Background: The prevalence of infertility has rarely been synthesized at the global level. Objective: To conduct a systematic review and meta-analysis to assess the community-based global prevalence of infertility. Search Strategy: PubMed, MEDLINE, Web of Science, and Science Direct were searched from inception until October 2022. Selection Criteria: Studies were included if they were published in English, had quantitative data, and reported the community-based prevalence of infertility. Data Collection and Analysis: Two authors independently extracted data. Random-effects meta-analysis was used to derive the pooled prevalence of infertility. Variations in the prevalence estimates in different subgroups. Univariate meta-regression was used to explore possible sources of heterogeneity. Main Results: The findings indicated the pooled prevalence of infertility was 12.87% (95% CI,12.41%-13.33%). The prevalences of primary infertility and secondary infertility were 7.34% and 6.01%, respectively. The overall prevalence of infertility among people was the highest in Africa (16.73%) and lowest in the North America (8.84%). Lower prevalence in cohort or prospective follow-up studies (9.75%) than in cross-sectional studies (12.93%). Women aged 35 and above had a higher prevalence of infertility (11.68%) compared to women below 35 years old (5.92%). The prevalence of infertility increased with the number of years, and increased with the degree of literature bias from low to high. Conclusions: This community-based study estimated the global prevalence of infertility to be 12.87% and suggested that an upward trend of the prevalence of infertility may persist in the future.

Skin lesion detection has gained a lot of attention in the last couple of years due to the spread of skin cancer around the world. System-assisted design requires training and classification structure that can only be precise if features are selected appropriately along with improved segmentation of the lesion. This paper introduces a hybrid classification and training algorithm architecture that uses machine learning in all aspects of training and feature selection. The algorithm has been improved by adding novel behavior of Particles and Moth flames to be precise on nature. The proposed algorithm uses a multilayer propagation network for training and classification. The proposed work has been compared with other state-of-the-art algorithms based on quantitative parameters. The proposed work shows a significant improvement in all parameters and aspects.

To ensure the engineering quality and durability of reinforced concrete, vibrating is necessary during the pouring process. Currently, the vibration process during the construction of high-rise buildings is mainly done manually using handheld vibrating rods. However, manual vibration relies heavily on human experience and often results in issues such as over-vibration or insufficient vibration. Once the concrete solidifies, these problems can lead to irreversible consequences. This paper proposes a vibration robot that replaces manual vibrating with a strictly programmed process, improving construction efficiency and project quality. The vibration robot is based on the YOLOv5s algorithm and incorporates Deformable Convolutional Networks (DCN) and Coordinate Attention (CA) mechanisms into the backbone network to enhance target recognition performance. Through image recognition, the vibration robot obtains the coordinates of the vibration center point for controlling the vibration operation. Experimental results show that this method achieves a target recognition rate of 95.24% and a frame transfer rate of 16.94 frames per second. Therefore, using a vibration robot for concrete vibration during pouring holds significant practical value.

Arthropod-eating birds comprise a diverse group with varying degrees of sensitivity to environmental changes and distinct responses to habitat degradation. In our study, we investigated the impact of landscape and habitat characteristics on the functional diversity of insectivorous birds in the Brazilian Atlantic Forest. Our hypotheses are focused on (I) how species composition and functional diversity respond to habitat turnover and nestedness and (II) whether an increase in native forest cover positively influences bird species richness and functional diversity. Our research encompasses 22 different landscapes within the Cantareira-Mantiqueira region, southeastern Brazil, including native forests, pastures, and marshes, within 1 km radius buffers. To assess functional diversity, we employed beta pair and beta multi-function indices for each environment type. Generalized mixed linear models were calculated to examine the effects of the native forest cover gradient and environment type on functional diversity. Our findings indicated negative effects of increased native forest cover on functional diversity indices. Bird communities were susceptibility to turnover in pasturelands, to nestedness in marshes, and both species nestedness and turnover in native forests. These results may be partially due to the predominantly second-growth, small-sized, and early successional stages of the native forest fragments in the region. These findings underscore the intricate interplay between landscape characteristics, habitat types, and bird functional diversity within the Brazilian Atlantic Forest. They also highlight the significance of considering habitat quality and succession stages in conservation efforts in this region.

Multi-shaft stirred reactors significantly impact the mixing efficiency and eliminate isolated mixed regions. Herein, the chaotic characteristics and spatiotemporal instability of flow fields were investigated in three different stirred reactor, and a novel flow field visualization technique was proposed to address limitations with low-viscosity fluids. Results demonstrated the chaotic behavior and energy transfer are inconsistent at various axial positions in the S-T-STR, D-T-STR, and T-T-STR flow fields, which are supported by pressure pulsation attractors, fractal dimension, largest Lyapunov exponents, multiscale entropy, and Kolmogorov entropy analysis. Torque signal attractor images confirmed stable periodic energy input to the flow field through the impeller. Hilbert spectrum analysis revealed time instability and periodic energy features after flow field stabilization. T-T-STR exhibited reduced spatial and temporal instability, denser periodic cycles, accelerated flow field structure evolution and energy transfer rate. These distinctions result from the distinctive flow field structure within each reactor configuration.

Background: In this study, the clinical and laboratory findings, complications, and responses to regular intravenous immunoglobulin (IVIG) treatment of 34 patients diagnosed with primary immunodeficiency (PID) carrying transmembrane activator and CAML interactor (TACI) protein mutations were retrospectively evaluated. Material and Method: Clinical characteristics of patients, complete blood counts, serum immunoglobulin and compleman levels, lymphocyte subgroups, and mutation types of the patients followed up in our clinic for PID and diagnosed with TACI Mutation with Next Generation Sequencing (NGS) Method were examined. Results: A total of 20 (59%) of the patients were male, 14 (41%) were female, 18 were children (<18 years old) who had a median age of genetic diagnosis of 6.2 years and 16 were adults (>18 years) with a median age of genetic diagnosis of 34 years. The most common complaint was recurrent respiratory tract infection (68%). According to the Euro Class Classification (ECC), 14 patients who met the diagnostic criteria of Common Variable Immunodeficiency (CVID) had significantly lower lymphocyte, naïve (CD19+IgD+27-), non-switched (CD19+IgD-27+) number and percentage of B cells than the 20 patients who did not match (p<0.05). A total of 24 of the 34 patients, 13 of whom were children and 11 of whom were adults, received regular IVIG treatment because they met the criteria for ECS and/or had comorbidities. Conclusion: In our study, the fact that bronchiectasis and recurrent pneumonia and the need for hospitalized treatment were less common than in the literature was thought to be related to early IVIG treatment.

Authors: Anju Murayama1,2*, Ayane Honda3

Objective: To explore the scope of antimicrobial stewardship activities based on the point prevalence study of antimicrobials among hospitalized patients in a tertiary-level care hospital in the UAE. Methods: A single-center cross-sectional prevalence study was conducted among inpatients admitted to a tertiary care hospital using the European Surveillance of Antimicrobial Consumption tool in February 2023. Antimicrobials used against bacteria only were surveyed. All patients admitted to the selected departments at 8 AM on the day of the survey were included. Data were described in numbers and percentages. Results: Among 136 patients admitted at the time of the study, 87 received antimicrobials, representing a prevalence of 64%. A total of 144 antimicrobial prescriptions were prescribed in 87 patients. The majority of the antimicrobials were administered parenterally (n=122, 84.7%), and over 60% (n=53) of the patients on antimicrobials received two antimicrobials. The majority of antimicrobials used for therapy were empiric in nature (n=68, 89.5%). Over half of the patients receiving antimicrobials for surgical prophylaxis were prescribed antimicrobials for two or more days. More than 60% of the antimicrobial orders were adherent to the hospital guidelines. Conclusion: The point prevalence of the use of antimicrobials is high, which highlights the need for more efficient and targeted stewardship efforts in improving adherence with the hospital guidelines. Wide usage of broadspectrum antimicrobials is observed.

Background: Intracardiac echocardiography (ICE) is increasingly used during left atrial appendage occlusion (LAAO) as an alternative to transesophageal echocardiography (TEE) Aim: To evaluate the impact of ICE vs. TEE guidance during LAAO on procedural characteristics and acute outcomes, as well the presence of peri-device leaks and residual septal defects during follow-up. Methods: All studies comparing ICE-guided vs. TEE-guided LAAO were identified. The primary outcomes were procedural efficacy and occurrence of procedure-related complications. Secondary outcomes included lab efficiency (defined as a reduction in in-room time), procedural time, fluoroscopy time, and presence of peri-device leaks and residual interatrial septal defects (IASD) during follow-up. Results: Twelve studies (n=5637) were included. There were no differences in procedural success group (98.3% vs. 97.8%; OR 0.73, 95% CI 0.42-1.27, p=0.27; I2=0%) or adverse events (4.5% vs. 4.4%; OR 0.81 95% CI 0.56-1.16, p=0.25; I2=0%) between the ICE-guided and TEE-guided groups. ICE guidance reduced in in-room time (mean-weighted 28.6-minute reduction in in-room time) without differences in procedural time or fluoroscopy time. There were no differences in peri-device leak (OR 0.93, 95% CI 0.68-1.27, p=0.64); however, an increased prevalence of residual IASD was observed with ICE-guided vs. TEE-guided LAAO (46.3% vs. 34.2%; OR 2.23, 95% CI 1.05-4.75, p=0.04). Conclusion: ICE guidance is associated with similar procedural efficacy and safety, but could result in improved lab efficiency (as established by a significant reduction in in-room time). No differences in the rate of periprocedural leaks were found. A higher prevalence of residual interatrial septal defects was observed with ICE guidance.

This study focuses on the evolution of the fatigue strength of L-PBF produced Ti-6Al-4V as a function of the chemical etching finishing process. The aim is to identify the critical fatigue crack initiation mechanisms and the transitions between them in terms of the evolution of the surface micro-geometry caused by the finishing process. This has been done using three different geometries and six different surface states, including the machined reference surface state. The evolution of the crack initiation mechanisms, identified via SEM observations of the fatigue failure surfaces, is then used to explain the evolutions of the fatigue strength and the fatigue scatter, in both the finite and the high cycle fatigue-life domains. As expected, chemical etching effects the fatigue life via a polishing effect on the micro-geometry, which directly influences both the finite and the high cycle fatigue domains. It is shown that chemical etching makes it possible to obtain fatigue strengths that are almost similar to those of the machined surface, despite the fact that the roughness is higher, even after an optimal etching time. However, it is also observed that etching cannot fully counter the effects of large surface connected porosities (typically lack-of-fusion) that lead to large surface cavities. Some minor scale or size effects can also be noted between the different coupon geometries. This does not modify the conclusions concerning the initiation mechanisms and their effect on the fatigue life.

Aims: Although alcohol consumption is proposed to trigger electrographic abnormalities, acute changes in arrythmias and conductance disturbances have not been systematically studied in young adults who are the age group most likely to binge drink. The aim of this study was to determine if changes in breath alcohol content (BrAC) during an acute binging episode influence electrographic abnormalities in young adults. Methods: Fifty-five university students (20.6±2.1 years of age), who were not regular users of alcohol, consumed 60% mixer and 40% vodka until 0.08% BrAC was reached (6.4±1.9 standard drinks). Five-lead Holter recordings were analysed by a blinded cardiac technician. Electrographic abnormalities were identified and classified according to location (supraventricular or ventricular) and type (arrhythmia or conduction disturbance). Results: Although heart rate was elevated with BrAC beyond 0.05% compared to 0.00%, no differences existed in the relative incidence of electrographic abnormalities by location or type. Logistic regression revealed that baseline electrographic abnormality significantly contributed to predicting electrographic abnormality in 0.00% to 0.05% (p=0.02) and 0.05% to 0.08% BrAC phases (p=0.01). Conclusions: Alcohol consumption, resulting in BrAC of 0.08%, increased heart rate after BrAC reached 0.05% but did not acutely influence the relative incidence of electrographic abnormality by location or type in apparently healthy young people. These results do not support the hypothesis that a binge drinking episode causes electrographic abnormalities in young adults.

Isophthalic acid (IPA) is a star phosphorescence molecule, which is a commercially available raw material with simple chemical structure, but is of good phosphorescence performance. However, the great research vacancy is still maintained because of its limited applications. Absolutely, polymer-matrix strategy is a common method to produce phosphorescence amorphous material by dispersing IPA into matrix such as polyvinyl alcohol (PVA). But how to further optimize the phosphorescence property of the resulted doping material (PVA-IPA)? Up to now, this question is new and very little attention has been paid. In this work, a co-doping strategy was explored, that is, charging the second dopant of ClCH2COOH into PVA-IPA was verified as a promising method to further enhance the phosphorescence property of PVA-IPA, leading to the co-doping material PVA-IPA-ClCH2COOH with ultralong phosphorescence lifetime as 500 ms and high phosphorescence quantum yield (ΦP) as 23.7%. Depending on these promising phosphorescence behaviors, PVA-IPA-ClCH2COOH was successfully applied in the fields of information anti‐counterfeiting and artificial light harvest.

Introduction: Limited data exist on the gross motor abilities of children with cystic fibrosis (CF). The objective of this quality improvement project was to implement a systematic gross motor assessment in children with CF ages 4-12 years. Methods: Physical therapists aimed to evaluate at least 50% of eligible children at our CF Center over 1 year using the Bruininks-Oseretsky Test of motor Proficiency, second edition (BOT-2), a norm referenced assessment for gross motor skills, with delays defined by scores less than 18 th percentile. Demographic and clinical data including body mass index, hospitalizations, genotype, and comorbidities were collected. Basic descriptive statistics summarized patient information. Parametric and non-parametric methods compared groups of interest. Linear regression assessed associations between BOT-2 measures and clinical characteristics. Results: Of the 105 eligible children, 72 (69%) completed the BOT-2 over 1 year. Forty-five (62.5%) scored below average in at least one category. Impaired strength (22.2%) was most common, followed by impaired balance (16.7%), running speed and agility (15.3%), and bilateral coordination (8.3%). Eleven (15.5%) scored below average on their total motor composite score (TMC). Increased age, comorbidities and hospitalizations were associated with a lower TMC. Conclusions: The BOT-2 was successfully implemented as part of routine CF care to screen for gross motor delays. Results suggest that a high percentage of children with CF, especially older children with comorbid conditions or a history of hospitalization, have impaired gross motor function. These findings support the need for routine gross motor evaluations and physical therapy interventions within pediatric CF clinics.

Paediatric home invasive mechanical ventilation patients are a small but resource intensive cohort, requiring close monitoring and multidisciplinary care. Patients are often dependent on their ventilator for life support, with any significant complications such as equipment failure, tracheostomy blockage, or accidental decannulation becoming potentially life threatening, if not identified quickly. This review discusses the indications and variations in practice worldwide, in terms of models of care, including home care provision, choice of equipment and monitoring. With advances in technology, optimal monitoring strategies for home, continue to be debated: In-built ventilator alarms are often inadequately sensitive for paediatric patients, necessitating additional external monitoring devices to minimise risk. Pulse oximetry has been the preferred monitoring modality at home, though in some special circumstances such as congenital central hypoventilation syndrome, home carbon dioxide monitoring may be important to consider. Children should be under regular follow up at specialist respiratory centres where clinical evaluation, nocturnal oximetry and capnography monitoring and/or poly(somno)graphy and analysis of ventilator download data can be performed regularly to monitor progress. Recent exciting advances in technology, particularly in telemonitoring, which have potential to hugely benefit this complex group of patients are also discussed.

Substance use disorders (SUDs) are highly prevalent and have deleterious effects on one’s health and well-being. Inpatient treatment for SUDs reduces patient relapse, which subsequently ameliorates these negative effects on the individual and society. Additionally, those who complete treatment are less likely to relapse compared to those who do not complete treatment. Thus, maintaining patient engagement in treatment and reducing the rates of those leaving against medical advice (AMA) is particularly important. Examining the factors and comorbidities that may contribute to treatment dropout has the potential to identify at-risk patients in need of additional individualized intervention. The current study aimed to examine comorbid anxiety, depression, and post-traumatic stress disorder (PTSD) symptoms as predictors of dropout AMA in a residential substance use treatment population. Results showed that patients with social anxiety were more likely to leave treatment AMA, while those with PTSD were more likely to complete treatment. Findings suggest that PTSD-specific treatment, as offered in this facility, may help with patient retention, while group focused therapy may be distressing to those with social anxiety. Clinical implications of this research may include incorporating evidence-based practice for social anxiety early during inpatient treatment to reduce anxiety such that patients may better engage with SUDs treatment.

Leather and leather products are the most traded commodities and play a significant role in the world’s economy. The traditional tanning methods and the high quality of Indian leathers receive global appreciation. The existing leather manufacturing methods made a significant loss in epidermal constituents which impact the commercial importance of the animal species. Embossing techniques could potentially contribute to an increase in fraudulent activities. Since the fate of genetic material in finished leather is questionable, which poses a challenge to the molecular approach for identification. In order to obviate the problem, the present study aims to recover amplifiable mtDNA from leather products and focus on developing probes and primers for RT-PCR, which significantly enhance cross-specificity. Data mining and phylogenetic analyses of mtDNA genes (12S rRNA, COI, and Cyt b) for Indian Ovis aries skins exhibit the taxonomic positions and the intraspecies relationships, thereby facilitating the probes desigining. The results indicate that the maximum intraspecies genetic divergence observed within 12S rRNA, followed by COI and Cyt b. Since the availability of genetic sequences with reference to Cyt b is comparatively large (602), primers and probes were designed for Cyt b. The RT-PCR analysis of finished Ovis aries leather mtDNA samples yield a ct value in the range of 22–23 cycles, even with a minimum quantity of template DNA as low as 0.3 ng. Results on the cross-specificity analysis are highly encouraging. Hence, it is feasible to identify genuine Ovis aries leather using mtDNA instilling confidence in the export of leather.

Phenotypic covariation among suites of traits may constrain or promote diversification both within and between species, yet few studies have empirically investigated this relationship. In this study we investigate whether phenotypic covariation of craniofacial traits is associated with diversification in an adaptive radiation of pupfishes found only on San Salvador Island, Bahamas. The full radiation of pupfishes includes generalist, durophagous, and lepidophagous pupfish species. We compare phenotypic variation and covariation (i.e., P matrix) between 1) allopatric populations of generalist pupfish from neighboring islands and estuaries in the Caribbean, 2) San Salvador Island pupfish populations not containing the full radiation of fishes, and 3) San Salvador Island pupfish populations containing the full radiation in sympatry. Additionally, we explore whether phenotypic covariation varies between purebred and hybrid pupfish. We found that the P matrix of SSI generalist populations not found in sympatry with specialists exhibited higher levels of mean trait correlation, higher levels of constraints, and lower levels of flexibility compared to generalist populations on other Caribbean islands and sympatric populations of all three species found on SSI. We also documented significant differences between hybrid and purebred phenotypic covariation, where hybrids displayed lower correlations between traits and higher levels of flexibility, which may produce differential fitness in the wild. Ultimately, this study suggests that differences in phenotypic covariation significantly contribute to producing and maintaining organismal diversity.

Soil fungi are involved in the decomposition of organic matter, and they alter soil structure and physicochemical properties and drive the material cycle and energy flow in terrestrial ecosystems. Grazing exclusion is one of the most common measures used to restore degraded grasslands worldwide. However, changes in soil fungal community characteristics during grazing exclusion in different types of grasslands are unknown. Here, we investigated the effects of a 9-year grazing exclusion on soil properties, fungal community composition and diversity in three grassland types (temperate desert, temperate steppe and mountain meadow). The results showed that in the 0-5 cm soil layer, grazing exclusion significantly affected the physicochemical parameters of all three studied grassland types. In the 5-10 cm soil layer, grazing exclusion significantly increased total phosphorus (TP) in temperate deserts by 34.1%, while significantly decreasing bulk density (BD) by 9.8% and the nitrogen: phosphorus ratio (N:P) by 47.1%. The soil fungal community composition differed among the grassland types, For example, significant differences were found among the three grassland types for the Glomeromycota and Mucoromycota, Grazing exclusion, grassland type, and the interaction between the two did not significantly affect soil fungal α-diversity or community composition(P > 0.05), but significantly altered fungal β-diversity (P < 0.05). Overall, our results highlight the importance of soil nutrient content, especially soil Kjeldahl nitrogen, total phosphorus and organic carbon on fungal diversity, and the results provide key insights into how soil fungi respond to grazing exclusion in different grassland types.

Title PageTitle : Comment on: Psychosocial risk and health care utilization in pediatric sickle cell diseaseArticle type : Letter to the editorKeywords: sickle cell disease; psychosocial risk; healthcare utilizationWords count: 441Correspondence: Saifullah Jamil

：The Qinghai−Tibet Plateau (QTP) is among the most sensitive regions to global environmental change worldwide. Although the climate change and engineering construction on the QTP have jointly modified the regional vegetation activity, little is known about how vegetation variation responds. Using Moderate Resolution Imaging Spectroradiometer (MODIS) enhanced vegetation index (EVI) data during 2000−2021, this study investigated the spatiotemporal variation of vegetation activity and the compound effects of climate change and construction along the G318 highway on the QTP (TG318) through the integration of trend, residual, and partial correlation analyses, as well as structural equation modeling. The results showed that the growing season EVI increased significantly at a rate of about 0.0020/year in the western QTP after reconstruction, but fluctuated in the east. Reconstruction generally had a significant effect on the growing season EVI, with contributions of 7.67%, 19.12%, 18.24%, and −4.15% in different sections of TG318, whereas climate change contributed −10.14% to 8.84% of the total variation. The growing season EVI negatively correlated with snow cover and minimum temperature in humid and sub-humid regions, whereas positively related to vapor pressure in semi-arid regions. Moreover, there existed an obvious lag effect of climate change on the growing season EVI, with lag time generally decreasing from west to east and apparent heterogeneity among different months and regions. These findings would help better understand the environmental impacts along the engineering corridors and provide a scientific basis for ecological conservation in the QTP region.

A document by Yunfei Zou. Click on the document to view its contents.

This paper presents a numerical model for the design, development, and feasibility of thermal energy storage systems. The energy storage was composed of a tank that stores phase change material and internal pipes with heat transfer fluid, coupled to a power block to dispatch electrical energy on a small scale for off-grid industrial applications. Subsequently, the evolution of the temperature in charge/discharge cycles, temperature degradation, and storage efficiency was determined with the appropriate magnitudes and behavior through the resolution of a numerical model. In addition, the proposed energy production plant that connects the system to was implemented in an industrial application for Chile. A numerical model was developed using the finite volumes method to simulate the thermocline performance. As a result, the temperature history reflects stable thermal behavior, low degradation, and high efficiency of approximately 92%, with a storage time increasing up to 13 [hrs] and 384.8 [kWh] capacity. Also, implementation was feasible on a small scale due to its compact, modular, and economically competitive characteristics in Concentrated Solar Power. Finally, the proposed design was proven to be an accurate and reliable alternative for small-scale off-grid mining applications.

Diagnosis of hypertrophic cardiomyopathy accompanied with secondary hypertension - case report

Seeds are an important part of plants, ensuring the continuation of plants’ life and providing nutrient reserves for humans and animals. Seed development is controlled by the interplay of several physiological processes. We applied label-free proteomics to round and wrinkled peas using seeds sampled at five growth stages (4 days after anthesis (DAA), 7DAA, 12DAA, 15DAA, and maturity). Phenotypic results indicated that wrinkled peas had lower starch concentration compared to round peas (29.5% vs. 46.6-55.1%). A total of 4,126 high confident proteins were detected, with 22–26% shared across all sampling times within an entry. Early seed growth stages were characterized by more unique proteins compared to maturity. Two-way ANOVA revealed 1,685 proteins significantly different among samples, of which 722 proteins were characterized into 29 functional classes. The four major classes (comprising over 50 proteins) were protein biosynthesis, protein homeostasis, enzymes, and carbohydrate metabolism. Of the two types of comparisons (time-point and entry-wise), time-point comparisons yielded more differentially abundance proteins (596 proteins in total). Different protein classes exhibited different patterns of change during seed development. For example, cell division related proteins were abundant early in seed development, whereas storage proteins were abundant later in seed development (especially after 12DAA). Compared to the round pea entries, the wrinkled entry had significantly lower abundance of starch branching enzymes, a protein involved in the biosynthesis of amylopectin in starch. In conclusion, the results of this study provide valuable information to improve our understanding of seed development and form the basis for further studies.