In children, the global burden of vaccines-preventable diseases (VPDs) and deaths can be averted by adopting timely immunization practices. Administering immunization to a child within 28 or 30 days of the designated immunization date is referred to as timely immunization. Delaying or missing vaccinations puts children, especially those in urban slums, at a higher risk of getting sick or dying from different diseases. This study was designed to examine the immunization practices and to measure the determinants of immunization non-compliance in children living in urban slums of Karachi, Pakistan. A community-based retrospective cohort was carried out from October-2018- to August-2019 in six different urban slums of Karachi. Immunization status of children aged less than 2 years was assessed by reviewing their vaccination card. Children from each slum were approached via 30x7 multistage stratified cluster sampling technique. Data of each child was analysed descriptively and inferentially using a statistical software, i.e., Jamovi version 1.2.25. The practice of timely immunization was observed in approximately half of children, i.e., 49.8%(n=457). The immunization rate at birth (first-visit) was 100%, of which 95.7% were timely immunized. Following the second immunization visit, a sharp decline in the immunization rate, including timely immunization rate was observed. Lack of knowledge, childhood illnesses, lack of interest, and vaccines unavailability were the main reasons of immunization non-compliance. However, an increase in paternal education was significantly associated to decrease the odds of immunization non-compliance. A decrease in the practice of timely immunization is replaced by either invalid and/or delayed and/or missed immunization practices. Thus, timely immunization is crucial for preventing the infectious diseases and promoting the health of a child.

Delayed discharge for non-clinical reasons is defined as a period of stay that continues after a patient has been deemed medically fit to leave the hospital but is unable to do so for non-medical reasons. This circumstance overburdens the healthcare system and constitutes a major problem for healthcare systems and the patients themselves in this situation.The aim of this study was to evaluate the delay in effective discharge for non-medical reasons in patients admitted to acute care hospitals in Spain. A scoping review was conducted in order to revise and obtain an up-to-date review. The initial search strategy identified a total of 123 references, which were successively screened to a final selection of 13 studies. To conclude, delayed discharge from hospital for non-clinical reasons is a multifactorial problem. It may be due to factors internal or external to the hospital, as well as personal factors. The main causes of the delay are similar among the studies found, as are the clinical characteristics of the patients, most of whom are elderly, frail, and more dependent due to declining functional capacities. Further studies addressing the socio-familial characteristics of the patients and the perspective of the patient and families would be necessary.

Many children have suspected delayed language development and need extensive support from parents and the health care team. This study aimed to investigate suspected delayed language development and factors associated with suspected delayed language development among early childhood in Southern Thailand. Children aged 24 to 60 months were recruited as study samples using stratified random sampling conducted in 23 districts and simple randomized seven sections (425 children). Instruments comprised demographic data of the children and families, The preschool temperament questionnaire, and the Language Development Screening questionnaire using developmental surveillance and promotion manual. I was collecting data from July 2020 to January 2021. Data analysis used descriptive statistics and logistic regression. The results showed that 40.9 percent suspected delayed development. Daily screen time exceeding 2 hours per day (A.O.R. = 17.30, 95% CI: 7.35-40.72), and regarding a child's temperament, moderate-to-difficult temperament (A.O.R. = 9.56, 95% CI: 5.12-17.85) were significantly associated with a suspected delay of language development. The study suggested two-way communication and appropriate responses will help develop children's language.

With the aging of China's population, the problem of pension security has become more and more prominent, and whether delayed retirement can effectively alleviate the pension fund gap and ensure the sustainability of the pension fund has become the focus of social concern. This study predicts the income and expenditure of urban workers' basic pension insurance fund from 2021 to 2050 by constructing an actuarial model of pension insurance fund income and expenditure, and simulates the effect of delayed retirement policy. The prediction results show that under the existing system, the basic pension insurance fund for urban workers will have a shortfall for the first time in 2027, and the shortfall will expand year by year. Compared with the non-implementation of delayed retirement policy, the simulation of the implementation of delayed retirementt program delayed the emergence of the fund gap until 2029, and the forecast period of the pension fund gap significantly narrowed, indicating that delayed retirement policy has a certain positive impact on alleviating the pressure of pension payments, but delayed retirementt can not completely eliminate the pension fund gap. In view of this, this paper suggests that a progressive and flexible delayed retirement policy should be introduced as soon as possible to better adapt to the needs of different groups. At the same time, differentiated policies should be formulated for different groups of people and a pension incentive mechanism for delayed retirement should be set up to improve public acceptance of delayed retirement policy. In addition, delayed retirement policy should be combined with other measures, such as lowering the corporate contribution rate and enhancing the value-added capacity of the pension fund, so as to ensure the sustainability of the pension fund.

The conventional explanation of delayed-choice experiments seems to violate our causal intuition. This apparent violation is caused by a misinterpretation of the conventional formulation of quantum mechanics. I reanalyze these experiments using advanced and time-symmetric formulations of quantum mechanics. All three formulations give the same experimental predictions, but the advanced and time-symmetric formulations violate our causal intuition that effects only happen after causes. I explore reasons why our causal intuition may be wrong at the quantum level. I also suggest how conventional causation might be recovered in the classical limit, and speculate on cosmological boundary conditions.

One of the main causes of the dismal prognosis in patients who survive the initial bleeding after aneurysmal subarachnoidal hemorrhage is the delayed cerebral ischaemia caused by vasospasm. Studies suggest that cerebral magnesium and pH may potentially play a role in the pathophysiology of this adverse event. Using phosphorous magnetic resonance spectrocopy (31P-MRS) we calculated the cerebral magnesium (Mg) and pH level in 13 patients who suffered aSAH. The values between the group that developed clinically significant vasospasm (n=7) and the group that did not (n=6) were compared. The results of this study showed significantly lower cerebral Mg levels (p=0.019) and higher pH (p<0.001) in cumulative group (all brain voxels together) in patients who developed clinically significant vasospasm. Further clinical studies on a larger group of carefully selected patients are needed in order to predict clinically significant vasospasm.

The diagnosis of celiac disease (CD) may be delayed due to non-specific clinical symptoms. The aim of the study was to evaluate the clinical manifestation and diagnostic process of CD in Polish children and adults. Methods: The members of the Polish Coeliac Society (n=2 500) were asked to complete a questionnaire on socio-demographic factors, clinical and diagnostic aspects of CD. The analysis was based on 796 responses from patients with confirmed CD diagnosis, and included 224 (28.1%) children and 572 (71.9%) adults. Results: The mean duration of symptoms prior to CD diagnosis in children was significantly shorter than in adults (p < 0.001), and amounted to 3.1 and 9 years respectively. The most frequent symptoms before CD diagnosis were abdominal pain and bloating in children (70.4%), and chronic fatigue in adults (74.5%). Although almost all CD patients claimed to strictly avoid gluten after CD diagnosis, symptoms were still present in the majority of these respondents. No comorbid diseases were reported by 29.8% of children and by 11.7% of adults (p < 0.001). Conclusions: The results indicate that CD diagnosis is delayed in Poland, espe-cially in adults, and clinicians should be aware of the diversity in CD presentation.

Background: Along with sarcopenia, delayed blood pressure (BP) recovery after standing and orthostatic hypotension (OH) are among key clinical challenges associated with ageing. Previous studies have reported an association between sarcopenia and delayed orthostatic BP recovery and OH. However, the haemodynamic mechanisms underlying this association remain unclear. Methods: 107 attendees to a falls and syncope clinic aged 50+ years underwent an active stand test with non-invasive beat-to-beat haemodynamic measurement. Hand grip strength and 5-chair stands time were measured. Muscle mass was estimated using bioelectrical impedance analysis, and participants were classified as non-sarcopenic and sarcopenic. Mixed effects models with linear splines were used to model the effect of sarcopenia status on Modelflow®-derived mean arterial pressure (MAP), cardiac output (CO), total peripheral resistance (TPR), stroke volume (SV) and heart rate (HR) after standing, while controlling for potential confounders. Results: Sarcopenia was associated with: attenuated recovery of MAP in the 10-20s period after standing (β -0.67, P<0.001); attenuated rise to peak (0-10s) and recovery from peak (10-20s) of CO (β -0.05, P<0.001; β 0.06, P<0.001); attenuated recovery (10-20s) of TPR from nadir (β -0.02, P<0.001) and attenuated recovery from peak (10-20s) of SV (β 0.54, P<0.001). HR was not significantly associated with sarcopenia status at any time interval after standing. Conclusion: The attenuated BP recovery after standing seen in sarcopenia appears to be driven by initial diminished peak of CO followed by attenuated recovery of CO from peak and TPR from nadir. The CO finding appears to be driven by SV rather than HR. Potential mechanisms for these findings include: cardio-sarcopenia, the effects of sarcopenia on the autonomic nervous system and/or the skeletal muscle pump.

In the first wave of COVID-19, up to 20% of patients had skin lesions with variable characteristics. There is no clear evidence of the involvement of the SARS-CoV-2 virus in all the cases; some of these lesions may be secondary to drug hypersensitivity. To analyze the possible cause of the skin lesions, we performed a complete allergology study on 11 patients. One year after recovery from COVID-19, we performed a lymphocyte transformation test (LTT) and Th1/Th2 cytokine secretion assays of PBMC. We included 5 nonallergic patients treated with the same drugs without lesions. Except for one patient who had an immediate reaction to azithromycin, all patients had a positive LTT to at least one of the drugs tested (azithromycin, clavulanic acid, hydroxychloroquine, lopinavir, and ritonavir). None of the nonallergic patients had a positive LTT. We found mixed Th1/Th2 cytokine secretion (IL-4, IL-5, IL-13, and IFN-γ) in patients with skin lesions corresponding to mixed drug hypersensitivity type IVa and IVb. In all cases, we identified a candidate drug as the culprit for skin lesions during SARS-CoV-2 infection, although only three patients had a positive drug challenge. Therefore, it would be reasonable to recommend avoiding the drug in question in all cases.

Previous studies have quantified repolarization variability using time-domain, frequency-domain and non-linear analysis in mouse hearts. Here, we investigated the relationship between these parameters and ventricular arrhythmogenicity in a hypokalaemia model of acquired long QT syndrome. Methods: Left ventricular monophasic action potentials (MAPs) were recorded during right ventricular regular 8 Hz pacing during normokalaemia (5.2 mM [K+]), hypokalaemia modelling LQTS (3 mM [K+]) or hypokalaemia with 0.1 mM heptanol in Langendorff-perfused mouse hearts. Results: During normokalaemia, mean APD was 33.5±3.7 ms. Standard deviation (SD) of APDs was 0.63±0.33 ms, coefficient of variation was 1.9±1.0% and the root mean square (RMS) of successive differences in APDs was 0.3±0.1 ms. Low- and high-frequency peaks were 0.6±0.5 and 2.3±0.7 Hz, respectively, with percentage powers of 38±22 and 61±23%. Poincaré plots of APDn+1 against APDn revealed ellipsoid morphologies with SD along the line-of-identity (SD2) to SD perpendicular to the line-of-identity (SD1) ratio of 4.6±1.1. Approximate and sample entropy were 0.49±0.12 and 0.64±0.29, respectively. Detrended fluctuation analysis revealed short- and long-term fluctuation slopes of 1.62±0.27 and 0.60±0.18, respectively. Hypokalaemia provoked ventricular tachycardia in six of seven hearts, prolonged APDs (51.2±7.9 ms), decreased SD2/SD1 ratio (3.1±1.0), increased approximate and sample entropy (0.68±0.08 and 1.02±0.33) and decreased short-term fluctuation slope (1.23 ± 0.20) (ANOVA, P<0.05). Heptanol prevented VT in all hearts studied without further altering the above repolarization parameters observed during hypokalaemia. Conclusion: Reduced SD2/SD1, increased entropy and decreased short-term fluctuation slope are associated with ventricular arrhythmogenesis in hypokalaemia. Heptanol exerts anti-arrhythmic effects without affecting repolarization variability.

In real financial market, the delayed market feedback and the delayed effect of government macro-control are inevitable. And both the delay of market feedback and the delay of macro-control effect bring about the mathematical difficulties in studying stabilization and synchronization of the hyper-chaotic financial system. However, employing Lyapunov function method, differential mean value theorem, suitable bounded hypotheses and pulse control technology results in the globally asymptotical stabilization and synchronization criteria. It is the first paper to drive the stabilization and synchronization criteria under the assumptions of the double delays. Finally, numerical examples illuminate the effectiveness of the proposed methods.

Much remains to be understood for delayed ultraweak photon emission (UPE) from organism in association with oxidative burst following external perturbation, a phenomenon that has been experimented for over three decades. Delayed UPE often decays hyperbolically; yet, it is not uncommon to have delayed UPE that reveals first-order kinetic patterns characterized by single-exponential, double exponential, or multi-exponential changes. Some delayed UPEs also presented transient patterns that are characteristic of second-order responses. A soliton-based photon-storage model has addressed the hyperbolic decaying pattern of delayed UPE; however, there are questions outstanding regarding modeling other non-hyperbolic kinetics as well as the large range of temporal scales of delayed UPE that can vary from 8.5 microseconds to many hours. This work proposes an alternative, phenomenological model-framework for interpreting the various kinetic patterns of delayed UPE following stress. The delayed UPE is considered to be governed by two sequential phases: a stress-transfer phase that transforms the external stress to photo-genesis for emitting photons, and a photon-diffusion phase that transmits the photons emitted by the photo-genesis to the surface of organism for being detected as delayed UPE. Time-resolved photon diffusion analysis reveals that any delayed UPE in organism with a delay time >100ns cannot be addressed by the inherent temporal spread that realistic tissue scattering will cause. A slow stress-transfer phase is thus required to explain the delay time-scales of delayed UPE at a minimum of 8.5 µs as reported experimentally. The stress-transfer phase is hypothesized to carry the following types of responses: single or multiple 1st-order low-pass, single 2nd-order low-pass with various damping factors, and single 2nd-order band-pass with various damping factors. A single 1st–order low-pass response with a time-varying kinetic rate is also analyzed. The responses of these modeled pathways to bolus and step inputs demonstrate that a kinetic pattern other than the exact single-exponential one may have multiple causes.

Treating clubfoot in walking age children is debated, despite studies showing that using Ponseti casting principles can correct the mid-foot effectively. We aimed to explore techniques and approaches for management of older children with clubfoot and identify areas of management consensus. A mixed-methods cross-sectional electronic survey on delayed presenting clubfoot (DPC) was sent to 88 clubfoot practitioners (response rate 56.8%). We collected data on decision-making, casting, imaging, orthotics, surgery, re-currence, rehabilitation, multidisciplinary care and contextual factors. The quantitative data were analysed using descriptive statistics and the qualitative data were analysed using conventional content analysis. Many respondents used the Pirani score and some used the PAVER score to aid deformity severity assessment and correctability [1,2]. Ponseti casting principles were consistently applied with a stepwise approach. Con-textual factors influenced the timing of the treatment, the decision to treat a bilateral deformity simultaneously, and casting intervals. Differences were seen around orthotic usage and use of tibialis anterior tendon transfer following full correction. The survey identified consensus areas in overall principles of management for delayed presenting clubfoot and implementation of Ponseti principles, indicating these principles are well recognized as a multidisciplinary approach for older children with clubfoot. Some dif-ferences in approach may reflect different economic or social contexts. The principles can be adapted well for different geographical and healthcare contexts.

The phenomenon of quantum erasure exposed a remarkable ambiguity in the interpretation of quantum entanglement. On the one hand, the data is compatible with the possibility of arrow-of-time violations. On the other hand, it is also possible that temporal non-locality is an artifact of post-selection. Twenty years later, this problem can be solved with a quantum monogamy experiment, in which four entangled quanta are measured at the same time. If Bell violations can be recovered from a “monogamous” quantum system, then the arrow of time is obeyed at the quantum level.

Addressing non-unions involves stabilizing the affected area through osteosynthesis and improving bone biology using bone grafts. However, there is no consensus on the optimal treatment method. This study aims to compare outcomes of non-union revision using conventional treatment methods (metal hardware ± graft) versus osteosynthesis with the human, allogeneic cortical bone screw (Shark Screw®). Thirty-four patients underwent conventional treatment, while 28 cases received Shark Screws®. Patient demographics, bone healing, time to bone healing, and complications were assessed. Results revealed a healing rate of 96.4% for the Shark Screw® group, compared to 82.3% for the conventionally treated group. The Shark Screw® group exhibited a tendency for faster bone healing (9.4±3.2 vs. 12.9±8.5 weeks, p=0.05061). Hardware irritations led to six metal removals in the conventional group versus two in the Shark Screw® group. The Shark Screw® emerges as a promising option for personalized non-union treatment in the foot, ankle, and select lower leg cases, facilitating effective osteosynthesis and grafting within a single construct, promoting high union rates, low complications, and a rapid healing process.

Injured peripheral nerves regenerate their axons in contrast to those in the central nervous system. However, functional recovery after surgical repair is often disappointing. The basis for the poor recovery is the progressive deterioration with time and distance, of the growth capacity of the neurons that lose their contact with targets (chronic axotomy) and the growth support of the chronically denervated Schwann cells (SC) in the distal nerve stumps. This is despite the retained capacity of chronically denervated and atrophic muscle to accept reinnervation. Progressive decline in regeneration associated genes in both axotomized neurons and denervated SCs accounts for the decline in regenerative success in association with silencing of neural activity in sensory neurons due to their disconnection from their sense organs and, in motoneurons due to loss of their synaptic contacts in the spinal cord. Whilst exogenous neurotrophic factors promote nerve regeneration, the profuse axonal outgrowth and difficulties in delivery are avoided by promoting their endogenous expression with brief (1 hour) low frequency (20Hz) electrical stimulation (ES) proximal to the injury site. ES accelerates axon outgrowth and in turn, target reinnervation in both animals and human subjects. Applying ES to intact nerve days prior to nerve injury, conditional ES (CES) increases axonal outgrowth and regeneration rate with the potential for application in nerve transfer surgeries and end-to-side neurorrhaphies. However, the additional surgery for applying CES electrodes may be a hurdle. ES is applicable in all surgeries with excellent outcomes.

The present study examined mechanisms underlying memory deficits in patients with Parkinson disease (PD)and their associations with structural metrics. Nineteen PD and 22 matched controls underwent two memory experiments. In experiment 1 (delayed memory task), subjects were asked to remember an array of colored rectangles with varying memory set sizes [Low-Load (2 items), Low-Load with Distractor, &amp; High-Load (5 items)]. After a 7s delay period, they reported whether the orientation of any relevant figures had changed (test period). In experiment 2 (working memory task), memory arrays were presented in varying set sizes (2 to 6 items) with no distractors that were followed by a 2s delay period and subsequent test period. Brain MRI data were acquired to assess structural differences (volumes and cortical thickness) in brain areas related to attention, working memory storage, and episodic memory. Compared to controls, PD patients had lower memory capacity scores in all memory load conditions for experiment 1 (p &lt;0.021) whereas there were no group differences in any memory load conditions for experiment 2 (p&gt;0.06). In addition, PD patients had lower thickness in the left superior temporal gyrus (p=0.02). Lower thickness values in the left superior temporal gyrus were significant predictors of lower delayed memory performance in Low-Load and Low-Load with Distractor conditions (ps’&lt;0.044) and working memory performance of memory load conditions of 4 and 5 items (p’s&lt;0.012). The present findings suggest that PD patients may have intact working memory storage capacity but impaired attentional filtering and memory consolidation that may lead to lower delayed memory scores. Lower delayed memory in PD may partly be associated with lower cortical thickness in the left superior temporal gyrus.

This paper gives solutions to puzzles of double Wheeler’s delayed choice experiments, a photon’s passing two paths simultaneously and wave collapse velocity measure, and shows new quantum control, new quantum oscillation and new controlling photon oscillator (that can be arranged in quantum computer and quantum network as their classical correspondences) in experiments. Furthermore, this paper obtains the measured attractive state and the new useful key technology of altering state’s evolving paths for quantum systems. We discover the reason and the technological way for the present changes the past, further show their feasible experiments of new quantum control, new quantum oscillation and new quantum oscillator. Finally, this paper achieves the collapse response time t of wave, further concretely deduces the measured collapse velocity of quantum system. In the past, the collapse velocity cannot be objectively deduced and experimentally measured.

In a recent paper [1], I argued against backward in time effects used by several authors to explain delayed choice experiments. I gave an explanation showing that there is no physical influence propagating from the present to the past and modifying the state of the system at a time previous to the measurement. However, though the solution is straightforward in the case of delayed choice experiments involving only one particle, it is subtler in the case of experiments involving two entangled particles because they give rise to EPR-like situations. Considering that a measurement is not an actual change of the physical state of a system and is relative to the observer allows to understand that there is neither backward in time effects nor instantaneous collapse of the second system when the first one is measured, as is often postulated. This allows also to get rid of any non-locality [2]. In this paper, I want to go further into the consequences of this way of considering the measurement, that I have called Convivial Solipsism, and show that even if, in the usual sense, there is no physical effect of the present or of the future on the past, we must nevertheless consider that the observer’s past is sometimes not entirely determined and that it becomes determined only when certain measurements are done latter. This apparent contradiction disappears if one understand that each observer builds, through her own measurements, her own world (that I call the phenomenal world in Convivial Solipsism) which is different from what we are used to consider as the common world shared by everybody.

Gold-centered carbene-metal-amides (CMAs) containing cyclic (alkyl)(amino)carbenes (CAACs) are promising emitters for thermally activated delayed fluorescence (TADF). Aiming at design and optimization of new TADF emitters, we report a density functional theory study of over 60 CMAs with various CAAC ligands, systematically evaluating computed parameters in relation to photoluminescence properties. We demonstrate that the efficiency of TADF of CMAs, arising from a compromise of exchange energy and oscillator strength, is governed by the overlap of HOMO and LUMO orbitals, where HOMO is localized on amide and LUMO on Au-carbene. The S0 ground states and excited T1 states of the CMAs adopt approximately coplanar geometries of carbenes and amides, but rotate perpendicular in the excited S1 states, resulting in degeneracy or near-degeneracy of S1 and T1, accompanied with lowering of the S1-S0 oscillator strength from its maximum at coplanar geometries to near zero at rotated geometries. Based on computations, promising new TADF emitters are proposed and synthesized. Bright CMA complex (Et2CAAC)Au(carbazolide) is obtained and fully characterized to demonstrate that high radiative rates up to 106 s-1 can be obtained for the gold-CMA complexes with small CAAC-carbene ligands.

The time series of daily new cases of Covid-19 infection in different zones of Italy, several European countries and New York City were analyzed in order to characterize the large fluctuations contained in them. The comparison shows that the time series share a similar evolution, although with delays of one or two weeks, with Italy that precedes the other countries. Correlation analysis indicates a strict resemblance between the time series of the first differences, which emphasize accelerations and slowdowns of the epidemic (e.g., correlation coefficient r=0.70 for Italian vs. worldwide data). According to Fourier analysis the signals have a dominant oscillatory component at a period of seven days, with minima located near the weekends. Some of the possible causes of this time modulation are discussed. In particular, it is hypothesized a delayed or missed recognition of a significant fraction of the new cases during the weekend, with possible consequences for the evolution of the epidemic.

Particles and photons appear to be total opposites; the former has rest mass which requires space to exist; the latter has kinetic energy which requires time to occur (oscillate). But they do share certain properties (e.g., quantization) that remain invariant when one is transformed (swapped) for the other. This gauge invariance is developed in some detail.The symmetry between particle and photon turns out to be one of inversion. It is the equalities of special relativity that support this inversion and the accompanying invariances: mass transformed to energy; space transformed to time. The great advantage of these symmetries (inversions) is that they provide guidance for an object little understood (the photon) based upon an object well understood (the particle). On this basis, progress can be made in the understanding of some long-standing issues: wave-particle duality, time’s arrow, the constant speed of light and nonlocality.

In our recent works we reported that physical and chemical characteristics of serum can vary in relation to the psychic activity of an individual depending on whether it is oriented to stress or relaxation. We wandered if these observations could be accompanied by an appreciable modification of the Ph, electric conductivity and Delayed Luminescence of the same serum samples. Our preliminary data may suggest that the serum pH could significantly increase during a Relaxation Response intervention while electric conductivity seems to decrease. Moreover, Delayed Luminescense could vary in the same subject according to the Relaxation Response practice. According to our proof of concept study, we postulate the appearance of a coherent system within the blood samples analyzed after the Relaxation Response. Further researches and some technical development are needed to support our preliminary findings.

We propose a novel tensor-based formalism for inferring causal structures from time series. An information theoretical analysis of transfer entropy (TE), shows that TE results from transmission of information over a set of communication channels. Tensors are the mathematical equivalents of these multi-channel causal channels. A multi-channel causal channel is a generalization of a discrete memoryless channel (DMC). We consider a DMC as a single-channel causal channel. Investigation of a system comprising three variables shows that in our formalism, bivariate analysis suffices to differentiate between direct and indirect relations. For this to be true, we have to combine the output of multi-channel causal channels with the output of single-channel causal channels. We can understand this result when we consider the role of noise. Subsequent transmission of information over noisy channels can never result in less noisy transmission overall. This implies that a Data Processing Inequality (DPI) exists for transfer entropy.

Primary care pediatricians encounter a wide range of complex conditions in their daily clinical practice. It is not uncommon for their patients to get exposed to medical errors. Diagnostic errors, defined as missed, delayed, or wrong diagnosis, are of great importance as they may cause significant harm to the pediatric patient with severe disease. These errors often occur when the symptoms and signs of a disease are atypical or missing. Data on the most frequent misdiagnosed situations in pediatrics is scarce. One of these groups of conditions is that regarding cardiac diseases. The pediatric cardiology field has met rapid development over the past few decades. Primary care providers play a key role in diagnosis, management, and referral of children with heart disease, both congenital and acquired, because many common cardiac complaints are first addressed in the primary care setting. The scope of this review is to investigate the cardiac entities that are often missed by the general pediatricians. In particular, it aims to spot the most common of them, to describe their clinical presentation, their diagnostic options, red flags, and tips, and to provide the ways to avoid erroneous, delayed, or missed diagnosis.

The ubiquitous connectivity for the space-air-ground integrated network (SAGIN) of the beyond fifth generation of communication and sixth generation of communication (B5G/6G) is envisaged to meet the needs for the demanded quality of service (QoS), green communication, and "dual carbon" target. However, the offloading and computation of massive latency-sensitive tasks dramatically increases the energy consumption of the network. Furthermore, the traditional power supply technology of the network base stations (BSs) enhances the carbon emission. To address these issues, we first propose a SAGIN architecture with energy harvesting devices, where the BS is powered by both renewable energy (RE) and the conventional grid. The BS explores wireless power transfer (WPT) technology to power the unmanned aerial vehicle (UAV) for stable network operation. RE sharing between neighbouring BSs is designed to fully utilize RE for reduce carbon emission. Secondly, on the basis of task offloading decision, UAV trajectory, and RE sharing ratio, we construct cost functions with joint latency-oriented, energy consumption, and carbon emission. Then, we develop a twin delayed deep deterministic policy gradient (TD3PG) algorithm based on deep reinforcement learning to minimize the cost function. Finally, simulation results demonstrate that the proposed algorithm outperforms the benchmark algorithm in terms of reducing latency, energy saving, and lower carbon emission.

The effects of simulated acid rain (SAR) on the photosynthetic performance of subtropical coniferous species have not been thoroughly investigated. In this study, we treated two coniferous species, Pinus massoniana (PM) and Cunninghamia lanceolata (CL), with SAR and then analyzed photosynthetic activities via the simultaneous measurement of prompt fluorescence(PF), delayed fluorescence(DF), and modulated reflection at 820 nm(MR820). Following the low-pH SAR treatment, the I–P phase of the OJIP curves of PM and CL decreased significantly and then the K-band and L-band were detectable. The delayed fluorescence for both PM and CL decreased as the pH of the SAR solution decreased, with a more significant decrease in the I1 peak than in the I2 peak. According to the MR820 curve, the exposure to SAR stress inhibited the rapid decrease and slow increase in the MR820 transients of PM and CL. The gradients of the decreasing and increasing phases were lower for CL than for PM at pH 2.5. In addition, SAR decreased the light energy captured per unit area (ABS/CSm) and the quantum yield of electron transfer per unit area (ETO/CSm), but it increased the accumulation of QA−, thereby decreasing primary photochemical efficiency (TRO/CSm, φPO). These changes in photosystem II (PSII) resulted in a decrease in the maximum quantum yield of PSII (Fv/Fm) and the performance index (PIABS). Moreover, PSII was protected from thylakoid membrane photodamages through the increase in heat dissipation per unit area (DIO/CSm) in response to SAR. The increase in δRO as the pH of the SAR solution decreased was observed for PM, but not for CL. Considered together, the study findings suggest that SAR treatments can decrease chlorophyll contents and damage the OEC in PM and CL, which obstructs the transfer of electrons on the donor and acceptor sides of PSII. However, PM is better able to withstand SAR stress than CL, likely because of the activation of a protective mechanism (reflected by the change in δRO). Therefore, in coniferous forest areas severely affected by acid rain, CL may need to be protected more than PM.

In this paper, we obtain the existence and uniqueness theorem for solutions of Caputo type fractional stochastic delay differential systems (FSDDSs) with Poisson jumps by utilizing delayed perturbation of Mittag-Leffler function. Moreover, by using Burkholder-Davis-Gundy's inequality, Doob's martingale inequality and Holder inequality, we prove that the solution of the averaged FSDDSs converges to that of the standard FSDDSs in the sense of Lp. Some known results in the literature are extended.

This service improvement project was carried out at LEKMA Hospital, Ghana. Ghana has high levels of antimicrobial resistance (AMR). There is an urgent need to introduce models of care that optimize antibiotic prescribing. Methods Delayed / back-up prescribing is a strategy that could reduce antibiotic use in suspected upper respiratory tract infections. Four different models of delayed / back-up prescribing [no prescription; post-dated prescription (given to patient); post-dated prescription (forwarded to pharmacy); and follow-up appointment for reassessment after 3 days] were implemented in discussion between clinician and patient. Patients were contacted 10 days after their appointment to record compliance, check on their wellbeing, and rate their experience. Results Over a 3-month period (12/2019-02/2020), 142 patients were eligible for delayed / back-up prescribing. The most common clinical diagnoses were sore throat (102/140, 73%), common cold (22/140, 16%) and sinusitis (10/140, 7%). In total, 12 (9%) patients remained symptomatic at day 10, and only one individual in the entire cohort took antibiotics. Most patients (95%) rated their experience as good or very good. Conclusions Delayed / back-up prescribing models can lead to substantial reduction in antibiotic consumption amongst outpatient department patients with suspected upper respiratory tract infections. Delayed / back-up prescribing can be implemented safely in low and middle-income countries.

This paper aims to address the exponential stability and stabilization problems for a class of delayed nonlinear Markov jump systems under randomly occurring Denial-of-Service (DoS) attack and packet loss. Firstly, the stochastic characteristics of DoS attack and packet loss are depicted by the attack success rate and packet loss rate. Secondly, a Period Observation Window (POW) method and a hybrid-input strategy are proposed to compensate for the impact of DoS attack and packet loss on the system. Thirdly, A Dynamic Event-triggered Mechanism (DETM) is introduced to save more network resources and ensure the security and reliability of systems. Then, by constructing a general common Lyapunov functional and combining with the DETM and other inequality analysis techniques, the less conservative stability and stabilization criteria for the underlying systems are derived. In the end, the effectiveness of our result is verified through a numerical example.

Recent studies have indicated that terahertz time-domain spectroscopy (THz-TDS) can stably and efficiently acquire output spectra using an affordable and compact multimode laser diode (MMLD) with delayed optical feedback as the light source. This research focused on a numerical analysis of the optimal conditions for employing an MMLD with delayed optical feedback (chaotic oscillating laser diode) in THz-TDS, utilizing multimode rate equations. The findings revealed that the intermittent chaotic output generated by the MMLD, characterized by concurrent picosecond pulse oscillations lasting several tens of picoseconds, proves to be highly effective for THz-TDS. By appropriately setting the amounts of injection current and optical feedback, and the delay time of optical feedback, intermittent chaotic oscillation can be attained within a considerably broad parameter range. Moreover, both the MMLD output spectrum and the THz-TDS output spectrum exhibit a consistently stable shape at the microsecond scale, demonstrating the attractor properties inherent in an MMLD with delayed optical feedback.

(1) Importance of problem: Breast cancer accounted for 685.000 deaths globally in 2020, and half of all cases occur in women with no specific risk factor beside gender and age-group. During last 4 decades we see a reduction by 40% of age-standardized breast cancer [1], which in turn means that the number of mastectomies performed for younger women increased, raising the need for adequate breast reconstructive surgery. Advances in oncological treatment have made it possible to limit the extent of what represents radical surgery for breast cancer, yet in the past decade, we see a marked trend toward mastectomy in breast conserving surgery eligible patients [2]. Prophylactic mastectomy has also registered an upward trend [3,4]. This trend together with new indication for breast reconstruction like chest feminization in transgender patients [5] have increased the need for breast reconstruction surgery. (2) Purpose: The purpose of this study is to analyze the types of reconstructive procedures, their indications, their limitations, their functional results and the safety profiles when used during the integrated treatment plan of the oncologic patient; (3) Methods: We conducted an extensive literature review of the main reconstructive techniques, especially the autologous procedures, summarized the findings and presented a few cases from our own experience for exemplification of the usage of breast reconstruction in oncologic patients. (4) Conclusions: Breast reconstruction has become a necessary step in the treatment of most breast cancers and many reconstructive techniques are now routinely practiced. Microsurgical techniques are considered the "gold standard", but they are not accessible to all services, from a technical or financial point of view, so pediculated flaps remain the safe and reliable option, along with alloplastic procedures, to improve the quality of life of these patients.

In synthetic diamond plate, the intrapulse correlated dynamics of self-phase modulation and spontaneous Raman scattering by optical phonons were for the first time directly investigated for tightly focused (focusing numerical aperture NA = 0.25) positively-chirped visible-range ultrashort laser pulses with variable durations (0.3-9.5 ps) and energies, transmitted through the sample. The observed modulation of the transmitted light spectra and Stokes Raman scattering spectra for the different pulse durations were related to nonthermal excitation of nonlinear phonon polarization and its eventual picosecond-scale suppression due to thermal decay of optical phonons on the timescale of electron-phonon thermalization in the material.

This paper attempts to develop a Dynamic Mode Decomposition (DMD) based Reduced Order Model (ROMs) which can quickly but accurately predict the forces and moments experienced by a road vehicle such that they be used by an on-board controller to determine the vehicle's trajectory. DMD can linearize a large dataset of high-dimensional measurements by decomposing them into low-dimensional coherent structures and associated time-dynamics. This ROM then also can be applied to predict the future state of the fluid flow. Existing literature on DMD is limited to low Reynolds number applications. This paper presents DMD analyses of the flow around an idealized road vehicle, called the Ahmed body, at a Reynolds number of 2.7E6. The high dimensional dataset used in this paper was collected from a computational fluid dynamics (CFD) simulation performed using Menter's shear stress transport (SST) turbulence model within the context of Improved Delayed Detached Eddy Simulations (IDDES). The DMD algorithm, as available in literature, was found to suffer nonphysical dampening of the medium-to-high frequency modes. Enhancements to the existing algorithm were explored, and a modified DMD approach is presented in this paper which includes: (a) a requirement of higher sampling rate to obtain higher resolution of data, and (b) a custom filtration process to remove spurious modes. The modified DMD algorithm thus developed was applied to the high Reynolds number, separation dominated flow past the idealized ground vehicle. The effectiveness of the modified algorithm was tested by comparing future predictions of force and moment coefficients as predicted by the DMD-based ROM to the reference CFD simulation data, and found to offer significant improvement.

We present an overview over eight brightly luminescent Cu(I) dimers of the type Cu2X2(PN)3 with X = Cl, Br, I and P^N = 2-diphenylphosphino-pyridine (Ph2Ppy), 2-diphenylphosphino-pyrimidine (Ph2Ppym), 1-diphenylphosphino-isoquinoline (Ph2Piqn) including three new crystal structures (Cu2Br2(Ph2Ppy)3, 1-Br, Cu2I2(Ph2Ppym)3, 2-I, and Cu2I2(Ph2Piqn)3, 3-I). However, we mainly focus on their photo-luminescence properties. All compounds exhibit combined thermally activated delayed fluorescence (TADF) and phosphorescence at ambient temperature. Emission color, decay time, and quantum yield varies over large ranges. For deeper characterization, we select Cu2I2(Ph2Ppy)3, 1-I, showing a quantum yield of 81 %. DFT and SOC-TDDFT calculations provide insight into the electronic structures of the singlet S1 and triplet T1 states. Both stem from metal+iodide-to-ligand charge transfer transitions. Evaluation of the emission decay dynamics, measured from 1.2 ≤ T ≤ 300 K, gives ∆E(S1-T1) = 380 cm-1 (47 meV), a transition rate of k(S1→S0) = 2.25×106 s-1 (445 ns), T1 zero-field splittings, transition rates from the triplet substates, and spin-lattice relaxation times. We also discuss the interplay of S1-TADF and T1-phosphorescence. The combined emission paths shorten the overall decay time. For OLED applications, utilization of both singlet and triplet harvesting can be highly favorable for improvement of the device performance.