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A jejunal intussusception as a presentation of retroperitoneal liposarcoma (RLPS) is a rare occurrence. The majority of RLPS are presented as an abdominal mass, however, having a jejunal obstruction is an interesting case. The aim is to describe the management of jejunal intussusception secondary to atypical lipomatous tumours with concurrent RLPS. A 61-year-old lady presented with a sudden onset of intestinal obstruction with 1 month of constitutional symptoms and an enlarging right lumbar mass. Computed tomography showed a small bowel intussusception with diffuse peritoneal and retroperitoneal lipomatosis. Emergency exploratory laparotomy, segmental bowel resection, and partial excision of intraperitoneal mesenteric lipoma were performed. A stage En-bloc resection of the RLPS and right nephrectomy was done later. However, she refused for subsequent surgery. A complete resection is the gold standard in managing RLPS. In this report, the management is rendered not to the standard as the patient first presented with intestinal obstruction requiring emergency reduction with a piecemeal resection. A stage surgery was required to determine a promising prognosis, but the patient refused such surgery. A small bowel intussusception in adults is rare but is mostly caused by a tumor or neoplasm. Early recognition of the complexity of the case should be preempted and referred to the tertiary team for further definitive surgery. Patient exhaustion from the subsequent surgery might hamper the only management available for the case.

Background/Purpose: Radiation-induced cardiac toxicity in lung cancer patients has received increased attention since RTOG 0617. However, large cohort studies with accurate cardiac substructure (CS) contours are lacking, limiting our understanding of the potential influence of individual CSs. Here, we analyse the correlation between CS dose and overall survival (OS) while accounting for deep learning (DL) contouring uncertainty, α/β uncertainty and different modelling approaches. Materials/Methods: This single institution, retrospective cohort study includes 730 patients (early-stage tumours (I or II). All treated: 2009–2019), who received stereotactic body radiotherapy (≥ 5 Gy per fraction). A DL model was trained on 70 manually contoured patients to create 12 cardio-vascular structures. Structures with median dice score above 0.8 and mean surface distance (MSD)

A 57-year-old lady presented with symptoms of intestinal obstruction preceded by a 2-day history of lower abdomen pain. Clinically, she had a distended abdomen with tenderness in her lower abdomen. Laboratory investigations were unremarkable. An abdominal radiograph showed a dilated small bowel with no extensive bowel gas. A computed tomography (CT) scan showed suspected intestinal obstruction secondary to herniation into the right broad ligament. The decision was made to proceed with surgery, and the intraoperative results confirmed the CT results. The literature review is outlined here, and this instance illustrates a surprising discovery.

Patients in intensive care unit (ICU) often have multiple vital signs monitored continuously. However, missing data is common in ICU settings, negatively impacting clinical decision-making and patient outcomes. In this study propose a multivariate data imputation method based on simple U-Shaped encoder-decoder network imputation (XU-NetI) method to learn the underlying patterns in the data and generate imputations for missing values of vital signs data with ICU patients. To evaluate the performance of this study's imputation methods, this study employed a publicly available database such the medical information mart for intensive care III (MIMIC III) v1.4. In this study proposed model has been developed to analyze 219.281 vital sign worth of data, focusing on eight essential vital sign features: body temperature, heart rate, respiration rate, systolic blood pressure, diastolic blood pressure, mean blood pressure, oxygen saturation, and glucose. The evaluation results demonstrates the effectiveness of the imputation techniques in improving the accuracy of predictive models. This study compared the XU-NetI approach to other state-of-the-art imputation methods including Autoencoder and Convolutional Neural Networks. As a result found, the technique using XU-NetI architecture outperformed them, in terms of root mean square error (RSME) by approximately 0.01, mean absolute error (MAE) by approximately 0.009, and R square (R2) by approximately 0.99. The XU-NetI method has the potential to enhance clinical decision-making and improve patient outcomes.

Background: Backward running (BR) and forward running (FR) activate distinct neuromuscular pathways and utilize differing biomechanical principles. Although FR is a well-established training modality, the potential advantages of BR for enhancing athletic performance and mitigating injury risk necessitate further exploration. Moreover, there exists a paucity of experimental data comparing these modalities in collegiate athlete populations. Purpose: This study sought to quantify the differential effects of BR intervention, FR intervention, and no intervention on agility, power, and speed performance in collegiate athletes. Methods: Thirty collegiate athletes (Aged 18–28 years) were randomly allocated to the BR group (n = 10), FR group (n = 10), and an absolute control (CON) group (n = 10). The BR and FR groups performed running sessions on a treadmill for matched time and intensity biweekly for eight weeks. All athletes were assessed for agility, speed, and power performance before and after the intervention. Results: Results revealed a significant main effect of time (p 0.05). Conclusions: BR intervention led to greater gains in CMJ performance and improved 10-m sprint performance compared to the control group, with little improvement compared to the FR group based on the mean difference data.

Glycosaminoglycans (GAGs) such as heparin and heparan sulfate (HS) play crucial roles in inflammation and wound healing, serving as regulators of growth factors and pro-inflammatory mediators. In this study, we investigated the influence of heparin/HS on thrombin proteolysis and its interaction with the generated 11 kDa thrombin-derived C-terminal peptides (TCPs). Employing various biochemical and biophysical methods, we demonstrated that 11 kDa TCPs aggregate in the presence of GAGs, including heparin, heparan sulfate, and chondroitin sulfate-B. Circular dichroism analysis demonstrated that 11 kDa TCPs, in the presence of GAGs, adopt a β-sheet structure, a finding supported by thioflavin T1 (ThT) fluorescence measurements and visualization of 11 kDa TCP-heparin complexes using transmission electron microscopy (TEM). Furthermore, our investigations revealed a stronger binding affinity between 11 kDa TCPs and GAGs with higher sulfate group contents. Congruently, in silico simulations showed that interactions between 11 kDa TCPs and heparin/HS are predominantly electrostatic in nature. Collectively, our study suggests that 11 kDa TCPs have the capacity to aggregate in the presence of GAGs, shedding light on their potential roles in inflammation and wound healing.

The study aimed to evaluate the effectiveness of a culinary nutrition education program at a 3-month follow-up, in terms of children's dietary practices and variety. The randomized-controlled trial was conducted among Malaysian children aged 10–11 years, in a school-based setting. The main intervention components include a parent-child session on the home food environment, followed by 5 experiential healthy meal preparation sessions, conducted fortnightly with each session lasting an hour. Dietary data were collected using an adapted guided form, in line with the Malaysian Dietary Guidelines for Children and Adolescents at baseline, post-intervention, and a 3-month follow-up (intervention: n = 41, control: n = 42, drop-out rate: 15.3 %). Overall, the children recruited were mainly from low-to middle-income households (76 %) whose families attained at least secondary or tertiary education (95 %). At the 3-month follow-up, significant group and time interaction effect (p

Assessing riverine pollutant loads is a more realistic method for analysing point and non-point anthropogenic pollution sources throughout a watershed. This study compares numerous mathematical modelling strategies for estimating riverine loads based on the chosen water quality parameters: Biochemical Oxygen Demand (BOD), Chemical Oxygen Demand (COD), Suspended Solids (SS), and Ammoniacal Nitrogen (NH3–N). A riverine load model was developed by employing various input variables including river flow and pollutant concentration values collected at several monitoring sites. Among the mathematical modelling methods employed are artificial neural networks with feed-forward backpropagation algorithms and radial basis functions. The classical multiple linear regression (MLR) statistical model was used for the comparison. Four widely used statistical performance assessment metrics were adopted to evaluate the performance of the various developed models: the root mean square error (RMSE), mean absolute error (MAE), mean relative error (MRE), and coefficient of determination (R2). The considerable number of errors (with RMSE, MAE, and MRE) discovered in estimating riverine loads using the multiple linear regression (MLR) statistical model can be attributed to the nonlinear relationship between the independent variables (Q and Cx) and dependent variables (W). The feed-forward neural network model with a backpropagation algorithm and Bayesian regularisation training algorithm outperformed the radial basis neural network. This finding implies that, in addition to suspended sediment loads, riverine loads may be predicted using an artificial neural network using pollutant concentration (Cx) and river discharge (Q) as input variables. Other geographical and temporal fluctuation characteristics that may impact river water quality, on the other hand, may be incorporated as input variables to enhance riverine load prediction. Finally, riverine load analyses were successfully conducted to reduce the riverine load.

الملخص: أهداف البحث: حب الشباب الشائع مشكلة شائعة، مع معدل حدوث مرتفع نسبيا بين الآسيويين. بالمناسبة، تم إثبات الخصائص المحتملة المضادة للميكروبات والمضادة للالتهابات لقشور الموز في دراسات سابقة؛ ومع ذلك، لم يتم دراستها في حالة حب الشباب. هدفت الدراسة الحالية إلى معرفة التأثيرات الوقائية لمستخلص قشر الموز (موسى بالبسيانا) بسبب حب الشباب. طريقة البحث: تم تقسيم ثلاثين جرذا إلى خمس مجموعات (عدد = 6 فئران في كل مجموعة): مجموعة حب الشباب، مجموعة حب الشباب الشائع المعالجة بـ 0.15 ٪ قشر الموز (موسى بالبيسيانا) ، مجموعة حب الشباب الشائع المعالجة بنسبة 0.30 ٪ قشر الموز (موسى بالبيسيانا)، مجموعة حب الشباب الشائع المعالجة 0.60 ٪ قشر الموز (موسى بالبيسيانا)، وحب الشباب الشائع المجموعة التي تم إعطاؤها الكليندامايسين كدواء قياسي. قمنا بتقييم حجم العقيدات وعدد البكتيريا وعلم الأنسجة ومستويات السيتوكين (انترليوكن-1، وانتر فيرون جاما، وعامل نخر العظم-ألفا، انترليوكن-8). تم استخدام المقايسات المناعية المرتبطة بالإنزيم لقياس مستويات السيتوكين. بالإضافة إلى ذلك، أجرينا دراسات الالتحام الجزيئي لتحديد التفاعلات بين المواد الكيميائية النباتية (تريغونيلين، الفانيلين، حمض الفيروليك، حمض الأيزوفانيليك، الروتين، والسالسولينول) عبر مسارات المستقبل الشبيه بالتول-2 والعامل النووي – كابا ب. النتائج: أدت جميع جرعات قشر الموز (موسى بالبيسيانا) إلى تثبيط نمو البكتيريا وإنتاج السيتوكينات المنشطة للالتهابات مقارنة بمجموعة حب الشباب، بالإضافة إلى علاج التهاب الأنسجة. تم قمع حجم العقدة بشكل معنوي بأعلى جرعتين من قشر الموز (موسى بالبيسيانا) مقارنة بمجموعة حب الشباب. ومع ذلك، يظل تأثيره الدوائي أدنى من تأثير الكليندامايسين. أظهرت دراسات الالتحام أن المركب النباتي ذو الطاقة التفاعلية الأكثر سلبية مع المستقبل الشبيه بالتول-2 والعامل النووي – كابا ب كان روتيني. الاستنتاجات: تشير هذه النتائج إلى أن مستخلص قشر الموز (موسى بالبيسيانا) يعمل كعامل مضاد للالتهابات ضد حب الشباب الشائع، عن طريق قمع تكوينات العقيدات، وتثبيط نمو البكتيريا، وتقليل إنتاج السيتوكينات المسببة للالتهابات. Abstract: Objective: Acne vulgaris (AV) is a common problem with a relatively high incidence rate among Asian people. The potential antimicrobial and anti-inflammatory properties of banana peels have been demonstrated in previous studies but have not been studied in cases of AV. Therefore, this study was aimed at investigating the protective effects of banana (Musa balbisiana) peel extract (MBPE) against AV. Methods: Thirty rats were divided into five groups (n = 6 rats per group): an AV group, AV group treated with 0.15% MBPE, AV group administered 0.30% MBPE, AV group administered 0.60% MBPE, and AV group administered clindamycin (the standard drug treatment). We assessed nodule size, bacterial count, histopathology, and cytokine levels (IL-1α, IFN-γ, tumor necrosis factor (TNF)-α, and IL-8). Enzyme linked immunoassays were used to measure the cytokine levels. In addition, we performed molecular docking studies to determine the interactions between phytochemicals (trigonelline, vanillin, ferulic acid, isovanillic acid, rutin, and salsolinol) via the Toll-like receptor 2 (TLR2) and nuclear factor-kappa B (NF-κB) pathways. Results: All MBPE treatment groups, compared with the AV group, showed suppression of both bacterial growth and proinflammatory cytokine production, as well as resolved tissue inflammation. The nodule size was significantly suppressed in the groups receiving the two highest doses of MBPE, compared with the AV group. However, the pharmacological action of MBPE remained inferior to that of clindamycin. Docking studies demonstrated that rutin was the phytocompound with the most negative interaction energy with TLR2 or NF-κB. Conclusions: Our results indicated that MBPE has anti-inflammatory effects against AV, by suppressing nodule formation, inhibiting bacterial growth, and decreasing proinflammatory cytokine production.

Adult intussusception presents a diagnostic challenge given its non-specific symptoms. It is not as common as in infants and young children. Traditionally, diagnostic steps are invariably fit for normal adults, but not in pregnancy which faces certain limitations. A 40-year-old pregnant mother, gravida 9 para 8 at 34-week gestation, complained of intermittent epigastric pain for 2 days, requiring hospitalization. She soon developed minimal per rectal bleeding that was ruled out as hemorrhoid. Imaging was limited due to her pregnancy status. She later developed spontaneous delivery to a premature baby. Computed tomography (CT) revealed an ileocolic intussusception, which was confirmed via exploratory laparotomy. Histology was consistent with inflammatory fibroid polyp. Acute abdomen in pregnancy can be due to various causes, thus a high index of suspicion and early CT abdomen might help in early diagnosis and treatment. The benefit of doing CT on the mother and the risk of CT on the fetus is to be weighed as the timely diagnosis can prevent bowel ischemia and reduce maternal morbidity and mortality. Surgery remains the definite management in adult intussusception and an exact diagnosis can be made during the operation.

The current era witnesses the advent of the Internet of Things (IoT), a transformative force giving rise to various technological innovations, most notably connected objects. This paradigm shift catalyzes the widespread adoption of autonomous decision-making systems, particularly in sectors like agriculture, where the aim is to amplify productivity. As a result of the agricultural domain, mushrooms have concurrently emerged as a significant component of daily diets, offering additional vitamins and flavor. Despite their popularity, cultivating mushrooms in open environments poses challenges in maintaining optimal environmental conditions, prompting numerous research efforts. Recognizing the inconsistencies in existing approaches to safeguard vital parameters in mushroom farms, this paper introduces an innovative system utilizing intelligent sensors whose real-time records are managed based on the fuzzy sets concept. These sensors, encompassing the Capacitive Soil Moisture Sensor v1.2, DHT22 Sensor, Light Dependent Resistor (LDR sensor), and Passive Infrared Receiver (PIR sensor), collectively capture essential data for decision-making in mushroom farming. Employing fuzzy logic, the system addresses pivotal aspects such as substrate watering, environmental control, light management, and pest detection. Through experimental results, it becomes evident that the proposed system not only exemplifies the potential of IoT technologies in agriculture but also offers a comprehensive and efficient approach to real-time decision-making. By aggregating sensor data, the system proves instrumental in enhancing the quality and yield of mushroom crops, showcasing a promising trajectory for sustainable and technologically driven agricultural practices.

This study is centered on the exploration of the inorganic perovskite material RbGeBr3 as an absorbing layer in various configurations of perovskite solar cells (PSCs). The Poisson, continuity, and transport equations are solved using the finite element method for calculation. Systematic variations in the thicknesses of the RbGeBr3 absorber layer and the electron transfer layer are performed, with gold (Au) and silver (Ag) utilized as metal contacts for the electrodes. The study also delves into the impact of temperature variations on the efficacy of these structures. Among the tested configurations, the FTO/TiO2/RbGeBr3/P3HT/Au configuration emerges as the most efficient, achieving a power conversion efficiency of 11.89 %, with a short-circuit current of 14.47 mA/cm2 and an open-circuit voltage of 0.96 V. Additionally, two alternative structures, FTO/ITO/RbGeBr3/PEDOT:PSS/Au and FTO/ITO/RbGeBr3/PEDOT:PSS/Ag, are investigated, yielding comparable power conversion efficiencies of 11.374 %. The findings of this study can serve as valuable insights for the design of more advanced and efficient perovskite solar cells based on mineral perovskite layers.

Environmental change and technological disruption are expanding phenomena impacting today's economic world. A dynamic business environment can inspire companies to engage in both exploitative and exploratory innovation at the same time. Traditional financial technologies have evolved substantially over the past decade. Although the environment challenges technology to adapt to business sustainability, artificial intelligence has not replaced human bankers. There is, however, a scarcity of research on the relationship between ambidextrous work and human capital, indicating that few studies have been undertaken. To better understand how banks can achieve such organizational ambidexterity, we develop a framework that investigates the combined effects of organizational human capital (O-HC), environmental dynamism (END), and technological capacity (TEC) on organizational ambidexterity (ORA). The theory of contingency is the theoretical foundation of the subject. This quantitative analysis used a sample size of sixty-three executives from Indonesia's banking industry and was analyzed using PLS-SEM and SPSS to determine the measurement and structural models. The results show that TEC and O-HC directly affected ORA, but END did not. We also found that firms with O-HC are more likely to utilize high TEC to promote ORA. The findings of this study provide practitioners with insight into how they can promote human capital and TEC as pillars of ambidextrous banking. This research contributes to the literature on ORA and offers managers insights on aligning their knowledge practices to develop TEC when pursuing ORA.

Background: Women of reproductive age frequently suffer from psychiatric disorders. The risk of developing anxiety, bipolar, and depressive disorders is especially significant during the perinatal period. Objectives: This article aims to identify and discuss the different psychiatric conditions that might affect pregnant women and update the mother's carers about the recent and updated bidirectional relationship between psychiatric disease and adverse pregnancy outcomes, As well as the most updates in diagnostic and management strategies. Methods: A thorough analysis of the literature was conducted using database searches in EMBASE, Science Direct, Google Scholar, Scopus, and PubMed to obtain the objectives and aim of the study. Results: The presence of maternal mental illness during pregnancy has been linked to preterm delivery, newborn hypoglycemia, poor neurodevelopmental outcomes, and disturbed attachment. Placental anomalies, small-for-gestational-age foetuses, foetal discomfort, and stillbirth are among more undesirable perinatal outcomes. Conclusions: Pregnancy-related psychiatric disorders are frequent. The outcomes for pregnant women, infants, and women's health are all improved by proper diagnosis and treatment of psychiatric problems.

In this study, nanocomposite solid polymer electrolytes (NSPEs) based on poly(ethylene glycol) (PEG), potassium nitrate (KNO3), and titanium oxide (TiO2) nanoparticles were synthesized using a solution casting technique. The impact of various TiO2 nanoparticle concentrations on the structural, thermal, electrical and electrochemical properties of the NSPEs was investigated. X-ray diffraction analysis revealed a decrease in the degree of crystallinity of the PEG–KNO3 electrolyte upon the addition of TiO2 nanoparticles. Differential scanning calorimetry measurements showed a decrease in the melting temperature of the NSPE with the incorporation of 6 wt.% TiO2 nanoparticle concentration. The ionic conductivity of the NSPEs increased with TiO2 concentration up to 6 wt.% (σ = 5.94 × 10−5 S/cm), beyond which a decrease was observed. Transference number measurements confirmed the dominance of ionic charge transport in the NSPE. A solid-state electrochemical cell fabricated using the optimal NSPE composition (80PEG–20KNO3–6 wt.% TiO2) exhibited promising discharge performance under a constant load of 100 kΩ.

The climate, geomorphological changes, and hydrological elements that have occurred have all influenced future flood episodes by increasing the likelihood and intensity of extreme weather occurrences like extreme precipitation events. River bank erosion is a natural geomorphic process that occurs in all channels. As modifications of sizes and channel shapes are made to transport the discharge, sediment abounds from the stream catchment, and floods are triggered dramatically. The aim of this study is to analyze the flood-sensitive regions along the Pahang River Basin and determine how climate and river changes would have an impact on flooding based on hydrometeorological data and information on river characteristics. The study is divided into three stages, namely the upstream, middle stream, and downstream of the Pahang River. The main primary hydrometeorological data and river characteristics, such as Sinuosity Index, Dominant Slope Range and Entrenchment Ratio collected as important inputs in the statistical analysis process. The statistical analyses, namely HACA, PCA, and Linear Regression applied in river classification. The result showed that the middle stream and downstream areas demonstrated the worst flooding affected by anthropogenic and hydrological factors. Rainfall distribution is one of the factors that contributed to the flood disaster. There are strong correlations between the Sinuosity Index (SI) and water level, which indicates that changes occurred at both planform and stream classification. The best management practices towards sustainability are based on the application of the outcomes that have been obtained after the analysis of Pahang River planform changes, Pahang River geometry, and the local rainfall pattern in the Pahang River Basin.

Purpose: To prove the effect of Miana (M), Quercetin (Q), and the combination as an anti-inflammatory agent and Cefixime (C) as an antibiotic in Balb/c mice infected with Salmonella enterica serovar Typhi (S. Typhi) and related to the dynamics of NF-κB mRNA expression and NF-κB protein levels. Methods: A cohort study on male Balb/c mice with subjects consisted of 8 groups with 5 each group by administration of M, Q, M + Q, M + C, Q + C, M + Q + C, C only and sterile distilled water group as negative control. The statistical significance of the difference group was defined as P values less than 0.05. Results: Decreased mRNA expression of NF-κB, NF-κB protein levels, and bacterial load after administration of M + C, Q + C, or M + Q + C showed significant differences when compared to the negative control. The decline in NF-κB was stronger when M + Q + C was given compared to M, Q, M + Q, or C only. Conclusion: The effects of NF-κB suppression appear to be the same between the administration of M, Q and the M + Q when C added. However, the suppression of NF-κB was not significant without adding C.

Streptococcus suis (S. suis) is a zoonotic pathogen that causes pneumonia, sepsis, endocarditis, and meningitis. S. suis is primarily found in the upper respiratory tract of pigs. To our knowledge, the first case of S. suis infection has resulted in pneumonia in Indonesia. A 40-year-old woman suffered from shortness of breath last month. The complaint worsened one week ago. She also complained of a productive cough with thick white phlegm. She has a history of late-stage cervical cancer. The patient's vital signs were normal, except for tachypnea. Vesicular breath sounds, no wheezing, and coarse lung crackles were discovered during a physical examination. A chest x-ray showed patchy airspace opacities and interstitial thickening throughout both lungs. The following results were obtained from routine laboratory leukocytosis. Gram stain of the sputum showed a few Gram-positive cocci, mostly in pairs. We confirmed this finding by performing the blood agar, and chocolate agar revealed small α-hemolytic and catalase-negative colonies. The strain was positive for penicillin and ceftriaxone in antimicrobial susceptibility testing. A combination of penicillin and ceftriaxone intravenous was utilized for definitive treatment. After completing a 14-day course of oral antibiotic medication, the patient was discharged. Her symptoms had subsided. This case should remind physicians about the possibility of cancer associated with S. suis infected patient and no clear history of exposure to pigs or other animals.

Summary: Trade restrictions for endangered elasmobranch species exist to disincentivise their exploitation and curb their declines. However, trade monitoring is challenging due to product variety and the complexity of import/export routes. We investigate the use of a portable, universal, DNA-based tool which would greatly facilitate in-situ monitoring. We collected shark and ray samples across the Island of Java, Indonesia, and selected 28 commonly encountered species (including 22 CITES-listed species) to test a recently developed real-time PCR single-assay originally developed for screening bony fish. In the absence of a bespoke elasmobranch identification online platform in the original FASTFISH-ID model, we employed a deep learning algorithm to recognize species based on DNA melt-curve signatures. By combining visual and machine-learning assignment methods, we distinguished 25/28 species, 20 of which were CITES-listed. With further refinement, this method can improve monitoring of the elasmobranch trade worldwide, without a lab or species-specific assays.

Introduction: During the past two decades, the incidence of chronic kidney disease (CKD) in children worldwide has steadily increased and, even in children, native arteriovenous fistula (AVF) remains the access of choice. Nevertheless, maintaining a well functioning fistula is limited by central venous occlusion due to the widespread use of central venous access devices before AVF creation. Report: A 10 year old girl with end stage renal failure dialysing through a left brachiocephalic fistula presented with left upper limb and facial swelling. She had previously exhausted the option of ambulatory peritoneal dialysis for recurrent peritonitis. A central venogram showed occlusion at the left subclavian vein, which was not amenable for angioplasty through either an upper limb or femoral approach. Given the precious fistula with concomitant worsening venous hypertension, an ipsilateral axillary vein to external iliac vein bypass was performed. Subsequently, her venous hypertension was significantly resolved. This report is the first in English literature on this surgical bypass in a child with central venous occlusion. Discussion: Central venous stenosis or occlusion rates are rising due to extensive central venous catheter use in the paediatric population with end stage renal failure. In this report, an ipsilateral axillary vein to external iliac vein bypass was used successfully as a safe temporary option to maintain AVF. Ensuring a high flow fistula pre-operatively and continued antiplatelet post-operatively will allow longer patency of the graft.

Iraq is facing a dire water crisis due to the decrease in water quantities flow in Tigris and Euphrates Rivers. Due to population growth, several studies estimated the water shortage in 2035 to be 44 Billion Cubic Meter (BCM). Thus, Water Budget-Salt Balance Model (WBSBM) has been developed, applied and examined for the Euphrates River basin to compute the net water saving from Non-Conventional Water Resources (NCWRs). WBSBM includes 4-stages; the first is to identify the required data correspond to the conventional water resources in the study-area. The second stage is demonstrating the water-users activities. Thirdly, develop model through the proposed NCWR projects that reflect the required data. The final stage involves net water saving computation while applying all the NCWR projects simultaneously. The results obtained the optimal potential net water saving amount, which are 6.823 and 6.626 BCM/year in 2025 and 2035, respectively. In conclusion, the proposed WBSBM model has comprehensively examined different scenarios of utilizing NCWRs and has determined the optimal potential the net water saving amounts.

Organizational ambidexterity has been widely established as necessary for economic sustainability in the financial services sector. Organizational ambidexterity is an organization's ability to be aligned and efficient in management to meet business needs while simultaneously adapting to environmental changes. To meet the challenges of the new digital economy, banking organizations require substantial technological changes and must also recognize that the banking business itself is one of technology. Organizational ambidexterity is essential for financial sector businesses, but their relationship and relative merits are unclear. This research focuses on the role of technological capacity and dynamic capability of the banking sector in Indonesia in an effort to achieve organizational ambidexterity in the face of a dynamic environment. This research uses quantitative methods by surveying leaders from Indonesian commercial banks and analyzed using the SMART PLS program. Our investigation found that technological capacity influences organizational Ambidexterity, with the link becoming stronger when mediated by an organization's dynamic capability. In the meantime, environmental dynamism has no impact on the organizational ambidexterity of the banking sector in Indonesia. Our findings also indicate that the associated security risk will increase if a bank improves its technological capacity in a highly dynamic environment. This paper is an empirical study of technological capacity and presents a method for creating organizational ambidexterity through dynamic capability, especially in the banking sector.

QSAR modelling as anticancer of 4-alkoxy cinnamic analogues has been done against their 3D descriptors. This modelling aims to develop the 4-alkoxy cinnamic analogues in better activity. We employed Kennard and Stone’s algorithm to split the data set into training and test set. Genetic Algorithm (GA) and Multiple Linear Regression (MLR) are used to select the influencing descriptors and to carry out statistically robust model.pIC50 = 2.7350 (±1.0653) ×RDF145u − 2.2276 (±0.9655) × RDF120m + 1.8369 (±1.1295) × E2m − 1.5611 (±0.4518)(R2training = 0.7436, R2test = 0.9812)Coefficient of Y-randomization (cR2p) as one of model validation for the selected model gave a value of 0.6569 that greater than 0.5 identifying the model is powerful and not inferred by chance. Descriptors which influencing the activity are RDF145u, RDF120m, and E2m. RDF145u is radial distribution function-145/unweighted, RDF120m is radial distribution function-120/weighted by atomic mass and E2m is 2nd component accessibility directional WHIM index, weighted by atomic mass. Selected QSAR model used to design and predict some of new 4-alkoxy cinnamic analogues. There are 10 newly designed compounds that have a better prediction activity and have no violation in the drug likeness property based on the Lipinski rule.

Cervicography visual inspection after acetic acid application (VIA) has been recognized as an alternative early screening in resource-limited settings, such as Indonesia. However, the accuracy of VIA results primarily relies on the examiner's expertise, and due to inadequate and comprehensive training of healthcare workers, the accuracy of VIA is diminishing. Our primary goal was to develop a real time mobile AI-assisted cervicography interpretation system empowered by lightweight model to promptly and autonomously determine precise VIA results. Our custom dataset comprises a substantial collection of 702 subjects from Dr Mohammad Hoesin General Hospital, Indonesia which were classified into two conditions: 418 with abnormal cervixes and 302 as a control. We conducted two experiments: one focused on the detection of the region of interest (RoI) of cervix, and the other on the segmentation of precancerous lesions. In this study, we utilize the object detection approach using the combined You Only Look Once (YOLO) framework. As a result, the proposed model achieves an exceptional mean average precision (mAP) of 99% for RoI cervix detection, while the segmentation of lesions achieves a mAP of 73% and an average intersection over union score of 40%. Furthermore, the model showcases an inference time of 10.4 ms, reflecting its efficiency in processing images and generating results swiftly. We also assessed the model with two oncologist consultants, and the results indicated a satisfactory agreement with a Kappa value of 0.838. The high Kappa value signifies a substantial level of agreement between the model's predictions and the assessments made by the oncologist consultants. This further validates the effectiveness and accuracy of the model in lesion segmentation and highlights its potential utility in clinical settings.

Fetal cardiac anatomical structure interpretation by ultrasound (US) is a key part of prenatal assessment. Unfortunately, the numerous speckles in US video, the small size of fetal cardiac structures, and unfixed fetal positions make manual detection processes difficult. To alleviate such problems, a deep learning model was developed to fully automate the processing of fetal echocardiographs with 2-dimensional cross-sectional images. The weakness of such an approach is that a physician immediately interprets US video with 3-dimensional objects to diagnose patients in clinical practice. To improve fetal cardiac anatomical structure interpretation via US for accurate and real time diagnosis, this paper proposes a real-time fetal cardiac substructure detection using US video with the You Only Look Once (YOLO) framework. In YOLO, an end-to-end neural network makes predictions for cardiac substructure objects, boxes, and class probabilities simultaneously. To achieve reliable performance, 40 fetal echocardiography videos were trained with the new YOLOv7 architecture and fine-tuned to work optimally and run efficiently. We conducted with nine fetal cardiac substructure objects such as the left atrium, right atrium, left ventricle, right ventricle, tricuspid valve, pulmonary valve, mitral valve, aortic valve, and aorta. The results yielded the highest mean average precision of 82.10%, reaching 17 frames per second (FPS) for nine cardiac substructure objects in 0.3 ms. The main finding of our study is that with even a limited number of US videos, YOLOv7 can detect fetal cardiac substructure objects in real-time. Such a network can work efficiently to detect small fetal cardiac objects automatically in a rapid phase with the help of proper fine-tuning. This work mainly assists medical experts in the fetal cardiac anatomy diagnostic process.

Neuroendocrine tumor (NET) commonly occurs in the gastrointestinal tract, however primary NET of the liver is rare, especially during pregnancy. We present a 34-year-old pregnant woman gravida 3 para 2 at 16 weeks period of gestation with primary liver NET discovered incidentally during the antenatal check-up. She has no risk factors for hepatocellular carcinoma. Her serum alpha-fetoprotein was elevated. A plain magnetic resonance imaging (MRI) of the liver delineating a large well-defined exophytic liver mass at segment V/VI measuring 7.1 × 7.4 × 7.8 cm. Given inconclusive MRI findings coupled with low-risk factors of HCC, we had decided to follow up her liver mass with imaging 6 weekly. She then underwent a right hepatectomy with a caesarean delivery at 32 weeks of gestation in the same setting. The histopathological formal report revealed a neuroendocrine tumor, grade 2 with a Ki-67 index of 3% with negative lymphovascular and perineural invasion, but positive for porta hepatis lymph nodes metastasis. A follow up after 1 year shows both patient and her infant are healthy. Antenatal discovery of liver masses poses a diagnostic and management dilemma to clinicians. A multidisciplinary approach and collective decision making are crucial to determine the best approach tailored to the maternal and fetal benefit. In cases of inconclusive non-contrast MRI in pregnancy with low-risk factors and lack of clinical evidence of HCC, follow-up with imaging modalities aiming to intervene at the third trimester can offer safer, and promising outcomes.

A primary endovascular approach is the mainstay of intervention for type C aortoiliac disease. When the femoral artery is unsuitable, upper extremity access can be critical in the setting of severe tortuosity or occlusive disease. The axillary artery represents alternative upper extremity access that may accommodate larger sheath sizes for therapeutic interventions. A 44-year-old gentleman with a history of right below-knee amputation was referred to the vascular unit with a left foot non-healing wound post wound debridement for diabetic foot ulcer. On examination, the left foot was non-salvageable with pitting oedema extended until knee level. Left lower limb pulses were non-palpable from femoral downwards. A biphasic signal was audible at the left femoral and monophasic at the popliteal. Photoplethysmography showed poor flow distally. Computed tomography angiogram revealed a 12 cm long segment total occlusion of the left external iliac artery just below the bifurcation of iliac vessel. On the right side, there was a long segment occlusion of the superficial femoral artery and calcified common femoral artery. The left axillary artery was used as an access and angioplasty was performed successfully. The advantages of upper extremity access in the axillary artery include the relatively large size and lower atherosclerotic burden. Larger profile stents for aortoiliac occlusion can easily be handled with a good strength through an axillary approach which is antegrade compared to a retrograde femoral approach. With the advancement of safety features of endovascular devices complications with an axillary approach have become less in the recent era.

Background and Purpose: The heart is important in radiotherapy either as target or organ at risk. Quantitative T1 and T2 cardiac magnetic resonance imaging (qMRI) may aid in target definition for cardiac radioablation, and imaging biomarker for cardiotoxicity assessment. Hybrid MR-linac devices could facilitate daily cardiac qMRI of the heart in radiotherapy. The aim of this work was therefore to enable cardiac-synchronized T1 and T2 mapping on a 1.5 T MR-linac and test the reproducibility of these sequences on phantoms and in vivo between the MR-linac and a diagnostic 1.5 T MRI scanner. Materials and methods: Cardiac-synchronized MRI was performed on the MR-linac using a wireless peripheral pulse-oximeter unit. Diagnostically used T1 and T2 mapping sequences were acquired twice on the MR-linac and on a 1.5 T MR-simulator for a gel phantom and 5 healthy volunteers in breath-hold. Phantom T1 and T2 values were compared to gold-standard measurements and percentage errors (PE) were computed, where negative/positive PE indicate underestimations/overestimations. Manually selected regions-of-interest were used for in vivo intra/inter scanner evaluation. Results: Cardiac-synchronized T1 and T2 qMRI was enabled after successful hardware installation on the MR-linac. From the phantom experiments, the measured T1/T2 relaxation times had a maximum percentage error (PE) of −4.4%/−8.8% on the MR-simulator and a maximum PE of −3.2%/+8.6% on the MR-linac. Mean T1/T2 of the myocardium were 1012±34/51±2 ms on the MR-simulator and 1034±42/51±1 ms on the MR-linac. Conclusions: Accurate cardiac-synchronized T1 and T2 mapping is feasible on a 1.5 T MR-linac and might enable novel plan adaptation workflows and cardiotoxicity assessments.

Digital technology has become an essential part of people's lives, and the Internet's innovation made it easier for humans to carry out activities. This systematic review aims to examine parenting with a specific internet-based intervention designed to help them gain information about child-rearing. Specifically, it analyses: 1) how the internet-based parenting intervention is studied, 2) how was the study of an internet-based parenting intervention done, and 3) what themes emerged from the systematic review. The finding suggests that most internet-based parenting interventions use transmitting information techniques visually, as the content is displayed through exciting and informative content. Four themes emerged from the thematic analysis: technology-assisted parenting programs, parenting interventions as support for mothers, professional support online, and improved parenting skills. Positive responses from parents as users show that this online parenting intervention can meet their needs and has the potential to continue to be developed. The literature is quite limited regarding assessing internet-based parenting intervention in early childhood education and developmental psychology. Because of that, further research to develop internet-based parenting interventions becomes essential to give parenting professional support.

Foreign body (FB) ingestion is common among children. It is alarming when it is a magnetic foreign body as it can cause interloop attraction resulting in perforation, fistulas and or volvulus. This case report presented 2 cases of magnetic FB ingestion by children. The first child had a history of FB ingestion and presented with signs and symptoms of intestinal obstruction. The parents of the second child gave no history of FB ingestion which might have caused the delay in diagnosis and treatment. The FB ingestion was confirmed by abdominal radiography in both cases and the patient recovered well after the reparation of perforation sites in an exploratory operation.

Enteric duplications (EDs) are rare congenital anomalies that result from defect during embryonic development of the gut. Although EDs can literally occur at any part of the gastrointestinal tract, ileocecal duplication is the commonest type followed by colorectal type. Morphologically, EDs are mostly cystic in nature; tubular duplications are uncommon. We report radiological diagnostic challenges encountered in dealing with a 10 month-old infant who presented with chronic constipation, progressive abdominal distension, and voiding difficulty for several weeks followed by colicky abdominal pain for three days. After a series of radiological procedures, a diagnosis of tubular colorectal duplication was made. The duplicated segment was loaded with impacted feces which exerted pressure effect on the rectum and urinary bladder. The case was treated surgically through laparoscopic procedure that included fenestration and stapling of the duplicated bowel followed by irrigation. Postoperatively, the child was followed up half-yearly for three years and was found to remain symptom-free. This case exemplifies the challenges a radiologist may experience while dealing with a case presenting with features of as acute-on-chronic intestinal obstruction and voiding difficulty.

Trocar site incisional hernia (TSIH) is an unpleasant complication of laparoscopic surgery. A 70-year-old male with low rectal carcinoma underwent a laparoscopic abdominoperineal resection after completion of neoadjuvant radiotherapy. The postoperative recovery was smooth; however, he developed abdominal distension and pain over the previous drain site after removal on day 3. In view of diagnostic ambiguity, an imaging tool was requested as an adjunct to further management. Computed tomography of the abdomen showed small bowel obstruction secondary to herniated ileal loops passing through the right iliac fossa anterior abdominal wall defect at the previous drainage site. An exploration was made and the rectus defect was closed using a non-absorbable suture.

The therapeutic efficacy of Artemisia annua L. is governed by artemisinin (ART), prevalently produced by A. annua extraction. Due to the modest amount of ART (0.01-1 %dw) in this plant, commercialization of ACTs is difficult. In this study, the floral-dip based transformation protocol for A. annua was developed to enhance expression of artemisinin biosynthesis genes and ART content. For dipping, the effective infiltration media components were optimized, and to obtain high transformation (26.9%) partially open bud stage capitulum of floral development was used. Hygromycin phospho-transferase (hptII) selection marker was used to validate the transformed T1 progenies. The copy numbers of the transgene (hptII) in T1 progenies were determined using a sensitive, high-throughput SYBR Green based quantitative RT-PCR. The results of the hptII transgene were compared with those of the low copy number, internal standard (hmgr). Using optimised PCR conditions, one, two and three transgene copies in T1 transformants were achieved.

Considering the rising global health challenges and public expectations in terms of safety and cost effectiveness, it is necessary to promote effective, safer and cheaper alternative treatment options, particularly to benefit low- and middle-income countries (LMICs). Therapeutic regimens implying natural sources i.e., plants and their secondary metabolites have been trusted by a large proportion of sufferers and extensively searched for their pharmacological actions. Berberis aristata, commonly known as Zarishk, Daruharidra and Indian barberry, is being used in traditional medicine systems across the globe, particularly Asian countries i.e., India and China, and has also gained much attention in the current era of modern medicine. The protective effects of B. aristata against a number of diseases are attributed to its bioactive metabolites, mostly alkaloids, including berberine, berbamine, aromoline, jatrorrhizine, oxyberberine, palmatine, tetrahydropalmatine, and lupeol. However, a comprehensive report describing the ethnopharmacological relevance, important secondary metabolites, cytotoxicity, and recent advances in its therapeutic efficacy against various ailments is either outdated or still lacking. Therefore, the current review summarizes the recent updates regarding the implications of B. aristata and its potential bioactive secondary metabolites in targeting various acute and chronic diseases including diabetes, cardiovascular complications, cancer, hepatic dysfunction, infectious diseases, oxidative stress, inflammation, neurodegeneration, and ageing-associated symptoms with special emphasis on the biochemical and molecular mechanisms/pathways.

Excessive consumption of fat and sugar is associated with various chronic diseases. However, the variation of fat and sugar content in the diet greatly affected the outcome. In this study, a high-fat, high-fructose diet (HFHFD) formula was made with a composition of 31.99% carbohydrate, 40.7% fat, 11.8% protein, and an additional 30% fructose drink to confirm the effects of HFHFD on metabolic health and pathological changes in organs, especially the liver, kidneys, pancreas, muscles, and spleen. A total of 24 male Wistar rats aged 8–12 weeks were divided into four groups: standard chow (SC), HFHFD, SC + carbon tetrachloride (CCl4), and HFHFD + CCl4. After eight weeks of dietary intervention, body mass index, obesity index, lipid profiles, liver function tests, fasting blood glucose, serum uric acid and urea levels, and tissue histopathology were examined. HFHFD with the main unsaturated fatty acids of linoleic acid (14.57%) and palmitoleic acid (8.28%), the main saturated fatty acids of stearic acid (13.62%) and myristic acid (10.09%), and a low trans-fatty acids content, did not promote the rats to become obese. However, liver histology examination showed severe hepatic steatosis (78.33%), leading to steatohepatitis accompanied by an increase in serum ALP (p < 0.01), triglyceride (p < 0.001), total cholesterol (p < 0.05), and uric acid (p < 0.001) levels. Other histological features showed moderate lesions (45%) of the kidney, slight vacuolization of the pancreas, and a mild increase of inflammatory cells in the spleen and muscle. So, this study found that although HFHFD did not promote obesity within 8 weeks of administration, it induced hepatic and renal lesions, dyslipidemia, and hyperuricemia as a metabolic consequence of excessive fatty acids and fructose.

Emphysematous pyelonephritis (EP) is an uncommon condition involving acute severe necrotising infection in the renal parenchyma, perinephric space and collecting system, with a mortality rate of up to 13%. A 62-year-old male with poorly controlled diabetes mellitus presented with severe epigastric pain and shortness of breath for three days. A computed tomography scan revealed class 3B EP, which failed medical therapy and percutaneous drainage. He underwent a nephrectomy and achieved an excellent clinical recovery. Septic shock and uncontrolled diabetes mellitus are two risk factors that lead to a poorer prognosis. Class 3B EP with failed medical therapy and percutaneous drainage would benefit from nephrectomy.

Situs inversus totalis (SIT) develops as a result of the embryological developmental anomaly. Managing this condition surgically is challenging as the anatomy will be mirror-imaged. A 42-year-old male had metal shrapnel broken loose from a hammer-head metal piece and pierced into his upper abdomen. A computed tomography scan of the abdomen revealed SIT with evidence of solid foreign body artefacts which were seen piercing through segment VIII of the liver and the anterior gastric wall. Exploratory laparotomy revealed a moderate amount of haemoperitoneum and a single perforation at the upper body of the stomach that was confirmed by on-table-endoscopy. The perforation was repaired with a modified Graham patch and the liver injury had stopped bleeding intraoperatively. The challenges arose during laparotomy assessment and endoscopic assessment due to inversed anatomy.

Empyema thoracis (ET) is defined as pus in the pleural space, either localized or involving the entire pleural cavity, due to diverse etiologies. In severe form, it may infiltrate the extrapulmonary region. Clinical guideline describes 3 stages of parapneumonic effusion before developing into an ET, namely the exudative stage, the fibrinopurulent stage, and the organizing/late stage. We highlight a 59-year-old gentleman who presented a back swelling masquerading as a deep-seated abscess, in which the diagnosis of ET had not been established early. The principles of treatment are treating the underlying condition such as pneumonia, pleural drainage and debridement, full re-expansion of the collapsed lung by performing chest physiotherapy, and improving nutrition. ET is a condition with a dynamic process due to diverse etiologies, either localized or involving the entire pleural cavity. The gold standard in diagnosing ET is the pleural aspiration of fluid from the pleural space, whereas the management of ET may include non-surgical and/or surgical treatments based on the basic principles of ET treatment.

Background: Fetal heart defect (FHD) examination by ultrasound (US) is challenging because it involves low light, contrast, and brightness. Inadequate US images of fetal echocardiography play an important role in the failure to detect FHDs manually. The automatic interpretation of fetal echocardiography was proposed in a previous study. However, the low quality of US images reduces the prediction rate of computer-assisted diagnosis results. Methods: To increase the FHD prediction rate, we propose low-light fetal echocardiography enhancement stacking with a dense convolutional network classifier named “FetalNet.” Our proposed FetalNet model was developed using 460 US images to produce an image enhancement model. The results showed that all raw US images could be improved with satisfactory performance in terms of increasing the peak signal-to-noise ratio of 30.85 dB, a structural similarity index of 0.96, and a mean squared error of 18.16. Furthermore, all reconstructed images were used as inputs in a convolutional neural network to generate the best classifier for predicting FHD. Results: The proposed FetalNet model increased the FHD prediction rate by approximately 25% in terms of accuracy, sensitivity, and specificity and produced 100% predictive negative using unseen data. Conclusions: The proposed deep learning model has the potential to identify FHD accurately and shows potential for practical use in identifying congenital heart diseases in the future.

The high mutation rate in retroviruses is one of the leading causes of drug resistance. In human immunodeficiency virus type-1 (HIV-1), synergistic mutations in its protease and the protease substrate – the Group-specific antigen (Gag) polyprotein – work together to confer drug resistance against protease inhibitors and compensate the mutations affecting viral fitness. Some Gag mutations can restore Gag-protease binding, yet most Gag-protease correlated mutations occur outside of the Gag cleavage site. To investigate the molecular basis for this, we now report multiscale modelling approaches to investigate various sequentially cleaved Gag products in the context of clinically relevant mutations that occur outside of the cleavage sites, including simulations of the largest Gag proteolytic product in its viral membrane-bound state. We found that some mutations, such as G123E and H219Q, involve direct interaction with cleavage site residues to influence their local environment, while certain mutations in the matrix domain lead to the enrichment of lipids important for Gag targeting and assembly. Collectively, our results reveal why non-cleavage site mutations have far-reaching implications outside of Gag proteolysis, with important consequences for drugging Gag maturation intermediates and tackling protease inhibitor resistance.

ABSTRACT: This study explores the key determinants of Supply Chain 4.0 (SC4.0) maturity in the context of a developing country by examining the relationships between supply chain ambidexterity, supply chain agility, and the maturity of SC4.0. The study was carried out using the survey method involving 154 managers from Indonesian manufacturing companies. The SC4.0 maturity model was developed and tested using structural equation modeling. From our analysis, it was found that supply chain ambidexterity emphasizing on innovation positively influences the companies’ agility and SC4.0 maturity levels, and supply chain agility partially mediates supply chain ambidexterity. This paper contributes to the operationalization of SC4.0 maturity determinants that incorporate innovation and technological aspects and extends the extant literature by empirically elaborating the determinants and antecedents of SC4.0 maturity that may expedite the achievement of SC4.0 maturity. This implies that companies and supply chain professionals aiming at achieving their SC4.0 maturity should do so by being outward-looking and, at the same time, foster supply chain collaboration with external networks. This paper is pioneering the empirical study on SC4.0 and offers a means to achieving SC4.0 maturity through SC ambidexterity and SC agility, particularly in the context of a developing country.

Background: Unhealthy eating practices and the continual rise in childhood obesity calls for an effective strategy to promote healthy eating among school-aged children. Aim: The study objective was to determine the change in children's food group consumption and weight status (BMI-for-age z-score, body fat percentage, waist circumference) after participating in a school-based experiential healthy meal preparation intervention. Methods: In this two-arm randomized-controlled trial, 2 schools were randomly assigned to intervention or control group. In total, 86 Malaysian schoolchildren aged 10–11 years participated. The intervention group underwent six 60-min healthy meal preparation modules conducted biweekly. The frequency of food group consumption was self-reported, while weight status was measured. Results: Intervention group consumed whole grains (+1.36 vs 0.00 times/day), vegetables (+2.35 vs −0.29 times/day), fruits (+1.64 vs −0.14 times/day) and legumes (+1.42 vs + 0.13 times/day) more frequently than the control group after the program (p

Public Private Partnerships (PPPs) have been used as a viable tool to accelerate infrastructural development in many countries. In recent years, the repercussions of climate change have heightened the need to adopt cleaner energy sources such as solar. Ghana has attempted investments in solar energy for obvious advantages such as ensuring energy security, cost advantage and expansion of rural electrification. PPPs have been adopted in various sectors of Ghana's economy including transport, construction, education, energy and health but the extent of success is arguable. This paper throws light on the history, current state, the challenges and prospects of the solar sector in Ghana. Issues such as accountability and transparency, tensions due to land litigation, politicisation of PPPs and poor bargaining abilities due to low knowledge of PPP agreements are established in this paper as hindrances to PPPs in Ghana. Indeed, Ghana has a huge prospect for solar energy and if PPPs are treated as a ‘Game’ of fairness or with the ‘Parito Optimality’ notion rather than with an ‘altruistic incline’, investor confidence may potentially rise. It is also recommended that, the current national policy on PPP under Ghana's Ministry of Finance and Economic Planning (MOFEP) must be enhanced and implemented fully in order to boost investor confidence in the solar sector.

This study presents essential oil composition of three Melaleuca species namely, Melaleuca bracteata F. Muell, Melaleuca fulgens R. Br. subsp. steedmanii and Melaleuca leucadendron (L.) L. collected from different regions of Pakistan. The chemical composition of essential oils was analyzed by GC-FID and GC–MS. Eugenol methyl ether was identified as a principal component in M. bracteata (82.3%), M. fulgens (87.8%) and M. leucadendron (95.4%) oils. In vitro antibacterial studies were done by agar well diffusion and microdilution method and the tested essential oils exhibited bacteriostatic and bactericidal effects against the tested foodborne pathogens at 4–8 µg/ml. Time kill assay showed significant bactericidal effect of oils for four weeks. The antioxidant potential was assessed by free radical scavenging activity and reducing power assay. The oils showed strong antioxidant activity with approximately 89.0–89.5% inhibition of 2,2-diphenyl-1-picrylhydrazyl radical and ferric reducing power in the range of 1.94 ± 0.007–2.04 ± 0.04% at 100 µg/ml. Keywords: Melaleuca bracteata, M. fulgens, M. leucadendron, Essential oils, Antibacterial activity, Antioxidant potential

Dysphagia due to extensive ossification at anterior segments of the cervical spine is a rare occurrence and is usually attributable to diffuse idiopathic skeletal hyperostosis (DISH).We present the case of a 74-year-old female with dysphagia most likely due to ossification in pseudohypoparathyroidism type 1a (PHP1a). PHP1a is a rare, autosomal dominant disorder caused by mutations in the GNAS1 gene. Our patient had characteristic phenotype features of PHP1a, also known as Albright's hereditary osteodystrophy (AHO), which was diagnosed without genetic confirmation.She was conservatively treated with dietary measures and observation, and reported persisting symptoms of dysphagia at six-month follow-up. This is the first case to describe dysphagia in PHP1a with a similar presentation to DISH.

Traumatic abdominal wall hernia (TAWH) is a rare type of hernia resulting from blunt abdominal trauma. It develops following the inertia of sudden, high-energy blunt trauma or focused low-energy impact. A 22-year-old motorcyclist presented to the emergency department following a collision with an automobile. Clinical examination demonstrated a bulging mass at the lower abdomen, resulting from impact with the motorcycle handlebar. A contrast-enhanced CT scan of the abdomen revealed a disruption of both rectus abdominis muscle and linea alba at the lower abdomen with loops of small bowels and mesentery herniating through the defect, associated with multiple air pockets and pneumoperitoneum. Exploratory laparotomy showed TAWH containing loops of small bowel and mesentery in addition to mesenteric tears. Small bowel resection with primary anastomosis and repair of the anterior abdominal wall defect using interrupted polypropylene sutures was performed. The patient recovered well postoperatively and was discharged home three days later. A follow-up at 1 year showed no evidence of recurrence.

BIPV has gained a lot of attention in the solar world especially in recent times as the push for Net Zero Energy Buildings (NZEB) and concerns about landscape aesthetics increases. Aesthetics plays a critical role in the adoption of BIPVs as it is one of the fundamental components architects and home owners look out for. This paper discusses the primacy of aesthetics by using the elements and principles of design as guide in BIPV applications. Essential elements of design such as colour, shape, and texture have been discussed. Principles of design such as variety, balance, rhythm, contrast and proportion have also been discussed as useful tools in BIPV adoption by home owners and architects. It is emphasised that the essence of BIPV is to introduce ‘beauty’ in Photovoltaic application and the earlier aesthetic is treated as ‘Gold’ and given primacy, the better for BIPV adoption. This paper identifies the basic elements and principles of design as the “building blocks” of BIPV design, application and adoption. Finally, it is argued that aesthetics plays a cardinal role in consumer purchasing decision. This paper offers an exceptional design perspective to BIPV application as various attempts have been made by several researchers to address the issue of aesthetics in BIPVs.

Spigelian hernia (SH) occurs due to the protrusion through a congenital or acquired defect or weakness in the Spigelian aponeurosis. SH accounts for only 0.1–0.4% of occurrence and a 17–24% risk of strangulation. We hereby report a case of a 34-year-old gentleman presented with concomitant incarceration of the omentum with small intestine and testis in Spigelian hernia sac. We have successfully operated on this patient via a transperitoneal approach with a small incision over the hernia site. This incision could be an alternative to midline laparotomy as a safe and effective method in managing incarcerated SH in an emergency setting.

Analysis of electrocardiogram (ECG) signals is challenging due to the complexity of their signal morphology. Any irregularity in a cardiac rhythm can change the ECG waveform. A reliable machine learning model is developed here to provide substantial input to cardiologists and help confirm their diagnoses. To achieve high diagnostic accuracy, nearly all ECG analytics tools require records of the positions and morphologies of various segments of P-waves, QRS complexes, and T-waves to be kept in ECG records. However, analyzing such vast amounts of ECG records is not always easy. In most cases, it is challenging and highly time-consuming. Hence, an in-depth investigation regarding automatic ECG signal delineation is necessary. This paper proposes an automated delineation algorithm for ECG waveform signals that utilizes recurrent neural networks (RNNs) with bidirectional long short-term memory (LSTM) architecture. This delineation process consists of four steps: noise cancellation, ECG waveform segmentation, ECG signal classification in four classes (P-wave, QRS complex, T-wave, and isoelectric line) and model evaluation. The classification is conducted based on time duration, and each waveform is determined by using annotated data from the well-known QT database (QTDB). The results show that the proposed model produces satisfactory performance for the four classes in terms of average accuracy, sensitivity, specificity, precision, and F1-score, with values of 99.64%, 98.74%, 99.75%, 98.81%, and 98.78%, respectively. The proposed model is validated with abnormal ECG signals from the QTDB, i.e., MIT-BIH Arrhythmia, MIT-BIH ST Change, MIT-BIH Supraventricular Arrhythmia, European ST-T, and MIT-BIH Long-Term ECG. The results show that bidirectional LSTM can delineate ECG signals from QTDB in both normal and abnormal conditions. The proposed delineation method could be utilized in potential applications following further investigation.

Congestive heart failure (CHF) is characterized by the heart's inability to pump blood adequately throughout the body without increased intracardiac pressure. Diverse approaches are used to treat CHF. These approaches, which include physical examination, echocardiography, and laboratory testing, require a high degree of competence to interpret findings and make diagnoses. Moreover, existing methods do not account for the relationships between variables and thus provide limited performance. Electrocardiogram (ECG), as a non-invasive test, may be used for CHF early diagnosis, which would require further examination to be referred. A previous study revealed a significant correlation between heart failure (HF) and ECG features. However, the method was only performed on small, balanced data; then, the features must be derived from trial and error. The current paper proposes deep-learning techniques—recurrent neural networks (RNNs) with long short-term memory (LSTM) architectures—to create a diagnostic algorithm that achieves high accuracy with limited information and automated feature extraction. The ECG signals used in this study were obtained from the public PhysioNet databases. We fine-tuned the hyperparameters of 24 LSTM models to obtain the best model. Moreover, ECG signal segmentation was compared among the first five and fifteen minutes as features. Out of the 24 LSTM models, the model with the first fifteen minutes of ECG signals (model 1) obtained the highest accuracy, sensitivity, specificity, precision, and F1-score (99.86%, 99.85%, 99.85%, 99.87%, and 99.86%, respectively). The first fifteen minutes of ECG signals performed well because the LSTM model learned an increasing number of features. In conclusion, the proposed LSTM model could give a clinician a preliminary CHF diagnosis for further medical attention. Deep learning can be a useful predictive method for increasing the number of identified CHF patients.