Equal Number Research Articles

Alamouti-coded DSP algorithm with a simplified PTBC decoder for next-generation optical access networks

The use of Alamouti-coded polarization-time block code (A-PTBC) in combination with a simple single polarization coherent receiver enables phase-diverse coherent detection without any optical polarization tracking. However, applying this technique to high-speed single-carrier systems is not straightforward, as it requires specialized digital signal processing (DSP) algorithms for data recovery, which increases DSP complexity. In this paper, we propose a novel Alamouti-coded coherent algorithm designed to significantly reduce the complexity of the receiver DSP for data recovery. The proposed algorithm achieves the comparable performance to the conventional algorithm but requires only half the number of necessary equalizers for data recovery. We validate its performance through simulations and also experimentally demonstrate a 100 Gb/s 16-quadrature amplitude modulation (QAM) single-carrier coherent system employed the single-polarization coherent receiver over 20 km of standard single-mode fiber (SMF). Through the performance verification, the coherent system with the proposed algorithm exhibits performance comparable to that of the conventional Alamouti-coded coherent system and achieves a power budget of 34 dB when the transmit launch power is set to 7 dBm at a Bit Error Rate (BER) of 1 × 10−2 for 0-20 km fiber transmission.

National eye health data from the Hungary's Comprehensive Health Protection Screening Program 2010–2020–2030 (MÁESZ)

AbstractPurposeThis paper provides a detailed presentation of the estimated number of people in Hungary with eye disease and refractive errors by both sex and age.Materials/methodsIn the past 12 years, 168,522 people (54.1% women and 45.9% men) have been screened under Hungary's Comprehensive Health Protection Screening Programme (MÁESZ).ResultsThe total number of people with eye disease in the adult Hungarian population (about 8 million people) is estimated to be 1,684,818, with women (1,078,026) outnumbering men (606,792). Eye diseases were found to be more common in older age groups, and more common in women than men in each age group. The estimated number of people with refractive errors in the Hungarian adult population is 5,005,095. The overall number of people with myopia in the adult Hungarian population is estimated to be 3,058,536, with roughly equal numbers of men and women. The majority of people with myopia (63.3%) are between 18 and 45 years of age.ConclusionsThe huge number of people in the Hungarian population affected by eye disease or refractive errors underscores the need to develop and implement an effective national strategy and specific programmes to prevent visual impairments.

Roaming Dogs, Intense Brown Dog Tick Infestation, and Emerging Rocky Mountain Spotted Fever in Tijuana, México.

A two decades-long epidemic of Rocky Mountain spotted fever in northern México reached the U.S. border city of Tijuana in 2021. Cases were near the city periphery in marginalized areas, some lacking infrastructure such as streets or utilities. We worked in the three census areas where human cases were reported and in 12 additional control Áreas Geoestadisticas Básicas. There were dogs, the primary tick host and Rickettsia rickettsii reservoir, in 76% of homes, with 2.2 owned dogs per home on average, approximately equal numbers of roaming dogs were seen, and 46.2% of owned dogs were allowed to roam in the street. Sixty-eight percent of people had heard of Rocky Mountain spotted fever (RMSF), and 35% self-reported tick infestation, including 19% of homes without dogs. Ticks appeared to move among houses of adjacent neighbors. Of 191 examined dogs, 61.8% were tick-infested, with 6-fold increased odds if they were allowed to roam. Although no dogs were Rickettsia polymerase chain reaction-positive, we found one R. rickettsii- and 11 Rickettsia massiliae-infected ticks. The rickettsial IgG seroprevalence by immunofluorescence antibody assay was 76.4%, associated with unhealthy body condition, adults, dogs with >10 ticks, more dogs being seen in the area, and dogs being permitted in the street. Insufficient medical and canine management resources have contributed to a case fatality rate of RMSF that has exceeded 50% in areas. High canine seroprevalence suggests risks to people and dogs; unfortunately, herd immunity is impeded by high turnover in the canine population owing to the birth of puppies and high death rates. Binational One Health workers should monitor disease spread, enact canine population management and tick eradication, and provide prevention, diagnostic, and treatment support.

First Report of Shoot Blight of Grapevine Caused by Sclerotinia sclerotiorum in Illes Balears, Mallorca, Spain.

In 2021, grapevines (Vitis vinifera L.) cv. Callet growing in a commercial vineyard located at Pollença (northeast of the island of Majorca, Spain) showed severe symptoms of shoot blight during spring and early summer, with an incidence of 70%. Symptoms consisted of elongated cankered-like lesions, surrounded by water-soaked darker tissues, that developed at the base or around the middle nodes of the shoot. For fungal isolation, shoot samples with lesions were collected, surface disinfected with 2% NaCl for 90s, rinsed twice with deionized water and placed in Petri plates containing potato dextrose agar (PDA). The plates were incubated at 25°C under 12 h light-darkness for 6 days. Isolations consistently yielded on kind of fungal colonies that produced white mycelium and black spherical to elongated sclerotia (2 to 10 mm in diameter). Morphological characterization was consistent with the description of Sclerotinia sclerotiorum (Lib.) de Bary (Bolton et al. 2006). Three isolates (UIB 118-1, UIB 118-26, and UIB 129-41) were preserved and deposited in the Culture Collection of Microbiology-Faculty of Sciences, University of Balearic Islands, Spain. Genomic DNA was extracted from isolates UIB 118-26 and UIB 129-41 using the EZNA Miniprep Kit (Omega Bio-Tek, Norcross, GA). The internal transcribed spacer (ITS) region of ribosomal DNA, β-tubulin (BTUB) and calmodulin (CAL) gene regions were amplified using ITS1F-ITS4 (Gardes and Bruns, 1996; White et al. 1990), Bt-2a/Bt-2b (Glass and Donaldson 1995) and CAL228F/CAL737R (Carbone and Kohn 1999) primer sets, respectively. Amplicons were sequenced and deposited in GenBank with accession numbers MZ604647 and MZ604648 for ITS, OK634402 and OK634403 for BTUB and OK634404 and OK634405 for CAL. BLASTn search showed that isolates were >99 % (ITS, BTUB and CAL) identical to S. sclerotiorum GenBank accession no. KF859933, CP017815 and KF871381, respectively. Pathogenicity tests were conducted using eight one-year old grapevines cv. Cabernet Sauvignon. Old and new green shoots were inoculated by inserting a 6-mm plug of mycelium taken from actively growing cultures on PDA into cuts made at the base and at the distal part of each shoot with a sterile scalpel with a total of eight inoculation points per plant. Inoculated wounds were sealed with Parafilm tape to avoid rapid dehydration. Inoculated plants and an equal number of wounded but non-inoculated plants (negative controls) were maintained at 25 ± 1°C for 48 h in plastic containers to ensure a high relative humidity (>90%). After 5 days, the infection girdled and rotted the green new shoots, whereas the older partially lignified shoots developed a localized long brown lesion that reached 16 cm in length. Due to the rotting of the basal part of the petiole, leaves turned gray, wilted, and died, easily detaching from the stem. In advanced stages of the disease, 7 days after infection, branches died and fell with the leaves remained attached (Fig 1 A, B). Reisolations from diseased shoots were successfully performed on PDA to fulfill Koch's postulates. S. slerotiorum was previously reported on grapevine causing shoot blight in Chile (Latorre and Guerrero, 2001), Korea (Jong-Han et al. 2009), California-USA (Boland and Hall, 1994) and Australia (Hall et al. 2002). AlsoS. sclerotiorum was reported among the endophytic mycobiota associated with Vitis vinifera in the Iberian Peninsula (Gonzalez and Tello, 2011) but not as a pathogen causing visible symptoms on that crop. So, this is the first report of the occurrence of S. slerotiorum as a pathogen of grapevines in Spain causing symptoms of canker and shoot blight. This finding highlights a potential risk of this fungal disease for the wine industry in the Mediterranean region and specially for Spain, the country with the largest acreage devoted to grapevines. Although chemical and biological are suitable control strategies, disease management is difficult as sclerotia of Sclerotinia can remain in the soil for up to eight years (Adams and Ayears, 1979), and preventive surveys are greatly recommended as an important epidemiological tool to monitor the epidemiology of disease and identify potential outbreaks of this new pathogen on grapevine in Spain.

Leaf Spot caused by Alternaria tenuissima on Rhamnella franguloides in China.

The small tree species Rhamnella franguloides, belonging to the genus Rhamnella in the tribe Rhamneae Hook. f. of Rhamnaceae (Hauenschild et al. 2016), is an important medicinal plant commonly used for making tea in China. In August 2023, leaf spot symptoms were observed on R. franguloides in Shangyao county, Yantai, Shandong, China, with a disease incidence of 45-65%. Initially appearing as small dark brown spots on the tip lesions, they later expanded and merged into irregular-shaped brown necrotic lesions with yellowish halos. To isolate pathogen, 20 symptomatic tissue fragments (5 × 5 mm) from ten sampling randomly plants were surface sterilized, placed on potato dextrose agar (PDA) plates, and incubated at 25°C in darkness for 3 days to obtain colonies.10 purified isolates with similar morphological characteristics were obtained by single-spore isolation from the colonies. The representative isolate MR13 was chosen for morphological and molecular analysis. The colonies On PDA medium initially appear as a circular yellow-brown ring with white round margins, ultimately turning into olive green with fluffy aerial hyphae. The conidiophores displayed brown pigmentation, solitary or branched, producing abundant short chains of conidia. The conidia were typically obclavate to obpyriform or ellipsoid in shape, 22.5-64.5 × 12.5-23.6μm in size, with a short conical beak at the apex, zero to three longitudinal septa and one to five transverse septa. Based on cultural and morphological characteristics, the fungus was identified as Alternaria spp (Simmons 2007). Due to morphological traits, five genes (the internal transcribed spacer [ITS], actin [ACT], plasma membrane ATPase [ATP], Alternaria major allergen [Alt a1] and histone 3 [H3]) form MR13 were amplified using primer pairs ITSI / ITS4, ACTDF1/R1, ATPDF1 / ATPDRI, Alt-for / Alt-rev, and H3-1a/1b, respectively (Hong et al. 2005; Lawrence et al. 2013; Lousie and Donaldson 1995). BLASTn analysis failed to confirm the identification of MR13 species based on ITS, ACT, ATP and Alt a1(ITS, OR668512; ACT, OR676918; ATP, OR676917; Alt a1, OR676919). The phylogenetic tree showed that it was closely related to Alternaria alternate, A. tenuissima, and A. destruens. The H3 sequence (OR676920) exhibited 100% similarity to A. tenuissima (OR485421). The phylogenetic tree constructed solely with H3 further confirmed MR13 as A. tenuissima. Pathogenicity tests were conducted by introducing the fungus onto healthy R. franguloides leaves in the field. Fifty leaves (five per plant) were treated with a 20ml suspension containing around 1x10^4 spores/ml, while an equal number of control samples were sprayed with distilled water. Transparent plastic bags were used to cover the treated leaves for 48 hours and maintain humidity. After fourteen days of inoculation, consistent leaf spotting symptoms were observed. In contrast, the control leaves showed no sign of infection. The fungal pathogen was successfully reisolated and identified as A. tenuissima through morphological and sequence analysis, fulfilling Koch's postulates. To our knowledge, this is the first report of A. tenuissima causing leaf spot disease on R. franguloides in China. Identifying the disease's causal agent is crucial for developing effective management strategies.

Shared Decision-Making in Cardiovascular Risk Factor Management

The effect of shared decision-making (SDM) and the extent of its use in interventions to improve cardiovascular risk remain unclear. To assess the extent to which SDM is used in interventions aimed to enhance the management of cardiovascular risk factors and to explore the association of SDM with decisional outcomes, cardiovascular risk factors, and health behaviors. For this systematic review and meta-analysis, a literature search was conducted in the Medline, CINAHL, Embase, Cochrane, Web of Science, Scopus, and ClinicalTrials.gov databases for articles published from inception to June 24, 2022, without language restrictions. Randomized clinical trials (RCTs) comparing SDM-based interventions with standard of care for cardiovascular risk factor management were included. The systematic search resulted in 9365 references. Duplicates were removed, and 2 independent reviewers screened the trials (title, abstract, and full text) and extracted data. Data were pooled using a random-effects model. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline. Decisional outcomes, cardiovascular risk factor outcomes, and health behavioral outcomes. This review included 57 RCTs with 88 578 patients and 1341 clinicians. A total of 59 articles were included, as 2 RCTs were reported twice. Nearly half of the studies (29 [49.2%]) tested interventions that targeted both patients and clinicians, and an equal number (29 [49.2%]) exclusively focused on patients. More than half (32 [54.2%]) focused on diabetes management, and one-quarter focused on multiple cardiovascular risk factors (14 [23.7%]). Most studies (35 [59.3%]) assessed cardiovascular risk factors and health behaviors as well as decisional outcomes. The quality of studies reviewed was low to fair. The SDM intervention was associated with a decrease of 4.21 points (95% CI, -8.21 to -0.21) in Decisional Conflict Scale scores (9 trials; I2 = 85.6%) and a decrease of 0.20% (95% CI, -0.39% to -0.01%) in hemoglobin A1c (HbA1c) levels (18 trials; I2 = 84.2%). In this systematic review and meta-analysis of the current state of research on SDM interventions for cardiovascular risk management, there was a slight reduction in decisional conflict and an improvement in HbA1c levels with substantial heterogeneity. High-quality studies are needed to inform the use of SDM to improve cardiovascular risk management.

A tight compact quadratically constrained convex relaxation of the Optimal Power Flow problem

In this paper, we consider the Optimal Power Flow (OPF) problem which consists in determining the power production at each bus of an electric network by minimizing the production cost. Our contribution is an exact solution algorithm for the OPF problem. It consists in a spatial branch-and-bound algorithm based on a compact quadratically-constrained convex relaxation. It is computed by solving the semidefinite rank relaxation of OPF once at the root node of the algorithm. An important result is that the optimal value of our compact relaxation is equal to the rank relaxation value. Then, at every sub-nodes of our branch-and-bound, the lower bound is obtained by solving a quadratic convex problem instead of an SDP. Another contribution is that we add only O(n+m) variables that model the squares of the initial variables, where n is the number of buses in the power system and m the number of transmission lines, to construct our relaxation. Then, since the relations between the initial and auxiliary variables are non-convex, we relax them to get a quadratic convex relaxation. Finally, in our branch-and-bound algorithm, we only have to force a reduced number of equalities to prove global optimality. This quadratic convex relaxation approach is here tailored to the OPF problem, but it can address any application whose formulation is a quadratic optimization problem subject to quadratic equalities and ring constraints. Our first experiments on instances of the OPF problem show that our new algorithm Compact OPF (COPF) is more efficient than the standard solvers and other quadratic convex relaxation based methods we compare it with.

Neighborhood Balanced Colorings of Graphs

Given a simple graph G, we ask when V(G) may be partitioned into two sets such that every vertex has an equal number of neighbors from each set. We establish a number of results for common families of graphs and completely classify 4-regular circulants which posses this property.

Abstract 46: Mechanisms and impact of bystander killing by CAR T cells

Abstract While CD19-directed chimeric antigen receptor (CAR) T cell therapy has improved outcomes of patients with relapsed/refractory diffuse large B cell lymphoma (r/r DLBCL), a majority will suffer disease relapse following CAR T cell infusion. Therefore, understanding mechanisms of CAR T cell killing is critical to enhance therapeutic efficacy. Cytolysis of CAR T cell targets presumably involves recognition of CD19 antigen by the CAR followed by activation of the granzyme/perforin axis. However, bystander elimination of CD19-negative lymphoma cells by CAR T cells has been reported, indicating that an alternative pathway may be required for optimal killing. Through in-depth phenotyping of a large panel of human DLBCLs and in vitro killing assays, we observed that CD19 expression levels on DLBCL cells and vulnerability to CAR T cell killing were weakly correlated. Conversely, cell surface expression of the death receptor, FAS, on DLBCL cells was strongly associated with susceptibility to CAR T cell killing. Although FAS expression across DLBCL cell lines varied, it could be broadly enhanced following exposure to IFNγ. Potent CAR T cell-mediated cytolysis of CD19-negative, Fas-positive murine DLBCL cells required the presence of CD19-positive lymphoma cells in the culture. CRISPR/Cas9 targeting was employed to delete FAS and/or CD19 in isogenic human DLBCL cells to generate CD19+FAS+, CD19+FAS−, CD19−FAS+, and CD19−FAS− subsets, which enabled us to define the extent to which CD19 engagement by the CAR was required to affect killing via FAS. When CAR T cells were co-cultured with equal numbers of the four gene-modified DLBCL cells described above, CD19+FAS+ DLBCL cells were killed most effectively, followed by CD19+FAS− DLBCL cells, and CD19−FAS+ DLBCL cells. Double-negative DLBCL cells were poorly killed. This result suggested that CD19 engagement by the CAR was required for optimal DLBCL cell killing via FAS, and that CD19 and FAS need not necessarily be engaged on the same target cell. Future studies will determine if Fas/FasL interactions can be exploited by overexpression of FasL in CAR T cells and examination of DLBCL killing in vitro and in vivo. Citation Format: Joanna Chorazeczewski, Lishi Xie, Xiufen Chen, Sidney Wang, Justin Kline. Mechanisms and impact of bystander killing by CAR T cells [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 46.

DNA metabarcoding reveals ecological patterns and driving mechanisms of archaeal, bacterial, and eukaryotic communities in sediments of the Sansha Yongle Blue Hole

The Sansha Yongle Blue Hole (SYBH) is the world’s deepest marine blue hole with unique physicochemical characteristics. However, our knowledge of the biodiversity and community structure in SYBH sediments remains limited, as past studies have mostly focused on microbial communities in the water column. Here, we collected sediment samples from the aerobic zone (3.1 to 38.6 m) and the deep anaerobic zone (150 m, 300 m) of the SYBH and extracted DNA to characterize the archaeal, bacterial, and eukaryotic communities inhabiting these sediments. Our results showed that the archaeal and bacterial communities were dominated by Thaumarchaeota and Proteobacteria, respectively. The dominant taxa of eukaryotes in different sites varied greatly, mainly including Phaeophyceae, Annelida, Diatomea and Arthropoda. All three examined domains showed clear vertical distributions and significant differences in community composition between the aerobic and anaerobic zones. Sulfide played a prominent role in structuring the three domains, followed by salinity, nitrous oxide, pH, temperature and dissolved oxygen, all of which were positively correlated with the turnover component, the main contributor to beta diversity. Neutral community model revealed that stochastic processes contributed to more than half of the community variations across the three domains. Co-occurrence network showed an equal number of positive and negative interactions in the archaeal network, while positive interactions accounted for ~ 80% in the bacterial and eukaryotic networks. Our findings reveal the ecological features of prokaryotes and eukaryotes in SYBH sediments and shed new light on community dynamics and survival strategies in the special environment of marine blue holes.

Biodegradable Local Chemotherapy Platform with Prolonged and Controlled Release of Doxorubicin for the Prevention of Local Tumor Recurrence.

Local recurrence after surgical and therapeutic treatment remains a significant clinical problem in oncology. Recurrence may be due to imperfections in existing therapies, particularly chemotherapy. To improve antitumor activity and prevent local cancer recurrence while keeping toxicity at acceptable levels, we have developed and demonstrated a biodegradable local chemotherapy platform that provides controlled and prolonged drug release. The platform consists of a polycaprolactone (PCL) substrate, which provides the structural integrity of the platform and the predominant unidirectional drug release, and a thin multilayer coating (∼200 nm) containing doxorubicin (DOX). The coating is an electrostatic complex obtained by the layer-by-layer (LbL) assembly and consists of natural polyelectrolytes [poly-γ-glutamic acid (γ-PGA) and chitosan (CS) or poly-l-lysine (PLL)]. To improve the release stability, an ionic conjugate of DOX and γ-PGA was prepared and incorporated into the multilayer coating. By varying the structure of the coating by adding empty (without DOX) bilayers, we were able to control the kinetics of drug release. The resulting platforms contained equal numbers of empty bilayers and DOX-loaded bilayers (15 + 15 or 30 + 30 bilayers) with a maximum loading of 566 ng/cm2. The platforms demonstrated prolonged and fairly uniform drug release for more than 5 months while retaining antitumor activity in vitro on ovarian cancer cells (SKOV-3). The empty platforms (without DOX) showed good cytocompatibility and no cytotoxicity to human fibroblasts and SKOV-3 cells. This study presents the development of a local chemotherapy platform consisting of a PCL-based substrate which provides structural stability and a biodegradable polyelectrolyte layered coating which combines layers containing a polyanion ionic complex with DOX with empty bilayers to ensure prolonged and controlled drug release. Our results may provide a basis for improving the efficacy of chemotherapy using drug delivery systems.

Aging-accumulated methylmalonic acid serum levels at breast cancer diagnosis are not associated with distant metastases.

Recent evidence suggests that age-accumulated methylmalonic acid (MMA) promotes breast cancer progression in mice. This study aims to investigate the association between baseline serum MMA concentrations in patients with breast cancer and the development of subsequent distant metastases. We included 32 patients with early Luminal B-like breast cancer (LumB, median age 62.4y) and 52 patients with early triple-negative breast cancer (TNBC, median age 50.5y) who developed distant metastases within 5years. They were matched to an equal number of early breast cancer patients (median age 62.2y for LumB and 50.5y for TNBC) who did not develop distant metastases with at least 5years of follow-up. Baseline serum MMA levels at breast cancer diagnosis showed a positive correlation with age (P < 0.001) and a negative correlation with renal function and vitamin B12 (all P < 0.02), but no statistical association was found with BMI or tumor stage (P > 0.6). Between matched pairs, no significant difference was observed in MMA levels, after adjusting for kidney function and age (P = 0.19). Additionally, in a mouse model, a significant decline in MMA levels was observed in the tumor-bearing group compared to the group without tumors before and after tumor establishment or at identical times for the control group (P = 0.03). Baseline serum MMA levels in patients with breast cancer are not correlated with secondary distant metastasis. Evidence in the mouse model suggests that the presence of a tumor perturbates MMA levels.

Do female and male family forest landowners think alike? A qualitative analysis from Georgia, United States

Family forest landowners own approximately 55 % of the state of Georgia's forestlands (24.6 million acres). Female forest ownership has grown in recent years and is expected to increase even further. Literature on forest landowners’ viewpoints about forestry in Georgia, in general, and about female forest landowners, in particular, is very limited. To address this research gap, we aim to investigate the viewpoints of family forest landowners regarding forestry in Georgia with a gender lens, i.e., the differences and similarities in how male and female family forest landowners view forestry-related issues in Georgia. Content analysis of responses to an open-ended question, which was in turn part of a mail survey, revealed six prominent themes, i.e., foresters/outreach, timber market, programs/resources/taxes, needs/suggestions, concerns, and desire to learn more. In general, a lower number of female responses fell under the foresters/outreach, programs/resources/taxes, needs/suggestions, and concerns themes, compared to their male counterparts. No female responses fell under the timber market theme, whereas the majority of male responses did. The desire to learn more theme received nearly equal number of responses from females and males. Our key findings indicate that 1) women require more assistance from foresters and need outreach opportunities to learn more about forest management, including topics such as timber markets, programs/resources/taxes; 2) males reported the timber market value is low and should increase; 3) males expressed more resources and programs are required for forest landowners to manage their forestlands (including tax incentives); 4) males and females suggested more public education about logging, expanded use of technology, and youth involvement in forest management; 5) women are concerned about invasive species and men about land development. These results are important to inform policymaking for supporting family forest landowners in Georgia, especially female forest landowners who are a rising segment of forest landownership in the state.

Pre-operative vs. post-operative stereotactic radiosurgery for operative metastatic brain tumors: study protocol for a phase III clinical trial

Background and ObjectivesAlmost one third of cancer patients in the United States will develop brain metastases on an annual basis. Surgical resection is indicated in the setting of brain metastases for reasons, such as maximizing local control in select patients, decompression of mass effect, and/or tissue diagnosis. The current standard of care following resection of a brain metastasis has shifted from whole brain radiation therapy to post-operative stereotactic radiosurgery (SRS). However, there is a significant rate of local recurrence within one year of postoperative SRS. Emerging retrospective and prospective data suggest pre-operative SRS is a safe and potentially effective treatment paradigm for surgical brain metastases. This trial intends to determine, for patients with an indication for resection of a brain metastasis, whether there is an increase in the time to a composite endpoint of adverse outcomes; including the first occurrence of either: local recurrence, leptomeningeal disease, or symptomatic radiation brain necrosis - in patients who receive pre-operative SRS as compared to patients who receive post-operative SRS.MethodsThis randomized phase III clinical trial compares pre-operative with post-operative SRS for brain metastases. A dynamic random allocation procedure will allocate an equal number of patients to each arm: pre-operative SRS followed by surgery or surgery followed by post-operative SRS.Expected outcomesIf pre-operative SRS improves outcomes relative to post-operative SRS, this will establish pre-operative SRS as superior. If post-operative SRS proves superior to pre-operative SRS, it will remain a standard of care and halt the increasing utilization of pre-operative SRS. If there is no difference in pre- versus post-operative SRS, then pre-operative SRS may still be preferred, given patient convenience and the potential for a condensed timeline.DiscussionEmerging retrospective and prospective data have demonstrated some benefits of pre-op SRS vs. post-op SRS. This study will show whether there is an increase in the time to the composite endpoint. Additionally, the study will compare overall survival; patient-reported outcomes; morbidity; completion of planned therapies; time to systemic therapy; time to regional progression; time to CNS progression; time to subsequent treatment; rate of radiation necrosis; rate of local recurrence; and rate of leptomeningeal disease.Trial registration numberNCT03750227 (Registration date: 21/11/2018).

After Abu Dhabi: Restoring Integrity and Accountability in Formula 1

The 2021 Abu Dhabi Grand Prix ended the 2021 Formula One World Championship in a dramatic and controversial fashion. Mercedes’ Lewis Hamilton and Red Bull’s Max Verstappen went into the final round with an equal number of points scored for the World Drivers’ Championship. The race was decided in the final few laps after Williams’ Nicholas Latifi crashed into the barriers with five laps remaining. After the safety car was deployed, Verstappen pitted for a fresh set of soft tyres, while Hamilton stayed out to maintain track position. On the second-to-last lap, Race Director Michael Masi directed only the five lapped cars between Verstappen and Hamilton to unlap themselves, in direct contravention of established Fédération Internationale de l'Automobile (FIA) rules. On the final lap, the green flag was deployed and the race resumed; Verstappen overtook Hamilton on his fresher tyres and maintained the lead, going on to win the Grand Prix and consequently the World Drivers’ Championship. Mercedes initially filed protests for breach of sporting regulations, but eventually withdrew them, citing a loss of faith in racing and that what happened in Abu Dhabi was "not right."

Trends in Admittance and Equity in Higher Education: Are Male Students in Uganda Disadvantaged?

The purpose of this study was to assess the impact of trends in admittance and equity in higher education. Using Qualitative approach in data collection, this study answered the following questions: Are Male students currently disadvantaged in admittance to higher education in favour of female students? What is the impact this imbalance in relation to job market demands for skilled labour from both sexes? What long-term initiatives might significantly increase the number of male students admitted to higher education institutions for gender equity? The findings were that the available data on trends in admitting students in higher institutions show an almost equal number of the ratio of females to male with some exceptional institutions where female ratios have exceeded male ratios. It is recommended that the government should review affirmative action policies so that the recruitment does not favor one gender as it were before the programs.

Expectations, experiences and challenges of nursing students using the virtual learning medium during the COVID-19 pandemic: A descriptive phenomenological study.

The COVID-19 pandemic caused several higher educational institutions to switch from traditional face-to-face to virtual learning medium. This abrupt shift came with new expectations, experiences and challenges to nursing/ midwifery students, particularly new users, and even more so when preparation, orientation, and support were lacking or ineffective. The present study therefore aimed at exploring the expectations, experiences and challenges of nursing students using the virtual learning medium during the COVID-19 pandemic. This was a descriptive phenomenological design using 12 purposively sampled nursing and midwifery students from a public university in Ghana. With the aid of a semi-structured guide, individual face-to-face interviews were audiotaped, transcribed verbatim at a later time and deductively analyzed into themes using the customer experience execution model. Participants were aged 22-36 years and involved equal number of males and females (n = 6), with majority being Christians (n = 11). Six themes were generated from the study: (1) "Initial thoughts and emotions" described participants initial reactions to the virtual educational medium during the pandemic; (2) "Expectations with the virtual medium" referred to the participants' anticipations regarding the convenience offered by the virtual medium; (3) "Experiences with the virtual medium" depicted the participants' recognition of both positive and negative encounters while using the virtual learning platform; (4) "Evaluation and recommendation" described participants' reports of meeting expectations and recommendations they made to enhance virtual learning; (5) "Challenges and limitations of the virtual medium" typically represented the obstacles encountered by nursing/ midwifery students when they embraced the virtual medium; (6) "Prospects of the virtual medium" referred to participants' views on the future of the virtual medium. The study has brought to light that the virtual education environment comes with its own expectations, experiences and challenges to students. Provision of adequate support such as orientation and simulation laboratories by higher education institutions to satisfy students' needs is necessary to enhance nursing education.

Fintech Service Quality of Saudi Banks: Digital Transformation and Awareness in Satisfaction, Re-Use Intentions, and the Sustainable Performance of Firms

The present study examined the effects of the service quality regarding fintech and customer satisfaction on the sustainable bank performance, with digital transformation and digital awareness as the mediator and moderator in the Saudi Arabian banks. Using an online survey questionnaire, data were collected from 306 customers and an equal number of customer care officers, resulting in a 62.58% response rate. The findings revealed that the tangibles, reliability, and empathy about the fintech services significantly influence customer satisfaction. However, assurance and responsiveness did not significantly influence customer satisfaction. The results also showed that customer satisfaction regarding fintech services significantly and positively influences the intention to re-use fintech services, indicating the centrality of maintaining a high customer satisfaction for retention. Interestingly, while the intention to re-use fintech was directly linked to the sustainable performance of banks, the direct impact of digital transformation on the performance was not significant. Additionally, digital awareness about using fintech services significantly and positively influences the sustainable bank performance. The study also tested the moderating effect of digital awareness between customer satisfaction and sustainable performance, but the relationship was not significant. By offering the study’s novel findings, this research underscores the implications of fintech adoption and its quality dimensions on bank performances in the Saudi context.

Comparative Sonographic Evaluation of the Gallbladder in Sickle Cell Disease Patients and Apparently Healthy Non-Sickle Cell Disease Individuals in a Nigerian Town

Background: Sickle cell disease (SCD) is an autosomal recessive blood disorder with multi-organ manifestations including the gall bladder. Studies have shown that individuals with sickle cell disease have strong tendency of developing pigment gallstones due to chronic red blood cell hemolysis and increased bilirubin levels.&#x0D; Aim and Objectives: The aim of this study was to evaluate and compare the gallbladder changes which includes volume, wall thickness, presence of biliary sludge and prevalence of calculi between age and sex-matched sickle cell disease patients and apparently healthy, normal non-SCD individuals.&#x0D; Materials and Methods: This was a cross-sectional comparative study of 50 known SCD patients attending the Haematology clinic of sub-urban tertiary health facility in Nigeria, and equal number of age and sex-matched apparently healthy, non-SCD volunteers attending the Well people clinic of the same hospital as controls. Each subject was evaluated for gallbladder volume, wall thickness, presence of biliary sludge and gallstones using a 3.5-5MHz curvilinear array transducer of a Mindray ultrasound machine, DC-6 model, 2016.&#x0D; Data Analysis: The data collected was analysed using the IBM Statistical Package for Social Sciences (SPSS) version 21.&#x0D; Statistical test was considered significant at p-value ≤ 0.05 and a confidence interval of 95%.&#x0D; Results: Out of the 100 subjects who underwent scanning, 50 were patients with sickle cell disease, consisting of 29 males (58.0%) and 21 females (42.0%), while the remaining 50 were non-sickle cell disease volunteers serving as controls, comprising 24 males (48.0%) and 26 females (52.0%). Their ages ranged from 2 to 65 years.&#x0D; The mean age of the cases and controls was 22.1±14.7 years and 19.9±12.6 years respectively. Among the patients; 8 (16.0%) had cholecystitis and 10 (20.0%) had gallstones, with no detectable abnormality in the controls.&#x0D; Conclusion: The ultrasonographic prevalence of gallbladder abnormalities was recorded only in patients with sickle cell disease when compared to apparently healthy controls as shown with increased prevalence with age.

A novel approach for intelligent diagnosis and grading of diabetic retinopathy

Diabetic retinopathy (DR) is a severe ocular complication of diabetes that can lead to vision damage and even blindness. Currently, traditional deep convolutional neural networks (CNNs) used for DR grading tasks face two primary challenges: (1) insensitivity to minority classes due to imbalanced data distribution, and (2) neglecting the relationship between the left and right eyes by utilizing the fundus image of only one eye for training without differentiating between them. To tackle these challenges, we proposed the DRGCNN (DR Grading CNN) model. To solve the problem caused by imbalanced data distribution, our model adopts a more balanced strategy by allocating an equal number of channels to feature maps representing various DR categories. Furthermore, we introduce a CAM-EfficientNetV2-M encoder dedicated to encoding input retinal fundus images for feature vector generation. The number of parameters of our encoder is 52.88 M, which is less than RegNet_y_16gf (80.57 M) and EfficientNetB7 (63.79 M), but the corresponding kappa value is higher. Additionally, in order to take advantage of the binocular relationship, we input fundus retinal images from both eyes of the patient into the network for features fusion during the training phase. We achieved a kappa value of 86.62% on the EyePACS dataset and 86.16% on the Messidor-2 dataset. Experimental results on these representative datasets for diabetic retinopathy (DR) demonstrate the exceptional performance of our DRGCNN model, establishing it as a highly competitive intelligent classification model in the field of DR. The code is available for use at https://github.com/Fat-Hai/DRGCNN.