Cumulative Size Research Articles

A crushing index for granular soils based on comminution energy consumption theory

Particle crushing is a common phenomenon in granular soils, which can affect the physical and mechanical properties of soils. The index which used to quantify the amount of particle crushing is crucial for the relevant research. Based on Kick's comminution energy consumption theory, size potential regarding as a property of soil and representing the energy of particles in a certain state was defined in this study, and a crushing index was proposed based on it. This index was determined according to a density distribution of particle size that voids the problem of sieving error propagation when using a cumulative grain size distribution curve. The validation of the proposed crushing index showed that it could quantitatively describe the amount of particle breakage, regardless of material, gradation, test type and particle size scale. In addition, the proposed crushing index was considered as a soil property index and could be divided into two categories: the ultimate crushing index and the mobilized crushing index, where the mobilized crushing index is obtained from the ultimate crushing index by replacing the ultimate breakage state with the final breakage state. The test results showed that the mobilized crushing index was equivalent to the input energy ratio between current and final breakage states. This relationship contributes to the understanding of the evolution of the grading curve caused by particle breakage.

Optimization of Ball Milling Parameters for Efficient Copper Slag Valorization

The ball milling process increasingly employed in a symbiotic materials recovery context is associated with high environmental footprint due to its energy-intensive nature. The current paper addresses this issue by optimizing the milling of copper slag, recognized as a promising alternative resource within the construction sector. The slag was milled in a stirred mill using stainless-steel (SS), carbon-steel, and yttria-stabilized zirconia (YSZ) balls with(out) grinding aid (GA). The milling time and energy, besides milled slag properties, were monitored. Performance variations of different milling balls were explained through the impact theory. Results show that efficient size reduction happens in the first hours regardless of the ball material and diameter. In a specific surface area (SSA) between 3600-3800cm2/g (d50=11µm), substituting SS with YSZ balls decreased milling time and energy by ∼50%, comparable to processes performed with GA. The addition of smaller balls (Ø6.3mm) to bigger balls (Ø9.5mm) caused energy consumption to decrease starting from SSA=3200±100cm2/g and cumulative particle size to slightly reduce. The effect of the ball-to-slag ratio on the milling efficiency was found stronger than the ball diameter change. A strong influence of the parameter optimization on the ball milling efficiency was proposed, potentially benefiting powder production industries.

First worldwide report on safety and efficacy of using small 7.5 Fr scope for pediatric ureteroscopy: prospective pilot series from Europe.

Although pediatric urolithiasis remains relatively uncommon, its global prevalence is on the rise. Technological advances have led to miniaturization of instruments especially in the form of single use scopes. As the evidence on the use of small single use ureteroscopes in children is scarce, we have conducted a pilot two-center study to analyze the outcomes of pediatric patients treated with the Pusen 7.5 Fr single use scopes at our institutions. This study included consecutive pediatric patients with urinary stones treated with the small Pusen 7.5 Fr single use ureteroscope. The study was conducted at two large European tertiary endourology centers that specialize in pediatric kidney stone management. Patient data and outcomes were prospectively collected, and analysis was performed regarding patient demographics, stone parameters, as well as stone free rate (SFR), operating time, and complications. In this pilot study, 26 patients were included with a median age of 12 years (7.0-16.0) and a male to female ratio of 14:12. The mean cumulative stone size was 15.15 mm (SD ±11.1) and multiple stones were present in 9 (34.6%) patients. Pre-operative stent, access sheath and post-operative stent usage was done in 12 (46.2%), 23 (88.5%) and 13 (50%) patients respectively. The median operative time was 47 minutes (IQR: 40.0-63.8). Following the initial procedure 24 (92.3%) patients were stone free, while no intra or postoperative complications were observed. Our study demonstrates that the use of the small 7.5 single use ureteroscope is safe and efficient for the treatment of urinary stones in pediatric patients with high stone-free rates and no complications noted in our series. While this might become a standard of care in future, to confirm and validate our findings further studies with larger cohorts are warranted.

Transformative Precision: Investigative Summary of PET/CT-Guided Radiation Therapy Simulation in Comprehensive Cancer Management

Positron Emission Tomography/Computed Tomography (PET/CT)-guided radiation therapy simulation has transformed cancer treatment, ushering in enhanced precision and individualization. This discussion delves into clinical indications, applications, procedures, and limitations, providing a comprehensive overview across cancer types. 
 Clinical indications underscore PET/CT's role in accurate staging, target volume delineation, treatment response assessment, and post-treatment recurrence detection. Accurate staging is crucial for tailored treatment plans, while target volume delineation benefits from PET's identification of metabolic patterns. Ongoing treatment response assessment enables dynamic adjustments, and post-treatment, PET/CT aids in detecting recurrent disease. 
 Applications highlight PET/CT's treatment planning optimization by combining anatomical and functional information. Fusion of PET
 and CT images customizes radiation plans, identifying active regions for targeted delivery while sparing healthy tissues. This fusion facilitates tailored strategies, minimizing radiation exposure and enabling dynamic adaptations. 
 Procedural aspects detail imaging acquisition, image fusion, target delineation, treatment planning, and ongoing monitoring. Starting with radiotracer administration, typically fluorodeoxyglucose (FDG), PET/CT captures functional and anatomical data. Image fusion aids in target delineation and optimizing plans. Ongoing monitoring allows real-time adjustments. 
 Specific clinical applications across cancers demonstrate PET/CT's versatility. In head and neck cancers, it ensures precise delineation while avoiding critical structures. In lung cancer, it improves tumor extent identification. Similar advantages apply to lymphomas, sarcomas, brain tumors, metastatic disease, and esophageal, gastrointestinal, breast, prostate, gynecological, and pediatric cancers. 
 Limitations include spatial resolution challenges, false positives, cumulative radiation exposure, lesion size, histology, and standardization issues. Ongoing research targets spatial resolution enhancement, radiomics and AI integration, novel tracers, hybrid imaging, patient-specific dosimetry, clinical trials, multimodal workflows, cost-effectiveness, accessibility, and education. 
 PET/CT-guided radiation therapy simulation is transformative. Ongoing advancements promise a more precise and individualized approach, enhancing patient outcomes in cancer management.

Age estimation and boulder population analysis of the West crater at Apollo 11 landing site using Orbiter High Resolution Camera on board Chandrayaan-2 mission

Orbiter High Resolution Camera (OHRC) on-board Chandrayaan-2 had acquired a high-resolution image (∼0.26 m) covering Apollo 11 landing site, showing the Lander Module (LM) along with other small-scale features, such as boulders, etc. In the east of Apollo 11 LM lies the West crater, which has a rich population of boulders spread around it. We studied this boulder distribution around the West crater to estimate the age of the West crater and to understand the aspects related to the impact cratering and space weathering through the analysis of boulder distribution. For this, we identified and mapped >8500 boulders around the West crater using the OHRC image, out of which 6466 boulders (>∼1 m in size) lying within 1–5 crater radius were used for further analysis. For estimating the age of the West crater, we applied various methods based on crater morphology, boulder distributions and Diviner Rock Abundance. The age was estimated to be in the range of 80 Ma to 120 Ma with the most probable age close to 100 Ma, the same as that expected from the cosmic ray exposure dating. Boulder distribution around the West crater was found to be highly anisotropic with majority of boulders lying in the eastern to north-eastern direction, suggesting an impact at very low angle. Relationship between crater size and largest boulder size also pointed towards primary origin of the West crater. The Height (H) to Diameter (D) ratio is estimated to be ∼0.25 considering all the boulders with diameter ≤ 4m, going up to 0.38 with comparatively poor correlation for boulders with diameter > 4m. The H/D ratio from Apollo mission photos for boulders around Apollo 11 LM is found to be approximately double that of the corresponding measurements from the OHRC image. We also fit a Power law and the Weibull distribution to the cumulative Boulder Size Frequency Distribution (BSFD) curve with Maximum Likelihood (ML) method and Kolmogrov-Smirnoff (KS) statistics. Both fit well with R2 of 0.999, but varying minimum diameter (dKS) of 1.85 m and 1.64 m, respectively. The good fit by Power-law with high slope value (b = 4.61) describes the fragmentation due to the West crater forming impact as complex. However, the higher diameter tail was better explained by the Weibull fit implying sequential fragmentation of boulders with time.

Coronary Stent Infection: A Systematic Review of Literature.

Coronary stent infection is a rare yet serious complication of coronary artery stenting, with potentially significant morbidity and mortality. This systematic review aimed to comprehensively assess the available evidence on the diagnosis, management, and outcomes of coronary stent infection. A comprehensive search of electronic databases, including PubMed, Embase, Cochrane Library, and Scopus, was conducted from inception until March 2023, in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of 1 case series and 41 case reports, covering a cumulative sample size of 44 patients, were included in the analysis. The predominant stent types were drug-eluting stents in 22 studies, bare-metal stents in 3 studies, and a combination of drug-eluting stents and bare-metal stents in 4 studies. Staphylococcus aureus was the predominant identified organism in microbiological profiles. Primary outcomes, including mortality, morbidity, and recurrence rates, were evaluated. The aggregate mortality rate across studies was 18%, underscoring the severity of coronary stent infections. Morbidity ranged from 3% to 60%, with a spectrum of complications such as sepsis, heart failure, and embolic events. Recurrence rates varied from 3% to 33%, emphasizing the importance of effective management. Treatment strategies encompassed antibiotics alone, antibiotics with stent removal, and antibiotics with stent retention, with the duration of antibiotic therapy ranging from 2 weeks to 12 months. The optimal management strategy remains uncertain due to limited high-quality evidence. Early diagnosis and treatment were emphasized as critical factors in improving outcomes. Prophylactic antibiotics during stenting procedures and increased awareness among healthcare providers were suggested as preventive measures.

The efficacy of peritoneal flap fixation on symptomatic lymphocele formation following robotic-assisted laparoscopic radical prostatectomy with pelvic lymph node dissection: a systematic review and meta-analysis.

Pelvic lymphocele is the most common complication after robot-assisted radical prostatectomy (RARP) with pelvic lymph node dissection (PLND), of which symptomatic lymphocele (sLC) ranges up to 10% and is associated with poorer perioperative outcomes. Peritoneal flap fixation (PFF) is a promising intraoperative modification to reduce sLC formation but the clinical evidence failed to reach consistency. Randomized and nonrandomized comparative studies comparing postoperative sLC occurrence with or without PFF after RARP with PLND were identified through a systematic literature search via MEDLINE/PubMed, Embase, Web of Science, and CENTRAL up to July 2023. Outcome data of sLC occurrence (primary) and major perioperative events (secondary) were extracted. Mean difference and risk ratio with 95% CI were synthesized as appropriate for each outcome to determine the cumulative effect size. Five RCTs and five observatory studies involving 3177 patients were finally included in the qualitative and quantitative analysis. PFF implementation significantly reduced the occurrence of sLC (RR 0.35, 95% CI: 0.24-0.50), and the specific lymphocele-related symptoms, without compromised perioperative outcomes including blood loss, operative time, and major nonlymphocele complications. The strength of the evidence was enhanced by the low risk of bias and low inter-study heterogeneity of the eligible RCTs. PFF warrants routine implementation after RARP with PLND to prevent or reduce postoperative sLC formation.

A Meta-Analytical Review of the Determinants of Social Media Discontinuance Intentions

ABSTRACT The use of social media has grown tremendously, but a considerable number of individuals have stopped using it. This meta-analysis aims to examine the factors that contribute to discontinuing social media use by reviewing 88 studies with a cumulative sample size of 42,159, including 33 effect sizes. Our study reveals that various stressors, including messaging overload (CO), social overload (SO), information collection overload (IO), system feature overload (SFO), privacy concerns (PC), and negative emotions such as technostress, fatigue (SNF), guilt, and dissatisfaction, are significantly correlated with social media discontinuance (DUIN). It is worth noting that only gratifications were negatively associated with both discontinuance and fatigue, but not with all other inhibitors. Furthermore, self-disclosure (S-disc), social comparison (SC), and fear of missing out (FoMo), as well as addiction, were significantly associated only with fatigue. Theoretical and practical implications are discussed, emphasizing the importance of social media operators balancing content supply with actual user demand to prevent overload, negative emotions, and discontinuance.

Fully resolved assembly of Fusarium proliferatum DSM106835 genome

In the United Arab Emirates, sudden decline syndrome (SDS) is a destructive disease of date palm caused by the soil-borne fungal pathogen Fusarium proliferatum (Fp) DSM106835. Here, a high-resolution genome assembly of Fp DSM106835 was generated using PacBio HiFi sequencing with Omni-C data to provide a high-quality chromatin-organised reference genome with 418 scaffolds, totalling 58,468,907 bp in length and an N50 value of 4,383,091 bp from which 15,580 genes and 16,321 transcripts were predicted. The assembly achieved a complete BUSCO score of 99.2% for 758 orthologous genes. Compared to seven other Fp strains, Fp DSM106835 exhibited the highest continuity with a cumulative size of 44.26 Mbp for the first ten scaffolds/contigs, surpassing the assemblies of all examined Fp strains. Our findings of the high-quality genome of Fp DSM106835 provide an important resource to investigate its genetics, biology and evolutionary history. This study also contributes to fulfill the gaps in fungal knowledge, particularly the genes/metabolites associated with pathogenicity during the plant-pathogen interaction responsible for SDS.

Signatures of the Self-organized Criticality Phenomenon in Precursors of Gamma-Ray Bursts

Precursors provide important clues to the nature of gamma-ray burst (GRB) central engines and can be used to contain GRB physical processes. In this Letter, we study the self-organized criticality in precursors of long GRBs in the third Swift/Burst Alert Telescope catalog. We investigate the differential and cumulative size distributions of 100 precursors, including peak flux, duration, rise time, decay time, and quiescent time with the Markov Chain Monte Carlo technique. It is found that all of the distributions can be well described by power-law models and understood within the physical framework of a self-organized criticality system. In addition, we inspect the cumulative distribution functions of the size differences with a q-Gaussian function. The scale-invariance structures of precursors further strengthen our findings. Particularly, similar analyses are made in 127 main bursts. The results show that both precursors and main bursts can be attributed to a self-organized criticality system with the spatial dimension S = 3 and driven by a similar magnetically dominated process.

Design and Implementation of Internet of Things (IoT) Platform Targeted for Smallholder Farmers: From Nepal Perspective

Nepal, a lower-middle-income country in South Asia, predominantly features smallholder farming communities operating on modest land holdings. These smallholders often adhere to traditional farming methods, relying on familial labor, which has become increasingly inefficient in contemporary agricultural landscapes. To enhance their productivity and efficiency, smallholder farmers require affordable and accessible Internet of Things (IoT)-based systems. However, the prevailing IoT solutions in the market primarily cater to large-scale commercial enterprises, rendering them unsuitable for the specific needs and constraints faced by smallholder farmers. In response to this gap, we have introduced a cost-effective, customizable, scalable, and dependable IoT platform tailored expressly for smallholder farmers. This platform empowers them to visualize, monitor, and control real-time data pertaining to their crops, livestock, and other agricultural assets. To ascertain the efficacy and suitability of our proposed platform, we conducted a comparative analysis with existing counterparts such as Blynk IoT and ThingSpeak IoT, evaluating their respective features and application services against standard requirements. Additionally, we subjected our platform to rigorous server load testing, assessing crucial performance parameters including throughput, response time, user capacity, and data sampling rates. Over an observation period spanning an average of 339 days, our platform successfully processed and stored a substantial volume of data, encompassing 817,633 sensor messages, averaging 2412 messages per day, with a cumulative storage size of 14,238.28 KB. Extrapolating from these results, it is noteworthy that an A0 instance with 20 GB of cloud space can adequately accommodate 200 users at a rate of 100 MB per user, which is adequate for the smallholder needs. Furthermore, the purposed platform was deployed inside a polyhouse to perform off-season grafting of citrus plants. The achieved success rate of 84% closely approached the success rate of 90–95% observed during on-season grafting. These empirical findings, coupled with the extensive data gathered during our research, underscore the reliability and performance of our proposed IoT platform for smallholder farmers.

Mini-percutaneous nephrolithotomy: Is smaller better for kidney stones in patients with neurogenic bladder?

IntroductionPatients with neurologic bladder are at an increased risk for urolithiasis, and currently, data on mini-percutaneous nephrolithotomy in this population are limited. Our objective was to compare mini (15F)-percutaneous nephrolithotomy, standard (24F)-PCNL and flexible ureteroscopy in terms of efficacy and safety in treatment of kidney stones in patients with neurogenic lower urinary tract dysfunction (NLUTD). MethodsWe conducted a retrospective monocentric study in our neuro-urological referral centre. All consecutive patients with NLUTD and a cumulative size of renal calculi greater than 15mm or 10mm in the lower calyx, who had extraction surgery between 2005 and 2020, were included. The primary endpoint was the one-session stone-free rate (SFR) at 3 months on a CT scan. The secondary endpoints were complication (Clavien-Dindo grading system), operative time, blood loss and length of hospital stay. ResultsWe performed 76 standard PCNL (sPCNL), 46 flexible ureteroscopy lithotripsy (fURL) and 25 miniaturized PCNL (mPCNL). The one-session SFR was 37.5% for the mPCNL group, 38.2% for the sPCNL group and 37% for the fURL group with no significant difference between the three procedures (P=0.99). Early complications, blood loss and transfusion rates were lower in the mPCNL group than in the sPCNL group (P=0.047) and comparable to fURL group. The final SFRs after a second intervention for mPCNL, sPCNL and fURL were 48%, 61.8% and 63%, respectively (P=0.67). ConclusionThe efficacy of mPCNL in patients with NLUTD was not different from other techniques, but a significantly lower rate of complications than sPCNL was observed. Level of proof3.

An image segmentation method of pulverized coal for particle size analysis

An important index to evaluate the process efficiency of coal preparation is the mineral liberation degree of pulverized coal, which is greatly influenced by the particle size and shape distribution acquired by image segmentation. However, the agglomeration effect of fine powders and the edge effect of granular images caused by scanning electron microscopy greatly affect the precision of particle image segmentation. In this study, we propose a novel image segmentation method derived from mask regional convolutional neural network based on deep learning for recognizing fine coal powders. Firstly, an atrous convolution is introduced into our network to learn the image feature of multi-sized powders, which can reduce the missing segmentation of small-sized agglomerated particles. Then, a new mask loss function combing focal loss and dice coefficient is used to overcome the false segmentation caused by the edge effect. The final comparative experimental results show that our method achieves the best results of 94.43% and 91.44% on AP50 and AP75 respectively among the comparison algorithms. In addition, in order to provide an effective method for particle size analysis of coal particles, we study the particle size distribution of coal powders based on the proposed image segmentation method and obtain a good curve relationship between cumulative mass fraction and particle size.

A New View of the Lunar South Pole from the Lunar Orbiter Laser Altimeter (LOLA)

Upcoming missions to the lunar south pole require detailed maps over large areas to fully characterize landing sites locally and regionally and to place their data into proper geologic context. To that end, we enhanced the Lunar Orbiter Laser Altimeter altimetry data set for the south polar region, from which we produced new maps of topography, topographic roughness, and permanently shadowed regions (PSRs). The roughness maps reveal a diversity of terrains characterized by hectometer-scale roughness that is controlled in this region primarily by cratering and downslope mass transport. The south polar region is littered with linear roughness features of order ∼1–10 km wide and approximately tens to hundreds of kilometers long hypothesized to be secondary impacts within extended ejecta rays. Nonuniformities in these features could reflect variations in secondary impactor properties and/or target terrain properties. Poleward of 80° S, the PSR cumulative size–frequency distribution (CSFD) shows an approximately power-law behavior whose exponent has a spatial variation of ∼10%. PSRs with areas <1 km2 contain 15% ± 5% of the total PSR area. Finally, we studied the effect of false positives and false negatives on the accuracy of the measured PSR CSFD and on the area for any individual PSR. The new maps presented here have many applications in the science and exploration of the lunar south polar region, such as geologic mapping and traverse planning.

Experimental study on chloride ion diffusion behavior and microstructure in concrete under alternating ambient humidity conditions

The migration of chloride in concrete in atmospheric zones is mainly influenced by climatic conditions, e.g., various dry-wet cycles in marine tidal zones, and ambient humidity is one of the most important influences. Ambient humidity also determines the moisture content in concrete, which is necessary for the diffusion or transport of chloride in concrete and can enhance the migration of chloride in micropores, thus affecting the distribution of chloride in concrete. In this study, the effects of chloride diffusion and its mechanism, and the evolution of moisture in concrete under alternating drying-wetting cycles, were investigated using an environmental moisture simulation chamber. Chloride diffusion tests were also performed to evaluate the effects of different dry-wet ratios and numbers of drying-wetting cycles on the chloride diffusion depth, chloride content and saturation in concrete. The microstructure of concrete was studied and analyzed using XRD, SEM and MIP technology. The findings showed that the saturation of concrete decreased rapidly with increasing number of wet-dry cycles and finally stabilized. Under different alternating moisture conditions, the saturation of concrete was greater, especially when the wetting time was longer. Additionally, in areas near the surface of concrete (depths of 2 mm-6 mm), the chloride content was proportional to the number of wet-dry cycles. In the interior of concrete (depth > 6 mm), when the number of drying-wetting cycles was larger, the chloride concentration was smaller. However, as the number of wet-dry cycles increased, this led to the decalcification of C-S-H gels, which resulted in the reduction in the number of C-S-H reticular gels with good crystallinity. A pore analysis showed that the cumulative pore size and the maximum probability pore size of concrete gradually increased with increasing number of wet-dry cycles, the deterioration of pore structure was more obvious, and the compactness of concrete gradually decreased, which accelerated the migration of chloride in the matrix. Overall, this study can provide reliable and valuable test data for the development and design of high-performance concrete for applications in atmospheric marine tidal zones.

Cytoreductive surgery for metastatic gastrointestinal stromal tumors treated with ripretinib: A single-center experience

BackgroundCytoreductive surgery (CRS) has been advocated as an additional treatment with survival benefits for advanced gastrointestinal stromal tumor (GIST), especially in patients with responsive disease or focal progression after treatment with imatinib. Ripretinib is a fourth-line therapy for advanced GIST. This single-center pilot study investigated the short-term safety and efficacy of CRS after treatment with ripretinib in selected patients with recurrent or metastatic GIST. MethodsMedical records of patients with recurrent or metastatic GIST who underwent CRS after ripretinib in the First Affiliated Hospital of Sun Yat-sen University between June 1st, 2020 and June 1st, 2022 were retrospectively reviewed. Patients’ clinicopathological characteristics, preoperative treatment and general condition, surgical information, and postoperative management were recorded. ResultsThis study included 7 patients who underwent CRS after ripretinib. Radiographic response to ripretinib included partial response (n ​= ​1), stable disease (n ​= ​5), and progressive disease (n ​= ​1). The cumulative size of targeted lesions shrank by 4.8%–45.3% in 5 patients. R0/R1 resection was achieved in 6 (85.7%) patients. Postoperative complications (IId) were reported in 2 (28.6%) patients. There were no delayed post-operative complications. Median follow-up was 11.8 months. Median time-to-progression and median post-operative progression-free survival were not reached. Four patients who did not progress before surgery had no evidence of disease. ConclusionRipretinib combined with CRS is safe and effective in select patients with advanced GIST despite extensive prior therapy.

The Role of Blood Pressure Load in Ambulatory Blood Pressure Monitoring in Adults: A Literature Review of Current Evidence.

The blood pressure load (BPL) is commonly defined as the percentage of readings in a 24-h ambulatory blood pressure monitoring (ABPM) study above a certain threshold, usually the upper normal limit. While it has been studied since the 1990s, the benefits of using this index have not been clearly demonstrated in adults. We present the first review on the associations of BPL with target organ damage (TOD) and clinical outcomes in adults, the major determinants for its role and utility in blood pressure measurement. We emphasize studies which evaluated whether BPL has added benefit to the average blood pressure indices on ABPM in predicting adverse outcomes. PubMed search for all English language papers mentioning ABPM and BPL. While multiple studies assessed this question, the cumulative sample size is small. Whereas the associations of BPL with various TODs are evident, the available literature fails to demonstrate a clear and consistent added value for the BPL over the average blood pressure indices. There is a need for prospective studies evaluating the role of BPL in blood pressure measurement. The current literature does not provide sound support for the use of BPL in clinical decisions.

Glaucomatous aqueous humor vesicles are smaller and differ in composition compared to controls

Cells communicate with each other using vesicles of varying sizes, including a specific repertoire known as exosomes. We isolated aqueous humor (AH)-derived vesicles using two different methods: ultracentrifugation and an exosome isolation kit. We confirmed a unique vesicle size distribution in the AH derived from control and primary open-angle glaucoma (POAG) patients using various techniques, including Nanotracker, dynamic light scattering, atomic force imaging, and electron microscopy. Bonafide vesicle and/or exosome markers were present by dot blot in both control and POAG AH-derived vesicles. Marker levels differed between POAG and control samples, while non-vesicle negative markers were absent in both. Quantitative labeled (iTRAQ) proteomics showed a reduced presence of a specific protein, STT3B, in POAG compared to controls, which was further confirmed using dot blot, Western blot, and ELISA assays. Along the lines of previous findings with AH profiles, we found vast differences in the total phospholipid composition of AH vesicles in POAG compared to controls. Electron microscopy further showed that the addition of mixed phospholipids alters the average size of vesicles in POAG. We found that the cumulative particle size of type I collagen decreased in the presence of Cathepsin D, which normal AH vesicles were able to protect against, but POAG AH vesicles did not. AH alone had no effect on collagen particles. We observed a protective effect on collagen particles with an increase in artificial vesicle sizes, consistent with the protective effects observed with larger control AH vesicles but not with the smaller-sized POAG AH vesicles. Our experiments suggest that AH vesicles in the control group provide greater protection for collagen beams compared to POAG, and their increased vesicle sizes are likely contributing factors to this protection.

Meta-analysis of Cerebrospinal Fluid Cell Count and Biochemistry to Diagnose Meningitis in Infants Aged < 90 Days.

Cerebrospinal fluid (CSF) white blood cell (WBC) count, protein, and glucose (cytochemistry) are performed to aid in the diagnosis of meningitis in young infants. However, studies have reported varying diagnostic accuracies. We assessed the diagnostic accuracy of CSF cytochemistry in infants below 90 days and determined the certainty of evidence. We searched PubMed, Embase, Cochrane Library, Ovid, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus databases in August 2021. We included studies that evaluated the diagnostic accuracy of CSF cytochemistry compared with CSF culture, Gram stain, or polymerase chain reaction in neonates and young infants <90 days with suspected meningitis. We pooled data using the hierarchical summary receiver operator characteristic (ROC) model. Of the 10,720 unique records, 16 studies were eligible for meta-analysis, with a cumulative sample size of 31,695 (15 studies) for WBC, 12,936 (11 studies) for protein, and 1,120 (4 studies) for glucose. The median (Q1, Q3) specificities of WBC, protein, and glucose were 87 (82, 91), 89 (81, 94), and 91% (76, 99), respectively. The pooled sensitivities (95% confidence interval [CI]) at median specificity of WBC count, protein, and glucose were 90 (88, 92), 92 (89, 94), and 71% (54, 85), respectively. The area (95% CI) under ROC curves were 0.89 (0.87, 0.90), 0.87 (0.85, 0.88), and 0.81 (0.74, 0.88) for WBC, protein, and glucose, respectively. There was an unclear/high risk of bias and applicability concern in most studies. Overall certainty of the evidence was moderate. A bivariate model-based analysis to estimate the diagnostic accuracy at specific thresholds could not be conducted due to a paucity of data. CSF WBC and protein have good diagnostic accuracy for the diagnosis of meningitis in infants below 90 days of age. CSF glucose has good specificity but poor sensitivity. However, we could not identify enough studies to define an optimal threshold for the positivity of these tests. · Median specificity of CSF leucocyte count, protein and glucose are similar in young infants.. · At median specificity, CSF leukocyte count and protein are more sensitive than glucose.. · Owing to inadequate data, bivariate modelling to suggest optimal diagnostic thresholds is not possible..

217-OR: The Supporting Emerging Adults with Diabetes (SEAD) Program—An Adult-Based Clinical Model That Improves Glycemic Control and Diabetes Technology Uptake in Underserved Young Adults (YA) with Type 1 Diabetes (T1D)

Background: Underserved YA with T1D transitioning from pediatric to adult care experience adverse outcomes, which stem from simultaneously unmet social, glycemic, and health system navigation needs. We developed a multidisciplinary clinical program called SEAD to address these challenges. In this analysis, we compared outcomes in YA with TID who were enrolled in SEAD to comparable YA in non-SEAD usual care. Methods: The SEAD model was integrated into routine adult diabetes care at Montefiore in 2019, offering equal access to all YA with T1D aged 18-35 years old. SEAD provides YA-centered care, ongoing T1D education, diabetes technology support, psychological focus, and equity-based social need screening and referrals. We collected data prospectively on YA receiving care in SEAD vs. non-SEAD at Montefiore from 2019-2022 for a priori program evaluation, using multivariate linear regression to compare primary glycemic outcomes and Kaplan-Meier analysis for secondary technology outcomes, adjusted for age, sex, race/ethnicity, DKA, and complications. Results: We included 416 YA with T1D (SEAD n=244, non-SEAD n=172): mean age 23 ± 4y, 49% F, 35% Black, 47% Hispanic, 73% Medicaid-insured (no baseline differences, p&amp;gt;0.05). Compared to non-SEAD care, YA in SEAD care experienced double the HbA1c improvement with a cumulative effect size of -0.9% vs. -0.45% over the 3-year study period [SEAD: -0.30%/yr (-0.43, -0.18); non-SEAD: -0.15%/yr (-0.27, 0.04)], and had higher likelihood of accepting insulin pump (HR 1.96, [1.24, 3.12]) and CGM therapy (HR 1.63, [0.97, 2.72]). Conclusion: Integration of the SEAD model into adult diabetes care to offer YA-centered T1D and social needs support improved glycemic control and diabetes technology uptake for underserved YA with T1D, compared to usual care. Cumulative effects over time could change YA trajectories into adulthood. Disclosure S.Agarwal: Advisory Panel; Medtronic, Consultant; Beta Bionics, Inc., Research Support; Abbott Diabetes, Dexcom, Inc. P.M.Mathias: None. C.Schechter: None. M.Greenberg: None. M.Finnan: None. J.A.Long: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (K23DK115896-05)