An acute case of expressive aphasia following ischaemic stroke

Mr. D.C. is a 75-year old gentleman brought to casualty after a neighbour found him unable to speak. Since he was severely aphasic, he was unable to give a proper history. The patient was able to understand commands, making this a pure expressive aphasia. He was also noted to have right hemiparesis and right facial weakness. On examination, Mr D.C. was found to have 0/5 power on the right half of his body and 3/5 power on the left side of his body using the MRC muscle power assessment scale. He was noted to have right facial weakness in an upper motor neurone lesion pattern. He was urgently admitted to a medical ward and a CT scan was requested. The scan confirmed a left middle cerebral artery (MCA) ischaemic infarct affecting the basal ganglia and Broca’s Area in the inferior frontal lobe.peer-reviewe

Social-Ecological Resilience and Law in the Platte River Basin

Efficiency and resistance to rapid change are hallmarks of both the judicial and legislative branches of the United States government. These defining characteristics, while bringing stability and predictability, pose challenges when it comes to managing dynamic natural systems. As our understanding of ecosystems improves, we must devise ways to account for the nonlinearities and uncertainties rife in complex social-ecological systems. This paper takes an in-depth look at the Platte River basin over time to explore how the system’s resilience—the capacity to absorb disturbance without losing defining structures and functions—responds to human driven change. Beginning with pre-European settlement, the paper explores how water laws, policies, and infrastructure influenced the region’s ecology and society. While much of the post-European development in the Platte River basin came at a high ecological cost to the system, the recent tri-state and federal collaborative Platte River Recovery and Implementation Program is a first step towards flexible and adaptive management of the social-ecological system. Using the Platte River basin as an example, we make the case that inherent flexibility and adaptability are vital for the next iteration of natural resources management policies affecting stressed basins. We argue that this can be accomplished by nesting policy in a resilience framework, which we describe and attempt to operationalize for use across systems and at different levels of jurisdiction. As our current natural resources policies fail under the weight of looming global change, unprecedented demand for natural resources, and shifting land use, the need for a new generation of adaptive, flexible natural resources governance emerges. Here we offer a prescription for just that, rooted in the social, ecological and political realities of the Platte River basin

An Android-based Image Steganography Approach to Data Communication Security using LSB and Password-based Encryption

The study's ultimate goal is to develop an Android app dedicated to Image Steganography, a technique for concealing sensitive information behind seemingly innocuous photographs. This information hiding technique is essential because of its many potential uses. Symmetric encryption, asymmetric encryption, and steganography are all brought together in this method. The initial picture is encrypted using a symmetric technique in this procedure. After that, the encrypted picture is quietly placed using a least significant bits Steganographic approach to conceal the secret key that was encrypted using an asymmetric algorithm. The steganography algorithm's simple but effective security mechanism is a major benefit. Integrating a secret message into a seemingly benign source makes it very difficult to detect the hidden message without prior knowledge of its existence and the appropriate decryption algorithm. The privacy of the concealed data is protected by this feature. The planned Android app would provide a user-friendly interface for using picture steganography methods, making it simple for anybody to choose commonplace photos and secret messages for obfuscation. Both the original picture and the concealed message will be kept secret thanks to the app's robust encryption methods. The hidden message will be seamlessly included into the regular picture using advanced steganographic methods like the least significant bits approach. The creation of this software is motivated by a desire to provide an easily accessible solution for people who want safe communication through hidden messages or encrypted photos. The robust encryption and steganographic technologies, paired with the straightforward interface, will enable users to effectively protect sensitive information. This work will strengthen the area of data security and highlight the need of sophisticated encryption and steganography in modern digital communication

Enhancing Trajectory-Based Operations for UAVs through Hexagonal Grid Indexing: A Step towards 4D Integration of UTM and ATM

Aviation is expected to face a surge in the number of manned aircraft and drones in the coming years, making it necessary to integrate Unmanned Aircraft System Traffic Management (UTM) into Air Traffic Management (ATM) to ensure safe and efficient operations. This research proposes a novel hexagonal grid-based 4D trajectory representation framework for unmanned aerial vehicle (UAV) traffic management that overcomes the limitations of existing square/cubic trajectory representation methods. The proposed model employs a hierarchical indexing structure using hexagonal cells, enabling efficient ground based strategic conflict detection and conflict free 4D trajectory planning. Additionally, the use of Hexagonal Discrete Global Grid Systems provides a more accurate representation of UAV trajectories, improved sampling efficiency and higher angular resolution. The proposed approach can be used for predeparture conflict free 4D trajectory planning, reducing computational complexity and memory requirements while improving the accuracy of strategic trajectory conflict detection. The proposed framework can also be extended for air traffic flow management trajectory planning, Air Traffic Control (ATC) workload measurement, sector capacity estimation, dynamics airspace sectorization using hexagonal sectors and traffic density calculation, contributing to the development of an efficient UTM system, and facilitating the integration of UAVs into the national airspace system with AT

Pharmacy and formulation support for paediatric clinical trials in England

Availability and sourcing of investigational drugs for paediatric clinical trials is known to be a challenge for investigator-led clinical trials. The National Institute of Health Research Clinical Research Network: Children (CRN: Children) provides support for formulations and pharmacy related issues to researchers planning and setting up paediatric clinical trials within England. This paper reviews pharmacy and formulation support provided to a consecutive series of investigator-led clinical studies supported by CRN:Children. Case studies are included to describe some of the unique pharmaceutical challenges encountered. 44 trials were reviewed and a total of 103 products were required to support these clinical trials. UK authorised products were suitable for use for 62 of these 103 products. In the remaining 41 cases, 4 could be sourced as an authorised product within the European Union and the remaining 37 required bespoke manufacture. Bespoke manufacture of an investigational drug or placebo is costly. Typical costs for the initial development and testing of a bespoke investigational drug or placebo were in the range of £30,000–100,000 per product. The estimated cost for 19 out of 45 trials was available; in summary, the costs on a per patient per day of therapy basis ranged from under £1 to almost £600; short studies involving multiple agents are obviously the most expensive. This range is dependent upon the need for bespoke manufacture and also the number of participants within the trial. The arrangements for investigational drug supply can greatly affect the study design, regulatory requirements, trial logistics, as well as the total cost of research. As investigational product related activities are often costly, necessitating months of advance planning, it is imperative that specialist inputs are sought from the very start of the study design and planning process

Organ preservation and survival by clinical response grade in patients with rectal cancer treated with total neoadjuvant therapy: A secondary analysis of the OPRA randomized clinical trial

IMPORTANCE: Assessing clinical tumor response following completion of total neoadjuvant therapy (TNT) in patients with locally advanced rectal cancer is paramount to select patients for watch-and-wait treatment. OBJECTIVE: To assess organ preservation (OP) and oncologic outcomes according to clinical tumor response grade. DESIGN, SETTING, AND PARTICIPANTS: This was secondary analysis of the Organ Preservation in Patients with Rectal Adenocarcinoma trial, a phase 2, nonblinded, multicenter, randomized clinical trial. Randomization occurred between April 2014 and March 2020. Eligible participants included patients with stage II or III rectal adenocarcinoma. Data analysis occurred from March 2022 to July 2023. INTERVENTION: Patients were randomized to induction chemotherapy followed by chemoradiation or chemoradiation followed by consolidation chemotherapy. Tumor response was assessed 8 (±4) weeks after TNT by digital rectal examination and endoscopy and categorized by clinical tumor response grade. A 3-tier grading schema that stratifies clinical tumor response into clinical complete response (CCR), near complete response (NCR), and incomplete clinical response (ICR) was devised to maximize patient eligibility for OP. MAIN OUTCOMES AND MEASURES: OP and survival rates by clinical tumor response grade were analyzed using the Kaplan-Meier method and log-rank test. RESULTS: There were 304 eligible patients, including 125 patients with a CCR (median [IQR] age, 60.6 [50.4-68.0] years; 76 male [60.8%]), 114 with an NCR (median [IQR] age, 57.6 [49.1-67.9] years; 80 male [70.2%]), and 65 with an ICR (median [IQR] age, 55.5 [47.7-64.2] years; 41 male [63.1%]) based on endoscopic imaging. Age, sex, tumor distance from the anal verge, pathological tumor classification, and clinical nodal classification were similar among the clinical tumor response grades. Median (IQR) follow-up for patients with OP was 4.09 (2.99-4.93) years. The 3-year probability of OP was 77% (95% CI, 70%-85%) for patients with a CCR and 40% (95% CI, 32%-51%) for patients with an NCR (P \u3c .001). Clinical tumor response grade was associated with disease-free survival, local recurrence-free survival, distant metastasis-free survival, and overall survival. CONCLUSIONS AND RELEVANCE: In this secondary analysis of a randomized clinical trial, most patients with a CCR after TNT achieved OP, with few developing tumor regrowth. Although the probability of tumor regrowth was higher for patients with an NCR compared with patients with a CCR, a significant proportion of patients achieved OP. These findings suggest the 3-tier grading schema can be used to estimate recurrence and survival outcomes in patients with locally advanced rectal cancer who receive TNT. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02008656

Decoloniality and Tropicality: Part Two

The papers collected together in this special issue on the theme ‘decoloniality and tropicality’ discuss and demonstrate how we can move towards disentangling ourselves from persistent colonial epistemologies and ontologies. Engaging theories of decoloniality and postcolonialism with tropicality, the articles explore the material poetics of philosophical reverie; the \u27tropical natureculture\u27 imaginaries of sex tourism, ecotourism, and militourism; deep readings of an anthropophagic movement, ecocritical literature, and the ecoGothic; the spaces of a tropical flâneuseand diasporic vernacular architecture; and in the decoloniality of education, a historical analysis of colonial female education and a film analysis for contemporary educational praxis

Examining Type 1 Diabetes Mathematical Models Using Experimental Data

Type 1 diabetes requires treatment with insulin injections and monitoring glucose levels in affected individuals. We explored the utility of two mathematical models in predicting glucose concentration levels in type 1 diabetic mice and determined disease pathways. We adapted two mathematical models, one with [Formula: see text]-cells and the other with no [Formula: see text]-cell component to determine their capability in predicting glucose concentration and determine type 1 diabetes pathways using published glucose concentration data for four groups of experimental mice. The groups of mice were numbered Mice Group 1–4, depending on the diabetes severity of each group, with severity increasing from group 1–4. A Markov Chain Monte Carlo method based on a Bayesian framework was used to fit the model to determine the best model structure. Akaike information criteria (AIC) and Bayesian information criteria (BIC) approaches were used to assess the best model structure for type 1 diabetes. In fitting the model with no [Formula: see text]-cells to glucose level data, we varied insulin absorption rate and insulin clearance rate. However, the model with [Formula: see text]-cells required more parameters to match the data and we fitted the [Formula: see text]-cell glucose tolerance factor, whole body insulin clearance rate, glucose production rate, and glucose clearance rate. Fitting the models to the blood glucose concentration level gave the least difference in AIC of [Formula: see text] , and a difference in BIC of [Formula: see text] for Mice Group 4. The estimated AIC and BIC values were highest for Mice Group 1 than all other mice groups. The models gave substantial differences in AIC and BIC values for Mice Groups 1–3 ranging from [Formula: see text] to [Formula: see text]. Our results suggest that the model without [Formula: see text]-cells provides a more suitable structure for modelling type 1 diabetes and predicting blood glucose concentration for hypoglycaemic episodes