widespread availability
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Regardless of many decades of research, the widespread availability of a vaccine and more recently highly visible WHO efforts to promote a unified global control strategy, Tuberculosis remains a leading cause of infectious mortality. In this paper, a Mathematical Model for Tuberculosis Epidemic with Passive Immunity and Drug-Sensitivity is presented. We carried out analytical studies of the model where the population comprises of eight compartments: passively immune infants, susceptible, latently infected with DS-TB. The Disease Free Equilibrium (DFE) and the Endemic Equilibrium (EE) points were established. The next generation matrix method was used to obtain the reproduction number for drug sensitive (𝑅𝑜𝑠) Tuberculosis. We obtained the disease-free equilibrium for drug sensitive TB which is locally asymptotically stable when 𝑅𝑜𝑠 < 1 indicating that tuberculosis eradication is possible within the population. We also obtained the global stability of the disease-free equilibrium and results showed that the disease-free equilibrium point is globally asymptotically stable when 𝑅𝑜𝑠 ≤ 1 which indicates that tuberculosis naturally dies out.

Abstract Introduction: Telemedicine gained an increasing use throughout the last years. Lifestyle tools like the Apple watch seem to have an increasing spread even in remote areas and underdeveloped regions. The increasing availability of these tools offers the chance to use the health care functions of these devices to improve provision of professional medical care. First data on the use of the Apple Watch as a remote monitoring device in children have been reported, showing good acceptability and usability of the Apple Watch for symptom monitoring in children. This study aimed to evaluate the accuracy of the Apple Watch iECG in comparison to a standard 12-lead ECG in pre-term babies. Methods: In this prospective, single-arm study, consecutive preterm neonates hospitalised in Leipzig University Hospital neonatal ICU were eligible. A 12-lead ECG and an iECG using Apple Watch 4 were performed. iECG and 12-lead ECG measurements were performed by a paediatric cardiologist. Cardiac rhythm was classified and amplitudes and timing intervals were analysed for comparability. Results: Fifty preterm neonates, gestational week (23–36 weeks), and body weight (0.65–3.09 kg) were enrolled. Overall good quality and excellent correlation of the Apple Watch generated iECG in comparison to the standard 12-lead ECG could be demonstrated (p < 0.001). When interpreted by a paediatric cardiologist, a correct rhythm classification could be done in 100% of cases. Conclusion: The Apple Watch iECG seems to be a valuable tool to record an ECG comparable to lead I of the standard 12-lead ECG even in pre-term neonates. With a widespread availability and excellent connectivity, the Apple Watch iECG function may provide practitioners with a tool to send an iECG for interpretation to a paediatric cardiac specialist.

Widespread availability of protein sequence-fitness data would revolutionize both our biochemical understanding of proteins and our ability to engineer them. Unfortunately, even though thousands of protein variants are generated and evaluated for fitness during a typical protein engineering campaign, most are never sequenced, leaving a wealth of potential sequence-fitness information untapped. This largely stems from the fact that sequencing is unnecessary for many protein engineering strategies; the added cost and effort of sequencing is thus unjustified. Here, we present every variant sequencing (evSeq), an efficient protocol for sequencing a variable region within every variant gene produced during a protein engineering campaign at a cost of cents per variant. Execution of evSeq is simple, requires no sequencing experience to perform, relies only on resources and services typically available to biology labs, and slots neatly into existing protein engineering workflows. Analysis of evSeq data is likewise made simple by its accompanying software (found at github.com/fhalab/evSeq, documentation at fhalab.github.io/evSeq), which can be run on a personal laptop and was designed to be accessible to users with no computational experience. Low-cost and easy to use, evSeq makes collection of extensive protein variant sequence-fitness data practical.

Background As in many other countries across sub-Saharan Africa, Malawi’s commercial gambling sector has grown considerably in recent years. Driven by the widespread availability of internet through mobile devices, the industry has penetrated both urban and rural settings. In Malawi the model commonly implemented by gambling companies is similar to that used by mobile phone operators. Agents equipped with cellular devices connect to providers’ servers to place wagers for customers and print receipts using simple printers attached to their devices. This has produced lucrative returns for providers. While increasing attention is being paid to this trend, most research focusses on sports betting and there is a deficit of papers that document gambling-related harms. Methods Here we present a narrative case report of a 16-year-old boy, ‘Wati’ (pseudonym), who lived in rural Malawi and took his own life after gambling and losing money that did not belong to him. As his community is part of a demographic surveillance site, a verbal autopsy was conducted, later supplemented with interviews with Wati’s close friend and uncle, to whom his mother referred us. We triangulated data from these three sources to create a narrative case report of Wati’s suicide and its relationship to his gambling practices. Results We found that the gambling harms leading up to Wati’s suicide were recurrent, that his gambling practices were diverse (lottery, football betting, digital games and cards) and that signs of distress were apparent before his suicide. Conclusions From this case report, we learn that underage individuals participate in gambling in Malawi, can develop harmful habits and that their gambling is not confined to sports betting. We also learn that there is a lack of accessible services for people who develop harmful gambling practices. Wati could have benefited from such services and they may have saved his life.

Abstract Deep learning is a rapidly growing research area having state of art achievement in various applications including but not limited to speech recognition, object recognition, machine translation, and image segmentation. In the current modern industrial manufacturing system, Machine Health Surveillance System (MHSS) is achieving increasing popularity because of the widespread availability of low cost sensors internet connectivity. Deep learning architecture gives useful tools to analyze and process these vast amounts of machinery data. In this paper, we review the latest deep learning techniques and their variant used for MHSS. We used Gearbox Fault Diagnosis dataset in this paper that contains the sets of vibration attributes recorded by SpectraQuest’s Gearbox Fault Diagnostics Simulator. In addition, the authors used the variant of auto encoders for feature extraction to achieve higher accuracy in machine health surveillance. The results showed that the bagging ensemble classifier based on voting techniques achieved 99% accuracy.

Abstract Background Actinomyces species are Gram positive anaerobic, non-sporulating, non-acid fast, non-motile, irregularly staining bacterium. It is associated with a wide range of infections including; dental caries, abscesses, intraabdominal and bloodstream infections. A. odontolyticus normally a commensal organism found in the mouth, was first isolated from dental caries in 1958. The incidence of Actinomyces odontolyticus bacteremia is less common. Methods We are reporting 15 cases of isolated A. odontolyticus blood stream infection at HMC, State of Qatar from 1/1/2016 to 1/11/2020. We aim to describe their clinical characteristic, risk factors and treatment outcome. Results Our patients with bacteraemia fall into one of two groups. The first group consists of paediatric patients with unremarkable co-morbidities. The second group includes older adults, often with co-morbidities that pre-dispose to infection, such as diabetes mellitus or hypertension. Fever was the main presenting sign and symptom in 12 patients (80%). Nine of the patients were females (60%). 13 patients (86%) received antibiotics. Maximum duration of antibiotics was 60 days and minimum duration was three days. The infectious disease team was consulted for six patients (40%). One patient died while the other 14 recovered uneventfully with a case fatality rate of 6.6%. Reported cases of Actinomyces odontolyticus bacteraemia in Hamad Medical Corporation between 1/1/2016 to 1/11/2020 Minimal inhibitory concentrations (MICs) of selected antibiotics against A. odontolyticus, including interpretations and breakpoints, as reported by the AMRHAI reference unit, PHE Colindale Conclusion Clinicians of all specialties need to be aware of the rising number of reports of Actinomyces species bacteraemia due to widespread availability of molecular identification techniques, including MALTI-TOF. 3 Furthermore, more studies are needed to determine guidelines for treating these resilient microbes Disclosures All Authors: No reported disclosures

Abstract This work compares heating and electricity demands with local renewable energy potentials at the example of Ludwigsburg county, a mostly suburban region in South-Western Germany. Bottom-up analyses of the energetic potentials are performed within an established regional energy simulation platform and are thus based on a consistent set of geoinformatic data. This approach has two advantages compared to a top-down analysis or using multiple specialized tools: it allows assessing energetic potentials in high spatial resolution and relates it to heating and electricity demands on a single-building scale. Secondly, it is transferable to other regions due to the widespread availability of most input data. Our results show that exploiting technical potentials for bioenergy, rooftop PV, wind onshore, and hydropower can cover 68% of electricity demand 7% of heat demand in 2019, indicating that energy autonomy is difficult to achieve for densely populated regions in Europe.

Abstract Introduction: Giant hydronephrosis, which implies a collecting system containing more than one liter of fluid, is becoming increasingly rare with the widespread availability of imaging facilities. We aimed to report a case and management of bilateral giant hydronephrosis due to bilateral ureteropelvis stenosis.Case presentation: A 45-year old male presented at the Emergency Department with the complaint of difficulty passing stools. On computed tomography (CT), bilateral giant hydronephrosis was determined covering the whole abdomen. After bilateral nephrostomy, 8 liters of urine was drained from the right kidney and 10 liters of urine from the left kidney after bilateral nephrostomy in the patient whose serum creatinine level was 1.06 mg/dl at the time of admission. Bilateral pyeloplasty was applied to the patient who was diagnosed with bilateral ureteropelvis stenosis after dynamic renal scintigraphy. After 4 years of follow-up, serum creatinine level was 1.3 mg / dl. Hydronephrosis was still present despite being smaller than its previous condition and the presence of bilateral double J stents.Conclusions: An interesting finding of the current case was that the creatinine level might be normal despite the fact that bilateral giant hydronephrosis. So rather than nephrectomy, pyeloplasty was applied and to date there has been no need for hemodialysis.

This article presents a simple technique where a silicone sheet is used during transoral robotic surgery (TORS) to protect the upper airway structures from thermal damage during a base of tongue procedure. We review 10 cases of TORS tongue base reduction with the use of this technique, with no complications and with reduction of thermal damage to the lingual epiglottis and surrounding pharyngeal wall. Furthermore, it served as a guide during tongue base dissection to provide visual and tactile feedback to the inferior limit of resection, as well as to protect the endotracheal tube. The silicone sheet is an ideal material for use as a thermal barrier due to its widespread availability, intrinsic thermal properties, and translucency. The technique of using the silicone sheet is easy to implement and may prove useful to many transoral robotic surgeons, especially for newly trained TORS users and trainees.

Abstract Background Since the widespread availability of contact-force sensing catheters the need of a waiting period has not been reassessed in paroxysmal atrial fibrillation (AF) ablation. Objective The purpose of this study was to evaluate if pulmonary vein isolation (PVI) guided by the Ablation Index (AI) could spare the need for a waiting phase. Methods This multicentre, prospective, randomized study consecutively recruited patients referred for first-time catheter ablation of symptomatic drug-refractory paroxysmal AF from May 2019 to February 2020. Patients performed PVI tailored to different AI values according to the different left atrium walls (550 for anterior, 500 for roof, 450 for inferior and 400 for posterior). Patients were enrolled in 1:1 ratio to PVI and 20 min of waiting time versus PVI without a waiting period. Acute reconnection (either spontaneous or after adenosine) and 1-year arrhythmia freedom were analyzed. Results The study included 124 patients (61 in the waiting period group and 63 in the group without the waiting period). There was no significant differences between groups regarding baseline characteristics, echocardiographic and procedure data. There were no significant differences between both groups regarding the first-pass PV isolation (P=0.49) and the presence of low voltage areas (P=0.71). Median PVI time (P=0.40), median fluoroscopy time (P=0.35) and median overall procedure time (P=0.70) were also similar between groups. The acute PVR rate was similar between both groups (8.2% for the waiting period group vs 11.1% in the group without a waiting phase, P=0.40). After a median follow-up of 14 (IQR 12–18) months, there was no significant difference on the arrhythmia recurrence between groups (4.9% for the waiting group vs 12.7% for the group without a waiting phase, P=0.13). Both groups presented a similar arrhythmia freedom over time (log rank P of 0.109). The waiting period time was not a predictor of recurrence during follow-up (p=0.13). Conclusion PVI guided by Ablation Index preclude the need of a waiting phase. Adding a 20-minute waiting period did not significantly increase the acute PV reconnection, neither improve the 1-year arrhythmia freedom. FUNDunding Acknowledgement Type of funding sources: None.