The chikungunya virus (CHIKV) is a mosquito‐transmitted alphavirus, which has infected millions of people in Africa, Asia, Americas, and Europe since it remerged in India and Indian Ocean regions in 2005–2006. The purpose of this study was to evaluate the genetic diversity and evolutionary changes in CHIKV from 2016 to 2018 in Pakistan. Blood specimens were collected and processed following the Centers for Disease Control and Prevention Trioplex Protocol. Sequencing and phylogenetic analysis of complete coding sequence of representative isolates from the CHIKV outbreak was carried out during December 2016 to July 2018, a total of 1549 samples were received, out of which 50% (n = 774) were found positive for CHIKV RNA. Mean age of chikungunya positive patients was 31.8 ± 15.7 years and most affected were between 21 and 40 years of age. The Pakistan CHIKV strains clustered with the Indian Ocean sublineage of East/Central/South African with cocirculation of some variants In the structural proteins region, two noteworthy changes (A226V and D284E) were observed in the membrane fusion glycoprotein E1. Key substitutions in the neutralizing epitopes site and a few changes indicative of adaptive to other insect cells were also detected in Pakistani strains. This study provides the emerging trend of CHIKV in the country for early identification of potential variants of high virulence and preventive measures for vector borne disease especially in the endemic areas.

Abstract For years, sustainable tourism has commanded the attention of academics and practitioners given its achievement through participatory planning. However, much research in the area has neglected to consider all voices of those (i.e., children) affected by tourism. This study, employing a post-test only experimental design, addresses this gap by including the voices of 498 children from six diverse European destinations concerning perceptions of tourism. Results show that children are willing to express their opinions given the opportunity. Moreover, their attitude towards tourists is negative, while they perceive locals to hold a subordinate position to tourists. In general, this study offers insight into children’s attitudes to tourism from the host perspective, demonstrating that there is a unique insider’s perspective that needs further research.

Abstract Background: The relationship between different surrogates of insulin resistance and left ventricular geometry in obese children is still unclear. Objective: We sought to explore the relationship between commonly used measures of insulin sensitivity/resistance (homeostatic model assessment index, serum uric acid, and triglycerides to high-density lipoprotein cholesterol ratio) and left ventricular geometry in normotensive obese children. Methods: In this cross-sectional study, 32 normotensive obese children were examined. Transthoracic echocardiography was used to measure left ventricular mass index and relative wall thickness. Homeostasis model assessment index, serum uric acid level, and a ratio of triglycerides to high-density lipoprotein cholesterol were used as markers of the insulin resistance. Simple and partial correlation analyses (to control for the effects of body mass index) were conducted to explore relationship between studied variables and left ventricular mass index or relative wall thickness as outcome variables. Results: We found positive correlations between homeostasis model assessment index and relative wall thickness (r = 0.47, p = 0.03) which remained significant after controlling for the effect of body mass index, z-score (r = 0.48, p = 0.03). The cutoff level of homeostasis model assessment index with the optimum sensitivity (Sn) and specificity (Sp) derived from the receiver operating characteristic (ROC) curves for predicting concentric remodelling was ≥5.51 with Sn = 83.33 and Sp = 68.75. Conclusion: There is a positive relationship between homeostasis model assessment index and relative wall thickness of obese normotensive children which may help to distinguish at risk obese normotensive children for the development of concentric left ventricular remodelling.

OBJECTIVES The physical activity level (PAL) has significantly decreased as a result of the social distancing and lockdown related to the COVID‑19 pandemic, but there is a lack of knowledge on the correlates of PAL during the pandemic. The aim of this research was to examine the influence of pre-pandemic sports participation and substance use and misuse (SUM) on PAL during the COVID‑19 pandemic. MATERIAL AND METHODS The study included 661 high-school students from Bosnia and Herzegovina (aged 15-18 years, 292 females). The investigation included 2 testing waves: before the COVID‑19 pandemic (baseline, January 2020) and during the COVID‑19 lockdown (follow-up, April 2020). The variables included PAL as measured by the Physical Activity Questionnaire for Adolescents, sports factors, and SUM. RESULTS Sports factors at baseline were positively correlated with PALs at both baseline and follow-up. Smoking tobacco negatively affected PALs at both baseline and follow-up. Alcohol consumption was positively correlated with PAL at baseline but had no effect on PAL at follow-up. CONCLUSIONS This study confirmed the importance of sports participation in maintaining PAL during challenging situations, such as the COVID‑19 lockdown. The substance-specific influence of SUM on PAL before and during the lockdown points to evident social and cultural aspects of SUM behaviors in adolescents. Further studies evidencing the cumulative effects of PAL decline during the lockdown are warranted.

This paper presents a novel control algorithm for variable speed wind generators (VSWG), designed to provide support to grid frequency regulation. The proposed control algorithm ensures that VSWG ‘’truly’’ emulates response of a conventional generating unit with non-reheat steam turbine (GUNRST) in the first several seconds after active power unbalance. A systematic method of analysis and synthesis of the new control algorithm is described in detail.

Enabling System-of-Systems (SoS) security is an important activity when engineering SoS solutions like autonomous vehicles, provided that they are also highly safety-critical. An early analysis of such solutions caters for proper security architecture decisions, preventing potential high impact attacks and ensuring people's safety. However, SoS characteristics such as emergent behavior, makes security decision-making at the architectural level a challenging task. To tackle this challenge, it is essential to first address known vulnerabilities related to each CS, that an adversary may exploit to realize his attacks within the unknown SoS environment. In this paper we investigate how to use Game Theory (GT) approaches to guide the architect in choosing an appropriate security solution. We formulate a game with three players and their corresponding strategies and payoffs. The proposal is illustrated on an autonomous quarry example showing its usefulness in supporting a security architect to choose the the most suitable security strategy.

Fluorescence-guided surgery is an intraoperative optical imaging method that provides surgeons with real-time guidance for the delineation of tumours. Currently, in phase 1 and 2 clinical trials, evaluation of fluorescence-guided surgery is primarily focused on its diagnostic performance, although the corresponding outcome variables do not inform about the added clinical benefit of fluorescence-guided surgery and are challenging to assess objectively. Nonetheless, the effect of fluorescence-guided surgery on intraoperative decision making is the most objective outcome measurement to assess the clinical value of this imaging method. In this Review, we explore the study designs of existing trials of fluorescence-guided surgery that allow us to extract information on potential changes in intraoperative decision making, such as additional or more conservative resections. On the basis of this analysis, we offer recommendations on how to report changes in intraoperative decision making that result from fluorescence imaging, which is of utmost importance for the widespread clinical implementation of fluorescence-guided surgery.