Higher Withdrawal Rate Research Articles

Formation of lamellar eutectic structure and improved mechanical properties of directional solidified Al0.9CoCrNi2.1 high-entropy alloy

In this study, Al0.9CoCrNi2.1 EHEA was prepared by directional solidification at various withdrawal rates from 6 to 120 μm/s. The lamellar eutectic structure is formed containing FCC (L12) and BCC (B2) at different withdrawal rates during directional solidification. The solid-liquid interface of the alloy transfers from nearly-planer to cellular eutectic interface and the lamellar spacing decreases from 7.17 μm to 1.65 μm as the withdrawal rate increases. The lamellar spacing is negatively correlated with withdrawal rates which was identified by the Jackson-Hunt model and its growth rate index (0.484) is closely related to the theoretical value (0.5). The tensile experiment demonstrates that the structure of Al0.9CoCrNi2.1 EHEA is finer and the ultimate tensile strength and elongation increase as the withdrawal rate increases. The elongation of Al0.9CoCrNi2.1 EHEA is two times higher than that of the as-cast alloy at the withdrawal rate of 120 μm/s. It is concluded that the formation of the L12 phase and Cr-rich precipitated phases in the directional solidified eutectic structure are associated with the enhancement of mechanical properties due to grain refinement at high withdrawal rates.

Once daily cediranib and weekly paclitaxel to prevent malignant bowel obstruction in at-risk patients with platinum-resistant ovarian cancer (CEBOC): a single-arm, phase II safety trial

ObjectiveCytotoxic chemotherapy for ovarian cancer can be augmented by co-administration of vascular endothelial growth factor inhibitors but these are contraindicated in patients with bowel obstruction due to the risk of...

Effect of withdrawal rate on freckle formation of large-size directional solidified nickel-based superalloy blades

The freckle formation and distribution in large-size directional solidified nickel-based superalloy blades at different withdrawal rates were investigated. The microstructure of freckles was analyzed by optical microscope (OM), and scanning electron microscope (SEM). The crystallographic orientation in the freckle regions was characterized by electron backscattered diffraction (EBSD). The solute segregation patterns on the surface of freckle regions were obtained by X-ray fluorescence (XRF). Numerical simulations for the temperature field were performed to analyze the mushy zone evolution during directional solidification. The experimental results indicated that the root region is prone to form freckles. The freckle chains were only distributed on the outward surface of the root region at low and middle withdrawal rates, and the inward side was free of freckles. When a high withdrawal rate was applied, a few freckles occurred on the inward side of the root region. The number and length of freckle chains increased as the withdrawal rate increased. The XRF results indicated that channel segregation formed on the surface of the root region. The segregation channels predicted by the macrosegregation simulation agreed well with the experimental observation. The concave or inclined solidification interface increased the propensity for freckle formation.

Acupuncture for Combat-Related Posttraumatic Stress Disorder

Current interventions for posttraumatic stress disorder (PTSD) are efficacious, yet effectiveness may be limited by adverse effects and high withdrawal rates. Acupuncture is an emerging intervention with positive preliminary data for PTSD. To compare verum acupuncture with sham acupuncture (minimal needling) on clinical and physiological outcomes. This was a 2-arm, parallel-group, prospective blinded randomized clinical trial hypothesizing superiority of verum to sham acupuncture. The study was conducted at a single outpatient-based site, the Tibor Rubin VA Medical Center in Long Beach, California, with recruitment from April 2018 to May 2022, followed by a 15-week treatment period. Following exclusion for characteristics that are known PTSD treatment confounds, might affect biological assessment, indicate past nonadherence or treatment resistance, or indicate risk of harm, 93 treatment-seeking combat veterans with PTSD aged 18 to 55 years were allocated to group by adaptive randomization and 71 participants completed the intervention protocols. Verum and sham were provided as 1-hour sessions, twice weekly, and participants were given 15 weeks to complete up to 24 sessions. The primary outcome was pretreatment to posttreatment change in PTSD symptom severity on the Clinician-Administered PTSD Scale-5 (CAPS-5). The secondary outcome was pretreatment to posttreatment change in fear-conditioned extinction, assessed by fear-potentiated startle response. Outcomes were assessed at pretreatment, midtreatment, and posttreatment. General linear models comparing within- and between-group were analyzed in both intention-to-treat (ITT) and treatment-completed models. A total of 85 male and 8 female veterans (mean [SD] age, 39.2 [8.5] years) were randomized. There was a large treatment effect of verum (Cohen d, 1.17), a moderate effect of sham (d, 0.67), and a moderate between-group effect favoring verum (mean [SD] Δ, 7.1 [11.8]; t90 = 2.87, d, 0.63; P = .005) in the intention-to-treat analysis. The effect pattern was similar in the treatment-completed analysis: verum d, 1.53; sham d, 0.86; between-group mean (SD) Δ, 7.4 (11.7); t69 = 2.64; d, 0.63; P = .01). There was a significant pretreatment to posttreatment reduction of fear-potentiated startle during extinction (ie, better fear extinction) in the verum but not the sham group and a significant correlation (r = 0.31) between symptom reduction and fear extinction. Withdrawal rates were low. The acupuncture intervention used in this study was clinically efficacious and favorably affected the psychobiology of PTSD in combat veterans. These data build on extant literature and suggest that clinical implementation of acupuncture for PTSD, along with further research about comparative efficacy, durability, and mechanisms of effects, is warranted. ClinicalTrials.gov Identifier: NCT02869646.

2021 European Resuscitation Council/European Society of Intensive Care Medicine Algorithm for Prognostication of Poor Neurological Outcome After Cardiac Arrest-Can Entry Criteria Be Broadened?

To explore broadened entry criteria of the 2021 European Resuscitation Council/European Society of Intensive Care Medicine (ERC/ESICM) algorithm for neuroprognostication including patients with ongoing sedation and Glasgow Coma Scale-Motor score (GCS-M) scores 4-5. Retrospective multicenter observational study. Four ICUs, Skane, Sweden. Postcardiac arrest patients managed at targeted temperature 36°C, 2014-2018. Neurologic outcome was assessed after 2-6 months according to the Cerebral Performance Category scale. None. In 794 included patients, median age was 69.5 years (interquartile range, 60.6-77.0 yr), 241 (30.4%) were female, 550 (69.3%) had an out-of-hospital cardiac arrest, and 314 (41.3%) had a shockable rhythm. Four hundred ninety-five patients were dead at follow-up, 330 of 495 died after a decision on withdrawal of life-sustaining therapies. At 72 hours after cardiac arrest 218 patients remained unconscious. The entry criteria of the original algorithm (GCS-M 1-3) was fulfilled by 163 patients and 115 patients with poor outcome were identified, with false positive rate (FPR) of 0% (95% CI, 0-79.4%) and sensitivity of 71.0% (95% CI, 63.6-77.4%). Inclusion of patients with ongoing sedation identified another 13 patients with poor outcome, generating FPR of 0% (95% CI, 0-65.8%) and sensitivity of 69.6% (95% CI, 62.6-75.8%). Inclusion of all unconscious patients (GCS-M 1-5), regardless of sedation, identified one additional patient, generating FPR of 0% (95% CI, 0-22.8) and sensitivity of 62.9% (95% CI, 56.1-69.2). The few patients with true negative prediction (patients with good outcome not fulfilling guideline criteria of a poor outcome) generated wide 95% CI for FPR. The 2021 ERC/ESICM algorithm for neuroprognostication predicted poor neurologic outcome with a FPR of 0%. Broadening inclusion criteria to include all unconscious patients regardless of ongoing sedation identified an additional small number of patients with poor outcome but did not affect the FPR. Results are limited by high rate of withdrawal of life-sustaining therapies and few patients with true negative prediction.

Post Hematopoietic Cell Transplantation Maintenance Therapy with Low-Dose Azacitidine in a Pediatric Population with High-Risk Myeloid Neoplasms

Patients with acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) undergoing allogeneic hematopoietic cell transplantation (HCT) remain at risk for relapse. Children with relapsed AML and high-risk features including prior HCT, early relapse, and high-risk cytomolecular features experience survival of ≈30%. Given the even more dismal survival and limited therapy options for post-HCT relapse, azacitidine (aza) has been explored as post-HCT maintenance therapy based on potential disease targeting activity and enhancement of graft versus leukemia. Studies to date suggest that this approach is safe with signals of favorable survival. A phase 3 trial in adults did not show a survival benefit, although results were confounded by a high rate of withdrawal and a minority of patients received all intended cycles. We performed a descriptive analysis of all patients with high-risk myeloid neoplasms who underwent allogeneic HCT at Seattle Children's Hospital (SCH) from November 2017 to January 2023 and received post-HCT maintenance aza. Patients were considered high-risk if they had undergone prior HCT, measurable residual disease at HCT, ≥CR2, or high-risk cytomolecular features. Patients received myeloablative conditioning according to standard protocols. All patients were in remission prior to aza initiation. Aza 36-50 mg/m 2 was administered as IV or subcutaneous infusions daily for 5 consecutive days on a 28-day cycle with intention to continue therapy with cycles beginning through 1-year post-HCT. Nineteen patients began aza therapy at a median of 109 days (range 66-263) post-HCT. Demographics and disease information plus the primary high-risk feature for consideration of post-HCT aza are reported in Table 1. Following aza initiation, 9 (47.4%) patients continued subsequent aza cycles at their referring institution with concurrent remote management by SCH as needed. Median post-HCT follow-up was 30.4 months (range 7-66). The median number of completed aza cycles was 8 (range 3-12) and 14 (73.7%) patients received all intended cycles through 1 year following HCT. In 3 patients, aza cycles were delayed >4 weeks due to non-neutropenic fever or infection; de-escalation to 36 mg/m 2 for subsequent courses in the 2 patients who were receiving 50 mg/m 2 led to no further delays. There were no delays due to marrow suppression, no increased transfusion needs, and no hospitalizations attributed to aza. Fourteen (73.7%) patients had grade II acute graft versus host disease (GVHD) prior to initiation of aza. Two (10.5%) of these patients subsequently developed chronic oral GVHD, 1 diagnosed incidentally during their last aza cycle and 1 diagnosed after completion of aza. Two (10.5%) patients experienced ≤ grade II acute GVHD flares while tapering systemic immunosuppressive treatment (IST) and receiving aza, prompting escalation of same systemic IST (n=1) or addition of topical IST (n=1). Seventeen of 18 patients who were in remission at 1-year post-HCT were tapering or off IST. Five (26.3%) patients discontinued aza before 1 year post-HCT: 2 due to relapse, 2 per family preference, and 1 for inflammatory process with persistent dual chimerism from double cord HCT. Three-year estimates for overall and relapse free survival were 92% (95% CI 54-99) and 76% (95% CI 46-91), respectively, and cumulative incidence of relapse was 24% (95% CI 7-48) (Figure 1). The 6 patients with history of prior HCT are all are alive with ongoing remission at ≥3 years following second HCT with aza maintenance. Our experience demonstrates that post-HCT maintenance therapy with low-dose aza for high-risk pediatric AML/ MDS is tolerable with limited toxicity and without significant impact on marrow suppression or GVHD. The ability to successfully implement a post-HCT aza regimen in partnership with local institutions allowed families to return home, potentially reducing emotional hardship and financial toxicity due to travel/ housing and supporting feasibility. Outcomes in this cohort were improved compared to historical controls; this was especially notable in patients undergoing 2 nd HCT and in patients ≥CR2. Our findings suggest a potential role for post-HCT low-dose aza in children with high-risk AML/ MDS but further prospective pediatric studies are needed to define optimal dosing and evaluate for benefit.

Impact of well interference on transient pressure behavior during underground gas storage: A comparative study

Underground natural gas storage (UGS) serves as an environmentally sustainable remedy for mitigating regional and temporal disparities in energy supply and demand. The phenomenon of substantial well interference and non-uniform pressure distributions in UGS, resulting from high injection and withdrawal rates, requires a comprehensive examination. This study presents an analytical model aimed at investigating the ramifications of well interference on transient pressure dynamics during UGS. Employing the Laplace transform method, an analytical framework for diverse wells within UGS is derived, with well interference effects being effectively incorporated through the application of the superposition principle. To validate the proposed analytical solutions under various scenarios, a commercial numerical simulator is employed. The analysis reveals that when an adjacent well is engaged in gas withdrawal, interference induces an initial rise in pressure derivative followed by a subsequent plateau. Conversely, during gas injection into an adjacent well, the pressure derivative curve exhibits a continuous decline, akin to situations characterized by constant pressure boundaries. Notably, the likelihood of interference with a target well is more pronounced when gas injection or production occurs in a vertical well as opposed to a horizontal one. Preliminary data from the Hutubi UGS in China, one of the largest projects of its kind, indicate cumulative gas injection and withdrawal volumes of 155.43 × 108 m3 and 130.81 × 108 m3, respectively, with a maximum storage capacity of 107 × 108 m3. Ultimately, the gas storage volume reaches 93.50% of the UGS's designated capacity. This substantial quantity of stored natural gas equates to the calorific value of 9.88 × 109 kg of crude oil or 1.29 × 1010 kg of coal. In comparison to conventional fossil fuels such as oil and coal, the utilization of natural gas in the Hutubi UGS results in a significant reduction of carbon dioxide emissions, amounting to 1.04 × 1010 kg and 1.38 × 1010 kg, respectively. This contribution advances the field by proposing an analytical model for the systematic analysis of well interference on pressure dynamics within the Hutubi UGS, thereby facilitating the transition from oil and coal to natural gas, a crucial step in the pursuit of cleaner and more sustainable energy production practises.

Modified red light 5-aminolevulinic acid photodynamic therapy versus low-dose isotretinoin therapy for moderate to severe acne vulgaris: A prospective, randomized, multicenter study

Modified 5-aminolevulinic acid photodynamic therapy (M-PDT) and isotretinoin (ISO) are effective treatments for moderate to severe acne vulgaris. To evaluate the efficacy and adverse effects of M-PDT and ISO for moderate to severe acne vulgaris. A multicenter, randomized clinical trial was conducted with participants randomly assigned to the M-PDT group (up to 5 weekly sessions following manual comedone extraction) or the ISO group (oral ISO, 0.5mg/kg/d for 6months) and followed up to 6-months after therapy. A total of 152 patients were allocated. The overall effective rates in the M-PDT group were significantly higher than the ISO group at 1month (67.74% vs 10.26%), whereas the opposite was the case 1month after treatment (75.81% vs 97.44%). Time to achieve 50% lesion improvement in the M-PDT group was significantly less than the ISO group (1 vs 8weeks). Overall, 70.67% of the ISO group patients experienced systemic side effects such as hepatotoxicity, whereas side effects were skin-limited in the M-PDT group. Limitations of this study included relatively low numbers of participants and high withdrawal rate. M-PDT offers a more rapid onset of improvement, comparable overall efficacy, good tolerability, and comparable durability of response compared with ISO.

Study finds high rate of alcohol withdrawal in patients with AH

Patients with alcohol‐associated hepatitis (AH) who are hospitalized may be treated with intravenous benzodiazepines for alcohol withdrawal; this is standard in the U.S. However, a new study has found that intravenous benzodiazepines and barbiturates are associated with mortality in such patients and recommends monitoring, and chlomethiazole, an oral thiamine derivative given universally to patients with alcohol‐associated hepatitis prophylactically, instead. Monitoring for alcohol withdrawal can then be done and treated if necessary.

Investigating Ineligibility of Potential Living Liver Donors for Transplantation: Experience from a Large Liver Transplant Center in Pakistan

BackgroundLiving Donor Liver Transplantation (LDLT) is common in Pakistan, where the deceased organ donation is lacking. However, not all potential living donors are suitable for the procedure due to various medical, technical, psychosocial, and ethical reasons. This study aims to investigate the reasons for the ineligibility of potential living liver donors in Pakistan. MethodsBetween June 2022 and March 2023, 530 potential living liver donors were assessed for liver transplant recipients at the Pakistan Kidney and Liver Institute & Research center (PKLI&RC). Potential donors were evaluated in three steps, including laboratory tests imaging, and consultations. Prospectively maintained data on all potential donors were examined and retrospectively assessed to identify the causes of donor rejection. ResultsOf the 530 potential living donors evaluated, 364 of the potential donors were considered ineligible (68.67% of donors were rejected). From these rejected donors, 193 (53%) were males, and 171 (47%) were females. The mean age of the rejected donors was 26 years old. The most common reason for disqualifying potential living liver donors was a withdrawal of consent (65 cases, 17.9%). Other factors contributing to ineligibility included fatty liver infiltration reflected by a liver attenuation index (LAI) < 0, future liver remnant (FLR) < 28%, and a graft-to-recipient weight ratio (GRWR) < 0.6. Medical issues, such as abnormal liver function tests and positive hepatitis serology, also resulted in disqualification. ConclusionThis study highlights the importance of meticulous assessment of potential living liver donors to ensure their safety and the success of the transplant. The high rate of withdrawal of consent and the prevalence of medical issues indicates the need for addressing ethical concerns and improving public education on the donation process. This study also emphasizes the importance of a deceased organ donation in developing countries like Pakistan to ensure the availability of organs for transplantation.

Corrected numbers and assumptions for understanding MSC certified fishery withdrawals: Commentary on Pierucci et al.

Pierucci et al.’s 2022 paper titled “A global review of MSC certification: Why fisheries withdraw?” states that 96 % of fisheries leave the MSC program during the assessment period or first two years of certification. The authors suggest deficiencies in the pre-assessment process or “the high initial costs of certification” may explain the high rate of withdrawal during the assessment period. Our response highlights methodological flaws in their study that bias estimates of withdrawn fisheries by nearly two-fold and subsequently invalidate their conclusions relating to fisheries not yet certified. Here we provide a detailed understanding of the multiple, intersecting improvement pathways that a fishery might take before and after certification to help clarify which barriers to certification are most likely to be at play during different stages of engagement with a sustainable seafood certification scheme. We explore how these barriers vary for different types of fisheries and in geographies with different markets, including disproportionate challenges to sustainable fisheries management, and how global efforts are required to address these inequities.

Feasibility and effect of 3/7 strength training method in cardiac rehabilitation: preliminary results

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Erasmus Hospital. Background Cardiovascular rehabilitation (CR) is a type 1A intervention for cardiovascular disease. Among the various exercise modalities, resistance training (RT) is recommended for improving cardiorespiratory fitness (volume of oxygen consumption [VO2] peak). However, different modalities of RT coexist and which modalities should be preferred is still a matter of discussion. A RT method, called 3/7, allowed in healthy young subject greater strength gains with a shorter training time. However, the feasibility, the safety and its effects have never been studied in CR. Purpose The aim was to assess the feasibility, safety and efficiency of the 3/7 method in CR to improve VO2 peak. Methods In this single center randomized clinical trial, participants underwent 12 weeks of supervised training. Intervention: Group 3/7 consisting of 5 incremental sets of 3 to 7 repetitions with 15 s of inter-set intervals of RT on leg press; leg extension, leg curl, triceps press machines. Group 3X9 (usual care) of 3 sets of 9 repetitions with 1 min of inter set intervals on the same machine and at the same intensity (70% of 1RM). Patients completed 3 sessions per week; endurance training is the same in both groups. The primary outcome was a change in VO2 peak during the cardiopulmonary exercise test from baseline to 12 weeks. Secondary outcomes were isokinetic leg strength at 60°/sec and feasibility. Results Between 2019 and 2022 101 patients (92 male) were enrolled and randomized to 3/7 (n=49) or 3x9 RT (n=52). The mean age was 62y±8 (range 34 – 85). A total of 65 participants completed testing at 12 weeks for the primary outcome, including 32 in the 3/7 group and 33 in the 3X9 group. There were similar improvements from baseline between groups, VO2 peak by 19% in 3/7 group with 17% in the 3X9 group (mean [SD] oxygen uptake: 3/7, 3.6 [4.1] mL/kg/min; 3X9, 3.3 [4.5] mL/kg/min; P = .4). 3/7 improved quadriceps strength by 12% compared with 11% in the 3X9 group (mean [SD] isokinetic leg strength: 3/7, 23 [21] N/m; 3X9, 10 [22] N/m; P = .01). We had more dropouts in the usual care group compared to the 3/7 group (19 vs 17). 3/7 group had high feasibility scores and low rates of withdrawal due to serious adverse events (1). Most dropouts were due to other conditions (Lost of follow-up [n=11], COVID-19 [n=6], other medical problems [n=6], returns to work [n=5], withdrew [n=4]). Conclusion(s) In this randomized clinical trial, a 12-week RT of the 3/7 method coupled with endurance training improved VO2 peak to the same level than the usual care in cardiac rehabilitation, but more leg strength was observed. The 3/7 method may reduce the number of dropouts compared to usual RT program because the time training is reduced for the same volume of work. Implications: These findings support inclusion of 3/7 method in cardiac rehabilitation programs as an adjunct or alternative modality to usual care.

Australian salt basins – options for underground hydrogen storage

As Australia and the world transition to net zero emissions, hydrogen will continue to grow in importance as a clean energy source, with underground hydrogen storage (UHS) expected to be a key component of this new industry. Salt (halite) caverns are a preferred storage option for hydrogen, given their scale, stability and the high injection and withdrawal rates they can support. The use of salt caverns for storing gas is an established industry in North America and Europe but not in Australia, where exploration for suitable storage locations is in the initial frontier stages. Australia’s known major halite deposits occur in Neoproterozoic and Paleozoic sequences and are predominantly located in western and central Australia. This analysis has identified potential in eastern Australia in addition to the proven thick halite in the Adavale Basin, Queensland. Building on Geoscience Australia’s previous salt studies in the Canning, Polda and Adavale basins, this study expands the portfolio of areas prospective for halite in onshore and offshore basins using both direct and indirect evidence. The study correlates paleogeography and paleoclimate reconstructions with evidence of salt in wells, and in geophysical and geochemical data. Salt cavern design for UHS, the solution mining process, and the preferred salt deposits are also discussed. The results will provide pre-competitive information through a comprehensive inventory of areas that may be prospective for UHS.

Automated assessment of human engineered heart tissues using deep learning and template matching for segmentation and tracking.

The high rate of drug withdrawal from the market due to cardiovascular toxicity or lack of efficacy, the economic burden, and extremely long time before a compound reaches the market, have increased the relevance of human in vitro models like human (patient-derived) pluripotent stem cell (hPSC)-derived engineered heart tissues (EHTs) for the evaluation of the efficacy and toxicity of compounds at the early phase in the drug development pipeline. Consequently, the EHT contractile properties are highly relevant parameters for the analysis of cardiotoxicity, disease phenotype, and longitudinal measurements of cardiac function over time. In this study, we developed and validated the software HAARTA (Highly Accurate, Automatic and Robust Tracking Algorithm), which automatically analyzes contractile properties of EHTs by segmenting and tracking brightfield videos, using deep learning and template matching with sub-pixel precision. We demonstrate the robustness, accuracy, and computational efficiency of the software by comparing it to the state-of-the-art method (MUSCLEMOTION), and by testing it with a data set of EHTs from three different hPSC lines. HAARTA will facilitate standardized analysis of contractile properties of EHTs, which will be beneficial for in vitro drug screening and longitudinal measurements of cardiac function.

Timing of Allergenic Food Introduction and Risk of Immunoglobulin E–Mediated Food Allergy

Earlier egg and peanut introduction probably reduces risk of egg and peanut allergy, respectively, but it is uncertain whether food allergy as a whole can be prevented using earlier allergenic food introduction. To investigate associations between timing of allergenic food introduction to the infant diet and risk of food allergy. In this systematic review and meta-analysis, Medline, Embase, and CENTRAL databases were searched for articles from database inception to December 29, 2022. Search terms included infant, randomized controlled trial, and terms for common allergenic foods and allergic outcomes. Randomized clinical trials evaluating age at allergenic food introduction (milk, egg, fish, shellfish, tree nuts, wheat, peanuts, and soya) during infancy and immunoglobulin E (IgE)-mediated food allergy from 1 to 5 years of age were included. Screening was conducted independently by multiple authors. The Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline was used. Data were extracted in duplicate and synthesized using a random-effects model. The Grading of Recommendations, Assessment, Development, and Evaluation framework was used to assess certainty of evidence. Primary outcomes were risk of IgE-mediated allergy to any food from 1 to 5 years of age and withdrawal from the intervention. Secondary outcomes included allergy to specific foods. Of 9283 titles screened, data were extracted from 23 eligible trials (56 articles, 13 794 randomized participants). There was moderate-certainty evidence from 4 trials (3295 participants) that introduction of multiple allergenic foods from 2 to 12 months of age (median age, 3-4 months) was associated with reduced risk of food allergy (risk ratio [RR], 0.49; 95% CI, 0.33-0.74; I2 = 49%). Absolute risk difference for a population with 5% incidence of food allergy was -26 cases (95% CI, -34 to -13 cases) per 1000 population. There was moderate-certainty evidence from 5 trials (4703 participants) that introduction of multiple allergenic foods from 2 to 12 months of age was associated with increased withdrawal from the intervention (RR, 2.29; 95% CI, 1.45-3.63; I2 = 89%). Absolute risk difference for a population with 20% withdrawal from the intervention was 258 cases (95% CI, 90-526 cases) per 1000 population. There was high-certainty evidence from 9 trials (4811 participants) that introduction of egg from 3 to 6 months of age was associated with reduced risk of egg allergy (RR, 0.60; 95% CI, 0.46-0.77; I2 = 0%) and high-certainty evidence from 4 trials (3796 participants) that introduction of peanut from 3 to 10 months of age was associated with reduced risk of peanut allergy (RR, 0.31; 95% CI, 0.19-0.51; I2 = 21%). Evidence for timing of introduction of cow's milk and risk of cow's milk allergy was very low certainty. In this systematic review and meta-analysis, earlier introduction of multiple allergenic foods in the first year of life was associated with lower risk of developing food allergy but a high rate of withdrawal from the intervention. Further work is needed to develop allergenic food interventions that are safe and acceptable for infants and their families.

Are antidepressants addictive? a literature review

IntroductionNowadays, the rates of antidepressant prescription are high and increasing. In this context, the issue of whether these medications are addictive has been increasingly discussed.ObjectivesThe aim of this review was to explore the debate about the addictive property of antidepressants.MethodsWe conducted a literature review in the Pubmed database, using the search terms “antidepressants”, “SSRI”, “tricyclic”, “addiction”, “dependence” in various combinations, and narrowing the search to the last 10 years, to identify articles about the addiction to antidepressants.ResultsAll the articles included in our study highlighted the fact that antidepressants were associated with withdrawal symptoms. These symptoms are heterogeneous, and long-lasting in some cases, and Paroxetine was shown to have particularly high rates of withdrawal symptoms.Some articles reported a psychological and physical dependence on antidepressants. However, the most recent studies agreed that, using established classification systems and concepts and after integrating neurobiological and behavioral criteria, antidepressants are shown to have no addictive property.ConclusionsAntidepressants are proven to be associated with withdrawal symptoms. Whether or not these symptoms are enough to constitute an “addiction” remains controversial, as recent studies agree that antidepressants should not be classified as addictive substances.Disclosure of InterestNone Declared

Investigating the effect of zinc supplementation on probability of relapse and mental health in patients with opioid use disorder undergoing methadone maintenance treatment

BackgroundConsidering different factors, such as high withdrawal rates in methadone maintenance treatment (MMT) programs alongside mental health (MH) problems appearing in patients with opioid use disorder and the lack of prior research on the effect of zinc supplementation in this respect, the present study aimed to investigate the effect of zinc supplementation on the probability of relapse (PoR) and MH problems in patients with opioid use disorder undergoing MMT.MethodsFor this purpose, a randomized controlled trial with a clinical basis was fulfilled on a total of 68 patients with opioid use disorder receiving MMT, allocated to two groups, viz. intervention, and control (each one consisting of 34 individuals). Then, the participants in the intervention group were given zinc supplements combined with methadone for three months, and the controls only took methadone, according to the treatment plan. The data were collected using the Relapse Prediction Scale (RPS) and the Depression, Anxiety, and Stress Scale 21 (DASS-21) before, one month after, and at the end of the intervention program.FindingsCompared to the control group, the likelihood of drug use (p = 0.01), drug craving (p = 0.002), and the RPS total score (p = 0.002) in the intervention group was significantly lower. Moreover, the results revealed a significant decreasing trend in depression (p = 0.01), anxiety (p < 0.001), stress (p = 0.001), and the DASS-21 total score (p = 0.001) in the intervention. Compared to the control group, the DASS-21 total score (p < 0.001) in the intervention group was significantly lower.ConclusionAccordingly, it was concluded that zinc supplementation could reduce the PoR and improve MH problems in patients with opioid use disorder experiencing MMT. However, further research is recommended to fill the gaps.Trial registrationThe research protocol has also been listed on the Iranian Registry of Clinical Trials (IRCT) with code no. IRCT2020050904736N1.

Effects of solidification rate and heat treatment on microstructure characterization and hot tensile strength of single crystal CMSX-4 superalloy

Single crystal CMSX-4 Ni-based superalloy, consisting of rhenium and hafnium elements, were directionally solidified at three different withdrawal rates of 2, 3, and 4 mm/min through a Bridgman furnace. After that a full solution heat treatment was followed by two step aging at 1140 °C/6 h and 870 °C/20 h respectively. Microstructural characteristics, e.g. the primary and secondary dendrite arm spacing, the size and volume fraction of γ ́ phase, and percentage of porosity were analyzed using the optical microscopy (OM) and scanning electron microscopy (SEM) equipped with an energy dispersive spectroscopy (EDS) detector. It was found that an increase in the withdrawal rate of the as-cast specimens led to a reduction in the values of primary and secondary dendrite arm spacing, the percentage of porosity and also size of γ ́. In addition, at higher withdrawal rates, the γ/γ ́ eutectic phase is distributed from a continuous and blocky shaped to fine scattered islands. Nevertheless, the minimum volume fraction of eutectic was obtained at the withdrawal rate of 3 mm/min. Heat-treatment of the specimens associated with formation of a noticeable cuboidal γ’-precipitates, which was about 70% at withdrawal rate of 3 mm/min. Furthermore, the aged specimens indicated the lower γ/γ ́ eutectic phase compared to as-cast specimens, while the percentage of porosity increased for aged specimens. Eventually, the highest ultimate tensile strength of the single crystal CMSX-4 at 870 °C was measured to be 1170 MPa which was obtained at a withdrawal rate of 3 mm/min, due to the high volume fraction of the γ ́ phase and the lower values of γ/γ ́ eutectic phase.

Teaching and Learning Online During Covid-19 Lockdown, Encouraging and Discouraging?

The study examined the teaching and learning online during the covid-19 lockdown, in terms of whether it is encouraging or discouraging from the perspectives of students and staff of the Library and Information Science Department in Nigerian universities. Three Library and Information Science(LIS) schools were selected from three different universities. The population was the LIS lecturers and students. FIVE students and FIVE lecturers were selected from each of the three Library schools. This gave a total of 15 students and 15 lecturers which amounts to a total of 30 respondents who represent the sample for the study. A pure qualitative method was adopted using focus group interviews which were conducted for the students and the staff in each of the schools as a method of data collection. The findings show that the experience of lecturers and students in learning and teaching online during the Covid-19 lockdown was encouraging, the lesson is very easy to prepare and interesting and the learners are enthusiastic and wanted others to know they were part of the class. The respondents want learning and teaching online to continue due to its flexibility, interesting nature of teaching online, and a high percentage of participation. The benefits of teaching and learning online during Covid-19 include flexibility, ease of learning and teaching, increased interactivity and class participation, social presence, improvement in critical thinking skills, and high engagement of lecturers and students. The challenges of learning and teaching LIS during Covid-19 are slow bandwidth, poor network, cost of data (lecturers and students bear the cost of data), and unstable electricity, high withdrawal rate, inadequate skills for both lecturers and students due to their first experience, high cost of data and electronic devices among others.

Chinese expert consensus on management of dyslipidemia in the elderly

Dyslipidemia is an important risk factor of atherosclerotic cardiovascular disease (ASCVD). Statins delay the occurrence and development of ASCVD, and reduce the risk of cardiovascular events and death. Due to safety concerns, there exist insufficient use of lipid-lowering agents and a high withdrawal rate of the agents in the elderly. To promote the prevention and treatment of ASCVD, this expert consensus is issued and focuses on the management of dyslipidemia of Chinese elderly basing on the clinical evidence of the use of lipid-lowering drugs by the elderly, and the lipid management guidelines and expert consensus recommendations at home and abroad.