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A significant number of causes for people killed by automobile accidents on both public and interior roads are the driver's failure to pay attention to the roadway, as well as other factors such as tiredness, sleep during driving, using the phone, or even the driver being intoxicated, etc. This work aims to identify sleepy status, pinpoint the onset of sleep, and alert the driver when their level of alertness drops below a level that does not improve productivity or the vehicle's overall safety protocols to prevent drowsiness-related crashes. In this article, we present a new method for implementing drowsiness detection inexpensively, using a Raspberry Pi as a central processor board that connects all practical measurement components. In addition, the proposed method includes the following activities: tracking the driver's head vibration while driving using tilt sensors. Moreover, a camera was mounted in front of the driver to take photos and record videos of the driver's health. As a result, the results were entirely satisfactory, and if the driver was operating the vehicle while fatigued, the response was 95% reliable and fast.

Purpose: This paper presents a multi-criteria assessment methodology to evaluate the remanufacturability of converting conventional surface grinding machines into CNC machine tools. Methodology: Conventional surface grinding machines remanufactured into CNC machine tools were analyzed and classified into five remanufacturing alternatives. A multi-criteria assessment model incorporating cost, time, accuracy, reliability, processing shape complexity, and ergonomics was developed. The importance of criteria and performance of alternatives were weighted through machine tool remanufacturing experience analysis and comparative literature review. Results: The Remanufacturability Index (RI) for remanufactured conventional surface grinding machines ranges from 0.637 to 0.999 based on the level of CNC upgrades from 2-axis to 5-axis configurations. Higher-axis remanufactured machines showed greater feasibility. Theoretical Contribution: This study provides a quantitative methodology to assess the technical, economic, and environmental feasibility of remanufacturing conventional machines into CNC machine tools. It extends the application of multi-criteria decision making to the field of machine tool remanufacturing. Practical Implications: The proposed methodology can guide small and medium-sized manufacturers in making decisions to upgrade their conventional machines to CNC through remanufacturing. It helps evaluate the benefits and risks of different upgrade configurations to support the implementation of machine tool remanufacturing in practice. Sustainable Development Goals (SDGs): SDG 9: Industry, Innovation and Infrastructure; SDG 12: Responsible Consumption and Production; SDG 8: Decent Work and Economic Growth; SDG 13: Climate Action; SDG 4: Quality Education

Tricuspid regurgitation (TR) is the most common pathology for the tricuspid valve. Moderate to severe TR is associated with morbidity and adverse outcomes. The concept that TR resolves on its own if the underlying disease is successfully treated has proven to be false. Only a few patients with significant TR are deemed suitable for surgery. Given the late presentation of patients with high perioperative risks and substantial perioperative mortality, the development of transcatheter therapies and the experience gained with transcatheter aortic valve implantation operations have turned attention towards treating this challenging group of patients. In this article, we review the treatment options and highlight the role of transcatheter valve therapies in patients with severe TR.

In this paper, the effect of ultrasonic peening surface treatment on the mechanical properties of TIG butt weld joints of low-carbon steel (AISI 1020) was studied. A single V-angle ( 45 °) was made on sheets of metal used then welded at constant parameters, namely: current, voltage. Wire filler ER70S-3 with argon was used to obtain many butt welding joints. Some of them were subjected to ultrasonic peening at one, two and three passes. The micro-hardness, microstructure, tensile and bending were tested. The results show increases in the tensile strength after the welding process. The test results showed improvements in the tensile strength of the weldments in comparison to the base metal. On the other hand, the tensile strength decreased with the ultrasonic process. Nevertheless, the tensile strength increased at a high number of ultrasonic passes. On the contrary, the ultrasonic process enhanced the bending strength compared to the base metal, whereas the weldments ability to bend deteriorated.

Copyright of Kufa Journal of Engineering is the property of Republic of Iraq Ministry of Higher Education & Scientific Research (MOHESR) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: This paper presents a multicriteria assessment methodology to evaluate the remanufacturability of converting conventional surface grinding machines into CNC machine tools. Methodology: Conventional surface grinding machines remanufactured into CNC machine tools were analyzed and classified into five remanufacturing alternatives. A multi-criteria assessment model incorporating cost, time, accuracy, reliability, processing shape complexity, and ergonomics was developed. The importance of criteria and performance of alternatives were weighted through machine tool remanufacturing experience analysis and comparative literature review. Results: The Remanufacturability Index (RI) for remanufactured conventional surface grinding machines ranges from 0.637 to 0.999 based on the level of CNC upgrades from 2-axis to 5-axis configurations. Higher-axis remanufactured machines showed greater feasibility. Theoretical Contribution: This study provides a quantitative methodology to assess the technical, economic, and environmental feasibility of remanufacturing conventional machines into CNC machine tools. It extends the application of multicriteria decision making to the field of machine tool remanufacturing. Practical Implications: The proposed methodology can guide small and medium-sized manufacturers in making decisions to upgrade their conventional machines to CNC through remanufacturing. It helps evaluate the benefits and risks of different upgrade configurations to support the implementation of machine tool remanufacturing in practice. [ABSTRACT FROM AUTHOR]

The relationship between left atrial enlargement (LAE) and primary cryptogenic stroke (PCS) remains a mystery. LAE has been proposed to be an independent risk factor of PCS, recurrent ischemic strokes, paroxysmal atrial fibrillation, and thromboembolism. Our study evaluates the prevalence of LAE among patients with PCS in the absence of atrial fibrillation, unlike previous studies that included atrial fibrillation, in order to isolate LAE as a risk factor. We hypothesize there is a direct correlation between the prevalence of LAE and the incidence of PCS. Our multi-center, retrospective, cross-sectional study constructed a database of 646 patients identified with a diagnosis of cerebral infarction over a three-year period. Detailed chart review excluded all patients with known etiologies for stroke, including atrial fibrillation, atrial flutter, prior stroke, systolic heart failure, carotid artery stenosis, patent foramen ovale, thromboembolic disease, previous anticoagulation, or an active cancer diagnosis. Diagnosis of LAE utilized a composite of criteria for transthoracic echocardiogram measurements, including left atrial diameter (LAD) and left atrial volume index (LAVI). All study criteria were met by 154 patients (24%) for analysis, where baseline characteristics included: 79 (51%) male, 104 (67.5%) Caucasian ethnicity, 108 (70%) diagnosed of hypertension (HTN), 80 (52%) previous or current tobacco users, and 47 (31%) diagnosed of diabetes (DM). We utilized logistic regression modeling to examine correlations in our population. Our preliminary analysis found that 74 (48%) patients met at least one criterion for LAE. The mean LAD for patients with and without LAE was 4.1 cm and 3.4 cm, respectively (SD 0.87 vs 0.55, p<0.0001). The mean LAVI for patients with and without LAE was 29.68 mL/m 2 and 18.44 mL/m 2 , respectively (SD 7.37 vs 5.13, p<0.0001). Our findings support the significance of LAE as a risk factor for cases of PCS. Multiple risk factors were identified in our study population that reflect the importance of preventative counseling for patients with HTN, hyperlipidemia, history of tobacco use, and DM. Routine screening for LAE in patients who suffer a PCS will encourage additional research that may elucidate the clinical relevance of identifying LAE in PCS. For example, whether LAE alone or in the setting of specific comorbidities warrants universal screening practices such as closer monitoring of arrhythmias such as paroxysmal atrial fibrillation to initiate anticoagulation earlier. Additionally, randomized control trials are necessary to determine whether prophylactic anticoagulation reduces future stroke risk among patients identified with LAE., Competing Interests: Human subjects: All authors have confirmed that this study did not involve human participants or tissue. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Rashid et al.)

Background: Ventral hernias are a common but heterogeneous disease. Communication among key stakeholders (eg, patients, clinicians, administrators, payers, and researchers) can be augmented by a widely utilized classification system. The European Hernia Society (EHS) developed an expert-opinion-based hernia classification system organized by hernia type (primary versus incisional) and size. We sought to assess what components of the EHS ventral hernia classification system were correlated to real-world clinical outcomes., Methods: This was a multicenter cohort study. All hospitals contributing to the database were affiliated with 1 of 6 academic institutions. All adult patients who underwent ventral hernia repair over a 4-year period were included. The primary endpoint was adverse events defined as any major (deep or organ space) surgical site infection (SSI), abdominal reoperation, or hernia recurrence. Utilizing a multivariable Cox regression, factors associated with adverse events were identified. Accuracy was assessed using Harrell's C concordance statistic., Results: Of the 2385 patients who underwent repair of ventral hernias (primary n = 810, 34.0% and incisional n = 1575, 66%), with a median follow-up of 11.1 months, 27.5% suffered adverse events including major SSIs (5.7%), hernia recurrences (12.1%), and abdominal reoperations (9.7%). In the overall cohort and the primary ventral hernia subgroup, all hernia-specific variables were associated with adverse events. American Society of Anesthesiologist score, low albumin, and prior SSI were associated with adverse events in the overall cohort and primary ventral hernia subgroup while surgical approach was associated with adverse events in the overall cohort and incisional ventral hernia subgroup. On multivariable Cox regression analyses, incisional ventral hernia and larger hernia width were independently associated with adverse events., Conclusion: Hernia size and type (primary versus incisional) from the EHS ventral hernia classification system were associated with clinical outcomes. Additional factors, including patient and operative factors, also impact outcomes. Our model allows key stakeholders to communicate more clearly regarding the challenges and outcomes of various patients with diverse ventral hernias., Competing Interests: Conflicts of Interest: The authors declare they have no conflicts of interest., (© 2024 HCA Physician Services, Inc. d/b/a Emerald Medical Education.)

Background: Communication with stakeholders for a graduate medical education (GME) program depends on shared visual and written content. Residency training programs are embracing social media as a communication channel. However, curated information that may only be viewed by subscribers or followers is difficult to archive and may appear overwhelming to novice users. An electronic, printable newsletter may be a unique communication tool for training programs to share information among residents, faculty, and hospital administration., Methods: We published a monthly electronic newsletter sent to all residents, teaching faculty, and additional stakeholders in our internal medicine residency program. We conducted an electronic anonymous survey and sent it to all residents in February 2023 and January 2024. The survey consisted of 5 questions to assess the satisfaction level of the newsletter., Results: Sixty of 232 (25.9%) residents completed the survey. Of those, 44 (73.3%) residents were very satisfied regarding overall satisfaction, 39 (65.0%) residents were very satisfied with the overall content, and 42 (70.0%) residents were very satisfied with the timeliness of the information presented. Thirty-six (60%) residents reported the importance of having a resident-led newsletter., Conclusion: We found an overall high satisfaction level in a resident-led newsletter based on a survey completed by residents within our program. Most survey respondents deemed resident leadership crucial for the newsletter. We also received strong positive feedback from key stakeholders ranging from hospital administration to residency applicants., Competing Interests: Conflicts of Interest: Dr Raghavan reports consulting fees from GSK Lupus Educators Network., (© 2024 HCA Physician Services, Inc. d/b/a Emerald Medical Education.)

Background: Many abdominal-pelvic surgeries utilize incisions not along the linea alba, such as transverse, laparoscopic, ostomy reversal, or ostomy formation incisions. The prevalence of ventral incisional hernias (VIH) at these sites and the efficacy of prophylactic mesh in preventing VIH remains unclear., Methods: PubMed, Embase, Scopus, and Cochrane databases were systematically reviewed from inception to September 2022. We included published randomized controlled trials (RCTs) that compared prophylactic mesh reinforcement versus no mesh. The primary outcome was the incidence of VIH at postoperative follow-up equal to or greater than 24 months. Secondary outcomes included surgical site infection (SSI) and surgical site occurrence (SSO)., Results: Of 3186 screened articles, only 3 RCTs with at least an 80% 2-year follow-up, encompassing a total of 901 patients, were included for analysis of non-midline VIH. Fifteen additional RCTs were included for analysis of secondary outcomes. The rate of parastomal hernias with prophylactic mesh was 21%, while it ranged from 44%-64% in the control group. The rate of incisional hernia after ostomy reversal with prophylactic mesh was 10%, and 16% in the control group. No clear evidence of a difference was found in rates of SSI or SSO between groups., Conclusion: There is limited evidence on the role of prophylactic mesh in preventing non-midline VIH. More studies at low risk for bias are needed to elucidate the balance of the long-term risks and benefits of prophylactic mesh for non-midline incisions., Competing Interests: Conflicts of Interest: The authors declare they have no conflicts of interest., (© 2024 HCA Physician Services, Inc. d/b/a Emerald Medical Education.)

Acute renal infarction is a rare condition that can progress to renovascular hypertension, chronic kidney disease, and end-stage kidney disease, depending on the severity. We present a case of a 30-year-old man with no significant past medical history who presented with sudden onset right flank pain. Initially pyelonephritis was suspected but it was later found to be acute renal infarction secondary to cardioemboli from atrial fibrillation., (Copyright © 2022 Baylor University Medical Center.)

Taraxacum officinale has been used in Jordan folk medicine to treat male infertility. A recent study has proved a contradictory effect of the whole plant aqueous extract. The aim of the current study was to determine if the leaves of T. officinale have similar anti-fertility activities, and whether this effect is mediated through the regulation of spermatogonial stem cells (SSCs). Fifty adult male rats were divided into five groups. Two groups were gavaged with 1/10 of LD50 of T. officinale whole plant (1.06 g kg(-1) body weight) or leaves (2.30 g kg(-1) body weight) aqueous extract; while two groups were gavaged with 1/20 of LD50 of T. officinale whole plant (2.13 g kg(-1)) or leaves (4.60 g kg(-1)) extract. The control group received distilled water. Oral administration of T. officinale (whole plant and leaves aqueous extract) caused a significant decrease in testis and seminal vesicle weight, a reduction in serum testosterone concentration, impaired sperm parameters, and a decrease in pregnancy parameters. Testicular histology of treated rats showed structural changes such as hypoplasia of germ cells, reduction in the thickness of germinal epithelium, arrest of spermatogenesis at spermatid stage (late maturation arrest) and reduction in the number of Leydig cells. Gene expression levels of two SSCs markers (GFRα1 and CSF1) responsible for self-renewal were relatively counter-balanced. In conclusion, T. officinale whole plant and leaves aqueous extracts changed the gene expression of two SSCs markers leading to the imbalance between spermatogonia self-renewal and differentiation causing late maturation arrest.