Ultimate Survival Research Articles

Impact of the CPS-EG score as a new prognostic biomarker in triple-negative breast cancer patients who received neoadjuvant chemotherapy

BackgroundThis study aimed to establish risk groups on the basis of CPS-EG scores, independent of pCR status, in triple-negative breast cancer (TNBC) patients receiving neoadjuvant chemotherapy (NACT) to identify the prognostic impact of the CPS-EG score.MethodsPatient characteristics included age, menopausal status, clinical stage, pathological stage, estrogen receptor (ER) expression, nuclear grade, Ki-67 proliferation index, residual cancer burden (RCB) score, HER2 status, and other tumor characteristics. The CPS-EG scoring system included clinical stage, pathological stage, ER status, and grade. Patients were divided into two groups on the basis of their CPS-EG scores ≤ 3 and > 3.ResultsA total of 148 patients who were diagnosed with TNBC and treated with NACT were included in the study. A total of 52.0% of the patients had a CPS-EG score of ≤ 3, whereas 48.0% had a score of > 3. The rate of patients who achieved pCR was 29.7% (n = 44). CPS-EG score (HR: 2.331; 95%CI; 1.179–4.608; p = 0.015), pCR (HR: 0.348; 95%CI; 0.144–0.844; p = 0.019), pre-treatment mKi-67 proliferation index (HR: 0.467; 95%CI; 0.251–0.871; p = 0.017), and RCB score (HR: 0.401; 95%CI; 0.174–0.923; p = 0.032) were identified as significant prognostic factors for 5-year DFS. For 5-year OS, significant prognostic factors were CPS-EG score (HR: 2.30; 95%CI; 1.036–4.799; p = 0.040) and pre-treatment mKi-67 proliferation index (HR: 0.484; 95%CI; 0.246–0.954; p = 0.036).ConclusionsThe CPS-EG score, pre-treatment mKi-67 level, and the pCR and RCB score were practical prognostic markers for long-term survival. Conversely, the prognostic significance of pCR status was diminished, particularly in predicting OS. These findings underscore the importance of not only post-treatment pathological staging but also the initial tumor stage and biological characteristics of the tumor in predicting ultimate survival outcomes following neoadjuvant chemotherapy in TNBC patients.

Medical science in peril? analyzing the anti-vaccine rhetoric on greek facebook in the COVID-19 era

In the post truth era the limits between facts and beliefs, science and pseudo-science seem to be quite blurred. Social media platforms, such as Facebook, provide the ideal vehicle for the widespread sharing of misinformation, by fostering the creation of “filter Bubbles” and “echo chambers”. For the purposes of our study, we analyzed Facebook posts from users’ pages and public groups over a three – month period (from September 2021 to November 2021) with a primary focus on the vaccination against COVID-19. Using thematic content analysis, we attempted to explore the major themes that skeptics of COVID-19 vaccines use to justify their hesitancy. According to research findings, the anti-vaccination discourse on Facebook platform in Greece combines features such as mistrust towards politicians, the medical community, the legacy media, the establishment as a whole, and facts regarding the safety/complications of COVID-19 vaccination itself. If the medical society aspires to combat misinformation regarding health issues, then, deconstructing the anti-vaccination rhetoric will be a pivotal step for the ultimate survival of epistemological truths and scientific discourse in the public sphere.

Predictors of leech therapy failure in revascularized and replanted digits

IntroductionVenous congestion is a common phenomenon following digital revascularization and replantation. Leech therapy allows for venous outflow while angiogenesis and neovascularization take place. The aim of this study is to evaluate the efficacy of leech therapy in the revascularized and replanted digits and determine risk factors for unsuccessful salvage. Materials and methodsA retrospective review was performed to identify all patients with complete or incomplete digital amputations at an academic Level 1 Trauma Center who underwent digital replantation or revascularization from January 2005 to December 2020. Amputations proximal to the palmar arch as well as revascularizations that showed any degree of perfusion on preoperative assessment were excluded. Leech therapy was initiated as soon as any signs of venous congestion appeared and was titrated to clinical effect. Patient demographics, medical history, injury mechanism, extent and level, operative details, leech therapy details, number of blood transfusions, hospitalization length, as well as the digit's ultimate survival data were collected. ResultsOf the 159 patients who underwent 213 digital revascularizations (n ​= ​135) and replantations (n ​= ​78), venous congestion requiring leech therapy developed in 27 digits in the revascularization group and in 26 in the replantation group. Of the digits that were leeched, 15 failed in the revascularization group (56 ​% failure rate) and 17 failed in the replantation group (65 ​% failure rate). Avulsion mechanism of injury and presence of a circumferential laceration were significantly associated with rate of failure in the revascularization cohort (p ​< ​0.01). Proximal level of injury was significantly associated with rate of failure in the replantation group (p ​< ​0.01). ConclusionLeech therapy has limited efficacy in avulsed or more proximally injured digits. These data can aid in determining the prognosis of a digit with venous congestion after revascularization and replantation.

Evaluation of Different Approaches for Sinus Membrane Perforation Repair During Sinus Elevation: A Systematic Review and Meta-analysis.

To evaluate the impact of different approaches to sinus membrane perforation (SMP) repair on bone formation, postoperative complications, and implant loss risk. Electronic searches on PubMed, Web of Science, Scopus, Embase, and Cochrane Library databases were conducted for publications up to February 2021. All included articles reported SMPs submitted for repair. The proportion of implant loss in repaired SMP sites was calculated using a random-effects model meta-analysis. A total of 130 studies reporting SMP repair protocols were included in the systematic review, with 20 selected for meta-analysis. A total of 1,972 sinuses that were perforated and repaired during sinus elevation using different approaches were included in the qualitative analysis. The resorbable collagen membrane was the most commonly reported treatment. The presence of sinusitis was the most frequently described complication. Regarding bone parameters, the majority of studies described no differences between perforated and repaired sinuses and intact membranes. No difference in the implant loss proportion was observed between sites with repaired SMP compared to undetected SMP. The proportion of implant loss in repaired sinuses membrane sites (independent of the material or implant placement time) was 4% (95% CI: 2.0 to 8.0). In meta-regression analysis, no association was observed between the SMP size and implant loss proportion (P = .86). The materials and techniques indicated for SMP management seem to securely seal the maxillary sinus, without a negative effect on the ultimate survival of the implants placed in the affected sinuses.

The Reading, Reception, and Collecting of Isabella Whitney’s A Sweet Nosgay, c.1573–1871

ABSTRACT Much recent scholarship on early modern women’s writing has focussed on their marginalia. Yet how active readers responded to their printed work after it left the bookseller’s stall has remained largely unexplored. This article responds to this critical gap by applying the principles of feminist bibliography to copy-specific annotations found in Isabella Whitney’s poetic miscellany A Sweet Nosgay (1573). Texts by early modern women often enjoyed a surprisingly long reception history and textual afterlife. By analysing early modern ownership inscriptions and nineteenth century marginalia found in the sole extant copy of Whitney’s text, this article considers how A Sweet Nosgay was read across time as a valuable work of ameliorating literature. Descriptions of Whitney's text in nineteenth century auction catalogues similarly allow us to trace changing attitudes towards, and readership of, her work: raising questions of how gender contributed to an author’s desirability, economic value, and ultimate survival. Ultimately, this case study demonstrates the need for a wider chronological and generic framework by which to consider the layered reception of the multitude of women’s texts like Whitney’s that survive in a single recorded source.

Effect of Mobile Phone-Based Digital Technologies on the Performance of Refugee Women-Led Micro, Small and Medium Enterprises in Kakuma Refugee Camp

The contribution of Micro, Small, and Medium Enterprises (MSMEs) to economic development as well as the role of digital technology in MSME performance are underscored in many studies globally. MSMEs provide over 70% of employment, contribute to national revenue, and are considered key to increasing productivity. In Africa, MSMEs are also recognized for skill development and upward mobility in diverse geographic areas and economic sectors, provide livelihood and income for diverse segments of the labor force, and are the backbone of Africa’s economy as well as key to its most pressing development challenges. Despite the potential of MSMEs for economic growth, many face a myriad of challenges, both internal and external to the firm, that constrain their performance and ultimate survival. This is especially critical for refugee-owned enterprises. In light of the constraints, the utilization of digital technology has emerged as an important strategy to secure the growth, performance, and survival of MSMEs. The objective of this study was to examine the effect of mobile phone-based digital technologies on the performance of refugee women-led MSMEs in Kakuma Refugee Camp. Two theoretical frameworks underpinned this study: the Resource-Based View (RBV) proposed by Barney (1991) and the Technology Acceptance Model (TAM) theory proposed by Davis (1986). The study adopted an analytical cross-sectional survey design for primary data collection using questionnaires. The targeted population was sampled using a stratified simple random sampling technique. A total of 111 enterprises were surveyed using a questionnaire. Descriptive statistics were generated to give summaries and describe the sample characteristics, while inferential statistics comprised correlation and regression analysis. The study found that mobile phone-based technology was a significant predictor of performance (r = 0.501, p-value =0.000 &lt; 0.05). The study recommends that mobile phone-based technology should be prioritized since it leads to an increase in sales and profits for a firm through improved mobile phone transactions.

Neutropenic enterocolitis in aplastic anemia – a case report from Nepal

Introduction and importance: Neutropenic enterocolitis (NE) is a life-threatening necrotizing enterocolitis, particularly in neutropenic patients. Case presentation: We are presenting a case of a 22-year-old male who presented chief complaints of abdominal pain, reddish black stool, abdominal distention, and low-grade fever with laboratory and bone marrow findings suggestive of aplastic anemia. Computed tomography scan of the abdomen and pelvis with contrast was used to establish the diagnosis of necrotizing enterocolitis. Nonsurgical management including broad-spectrum antimicrobials, bowel rest, nasogastric suction, fluid and nutritional support, and blood product support, helped this patient to recover. Clinical discussion: NE is a life-threatening inflammatory condition of the small and large intestines. Typical symptoms of NE include diffuse abdominal pain, fever, and watery or bloody diarrhea. Diagnosis of NE is done by clinical and imaging findings. Management of the primary disease is important to improve the ultimate survival of the disease. Conclusion: Early identification and management of neutropenic enterocolitis help to reduce mortality.

A retrospective study: analysis of the relationship between lactate dehydrogenase and castration-resistant prostate cancer based on restricted cubic spline model.

Different prostate cancer patients take different amounts of time to progress to castration-resistant prostate cancer (CRPC), and this difference in time determines the patient's ultimate survival time. If the time to progression to CRPC can be estimated for each patient, the treatment can be better individualized. Castration-resistant prostate cancer is a challenge in attacking prostate cancer, the aim of the paper is to analyze the correlation between lactate dehydrogenase (LDH) and CRPC occurrence based on the restricted cubic spline model, and to provide a theoretical basis for LDH as a prognostic biomarker for prostate cancer patients. We retrospectively analyzed clinical and follow-up data of patients diagnosed with prostate cancer and treated with Androgen Deprivation Therapy (ADT) in our hospital from October 2019 to August 2022. Investigate the correlation between LDH and CRPC by COX regression, restricted cubic spline model and survival analysis. The initial tPSA concentration, prostate volume, LDH and alkaline phosphatase levels in patients with prostate cancer with rapid progression are higher than those in patients with prostate cancer with slow progression. Multivariate COX regression showed that initial tPSA level and LDH level are independent risk factors for prostate cancer. Restricted cubic spline model further showed that LDH level is linearly correlated with the risk of CRPC in prostate cancer patients (total P<0.05, nonlinear P>0.05). LDH was associated with the prognosis of prostate cancer and had a dose-response relationship with the risk of CRPC in prostate caner patients.

Hematology and Blood Chemistry Reference Intervals for Antillean Manatees (Trichechus manatus manatus) in Colombia

Hematology and blood chemistry tests constitute an easy-to-apply veterinary tool that evaluates an organism’s systemic functioning and disease process by comparing the level of specific analytes against species norms. Such analyses help monitor marine mammals’ health and nutritional status. Although reference values have been published for a few manatee populations, there are none for Antillean manatees (Trichechus manatus manatus) in Colombia. We aim to establish the reference values for hematology and serum chemistries for these manatees and determine if there are variations between individuals of different age groups and sex. Thus, we obtained whole blood and serum samples from 45 rehabilitated manatees from Colombia between 1992 and 2021. Complete Blood Count and Comprehensive Metabolic Panel values were calculated, and differences between age groups and sex were determined. Results were compared with published reference intervals of other Antillean manatee populations, Florida manatees (Trichechus manatus latirostris), and Amazonian manatees (Trichechus inunguis) from Brazil. We determined the reference intervals of hematology and serum chemistry for manatees in Colombia for different age and sex categories. No relevant clinical variations were found in hematological parameters due to sex. Marked differences were found between age groups, mainly among young animals with an expected faster metabolism. There were significant variations between hematological and blood chemistry values when the Colombian manatees were compared to manatees from Puerto Rico and Amazonian manatees from Brazil. Such variations are likely influenced by evolutionary history and environmental factors associated with differences in habitat salinity and diet. We recommend that future studies correlate these blood tests with specific panels. We further recommend conducting wild manatee health assessments as this information will yield essential data for species management schemes needed due to the multiple anthropogenic and environmental threats that manatees face today which put the Colombian manatee’s health and ultimate survival at risk.

A novel cuproptosis pattern and tumor immune microenvironment characterization in urothelial carcinoma of the bladder.

Urothelial carcinoma of the bladder (UCB) is the most prevalent malignant tumor of the urinary system worldwide, which has a significant recurrence rate despite multiple treatment options available. As a unique and novel copper-dependent programmed cell death mechanism, the comprehensive impact of cuproptosis on the tumor immune microenvironment, clinicopathological characteristics and the prognosis of patients remains largely unclear. A total of 568 UCB samples were thoroughly examined for cuproptosis patterns using data downloaded from TCGA and GEO, based on 10 cuproptosis-related genes reported previously. Then, the univariate COX regression analysis was performed on the genes that differed across the various patterns. To measure individual cuproptosis pattern, a cuproptosis score system was constructed using a principal component analysis algorithm. To validate the scoring system, immunohistochemical staining was performed on tumor tissues with different pathological grades, and experiments in vitro were conducted about the differentially expressed genes related to prognosis. Finally, the capacity of scoring system to predict the response to immunotherapy was verified by using data from IMvigor 210 cohort. Four unique cuproptosis clusters and two gene clusters were finally found by the investigation. The clinical features and prognosis of patients, as well as the mRNA transcriptome, pathway enrichment, and immune cell infiltration in TME, varied dramatically between various cuproptosis clusters and gene clusters. To identify individual cuproptosis patterns in UCB patients, we also established a cuproptosis scoring system. After validation with multiple methods, it was indicated that the score system could predict the prognosis of UCB patients and was significantly connected to clinical features such TNM category, tumor grade, molecular type and ultimate survival status. The clinical outcomes of UCB patients were predicted effectively according to the tumor mutation burden in conjunction with the scoring system. Furthermore, we found that the cuproptosis score had a significant correlation with the response to immunotherapy and the sensitivity to chemotherapy. This study revealed the potential impact of cuproptosis on the UCB tumor immune microenvironment and clinical pathological characteristics. The cuproptosis score system could effectively predict the prognosis of patients and the response to chemotherapy and immunotherapy.

Demystifying a Miracle in the Movie-127 Hours

The desire to move as a part of an adventure, at the cost of life, simply serves for personal pleasure and self-complacency. However, the hero’s journey is not a linear path but a cyclic one and it inevitably comes across to face challenges and resistance that eventually nurtures him to grow with greater knowledge and wisdom. This paper, Danny Boyle directed movie- 127 Hours; based on true story of life, employs the Magic(al) Realism against the backdrop of Joseph Campbell’s concept of hero’s journey to examine how James Franco starred Aron Ralston, a common man of 27, undergoes a transformation of self-discovery for his ultimate survival, after five days of his unfailing struggle. The struggle was with the boulder that trapped his hand in the deep and distant Bluejohn Canyons of Utah in 2003 while canyoneering. Throughout the course of an ordeal, he regenerates his energy recalling the divine qualities of his son, mother, home, friends as well as his spouse, and resorts to the desperate measures of life. All the imagined reality comes to be true in his real life. Finally, Aron amputates his hand, escapes his fate from the inescapable, and eventually becomes an international icon, a story to be told to the rest of the world. The whole journey of the hero reflects the three stages in general as archetypes-departure, initiation and return, which is common in everyone’s life. The journey of Franco is a message of perseverance for the unfailing efforts as to reap success, instead of being helpless and hopeless while facing the boulder like obstacle, s and fighting the ordeal to ascertain one’s existence in life.

Pulmonary hemorrhage and associated risk factors among newborns admitted to a tertiary level neonatal unit in Botswana.

Pulmonary hemorrhage (PH) is a life-threatening complication seen in very sick newborns with high morbidity and mortality. There is little data on the incidence, risk factors, and ultimate survival of newborns with pulmonary hemorrhage in sub-Saharan countries, where the healthcare provision and facility differ in many ways compared to high-income countries. Hence, this study aimed to determine the incidence, identify the risk factors, and describe the outcome of pulmonary hemorrhage in newborns in a low middle income country setting. A cohort study with prospective data collection was conducted in a public, tertiary-level hospital in Botswana, the Princess Marina Hospital (PMH). All newborns admitted to the neonatal unit from 1 January 2020 to 31 December 2021 were included in the study. Data were collected using a checklist developed on the RedCap database (https//:ehealth.ub.ac.bw/redcap). The incidence rate of pulmonary hemorrhage was calculated as the number of newborns who had pulmonary hemorrhage per 1,000 newborns in the 2-year period. Group comparisons were made using X2 and Student's t-tests. Multivariate logistic regression was used to identify risk factors independently associated with pulmonary hemorrhage. There were 1,350 newborns enrolled during the study period, of which 729 were male newborns (54%). The mean (SD) birth weight was 2,154(±997.5) g, and the gestational age was 34.3 (±4.7) weeks. In addition, 80% of the newborns were delivered in the same facility. The incidence of pulmonary hemorrhage was 54/1,350 {4% [95% CI (3%-5.2%)]} among the newborns admitted to the unit. The mortality rate in those diagnosed with pulmonary hemorrhage was 29/54 (53.7%). Multivariate logistic regression identified birth weight, anemia, sepsis, shock, disseminated intravascular coagulopathy (DIC), apnea of prematurity, neonatal encephalopathy, intraventricular hemorrhage, mechanical ventilation, and blood transfusion as risk factors independently associated with pulmonary hemorrhage. This cohort study identified a high incidence and mortality rate of pulmonary hemorrhage in newborns in PMH. Multiple risk factors, such as low birth weight, anemia, blood transfusion, apnea of prematurity, neonatal encephalopathy, intraventricular hemorrhage, sepsis, shock, DIC, and mechanical ventilation, were identified as independently associated risk factors for PH.

Treprostinil in Neonates with Congenital Diaphragmatic Hernia-Related Pulmonary Hypertension

To describe our experience with treprostinil, evaluate correlations with cardiac function, and assess for adverse effects in neonates with congenital diaphragmatic hernia-related pulmonary hypertension (CDH-PH). A retrospective review of a single-center prospective registry at a quaternary care children's hospital. Patients included in the study had CDH-PH treated with treprostinil between April 2013 and September 2021. Assessed outcomes were brain-type natriuretic peptide levels and quantitative echocardiographic parameters collected at baseline, 1week, 2weeks, and 1month after treprostinil initiation. Right ventricular (RV) function was assessed by tricuspid annular plane systolic excursion Z-score and speckle tracking echocardiography (global longitudinal and free wall strain). Septal position and left ventricular (LV) compression were assessed by eccentricity index and M-mode Z-scores. Fifty-one patients were included, with an average expected/observed lung-to-head ratio of 28.4±9.0%. Most patients required extra-corporeal membrane oxygenation (n=45, 88%). Survival to hospital discharge was 31/49 (63%). Treprostinil was initiated at a median age of 19days with a median effective dose of 34ng/kg/minute. Median baseline brain-type natriuretic peptide level decreased from 416.9 pg/mL to 120.5 pg/mL after 1month. Treprostinil was associated with improved tricuspid annular plane systolic excursion Z-score, RV global longitudinal strain, RV free wall strain, LV eccentricity index, and LV diastolic and systolic dimensions, reflecting less compression by the RV, regardless of ultimate patient survival. No serious adverse effects were recorded. In neonates with CDH-PH, treprostinil administration is well tolerated and is associated with improved RV size and function.

Feeding Washington's Army: Surviving the Valley Forge Winter of 1778 by Ricardo A. Herrera

Reviewed by: Feeding Washington's Army: Surviving the Valley Forge Winter of 1778 by Ricardo A. Herrera Ann M. Becker (bio) George Washington, American Revolution, Valley Forge, Continental Army, Grand Forage Feeding Washington's Army: Surviving the Valley Forge Winter of 1778. By Ricardo A. Herrera. (Chapel Hill: University of North Carolina Press, 2022. Pp. 256. Cloth, $28.00.) [End Page 176] The privations endured by the Continental Army during the Valley Forge winter encampment have been well documented by historians, yet efforts by General George Washington and his staff to alleviate the lack of provisions, supplies, and clothing have rarely been the focus of the numerous books that address Valley Forge. For example, while Bob Drury and Tom Clavin's book Valley Forge (New York, 2018) describes the transformation of the Continental Army during this winter encampment, highlighting Baron von Steuben's training of the troops, Alexander Hamilton's supporting Washington in the face of attacks by political rivals, and the Marquis de Lafayette's lobbying France for assistance, it does not address the crucial need for forage to keep the soldiers alive and the army viable for a spring campaign. Professor Ricardo Herrera, on the other hand, provides a comprehensive view of those efforts in his book, Feeding Washington's Army: Surviving the Valley Forge Winter of 1778. Painting a realistic picture of the shocking state of the army, which had held together despite the many battlefield losses and desperate need for food and shelter, Herrera credits Washington and his officers and staff with actively being engaged in finding ways to survive and persevere. The first section of the book describes the "Grand Forage," a series of foraging expeditions over six weeks beginning in February of 1778, as a proactive attempt to both reduce the suffering of the American soldiers and to prevent the British Army, quartered nearby in Philadelphia, from procuring the limited supplies of food, fodder, wagons, and livestock available across the Pennsylvania countryside and beyond. Detailing the challenges of the Continental Army, which included the presence of disease, incidences of desertion, and the possibility of mutiny, in addition to the lack of food and shelter, the author argues that taking action to support and feed the troops was crucial to its survival and the ultimate survival of the Revolution itself. Longstanding problems within the quartermaster general's department and with the commissariat charged with supplying and feeding the army had roots in the Congressional fear of central authority and corruption, leading to a distrust of military power. Inability to provide sustenance for the Continental Army led to the Grand Forage, which Herrera frames as illustrating Washington's "burgeoning acumen as a planner and commander, and his long-standing willingness to accept risk" (5). The amount of food needed to sustain the troops was staggering, with the average monthly consumption of bread nearly 454 tons, and meat consumption about 397 tons. The daily ration per soldier was one pound of meat and [End Page 177] bread, a pint of milk, a quart of beer, one ounce of rice, six ounces of peas or beans and a small amount of butter. On average, the army needed about 1.7 million pounds of food per month to provide adequately for its soldiers. One of the most problematic aspects of supplying these vast quantities was the lack of horses and wagons to transport any food and supplies foraged. Needing over 113 wagons per day, the army had only 8, with few horses to pull them. The challenges also included unwilling sellers, with the local population hoarding supplies for their own use or to sell to the British who paid with hard specie rather than the nearly worthless Continental script offered by the Americans. Ultimately Washington placed his trust in Nathanael Greene, Anthony Wayne, and Henry Lee, Jr. as he planned his grand foraging expedition. By mid-February 1778 the soldiers at Valley Forge had been short of meat for four days. Regardless of the danger of allowing the British to know how dire the situation was, and the irony of denying local residents their liberty and property in the name of political and economic freedom from Britain, Washington had...

Effect of extracorporeal hemoadsorption in critically ill patients with COVID-19: A narrative review.

COVID-19 has been affecting the world unprecedentedly and will remain widely prevalent due to its elusive pathophysiological mechanism and the continuous emergence of new variants. Critically ill patients with COVID-19 are commonly associated with cytokine storm, multiple organ dysfunction, and high mortality. To date, growing evidence has shown that extracorporeal hemoadsorption can exert its adjuvant effect to standard of care by regulating immune homeostasis, reducing viremia, and decreasing endotoxin activity in critically ill COVID-19 cases. However, the selection of various hemofilters, timing of initiation and termination of hemoadsorption therapy, anticoagulation management of extracorporeal circuits, identification of target subgroups, and ultimate survival benefit remain controversial. The purpose of this narrative review is to comprehensively summarize the rationale for the use of hemoadsorption in critically ill patients with COVID-19 and to gather the latest clinical evidence in this field.

Factors associated with the severity of traumatic brain injury.

Traumatic brain injury (TBI) is a defect in the brain function resulting from the action of external factors. The condition ranges from transient shifts in cellular ionic concentrations to total structural damage; the clinical symptoms can vary from brief confusion to death. The current classification system, based on the Glasgow Coma Scale (GCS), divides TBI into mild (GCS 14 to 15), moderate (GCS 9 to 13), and severe TBI (GCS 3 to 8). The leading causes of head injury in the population can be falls, motor vehicle collisions, blasts, and bullet injuries. The ultimate survival and neurologic outcome of the head trauma patient depend on the extent of TBI occurring at the time of injury. The aim of the study is to assess the factors associated with brain injury and their effect on its severity. A cross sectional, retrospective study including 469 adult patients with head injury was carried out in the emergency department of Baghdad teaching hospital between 1 October 2016 - 30 October 2017. Data of all the patients were entered and analyzed using the statistical package for social sciences (SPSS) software for Windows, version 24. The significance of correlation was assessed using a Chi-square test. Level of significance was set at ≤ 0.05. Final findings were presented in tables with an explanatory paragraph for each table using the MS. Office (Word 2013) for Windows. A total number of 469 patients were enrolled in this study with a mean age of 42.6 ± 13.7 years. The vast majority of the patients were males (383/469), which represented 81.7%. The male to female ratio was 4.45 to 1. The distribution of the patients according to their traumatic brain injury was 241 patients (51.4%) with mild, 99 (21.1%) with moderate and 129 (27.5%) with severe TBI. Associated injuries among the studied group were facial injuries in 133 (28.4%), skull fracture in 150 (32%), and thoracolumbar fracture in 51 (10.9%). The associated injuries were more frequent in the extremities - 112/469 (23.9%), combined injuries in 112 (23.9%), chest and abdomen injuries were reported in only 6% and 6.8%, respectively. The causes of injuries in the studied group were road traffic accidents (RTA), the most frequent mechanism - 37.1% of the cases, followed by fall from height (FFH) (23.9%), blast injury (16.8%), bullet injury (13%), while other mechanisms represented only (9.2%). There is a significant association reported with gender, where severe injuries were more frequent among males than females (P=0.014). All associated injuries were significantly associated with severe traumatic brain injury (P<0.05), also bullet injury was significantly associated with severe traumatic brain injury, followed by blast injury (P<0.001). Severe traumatic brain injury was significantly associated with the presence of clinical and radiographic findings (P<0.001). The severity of TBI is significantly related to the type of the associated injury, mechanism of injury, clinical and radiological findings, and to the male gender, while it is not dependent on the age of the patient.

Battle Royale Optimization-Based Resource Scheduling Scheme for Cloud Computing Environment

Cloud computing (CC) is developing as a powerful and flexible computational structure for providing ubiquitous service to users. It receives interrelated software and hardware resources in an integrated manner distinct from the classical computational environment. The variation of software and hardware resources were combined and composed as a resource pool. The software no more resided in the single hardware environment, it can be executed on the schedule of resource pools to optimize resource consumption. Optimizing energy consumption in CC environments is the question that allows utilizing several energy conservation approaches for effective resource allocation. This study introduces a Battle Royale Optimization-based Resource Scheduling Scheme for Cloud Computing Environment (BRORSS-CCE) technique. The presented BRORSS-CCE technique majorly schedules the available resources for maximum utilization and effectual makespan. In the BRORSS-CCE technique, the BRO is a population-based algorithm where all the individuals are denoted by a soldier/player who likes to go towards the optimal place and ultimate survival. The BRORSS-CCE technique can be employed to balance the load, distribute resources based on demand and assure services to all requests. The experimental validation of the BRORSS-CCE technique is tested under distinct aspects. The experimental outcomes indicated the enhancements of the BRORSS-CCE technique over other models.

Whites Only: Race and Mobility in Kym Ragusa's The Skin Between Us: A Memoir of Race, Beauty, and Belonging and Claudia Rankine's Citizen: An American Lyric

Whites Only: Race and Mobility in Kym Ragusa's <i>The Skin Between Us: A Memoir of Race, Beauty, and Belonging</i> and Claudia Rankine's <i>Citizen: An American Lyric</i>

Dietary Compound Diosmetin Chemosensitizes Breast Cancer Stem Cells by Suppressing HMGB1-mediated Autophagy

Breast cancer stem cells (CSCs) are a small cluster of highly tumorigenic cell subsets with self-renewal and multi-directional differentiation potential. Accumulating studies have shown that CSCs lead to chemotherapy resistance and recurrence of breast cancer, which is the main reason for the failure of chemotherapy in breast cancer. Autophagy is one of the key mechanisms to protect tumor cells from chemotherapeutic stimulation and other stresses, which contributes to the ultimate survival of CSCs in refractory or recurrent tumors. This study was carried out in terms of multiple strategies such as flow cytometry, stem-like detection, zebrafish tumor xenograft model construction, autophagy lentivirus construction, and western blotting analysis to prove that a natural flavonoid compound diosmetin safely and effectively promoted the tumor-killing effect of chemotherapeutic drug for breast cancer. The involved mechanism was closely related to its ability to reduce HMGB1 expression and subsequently block the autophagy pathway of breast CSCs. This study will provide new ideas and tools for the development of breast cancer drug resistance mechanism and targeted drugs.

Integrated Reporting and Earnings Quality Among Listed Firms in East Africa

Despite numerous studies on earnings quality, companies have continued to report low‐quality earnings. Earnings quality has continued to attract the interest of scholars, practitioners, and policymakers due to the stakeholderʹs interest in earnings and the ultimate survival of the firms. Although the study on the quality of earnings has been extensively researched, the results are inconclusive or have mixed findings. Thus, the interest of the study in integrated reporting (IR) and earnings quality in East Africa. The objective of the study was to examine the relationship between integrated reporting and earnings quality among the listed firms in East Africa. The study was guided by agency, stewardship, and signaling theories. The study adopted explanatory and longitudinal research designs with panel data to establish the causal relationship between the research variables. The target population comprised 117 firms listed on East African Securities Exchanges. The inclusion/exclusion criteria was adopted, drawing a sample of 78 firms for the study period of 2014–2021. Data was collected from the firms’ audited annual reports and analysed using descriptive and inferential statistics. The findings demonstrate that integrated reporting and earnings quality have a positive relationship. As a result, at the 5% significance level (β= ‐0.011; p&lt;0.05), voluntary adoption of integrated reporting is related to higher earnings quality. The findings are useful for East African listed companies considering adopting and disseminating IR in their annual reports in the future, as well as understanding the value of IR in improving the quality of their earnings.