High Volume Research Articles

Potassium salts activated lignin-based biochar as an effective adsorbent for malachite green adsorption

Herein, a series of lignin-based porous carbons (LC) were prepared from sulfonated lignin through a simple and environmentally-friendly one-pot activated carbonization together with various potassium compounds as activators, and used for malachite green (MG) adsorption. The results showed that the prepared biochar, especially after K2CO3 activation, exhibited a honeycomb profile with large surface area (2107.6 m2/g) and high total pore volume (1.1591 cm3/g), having excellent efficiency for MG adsorption, and the biggest adsorption capacity was 2970.0 mg/g. The kinetic study together with thermodynamic analysis indicated that the adsorption of MG by LC-K2CO3 conformed to pseudo-second-order model and the adsorption process was spontaneous, feasible, and endothermic. Moreover, LC-K2CO3 also displayed good stability and selectivity, and can selective separate the cationic dye from binary-dye system. Furthermore, the adsorption mechanism proposed in this work manifested that the high-efficient MG adsorption by LC-K2CO3 was a result of multiple actions including hydrogen bonding, electrostatic attraction, π-π interaction and n-π interaction as well as physical absorption. The work not only provide a fundamental theory for dye removal from wastewater, but offered a new insight for lignin valorization.

Hot deformation and dynamic recrystallization of Mg-Gd-Y-Zn-Zr alloy containing high volume fraction 18R-LPSO phase

The deformation behavior including flow behavior, hot workability and dynamic recrystallization (DRX) mechanism of as-cast Mg-9Gd-3Y-3.75Zn-0.6Zr alloy containing 26.5 % volume fraction 18R long-period stacking ordered (LPSO) phase distributed in continuous network morphology were studied by hot compression experiments at deformation condition of 350 ℃-500 ℃, 0.01–1 s−1 strain rate and 0.75 true strain. The influence of deformation conditions on the microstructural evolution was analyzed by using optical microscopy (OM), scanning electron microscope (SEM), electron back scatter diffraction (EBSD) and transmission electron microscope (TEM). Results display that stress exponent and deformation activation energy are 5.58 and 241.39 kJ·mol−1 correspondingly, which suggested that dislocation climb is the principal deformation mechanism. The Arrhenius type constitutive equation is established as ε̇=4.09×1016sinh(9.922×10−3σ)5.58exp(−241394RT). Microstructure evolution can be characterized by Zener-Holomon parameter (Z) which reflects the combining effect of temperature and strain rate on microstructure. At low lnZ (lnZ<36), the 18R-LPSO phase dissolves from continuous network to blocks and high DRX volume (>50 %) is realized by particle-stimulated nucleation and discontinuous dynamic recrystallization. At moderate lnZ (36≤lnZ<40), a fine and coarse grains bimodal structure is formed at the original grain boundary by continuous dynamic recrystallization resulting in a DRX volume between 10 % and 50 %. At high lnZ (lnZ≥40), layered 14H‐LPSO phase precipitates and inhibits DRX (DRX volume＜10 %) by absorbing dislocations. With combination of dissipation coefficient, instability factor and microstructure analysis, 400 ℃/0.01–0.05 s−1 and 450 ℃/0.01 s−1 are confirmed as optimal hot working domains for the as-cast alloy, under which conditions bimodal microstructure and equiaxed grains microstructure (average grain size 10.3 μm) can be formed correspondingly.

Mesoporous carbon with extremely low micropore content synthesized from graphene oxide modified with alkali metal nitrates

High-temperature thermal exfoliation is a simple, rapid, and cost-efficient method for transforming graphene oxide (GO) materials into reduced graphene oxide (rGO) materials. In this study, GO materials were dispersed with alkali metal nitrates (MNO3), leading to the preparation of porous rGO materials characterized by high specific surface area (SSA) and pore volume via high-temperature thermal exfoliation. Experimental data indicate that the metal cations of MNO3 tend to react directly with the oxygen functional groups (OFG) of GO, modulating the OFG content. Simultaneously, nitrate anions have preferential interaction with alkali metal ions and adhere to the surface of the GO. The presence of MNO3 on the surface of GO facilitates the thermal exfoliation process and leads to the formation of structures with an extremely high proportion of mesoporous content. The isothermal gas adsorption results show that the exfoliation efficiency of the samples activated with different nitrate salts decreases in the order rGO-KNO3 > rGO-NaNO3 > rGO-LiNO3. Among these samples, rGO modified with KNO3 exhibited the greatest exfoliation efficiency, with a mesopore-to-micropore volume ratio of 22.4, more than 1.7 times that of rGO. Its SSA and pore volume were 359 m2 g−1 and 1.26 cm3 g−1, respectively. These values significantly surpass those of rGO. Our research findings demonstrate that activation with MNO3 significantly increases the SSA and pore volume of the GO material after high-temperature annealing.

Interaction of aluminum alloys with MKPC and Portland-based cements on the metal-matrix interface

Cementitious matrices are considered for the immobilisation of radioactive aluminium. The processes occurring at the interface between both materials are relevant for the long-term stability of the repository. The present study compares Ordinary Portland cement (OPC), CEM I-type, with alternative Portland blended cement (CEM IV and CEM I + 50% silica fume) and magnesium potassium phosphate cement (MKPC). Al A1050 and Al AA5754, with 3.5% Mg, have been used as reactive metal alloys. Two exposure conditions were employed: (1) water immersion and (2) isolated in sealed plastic films. Long-term corrosion monitoring (Ecorr, icorr and Vcorr) was evaluated to understand the effect of Al reactivity in the matrix. The associated H2 release was quantified to understand the changes at the metal/matrix interface. Furthermore, pore ion concentrations and the pore microstructure were evaluated. The metal/matrix interface alterations were analysed at the end of the tests. The study revealed that after 300 days of water immersion, the CEM I + 50% of silica fume matrix had reduced the pore solution pH down to 10.5 compared to CEM I, which remained high alkaline (pH 12.9), and CEM IV with no significant decreases (pH 12.3). In contrast, MKPC showed the lowest pH (7–9.8). Low Al corrosion rates were found with MKPC, followed by CEM I + 50% SF according to their lower pH. A corrosion product layer of 90-50 μm thickness was observed at the Al/CEM I matrix interface constituted of aluminium and oxygen. Furthermore, enrichment in Al was detected in the matrix (around 1 mm depth), causing the formation of ettringite nodules. Voids were detected at the interface level associated with the high volume of H2 released. The MKPC matrix showed no alteration at the metal/matrix interface due to the lower reactivity of the matrix and lower H2 release. A homogeneous and dense region (30 μm) rich in phosphorous, potassium and magnesium was observed near the metal surface.

The impact of aneurysm volume on midterm Post-EVAR outcomes

Aim: We examined the impact of preoperative three-dimensional aortic volume on outcomes following Endovascular Aortic Repair (EVAR). Material and Methods: A total of 146 patients who underwent elective EVAR at our hospital between January 2018 and January 2023, and who had preoperative and postoperative multislice Computed Tomographic Angiography (CTA), were included in the study. The effects of aneurysm sac volumetric measurements on post-EVAR endoleak, reintervention, and late mortality were evaluated. Since there is no definite cut-off value for aneurysm volume and EVAR results in the literature, we compared patients with aneurysm volumes above and below 231.7 cm³ obtained by roc analysis. Results: During the follow-up period, the rate of secondary intervention was higher if the preoperative aneurysm volume was greater than 231.7 cm³ (p=0.001) or if the preoperative thrombus volume was greater than 206.1 cm³ (p=0.002). There was no notable difference in terms of endoleak (p=0.5) and during follow-up mortality rate (p=0.8) between patients with sac volumes above and below 231.7 cm³. After EVAR, when morphological changes were examined, it was noted that there was a dilatation of the neck (preoperative 23±4 mm and postoperative 26±4 mm) (p&lt;0.001) and a decrease in neck (infrarenal) angulation (preoperative 39 degrees and postoperative 31.5 degrees) (p&lt;0.001). Conclusion: This study demonstrates that aneurysms with high volume are prone to secondary intervention. However, it is not correlated with early or midterm mortality and outcomes. Volumetric analysis of the aneurysms preoperatively may be an indicator of surveillance protocols and treatment choices. Lifetime follow-up and volumetric analysis of aneurysms seem crucial for effective and reliable surveillance.

Applying Socio-Technical Models to Alarm Management: Tailoring Bed Exit Alerts in Medical-Surgical Units.

Integration of smartphone technology with the patient call-bell system provides the opportunity to enhance patient safety by supporting nurses' ability to communicate and prioritize care delivery directly. However, challenges are associated with achieving a balance between alarm support and alarm fatigue, including distracting nurses from patient care or desensitizing the nurse to other alarms and calls [1]. Our hospitals have quantitative and anecdotal reports of seriously high volumes of wireless alerts on the nurses' smartphones. Nurses have complained that the phones are generating too much noise to consume or timely prioritize. Preliminary alarm inventory revealed the Bed Exit wireless alert as a leading contributor of signal volume across many units and hospitals. The lack of standard policies and workflow improvement processes has increased nuisance alarms, making these Health Information Technologies less useful and safe. Using system data, workflow observations, and nursing interviews, Singh and Sittig's HIT Safety framework [2] was applied to identify and prioritize sociotechnical factors and interventions that impact the end-to-end Bed Exit alarm workflow. This study reviews the application of sociotechnical models and frameworks to reduce wireless calls without introducing risk and impacting patient care.

Development of an Al–Ti–Hf Composite Alloy Strengthened with High Volume Fraction of In-situ formed Al3(Ti, Hf)-Type Trialuminide Intermetallic Phase

Development of an Al–Ti–Hf Composite Alloy Strengthened with High Volume Fraction of In-situ formed Al3(Ti, Hf)-Type Trialuminide Intermetallic Phase

A novel guided approach to radiofrequency ablation of thyroid nodules: the Toronto Sunnybrook experience.

Thyroid nodules are extremely common being detected by ultrasonography in up to 67% of the population, with current surgical tenet maintaining that lobectomy is required for large symptomatic benign nodules or autonomously functionally nodules resulting in a risk of hypothyroidism or recurrent laryngeal nerve injury even in high volume centres. The introduction of radiofrequency ablation (RFA) has allowed thermal ablation of both benign and autonomously functioning thyroid nodules with minimal morbidity. The moving shot technique is the most well-established technique in performing RFA of thyroid nodules, and has proven to be safe, efficacious, accurate and successful amongst experienced clinicians. The purpose of this article to propose the use of a novel guide when performing RFA of thyroid nodules in clinical practice utilizing the moving shot technique. The technique proposed of RFA involves the use of a 10MHz linear ultrasound probe attached to an 18G guide which provides robust in line visualisation of a 7cm or 10cm radiofrequency probe tip (STARmed, Seoul, Korea) utilizing the trans isthmic moving shot technique. A geometric analysis of the guide has been illustrated diagrammatically. The use of an 18G radiofrequency probe guide (CIVCO Infiniti Plus™ Needle Guide) maintains in line visualisation of the radiofrequency probe over a cross-sectional area up to 28cm2, facilitating efficient and complete ablation of conceptual subunits during RFA of thyroid nodules. Radiofrequency ablation of thyroid nodules can be performed safely and effectively using the novel radiofrequency probe guide proposed which we believe potentially improves both accuracy and overall efficiency, along with operator confidence in maintaining visualisation of the probe tip, and hence we believe provides a valuable addition to the armamentarium of clinicians wishing to embark on performing RFA of thyroid nodules.

Endurance training volume cannot entirely substitute for the lack of intensity.

Very low intensity endurance training (LIT) does not seem to improve maximal oxygen uptake. The purpose of the present study was to investigate if very high volume of LIT could compensate the lack of intensity and is LIT affecting differently low and high intensity performances. Recreationally active untrained participants (n = 35; 21 females) cycled either LIT (mean training time 6.7 ± 0.7 h / week at 63% of maximal heart rate, n = 16) or high intensity training (HIT) (1.6 ± 0.2 h /week, n = 19) for 10 weeks. Two categories of variables were measured: Low (first lactate threshold, fat oxidation at low intensity exercise, post-exercise recovery) and high (aerobic capacity, second lactate threshold, sprinting power, maximal stroke volume) intensity performance. Only LIT enhanced pooled low intensity performance (LIT: p = 0.01, ES = 0.49, HIT: p = 0.20, ES = 0.20) and HIT pooled high intensity performance (LIT: p = 0.34, ES = 0.05, HIT: p = 0.007, ES = 0.48). Overall, very low endurance training intensity cannot fully be compensated by high training volume in adaptations to high intensity performance, but it nevertheless improved low intensity performance. Therefore, the intensity threshold for improving low intensity performance is lower than that for improving high intensity performance. Consequently, evaluating the effectiveness of LIT on endurance performance cannot be solely determined by high intensity performance tests.

Relationship Between Exchange Rate and Inflation in Afghanistan

Afghanistan is an import dependent country and has been facing perpetual trade balance deficit for decades. In case of imperfect competition in the market or existence of market monopoly, there is a higher chance of reflecting the exchange rate changes on the prices of the goods. In Addition, countries with low level of domestic production and higher amounts of imports usually experience higher degree of the exchange rate pass-through effect on inflation. Countries with high import volumes and low export levels often face a deficit in foreign currency inflows and an excess in outflows. These countries need substantial foreign currency to purchase and import goods from both neighboring and international markets, increasing domestic demand for foreign currencies and consequently leading to domestic currency depreciation. This study investigated the relationship between exchange rates and inflation in Afghanistan, examining how exchange rates impact inflation and the benefits associated with exchange rate mechanisms. The primary research questions include: What is the relationship between exchange rates and inflation in Afghanistan? How does the exchange rate influence inflation in the country? What are the benefits of exchange rate systems? The hypothesis posits that higher inflation typically depresses a country's currency value and that exchange rates directly affect inflation. Additionally, exchange rates determine the value of currency exchanges between different nations. This research aims to elucidate the relationship between exchange rates and inflation in Afghanistan, assess the impact of exchange rates on inflation, and explore the benefits of exchange rate systems. The methodology involves a binary system and utilizes secondary data collected from books, websites, and research papers. Findings indicate that Afghanistan's reliance on imports results in a persistent trade balance deficit, with a significant portion of goods, especially non-food items, being imported due to insufficient domestic production. To import goods, Afghanistan requires foreign currencies, which are typically earned through exports of goods and services as of a result, Afghanistan will experience stability in the exchange rate and in the domestic prices.

Sepsis Alert Systems, Mortality, and Adherence in Emergency Departments

Early detection and management of sepsis are crucial for patient survival. Emergency departments (EDs) play a key role in sepsis management but face challenges in timely response due to high patient volumes. Sepsis alert systems are proposed to expedite diagnosis and treatment initiation per the Surviving Sepsis Campaign guidelines. To review and analyze the association of sepsis alert systems in EDs with patient outcomes. A thorough search was conducted in PubMed, EMBASE, Web of Science, and the Cochrane Library from January 1, 2004, to November 19, 2023. Studies that evaluated sepsis alert systems specifically designed for adult ED patients were evaluated. Inclusion criteria focused on peer-reviewed, full-text articles in English that reported on mortality, ICU admissions, hospital stay duration, and sepsis management adherence. Exclusion criteria included studies that lacked a control group or quantitative reports. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Two independent reviewers conducted the data extraction using a standardized form. Any disagreements were resolved through discussion. The data were synthesized using a random-effects model due to the expected heterogeneity among the included studies. Key outcomes included mortality, intensive care unit admissions, hospital stay duration, and adherence to the sepsis bundle. Of 3281 initially identified studies, 22 (0.67%) met inclusion criteria, encompassing 19 580 patients. Sepsis alert systems were associated with reduced mortality risk (risk ratio [RR], 0.81; 95% CI, 0.71 to 0.91) and length of hospital stay (standardized mean difference [SMD], -0.15; 95% CI, -0.20 to -0.11). These systems were also associated with better adherence to sepsis bundle elements, notably in terms of shorter time to fluid administration (SMD, -0.42; 95% CI, -0.52 to -0.32), blood culture (SMD, -0.31; 95% CI, -0.40 to -0.21), antibiotic administration (SMD, -0.34; 95% CI, -0.39 to -0.29), and lactate measurement (SMD, -0.15; 95% CI, -0.22 to -0.08). Electronic alerts were particularly associated with reduced mortality (RR, 0.78; 95% CI, 0.67 to 0.92) and adherence with blood culture guidelines (RR, 1.14; 95% CI, 1.03 to 1.27). These findings suggest that sepsis alert systems in EDs were associated with better patient outcomes along with better adherence to sepsis management protocols. These systems hold promise for enhancing ED responses to sepsis, potentially leading to better patient outcomes.

Calcium-activated potassium channels as amplifiers of TRPV4-mediated pulmonary edema formation in male mice.

As a mechanosensitive cation channel and key regulator of vascular barrier function, endothelial transient receptor potential vanilloid-type 4 (TRPV4) contributes critically to ventilator-induced lung injury (VILI) and edema formation. Ca2+ influx via TRPV4 can activate Ca2+-activated K + (KCa) channels, categorized into small (SK1-3), intermediate (IK1), and big (BK) KCa, which may in turn amplify Ca2+ influx by increasing the electrochemical Ca2+ gradient and thus, promote lung injury. We therefore hypothesized that endothelial KCa channels may contribute to the progression of TRPV4-mediated VILI. Male C57Bl/6J mice were ventilated for 2 h with low or high tidal volumes in the presence or absence of the non-selective KCa antagonists apamin, charybdotoxin, or the selective IK1 antagonist TRAM34. Lung injury was similarly assessed in overventilated, endothelial-specific TRPV4-deficient mice or TRAM34-treated C57Bl/6J mice challenged with intratracheal acid installation. Changes in endothelial Ca2+ concentration ([Ca2+]i) were monitored by real-time imaging in isolated-perfused lungs in response to airway pressure elevation or in human pulmonary microvascular endothelial cells (HPMECs) in response to TRPV4 activation with or without inhibition of KCa channels. Analogously, changes in intracellular potassium concentration ([K+]i) and membrane potential (Vm) were imaged in vitro. Endothelial TRPV4 deficiency or inhibition of KCa channels, and most prominently inhibition of IK1 by TRAM34 attenuated VILI as demonstrated by reduced lung edema, protein leak, and by quantitative lung histology. All KCa antagonists reduced the [Ca2+]i response to mechanical stimulation or direct TRPV4 activation in isolated lungs. TRAM34 and charybdotoxin, yet not apamin prevented TRPV4-induced K+ efflux and membrane hyperpolarization in HPMECs. TRAM34 also attenuated the TRPV4 agonist-induced Ca2+ influx in vitro and reduced acid-induced lung injury in vivo. KCa channels, specifically IK1, act as amplifiers of TRPV4-mediated Ca2+ influx and establish a detrimental feedback that promotes barrier failure and drives the progression of VILI.

Survival benefit of living donor liver transplant for patients with hepatocellular carcinoma.

With the increasing incidence of hepatocellular carcinoma (HCC) in both the United States and globally, the role of liver transplantation in management continues to be an area of active conversation as it is often considered the gold standard in the treatment of HCC. The use of living donor liver transplantation (LDLT) and the indications in the setting of malignancy, both generally and in HCC specifically, are frequently debated. In terms of both overall survival and recurrence-free survival, LDLT is at least equivalent to DDLT, especially when performed for disease within Milan criteria. Emerging and compelling evidence suggests that LDLT is superior to DDLT in treating HCC as there is a significant decrease in waitlist mortality. As the oncologic indications for liver transplantation continue to expand and the gap between organ demand and organ availability continues to worsen, high volumes centers should consider using LDLT to shrink the ever-expanding waitlist.

New insights into the resistance of silica aerogel to temperature up to 1200 °C

Silica aerogel (SA) with high specific surface area (903 m2/g) and pore volume (6.81 cm3/g) was synthesized via base-catalyzed one-step sol–gel process. Thermal stability of SA under high temperature was estimated from structure evolution with temperature and time. The results demonstrate that the SA is thermally stabile at 1000 °C within 120 min (leaving specific surface area of 286 m2/g and pore volume of 1.46 cm3/g) and 1200 °C within 30 min (leaving specific surface area of 129 m2/g and pore volume of 0.59 cm3/g). The research provides new insights into the resistance of silica aerogels to high temperature, which is significant for application under harsh conditions.

Characterizing electronic messaging use among hospitalists and its association with patient volumes.

Secure electronic messaging is increasingly being utilized for communications in healthcare settings. While it likely increases efficiency, it has also been associated with interruptions, high message volumes, and risk of errors due to multitasking. We aimed to characterize patterns of secure messaging among hospitalists to understand the volume of messages, message patterns, and impact on hospitalist workload. This was a retrospective cross-sectional study of Epic Secure Chat secure electronic messages received and sent by hospitalists from April 1 to April 30, 2023 at a large academic medical center. Number of conversations per day, number of chats sent and accessed per hour, and average minutes between when a chat was sent and accessed (lag time) were analyzed using a Pearson correlation coefficient test. Measures were plotted against patient volume and time of day. Hospitalists sent or received an average of 130 messages per day with an average of 13 messages sent or received per hour. The median lag time was 39 s. There was a statistically significant correlation between hospital medicine morning census and number of conversations per day, number of chats sent per hour, and number of chats accessed per hour, but census did not impact lag time. Secure messaging volumes may be higher than previously reported, which may affect hospitalist workload and workflow and have unintended effects on interruptions, multitasking, and medical errors. Additional work should be done to better understand local messaging patterns and opportunities to optimize volume of work and distractions.

Role of Brand Familiarity on the Influence of Electronic Word-of-Mouth and Customers’ Behavioral Intentions

Despite the increased confidence in e-commerce, consumers remain skeptical when shopping online and therefore rely on electronic word-of-mouth generated by other consumers to aid their brand or store choice. Because eWOM can have detrimental or beneficial effects on brands and is beyond the control of firms, measuring the extent to which consumers use this information source to inform their decisions is a major challenge facing scholars and practitioners. This study examines the influence of eWOM on customers’ behavioral intentions and tests the role of brand familiarity. Five hypotheses are developed and tested based on the accessibility-diagnosticity theory and the elaboration likelihood model. A sample of 432 participants was recruited from a university in Southeastern Nigeria to participate in a [Formula: see text] between-subject factorial experiment. The results show that the positive or negative sentiments conveyed in eWOM messages and the familiarity of a brand affect customers’ behavioral intentions independently, and that the volume of eWOM messages interacts with brand familiarity to impact these behavioral intentions such that unfamiliar brands benefit more from high volume than familiar retailers do. The implication is that firms can overcome the problem of familiarity and performance risk by motivating and displaying as many eWOM communications as possible in their social media and advertisements.

Pore Size Distribution and Fractal Characteristics of Deep Coal in the Daning-Jixian Block on the Eastern Margin of the Ordos Basin.

Important breakthroughs have recently been achieved in deep coalbed methane (CBM) exploration and development in regions such as the eastern margin of the Ordos Basin, China. Investigating the development characteristics of various-scale pores in deep coalbeds is of great significance for resource assessment and selection of favorable zones for CBM exploration. Herein, six deep coal samples were selected from the Shanxi and Taiyuan Formations in the Daning-Jixian block on the eastern margin of the Ordos Basin. Low-pressure CO2/N2 adsorption (LP-CO2/N2GA) and high-pressure mercury intrusion (HPMI) methods were employed to analyze pore volume, specific surface area, and pore size distribution, thereby evaluating the full-scale pore characteristics. Furthermore, the fractal dimension characteristics of deep coal rock pores were elucidated, revealing the influence of pore structure, burial depth, and coal composition. The results indicate that micropores in deep coal rocks have the highest volume and specific surface area proportions, while mesopores have the smallest volume proportion, and macropores make the least contribution to the total specific surface area. The V-S, Frenkel-Halsey-Hill, and Sierpinski models were suitable for calculating the fractal dimensions of micropores, mesopores, and macropores with LP-CO2GA, LP-N2GA, and HPMI experimental data, respectively. Other than the relatively smaller mesopore fractal dimension of samples 20-8 and 20-10, the micropore, mesopore, and macropore fractal dimensions successively increased in the other four samples. The comprehensive fractal dimension, which exhibited a decreasing trend with increasing pore volume and specific surface area, was negatively correlated with burial depth, mineral and moisture contents, and ash and volatile component yields, while it was positively correlated with vitrinite and fixed carbon contents.

Raman Study of Novel Nanostructured WO3 Thin Films Grown by Spray Deposition.

The present communication reports on the effect of the sprayed solution volume variation (as a thickness variation element) on the detailed Raman spectroscopy for WO3 thin films with different thicknesses grown from precursor solutions with two different concentrations. Walls-like structured monoclinic WO3 thin films were obtained by the spray deposition method for further integration in gas sensors. A detailed analysis of the two series of samples shows that the increase in thickness strongly affects the films' morphology, while their crystalline structure is only slightly affected. The Raman analysis contributes to refining the structural feature clarifications. It was observed that, for 0.05 M precursor concentration series, thinner films (lower volume) show less intense peaks, indicating more defects and lower crystallinity, while thicker films (higher volume) exhibit sharper and more intense peaks, suggesting improved crystallinity and structural order. For higher precursor concentration 0.1 M series, films at higher precursor concentrations show overall more intense and sharper peaks across all thicknesses, indicating higher crystallinity and fewer defects. Differences in peak intensity and presence reflect variations in film morphology and structural properties due to increased precursor concentration. Further studies are ongoing.

Ultrasound-guided quadratus lumborum block with 0.5 mL of 0.2% bupivacaine/kg is a valuable perioperative analgesic adjunct for cats undergoing ovariectomy.

To assess the perioperative analgesic effects of bilateral ultrasound (US)-guided quadratus lumborum block (QLB) using low-volume (LV) or high-volume (HV) bupivacaine, compared to a control group, in cats undergoing ovariectomy. 48 healthy female cats. Cats were sedated with IM dexmedetomidine (5 µg/kg), ketamine (1 mg/kg), and methadone (0.2 mg/kg) followed by IV propofol induction and isoflurane maintenance. Cats were randomly assigned to 3 groups of 16 patients each: QLB-LV group (0.3 mL/kg/side), QLB-HV group (0.5 mL/kg/side), and control group (no QLB). Bilateral, in-plane, US-guided QLB was performed with lateral approach at the L2 transverse process with bupivacaine 0.2%. Physiological variables were recorded intraoperatively by a masked investigator. If intraoperative nociception occurred, fentanyl (1 µg/kg) was administered IV. Rescue postoperative analgesia (buprenorphine, 0.2 mg/kg) was administered in case of a Feline Grimace Scale score ≥ 4 after a 4-hour evaluation period. In the control group, heart rate (HR) was higher than the QLB-LV group during the first ovarian manipulation (P < .001) and higher than the QLB-HV group during both ovarian manipulations (P < .001 and P = .006). The need for intraoperative rescue analgesia and postoperative pain scores were significantly higher in the QLB-LV (P = .005 and P = .047) and control (P < .001 and P < .001) groups compared to the QLB-HV group. Buprenorphine was administered once in the control group. No clinical signs of bupivacaine toxicity or QLB complications were observed. Bilateral US-guided QLB-HV may effectively provide perioperative analgesia in feline patients undergoing ovariectomy.

Prompt engineering on leveraging large language models in generating response to InBasket messages.

Large Language Models (LLMs) have been proposed as a solution to address high volumes of Patient Medical Advice Requests (PMARs). This study addresses whether LLMs can generate high quality draft responses to PMARs that satisfies both patients and clinicians with prompt engineering. We designed a novel human-involved iterative processes to train and validate prompts to LLM in creating appropriate responses to PMARs. GPT-4 was used to generate response to the messages. We updated the prompts, and evaluated both clinician and patient acceptance of LLM-generated draft responses at each iteration, and tested the optimized prompt on independent validation data sets. The optimized prompt was implemented in the electronic health record production environment and tested by 69 primary care clinicians. After 3 iterations of prompt engineering, physician acceptance of draft suitability increased from 62% to 84% (P <.001) in the validation dataset (N = 200), and 74% of drafts in the test dataset were rated as "helpful." Patients also noted significantly increased favorability of message tone (78%) and overall quality (80%) for the optimized prompt compared to the original prompt in the training dataset, patients were unable to differentiate human and LLM-generated draft PMAR responses for 76% of the messages, in contrast to the earlier preference for human-generated responses. Majority (72%) of clinicians believed it can reduce cognitive load in dealing with InBasket messages. Informed by clinician and patient feedback synergistically, tuning in LLM prompt alone can be effective in creating clinically relevant and useful draft responses to PMARs.