A modified particle swarm optimization rat search algorithm and its engineering application.

Solar energy generation requires photovoltaic (PV) systems to be optimised, regulated, and simulated with efficiency. The performance of PV systems is greatly impacted by the fluctuation and occasionally restricted accessibility of model parameters, which makes it difficult to identify these characteristics over time. To extract the features of solar modules and build highly accurate models for PV system modelling, control, and optimisation, current-voltage data collecting is essential. To overcome these difficulties, the modified particle swarm optimization rat search algorithm is presented in this manuscript. The modified rat search algorithm is incorporated to increase the PSO algorithm's accuracy and efficiency, which leads to better outcomes. The RSA mechanism increases both the population's diversity and the quality of exploration. For triple diode model of both monocrystalline and polycrystalline, PSORSA has showed exceptional performance in comparison to other algorithm i.e. RMSE for monocrystalline is 3.21E-11 and for polycrystalline is 1.86E-11. Similar performance can be observed from the PSORSA for four diode model i.e. RMSE for monocrystalline is 4.14E-09 and for polycrystalline is 4.72E-09. The findings show that PSORSA outperforms the most advanced techniques in terms of output, accuracy, and dependability. As a result, PSORSA proves to be a trustworthy instrument for assessing solar cell and PV module data.

A Multicenter Retrospective Cohort Study on Management Protocols and Clinical Outcomes After ABO-incompatible Kidney Transplantation in India.

BACKGROUND: There is no robust evidence-based data for ABO-incompatible kidney transplantation (ABOiKT) from emerging countries. METHODS: Data from 1759 living donor ABOiKT and 33 157 ABO-compatible kidney transplantations (ABOcKT) performed in India between March 5, 2011, and July 2, 2022, were included in this retrospective, multicenter (n = 25) study. The primary outcomes included management protocols, mortality, graft loss, and biopsy-proven acute rejection (BPAR). RESULTS: Protocol included rituximab 100 (232 [13.18%]), 200 (877 [49.85%]), and 500 mg (569 [32.34%]); immunoadsorption (IA) (145 [8.24%]), IVIG (663 [37.69%]), and no induction 200 (11.37%). Mortality, graft loss, and BPAR were reported in 167 (9.49%), 136 (7.73%), and 228 (12.96%) patients, respectively, over a median follow-up of 36.3 mo. In cox proportional hazard model, mortality was higher with IA (hazard ratio [HR]: 2.53 [1.62-3.97]; P < 0.001), BPAR (HR: 1.83 [1.25-2.69]; P = 0.0020), and graft loss (HR: 1.66 [1.05-2.64]; P = 0.0310); improved graft survival was associated with IVIG (HR: 0.44 [0.26-0.72]; P = 0.0010); higher BPAR was reported with conventional tube method (HR: 3.22 [1.9-5.46]; P < 0.0001) and IA use (HR: 2 [1.37-2.92]; P < 0.0001), whereas lower BPAR was reported in the prepandemic era (HR: 0.61 [0.43-0.88]; P = 0.008). Primary outcomes were not associated with rituximab dosing or high preconditioning/presurgery anti-A/anti-B titers. Incidence of overall infection 306 (17.39%), cytomegalovirus 66 (3.75%), and BK virus polyoma virus 20 (1.13%) was low. In unmatched univariate analysis, the outcomes between ABOiKT and ABOcKT were comparable. CONCLUSIONS: Our largest multicenter study on ABOiKT provides insights into various protocols and management strategies with results comparable to those of ABOcKT.

Sustainable development of fuel cell using enhanced weighted mean of vectors algorithm.

Using the mathematical model of a Direct Methanol Fuel Cell (DMFC) stack, a new optimum approach is presented for estimating the seven unknown parameters i.e., ( e o , α , R , j e i d , C 1 , ß ,req) optimally. Specifically, a method is proposed for minimization of the Sum of Squared Errors (SSE) associated with the estimated polarization profile, based on the experimental data from simulations. The Enhanced Weighted mean of vectors (EINFO) algorithm is a novel metaheuristic method that is proposed to achieve this goal. An analysis of the results of this method is then compared to various metaheuristic algorithms such as the Particle Swarm Optimization (PSO), Sine Cosine Algorithm (SCA), Dragonfly Algorithm (DA), Atom Search Optimization (ASO), and Weighted mean of vectors (INFO) well known in literature. As a final step to confirm the proposed approach's effectiveness, the sensitivity analysis is carried out using temperature changes, along with comparison against different approaches described in the literature to demonstrate its superiority. After comparison of parameter estimation and different operating temperature a non-parametric test is also performed and compared with the rest of the metaheuristic algorithms used in the manuscript. From these tests it is concluded that the proposed algorithm is superior to the rest of the compared algorithms.

Helicobacter pylori Treatment Regimen Selection and Eradication Rates Across Department of Defense Patients for Fiscal Years 2016-2018.

INTRODUCTION: The objective of this study was to measure the number of treatment successes and failures of various Helicobacter pylori treatment regimens among DoD beneficiaries. MATERIALS AND METHODS: This was a retrospective cross-sectional study of all adult DoD beneficiaries with H. pylori diagnosis, treatment, and eradication testing from October 2015 to September 2018. All stool antigen testing, urea breath test, and immunoglobulin G serologies were identified. Patients were excluded if they did not have a positive test, did not have treatment, or did not have eradication testing. RESULTS: In total, 20,548 H. pylori diagnostic tests were performed over the study period. A total of 1,592 non-active duty and 374 active duty patients were diagnosed with H. pylori, were treated, and had eradication testing. The best performing regimens were tetracycline-based bismuth quadruple therapy and tinidazole-based clarithromycin triple therapy with eradication rates of 85% and 82%, respectively. Clarithromycin triple therapy was the most prescribed (63.9% of all regimens included in analysis). Of the 1,592 non-active duty and 374 active duty patients, 75.5% (1,202) and 70.6% (264) cleared the infection with treatment, respectively (P = 0.0449). Although trends were identified in differences in geographic eradication rates, none of these achieved the threshold of significance. CONCLUSIONS: This is the largest and most geographically widespread H. pylori treatment efficacy study in the USA over 20 years. None of the treatment regimens (when used in over five patients) achieved an eradication rate greater than 90%, but tetracycline-based bismuth quadruple therapy performed best among all regimens and populations. Eradication rates were lower in the active duty populations, with no treatment regimen achieving an eradication rate greater than 80%.

Entero-Urachal Fistula: An Unusual Initial Presentation of Penetrating and Stricturing Crohn's Disease.

Crohn's disease (CD) has a wide variety of clinical presentations, ranging from abdominal pain to stricture and fistula. Fistulas involving the genitourinary tract can be severe and often require surgical intervention. Given the array of presenting symptoms, a delay in diagnosis can occur. We present the case of a healthy active duty soldier, with no previous medical history, found to have CD through an initial presentation of isolated umbilical drainage. Imaging workup identified an entero-uracho-cutaneous fistula with involvement of the transverse colon. Urachal anomalies are uncommon, and entero-urachal fistula as an initial presentation of CD is exceedingly rare. This case highlights the need to consider CD in the differential for patients with umbilical drainage despite a lack of concurrent more frequent presenting symptoms (abdominal pain, bloody diarrhea, and perianal fistula). Maintaining awareness of uncommon initial presentations of CD can minimize delay in diagnosis and thereby mitigate the risk of severe complications.

Minimizing scattered radiation dose in cardiac catheterization laboratory during interventional procedures using lead free drape - MILD study.

OBJECTIVE: RADPAD is a lead-free sterile drape that reduces scattered radiation during fluoroscopic procedures. We aimed to study the effect of using RADPAD on primary operator (PO) and secondary operator (SO) during coronary angiography (CAG) as well as percutaneous coronary intervention (PCI). METHODS: 137 patients undergoing elective CAG and PCIwere randomized in a 1:1 pattern with or without the RADPAD. The ratio of PO received dose in mrem to total Air Kerma (AK) in mGy, Dose Area Product (DAP) in mGycm2 and Cine Adjusted Screening Time (CAST) in minute, at the end of the procedure with or without RADPAD were measured and designated as dose relative to AK, DAP and CAST. The exposure ratios were compared for both cohorts. RESULTS: There was no significant difference in CAST, DAP and AK between the two patient cohorts. PO radiation dose relative to CAST was 0.15 ± 0.18 mrem/min for RADPAD cohort and 0.43 ± 0.31 mrem/min for No RADPAD cohort (p < 0.00001). PO dose relative to DAP was 0.00042 ± 0.00049 mrem/mGycm2 for RADPAD cohort and 0.0011 ± 0.0013 mrem/mGycm2 for No RADPAD cohort (p = 0.000014). PO dose relative to AK was 0.0030 ± 0.0037 mrem/mGy for RADPAD cohort and 0.0071 ± 0.0049 mrem/mGy for No RADPAD cohort (p < 0.00001). All PO doses relative to CAST, DAP and AK were significantly reduced in the RADPAD cohort compared to the No RADPAD cohort. Similar findings were observed for the SO also. CONCLUSION: RADPAD significantly reduces radiation exposure to both PO and SO during CAG and PCI.

Almost One-Third of Large Sessile Serrated Polyps Are Missed on CT Colonography.

BACKGROUND: Nearly one-third of colorectal cancers (CRC) arise via the serrated pathway. CT colonography (CTC) is a CRC screening examination. Endoscopic detection of sessile serrated polyps (SSPs) varies widely; it is unknown whether CTC effectively detects SSPs. The aim of this study is to determine whether CTC detects SSPs at an institution that performs a large volume of CTC. METHODS: We conducted a search of pathology records to identify serrated polyps (SPs) from 2005 to 2012. We extracted demographic data from the electronic health records (EHRs) of subjects with an SSP and examined endoscopy reports for location and size of each SSP. We identified subjects with a CTC within 1 year prior to the colonoscopy that found an SSP, and determined if the CTC identified the SSP. RESULTS: Our search found 3978 subjects with SP over the 7-year period. Seven hundred thirty-two subjects had at least 1 SSP. Eightytwo subjects had CTC done within 1 year prior to the colonoscopy that identified SSP. Seventy-nine subjects' polyps were identified on CTC. CT colonography was done an average of 38 ± 54 days prior to colonoscopy. One hundred fifteen SSPs were identified endoscopically. A total of 48.7% of all SSPs were identified via CTC; larger SSPs were more likely to be seen on CTC (P < .001), and 69.6% of SSPs larger than 10 mm were found via CTC. Proximal SSPs were more often identified than distal SSPs (P = .005). CONCLUSION: Given the miss rate for SSPs on CTC, endoscopists should be vigilant about examining the proximal colon in subjects referred after CTC, even if the imaging does not reveal a proximal polyp.

Parameter estimation of proton exchange membrane fuel cell using a novel meta-heuristic algorithm.

In recent years, proton exchange membrane fuel cells (PEMFCs) have been known to be a viable method for meeting the electrical energy needs, thereby enhancing the overall reliability of renewable energy systems. PEMFCs demonstrate various promising attributes like pollution-free, totally sustainable, non-self-discharging. These need hydrogen as fuel, and air for their operation, while the final product is pure water only. Thus, under varying operating conditions, the appropriate modeling and parameter optimization of PEMFCs have gained considerable importance in recent times. The evolutionary optimization approaches had been utilized in recent past for estimating PEMFCs parameters as exact modeling of the same does not exist in the literature. For the evaluation of PEMFCs performance criteria, a newly proposed algorithm is developed in this manuscript i.e. black widow optimization (BWO). Firstly, the performance of this proposed algorithm is checked by complex benchmark results. After that, this proposed algorithm is applied to extract the parameters of PEMFCs models under different operating temperatures. The parameter optimization results are obtained using BWO and are further compared with those obtained with five other algorithms, i.e., particle swarm optimization (PSO), multi-verse optimizer (MVO), sine cosine algorithm (SCA), whale optimization algorithm (WOA), and grey wolf optimization (GWO). The complete error analysis is carried out for the two data sheets of the PEMFCs to establish the superiority of BWO. It has been observed that the developed proposed algorithm gives better results when compared to those obtained with rest of the algorithms considered in this work. After calculating the error, non-parametric test is performed which suggests that the BWO is better than the rest of the compared algorithms.

Hydrogen fuel and fuel cell technology for cleaner future: a review.

One of the main problems facing our planetary bodies is unexpected and sudden climate change due to continuously increasing global energy demand, which currently is being met by fossil fuels. Hydrogen is considered as one of the major energy solutions of the twenty-first century, capable of meeting future energy needs. Being 61a zero-emission fuel, it could reduce environmental impacts and craft novel energy opportunities. Hydrogen through fuel cells can be used in transport and distributed heating, as well as in energy storage systems. The transition from fossil-based fuels to hydrogen requires intensive research to overcome scientific and socio-economic barriers. The purpose of this paper is to reflect the current state, related issues, and projection of hydrogen and fuel elements within the conceptual framework of 61a future sustainable energy vision. An attempt has been made to compile in this paper the past hydrogen-related technologies, present challenges, and role of hydrogen in the future.

The Patterns and Associated Cost of Serologic Testing for Helicobacter pylori in the U.S. Military Health System.

INTRODUCTION: Helicobacter pylori (H. pylori) infection affects about half of the world's population and can lead to multiple complications if left untreated. Testing for H. pylori infection in appropriate patients with prompt treatment followed by the testing of eradication is the standard of care in the United States. Active Duty Service members (ADSMs) in the U.S. military are a unique patient population that may be at higher risk for acquiring H. pylori infection given frequent deployments to developing countries. Noninvasive diagnostic strategies include the urea breath test, the stool antigen test, and serologic testing, which include H. pylori immunoglobulin M (IgM), immunoglobulin A (IgA), and immunoglobulin G (IgG) antibodies. Among noninvasive methods, the least sensitive is serology, and although there is clinical utility in testing for H. pylori IgG antibodies, H. pylori IgA or IgM antibodies have limited clinical utility. Despite this, H. pylori IgA and IgM antibodies are still widely ordered across the Military Health System. MATERIALS AND METHODS: In order to determine how frequently this testing is being ordered and the associated cost, we conducted a retrospective cross-sectional study of H. pylori serologic testing utilization in the MHS from October 2015 to September 2018 in adult patients using the MHS Data Repository. All H. pylori IgM, IgA, and IgG antibodies, H. pylori stool antigen tests, and H. pylori urea breath tests were queried during this time period across all ADSMs, retirees, and ADSM dependents for all adults. Cost information was obtained from LabCorp, and the institutional price used for cost analysis was the same throughout all military treatment facilities in the Department of Defense (DOD). RESULTS: We discovered that over a 3-yr period, 1,916 H. pylori IgA and 2,492 IgM antibodies were ordered. In total, the DOD spent close to $400,000 on antibody-based testing for H. pylori not accounting for indirect associated costs like personnel, supplies, repeat testing, as well as the costs of delayed diagnosis and associated complications. CONCLUSION: H. pylori IgM and IgA have limited clinical utility, are inaccurate, and are costly to maintain, especially when more accurate alternative tests are available. Based on our analysis, we strongly recommend the removal of the H. pylori IgA and IgM serologic tests throughout the DOD in order to improve the efficiency and quality of care for patients suspected of having an H. pylori infection. Further research is needed to determine how these tests are ordered, how providers are responding to the results of the serologic tests, and if noninvasive testing is being ordered appropriately.

Clinical codes combined with procedure codes increase diagnostic accuracy of Crohn's disease in a US Military health record.

Background and aims: Previous examinations of International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) codes to predict accuracy of diagnosis in inflammatory bowel disease have had limited chart review to confirm diagnosis. We aimed to evaluate using the ICD-9-CM for identifying Crohn's disease (CD) in a large electronic health record (EHR) database. Methods: This is a retrospective case-control study with a 3:1 allocation of EHRs of active duty service members diagnosed with CD from 1996 to 2012. Subjects were selected by having two ICD-9-CM codes for CD during the study period. Gastroenterologists reviewed each chart and confirmed the diagnosis of CD by analysing medication history and clinical, endoscopic, histological, and radiographic exams. Results: 300 cases of CD were selected; 14 cases were discarded due to lack of data, limiting our analysis to 284 subjects. Two diagnostic codes for CD had sensitivity, specificity, and positive predictive value (PPV) of 1.0, 0.53, and 0.69, respectively, for confirmed CD. If two encounters listing CD were with a gastroenterologist, the sensitivity, specificity, and PPV was 0.76, 0.81, and 0.80, respectively. If a colonoscopy was performed within 90 days of any three encounters with a CD code, the sensitivity, specificity, and PPV was 0.51, 0.94, and 0.89, respectively. Conclusions: The poor PPV of ICD-9-CM codes in making the diagnosis of CD should be taken into consideration when interpreting results and when conducting research using such codes. Limiting these codes to those patients who have been given this diagnosis by a gastroenterologist, or to those who have had a colonoscopy near the time of diagnosis, increases the PPV.

Levels of Vitamin D Are Low After Crohn's Disease Is Established But Not Before.

BACKGROUND & AIMS: Low serum levels of vitamin D have been associated with Crohn's disease (CD). However, it is unclear whether low vitamin D levels cause CD or CD reduces serum vitamin D. METHODS: United States military personnel with CD (n = 240) and randomly selected individuals without CD (controls, n = 240) were matched by age, sex, race, military branch, and geography. We measured 25-hydroxyvitamin D in sera 8-3 years (pre-2) and 3 years to 3 months before diagnosis (pre-1) and 3 months before through 21 months after diagnosis (pre-0). We genotyped VDR and GC vitamin D related polymorphisms. We used conditional logistic regression, including adjustments for smoking, season, enlistment status, and deployment, to estimate relative odds of CD according to vitamin D levels and interactions between genetic factors and levels of vitamin D. RESULTS: Levels of vitamin D before diagnosis were not associated with CD in pre-2 (P trend = .65) or pre-1 samples (P trend = .84). However, we found an inverse correlation between CD and highest tertile of vitamin D level in post-diagnosis samples (P trend = .01; odds ratio, 0.51; 95% CI, 0.30-0.86). Interactions were not detected between vitamin D levels and VDR or GC polymorphisms. We observed an association between VDR Taq1 polymorphism and CD (independent of vitamin D) (P = .02). CONCLUSIONS: In serum samples from military personnel with CD and matched controls, we found no evidence for an association between CD and vitamin D levels up to 8 years before diagnosis. However, we observed an inverse-association between post-diagnosis vitamin D levels and CD. These findings suggest that low vitamin D does not contribute to development of CD-instead, CD leads to low vitamin D.