Federated learning has attracted much attention in fault diagnosis since it can effectively protect data privacy. However, efficient fault diagnosis performance relies on the uninterrupted training of model parameters with massive amounts of perfect data. To solve the problems of model training difficulty and parameter negative transfer caused by data corruption, a novel cross-device fault diagnosis method based on repaired data is proposed. Specifically, the local model training link in each source client performs random forest regression fitting on the fault samples with missing fragments, and then the repaired data is used for network training. To avoid inpainting fragments to produce the wrong characteristics of faulty samples, joint domain discrepancy loss is introduced to correct the phenomenon of parameter bias during local model training. Considering the randomness of the overall performance change brought about by the local model update, an adaptive update is proposed for each round of global model download and local model update. Finally, the experimental verification was carried out in various industrial scenarios established by three sets of bearing data sets, and the effectiveness of the proposed method in terms of fault diagnosis performance and data privacy protection was verified by comparison with various currently popular federated transfer learning methods. With the rapid development of digital intelligent manufacturing, data-driven deep learning methods have made significant progress ,2. VarioIn practical scenarios, the majority of users in the industrial field possess private condition monitoring data, and there exist analogous mechanical equipment configurations among them . TherefoDespite the preliminary progress made in research on protecting data privacy through federated learning, further advancements are necessary to fully address this issue . ExistinThe existing federated transfer learning model often assumes that each user has stored relatively complete and perfect data sample information when solving multi-user fault diagnosis tasks, which is not common in actual industrial scenarios. Simultaneously, the federated learning strategy does not fully utilize the diagnostic knowledge learned from each source client for other source clients after the global model communication link or completely abandons the accumulated sample diagnostic knowledge of each source client in the local client training link in the current research. A novel federated learning strategy is proposed to solve the problem that the source client lacks complete samples for network training, which rarely occurs in current federated transfer learning research.The joint function proposed for optimizing source-client networks in federated transfer learning strategies employs Wasserstein distance and multi-kernel MMD to measure domain distances and effectively alleviates the model-negative transfer phenomenon caused by distribution discrepancies through periodic training.To address the challenge of diagnosing targets across different devices and under varying working conditions, an adaptive global model update method is employed by the central server. This approach ensures excellent fault diagnosis performance while safeguarding source client data privacy.Referring to the aforementioned issues in current research, this study proposes a federated transfer learning strategy based on data restoration (FTLS-DR). When faced with data damage in the client, this strategy employs linear regression completion on the damaged data as a preliminary step before utilizing it for source client network training. To mitigate any negative transfer effects of broken data on the local model, an offset optimization of the source client network is performed using a joint function composed of maximum mean discrepancy (MMD) and Wasserstein distance (WD). Subsequently, the central server dynamically evaluates the global model based on its performance in task verification for each source client and builds a new round of each source client network by adaptively weighting the global model download link. The main innovations in this paper are as follows:The subsequent sections of this article are structured as follows: Federated learning was initially proposed as a solution to address the challenge of safeguarding client data privacy in the realm of cross-device fault diagnosis . The fraThe training process of the federated learning strategy is distributed to each client, and finally, the aggregation of diagnostic knowledge is realized on the central server, which not only ensures the privacy of all source client users but also promotes knowledge sharing among clients ,23. For The data-driven deep learning model demonstrates efficient performance in diagnosing faults based on a comprehensive analysis of monitoring data. However, establishing an ideal data set for training deep learning models is challenging in real-world industrial scenarios due to various factors . The maiTransfer learning, as a technique for utilizing diagnostic knowledge from known datasets to address less strongly related fault diagnosis tasks, is highly beneficial for most current domain adaptation methods . For insTa, a = 1, …, Rtree) from the predictions given by multiple sets of decision tree models  represents the probability score of the sample fault type by the softmax classifier.The Maximum Mean Discrepancy (MMD) is introduced as the feedback loss During the initial phase of source client training, the domain discrepancy loss and the feedback loss are jointly composed of the joint domain discrepancy loss. The local model simultaneously optimizes the joint domain discrepancy loss and the sample classification loss to minimize the domain discrepancy between the source and target domains in the source client task while also utilizing them to rectify model hyperparameters caused by inpainting data offset. The specific mathematical expression is as follows:The local training in the second stage cancels the optimization of the network parameters by the classification loss. The joint domain discrepancy loss is further optimized to alleviate the negative transfer phenomenon of sample error features to network training caused by random forest regression fitting, and the specific function formula is shown in Equation (6).The local model is iteratively updated through the continuous joint training of the three sets of objective functions until it reaches the initial preset value. The source client ultimately acquires a set of feature extractors that can effectively capture the relevant information from the fitting data, as well as a set of classifiers capable of distinguishing incomplete feature samples, thereby enabling periodic training for the source client.The dynamic interaction process of the federated transfer learning strategy proposed in this paper mainly includes three links: the global model update link, the source client task verification link, and the local model adaptive update link.i-th client in the j-th round of federated communication, i-th client in the j-th round of source client training.The local model parameters from each source client are initially transmitted to the central server, as shown in 1, z2, …, zK] represents the distribution of diagnostic results of the global model of K-group source client tasks, i-th source client, Following this, the updated global model is downloaded to each source client for model validation. Specifically, the central server performs reverse verification on all source client tasks one by one and obtains the corresponding sample diagnostic loss to optimize the parameters of the local model, which can effectively improve the ability of the local model to extract the cross-domain universal characteristics of fault samples.j-th round of the global model for the i-th client task, In the local model adaptive update link, the parameter information of the global model and the sample diagnostic loss of the source client task are used for a new round of local model parameter updates. Considering the specificity of each source client task, the local model parameters are not completely replaced by the global model. To enhance the generalization performance of local models for cross-domain fault samples while preserving the sample diagnostic knowledge of local tasks, the local model parameters of each source client are adaptively updated, as shown in Formulas (12) and (13):The three sets of steps of the federation dynamic interaction cycle alternately: the global model gradually masters the fault diagnosis knowledge of all source clients, and the local model of each source client is optimized. Finally, the optimized global model will be delivered to the target client for final verification of the target task.In this section, three sets of bearing datasets (including a public dataset and two laboratory simulation datasets) are utilized to validate the efficacy of the proposed method, encompassing three health status categories: normal condition (NC), inner ring fault (IRF), and outer ring fault (ORF). The data set information is shown in The CWRU Bearing Dataset from Case Western Reserve University comprises sample data obtained by the Electromechanical Signal Analyzer at four distinct rotational speeds. The damage diameters of the outer and inner ring faults are categorized as 0.1778 mm, 0.3556 mm, and 0.5334 mm, respectively. In the experiment, the vibration acceleration signal collected by the sensor located at the 6 o’clock position of the motor drive end is selected for research and discussion. Simultaneously, two groups of sampling frequencies are set to 12 kHz and 48 kHz, respectively.The Motor Drive Simulation (MDS) Experiment Dataset is collected by the LMS vibration data acquisition instrument at a sampling frequency of 12.8 kHz and a three-way acceleration sensor, specifically the PCB353B33 model. The damage sizes of the outer and inner rings of the bearing are specifically artificial EDM cracks, each with a width and depth of 0.5 mm. Additionally, sample information was collected on the health status of rolling bearings at three different speeds: 1000 rpm, 1300 rpm, and 1500 rpm. The fault samples collected in the time domain are subjected to Fast Fourier Transform (FFT) processing to obtain frequency domain signal samples for training.The Gear Power Transmission Fault Simulation (GPTFS) Experimental Dataset uses a specially processed cylindrical roller bearing (NU205EM) for experiments and artificially increases crack faults in the outer ring and inner ring of the bearing . During the data collection process, the PCB315A acceleration sensor was mounted onto the bearing base and set to a signal collection frequency of 12.8 kHz, and the test bench is shown in In order to demonstrate the superiority of the proposed federated transfer learning scheme in addressing the few-shot learning problem, multiple sets of comparative experiments with identical experimental configurations were conducted to validate its effectiveness.Baseline: The baseline method [e method , which dFedAvg: The Federated Averaging (FedAvg) method [ensure diagnostic knowledge sharing while preserving data privacy.) method  aims to FTLS-DPP: The Federated Transfer Learning Scheme based on Data Privacy Protection (FTLS-DPP) method is a collaborative strategy designed to address the issue of industrial data islands, with its training process being executed independently on each local client. Specifically, the local model employs differential training to enhance the diagnostic accuracy and generalization of the network, while the global model assesses the task contribution of each local model for weighted aggregation. These two sets of training cycles alternate to accomplish the target customer terminal task.K sets of source clients and a group of target clients were established using bearing samples collected by three sets of test platforms under various working conditions during the experimental verification stage. Each set of clients contains unique fault diagnosis tasks that are consistent with the final target, and there are notable differences in these tasks.The training process of each source client model is conducted independently in the experiment, thereby ensuring the privacy of individual client data. The complete training of the federated transfer policy does not involve any information regarding the target client tasks, and the detailed experimental task settings are presented in Four groups of samples with missing information and client tasks were established in this study to simulate diagnostic tasks under various working conditions. In the first scenario, each source client sample set contains ideal sample data, and there are discernible discrepancies in the diagnostic tasks of each source client. In the second scenario, not only does the training data contain defects in each client diagnosis task, but it also exhibits a 12.5% rate of sample damage. Furthermore, the federation strategy focuses on more intricate cross-device and cross-type fault sample diagnoses in this scenario. In the third and fourth scenarios, both cross-device and cross-model diagnostic tasks were present in the target client, while load information was also integrated into the data of each source client. By setting up four groups of federated diagnostic tasks, the proposed diagnostic strategy is fully applied. To clarify the operation of the proposed federated transfer learning strategy, the relevant parameter information is established based on the requirements of the target task and presented in The random forest algorithm is used to perform regression fitting on the damaged training data in the source client, and the fitted data is directly applied to the training process of the network. In the experimental phase, each diagnostic method was tested five times in each scenario to ensure experiment reliability. The diagnostic accuracy rate and corresponding standard deviation of these comparative experiments are presented in The FTLS-DR method proposed in this study outperforms other comparison methods in terms of diagnostic accuracy and fluctuation range across all four cases. Specifically, in the case of complete data training in case 1, the diagnostic accuracy of the proposed method in each client task and target client task is higher than 98%, with a standard deviation of 1.04%. Comparing the FedAvg method with the FTLS-DPP method, the diagnostic accuracy is only 84.78% and 92.83%, and the standard deviation is greater than 7.21%. The proposed method still demonstrates superior model generalization performance and diagnostic accuracy, even in the presence of corrupted training data. Specifically, the diagnostic accuracy for the unknown target client diagnosis task remains above 78.06% when 25% of the training data is damaged. It can be inferred that the FTLS-DR method proposed in this paper has better universal feature extraction capabilities for fault samples, rendering it more suitable for diagnostic tasks in complex scenarios.In order to demonstrate the distribution of features extracted from data samples and validate the advantages of feature extraction using the proposed FTLS-DR method, the high-dimensional features of the target client sample extracted in the final verification link are visualized and displayed through dimension reduction , as showAiming at the problem of data privacy protection in actual industrial scenarios, this paper proposes a new cross-device fault diagnosis method based on repaired data. The proposed federated transfer learning strategy is different from the traditional fault diagnosis method. The target client sample does not participate in the network training and parameter updates from the initial training stage to the final target task verification process. Multiple sets of diagnostic tasks are established on three sets of bearing datasets to simulate engineering requirements in real-world scenarios. The results show that the proposed federated transfer learning strategy effectively solves the problem of difficult diagnosis of fault samples caused by the lack of complete local training samples. The proposed FTLS-DR method not only effectively guarantees the privacy of client data but also achieves the best diagnostic results among other comparison methods. In addition, the key indicators and fitting accuracy of the restoration data were measured from multiple perspectives, and the comprehensive evaluation proves that the method has a good prospect for practical engineering diagnosis.


For many decades, the cellular and molecular mechanisms that orchestrate the differentiation of epithelial subtypes in the mammary gland have been a focus of intense investigations. Despite the orderly development of epithelial lineages with specific functions, individual cells or clusters of cells can switch identities in response to stress conditions and during the onset and progression of breast cancer. This review provides a comprehensive overview of factors that promote cellular plasticity. Changes in epithelial cell identity associated with pregnancy and lactation, inflammation, tissue repair, as well as the origin and progressive development of breast cancer subtypes discussed in this review demonstrate the broad impact of cellular plasticity on normal mammary gland development and the formation of malignant tumors.Cellular plasticity is a phenomenon where cells adopt different identities during development and tissue homeostasis as a response to physiological and pathological conditions. This review provides a general introduction to processes by which cells change their identity as well as the current definition of cellular plasticity in the field of mammary gland biology. Following a synopsis of the evolving model of the hierarchical development of mammary epithelial cell lineages, we discuss changes in cell identity during normal mammary gland development with particular emphasis on the effect of the gestation cycle on the emergence of new cellular states. Next, we summarize known mechanisms that promote the plasticity of epithelial lineages in the normal mammary gland and highlight the importance of the microenvironment and extracellular matrix. A discourse of cellular reprogramming during the early stages of mammary tumorigenesis that follows focuses on the origin of basal-like breast cancers from luminal progenitors and oncogenic signaling networks that orchestrate diverse developmental trajectories of transforming epithelial cells. In addition to the epithelial-to-mesenchymal transition, we highlight events of cellular reprogramming during breast cancer progression in the context of intrinsic molecular subtype switching and the genesis of the claudin-low breast cancer subtype, which represents the far end of the spectrum of epithelial cell plasticity. In the final section, we will discuss recent advances in the design of genetically engineered models to gain insight into the dynamic processes that promote cellular plasticity during mammary gland development and tumorigenesis in vivo.  KRAS, cause the formation of precursor lesions for pancreatic ductal adenocarcinoma  [Eef1a1 locus can facilitate a sustained expression of an oncogene as cancer cells transdifferentiate and undergo advanced EMT  led to the progressive development of cells expressing both luminal-type and basal-type cytokeratins. These cells gave rise to basal-like tumors that swiftly progressed into claudin-low mammary cancers with features of advanced EMT and a high propensity to metastasize. Notably, the dissimilar cancer subtype characteristics between the MMTV-tTA and EF1-tTA transgenic models were not a consequence of differences in the expression of the mutant KRASG12D protein. The expression of mutant KRAS in tumors from both transgenic models was identical and comparable to the basal-like and claudin-low mammary tumors of mice that express the oncogene from the endogenous Kras locus (MMTV-Flp G12DFSF-Kras) [independent manner.Two main experimental approaches have been used successfully to express oncogenes in the mammary epithelium in a cell differentiation-t manner B. The fir  . The colWap gene promoter (WAP-TGFα) is preceded by the formation of polyclonal precursor lesions. The rate of polyclonality during cancer progression, however, was not investigated and similar studies are missing that demonstrate this phenomenon in cancer models that express other oncoproteins acting as ligands for juxtracrine and paracrine signaling in addition to their suggested autocrine role in cancer cells. Despite the epithelial cell-specific dependency of oncogene expression, a subset of tumors from selected first-generation transgenic tumor models, such as the TgWAP-T121 line expressing a truncated form of the SV40 T-antigen (TAg), exhibit variations in their histopathology and gene expression profiles . The occOver several decades, a major focus in the field of mammary gland biology has been the identification of mammary epithelial stem and progenitor cells as well as elucidating the hierarchical development of mammary epithelial cell lineages. The major attention on putative stem cell populations and their suggested significant roles in development and breast tumorigenesis may have contributed to a perception of cellular plasticity that is limited to stem cell function or EMT. In comparison to other exocrine organs like the pancreas where cellular plasticity plays pivotal roles in tissue regeneration, the terms dedifferentiation and transdifferentiation are infrequently used to describe developmental phenomena in the biology of the mammary gland. In this review, we highlighted changes in cell identity and the emergence of cellular states associated with the gestation cycle that are associated with dedifferentiation. We also discussed the effects of the microenvironment  on cellular reprogramming and molecular pathways that control lineage determination that, when deregulated, can instigate the transdifferentiation of epithelial cells. Several of these pathways play key roles in mammary tumor formation where they promote diverse developmental trajectories of transforming epithelial cells. There is increasing experimental evidence that luminal progenitors and the luminal-to-basal transdifferentiation of their descendants contribute to the formation of basal-like mammary cancers. During tumor progression, EMT is mostly portrayed as a temporary cellular state that promotes invasion and metastasis. The more widespread transdifferentiation of luminal and basal tumor cells towards a mesenchymal fate and the manifestation of the claudin-low breast cancer subtype is a prime example of cellular plasticity. It should be noted that human TNBC cell lines that are commonly used in biomedical research, including MDA-MB-231 cells, are claudin-low . This su


Mass vaccination, currently the most promising solution to contain communicable diseases, including COVID-19 requires collaboration between a variety of partners to improve the supply and demand and alleviate vaccine inequity. Vaccine hesitancy features in WHO’s list of top 10 threats to global health, and there is plethora of disinformation instigating conflict between COVID-19 vaccination drive and religious sentiments. Negotiating public health partnerships with FBOs (Faith Based Organizations) has always been challenging. A handful of faith leaders have always shown resistance to ideas such as child immunization, and family planning. Many others have been supportive on other fronts like helping people with food, shelter, and medical aid in the times of public health crisis. Religion is an important part of life for the majority of the Indian population. People confide in faith-based leaders in the times of difficulty. This article presents experiences from the strategic engagement with FBOs  to promote uptake of COVID-19 vaccination, especially among the vulnerable and marginalized communities. The project team collaborated with 18 FBOs and more than 400 religious institutions to promote COVID-19 vaccination and build confidence for the vaccination program. As a result, a sustainable network of sensitized FBOs from diverse faiths was created. The FBOs mobilized and facilitated vaccination of 0.41 million beneficiaries under the project.  Vaccination continues to be the most effective method for containing the spread of communicable diseases and limiting damage by developing herd immunity, especially the ones such as COVID-19 . AccordiThe contextual factors comprise influences arising from political, socio-cultural, historic, environmental, economic, and institutional factors. ‘Religion’ and ‘culture’ are integrated within the contextual factors. The individual/group influences comprise of awareness, knowledge, beliefs, and attitudes. Vaccine-specific issues contain factors such as questions around the introduction of new vaccines, cost, risk/benefits, operational issues, the strength of recommendation, schedule etc. The interplay of these factors has a major role in determining hesitancy or confidence in the vaccine. Over the last decade, the dynamics of these factors have changed substantially. COVID-19 vaccine with a status “approval for restricted use in an emergency situation” faced an unprecedented level of ‘Vaccine Hesitancy’ offered by a complex interplay of the above-mentioned factors.India’s massive COVID-19 immunization program began on 16 January 2021, and it was one of the largest in the world. The program started with two indigenously developed vaccines- Covishield (Oxford-AstraZeneca/Serum Institute of India) and Covaxin . It gradually included vaccines like Corbevax, Zycov D, Sputnik  In May 2Religious faith represents a key social and environmental driver that can influence an individual’s beliefs, health behavior, and practices . Health Faith and immunization have historically had both positive and negative associations. While some religious leaders took charge in pushing vaccination, others needed a lot of persuasion to agree to and tolerate this strategy . CommuniVaccine hesitancy has been identified among the top ten threats to global health by the World Health Organization . HesitanWhen COVID-19 vaccination efforts began, utilizing all possible modes of communication became crucial for informing the public appropriately and obtaining effective results. The majority of the Indian population places a high value on their FBOs. As a result, we examined how the involvement of FBOs contributes to community engagement in the time of public health emergencies.Although the project activities span 18 prominent states in India, collaboration with faith-based organizations was eminently considered in the project states representing religious minorities and areas showing higher resistance to vaccination due to faith-based reasons. The selection of FBOs was based on (1) the size of the followership group represented by the FBO (2) display of community ownership in the time of public health crisis (3) the capacity and resource pool to facilitate the vaccination and, (4) the willingness to engage in strategic collaboration. The level of engagement of the FBO was closely observed for the width of impact and depth of community response on tangible and intangible parameters. The identification and engagement of FBOs included line listing of FBOs registered in the project geography, comparing the FBOs on the size of follower group by factoring in the population of devotee’s basis religion, caste etc., identifying vaccination champions from FBOs who could be recognized for supporting COVID-19 vaccination, creating a sustainable network of FBOs duly sensitized and oriented on COVID-19 immunization by building capacities of FBOs on COVID-19 virus and vaccination through sensitization meetings. The details of the process are shared in the forthcoming sections.A scoping review by Joshi et al.  found “TBecause FBOs are a crucial resource in helping the community develop vaccine trust, we designed the community engagement and mobilization approach to make FBOs frontrunners in areas with a high inclination towards religion and faith and low confidence in the vaccination drive. The key implementation strategies used to achieve community engagement goals were based on an operational framework depicted in The collaboration with FBOs aimed to achieve two goals, garnering community response on the COVID-19 vaccine and developing long-term relationships with the FBO to ensure future readiness by developing trust. In the short run, the influence of religious leaders was utilized to garner support for COVID-19 vaccination and build confidence in vulnerable communities by highlighting the vaccine’s safety and efficacy. The FBOs also helped to counter myths/rumors associated with religious beliefs by preaching the importance of preventive care during their recitation in religious gatherings. FBOs led the creation of an enabling environment for the COVID-19 vaccination program with a focus on vulnerable communities.The first step in this direction was to partner with faith-based leaders who could influence the community. Merging a science-based approach with a faith-based outreach was essential to persuade those who were hesitant purely based on a religious perspective. Secondly, the physical manifestations of faith-based organizations like churches, mosques, temples, gurudwaras (place of worship for Sikhs) etc., have always been the haven of service provision during emergencies. During the COVID-19 crisis, these institutions had become a critical source of food, medical resources and sometimes shelter. Therefore, strategically partnering with these institutions to reach the marginalized living in the close vicinity of these institutions is important to reach the last mile. After making forays into the community with the help of the FBO leaders, the project team forged strategic relationships with the community leaders. Beyond the current project efforts, the goal was to create lasting ownership of not only this vaccination effort but any future public health crises which may arise.The FBO leaders were historically known for being role models for their followers, making it critical that these leaders become advocates and voices of their communities. In times of crisis, the community may not accept the word of political or social leaders but many will follow the guidance of their faith leaders. Therefore, it was strategically important to ensure that the FBO leaders understood the efficacy, safety, and benefits of the vaccine and also became long-term change agents in communities for public health interventions.Implementation process: The project adopted a list of strategic activities to achieve its goals and objectives.Line listing of FBOs in the project geography which could influence the target communitiesIdentifying vaccination champions from FBOs who could be recognized for supporting COVID-19 vaccinationCreating a sustainable network of FBOs duly sensitized and oriented on COVID-19 vaccinationBuilding capacities of FBOs on SARS coV-2 virus that causes COVID-19, and on vaccination through sensitization meetings with religious leaders to clear myths and misconceptions related to COVID-19 vaccinationDissemination of written appeal/video snippets from key religious leaders in the support of COVID-19 vaccinationTargeting vulnerable populations in project areas by the intense use of social media along with mass media and mid-media with appeals of FBO leaders.Dispelling rumours related to vaccination through announcements and appeals during religious meetings/gatheringsOrganizing COVID-19 vaccination sessions within FBO premises to increase vaccine confidence in the target communitiesLeveraging mass gathering at religious places for vaccination such as Friday prayers, EID gatherings in the mosques and Sunday masses, and Christmas campaigns in the churches.The project team collaborated with various FBOs in the project states. Sensitization meetings and training sessions were done with Muslim institutions in the states of Maharashtra, Madhya Pradesh, Jharkhand, Rajasthan, and Jammu & Kashmir . A positive environment for vaccination emerged from extensive community engagement activities, such as advocacy meetings, and announcements from prominent mosques during Eid prayers and Friday prayers. Written appeals and video snippets from the leaders were spread through social media platforms such as Facebook and WhatsApp. Live streaming of sermons at religious events was done on Facebook, and vaccination camp-related information was disseminated through WhatsApp. Community ownership of the vaccination program was developed through the FBOs. The leaders were oriented on COVID-19 appropriate behaviors compatible with religious teachings. COVID-19 vaccination was done during these events. These activities have also reduced vaccine hesitancy and increased vaccine confidence among community members who had reservations about vaccination.The project team collaborated with the largest Sikh institution, the Sikh Gurudwara Prabandhak Committee, and organizations like Dhan Dhan Satguru and Radha Swami Satsang in Punjab. As a result, vaccination camps were held on the grounds of Gurudwaras and other Faith-based organizations, and more than one hundred thousand beneficiaries were immunized on the grounds of FBOs in the state. The project collaborated with churches affiliated with different states in the northeastern states such as Nagaland, Manipur, Mizoram, Assam, Meghalaya, Tripura and Arunachal Pradesh. In Nagaland, special COVID-19 vaccination clinics were organized on Sundays. As part of this campaign, termed Sunday vaccination or the Har Church Dastak Initiative (Knock every church for COVID-19 vaccination), the pastors made announcements during the Sunday Masses before the devotees were immunized. The Vaccination camps were also conducted in collaboration with several Hindu FBOs in various project states.The team also carried out COVID-19 vaccination awareness camps in well-known FBO premises. The devotees and pilgrims were called upon by the faith leaders to attend the awareness cum vaccination. The project held awareness sessions to educate people about the importance of vaccination and resolve doubts of reluctant devotees and pilgrims. Along with this, teams have also utilized religious occasions like Jagrans, religious fairs, and other religious gatherings to create awareness and vaccination in these gatherings. Additionally, in the States of Jharkhand and Maharashtra, on-ground mobilization was conducted to address vaccine hesitancy, banners were displayed during Eid prayers, counseling sessions were hosted after prayer meetings and religious leaders were also sensitized about the importance of getting fully vaccinated. In Jharkhand, 50 faith leaders took the COVID-19 vaccine during the Eid gatherings to act as role models. Similar efforts were undertaken to motivate faith-based leaders to act as role models. Over the ensuing eighteen months since August 2021, the strategic engagement took shape in the form of sensitizing key religious leaders, using their influence to show support for the COVID-19 vaccination, dispelling rumors and myths, leveraging their reach to create an enabling environment for the vaccination, and utilizing the places of worship for information dissemination and administering vaccinations.The immediate impact of engaging faith leaders and faith-based organizations was vaccinating 0.41 million beneficiaries of eligible cohorts till January 2023. This was done through awareness campaigns that sensitized many FBO leaders and their followers on the efficacy and safety of the vaccines. FBOs were made aware of the COVID-19 vaccination program and encouraged to motivate their congregations to get vaccines and protect themselves against the COVID-19 disease. COVID-19 preventive behaviors  were adopted by faith-based leaders publicly. Compliance with COVID-19 appropriate behavior and vaccination practice were emphasized at worship places. Further, communication within families to create a more supportive environment for the COVID-19 vaccination for all eligible beneficiaries was facilitated. Reminding families about the responsibility of every follower to get himself/herself vaccinated as well as act as a “Cause Ambassador” in his/her area of influence was ensured.The engagement of faith leaders helped disseminate positive messaging, thereby increasing confidence in vaccines and reducing vaccine hesitancy. In the geography of 298 districts across 18 states of India, 3717 camps were organized with the support of FBOs, which included mobilization efforts, the presence of local FBO leaders, and conducting the session in the premises of the religious practice .The engagement efforts are also expected to bring community level acceptance to vaccination in the long run. Some efforts were initiated by project team such as the creation of support groups to facilitate an enabling environment for the vaccination which can act as behavioral drivers to create a positive atmosphere for vaccination among vulnerable and marginalized communities. With the concerted efforts of the project team in partnership with the FBOs across the 18 states and union territories enrolled in this project, thousands more continue to get fully vaccinated and protected every day. Some selected case studies of this work from various geographies are:Radha Soami Satsang, Beas and FBO based in the Mansa district of Punjab became a key partner in reaching the community in the village of Jhunir. This remote village is underserved in many aspects, however, the population residing here has great faith in this religious institution. The leaders of the FBO have backed the immunization program and have made announcements from their institutions to encourage the community to get the COVID-19 vaccine. Before holding a vaccination camp, the team conducted group/interpersonal communication activities and distributed flyers to dispel myths about COVID-19 vaccination among the village population. The immunization campaign was a huge success, and over 600 people were vaccinated through the Radha Soami Satsang, Beas partnership.In a geographically and religiously diverse country like India, the barriers to access healthcare or other social care services can be multi-layered as seen in the case of Falihamari Habi Char in Assam. Separated from the mainland by the river Brahmaputra, the residents of the area, who are predominantly farmers, have to walk miles to access most services. There is little to no public transportation and the population is cut-off from most public services. For COVID-19 vaccination, there was minimal response and most community members were wary of a largely unknown entity administering vaccination. However, the strategic intervention utilized in other regions proved effective here by engaging the Imam (religious leader of the mosque) as an ally to the vaccination efforts. Critical interventions were implemented by the Imam such as announcements and counselling sessions at the mosque itself after the Friday prayers and shifting the base camp for vaccinations within the char area so the community members could easily access it without losing a day of wages travelling to the mainland.In states across the country, engagement with mosques on the occasion of Eid to spread the message that vaccines are essential “to celebrate the festival with uninterrupted joy” has helped immensely to improve COVID-19 vaccine uptake. Social media posts and printed materials in local languages and dialects were disseminated throughout the festive season. In Jharkhand and Maharashtra, on-ground mobilization was conducted to address vaccine hesitancy, banners were displayed during Eid prayers, counselling sessions were hosted after prayer meetings and religious leaders were sensitized about the importance of getting fully vaccinated. Special COVID-19 vaccination camps on Eid at various sites of the celebrations in Maharashtra which reached over 500 devotees. In Aurangabad, public addresses through miking on vans and street plays were organized to inform and counsel those participating in the Eid festivities. The religious and community leaders were oriented on both COVID-19-appropriate behaviors for practicing the faith safely and on the benefits and efficacy of the vaccine. Hundreds were reached through this messaging and were able to overcome their vaccine hesitancy. The most significant long-term outcome has been the ownership of the vaccination program by faith-based leaders. This will ensure the sustained participation of the FBOs in the current and future public health crises and vaccination drives.Buddhism is the most practiced religion in Ladakh and the Monastery plays an important role in determining the behavior pattern of the community. Understanding the key role of these institutions, the project team approached the HCC Committee (religious group of the Buddhist Monastery) located at Hemis Gompa, which is the one prime body having a strong influence over the people of Ladakh. The committee prohibits the organization of any event other than a religious event on the institution’s property. The project team consistently endeavored to organize monks’ meetings for COVID-19 vaccine sensitization. The team interacted with the major leaders at the seminary, who permitted them to organize the awareness session. Around 50 committee members participated in this meeting and initiated the communication efforts to help and encourage the villagers in their areas to take the COVID-19 vaccine.This study highlights the significance of partnering with FBOs and religious leaders in vaccination programs to engage communities meaningfully by dispelling myths, clearing up misunderstandings, building vaccine confidence, and encouraging vaccine uptake. Our findings echo the results of a systematic review by Syed et al.  who emphRight from the beginning of the COVID-19 crisis, international, national, state, and local organizations have looked towards faith-based organizations for support. In May 2020, the World Health Organization (WHO) and UNICEF brought together a panel of state government officials and leaders of FBOs such as Catholic Faith, Art of Living, Jamaat-I-Islami Hind, All India Muslim Personal Law Board, Jamiat-e-Ulema-Hind, All India Ulema Council, ISKCON, Isha Foundation, Rama Krishna Mission Math etc. The state government ministers appealed to the religious leaders to raise their voices against stigma and discrimination by sharing powerful examples from religious scriptures through their network and giving a voice to the unseen ‘Corona Heroes’ in the field. The religious institutions were also requested to provide quarantine facilities to support the government’s efforts.To maximize the efforts, the project team deemed engagement with FBOs as one of the most strategically important interventions. Every previous vaccination effort such as for polio or measles-rubella had proven that communities across socioeconomic barriers are often held together by their religious faith. Finding allies within faith-based leaders was essential to reach the hardest to reach and most vulnerable. The local FBO and their leaders mostly spoke the dialects of the community they were engaged with and had the complete trust of the families. Often very personal decisions about marriage, childbirth, healthcare, and social engagements are made in consultation with local religious leaders.Connecting with religious leaders to create a movement to support vaccination and motivate and educate followers to adopt other healthy behaviors that are compatible with religious teachingsEstablish COVID-19 support groups in the communityLong-term participation of FBOs in grassroots mobilization and tackling vaccine hesitancy related to faith-based concernsReligious sites such as temples, mosques, gurudwaras, etc. established as having a key role in vaccination drivesEstablish at least one state and district-level partnership with FBOs to enhance ownership of vaccination programs by FBOsMany valuable lessons were learned on targeting devotees with the help of faith-based leaders during key religious and cultural festivals throughout the year. Sustaining the gains is much more important than the immediate results and this can be ensured by:Faith-based organizations (FBOs) in India have historically been part of the vaccination efforts of the government ,38. In pThere are many instances of leveraging support from FBOs to promote vaccination in India, especially in the last two decades. FBOs acted as a vital cog in the wheel of involving all stakeholders in reaching the last mile and vaccinating every beneficiary. While for polio and measles campaigns the beneficiary group was primarily limited to children, in the case of COVID-19 it was to vaccinate all age groups above 12 years. Due to the sheer number of beneficiaries, it required an enormous effort. Even after mitigating the technical challenges of supply chain management to ensure vaccine availability, geographical access and effective communication remained the task to convince an adult free-thinking population diverse in ethnicity, religious belief, religion of the need for vaccination. FBOs acted in unison with the local community leaders, political leaders and acted as a trigger for the vaccination which ensured success of COVID-19 vaccination program in India.The expanding transnational significance of FBOs cannot be denied either. FBOs are receiving more scholarly and policy attention at International Organizations such as United Nations . A noteworthy number of NGOs with consultative status with the UN’s Economic and Social Council (ECOSOC) are FBOs . The relThe role of FBOs was critical in addressing myths especially related to faith/beliefs, building confidence among community members thereby leading to increased acceptance of COVID-19 vaccine and behavior change in communities. The influence of FBOs can be leveraged in adult vaccination including routine immunization in children. The FBOs encouraged the community to abide by official directives and backed national measures in religious sensitive areas. The team also took an active position against false information regarding the pandemic and the nationwide immunization program. Additional methods for adjusting religious services were also adopted. Some of the organizations facilitated vaccination camps and offered premises for medical camps to serve critically ill cases. This shows that a dedicated effort will have a far-reaching impact on community engagement. We see FBOs as a direct bridge with community. Partnerships with them might even become more significant over time, particularly for routine immunization and life course vaccination.It makes sense that the public health and FBOs representing hard-to-reach communities would want to collaborate with one another to further the shared objective of preventing suffering. Each side has vital content that the other does not, therefore neither can afford to move forward without the other. A careful and rational approach to cooperation is essential for the successful resolution of vaccine hesitancy.In collaboration with public health stakeholders, FBOs have a significant role to play. In light of the aforementioned experiences, we share the following recommendations:We Recommendations Working at Three Levels:Upgrading roles: In India, faith leaders have been active in the political landscape so much so that a few ministerial roles have been served by a few of them. The faith-based leaders are already playing a dual role, promoting spirituality and inculcating the healthy lifestyle, sensibility to towards environment and humanity. Some have gone far to the extent of running charitable hospitals, schools, and shelters for the needy. Having done all this, they deserve a role more than working as mouthpiece on COVID-19 communications. They must be invited to take leadership roles, particularly those representing marginalized communities and religious minorities.Integration: Faith-based leaders are among the most powerful community partners. Integrating FBOs in the public health system will ensure that actions respect cultural differences and don’t clash with deeply held (religious) values. Moreover, their presence in conflict-reducing. The mistrust on Government and public health agencies whenever instigated through misinformation can be lessened with the help of FBOs. The limitations of what is currently known about safety, efficacy, breakthrough cases, variations, and other matters that could worry the general public can be conveyed by utilizing the expertise of FBOs.Operational partnership: Deep rooted FBOs with motivated taskforce and unconditional followership and well-developed premises offer a lucrative advantage for premises and taskforce for vaccine storage, distribution and inoculation. They are accessible and trustworthy institutions for the local devotees and therefore, important for the existing and potential health programs. Such collaborations ought to continue after the COVID-19 pandemic and constitute an ongoing component of the community.The collaboration follows the basics of existing behavior change theories and frameworks on behavioral and social drivers for vaccine uptake and offers a bedrock to test and upgrade the frameworks. The vaccine hesitancy models can be can be further tested by including mediating or moderating variables such as religion, faith, beliefs, age, gender, and so forth. This will help gain a thorough understanding and exploration of the other influential factors to direct policymakers and protect human lives.Our article draws on a diverse set of experiences in engaging with FBOs from different religions in almost 20 states in India. This extensive scope offers us detailed insights into how best to partner with FBOs in different contexts. Another strength of this article is that all the activities described were implemented over several months affording us time to implement and adapt our FBO-community engagement plans and improve vaccination coverage. Faith leaders are members of the community who are acknowledged for their role in directing and motivating religious and faith-based beliefs and practices of the community, acting in an influential leadership capacity. By disseminating messages about vaccine best practices, religious leaders and organizations serve as an important resource in helping the community develop its vaccine confidence.This approach enables behavior change in the project/program to address the barriers entrenched in sociocultural and religious beliefs. Vaccine support messaging and information coming from a faith-based leader will resonate and is seems valid to utilize. The results of public health programs can be greatly enhanced by effective communication with faith-based communities.The article reports the experiential insights of collaboration with FBOs at the ground level for the implementation of a National program. However, our approach was ad-hoc when it came to identifying and approaching the FBOs for collaboration. We recommend that other projects that seek to engage FBOs identify criteria by which to select the organizations so that they can serve as a blueprint for other similar initiatives. Our approach to measurement was also more anecdotal and we suggest future projects devise outcomes-based research that clearly links FBO engagement to improved health impact. Most of the Faith-Based leaders except “Brahma Kumaris”  were men. Moving forward, it would be advantageous to investigate and facilitate the participation of female faith leaders to invite higher female participation and resolution of gender-specific issues.Some groups could not be mobilized despite being approached through FBOs. They had deeper apprehensions that required efforts at a personal level rather than a mass approach. Although not a significant number some of the faith leaders themselves were not convinced about vaccination even after the orientation and their own resistance might affect the behavioral pattern of the communityDespite repetitive efforts, the project team could not reach or engage a few prestigious religious bodies with strong influence in the community.Suboptimal ownership of the few faith leaders in the program because of their indifferent opinions was also evident in a few low-performing areas.Working with FBOs requires efforts and multiple meetings for sensitization and securing their buy-in for the cause. Some religious leaders after intensive persuasion efforts do not wish to be associated with the cause. The project in that case will then need to identify other community-based leaders to further the cause.At the field level following limitations were realized which can be managed with careful planning in the future:


Spontaneous quadriceps tendon rupture is very rare. Its occurrence is usually linked to an underlying disease that weakens the tendons causing them to rupture. Here, we report the case of a 44-year-old patient undergoing long-term hemodialysis who had spontaneous bilateral quadriceps tendon rupture. We present the clinical presentation and the management of this injury. The extensor apparatus of the knee is a functional and anatomical entity made up of the femoral quadriceps muscle, the quadriceps tendon, the patella, and the patellar tendon linking it to the tibial tuberosity. The soft tissue structures provide both static and dynamic stability to the patella .The rupture of the quadriceps tendon is defined by a solution of continuity of the chain of transmission of the extension of the leg on the thigh.The mechanisms of quadriceps tendon tear can be a rapid and unusual muscle contraction with a planted foot and a partially flexed knee, direct localized trauma or tendon tear, or a fall with a flexed knee . A complTo date, the pathophysiological mechanisms of tendon ruptures are not entirely understood. One of the suggested reasons was the vascular compromise or the disruption of the tendon structure triggered by systemic conditions. Degenerative changes, mainly tendon lipomatosis, were the most common finding in the pathology assessment of spontaneously ruptured tendons making them its most probable cause ,4. SeverIn chronic renal disease (CKD), especially in patients on long-term hemodialysis, the pathogenesis remains unclear but three factors are particularly involved, namely, degeneration caused by chronic acidosis leading to the deposition of elastin in the tendons; secondary hyperparathyroidism which weakens the bone-tendon junction (increased bone resorption); and β2 microglobulin amyloidosis which accumulates, in particular, in the joints, bones, and tendons resulting in decreased tendon elasticity ,5.2 low-flux dialyzer), with a history of secondary hyperparathyroidism and vascular and soft tissue calcifications, presented on the day of his hemodialysis session complaining of weakness in both lower limbs. Prior to this incident, the patient was ambulatory and could walk with the aid of a cane. The patient did not report any fall or trauma. According to the patient, after waking up in the morning, he was unable to stand up and felt intense pain in the knees every time he tried to.A 44-year-old patient, suffering from CKD of undetermined origin and undergoing long-term hemodialysis since 2013 . Subsequently, the optimization of dialysis by increasing the dialysis dose from 10 hours/week to 15 hours/week divided into three sessions  and using a low calcium dialysate . The vitamin D deficiency was corrected using cholecalciferol (26 ng/mL), and after controlling hyperphosphatemia (56 mg/L), an active form  was used in the hope of controlling hyperparathyroidism.Eleven months later, a parathyroidectomy was scheduled after an insufficient decline of the parathyroid hormone (PTH)  using available medical means .The fast diagnosis of bilateral quadriceps tendon ruptures is vital because early surgical intervention is an important prognostic factor, allowing both end-to-end tendon repair and optimization of tendon-bone anchorage . AlthougThis case is the prime example of why one should not neglect the treatment of the underlying causes, such as secondary hyperparathyroidism and inadequate dialysis. The 2017 Kidney Disease Improving Global Outcomes guidelines on CKD-mineral and bone disorders recommended a treatment strategy based on the assessment of phosphate, calcium, and PTH levels .The phosphate level should be kept close to the upper level because a low level can be predictive of malnutrition. Adequate dietary control of phosphate intake can help achieve this goal. Favoring proteins of vegetal origin over animal ones and avoiding inorganic phosphate present in processed food can help lower phosphate intake without impacting the nutritional status of the patient. Additionally, prescribing phosphate-lowering medication is often necessary because of the high phosphate intake and its low clearance when using conventional dialysis methods . Lastly,The calcium level should be kept at a normal range using calcium and vitamin D supplements when needed, and special care should be taken to avoid hypercalcemia and the associated vascular and soft tissue calcification .The PTH level should be monitored and interpreted at the same time as the calcium and phosphate due to the tight link between them. In fact, the control of calcium and phosphate levels alone can lower the PTH to acceptable levels . The usThe β2 microglobulin accumulation in dialysis patients was not only linked to dialysis-related amyloidosis but was also responsible for increased mortality in this population . While mThe spontaneous rupture of both quadriceps tendons is very rare and usually the result of a systemic disease. The quick diagnosis and surgical treatment of this tendon tear are vital to achieving a full recovery. In our case, the clinical presentation suspected the diagnosis and the MRI confirmed the tendon rupture. The same-day surgical repair of the tear and the early rehabilitation helped our patient recover the full motor function of both limbs. The management of the underlying disease, namely, hyperparathyroidism and contributing factors of metabolic acidosis and inadequate dialysis, was needed to prevent further complications.


In this paper, we aim to present a powerful approach for the approximate results of multi-dimensional diffusion problems with time-fractional derivatives. The fractional order is considered in the view of the Caputo fractional derivative. In this analysis, we develop the idea of the Yang homotopy perturbation transform method (YHPTM), which is the combination of the Yang transform (YT) and the homotopy perturbation method (HPM). This robust scheme generates the solution in a series form that converges to the exact results after a few iterations. We show the graphical visuals in two-dimensional and three-dimensional to provide the accuracy of our developed scheme. Furthermore, we compute the graphical error to demonstrate the close-form analytical solution in the comparison of the exact solution. The obtained findings are promising and suitable for the solution of multi-dimensional diffusion problems with time-fractional derivatives. The main advantage is that our developed scheme does not require assumptions or restrictions on variables that ruin the actual problem. This scheme plays a significant role in finding the solution and overcoming the restriction of variables that may cause difficulty in modeling the problem. In recent years, numerous researchers have introduced the analytical and numerical approaches to obtain their approximate solutions. Malan and Lewis3 utilized edge-based finite volume method to model heat and mass transfer in heterogeneous porous materials. Arafa and Hagag4 presented q-Homotopy analysis transform method for the analytic solution of fractional coupled Ramani problem. El-Sayed et al.5 developed the idea of Adomian’s decomposition method for the approximate solution of the reaction-diffusion model of fractional order. It is still challengeable task to obtain the exact solution of these fractional problems. Most of the fractional system do not have the exact solutions due to the difficulty of fractional order. To investigate their approximate solutions, various authors presented their schemes that obtain the results very close to the exact solution such as Fractional Temimi–Ansari method6, Differential transform scheme7, Haar wavelet operational matrix8, Natural transform9, Sumudu residual power series method10, Finite difference approach11, High-order finite element scheme12, Local fractional Sumudu transform13, Sub-equation method14.The study of fractional calculus is becoming more interesting in various branches of mathematical problems including integral and derivatives of fractional order. The phenomena of fractional order problems have a great attraction in other branches of science and engineering such as as astronomy, optical fiber, biomechanics, chemical reactions, heat transform, and fluid flows16:This work is concerned with the time fractional multi-dimensional diffusion equation17 proposed the idea of Yang transform for the first time and showed that this scheme is straightforward for deriving the results of a steady heat transfer equation. The idea of homotopy perturbation method (HPM) was constructed by He in 2004 and showed that this scheme is suitable for different types of problems18. Later, many researchers extend this study and combined HPM to obtain the approximate solution of some more fractional differential problems. Liu19 et al. combined Yang transform with HPM to derive the analytical results of time-fractional Klein–Gordon problems. Yasmin20 combined Yang transform with the Adomian decomposition approach to present the analysis of the Whitham–Broer–Kaup problem with time-fractional order. The Yang transform with HPM performed excellent results in finding a solution of fractional order KdV and Burger problem21. The study of HPM22 has becoming more and more interesting and numerous researchers have showed the combination of HPM with an other operator produces faster rate of convergence24. Akbarzade and Langari25 showed that HPM is more reliable tool than variational iteration scheme in finding the approximate results of three dimensional heat problems. Kumar et al.16 applied the modification of HPM whereas Prakash and Kumar26 suggested the application of fractional variational iteration scheme to present the analytical view of multi-dimensional diffusion problems. Researchers showed that combination of these transformation with the HPM provide the excellent results than the traditional HPM. Since various analytical and numerical schemes are presented by experts in the literature. In the most of schemes, authors have faced some difficulties and limitations due to the heavy calculations in the iteration series. The use of integration in variational iteration scheme and convolution theorem Laplace transform make the solution complicated and may occur some assumption and restrictions on variables that is the main drawback of these schemes28. To overcome, this drawback, we propose the idea of YHPTM for the approximate solution of multi-dimensional diffusion problems with time-fractional derivatives.Recently, YangIn this work, we combine the YT with HPM to develop a novel scheme that is expressed by YHPTM. We consider a few problems to test the accuracy and performance of this proposed scheme. We note that our developed scheme produces results very close to the exact results after a few iterations and some graphical visuals are also provided to show its performance with graphical errors. We begin this article as; we present the idea of Yang transform in “In this segment, we define the concept of YT with its basic properties.30The Caputo fractional derivative is defined as19The YT is stated as19The YT of a fractional derivative is given asThe differential properties of YT for a functionare defined as19In this section, we construct the idea of YHPTM which is used to derive the approximate results of multi-dimensional diffusion problems with time-fractional derivatives. This scheme does not require the restriction of variables and any hypothesis. Let’s assume the following differential problem of time-fractional order asOperating YT on Eq.  such as\This impliesHence Operating inverse YT on Eq. , it yielNow, HPM is defined asUse Eqs.  and 7)  7) in Eqp, we obtainComparing the coefficient of Equation  represenThe following theorems are built on the idea of the proposed scheme and provided to show the convergence and error analysis of the problem Letbe the exact results of Eq. (and considerandwhererepresents the Hilbert space. Then, the derived resultscan convergein case ofthus, for anythere isentclass1pt{minimaLet a sequence such as To achieve the valuable solution, we must show that For As Letis finite andshows the derived series results. Considersuch asthen the following relation produces the maximum absolute error.Since This ends the proof. We illustrate four applications of multi-dimensional diffusion problems with time-fractional derivatives. We consider two-dimensional and three-dimensional heat flow problems in the sense of Caputo fractional derivative. These examples exhibit the performance and capability of the presented scheme. Graphical results and absolute errors show that YHPTM is a very promising tool for solving fractional differential problems. MATHEMATICA 11 software is used for numerical computations during the calculation phase and construction of figures.Let us consider the two-dimensional homogeneous time-fractional heat flow problemApplying the YT on Eq. , we get\The application of YT in fractional form yieldsThus, Using inverse YT on Eq. , we get1Implementing the idea of of HPM to derive the He’s iterationsp, we getRelating the similar components of Similarly, it can be continued to the following seriesIn Fig. entclass1pt{minimaConsider the following time-fractional heat flow problem in a inhomogeneous two-dimensional formApplying the YT on Eq. , we get\The application of YT in fractional form yieldsThus Using inverse YT on Eq. , we get2Implementing the idea of HPM to derive the He’s iterationsp, we getRelating the similar components of Similarly, it can be continued to the following seriesIn Fig. entclass1pt{minimaConsider the following time-fractional heat flow problem in a three-dimensional homogeneous formApplying the YT on Eq. , we get\Using the properties functions of YT , we obtainThus Using inverse YT on Eq. , we get3Implementing the idea of HPM to derive the He’s iterationsp, we getRelating the similar components of Similarly, it can be continued to the following seriesIn Fig. Consider the following time-fractional heat flow problem in a three-dimensional inhomogeneous formThe application of YT in fractional form yieldsUsing the properties functions of YT, we obtainThus Using inverse YT on Eq. , we get3Implementing the idea of HPM to derive the He’s iterationsp, we getRelating the similar components of Similarly, it can be continued to the following seriesIn Fig. In this study, we successfully developed the YHPTM approach for obtaining the approximate solution of the two-dimensional and three-dimensional heat flow problems. Since the equations involving fractional order are quite difficult to solve directly, we introduce the idea of YT to dissolve the fractional order of the problem. The scheme of YT is limited and unable to generate the series solution, therefore, we implement HPM to derive the successive iterations from the classical equation that leads the results to the exact solution very easily. We consider four test problems to show the efficiency and effectiveness of this proposed scheme. It has been found that our derived results demonstrate a great confirmation of compromise with the exact solution. We also analyzed the efficiency of our proposed scheme in two-dimensional and three-dimensional through graphical structures. The obtained results are efficient and significant, demonstrating that YHPTM is accurate and authentic for fractional problems. It is expected to consider this scheme for fractional problems in the sense of Atangana–Baleanu derivatives and other partial differential equations involving fractal theory and fractional calculus in our future work.


Currently, the treatment of anemia in preterm infants is based on packed red blood cell (RBC) transfusions from adult donors. Oxygen (O2) is mainly transported to the tissues bound to hemoglobin (Hb). In extremely low gestational age neonates (ELGANs), fetal hemoglobin (HbF), which has a higher affinity for O2, represents up to 95% of circulating hemoglobin. During the first month of life, the majority of ELGANs will require an adult-donor RBC transfusion causing HbF levels to rapidly drop. HbA releases 50% more oxygen in peripheral tissues than HbF. Increased release of O2 in the retina is one of the main factors related to the development of retinopathy of prematurity (ROP). Collecting umbilical cord blood and using autologous umbilical cord whole blood (UCB) transfusions would contribute to maintaining physiological HbF concentrations in newborns and avoid oxygen-in-excess derived damage.This is a randomized, double-blinded, multicenter clinical trial. ELGANs ≤28 weeks of gestational age will be randomized 1:1 to receive an autologous umbilical cord blood transfusion (intervention arm) or standard transfusion of packed RBC from an adult donor (control arm) to assess ROP development. Assuming a 50% reduction in ROP incidence, 134 patients (67 per group) will be recruited. When blood transfusion is indicated, the Blook Bank will supply UCB or RCB according to the patient's group. The primary endpoint is the incidence of any ROP. Secondary endpoints are assessessment of treatment safety, results of biomarkers related to ROP and its chronology, and urine oxidative stress markers. In addition, the cellular composition of umbilical cord blood and its relationship with prematurity-related pathologies will be analyzed. All patients will be followed-up to 24 months of corrected age to evaluate their neurodevelopment.ROP is a major cause of irreversible blindness in preterm newborns. Transfusions with adult donor blood can lead to complications, including ROP. UCB transfusions offer advantages by maintaining physiological HbF levels and potentially optimizing postnatal development. Moreover, autologous UCB transfusion could reduce risks associated with heterologous blood products, although volume collection remains challenging. UCB contains growth factors and progenitor cells that may impact ROP. Retinopathy of prematurity (ROP) is a common comorbidity associated with extreme prematurity that affects up to 64% of extremely low gestational age neonates (ELGANs) below 28 weeks of gestational age (GA) , 2. ROP Physiologic retinal development requires a relative hypoxemic microenvironment during intrauterine growth, where the arterial partial pressure of oxygen (PaO2) ranges from 30 to 40 mmHg. However, PaO2 rapidly increases to 100 mmHg whithin minutes after premature birth, hindering retinal blood vessel growth. In the first stage of ROP, hyperoxia suppresses the production of vascular endothelial growth factor (VEGF) and erythropoietin (EPO), leading to retinal vasoconstriction and localized hypoxia, ultimately causing delayed retinal development. Additionally, preterm birth causes the depletion of factors such as insulin-like growth factor 1 (IGF-1), which seems to contribute to the alteration of retinal vascular development . In the The severity of ROP inversely correlates with the degree of prematurity . PrematuRed blood cell (RBC) transfusions have been associated with a higher incidence of ROP, and its severity is directly related to the volume of blood transfused . In termBased on these premises, the utilization of umbilical cord blood transfusion (UCB) from healthy newborns has been proposed to prevent ROP in preterm infants . This apWe hypothesize that using UCBa in the first weeks after birth will contribute to keeping elevated HbF blood concentrations and subsequently reduce the risks inherent to HbA of interfering with the growth of the retinal vascular system.This study aims to assess the effect of UCBa transfusion vs. standard treatment with packed adult-donor RBC in the incidence of ROP. Secondary objectives are to determine the impact of UCB autologous transfusion on the expression of biochemical markers of ROP, to determine the effect of UCB autologous transfusion on oxidative stress, to characterize the specific composition of stem cells in UCB in preterm newborns and its relationship with complications of prematurity.To test the hypothesis, we have designed a randomized, multicenter, double-blinded trial to evaluate the effect of UCBa transfusion on the development of ROP compared to transfusion of adult-donor RBC in preterm infants with GA ≤28 weeks. Patients will be randomized in a 1:1 ratio to receive either UCBa transfusion or standard treatment with adult-donor RBC.The study will be conducted at three hospitals: The University and Polytechnic Hospital La Fe , the University Clinical Hospital of Santiago , and the Maternal and Child University Hospital Complex of Las Palmas . The protocol was written following the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) guidelines. The study was registered at European Union Drug Regulating Authorities Clinical Trials Database (EudraCT) with the identifier number 2022-003821-22. Inclusion criteria: Preterm infants with GA ≤28 + 6 weeks of GA.Exclusion criteria are one or more of the following: major congenital malformations, monochorionic twin pregnancy, chromosomal abnormalities, hemoglobinopathies, isoimmunization, critical condition at birth with a predicted fatal outcome, and refusal to participate and sign the informed consent.Patients will be managed according to the usual protocols regarding oxygenation limits. The enrolled patients’ targeted oxygen saturation range will be 91%–95%. Transfusion thresholds will be carried out according to local guidelines.Patients will be randomized to receive either whole UCBa, intervention group, or standard adult-donor packed RBC, control group. For patients with anemia requiring blood transfusion according to the Spanish Society of Neonatology's standards Committee threshold's recommendations , the resThe primary outcome is the incidence of ROP in both groups. Diagnosis and staging of ROP will be established according to “International Classification of the Retinopathy of Prematurity, Third Edition (ICROP3)”. ROP diagnosis will be made by an expert ophthalmologist using indirect ophthalmoscopy and RetCam imaging.-Recovery of hematocrit and hemoglobin values.-Transfusion requirements during admission (number and volume of transfusions received).-Treatment with EPO and other adjuvant treatments for anemia such as iron and folic acid supplementation .-Assessment of post-transfusion tissue oxygen transfer status: Brain and somatic NIRS value, oxygen saturation measured by pulse oximetry, lactate, HbF levels.Outcomes related to safety-Incidence of acute transfusion reactions.-Incidence of late complications: bronchopulmonary dysplasia, periventricular leukomalacia, necrotizing enterocolitis, hemodynamically significant patent ductus arteriosus, sepsis, and death.Outcomes related to retinopathy markers-Serum levels of EPO, VEGF and IGF-1.-HbF levels.Outcomes related to ROP treatment-ROP severity-Laser therapy-Anti-VEGF administrationOutcomes related to UCB cellularity and oxidative stress.-Quantification of reactive oxygen species in urine.-Composition of stem cells in UCB.Outcomes related to effectivenessData concerning retinopathy and oxidative stress biomarkers quantification and stem cells typification is provided in We consider the development of ROP a competitive outcome with mortality due to its late onset during postnatal development. The combined variable death or ROP was considered the primary study variable. The incidence of death or ROP in our center in ≤28 weeks is 41%. A 50% reduction in the incidence will be considered clinically significant, so considering a significance level of 0.05 and a power of 0.8, the calculated sample size is 122 patients. Assuming a drop ratio of 10%, 134 patients will be recruited for the study (67 in each group).University and Polytechnic Hospital La Fe is a tertiary center with 6,000–6,500 births annually. In addition, two other recruiting centers, University Clinical Hospital of Santiago  and Maternal and Child University Hospital Complex of Las Palmas , are included in the study, so we estimate that the sample size could be accomplished in the three years of the study duration.Once a potential study participant has been identified, investigators will ask for informed consent from the infant's parents or legal guardians. Written informed consent will be obtained prenatally before delivery, reviewed, signed, and dated by the investigator and parents/legal guardians. The patient information sheet will include all the complementary tests carried out during the study.Randomization will be done just before birth and generated by random numbers using the R® 3.5.1 software . Patient numbers will be assigned sequentially by order of entry into the study. Randomization will be stratified into two groups by gestational age (GA) (23–25 and 26–28), using block randomization. The Biostatistics Unit will provide a randomization list for the corresponding Neonatology Service containing the patient number and another for the Blood Bank Service holding the related treatment branch and the patient number. The neonatologist in charge of the patient will assign the patient a number for the study, ensuring that it has not been given to any other patient. Once the number has been provided, it will be sent to the Blood Bank, responsible for keeping the randomization list containing all the information about it.The Blood Bank will receive the UCB from the delivery room. It will verify that it meets the quality criteria established by the Blood Bank and aliquot it into one or several units of blood, depending on the volume available. Once a transfusion is prescribed for a participating patient, the Blood Bank will dispense either UCB or RBC according to the assigned group in the same container bag typically used in the Neonatology Unit to be indistinguishable from guaranteeing the blinding. The neonatologist will remain blind to the randomization group, as will the nursing staff and specialists in charge of patient care.The clinical evaluation will be performed during follow-up at 40 weeks, 12 months, and 24 months of corrected age. Weight, height, and head circumference will be measured, and the child's complete structured physical evaluation will be performed at each visit. A comprehensive neurodevelopmental assessment using the Bayley IV scale will be served at a two-year follow-up.The blinding will be opened in those emergency cases in which knowledge of the assigned treatment is essential for the medical care and well-being of the patient. In such a case, the researcher should note the date and reason for unblinding.The researcher or neonatologist in charge will contact the Blood Bank Service or unblinded operator, and the patient's treatment information will be provided. The blinding will be opened once the last patient enrolled in the study has been discharged from the hospital so that the results can be statistically analyzed. The neurodevelopmental specialist performing the long-term follow-up will remain blinded until the 24-month corrected age control of the last patient included in the study.A record must be completed for each patient included in the study. Data will be anonymized using a unique code for each participant. The critical document containing each patient's name related to the code number will be stored in each center's principal investigator's folder. Data will be kept in an institutional research location of the principal investigator, secured with a password or key for the period specified by legislation.During the trial, periodic monitoring visits will be carried out by an external monitor independent from the research team to ensure that the protocol and good clinical practices are followed. The monitors can review the source documents to confirm that the data collected are accurate. The researcher and the institution guarantee the monitors direct access to the source documents and the relevant regulatory authorities for verification.Considering the characteristics of the investigated product, adverse events related to transfusions are managed in compliance with the regulations specified by the National Transplant Organization. The initiation of the study has been reported to the National Transplant Organization.The following sets of analyses are planned: (1) All included patients, regardless of whether they were transfused or not; (2) All included patients who received transfusions, as per intention-to-treat ; (3) All included patients who received transfusions as per protocol (excluding intervention group patients who received adult donor blood transfusions). Secondary analyses will also examine the effect of the two treatment strategies on the described secondary variables. An interim analysis of the results will be conducted once half of the sample has been collected to assess the presence of any relevant safety or mortality outcomes. An external committee will be proposed to perform the calculations while maintaining blinding until evaluation.p > 0.05 in the Shapiro–Wilk test), they are described with the mean ± standard deviation. They are compared using Student's t-test, first testing the hypothesis of equality of variances using Levene's test. If abnormal, they are described with a median  and compared with the nonparametric Mann–Whitney U-test. Comparison between both groups of repeated measures over time is performed by a two-way analysis of variance (ANOVA) test, first testing Mauchly's sphericity hypothesis and rejecting it with p < 0.05. Survival times are expressed with their median [95% confidence interval (95% CI)], and between-group comparison is performed with the log-rank test. Throughout the study, a p < 0.05 is accepted as the limit of statistical significance. The magnitude of the effect is quantified with the risk difference (expressed as a percentage), and its precision is indicated with the 95% CI.Categorical variables are described with each category's numerical count (percentage). If the application assumptions are met, they are compared with Pearson's chi-square test, and if not, Fisher's exact test. Continuous variables are represented with Tuckey box plots. If the constant variables are standard , and the Approval Number is 2021-269-1 also by the local IRBs of the participating hospitals. The study will be conducted by the protocol, ICH guidelines, the applicable regulations and guidelines governing clinical studies in Spain, and the ethical principles from the Declaration of Helsinki.Retinopathy of prematurity is an exclusive disease of preterm newborns and the leading cause of irreversible blindness in this group of patients. Due to the improvement in the survival of highly preterm newborns, this disease is expected to increase even more in the coming decades. Any intervention focused on reducing the incidence of this pathology will improve the quality of life of premature patients and significantly impact the direct and indirect costs that blindness entails in such early stages of life. Autologous cord blood transfusions represent a simple and cheap procedure that has already been evaluated in similar scenarios in the neonatal population. Its use is not only not expected to present side effects but also very likely to prevent the side effects associated with the compared intervention, which is of great interest.in utero. Thus, autologous UCB transfusions would maintain a physiological concentration of HbF during the first weeks of life, which has a greater affinity for oxygen and is more stable in an oxidative environment, maintaining similar oxygen transportation and tissue delivery as in the fetal stage. This fact could optimize the postnatal development of different immature tissues. Moreover, UCBa transfusion reduces the inherent risks of receiving heterologous blood products because the product is entirely compatible with the recipient.Transfusions with packed red blood cells from adult donors are now unavoidable in the context of premature infants. Their administration has been associated with various complications, including ROP. The main potential advantage of umbilical cord blood is that it contains the same amount of HbF as newborns Umbilical cord blood is rich in growth factors that play a unique role in the pathogenesis of this disease, as previously mentioned. It also contains progenitor cells that could promote better postnatal development. To confirm the influence of these factors, basic research studies and randomized clinical trials are needed. This trial will study all these factors and the expression of oxidative stress markers. Physiological mechanisms of retinopathy of prematurity will be analyzed, and a predictive model based on biomarker expression could be designed to apply targeted preventive and therapeutic strategies. Moreover, it will allow us to expand the insufficient knowledge regarding the cellular components of preterm cord blood and explore new lines of research.The limitations of this study are inherent to a clinical trial and are mainly manifested in two aspects. Firstly, the difficulty of recruiting patients in the complex environment of Neonatal Intensive Care Units at the birth of a preterm patient, where uncertainty about potential complications of this condition and other concurrent factors makes it challenging to approach the parents of eligible patients. For this reason, a multicenter design has been implemented, including three clinical units with sufficient annual admissions. On the other hand, there might be cases where the volume of blood collected needs to meet the complete transfusion needs of the patient. It is assumed that the most significant benefit of autologous transfusion will occur within the first two weeks of life due to the pathophysiology of the disease, during which time transfusion needs will be met. However, allogeneic transfusions are usually required as a supplement to meet complete requirements. This hypothesis is reinforced by the results presented by Hellstrom et al. , who fouThe relevance of the trial is based on the need to address ROP, a serious ocular complication that currently lacks an effective treatment. Clinical trials like the one presented can be the beginning of a paradigm shift in transfusion medicine, using neonatal blood for neonatal patients whose situation differs significantly from adult patients, thereby improving the quality of care and clinical outcomes in this patient population.


The Luangwa Basin, Zambia, which forms part of the Zambezi drainage, is strategically located between the Central African plateau and the East African Rift system. The Luangwa River and major tributaries, such as the Luwumbu River, are perennial water sources supporting essential resources that sustain human communities and a rich and diverse fauna and flora. The archaeological record of Luangwa is relatively unknown, despite early archaeological exploration hinting at its potential. Recent research in the southern Luangwa valley, however, suggests that it preserves a long record of hominin occupation spanning the Early to Late Stone Age. The research described here details fieldwork carried out in northeastern Luangwa, in the Luwumbu Basin, that confirms that a relatively deep package of Quaternary deposits, containing evidence of the Stone Age occupation of the region persists in the upper piedmont zone. The Luangwa Valley is a lateral extension of the East African Rift system, cutting diagonally through the high central plateau of Zambia . The valth Century hydrocarbon exploration, advances in satellite imagery and the development of wetland management schemes contributed to renewed scientific interest in the hydrology and sedimentary history of the Luangwa Basin, e.g.,  the fans likely formed braided streams rather than debris flows, such as the ones documented in the foothills of eastern Luangwa, near Chipata  and gullying are potentially the driving factors behind the formation of the terrace by removal of sediments of Unit 4. The removal of fine sediment has reached the level of the cobbles at the edges of the terrace, while ca. 70 cm of Unit 4 sediment was observed above the cobbles in central parts of the terrace. A similar process is underway at SW23A. This may explain why the archaeological deposits from these localities, and others in the region, are typologically mixed. At SW23B, however, field observations of sediment exposures and archaeological excavations (reported elsewhere) also reveal the presence of some archaeological material, including flakes and informal cores, in the undated sediment package overlying the Upper Grit, hinting at the untapped archaeological potential of the site.Fossil vertebrates, fossil wood and archaeological material all occur on the contemporary piedmont surface above ~850 m asl but are, for the most part, spatially segregated indicating that intact sequences of Quaternary sediment exist, separated by outcrops of Upper Grit. Older sediment exposures occur when overlying Quaternary sequences have been stripped away by erosion, e.g., on the lower margins of the piedmont where paleontological fieldwork has concentrated.The cobbles that mantle the contemporary piedmont surface could derive from the Makutu Range, which consists mainly of schists and quartzites overlying basal granite –29. TheyTypologically, archaeological material from the Luwumbu sub-basin spans the Early and Middle Stone Age, confirming that hominins occupied northeastern Luangwa more or less continuously after initial piedmont formation. The lithic assemblages see:  are lag Extensive geoarchaeological fieldwork in central Luangwa, in the southern sub-basin along a transect of the floodplain from the Nchindeni Hills to the Muchinga escarpment, was undertaken as part of the Past Peoples and Environments Project , 13. In At Manzi, a Stone Age locality situated near the confluence of the Manzi and the Luangwa rivers just south of the transect studied by Colton, a discontinuous sequence of fluvial and colluvial deposits containing cobble layers and small numbers of artefacts in secondary context, unconformably overlies Karoo sediments . Six seqIn summary, lithic assemblages from central and northeastern Luangwa are dominated by simple flake production, complicating chronological attributions. Relative chronologies have been established in the central region (above) indicating a hominin presence from at least circa 1 Ma associated with a simple core reduction technology (Mode 1), to more recent, MSA (Mode 3) and LSA (Mode 5) occupations of the valley during the Middle/Late Pleistocene.ante quem date of ~1 Ma is suggested, but the presence of LCTs suggests the ESA or early MSA (EMSA). LSA components in the study region are very rare, a pattern that differs somewhat from observations in nearby Malawi [Geomorphological evidence points to periodic pulses of climate-driven, high-energy deposition in the floodplain and in the foothills of the Luangwa valley. Their precise chronology is as yet undetermined, but they washed good-quality raw material down from nearby hills, forming successive cobble deposits that were eventually buried and then locally exposed by incision. The availability of these reliable sources of raw material in the Luangwa valley could explain the prevalence of simple cores and flakes in the archaeological assemblages. The earliest hominin occupation of the piedmont zone in northeastern Luangwa could be roughly contemporaneous with the lower levels at Manzi, for which an y Malawi  and Mozay Malawi , indicatThe information gathered from the lithic scatters studied for this project does not include a small fraction, which would have allowed us to draw conclusions about hominin mobility strategies from lithic reduction patterns . In addiA systematic archaeological survey in the Karonga district of Malawi, on the other side of the Makutu Range, is instructive . The preIn our sample from northeastern Luangwa, cores occur as isolated artefacts on the landscape and in surface scatters associated with naturally occurring cobble concentrations which functioned as raw material sources. Most of the cores in the surface scatters are not highly curated and we recorded a relatively large number of unmodified flakes . The eviGeomorphological research in the central Luangwa Valley has uncovered evidence of several periods of large-scale instability marked by massive landslides, debris flow and cycles of erosion and redeposition in the eastern piedmont region , 9 and iDating the archaeological material recovered from various locations in the Luangwa Valley directly has proven challenging, e.g., . The cliPhytolith analyses (see: Results) indicate that a series of climate fluctuations occurred during the deposition of the sediment package that overlies the cobble layer at SW23 and forms the upper piedmont surface. Sediment cores from Lake Malawi record a shift to wetter conditions in Central Africa during the Middle Pleistocene, followed by a series of aridification cycles , 59. ArcThe preservation of a sedimentary sequence that overlies the Upper Grit formation in the piedmont zone of northeastern Luangwa highlights the archaeological potential of the study region, which preserves a record of hominin presence spanning the Early to Late Stone Age. A concerted effort to obtain direct dates will be required to establish chronostratigraphic control of the sediment record of northeast Luangwa Valley, without which it will be difficult to reconstruct the history of hominin occupation in the region. It is nevertheless possible to draw some interesting conclusions from the survey results.The complex history of piedmont formation and subsequent erosion in northeastern Luangwa (see: Discussion) is a confounding factor, resulting in typologically mixed lithic scatters exposed in surface deposits. Despite this, the assemblages described above have a strong MSA signal. The presence of LCTs, including picks with trihedral points, could also indicate an early post-Acheulean component, possibly dated to the Middle Pleistocene . The MSANortheastern Luangwa would have been an ecologically attractive environment during the Pleistocene. Topographic controls on regional rainfall patterns governed by orbital forcing will have ensured, then as now, that the valley was relatively well-watered throughout the Pleistocene. Phytolith analyses from the piedmont zone (see: Results) indicate the persistence of miombo forest or dry woodland. This type of environment, characteristic of the Zambezi drainage, is thought to have been one of the most productive environments available to prehistoric hominins in the region . FluvialThe abundance of good-quality lithic raw material in the form of quartz and quartzite cobbles, deposited as fanglomerates during the formation of the piedmont zone and re-exposed by incision, could also explain the persistence of hominin occupation in the region. Patterning in the lithic assemblages suggests a time-transgressive provisioning strategy that includes the expedient exploitation of raw materials at their source and the provisioning of individuals. Finally, in addition to the availability of key resources and an attractive environment, the Luangwa Valley is a natural corridor for human mobility, linking the Central African plateau to the Rift Valley . The arcS1 FileTopographic and geological attributes of the survey localities.(DOCX)Click here for additional data file.S2 File(DOCX)Click here for additional data file.S3 File(DOCX)Click here for additional data file.S4 File(DOCX)Click here for additional data file.S5 File(DOCX)Click here for additional data file.