Consecutive Rounds Research Articles

ESSD-ESGAR best practice position statements on the technical performance of videofluoroscopic swallowing studies in adult patients with swallowing disorders.

Videofluoroscopic swallowing studies (VFSS) remain the gold standard for the instrumental assessment of oropharyngeal swallowing disorders alongside flexible endoscopic evaluation of swallowing (FEES), requiring a high standard of quality and correct implementation. The current best practice position statements aim to guide the clinical practice of VFSS in individuals experiencing swallowing disorders. An international expert consensus panel with expertise in oropharyngeal dysphagia, comprised of radiologists, speech-language therapists, otolaryngologists, and other professionals in the field, convened by the European Society of Swallowing Disorders (ESSD) and the European Society of Gastrointestinal and Abdominal Radiology (ESGAR), developed best practice position statements. They were established using an online Delphi methodology involving an online panel discussion and item preparation and three consecutive rounds. Consensus was reached when ≥ 80% of the participants agreed on a specific recommendation. Eighteen best practice position statements were formulated, thereby establishing standard recommendations on the technical performance of VFSS. They cover VFSS planning, correct implementation, documentation, radiation protection, equipment and maintenance, and education and training. These position statements summarise the panel's deliberations and recommendations in performing VFSS, representing the agreed consensus of experts from ESSD and ESGAR. They provide a structured framework for optimising and standardising the performance of VFSS in patients with swallowing disorders. Question Significant regional and national differences in clinical practice when performing VFSS highlight the need for interdisciplinary recommendations to optimise patient care. Findings Eighteen statements were developed by representatives of the ESSD and the ESGAR. Clinical relevance These best practice position statements on the technical performance of VFSS may serve as a basis for standardising the procedure and ensuring high-quality service.

FGRL: Federated Growing Reinforcement Learning for Resilient Mapless Navigation in Unfamiliar Environments

In this paper, we propose a federated growing reinforcement learning (FGRL) approach for solving the mapless navigation problem of unmanned ground vehicles (UGVs) facing cluttered unfamiliar obstacles. Deep reinforcement learning (DRL) has the potential to provide adaptive behaviors for autonomous agents through interactive learning, but standard episodic DRL algorithms often struggle with out-of-distribution observations. For navigation tasks, UGVs often encounter unfamiliar situations where novel obstacles differ from prior experience. To address this problem, the proposed FGRL approach enables multiple agents to obtain their individual navigation models in diverse scenarios, and achieves online knowledge aggregation to obtain an adaptive and resilient model that copes with unfamiliar uncertain obstacles. Specifically, during the learning process of navigation tasks, we introduce the growth rate of each agent’s local model based on the performance of consecutive learning rounds. Then, we weight the local model of each agent based on the growth rate to achieve knowledge aggregation in a shared model. We also consider a growth threshold to eliminate the interference of low-quality local models. We carry out extensive simulations to validate the proposed solution, and the results show that our approach can learn resilient behaviors of collision avoidance for UGVs to cope with never encountered and cluttered unfamiliar obstacles.

The Lamella Ostium Extent Mucosa (LOEM) system: a new classification and pilot study for endoscopic sinus surgery

Abstract Purpose This study proposes the Lamella Ostium Extent Mucosa (LOEM) system as a compact and user-friendly classification for endoscopic sinus surgery (ESS), based on surgical bone extension and mucosal management, aiming to resolve inconsistencies in describing surgical techniques and extension levels, and to enhance comparability of outcomes in chronic rhinosinusitis (CRS). Methods LOEM uses a lettering system representing a specific topographical level: L identifies the lamellae, O the ostia, E the opening of the sinus walls, and M the mucosal approach. Eleven CRS surgical cases were independently evaluated by seven rhinologists following a Delphi method in two consecutive rounds. Consensus was assessed using Cohen's kappa. Results A substantial agreement was found among the experts (κ = 0.77) in the first round, although the M item only showed fair agreement (κ = 0.37). Clarifications for this item were given in the second round, after which, the overall agreement increased to κ = 0.81 and to κ = 0.79 for the M item. A decrease in agreement from substantial to moderate for O and E items in the second round was found. Test–retest analysis showed an almost perfect agreement (92.96%, κ = 0.82). In this study, a web-based app is provided to assist with the regular use of the LOEM system. Conclusions The LOEM system provides a compact, comprehensive code for ESS, integrating anatomical and functional aspects to represent surgical techniques described so far. This system may be suitable for facilitating communication between surgeons and collecting robust labeled data, hopefully leading to further standardization and validation of surgical approaches in future CRS studies.

Costs of colorectal cancer screening in Sweden: an observational, longitudinal cost description

ObjectiveColorectal cancer (CRC) screening programmes have been implemented worldwide, but the evidence of the economic consequences of screening programmes relies on data from short-term trials. The aim of this paper...

Trends in adherence to physical activity guidelines from 1997 to 2018 among adults with obesity: An analysis from the US National Health Interview Survey.

The aim of this study was to estimate the temporal trends in adherence rates to the physical activity (PA) guidelines for aerobic and muscle-strengthening activities (MSA) among United States(US) adults with obesity. We retrieved data from 22 consecutive rounds of the National Health Interview Survey (NHIS) conducted between 1997 and 2018. Meeting with the PA guidelines recommended by the World Health Organization was determined as follows: individuals achieving ≥150 weekly minutes of moderate physical activity (MPA), ≥75 weekly minutes of vigorous physical activity (VPA), and ≥2 weekly MSA training sessions. The prevalence of meeting PA guidelines increased from 9.4% in 1997 to 15.0% in 2018, although less than 2 in 10 adults with obesity met the guidelines throughout the study period. Overall, compared to females, males with obesity were more likely to adhere to PA recommendations (odds ratio (OR) = 2.03 [95% confidence interval (CI), 1.94 to 2.12]). Also, each age year significantly reduced the odds of adhering to PA recommendations overall (OR = 0.97 [95% CI, 0.97 to 0.98]). Compared with their White counterparts, Black and other races people with obesity have higher significant odds of adhering to PA recommendations with, respectively, OR = 1.18 (95% CI, 1.12 to 1.24) and OR = 1.30 (95% CI, 1.18 to 1.43). In representative samples of adults with obesity from the US, there was an increasing trend for meeting PA guidelines, although only less than 2 in 10 met them.

Development of a framework of interpersonal communication skills for MPharm students: a UK eDelphi study

Abstract Introduction The importance of communication skills for pharmacists in their daily activities, particularly in patient-centred care, is paramount. Effective healthcare, including complex tasks such as health promotion and medication reviews, heavily relies on quality communication. The GPhC emphasises the importance of graduates being able to employ communication skills in various settings1 although consensus on essential communication competencies in student pharmacist education is lacking. Aim To achieve consensus on a framework of interpersonal communication competencies for MPharm students. Method With approval from Keele University’s Research Ethics Committee, a draft interpersonal communication competency framework was developed after thorough literature review. Panellists with an interest in pharmacy education (including graduates, pharmacists and non-pharmacists) were invited to participate in an online three-round modified eDelphi study. Round 1 involved participants reviewing the draft framework, providing feedback on competency relevance/ wording and identifying missing competencies. Round 2 evaluated an updated framework for competency importance, with competencies needing 80% agreement to achieve consensus. Competencies without consensus underwent Round 3 review. Feedback was provided after each round. Results Panellists from across UK came from diverse pharmacy sectors like community, hospital, primary care, academia, industry, regulatory and education. In addition, there was as considerable participant experience, knowledge and expertise, which contributed distinct insights and viewpoints. The draft framework comprised 123 competencies across four Domains: Generic Communication (sub-divided into: organisation of an encounter, initiating and closing discussions, verbal and non-verbal communication, encouragement of person involvement, and adjusting communication based on contextual or cultural factors); Patient-Specific Communication (sub-divided into: gathering patient information and shared decision making); Peer Communication, and Other Communication (e.g., written). In total, 56, 49, and 47 participants completed each of the three consecutive rounds. In Round 1, over 500 comments prompted considerable amendments, including competency additions, removals, and mergers. This led to 126 competencies being rated for importance in Round 2 and 120 competencies (95%) were deemed important by at least 80% of eDelphi participants. Alongside competency ratings, an additional 130 comments were received, offering constructive insights. Six competencies that failed to achieve consensus in Round 2 underwent review again in Round 3. Subsequently, three more competencies failed to achieve consensus, resulting in a final agreed-upon framework of 123 competencies. Discussion This is the first competency framework developed for pharmacy student education. This study underscores the importance of interpersonal communication skills in pharmacy education and the experience of participants enriched the study, providing diverse and essential perspectives that were crucial in defining these competencies. The robustness of the iterative eDelphi process was instrumental in refining these competencies through multiple rounds. Although most competencies achieved consensus, a few contentious competencies underscored the challenges of aligning participant perspectives. The finalised framework, grounded in evidence-based development and stakeholder involvement, potentially serves as a flexible foundation for structuring pharmacy education curricula, but the scope of the study may face limitations, with the range of competencies either being too broad or too narrow, which could make implementation a challenge. Future research could focus on assessing these competencies across diverse healthcare settings. Reference 1. General Pharmaceutical Council, (2017). Standards for pharmacy professionals. Retrieved from https://www.pharmacyregulation.org/sites/default/files/standards_for_pharmacy_professionals_may_2017_0.pdf.

Dementia Prevalence, Incidence, and Mortality Trends Among U.S. Adults Ages 72 and Older, 2011-2021.

U.S.-focused studies have reported decreasing dementia prevalence in recent decades, but have not yet focused on the implications of the coronavirus disease 2019 (COVID-19) pandemic for trends. We use the 2011-2021 National Health and Aging Trends Study (N = 48 065) to examine dementia prevalence, incidence, and mortality trends among adults ages 72 and older, and the contribution to prevalence trends of changes in the distribution of characteristics of the older population ("compositional shifts") during the full and prepandemic periods. To minimize classification error, individuals must meet dementia criteria for 2 consecutive rounds. The prevalence of probable dementia declined from 11.9% in 2011 to 9.2% in 2019 and 8.2% in 2021 (3.1% average annual decline). Pre-pandemic declines continued for women and non-Hispanic White individuals and emerged over the 2011-2021 period for men and those ages 80-89. Declines in dementia incidence were stronger for the 2011-2021 period than for the prepandemic period, while mortality among those with dementia rose sharply with the onset of the COVID-19 pandemic. Shifts in the composition of the older population accounted for a smaller fraction of the decline over the full period (27%) than over the prepandemic period (45%). Declines in dementia prevalence continued into years marked by onset of the COVID-19 pandemic, along with declines in incidence and sharp increases in mortality among those with dementia. However, declines are no longer largely attributable to compositional changes in the older population. Continued tracking of dementia prevalence, incidence, and mortality among those with and without dementia is needed to understand long-run consequences of the pandemic.

Population dynamics of HIV drug resistance during treatment scale-up in Uganda: a population-based longitudinal study.

Clinical studies have reported rising pre-treatment HIV drug resistance during antiretroviral treatment (ART) scale-up in Africa, but representative data are limited. We estimated population-level drug resistance trends during ART expansion in Uganda. We analyzed data from the population-based open Rakai Community Cohort Study conducted at agrarian, trading, and fishing communities in southern Uganda between 2012 and 2019. Consenting participants aged 15-49 were HIV tested and completed questionnaires. Persons living with HIV (PLHIV) provided samples for viral load quantification and virus deep-sequencing. Sequence data were used to predict resistance. Population prevalence of class-specific resistance and resistance-conferring substitutions were estimated using robust log-Poisson regression. Data from 93,622 participant-visits, including 4,702 deep-sequencing measurements, showed that the prevalence of NNRTI resistance among pre-treatment viremic PLHIV doubled between 2012 and 2017 (PR:1.98, 95%CI:1.34-2.91), rising to 9.61% (7.27-12.7%). The overall population prevalence of pre-treatment viremic NNRTI and NRTI resistance among all participants decreased during the same period, reaching 0.25% (0.18% - 0.33%) and 0.05% (0.02% - 0.10%), respectively (p-values for trend = 0.00015, 0.002), coincident with increasing treatment coverage and viral suppression. By the final survey, population prevalence of resistance contributed by treatment-experienced PLHIV exceeded that from pre-treatment PLHIV, with NNRTI resistance at 0.54% (0.44%-0.66%) and NRTI resistance at 0.42% (0.33%-0.53%). Overall, NNRTI and NRTI resistance was predominantly attributable to rtK103N and rtM184V. While 10.52% (7.97%-13.87%) and 9.95% (6.41%-15.43%) of viremic pre-treatment and treatment-experienced PLHIV harbored the inT97A mutation, no major dolutegravir resistance mutations were observed. Despite rising NNRTI resistance among pre-treatment PLHIV, overall population prevalence of pre-treatment resistance decreased due to treatment uptake. Most NNRTI and NRTI resistance is now contributed by treatment-experienced PLHIV. The high prevalence of mutations conferring resistance to components of current first-line ART regimens among PLHIV with viremia is potentially concerning.

Cross-cultural adaptation and validation of the 2021 Louisiana Needs Assessment Questionnaire for Arabic-speaking people living with HIV

BackgroundDespite the global decline in HIV infections and mortality worldwide, the HIV epidemic is still growing in the MENA region. In the region, People Living with HIV (PLWH) are facing many challenges related to cultural values, norms, and provided services which create significant obstacles to HIV prevention and control efforts. This study aimed to translate, culturally adapt, and validate the “2021 Louisiana Needs Assessment Questionnaire” for use among Egyptians and Arabic-speaking population.MethodsArabic translation and cultural adaptation of the questionnaire passed through five stages. The questionnaire was translated forward and backward then an expert committee reviewed the translated version. Another expert committee reviewed the developed version after modification to assess the content validity using the Content Validity Index (CVI). The last step included a cognitive interview of a convenient sample of 50 adult PLWH in five consecutive rounds to assess subjects’ understanding of questions and response items and their meanings.ResultsModifications were carried out all through the translation and adaptation process of the questionnaire including used words, nomenclature of services, adding or omitting response items, and ordering of questions and response items. The synthesized Arabic-adapted questionnaire has adequate content validity and all questions are clearly understood by the studied subjects. The calculated Content Validity Index of all questionnaire items ranged from 0.82 to 1.ConclusionThe developed culturally adapted questionnaire has adequate content validity/semantic appropriateness. It can be used to assess the needs of PLWH in the MENA region with minor adaptations to fit each country. It can also be used to follow the outcome and impact of implemented programs and services. Further research is recommended to assess its psychometric properties.

Artificial Intelligence Algorithm for Subclinical Breast Cancer Detection

Early breast cancer detection is associated with lower morbidity and mortality. To examine whether a commercial artificial intelligence (AI) algorithm for breast cancer detection could estimate the development of future cancer. This retrospective cohort study of 116 495 women aged 50 to 69 years with no prior history of breast cancer before they underwent at least 3 consecutive biennial screening examinations used scores from an AI algorithm (INSIGHT MMG, version 1.1.7.2; Lunit Inc; used September 28, 2022, to April 5, 2023) for breast cancer detection and screening data from multiple, consecutive rounds of mammography performed from September 13, 2004, to December 21, 2018, at 9 breast centers in Norway. The statistical analyses were performed from September 2023 to August 2024. Artificial intelligence algorithm score indicating suspicion for the presence of breast cancer. The algorithm provided a continuous cancer detection score for each examination ranging from 0 to 100, with increasing values indicating a higher likelihood of cancer being present on the current mammogram. Maximum AI algorithm score for cancer detection and absolute difference in score among breasts of women developing screening-detected cancer, women with interval cancer, and women who screened negative. The mean (SD) age at the first study round was 58.5 (4.5) years for 1265 women with screening-detected cancer in the third round, 57.4 (4.6) years for 342 women with interval cancer after 3 negative screening rounds, and 56.4 (4.9) years for 116 495 women without breast cancer all 3 screening rounds. The mean (SD) absolute differences in AI scores among breasts of women developing screening-detected cancer were 21.3 (28.1) at the first study round, 30.7 (32.5) at the second study round, and 79.0 (28.9) at the third study round. The mean (SD) differences prior to interval cancer were 19.7 (27.0) at the first study round, 21.0 (27.7) at the second study round, and 34.0 (33.6) at the third study round. The mean (SD) differences among women who did not develop breast cancer were 9.9 (17.5) at the first study round, 9.6 (17.4) at the second study round, and 9.3 (17.3) at the third study round. Areas under the receiver operating characteristic curve for the absolute difference were 0.63 (95% CI, 0.61-0.65) at the first study round, 0.72 (95% CI, 0.71-0.74) at the second study round, and 0.96 (95% CI, 0.95-0.96) at the third study round for screening-detected cancer and 0.64 (95% CI, 0.61-0.67) at the first study round, 0.65 (95% CI, 0.62-0.68) at the second study round, and 0.77 (95% CI, 0.74-0.79) at the third study round for interval cancers. In this retrospective cohort study of women undergoing screening mammography, mean absolute AI scores were higher for breasts developing vs not developing cancer 4 to 6 years before their eventual detection. These findings suggest that commercial AI algorithms developed for breast cancer detection may identify women at high risk of a future breast cancer, offering a pathway for personalized screening approaches that can lead to earlier cancer diagnosis.

Carbonic anhydrase-embedded ZIF-8 membrane reactor with improved the recycling and stability for efficient CO2 capture

Carbonic anhydrase (CA) enzyme-based absorption technology for CO2 capture has been intensively investigated. However, low solubility of CO2 and poor stability of CA severely limits its industrial utilization. Here, hydrolyzed polyacrylonitrile (PAN) membrane (HPAN) was first modified by polyethyleneimine (PEI) with a large number of amino groups, which has a strong affinity for CO2. Then, ZIF-8 was grown in situ on the surface of HPAN/PEI membrane by using the metal chelation of PEI and Zn2+. In this process, CA was embedded inside ZIF-8 by co-precipitation (CA@HPAN/PEI/ZIF-8). The resultant CA@HPAN/PEI/ZIF-8 exhibited high catalytic activity for CO2 capture compared with free CA, which was due to the synergistic enhancement of CO2 capture by PEI and ZIF-8 with high affinity to CO2 and enzymatic catalysis. The yield of CaCO3 by CA@HPAN/PEI/ZIF-8 in the process of one-time conversion of CO2 was 13.6-fold higher than free CA. Furthermore, the CA@HPAN/PEI/ZIF-8 showed better thermal stability, storage and reusability than free CA. Free CA retained only 18.3 % of its original activity after 18 days of storage, whereas CA@HPAN/PEI/ZIF-8 remained 48.7 % of its original activity. The total CaCO3 yield by CA@HPAN/PEI/ZIF-8 was 74.9-fold that of free CA after 8 consecutive rounds of CO2 conversion.

The modernisation of newborn screening as a pan-European challenge – An international delphi study

Newborn screening is a public health measure to diagnose rare diseases at birth, thereby minimising negative effects of late treatment. Genomic technologies promise an unprecedented expansion of screened diseases at low cost and with transformative potential for newborn screening programmes. However, barriers to the public funding of genomic newborn screening are poorly understood, particularly in light of the heterogenous European newborn screening landscape. This study therefore aims to understand whether international newborn screening experts share a common understanding of the barriers to fund genomic newborn screening. For this purpose, we convened 21 European newborn screening experts across a range of professions and national backgrounds in a Delphi study. Stable consensus, determined via the Wilcoxon matched-pairs signed-ranks test, was found via three consecutive survey rounds for all presented barriers. Experts generally judged the scenario of genomic newborn screening being available to every newborn in seven years to be unlikely, identifying treatability and the absence of counselling and a skilled workforce as the most significant barriers to public funding. We identify value re-definition for rare disease treatments, centralisation of genomic expertise, and international research consortia as avenues for pan-European actions which build on the consensus achieved by our Delphi panel.

Combinatorial iterative method for metabolic engineering of Yarrowia lipolytica: Application for betanin biosynthesis

Combinatorial library-based metabolic engineering approaches allow lower cost and faster strain development. We developed a genetic toolbox EXPRESSYALI for combinatorial engineering of the oleaginous yeast Yarrowia lipolytica. The toolbox enables consecutive rounds of engineering, where up to three combinatorially assembled gene expression cassettes can be integrated into each yeast clone per round. The cassettes are integrated into distinct intergenic sites or an open reading frame of a target gene if a simultaneous gene knockout is desired. We demonstrate the application of the toolbox by optimizing the Y. lipolytica to produce the red beet color betanin via six consecutive rounds of genome editing and screening. The library size varied between 24 and 360. Library screening was facilitated by automated color-based colony picking. In the first round, betanin pathway genes were integrated, resulting in betanin titer of around 20 mg/L. Through the following five consecutive rounds, additional biosynthetic genes were integrated, and the precursor supply was optimized, resulting in a titer of 70 mg/L. Three beta-glucosidases were deleted to prevent betanin deglycosylation, which led to a betanin titer of 130 mg/L in a small scale and a titer of 1.4 g/L in fed-batch bioreactors. The EXPRESSYALI toolbox can facilitate metabolic engineering efforts in Y. lipolytica (available via AddGene Cat. Nr. 212682–212704, Addgene kit ID # 1000000245).

Association of aerobic and muscle-strengthening activity with chronic low back pain: population-based study

BACKGROUND CONTEXTChronic low back pain (CLBP) is a significant global health burden, primarily affecting the middle-aged and older; However, there is a lack of clear, evidence-based guidelines for leisure-time physical activity aimed at preventing CLBP. PURPOSEThis study sought to delineate the association between aerobic physical activity (APA) and muscle strengthening activities (MSA) and the prevalence of CLBP. STUDY DESIGNThis was a population-based study conducted across the United States. PATIENT SAMPLEThis nationwide study utilizes deidentified data from 22 consecutive rounds of the National Health Interview Survey (NHIS) from 1997 to 2018. OUTCOME MEASURESThe primary outcome was self-reported CLBP. METHODSWe analyzed the prevalence of CLBP in a representative sample of 324,793 middle-aged and older people. Among 263,871 individuals, we used multiple logistic regression to investigate individual and joint association between the amount of APA and MSA with CLBP. RESULTSIn total, 263,871 participants (mean age, 59.0 years; SD, 9.7) were included in the final analysis. From 1997 to 2018, the prevalence of CLBP was approximately 32%, with an annual increase. Engaging in APA for 75 to 150 minutes weekly was associated with a modest reduction in CLBP risk (OR [95% CI] = 0.97 [0.97–0.98]). Similar benefits were seen with 150 to 225, 225 to 300, and >300 minutes. Engaging in MSA 2 to 3 times and 4 to 5 times weekly also reduced CLBP risk (0.98 [0.98–0.99] and 0.98 [0.97–0.99], respectively). Optimal reductions of CLBP risk may be associated with balanced levels of APA and MSA, with recommended amounts being 225 to 300 min/w of APA and 4 to 5 times/w of MSA (0.92 [0.89–0.95]). CONCLUSIONSThe study found engaging in over 75 minutes of APA and 2 to 5 weekly MSA sessions is associated with a reduced risk of CLBP. Furthermore, a balanced combination of APA and MSA may correspond to the greatest reduction in CLBP risk.

The highly dynamic satellitomes of cultivated wheat species.

Durum wheat, Triticum turgidum, and bread wheat, Triticum aestivum, are two allopolyploid species of very recent origin that have been subjected to intense selection programs during the thousands of years they have been cultivated. In this paper, we study the durum wheat satellitome and establish a comparative analysis with the previously published bread wheat satellitome. We revealed the durum wheat satellitome using the satMiner protocol which is based on consecutive rounds of clustering of Illumina reads by RepeatExplorer2, and estimated abundance and variation for each identified satDNA with RepeatMasker v4.0.5. We have also performed a deep satDNA families characterization including chromosomal location by Fluorescence In Situ Hybridization (FISH) in durum wheat and its comparison with FISH patterns in bread wheat. Basic Local Alignment Search Tool (BLAST®) was used for trailing each satDNA in the assembly of durum wheat genome through NCBI's Genome Data Viewer (GDW) and the genome assemblies of both species were compared. Sequence divergence and consensus turnover rate (CTR) between homologous satDNA families of durum and bread wheat were estimated using MEGA11. This study reveals that in an exceedingly short period, significant qualitative and quantitative changes have occurred in the set of satellite DNAs (satDNAs) of both species, with expansions/contractions of the number of repeats and the loci per satellite, different in each species, and a high rate of sequence change for most of these satellites, in addition to the emergence/loss of satDNAs not shared between the two species analysed. These evolutionary changes in satDNA are common between species but what is truly remarkable and novel about this study is that these processes have taken place in less than the last ~8000 years separating the two species, indicating an accelerated evolution of their satDNAs. These results, together with the relationship of many of these satellites with transposable elements and the polymorphisms they generate at the level of centromeres and subtelomeric regions of their chromosomes, are analysed and discussed in the context of the evolutionary origin of these species and the selection pressure exerted by man throughout the history of their cultivation.

Conceptual shaking table tests for resilient segmental bridge columns with resettable sliding joints

The ever-increasing demand for accelerated construction of urban bridges or viaducts calls for more prefabrication with various joint schemes, while satisfying the need for seismic resilience. On the other hand, segmentation into components of various shapes and morphologies is common for multifunctional structures found in living organisms and ancient Chinese timber structures, which also inspires the development of resilient segmental bridge column design. To provide further insights into the cost-effective resilient design of precast bridge columns, this paper suggests the use of resettable sliding joints (RSJ) comprising lubricated gently-inclined joint interface with partially debonded tendon arrangement, essentially forming a hybrid sliding and rocking seismic isolation system of precast segmental structures. The deformability of the proposed design is high. Similitude analysis was conducted considering the rigid body behavior of individual segments under seismic input. It presents the conceptual shaking table testing of four 1:12 prestressed segmental column models fabricated with special three-dimensional (3D) printed plastic molds and interface treatment. A motion capture system was installed for accurate 3D displacement data acquisition and five typical major near-fault earthquake records were selected. Among all specimens, the RSJ segmental column could reach a high damping ratio of about 20 % during the tests, and it outperformed the others in many aspects: (i) a tolerable maximum top drift of about 1 %; (ii) a moderate percentage of transient rocking of about 20 %; (iii) an evenly distributed sliding displacement among all sliding joints; and (iv) negligible residual sliding drift at sliding joints. These superior attributes of RSJ segmental column are consistent under excitation of consecutive rounds of different major earthquake records, indicating high robustness as well as high seismic resilience in the design of RSJ segmental columns.

Deep abdominal breathing reduces heart rate and symptoms during orthostatic challenge in patients with postural orthostatic tachycardia syndrome.

This study investigated the effects of deep abdominal breathing on cardiovascular parameters and symptoms in patients with postural orthostatic tachycardia syndrome (POTS) during head-up tilt-table (HUT) challenge. Thirty POTS patients completed two consecutive rounds of 10-min HUT in a crossover design. One round was HUT without intervention, and one round combined the HUT with deep breathing at a rate of 6 breaths/min. Cardiovascular parameters, including mean blood pressure and maximum and mean heart rate (HR), were measured supine and standing. Symptoms were assessed using the Vanderbilt Orthostatic Symptom Score (VOSS). During the breathing technique, the mean HR increase was -7.35 bpm (95% confidence interval [CI] = -11.71 to -2.98), and the maximum HR increase was -6.27 bpm (95% CI = -11.85 to -0.68, p = 0.041), significantly lower compared to normal breathing. Additionally, improvements were observed in all absolute cardiovascular parameters during standing, with VOSS symptoms simultaneously and significantly decreasing by -5.38 (95% CI = -10.43 to -0.36). Slow deep abdominal breathing can act as a simple technique to reduce the standing HR increase upon HUT in patients with POTS. This suggests that modulation of the cardiopulmonary neurocircuits and the respiratory pump may reduce HR increase and symptoms in patients with POTS. The findings of this study highlight the use of a safe, zero-cost, and simple behavioral tool to suggest to POTS patients for symptom relief apart from standard treatment. The observed improvements in cardiovascular parameters and symptoms offer a promising therapeutic approach for patients in times of inadequate treatment options.

The European Universities Initiative: further stratification in the pursuit of European cooperation?

ABSTRACT The European Commission’s flagship European Universities Initiative (EUI) announced in 2017 laid out a novel regional approach to internationalisation by promoting the establishment of integrated transnational networks of universities, or alliances. Launched in consecutive pilot rounds, the EUI provided a fixed-sum grant to each alliance with the expectation that participating institutions and national governments co-fund their activities. Given the hierarchical structure of the European higher education space and varying national support for the Initiative, capacities of institutions to participate appear both unequal and exclusionary. This study draws on documentary evidence and interviews with EUI alliance representatives, exploring accounts from three distinct alliances from the 2019 pilot round. With nuances between the examined cases, it argues that the design of the EUI, intended as a vehicle for enhancing cooperation and excellence, intensifies vertical stratification of European higher education by supporting relatively advantaged institutions with respect to international partnership opportunities and resources.

Proficiency of phenotypic drug susceptibility testing for Mycobacterium tuberculosis in China, 2008-2021.

To analyze the results of proficiency testing for anti-tuberculosis drug susceptibility testing (DST) in China. Number of laboratory participating the proficiency testing performed DST, and the sensitivity, specificity, reproducibility, and accordance rate were calculated from data of 13 rounds proficiency testing results for DST from 2008 to 2021. A total of 30 and 20 strains of Mycobacterium tuberculosis with known susceptibility results were sent to each laboratory in 2008 to 2019, 2020 and 2021, respectively. The number of participating laboratories ranged from 30 in 2009 to 546 in 2021. L-J DST was the predominant method. The specificity presented relatively higher than sensitivity. Improvement of specificity were observed for all drugs through the years, while sensitivity did not show improvement for amikacin and capreomycin. Accordance rate of pyrazinamide and kanamycin and reproducibility of capreomycin and pyrazinamide were not significantly improved through the years. Most of the participating laboratories significantly improved the quality of their DST through the consecutive rounds of proficiency testing except for second-line injectable drugs and pyrazinamide. The results highlight the importance of developing novel and/or improving existing methods for phenotypic DST for certain drugs.

Development of an International Standard Set of Outcomes and Measurement Methods for Routine Practice for Infants, Children, and Adolescents with Epilepsy: The International Consortium for Health Outcomes Measurement Consensus Recommendations.

At present, there is no internationally accepted set of core outcomes or measurement methods for epilepsy clinical practice. The International Consortium for Health Outcomes Measurement (ICHOM) convened an international working group of experts in epilepsy, people with epilepsy, and their representatives to develop minimum sets of standardized outcomes and outcome measurement methods for clinical practice. Using modified Delphi consensus methods with consecutive rounds of online voting over 12 months, a core set of outcomes and corresponding measurement tool packages to capture the outcomes were identified for infants, children, and adolescents with epilepsy. Consensus methods identified 20 core outcomes. In addition to the outcomes identified for the ICHOM Epilepsy adult standard set, behavioral, motor, and cognitive/language development outcomes were voted as essential for all infants and children with epilepsy. The proposed set of outcomes and measurement methods will facilitate the implementation of the use of patient-centered outcomes in daily practice.