Economic Evaluation of Universal Lynch Syndrome Screening Protocols among Newly Diagnosed Patients with Colorectal Cancer

We conducted an updated economic evaluation, from a healthcare system perspective, to compare the relative effectiveness and efficiency of eight Lynch syndrome (LS) screening protocols among newly diagnosed colorectal cancer (CRC) patients. We developed decision analytic models for a hypothetical cohort of 1000 patients. Model assumptions and parameter values were based on literature and expert opinion. All costs were in 2018 USD. For identifying LS cases, the direct germline sequencing (DGS) protocol provided the best performance (sensitivity 99.90%, 99.57–99.93%; specificity 99.50%, 97.28–99.85%), followed by the tumor sequencing to germline sequencing (TSGS) protocol (sensitivity, 99.42%, 96.55–99.63%; specificity, 96.58%, 96.46–96.60%). The immunohistochemistry (IHC) protocol was most efficient at $20,082 per LS case identified, compared to microsatellite instability (MSI) ($22,988), DGS ($31,365), and TSGS ($104,394) protocols. Adding double-somatic testing to IHC and MSI protocols did not change sensitivity and specificity, increased costs by 6% and 3.5%, respectively, but reduced unexplained cases by 70% and 50%, respectively. DGS would be as efficient as the IHC protocol when the cost of germline sequencing declines under $368 indicating DGS could be an efficient option in the near future. Until then, IHC and MSI protocols with double-somatic testing would be the optimal choices.

Energy and Heat for Medium-sized Cities in a Temperate Climate From a Small Nuclear Reactor and Solar Panels

The article discusses the possibilities of using a system consisting of small nuclear reactors, solar collectors and a heat accumulator in future carbon-free conditions. Kraków (Poland) was chosen as an example of a city supplied with electricity, and heat from the discussed system. The demand for electricity and heat was estimated, possible technical solutions were proposed in an approximate manner and monthly balances of electricity and heat were calculated. It was found impossible to meet the energy needs by using only renewable sources in specific conditions of moderate and season-dependent intensity values of sun and wind. The only and efficient option that is able to cover the city's demand for electricity and heat is a nuclear power plant, consisting, for example, of NuScale nuclear units in combination with solar collectors and a properly selected heat accumulator. Fifty MWel reactors were considered, but a new version of the NuScale modular reactor with a modular capacity of 77 MWel is also briefly shown.

Super-Adsorbent Hydrogels for Removal of Methylene Blue from Aqueous Solution: Dye Adsorption Isotherms, Kinetics, and Thermodynamic Properties

Removal of dyes through adsorption from wastewater has gained substantial interest in recent years, especially in development of hydrogel based adsorbents, owing to their easy use and economical nature. The aim of the present study was to design a super-adsorbent hydrogel based on sodium styrenesulfonate (NaSS) monomer for removal of dyes like methylene blue (MB). NaSS displays both an aromatic ring and strongly ionic group in its monomer structure that can enhance adsorption capacity. Poly(sodium styrenesulfonate-co-dimethylacrylamide) hydrogels were prepared by solution free radical polymerization using gelatin methacryloyl (GelMA) as crosslinker, creating a highly porous, three-dimensionally crosslinked polymer network contributing to higher swelling ratios of up to 27,500%. These super-adsorbent hydrogels exhibited high adsorption capacity of 1270 mg/g for MB adsorption with above 98% removal efficiency. This is the first report for such a high adsorption capacity for dye absorbance for NaSS-based hydrogels. Additionally, the adsorption kinetics using a pseudo-first-order and the Freundlich adsorption isotherm models for multilayer, heterogeneous adsorption processes has been reported. The adsorbents’ reusability was confirmed through 4 repeated cycles of desorption-adsorption. The results discussed herein illustrate that NaSS based chemistries can be used as an efficient option for removal of organic dyes from contaminated wastewater.

A Finer-Grain Analysis of the Leakage (Non) Resilience of OCB

OCB3 is one of the winners of the CAESAR competition and is among the most popular authenticated encryption schemes. In this paper, we put forward a fine-grain study of its security against side-channel attacks. We start from trivial key recoveries in settings where the mode can be attacked with standard Differential Power Analysis (DPA) against some block cipher calls in its execution (namely, initialization, processing of associated data or last incomplete block and decryption). These attacks imply that at least these parts must be strongly protected thanks to countermeasures like masking. We next show that if these block cipher calls of the mode are protected, practical attacks on the remaining block cipher calls remain possible. A first option is to mount a DPA with unknown inputs. A more efficient option is to mount a DPA that exploits horizontal relations between consecutive input whitening values. It allows trading a significantly reduced data complexity for a higher key guessing complexity and turns out to be the best attack vector in practical experiments performed against an implementation of OCB3 in an ARM Cortex-M0. Eventually, we consider an implementation where all the block cipher calls are protected. We first show that exploiting the leakage of the whitening values requires mounting a Simple Power Analysis (SPA) against linear operations. We then show that despite being more challenging than when applied to non-linear operations, such an SPA remains feasible against 8-bit implementations, leaving its generalization to larger implementations as an interesting open problem. We last describe how recovering the whitening values can lead to strong attacks against the confidentiality and integrity of OCB3. Thanks to this comprehensive analysis, we draw concrete requirements for side-channel resistant implementations of OCB3.

The Lack of Qualified EFL Teachers in Saudi Schools: A Qualitative Interview Study

Despite teaching English language in Saudi Arabia for 6 decades, yet the outcomes are unsatisfactory. In this article, the lack of qualified English teachers in Saudi Arabia is the main reason for causing that issue. To address the issue, this study attempts to understand how untrained teachers have a negative influence on students' performance and competence. Unstructured interviews were conducted with students from two Saudi schools to reflect on the problems and obstacles that Saudi pupils encounter as a result of their incompetent instructors. Instead of interviewing instructors, we interviewed students to know the strategies, methods, and techniques employed by their teachers, which resulted in their incapacity to improve. According to the participants, the majority of English teachers in Saudi schools speak Arabic in English lessons rather than English. They also employ traditional approaches such as the teacher-centered method. They educate and explain in English, but when they reach a major obstacle, they immediately switch to Arabic as an efficient option. The study's findings highlight the necessity of having trained teachers to teach English in EFL programs in Saudi Arabia. The study's objective is to demonstrate that instructors are at the heart of the issues that affecting students' growth and how to assist them to overcome those problems.  

RP-HPLC method development and validation for simultaneous estimation of efonidipine hydrochloride ethanolate and telmisartan in their synthetic mixture

A Novel, selective, accurate and rapid Reversed Phase High Performance Liquid Chromatographic (RPHPLC) method for the analysis of Efonidipine Hydrochloride Ethanolate and Telmisartan in binary mixture has been developed and validated. The chromatographic system consisted of a Phenomenex Kinetex ® 5µ C18 Size: 150 * 4.6mm column and the separation was achieved by using ambient temperature with a mobile phase containing mobile Phase Acetonitrile:25mM Phosphate Buffer pH 4.9 (45:55). The samples were monitored at 253 nm for detection at a flow rate of 1.0 mL/min and the retention time was about 7.77 and 4.10 mins for Efonidipine Hydrochloride Ehanolate and Telmisartan respectively. The calibration curve was linear over the concentration range 5-30 and 10-60 ?g/mL for Efonidipine Hydrochloride Ehanolate and Telmisartan respectively. The proposed method is accurate in the range of 99.75% - 100.10% recovery and precise (%RSD of intraday variation and % RSD of inter day variation were found to be within the acceptance criteria). Therefore, this method can be used as a more convenient and efficient option for the analysis of Efonidipine Hydrochloride Ehanolate and Telmisartan in Quality control laboratory.

Complex Subsurface Well Abandonments Using Relief Well Methodologies

The field experience in the continental US suggests that approximately 33% of plug and abandonment operations are non-routine, and 5% require re-entry (Greer C.R., 2018). In some scenarios, the most cost-efficient option for the intervention is drilling an intercept well to re-enter the target well or multiple wells externally using advanced survey management and magnetic ranging techniques. This paper presents the methods applied of relief well methodologies from the planning to execution of a complex multiple-well abandonment project. Improvements in Active Magnetic Ranging sensor design and applications have improved the availability of highly precise tools for the purpose of locating and intercepting wellbores where access is not possible. These instruments were commonplace on relief well interventions, however, have found a new application in solving one of the major issues facing the oil and gas industry. Subsurface abandonments are a complex task that requires a robust methodology. In this paper, we describe the techniques that have been built upon the best practices from industry experience (ISCWSA WISC eBook). This paper also illustrates how the combination of advanced survey management, gyro surveying, and magnetic ranging can be used following the best industry practices for fast and cost-efficient non-routine plug and abandonment. Case studies of several abandonment projects are presented showing the various technical challenges which are common on idle and legacy wells. The projects include wells that are currently under the ownership of an operator and orphaned wells that have been insufficiently abandoned and left idle over many decades. The case studies outline how the application of relief well methodologies to the execution of complex sub surface interventions led to the successful outcomes of meeting environmental and government regulations for wellbore abandonment. This includes performing multiple zonal isolations between reservoirs, water zones and preventing oil and gas seepage to the surface. The projects and their outcomes prove economically viable strategies for tackling the growing issue of idle and orphaned wells globally in a fiscally responsible manner. Combining industry best practice methods for relief well drilling, along with the technological advancements in magnetic ranging systems is a solution for one of the largest dilemmas facing the oil and gas industry in relation to idle and orphaned wellbores. These applications allow previously considered impossible abandonments to be completed with a high probability of long-term success in permanent abandonment.

At what Pressure Shall CO2 Be Transported by Ship? An in-Depth Cost Comparison of 7 and 15 Barg Shipping

The pipeline has historically been the preferred means to transport CO2 due to its low cost for short distances and opportunities for economies of scale. However, interest in vessel-based transport of CO2 is growing. While most of the literature has assumed that CO2 shipping would take place at low pressure (at 7 barg and −46 °C), the issue of identifying best transport conditions, in terms of pressure, temperature, and gas composition, is becoming more relevant as ship-based carbon capture and storage chains move towards implementation. This study focuses on an in-depth comparison of the two primary and relevant transport pressures, 7 and 15 barg, for annual volumes up to 20 MtCO2/year and transport distances up to 2000 km. We also address the impact of a number of key factors on optimal transport conditions, including (a) transport between harbours versus transport to an offshore site, (b) CO2 pressure prior to conditioning, (c) the presence of impurities and of purity constraints, and (d) maximum feasible ship capacities for the 7 and 15 barg options. Overall, we have found that 7 barg shipping is the most cost-efficient option for the combinations of distance and annual volume where transport by ship is the cost-optimal means of transport. Furthermore, 7 barg shipping can enable significant cost reductions (beyond 30%) compared to 15 barg shipping for a wide range of annual volume capacities.

Past and Future Trends in Medical Spas: A Co-Word Analysis

The present paper consists of a co-word analysis of the previous research in the medical spa field published in the Web Science Core Collection database. The study’s main purpose is to identify the past trends in the medical spa field from the tourist and medical perspectives and to anticipate the future research focuses in the field. In this regard, the article is based on four objectives that create a descriptive picture of the research in the medical spa area, such as (i) studying the current state of the art, (ii) analysing the most visible articles in the field, (iii) highlighting the leading research interests in medical spa research and (iv) anticipating new possible research trends that link cost-effective medical spa activity to COVID-19 post-recovery treatments. A total of 627 articles, published between 1997 and 2021 (March), were analysed, and the data were interpreted using the VOS Viewer software. The study results indicate that high interest in medical spas started to become observable in 2015, when the funding bodies became interested in this field and began supporting publishing and research regarding medical spas. The main subjects investigated in previous studies were related to the specific issues of the industry and tourism activity. They also considered the medical approach of the spa and the use of natural resources in treating different diseases. Except for these main interests, since 2020, it has started to become evident that another approach in the published studies may lead to a new trend in research. The study results show that researchers have begun to investigate the possibility of using medical spa resorts to aid post-COVID-19 recovery, which is considered a cost-efficient option for completing traditional treatment. This new focus in research proves that the medical spa field can rebrand itself as playing a supportive role in national healthcare systems in countries with a long tradition in balneotherapy, and gives a new developing trajectory to the medical spa industry.

The role of brush encroachment in Mediterranean ecosystems: a review

Encroachment of woody plants into grasslands and subsequent brush management are among the most prominent changes occurring in arid and semiarid ecosystems over the past century. The reduced number of farms, the abandonment of marginal land and the decline of traditional farming practices have led to encroachment of the woody and shrubby components into grasslands. This phenomenon, specifically in the Mediterranean region, which is followed by a reduction in herbage production, biodiversity and increased fire risk, is generally considered an undesirable process. Sarcopoterium spinosum has had great success in the eastern Mediterranean as a colonizer and dominant bush species on a wide variety of sites and climatic conditions. In the Mediterranean dehesa, the high magnitude and intensity of shrub encroachment effects on pastures and on tree production were shown to be dependent on temporal variation. Accordingly, there are attempts to transform shrublands into grassland-woodland matrices by using different techniques. The main management interventions that are commonly used include grazing, woodcutting, shrub control with herbicides or by mechanical means, amelioration of plant mineral deficits in the soil, and fire. However, the effects of these various treatments on the shrubs under diverse environmental conditions were found to be largely context-specific. As such, the most efficient option for suppressing encroachment of shrubs is combining different interventions. Appropriate management of grazing, periodic control of the shrub component, and occasional soil nutrient amelioration can lead to the development of attractive open woodland with a productive herbaceous understory that provides a wider range of ecological services.