Blockchain technology has recently enhanced energy trading by providing a new low-cost, secure, and decentralized transaction mechanism. This paper proposes a new methodology for applying blockchain in energy trading for a hybrid microgrid. The proposed methodology accounts for droop-based hybrid microgrids. The active power droop for both AC and DC sub-grids are used to reflect the suppliers bidding. A bidding strategy is implemented to minimize the generation cost and therefore maximizes the social welfare. On the other hand, the reactive power droop for the AC sub-grids is utilized to minimize the power loss on the microgrid through bus voltage support. Further, the paper presents a power losses allocation approach for precisely allocating system losses to each node. A case study with many transactions is conducted. The results demonstrate the suggested framework’s efficacy in maximizing social welfare while minimizing system losses.

{\textless}sec{\textgreater}{\textless}title{\textgreater}Introduction{\textless}/title{\textgreater}{\textless}p{\textgreater}The colonization of patients by carbapenemase-producing {\textless}italic{\textgreater}Enterobacterales{\textless}/italic{\textgreater} ({CPE}) has been associated with heightened mortality, especially in vulnerable individuals within intensive care units ({ICUs}). Our study aimed to comprehensively assess {CPE} prevalence among {ICU} patients across the Mediterranean region pre-{COVID}-19, conducting a multicenter prevalence study in the first quarter of 2019.{\textless}/p{\textgreater}{\textless}/sec{\textgreater}{\textless}sec{\textgreater}{\textless}title{\textgreater}Methods{\textless}/title{\textgreater}{\textless}p{\textgreater}We collected clinical data and rectal or fecal samples from 256 {ICU} patients for {CPE} testing. Additionally, we performed whole-genome sequencing on 40 representative {CPE} strains to document their molecular characteristics.{\textless}/p{\textgreater}{\textless}/sec{\textgreater}{\textless}sec{\textgreater}{\textless}title{\textgreater}Results{\textless}/title{\textgreater}{\textless}p{\textgreater}Among the 256 patients, {CPE} was detected in 73 samples (28.5%), with prevalence varying from 3.3 to 69.0% across participating centers. We observed 13 colistin-resistant {CPE} strains, affecting three {ICUs}. Genetic analysis revealed highly diverse {\textless}italic{\textgreater}E. coli{\textless}/italic{\textgreater} and {\textless}italic{\textgreater}K. pneumoniae{\textless}/italic{\textgreater} strains, predominantly from international high-risk clones. Notably, {\textless}italic{\textgreater}bla{\textless}/italic{\textgreater}$_{\textrm{{OXA}-48}}$ and {\textless}italic{\textgreater}bla{\textless}/italic{\textgreater}$_{\textrm{{NDM}-1}}$ were the most prevalent carbapenemase genes. Molecular typing uncovered potential patient clusters in six centers. Significantly, longer hospital stays were associated with increased {CPE} carriage ({\textless}italic{\textgreater}p{\textless}/italic{\textgreater} < 0.001). Nine centers across Morocco, Tunisia, Egypt, and Lebanon voluntarily participated.{\textless}/p{\textgreater}{\textless}/sec{\textgreater}{\textless}sec{\textgreater}{\textless}title{\textgreater}Discussion{\textless}/title{\textgreater}{\textless}p{\textgreater}Our study provides {CPE} prevalence in Mediterranean {ICUs} and reaffirms established {CPE} presence in this setting but also provides updates on the molecular diversity of {CPE} strains. These findings highlight the imperative of reinforcing infection control measures in the participating {ICUs} to curtail escalated mortality rates, and of strictly applying isolation measures around patients originating from the Mediterranean region when transferred to other healthcare institutions.{\textless}/p{\textgreater}{\textless}/sec{\textgreater}

OBJECTIVES: To explore prevalence, characteristics and risk factors of COVID-19 breakthrough infections (BIs) in idiopathic inflammatory myopathies (IIM) using data from the COVID-19 Vaccination in Autoimmune Diseases (COVAD) study.

METHODS: A validated patient self-reporting e-survey was circulated by the COVAD study group to collect data on COVID-19 infection and vaccination in 2022. BIs were defined as COVID-19 occurring ≥14 days after 2 vaccine doses. We compared BIs characteristics and severity among IIMs, other autoimmune rheumatic and non-rheumatic diseases (AIRD, nrAID), and healthy controls (HC). Multivariable Cox regression models assessed the risk factors for BI, severe BI and hospitalisations among IIMs.

RESULTS: Among 9449 included response, BIs occurred in 1447 (15.3%) respondents, median age 44 years (IQR 21), 77.4% female, and 182 BIs (12.9%) occurred among 1406 IIMs. Multivariable Cox regression among IIMs showed age as a protective factor for BIs [Hazard Ratio (HR)=0.98, 95%CI = 0.97-0.99], hydroxychloroquine and sulfasalazine use were risk factors (HR = 1.81, 95%CI = 1.24-2.64, and HR = 3.79, 95%CI = 1.69-8.42, respectively). Glucocorticoid use was a risk factor for severe BI (HR = 3.61, 95%CI = 1.09-11.8). Non-White ethnicity (HR = 2.61, 95%CI = 1.03-6.59) was a risk factor for hospitalisation. Compared with other groups, patients with IIMs required more supplemental oxygen therapy (IIM = 6.0% vs AIRD = 1.8%, nrAID = 2.2%, and HC = 0.9%), intensive care unit admission (IIM = 2.2% vs AIRD = 0.6%, nrAID, and HC = 0%), advanced treatment with antiviral or monoclonal antibodies (IIM = 34.1% vs AIRD = 25.8%, nrAID = 14.6%, and HC = 12.8%), and had more hospitalisation (IIM = 7.7% vs AIRD = 4.6%, nrAID = 1.1%, and HC = 1.5%).

CONCLUSION: Patients with IIMs are susceptible to severe COVID-19 BI. Age and immunosuppressive treatments were related to the risk of BIs.

BACKGROUND: Despite the overall safety and efficacy of COVID-19 vaccinations, rare cases of systemic autoimmune diseases (SAIDs) have been reported post-vaccination. This study used a global survey to analyze SAIDs in susceptible individuals' post-vaccination.

METHODS: A cross-sectional study was conducted among participants with self-reported new-onset SAIDs using the COVID-19 Vaccination in Autoimmune Diseases (COVAD) 2 study dataset-a validated, patient-reported e-survey-to analyze the long-term safety of COVID-19 vaccines. Baseline characteristics of patients with new-onset SAIDs and vaccinated healthy controls (HCs) were compared after propensity score matching based on age and sex in a 1:4 ratio.

RESULTS: Of 16 750 individuals, 74 (median age 52 years, 79.9% females, and 76.7% Caucasians) had new-onset SAID post-vaccination, mainly idiopathic inflammatory myopathies (IIMs) (n = 23, 31.51%), arthritis (n = 15; 20.53%), and polymyalgia rheumatica (PMR) (n = 12, 16.40%). Higher odds of new-onset SAIDs were noted among Caucasians (OR = 5.3; 95% CI = 2.9-9.7; p < .001) and Moderna vaccine recipients (OR = 2.7; 95% CI = 1.3-5.3; p = .004). New-onset SAIDs were associated with AID multimorbidity (OR = 1.4; 95% CI = 1.1-1.7; p < .001), mental health disorders (OR = 1.6; 95% CI = 1.3-1.9; p < .001), and mixed race (OR = 2.2; 95% CI = 1.2-4.2; p = .010), where those aged >60 years (OR = 0.6; 95% CI = 0.4-0.8; p = .007) and from high/medium human development index (HDI) countries (compared to very high HDI) reported fewer events than HCs.

CONCLUSION: This study reports a low occurrence of new-onset SAIDs following COVID-19 vaccination, primarily IIMs, PMR, and inflammatory arthritis. Identified risk factors included pre-existing AID multimorbidity, mental health diseases, and mixed race. Revaccination was well tolerated by most patients; therefore, we recommend continuing COVID-19 vaccination in the general population. However, long-term studies are needed to understand the autoimmune phenomena arising post-vaccination.

BACKGROUND: Climate change, a pervasive global phenomenon, exerts discernible impacts on the physical, social, and psychological dimensions of well-being. The apprehension surrounding this complex environmental issue has reached a critical juncture, with over 76,000 individuals across more than thirty nations expressing profound levels of concern, characterizing their anxiety as either "very" or "extremely" pronounced. This surge in awareness regarding the potential consequences of climate change has given rise to an emergent and escalating challenge known as climate anxiety. This distinctive form of anxiety manifests through profound feelings of fear, helplessness, and despair elicited by the impending repercussions of climate change. Notably, the intersection of climate anxiety with occupational domains, particularly within the context of Nursing University Colleagues, suggests a nuanced relationship with job engagement, wherein the psychological responses to climate change may influence professional commitment and involvement.

AIM OF THE STUDY: To examine the correlation among Climate Anxiety, Environmental Attitude, and Job Engagement among Nursing University Colleagues comprising eight distinct nursing faculties.

DESIGN: A multicenter descriptive, cross-sectional research design study followed.

SUBJECT: Three hundred fifty-nine participants from the Centre, Delta, West, Suez Canal, and Upper regions of Egypt using a stratified random cluster sampling technique.

MEASUREMENTS: Social and health related to climate data structured questionnaire, climate anxiety scale, environmental attitude inventory, and job engagement scale.

RESULTS: The influence of demographics on climate anxiety, environmental attitude, and job involvement was not observed. Nevertheless, geographical variations emerged as a noteworthy factor. A statistically significant inverse correlation was identified between climate anxiety, job engagement dimensions, and the overall score of environmental attitudes.

CONCLUSION: Climate anxiety was strongly associated with environmental attitudes and job engagement among nursing university colleagues. Higher climate anxiety is associated with a lower attitude towards the environment and decreased job engagement. Additionally, a higher attitude towards the environment is associated with decreased overall engagement in participants' jobs.

IMPLICATIONS: The study's patterns make it clear how important it is to provide targeted psycho-educational interventions to help reduce climate anxiety among the group of nursing university colleagues. The imperative lies not only in alleviating the immediate psychological distress associated with heightened climate anxiety but also in fostering adaptive coping mechanisms. By doing so, these interventions serve as instrumental tools in nurturing resilience, thereby fortifying the mental well-being of nursing professionals amidst the evolving landscape of climate-related concerns.

Summary Congenital diaphragmatic hernia (CDH) is a severe congenital anomaly often accompanied by other structural anomalies and/or neurobehavioral manifestations. Rare de novo protein-coding variants and copy-number variations contribute to CDH in the population. However, most individuals with CDH remain genetically undiagnosed. Here, we perform integrated de novo and common-variant analyses using 1,469 CDH individuals, including 1,064 child-parent trios and 6,133 ancestry-matched, unaffected controls for the genome-wide association study. We identify candidate CDH variants in 15 genes, including eight novel genes, through deleterious de novo variants. We further identify two genomic loci contributing to CDH risk through common variants with similar effect sizes among Europeans and Latinx. Both loci are in putative transcriptional regulatory regions of developmental patterning genes. Estimated heritability in common variants is ∼19%. Strikingly, there is no significant difference in estimated polygenic risk scores between isolated and complex CDH or between individuals harboring deleterious de novo variants and individuals without these variants. The data support a polygenic model as part of the CDH genetic architecture.

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PURPOSE: Compare two simple ways for treating boxer's fractures in active adults; conservative management by ulnar gutter slab and transverse pinning in fixation of fifth metacarpal's neck fracture regarding union, functional outcomes, and complications.

PATIENTS AND METHODS: Ninety patients with fifth metacarpals' neck fractures with palmar angulation (30-70°) were managed either conservatively by an ulnar gutter slab or surgically by transverse pinning technique from January 2020 to December 2021. Only 84 patients completed a 1-year follow-up. Patients with old, open, or mal-rotated fractures were excluded. The block-randomization method was used to create equal groups. Patients were evaluated clinically and radiologically every 2-3 weeks until union, then at 6 and 12 months. Functional assessment at the final visit was done using the quick DASH score, total active motion (TAM), and total Active Flexion (TAF).

RESULTS: The mean radiological union time for the conservative group in this study was 7.76 weeks, while for the transverse pinning group, it was 7.38 weeks. There was no statistically significant difference between the two techniques regarding union rates and functional outcomes. All patients returned to their pre-injury jobs and level of activity.

CONCLUSION: Both conservative management in ulnar gutter slab and percutaneous transverse pinning are considered effective methods in the treatment of simple extra-articular fifth metacarpal neck fractures with angulation between 30 and 70 degrees (AO: 77 A3.1). The functional and radiological results using both methods were satisfactory and statistically comparable.

Nickel-based catalysts have been widely recognized as highly promising electrocatalysts for oxidation. Herein, we designed a catalyst surface based on iron oxide electrodeposited on NiCo2O4 spinel oxide. Nickel foam was used as a support for the prepared catalysts. The modified surface was characterized by different techniques like electron microscopy and X-ray photon spectroscopy. The activity of the modified surface was investigated through the electrochemical oxidation of different organic molecules such as urea, ethanol, and ethylene glycol. Therefore, the modified Fe@ NiCo2O4/NF current in 1.0 M NaOH and 1.0 M fuel concentrations reached 31.4, 27.1, and 17.8 mA cm−2 for urea, ethanol, and ethylene glycol, respectively. Moreover, a range of kinetic characteristics parameters were computed, such as the diffusion coefficient, Tafel slope, and transfer coefficient. Chronoamperometry was employed to assess the electrode’s resistance to long-term oxidation. Consequently, the electrode’s activity exhibited a reduction ranging from 17% to 30% over a continuous oxidation period of 300 min.

This study aimed to assess the incidence, predictors, and outcomes of breakthrough infection (BI) following coronavirus disease (COVID-19) vaccination in patients with systemic sclerosis (SSc), a risk group associated with an immune-suppressed state and high cardiopulmonary disease burden. Cross-sectional data from fully vaccinated respondents with SSc, non-SSc autoimmune rheumatic diseases (AIRDs), and healthy controls (HCs) were extracted from the COVAD database, an international self-reported online survey. BI was defined according to the Centre for Disease Control definition. Infection-free survival was compared between the groups using Kaplan-Meier curves with log-rank tests. Cox proportional regression was used to assess the association between BI and age, sex, ethnicity, and immunosuppressive drugs at the time of vaccination. The severity of BI in terms of hospitalization and requirement for oxygen supplementation was compared between groups. Of 10,900 respondents, 6836 fulfilled the following inclusion criteria: 427 SSc, 2934 other AIRDs, and 3475 HCs. BI were reported in 6.3% of SSc, 6.9% of non-SSc AIRD, and 16.1% of HCs during a median follow-up of 100 (IQR: 60-137) days. SSc had a lower risk for BI than HC [hazard ratio (HR): 0.56 (95% CI 0.46-0.74)]. BIs were associated with age [HR: 0.98 (0.97-0.98)] but not ethnicity or immunosuppressive drugs at the time of vaccination. Patients with SSc were more likely to have asymptomatic COVID-19, but symptomatic patients reported more breathlessness. Hospitalization [SSc: 4 (14.8%), HCs: 37 (6.6%), non-SSc AIRDs: 32(15.8%)] and the need for oxygenation [SSc: 1 (25%); HC: 17 (45.9%); non-SSc AIRD: 13 (40.6%)] were similar between the groups. The incidence of BI in SSc was lower than that in HCs but comparable to that in non-SSc AIRDs. The severity of BI did not differ between the groups. Advancing age, but not ethnicity or immunosuppressive medication use, was associated with BIs.

OBJECTIVES: We investigated coronavirus disease 2019 (COVID-19) vaccine safety in pregnant and breastfeeding women with autoimmune diseases (AID) in the COVID-19 Vaccination in Autoimmune Diseases (COVAD) study.

METHODS: Delayed-onset (>7 days) vaccine-related adverse events (AE), disease flares and AID-related treatment modifications were analysed upon diagnosis of AID vs healthy controls (HC) and the pregnancy/breastfeeding status at the time of at least one dose of vaccine.

RESULTS: Among the 9201 participants to the self-administered online survey, 6787 (73.8%) were women. Forty pregnant and 52 breastfeeding patients with AID were identified, of whom the majority had received at least one dose of COVID-19 vaccine (100% and 96.2%, respectively). AE were reported significantly more frequently in pregnant than in non-pregnant patients (overall AE 45% vs 26%, P = 0.01; minor AE 40% vs 25.9%, P = 0.03; major AE 17.5% vs 4.6%, P < 0.01), but no difference was found in comparison with pregnant HC. No difference was observed between breastfeeding patients and HC with respect to AE. Post-vaccination disease flares were reported by 17.5% of pregnant and 20% of breastfeeding patients, and by 18.3% of age- and disease-matched non-pregnant and non-breastfeeding patients (n = 262). All pregnant/breastfeeding patients who experienced a disease flare were managed with glucocorticoids; 28.6% and 20% of them required initiation or change in immunosuppressants, respectively.

CONCLUSION: This study provides reassuring insights into the safety of COVID-19 vaccines administered to women with AID during the gestational and post-partum periods, helping overcome hesitant attitudes, as the benefits for the mother and for the fetus by passive immunization appear to outweigh potential risks.