Potential Causes Research Articles

Surveillance for Selected Pathogens and Parasites of Northern Bobwhite (Colinus virginianus) from Western Oklahoma, USA, 2018-20.

The Northern Bobwhite (Colinus virginianus) has been undergoing a range-wide population decline. Potential causes for declines across its historic range have been investigated for decades and include habitat loss and fragmentation and a variety of parasitic and infectious diseases. Although there have been studies on bobwhite ecology in Oklahoma, USA, relatively little is known about parasites and pathogens in the region. We evaluated the health of free-ranging bobwhites from nine sites in western Oklahoma. From 2018 to 2020, 206 bobwhites were evaluated for gross and microscopic lesions and tested for selected pathogens. In general, bobwhites were in good nutritional condition with ample muscle mass and fat stores. No significant gross lesions were observed in any bobwhite and no significant histologic lesions were detected in a subset. There was no evidence of infection with or exposure to reticuloendotheliosis virus, West Nile virus, respiratory Mycoplasmataceae species, Pasteurella multocida, intestinal Eimeria spp., or oral Trichomonas spp. Several pathogens of potential concern were detected, including avian adenovirus (8.6%), Toxoplasma gondii (2.3%), and haemosporidians (a Haemoproteus sp. (1.5%), Leucocytozoon schoutedeni (1.5%), and Plasmodium homopolare haplotype 2 [lineage LAIRI01; 3.6%]). Physaloptera sp. (12%) and Sarcocystis sp. (1%) were detected in the breast muscle. Low intraspecific genetic diversity was noted for Physaloptera sp., and sequences were most similar to Physaloptera sequences from bobwhites and grasshoppers (Orthoptera) in Texas. Low intensities of chewing lice, chiggers, and ticks were observed. A subset of bobwhites had evidence of exposure to selected toxicants and heavy metals; a small number had low levels of iron, manganese, zinc, molybdenum, and copper, which were not considered diagnostically relevant. In general, bobwhites from western Oklahoma appeared to be in good health with a low diversity of pathogens detected, but future work is needed to understand potentially changing disease risks for this population.

Regional Differences in Outcomes with Ablation Versus Drug Therapy for Atrial Fibrillation: Results from the CABANA Trial

The finding of unexpected variations in treatment benefits by geographic region in international clinical trials raises complex questions about the interpretation and generalizability of trial findings. We observed such geographical variations in outcome and in the effectiveness of atrial fibrillation (AF) ablation versus drug therapy in the Catheter Ablation vs Antiarrhythmic Drug Therapy for Atrial Fibrillation (CABANA) trial. This paper describes these differences and investigates potential causes. The examination of treatment effects by geographic region was a prespecified analysis. CABANA enrolled patients from 10 countries, with 1,285 patients at 85 North American (NA) sites and 919 at 41 non-NA sites. The primary endpoint was a composite of death, disabling stroke, serious bleeding, or cardiac arrest. Death and first atrial fibrillation recurrence were secondary endpoints. At least 1 primary endpoint event occurred in 157 patients (12.2%) from NA and 33 (3.6%) from non-NA sites over a median 54.9 and 40.5 months of follow-up, respectively (NA/non-NA adjusted hazard ratio (HR) 2.18, 95% confidence interval (CI) 1.48-3.21, P < .001). In NA patients, 78 events occurred in the ablation and 79 in the drug arm, (HR 0.91, 95% CI 0.66, 1.24) while 11 and 22 events occurred in non-NA patients (HR 0.51, 95% CI 0.25,1.05, interaction P = .154). Death occurred in 53 ablation and 51 drug therapy patients in the NA group (HR 0.96, 95% CI 0.65,1.42) and in 5 ablation and 16 drug therapy patients in the non-NA group (HR 0.32, 95% CI 0.12,0.86, interaction P = .044). Adjusting for baseline regional differences or prognostic risk variables did not account for the regional differences in treatment effects. Atrial fibrillation recurrence was reduced by ablation in both regions (NA: HR 0.54, 95% CI 0.46, 0.63; non-NA: HR 0.44, 95% CI 0.30, 0.64, interaction P = .322). In CABANA, primary outcome events occurred significantly more often in the NA group but assignment to ablation significantly reduced all-cause mortality in the non-NA group only. These differences were not explained by regional variations in procedure effectiveness, safety, or patient characteristics. ClinicalTrials.gov Identifier: NCT0091150; https://clinicaltrials.gov/study/NCT00911508.

“A Comprehensive Review of Anaemia Associated with Hypothyroidism”

Background: Thyroid hormones play a crucial role in erythropoiesis, both directly and indirectly, with reduced secretion potentially causing anaemia—a commonly overlooked symptom of hypothyroidism. By compiling existing data, discussing recent advancements, identifying root causes, and proposing potential treatment options, this work acknowledges the complexity of the issue and aims to serve as a foundational reference for those in the early stages of research or clinical practice. Methods: To comprehend the concept of this disease condition, a number of medical textbooks were consulted. Various search engines, such as PubMed, Google Scholar, Research Gate, Science Direct, Scopus, etc., were cited to explore the recent advancements and obtain data on the topic in question. Later, all the information and data gathered were organised into a review article. Conclusion: Anemia, often referred to as the “haematological mask” of hypothyroidism, can manifest even before hypothyroidism is clinically diagnosed. Hypothyroidism must be considered as a potential cause when confronted with refractory anemia, as its treatment is pivotal for achieving comprehensive and lasting improvements in haematological parameters.

Burden of intracranial artery calcification in white patients with ischemic stroke.

The diagnostic workup of stroke doesn't identify an underlying cause in two-fifths of ischemic strokes. Intracranial arteriosclerosis is acknowledged as a cause of stroke in Asian and Black populations, but is underappreciated as such in whites. We explored the burden of Intracranial Artery Calcification (IAC), a marker of intracranial arteriosclerosis, as a potential cause of stroke among white patients with recent ischemic stroke or TIA. Between December 2005 and October 2010, 943 patients (mean age 63.8 (SD ± 14.0) years, 47.9% female) were recruited, of whom 561 had ischemic stroke and 382 a TIA. CT-angiography was conducted according to stroke analysis protocols. The burden of IAC was quantified on these images, whereafter we assessed the presence of IAC per TOAST etiology underlying the stroke and assessed associations between IAC burden, symptom severity, and short-term functional outcome. IAC was present in 62.4% of patients. Furthermore, IAC was seen in 84.8% of atherosclerotic strokes, and also in the majority of strokes with an undetermined etiology (58.5%). Additionally, patients with larger IAC burden presented with heavier symptoms (adjusted OR 1.56 (95% CI [1.06-2.29]), but there was no difference in short-term functional outcome (1.14 [0.80-1.61]). IAC is seen in the majority of white ischemic stroke patients, aligning with findings from patient studies in other ethnicities. Furthermore, over half of patients with a stroke of undetermined etiology presented with IAC. Assessing IAC burden may help identify the cause in ischemic stroke of undetermined etiology, and could offer important prognostic information.

Dissolution Mechanisms of Amorphous Solid Dispersions: Application of Ternary Phase Diagrams To Explain Release Behavior.

The use of amorphous solid dispersions (ASDs) in commercial drug products has increased in recent years due to the large number of poorly soluble drugs in the pharmaceutical pipeline. However, the release behavior of ASDs is complex and remains not well understood. Often, the drug release from ASDs is rapid and complete at lower drug loadings (DLs) but becomes slow and incomplete at higher DLs. The DL where release becomes hindered is termed the limit of congruency (LoC). Currently, there are no approaches to predict the LoC. However, recent findings show that one potential cause leading to the LoC is a change in phase morphology after water-induced phase separation at the ASD/solution interface. In this study, the phase behavior of ASDs in contact with aqueous solutions was described thermodynamically by constructing experimental and computational ternary phase diagrams, and these were used to predict morphology changes and ultimately the LoC. Experimental ternary phase diagrams were obtained by equilibrating ASD/water mixtures over time. Computational ternary phase diagrams were obtained by Perturbed Chain Statistical Associating Fluid Theory (PC-SAFT). The morphology of the hydrophobic phase was studied with fluorescence confocal microscopy. It was demonstrated that critical point (plait point) composition approximately corresponded to the ASD DL, where the hydrophobic phase, formed during phase separation, became interconnected and hindered ASD release. This work provides mechanistic insights into the ASD release behavior and highlights the potential of in silico ASD design using phase diagrams.

Quercetin improves diabetic kidney disease by inhibiting ferroptosis and regulating the Nrf2 in streptozotocin-induced diabetic rats

Diabetic kidney disease (DKD) is a leading factor in end-stage renal disease. The complexity of its pathogenesis, combined with the limited treatment efficacy, necessitates deeper insights into potential causes. Studies suggest that ferroptosis-driven renal tubular damage contributes to DKD's progression, making its counteraction a potential therapeutic strategy. Quercetin, a flavonoid found in numerous fruits and vegetables, has demonstrated DKD mitigation in mouse models, though its protective mechanism remains ambiguous. In this study, we delved into quercetin’s potential anti-ferroptotic properties, employing a DKD rat model and high glucose (HG)-treated renal tubular epithelial cell models. Our findings revealed that HG prompted unusual ferroptosis activation in renal tubular epithelial cells. However, quercetin counteracted this by inhibiting ferroptosis and activating NFE2-related factor 2 (Nrf2) expression in both DKD rats and HG-treated HK-2 cells, indicating its renal protective role. Further experiments, both in vivo and in vitro, validated that quercetin stimulates Nrf2. Thus, our research underscores quercetin’s potential in DKD treatment by modulating the ferroptosis process via activating Nrf2 in a distinct DKD rat model, offering a fresh perspective on quercetin’s protective mechanisms.

Challenges and promising practices in background check systems for firearm purchases

AbstractAimThe U.S. prohibits firearm purchase among individuals with specific risk factors. These prohibitions are operationalized using background checks for firearm purchase. Despite these restrictions, prohibited persons have obtained firearms after passing background checks, sometimes with devastating effects.Materials and MethodsWe conducted a mixed‐methods, descriptive study of the records and record‐keeping practices that underpin background checks for firearm transfers. Sources included key informant interviews with individuals working in a leadership capacity with state record‐keeping systems as well as data from state surveys and administrative records. We analyzed quantitative data using descriptive statistics and qualitative data using a thematic analysis approach to code the data and identify themes. Three investigators coded each interview. We returned to all data sources to develop key findings in an iterative process.ResultsKey informants described major improvements in the collection of specific record types that were previously a “black hole” (e.g. criminal history records housed in military justice systems, and records relating to involuntary commitments for mental illness) and advances in the automation of record transfer across agencies, themes corroborated by administrative data. Key informants also identified potential causes and solutions for challenges relating to missing or incomplete information and delays in resolving ambiguous background check results. Examples include manual processes for confirming relationship status in misdemeanor crimes of domestic violence and discordant practices for processing arrest and court records that result in dispositions that cannot be entered or arrests with no disposition.ConclusionBackground checks are the backbone of many policies designed to prevent firearm harm in the United States. This study highlights actionable ways in which states could make background check practices and policies more robust.

MYOCARDITIS IN PEDIATRICS: A GROWING CONCERN FOR HEALTHCARE SYSTEMS IN PAKISTAN

Myocarditis, defined as an inflammation of the heart muscle, can pose significant challenges in pediatric cardiology due to its varied causes and potentially serious consequences. While there are several potential causes of myocarditis, for instance, autoimmune diseases and toxins, viral infections account for a large majority of cases in pediatric populations (Tschöpe et al., 2021). The frequency of myocarditis is still rather high due to the increased prevalence of viral diseases in children, especially during specific seasons; this puts a significant strain on hospital resources. Myocarditis in paediatric patients has consequences that go beyond the initial inflammatory insult to the heart. Patients affected with myocarditis can often exhibit acute heart failure, arrhythmias, and, in severe cases, cardiogenic shock (Ammirati et al., 2021). Moreover, long-term consequences can manifest as chronic heart failure, which necessitates continuous, ongoing monitoring and management to optimize cardiac function and quality of life (Upadhya and Kitzman, 2020). We have noticed a worrying trend in our pediatric cardiology practice at Lady Reading Hospital Peshawar, whereby approximately half of the patients who consult our outpatient and inpatient departments have left ventricular failure. A significant portion of these cases are diagnosed as viral myocarditis. We have noticed a worrying trend in our pediatric cardiology practice: about 50% of the cases that come into our outpatient and inpatient departments have left ventricular failure, and a sizable percentage of those cases are diagnosed with myocarditis. This finding not only highlights the frequency of myocarditis but also highlights the pressing need for increased awareness, prompt diagnosis, and effective management of viral myocarditis in order to reduce negative consequences in vulnerable pediatric populations. In resource-poor environments like Pakistan managing myocarditis can unique challenges. Treatment methods such as IV immunoglobulin treatment which can have proven success in some patients, are generally expensive and not readily available (Ammirati et al., 2021). This gap in access to modern treatments can further exacerbate the load on healthcare systems that are already strained by the high prevalence of myocarditis. In low and middle-income countries (LMICs) like Pakistan, proactive preventative interventions are especially important to reduce the strain on already overburdened healthcare systems. The increased frequency of myocarditis in pediatric populations can be decreased by highlighting the significance of vaccination against common viral infections linked to the illness such as adenovirus and enterovirus (Makimaa et al., 2020; Upadhya and Kitzman, 2020). In addition, raising awareness among caregivers and medical professionals about the early detection of myocarditis symptoms and the importance of promptly referring patients to specialized clinics will help to expedite intervention and enhance long-term results (Inoue et al., 2019). In summary, the growing incidence of myocarditis in pediatric patients demands a multimodal strategy that includes early detection, prevention, and complete therapeutic techniques. By addressing these issues collectively and pushing for fair access to key treatments, we can seek to lessen the impact of myocarditis on pediatric cardiac health and alleviate the load on healthcare systems, particularly in resource-limited settings.

Tacrolimus-associated neurotoxicity isolated to the brainstem: two illustrative cases and a systematic review of the literature.

Tacrolimus-associated neurotoxicity (TAN) manifests with wide clinical spectrum, ranging from mild tremors to severe encephalopathy. The isolated involvement of the brainstem is a rarely documented presentation of TAN, and its clinical and diagnostic characteristics are unclear. We report two cases of brainstem-isolated TAN (bi-TAN). Moreover, we performed a systematic review of the literature on bi-TAN and extracted data concerning demographics, clinical characteristics, radiological features, and management. The systematic literature search followed PRISMA guidelines and a pre-defined protocol. Eleven patients, including our two, were identified (mean age: 41.3years, ± 18.8; five males, 45%). Speech disturbance was the most common clinical presentation (45%). The mean latency from Tacrolimus initiation to bi-TAN onset was 26days (± 30.8). Tacrolimus serum level tested above the reference range in three patients (mean: 26.83 ± 5.48). Brain MRI showed T2-FLAIR hyperintensities; three showed restricted diffusion on ADC maps. Neurological symptoms resolved completely in seven patients (63%) after Tacrolimus withdrawal or dose reduction. Our findings suggest that bi-TAN could represent a brainstem variant of posterior reversible encephalopathy syndrome. Recognition of bi-TAN as a potential cause of isolated brainstem lesions is crucial to disentangle the diagnostic work-up and ensure prompt withdrawal or reduction of the offending agent.

Delays in the diagnosis and surgical treatment of drug-resistant epilepsy: A cohort study.

Delay in referral for epilepsy surgery of patients with drug-resistant epilepsy (DRE) is associated with decreased quality of life, worse surgical outcomes, and increased risk of sudden unexplained death in epilepsy (SUDEP). Understanding the potential causes of delays in referral and treatment is crucial for optimizing the referral and treatment process. We evaluated the treatment intervals, demographics, and clinical characteristics of patients referred for surgical evaluation at our level 4 epilepsy center in the U.S. Intermountain West. We retrospectively reviewed the records of patients who underwent surgery for DRE between 2012 and 2022. Data collected included patient demographics, DRE diagnosis date, clinical characteristics, insurance status, distance from epilepsy center, date of surgical evaluation, surgical procedure, and intervals between different stages of evaluation. Within our cohort of 185 patients with epilepsy (99 female, 53.5%), the mean ± standard deviation (SD) age at surgery was 38.4 ± 11.9 years. In this cohort, 95.7% of patients had received definitive epilepsy surgery (most frequently neuromodulation procedures) and 4.3% had participated in phase 2 intracranial monitoring but had not yet received definitive surgery. The median (1st-3rd quartile) intervals observed were 10.1 (3.8-21.5) years from epilepsy diagnosis to DRE diagnosis, 16.7 (6.5-28.4) years from epilepsy diagnosis to surgery, and 1.4 (0.6-4.0) years from DRE diagnosis to surgery. We observed significantly shorter median times from epilepsy diagnosis to DRE diagnosis (p < .01) and epilepsy diagnosis to surgery (p < .05) in patients who traveled further for treatment. Patients with public health insurance had a significantly longer time from DRE diagnosis to surgery (p < .001). Both shorter distance traveled to our epilepsy center and public health insurance were predictive of delays in diagnosis and treatment intervals. Timely referral of patients with DRE to specialized epilepsy centers for surgery evaluation is crucial, and identifying key factors that may delay referral is paramount to optimizing surgical outcomes.

Transient postictal dysphagia in older adults with focal structural epilepsy.

Seizures can cause transient neurological symptoms, such as hemiparesis and aphasia. However, temporary swallowing changes leading to postictal dysphagia have not been previously described. Therefore, this study evaluated the presence of swallowing disorders following seizure. In addition, dysphagia severity and duration of any recovery from dysphagic symptoms were investigated. The local clinical database of all fiberoptic endoscopic evaluation of swallowing (FEES) examinations performed from 2008 to 2019 was screened for patients diagnosed with seizures, but excluding patients with intensive care unit admission or intubation >24 h. Patient charts were evaluated to identify preexisting dysphagia or potential concurrent medical causes for dysphagia, including hyponatremia, increased intracranial pressure, sepsis, or other encephalopathies associated with infections, or other possible causes at the time of admission. Patients receiving >.5 defined daily doses of benzodiazepines or neuroleptics were also excluded. Age, sex, seizure semiology and etiology, comorbidities, concurrent pneumonia, and dysphagia course during hospitalization were evaluated as predictors of the occurrence of dysphagia or its potential duration. We identified 41 patients with dysphagia following a seizure, without evidence of any concurrent cause of swallowing dysfunction. These patients all presented with focal structural epilepsy, they had a mean age of 79 ± 11.3 years (range = 44-95 years), and 21 were women. The mean Elixhauser Comorbidity Score was 4.8. Hospital-acquired pneumonia was detected in 21 patients (51.2%). FEES diagnosed mild and severe dysphagia in 21 (51.2%) and 20 (48.8%) patients, respectively. Dysphagia improved significantly (p = .001) during hospitalization, persisting for an average of 3.9 days (median = 3 days, SD = 2.07 days, range = 1-8 days). Dysphagia is a potential transient neurological deficit following seizure. Our findings suggest that older patients, with focal structural epilepsy, are at risk for postictal dysphagia. Further studies are needed to ascertain the prevalence, complications, and predictors of postictal dysphagia. Dysphagia screening may improve early detection in patients with relevant risk factors, as well as reduce the occurrence of aspiration pneumonia.

(278) The Loss of Histone Reader Phf7 Leads to Immune Pathways Activation via Endogenous Retroviruses During Spermiogenesis

Abstract Introduction PHF7 has been identified as playing a crucial role in germline development in animals. However, its correlation with human infertility remains ambiguous. Objective To ascertain if a germline mutation in the human PHF7 gene correlates with azoospermic patients and to further determine if this mutation is a potential cause of non-obstructive azoospermia. Methods Genetic screening of azoospermic patients for PHF7 mutations. Using Phf7 knockout mice models to simulate the human mutation, aiming to validate if these mutations are directly responsible for male infertility. Investigating the role of endogenous retroviruses related to Phf7 deletion and its link to activating the immune pathway. Results A germline mutation of the human PHF7 gene was identified in azoospermic patients. In the Phf7 knockout mice model, male infertility was observed, specifically stemming from an inhibited histone-to-protamine exchange process. The absence of spermatogenesis due to the Phf7 deletion was found to be associated with the activation of the immune pathway, mediated by endogenous retroviruses. PPARα was identified as a significant factor in the testis, which is suppressed by endogenous retroviruses. Conclusions PHF7 is an essential gene associated with human infertility, particularly in non-obstructive azoospermic patients. Its role as an epigenetic reader became evident, and the absence of PHF7 leads to immune pathway activation. The study also highlighted that the PPARα agonist, Astaxanthin, holds promise as a therapeutic agent to treat male infertility resulting from PHF7 mutations. Disclosure No.

Childhood Adversity and Incident Psychotic Experiences in Early Adulthood: Cognitive and Psychopathological Mediators.

Childhood adversity is often described as a potential cause of incident psychotic experiences, but the underlying mechanisms are not well understood. We aimed to examine the mediating role of cognitive and psychopathological factors in the relation between childhood adversity and incident psychotic experiences in early adulthood. We analyzed data from the Avon Longitudinal Study of Parents and Children, a large population-based cohort study. Childhood adversity was measured prospectively from birth to age 11 years, mediators (anxiety, depression, external locus of control [LoC], negative symptoms) were assessed at approximately 16 years of age, and incident psychotic experiences were assessed at ages 18 and 24 years. Mediation was examined via the counterfactual g-computation formula. In total, 7% of participants had incident suspected or definite psychotic experiences in early adulthood. Childhood adversity was related to more incident psychotic experiences (ORadjusted = 1.34, 95% CI = 1.21; 1.49), and this association was partially mediated via all mediators examined (proportion mediated: 19.9%). In separate analyses for each mediator, anxiety, depression, external LoC, and negative symptoms were all found to mediate the link between adversity and incident psychotic experiences. Accounting for potential confounders did not modify our results. Our study shows that cognitive biases as well as mood symptomatology may be on the causal pathway between early-life adversity and the development of psychotic experiences. Future studies should determine which mediating factors are most easily modifiable and most likely to reduce the risk of developing psychotic experiences.

The etiology, diagnostics, and treatment of the spasm of the near reflex - a narrative review.

Physiological adaptation of the eye to the visual perception of near objects consists of the "near triad": convergence, accommodation, and pupil miosis. Normally, these tend to revert when one stops fixating on a near object. Spasm of the near reflex (SNR) is a pathological phenomenon, which manifests itself by the persistence of the above-mentioned adjustments, which prevents the eye from returning to its relaxed state. In this narrative review, we aim to summarize the etiology, diagnostics, treatment, and prevention of SNR. The literature review was performed by searching online databases. The clinical presentation of SNR is diverse; it presents as isolated accommodative spasm more frequently than impairment of all three components of the near triad. Patients usually present with fluctuations in visual acuity, blurred vision, diplopia, and asthenopia. The etiology is not fully understood. Potential causes include neuroanatomic, organic, and psychogenic disorders. The diagnosis is clinical, based on the constellation of symptoms and assessment of the near triad. The diagnostic golden standard is a cycloplegic examination of refraction, preferably using cyclopentolate hydrochloride (1%, 0.5%, or 0.1% solution). The first-line treatment requires the administration of a cycloplegic drug in combination with plus lenses, flipper lenses, optical fogging, or miotics. For secondary cases, causal treatment should be implemented. Prevention of SNR should be based on eliminating modifiable risk factors. We propose including screening for SNR symptoms in every ophthalmic examination, especially among patients with psychogenic or neural disorders, after brain trauma, or young adults spending much time in front of computer screens.

Immunologic Factors and Genomic Considerations in Recurrent Pregnancy Loss: A Review

Recurrent pregnancy loss (RPL), which is also known as repeated miscarriage, affects around 2-3% of women who are trying to conceive. While some factors contributing to RPL have been identified, the cause of almost half of all cases remains unknown. Immunological factors have been proposed as one of the potential causes of such miscarriages. However, it is hard to track the common factors leading to RPL since the individual genomic identity of aborted fetuses is different in a family like other siblings. The immunological factors involved in the pathogenesis of miscarriage generally result from either the function of the maternal immune system attributable to her genomic background or the fetal origination established by both maternal and paternal genomic backgrounds that constitute the fetal genome.

Beyond Symptom Relief: Enhancing Patient Outcomes in Sinusitis Management through a Patient-Centered Lens

Hypersalivation, or excessive saliva production, can be a bothersome symptom associated with various underlying conditions. Sinusitis, inflammation of the sinus cavities, is a potential cause of hypersalivation due to drainage and irritation in the upper respiratory tract. This paper investigates the connection between sinus issues and hypersalivation, exploring the mechanisms at play, common symptoms, and potential treatment options. The paper aims to provide a concise overview of this often-overlooked link and its impact on individuals experiencing both conditions.

A fuzzy Bayesian network risk assessment model for analyzing the causes of slow-down processes in two-stroke ship main engines

ABSTRACT This paper presents a risk assessment approach for analyzing the causes of malfunction-related main engine slowdowns. A fuzzy Bayesian Network-based methodology is used to assess the factors contributing to the engine’s slow-down processes. The model addresses the complexity and uncertainty inherent in maritime operations with fuzzy sets where numerous interrelated factors can affect engine performance, and the Bayesian network to capture probabilistic dependencies. It considers various potential causes of the slow-down of ship engines that the manufacturer provides. Results demonstrate the model's ability to identify the influential factors leading to engine slow-down events and quantify the overall risk. Integrating fuzzy logic and Bayesian Networks comprehensively assesses relevant risk factors. It enables maritime stakeholders to manage engine performance and improves operational safety proactively. Findings can inform decision-makers, enabling the implementation of targeted maintenance strategies, fuel quality control measures, and crew training programs in the maritime industry.

Stromal Pbrm1 mediates chromatin remodeling necessary for embryo implantation in the mouse uterus.

Early gestational loss occurs in approximately 20% of all clinically recognized human pregnancies and is an important cause of morbidity. Either embryonic or maternal defects can cause loss, but a functioning and receptive uterine endometrium is crucial for embryo implantation. We report that the switch/sucrose nonfermentable (SWI/SNF) remodeling complex containing polybromo-1 (PBRM1) and Brahma-related gene 1 (BRG1) is essential for implantation of the embryonic blastocyst on the wall of the uterus in mice. Although preimplantation development is unaffected, conditional ablation of Pbrm1 in uterine stromal cells disrupts progesterone pathways and uterine receptivity. Heart and neural crest derivatives expressed 2 (Hand2) encodes a basic helix-loop-helix (bHLH) transcription factor required for embryo implantation. We identify an enhancer of the Hand2 gene in stromal cells that requires PBRM1 for epigenetic histone modifications/coactivator recruitment and looping with the promoter. In Pbrm1cKO mice, perturbation of chromatin assembly at the promoter and enhancer sites compromises Hand2 transcription, adversely affects fibroblast growth factor signaling pathways, prevents normal stromal-epithelial crosstalk, and disrupts embryo implantation. The mutant female mice are infertile and provide insight into potential causes of early pregnancy loss in humans.

Collisional-radiative modeling of shock-heated nitrogen mixtures

A three-temperature collisional-radiative model for shock-heated nitrogen–argon mixtures is developed to facilitate the study of nonequilibrium electronic excitation and ionization behind strong shock waves. Model predictions accurately reproduce measurements of N2 dissociation for mixtures of 2%–10% N2 in argon, with some discrepancies observed for 20% N2 mixtures. Potential causes of the discrepancies are discussed. Net dissociation in mixtures containing 20% N2 is significantly impacted by the dissociation of N2(A), the first excited electronic state of N2, indicating that molecular electronic excitation can affect net dissociation in shock-heated nitrogen flows. The collisional-radiative model successfully predicts the three-stage behavior and induction time observed in concentration measurements of atomic nitrogen in its fourth excited state, the 3s4P level, behind reflected shocks. Mechanisms for the observed behavior are discussed, which deviate from those inferred using a simpler kinetic model. Excited state number density predictions are strongly influenced by the modeling of radiation self-absorption and the inclusion of the measured non-ideal pressure rise. At higher N2 concentrations, the measured data indicate increased efficiency of atomic nitrogen electronic excitation in collisions with N as compared to collisions with N2 and Ar. A global sensitivity analysis of the excited state predictions is then performed, identifying the processes in the kinetic model that most sensitively influence the predicted excited state time history and further clarifying the dominant mechanisms affecting the experimental observables.

False Electrical Capture in Prehospital Transcutaneous Pacing by Paramedics: A Case Series

Introduction The use of transcutaneous pacing (TCP) for unstable bradycardia has a class 2B recommendation from the American Heart Association. Prior studies have not adequately described the frequency or possible causes of treatment failure. EMS clinicians and leaders have reported false electrical capture as a potential cause. In this study, we aimed to describe the frequency of true electrical capture, documented verification of mechanical capture, and its association with systolic blood pressure (SBP) and survival. Methods This was a retrospective study of patients treated by an urban, hospital-based EMS network comprising two EMS agencies between March 2021 and March 2023. Inclusion criteria were adults with a heart rate of <60 bpm and attempted TCP. Variables included: initial electrocardiogram rhythm, SBP, current applied, neurological status at discharge, and diagnosis. The primary outcome was true electrical capture, defined as the presence of a visible wide QRS and T wave. This enabled calculation of false electrical capture. Additional outcomes included change in SBP and neurological status at discharge. Results 19 of the 23 (82.6%) patients who underwent TCP had false electrical capture despite all 23 having documented mechanical capture by palpated pulse. For patients with true electrical capture, the median change in SBP was +40 mmHg (IQR = 24.25, range= −12 to +49 mmHg). For patients with false electrical capture, the median change in SBP was −1 mmHg (IQR = 58.50, range= −90 to +23 mmHg). Median current for patients with true electrical capture was 95 mA (IQR = 13.75, range = 85–110) versus 70 mA (IQR = 30, range = 55–160) in those with false electrical capture. 16 (69.6%) had outcome data available. Patients with true electrical capture and outcome data (n = 2) survived to admission but only one survived to discharge with good functional capacity. Of 14 with false electrical capture and outcome data, 10 (71.4%) survived to admission; none survived to discharge with functional capacity. Conclusions These findings suggest a high proportion of patients undergoing TCP are at risk of false electrical capture despite a recorded palpable pulse. While our analysis is limited to a single EMS network, these data raise concerns regarding the incidence of prehospital false electrical capture. Further research is warranted to calculate the incidence of false electrical capture and evaluate mitigation strategies.