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ImportanceHealthcare organizations operate in a data-rich environment and depend on digital computerized systems; thus, they may be exposed to cyber threats. Indeed, one of the most vulnerable sectors to hacks and malware is healthcare. However, the impact of cyberattacks on healthcare organizations remains under-investigated.ObjectiveThis study aims to describe a major attack on an entire medical center that resulted in a complete shutdown of all computer systems and to identify the critical actions required to resume regular operations.SettingThis study was conducted on a public, general, and acute care referral university teaching hospital.MethodsWe report the different recovery measures on various hospital clinical activities and their impact on clinical work.ResultsThe system malfunction of hospital computers did not reduce the number of heart catheterizations, births, or outpatient clinic visits. However, a sharp drop in surgical activities, emergency room visits, and total hospital occupancy was observed immediately and during the first postattack week. A gradual increase in all clinical activities was detected starting in the second week after the attack, with a significant increase of 30% associated with the restoration of the electronic medical records (EMR) and laboratory module and a 50% increase associated with the return of the imaging module archiving. One limitation of the present study is that, due to its retrospective design, there were no data regarding the number of elective internal care hospitalizations that were considered crucial.Conclusions and relevanceThe risk of ransomware cyberattacks is growing. Healthcare systems at all levels of the hospital should be aware of this threat and implement protocols should this catastrophic event occur. Careful evaluation of steady computer system recovery weekly enables vital hospital function, even under a major cyberattack. The restoration of EMR, laboratory systems, and imaging archiving modules was found to be the most significant factor that allowed the return to normal clinical hospital work.

Background: Operating rooms are the core of hospitals. They are a primary source of revenue and are often seen as one of the bottlenecks in the medical system. Many efforts are made to increase throughput, reduce costs, and maximize incomes, as well as optimize clinical outcomes and patient satisfaction. We trained a predictive model on the length of surgeries to improve the productivity and utility of operative rooms in general hospitals. Methods: We collected clinical and administrative data for the last 10 years from two large general public hospitals in Israel. We trained a machine learning model to give the expected length of surgery using pre-operative data. These data included diagnoses, laboratory tests, risk factors, demographics, procedures, anesthesia type, and the main surgeon’s level of experience. We compared our model to a naïve model that represented current practice. Findings: Our prediction model achieved better performance than the naïve model and explained almost 70% of the variance in surgery durations. Interpretation: A machine learning-based model can be a useful approach for increasing operating room utilization. Among the most important factors were the type of procedures and the main surgeon’s level of experience. The model enables the harmonizing of hospital productivity through wise scheduling and matching suitable teams for a variety of clinical procedures for the benefit of the individual patient and the system as a whole.

Systemic sclerosis (SSc) is a rare and complex connective tissue disease associated with high morbidity and mortality. SSc is characterized by ischemic vasculopathy, cutaneous and visceral fibrosis and a dysimmune state (Denton and Khanna, 2017; Volkmann et al., 2023; Barnes and Mayes, 2012). We have derived induced pluripotent stem cell (iPSC) lines from two SSc patients aged 38 and 67 years with severe vascular phenotype. These iPSC lines expressed pluripotent markers, exhibited normal and stable genome, and differentiated into trilineage embryonic layers in teratoma formation assays. These SSc-specific iPSC lines can be differentiated into endothelial cells, providing a valuable model to elucidate vascular dysfunction and develop personalized therapeutic approaches.

Many works in the literature have studied the kinematical and dynamical issues of parallel robots. But it is still difficult to extend the vast control strategies to parallel mechanisms due to the complexity of the model-based control. This complexity is mainly caused by the presence of multiple closed kinematic chains, making the system naturally described by a set of differential–algebraic equations. The aim of this work is to control a two-degree-of-freedom parallel manipulator. A mechanical model based on differential–algebraic equations is given. The goal is to use the structural characteristics of the mechanical system to reduce the complexity of the nonlinear model. Therefore, a trajectory tracking control is achieved using the Takagi-Sugeno fuzzy model derived from the differential–algebraic equation forms and its linear matrix inequality constraints formulation. Simulation results show that the proposed approach based on differential–algebraic equations and Takagi-Sugeno fuzzy modeling leads to a better robustness against the structural uncertainties.

This study presents a numerical investigation of turbulent crude oil flows in circular curved pipelines, with a focus on the deposition patterns of solid particles within the fluid. Simulations were conducted using the Reynolds–Averaged Navier–Stokes equations coupled with the k–ε turbulence model to examine the influence of structural characteristics, such as bend curvature angle and bend curvature radius, on flow dynamics and particle deposition. The results reveal that the complex flow patterns generated by these geometric features significantly affect pressure gradients and particle trajectories. Specifically, the study shows that turbulent flows within bends exhibit intricate behaviors, with deposition patterns being strongly influenced by the pipeline's geometric parameters. Sand particles, commonly present in petroleum flows, are found to be more effectively transported in pipes with larger curvature angles, while they exhibit a higher propensity to settle at smaller curvature angles and larger bend curvature radii. Furthermore, the simulations indicate that the majority of deposited particles accumulate on the inner wall immediately downstream of the elbow entrance. [ABSTRACT FROM AUTHOR]

The ability of foam to reduce CO2 mobility in CO2 sequestration and CO2 enhanced oil recovery processes relies on maintaining foam stability in the reservoir. Foams can destabilize in the presence of oil due to mechanisms impacting individual lamellae. Few attempts have been made to measure the stability of CO2 foams in the presence of oil in a realistic pore network at reservoir pressure. Utilizing lab-on-a-chip technology, the pore-level stability of dense-phase CO2 foam in the presence of a miscible and an immiscible oil was investigated. A secondary objective was to determine the impact of increasing surfactant concentration and nanoparticles on foam stability. In the absence of oil, all surfactant-based foaming solutions generated fine-textured and strong foam that was less stable both when increasing surfactant concentrations and when adding nanoparticles. Ostwald ripening was the primary destabilization mechanism both in the absence of oil and in the presence of immiscible oil. Moreover, foam was less stable in the presence of miscible oil, compared to immiscible oil, where the primary destabilization mechanism was lamellae rupture. Overall, direct pore-scale observations of dense-phase CO2 foam in realistic pore network revealed foam destabilization mechanisms at high-pressure conditions. Highlights: Pore-scale observations of dense-phase CO2 foam in realistic pore network revealed foam destabilization mechanisms at high-pressure conditions. A comprehensive laboratory investigation of CO2 foam stability in the presence of oil at high pressure. [ABSTRACT FROM AUTHOR]

Abstract Background Neuronal cytoplasmic inclusions containing TAR DNA-binding protein 43 (TDP-43) are a neuropathological feature of several neurodegenerative diseases, including amyotrophic lateral sclerosis (ALS), frontotemporal dementia (FTD), and Alzheimer’s Disease (AD). Emerging evidence also indicates that systemic inflammation may be a contributor to the pathology progression of these neurodegenerative diseases. Methods To investigate the role of systemic inflammation in the progression of neuronal TDP-43 pathology, AAV9 particles driven by the UCHL1 promoter were delivered to the frontal cortex of wild-type aged mice via intracranial injections to overexpress TDP-43 or green fluorescent protein (GFP) in corticospinal motor neurons. Animals were then subjected to a low-dose (500 μg/kg) intraperitoneal E. coli lipopolysaccharide (LPS) administration challenge for 2 weeks to mimic a chronically altered low-grade systemic inflammatory state. Mice were then subjected to neurobehavioral studies, followed by biochemical and immunohistochemical analyses of the brain tissue. Results In the present study, we report that elevated neuronal TDP-43 levels induced microglial and astrocytic activation in the cortex of injected mice followed by increased RANTES signaling. Moreover, overexpression of TDP-43 exerted abundant mouse immunoglobulin G (IgG), CD3, and CD4+ T cell infiltration as well as endothelial and pericyte activation suggesting increased blood-brain barrier permeability. The BBB permeability in TDP-43 overexpressing brains yielded the frontal cortex vulnerable to the systemic inflammatory response following LPS treatment, leading to marked neutrophil infiltration, neuronal loss, reduced synaptosome-associated protein 25 (SNAP-25) levels, and behavioral impairments in the radial arm water maze (RAWM) task. Conclusions These results reveal a novel role for TDP-43 in BBB permeability and leukocyte recruitment, indicating complex intermolecular interactions between an altered systemic inflammatory state and pathologically prone TDP-43 protein to promote disease progression.

Objective Immunoglobulin G4-related disease (IgG4-RD) is a rare orphan disease. Lung, pleura, pericardium, mediastinum, aorta and lymph node involvement has been reported with variable frequency and mostly in Asian studies. The objective of this study was to describe thoracic involvement assessed by high-resolution thoracic computed tomography (CT) in Caucasian patients with IgG4-RD. Methods Thoracic CT scans before treatment were retrospectively collected through the French case registry of IgG4-RD and a single tertiary referral centre. CT scans were reviewed by two experts in thoracic imagery blinded from clinical data. Results 48 IgG4-RD patients with thoracic involvement were analysed. All had American College of Rheumatology/European League Against Rheumatism classification scores ≥20 and comprehensive diagnostic criteria for IgG4-RD. CT scan findings showed heterogeneous lesions. Seven patterns were observed: peribronchovascular involvement (56%), lymph node enlargement (31%), nodular disease (25%), interstitial disease (25%), ground-glass opacities (10%), pleural disease (8%) and retromediastinal fibrosis (4%). In 37% of cases two or more patterns were associated. Asthma was significantly associated with peribronchovascular involvement (p=0.04). Among eight patients evaluated by CT scan before and after treatments, only two patients with interstitial disease displayed no improvement. Conclusion Thoracic involvement of IgG4-RD is heterogeneous and likely underestimated. The main thoracic CT scan patterns are peribronchovascular thickening and thoracic lymph nodes.

The purpose of this study is to investigate how the open-air museum of Skansen in Stockholm as venue for celebration of Persian Fire Festival is assessed by the festival’s visitors. The study is based on a delimited part of a larger online survey with 280 completed questionnaires including both close-ended and open-ended questions, and a qualitative thematic analysis method has been used in this paper. The results show a high level of appreciation of the Skansen venue that gives the visitors positive emotions, meanings, place attachment, place identity and a sense of place. Contributing factors have been the high status of the venue that has given the visitors pride and dignity; security and safety of the venue; size of the venue; and the natural beauty of the venue. The most important disadvantage factor has been the lack of accessibility combined with lack of sufficient public transport. The results have implications for the Swedish society, for the policy makers in Stockholm city and for both the host and the organiser of the festival and gives rise to new debates on immigrants’ socio-cultural integration into Swedish society. This paper gives a contribution to existing literature on festival venue and its impact on the visitor’s overall assessment of the festival.