Towards Scalable Parallel Fibonacci Heap Implementation

With the advancement of multiple processors, the sequential algorithms are being investigated and gradually substituted for its concurrent equivalent to effectively exploit the parallel architecture. Parallel algorithms speed up the performance by dividing the task into a number of processes (or threads) that can be scheduled and executed simultaneously in independent processing units. Various well-known basic algorithms and data-structures have been explored for its efficient parallel counterparts and have been published as popular libraries. However, advanced data-structures and algorithms have not seen similar investigation mainly because they have many optimization steps mostly backed by many states and finding safe and efficient parallel implementation isn’t an easy endeavor. Safety concerns for shared-memory parallel implementation are of utmost importance as it provides a basis for consistency of any data structure and algorithm. There are well-known tools like locks, semaphores, atomic operations and so on that assist towards safe parallel implementation but using them effectively and in well-defined synchronization are key factors in the overall performance of any data-structures and algorithms. This paper explores an advanced data structure, Fibonacci Heap, and its operations to evaluate its implementation using two different synchronization mechanisms: Coarse-grained and Fine-grained. The analysis in this paper shows that a fine-grained synchronized Fibonacci Heap implementation with certainly relaxed semantics is more scalable with growing number of concurrency in comparison to the coarse-grained synchronized Fibonacci Heap implementation

Neck shrivel in European plum is caused by cuticular microcracks, resulting from rapid lateral expansion of the neck late in development

Susceptibility to the commercially important fruit disorder ‘neck shrivel’ differs among European plum cultivars. Radial cuticular microcracking occurs in the neck regions of susceptible cultivars, but not in non-susceptible ones, so would seem to be causal. However, the reason for the microcracking is unknown. The objective was to identify potential relationships between fruit growth pattern and microcracking incidence in the neck (proximal) and stylar (distal) ends of selected shrivel-susceptible and non-susceptible cultivars. Growth analysis revealed two allometric categories: The first category, the ‘narrow-neck’ cultivars, showed hypoallometric growth in the neck region (i.e., slower growth than in the region of maximum diameter) during early development (stages I + II). Later (during stage III) the neck region was ‘filled out’ by hyperallometric growth (i.e., faster than in the region of maximum diameter). The second category, the ‘broad-neck’ cultivars, had more symmetrical, allometric growth (all regions grew equally fast) throughout development. The narrow-neck cultivars exhibited extensive radial cuticular microcracking in the neck region, but little microcracking in the stylar region. In contrast, the broad-neck cultivars exhibited little microcracking overall, with no difference between the neck and stylar regions. Across all cultivars, a positive relationship was obtained for the level of microcracking in the neck region and the difference in allometric growth ratios between stage III and stages I + II. There were no similar relationships for the stylar region. The results demonstrate that accelerated stage III neck growth in the narrow-neck plum cultivars is associated with more microcracking and thus with more shrivel

Managing risk, changing aspirations and household dynamics: implications for wellbeing and adaptation in semi-arid Africa and India

Semi-arid regions across Africa and Asia are characterized by rapidly changing biophysical regimes, structural vulnerabilities, and increasing livelihood precarity. Gender, class, and caste/ethnic identities and relationships, and the specific social, economic and political power, roles and responsibilities they entail, shape the choices and decisions open to individuals and households in managing the risks they face. Unpacking the multiple, intersecting inequalities confronting rural populations in these climate hotspots is therefore vital to understand how risk can be managed in a way that supports effective, inclusive, and sustainable local adaptation. Drawing on empirical evidence from six countries, generated through a mixed methods approach, we examine how changes in household dynamics, structure, and aspirations, shape risk management with implications for household well-being, adaptive capacity, and ultimately sustainable development. The ability of individuals within households, differentiated by age, marital status, or education, to manipulate the very structure of the household and the material and social resources it offers, differentiates risk management strategies such as livelihood diversification, migration, changing agricultural practices and leveraging social support. Our evidence suggests that while greater risks can drive conflictive behavior within households, with women often reporting lower subjective wellbeing, new forms of cooperative behavior are also emerging, especially in peri-urban spaces. Through this study, we identify entry points into enabling sustainable and inclusive adaptation behavior, emphasizing that interventions should work for both women and men by challenging inequitable social and gender norms and renegotiating the domains of work and cooperation to maintain overall household wellbeing

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Fine-scale habitat characteristics influence the winter habitat use of swamp deer (Rucervus duvaucelii) in Shuklaphanta National Park, Nepal

Endemic to India and Nepal, the swamp deer (Rucervus duvaucelii) is crucial for restoring and sustaining populations of top predators like tigers. Despite recent signs of species recovery in protected areas, the species remains vulnerable to extinction due to increasing anthropogenic activities. Information on factors influencing the occurrence of swamp deer is essential to formulate suitable management plans that can help to maintain their viable population and protect their habitats. We recorded swamp deer presence via direct sightings and indirect signs (pellets and footprints) through line transect surveys. Two ecological drivers i.e., habitat variables and disturbance variables that included eleven predictor variables were measured in the field where swamp deer was present ("used plots") and absent ("habitat availability plot"). Binary logistic regression was used to analyze the factors associated with the probability of detecting the swamp deer. The model's outcomes showed that an increase in road/path/fireline distance and settlement distance, mixed forest habitat, and depth of leaf litter were positively correlated with the probability of locating swamp deer, while the other significant predictor variables (canopy cover, distance from water source, and presence of predator) had inverse relationships. In summary, our study has provided crucial insights into the factors influencing the presence of swamp deer in their habitat. These findings are useful for local governments and protected area authorities by providing fine-scale field-based scientific information, that can benefit swamp deer and its habitat. We also recommend similar studies in species range locations considering other influencing factors such as season, climate, interaction with other herbivore species, and predators that might affect the habitat use of swamp deer.Peer reviewe

Takotsubo cardiomyopathy precipitated by delirium tremens

A 57-year-old woman presented with alcohol withdrawal symptoms, which later progressed to delirium tremens. During hospitalization, she developed respiratory distress with acute pulmonary edema. Electrocardiogram (ECG) showed diffuse ST elevation with elevated cardiac enzymes. Echocardiogram showed estimated ejection fraction of 20–25% with characteristic apical ballooning. After several days of supportive care, the patient showed significant clinical improvement with normalization of ECG, cardiac enzymes, and echocardiographic findings. Coronary angiogram revealed no coronary abnormalities. Although Takotsubo cardiomyopathy has been associated with diverse forms of physical or emotional stress, only a few cases have been described with delirium tremens in the medical literature

Tricuspid valve endocarditis complicated by Mobitz type II heart block – a case report and literature review

We present a case of a middle-aged male who manifested with low-grade fever and lower back pain. MRI and bone scan of the spine were suggestive of vertebral osteomyelitis. Blood cultures were persistently positive for Enterococcus faecalis and echocardiogram revealed tricuspid valve endocarditis. There was no history of IV drug use and urine toxicology was negative. EKG showed Mobitz type II AV block and a transesophageal echocardiogram revealed no valve ring or septal abscesses. The heart block persisted despite antibiotic therapy and an epicardial pacemaker was placed. This is a rare presentation of high-grade AV block with tricuspid endocarditis in the absence of echocardiographic evidence of perivalvular extension of infection. Also, unique in this case is the finding of E. faecalis hematogenous vertebral osteomyelitis

Use of flexible bronchoscopy in an adult for removal of an aspirated foreign body at a community hospital

Foreign body aspiration (FBA) is more common in children than adults with about 80% occurring in children aged less than 15 years. FBA in adults is often overlooked as a potential cause of airway obstruction especially if there is no asphyxiation. We present a case of a 45-year-old male with alcohol abuse who presented with post-obstructive pneumonia secondary to aspiration of tooth of unknown duration. The tooth was removed via flexible bronchoscopy (FBr) and we will discuss the use of FBr for foreign body (FB) removal, which FB can be easily removed by FBr, and the different techniques and devices used for FB removal via FBr

Pseudo-thrombotic thrombocytopenic purpura presenting as multi-organ dysfunction syndrome: A rare complication of pernicious anemia

Objective: We present a rare case of pernicious anemia presented as multi-organ dysfunction syndrome, later found to have pseudo-thrombotic thrombocytopenic purpura. Methods: An 86-year-old female presented with respiratory distress, altered mental status, acute renal failure and was intubated in emergency room. She was found to have severe anemia, thrombocytopenia, high lactate, high lactate dehydrogenase and low haptoglobin. Peripheral smear revealed multilobulated neutrophils with schistocytes, poikilocytes and anisocytes. Results: She was admitted to intensive care unit for altered mental status, multi-organ dysfunction syndrome with severe metabolic acidosis in setting of hemolysis. She was intubated and managed with intravenous antibiotics and blood transfusion. Patient improved significantly after blood transfusion. Lactic acid normalized, acute kidney injury resolved and mentation improved after transfusion. Laboratory investigation revealed low vitamin B12, high methylmalonic acid, high homocysteine, high lactate dehydrogenase, low haptoglobin, high anti-parietal antibody and high anti-intrinsic factor antibody. Patient was diagnosed with pernicious anemia and pseudo-thrombotic thrombocytopenic purpura with concomitant intramedullary hemolysis. Her hematological parameters and her clinical condition improved significantly after starting therapy with cyanocobalamin. Conclusion: Pernicious anemia is a chronic disease with subtle presentation but may present as life-threatening complications. Hemolysis and pseudo-thrombotic thrombocytopenic purpura may present as multi-organ dysfunction syndrome which has dramatic response to appropriate therapy

Multidrug resistance, biofilm formation and detection of blaCTX-M and blaVIM genes in E. coli and Salmonella isolates from chutney served at the street-food stalls of Bharatpur, Nepal

Antimicrobial resistance (AMR) amid the bacteria found in ready-to-eat foods is a grave concern today warranting an immediate intervention. The current study was undertaken to explore the status of AMR in E. coli and Salmonella species in ready-to-eat Chutney samples (n = 150) served at the street food stalls in Bharatpur, Nepal, with a major focus on detecting extended-spectrum β-lactamase (ESBL) and metallo β-lactamase (MBL) genes along with biofilm formation. Average viable counts, coliform counts, and Salmonella Shigella counts were 1.33 × 106±141481.4, 1.83 × 105±91303.6, and 1.24 × 105±63933.19 respectively. Out of 150 samples, 41 (27.33%) harbored E. coli, of which 7 were E. coli O157:H7; whereas Salmonella spp. were found in 31 (20.67%) samples. Bacterial contamination of Chutney by E. coli and Salmonella and ESBL-production were both found significantly affected by different sources of water used, personal hygiene and literacy rate of the vendors as well as by the type of cleaning materials used to wash knives and chopping boards (P < 0.05). Antibiotic susceptibility testing revealed that imipenem was the most effective drug against both types of bacterial isolates. Additionally, 14 (45.16%) Salmonella isolates and 27 (65.85%) E. coli isolates were found to be multi-drug resistant (MDR). Total ESBL (blaCTX-M) producers reported were 4 (12.90%) Salmonella spp. and 9 (21.95%) E. coli. Only 1 (3.23%) Salmonella spp. and 2 (4.88%) E. coli isolates were blaVIM gene carriers. Dissemination of knowledge of personal hygiene amongst the street vendors and consumer awareness regarding ready-to-eat foods are crucial factors that can be suggested to curtail the emergence and transmission of food-borne pathogens