Pursuit-evasion games are the next logical stage in the exploring of powerful, intelligent, adaptive performance. In fact the optimal strategy is known for games in an infinitely sized playing field. The quality of the machine learning methods can thus be compared to the optimal performance possible. Therefore, we consider in this study a pursuit-evasion differential game in Hilbert space l2 with a hybrid system of dynamics. The game consists of a non-inertial pursuer and an inertial evader where controls of the pursuer and the evader are satisfied to the integral constraints. The duration of the game, φ, is fixed. The position of the evader at time φ satisfies to the phase constraint. We obtain attainability domains of the players and then we make a winning strategy for the pursuer which guarantees capturing the evader. We show that our constructed strategy is admissible as well.

The mechanical properties of biofilms can be used to predict biofilm deformation, for example under fluid flow. We used magnetic tweezers to spatially map the compliance of Pseudomonas aeruginosa biofilms at the micron scale, then used modeling to assess its effects on biofilm deformation. Biofilms were grown in capillary flow cells with Reynolds numbers (Re) ranging 0.28 to 13.9, bulk dissolved oxygen (DO) concentrations from 1 mg/L to 8 mg/L, and bulk calcium ion (Ca2+) concentrations of 0 and 100 mg CaCl2/L. Higher Re numbers resulted in more uniform biofilm morphologies. The biofilm was stiffer at the center of the flow cell than near the walls. Lower bulk DO led to more stratified biofilms. Higher Ca2+ led to increased stiffness and more uniform mechanical properties. Using the experimental mechanical properties, fluid-structure interaction models predicted up to 64% greater deformations for heterogeneous biofilms, compared to a homogeneous biofilms with the same average properties. However, the error depended on the biofilm morphology and flow regime. Our results show significant spatial mechanical variability exists at the micron scale, and that this variability can potentially affect biofilm deformation. The average mechanical properties, provided in many studies, should be used with caution when predicting biofilm deformation.

Abstract Objective: Since technological devices used for communication affect communication between people, Nomophobia is a disorder of a new age. In this study, we discuss the relationship between nomophobia and smoking addiction and the factors affecting them. Methods: The Demographic Information Form and Nomophobia Scale (NMP-Q), ıf they were smoking we applied the Fagerström Test for Nicotine Dependence (FTND) Scales were directed among students (N = 641) at Süleyman Demirel University studying Medicine, Dental, Nursing, and Physiotherapy departments in the 1st and 4th grades. Mann-Whitney U, Kruskal Wallis test to compare the scores of the variables with more groups. Correlation analysis was performed between the NMP-Q and Fagerström Test for Nicotine Dependence scores by Spearman correlation. Bonferroni test applied as Post Hoc test for multiple comparisons of groups. Results: In our study, 267 (42,6%) of participants who had nomophobia refuse to be dependent and smartphone addiction level was found to be 99.69 for all students.Responses were received from 73,2% (n=469) female and 26,8% (n=172) male participants. There is no significant difference between smokers in terms of factors in nomophobia (p>0.05). Total score of the questionnaire (p<0.01*) by gender and averages scores of women were higher in all mentioned sub-dimensions and total scores. Conclusions: In our study, there was no correlation between nomophobia and cigarette addiction due to the low number of smokers participating in our survey. Therefore, new conflicts with wider audiences are needed to examine the relationship between these two addictions Keywords: Nomophobia, Smartphone Addiction, Cigarette, Addiction What’s Already Known About This Topic? All addictions trigger each other. Here, we examined the effects of these two addictions on each other. ’What does this article add? There are not many studies on the effects of nomophobia and smoking addiction on each other. People should be careful about these two addictions.

Aim: We aimed to investigate the predictor role of the systemic immune-inflammation index (SII) on Bacille Calmette Guerin (BCG) response in patients with high-risk non-muscle invasive bladder cancer (NMIBC). Methods: A total of 96 patients with high-risk NMIBC, who received intravesical BCG, were enrolled in the study. BCG responsive group (group 1) and BCG failure group (group 2) were compared in terms of demographic and pathological data, peripheral lymphocyte, neutrophil, and platelet counts, neutrophile lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), SII, recurrence free survival (RFS) and progression free survival (PFS). The prognostic ability of the SII for progression was analyzed with multivariate backward stepwise regression models. Results: The mean follow-up time 34.635±14.7 months. Group 2 had significantly higher SII, peripheral lymphocyte, neutrophil, and platelet counts than group 1. A ROC curve was plotted for the SII to predict the BCG failure and the cut-off point was calculated as 672.75. Effect of the SII to the model was statistically significant (p=0.003) and a higher SII increased the progression one-fold. A tumor greater than 30 mm in size and a high SII together increased the progression 3.6 folds. Conclusions: The SII might be a successful, non-invasive and low-cost parameter for prediction of BCG failure in patients with high-risk NMIBC. The cut-off value for SII is 672.75 and above this level BCG failure and progression to MIBC might be anticipated. However, these results should be validated in prospective randomized controlled studies with large patient groups.

Background and Purpose: The activation of the defense reaction inhibits the baroreflex response through the B3 and nucleus tractus solitarius (NTS) regions. Our aim was to determine whether and how baroreflex inhibition induced by the disinhibition of the rostral cuneiform nucleus, part of the defense pathway, involves serotonin cells in B3 and 5-HT3 receptors in the NTS. Experimental Approach: We performed immunohistochemistry and anatomical experiments to determine whether raphe serotonin cells expressing Fos were directly targeted by the rostral cuneiform nucleus. The effect of blocking raphe serotonin transmission and NTS 5-HT3 receptors, on cuneiform-induced inhibition of the baroreflex cardiac response, were also analyzed. Key Results: Bicuculline microinjected into the rostral cuneiform nucleus induced an increase of double labeled Fos-5-HT IR cells in both the LPGi and Raphe Magnus. The anterograde tracer Phaseolus vulgaris leucoaggutinin into the rostral cuneiform nucleus revealed a dense projection to the LPGi but not Raphe Magnus. Cuneiform-induced baroreflex inhibition was prevented by B3 injection of 8-OH-DPAT, a specific agonist for 5-HT1A receptors. Cuneiform disinhibition also failed to inhibit the baroreflex bradycardia after microinjection of a 5-HT3 receptor antagonist (granisetron) into the NTS or in 5-HT3 receptor knock-out mice. Conclusion and Implications: In conclusion, the rostral cuneiform nucleus participates in the defense inhibition of the baroreflex bradycardia via direct activation of the LPGi and a relay to the Raphe Magnus, to activate NTS 5-HT3 receptors and inhibit second-order baroreflex neurons. These data bring new insights in primary and secondary mechanisms involved in vital baroreflex prevention during stress.

Objective: The aim of this study is to find out the potential risk factors including Charlson Comorbidity index (CCI) score associated with death in COVID-19 cases hospitalized due to pneumonia and try to find a novel COVID-19 mortality score for daily use. Methods: All patients diagnosed as confirmed or probable COVID-19 pneumonia whom hospitalized in our Chest Diseases Education and Research Hospital between March 11, 2020 and May 15,2020 were enrolled. The optimal cut-off values, sensitivity and specificity values and odds ratios to be used in mortality prediction of the novel scoring system created from these parameters were calculated by ROC analysis according to the area under the curve and Youden index. Results: Over 383 patients (n:33 deceased, n:350 survivors) univariate and multivariate regression analysis showed that CCI and lymphocyte ratio were prognostic factors for COVID-19 related mortality. Using this analysis, a novel scoring model CoLACD (CoVID-19 Lymphocyte ratio, Age, CCI score, Dyspnea) was established. The cut-off value of this scoring system, which determines the mortality risk in patients, was 2.5 points with 82% sensitivity and 73% specificity (AUC = 0.802, 95% CI 0.777-0.886, p <0.001). The risk of mortality was 11.8 times higher in patients with a CoLACD mortality score higher than 2.5 points than patients with a score lower than 2.5 (OR = 11.8 95% CI 4.7-29.3 p <0.001). Conclusion: This study showed that by using the CoLACD mortality score, clinicians may achieve a prediction of mortality in COVID-19 patients hospitalized for pneumonia.

Rationale The end of life (EOL) experience in the intensive care unit (ICU) can be psychologically distressing. The 3 Wishes Project (3WP) personalizes the EOL experience by carrying out wishes for dying patients and their families. While the 3WP has been integrated in academic, tertiary care ICUs, implementing this project in a community ICU has yet to be described. Objectives To examine facilitators of, and barriers to, implementing the 3WP in a community ICU from the clinician and key-stakeholder perspective. Methods This mixed-method study evaluated the implementation of the 3WP in a 20-bed community ICU in Southern Ontario, Canada. Patients were considered for the 3WP if they had a high likelihood of imminent death or planned withdrawal of life-sustaining therapy. Quantitative data include patient demographic data and wishes implemented. Following the qualitative descriptive approach, semi-structured interviews were conducted with purposively sampled clinicians and key-stakeholders. Data from transcribed interviews were analyzed in triplicate through qualitative content analysis. Results During the 10-month period, 66 of 67 wishes were completed, with a median of 4.5 wishes per patient-family dyad. Interviews with 12 participants indicated that the 3WP personalized and enriched the EOL experience for patients, families and clinicians. Interviewees indicated higher intensity education strategies were needed to enable spread as the project grew. Clinicians described many physical resources for the project but required more non-clinical project support for orientation, continuing education and data collection. Instead, these roles were completed by clinicians with saturated work capacity which may have inhibited the spread of the project. Conclusions In this community hospital, ICU clinicians and key stakeholders reported the 3WP improved EOL care for patients, families, and clinicians. Project implementation in a community ICU requires investigators take into account project characteristics and adapt the intervention to the community hospital context.

The Maximum Entropy Theory of Ecology (METE) predicts the shapes of macroecological metrics in relatively static ecosystems using constraints imposed by static state variables. In disturbed ecosystems, however, with time-varying state variables, its predictions often fail. We extend macroecological theory from static to dynamic by combining the MaxEnt inference procedure with explicit mechanisms governing disturbance. In the static limit, the resulting theory, DynaMETE, reduces to METE but also predicts new scaling relationships among static state variables. Under disturbances, expressed as shifts in demographic, ontogenic growth, or migration rates, DynaMETE predicts the time trajectories of the state variables as well as the time-varying shapes of macroecological metrics such as the species abundance distribution and the distribution of metabolic rates over individuals. An iterative procedure for completely solving the dynamic theory is presented. In a lowest-order iteration, characteristic signatures of the deviation from static predictions of macroecolgoical patterns are shown to result from different kinds of disturbance. Because DynaMETE combines MaxEnt inference with explicit dynamical mechanisms, but does not assume any specific trait distributions over species or individuals, it is widely applicable across diverse ecosystems. This makes it a promising theory of macroecology for ecosystems responding to anthropogenic or natural disturbances.

Purpose Tear fluid N-Glycome from patients affected with vernal (VKC) and atopic keratoconjunctivitis (AKC) was investigated to identify specific changes in tears and to recognize possible glyco-biomarkers. Methods The analysis of N-glycans was performed using matrix-assisted laser desorption ionization mass spectrometry on single tear samples. Tears from control normal subjects (CTRL), VKC and AKC patients were processed and treated with peptide N-glycosidase F (PNGase F) to deglycosylate N-glycoproteins. Released N-glycans were purified, permethylated and analyzed by Matrix-Assisted Laser Desorption/Ionization-Time Of Flight Mass Spectrometry and tandem Mass Spectrometry (MALDI-TOF MS and MALDI-TOF MS/MS). Results More than 150 complex N-glycans, including highly fucosylated biantennary, triantennary, tetraantennary and bisecting species, were observed in our spectra. Three distinct patterns for CTRL, VKC and AKC patients were identified in terms of relative intensities for some N-glycans structures. Major variations involved bisecting and hyperfucosylated glycoforms. The most intense ions were associated to species at m/z 1907.0 (asialo, agalacto, bisected, biantennary structure – NGA2B) in CTRL MS profiles, at m/z 2605.3 and 2966.5 in VKC, and at m/z 2792.4 in AKC corresponding to a well-known biantennary, disialylated N-glycan. Several peaks were associated to structures bearing one or two Lewis X epitopes. Structures were confirmed by MS/MS analysis. Quantitative differences among the three groups were statistically significant. Conclusions Tear MS profiles are rich in specific glycoforms, particularly those with a high fucosylation degree, indicating both core and peripheral decoration. Tear N-glycome analysis provided important information for a better comprehension of VKC and AKC alterations at the molecular level

The Ocean Barcode Atlas (OBA) is a user friendly web service designed for biologists who wish to explore the biodiversity and biogeography of marine organisms locked in otherwise difficult to mine planetary scale DNA metabarcode datasets. Using just a web browser, a comprehensive picture of the diversity of a taxon or a barcode sequence is visualized graphically on world maps and interactive charts. Interactive results panels allow dynamic threshold adjustments and the display of diversity results in their environmental context measured at the time of sampling (temperature, oxygen, latitude, etc.). Ecological analyses such as alpha and beta-diversity plots are produced via publication quality vector graphics representations. Currently, the Ocean Barcode Altas is deployed online with the i) Tara Oceans eukaryotic 18S-V9 rDNA metabarcodes, ii) Tara Oceans 16S/18S rRNA miTags, and iii) 16S-V4V5 metabarcodes collected during the Malaspina-2010 expedition. Additional prokaryotic or eukaryotic plankton barcode datasets will be added upon availability, given they provide the required complement of barcodes (including raw reads to compute barcode abundance) associated with their contextual environmental variables. Ocean Barcode Atlas is a freely-available web service at: http://oba.mio.osupytheas.fr/ocean-atlas/.

Background: Differences in cardiac remodeling after mitral valve (MV) surgery between the sexes is poorly understood. Inferior outcomes for females undergoing MV surgery compared to males have been suggested in the literature, although causative factors behind this discrepancy have not been identified. Materials and Methods: In this propensity-matched, retrospective, single-center study, we sought to identify the impact that sex may have on cardiac remodeling and long-term outcomes to better inform clinical decision making in MV surgical intervention. Outcomes were compared between males and females undergoing MV replacement (MVR) between 2004 and 2018. The primary outcome was cardiac remodeling 1 year postoperatively. Secondary outcomes included mortality, stroke, myocardial infarction (MI), reoperation of the MV, and rehospitalization. Results: 314 males and 314 females were included after propensity matching. Males demonstrated a significant degree of improved left ventricular remodeling while females did not, and females showed a significant degree of left atrial remodeling while males did not. Mortality rates were relatively equivalent between the two groups, although males were more likely to develop sepsis and require rehospitalization due to MI. Conclusions: There has been little research exploring the differences in cardiac remodeling between the sexes after MVR. The results of this study have suggested that MVR is equally safe for both sexes and has demonstrated a difference in the heart’s ability to remodel after MVR. The significance of this difference has the potential to result in largely different clinical outcomes for males and females. Further study is necessary to fully elucidate this relationship.

Inadvertent endocardial lead malposition is recognised as a rare incident which is usually underreported and if recognised during implantation can be easily corrected. This phenomenon is caused by the ventricular lead unintentionally crossing a pre-existing patent foremen ovale, septal defects (atrial or ventricular) or directly from the aorta via an accidental subclavian puncture resulting in the lead implanting into the left ventricle. While this is a rare occurrence we report the incidental finding of pacemaker lead malposition during a routine follow-up transthoracic echocardiogram and the benefits of three dimensional transoesophageal echocardiography in this patient prior to lead extraction.

The serious drawbacks of conventional pancreatic ductal adenocarcinoma (PDAC) therapy like nonspecific toxicity and high resistance to chemo and radiation therapy, prompted the development and application of countless siRNA-based therapeutics. Significant technological success has been achieved in this area; however, the major challenges to siRNA-based therapeutics becoming a new paradigm in the pancreatic cancer therapy stem from enzymatic digestion, off-target effects, difficulty to enter cells, induction of innate immune responses, and renal clearance. Recent advances in drug delivery systems hold great promise for improving siRNA-based therapeutics and developing a new class of drugs, nano-siRNA drugs. However, a number of fundamental questions, regarding toxicity, immunostimulation, and poor knowledge of nano-bio interactions, need to be addressed before clinical translation. In this review, we provide recent achievements in designing and development of various non-viral delivery vehicles for pancreatic cancer therapy. More importantly, co-delivery of conventional anticancer drugs with siRNA as a new revolutionary pancreatic cancer combinational therapy is completely discussed.

The Jordan River Basin, and its seven sub-catchments of the Central Wasatch Mountains immediately east of Salt Lake City, UT, are home to an array of research infrastructrure that collectively form the Wasatch Environmental Observatory (WEO). Each sub-catchment is comprised of a wildland to urban land use gradient that spans an elevation range of over 2000 m in a linear distance of ~25km. Geology varies across the sub-catchments, ranging from granitic, intrusive to mixed sedimentary rocks in uplands that drain to the alluvial or colluvial sediments of the former Lake Bonneville. Vegetation varies by elevation, aspect, distance to stream channels, and land use.  The sharp elevation gradient results in a range of precipitation from 700 to 1200 mm/yr (roughly 2/3 as snow) and mean annual temperature from 3.5 o to 6.8o C. Spring snowmelt dominates annual discharge. Although climate is relatively similar across the catchments, annual water yield varies spatially by more than a factor of 3, ranging from 0.18 to 0.63. With historical strengths in ecohydrology, water supply, and social-ecological research, current infrastructure supports both basic and applied research in meteorology, climate, atmospheric chemistry, hydrology, ecology, biogeochemistry, resource management, sustainable systems, and urban redesign. Climate and discharge data span over a century for the seven sub-catchments of the larger basin. These data sets, combined with multiple decades of hydrochemistry, isotopes, ecological data sets, social survey data sets, and high-resolution LiDAR topography and vegetation structure, provide a baseline for long-term data collected by NEON, public agencies, and individual research projects. The combination of long-term data with active state of the art observing facilities allows WEO to serve as a unique natural laboratory for addressing research questions facing rapidly growing, seasonally snow-covered, semi-arid regions worldwide and an excellent facility for providing student education and research training.

It has been long believed that ischemic mitral regurgitation is secondary to left ventricular remodelling and the mitral per se remains unaffected. This proviso has recently been challenged and the mitral valve has been described as a structure that responds and adapts to challenges and attempts to correct the mitral regurgitation. The response of mitral valves in this setting can be incomplete or can even be mal-adapted. The ability of the mitral valve to respond in this manner has been described as “mitral plasticity”. Endothelial to Mesenchymal transition and Valvular Interstitial Cells are key to this mitral plasticity and function through a complex array of signalling pathways. Identification and manipulation of these pathways may provide a possibility to correct the incomplete or mal-adapted mitral valve responses. Surgical treatment can also be tailored based on whether the valve has maladapted or has undergone incomplete adaptation.

A total of 130 patients who underwent robotic mitral valve surgery and conventional mitral valve surgery with full sternotomy between 2014 and 2020 were included in our study. All patients were divided into two groups; Group I, with 64 patients who underwent robotic mitral valve replacement, and Group II, with 66 patients with conventional full sternotomy. General demographic data (age, gender, body weights, etc.), comorbidities (hypertension, diabetes mellitus, chronic obstructive pulmonary disease, peripheral artery disease, hyperlipidemia, etc.), intraoperative variables (cardiopulmonary bypass times, cross-clamp times) postoperative ventilation times, drainage amounts, transfusion amount, inotropic need, revision, arrhythmia, intensive care and hospital stay times and mortality were analyzed retrospectively. According to conventional methods, robotic mitral valve replacement is an effective and reliable method, since total perfusion and cross clamp times are longer, drainage amount and blood transfusion need are less, ventilation time, intensive care and hospital stay time are shorter. Compared to conventional methods, robotic surgery is an increasingly widespread successful treatment option because of its early mobilization, rapid recovery, better cosmetic outcome and improving quality of life.

Objectives:Surgical management of aortic arch hypoplasia with associated intra-cardiac anomalies is a challenge in newborns.We reviewed the characteristics and outcomes of neonates and infants who underwent pulmonary artery banding concomitant to arch repair and single-stage total repair at our institution. Methods:Medical records of 60 patients undergoing aortic arch reconstruction for aortic arch hypoplasia between 2014 to 2019 were retrospectively reviewed.Twenty-five patients were female (41.6%), and the age of the patients ranged from 4 to 120 days (median 19.5 days).The patients were divided into two groups;Group 1 (23 patients) underwent pulmonary artery banding concomitant to arch repair, Group 2 (37 patients) underwent single-stage total repair in addition to arch repair.All arch repair procedures consisted of an extended (to the midportion of the ascending aorta)patch aortoplasty. Results:Postoperative early mortality occurred in 12 patients, 8 in Group 1(34.8%), and 4 in Group 2 (10.8%).There was an early survival advantage in group 2 (p=0.019).Recoarctation was occurred in 13 cases (21.6%), and 11 (18.3%) of them required reintervention (balloon angioplasty:7, re-operation:4).On univariate analysis, risk factors associated with death were pulmonary artery banding (HR,0.44;CI,0.09-2;p=0.019),prematurity (HR,4,67;CI,1.34-16.18;p=<0.001),preoperative mechanical ventilation support requirement (HR,0.048;CI, 0.52-6.39;p=0.048),and functional single ventricle (HR,0.43;CI,0.1-1.86;p=0.006).The mean duration of follow-up was 21.9±15.1 months, and there was no late death in each group. Conclusion:Single-stage repair of aortic arch hypoplasia with intracardiac pathologies has better results than palliation, according to survival rates and postoperative results.The use of patch augmentation technique in aortic arch hypoplasia is valid and associated with an acceptable incidence of recurrent arch obstruction.

A document by Atish Bakane. Click on the document to view its contents.