Complete Procedure Research Articles

Spatially resolved epigenome sequencing via Tn5 transposition and deterministic DNA barcoding in tissue.

Spatial epigenetic mapping of tissues enables the study of gene regulation programs and cellular functions with the dependency on their local tissue environment. Here we outline a complete procedure for two spatial epigenomic profiling methods: spatially resolved genome-wide profiling of histone modifications using in situ cleavage under targets and tagmentation (CUT&Tag) chemistry (spatial-CUT&Tag) and transposase-accessible chromatin sequencing (spatial-ATAC-sequencing) for chromatin accessibility. Both assays utilize in-tissue Tn5 transposition to recognize genomic DNA loci followed by microfluidic deterministic barcoding to incorporate spatial address codes. Furthermore, these two methods do not necessitate prior knowledge of the transcription or epigenetic markers for a given tissue or cell type but permit genome-wide unbiased profiling pixel-by-pixel at the 10 μm pixel size level and single-base resolution. To support the widespread adaptation of these methods, details are provided in five general steps: (1) sample preparation; (2) Tn5 transposition in spatial-ATAC-sequencing or antibody-controlled pA-Tn5 tagmentation in CUT&Tag; (3) library preparation; (4) next-generation sequencing; and (5) data analysis using our customed pipelines available at: https://github.com/dyxmvp/Spatial_ATAC-seq and https://github.com/dyxmvp/spatial-CUT-Tag . The whole procedure can be completed on four samples in 2-3 days. Familiarity with basic molecular biology and bioinformatics skills with access to a high-performance computing environment are required. A rudimentary understanding of pathology and specimen sectioning, as well as deterministic barcoding in tissue-specific skills (e.g., design of a multiparameter barcode panel and creation of microfluidic devices), are also advantageous. In this protocol, we mainly focus on spatial profiling of tissue region-specific epigenetic landscapes in mouse embryos and mouse brains using spatial-ATAC-sequencing and spatial-CUT&Tag, but these methods can be used for other species with no need for species-specific probe design.

Higher intraoperative detection rate of suspicious non-palpable lesions using wire marking in skin cancer patients.

Follow-up protocols in patients after complete resection of high-risk cutaneous tumors lead to a discovery of metastases in very early stages, but surgery on non-palpable lesions proves to be challenging. In this monocenter retrospective study 39 patients suffering from malignant skin tumors with suspicious non-palpable lesions located in the lymph nodes (90%) or deep subcutaneously/intramuscularly (10%) were included. In 21 patients the lesions were excised under ultrasound guidance, and 18 patients received a wire marking before surgery. Both patient groups were compared regarding successful intraoperative finding of the lesion, duration of the procedure, and complications. Wire marking led to a significantly higher intraoperative detection rate of 100% versus 76% (p<0.05). The average time needed for the complete procedure (p = 0.91) or the rate of complications (p = 0.70) did not differ significantly between both groups. The size of the malignant lesions successfully removed by wire marking was significantly smaller (p<0.05). Of all 34 detected lesions only 20 (58.8%) were confirmed to be malignant. Wire marking increases the detection rate of non-palpable suspicious subcutaneous or lymphatic lesions. It leads to earlier diagnosis of metastasis but also allows to avoid unnecessary complete lymph node dissection.

Comparing the use of colored Trace Images in Kids' Books with passive distractions to decrease pain and fear during cannulation in children: A randomized clinical trial

IntroductionCannulation can be frightening and a source of pain and fear for pediatric patients. The study evaluated the effectiveness of Trace Image and Coloring for Kids-Book (TICK-B) as active distraction with two passive distractions in reducing children's pain and fear during cannulation. MethodsThis study employed a prospective, controlled, randomized experiment conducted from January 2023 to April 2023 at Heevi Pediatric hospital in the Kurdistan region of Iraq. A total of 176 participants were randomly assigned in to one of four study groups, with 44 participants assigned to each group. The interventions were administered 2–3 min before continued until the cannulation procedure finished. Data were collected through interviews conducted before and after the procedure. Children reported pain using Wong-Baker FACES® scale, and fear evaluated with the Child Fear Scale as an outcome after the cannulation procedure. Children's outcomes during and after procedure were measured 2–3 min after completed procedure. ResultsAll distraction methods significantly reduced children's pain and fear compared to the control group. TICK-B showed large effects in reducing average pain (mean difference = -4.65, 95 % CI: -5.67 to -3.65) and fear (mean difference = -2.18, 95 % CI: -2.67 to -1.69) during cannulation. Post-procedure, TICK-B maintained large pain relief (mean difference = -4.10, 95 % CI: -4.98 to -3.22) and fear reduction (mean difference = -1.89, 95 % CI: -2.39 to -1.39) effects. Music listening and cartoon watching both showed improvements compared to the control group, with minimal differences between them in terms of pain and fear during the procedure. Also, the differences were the same after the procedure. No adverse events were reported. ConclusionAll distraction techniques effectively and safely decreased children's pain and fear during cannulation. The TICK-B technique most effectively reduced children's pain and fear during cannulation procedures compared to music-listening and cartoon-watching techniques. Trial registrationNCT04977323.

Robotic-assisted thoracic surgery training in France: a nation-wide survey from young surgeons.

Evaluate theoretical and practical training of thoracic surgeons-in-training in robotic-assisted thoracic surgery (RATS) in France. A survey was distributed to thoracic surgeons-in-training in France from November 2022 to February 2023. We recruited 101 thoracic surgeons-in-training (77% response rate). Over half had access to a surgical robotics system at their current institution. Most (74%) considered robotic surgery training essential, 90% had attended a robotic procedure. Only 18% had performed a complete thoracic robotic procedure as the main operator. A complete RATS procedure was performed by 42% of fellows and 6% of residents. Of the remaining surgeons, 23% had performed part of a robotic procedure. Theoretical courses and simulation are well developed; 72% of residents and 91% of fellows had undergone simulation training in the operating room, at training facilities, or during congress amounting to <10 h (for 73% of the fellows and residents), 10-20 h (17%), 20-30 h (8%) or >30 h (3%). Access to RATS was ≥1 day/week in 71% of thoracic departments with robotic access. Fellows spent a median of 2 (IQR 1-3) semesters in departments performing robotic surgery. Compared with low-volume centres, trainees at high-volume centres performed significantly more complete robotic procedures (47% vs 13%; P = 0.001), as did fellows compared with residents. Few young surgeons perform complete thoracic robotic procedures during practical training, and access remains centre dependent. Opportunities increase with seniority and exposure; however, increasing availability of robotic devices, theoretical formation, and simulation courses will increase opportunities.

Checking equivalence of corecursive streams: An inductive procedure

In recent work, non-periodic streams have been defined corecursively, by representing them with finitary equational systems built on top of various operators, besides the standard constructor. When only the stream constructor is allowed in equations, only periodic streams can be represented, and the structures of periodic streams and infinite regular trees are isomorphic. Therefore, one can use the theory of regular trees to get a sound and complete procedure to decide whether two equational systems are equivalent, that is, define the same streams. However, such an isomorphism no longer exists if one allows other operators in equations; in particular, there exist systems of equations which have the same unique solution as streams, but not as regular trees. Hence, equality of regular trees becomes stronger then equality of streams, with a negative impact on termination of functions whose definition is based on the equivalence of the representation of streams as finitary equational systems. To overcome this problem, we provide a weaker definition of equivalence, and prove its soundness and relative completeness. This definition is coinductive, hence non-algorithmic. However, we show that it can be turned into an equivalent inductive procedure.

All-optical voltage imaging-guided postsynaptic single-cell transcriptome profiling with Voltage-Seq.

Neuronal pathways recruit large postsynaptic populations and maintain connections via distinct postsynaptic response types (PRTs). Until recently, PRTs were accessible as a selection criterion for single-cell RNA sequencing only through probing by low-throughput whole-cell electrophysiology. To overcome these limitations and target neurons on the basis of specific PRTs for soma collection and subsequent single-cell RNA sequencing, we developed Voltage-Seq using the genetically encoded voltage indicator Voltron in acute brain slices from mice. We also created an onsite analysis tool, VoltView, to guide soma collection of specific PRTs using a classifier based on a previously acquired database of connectomes from multiple animals. Here we present our procedure for preparing the optical path, the imaging setup and detailing the imaging and analysis steps, as well as a complete procedure for sequencing library preparation. This enables researchers to conduct our high-throughput all-optical synaptic assay and to obtain single-cell transcriptomic data from selected postsynaptic neurons. This also allows researchers to resolve the connectivity ratio of a specific pathway and explore the diversity of PRTs within that connectome. Furthermore, combining high throughput with quick analysis gives unique access to find specific connections within a large postsynaptic connectome. Voltage-Seq also allows the investigation of correlations between connectivity and gene expression changes in a postsynaptic cell-type-specific manner for both excitatory and inhibitory connections. The Voltage-Seq workflow can be completed in ~6 weeks, including 4-5 weeks for viral expression of the Voltron sensor. The technique requires knowledge of basic laboratory techniques, micromanipulator handling skills and experience in molecular biology and bioinformatics.

A new insight on evaluation of the fertility and pregnancy outcome in patients with primary Sjögren syndrome: a propensity score matched study in multi-IVF centers

BackgroundPrimary Sjögren syndrome (pSS) is often related to adverse neonatal outcomes. But it’s currently controversial whether pSS has an adverse effect on female fertility and clinical pregnancy condition. More importantly, it’s unclear regarding the role of pSS in oocyte and embryonic development. There is a lack of comprehensive understanding and evaluation of fertility in pSS patients.ObjectiveThis study aimed to investigate oocyte and embryonic development, ovarian reserve, and clinical pregnancy outcomes in Primary Sjögren syndrome (pSS) patients during in vitro fertilization (IVF) treatment from multi-IVF centers.MethodsWe performed a muti-central retrospective cohort study overall evaluating the baseline characteristics, ovarian reserve, IVF laboratory outcomes, and clinical pregnancy outcomes between the pSS patients and control patients who were matched by Propensity Score Matching.ResultsFollowing PSM matching, baseline characteristics generally coincided between the two groups. Ovarian reserve including anti-müllerian hormone (AMH) and antral follicle counting (AFC) were significantly lower in the pSS group vs comparison (0.8 vs. 2.9 ng/mL, P < 0.001; 6.0 vs. 10.0, P < 0.001, respectively). The pSS group performed significant reductions in numbers of large follicles, oocytes retrieved and MII oocytes. Additionally, pSS patients exhibited obviously deteriorate rates of oocyte maturation, 2PN cleavage, D3 good-quality embryo, and blastocyst formation compared to comparison. As for clinical pregnancy, notable decrease was found in implantation rate (37.9% vs. 54.9%, P = 0.022). The cumulative live birth rate (CLBR) following every embryo-transfer procedure was distinctly lower in the pSS group, and the conservative and optimal CLBRs following every complete cycle procedure were also significantly reduced in the pSS group. Lastly, the gestational weeks of the newborns in pSS group were distinctly early vs comparison.ConclusionPatients with pSS exhibit worse conditions in terms of female fertility and clinical pregnancy, notably accompanied with deteriorate oocyte and embryo development. Individualized fertility evaluation and early fertility guidance are essential for these special patients.

Adaptive impact analysis in flexible multibody systems based on hierarchically refined IGA models

Usually, detailed impact simulation models within flexible multibody systems have to be set up manually rather than being generated automatically. This is because the process requires prior knowledge of the time and location of the impact, as well as the element resolution within the contact area. If the penalty method is used to determine the occurring contact forces, the corresponding penalty factor also needs to be determined manually. This work, however, presents an adaptive algorithm to simulate impacts within flexible multibody systems fully automatically using reduced isogeometric analysis models, the floating frame of reference formulation, and quasistatic contact models for an efficient but still accurate simulation. The adaptive algorithm detects impacts in the system, determines the contact locations on the bodies, refines the contact area, and determines the penalty factor, and therefore automatically simulates impacts. The work shows how to automatically simulate impacts in flexible multibody systems without user action or prior knowledge of impact location and size. The first application example simulates significant elastodynamic effects within a long flexible rod. The goal is to validate the algorithm by preserving the wave propagation and energy of the system. The second application example simulates the impacts of two flexible double pendulums. This setup is a suitable benchmark for the complete adaptive impact analysis procedure as the flexible double pendulums undergo large rigid body motions.

Giving adolescents with cystic fibrosis a voice: Predicting cystic fibrosis nutritional adherence from their decision-making involvement.

Suboptimal nutritional adherence in adolescents with cystic fibrosis (awCF) has been associated with lower lung function. AwCF often have more independence in dietary decisions than younger children, yet little research has examined how adolescent decision-making relates to nutritional adherence. This study explored whether components of adolescent decision-making involvement facilitate enzyme and caloric adherence in awCF. 37 families participated and completed study procedures. AwCF and caregivers completed electronic surveys, including the Decision-Making Involvement Scale (DMIS). The DMIS evaluated awCF behaviors during nutrition-related decision-making/discussions with caregivers using DMIS subscales: Child Seek (asking for help/advice from caregivers), Child Express (awCF stating opinions) and Joint/Options (awCF participating in joint decision-making or caregiver providing options). AwCF completed 2, 24-hr diet recalls via videoconferencing/phone to estimate adherence. Chart reviews collected medical information. DMIS subscales were regressed onto enzyme and caloric adherence. 43% of awCF met calorie recommendations; 48.6% took all enzymes as prescribed. Caloric adherence was positively correlated with adolescent- and parent-reported Child Seek (r = 0.53; r = 0.36) and adolescent-reported Joint/Options (r = 0.41). Per adolescent-report, the caloric adherence regression model was significant, with Child Seek contributing unique variance in caloric adherence (β = .62, p = .03). Parent-reported adolescent-decision-making involvement significantly predicted caloric adherence, but none of the subscales contributed unique variance. No other regressions were significant. When awCF participated in nutrition-related discussions with a caregiver, especially with questions, caloric adherence was better. Future research should examine whether family factors influence these results. AwCF are encouraged to ask questions in nutrition discussions.

Improving instrumental neutron activation analysis detection limit using Monte Carlo simulation for lanthanides determination in Algerian phosphate

ABSTRACT Instrumental Neutron Activation Analysis (INAA) is one of the best methods to analyse Rare Earth Elements (REE) with a low detection limit in phosphate samples. Since most lanthanides emit gamma rays at the energy below 1000 keV, this energy range is affected by the Bremsstrahlung noise of beta emission produced by the 31P(n,γ)32P reaction, when the irradiation of the P2O5 composing the phosphate matrix (approximately 30%). This beta (β−) spectrum with a maximum energy of 1.71 MeV (average energy of 695 keV) affects the gamma spectrum and will reduce the detection limit significantly, other factors decrease the detection limit of lanthanides like neutron self-shielding and interference. In the present work, an analysis methodology based on optimising the measurement parameters of the INAA technique was implemented to improve the detection limits for the precise evaluation of lanthanide concentrations in Algerian phosphate deposits. The complete procedure was developed using a combination of a Monte Carlo simulation approach and experimental measurements. Two models were developed based on Monte Carlo simulation for the calibration of HPGe detector efficiency and the optimisation of type and filter thickness to reduce the beta spectrum (Bremsstrahlung) emitted by the 32P produced by neutron capture reaction 31P(n, γ) 32P. The developed model allowed a considerable improvement in the detection limit of the INAA technique and reduced the uncertainty in the lanthanide concentration. Finally, the methodology was applied to determine lanthanide elements in phosphate samples with good precision.

Unique root anatomy of mandibular second premolars: clinical strategies for effective disinfection and preservation of dentine structure in root canal treatment—a case report

It is difficult to predict the outcomes of non-surgical root canal treatment (NSRCT) for mandibular second premolars with multiple root canals. In these teeth, the complicated anatomy with fin(s), or a C-shape, and possible secondary canal(s) varies unpredictably. The morphology of the root canals provides shelters for bacteria to remain, regrow, and form biofilms despite the endodontic treatment. Moreover, the prevalence of mandibular second premolars with multiple canals is extremely infrequent. Therefore, the clinical management of NSRCT in such cases is not sufficiently reported. This case report introduces two cases of NSRCT for mandibular second premolars with a radicular groove and also presents the appropriate clinical strategies and techniques. Cone-beam computed tomography (CBCT) imaging was used preoperatively. After the completion of NSRCT, CBCT was reused to review the completed procedures using the Nerve Canal tool in CS 3D Imaging v3.2.9 and v3.8.7. Five canals were obturated in case 1, and four canals in case 2 along with a C-shape morphology. Analyzing the configuration of the root canals by CBCT was critical to achieve successful NSRCT because the numbers, exits, configurations, and volumes of the secondary canals were not anticipated after reviewing 2D radiographs. Based on the interpretation, the advanced protocols of NSRCT were planned: first, augmentation of chemo-mechanical cleaning, but minimizing the loss of dentine; second, the tactile examination to locate and negotiate the orifices of the secondary canals; and lastly, the optimized plan and technique for root canal filling of the complex canal systems.

Abstract PO4-27-02: Pandemic Shifts: How did elective breast cancer care change?

Abstract Introduction: As the COVID-19 pandemic began, concerns arose that timely utilization of elective breast cancer care would decrease due to state moratoriums, travel restrictions, or fear, resulting in poorer long-term outcomes. Advances in telemedicine provided a new avenue for care; however, rapid implementation brought concerns about variable uptake and disparities. To support longitudinal clinical and epidemiological studies, this analysis described elective breast cancer care utilization during the first year of the pandemic, including patient, hospital, and geographic barriers and facilitators. Methods: The Multidisciplinary Breast Reconstruction Research Program team reviewed all breast cancer surgeries and procedures at The University of Texas MD Anderson Cancer Center during the pre-pandemic (March 1, 2019 to February 29, 2020) and pandemic (March 1, 2020 to February 28, 2021) periods. The team identified procedures that were deemed elective or preference-sensitive, and summarized the timeline of pandemic milestones and changes, including the implementation of telemedicine appointments. A data analyst summarized the distributions of completed, canceled, rescheduled, and never completed procedures. T tests and analyses of variance tested differences between the pre-pandemic and pandemic year. Generalized linear models assessed patient, hospital, and geographic factors that correlated with successful access to, and completion of, procedures. Two focus groups reviewed data and informed the interpretation of results. Results: During the first pandemic year, 30 breast care procedures were identified that were postponed during March-April, July-August, and December-January. Surprisingly, no decrease in overall utilization of elective care procedures was observed; in fact, 19% more elective breast cancer care surgeries and procedures were scheduled (4752 pre-pandemic vs 4003 pandemic) in 13% more episodes of care (2723 pre-pandemic vs 2415 pandemic). As expected, rescheduling of procedures increased 98% (from 14% pre-pandemic to 27% pandemic); however, the majority of procedures were able to be completed by the end of the year (72% pre-pandemic, 73% pandemic). Telemedicine did not significantly mediate successful completion, as the majority of procedures were prophylactic or reconstructive surgeries. However, extended hours (p = 0.03) and proximity to the hospital facilitated access and successful completion of care (p&amp;lt; 0.01). The most common procedures that were not able to be performed within the first year of the pandemic were autologous breast reconstruction, revision, and mastopexy. Notably, patients reported slightly improved rates of anxiety and depression during the initial pandemic year (11% vs 14%, p = 0.04), possibly due to relative privation or comparison bias. Clinicians and patients/survivors noted several “lessons learned” that may inform access and preference-sensitive care delivery. Conclusions: Despite three periods of state-mandated discontinuation of elective care procedures, the majority of patients were able to access and successfully complete elective breast cancer care during the first year of the COVID-19 pandemic. Future studies and initiatives may use this information to explore innovations in care delivery and short- and long-term effects on health outcomes. Citation Format: Haoqi Wang, Greg Reece, Mary Catherine Bordes, Mia Markey, Aubri Hoffman. Pandemic Shifts: How did elective breast cancer care change? [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-27-02.

Conversion to Radical Nephrectomy From Robotic Partial Nephrectomy Is Most Commonly Due to Anatomic and Oncologic Complexity.

Partial nephrectomy is standard-of-care treatment for small renal masses. As utilization of partial nephrectomy increases and includes larger and complex tumors, the risk of conversion to radical nephrectomy likely increases. We evaluated incidence and reason for conversion to radical nephrectomy in patients scheduled for partial nephrectomy by surgeons participating in MUSIC (the Michigan Urologic Surgery Improvement Collaborative). All patients in whom robotic partial nephrectomy was planned were stratified by completed procedure (robotic partial nephrectomy vs radical nephrectomy). Preoperative and intraoperative records were reviewed for preoperative assessment of difficulty and reason for conversion. Patient, tumor, pathologic, and practice variables were compared between cohorts. Of 650 patients scheduled for robotic partial nephrectomy, conversion to radical nephrectomy occurred in 27 (4.2%) patients. No conversions to open were reported. Preoperative documentation indicated a plan for possible conversion in 18 (67%) patients including partial with possible radical (n = 8), partial vs radical (n = 6), or likely radical nephrectomy (n = 4). Intraoperative documentation indicated that only 5 (19%) conversions were secondary to bleeding, with the remaining conversions due to tumor complexity and/or oncologic concerns. Patients undergoing conversion had larger (4.7 vs 2.8 cm, P < .001) and higher-complexity tumors (64% vs 6%, P < .001) with R.E.N.A.L. (for radius, exophytic/endophytic, nearness of tumor to collecting system, anterior/posterior, location relative to polar line) nephrometry score ≥ 10. The converted cases had a higher rate of ≥ pT3 (27% vs 8.4%, P = .008). There was a low rate of conversion from robotic partial to radical nephrectomy in the MUSIC-KIDNEY (Kidney mass: Identifying and Defining Necessary Evaluation and therapY) collaborative, and an even lower risk of conversion due to uncontrolled bleeding. Targeted review of each conversion identified appropriate decision-making based on oncologic risk in most cases.

Design and Development of GaN-Based Power Amplifier for Radar Applications

This paper presents a comprehensive overview of Gallium nitride (GaN)-based power amplifier (PA) design for various frequency bands. GaN-based technology has emerged as a promising alternative to traditional silicon-based amplifiers due to its superior performance characteristics, which are discussed in this paper. This paper also discusses the key design parameters and challenges associated with PA design. Various design techniques and topologies for GaN power amplifiers are explored besides addressing theoretical considerations of PA design along with a complete systematic design procedure for L-Band amplifier using the wolfspeed large signal GaN HEMT model. To further demonstrate the useful methodology, the designs of S-band and C-band PAs are also presented. GaN-based devices are very promising candidates for high-power applications. It is widely used in various high-power applications including communication and radar.

Evolution of bismuth electrodes activating electrosynthesis of formate from carbon dioxide reduction

Electrochemical conversion of CO2 into valuable chemicals and fuels has emerged as a promising approach to achieving the net-zero emission target. In this work, bismuth (Bi)-based gas diffusion electrodes (GDEs) are prepared via scalable inkjet printing of the precursor on carbon papers, and subsequent thermal treatment. The optimization of the GDEs aims at the efficient CO2 reduction to formate (HCOO−) with good selectivity and high current density. Ex situ FESEM, XRD, and XPS analyses evidence the morphological and structural transformations of Bi-based catalysts during electrolysis. In situ Raman spectroscopy illustrates the dynamic evolution of the electrocatalysts in a range of potentials. The complete procedure is represented as the transformation of Bi2O3 polyhedral microcrystals to a flower-like assembly of Bi2O2CO3 nanoflakes when exposed to KHCO3 electrolyte under electrochemical conditions, and then to metallic Bi at more negative potentials (< −0.6 V vs. RHE). The evolution of Bi-GDEs confirms that metallic Bi nanostructure provides abundant active sites for selective conversion of CO2 to HCOO−, and is highly promising for applications at industrially relavant scales.

The Development of a Multienzyme Isothermal Rapid Amplification Assay to Visually Detect Duck Hepatitis B Virus.

Duck hepatitis B virus (DHBV) is widely prevalent in global ducks and has been identified in Chinese geese with a high prevalence; the available detection techniques are time-consuming and require sophisticated equipment. In this study, an assay combining multienzyme isothermal rapid amplification (MIRA) and lateral flow dipstick (LFD) was developed for the efficient and rapid detection of DHBV. The primary reaction condition of the MIRA assay for DHBV detection was 10 min at 38 °C without a temperature cycler. Combined with the LFD assay, the complete procedure of the newly developed MIRA assay for DHBV detection required only 15 min, which is about one-fourth of the reaction time for routine polymerase chain reaction assay. And electrophoresis and gel imaging equipment were not required for detection and to read the results. Furthermore, the detection limit of MIRA was 45.6 copies per reaction, which is approximately 10 times lower than that of a routine polymerase chain reaction assay. The primer set and probe had much simpler designs than loop-mediated isothermal amplification, and they were only specific to DHBV, with no cross-reactivity with duck hepatitis A virus subtype 1 and duck hepatitis A virus subtype 3, goose parvovirus, duck enteritis virus, duck circovirus, or Riemerella anatipestifer. In this study, we offer a simple, fast, and accurate assay method to identify DHBV in clinical serum samples of ducks and geese, which would be suitable for widespread application in field clinics.

Remote Symptom Monitoring Using Patient-Reported Outcomes in Patients With Chronic Kidney Disease: Process Evaluation of a Randomized Controlled Trial.

In Denmark, outpatient follow-up for patients with chronic kidney disease (CKD) is changing from in-hospital visits toward more remote health care delivery. The nonuse of remote patient-reported outcomes (PROs) is a well-known challenge, and it can be difficult to explain which mechanisms of interventions influence the outcome. Process evaluation may, therefore, be used to answer important questions on how and why interventions work, aiming to enhance the implications for clinical practice. This study aimed to provide insight into the intervention process by evaluating (1) the representativity of the study population, (2) patient and physician use patterns, (3) patient adherence to the intervention, and (4) clinical engagement. A process evaluation determining the reach, dose, fidelity, and clinical engagement was carried out, alongside a multicenter randomized controlled trial (RCT). We developed and implemented an intervention using PRO measures to monitor outpatients remotely. Data were collected for the PRO intervention arms in the RCT from 4 sources: (1) PRO data from the participants to determine personal factors, (2) the web-based PRO system to identify key usage intervention patterns, (3) medical records to identify clinical factors relating to the use of the intervention, and (4) semistructured interviews conducted with involved physicians. Of the 320 patients invited, 152 (47.5%) accepted to participate. The study population reflected the target population. The mean adherence rate to the PRO intervention arms was 82% (95% CI 76-87). The questionnaire response rate was 539/544 (99.1%). A minority of 13 (12.9%) of 101 patients needed assistance to complete study procedures. Physicians assessed 477/539 (88.5%) of the questionnaires. Contact was established in 417/539 (77.4%) of the cases, and 122/539 (22.6%) of the patients did not have contact. Physicians initiated 288/417 (69.1%) and patients requested 129/417 (30.9%) of all the contacts. The primary causes of contact were clinical data (242/417, 58%), PRO data (92/417, 22.1%), and medication concerns and precautionary reasons (83/417, 19.9%). Physicians found the use of PRO measures in remote follow-up beneficial for assessing the patient's health. The inclusion of self-reported clinical data in the questionnaire motivated physicians to assess patient responses. However, some barriers were emphasized, such as loss of a personal relationship with the patient and the risk of missing important symptoms in the absence of a face-to-face assessment. This study demonstrates the importance and practical use of remote monitoring among patients with CKD. Overall, the intervention was implemented as intended. We observed high patient adherence rates, and the physicians managed most questionnaires. Some physicians worried that distance from the patients made it unfeasible to use their "clinical glance," posing a potential risk of overlooking crucial patients' symptoms. These findings underscore key considerations for the implementation of remote follow-up. Introducing a hybrid approach combining remote and face-to-face consultations may address these concerns. ClinicalTrials.gov NCT03847766; https://clinicaltrials.gov/study/NCT03847766.

KEMAMPUAN NUMERASI LEVEL 3; SURVEI TERHADAP PESERTA DIDIK SEKOLAH DASAR DI KOTA KUPANG

Numeracy ability is one of the abilities that students need to have to be able to overcome problems related to mathematical logic. The results of the PISA survey stated that Indonesia is classified as a country with the numeracy ability of students that has not been maximized. Meanwhile, to be more specific, the numeracy ability of students in areas spread throughout Indonesia is not clearly known. This research method is quantitative research, with a survey type. The subjects in this study were 364 students from elementary schools spread across Kupang City. Data collection was carried out using test techniques with a total of 15 numeracy test questions. The collected data was analyzed using descriptive statistics so that the average and distribution of the frequency of numeracy skills of students in elementary schools in Kupang City was known based on the level of their levels. The results showed that as many as 157 students or 45.35% had numeracy skills at level 3, namely being able to choose and apply simple problem-solving strategies; 143 respondents or 41.33% have numeracy skills at level 2, namely being able to use formulas, carry out procedures or agreements in solving problems; and the remaining 46 respondents or 13.29% have numeracy skills in Level 1 is being able to identify information and complete routine procedures according to clear instructions for the situation

History and evolution of the laryngectomy

Total laryngectomy remains the gold standard for advanced laryngeal cancer to which all other treatments must be compared, benefitting from over 150 years of technical advancements since first performed by Theodor Billroth in 1873. The treatment paradigm has evolved with advances in both nonsurgical and surgical laryngeal preservation. The tenets of treatment, weighing oncologic outcome with functional and quality of life outcomes, have remained the same. This article reviews the history of laryngectomy, progression of surgical techniques, concurrent advancements in vocal rehabilitation, and role of complete and partial laryngectomy procedures in the current era.

Acute Knee Crutch Use Provokes Changes to Postural Strategy.

Single-leg knee crutches are a relatively new, hands-free mobility assistive device with benefits over standard axillary crutches. Our main goal in this study was to evaluate balance ability in a healthy population upon first exposure to the knee crutch device. We had 20 healthy individuals (M age = 21.1; SD = 1.5years) complete baseline static and dynamic balance tests on a force plate, followed by knee crutch fitting, a self-selected duration of ambulation practice, and another round of balance testing while wearing the knee crutch. We used the BTrackS Balance Test (BBT) to measure static balance, and the BTrackS Limits of Stability (BLOS) test to measure dynamic balance, and we created a custom lateral bias score from the BLOS results. On average, participants self-selected 3.1minutes of ambulation practice. Wearing the knee crutch caused a near doubling of static balance path length and a large reduction in percentile ranking on the BBT. Dynamic balance area was more than halved (p < .001), with lateral bias scores during the BLOS, indicating that participants heavily favored their non-crutched leg (p < .001). Our results indicate that static and dynamic balance were significantly altered when wearing the knee crutch, and participants seemed to switch to a single leg stance strategy. Despite these balance changes, participants were quickly ready and willing to complete independent ambulation and balance testing procedures using the single-leg knee crutch.