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Background: Hemorrhoids are a prevalent human ailment, and there are limited options available for traditional open surgical procedures. The primary complication frequently associated with open surgical procedures is the discomfort resulting from the contraction of the inner sphincter muscle. Performing a lateral internal sphincterotomy is a common procedure aimed at alleviating spasm and pain. The study aim was to compare the open hemorrhoidectomy with and without lateral internal sphincterotomy. Study type, settings & duration: This comparative randomized control trial was done at the Department of General Surgery, Akbar Niazi Teaching Hospital, Islamabad from September 2022 to September 2023. Methodology: Consecutively enrolled patients who underwent surgical intervention for 3rd and 4th degree hemorrhoids at the hospital were included, with the option of either receiving lateral internal sphincterotomy or undergoing the procedure without it. A total of 40 patients, ages 20-60 years were selected while adhering to the inclusion criteria of the study. There were 20 patients in the open hemorrhoidectomy-only group (Group A), while another 20 patients were in the open hemorrhoidectomy group (Group B), which included lateral internal sphincterotomy. The data underwent analysis using SPSS v 25. Results: The patients mean age was 38.66±9.32 years, 70% (n=28) were male, while the remaining 30% (n=12) were female. Group-B patients reported lower postoperative pain levels compared to those in Group-A. Upon final assessment, we identified 17 patients in group-B who reported being entirely free of pain, while in group-A, there were 9 patients with the same outcome. During the postoperative...........

Abstract Background A shorter length of stay (LOS) is associated with fewer hospital-acquired adverse conditions and decreased utilization of hospital resources. While modern perioperative care protocols have enabled some ambitious surgical teams to achieve discharge as early as within postoperative day 1 (POD1), most other teams remain cautious about such an approach due to the perceived risk of missing postoperative complications and increased readmission rates. We aimed to identify factors that would help guide surgical teams aiming for safe and successful POD1 discharge after lung resection. Methods We searched the PubMed, Embase, Scopus, Web of Science and CENTRAL databases for articles comparing perioperative characteristics in patients discharged within POD1 (DWPOD1) and after POD1 (DAPOD1) following lung resection. Meta-analysis was performed using a random-effects model. Results We included eight retrospective cohort studies with a total of 216,887 patients, of which 22,250 (10.3%) patients were DWPOD1. Our meta-analysis showed that younger patients, those without cardiovascular and respiratory comorbidities, and those with better preoperative pulmonary function are more likely to qualify for DWPOD1. Certain operative factors, such as a minimally invasive approach, shorter operations, and sublobar resections, also favor DWPOD1. DWPOD1 appears to be safe, with comparable 30-day mortality and readmission rates, and significantly less postoperative morbidity than DAPOD1. Conclusions In select patients with a favorable preoperative profile, DWPOD1 after lung resection can be achieved successfully and without increased risk of adverse outcomes such as postoperative morbidity, mortality, or readmissions.

The tri-allelic pattern is a genotyping abnormality that can be observed during routine short tandem repeat (STR) profiling in the field of forensic science. Fourteen tri-allelic patterns have been observed in nine different loci during routine forensic casework consisting of 20,000 STR profiles. All these 20,000 STR unrelated profiles were profiled using AmpFlSTR Identifiler Plus® and Global Filer® kits. Tri-allelic patterns can be divided into two types based on RFUs (relative fluorescent units) in peaks of three component alleles. Unequal RFUs of all three peaks are observed in the Type-I pattern, whereas in the Type-II pattern, RFUs of all three peaks are nearly equal. A total of nine novel tri-allelic genotypes were observed out of 20,000 unrelated individuals in the Pakistani population. All of these forensic cases belonged to the Type-I pattern which means that the sum of the height of two smaller peaks is nearly equal to the height of the third larger peak. The frequency of occurrence for all these patterns was compared with already reported data. In this study, eight novel tri-allelic patterns have been reported which are not listed in the National Institute of Standards and Technology (NIST) database as well as in any published article.

Abstract Background Schwannomas are solitary well-circumscribed encapsulated benign tumors that exhibit Schwann cell differentiation, and arise directly from myelinated peripheral or central nerves. Although they are usually asymptomatic and found incidentally, schwannomas can cause symptoms due to compression of nearby structures which, depending on the location, can make clinical presentations widely variable. Despite their rarity, schwannomas have been documented in a number of locations including the limbs, cerebellopontine angle, posterior mediastinum, and, far more infrequently, the lungs. Case presentation In this article, we report an incidental finding of an intrapulmonary schwannoma in a 59-year-old Pakistani woman who was grossly asymptomatic upon presentation to the cardiothoracic surgery clinic. An [18F]fluorodeoxyglucose positron emission tomography/computed tomography scan revealed a lobulated soft-tissue lesion measuring 23 mm × 23 mm in the lower lobe of the right lung. A computed tomography-guided core biopsy of the mass was performed, which revealed a benign spindle cell lesion based on histopathological examination and immunohistochemical staining. The mass was surgically resected via a right lower lobectomy, and subsequently confirmed to be an encapsulated neoplastic lesion composed of well-differentiated Schwann cells. There were no short- or long-term complications, morbidities, or recurrences based on 1-year follow-up. Conclusion This report underscores the predominantly asymptomatic nature of schwannomas and reemphasizes the efficacy of surgical resection as a safe and curative procedure for a tumor of this nature. Albeit very rare, intrapulmonary schwannomas can be considered a differential diagnosis when encountering solitary asymptomatic pulmonary nodules or masses.

Abstract Authorship determination on a research article remains a largely subjective process. Existing guidelines on authorship taxonomy lack objectivity and are more useful in determining who deserves authorship rather than determining the order of authors. To promote best practices in authorship taxonomy, we developed an authorship rubric that provides a fair, objective, and transparent means of crediting authorship. We christened this tool the “CalculAuthor”. The following steps are to be undertaken to create a scoring system based on the requirements of the projects: determining creditable criteria, assigning credit weightages, deciding levels of contribution, determining each author’s contribution, calculating authorship scores and ranking. These must be performed by or in close collaboration with the primary investigator (PI), with conflicts being resolved at the PI’s discretion. All team members should be informed about the authorship determination process early in the project and their agreement regarding its use must be obtained. While the CalculAuthor was developed to be used in medical research, its customizability enables it to be employed in any field of academia. We recommend that the CalculAuthor be piloted within institutions before its mainstream adoption, and any institution-specific factors should be considered to make the process more efficient and suitable.

ABSTRACTDamage to body tissue either deeply or superficially causes pain sensation in response to which Inflammation occurs which is a normal protective natural response of the body to a variety of hostile agents. Different treatment options, including conventional and herbal therapies, are available for pain and inflammation. This study was designed to evaluate the polyherbal n-hexane and methanolic extracts and their hydrogel formulations prepared from commonly available medicinal plants for their analgesic and anti-inflammatory potential. Cinnamomum verum J. (bark), Moringa oleifera L. (leaves), Nigella sativa L. (seed), and Trigonella foenum graecum L. (seed) were collected and purchased from the vicinity and local market of Multan Punjab, Pakistan. After drying, extraction was carried out by maceration separately with two different solvents (methanol and n-hexane). An equal quantity of all methanolic and n-hexane extracts was used to formulate polyherbal methanolic and n-hexane extracts separately. Then 1%, 3%, and 5% pH-based hydrogel formulations of methanolic and n-hexane polyherbal extract were prepared. All prepared six formulations were evaluated for pH, rheological study, spreadability, extrudability, stability study, texture, color, and for toxicological study. Then analgesic and anti-inflammatory potential of methanol and n-Hexane polyherbal extracts at (200, 400 and 800.0 mg/kg) in comparison with diclofenac sodium (100 mg/kg) and prepared gel formulations (1%, 3%, and 5%) were also evaluated in comparison to diclofenac sodium 1% gel (standard drug). Both polyherbal extracts and their gel formulations have significant analgesic and anti-inflammatory potential but methanolic extract and its hydrogel have slightly more potential as compared to n-hexane extracts and its prepared hydrogel. Results also revealed that their gel formulations have more significant analgesic and anti-inflammatory potentials as compared to extracts. All pH-based gels have good texture, spreadability, extrudability, stability, and are safe to use. It is concluded that methanolic polyherbal extract and hydrogel prepared from methanolic extract have more analgesic and anti-inflammatory potential as compare to n-Hexane extract and hydrogel prepare from n-Hexane extract.

Traditional deterministic channel modeling is accurate in prediction, but due to its complexity, improving computational efficiency remains a challenge. In an alternative approach, we investigated a multilayer artificial neural network (ANN) to predict large-scale and small-scale channel characteristics in metro tunnels. Simulated high-precision training datasets were obtained by combining measurement campaign with a ray tracing (RT) method in a metro tunnel. Performance on the training data was used to determine the number of hidden layers and neurons of the multilayer ANN. The proposed multilayer ANN performed efficiently (10 s for training; 0.19 ms for prediction), and accurately, with better approximation of the RT data than the single-layer ANN. The root mean square errors (RMSE) of path loss (2.82 dB), root mean square delay spread (0.61 ns), azimuth angle spread (3.06 dgree), and elevation angle spread (1.22 dgree) were impressive. These results demonstrate the superior computing efficiency and model complexity of ANNs.

An ideal metasurface design encompasses the control of all the degrees of freedom of electromagnetic (EM) waves. Here, we present a digital coding metasurface optimized for dual-band operations (in K and Ka band) for orthogonal polarizations. The proposed design allows for independent and the simultaneous control of the phases and amplitudes of cross-polarized transmitted waves in both (±z) direction. We employ the design to demonstrate distinct functionalities, which include single and multiple vortex beams carrying orbital angular momentum (OAM) of orders ‘l=+1’ and ‘l=−1’, and beam shaping with the feature of intensity modulations in distinct operating bands. We tested a prototype of the proposed design in the standard EM measurement environment, and the measured results agree well with the corresponding simulations. We remark that the digital coding metasurfaces presented here should improve the capacity of multiple-input multiple-output (MIMO) optical communication systems for power allocations in multi-band operations.

Introduction: Rhodococcus is an extremely rare, gram positive, aerobic, coccobacillary organism, usually found in the soil or in dairy and livestock animals. It is most commonly affecting the immunocompromised. Only 15 % of cases have been reported in immunocompetent hosts. Case report: We bring forth the unusual case of a 45-year-old gem minor who had already undergone pericardial window due to pericardial effusion. He presented to us with recurrent pericardial effusion and anterior mediastinal mass diagnosed on Computed Tomography Pulmonary Angiogram scan. He was diagnosed with Rhodococcus as being the causative organism of the condition on pericardial fluid cultures. This is an extremely rare manifestation of Rhodococcus infection, which has not yet been reported in literature to the best of our knowledge. Discussion: The first human case of Rhodococcus was reported in a young male upon steroidal therapy for autoimmune hepatitis who developed pneumonia in 1967. Rhodococci infections are usually common in immunocompromised hosts, and only 19 cases have been reported in immunocompetent hosts till now. The usual signs of presentation are cough, pleuritic chest pain, and fever; however, it varies according to the site of infection. The most common manifestation is pneumonia, although other presentations include osteomyelitis, brain abscess, wound infections, etc. Result: The diagnosis and treatment of Rhodococci is very difficult due to the rarity of presentation. Despite that, surgical intervention should be considered as the preferred modality for diagnostic purposes and in infections resistant to medical management.

Testicular choriocarcinomas make up less than 1% of all germ-cell tumors and are highly malignant, attributable to hematogenous spread. While the most common sites of metastasis are the lungs and liver, metastatic spread to the gastrointestinal tract is rare wherein patients may present with GI distress or even an upper GI bleed. In this report, we present a case of known testicular choriocarcinoma in a 40-year-old male who presented to the emergency room with severe anemia and a suspected upper GI bleed.

AbstractCurrent work on image-based story generation suffers from the fact that the existing image sequence collections do not have coherent plots behind them. We improve visual story generation by producing a new image-grounded dataset, Visual Writing Prompts (VWP). VWP contains almost 2K selected sequences of movie shots, each including 5-10 images. The image sequences are aligned with a total of 12K stories which were collected via crowdsourcing given the image sequences and a set of grounded characters from the corresponding image sequence. Our new image sequence collection and filtering process has allowed us to obtain stories that are more coherent, diverse, and visually grounded compared to previous work. We also propose a character-based story generation model driven by coherence as a strong baseline. Evaluations show that our generated stories are more coherent, visually grounded, and diverse than stories generated with the current state-of-the-art model. Our code, image features, annotations and collected stories are available at https://vwprompt.github.io/.

Thermo-physiological comfort of textile is related to thermal equilibrium between environment and human body and also provides a balance between the heat production of body and loss of heat. During working actions executed in hot conditions, body produces heat energy in large amount which increase the temperature of body. In consequence, body perspires in vapor and liquid form to reduce the temperature of the body. Thus the clothing requires next to the skin should have the capacity to allow the passage of heat and perspiration through it. Otherwise, it will cause the discomfort for the workers who work in hot environment. That is why the moisture management, air permeability, thermal resistance, and water vapor permeability of the fabric wear next to the skin are very important to maintain the thermal comfort of the worker. In this study eight different type of pure yarns were produced in which two are syntactic and other six are cellulosic and regenerated cellulosic. The six single jersey knitted fabrics were produced from the pure standard polyester yarn combination with cellulosic and regenerated cellulosic yarns through the single feeder of the sample knitting machine. The other six samples were produced from the pure micro polyester yarn combination with cellulosic and regenerated cellulosic yarns. The different tests were performed on the samples to evaluate the thermal comfort properties of the fabrics. The results showed that the single jersey knitted fabric produced from the pure micro polyester yarn combined with the pure tencel yarn provide good all over properties for the hot environment next to skin wear.

Introduction Surgical site infections (SSIs) are among the the most common postoperative complications, despite being highly preventable. Multiple studies have explored the incidence and risk factors of SSIs globally. However, nationally representative data capable of informing evidence-based guidelines remain limited in Pakistan. Hence, the aim of this study is to identify the incidence and risk factors of developing SSIs following surgery and to explore existing SSI prevention practices in Pakistan.Methods and analysis This study is a multicentre, prospective cohort study across various sites in Pakistan. All consecutive adult patients undergoing inpatient elective surgery in a 1 month patient recruitment window from one or more of the nine eligible subspecialties will be included in the study. Patients with preoperative infections, emergency surgeries or intraoperative mortality are to be excluded. The following surgical subspecialties are included: breast surgery, cardiac surgery, colorectal surgery, cranial surgery, general surgery, obstetrics and gynaecology, orthopaedics surgery, spine surgery and vascular surgery. Each mini-team of up to three collaborators can select one of the nine subspecialties and a 1 month patient recruitment window from 20 September 2022 to 31 March 2023. Multiple mini-teams from the same sites can recruit patients across the same subspecialty in distinct patient recruitment windows. Additionally, multiple mini-teams from the same sites can recruit patients across different subspecialties in the same or distinct patient recruitment windows. The primary outcome is 30 day SSIs. Secondary outcomes include 30 day antibiotic-resistant SSIs, organ-space infections, other healthcare associated infections, reinterventions and all-cause mortality.Ethics and dissemination Approval was received by the Aga Khan University (AKU) Ethics Review Committee (ERC) and the National Bioethics Committee (NBC) Pakistan. The results from this study will be disseminated by the steering committee in journal publications, conference presentations and on other academic platforms. Evidence-based guidelines that result from these data will be disseminated to all surgical care providers in Pakistan through national networks.

Existing atherosclerotic cardiovascular disease (ASCVD) risk stratification algorithms are predominantly validated only for Western populations, and do not include parameters of metabolic syndrome (MetS) which may increase the relative risk for cardiovascular disease in South Asians. This study aimed to compare the differences between 10-year ASCVD risk by the Framingham Risk Score (FRS), Pooled Cohort Risk Equations (PCE), and QRISK3 calculators in a cohort of apparently healthy Pakistani adults and stratify the ASCVD risk by MetS status.A cross-sectional study recruited 179 subjects between the ages of 40 to 74 years from the outpatient department of the Aga Khan University Hospital between May 2019 to November 2022. Anthropometry, demography, and blood samples were collected from each subject after informed consent. The IDF criteria were used to categorize subjects as MetS positive (n = 122) and MetS negative (n = 57). The mean age of study participants was 51.07±7.38 years. The average 10-year ASCVD risk (%) for our cohort was calculated to be 15.34 ± 11.60, 9.66 ± 10.87, and 17.02 ± 14.66 using the FRS algorithm, PCE calculator, and QRISK3 calculator respectively. MetS status did not show a statistically significant association with the risk categories determined by any of the calculators, although numerical ASCVD risk estimates were significantly higher in the MetS positive group for all calculators.Although ASCVD risk is a useful way to reduce CVD burden by identifying asymptomatic individuals at the highest risk of developing ASCVD, a high proportion of individuals with MetS may still be identified as low risk by the current risk stratification algorithms in South Asians. Powered validation studies with larger sample sizes and longitudinal follow-up are needed in South Asians to modify existing calculators to make them more applicable to South Asian populations.

This article investigates an operational orbit's design and sensitivity analysis for Earth observation (EO) missions in non-sun-synchronous orbits. Sun-synchronous orbits are the primary choice for deploying EO satellites, but in the absence of access to such orbits, alternative options can be considered, including multi-sun-synchronous orbits (MSSO) capable of repeating ground track (RGT).In this research, sets of such orbits are designed, taking into account the defined mission and considering the available altitude and inclination of the orbit. To achieve this, a constrained search problem is formulated, considering the constraints related to the characteristics of multi-sun-synchronicity and repeating ground tracks to search for orbit characteristics.Furthermore, to identify the allowable range of injection errors, a sensitivity analysis of the designed orbit's characteristics has been conducted to assess their sensitivity to uncertainties in injection accuracy during a case study investigation.

Climate change has and will continue to lead to unexpected weather patterns worldwide. These threaten to increase the risk of numerous diseases and disasters that negatively impact the health of populations. As a developing country, Pakistan must bolster its preparedness for such weather-related health problems by efficienty allocating resources to preventive measures and proactively implementing them. In recent history, torrential rainfall in areas such as Karachi, which usually receive meagre amounts of annual rainfall, has left many economic and health-related issues that harm the health of the population and disrupt healthcare delivery. For example, the massive accumulation of stagnant water following heavy rainfall acts is a breeding ground for mosquitoes. Thus, urban flooding is often accompanied by an increase in mosquito-related diseases such as dengue and malaria (1,2). Furthermore, the presence of airborne and allergenic fungal spores in the environment is positively correlated with increased amounts of rainfall (3). Heavy rain damages infrastructure, such as roads and electricity lines in urban areas. In addition to the disruption of transport and utilities, such damage leads to numerous hospitalizations and deaths in incidents such as motor accidents, burns, electrocution, falling into exposed gutters, drowning, and other similar tragedies (4). Beyond these direct effects on human health, healthcare delivery and resource mobilization are also hindered (5), further hampering the responsiveness and effectiveness of the healthcare system. While measures like disinfection drives may be useful in decreasing rain-related morbidity and mortality, a reactive approach must become an initiative-taking one. With comprehensive analyses of trends, such as those of hospitalizations during the monsoon season or the frequency of rain-related injury and disease in different areas, more informed preventive measures and “evidence-based anticipation” (5) of health burdens can be devised and deployed. Programmes to promote safety measures and awareness can be tailored to the needs of at-risk communities and burdened health-care centres. The allocation of precious resources can be made to those that need them most ahead of destructive weather. Climate change is a stark reality, as is the shortage of resources in developing countries like Pakistan. It is vital to acknowledge the profound impact of destructive weather on the public’s well-being and to act efficiently and proactively to mitigate it.

The automotive family design is known as one of the most complex engineering design problems with multiple groups of stakeholders involved from different domains of interest and contradictory attributes. Taking into account all stakeholders’ preferences, which are generally symmetrical, non-deterministic distributions around a mean value, and determining the right value of attributes for each alternative are two basic challenges for these types of decision-making problems. In this research, the possibility to achieve a robust-reliable decision by focusing on the two aforementioned challenges is explored. In the proposed methodology, a random simulation technique is used to elicit stakeholders’ preferences and determine the relative importance of attributes. The decision space and values of attributes are determined using the Knowledge Discovery in Databases (KDD) technique, and to achieve a robust-reliable decision, statistical and sensitivity analyses are performed. By implementing this methodology, the decision-maker is assured that the preferences of all stakeholders are taken into account and the determined values for attributes are reliable with the least degree of uncertainty. The proposed methodology aims to select benchmark platforms for the development of an automotive family. The decision space includes 546 automobiles in 11 different segments based on 34 platforms. There are 6223 unique possible states of stakeholders’ preferences. As a result, five platforms with the highest degree of desirability and robustness to diversity and uncertainty in the stakeholders’ preferences are selected. The presented methodology can be implemented in complex decision-making problems, including a large and diverse number of stakeholders and multiple attributes. In addition, this methodology is compatible with many Multi-Attribute Decision-Making (MADM) techniques, including SAW, AHP, SWARA, and TOPSIS.

Plants in coastal ecosystems are primarily known as natural sinks of trace metals and their importance for phytoremediation is well established. Salvadora persica L., a medicinally important woody crop of marginal coasts, was evaluated for the accumulation of metal pollutants (viz. Fe, Mn, Cu, Pb, Zn, and Cr) from three coastal areas of Karachi on a seasonal basis. Korangi creek, being the most polluted site, had higher heavy metals (HM’s) in soil (Fe up to 17,389, Mn: 268, Zn: 105, Cu: 23, Pb: 64.7 and Cr up to 35.9 mg kg−1) and S. persica accumulated most of the metals with >1 TF (translocation factor), yet none of them exceeded standard permissible ranges except for Pb (up to 3.1 in roots and 3.37 mg kg−1 in leaves with TF = 11.7). Seasonal data suggested that higher salinity in Clifton and Korangi creeks during pre- and post-monsoon summers resulted in lower leaf water (ΨWo) and osmotic potential at full turgor (ΨSo) and bulk elasticity (ε), higher leaf Na+ and Pb but lower extractable concentrations of other toxic metals (Cr, Cu, and Zn) in S. persica. Variation in metal accumulation may be linked to metal speciation via specific transporters and leaf water relation dynamics. Our results suggested that S. persica could be grown on Zn, Cr and Cu polluted soils but not on Pb affected soils as its leaves accumulated higher concentrations than the proposed limits.

Textile-supported nanocomposite as a scaffold has been extensively used in the medical field, mainly to give support to weak or harmed tissues. However, there are some challenges in fabricating the nanofiber/textile composite, i.e., suitable porous structure with defined pore size, less skin contact area, biocompatibility, and availability of degradable materials. Herein, polyamide-6 (PA) nanofibers were synthesized using needleless electrospinning with the toothed wheel as a spinneret. The electrospinning process was optimized using different process and solution parameters. In the next phase, optimized PA nanofiber membranes of optimum fiber diameter with uniform distribution and thickness were used in making nanofiber membrane–textile composite. Different textile fabrics (woven, non-woven, knitted) were developed. The optimized nanofiber membranes were combined with non-woven, woven, and knitted fabrics to make fabric-supported nanocomposite. The nanofiber/fabric composites were compared with available market woven and knitted meshes for mechanical properties, morphology, structure, and chemical interaction analysis. It was found that the tear strength of the nanofiber/woven composite was three times higher than market woven mesh, and the nanofiber/knitted composite was 2.5 times higher than market knitted mesh. The developed composite structures with woven and knitted fabric exhibited improved bursting strength (613.1 and 751.1 Kpa), tensile strength (195.76 and 227.85 N), and puncture resistance (68.76 and 57.47 N), respectively, than market available meshes. All these properties showed that PA nanofibers/textile structures could be utilized as a composite with multifunctional properties.

Abstract Background We investigated the surgical feasibility, safety and effectiveness of 50 W (low power) Holmium Laser enucleation of the prostate (HoLEP) in patients who have undergone previous template biopsy of the prostate (TPB). Methods Data encompassing pre-operative baseline characteristics, intra-operative measures and post-operative outcomes was collected for 109 patients undergoing HoLEP across two UK centres. Patients were stratified into two groups; group 1 (n = 24) had undergone previous TPB were compared with ‘controls’ (no previous TPB) in group 2 (n = 85). The primary outcome was successful HoLEP. Results There were no statistically significant differences in either key baseline characteristics or mass of prostate enucleated between groups 1 and 2. There was no statistically significant difference in enucleation or morcellation times parameters between the two groups other than enucleation efficiency in favour of group 1 (p = 0.024). Functional outcomes improved, without any statistically significant difference, in both groups. Conclusions In patients with a previous TPB, HoLEP is surgically feasible, safe and effective. TPB should not be considered a contraindication to HoLEP. Our work provides a strong foundation for further research in this area.

In this paper, a geometrically-based single-bounce multiple-input-multiple-output (GBSB- MIMO) channel model is proposed for the long term evolution-metro (LTE-M) system in tunnel scenarios. The periodic slots of leaky coaxial cable (LCX) are equivalent to a series of magnetic dipoles. Based on the electric field distribution of the LCX, the theoretical model for line-of-sight (LOS) and non-line-of-sight (NLOS) propagation paths in the tunnel environment are derived. The measurement and simulation results are compared in terms of condition number (CN), channel capacity, and channel correlation function (CF), which verifies the feasibility and rationality of the new proposed model. The simulation results demonstrate, under such circumstances when the Ricean K-factor is smaller, the LCX spacing has a little influence on the channel capacity and CN due to a large number of the NLOS propagation paths in the tunnel, while as Ricean K-factor increases, the LCX spacing has more influence on the channel capacity and CN. By comparison of the measurement and simulation results, it was found that the capacity and CN of the LCX-MIMO is better than the dipole MIMO with different Ricean K-factor values, and under such conditions when the spacing between LCXs and the dipole antennas is increased. Therefore, this paper delivers an optimal system design for channel capacity based on the LCX deployment in the tunnel environment.

In next-generation radio communication systems, the use of higher frequency bands and the massive multiple-input-multiple-output (MIMO) systems has turned into hot research topics because they have the potential to increase network capacity significantly by exploiting the available narrowband and broadband spectrums. Therefore, the narrowband channel measurements are executed at the following five potential frequency bands, including 2.6 GHz, 3.5 GHz, 5.6 GHz, 10 GHz, and 28 GHz in the Shanghai subway tunnel environment in order to fulfill the latest standards of fifth generation (5G). Moreover, in the broadband channel measurements, the center frequency is 3.5 GHz and 5.6 GHz and the bandwidth is considered as 160 MHz, respectively. At the transmitter (Tx) side, a uniform rectangular antenna array composed of 32 elements is fixed on the platform near the tunnel walls. The receiver (Rx) is equipped with a uniform cylindrical antenna array consisting of 64 elements, which is set on a trolley along the track. Based on the acquired massive MIMO channel impulse responses, delay spread, angle spread, eigenvalue and channel capacity are analyzed. The results reveal that the multipath delay in the tunnel scenario is quite short, the delay spread and angle spread drop rapidly as the distance between Tx and Rx increases and the channel matrix gradually becomes serious. This research provides a reference for the deployment of future 5G systems in the subway tunnel.

In order to meet the higher data transmission rate requirements of subway communication services, the millimeter wave (mmWave) broadband communication is considered as a potential solution in 5G technology. Based on the channel measurement data in subway tunnels, this paper uses ray-tracing (RT) simulation to predict the propagation characteristics of the 28 GHz millimeter wave frequency band in different tunnel scenarios. A large number of simulations based on ray-tracing software have been carried out for tunnel models with different bending radiuses and different slopes, and we further compared the simulation results with the real time measurement data of various subway tunnels. The large-scale and small-scale propagation characteristics of the channel, such as path loss (PL), root mean square delay spread (RMS-DS), and angle spread (AS), for different tunnel scenarios are analyzed, and it was found that the tunnel with a greater slope causes larger path loss and root mean square delay spread. Furthermore, in the curved tunnel, the angle spread of the azimuth angle is larger than that in a straight tunnel. The proposed results can provide a reference for the design of future 5G communication systems in subway tunnels.

An important and typical scenario of radio propagation in a railway or subway tunnel environment is the cascaded straight and curved tunnel. In this paper, we propose a joint path loss model for cascaded tunnels at 3.5 GHz and 5.6 GHz frequency bands. By combining the waveguide mode theory and the method of shooting and bouncing ray (SBR), it is found that the curvature of tunnels introduces an extra loss in the far-field region, which can be modeled as a linear function of the propagation distance of the signal in the curved tunnel. The channel of the cascaded straight and curved tunnel is thus characterized using the extra loss coefficient (ELC). Based on the ray-tracing (RT) method, an empirical formula between ELC and the radius of the curvature is provided for 3.5 GHz and 5.6 GHz, respectively. Finally, the accuracy of the proposed model is verified by measurement and simulation results. It is shown that the proposed model can predict path loss in cascaded tunnels with desirable accuracy and low complexity.

The phase of the channel matrix elements has a significant impact on channel capacity in a mobile multiple-input multiple-output (MIMO) communication system, notably in line-of-sight (LoS) communication. In this paper, the general expression for the phase of the channel matrix at maximum channel capacity is determined. Moreover, the optimal antenna configuration of the 2 × 2 and 3 × 3 transceiver antenna array is realized for LoS communication, providing methods for n×n optimal antenna placement, which can be used in short-range LoS communication and non-scattering environment communication, such as coupling train communication and inter-satellite communication. Simulation results show that the 2 × 2 rectangular antenna array is more suitable for the communication of coupling trains, while the 3 × 3 circular arc antenna array is more suitable for virtual coupling trains according to antenna configurations. Moreover, the 2 × 2 antenna rectangular configuration proposed in this paper has reached the optimal channel in inter-satellite communication, which lays a foundation for the deployment of communication systems.

Long Term Evolution-Metro (LTE-M), as a special communication system for train control, has strict requirements on adjacent channel interference (ACI). According to the 3rd Generation Partnership Project (3GPP) protocol of the European Telecommunications Standards Institute (ETSI) standards, this paper presents the required isolation degree for LTE-M systems to resist ACI. Aiming at the scenario of leaky cable transmission and antenna transmission adopted by the underground LTE-M system of the subway, the isolation degree required for LTE-M system deployment is deduced by combining the channel description with the principle of ACI. For the coexistence of a LTE-M system and an adjacent cellular system in a subway ground scenario, the Monte-Carlo (MC) method is used to simulate several conceivable scenarios of the LTE-M system and the adjacent frequency cellular system. In addition, the throughput loss of the LTE-M system is estimated by considering signal to interference plus noise ratio (SINR). Simulation results demonstrate that adjacent frequency user equipment (UE) has negligible small interference with the LTE-M underground system when using the leaky cable radiation pattern, whereas for the LTE-M ground system, the main interference comes from the adjacent frequency UE to the LTE-M base station (BS). Finally, interference avoidance solutions are presented, which can be utilized as a reference in the design and deployment of LTE-M systems in the rail transit environment.

We present a multi-agent computational approach to partitioning semantic spaces using reinforcement-learning (RL). Two agents communicate using a finite linguistic vocabulary in order to convey a concept. This is tested in the color domain, and a natural reinforcement learning mechanism is shown to converge to a scheme that achieves a near-optimal trade-off of simplicity versus communication efficiency. Results are presented both on the communication efficiency as well as on analyses of the resulting partitions of the color space. The effect of varying environmental factors such as noise is also studied. These results suggest that RL offers a powerful and flexible computational framework that can contribute to the development of communication schemes for color names that are near-optimal in an information-theoretic sense and may shape color-naming systems across languages. Our approach is not specific to color and can be used to explore cross-language variation in other semantic domains.

Ethiopia’s irrigated agriculture productivity has been threatened by severe salinity and sodicity problems which have resulted in significantly lower yields, food insecurity, and environmental degradation. The destructive effects of poor irrigation water management with the absence of drainage and anticipated future climate changes can accelerate the formation of salt-affected soil, potentially expanding the problem to currently unaffected regions. This paper synthesizes the available information on the causes, extent, and effects of salt-affected soils on soil and crop production and suggest chemical, biological, and physical reclamation and management approaches for tackling salinity and sodicity problems. The mitigation approaches (e.g., the addition of amendments, plantation of salt-tolerant crops, appropriate irrigation and drainage management, phytoremediation, and bioremediation) have successfully tackled soil salinity and sodicity problems in many parts of the world. These approaches have further improved the socioeconomic conditions of farming communities in salt-affected areas. The paper also discusses the effectiveness of these mitigation strategies under Ethiopian conditions. The policy interventions for reclamation of soil salinity and sodicity that indicates future research attention to restoring agricultural sustainability are also foci of this paper.

This paper presents the spatial domain and propagation characteristics of different wideband channels using leaky coaxial cables (LCXs) for underground environment at 1.8GHz corresponding to the Long Term Evolution for Metro (LTE-M) standards. Angular dispersion of the signal significantly affects the channel capacity, and it can be exactly predicted in both the near and far fields for underground environments by means of a multimode waveguide. A ray tracing phenomenon was exploited to visualize the wave propagation for different transmitter and receiver antenna distances by using the time domain approach for both the horizontally and vertically polarized LCXs. In order to achieve this goal, we characterized the power azimuth spectrum (PAS) and power angle profile (PAP) for different tunnel dimensions and found that the PAS can be demonstrated by a zero-mean Gaussian distribution whose angular spread (AS) is dependent on the transmitter-receiver distances and the tunnel dimensions. The results demonstrate that the horizontally polarized LCX has higher angular spread values than the vertically polarized one, and the correlation coefficient follows the decreasing function with the increment of angular spread.

This paper presents a three-dimensional (3D) geometry-based stochastic model (GBSM) for capturing the non-stationarity of radio channel at 1.8 GHz in a rectangular tunnel. A time-variant (TV) complex channel gain is derived for obtaining the statistical properties in time, frequency, and spatial domains such as the time-variant autocorrelation function (TV-ACF), the time-variant Doppler power spectral density (TV-DPSD), and the time-variant spatial cross-correlation function (TV-CCF), respectively. Then the TV channel statistical properties at different time instants can be extracted and the non-stationary channel characteristics caused by the TV scattering environment are thoroughly discussed. Furthermore, three cases including “approach”, “arrival”, and “away” are set to allow a comprehensive study on how the DPSD behaves with the relative position between transmitter and receiver. The reliability of proposed 3D GBSM is highlighted by a good agreement with the measured result in terms of the correlation function.

Orbital parameters are raised as one of the main inputs of electrical power subsystem and thermal control subsystem of a satellite. Some variables such as eclipse time, sun incidence angle to the panels, albedo and thermal radiation of Earth are dependent on satellite orbital features. In this paper, all of the parameters above are simulated using precise simulation methods within the satellite mission. That is, the process of optimal orbital design is performed with the aid of evolutionary optimization methods. This process is aimed at minimizing number of mission days that misses the assurance of satellite power supply in addition to minimizing thermal load exerted to satellite and also its standard deviation. At last, a pair of optimal solutions for two different configurations is compared.

In many industries inclusive of automotive vehicle industry, predictive maintenance has become more important. It is hard to diagnose failure in advance in the vehicle industry because of the limited availability of sensors and some of the designing exertions. However with the great development in automotive industry, it looks feasible today to analyze sensor’s data along with machine learning techniques for failure prediction. In this article, an approach is presented for fault prediction of four main subsystems of vehicle, fuel system, ignition system, exhaust system, and cooling system. Sensor is collected when vehicle is on the move, both in faulty condition (when any failure in specific system has occurred) and in normal condition. The data is transmitted to the server which analyzes the data. Interesting patterns are learned using four classifiers, Decision Tree, Support Vector Machine, K Nearest Neighbor, and Random Forest. These patterns are later used to detect future failures in other vehicles which show the similar behavior. The approach is produced with the end goal of expanding vehicle up-time and was demonstrated on 70 vehicles of Toyota Corolla type. Accuracy comparison of all classifiers is performed on the basis of Receiver Operating Characteristics (ROC) curves.

Thematic fit is the extent to which an entity fits a thematic role in the semantic frame of an event, e.g., how well humans would rate “knife” as an instrument of an event of cutting. We explore the use of the SENNA semantic role-labeller in defining a distributional space in order to build an unsupervised model of event-entity thematic fit judgements. We test a number of ways of extracting features from SENNA-labelled versions of the ukWaC and BNC corpora and identify tradeoffs. Some of our Distributional Memory models outperform an existing syntax-based model (TypeDM) that uses hand-crafted rules for role inference on a previously tested data set. We combine the results of a selected SENNA-based model with TypeDM’s results and find that there is some amount of complementarity in what a syntactic and a semantic model will cover. In the process, we create a broad-coverage semantically-labelled corpus.

This paper proposes a supplementary method for conceptual design of satellite electrical power subsystem(EPS). Each of represented methods for satellite electricalpower subsystemconceptual design in different references have some advantages and also disadvantages, besides in each of the methods a determined part of this subsystem has been in focused. In this research, first advantages and disadvantages of existing approaches for the conceptual design of electrical power subsystemwere reviewed, continued with combining of previous methods, improved relationships and using some of the simulation methods plus the using of statistical databases, a complementary method with more ascendency and less disadvantages in comparison with other approaches was presented. Finally, using a data from a specific satellite and the results of the statistical design, the complementary method has been validated.

The new radiation model for the electric field scattering of single leaky coaxial cable (LCX) being a transmitting antenna in the rectangular blind zone at 1.8 GHz is reported. The effect of varying the receiving antenna distance from the LCX on the fluctuation of radiated field using Ray-Tracing Method is examined. The line of sight and reflected paths between the LCX and receiving antenna for both horizontal and vertical polarizations are considered. Furthermore, it is inferred that the selection of appropriate period of slots and distance of the receiver reduce the fluctuations of electric field. The theory and procedures used in this paper can be extrapolated in different slot patterns of the LCX and zones which have many valuable applications for mobile communication in underground mines, tunnels, and railways.

The livestock productivity in Ethiopia is seriously constrained by the shortage of fodder due to increasing soil salinization. Therefore, restoration of salt-affected lands into productive soils through salt-tolerant forages and improved irrigation and crop management practices is crucial for enhancing the productivity of the livestock sector in Ethiopia. In this three-year study, pot trials were conducted to evaluate the impact of five different soil salinity levels (i.e., 0, 5, 10, 15, and 20 dS m−1) on plant growth, biomass production, and nutrient quality attributes of three Rhodes grass (Chloris gayana) genotypes (ILRI-6633, ILRI-7384, CV-massaba). Increasing soil salinity negatively affected germination percentage (GP) and mean germination time (MGT) of all genotypes. For all salinity levels, the highest GP was observed for ILRI-6633 and the lowest for CV-massaba. Plant height and chlorophyll content for ILRI-6633 was higher than the other two genotypes. The crude protein (CP) content was higher in low dry matter-producing genotype (ILRI-7384). The performance of ILRI-6633 at all salinity levels was superior to the other two genotypes. CV-massaba genotype performed better under low to medium soil salinity conditions. Therefore, ILRI-6633 and CV-massaba genotypes have excellent potential to increase forage production in salt-affected areas of Ethiopia.

ABSTRACT: Objective: The condition of 46XX congenital adrenal hyperplasia (CAH) causes a wide spectrum of phenotypic manifestations, ranging from ambiguous genitalia to complete virilization with an absence of testicular tissue. While this condition is usually diagnosed during childhood, rare cases have been diagnosed later in life.Methods: We report the case of an elderly male patient presenting at a tertiary health care facility in the United States with severe CAH. He was diagnosed as a chromosome 46XX phenotypic male with metastatic cervical cancer during a workup for gross hematuria.Results: A 78-year-old infertile male presented with sepsis, abdominal pain, and abdominal and pelvic masses. Imaging studies unexpectedly showed a uterus and an adnexal mass. Karyotype analysis revealed the patient as 46XX. The results of subsequent laboratory analyses were consistent with CAH. Surgical removal of the uterus revealed a cervical adenocarcinoma and a benign ovarian mass.Conclusion: This case highlights the potential for late diagnosis of severe CAH in 46XX individuals and the risks associated with unrecognized CAH.Abbreviations: CAH = Congenital adrenal hyperplasia DSD = disorder of sexual differentiation

While it has long been known that the pupil reacts to cognitive load, pupil size has received little attention in cognitive research because of its long latency and the difficulty of separating effects of cognitive load from the light reflex or effects due to eye movements. A novel measure, the Index of Cognitive Activity (ICA), relates cognitive effort to the frequency of small rapid dilations of the pupil. We report here on a total of seven experiments which test whether the ICA reliably indexes linguistically induced cognitive load: three experiments in reading (a manipulation of grammatical gender match/mismatch, an experiment of semantic fit, and an experiment comparing locally ambiguous subject versus object relative clauses, all in German), three dual-task experiments with simultaneous driving and spoken language comprehension (using the same manipulations as in the single-task reading experiments), and a visual world experiment comparing the processing of causal versus concessive discourse markers. These experiments are the first to investigate the effect and time course of the ICA in language processing. All of our experiments support the idea that the ICA indexes linguistic processing difficulty. The effects of our linguistic manipulations on the ICA are consistent for reading and auditory presentation. Furthermore, our experiments show that the ICA allows for usage within a multi-task paradigm. Its robustness with respect to eye movements means that it is a valid measure of processing difficulty for usage within the visual world paradigm, which will allow researchers to assess both visual attention and processing difficulty at the same time, using an eye-tracker. We argue that the ICA is indicative of activity in the locus caeruleus area of the brain stem, which has recently also been linked to P600 effects observed in psycholinguistic EEG experiments.

An Ellipsometric experimental set up of SOPRA ES4G type with a powerfulWVASE software for the theoretical calculus of the Ellipsometry parameters. TheEllipsometry Technique can determine amplitude and phase information Ψ( and Δ)dependent on wavelength range 250 nm to 900 nm (1.5 - 5 eV), including originalpractical solutions, were developed. Encouraging results of TiO2 were obtained inapplying the simple Ellipsometric method of azimuths to determine the opticalconstants for TiO2 with this optoelectronic device.

Aim: The study aimed to explore the incidence of cancer as an adverse event to SGLT2 inhibitors (SGLT2i) use in Type 2 diabetes. Materials & methods: The study followed PRISMA guidelines to pool RCTs conforming the inclusion criteria. Random effects model was used to pool risk ratios. Results & conclusion: After reviewing 19 studies, the analysis suggested a possible increased risk of reproductive, breast, thyroid, hematologic/lymphatic, urinary, skin and skeletal cancers with SGLT2i use. Conversely, lower incidences of respiratory and cardiovascular cancers were noted. However, these associations lacked statistical significance. Caution is advised in using SGLT2i due to potential cancer risks, especially in diabetic patients prone to cancer. More RCTs are essential due to limited research in this area.

Ready-to-use supplemental foods (RUSF) are energy-dense meals formulated to prevent and treat moderate and severe childhood acute malnutrition (MAM and SAM) in high-risk settings. Although lifesaving, the degree and durability of weight recovery with RUSF is unpredictable. We examined whether environmental enteric dysfunction (EED) and gut microbiota perturbations are risk factors for RUSF failure in a birth cohort of 416 rural Pakistani children followed for growth, common childhood illnesses, and biomarkers from blood, urine, and stool. Infants who developed wasting (weight-for-length Z score <-2, n=187, 45%) during surveillance received Acha Mum (a chickpea-based RUSF) daily for eight weeks. Machine learning identified seven biomarkers that predicted RUSF response (n=75) vs. non-response (n=112) with 73% accuracy. Remarkably, gut microbiome composition predicted RUSF response with 93% (pre-supplementation) and 98% (post-supplementation) accuracy. Seven outliers whose microbiome falsely predicted positive response experienced extraordinary burdens of inflammation and illness during supplementation. These findings identify gut microbial signatures and biomarkers of gut and systemic inflammation as robust predictors of RUSF response in infants free from intercurrent illness during recovery, setting the stage for predictive models to guide precision use of RUSF and adjunct therapies in undernourished children.

Diabetic retinopathy (DR) is a prominent reason of blindness globally, which is a diagnostically challenging disease owing to the intricate process of its development and the human eye's complexity, which consists of nearly forty connected components like the retina, iris, optic nerve, and so on. This study proposes a novel approach to the identification of DR employing methods such as synthetic data generation, K- Means Clustering-Based Binary Grey Wolf Optimizer (KCBGWO), and Fully Convolutional Encoder-Decoder Networks (FCEDN). This is achieved using Generative Adversarial Networks (GANs) to generate high-quality synthetic data and transfer learning for accurate feature extraction and classification, integrating these with Extreme Learning Machines (ELM). The substantial evaluation plan we have provided on the IDRiD dataset gives exceptional outcomes, where our proposed model gives 99.87% accuracy and 99.33% sensitivity, while its specificity is 99. 78%. This is why the outcomes of the presented study can be viewed as promising in terms of the further development of the proposed approach for DR diagnosis, as well as in creating a new reference point within the framework of medical image analysis and providing more effective and timely treatments., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Kamal et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Respiratory syncytial virus (RSV) is one of the leading causes of infant morbidity and mortality worldwide, especially in Pakistan. To date, few studies have explored RSV epidemiology in different areas of Pakistan. However, none have performed comprehensive phylogenetic and phylodynamic analyses of RSV strains. This study presents a comprehensive genetic and phylodynamic analysis of RSV strains in children less than five years old in Karachi, Pakistan., Methods: This study used retrospectively collected nasopharyngeal (swab) samples from 155 children with qPCR-confirmed RSV infection. The samples were used to perform RSV genotyping using PCR employing RSV glycoprotein gene-specific primers. The RSVA and RSVB genotyping was performed using BLAST and Maximum-likelihood (ML) phylogenetic methods. Similarly, the relationship with other RSV strains was analyzed using ML phylogenetic cluster analysis. The RSVA and RSVB mean genetic diversity and coefficient of differentiation were calculated using MEGA7 software. Furthermore, the time to the most common recent ancestor (tMRCA) and effective population size of RSV genotypes A and B were estimated using a Bayesian MCMC analysis. Finally, site selection pressure and glycosylation analyses were performed using FUBAR and NetNGlyc/NetOGlyc tools., Results: Out of 155, 98 and 57 sequences were RSVA and RSVB, respectively. The tMRCA was estimated to be around 2002 and 2005 for RSVA and RSVB, respectively. RSVA sequences formed two NA1 genotype clusters, comprising 95 and three sequences, respectively. RSVB formed three clusters, where 24 and two sequences clustered with BA9 and BA12 genotypes, respectively, while 31 sequences formed a unique cluster. The RSVA and RSVB glycoprotein gene sequences exhibited N- and O- glycosylation and selection pressure at several sites. RSV B exhibited slightly higher (0.042) nucleotide diversity per site (π) as compared to RSVA (0.019)., Conclusions: Our results suggest that RSVA and RSVB strains in Pakistan exhibit distinct genotypic clusters and differ in their estimated tMRCA. Additionally, both genotypes showed glycosylation and selection pressure at specific sites, with RSVB exhibiting higher nucleotide divergence per site (π), indicating its potential to undergo further evolutionary changes and adaptation. Overall, this study provides unique insights into RSV molecular epidemiology. The study may also help improve our understanding of RSV evolutionary changes and the emergence of new genotypes in different regions worldwide and within Pakistan., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Cardiovascular disease (CVD), including atherosclerosis, valvular etiologies, or myocardial disorders, is typically asymptomatic for several years, representing an occult phase of illness. Readily available preventive treatments to reduce cholesterol and blood pressure, among other risk factors, have the potential to reduce and delay incident myocardial infarction (MI), heart failure, and cardiovascular (CV) deaths. Measurement of circulating levels of cardiac troponin T (cTnT) and troponin I (cTnI) released from cardiomyocytes, as a result of injury, has been the biochemical standard for the diagnosis of MI for more than 20 years. The recent adoption of high-sensitivity (hs) assays, which are capable of measuring cTnT and I levels in more than 50% of the general population, has revealed a clear association between progressively higher biomarker levels and future CV events. In cross-sectional imaging studies, cTn levels measured by hs assays have also demonstrated correlations between elevated biomarker levels and occult CVD such as coronary artery disease and myocardial fibrosis. In this review, we provide evidence to consider measuring hs-cTnT and hs-cTnI to screen for patient CV risk and provide an example of a scenario in which such screening may improve outcomes through decision support for aggressive management of blood pressure., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Awwad, Parashar, Bagchi, Siddiqui, Ajari and deFilippi.)

Objective: Pretrained language models have recently demonstrated their effectiveness in modeling Electronic Health Record (EHR) data by modeling the encounters of patients as sentences. However, existing methods fall short of utilizing the inherent heterogeneous correlations between medical entities-which include diagnoses, medications, procedures, and lab tests. Existing studies either focus merely on diagnosis entities or encode different entities in a homogeneous space, leading to suboptimal performance. Motivated by this, we aim to develop a foundational language model pre-trained on EHR data with explicitly incorporating the heterogeneous correlations among these entities., Methods: In this study, we propose HEART, a heterogeneous relation-aware transformer for EHR. Our model includes a range of heterogeneous entities within each input sequence and represents pairwise relationships between entities as a relation embedding. Such a higher-order representation allows the model to perform complex reasoning and derive attention weights in the heterogeneous context. Additionally, a multi-level attention scheme is employed to exploit the connection between different encounters while alleviating the high computational costs. For pretraining, HEART engages with two tasks, missing entity prediction and anomaly detection, which both effectively enhance the model's performance on various downstream tasks., Results: Extensive experiments on two EHR datasets and five downstream tasks demonstrate HEART's superior performance compared to four SOTA foundation models. For instance, HEART achieves improvements of 12.1% and 4.1% over Med-BERT in death and readmission prediction, respectively. Additionally, case studies show that HEART offers interpretable insights into the relationships between entities through the learned relation embeddings., Conclusion: We study the problem of EHR representation learning and propose HEART, a model that leverages the heterogeneous relationships between medical entities. Our approach includes a multi-level encoding scheme and two specialized pretrained objectives, designed to boost both the efficiency and effectiveness of the model. We have comprehensively evaluated HEART across five clinically significant downstream tasks using two EHR datasets. The experimental results verify the model's great performance and validate its practical utility in healthcare applications. Code: https://github.com/Graph-and-Geometric-Learning/HEART., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

We introduce Cell2Sentence (C2S), a novel method to directly adapt large language models to a biological context, specifically single-cell transcriptomics. By transforming gene expression data into "cell sentences," C2S bridges the gap between natural language processing and biology. We demonstrate cell sentences enable the finetuning of language models for diverse tasks in biology, including cell generation, complex celltype annotation, and direct data-driven text generation. Our experiments reveal that GPT-2, when fine-tuned with C2S, can generate biologically valid cells based on cell type inputs, and accurately predict cell types from cell sentences. This illustrates that language models, through C2S fine-tuning, can acquire a significant understanding of single-cell biology while maintaining robust text generation capabilities. C2S offers a flexible, accessible framework to integrate natural language processing with transcriptomics, utilizing existing models and libraries for a wide range of biological applications.

Background: Environmental enteric dysfunction (EED) is an inflammatory condition of the small intestine that is prevalent in children residing in low- and middle-income countries. EED is accompanied by profound histopathologic changes in the small bowel, loss of absorptive capacity, increased intestinal permeability, increased microbial translocation, and nutrient loss., Objectives: We sought to identify dysregulated genes and pathways that might underlie pediatric EED., Methods: RNA-sequencing libraries were generated from endoscopically obtained duodenal tissue from undernourished children with EED from 3 prospective cohorts of children with EED. The EED transcriptome was defined in comparison to North American children without EED. Weighted gene coexpression network analysis (WGCNA) was tested for gene modules associated with EED and its histologic features., Results: The 1784 upregulated genes in EED were highly enriched for immune and inflammatory processes, including IL-17 and JAK-STAT signaling, and cytokine-cytokine receptor interactions. The 1388 downregulated genes included genes corresponding to xenobiotic metabolism, detoxification, and antioxidant capacities. A gene coexpression module enriched for antimicrobial responses and chemokine activity was significantly associated with villous blunting, goblet cell depletion, and overall histologic severity of EED., Conclusions: The transcriptome signatures of EED include specific innate and adaptive immune responses that are consistently elevated across study centers, coupled with reduced detoxification and antioxidant capacities. These data may have implications for targeted interventions to improve EED outcomes., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)