Current Utilization Research Articles

Investigating the Potential Double-Edged Score of Immigration-Related Stress, Discrimination, and Mental Health Access.

Prior work has suggested that discrimination and immigration-related stress may impede mental health care seeking and utilization among Latinx populations. These effects may be more nuanced as both discrimination and immigration-related stress may increase symptomology, particularly post-traumatic stress disorder (PTSD) and depression. Both symptoms may, in turn, prompt attempts to seek care. The current study examined the direct effects of discrimination and immigration-related stress on care access, as well as potentially indirect effects with PTSD and depression symptoms as mediators. Interviews and online surveys were completed with 234 Latinx residents of the Midwest, assessing everyday discrimination, discrimination in healthcare, PTSD symptoms, depression symptoms, current mental health utilization, and previous unsuccessful attempts to seek care. Direct effects of discrimination and immigration-related stress were largely unrelated to care access variables. Discrimination in healthcare settings predicted both unsuccessful attempts to seek care and current use, but this effect was positive. The indirect effect was largely supported, but only for PTSD symptoms and not depression. Results indicate that further investigation is necessary to understand the direct effects of discrimination on care access. Further, discrimination and immigration-related stress may indirectly prompt attempts to seek mental health care.

A Review of Machine Learning Techniques in Agroclimatic Studies

The interplay of machine learning (ML) and deep learning (DL) within the agroclimatic domain is pivotal for addressing the multifaceted challenges posed by climate change on agriculture. This paper embarks on a systematic review to dissect the current utilization of ML and DL in agricultural research, with a pronounced emphasis on agroclimatic impacts and adaptation strategies. Our investigation reveals a dominant reliance on conventional ML models and uncovers a critical gap in the documentation of methodologies. This constrains the replicability, scalability, and adaptability of these technologies in agroclimatic research. In response to these challenges, we advocate for a strategic pivot toward Automated Machine Learning (AutoML) frameworks. AutoML not only simplifies and standardizes the model development process but also democratizes ML expertise, thereby catalyzing the advancement in agroclimatic research. The incorporation of AutoML stands to significantly enhance research scalability, adaptability, and overall performance, ushering in a new era of innovation in agricultural practices tailored to mitigate and adapt to climate change. This paper underscores the untapped potential of AutoML in revolutionizing agroclimatic research, propelling forward the development of sustainable and efficient agricultural solutions that are responsive to the evolving climate dynamics.

Assessing the current utilization status of wearable devices in clinical research.

Information regarding the use of wearable devices in clinical research, including disease areas, intervention techniques, trends in device types, and sample size targets, remains elusive. Therefore, we conducted a comprehensive review of clinical research trends related to wristband wearable devices in research planning and examined their applications in clinical investigations. As this study identified trends in the adoption of wearable devices during the planning phase of clinical research, including specific disease areas and targeted number of intervention cases, we searched ClinicalTrials.gov-a prominent platform for registering and disseminating clinical research. Since wrist-worn devices represent a large share of the market, we focused on wrist-worn devices and selected the most representative models among them. The main analysis focused on major wearable devices to facilitate data analysis and interpretation, but other wearables were also surveyed for reference. We searched ClinicalTrials.gov with the keywords "ActiGraph,""Apple Watch,""Empatica,""Fitbit,""Garmin," and "wearable devices" to obtain studies published up to 21 August 2022. This initial search yielded 3214 studies. After excluding duplicate National Clinical Trial studies (the overlap was permissible among different device types except for wearable devices), our analysis focused on 2930 studies, including simple, time-series, and type-specific assessments of various variables. Overall, an increasing number of clinical studies have incorporated wearable devices since 2012. While ActiGraph and Fitbit initially dominated this landscape, the use of other devices has steadily increased, constituting approximately 10% of the total after 2015. Observational studies outnumbered intervention studies, with behavioral and device-based interventions being particularly prevalent. Regarding disease types, cancer and cardiovascular diseases accounted for approximately 20% of the total. Notably, 114 studies adopted multiple devices simultaneously within the context of their clinical investigations. Our findings revealed that the utilization of wearable devices for data collection and behavioral interventions in various disease areas has been increasing over time since 2012. The increase in the number of studies over the past 3 years has been particularly significant, suggesting that this trend will continue to accelerate in the future. Devices and their evaluation methods that have undergone thorough validation, confirmed their accuracy, and adhered to established legal regulations will likely assume a pivotal role in evaluations, allowing for remote clinical trials. Moreover, behavioral intervention therapy utilizing apps is becoming more extensive, and we expect to see more examples that will lead to their approval as programmed medical devices in the future.

Putting the coach in the game: Current and future state of surgical coaching in pediatric urology

Surgical coaching has been proposed as a mechanism to fill gaps in proficiency and encourage continued growth following formal surgical training. Coaching benefits have been demonstrated in other surgical fields; however, have not been evaluated within pediatric urology. The aims of this study were to survey members of The Societies for Pediatric Urology (SPU) to assess the current understanding and utilization of surgical coaching while gauging interest, potential barriers and personal goals for participation in a coaching program. Following IRB approval, members of the SPU were invited to electronically complete an anonymous survey which assessed 4 domains: 1) understanding of surgical coaching principles, 2) current utilization, 3) interest and potential barriers to participation, and 4) personal surgical goals. To evaluate understanding, questions with predefined correct answers on the key principles of coaching were posed either in multiple choice or True/False format to the SPU membership. Of the 674 pediatric urologists invited, 146 completed the survey (22%). Of those, 46% correctly responded the definition of surgical coaching. Coaching utilization was reported in 27% of respondents currently or having previously participated in a surgical coaching program. Despite current participation rates, only 6 surgeons (4%) have completed training in surgical coaching, despite 79% expressing interest to participate in a surgical coaching program. The most influential barrier to participating in a coaching program was time commitment. Respondents largely prioritized technical and cognitive skill improvement as their primary goals for coaching (see figure below). While interest in surgical coaching is high among pediatric urologists, the principles of surgical coaching were not universally understood. Furthermore, formal coach training is markedly deficient, representing a gap in our profession and an opportunity for significant avenues for improvement, especially for technical and cognitive skills. Development of a coaching model based on these results would best suit the needs of pediatric urologists providing that the time commitment barrier for these endeavors can be mitigated and/or reconciled.

Preparation and Characteristics of Kluwak Shell Carbon Adsorbent

Kluwak shell carbon (KTK) is a biomass with potential as an adsorbent, containing cellulose, hemicellulose, lignin, and fixed carbon at a content of 92.15%. However, the current utilization of KTK in adsorbing free fatty acids and methylene blue is limited and can be improved through thermal activation at a range of temperatures. The study aims to investigate the impact of activation temperature on CEC by examining the adsorption capacity of methylene blue solution, iodine solution, and surface area. Activation was carried out for 2 hours at temperatures ranging from 500 to 900 C on Kluwak shell carbon. The adsorbent performance of the activated KTKAT was initially tested using methylene solution with a concentration of 50 ppm, a volume of 50 ml, and 0.15 grams of KTKAT. The solution was placed in an orbit shaker for 90 minutes and filtered. The absorbance of the filtrate adsorption results was measured at a wavelength of 662 nm using UV VIS. For the second test, 50 ml of 0.1 N Iodine and 0.5 g KTKAT were stirred for 15 minutes and then centrifuged for approximately 15 minutes. A volume of 10 ml of the resulting iodine solution adsorption filtrate was titrated with 0.1 N Sodium Thiosulfate. The surface area was determined using the BET method. The concentration (ppm) of methylene blue solution was determined by converting the absorbance measurement using the standard curve equation. The iodine number was determined by titrating the iodine adsorption filtrate with sodium thiosulfate (ml). These data show that there is an obvious correlation between activation temperature and methylene blue absorbance, iodine number, and surface area. At 800°C, the methylene blue adsorption is 12.41 mg/g, the iodine number is 875.61 mg/g, and the surface area is 561.404 m²/g.

Developing a framework taking into account negative environmental impacts to evaluate water-energy-food coupling efficiency

Increased water, energy, and food demand lead to resource risks and environmental threats. There is a complex nexus between the three. Evaluating WEF coupling efficiency based on WEF Nexus helps suggest sustainable resource utilization by analyzing the current resource coupling utilization situation. However, neglecting the influence of the external environment and lacking a clear understanding of the interactions within the WEF system can lead to biased assessments. Therefore, this study considers negative environmental impacts and clarifies interactions within the WEF system based on resource conversion relationships to develop a new framework for evaluating the WEF coupling efficiency. The framework is applied to the Yellow River Basin to provide relevant suggestions for promoting the healthy development of resources and the environment. The results indicate that WEF coupling efficiency in the Yellow River Basin during 2000–2020 was maintained at a medium level with an overall increasing trend. The middle and lower regions are medium to high efficiency, and 65% are on an upward trend. However, the low-efficiency areas are all located upstream, and 80% of them are decreasing. There is a growing gap in WEF coupling efficiency between regions. The increase in efficiency was mainly attributed to improvements in energy and food systems. The water system was the key reason for the lower efficiency. Evaluating environmental impacts based on sensitivity analysis, the energy system's negative environmental factors (NEFs) led to the most significant decrease in WEF coupling efficiency, with an average reduction of up to 8%. Based on the Tobit model to analyze the external drivers of WEF coupling efficiency, WEF coupling efficiency is higher in the case of richer cultivated land resources, more intensive labor force, and less precipitation. In conclusion, promoting technological innovation of the water system, optimizing resource allocation, and controlling pollutant emissions are effective measures to optimize the efficiency of WEF coupling for the high-quality development of the Yellow River Basin.

UTILIZING ARTIFICIAL INTELLIGENCE APPLICATIONS IN TRAINING: REALITY & CHALLENGES

The field of artificial intelligence (AI) is a modern science that has benefited various disciplines, contributing to the enhancement of service quality across different sectors, including training. This study aims to explore the use of AI applications in the training field in the Sultanate of Oman. The research investigates the current utilization of these applications in training, the challenges faced by trainers, and the key areas of application in training. The researcher employed a descriptive methodology, suitable for this study, with a study population comprising members of the Omani Trainers Association affiliated with the Human Resources Association. The sample targeted 78 trainers in various fields. A questionnaire, consisting of 26 items distributed across two axes (reality and challenges), was prepared for data collection. Additionally, an open-ended question was included for the third aspect of the study. Statistical methods, including frequency and percentage calculations, mean, standard deviation, Pearson correlation coefficient, and Cronbach's alpha, were used to analyze the data, ensuring the reliability and validity of the study tool. The study results indicate that, from the perspective of the study sample, the current implementation of AI applications in training is perceived as average. This reflects their dissatisfaction with this reality, which contradicts the vision and mission of a true trainer. The study also identifies various challenges in the use of AI applications in training, emphasizing the need for collaborative efforts to find practical solutions and provide better services that help organizations achieve their goals. Furthermore, the study highlights seven areas where trainers utilize AI applications in training, with knowledge and information search and scientific facts research leading among these areas. The study recommends the development of a specialized program for training professional trainers in the application of AI across all fields

Revealing the Crucial Role and Prospect of Nano-biofertilizers for Improving Soil Health and Advancing Sustainable Crop Productivity

Summary In recent years, the agriculture practices have seen a growing interest in innovative technologies aimed at enhancing productivity while promoting sustainability. Nano-biofertilizers, a novel approach to crop nutrition, have emerged as a potential game-changer. This study is aimed comprehensively to uncover the potential and current utilization status of nano-biofertilizers in soil health improvement and sustainable enhancement of crop productivity. The methodology used in this study involved the application of systematic literature review (SLR) methods in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The review focused on scientific literature published from 2013 to 2023, utilizing databases such as ScienceDirect, Scopus, and PubMed. A total of 631 articles were identified through this process. Out of this pool, 10 articles were chosen based on their relevance and topic and they underwent a comprehensive and detailed review. The results showed that use of nano-biofertilizers improves the soil health, plant growth, and productivity significantly. The biological selenium nanoparticles (100 mg/mL) significantly increased the length and weight of spike, root, and shoot, grain quantity in spike, and 1000 grain weight by 5%–40% compared to control. Comamonas testosteroni biofertilizer combined with silver nanoparticles (AgNPs) could alleviate the salinity threatening plant growth. Nano-biofertilizers enhance plant growth, elevate their nutritional value, improve productivity, extend shelf life, and bolster their defenses against biotic and abiotic stress factors.

Artificial intelligence tools for optimising recruitment and retention in clinical trials: a scoping review protocol

IntroductionIn recent years, the influence of artificial intelligence technology on clinical trials has been steadily increasing. It has brought about significant improvements in the efficiency and cost reduction of clinical...

Retrospective analysis of real-world prescribing data for managing cisplatin-based chemotherapy-induced nausea and vomiting in China.

The current utilization of neurokinin-1 receptor antagonists (NK1RAs) and the impact of updated guidelines on prescription patterns of antiemetic drugs among Chinese patients receiving highly emetogenic chemotherapy (HEC) remain undetermined. This study aims to analyze the present situation of Chinese cancer patients using antiemetic drugs and assess the appropriateness of antiemetic regimens. Prescription data were collected between January 2015 and December 2020 from cancer patients receiving cisplatin-based chemotherapy at 76 hospitals in six major cities in China. Trends in the use of antiemetic drugs, prescribing patterns and adherence to antiemetic guidelines were assessed. Among the 108,611 patients included in this study, 6 classes and 17 antiemetic drugs were identified as monotherapy or combination therapy in 93,872 patients (86.4%), whereas 14,739 patients (13.6%) were administered no antiemetic treatment. 5-hydroxytryptamine 3 receptor antagonists (5-HT3RAs) and glucocorticoids were the two most frequently used classes of antiemetics, followed by metoclopramide. NK1RAs were underused across the six cities, only 9332 (8.6%) and 1655 (1.5%) cisplatin-based treatments were prescribed aprepitant and fosaprepitant, respectively. Prescriptions of olanzapine and lorazepam were very low throughout the study period. In prescribing patterns of antiemetic drugs, dual combination regimens were the most common (40.0%), followed by triple combination therapy and monotherapy (25.8% and 15.1%, respectively). Overall, the adherence to antiemetic guidelines for patients undergoing cisplatin-based regimens was only 8.1% due to inadequate prescription of antiemetic drugs. Finally, our study also revealed that 5-HT3RAs and glucocorticoids were overprescribed in 8.8% and 1.6% of patients, respectively. The current study reveals suboptimal utilization of recommended antiemetic drugs for managing cisplatin-based HEC-induced nausea and vomiting in China. Improving the management of CINV is crucial, and these findings provide valuable insights into optimizing antiemetic drug practices.

Long-Acting Reversible Contraception Knowledge Among Female Adolescents Presenting to a Pediatric Emergency Department.

The objective of this study was to assess awareness and use of long-acting reversible contraception (LARC) among female adolescents presenting to a pediatric emergency department (PED). During routine presentation to an urban PED in New Jersey, female adolescents, aged 15-19 years, were asked to voluntarily complete an electronic survey about sexual practices and contraception. The PED is in an urban teaching hospital, treating 35,000 children annually. Patients could schedule a follow-up appointment at the hospital's obstetrics/gynecology clinic. Data were collected over 13 months, and follow-up was monitored to determine if they attended an outpatient appointment, and if so, what the outcome was. Data for 199 participants were analyzed. The median age of participants was 18 years, whereas 79% self-identified as Black, and 17.6% self-identified as Latina. Twenty-one percent of participants used a form of birth control during their first sexual encounter, the largest percentage being condoms (77.8%). Forty percent of participants reported some prior knowledge about contraceptive implants, and 20% had knowledge about intrauterine devices, whereas only 3 (1.5%) intrauterine devices and 2 (1%) arm implants had been previously used. Of the 78 participants that requested a follow-up, 14 (17.9%) completed their appointment. Of those, 2 (14%) were prescribed contraception (Depo-Provera shot and oral contraceptive pills). Knowledge about LARC remains low in our PED, despite it being the most effective method of contraception. Even when interventions were made to link interested respondents to outpatient women's health services, follow-up attendance was poor, and no patients obtained LARC. There is a significant discrepancy between the consensus standard of contraception care across all relevant medical specialties and current utilization by high-risk populations. Future efforts must focus on how to close this gap, and the ED could be pivotal for improving both reproductive health education and intervention among adolescent patients.

New approach to soil fertility management: Biogeosystem Technique methodology (critical review)

AbstractA standard management soil priming effect is short term. A current soil plowing, irrigation and waste utilization soil priming action shortcomings elimination is needed. The Biogeosystem Technique (BGT*) priming action system was developed for soil management to provide a higher‐level priming effect. The BGT* is focused on a soil biogeochemical cycle activation similar to the biodegradation in a colon of a live organism as an efficient benchmark bioreactor. Fluorescence in situ hybridization showed a cooperation of bacteria within polymicrobial biofilms and a probability of the polymicrobial biofilms biodegradation process acceleration and soil organic matter (SOM) regime improvement. The soil priming actions the BGT* technological management is capable of providing are based on the BGT* constituents, whose essence, applications and corresponding detailed data are presented in available studies. The main BGT* components are as follows. The illuvial horizon intra‐soil milling artificial soil aggregation (a form of crumbling and mixing) priming action provides the soil structuring, a SOM content increase and an annual yield increment direct priming effects. A long‐term secondary priming effect is a technology life cycle with higher profitability compared to the standard moldboard, chiseling and three‐tier plowing. The intra‐soil pulse sequential‐discrete watering priming action is performed through water injection into the soil in sequence. A next water spreading provides the soil aggregate stability, the seedling length and weight increment direct priming effect and a water‐saving secondary priming effect. The intra‐soil dispersed liquid, paste‐like and loose granular nutrition and structuring matter intra‐soil milling application priming action ensures soil structuring direct priming effects, heavy metals passivation and long‐term yield increment secondary priming effects. The BGT* methodology could be useful for soil management improvement.

The Rise and Fall of the Thoracoabdominal Incision in Urological Oncology

Objectives The thoraco-abdominal incision (TAI) has been used to provide maximal surgical exposure in the management of combined supra- and infra-diaphragmatic pathologic processes such as levels III or IV thrombi of the IVC. The TAI was once a cornerstone of urological oncology but is becoming increasingly uncommon in the era of robotic approaches to the renal hilum, suprahilar lymph node chain, and minimal access chest surgery to the supradiaphragmatic IVC. We wished to explore the complete history of the TAI, from first description to its height of popularity and its current utilization by contemporary urologic oncologists. Methods Primary source material included an interview with Donald Skinner, an early proponent of the TAI. We conducted a novel survey of active urologists in contemporary practice to investigate the usage of the TAI in practice. We reviewed documents from the Second Auxiliary Surgical Group (SASG) from 1941-1944; reports by military surgeon DF Marshall, recognized as performing the first TAI for a genitourinary indication during World War II; and records of the 8055th US Army (MASH) Unit in Korea, credited with improving the battlefield usage of the TAI; and secondary sources from the AUA’s WP Didusch Archive, PubMed, and Googlescholar. Results The thoraco-abdominal incision (TAI) can originally be traced back to French civilian usage in the latter 19th century, but the TAI was not adopted for battlefield trauma surgery until the Second World War. The safety and effectivness of the TAI increased greatly during the Korean War with teaching, organized outcomes analyses, and improvement efforts. Trauma indications during these conflicts allowed for later adoption in the field of urologic oncology due to the incision’s excellent exposure and became the hallmark of at least one fellowship in urologic oncology. Fewer than 15% of surveyed urologists in the contemporary era have used the TAI in the past 5 years. Conclusions The thoracoabdominal incision’s later adoption by the civilian population is a testament to the ingenuity and resourcefulness of military surgeons in the former part of the twentieth century. Their contributions should not be forgotten as urological surgery moves towards minimally invasive approach.

Efficient and Selective Electrochemical Nitrate Reduction to N2 Using a Flow-Through Zero-Gap Electrochemical Reactor with a Reconstructed Cu(OH)2 Cathode: Insights into the Importance of Inter-Electrode Distance.

Electrochemically converting nitrate, a widely distributed nitrogen contaminant, into harmless N2 is a feasible and environmentally friendly route to close the anthropogenic nitrogen-based cycle. However, it is currently hindered by sluggish kinetics and low N2 selectivity, as well as scarce attention to reactor configuration. Here, we report a flow-through zero-gap electrochemical reactor that shows a high performance of nitrate reduction with 100% conversion and 80.36% selectivity of desired N2 in the chlorine-free system at 100 mg-N·L-1 NO3- while maintaining a rapid reduction kinetics of 0.07676 min-1. More importantly, the mass transport and current utilization efficiency are significantly improved by shortening the inter-electrode distance, especially in the zero-gap electrocatalytic system where the current efficiency reached 50.15% at 5 mA·cm-2. Detailed characterizations demonstrated that during the electroreduction process, partial Cu(OH)2 on the cathode surface was reconstructed into stable Cu/Cu2O as the active phase for efficient nitrate reduction. In situ characterizations revealed that the highly selective *NO to *N conversion and the N-N coupling step played crucial roles during the selective reduction of NO3- to N2 in the zero-gap electrochemical system. In addition, theoretical calculations demonstrated that improving the key intermediate *N coverage could effectively facilitate the N-N coupling step, thereby promoting N2 selectivity. Moreover, the environmental and economic benefits and long-term stability shown by the treatment of real nitrate-containing wastewater make our proposed electrocatalytic system more attractive for practical applications.

Analysis on Improving the Utilisation Rate of Commuter Railways in Mature Metropolitan Areas in China in the Context of High-quality Development

China’s six mature metropolitan areas are facing a shortage of land resources. Commuter railways are a solution to this problem in the context of high-quality development. Nevertheless, the current commuter rail utilisation rate in these metropolitan areas is significantly lower than those in developed countries. Therefore, on the basis of analyses through the literature survey method, this paper collects the latest data on commuter railway services in the six metropolitan areas to discuss the reasons for the current low utilisation of commuter railways in terms of coverage, efficiency and operation, and to propose corresponding practicable solutions. The study found that the number of routes currently in operation is too small. In addition, there are issues including irrational station distribution, sparse train frequency and short operating hours and slow interchange in the services, all of which make the commuter railways fail to achieve the idealised time-saving effect, and serve as a reason for commuters to rely on private cars. In the foreseeable future, with the imposition of the concepts of sustainable development, transportation integration and service orientation, there is possibility that the utilisation rate of commuter railways in these metropolitan areas will be elevated.

Exploring why individuals utilise naturopathic treatment and choose to combine naturopathy with biomedicine

IntroductionThere has been a global increase in the utilisation of traditional, complementary, and integrative medicine (TCIM), including that of naturopathy. Limited New Zealand research exists that has examined why individuals use naturopathic treatment, and why in some cases, naturopathy is combined with biomedicine. The present study had two main aims: (1) To identify why individuals utilise naturopathic treatment, and (2) to identify why individuals choose to combine naturopathy with biomedicine in the management of chronic health conditions or ongoing symptoms. MethodsParticipants were 20 clients who attended a student naturopathy and herbal medicine teaching clinic in Auckland, New Zealand. Participants were individually interviewed. A structured interview schedule comprising of open-ended questions was used. Data was analysed using an inductive thematic approach. ResultsFive main themes were identified in relation to why individuals utilised naturopathic treatment and combined naturopathy with biomedicine in the management of their chronic health conditions or ongoing symptoms: (1) A holistic approach, (2) a new and different approach, (3) wanting to utilise natural remedies, (4) previous use of naturopathic treatment and/or other forms of TCIM, and (5) word-of-mouth: the role of family and friends in influencing the utilisation of naturopathic treatment. ConclusionsThere was an alignment between what participants desired to seek from naturopathic treatment and the philosophy and core naturopathic treatment principles: a holistic approach to health and healing and the utilisation of natural remedies. Participants combined naturopathic treatment with biomedicine, as it allowed for the use of natural and less invasive ways in treating and managing some of their symptoms. Integration of treatment modalities allowed individuals to retain some control over how their body was treated. Previous use of naturopathy and/or other forms of TCIM influenced current utilisation of naturopathy, either for the same condition or for new condition(s). Family and friends also had a salient role in influencing individuals to seek naturopathic treatment.

Use of LCP-Tacrolimus (LCPT) in Kidney Transplantation: A Delphi Consensus Survey of Expert Clinicians.

BACKGROUND LCPT (Envarsus XR®) is a common once-daily, extended-release oral tacrolimus formulation used in kidney transplantation. However, there are minimal evidence-based recommendations regarding optimal dosing and treatment in the de novo and conversion settings. MATERIAL AND METHODS Using Delphi methodology, 12 kidney transplantation experts with LCPT experience reviewed available data to determine potential consensus topics. Key statements regarding LCPT use were generated and disseminated to the panel in an online Delphi survey. Statements were either accepted, revised, or rejected based on the level of consensus, perceived strength of evidence, and alignment with clinical practice. Consensus was defined a priori as ≥75% agreement. RESULTS Twenty-three statements were generated: 14 focused on de novo LCPT use and 9 on general administration or LCPT conversion use. After 2 rounds, consensus was achieved for 11/14 of the former and 7/9 of the latter statements. In a de novo setting, LCPT was recognized as a first-line option based on its safety and efficacy compared to immediate-release tacrolimus. In particular, African Americans and rapid metabolizer populations were identified as preferred for first-line LCPT therapy. In a conversion setting, full consensus was achieved for converting to LCPT to address neurological adverse effects related to immediate-release tacrolimus and for the time required (approximately 7 days) for steady-state LCPT trough levels to be reached. CONCLUSIONS When randomized clinical trials do not replicate current utilization patterns, the Delphi process can successfully generate consensus statements by expert clinicians to inform clinical decision-making for the use of LCPT in kidney transplant recipients.

Access to and utilization of COVID-19 antigen rapid diagnostic tests (Ag-RDTs) among people living with HIV (PLWH): A mixed methods study from Cambodia.

Several COVID-19 antigen rapid diagnostic tests have been approved in Cambodia, but no evidence exists about the access to and utilization of these tests. This limits public health interventions to increase testing, especially among vulnerable populations such as people living with HIV (PLWH). We conducted a mixed method study among PLWH in Phnom Penh, Cambodia, between July and August 2022 to understand their current Ag-RDT access and utilization levels, as well as key barriers and drivers. We undertook a cross-sectional survey and focus group discussions among 280 and 10 PLWH, respectively, from five HIV treatment centres using a probability-proportional-to-size and simple random sampling approach. Access was defined as having received a COVID-19 Ag-RDT within the six months and utilization as having administered a COVID-19 Ag-RDT, either to oneself or to others, within the 12 months prior to the study. We calculated means, standard deviations and proportions for continuous and categorical variables, using a linear regression model with random effects to account for clustering. Additionally, we fitted a logistic model with random effects to assess factors associated with Ag-RDT access. For the qualitative data, we used thematic analyses to identify barriers/enablers of Ag-RDT access and utilization. About 35% (n = 101) of PLWH reported having had access to an Ag-RDT test in the past six months. About 11% (n = 32) of the study participants administered the Ag-RDT to themselves, 4% (n = 10) to others and 9% (n = 24) have done both, in the past 12 months. Age and education appeared to be associated with Ag-RDT access in the logistic models. Price and advice from pharmacists were commonly reported to be the main selection criteria for the brand of Ag-RDT chosen. Ag-RDTs are an important diagnostic tool for COVID-19 among PLWH in Cambodia, but familiarity of use and price could hinder better uptake, access and utilization.

Spatial distribution dynamics for Epimedium brevicornum Maxim. from 1970 to 2020.

At different time scales, a species will experience diverse distribution changes. For Epimedium brevicornum Maxim, the phenomenon is obvious, but the understanding of the spatial dynamics of E. brevicornum under distinct time scales is poor. In this study, we modeled the potential distribution for E. brevicornum for five time scales, 1970-1979, 1980-1989, 1990-1999, 2000-2009, and 2010-2019, with different occurrence data, and the Kuenm package was used to optimize the parameter combination. Then, SDM tools and a Venn diagram were utilized to simulate the changes in highly suitable areas and spatial dynamics, respectively. Comprehensive results show that temperature seasonality (BIO4, 37.54%) has the greatest effect on the distribution of E. brevicornum, followed by minimum temperature (TMIN, 21.42%). The areas of distribution for E. brevicornum are 35.06 × 105 km2, 25.7 × 105 km2, 67.64 × 105 km2, 27.29 × 105 km2, and 9.87× 105 km2, which are mainly concentrated in Gansu, Shaanxi, Shanxi, and Henan, respectively. In addition, the largest regions for expansion, stability, and contraction under various time scales are 5.6 × 105 km2, 3.54 × 105 km2, and 3.47 × 105 km2, respectively. These changes indicate that approximately 7.96% of the regions are highly stable, and three critical counties, Wanyuan, Chenggu, and Hechuan, and Xixiang, have become significant areas for migration. Overall, our results indicate that there are different spatial distribution patterns and dynamics for E. brevicornum for different time scales. Given these results, this study also proposes comprehensive strategies for the conservation and management of E. brevicornum, which will further improve the current resource utilization status.

Irreversible Electroporation of the Hepatobiliary System: Current Utilization and Future Avenues.

Liver cancer remains a leading cause of cancer-related deaths worldwide despite numerous advances in treatment. While surgical resection remains the gold standard for curative treatment, it is only possible for a minority of patients. Thermal ablation is an effective option for the treatment of smaller tumors; however, its use is limited to tumors that are not located in proximity to sensitive structures due to the heat sink effect and the potential of thermal damage. Irreversible electroporation (IRE) is a non-thermal ablative modality that can deliver targeted treatment and the effective destruction of tumors that are in close proximity to or even surrounding vascular or biliary ducts with minimal damage to these structures. IRE produces short pulses of high-frequency energy which opens pores in the lipid bilayer of cells leading to apoptosis and cell death. IRE has been utilized clinically for over a decade in the treatment of liver cancers with multiple studies documenting an acceptable safety profile and high efficacy rates.