Set Of Protocols Research Articles

Scoping review of literature and systematic search of web-based resources: parasport classification instructions, experiences, and outcomes

ABSTRACT While classification is essential to parasport, members of the Paralympic Movement commonly report having limited access to information on the topic. Despite increased academic interest in recent years, the total body of research on classification has not yet been mapped or documented. To assess the breadth of literature on classification, we conducted a scoping review following the protocol set forth by Arksey and O’Malley (2005). Additionally, we completed a six-step systematic online search as outlined by Stansfield et al. (2016) to document the type and quality of information on classification available outside bibliographic databases. The most frequent topics discussed in the literature were (a) coach/classifier roles during classification, (b) athletes’ perspectives on classification, and (c) the influence of classification on athletes’ participation (e.g. on social dynamics, athlete development). Webpages reviewed were of relatively low quality, with <50% reporting authorship, references, or a statement of disclosure. Webpages reviewed were primarily produced by national/international sport organizations and provided more professional (i.e. technical) information on classification than inter-/intrapersonal information or instruction. This review provides insight into the type and quality of classification knowledge available to parasport participants and may inform future research and practice related to parasport at all levels.

Accelerating Evidence Synthesis in Observational Studies: Development of a Living Natural Language Processing-Assisted Intelligent Systematic Literature Review System.

Systematic literature review (SLR), a robust method to identify and summarize evidence from published sources, is considered to be a complex, time-consuming, labor-intensive, and expensive task. This study aimed to present a solution based on natural language processing (NLP) that accelerates and streamlines the SLR process for observational studies using real-world data. We followed an agile software development and iterative software engineering methodology to build a customized intelligent end-to-end living NLP-assisted solution for observational SLR tasks. Multiple machine learning-based NLP algorithms were adopted to automate article screening and data element extraction processes. The NLP prediction results can be further reviewed and verified by domain experts, following the human-in-the-loop design. The system integrates explainable articificial intelligence to provide evidence for NLP algorithms and add transparency to extracted literature data elements. The system was developed based on 3 existing SLR projects of observational studies, including the epidemiology studies of human papillomavirus-associated diseases, the disease burden of pneumococcal diseases, and cost-effectiveness studies on pneumococcal vaccines. Our Intelligent SLR Platform covers major SLR steps, including study protocol setting, literature retrieval, abstract screening, full-text screening, data element extraction from full-text articles, results summary, and data visualization. The NLP algorithms achieved accuracy scores of 0.86-0.90 on article screening tasks (framed as text classification tasks) and macroaverage F1 scores of 0.57-0.89 on data element extraction tasks (framed as named entity recognition tasks). Cutting-edge NLP algorithms expedite SLR for observational studies, thus allowing scientists to have more time to focus on the quality of data and the synthesis of evidence in observational studies. Aligning the living SLR concept, the system has the potential to update literature data and enable scientists to easily stay current with the literature related to observational studies prospectively and continuously.

Formal Security Analysis of the OpenID FAPI 2.0 Family of Protocols: Accompanying a Standardization Process

FAPI 2.0 is a suite of Web protocols developed by the OpenID Foundation’s FAPI Working Group (FAPI WG) for third-party data sharing and digital identity in high-risk environments. Even though the specifications are not completely finished, several important entities have started to adopt the FAPI 2.0 protocols, including Norway’s national HelseID, Australia’s Consumer Data Standards, as well as private companies like Authlete and Australia-based connectID; the predecessor FAPI 1.0 is in widespread use with millions of users. The FAPI WG asked us to accompany the standardization of the FAPI 2.0 protocols with a formal security analysis to proactively identify vulnerabilities before widespread deployment and to provide formal security guarantees for the standards. In this paper, we report on our analysis and findings. Our analysis is based on a detailed model of the Web infrastructure, the so-called Web Infrastructure Model (WIM), which we extend to be able to carry out our analysis of the FAPI 2.0 protocols including important extensions like FAPI-CIBA. Based on the (extended) WIM and formalizations of the security goals and attacker model laid out in the FAPI 2.0 specifications, we provide a formal model of the protocols and carry out a formal security analysis, revealing several attacks. We have worked with the FAPI WG to fix the protocols, resulting in several amendments to the specifications. With these changes in place, we have adjusted our protocol model and formally proved that the security properties hold true under the strong attacker model defined by the FAPI WG.

Development of an Integrated Physiotherapy Treatment Protocol for Desk Job Personals: A Pilot Research

Objectives: To develop an Integrated validated Physiotherapy Treatment Protocol for Desk Job personnel along with an assessment of its effectiveness. Methods: The research was conducted utilizing a mixed-method methodology. Interviews with thirty computer professionals (having more than five years of experience) and a thorough in-depth literature research were conducted to identify various symptoms which are commonly seen among computer professionals. Search engines such as Ovid MEDLINE, Cochrane Library, Pubmed, and EBSCO CINAHL were used with terms such as Neck Problems in Computer Professionals(cs), Treatment Techniques used in Cervical Spondylitis, and Motor or Sensory issues in Computer Professionals. The treatment protocol was created with the help of identified symptoms and validated using the Delphi technique. After the protocol was developed, a randomized control trial was conducted with thirty samples in each group. A developed and validated regimen was provided to the participants. Findings: Item level CVI ranges from 0.79 to 1. The Kappa results demonstrated the protocol's strong content validity, which ranged from 0.79 to 1. In comparison to day 1, there was a decline in both groups' scores of NDI and NPRS on day 30, and there was an even more noticeable decrease on day 60. The experimental group showed a much greater reduction in neck pain and disability when compared to the control group. Novelty: The study has focussed on a new category of occupational health issues, namely computer-related health issues, for which there is no established set of Physiotherapy Protocol that can either prevent or treat the issues. Keywords: Numeric Pain Rating Scale (NPRS), Neck Disability Index (NDI), Content Validity Ratio (CVR) and Content Validity Index (CVI), Integrated Physiotherapy Treatment Protocol (IPTP)

Advancing healthcare systems: A tri‐tier architecture by using data communication, AI data generative and regulation and compliance standards

AbstractTraditional healthcare systems have suffered from different data communication, security, data processing, and compliance issues. The traditional systems are also not well equipped to handle the new technologies like Artificial Intelligence (AI) by enabling more accurate diagnostics, personalized treatment plans, and improved patient outcomes. The existing data communication and security protocols and compliance are also not fully implemented to tackle the system's challenges. This article proposes a Tri‐Tier architecture by using data communication, AI data generative, and regulation and compliance tiers. The data communication tier is based on advanced sensing and monitoring technologies like cloud and edge‐based systems integrated with security detection mechanisms. The edge and cloud layer provides the all functions of the perception layer like smart sensing, visual sensing, and monitoring services, and can control the device's perception and behaviour. The second tier provides the AI data generative functionalities to handle real‐time synthetic medical images for predictive analytics to enhance patient care. This tier also automates routine tasks, such as administrative work and data analysis, which can free up healthcare professionals to focus on more complex tasks. The last regulation and compliance tier is responsible for handling the standards and compliance for healthcare systems. Experiments are conducted to test the data communication and security level of the proposed architecture. The results showed the suitability of existing solutions and synchronization with the proposed architecture.

Privacy-preserving and verifiable convolution neural network inference and training in cloud computing

With the rapid development of cloud computing, outsourcing massive data and complex deep learning model to cloud servers (CSs) has become a popular trend, which also brings some security problems. One is that the model stored in the CSs may be corrupted, leading to incorrect inference and training results. The other is that the privacy of outsourced data and model may be compromised. However, existing privacy-preserving and verifiable inference schemes suffer from low detection probability, high communication overhead and substantial computational time. To solve the above problems, we propose a privacy-preserving and verifiable scheme for convolutional neural network inference and training in cloud computing. In our scheme, the model owner generates the authenticators for model parameters before uploading the model to CSs. In the phase of model integrity verification, model owner and user can utilize these authenticators to check model integrity with high detection probability. Furthermore, we design a set of privacy-preserving protocols based on replicated secret sharing for both the inference and training phases, significantly reducing communication overhead and computational time. Through security analysis, we demonstrate that our scheme is secure. Experimental evaluations show that the proposed scheme outperforms existing schemes in privacy-preserving inference and model integrity verification.

Assessment of the Level of Knowledge and Attitude Regarding Advanced Life Support Skills among Nurses Working in the Critical Areas (CCU, ICU and ER) of Punjab Institute of Cardiology, Lahore

Advance life support is the basic intervention to deal with cardiac arrest. Cardiac arrest has no time, place, or personal boundaries. According to WHO, it is estimated that about 23 million of people will die every year due to cardiovascular diseases and the chances of cardiac arrest are greater in people who have history of cardiovascular diseases. Advanced life support training consists of a set of life-saving protocols, interventions, and skills. Objectives: To determine the level of knowledge and attitude of critical care nurses regarding Advanced Life Support (ALS) skills and to assess association between level of knowledge and attitude and demographic characteristics of nurses. Methods: A descriptive cross-sectional study was conducted among critical care nurses of Punjab Institute of Cardiology. About 115 nurses were selected through convenient sampling method. The study was completed in four months from October 2023 to January 2024. Data were analyzed using SPSS Version 25. Results: Findings of study showed that 18 participants were male and 97 were female. Overall results indicated that 8.7% (n=10) nurses have poor knowledge, 39.1% (n=45) have average knowledge, 43.5% (n=50) have a good knowledge and only 8.7% (n=10) have excellent knowledge. On the other side, 71.3% (n=82) have a positive attitude and 28.7% (n=33) have negative attitude regarding ALS. Conclusions: A significant proportion of nurses have average to good knowledge and positive attitude. Only a few nurses have poor knowledge and negative attitude.

Evaluation of a Standardized Obstetrics Insulin Drip Protocol and Order Set

Objective The prevalence of pregnancies affected by diabetes is increasing, with the Centers for Disease Control and Prevention reporting that 1–2% of pregnant women have type 1 or type 2 diabetes and up to 10% of pregnancies are affected by gestational diabetes as of 2018. Maternal glycemic management is directly related to fetal and neonatal outcomes, and aberrant maternal hyperglycemia has known negative outcomes. Although most of glycemic management centers on outpatient treatment, evidence exists to support the use of intravenous insulin drips during inpatient admissions. This study aimed to evaluate an intravenous insulin protocol specific to the obstetric (OB) population. Research Design and Methods This was a single-center retrospective pre-/post- cohort study of OB patients with diabetes admitted to an academic medical center. Groups were differentiated based on admission date and protocol implementation with a 6-month washout period. Included patients received an intravenous insulin drip around either antenatal corticosteroid administration or during labor and delivery. Those who were within 7 days of receiving a diabetic ketoacidosis diagnosis or who were admitted to an intensive care unit were excluded. Results Fifty-nine patients received 69 distinct insulin drip orders. Twelve drips were included in the group admitted before initiation of the insulin drop protocol (pre-group) and 57 in the group admitted after the protocol went into effect (post-group). Time spent within the goal glucose range while on an insulin drip in the pre-group was 1.63% compared with 39.30% in the post-group (P &amp;lt;0.001). Glucose levels &amp;lt;70 mg/dL was 0.00% in the pre-group compared with 3.23% in the post-group (P = 0.045). There were no differences in severe hypoglycemia (glucose &amp;lt;50 mg/dL), hyperglycemia (glucose &amp;gt;110 mg/dL), or neonatal outcomes. Conclusion Implementation of a nursing-driven, obstetrics-specific intravenous insulin drip protocol significantly improved maternal glycemic management within a goal glucose range of 70–110 mg/dL during antenatal corticosteroid administration and labor and delivery.

The efficacy of keverprazan-based quadruple therapy for Helicobacter pylori eradication: a phase III, randomised, double-blind, multicentre trial

IntroductionKeverprazan is a novel potassium-competitive acid blocker. The advantages of keverprazan as a potent acid suppressor in Helicobacter pylori eradication have not yet been demonstrated. The aim of this study was to evaluate the efficacy of keverprazan as a component of bismuth quadruple therapy in H. pylori treatment. MethodsAdult patients with H. pylori infection were enrolled and randomised to take keverprazan (KEV group)- or esomeprazole (ESO group)-quadruple therapy. The regimens contained keverprazan 20 mg or esomeprazole 20 mg, clarithromycin 500 mg, amoxicillin 1000 mg and bismuth potassium citrate 240 mg and were administered twice daily for 14 days. The primary endpoint was the H. pylori eradication rate at 4 weeks after treatment. ResultsThe full analysis set showed that the H. pylori eradication rates were 87.8% (252/287) and 82.52% (236/286) for the KEV and ESO groups, respectively (difference: 5.29%; 95% confidence interval [CI]: -0.55–11.18). Keverprazan was superior to esomeprazole in terms of eradication rate in the per protocol set (P=0.0382). The eradication rates for patients resistant or non-resistant to clarithromycin were both numerically higher in the KEV group than the ESO group (83.45% vs. 76.98% for clarithromycin-resistance; 92.31% vs. 88.16% for clarithromycin-non-resistance). The incidence of adverse events was similar in the KEV and ESO groups (76.31% vs. 77.62%), with most adverse events (>90%) being mild in severity. No TEAEs led to death in either group. ConclusionsKeverprazan 20 mg twice daily, used as a component of bismuth quadruple therapy, provided effective H. pylori eradication and was non-inferior to an esomeprazole-based regimen.

Tranq Dope: Characterization of an ED cohort treated with a novel opioid withdrawal protocol in the era of fentanyl/xylazine

BackgroundTreating opioid use disorder has reached a new level of challenge. Synthetic opioids and xylazine have joined the non-medical opioid supply, multiplying the complexities of caring for individuals in emergency departments (ED). This combination, known as ‘tranq dope,’ is poorly described in literature. Inadequate withdrawal treatment results in a disproportionately high rate of patient-directed discharges (also known as against medical advice dispositions, or AMA). This study aimed to describe a cohort of individuals who received a novel order set for suspected fentanyl and xylazine withdrawal in the ED. MethodsThis is a descriptive study evaluating a cohort of ED patients who received withdrawal medications from a novel protocol and electronic health record order set. Individuals being assessed in the ED while suffering from withdrawal were eligible. Individuals under age 18, on stable outpatient MOUD or who were pregnant were excluded. Treatment strategies included micro-induction buprenorphine, short acting opioids, non-opioid analgesics, and other adjunctive medications. Data collected included: demographics including zip code, urine toxicology screening, order set utilization and disposition data. Clinical Opiate Withdrawal Scale (COWS) scores were recorded, where available, before and following exposure to the medications. ResultsThere were 270 patient encounters that occurred between September 14, 2022, and March 9, 2023 included in the total study cohort. Of those, 66 % were male, mean age 37 with 71 % residing within Philadelphia zip codes. 100 % of urine toxicology screenings were positive for fentanyl. Of the 177 patients with both pre- and post-exposure COWS scores documented, constituting the final cohort, patients receiving medications had their COWS score decrease from a median of 12 to a median of 4 (p < 0.001). The AMA rate for this cohort was 3.9 %, whereas the baseline for the population with OUD was 10.7 %. Recorded adverse effects were few and resolved without complication. ConclusionsFentanyl and xylazine withdrawal are challenging for patients and providers. A novel tranq dope withdrawal order set may reduce both COWS scores and rate of patient-directed discharge in this cohort of patients, though further investigation is needed to confirm findings.

Acupuncture-assisted therapy for prolonged disorders of consciousness: study protocol for a randomized, conventional-controlled, assessor-and-statistician-blinded trial.

Acupuncture is a promising non-pharmaceutical complementary therapy in treating prolonged Disorders of consciousness (pDOC), but solid evidence to support its effectiveness and safety is still lacking. Thus, the purpose of this study is to investigate the efficacy and safety of acupuncture-assisted therapy for pDOC patients. A single-center, prospective, randomized, conventional-controlled, assessor-and-statistician-blinded trial has been designed and is being conducted at West China Hospital of Sichuan University. A total of 110 participants will be randomly assigned to the experimental group and the control group in a 1:1 allocation ratio and evaluated using Coma Recovery Scale-Revised (CRS-R) at 8 a.m., 12 p.m., and 4 p.m. on 2 consecutive days before enrollment to determine the consciousness level. The experimental group will receive acupuncture combined with conventional treatment, while the control group will receive only conventional treatment during the trial observation period. The treatment duration of both groups will be 20 days. Among them, the frequency of acupuncture-assisted therapy is once a day, with 10 consecutive sessions followed by a day's rest for a total of 24 days. Data will be collected separately during baseline and after the final treatment. For data analysis, both Full Analysis Set (FAS) and Per Protocol Set (PPS) principles will be performed together by applying SPSS 27.0 software. The primary outcome measures are the changes of CRS-R before and after treatment, while the secondary outcome measures are the changes of Full Outline of Unresponsiveness Scale (FOUR), the changes of Nociception Coma Scale-Revised (NCS-R), the changes of Disability Rating Scale (DRS), the changes of Mismatch Negativity (MMN) and P300 before and after treatment, respectively. This trial aims to rationally assess the consciousness level from multiple 2 perspectives through subjective evaluation and objective detection by selecting several standardized clinical scales combined with Event-Related Potential (ERP) detection technology. In this way, we will be able to reduce the subjectivity of consciousness assessment and objectively evaluate the clinical efficacy of acupuncture-assisted therapy for pDOC. The study, if proven to be effective and safe enough, will provide a favorable evidence to guide medical decision-making choices and future researches. https://www.chictr.org.cn/, identifier ChiCTR2300076180.

A randomized, double-blind, placebo-controlled phase II study of olanzapine-based prophylactic antiemetic therapy for delayed and persistent nausea and vomiting in patients with HER2-positive or HER2-low breast cancer treated with trastuzumab deruxtecan: ERICA study (WJOG14320B)

Nausea and vomiting are common adverse events associated with trastuzumab deruxtecan (T-DXd). We evaluated the efficacy of an olanzapine-based triplet regimen for preventing nausea and vomiting in patients receiving first cycle T-DXd. This multi-institutional, randomized, double-blind, placebo-controlled (ERICA) phase II study enrolled patients with HER2-positive/HER2-low metastatic breast cancer receiving their first cycle of T-DXd. Patients were randomized to olanzapine 5 mg or placebo once daily (1:1 ratio) from Day 1 to 6, plus a 5-hydroxytryptamine type 3-receptor antagonist (5-HT3RA) and dexamethasone 6.6 mg intravenously or 8 mg orally on Day 1. The total observation period was 504 hours (21 days) from the first T-DXd administration. The primary endpoint was complete response (CR), defined as no emetic events and no rescue medications, in the delayed phase (24-120 hours post-T-DXd), with the type I error rate of 0.2 (one-sided) for the comparison. Secondary endpoints included no nausea rate in the delayed and persistent phases (120-504 hours), adverse event by CTCAE and PRO-CTCAE. In total, 168 patients were enrolled at 43 sites in Japan (Nov 2021-Sep 2023) with 162 patients (olanzapine, n = 80; placebo, n = 82) included in the per protocol set. The primary endpoint was met as the delayed phase CR rate was significantly greater with olanzapine than placebo (70.0% versus 56.1%, P = 0.047). Efficacy was maintained in the persistent phase (63.9% versus 44.4%). No nausea rate was also greater with olanzapine (delayed phase: 57.5% versus 37.8%; persistent phase: 51.4% versus 31.9%). CR rates in the delayed phase favored olanzapine across subgroups. Appetite loss was also decreased with olanzapine. Hyperglycemia and somnolence were mostly of low-grade severity. Olanzapine 5mg for 6 days with 5-HT3RA and dexamethasone appears effective for T-DXd-treated patients to prevent delayed and persistent nausea and vomiting.

P205 HYPERTENSION AWARENESS, TREATMENT, AND CONTROL RATE IN NEPAL: AN EFFECTIVENESS OF WHO-PEN PACKAGE INTEGRATION THROUGH PRIMARY CARE TO ADDRESS THE NCDs

WHO-PEN, the essential NCD services even in resource constraint settings through PHC approach has been implemented in Nepal since 2017. PEN approach consists of set of protocols for the management of listed major diseases and behavioral interventions to address the associated major modifiable risk factors. The major focused diseases in PEN includes cardiovascular diseases, diabetes, cancer and chronic respiratory diseases. By 2021 it has been expanded across all 77 districts of Nepal. The aim of this analysis is to assess the before and after PEN package changes in hypertension prevalence, awareness, treatment and control rate in Nepal. This analysis used the 2016 Nepal demographic and health survey (NDHS) data as a baseline(N=14,823) and 2022 NDHS data as an Edline(N=10,022). Awareness, treatment and control rate was calculated from the population aged 15 years and above along with the concentration Index (CI) to assess the changes in magnitude and inequalities before and after the intervention. Cluster sampling design was considered for all the inferential statistics and sample weight was used to obtain the population estimates. P&lt;0.05 were considered statistically significant. The study revealed a non-significant change in the hypertension prevalence before and after the intervention (19.6% vs 20.1%;p&gt;0.05). However, a significant change was observed in the awareness rate (40% vs 50.2%,p&lt;0.05) and treatment rate (20.2% vs 31.7%,p&lt;0.05). A significant wealth inequality was observed in awareness ((CI:0.12,p&lt;0.001 in 2016) and (CI:0.13,p&lt;0.001 in 2022)) and treatment rate ((CI:0.24,p&lt;0.001 in 2016) and (CI:0.21,p&lt;0.001 in 2022)) over the period of time. We did not find a significant change (51.7% vs 56.7%, p&gt;0.05) and wealth inequalities in control rate (figure 1). The improvement in awareness and treatment rate over the period entails the integration of WHO-PEN package through primary care is effective, however, the persistent wealth inequalities indicate next level community-based intervention should be instrumental to address the NCDs burden targeted to ultra-poor/poor and marginalized population of Nepal.

Dietary Collagen Peptides Ameliorate the Mood Status of Fatigue and Vigor: A Randomized, Double-Blinded, Placebo-Controlled, Parallel-Group Comparative Trial

The mood status of fatigue can impact daily activities. Dietary collagen peptides have been reported to be beneficial for health conditions. A randomized, double-blinded, placebo-controlled, parallel-group study investigated the effects of collagen peptides on mood status including fatigue, physical condition, and immunological status. The participants who were healthy but easily fatigued consumed active food containing collagen peptides (10 g/day) (n = 33) or placebo food (n = 33) for eight weeks. POMS® 2 was used to assess the perceived fatigue and other mood status. The primary outcome was the T-scores of Fatigue-Inertias at eight weeks. In addition, their physical condition and immunological parameters were evaluated. The data set was a per protocol set of 31 participants each in both groups. As for POMS® 2, the T-score of Fatigue-Inertias at eight weeks was significantly lower in the active group than in the placebo group (47.0 ± 7.4 versus 51.5 ± 9.0, p = 0.045). The T-score of Vigor-Activity was significantly higher in the active group than in the placebo group after eight weeks (53.9 ± 10.7 versus 47.3 ± 9.6, p = 0.002). Regarding the questionnaire on the physical condition, the Likert scale score on fatigue after a night’s sleep at eight weeks was significantly lower in the active group than in the placebo group (median; 3.0 versus 4.0, p = 0.038). There were no significant differences in the measured values of immunological parameters. No safety-related issues were reported in this trial. The intake of collagen peptides (10 g/day) for eight weeks ameliorated the mood status of fatigue and vigor and increased the feeling of sleep restfulness. Dietary collagen peptides were efficient and safe nutritional ingredients for healthy but easily fatigued individuals.Clinical trial registry number and website: UMIN-CTR, UMIN000042291 https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000048280

Comparison of exsanguination and hemostasis devices for Limb surgery: a multicenter randomized controlled study

BackgroundExcessive intraoperative bleeding remains a challenge in limb surgeries. The exsanguination tourniquet ring has emerged as a potential solution for effective exsanguination and hemostasis. This study aims to evaluate its efficacy and safety compared to the conventional exsanguination and hemostasis approach (pneumatic tourniquet combined with Esmarch bandage).MethodsThis randomized controlled trial evaluates the exsanguination tourniquet ring’s effectiveness and safety versus the conventional approach in 220 participants undergoing various limb surgeries. Allocation included experimental and control groups, assesses through efficacy (including intraoperative and total blood loss, hemoglobin levels, and exsanguination and hemostasis effectiveness) and safety (adverse event occurrence) indicators.ResultsThe experimental group (n = 110) utilizes the exsanguination tourniquet ring, while the control group (n = 110) employs the conventional approach. As for intraoperative blood loss, the experimental group is non-inferior to the control group (p-value < 0.001). While no significant difference is found in total blood loss (for the full analysis set, p-value = 0.442; for the per protocol set, p-value = 0.976) and differences in postoperative and preoperative hemoglobin levels (for the full analysis set, p-value = 0.502; for the per protocol set, p-value = 0.928). Regarding exsanguination and hemostasis effectiveness, the full analysis set reveals significantly superior ratings in the experimental group compared to the control group (p-value = 0.002 < 0.05), while the per protocol set analysis indicates no significant difference between the groups (p-value = 0.504). As for safety indicators, adverse events related to the device are minimal in two groups, with only one severe event unrelated to the device.ConclusionsThe exsanguination tourniquet ring is an effective and safe device for intraoperative blood loss control in various limb surgeries.Trial registrationComparison of Exsanguination and Hemostasis Devices for Limb Surgery A Prospective Multicenter Randomized Controlled Study, ChiCTR2300077998, 11/27/2023.

Simultaneous Qualitative and Quantitative Determination of 33 Compounds from Rubus Alceifolius Poir Leaves Using UHPLC-Q-Orbitrap-MS/MS Analysis

Background: Rubus alceifolius Poir leaves are a widely distributed medicinal plant material in the Eastern Hemisphere. However, there has been no report regarding their chemistry until now. Methods: Fresh R. alceifolius leaves were treated using a set of experimental protocols to prepare a lyophilized aqueous extract. Subsequently, the extract was qualitative and quantitatively analyzed using the database-affinity ultra-high-performance liquid chromatography-quadrupole-Exactive- Orbitrap-tandem mass spectrometry (UHPLC-Q-Exactive-Orbitrap-MS/MS) technology. Results: Based on MS/MS elucidation and comparison with the database in UHPLC-Q-Exactive- Orbitrap-MS/MS apparatus, 33 compounds were qualitatively identified. Especially, 12 isomers were strictly distinguished, including apigenin vs. 2'-hydroxydaidzein, luteolin 7-O-glucuronide vs. scutellarin, (+) catechin vs. (-) epicatechin, 3-O-caffeoylquinic acid vs. 4-O-caffeoylquinic acid vs. 5-Ocaffeoylquinic acid, and 3,4-O-dicaffeoylquinic acid vs 3,5-O-dicaffeoylquinic acid vs 4,5-Odicaffeoylquinic acid. In addition, 21 non-isomeric compounds, such as ellagic acid and gallic acid, were also found under negative or positive ion models. The quantitative analysis suggested that ellagic acid was found to be of the highest level (133.00 ± 3.50 μg/g), while (+)-4-cholesten-3-one was calculated to be of the lowest level (0.035 ± 0.0050 μg/g). Conclusion: These findings will help to understand the substance basis of the traditional medicinal functions of R. alceifolius leaves and to find their suitable quality markers.

To draw or not to draw? Evaluating the impact of computer-aided drawing tools on productivity in architectural design

This empirical study investigates the architectural design process, focusing on the influence of computer-aided drawing (CAD) tools during the initial design stages. Given the increasing reliance on CAD tools in contemporary architectural practice, the primary objective is to assess quantitatively how CAD tool adoption affects design productivity. The research was conducted in two phases, utilizing the protocol analysis method. In the first phase, we introduced a novel approach by having third-year architecture students complete two design assignments: the first using traditional freehand sketches and the second employing CAD tools. This unique method allowed us to capture their design actions and thoughts using the Concurrent verbalization technique. In the second phase, a meticulous comparison of the two sets of design protocols was undertaken. The analysis yielded surprising and counterintuitive results. Contrary to common beliefs, the use of CAD tools during early design phases can lead to unintended outcomes. Despite their digital precision and convenience, these tools may inadvertently impede cognitive productivity. Designers employing CAD tools showed signs of hesitation and indecision, resulting in prolonged design timelines and diminished ideational productivity. These findings have profound implications for architectural education and practice. They underscore the necessity for a balanced approach to integrating CAD tools into design processes. Educators and professionals must carefully consider the potential impact of these tools on the creative process, prompting a reassessment of their role in architectural design curricula and workflows. Future research holds great promise in exploring strategies to optimize CAD tool usage to mitigate their disruptive effects on early-stage architectural design. Additionally, investigating the role of training and interface design in enhancing the synergy between designers and digital tools offers exciting and fruitful research directions. In summary, this study highlights the complex relationship between CAD tools and cognitive productivity in architectural design, prompting a reexamination of their role in shaping the design landscape.

Combined Multireference-Multiscale Approach to the Description of Photosynthetic Reaction Centers.

A first-principles description of the primary photochemical processes that drive photosynthesis and sustain life on our planet remains one of the grand challenges of modern science. Recent research established that explicit incorporation of protein electrostatics in excited-state calculations of photosynthetic pigments, achieved for example with quantum-mechanics/molecular-mechanics (QM/MM) approaches, is essential for a meaningful description of the properties and function of pigment-protein complexes. Although time-dependent density functional theory has been used productively so far in QM/MM approaches for the study of such systems, this methodology has limitations. Here we pursue for the first time a QM/MM description of the reaction center in the principal enzyme of oxygenic photosynthesis, Photosystem II, using multireference wave function theory for the high-level QM region. We identify best practices and establish guidelines regarding the rational choice of active space and appropriate state-averaging for the efficient and reliable use of complete active space self-consistent field (CASSCF) and the N-electron valence state perturbation theory (NEVPT2) in the prediction of low-lying excited states of chlorophyll and pheophytin pigments. Given that the Gouterman orbitals are inadequate as a minimal active space, we define specific minimal and extended active spaces for the NEVPT2 description of electronic states that fall within the Q and B bands. Subsequently, we apply our multireference-QM/MM protocol to the description of all pigments in the reaction center of Photosystem II. The calculations reproduce the electrochromic shifts induced by the protein matrix and the ordering of site energies consistent with the identity of the primary donor (ChlD1) and the experimentally known asymmetric and directional electron transfer. The optimized protocol sets the stage for future multireference treatments of multiple pigments, and hence for multireference studies of charge separation, while it is transferable to the study of any photoactive embedded tetrapyrrole system.

Protocol of a cost-effectiveness analysis of a combined intervention for depression and parenting compared with enhanced standard of care for perinatally depressed, HIV-positive women and their infants in rural South Africa

IntroductionPoverty, HIV and perinatal depression represent a triple threat to public health in sub-Saharan Africa because of their combined negative effects on parenting and child development. In the resource-constrained context...

Examining the Intricacies of Infrared Data Communication Protocols in Wireless Communication

Examining the Intricacies of Infrared Data Communication Protocols in Wireless Communication