血压随年龄而升高,老年人高血压患病率较高。收缩压升高可能是老年人心血管病的最重要危险因素。最近几项大型临床试验显示,降压药降低血压的同时可降低老年人的心血管事件和死亡率。对年龄〉80岁患者进行降压治疗的老老年高血压试验（h...血压随年龄而升高,老年人高血压患病率较高。收缩压升高可能是老年人心血管病的最重要危险因素。最近几项大型临床试验显示,降压药降低血压的同时可降低老年人的心血管事件和死亡率。对年龄〉80岁患者进行降压治疗的老老年高血压试验（hypertension in the very elderly trial,展开更多
One of the most significant annual expenses that a person has is their health insurance coverage. Health insurance accounts for one-third of GDP, and everyone needs medical treatment to varying degrees. Changes in med...One of the most significant annual expenses that a person has is their health insurance coverage. Health insurance accounts for one-third of GDP, and everyone needs medical treatment to varying degrees. Changes in medicine, pharmaceutical trends, and political factors are only a few of the many factors that cause annual fluctuations in healthcare costs. This paper describes how a system may analyse a person’s medical history to display their insurance plans and make predictions about their health insurance premiums. The performance of four ML models—XGBoost, Lasso, KNN, and Ridge—is evaluated using R2-score and RMSE. The analysis of medical health insurance cost prediction using Lasso regression, Ridge regression, and K-Nearest Neighbours (KNN), and XGBoost (XGB) highlights notable differences in performance. KNN has the lowest R2-score of 55.21 and an RMSE of 4431.1, indicating limited predictive ability. Ridge Regression improves on this by an R2-score of 78.38 but has a higher RMSE of 4652.06. Lasso Regression slightly edges out Ridge with an R2-score of 79.78, yet it suffers from an advanced RMSE of 5671.6. In contrast, XGBoost excels with the highest R2-score of 86.81 and the lowermost RMSE of 4450.4, demonstrating superior predictive accuracy and making it the most effective model for this task. The best method for accurately predicting health insurance premiums was XGBoost Regression. The findings beneficial for policymakers, insurers, and healthcare providers as they can use this information to allocate resources more efficiently and enhance cost-effectiveness in the healthcare industry.展开更多
This paper proposes a blockchain-based system as a secure, efficient, and cost-effective alternative to SWIFT for cross-border remittances. The current SWIFT system faces challenges, including slow settlement times, h...This paper proposes a blockchain-based system as a secure, efficient, and cost-effective alternative to SWIFT for cross-border remittances. The current SWIFT system faces challenges, including slow settlement times, high transaction costs, and vulnerability to fraud. Leveraging blockchain technology’s decentralized, transparent, and immutable nature, the proposed system aims to address these limitations. Key features include modular architecture, implementation of microservices, and advanced cryptographic protocols. The system incorporates Proof of Stake consensus with BLS signatures, smart contract execution with dynamic pricing, and a decentralized oracle network for currency conversion. A sophisticated risk-based authentication system utilizes Bayesian networks and machine learning for enhanced security. Mathematical models are presented for critical components, including transaction validation, currency conversion, and regulatory compliance. Simulations demonstrate potential improvements in transaction speed and costs. However, challenges such as regulatory hurdles, user adoption, scalability, and integration with legacy systems must be addressed. The paper provides a comparative analysis between the proposed blockchain system and SWIFT, highlighting advantages in transaction speed, costs, and security. Mitigation strategies are proposed for key challenges. Recommendations are made for further research into scaling solutions, regulatory frameworks, and user-centric designs. The adoption of blockchain-based remittances could significantly impact the financial sector, potentially disrupting traditional models and promoting financial inclusion in underserved markets. However, successful implementation will require collaboration between blockchain innovators, financial institutions, and regulators to create an enabling environment for this transformative system.展开更多
Objectives:As Watson's Human Caring Theory continues to evolve and guide the discipline of nursing,the challenge is to find ways to integrate it into practice.The purpose of this study is to describe interprofessi...Objectives:As Watson's Human Caring Theory continues to evolve and guide the discipline of nursing,the challenge is to find ways to integrate it into practice.The purpose of this study is to describe interprofessional team members'perspectives on human caring based on the Ten Caritas Processes(R)/Caritas-Veritas Literacy of Watson's Human Caring Theory within the Unitary Caring Science.Methods:This is a qualitative directed content analysis study,taking place in a Children's Hospital in the United States between November 2017 and April 2018.Information redundancy was utilized to guide the recruitment.Data were collected via a one-time face-to-face individual interview.A qualitative directed content analysis was conducted using Watson's Ten Caritas Processes(R)/Caritas-Veritas Literacy as a coding framework.Results:Twenty-seven healthcare professionals participated in the study.Interprofessional human caring,based on the Ten Caritas Processes(R)/Caritas-Veritas Literacy,was referred to as performing lovingkindness to patients,each other,and self;maintaining faith-hope in teamwork;valuing intersubjective interactions and building trust among team members;cultivating heart-centered-caring relations;acknowledging and processing positive and negative feelings non-judgmentally;applying all ways of knowing in caring;encouraging reciprocal teaching-learning;developing caring-healing environments collaboratively;respecting human dignity of patients and each other;and being open-minded to the unknowns and believing in miracles.Conclusions:Watson's Human Caring Theory can be an underlying guide to enrich human-to-human relations and create a caring-healing environment.When human caring is applied in interprofessional teams,healthcare professionals find a caring consciousness to care for oneself and each other and promote patient care.展开更多
Objectives:To explore the factors affecting breastfeeding behaviors in women after cesarean section.Methods:This is a qualitative study that used a phenomenological approach.This study used individual face-to-face int...Objectives:To explore the factors affecting breastfeeding behaviors in women after cesarean section.Methods:This is a qualitative study that used a phenomenological approach.This study used individual face-to-face interviews with 19 women who underwent a cesarean section in a Women and Children’s Hospital in China between July to September 2019.Information saturationwas used to determine sample size.Data were analyzed using a thematic content analysis method.Themes were developed based on the theory of planned behavior.Results:Thirteen(68.42%)had a planned cesarean section,and six(31.58%)cesarean sections were unplanned or emergent.Three major themes emerged:ambivalent attitude about breastfeeding,motivation to comply with the traditional cultural norms,and barriers and challenges.The motivating factors for breastfeeding after cesarean sections included perceived benefits of human milk,support from healthcare professionals,and responsibility for breastfeeding.The challenges for breastfeeding after cesarean sections included physical discomfort,knowledge and skills deficit of breastfeeding,lactation deficiency,and lack of knowledge and coping skills in managing their depressive mood after cesarean sections.There were a couple of neutral factors,such as the influences of family and peers.These factors could influence women either positively as facilitators or negatively as barriers.Conclusions:The findings can offer valuable information for healthcare professionals to help women breastfeed after cesarean sections.To promote women’s breastfeeding behaviors after cesarean sections,it is necessary to change women’s attitudes,belief systems,and the external environments and help them become more confident.展开更多
Honeybees (Apis mellifera) are important pollinators of flowering plants and agricultural crops contributing annually to billions of dollars in revenues to crop production. Honeybees have an average lifespan between 8...Honeybees (Apis mellifera) are important pollinators of flowering plants and agricultural crops contributing annually to billions of dollars in revenues to crop production. Honeybees have an average lifespan between 8 weeks to 5 years. Dead honeybees are abundantly available in beehives and can be utilized as an alternative source to synthesize nanoparticles. In recent years, biologically synthesized nanoparticles have been preferred over their chemical counterparts. However, honeybee-based-green synthesis of nanoparticles has not been explored yet. Herein, we report the biosynthesis of silver nanoparticles from honeybees and its antibacterial activity. The synthesis of silver nanoparticles was monitored visually through a gradual change in color. Furthermore, the biosynthesized nanoparticles were confirmed and characterized by UV-visible spectroscopy. Scanning Electron Microscope was utilized to analyze the average size and morphologies of the biosynthesized nanoparticles. Subsequently, the antibacterial potential of the biosynthesized silver nanoparticles was tested against selected Gram-positive and Gram-negative bacterial strains. It was found that a distinct color change from yellow to brown in the reaction solution suggested the formation of silver nanoparticles. The biosynthesized nanoparticles exhibited absorption maxima at 430 nm. The SEM analysis confirmed the spherical and cuboidal shape of the biosynthesized silver nanoparticles with a size range between 10 - 40 nm. Furthermore, the biosynthesized silver nanoparticles exhibited strong antimicrobial potential against tested Gram-positive and Gram-negative bacteria strains by aggregating on the cell surface. This study showcases the biomedical and agricultural applications of biosynthesized silver nanoparticles from honeybee wings. .展开更多
Customer churn poses a significant challenge for the banking and finance industry in the United States, directly affecting profitability and market share. This study conducts a comprehensive comparative analysis of ma...Customer churn poses a significant challenge for the banking and finance industry in the United States, directly affecting profitability and market share. This study conducts a comprehensive comparative analysis of machine learning models for customer churn prediction, focusing on the U.S. context. The research evaluates the performance of logistic regression, random forest, and neural networks using industry-specific datasets, considering the economic impact and practical implications of the findings. The exploratory data analysis reveals unique patterns and trends in the U.S. banking and finance industry, such as the age distribution of customers and the prevalence of dormant accounts. The study incorporates macroeconomic factors to capture the potential influence of external conditions on customer churn behavior. The findings highlight the importance of leveraging advanced machine learning techniques and comprehensive customer data to develop effective churn prevention strategies in the U.S. context. By accurately predicting customer churn, financial institutions can proactively identify at-risk customers, implement targeted retention strategies, and optimize resource allocation. The study discusses the limitations and potential future improvements, serving as a roadmap for researchers and practitioners to further advance the field of customer churn prediction in the evolving landscape of the U.S. banking and finance industry.展开更多
Cholesteatoma is a fairly otologic common problem. However, cholesteatoma invading the internal auditory canal (IAC) is rare and typically results in profound hearing loss and facial paralysis. This is a case of a 46-...Cholesteatoma is a fairly otologic common problem. However, cholesteatoma invading the internal auditory canal (IAC) is rare and typically results in profound hearing loss and facial paralysis. This is a case of a 46-year-old female with a history of prior right complex cholesteatoma that had undergone multiple procedures. She had multiple complications including right cerebral spinal fluid (CSF) leak, meningitis, recurrent mastoid bowl infections and right facial paralysis which resulted in multiple facial plastics procedures and overclosure of the right ear. Over the last three years, she has noticed an increase in right sided otalgia, facial pressure, facial numbness and headaches. An MRI temporal bone with diffusion weighted imaging (DWI) showed a DW positive soft tissue mass filling the mastoid bowl as well as extending into the IAC and cerebellar pontine angle (CPA) cistern with contact of the middle cerebellar peduncle and trigeminal nerve. A translabyrinthine approach to the IAC found the mastoid bowl to be filled with cholesteatoma and an osseous defect from the mastoid bowl along the labyrinthine facial nerve tracking cholesteatoma into the IAC/CPA. This case highlights the complex and aggressive nature a cholesteatoma can take and the need for diligent surveillance in any ear that had prior cholesteatoma. The utilizations of MRI temporal bone with diffusion weighted imaging allow for surveillance in an over closed ear canal that is vital to the care of cholesteatoma patients who have a similar history.展开更多
This case is a 49-year-old female patient who presented with suspected eustachian tube dysfunction symptoms that were refractory to medical treatment. She presented with conductive hearing loss and aural fullness on t...This case is a 49-year-old female patient who presented with suspected eustachian tube dysfunction symptoms that were refractory to medical treatment. She presented with conductive hearing loss and aural fullness on the left. A physical exam revealed an epitympanic fleshy mass in the middle ear with effusion. Imaging with MRI and CT showed opacification of the epitympanum with surrounding bony demineralization bilaterally left greater than right and significant thinning versus dehiscence of the tegmen mastoideum and tympani on the left with only thinning of the tegmen on the right. An MR temporal bone with and without contrast, demonstrated enhancement of the left middle ear extending to the tegmen and corresponding enhancement of the dura along the floor of the left middle cranial fossa as well as extending along foramen ovale into the infratemporal fossa. There was to a lesser degree similar appearance on the right. A biopsy of the middle ear mass on the left revealed meningioma. This case highlights the need to widen your differential with common symptoms when they are refractory to treatment.展开更多
This is a case of a 60-year-old male with a history of prior left middle fossa meningioma that was partially resected with an operative report noting diffuse attachment to the middle fossa floor. Gamma knife was recom...This is a case of a 60-year-old male with a history of prior left middle fossa meningioma that was partially resected with an operative report noting diffuse attachment to the middle fossa floor. Gamma knife was recommended but he never completed this management. He then presented about eight years later with a mass from his left external auditory canal. It was reported that two years prior another surgeon operated on the left ear for a cholesteatoma. CT temporal bone showed complete opacification of left EAC, mastoid bowl, and remaining mastoid air cells. In addition, there were irregular bony/hyperostotic changes seen within the left sphenoid and temporal bone. There was dural thickening within the middle fossa adjacent to the previously described hyperostotic bony changes. A mastoidectomy and excision of mass revealed extensive adhesive tissue throughout the middle ear, and mastoid up to the tegmen. Pathology of the portions that were resected confirmed Grade 1 meningioma. Stereotactic gamma knife radiation was completed to the area to prevent further growth. This case highlights extracranial meningioma that did not have definitive management for prior middle fossa floor meningioma. It also highlights the need to think of less common pathology in the middle ear and external auditory canal.展开更多
Glioblastoma Multiforme (GBM) represents one of the most aggressive and metastatic brain tumors, with a dismal success rate of less than three percent after five years, particularly in tumors with active immune checkp...Glioblastoma Multiforme (GBM) represents one of the most aggressive and metastatic brain tumors, with a dismal success rate of less than three percent after five years, particularly in tumors with active immune checkpoints. This necessitates the development of targeted endogenous agents for precise GBM treatment. Previous experiments utilizing Chemovar Specific Cannabis Extractions (CSCEs), fractionated with polar solvents and quantified using Liquid and Gas Column Chromatography combined with Mass Spectrometry (LC/GCMS), have shown reduced viability and motility in human GBM cell lines. However, the complexity of the botanical substance has hindered the personalization of standard cannabis medicines for GBM due to unknown synergistic effects of multiple compounds. To address this limitation, our study focuses on exposing AM251 cells to chemovar fractions extracted using a non-polar solvent, thereby isolating a broader spectrum of constituents. By employing LC/GCMS in conjunction with Nuclear Magnetic Resonance (NMR), we have identified and quantified nine* compounds present in the non-polar CSCE that exhibit significant efficacy (0.1 μM) in inducing cytotoxicity* in GBM tumor cells. Conversely, the polar fraction in our experiment did not demonstrate efficacy against UM251 cells. The quantification of individual compounds within a cannabis extraction that selectively induces cell death in brain tumors holds promise for guiding future research and facilitating the development of a standardized CSCE for GBM therapy.展开更多
Introduction: Transition of care strategies have shown to improve quality of lives of heart failure patients, but it has little implemented in clinical settings. Objective: To evaluate context-specific perceived barri...Introduction: Transition of care strategies have shown to improve quality of lives of heart failure patients, but it has little implemented in clinical settings. Objective: To evaluate context-specific perceived barriers and experiences of heart failure patients during their admission and after they were discharged from hospital. Methods: A cross-sectional qualitative study was conducted among 13 heart failure patients at two large referral hospitals in northwestern Tanzania. In-depth interviews among heart failure patients, in line with the Consolidated Criteria for Reporting Qualitative research checklist, were used to collect data. Interviews were audio recorded, transcribed, and translated into English. Results: Three key barriers were identified, as well as possible solutions that could improve the transition of care for heart failure patients. These include strengthening healthcare provider communications, organizing medication management, and assisting with follow-up appointments. Conclusion: The barriers identified are real and challenging in clinical resource- limited settings. Findings suggest they can be overcome when realistic and tailor-made interventions are in place.展开更多
Objectives:To examine the efficacy of an intervention based on the theory of planned behavior(TPB)in improving breastfeeding behavior among women with cesarean sections(C-sections).Methods:This research was a randomiz...Objectives:To examine the efficacy of an intervention based on the theory of planned behavior(TPB)in improving breastfeeding behavior among women with cesarean sections(C-sections).Methods:This research was a randomized controlled trial.Women with planned elective C-sections were recruited to participate in a randomized controlled trial between June and September 2020.One hundred thirty-two women were divided randomly into the intervention(n=66)and control group(n=66)by systematic random sampling.In the intervention group,an intervention project was implemented after Keywords:Breastfeeding Cesarean section Intervention studies Theory of planned behavior the C-section to establish positive breastfeeding attitudes,cultivate supportive subjective norms,enhance perceived behavioral control,and strengthen breastfeeding intention to change behaviors.Those in the control group received routine pre-and post-delivery care.Exclusive breastfeeding rate and breast problem were collected at 5 days,2 weeks,and 1 month after C-section.The modified Breastfeeding Attrition Prediction Tool(BAPT)on the first day in the hospital,two weeks,and one month after C-section and Numerical Rating Scale(NRS)24 h postoperatively were used to compare the intervention effect between the two groups.Results:After the intervention,the intervention group had significantly higher exclusive breastfeeding rates than the control group at five days(86.4%vs.60.6%),two weeks(77.3%vs.57.6%),and one month(74.2%vs.50.0%)after the C-section.Besides,the intervention group was less likely to have sore nipples at five days(6.1%vs.18.2%in the control group,P<0.05)and two weeks(9.1%vs.12.1%in the control group,P<0.05).After two weeks of intervention,attitude scores(90.64±8.31 vs.87.20±8.15,P<0.05),subjective norm scores(88.07±24.65 vs.79.42±19.47,P<0.05)and behavior control scores in the intervention group were significantly higher than those in the control group.After one month of intervention,attitude scores(90.34±10.35 vs.84.22±10.51,P<0.05)and behavior c展开更多
文摘血压随年龄而升高,老年人高血压患病率较高。收缩压升高可能是老年人心血管病的最重要危险因素。最近几项大型临床试验显示,降压药降低血压的同时可降低老年人的心血管事件和死亡率。对年龄〉80岁患者进行降压治疗的老老年高血压试验（hypertension in the very elderly trial,
文摘One of the most significant annual expenses that a person has is their health insurance coverage. Health insurance accounts for one-third of GDP, and everyone needs medical treatment to varying degrees. Changes in medicine, pharmaceutical trends, and political factors are only a few of the many factors that cause annual fluctuations in healthcare costs. This paper describes how a system may analyse a person’s medical history to display their insurance plans and make predictions about their health insurance premiums. The performance of four ML models—XGBoost, Lasso, KNN, and Ridge—is evaluated using R2-score and RMSE. The analysis of medical health insurance cost prediction using Lasso regression, Ridge regression, and K-Nearest Neighbours (KNN), and XGBoost (XGB) highlights notable differences in performance. KNN has the lowest R2-score of 55.21 and an RMSE of 4431.1, indicating limited predictive ability. Ridge Regression improves on this by an R2-score of 78.38 but has a higher RMSE of 4652.06. Lasso Regression slightly edges out Ridge with an R2-score of 79.78, yet it suffers from an advanced RMSE of 5671.6. In contrast, XGBoost excels with the highest R2-score of 86.81 and the lowermost RMSE of 4450.4, demonstrating superior predictive accuracy and making it the most effective model for this task. The best method for accurately predicting health insurance premiums was XGBoost Regression. The findings beneficial for policymakers, insurers, and healthcare providers as they can use this information to allocate resources more efficiently and enhance cost-effectiveness in the healthcare industry.
文摘This paper proposes a blockchain-based system as a secure, efficient, and cost-effective alternative to SWIFT for cross-border remittances. The current SWIFT system faces challenges, including slow settlement times, high transaction costs, and vulnerability to fraud. Leveraging blockchain technology’s decentralized, transparent, and immutable nature, the proposed system aims to address these limitations. Key features include modular architecture, implementation of microservices, and advanced cryptographic protocols. The system incorporates Proof of Stake consensus with BLS signatures, smart contract execution with dynamic pricing, and a decentralized oracle network for currency conversion. A sophisticated risk-based authentication system utilizes Bayesian networks and machine learning for enhanced security. Mathematical models are presented for critical components, including transaction validation, currency conversion, and regulatory compliance. Simulations demonstrate potential improvements in transaction speed and costs. However, challenges such as regulatory hurdles, user adoption, scalability, and integration with legacy systems must be addressed. The paper provides a comparative analysis between the proposed blockchain system and SWIFT, highlighting advantages in transaction speed, costs, and security. Mitigation strategies are proposed for key challenges. Recommendations are made for further research into scaling solutions, regulatory frameworks, and user-centric designs. The adoption of blockchain-based remittances could significantly impact the financial sector, potentially disrupting traditional models and promoting financial inclusion in underserved markets. However, successful implementation will require collaboration between blockchain innovators, financial institutions, and regulators to create an enabling environment for this transformative system.
基金This study was supported in part by a Seed Grant from the College of Nursing at East Carolina University received by the first author
文摘Objectives:As Watson's Human Caring Theory continues to evolve and guide the discipline of nursing,the challenge is to find ways to integrate it into practice.The purpose of this study is to describe interprofessional team members'perspectives on human caring based on the Ten Caritas Processes(R)/Caritas-Veritas Literacy of Watson's Human Caring Theory within the Unitary Caring Science.Methods:This is a qualitative directed content analysis study,taking place in a Children's Hospital in the United States between November 2017 and April 2018.Information redundancy was utilized to guide the recruitment.Data were collected via a one-time face-to-face individual interview.A qualitative directed content analysis was conducted using Watson's Ten Caritas Processes(R)/Caritas-Veritas Literacy as a coding framework.Results:Twenty-seven healthcare professionals participated in the study.Interprofessional human caring,based on the Ten Caritas Processes(R)/Caritas-Veritas Literacy,was referred to as performing lovingkindness to patients,each other,and self;maintaining faith-hope in teamwork;valuing intersubjective interactions and building trust among team members;cultivating heart-centered-caring relations;acknowledging and processing positive and negative feelings non-judgmentally;applying all ways of knowing in caring;encouraging reciprocal teaching-learning;developing caring-healing environments collaboratively;respecting human dignity of patients and each other;and being open-minded to the unknowns and believing in miracles.Conclusions:Watson's Human Caring Theory can be an underlying guide to enrich human-to-human relations and create a caring-healing environment.When human caring is applied in interprofessional teams,healthcare professionals find a caring consciousness to care for oneself and each other and promote patient care.
基金We thank all the mothers who participated in this study.
文摘Objectives:To explore the factors affecting breastfeeding behaviors in women after cesarean section.Methods:This is a qualitative study that used a phenomenological approach.This study used individual face-to-face interviews with 19 women who underwent a cesarean section in a Women and Children’s Hospital in China between July to September 2019.Information saturationwas used to determine sample size.Data were analyzed using a thematic content analysis method.Themes were developed based on the theory of planned behavior.Results:Thirteen(68.42%)had a planned cesarean section,and six(31.58%)cesarean sections were unplanned or emergent.Three major themes emerged:ambivalent attitude about breastfeeding,motivation to comply with the traditional cultural norms,and barriers and challenges.The motivating factors for breastfeeding after cesarean sections included perceived benefits of human milk,support from healthcare professionals,and responsibility for breastfeeding.The challenges for breastfeeding after cesarean sections included physical discomfort,knowledge and skills deficit of breastfeeding,lactation deficiency,and lack of knowledge and coping skills in managing their depressive mood after cesarean sections.There were a couple of neutral factors,such as the influences of family and peers.These factors could influence women either positively as facilitators or negatively as barriers.Conclusions:The findings can offer valuable information for healthcare professionals to help women breastfeed after cesarean sections.To promote women’s breastfeeding behaviors after cesarean sections,it is necessary to change women’s attitudes,belief systems,and the external environments and help them become more confident.
文摘Honeybees (Apis mellifera) are important pollinators of flowering plants and agricultural crops contributing annually to billions of dollars in revenues to crop production. Honeybees have an average lifespan between 8 weeks to 5 years. Dead honeybees are abundantly available in beehives and can be utilized as an alternative source to synthesize nanoparticles. In recent years, biologically synthesized nanoparticles have been preferred over their chemical counterparts. However, honeybee-based-green synthesis of nanoparticles has not been explored yet. Herein, we report the biosynthesis of silver nanoparticles from honeybees and its antibacterial activity. The synthesis of silver nanoparticles was monitored visually through a gradual change in color. Furthermore, the biosynthesized nanoparticles were confirmed and characterized by UV-visible spectroscopy. Scanning Electron Microscope was utilized to analyze the average size and morphologies of the biosynthesized nanoparticles. Subsequently, the antibacterial potential of the biosynthesized silver nanoparticles was tested against selected Gram-positive and Gram-negative bacterial strains. It was found that a distinct color change from yellow to brown in the reaction solution suggested the formation of silver nanoparticles. The biosynthesized nanoparticles exhibited absorption maxima at 430 nm. The SEM analysis confirmed the spherical and cuboidal shape of the biosynthesized silver nanoparticles with a size range between 10 - 40 nm. Furthermore, the biosynthesized silver nanoparticles exhibited strong antimicrobial potential against tested Gram-positive and Gram-negative bacteria strains by aggregating on the cell surface. This study showcases the biomedical and agricultural applications of biosynthesized silver nanoparticles from honeybee wings. .
文摘Customer churn poses a significant challenge for the banking and finance industry in the United States, directly affecting profitability and market share. This study conducts a comprehensive comparative analysis of machine learning models for customer churn prediction, focusing on the U.S. context. The research evaluates the performance of logistic regression, random forest, and neural networks using industry-specific datasets, considering the economic impact and practical implications of the findings. The exploratory data analysis reveals unique patterns and trends in the U.S. banking and finance industry, such as the age distribution of customers and the prevalence of dormant accounts. The study incorporates macroeconomic factors to capture the potential influence of external conditions on customer churn behavior. The findings highlight the importance of leveraging advanced machine learning techniques and comprehensive customer data to develop effective churn prevention strategies in the U.S. context. By accurately predicting customer churn, financial institutions can proactively identify at-risk customers, implement targeted retention strategies, and optimize resource allocation. The study discusses the limitations and potential future improvements, serving as a roadmap for researchers and practitioners to further advance the field of customer churn prediction in the evolving landscape of the U.S. banking and finance industry.
文摘Cholesteatoma is a fairly otologic common problem. However, cholesteatoma invading the internal auditory canal (IAC) is rare and typically results in profound hearing loss and facial paralysis. This is a case of a 46-year-old female with a history of prior right complex cholesteatoma that had undergone multiple procedures. She had multiple complications including right cerebral spinal fluid (CSF) leak, meningitis, recurrent mastoid bowl infections and right facial paralysis which resulted in multiple facial plastics procedures and overclosure of the right ear. Over the last three years, she has noticed an increase in right sided otalgia, facial pressure, facial numbness and headaches. An MRI temporal bone with diffusion weighted imaging (DWI) showed a DW positive soft tissue mass filling the mastoid bowl as well as extending into the IAC and cerebellar pontine angle (CPA) cistern with contact of the middle cerebellar peduncle and trigeminal nerve. A translabyrinthine approach to the IAC found the mastoid bowl to be filled with cholesteatoma and an osseous defect from the mastoid bowl along the labyrinthine facial nerve tracking cholesteatoma into the IAC/CPA. This case highlights the complex and aggressive nature a cholesteatoma can take and the need for diligent surveillance in any ear that had prior cholesteatoma. The utilizations of MRI temporal bone with diffusion weighted imaging allow for surveillance in an over closed ear canal that is vital to the care of cholesteatoma patients who have a similar history.
文摘This case is a 49-year-old female patient who presented with suspected eustachian tube dysfunction symptoms that were refractory to medical treatment. She presented with conductive hearing loss and aural fullness on the left. A physical exam revealed an epitympanic fleshy mass in the middle ear with effusion. Imaging with MRI and CT showed opacification of the epitympanum with surrounding bony demineralization bilaterally left greater than right and significant thinning versus dehiscence of the tegmen mastoideum and tympani on the left with only thinning of the tegmen on the right. An MR temporal bone with and without contrast, demonstrated enhancement of the left middle ear extending to the tegmen and corresponding enhancement of the dura along the floor of the left middle cranial fossa as well as extending along foramen ovale into the infratemporal fossa. There was to a lesser degree similar appearance on the right. A biopsy of the middle ear mass on the left revealed meningioma. This case highlights the need to widen your differential with common symptoms when they are refractory to treatment.
文摘This is a case of a 60-year-old male with a history of prior left middle fossa meningioma that was partially resected with an operative report noting diffuse attachment to the middle fossa floor. Gamma knife was recommended but he never completed this management. He then presented about eight years later with a mass from his left external auditory canal. It was reported that two years prior another surgeon operated on the left ear for a cholesteatoma. CT temporal bone showed complete opacification of left EAC, mastoid bowl, and remaining mastoid air cells. In addition, there were irregular bony/hyperostotic changes seen within the left sphenoid and temporal bone. There was dural thickening within the middle fossa adjacent to the previously described hyperostotic bony changes. A mastoidectomy and excision of mass revealed extensive adhesive tissue throughout the middle ear, and mastoid up to the tegmen. Pathology of the portions that were resected confirmed Grade 1 meningioma. Stereotactic gamma knife radiation was completed to the area to prevent further growth. This case highlights extracranial meningioma that did not have definitive management for prior middle fossa floor meningioma. It also highlights the need to think of less common pathology in the middle ear and external auditory canal.
文摘Glioblastoma Multiforme (GBM) represents one of the most aggressive and metastatic brain tumors, with a dismal success rate of less than three percent after five years, particularly in tumors with active immune checkpoints. This necessitates the development of targeted endogenous agents for precise GBM treatment. Previous experiments utilizing Chemovar Specific Cannabis Extractions (CSCEs), fractionated with polar solvents and quantified using Liquid and Gas Column Chromatography combined with Mass Spectrometry (LC/GCMS), have shown reduced viability and motility in human GBM cell lines. However, the complexity of the botanical substance has hindered the personalization of standard cannabis medicines for GBM due to unknown synergistic effects of multiple compounds. To address this limitation, our study focuses on exposing AM251 cells to chemovar fractions extracted using a non-polar solvent, thereby isolating a broader spectrum of constituents. By employing LC/GCMS in conjunction with Nuclear Magnetic Resonance (NMR), we have identified and quantified nine* compounds present in the non-polar CSCE that exhibit significant efficacy (0.1 μM) in inducing cytotoxicity* in GBM tumor cells. Conversely, the polar fraction in our experiment did not demonstrate efficacy against UM251 cells. The quantification of individual compounds within a cannabis extraction that selectively induces cell death in brain tumors holds promise for guiding future research and facilitating the development of a standardized CSCE for GBM therapy.
文摘Introduction: Transition of care strategies have shown to improve quality of lives of heart failure patients, but it has little implemented in clinical settings. Objective: To evaluate context-specific perceived barriers and experiences of heart failure patients during their admission and after they were discharged from hospital. Methods: A cross-sectional qualitative study was conducted among 13 heart failure patients at two large referral hospitals in northwestern Tanzania. In-depth interviews among heart failure patients, in line with the Consolidated Criteria for Reporting Qualitative research checklist, were used to collect data. Interviews were audio recorded, transcribed, and translated into English. Results: Three key barriers were identified, as well as possible solutions that could improve the transition of care for heart failure patients. These include strengthening healthcare provider communications, organizing medication management, and assisting with follow-up appointments. Conclusion: The barriers identified are real and challenging in clinical resource- limited settings. Findings suggest they can be overcome when realistic and tailor-made interventions are in place.
文摘Objectives:To examine the efficacy of an intervention based on the theory of planned behavior(TPB)in improving breastfeeding behavior among women with cesarean sections(C-sections).Methods:This research was a randomized controlled trial.Women with planned elective C-sections were recruited to participate in a randomized controlled trial between June and September 2020.One hundred thirty-two women were divided randomly into the intervention(n=66)and control group(n=66)by systematic random sampling.In the intervention group,an intervention project was implemented after Keywords:Breastfeeding Cesarean section Intervention studies Theory of planned behavior the C-section to establish positive breastfeeding attitudes,cultivate supportive subjective norms,enhance perceived behavioral control,and strengthen breastfeeding intention to change behaviors.Those in the control group received routine pre-and post-delivery care.Exclusive breastfeeding rate and breast problem were collected at 5 days,2 weeks,and 1 month after C-section.The modified Breastfeeding Attrition Prediction Tool(BAPT)on the first day in the hospital,two weeks,and one month after C-section and Numerical Rating Scale(NRS)24 h postoperatively were used to compare the intervention effect between the two groups.Results:After the intervention,the intervention group had significantly higher exclusive breastfeeding rates than the control group at five days(86.4%vs.60.6%),two weeks(77.3%vs.57.6%),and one month(74.2%vs.50.0%)after the C-section.Besides,the intervention group was less likely to have sore nipples at five days(6.1%vs.18.2%in the control group,P<0.05)and two weeks(9.1%vs.12.1%in the control group,P<0.05).After two weeks of intervention,attitude scores(90.64±8.31 vs.87.20±8.15,P<0.05),subjective norm scores(88.07±24.65 vs.79.42±19.47,P<0.05)and behavior control scores in the intervention group were significantly higher than those in the control group.After one month of intervention,attitude scores(90.34±10.35 vs.84.22±10.51,P<0.05)and behavior c
