This paper presents a study of the 2D roughness profiles on a flat surface generated on a steel work piece, by ball nose end milling, with linear equidistant tool paths (pick-intervals). The milled surface exploration with a surface roughness tester (on pick and feed directions) produces usually 2D roughness profiles having periodical evolutions. These evolutions can be seen as time-dependent signals, describable as a sum of sinusoidal components (the wavelength of each component being regarded as a period). In order to detect a well approximated description of these components, two appropriate signal processing techniques are used in this work: first technique provides a direct mathematical (analytical) description and is based on computer aided curve (signal) fitting (more accurate), the second technique (providing an indirect and incomplete description) is based on the spectrum generated by fast Fourier transform (less accurate). This study can be seen as a way for a better understanding the interaction between the tool and the work piece or to achieve a mathematical description of the machined surface microgeometry in terms of roughness (e. g. its description being a collection of closely spaced 2D roughness profiles).

This paper aims to study the surface homogenization and integrity of Ti-6Al-4V alloy by longitudinal-torsional coupled ultrasonic vibration assisted ball-end milling. A method of continuous processing between the flat surface and freeform surface connection is proposed by using ultrasonic vibration assisted ball-end precision milling, during this process, it is not necessary to exchange the cutting tool. The way has been explored for changing the homogenization of surface on Ti-6Al-4V by ultrasonic vibration-assisted milling (UVAM). Cutting experiments employing three parameters, cutting speed, feed rate and depth of cut and two types of machining forms using ball-end milling with UVAM and conventional milling (CM) respectively. The high frequency cutting force, finished surface roughness, topography and residual stresses on the surface and tool wear have been measured by advanced instruments. Particularly, adopting the high frequency cutting force measurement system, it is concluded cutting force in ball-end milling decreased significantly using UVAM as against CM. Moreover, the surface roughness by UVAM with ball-end milling is much better than the CM at a high cutting speed. However, an opposite trend is observed at a low cutting speed. Especially, there is a steep decrease from Ra 0.828 μm average value at 4000 rpm to Ra 0.129 μm average value at 5000 rpm. At the same time, the homogenization of surface roughness and residual stresses decrease significantly in UVAM as compared to which in CM when taking the transversal-longitudinal ratio into consideration. Cutting experiments and measuring results are demonstrated the validity and feasibility of UVAM with ball-end milling, and this method enjoys significant advantages compared to CM process.

In the current study nanocellulose was isolated from walnut shell using mechanical and chemical methods. This study highlights the particle size, morphology and these methods’ efficiency in nano structure extraction. The difference between morphology and size of the particles (of the both extracted methods) were investigated by field emission scanning electron microscopy (FESEM). Walnut shell is an agro-waste material with source of lignin and cellulose. Ball mill-ing with different times, in the presence and absence of additive and acid hydrolysis were used as mechanical and chemical methods, respectively. The result showed mechanical method is unable to extract nanoparticle and just reshape the walnut shell. Milling time were also found important in morphology of fiber extracted. FE-SEM images represented that structure mean diameter of using ball mill was 1± 5 μm while hydrolysis acid method extract nano particle with mean diameter of 40± 20 nm.

The microstructural evolution, thermodynamics and kinetics of Mo-21%Tm₂O₃ (mass fraction, %) powder mixtures during ball milling were investigated using X-ray diffraction and transmission electron microscopy. Ball milling induced Tm₂O₃ to be decomposed and then dissolved into Mo crystal. The supersaturated nanocrystalline solid solution of Mo (Tm, O) was obtained after 96 h of ball milling. The elements of Mo, Tm and O were distributed uniformly in the ball-milled particles. Based on the semi-experimental theory of Miedema, a thermodynamic model was developed to calculate the driving force of phase evolution. There was no chemical driving force to form a crystal solid solution of Tm atoms in Mo crystal or an amorphous phase because the Gibbs free energy for both processes was higher than zero. For Mo-21%Tm₂O₃, it was mechanical work, not negative heat of mixing, that provided the driving force to form supersaturated nanocrystalline Mo (Tm, O) solid solution.

The present work was aimed at the investigation of effect of High Energy Ball Milling (HEBM) time on the sintering kinetics, structure, and properties of heavy tungsten alloy (HTA) W-7%Ni-3%Fe. The HTA samples were obtained from the nanopowders (20-80 nm) by conventional liquid phase sintering (LPS) in hydrogen and by Spark Plasma Sintering (SPS) in vacuum. The HTA density was shown to depend on the HEBM time non-monotonously that originates from the formation of non-equilibrium solid solutions in the W-Ni-Fe systems during HEBM. The SPS kinetics of the HTA nanopowders was shown to have a two-stage character, the intensity of which depends on the Coble diffusion creep rate and on the intensity of diffusion of the tungsten atoms in the crystal lattice of the -phase. The kinetics of sintering of the initial submicron powders have a single-stage character originating from the intensity of the grain boundary diffusion in the -phase. The dependencies of the hardness and of the yield strength on the grain sizes were found to obey the Hall-Petch relation. The hardness, strength, and dynamic strength in the compression tests of the fine-grained tungsten alloys obtained by SPS and LPS were studied.

A rheological modifier was used to prepare solutions with viscosities of 1, 4, 6 and 8 cp, which exhibited Newtonian behavior. These solutions were later used to prepare suspensions of monosize quartz (53, 45 and 38 microns) at 60 % in solids. Monosize grinding tests in a laboratory ball mill were performed to determine breakage parameters, with different ball diameters. A model was developed to determine the specific rate of breakage in terms of the system rheology. With this model, it was demonstrated that an increase in suspending fluid viscosity until 6 cp, leads to an increased fracture rate and consequently affects the grinding degree. The above test is considered as an alternative for improving and optimizing such operations with excellent quality products with low energy and steel consumption, thereby minimizing environmental impact.

Comminution is a very important and result-determining step in mineral processing. This is because further downstream processes in the beneficiation chain depend entirely on it. Comminution includes the blasting, crushing, and grinding of ore to liberate valuable mineral particles. It consumes most of the energy used in mineral processing plants with grinding using up to 50% of the provided energy. Tumbling mills are an old technology that is still commonly used for grinding. One of the most used tumbling mills is the ball mill. This paper reviews different types of grinding media that have been developed and improved over the years and their properties. Also reviewed are the effects of grinding media on various aspects such as energy consumption, mill efficiency, minerals liberation and grinding rate. A comparison of the grinding media is given together with the knowledge gaps that still need to be bridged to improve the quality and performance of grinding media used in ball mills. Despite various research conducted on ball mills, the grinding process is still a very energy inefficient process. This creates a great opportunity for further research to improve the process because just a slight improvement in the process efficiency significantly reduces the production costs and provides a lot of environmental benefits.

An investigation was made to determine the effects of tungsten surface coating on the coefficient of friction of sliding contact between lubricated steel surfaces. The four-ball test was modified, using a tungsten carbide ball bearing in the spindle to cause sliding contact onto three hard steel ball bearings coated with tungsten disulfide lamellar dry lubricant coating, with a coating of grease lubrication applied to the ball bearings. The coatings, loads, speed, and grease level was varied to best understand the impact of different conditions to the friction coefficient.

Abstract: The traditional model of closed circuit ball milling systems has been used for several decades, however, if the classifier of the closed circuit ball mill system performs the duties of both pre-classification and check-classification, the characterization error of the traditional model is large. To address this problem, a new model is obtained by modifying and supplementing the traditional one. The most important feature of the new model compared to the traditional model is that the circulating load is considered to be the fresh feed for the entire system rather than the ball mill. The error between the slurry level height calculated using the traditional model and the actual is 52.31%, which is 13.77 times higher than that of the new model. When the relative capacity varies greatly, that of the ball mill calculated by the traditional model fluctuates between 0.95 and 1.15, while the new model is 0.6 to 1.4. The new model has a higher accuracy than the traditional model in characterizing the production status of the grinding system, which is of some significance for industrial production.

As an emerging building solution, cross-laminated timber (CLT) floors have been increasingly used in mass timber construction. The current vibration design of CLT floors is conservative due to the assumption of simple support conditions in the floor-to-wall connections. It is noted that end fixity occurs as a result of clamping action at the ends, arising from the gravity load applied by the structure above the floor and by the mechanical fasteners. In this paper, the semi-rigid floor-to-wall connections are treated as elastically restrained edges against rotations to account for the effect of partial constraint. A rotational end-fixity factor was first defined to reflect the relative bending stiffness between CLT floors and elastic restraints at the edges. Then, for the design of vibration serviceability of CLT floors as per the Canadian Standard for Engineering Design in Wood (CSA O86), restraint coefficients were defined and their analytical expressions were derived for natural frequencies and the mid-span deflection under a concentrated load, respectively. In particular, a simplified formula of the restraint coefficient for the fundamental frequency was developed to assist engineers in practical design. At last, by comparing with reported experimental data, the proposed design formula showed excellent agreement with test results. In the end, the proposed end fixity factor with their corresponding restraint coefficients is recommended as an effective mechanics-based approach to account for the effect of end support conditions of CLT floors.

Abstract: Chryseobacterium indologenes is an opportunistic pathogen isolated from human infec-tions and rarely from some aquatic animals. A 3-year-old male ball python (Python regius) was admitted to the veterinary clinic by a pet owner because of acute respiratory and swallowing failure. During physical examinations, oral secretions and abscesses were observed on the mouth cavity and throat of the animal. After microbiological analysis including isolation, identi-fication, and 16s rRNA sequencing; Ch. indologenes was detected as the main cause of the oral abscess in this case. Phylogenetic relatedness analysis showed a close relationship between this isolate and other strains isolated from human infections. Antimicrobial susceptibility testing re-vealed that the isolate was multi-drug resistant. However, it was very sensitive to minocycline, ceftazidime, and tetracycline. The patient was treated by antibiotic therapy and completely re-covered after two weeks. To our best knowledge, this is the first incidence of Ch. indologenes in an oral abscess in a ball python. As result we would consider this organism as an opportunistic animal pathogen with zoonotic potentiality.

A sustainable green one pot procedure for the synthesis of dihydropyrimidinones (DHPMs) derivatives by a three-component reaction of β-ketoester derivatives, aldehyde and urea or thiourea over the alkali-treated H-ZSM-5 zeolite under ball-milling has been developed. The product was isolated by simple washing of the crude reaction residue with ethyl acetate followed by evaporation of solvent. The hierachical zeolite catalyst (MFI27_6) showed high yield (86–96%) of dihydropyrimidinones (DHPMs), in very short time (10-30 min). The catalyst is recycled for subsequent reactions in four runs without appreciable loss of activity and high yields of products provide efficient protocol for Biginelli reactions.

Aiming at the problem of model error and tracking dependence in the process of intelligent vehicle motion planning, an intelligent vehicle model transfer trajectory planning method based on deep reinforcement learning is proposed, which obtain an effective control action sequence directly. Firstly, an abstract model of the real environment is extracted. On this basis, Deep Deterministic Policy Gradient (DDPG) and vehicle dynamic model are adopted to jointly train a reinforcement learning model, and to decide the optimal intelligent driving maneuver. Secondly, the actual scene is transferred to equivalent virtual abstract scene by transfer model, furthermore, the control action and trajectory sequences are calculated according to trained deep reinforcement learning model. Thirdly, the optimal trajectory sequence is selected according to evaluation function in the real environment. Finally, the results demonstrate that the proposed method can deal with the problem of intelligent vehicle trajectory planning for continuous input and continuous output. The model transfer method improves the model generalization performance. Compared with the traditional trajectory planning, the proposed method output continuous rotation angle control sequence, meanwhile, the lateral control error is also reduced.

The phenomenon of seat occupancy in university libraries is a prevalent issue. However, existing solutions, such as software-based seat reservations and sensors-based occupancy detection, have proven to be inadequate in effectively addressing this problem. In this study, we propose a novel approach: a serial dual-channel object detection model based on Faster RCNN. Furthermore, we develop a user-friendly web interface and mobile APP to create a computer vision-based platform for library seat occupancy detection. To construct our dataset, we combine real-world data collection with UE5 virtual reality. The results of our tests also demonstrate that the utilization of personalized virtual dataset significantly enhances the performance of the convolutional neural network (CNN) in dedicated scenarios. The serial dual-channel detection model comprises three essential steps. Firstly, we employ Faster RCNN algorithm to determine whether a seat is occupied by an individual. Subsequently, we utilize an object classification algorithm based on transfer learning, to classify and identify images of unoccupied seats. This eliminates the need for manual judgment regarding whether a person is suspected of occupying a seat. Lastly, the web interface and APP provide seat information to librarians and students respectively, enabling comprehensive services. By leveraging deep learning methodologies, this research effectively addresses the issue of seat occupancy in library systems. It significantly enhances the accuracy of seat occupancy recognition, reduces the computational resources required for training CNNs, and greatly improves the efficiency of library seat management.

The high protein content of several microalgal species makes them attractive and unconventional for applications in the food and pharmaceutical industries. Due to microalgae's robust cell wall, cell rupture is necessary to improve the extraction of their intracellular proteins. Thus, choosing a suitable cell-breaking treatment before protein extraction is a vital downstream processing step. Additionally, it is necessary to use an effective technique for monitoring and measuring the impact of rupture treatments on microalgal cell walls. In our study, Tetradesmus obliquus cells were disrupted by three different mechanical rupture methods: high-pressure homogenization (HPH), ultrasound (US), and ball milling (BM). The ruptured biomass cells were counted, and soluble proteins were extracted and quantified. The cell counting technique did not detect differences between intact and damaged cells after BM treatment because the dye (erythrosine B) did not permeate the microalgae biomass accurately. The US treatment promoted the highest yield of total protein extraction (19.95%). The yields of protein extraction of T. obliquus with HPH (15.68%) and BM (14.11%) were significantly (p value ≤ 0.05) lower than that achieved in the US treatment. The increase in the number of extraction steps increased the protein recovery. Thus, the content of extracted soluble protein was a reliable indirect index for a quantitative comparison of the cell disruption level.

Tanzania like any other developing countries is depending on uncertain rainfall for their subsistence and commercial agriculture. In this paper the start and end of rains for Mbeya Meteorological Station in Tanzania Mainland was analyzed and critically examined. Data were kindly given by Tanzania Meteorological Agency (TMA) during face to face Statistics in Applied Climatology (fSIAC) workshop which was held at Sokoine University of Agriculture (SUA) the year 2013 prior to online Course on Statistics in Applied climatology (eSIAC). In this study data were analyzed using Instat (for windows version 3.3.7) package developed by the Statistical Services Centre of the University of Reading. The analysis showed that much of rains start early December all the way to May. There is also 50 percent chance of having below and above the mean for both total annual rainfall and number of rains, in other word one in two years the total rains are below means likewise the number of rain days.

The research deals with the particularities of the initiation in the sport of kin ball, of 94 students (54 boys and 40 girls), without a history of practicing the sport intensively, and the measure of the influence of some components of the motor capacity. Kin ball is a sport that appeared in Canada, in an academic setting and can become an alternative sport in the common university curricula in Romania. The research was carried out in 4 research groups in 2019 and 2022, two of boys and two of girls, similarly, before and after the declaration of the acute phase of the Covid-19 Pandemic, generating physical activity constraints. The originality of the research refers to the initiation, unprecedented in Romania, in the Kin ball sport, through 20 training sessions, carried out in 10-day stages and the evaluation of some motor skills on the subjects. During the experiment, the following components were tested pre- and post-intervention Kin-Ball: palmar muscle strength using the dynamometer, general resistance by running as long as possible for 2 min and general coordination function - body balance, by the Matorin test. The statistical calculation included the application of the Kolmogorov-Smirnov test, depending on which parametric or non-parametric statistical significance tests were applied and the estimation of the size of the intervention effect. The results highlighted particularities of initiation in Kin ball, but also significant differences (p<0.05) in all measurements performed in 2022. The tests in 2019 recorded both significant and statistically insignificant differences, also highlighted by the calculation of the d indicator of to Cohen. The lower initial level of all motor components measured in 2022 and their significant improvement represent aspects that can be understood as collateral effects of the lack of movement during the pandemic.

Several studies have shown that combining TiO2 and Cu2O enhances the photocatalytic activity of the material by generating a heterojunction capable of extending the light absorption in the visible and reducing the electron-hole recombination rate. Ball milling has been chosen as an alternative methodology for photocatalyst preparation, among the several techniques documented in the literature review. The results of a previously reported investigation enabled the identification of the most effective photocatalyst that can be prepared for hydrogen generation by combining Cu2O and TiO2 (i.e., 1%wt Cu2O in TiO2 photocatalyst prepared by ball-milling method at 200 rpm and 1 min milling time). To optimize photocatalytic hydrogen generation in the presence of the greatest photocatalyst, the effects of (i) sacrificial species and their concentration, (ii) temperature, and (iii) pH of the system are taken into account, resulting in a light-to-chemical energy efficiency of 8% under the best-tested conditions. Last but not least, the possibility of using the present photocatalytic system under direct solar light irradiation is evaluated: the results indicate that nearly 60% of the hydrogen production recorded under sunlight can be attributed to the visible component of the solar spectrum, while the remaining 40% can be attributed to the UV component.

An effort was made to find a relationship between the ratio of average asperities height and lubricant thickness at the point of contact of rolling element ball bearings, and empirical equations to predict the life for bearings under constant motion. Two independent failure mechanisms were considered, fatigue failure and lubricant failure resulting in seizing of the roller bearing. A theoretical formula for both of these methods was established for the combined probability of failure using both of these failure mechanisms. Fatigue failure was modeled with the empirical equations of Lundberg and Palmgren and standardized in DIN/ISO281. The seizure failure, which this effort sought to investigate, was predicted using Greenwood and Williamson's theories on surface roughness and asperities during lubricated contact. These two mechanisms were combined, and compared to predicted cycle lives of commercial roller bearing, and a clear correlation was demonstrated. This effort demonstrated that the Greenwood-Williams theories on the relative height of asperities versus lubricant film thickness can be used to predict the probability of a lubricant failure resulting in a roller bearing seizing during use.

An effort was made to find a relationship between the predicted tribological conditions at the point of contact of ball bearings, and empirical equations to predict the life for bearings under constant motion. The model was modified to predict the temperature dependence, and compare rapid accelerations and decelerations with empirical extrapolations.

Autonomous driving navigation relies on diverse approaches, each with advantages and limitations depending on various factors. For HD maps, modular systems excel, while end-to-end methods dominate mapless scenarios. However, few leverage the strengths of both. This paper innovates by proposing a hybrid architecture that seamlessly integrates modular perception and control modules with data-driven path planning. This innovative design leverages the strengths of both approaches, enabling a clear understanding and debugging of individual components while simultaneously harnessing the learning power of end-to-end approaches. Our proposed architecture achieved 1st and 2nd place in the 2023 CARLA Autonomous Driving Challenge’s SENSORS and MAP tracks, respectively. These results demonstrate the architecture’s effectiveness in both map-based and mapless navigation.

Speech recognition, or automatic speech recognition (ASR), is a technology designed to convert spoken language into text using software. However, conventional ASR methods involve several distinct components, including language, acoustic, and pronunciation models with dictionaries. This modular approach can be time-consuming and may influence performance. In this study, we propose a method that streamlines the speech recognition process by incorporating a unified recurrent neural network (RNN) architecture. Our architecture integrates a convolutional neural network (CNN) with an RNN and employs a connectionist temporal classification (CTC) loss function. Key experiments were carried out using a dataset comprising 576,656 valid sentences, using erosion techniques. Evaluation of the model performance, measured by the word error rate (WER) metric, demonstrated remarkable results, achieving a WER of 2%. This approach has significant implications for the realm of speech recognition, as it alleviates the need for labor-intensive dictionary creation, enhancing the efficiency and accuracy of ASR systems, and making them more applicable to real-world scenarios. For future enhancements, we recommend the inclusion of dialectal and spontaneous data in the dataset to broaden the model's adaptability. Additionally, fine-tuning the model for specific tasks can optimize its performance for targeted objectives or domains, further enhancing its effectiveness in those areas.

To improve the effect of multi-point stretch forming of sheet metal, it is proposed in this paper to replace fixed ball head with swinging ball head. According to the multi-point dies with different arrangements, this research establishes the finite element models of the following stretch forming, i.e. fixed ball heads with conventional arrangement, swinging ball heads with conventional arrangement, swinging ball heads with declining staggered arrangement, and swinging ball heads with parallel staggered arrangement and then numerical simulation is performed. The simulation results show that by replacing fixed ball head with swinging ball head, the surface indentation of the formed part was effectively suppressed, the stress and tension strain distribution of the formed part was improved and the forming quality was improved; that the thickness of the elastic pad was reduced, the springback was reduced and the forming accuracy was improved; and that when the ball head was applied to multi-point die with staggered arrangement, better forming result was achieved, where the best forming result was achieved in combining the swinging ball heads with the multi-point die with parallel staggered arrangement. The forming experiments were carried out, and the experimental results were consistent with the trend of numerical simulation results, which verified the correctness of the numerical simulation.

Biotechnological potential of Thermoanaerobacter strain AK15 to produce ethanol and valuable alcohols from carbohydrates and amino acids were evaluated in present study. The strain is highly ethanologenic, producing a maximum of 1.57 mol ethanol per mol of glucose degraded at high liquid-gas phase ratios. The strain degrades most of the sugars tested as well as starch and pretreated hydrolysates of biopolymers (Whatman paper, newspaper, Timothy grass, Rhubarb leaves, and several macroalgae species) to ethanol mainly. The strains degraded serine and threonine when used as a single substrate, producing mainly acetate and ethanol as end products, and the branched-chain amino acids (leucine, isoleucine, valine) when cultivated in the presence of thiosulfate. The main end products from branched-chain amino acids were a mixture of their corresponding branched-chain fatty acids and alcohols. Finally, the strain was also shown to use butyrate as an electron sink during glucose degradation resulting in the reduced product butanol in addition to end products produced from glucose. Thus, strain AK15 is a promising candidate for ethanol and fine chemical production from a range of lignocellulosic and algal biomass.

Abstract: Like other plants, every PV power plant will one day reach the end of its service life. Calculations show that 20,400 tons of PV waste will be generated worldwide by 2030 and 60.2 million tons by 2050, not including the mass of the support structure. Such large amounts of waste pose a potential threat to the environment and people if not properly managed. The paper analysed the options for dealing with PV waste, namely reuse, recycling and landfilling. For recycling as the best option in terms of environmental protection and circular economy, an overview of recycling technologies and the percentage of achievable recycling for the materials contained in each PV system component is given. In addition, the current situation of legislation and recycling of PV modules in Europe was examined with special reference to the Balkan countries. There are a small number of factories for recycling PV modules in Europe, but none in the Balkan countries. The main reason for this is the small amount of PV waste in these countries and consequently the economic unprofitability. For this reason, PV modules (after dismantling the aluminum frame and cables) are mostly disposed of as non-hazardous waste in landfills in these countries. Finally, the main barriers to faster implementation of PV module reuse and recycling are listed, along with guidelines for their removal. The cost of recycling Si modules is about ten times higher than the cost of disposal. To change this ratio in favor of recycling, cheaper recycling methods need to be developed and taxes on landfill disposal need to be increased.

Doppler findings of persistent reverse end-diastolic flow (PREDF) in a fetal middle cerebral artery (MCA) are a very rare sonographic finding and are a marker of poor fetal condition. This finding often leads to intrauterine fetal death or early neonatal death. The reverse end-diastolic flow in the middle cerebral artery is the terminal hemodynamic event. Fetal cerebral circulation normally has a high impedance; in the event of fetal hypoxemia, impedance decreases, resulting in the central redistribution of blood flow to vital organs, which maintains the oxygen delivery to the brain. Reverse flow in the middle cerebral arteries describes the loss of this autoregulatory process. PREDF is a sequence happening due to increased extracranial or intracranial pressure. Previous case reports mentioned intracranial hemorrhage, intrauterine growth restriction (IUGR), fetal anemia, and fetal hepatic abnormalities as leading problems to PREDF. This condition presumably arises due to cerebral edema associated with severe hypoxemia. We reported Doppler findings of PREDF MCA in a 33-year-old female at 30 weeks gestation who was referred to the hospital with severe preeclampsia accompanied by IUGR and oligohydramnios. A cesarean section was performed due to severe preeclampsia and a low bishop score. Hypotheses on various etiologies and their association with intrauterine/neonatal death as well as the best management still require further investigation.

Utility perceived by individuals is believed to be different from the utility experienced by that individual. System dynamicists implicitly categorize this phenomenon as a form of bounded rationality and traditionally employ a simple smoothing function to capture it. We challenge this generalization by testing it against an alternative formulation of utility perception that is suggested by modern theories of behavioral economics. In particular, the traditional smoothing formulation is compared with the peak-end rule in a simple theoretical model as well as in a medium-size model of electronic health record implementation. Experimentation with the models reveals that the way utility perception is formulated is important and might affect behavior and policy implications of system dynamics models.

(1) Background: Learning and training in variable conditions favors adapting to unstable or changing environments. The aim of the study was to test the effect of variable practice on the accuracy of the forehand net approach shot in tennis.; (2) Methods: Thirty (n=30) first-class national players (12.9 ± 1.1 years old) participated, divided into three groups: i) induced variability training (n=10) (varying court surfaces and balls), ii) specific training (n=10) and iii) usual training -control group- (n=10). All groups trained for a month: 12 sessions of 20 minutes -3 per week-. The accuracy of the shots were analyzed through a 2D capture and digitization process of the ball bounce on the court; (3) Results: The variability group presented better accuracy values after the period without practice than the stable training group (p = 0.041; ES= 0.51).; (4) Conclusions: the application of variability in the game conditions during tennis training seems to have a favorable effect on the retention of accuracy in the forehand down the line approach to the net.

Present research focus on the effect of different processing routes on physical and mechanical properties of nano Ti(CN) based cermet’s with metallic binders. Tungsten carbide (WC) is added as secondary carbide and Ni-Co are added as metallic binders in nano Ti(CN) based cermet processed via Conventional and Spark Plasma Sintering (SPS). Systematic comparison of composition and sintering conditions for different cermet’s’ systems is done to design the novel composition and sintering conditions. Nano TiCN powder was prepared by 30hr of ball milling. Highest density of >98.5% percent was achieved for SPS processed cermet’s sintered at 1200°C and 1250°C for 3 min. at 60 MPa pressure in comparison to conventionally sintered cermet’s at 1400°C for 1hr with two stage compaction process, uniaxially at 150 MPa and isostatically at 300 MPa pressure respectively. Comparison of XRD analysis of milled powders of different time intervals was done to understand the characteristics of the as received and milled powders. Peak broadening was observed after 5 hr. of ball milling, and it increased till 30hr. Also, peak broadening and refined carbide size was observed in XRD and SEM micrograph of SPS processed cermet. TEM analysis of milled powder showed internal structure having regular periodic arrangement of planes. SEM (BSE) images of all cermets primarily showed three major microstructural phases of core-rim-binder with black, grey and white contrast respectively. In the present sintering conditions high hardness of ~16 GPa and fracture toughness of ~9 MPa m1/2 was obtained for SPS processed cermets sintered at higher temperature.

The steel grid structure with bolted ball joints is gaining popularity in offshore platforms and aquaculture cages, but the corrosion resistance of these joints is a critical safety concern. This article introduces an innovative method to enhance the sealing performance of bolted ball joints, preventing seawater ingress and corrosion. The approach involves creating a sealed surface within the contact gap between the sleeve and connecting components. Circular grooves and sealing washers are added to both ends of the sleeve. A two-dimensional finite element analysis model of the bolted ball joint with the sealing structure was created using SOLIDWORKS and ANSYS. The study analyzes the sealing gasket's contact pressure at various compression levels and evaluates its performance with bubble tests for air tightness. Research results show a linear relationship between contact pressure and compression rate, with a sealing pressure of 5.95MPa achieved at a 14% compression rate. This simple, cost-effective sealing method effectively prevents corrosion from seawater, making it ideal for marine environments.

Heterojunctions based on metal halide perovskites (MHPs) are promising systems for photocatalytic hydrogen evolution reaction (HER). In this work, we coupled Cs3Bi2Br9 nanocrystals (NCs), obtained by wet ball milling synthesis, with g-C3N4 nanosheets (NSs) produced by thermal oxidation of bulk g-C3N4 in air. These methods are reproducible, inexpensive, and easy to scale up. Heterojunctions with different loadings of Cs3Bi2Br9 NCs were fully characterized and tested for HER. A relevant improvement of H2 production with respect to pristine carbon nitride was achieved at low NCs levels reaching values up to about 4600 µmol g-1 h-1. This work aims to provide insights on the synthesis of inexpensive and high performing heterojunctions using MHP for photocatalytic applications.

IgA nephropathy (IgAN) is the most common primary glomerulonephritis worldwide. IgAN causes end-stage kidney disease (ESKD) in 20–40% of all cases. The activation of the complement system by pathological circulating IgAs, which is often associated with low serum C3 levels (LowC3), seems to play a crucial role. Previous studies have shown an association between histological evidence of TMA, which is the result of alternative complement activation, and poor outcome. However, it is not known to what extent the decrease in serum C3 levels reflects ongoing TMA injury. Our study aimed at assessing the association of LowC3 and ESKD and whether this association reflects ongoing TMA. We enrolled all patients with biopsy-proven IgAN and followed-up patients until last visit, ESKD or death. Of the 56 patients included in the study, 12 (21%) presented low serum C3 (LowC3) at the time of renal biopsy. TMA was significantly more frequent in the LowC3 group [7/12 (58%) vs 9/44 (20%), p=0.02]. After adjusting for potential confounders, LowC3 was strongly associated with an increased hazard of ESKD (hazard ratio [HR]: 5.84 [95%CI: 1.69,20.15; P=0.005). The association was not affected by adjusting for TMA. The estimated overall proportion of the relation between C3 and ESKD mediated by TMA was low and not statistically significant. Our study provides evidence that C3 hypocomplementemia is associated with an increased risk of ESKD with mechanisms that are largely independent from TMA.

To study the coupling mechanism and dynamic response of the end-face movable gear trans-mission system under complex excitation, a specific configuration of end-meshing movable gear reduction mechanism was used to achieve predetermined rigid thrust transmission and mis-matched gear meshing functions, which solved the inherent defects of traditional harmonic gear mechanism thin-wall flexible wheel easy to be damaged by fatigue. Considering the phenomenon of elastic deformation of live teeth accompanied by significant changes in meshing characteristics in the transmission process of end-meshing harmonic reducer, the influence of dynamic meshing parameters, live tooth deformation, time-varying stiffness of tooth meshing, and time-varying backlash on nonlinear dynamic performance was explored, as well as the mechanism of mul-ti-parameter coupling on transmission performance. The nonlinear dynamics model of the end-meshing harmonic reducer is established to solve the chattering prediction problem. Finally, a comprehensive test bed for the transmission system of harmonic reducer with meshing type with adjustable characteristic end was built to verify the correctness of the theoretical model and provide the theoretical and technical basis for exploring the optimal parameter selection of pas-sive vibration suppression problem.

The recycling of wastes to obtain value-added products is a great challenge in the sustainable economy. In our studies, a mixed precursor containing aluminium scrap from end – of – life vehicles and TiO2 Degussa P25 was used to prepare TiO2 modified Al photocatalyst through solid state reaction. Al scrap and TiO2 Degussa P25 in the ration of n(Ti) / n(Al) = x (x = 0.0 - 2.5%), and acetylacetonate and Tween 80 was mixed under magnetic stirring and sintered using a con-ventional furnance at 550°C. DTA – TG – DTG, X – ray diffraction, Fourier – transform infrared, UV – Vis and photoluminescence spectroscopies were assed to investigate the thermal, structural, optical properties and photocatalytic activity. The effect of aluminium concentration on the characteristics of TiO2 Degussa P25 depending on the above instruments are studied. XRD revealed that the materials have crystal structure of anatase TiO2, rutile TiO2 and aluminium. The opto-electronic properties show that Al addition shifted the absorption spectra toward the visible range. The photocatalytic performance of Al – TiO2 composites was quantified by the degradation of Allura Red solution under a visible condition. The highest photocatalytic activity (79.99%) was achieved for the sample containing 0.5% Al and a higher concentration of Al particles shields the active centres of the semiconductor, thus reducing its photocatalytic activity. Aluminium scrap from end-of-life vehicles can be a source of raw material to be considered in semiconductor production. The spin-trapping technique evidenced that •O2- was the main species generated responsible for the Allura Red degradation.

Background: The UNHLM pledged to enroll 30 million in TB preventive treatment (TPT) by 2022, necessitating TPT expansion to all at TB risk. We assessed uptake and completion of a 12-dose, weekly isoniazid-rifapentine (3HP) TPT regimen. Methods: Between February 2018 - March 2019 in Dhaka, community-based TPT using 3HP targeted household contacts of 883 confirmed drug-sensitive pulmonary TB patients. Adhering to WHO guidelines, contacts underwent active TB screening before TPT initiation. Results: Of 3,193 contacts who advised health facility visits for screening, 67% (n=2,149) complied. Among these, 1,804 (84%) received chest X-rays. Active TB was diagnosed in 39 (2%) contacts; they commenced TB treatment. Over 97% of 1,216 contacts began 3HP TPT, with completion rates higher among females, those with more education and income, non-slum residents, and those without 3HP-related adverse events. Adverse events, mainly mild, occurred in 5% of participants. Conclusions: The 3HP weekly regimen, with its short duration, self-administered option, and minimal side effects, achieved satisfactory completion rates. A community-focused 3HP TPT approach is feasible, scalable nationally, and aligns with UNHLM targets.

Speech recognition, also known as automatic speech recognition (ASR), is a technology that enables software to transcribe spoken language into text. However, existing Amharic ASR methods require multiple separate blocks, such as language, acoustic, and pronunciation models with dictionaries, which can be time-consuming and influence performance. This study proposes an approach that replaces much of the speech pipeline with a single recurrent neural network (RNN) architecture. Our proposed architecture is based on a hybrid approach that combines a convolutional neural network (CNN) with a recurrent neural network (RNN) and a connectionist temporal classification (CTC) loss function. We conducted several experiments with noisy audio data that contain 20,000 valid sentences. The model was evaluated using the word error rate (WER) metric, achieving impressive results of 7% WER on noisy data. This approach has significant implications for the field of speech recognition, as it reduces the human effort required to create dictionaries and improves the efficiency and accuracy of ASR systems, making them more practical for real-world applications.

In this paper, an adaptive technology and the interconnection and damping assignment passivity-based control method are combined to solve the stabilization problem for underactuated mechanical systems with uncertainties (including matched and unmatched). Uncertainties include unknown friction coefficients and unknown terms in kinetic energy and potential energy. A novel adaptive interconnection and damping assignment passivity-based control scheme is proposed and an adaptive stabilization controller is designed to make the closed-loop system locally stable. Verification is conducted on the ball and beam system, taking into account uncertainties of friction coefficients, kinetic energy, and potential energy. The locally asymptotic stability is demonstrated using the LaSalle’s invariance principle and approximate linearization. The effectiveness of the proposed control law is verified through numerical simulations.

In this study we used a non-autonomous Chua’s Circuit, and the fractional Lorenz chaos system together with a detection method from Extension theory to analyze the voltage signals. The measured bearing signals by acceleration sensor were introduced into the master and slave systems through a Chua’s Circuit. In a chaotic system minor differences can cause significant changes that generate dynamic errors, and extension matter-element models can be used to judge the bearing conditions. Extension theory can be used to establish classical and sectional domains using the dynamic errors of the fault conditions. The results obtained were compared with those from Discrete Fourier Transform analysis, Wavelet analysis and an integer order chaos system. The diagnostic ratio showed the fractional order master and slave chaos system calculations. The results show that the method presented in this paper is very suitable for monitoring the operational state of ball bearing system to be superior to the other methods. The diagnosis ratio was better and there were other significant advantages such as low cost and few.

Recent literature has seen a rapid expansion in the reference to front-end forensics as an indication of the untapped value of forensic science. While some of these contributions have centered on development of forensic intelligence from a single area of investigation, others call for a more fundamental change in the relationship between crime laboratories and policing, particularly relating early laboratory analysis with big datasets to provide leads to investigators. We highlight several recently implemented tactical strategies of crime laboratories that contribute to the body of forensic intelligence. Beyond the scientific gains from these tactical applications, the corresponding details on associated efficiencies, costs, time savings, and quality improvements offer insights towards patterns of success for the community of crime laboratories. Further details expand an interpretation of what constitutes success with an eye on the contributions of the crime laboratory towards public health, safety, and protection of the innocent in addition to societal gains from conviction of the guilty. The economic interpretation of the value provided by the forensic laboratory assists in the cost-benefit review of strategic and tactical decisions and supports the justification for laboratory public funding with measures of the return on investment from public support of the forensic laboratory

Introduction: Advanced glycation end-products (AGEs) may play a relevant role as inducers in the chronic inflammatory pathway present in immune-mediated diseases, such as systemic lupus erythematosus (SLE). AGEs concentrations have been associated, with discrepant results to date, with some parameters such as disease activity or accrual damage, suggesting their potential usefulness as biomarkers of the disease. Objectives: To confirm differences in AGEs levels measured by cutaneous autofluorescence between SLE patients and healthy controls (HC) and study their correlation with various disease parameters. Methods: Cross-sectional study, where AGEs levels were measured by skin autofluorescence, and SLE patients’ data were compared with those of sex- and age-matched HC in a 1:3 proportion through a multiple linear regression model. Correlations of AGEs levels with demographic and clinical data were analyzed through ANOVA tests. Both analyses were adjusted for confounders. Results: AGEs levels in SLE patients were significantly higher than in HC (p<0.001). We found statistically significant positive correlation with SLE disease activity index (SLEDAI) and damage index (SDI), physician and patient global assessment, C-reactive protein, leukocyturia, complement C4, IL6 and oral ulcers. We also found a negative statistically significant correlation with current positivity of anti-nuclear and anti-Ro60 antibodies. Conclusions: AGEs seem to have a role in LES pathophysiology, becoming a new management and prognosis biomarker in this disease. The association with specific antibodies and disease manifestations may indicate a specific clinical phenotype related to higher AGEs levels.

The LED light source is an important light source for indoor visible light communication. It has the characteristics of a large divergence angle and a high transmission rate. Therefore, using LED as the light source for visible light full-duplex communication can not only satisfy the lighting requirements but also transmit information at high speed. To analyze the factors that affect the optical power of the indoor single-light source visible light communication uplink receiving end, an indoor visible light communication model was established, and mathematical calculation formulas were derived based on the model establishment, and the maximum movable range formula of the retroreflective end under specific conditions was derived; The reliability of the formula was verified with the help of Zemax simulation software. Theoretical analysis and experimental results show that increasing the movement range of the retroreflective end can be achieved by increasing the lens diameter, reducing the focal length, and increasing the link distance.

There is a pressing need for more precise biomarkers of chronic kidney disease (CKD). Plasma samples from 820 subjects [231 with CKD, 325 with end-stage kidney disease (ESKD) and 264 controls] were analyzed by LC-MS/MS to determine a metabolic profile of 28 aminoacids (AA) and biogenic amines to test their value as markers of CKD risk and progression. The Kynurenine/Tryptophan ratio showed the strongest correlation with estimated glomerular filtration rate values (coefficient=-0.731, P&lt;0.0001). Models created with Orthogonal Partial Least Squares-Discriminant Analysis (OPLS-DA) containing the metabolic signature showed high goodness of fit and predictability for controls/CKD (R2X:0.73;R2Y:0.92;Q2:0.92) and lower for CDK/ESKD (R2X:0.56;R2Y:0.59;Q2:0.55). Based on generated VIP scores, the most relevant markers for segregating samples into control/CKD or CKD/ESKD groups were citrulline (1.67) and tryptophan (1.59), respectively. ROC analysis showed that the addition of the metabolic profile to a model including CKD classic risk factors improved AUC from 86.7% (83.6-89.9) to 100% (100-100) for CKD risk (P&lt;0.0001), and from 63.0% (58.2-67.8) to 96.5% (95.3-97.8) for the risk of progression from CKD to ESKD (P&lt;0.0001). Plasma concentrations of AA and related amines may be useful as diagnostic biomarkers of kidney disease, both for CKD risk and for progression of CKD patients to ESKD.

The right to live with dignity during the final stages of existence, enshrined in national and supranational Charters of Rights, represents a significant step towards humanizing medicine and is integral to the right to health. Palliative Care, rooted in health, dignity, and therapeutic self-determination, has emerged as a fundamental human right and a moral imperative within health systems. It seeks to alleviate suffering, emphasizing the holistic well-being of patients with life-limiting illnesses. This paper provides a comprehensive global perspective on Palliative Care, with special attention to its implementation in Italy. Palliative Care is a crucial dimension of care, designed to enhance the quality of life for patients suffering from progressive and incurable diseases. Despite its growing need due to an aging population and increased prevalence of chronic illnesses, still remains a significant disparity in access to these essential services worldwide. Insufficient resources, legislative constraints, and limited training for healthcare providers pose challenges to the widespread adoption of Palliative Care. In Italy, although laws have been enacted to ensure the provision of Palliative Care, its availability remains inconsistent across different regions. Financial constraints and insufficient support hinder the comprehensive dissemination of these services. Recognizing the significance of Palliative Care, the Catholic Church also endorses its implementation as a response to human suffering and an approach to end-of-life care. Efforts to strengthen Palliative Care are critical to meeting the rising demand and ensuring access to compassionate and dignified care for all individuals in need. Through legislative advancements and adequate resources, Italy can make significant strides in advancing the provision of Palliative Care.

Introduction: The treatment of peritoneal dialysis in end-stage renal disease is increasing in clinical practice. The main purpose of this study was to evaluate the effect of far-infrared radiation therapy on inflammation and the cellular immunity of patients undergoing peritoneal dialysis. Materials and Methods: We recruited 56 patients undergoing peritoneal dialysis, and we included 32 patients from the experimental group and 24 patients from the control group in the final analysis. The experimental evaluation in our study was as follows: (1) We used abdominal computed tomography to measure the diameter and degree of hardening of the abdominal veins and large blood vessels to explore the changes in abdominal blood vessels. (2) The study compared the effects of peritoneal dialysis using albumin, blood urea nitrogen, creatinine, white blood cell, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, erythrocyte sedimentation rate, Hs-CRP clearance rate, and HBAlC. (3) We compared the cytokine concentration of blood between the two groups while controlling for GM-CSF, IL-2, IFN-γ, IL-6, IL-18, IL-4, IL-5, IL-13, IL-12p70, TNF-α, and IL-1β. Results and Discussion: (1) There was no significant difference in the abdominal blood vessels of the experimental group relative to the control group according to abdominal CT measured over 6 months. (2) Our study demonstrates the statistically significant effect of FIR therapy on the following parameters: albumin (p = 0.048*), creatinine (p = 0.039*), and Hs-CRP (p < 0.001**) decreased significantly, and glomerular filtration rate (eGFR, p = 0.043*) and glucose (p < 0.001**) increased significantly. Our study found that, in the experimental group, albumin and creatinine decreased significantly due to FIR therapy for 6 months. However, our study also found that, in the experimental group, glucose (p < 0.001**) increased significantly due to FIR therapy for 6 months. Peritoneal dialysis combined with FIR can reduce the side effects of glucose in dialysis buffer, which interferes with peritoneal inflammation and peritoneal mesothelial cell fibrosis. In addition, we also found that, in the experimental group, Hs-CRP (p < 0.001**) decreased significantly due to FIR therapy for 6 months. (3) No statistical significance in the inflammatory cytokines related to FIR therapy differences was observed in our study. IFN-γ (p = 0.124), IL-12p70 (p = 0.093), IL-18 (p = 0.213), and TNF-α (p = 0.254) did not exhibit significant improvements in peritoneal dialysis with FIR treatment over 6 months. IFN-γ and IL-18 in the plasma of patients in the experimental group and the control group were higher in the third month than in the first month. Conclusion: We found that the effect of peritoneal dialysis improved significantly with FIR therapy, and significant improvements in the peritoneal permeability and inflammatory response were observed. end-stage renal disease; peritoneal dialysis; far-infrared therapy (FIR)

Packaging of the eukaryotic DNA genome with histone and other proteins forms a chromatin structure that regulates the outcome of all DNA mediated processes. The cellular pathways that ensure genomic stability detect and repair DNA damage through mechanisms which are critically dependent upon chromatin structures established by histones and, particularly, transient histone post-translational modifications . Though subject to a range of modifications, histone methylation is especially crucial for DNA damage repair as the methylated histones often form platforms for subsequent repair protein binding at damaged sites. In this review, we highlight and discuss how histone methylation impacts the maintenance of genome integrity through effects related to DNA repair and repair pathway choice.

Short stature has been associated with increased various disease and all-cause death, but no reliable data exist the association between height and end-stage renal disease (ESRD) in diabetic patients. We investigated the relationship between short stature, development of ESRD, and mortality in type 2 diabetes. This study analyzed clinical data using the National Health Insurance Database in Korea. Height was stratified by five groups according to age and sex. Risk of ESRD and all-cause mortality was analyzed with Cox proportional hazards models. During a 6.9-year follow-up period, 220,457 subjects (8.4%) died and 28,704 subjects (1.1%) started dialysis. Short stature significantly increased the incidence of ESRD and all-cause mortality in the overall cohort analysis. In multivariable analysis, hazard ratios (HR) for development of ESRD comparing the highest versus lowest quartiles of adult height were 0.86 (95% confidence interval (CI), 0.83–0.89). All-cause mortality also decreased with highest height compared to patients with lowest height after fully adjusting for confounding variables (HR 0.79, 95% CI, 0.78–0.81). Adult height had an inverse relationship with newly diagnosed ESRD and all-cause in both males and females. Short stature is strongly associated with an increased risk of ESRD and all-cause mortality in type 2 diabetes.

Health information and communication are key elements that allow patients and family members to make decisions about end-of-life process and guarantee a death with dignity. Objective: To understand carers’ experiences regarding health information and communication during the illness and death of family members. Methods: This qualitative study was conducted in Andalusia based on the paradigm of hermeneutic phenomenology. Participants were carers who had accompanied a family member at the end of life for over 2 months and less than 2 years. Five nominal groups and 5 discussion groups were established, and 41 in-depth interviews with 123 participants were conducted. Atlas.ti 7.0 software was used to analyse the discourses. Results: Four dimensions of the dying process emerged: differences in carers’ perceptions of information and communication, a conspiracy of silence, consequences of the absence or presence of information, and the need for a culture change. Conclusions: Poor management of health information and communication at the end of life suffering and discomfort patients and their families. The culture of denying and avoiding death is still present today. A change in education about death would better enable health professionals to care for patients at the end of life.

Parallel manipulators with multiple end-effectors bring us interesting advantages over conventional parallel manipulators such as improved manipulability, workspace and avoidance of singularities. In this work the kinematics of a five-bar planar parallel manipulator equipped with two end-effectors is approached by means of the theory of screws. As an intermediate step the displacement analysis of the robot is also investigated. The input-output equations of velocity and acceleration are systematically obtained by resorting to reciprocal-screw theory. In that regard the Klein form of the Lie algebra se(3) of the Euclidean group SE(3) plays a central role. In order to exemplify the method of kinematic analysis, a case study is included. Furthermore, the numerical results obtained by means of the theory of screws are confirmed with the aid of special software like ADAMS.^TM

\abstract{The existence of vorticies is well known in fluid mechanics and particularly in turbulence theory. In the context of the millennium problem of the Clay Institute on the existence (or not) of Global solutions in time of the Periodic Navier Stokes equations (PNS) results are now proposed to confirm that Global solutions do not exist in the general case of PNS defined on $\mathbb{T}^3$. This corresponds to part ($D$) proposition in the Navier Stokes problem as posted by C.Fefferman. Recent work has shown that for the Euler equations defined on the 3-Torus there exists a H\"older continuous solution for the third component of velocity $v_3$ at the center of each cell or cube of the 3-Torus Lattice. It has also been determined that as the kinematic viscosity changes from the corresponding value at $\nu=0$ to the fully viscous case for the Periodic Navier Stokes equations (PNS) at the value $\nu=1$ the solution reaches a peak ($\frac{\partial v_3}{\partial y_3} = 0$ ) in $y_3$. (third component of $\vec{r}=(y_1,y_2,y_3)$ in Cartesian co-ordinates) Here in the viscous case there exists a dipole which is not centered at the center of the cell of the Lattice. This immediately implies that since the dipole by definition has an equal in magnitude positive and negative peak in the third component of velocity, then the dipole Riemann cut-off surface is covered by a closed surface which is the sphere $\|\vec{r}\|=1$ and where a given cell of dimensions $[-1,1]^3$ is circumscribed on a sphere of radius $1$. For such a closed surface containing a dipole it necessarily follows that the flux at the surface of the sphere of $v_3$ wrt to surface normal $\vec{n}$ is zero including at $y_i, i=1\dots 3$ is zero at the points where the surface of sphere touches the cube walls. At the finite time singularity on the sphere a rotation boundary condition is deduced. Here $\frac{\partial v_3}{\partial \vec{n}}= \vec{n}\cdot \nabla v_3$. Also a boundary condition on the sphere shows rotation of sphere. Finally as a result, on the sphere a solution for $v_3$ is obtained which is proven to be H\"older continuous and it is proven that it is possible to extend H\"older continuity on the sphere uniquely to all of the interior of the ball.}

Clay ball is a pavement surface defect which refers to a clump in which clay or dirt is mixed with hot asphalt mixture. Clay ball is typically caused by a combination of aggregate contamination of clay or soil, high aggregate moisture, and low production temperature at the asphalt plant. It usually appears a few weeks or months after paving under traffic load, after being liquefied and knocked from the pavement surface. Clay balls can be the source of potholing, raveling, and other issues such as moisture infiltration and reduced ride quality. This paper presents an investigation of the clay balls on US-31 one winter after construction in Hamilton County, Indiana. In order to understand the pavement condition, their severity was measured using both visual observation and infrared image collection system. In addition, a clay ball distribution pattern, its density, and cores condition were evaluated. A precipitation effect on clay ball formation was investigated for finding a cause of the clay balls. The investigation found that infrared image collection system was appropriate in detecting the clay balls. The clay balls were elliptic in shape with 1 inch to 4 inches in diameter, and the maximum clay ball depth is almost penetrating the entire surface course. It was also found that the asphalt paving on the raining days or right after raining could increase the potential of clay balls. Monitoring of aggregate moisture during construction on or after raining days should be able to reduce the risk of clay balls.

Aluminum wire is a common material for wire bonding due to its resistance to oxidation and low price. It does not melt when becoming a free air ball (FAB) during the electronic flame-off (EFO) process with wettability, and is applied by wedge bonding. This study used 20μm Zn-Coated Al-0.5wt.%Si (ZAS) wires to improve the FAB shape after the EFO process, while maintaining stability of the mechanical properties, including the interface bonding strength and hardness. In order to test circuit stability after ball bonding, the current-tensile test was performed. During the experiment, it was found that 80nm ZAS with wire bonding has lower resistance and higher fusing current. For the bias tensile test, the thicker Zn film diffused into the Al-Si matrix easily, after which the strength was reduced. The ball-bond interfaces had no change in their condition before and after the bias. Accordingly, ZAS could be a promising candidate for ball bonding in the future.

To address the problems of poor recognition, low detection accuracy, a large number of model parameters and computation, complex network structure, and unfavorable portability to embedded devices in traditional tennis ball detection algorithms, this study proposes a lightweight tennis ball detection algorithm YOLOv5s-Z based on Robomater EP. The main work is as follows: Firstly, constructing lightweight G-Backbone and G-Neck network layers to reduce the number of parameters and computation of the network structure. Secondly, the convolutional coordinate attention is incorporated in G-Backbnone to embed the location information into the channel attention, which makes the network obtain the location information in a larger area through multiple convolutions and enhances the expression ability of the mobile network learning features. In addition, the Concat module in the original feature fusion is modified into a weighted bi-directional feature pyramid W-BiFPN with settable learning weights to improve the feature fusion capability and achieve efficient weighted feature fusion and bi-directional cross-scale connectivity. The EIOU loss is introduced to split the influence factor of aspect ratio and calculate the length and width of the target frame and anchor frame respectively, combined with Focal-EIOU Loss to solve the problem of imbalance between difficult and easy samples. The activation function Meta-ACON is introduced to achieve an adaptive selection of whether to activate the neurons and improve the detection accuracy. Finally, the experimental results show that compared with the original algorithm, the YOLOv5s-Z algorithm reduces the number of parameters and computation by 42$\%$ and 44$\%$, the model size by 39$\%$, and 2$\%$ improvement in average accuracy mean value, which verifies the effectiveness of the improved algorithm and the light weight of the model to meet the deployment requirements of embedded devices, and adapts Robomaster EP for accurate detection and real-time recognition of tennis balls.

In this paper, we introduced a generalized ∆-implicit locally contractive condition and give some examples to support it and to show its significance in fixed point theory. We prove that the mappings satisfying generalized ∆-implicit locally contractive condition admits a common fixed point, where, the ordered multiplicative GM−metric space is chosen as underlying space. The obtained fixed point theorems generalize many earlier fixed point theorems on implicit locally contractive mappings. In addition, some nontrivial and interesting examples are provided to support our findings. To demonstrate the originality of our new main result, we apply it to show existence of solutions to a system of nonlinear -Volterra type- integral equations.

This paper presents the process of designing, fabrication, assembling, programming and optimizing a prototype of a nonlinear mechatronic Ball-Plate System (BPS) as a laboratory platform for STEM engineer education. Due to the nonlinearity and complexity of BPS, task presents challenging issues, such as: 1) difficulties in controlling the stabilization of a given position point known as steady state error, 2) position resolution known as specific distance error and 3) adverse environmental effects - light shadow error, also discussed in this paper. The laboratory BPS prototype for education was designed, manufactured and installed at the Karlovac University of Applied Sciences at the Department of Mechanical Engineering, Study of mechatronics. The low-cost two degrees BPS system uses a USB HD camera for computer vision as feedback and two DC servomotors as actuators. Due to controlling problems, an advanced block diagram of control system is proposed and discussed. An open-source control system based on Python scripts that allows the use of ready-made functions from the library allows changing the color of the ball and the parameters of the PID controller, thus indirectly simplifying control system and directly the mathematical calculation. The authors will continue their research on this BPS mechatronic platform and control algorithms.

In this paper, a resonant system that produces a movement of low amplitude and ultrasonic frequency is used to achieve the vibration assistance in a ball-burnishing process. A full vibration characterization of this process performed in a lathe was done. It is carried out by a new tool designed in the research group of the authors. Its purpose is to demonstrate that the machine and the tool do not have any resonance problem during the process and to prevent possible failures. The analysis of this dynamic behaviour permits to validate the suitability of the tool when it is anchored to a numerical control lathe. This is very important for its future industrial implementation. It is also intended to confirm that the system adequately transmits vibrations through the material. To do this, a methodology to validate the dynamic tool behaviour was developed. Several techniques that combine the usual and ultrasonic vibration ranges through static and dynamic measurements were merged: vibration and acoustic emission measurements. An operational deflection shape (ODS) exercise has been also performed. Results show the suitability of the tool used to transmit the assistance vibrations, and that no damage is produced in the material in any case.

Advanced glycation end-products (AGEs) form through non-enzymatic glycation of various proteins. Optic nerve degeneration is a frequent complication of diabetes, and retinal AGEs accumulation is strongly linked to diabetic retinopathy development. Type 2 diabetes mellitus (T2DM) is a major risk factor for Alzheimer's disease (AD), with patients often exhibiting optic axon degeneration in the nerve fiber layer. Notably, a gap exists in our understanding of how AGEs contribute to neuronal degeneration in the optic nerve within the context of both diabetes and AD. Our previous work demonstrated that glyceraldehyde (GA)-derived toxic advanced glycation end-products (TAGE) disrupt neurite outgrowth through TAGE-β-tubulin aggregation and tau phosphorylation in neural cultures. In this study, we further illustrated GA-induced suppression of optic nerve axonal elongation via abnormal β-tubulin aggregation in mouse retinas. Elucidating this optic nerve degeneration mechanism holds promise for bridging the knowledge gap regarding vision loss associated with DM and AD.

Breeding for low hydrogen cyanide (HCN) varieties is a major objective of programmes targeting boiled cassava food product. To enhance breeding for low HCN, knowledge on genetic variation and trait heritability is essential. In this study, 64 cassava clones established across four locations and evaluated for HCN using three HCN assessment methods; 1 to 9 scale, 0 ppm to 800 ppm scale and a quantitative assay based on spectrophotometer readings (HCN_Spec). Data were also collected on the weather variables precipitation, relative humidity, and temperature. Significant differences were observed among clones (P &lt; 0.001) and locations (p &lt; 0.001). There were also significant (p &lt; 0. 001) clone by environment interactions. Locations Arua and Serere posted higher HCN scores among clones and were associated with significantly higher (p &lt; 0.001) mean daily temperature (K) and lower relative humidity (%) across 12-hour and 18-hour intervals. Within locations HCN broad sense heritability estimates ranged 0.22 – 0.64 while combined location heritability estimates ranged 0.14 to 0.32. Relationships between the methods were positive and strong (R2 = 0.75 – 0.92). It is expected that the information herein will accelerate efforts towards breeding for low HCN cassava varieties.

Chronic hemodialysis (HD) patients have very high cardiovascular risk. Acute vascular changes during dialysis mediated by factors of the endothelium may have a crucial role in this. Aim: To study acute vascular changes during HD. In 29 consecutive chronic HD patients (age: 65.6±10.4 years) pre-, mid-, and post-HD plasma syndecan-1 (SDC-1) and endothelin-1 (ET-1) levels were measured. Applanation tonometry was performed before HD. SDC-1 levels increased during HD (p=0.004). Males had higher ET-1 levels. Patients were divided into 2 groups based on pulse wave velocity (PWV): PWV≥12 m/s and PWV<12 m/s. Pre-HD and mid-HD SDC-1 levels were higher in the group with PWV≥12 m/s (10.174±2.568 vs. 7.928±1.794 ng/ml, p=0.013, and 10.319±3.482 vs. 8.248±1.793 ng/ml, p=0.044, respectively). Post-HD ET-1 levels were higher in the patient group having PWV≥12 m/s (10.88±3.00 vs. 8.05±3.48 pg/l, p=0.027). Patients having PWV≥12 m/s had higher pre-HD peripheral and aortic systolic blood pressure (p<0.05). Total cholesterol correlated with the SDC-1 decrease during HD (r=0.539; p=0.008). Pre-, mid-, and post-HD SDC-1 correlated with the ultrafiltration (r=0.432, p=0.019; r=0.377, p=0.044; and r=0.401, p=0.012, respectively). SDC-1 and ET-1 contribute to vascular changes observed during HD, and they have correlations with some cardiovascular risk factors.

Hundreds of thousands of kilometers of communication and power (umbilical) cables and flowlines lie undersea worldwide. Most of these offshore cables and flowlines have reached or will soon be nearing the end of their service life, necessitating the need for a viable recycling approach to recover some valuable material, e.g., copper. However, separation into constituent materials has proven very challenging due to the highly robust design of the composite cables (and flowlines) to withstand service conditions and the tough external plastic sheaths that protect against seawater corrosion. Here, we summarize the findings of the cryogenic comminution of subsea cables and flowlines for an effective separation and recovery of component materials. Heat transfer analyses of complex multilayer flowlines and umbilicals were conducted to evaluate the time required for these structures to reach their respective critical brittle-transition temperatures. Subsequently, the time was used as a guide to crush the flowline and umbilical cables under cryogenic conditions. The results show that the flowlines and umbilical cables will reach the brittle-transition temperature after approximately 1000s (i.e., 17 min) of submergence in liquid nitrogen (LN). Comminution of the materials at temperatures near the brittle-transition temperature was proven relatively efficient compared to room-temperature processing. The present evaluation of heat transfer and lab-scale crushing will afford accurate process modelling and design of a pilot cryogenic comminution of decommissioned flowlines in an LN-doped atmosphere.

Diabetic nephropathy (DN), one of the primary consequences of diabetes mellitus, affecting many people worldwide. Diabetes affects yearly 463 million adults globally between the ages of 20 and 79, and is the main cause of death under the age of 60. ROS production rises during hyperglycemia and is crucial to the development of diabetic complications. Advanced glycation end products (AGEs) are produced excessively in a diabetic state and accumulate in the kidney, where they change renal architecture and impair renal function. Another important targeted pathway for the formation of DN includes NF-B, Nrf2, NLRP3, Akt/mTOR, and autophagy. About 40% of individuals with diabetes eventually acquire diabetic kidney disease and end stage renal disease that needs hemodialysis, peritoneal dialysis, or kidney transplantation, to survive. The current state of acceptable therapy for this kidney ailment is limited. The studies revealed that some naturally occurring bioactive substances might shield the kidney by controlling oxidative stress, renal fibrosis, inflammation, and autophagy. In order to provide new potential therapeutic lead bioactive compounds for contemporary drug discovery and clinical management of DN, this review was designed to examine the various mechanistic pathways by which current conventional plants derive phytocompounds that are effective for the control and treatment of DN.

Regular exercise can reduce depression. However, the uptake of exercise is limited in patients with end-stage renal disease undergoing hemodialysis. To address the gap, we designed a gamified non-weight-bearing exercise program (Exergame), which can be executed during hemodialysis treatment. The Exergame is virtually supervised based on its interactive feedback via wearable sensors attached on lower extremities. We examined the effectiveness of this program to reduce depression symptom compared to supervised exercise in 73 hemodialysis patients (age=64.5±8.7years, BMI=31.6±7.6kg/m2). Participants were randomized into an Exergame group (EG) or a Supervised-exercise group (SG). Both groups received similar exercise tasks for 4-week, 3-session per week, 30-min per session, during hemodialysis treatment. Depression symptom was assessed at baseline and 4-week using Center for Epidemiologic Studies Depression (CES-D). Both groups showed significant reduction in depression score (37%, p<0.001, Cohen’s effect size d=0.69 in EG vs. 41%, p<0.001, d=0.65 in SG) with no between-group difference for the observed effect (p>0.050). The EG expressed a positive exercise experience including fun, safety, and helpfulness of sensor-feedback. Together, results suggested that the virtually-supervised low-intensity Exergame is feasible during routine hemodialysis treatment. It is as effective as supervised-exercise to reduce depression symptom, while reducing burden of administrating exercise in dialysis clinics.

Pit lakes can represent significant liabilities at mine closure. However, pit lakes also present opportunities to provide significant regional benefit and address residual closure risks of both their own and overall project closure, and even offset the environmental costs of mining by creating new end uses. Unfortunately, many pit lakes have continued to be abandoned without repurposing for an end use. We reviewed published pit lake repurposing case studies of abandoned mine pit lakes. We found beneficial end use type and outcome varied dependent upon climate and commodity; but equally important social and political dynamics that manifest as mining company commitments or regulatory requirements. Many end uses have been realized: passive and active recreation, nature conservation, fishery and aquaculture, drinking and industrial water storage, greenhouse carbon fixation, flood protection and waterway remediation, disposal of mine and other waste, mine water treatment and containment, and education and research. Common attributes and reasons that led to successful repurposing of abandoned pit lakes as beneficial end uses are discussed. Recommendations are given for all stages of mine closure planning to prevent pit lake abandonment and to achieve successful pit lake closure with beneficial end uses.

Filamentous fungi such as Aspergillus spp. are opportunistic pathogens, which cause highly invasive infections, especially in immunocompromised individuals. Control of such fungal pathogens is increasingly problematic due to the small number of effective drugs available for treatment. Moreover, the increased incidence of fungal resistance to antifungal agents makes this problem a global human health issue. The cell wall integrity system of fungi is the target of antimycotic drugs echinocandins, such as caspofungin (CAS). However, echinocandins cannot completely inhibit the growth of filamentous fungal pathogens, which results in survival/escape of fungi during treatment. Chemosensitization was developed as an alternative intervention strategy, where co-application of CAS with the intervention catalyst octyl gallate (OG; chemosensitizer) greatly enhanced CAS efficacy, thus achieved ≥ 99.9% elimination of filamentous fungi in vitro. Based on hypersensitive responses of Aspergillus antioxidant mutants to OG, it is hypothesized that, besides destabilizing cell wall integrity, the redox-active characteristic of OG may further debilitate fungal antioxidant system.

Swarf of aluminum alloy with high corrosion resistance and ductility was successfully converted into fine hydroreactive powders via its ball milling with silver powder and either lithium chloride or gallium. The later substances significantly intensified particle size reduction, while silver formed ‘cathodic’ sites (Ag, Ag2Al) promoting Al corrosion in aqueous saline solutions with hydrogen generation. The diffraction patterns, microphotographs, and elemental analysis results demonstrated partial aluminum oxidation in the samples and their contamination with tungsten carbide from milling balls. Those effects were responsible for obtaining hydrogen yields lower than expected. For AlCl3 solution at 60 °C, Al–LiCl–Ag, Al–LiCl, Al–Ga–Ag, and Al–Ga composites delivered (84.6±0.2), (86.8±1.4), (80.2±0.5), and (76.7±0.7)% of the expected hydrogen respectively. Modification with Ag promoted Al oxidation thus providing higher hydrogen evolution rates. The samples with Ag were tested in CaCl2 solution as well, for which the reaction proceeded much slower. At a higher temperature (80 °C) after 3 h of experiment, the hydrogen yields for Al–LiCl–Ag and Al–Ga–Ag powders were (46.7±2.1) and (31.8±1.9)%. The tested Ag-modified composite powders were considered promising for hydrogen generation and had a potential for further improvement to provide higher performance.

Ptolemy’s Theorem in Euclidean geometry, named after the Greek astronomer and mathematician Claudius Ptolemy, is well known. We translate Ptolemy’s Theorem from analytic Euclidean geometry into the Poincar´e ball model of analytic hyperbolic geometry, which is based on M¨obius addition. The translation of Ptolemy’s Theorem from Euclidean geometry into hyperbolic geometry is achieved by means of the hyperbolic trigonometry, called gyrotrigonometry, to which the Poincar´e ball model gives rise, and by means of the duality of trigonometry and gyrotrigonometry.

The Sun is a frame at relative rest in which sunlight travels at the emitted speed c. Earth travels at the revolving speed v in this frame. The reflection of light as a mechanical phenomenon applies to the modified Michelson interferometer employed by Miller in his experiments with light from the Sun. Unlike the Tomaschek experiments, which use light from stars that may travel in the Universe at velocities different from that of the Sun, the fringe shifts in the Miller experiments are predictable. Based on Michelson's derivation, Miller expected in his experiments at Mount Wilson a 1.12 fringe shift and observed a fringe shift of 0.08 in 1921 and 0.088 in 1925. The reflection of light as a mechanical phenomenon predicts zero fringe shift for Miller's experiment agreeing only with his observations at the Cleveland laboratory in 1924.

Objective: To examine variations in end-of-life care for breast cancer, heart failure, and dementia patients. Data and methods: Data from four Norwegian health registries were linked using a personal identification number. Longitudinal trends over 365 days and the type of care on the final day of life were analyzed using descriptive techniques and logistic regression analysis. Results: Patients with dementia were most commonly placed in nursing homes, while patients with heart failure and breast cancer were more frequently hospitalized. Breast cancer and heart failure patients had a higher likelihood of dying at home. The presence of general practitioners increased the probability of home-based end-of-life care for cancer patients, while non-physician healthcare workers increased the likelihood of home-based care for the other patient groups. Conclusion: Diagnoses, individual characteristics, and service availability are all associated with the place of death in end-of-life care.

Heat using behavior has a large impact on in heating energy in heat metering system, and therefore a better understanding can assist in behavior guidance to reduce energy. To understand the current situation of indoor thermal environment and heat using behavior for heat metering households in northern China, including adjusting heating end valves and operating windows, 30 households were measured and surveyed. The factors influencing heat using behavior, including outdoor and indoor environmental parameters and time of the day, were analyzed. The results are :1) Thermal neutral temperature for heat metering households is relatively high, up to 24.5℃; 2) The heat using behavior of households is lack of rationality: low proportion of active households; high indoor temperature setting; more frequency of window opening. Improving indoor comfort is the main reason for households to adjust the heating end valve, and only 7.15% of households have considered the economic benefits brought by adjusting the valve. " Thermostat control valve does not work" is the main reason for households without adjustment; 3) Time of the day and indoor temperature affect active households’ willingness to adjusting heating end valve. Time of the day, indoor temperature and outdoor temperature have impacts on opening window during heating period.

Traditional end-effector robots for arm rehabilitation are usually attached a­t the hand, primarily focusing on coordinated multi-joint training. Therapy at an individual joint level of the arm for severely impaired stroke survivors is not always possible with existing end-effector robots. The Arm Rehabilitation Robot (AREBO)—an end-effector robot—was designed to provide both single and multi-joint assisted training while retaining the advantages of traditional end-effector robots, such as ease of use and cost-effectiveness (compared to exoskeletons). This work presents the design, optimization, and characterization of AREBO for training single-joint movements of the arm. The AREBO has three actuated and three unactuated degrees of freedom, allowing it to apply forces in any arbitrary direction at its endpoint and self-align to arbitrary orientations within its workspace. The AREBO’s link lengths were optimized to maximize its workspace and manipulability. The AREBO provides single-joint training in both unassisted and adaptive weight support modes using a human arm model to estimate the human arm's kinematics and dynamics without using additional sensors. The characterization of the robot’s controller and the algorithm for estimating the human arm parameters were performed using a two degrees of freedom mechatronic model of the human shoulder joint. The results demonstrate that: (a) the movements of the human arm can be estimated using a model of the human arm and robot’s kinematics, (b) the AREBO has similar transparency to that of existing arm therapy robots in the literature, and (c) the adaptive weight support mode control can adapt to different levels of impairment in the arm. This work demonstrates how an appropriately designed end-effector robot can be used for single-joint training, which can be easily extended to multi-joint training. Future work will focus on the evaluation of the system on patients with any neurological condition requiring arm training.

Background. There is limited evidence on the relationship between chronic kidney disease (CKD) and frailty in older people in Vietnam. This study aimed to examine the prevalence of frailty and its impact on mortality in older patients with end-stage renal disease. Method. This is a prospective, observational study at two large Dialysis Centres in Vietnam from November 2020 to June 2021. Consecutive older patients diagnosed with end-stage renal disease and on dialysis were recruited. Participants’ frailty status was defined by the Clinical Frailty Scale (CFS). The study outcome was all-cause mortality at 6th month. Results. A total of 175 participants were recruited (mean age 72.4 years, 58.9% female). Using the cut-point of CFS ≥4, 87.4% of the participants were frail. Mortality at 6th month was 14.9%, 31.9% in participants with CFS ≥7, 12.8% in participants with CFS=6, 7.5% in participants with CFS from 4 to 5, and 4.5% in participants with CFS ≤3 (p=0.001). Cox regression analysis showed that compared to the non-frail participants, the probability of death over 6 months was nearly 2-fold higher in the mildly frail, 3-fold higher in the moderately frail, and 9-fold higher in the severely frail participants. Conclusion. This study demonstrated a very high prevalence of frailty in older patients with end-stage renal disease and dialysis and the significant impact of frailty severity on mortality. Healthcare providers should consider incorporating frailty screening into routine care for older patients with end-stage renal disease and dialysis.

Digital health research is an emerging discipline that requires easy-to-understand theoretical frameworks and implementation models for digital health providers in health and social care settings. The COVID-19 pandemic has heightened demand for digital health discipline-specific instruction on ‘how to’ manage evidence-based digital health transformation. Access to the use of these models guarantees that digital health providers can investigate phenomena using safe and suitable approaches and methods to conduct research and identify answers to challenges and problems that arise in health and social care settings. The COMPASS theory is designed to aid transformation of health and social care environments. A navigational rose of primary quadrants is divided by four main compass points, with person-centred care being central to the philosophy. Two axes produce Cartesian planes that intersect to form a box plot, which can be used to discover human and physical resource weightings to augment digital health research design and implementation. A third continuum highlights stakeholders' capabilities, critical for any multidisciplinary study. The COMPASS mnemonic guides end-users through the process of design, development, implementation, evaluation, and communication of digital health transformations. The theory's foundations are presented and explained in context of the 'new normal' of health and social care delivery.

Background: Membranous glomerulonephritis (MGN) is one of the most common causes of nephrotic syndrome in non-diabetic adults, accounting for up to one-third of biopsy diagnostics in some regions. A watchful waiting strategy has been adopted to accurately assess the success of MGN. In this study, we predict prognostic risk factors for primary MGN patients for effective intervention and prognosis. Materials and Methods: This is a retrospective study design involving 125 biopsy-proven MGN subjects on follow-up from January 2012 to October 2019 in Hospital Serdang and Hospital Kuala Lumpur, Malaysia. Result and Conclusion: After the median follow-up of 36 (15.0-57.0) months, 26 (20.8%) consisting of 17 (13.6%) primary MGN and 9 (7.2%) secondary MGN subjects achieved complete remission while 17 (13.6%) and 10 (8.0%) of primary and secondary MGN subjects respectively achieved spontaneous remission. Subjects with nephrotic range proteinuria have 2.917 odds more at risk of primary MGN while subjects with hypertension have 2.417 odds risk of primary MGN compared to those with no hypertension at presentation. Multiple logistic regression models retained only factors directly associated with MGN with only nephrotic range proteinuria associated with primary MGN. Those with nephrotic range proteinuria were 3.04 times the odds of primary MGN when compared with those without nephrotic syndrome (95% C. I = 1.089, 8.472). The nephrotic syndrome could be used to determine the prognosis in patients with primary MGN especially those at risk of end-stage kidney disease.

Initially, retinol-binding protein (RBP), was thought to be a biomarker for proximal convoluted tubule dysfunction could be important in chronic kidney diseases (CKD). Membranous glomerulonephritis (MGN) is an important cause of CKD and end-stage renal disease (ESRD). Therefore, monitoring MGN patients using urinary RBP is important in effective treatment decision making and prognostication of MGN patients. Enzyme-linked immunosorbent assay (ELISA) technique was used to detect the RBP in the urine samples of 69 MGN patients comprising 47 primary and 22 secondary MGN, at the end of the follow-up period. The test for the urinary biomarker gave the following results: urinary RBP was detected in 27 (39.1%) and 6 (8.7%) of the primary and secondary MGN patients, respectively. The correlation analysis demonstrated a significant relationship between urinary RBP and renal function test parameters, in addition to a logistic regression analysis that proved urinary RBP as a prognostic non-invasive biomarker for primary MGN. Therefore, urinary RBP could be employed to monitor and provide effective prognosis and early treatment decisions in primary MGN.

This work assesses sea-level rise using three different models created on Free and Open-Source Software for Geographic Information System (FOSS4GIS). Based on regional projections of Special Report on Climate Change and Oceans and Cryosphere (SROCC) of the Intergovernmental Panel on Climate Change (IPCC), the models were applied to a case of study on Rio Grande do Sul coast – Brazil under different sea-level rise scenarios by the end of this century. The End Point Rate for QGIS (EPR4Q), calculates a shoreline projection using End Point Rate method. The Uncertainty Bathtub Model (uBTM), analyses the sea-level rise impact by the uncertainty of sea-level projec-tions and vertical error of the Digital Elevation/Terrain Model (DEM/DTM). The Bruun Rule for Google Earth Engine Model (BRGM) predicts the shoreline position with sea-level rise, using topographic and bathymetric data from Unmanned Aerial Vehicles (UAV) and Coastal Modelling System (SMC – Brazil), respectively. The results indicated a maximum shoreline retreat for 2100 of -502 m and -1727 m using EPR4Q and BRGM, correspondingly. The uBTM using the land-use of Mapbiomas showed a maximum of 44.57 km2 of urban area impacted by the sea-level flood. This research highlights the possibility of performing coastal management analysis in GIS environ-ment using non-commercial software.

Critically the paper argues that a truly people-centered technology supported chronic care system can only be designed by understanding and responding to the needs, attributes and capabilities of the most vulnerable in society. The paper suggests innovative ways of supporting interactions with these ‘end-users’ and highlights how reflection on these approaches can contribute to emancipating both the health system to move towards more socially inclusive e-health solutions.

Abstract The aim of this research is to conduct a systematic review analysing the role of the physiotherapy interventions in palliative care. PRISMA as a critical appraisal tool was utilised for the selection of the research articles. The inclusion criteria were based on the year of publication, ease of availability, language, geographical location, and study type. To ensure the credibility, databases such as Elsevier, Proquest, and EBSCO Host were used to filter the grey content. Data published in the past ten years (2009-onwards) was only included to ensure the selection of the most recent interventions used by the physiotherapists. A total of 11 articles were selected which determined that physiotherapy interventions involving breathing exercises, aerobic exercises, manual therapies, and educational awareness were critical to promoting the functional capability and empower the patients.

The urbanisation phenomenon and related cities expansion and transport networks entail preventing the increase of population exposed to environmental pollution. Regarding noise exposure, the Environmental Noise Directive demands on main metropolis to produce noise maps. While based on standard methods, these latter are usually generated by proprietary software and require numerous input data concerning, for example, the buildings, land use, transportation network and traffic. The present work describes an open source implementation of a noise mapping tool fully implemented in a Geographic Information System compliant with the Open Geospatial Consortium standards. This integration makes easier at once the formatting and harvesting of noise model input data, cartographic rendering and output data linkage with population data. An application is given for a French city, which consists in estimating the impact of road traffic-related scenarios in terms of population exposure to noise levels both in relation to a threshold value and level classes.

Advanced Glycation End Products (AGEs) represent a set of substances that contribute directly to the triggering and/or aggravation of pathologies associated with ageing. AGEs are produced by the reaction between reducing sugars (or α-dicarbonyl compounds) proteins and amino acid residues. Current methodologies require an incubation period of 1-3 weeks to generate AGEs. In this study the reaction time for the formation of AGEs (48 and 3 hours) is significantly reduced by coupling and adapting procedures already existing in the literature to the free radical generation system called the hypoxanthine/xanthine oxidase assay. The capacity of different classes and chemical compounds (aminoguanidine, chlorogenic acid, rutin, extracts of Hancornia speciosa Gomes) were evaluated to inhibit the protein glycation process, acting as capturing agents of α-dicarbonyl species. Aminoguanidine, rutin and the leaf extracts of Hancornia speciosa Gomes show a high capacity to act as α-dicarbonyl compound scavengers (RCS-trapping) and resulting in the inhibition of AGEs formation.

The multivariate Gaussian random fields with matrix-based scaling laws are widely used for inference in statistics and many applied areas. In such contexts interests are often in symmetry and in the rates of change of spatial surfaces in any given direction. This article analyzes the almost sure sample function behavior for operator fractional Brownian motion, including multivariate fractional Brownian motion. We obtain the estimations of small ball probability and the strongly locally nondeterministic for operator fractional Brownian motion in any given direction. Applying these estimates we obtain Chung's laws of the iterated logarithm for spatial surfaces of operator fractional Brownian motion. Our results show that the precise rates of change of spatial surfaces are completely determined by the self-similarity exponent.

This study innovatively assesses the Mun River flow components in Thailand, integrating Artificial Neural Networks (ANN) and Isotopic (18O) End-Member Mixing Analysis (IEMMA). It quantifies the contributions of the Upper Mun River (UMR) and Chi River (CR) to the overall flow, revealing a discrepancy in their estimated contributions. ANN predicts the UMR and CR contribute approximately 70.1% and 29.5% respectively, while IEMMA indicates a more pronounced disparity with 84% from UMR and 16% from CR. This divergence highlights the distinct perspectives of ANN, focusing on hydrological data patterns, and IEMMA, emphasizing isotopic signatures. Despite discrepancies, both methods validate UMR as a significant contributor to the overall flow, highlighting their utility in hydrological research. The findings underscore the complexity of river systems and advocate for an integrated approach of river flow analysis for a comprehensive understanding, crucial for effective water resource management and planning.

Dielectric elastomer actuators (DEAs) offer robust, high energy density solutions for soft robotics. The proposed end effector consists of three spring roll configuration DEAs, each acting as a robotic finger, using a 3M VHB-F9473PC adhesive membrane. The lateral force, bending angle and response time of the actuator are measured experimentally and compared with the predictions of an analytical model. The cylindrical actuator measures 70 mm in length and 15 mm in diameter and achieved a lateral force of 30 mN, a bending angle of 6.8 ° and a response time of ≈ 1 s. Spring roll configuration DEAs are shown to reduce the effects of viscoelasticity seen in the membrane, making the actuator more controllable at higher voltages. The dielectric constant of the membrane is shown to be a limiting factor of actuation, with a decrease in dielectric constant resulting in larger actuation. The end effector successfully gripped numerous light objects for extended periods, showing the applicability of spring roll DEAs for soft end effectors.

This paper discusses a MEMS switch that can be fabricated using low temperature (<100^oC) deposition and patterning techniques suitable for the back-end-of-the-line integration with CMOS. The resulting cross-bar switches can be used for electrostatic discharge protection, FPGA implementation, chip security assessment and lock-down, and circuit block power management. We discuss platinum and iron switch with turn-on voltages of ~ 1.8 V. In the case of the iron switches, we also show that they can be magnetized to have “memory” and stay on when turned on. Platinum switch cycling of up to 1000 times did not show any changes in their turn-on voltage and their contact resistance was unchanged. The 10-100 nm switch airgaps were formed using low temperature sputtered sacrificial polysilicon and XeF₂ etching. XeF₂ does not attack any of the metals used in CMOS enabling fabrication of cross-bar switches with any of these metals. Once activated, it takes ∿ 6 to mechanically turn on the switch that can be decreased to ~1 ns by optimizing the device structure. Interestingly, the nm-scale gaps can be used as spark gap as a fast plasma switch to discharge first followed by the activation of the MEMS switch.

For older adults, approaching end-of-life (EOL) brings unique transitions related to family relationships. Unfortunately, most families greatly underestimate the need to discuss these difficult issues. For example, parents approaching EOL issues often struggle with receiving assistance from others, avoiding family conflict, and maintaining their sense of personhood. In addition, discussions of EOL issues force family members to face their parents’ mortality, which can be particularly difficult for the adult children to process emotionally. This study explored aging issues identified by aging parents and their families as they traverse these impending EOL changes. Ten focus groups of seniors (n = 65) were conducted. Focus groups were organized according to race (African American/Caucasian), gender, and whether the older adult was living independently or in an assisted care facility. When asked open-ended questions about discussing aging and EOL issues with family members, participants revealed tensions that led us to consider Relational Dialectics Theory as a framework for analysis. The predominant tension highlighted in this report was certainty versus uncertainty, with the two sub-themes of sustained life versus sustained personhood and confronting versus avoiding EOL issues. For these data, there were more similarities than differences as a result of gender, race, or living situation than one might expect, although culture and financial status were found to be influential in the avoidance of EOL discussions. The results of this study help to provide additional insight into relational dialectics related to aging, EOL, and the importance of communication in facilitating family coping.

This study introduces a fruit harvesting mechanism powered by a single motor, designed for integration with unmanned aerial vehicles (UAVs). The mechanism performs reciprocating motion by converting linear motion into rotational motion. Consequently, the end-effector can execute multi-dimensional kinematic trajectories, including biaxial and rotational movements, synchronized with the motor's position. These axial and rotational motions facilitate the gripper's ability to reach, retrieve, and detach fruit from branches during the harvesting process. Notably, a critical consideration in designing this fruit harvesting mechanism is to generate the necessary torque at the end-effector while minimizing reaction forces and torque that could destabilize the UAV during flight. With these considerations in mind, this preliminary study aimed to harvest a Fuji apple and conducted dynamic analysis. We constructed a prototype of the single motor-driven fruit harvesting mechanism using a suitable servo motor. To assess its mechanical performance and evaluate its impact on the hexacopter, we developed both a specific test platform featuring a six-spherical-prismatic-spherical parallel structure and a virtual environmental flight simulator. Overall, the results demonstrate the successful harvesting of a Fuji apple weighing approximately 300 g by the single motor-driven fruit harvesting mechanism, with no adverse effects observed on the hexacopter's operation.

In contrast to some low molar-mass per- and polyfluoroalkyl substances (PFASs), well-established to be toxic, persistent, bioaccumulative and mobile, fluoropolymers (FPs) are water insoluble, safe, bio-inert, durable niche high performance polymers which fulfil the 13 polymer of low concern (PLC) criteria in their recommended conditions of use. In addition, more recent innovations (e.g., the use of non-fluorinated surfactants in aqueous radical (co)polymerization of fluoroalkenes) from industrial manufacturers of FPs are highlighted. This review also aims at showing how these specialty polymers endowed with outstanding properties are essential (even irreplaceable since hydrocarbon polymer alternatives used in similar conditions fail) for our daily life (electronics, Energy, optics, internet of things, transportation, etc) and constitute a special family a part from other “conventional” C1-C10 PFASs found everywhere on the Earth and Oceans. Furthermore, some information reports the recycling (e.g. the unzipping depolymerization of polytetrafluoroethylene, PTFE, into TFE), end of life of FPs, their risk assessment, circular economy and regulations. Various researches are devoted to Environment involving FPs, though they represent a niche volume (with a yearly production of 330,300 tonnes) compared to all plastics (with 460 million tonnes). Complementary to other reviews on PFASs, which lack of such above data, this review presents both fundamental and applied strategies as evidenced by major FP producers.

(1) Background: This article reviews the available scientific literature on drug-related problems and negative outcomes associated with medications identified by medication review with follow-up for end-stage renal disease and discussed with the physicians; (2) Methods: A systematic review was conducted of the scientific literature retrieved from the following databases: MEDLINE (via PubMed), Web of Science, SCOPUS, Cochrane Library: The Cochrane Central Register and Control Trials (CENTRAL) and Literatura Latinoamericana y del Caribe (LILACS), Medicina en Español (MEDES), and the SciELO bibliographic database (collection of scientific journals). The following terms were used as descriptors and searched in free text: "end-stage renal disease", "medication review", and "drug-related problems” and “negative outcomes associated with medication". The following limits were applied: "humans" and "adults (more than 18 years)”; (3) Results: A total of 59 references were recovered and after applying inclusion/exclusion criteria, 16 articles were selected. Of these selected articles, 15 provided information on drug-related problems and only 1 on negative outcomes associated with medications; (4) Conclusions: It can be concluded that drug-related problems and negative outcomes associated with medication affect patients with end-stage renal disease, mainly those receiving renal replacement therapy. More evidence is needed, especially on negative outcomes associated with medication.

Industrial data scarcity is one of the largest factors holding back the widespread use of machine learning in manufacturing. To overcome this problem, the concept of transfer learning was developed and it achieved high attention in recent industrial research. Our paper focuses on the problem of time series segmentation and presents the first in-depth research about transfer learning for deep-learning based time series segmentation on the example of industrial end-of-line pump testing. In particularly, we investigate if the performance of deep learning models can be increased by pretraining the network with data from other domains. Three different scenarios are analyzed: source and target data being closely related, source and target data being distantly related, and source and target data being non-related. The results demonstrate that transfer learning can enhance the performance of time series segmentation models in respect to accuracy and training speed. The benefit is most clearly seen in scenarios where source and training data are closely related and the number of target training data samples is lowest. However, in the scenario of non-related datasets, cases of negative Transfer Learning were observed as well. Thus, the research emphasizes the potential, but also the challenges of industrial Transfer Learning.

Patients living with cancer often experience serious adverse events due to their condition or its treatments. Those events may lead to a critical care unit admission or even result in death. One of the most important but challenging part of care is to build a caring plan according to the patient’s wishes, meeting his goals and values. Advance directives (ADs) allow everyone to give their preferences in advance regarding life sustaining treatments, continuation, and withdrawal or withholding of treatments in case one is not able to speak his mind anymore. While the absence of ADs is associated with a greater probability of receiving unwanted intensive care around the end of his life, their existence correlates with the respect of the patient’s desires and his greater satisfaction. Although progress has been made to promote ADs’ completion, they are still scarcely used among cancer patients in many countries. Several limitations to their acceptation and use can be detected. Efforts should be made to provide tailored solutions for the identified hindrances. This narrative review aims to depict the situation of ADs in the oncology context, and to highlight the future areas of improvement.

In the paper, a coordinated control methodology of single-phase (1-P) end-users switching oper-ations on the phases of an active electric distribution network (AEDN) has been proposed to ob-tain a minimum unbalance degree at the coupling common point (CCP) level with the main dis-tribution system. The phase load balancing (PLB) process considers the smart devices that switch from one phase to another phase the 1-P end-users (consumers and prosumers) to compensate for the phase load unbalance. The proposed methodology has been tested successfully in an AEDN belonging to a Romanian Distribution Network Operator (DNO) containing 114 end-users (104 consumers/10 prosumers) integrated into the Smart Metering System (SMS). The op-timal solution leads to a value of the objective function by 1.00004, represented by the unbalance factor, very close to the ideal target, 1.00. A comparative analysis was conducted considering other possible PLB cases (the consumer-level PLB and prosumer-level PLB), obtaining similar values of the UF (1.027 vs. 1.028), slightly higher than in the hybrid-level PLB. Also, the signifi-cant technical benefits were quantified through an energy-saving of 58.73% and decreasing the phase voltage unbalance rate by 91 % compared to the initial case (without PLB). These results emphasized the positive impact of the proposed coordinated control methodology on the PLB process and evidenced its effectiveness and applicability in the AEDNs.

Background. Pregnancy rates in women on dialysis have increased in the last decades, thus making it a topic of growing interest. The rarity of this event is predominantly due to fertility problems and to the high rates of pregnancy failure including stillbirth, fetal and neonatal deaths [1]. Methods. We conducted a narrative review of existent literature in order to analyse the major issues about pregnancy on dialysis to give the reader a full updated prospective about this topic which, even if not common, is becoming more and more frequent. Results. Even if recently acquired knowledge has improved diagnosis and treatment of dialysis pregnancies focusing on several aspects, pregnancy on dialysis remains a great challenge for obstetricians and should be managed by a multidisciplinary expertise team. Conclusion. Dialysis in pregnancy may be necessary for women previously affected by end stage renal disease (ESRD) becoming pregnant, or in case of acute renal injury presenting for the first time during gestation or, again in case of existent renal pathology worsening during pregnancy and requiring dialysis. Although some evidence suggests that more intensive dialysis regimens are correlated with better obstetric outcomes, the optimal therapeutic protocol still remains to be established.

Recently, significant events took place that added immensely to the sociotechnical pressure for developing sustainable composite recycling solutions, namely (1) a ban on composite landfilling in Germany in 2009, (2) the first major wave of composite wind turbines reaching their End-of-Life (EoL) and being decommissioned in 2019-2020, (3) the acceleration of aircraft decommissioning due to the COVID-19 pandemic, and (4) the increase of composites in mass production cars, thanks to the development of high volume technologies based on thermoplastic composites. Such sociotechnical pressure will only grow in the upcoming decade of 2020s as other countries are to follow Germany by limiting and banning landfill options, and by the ever-growing number of expired composites EoL waste. The recycling of composite materials will therefore play an important role in the future, in particular for the wind energy, but also for aerospace, automotive, construction and marine sectors to reduce environmental impacts and to meet the demand. The scope of this manuscript is a clear and condensed yet full state-of-the-art overview of the available composite recycling technologies of both low and high Technology Readiness Levels (TRL). TRL is a framework that has been used in many variations across industries to provide a measurement of technology maturity from idea generation (basic principles) to commercialization. In other words, this work should be treated as a technology review providing guidelines for the sustainable development of the industry that will benefit the society. The authors propose that one of the key aspects for the development of sustainable recycling technology is to identify the optimal recycling methods for different types of composites. Why is that the case can be answered with a simple price comparison of E-glass fibers (~2 $/kg) versus a typical carbon fiber on the market (~20 $/kg) – which of the two is more valuable to recover? However, the answer is more complicated than that – the glass fiber constitutes about 90% of the modern reinforcement market, and it is clear that different technologies are needed. Therefore, this work aims to provide clear guidelines for economically and environmentally sustainable End-of-Life (EoL) solutions and development of the composite material recycling.

Not a lot is known about either death or the dying process. Politicians and many in the medical profession in the UK tend to shy away from interfering with it by not allowing euthanasia as an end of life option for the patient. This is the first paper in a series of two, comparing the situation in human medicine and veterinary medicine, in which euthanasia is well practiced for relieving suffering at the end of an animal’s life. This first part takes the form of a literature review including best practice around end of life care, its deficiencies and the need for assisted dying. Veterinary surgeons are well trained in the ethics of euthanasia and put it to good use in the best interest of their animal patients. In countries which have legalized physician assisted suicide for the terminally ill reporting indicates that it works well, without increases in involuntary euthanasia and most importantly without intimidation of the vulnerable. However, there is still an ever increasing tendency to overuse sedation and opioids at the end of life, which merits further investigation. With advances in medical science able to significantly prolong the dying process, patient autonomy demands a review of the law in the UK.

The rapid increase in metabolic diseases occurred in the last three decades in both industrialized and developing countries has been related to the rise in sugar-added foods and sweetened beverages consumption. An emerging topic in the pathogenesis of metabolic diseases related to modern nutrition is the role of Advanced Glycation Endproducts (AGEs). AGEs can be ingested with high temperature processed foods, but also endogenously formed as consequence of a high dietary sugars intake. Animal models of high sugars consumption, in particular fructose, have reported AGEs accumulation in different tissues in association with peripheral insulin resistance and lipid metabolism alterations. The in vitro observation that fructose is one of the most rapid and effective glycating agent when compared to other sugars has prompted the investigation of the in vivo fructose-induced glycation. In particular, the widespread employment of fructose as sweetener has been ascribed by many experimental and observational studies for the enhancement of lipogenesis and intracellular lipid deposition. Indeed, diet-derived AGEs have been demonstrated to interfere with many cell functions such as lipid synthesis, inflammation, antioxidant defences, and mitochondrial metabolism. Moreover, emerging evidences also in humans suggest that this impact of dietary AGEs on different signalling pathways can contribute to the onset of organ damage in liver, skeletal and cardiac muscle, and brain, affecting not only metabolic control, but global health. Indeed, the here reviewed most recent reports on the effects of high sugars consumption and diet-derived AGEs on human health suggest the need to limit the dietary sources of AGEs, including added sugars, to prevent the development of metabolic diseases and related comorbidities.

Toxic advanced glycation end-products (TAGE), formed by glyceraldehyde (GA) as an intermediate in the non-enzymatic reaction with intracellular proteins, are highly cytotoxic and have been implicated in the pathogenesis of various diseases. However, the mechanisms underlying the degradation and removal of TAGE remain largely unknown. In the present study, we identified the checkpoint kinase-1 (CHK1) mutant, d270KD, which was rapidly degraded intracellularly by GA, and showed that its degradation was mainly mediated by the ubiquitin-proteasome pathway. The high-molecular-weight complexes formed by the GA stimulation of d270KD were abundant in the RIPA-insoluble fraction, which also contained high levels of TAGE. The knockdown of p62/SQSTM1 reduced the amount of high-molecular-weight complexes in the RIPA-insoluble fraction, indicating its involvement in the formation of TAGE aggregates. The present results suggest that the ubiquitin-proteasome pathway and p62 play a role in the degradation and aggregation of intracellular TAGE formed by GA. This study provides new insights into the mechanisms underlying TAGE metabolism and may lead to the development of novel therapeutic strategies for diseases associated with TAGE accumulation.

We report the first case of Daratumumab interference of allogeneic crossmatch tests repeatedly causing aberrant false-positive results, which inadvertently delayed transplant for a waitlisted renal patient with multiple myeloma. Daratumumab is an IgG1κ human monoclonal antibody commonly used to treat multiple myeloma, characterized by cancerous plasma cells and often leads to renal failure requiring kidney transplant, by depleting CD38-expressing plasma cells. In this case study, the patient had end-stage renal disease secondary to multiple myeloma and was continuously receiving Daratumumab infusions. The patient did not have any detectable antibodies to human leukocyte antigens but repeatedly had unexpected positive crossmatch by the flow cytometry-based method with 26 of the 27 potential deceased organ donors, implying donor-recipient immunological incompatibility. However, further review and analysis suggested that the positive crossmatches were likely false-positive as a result of interference from Daratumumab binding to donor cell surface CD38 as opposed to the presence of donor-specific antibodies. The observed intensity of the false-positive crossmatches was also highly variable, potentially due to donor- and/or cell-dependent expression of CD38. The variability of CD38 expression was, therefore, for the first time, characterized on the T and B cells isolated from various tissues and peripheral blood of 78 individuals. Overall, T cells were found to have a lower CD38 expression profile than the B cells, and no significant difference was observed between deceased and living individuals. Finally, we show that a simple cell treatment by dithiothreitol can effectively mitigate Daratumumab interference thus preserving the utility of pre-transplant crossmatch in multiple myeloma patients awaiting kidney transplant.

：An effective technology for predicting the end-point phosphorous content of basic oxygen furnace (BOF) can provide theoretical instruction to improve the quality of steel via controlling the hardness and toughness. Given the slightly inadequate prediction accuracy in the existing prediction model, a novel hybrid method was suggested to more accurately predict the end-point phosphorus content by integrating an enhanced sparrow search algorithm (ESSA) and a multi-strategy with a deep extreme learning machine (DELM) as ESSA-DELM in this study. To begin with, the input weights and hidden biases of DELM were randomly selected, resulting in that DELM inevitably had a set of non-optimal or unnecessary weights and biases. Therefore, the ESSA was used to optimize the DELM in this work. For the ESSA, the Trigonometric substitution mechanism and Cauchy mutation were introduced to avoid trapping in local optima and improve the global exploration capacity in SSA. Finally, to evaluate the prediction efficiency of ESSSA-DELM, the proposed model was tested on process data of the converter from the Baogang steel plant. The efficacy of ESSA-DELM was more superior to that of other DELM-based hybrid prediction models and conventional models. The result demonstrated that the hit rate of end-point phosphorus content within ±0.003%, ±0.002%, and ±0.001% was 91.67%, 83.33%, and 63.55%, respectively. The proposed ESSA-DELM model could possess better prediction accuracy compared with other models, which could guide field operations.

SETMAR is a protein lysine methyltransferase that is involved in several DNA processes, including DNA repair via the non-homologous end joining (NHEJ) pathway, regulation of gene expression, illegitimate DNA integration, and DNA decatenation. However, SETMAR is an atypical protein lysine methyltransferase since in anthropoid primates, the SET domain is fused to an inactive DNA transposase. The presence of the DNA transposase domain confers to SETMAR a DNA binding activity towards the remnants of its transposable element, which has resulted in the emergence of a gene regulatory function. Both the SET and the DNA transposase domains are involved in the different cellular roles of SETMAR, indicating the presence of novel and specific functions in anthropoid primates. In addition, SETMAR is dysregulated in different types of cancer, indicating a potential pathological role. While some light has been shed on SETMAR functions, more research and new tools are needed to better understand the cellular activities of SETMAR and to investigate the therapeutic potential of SETMAR.

Neonatal palliative care (NPC) is an integrated and holistic approach that is an integral part of the contemporary neonatal treatment delivery paradigm. It is the highest fulfillment of the notion of beneficence (doing or creating 'good') that has otherwise been neglected/underestimated by the focus of modern medicine on technology and instrumental treatments by its commitment to alleviating patient pain and quality of life. For decades, the Double-Effect Doctrine (DDE) has been used to consider and address a range of ethically questionable circumstances, often at the end of life, including euthanasia, termination of pregnancy to save maternal life, and morally justified warfare. The theory has continued to be mired in controversy as ethicists, legal scholars, theologians, and philosophers discuss the abstract concepts of moral reasoning, purpose, foresight, and other underlying moral theories. In this paper, the moral theory of DDE is discussed in its clinical application to the ethical decision-making process in neonatal palliative and end-of-life treatment, specifically 1) the administration of opioids as required for symptom control and 2) the use of palliative sedation for intractable symptom care.

Skin involvement is an overlooked aspect in the management of paediatric patients with type 1 diabetes. A comprehensive search of published literature using the PubMed database was carried out using the following key terms: “children”, “pediatric/paediatric patients”, “skin”, “skin disorders”, “type 1 diabetes”. Dermatological side effects are frequently observed among diabetic children and adolescents. Insulin-induced lipodystrophies and allergic contact dermatitis caused by insulin pumps or glycaemic sensors are the most common skin reactions in these patients. Furthermore, several diabetes-associated skin diseases such as necrobiosis lipoidica, granuloma annulare, vitiligo, and bullosis diabeticorum may already be present in paediatric age. Paediatric diabetes specialists should pay attention to their patients’ skin so as to recognize these disorders, identify the potential causes, and choose the most suitable treatment. Finally, the evaluation of skin concentrations of advanced glycation end-products using non-invasive diagnostic techniques may be used to assess the risk of chronic complications of diabetes as early as adolescence.

This paper reports the findings from a pilot study designed to explore the barriers, facilitators and similarities with the delivery and implementation of two distinct models of Advance Care Planning (ACP) documentation for older adults in their last year of life used by health care professionals in their clinical practice. PACe (Proactive Anticipatory Care Plan): a GP led model and PEACE (Proactive Elderly Persons’ Advisory CarE): a nurse led model with community geriatrician oversight were used by participants in their clinical practice. Telephone interviews were conducted with general practitioners (GPs) to explore their views of using the PACe tool. Hospital admission avoidance matrons took part in face to face interviews and care staff employed in private residential care homes took part in individual telephone interviews to explore their views of using the PEACE tool. GPs and admission avoidance matrons were employed by Clinical Commissioning Groups (CCGs) and all study participants were recruited from the South East of England where data collection took place in 2015. Nine telephone interviews and two face-to-face interviews (one joint and one individual) were conducted with twelve participants. The data was analysed thematically. Participants highlighted the similarity of both tools in providing focus to ACP discussions to inform individual end-of-life care preferences. The importance of relationships was a pivotal theme-established, trusting inter-professional relationships to enable multidisciplinary teamwork and a prior relationship with the older person (or their proxy in the case of cognitive impairment) to enable conversations of this nature. Using both tools enabled participants to think critically and reflect on their own practice was another theme identified. Notwithstanding participants’ views to improve the layout of both tools, using a paper-based approach to deliver streamlined ACP and end-of-life care was a theme to emerge as a barrier which focused on the problems with access to paper-based documentation, accuracy and care co-ordination in the context of multidisciplinary team working. The value of technology in overcoming this barrier and underpin ACP as a means to help simplify service provision, promote integrated professional practice and provide seamless care was put forward as the solution.