3rd Round Research Articles

Assessing the effect of K2CO3 and aqueous phase recycling on hydrothermal liquefaction of corn stover

The effects of reaction temperature (300–340 °C) and reaction time (30–90 min), catalyst loading (0–10% K2CO3), and aqueous phase recycling (up to 3 recycling rounds) on the hydrothermal liquefaction (HTL) of corn stover were investigated. The oil yield ranged from 0.28 to 14.54%daf. A high reaction temperature and a long reaction time have a synergistic effect on the oil production under non-catalytic HTL. The effect of K2CO3 loading on oil yield is dependent on the reaction temperature. The FTIR analysis of the solid residue showed that the peak characteristics of lignin and cellulose are still intact without or with different K2CO3 loading suggesting low lignin and cellulose degradation. The effect of the aqueous phase with the presence of K2CO3 showed an increased oil yield, energy recovery, and abundance in silanes and siloxanes after the 3rd round of recycling.

Consensus evidence-based clinical practice guidelines for the diagnosis and treat-to-target management of osteoporosis in Africa: an initiative by the African Society of Bone Health and Metabolic Bone Diseases

SummaryThe objective of this consensus statement is to inform the clinical practice communities, research centres and policymakers across Africa of the results of the recommendations for osteoporosis prevention, diagnosis and management. The developed guideline provides state-of-the-art information and presents the conclusions and recommendations of the consensus panel regarding these issues.PurposeTo reach an African expert consensus on a treat-to-target strategy, based on current evidence for best practice, for the management of osteoporosis and prevention of fractures.MethodA 3-round Delphi process was conducted with 17 osteoporosis experts from different African countries. All rounds were conducted online. In round 1, experts reviewed a list of 21 key clinical questions. In rounds 2 and 3, they rated the statements stratified under each domain for its fit (on a scale of 1–9). After each round, statements were retired, modified or added in view of the experts’ suggestions and the percent agreement was calculated. Statements receiving rates of 7–9 by more than 75% of experts’ votes were considered as achieving consensus.ResultsThe developed guidelines adopted a fracture risk-centric approach. Results of round 1 revealed that of the 21 proposed domains, 10 were accepted whereas 11 were amended. In round 2, 32 statements were presented: 2 statements were retired for similarity, 9 statements reached consensus, whereas modifications were suggested for 21 statements. After the 3rd round of rating, the experts came to consensus on the 32 statements. Frequency of high-rate recommendation ranged from 83.33 to 100%. The response rate of the experts was 100%. An algorithm for the osteoporosis management osteoporosis was suggested.ConclusionThis study is an important step in setting up a standardised osteoporosis service across the continent. Building a single model that can be applied in standard practice across Africa will enable the clinicians to face the key challenges of managing osteoporosis; furthermore, it highlights the unmet needs for the policymakers responsible for providing bone health care together with and positive outcomes of patients’ care.

Are the Poor Catching Up with the Rich in Utilising Maternal Health Care Services? Evidence from India

India launched the National Rural Health Mission (NRHM) in 2005 to improve maternal and child health by providing good quality health services to all, especially deprived sections of society, to reduce inequality in access to health services. With the backdrop of NRHM, we analysed the extent to which the utilisation of maternal health care services (MHCSs) in the three stages of the continuum of care—antenatal care (ANC), care during child delivery and postnatal care (PNC)—–has improved among the poor vis-à-vis the rich in India, and the corresponding narrowing down in inequality in the period 2006–2016. Data from the 3rd round of the National Family Health Survey (NFHS) in 2005–2006, capturing the pre-NRHM period and the 4th round of NFHS 2015–2016, capturing the post-NRHM era ten years after the implementation of the flagship programme, are used for the analysis. We estimated absolute as well as relative measures of inequality, absolute gap and coverage ratio between the poor and rich, slope index of inequality and concentration index. Our findings show that maternal health care coverage increased significantly among the poor for all components of MHCSs. Even so, the extent of utilisation of services remains significantly lower among the poor in 2015–2016 compared to the coverage among the rich in 2005–2006. Although inequality declined at the national level over the decade, it still persists. High equity has been achieved in using skilled birth attendance during child delivery and institutional delivery during 2015–2016, however, inequality continues to be higher for ANC indicators including consumption of iron and folic acid supplements for at least 100 days, receipt of four or more antenatal check-ups and comprehensive health check-ups at least once during antenatal visits and receipt of first check-up in the first trimester.

A theoretical investigation on the distinguishers of Salsa and ChaCha

Salsa and ChaCha are two of the most well-known stream ciphers in last two decades. These two ciphers came into the picture when a massively used cipher RC4 was going through severe cryptanalysis and a significant number of observed weaknesses of it showed the requirement of new stream ciphers in the market. Later, ChaCha was adopted by Google as their encryption algorithm, which further increased the importance of research work on these two ciphers. Salsa and ChaCha have gone through differential key recovery attack up to the 8-th and 7-th round respectively. Initially, this attack used an experimentally observed distinguisher by observing a single bit position up to the 4th round for Salsa and 3rd round for ChaCha. Later, Maitra (2016) improved the attack complexity by minimizing the propagation of the difference after the first round using properly chosen IV values. Also, using this distinguisher, Choudhuri et al. (FSE 2016) provided a technique to construct a distinguisher for the next round of both the ciphers by observing multiple bits. Among all these attacks which were mostly based on experimental observations, theoretical works did not get much importance for these two ciphers. In this paper, we aim to theoretically investigate the reason behind these experimentally observed distinguishers for these chosen IV distinguishers, where the difference propagation is minimized up to the first round. We provide a mathematical proof of the observed probabilities for the distinguishers of both the ciphers in the single and multiple bits.

Monitorización de la COVID-19 en España: ¿es posible un análisis con perspectiva de género?

ObjectiveTo analyse the sex disaggregation and availability of gender indicators in the reports of the National Epidemiological Surveillance Network (RENAVE) and the National Study of Sero-Epidemiology (ENE-COVID-19). MethodPeer review of indicators available in 72 RENAVE reports and 4 rounds of the ENE-COVID-19 study to calculate the percentage of those disaggregated by sex and their variation over time. ResultsIn March 2021, 52.4% of RENAVE indicators were disaggregated by sex. From July 2020, 54% of disaggregated indicators ceased to be published and 23% lost their disaggregation. In the ENE-COVID-19 study, the 1st round 88,23% of the indicators are disaggregated and the 4th round 94,74%. The 2nd and 3rd round do not disaggregated by sex. ConclusionsThe RENAVE reports do not allow for a gender-sensitive analysis while the ENE-COVID-19 study provides the most information on social determinants.

Rejection Sampling Revisit: How to Choose Parameters in Lattice-Based Signature

Rejection sampling technology is a core tool in the design of lattice-based signatures with ‘Fiat–Shamir with Aborts’ structure, and it is related to signing efficiency and signature, size as well as security. In the rejection sampling theorem proposed by Lyubashevsky, the masking vector of rejection sampling is chosen from discrete Gaussian distribution. However, in practical designs, the masking vector is more likely to be chosen from bounded uniform distribution due to better efficiency and simpler implementation. Besides, as one of the third-round candidate signatures in the NIST postquantum cryptography standardization process, the 3rd round version of CRYSTALS-Dilithium has proposed a new method to decrease the rejection probability in order to achieve better efficiency and smaller signature size by decreasing the number of nonzero coefficients of the challenge polynomial according to the security levels. However, it is seen that small entropies in this new method may lead to higher risk of forgery attack compared with former schemes proposed in its 2nd version. Thus, in this paper, we first analyze the complexity of forgery attack for small entropies and then introduce a new method to decrease the rejection probability without loss of security including the security against forgery attack. This method is achieved by introducing a new rejection sampling theorem with tighter bound by utilizing Rényi divergence where masking vector follows uniform distribution. By observing large gaps between the security claim and actual security bound in CRYSTALS-Dilithium, we propose two series of adapted parameters for CRYSTALS-Dilithium. The first set can improve the efficiency of the signing process in CRYSTALS-Dilithium by factors of 61.7 % and 41.7 % , according to the security levels, and ensure the security against known attacks, including forgery attack. And, the second set can reduce the signature size by a factor of 14.09 % with small improvements in efficiency at the same security level.

Аналіз змагальної діяльності кваліфікованих тхеквондистів-юніорів

Purpose: to analyze the competitive activity of qualified junior taekwondo athletes. Material and methods. The research used the following methods: analysis of scientific and methodological information and Internet sources; generalization of best practical experience; video computer analysis of the competitive activity of qualified junior taekwondo athletes; methods of mathematical statistics. A specialized computer program «Martial Arts Video Analysis» was used to analyze the fights. The study analyzed the quarterfinal, semifinal and final fights, a total of 60 rounds (20 competitive fights) of qualified junior taekwondo fighters in weight categories in the 46-78 kg range. Results: analysis of scientific and methodological information and generalization of advanced practical experience made it possible to reveal that successful training of taekwondo fighters of any level is impossible without a thorough analysis of the structural components of the competitive activity of the world's leading athletes. Based on the study, it was found that the winners receive more points, with the same number of actions with the losers, due to the quality of the performance of technical and tactical actions and their diversity (on average, 3,25 points more than the losers). It was noted that in the 3rd round, regardless of weight categories, there is a statistically significant increase in the number of actions (t=3,07; p<0,01), a decrease in the time intervals between actions (t=1,81; p<0,05) , the number of points received increases (t=1,76; p <0,05). Conclusions. The analysis of competitive activity made it possible to determine the arsenal of technical and tactical actions of qualified junior taekwondo athletes, depending on their weight categories, thanks to which combatants receive victory points. So, the actions that athletes perform more often and receive the greatest number of points for them include: for weight categories 46-52 kg – «Dollyeo Chagi», for categories 55-59 kg – «Dollyeo Chagi», «Naeryeo Chagi», for categories 63-68 kg – «Dollyeo Chagi», «Dollyeo Chagi», for categories 73-78 kg – «Yeop Chagi», «Dollyeo Chagi», «Naeryeo Chagi». Keywords: competitive activity, indicators, taekwondo, qualified athletes, computer program.

P392 A mobile application to monitor Inflammatory Bowel Disease patients during intravenous biologic treatment: Results of a feasibility study

Abstract Background Active monitoring of IBD patients during intravenous (iv) biologic treatment is recommended but time-consuming and inconvenient for both patients and nurses. We developed a mobile application to promote self-management and monitor IBD patients cost-effectively during iv biologic treatment. We aimed to study the feasibility of the mobile application. Methods A prospective cohort study was performed in a secondary care centre with adult IBD patients treated with infliximab (iv) or vedolizumab (iv) for at least three months. The mobile application was used during four rounds of iv biologic treatment (figure 1). The application includes information modules and a personal interactive timeline with messages one week prior to iv biologic treatment (figure 1). Patients are asked to fill in a health check prior to each treatment to screen for contra-indications, such as respiratory infections or severe side-effects. Patients can also note any particularities or request contact with the IBD nurse. Blood tests are performed before every other infusion. Previously, patients were contacted by telephone prior to each biologic treatment by the IBD nurse. Using the application, patients are only personally contacted in case of abnormalities or upon request. Results Of 55 included patients, 52 patients completed the study. Mean age was 42 years (min 19 – max 68), 71% had Crohn’s disease, 76% had clinically quiescent disease, 85% used infliximab and 15% vedolizumab. Most patients used internet for over three years (98%) and their smartphone or tablet every day (98%). Compliance to health checks and blood tests was 67% during the 1st round of biologic treatment and 70%, 87% and 80% during the 2nd, 3rd and 4th round respectively. Patients used the application between median 6 (IQR 5 – 9) and 8 (IQR 5 – 11) times per round of biologic treatment. Patient satisfaction with the application was median 8 (VAS score, IQR 7 – 9). Prior to the 1st round of biologic treatment, all patients (100%) were contacted by telephone as in previous standard care. Using the application the number of patients requiring telephone contact decreased to 47%, 35% and 49% before the 2nd, 3rd and 4th round respectively. Patients remained equally satisfied with IBD care: median VAS score 8 (IQR 8 – 9) before and after implementation of the mobile application. The majority of patients (92%) wanted to continue using the application after the study ended. Figure 1: Study procedures Conclusion Monitoring of IBD patients treated with biologics using a mobile application is feasible. We saw a high compliance and satisfaction of patients, and reduction of health-care utilization. Almost all patients preferred using the application over previous standard care.

Research and analysis of implementations of the NIST PQC competition second round candidates focused on the Xilinx FPGA family

Today, the question of the stability of modern existing cryptographic mechanisms to quantum algorithms of cryptanalysis in particular and quantum computers in general is quite acute. This issue is actively discussed at the international level. Therefore, to solve it, NIST USA has decided to organize and is currently holding a competition for candidates for post-quantum cryptographic algorithms NIST PQC. The result of the competition should be the adoption of various types of cryptographic algorithms for standardization, namely, asymmetric encryption, key encapsulation and electronic signature (at least one algorithm of each type). 82 algorithms were submitted by the start of the competition for the standardization process. Based on the minimum eligibility criteria defined by NIST, 69 algorithms were considered for the 1st round. Given several parameters, namely, security, cost, performance, implementation characteristics, etc., 43 and 11 algorithms were excluded at the end of the 1st and 2nd rounds, respectively, and the other 15 algorithms were left for participation in the 3rd round. The algorithms left in the 2nd round can be divided into 5 different categories depending on their mathematical basis: those based on the isogeny of elliptic curves, those based on algebraic lattices, those based on mathematical code, those based on multivariate transformations and those based on hash functions. Security is the main evaluation criterion that determines competition in the NIST competition, and it is clear that candidates' software implementations are focused mainly on it. However, it is extremely important that the algorithm has an effective hardware implementation. Timely identification of hardware inefficiencies will help focus the cryptographic community efforts on more promising candidates, potentially saving a large amount of time that can be spent on cryptanalysis. This paper discusses and compares the FPGAs of Xilinx family. Data on the implementation of the candidates of the 2nd round in the process of standardization of post-quantum cryptography NIST, which are focused on the FPGA of the Xilinx family, are presented and compared.

Translation of professionalism in physical therapy questionnaire for Portuguese of Portugal: Core values

Introduction Physiotherapists play a key role in today’s healthcare and are recognised as the professionals in charge of rehabilitation, prevention and risk reduction [1]. Professionalism is interconnected and inherent with the profession; physiotherapists have the duty to act in an ethically correct way and for this must be governed by certain ethical principles [2]. The evaluation of professionalism is difficult to achieve because of various qualities that should be present, and also because it is needed to use several measurement methods, particularly in complex real world contexts [3]. The linguistic adaptation of an instrument is carried out using the Delphi Method, which brings a group of experts where a series of rounds is conducted until consensus of the translation is reached [4]. The aim of the study is the translation of the instrument Professionalism in Physical Therapy: Core Values, of the American Physical Therapy Association (APTA), with the intention to be used by physiotherapists in Portugal. Materials and methods The translation/back-translation was made by the Delphi Method with three rounds which were performed until de adaptation of the instrument to the Portuguese culture was achieved. A group of five experts, all with master and PhD academic degree, all with more than 25 years as Physiotherapist and Portuguese as their first language were selected. Results In order to reach consensus on the translation of the instrument, 3 rounds were carried out using the Delphi method, thus allowing linguistic equivalence to be obtained. In the 1st round of the process regarding the physical therapist's part, a 92 questions questionnaire was sent to the experts. In the 2nd round 42 questions were held and in the 3rd and final round, 5 questions were translated. Regarding the patient's part of the questionnaire, in the 1st round 18 questions were sent and in the 2nd round the number decreased to 9 questions. Consensus was achieved at 2nd round. The level of minimum agreement in each item was set to 80%, ensuring good translation and adaptation for Portuguese culture. Discussion and conclusions The aim of the study was achieved, and the linguistic translation was completed. As next step, it is needed to conduct validation of the instrument for Portuguese culture by performing a pre-test. The results of this content validation by experts will be useful to improve the standard of care, teaching and research in physiotherapy, based on a standardised instrument which allow to measure Portuguese Physiotherapists professionalism, and perform international benchmark as well.

An update on outpatient competence restoration outcomes: The Washington DC Model

This study provides an update to a previous study exploring time to restoration of adjudicative competence within an Outpatient Competence Restoration Program (OCRP). Authors examined the probability of restoration for individuals referred for outpatient competence restoration in the U.S. capital, and revisited the requirements of American Law, taking a closer look at how programmatic changes improve restoration and encourage adherence. Competence to stand trial remains a critical screening function of the judicial system to ensure that defendants have a basic understanding of courtroom procedures. Competency restoration is therefore an attempt to protect both the integrity of the system and the rights of defendants. Aggregate data from the OCRP’s previous four years of competence restoration efforts were reviewed for demographic characteristics, restoration rates, and time to restoration. Poisson regression modeling identified probability differences in restoration between sequential restoration periods. Since our initial analysis, the DC OCRP has been successful in restoring 97 of 345 participants (28.1%), with referral rates increasing from year to year. 39.2% are now restored after the 3rd round of competency restoration. Poisson regression modeling of individuals attaining competence during six successive restoration periods showed that differences for the first five rounds of restoration were not statistically significant (p = 0.418). In the 6th round, however, the difference in percentage of restored participants was statistically significant compared to previous rounds (irr = 0.32; p = 0.0001). We discuss the policy implications, especially those that suggest that the DC OCRP has improved its ability to restore competence beyond the 1st round of restoration.

Caregiver-Centered Care Health Workforce Competencies: Developing Consistent Support for Family Caregivers

Family caregivers [FCGs] are the backbone of the health system. They provide over 80% of the care for people with dementia, chronic illnesses and impairments. Despite evidence of their contributions and consequences of caregiving, support for FCGs has not been a health system priority. Education to prepare health providers to effectively identify, engage, assess, and support FCGs throughout the care trajectory is an innovative approach in addressing inconsistent system of supports for FCGs. We report on development and validation of the Caregiver-Centered Care Competency Framework to help with curricular design and subsequent evaluation of effectiveness of care providers working within healthcare settings to engage and support FCGs. We used a three round modified Delphi approach. An expert panel of 42 international, national, and provincial stakeholders agreed to participate. In the first 2 rounds, multi-level, interdisciplinary participants, rated the indicators in terms of importance and relevance. In the 3rd round consensus meeting, participants validated the six competency domains, including indicators in small group sessions. Thirty-four experts (81%) participated in the round 1, 36 (85.7%) in round 2, and 42 people (100%) in round 3. There was stable consensus across all three rounds, 96.07% of participants rated the indicators as essential or important (Round 1, 95.81%; Round 2, 94.15; Round 3, 98.23%). FCG research has been primarily focussed on educating FCGs to provide care. These competencies will shape the design of educational curricula and interdisciplinary training programs aimed at supporting the health and social care workforce to provide caregiver-centered care.

A study protocol for expanding the screening interval of endoscopic screening for gastric cancer based on individual risks: prospective cohort study of gastric cancer screening.

BackgroundThe Japanese government has recommended a 2-year endoscopic screening interval for gastric cancer. However, insufficient resources have constrained participation in endoscopic screening for gastric cancer. One way to avoid endoscopic screening harms and provide equal access is to define the appropriate screening interval.MethodsTo expand screening interval from more than 2 years for low-risk group, a single-arm cohort of endoscopic screening started. At the baseline screening, the participants underwent endoscopic screening for gastric cancer, Helicobacter pylori (H. pylori) antibody test, and serum pepsinogen test (first year), and followed after 2 and 4 years (within the first 5 years). We also assessed H. pylori infection and atrophy status on images of upper gastrointestinal endoscopy at the baseline. A new screening model will be developed by dividing the participants into high-risk and low-risk groups based on demographics, history of H. pylori eradication, serological testing, and endoscopic diagnosis. The cumulative gastric cancer incidence after negative results at baseline are compared between the low-risk group on the 3rd screening round after 4 years from baseline and the total screening group on the 2nd screening round after 2 years. If the cumulative gastric cancer incidence in the low-risk group on the 3rd screening round is lower than that in the total screening group on the 2nd screening round, the screening interval can be expanded to 4 years in the low-risk group.DiscussionTo reduce mortality from gastric cancer, a high participation rate of the target population is required. The screening interval of endoscopic screening can be changed if the individual risks for H. pylori infection are clarified. Our goal in this study is to obtain relevant data that can be used to improve the efficient use of endoscopic screening for gastric cancer by referring to individual risks in Japan.Trial registrationUMIN000025839 (University Hospital Medical Information Network, Japan)

Caregiver‐centered care health workforce competencies: Taking steps to support family caregivers of people living with dementia throughout the care trajectory

AbstractBackgroundFamily caregivers [FCGs] are the backbone of the health system [1‐3]. They provide over 80% of the care for people with dementia, chronic illnesses and impairments [4 5]. Despite evidence of their contributions and consequences of caregiving, support for FCGs has not been a health system priority[6‐8]. Multi‐level interdisciplinary Alberta stakeholders recommended developing Caregiver‐Centered Care Education for the health workforce to fill this gap [9‐14]. Education to prepare health providers to effectively identify, engage, assess, and support FCGs throughout the care trajectory is an innovative approach in addressing inconsistent system of supports for FCGs [5 6 15‐17]. Objective: We report on development and validation of the Caregiver‐Centered Care Competency Framework to help with curricular design and subsequent evaluation of effectiveness of care providers working within healthcare settings to engage and support FCGs. Project description: We used a modified Delphi approach. In the first 2 rounds, multi‐level, interdisciplinary participants, rated the indicators in terms of importance and relevance. In the 3rd round consensus meeting, participants validated the final competency indicators in small group sessions. Participants: Expert panel of international, national, and provincial stakeholders were invited to a 2‐day symposium March 14‐15, 2019 and participate in the Modified Delphi Process.ResultsAn expert panel of 42 international, national, and provincial stakeholders participated. Thirty‐four experts (81%) participated in the round 1, 36 (85.7%) in round 2, and 42 people (100%) in round 3. There was stable consensus across all three rounds, 96.07% of participants rated the indicators as essential or important (Round 1, 95.81%; Round 2, 94.15; Round 3, 98.23%). Six competency domains, including indicators, were validated. Discussion: FCG research has been primarily focused on educating FCGs to provide care [18‐20]. Our stakeholder engagement processes [9‐14] is critical to intervention research and practice that supports FCGs. The direct inclusion of multilevel stakeholders, particularly the FCGs, provided a robust forum for discussion and increased consensus around the value of a healthcare workforce trained to support FCGs.ConclusionsThese competencies will shape the design of educational curricula and interdisciplinary training programs aimed at supporting the health and social care workforce to provide caregiver‐centred care.

Efficient and robust isolation of rabbit scFv antibodies using antigen-coupled multilamellar vesicles

We demonstrated an efficient screening method for rabbit scFv antibodies using antigen-coupled multi-lamellar vesicles (Ag-MLVs) as solid supports. Model phages displaying mouse anti-human IgG scFv at a probability of 10-4-10-5% were successfully isolated by Ag-MLVs after 3 or less rounds of biopanning, whereas they could not be isolated using conventional antigen-coated immunotubes. This screening method was applied to isolate rabbit antigen-specific scFvs from 4 different phage libraries. Biopanning procedures employing Ag-MLVs yielded positive phages in the 3rd round or earlier, and specific antigen-binding of scFvs was observed after the 1st round in two biopanning selections. The dissociation rate constants (koff) of isolated scFv clones tended to decrease with progressing biopanning rounds. The average dissociation constants (KD) of the isolated scFvs ranged between 1.7 and 87nM, whereas the lowest KD of 12 pM was recorded for anti-CRP scFv. Comprehensive characterization of 355 different clones of the isolated rabbit scFvs presented a relatively low isoelectric point, and most of these were more thermo-stable than the conventional mouse scFvs, based on their instability and aliphatic indices. These results clearly indicate the advantages and potential of a combination of rabbit scFv-displaying phage library and biopanning using Ag-MLVs for antibody discovery. In addition, the results obtained in this study support the suitability of rabbit scFvs for several applications, including the development of diagnostic agents and affinity ligands for molecular diagnosis and bioseparation.

Substrate specificity of 2-deoxy-D-ribose 5-phosphate aldolase (DERA) assessed by different protein engineering and machine learning methods

In this work, deoxyribose-5-phosphate aldolase (Ec DERA, EC 4.1.2.4) from Escherichia coli was chosen as the protein engineering target for improving the substrate preference towards smaller, non-phosphorylated aldehyde donor substrates, in particular towards acetaldehyde. The initial broad set of mutations was directed to 24 amino acid positions in the active site or in the close vicinity, based on the 3D complex structure of the E. coli DERA wild-type aldolase. The specific activity of the DERA variants containing one to three amino acid mutations was characterised using three different substrates. A novel machine learning (ML) model utilising Gaussian processes and feature learning was applied for the 3rd mutagenesis round to predict new beneficial mutant combinations. This led to the most clear-cut (two- to threefold) improvement in acetaldehyde (C2) addition capability with the concomitant abolishment of the activity towards the natural donor molecule glyceraldehyde-3-phosphate (C3P) as well as the non-phosphorylated equivalent (C3). The Ec DERA variants were also tested on aldol reaction utilising formaldehyde (C1) as the donor. Ec DERA wild-type was shown to be able to carry out this reaction, and furthermore, some of the improved variants on acetaldehyde addition reaction turned out to have also improved activity on formaldehyde.Key points• DERA aldolases are promiscuous enzymes.• Synthetic utility of DERA aldolase was improved by protein engineering approaches.• Machine learning methods aid the protein engineering of DERA.

Effects of Repeated Intravitreal Injections of Dexamethasone Implants on Intraocular Pressure: A 4-Year Study.

PurposeDexamethasone and other corticosteroids are administered intravitreally to treat a variety of retinal diseases. As a side effect, they can alter intraocular pressure (IOP). The purpose of this study is to describe the incidence, severity, and management of ocular hypertension following the administration of multiple intravitreal injections of dexamethasone implants.Materials and MethodsA total of 78 eyes of 78 subjects (males 62%; females 38%; mean age 67 ± 13 years SD) received a total of 152 intravitreal injections of 0.7 mg dexamethasone implants over 4 years. Indications included retinal vein occlusion (87%), diabetic macular edema (9%), wet-type age-related macular degeneration (4%). Ocular hypertension was defined as intraocular pressure above 23 mmHg or any pressure increase of 10 mmHg or more from baseline values. IOP was measured by applanation tonometry before the injection (T0), as well as one week (T1), one month (T2), and three months (T3) afterwards.ResultsFive percent (4/78) of subjects developed ocular hypertension after the 1st injection. On the second and third rounds, additional 7.2% (3/42) and 4.2% (1/24) of subjects developed the same side effect. Among the 8 subjects who received a fourth injection, none was found with OHT. Pressure elevations were detected at T2 and T3. In all patients, topical medical therapy was sufficient to lower the IOP below threshold. Mean pressure variations following the first injection as compared to previous recorded values were +0.97 mmHg (T1), +0.92 mmHg (T2), and −0.41 mmHg (T3) (p < 0.05). Mean pressure variations following the second injection were +0.54 mmHg (T1), +0.23 mmHg (T2) and −0.66 mmHg (T3) (p < 0.05).ConclusionOcular hypertension is a recognized side effect of intravitreal dexamethasone. Some patients develop it right after the first injection, while others develop it subsequently, on the 2nd or 3rd round. This side effect becomes most apparent 30–90 days following the implantation procedure and responds well to topical pressure-lowering medications.

THE RELIABILITY OF A QUALITATIVE SCORING SYSTEM OF TRUNK AND LIMB ALIGNMENT DURING A 45-DEGREE SIDE STEP CUT

Background:Three dimensional (3D) motion analysis is considered the “gold standard” for evaluating human movements. However, its clinical utility is limited due to cost, operating expertise and lengthy post-processing time. Numerous qualitative scoring systems, using videos, have been introduced to assess trunk and lower extremity (LE) alignment in dynamic maneuvers. However, it is unknown if a qualitative scoring system is a reliable method to evaluate cutting movement.Hypothesis/Purpose:To assess the inter-rater and intra-rater reliability of a qualitative scoring system to evaluate trunk and LE alignment during a 45-degree side step cut. The sub-aim was to investigate the effect of interactive peer discussion on inter-rater reliability.Methods:A repeated measures study design was used. Six raters (2 MDs, 2 PTs, and 2 ATs) independently viewed 10 videos, consisting of a 45-degree side step cut performed by adolescent male and female athletes. A clinically established checklist (Figure 1) was given to examine quality of movements. After the 1st round, an interactive peer discussion was held to discuss videos, movement quality, and the checklist. Subsequently, after a 1-week wash out period, a 2nd round of evaluation (examining the same 10 videos) was performed. Following the 2nd round, and a 2-week wash out period, a 3rd round was performed to assess intra-rater reliability. In each round, video sequences were altered in random order to avoid memory bias. Intraclass correlation coefficient (ICC) and their 95% confident intervals (95% CIs) were calculated. Values less than 0.50, between 0.50 and 0.75, between 0.75 and 0.90, and greater than 0.90 were defined as poor, moderate, good and excellent reliability, respectively.Results:Inter-rater reliability for the 1st round was moderate (ICC: 0.565, 95%CIs: 0.074-0.866). Inter-rater reliability for the 2nd round was better, however, was still moderate (ICC: 0.632, 95%CIs: 0.100-0.895). Intra-rater reliability between the 2nd and 3rd round ranged from moderate to excellent (ICC: 0.589-0.910).Conclusion:The results of this study showed moderate inter-rater reliability and moderate to excellent intra-rater reliability of the qualitative checklist. Following the interactive peer discussion, slight improvements in inter-rater reliability were observed. The findings indicate that this checklist may allow clinicians to standardize their assessment of trunk and LE alignment during a cutting task, however, more objective methods to evaluate multiplane movements, such as genu valgum, may be warranted.Figure 1.45-Degree Side Step Cut Checklist

Developing the Role of Sexual Assault Nurse Examiner in South Korea: Using Delphi Method

본 연구는 국내 실정에 맞는 성폭력 전담 간호사의 역할을 개발하여 전국의 성폭력 피해자 지원기관에서 근무하는 간호사의 역할을 표준화하고 전문영역으로 자리매김하는데 기여하고자 시도되었다. 문헌고찰을 통해 국내외 성폭력 전담 간호사의 역할을 정리하고, 이를 토대로 관련 전문가 16명에게 3차례의 델파이 조사로 의견 합치 후, 법적 타당성 검토를 시행하였다. 3차 델파이 조사에서 연구 설계 시 설정한 합의도 0.75 이상, 수렴도 0~0.5, 내용타당도 비율 0.49 이상에 대한 기준을 모두 충족하였다. 연구 결과 5개 역할, 6개 영역, 61개 간호활동을 도출하였으며, 국내 성폭력 전담 간호사의 역할은 보건의료 정책과 의료법의 차이로 인해 국외와는 다르게 나타났다. 본 연구로 도출된 역할을 국내 성폭력 피해자 지원기관에 적용하고, 간호사의 역량이 부족하게 나타나는 부분에 대해 교육을 실시하여 업무 수행 능력을 향상시킨다면 궁극적으로 성범죄의 감소에 기여할 수 있을 것이다.This study aimed to develop the role of sexual assault nurse examiners (SANE) in South Korea. This will attempt to standardize the role of nurses in Sexual Violence Victim Support Centers across the country. This research was conducted with three steps: integrated literature review, Delphi study, and legal validity review. Three-round Delphi surveys were undertaken with 16 Korean experts. In the 3rd round, there was consensus in the degree of consensus, degree of convergence, and content validity ratio (CVR). The result of the study identified five roles, six domains, and 61 nursing activities. The role of the Korean SANE was found to be different from that in other countries due to differences in the Korean medical system and law. If this study is applied to practice in Sexual Violence Victim Support Centers and nurses are accordingly educated, performance of SANEs is predicted to improve. This will then contribute to the reduction of sexual crimes.

Consensus Recommendations for 4th Generation Non-Microneedling Monopolar Radiofrequency for Skin Tightening: A Delphi Consensus Panel

IMPORTANCE: The demand for non-invasive methods for facial and body rejuvenation has experienced exponential growth over the last two decades. While multiple treatment systems exist, device specific guidelines to help guide clinicians to achieve the best outcomes are lacking. OBJECTIVE: To develop expert consensus on the use of 4th generation non-microneedling monopolar radiofrequency. Design: In a modified Delphi process, a panel of 8 international experts in aesthetic dermatology participated in 3 rounds of consensus building commencing in April 2019. Initially, 32 consensus statements were developed addressing patient selection, patient outcomes, treatment settings, and practical use of non-microneedling monopolar radiofrequency. By the 3rd round, these had been reduced and refined to a total of 19 statements. The consensus process was completed in June 2019 and the data were analyzed in July 2019. RESULTS: In 3 Delphi rounds, the 8 panelists achieved consensus on 19 recommendations on the use of 4th generation non-microneedling monopolar radiofrequency and developed additional explanatory guidance to support 12 of the consensus statements including those related to patient selection, procedural technique, and anticipated treatment outcomes. CONCLUSIONS AND RELEVANCE: Although guidelines will never replace individual clinical judgment, as the demand for noninvasive tissue tightening increases, so too does the need for positive, reproducible outcomes. Careful patient selection, pre-treatment counseling, treatment planning, and good technique, are all critical for success. These consensus statements should assist clinicians in each of these areas.