Optimizing N,N,N-trimethyl chitosan synthesis: A design of experiments (DoE) approach.

This study aimed to optimize the synthesis of trimethyl chitosan (TMC) with a high degree of N,N,N-trimethylation (DTM) through a one-step procedure, minimizing reagent use, reaction time, and avoiding O-methylation, using the Design of Experiments (DoE) approach. Initially, sequential designs were done. Following the determination of the initial conditions a Fractional Factorial Design was used, investigating methyl iodide (MeI) and NaHCO3 molar ratios, temperature, and reaction time on DTM. MeI and NaHCO3 molar ratios were found to be significant (p-values equal to 0.02 and 0.02, respectively), the reaction temperature (p = 0.04) displayed a non-linear effect, while the reaction time was found to be non-significant (p = 0.93). Finally, a Full Factorial Design was done to optimize temperature and base addition methods. Incremental addition of the base was determined to be feasible without affecting the DTM, thereby preventing any viscosity-related problems. DTM was achieved up to 72 % in a one-step procedure, with no O-methylation. These optimized conditions offer a cost-effective, one-step synthesis method for TMC production, holding significant promise for industrial applications by avoiding multistep reactions, ensuring minimal reagent use, and preventing O-methylation. The findings mark a substantial advancement in TMC synthesis, presenting a streamlined and efficient approach with substantial practical implications for process development.

An Improved OMP Algorithm for Enhancing the Anti-Interference Performance of Array Antennas.

The demand for precise positioning in noisy environments has propelled the development of research on array antenna radar systems. Although the orthogonal matching pursuit (OMP) algorithm demonstrates superior performance in signal reconstruction, its application efficacy in noisy settings faces challenges. Consequently, this paper introduces an innovative OMP algorithm, DTM_OMP_ICA (a dual-threshold mask OMP algorithm based on independent component analysis), which optimizes the OMP signal reconstruction framework by utilizing two different observation bases in conjunction with independent component analysis (ICA). By implementing a mean mask strategy, it effectively denoises signals received by array antennas in noisy environments. Simulation results reveal that compared to traditional OMP algorithms, the DTM_OMP_ICA algorithm shows significant advantages in noise suppression capability and algorithm stability. Under optimal conditions, this algorithm achieves a noise suppression rate of up to 96.8%, with its stability also reaching as high as 99%. Furthermore, DTM_OMP_ICA surpasses traditional denoising algorithms in practical denoising applications, proving its effectiveness in reconstructing array antenna signals in noisy settings. This presents an efficient method for accurately reconstructing array antenna signals against a noisy backdrop.

Client and clinician perspectives about a virtual education and exercise chronic disease management programme for people with hip and knee osteoarthritis.

INTRODUCTION: Osteoarthritis (OA) is one of the most prevalent chronic conditions in Canada. Despite the established benefits of non-pharmacological management (education, exercise) for people with OA, many do not receive treatment, resulting in pain, decreased physical function, and poorer quality of life. Virtual programme options grew significantly during the recent pandemic and may provide longer-term opportunities for increased uptake by reaching individuals otherwise unable to participate. This study explored the experiences and perspectives of clients participating in and clinicians providing the Good Life with osteoArthritis: Denmark (GLA:DTM) Canada remote programme. METHODS: This qualitative descriptive study recruited 10 clients with hip and/or knee OA and 11 clinicians across Canada using purposive sampling. An online pre-interview survey was completed, and individual interviews were conducted, audio-recorded, transcribed verbatim and analysed independently by two researchers using inductive thematic analysis. Coding and analyses were initially conducted separately by group and then compared and combined. RESULTS: Four overarching themes (and 11 subthemes) were identified: (1) Expected and unexpected benefits of virtual programs; (2) Drawbacks to virtual programs; (3) Programme delivery in a virtual world; (4) Shifting and non-shifting perspectives. Although initially sceptical, after completion of the programme, clients were in favour of virtual delivery with many benefits described. Clinicians' perspectives varied about feedback aimed to correct client movement patterns. CONCLUSIONS: Clients and clinicians identified important experiential and procedural elements for virtual chronic disease management programs that include education and exercise. Additional work is needed to understand if the GLA:DTM remote outcomes are equivalent to the in-person programme.

Structured Literature Review to Identify Human Papillomavirus's Natural History Parameters for Dynamic Population Models of Vaccine Impacts.

Human papillomavirus (HPV) is a common sexually transmitted virus that can cause cervical cancer and other diseases. Dynamic transmission models (DTMs) have been developed to evaluate the health and economic impacts of HPV vaccination. These models typically include many parameters, such as natural history of the disease, transmission, demographic, behavioral, and screening. To ensure the accuracy of DTM projections, it is important to parameterize them with the best available evidence. This study aimed to identify and synthesize data needed to parametrize DTMs on the natural history of HPV infection and related diseases. Parameters describing data of interest were grouped by their anatomical location (genital warts, recurrent respiratory papillomatosis, and cervical, anal, vaginal, vulvar, head and neck, and penile cancers), and natural history (progression, regression, death, cure, recurrence, detection), and were identified through a systematic literature review (SLR) and complementary targeted literature reviews (TLRs). The extracted data were then synthesized by pooling parameter values across publications, and summarized using the range of values across studies reporting each parameter and the median value from the most relevant study. Data were extracted and synthesized from 223 studies identified in the SLR and TLRs. Parameters frequently reported pertained to cervical cancer outcomes, while data for other anatomical locations were less available. The synthesis of the data provides a large volume of parameter values to inform HPV DTMs, such as annual progression rates from cervical intraepithelial neoplasia (CIN) 1 to CIN 2+ (median of highest quality estimate 0.0836), CIN 2 to CIN 3+ (0.0418), carcinoma in situ (CIS) 2 to local cancer+ (0.0396), and regional to distant cancer (0.0474). Our findings suggest that while there is a large body of evidence on cervical cancer, parameter values featured substantial heterogeneity across studies, and further studies are needed to better parametrize the non-cervical components of HPV DTMs.

The mitochondria-targeted Kaempferol nanoparticle ameliorates severe acute pancreatitis.

Kaempferol (KA), an natural antioxidant of traditional Chinese medicine (TCM), is extensively used as the primary treatment for inflammatory digestive diseases with impaired redox homeostasis. Severe acute pancreatitis (SAP) was exacerbated by mitochondrial dysfunction and abundant ROS, which highlights the role of antioxidants in targeting mitochondrial function. However, low bioavailability and high dosage of KA leading to unavoidable side effects limits clinical transformation. The mechanisms of KA with poor bioavailability largely unexplored, hindering development of the efficient strategies to maximizing the medicinal effects of KA. Here, we engineered a novel thioketals (TK)-modified based on DSPE-PEG2000 liposomal codelivery system for improving bioavailability and avoiding side effects (denotes as DSPE-TK-PEG2000-KA, DTM@KA NPs). We demonstrated that the liposome exerts profound impacts on damaging intracellular redox homeostasis by reducing GSH depletion and activating Nrf2, which synergizes with KA to reinforce the inhibition of inadequate fission, excessive mitochondrial fusion and impaired mitophagy resulting in inflammation and apoptosis; and then, the restored mitochondrial homeostasis strengthens ATP supply for PAC renovation and homeostasis. Interestingly, TK bond was proved as the main functional structure to improve the above efficacy of KA compared with the absence of TK bond. Most importantly, DTM@KA NPs obviously suppresses PAC death with negligible side effects in vitro and vivo. Mechanismly, DTM@KA NPs facilitated STAT6-regulated mitochondrial precursor proteins transport via interacting with TOM20 to further promote Drp1-dependent fission and Pink1/Parkin-regulated mitophagy with enhanced lysosomal degradation for removing damaged mitochondria in PAC and then reduce inflammation and apoptosis. Generally, DTM@KA NPs synergistically improved mitochondrial homeostasis, redox homeostasis, energy metabolism and inflammation response via regulating TOM20-STAT6-Drp1 signaling and promoting mitophagy in SAP. Consequently, such a TCM's active ingredients-based nanomedicine strategy is be expected to be an innovative approach for SAP therapy.

Traqueotomía versus traqueostomía, la necesidad de una aclaración lexicográfica / Tracheotomy versus tracheostomy, the need for lexicographical clarification

Con frecuencia se usan en el ámbito sanitario los términos traqueotomía y traqueostomía, pudiendo generar dudas entre los propios profesionales sobre qué definición corresponde a cada término o cuál de ellos debe considerarse más correcto en casos concretos. Se ha realizado una búsqueda de los términos «traqueotomía» y «traqueostomía» en los diccionarios generalistas en idioma español del Diccionario de la Real Academia Española (DRAE) y del Diccionario Histórico de la Lengua Española de la Real Academia Española (DHLE), y de los términos en inglés «tracheotomy» y «tracheostomy» en los diccionarios generalistas en idioma inglés del Oxford Dictionary, del Cambridge Dictionary y del Collins English Dictionary. Asimismo, se ha hecho una búsqueda en los diccionarios de términos médicos en español del Diccionario de Términos Médicos de la Real Academia Nacional de Medicina (DTM) y en inglés del Farlex Dictionary. Los términos se buscaron también en el buscador generalista de Internet Google®. Se analizaron las definiciones desde el punto de vista lexicográfico y etimológico. Las definiciones que aparecen en los diccionarios generalistas, tanto en español como en inglés, son imprecisas, limitadas y adolecen de ambigüedad por mezclar indicaciones desactualizadas con criterios alejados de la etimología. Sin embargo, las definiciones en los diccionarios de términos médicos en ambos idiomas están más ajustadas a la etimología. La traqueotomía identifica estrictamente el procedimiento quirúrgico de realización de una apertura en la cara anterior de la tráquea. La traqueostomía identifica la realización de un orificio que comunica la tráquea con el exterior e implica una modificación del tracto aéreo superior al proporcionar una entrada adicional de la vía respiratoria. Solo en las laringectomías totales la traqueostomía es la única vía de entrada al tracto aéreo. Ambos términos pueden utilizarse sinónimamente cuando una traqueotomía culmina con una traqueostomía. No convendrá utilizar el término traqueostomía cuando se produce el cierre de los planos al final del procedimiento y este no resulta en la creación de un estoma. Los traqueostomas pueden ser cualificados con adjetivos de tiempo de permanencia (temporal/permanente), tamaño (grande/pequeño), forma (redondo/elíptico), o profundidad por sí mismos, sin vincularse a ningún tipo de enfermedad o de indicación quirúrgica. No todos los traqueostomas permanentes tienen lugar en laringectomías totales ni tienen sistemáticamente un carácter irreversible.(AU)

In the healthcare field, the terms “traqueotomía” and “traqueostomía” are frequently used, often leading to confusion among professionals regarding the appropriate definition for each term or which one should be considered more correct in specific cases. A search was conducted for the terms “traqueotomía” and “traqueostomía” in general Spanish-language dictionaries such as the Dictionary of the Royal Spanish Academy (DRAE) and the Historical Dictionary of the Spanish Language of the Royal Spanish Academy (DHLE), as well as for the English terms “tracheotomy” and “tracheostomy” in English general dictionaries like the Oxford Dictionary, the Cambridge Dictionary, and the Collins English Dictionary. Additionally, searches were performed in medical dictionaries in both Spanish, specifically the Dictionary of Medical Terms of the National Academy of Medicine (DTM), and English, including the Farlex Dictionary. The terms were also explored using the Google search engine. Definitions were analyzed from both lexicographical and etymological perspectives. Definitions found in general dictionaries, in both Spanish and English, were found to be imprecise, limited, and ambiguous, as they mixed outdated indications with criteria that deviated from etymology. In contrast, definitions in medical dictionaries in both languages were more aligned with etymology. “Traqueotomía” strictly identifies the surgical procedure of creating an opening in the anterior face of the trachea. “Traqueostomía” identifies the creation of an opening that connects the trachea to the exterior, involving a modification of the upper airway by providing an additional entry for the respiratory pathway. “Traqueostomía” becomes the sole means of entry to the airway in total laryngectomies. Both terms can be used synonymously when a traqueotomía culminates in a traqueostomía. However, it is not appropriate to use the term “traqueostomía” when the procedure concludes with the closure of the planes and does not result in the creation of a stoma. Traqueostomas can be qualified with adjectives indicating permanence (temporary/permanent), size (large/small), shape (round/elliptical), or depth, without being linked to any specific disease or surgical indication. Not all permanent traqueostomas are the result of total laryngectomies, and they do not necessarily have an irreversible character systematically.(AU)

Three years of weekly DEMs, aerial orthomosaics and surveyed shoreline positions at Waikiki Beach, Hawai'i.

In this dataset, we present 128 coastal surveys conducted between 2018 and 2021 at Kahaloa Beach, also known as the Royal Hawaiian Beach, in Waikiki, Hawai'i. Surveys were conducted on a near-weekly basis, providing a 0.5 m digital elevation model, an orthorectified image mosaic with 0.03 m resolution, and shoreline vectors at MHHW and MSL, along with a surveyed shoreline position for each survey. We captured overlapping images using a small Unoccupied Aerial System (sUAS), processing the imagery with photogrammetric software to produce orthomosaics and Digital Terrain Models (DTM). Simultaneously, the shoreline position and reference points for sUAS-derived products were surveyed using total station and rod-mounted surveying prism. A quality assessment of 424 randomly sampled points across two surveys showed normally distributed errors of DTM elevations (µ1 = 0.0060 m; σ1 = 0.0998 m; µ2 = 0.0035 m; σ2 = 0.0680). Elevation uncertainties were quantified as 95% confidence intervals (±0.0130 m and ±0.0095 m). These data are intended to encourage research on reef-fringed beaches and provide a dataset for evaluating the accuracy of satellite-derived shorelines at reef-fringed beaches.

Diffusion tensor imaging metrics as natural markers of multiple sclerosis-induced brain disorders with a low Expanded Disability Status Scale score.

Non-invasive and effective differentiation along with determining the degree of deviations compared to the healthy cohort is important in the case of various brain disorders, including multiple sclerosis (MS). Evaluation of the effectiveness of diffusion tensor metrics (DTM) in 3T DTI for recording MS-related deviations was performed using a time-acceptable MRI protocol with unique comprehensive detection of systematic errors related to spatial heterogeneity of magnetic field gradients. In a clinical study, DTMs were acquired in segmented regions of interest (ROIs) for 50 randomly selected healthy controls (HC) and 50 multiple sclerosis patients. Identical phantom imaging was performed for each clinical measurement to estimate and remove the influence of systematic errors using the b-matrix spatial distribution in the DTI (BSD-DTI) technique. In the absence of statistically significant differences due to age in healthy volunteers and patients with multiple sclerosis, the existence of significant differences between groups was proven using DTM. Moreover, a statistically significant impact of spatial systematic errors occurs for all ROIs and DTMs in the phantom and for approximately 90 % in the HC and MS groups. In the case of a single patient measurement, this appears for all the examined ROIs and DTMs. The obtained DTMs effectively discriminate healthy volunteers from multiple sclerosis patients with a low mean score on the Expanded Disability Status Scale. The magnitude of the group differences is typically significant, with an effect size of approximately 0.5, and similar in both the standard approach and after elimination of systematic errors. Differences were also observed between metrics obtained using these two approaches. Despite a small alterations in mean DTMs values for groups and ROIs (1-3 %), these differences were characterized by a huge effect (effect size ∼0.8 or more). These findings indicate the importance of determining the spatial distribution of systematic errors specific to each MR scanner and DTI acquisition protocol in order to assess their impact on DTM in the ROIs examined. This is crucial to establish accurate DTM values for both individual patients and mean values for a healthy population as a reference. This approach allows for an initial reliable diagnosis based on DTI metrics.

DeltaDTM: A global coastal digital terrain model.

Coastal elevation data are essential for a wide variety of applications, such as coastal management, flood modelling, and adaptation planning. Low-lying coastal areas (found below 10 m +Mean Sea Level (MSL)) are at risk of future extreme water levels, subsidence and changing extreme weather patterns. However, current freely available elevation datasets are not sufficiently accurate to model these risks. We present DeltaDTM, a global coastal Digital Terrain Model (DTM) available in the public domain, with a horizontal spatial resolution of 1 arcsecond (∼30 m) and a vertical mean absolute error (MAE) of 0.45 m overall. DeltaDTM corrects CopernicusDEM with spaceborne lidar from the ICESat-2 and GEDI missions. Specifically, we correct the elevation bias in CopernicusDEM, apply filters to remove non-terrain cells, and fill the gaps using interpolation. Notably, our classification approach produces more accurate results than regression methods recently used by others to correct DEMs, that achieve an overall MAE of 0.72 m at best. We conclude that DeltaDTM will be a valuable resource for coastal flood impact modelling and other applications.

Ensuring fidelity: key elements to consider in disseminating a diabetes telemanagement program for underserved Hispanic/Latinos living with type 2 diabetes.

Background: The Hispanic/Latino population has greater risk (estimated >50%) of developing type 2 diabetes (T2D) and developing it at a younger age. The American Diabetes Association estimates costs of diagnosed diabetes in 2017 was $327 billion; with medical costs 2.3x higher than patients without diabetes. The purpose of this manuscript is to describe the methodology utilized in a randomized controlled trial aimed at evaluating the efficacy of a diabetes telemanagement (DTM) program for Hispanic/Latino patients with T2D. The intent is to provide information for future investigators to ensure that this study can be accurately replicated. Methods: This study was a randomized controlled trial with 240 participants. Eligible patients (Hispanic/Latino, aged 18+, living with T2D) were randomized to Comprehensive Outpatient Management (COM) or DTM. DTM was comprised of usual care, including routine clinic visits every three months, as well as: Biometrics (a tablet, blood glucose meter, blood pressure monitor, and scale); Weekly Video Visits (facilitated in the patient's preferred language); and Educational Videos (including culturally congruent diabetes self-management education and quizzes). COM consisted of usual care including routine clinic visits every three months. For this study, COM patients received a glucometer, glucose test strips, and lancets. Establishing a therapeutic nurse-patient relationship was a fundamental component of our study for both groups. First contact (post-enrollment) centered on ensuring that patients and caregivers understood the program, building trust and rapport, creating a non-judgmental environment, determining language preference, and establishing scheduling availability (including evenings and weekends). DTM were provided with a tablet which allowed for self-paced education through videos and weekly video visits. The research team and Community Advisory Board identified appropriate educational video content, which was incorporated in diabetes educational topics. Video visits allowed us to assess patient involvement, motivation, and nonverbal communication. Communicating in Spanish, and awareness of diverse Hispanic/Latino backgrounds was critical, as using relevant and commonly-used terms can increase adherence and improve outcomes. Shared decision-making was encouraged to make realistic health care choices. Conclusion: Key elements discussed above provide a framework for future dissemination of an evidence-based DTM intervention to meet the needs of underserved Hispanic/Latino people living with T2D.

Selection of M5 mutant lines of wheat (Triticum aestivum L.) for agronomic traits and biomass allocation under drought stress and non-stressed conditions.

Introduction: In the face of climate changes and limited water availability for irrigated crop production, enhanced drought tolerance and adaptation is vital to improve wheat productivity. The objective of this study was to determine the responses of newly bred and advanced mutant lines of wheat based on agronomic traits and biomass allocation under drought-stressed and non-stressed environments for production and breeding. Methods: Fifty-three mutant lines, including the parental check and six check varieties, were evaluated under non-stressed (NS) and drought stressed (DS) conditions in the field and controlled environments using a 20 x 3 alpha lattice design with two replicates. The following agronomic data were collected: days to 50% heading (DTH), days to maturity (DTM), plant height (PH), number of productive tillers (PTN), shoot biomass (SB), root biomass (RB), total biomass (TB), root: shoot ratio (RSR), spike length (SL), thousand seeds weight (TSW) and grain yield (GY). Data were analyzed and summarized using various statistical procedures and drought tolerance indices were computed based on grain yield under NS and DS conditions. Results: Significant (P < 0.05) differences were recorded among the mutant lines for most assessed traits under NS and DS conditions. Grain yield positively and significantly (p < 0.001) correlated with PTN (r = 0.85), RB (r = 0.75), SB (r = 0.80), SL (r =0.73), TB (r = 0.65), and TSW (r = 0.67) under DS condition. Principal component analysis revealed three components contributing to 78.55% and 77.21% of the total variability for the assessed agronomic traits under DS and NS conditions, respectively. The following traits: GY, RB, SB, and PTN explained most of the variation with high loading scores under DS condition. Geometric mean productivity (GMP), mean productivity (MP), harmonic mean (HM), and stress tolerance index (STI) were identified as the best drought tolerance indices for the identification of tolerant lines with positive correlations with GY under NS and DS conditions. Discussion: Among the advanced lines tested, LMA16, LMA37, LMA47, LMA2, and LMA42 were selected as the superior lines with high performance and drought tolerance. The selected lines are recommended for multi-environment trails and release for production in water-limited environments in South Africa.

Topic evolution before fall incidents in new fallers through natural language processing of general practitioners' clinical notes.

BACKGROUND: Falls involve dynamic risk factors that change over time, but most studies on fall-risk factors are cross-sectional and do not capture this temporal aspect. The longitudinal clinical notes within electronic health records (EHR) provide an opportunity to analyse fall risk factor trajectories through Natural Language Processing techniques, specifically dynamic topic modelling (DTM). This study aims to uncover fall-related topics for new fallers and track their evolving trends leading up to falls. METHODS: This case-cohort study utilised primary care EHR data covering information on older adults between 2016 and 2019. Cases were individuals who fell in 2019 but had no falls in the preceding three years (2016-18). The control group was randomly sampled individuals, with similar size to the cases group, who did not endure falls during the whole study follow-up period. We applied DTM on the clinical notes collected between 2016 and 2018. We compared the trend lines of the case and control groups using the slopes, which indicate direction and steepness of the change over time. RESULTS: A total of 2,384 fallers (cases) and an equal number of controls were included. We identified 25 topics that showed significant differences in trends between the case and control groups. Topics such as medications, renal care, family caregivers, hospital admission/discharge and referral/streamlining diagnostic pathways exhibited a consistent increase in steepness over time within the cases group before the occurrence of falls. CONCLUSIONS: Early recognition of health conditions demanding care is crucial for applying proactive and comprehensive multifactorial assessments that address underlying causes, ultimately reducing falls and fall-related injuries.

Comparison of a static cohort model and dynamic transmission model for respiratory syncytial virus intervention programs for infants in England and Wales.

BACKGROUND: A recent study comparing results of multiple cost-effectiveness analyses (CEAs) in a hypothetical population found that monoclonal antibody (mAb) immunoprophylaxis for respiratory syncytial virus (RSV) in infants averted fewer medically attended cases when estimated using dynamic transmission models (DTMs) versus static cohort models (SCMs). We aimed to investigate whether model calibration or parameterization could be the primary driver of inconsistencies between SCM and DTM predictions. METHODS: A recently published DTM evaluating the CEA of infant mAb immunoprophylaxis in England and Wales (EW) was selected as the reference model. We adapted our previously published SCM for US infants to EW by utilizing the same data sources used by the DTM. Both models parameterized mAb efficacy from a randomized clinical trial (RCT) that estimated an average efficacy of 74.5% against all medically attended RSV episodes and 62.1% against RSV hospitalizations. To align model assumptions, we modified the SCM to incorporate waning efficacy. Since the estimated indirect effects from the DTM were small (i.e., approximately 100-fold smaller in magnitude than direct effects), we hypothesized that alignment of model parameters should result in alignment of model predictions. Outputs for model comparison comprised averted hospitalizations and averted GP visits, estimated for seasonal (S) and seasonal-with-catchup (SC) immunization strategies. RESULTS: When we aligned the SCM intervention parameters to DTM intervention parameters, significantly more averted hospitalizations were predicted by the SCM (S: 32.3%; SC: 51.3%) than the DTM (S: 17.8%; SC: 28.6%). The SCM most closely replicated the DTM results when the initial efficacy of the mAb intervention was 62.1%, leading to an average efficacy of 39.3%. Under this parameterization the SCM predicted 17.4% (S) and 27.7% (SC) averted hospitalizations. Results were similar for averted GP visits. CONCLUSIONS: Parameterization of the RSV mAb intervention efficacy is a plausible primary driver of differences between SCM versus DTM model predictions.

'I do hope more people can benefit from it.': The qualitative experience of individuals living with osteoarthritis who participated in the GLA:D™ program in Alberta, Canada.

INTRODUCTION: The Good Life with osteoArthritis: Denmark (GLA:DTM) is an evidence-based program designed for individuals with symptomatic hip and knee osteoarthritis (OA). This program has reported improvement in pain, quality of life and self-efficacy, as well as delays in joint replacement surgery for adults with moderate to severe hip or knee OA. Evaluations of GLA:DTM implementation in several countries have focused on effectiveness, training, and feasibility of the program primarily from the provider perspective. Our objective was to examine how the GLA:DTM program was perceived and experienced by individuals with hip and knee OA to inform on-going program refinement and implementation. METHODS: Thirty semi-structured telephone interviews were conducted with participants who completed the GLA:DTM program in Alberta. An interpretive description approach was used to frame the study and thematic analysis was used to code the data and identify emergent themes and sub-themes associated with participants' experience and perception of the GLA:DTM program. RESULTS: Most participants had a positive experience of the GLA:DTM program and particularly enjoyed the group format, although some participants felt the group format prevented one-on-one support from providers. Three emergent themes related to acceptability were identified: accessible, adaptable, and supportive. Participants found the program to be accessible in terms of location, cost, and scheduling. They also felt the program was adaptable and allowed for individual attention and translatability into other settings. Finally, most participants found the group format to be motivating and fostered connections between participants. CONCLUSION: The GLA:DTM program was perceived as acceptable by most participants, yet the group format may not be useful for all individuals living with OA. Recommended improvements included adapting screening to identify those suited for the group format, providing program access earlier in the disease progression trajectory, modifying educational content based on participants' knowledge of OA and finally, providing refresher sessions after program completion.

Machine learning based multi-method interpretation to enhance dissolved gas analysis for power transformer fault diagnosis.

Accurate interpretation of dissolved gas analysis (DGA) measurements for power transformers is essential to ensure overall power system reliability. Various DGA interpretation techniques have been proposed in the literature, including the Doernenburg Ratio Method (DRM), Roger Ratio Method (RRM), IEC Ratio Method (IRM), Duval Triangle Method (DTM), and Duval Pentagon Method (DPM). While these techniques are well documented and widely used by industry, they may lead to different conclusions for the same oil sample. Additionally, the ratio-based methods may result in an out-of-code condition if any of the used gases fall outside the specified limits. Incorrect interpretation of DGA measurements can lead to mismanagement and may lead to catastrophic consequences for operating power transformers. This paper presents a new interpretation technique for DGA aimed at improving its accuracy and consistency. The proposed multi-method approach employs s scoring index and random forest machine learning principles to integrate existing interpretation methods into one comprehensive technique. The robustness of the proposed method is assessed using DGA data collected from several transformers under various health conditions. Results indicate that the proposed multi-method, based on the scoring index and random forest; offers greater accuracy and consistency than individual conventional interpretation methods alone. Furthermore, the multi-method based on random forest demonstrated higher accuracy than employing the scoring index only.

Asia-Inclusive Global Development of Enpatoran: Results of an Ethno-Bridging Study, Intrinsic/Extrinsic Factor Assessments and Disease Trajectory Modeling to Inform Design of a Phase II Multiregional Clinical Trial.

Enpatoran is a novel, highly selective, and potent dual toll-like receptor (TLR)7 and TLR8 inhibitor currently under development for the treatment of autoimmune disorders including systemic lupus erythematosus (SLE), cutaneous lupus erythematosus (CLE), and myositis. The ongoing phase II study (WILLOW; NCT05162586) is evaluating enpatoran for 24 weeks in patients with active SLE or CLE and is currently recruiting. To support development of WILLOW as an Asia-inclusive multiregional clinical trial (MRCT) according to International Conference on Harmonisation E5 and E17 principles, we have evaluated ethnic sensitivity to enpatoran based on clinical pharmacokinetic (PK), pharmacodynamic (PD), and safety data from an ethno-bridging study (NCT04880213), supplemented by relevant quantitative PK, PD, and disease trajectory modeling (DTM) results, and drug metabolism/disease knowledge. A single-center, open-label, sequential dose group study in White and Japanese subjects matched by body weight, height, and sex demonstrated comparable PK and PD properties for enpatoran in Asian vs. non-Asian (White and other) subjects across single 100, 200, and 300 mg orally administered doses. DTM suggested no significant differences in SLE disease trajectory for Asian vs. non-Asian individuals. Aldehyde oxidase (AOX) is considered to be a key contributor to enpatoran metabolism, and a literature review indicated no relevant ethnic differences in AOX function based on in vitro and clinical PK data from marketed drugs metabolized by AOX, supporting the conclusion of low ethnic sensitivity for enpatoran. Taken together, the inclusion of Asian patients in MRCTs including WILLOW was informed based on a Totality of Evidence approach.

Theoretical Insights on the Charge State and Bifunctional OER/ORR Electrocatalyst Activity in 4d-Transition-Metal-Doped g-C3N4 Monolayers.

Exploring efficient and stable electrocatalysts for the bifunctional oxygen evolution reaction (OER) and oxygen reduction reaction (ORR) is vital to developing renewable energy technologies. However, due to the substantial and intricate design space associated with these bifunctional OER/ORR electrocatalysts, their development presents a formidable challenge, resulting in their cost-prohibitive nature in both experimental and computational studies. Herein, using the defect physics method, we systematically investigate the formation energies and bifunctional overpotential (ηBi) of 4d-transition-metal (4d-TM, 4d-TM = Zr, Nb, Mo, Ru, Rh, Pd, and Ag)-doped monolayer supercell g-C3N4 (4d-TM@C54N72) based on the density functional theory (DFT) calculations. Under N-rich and C-rich conditions, we find that the formation energies of RhN@C54N71 (Rh occupation N) and PdN@C54N71 (Pd occupation N) are smaller than that of other 4d-TMN@C54N71 (4d-TM occupation N site); for the 4d-TMint@C54N72 (4d-TM interstitial site occupation), the lowest-formation energy defects are Pdint@C54N72. These results indicate that they have better stabilities. Interestingly, for these formation energy lower systems, Pd0int@C54N72 (ηBi = 1.00 V) and Rh1+N@C54N71 (ηBi = 0.73 V) have ultralow overpotential and can be great candidates for bifunctional OER/ORR electrocatalysts. We find the reason is that adjusting the charge states of 4d-TM@C54N72 can tune the interaction strength between the oxygenated intermediates and the 4d-TM@C54N72, which plays a crucial role in the activity of reactions. Additionally, the data obtained through machine learning (ML) application suggest that the electronegativity (Nm) and bond length of 4d-TM and coordination atoms (dTM-OOH) are primary descriptors characterizing the OER and ORR activities, respectively. The charged defect tuning of the bifunctional OER/ORR activity for 4d-TM@C54N72 would enable electrocatalytic performance optimization and the development of potential electrocatalysts for renewable energy applications.

Tracheotomy versus tracheostomy, the need for lexicographical clarification.

In the healthcare field, the terms "traqueotomía" and "traqueostomía" are frequently used, often leading to confusion among professionals regarding the appropriate definition for each term or which one should be considered more correct in specific cases. A search was conducted for the terms "traqueotomía" and "traqueostomía" in general Spanish-language dictionaries such as the Dictionary of the Royal Spanish Academy (DRAE) and the Historical Dictionary of the Spanish Language of the Royal Spanish Academy (DHLE), as well as for the English terms "tracheotomy" and "tracheostomy" in English general dictionaries like the Oxford Dictionary, the Cambridge Dictionary, and the Collins English Dictionary. Additionally, searches were performed in medical dictionaries in both Spanish, specifically the Dictionary of Medical Terms of the National Academy of Medicine (DTM), and English, including the Farlex Dictionary. The terms were also explored using the Google search engine. Definitions were analyzed from both lexicographical and etymological perspectives. Definitions found in general dictionaries, in both Spanish and English, were found to be imprecise, limited, and ambiguous, as they mixed outdated indications with criteria that deviated from etymology. In contrast, definitions in medical dictionaries in both languages were more aligned with etymology. "Traqueotomía" strictly identifies the surgical procedure of creating an opening in the anterior face of the trachea. "Traqueostomía" identifies the creation of an opening that connects the trachea to the exterior, involving a modification of the upper airway by providing an additional entry for the respiratory pathway. "Traqueostomía" becomes the sole means of entry to the airway in total laryngectomies. Both terms can be used synonymously when a traqueotomía culminates in a traqueostomía. However, it is not appropriate to use the term "traqueostomía" when the procedure concludes with the closure of the planes and does not result in the creation of a stoma. Traqueostomas can be qualified with adjectives indicating permanence (temporary/permanent), size (large/small), shape (round/elliptical), or depth, without being linked to any specific disease or surgical indication. Not all permanent traqueostomas are the result of total laryngectomies, and they do not necessarily have an irreversible character systematically.

A modified Blumgart method using a homemade crochet needle facilitates pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy: a retrospective cohort study.

BACKGROUND: Among the safest procedures for anastomosis in pancreaticoduodenectomy, Blumgart pancreaticojejunostomy is associated with low rates of postoperative pancreatic fistula (POPF) and postoperative complications. However, this technique is difficult to perform during laparoscopic pancreaticoduodenectomy (LPD). This study presents a modified Blumgart method using a homemade crochet needle to facilitate laparoscopic pancreaticojejunostomy and evaluates its safety and reliability. METHODS: From February 2019 to October 2022, 96 LPD surgeries with the new technique were performed by the same surgeons in the Second Affiliated Hospital of Zhejiang University School of Medicine. The operative details (operative time, pancreaticojejunostomy time, POPF rate, postoperative complication rate, mortality rate) were analyzed along with clinical and pathological indicators (pancreatic duct diameter, pancreatic texture, and histopathological findings). RESULTS: There were 54 men and 42 women with a mean age of 63.38 ± 10.41 years. The intraoperative bleeding volume, operative time and postoperative length of hospital stay were 198.43 ± 132.97 mL, 445.30 ± 87.05 min and 13.68 ± 4.02 days, respectively. The operation time of pancreaticojejunostomy was 66.28 ± 10.17 min. Clinically relevant POPFs (grades B and C) occurred in 14.6% of patients. Only one patient had postoperative abdominal hemorrhage and was cured after reoperation. There were no operative or in-hospital deaths. With our proposed modification, the pancreatic duct and jejunal orifice are aligned correctly during duct-to-mucosa (DTM) after the application of external traction through the homemade crochet needle. The space between the posterior wall of pancreatic remnant and jejunal loop can be exposed by adjusting the tension of the external threads, which can facilitate DTM. CONCLUSIONS: A modified Blumgart method using a homemade crochet needle could be technically feasible and safe during LPD. A randomized control trial is needed to confirm these findings.

Modelling optimal water retention in hydrogenic habitats using LIDAR laser data.

Degradation of hydrogenic habitats in climate change increased rapidly. It is important that we take actions to stop this process. Solution is to increase efficiency of water usage by ecosystems - especially water based ones. Building devices for delaying surface water runoff - like locks and dams - should improve hydrogenic habitats conditions and allow surrounding ecosystems use rainwater more efficient. Modelling of small retention in forests is an important aspect in decision making schema. Aim of this paper is to point optimal solutions for height and placement of devices which delay surface water runoff to set necessary water table level for renaturalization and maintenance of degrading natural habitats. Data used for analyses were acquired in the Polanów Forest Inspectorate in West Pomeranian voivodeship because of the topography diversification and the drainage infrastructure presence. There were three research plots selected based on decreased stability of habitats and historic data stated that there were natural water reservoirs, which were drained in past. Based on 2012 LiDAR (Light Detection and Ranging) point cloud the digital terrain model (DTM) was built. Water outflow points - melioration canals - were identified and analysed for optimal device localization. In following part of research specific data for each hydrogenic habitat were used to model height of devices which delay surface water runoff. Optimal level of device and area covered by water were set for each site separately. The results were handed over to the investor for implementation, then the compliance of the assumptions of the simulation of raising the water table with the as-built field measurements was checked. Study shows that it is possible to use laser technology to optimize location and height of devices which delay surface water runoff what allows to restore degraded hydrogenic habitats. Presented method supports small local retention what increases limited water resources in this region, decreases rapid runoff of surface water which causes frequent floods. Proposed method of modelling the location and height of the dams or locks is universal. Even though results are unique for each object the method is possible to be applied to every other situation.