The paper is dedicated to the modeling and asymptotic investigation of a linear elasticity problem, in the form of variational inequality, for a textile structure. The textile is made of long and thin fibers crossing each others, forming a periodic squared domain. The domain is clamped only partially and an in plane sliding between the fibers is bounded by a contact function, which is chosen to be loose. We also assume a non-penetration condition for the fibers. Both partial clamp and loose contact arise a domain split, leading to different behaviors in each of the four parts. The homogenization is made via unfolding method, with an additional dimension reduction to further simplify the problem. The four cell problems are inequalities heavily coupled by the outer plane macro-micro constraints, while the macroscopic limit problem results to be an inequality of Leray-Lions type with only macro in plane constraints. On both scales, no uniqueness is expected.

The modified auxiliary equation (MAE) approach and the generalized projective Riccati equation (GPRE) method are used to solve the Zoomeron problem in this study. Different types of exact traveling wave solutions are achieved, including solitary wave, periodic wave, bright, dark peakon, and kink-type wave solutions. Earned results are given as hyperbolic and trigonometric functions. Moreover, the dynamical features of obtained results are demonstrated through interesting plots.

With the increasing world population, the need for health prevention is also increasing. In these recent years, there is a rapid advancement in clinical care due to the technological advancements in the various fields of sensors, micro-controllers, and computers for assuring fast recovery of patients in the hospitals. The major and crucial necessity of the hospitalized patients is that each patient ought to be provided with a better treatment and observation and ought to be provided the right measure of vital nutrition at the right time. Saline solution is used for the covid patients to reduce the inflammation in different parts of the body such as lungs, heart, kidney and skin. Among the various treatments, the saline therapy is the most important treatment that numerous patients receive from the hospitals. Whenever a saline is fed to the patients, the patient needs to be persistently administered by a nurse or a care-taker. But unfortunately, there are some circumstances like patient’s blood flow backwards into the saline tubing system. So countless patients are dying or are being harmed in the hospitals. The most well-known effect of saline fluid is that it increases the patient’s body temperature and heart rate. The saline level monitoring and automatic alert system was developed in order to protect the patient and to provide them with safety during saline feeding hours.

Introduction Radiofrequency (RF) is the preferred thermal energy used in electrophysiology. RF catheter must deliver the energy close to arrhythmia foci. A new method to deliver RF to deeper locations using a pacemaker lead is explored. Methods A Medtronic 3830 lead screwed in chicken breasts delivered 50 watts RF energy in three methods: A) direct fashion (RF catheter touching the proximal end of the 3830 lead, acting as an extension of RF catheter), or B) 3830 lead as a return patch (RF delivered in the bath without contact), or C) 3830 lead as a return patch (RF delivered touching the breast surface close to the 3830 lead screwed deep in the flesh). Different power settings were also tested. Lesion surface area is reported in cm2. Results 76 measurements were available. Bigger lesions were obtained at 10W method A (0.78cm2), 50W method C (0.72cm2) and 5W method B (0.44cm2). High impedances were noted at 10W and 50W with tissue remaining attached to the lead when removed. Conclusion RF can be delivered to deeper foci through a 3830-pacemaker lead with maximum size lesion formation using proximal unipolar direct delivery and proximal close bipolar as the return patch. In humans, it opens a path to attain deep septal foci (LV summit) or epicardial structures (vein of Marshall, transmural ablation from RF endocardial to LV coronary sinus lead as return patch): using standard, 4F pacemaker leads, and 2F small EP catheters or even isolated guidewires.

In this article, we consider the relatively exact controllability of fractional stochastic delay system (FSDS) driven by Lévy noise. Firstly, we derive the solution of linear FSDS via delayed matrix functions of Mittag-Leffler (M-L). Subsequently, by virtue of the controllability Grammian matrix, we explore the relatively exact controllability of linear FSDS. In addition, with the aid of Jensen’s inequality, Hölder’s inequality and Itô’s isometry, the existence and uniqueness of the considered nonlinear FSDS are investigated by employing Banach contraction principle.Thereafter, the relatively exact controllability of nonlinear FSDS is discussed. Finally, the theoretical results are supported through an example.

A high gain and wide output swing dynamic amplifier is proposed for low power single-loop 1-bit quantization based delta sigma ADCs, which require wide output swing for integrator for achieving the required bandwidth and resolution with low power and small area in sensor readout and audio application. A dynamic folded cascode concept is proposed to enlarge the output swing of the conventional cascode dynamic amplifier. Additionally, a novel speed-enhancement technique and a low power common mode detection circuit are proposed to reduce the power consumption of the dynamic amplifier. Under 1.8V power supply in 180nm CMOS technology, the proposed dynamic amplifier achieves 35dB with less than 1dB drop over an output swing of 2.4V. The proposed dynamic amplifier consumes a total power of 16μW at an operating frequency of 4MHz.

The inherent relation between the linear antenna array and the finite impulse response filter of digital signal processing is revealed and the least square linear-phase finite impulse response filter design method is introduced for the linear antenna array to obtain a similar main lobe width of uniform linear antenna array but much lower sidelobe level.

A low voltage two-stage rail-to-rail regenerative comparator is presented. For the first time, a thyristor-based latch is introduced in this work, enabling the comparator’s rail-to-rail operation. The proposed comparator is post-layout simulated in a standard 180nm CMOS technology. The results certify that the comparator’s delay and power are less than 28ns and 230nW with 0.6V supply voltage and 1MHz sample rate. The total input-referred offset voltage (3std+mean) is less than 6.2mV over the entire rail-to-rail common-mode voltage range. In comparison with similar works the proposed comparator has the lowest delay and offset and achieves the best FOM.

BACKGROUND: Post-operative management of chronic rhinosinusitis is very crucial for outcomes following surgery, Normal saline nasal irrigation and steroid spray form the standard treatment of care in this period. However nasal irrigation may not be adequate and spary is usually started after 2wks of surgery which in any case does not deliver optimum dosage of drug to the paranasal sinus mucosa. Budesonide nasal irrigation in a high-volume low-pressure system could be the solution for a better outcome. METHODS: A double blinded randomized control trial with 88 patients in 2 groups of 44 each received normal saline or Budesonide nasal irrigation (0.5mg in 200ml) twice daily. Patients were followed up at 2 weeks post-operatively and 3 months, a SNOT 22 and Lund Kennedy Endoscopic scores were assessed for subjective and objective assessment. Subset analysis of only CRS patients (55) were done, and results presented. RESULTS: Patient reported subjective score at 3 months post operatively, SNOT22 was significantly (p<0.0001) improved with the use of Budesonide irrigation (26.69+/-2.92) as compared to Normal saline (30.54+/-2.81) and objective assessment score, LKES was significantly(p=0.0031) better in Budesonide group (4.06+0.74) in comparison to Normal saline in the saline (4.50+0.67)respectively. The mean scores 3 months post op visit was significantly lower for both subjective SNOT(p<0.001) and objective score LKES (p<0.0001) in Budesonide groups. CONCLUSION: Budesonide nasal irrigation with positive pressure high volume device has better patient benefits and wound healing when compared to normal saline irrigation in the post-operative management of chronic rhinosinusitis.

Objectives Dizziness has a lifetime prevalence of 17 – 30%. These symptoms have multiple aetiologies and can be difficult to diagnose in a routine ENT clinic. Several units have established multi-disciplinary ‘Dizzy Clinics’ to standardise the management of complex patients. We have developed a multi-disciplinary ‘Dizzy Clinic’ comprising clinicians and allied healthcare professionals, which incorporates a telephone triage service. Our service has been radically changed to triage patients to either a rapid access 30-minute BPPV clinic, or a 1-hour complex balance clinic and this study assesses the efficacy of our new model. Methods We conducted a retrospective audit of 124 patients referred to ‘generic’ ENT clinics for dizziness in 2019. This data was used to implement a new service where patients would receive a telephone triage before progressing to a multi-disciplinary clinic comprising audiologists, physiotherapists, and ENT surgeons. We prospectively re-audited 151 patients referred to this service in 2021. Results 40% of patients referred with dizziness in 2019 did not require a face-to-face appointment for an assessment of their dizziness. A telephone triage introduced to our ‘Dizzy Clinic’ streamed only 35.8% of referrals to a face-to-face appointment. 90% of face-to-face appointments from the ‘Dizzy Clinic’ were performed by a non-ENT surgeon. The ‘Dizzy Clinic’ showed more thorough and improved examinations compared to the previous cycle, and 60% were discharged from the ‘Dizzy Clinic’ after their first assessment, compared to 61% in the previous cycle. Conclusions Our ‘Dizzy Clinic’ effectively triages patients and enables a multi-disciplinary team to contribute to the management of dizzy patients.

Objective: Tonsillectomy is one of the most common surgeries worldwide, mostly indicated for recurrent throat infections and sleep-disordered breathing. The most significant complication is post-tonsillectomy bleeding. Although several risk factors for post-tonsillectomy bleeding in adults have been described, the role of post-operative pain as a risk factor for hemorrhage has not been described in this patient population. Design: Retrospective cohort study of adult patients (18 years and older) who underwent tonsillectomy in a tertiary referral center. Multi-variable logistic regression model was used to test correlation between the independent variables and post-tonsillectomy bleeding. Results: 305 patients (male to female ratio 1:1) with a mean age of 30.5 years old (18-82, ± 12). Mean body mass index was 26.6 (16-42, ±5) and 13% of patients were current smokers. Post-tonsillectomy pain on post-operative day 1 and 2 was associated with increased risk of bleeding (adjusted odds ratio 2.18, 95% confidence interval 1.73-2.44). Other factors that were associated with increased risk of post-tonsillectomy bleeding were male sex, young age (18-30 years old), smoking, recurrent throat infections as an indication for surgery and the usage of hot technique (p < 0.05). Conclusions: Increased post-operative pain following tonsillectomy is associated with increased risk of bleeding in adults. Other factors such as younger age group, males, smoking, previous throat infections and using hot dissection technique are also associated with risk of post-tonsillectomy bleeding. Further studies should explore the effect of strict pain control regimens on post-tonsillectomy bleeding in adults.

1. Bumble bees are key pollinators with some species reared in captivity at a commercial scale, but with evidence of population declines and with alarming predictions under climate change scenarios. While studies on the thermal biology of temperate species are still limited, they are entirely absent from the tropics where the effects of climate change are expected to be greater. 2. Herein we test if tropical bumble bees’ lower (CTMin) and upper (CTMax) critical thermal limits decrease with elevation and if the stable optimal conditions used in laboratory-reared colonies reduces their thermal tolerance. 3. We assessed changes in CTMin and CTMax of four species at two elevations (2600 and 3600 m) in the Colombian Andes and of laboratory-reared individuals of B. pauloensis. In addition, we examined the effect of body size and compiled information on bumble bees’ thermal limits from the literature to assess potential predictors for broad-scale patterns of variation. 4. CTMin decreased with elevation while CTMax did not. CTMax was slightly higher (0.84 °C) in laboratory-reared than in wild-caught bees while CTMin was similar. CTMin decreased with increasing body size while CTMax did not. Latitude is a good predictor for variations in CTMin while annual mean temperature and extreme monthly temperatures are good predictors for both CTMin and CTMax. 5. The stronger response in CTMin with increasing elevation supports Brett’s heat-invariant hypothesis. Tropical bumble bees appear to be about as heat tolerant as those from temperate areas, suggesting that other aspects of climate besides temperature (e.g., water balance) might be more determinant environmental factors for these species under global warming. Laboratory-reared colonies are adequate surrogates for addressing questions on thermal tolerance and global warming impacts.

Patterns of biodiversity provide insights into the processes that shape biological communities around the world. Variation in species diversity along biogeographical or ecological gradients, such as latitude or precipitation, can be attributed to variation in different components of biodiversity: changes in the total abundance (i.e. more-individual effects) and changes in the regional species abundance distribution (SAD). Rarefaction curves can provide a tool to partition these sources of variation on diversity, but first must be converted to a common unit of measurement. Here, we partition species diversity gradients into components of the SAD and abundance using the effective number of species (ENS) transformation of the individual-based rarefaction curve. Because the ENS curve is unconstrained by sample size, it can act as a standardized unit of measurement when comparing effect sizes among different components of biodiversity change. We illustrate the utility of the approach using two datasets spanning latitudinal diversity gradients in trees and marine reef fish, and find contrasting results. Whereas the diversity gradient of fish was mostly associated with variation in abundance (86%), the tree diversity gradient was mostly associated with variation in the SAD (59%). These results suggest that local fish diversity may be limited by energy through the more-individuals effect, while species pool effects are the larger determinant of tree diversity. We suggest that the framework of the ENS-curve has the potential to quantify the underlying factors influencing most aspects of diversity change.

Aims: Long QT syndrome (LQTS) is a rare heterogeneous syndrome that may be congenital or, more frequently, acquired (aLQTS). The real-world prevalence of acquired LQTS in the emergency department is unknown. Methods: The aim of this study was to determine the prevalence of this syndrome in the emergency room and to identify risk factors. Electrocardiograms (ECG) of 5056 consecutively patients admitted in the ER of a tertiary hospital between January 28th and March 17th of 2020 were reviewed. All patients with aLQTS were included. Clinical data with a focus on QT prolonging drugs and clinical factors were recorded. Statistical comparison was made between the groups with and without QT interval greater than 500ms. Results: A total of 390 ECGs with prolonged QTc were recognized, corresponding to a prevalence of aLQTS at admission of 7.95%. Patients with aLQTS were more commonly men (53.1%) with an age of 73.6 ± 14.7 years old and QTc interval of 502.14 ± 32.2ms. Only 20% of these patients with aLQTS were symptomatic. No ventricular arrhythmias were recorded. Patients with QT interval greater than 500ms were more frequently female (p<0.001) and were more frequently on QT prolonging drugs (p=0.002). Main contributing factor was intake of antibiotics (odds ratio (OR) 3.497) followed by female gender (OR 2.518) and antipsychotics (OR 1.960). Conclusions: Acquired LQTS is particularly prevalent in the ER. Female patients on antibiotics and antipsychotics are at particularly high risk. Efforts must be made to avoid, detect and treat aLQTS as early as possible.

Mucormycosis is an opportunistic infection that has become a serious concern as a result of the immunosuppressive drugs used during COVID-19. In this report, we describe two cases of rhino-orbital-cerebral mucormycosis with neurological presentation and ophthalmologic problems accompanied by a history of COVID-19 and diabetes.

A spectral problem is considered in a domain $\Omega_{\varepsilon}$ that is the union of a domain $\Omega_{0}$ and a lot of thin trees situated $\varepsilon$-periodically along some manifold on the boundary of $\Omega_{0}.$ The trees have finite number of branching levels. The perturbed Robin boundary condition $\partial_{\nu}u^{\varepsilon} + \varepsilon^{\alpha_i} k_{i,m}u^{\varepsilon} = 0$ is given on the $i$th branching layer; $\{\alpha_i\}$ are real parameters. The asymptotic analysis of this problem is made as $\varepsilon\to0,$ i.e., when the number of the thin trees infinitely increases and their thickness vanishes. In particular, the Hausdorff convergence of the spectrum to the spectrum of the corresponding nonstandard homogenized spectral problem is proved, the leading terms of asymptotics are constructed, and the corresponding asymptotic estimates are justified for the eigenvalues and eigenfunctions.

Background: The relationship between microgenia and obstructive sleep apnea syndrome is well known. Patients: 27-year-old woman. She underwent a combination of Le Fort I with horseshoe osteotomies and mandibular distraction osteogenesis and genioplasty. Results and Conclusions: She was satisfied with the aesthetics of her face, with an AHI of 7.8/h.

An upsurge in anthropogenic climate change has accelerated the habitat loss and fragmentation of wild animal and plants. The rare and endangered plants is an important elements of biodiversity, but holistic conservation management has been hampered by lacking of detailed and reliable information about their spatial distribution. Our aim is to study the consequences of climate change on geographical distributions of a rare tree species Firmiana kwangsiensis (Malvaceae) to provide reference for conservation, introduction and cultivation of this species. Based on 30 effective occurrence records and 27 environmental variables, we modeling the potential distribution of F. kwangsiensis under current and two future climate scenarios in maximum entropy. We found that the potential suitable habitat boundary of F. kwangsiensis were limited by precipitation-associated variables and temperature-associated variables. Our model predicted 259,504 km2 of F. kwangsiensis habitat based on 25 percentile thresholds in contemporary, of which the high suitable area is about 41,027 km2. Guangxi’s protected areas provide the most coverage for F. kwangsiensis habitat. However, the existing reserves encompass 2.7% of the total suitable habitat and 4.2% of the high suitable habitat, which is lower than the average protection intensity in Guangxi (7.2%), meaning protected areas network is currently insufficient and alternative conservation mechanisms are needed to protect the habitat. Our findings will help to identify additional localities where F. kwangsiensis may exist, and also where it may spread to. It provides important information for the conservation management and cultivation of such rare tree species.

Systemic lupus erythematosus (SLE; lupus) is an autoimmune disease. The common neurological manifestations are psychosis, cognitive dysfunction, and headache. Transverse myelitis (TM) may be the first manifestation of lupus. We describe one such case in which TM was the only presentation of SLE.

The healthcare profile of an individual is scattered across multiple data sources which can be difficult to access in a timely fashion. Furthermore, while the need to secure an individual’s personal health record is of paramount importance to prevent compromises such as cyber-attacks, it is important to be able to be able to seamlessly and quickly share information across healthcare providers to further enable precision and personalized health care. We present IntelliMedChain, a blockchain-powered knowledge-driven data sharing framework that gives patients complete control of their medical data and which can extract rich information hidden in the medical records using knowledge graphs (KGs). By incorporating both blockchain and KGs, we can provide a platform for a secure data sharing amongst stakeholders by maintaining data privacy and integrity through data authentication and robust data integration. We conduct a pilot study of the IntelliMedChain network using Ethereum blockchain technology to share knowledge across stakeholders. We show how it mitigates the issues around scalability by efficiently managing large-scale data and interoperability through seamless adoption of data regulations, as prescribed by various regulatory bodies for efficient governance.

A case of acute promyelocytic leukemia with circulating aberrant basophils was reported by us. Recent studies have shown that basophilic differentiation is not uncommon in APL and likely under-recognized in morphologic and immunophenotypic assessments.

Introduction: Obstructed labor is still the major cause of maternal morbidity and mortality, and adverse birth outcomes in low-income countries. This study aims to assess obstructed labour and associated factors among laboring women in Northeast Ethiopia. Methods: A retrospective cross-sectional study was conducted among 183 labouring mothers at Mekane Selam Primary Hospital in Northeast, Ethiopia. A random sampling method was employed to recruit a sampled chart from labour and delivery register through lottery methods. The adjusted odds ratio with a 95% confidence interval was used to calculate the strength of the association between obstructed labour and independent predictors. Variables with P-value less than 0.05 were considered statistically significant in multivariable logistic regression analysis. Result: The prevalence of obstructed labour was 14.8% [95% CI: 9.9-19.8], which significantly associated with primiparity [AOR =14.79, 95% CI: (1.78, 122.69)], mothers who stayed from 12-24 hours and >24 hours before visiting hospital [ AOR =5.908, 95% CI (1.438, 24.275)], [AOR=8.49, 95% CI:(1.045, 69.001], respectively and mothers who got intervention in > 8 hours after arrival in health setting [AOR=6.40, 95% CI (1.310, 31.229). Conclusion: Obstructed labour was high among mothers who gave birth at Mekane Selam General Hospital. Factors like time of arrival to intervention, parity, and duration of labour before visiting the hospital (12-24 Hrs’ and >24 hrs) were significantly associated with obstructed labor in multivariable analysis. Government and health professionals should emphasize system of prevention and reduction of these risk factors.

Takenouchi-Kosaki syndrome (TKS) exhibits clinical features represented by macrothrombocytopenia, developmental delay, dysmorphic facial features, and deafness. There is little information on the treatment for macrothrombocytopenia in TKS. Splenectomy has been a contraindication for inherited thrombocytopenia. In the case of autoimmune haemolytic anaemia (AIHA) with TKS that we previously reported, AIHA initially resolved with prednisolone; however, it gradually became resistant to drug therapy. We performed splenectomy, and post-operatively, both anaemia and macrothrombocytopenia improved. This is a novel effect of splenectomy for thrombocytopenia in TKS, which suggests that splenectomy could be a treatment option for thrombocytopenia in TKS.

ABSTRACT Objective: Recent increased awareness and research studies reflect possible associations between opioid exposure and cancer outcomes. Children with neuroblastoma (NB) often require opioid treatment for pain. However, associations between tumor response to chemotherapy and opioid exposure have not been investigated in clinical settings. Methods: This is a single institution retrospective review of patients with NB treated between 2013 and 2016. We evaluated opioid consumption quantified in morphine equivalent doses (mg/kg) based on nurse- or patient-controlled analgesia during antibody infusions. We also analyzed their associations with change in tumor volume and extra-adrenal tumor burden. Results: Of 42 patients given opioids for pain related to anti-GD2 mAb, data completion was achieved for 36 and details of statistical analyses were entered. Median total weight-based morphine equivalent (over 8 days) was 4.71 mg/kg (interquartile range 3.49-7.96). We found a statistically insignificant weak negative relationship between total weight-based morphine equivalents and tumor volume ratio (correlation coefficient -0.0103, p-value 0.9525) and a statistically insignificant weak positive relationship between total weight-based morphine equivalent and Curie score (correlation coefficient 0.1096, p-value 0.5247). Conclusion: Our study found no statistically significant correlation between opioid consumption and NK cell-mediated killing of NB cells as measured by effects on tumor volume/tumor load.