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Objectives Investigate the prevalence of Rh and the K antigens and their phenotypes in the red blood cells of blood donors in Riyadh, Saudi Arabia. Methods This is a retrospective study. The five principal Rh antigens (D, C, c, E, e) and the Kell antigen from the Kell blood group were tested in 4,675 random samples collected from four blood bank centers in Riyadh. Data were collected for seven weeks (from January 4, 2019 to February 28, 2019). Antigens were tested using the TANGO Optimo system. Results We found that approximately 86% of the donors had the D antigen, 66% had C, 78% had c, 26% had E, 97% had e and 14% had K. The most common Rh phenotypes were R1r (31%) and R1R1 (22%). Conclusion The differences in the results between the study population and other populations, such as Caucasian, Indian and African populations indicate the importance of establishing a population-specific database.

Background Bronchial thermoplasty is a device-based treatment for subjects ≥18 years with severe asthma poorly controlled with inhaled corticosteroids and long-acting beta-agonists. The Post-FDA Approval Clinical Trial Evaluating Bronchial Thermoplasty in Severe Persistent Asthma (PAS2) study collected data on severe asthmatics undergoing this procedure. Research Question What are the 5-year efficacy and safety results in severe asthmatics who have undergone bronchial thermoplasty? Study Design and Methods This was a prospective, open-label, observational, multi-center study conducted in the United States and Canada. Subjects aged 18-65, taking inhaled corticosteroids ≥1000μg/day (beclomethasone or equivalent) and long-acting β-agonists ≥80μg/day (salmeterol or equivalent) were included. Severe exacerbations, hospitalization, emergency department visits, and medication usage were evaluated for the 12 months prior to and at years 1-5 post-treatment. Spirometry was evaluated at baseline and at years 1-5 post-treatment. Results 284 subjects were enrolled at 27 centers; 227 subjects (80%) completed 5 years of follow-up. By year 5 post-treatment, the proportion of subjects with severe exacerbations, emergency department visits, and hospitalizations was 42.7%, 7.9%, and 4.8%, respectively, compared to 77.8%, 29.4%, and 16.1% in the 12 months prior to treatment. The proportion of subjects on maintenance oral corticosteroids decreased from 19.4% at baseline to 9.7% at 5 years. Analyses of subgroups based on baseline clinical and biomarker characteristics revealed a statistically significant clinical improvement among all subgroups. Interpretation Five years after treatment, subjects experienced decreases in severe exacerbations, hospitalizations, emergency department visits and corticosteroid exposure. All subgroups demonstrated clinically significant improvement, suggesting that bronchial thermoplasty improves asthma control in different asthma phenotypes.

Information on neurodevelopmental effects of antenatal exposure to antipsychotics is limited to 10 studies, all examining children up to 5 years of age or less. The paper aimed to investigate the association between in utero exposure to antipsychotics and psychiatric outcomes in children using Danish nationwide registers. In total, 9011 liveborn singletons born 1998–2015 in Denmark whose mothers took antipsychotic medication before pregnancy were identified. Children whose mothers continued to take antipsychotics during pregnancy were compared with children of mothers who discontinued antipsychotics before pregnancy. As a negative control, paternal antipsychotic use in the same window was investigated. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazards regression for the primary outcome of psychiatric disorders, as well for subcategories of psychiatric disorders. In total, 9.9% of children in the discontinuation group and 11.0% of children in the continuation group received a psychiatric disorder diagnosis during follow-up. The adjusted HR for psychiatric disorders among offspring in the continuation group compared to the discontinuation group was 1.10 (95% CI 0.93–1.30). For antipsychotic use in the fathers, the HR was 1.05 (95% CI 0.89–1.24). The study does not provide evidence of increased risk of psychiatric disorders among children of women who continue antipsychotic treatment during pregnancy. This was observed after accounting for the underlying risk conferred by maternal psychiatric disorders. This suggests women who need to continue antipsychotic medications during pregnancy can do so without adverse psychiatric outcomes for offspring.

To dehumidify a humid air stream, existing air conditioning (AC) systems substantially overcool the outdoor humid air below its dew point, thereby significantly reducing energy efficiency. Directly capturing humidity, membrane-based liquid-desiccant dehumidification systems separate sensible and latent cooling (SSLC) loads and thus offer a promising pathway for a high-performance AC solution. Design of an energy-efficient SSLC-AC system, however, rests largely on detailed understating of the dehumidification process. While some studies have identified the dehumidification process mainly depends on membrane characteristics, other studies have argued that the process is limited by desiccant liquid or alternatively air thermo-hydraulic physics for typical humid climate conditions. The present study examines performance and physics of the membrane-based liquid-desiccant dehumidification process over a wide range of climate conditions through a novel 3D, two-phase, multi-species CFD model. Decoupling the thermodynamic and hydraulic effects, the study reveals that the dehumidification rate is a linear function of the water vapor pressure potential (J=α ΔP) summarizing the system's thermodynamic state. The slope of the curve (i.e., α) depends on hydraulic transport characteristics of the membrane pores, air stream, and desiccant solution. More importantly, it was found that the air dehumidification process is mainly limited by the air-side transport physics for thin liquid-desiccant films and commonly used porous superhydrophobic membranes. Additionally, results show that, depending on ambient/desiccant conditions and physical dehumidifier characteristics, energy effectiveness and dehumidification rate vary from 13 to 34% and from 0.13 to 1.4 g m−2 s−1, respectively. Therefore, the present study allows to efficiently design future SSLC-based AC systems exhibiting high performance energy metrics.

Objectives We provide a brief introduction to the objectives, data, methods and results of the World Health Organization (WHO)/International Labor Organization (ILO) Joint Estimates of the Work-related Burden of Disease and Injury (WHO/ILO Joint Estimates), which estimated the burden attributable to 19 selected occupational risk factors. Methods The WHO/ILO Joint Estimates were produced within the global Comparative Risk Assessment framework, which attributes the burden of one specific health outcome (ie, disease/injury) to a specific occupational risk factor. For 39 established occupational risk factor-health outcome pairs, estimates are produced using population attributable fractions (PAF) from recent burden of disease estimates. For two additional pairs, PAF are calculated from new databases of exposure and risk ratios produced in WHO/ILO systematic reviews. Attributable disease burdens were estimated by applying the PAF to total disease burdens. Results Globally in 2016, it is estimated that 1.88 [95% uncertainty range (UR) 1.84-1.92] million deaths and 89.72 (95% UR 88.61-90.83) million disability-adjusted life years were attributable to the 19 selected occupational risk factors and their health outcomes. A disproportionately large work-related burden of disease is observed in the WHO African Region (for disability-adjusted life years), South-East Asia Region, and Western Pacific Region (for deaths), males and older age groups. Conclusions The WHO/ILO Joint Estimates can be used for global monitoring of exposure to occupational risk factors and work-related burden of disease and to identify, plan, cost, implement and evaluate policies, programs and actions to prevent exposure to occupational risk factors and their associated burden.

Rationale: Transbronchial lung cryobiopsy (TBLC) has emerged as a less invasive method to obtain a tissue diagnosis in patients with interstitial lung disease (ILD). The diagnostic yield of TBLC compared to surgical lung biopsy (SLB) remains uncertain. Objectives: The aim of this study was to determine the diagnostic accuracy of forceps transbronchial lung biopsy (TBLB) and TBLC compared to SLB when making the final diagnosis based on multidisciplinary discussion (MDD). Methods: Patients enrolled in the study underwent sequential TBLB and TBLC followed immediately by SLB. De-identified cases, with blinding of the biopsy method, were reviewed by a blinded pathologist and then discussed at a multidisciplinary conference. Main Results: Between August 2013 and October 2017, we enrolled 16 patients. The raw agreement between TBLC and SLB for the MDD final diagnosis was 68.75% with a Cohen’s kappa of 0.6 (95% CI 0.39, 0.81). Raw agreement and Cohen’s kappa of TBLB versus TBLC and TBLB versus SLB for the MDD final diagnosis were much lower (50%, 0.21 [95% CI 0, 0.42] and 18.75%, 0.08 [95% CI −0.03, 0.19], respectively). TBLC was associated with mild bleeding (grade 1 bleeding requiring suction to clear) in 56.2% of patients. Conclusions: In patients with ILD who have an uncertain type based on clinical and radiographic data and require tissue sampling to obtain a specific diagnosis, TBLC showed moderate correlation with SLB when making the diagnosis with MDD guidance. TBLB showed poor concordance with both TBLC and SLB MDD diagnoses.

Miniaturized spectrometers are being developed in the recent few years leveraging the rapidly-progressing technology and triggering new markets in the field of on-site and mobile spectroscopic analysis. Although some devices were commercialized for the near-infrared spectroscopy (NIRS), their size and cost still don't meet the requirements for the ubiquitous deployment of the spectrometer as a spectral sensor needed for the smart industry and IoT applications. In this work we report an integrated microelectromechanical system (MEMS)-based Fourier Transform Infrared (FT-IR) spectral sensor. A monolithic scanning Michelson interferometer MEMS chip and an extended InGaAs photodetector chip are integrated with a micro-optical system in a tiny package with a footprint of 18 mm, presenting the smallest reported FT-IR solution to date. A compact light source head is designed and implemented targeting diffuse-reflection applications. The reported sensor's spectral resolution is about 66.6 cm-1 across the spectral range of 1350-2550 nm. The signal-to-noise ratio (SNR) achieved is 8000:1 at 2400 nm in 2 seconds, with an order of magnitude improvement with respect to previously reported fiber-coupled solution. The presented solution provides a low cost, low power, wide wavelength range NIR spectral sensor that can be manufactured with high volumes leveraging economies of scale.

Left atrial appendage aneurysm is a rare heart defect; Most often diagnosed incidentally but may be potentially hazardous when presented with a systemic embolization or arrhythmia. So early diagnosis and treatment is indicated. We have successfully operated two cases of left atrial aneurysm in recent past and sharing our experiences through this case reports. Bangladesh Heart Journal 2021; 36(2): 158-163

Struggling to curb misinformation, social media platforms are experimenting with design interventions to enhance consumption of credible news on their platforms. Some of these interventions, such as the use of warning messages, are examples of nudges -- a choice-preserving technique to steer behavior. Despite their application, we do not know whether nudges could steer people into making conscious news credibility judgments online and if they do, under what constraints. To answer, we combine nudge techniques with heuristic based information processing to design NudgeCred -- a browser extension for Twitter. NudgeCred directs users' attention to two design cues: authority of a source and other users' collective opinion on a report by activating three design nudges -- Reliable, Questionable, and Unreliable, each denoting particular levels of credibility for news tweets. In a controlled experiment, we found that NudgeCred significantly helped users (n=430) distinguish news tweets' credibility, unrestricted by three behavioral confounds -- political ideology, political cynicism, and media skepticism. A five-day field deployment with twelve participants revealed that NudgeCred improved their recognition of news items and attention towards all of our nudges, particularly towards Questionable. Among other considerations, participants proposed that designers should incorporate heuristics that users' would trust. Our work informs nudge-based system design approaches for online media., Comment: 30 pages, CSCW 2021

Background: Workplace violence (WPV) is a prevalent phenomenon in Egyptian emergency departments (EDs), an issue that threatens an already scarce resource of healthcare workers. Furthermore, changes and modifications are continuously taking place in hospitals, with no consideration to the important role those changes might play in reducing or encouraging WPV behaviors. Objective: This research serves as an initial step in offering answers on how the environmental design of an ED can be modified and manipulated to prevent and control WPV. Accordingly, the objective of this research is to identify the environmental features that potentially influence WPV in the ED. This could provide healthcare designers with the necessary tools to forecast the location of WPV and define the measures needed for a safer working environment. Method: The study comprised a hybrid method approach that evaluates the implementation of crime prevention through environmental design (CPTED) through field observation and combined with space syntax analyses (SSAs) of the spatial attributes. Results: The results showed a positive relationship between the spatial properties (high integration and connectivity values) and WPV locations. The results also demonstrated that situational factors as natural surveillance played an important role in displacing the WPV locations. Conclusions: The contribution of this research lies in elaborating the SSA and CPTED from a conceptual to an empirical level. Combining those tools will help identify the location of WPV in the ED and hence facilitates successful future environmental intervention strategies.

Background: The patients with early retinopathy can be asymptomatic with normal fundus before any signs of maculopathy appear; hence, screening for early detection in the premaculopathy stage is recommended. Spectral domain optical coherence tomography (SD-OCT) detects early structural damage to macula in patients on hydroxychloroquine (HCQ) therapy.Aim of the work: To evaluate the role of spectral-domain optical coherence tomography (SD-OCT) in early detection of hydroxyl-chloroquine (HCQ) maculopathy.Patients and methods: This cross-sectional observational study was conducted between November 2017 and November 2019 on 100 adult female patients taking HCQ referred from the ophthalmology and rheumatology outpatient clinics of Ain Shams University Hospital. The age of the participants ranged between 25 and 60 years. Fifty age and sex matched healthy subjects were assessed as a control group. The study was conducted in accordance with the ethical standards stated in the Faculty of Medicine - Ain Shams University, with informed consent obtained.Results: The mean central foveal thickness was found to be thinner in the hydroxychloroquine group than the normal controls, which was statistically significant (p value = 0.042). The upper, lower, nasal and temporal parafoveal thickness were thinner in the hydroxychloroquine group in comparison to that of the control group (p value = 0.001, 0.020, 0.001 & 0.001 respectively). The upper, temporal and lower perifoveal thickness showed statistically significant thinning in the hydroxychloroquine group (p value = 0.002, < 0.001 & 0.041 respectively) in all quadrants except the nasal quadrant which was not statistically significant (p = 0.169). No significant difference was detected between the two groups regarding ganglion cell complex thickness.Conclusion: Preclinical hydroxychloroquine toxicity can lead to early thinning in the central fovea as well as the parafoveal and perifoveal regions that is detected by SD-OCT.

Background Drug reaction with eosinophilia and systemic symptoms (DRESS) is a cutaneous and systemic drug allergy disorder. Patients exist on a severity spectrum, with some experiencing a mild form of the disorder that fails to meet the Registry of Severe Cutaneous Adverse Reactions (SCAR) to Drugs diagnostic criteria for DRESS. Objective We sought to determine whether there were any cutaneous or dermatopathologic features that discriminate between the mild form of DRESS (DRESS minor) and the severe phenotype (DRESS major). Methods Hospitalized patients from a single center with a diagnosis of DRESS were prospectively recruited over a 7-year period. Clinical and dermatopathologic features were analyzed to discriminate between DRESS minor and DRESS major. Results Forty-five patients were included, of whom 19 had a Registry of Severe Cutaneous Adverse Reactions (SCAR) to Drugs score of ≤3 (DRESS minor) and 26 had a score of ≥4 (DRESS major). The mean latency period (P = .001), fever >38.5 °C (P = .001), and a reaction lasting >15 days (P = .010) discriminated DRESS major from DRESS minor. Facial edema was the sole discerning cutaneous feature (P = .025). Discriminating histopathologic features included basal squamatization (P = .005), dermal red blood cell extravasation (P = .009), and interface inflammation (P = .005). Conclusion We propose a new classification system—DRESS minor—to distinguish the milder illness from the severe form, DRESS major. Facial edema and certain histopathologic features can help discriminate between major and minor versions.

Depression is associated with general medical conditions (GMCs), but it is not known if treatment-resistant depression (TRD) affects GMC risk and vice versa. We estimated bidirec-tional associations between TRD and GMCs (prior and subsequent). All individuals aged 18-69 years, born and living in Denmark, with a first-time prescription for an antidepressant between 2005 and 2012 were identified in the Danish Prescription Registry ( N = 154,513). TRD was de -fined as at least two shifts in treatment regimes. For prior GMCs, we estimated odds ratios (ORs) using conditional logistic regression comparing TRD patients with matched non-TRD controls adjusted for other GMCs and number of other GMCs. For subsequent GMCs, we used Cox regression to calculate hazard ratios (HRs) in TRD vs. non-TRD patients adjusted for age at first prescription, calendar time, other GMCs and number of other GMCs. Patients with TRD had higher prevalence of prior GMCs related to the immune or neurological systems; musculoskeletal disorders (women aOR: 1.35, 95% CI: 1.26-1.46, men aOR: 1.30, 95% CI: 1.19-1.42) and migraine (women aOR: 1.22, 95% CI: 1.09-1.36, men aOR: 1.25, 95% CI: 1.00-1.56). Subsequent GMCs were related to a broader spectrum; cardiovascular (women aHR: 1.43, 95% CI: 1.32-1.54, men aHR: 1.31, 95% CI: 1.19-1.43), endocrine (women aHR: 1.52, 95% CI: 1.37-1.67, men aHR: 1.24, 95% CI: 1.07-1.44), and neurological disorders (women aHR: 1.24, 95% CI: 1.13-1.35, men aHR: 1.19, 95% CI: 1.07-1.34). Our study presents a broad overview of comorbid medical conditions in patients with TRD and further studies are needed to explore the associations in detail. (c) 2021 The Author(s). Published by Elsevier B.V. This is an open access article under the CC BY license ( http://creativecommons.org/licenses/by/4.0/ )

Background Percutaneous transvenous mitral commissurotomy (PTMC) is the standard of treatment for symptomatic severe rheumatic mitral stenosis (MS). PTMC has the standard Inoue technique, but we have to modify the procedure in many technically challenging cases, especially to cross the mitral valve. Methodology Two over-the-wire strategies to enter the LV were taken in 80 complex cases of PTMC. The first one was done by exchanging the J-shaped wire from the balloon, introducing the spring wire into it, and pushing it into LV. The second one-removal of balloon keeping the spring wire in LA and the Mullin's sheath was introduced, and the tip of the wire was pushed into LV, and the balloon was introduced over the wire. We also changed the left atrium (LA) graphy in the RAO view instead of the AP view to facilitating entry into LV. Results We succeeded in 76 (95 %) cases. Strategy one was applied to all but successful in only 25 cases (31 %), and strategy 2 was applied in the remaining. Strategy 1 required less procedural time and fluoroscopic time in comparison to strategy 2 (40 ± 10 vs 60 ± 16 min, 25 ± 7 vs 35 ± 8 min). After modification of taking the LA graphy in RAO view, our rate of facing the difficulties decreased from 21 % to 9 %. Critical MS (31 %) and the giant LA (30 %) were the topmost causes of difficulties. No major complications were recorded. Conclusion Over-the-wire entry into LV is cost-effective, requiring no new equipment and is safe and can be used in complex cases.

microRNAs (miRs) are small regulatory RNAs that are frequently deregulated in liver disease. Liver fibrosis is characterized by excessive scarring caused by chronic inflammatory processes. In this study, we determined the functional role of miR-132 using a locked nucleic acid (LNA)-anti-miR approach in liver fibrosis. A significant induction in miR-132 levels was found in mice treated with CCl4 and in patients with fibrosis/cirrhosis. Inhibition of miR-132 in mice with LNA-anti-miR-132 caused decreases in CCl4-induced fibrogenesis and inflammatory phenotype. An attenuation in collagen fibers, α SMA, MCP1, IL-1β, and Cox2 was found in LNA-anti-miR-132-treated mice. CCl4 treatment increased caspase 3 activity and extracellular vesicles (EVs) in control but not in anti-miR-132-treated mice. Inhibition of miR-132 was associated with augmentation of MMP12 in the liver and Kupffer cells. In vivo and in vitro studies suggest miR-132 targets SIRT1 and inflammatory genes. Using tumor cancer genome atlas data, an increase in miR-132 was found in hepatocellular carcinoma (HCC). Increased miR-132 levels were associated with fibrogenic genes, higher tumor grade and stage, and unfavorable survival in HCC patients. Therapeutic inhibition of miR-132 might be a new approach to alleviate liver fibrosis, and treatment efficacy can be monitored by observing EV shedding., Graphical abstract, Liver fibrosis is an integral part of chronic liver disease and a risk factor for HCC. This study highlights the role of miR-132 in liver fibrosis. LNA-anti-miR-132 has an antifibrotic effect, protecting from inflammatory and profibrogenic gene induction. Inhibition of miR-132 might be a novel approach to alleviate liver fibrosis.

BACKGROUND Immediate implant placement with socket shield technique (SST) may maintain the buccal bone plate and soft tissue levels, however, the potential clinical benefits of SST lack strong scientific evidence. The aim of this systematic review and meta-analysis was to evaluate the effects of SST on dimensional changes of hard tissues, esthetic outcomes, implant stability, complication, and implant failure rates. METHODS Electronic databases were searched to identify randomized controlled trials (RCTs) that compared immediate implant placement with and without SST. The risk of bias was assessed using the Cochrane Collaboration's Risk of Bias tool. Data were analyzed using a statistical software program. RESULTS A total of 982 studies were identified, of which, seven RCTs with 206 immediately placed dental implants in 191 participants were included. Overall meta-analysis showed significant differences in the changes in buccal bone plate width (mean difference (MD) -0.22; 95% confidence interval (CI) -0.30 to -0.15; p

Myocardial tuberculosis is an exceptionally rare form of extra-pulmonary TB. Few cases were reported world-wide. Here a young snake charmer who had skin tuberculosis 5 yrs back admitted into National institute of diseases of Chest and hospital (NIDCH), Dhaka with the complaints of cough, palpitation and breathlessness for 2 months. He had right axillary firm matted lymphadenopathy, left sided large pleural effusion, left ventricular and septal hypertrophy with band and mass inside the ventricle (evident on CT scan of heart and echocardiography). His ESR was 95 mm in1st hr, Mantaux test was 15mm, Pleural fluid was exudative lymphocyte predominant with adenosin deaminase (ADA) 68.6 U/L. Fine needle aspirates from right axillary LNs showed Mycobacterium tuberculosis on GeneXpert for MTB/RIF testing and caseous granuloma on cytopathological study. Whole Body F18 FDG PET-CT revealed numerous low FDG avid size significant lymph nodes in right side of neck, mediastinum and right axilla with cardiomegaly with focal FDG avid within the left ventricular cavity likely to be prominent papillary muscle. MRI of heart or Myocardial biopsy for histology was not done due to their cost and invasiveness and also for that there was sufficient evidence of having tuberculosis in lymph node, pleura nas myocardium. This patient was treated with anti tubercular medications (3HRZE2S/5HRE) with prednisolone for six months. After treatment, myocardial lesions, pleural effusion and lymphadenopathy were found resolved. Thus a case of fatal and serious tuberculosis was explored and managed successfully.

Advanced interventional pulmonary procedures of the airways, pleural space, and mediastinum continue to evolve and be refined. Health care, finance, and clinical professionals are challenged by both the indications and related coding complexities. As the scope of interventional pulmonary procedures expands with advanced technique and medical innovation, program planning and ongoing collaboration among clinicians, finance executives, and reimbursement experts are key elements for success. We describe advanced bronchoscopic procedures, appropriate Current Procedural Terminology coding, valuations, and necessary modifiers to fill the knowledge gap between basic and advanced procedural coding. Our approach is to balance the description of procedures with the associated coding in a way that is of use to the proceduralist, the coding specialist, and other nonclinical professionals.

PurposeThe purpose of this article is to illuminate the relations of work-related practices of local managers of live music events in Ostwestfalen-Lippe (OWL) and barriers and needs of vulnerable customers (VC) in order to explore possibilities to increase cultural participation of VC.Design/methodology/approachThis article explores work-related practices of managers of live music events in OWL and asks if and to what extent these practices have an influence on the cultural participation of “vulnerable customers” (VC). It combines the findings of two studies: a) an explorative investigation on the work-related self-conceptions of managers of live music events in OWL (Study 1), and b) a sub-project on cultural participation of VC, which is part of the research project “kulturPreis. Increasing cultural participation through innovative and economically sustainable pricing concepts”, funded by the German Federal Ministry of Education and Research (Study 2).FindingsIt can be stated that there is an imbalance of knowledge: while VC tend to have a clear understanding of which barriers are the responsibility of managers of live music events, managers tend to lack knowledge regarding the needs of VC, and regarding the interrelationships between financial and social barriers facing them. Whether this knowledge and understanding can be developed in the future depends on the possibilities of exchanges between managers of live music events, cultural institutions, welfare organisations, political institutions and not least VC.Originality/valueBased on these studies, this article combines different approaches by linking work-related practices of managers of live music events with cultural participation of VC.

Objective:This study aimed to assess the validity and reliability of Depression, Anxiety, and Stress Scales-42 (DASS-42) in Dari, in adult population of Herat province of Afghanistan.Methods:The Dari-translated version of DASS-42 questionnaire was administered to 1310 non-clinical samples randomly selected in Herat. Internal reliability, exploratory factor analyses, confirmatory factor analyses and Pearson's product moment correlation were assessed to test the validity and reliability of the questionnaire. Data analyses were performed in IBM SPSS Statistics 23.0 and AMOS 23.0.Results:Internal consistency of the Dari-translated version of DASS-42 questionnaire subscales was high with Cronbach's alpha values of 0.888, 0.866 and 0.833 for depression, anxiety and stress, respectively. Construct validity was further supported with acceptable correlation measures of 0.799, 0.822 and 0.818 for depression, anxiety and stress subscales, respectively, which all were statistically significant (p

Due to the current financial constraints in the energy industry, investors need realistic risk evaluation and economic analysis in energy investment projects. On the other hand, energy system operators are continuously facing a wide range of challenges when dealing with asset management practices of the system components. In this paper, a novel method is proposed for the availability assessment of energy systems. This method provides an opportunity to predict system real behavior patterns in simulated time. According to the designed procedure, two new parameters for availability assessment are defined as the Failure Moment (FM) and the Repair Moment (RM). FM and RM of the components are estimated by the Monte Carlo method based on the time-varying failure rate and repair rate, respectively. This process is continued for all selected components in the system lifetime. As a common practice for demonstrating novel methodologies, the proposed method of this study is applied to the Combined Cycle Gas Turbine Power Plants. The results show that realistic availability evaluation for energy systems with the Monte Carlo method can cause a 4.4% reduction in nominal fuel consumption (16.79 kg/s as an average fuel flow rate vs. 17.562 kg/s as nominal amount) and a 5.05% reduction in nominal power generation. Therefore, this consideration makes the investment analysis more accurate and the decision to invest more interesting.

Background: Laryngeal cancer comprises 2 to 5% of all malignant diseases diagnosed annually worldwide. Cartilage invasion by the laryngeal cancer is of great importance through the staging of laryngeal carcinoma according to TNM classi-fication and has a great impact on management plan. There is a scarcity in the published literature regarding the comparison between MRI and CT for assessment of cartilage involvement. Aim of Study: To assess the validity of MRI and to compare this with CT findings in predicting inner and outer thyroid cartilage laminae invasion in patients with laryngeal carcinoma. Patients and Methods: The present study was an obser-vational analytical study that was carried out from January 2018 to June 2019 at the Radiology Department of Faculty of Medicine, Cairo University. A total of 30 patients with laryngeal carcinoma were included. CT and MRI was done for all patients. Results: There was a good agreement between readers in CT interpretation in term of inner lamina involvement (K=0.78) and very good agreement in term of outer lamina involvement (K=0.87). While in MRI interpretation, there was a very good agreement between readers in term of inner lamina involvement (K=0.83) and outer lamina involvement (K=0.92). However higher accuracy & confidence levels were found on interpre-tation of both CT and MRI together. We found a higher interobserver agreement between interpretation of CT and MRI together (K=1.00). Conclusion: MRI showed high validity and precision in detecting inner and outer thyroid lamina invasion by laryngeal caner than CT scan. We found that the combination of CT and MRI together was associated with more accuracy and confidence level for the readers.

Objective: To explore (a) the risk factors associated with a deficiency of vitamin B12, and (b) the baseline (cutoff) serum level of vitamin B12 for a clinically-symptomatic deficiency in the Jordanian adult population. Background: Compared to the data available for developed countries, there is a marked scarcity of information on the levels and symptomology of vitamin B12 deficiency in developing countries, particularly in the Middle Eastern region. Methods: A total of 485 subjects were included in this study. Blood samples were drawn for biochemical analysis and data regarding socio-demographics, general health, anthropometric measures, and past medical, surgical, and medication history were collected. To explore the cut-off point, we compared all parameters included in a standard complete blood count as well as main symptoms reported to be associated with B12 deficiency between groups of different B12 cut-off values, consisting of those above and below 200, 175, 150 and 125 pg/ml. Results: Dietary habits, age, recurrent headaches, heart burn and peptic ulcer disease were found to be significantly associated with lower vitamin B12 levels. Surprisingly, daily smoking was associated with significantly higher B12 levels. The results revealed that none of the included potential indicators of B12 deficiency could be considered an indicative feature of deficiency. There were no significant differences neither in the symptoms nor in the CBC parameters between any of the tested study groups. Conclusion: Low dietary intake, older ages, recurrent headaches, heartburn and peptic ulcer disease, all could be considered as a risk factors of having low vitamin B12 levels within the Jordanians. Also, they tend to have lower levels of vitamin B12 levels, in comparison to countries in the West, without necessarily having deficiency symptoms. Cut-off value to diagnose functional B12 deficiency could be less than 125 pg/ml for the Jordanians. More local studies are needed to establish an accurate vitamin B12 cut-off value for the population in Jordan.

BACKGROUND: The diagnosis of osteomyelitis is a key step of diabetic foot management. Procalcitonin (PCT) is a novel infection marker. This study aimed to investigate the diagnostic value of procalcitonin and other conventional infection markers and clinical findings in diagnosis of osteomyelitis in diabetic foot patients. METHODS AND MATERIALS: This diagnostic value study was carried out on ninety patients with diabetic infected foot ulcers admitted in Kashan Beheshti Hospital, 2016. After obtaining consent, 10 cc blood sample was taken for measuring serum PCT, CBC, ESR, CRP and FBS. Clinical characteristics of the wounds were noted. Magnetic resonance imaging of the foot was performed in all patients to diagnose osteomyelitis. All statistical analyses were done with the use of SPSS-16. RESULTS: PCT levels were 0.13 ± 0.02 ng/mili patients with osteomyelitis (n= 45) and 0.04 ± 0.02 ng/ml in patients without osteomyelitis (n= 45). PCT, Erythrocyte sedimentation rate and C-reactive protein was found significantly higher in patients with osteomyelitis (p< 0.001). The ROC curve was calculated for PCT. The area under the ROC curve for infection identification was 1 (p< 0.001). The best cut-off value for PCT was 0.085 ng/ml. Sensitivity, specificity, and positive and negative predictive values were 100%, 97.8%,97.8% and 100%, respectively. CONCLUSION: In this group of patients, PCT was useful to discriminate patients with bone infection. Also, Erythrocyte sedimentation rate and C-reactive protein can be used as a marker of osteomyelitis in diabetic patients.

BACKGROUND: The inborn errors of immunity (IEIs) are a group of heterogeneous disorders mainly characterized by severe and recurrent infections besides other complications including autoimmune and inflammatory diseases. In this study, we aim to evaluate clinical, immunological, and molecular data of monogenic IEI patients with and without autoimmune manifestations. METHODS: We have retrospectively screened cases of monogenic IEI in the Iranian PID registry for the occurrence of autoimmunity and immune dysregulation. A questionnaire was filled for all qualified patients with monogenic defects to evaluate demographic, laboratory, clinical, and molecular data. RESULTS: A total of 461 monogenic IEI patients (290 male and 171 female) with a median (IQR) age of 11.0 (6.0-20.0) years were enrolled in this study. Overall, 331 patients (72.1) were born to consanguineous parents. At the time of the study, 330 individuals (75.7) were alive and 106 (24.3) were deceased. Autoimmunity was reported in 92 (20.0) patients with a median (IQR) age at autoimmune diagnosis of 4.0 (2.0-7.0) years. Sixteen patients (3.5) showed autoimmune complications (mostly autoimmune cytopenia) as the first presentation of the disease. Most of the patients with autoimmunity were diagnosed clinically with common variable immunodeficiency (42.4). The frequency of sinusitis and splenomegaly was significantly higher in patients with autoimmunity than patients without autoimmunity. In patients with autoimmunity, the most common pathogenic variants were identified in LRBA (in 21 patients, 23.0), ATM (in 13 patients, 14.0), and BTK (in 9 patients, 10.0) genes. In the evaluation of autoimmunity by different genes, 4 of 4 IL10RB (100), 3 of 3 AIRE (100), 21 of 30 LRBA (70.0) mutated genes had the highest prevalence of autoimmunity. CONCLUSIONS: Autoimmune phenomena are common features among patients with monogenic IEI and are associated with a more complicated course of the disease. Therefore, when encountering autoimmune disorders especially in the setting of dysgammaglobulinemia, it would be appropriate to conduct next generation sequencing (due to phenocopies of IEI genes) to discover responsible genes for the immune dysregulation at an early stage of the disease.

Amyloidosis is a condition characterised by extracellular tissue deposition of fibrils causing a wide range of clinical manifestations. This protein deposition can occur in any tissue, most commonly in the kidney, heart, skin, peripheral nervous system, and gastrointestinal tract. However, the deposition of amyloid fibrils in the synovium is seldom reported. Musculoskeletal manifestations are subtle, subclinical and rarely the patient presents with symptoms that resemble rheumatic diseases. Here, we describe a 55-year-old man with AL (amyloid light chain) amyloidosis who presented with inflammatory polyarthritis with significant morning stiffness, inflammatory low back pain, and painful thickened tongue. The patient had anaemia, macroglossia with lateral scalloping of the tongue, papules, and plaques in the periocular, perioral and perinasal area, bilateral carpal tunnel syndrome, localised soft tissue swelling over the joints, restricted movement in different joints with flexion contractures in some joints. Rheumatoid factor and ACPA were negative and the X-ray of the sacroiliac joints was normal. We confirmed amyloidosis by biopsy of an affected skin lesion. In the urine, no Bence Jones protein was found and bone marrow study and x-ray of the skull were normal. Plasma immuno-electrophoresis and serum free light chain (FLC) assay confirmed lambda light chain type monoclonal gammopathy. Take home message: Although AL amyloidosis is a rare condition, it should be considered while evaluating atypical symptoms in patients presenting with rheumatic complaints. A high index of suspicion is necessary for proper diagnosis as delay in diagnosis will yield a poorer treatment outcome.

Rationale: Patients with malignant/paramalignant pleural effusions (MPE/PMPEs) may have tunneled pleural catheter (TPC) management withheld due to infection concerns from immunosuppression associated with antineoplastic therapy. Objective: To determine the rate of infections related to TPC use and to determine the relationship to antineoplastic therapy, immune system competency and overall survival (OS)? Methods: We performed an international, multi-institutional study of MPE/PMPE patients undergoing TPC management from 2008-2016. Patients were stratified by whether or not they underwent antineoplastic therapy and/or were immunocompromised or not. Cumulative incidence functions and multivariable competing risk regression analyses were performed to identify independent predictors of TPC-related infection. Kaplan-Meier method and multivariable Cox proportional-hazards modeling were performed to examine for independent effects on OS. Results: A total of 1,408 TPCs were placed in 1,318 patients. Patients had a high frequency of overlap between antineoplastic therapy and an immunocompromised state (75-83%). No difference in the overall (6-7%), deep pleural (3-5%) or superficial (3-4%) TPC-related infection rates between subsets of patients stratified by antineoplastic therapy or immune status was observed. The median time to infection was 41 (interquartile range: 19-87) days following TPC insertion. Multivariable competing risk analyses demonstrated longer TPC duration was associated with a higher risk of TPC-related infection [subdistribution hazard ratio (95% CI): 1.03 (1.00-1.06), p=0.028]. Cox proportional-hazards analysis showed antineoplastic therapy was associated with better OS [hazard ratio (95% CI): 0.84 (0.73-0.97), p=0.015]. Conclusion: The risk of TPC-related infection does not appear to be increased by antineoplastic therapy use or an immunocompromised state. The overall rates of infection are low and comparable to immunocompetent patients with no relevant antineoplastic therapy. These results support TPC palliation for MPE/PMPE regardless of plans for antineoplastic therapy.

BACKGROUND: Mental disorders account for a substantial proportion of the years lived with disability (YLDs) globally. These estimates have generally been calculated top down based on summary statistics. The aim for this study was to calculate YLDs and a novel related measure, Health Loss Proportion (HeLP), for 18 mental and substance use disorders, based on person-level register data (bottom up).METHODS: A cohort of 6 989 627 Danish residents (5·9% had a diagnosis of a mental or substance use disorder registered in the Danish Psychiatric Central Research Register) was investigated. YLDs (the duration of disease multiplied by a disability weight) were calculated for the disorder of interest and for comorbid mental and substance use disorders. HeLPs were estimated as YLDs associated with an index disorder and comorbid mental and substance use disorders divided by person-years at risk in persons with the index disorder. All analyses were adjusted for mental and substance use comorbidity using a multiplicative model of disability weights.FINDINGS: Major depressive disorder was the most prevalent disorder, although schizophrenia was the leading cause of YLDs in both sexes combined (YLDs 273·3 [95 % CI 232·3-313·6] per 100 000 person-years). People diagnosed with schizophrenia lost the equivalent of 73% (63-83%) of healthy life per year due to mental and substance use disorders, the largest HeLP of all mental and substance use disorders. Comorbidity of mental and substance use disorders accounted for 69-83% of HeLPs in people with either cannabis use disorders, other drug use disorder and ADHD. By contrast, comorbidity explained 11-23% of the HeLPs in people with autism spectrum disorders, conduct disorder, and schizophrenia.INTERPRETATION: Substantial variation in disability was observed across age, sex, and disorders. The new HeLP metric provides novel details of the contribution of comorbidity to the disability associated with mental and substance use disorders.FUNDING: The Danish National Research Foundation, Queensland Government Department of Health, European Union's Horizon 2020, Lundbeck Foundation, Stanley Medical Research Institute.TRANSLATION: For the Danish translation of the abstract see Supplementary Materials section.

Background: Meningiomas that have any relation to the superior sagittal sinus are called parasagittal meningiomas. They have an insidious onset and grow gradually and can reach a large size without any manifestations. The surgical management of these tumors is still controversial whether to excise the tumor completely with risks of cerebral infarction and massive brain edema or to excise it gradually with lifting some tumor remains with the risk of tumor recurrence. Objective: To report our experience with the surgically managed parasagittal meningiomas with analysis of factors that influence the patients’ outcome and reporting the complications including tumor recurrence. Patient and method: A retrospective study was applied on 27 patients (17 females and 10 males) with parasagittal meningiomas in Sohag District between September 2015 and September 2018 with a mean age of 53.5 ± 2 years. Preoperative and postoperative data were collected and analyzed. Results: Out of 27 patients, in 14 of them the sinus was patent, in 9 the sinus was partially occluded, and 4 patients had complete sinus occlusion. The sinus was ligated and excised with the tumor in 11 patients, of those eleven patients, four had venous infarction and three had postoperative massive brain edema. The second group included 16 patients at which, residuals of tumors were left behind with the sinus. Remote follow-up of this group show recurrence in 3 patients. Conclusion: The outcome of radical resection is favorable whenever possible as the main limiting factor for achieving gross total resection is sinus involvement. However complete excision is crucial to prevent recurrence and many factors share in the success of the surgery. However, the sinus invaded meningiomas should be cautiously managed to prevent postoperative hemodynamic complications.

BACKGROUND The influence of using different insertion torque values on clinical and radiographic outcomes of implant therapy is unclear in the current literature. The aim of this systematic review and meta-analysis was to evaluate the implant outcomes and complications rates using high insertion torque values compared with those using regular insertion torque value levels. METHODS Randomized controlled trials (RCTs), nonrandomized controlled clinical trials (NRCCTs), prospective and retrospective cohorts were searched for in electronic databases and complemented by hand searching relevant dental journals. The risk of bias was assessed using the Cochrane Collaboration's Risk of Bias tool for randomized and nonrandomized studies. Data were analyzed using a statistical software. RESULTS A total of 718 studies were identified, of which, nine studies were included with 1229 dental implants in 684 participants. The meta-analysis of RCTs showed that the overall implant failure rate was not notably in favor of any insertion torque value and the difference between the two groups was not statistically significant (risk ratio 0.85; 95% confidence interval 0.07-10.52; P = 0.90). None of the RCTs was registered. The secondary analyses of non-RCTs did not either show any statistically significant difference. Overall meta-analysis did not show any significant differences in peri-implant marginal bone loss or biological/technical complications between high (≥50 Ncm) and regular insertion torque (

Objectives: Demodicosis is a vital skin problem in dogs. The present study has determined the prevalence and associated risk factors of demodicosis in dogs and the response to treatment. Materials and Methods: A total of 100 skin scrapings were collected from dogs having dermatolog¬ical lesions brought to the Teaching and Training Pet Hospital and Research Center of Chattogram Veterinary and Animal Sciences University for treatment purpose. The collected scrapings were dissolved in 10% potassium hydroxide to detect mites through microscopic examination. Various risk factors like breed, age, sex, hair type, health status, and management system (indoor and outdoor) were analyzed using the logistic regression model. Positive cases were treated with oral ivermectin (Scabo®; at 0.6 mg/kg/day) along with amitraz 12.5% (Ridd®) diluted to 0.05% for rub¬bing on the body after bathing with chlorhexidine shampoo (PetHex®). Clavulanate amoxicillin (Moxaclav®) and omega-3 fatty acids (OMG-3®) were also suggested to prevent secondary bacte¬rial infection and to maintain skin and hair coat integrity. The recovery rate was observed every 24 weeks of treatment upto 1113 weeks. Results: The overall prevalence of demodicosis was recorded as 27%. Hair type, health status, and management system were significantly (p < 0.05) associated with the occurrence of demodicosis in dogs. Following treatment, the first negative skin scraping for mite was noticed at 810 weeks of treatment, and in all cases, clinical signs completely disappeared at 8090 days of treatment. Conclusion: A good percentage of the dogs having dermatological lesions was determined as demodicosis. Long-term oral ivermectin and topical amitraz, an oral antibiotic, and nutritional therapy are effective against canine demodicosis. Keeping long-haired dogs with good body con¬dition and indoor management is highly suggestive of preventing and controlling the disease. [J Adv Vet Anim Res 2021; 8(1.000): 116-122]

As network security monitoring grows more sophisticated, there is an increasing need for outsourcing such tasks to third-party analysts. However, organizations are usually reluctant to share their network traces due to privacy concerns over sensitive information, e.g., network and system configuration, which may potentially be exploited for attacks. In cases where data owners are convinced to share their network traces, the data are typically subjected to certain anonymization techniques, e.g., CryptoPAn, which replaces real IP addresses with prefix-preserving pseudonyms. However, most such techniques either are vulnerable to adversaries with prior knowledge about some network flows in the traces or require heavy data sanitization or perturbation, which may result in a significant loss of data utility. In this article, we aim to preserve both privacy and utility through shifting the trade-off from between privacy and utility to between privacy and computational cost. The key idea is for the analysts to generate and analyze multiple anonymized views of the original network traces: Those views are designed to be sufficiently indistinguishable even to adversaries armed with prior knowledge, which preserves the privacy, whereas one of the views will yield true analysis results privately retrieved by the data owner, which preserves the utility. We formally analyze the privacy of our solution and experimentally evaluate it using real network traces provided by a major ISP. The experimental results show that our approach can significantly reduce the level of information leakage (e.g., less than 1% of the information leaked by CryptoPAn) with comparable utility.

Coronavirus disease 2019 (COVID-19) is a contagious disease which was first identified in Wuhan, China in December 2019. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for this ongoing pandemic worldwide. COVID-19 itself has a high mortality rate but in addition with bacterial co-infection, the risk of death amplifies much higher. The diagnosis of COVID-19 along with other respiratory co-infections can be a difficult task due to the similarities in their presentations. Here, we present a case of 60-years-old gentleman who was COVID-19 positive, co-infected with three types of bacterial pathogens, which were Mycobacterium tuberculosis, Enterobacter spp. and Pseudomonas. The patient was isolated and treated according to the pathogens’ culture sensitivity reports and was discharged when his condition improved and advised for routine follow-up. The source of the co-infection could not be identified and may have been hospital acquired. Therefore, every hospital should give utmost priority to infection prevention and control (IPC) strategies.

Background: Autism Spectrum Disorder (ASD) is a neurobehavioral disorder for which till date, no pharmacological treatment has been proven effective. Some studies on complementary alternative medicines have shown neurobehavioral improvements among children diagnosed with ASD, notably with the administration of a combination of Vitamin B6 and Magnesium. Methods: This trial was designed to observe the effectiveness of a combination of Vitamin B6 and Magnesium in children with ASD with hyperactivity. One of the primary aim was to investigate any improvement among the six domains of ASD: general observation, cognition, emotion, social behavior, communication, and sensory deficits. Patients attending the outpatient department of the Institute of Pediatric Neurodisorder and Autism (IPNA), Bangabandhu Sheikh Mujib Medical University, diagnosed as ASD, were selected for this trial on meeting the selection criteria diagnosed by DSM 5 (Diagnostic and Statistical manual of Mental disorders) and ADCL (Autism Diagnostic CheckList). Then the patients were randomly assigned into intervention group (Vitamin B6 and Magnesium) or placebo group. The intervention group received tablets of Vitamin B6 and Magnesium daily, for 3 months, where the dosage was pre-determined by age of the subjects. Patients aged 2-3 years received 50mg Magnesium and 25mg Vitamin B6 daily, aged 4-8 years received 100mg Magnesium and 50mg Vitamin B6 daily, and patients aged 9-12 years were given 200mg Magnesium and 100mg Vitamin B6 daily. The placebo group received similar looking oral placebo tablets for the duration as the intervention group. After 3 months, each patient was assessed once again using ADCL tool by a psychologist. Results: Seventy (70) patients were enrolled for this study over a period of seven months. Among them fifty (50) met all criteria to be eligible for analysis. Therefore, intention to treat (ITT) was seventy (70) and per protocol treatment was fifty (50). Of these patients, twenty-seven (27) received Vitamin B6 and Magnesium and twenty-three (23) received placebo. The improvement observed in the proportion of patients in the intervention group (81%) was significantly (pd”0.05) higher compared to placebo (47%) group. This study revealed an overall improvement in the symptoms of autism along with improvements in specific domains e.g., Emotion (pd”0.01) and Cognition (pd” 0.05). Conclusion: Despite the small population size, this study demonstrated neurobehavioural improvement among children with ASD with hyperactivity and irritability. Consequently, this can be expected that future studies conducted on a larger scale might help to establish the beneficial role of Vitamin B6 and Magnesium as a complementary treatment for autism with hyperactivity and irritability. Bangladesh J Medicine January 2021; 32(1) : 12-18

Background: Despite increased use of rigid bronchoscopy (RB) for therapeutic indications and recommendations from professional societies to use performance-based competency, an assessment tool has not been utilized to measure the competency of trainees to perform RB in clinical settings. Objectives: The aim of the study was to evaluate a previously developed assessment tool – Rigid Bronchoscopy Tool for Assessment of Skills and Competence (RIGID-TASC) – for determining the RB learning curve of interventional pulmonary (IP) trainees in the clinical setting and explore the variability of learning curve of trainees. Methods: IP fellows at 4 institutions were enrolled. After preclinical simulation training, all RBs performed in patients were scored by faculty using RIGID-TASC until competency threshold was achieved. Competency threshold was defined as unassisted RB intubation and navigation through the central airways on 3 consecutive patients at the first attempt with a minimum score of 89. A regression-based model was devised to construct and compare the learning curves. Results: Twelve IP fellows performed 178 RBs. Trainees reached the competency threshold between 5 and 24 RBs, with a median of 15 RBs (95% CI, 6–21). There were differences among trainees in learning curve parameters including starting point, slope, and inflection point, as demonstrated by the curve-fitting model. Subtasks that required the highest number of procedures (median = 10) to gain competency included ability to intubate at the first attempt and intubation time of Conclusions: Trainees acquire RB skills at a variable pace, and RIGID-TASC can be used to assess learning curve of IP trainees in clinical settings.

Objective Tea lovers are increasing worldwide. We hope that this report is the first to discuss the possible impacts of high black tea consumption on gestational weight gain (GWG) and birth parameters. Methods Throughout one year, a total of 7,063 pregnant ladies coming for first antenatal visit were screened in a major tertiary center. Of them, 1,138 were involved and divided according to their preference into 3 groups: excessive tea (ET), usual tea (UT), and mixed beverages group. The study included women who gave birth to healthy neonates. Results The rate of ET consumption was 4.13% with a total of 41 cases. The UT group (controls) comprised 94 women. ET was significantly associated (P

Aim: Nosocomial infection is one the most important health problem in the world. In trauma patients, nosocomial infection is one the most important factor of morbidity and mortality, increased hospitalization days, economic costs, and patient dissatisfaction. This study aimed at assessing the frequency of nosocomial infection and its related factors in hospitalized trauma patients in Beheshti Hospital in Kashan, Iran. Materials and Methods: This descriptive study was conducted on 338 trauma patients who had been admitted to Kashan Beheshti Hospital during 2015. Data were collected using the questionnaire containing demographic and paraclinical results in trauma patients. The patients were examined for fever and nosocomial infection daily. The data were analyzed using t-test and Chi-square by the SPSS software version 16. Results: Twenty-one (6.2%) out of 338 trauma patients had nosocomial infection. There were 7 (33.3%) surgical site infections, 5 (23.8%) pneumonia, 5 (23.8%) soft-tissue infection, and 3 (14.2%) urinary tract infection and 4 (19.04%) fever with of unknown origin. There was a significant statistical association between underlying disease, duration of hospitalization, multiple trauma, surgical intervention, using the device, and history of admission to ICU with the rate of the infections. However, there was no significant association between sex, age, body mass index, and smoking with the rate of the infection. Conclusions: The rate of nosocomial infection was 6.2% and it was lower than other studies. The nosocomial infection is more frequent in patients with underlying diseases, with surgical intervention, admission in ICU, using device, multiple trauma, and more duration of hospitalization.

Purpose This paper aims to highlight the very recent cases of internet shutdown during the creation of Union territory of Jammu and Kashmir and enactment of Citizenship Amendment Act and the detention under Section 66 (A) of Information Technology Act 2000. Design/methodology/approach This study takes up a broad explorative discussion of the challenges posed to the consolidation of democracy in India due to frequent internet shutdowns for online communication and social media usages. Findings As findings, it is narrated that due to politically motivated reasons, India compromises its commitment to the pluralism and diversity in views, in particular, individual rights to freedom of expression and opinion, enshrined in the constitution. Originality/value Right to freedom of speech and expression has now taken a new shape due to the emergence and availability of the internet that enriches the quality of democracy.

The paper seeks to present an innovative Bio-mimicking approach that utilizes Cyber-Physical Systems technology as a construction system based on a Knowledge-Based System that can ease the integration of this technology to the built environment. The paper starts by reviewing the relation between biological and architectural systems. Then it moves to bio-mimicking as a sustainability achieving approach and executes a review for growth phenomenon and self-organizing process. It then tracks the current paradigms of architectural robotics, with a specific focus on cyber-physical systems. After that, it comprehensively analyses an especially developed knowledge-based system that is architecturally oriented to control the construction process based on cyber-physical systems. Finally, the paper presents a successful construction process simulation for a complex case study based on a previously developed cyber-physical systems prototype to examine the functionality of the knowledge-based system, especially on generating and modifying building configurations. The paper represents a benchmark for creating a comprehensive and functional software for the using cyber-physical systems on the built environment field; however, there are some remaining obstacles, especially on the hardware level. Additionally, there is a critical need for real-time experiments to validate the cyber-physical systems as a reliable construction system.

Although it is estimated that COVID-19 life-threatening conditions may be diagnosed in less than 1:1000 infected individuals below the age of 50, but the real impact of this pandemic on pediatric patients with different types of primary immunodeficiency (PID) is not elucidated. The current prospective study on a national registry of PID patients showed that with only 1.23 folds higher incidence of infections, these patients present a 10-folds higher mortality rate compared to population mainly in patients with combined immunodeficiency and immune dysregulation. Therefore, further management modalities against COVID-19 should be considered to improve the survival rate in these two PID entities using hematopoietic stem cell transplantation and immunomodulatory agents. Supplementary Information The online version contains supplementary material available at 10.1007/s10875-020-00928-x.

Background and Purpose: We aim to describe the burden, characteristics, and cognitive associations of cerebral small vessel disease in a Canadian sample living with multimorbidity in precarious housing. Methods: Participants received T1, T2-fluid-attenuated inversion recovery, and susceptibility-weighted imaging 3T magnetic resonance imaging sequences and comprehensive clinical, laboratory, and cognitive assessments. Cerebral small vessel disease burden was characterized using a modified Small Vessel Disease (mSVD) score. One point each was given for moderate-severe white matter hyperintensities, ≥1 cerebral microbleeds, and ≥1 lacune. Multivariable regression explored associations between mSVD score, risk factors, and cognitive performance. Results: Median age of the 228 participants (77% male) was 44.7 years (range, 23.3–63.2). In n=188 participants with consistent good quality magnetic resonance imaging sequences, mSVD scores were 0 (n=127, 68%), 1 (n=50, 27%), and 2 (n=11, 6%). Overall, one-third had an mSVD ≥1 n=61 (32%); this proportion was unchanged when adding participants with missing sequences n=72/228 (32%). The most prevalent feature was white matter hyperintensities 53/218 (24%) then cerebral microbleed 16/191 (8%) and lacunes 16/228 (7%). Older age (odds ratio, 1.10 [95% CI, 1.05–1.15], P P =0.008), and a history of injection drug use (odds ratio, 3.13 [95% CI, 1.07–9.16], P =0.037) had significant independent associations with a mSVD score of ≥1 in multivariable analysis. mSVD ≥1 was associated with lower performance on tests of verbal memory, sustained attention, and decision-making, contributing 4% to 5% of the variance in each cognitive domain. Conclusions: The 32% prevalence of cerebral small vessel disease in this young, socially marginalized cohort was higher than expected for age and was associated with poorer cognitive performance.

The study presents the determinants of the usage of social networking sites (SNSs) to accelerate the business potential of young entrepreneurs in a developing nation. It’s a quantitative study that considers 168 young entrepreneurs of Bangladesh. In analyzing the data, exploratory factor analysis has been used to justify the items associated with each variable while using a structural equation modeling approach to test the driven hypothesis. The study reveals that using social media as a promotional tool helps entrepreneurs to hasten their venture. In addition, changing purchasing behavior in this digital era and convenience and speed of Internet access also influence them to use SNSs intensively for growing their business enterprise. The findings of the study will help the key stakeholders to initiate key steps in order to create a more favorable business environment particularly for young entrepreneurs in this digital age of communication.

Background The management of recurrent pleural effusions remains a challenging issue for clinicians. Advances in management have led to increased use of indwelling tunneled pleural catheters (IPC) because of their effectiveness and ease of outpatient placement. However, with the increase in IPC placement there have also been increasing reports of complications, including infections. Currently there is minimal guidance in IPC-related management issues after placement. Research Question Our objective was to formulate clinical consensus statements related to perioperative and long-term IPC catheter management based on a modified Delphi process from experts in pleural disease management. Study Design and Methods Expert panel members used a modified Delphi process to reach consensus on common perioperative and long-term management options related to IPC use. Members were identified from multiple countries, specialties, and practice settings. A series of meetings and anonymous online surveys were completed. Responses were used to formulate consensus statements among panel experts, using a modified Delphi process. Consensus was defined a priori as greater than 80% agreement among panel constituents. Results A total of 25 physicians participated in this project. The following topics were addressed during the process: definition of an IPC infection, management of IPC-related infectious complications, interventions to prevent IPC infections, IPC-related obstruction/malfunction management, assessment of IPC removal, and instructions regarding IPC management by patients and caregivers. Strong consensus was obtained on 36 statements. No consensus was obtained on 29 statements. Interpretation The management of recurrent pleural disease with IPC remains complex and challenging. This statement offers statements for care in numerous areas related to IPC management based on expert consensus and identifies areas that lack consensus. Further studies related to long-term management of IPC are warranted.

Liver cancer is the second leading cause of cancer deaths worldwide. Without treatment, the five-year survival rate is less than 5%. Liver tumors are often detected using MRI. MRI is preferable over other imaging modalities include absence of ionizing radiation, superior soft tissue contrast resolution, and multiplanar imaging capabilities. Needle interventions are then needed for further diagnosis (biopsy) and treatment (ablation). Respiratory motion is the main cause of inaxccurate needle placement leading to misdiagnosis and insufficient treatment. In order to train clinicians to compensate for the liver respiratory motion during intervention, and also test needle insertion robotics technologies, a realistic liver motion simulator is of great interest which can be used inside MRI scanner. In this study, an MR-compatible soft robotic platform is developed to simulate liver respiratory motion. Pneumatically actuated soft robotic actuators were developed and validated using finite element simulations. A feedforward controller was developed to control the input air pressures of the pneumatic actuators to simulate the respiratory motion. The evaluative experiments indicated that the developed soft robotics diaphragm could acceptably simulate liver respiratory motion in the two directions of motion: superior-inferior and anterior-posterior directions.

Sufficient high-quality data are unavailable to describe the management approach and guideline of COVID-19 disease in pediatric and adolescent population which may be due to mild presentation in most of cases and less severe complications than older ages. World Health Organization was concerned with the establishment of an approved guideline to manage the increasing number of COVID-19 patients worldwide aiming to prevent or lessen COVID-19 global burden. The clinical features have a wide spectrum starting from uncomplicated mild illness, mild-moderate pneumonia, severe pneumonia, acute respiratory distress syndrome, sepsis, septic shock, and multisystem inflammatory syndrome in children. Many important definitions were developed to identify the COVID-19 case status including confirmed, suspected, and probable case. Many laboratory tests may be beneficially done but reverse transcriptase – polymerase chain reaction (RT-PCR) for SARS-CoV-2 RNA is diagnostic. Patient isolation and adequate intake of fluid and calories, antipyretics (preferably paracetamol), antibiotics (in secondary bacterial infections), and bed rest are the mainstay of approved supportive treatment. While oxygen supplementation may be added in moderate to severe cases; anticoagulation prophylaxis (enoxaparin) is strongly advised in children with certain situations where hypercoagulability state is identified, and therapy should be evaluated based on risk factors. New approaches, drugs, and therapies are currently under research to manage COVID-19 pediatric and adolescent patients including antivirals (lopinavir/ritonavir, and favipiravir), remdesivir, tocilizumab, dexamethasone, convalescent plasma, and specific treatment of multisystem inflammatory syndrome in children (immunoglobulin, steroids, tocilizumab, anakinra, and aspirin). The practical approach was summarized in a flow chart scheme to assist health care professionals to manage COVID-19 in children and adolescents within a rapid look though details are given in the text.

Misinformation about critical issues such as climate change and vaccine safety is oftentimes amplified on online social and search platforms. The crowdsourcing of content credibility assessment by laypeople has been proposed as one strategy to combat misinformation by attempting to replicate the assessments of experts at scale. In this work, we investigate news credibility assessments by crowds versus experts to understand when and how ratings between them differ. We gather a dataset of over 4,000 credibility assessments taken from 2 crowd groups---journalism students and Upwork workers---as well as 2 expert groups---journalists and scientists---on a varied set of 50 news articles related to climate science, a topic with widespread disconnect between public opinion and expert consensus. Examining the ratings, we find differences in performance due to the makeup of the crowd, such as rater demographics and political leaning, as well as the scope of the tasks that the crowd is assigned to rate, such as the genre of the article and partisanship of the publication. Finally, we find differences between expert assessments due to differing expert criteria that journalism versus science experts use---differences that may contribute to crowd discrepancies, but that also suggest a way to reduce the gap by designing crowd tasks tailored to specific expert criteria. From these findings, we outline future research directions to better design crowd processes that are tailored to specific crowds and types of content.