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Pseudohypoparathyroidism (PHP) is a group of disorders characterized by end-organ resistance to parathyroid hormone (PTH), resulting in high serum PTH, low calcium, and high phosphate levels. Among its 5 subtypes, PHP type 1a is the most common and leads to hereditary osteodystrophy, marked by short stature, short metacarpals, and electrolyte abnormalities such as hyperphosphatemia and hypocalcemia, which can cause tetany and seizures. Rarely, PHP patients can experience pathological fractures of long bones. This report discusses a 22-year-old female with PHP who presented with myoclonic seizures and bilateral hip fractures. Initial symptoms included fits, flank pain, and later, leg weakness. Diagnosis was based on clinical history, elevated serum PTH, low calcium, high phosphate, bilateral cataracts, hypothyroidism, basal ganglia calcification, and family history. Treatment began with IV calcium, followed by alfacalcidol, oral calcium, and antibiotics, leading to symptom remission. Hip fractures were managed with a POP cast and later closed reduction. The patient was discharged with calcium and 1,25 dihydroxy Vitamin D supplementation and scheduled for regular follow-up.

Objective: To develop deep learning (DL) models applied to neonatal cranial ultrasound (CUS) and clinical variables to predict neurodevelopmental impairment (NDI) in very preterm infants (VPIs) at 3 years of corrected age. Patients and Methods: This is a retrospective study of a cohort of VPI (220-306 weeks’ gestation) born between 2004 and 2016 in Nova Scotia, Canada. Clinical data at hospital discharge and CUS images at 3 time points were used to develop DL models using elastic net (EN) and convolutional neural network (CNN). The models’ performances were compared using precision recall area under the curve (PR-AUC) and area under the receiver operation characteristic curve (ROC-AUC) with their 95% ci. Results: Of 665 eligible VPIs, 619 (93%) infants with 4184 CUS images were included. The CNN model combining CUS and clinical variables reported better performance (PR-AUC, 0.75; 95% CI, 072-0.79; ROC-AUC, 0.71; 95% CI, 0.67-0.74) in the prediction of positive NDI outcome compared with the traditional models based solely on clinical predictors (PR-AUC, 0.60; 95% CI, 0.52-0.68; ROC-AUC, 0.72; 95% CI, 0.68-0.75). When analyzed by the CUS plane and acquisition time point, the model using the anterior coronal plane at 6 weeks of age provided the highest predictive accuracy (PR-AUC, 0.81; 95% CI, 0.77-0.91; ROC-AUC, 0.78; 95% CI, 0.66-0.87). Conclusion: We developed and internally validated a DL prognostic model using CUS and clinical predictors to predict NDI in VPIs at 3 years of age. Early and accurate identification of infants at risk for NDI enables referral to targeted interventions, which improves functional outcomes.

The thermal Charcoal for domestic used was crushed into powder and mixed with gravel. Four reactors of different proportion and size of charcoal and gravel were set up without vegetation. Sample of landfill leachates obtained from site of Pulau Burung Landfill, Penang, was introduced into the reactors. Ammonia, chemical oxygen demand (COD), and iron of inlet and outlet from four reactors were analyzed by standard methods. Result shows that overall performance of removing ammonia and iron were much better than COD. Keywords: charcoal, leachate, filter media

Background: Management of acromioclavicular (AC) joint injuries has been an ongoing source of debate, with over 150 variations of surgery described in the literature. Without a consensus on surgical technique, patients are seeking answers to common questions through internet resources. This study investigates the most common online patient questions pertaining to AC joint injuries and the quality of the websites providing information. Hypothesis: 1) Question topics will pertain to surgical indications, pain management, and success of surgery and 2) the quality and transparency of online information are largely heterogenous. Methods: Three AC joint search queries were entered into the Google Web Search. Questions under the “People also ask” tab were expanded in order and 100 results for each query were included (300 total). Questions were categorized based on Rothwell’s classification. Websites were categorized by source. Website quality was evaluated by the Journal of the American Medical Association (JAMA) Benchmark Criteria. Results: Most questions fell into the Rothwell Fact category (48.0%). The most common question topics were surgical indications (28.0%), timeline of recovery (13.0%), and diagnosis/evaluation (12.0%). The least common question topics were anatomy/function (3.3%), evaluation of surgery (3.3%), injury comparison (1.0%), and cost (1.0%). The most common websites were medical practice (44.0%), academic (22.3%), and single surgeon personal (12.3%). The average JAMA score for all websites was 1.0 ± 1.3. Government websites had the highest JAMA score (4.0 ± 0.0) and constituted 45.8% of all websites with a score of 4/4. PubMed articles constituted 63.6% (7/11) of government website. Comparatively, medical practice websites had the lowest JAMA score (0.3 ± 0.7, range [0-3]). Conclusion: Online patient AC joint injury questions pertain to surgical indications, timeline of recovery, and diagnosis/evaluation. Government websites and PubMed articles provide the highest-quality sources of reliable, up-to-date information but constitute the smallest proportion of resources. In contrast, medical practice represents the most visited websites, however, recorded the lowest quality score. Physicians should utilize this information to answer frequently asked questions, guide patient expectations, and help provide and identify reliable online resources.

Papillary fibroelastomas (PFEs) are small, slowly growing benign cardiac tumors with clinically significant risk of embolization. Surgical excision is the definitive treatment of symptomatic PFE and is conventionally performed through a median sternotomy. In this study, we report a series of 12 patients, who underwent robotic-assisted PFE removal at the Mayo Clinic. PFE involved the mitral valve, left atrium, and tricuspid valve. No major complications occurred after the procedure, and most patients were discharged 4 days after the surgery. On follow-up, 1 patient demonstrated pericarditis.

In this paper, a novel Hybrid Excitation Flux Switching Machine (HE-FSM) with DC-field excitation coil (DC-FEC) wounded in radial direction is proposed. The design is able to generate high torque and power performance because of a few points of interest such as robust rotor structure, non-overlapping windings and reduction of flux cancellation in stator yoke. However, the design with FEC in radial direction required no space between upper FEC and outer stator of machine which is lead to flux loss to surrounding area and flux saturation in stator yoke. As a solution, iron flux bridges have been introduced on the stator core to produce high torque execution. By using JMAG Designer ver. 14, numerous configuration of iron flux bridges have been presented and overviewed. Then, performances of torque at numerous flux bridges is analysed and compared. A design with highest torque is chosen to investigate the other performances of the machine.

In recent years, lean manufacturing is being followed by various sectors in order to keep their competitiveness in the global markets. Lean manufacturing plays a vital role in improving the efficiency of operation by eliminating or reducing wastes. Nonetheless, most of small and medium enterprises (SMEs) lack sufficient knowledge or information on the benefits of implementing lean manufacturing. The main objective of this study is to apply value stream mapping, one of lean manufacturing tools, for improving the productivity in a SME by eliminating non-value added activities. In this study, lean manufacturing was adopted at a SME, particularly a food industry. Value stream mapping was served as main tool to identify the wastes and improvement opportunities in production line. Subsequently, different lean manufacturing tools such as Kaizen Burst, one piece flow, and 5S were applied to eliminate or reduce identified wastes. Based on the future state value stream mapping, final results showed that the total operation time and non-added value activities time were successfully decreased from 1993 seconds to 1719 seconds, and 234 seconds to 104 seconds, respectively. The findings of this study indicate that value stream mapping is an effective approach to eliminate the wastes and improve the productivity.

Lean manufacturing is a systematic approch could increase manufacturing competitiveness by identifying and elminating waste through lean tools. However, these tools are often categorized into different groups, continues to be difficult for companies to select the most appropriate lean tool to be adopted, especially in respect of the SMEs whose knowledge of lean tools and associated principles are limited. This study is to propose solution on how to implement appropriate lean tools in food manufacturing industry located at Rengit, Johor. Qualitative method is used as a methodology to see the changes after the implementation of lean tools. Interview session also a part of method to collect data from respondents. The finding from this paper shows that implementation of an appropriate lean tool will help to eliminate waste in industry sector, maintain and control the inventory, improve quality of the product and improve overall operational process.

Background: Evidence regarding the effect of long-term exposure to particulate matter (PM) 2.5 and comorbid cancer and cardiovascular disease (CVD) mortality is limited. Objectives: In this study, the author report the association between long-term exposure to PM 2.5 and CVD mortality, cancer mortality and comorbid cancer and CVD mortality in the U.S. population. Methods: The Centers for Disease Control and Prevention (CDC) WONDER (Wide-Ranging Online Data for Epidemiologic Research) multiple-cause-of-death database was used to obtain U.S. county-level mortality and population estimates from 2016 to 2020. Data on average daily density of PM 2.5 were abstracted from the 2018 CDC’s National Environmental Public Health Tracking system. Counties were divided into quartiles with Q1 representing counties with least average daily density and Q4 representing counties with maximum average daily density of PM 2.5. Age-adjusted mortality rates were abstracted for each quartile, for the overall population and subgroups of population. Results: The age-adjusted mortality rates for CVD, cancer, and comorbid cancer and CVD mortality were 505.3 (range: 505.0-505.7), 210.7 (range: 210.5-210.9), and 62.0 (range: 61.8-62.1) per 100,000 person-years, respectively. CVD mortality had the highest percentage excess mortality in Q4 compared with Q1, followed by comorbid cancer and CVD. Cancer had the least percentage excess mortality. A disproportionate effect of PM 2.5 exposure was noted on vulnerable and minority groups, based on Social Vulnerability Index and race stratification, respectively. Conclusions: Higher levels of long-term PM 2.5 exposure reported increased CVD mortality, cancer mortality and comorbid cancer and CVD disease mortality, with a pronounced detrimental effect in vulnerable and minority population.

Objective: Postoperative delirium after cardiac surgery is associated with long-term cognitive decline and mortality. We investigated whether increased ICU Confusion Assessment Method scores were associated with greater 30-day mortality and failure to rescue after cardiac surgery. Methods: We studied 4030 patients who underwent a Society of Thoracic Surgeons index operation at the University of Virginia Health System from 2011 to 2021. We obtained all ICU Confusion Assessment Method scores recorded during patients' admission and summarized scores for the first 7 postoperative days. Univariate and multivariable logistic regression analyzed the association between ICU Confusion Assessment Method score/delirium presence and postoperative complications, operative mortality, and failure to rescue. Results: Any episode of ICU Confusion Assessment Method screen-positive delirium and nearly all components of the score were associated with increased 30-day mortality on univariate analysis. We found that a single episode of delirium was associated with increased mortality. Feature 2 (inattention) had the strongest association with poorer outcomes, including failure to rescue in our analysis, as were patients with higher peak Richmond Agitation Sedation Scale scores. Patients with higher mean Richmond Agitation Sedation Scale scores had an association with decreased failure to rescue. Conclusions: A single episode of delirium, as measured using ICU Confusion Assessment Method scores, is associated with increased mortality. Inattention and higher peak Richmond Agitation Sedation Scale scores were associated with failure to rescue. Screening may clarify diagnosing delirium and assessing its implications on mortality and failure to rescue. Our findings suggest the importance of identifying and managing risk factors for delirium to improve patient outcomes and reduce mortality and failure to rescue rates.