Comprehensive Procedure Research Articles

Sample preparation for suspect and non-target screening of xenobiotics in human biofluids by liquid chromatography—High resolution tandem mass spectrometry

The concept of exposome covers all the exposures an individual suffers from conception to death, which can be partially assessed through the monitoring of human biofluids. In there, target analytical approaches tend to focus on a limited set of xenobiotics, whereas exposomic studies need broad scopes in search of a full understanding. Given the issue, suspect and non-target screening are feasible alternatives. However, adequate sample preparation procedures should minimize interferences without significantly reducing the number of xenobiotics. Within this context, the present article aims to describe comprehensive sample preparation procedures for suspect or non-target screening of organic xenobiotics in several human biofluids, all coupled to unified separation and detection conditions based on ultra-high performance liquid chromatography-high resolution tandem mass spectrometry (UHPLCHRMS/MS). The referred biofluids consist of human urine, breast milk, saliva and ovarian follicular fluid.•Analytical methods for untargeted analysis of a wide range of xenobiotics in human biofluids are fully described in order to ensure reproducibility.•The sample preparation procedures balance selectivity and sensitivity.•Unified analysis conditions allow simultaneous analysis of diverse biofluids.

Exploring Current Practices, Needs, and Barriers for Expanding Distributed Medical Education and Scholarship in Psychiatry: Protocol for an Environmental Scan Using a Formal Information Search Approach and Explanatory Design.

Distributed medical education (DME) offers manifold benefits, such as increased training capacity, enhanced clinical learning, and enhanced rural physician recruitment. Engaged faculty are pivotal to DME's success, necessitating efforts from the academic department to promote integration into scholarly and research activities. Environmental scanning has been used to gather, analyze, and apply information for strategic planning purposes. It helps organizations identify current practices, assess needs and barriers, and respond to emerging risks and opportunities. There are process models and conceptual frameworks developed for environmental scanning in the business and educational sectors. However, the literature lacks methodological direction on how to go about designing and implementing this strategy to guide research and practice in DME, especially in the psychiatry field. This paper presents a protocol for an environmental scanning that aims to understand current practices and identify needs and barriers that must be addressed to facilitate the integration of psychiatrists from the Dalhousie University Faculty of Medicine's distributed education sites in Nova Scotia and New Brunswick into the Department of Psychiatry, contributing for the expansion of DME in both provinces and informing strategic planning and decision-making within the organization. This protocol adopts an innovative approach combining a formal information search and an explanatory design that includes quantitative and qualitative data. About 120 psychiatrists from 8 administrative health zones of both provinces will be invited to complete an anonymous web-based survey with questions about demographics, participants' experience and interest in undergraduate, postgraduate, and continuing medical education, research and scholarly activities, quality improvement, and knowledge translation. Focus group sessions will be conducted with a purposive sample of psychiatrists to collect qualitative data on their perspectives on the expansion of DME. Results are expected within 6 months of data collection and will inform policy options for expanding Dalhousie University's psychiatry residency and fellowship programs using the infrastructure and human resources at distributed learning sites, leveraging opportunities regionally, especially in rural areas. This paper proposes a comprehensive environmental scan procedure adapted from existing approaches. It does this by collecting important characteristics that affect psychiatrists' desire to be involved with research and scholarly activities, which is crucial for the DME expansion. Furthermore, its concordance with the literature facilitates interpretation and comparison. The protocol's new method also fills DME information gaps, allowing one to identify insights and patterns that may shape psychiatric education. This environmental scan's results will answer essential questions about how training programs could involve therapists outside the academic core and make the most of training experiences in semiurban and rural areas. This could help other psychiatry and medical units outside tertiary care establish residency and fellowship programs. DERR1-10.2196/46835.

Pandemic, Hoaxes and Information Security of Kazakhstan

ABSTRACT The growing share of information technologies in the daily lives of citizens of the Republic of Kazakhstan during the pandemic leads to the fact that various institutions use an increasingly wide range of information elements and mechanisms. The expectations of society are not only to improve the functioning of electronic administration, but also to ensure that all stored data is properly protected from unauthorized access, so that ensuring the security of information processing becomes one of the most important tasks of the State and the public. The purpose of the study is to consider aspects of the functioning of information security in the Republic of Kazakhstan during the pandemic and to identify the factors of reliable information security by state policy in order to distinguish hoaxes from real malicious actions. The methodological approach of the research is institutional, structural–functional, and systemic. Improper management of information security can lead to leakage, loss, or falsification of stored data, paralyzing completely relevant activities. Kazakhstan has made notable advancements in establishing a comprehensive legal framework for cybersecurity, positioning itself ahead of certain Central Asian neighbors. Government agencies develop, install, implement, operate, monitor, and analyze an information security management system, ensuring confidentiality, accessibility, and integrity of information. Information security requires the establishment of comprehensive procedures for all ongoing processes, taking into account the use of personal data. Information is an integral part of society, acting as a strategic resource for creating national security. Kazakhstan has been particularly active in forging collaborations and alliances to bolster their cybersecurity postures. The practical significance lies in the improvement of state measures aimed at protecting information, as well as preventing material, physical, moral, or other damage to the state and society as a result of information activities.

The effects of the spatial transformation and the dynamics of transportation systems of the city and its surroundings. A case study of Latakia

ABSTRACT Syrian coastal city, Latakia, is suffering from an urban sprawl towards the surrounding settlements. This research aims to investigate the spatial transformations and the role of transportation systems in the expansion of Latakia and its surroundings. The study was done by carrying out a statistical visualization of the changes in the number of transportation modes, the size of the population, and the spatial extent of the city expansion. Additionally, accessibility of the public transportation networks was measured using the ArcGIS network analyst tool. The research found that the transportation systems had been a major contributor to the transformations of the borders of Latakia. In addition to seeing an increased population and significant waves of migration to the city and its surroundings, Latakia city witnesses massive urbanization of its neighboring areas, since they have a high level of accessibility from the city. The local authorities are not able to control this massive urbanization. Therefore, these areas around the current administrative borders of Latakia are expected to be merged with the city as a result of further expansion. Comprehensive urban and transportation planning procedures could be put in place in these settlements to control the expansion of the city.

2024 Recommendations for Validation of Noninvasive Arterial Pulse Wave Velocity Measurement Devices.

Arterial stiffness, as measured by arterial pulse wave velocity (PWV), is an established biomarker for cardiovascular risk and target-organ damage in individuals with hypertension. With the emergence of new devices for assessing PWV, it has become evident that some of these devices yield results that display significant discrepancies compared with previous devices. This discrepancy underscores the importance of comprehensive validation procedures and the need for international recommendations. A stepwise approach utilizing the modified Delphi technique, with the involvement of key scientific societies dedicated to arterial stiffness research worldwide, was adopted to formulate, through a multidisciplinary vision, a shared approach to the validation of noninvasive arterial PWV measurement devices. A set of recommendations has been developed, which aim to provide guidance to clinicians, researchers, and device manufacturers regarding the validation of new PWV measurement devices. The intention behind these recommendations is to ensure that the validation process can be conducted in a rigorous and consistent manner and to promote standardization and harmonization among PWV devices, thereby facilitating their widespread adoption in clinical practice. It is hoped that these recommendations will encourage both users and developers of PWV measurement devices to critically evaluate and validate their technologies, ultimately leading to improved consistency and comparability of results. This, in turn, will enhance the clinical utility of PWV as a valuable tool for assessing arterial stiffness and informing cardiovascular risk stratification and management in individuals with hypertension.

Observed Precipitation Trends Inferred from Canada’s Homogenized Monthly Precipitation Dataset

Abstract This study first developed a comprehensive semiautomatic data homogenization procedure to produce gap-infilled and homogenized monthly precipitation data series for 425 long-term/critical stations in Canada, which were then used to assess Canadian historical precipitation trends. Data gaps in the 425 series were infilled by advanced spatial interpolation of a much larger dataset. The homogenization procedure repeatedly used multiple homogeneity tests without and with reference series to identify changepoints/inhomogeneities, the results from which were finalized by manual analysis using metadata and visual inspection of the multiphase regression fits. As a result, 298 out of the 425 data series were found to be inhomogeneous. These series were homogenized using quantile matching adjustments. The homogenized dataset shows better spatial consistency of trends than does the raw dataset. The improved gridding and regional mean trend estimation methods also provide more realistic trend estimates. With these improvements, Canadian historical precipitation trends were found to be dominantly positive and significant, except in central-south Canada where the trends are generally insignificant and small with mixed directions. For annual precipitation, the largest increases are seen in southeastern Canada and along the Pacific coast; however, the largest relative increases (in percent of the 1961–90 mean) are seen in northern Canada. The largest trend difference between northern and southern Canada is seen in winter, in which significant increases in the north were matched with significant decreases in the south. Significance Statement This study aims to produce a homogenized long-term monthly precipitation dataset for Canada, which is then used to assess Canadian historical precipitation trends. The work is important because it developed a comprehensive algorithm for homogenization of precipitation data, and the results provide better representation of precipitation climate and more robust estimates of precipitation trends. It also identified the causes for large biases in the published estimates of precipitation trends over Canada.

Elevating healthcare through artificial intelligence: analyzing the abdominal emergencies data set (TR_ABDOMEN_RAD_EMERGENCY) at TEKNOFEST-2022.

The artificial intelligence competition in healthcare at TEKNOFEST-2022 provided a platform to address the complex multi-class classification challenge of abdominal emergencies using computer vision techniques. This manuscript aimed to comprehensively present the methodologies for data preparation, annotation procedures, and rigorous evaluation metrics. Moreover, it was conducted to introduce a meticulously curated abdominal emergencies data set to the researchers. The data set underwent a comprehensive central screening procedure employing diverse algorithms extracted from the e-Nabız (Pulse) and National Teleradiology System of the Republic of Türkiye, Ministry of Health. Full anonymization of the data set was conducted. Subsequently, the data set was annotated by a group of ten experienced radiologists. The evaluation process was executed by calculating F1 scores, which were derived from the intersection over union values between the predicted bounding boxes and the corresponding ground truth (GT) bounding boxes. The establishment of baseline performance metrics involved computing the average of the highest five F1 scores. Observations indicated a progressive decline in F1 scores as the threshold value increased. Furthermore, it could be deduced that class 6 (abdominal aortic aneurysm/dissection) was relatively straightforward to detect compared to other classes, with class 5 (acute diverticulitis) presenting the most formidable challenge. It is noteworthy, however, that if all achieved outcomes for all classes were considered with a threshold of 0.5, the data set's complexity and associated challenges became pronounced. This data set's significance lies in its pioneering provision of labels and GT-boxes for six classes, fostering opportunities for researchers. The prompt identification and timely intervention in cases of emergent medical conditions hold paramount significance. The handling of patients' care can be augmented, while the potential for errors is minimized, particularly amidst high caseload scenarios, through the application of AI. • The data set used in artificial intelligence competition in healthcare (TEKNOFEST-2022) provides a 6-class data set of abdominal CT images consisting of a great variety of abdominal emergencies. • This data set is compiled from the National Teleradiology System data repository of emergency radiology departments of 459 hospitals. • Radiological data on abdominal emergencies is scarce in literature and this annotated competition data set can be a valuable resource for further studies and new AI models.

Developing a digital informed consent app: opportunities and challenges of a new format to inform and obtain consent in public health research

BackgroundInformed consent procedures for large population-based cohort studies should be comprehensive and easy-to-use. This is particularly challenging when participants from different socio-economic groups and multicultural ethnic backgrounds are involved. Recently, more and more studies have tried to use multimedia in informed consent procedures. We describe the development and testing of a digital informed consent app and elaborate on whether this may contribute to a comprehensive and practical procedure to obtain informed consent for public health research.MethodsIn a sample of parents with young children, we used a mixed method approach to study the user experience of an informed consent app and evaluate whether it can be used to adequately inform people and register their consent. Through semi-structured interviews we investigated participants’ experiences with and opinions about the app, with a special focus on comprehensibility of the content and the usability of the app. Information retention questions were asked to evaluate to what extent participants could recall key aspects of the provided study information.ResultsThe 30 participants in this study used the app between 4 and 15 min to give their consent. Overall, they found the app well-designed, informative and easy to use. To learn more about the study for which informed consent is asked, most of the participants chose to watch the animated film, which was generally found to convey information in a clear manner. The identification process was met with mixed reactions, with some feeling it as a secure way to give consent, while for others it contradicted their view of using data anonymously. Information retention questions showed that while all participants remembered various aspects of the study, fewer than half answered all four questions satisfactorily.ConclusionOur study shows that a well-designed informed consent app can be an effective tool to inform eligible participants and to record consents. Still, some issues remain, including trust barriers towards the identification procedure and lack of information retention in some participants. When implementing consent procedures that incorporate digital formats, it may be beneficial to also invest in a complementary face-to-face recruitment approach.

A coupled level-set and tangent of hyperbola interface capturing (THINC) scheme with a single-step time integration for incompressible flows

In this paper, we present a concise and efficient interface capturing scheme on polyhedral unstructured mesh with its numerical implementation for incompressible fluid simulation with surface tension. The so-called coupled Level-Set and Tangent of Hyperbola INterface Capturing scheme with a Consistent Single-step time integration (THINC/CSLS) updates both the volume-of-fluid (VOF) and level-set function simultaneously from a THINC reconstruction function. The proposed scheme has the potential to integrate the positive aspects of mass conservation from the VOF method and the accurate geometric representation from the level-set method. Other innovative and noteworthy aspects of the present scheme are listed as (1) an adaptive THINC reconstruction strategy is applied to ensure the boundness of the VOF function for various Courant–Friedrichs–Lewy (CFL) numbers and the high quality of the level-set function for surface tension; (2) a single-step update procedure for both VOF and level-set function is implemented for better algorithmic consistency and efficiency; (3) a well-adapted numerical model is developed for incompressible simulation with free surface for both structured and unstructured grids. A comprehensive numerical procedure is introduced and validated by various well-received benchmark tests. Convincing evidence suggests that the present scheme is both accurate and efficient compared with other most advanced methods.

Efficacy of Antibiotic Bone Cement in the Treatment of Burkholderia cepacia Infection After Spinal Internal Fixation Surgery: Case Report and Literature Review

In recent years, the number of spinal internal fixation operations has increased significantly, correlating with an elevated risk of postoperative surgical site infection and a rising incidence rate. While the conventional treatment approach involves surgical debridement combined with antibiotic administration, there is a notable gap in reported strategies for Burkholderia cepacia infection and patients exhibiting multidrug resistance. Surgical site infection occurred in a patient following internal fixation surgery for thoracic vertebral fractures. Despite the application of systemic antibiotics and regular dressing changes, no improvement was observed. Bacterial culture and drug sensitivity experiments revealed a multidrug-resistant Burkholderia cepacia infection. Two comprehensive debridement procedures were performed along with continuous post-operative irrigation combined with antibiotic administration; however, no significant improvement was observed. The patient's infection was significantly controlled following treatment with vancomycin loaded bone cement. Following spinal internal fixation surgery, the management of a B.cepacian infection with multidrug resistance presented a significant challenge, despite the application of debridement procedures and systemic antibiotics. In this case, after 20days of treatment with vancomycin-loaded bone cement, the patient's C-reactive protein level decreased to 54mg/L, was normalized by February, and normal levels were maintained in the surgical area 1month and 6months after bone cement removal. The use of vancomycin-loaded bone cement proves effective in treating postoperative B.cepacian infection in a multidrug-resistant case following spinal internal fixation surgery.

Efficacy and Safety of Distal Radial Artery Approach for Coronary Angiography: A Retrospective Study

Background: The distal radial artery approach has been employed as a potential alternative technique for coronary angiography. Nevertheless, its clinical implementation is significantly constrained by the narrow diameter of the radial artery. A comprehensive investigation of the efficacy and safety of the distal radial artery approach for coronary angiography is lacking. The objective of this study is to investigate the impact of the distal radial artery approach for coronary angiography and transradial artery access for interventional diagnosis and treatment. In addition, the effectiveness and safety of the distal radial artery approach for coronary artery angiography will be analyzed, for the wider adoption of this technique in clinical practice. Methods: A total of 68 patients with coronary heart disease (CHD) who underwent coronary catheterization via the left distal radial artery approach from December 2020 to December 2022 using the Distal radial artery approach (TRA) comprised the case-control study group. Seventy-three CHD patients who underwent routine left Transradial Artery Access coronary catheterization were selected as the Regular TRA group during the same period. Clinical data including age, body mass index (BMI), gender, CHD risk factors, routine drug treatment, ultrasonic-related indicators and operation-related indicators were collected from electronic medical records and the catheterization database from the two groups of patients. Results: The diameter and Endothelium-dependent vasodilation (noe FMD) of puncture vessels in the Distal TRA group were significantly lower than those in the Regular radial artery approach (TRA) group (p-value < 0.05). After a period of 48 hours following the catheterization, the puncture vessel diameter and flow-mediated dilation (FMD) of the Distal TRA group were significantly lower compared to those of the Regular TRA group (p-value < 0.05). The effectiveness of transradial artery access was then compared between the two groups. It was determined that the Distal TRA group exhibited significantly higher values in terms of the Visual Analog Scale (VAS) score, puncture time, and heparin usage, in comparison to the Regular TRA group (p-value < 0.05). The occurrence rates of local hematoma, mediastinal hematoma, retroperitoneal hematoma, pseudoaneurysm, arteriovenous fistula, vagal reflex, vasospasm, blood transfusion, and other complications among patients in the Distal TRA group were comparable to those in the Regular TRA group (p-value > 0.05). The incidence of puncture and X-ray radiation in the Distal TRA group was found to be marginally higher compared to the Regular TRA group. This study suggests that the safety profile of patients undergoing coronary artery catheterization via the distal radial artery is relatively higher than those undergoing the procedure via the transradial artery, although the difference was not statistically significant (p-value > 0.05). Conclusions: The Distal radial artery approach can be used for conducting comprehensive coronary interventional diagnosis and treatment procedures, offering benefits such as reduced postoperative compression time, better hemostasis through the distal radial artery approach, and enhanced patient comfort. This approach demonstrates favorable efficacy and safety, making it a suitable routine puncture method for clinical treatment.

Comprehensive Assessment Procedure for Metropolitan Drainage Pipe Network Considering Key Nodes

Comprehensive Assessment Procedure for Metropolitan Drainage Pipe Network Considering Key Nodes

Irradiated and radioactively contaminated foods: Analysis of EU RASFF notifications from 1997 to 2022

Food irradiation technique is an authorized tool used on a commercial scale in many countries to preserve different types of foodstuffs from deterioration caused by microorganisms, insects, and metabolic activity to prolong their shelf life without leaving any residual effect on processed foods, unlike preservatives and pesticides. This study was carried out to analyse the EU Rapid Alert System for Food and Feed (RASFF) notifications on food radiation from 1997 to 2022 in order to identify the most frequently reported products, their origin countries and associated reasons for notification, as well as the most notifying countries, product categories, notification classification, risk decisions, and actions taken. A total of 488 notifications were recorded during this time period. China was the most frequently notified origin country, accounting for 19.88% of all notifications, followed by the United States (11.68%), Russia (7.99%), Vietnam (7.17%), and Poland (5.53%). The top notified product categories were “dietetic foods, food supplements, and fortified foods” (37.09%), followed by fruits and vegetables (23.16%), herbs and spices (8.81%), and prepared dishes and snacks (5.53%). The top 5 notified products were food supplements (25.00%), mushrooms (20.70%), noodles (7.58%), tea (4.51%), and spices (3.69%). The four main reasons for food radiation notifications were unauthorized irradiation (57.58%), too high levels of radioactivity (22.34%), unlabeled irradiation (19.47%), and unauthorized facilities (14.96%). Too many notifications included more than one reason for the notification. Out of 109 notifications related to too-high levels of radioactivity (up to 10755 Bq/kg), 101 were due to the presence of 137Cs, 134Cs, 60Co, and 48Cd in mushrooms, mainly originating from Poland (25), Bulgaria (24), Ukraine (15), and Belarus (12). Such studies provide the necessary data to ensure food safety and encourage countries to implement comprehensive procedures to protect consumers health.

Mechanical characterisation of cementitiously stabilised moorum for use as structural layers in paving road construction

Due to the depletion of supplies for high-quality aggregates, it has become necessary to incorporate marginally soft materials like moorum in pavement structural layers. This study aimed to investigate the mechanical characteristics of cementitiously stabilised moorum materials (CSMM), which would be relevant during the mechanistic design of pavements. The tests includes the unconfined compressive strength, california bearing ratio in a soaked state, flexural strength, indirect tensile strength, durability and shrinkage behaviour through a comprehensive laboratory investigation procedure. In this investigation, the collected moorum sample was from Bihar, the eastern state of India. Relationships between various mechanical characteristics have been developed for pavement analyses. The properties are achieved as per standards to study the behaviour of the pavement structures. Based on the research findings, the effectiveness of the strength and shrinkage characteristics in determining the acceptability of CSMM as a road base and subbase applications have been discussed.

Use of Injectable Platelet-Rich Fibrin Accompanied by Bone Graft in Socket Endurance: A Radiographic and Histological Study.

Background Ridge preservation became a crucial dental health issue and strategy to keep away from ridge defacement after post-tooth loss. The recent scientific evolution of platelet-rich fibrin (PRF) comprises a parenteral formulation of PRF. The combined allograft for socket preservation gives benefits. In this study, bone allografts, demineralized freeze-dried bone allografts (DFDBA) and freeze-dried bone allografts (FDBA) are used in a 30:70 ratio alone or in combination with injectable PRF (I-PRF) for socket preservation. Methods This study is a radiographic and histological examination conducted on 60 participants aged between 19-65 years. Participating patients agreed voluntarily that theywould not bear any fixed prosthesis for the next nine months and plan for implantedteethplacement, including multi-rooted mandibular molars denticles. Both groups received atraumatic extraction; then, the socket was preserved with bone allograft alone in the control group and bone allograft mixed with I-PRF, forming sticky bone, in the experimental group. Clinical, radiological, and histological assessments were taken at the inception stage, three months, six months, and nine months. A multivariate regression model and a generalized estimating equation (GEE) model were used to analyse the effects of these changes on outcomes. Results In all the parameters, the test group indicated a good amount of bone growth with increasing intervals of time for bone height radiographically with statistically significant difference present (p<0.05) and histologically after nine months when socket site grafted with bone graft in combination with I-PRF. Conclusion This study's results demonstrated thatI-PRF possesses the potential to regenerate and healin the tooth-extracted socket. This study further recommends the implementation of I-PRF in safeguarding and conserving the raised rim of the tooth. Future research should take place on the osteogenic capability of I-PRF in more comprehensive ridge accession surgical procedures and additional expanding and improving capacities in periodontal reconstruction.

A network system for the prevention and treatment of mushroom poisoning in Chuxiong Autonomous Prefecture, Yunnan Province, China: implementation and assessment

BackgroundMushroom poisoning is a major public health issue in China. The integration of medical resources from different institutes of different levels is crucial in reducing the harm of mushroom poisoning. However, few studies have provided comprehensive implementation procedures and postimplementation effectiveness evaluations. To reduce the harm caused by mushroom poisoning, a network system for the prevention and treatment of mushroom poisoning (NSPTMP) was established in Chuxiong, Yunnan Province, a high-risk area for mushroom poisoning.MethodsThe NSPTMP consists of three types of institutions, namely, centers for disease prevention, hospitals, and health administration departments, with each kind of institution comprising prefecture, county/city, town, and village levels. After three years of implementation, the network was evaluated by comparing the indices before and after network implementation using data from the “Foodborne Disease Outbreak Surveillance System” and 17 hospitals in Chuxiong. The indices included the fatalities caused by mushroom poisoning, the composition ratios of different types of mushrooms for both outpatients and inpatients and the hospitalization rates.ResultsCompared to the average fatality rate of mushroom poisoning from 2015 to 2017, the average fatality rate from 2018 to 2020 significantly decreased from 0.57 to 0.06% (P < 0.001). Regarding the poisonous genus containing lethal mushrooms, the outpatient and inpatient composition ratios significantly decreased for Amanita (9.36–2.91% and 57.23–17.68%, respectively) and Russula (15.27–8.41%) (P < 0.05). Regarding poisonous mushrooms that caused mild symptoms, the outpatient and inpatient composition ratios significantly increased for Scleroderma (5.13–13.90% and 2.89–18.90%, respectively) and Boletaceae (19.08–31.71%) (P < 0.05), and the hospitalization rates significantly increased for Scleroderma (6.33–18.02%) and Boletaceae (5.65–12.71%) (P < 0.05).ConclusionsThese findings suggest that the NSPTMP effectively reduced the harm caused by mushroom poisoning. In addition to the integration of medical resources, the development of poisonous mushroom identification, hierarchical treatment systems in hospitals, public education, and professional training also played important roles in improving the system’s effectiveness. The establishment and evaluation of the NSPTMP in Chuxiong Prefecture can provide valuable insights and serve as a model for other regions facing similar challenges in managing mushroom poisoning.

Long-term outcome of minimally invasive staging surgery for clinical stage I endometrial cancer: A single institute experience in Taiwan.

Endometrial cancer is the most common gynecological cancer in developed countries. With recent advances in equipment and knowledge, minimally invasive surgery (MIS) is widely accepted for the treatment of endometrial cancer. This study had the largest number of cases to date in Taiwan, comparing outcomes between MIS and laparotomy staging surgery using real-world data with long-term follow-up. We retrospectively reviewed patients with clinical stage 1 endometrial cancer from 2009 to 2020 in our institute. All patients underwent comprehensive surgical staging procedures by MIS or laparotomy. The safety, morbidity, progression-free survival (PFS), and overall survival (OS) rates of the two groups were compared. Clinical and pathologic factors were compared with Chi-square and Fisher Exact test. PFS and OS were estimated by the Kaplan-Meier method. Differences between survival curves were analyzed using the log-rank test. A p value of <0.05 was considered statistically significant. Using Cox proportional hazards models, all factors found to be significantly associated with risk of recurrence on univariate analyses were then assessed together through multivariable models, resulting in a final oncologic outcome between MIS and laparotomy. A total of 665 cases (412 cases in MIS group and 253 cases in laparotomy group) were enrolled for data analysis. Median operation time was shorter in MIS group (244 and 265 minutes, p < 0.001). Median blood loss was also less (75 and 430 mL, p < 0.001). Median postoperative hospitalization duration was longer in the laparotomy group (2 and 7 days, p = 0.001). After adjusting presurgery risk factors, the PFS and OS were no significant difference in MIS and laparotomy groups. Using real-world data with long-term follow-up, we could confirm excellent PFS and OS in selective patients with clinical stage 1 endometrial carcinoma who received MIS, and the surgical time, hospital day, and blood loss were also less.

A Whole Education Approach to Education Reform in Barbados: Effective Provision for Students with Special Educational Needs and Disabilities

Improving education provision for children with special educational needs and disabilities in Barbados is the focus of this article. It takes into account the wider historical and educational context and uses a whole education approach to conduct the analysis and propose transformation of the education system, involving three key components. First, abandoning the system of selective secondary education based on the results of a high-stakes examination, the 11 plus, and replacing it with a more equitable system of geographical zoning. Second, revamping curricula at primary and secondary schools to emphasise the development of literacy, numeracy, interpersonal and vocational skills rather than focusing mainly on preparing students for academic examinations, especially the 11 plus examination. Third, implementing comprehensive policy and procedures for the identification and effective education of children with special educational needs and disabilities in order to maximise outcomes for all students.

RNA-Based Strategies for Cancer Therapy: In Silico Design and Evaluation of ASOs for Targeted Exon Skipping.

Precision medicine in oncology has made significant progress in recent years by approving drugs that target specific genetic mutations. However, many cancer driver genes remain challenging to pharmacologically target ("undruggable"). To tackle this issue, RNA-based methods like antisense oligonucleotides (ASOs) that induce targeted exon skipping (ES) could provide a promising alternative. In this work, a comprehensive computational procedure is presented, focused on the development of ES-based cancer treatments. The procedure aims to produce specific protein variants, including inactive oncogenes and partially restored tumor suppressors. This novel computational procedure encompasses target-exon selection, in silico prediction of ES products, and identification of the best candidate ASOs for further experimental validation. The method was effectively employed on extensively mutated cancer genes, prioritized according to their suitability for ES-based interventions. Notable genes, such as NRAS and VHL, exhibited potential for this therapeutic approach, as specific target exons were identified and optimal ASO sequences were devised to induce their skipping. To the best of our knowledge, this is the first computational procedure that encompasses all necessary steps for designing ASO sequences tailored for targeted ES, contributing with a versatile and innovative approach to addressing the challenges posed by undruggable cancer driver genes and beyond.

A comprehensive procedure for pollen extraction from bat guano deposits in organic and detrital matrices

Although bat guano deposits have been proven to be excellent environmental archives for paleoecological and paleoclimate studies, the development of a standardized method specially catering to pollen extraction has received no attention so far. In general, the processing procedure is quite similar among published studies, but adjustments must be made regarding the proportion of organic and particulate matter in the guano deposit. In this study, we present step-by-step optimized sample processing methods for pollen analysis. These procedures first apply a chemical treatment for the removal of siliceous and organic material, followed by a sieving step to remove the remaining inorganic matter from those samples with high detrital content. Overall, our methods can efficiently remove particulate matter and improve the quality of the final residue, resulting in cleaner slides and better visualization of pollen and spores.•Remove humic acid and organic material with Potassium hydroxide.•Remove inorganic matter with hydrofluoric acid and sieving.•Concentrate and store the pollen residues in glycerin.