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Abstract Background Soft tissue sarcomas (STS), have significant inter- and intra-tumoral heterogeneity, with poor response to standard neoadjuvant radiotherapy (RT). Achieving a favorable pathologic response (FPR ≥ 95%) from RT is associated with improved patient outcome. Genomic adjusted radiation dose (GARD), a radiation-specific metric that quantifies the expected RT treatment effect as a function of tumor dose and genomics, proposed that STS is significantly underdosed. STS have significant radiomic heterogeneity, where radiomic habitats can delineate regions of intra-tumoral hypoxia and radioresistance. We designed a novel clinical trial, Habitat Escalated Adaptive Therapy (HEAT), utilizing radiomic habitats to identify areas of radioresistance within the tumor and targeting them with GARD-optimized doses, to improve FPR in high-grade STS. Methods Phase 2 non-randomized single-arm clinical trial includes non-metastatic, resectable high-grade STS patients. Pre-treatment multiparametric MRIs (mpMRI) delineate three distinct intra-tumoral habitats based on apparent diffusion coefficient (ADC) and dynamic contrast enhanced (DCE) sequences. GARD estimates that simultaneous integrated boost (SIB) doses of 70 and 60 Gy in 25 fractions to the highest and intermediate radioresistant habitats, while the remaining volume receives standard 50 Gy, would lead to a > 3 fold FPR increase to 24%. Pre-treatment CT guided biopsies of each habitat along with clip placement will be performed for pathologic evaluation, future genomic studies, and response assessment. An mpMRI taken between weeks two and three of treatment will be used for biological plan adaptation to account for tumor response, in addition to an mpMRI after the completion of radiotherapy in addition to pathologic response, toxicity, radiomic response, disease control, and survival will be evaluated as secondary endpoints. Furthermore, liquid biopsy will be performed with mpMRI for future ancillary studies. Discussion This is the first clinical trial to test a novel genomic-based RT dose optimization (GARD) and to utilize radiomic habitats to identify and target radioresistance regions, as a strategy to improve the outcome of RT-treated STS patients. Its success could usher in a new phase in radiation oncology, integrating genomic and radiomic insights into clinical practice and trial designs, and may reveal new radiomic and genomic biomarkers, refining personalized treatment strategies for STS. Trial registration NCT05301283. Trial status The trial started recruitment on March 17, 2022.

Background: Coronary Artery Disease (CAD) is a complex interaction of genetic and multifactorial environmental factors. This study was conducted to evaluate the association of blood groups with the severity of coronary artery lesions in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention (PCI). Methods: This descriptive cross-sectional study was conducted at a tertiary cardiac care center in Karachi, Pakistan. Consecutive adult patients of either gender diagnosed with ST-segment elevation myocardial infarction (STEMI) undergone primary PCI during the study period of November 2020 to February 2021 were included. Based on blood grouping patients were stratified into two groups, non-O and O. comparative analysis of clinical and angiographic findings was performed and Chi-square test was used with p-value ≤ 0.05 was considered statistically significant. Results: A total of 398 patients were included in this study out of which 296(74.4%) were males (mean age: 57.15±10.95 years) and 102(25.6%) females. Type O blood group distribution was 107(26.9%) and non-O blood groups were 291(73.1%). The non-O blood group included A=110(27.6%), AB=43(10.8%), and B=138(34.7%). Significant results in type O and non-O group were seen among single vessel diseases (41.1%, 29.6%) (p=0.029) and circumflex artery as culprit (16.8%,9.6%) (p=0.046), whereas in post-procedure complication no significant results were found (p=0.554) with in-hospital mortality rate (p=0.642). Conclusion: Blood group type O was found to be associated with single-vessel coronary artery diseases. However, no association of blood groups was observed with lesion complexity, post-procedure complications and mortality. Keywords: Ischemic Heart Diseases; Coronary Artery Diseases; Myocardial Infarction; Blood Group.

Abstract Background Orbital cellulitis is common in young children and is often secondary to coexisting sinus disease. Coexisting orbital cellulitis and panophthalmitis is a rare clinical event and usually occurs secondary to trauma or from an endogenous source. Case presentation A febrile 2-year-old male presented with periorbital inflammation and exudative retinal detachment. Imaging showed acute sinusitis and extensive orbital cellulitis. Because of progressive scleral thinning, the patient underwent enucleation. Conclusion We present a case of concurrent orbital cellulitis, panophthalmitis, and scleral necrosis in an immunocompetent pediatric patient. Timely intervention is important to prevent life threatening complications with the rare occurrence of coexistent orbital cellulitis and panophthalmitis.

Abstract Background The coronavirus disease 2019 (COVID-19) pandemic has transformed the global view of education, including graduate and postgraduate education making the development of an alternative approach in times of social isolation an academic imperative. The present review aims to investigate the challenges experienced among undergraduate and postgraduate education and the strategies adopted to address these challenges during the pandemic. Method The preferred reporting items for the systematic review and meta-analyses extension for Scoping Reviews (PRISMA-ScR) were followed. The aim was to include journal articles published in the English language that discussed the influence of the pandemic on educational processes and applied innovative approaches as a solution to educational challenges. From January to August 2020, PubMed, EMBASE, and Google Scholar were searched for articles, yielding 10,019 articles. Two groups of authors examined the retrieved articles separately to avoid any risk of bias. The title and abstract of the articles were used for scrutiny, followed by full-text screening based on the established inclusion and exclusion criteria. The facts and findings of the studies were also discussed based on per capita income, literacy rate, and Internet accessibility. Results Thirty of the obtained articles were included in the study. The selected articles were from North and South/Latin America, Asia & Pacific, South Africa, and Europe regions. Nineteen of the selected articles dealt with undergraduate education, ten with postgraduate, and one with both groups. The affordability of digital devices and the availability of Internet services were the major challenges for low- and middle-income economies. The ZOOM platform has been adopted by more than 90% of the education systems. Conclusion Means of communication, including visual media, digitized content, and other web-based platforms, have been recognized as efficient learning and training tools, but have not been fully accessible for mass application and use due to the lack of availability of resources, their cost, and insufficient training among the users. In light of this review, it is suggested that harmonized and collaborative efforts should be made to develop cost-effective and user-friendly tools to overcome the current challenges and prevent future educational crises. Systemic review registration The review was not registered.

Urinary tract infection (UTI) is a common condition defined as the presence of bacteria within the urine above a certain threshold (usually >100,000 m/L). The lifetime risk in women is estimated to be 50%, of whom 25% will develop recurrence within 6 months. Unfortunately, the use of antibiotics to treat and manage recurrent UTI (rUTI) is a growing problem, due to the burden of growing antibiotic resistance on public health. As such, new approaches to manage rUTI are being investigated and developed. Competitive inoculation via instillation of Escherichia coli 83972 or HU2117 in the bladder is a new prophylactic non-antimicrobial therapy for rUTIs. It utilizes the principle of the protective nature of asymptomatic bacteriuria to prevent recurrence of symptomatic UTIs. However, the effectiveness and safety of this technique remains unclear. This systematic review examined the current outcomes data on competitive inoculation as an effective and safe treatment for rUTI prophylaxis. Based on a limited number of studies, current evidence suggests that competitive inoculation is an effective and safe prophylactic measure against UTIs in a select group of patients with incomplete bladder emptying. However, administration of the technology is both resource and time intensive, and there is strong data demonstrating low successful colonisation rates. Competitive inoculation is an alternative to antibiotics only to rUTI patients with incomplete bladder emptying. There is no evidence to suggest that the technology would be suitable for other subsets of rUTI patients. Further randomized controlled trials should be conducted to improve the evidence base before drawing conclusions for clinical practice, and ideas to improve colonisation rates and simplify the administration process should be explored.

Background: Patients with unmet healthcare needs are more likely to access unscheduled care. Identifying these patients through data-driven and clinical risk stratification for active case management in primary care can help address patient need and reduce demand on acute services. Aim: To determine how a proactive digital healthcare system can be used to undertake comprehensive needs analysis of patients at risk of unplanned admission and mortality. Design & setting: Prospective cohort study of six general practices in a deprived UK city. Method: To identify those with unmet needs, the study’s population underwent digitally-driven risk stratification into Escalated and Non-escalated groups using seven risk factors. The Escalated group underwent further stratification using GP clinical assessment into Concern and No concern groups. The Concern group underwent Unmet Needs Analysis (UNA). Results: From 24 746 patients, 516 (2.1%) were triaged into the Concern group and 164 (0.7%) underwent UNA. These patients were more likely to be older (t = 4.69, P

The growing demand for fuel-efficient, lightweight and lower CO2 emissions is led to the development of lightweight materials. Aluminium metal and its various alloys are extensively used in many structural applications, due to its specific properties including a high strength-to-weight ratio and comparatively good mechanical properties in comparison to the other metals and alloys. The mechanical properties of aluminium alloys can further be improved when they are used to fabricate metal matrix composites (MMCs). Various nano additives such as ceramics nanoparticles are regarded as promising nano reinforcement for aluminium-based MMC (AMMC), due to their various attractive properties such as high fracture strength and low weight. Herein, we comprehensively surveyed aluminium 7075 alloy-based MMC reinforced with various nanoparticles (organic and inorganic) manufactured through various processes and their influences are outlined on mechanical and tribological properties by highlighting outstanding results of recently published studies. To date, various fabrication techniques have been extensively used to exploit the full potential of nanoparticles. It was found that the stir casting technique with usually ceramic nanoparticles significantly improved the mechanical properties of aluminium 7075-based MMC from an aerospace sector perspective. This review also elucidates some current challenges and provides a complete framework for future research in the proposed field.

Persistent primitive hypoglossal artery (PPHA) is a highly uncommon abnormal connection between the internal carotid artery (ICA) and vertebral artery (VA), with reported incidences ranging from 0.027 to 0.26%. Attempting endovascular intervention in such cases presents a considerable challenge as it carries a higher risk of embolization and other procedure-related complications that may affect a wide area of the brain. We present a case study involving the utilization of mechanical thrombectomy (MT) to treat an ischemic stroke in the M1 segment of the middle cerebral artery (MCA) despite the presence of PPHA. Performing mechanical thrombectomy in an anomalous vascular connection is feasible; however, it necessitates heightened vigilance, thorough knowledge of the anatomy, and utmost caution.

Introduction: Slow flow/no reflow (SF/NR) phenomenon during emergency percutaneous revascularization is a feared complication associated with increased risk of adverse outcomes.CHA2DS2-VASc score has been proposed for the risk stratification but a very limited evidences are available regarding the accuracy of this system. Therefore, we conducted this study to assess the predictive value of -VASc score for predicting SF/NR phenomenon during primary percutaneous coronary intervention (PCI). Methods: This analytical cross-sectional study included 596 consecutive patients undergoing PCI for STEMI at a tertiary care cardiac center of Karachi, Pakistan. Baseline -VASc sore was calculated and development of SF/NR phenomenon during primary PCI was recorded. Predictive value of the score was assessed through area under the curve (AUC) of receiver operating characteristic curve analysis and sensitivity and specificity were computed. Logistic regression analysis was performed to assess the predictive strength of the score. Results: A total of 596 patients were included, mean age was 56.28±11.44 years, and75.7%(451) were male. The slow/no reflow phenomenon during the procedure was observed in36.6%(218) of the patients. -VASc≥2 was observed in 50.2%(299) of the patients. The CHA2DS2-VASc score was significantly higher in SF/NR patients, 2.06±1.25 vs. 1.37±1.33; P

This article gives a numerical study of tangent hyperbolic nanofluid flow across an exponentially stretched sheet by considering two heat transfer situations: prescribed exponential order surface temperature (PEST) and prescribed exponential order heat flux (PEHF). Tangent hyperbolic nanofluid is being used extensively in the cooling of electronic components, which generate a lot of heat during operation. The improved thermal conductivity of tangent hyperbolic nanofluids can help to dissipate the heat more effectively, reducing the risk of overheating and component failure. A mathematical model of the problem is based on conservation laws of momentum, mass, and energy. The governing system of nonlinear PDEs is transformed into a system of nonlinear ODEs using appropriate similarity transformations. MATLAB's bvp4c tool was utilised to address the converted system of modelled equations. The drag coefficient, heat transfer, and mass transfer rate values are tabulated. It is observed that both the magnetic parameter (M) and Weissenberg number (We) causes to reduce the boundary layer. It is also noticed that increasing the Brownian motion parameter (Nb) and the thermophoresis parameter (Nt) leads the temperature θ(η) and concentration profile g(η) to increase for both cases of heat transfer i.e., PEST and PEHF.

Objective Knowledge regarding the short-term outcomes after same-day discharge (SDD) post primary percutaneous coronary intervention (PCI) is lacking. In this study, we evaluated 1-year major adverse cardiovascular events (MACE) among SDD patients after primary PCI.Design 1-year follow-up analysis of a subset of patients from an existing prospective cohort study.Setting Tertiary care cardiac hospital in Karachi, Pakistan.Participants Consecutive patients, from August 2019 to July 2020, with ST segment elevation myocardial infarction who had undergone primary PCI with SDD (within 24 hours) after the procedure by the treating physician and with at least one successful follow-up up to 1 year.Outcome measure Cumulative MACE during follow-up at the intervals of 1 week, 1 month, 6 months and 1 year.Results 489 patients were included, with a gender distribution of 83.2% (407) male patients and a mean age of 54.58±10.85 years. Overall MACE rate during the mean follow-up duration of 326.98±76.71 days was 10.8% (53), out of which 26.4% (14/53) events occurred within 6 months of discharge and the remaining 73.6% (39/53) occurred between 6 months and 1 year. MACE was significantly higher among patients with a Zwolle Risk Score (ZRS) ≥4 at baseline, with an incidence rate of 21.9% (16/73) vs 8.9% (37/416; p=0.001) in patients with ZRS≤3 (relative risk 2.88 (95% CI 1.5 to 5.5)).Conclusion A significant burden of short-term MACE was identified among SDD patients after primary PCI; most of these events occurred after 6 months of SDD, mainly among patients with ZRS≥4. A systematic risk assessment based on risk stratification modalities such ZRS could be a viable option for SDD patients with primary PCI.

BackgroundThe mental wellbeing implications of a prostate cancer diagnosis are increasingly being realised. Significant mental health symptoms such as depression and anxiety, along with related constructs such as fear of cancer recurrence, body image and masculine self-esteem issues are prevalent. However, less is understood about potential prognostic factors for these outcomes in prostate cancer patients. Therefore, this study aims to primarily explore potential treatment, patient and oncological factors associated with mental wellbeing outcomes in the initial prostate cancer follow-up period.MethodsMIND-P is a multi-institutional prospective cohort study recruiting newly diagnosed prostate cancer patients for 12-month follow up. It will aim to recruit a final sample of 300 participants undergoing one of four treatment options: active surveillance, radical prostatectomy, radical radiotherapy, or hormone monotherapy. Questionnaire-based data collection consists of multiple validated mental, physical, and social wellbeing outcomes at baseline and 3-monthly intervals until study completion. Primary analysis will include evaluation of treatment undergone against multiple mental wellbeing outcomes. Secondary analysis will additionally explore multiple patient and oncological prognostic factors of potential importance, along with the cumulative incidence of these outcomes, symptom trajectory and their association with subsequent functional and social outcomes.ConclusionThis cohort study aims to add to the existing limited literature evaluating significant prognostic factors for multiple mental wellbeing outcomes in newly diagnosed prostate cancer patients. This may be of potential use for guiding future prognosis research and of clinical use for identifying individuals potentially requiring additional surveillance or support during routine cancer follow up.Study registrationThis study was prospectively registered on ClinicalTrials.gov (NCT04647474).

This study aims to measure the entrepreneur's opinions towards their credit rating in Saudi Arabia. Credit rating plays a pivotal role in the financial market, especially its more significant impact on new startups from the micro and macro levels. On the other hand, the credit rating industry, in general, is in its infancy stage in the Saudi financial market. Therefore, a minor objective of this study is to present the problems and prospects of entrepreneurs towards their credit rating. The study has adopted the questionnaire from earlier research on credit rating. A sample of 210 respondents participated in this survey comprising entrepreneurs, business incubation managers, bankers, university professors, engineers, doctors, and other professionals. Descriptive statistics and Exploratory Factor Analyses were used to analyze the data. Findings show there are five essential factors affecting credit rating in Saudi Arabia, i.e., (1) Credibility, (2) Clarity, (3) Competence, (4) Communications, and (5) Customer Services. The research provides valuable insights into the credit rating business and recommends that CRAs in Saudi Arabia and elsewhere improve upon these five factors to strengthen their business.

Abstract Background Significance of total ischemic time (TIT) in the context of ST-segment elevation myocardial infarction (STEMI) is still controversial. Therefore, in this study, we have evaluate the association of TIT with immediate outcomes in STEMI patients in whom recommended door to balloon (DTB) time of less than 90 min was achieved. Results A total of 5730 patients were included in this study, out of which 80.9% were male and median age was 55 [61–48] years. The median DTB was observed to be 60 [75–45] min and onset of chest pain to emergency room (ER) arrival time was 180 [300–120] min. Prolonged TIT was associated with poor pre-procedure thrombolysis in myocardial infarction (TIMI) flow grade (p = 0.022), number of diseased vessels (p = 0.002), use of intra-aortic balloon pump (p = 0.003), and in-hospital mortality (p = 0.002). Mortality rate was 4.5%, 5.7%, and 7.8% for the patients with TIT of ≤ 120 min, 121 to 240 min, and > 240 min, respectively. Thirty days’ risk of mortality on TIMI score was 4.97 ± 7.09%, 5.01 ± 6.99%, and 7.12 ± 8.64% for the patients with TIT of ≤ 120 min, 121 to 240 min, and > 240 min, respectively. Conclusions Prolonged total ischemic was associated with higher in-hospital mortality. Therefore, TIT can also be considered in the matrix of focus, along with DTB time and other clinical determinants to improve the survival from STEMI.

The study is based on using SeDeM expert system in developing controlled-release tramadol HCl osmotic tablets and its in-silico physiologically based pharmacokinetic (PBPK) modeling for in-vivo pharmacokinetic evaluation. A Quality by Design (QbD) based approach in developing SeDEM-driven full factorial osmotic drug delivery was applied. A 24 Full-factorial design was used to make the trial formulations of tramadol HCl osmotic tablets using NaCl as osmogen, Methocel K4M as rate controlling polymer, and avicel pH 101 as diluent. The preformulation characteristics of formulations (F1-F16) were determined by applying SeDeM Expert Tool. The formulation was optimized followed by in-vivo predictive pharmacokinetic assessment using PBPK “ACAT” model of GastroPlus™. The FTIR results showed no interaction among the ingredients. The index of good compressibility (ICG) values of all trial formulation blends were ≥5, suggesting direct compression is the best-suited method. Formulation F3 and F4 were optimized based on drug release at 2, 10, and 16 h with a zero-order kinetic release (r2 = 0.992 and 0.994). The SEM images confirmed micropores formation on the surface of the osmotic tablet after complete drug release. F3 and F4 were also stable (shelf life 29.41 and 23.46 months). The in vivo simulation of the pharmacokinetics of the PBPK in-silico model revealed excellent relative bioavailability of F3 and F4 with reference to tramadol HCl 50 mg IR formulations. The SeDeM expert tool was best utilized to evaluate the compression characteristics of selected formulation excipients and their blends for direct compression method in designing once-daily osmotically controlled-release tramadol HCl tablets. The in-silico GastroPlus™ PBPK modeling provided a thorough pharmacokinetic assessment of the optimized formulation as an alternative to tramadol HCl in vivo studies.

This investigation examines the Williamson nanofluid flow over an exponentially stretched surface with variable thickness. Cattaneo-Christov double diffusion (CCDD) heat flux model is applied while examining two cases of heat transfer, i.e., prescribed exponential surface temperature (PEST) and prescribed exponential heat flux (PEHF). A mathematical model of the problem based on momentum, mass, and energy conservation. The governing non-linear partial differential equation (PDEs) are converted into non-linear ordinary differential equations (ODEs) via similarity transformations. The velocity, temperature, and concentration profiles are obtained numerically.Additionally, the impacts of numerous physical parameters of engineering significance are visually depicted through graphs and tables. It is noted that by raising the thermal relaxation parameter γ1, the temperature profile decreases. When the concentration relaxation parameter γ2 rises, then the concentration distribution also decays. When the magnetic parameter M increases, then the velocity profile decreases. For the selected numeric values of the Prandtl number Pr, the temperature profile decreases for both PEST and PEHF cases.

Brain metastases are the most common form of brain cancer. Increasing knowledge of primary tumor biology, actionable molecular targets and continued improvements in systemic and radiotherapy regimens have helped improve survival but necessitate multidisciplinary collaboration between neurosurgical, medical and radiation oncologists. In this review, we will discuss the advances of targeted therapies to date and discuss findings of studies investigating the synergy between these therapies and stereotactic radiosurgery for non-small cell lung cancer, breast cancer, melanoma, and renal cell carcinoma brain metastases.

Objectives: No-reflow is a complication that frequently occurs after stenting during primary percutaneous coronary intervention. In this study, we focused on angiographic results and clinical outcomes after no-reflow in the left anterior descending (LAD) artery versus non–left anterior descending artery ST-elevation myocardial infarction (STEMI). Methods: In this prospective study, a total of 201 patients who had developed no-reflow during primary percutaneous coronary intervention were enrolled. The patients were divided into left anterior descending artery culprit and non-left anterior descending artery culprit groups. The primary endpoints were final thrombolysis in myocardial infarction flow, corrected thrombolysis in myocardial infarction frame count and final myocardial blush grade. Secondary endpoints were major adverse cardiovascular events in-hospital and at 1 month. Results: Out of the 201 patients, 60.19% had culprit left anterior descending artery. Pulse rate, baseline systolic and diastolic blood pressure, single-vessel disease, left ventricular ejection fraction 40% were significantly greater in the non–left anterior descending artery group. However, for both in-hospital and at 30 days, overall major adverse cardiovascular event was similar in the two groups. The demographics, clinical and medication profiles and the routes used to treat no-reflow were all comparable in both groups. Conclusions: No-reflow in left anterior descending artery ST-elevation myocardial infarction is associated with lower final thrombolysis in myocardial infarction III flow, higher thrombolysis in myocardial infarction frame count and relatively lower Grade III myocardial blush than non-left anterior descending artery ST-elevation myocardial infarction with subsequent lower left ventricular ejection fraction and a higher frequency of in-hospital heart failure and hospitalisation due to heart failure.

This work presents the application of both uniaxial and bi-axial in-plane loads to unidirectional carbon fiber reinforced polymer laminates using a newly developed Arcan fixture, which is a reliable experimental set-up to obtain a uniform shear stress field in a butterfly specimen. The set-up can be used for both damage model validation and parameters identification at various fiber orientations while using the same specimens. A sequential damage study was completed to highlight the influence of diffused damage induced in pure shear on the fiber direction tensile behavior of the laminate. This was accomplished by applying load on the specimens in two steps: (i) the pure shear step and then unloading at approximately 70% of the shear failure strength, (ii) in the tensile step until final failure. A clear drop in the tensile behavior of the laminate was observed by the diffused damage induced in the first loading step of pure shear. The experimental study is also supplemented with numerical simulations using a nonlinear elasto-plastic coupled damage constitutive law by employing Puck’s failure theory for mesodamage activation. In addition to the damage pattern, the non-linear mechanical behavior in shear is predicted and found in good correspondence with the experimental results.

Abstract Background Diseases Surveillance is a continuous process of data collection, analysis interpretation and dissemination of information for swift public health action. Recent advances in health informatics have led to the implementation of electronic tools to facilitate such critical disease surveillance processes. This study aimed to assess the performance of the national electronic Disease Early Warning System in Yemen (eDEWS) using system attributes: data quality, timeliness, stability, simplicity, predictive value positive, sensitivity, acceptability, flexibility, and representativeness, based on the Centres for Disease Control & Prevention (US CDC) standard indicators. Methods We performed a mixed methods study that occurred in two stages: first, the quantitative data was collected from weekly epidemiological bulletins from 2013 to 2017, all alerts of 2016, and annual eDEWS reports, and then the qualitative method using in-depth interviews was carried out in a convergent strategy. The CDC guideline used to describe the following system attributes: data quality (reporting, and completeness), timeliness, stability, simplicity, predictive value positive, sensitivity, acceptability, flexibility and representativeness. Results The finding of this assessment showed that eDEWS is a resilient and reliable system, and despite the conflict in Yemen, the system is still functioning and expanding. The response timeliness remains a challenge, since only 21% of all eDEWS alerts were verified within the first 24 h of detection in 2016. However, identified gaps did not affect the system’s ability to identify outbreaks in the current fragile situation. Findings show that eDEWS data is representative, since it covers the entire country. Although, eDEWS covers only 37% of all health facilities, this represents 83% of all functional health facilities in all 23 governorates and all 333 districts. Conclusion The quality and timeliness of responses are major challenges to eDEWS’ functionality, the eDEWS remains the only system that provides regular data on communicable diseases in Yemen. In particular, public health response timeliness needs improvement.

IntroductionQuality of life in prostate cancer survivorship is becoming increasingly important, with mental and social wellbeing recognised as key components. However, limited global evaluation of psychosocial challenges experienced after treatment exists. Therefore, we aimed to explore the lived experiences of men who underwent radical treatment, and its psychosocial impact.Material and methodsThis qualitative study was conducted using 19 men who had undergone radical treatment (prostatectomy or radiotherapy) for their cancer. Semi-structured interviews were conducted exploring lived experiences of men after treatment. A Structured thematic analysis of collected data was undertaken, with an inductive co-construction of themes through the lens of the biopsychosocial model. Themes generated were considered within a psychological, social, and physical wellbeing framework.ResultsAn initial knowledge gap meant mental wellbeing was strongly impacted initially leading to a 'Diagnostic Blow and the Search for Clarity'. Doubt over individuals' future resulted in 'An Uncertain Future' in many men. Once treatment was completed a 'Reflective journey' began, with men considering their outcomes and decisions made. Social wellbeing was also impacted with many identifying the 'Emotional Repercussions' on their relationships and the impact their diagnosis had on their partner and family. Many subsequently sought to increase their support through 'The Social Network and Advocacy', while physical changes led to an increased need for 'Social Planning'. Finally, physical wellbeing was highlighted by a continual acknowledgement of the 'Natural process of ageing' leading to a reluctancy to seek help, whilst simultaneously attempting to improve existing health via 'The Health Kick'.ConclusionsRadical treatments have a considerable impact on mental and social wellbeing of individuals. Anxiety after diagnosis and significant uncertainty over individual futures exist, with physical complications of treatment leading to social repercussions. Future research should aim to identify forms of support to improve quality of life of these men.

Purpose: To monitor intrafraction motion during spine stereotactic body radiotherapy(SBRT) treatment delivery with readily available technology, we implemented triggered kV imaging using the on-board imager(OBI) of a modern medical linear accelerator with an advanced imaging package. Methods: Triggered kV imaging for intrafraction motion management was tested with an anthropomorphic phantom and simulated spine SBRT treatments to the thoracic and lumbar spine. The vertebral bodies and spinous processes were contoured as the image guided radiotherapy(IGRT) structures specific to this technique. Upon each triggered kV image acquisition, 2D projections of the IGRT structures were automatically calculated and updated at arbitrary angles for display on the kV images. Various shifts/rotations were introduced in x, y, z, pitch, and yaw. Gantry-angle-based triggering was set to acquire kV images every 45°. A group of physicists/physicians(n = 10) participated in a survey to evaluate clinical efficiency and accuracy of clinical decisions on images containing various phantom shifts. This method was implemented clinically for treatment of 42 patients(94 fractions) with 15 second time-based triggering. Result: Phantom images revealed that IGRT structure accuracy and therefore utility of projected contours during triggered imaging improved with smaller CT slice thickness. Contouring vertebra superior and inferior to the treatment site was necessary to detect clinically relevant phantom rotation. From the survey, detectability was proportional to the shift size in all shift directions and inversely related to the CT slice thickness. Clinical implementation helped evaluate robustness of patient immobilization. Based on visual inspection of projected IGRT contours on planar kV images, appreciable intrafraction motion was detected in eleven fractions(11.7%). Discussion: Feasibility of triggered imaging for spine SBRT intrafraction motion management has been demonstrated in phantom experiments and implementation for patient treatments. This technique allows efficient, non-invasive monitoring of patient position using the OBI and patient anatomy as a direct visual guide.

Objectives: This study aimed to compare Mehran Risk Score (MRS) with three well -known scoring systems namely CHA2DS2-VASc score, Canada Acute Coronary Syndrome Risk Score (C-ACS), and Thrombolysis in Myocardial Infarction risk index (TRI) to predict the contrast-induced acute kidney injury (CI-AKI) after primary percutaneous coronary intervention (PCI). Background: CI-AKI is a common complication after primary PCI associated with an adverse prognosis. Methods: In this study consecutive patients of primary PCI were included. Patients with chronic kidney diseases, exposure to the contrast medium within the past 7 days, and Killip class IV at presentation were excluded. MRS along with three risk scores namely CHA2DS2-VASc, C-ACS, and TRI were calculated for all patients and CI-AKI was defined as either 0.5 mg/dL or 25% relative increase in post-procedure serum creatinine. The area under the curve (AUC) curve was reported. Results: Post primary PCI CI-AKI was observed in 63 (9.1%) patients out of 691 patients. The AUC was 0.745 [0.679–0.810] for MRS, 0.725 [0.662–0.788] for CHA2DS2-VASc, 0.671 [0.593–0.749] for C-ACS, and 0.734 [0.674–0.795] for TRI. Sensitivity and specificity were 61.9% [48.8–73.8%] and 76.0% [72.4–79.3%] for MRS ≥ 6.5, 66.7% [53.7–78.0%] and 66.7% [62.9–70.4%] for CHA2DS2-VASc ≥ 2, 52.4% [39.4–65.1%] and 79.9% [76.6–83.0%] for C-ACS ≥ 1, and 87.3% [76.5–94.4%] and 49.2% [45.2–53.2%] for TRI ≥ 16 respectively. Conclusions: The MRS has shown higher discriminating power than CHA2DS2-VASc, C-ACS, and TRI. However, the TRI can be of good value in clinical practice due to its simplicity and high sensitivity in detecting patients at higher risk of CI-AKI after primary PCI.

This study aims to investigate the flow of two-dimensional magnetohydrodynamics (MHD) Williamson nanofluid over the permeable exponential stretching curved surface with variable thermal conductivity and activation energy. The Navier Stokes Equation along with Williamson fluid model is used to govern the partial differential equations (PDEs) and to transfer these PDEs into ordinary differential equations (ODEs), appropriate similarity transformations are utilized. The obtained ODEs are solved numerically. The effect of the physical parameters that are Williamson fluid parameter, curvature parameter, permeability parameter, temperature factors (Biot, Brinkman, thermal conductivity, temperature ratio, temperature difference, radiation, unequal heat source/sink), suction/injection parameter, magnetic parameter, nanofluid parameters (Brownian motion, thermophoresis), activation energy factors (reaction rate, fitted rate constant), Schmidt number, on velocity, pressure, temperature, and concentration profiles are shown through graphs.

Purpose: This research aims to examine gender preferences for men and women advertising models in Saudi advertisements. Saudi Arabia is known as one of the most gender-segregated society in the world, and it has gender-specific roles, characteristics, and behaviors that are undesirable for the other gender. Methodology: The questionnaire was developed with the help of earlier studies on perceptions towards advertising models and validated by a jury of experts and focus groups. The gender preferences for ten product categories (including automobiles, baby care products, cigarettes, cosmetics for women, fashion, food & beverages, motorcycles, personal care for men, personal care for women, sporting goods) were examined for men and women models. Similarly, three personal preferences characteristics for both genders (face beauty, voice quality, and Islamic dress), two characteristics for women models (body shape, femininity), and two characteristics for men models (height-weight balance, masculinity) were examined for men and women models separately. Finally, a survey was conducted to solicit responses from respondents (N=412). Findings: Results indicated significant gender preferences for gender-specific product categories and typical gender stereotypes in advertising models. Men models were preferred in men-specific products, and women models were required in women-specific products. Some product categories (including personal care for men and sporting goods) were ranked higher for men advertising models, while for women advertising models, other product categories (including personal care for women and cosmetics for women) were ranked higher. Masculinity was ranked highest as the preferred personal characteristic for men advertising models, while voice quality was highest for women advertising models. Finally, there is a significant difference between the preferred personal characteristic for men and women advertising models for three characteristics, including face beauty, Islamic dress, and masculinity and femininity. Implications: Saudi Arabia is a unique society with predominantly unique cultural dominance. Consequently, local culture greatly influences advertisements. It has stereotyped gender roles even in advertisements. This study will establish a baseline for further research on the subject area.

Background: Soft-tissue sarcomas (STS) are heterogeneous with variable response to radiation therapy (RT). Utilizing the radiosensitivity index (RSI) we estimated the radiobiologic ratio of lethal to sublethal damage (α/β), genomic-adjusted radiation dose(GARD), and in-turn a biological effective radiation dose (BED). Methods: Two independent cohorts of patients with soft-tissue sarcoma were identified. The first cohort included 217 genomically-profiled samples from our institutional prospective tissue collection protocol; RSI was calculated for these samples, which were then used to dichotomize the population as either highly radioresistant (HRR) or conventionally radioresistant (CRR). In addition, RSI was used to calculate α/β ratio and GARD, providing ideal dosing based on sarcoma genomic radiosensitivity. A second cohort comprising 399 non-metastatic-STS patients treated with neoadjuvant RT and surgery was used to validate our findings. Results: Based on the RSI of the sample cohort, 84% would historically be considered radioresistant. We identified a HRR subset that had a significant difference in the RSI, and clinically a lower tumor response to radiation (2.4% vs. 19.4%), 5-year locoregional-control (76.5% vs. 90.8%), and lower estimated α/β (3.29 vs. 5.98), when compared to CRR sarcoma. Using GARD, the dose required to optimize outcome in the HRR subset is a BEDα/β=3.29 of 97 Gy. Conclusions: We demonstrate that on a genomic scale, that although STS is radioresistant overall, they are heterogeneous in terms of radiosensitivity. We validated this clinically and estimated an α/β ratio and dosing that would optimize outcome, personalizing dose.

This research work describes and investigates Williamson nanofluid flow over an exponentially stretching permeable vertical plate with temperature-dependent thermal conductivity and viscosity. The governing non-linear partial differential equations (PDEs) are metamorphosed into coupled non-linear ordinary differential equations (ODEs) by using similarity transformation. The succeeding equations were numerically solved using MATLAB function bvp4c for various values of parameters. For velocity, temperature, concentration, the skin friction coefficient, and the local Nusselt number, data are presented in the form of graphs and tables. It is noted that for increasing values of magnetic parameter M, Williamson parameter λ, and viscosity parameter α, the boundary layer thickness of the velocity profile decreases, while it increases for the temperature profile. The findings of the present work are validated through the published results.

Abstract Background Difficult surgical procedures may result in a higher mental workload, leading to increased fatigue and subsequent errors. This study was aimed to investigate the effect of repeated simulation training in ureterorenoscopy in a high-fidelity setting on the performance and mental workload of novice operators. Methods Medical students voluntarily participated in the present simulation study. After a didactic and video-based lecture, they underwent simulation training involving a renal stone case, including a rigid cystoscope component (task 1, performing a WHO checklist, assembling a scope, and insertion of a guide-wire and an access sheath after examining the bladder) and a flexible ureterorenoscope component (task 2, retrieving a stone located in the upper calyx using a basket after inspecting the upper, middle, and lower calyx). Training was performed in a mock operating theater. Technical skills were assessed by one author (an experienced urologist) onsite using an Objective Structured Assessment of Technical Skills (OSATS) score at each training session. The mental workload was subjectively evaluated by the National Aeronautics and Space Administration Task Load Index (NASA-TLX) questionnaire after each training session. Results Seventeen students completed a minimum of 6 training sessions (male: female = 10: 7, median age of 22) over a median of 21 days (range, 10–32). In both tasks 1 and 2, the OSATS score improved over the 6 sessions with evidence of plateauing (MANOVA model, task 1: p

(1) Background: The association between ABO blood groups and COVID-19 outcomes was investigated in several studies. The results were controversial. This study aimed to explore the association between ABO blood groups and COVID-19 outcomes. (2) Methods: This retrospective study included 303 COVID-19 patients treated at the NMC Royal Hospital in the United Arab Emirates between 8 April 2020 and 30 June 2020. (3) Results: The mean age of patients included in the study was 39.3 ± 10.7 years, and 72.9% of patients were males. The prevalence of blood groups O, A, B, and AB was 40.3%, 27.7%, 25.1%, and 6.9%, respectively. The correlation between ABO blood groups and COVID-19 outcomes was insignificant except in the AB group, with significantly higher odds of disease severity. Increased age, higher body mass index (BMI), and being of male gender increased the risk for pneumonia among all blood groups. Both increased age and higher BMI increased the risk of mortality, and increased age increased the risk of disease severity. Troponin and platelet counts were significantly different in the A group compared to the non-A groups. Time to viral clearance was not different among blood groups. However, adjustment for Rh groups resulted in a significantly shorter time in the B group. (4) Conclusions: There was no significant association between ABO blood groups and COVID-19 outcomes, with the exception of group AB.

This research work describes the investigation of a magnetohydrodynamic flow of Williamson nanofluid over an exponentially porous stretching surface considering two cases of heat transfer i.e. , prescribed exponential order surface temperature (PEST), and prescribed exponential order heat flux (PEHF). As a result of this infestation, a mathematical model of the problem based on conservation of linear momentum and law of conservation of mass and energy is developed. Whereas governing nonlinear partial differential equations (PDEs) are converted to nonlinear ordinary differential equations (ODEs). Subsequently, the velocity, concentration, and temperature profiles are developed by using the method of similarity transformation. Furthermore, the effects of various physical parameters of engineering interests are demonstrated graphically. It is highlighted that both the magnetic parameter ( M ) and Williamson parameter ( λ ) causes to reduce the boundary layer thickness.

ObjectivesThere is an increased awareness of the effect of a bladder cancer diagnosis and its treatments on the mental wellbeing of patients. However, few studies have evaluated the efficacy, feasibility and acceptability of interventions to improve this mental wellbeing. This systematic review is the first phase of the Medical Research Council Framework for developing complex interventions and provides an overview of the published mental wellbeing interventions that could be used to design an intervention specific for BC patients.MethodsThis review was conducted in accordance with the PRISMA guidelines in January 2019 and studies were identified by conducting searches for Medline, the Cochrane Central Register of Controlled Trials and Ovid Gateway. All included studies met the following criteria: mental wellbeing interventions of adults with medically confirmed diagnosis of any type of urological cancer, reported outcomes for specific HRQoL domains including psychological factors. The quality of evidence was assessed according to Down and Black 27-item checklist.ResultsA total of 15,094 records were collected from the literature search and 10 studies matched the inclusion and exclusion criteria. Of these, nine interventions were for patients with prostate cancer and one for patients with kidney cancer. No studies were found for other urological cancers. Depression was the most commonly reported endpoint measured. Of the included studies with positive efficacy, three were group interventions and two were couple interventions. In the group interventions, all showed a reduction in depressive symptoms and in the couple interventions, there was a reduction in depressive symptoms and a favourable relationship cohesion. The couple interventions were the most feasible and acceptable, but further research was required for most of the studies.ConclusionWhile awareness of the importance of mental wellbeing in bladder cancer patients is growing, this systematic literature review highlights the gap of feasible and acceptable interventions for this patient population.

Bays International was incorporated in 1996. Over the years it faced numerous challenges including: high employee turnover (particulary saleforce), limited expansion capabilities, low penetration in semi-urban markets, high operating expenses like rentals, increasing duties (on luxury products), low cash-flows, low budgets for advertising and marketing as compared to competitors, less awareness amongst consumers, volatile consumer preferences (especially by millennial), weak brands’ loyalties, counterfeits/fake products, smuggling and infiltration from grey channels, high number of foreign and local chains entering the market, price war especially with local chains, and uncertain political situation. Four interviews were conducted from management and two interviews from ex employees. Moreover, a lot of open access documents of the company were reviewed. Pertinent literature reveiew also revealed interesting insights about emerging consumer trends and cosmetic industry along with interviews of some marketing directors of leading global brands. The Bays leadership believes that key parameters are improving over time. The case covers how the company maneuvered itself since its inception and launched numerous other brands targeted towards different segments of the society, in order to steer towards growth in changing internal and external environment. The case is based on a scenario when there is yet another increase of taxes by the government in 2019 and presents troublesome situations to branding cum marketing strategy for the company to consider.

The objective of the study was to evaluate different types of cancer and its chemotherapy in various ethnic groups of Pakistan. Ethnic groups includes, Pukhtoons, Punjabis, Sindhis, Muhajirs, Siraikis, Memoons, Hazaras, Hindkos, Baltis, Gilgitis, Kashmiris, and Afghanis. The data was collected from well reputed hospitals located in the different provinces of Pakistan. The collected data was taken from 15 hospitals where around 8500 patients visited during 2010 to 2017. From the visited patients, 8356 were analyzed for their ethnicity, age and sex while, 144 patients (male 77 and female 67) were excluded from analysis due to incomplete information or loss of follow-up. Among 8356 patients, 3762 were male (45%) whereas, 4594 were female (55%). The chemotherapy was carried out as per National Comprehensive Cancer Network guidelines (NCCN- guidelines). The most common five prevalent cancer among these ethnic groups were Head and Neck, Blood, Respiratory, Genito-urinary and Breast cancer. The most common cancer in female was breast cancer while, head and neck cancer was more prevalent in male. It can be concluded that the prevalence of cancer in Pakistan is very alarming, which may be due to lack of awareness, illiteracy, lack of national cancer control programs, and economics issues.

The present investigation aims to examine the heat flux mechanism in the hagnetohydrodynamic (MHD) mixed convective flow of Williamson-type fluid across an exponential stretching porous curved surface. The significant role of thermal conductivity (variable), non-linear thermal radiation, unequal source-sink, and Joules heating is considered. The governing problems are obtained using the Navier–Stokes theory, and the appropriate similarity transformation is applied to write the partial differential equations in the form of single-variable differential equations. The solutions are obtained by using a MATLAB-based built-in bvp4c package. The vital aspect of this analysis is to observe the effects of the curvature parameter, magnetic number, suction/injection parameter, permeability parameter, Prandtl factor, Eckert factor, non-linear radiation parameter, buoyancy parameter, temperature ratio parameter, Williamson fluid parameter, and thermal conductivity (variable) parameter on the velocity field, thermal distribution, and pressure profile which are discussed in detail using a graphical approach. The correlation with the literature reveals a satisfactory improvement in the existing results on permeability factors in Williamson fluids.

Abstract Background Antiemetic agent Meclizine HCl, widely prescribed in vertigo, is available only in immediate release dosage forms. The approved therapeutic dose and shorter elimination half-life make Meclizine HCl a potential candidate to be formulated in extended release dosage form. This study was aimed to develop extended release Meclizine HCl pellets by extrusion spheronization using natural and synthetic lipids. Influence of lipid type, drug/lipid ratio and combinations of different lipids on drug release and sphericity of pellets were evaluated. Methods Thirty two formulations were prepared with four different lipids, Glyceryl monostearate (Geleol®), Glyceryl palmitostearate (Precirol®), Glyceryl behenate (Compritol®) and Carnauba wax, utilized either alone or in combinations of drug/lipid ratio of 1:0.5–1:3. Dissolution studies were performed at variable pH and release kinetics were analyzed. Fourier transform infrared spectroscopy was conducted and no drug lipid interaction was found. Results Sphericity indicated by shape factor (eR) varied with type and concentration of lipids: Geleol® (eR = 0.891–0.997), Precirol® (eR = 0.611–0.743), Compritol® (eR = 0.665–0.729) and Carnauba wax (eR = 0.499-0.551). Highly spherical pellets were obtained with Geleol® (Aspect ratio = 1.005–1.052) whereas irregularly shaped pellets were formed using Carnauba wax (Aspect ratio = 1.153–1.309). Drug release was effectively controlled by three different combinations of lipids: (i) Geleol® and Compritol®, (ii) Geleol® and Carnauba wax and (iii) Geleol®, Compritol® and Carnauba wax. Scanning electron microscopy of Compritol® pellets showed smooth surface with pores, whereas, irregular rough surface with hollow depressions was observed in Carnauba wax pellets. Energy dispersive spectroscopy indicated elemental composition of lipid matrix pellets. Kinetics of (i) Geleol® and Compritol® pellets, explained by Korsmeyer-Peppas (R2 = 0.978–0.993) indicated non-Fickian diffusion (n = 0.519-0.597). Combinations of (ii) Geleol® and Carnauba wax and (iii) Geleol®, Compritol® and Carnauba wax pellets followed Zero-order (R2 = 0.991–0.995). Similarity test was performed using combination of Geleol® and Compritol® (i) as a reference. Conclusions Matrices for the extended release of Meclizine HCl from extruded-spheronized pellets were successfully formed by using three lipids (Geleol®, Compritol® and Carnauba wax) in different combinations. The encapsulated pellets of Meclizine HCl can be effectively used for treatment of motion sickness, nausea and vertigo for extended period of time.

Background: The aim of this study was to evaluate the validity of evidence of the Endo-Uro Trainer (SAMED, Dresden, Germany) for semi-rigid ureteroscopy. Methods: Novice ( n = 29), intermediate-level ( n = 25), and expert ( n = 24) urological surgeons were recruited to participate in the study. Novices were allocated randomly to Groups A and B, where A performed two set procedures using the already validated Uro-Scopic Trainer (Limbs and Things, Bristol, UK), and Group B used the Endo-Uro trainer. Subsequently they were crossed over to perform the same two procedures using the other model. Intermediate and expert groups performed the same procedure on the Endo-Uro trainer only. Objective Structured Assessment of Technical Skills (OSATS) and the procedural times were collected and analyzed. All participants were invited to complete a final evaluation survey. Results: The evaluation survey revealed a realism rating in all aspects, with a mean Likert rating of 4.04/5. Significant differences were observed in performance time between novices and experts ( p = 0.0014), and between intermediates and experts ( p = 0.0113). OSATS scores differed significantly between all groups ( p

Unmanned Underwater Vehicles (UUV) are the robots that are used to monitor underwater environment at remote distance, either for inspection of underwater wreckage or for surveillance of underwater environment. Any such robot due to harshness of environment conditions needs a robust watertight design and requires various sensors for effective environment monitoring. The entire UUV structure is comprise of the vehicle, which is linked with operators on top of the surface by a set of cables that hold relevant cables for data and power communication. In this context, a lightweight underwater vehicle was designed using PVC (Polyvinyl Chloride) pipes and equipped with brushless DC motors, electronic speed controller, relay module, sonar, claw arm and Camera. It can navigate navigated in six directions (up, down, left, right, forward, backward) and camera allows underwater surveillance of the environment, with sonar helping to indicate the target depth. The designed UUV can also perform basic pick and place task using a claw arm and is remotely operated using a joystick controller. Overall, the designed UUV prototype has shown its potential capabilities for underwater surveillance and environment monitoring through practical demonstrations

Introduction and Hypothesis: Fournier’s gangrene is a rare, necrotising fasciitis of the external genitalia, perineal or perianal regions. The disease has a higher incidence in males and risk factors for development include diabetes, HIV, alcoholism and other immune-compromised states. The aggressive disease process is associated with a high mortality rate of 20-30%. In addition, the increasing age and prevalence of diabetes in the population, begs the need for increased clinical awareness of Fournier’s gangrene with emphasis on early diagnosis and management. This review aims to highlight the relevant research surrounding Fournier’s gangrene, in particular the various prognostic indicators and management strategies. Methods: A search was conducted on the MEDLINE database for all applicable research; clinical reviews, retrospective studies and case reports. In addition to which a search of the European Association of Urology, the British Association for Urological Surgeons and the British Medical Journal was conducted for the most recent recommendations. Results: Immediate broad-spectrum antibiotic therapy and urgent surgical debridement are the core managerial principles of Fournier’s gangrene. The use of adjunctive therapies such as hyperbaric oxygen and vacuum assisted closure are supported in some aspects of the literature and disputed in others. The lack of randomized controlled studies limits the use of these potential additional therapies to patients unresponsive to conventional management. The value of unprocessed honey as a topical antimicrobial agent has been highlighted in the literature for small lesions in uncomplicated patients. Conclusion: Fournier’s gangrene is a urological emergency with a high mortality rate despite advances in the medical and surgical fields. The aggressive nature of the infection advocates the need for early recognition allowing immediate surgical intervention. The opposing results of available research as well as the lack of high quality evidence surrounding emergent therapies prevents their routine use in the management of Fournier’s gangrene. The absence of a specific care pathway may hinder efficient management of Fournier’s gangrene, thus based on current guidelines a management pathway is suggested.

Firm’s credit rating and optimal capital structure are directly related. Firms with high crediting rating tend to finance more by debts. However, there is no appropriate figure available for optimal capital structure in literature. Firms mostly decide mix of debt and equity based on its operating environment. Knowing fact of high credibility among locals and lower costs associated with debts, managers prefer debts to equity. This paper used factors like profitability, liquidity, firm’s size and leverage, to determine crediting rating of firms. This paper has used data from balance sheets of top twenty banks in Pakistan for last seven years. It was found that profitability and liquidity have negative impacts on credit rating of banks in Pakistan, while size and leverage being more significant have positive correlation with credit rating.

Background: Spine stereotactic body radiation therapy (SBRT) is becoming widely accepted as first-line treatment of oligometastatic spine disease as well as in the postoperative setting. The reported incidence of myelopathy is very low and guidelines vary widely on the maximum tolerable dose of the spinal cord and thecal sac. Methods and materials: Between April 2008 and December 2010, radiation parameters were exported for 46 patients treated with spine SBRT at the Mayo Clinic. Using an in-house data mining program, dose-volume histogram constraints were extracted, including dose prescription, dose fractionation, planning target volume, planning target volume coverage, maximum dose to the cord, D2cc thecal sac, and D2cc spinal cord. Diagnostic magnetic resonance imaging scans and/or computed tomography myelograms were fused with the planning set to delineate the cord and thecal sac for receiver operating characteristic analysis of cord and thecal sac subvolume doses. A high-resolution planning at-risk volume was created in 1-mm increments for cord (1-7 mm) and the thecal sac (1-2 mm) to examine dose gradients that might be correlated with toxicity. Results: No patients experienced myelopathy with a median follow-up of 14 months. The most common toxicities were pain and nausea. Median values of D2cc maximum dose (maximum dose received by 2 cc of the organ at risk; biologically equivalent 2-Gy dose maximum [EQD2]) for cord and thecal sac were 38.5 Gy (range, 7.5-67.9 Gy) and 67.7 Gy (range, 15.5-155.8 Gy), respectively. Median values for high-dose subvolumes for cord and thecal sac were 2 times higher than the doses for 5% predicted grade 3 cord toxicity as recommended in the current literature. Cord D0.1cc[EQD2] ≥23.8 Gy was correlated with pain flare (n = 5). Thecal sac D2cc [EQD2] ≥29.3 Gy was a significant indicator of nausea. Conclusion: Current guidelines may overestimate the risk of myelopathy from spine SBRT. The current study's population included both radiation-naïve and retreatment cases, but no myelopathy was observed despite exceeding recommended spine limits.

In general, aerospace structures manufactured using fiber reinforced polymer composites are exposed to fluctuating temperatures and subjected to cyclic loading during their service life. Therefore, studying the temperature-frequency dependent properties of composites for different fiber orientations is essential. However, such experiments are expensive, time-consuming and labor-intensive while theoretical models minimize these issues, but temperature-frequency-dependent viscoelastic models for predicting the full-range of the storage and loss moduli curves of composites are limited. In this study, the dynamic mechanical properties of a neat epoxy resin, unidirectional ([0°]6, [45°]6 and [90°]6), symmetric angle-ply [+45°/−45°/+45°]s and quasi-isotropic [±45°/0°/90°]s carbon/epoxy and glass/epoxy composite panels were investigated. Experiments were performed from room temperature (approximately 35 °C) to 160 °C at five different frequencies (1, 10, 20, 33 and 50 Hz). Two parameter viscoelastic models as function of temperature and frequency were used, and their applicability in predicting the storage and loss moduli for the entire region of the temperature curve is shown. The storage modulus values were compared and validated against the static flexural modulus values coupled with scanning electron microscopy analysis. The flexural and storage moduli values were found to be higher for [0°]6 carbon/epoxy composites, while the activation energy values were found to be higher in the case of [+45°/−45°/+45°]s carbon/epoxy composites compared with epoxy resin and other laminates in different orientations. The predicted results were in reasonably good agreement with the experiments. Both experimental and modeling approaches used in this study are highly valuable for designing aerospace composites for harsh in-service loading conditions.

This paper focuses on the design and control of unmanned ground vehicle for search and rescue missions which is controlled remotely. This robot is able to move on a variety of surfaces, also having capability of Picking and Placing of various objects and overcome the dangerous areas. The unmanned system is controlled wirelessly using Xbee wireless communication technology. A camera is attached on this mobile robot for live feedback purpose. Many experiments are conducted to test the potential and performance of the robot.