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Abstract Background Sexual coercion is one of the major public health concerns globally. This is even more worrying among young people with disabilities (YPWDs). This study assessed the prevalence and factors associated with sexual coercion among in-school young people with disabilities in Ghana. Methods Using a cross-sectional study design, pre-tested questionnaires were used to collect data from 979 YPWDs in 15 special schools for the visually and hearing impaired in Ghana. Sexual coercion was the outcome variable. Both descriptive (frequencies and percentages) and inferential analysis (binary logistic regression) were conducted. Results About 68% reported that they had been sexually coerced at some point in their lifetime. This was higher among males (69.9%) compared to females (66.8%). Those aged 15–19 (72.19%) had the highest prevalence compared to those aged 20–24 (61.74%). YPWDs in Junior High School [JHS] [aOR = 1.722; CI = 1.227,2.417], and those in the coastal zone [aOR = 1.616; CI = 1.068,2.443] had higher odds of being coerced. However, those belonging to the Islamic religion [aOR = 0.266; CI = 0.0764,0.928] and the visually impaired [aOR = 0.477; CI = 0.318,0.716] had lower odds of being coerced compared to those with no religion, and the hearing impaired, respectively. Conclusion There is a relatively high prevalence of sexual coercion among in- school YPWDs in Ghana. This is significantly associated with level of education, ecological zone, religion, and the type of disability. This calls for a concerted effort by policy makers such as the Ghana Education Service, Ghana Federation of the Disabled, Ministry of Education, Ministry of Gender, Children and Social Protection to intensify sex education and put in pragmatic steps to halt this serious public health issue.

Background: Surgical education lacks a standardized, proficiency-based approach to evaluation and feedback. Objective: To assess the implementation and reception (ie, feasibility) of an automated, standardized, longitudinal surgical skill assessment and feedback system, and identify baseline trainee (resident and fellow) characteristics associated with achieving proficiency in robotic surgery while learning robotic-assisted laparoscopic prostatectomy. Design, setting, and participants: A quality improvement study assessing a pilot of a surgical experience tracking program was conducted over 1 yr. Participants were six fellows, eight residents, and nine attending surgeons at a tertiary cancer center. Intervention: Trainees underwent baseline self-assessment. After each surgery, an evaluation was completed independently by the trainee and attending surgeons. Performance was rated on a five-point anchored Likert scale (trainees were considered “proficient” when attending surgeons’ rating was ≥4). Technical skills were assessed using the Global Evaluative Assessment of Robotic Skills (GEARS) and Prostatectomy Assessment and Competency Evaluation (PACE). Outcome measurements and statistical analysis: Program success and utility were assessed by evaluating completion rates, evaluation completion times, and concordance rates between attending and trainee surgeons, and exit surveys. Baseline characteristics were assessed to determine associations with achieving proficiency. Results and limitations: Completion rates for trainees and attending surgeons were 72% and 77%, respectively. Fellows performed more steps/cases than residents (median [interquartile range]: 5 [3–7] and 3 [2–4], respectively; p < 0.01). Prior completion of robotics or laparoscopic skill courses and surgical experience measures were associated with achieving proficiency in multiple surgical steps and GEARS domains. Interclass correlation coefficients on individual components were 0.27–0.47 on GEARS domains. Conclusions: An automated surgical experience tracker with structured, longitudinal evaluation and feedback can be implemented with good participation and minimal participant time commitment, and can guide curricular development in a proficiency-based education program by identifying modifiable factors associated with proficiency, individualizing education, and identifying improvement areas within the education program. Patient summary: An automated, standardized, longitudinal surgical skill assessment and feedback system can be implemented successfully in surgical education settings and used to inform education plans and predict trainee proficiency.

Background. The need to implement controlled coupling between qubits, which are the logical elements of quantum devices such as quantum computers and quantum networks, requires, along with the use of traditional methods, the development of new, more effective ways to organize the interaction of qubits with the microwave fields of resonators used to generate and control the entanglement of qubits. As one of these methods, a method based on the influence of frequency-regulated radio frequency signals on a superconducting Josephson qubit connected by a large Josephson junction to a free qubit has been proposed. Aim. The influence of the Kerr medium of the resonator, in which one of the two qubits is placed, on their entanglement induced by the coherent or thermal frequency-regulated radio frequency field of the resonator is considered. Methods. To analyze the dynamics of the system under consideration, the solution of the quantum Liouville equation for the full density matrix is studied. An exact solution o this equation is found in the case of initial separable and entangled states of qubits. The exact solution of the evolution equation is used to calculate the criterion of qubit-qubit entanglement – cconcurrence. Numerical modeling of the concurrence was carried out for various states of qubits, coherent and thermal fields of the resonator, as well as various values of the intensity of the resonator field and the Kerr nonlinearity parameter. Results. It is shown that for separable initial states of qubits, the inclusion of Kerr nonlinearity reduces the maximum degree of entanglement of qubits. For an entangled initial state of qubits, the possibility of creating long-lived entangled states in the presence of Kerr nonlinearity is shown. Conclusion. The type of initial states of qubits and the range of values of the intensities of the resonator fields and the Kerr nonlinearity parameters have been established, for which the most effective control and operation of the evolution of qubits, as well as the degree of their entanglement, in the physical system under consideration, is possible.

Background. Interest in the study of entangled states of systems of natural and artificial atoms (qubits) interacting with selected modes of microwave resonators is associated with their use as logic elements of quantum computers. At the same time, the most important task of the physics of quantum computing is the choice of the most effective mechanisms for manipulating and controlling the entangled states of qubits in such devices. Aim. The dynamics of the entanglement of two dipole-coupled superconducting Josephson qubits induced by a thermal noise of a coplanar resonator is studied for various initial states of the qubits. Methods. Based on the exact solution of the quantum Liouville equation for the whole density matrix of the system under consideration, the time behavior of the qubit entanglement parameter (negativity) is found for chaotic thermal, pure separable, and entangled initial states of qubits. Results. It is shown that the entanglement of qubits induced by the thermal noise of the resonator is possible for both the chaotic thermal states and separable states of qubits, except the case when both qubits are excited. It has also been found that, for small values of the dipoledipole interaction parameter, taking this interaction into account leads to an increase in the degree of entanglement. For values of the dipole-dipole interaction parameter greater than some limit value, the opposite effect takes place. It is found that for entangled initial states of qubits, the inclusion of direct interaction has a small effect on the entanglement dynamics. It is shown that the initial coherence of qubit states can lead to a significant increase in the degree of their entanglement in the presence of a dipoledipole interaction. Conclusion. The dipole-dipole interaction can be used as an effective mechanism for qubits entanglement manipulation and controlling.

Abstract Background: This systematic review and meta-analysis will review randomized control trials for localized bladder cancer, evaluating surgical and pathologic outcomes of ORC versus RARC. Methods: Randomized studies evaluating adults with non-metastatic bladder cancer who underwent a radical cystectomy. Randomized trials were selected for final review. Data was extracted and analyzed with Revman 5 software. The primary outcome was complication rates within 90 days. Secondary outcomes included postoperative quality of life, estimated intraoperative blood loss, and other perioperative outcomes. Continuous variables were reported using mean difference with 95% confidence intervals, and dichotomous variables were reported using risk difference with 95% confidence intervals with RARC as the experimental group and ORC as the reference group. Results: Of 134 articles screened, six unique randomized studies were selected. For Grade I-II complications, the risk ratio (RR) was 0.92 (95% CI [0.79,1.08], p = 0.33), and for Grade III-V complications, RR 0.93 (95% CI [0.73,1.18], p = 0.59). RARC resulted in decreased blood loss (95% CI [−438.08, −158.44], p < 0.00001) and longer operative time (95% CI [55.23, 133.13], p < 0.00001). Quality of life using the EORTC-QLQ-30 global health score at 3 months post-op appeared to favor RARC with a mean difference of 4.46 points (95% CI [1.78, 7.15], p = 0.001). Pathologic outcomes neither statistically nor clinically favored one modality, as there was no significant difference between mean lymph node yield (p = 0.49), positive lymph nodes (p = 1.00), and positive surgical margins (p = 0.85) between the surgical modalities. Conclusions: Although one surgical modality is not overtly superior, the choice may be decided by mitigating individual operative risk factors like intraoperative blood loss, operative time, post-operative quality of life, as well as institutional costs and learning curve among surgeons.

IntroductionBefore 2020 and the advent of the COVID-19 pandemic, mental disorders, including anxiety and mood disorders, were considered the leading causes of the global disease burden. There is evidence from multiple countries and social contexts that suggest the high risk of anxiety and mood disorders among students. Yet, there is a knowledge gap concerning understanding the association between the experience of discrimination and the risk of anxiety and mood disorders. We examined the association between the experience of discrimination and the risk of anxiety and mood disorders among university students.MethodsThis study is a cross-sectional survey among university students in Ghana. A quota sampling technique was used to recruit 1,601 students. Data were collected using structured questionnaires. All data were analyzed using Stata. Binary logistic regression model was used to examine the significant association between the outcome variable and the explanatory variables.ResultsThe prevalence of anxiety disorder among the respondents was 67 per cent. Students who had experienced discrimination or had any member of their family experienced discrimination had higher odds (OR = 4.59, Cl = 2.64, 7.96) of anxiety and mood disorder compared to those who had not experienced any form of discrimination. Respondents aged 20–24 years had higher odds (OR = 1.47, Cl = 1.16, 1.85) of anxiety and mood disorder than those aged 15–19. Students with a high perceived risk of contracting COVID-19 had a higher odd (OR = 1.52, CI = 1.10, 2.10) compared to those with a low perceived risk.ConclusionThe findings underscore a need for university authorities to lay out clear initiatives that will reinforce and meet the mental health needs of university students during and after periods of crisis, such as returning from COVID-19 lockdown. There must be a conscious effort to advocate and raise students’ awareness of anxiety disorders. Also, it is imperative to create support groups within the university set up to address the mental health needs of all students. Younger students should be the primary focus of these interventions.

IntroductionSeveral clinical prediction rules (CPRs) have been published, but few are easily accessible or convenient for clinicians to use in practice. We aimed to develop, implement, and describe the process of building a web-based CPR for predicting independent walking 1-year after a traumatic spinal cord injury (TSCI).MethodsUsing the published and validated CPR, a front-end web application called “Ambulation” was built using HyperText Markup Language (HTML), Cascading Style Sheets (CSS), and JavaScript. A survey was created using QualtricsXM Software to gather insights on the application's usability and user experience. Website activity was monitored using Google Analytics. Ambulation was developed with a core team of seven clinicians and researchers. To refine the app's content, website design, and utility, 20 professionals from different disciplines, including persons with lived experience, were consulted.ResultsAfter 11 revisions, Ambulation was uploaded onto a unique web domain and launched (www.ambulation.ca) as a pilot with 30 clinicians (surgeons, physiatrists, and physiotherapists). The website consists of five web pages: Home, Calculation, Team, Contact, and Privacy Policy. Responses from the user survey (n = 6) were positive and provided insight into the usability of the tool and its clinical utility (e.g., helpful in discharge planning and rehabilitation), and the overall face validity of the CPR. Since its public release on February 7, 2022, to February 28, 2023, Ambulation had 594 total users, 565 (95.1%) new users, 26 (4.4%) returning users, 363 (61.1%) engaged sessions (i.e., the number of sessions that lasted 10 seconds/longer, had one/more conversion events e.g., performing the calculation, or two/more page or screen views), and the majority of the users originating from the United States (39.9%) and Canada (38.2%).DiscussionAmbulation is a CPR for predicting independent walking 1-year after TSCI and it can assist frontline clinicians with clinical decision-making (e.g., time to surgery or rehabilitation plan), patient education and goal setting soon after injury. This tool is an example of adapting a validated CPR for independent walking into an easily accessible and usable web-based tool for use in clinical practice. This study may help inform how other CPRs can be adopted into clinical practice.

Background: Competency based residency programs depend on high quality feedback from the assessment of entrustable professional activities (EPA). The Quality of Assessment for Learning (QuAL) score is a tool developed to rate the quality of narrative comments in workplace-based assessments; it has validity evidence for scoring the quality of narrative feedback provided to emergency medicine residents, but it is unknown whether the QuAL score is reliable in the assessment of narrative feedback in other postgraduate programs. Methods: Fifty sets of EPA narratives from a single academic year at our competency based medical education post-graduate anesthesia program were selected by stratified sampling within defined parameters [e.g. resident gender and stage of training, assessor gender, Competency By Design training level, and word count (≥17 or

In this study, solid waste incinerator fly ash (SWI-FA) based geopolymer adsorbents were prepared by alkalination of hazardous SWI-FA and cured at different temperatures of 30 0C (GP30), 50 0C (GP50), 70 0C (GP70), and 90 0C (GP90). The geopolymers were applied as low-cost adsorbents for the removal of anionic bromocresol green (BCG) dye from water under varying conditions. The precursor and geopolymers were characterized by XRD, SEM-EDS, FT-IR, and point of zero charge (PZC). The geopolymers were morphologically different with varying chemical compositions. The kinetic data were best described by the pseudo second order model. The experimental equilibrium adsorption data were fitted to Langmuir, Freundlich, Temkin and Dubinin-Radushkevich-Kaganer adsorption isotherm models. The Langmuir monolayer maximum adsorption capacities increased consistently with curing temperature, from 41.70 mg/g to 515.5 mg/g for GP30 and GP90, respectively, a new benchmark for these materials for anionic dyes. The thermodynamic parameters, namely enthalpy (ΔH0) and activation energy (Ea) indicated that the processes are spontaneous, exothermic, physical (Ea

Accurate classification of genetic variants is critical for research and patient care. Here, the authors report that population-based associations between rare variants and quantitative endophenotypes for monogenic diseases can provide support for variant pathogenicity.

In this paper we report experiences in implementing a new course ‘Understanding Drone & Robotics Technology – History, Usage, Ethics & Legal Issues’ at the Singapore Management University framed as a strategic knowledge management (KM) initiative in an institution of higher learning aimed at capturing, sharing and creating new knowledge about disruptive technologies such as unmanned aerial vehicles. We posit the new course as a knowledge innovation initiative (similar to a KM-enabled business case in a corporate setting) in support of the university’s mission and vision so as to deliver new value to students and to stay ahead of the latest technological developments. In line with a ‘normal’ KM initiative, we examine how the new learning and teaching initiative was conceived, pushed forward and eventually launched, creating a new multi-disciplinary learning experience for students, instructors and other stakeholders. We explain the knowledge strategy of the course and use I. Nonaka’s SECI framework to shed light on selected aspects of the pedagogical approach towards achieving the desired learning outcomes. Overall, the paper intends to make a case for more collaborative knowledge leadership as a strategic enabler of multi-disciplinary knowledge innovation in a rapidly changing higher education landscape.

Purpose: Given limited ambulatory access to genetics specialists, innovative service delivery solutions are needed. Electronic consultation (e-consult) programs are growing to connect clinicians to specialists. We explored the utilization and outcomes of a genetics and genomics e-consult program at Massachusetts General Hospital system in its first year. Methods: A retrospective observational analysis of genetics e-consults ordered between April 2021 and March 2022. Results: In its first year, the e-consult service triaged 153 requests and completed 122 in a median of 2.0 days. Of the 97 e-consults with actionable recommendations, there was documentation that most ordering clinicians followed through (82%). A variety of providers used the service, though the majority (77%) were generalists. Conclusion: e-Consult models should be considered as one way to increase access to genetics expertise.

Background: Predictive analytics are being used increasingly in the field of spinal surgery with the development of models to predict post-surgical complications. Predictive models should be valid, generalizable, and clinically useful. The purpose of this review was to identify existing post-surgical complication prediction models for spinal surgery and to determine if these models are being adequately investigated with internal/external validation, model updating and model impact studies. Methods: This was a scoping review of studies pertaining to models for the prediction of post-surgical complication after spinal surgery published over 10 years (2010-2020). Qualitative data was extracted from the studies to include study classification, adherence to Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD) guidelines and risk of bias (ROB) assessment using the Prediction model study Risk Of Bias Assessment Tool (PROBAST). Model evaluation was determined using area under the curve (AUC) when available. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement was used as a basis for the search methodology in four different databases. Results: Thirty studies were included in the scoping review and 80% (24/30) included model development with or without internal validation. Twenty percent (6/30) were exclusively external validation studies and only one study included an impact analysis in addition to model development and internal validation. Two studies referenced the TRIPOD guidelines and there was a high ROB in 100% of the studies using the PROBAST tool. Conclusions: The majority of post-surgical complication prediction models in spinal surgery have not undergone standardized model development and internal validation or adequate external validation and impact evaluation. As such there is uncertainty as to their validity, generalizability, and clinical utility. Future efforts should be made to use existing tools to ensure standardization in development and rigorous evaluation of prediction models in spinal surgery.

ABSTRACT Background: Guideline-based best practice treatment for muscle invasive bladder cancer (MIBC) involves neoadjuvant chemotherapy followed by radical cystectomy (NACRC). Prior studies have shown that a minority of patients receive NACRC and older age and renal function are drivers of non-receipt of NACRC. This study investigates treatment rates and factors associated with not receiving NACRC in MIBC patients with lower comorbidity status most likely to be candidates for NACRC. Materials and Methods: Retrospective United States National Cancer Database analysis from 2006 to 2015 of MIBC patients with Charlson comorbidity index (CCI) of zero. Analysis of NACRC treatment trends in higher CCI patients was also performed. Results: 15.561 MIBC patients met inclusion criteria. 1.507 (9.7%) received NACRC within 9 months of diagnosis. NACRC increased over time (15.0% in 2015 compared to 3.6% in 2006). Higher NACRC was noted in females, cT3 or cT4 cancer, later year of diagnosis, and academic facility treatment. Lower utilization was noted for blacks and NACRC decreased with increasing age and CCI. Only 16.9% of patients aged 23-62 in the lowest age quartile with muscle invasive bladder cancer and CCI of 0 received NACRC. Conclusions: Although utilization is increasing, receipt of NACRC remains low even in populations most likely to be candidates. Further study should continue to elucidate barriers to utilization of NACRC.

Abstract Background Communities and their composition have an impact on neonatal mortality. However, considering the smallest health administrative units as communities and investigating the impact of these communities and their composition on neonatal mortality in Ghana have not been studied. Therefore, this study aimed to investigate the effect of community-, household- and individual-level factors on the risk of neonatal mortality in two districts in Ghana. Methods This was a longitudinal study that used the Kintampo Health and Demographic Surveillance System as a platform to select 30,132 neonatal singletons with 634 deaths. Multilevel cox frailty model was used to examine the effect of community-, household- and individual-level factors on the risk of neonatal mortality. Results Regarding individual-level factors, neonates born to mothers with previous adverse pregnancy (aHR = 1.38, 95% CI: 1.05–1.83), neonates whose mothers did not receive tetanus toxoid vaccine (aHR = 1.32, 95% CI: 1.08–1.60) and neonates of mothers with Middle, Junior High School or Junior Secondary School education (aHR = 1.30, 95% CI: 1.02–1.65) compared to mothers without formal education, had a higher risk of neonatal mortality. However, female neonates (aHR = 0.61, 95% CI: 0.51–0.73) and neonates whose mother had secondary education or higher (aHR = 0.37, 95% CI: 0.18–0.75) compared to those with no formal education had a lower risk of mortality. Neonates with longer gestation period (aHR = 0.95, 95% CI: 0.94–0.97) and those who were delivered at home (aHR = 0.56, 95% CI: 0.45–0.70), private maternity home (aHR = 0.45, 95% CI: 0.30–0.68) or health centre/clinic (aHR = 0.40, 95% CI: 0.26–0.60) compared to hospital delivery had lower risk of mortality. Regarding the household-level, neonates belonging to third quintile of the household wealth (aHR = 0.70, 95% CI: 0.52–0.94) and neonates belonging to households with crowded sleeping rooms (aHR = 0.91, 95% CI: 0.85–0.97) had lower risk of mortality. Conclusion The findings of the study suggest the risk of neonatal mortality at the individual- and household-levels in the Kintampo Districts. Interventions and strategies should be tailored towards the high-risk groups identified in the study.

Raised bed production trials were conducted to evaluate the effectiveness of effluent from a biofloc-style recirculating aquaculture system producing nile tilapia (Oreochromis niloticus) as nutrient-rich irrigation water for fall ‘Celebrity’ tomato (Solanum lycopersicum) production. The objective of this study was to provide baseline vegetable production data and justification for using aquaculture effluent as a water and nutrient resource. The experiment was a split-plot, randomized block design with three treatments: aquaculture effluent, granular fertilizer, and fertigation. Tomato seeds were sown in June, transplanted in August, and grown until Oct. 2019 in nine replicated raised beds. Conventional field tomato production practices were followed throughout the trial, and data were collected for tomato fruit yield, market quality, size, leaf greenness (SPAD), and foliar nutrient analysis. Fruit yield was similar between fertigated and aquaculture effluent treatments, with granular fertilizer resulting in yield that was significantly lower (P ≤ 0.033). SPAD measurements were similar among treatments. All nutrients met or exceeded sufficiency ranges. Foliar nutrient analysis revealed no significant difference for nitrogen, phosphorus, potassium, magnesium, calcium, boron, zinc, manganese, and iron among treatments. Sulfur and copper levels were significantly lower (P < 0.05) with aquaculture effluent treatment as compared with the granular and fertigated treatments. Overall, tomato production using aquaculture effluent as a water and nutrient supplement produced similar yields to commercial practices, making it potentially viable for producers.

The sandwich format immunoassay is generally more sensitive and specific than more common assay formats, including direct, indirect, or competitive. A sandwich assay, however, requires two receptors to bind non-competitively to the target analyte. Typically, pairs of antibodies (Abs) or antibody fragments (Fabs) that are capable of forming a sandwiching with the target are identified through a slow, guess-and-check method with panels of candidate binding partners. Additionally, sandwich assays that are reliant on commercial antibodies can suffer from changes to reagent quality outside the researchers’ control. This report presents a reimagined and simplified phage display selection protocol that directly identifies sandwich binding peptides and Fabs. The approach yielded two sandwich pairs, one peptide–peptide and one Fab–peptide sandwich for the cancer and Parkinson’s disease biomarker DJ-1. Requiring just a few weeks to identify, the sandwich pairs delivered apparent affinity that is comparable to other commercial peptide and antibody sandwiches. The results reported here could expand the availability of sandwich binding partners for a wide range of clinical biomarker assays.

As a result of the significance of childbearing in the Ghanaian culture, couples would go to all lengths to have biological children. One of the means that has made it possible for childless couples to have children is through the use of various assisted reproductive technologies. Using a qualitative research design, the paper explores the experiences of 40 women who have delivered following the use of assisted reproductive technology in Ghana. A semi-structured interview guide was utilised to explore women's experiences and results were analysed thematically. The study revealed that childless women faced hostile treatment but the birth of a child ceased the hostility, giving couples social recognition. The study also revealed that the transition to motherhood is characterised by excitement, high self-esteem, recognition and acceptance into spouses' families. It was a source of anxiety for other women due to society's perception of children born following the use of assisted reproductive technologies. However, women perceived that having a second or third child could change society's perception about the use of assisted reproductive technologies to have children. Based on these assumptions, there is a need for public education to change the societal perception about women who utilise assisted reproductive technologies to meet their parenthood desires as well as children who are born following the use of assisted reproductive technologies.

Flowering dogwood (Cornus florida) is a valuable nursery product typically produced as a field-grown crop. Container-grown flowering dogwood can grow much faster than field-grown plants, thus shortening the production cycle, yet unacceptable crop loss and reduced quality continue to be major issues with container-grown plants. The objective of this research was to evaluate the effects of container size and shade duration on growth of flowering dogwood cultivars Cherokee Brave™ and Cherokee Princess from bare-root liners. In 2015, bare-root liners were transplanted to 23-L (no. 7) containers and placed under shade for 0 months (full sun), 2 months (sun4/shade2), 4 months (sun2/shade4), or 6 months (full shade) during the growing season. In 2016, one-half of the plants remained in no. 7 containers and the other half were transplanted to 50-L (no. 15) containers and assigned to the same four shade treatments. In 2015, plant height was greatest with full shade for both cultivars, whereas stem diameter and shoot dry weight (SDW) were greatest in full shade for Cherokee Brave™. In 2016, both cultivars in no. 15 containers had greater plant height, stem diameter, root dry weight (RDW), and SDW. Full shade resulted in the greatest height, stem diameter, RDW, and SDW for Cherokee Brave™, and improved overall growth for ‘Cherokee Princess’. However, vigorous growth due to container size and shade exposure increased the severity of powdery mildew (Erysiphe pulchra) in both years. Substrate leachate nutrient concentration (nitrate nitrogen and phosphate) was greater in no. 15 containers but shade duration had no effect.

Abstract Background Quality-adjusted-life-years (QALYs) are used to concurrently quantify morbidity and mortality within a single parameter. For this reason, QALYs can facilitate the discussion of risks and benefits during patient counseling regarding treatment options. QALYs are often calculated using partitioned-survival modelling. Alternatively, QALYs can be calculated using more flexible and informative state-transition models populated with transition rates estimated using multistate modelling (MSM) techniques. Unfortunately the latter approach is considered not possible when only progression-free survival (PFS) and overall survival (OS) analyses are reported. Methods We have developed a method that can be used to estimate approximate transition rates from published PFS and OS analyses (we will refer to transition rates estimated using full multistate methods as true transition rates). Results The approximation method is more accurate for estimating the transition rates out of health than the transition rate out of illness. The method tends to under-estimate true transition rates as censoring increases. Conclusions In this article we present the basis for and use of the transition rate approximation method. We then apply the method to a case study and evaluate the method in a simulation study.

Helicenes represent key building blocks leading eventually to carbonaceous nanostructures. Here, exploiting [4]-helicene as a benchmark, the authors present a synthetic route to racemic helicenes via a vinylacetylene mediated gas phase chemistry with aryl radicals involving ring annulation.

Background: Underweight is a key indicator of malnutrition in children and results in long term effects such as abnormalities in physical and mental health, behavioural problems, and low educational achievement. Objective: Using the conceptual framework for child malnutrition by the United Nations Children's Fund, we examined the predictors of underweight in children under five years in Ghana. Methods: This cross-sectional study made use of data from the 2014 Ghana Demographic and Health Survey. A total of 2720 children were included in the analysis. Descriptive and inferential statistics comprising frequency, percentage, chi-square, and binary logistic regression were used in analysing the data. Results: The prevalence of underweight was 11%. Age, wealth status, mother’s education, region, ethnicity, household toilet facility, the source of drinking water, the incidence of diarrhoea, and subscription to health insurance significantly predicted underweight in the children. The risk of being underweight was higher in females than males (OR=1.04, 95% CI=0.81–1.34). This was, however, not statistically significant. The probability of being underweight also declined significantly with mother’s level of education. Conclusion: Our findings underscore the need for the Ghana Health Service and other health sector stakeholders to apportion interventions with a focus on improving complementary feeding, poverty alleviation, and health status of children. Funding: No funding was received for the study Keywords: malnutrition, underweight, predictors, children, under five, Ghana

Abstract Background Hepatitis B affects 257 million people worldwide. Mother-to-child hepatitis B virus (HBV) transmission is a preventable cause of substantial morbidity and mortality and poses greatest risk for developing chronic HBV infection. The World Health Organization recommends that all countries institute universal hepatitis B birth dose (HepB BD) vaccination during the first 24 h of life, followed by timely completion of routine immunization. The objective of this analysis was to assess the cost-effectiveness of adding HepB BD vaccination among sub-Saharan African refugee populations where the host country’s national immunization policy includes HepB BD. Methods We performed a cost-effectiveness analysis of three hepatitis B vaccination strategy scenarios for camp-based refugee populations in the African Region (AFR): routine immunization (RI), RI plus universal HepB BD, and RI plus HepB BD only for newborns of hepatitis B surface antigen-positive mothers identified through rapid diagnostic testing (RDT). We focused analyses on refugee populations living in countries that include HepB BD in national immunization schedules: Djibouti, Algeria and Mauritania. We used a decision tree model to estimate costs of vaccination and testing, and costs of life-years lost due to complications of chronic hepatitis B. Results Compared with RI alone, addition of HepB BD among displaced Somali refugees in Djibouti camps would save 9807 life-years/year, with an incremental cost-effectiveness ratio (ICER) of 0.15 USD (US dollars) per life-year saved. The RI plus HepB BD strategy among Western Saharan refugees in Algerian camps and Malian refugees in Mauritania camps would save 27,108 life-years/year with an ICER of 0.11 USD and 18,417 life-years/year with an ICER of 0.16 USD, respectively. The RI plus RDT-directed HepB BD was less cost-effective than RI plus delivery of universal HepB BD vaccination or RI alone. Conclusions Based on our model, addition of HepB BD vaccination is very cost-effective among three sub-Saharan refugee populations, using relative life-years saved. This analysis shows the potential benefit of implementing HepB BD vaccination among other camp-based refugee populations as more AFR countries introduce national HepB BD policies.

Use of foliar auxin applications are increasing in the nursery and greenhouse industry. However, previous research has shown that insufficient auxin is absorbed or translocated to the site of action when foliar auxin applications are used. It is theorized that adding surfactants to foliar applications of auxin may help with the absorption and translocation of auxin to the site of action. Research was conducted to determine whether adding surfactants to one-time foliar applications of indole-3-butyric acid (IBA) would be as effective as the current industry standard, the basal quick-dip. Terminal, semi-hardwood cuttings of Red Cascade™ miniature climbing rose (Rosa ‘MOORcap’), common camellia (Camellia japonica) and ‘Southern Charm’ magnolia (Magnolia grandiflora ‘Southern Charm’) were sprayed to the drip point using Hortus IBA Water Soluble Salts™ at concentrations of 0 ppm, 50 ppm, 75 ppm, or 100 ppm for rose cuttings or 0 ppm, 500 ppm, 1000 ppm, or 1500 ppm IBA for camellia or magnolia. To serve as an industry control, the basal end of cuttings was immersed for 3-s in a solution of either 250 ppm, 4000 ppm or 2500 ppm for rose, camellia, or magnolia, respectively. A foliar application of 1500 ppm after sticking was as effective as the basal quick-dip for cuttings of ‘Southern Charm’, while other spray treatments were less effective. A basal quick-dip was more effective than a foliar spray for rooting cuttings of camellia. Auxin rate had no impact on rooting of Red Cascade™ miniature rose. The goal of commercial plant propagation is to produce high-quality rooted cuttings as quickly as possible. Plant propagation places a large demand on labor within the nursery industry, with one recent report being that labor accounts for >50% of a nursery’s budget. Our results from this trial affirm the results reported by similar trials into foliar applications of auxin suggests that the benefits of foliar applications are species dependent Further work is warranted on examining other auxin and surfactant formulations.

Wolbachia, a widespread bacterium which can influence mosquito-borne pathogen transmission, has recently been detected within Anopheles (An.) species that are malaria vectors in Sub-Saharan Africa. Although studies have reported Wolbachia strains in the An. gambiae complex, apparent low density and prevalence rates require confirmation. In this study, wild Anopheles mosquitoes collected from two regions of Guinea were investigated. In contrast with previous studies, RNA was extracted from adult females (n = 516) to increase the chances for the detection of actively expressed Wolbachia genes, determine Wolbachia prevalence rates and estimate relative strain densities. Molecular confirmation of mosquito species and Wolbachia multilocus sequence typing (MLST) were carried out to analyse phylogenetic relationships of mosquito hosts and newly discovered Wolbachia strains. Strains were detected in An. melas (prevalence rate of 11.6%–16/138) and hybrids between An. melas and An. gambiae sensu stricto (prevalence rate of 40.0%–6/15) from Senguelen in the Maferinyah region. Furthermore, a novel high-density strain, termed wAnsX, was found in an unclassified Anopheles species. The discovery of novel Wolbachia strains (particularly in members, and hybrids, of the An. gambiae complex) provides further candidate strains that could be used for future Wolbachia-based malaria biocontrol strategies.

IntroductionIdentifying high risk geographical clusters for neonatal mortality is important for guiding policy and targeted interventions. However, limited studies have been conducted in Ghana to identify such clusters.ObjectiveThis study aimed to identify high-risk clusters for all-cause and cause-specific neonatal mortality in the Kintampo Districts.Materials and methodsSecondary data, comprising of 30,132 singleton neonates between January 2005 and December 2014, from the Kintampo Health and Demographic Surveillance System (KHDSS) database were used. Verbal autopsies were used to determine probable causes of neonatal deaths. Purely spatial analysis was ran to scan for high-risk clusters using Poisson and Bernoulli models for all-cause and cause-specific neonatal mortality in the Kintampo Districts respectively with village as the unit of analysis.ResultsThe study revealed significantly high risk of village-clusters for neonatal deaths due to asphyxia (RR = 1.98, p = 0.012) and prematurity (RR = 5.47, p = 0.025) in the southern part of Kintampo Districts. Clusters (emerging clusters) which have the potential to be significant in future, for all-cause neonatal mortality was also identified in the south-western part of the Kintampo Districts.ConclusionsStudy findings showed cause-specific neonatal mortality clustering in the southern part of the Kintampo Districts. Emerging cluster was also identified for all-cause neonatal mortality. More attention is needed on prematurity and asphyxia in the identified cause-specific neonatal mortality clusters. The emerging cluster for all-cause neonatal mortality also needs more attention to forestall any formation of significant mortality cluster in the future. Further research is also required to understand the high concentration of prematurity and asphyxiated deaths in the identified clusters.

Although biomimetic stimuli, such as microgroove-induced alignment (μ), triiodothyronine (T3) induction, and electrical conditioning (EC), have been reported to promote maturation of human pluripotent stem cell-derived cardiomyocytes (hPSC-CMs), a systematic examination of their combinatorial effects on engineered cardiac tissue constructs and the underlying molecular pathways has not been reported. Herein, human embryonic stem cell-derived ventricular cardiomyocytes (hESC-VCMs) were used to generate a micro-patterned human ventricular cardiac anisotropic sheets (hvCAS) for studying the physiological effects of combinatorial treatments by a range of functional, calcium (Ca2+)-handling, and molecular analyses. High-resolution optical mapping showed that combined μ-T3-EC treatment of hvCAS increased the conduction velocity, anisotropic ratio, and proportion of mature quiescent-yet-excitable preparations by 2. 3-, 1. 8-, and 5-fold (>70%), respectively. Such electrophysiological changes could be attributed to an increase in inward sodium current density and a decrease in funny current densities, which is consistent with the observed up- and downregulated SCN1B and HCN2/4 transcripts, respectively. Furthermore, Ca2+-handling transcripts encoding for phospholamban (PLN) and sarco/endoplasmic reticulum Ca2+-ATPase (SERCA) were upregulated, and this led to faster upstroke and decay kinetics of Ca2+-transients. RNA-sequencing and pathway mapping of T3-EC-treated hvCAS revealed that the TGF-β signaling was downregulated; the TGF-β receptor agonist and antagonist TGF-β1 and SB431542 partially reversed T3-EC induced quiescence and reduced spontaneous contractions, respectively. Taken together, we concluded that topographical cues alone primed cardiac tissue constructs for augmented electrophysiological and calcium handling by T3-EC. Not only do these studies improve our understanding of hPSC-CM biology, but the orchestration of these pro-maturational factors also improves the use of engineered cardiac tissues for in vitro drug screening and disease modeling.

Objectives Chronic diseases, including back pain, result in significant patient morbidity and societal burden. Overall improvement in physical fitness is recommended for prevention and treatment. Walking is a convenient modality for achieving initial gains. Our objective was to determine whether neighbourhood walkability, acting as a surrogate measure of physical fitness, was associated with the presence of chronic disease. Methods We conducted a cross-sectional study of prospectively collected data from a prior randomized cohort study of 227 patients referred for tertiary assessment of chronic back pain in Ottawa, ON, Canada. The Charlson Comorbidity Index (CCI) was calculated from patient-completed questionnaires and medical record review. Using patients’ postal codes, neighbourhood walkability was determined using the Walk Score, which awards points based on the distance to the closest amenities, yielding a score from 0 to 100 (0-50: car-dependent; 50-100: walkable). Results Based on the Walk Score, 134 patients lived in car-dependent neighborhoods and 93 lived in walkable neighborhoods. A multivariate logistic regression model, adjusted for age, gender, rural postal code, body mass index, smoking, median household income, percent employment, pain, and disability, demonstrated an adjusted odds ratio of 2.75 (95% confidence interval, 1.16 to 6.53) times higher prevalence for having a chronic disease for patients living in a car-dependent neighborhood. There was also a significant dose-related association (p=0.01; Mantel-Haenszel chi-square=6.4) between living in car-dependent neighbourhoods and more severe CCI scores. Conclusions Our findings suggest that advocating for improved neighbourhood planning to permit greater walkability may help offset the burden of chronic disease.

In utero cannabis exposure can disrupt fetal development and increase risk for various behavioral disruptions, including hyperactivity, inattention, delinquent behaviors, and later substance abuse, among others. This review summarizes the findings from contemporary investigations linking prenatal cannabis exposure to the development of psychopathology and identifies the limitations within the literature, which constrain our interpretations and generalizability. These limitations include a lack of genetic/familial control for confounding and limited data examining real world products, the full range of cannabinoids, and motives for use specifically in pregnant women. Taken together, our review reveals the need to continue to improve upon study designs in order to allow researchers to accurately draw conclusions about the development of behavioral consequences of prenatal cannabis exposure. Findings from such studies would inform policy and practices regarding cannabis use during pregnancy and move the field toward developing a comprehensive teratogenic profile of cannabis similar to what is characterized in the prenatal alcohol and tobacco literature.

This paper summarizes the estimates of the total changes in sales, expenses, and income of participants of the horticulture research and extension programs at the Mississippi State University—Coastal Research and Extension Center for the past five years. Major items outline the estimation procedures for the past five years. The average annual values were used in estimating the total economic impacts of added gross sales, expenses, and incomes of participants in horticulture events. The cumulative total impacts reach USD 8.7 million in sales, 76 jobs, USD 1.4 million in labor income, USD 2.4 million in value-added, and USD 0.4 million in local, state, and federal taxes. In addition, the total willingness to pay for the horticulture program by the adult participants reached USD 1.8 million. In comparison, the annual public spending on the horticulture program averaged USD 1.4 million, creating additional substantial economic impacts to the region.

Summary: Accurately predicting cardioactive effects of new molecular entities for therapeutics remains a daunting challenge. Immense research effort has been focused toward creating new screening platforms that utilize human pluripotent stem cell (hPSC)-derived cardiomyocytes and three-dimensional engineered cardiac tissue constructs to better recapitulate human heart function and drug responses. As these new platforms become increasingly sophisticated and high throughput, the drug screens result in larger multidimensional datasets. Improved automated analysis methods must therefore be developed in parallel to fully comprehend the cellular response across a multidimensional parameter space. Here, we describe the use of machine learning to comprehensively analyze 17 functional parameters derived from force readouts of hPSC-derived ventricular cardiac tissue strips (hvCTS) electrically paced at a range of frequencies and exposed to a library of compounds. A generated metric is effective for then determining the cardioactivity of a given drug. Furthermore, we demonstrate a classification model that can automatically predict the mechanistic action of an unknown cardioactive drug. : Analysis methods must be improved in parallel with advancements in drug screening platforms. Machine learning principles are used here to analyze multidimensional datasets to determine cardioactivity of unknown drugs. Furthermore, this study describes the use of multiclassification algorithms to classify unknown drugs based on their mechanistic action and compare their potency with related drugs. Keywords: human pluripotent stem cell-derived cardiomyocytes, drug-induced cardiotoxicity, machine learning, human engineered cardiac tissue, drug classification library

ObjectivesGender-based violence is a global public health crisis, which has health, social, and economic impacts on survivors. In Ghana, responding to and preventing sexual violence on university campuses, has become a priority area. However, data are lacking on the healthcare provider response to students who have experienced sexual violence. The purpose of this study was to conduct a situational analysis to better understand the healthcare provider response to sexual violence in Cape Coast, Ghana.MethodsFirst, an observational facility assessment about healthcare services for survivors of sexual violence was conducted at two hospitals serving university students in Cape Coast, Ghana. Next, healthcare providers at the two hospitals completed: 1) a 113-item questionnaire about healthcare services, knowledge, and attitudes related to sexual violence and 2) in-depth semi-structured interviews describing their experiences providing healthcare to survivors of sexual violence. Descriptive statistics and frequencies were computed, and thematic analysis was used to analyze the qualitative data.ResultsBoth sites lacked supplies, including pre-packed rape kits, post-exposure HIV prophylaxis, and informational handouts on medications and support services for survivors. Further, healthcare providers lacked training on gender-based violence, including best practices for caring for survivors and evidence collection procedures. Providers described the clinical management for survivors of sexual violence, including providers' role in reporting sexual violence to authorities, medical forensic exams, reproductive and sexual health services, and referral for mental healthcare. Finally, providers described a number of barriers to survivors accessing post-assault healthcare, including stigma and structural barriers, such as cost of medical supplies and lack of privacy within the healthcare facilities.ConclusionsThe current healthcare response to sexual violence in Ghana is limited by lack of supplies, knowledge, and training for healthcare providers. Personal and structural barriers may prevent survivors from accessing needed healthcare following sexual violence.

Background: Cervical spinal epidural abscess (CSEA) is a localized infection between the thecal sac and cervical spinal column which may result in neurological deficit and death if inadequately treated. Two treatment options exist: medical management and surgical intervention. Our objective was to analyze CSEA patient outcomes in order to determine the optimal method of treatment. Methods: An electronic literature search for relevant case series and retrospective reviews was conducted through June 2016. Data abstraction and study quality assessment were performed by two independent reviewers. A lack of available data led to a post hoc decision not to perform meta-analysis of the results; study findings were synthesized qualitatively. Results: 927 studies were identified, of which 11 were included. Four studies were ranked as good quality, and seven ranked as fair quality. In total, data from 173 patients were included. Mean age was 55 years; 61.3% were male. Intravenous drug use was the most common risk factor for CSEA development. Staphylococcus aureus was the most commonly cultured pathogen. 140 patients underwent initial surgery, an additional 18 patients were surgically treated upon failure of medical management, and 15 patients were treated with antibiotics alone. Conclusion: The rates of medical management failure described in our review were much higher than those reported in the literature for thoracolumbar spinal epidural abscess patients, suggesting that CSEA patients may be at a greater risk for poor outcomes following nonoperative treatment. Thus, early surgery appears most viable for optimizing CSEA patient outcomes. Further research is needed in order to corroborate these recommendations.

We have tested the possibility of using monomolecular layers of bacteriorhodopsin (BR) for the synthesis of highly sensitive and highly selective sensors based on second harmonic generation and surface plasma waves. We have used various methods to study the optical and nonlinear optical properties of Langmuir-Blodgett films of BR in order to clarify the extent to which specific properties of BR molecules are retained during their transfer from the surface of water to a solid substrate. We show that the second harmonic generation method is efficient for analyzing the molecular orientation and quality of Langmuir-Blodgett films. The experimental nonlinear optical susceptibility of second order BR molecules is 3.4·10−11 m/V. The relative change in the resonant wave vector is (3.6±0.1)·10−2 at an excitation light wavelength of 630 nm. We have obtained a BR spectrum with the effective excitation by incident radiation of surface plasma waves. On the basis of these studies, we have proposed new schemes of biosensors operating on the basis of second harmonic generation and surface plasma resonance caused by fundamental frequency reflection from BR monomolecular layers. This scheme was tested for a model device and demonstrated the possibility of obtaining sensitivities of the order of 1011 molecules/cm3.

OBJECTIVE:Identify patient subgroups defined by trajectories of pain and disability following surgery for degenerative lumbar spinal stenosis, and investigate the construct validity of the subgroups by evaluating for meaningful differences in clinical outcomes. METHODS:We recruited patients with degenerative lumbar spinal stenosis from 13 surgical spine centers who were deemed to be surgical candidates. Study outcomes (leg and back pain numeric rating scales, modified Oswestry disability index) were measured before surgery, and after 3, 12, and 24 months. Group-based trajectory models were developed to identify trajectory subgroups for leg pain, back pain, and pain-related disability. We examined for differences in the proportion of patients achieving minimum clinically important change in pain and disability (30%) and clinical success (50% reduction in disability or Oswestry score ≤22) 12 months from surgery. RESULTS:Data from 548 patients (mean[SD] age = 66.7[9.1] years; 46% female) were included. The models estimated 3 unique trajectories for leg pain (excellent outcome = 14.4%, good outcome = 49.5%, poor outcome = 36.1%), back pain (excellent outcome = 13.1%, good outcome = 45.0%, poor outcome = 41.9%), and disability (excellent outcome = 30.8%, fair outcome = 40.1%, poor outcome = 29.1%). The construct validity of the trajectory subgroups was confirmed by between-trajectory group differences in the proportion of patients meeting thresholds for minimum clinically important change and clinical success after 12 postoperative months (p < .001). CONCLUSION:Subgroups of patients with degenerative lumbar spinal stenosis can be identified by their trajectories of pain and disability following surgery. Although most patients experienced important reductions in pain and disability, 29% to 42% of patients were classified as members of an outcome trajectory subgroup that experienced little to no benefit from surgery. These findings may inform appropriate expectation setting for patients and clinicians and highlight the need for better methods of treatment selection for patients with degenerative lumbar spinal stenosis.

PurposeBladder cancer is a "Warburg-like" tumor characterized by a reliance on aerobic glycolysis and expression of pyruvate kinase M2 (PKM2). PKM2 oscillates between an active tetramer and an inactive dimer. We aim to further characterize PKM2, in particular PKM2 dimer, as a urinary biomarker of bladder cancer and a potential target for treatment.MethodsHTB-9, HTB-5, and UM-UC3 bladder cancer cells were assessed for proliferation under differential glucose levels using the hexosaminidase assay. Western blot and Blue-native analysis was performed for protein expression of PKM2. Shikonin, an herb that is known to bind and inhibit PKM2, was utilized to determine if PKM2 has a role in glucose usage and cellular proliferation in bladder cancer cells by caspase activity assay. Institutional review board approval was obtained to collect healthy control and bladder cancer patient urine samples. The ScheBo M2-PK EDTA Plasma Test was performed on urine samples to assess urine Tumor M2-PK values.ResultsThe three bladder cancer cell lines tested all demonstrate statistically significant increases in proliferation when exposed to higher level of glucose (200mg/dL). Similarly, low doses of glucose (25mg/dL) result in reduced proliferation. Increased cell growth in higher glucose concentration correlated with up-regulation of PKM2 protein expression. Shikonin, a PKM2 inhibitor, reduced cell proliferation and switched PKM2 isoforms from the dimer to tetramer. Lastly, dimer PKM2 (Tumor-M2PK) levels were assessed in the urine samples from bladder cancer (Bca) patients and healthy controls. Tumor M2-PK significantly correlated with the presence of BCa in our subjects.ConclusionsOur studies demonstrate the potential of PKM2, specifically the dimer (Tumor-M2PK) as a target of drug therapy and as a urinary marker for bladder cancer.

Container-grown nursery crops are commonly exposed to root zone stress due to inadequate moisture and supraoptimal root zone temperature (RZT). Compost substrates can improve water and nutrient retention but plant responses can vary due to physical and chemical properties. Dark color containers absorb solar radiation through the container side wall leading to excessive heat buildup in the substrate, yet white containers can reduce RZT. Compost substrates and container color were examined for effects on RZT and growth of “Green Giant” arborvitae (Thuja standishii × plicata “Green Giant”). “Green Giant” arborvitae were transplanted into white or black containers (11.3 L) filled with a pine bark substrate (PB) or PB mixed with compost (C) at two different proportions [PB:C (9:1) and PB:C (7:3)]. White containers reduced maximum RZT by up to 7 °C and RZT remained above 38 °C for only 3% of the time compared to 21% of the time in black containers. Shoot growth increased over 50% in white containers compared to black containers. Compost increased substrate volumetric water content (VWC), increased shoot growth by up to 24%, and reduced total irrigation volume by up to 40%. Utilizing white containers for minimizing RZT and compost-amended substrates to maintain adequate VWC can improve root and shoot growth and overall crop quality while reducing nursery production inputs.

Root zone temperature (RZT) in nursery containers commonly exceeds ambient temperature during the growing season, negatively impacting crop growth and quality. Black nursery containers absorb radiant heat resulting in excessive RZT, yet other types of containers and different substrates can moderate RZT. We conducted studies in Tennessee and Alabama to evaluate the effects of container type and substrate on RZT and growth of ‘Green Giant’ arborvitae (Thuja standishii × plicata ‘Green Giant’). Trade gallon arborvitae were transplanted into black, white, or air pruning containers filled with pine bark (PB) or 4 PB: 1 peatmoss (v:v) (PB:PM). Plants grown in PB:PM were larger and had greater shoot and root biomass than plants grown in PB, likely due to increased volumetric water content. Plant growth response to container type varied by location, but white containers with PB:PM produced larger plants and greater biomass compared with the other container types. Root zone temperature was greatest in black containers and remained above 38 °C and 46 °C for 15% and 17% longer than white and air pruning containers, respectively. Utilizing light color containers in combination with substrates containing peatmoss can reduce RZT and increase substrate moisture content thus improving crop growth and quality.

In the present paper we investigate the dynamics of the system of two twolevel natural or artificial atoms, in which only one atom couples to a thermal one-mode field in finite-Q cavity, since one of them can move around the cavity. For the description of the dynamics of the system we find the eigenvalues and eigenfunctions of a Hamiltonian of the system. With their help we derive the exact expression for a density matrix of the system in case of a pure initial state of atoms and a thermal state of a field. The reduced atomic density matrix is found. The one-qubit transposing of an atomic density matrix is carried out. With its help the Peres-Horodecki criterium is calculated. Numerical calculations of entanglement parameter is done for different initial pure states of atoms and mean photon numbers in a thermal mode. It is found that the thermal field can induce a high degree of qubits entanglement in considered model. Thus we have derived that one can use the strength of dipole-dipole interaction and cavity temperature for entanglement control in the considered system. It is shown also that the maximum degree of entanglement is reached for one-atom excited state.

Abstract Objective Cervical spine can be stabilized by different techniques. One of the common techniques used is the lateral mass screws (LMSs), which can be inserted either by freehand techniques or three-dimensional (3D) navigation system. The purpose of this study is to evaluate the difference between the 3D navigation system and the freehand technique for cervical spine LMS placement in terms of complications. Including intraoperative complications (vertebral artery injury [VAI], nerve root injury [NRI], spinal cord injury [SCI], lateral mass fracture [LMF]) and postoperative complications (screw malposition, screw complications). Methods Patients who had LMS fixation for their subaxial cervical spine from January 2014 to April 2015 at the Ottawa Hospital were included. A total of 284 subaxial cervical LMS were inserted in 40 consecutive patients. Surgical indications were cervical myelopathy and fractures. The screws' size was 3.5 mm in diameter and 8 to 16 mm in length. During the insertion of the subaxial cervical LMS, the 3D navigation system was used for 20 patients, and the freehand technique was used for the remaining 20 patients. We reviewed the charts, X-rays, computed tomography (CT) scans, and follow-up notes for all the patients pre- and postoperatively. Results Postoperative assessment showed that the incidence of VAI, SCI, and NRI were the same between the two groups. The CT scan analysis showed that the screw breakage, screw pull-outs, and screw loosening were the same between the two groups. LMF was less in the 3D navigation group but statistically insignificant. Screw malposition was less in the 3D navigation group compared with the freehand group and was statistically significant. The hospital stay, operative time, and blood loss were statistically insignificant between the two groups. Conclusions The use of CT-based navigation in LMS insertion decreased the rate of screw malpositions as compared with the freehand technique. Further investigations and trials will determine the effect of malpositions on the c-spine biomechanics. The use of navigation in LMS insertion did not show a significant difference in VAI, LMF, SCI, or NRI as compared with the freehand technique.

Introduction: We aimed to identify peri-operative and pathologic characteristics that may predict the need for clean intermittent catheterization (CIC) following radical cystectomy (RC) with orthotopic neobladder (ONB) in order to improve patient counseling on choice of urinary diversion. Materials and Methods: Between July 2004 and February 2013, all patients who underwent RC with ONB were identified. Peri-operative clinical and pathological features were evaluated and correlated with patients reported need for CIC. The independent T-test was performed for continuous variables and Chi-square test was performed for categorical variables. Multivariate forward stepwise logistic regression analysis was used to identify variables that correlated with need for CIC after ONB. Results: During the study period, 114 patients underwent RC with ONB creation. On univariate analysis, patients with higher body mass index, younger age, and non-vaginal or non-nerve-sparing procedures were more likely to require catheterization for complete emptying. Multivariate analysis demonstrates that conservative surgery (nerve sparing in males or vaginal sparing in females) was associated with a significantly lower rate of requiring CIC (Odds Ratio [OR] 0.20, P < 0.01). Surprisingly, older age was also associated with a slightly lower, but statistically significant, rate of requiring CIC (OR 0.92,P < 0.01). Conclusions: When counseling patients regarding the different types of diversions after RC, the potential need for long-term CIC after ONB must be discussed. The clinical factors that appear to increase the need for CIC include non-conservative RC (non-nerve sparing in males and non-vaginal sparing in females) and, to a certain degree, younger age.

In this paper we report experiences in implementing a new course 'Understanding Drone & Robotics Technology -- History, Usage, Ethics & Legal Issues' at the Singapore Management University framed as a strategic knowledge management (KM) initiative in an institution of higher learning aimed at capturing, sharing and creating new knowledge about disruptive technologies such as unmanned aerial vehicles. We posit the new course as a knowledge innovation initiative (similar to a KM-enabled business case in a corporate setting) in support of the university's mission and vision so as to deliver new value to students and to stay ahead of the latest technological developments. In line with a 'normal' KM initiative, we examine how the new learning and teaching initiative was conceived, pushed forward and eventually launched, creating a new multi-disciplinary learning experience for students, instructors and other stakeholders. We explain the knowledge strategy of the course and use I. Nonaka's SECI framework to shed light on selected aspects of the pedagogical approach towards achieving the desired learning outcomes. Overall, the paper intends to make a case for more collaborative knowledge leadership as a strategic enabler of multi-disciplinary knowledge innovation in a rapidly changing higher education landscape.

We investigate the evolution of a quantum system described by the two-atom Jaynes–Cummings model with an intensity-dependent couplings by displaying the linear atomic entropy and the asymptotic behavior of state vector. The possibility of the system being initially in a pure disentangled state to revive into this state during the evolution process is shown. Conditions and times of disentanglement are derived.

The entanglement of two two-level atoms with the nondegenerate two-photon transitions interacting with two-mode thermal field in lossless cavity has been considered. The possibility of entanglement degree growth in the presence of an atomic coherence and direct dipole-dipole interaction of atoms has been derived.

The peculiarities of atom-field entanglement in the model of two nonidentical atoms interacting with one-mode coherent electromagnetic field in lossless cavity via degenerate two-photon Raman transitions have been investigated. The times of atoms and field states disentanglement have been calculated on the basis of time-dependent wave function behavior and the linear atomic entropy concept.

Fahad Alkherayf1,2,3, Eugene K Wai4,5,6, Eve C Tsai1,3,4,6, Charles Agbi1,3,41University of Ottawa, Division of Neurosurgery, Ottawa, Ontario; 2University of Ottawa, Department of Clinical Epidemiology, Ottawa, Ontario; 3The Ottawa Hospital, Civic campus, Division of Neurosurgery, Ottawa, Ontario; 4The Ottawa Hospital, Civic Campus, Spine Unit Ottawa, Ontario; 5The Ottawa Hospital, Civic Campus, Division of Orthopedic Surgery, Ottawa, Ontario; 6The Ottawa Hospital Research Institute, Ottawa, Ontario, CanadaBackground: Lower back pain (LBP) is one of the primary causes of disability in the Canadian community. However, only a limited number of studies have addressed the association between daily smoking and LBP in Canada. Of the studies that have explored this association, many had small sample sizes and failed to control for confounders.Objective: The primary objective of the study was to determine if daily smoking is associated with an increased risk of having LBP. The secondary objectives were to assess the risk for LBP among occasional smokers and to determine the prevalence of LBP in relation to different covariates.Data and study design: Using the Canadian Community Health Survey (cycle 3.1) data, 73,507 Canadians between the ages of 20 and 59 years were identified. LBP status, smoking level, sex, age, body mass index (BMI), level of activity and level of education were assessed in these subjects.Methods: Stratified analysis and logistic regression analysis were used to detect effect modifications and to adjust for covariates. Population weight and design were taken into consideration.Results: The prevalence of LBP was 23.3% among daily smokers and 15.7% among non-smokers. Age and sex were found to be effect modifiers. The association between LBP and daily smoking was statistically significant in all ages and genders; this association was stronger for younger age groups. The adjusted odds ratio for male daily smokers aged 20 to 29 was 1.87 (95% CI = 1.62, 2.17); findings were similar for women. Occasional smoking slightly increased the odds of having back pain.Conclusion: Young Canadian daily smokers are at higher risk for LBP. This study also suggests a positive correlation between smoking dose and the risk of LBP. These findings indicate that smoking behavioral modification may have an impact on reducing back pain especially among young adults.Keywords: lower back pain, smoking, Canadian Community Health Survey, sex, adult Canadians

The sandwich format immunoassay is generally more sensitive and specific than more common assay formats, including direct, indirect, or competitive. A sandwich assay, however, requires two receptors to bind non-competitively to the target analyte. Typically, pairs of antibodies (Abs) or antibody fragments (Fabs) that are capable of forming a sandwiching with the target are identified through a slow, guess-and-check method with panels of candidate binding partners. Additionally, sandwich assays that are reliant on commercial antibodies can suffer from changes to reagent quality outside the researchers' control. This report presents a reimagined and simplified phage display selection protocol that directly identifies sandwich binding peptides and Fabs. The approach yielded two sandwich pairs, one peptide-peptide and one Fab-peptide sandwich for the cancer and Parkinson's disease biomarker DJ-1. Requiring just a few weeks to identify, the sandwich pairs delivered apparent affinity that is comparable to other commercial peptide and antibody sandwiches. The results reported here could expand the availability of sandwich binding partners for a wide range of clinical biomarker assays.