Search

ABSTRACT Accurate forecasts of renewable and nonrenewable energy output are essential for meeting global energy needs and resolving environmental issues. Energy sources like the sun and wind are variable, making forecasting difficult. Changes in weather, demand, and energy policy exacerbate this unpredictability. These challenges will be addressed by the bidirectional gated recurrent unit (Bi‐GRU) model, which forecasts power‐generating outcomes more efficiently. The investigation is done over a health data set from 2000 to 2023, including the energy states of the United Kingdom, Finland, Germany, and Switzerland. The comparison of our model (Bi‐GRU) performance with other popular models, including bidirectional long short‐term memory (Bi‐LSTM), ensemble techniques combining convolutional neural networks (CNN) and Bi‐LSTM, and CNNs, make the study more interesting. The performance remains better with a mean absolute percentage error (MAPE) of 2.75%, root mean square error (RMSE) of 0.0414, mean squared error (MSE) of 0.0017, and authentify that Bi‐GRU performs much better than others. This model's superior prediction accuracy significantly enhances our ability to forecast renewable and nonrenewable energy outputs in European states, contributing to more effective energy management strategies.

Abstract Network operators with significant solar photovoltaic (PV) penetration are having difficulty maintaining grid frequency and voltage within acceptable bounds due to the progressive displacement of synchronous machines. Utility‐scale solar PV plants have a huge potential for participation in frequency and voltage regulation since they are linked to the grid through power electronic interfaces with flexible, decoupled control of active and reactive power. A comprehensive control strategy for a utility‐scale solar PV plant is proposed to simultaneously participate in frequency and voltage control without the aid of any energy storage. The frequency response is accomplished by maintaining some active power reserves that enable the PV plant to participate in both over‐ and under‐frequency events. The active power of the PV plant is modulated by operating the PV as a virtual synchronous generator (VSG). Unlike the classic notion of VSG, an intelligent fuzzy‐based technique is employed to adapt the gains of the VSG controller for improved control performance. Additionally, an adaptive droop‐based voltage control mechanism is proposed to control the reactive power reference for the PV plant. The gain of the droop controller is adapted to the varying maximum reactive power capacity of the PV plant. This ensures that the PV system's unused reactive power capability is fully utilised. Through simulation studies, the efficiency of the proposed frequency and voltage control mechanisms is validated under a range of realistic circumstances. The findings show that the suggested control approach can efficiently leverage the PV plants' capacity to handle both frequency and voltage events.

Abstract Over the past few years, the application and usage of Machine Learning (ML) techniques have increased exponentially due to continuously increasing the size of data and computing capacity. Despite the popularity of ML techniques, only a few research studies have focused on the application of ML especially supervised learning techniques in Requirement Engineering (RE) activities to solve the problems that occur in RE activities. The authors focus on the systematic mapping of past work to investigate those studies that focused on the application of supervised learning techniques in RE activities between the period of 2002–2023. The authors aim to investigate the research trends, main RE activities, ML algorithms, and data sources that were studied during this period. Forty‐five research studies were selected based on our exclusion and inclusion criteria. The results show that the scientific community used 57 algorithms. Among those algorithms, researchers mostly used the five following ML algorithms in RE activities: Decision Tree, Support Vector Machine, Naïve Bayes, K‐nearest neighbour Classifier, and Random Forest. The results show that researchers used these algorithms in eight major RE activities. Those activities are requirements analysis, failure prediction, effort estimation, quality, traceability, business rules identification, content classification, and detection of problems in requirements written in natural language. Our selected research studies used 32 private and 41 public data sources. The most popular data sources that were detected in selected studies are the Metric Data Programme from NASA, Predictor Models in Software Engineering, and iTrust Electronic Health Care System.

ABSTRACT Cachexia affects up to 60% of patients with lung cancer, with its prevalence rising up to 80% in advanced stages of disease. In approximately 20% of cases, it is the primary cause of mortality. Five studies, including a total of 4467 patients, across range of cancer types reported data on weight gain in cancer patients undergoing chemotherapy. Across all five studies, an average of 18.3% of patients experienced weight gain > 5% (816 out of 4467 patients). The frequency of weight gain > 5% was highest among breast cancer patients, 18.9% in Pedersini et al (n = 169) and 33.0% in Sella et al (n = 687). In NSCLC patients, weight gain was reported in 18.3% in patients in Patel et al (n = 2301) and 11.7% in Roeland et al (n = 1030). In contrast, colorectal cancer patients showed only 5.7% of weight gain > 5% (Zutphen et al, n = 280). Additionally, weight loss > 5% was reported in 15.1% of breast cancer patients and 28.3% of colorectal cancer patients. Despite weight loss being quantified as a common endpoint in clinical trials focused on cancer cachexia, there is limited data on the impact of weight gain as a marker of a positive outcome among cancer patients. Studies have shown that weight gain of more than 5% within 3 months in NSCLC patients can be associated with improvement in overall survival (OS) and progression‐free survival (PFS) scores. In this post hoc analysis by Roeland et al., the authors defined different percentage cut‐off values for maximum weight gain among patients with non–small cell lung cancer within 3 months of starting platinum‐based chemotherapy. Among all categories, namely, weight gain > 0%, > 2.5% and > 5%, a significant benefit in overall and progression‐free survival was seen and was comparable among all groups. These findings highlight the clinical significance of incorporating strategies that encourage weight gain and to prevent weight loss at the least among cancer patients. Along with further delving into the prognostic value of weight gain and developing methods to encourage this response among cancer patients, future studies should use standardized assessment tools to identify weight gain that could be attributed to underlying pathologic processes such as oedema and congestion. We also suggest that monitoring and reporting of weight changes should be done in all cancer trials.

ABSTRACT The effectiveness of glucagon‐like peptide‐1 receptor agonists in facilitating weight loss among patients with diabetes is widely recognized. However, there are limited data available on the relative effectiveness and safety of once‐weekly semaglutide versus once‐daily liraglutide. We conducted a systematic review and meta‐analysis of randomized controlled trials (RCTs) identified through a comprehensive search of the Cochrane Library, PubMed, and ScienceDirect databases from inception until July 2024. Statistical analysis was conducted using R version 4.4.1 with the “meta” package, employing a random effects model. Three RCTs with a total of 922 patients were included in our meta‐analysis. The results indicated that OW semaglutide significantly reduced body weight (WMD: −4.55; 95% CI: −6.43, −2.67, p

ABSTRACT Mucormycosis is an infrequent fungal infection commonly seen in immunocompromised individuals. However, it can also occur in immunocompetent patients, especially following trauma. We present a case of a 15‐month‐old girl with increasing swelling and redness in her left eye after a minor traumatic injury. Imaging showed sinusitis with orbital involvement. Histopathology validated the diagnosis of mucormycosis caused by Rhizopus species. The patient had emergency surgery, followed by antifungal and antibiotic therapy. Despite febrile reactions to the treatment, the infection was managed, and the patient was discharged after 2 months. This case highlights the importance of considering mucormycosis in immunocompetent patients with unexplained ocular symptoms after trauma. Early diagnosis and aggressive treatment are essential for improving outcomes, especially in pediatric patients.

ABSTRACT We present a case report of a 45‐year‐old female with acute onset right‐sided facial weakness, worsening vision, and diplopia. Upon evaluation, the patient exhibited total right‐side facial palsy (House‐Brackmann grade IV) with III, IV, and VI Cranial Nerve Ophthalmoplegia. There was no perception of light associated with optic atrophy on ocular examination. Computed tomography and magnetic resonance imaging showed a sizeable sphenoid sinus mass compressing the right optic nerve, consistent with neoplasia or invasive fungal infection. Eventually, we removed the mass endoscopically through a transnasal approach and diagnosed it as invasive Aspergillosis on histopathological examination, even though no previous record of immunodeficiency existed. The patient received intravenous followed by oral voriconazole. Postoperatively, there was partial recovery of her facial nerve function. This case highlights the importance of considering invasive fungal infections, even in immunocompetent patients, when managing space‐occupying lesions with neuro‐ophthalmic involvement.

ABSTRACT The coexistence of systemic lupus erythematosus (SLE) and Wilson's disease (WD) is exceedingly rare, posing significant diagnostic challenges due to overlapping clinical presentations. Neurological and psychiatric manifestations commonly associated with WD can obscure or mimic symptoms of other systemic diseases, complicating accurate diagnosis and management. We report the case of a 17‐year‐old female diagnosed with WD and concurrent SLE, treated at Civil Hospital, Karachi, Pakistan. The patient initially presented with neuropsychiatric symptoms typical of WD, confirmed by diagnostic findings indicative of hepatic copper accumulation. She later developed significant proteinuria, hematuria, fever, and positive autoimmune serologies, raising suspicion of concurrent SLE. Despite therapeutic interventions, including methylprednisolone (1 mg), the patient's condition deteriorated, and she unfortunately succumbed to complications from a blood transfusion reaction. This case underscores the importance of heightened clinical vigilance when managing overlapping presentations of WD and systemic autoimmune disorders like SLE. Early recognition of WD‐specific neurological and psychiatric symptoms is critical for timely diagnosis and intervention, potentially mitigating the risk of severe complications and poor outcomes.

ABSTRACT Extra‐nasopharyngeal angiofibroma is a rare entity, with only a few cases reported to date. It usually presents with symptoms resembling those of typical nasopharyngeal angiofibroma, but it arises from a site other than the site of origin of typical nasopharyngeal angiofibroma. A 20‐year‐old male presented with complaints of left‐sided nasal obstruction and epistaxis for 10 days. On examination, a mass was seen attached to the anterior nasal septum. Throat and ear examinations were unremarkable. Blood investigations also came out to be as expected. A deviated nasal septum was seen, which was caused by a nasal trauma to this patient 3 years ago. This mass was removed, and the specimen was sent for histologic examination. Histologic examination of the specimen proved the mass to be extra‐nasopharyngeal angiofibroma. The selection of appropriate surgical techniques and subsequent histologic examinations is extremely important to determine the exact diagnosis in such cases. The case addressed in this case report is extremely important for uncovering another rare case of extra‐nasopharyngeal angiofibroma. This case might also suggest a possible linkage between extra‐nasopharyngeal angiofibroma and a deviated nasal septum.

Conclusion: The study highlights significant gaps in trauma care management in Pakistani tertiary care hospitals, including shortages of personnel, infrastructure deficiencies, and lack of standardized protocols. These findings underscore the urgent need for systemic improvements in trauma care delivery. Recommendations include increased investment in medical infrastructure, addressing staffing and training deficiencies, and standardizing clinical management protocols to enhance trauma care outcomes and reduce morbidity and mortality rates in Pakistan. This research contributes novel insights into the specific barriers faced by trauma care systems in Pakistan, which have not been previously addressed in existing literature.

ABSTRACT The population structure and breeding biology of a Xanthid crab, Etisus laevimanus Randall, 1840, a commonly occurring species on the rocky intertidal region of Saurashtra coast of Gujarat State, India, were investigated. Samples were collected from the intertidal region for 12 consecutive months during low tide using catch per unit effort in a 500 m2 area. The individuals were categorized into male, non‐ovigerous female, or ovigerous female. For fecundity estimation, the total number of eggs, size of eggs, and weight of egg mass were measured along with the carapace width and body weight of the respective ovigerous females. Sexual dimorphism was evident in the collected samples, with males being significantly larger than females. The overall as well as monthly sex ratio was female‐biased. Size frequency distribution showed a bimodal frequency distribution in males while being unimodal in females. The occurrence of ovigerous females throughout the year suggests that the species has a continuous breeding pattern with peaks from December to April. The total number of eggs, size of eggs, and weight of the egg mass showed a significantly positive correlation with the carapace width of the ovigerous females.

ABSTRACT Sympathetic ophthalmia (SO) is a rare, bilateral, granulomatous, panuveitis following perforating trauma or surgical intervention in one eye. Here, and to the best of knowledge, we report the first case of SO following an evisceration surgery in Pakistan. A 32‐year‐old, Pakistani, female presented with pain and decreased visual acuity in her right eye, at Civil Hospital, Karachi, 1 week after an evisceration surgery was performed on her left eye, following corneal perforation due to unresolved keratitis. Diagnosis of SO was made on the basis of clinical presentation and confirmed by slit lamp examination which revealed mutton fat keratic precipitates, posterior synechiae, and optic disc swelling. She was administered high‐dose corticosteroids to which she did not respond. She was then prescribed methotrexate which resolved the inflammation and improved visual acuity. Initiating prompt treatment for the sympathizing eye led to effective management of the patient and prevented complete blindness.

ABSTRACT Objective To study the interobserver agreement for diagnosing Helicobacter pylori gastritis using narrow band imaging (NBI) with magnification. Methods This prospective study recruited patients who underwent gastroscopy for dyspepsia in the Department of Gastroenterology, Aster MIMS Hospital, Kannur.361 patients were included in the study. The gastroscopy was performed using high‐definition white light endoscopy (WLE) and NBI with magnification. Histopathology and rapid urease test were used to detect HP infection. Endoscopy videos were analyzed by three trained endoscopists who were blinded to each other. NBI patterns were classified into four types (Types 1, 2A, 2B, and 3). Interobserver variability was examined using Kappa Statistics. Results 164 of 361 patients had HP infection (45.42%). Of 361 people, 199 had Type 1 (55.12%), 54 Type 2a (14.95%), 65 Type 2b (18%), and 43 Type 3 cases (11.91%). There was good interobserver agreement with a kappa value of 0.730 (95% confidence interval (CI) 0.693–0.768). 87% of HP‐negative patients had Type 1 NBI pattern. 79.5% of type 2A and 89.2% of Type 2b pattern were HP positive. The Type 1 pattern identified normal gastric mucosa with 84.75% sensitivity, 88.32% specificity and 87.4% negative predictive value. Type 2 and Type 3 NBI patterns had high positive predictive value and specificity for HP infection. Conclusions This study demonstrates excellent interobserver agreement among experienced endoscopists in using NBI to identify gastric mucosal patterns associated with HP infection. While biopsies remain essential for comprehensive evaluation of gastric pathologies, our findings suggest that NBI, with appropriate training and validation, may have the potential to reduce the need for biopsies in specific cases where the primary concern is HP infection. The good level of interobserver agreement seen in our study is encouraging and suggests that NBI has the potential to be a reliable tool for diagnosing HP infection.

ABSTRACT Background A conservative strategy is the primary modality of treatment for acute pancreatitis of which fluid replacement is an important component. Since the results regarding early aggressive versus moderate fluid replenishment for acute pancreatitis are inconsistent, we sought to compare outcomes between the two resuscitation strategies in our meta‐analysis. Methods We searched MEDLINE (PubMed), Embase, the Cochrane Library, and ClinicalTrials.gov for all available randomized controlled trials (RCTs) assessing outcomes for patients treated with aggressive fluid replacement compared to moderate fluid replacement. Our primary outcome was all‐cause mortality. Results Our meta‐analysis included 6 RCTs involving a total of 632 patients. Our results showed that aggressive fluid resuscitation increased the risk of all‐cause mortality as compared to moderate fluid replacement (RR 2.40, CI: 1.38–4.19). For all of our secondary outcomes which included the development of organ failure, severe pancreatitis, pancreatic necrosis, clinical improvement, development of SIRS, persistent SIRS, and length of hospital stay, the results indicate that there was no significant difference between the two groups. Conclusions Aggressive fluid resuscitation is associated with higher mortality as compared to moderate fluid replacement in patients with acute pancreatitis. RCTs with larger sample sizes are needed to provide greater statistical power and establish more definitive conclusions.

ABSTRACT Aims Hepatocellular carcinoma (HCC) is a type of malignant tumor and the sixth leading cause of death worldwide. It is caused by HBV, HCV infection, and alcohol consumption. MicroRNAs are typically small, non‐coding RNAs that are involved in the regulation of mRNA expression. Recent studies revealed miRNAs' regulatory roles in liver cancer, linked to risk factors like HCV, HBV infection, alcoholism, drug use, and auto‐immune hepatic disorders. Circular RNAs also belong to the class of non‐coding RNAs; they act as ceRNAs to regulate miRNA expression and regulate different oncogenic pathways in HCC progression. This study aimed to check the hsa_circ_0070269, circ‐102,166 (hsa_circ_0004913), and miR‐182 expression in HCV induced HCC patients. Methods Data analysis was used to find out studies related to the role of hsa_circ_0070269, circ‐102,166, and miR‐182 in HCC; miR‐182 targeted genes, their role in different diseases; and miR‐182 interactions with hsa_circ_0070269 and circ‐102,166 in the HCC. It was revealed that the hsa_circ_0070269, circ‐102,166, and miR‐182 correlations in HCV induced HCC have not been explored yet. Therefore, to validate data from literature mining, expression analysis of dysregulated hsa_circ_0070269, circ‐102,166, and miR‐182 was performed in HCV induced HCC patients using RT‐PCR. Results It was found that miR‐182 was significantly upregulated and acts as an oncomiRNA in HCV induced HCC, and hsa_circ_0070269 and circ‐102,166 were downregulated in HCV induced HCC. We have identified that miR‐182 relative expression level was significantly high (p

ABSTRACT Aims and Objectives Hepatitis C virus (HCV) infection is a significant risk factor for the development of hepatocellular carcinoma (HCC). Serum‐derived circular RNAs (circRNAs) play several crucial roles in HCV and HCC. They represent a promising area of research for improving the diagnosis and understanding the mechanisms of HCV‐HCC. This study aims to identify a serum‐derived circular RNA (circRNA) diagnostic panel for HCV‐HCC and to elucidate the regulatory mechanisms underlying their role in cancer progression. Methods In this study, data mining and in silico analysis were conducted to identify the role of circular RNAs (hsa_circ_0003288, circ‐RNF13, hsa_circ_0004277, circANRIL, circUHRF1, hsa_circ_103047) and their associated biomarkers (IL‐6 and NF‐κB) in HCV‐HCC pathogenesis. Additionally, RT‐PCR was performed to assess their expression levels across different study groups (G0 = control, G1 = HCV, G2 = HCC, and G3 = HCV‐induced HCC). Results The expression levels of circular RNAs, including hsa_circ_0003288, circ‐RNF13, hsa_circ_0004277, circANRIL, circUHRF1, and hsa_circ_103047, as well as the biomarkers IL‐6 and NF‐κB, were significantly elevated in the G3 group compared to the G0 group. ROC analysis also revealed significantly different expression rates for G3 group and G0 group. Conclusion The data revealed that cricRNAs panel (hsa_circ_0003288, circ‐RNF13, circANRIL, circUHRF1, and hsa_circ_103047) could serve as a diagnostic biomarker and therapeutic target for HCV‐induced HCC.

ABSTRACT Introduction Partnering with Consumers in healthcare systems is now widely accepted and mandated in many countries. Despite this acceptance, there is minimal information regarding the best practice of how to successfully establish systems to embed this practice into healthcare systems. Methods This evaluation used the RE‐AIM implementation framework to retrospectively analyse data from a 3‐year timeline to review the events relating to the transition of Consumer Partnering into a Clinical Governance Unit. Data was sourced via Phase 1 – a focus group to establish a 3‐year timeline of events, enablers and barriers, and Phase 2 – a quantitative and qualitative semi‐structured interview to review systems that had been developed to support embedding partnering with consumers into Clinical Governance. Results Five primary enablers and five barriers to successfully embedding a Consumer Partnering Team into a Clinical Governance Unit were identified. Enablers included Executive sponsorship and ownership of the value of partnering with consumers, Executive leadership influence on local area uptake, an organization‐wide network, valuing via remuneration, and a centralized orientation and onboarding programme for Consumer Partners. Barriers included skills and attitudes of committee chairs, the size of the Directorate (smaller local areas can be easier to influence change), patient feedback data requires interpretation to be useful, staff turnover can reduce the relationships with Consumer Partners, and financial insecurity is a barrier to implementation and maintenance. Conclusions This article described how an Australian Health Service embedded a Consumer Partnering Team into a Clinical Governance Unit to ensure that partnering became business as usual practice. Enablers, barriers, and unintended consequences can be used as learnings for other organizations to develop a similar approach. Patient or Public Contribution Two Consumer Partners with lived experience of the health service, and members of the organizations committee structures are part of the evaluation team. As team members, the consumers participated as equal contributors in evaluation design, analysis of the focus group and interview data, and contribution to the writing and review of the manuscript. Two Consumer Partners with lived experience of the health service, and members of the committee structures participated in the focus groups and the interviews.

Background Significant gap remains in the implementation of guideline‐directed medical therapy (GDMT) in patients with heart failure after a hospitalization. We aimed to evaluate the use and titration of GDMT at discharge and over a 12‐month period after hospital discharge and to identify factors associated with GDMT use and titration. Methods and Results The CONNECT‐HF (Care Optimization Through Patient and Hospital Engagement Clinical Trial for Heart Failure) trial evaluated the effect of a hospital and postdischarge quality improvement intervention in participants with heart failure with reduced ejection fraction. In this secondary analysis, we examined use and titration to at least 50% of the target dose of GDMTs at hospital discharge and over time. Among 4646 participants (mean age 63 years, 34% women), GDMT use did not numerically improve from discharge to 12 months: beta blockers (84%–78%), angiotensin‐converting enzyme inhibitors/angiotensin II receptor blockers/angiotensin receptor‐neprilysin inhibitors (73%–65%), mineralocorticoid receptor antagonists (39%–36%), and sodium‐glucose cotransporter 2 inhibitors (1.5%–2.1%). Achieving ≥50% of the target dose also showed little change over 12 months: beta blockers (35%–32%), angiotensin‐converting enzyme inhibitors/angiotensin II receptor blockers/angiotensin receptor‐neprilysin inhibitors (28%–25%). For all medications, use of GDMT at discharge was associated with the use and achieving ≥50% of the target dose at 12 months. Conclusions Following a hospitalization for heart failure, GDMT use remained low and did not numerically improve over 12 months. Use of GDMT at discharge was significantly associated with the use of GDMT over time, highlighting the importance of initiating GDMT during hospitalization.

Background Cigarette smoking has been associated with incident heart failure (HF). However, the association between cigarette smoking and smoking cessation with HF subtypes has not been well elucidated, particularly among Black people. Methods and Results We investigated 4189 (never smoker n=2934, former smoker n=761, current smoker n=464) Black participants (mean age 54 years, 64% women) without a history of HF or coronary heart disease at baseline in the Jackson Heart Study. We examined the association of cigarette smoking with incident HF hospitalization and HF subtypes (HF with preserved ejection fraction and HF with reduced ejection fraction). After adjustment for confounding factors, current smoking was associated with incident HF (both subtypes) compared with never smoking. Smoking intensity among those who identified as currently smoking and smoking burden among those who ever smoked were associated with higher incidence of HF with preserved ejection fraction compared with never smoking. Lung function evaluated by spirometry at baseline did not significantly influence these associations. The risk of developing HF decreased with more years after smoking cessation, and more than 20 years of smoking cessation were required to reach a risk comparable to that of never smoking. Conclusions Smoking cigarettes was associated with developing both subtypes of HF and it was independent from the influences on baseline lung function. Long‐term smoking cessation is necessary to prevent the onset of HF in people who smoke cigarettes.

Abstract Background Vulval disease significantly impacts quality of life but is historically under‐researched. The epidemiology and aetiology of many vulval conditions is unclear. Data to optimise patient care are lacking. Objectives To describe the population attending a specialist vulval dermatology clinic and achieve consensus amongst vulval experts on data items to be collected for a future national vulval database. Methods This descriptive cross‐sectional study analysed data that was prospectively collected during clinical contact with consecutive new patients at a vulval dermatology clinic over 4 years. A two‐stage electronic‐Delphi survey was performed with British vulval experts. Consensus was defined as ≥75% agreement on items for inclusion. Results The database included 424 (including 29 paediatric) patients. Most patients were White British (71%), with a significant Asian population (13%). Long symptom duration (9.5% > 10 years) and multiple diagnoses, up to 4, were common. Exploratory associations were identified between irritant contact dermatitis and urinary and faecal incontinence, frequent vulval washing and lichen simplex, urinary incontinence and lichen sclerosus and a negative association between candidiasis and age. Following two rounds of the electronic‐Delphi survey, consensus was achieved for 18 items that 28 participants agreed were important for a future database. Conclusions We report disease incidence, patient pathways, outcome measures and potential associations. Though not generalisable, this large UK‐based study could inform future projects to improve patient care and support ongoing research, such as a national vulval disease database, for which we also achieve expert consensus on the most valuable items to include.

Abstract Aims Patients with HFrEF and worsening HF events (WHFE) are at particularly high risk and urgently need disease‐modifying therapy. CHART‐HF assessed treatment patterns and reasons for medication decisions among HFrEF patients with and without WHFE. Methods and results CHART‐HF collected retrospective electronic medical records of outpatients with HF and EF

Abstract Autism spectrum disorder (ASD) is a complex psychological syndrome characterized by persistent difficulties in social interaction, restricted behaviours, speech, and nonverbal communication. The impacts of this disorder and the severity of symptoms vary from person to person. In most cases, symptoms of ASD appear at the age of 2 to 5 and continue throughout adolescence and into adulthood. While this disorder cannot be cured completely, studies have shown that early detection of this syndrome can assist in maintaining the behavioural and psychological development of children. Experts are currently studying various machine learning methods, particularly convolutional neural networks, to expedite the screening process. Convolutional neural networks are considered promising frameworks for the diagnosis of ASD. This study employs different pre‐trained convolutional neural networks such as ResNet34, ResNet50, AlexNet, MobileNetV2, VGG16, and VGG19 to diagnose ASD and compared their performance. Transfer learning was applied to every model included in the study to achieve higher results than the initial models. The proposed ResNet50 model achieved the highest accuracy, 92%, compared to other transfer learning models. The proposed method also outperformed the state‐of‐the‐art models in terms of accuracy and computational cost.

Abstract Background Excess muscle fat is observed in obesity and associated with greater burden of cardiovascular risk factors and higher risk of mortality. Liraglutide reduces total body weight and visceral fat but its effect on muscle fat and adverse muscle composition is unknown. Methods This is a pre‐specified secondary analysis of a randomized, double‐blind, placebo‐controlled trial that examined the effects of liraglutide plus a lifestyle intervention on visceral adipose tissue and ectopic fat among adults without diabetes with body mass index ≥30 kg/m2 or ≥27 kg/m2 and metabolic syndrome. Participants were randomly assigned to a once‐daily subcutaneous injection of liraglutide (target dose 3.0 mg) or matching placebo for 40 weeks. Body fat distribution and muscle composition was assessed by magnetic resonance imaging at baseline and 40‐week follow‐up. Muscle composition was described by the combination of thigh muscle fat and muscle volume. Treatment difference (95% confidence intervals [CI]) was calculated by least‐square means adjusted for baseline thigh muscle fat. The association between changes in thigh muscle fat and changes in body weight were assessed using Spearman correlation coefficients. The effect of liraglutide versus placebo on adverse muscle composition, denoted by high thigh muscle fat and low thigh muscle volume, was explored. Results Among the 128 participants with follow‐up imaging (92.2% women, 36.7% Black), median muscle fat at baseline was 7.8%. The mean percent change in thigh muscle fat over median follow‐up of 36 weeks was −2.87% among participants randomized to liraglutide (n = 73) and 0.05% in the placebo group (absolute change: −0.23% vs. 0.01%). The estimated treatment difference adjusted for baseline thigh muscle fat was −0.24% (95% CI, −0.41 to −0.06, P‐value 0.009). Longitudinal change in thigh muscle fat was significantly associated with change in body weight in the placebo group but not the liraglutide group. The proportion of participants with adverse muscle composition decreased from 11.0% to 8.2% over follow‐up with liraglutide, but there was no change with placebo. Conclusions In a cohort of predominantly women with overweight or obesity in the absence of diabetes, once‐daily subcutaneous liraglutide was associated with a reduction in thigh muscle fat and adverse muscle composition compared with placebo. The contribution of muscle fat improvement to the cardiometabolic benefits of liraglutide requires further study.

Background Diagnostic variables from insertable cardiac monitors may be useful in identifying patients at increased risk of heart failure (HF) events. High‐risk alerts must be coupled with interventions to improve outcomes. We aim to assess the safety of a predefined protocolized intervention pathway activated by insertable cardiac monitor high‐risk alerts. Methods and Results ALLEVIATE‐HF (Algorithm Using LINQ Sensors for Evaluation and Treatment of Heart Failure) Phase 1 was a randomized interventional study enrolling patients with New York Heart Association class II/III and a recent HF event. A HF risk score based on insertable cardiac monitor diagnostics, including impedance, respiration rate, atrial fibrillation burden, heart rate during atrial fibrillation, heart rate variability, and activity duration, was calculated. A protocolized intervention pathway was activated when high‐risk scores were detected that involved physician‐prescribed nurse‐implemented uptitration of diuretic for 4 days, unless safety rule‐out conditions were met. Interventions could be repeated if high‐risk scores persisted and did not require worsening symptoms. In total, 59 patients were randomized (mean age 68.2±11.8 years; 59.3% male); 67.8% with ejection fraction ≥50%. The mean follow‐up was 11.8±8.1 months. Overall, 146 high‐risk scores were recorded in 33 patients and 118 interventions occurred in 75 (51.4%) high‐risk alerts that did not meet safety rule‐out criteria. There were no serious adverse events and 13 adverse events related to interventions. In patients with symptoms at intervention initiation, symptoms resolved in 37 interventions (80%) and worsened in 8 (17%). In asymptomatic patients, symptoms developed in 3 interventions (7%). Conclusions A personalized medication intervention based on insertable cardiac monitor risk score can be safely instituted in patients with HF, irrespective of symptoms. Registration URL: https://www.clinicaltrials.gov; Unique Identifier: NCT04452149.

Abstract A natural product is a compound or substance originating from a living organism and found in nature. Daidzein belongs to the class of bioflavonoids, which are plant‐derived compounds with various biological activities. Predominantly exists in soybeans and several legumes in either glycoside or aglycone forms. Its primary chemical constituents include metabolites like equol and trihydroxy isoflavone, generated through the influence of intestinal bacteria. Daidzein has exhibited pharmacological impacts on different ailments, including cardiovascular disease, cancer, diabetes, skin disorders, osteoporosis, and neurodegenerative disorders. Daidzein's mechanisms of action involve interactions with estrogen receptors, as well as its antioxidant and anti‐inflammatory properties, along with its ability to regulate apoptosis and the cell cycle. In efforts to enhance its solubility, stability, bioavailability, and targeting, daidzein has been innovatively formulated into novel dosage forms, including nanoparticles, liposomes, microemulsions, and nanosuspensions. As a promising nutraceutical, daidzein presents multiple health benefits and holds potential for various clinical applications. Additional investigation is required to comprehend the molecular mechanisms of this phenomenon and assess its safety. The purpose of this review is to provide a short description of the therapeutic properties, chemical composition, traditional use, toxicology profile, new insights on the dosage form, and future prospects of daidzein.

Abstract Little information is available on optimizing the number of nitrogen (N) splits based on nitrate (NO3‐N) leaching and maize yield in sandy soils. To address this gap, we evaluated the impact of multiple N splits (2‐, 3‐, 4‐, and 5‐N splits) on NO3‐N leaching and maize (Zea mays L.) grain yield in irrigated loamy sand soil at a producer site in the Bazile Groundwater Management Area of Northeast Nebraska. Porous suction cup lysimeters were installed at a depth of 120 cm to collect pore water samples from 23 leaching events in 2021, a dry year. Increasing the number of N‐splits did not affect the pore‐water NO3‐N concentration; however, it was 169%, 152%, 150%, and 129% higher in 2‐, 3‐, 4‐, and 5‐N split treatments compared to control, that is, without N application. Though the 2‐, 3‐, 4‐, and 5‐N splits had 110%, 71%, 120%, and 91% higher area‐based NO3‐N leaching than the control, less deep percolation and more evapotranspiration in control led to no significant differences in area‐based NO3‐N leaching among all treatments. All N‐splits resulted in higher maize yield, nitrogen use efficiency, plant N uptake, harvest index, and aboveground biomass than control; however, the number of N‐splits did not affect these parameters. The inclusion of environmental cost reduced the return to nitrogen by 92–143 $ ha−1 across all N‐split treatments but did not significantly affect the differences among the splits. Overall, the results indicate that increasing the number of N‐splits does not provide agronomic, economic, and environmental benefits in irrigated maize fields during a dry year.

Abstract Aims The relationship between accelerometry data and changes in Kansas City Cardiomyopathy Questionnaire‐Physical Limitation Score (KCCQ‐PLS) or 6 min walk test (6MWT) is not well understood. Methods and results VITALITY‐HFpEF accelerometry substudy (n = 69) data were assessed at baseline and 24 weeks. Ordinal logistic regression models were used to assess the association between accelerometry activity and deterioration, improved, or unchanged KCCQ‐PLS (≥8.33 and ≤ −4.17 points) and 6MWT (≥32 vs. ≤ −32 m). KCCQ‐PLS score deteriorated in 16 patients, improved in 34, and was unchanged in 19. 6MWT deteriorated in 8 patients, improved in 21, and was unchanged in 19. Mean accelerometer wear was 21.4 (±2.1) h/day. Changes in hours active from baseline to 24 weeks were not significantly different among patients who exhibited deterioration, improvement, or no change in KCCQ‐PLS [odds ratio (OR) 0.91, 95% confidence interval (CI) 0.71–1.18; P = 0.48] or 6MWT (OR 1.21, 95% CI 0.91–1.60; P = 0.18). Similar lack of association was observed for other accelerometry metrics and change in KCCQ and 6MWT. These findings were unaffected when KCCQ and 6MWT were examined as continuous variables. Conclusions Accelerometer‐based activity measures did not correlate with subjective or objective standard measures of health status and functional capacity in heart failure with preserved ejection fraction. Further investigation of their relationships to clinical outcomes is required.

Abstract Background Frailty is a severe, common co‐morbidity associated with heart failure (HF) with preserved ejection fraction (HFpEF). The impact of frailty on HFpEF outcomes may affect treatment choices in HFpEF. The impact of frailty on HFpEF patients and any impact on the clinical benefits of sodium glucose co‐transporter 2 (SGLT2) inhibition in HFpEF have been described in only a limited number of trials. Whether the SGLT2 inhibitor empagliflozin would improve or worsen frailty status when given to HFpEF patients is also not known. The aims of this study were, therefore, to evaluate, in HFpEF patients enrolled in the EMPEROR‐Preserved trial (Empagliflozin Outcome Trial in Patients With Chronic Heart Failure With Preserved Ejection Fraction), the impact of frailty on clinical outcomes, and on the effects of empagliflozin, as well as the effect of empagliflozin on frailty status during treatment period. Methods We calculated a cumulative deficit‐derived frailty index (FI) using 44 variables including clinical, laboratory and quality of life parameters recorded in EMPEROR‐Preserved. Patients were classified into four groups: non‐frail (FI

Giant cell arteritis (GCA) is a chronic granulomatous vasculitis of medium and large arteries leading to cranial and extracranial manifestations. Temporal artery biopsy is considered the gold standard; however, its sensitivity is low at 47%. We report a unique case of Bing–Neel Syndrome (BNS) presenting as biopsy-proven GCA. BNS is a rare complication (1%) of Waldenstrom Macroglobulinemia (WM), which results from infiltration of lymph plasmacytoid cells and plasma cells into the central nervous system. A 77-year-old female with a past medical history of glaucoma, hypertension, diabetes, and chronic ocular ischemic syndrome in her right eye presented with progressive left eye vision loss for 5 days. Fundoscopic examination was notable for pseudophakic pseudopallor but no optic disc edema. Intraocular pressure was >40 and normalized after acetazolamide. The patient was started on pulse dose steroids by her neuro-ophthalmologist. She was discharged home on 60 mg of prednisone. At follow up with her neuro-ophthalmologist, new dot blot hemorrhages in the left eye were noted and she was readmitted for pulse dose of intravenous methylprednisolone. Temporal artery biopsy was consistent with GCA spectrum. Work up revealed paraproteinemia and subsequent bone marrow biopsy demonstrated WM. The patient was treated for her WM and her ophthalmic complications stabilized.

Abstract Aims Serial assessment of natriuretic peptides is widely utilized in heart failure clinics. Uncertainty exists regarding the value of multiple natriuretic peptide measurements and how they might be best interpreted. Methods and results Six hundred thirty‐two patients with heart failure with reduced ejection fraction ( 0.1). However, among those with higher baseline NT‐proBNP, those with lower subsequent AUC had a greater improvement in cardiac remodelling indices (P‐value

Abstract The rapid increase in nontechnical loss (NTL) has become a principal concern for distribution system operators (DSOs) over the years. Electricity theft makes up a major part of NTL. It causes losses for the DSOs and also deteriorates the quality of electricity. The introduction of advanced metering infrastructure along with the upgradation of the traditional grids to the smart grids (SGs) has helped the electric utilities to collect the electricity consumption (EC) readings of consumers, which further empowers the machine learning (ML) algorithms to be exploited for efficient electricity theft detection (ETD). However, there are still some shortcomings, such as class imbalance, curse of dimensionality, and bypassing the automated tuning of hyperparameters in the existing ML‐based theft classification schemes that limit their performances. Therefore, it is essential to develop a novel approach to deal with these problems and efficiently detect electricity theft in SGs. Using the salp swarm algorithm (SSA), gate convolutional autoencoder (GCAE), and cost‐sensitive learning and long short‐term memory (CSLSTM), an effective ETD model named SSA–GCAE–CSLSTM is proposed in this work. Furthermore, a hybrid GCAE model is developed via the combination of gated recurrent unit and convolutional autoencoder. The proposed model comprises five submodules: (1) data preparation, (2) data balancing, (3) dimensionality reduction, (4) hyperparameters' optimization, and (5) electricity theft classification. The real‐time EC data provided by the state grid corporation of China are used for performance evaluations via extensive simulations. The proposed model is compared with two basic models, CSLSTM and GCAE–CSLSTM, along with seven benchmarks, support vector machine, decision tree, extra trees, random forest, adaptive boosting, extreme gradient boosting, and convolutional neural network. The results exhibit that SSA–GCAE–CSLSTM yields 99.45% precision, 95.93% F1 score, 92.25% accuracy, and 71.13% area under the receiver operating characteristic curve score, and surpasses the other models in terms of ETD.

Abstract At least half of all patients with heart failure (HF) are affected by frailty, a syndrome that limits an individual ability to recover from acute stressors. While frailty affects up to 90% of patients with HF with preserved ejection fraction, it is also seen in ~30–60% of patients with HF with reduced ejection fraction, with ~26% higher prevalence in women compared with men. The relationship between frailty and HF is bidirectional, with both conditions exacerbating the other. Frailty is further complicated by a higher prevalence of sarcopenia (by ~20%) in HF patients compared with patients without HF, which negatively affects outcomes. Several frailty assessment methods have been employed historically including the Fried frailty phenotype and Rockwood Clinical Frailty Scale to classify HF patients based on the severity of frailty; however, a validated HF‐specific frailty assessment tool does not currently exist. Frailty in HF is associated with a poor prognosis with a 1.5‐fold to 2‐fold higher risk of all‐cause death and hospitalizations compared to non‐frail patients. Frailty is also highly prevalent in patients with worsening HF, affecting >50% of patients hospitalized for HF. Such patients with multiple readmissions for decompensated HF have markedly poor outcomes compared to younger, non‐frail cohorts, and it is hypothesized that it may be due to major physical and functional limitations that limit recovery from an acute episode of worsening HF, a care aspect that has not been addressed in HF guidelines. Frail patients are thought to confer less benefit from therapeutic interventions due to an increased risk of perceived harm, resulting in lower adherence to HF interventions, which may worsen outcomes. Multiple studies report that

Key Clinical Message Scalp metastasis from atypical meningioma, though rare, underscores the importance of meticulous surgical techniques to prevent tumor cell implantation. Early detection and comprehensive management, including surgery and adjuvant therapy, are crucial for optimal outcomes. Abstract Meningiomas are tumors of the meninges that originate in the arachnoid layer from arachnoid cap cells. Atypical meningiomas, classified as WHO grade 2 tumors, tend to metastasize and recur if not surgically managed properly. Scalp metastasis is a rare occurrence that presents as a subcutaneous elevation. A 33‐year‐old patient presented with a complaint of a constant, dull pressure headache persisting for the past 12 months, exacerbated by exertion, along with seizures and neuropsychiatric symptoms. The patient had no significant medical history but had undergone surgery 4 years ago for a WHO grade 2 meningioma. The current brain MRI revealed a dural tail sign, along with masses on both the left and right sides of the frontal lobe, extending to involve the skin on the forehead and scalp. The patient underwent surgical resection and adjuvant radiation therapy. At the 12‐month follow‐up, no neurological deterioration or tumor recurrence was observed. A literature review on scalp metastasis in patients with atypical meningioma was also conducted, including eight articles published up to September 2023. The mechanism of metastasis development appears to be consistent in all eight reported cases, involving the implantation of tumor cells during resection. Therefore, there is a critical need for meticulous intra‐ and post‐operative surgical techniques to prevent such implantation.

Abstract Objectives The study aimed to assess the effectiveness of anxiety reduction protocol using auditory distraction in alleviating dental anxiety among patients undergoing tooth extraction. Materials and Methods A randomized controlled trial was conducted at the Oral Surgery Department at Islamabad Dental Hospital from July to December 2022, involving 50 patients scheduled for tooth extraction. Participants were randomly divided into two groups: an interventional group, exposed to auditory distraction, and a noninterventional group, without exposure to auditory distraction before the dental extraction. Dental anxiety was measured using the modified dental anxiety scale (MDAS) questionnaire, which scores anxiety levels on a range from 5 (not anxious) to 25 (extremely anxious). Anxiety levels were assessed in the waiting room and just before extraction, and the results were compared across both groups to evaluate the effectiveness of auditory distraction in reducing dental anxiety. Results The sample size of 50 was randomly and equally allocated to the interventional and noninterventional groups. The study population consisted of 28 (56%) female and 22 (44%) male participants. No significant difference was observed between the anxiety scores of interventional and noninterventional groups at baseline. A significant reduction in anxiety scores was observed in the intervention group during postintervention assessment, while no significant difference was seen in the noninterventional group's anxiety scores. Conclusions The study supports the efficacy of anxiety reduction protocol using auditory distraction as a practical tool for reducing dental anxiety among patients undergoing tooth extraction.

Abstract Drought is a major constraint for wheat production that is receiving increased attention due to global climate change. This study conducted isobaric tags for relative and absolute quantitation proteomic analysis on near‐isogenic lines to shed light on the underlying mechanism of qDSI.4B.1 quantitative trait loci (QTL) on the short arm of chromosome 4B conferring drought tolerance in wheat. Comparing tolerant with susceptible isolines, 41 differentially expressed proteins were identified to be responsible for drought tolerance with a p‐value of 1.3 or

Abstract Small and Medium Enterprises (SMEs) are steadily moving in the direction of implementing digital and smart technologies, including the Industrial Internet of Things (IIoT) for improving their products and services. The adoption of IIoT allows manufactures and producers to make quick decisions for improving productivity and quality in real‐time. For this purpose, the era of digital industrial revolution from IR 1.0 to IR 5.0 is briefly explained. In this research study, the authors have reviewed and analysed the existing reviews, surveys and technical research studies on IIoT technologies for the manufacturing and production SMEs to highlight the concern raised. Forty‐seven (47) influencing factors are identified and classified into four groups based on the TOEI framework. Based on the identified influencing factors, IIoT adoption model is proposed for the manufacturing and production SMEs to adopt the new IIoT technologies in their business environments. Furthermore, a comparative analysis of the influencing factors has been done for the adoption of IIoT to increase efficiency, productivity and competitiveness for the manufacturing and production SMEs in developing countries. The proposed IIoT adoption model will help future policymakers and stakeholders to develop policies and strategies for the successful adoption and implementation of IIoT in manufacturing and production SMEs in developing countries. Also, recommendations are suggested to encourage IIoT adoption in production and manufacturing environments so that manufacturers and producers can respond easily and quickly to highly changing demands, product trends, skills gaps and other unexpected challenges in the future.

Abstract Cachexia, in the form of unintentional weight loss >5% in 12 months or less, and secondary sarcopenia in the form of muscle wasting are serious conditions that affect clinical outcomes. A chronic disease state such as chronic kidney disease (CKD) often contributes to these wasting disorders. The purpose of this review is to summarize the prevalence of cachexia and sarcopenia, their relationship with kidney function, and indicators for evaluating kidney function in patients with CKD. It is estimated that approximately half of all persons with CKD will develop cachexia with an estimated annual mortality rate of 20%, but few studies have been conducted on cachexia in CKD. Hence, the true prevalence of cachexia in CKD and its effects on kidney function and patient outcomes remain unclear. Some studies have highlighted the concept of protein‐energy wasting (PEW) which usually include sarcopenia and cachexia. Several studies have examined kidney function and CKD progression in patients with sarcopenia. Most studies use serum creatinine levels to estimate kidney function. However, creatinine may be influenced by muscle mass, and creatinine‐based glomerular filtration rate may overestimate kidney function in patients with reduced muscle mass or muscle wasting. Cystatin C, which is least affected by muscle mass, has been used in some studies, and creatinine‐to‐cystatin‐C ratio has emerged as an important prognostic marker. A previous study incorporating 428 320 participants reported that participants with CKD and sarcopenia had a 33% higher hazard of mortality compared with those without (7% to 66%, P = 0.011), and that those with sarcopenia were twice as likely to develop end‐stage kidney disease (hazard ratio: 1.98; 1.45 to 2.70, P

Abstract Background Maintaining the ability to perform self‐care is a critical goal in patients with cancer. We assessed whether the patient‐reported ability to walk 4 m and wash oneself predict survival in patients with pre‐terminal cancer. Methods We performed a prospective observational study on 169 consecutive hospitalized patients with cancer (52% female, 64 ± 12 years) and an estimated 1–12 months prognosis at an academic, inpatient palliative care unit. Patients answered functional questions for ‘today’, ‘last week’, and ‘last month’, performed patient‐reported outcomes (PROs), and physical function assessments. Results Ninety‐two (54%) patients reported the ability to independently walk 4 m and 100 (59%) to wash ‘today’. The median number of days patients reported the ability to walk 4 m and wash were 6 (IQR 0–7) and 7 (0–7) days (‘last week’); and 27 (5–30) and 26 (10–30) days (‘last month’). In the last week, 32% of patients were unable to walk 4 m on every day and 10% could walk on 1–3 days; 30% were unable to wash on every day and 10% could wash on 1–3 days. In the last months, 14% of patients were unable to walk 4 m on every day and 10% could only walk on 1–10 days; 12% were unable to wash on every day and 11% could wash on 1–10 days. In patients who could walk ‘today’ average 4 m gait speed was 0.78 ± 0.28 m/s. Patients who reported impaired walking and washing experienced more symptoms (dyspnoea, exertion, and oedema) and decreased physical function (higher Eastern Cooperative Oncology Group Performance Status, and lower Karnofsky Performance Status and hand‐grip strength [unable vs. able to walk ‘today’: 205 ± 87 vs. 252 ± 78 Newton, P = 0.001; unable vs. able to wash ‘today’: 204 ± 86 vs. 250 ± 80 Newton, P = 0.001]). During the 27 months of observation, 152 (90%) patients died (median survival 46 days). In multivariable Cox proportional hazards regression analyses, all tested parameters were independent predictors of survival: walking 4 m ‘today’ (HR 0.63, P = 0.015), ‘last week’ (per 1 day: HR 0.93, P = 0.011), ‘last month’ (per 1 day: HR 0.98, P = 0.012), 4 m gait speed (per 1 m/s: HR 0.45, P = 0.002), and washing ‘today’ (HR 0.67, P = 0.024), ‘last week (per 1 day HR 0.94, p=0.019), and ‘last month’ (per 1 day HR 0.99, P = 0.040). Patients unable to walk and wash experienced the shortest survival and most reduced functional status. Conclusions In patients with pre‐terminal cancer, the self‐reported ability to walk 4 m and wash were independent predictors of survival and associated with decreased functional status.

Abstract Aims Sodium‐glucose cotransporter type 2 inhibitors (SGLT‐2i) represent a unique class of anti‐hyperglycaemic agents for type 2 diabetes mellitus that selectively inhibit renal glucose reabsorption, thereby increasing urinary excretion of glucose. Several studies have demonstrated the cardioprotective effects of SGLT‐2i in patients with heart failure (HF), unrelated to its glucosuric effect. It is unclear whether the benefits of SGLT‐2i therapy also rely on the improvement of left ventricular (LV) and/or right ventricular (RV) function in patients with HF. This study aimed to evaluate the effect of SGLT‐2i on LV and RV function through conventional and advanced echocardiographic parameters with a special focus on RV function in patients with HF. Methods and results The Biventricular Evaluation of Gliflozins effects In chroNic Heart Failure (BEGIN‐HF) study is an international multicentre, prospective study that will evaluate the effect of SGLT‐2i on echocardiographic parameters of myocardial function in patients with chronic stable HF across the left ventricular ejection fraction (LVEF) spectrum. Patients with New York Heart Association Class II/III symptoms, estimated glomerular filtration rate > 25 mL/min/1.73 m2, age > 18 years, and those who were not previously treated with SGLT‐2i will be included. All patients will undergo conventional, tissue‐derived imaging (TDI), and strain echocardiography in an ambulatory setting, at time of enrolment and after 6 months of SGLT‐2i therapy. The primary endpoint is the change in LV function as assessed by conventional, TDI, and myocardial deformation speckle tracking parameters. Secondary outcomes include changes in RV and left atrial function as assessed by conventional and deformation speckle tracking echocardiography. Univariate and multivariate analyses will be performed to identify predictors associated with primary and secondary endpoints. Conclusions The BEGIN‐HF will determine whether SGLT‐2i therapy improves LV and/or RV function by conventional and advanced echocardiography in patients with HF irrespective of LVEF.

Conclusion: Despite that microbial signatures have been established for various subtypes of breast cancer, the crux of healthy microbiome yet needs to be detected. This review represents a modest attempt to compile the body of knowledge regarding the relationship between breast cancer and the human microbiome.

This case report discusses the diagnosis and management of a 25-year-old pregnant patient presenting with persistent tachycardia. The patient, with a past medical history of thyroiditis, polycystic ovarian syndrome, and obesity, was admitted due to palpitations and was diagnosed with atrial tachycardia. Despite medical management with metoprolol, adenosine, digoxin, and flecainide, the tachycardia persisted, necessitating discussion about cardiac ablation. The report emphasizes that atrial tachycardia poses a significant clinical challenge when refractory to medical therapy. It also highlights the condition’s association with tachycardia-induced cardiomyopathy and the role of catheter ablation in its management. This case underscores the need for a high index of suspicion for atrial tachycardia in pregnant patients presenting with persistent tachycardia and the importance of appropriate referral for invasive management when medical therapy fails. The case also highlights that atrial tachycardia in pregnancy can be safely managed with ablation.

Soils exhibit structural heterogeneity across diverse spatio-temporal scales, yielding myriad of microhabitats, highlighting the need for a nuanced understanding of the intricate interactions within the soil matrix. At the nanometer scale, the interplay among organic matter (OM), mineral particles, and microbiota intricately govern the long-term destiny of soil carbon (C), nutrient cycling, and the fate of both organic and inorganic pollutants. Notably, the sorption of soil organic matter (SOM) onto smaller clay particles and its entrapment in microaggregates further contribute to this complex dynamic. Understanding these processes depends on recognizing their scale-dependent nature, necessitating sophisticated techniques for investigation. Although various methods are employed across scales, the current set of techniques still lacks the requisite sensitivity and resolution for microscale data collection. To address this limitation, the adoption of novel microscopic and spectroscopic techniques capable of probing molecular, isotopic, and elemental patterns at the micro to nano scale becomes imperative. Among these cutting-edge methodologies, the nano-scale secondary ion mass spectrometer (NanoSIMS) emerges as a paradigm-shifting tool. Representing the latest evolution in ion microprobes, NanoSIMS seamlessly integrates high-resolution microscopy and isotopic analysis, maintaining unparalleled signal transmission and spatial resolution, reaching as fine as 50 nm. Its capabilities extend beyond conventional applications in science, as evidenced by recent breakthroughs in utilizing NanoSIMS to study biophysical interfaces in soils. This article underscores the pressing need to advance the incorporation of NanoSIMS as a pioneering instrumentation technique in soil studies. Furthering the implementation of this novel instrumentation technique in soil studies will pave avenues and aid in the advancement of future research.

This paper introduces a novel hybrid controller designed for a wind turbine power generation system (WTPGS) that utilizes a permanent magnet synchronous generator (PMSG). This hybrid controller combines the adaptability of an adaptive neuro-fuzzy inference system (ANFIS) with the simplicity of a proportional-integral (PI) controller. The PI controllers are traditionally used for stability and noise handling. ANFIS adds adaptability, making it more suitable to cope with the variable nature of wind energy. The primary objective of this hybrid strategy is to augment the overall control performance and reliability of PMSG-based WTPGS when encountered with continuous variable wind conditions. However, implementing the PI controller alone with the WTPGS often suffers from high overshoot and sluggish response in nonlinear systems like WTPGS. In contrast, ANFIS controllers offer superior performance to PI and other artificial intelligence controllers but are still susceptible to noise issues. In this paper, the proposed WTPGS system is designed in MATLAB/Simulink software where a hybrid controller (ANFIS-PI) is implemented in the machine-side converter (MSC) and grid-side converter (GSC) of a variable speed PMSG-based wind turbine to enhance its performance subjected to wind variations. The hybrid controller is implemented in such a way that the ANFIS controller is implemented in the outer layers while the PI controller is applied in the inner layers of both MSC and GSC. The simulation results for this hybrid controller in the MSC outperform those of the conventional PI controller. They demonstrate minimal overshooting and settling time, maintaining consistent stability even when subjected to various test signals at different intervals. Similarly, the GSC also surpasses conventional PI controllers, achieving a significant 6.4% reduction in maximum overshoot and a decrease of 4.36 seconds in settling time. This highlights its strong suitability for wind turbine applications.

Abstract This study evaluates land use transformation in Kandahar's old city, also known as Ahmad Shahi city, the birthplace and first capital of modern Afghanistan. The city consists of four rectangular quarters and is surrounded by a high strong mud wall, entrance gates, and a moat. In the early 20th century, the city experienced significant and arbitrary expansion, which certainly affected the urban fabric of the area, the streets were widened, and the city wall, towers, and gates were demolished, and the area was added to the construction of new government buildings, commercial establishments, and residential plots. This study aims to evaluate the alterations in the old city's urban morphology, culture, and sociology by conducting a comparative analysis of three maps from different time periods and considering various factors within the target area.

This study investigates the influence of Withania somnifera root powder (WSRP) on different aspects of common carp (Cyprinus carpio), including growth, hematobiochemical parameters, antioxidant status, nonspecific immune response, and resilience to bacterial infections. Over a 60-day period, 180 common carp fingerlings (11.73 ± 0.52 g) were subjected to diets supplemented with increasing WSRP levels (0 (control), 1% (WSRP1), 2.5% (WSRP2.5), and 4% (WSRP4)). Nonspecific immune parameters were evaluated using serum samples collected at intervals of 0, 20, 40, and 60 days. After the feeding trial, the fish underwent experimental challenge with Aeromonas hydrophila, and relative percentage survival (RPS) was monitored for 14 days. The findings revealed a considerable (p 0.05) in serum glucose and cortisol levels compared to other groups. In conclusion, WSRP proves valuable for enhancing growth, blood parameters, antioxidant balance, immune response, and infection resistance in common carp, especially at 2.5%–4% dietary supplementation levels. In the future, it will be crucial to study the long-term effects of WSRP supplementation on fish health, as well as its potential for large-scale aquaculture and economic viability in the aquafeed industry.

Despite its collapsible nature and weakness, desert sand can be used for construction purposes all over the world if properly stabilized. Therefore, the aim of this study is to evaluate the effectiveness of cement and fiber in stabilizing locally available dune sand. A test plan was used to investigate the effects of varying quantities of alkali resistance glass (ARG) fiber (F: 0%, 0.2%, 0.4%, and 0.6%) and portland cement (C: 0.0%, 1.0%, 3.0%, and 5.0%) on the mechanical and microstructural properties of dune sand. Mechanical properties such as unconfined strength (UCS), strain at failure (εf), California bearing ratio (CBR), and modulus of elasticity (Es) were evaluated, and microstructure properties were investigated using Raman spectrum and laser-scanning microscopy (LSM) tests on stabilized sand samples. The results of the experimental study showed that the percentage of cement in the treated sand has a more significant impact on the investigated properties of the treated sand than the percentage of fibers. In addition, increasing fiber content results in an increase in the ductility of the sand mix. Raman analysis revealed significant interactions between sand mix components. Moreover, LSM results showed that fiber–cement interaction increased with increasing cement percentage, as calcium silicate hydrates (CSH) formed in the mix and filamentous and intrastrand binding occurred. The findings of this study indicate that ARG fiber and cement can be effective in the stabilization of dune sand for construction purposes even with the use of low percentages of ARG fiber (0.2%–0.4%) and cement (3%).

This article designs a cleaner production scheduling model for defective products with flexible rework rate and shortages by considering the transportation cost as proportional to pandemic intensity. The model incorporates a variable setup cost and carbon emissions originating from various activities, both of which are targeted for reduction through investments in green technologies. The main aim of this work is to determine optimal production strategies for firms operating in emergency situations like pandemics, conflicts, and other unforeseen circumstances. The scenario is mathematically formulated with the objective of minimizing both total cost and overall emissions by optimizing decision variables such as production lot size, backorder, setup cost, and green investment. A numerical example is stated to validate the mathematical formulation, and the discussion of parameter effects on optimal solutions, along with managerial insights, is conducted through sensitivity analysis.

Calotropis procera is a medicinal, traditional, and therapeutic plant in Pakistan. In this research study, the biological activities, for instance, anticancer, antileishmanial, antibacterial, antifungal, anti-inflammatory, and brine shrimp lethality assay and GC-MS are studied. MTT assay, antileishmanial bioassay, microplate Alamar Blue assay, agar tube dilution method, oxidative burst assay using chemiluminescence technique, B-hatching techniques, and triple quadrupole acquisition method MS parameters were the methods used for anticancer, antileishmanial, antibacterial, antifungal, anti-inflammatory, brine shrimp lethality assay, and gas chromatography-mass spectrometry. Whole plant methanol extract of Calotropis procera (WMECP) inhibited 69.1% of the growth of HeLa cell line with an IC50 value of 3.1 ± 0.4 and whole plant n-hexane fraction of Calotropis procera (WHFCP) and whole plant and aqueous fraction of Calotropis procera (WAFCP) inhibited the growth by 70.2% and 65.2% with IC50 values of 5.0 ± 0.3 and 17.1 ± 1.0. Whole plant methanol extract of Calotropis procera (WMECP) inhibited 70.1% of the growth of the PC3 cell line with an IC50 value of 5.1 ± 0.3 and whole plant n-hexane fraction of Calotropis procera (WHFCP) and whole plant aqueous fraction of Calotropis procera (WAFCP) inhibited 61.6% and 59.7% with IC50 values of 3.7 ± 0.5 and 16.4 ± 1.0. None of the extract and fractions of Calotropis procera showed anticancer activities against the 3T3 cell line. None of the extract and fractions of Calotropis procera showed antileishmanial, antibacterial, antifungal, and anti-inflammatory activities. Whole plant methanol extract of Calotropis procera (WMECP) exhibited lethality at the highest concentration while other fractions did not exhibit lethality. GC-MS studies revealed that the whole plant methanol extract of Calotropis procera (WMECP) consists of 11 compounds, whole plant n-hexane fraction of Calotropis procera (WHFCP) consists of 9 compounds, and whole plant aqueous fraction of Calotropis procera (WAFCP) consists of 7 compounds.

Abstract Aims Heart failure (HF) remains a major public health problem with increasing prevalence in China. This study evaluated the clinical performance and quality measures for HF management to identify gaps in the standardization of care for patients hospitalized for HF in China. Methods and results Following the results of China‐HF stage I (2012–2015), the second stage of the China‐HF was launched in 2017. Among 113 hospitals with ≥100 cases, the China‐HF Stage II assessed the quality of care measures for HF and compared results with previous data in China and the US‐based Get with The Guidelines‐Heart Failure (GWTG‐HF) registries. In total, 34 938 patients hospitalized with HF were enrolled from January 2017 to October 2020. Echocardiographic left ventricular function and natriuretic peptide test were performed in 93.7% and 93.0% of the cases, respectively. Adherence to standardized guidelines in China‐HF stage II was higher than that in the China‐HF stage I, but generally lower than GWTG‐HF registry with 78.2% of eligible patients was prescribed oral diuretics, 78.7% renin‐angiotensin‐system inhibitors, and 82.2% beta‐blockers. Implantable cardioverter‐defibrillators and cardiac resynchronization devices were implanted in 3.9% and 14.6%, respectively. In contrast, the proportion of eligible patients discharged with spironolactone (87.8%) was higher than GWTG‐HF. The median length of hospitalization was 9 (6, 12) days, and 938 (2.8%) patients died or withdrew from treatment during hospitalization. Conclusions Despite significant improvements in the use of guideline‐recommended testing and therapy, there remain major gaps in quality of care for patients hospitalized for HF in China that are generally larger than gaps observed in the United States.