Flowchart Research Articles

Ion transport membrane heat engine integration with autothermal reforming-based methanol production

This study focused on improving the energy demand of conventional large-scale natural gas to methanol flow sheet where even a small efficiency improvement has significant economics and carbon emissions benefits. A conventional flow sheet, case A, was based on best available literature information. A case B where the conventional cryogenic air separation unit (ASU) is replaced with the novel ion transport membrane (ITM) oxygen unit was developed. The ITM oxygen is also heat integrated into the autothermal reformer (ATR) process. A case C where the methanol synthesis process is configured into a gas turbine cycle was developed from further modifying case B. The flow sheets were constructed and modelled in Aspen Plus V10 and, heat and material balance results are reported. To our knowledge, the integration of ITM oxygen membranes into the ATR-based methanol process has not been assessed previously.Energy and exergy results are generated and analysed. It was found that is it possible to replace the cryogenic ASU with the ITM oxygen for oxygen production in the ATR process. There is enough process syngas heat available to provide the ITM oxygen unit heating requirement and to generate process steam feed to the ATR. Case A was found to consume only 12 % natural gas as utility fuel which is lower than typical SMR-based methanol processes. This reduced to about 5 % in case B and C. Power production improved by 47 % in case B and 68 % in case C compared to case A.A thermal efficiency definition suitable for combined process steam, power and oxygen production was proposed. This showed that integration of a high temperature gas power cycle enables combined steam (heat) and power configuration which has a higher efficiency compared to single cycles, such as the steam cycles. The overall plant exergy losses decreased by up to 21 %.

Approaches to Establishing National Diagnostic Reference Levels for Computed Tomography: A Systematic Review

Background: The international commission on radiation protection (ICRP) publican 135 recommends that Diagnostic Reference Levels (DRLs) should be tied to defined technical and patient parameters for the imaging task. Whereas for computed tomography (CT) examinations, DRLs are defined in terms of two established technical parameters namely, Volume-based Computed Tomography Dose Index (CTDIvol) and Dose Length Product (DLP), a debate has ensued as to whether patient size, age and weight or clinical indication should be used as patient parameters. The objective of diagnostic reference levels (DRLs) is to assist in the optimisation of radiation dose to the patients while maintaining diagnostic image quality. It is generally accepted that each country requires having national DRLs to guide the practice of radiography regarding dose optimization as a prerequisite to good radiation protection practice. Objective: This review aimed to establish commonly used approaches to establishing national diagnostic reference levels for computed tomography. Methods: A systematic literature search in databases containing leading journals in radiography, radiology and medical physics was performed aided by the use of carefully selected search terms that relate to CT and DRLs. The literature search was achieved by the use of the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) flow chart. A total of 109 studies were screened out of which 54 were excluded and 55 sought for retrieval. After further assessment for quality, 20 studies were included in this study for review. Key Findings: 95% of the studies in this review used CTDIvol and DLP as technical parameters indicating dose. 70% of the studies reviewed used patient size, age and weight while 30% used clinical indication as patient parameters. 30% of the reviewed articles did indicate that the surveys to establish NDRLs employed a retrospective approach, while 35% employed a prospective approach and 35% did ..

Development of the management for parenteral nutrition traceability in a standard hospital

Objectiveto develop the traceability control and the hazard analysis in the processes of parenteral nutrients (PN). Methoda standardized graphical notation was generated, describing in detail each of the stages in the overall process. The presence of hazards was analysed by sequencing decisions. The existence of Control Points (CP) or Critical Control Points (CCP) was estimated by Criticality Index (CI) for each hazard taking into account the probability of occurrence and the severity of the damage. The threshold for the IC was set in 6. Resultsa specific flow chart for the management and tra-ceability of PN was obtained, defining each of the stages in CPs (validation and transcription of the prescription and administration) or CCPs (preparation, storage and infusion pump -flow and filter-). Stages regarding the delivery, the recovery and the recycle of the packing material of PNs are not considered CPs and, therefore, they were not included in the dashboard. ConclusionsPN must be dealt with in the frame of a standardized management system in order to improve patient safety, clinical relevance, maximize resource efficiency and minimize procedural issues. The proposed system provides a global management model whose steps are fully defined, allowing monitoring and verification of PN. It would be convenient to make use of a software application to support the monitoring of the traceability management and to store the historical records in order to evaluate the system.

Assessing the barriers and enablers to the implementation of the diagnostic radiographer musculoskeletal X-ray reporting service within the NHS in England: a systematic literature review

IntroductionThe United Kingdom (UK) government's healthcare policy in the early 1990s paved the way adoption of the skills mix development and implementation of diagnostic radiographers' X-ray reporting service. Current clinical practice within the public UK healthcare system reflects the same pressures of increased demand in patient imaging and limited capacity of the reporting workforce (radiographers and radiologists) as in the 1990s. This study aimed to identify, define and assess the longitudinal macro, meso, and micro barriers and enablers to the implementation of the diagnostic radiographer musculoskeletal X-ray reporting service in the National Healthcare System (NHS) in England.MethodsMultiple independent databases were searched, including PubMed, Ovid MEDLINE; Embase; CINAHL, and Google Scholar, as well as journal databases (Scopus, Wiley), healthcare databases (NHS Evidence Database; Cochrane Library) and grey literature databases (OpenGrey, GreyNet International, and the British Library EthOS depository) and recorded in a PRISMA flow chart. A combination of keywords, Boolean logic, truncation, parentheses and wildcards with inclusion/exclusion criteria and a time frame of 1995–2022 was applied. The literature was assessed against Joanna Briggs Institute's critical appraisal checklists. With meta-aggregation to synthesize each paper, and coded using NVivo, with context grouped into macro, meso, and micro-level sources and categorised into subgroups of enablers and barriers.ResultsThe wide and diverse range of data (n = 241 papers) identified barriers and enablers of implementation, which were categorised into measures of macro, meso, and micro levels, and thematic categories of context, culture, environment, and leadership.ConclusionThe literature since 1995 has reframed the debates on implementation of the radiographer reporting role and has been instrumental in shaping clinical practice. There has been clear influence upon both meso (professional body) and macro-level (governmental/health service) policies and guidance, that have shaped change at micro-level NHS Trust organisations. There is evidence of a shift in culturally intrenched legacy perspectives within and between different meso-level professional bodies around skills mix acceptance and role boundaries. This has helped shape capacity building of the reporting workforce. All of which have contributed to conceptual understandings of the skills mix workforce within modern radiology services.

A novel time-lagged logistic grey model and its application in forecasting energy production volume

Scientific and accurate prediction of energy production is important for exploring energy alternative paths, adjusting energy structure and industrial layout in a targeted manner, and promoting strategic energy transformation. In this paper, a time-lagged logistic grey forecasting model with harvesting term is established by combining the Logistic model, which has the ability of historical recurrence and short- and medium-term forecasting ability, and the grey forecasting model, which has the characteristics of strong adaptability and small computational effort. The least squares method is used to estimate the parameters of the new model, and the mathematical method is used to calculate the time response equation of the new model, and the modeling steps and flow chart of the new model are obtained. Finally, the oil production data of a province in China is used as the validity analysis of the model, and the new model is compared with two classical grey prediction models, three optimized grey prediction models, and one other prediction model. Through the comparison of seven indicators, the results show that the new model is significantly better than other models. Based on the validity analysis results, the new model is applied to the energy production forecast of three typical provinces in China. The horizontal and vertical comparison shows that the model can effectively predict the three kinds of energy production, and can provide technical support for the strategy and measures to adjust the energy security structure and promote the healthy and sustainable development of the energy industry.

Caution Signages and Their Relevance in Commuter Safety in High-Density Construction and Traffic Areas of Two Smart Cities in Odisha: A Cross-Sectional Study to Ensure Eco-Mobility

INTRODUCTION: India has regulations to control RTA and is thus skewed towards regulating traffic and imposing fines if appropriate protective gear is not worn while driving. However, considering the population and perhaps also the socioeconomic standards of a major section of society, it is imperative to be equally vigilant towards the protection of commuters. Commuters can fall into all age ranges and, given the compounded problems of multiple constructions, bad roads, lack of proper walking space, stray animals, and mostly even rash driving, are at the highest risk of accidents. The most cost-effective and basic initial effort to offer them some protection would be to have signages and instructions posted at appropriate points of busy junctions or requisite points. OBJECTIVES: Primary: 1. To assess the awareness among commuters regarding danger signages and pedestrian norms in age groups and among genders. Secondary: 1. To identify the enabling factors that contribute to injuries/accidents among this section of the population on busy roads in sampled areas. 2. To make recommendations to ensure commuter safety and compliance with safety rules. METHODS: Select four sites each as per police station jurisdiction in the twin cities of Bhubaneswar and Cuttack. Two team members are deputed to stand at a convenient hour and seek permission as well as consent from commuters and assess their knowledge from a standardized pictorial flow chart by the Disaster Management Board. Responses were noted in a Google form by the survey team comprising interns and postgraduate students and interviewed at least ten each day. Five consecutive consenting commuters, each from age groups 11-21, 21-50, and >50 years from each gender, for five working days of two weeks, were completed. In the last six months, data from the police station was taken regarding reports of accidents by commuters in those areas and correlations were developed between relevant factors. Results were shared with the commuters and police in random groups to educate and generate a felt need for reinforcement of regulations that would prevent accidents to some extent. The study was conceived in the two busiest cities of Odisha state- Cuttack and Bhubaneswar, where active development activities occur throughout the year. RESULTS: From both cities, 64 commuters were selected for the study. Awareness of signages improved with increasing age, from 56% to 65% to 88%. Signages for construction sites and malls were poor in Cuttack, as it did not have many malls. Accidents were common among those aged 11 to 21 years, especially among females, and no correlation was seen between the reported injuries, gender-wise or socioeconomic status. Although increasing age was protective for injuries (21%; SD ±4.5, OR 0.21, p<0.03), the ones reported were primarily due to the use of alcohol, oversight, and lack of knowledge of signages. The police administration also admitted to under-reporting such injuries. The presence of stray animals was also a highly significant enabling factor for such injuries (OR 5.6, P<0.0001).

MLH1 Promoter Methylation Could Be the Second Hit in Lynch Syndrome Carcinogenesis.

(1) Background: MLH1 hypermethylation is an epigenetic alteration in the tumorigenesis of colorectal cancer (CRC) and endometrial cancer (EC), causing gene silencing, and, as a consequence, microsatellite instability. Commonly, MLH1 hypermethylation is considered a somatic and sporadic event in cancer, and its detection is recognized as a useful tool to distinguish sporadic from inherited conditions (such as, Lynch syndrome (LS)). However, MLH1 hypermethylation has been described in rare cases of CRC and EC in LS patients. (2) Methods: A total of 61 cancers (31 CRCs, 27 ECs, 2 ovarian cancers, and 1 stomach cancer) from 56 patients referred to cancer genetic counselling were selected for loss of MLH1 protein expression and microsatellite instability. All cases were investigated for MLH1 promoter methylation and MLH1/PMS2 germline variants. (3) Results: Somatic MLH1 promoter hypermethylation was identified in 16.7% of CRC and in 40% of EC carriers of MLH1 germline pathogenic variants. In two families, primary and secondary MLH1 epimutations were demonstrated. (4) Conclusions: MLH1 hypermethylation should not be exclusively considered as a sporadic cancer mechanism, as a non-negligible number of LS-related cancers are MLH1 hypermethylated. Current flow charts for universal LS screening, which include MLH1 methylation, should be applied, paying attention to a patient's family and personal history.

Screening for atrial fibrillation by village doctors in rural areas of china: the jiangsu province rural community atrial fibrillation project

Abstract Background No study has systematically investigated the quality of long-term care delivered to the rural elderly with chronic diseases in China. Since atrial fibrillation (AF) is becoming an increasing burden on healthcare systems worldwide. Purpose We conducted an AF screening programme in rural elderly and evaluated healthcare efficiency led by the village doctors in China. Methods This cross-sectional study of the rural population aged ≥65 years was conducted from April to June 2019 in our towns of Jiangsu Province. AF was identified using 12-lead electrocardiography in the first-step (government-led health examination) and single-lead electrocardiography in the second-step (in-house AF screening). Questionnaire surveys were designed for the AF patients and their village doctors, respectively. Results Among the 31,342 registered subjects, 12,630 (40·3%) declined, 7,956 (25·3%) participated in the first-step and 10,756 (34·3%) in the second-step (Figure 1). The overall AF detection rate was 4·3% (810/18,712). Of the 810 patients with AF (mean age 76·1±5·9 years; 51·4% female), 51·5% had education level below primary school, 2·6% could use smartphone applications, and 8·1% lived with their children. Common risk factors were older age, men, hypertension, diabetes, prior stroke, vascular disease, and congestive heart failure. Among the 402 patients who were aware of AF, there were 367 were at high risk of stroke (CHA2DS2-VASc score ≥3 in women or ≥2 in men) and OAC was currently used in only 10·9% (40/367) of these (Figure 2). Only 17·6% (91/516) of patients with known hypertension had a resting blood pressure level <140/90 mmHg, and 6·0% (8/132) of patients with known diabetes had a fasting blood glucose level ≤6·1 mmol/L. Our questionnaire survey for village doctors showed that only 7·3% (9/122) reported having the knowledge or ability for providing integrated care AF management. Conclusions This screening project in rural villages identified AF in 4·3%, but AF management was suboptimal with low use of oral anticoagulation. The current village doctor-dominant rural healthcare system is far from delivering optimal standardized AF management for older patients in rural China. There is a urgent need to support these rural clinics and empower the village doctors in optimising the care of AF patients.The flow chart of this studyThe use of oral anticoagulation

Effects of SGLT2i on reducing risks of cardiovascular events and dementia in atrial fibrillation patients with diabetes mellitus: a nationwide cohort study

Abstract Background/Introduction Patients with atrial fibrillation (AF) are associated with higher risk for cognitive decline and progression to dementia. There are limited data whether sodium-glucose cotransporter-2 inhibitor (SGLT2i) reduces new-onset cognitive dysfunction, especially in Asian patients with AF who also have diabetes mellitus. Purpose This study aimed to investigate whether SGLT2i reduces the risks of cardiovascular events and dementia among AF patients with diabetes. Methods We identified AF patients with diabetes based on the Taiwan's National Health Insurance Research Database (2016). AF patients without prior dementia history and aged 55-85 years were studied: 810 patients were prescribed SGLT2i for at least 180 days and were matched with 1620 patients without SGLT2i using propensity scores (Figure 1). Cardiovascular and dementia events were followed through the end of 2021. Subtypes of dementia were investigated using competing risk models. Results During a follow-up period of 5 years of AF patients with diabetes receiving SGLT2i, as shown in Figure 2, this study provides a detailed insight into the results of survival analyses for clinical outcomes of AF, stroke, total dementia, vascular dementia, all-cause death, and cardiovascular (CV) death. After multivariable adjustment, the risks of AF-related hospitalization (HR: 0.741, 95% CI: 0.563-0.976), stroke (HR: 0.748, 95% CI: 0.599-0.934) and all-cause death (HR: 0.338, 95% CI: 0.245-0.466), were significantly decreased. Both CV death (HR: 0.449, 95% CI: 0.268-0.755) and non-CV death (HR: 0.298, 95% CI: 0.198-0.448) were significantly reduced. SGLT2i use was associated with a significantly decreased risk of total dementia (HR: 0.615, 95% CI: 0.436-0.869) and vascular dementia (HR: 0.419, 95% CI: 0.221-0.793). The reduced risks of Alzheimer’s dementia and other/mixed dementia were not statistically significant. After multivariable adjustment, total dementia and vascular dementia were associated with higher age and stroke events. The beneficial effect on dementia was irrespective of novel oral anticoagulants (NOAC) use, although the SGLT2i benefits were greater in non-warfarin and non-dipeptidyl peptidase 4 (DPP4) users compared to users. Conclusions There were decreased risks of AF-related hospitalization, stroke event, all-cause death, and vascular dementia in the users of SGLT2i in AF patients with diabetes. This was irrespective of NOAC use, although the SGLT2i benefits were greater in non-warfarin users compared to warfarin users.Figure 1:Study flow chart

Utilization of the En Route Aeromedical Patient Movement Form by Critical Care Air Transport Teams.

Understanding usage patterns of current paper-based documentation can inform the development of electronic documentation forms for en route care. The primary objective was to analyze the frequency of use of each field within the 3899 L Patient Movement Record documented by en route Critical Care Air Transport Teams. Secondary objectives were to identify rarely utilized form fields and to analyze the proportion of verifiable major events documented within the 3899 L form. We performed a retrospective review of 3899 L patient movement records for patients transported via Critical Care Air Transport Teams from January 2019 to December 2019. Scanned 3899 L forms were manually transcribed into a Microsoft Access database for evaluation and analysis. Proportions were calculated for completed fields. Major vital sign event frequency was compared for checkbox fields versus the vital sign flow sheet for each patient. We performed descriptive analyses for the proportion of charts with completed documentation in each evaluated field and the proportion of flow sheet events documented in major event fields. We analyzed 130 records. Fourteen of 18 (77.8%) demographic fields had a 75% or greater completion ratio. Sections with the largest proportion of rarely or never utilized fields (<1.5% completed) were procedures (77.8% of fields) and major events (63.9% of fields). Major event checkboxes had low sensitivity for documented events in the flow sheet: Change in heart rate greater than 20% (1 of 28 patients); increase in the fraction of inspired oxygen requirement of greater than 10% (6 of 23 patients); decrease in mean arterial pressure of greater than 20% (1 in 12 patients); and temperature less than 35.6°C (1 in 13 patients). Many of the current 3899 L fields are highly utilized, but some 3899 L sections contain high proportions of rarely utilized fields. Major event checkboxes did not consistently capture events documented within the in-flight vital sign flow sheet.

Abstract 15311: Predict Factors Affected With In-Hospital Clinical Outcomes Between Endovascular Therapy and Fogarty Thrombectomy for Patients With Acute Limb Ischemia: A Large Number Analysis Based on JROAD-DPC Database

Background: The etiology of acute limb ischemia (ALI) has been often reported to be embolism caused by atrial fibrillation (Af) and/or atrial flutter (AFL), and thrombosis caused by atherosclerosis. Although endovascular therapy (EVT) or fogarty thrombectomy (Fogarty) is recommended as a primary treatment for patients with ALI, which treatment should be chosen is still controversial. Aim: To evaluate differences of clinical outcomes between primary treatments for patients with ALI, and identify prognostic predictors. Methods: This was a retrospective study based on the database in the JROAD-DPC (Japanese Registry of All Cardiac and Vascular Diseases and the Diagnosis Procedure Combination). Figure.1 showed the flow chart of this study. Comparison with EVT-alone and Fogarty-alone group was analyzed using propensity score matching with 16 clinically relevant covariates. Clinical outcomes were death, major adverse cardiovascular events (MACE; myocardial infarction, coronary intervention, heart failure, stroke, cerebral hemorrhage), bleeding complications with bleeding academic research consortium (BARC) type 3-5, and any amputation. Results: Figure2-4 showed the results of this study. Figure.3 demonstrated that bleeding complications and any amputation in Fogarty-alone group were significantly less than EVT-alone group. Figure.4 revealed that Fogarty tended to decrease an amputation-free survival rate in ALI patients who had no history of peripheral artery disease (PAD) and not administered an antiplatelet before onset. Conclusions: Fogarty should be selected as the primary treatment as much as possible for ALI patients, especially those without PAD.

Evidence-based Egyptian clinical practice guidelines: for the prevention and management of iron deficiency and iron deficiency anemia in infants, children and adolescents

BackgroundIron deficiency (ID) is the most common nutritional disorder affecting all age groups. Infants and young children are vulnerable to anemia especially iron deficiency anemia (IDA), which represents a public health problem with defined impacts on the health of communities. IDA, however, is a preventable and treatable condition; therefore, early diagnosis represents the cornerstone in protection from its adverse consequences and combating its contributing factors. Several international guidelines for the management of ID/IDA are available, however national guidelines that can be implemented and suits our local needs are lacking.ObjectiveTo adapt the pre-existing high-quality practice guidelines for the screening, prevention and management of ID/IDA in different pediatric age groups, to be available for the national use by general practitioners, pediatricians, and other health care professionals.ResultsThe adaptation group for this guideline included key leaders from different Egyptian institutions. The panel used the ADAPTE methodology for adaptation of guidelines. The panel prioritized the health questions and recommendations according to their importance for clinicians and patients. The procedure included searching for existing guidelines, quality appraisal, and adaptation of the recommendations to the target context of use. The guideline covered all important aspects of detection, identification of infants, children, and adolescents at high risk of developing ID/IDA, proper management, and prevention. The final version of the adapted clinical practice guideline has been made after thorough review of an external review panel and was guided by their official recommendations and modifications. Implementation tools included algorithms, tables, and flow charts to aid decision making in practice, as well as patient-directed information in the Arabic language.ConclusionsThis adapted guideline serves as a tool for the screening, prevention and management of ID/IDA in different pediatric age groups.

SISTEM INFORMASI MANAJEMEN DOKUMEN MENGGUNAKAN METODE PROTOTYPING PADA PT. BANGUN INDAH SAPUTRA

PT. Bangun Indah Saputra is a service company that serves the process of making documents. The purpose of this study is to provide convenience in the management of document maker data. In addition, data security and accuracy are more guaranteed and human resources become more efficient. The research methodology used is Grounded Research method with data collection techniques, namely observation and literature studies that are relevant to the rental system. To build this system is used system design tools that are data flow chart (DAD) context, Zero and detail and by using Java programming language with Netbeans and MySQL database using XAMPP. This system can facilitate the work of the admin in the record so as to increase the effectiveness and consistency of the company PT. Bangun Indah Saputra

Factors influencing health worker compliance in implementing patient safety goals in Indonesia: Systematic review

The compliance rate of health workers in patient safety is not fully good at 68.7% and the implementation of patient safety in Indonesia is not optimal at 74.2% whereas in 2016 in Indonesia there were still 31 cases related to patient safety. To determine the factors that affect the compliance of health workers in the implementation of patient safety goals using a systematic review approach. This study uses a systematic review method from 9 studies using a quantitative approach commonly called a meta-analysis. The search for the source of this research data uses PRISMA flow charts from several databases such as Google Scholar, garuda portal, ProQuest, and Elsevier. Where published in the last 10 years (2013-2023). 25 variables were the same in the study between one researcher and another, namely age, gender, marital status, number of dependents, length of work, nurse knowledge, nurse motivation, supervision, nursing, organizational influence, educational status, compliance behavior, ability, supervisor support, fellow nurse support, workplace comfort, employment status, motivation, perception, nurse compliance, 6 patient safety goals, patient safety culture, patient identification, patient safety events, and patient fall prevention. The average P-Value value is 0.180, the minimum value of P-Value = 0.000, and the maximum value of P-Value = 0.995. 8 dominant factors influence health workers in implementing patient safety goals. 8 dominant factors influence health workers in implementing patient safety goals, namely knowledge, length of work, nurse work motivation, nurse perception, stress level and workload, nurse compliance, organizational influence, and supervisor support.

Chengai Nomogram: A Comprehensive Study of Uroflow Parameters and Characteristics in Healthy Adult Males From South India.

Introduction Uroflowmetry is a widely accepted non-invasive diagnostic modality used in the evaluation of lower urinary tract dysfunction. While various nomograms have been established for different populations and races, there has been a lack of studies that focus on the South Indian populations. Consequently, the objective of the study was to investigate the urinary flow parameters in a healthy adult male South Indian population using uroflowmetry and identify the variations in flow rates. Additionally, the study sought to assess the influence of age and voided volume (VV) on flow rates and create a representative nomogram. Methods A total of 500 uroflowmetry tests were prospectively performed on healthy adult males. The gravimetric method was utilized for uroflowmetry. Flow charts and parameters were analyzed for correlation and linear regression models, and statistical calculations were employed to generate uroflow nomograms. Results The mean age of the participants was 37.77±9.91 years. The mean values for maximum flow rate (Qmax), average flow rate (Qavg), and VV were 23.42±6.64 mL/s, 11.71±3.77 mL/s, and 229.90±59 mL, respectively. A significant correlation was observed between flow rates (Qmax and Qavg) and VV, which indicated that increased VV leads to higher flow rates. Additionally, a significant negative correlation between the flow rates and age was noted. Conclusion The findings provide insight into the uroflow parameters of the South Indian adult male population and contribute to the development of nomograms, establishing normal reference ranges for flow rates across varying VVs. As a tribute to the hospital and the study participants, the nomogram was named the "Chengai Nomogram."

Flowchart for predicting achieving the target area under the concentration-time curve of vancomycin in critically ill Japanese patients: A multicenter retrospective study

IntroductionIn therapeutic drug monitoring (TDM) of vancomycin (VCM), the area under the concentration-time curve (AUC) is related to the clinical efficacy and toxicity. Therefore, herein, we examined the factors associated with achieving the target AUC at follow-up and developed a decision flowchart for achieving the target AUC in critically ill patients. MethodsThis multicenter retrospective observational study was conducted at eight hospitals. We retrospectively analyzed data from patients who had received VCM in the intensive care unit from January 2020 to December 2022. Decision-tree (DT) analysis was performed using factors with p < 0.1 in univariate analysis as the independent variables. Case data were split up to two times, and four subgroups were included. The primary endpoint was achieving the target AUC at the follow-up TDM (AUCfollow-up) and target AUCfollow-up achievement was defined as an AUC of 400–600 μg‧h/mL. The initial AUC values were calculated with the 2-point concentrations (peak and trough) using the Bayesian estimation software Practical AUC-guided TDM (PAT). ResultsAmong 70 patients (median age [interquartile range], 66 [56, 79] years; 50 % women), the AUCfollow-up was achieved in 70 % (49/70). Three factors were selected for the decision flow chart: predicted AUCfollow-up of 400–600 μg‧h/mL, dosing at 12-h intervals, and CCr of 130 mL/min/1.73 m2 or higher; the accuracy was adequate (92 %, R2 0.52). ConclusionWe successfully identified the factors associated with achieving the target AUC of VCM at follow-up TDM and developed a simple-to-use DT model. However, the validity of the findings needs to be evaluated.

Generation and Screening of Various CD70 CAR NK Cells Identify the Most Effective Construct Against Hematologic Malignancies

The ability to re-direct the intrinsic power of the immune system against cancer has resulted in unprecedented outcomes in certain patients with otherwise incurable diseases. Natural killer (NK) cells, similar to T cells, are powerful immune effectors that possess intrinsic anti-tumor properties and are capable of generating a strong cytotoxic response upon engaging tumor cells. However, unlike T cells, NK cells do not identify specific antigens and do so in a way that is HLA-independent, posing minimal risk of GvHD. Thus, NK cells have are being explored as a possible allogeneic source for over-the-counter cellular immunotherapy. CD70, the ligand for the CD27 receptor, is an attractive “pan-cancer antigen”, since in addition to being expressed in hematologic malignancies such as acute myeloid leukemia (AML) and lymphoma, it is also expressed on many solid tumors, including bladder, lung, triple negative breast cancer, renal cell carcinoma, pancreatic cancer, and melanoma. Moreover, CD70 is only transiently found on activated T and B lymphocytes and on dendritic cells. To target CD70-expressing cancers, we designed and tested a number of different chimeric antigen receptors (CAR). Briefly, we used the natural interaction between CD70 and CD27 to make a CAR construct that incorporated the extracellular domain of human CD27, which is the natural receptor for CD70. We generated various second-generation CAR constructs that differed in their transmembrane domains (CD27 vs. CD28) and costimulatory domains. We included co-stimulatory domains that are NK-centric (DAP10 and DAP12), T-cell-centric (CD28), or bi-centric (4-1BB). The CD3ζ chain was used as a signaling endodomain, and all the CAR constructs also included IL-15 to enhance in vivo proliferation and persistence. Cord blood (CB)-derived NK cells were efficiently retrovirally transduced with the different CAR constructs and subjected to an in vitro functional screen against various cancer cells to evaluate the best constructs for in vivo validation (Figure 1). The top constructs from our in vitro screen were further evaluated in multiple in vivo models, including a Raji lymphoma model and a THP-1 AML model. The best CAR construct in terms of superior tumor control and prolongation of survival was selected for GMP manufacturing. Based on these preclinical findings, a Phase I/II clinical study is now being conducted at our center to assess the safety and effectiveness of CD70 CAR NK cells against CD70-expressing hematologic malignancies (NCT05092451). Figure 1: Flow chart showing the screening process to identify the most effective CAR construct.

Optimizing metal recovery from slag leaching solutions: Advanced ion exchange techniques for sustainable resource extraction

Metal recovery through ion exchange (IX) is a promising strategy for resource extraction and environmental conservation. We assessed the efficacy of IX in recovering metal ions from slag leachates sourced from a Chilean copper processing plant. At pH 4.3, selective precipitation removed over 90 % of Fe(III) and Al(III). In batch mode, an iminodiacetic-functionalized resin selectively adsorbed Fe(III) and Al(III) ions, outcompeting other valuable metals. Optimizing pH and matrix composition in column operations boosted nickel recovery to 0.65 eq/L using a bispicolylamine-functionalized resin. A 3.5 % NH4OH solution proved effective for nickel elution, reaching 10 g/L peak concentration. The successful upscaling of the process from a 10 mL to a 100 mL bed volume demonstrates positive insights for industrial application, enabling efficient nickel recovery from larger volumes of water. SEM analysis revealed the physical state on the resin, and metal ion interactions, which verified the interpretations from water analyses, reinforcing the reliability and coherence of the results. Ongoing work aims to extend this method to selective zinc and cobalt recovery. The flow charts developed in this study aid in selecting appropriate IX-based wastewater treatments. This research aims to recover metals from mining-affected water, reduce waste, and promote metal recycling while enhancing environmental conservation efforts.

A Practical Group Symbol and Group Name Approach (PSNA) according to EN ISO 14688-2:2018

Classification systems are crucial to the description and classification of soils, helping to facilitate soil identification, as well as the understanding, and interpretation of soil materials worldwide. In this study, EN ISO 14688-2:2018 and ASTM D2487-17e1 were employed to develop a practical soil identification approach called Practical Group Symbol and Group Name Approach (PSNA). The method presented herein is not a classification system or a standard but is rather an approach that makes EN ISO 14688-2:2018 usable in practice and enables soil particle identification in detail. The use of this practical method can eliminate any ambiguity in communicating soil characteristics. Practical flow charts were prepared for defining group names and symbols of soil particles. The method enables the classification of gravel, sand, silt, clay, and organic material. A user-friendly macro was also developed in Microsoft Excel, utilizing the integrated programming language Visual Basic for Applications (VBA) to facilitate the implementation of this approach. In the present study, an Excel-based triangular diagram was developed. In addition to the triangular diagram, two charts were considered. From these contributions, the group symbol and group name of soil mixtures can be easily and practically defined.

Wide-body aircraft fuel jettison system design and analysis

In order to design the highly integrated fuel jettison system, the hydrodynamic performance design flow chart for the highly integrated fuel system has been proposed, and the 1-D fuel line network performance model has been developed. An innovative fuel jettison system for wide-body aircraft has been designed. The system performance has been simulated and analyzed. The results show that the proposed flow chart can be used for the highly integrated fuel system design, and the fuel jettison performance requirements can be met. The system parameters including the wing tank main pump characteristic, the flow area of the orifice set in the fuel line connecting the feeding line and the refueling line, and the flight height have significant effects on the fuel jettison performance. Besides, the aircraft total fuel jettison performance is also affected by the central tank override pump characteristic, the engine fuel consumption, and the flow resistance of fuel line network.