Resilience, the 6th Vital Sign: Conceptualizing, Contextualizing, and Operationalizing All Six Vital Signs

There are five vital signs that healthcare providers assess: temperature, pulse, respiration, blood pressure, and pain. Normal levels for the five vital signs are published by the American Heart Association, and other specialty organizations, however, the sixth vital sign (resilience) which adopts the measure of immune resilience is suggested in this paper. Resilience is the ability of the immune system to respond to attacks and defend effectively against infections and inflammatory stressors, and psychological resilience is the capacity to resist, adapt, recover, thrive, and grow from a challenge or a stressor. Individuals with better optimal immune resilience had better health outcomes than those with minimal immune resilience. The purpose of this paper is to conceptualize, contextualize, and operationalize all six vital signs. We suggest measuring resilience subjectively and objectively. Subjectively, use a 5-item guided interview revised from the Connor-Davidson Resilience Scale (CDRC), a scale of 10 items. The revised CDRC scale is a 5-item scale. The scale is rated on a 5-point Likert scale from 0 (not true) to 4 (true all the time). The total score ranges from 0 to 20, with higher total scores indicating greater resilience. The scale demonstrated good construct validity and internal consistency (α = 0.85) during the development of the scale. The CD-RISC had a good Cronbach’s alpha level of 0.85. The Revised CD-RISC can be completed in 2 - 4 minutes. To measure resilience objectively, we suggest using Immune Resilience (IR) levels, the level of resilience to preserve and/or rapidly restore immune resilience functions that promote disease resistance and control inflammation and other inflammatory stress. IR levels are gauged with two peripheral blood metrics that quantify the balance between CD8 and CD4 T-cell levels and gene expression signatures tracking longevity-associated immunocompetence and mortality- or entropy-associated inflammation. IR deregulation is potentially reversible by decreasing inflammatory stress. IR metrics and mechanisms have utility as vital signs and biomarkers for measuring immune health and improving health outcomes.

Leveraging EfficientNetB3 in a Deep Learning Framework for High-Accuracy MRI Tumor Classification

Brain tumor is a global issue due to which several people suffer,and its early diagnosis can help in the treatment in a more efficient manner.Identifying different types of brain tumors,including gliomas,meningiomas,pituitary tumors,as well as confirming the absence of tumors,poses a significant challenge using MRI images.Current approaches predominantly rely on traditional machine learning and basic deep learning methods for image classification.These methods often rely on manual feature extraction and basic convolutional neural networks(CNNs).The limitations include inadequate accuracy,poor generalization of new data,and limited ability to manage the high variability in MRI images.Utilizing the EfficientNetB3 architecture,this study presents a groundbreaking approach in the computational engineering domain,enhancing MRI-based brain tumor classification.Our approach highlights a major advancement in employing sophisticated machine learning techniques within Computer Science and Engineering,showcasing a highly accurate framework with significant potential for healthcare technologies.The model achieves an outstanding 99%accuracy,exhibiting balanced precision,recall,and F1-scores across all tumor types,as detailed in the classification report.This successful implementation demonstrates the model’s potential as an essential tool for diagnosing and classifying brain tumors,marking a notable improvement over current methods.The integration of such advanced computational techniques in medical diagnostics can significantly enhance accuracy and efficiency,paving the way for wider application.This research highlights the revolutionary impact of deep learning technologies in improving diagnostic processes and patient outcomes in neuro-oncology.

Spatial Attention Integrated EfficientNet Architecture for Breast Cancer Classification with Explainable AI

Breast cancer is a type of cancer responsible for higher mortality rates among women.The cruelty of breast cancer always requires a promising approach for its earlier detection.In light of this,the proposed research leverages the representation ability of pretrained EfficientNet-B0 model and the classification ability of the XGBoost model for the binary classification of breast tumors.In addition,the above transfer learning model is modified in such a way that it will focus more on tumor cells in the input mammogram.Accordingly,the work proposed an EfficientNet-B0 having a Spatial Attention Layer with XGBoost(ESA-XGBNet)for binary classification of mammograms.For this,the work is trained,tested,and validated using original and augmented mammogram images of three public datasets namely CBIS-DDSM,INbreast,and MIAS databases.Maximumclassification accuracy of 97.585%(CBISDDSM),98.255%(INbreast),and 98.91%(MIAS)is obtained using the proposed ESA-XGBNet architecture as compared with the existing models.Furthermore,the decision-making of the proposed ESA-XGBNet architecture is visualized and validated using the Attention Guided GradCAM-based Explainable AI technique.

Sequences of low-copy nuclear gene support the monophyly of Ostrya and paraphyly of Carpinus （Betulaceae）

Coryloideae consists of four genera: Corylus, Ostryopsis, Carpinus, and Ostrya. While both molecular and non-molecular data support the close relationship of Carpinus and Ostrya, the monophyly of the two genera has remained controversial. In this study, sequences of the nuclear nitrate reductase (Nia) were used to test the naturalness of the two genera. Ostrya species form a robust clade, supporting the monophyly of the genus. The clade, however, is located between Carpinus cordata and the remaining species of Carpinus, indicating that Carpinus is paraphyletic, and Ostrya has evolved from within Carpinus. Within Carpinus, section Distegocarpus is polyphyletic, whereas section Carpinus is a clade where subsections Polyneurae and Carpinus are more closely related to each other than either is to subsection Monbeigianae.

Phylogeny of Catalpa （Bignoniaceae） inferred from sequences of chloroplast ndhF and nuclear ribosomal DNA

Phylogenetics of Chilopsis and Catalpa (Bignoniaceae) was elucidated based on sequences of chloro-plast ndhF and the nrDNA ITS region. In Bignoniaceae, Chilopsis and Catalpa are most closely related as sister genera. Our data supported section Macrocatalpa of the West Indies and section Catalpa of eastern Asian and North American continents. Within section Catalpa, Catalpa ovata of eastern Asia form a clade with North American species, C. speciosa and C. bignonioides, while the other eastern Asian species comprise a clade where C. duclouxii is sister to the clade of C. bungei and C. fargesii. The Caribbean species of Catalpa diverged early from the continental species. More studies are needed to test whether the phylogenetic pattern is common in eastern Asian-North American disjunct genera with species in the West Indies.

Synthesis of Multi-component Mass-exchange Networks

This paper presents a superstructure-based formulation for the synthesis of mass-exchange networks (MENs) considering multiple components. The superstructure is simplified by directly using the mass separation agents (MSA) from their sources, and therefore the automatic synthesis of the multi-component system involved in the MENs can be achieved without choosing a 'key-component' either for the whole process or the mass exchangers. A mathematical model is proposed to carry out the optimization process. The concentrations, flow rates, matches and unit operation displayed in the obtained network constitute the exact representation of the mass exchange process in terms of all species in the system. An example is used to illustrate and demonstrate the application of the proposed method.

Amphibians and Reptiles of Luzon Island, Philippines: the Herpetofauna of Pantabangan-Carranglan Watershed, Nueva Ecija Province, Caraballo Mountain Range

We present detailed species accounts for fifty-nine(59) species of amphibians and reptiles(17 frogs, 14 skinks, 3 agamids, 6 gekkonid lizards, 2 varanids, and 17 snakes) from Pantabangan-Carranglan Watershed, which lies within the Caraballo Mountain Range, whose biota is poorly-known. This was also the first extensive survey of herpetofauna within the watershed. Together with data from previous literature reviews, our records bring the total number of species of amphibians and reptiles for the Caraballo Mountain Range to 66. Forty-two(42) species from the area were Philippine endemics, with 25 species recorded only from Luzon faunal region. Seven species of herpetofauna are associated with unresolved taxonomic issues(new species and species complexes needing taxonomic partitioning, e.g. splitting of species groups). Two species recorded from the area were rarely represented in museum collections. Major distributional and elevational range extensions were recorded for several species. Comparison with Luzon’s other mountain ranges showed that the Caraballo Mountain Range is similar, in terms of species composition, to the northern Sierra Madre and Cordillera Mountain Ranges. The result of this survey showed the Caraballo Mountain Range and its mountains as a possible new center of herpetofaunal diversity and endemicity within Luzon. The importance of the Caraballo Mountain Range as an important biogeographic link merits further study.

Effect of whisker alignment on microstructure,mechanical and thermal properties of Mg-SiC_(w)/Cu composite fabricated by a combination of casting and severe plastic deformation(SPD)

In this research,microstructure evaluation,mechanical properties and thermal conductivity of the Mg-SiC_(w)/Cu composite with laminar structure were investigated.For this purpose,SiC whiskers were added to magnesium alloy by using stir-casting,then the Mg-SiC_(w)composite was bonded to copper layers by warm accumulative roll bonding(ARB).Based on the results of optical microscopy(OM)and scanning electron microscopy(SEM),SiC whiskers were well distributed in the magnesium matrix and they were aligned parallelly when the composites were plastically deformed at higher rolling passes.Furthermore,all layers remained continuous with localized necking sites.Also,no intermetallic compounds and phases were detected by XRD and EDS analyzes.Apart from the significant effect of severe plastic deformation on mechanical properties,the findings of mechanical tests point to the usefulness of reinforcements in improving up to 60%microhardness,Young’s modulus,yield,and up to 41%tensile strengths.Further,thermal conductivities of composites increased by adding reinforcement and above all by increasing the number of rolling passes.This growth is attributed to the higher thermal diffusivity of copper and whiskers as well as the increased number of conductive layers within composite.

Phylogenetics and biogeography of eastern Asian–North American disjunct genus Pachysandra (Buxaceae) inferred from nucleotide sequences

Pachysandra is an eastern Asian-North American disjtunct genus with three species, two in eastern Asia （Pachysandra axillaris and Pachysandra terminalis） and one in eastern North America （Pachysandra procurnbens）. Although morphological and cytological studies suggest a close affinity of Pprocumbens with P axillaris, molecular data from nuclear and chloroplast DNA regions have provided conflicting signals. In this study, we tested previous phylogenetic hypotheses using sequences of nuclear ribosomal DNA internal transcribed spacers and chloroplast ndhF gene from multiple individuals of each of the three species. We also estimated the time of divergence between eastem Asia and eastern North America. Our results support the morphological and cytological conclusion that P procumbens is more closely related to P axillaris than to P terminalis. The estimated time of divergence of P axillaris and P procumbens was 14.6±5.5 mya, consistent with estimates from many other eastern Asian-North American disjunct genera. The migration of Pachysandra populations from eastern Asia to North America might have occurred by way of the North Atlantic land bridge.

Comment of Walker and Avant’s method of concept analysis

In order to promote the nursing discipline to developindependently and scientifically, nursing practice shouldbe guided by nursing theory instead of intuition andexperience of nurses [1]. Nursing theory can assist nursesto deliver individual patient’s care and help to improveobservation and recognition of specific patient need, be itbiological, psychological or social [2]. Nursing theory hasdeveloped quickly and successfully in recent decadesinternationally; however, it is still in the early stage ofdevelopment in China.

High Intensity Neuromuscular Electrical Stimulation to Enhance Quadriceps Strength after Anterior Cruciate Ligament Reconstruction

Despite the implementation of accelerated ACL reha-bilitation and improved surgical technique, persistent quadriceps weakness continues to be reported in the liter-ature following ACL reconstruction.[1-4] The literature sug-gests, that the exclusive use of multijoint CKC

Deuterated dextromethorphan/quinidine for agitation in Alzheimer's disease

Alzheimer's disease(AD)is the most common type of neurode generative disorder;it affects around 47 million individuals worldwide(Prince et al.,2013).AD rose from the 12 th most burdensome disease in the United States in 1990 to the sixth in 2016 in terms of disability-adjusted life years(Alzheimer's Disease.

Prevalence of Group A Rotavirus in Piglets in a Peri-Urban Setting of Arusha, Tanzania

Aims: Rotavirus-associated enteritis is a major problem in livestock, notably in young piglets and calves, and is also a zoonosis. It is also associated with diarrhoea mainly in children less than five years of age. In Tanzania however, no study has addressed Rotavirus in livestock species. Following our previous report on Rotavirus infection in children within urban and peri-urban Arusha, we sought to understand the disease situation in livestock in the same area. Study Design: Place and Duration of Study: In this study, we investigated the prevalence of Rotavirus in pigs of suckling, weaning and post weaning/grazing/fattening age categories in Lemara, Moshono and Sokoni I areas of Arusha peri-urban. Methodology: Molecular detection of Rotavirus in stool samples was done using conventional PCR with primers targeting Group A Rotavirus (GARV). Using a standardized questionnaire, we sought to find out risk factors associated with positive cases of Rotavirus including age, sex, location, diarrhoea status, recent diarrhoea case in the farm, breed, type of grazing system and type of feeding of individual pigs. Results: Out of a total of 110 pigs sampled (fecal samples), 41.8% were positive for Rotavirus. Chi Square’s (χ2) Fisher’s Exact Test was used to relate PCR test results with various possible risk factors. Recent diarrhoea case in the farm was significantly (p < 0.05) associated with Rotavirus infection in pigs indicating the possible role of cross-infection within farm and also the environmental resistance and persistence of the virus in the farm. Conclusions: This was the first study to report on Rotavirus infection in pigs in Tanzania. The information obtained should form the platform for further studies to address the molecular epidemiology and relatedness of Rotavirus from human and porcine positive cases.

Endoscopic assisted facial rejuvenation: a 35 year personal journey

Aim:Traditional facelift techniques rely on pulling.They approach the superficial or intermediate layers where the facial nerves and muscles are located,increasing the risk of facial nerve injury.They approach the central oval from the periphery and produce unnatural vectors of pull and aesthetic results.Alternative techniques that work on the subperiosteal plane using endoscopic techniques are described.Modern concepts of volume augmentation,beautification and rejuvenation of the facial expression are an inherent part of such techniques,or can be easily integrated.Methods:The central oval is approached via four small scalp incisions and additional intraoral,upper gingivo-buccal incisions.The interconnected frontal subperiosteal,temporal subfascial and midface subperiosteal areas are lifted,imbricated and suspended sequentially.The brow/forehead is suspended to the skull using cortical screws.The midface and lower periorbita are suspended to the fascia of the temporal muscle.The buccal fat pad is used to enhance the ogee line of the midface.Other three-dimensional volumetric maneuvers can easily be applied.In this setting,upper and lower lid blepharoplasties become more straightforward,skin only procedures.Actinic or nicotine damaged skin can be treated with lasers,peels or fluidified fat grafting in the same setting.The excess skin on the lower face and neck can be redrapped with standard cervicofacial techniques.Deep subplatysmal cervicoplasty can be done concomitantly,or at another time to complete comprehensive rejuvenation.Results:The procedures described herein has been performed in 824 patients with excellent aesthetic results and low complication rate.The average rate of rejuvenation was 18 years. ;Conclusion:These combination techniques are called Biplanar Endoscopic Assisted Mask and Triplanar Endoscopic Assisted Mask facial rejuvenation.They are advanced techniques of facial rejuvenation that provide comprehensive,natural,long lasting results.