The eastern tree hyrax is thought to be a solitarily living arboreal species of the forests of East Africa. However, in the coast of Kenya, indigenous forests have been almost entirely cleared, and some of the last tree hyrax populations live in limestone rocky formations and caves. Interestingly, they seem to be living in social groups. Here, we describe and document photographically these unique tree hyrax populations. We also describe their acoustical communication and their calling activity in three different habitats. Based on these animals' physical appearance and acoustic analyses of their calls, they represent the species eastern tree hyrax, Dendrohyrax validus. Due to immence pressure from humans, the future of these small and isolated, cave-living tree hyrax populations does not seem bright.
Background: Catheter ablation for atrial fibrillation (AF) is a common therapeutic strategy for patients with either paroxysmal or persistent AF, but long-term ablation success rates are imperfect. Maintenance of sinus rhythm immediately prior to ablation with anti-arrhythmic drug (AAD) therapy has been associated with improved outcomes in patients undergoing ablation. Amiodarone has superior efficacy relative to other AADs. Whether failure of amiodarone to maintain sinus rhythm prior to ablation for either paroxysmal or persistent AF is associated with poor outcomes is unknown. Methods: A total of 307 patients who received amiodarone in a one-year window before undergoing catheter ablation for AF were included. Patients were divided into amiodarone success (n=183) and amiodarone failure (n=124) groups based on the response to pre-ablation amiodarone treatment. Analysis of procedural outcomes as a function of response to amiodarone therapy was performed. Patients were followed for at least 12 months post-ablation to assess outcomes (adverse events and arrhythmia recurrence). Procedural success was defined by the absence of documented arrhythmia (>30s) without any anti-arrhythmic agents beyond a 90d blanking period. Results: Following ablation for either paroxysmal or persistent AF, freedom from any recurrent atrial arrhythmia at 1y was 57.7% for the entire cohort. One-year freedom from recurrent arrhythmia in the amiodarone success group was comparable to that in the amiodarone failure group (55.7% vs 60.5%; p=0.54). Success rates following ablation did not vary by the response to amiodarone when analyzed for paroxysmal or persistent AF subgroups. Conclusion: Failure to restore and maintain sinus rhythm with amiodarone prior to ablation for either paroxysmal or persistent AF is not a predictor of ablation procedural failure. Amiodarone failure alone should not deter practitioners from considering ablation therapy for patients with AF.
Aims A multipolar pulsed-field ablation (PFA) catheter was recently introduced for pulmonary vein isolation and shows great promise with respect to procedural efficacy and safety. We describe our initial experience using this multipolar PFA catheter for the treatment of left atrial (LA) reentry tachycardia. Methods We included all patients with LA reentry tachycardia treated with PFA at our institution between September 2021 and March 2022. The tachycardia mechanism was identified using 3D electro-anatomical mapping (3D-EAM). Subsequently, a roof line, anterior line, or mitral isthmus line was ablated as appropriate. Roof line ablation was always combined with LA posterior wall (LAPW) isolation. Supplementary ablation of a roof- or anterior line was added in patients with extensive low-voltage areas to avoid future arrhythmias. Positioning of the PFA catheter was guided by a 3D-EAM system, and by fluoroscopy. Bidirectional block across lines was verified using standard criteria. Additional focal radiofrequency ablation (RFA) was used to achieve bidirectional block as necessary. Results Among 22 patients (median age 70 (59-75) years; 9 females), we identified 27 LA reentry tachycardia: Seven roof dependent macro-reentries, one micro-reentry located on the posterior wall, twelve peri-mitral macro-reentries, and seven micro-reentries located on the anterior wall. We ablated a total of 20 roof lines, 13 anterior lines and 6 mitral isthmus lines. Additional RFA was necessary for two anterior lines (15%) and three mitral isthmus lines (50%). Bidirectional block was achieved across all roof lines, 92% of anterior lines and 83% of mitral isthmus lines. We observed no acute procedural complications. Conclusion Ablation of a roof line and LAPW isolation is feasible, effective and safe using this multipolar PFA catheter. However, the catheter is less suited for ablation of the mitral isthmus and the anterior line. A focal pulsed-field ablation catheter may be more effective for ablation of these lines.
Introduction Oral sotalol initiation requires a multiple-day, inpatient admission to monitor for QT prolongation during loading. A one-day intravenous (IV) sotalol loading protocol was approved by the FDA in March 2020, but limited data on clinical use and administration currently exists. This study describes implementation of an IV sotalol protocol within an integrated health system, provides initial efficacy and safety outcomes, and examines length of stay compared to oral sotalol initiation. Methods IV sotalol was administered according to a pre-specified initiation protocol to adult patients with refractory atrial or ventricular arrhythmias. Baseline characteristics, safety and feasibility outcomes, and length of stay (LOS) were compared to patients receiving oral sotalol over a similar time period. Results From January 2021 to June 2022, a total of 29 patients (average age 66.0 ± 8.6 years, 27.6% women) underwent IV sotalol load and 20 patients (average age 60.4 ± 13.9 years, 65.0% women) underwent PO sotalol load. The load was successfully completed in 22/29 (75.9%) patients receiving IV sotalol and 20/20 (100%) of patients receiving oral sotalol, although 7/20 of the oral sotalol patients (35.0%) required dose reduction. Adverse events interrupting IV sotalol infusion included bradycardia (7 patients, 24.1%) and QT prolongation (3 patients, 10.3%). No patients receiving IV or oral sotalol developed sustained ventricular arrhythmias prior to discharge. LOS for patients completing IV load was 2.6 days shorter (mean 1.0 vs 3.6, p < 0.001) compared to LOS with oral load. Conclusion Intravenous sotalol loading has a safety profile that is similar to oral sotalol. It significantly shortens hospital LOS, potentially leading to large cost savings.
End stage renal disease (ESRD), characterized by cessation in kidney function, has been linked to severe metabolic disturbances, caused by buildup of toxic solutes in blood. To remove these solutes, ESRD patients undergo dialysis. As a proof of concept, we tested whether ESRD-related metabolic signatures can be detected in perspiration samples using a combined methodology. Our rapid methodology involves swabbing a glass slide across the patient’s forehead, detecting the metabolites in the imprint using desorption electrospray ionization mass spectrometry, and identifying the key differences using machine learning methods. Based on collecting 42 healthy and 27 ESRD samples, we find saturated fatty acids are consistently suppressed in ESRD patients, with little change after dialysis. Also, our method enables the detection of uremic solutes, where we find elevated levels of uric acid (6.7 fold higher on average) that sharply decrease after dialysis. Beyond the study of individual metabolites, we find that a lasso model, which selects for 8 m/z fragments from 24,602 detected analytes, achieves area under the curve performance of 0.85 and 0.87 on training (n=52) and validation sets (n=17) respectively. Together, these results suggest that this methodology is promising for detecting signatures relevant for Precision Health.
In this work, we proposed a two-stage stochastic programming model for a four-echelon supply chain problem considering possible disruptions at the nodes (supplier and facilities) as well as the connecting transportation modes and operational uncertainties in form of uncertain demands. The first stage decisions are supplier choice, capacity levels for manufacturing sites and warehouses, inventory levels, transportation modes selection, and shipment decisions for the certain periods, and the second stage anticipates the cost of meeting future demands subject to the first stage decision. Comparing the solution obtained for the two-stage stochastic model with a multi-period deterministic model shows that the stochastic model makes a better first stage decision to hedge against the future demand. This study demonstrates the managerial viability of the proposed model in decision making for supply chain network in which both disruption and operational uncertainties are accounted for.
Within complex chemical engineering applications, subsystems or technologies have to be pre-selected and evaluated, without being an expert in each technology. In such cases, a surrogate model can help, if it can be set up with easily available reliable tools and data from publications. Here, a pressure swing adsorption (PSA) surrogate model for hydrogen separation was developed. Therefore, 90 published data sets were chosen for training and five different machine learning algorithms were tested. For these data sets a random forest regression yielded the best results when 80 % of the data was used for training and 20 % for testing. The predicted hydrogen recovery deviated from the true value by 6.6 %. The procedure of the surrogate development and analysis is described in this work as a transferable methodology to other scientific questions, not limited to PSA applications.
Legislative change to cannabis use has generated significant interest into the therapeutic utility of cannabis-derived medical products, particularly in the field of oncology. However, much of this research has focused on adults, leaving physicians and caregivers uncertain as to the safety and efficacy of cannabinoids amongst the pediatric demographic. To this end, the aim of this review is to examine the scope of pharmaceutical cannabis in treatment of pediatric cancer, evaluating its utility as an anti-cancer therapeutic as well as symptom relief agent. This systematic review was conducted following the PRISMA guidelines. 30 included articles comprised of 16 clinical and 14 preclinical studies. There is reasonable evidence to support the use of cannabis in CINV, with plausible utility for other facets of symptomatic relief. Preclinical pediatric cancer models, investigating anti-cancer cannabinoid effect, have provided evidence that may warrant first phase clinical trials.
This paper presents information about Crambe Abyssinica Hochst and discusses various aspects of oil planting, extraction and treatment, chemical composition, and the physical and chemical properties of the oil. In addition, it discusses the possibility of its use as a raw material for biofuels. Crambe Abyssinica Hochst is an oilseed from the Mediterranean that has a good oil content in its seed (~ 38%). Other advantages are presented as the short growth period and can be grown in environments considered unsuitable, which are desirable requirements for use in the production of biofuels. Crambe oil has erucic acid as its main fatty acid, which is not edible, so it is an oil that does not compete with the food industry. This crop is already used in the industry in various parts of the world for the production of various products, including biodiesel with oxidative stability considered promising.
Due to the apparent demands and constraints faced by energy systems operating in the market world, the Prosumer Energy trade strategy was selected as a potential opportunity for research and industries. Energy trading has expanded due to the availability of dispersed energy sources and power users who produce more electricity than they would otherwise and can profitably export their excess fuel. The energy trading system blends energy from various sources and effectively coordinates it to ensure stable and optimal usage of available resources and better facilities for energy users. Peer-to-peer (P2P) energy trading is a joint research topic that involves various managerial and technical challenges. This paper provides an overview of peer-to-peer energy exchange and how blockchain can be used to increase transparency and overall performance, including the degree of decentralization, scalability, and device reliability. A thorough examination of the Prosumer Smart Grid environment is explored and clarified. The energy sharing mechanism among consumers comprises two major components: information/digital technology and optimization techniques. Three blockchain-based energy sharing models have been proposed to overcome technical and market barriers to adopt this revolutionary technology. The paper further discusses open topics and possible future paths for peer-to-peer blockchain-based energy sharing.
Background: There is an increasing interest in health care systems worldwide for maternal satisfaction with childbirth experience. The WHO launched a recommendation in 2018 regarding women’s right to equal intrapartum care, where the importance of pharmacological pain relief was highlighted. Objectives: To assess the current knowledge regarding the impact of obstetric pharmacological pain relief on maternal satisfaction with childbirth. Search strategy: Pub Med, Cochrane, EMBASE and CINAHL were searched for studies in English language, published after 1999 that investigated the effect of pharmacological pain relief on women’s birth satisfaction after vaginal delivery. Selection criteria: Studies reporting assessments of subjective satisfaction with childbirth in women planned for vaginal delivery Data Collection and Analysis: Results were summarised qualitatively. A forest plot is presented for the five studies where comparable association measures were available. Due to the heterogeneity between studies and indirectness of measuring instruments, no meta-analyses were performed. Main Results: In total, 8,847 women were included from 11 studies: one randomised controlled study, ten observational studies, all with moderate or high risk of bias. Inconsistent methods were used to measure outcome; consequently, no conclusion could be drawn regarding a possible correlation between pharmacological pain relief and birth satisfaction. Conclusions: This systematic review could not show a correlation between pharmacological pain relief and women’s experiences of childbirth, mainly because a large heterogeneity between the studies. In order to evaluate pain relief during labour and improve women’s childbirth experiences, high quality research is urgently needed. Keywords Childbirth-satisfaction, Birth-experience, Pharmacological pain relief, pregnancy, labour
In order to reduce the vibration fatigue test time of aeronautical engineering components made of aluminum-alloy, a random vibration fatigue acceleration model under narrow-band excitation is proposed in this paper. A three-parameter S- N curve is adopted to consider the effect of small stress response, while a scale factor α is introduced to consider the effect of stress distribution. The random vibration fatigue tests of 2024-T3 and 7075-T6 aluminum-alloy specimens with elliptical holes are performed, where the vibration fatigue lives of load spectra with the same bandwidth and different excitation acceleration levels are obtained. The test results show that the proposed model is in sound agreement with the test results.
Hydralazine can cause interstitial lung disease, pauci-immune glomerulonephritis and hypocomplementemia. Hydralazine- induced ANCA- associated vasculitis and hydralazine-induced lupus are rare. We describe a case of hydralazine-associated vasculitis with rapidly progressive glomerulonephritis and highlight the importance of early diagnosis and treatment as it can be rapidly progressive and fatal.
We present a 54-year-old male with a gastric mass with pre-operative biopsy being consistent with a gastrointestinal stromal tumor. After surgical resection, final pathology revealed a plexiform fibromyxoma. One must consider the histopathological and gross features of plexiform fibromyxoma to distinguish it from other mesenchymal tumors of the GI tract.
1. Our understanding of how bees (Apoidea) use temperate forests is largely limited to sampling the understory and forest floor. Studies over the last decade have demonstrated that bee communities are vertically stratified within forests, yet the ecology of bee assemblages immediately above the canopy, the canopy-aerosphere interface, remains unexplored. 2. We sampled and compared bee communities above the canopy of a temperate forest to the understory (1 m), midstory (10 m), and canopy (20 m) on the campus of the University of Massachusetts, in Amherst, Massachusetts, USA from April – August, 2021. 3. Overall, we found that assemblages above the canopy had more bees than in the understory, were distinct in composition from all other strata, and included the greatest proportion of unique species. Bee abundance and species richness were highest in the understory throughout the spring (April and May) and decreased as the season progressed, while bee abundance and species richness at higher strata increased into the summer months. We also found that bees with preferences to nest in moist and rotting wood were largely restricted to canopy and midstory strata. 4. We conclude that bee assemblages occupying the space above the forest canopy are abundant and diverse, and their unique composition suggests that this canopy-aerosphere interface plays an additional role in the bee community of temperate forests. Alternatively, our findings question how forest bee communities should be defined while highlighting the need for research on fundamental processes governing species stratification in and above the canopy.