Chicken skin based Milli Watt range biocompatible triboelectric nanogenerator for biomechanical energy harvesting.

This work reports a high-performance, low-cost, biocompatible triboelectric nanogenerator (TENG) using chicken skin (CS). The device is suitable to power wearable devices, which is critical to adapt electronics in monitoring, predicting, and treating people. It also supports sustainability by providing a cost-effective way to reduce the poultry industry's waste. It has been shown here that CS-derived biowaste is an effective means of generating tribopositive material for TENGs. The CS contains amino acid functional groups based on (Glycine, Proline, and Hydroxyproline), which are essential to demonstrate the electron-donating ability of collagen. The skin was cut into 3 × 3 cm2 and used as the raw material for fabricating the TENG device with a stacking sequence of Al/Kapton/spacing/CS/Al. The chicken skin-based TENG (CS-TENG) is characterized at different frequencies (4-14 HZ) using a damping system. The CS-TENG produces an open-circuit voltage of 123 V, short-circuit current of 20 µA and 0.2 mW/cm2 of a power density at 20 MΩ. The biocompatible CS-TENG presents ultra-robust and stable endurance performance with more than 52,000 cycles. The CS-TENG is impressively capable of scavenging energy to light up to 55 commercial light-emitting diodes (LEDs), a calculator, and to measure the physiological motions of the human body. CS-TENG is a step toward sustainable, battery-less devices or augmented energy sources, especially when using traditional power sources, such as in wearable devices, remote locations, or mobile applications is not practical or cost-effective.

Metastatic yolk sac tumor masquerading as multifocal hepatocellular carcinoma in a young adult: A case report.

Primary yolk sac tumor of the liver is very rare and can present as multifocal liver lesions. Multifocal nature may mimic other diagnoses such as hepatocellular carcinoma. Early recognition and therapeutic intervention are important as the prognosis of metastatic yolk sac tumors is poor. We present a case of a young adolescent who presented with bleeding per rectum abdominal pain and multiple liver lesions.

An energy-aware routing method using firefly algorithm for flying ad hoc networks.

Flying ad-hoc networks (FANETs) include a large number of drones, which communicate with each other based on an ad hoc model. These networks provide new opportunities for various applications such as military, industrial, and civilian applications. However, FANETs have faced with many challenges like high-speed nodes, low density, and rapid changes in the topology. As a result, routing is a challenging issue in these networks. In this paper, we propose an energy-aware routing scheme in FANETs. This scheme is inspired by the optimized link state routing (OLSR). In the proposed routing scheme, we estimate the connection quality between two flying nodes using a new technique, which utilizes two parameters, including ratio of sent/received of hello packets and connection time. Also, our proposed method selects multipoint relays (MPRs) using the firefly algorithm. It chooses a node with high residual energy, high connection quality, more neighborhood degree, and higher willingness as MPR. Finally, our proposed scheme creates routes between different nodes based on energy and connection quality. Our proposed routing scheme is simulated using the network simulator version 3 (NS3). We compare its simulation results with the greedy optimized link state routing (G-OLSR) and the optimized link state routing (OLSR). These results show that our method outperforms G-OLSR and OLSR in terms of delay, packet delivery rate, throughput, and energy consumption. However, our proposed routing scheme increases slightly routing overhead compared to G-OLSR.

Using discrete choice experiment to investigate patients' and parents' preferences for initiating ADHD medication.

BACKGROUND: The decision to initiate medication is complex and is influenced by a variety of factors. There is limited information on the relative importance of factors that influence the initiation of ADHD medication. AIMS: To investigate the factors, and their relative importance, that influence the decision to initiate medication in adults, and parents of children, with ADHD. METHODS: A discrete choice experiment was conducted using eight choice tasks made up of five attributes that described the outcomes of initiating medication. A mixed multinomial logit model was used to estimate preferences for medication. RESULTS: Respondents' overall preferences for initiating medication were negative (Mean (ß)= -0.72705, p < 0.1), however, significant heterogeneity was noted in preferences (SD: 0.93604, p < 0.001). Side-effects were the most important factor for both adults (Relative importance (RI) = 40.39%) and parents (RI = 41.99%). Improvement in education had a greater weighting in adults' decision-making compared to parents (RI = 36.93% vs 30.47%) while improvement in aggressive (RI = 14.38% vs 11.84%) and social behaviour (RI = 12.59% vs 10.37%) was more important to parents. CONCLUSIONS: Important differences in preferences of patients and parents were identified, highlighting that the decision to initiate medication is influenced differently in different individuals and groups.

Cloud Servers: Resource Optimization Using Different Energy Saving Techniques.

Currently, researchers are working to contribute to the emerging fields of cloud computing, edge computing, and distributed systems. The major area of interest is to examine and understand their performance. The major globally leading companies, such as Google, Amazon, ONLIVE, Giaki, and eBay, are truly concerned about the impact of energy consumption. These cloud computing companies use huge data centers, consisting of virtual computers that are positioned worldwide and necessitate exceptionally high-power costs to preserve. The increased requirement for energy consumption in IT firms has posed many challenges for cloud computing companies pertinent to power expenses. Energy utilization is reliant upon numerous aspects, for example, the service level agreement, techniques for choosing the virtual machine, the applied optimization strategies and policies, and kinds of workload. The present paper tries to provide an answer to challenges related to energy-saving through the assistance of both dynamic voltage and frequency scaling techniques for gaming data centers. Also, to evaluate both the dynamic voltage and frequency scaling techniques compared to non-power-aware and static threshold detection techniques. The findings will facilitate service suppliers in how to encounter the quality of service and experience limitations by fulfilling the service level agreements. For this purpose, the CloudSim platform is applied for the application of a situation in which game traces are employed as a workload for analyzing the procedure. The findings evidenced that an assortment of good quality techniques can benefit gaming servers to conserve energy expenditures and sustain the best quality of service for consumers located universally. The originality of this research presents a prospect to examine which procedure performs good (for example, dynamic, static, or non-power aware). The findings validate that less energy is utilized by applying a dynamic voltage and frequency method along with fewer service level agreement violations, and better quality of service and experience, in contrast with static threshold consolidation or non-power aware technique.

Ionic liquid multistate resistive switching characteristics in two terminal soft and flexible discrete channels for neuromorphic computing.

By exploiting ion transport phenomena in a soft and flexible discrete channel, liquid material conductance can be controlled by using an electrical input signal, which results in analog neuromorphic behavior. This paper proposes an ionic liquid (IL) multistate resistive switching device capable of mimicking synapse analog behavior by using IL BMIM FeCL4 and H2O into the two ends of a discrete polydimethylsiloxane (PDMS) channel. The spike rate-dependent plasticity (SRDP) and spike-timing-dependent plasticity (STDP) behavior are highly stable by modulating the input signal. Furthermore, the discrete channel device presents highly durable performance under mechanical bending and stretching. Using the obtained parameters from the proposed ionic liquid-based synaptic device, convolutional neural network simulation runs to an image recognition task, reaching an accuracy of 84%. The bending test of a device opens a new gateway for the future of soft and flexible brain-inspired neuromorphic computing systems for various shaped artificial intelligence applications.

Patient preferences for the treatment of type 2 diabetes in Australia: a discrete choice experiment.

Background: Australia has a high proportion of migrants, with an increasing migration rate from India. Type 2 diabetes is a chronic condition common amongst the Indian population. The decision to initiate and continue medication therapy (conventional or ayurvedic medicine) is complex and is influenced by a wide range of factors. Objective: To determine preferences for conventional vs. ayurvedic medicines in Indian migrants with diabetes, and to identify the factors that may influence their preferences. Methods: A discrete choice experiment was conducted with participants in Australia who were migrants from India with type 2 diabetes (n=141). Each respondent evaluated eight choice tasks consisting of eight attributes describing medicines and outcomes of medication taking; and were asked to choose 'conventional', or 'ayurvedic' medicine. A mixed multinomial logit model was used to estimate preferences. Results: Overall, respondents' preference to initiate a medicine was negative for both conventional (ß=-2.33164, p<0.001) and ayurvedic medicines (ß=-3.12181, p<0.001); however, significant heterogenicity was noted in participants' preferences (SD: 2.33122, p<0.001). Six significant attributes were identified to influence preferences. In decreasing rank order: occurrence of hypoglycaemic events (relative importance, RI=24.33%), weight change (RI=20.00%), effectiveness of medicine (RI=17.91%), instructions to take with food (RI=17.05%), side effects (RI=13.20%) and formulation (RI=7.49%). Respondents preferred to initiate a medicine despite potential side effects. Conclusions: There was a greater preference for conventional medicine, though neither were preferred. Medicine attributes and medication-taking outcomes influenced people's preferences for an antidiabetic medicine. It is important to identify individual preferences during healthcare consultations to ensure optimal medication-taking.

Hepatocellular Carcinoma Due to Nonalcoholic Fatty Liver Disease: Current Concepts and Future Challenges.

Obesity has been labeled as the global pandemic of the 21st century, resulting from a sedentary lifestyle and caloric excess. Nonalcoholic fatty liver disease (NAFLD), characterized by excessive hepatic steatosis, is strongly associated with obesity and metabolic syndrome and is estimated to be present in one-quarter of the world population, making it the most common cause of the chronic liver disease (CLD). NAFLD spectrum varies from simple steatosis to nonalcoholic steatohepatitis (NASH) and cirrhosis. The burden of NAFLD has been predicted to increase in the coming decades resulting in increased rates of decompensated cirrhosis, hepatocellular carcinoma (HCC), and liver-related deaths. In the current review, we describe the pathophysiology of NAFLD and NASH, risk factors associated with disease progression, related complications, and mortality. Later, we have discussed the changing epidemiology of HCC, with NAFLD emerging as the most common cause of CLD and HCC. We have also addressed the risk factors of HCC development in the NAFLD population (including demographic, metabolic, genetic, dietary, and lifestyle factors), presentation of NAFLD-associated HCC, its prognosis, and the issue of HCC development in non-cirrhotic NAFLD. Lastly, the problems related to HCC screening in the NAFLD population, the remaining challenges, and future directions, especially the need to identify the high-risk individuals, will be discussed. We will conclude the review by summarizing the clinical evidence for treating fibrosis and preventing HCC in those at risk with NAFLD-associated HCC.

Eliciting preferences for continuing medication among adult patients and parents of children with attention-deficit hyperactivity disorder.

BACKGROUND: Adherence to medication for attention-deficit hyperactivity disorder (ADHD) is less than optimal. Previous studies have primarily focused on qualitative assessment of factors that influence medication adherence. OBJECTIVE: This study aimed to quantify the factors that influence patient and parent preferences for continuing ADHD medication. METHOD: A discrete-choice experiment was conducted to investigate preferences. Adults, and parents of children, with ADHD were presented with eight hypothetical choice tasks of three options (Medication A, Medication B, No Medication) described by six attributes related to medication outcomes. Preferences were estimated using a mixed multinomial logit model. RESULTS: Overall, respondents' preferences (n = 216) for continuing medication were negative (mean [ß] = -1.426, p < .001); however, a significant heterogeneity in preferences was observed amongst respondents (standard deviation = 0.805, p < .001). Improvements in education, aggressive behaviour, social behaviour and family functioning, and side effects and stigma, influenced respondents' decision to continue taking medication. The respondents were willing to continue medication if they experienced positive effects, but side effects (even moderate) were the strongest concern for not continuing medication. While side effects were the most important factor for both adult patients and parents of children with ADHD, improvement in education was relatively more important for adults and improvement in aggressive behaviour, social behaviour and family functioning was relatively more important for parents of children with ADHD. Parents were more likely to not continue a medication with severe side effects even at the highest level of improvement in education. CONCLUSIONS: Side effects are the most important factor that influenced preferences for continuing medication for both adults with ADHD, as well as parents of children with ADHD. While overall the respondents preferred not to take/give medication, discrete-choice experiment showed that the relative importance of factors that influenced continuation of medications was different for the two groups. PATIENT AND PUBLIC INVOLVEMENT: Adults, and parents of children, with ADHD participated in this study by completing the online questionnaire. The questionnaire was based on findings of research in the literature, as well as earlier focus groups conducted with adults, and parents of children, with ADHD. The face validity of the questionnaire was determined by asking parents of children, and adults, with ADHD (n = 3) to complete the survey and participate in a short discussion on their understanding of the questions and their recommendations on improving the clarity of the survey.

The Role of Religion, Spirituality and Fasting in Coping with Diabetes among Indian Migrants in Australia: A Qualitative Exploratory Study.

Australia has a high proportion of migrants, with an increasing migration rate from India. While many factors influence diabetes self-management among Indian migrants, very little is known about the influence of religious beliefs and spirituality. This study explored the religious beliefs of Indian migrants in Australia and the influence of those beliefs on their diabetes self-management. Semi-structured interviews were conducted with a convenience sample of 23 Indian migrants. All interviews were audio-recorded, transcribed verbatim and thematically analysed. Most participants believed that prayers helped them alleviate stress and improve diabetes management participants also believed that receiving blessings/prayers from religious leaders prevent or cure diseases including diabetes. There were mixed views on beliefs about using insulin obtained from animal sources. Some participants were concerned about the use of animal-based insulin as it was against their religious beliefs and teachings. Some participants believed that religious fasting does not have any impact on their diabetes while others believed that it can be detrimental to their health. Religious beliefs therefore played an important role in how Indian migrants managed their diabetes. Healthcare professionals should consider their patients' religious beliefs during consultations, enlist support, such as religious scholars, to better address people's misconceptions, and identify strategies for effective diabetes management that consider religious beliefs.

Adverse Drug Reaction Reporting and Prescribing Trends of Drugs for Attention Deficit Hyperactivity Disorder in Primary Care England, 2010-2019.

OBJECTIVE: We investigated the prescription trends and adverse drug reactions (ADRs) of ADHD drugs in primary care, England between 2010 and 2019. METHODS: The Prescription Cost Analysis database presenting the primary care prescriptions data and the Interactive Drug Analysis Profiles presenting all suspected ADRs reported for each drug were screened. The data were analyzed using linear regression analysis to examine the annual average change per year. RESULTS: The prescription items dispensed for ADHD showed an average 11.07% (95% CI 10.54-11.60, p = .001) increase per year and there was a mean 11.54% (95% CI 11.03-12.06, p = .001) increase per year in the costs. The overall reporting of serious and fatal ADR was reduced by 1.79% per year for ADHD drugs. Guanfacine showed a 40% mean increase per year. CONCLUSION: The increasing use of ADHD drugs within primary care in England could be a result of multiple factors such as growing ADHD prevalence.

Soft and flexible: core-shell ionic liquid resistive memory for electronic synapses.

The human brain is the most efficient computational and intelligent system, and researchers are trying to mimic the human brain using solid-state materials. However, the use of solid-state materials has a limitation due to the movement of neurotransmitters. Hence, soft memory devices are receiving tremendous attention for smooth neurotransmission due to the ion concentration polarization mechanism. This paper proposes a core-shell soft ionic liquid (IL)-resistive memory device for electronic synapses using Cu/Ag@AgCl/Cu with multistate resistive behavior. The presence of the Ag@AgCl core shell in the liquid electrolyte significantly helps to control the movement of Cu2+ ions, which results in multistate resistive switching behavior. The core-shell IL soft memory device can open a gateway for electronic synapses.

A Qualitative Study on Medication Taking Behaviour Among People With Diabetes in Australia.

Background: Australia has a high proportion of migrants with an increasing migration rate from India. Type II diabetes is a long-term condition common amongst the Indian population. Aims: To investigate patients' medication-taking behaviour and factors that influence adherence at the three phases of adherence. Methods: Semi-structured interviews were conducted with a convenience sample of 23 Indian migrants living in Sydney. All interviews were audio-recorded, transcribed verbatim and thematically analysed. Results: 1) Initiation: The majority of participants were initially prescribed oral antidiabetic medicine and only two were started on insulin. Most started taking their medicine immediately while some delayed initiating therapy due to fear of side-effects. 2) Implementation: Most participants reported taking their medicine as prescribed. However, some reported forgetting their medicine especially when they were in a hurry for work or were out for social events. 3) Discontinuation: A few participants discontinued taking their medicine. Those who discontinued did so to try Ayurvedic medicine. Their trial continued for a few weeks to a few years. Those who did not receive expected results from the Ayurvedic medicine restarted their prescribed conventional medicine. Conclusion: A range of medication-taking behaviours were observed, ranging from delays in initiation to long-term discontinuation, and swapping of prescribed medicine with Ayurvedic medicine. This study highlights the need for tailored interventions, including education, that focus on factors that impact medication adherence from initiation to discontinuation of therapy.

Wide range and highly linear signal processed systematic humidity sensor array using Methylene Blue and Graphene composite.

This paper proposes a signal processed systematic 3 × 3 humidity sensor array with all range and highly linear humidity response based on different particles size composite inks and different interspaces of interdigital electrodes (IDEs). The fabricated sensors are patterned through a commercial inkjet printer and the composite of Methylene Blue and Graphene with three different particle sizes of bulk Graphene Flakes (BGF), Graphene Flakes (GF), and Graphene Quantum Dots (GQD), which are employed as an active layer using spin coating technique on three types of IDEs with different interspaces of 300, 200, and 100 µm. All range linear function (0-100% RH) is achieved by applying the linear combination method of nine sensors in the signal processing field, where weights for linear combination are required, which are estimated by the least square solution. The humidity sensing array shows a fast response time (Tres) of 0.2 s and recovery time (Trec) of 0.4 s. From the results, the proposed humidity sensor array opens a new gateway for a wide range of humidity sensing applications with a linear function.

Humidity sensor based on Gallium Nitride for real time monitoring applications.

Gallium Nitride (GaN) remarkably shows high electron mobility, wide energy band gap, biocompatibility, and chemical stability. Wurtzite structure makes topmost Gallium atoms electropositive, hence high ligand binding ability especially to anions, making it usable as humidity sensor due to water self-ionization phenomenon. In this work, thin-film GaN based humidity sensor is fabricated through pulse modulated DC magnetron sputtering. Interdigitated electrodes (IDEs) with 100 µm width and spacing were inkjet printed on top of GaN sensing layer to further enhance sensor sensitivity. Impedance, capacitance, and current response were recorded for humidity and bio-sensing applications. The sensor shows approximate linear impedance response between 0 and 100% humidity range, the sensitivity of 8.53 nF/RH% and 79 kΩ/RH% for capacitance and impedance, and fast response (Tres) and recovery (Trec) time of 3.5 s and 9 s, respectively. The sensor shows little hysteresis of < 3.53% with stable and wide variations for accurate measurements. Especially, it demonstrates temperature invariance for thermal stability. Experimental results demonstrate fabricated sensor effectively evaluates plant transpiration cycle through water level monitoring by direct attachment onto leaves without causing any damage as well as freshness level of meat loaf. These properties of the proposed sensor make it a suitable candidate for future electronics providing a low-cost platform for real time monitoring applications.

Surging trends in prescriptions and costs of antidepressants in England amid COVID-19.

The social restrictions amid coronavirus disease 2019 (COVID-19) pandemic have posed a serious threat to mental health and have implications in the use of medications for mental health including antidepressants (ADs). This study investigated the trends in prescriptions and costs of various ADs in England during COVID-19 pandemic. National prescribing rates and net ingredient costs (NIC) of all ADs prescriptions during 2016 to 2020 were analyed. The total number of ADs prescriptions dispensed during COVID-19 pandemic (January to December 2020) were 78 million, 4 million more than in 2019 that costed NHS England £ 139 million more than in 2019. Sertraline, an SSRI antidepressant drug, alone accounted for an extra £113 million during 2020 than in 2019. The peak dispensing for ADs was observed in March 2020 while the total costs for AD drugs peaked in April 2020. The rising prescription costs for ADs during COVID-19 pandemic is a potential cause of concern, in particular the increasing use in adolescents and younger adults needs attention, who are at a higher risk of life-threatening adverse drug reactions.

Digestive system involvement and clinical outcomes among COVID-19 patients: A retrospective cohort study from Qatar.

BACKGROUND: Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 virus most commonly presents with respiratory symptoms. While gastrointestinal (GI) manifestations either at presentation or during hospitalization are also common, their impact on clinical outcomes is controversial. Some studies have described worse outcomes in COVID-19 patients with GI symptoms, while others have shown either no association or a protective effect. There is a need for consistent standards to describe GI symptoms in COVID-19 patients and to assess their effect on clinical outcomes, including mortality and disease severity. AIM: To investigate the prevalence of GI symptoms in hospitalized COVID-19 patients and their correlation with disease severity and clinical outcomes. METHODS: We retrospectively reviewed 601 consecutive adult COVID-19 patients requiring hospitalization between May 1-15, 2020. GI symptoms were recorded at admission and during hospitalization. Demographic, clinical, laboratory, and treatment data were retrieved. Clinical outcomes included all-cause mortality, disease severity at presentation, need for intensive care unit (ICU) admission, development of acute respiratory distress syndrome, and need for mechanical ventilation. Multivariate logistic regression model was used to identify independent predictors of the adverse outcomes. RESULTS: The prevalence of any GI symptom at admission was 27.1% and during hospitalization was 19.8%. The most common symptoms were nausea (98 patients), diarrhea (76 patients), vomiting (73 patients), and epigastric pain or discomfort (69 patients). There was no difference in the mortality between the two groups (6.21% vs 5.5%, P = 0.7). Patients with GI symptoms were more likely to have severe disease at presentation (33.13% vs 22.5%, P < 0.001) and prolonged hospital stay (15 d vs 14 d, P = 0.04). There was no difference in other clinical outcomes, including ICU admission, development of acute respiratory distress syndrome, or need for mechanical ventilation. Drugs associated with the development of GI symptoms during hospitalization were ribavirin (diarrhea 26.37% P < 0.001, anorexia 17.58%, P = 0.02), hydroxychloroquine (vomiting 28.52%, P = 0.009) and lopinavir/ritonavir (nausea 32.65% P = 0.049, vomiting 31.47% P = 0.004, and epigastric pain 12.65% P = 0.048). In the multivariate regression analysis, age > 65 years was associated with increased mortality risk [odds ratio (OR) 7.53, confidence interval (CI): 3.09-18.29, P < 0.001], ICU admission (OR: 1.79, CI: 1.13-2.83, P = 0.012), and need for mechanical ventilation (OR: 1.89, CI:1.94-2.99, P = 0.007). Hypertension was an independent risk factor for ICU admission (OR: 1.82, CI:1.17-2.84, P = 0.008) and need for mechanical ventilation (OR: 1.66, CI: 1.05-2.62, P = 0.028). CONCLUSION: Patients with GI symptoms are more likely to have severe disease at presentation; however, mortality and disease progression is not different between the two groups.

Exploring factors influencing initiation, implementation and discontinuation of medications in adults with ADHD.

BACKGROUND: Adherence to ADHD medication is a complex phenomenon as the decision to adhere is influenced by a range of factors. To design tailored interventions to promote adherence, it is important to understand the factors that influence adherence in the context of its three phases: initiation, implementation and discontinuation. OBJECTIVE: The objective of this study was to explore the phase-specific factors that influence adherence to medication in adults who have a diagnosis of ADHD. METHODS: Three focus groups (FGs) were conducted with twenty adults with ADHD in different metropolitan areas of Sydney, Australia. FGs were transcribed verbatim and thematically analysed. RESULTS: Participants' decision to initiate medication (the initiation phase) was influenced by their perceived needs (desire to improve academic and social functioning) and concerns (fear of side-effects) about medication following a similar process as defined by the Necessity-Concerns Framework (NCF). The balance between benefits of medication (needs) and side-effects (concerns) continued to determine participants' daily medication-taking (the implementation phase) and persistence (or discontinuation) with their medication. Forgetfulness and stigma were reported as concerns negatively impacting the implementation phase, while medication cost and dependence influenced the discontinuation phase of adherence. CONCLUSIONS: Adults' decision to initiate, continue or discontinue medication is influenced by a range of factors; some are unique to each phase while some are common across the phases. Participants balanced the needs for the medication against their concerns in determining whether to adhere to medication at each phase. It appears that the NCF has applicability when decision making about medication is explored at the three phases of adherence.