Design and Evaluation of a Low-Power Wide-Area Network (LPWAN)-Based Emergency Response System for Individuals with Special Needs in Smart Buildings.

The Internet of Things (IoT) is a growing network of interconnected devices used in transportation, finance, public services, healthcare, smart cities, surveillance, and agriculture. IoT devices are increasingly integrated into mobile assets like trains, cars, and airplanes. Among the IoT components, wearable sensors are expected to reach three billion by 2050, becoming more common in smart environments like buildings, campuses, and healthcare facilities. A notable IoT application is the smart campus for educational purposes. Timely notifications are essential in critical scenarios. IoT devices gather and relay important information in real time to individuals with special needs via mobile applications and connected devices, aiding health-monitoring and decision-making. Ensuring IoT connectivity with end users requires long-range communication, low power consumption, and cost-effectiveness. The LPWAN is a promising technology for meeting these needs, offering a low cost, long range, and minimal power use. Despite their potential, mobile IoT and LPWANs in healthcare, especially for emergency response systems, have not received adequate research attention. Our study evaluated an LPWAN-based emergency response system for visually impaired individuals on the Hazara University campus in Mansehra, Pakistan. Experiments showed that the LPWAN technology is reliable, with 98% reliability, and suitable for implementing emergency response systems in smart campus environments.

Effect of Buerger-Allen exercise on wound healing in patients with diabetic foot ulcers: a randomised controlled trial.

OBJECTIVE: A diabetic foot ulcer (DFU) is a complication of type 2 diabetes that is difficult to treat. Buerger-Allen exercise has shown effectiveness in improving foot circulation and neuropathy in several studies; however, to the best of our knowledge, no randomised controlled study has investigated its effectiveness for DFU healing. Therefore, this study aimed to assess the effects of Buerger-Allen exercise on the healing of DFUs in patients with type 2 diabetes. METHOD: This is a parallel-group randomised controlled trial (RCT). Of 50 patients with neuropathic DFUs, 41 completed the study. They were assigned randomly to a study group (n=21) and a control group (n=20). Patients in the study group received the standard medical treatment and semi-supervised Buerger-Allen exercise for three sessions per week for four weeks, while patients in the control group only received the standard medical treatment. The outcome measures were: ankle-brachial pressure index (ABPI); ulcer size; ulcer depth; SINBAD score; and ulcer risk for poor outcomes (based on the SINBAD score). RESULTS: The study group's mean age was 49.48±6.45 years and the control group's mean age was 49.15±5.85. The study group's ABPI increased significantly compared to the baseline (1.17±0.04 versus 1.11±0.05, respectively; p<0.001) and the control group (1.17±0.04 versus 1.14±0.05, respectively; p=0.04) post-intervention. Ulcer size also reduced significantly in the study group compared to the baseline (2.63±2.0 versus 7.48±5.55cm2, respectively; p<0.001) and the control group (2.63±2.0 versus 6.43±4.45cm2, respectively; p<0.001) post-intervention. Ulcer depth decreased significantly in the study group compared to the baseline (1.71±1.05 versus 4.19±1.74mm, respectively; p<0.001) and the control group (1.71±1.05 versus 2.80±1.57mm, respectively; p=0.01) post-intervention. Furthermore, the SINBAD score in the study group decreased significantly compared to the baseline (1.38±0.86 versus 2.14±1.06, respectively; p<0.001) and the control group (1.38±0.86 versus 2.0±0.79, respectively; p=0.02) post-intervention. Moreover, the ulcer risk for poor outcomes, based on the SINBAD score, reduced significantly only in the study group, compared to the baseline (p=0.041). The control group showed non-significant changes compared to the baseline in all outcome measures (p>0.05). CONCLUSION: From the findings of this RCT, Buerger-Allen exercise, in combination with standard wound care, may help accelerate the healing of neuropathic DFUs in patients with type 2 diabetes, and could be suggested as part of the management plan for such conditions as an easy-to-perform offloading exercise intervention.

Removal of amoxicillin from contaminated water using modified bentonite as a reactive material.

This study concerns the removal of a trihydrate antibiotic (Amoxicillin) from synthetically contaminated water by adsorption on modified bentonite. The bentonite was modified using hexadecyl trimethyl ammonium bromide (HTAB), which turned it from a hydrophilic to a hydrophobic material. The effects of different parameters were studied in batch experiments. These parameters were contact time, solution pH, agitation speed, initial concentration (C0) of the contaminant, and adsorbent dosage. Maximum removal of amoxicillin (93 %) was achieved at contact time = 240 min, pH = 10, agitation speed = 200 rpm, initial concentration = 30 ppm, and adsorbent dosage = 3 g bentonite per 1L of pollutant solution. The characterization of the adsorbent, modified bentonite, was accomplished using Fourier transform infrared spectroscopy, scanning electron microscopy, X-ray diffraction, and Brunauer-Emmett-Teller. The isotherm models were also investigated, and it was found that the Freundlich isotherm model fitted well with the experimental data (R2 = 94.77), which suggests heterogeneity in the multilayer adsorption of amoxicillin onto modified bentonite. The kinetics of the adsorption process were studied. The experimental data were found to obey the pseudo-first-order kinetic model (R2 = 95.1). Thermodynamic studies indicated that the adsorption process was physisorption and endothermic. Finally, the modified bentonite proved to be a good adsorbent for the removal of amoxicillin from contaminated solutions.

Diagnostic accuracy of telestroke consultation: a Louisiana based tele-network experience.

Background and purpose: Telestroke has grown significantly since its implementation. Despite growing utilization, there is a paucity of data regarding the diagnostic accuracy of telestroke to distinguish between stroke and its mimics. We aimed to evaluate diagnostic accuracy of telestroke consultations and explore the characteristics of misdiagnosed patients with a focus on stroke mimics. Methods: We conducted a retrospective study of all the consultations in our Ochsner Health's TeleStroke program seen between April 2015 and April 2016. Consultations were classified into one of three diagnostic categories: stroke/transient ischemic attack, mimic, and uncertain. Initial telestroke diagnosis was compared with the final diagnosis post review of all emergency department and hospital data. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+) and negative likelihood ratio (LR-) for diagnosis of stroke/TIA versus mimic were calculated. Area under receiver-operating characteristic curve (AUC) analysis to predict true stroke was performed. Bivariate analysis based on the diagnostic categories examined association with sex, age, NIHSS, stroke risk factors, tPA given, bleeding after tPA, symptom onset to last known normal, symptom onset to consult, timing in the day, and consult duration. Logistic regression was performed as indicated by bivariate analysis. Results: Eight hundred and seventy-four telestroke evaluations were included in our analysis. Accurate diagnosis through teleneurological consultation was seen in 85% of which 532 were strokes (true positives) and 170 were mimics (true negatives). Sensitivity, specificity, PPV, NPV were 97.8, 82.5, 93.7 and 93.4%, respectively. LR+ and LR- were 5.6 and 0.03. AUC (95% CI) was 0.9016 (0.8749-0.9283). Stroke mimics were more common with younger age and female gender and in those with less vascular risk factors. LR revealed OR (95% CI) of misdiagnosis for female gender of 1.9 (1.3-2.9). Lower age and lower NIHSS score were other predictors of misdiagnosis. Conclusion: We report high diagnostic accuracy of the Ochsner Telestroke Program in discriminating stroke/TIA and stroke mimics, with slight tendency towards over diagnosis of stroke. Female gender, younger age and lower NIHSS score were associated with misdiagnosis.

Heterogeneously catalyzed transesterification reaction using waste snail shell for biodiesel production.

Biodiesel as an attractive energy source; a low-cost and green synthesis technique was utilized for biodiesel preparation via waste cooking oil methanolysis using waste snail shell derived catalyst. The present work aimed to investigate the production of biodiesel fuel from waste materials. The catalyst was greenly synthesized from waste snail shells throughout a calcination process at different calcination time of 2-4 h and temperature of 750-950 °C. The catalyst samples were characterized using X-Ray Diffraction (XRD), Brunauer-Emmett-Teller (BET), Energy Dispersive X-ray (EDX), and Fourier Transform Infrared (FT-IR). The reaction variables varying in the range of 10:1-30:1 M ratio of MeOH: oil, 3-11 wt% catalyst loading, 50-70 °C reaction temperature, and 2-6 h reaction time. The designed model optimization was set its parameters at 21.5 methanol molar ratio, 9.8 wt% catalyst loading, 4.8 h reaction time, and 62.2 °C reaction temperature, resulting in a mixture comprised of 95% esters content.

Food Insecurity Screening in Primary Care: Patterns During the COVID-19 Pandemic by Encounter Modality.

INTRODUCTION: Screening for food insecurity in clinical settings is recommended, but implementation varies widely. This study evaluated the prevalence of screening for food insecurity and other social risks in telehealth versus in-person encounters during the COVID-19 pandemic and changes in screening before versus after widespread COVID-19 vaccine availability. METHODS: These cross-sectional analyses used electronic health record and ancillary clinic data from a national network of 400+ community health centers with a shared electronic health record. Food insecurity screening was characterized in 2022 in a sample of 275,465 first encounters for routine primary care at any network clinic during March 11, 2020-December 31, 2021. An adjusted multivariate multilevel probit model estimated screening prevalence on the basis of encounter mode (in-person versus telehealth) and time period (initial pandemic versus after vaccine availability) in a random subsample of 11,000 encounters. RESULTS: Encounter mode was related to food insecurity screening (p<0.0001), with an estimated 9.2% screening rate during in-person encounters, compared with 5.1% at telehealth encounters. There was an interaction between time period and encounter mode (p<0.0001), with higher screening prevalence at in-person versus telehealth encounters after COVID-19 vaccines were available (11.7% vs 4.9%) than before vaccines were available (7.8% vs 5.2%). CONCLUSIONS: Food insecurity screening in first primary care encounters is low overall, with lower rates during telehealth visits and the earlier phase of the COVID-19 pandemic. Future research should explore the methods for enhancing social risk screening in telehealth encounters.

Examining the Factors Influencing Applicants' Placement on One General Surgery Program's Rank Order List.

PURPOSE: Surgery residency applications include variables that determine an individual's rank on a program's match list. We performed this study to determine which residency application variables are the most impactful in creating our program's rank order list. METHODS: We completed a retrospective examination of all interviewed applicants for the 2019 match. We recorded United States Medical Licensing Examinations (USMLE) step I and II scores, class quartile rank from the Medical Student Performance Evaluation (MSPE), Alpha Omega Alpha (AOA) membership, geographic region, surgery clerkship grade, and grades on other clerkships. The MSPE and letters of recommendation were reviewed by two of the authors and assigned a score of 1 to 3, where 1 was weak and 3 was strong. The same two authors reviewed the assessments from each applicant's interview and assigned a score from 1-5, where 1 was poor and 5 was excellent. Univariate analysis was performed, and the significant variables were used to construct an adjusted multivariate model with significance measured at P < .05. RESULTS: Univariate analysis for all 92 interviewed applicants demonstrated that USMLE step 2 scores (P = .002), class quartile rank (P = .004), AOA status (P = .014), geographic location (P < .001), letters of recommendation (P < .001), and interview rating (P < .001) were significant in predicting an applicant's position on the rank list. On multivariate analysis only USMLE step 2 (P = .018) and interview (P < .001) remained significant. CONCLUSION: USMLE step 2 and an excellent interview were the most important factors in constructing our rank order list. Applicants with a demonstrated strong clinical fund of knowledge that develop a rapport with our faculty and residents receive the highest level of consideration for our program.

Breast cancer: age incidence, hormone receptor status and family history in Najaf, Iraq.

Breast cancer is the primary type of cancer affecting women. Patients with hormone receptor-positive cells have lower mortality rates. Both chemotherapy and hormone therapy can improve the survival rate. This study aimed to evaluate the hormonal receptor status in female breast cancer and assess the relationship with the patient's age and family history in Najaf, Iraq. A prospective study of two-hundred and fifty-one women with mastectomies (for cancers) was performed at AL Sader Medical City from January 2019 to January 2021. We collected and analyzed data regarding the age of patients, site and size of the tumor, number of pregnancies, family history, weight, smoking, and hormone receptor status. The average age of patients was 48 years, and the peak incidence was in the 40-49 age group (30.27% of patients). Of all age groups, 48.6% (122 patients) were negative for all hormone receptors (triple negative), and only 22.70% had a positive family history. The peak incidence of cancer in our study was in the 40-49 years group. A high proportion of the hormone receptors for patients were negative (triple-negative), and most patients had a negative family history.

The Association Between Tacrolimus Levels and Hyperkalemia in Allograft Recipients Who Underwent Heart or Lung Transplantation in New Orleans, USA Between 2013 and 2019: A Single-Center Retrospective Study.

BACKGROUND Tacrolimus, a calcineurin inhibitor, is the cornerstone of immunosuppressive strategies in transplantation. Other studies have concluded that hyperkalemia correlates with tacrolimus therapy, though the impact is poorly understood. In 2 separate analyses, the aim of this study was to investigate if the presence and/or magnitude of exposure to tacrolimus increased potassium levels in heart or lung transplant recipients. MATERIAL AND METHODS This retrospective study identified allograft recipients who underwent heart or lung transplantation from January 2013 to December 2019 at Ochsner Health in New Orleans, USA. The first analysis (A-1) comprised 103 lung transplant patients' assessed potassium levels and prevalence of hyperkalemia in the absence of tacrolimus before transplant versus 30 days after transplant on tacrolimus. The second analysis (A-2) included 187 heart or lung transplant recipients and compared potassium levels and prevalence of hyperkalemia at day 30 after transplant during higher tacrolimus exposure (High-TAC) vs day 300 during lower tacrolimus exposure (Low-TAC). RESULTS In A-1, patients on tacrolimus had higher median potassium (4.7 mmol/L vs 4.1 mmol/L, P<0.0001) and prevalence of hyperkalemia (32.04% vs 5.83%, P<0.0001). In A-2, patients in the High-TAC group had higher median potassium (4.6 mmol/L vs 4.4 mmol/L, P=0.0005) and prevalence of hyperkalemia (22.46% vs 12.30%, P=0.0056). CONCLUSIONS Our findings support those from previous studies. Presence of and higher levels of tacrolimus were associated with hyperkalemia following heart and lung transplantation. These findings highlight the importance of long-term monitoring of potassium levels in patients treated with tacrolimus.

Synthesis of New Norfloxacin-Tin Complexes to Mitigate the Effect of Ultraviolet-Visible Irradiation in Polyvinyl Chloride Films.

Polyvinyl chloride is used in the manufacturing of a wide range of products, but it is susceptible to degradation if exposed to high temperatures and sunlight. There is therefore a need to continuously explore the design, synthesis, and application of new and improved additives to reduce the photodegradation of polyvinyl chloride in harsh environments and for outdoor applications. This research investigates the use of new norfloxacin-tin complexes as additives to inhibit the photodegradation of polyvinyl chloride to make it last longer. Reactions between norfloxacin and substituted tin chlorides, in different molar ratios and in methanol under reflux conditions, gave the corresponding organotin complexes in high yields. The chemical structures of the synthesized complexes were established, and their effect on the photodegradation of polyvinyl chloride due to ultraviolet-visible irradiation was investigated. Norfloxacin-tin complexes were added to polyvinyl chloride at very low concentrations and homogenous thin films were made. The films were irradiated for a period of up to 300 h, and the damage that occurred was assessed using infrared spectroscopy, polymeric materials weight loss, depression in molecular weight, and surface inspection. The degree of photodegradation in the polymeric materials was much less in the blends containing norfloxacin-tin complexes compared to the case where no additives were used. The use of the additives leads to a reduction in photodegradation (e.g., a reduction in the formation of short-chain polymeric fragments, weight loss, average molecular weight depletion, and roughness factor) of irradiated polyvinyl chloride. The norfloxacin-tin complexes contain aromatic moieties (aryl and heterocycle), heteroatoms (nitrogen, oxygen, and fluorine), and an acidic center (tin atom). Therefore, they act as efficient photostabilizers by absorbing the ultraviolet radiation and scavenging hydrogen chloride, peroxides, and radical species, thereby slowing the photodegradation of polyvinyl chloride.

Fabrication of Highly Photostable Polystyrene Films Embedded with Organometallic Complexes.

Polystyrene is a common thermoplastic and is produced in different shapes and forms. The scale of manufacture of polystyrene has grown over the years because of its numerous applications and low cost of production. However, it is flammable, brittle, has low resistance to chemicals, and is susceptible to photodegradation on exposure to ultraviolet radiation. There is therefore scope to improve the properties of polystyrene and to extend its useful lifetime. The current work reports the synthesis of organometallic complexes and investigates their use as photostabilizers for polystyrene. The reaction of excess ibuprofen sodium salt and appropriate metal chlorides in boiling methanol gave the corresponding complexes excellent yields. The organometallic complexes (0.5% by weight) were added to polystyrene and homogenous thin films were made. The polystyrene films blended with metal complexes were irradiated with ultraviolet light for extended periods of time and the stabilizing effects of the additives were assessed. The infrared spectroscopy, weight loss, depression in molecular weight, and surface morphology of the irradiated blends containing organometallic complexes were investigated. All the synthesized organometallic complexes acted as photostabilizers for polystyrene. The damage (e.g., formation of small polymeric fragments, decrease in weight and molecular weight, and irregularities in the surface) that took place in the polystyrene blends was much lower in comparison to the pure polystyrene film. The manganese-containing complex was very effective in stabilizing polystyrene and was superior to cobalt and nickel complexes.

Direct Oral Anticoagulants Versus Warfarin for Treatment of Thrombosis or Atrial Fibrillation in Patients With Cirrhosis: A Retrospective Cohort Study.

BACKGROUND: Evidence for direct oral anticoagulants (DOACs) in patients with cirrhosis is limited. Few patients with Child-Turcotte-Pugh (CTP) class B and C cirrhosis have been studied. OBJECTIVE: To compare major bleeding rates in patients with cirrhosis receiving a DOAC versus warfarin. METHODS: A retrospective cohort study was conducted in adults with cirrhosis receiving a DOAC versus warfarin for venous thromboembolism, portal-vein thrombosis, or atrial fibrillation. The primary outcome was the rate of major bleeding. Secondary outcomes included time to major bleeding, clinically relevant nonmajor bleeding, all bleeding, gastrointestinal bleeding, intracranial bleeding, and new thromboembolic events. The study was approved by the Ochsner Health System Institutional Review Board. RESULTS: A total of 44 patients receiving a DOAC and 41 patients receiving warfarin were included. Major bleeding occurred in 4 patients receiving a DOAC and 6 patients receiving warfarin (9.1% vs 14.6%; P = 0.881). Rates of major bleeding were similar in 24 DOAC and 17 warfarin patients with CTP Class B (4.2% vs 17.6%; P = 0.37) and 8 DOAC and 9 warfarin patients with CTP Class C (37.5% vs 11.1%; P = 0.41) cirrhosis. Secondary bleeding and efficacy outcomes were similar between cohorts. The study was limited by a small sample size. CONCLUSION AND RELEVANCE: Treatment with DOACs in patients with cirrhosis was associated with a similar rate of major bleeding compared with warfarin. Inclusion of CTP class C patients in future studies remains valuable to evaluate safety and efficacy of DOACs in this population.

Inhibition of oxidative stress, IL-13, and WNT/ß-catenin in ovalbumin-sensitized rats by a novel organogel of Punica granatum seed oil saponifiable fraction.

Bronchial asthma is a chronic inflammatory disease marked by inflammation, oxidative stress, and structural remodeling. Here, we prepared two pomegranate fractions from the seed oil, saponifiable (Sap) and unsaponifiable (UnSap). Two organogels (Orgs) were also formulated with the Sap (Org1) or the UnSap (Org2) fraction and beeswax (BW). All preparations were evaluated in vitro for their antioxidant and anti-inflammatory impacts. The transdermal delivery of the most efficient one was evaluated against ovalbumin (OV)-induced bronchial asthma in rats compared to dexamethasone (DEX). The results showed that the prepared pomegranate fractions and BW had considerable amounts of phenolics (flavonoids and tannins) and triterpenoids. Org1 was shown to be the most effective antioxidant and anti-inflammatory fraction with synergistic activities (combination index, 1), as well as having protective and therapeutic influences on OV-sensitized rats. Org1 inhibited the multiple OV-induced signaling pathways, comprising ROS, WNT/ß-catenin, and AKT, with an efficiency superior to DEX. Subsequently, the pro-inflammatory (COX-2, NO, and IL-13), and pro-fibrotic (COL1A1) mediators, oxidative stress, and mucin secretion, were all down-regulated. These outcomes were verified by the histopathological results of lung tissue. Collectively, these outcomes suggest that the transdermal delivery of Org1 to OV-sensitized rats shows promise in the protection and treatment of the pathological hallmarks of asthma.

Cost-Effectiveness of HCV Core Antigen versus PCR for Monitoring Treatment Response in DAAS-Treated Egyptian Patients

PCR is currently the non-debatable proof for diagnosis of HCV infection as well as conclusion of treatment outcomes. HCV core antigen (HCVcAg) testing is a neglected, less expensive and less time consuming test that's presumed to achieve the same aims. The aim of this study is to find the cost-effectiveness of HCV core antigen testing in the monitoring of treatment response as an alternative to the gold-standard PCR test

Association of anxiety-depressive disorders with irritable bowel syndrome among patients attending a rural family practice center: a comparative cross-sectional study.

BACKGROUND: Comorbidity of irritable bowel syndrome (IBS) and psychiatric disorders is common, and the prevalence of at least one psychiatric disorder has been reported as high as 80% among patients with IBS. AIMS: To explore the association of anxiety-depressive disorders with IBS and its different subtypes, and to evaluate the associations of lifestyle habits, dietary habits and sleeping quality with IBS. METHODS: A comparative cross-sectional study was conducted at the AL-Mahsama Family Practice Center, Ismailia, Egypt. It was carried out between October 2019 and October 2020. Participants were categorised into 175 patients with IBS, diagnosed using the Rome IV criteria, and 175 patients without IBS. A semistructured questionnaire was used to collect data on sociodemographic characteristics, lifestyle habits, dietary habits and sleep quality from both groups. The Hamilton Anxiety Rating Scale was used to assess anxiety symptoms, whereas the Beck Depression Inventory Second Edition was used to assess depression symptoms. RESULTS: There was a high statistically significant difference between both groups with regard to age, education, occupation and socioeconomic status (SES), being a smoker, being physically inactive, having sleep disturbance and having irregular meals; being either obese or overweight was more reported in the IBS group. There was a high statistically significant difference in the rate of anxiety and depression between patients with and without IBS. Mild, moderate and severe anxiety were reported in 37.1%, 42.9% and 20.0% of patients with IBS while most (80.0%) of the patients without IBS reported mild anxiety. Regarding depression, mild, moderate and severe depression were reported in 60.0%, 14.3% and 25.7% of the patients with IBS while most (82.9%) of the non-IBS participants reported mild depression. CONCLUSIONS: The study shows a significant association between anxiety-depressive disorders and IBS, but no significant associations between anxiety-depressive disorders and IBS subtypes.

Fault-Tolerant and Data-Intensive Resource Scheduling and Management for Scientific Applications in Cloud Computing.

Cloud computing is a fully fledged, matured and flexible computing paradigm that provides services to scientific and business applications in a subscription-based environment. Scientific applications such as Montage and CyberShake are organized scientific workflows with data and compute-intensive tasks and also have some special characteristics. These characteristics include the tasks of scientific workflows that are executed in terms of integration, disintegration, pipeline, and parallelism, and thus require special attention to task management and data-oriented resource scheduling and management. The tasks executed during pipeline are considered as bottleneck executions, the failure of which result in the wholly futile execution, which requires a fault-tolerant-aware execution. The tasks executed during parallelism require similar instances of cloud resources, and thus, cluster-based execution may upgrade the system performance in terms of make-span and execution cost. Therefore, this research work presents a cluster-based, fault-tolerant and data-intensive (CFD) scheduling for scientific applications in cloud environments. The CFD strategy addresses the data intensiveness of tasks of scientific workflows with cluster-based, fault-tolerant mechanisms. The Montage scientific workflow is considered as a simulation and the results of the CFD strategy were compared with three well-known heuristic scheduling policies: (a) MCT, (b) Max-min, and (c) Min-min. The simulation results showed that the CFD strategy reduced the make-span by 14.28%, 20.37%, and 11.77%, respectively, as compared with the existing three policies. Similarly, the CFD reduces the execution cost by 1.27%, 5.3%, and 2.21%, respectively, as compared with the existing three policies. In case of the CFD strategy, the SLA is not violated with regard to time and cost constraints, whereas it is violated by the existing policies numerous times.

Locust Inspired Algorithm for Cloudlet Scheduling in Cloud Computing Environments.

Cloud computing is an emerging paradigm that offers flexible and seamless services for users based on their needs, including user budget savings. However, the involvement of a vast number of cloud users has made the scheduling of users' tasks (i.e., cloudlets) a challenging issue in selecting suitable data centres, servers (hosts), and virtual machines (VMs). Cloudlet scheduling is an NP-complete problem that can be solved using various meta-heuristic algorithms, which are quite popular due to their effectiveness. Massive user tasks and rapid growth in cloud resources have become increasingly complex challenges; therefore, an efficient algorithm is necessary for allocating cloudlets efficiently to attain better execution times, resource utilisation, and waiting times. This paper proposes a cloudlet scheduling, locust inspired algorithm to reduce the average makespan and waiting time and to boost VM and server utilisation. The CloudSim toolkit was used to evaluate our algorithm's efficiency, and the obtained results revealed that our algorithm outperforms other state-of-the-art nature-inspired algorithms, improving the average makespan, waiting time, and resource utilisation.

Synbiotic Effects of Saccharomycescerevisiae, Mannan Oligosaccharides, and ß-Glucan on Innate Immunity, Antioxidant Status, and Disease Resistance of Nile Tilapia, Oreochromis niloticus.

Synbiotic (SYN) additives were assessed as an antibiotic alternative on the effects on the nonspecific immune response and disease resistance of O. niloticus to P. aeruginosa. Healthy fish (n = 120, average initial weight 18 ± 2 g) were allotted randomly into four experimental groups (3 replicates for each); 1) a control group with no additives (CON), 2) basal diet complemented with 0.1 g kg-1 diets of norfloxacin, NFLX, 3) basal diet fortified with 1 mL kg-1 diet of SYN, and 4) basal diet complemented with a mixture of NFLX and SYN, which was carried out for eight weeks. Results showed a significant increase (p < 0.01) in the serum immune parameters (total protein, globulin and albumin, nitric oxide (NO), and lysozyme activity) in the SYN group and the NFLX+SYN group compared with the CON and NFLX groups. The serum glucose, cholesterol, and triglycerides were higher in NFLX and NFLX+SYN groups than the CON and SYN groups. The catalase (CAT), superoxide dismutase, glutathione peroxidase (GPX) activities were significantly augmented in the NFLX+SYN group, followed by the SYN group compared with CON and NFLX groups. The cumulative mortality rate (CMR) of O. niloticus following the P. aeruginosa challenge was decreased in the SYN group compared to other groups. The results emphasize that synbiotic could be used as a norfloxacin alternative to enhance the related immunological parameters, including antioxidant activity and disease resistance against P. aeruginosa infection of O. niloticus.

Differential rates of progression of low-grade carotid stenosis detected by follow-up ultrasound: A single institution experience.

OBJECTIVES: The growing body of evidence suggesting that lifestyle changes and aggressive medical management reduce the risk of strokes in patients with carotid stenosis has fostered interest in noninvasive screening. The objective of this study was to develop recommendations for follow-up carotid ultrasound surveillance of patients with <60% carotid stenosis. METHODS: This retrospective observational cohort study includes 2956 patients seen between August 1998 and March 2015 in 4440 visits. Data analysis was restricted to 7710 carotid ultrasounds. Primary outcome was progression of carotid stenosis as defined by the "bulb" method: baseline stenosis of 0%-39% progressed to 40%-59% on subsequent examination, baseline stenosis of 0%-39% progressed to ≥60%, or baseline of 40%-59% progressed to ≥60%. Progression was estimated using Cox proportional hazard ratios and the Kaplan-Meier method. RESULTS: More than 10% of patients progressed in the 40%-59% baseline group within 12 months compared to 78 months for the 0%-39% baseline group. Patients who progressed had a higher proportion of peripheral vascular disease, and current/former smoking compared to those who did not. While there were statistically significant correlations between medication classes and comorbidities, none of the medications studied appeared to slow carotid stenosis progression. CONCLUSIONS: In our experience, for patients with a 0%-39% carotid stenosis, follow-up examination should be performed at 6-year intervals. For patients with 40%-59% carotid stenosis, follow-up should be obtained annually to identify those who progress to a level requiring intervention. Future studies should examine whether study findings can be replicated using other approaches for determining carotid stenosis.

Prospective Evaluation of a Noninvasive Hemoglobin Measurement System in Total Joint Arthroplasty.

We sought to prospectively determine the efficacy of a noninvasive hemoglobin measurement system compared to a traditional blood draw in patients undergoing total joint arthroplasty. One hundred consecutive patients had their hemoglobin level measured by blood draw and the noninvasive device, simultaneously. Results were analyzed for the entire group and further stratified based on race and perfusion index measured by the device. The financial implications and patient satisfaction were compared. Hemoglobin measurements in the entire group and the two sub-groups were similar between the noninvasive device and the traditional blood draw. The noninvasive system was preferred by 100% of patients. Additionally, cost savings per patient using the noninvasive system was $16.50. This correlated to an 86% savings per case over the standard blood draw. The noninvasive hemoglobin monitoring system offers comparable measurements to a standard blood draw, while improving patient satisfaction and lowering costs. (Journal of Surgical Orthopaedic Advances 29(2):94-98, 2020).