Ethnobotanical knowledge on non-conventional food plants and medicinal plants in Extractivist Reserve in the Brazilian Amazon / Conocimiento etnobotánico sobre plantas alimenticias no convencionales y plantas medicinales en una Reserva Extractivista en la Amazonía Brasileña

Information on the knowledge and ways of using food and medicinal plants by traditional populations, family farmers and Brazilian native population in the Amazon is essential to guarantee the food sovereignty of these groups. This study was conducted using semi-structured interviews applied to local respondents. A total of 269 species of both non-conventional food plants and medicinal plants were identified, distributed in 83 botanical families and 198 genera. The Arecaceae and Lamiaceae families had the highest species richness (11 and 7, respectively). The Shannon-Wiener (H') and Pielou (J') diversity indices were considered high (5.02 and 0.9, respectively) when compared to other ethnobotanical works. In the environment in which these families are found, these species become the only food and medicinal resources available.

La información sobre los saberes y formas de uso de las plantas alimenticias y medicinales por parte de las poblaciones tradicionales, agricultores familiares e indígenas brasileños en la Amazonía es fundamental para garantizar la soberanía alimentaria de estos grupos. Este estudio se realizó utilizando entrevistas semiestructuradas aplicadas a encuestados locales. Se identificaron un total de 269 especies tanto de plantas alimenticiasno convencionales como de plantas medicinales, distribuidas en 83 familias botánicas y 198 géneros. Las familias Arecaceae y Lamiaceae tuvieron la mayor riqueza de especies (11 y 7, respectivamente). Los índices de diversidad de Shannon-Wiener (H') y Pielou (J') fueron considerados altos (5,02 y 0,9, respectivamente) en comparación con otros trabajos etnobotánicos. En el ambiente en que se encuentran estas familias, estas especies se convierten en los únicos recursos alimenticios y medicinales disponibles.

Understanding social needs screening and demographic data collection in primary care practices serving Maryland Medicare patients.

BACKGROUND: Health outcomes are strongly impacted by social determinants of health, including social risk factors and patient demographics, due to structural inequities and discrimination. Primary care is viewed as a potential medical setting to assess and address individual health-related social needs and to collect detailed patient demographics to assess and advance health equity, but limited literature evaluates such processes. METHODS: We conducted an analysis of cross-sectional survey data collected from n = 507 Maryland Primary Care Program (MDPCP) practices through Care Transformation Requirements (CTR) reporting in 2022. Descriptive statistics were used to summarize practice responses on social needs screening and demographic data collection. A stepwise regression analysis was conducted to determine factors predicting screening of all vs. a targeted subset of beneficiaries for unmet social needs. RESULTS: Almost all practices (99%) reported conducting some form of social needs screening and demographic data collection. Practices reported variation in what screening tools or demographic questions were employed, frequency of screening, and how information was used. More than 75% of practices reported prioritizing transportation, food insecurity, housing instability, financial resource strain, and social isolation. CONCLUSIONS: Within the MDPCP program there was widespread implementation of social needs screenings and demographic data collection. However, there was room for additional supports in addressing some challenging social needs and increasing detailed demographics. Further research is needed to understand any adjustments to clinical care in response to identified social needs or application of data for uses such as assessing progress towards health equity and the subsequent impact on clinical care and health outcomes.

Categorization of Patients with Pulmonary Embolism by Charlson Comorbidity Index.

BACKGROUND: Short-term outcomes of pulmonary embolism are closely related to right ventricular dysfunction and patient's hemodynamic status, but also to individual comorbidity profile. However, the impact of patients' comorbidities on survival during pulmonary embolism might be underrated. Although the Charlson Comorbidity Index (CCI) is the most extensively studied comorbidity index for detecting comorbidity burden, studies analysing the impact of CCI on pulmonary embolism patients' survival are limited. METHODS: We used the German nationwide inpatient sample to analyse all hospitalised patients with pulmonary embolism in Germany 2005-2020 and calculated CCI for each patient, compared the CCI classes (very-low: CCI=0points, mild: CCI=1-2 points, moderate: CCI=3-4, high severity: CCI>4 points) and impact of CCI class on outcomes. RESULTS: Overall, 1,373,145 hospitalizations of patients with acute pulmonary embolism (53.0% females, 55.9% aged ≥70years) were recorded in Germany between 2005 and 2020; the CCI class stratified them. Among these, 100,156 (7.3%) were categorized as very-low, 221,545; (16.1%) as mild, 394,965 (28.8%) as moderate, and 656,479 (47.8%) as patients with a high comorbidity burden according to CCI class. In-hospital case-fatality increased depending on the CCI class: 3.6% in very-low, 6.5% in mild, 12.1% in moderate and 22.1% in high CCI class (P<0.001). CCI class was associated with increased in-hospital case-fatality (OR 2.014 [95%CI 2.000-2.027], P<0.001). CONCLUSION: Our study results may help to better understand and measure the association between an aggravated comorbidity profile and increased in-hospital case-fatality in patients with pulmonary embolism.

Life satisfaction and job and personal resources among public workers with non-standard work schedules.

BACKGROUND: While the link between non-standard work schedules and poor health outcomes is established, few studies have examined how resources both in and outside of work can support the well-being of workers with non-standard work schedules. METHODS: Using a cross-sectional survey, we assessed the association between one facet of well-being, life satisfaction, and job and personal resources. In 2019, an electronic survey was administered to two unionized, public service populations who work non-standard work schedules: transportation maintainers and correctional supervisors. We assessed life satisfaction with a 10-item scale; a broad set of job resources (reward satisfaction, supervisor support, co-worker support, schedule satisfaction, and working hours fit); and a broad set of personal resources (health status, sleep, physical activity, and finances). We used log-binomial regression models to estimate prevalence ratios and 95% confidence intervals among statistically significant univariate predictors. RESULTS: Of the 316 workers surveyed, the majority were male (86%), White (68%), and reported positive life satisfaction (56%). In multivariate models, the prevalence of positive life satisfaction was higher in workers reporting reward satisfaction (PR:1.35, 95% CI: 1.11, 1.65; p = 0.003), good work schedule fit (PR:1.43, 95% CI: 1.12, 1.83; p = 0.004), good health (PR:2.92, 95% CI: 1.70, 4.99; p < 0.0001), and good finances (PR:1.32, 95% CI: 1.01, 1.72; p = 0.04). CONCLUSION: Employers should consider increasing work recognition, as well as improving schedule fit, financial well-being, and overall good health in support of worker life satisfaction and ultimately well-being.

Load frequency stabilization of distinct hybrid conventional and renewable power systems incorporated with electrical vehicles and capacitive energy storage.

Maintaining a power balance between generation and demand is generally acknowledged as being essential to maintaining a system frequency within reasonable bounds. This is especially important for linked renewable-based hybrid power systems (HPS), where disruptions are more likely to occur. This paper suggests a prominent modified "Fractional order-proportional-integral with double derivative (FOPIDD2) controller" as an innovative HPS controller in order to navigate these obstacles. The recommended control approach has been validated in power systems including wind, reheat thermal, solar, and hydro generating, as well as capacitive energy storage and electric vehicle. The improved controller's performance is evaluated by comparing it to regular FOPID, PID, and PIDD2 controllers. Furthermore, the gains of the newly structured FOPIDD2 controller are optimized using a newly intended algorithm terms as squid game optimizer (SGO). The controller's performance is compared to benchmarks such as the grey wolf optimizer (GWO) and jellyfish search optimization. By comparing performance characteristics such as maximum frequency undershoot/overshoot, and steadying time, the SGO-FOPIDD2 controller outperforms the other techniques. The suggested SGO optimized FOPIDD2 controller was analyzed and validated for its ability to withstand the influence of power system parameter uncertainties under various loading scenarios and situations. Without any complicated design, the results show that the new controller can work steadily and regulate frequency with an appropriate controller coefficient.

Emotional Exhaustion and Emotional Contagion: Navigating Turnover Intention of Healthcare Personnel.

Purpose: This study aimed to examine the role of personal emotions and emotional contagion within organizations on the behavior and attitudes of healthcare personnel. This study is expected to provide a theoretical foundation for reducing resignation behaviors and improving healthcare quality. Materials and Methods: This study adopted a quantitative research method with a cross-sectional survey through an online questionnaire. The bootstrap method with 5000 iterations was used to validate the role of variables within a 95% confidence interval. SPSS 26.0 and Model 5 in Process 3.4 for SPSS were used for the data analysis. Results: This research involved 459 healthcare personnel, whose levels of role overload (3.821±0.925), emotional exhaustion (3.436±1.189), and turnover emotional contagion (3.110±1.099) were notably high. Role overload was positively related to turnover intention, with emotional exhaustion as a mediator. Notably, turnover emotional contagion exerted a positive moderating effect. Conclusion: This study emphasizes the adverse effects of emotional exhaustion and turnover emotional contagion in the Chinese context, offering practical recommendations for medical organizational managers to navigate turnover intention among healthcare personnel. This study suggests paying attention to the emotional state of healthcare personnel and providing adequate support resources. Managers should routinely assess and track turnover emotional contagion within the organization, fostering a positive emotional atmosphere.

Thematic analysis of stakeholder perceptions for co-creative healthcare XR resource design and development; traversing a minefield of opportunities.

Introduction: The expansive curricular volume of healthcare education makes a necessity the incorporation of innovative methods and immersive media in it. The core challenge in such approaches is the timely development of relevant immersive content such as Virtual, Augmented or Mixed Reality (VR/AR/MR) resources for healthcare topics. There is currently significant interest in the use of co-creative methods for streamlining immersive content development. Methods: A core research pursuit in this translational research field is the formulation of evidence-based, optimized workflows that streamline immersive content creation allowing for rapid expansion of innovative educational approaches in healthcare curricula. The purpose of this paper is to aggregate the perceptions of healthcare technologists and educators who participated in a series of co-creation sessions in order to elicit their best practice insights for design and development of XR educational resources using co-creative methods. Results: According to our thematic analysis, findings of the qualitative study demonstrated that a rigorous organizational approach is required to maintain a constructive exchange of information and to keep the design process alive for both content and technical experts. In addition, rapid prototype and display of co-created features can empower their contributions and help them design more efficiently. Discussion: Co-creative content production can benefit from adaption of existing frameworks and lightweight authoring environments that can facilitate generalized XR content development use cases.

Comprehensive intuitionistic fuzzy network data envelopment analysis incorporating undesirable outputs and shared resources.

The economic growth rate is intricately linked to the efficiency and effectiveness of the banking industry. A widely applicable mathematical technique for such assessments is Data Envelopment Analysis (DEA), which evaluates the relative efficiency of Decision-Making Units (DMUs) by comparing their inputs and outputs. Traditional DEA treats DMUs as black boxes, neglecting internal processes that contribute to inefficiencies in individual DMUs. Additionally, it assumes precise values for inputs and outputs that do not apply to real-world problems. This study introduces a comprehensive network series of two-stage DEA, incorporating shared inputs and intermediate measures, undesirable outputs, external inputs and outputs, initial inputs, and terminal outputs. The network two-stage DEA is extended to intuitionistic fuzzy circumstances to address uncertainty. In this extension, a non-linear intuitionistic fuzzy number, namely a parabolic intuitionistic fuzzy number, represents higher-order imprecise datasets. An illustrative example validates the proposed methodology, and comparisons with existing methods are conducted. Moreover, the methodology is applied to assess the efficiency of Indian public sector banks, demonstrating its applicability and showcasing the efficacy of the procedures and algorithms used. Decision-makers can make better choices using optimal efficiency values to gain insights into inputs, intermediate measures, and outputs.•The research study focused on a network two-stage DEA model, incorporating undesirable outputs and shared resources in the presence of uncertainty.•The methodology involves solving the network two-stage DEA model using parabolic intuitionistic fuzzy numbers.•The experimental analysis involves assessing the efficiency of Indian public sector banks.

Optimal scheduling of electricity and hydrogen integrated energy system considering multiple uncertainties.

The spread of renewable energy (RE) generation not only promotes the economy and environmental protection, but also brings uncertainty to the power system. As the integration of hydrogen and electricity can effectively mitigate the fluctuation of RE generation, an electricity-hydrogen integrated energy system is constructed. Then, this paper studies the source-load uncertainties and corresponding correlation as well as the electricity-hydrogen price uncertainties and corresponding correlation. Finally, an optimal scheduling model considering economy, environmental protection, and demand response (DR) is proposed. The simulation results indicate that the introduction of the DR strategy and the correlation of electricity-hydrogen price can effectively improve the economy of the system. After introducing the DR, the operating cost of the system is reduced by 5.59%, 10.5%, and 21.06% in each season, respectively. When considering the correlation of EP and HP, the operating cost of the system is reduced by 4.71%, 6.47%, 1.4% in each season, respectively.

Suitability of treated wastewater for irrigation and its impact on groundwater resources in arid coastal regions: Insights for water resources sustainability.

Water scarcity threatens agriculture and food security in arid regions like Saudi Arabia. The nation produces significant quantities of municipal wastewater, which, with adequate treatment, could serve as an alternative water source for irrigation, thereby reducing reliance on fossil and non-renewable groundwater. This study assessed the appropriateness of using treated wastewater (TWW) for irrigation in a dry coastal agricultural region in Eastern Saudi Arabia and its impact on groundwater resources. Field investigations were conducted in Qatif to collect water samples and field measurements. A multi-criteria approach was applied to evaluate the TWW's suitability for irrigation, including complying with Saudi Standards, the Irrigation Water Quality Index (IWQI), the National Sanitation Foundation water quality index (NSFWQI), and the individual irrigation indices. In addition, the impact of TWW on groundwater was assessed through hydrogeological and isotope approaches. The results indicate that the use of TWW in the study area complied with the Saudi reuse guidelines except for nitrate, aluminum, and molybdenum. However, irrigation water quality indices classify TWW as having limitations that necessitate the use for salt-tolerant crops on permeable and well-drained soils. Stable isotopic analysis (δ2H, δ18O) revealed that long-term irrigation with TWW affected the shallow aquifer, while deep aquifers were minimally impacted due to the presence of aquitard layer. The application of TWW irrigation has successfully maintained groundwater sustainability in the study area, as evidenced by increased groundwater levels up to 2.3 m. Although TWW contributes to crop productivity, long term agricultural sustainability could be enhanced by improving effluent quality, regulating irrigation practices, implementing buffer zones, and monitoring shallow groundwater. An integrated approach that combines advanced wastewater treatment methods, community involvement, regulatory oversight, and targeted monitoring is recommended to be implemented.

In Vitro Exploration of Dark Cytotoxicity of Anthocyanin-Curcumin Combination, A Herbal Photosensitizer.

BACKGROUND: Photodynamic therapy can be used to treat a variety of lesions noninvasively, including oral cancer. High-power laser therapy has also been used to treat oral squamous cell carcinomas. The two main components of photodynamic treatment are the photosensitizer and the light source. Herbal formulations of photosensitizers are used to mask the disadvantages of other photosensitizers. METHODOLOGY: A methanol-diluted 25 grams of Punica granatum was used to create an anthocyanin extract using the flash evaporation method. Dimethyl sulfoxide (DMSO) was used as the first dilution agent for curcumin; later further dilution was done with distilled water. Following that, MCF-7 cells (a cancer cell line) were cultured with the produced samples, and the mono-tetrazolium salt (MTT) assay was used to determine the vitality of the cells. RESULTS: Cell reduction was significantly evident in all three groups, but the most significant cell death was found in the anthocyanin-curcumin group, at 29%. CONCLUSION: The combination of anthocyanin-curcumin has one of the photophysical properties (dark cytotoxicity) and hence can aid as a photosensitizer.

The Birth of the Contextual Health Education Readability Score in an Examination of Online Influenza Patient Education Materials.

Introduction Influenza is a major global health concern, with its rapid spread and mutation rate posing significant challenges in public health education and communication. Effective patient education materials (PEMs) are crucial for informed decision-making and improved health outcomes. This study evaluates the efficacy of online influenza PEMs using traditional readability tools and introduces the Contextual Health Education Readability Score (CHERS) to address the limitations of existing methods that do not capture the diverse array of visual and thematic means displayed. Materials and methods A comprehensive search was conducted to select relevant online influenza PEMs. This involved looking through Google's first two pages of results sorted by relevance, for a total of 20 results. These materials were evaluated using established readability tools (e.g., Flesch Reading Ease, Flesch-Kincaid Grade Level) and the Patient Education Materials Assessment Tool (PEMAT) for understandability and actionability. The study also involved the creation of CHERS, integrating factors such as semantic complexity, cultural relevance, and visual aid effectiveness. The development of CHERS included weighting each component based on its impact on readability and comprehension. Results The traditional readability tools demonstrated significant variability in the readability of the selected materials. The PEMAT analysis revealed general trends toward clarity in purpose and use of everyday language but indicated a need for improvement in summaries and visual aids. The CHERS formula was calculated as follows: CHERS = (0.4 × Average Sentence Length) + (0.3 × Average Syllables per Word) + (0.15 × Semantic Complexity Score) + (0.1 × Cultural Relevance Score) + (0.05 × Visual Aid Effectiveness Score), integrating multiple dimensions beyond traditional readability metrics. Discussion The study highlighted the limitations of traditional readability tools in assessing the complexity and cultural relevance of health information. The introduction of CHERS addressed these gaps by incorporating additional dimensions crucial for understanding in a healthcare context. The recommendations provided for creating effective influenza PEMs focused on language simplicity, cultural sensitivity, and actionability. This may enable further research into evaluating current PEMs and clarifying means of creating more effective content in the future. Conclusions The study underscores the need for comprehensive readability assessments in PEMs. The creation of CHERS marks a significant advancement in this field, providing a more holistic approach to evaluating health literacy materials. Its application could lead to the development of more inclusive and effective educational content, thereby improving public health outcomes and reducing the global burden of influenza. Future research should focus on further validating CHERS and exploring its applicability to other health conditions.

Regional Inequality and Associated Factors of Emergency Medicine Beds Distribution in China.

Objective: The regional inequality of emergency medicine beds distribution has a great impact on population health as well as the accessibility of emergency services. This study aimed to explore the regional inequality of emergency medicine bed distribution and its influencing factors. Methods: The Gini coefficient and health resource agglomeration were used to analyze the regional inequality of emergency medicine beds distribution by area from 2012 to 2021 in China. Grey correlation models were used to explore the factors influencing the regional inequality of emergency medicine beds distribution. Results: From 2012 to 2021, Gini coefficients of emergency medicine beds distribution by geographic in China showed a worsening trend, rising from 0.6229 to 0.6636. The average HRAD index was 3.43 in the east and 0.44 in the west. Population structure factors have the greatest influence on the regional inequality of emergency medicine beds distribution. Conclusion: Health resources allocation strategy only according to population size should be changed. In formulating policies for emergency medicine beds allocation should take into account population structure, financial structure of expenditure, the inequality of geographical distribution and so on.

Postural control and cognitive flexibility in skilled athletes: Insights from dual-task performance and event-related potentials.

Athletes of skill-oriented sports (hereinafter referred to as "skilled athletes"), such as gymnasts and rhythmic gymnasts, have demonstrated better postural control than nonathletes. However, previous studies have mainly focused on single postural tasks and have not considered how skilled athletes use and allocate attentional resources during postural control. This research used the event-related potential (ERP) to explore the postural control performance of skilled athletes under cognitive processes and their utilization and allocation of attentional resources. A dual-task paradigm was used to simulate the actual situation in sports. 26 skilled athletes and 26 nonathletes were required to perform postural control and task-switching simultaneously. The results showed that skilled athletes demonstrated more postural control stability and a higher accuracy of task-switching than nonathletes in all dual tasks. Compared with nonathletes, they showed a stable enhanced N1 (electrodes: Oz, O1, and O2) amplitude during three postures. Moreover, larger N2 component on Fz, FCz, and Cz and theta band power was found in the frontal cortex (on Fz, FCz) of skilled athletes under feet together and single leg standing posture. The study illustrated that skilled athletes show greater frontal activation during dual tasks, which allows for more rational and flexible brain attentional resource input and allocation in cognitive processes, this may be due to long-term professional training, which enables them to have a higher level of automation of postural control and cognitive flexibility. This study's results offer valuable insights into the interplay between postural control and multitasking in skilled athletes, and its outcomes carry significant implications for the training and assessment of athletes across various sports.

Development and Evaluation of a Clinician-Vetted Dementia Caregiver Resources Website: Mixed Methods Approach.

BACKGROUND: About 11 million Americans are caregivers for the 6.7 million Americans currently living with dementia. They provide over 18 billion hours of unpaid care per year, yet most have no formal dementia education or support. It is extremely difficult for clinicians to keep up with the demand for caregiver education, especially as dementia is neurodegenerative in nature, requiring different information at different stages of the disease process. In this digital age, caregivers often seek dementia information on the internet, but clinicians lack a single, reliable compendium of expert-approved digital resources to provide to dementia caregivers. OBJECTIVE: Our aim was to create a dementia caregiver resources website to serve as a hub for user-friendly, high-quality, and expert-reviewed dementia educational resources that clinicians can easily supply to family caregivers of people with dementia. METHODS: An interdisciplinary website development team (representing dementia experts from occupational therapy, nursing, social work, geriatrics, and neurology) went through 6 iterative steps of website development to ensure resource selection quality and eligibility rigor. Steps included (1) resource collection, (2) creation of eligibility criteria, (3) resource organization by topic, (4) additional content identification, (5) finalize resource selection, and (6) website testing and launch. Website visits were tracked, and a 20-item survey about website usability and utility was sent to Veterans Affairs tele-geriatrics interdisciplinary specialty care groups. RESULTS: Following website development, the dementia caregiver resource website was launched in February 2022. Over the first 9 months, the site averaged 1100 visits per month. The 3 subcategories with the highest number of visits were "general dementia information," "activities of daily living," and "self-care and support." Most (44/45, 98%) respondents agreed or strongly agreed that the website was easy to navigate, and all respondents agreed or strongly agreed that the resources were useful. CONCLUSIONS: The iterative process of creating the dementia caregiver resources website included continuous identification, categorization, and prioritization of resources, followed by clinician feedback on website usability, accessibility, and suggestions for improvement. The website received thousands of visits and positive clinician reviews in its first 9 months. Results demonstrate that an expert-vetted, nationally, and remotely available resource website allows for easy access to dementia education for clinicians to provide for their patients and caregivers. This process of website development can serve as a model for other clinical subspecialty groups seeking to create a comprehensive educational resource for populations who lack easy access to specialty care.

A Multidisciplinary Assessment of ChatGPT's Knowledge of Amyloidosis: Observational Study.

BACKGROUND: Amyloidosis, a rare multisystem condition, often requires complex, multidisciplinary care. Its low prevalence underscores the importance of efforts to ensure the availability of high-quality patient education materials for better outcomes. ChatGPT (OpenAI) is a large language model powered by artificial intelligence that offers a potential avenue for disseminating accurate, reliable, and accessible educational resources for both patients and providers. Its user-friendly interface, engaging conversational responses, and the capability for users to ask follow-up questions make it a promising future tool in delivering accurate and tailored information to patients. OBJECTIVE: We performed a multidisciplinary assessment of the accuracy, reproducibility, and readability of ChatGPT in answering questions related to amyloidosis. METHODS: In total, 98 amyloidosis questions related to cardiology, gastroenterology, and neurology were curated from medical societies, institutions, and amyloidosis Facebook support groups and inputted into ChatGPT-3.5 and ChatGPT-4. Cardiology- and gastroenterology-related responses were independently graded by a board-certified cardiologist and gastroenterologist, respectively, who specialize in amyloidosis. These 2 reviewers (RG and DCK) also graded general questions for which disagreements were resolved with discussion. Neurology-related responses were graded by a board-certified neurologist (AAH) who specializes in amyloidosis. Reviewers used the following grading scale: (1) comprehensive, (2) correct but inadequate, (3) some correct and some incorrect, and (4) completely incorrect. Questions were stratified by categories for further analysis. Reproducibility was assessed by inputting each question twice into each model. The readability of ChatGPT-4 responses was also evaluated using the Textstat library in Python (Python Software Foundation) and the Textstat readability package in R software (R Foundation for Statistical Computing). RESULTS: ChatGPT-4 (n=98) provided 93 (95%) responses with accurate information, and 82 (84%) were comprehensive. ChatGPT-3.5 (n=83) provided 74 (89%) responses with accurate information, and 66 (79%) were comprehensive. When examined by question category, ChatGTP-4 and ChatGPT-3.5 provided 53 (95%) and 48 (86%) comprehensive responses, respectively, to "general questions" (n=56). When examined by subject, ChatGPT-4 and ChatGPT-3.5 performed best in response to cardiology questions (n=12) with both models producing 10 (83%) comprehensive responses. For gastroenterology (n=15), ChatGPT-4 received comprehensive grades for 9 (60%) responses, and ChatGPT-3.5 provided 8 (53%) responses. Overall, 96 of 98 (98%) responses for ChatGPT-4 and 73 of 83 (88%) for ChatGPT-3.5 were reproducible. The readability of ChatGPT-4's responses ranged from 10th to beyond graduate US grade levels with an average of 15.5 (SD 1.9). CONCLUSIONS: Large language models are a promising tool for accurate and reliable health information for patients living with amyloidosis. However, ChatGPT's responses exceeded the American Medical Association's recommended fifth- to sixth-grade reading level. Future studies focusing on improving response accuracy and readability are warranted. Prior to widespread implementation, the technology's limitations and ethical implications must be further explored to ensure patient safety and equitable implementation.

Effect of mortality prediction models on resource use benchmarking of intensive care units.

PURPOSE: Intensive care requires extensive resources. The ICUs' resource use can be compared using standardized resource use ratios (SRURs). We assessed the effect of mortality prediction models on the SRURs. MATERIALS AND METHODS: We compared SRURs using different mortality prediction models: the recent Finnish Intensive Care Consortium (FICC) model and the SAPS-II model (n = 68,914 admissions). We allocated the resources to severity of illness strata using deciles of predicted mortality. In each risk and year stratum, we calculated the expected resource use per survivor from our modelling approaches using length of ICU stay and Therapeutic Intervention Scoring System (TISS) points. RESULTS: Resource use per survivor increased from one length of stay (LOS) day and around 50 TISS points in the first decile to 10 LOS-days and 450 TISS in the tenth decile for both risk scoring systems. The FICC model predicted mortality risk accurately whereas the SAPS-II grossly overestimated the risk of death. Despite this, SRURs were practically identical and consistent. CONCLUSIONS: SRURs provide a robust tool for benchmarking resource use within and between ICUs. SRURs can be used for benchmarking even if recently calibrated risk scores for the specific population are not available.

Implementing and evaluating resources to support good maternity care for parents with learning disabilities: A qualitative feasibility study in England.

PROBLEM: Parents with learning disabilities are often disadvantaged and their needs not well understood in maternity services. BACKGROUND: Despite a global vision to improve maternity care, current evidence confirms poor pre- and post-natal care for parents with learning disabilities and their families. Midwives have expressed a need for support in the delivery of good care to this population of parents. AIM: To test the feasibility of implementing and evaluating two evidence-based and values-based resources - the Together Toolkit and Maternity Passport - to support good maternity care for people with learning disabilities. METHODS: A qualitative feasibility study employing semi-structured interviews with 17 midwives and 6 parents who had used the resources in practice in four NHS Trusts in the south of England. FINDINGS: Midwives and parents described how the resources positively impacted maternity care by enabling midwives, connecting networks and empowering parents. Factors affecting effective implementation of the resources were reported at an individual and setting level. DISCUSSION: Staff training to raise awareness and confidence in supporting parents with learning disabilities, and improved systems for recording parent's individual needs are required to enable the delivery of personalised care. CONCLUSION: Reasonable adjustments need to be prioritised to facilitate implementation of resources to support personalised maternity care and to address inequity for parents with learning disabilities. Aspirations for equity suggested commitment from midwives to challenge and overcome barriers to implementation. Recommendations were made to improve the resources and their implementation. These resources are free and accessible for use [www.surrey.ac.uk/togetherproject].

Techno-economic assessment of bioleaching for metallurgical by-products.

This study focused on the economic feasibility of two potential industrial-scale bioleaching technologies for metal recovery from specific metallurgical by-products, mainly basic oxygen steelmaking dust (BOS-D) and goethite. The investigation compared two bioleaching scaling technology configurations, including an aerated bioreactor and an aerated and stirred bioreactor across different scenarios. Results indicated that bioleaching using Acidithiobacillus ferrooxidans proved financially viable for copper extraction from goethite, particularly when 5% and 10% pulp densities were used in the aerated bioreactor, and when 10% pulp density was used in the aerated and stirred bioreactor. Notably, a net present value (NPV) of $1,275,499k and an internal rate of return (IRR) of 65% for Cu recovery from goethite were achieved over 20-years after project started using the aerated and stirred bioreactor plant with a capital expenditure (CAPEX) of $119,816,550 and an operational expenditure (OPEX) of $5,896,580/year. It is expected that plant will start to make profit after one year of operation. Aerated and stirred bioreactor plant appeared more reliable alternative compared to the aerated bioreactor plant as the plant consists of 12 reactors which can allow better management and operation in small volume with multiple reactors. Despite the limitations, this techno-economic assessment emphasized the significance of selective metal recovery and plant design, and underscored the major expenses associated with the process.

[Synthesis and tissue distribution of bufadienolides in Bufo bufo gargarizans].

This study explored the biosynthesis of bufadienolides(BDs) in Bufo bufo gargarizans to solve the dilemma of the decreasing resources of B. bufo gargarizans and provide a theoretical basis for the sustainable utilization of the resources. Ultra-high performance liquid chromatography-Orbitrap-mass spectrometry(UHPLC-Orbitrap-MS) was employed to detect the synthesis sites of BDs in B. bufo gargarizans, and the results were verified by desorption electrospray ionization-mass spectrometry imaging(DESI-MSI) and homogenate incubation experiments. BDs in B. bufo gargarizans had the highest content in the liver and the highest concentration in the gallbladder, in addition to the parotid gland and skin, which suggested that the liver could synthesize BDs. The results of DESI-MSI also showed that BDs were mainly enriched in the liver rather than the immature parotid gland. The incubation experiment of liver homogenates demonstrated the liver of B. bufo gargarizans had the ability to synthesize BDs. This study showed that the liver was a major organ for the synthesis of BDs in B. bufo gargarizans during metamorphosis, development, and growth, which provided strong theoretical support for the biosynthesis of BDs and the sustainable utilization of B. bufo gargarizans resources.