (CTE) after COVID-19 vaccines. Methods: Data were collected from the U.S. Centers for Disease Control and Prevention (CDC) and Food and Drug Administration (FDA) Vaccine Adverse Event Reporting System (VAERS) database from January 1, 1990 to December 31, 2023. CTE AEs after COVID-19 vaccines were compared to those after influenza vaccines and after all other vaccines using proportional reporting ratio (PRR) analysis by time. Results: There are 5137 cerebral thromboembolism AEs reported in the 3 years (36 months) after COVID-19 vaccines compared to 52 AEs for the influenza vaccines over the past 34 years (408 months) and 282 AEs for all other vaccines (excluding COVID-19) over the past 34 years (408 months). The PRR’s are significant when comparing AEs by time from COVID-19 vaccines to that of the influenza vaccines (p < 0.0001) or to that of all other vaccines (p < 0.0001). The CTE AEs PRR by time (95% confidence intervals) for the COVID-19 vaccine AEs vs influenza AEs is 1120 (95% confidence interval (723-1730), p < 0.0001) and for COVID-19 vaccines vs all others is 207 (95% confidence interval (144-296), p < 0.0001). Cerebral venous thromboembolism AEs are female predominant with a female/male odds ratio of 1.63 (95% confidence interval (1.52-1.74), p < 0.0001). Conversely, cerebral arterial thromboembolism has a nonsignificant male preponderance. Cerebral venous thromboembolism is far more common than cerebral arterial thromboembolism over 36 months with an odds ratio (OR) of 14.8 (95% confidence interval 14.0-15.5, p < 0.0001). Atrial fibrillation, the most common identifiable cause of cerebral arterial thromboembolism, occurs far more commonly after the COVID-19 as compared to all other vaccines with a PRR of 123 (95% CI 88.3-172, p < 0.0001) Conclusions: There is an alarming breach in the safety signal threshold concerning cerebral thrombosis AEs after COVID-19 vaccines compared to that of the influenza vaccines and even when compared to that of all other vaccines. An immediate global moratorium on the use of COVID-19 vaccines is necessary with an absolute contraindication in women of reproductive age.

The use of artificial intelligence technologies may help companies obtain the optimal use of resources and accomplish more activities with an increase in productivity by 40%. With access to real-time data and the ability to learn from patterns and behaviors, AI can perform these routine tasks more efficiently. Ambient intelligence, Ami, is one of the applications of artificial intelligence, which is called artificial environmental intelligence, which is a concept that focuses on using technology to create an environment that is intelligent and responsive to the needs of its users. This technology has the potential to revolutionize disaster response and management, which in turn facilitates access to necessary information and resources. necessary vitality in the event of a crisis. It may use ambient intelligence to create a network of sensors that can detect and respond to changes in the environment. So that this network can be used to monitor the environment for potential disasters, such as floods, fires and earthquakes. Sensors can also be used to detect changes in temperature, humidity, and other environmental factors that may indicate a potential disaster. This information can then be used to alert emergency responders and provide them with the information needed to respond quickly and effectively. Ambient intelligence can also be used to create a comprehensive database of resources and information that can be accessed in times of crisis. This database may include information about the location of shelters, medical facilities, and other resources that can be used to assist those affected by a disaster. It may also provide information about the condition of roads, bridges, and other infrastructure that may be affected by a disaster. This information can be used to inform response and management decisions, helping to ensure that resources are used in the most efficient way possible. Ambient intelligence can be used to create a communication platform between emergency responders and those affected by a disaster. This platform can also be used to provide updates on the emergency situation, in addition to providing information about available resources to those affected. This can help ensure that those affected by a disaster can access the resources they need in a timely manner.

Objective: To evaluate which risk factors contribute directly or indirectly to Toxoplasma gondii infection in patients with ocular toxoplasmosis. Methods: Between 2018-2020, a total of 306 patients were selected, and treated at the Retinology Outpatient Clinic of the Specialty Hospital of Sāo José do Rio Preto, in the state of São Paulo. After the fundoscopy test, the Enzyme Linked Fluorescent Assay (ELFA) was used to determine IgG and IgM class anti-Toxoplasma gondii antibodies. Results: The results showed that individuals aged 60 years or older, and women who had a previous pregnancy, (p=0.000, OR= 8.137 and 95 % CI = 2.562 – 25.844), (p=0.016, OR= 7.395 and CI 95 % = 1,449 – 37,725) respectively, were 48.6 % more likely to develop ocular toxoplasmosis. Conclusion: In this way, previous pregnancy is a risk factor for the reactivation of toxoplasma, as well as for the generation of retinochoroiditis in previously infected women.

Background: Vitamin B12 is a water-soluble vitamin with important cellular functions and is an essential vitamin. The aim of this study is to determine the B12 levels of children in the period from the 6th month when they start taking additional foods to the age of 7 and the risk factors affecting them. Methods: One hundred pediatric patients aged 6-72 months who were diagnosed with vitamin B12 deficiency and their parents who agreed to participate in Istanbul Atlas University, Medical Faculty, “Medicine Hospital” Pediatric Clinic between September 2022 and June 2023 were prospectively included in this study. Results: B12 deficiency was significantly higher in the 6-11 (25%) month group than those in the 12-23 (5.8%) and 24-47 (2.8%) month groups. Homocysteine levels were highest in those with insufficient B12 levels compared to the other groups. There was no statistically significant difference in weekly dairy and meat consumption levels between age groups. B12 levels were lower in the 6-11-month group than in the other groups. Homocysteine levels were highest in those with insufficient B12 levels [<200 pg/mL (148 pmol/L)]. Folic acid levels were lower in the 24-47 month and 48-72 month groups than in the 6-11 month and 12-23 month groups. Conclusions: The results obtained in this study showed that low vitamin B12 and increased homocysteine levels seem to be important risk factors in children, especially from the 6th month when they start taking additional foods. The diagnosis of B12 deficiency can be confirmed by elevated serum total homocysteine levels, which are evidence of functional cobalamin deficiency.

The city administration of China planned numerous metro projects and more metros can hardly avoid undercrossing a bridge. While metro shield construction when undercrossing a bridge (MSCUB) is frequently located in complicated natural and social context, which made the construction process more susceptible to safety accidents. Therefore, it is crucial to look into safety risk of MSCUB. The paper identified the safety risk factors during SSCUR by using literature review and experts’ evaluation, proposed a novel safety risk assessment model by integrating CFA and FER, and then selected a project case to test the validity of the suggested model. Research results show that (a) a safety risk factors list of MSCUB was identified, including 4 first-level safety risks and 37 second-level safety risk factors; (b) the proposed safety risk assessment model can be used to measure the risk values of the overall worksite safety risk, the first-level safety risks and the safety risk factors of MSCUB; (c) environment-type safety risk and personnel-type safety risk have higher risk values when shield construction undercrossing a bridge; (d) when compared to worker-type safety risk, manager-type safety risk is the higher risk value. The research can enrich the theoretic knowledge of MSCUB safety risk assessment and provide references to safety managers for conducting scientific and effective safety management on the construction site when subway undercrossing a river.

In this systematic review of the literature on using Machine Learning (ML) for credit risk prediction, we raise the need for financial institutions to use AI and ML to assess credit risk, analyzing large volumes of information. We posed research questions about algorithms, metrics, results, data sets, variables, and related limitations in predicting credit risk. We searched renowned databases to answer them and identified 52 relevant studies with the credit industry microfinance. Challenges and approaches in credit risk prediction using ML models we identified, difficulties with the implemented models such as the black box model, the need for explanatory artificial intelligence, the importance of selecting relevant features, addressing multicollinearity, and the problem of the imbalance in the input data. By answering the questions, we identified that the Boosted Category is the most researched family of ML models; the most commonly used metrics for evaluation are Area Under Curve (AUC), Accuracy (ACC), Recall, precision measure F1 (F1), and Precision; Research mainly uses public data sets to compare models, and private ones to generate new knowledge when applied to the real world. The most significant limitation identified is the representativeness of reality, and the variables primarily used in the microcredit industry are related data to the demographic, the operation, and payment behavior. This study aims to guide the developers of credit risk management tools and software towards the existing offer of ML methods, metrics, and techniques used to forecast it, thereby minimizing possible losses due to default and guiding risk appetite.

Forests, integral to human civilization, hold immense value and play a vital role in maintaining ecological harmony. Despite India's goal of extensive forest coverage, significant progress is still needed. Uncontrolled forest fires pose a severe threat, particularly in Uttarakhand's Pauri Garhwal district. To address this challenge, a comprehensive study examined surface and subsurface hydrological factors influencing the forest fire occurrences, such as elevation, aspect, slope, vegetation, proximity to human settlements, proximity to waterbodies, Active faults and lineament density. A total of 15 such factors were integrated with advanced techniques of remote sensing and GIS and coupled with historical fire data to create a precise forest fire risk map using the support vector machine algorithm. Forest fire risk map was classified into 5 distinct risk zones, Very High Risk (47.38 Km2), High Risk (275.98 km2, Moderate Risk (985.49 km2), Low Risk (1741.17 km2) and Very Low Risk (2374.11 km2) aiding in proactive fire management. By embracing this innovative tool, decision-makers can protect forests, preserve biodiversity, and ensure a sustainable future for generations to come.

Endocrine and nervous systems reciprocally interact to manage physiological individual functions and homeostasis. The nervous system modulates hormone release through the hypothalamus, the main cerebrally specialized structure of the neuroendocrine system. Indeed, it is involved in various metabolic processes, administering hormone and neuropeptide release at different levels. This complex activity is affected by neurons of various cerebral areas, environmental factors, peripheral organs, and mediators through feedback mechanisms. Therefore, neuroendocrine pathways have a key role in metabolic homeostasis control, and their abnormalities have been associated with the development of Metabolic Syndrome (MetS) in children. The impaired functioning of genes, hormones, and neuropeptides of various neuroendocrine pathways involved in several metabolic processes has been related to an increased risk of dyslipidaemia, visceral obesity, insulin resistance, type 2 diabetes mellitus, and hypertension. This review examines the neuroendocrine effects on the risk of MetS in children, identifying and underlying the several conditions associated with neuroendocrine pathway disruption. Neuroendocrine systems should be considered in the complex pathophysiology of MetS, and, when genetic or epigenetic mutations in "hot" pathways occur, they could be studied for new potential target therapies in severe and drug-resistant paediatric forms of MetS.

Background Pregnancy is a process of maturity for women that requires adaptation to the changes in their new roles. Adjustment to a new role is not easy, especially if the pregnancy is accompanied by risks, so it is necessary to get treatment to minimize complications. Dyad models that optimize husband or family support are very important to prevent the risk of complications and adapt mothers to their new roles. The purpose of this study was to determine the effect of the dyad model on high-risk pregnancies. The method used with a literature review is through the collection of articles from Scopus, ebsco, ProQuest and PubMed. The results obtained were articles from Scopus 9, Ebsco 107, PubMed 214 and ProQuest 85 which carried out identification, screening and eligibility for 25 articles. Overall results mention. Journals are categorized into 4 groups, Dyad Model and social support, high-risk pregnancy, maternal role and Self Efficacy. Conclusion, there is an effect of the dyad model on care for high-risk pregnancies.

SARS-CoV-2 infections underlie the current Coronavirus disease (COVID-19) pandemic and are causative for a high death toll particularly among elderly subjects and those with comorbidities. Selenium (Se) is an essential trace element of high importance for human health and particularly for a well-balanced immune response. Mortality risk from severe disease like sepsis or polytrauma is inversely related to Se status. We hypothesized that this relation also applies to COVID-19. Serum samples (n=166) from COVID-19 patients (n=33) were collected consecutively and analysed for total Se by X-ray fluorescence and selenoprotein P (SELENOP) by a validated ELISA. Both biomarkers showed the expected strong correlation (r=0.7758, p<0.001), pointing to an insufficient Se status for optimal selenoprotein expression. In comparison to reference data from a European cross sectional analysis (EPIC, n=1915), the patients showed a pronounced deficit in total serum Se (mean±SD, 50.8±15.7 vs. 84.4±23.4 µg/L) and SELENOP (3.0±1.4 vs. 4.3±1.0 mg/L). A Se status below the 2.5th percentile of the reference population, i.e., [Se] < 45.7 µg/L and [SELENOP] < 2.56 mg/L was present in 43.4% and 39.2% of COVID samples, respectively. The Se status was significantly higher in samples from surviving COVID patients as compared to non-survivors (Se; 53.3±16.2 vs. 40.8±8.1 µg/L, SELENOP; 3.3±1.3 vs. 2.1±0.9 mg/L). We conclude that Se status analysis in COVID patients provides diagnostic information. However, causality remains unknown due to the observational nature of this study. Nevertheless, the findings strengthen the notion on a relevant role of Se for COVID convalescence, and support the discussion on adjuvant Se supplementation in severely diseased and Se-deficient patients.

It has been a long time since the world has experienced a pandemic with such a rapid devastating impact as the current COVID-19 pandemic. The causative agent, the Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) is further unusual in that it appears capable of infecting many different mammal species. As a significant proportion of people worldwide are infected with SARS-CoV-2 and may spread the infection unknowingly before symptoms occur or without any symptoms ever occurring, there is a non-negligible risk of humans spreading SARS-CoV-2 to wildlife, in particular mammals. Because of SARS-CoV-2’s evolutionary origins in bats and reports of humans transmitting the virus to pets and zoo animals, regulations for prevention of human-to-animal transmission have so far focused mostly on these animal groups. Here, we summarize recent studies and reports that show that a wide range of distantly related mammals are likely susceptible to SARS-CoV-2 and that susceptibility or resistance to the virus is in general not predictable, or only to some extent, by phylogenetic proximity to known susceptible or resistant hosts. In the absence of solid evidence on the SARS-CoV-2 susceptibility/resistance for each of the >5,500 mammal species, we argue that sanitary precautions should be taken when interacting with any mammal species in the wild. Preventing human-to-wildlife SARS-CoV-2 transmission is important for protecting these (sometimes endangered) animals from disease, but also to avoid establishment of novel SARS-CoV-2 reservoirs in wild animals. The risk of repeated re-infection of humans from such a wildlife reservoir could severely hamper SARS-CoV-2 control efforts. For wildlife fieldworkers interacting directly or indirectly with mammals, we recommend sanitary precautions such as physical distancing, wearing face masks and gloves, and frequent decontamination, which are very similar to regulations currently imposed to prevent transmission among humans.

The recent worldwide outbreak of the novel corona-virus (COVID-19) opened up new challenges to the research community. Artificial intelligence (AI) driven methods can be useful to predict the parameters, risks, and effects of such an epidemic. Such predictions can be helpful to control and prevent the spread of such diseases. The main challenges of applying AI is the small volume of data and the uncertain nature. Here, we propose a shallow Long short-term memory (LSTM) based neural network to predict the risk category of a country. We have used a Bayesian optimization framework to optimized and automatically design country-specific networks. We have combined the trend data and weather data together for the prediction. The results show that the proposed pipeline outperforms against state-of-the-art methods for 170 countries data and can be a useful tool for such risk categorization. The tool can be used to predict long-duration outbreak of such an epidemic such that we can take preventive steps earlier.

As there is lack of understanding about the effect of transitioning between different flooring materials on the gait of older adults, this study investigated the effect of transitioning between a carpeted floor and a vinyl floor on the gait characteristics of older adults. Fourteen older (65 years old and over) and 14 younger (18 to 35 years old) adults walked on different transitional floors by measuring various gait parameters. While the older participants had greater toe clearance than their younger counterparts, the older participants had smaller toe clearance on a carpeted floor than on a vinyl floor, which would increase the probability of a trip-induced fall. Further, the study found the slower transitional acceleration of the whole body COM and the increased friction demand, especially during the toe-off phase, rather than heel contact phase, which will lead to a slip-induced fall on a vinyl floor shortly after transitioning from a carpeted floor to a vinyl floor. Although the increased likelihood of a slip or trip accident was found throughout the changes in gait parameters, the older participants did not perceive of slipping and tripping much. Therefore, older adults are recommended to be made aware of the danger of slipping and tripping while transitioning between different flooring materials.

Malignant mesothelioma is a rare proliferative cancer that develops in the thin layer of tissues surrounding the lungs. Malignant mesothelioma is associated with an extremely poor prognosis and the majority of patients do not show symptoms. The epidemiology of mesothelioma is important for the identification of disease. The primary aim of this study is to explore the risk factors associated with mesothelioma. The dataset consists of healthy and mesothelioma patients but only mesothelioma patients were selected for the identification of symptoms. The raw data set has been pre-processed and then the Apriori method was utilized for association rules with various configurations. The pre-processing task involved the removal of duplicated and irrelevant attributes, balanced the dataset, numerical to the nominal conversion of attributes in the dataset and creating the association rules in the dataset. Strong associations of disease’s factors; asbestos exposure, duration of asbestos exposure, duration of symptoms, erythrocyte sedimentation rate and Pleural to serum LDH ratio determined via Apriori algorithm. The identification of risk factors associated with mesothelioma may prevent patients from going into the high danger of the disease. This will also help to control the comorbidities associated with mesothelioma which are cardiovascular diseases, cancer-related emotional distress, diabetes, anemia, and hypothyroidism.

The use of risk measures such as the Value at Risk (VaR) or Tail Conditional Expectation (TCE) is required by the Basel Committee on Banking Supervision in determining a bank’s risk profile. However, both measures can be shown to have shortcomings in the information that they provide to regulators and investors. In this paper we present an introduction to risk measure calculations before demonstrating the weaknesses of these measures. Through the exploration of specific cases we show how familiar yet differing risk profiles have identical values for combinations of these measures. From this evidence we recommend that a sequence of several risk measures should be used to give a more accurate representation of the risk contained on banking balance sheet.

The term “risk” is connoted with divergent meanings in natural hazard risk research and the practice of risk management. Whilst the technical definition is accurately defined, in practice, the term “risk” is often synonymously used with “danger”. Considering this divergence as a deficiency, risk communication often aims to correct laypersons’ understanding. We suggest in reference to Breakwell (2001) to treat the variety of meanings as a resource for risk communication strategies instead. However, there is no investigation so far, of what laypersons’ meanings of risk actually comprise. To address this gap, we examine the meanings of risk applying a social representations approach (Moscovici, 2001) in a qualitative case study design. Results of the study among inhabitants of Swiss mountain villages show that differences in meanings were found according to hazard experience and community size. We found commonly shared core representations, and single peripheral ones. We conclude with suggestions on how to make usage of the knowledge on SR in risk communication.

El Niño is a quasi-periodic pattern of climate variability and extremes often associated with hazards and disease. While El Niño links to individual diseases have been examined, less is known about the cluster of multi-disease risk referred to as an ecosyndemic, which emerges during extreme events. The objective of this study was to explore a mapping approach to represent the spatial distribution of ecosyndemics in Piura, Peru at the district-level during the first few months of 1998. Using geographic information systems and multivariate analysis, two methodologies were employed to map disease overlap of 7 climate-sensitive diseases and construct an ecosyndemic index, which was then mapped and applied to another El Niño period as proof of concept. The main findings showed that many districts across Piura faced multi-disease risk over several weeks in the austral summer of 1998. The distribution of ecosyndemics were spatially clustered in western Piura among 11 districts. Furthermore, the ecosydemic index in 1998 when compared to 1983 showed a strong positive correlation, demonstrating the utility of the index. The study supports PAHO efforts to develop multi-disease based and interprogrammatic approaches to control and prevention, particularly for climate and poverty-related infections in Latin America and the Caribbean.

Various sudden shifts in financial market conditions over the past decades have demonstrated the significant impact of market structural breaks on firms' credit behavior. To characterize such effect quantitatively, we develop a continuous-time modulated Markov model for firms' credit rating transitions with the possibility of market structural breaks. The model takes a semi-parametric multiplicative regression form, in which the effects of firms' observable covariates and macroeconomic variables are represented parametrically and nonparametrically, respectively, and the frailty effects of unobserved firm-specific and market-wide variables are incorporated via the integration form of the model assumption. We further develop a mixtured-estimating-equation approach to make inference on the effect of market variations, baseline intensities of all firms' credit rating transitions, and rating transition intensities for each individual firm. We then use the developed model and inference procedure to analyze the monthly credit rating of U.S. firms from January 1986 to December 2012, and study the effect of market structural breaks on firms' credit rating transitions.

The aim of this study was a large-scale ecological analysis of nutritional and other environmental factors potentially associated with the incidence of cardiovascular diseases (CVDs) in the global context. Indicators of CVDs from 158 countries were compared with the statistics of mean intake (supply) of 60 food items between 1993 and 2011, obesity rates, health expenditure and life expectancy. This comparison shows that the relationship between CVD indicators (raised blood pressure, CVD mortality, raised blood glucose) and independent variables in the global context is influenced by various factors such as short life expectancy, religiously conditioned dietary customs, the imprecision of some statistics and undernutrition. However, regardless of the statistical method used, the results always show very similar trends and identify high carbohydrate consumption (mainly in the form of cereals and wheat in particular) as a dietary factor most consistently associated with the risk of CVDs. These findings are in line with the changing view of the causes of CVDs. Because only the statistics of raised blood glucose include people using medications and reflect true prevalence that is independent of healthcare, more objective data on the prevalence of CVDs are needed to confirm these observed trends.

This study evaluates and contrasts the changes in vegetation cover over three decades in two forest areas in northern Mexico with different management statuses: one with sustainable forest exploitation and the other under protection as a Flora and Fauna Protection Area (FFPA). The hypothesis proposed that both areas would maintain or increase their vegetation cover since 1995. Using QGIS 3.32 “Lima” software and supervised and unsupervised classification methods, satellite images from the periods 1995-2008, 2008-2014, 2014-2021, and 1995-2022 were analyzed. The results showed that the Ejido El Largo y Anexos significantly increased forest areas and reduced grasslands due to sustainable management practices, with notable expansion of pine-oak and pine forests. In contrast, the Tutuaca Flora and Fauna Protection Area (FFPA) showed a notable loss of oak and oak-pine forests, suggesting ineffectiveness in its conservation policies. However, a lesser loss of Douglas fir forest was observed, indicating some effective protection efforts. The comparison reveals opposing dynamics: while Ejido El Largo y Anexos demonstrates success in sustainable management, the Tutuaca FFPA faces conservation challenges. In conclusion, this study highlights the need for active management approaches to maintain ecosystem cover and functionality.

The “Pay-as-you-throw” scheme, PAYT, is an economic instrument of waste management that implements the “polluter pays” principle by charging inhabitants of municipalities according to the amount of residual, organic and bulky waste they send for third-party waste management. When combined with well-developed infrastructure to collect the different waste fractions (residual waste, paper and cardboard, plastics, bio waste, green cuttings, many recyclables) as well as with a good level of citizen’s awareness, its performance has frequently been linked to high collection rates of recyclables. However, the establishment and operation of PAYT systems can require significant resource inputs from municipalities. In this paper, PAYT is analysed through a case study from the German County of Aschaffenburg, covering nearly 20 years of implementation across 173,000 inhabitants. Key performance indicators applied include temporal trends in the county’s recyclables collection rate, waste treatment fees for residents and municipal waste management costs, benchmarked against German municipalities not implementing PAYT.

This study is a retrospective analysis aimed to understand the incidence and risk factors of proximal junctional kyphosis (PJK) following long instrumented spinal fusion from L1 to the sacrum in patients with mild to moderate sagittal imbalance. It recruited consecutive patient undergone instrumented fusion from L1 to the sacrum for degenerative lumbar disease between June 2006 and November 2019 in a single institution. The patients’ preoperative clinical data, muscle status at T12-L1 on magnetic resonance images, and sagittal spinopelvic parameters were analyzed. Univariate analysis was used to compare clinical and radiographic data between PJK and non-PJK patients. Logistic regression analysis was used to investigate the independent risk factors for PJK. A total of 56 patients were included in the study. The mean age at surgery was 67.3 years and mean follow-up period was 37.3 months. Seven were male and 34 were female. PJK developed in 23 (41.1%) out of 56; of these patients, 20 (87.0%) developed PJK within postoperative 1 year. On univariate analysis between PJK and non-PJK patients, PJK group showed more frequent osteoporosis, lower body mass index, smaller cross-sectional area (CSA) and more fat infiltration (FI) in erector spinae muscle at T12-L1, larger preoperative TLK and PT with statistical significance (p&lt;0.05). On logistic regression analysis, severe (&gt;50%) FI in erector spinae muscle (OR=43.60, CI 4.10-463.06, R2N =0.730, p=0.002) and osteoporosis (OR=20.49, CI 1.58-264.99, R2N =0.730, p=0.021) were statistically significant. Preexisting severe (&gt;50%) fat infiltration in erector spinae muscle and osteoporosis were significant independent risk factors associated with PJK following instrumented fusion from L1 to the sacrum, but age was not a risk factor.

The study examines the risk and protective factors in childhood for boys and girls who engage in unlawful behavior, through the lens of developmental criminology. This field explores the elements contributing to the emergence of antisocial and prosocial behaviors in childhood, which are linked to the increase or desistance of delinquency in later years. To enhance understanding in this domain, the study analyzes risk and protective factors associated with criminality in children across various levels: individual, family, and community. Utilizing a systematic review grounded in the PRISMA method, the study identifies and categorizes a range of factors, including conduct problems, socio-emotional competencies, biological determinants, social exclusion, interpersonal relationships, institutional governance, family adversity, caregiver characteristics, and family composition. This review underscores the significance of recognizing risk and protective factors in child development to design interventions at multiple levels, aiming to prevent antisocial behavior proactively.

Human papillomavirus (HPV) infections, primarily transmitted through sexual contact, have been linked to various cancers, including cervical, penile, anal, oropharynx, breast, and prostate cancers. This study presents a unique case of concurrent high-risk HPV35, HPV45, and HPV59 infections in both prostate and bladder cancer tissues from a single patient, representing the first documented instance worldwide with identical HPV types detected in two adjacent organs of the same individual. Employing a multiplex-PCR approach, gel electrophoresis, and Sanger sequencing, we confirmed the presence of these high-risk HPV types. Additionally, Western blot analysis using an HPV E7 antibody demonstrated the active expression of HPV oncoproteins in both cancer types. This discovery underscores the potential for HPV intra-organ transmission and necessitates further exploration of alternative transmission routes. The implications of our results offer new insights into the complex dynamics of HPV transmission in cancer pathogenesis.

More than fifty million people over the age of fifty have osteoporosis issues due to low bone mass, disease contribution, and not exercising continuously. Certain most important risk factors and causes of osteoporosis contain age, gender, hormones, visits to inexperienced doctors, and certain medical conditions. In this manuscript, we diagnosed certain frank operational laws under the availability of complex intuitionistic fuzzy (CIF) information. Furthermore, using the evaluated operational laws, we pioneered the theory of CIF frank weighted averaging (CIFFWA), CIF frank ordered weighted averaging (CIFFOWA), CIF frank hybrid averaging (CIFFHA), CIF frank weighted geometric (CIFFWG), CIF frank ordered weighted geometric (CIFFOWG), CIF frank hybrid geometric (CIFFHG) operators, and described their beneficial and valuable results with certain useful properties. Moreover, we aim to evaluate the most dangerous type of osteoporosis based on their symptoms, causes, and risk factors using diagnosed approaches. Finally, to enhance the worth of the evaluated operators, we compare the diagnosed result with certain prevailing results and illustrated their geometrical representation with the help of MATLAB.

Primary and secondary cardiovascular prevention is less effective than expected due to the concern about polymedication by professionals and the lack of patient adherence to medications prescribed in the medium and long term. Polypills have been presented as a possible solution. A comprehensive bibliographic review is presented about polypills as mechanisms for facilitating adherence and a proposed guide for the use of polypills for the prevention of cardiovascular risk. 41 articles were included, showing options for the polypill as a method of primary and secondary cardiovascular prevention.The polypill increases therapeutic adherence in the medium and long term, also increasing the therapeutic results compared to the administration of the various drugs separately. Based on the evidence, a flow diagram is proposed for the prescription of a polypill.Polypills increase the effectiveness and adherence of patients to primary and secondary cardiovascular prevention programs, without increasing the cost of the intervention. The use of a polypill in cardiovascular prevention can be effective as a prescription tool.

The health of the landing gear retraction and extension hydraulic system may be assessed using fuzzy comprehensive evaluation (FCE), however the traditional FCE method depends solely on human assessment by specialists, which is excessively subjective. To address the issue of excessive human subjective variables in the assessment, an improved FCE model based on enhanced risk coefficient is provided, which includes four consideration indexes: failure probability, failure severity, failure detection difficulty, and failure repair difficulty. To reduce subjective human judgment errors entirely due to expert experience, the improved FCE takes into account the likelihood of failure using a statistical method, the severity of failure using a fault simulation analysis based on the LMS Imagine.Lab AMESim simulation platform, and the difficulty of fault detection and repair using the aircraft manufacturer's professional maintenance information. As part of the evaluation model, the range of health assessment values and accompanying treatment methods are included, making it easier to implement on a daily basis in aircraft maintenance. As a final step, the simulation is evaluated and the simulated faults are calculated.

The Arctic is a remote region that has become increasingly globalised yet remains extremely vulnerable to many risks. The COVID-19 pandemic presented new challenges to the region. Using the Search, Appraisal, Synthesis and Analysis (SALSA) approach to conduct a meta-synthesis of the academic and grey literature on the impacts of the pandemic, an assessment is conducted of the types of risks that have been presented by the COVID-19 pandemic, the scales, and the national response strategies for mitigating the risks. Two case studies are explored, Iceland and Greenland, island nations that exemplify the extremes of the Arctic and reliance on tourism, a sector that was nearly entirely suspended by the pandemic. An evaluative matrix is employed which combines five different scales of risk – nano, micro, meso, macro and cosmic – with a sustainability categorisation of impacts. The risks of the pandemic cut across the respective scale and categories, with the potential for macro-scale events (systemic risk) to unfold linked to economic spillover effects driven by the curtailment of tourism and various supply chain delays. Both Iceland and Greenland have exemplified risk mitigation strategies which prioritise health over wealth, very strictly in the case of the latter. Strict border controls and domestic restrictions have enabled Iceland and Greenland to have much lower case and death numbers than most nations. In addition, Iceland has led the way, globally, in terms of testing and accumulating scientific knowledge concerning the genetic sequencing of the virus. The academic contribution of the paper concerns its broadening of understanding concerning systemic risk, which extends beyond financial implications to includes sustainability dimensions. For policymakers and practitioners, the paper highlights successful risk mitigation and science-based measures that will be useful for any nation tackling a future pandemic, regardless of whether they are island states, Arctic nations or another country.

The etiology of ‘dual harm’ (the co-occurrence of self-harm and externalized violence in the same individual) is under-researched. Risk factors have mostly been investigated for each behavior separately. We aimed to examine adversities experienced between birth and age 15 years among adolescents and young adults with histories of self-harm and violent criminality, with a specific focus on dual harm. Three nested case-control studies were delineated using national interlinked Danish registers; 58,409 cases in total aged 15-35 were identified: 28,956 with a history of violent criminality (but not self-harm), 25,826 with a history of self-harm (but not violent criminality), and 3987 with dual harm history. Each case was matched by date of birth and gender to 20 controls who had not engaged in either behavior. We estimated exposure prevalence for cases vs. controls for each of the three behavior groups, and incidence rate ratios (IRRs). Experiencing 5 or more childhood adversities was more prevalent among individuals with dual harm history (19.3%; 95% CI 18.0, 20.8%) versus self-harm (10.9%; 10.5, 11.3%) and violence (11.4%; 11.0%, 11.8%) histories. The highest IRRs for dual harm were linked with parental unemployment (5.15; 95% CI 4.71, 5.64), parental hospitalization following self-harm (4.91; 4.40, 5.48) or assault (5.90; 5.07, 6.86), and parental violent criminality (6.11; 5.57, 6.70). Growing up in environments that are characterized by poverty, violence and substance misuse, and experiencing multiple adversities in childhood, appear to be especially strongly linked with elevated dual harm risk. These novel findings indicate potential etiologic pathways to dual harm.

Understanding tourist behaviour during and after major tourism crises is essential to help destinations recover. The COVID-19 pandemic, a period of uncertainty and risk, makes it relevant to assess factors that influence travel intentions. There has been little research on tourist behaviour during health crises and, in particular, on perceived health risk and uncertainty effects on travel intentions. This study was carried out during the first months of the pandemic in Brazil and aims to investigate the role of health risk perception and intolerance of uncertainty on travel intentions for 2020 and 2021. We applied an online survey to 1,150 Brazilian participants from March to May of 2020. Our findings indicate that perceived COVID-19 severity, perceived probability of contracting it, and expected pandemic duration are significant predictors of travel intentions for both years. This paper sheds new light on tourist behaviour in the context of global health crises.

Background: The prognostic value of erythrocyte levels of the n-6 fatty acids (FAs) for total mortality and cardiovascular disease (CVD) outcomes remains an open question. Methods: We examined CV outcomes and death in 2500 individuals in the Framingham Heart Study Offspring cohort without prevalent CVD (mean age 66 years, 57% women) as a function of baseline levels of different length n-6 FAs (18 carbon, 20 carbon and 22 carbon) in the erythrocyte membranes. Clinical outcomes were monitored for up to 9.5 years (median follow up, 7.26 years). Cox proportional hazards models were adjusted for a variety of demographic characteristics, clinical status and RBC n-6 and long chain n-3 FA content. Results: There were 245 CV events, 119 CHD events, 105 ischemic strokes, 58 CVD deaths, and 350 deaths from all causes. Few associations between either mortality or CVD outcomes were observed for the n-6 FAs, with those that were observed becoming non-significant after adjusting for n-3 FA levels. Conclusions: Higher circulating levels of the marine n-3 FA levels are associated with reduced risk for incident CVD and ischemic stroke and for death from CHD and all-causes, however in the same sample, little evidence exists for association with n-6 FAs. Further work is needed to identify a full profile of FAs associated with cardiovascular risk and mortality.

Since the 1960s, forest planners have used linear programming models to develop management plans for large, forested areas. Hundreds of academic papers have presented such models, incorporating multiple objectives, a growing diversity of management interventions, and uncertainty, among other things. Three basic ways to formulate these models have been used: Model I, III, and III. We define these models based on the sequence of management unit states represented by the variables. In Model I, variables represent a sequence of states from the beginning of the planning horizon to the end. In Model II, variables represent a sequence of states from one intervention to the next. Finally, in Model III, variables represent a single arc in a management unit’s decision tree, including only a beginning and an ending state. We formulate each type of model for a case study with three increasingly complex scenarios incorporating additional ecosystem services. Our results indicate that, despite requiring more variables and constraints, Model III requires the least time to formulate, largely because it has the least dense parameter matrix. Model II has the shortest solution times, with Model III close behind. Model I requires both the longest formulation and solution times.

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 article introduces a novel nature-inspired metaheuristic algorithm called Frilled Lizard Optimization (FLO), which emulates the hunting behavior of frilled lizards in their natural habitat. FLO draws in-spiration from the sit-and-wait strategy observed in frilled lizards during hunting. The underlying theory of FLO is presented and mathematically formulated in two phases: (i) an exploration phase, simulating the frilled lizard's attack towards prey, and (ii) an exploitation phase, simulating the lizard's retreat to the top of the tree after feeding. To assess FLO's efficacy in solving optimization problems, the algorithm's performance is evaluated across fifty-two standard benchmark functions, encompassing unimodal, high-dimensional multimodal, fixed-dimensional multimodal, and the CEC 2017 test suite. Comparative analyses with twelve existing metaheuristic algorithms are conducted. The simulation results reveal that FLO, distinguished by its adeptness in exploration, exploitation, and balancing them during search process, outperforms competing algorithms. Additionally, FLO is implemented on twenty-two constrained optimization problems from the CEC 2011 test suite and four engineering design problems, demonstrating its effectiveness in addressing real-world optimization applications.

Savannas and adjacent vegetation types like gallery forests are highly valuable ecosystems contributing to several ecosystem services including carbon budgeting. Financial mechanisms such as REDD+ have provided an opportunity for developing countries to alleviate poverty through conservation of its forestry resources. For availing this opportunity carbon stock assessments are essential. Therefore, a research study at two protected areas i.e. Nazinga Game Ranch and Bontioli Nature Reserve, in Burkina Faso was conducted with the objective of assessing carbon Mg C ha-1 in aboveground biomass (AGB)dry of trees in different formations of the south-sudanian savanna in Burkina Faso, West Africa. Similarly analysis of various vegetation parameters was also conducted to understand the overall vegetation structure of these two protected areas. For estimating AGBdry, existing allometric equation for dry tropical woody vegetation types was used. The Importance Value Index (IVI) and Family Importance Value (FIV) were estimated through standard procedures. Various linear and non-linear regression analyses were conducted to test the relationships between carbon and other parameters such as DBH, height and basal area (BA). The results showed that both sites collectively contain mean carbon of 3.41 ± 4.98 Mg C ha-1. Amongst different vegetation types, gallery forests recorded the highest mean carbon of 9.38 ± 6.90 Mg C ha-1. The highest IVI of 115.56 at Nazinga Game Ranch was recorded for Anogeissus leiocarpa. Similarly, highest IVI of 98.59 was recorded for Mitragyna inermis at Bontioli Nature Reserve. The highest FIV was recorded for Combretaceae for both of the sites. To our knowledge, this was the first study conducted to assess the carbon stocks at the two protected areas in southern Burkina Faso. The study therefore was an attempt for addressing the knowledge gap particularly on carbon stocks of protected savannas. It could serve as a baseline for carbon stocks for future initiatives such as payment for environmental services and REDD+ at these areas.

Purpose: To evaluate prognostic factors for visual outcome in patients with diabetes who have undergone vitrectomy (PPV) for severe proliferative diabetic vitreo-retinopathy (PDVR) in at least one eye in the past 15 years. Methods: Medical records of 132 eyes of 66 patients were analyzed (median age 52ys 21-80; patients with type 1/2 diabetes 40/26, median follow-up 38 months 9-125). Correlation between final good visual outcome defined as 0.5≤ best corrected visual acuity (BCVA) and prognostic factors (age, sex, type and duration of diabetes, metabolic status, BCVA, diabetic retinopathy status, data of preoperative management, data of vitrectomy, postoperative complications) were analyzed. Results: BCVA improved significantly in the entire study cohort (from median 0.05 min-max 0.001-1 to 0.32 0.001-1, p <0.000). Visual stabilization was achieved in the majority of patients, and relatively good visual acuity (0.5≤BCVA) was maintained in more than one third of eyes. Multivariable GEE statistics showed that in addition to duration of diabetes and stable HbA1c values, only preoperative tractional macular detachment proved to be an independent significant predictor of visual outcome. Conclusions: Pars plana vitrectomy is a useful tool when performed early before tractional macular detachment. However, long-term visual stability can only be achieved with good metabolic control.

Nutritional management of depression has long been discussed due to the perceived benefit of a nutritional product having less side effects than pharmaceutical agents. Candidate nutrients for managing depression include Vitamin D, B-vitamins, tryptophan, branch chain amino acids, probiotics, omega-3 fatty acids, folate/methylfolate (aka Vitamin B9), and s-adenosylmethionine. This paper reviews three nutrients which have significant scientific support for the management of depression and have evidence of low levels in subjects with depression, and that correction of the nutritional deficiency provides clinical benefit. We present epidemiological evidence, mechanistic explanation and a review of interventional studies for these nutrients. Finally, relevant nutritional guidelines are presented with their conclusion for the role of each nutrient in the management of depression.

The work aims to improve the battery performance in hybrid electric vehicles (HEVs) by reducing the vehicle speed. We develop a specific protocol for managing battery use and optimizing the energy consumption rate to achieve this goal. The protocol automatically controls the driving operation, avoiding incompatible driving patterns with energy-saving mode and performance improvement. The protocol is submitted to a simulation process to predict the energy rate lowering and battery performance enhancement. The proposed protocol applies to any hybrid electric vehicle type and route conditions since it uses vehicle mass, drag and rolling coefficients, and road slope as variable parameters to determine the minimum energy consumption rate. We run experimental tests to validate the simulation data and the proposed protocol. Furthermore, the protocol applies to variable starting vehicle speeds, from 10 to 50 km/h, corresponding to the current driving patterns, sport, normal, and eco, set up by car manufacturers. A reduction of 10% in vehicle speed in urban and peripheral routes achieves a minimum energy rate, enhancing battery management. Current vehicle speed shows a deviation from optimum management of 18% while applying the vehicle speed reduction limits the deviation to 0.2%. Experimental results show a good agreement with simulation data with 94% accuracy. We tested the protocol for urban and peripheral routes with maximum vehicle speed limits of 60 and 90 km/h.

The need for effective bridge asset management in Indonesia has become crucial. Currently, the number of bridge assets in Indonesia is continuously increasing, parallel to the rising budget allocations for infrastructure development in the road and bridge sectors to enhance regional connectivity more efficiently. This situation places demands on asset managers to work harder and possess expertise in bridge asset management. However, the reality reveals persistent issues related to the incapacity of bridge asset managers in various regions to manage their assets effectively. This raises the question of whether asset managers have the intention to implement asset management or what factors might drive their appeal to have an intention towards effective asset management. To address these questions, a survey was conducted involving asset managers and experts to evaluate the current state of bridge asset management in Indonesia. The research findings provide insights into the relationships among factors such as budget, data, policy, resources, and system that associated with bridge asset management and the intention of an asset manager. The model's solutions show that data and system are anticipated to achieve effective and efficient implementation of bridge asset management. It is hoped that this research will assist asset managers in Indonesia in enhancing their intention towards better bridge asset management.

Effective management of water distribution systems requires an integrated approach, but none of the available frameworks for one are in broad use in the water supply industry. Frameworks developed include a management standard of the American Water Works Association and Distribution System Optimization, a methodology for physical, hydraulic, and water quality performance assessment. The intelligent systems framework also offers a pathway to integration, but it lacks a definite structure. The voluntary aspect of adopting innovations within the fragmented and unregulated nature of the water utility industry poses a barrier to adoption of such innovations. Another barrier is the uncoordinated arrangements of water research stakeholders with different incentive structures. Intelligent water systems offer a way to incentive utilities to encourage implementation. They can provide a bottom-up approach where utilities see advantages, as opposed to a top-down approach where they are expected to adopt a method without seeing clear benefits. Research to develop new and improved tools is needed, but the research roadmap should prioritize implementation.

This study analyzes the convergence between artificial intelligence (AI) and management accounting in hospital contexts. Management accounting plays a central role in the effectiveness of planning, control and decision-making in healthcare institutions such as hospitals. The application of AI in this scenario offers powerful tools to improve accounting processes, optimize operational efficiency and maximize the use of available resources, resulting in an improvement in the quality of care provided to patients. Through in-depth analysis, the article explores how AI is bringing about a revolution in hospital management accounting, presenting case studies illustrating its successful implementation, outlining the tangible benefits.

The incidence of articular injury, particularly osteochondral fractures (OCF), has seen a notable increase in recent years. Regardless of their location, fragments might be overlooked by plain radiographs which might lead to osteoarthritis in the long run. Diagnostic imaging has a pivotal role in the assessment and classification of the fracture severity, as well as the presence of any associated dislocations. These fractures require surgical intervention for the restoration of joint function and the reduction of long-term complications. The paper aims to present the surgical correction and post-operative treatment of osteochondral fractures with absorbable implants in three children. Affected areas are discussed as follows: lateral condyle of the femur, patella, and radial head. Utilising absorbable implants for the management of OCFs provides numerous advantages, including the elimination of the need for reanaesthesia and reoperation, reducing complications, and enabling early rehabilitation. This approach also minimises the period of hospitalisation and proved effective in pediatric OCF treatment.

The healthcare system is intricate and dynamic. For the purpose of organising and planning a system, where allocating funds appropriately is essential and therefore managerial skills play a critical role. A certain portion of each nation's GDP is allotted to the health sectors. Managers and decision-makers in the healthcare systems are using resources effectively, yet the quantity of funding they receive from the government or other stakeholders is insufficient sometimes. A sound understanding of both basic and advanced economics is necessary for the care management, to make cost-effective judgements in public health. Healthcare officials at all levels (regional, state, federal, or international), need to be knowledgeable about public health issues and the related modern economic climates. Business executives and healthcare managers need effective practical knowledge to handle partner-financial allocation (demand-supply chain) and handle economic volatility.

This paper reviews the appearance of joint lesions during arthroscopic surgery of inter-est to the arthroscopic surgeon and their interpretation within the continuum of joint disease. It also points out the relevance of surgical findings as well as giving directions to the surgeon as to how to approach an appropriate decision-making process during an arthroscopic procedure and what therapeutic options are optimal.

A large amount of raw data collected by satellites is processed by the production chain to obtain a large amount of product data, of which the secure exchange and storage is of interest to researchers in the field of remote sensing information science. Authentic, secure data is a critical foundation for data analysis and decision-making. And traditional centralized cloud computing systems are vulnerable to attacks, and once the central server is successfully attacked, all data will be lost. Distributed Ledger Technology (DLT) is an innovative computer technology that can ensure information security, traceability and tamper-proof, and can be applied to the field of remote sensing. Although there are many advantages to using DLT in remote sensing applications, there are some obstacles and limitations to its application. Remote sensing data has the characteristics of large data volume, spatiotemporal nature, global and so on, and it is difficult to store and interconnect remote sensing data in the blockchain. To address these issues, this paper proposes a trustworthy and decentralized system using blockchain. The novelty of this paper is to propose a multi-level blockchain architecture in which the system collects remote sensing data and stores it in the Interplanetary File System (IPFS) network, after generating the IPFS hash, the network rehashes the value again and uploads it on the Ethereum chain for public query. Distributed data storage improves data security, supports the secure exchange of information, and improves the efficiency of data management.

Purpose: This study's objective was to examine international research trends in behavior management that had been written about in journals that were indexed by Scopus and authored by scientists from all around the world.Patients and methods: We examined publications in the Scopus database using bibliometric and content analysis. We only retrieved English-language articles. The VOSviewer program was used for content analysisResults: We found 808 papers on behavior management during the previous 50 years by following the study strategy. The study concentrated more on authors, nations, institutions, journals, documents, and keywords, as well as the annual scientific production (classification by subject area and document type)Conclusion: The finding prompts a discussion regarding behavior management for next research.

: Forty-nine children who started wearing cartilage conduction hearing aids (CC-HA) before elementary school graduation (including 17 cases of bilateral hearing loss and 32 cases of unilateral hearing loss) were followed up and examined. The wearing and utilization status of CC-HA, as well as the progress to date, were evaluated. In addition, 33 participants who purchased CC-Has were interviewed to assess the wearing effect. Eleven of the 17 children with bilateral hearing loss and 25 of the 32 children with unilateral hearing loss have continued using CC-HA. In terms of wearing effect, a good wearing effect was reported, even by those with one-sided hearing loss. In cases where it is difficult to wear CC-HAs stably with pasting or ear tips, it is possible to fix them stably using commercially available hair bands and eyeglass vines. In two cases, CC-HAs were worn from the age of 0. With ingenuity and appropriate educational and medical support, it is possible to wear CC-HA from infancy.

Cellular automata (CA) models have emerged as a valuable tool in corrosion management. This manuscript provides an overview of the application of cellular automata models in corrosion research, highlighting their benefits and contributions to understanding the complex nature of corrosion processes. Cellular automata models offer a computational approach to simulate corrosion behavior at the microscale, capturing the intricate interactions between electrochemical reactions, material properties, and environmental factors generating a new vision of predictive maintenance. It discusses the key features of cellular automata, such as the grid-based representation of the material surface, the definition of state variables, and the rules governing cell-state transitions. The ability to model local interactions and emergent global behavior makes cellular automata particularly suitable for simulating corrosion processes. Finally, cellular automata models offer a powerful and versatile approach to studying corrosion processes, expanding models that can continue to enhance our understanding of corrosion and contribute to the development of effective corrosion prevention and control strategies.

Background The main aim of reconstructive surgery (RS) is to restore the integrity of soft tissues damaged by trauma, surgery, congenital deformity, burns or infection. Microsurgical techniques consist of harvesting tissues that are separated from the vascular sources of the donor site and anastomosed to the vessels of the recipient site. In these procedures, there are some preoperative modifiable factors that have the potential to influence the outcome of the flap transfer and its anastomosis. Methods Chronic inflammatory anaemia (ACD) is a constant condition in patients who have undergone RS and correlates with the perfusion of the free flap. In RS, it is important to maintain good tissue oxyporesis, avoiding blood hyperviscosity. From January 2017 to September 2019, we studied 16 patients (16 males, mean age 38 years) who underwent microsurgical procedures for RS. Haemoglobin (Hb) levels, Corpuscular Indexes, Transferring saturation (TSAT) ferritin concentrations and creatinine clearance have been measured the first day after surgery (T0), after the first week (T1) and after five weeks (T2). At T0 all patients showed low hemoglobin levels (average 7.4 g/dl, STD 0,71range 6,2-7,4 g dL-1), with an MCV of 72, MCH 28, MCHC 33, RDW 16, Sideremy 35, Ferritin 28, Ret% 1,36, TRF 277 and Creatinine Clearance 119. . We assessed all patients for clinical status, medical history and comorbidities before starting therapy. Results. In collaboration between the two departments, we started a therapeutic protocol with erythropoietic stimulating agents (ESAs) (Binocrit 6000 UI/week) and intravenous iron every other day, on the second day after surgery. Thirteen patients received ESAs and FCM (500-1000 mg per session), three patients received ESAs and iron gluconate (1 vial every other day). No patients received blood transfusions. No side effects were observed and, most importantly, no limb or flap rejection. Conclusions Preliminary data from our protocol show an optimal therapeutic response in a surgical setting with limited data in the scientific literature. The enrolment of further patients will allow us to validate this therapeutic protocol with statistically significant data.

We explore, for the first time in the literature, how the revenues of the ship-management companies respond to macroeconomic exogenous shocks. Using data for ship-management companies in Cyprus, we find evidence that a demand shock has the largest impact on revenues, exhibiting an almost one-for-one relationship. If the demand shock is permanent, we observe a ceteris paribus permanent effect on revenues. Similarly, this occurs irrespective of the final effect that demand has on the relevant freight rate, proxied via the Baltic dry and tanker (dirty and clean) indices. The BDI and the BDTI indices have smaller effect on revenues, standing at approximately 0.05% for every 1% shock, while the clean tanker index does not have an effect, most likely due to their fleet composition. In accordance with the literature, we find that a shock in the price of Brent oil increases revenues. Our results bear importance not only for ship-management companies per se, but also for countries that are ship-management hubs.

With the rapid development of Internet of Vehicles (IoV), particularly the introduction of mobile edge computing (MEC), vehicles can efficiently share data with one another. However, edge computing nodes are vulnerable to various network attacks, posing security risks to data storage and sharing. Moreover, the presence of abnormal vehicles during the sharing process poses significant security threats to the entire network. To address these issues, this paper proposes a novel reputation management scheme, which proposes an improved multi-source multi-weight subjective logic algorithm. This algorithm fuses direct and indirect opinion feedback of nodes through the subjective logic trust model while considering factors such as event validity, familiarity, timeliness, and trajectory similarity. Vehicle reputation values are periodically updated, and abnormal vehicles are identified through reputation thresholds. Finally, blockchain technology is employed to ensure the security of data storage and sharing. By analyzing real vehicle trajectory datasets, the algorithm is proven to effectively improve the differentiation and detection rate of abnormal vehicles.

Dry eye disease (DED) is a multifactorial disorder in which tear fluid homeostasis is lost, resulting in increased tear film osmolarity and ocular surface irritation. In Asia, the short tear film breakup time type-DED is common, and stabilization of the tear film is the first goal of treatment. Treatment of DED begins with eye drops. Until now, artificial tears and steroid eye drops have been the main treatment for DED. However, artificial tears require frequent administration of eye drops and thus pose adherence problems, while steroids have problems with side effects (cataracts, increased intraocular pressure). This review evaluates the new generation of DED therapies in Asia based on what is known about them and demonstrates that they are more effective for DED than traditional therapies such as artificial tears and steroids. Based on these considerations, it is proposed that the optimal treatment for DED in Asia is the initial application of mucin secretion enhancing eye drops (long-acting diquafosol) and oral supplements, and if additional treatment is needed, cyclosporine eye drops and the adjunctive therapies presented in this review are added.

In the wake of the Covid-19 crisis, a need has arisen to prevent and treat two related conditions, Covid vaccine injury and long Covid, both of which have a significant vascular component. Therefore, the management of these conditions require the development of strategies to prevent or dissolve blood clots and restore circulatory health. This review summarizes the evidence on strategies that can be applied to treat both long and vaccine injuries based on similar mechanisms of action.

In the chemical processing industries, sensors for pumps are among the most commonly used machinery. Condition-based maintenance (CBM) and prognosis health management (PHM) determine the most cost-effective time to overhaul pumps. In order to determine the status of the pump, a signal-emitting accelerometer is employed. Stationarity-based feature extraction from amplitude signals is used to process the signal. Utilizing the time-domain function, multiple statistical results were produced. Eight fault codes were classified using support vector machine method. The enormous amount of data points necessitated the use of feature selection. In terms of accuracy, precision, recall, and F1 score, the Chi-square feature selection method exceeds other approaches.

The state of BIM adoption and implementation in facility management in Africa has been regarded as a developmental discourse gradually gaining grounds. While several studies have focused on manual review of the intellectual progression of BIM research, this confined review however understates the evolution of BIM in facility management. This approach therefore is not always representative of the picture of BIM in facility management at its formative stage. This paper aims to present a scientometric review of BIM in facility management exploring the intellectual progress made so far by authors. The state of the art of BIM in facility management research and practice and the challenges debilitating against BIM in facility management research. The review revealed a considerable amount of research endeavours limited by inadequate collaboration acorss organizations and institutions. The study also revealed the low degree of awareness amongst researchers in the AEC sector. While North America and China were leading countries due to the activity of few universities, Africa wasn’t as visible in research endeavours. The study recommended an increase in awareness drive across countries and increased government effort, joint funding for research to include gaps in practice issues.

In recent years, Cloud Computing and Big Data have been considered the most attractive areas that are revolutionizing the IT world. Cloud Computing paradigm has recently appeared that allows running proprietary or difficult portable applications outside their original software environment on one or more virtual hardware platforms. Therefore, we are to developing such techniques which make it possible to secure communication between the communicating Cloud entities. These techniques must take into account several factors due to the data transmitted in this type of environment is proprietary and of significant size. Conventional data security techniques are not suitable for today's cloud usage. Hence, the main research of this thesis is to define an adaptable architecture with the aim to propose a scalable system that supports cloud services.

Ever-increasing need for improving the livability of a city and improve outcomes for its residents, over the last decade, the adoption of technology to develop urbanised societies around the world has given rise to the need for developing smart cities. The speed at which the world population is growing, the use of Internet of Things in smart cities have really advanced the quality of life. One significant area of concern within the smart city framework is waste management. If the waste within a city is not adequately managed, then it leads to issues in the health of the citizens. Additionally, the waste management has such a high impact on the environmental footprint, hence the need to have a smart way of managing waste is of critical importance. Through our research, we analyse the challenges of waste management within a city to understand the impact of the problem on to the citizens and overall city operations. We then investigate ways in which we can solve these problems using the emerging technologies, such as the Internet of Things, to collect valuable data of large volumes arriving at an astronomical rate, then apply multi-agent deep reinforcement learning algorithms to harness the power of big data to extract meaningful information and actionable insights. We ingest data generated by our Internet of Things into our algorithm for three main purposes including providing the notifications to an external system, for example, a map navigation engine out of the scope for this project but a future extension for route optimisation and waste vehicle tracking; extracting and reporting the actionable insights from the underlying data; and consuming the extracted data for predictive forecasting to draw out the unknown patterns of waste fill levels within various geographical locations and again send out triggers and notification to external systems for example a waste collection authority who can efficiently schedule the waste collection vehicles and optimise the route. To achieve the above mentioned outcomes, we propose a framework that is agnostic of the hardware that it connects to and can effectively interface with a wide variety of hardware keeping a level of abstraction in the architecture.

With the fast development of blockchain technology in latest years, its application in scenarios that require privacy, such as health area, became encouraged and widely discussed. This paper presents an architecture to ensure the privacy of health-related data, which are stored and shared within a blockchain network in a decentralized manner, through the use of encryption with the RSA, ECC and AES algorithms. Evaluation tests were performed to verify the impact of cryptography on the proposed architecture in terms of computational effort, memory usage and execution time. The results demonstrate an impact mainly on the execution time and on the increase in the computational effort for sending data to the blockchain, however, justifiable considering the privacy and security provided with the architecture and encryption.

Forest road pavement needs an evaluation methodology based on a comprehensive assessment of road conditions. This research was conducted to evaluate the performance of a method for rating the surface condition of forest roads and eventually to adapt the method to the situation prevailing in a forest road network. The rating method selected as the basis for this experiment was the pavement condition index (PCI) developed by the U.S. Army Corps of Engineers. A 53 km of forest roads were selected contained the most influential factors and conditions variability. Eventually, 201 road segments were delineated between 150-300 m in length. Within the given segments, sample plots were set 20 m in length consecutively. It was concluded that the panel scores for distress and surface condition of sample unit and section differed from forest road pavement condition index (FRPCI) and PCI. Linear regression was used to derive equations between distress and PCI score to determine effective FRPCI parameters that provide a numerical rating for the condition of road segments within the road network, where 0 worlds are the worst possible condition, and 100 is the best possible condition best. Also, regression analysis showed the FRPCI model with a 0.87 correlation for the total of the road is a performance index used for the first time in forest roads. This study showed a range of FRPCI from 7.8 to 96.3, different from PCI and URCI ratings (0.85-45 and 1.2-53). The FRPCI index helps forest managers in road maintenance, harvesting, and planning to use road information.

In the current business environment, firms are eager to adopt new technology as they witness and perceive more and more successful business applications of new technologies, e.g., Big Data, Artificial Intelligence (A.I.), Cloud Computing, etc. As one of the disruptive technologies, Blockchain technology (BCT) is now drawing public attention owing to the cryptocurrency phenomenon (e.g., Bitcoin), for which Blockchain serves as the backbone technology. Given certain innovative features of BCT, especially its transparency, traceability, security, efficiency, confidentiality, and immutability, BCT holds out the promise of impacting supply chain operational and financial efficiencies. Recently, the burgeoning of Metaverse and Non-Fungible Token (NFT) has boosted the BCT as state-of-the-art technology to another notch. Motivated by the proliferating adoption of BCT, we conduct a holistic literature review with a focus on the status of research on BCT in the context of Supply Chain Management (SCM). In particular, this Blockchain-centered research reviews the research up to date on the Blockchain application in SCM. It provides holistic review in terms of (1) the functionality of BCT and its salient features; (2) the prevailing and potential applications of BCT; (3) and the business benefits and impact of BCT in SCM. Finally, we substantiate and highlight a variety of research directions.

Nowadays, people live amidst the smart home domain, business opportunities in the industrial smart city and health care, though, along with concerns about security. Security is central for IoT systems to protect sensitive data and infrastructure, whilst security issues become increasingly expensive, in particular in Industrial Internet of Things (IIoT) domains. Nonetheless, there are some key challenges for dealing with those security issues in IoT domains: Applications operate in distributed environments such as Blockchain, varied smart objects are used, and sensors are limited in what comes to machine resources. In this way, traditional security does not fit in IoT systems. In this vein, the issue of cyber security has become paramount to the Internet of Things (IoT) and Industrial Internet of Things (IIoT) in mitigating cyber security risk for organizations and end users. New cyber security technologies / applications present improvements for IoT security management. Nevertheless, there is a gap on the effectiveness of IoT cyber risk solutions. This review article discusses the, trends around opportunities and threats in cyber security for IIoT.

The present study aims to identify tomato (Solanum lycopersicum L.) cultivars with weed-suppressive ability against target weed species in the tomato growing season. A greenhouse study was conducted with 17 tomato cultivars and target weeds Palmer amaranth (Amaranthus palmeri S. Wats), yellow nutsedge (Cyperus esculentus L.), and large crabgrass (Digitaria sanguinalis L.). Tomato plants and weed species were grown in the same pot. The height, chlorophyll, and dry weight biomass of the weeds were measured 28 days after sowing. The largest effect of tomato interference was on Palmer amaranth. Cultivar 15 reduced Palmer amaranth height, chlorophyll, and biomass by 58, 28, and 83%, respectively. Chlorophyll percentage of yellow nutsedge seedlings was suppressed by 15% by cultivar 64, whereas 13% of its height was reduced by cultivar 20. Cultivar 15 reduced biomass of yellow nutsedge by 40%. The percentage of chlorophyll of large crabgrass was reduced by 22% with cultivar 5, whereas the height and biomass were reduced by 35 and 44% with cultivars 38 and 63, respectively. Factoring all parameters evaluated, cultivars 38, 33, and 7 were most suppressive against the problematic weed species in tomato.

Background: Indonesia is an archipelago with various cultured, will bee affects all aspects of people's lives, including beliefs related to health behavior and health care. One problem that needs serious attention is the elderly group because the elderly are a vulnerable group who have a high risk of experiencing health problems, such as anemia with hypertension, so they need good care management. The research objective was to determine self-management intervention for hypertensive elderly. Methods: This research is a literature review with five databases (Scopus, CINAHL, ScienceDirect, PubMed, Proquest), the study design used is an experimental, descriptive, cross-sectional, and review systematic, in March 2021. Guidelines for using JBI to measure quality and listing check out Prisma in this review guide. A feasibility study based on title, abstract, full text, and research methodology. The data analysis used narrative analysis based on the research findings. Results: Twelve articles met the predefined review inclusion criteria. The study found eight interventions for self-management in elderly hypertension, namely: 1) Knowledge of hypertension, 2) Regulation of physical activity, 3) Limitation of alcohol and cigarette consumption, 4) Sleep rest and stress management, 5) Diet and body weight management, 6) Blood pressure control, 7) Family and social support, 8) Adherence to therapy regimens. Conclusion: The conclusion of the study results obtained eight elderly self-management interventions, this done properly will affect compliance in optimizing the health of the elderly.

Adjuvant chemotherapy is currently used in all patients with resected pancreatic cancer who are able to begin treatment within 3 months after surgery. Since the recent publication of the PRODIGE 24 trial results, modified FOLFIRINOX has become the standard-of-care in the non-Asian population with localized pancreatic adenocarcinoma following surgery. Nevertheless, there is still a risk of toxicity, and feasibility may be limited in heavily pre-treated patients. In more frail patients, gemcitabine-based chemotherapy remains a suitable option, for example gemcitabine or 5FU in monotherapy. In Asia, although S1-based chemotherapy is the standard of care it is not readily available outside Asia and data are lacking in non-Asiatic patients. In patients in whom resection is not initially possible, intensified schemes such as FOLFIRINOX or Gemcitabine-Nabpaclitaxel have been confirmed as options to enhance the response rate and resectability, promoting research in adjuvant therapy. In particular, should oncologists prescribe adjuvant treatment after a long sequence of chemotherapy +/- chemoradiotherapy and surgery? Should oncologists consider the response rate, the R0 resection rate alone, or the initial chemotherapy regimen? And finally, should they take into consideration the duration of the entire sequence, or the presence of limited toxicities of induction treatment? The aim of this review is to summarize adjuvant management of resected pancreatic cancer and to raise current and future concerns, especially the need for biomarkers and the best holistic care for patients.

There are uncertainties associated with every phase of the stock assessment process, ranging from the collection of data, assessment model choice, model assumptions and interpretation of risk to the implementation of management advice. The dynamics of fish populations are complex, and our incomplete understanding of those dynamics (and limited observations of important mechanisms) necessitate that models are simpler than nature. The aim is for the model to capture enough of the dynamics to accurately estimate trends and abundance and to provide advice to managers about sustainable harvests. The \textit{status quo} approach to assessment modelling has been to identify the `best' model, based on diagnostics and model selection criteria, and to generate advice from that model, mostly ignoring advice from other model configurations regardless of how closely they performed relative to the chosen model. We review the suitability of the ensemble modelling paradigm to more fully capture uncertainty in stock assessment model building and the provision of advice. We recommend further research to evaluate potential gains in modelling performance and advice from the use of ensemble modelling, while also suggesting revisions to the formal process for reviewing models and providing advice to management bodies.

The issue of actualization of labor interests as a motivational driver and one of the sources of labor productivity is little-studied in applied and organizational psychology. The study given in the paper fills some “blanks” of this problem. The leading approach to research is the motivational system proposed on the basis of theoretical analysis and the developed psychological model of labor interests. Using the methods of a special survey, questioning and interview guides, the analysis and comparative assessment of the labor interests of 50 candidates for the service manager position (entertainment and restaurant industry field) was conducted; as well as of 45 employees in this industry aged 18 to 25. The main results of the paper show the connection of labor interests with the company's personnel management system, namely with the processes of selection, adaptation, and training. It was revealed that the candidates selected for the service manager position were of primary group interest and financial incentive was secondary. At the same time, financial incentive contributed to the successful passage of the adaptation period. Occupational interests of employees depended on their education and job specifics. Career interests were influenced by the time spent with the company. The recommendations necessary for employers to create the conditions corresponding to the leading labor interests of employees were substantiated.

Governance is one of the most essential instruments for environmental management. Biodiversity is in the core field of environmental governance. Yet environmental authorities are persistently challenged the loss of biodiversity as a very important global issue for several years due to high dependent exposure to risks. The study attempts to relook at the key governance tools that strengthen policies towards managing biodiversity within and around the national park’s survey in Moulvibazar district. The study showed that biodiversity related legislation amended was the highest in Bangladesh for the period of 2010 to 2016. The growth of policy instruments maximized at but in low environmental governance services within the same period. The study assessed that the existing environmental policy instrument is inadequate and sluggish for effective conservation, compared with several others governance tools and various performances are still below par. Governance knowledge is indispensable for biodiversity management but such knowledge is poorly identified. These results reflect the importance of effective governance for transparency that the State provides. The research is to represent a dynamic and adaptable framework that can be applied for collective governance relevant to policy integration, participation and enforcement in order to foster environmental conservation sustainability.

This study purposes the use of plug-in electric vehicles for demand side management (DSM) considering uncertainties in demand as well as uncertainties due to mobility of PEV to mitigate peak demand. The solution also seeks to reduce electric cost in addition to reducing the effects of greenhouse gases. In recent years DSM using distributed storage system such as battery energy management system (BESS) and plugged-in electric vehicles (PEV) have become very prevalent with most implementations resorting to deterministic load forecast. These methods do not consider the potential growth in demand making their solutions less robust. In this study we propose a real-time density demand forecast and stochastic optimization for robust operation of PEV for a building. This method accounts for demand uncertainties in addition to uncertainties in mobile energy storage as found in PEV, making the resulting solution robust as compared to the deterministic case. A case study on a real site in South Korea is used for verification and testing. The proposed study is verified and tested against existing algorithms. The result verifies the effectiveness of the proposed approach

Heated intraperitoneal chemotherapy (HIPEC) has several potential benefits. Higher doses of chemotherapy can be used with HIPEC because the plasma-peritoneal barrier results in little absorption into the blood stream. HIPEC offers higher peritoneal penetration in comparison to an intravenous (IV) regimen and does not have the traditional normothermic intraperitoneal (IP) regimen limitation of post-operative adhesions. Hyperthermia itself has cytotoxic effects and can potentiate antineoplastic effects of chemotherapy in part by increasing the depth of tumor penetration by up to 3 mm. For the treatment of ovarian cancer, HIPEC has been evaluated in the recurrent setting with secondary cytoreduction. Recent studies, including a prospective trial, have evaluated its role in primary management of ovarian cancer. This review summarizes previous and ongoing studies regarding the use of HIPEC in the management of ovarian cancer.

A Demand-side management technique are deployed along with battery energy-storage systems (BESSs) to lower the electricity cost by mitigating the peak load of a building. Most of the existing methods rely on manual operation of the BESS, or even an elaborate building energy-management system resorting to a deterministic method that is susceptible to unforeseen growth in demand. In this study we propose a real-time optimal operating strategy for BESS based on density demand forecast and stochastic optimization. This method takes into consideration uncertainties in demand when accounting for an optimal BESS schedule, making it robust compared to the deterministic case. The proposed method is verified and tested against existing algorithms. Data obtained from a real site in South Korea is used for verification and testing. The results show that the proposed method is effective, even for the cases where the forecasted demand deviates from the observed demand

Capturing atmospheric CO2 and storing it in natural rock systems (i.e., alkaline earth silicate and hydroxide minerals) through carbonation reactions is a promising greenhouse gas mitigation research, and largely depends on the use of hydrated ultramafic rocks (serpentinites), which are widespread in orogenic belts around the globe. The Jurassic ophiolites in the Southern Apennines represent a natural analogue and a great opportunity for the mineralogical sequestration of CO2. Serpentinites of the Pollino ophiolite Massif have been widely studied for their mineralogical, petrographic, and chemical characteristics, providing major findings on their impact on environmental and human health issues. Serpentinites here have been divided into cataclastic and massive types based on their structures and are characterized by pseudomorphic and vein textures. The mineralogy of the studied serpentinites consists of lizardite, antigorite, clino-crysotile, Cr-chlorite, magnetite, tremolite, actinolite, pyroxene and calcite, and the most commonly occurring serpentine minerals are polymorphs of serpentine including lizardite, clino-crysotile and antigorite. Systematic petrographic and mineralogical studies of serpentinites in ophiolites, such as those outcropping in the Southern Apennines can represent a starting point for the study of natural materials, which can be used for CO2 storage and sequestration. A particular attention must be given to those carbonate phases, produced by carbonation processes to check whether the serpentinites of the Pollino Massif can be used for the induced mineral Carbon Capture Storage (CCS). If successful, this technique and the Pollino Massif serpentinites can become highly significant in safeguarding the health of our planet's climate.

Background/Objectives: This study looks at how a kinematic chain exercise regimen that targets the lower, core, and upper body affects university shot put participants' shoulder muscle strength and throwing efficiency. This study fills an apparent research void on shot put training approaches by presenting a comprehensive kinematic chain workout program. It was anticipated that this method would improve performance the most, considering the complex biomechanical require-ments of the sport. Methodology: Athletes, seventy in age (19.87 ± 1.31 years), were assigned into two groups at random: experimental (n = 35) and control (n = 35). While the control group carried on with their usual training, the experimental group participated in an 8-week kinematic chain training program, pre- and post-training evaluations were carried out to evaluate shot put throwing ability, shoulder muscle strength, and participant satisfaction with the exercise regimen. Results: demonstrated that, when compared to the control group, the athletes in the kinematic chain program had a significantly improved throwing distance (p = 0.01) and shoulder muscle strength (p = 0.01). Furthermore, there was a significant difference (p = 0.005) in the athletes' satisfaction levels with the workout program among those in the experimental group. This implies that a kinematic chain-focused strategy improves performance and emphasizes the significance this type of training is for shot put athlete performance. Conclusion: As an improvement forward in sports science, the study's finding promotes the inclusion of kinematic chain workouts in shot put training programs and calls for more research on kinematic chain-based approaches in a variety of sports.

Postoperative RT is recommended after breast conserving surgery and mastectomy (with risk factors). Consideration of pros and cons including potential side effects demands for optimization of adjuvant RT and a risk-adapted approach. There is clear de-escalation in fractionation - hypofractionation should be considered standard. For selected low risk situations PBI only or even the omission of RT might be appropriate. In contrast, tendencies in escalating RT are obvious. Preoperative RT seems attractive for patients in whom breast reconstruction is planned or for defining the tumor location more precisely with the potential of giving ablative doses. Dose escalation by a (simultaneous integrated) boost or the combination with new compounds/systemic treatments may increase antitumor efficacy but also toxicity. Despite low evidence, RT for oligometastatic disease is becoming increasingly popular. The omission of axillary dissection in node-positive disease led to an escalation of regional RT. Studies are ongoing to test if any axillary treatment can be omitted and which oligometastatic patients do really benefit from RT. Besides technical improvements the incorporation of molecular risk profiles but also the response to neoadjuvant systemic therapy have the potential to optimize the decision-making if and how local and/or regional RT should be administered.

Background Popular movement-based injury risk screens have been shown to lack predictive precision, leading to interest in multifactorial models. Furthermore, there is a lack of research regarding injury risk assessment for those currently or planning to be recreationally active. This study aims to provide injury risk insights by analyzing multifactorial injury risk models and as-sociated clinical measures in the U.S. population. Methods Data related to injury, inflammatory markers, physical functioning, body composition, physical activity, and other variables from 21,033 respondents were extracted from NHANES. Odds ratios for self-reported injury were calculated for single predictors and risk models. Case-control and principal component analyses (PCA) were conducted to elucidate confounders and identify risk factor clusters, respectively. Receiver operating characteristic analysis was used to test the precision of a risk factor cluster to identify pain points and functional difficulties. Results Sociodemographic, individual, and lifestyle factors were strongly associated with higher odds of injury. Increases in fibrinogen and C-reactive protein were significantly associated with all risk groups. Membership to the high-risk group (age over 40, obesity, no muscle-strengthening activities, sedentary lifestyle, and low back pain) predicted at least one functional difficulty with 67.4% sensitivity and 87.2% specificity. In the injury group, bone turnover markers were higher, yet confounded by age and there was a significantly higher prevalence of self-reported osteoporosis compared to the control. In males, low testosterone was associated with injury, and higher estradiol was associated with pain and functional difficulties. In females, higher levels of follicle-stimulating hormone were associated with functional difficulties. PCA revealed four high-risk profiles, with markers and activities showing distinct loadings. Conclusion A comprehensive approach to injury risk assessment should consider the nexus of aging, lifestyle, and chronic disease to enhance tailored injury prevention strategies, fostering safe and effective physical activity participation and reducing the burden of musculoskeletal disorders.

Intermediate CAG expansions in the gene ataxin-2 (ATXN2) are a known risk factor for ALS, but little is known about their role in FTD risk. Moreover, their contribution to the risk and phenotype of patients might vary in populations with different genetic background. The aim of this study was to assess the relationship of intermediate CAG expansions in ATXN2 with the risk and phenotype of ALS and FTD in the Spanish population. Repeat-Primed PCR was performed in 620 ALS and 137 FTD patients in three referral centers of Spain to determine the exact number of CAG repeats. In our cohort, ≥27 CAG repeats in ATXN2 was associated with a higher risk of developing ALS (odds ratio [OR] = 2.666 [1.471-4.882]; p = 0.0013), but not FTD (odds ratio [OR] = 1.446 [0.558-3.574]; p = 0.44). Moreover, ALS patients with ≥27 CAG repeats in ATXN2 showed shorter survival rate compared to those with &lt;27 repeats (hazard ratio [HR] 1.74 [1.18, 2.56], p = 0.005), more frequent limb onset (odds ratio [OR] = 2.34 [1.093-4.936]; p = 0.028), as well as family history of ALS (odds ratio [OR] = 2.538 [1.375-4.634]; p = 0.002). Intermediate CAG expansions of ≥27 repeats in ATXN2 are associated with ALS risk, but not with FTD, in the Spanish population. ALS patients carrying an intermediate expansion in ATXN2 show more frequent limb onset, but worse prognosis than those without expansions. In patients carrying C9orf72 expansions, the intermediate ATXN2 expansion might increase the penetrance and modify the phenotype.

The use of miniplates for stabilizing bones after orthognathic surgeries, has become increasingly popular for their effectiveness in ensuring stability and promoting swift recovery. However, the post-surgical fate of these miniplates remains a subject of contention among surgeons. Some advocate for their removal, while others suggest leaving them in place. The aims of this study, is to evaluate the incidence, causes, and potential risk factors associated with the removal of miniplates in orthognathic surgeries. A comprehensive meta-analysis was conducted by reviewing studies from various databases like PubMed, Google Scholar, Research Gate, Embase, and Scopus, focusing on publications from 1989 to 2023. Ten studies encompassing a total of 1603 patients which conformed to the inclusion criteria were selected and included in the meta-analysis. With M:F ratio range from 4:1 to 109:141. Total number of miniplates inserted was 5595, and total number of miniplates removed were 294 (5.3%). The most common reasons for miniplates removal were, infection was reported in 161 cases (2.9%), followed by miniplates exposure (34 cases, 0.6%) and palpable plates (23 cases 0.4%). Other indications included pain, patient’s preference, and temperature sensitivity. Relatively less common reasons that resulted in miniplates removal include, sinusitis, second surgery and dental pathology. The mean duration of miniplates removal was 5.5 months with the majority of miniplates (56.1%) were removed from the mandible compared to maxilla. In conclusion, this meta-analysis underscores the importance of miniplate removal in cases where hardware causes diverse complications and physical discomfort. The primary reasons for miniplates removal were infections and plates exposure, with the mandible being the most common site for removal. These findings emphasize the need for continued monitoring to assess the fate of miniplates in orthognathic surgery and provide valuable insights for future clinical decision-making.

Non-alcoholic fatty liver disease (NAFLD) affects up to a quarter of the adult population in many developed and developing countries. This spectrum of liver disease ranges from simple steatosis to nonalcoholic steatohepatitis (NASH) and cirrhosis. The incidence of NASH is projected to increase by up to 56% over the next 10 years. There is growing epidemiological evidence that NAFLD has become the fastest growing cause of hepatocellular carcinoma (HCC) in industrialized countries. The annual incidence of HCC varies between patients with NASH cirrhosis and patients with noncirrhotic NAFLD. In this review, NAFLD/NASH-associated HCC will be described, including its epidemiology, risk factors promoting hepatocarcinogenesis, and management of HCC in patients with obesity and associated metabolic comorbidities, including preventive strategies and therapeutic approaches to address this growing problem.

Microbiota and the metabolites they produce within the large intestine interact with the host epithelia under the influence of a range of host-derived metabolic, immune, and homeostatic factors. This complex host-microbe interaction affects intestinal tumorigenesis but established microbial or metabolite profiles predicting colorectal cancer (CRC) risk are missing. Here we describe alterations in fecal bacteria and volatile organic compounds (VOC) in healthy (Non-Adenoma, NA) versus CRC prone (High-Risk Adenoma, HRA) individuals. Analyzing samples from 117 participants undergoing routine colonoscopy we highlight the higher abundance of Proteobacteria and Parabacteroides distasonis, and the lower abundance of Lachnospiraceae species, Roseburia faecis, Blautia luti, Fusicatenibacter saccharovorans, Eubacterium rectale and Phascolarctobacterium faecium, in the fecal samples of HRA individuals. Volatolomic analysis reveals higher concentration in the feces of HRA individuals of 5 compounds, isobutyric acid, methyl butyrate, methyl propionate, 2-hexanone and 2-pentanone. Interestingly, there is a level of complexity revealed by assessing fecal bacteria-VOC associations and another one by assessing differences in these associations between NA and HRA individuals. For example, isobutyric acid corelates positively with the Lachnospiraceae incertae sedis and Bacteroides genera in NA individuals, and negatively in HRA individuals. In contrast, Coprococcus and Colinsella genera correlate negatively with isobutyric acid in NA individuals, and positively in HRA individuals. The described differences in the fecal microbiota and VOC profiles and their associations in NA versus HRA individuals indicate the significance of multiple levels of combinatorial analysis towards the identification of testable CRC risk biomarkers.