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Aims: This study aimed to compare the efficacy and utility of the McGrath™ videolaryngoscope, using the Macintosh-like McGrath™ MAC blade and the hyperangulated McGrath™ MAC Xblade with a conventional Macintosh blade under simulated resuscitation conditions.

Methods: A prospective, randomized study under conditions mimicking ongoing chest compressions was conducted with 90 anesthesiologists. Intubation success rates, time-to-vocal cords, time-to-intubate, and time-to-ventilate were measured. Additionally, the study assessed the subjective ratings and the perceived workload using the 'NASA-task-load-index' during the procedure.

Results: The overall intubation success rate was device dependent 99-100%. The McGrath™ MAC and McGrath™ MAC Xblade showed faster visualization times compared to conventional blades. The MAC blade demonstrated superior performance in time-to-intubate and time-to-ventilate compared to both conventional and MAC Xblades. Despite excellent visualization, the MAC Xblade posed challenges in tube placement, reflected in a prolonged intubation time of >120 seconds in one case. Both MAC and MAC Xblade reduced potential dental injuries and interruptions to chest compressions compared to conventional laryngoscopes. User experience significantly impacted intubation times with conventional laryngoscopes, but this effect was mitigated with videolaryngoscopy. Participants reported lower stress and effort when using videolaryngoscopes, with the MAC blade rated superior in perceived time pressure.

Conclusion: The study supports the superiority of videolaryngoscopy with a Macintosh-like blade over conventional laryngoscopy during mechanical chest compressions, particularly for less experienced users. The McGrath™ MAC blade, in particular, offers advantages in intubation time, user-friendliness, and reduced stress. However, the MAC Xblade's challenges during tube placement highlight the need for further clinical validation. Continued research is essential to refine guidelines and improve resuscitation outcomes.

Adaptation to technological advancements and intelligent digital tools can enable healthcare providers to overcome the challenges of their patient-oriented care systems and processes. One such intelligent tool is automated assistive robots, which can improve patient care and safety in the health sector. This paper presents an invariant set of continuous nonlinear control laws for an assistive robot and a rehabilitation wheelchair robot modeled as a new autonomous robotic dog and rehabilitation wheelchair system for navigating a highly constrained environment. The control laws are derived from the Lyapunov-based control scheme classified under the umbrella of artificial potential field (APF) methods, and inherently proved stability of the new heterogeneous system. The robotic dog guides the wheelchair robot during the navigation process in a cluttered environment where the avoidances are from the robotic dog and the integrated dynamic protective polygon. The wheelchair traverses the obstacle-free path traced by the dynamic polygon. The leash is flexible, and its length is bounded, which invariably provides the protective polygon to change its intrinsic dimension. Thus, the dual-robot system has increased mobility for obstacle avoidance and passing through narrow passageways. The solution proffered herein is only feasible in a highly constrained and isolated human environment where nothing else appears to be moving in the direction of the robotic dog and wheelchair. The computer simulations and associated convergence graphs present the efficacy of the unique control laws for the new heterogeneous robotic system. Adoption of such control laws and their suitable variants can make a big impact in the healthcare industry.

Background: Angiogenesis inhibitors targeting VEGF, or its receptors have consistently produced disappointing clinical outcomes in breast cancer. Therefore, there is an urgent need to explore alternative angiogenic pathways in breast cancer. This study aimed to describe the gene expression of pivotal pro-angiogenic genes in breast cancer and to further analyze the associations with the clinicopathologic tumor features, prognostic factors, and overall survival. Such findings would expand the understanding of the role of different angiogenic pathways in breast cancer pathogenesis and identify patients at risk of more aggressive disease who could be eligible for intense treatment regimens. Additionally, exploring angiogenic pathways helps identify new potential drug targets for breast cancer.

Methods: The mRNA expression levels for eight pro-angiogenic genes [VEGFA, HGF, FGF1, FGF2, ANGPT1, ANGPT2, PDGFA, and PDGFB] were obtained from the METABRIC (Molecular Taxonomy of Breast Cancer International Consortium) dataset available at cBioPortal public domain. Pertinent demographic and tumor information were retrieved.

Results: VEGFA and ANGPT2 genes had the highest expression levels with average mRNA log intensities of 7.18±0.7 and 7.11±0.53, respectively. VEGFA expression was not correlated with the expression of other pro-angiogenic genes, the clinicopathologic tumor features, and the overall survival of patients. FGF1, ANGPT1, and PDGFA mRNA levels were negatively correlated with the age of patients at diagnosis. The expression of FGF1 and FGF2 correlated inversely with tumor size and the Nottingham Prognostic Index (p = 0.03 and p = 0.002, respectively). Expression of HGF was significantly associated with advanced tumor stage (p<0.05). Expression of ANGPT1 and ANGPT2 was associated with hormone receptor-negative status and the non-luminal subtypes. PDGFB expression was significantly higher in patients with high-grade disease and HER2-positive status. Patients with high expression status of ANGPT2 and PDGFB had significantly reduced overall survival compared to those with low expression levels of these genes (p = 0.004 and p = 0.0001, respectively).

Conclusions: In this dataset of patients with breast cancer, the expression levels of 8 different pro-angiogenic genes revealed remarkable differences in terms of their association with clinicopathologic tumor characteristics and prognosis. The expression of ANGPTs and PDGFs was associated with adverse tumor features, worse prognosis, and reduced survival in patients. Targeting ANGPTs and PDGF pathways could provide new insights for effective anti-angiogenic drugs in breast cancer.

To achieve the actual situation of water pressure stabilization during underground and tunnel water inrush disasters, the team independently developed a stable water pressure test system and conducted fracture and failure tests on fissured rock masses under the coupling effect of 1MPa stable water pressure and stress and without water pressure. Combined with data collected by acoustic emission instruments, the mechanical characteristics of fracture and failure, crack propagation mechanism, and acoustic emission response mechanism of fissured rock masses under the coupling effect of stable hydraulic pressure and stress were studied. The results showed that throughout the entire experimental process, the hydraulic pressure remained continuously stable, with a decrease of only 0.14%; The variation pattern of peak strength of fissured rock mass with increasing crack inclination angle under stable hydraulic pressure changes from a decrease and then an increase in the absence of hydraulic pressure to an increasing trend; The crack propagation length of low angle fissured rock mass is generally higher than that of high angle fissured specimens. The longer propagation path increases the range and effect of hydraulic pressure, and the initial crack propagation length of fissured rock mass under hydraulic pressure is also significantly longer than that of specimens without hydraulic pressure; During the loading process, both the acoustic emission ringing count and damage variable can be divided into four stages. From the cumulative total number of acoustic emission ringing counts, it can be seen that during the loading process, the total number of acoustic emission ringing in fissured rock masses subjected to hydraulic pressure is significantly lower than that of specimens without hydraulic pressure, and the trend is also relatively stable.

Introduction: The microscopy-based Kato-Katz and urine filtration techniques have traditionally faced challenges in the detection of schistosomiasis in areas with low infection levels. A modified singleplex Schistosoma genus-specific quantitative real-time polymerase chain reaction (qPCR) assay was therefore evaluated as a sensitive and confirmatory schistosomiasis diagnostic test.

Methodology: The qPCR assay utilized primers and probe targeting internal transcribed spacer- 2 (ITS2) sequence of S. mansoni, S. haematobium and S. intercalatum. A plasmid (pDMD801, 100pg/ul) was used as an internal amplification control and its qPCR assays were run in parallel to the Schistosoma assays. This assay utilized samples collected from 774 participants and microscopically examined for three consecutive days. A total of 699 day-one samples (urine and stools) from two schistosomiasis endemic sites were analyzed. Similarly, 75 persons from a non-endemic control site provided both urine and stool samples that were also analyzed.

Results: Using microscopy, the proportion of positives in the two endemic regions altogether was 289/699 (41.3%). Using qPCR, 50.4% of the samples (352/699) were found to be positive for schistosome infection. The percentage of positive samples was slightly higher at 57.8% (203/351) in the S. mansoni endemic site compared with the S. haematobium site at 42.8% (149/348). Majority of the microscopy results were light infections at 26.8% (n = 94) and 26.1% (n = 91) while qPCR majority of the infections were high at 41.6% (n = 146) and 31.3% (n = 109) for the S. mansoni and S. haematobium sites, respectively. There were no positives detected by either microscopy or qPCR in the non-endemic site. Using Bayesian Latent Class Model, which does not use any technique as a gold standard, qPCR showed higher sensitivity (86.4% (PCI: 82.1-90.3)) compared to microscopy (75.6% (PCI: 71.1-80.0)).

Conclusions: This study documents a single day-one sample modified Schistosoma qPCR assay as a powerful improved molecular assay for the detection of schistosomiasis infection that utilize either stool or urine samples. The assay is therefore recommended for monitoring in areas with low infection levels to enable accurate determination of the disease's control endpoint.

Packet information encoding of neural signals was proposed for vision about 50 years ago and has recently been revived as a plausible strategy generalizable to natural and artificial sensory systems. It involves discrete image segmentation controlled by feedback and the ability to store and compare packets of information. This article shows that neurons of the cerebellum-like electrosensory lobe (EL) of the electric fish Gymnotus omarorum use spike-count and spike-timing distribution as constitutive variables of packets of information that encode one-by-one the electrosensory images generated by a self-timed series of electric organ discharges (EODs). To evaluate this hypothesis, extracellular unitary activity was recorded from the centro-medial map of the EL. Units recorded in high-decerebrate preparations were classified into six types using hierarchical cluster analysis of post-EOD spiking histograms. Cross-correlation analysis indicated that each EOD strongly influences the unit firing probability within the next inter-EOD interval. Units of the same type were similarly located in the laminar organization of the EL and showed similar stimulus-specific changes in spike count and spike timing after the EOD when a metal object was moved close by, along the fish's body parallel to the skin, or when the longitudinal impedance of a static cylindrical probe placed at the center of the receptive field was incremented in a stepwise manner in repetitive trials. These last experiments showed that spike-counts and the relative entropy, expressing a comparative measure of information before and after the step, were systematically increased with respect to a control in all unit types. The post-EOD spike-timing probability distribution and the relatively independent contribution of spike-timing and number to the content of information in the transmitted packet suggest that these are the constitutive image-encoding variables of the packets. Comparative analysis suggests that packet information transmission is a general principle for processing superposition images in cerebellum-like networks.

We evaluated by comparing the performance of three pneumatically-driven bioreactors in the production of L-asparaginase (L-ASNase), an enzyme used to treat leukaemia and lymphoma. A two-step screening process was conducted to detect Cunninghamella spp. strains producing L-ASNase. Cunninghamella echinulata DSM1905 produced the highest levels of L-ASNase during screening assays. Subsequently, fermentations were performed in bubble column (BCR), airlift (ALR), and hybrid fixed-bed airlift (FB-ALR) bioreactors to determine the best upstream bioprocess. Mycelial biomass production was higher in BCR than in ALR and FB-ALR (p ≤ 0.0322). The activity of L-ASNase produced in FB-ALR, in which the fungus grew as a consistent biofilm, was significantly higher (p ≤ 0.022) than that from ALR, which was higher than that of BCR (p = 0.036). The specific activity of ALR and FB-ALR presented no differences (p = 0.073), but it was higher than that of BCR (p ≤ 0.032). In conclusion, C. echinulata DSM1905, grown under the biofilm phenotype, produced the highest levels of L-ASNase, and FB-ALR was the best upstream system for enzyme production.

Introduction: Cannabis products have been used in the management of headaches in adults and may play a role in pediatric chronic pain. Canadian pediatricians report increasing use of cannabis for the management of chronic headaches, despite no well-controlled studies to inform its dosing, safety, and effectiveness. The aim of our clinical trial is to determine the dosing and safety of a Cannabidiol (CBD)-enriched Cannabis Herbal Extract (CHE) for the treatment of chronic headaches in adolescents.

Methods and analysis: Youth, parents, and an expert steering committee co-designed this tolerability study. Twenty adolescents (aged 14 to 17 years), with a chronic migraine diagnosis for more than 6 months that has not responded to other therapies will be enrolled into an open label, dose escalation study across three Canadian sites. Study participants will receive escalating doses of a CBD-enriched CHE (MPL-001 with a THC:CBD of 1:25), starting at 0.2-0.4 mg/kg of CBD per day and escalating monthly up to 0.8-1.0 mg/kg of CBD per day. The primary objective of this study is to determine the safety and tolerability of CBD-enriched CHE in adolescents with chronic migraine. Secondary objectives of this study will inform the development of subsequent randomized controlled trials and include investigating the relationship between the dose escalation and change in the frequency of headache, impact and intensity of pain, changes in sleep, mood, function, and quality of life. Exploratory outcomes include investigating steady-state trough plasma levels of bioactive cannabinoids and investigating how pharmacogenetic profiles affect cannabinoid metabolism among adolescents receiving CBD-enriched CHE.

Discussion: This protocol was co-designed with youth and describes a tolerability clinical trial of CBD-enriched CHE in adolescents with chronic headaches that have not responded to conventional therapies. This study is the first clinical trial on cannabis products in adolescents with chronic headaches and will inform the development of future comparative effectiveness clinical trials.

Trial registration: CAN-CHA trial is registered with ClinicalTrials.gov with a number of register NCT05337033.

We develop a general framework for state estimation in systems modeled with noise-polluted continuous time dynamics and discrete time noisy measurements. Our approach is based on maximum likelihood estimation and employs the calculus of variations to derive optimality conditions for continuous time functions. We make no prior assumptions on the form of the mapping from measurements to state-estimate or on the distributions of the noise terms, making the framework more general than Kalman filtering/smoothing where this mapping is assumed to be linear and the noises Gaussian. The optimal solution that arises is interpreted as a continuous time spline, the structure and temporal dependency of which is determined by the system dynamics and the distributions of the process and measurement noise. Similar to Kalman smoothing, the optimal spline yields increased data accuracy at instants when measurements are taken, in addition to providing continuous time estimates outside the measurement instances. We demonstrate the utility and generality of our approach via illustrative examples that render both linear and nonlinear data filters depending on the particular system. Application of the proposed approach to a Monte Carlo simulation exhibits significant performance improvement in comparison to a common existing method.

Background: Participation in youth sports is a major determinant of current and future health, yet participation rates are declining. It is of great importance to examine the factors that potentially influence adolescents' levels of participation in organised sports.

Aim: First, we examined change in participation over two years from the start of secondary education. Second, we examined whether a combination of factors (i.e. motives, barriers, perceived competence, encouragement and motor skills) based on the Youth Physical Activity Promotion model was associated with participation after one year. Third, we examined whether the associations between each of the factors and participation in organised sports changed over time.

Methods: Data were collected on three occasions between October 2020 and November 2022 using questionnaires, motor skill test items and anthropometric measurements. We analysed data from 204 Dutch adolescents (11 to 14 years) using dependent t tests, Cochran's Q test and multilevel linear fixed effects regression models.

Results: First, participation in organised sports was stable during the first years of secondary education. Second, adolescents who reported higher motives, higher perceptions of competence and more encouragement spent more time in organised sports one year later. Barriers and motor skills did not predict participation. Third, relationships of each of the six factors with participation remained stable over time.

Conclusion: Although participation in organised sports is often considered to decline during the first years of secondary education, it can be stable for a significant portion of the population. Motives, perceived competence, and encouragement seem crucial to stimulate adolescents' participation in organised sports.