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Background Most adults with sickle cell disease will experience a silent cerebral infarction (SCI) or overt stroke. Identifying patient subgroups with increased stroke incidence is important for future clinical trials focused on stroke prevention. Our 3‐center prospective cohort study tested the primary hypothesis that adults with sickle cell disease and SCIs have a greater incidence of new stroke or SCI compared with those without SCI. A secondary aim focused on identifying additional risk factors for progressive infarcts, particularly traditional risk factors for stroke in adults. Methods and Results This observational study included adults with sickle cell disease and no history of stroke. Magnetic resonance imaging scans of the brain completed at baseline and >1 year later were reviewed by 3 radiologists for baseline SCIs and new or progressive infarcts on follow‐up magnetic resonance imaging. Stroke risk factors were abstracted from the medical chart. Time‐to‐event analysis was utilized for progressive infarcts. Median age was 24.1 years; 45.3% of 95 participants had SCIs on baseline magnetic resonance imaging. Progressive infarcts were present in 17 participants (17.9%), and the median follow‐up was 2.1 years. Incidence of new infarcts was 11.95 per 100 patient‐years (6.17–20.88) versus 3.74 per 100 patient‐years (1.21–8.73) in those with versus without prior SCI. Multivariable Cox regression showed that baseline SCI predicts progressive infarcts (hazard ratio, 3.46 [95% CI, 1.05–11.39]; P=0.041); baseline hypertension was also associated with progressive infarcts (hazard ratio, 3.23 [95% CI, 1.16–9.51]; P=0.025). Conclusions Selecting individuals with SCIs and hypertension for stroke prevention trials in sickle cell disease may enrich the study population with those at highest risk for infarct recurrence.

Abstract With humans, animals and the environment being as interconnected as they are, the science describing their interactions needs to cut across disciplinary boundaries. Systems research at the interface between the three goes by several names, such as ‘Eco‐Health’ and ‘Planetary Health’, each with a varied focus, but the concept of ‘One Health’ (OH) has stood out as the most popular one. COVID‐19 has reiterated the importance of OH in response to health challenges. This review aimed to assess the OH approach integration and implementation level in Kerala state, India, in the context of emerging zoonotic diseases. A systematic literature review was conducted by searching for relevant articles with specific keywords across six electronic databases. This involved screening the initial hits for titles and abstracts, then systematic sorting to identify the ones that met the criteria, followed by more thorough scrutiny to finally shortlist the six studies to be included in the review. We found that OH in Kerala has made good progress, as evident from a few recent examples, but has a long way to go with significant challenges. In line with the study's aim, identifying and analysing what is already done, what is missing and what needs to be done can have wider implications for future OH implementation. Relevant threats and opportunities were identified, with lessons for Kerala and India and broader applications.

Background Health concordance within couples presents a promising opportunity to design interventions for disease management, including hypertension. We compared the concordance of prevalent hypertension within middle‐aged and older heterosexual couples in the United States, England, China, and India. Methods and Results Cross‐sectional dyadic data on heterosexual couples were used from contemporaneous waves of the HRS (US Health and Retirement Study, 2016/17, n=3989 couples), ELSA (English Longitudinal Study on Aging, 2016/17, n=1086), CHARLS (China Health and Retirement Longitudinal Study, 2015/16, n=6514), and LASI (Longitudinal Aging Study in India, 2017/19, n=22 389). Concordant hypertension was defined as both husband and wife in a couple having hypertension. The prevalence of concordant hypertension within couples was 37.9% (95% CI, 35.8–40.0) in the United States, 47.1% (95% CI, 43.2–50.9) in England, 20.8% (95% CI, 19.6–21.9) in China, and 19.8% (95% CI, 19.0–20.5) in India. Compared with wives married to husbands without hypertension, wives married to husbands with hypertension were more likely to have hypertension in the United States (prevalence ratio, 1.09 [95% CI, 1.01– 1.17), England (prevalence ratio, 1.09, 95% CI, 0.98–1.21), China (prevalence ratio, 1.26 [95% CI, 1.17–1.35), and India (prevalence ratio, 1.19 [95% CI, 1.15–1.24]). Within each country, similar associations were observed for husbands. Across countries, associations in the United States and England were similar, whereas they were slightly larger in China and India. Conclusions Concordance of hypertension within heterosexual couples was consistently observed across these 4 socially and economically diverse countries. Couple‐centered interventions may be an efficient strategy to prevent and manage hypertension in these countries.

Abstract Background Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in children occurring most commonly in the head and neck region. The treatment involves using a multimodality approach including chemotherapy, surgery, and radiation therapy. Survival for patients with localized disease has improved markedly, but the treatment of advanced disease remains a challenge. We report the clinical characteristics and outcome for patients treated at a tertiary care center in Saudi Arabia. Methods Patients aged 0–14 years diagnosed with RMS between 2005 and 2018 were included. Statistical analysis was performed using SPSS software. Kaplan–Meier method was used to calculate overall and event free survival. Cox proportional hazards model was used for multivariate analysis. Results One hundred and twenty‐four patients were analyzed. The median age was 5.7 years with male predominance (2.4:1). The most common primary sites were head/neck (30%) and the genitourinary tract (25%). Embryonal RMS was present in 81%; alveolar in 19%. Most patients had intermediate risk disease (60%). The 5‐year overall and event free survivals were 64.3% and 53.3%, respectively. Survival was influenced by primary tumor site, histology, and clinical risk group. Unfavorable primary site, high risk stratification, and poor initial response to therapy predicted a poor outcome. Conclusion This study provides an insight on the current management outcomes for our patients with RMS. Cytogenetics and molecular diagnostics need to be incorporated as standard of care in the therapeutic approach of our patients. In addition, there is a need for national collaborative efforts to improve the outcome of RMS in children and adolescents.

Background Timely hospitalization of patients who are diagnosed with an acute coronary syndrome (ACS) at the emergency department (ED) is a crucial step to lower the risk of ACS mortality. We examined whether there are racial and ethnic differences in the risk of being discharged home among patients who received a diagnostic code of ACS at the ED and whether having health insurance plays a role. Methods and Results We examined 51 022 910 discharge records of ED visits in Florida, New York, and Utah in the years 2008, 2011, 2014, and 2016/2017 using state‐specific data from the Healthcare Cost and Utilization Project. We identified ED admissions for acute myocardial infarction or unstable angina using the International Classification of Diseases, Ninth Revision (ICD‐9)/International Statistical Classification of Diseases, Tenth Revision (ICD‐10) diagnostic codes. We used generalized estimating equation models to compare the risk of being discharged home across racial and ethnic groups. We used Poisson marginal structural models to estimate the mediating role of health insurance status. The proportion discharged home with a diagnostic code of ACS was 12% among Black patients, 6% among White patients, 9% among Hispanic patients, and 9% among Asian/Pacific Islander patients. The incidence risk ratio for being discharged home was 1.26 (95% CI, 1.18–1.34) in Black patients, 1.23 (95% CI, 1.15–1.32) in Hispanic patients, and 1.11 (95% CI, 0.93–1.31) in Asian/Pacific Islander patients compared with White patients. Race and ethnicity were marginally associated with discharge home via pathways not mediated by health insurance. Conclusions Racial and ethnic disparities exist in the hospitalization of patients who received a diagnostic code of ACS in the ED. Possible causes need to be investigated.

Abstract Objectives The predictive accuracy and clinical role of the focused assessment with sonography for trauma (FAST) exam in pediatric blunt abdominal trauma are uncertain. This study investigates the performance of the emergency department (ED) FAST exam to predict early surgical intervention and subsequent free fluid (FF) in pediatric trauma patients. Methods Pediatric level 1 trauma patients ages 0 to 15 years with blunt torso trauma at a single trauma center were retrospectively reviewed. After stratification by initial hemodynamic (HD) instability, the association of a positive FAST with (1) early surgical intervention, defined as operative management (laparotomy or open pericardial window) or angiography within 4 hours of ED arrival and (2) presence of FF during early surgical intervention was determined. Results Among 508 salvageable pediatric trauma patients with an interpreted FAST exam, 35 (6.9%) had HD instability and 98 (19.3%) were FAST positive. A total of 42 of 508 (8.3%) patients required early surgical intervention, and the sensitivity and specificity of FAST predicting early surgical intervention were 59.5% and 84.3%, respectively. The specificity and positive predictive value of FF during early surgical intervention in FAST‐positive HD unstable patients increased from 50% and 90.9% at 4 hours after ED arrival to 100% and 100% at 2 hours after ED arrival, respectively. Conclusions In this large series of injured children, a positive FAST exam improves the ability to predict the need for early surgical intervention, and accuracy is greater for FF in HD unstable patients 2 hours after arrival to the ED.

The Lorenz-Stenflo mathematical model describes a complex dynamical behavior related to atmospheric acoustic-gravity waves. In this study, qualitative analysis of the four-dimensional hyperchaotic Lorenz-Stenflo system via the Caputo fractional derivative is implemented. By using the Matignon stability criterion, the local stability analysis of the system showed that all the equilibrium points of the system are locally unstable. Calculation of the Lyapunov exponents along with the relevant bifurcation diagrams with respect to different fractional orders exposed the hyperchaotic dynamical behavior for the system. Bifurcation diagrams for all the four parameters in the system also showed the hyperchaotic nature of the Lorenz-Stenflo system. Different phase attractors of the system corresponding to different fractional derivatives and parameters are presented to specify the dynamical nature of the system. The Lorenz-Stenflo system showed sensitivity to initial conditions. The master and slave systems showed a strong correlation among themselves, as verified by graphs of time series solutions of the two systems.

Treatment of Class II malocclusion accompanied with a skeletal discrepancy is challenging. The approach of correction depends on several factors such as the status and pattern of growth, severity of the malocclusion, and patient cooperation. This case report describes a successful management of a 12-year-old young adolescent boy that was presented with a Class II division 1 malocclusion with an underlying skeletal discrepancy in horizontal and vertical dimensions. Growth modification was achieved by means of bite opening and unlocking the mandible together with Class II elastics and mechanics. Treatment was highly effective and efficient by achieving all treatment goals within a period of 18 months.

The oscillation of even-order nonlinear differential equations (NLDiffEqs) with mixed nonlinear neutral terms (MNLNTs) is investigated in this work. New oscillation criteria are obtained which improve, extend, and simplify the existing ones in other previous works. Some examples are also given to illustrate the validity and potentiality of our results.

In chemical graph theory, benzenoid systems are interrogated as they exhibit the chemical compounds known as benzenoid hydrocarbons. Benzenoid schemes are circumscribed as planar connected finite graphs having no cut vertices wherein the entire internal sections are collaboratively congruent regular hexagon. The past couple of decennium has acknowledged an extravagant development regarding implementation of information theoretic framework in miscellaneous ramification of science, for instance, in social sciences, biological, physical, and engineering. Explicitly, this tremendous improvement has been outstanding in the field of soft computing, molecular biology, and information technology. The information theory, delineated by Claud Shannon, has no less importance when it was considered. Shannon put forwarded the apprehension of entropy to enumerate upper bounds in transmission rates in telephonic channels, in optical communication, and in wireless. The prestigious feature of entropy is that it entitles the amount of uncertainty in a system. The substantial participation of this paper is to explore characteristics of graph entropies and then keep moving forward to talk about the formation of coronoid polycyclic aromatic hydrocarbons. Likewise, we estimate entropies through precise topological indices established on degree of terminal nodes.

This work addresses 3D bioconvective viscoelastic nanofluid flow across a heated Riga surface with nonlinear radiation, swimming microorganisms, and nanoparticles. The nanoparticles are tested with zero (passive) and nonzero (active) mass flux states along with the effect of thermophoresis and Brownian motion. The physical system is visualized via high linearity PDE systems and nondimensionalized to high linearity ordinary differential systems. The converted ordinary differential systems are solved with the aid of the homotopy analytic method (HAM). Several valuable and appropriate characteristics of related profiles are presented graphically and discussed in detail. Results of interest such as the modified Hartmann number, mixed convection parameter, bioconvection Rayleigh number, and Brownian motion parameter are discussed in terms of various profiles. The numerical coding is validated with earlier reports, and excellent agreement is observed. The microorganisms are utilized to improve the thermal conductivity of nanofluid, and this mechanism has more utilization in the oil refinery process.

The Black-Scholes model is well known for determining the behavior of capital asset pricing models in the finance sector. The present article deals with the Black-Scholes model via the Caputo fractional derivative and Atangana-Baleanu fractional derivative operator in the Caputo sense, respectively. The Jafari transform is merged with the Adomian decomposition method and new iterative transform method. It is worth mentioning that the Jafari transform is the unification of several existing transforms. Besides that, the convergence and uniqueness results are carried out for the aforesaid model. In mathematical terms, the variety of equations and their solutions have been discovered and identified with various novel features of the projected model. To provide additional context for these ideas, numerous sorts of illustrations and tabulations are presented. The precision and efficacy of the proposed technique suggest its applicability for a variety of nonlinear evolutionary problems.

In this paper, a novel analytical method for solving nonlinear partial differential equations is studied. This method is known as triple Laplace transform decomposition method. This method is generalized in the sense of conformable derivative. Important results and theorems concerning this method are discussed. A new algorithm is proposed to solve linear and nonlinear partial differential equations in three dimensions. Moreover, some examples are provided to verify the performance of the proposed algorithm. This method presents a wide applicability to solve nonlinear partial differential equations in the sense of conformable derivative.

In this paper, a new class of a neutral functional delay differential equation involving the generalized ψ-Caputo derivative is investigated on a partially ordered Banach space. The existence and uniqueness results to the given boundary value problem are established with the help of the Dhage’s technique and Banach contraction principle. Also, we prove other existence criteria by means of the topological degree method. Finally, Ulam-Hyers type stability and its generalized version are studied. Two illustrative examples are presented to demonstrate the validity of our obtained results.

In this paper, we find the second variational formula for a generalized Sasakian space form admitting a semisymmetric metric connection. Inequalities regarding the stability criteria of a compact generalized Sasakian space form admitting a semisymmetric metric connection are established.

The present study evaluated subjective and objective cognitive measures as predictors of fluid intelligence in healthy older adults. We hypothesized that objective cognitive measures would predict fluid intelligence to a greater degree than self-reported cognitive functioning. Ninety-three healthy older (>65 years old) community-dwelling adults participated. Raven’s Advanced Progressive Matrices (RAPM) were used to measure fluid intelligence, Digit Span Sequencing (DSS) was used to measure working memory, Trail Making Test (TMT) was used to measure cognitive flexibility, Design Fluency Test (DFT) was used to measure creativity, and Tower Test (TT) was used to measure planning. The Cognitive Failures Questionnaire (CFQ) was used to measure subjective perceptions of cognitive functioning. RAPM was correlated with DSS, TT, and DFT. When CFQ was the only predictor, the regression model predicting fluid intelligence was not significant. When DSS, TMT, DFT, and TT were included in the model, there was a significant change in the model and the final model was also significant, with DFT as the only significant predictor. The model accounted for approximately 20% of the variability in fluid intelligence. Our findings suggest that the most reliable means of assessing fluid intelligence is to assess it directly.