Ideal Setting Research Articles

Reframing conceptualizations of primary care involvement in opioid use disorder treatment

BackgroundOpioid-related harms and opioid use disorder (OUD) are health priorities requiring urgent policy responses. There have been many calls for improved OUD care in primary care, as well as increasing involvement of primary care providers in countries like Canada and Australia, which have been experiencing high rates of opioid-related harms.MethodsUsing Starfield’s 4Cs conceptualization of primary care functions, we examined how and why primary care systems may be suited towards, or pose challenges to providing OUD care, and identified health system opportunities to address these challenges. We conducted 14 semi-structured interviews with 16 key informants with experience in opioid use policy in Canada and Australia.ResultsPrimary care was identified to be an ideal setting for OUD care delivery due to its potential as the first point of contact in the health system; the opportunity to offer other health services to people with OUD; and the ability to coordinate care with other health providers (e.g. specialists, social workers) and thus also provide care continuity. However, challenges include a lack of resources and support for chronic disease management more broadly in primary care, and the prevailing model of OUD treatment, where addictions care is not seen as part of comprehensive primary care. Additionally, the highly regulated OUD policy landscape is also a barrier, manifesting as a ‘regulatory cascade’ in which restrictive oversight of OUD treatment passes from regulators to health providers to patients, normalizing the overly restrictive nature and inaccessibility of OUD care.ConclusionsWhile primary care is an essential arena for providing OUD care, existing sociocultural, political, health professional, and health system factors have led to the current model of care that limits primary care involvement. Addressing this may involve structurally embedding OUD care into primary care and strengthening primary care in general.

Effectiveness of nutrition interventions targeting university-level student populations across the League of Arab States: a systematic scoping review.

The university setting is an ideal setting to implement nutrition education interventions. Because the transition to college life often overlaps with young adults' increase in independence in food choice and nutrition related behavior, this is an optimal time to target this population and several models exist to best utilize the college setting to support nutrition education interventions. This review aimed to examine the effectiveness of nutrition interventions in university student populations across the League of Arab States. A scoping review following the PRISMA-ScR guidelines was conducted across 14 databases for relevant publications published through May 2023 to find studies conducted across Arab countries. Quality assessment was conducted using the Effective Public Health Practice Project tool. Seven primary studies were included in this review. Although the interventions and outcome measures were disparate, there were positive impacts of the interventions, including improved nutrition knowledge and nutrition habits, knowledge of nutrient sources, and knowledge about the relationship between diet and disease. Recommendations to maximize the efficacy of nutrition interventions conducted across the League of Arab States include purposeful design of the intervention based on a theoretical framework, the use of a control group in the research design, and follow-up measures to examine post-intervention effects. Consideration should also be given to intervention duration and availability in college-students' schedules. Adaptation of intervention materials, measures and delivery methodologies should emphasize local foods, food culture and dietary practices.

Potentially Inappropriate Medications and De-prescribing: An Audit of STOPP/START on an Inpatient Rehabilitation Ward

Abstract Background Polypharmacy is well recognized in older adults with many adverse outcomes. Practical tools, such as the ‘STOPP/START’ criteria, aid clinicians in de-prescribing to tackle medication related morbidity. Current research suggests these tools are insufficiently implemented in clinical practice (1). Many older adults require rehabilitation after acute hospital admissions which can provide an ideal setting for medication review and de-prescribing. Methods A retrospective audit was carried out of 35 older adults in a gerontological inpatient rehabilitation facility between 8th February and 8th April 2024. Demographic and clinical data was collected using electronic and handwritten patient records. Each patients’ medication prescription was reviewed from date of admission to rehabilitation facility. Number of medications prescribed was recorded. Using the ‘STOPP/START’ criteria, potentially inappropriate medications (PIMs were identified, and de- prescribing was noted for the PIM where taken. Results 35 patients were included in the study. No patient was excluded. Mean age was 86.14 years and mean number of prescribed medications per patient was 11. The most common presenting complaint was a fall in 57.14% of patients, in which 95% had acute fracture. Other presenting complaints for acute admission included delirium and infection. Mean clinical frailty score was 5.71. 38 PIMswere identified, totalling 10% of all medication prescriptions. Of these, 12 de-prescribing opportunities were taken, one of which was a dose reduction. The most common PIMswere prescribing of PPI at full therapeutic dose (n=12), inappropriate opioid prescribing (n=4) and hypnotics (n=7) in high-risk groups. Conclusion Polypharmacy and PIMsare common in older adults and are related to adverse outcomes, especially in frail adults at risk of falls, fracture, and delirium. The rehabilitation setting is an ideal location for use of de-prescribing tools however their implementation varies. This may be improved by education and structured medication review in collaboration with trained pharmacists.

“Balancing work and movement”: barriers and enablers for being physically active at Indian workplaces – findings from SMART STEP trial

BackgroundNon-communicable diseases are rising rapidly in low- and middle-income countries, leading to increased morbidity and mortality. Reducing sedentary behavior (SB) and increasing physical activity (PA) offer numerous health benefits. Workplaces provide an ideal setting for promoting SB/PA interventions; however, understanding the barriers and enablers is crucial for optimizing these interventions in workplace environments.MethodsNested within a cluster randomised controlled trial (the SMART-STEP trial), the present study employed in-depth interviews with 16 office workers who have completed 24 weeks of two distinct (technology assisted and traditional) workplace SB/PA interventions. Using a deductive analysis, semi-structured interviews were administered to explore the barriers and enablers to the SB/PA interventions at individual, interpersonal and organisational level using the socio-ecological model.ResultsSeveral individual (poor goal setting, perceived health benefits & workload, attitude, intervention engagement), interpersonal (lack of peer support) and organisational (task prioritisation, lack of organisational norm and material or social reward) barriers were identified. Indian women engaged in desk-based office jobs often find themselves burdened with intense home and childcare responsibilities, often without sufficient support from their spouses. A primary concern among Indian office workers is the poor awareness and absence of cultural norms regarding the health risks associated with SB.ConclusionsRaising awareness among workplace stakeholders—including office workers, peers, and the organization—is crucial before designing and implementing SB/PA interventions in Indian workspaces. Personalized interventions for Indian female office workers engaged in desk-bound work are warranted.

The Criminal Code of Mongolia. The General Part. Crime

Introduction. In a number of positions, the Criminal Code of Mongolia is recognized as more progressive than the Criminal Code of the Russian Federation. Therefore, it is no coincidence that there is a noticeable increase in the number of publications devoted to legislative decisions of the Criminal Code of Mongolia, which are of undoubted interest in scientific discussions on key criminal law issues.General provisions. The Criminal Code opens with Chapter 1 "General provisions", which sets out the goals, principles of the criminal legislation of Mongolia, the rules of its operation in space and time. The Criminal Code of Mongolia enshrines only three principles: legality, justice and guilt. The law explicitly states that it is not allowed to bring a person to criminal responsibility for opinions or beliefs. The issue of the time of commission of ongoing and ongoing crimes has been resolved. The rules on the statute of limitations of a crime have been moved to this chapter.Crime. The foresight of an act in the criminal law is called an indispensable condition for the recognition of an act and omission as criminal, and, in particular, a careless act. The concepts of a continuing crime and an ideal set of crimes are revealed. Only two categories of crimes are fixed: serious and minor. The form of guilt for the purposes of categorization of crimes in the Criminal Code of Mongolia is insignificant. The very forms of guilt (intent and negligence) are named in art. 2.3. At the same time, intent is not divided into types. TheCriminal Code of Mongolia defines the concept of damage and harm caused by a crime. The chapter ends with the regulations on the unfinished crime.Complicity. It is noteworthy that the form of guilt of the crime committed is not specified in the law. A mediocre performer is a person who has committed a crime by using not only a person who has not reached the age from which criminal responsibility begins, an insane person, but also other persons who have not committed a crime in complicity with the perpetrator and do not realize that a crime is being committed, or livestock or other animals. The perpetrator of a crime is also recognized as a person who inclines another person to commit a crime under the influence of physical or mental coercion.Circumstances precluding the criminality of the act. This institution has found regulation in Chapter 4 of the Criminal Code. It can distinguish significant differences from the Russian Criminal Code in regulating necessary defense, extreme necessity, coercion, reasonable risk, and execution of an order.The procedure, grounds for criminal prosecution and exemption from criminal liability. Chapter 6 contains regulatory requirements that define: (1) signs of the subject of the crime – an individual; (2) general rules for bringing to criminal responsibility and (3) special rules for sentencing; (4) rules for exemption from criminal liability and punishment.Liability of legal entities. Chapter 9, which closes the General Part, is devoted to their responsibility, which defines the grounds for bringing legal entities to criminal responsibility; types of criminal liability; guarantees of its inevitability. The basis for the imposition of punishment is the sole or joint decision of authorized officials representing a legal entity, or actions or omissions committed in the interests of a legal entity that contain signs of an appropriate corpus delicti.Conclusions. Modern Mongolian criminal legislation, while maintaining continuity and honoring legal and cultural traditions, has a qualitative originality. The normative prescriptions proposed in it are of interest to Russian criminal law science and the legislator. Undoubtedly, the experience of Mongolian criminal law regulation can and should be taken into account by the domestic legislator.

Secondary school randomized controlled interventions with a minimum dual approach to health and the links to BMI in pupils: A systematic review and meta-analysis within the project From Science 2 School

Introduction & Purpose Health behavior offers a pivotal domain of health for managing current global crises, including physical inactivity and overweight/obesity (Schroeder, 2007). However, adults have limited capacity for adopting healthy behavior into their lifestyle (Prochaska & Velicer, 1997). Schools offer an ideal setting for implementing health interventions considering the breadth of children that can be reached and the amount of time children spend in school (Tanous et al., 2022). The present study hypothesized that appropriately planned physical activity (PA) intervention for pupils and during compulsory secondary school time results in healthier body weight management. Methods A systematic review and meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, a published protocol (Tanous et al., 2022), and a trial registration was completed on the International Register of Systematic Reviews (PROSPEO: CRD4202347770). The databases searched (12/2021) included PubMed, Education Source, and EMBASE. Only school-based randomized controlled trial interventions on PA and/or diet published in English or German were included. The study population included pupils (10-19 years of age) enrolled in secondary schools and without major nutritional deficit or unstable health condition. The study sample was refined using exclusion criteria: (i) no outcome on body weight, body mass index (BMI), or self-reported, (ii) intervention groups only targeting overweight and/or obese pupils, (iii) interventions outside of regular school hours or implemented beyond the school setting, (iv) total intervention duration less than eight weeks, (v) branches of schools specializing on physical exercise/sports in general, and (vi) no control group. Title/abstract and full-text screening, data appraisal, and summary data extraction were completed by two reviewers. Results A total of 5,945 articles were identified by the search process, including 23 studies and 9,441 pupils (of which 4,787 males and 4,654 females) eligible for the analysis. PA interventions ranged from eight weeks to eight months and included jumping (n = 2), strength exercises (n = 3), cardiovascular endurance (n = 4), or a combination (n = 2). For PA intervention implemented in the secondary level school setting for at least eight weeks duration, a random effect size of -0.12 units (95% CI [-0.26. 0.02]) of BMI (kg/m2) was found with low statistical heterogeneity (I2 = 0%; p = 0.60). Discussion Due to the behavioral constraints of the school setting, children are denied from achieving the minimum level of health protection, which adversely contributes to the poor global health status with a major impact. Previous meta-analyses identified a small PA intervention effect for improving BMI in pupils (-0.02 kg/m2 and -0.05 kg/m2; Guerra et al., 2013; Harris et al., 2009) with considerable heterogeneity (I2 = 77% and 54%, respectively). The findings of the present investigation revealed a more precise effect measure than previous meta-analyses (Guerra et al., 2013; Harris et al., 2009) regarding the exclusive power of the secondary school setting over PA levels and the BMI health improvement possibility for pupils (-0.12 kg/m2). Conclusion PA intervention in secondary schools contributes to limited, yet beneficial body weight management for pupils in the ongoing global health crisis (Schroeder, 2007; Tanous et al., 2022). Considering the lack of formal organization at homes, schools are urged to achieve 60 minutes of PA daily.

Material Selection and Design for Assembly Applied in the Development of an Energy Generating Device

This study used the Design for Assembly (DFA) and material selection methods as tools to aid the development of a conceptual design of a functional device to transform alternate movement into rotational movement on the axis of a microgenerator. Also, material selection software was used to define the most suitable thermoplastic materials for some components of the projected device, focusing both on performance and low cost. There was a considerable reduction in the number of parts in the set from the basic device (prototype), which had 47 parts, to the conceptual design I, with 34 parts, and the conceptual design II, with 14 parts. The total mass of the set was also considerably reduced, from 160 grams for the basic device to 57.01 grams in the conceptual design I and, finally, 18.30 grams in the conceptual design II. Of thermoplastic materials analysed, considering a selection focused only on performance the most promising candidate, with an ideal set of properties is PEEK. But for a selection that considers the price, that is one of the key variables in the materials selection for most products, PEEK shows is prohibitively price.

Unraveling the distribution pattern and driving forces of soil microorganisms under geographic barriers.

The Altai Mountains (ALE) and the Greater Khingan Mountains (GKM) in northern China are forest regions dominated by coniferous trees. These geographically isolated regions provide an ideal setting for studying microbial biogeographic patterns. In this study, we employed high-throughput techniques to obtain DNA sequences of soil myxomycetes, bacteria, and fungi and explored the mechanisms underlying the assembly of both local and cross-regional microbial communities in relation to environmental factors. Our investigation revealed that the environmental heterogeneity in ALE and GKM significantly affected the succession and assembly of soil bacterial communities at cross-regional scales. Specifically, the optimal environmental factors affecting bacterial Bray-Curtis similarity were elevation and temperature seasonality. The spatial factors and climate change impact on bacterial communities under the geographical barriers surpassed that of local soil microenvironments. The assembly pattern of bacterial communities transitions from local drift to cross-regional heterogeneous selection. Environmental factors had a relatively weak influence on myxomycetes and fungi. Both soil myxomycetes and fungi faced considerable dispersal limitation at local and cross-regional scales, ultimately leading to weak geographical distribution patterns.IMPORTANCEThe impact of environmental selection and dispersal on the soil microbial spatial distribution is a key concern in microbial biogeography, particularly in large-scale geographical patterns. However, our current understanding remains limited. Our study found that soil bacteria displayed a distinct cross-regional geographical distribution pattern, primarily influenced by environmental selection. Conversely, the cross-regional geographical distribution patterns of soil myxomycetes and fungi were relatively weak. Their composition exhibited a weak association with the environment at local and cross-regional scales, with assembly primarily driven by dispersal limitation.

The role of substrata width and millimeter scale surface micro-structure in the attachment of juvenile mussels

The global mussel aquaculture industry is constrained by the unreliable supply of wild seed mussels and high losses of seed mussels shortly after they are seeded onto coastal farms. The success in the collection of the settling larvae of mussel in the wild and the subsequent on-growing of early seed mussels in aquaculture are largely determined by the settlement and attachment behaviour of the larval and juvenile mussels, which is strongly influenced by the physical structure of their attachment substrata, especially filamentous substrata. This study aimed to identify an ideal set of morphological characteristics of filamentous substrata that would promote the improved attachment of early mussels and contribute to reducing the shortage of seed mussels in the New Zealand green-lipped mussel (Perna canaliculus) aquaculture industry. Artificial filamentous substrata with varying branch width and textured surfaces were tested for their ability to promote the attachment of wild juvenile mussels. The attachment of early juvenile mussels to 1.6 mm wide filamentous substrate was six times higher than their wider counterparts (i.e., 3.7, 5.6, 7.4, and 9.5 mm). There was also a higher proportion of small-size mussels (<0.99 mm shell length) on the 1.6 mm substrata. Furthermore, the filamentous substrata with regularly ridged surface contours (1 mm spacings) tended to attract more juvenile mussels. However, this preference was not consistent for small-size mussels on filaments of thinner width (i.e., 0.4, 0.8, 1.6, and 3.7 mm). Overall, the dimensions of filamentous substrates identified through this study will be valuable for improving the design of artificial substrata used in mussel aquaculture for improving its effectiveness for the attachment of seed mussels.

Laparoscopic Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy, an Update From the International PSOGI Registry.

Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are established treatments for peritoneal surface malignancies, traditionally performed via laparotomy. Recent advancements in laparoscopic approaches (L-CRS + HIPEC) have shown promising results in selected patients. The PSOGI registry, established in November 2019, collects data from specialized centers performing L-CRS + HIPEC. Data were collected prospectively and analyzed retrospectively, excluding risk-reducing procedures without peritoneal disease. The learning curve was assessed using a 14-cases cutoff. Today, 323 patients have been registered, 193 were included finally. Perioperative outcomes improved after 14 cases: Length of hospital stay was 7.78 ± 3.64 days (consolidation) versus 8.8 ± 8.79 days (learning) and major morbidity was 0% (consolidation) versus 5% (learning), (p = n.s.). Estimated blood loss was lower in the consolidation phase. Oncological outcomes also improved: Recurrence rate was 8.7% (consolidation) versus 17.8% (learning). Disease-free survival 5 years, 65% (learning) versus 88% (consolidation) (p = 0.012). The L-CRS + HIPEC is a safe procedure with non-inferior oncologic outcomes which it is evaluating in an IDEAL setting by an international group. The validation of the learning curve, gives us the knowledge that a mentoring program must be setup to reduce the learning curve impact in oncologic failure.

Sediment dynamics of a major piedmont glacier: the Salzach Glacier in the North Alpine Foreland

Abstract. The foreland basins of the European Alps were repeatedly covered by major piedmont glaciers during Quaternary glacial maxima. The Salzach Glacier was the easternmost of a series of large Pleistocene piedmont glaciers entering the North Alpine Foreland through major Alpine valleys. It covered an area of more than 1000 km2 during at least four glacial maxima. The slightly elevated molasse bedrock provides a high potential for preservation of glacial landforms and offers an ideal setting to explore the erosional and depositional dynamics of a major glacier piedmont lobe. This field excursion guide leads to some selected key sites representing deposits of glacial advance, relative equilibrium, and ice lobe collapse.

Flexible representative democracy

AbstractWe introduce Flexible Representative Democracy (FRD), a novel hybrid of Representative Democracy and Direct Democracy in which voters can alter the issue-dependent weights of a set of elected representatives. In line with the literature on Interactive Democracy, our model allows the voters to actively determine the degree to which the system is direct versus representative. However, unlike Liquid Democracy, Flexible Representative Democracy uses strictly non-transitive delegations, making delegation cycles impossible, and maintains a fixed set of accountable, elected representatives. We present Flexible Representative Democracy and analyze it using a computational approach with issues that are binary and symmetric. We compare the outcomes of various voting systems using Direct Democracy with majority voting as an ideal baseline. First, we demonstrate the shortcomings of Representative Democracy in our model. We provide NP-Hardness results for electing an ideal set of representatives, discuss pathologies, and demonstrate empirically that common multi-winner election rules for selecting representatives do not perform well in expectation. To analyze the effects of adding delegation to representative voting systems, we begin by providing theoretical results on how issue-specific delegations determine outcomes. Finally, we provide empirical results comparing the outcomes of various voting systems: Representative Democracy, Proxy Voting, and FRD with issue-specific delegations. Our results show that variants of Proxy Voting yield no discernible benefit over unweighted representatives and reveal the potential for Flexible Representative Democracy to improve outcomes as voter participation increases.

Universal Prevention Strategies to Prevent Opioid Misuse on a U.S. College Campus.

Opioid misuse and risk of death due to overdose are critical public health issues and young adults are at risk. College campus communities are ideal settings for the prevention of opioid misuse among young adults due to high enrollment rates, the diversity and availability of resources within the campus community, and the range of risk and protective factors that can be targeted. This practitioner narrative describes a grant-funded three-year opioid misuse prevention project implemented on a U.S. college campus. In keeping with the focus of the grant, the project involved a range of universal prevention activities implemented across the campus community. Lessons learned regarding factors that facilitated implementation in this community context are discussed and may be useful for others interested in implementing prevention activities to help prevent opioid misuse among young adults in their campus communities. Additionally, a reflection on the project and the efficacy of universal prevention to prevent opioid misuse among college students are offered for consideration.

Bayesian modeling and optimization for split-plot experiments with multiple responses

In many industrial processes, cost or time constraints make some input variables harder to change or control than others. An appropriate experimental design method is restricted randomization, which results in split-plot experiments. Empirical models that connect multiple quality characteristics with input variables play a crucial role in robust parameter design for split-plot experiments. At present, many modeling methods typically adopt the single response model for analyzing industrial processes in the split-plot experiments without considering correlation among multiple responses, correlation among whole plots, and uncertainty of model parameters. However, ignoring these issues can lead to poor product or process design. To solve these issues, this paper suggests a novel Bayesian modeling and optimization approach. We first construct a Bayesian multi-response linear mixed-effects model and obtain the posterior distribution for model parameters by employing Bayesian theorem. Then, the Gibbs sampling procedure is employed for the estimation of model parameters. Finally, the overall weighted desirability optimization function meeting the specification is developed to avoid acquiring ideal input settings with outliers. A simulation and an engineering case study demonstrate the validity of the proposed method. In comparison to existing methods, the optimization results given the proposed method are more robust and reliable.

The cost-effectiveness of preventing, diagnosing, and treating postpartum haemorrhage: A systematic review of economic evaluations.

Postpartum haemorrhage (PPH) is an obstetric emergency. While PPH-related deaths are relatively rare in high-resource settings, PPH continues to be the leading cause of maternal mortality in limited-resource settings. We undertook a systematic review to identify, assess, and synthesise cost-effectiveness evidence on postpartum interventions to prevent, diagnose, or treat PPH. This systematic review was prospectively registered on PROSPERO (CRD42023438424). We searched Medline, Embase, NHS Economic Evaluation Database (NHS EED), EconLit, CINAHL, Emcare, Web of Science, and Global Index Medicus between 22 June 2023 and 11 July 2024 with no date or language limitations. Full economic evaluations of any postpartum intervention for prevention, detection, or management of PPH were eligible. Study screening, data extraction, and quality assessments (using the CHEC-E tool) were undertaken independently by at least 2 reviewers. We developed narrative syntheses of available evidence for each intervention. From 3,993 citations, 56 studies were included: 33 studies of preventative interventions, 1 study assessed a diagnostic method, 17 studies of treatment interventions, 1 study comparing prevention and treatment, and 4 studies assessed care bundles. Twenty-four studies were conducted in high-income countries, 22 in upper or lower middle-income countries, 3 in low-income countries, and 7 studies involved countries of multiple income levels. Study settings, methods, and findings varied considerably. Interventions with the most consistent findings were the use of tranexamic acid for PPH treatment and using care bundles. In both cases, multiple studies predicted these interventions would either result in better health outcomes and cost savings, or better health outcomes at acceptable costs. Limitations for this review include that no ideal setting was chosen, and therefore, a transferability assessment was not undertaken. In addition, some sources of study uncertainty, such as effectiveness parameters, were interrogated to a greater degree than other sources of uncertainty. In this systematic review, we extracted, critically appraised, and summarised the cost-effectiveness evidence from 56 studies across 16 different interventions for the prevention, diagnosis, and treatment of PPH. Both the use of tranexamic acid as part of PPH treatment, and the use of comprehensive PPH bundles for prevention, diagnosis, and treatment have supportive cost-effectiveness evidence across a range of settings. More studies utilizing best practice principles are required to make stronger conclusions on which interventions provide the best value. Several high-priority interventions recommended by World Health Organization (WHO) such as administering additional uterotonics, non-pneumatic anti-shock garment, or uterine balloon tamponade (UBT) for PPH management require robust economic evaluations across high-, middle-, and low-resource settings.

Effect of repetitive transcranial magnetic stimulation on trigeminal-mediated headshaking in 17 horses.

Trigeminal-mediated headshaking is a neuropathic facial pain condition in horses. No treatment has been entirely successful. Repetitive transcranial magnetic stimulation (rTMS) is used in human medicine as a treatment for various neuropathic pain conditions, and good results have been achieved in cases of trigeminal neuralgia. Apply rTMS to horses with trigeminal-mediated headshaking (TMHS) and to evaluate tolerability, application of the setting, and success rate. Seventeen horses with nonseasonal signs of TMHS. Other underlying causes of headshaking were ruled out. The rTMS was performed under standing sedation on 5 consecutive days applying 3 sets of 500 stimulations each, with a stimulation strength of 5 Hz. Horses were evaluated on Day 1 (t0) and Day 5 (t1) of the treatment and 2 (t2) and 4 weeks (t3) afterwards using a special scoring system. The rTMS was well tolerated. Headshaking signs during exercise were decreased by 70% (Day 5; t1). Four weeks after rTMS, signs were still decreased (mean reduction of 50%) during exercise. Improvement of mean resting and exercise scores was significant (P < .05) and effect sizes between pretreatment and all time points after treatment (t1, t2, t3) were large (>±0.8). Repetitive transcranial magnetic stimulation may be a promising treatment for neuropathic pain and headshaking in affected horses. Pain-free periods after treatment differ individually, and repeated treatment may be necessary. More studies should be performed to determine ideal settings for horses.

An Innovative Approach to Determine Programmed Intermittent Epidural Bolus Pump Settings for Labor Analgesia: A Randomized Controlled Trial.

Three settings are required on a programmed intermittent epidural bolus (PIEB) pump for labor analgesia: the PIEB next bolus (PIEBnb), PIEB interval (PIEBi), and PIEB volume (PIEBv). The ideal settings for these parameters are still unknown. We hypothesized a mathematical modeling tool, response surface methodology (RSM), could estimate 3 PIEB pump parameters while balancing 3 clinically important patient outcomes simultaneously. The study objective was to use RSM to estimate PIEB settings (PIEBnb, PIEBi, and PIEBv) while maximizing maternal satisfaction, minimizing the need for clinician-administered boluses, and optimizing the ratio of delivered/requested patient-controlled epidural analgesia (PCEA) boluses simultaneously. With institutional ethics approval, a double-blind randomized trial was completed in a tertiary care labor and delivery center. Nulliparous, English-speaking American Society of Anesthesiologists (ASA) physical status II patients aged 18 to 45 years at full term, single gestation in vertex presentation, in spontaneous labor and ≤7 cm cervical dilation were included. Patients with comorbidities, contraindications to neuraxial analgesia, using chronic analgesics, <152 cm, or body mass index (BMI) >45 kg/m 2 were excluded. After informed consent, labor analgesia was initiated using 10 mL ropivacaine 0.2% with 10 µg/mL fentanyl solution and PCEA (volume 6 mL every 10 minutes). Patients were randomized to predetermined PIEB settings. RSM identified 3 pump settings that represented a stationary point that best maximized or minimized 3 outcomes simultaneously: PCEA ratio (a ratio closest to 1), clinician bolus (optimal is 0), and maternal satisfaction (visual analog scale, 0-100, ideal response is ≥90). Of 287 potential participants, 192 did not meet inclusion criteria or declined to participate, and 26 were withdrawn, leaving 69 patients for study inclusion. Using RSM, the suggested PIEB settings for all the primary study outcomes were as follows: PIEBnb = 29.4 minutes, PIEBi = 59.8 minutes, and PIEBv = 6.2 mL. These PIEB settings corresponded to the following clinical outcomes: maternal satisfaction at 93.9%, PCEA ratio at 0.77, and need for clinician bolus at 0.29. The dermatome sensory score was between T10 and T5 in 89% of the patients. The median lowest Bromage score was 4. This novel study used a mathematical model to estimate PIEB pump settings while simultaneously maximizing 3 clinical outcomes. Equally weighted clinical outcomes prevent maximal outcome optimization and may not reflect patient priorities. Future studies or quality improvement endeavors could use RSM methodology to estimate PIEB pump settings targeting optimal values for a single clinical outcome of determined importance to parturients.

Improving biogas production with application of trimetallic nanoparticle using response surface methods

The potential of trimetallic nanoparticles (TMNPs) to enhance biogas production through microbe-to-microbe interactions and boost biogas yield is evident. This present study employed the central composite design (CCD) of response surface methods (RSM) to determine the optimal conditions of iron-cobalt-zinc TMNPs influenced anaerobic digestion for higher biogas yield. The impact of initial pH (6.6–7.4), TMNPs concentration (0–30 mg L−1), temperature (25-45 °C), and hydraulic retention time (HRT) (0-4 days) were modelled for improved biogas production. The results indicated that the linear model terms of pH and TMNPs concentration, and quadratic model terms of temperature and HRT, significantly affect the biogas production. Linear model terms of TMNPs, temperature, pH, and HRT have significant interactive effects and the numerical analysis identified the best conditions for the evaluated parameters. Ideal anaerobic process settings generated a maximum cumulative biogas production of 3700 mL−1POME than blank (2000 mL−1), corresponding to an 85 % yield. Optimizing the initial pH, TMNPs concentration, temperature, and HRT can significantly improve biogas yield and could be helpful for developing more efficient AD processes at large volume and commercial biogas plants. Promoting TMNPs as catalysts positively improves an AD process towards sustainable biogas production.

Enhancing Tribological Characteristics of Titanium Grade-5 Alloy through HVOF Thermal-Sprayed WC-Co Nano Coatings by TOPSIS and Golden Jack Optimization Algorithm.

Thermal spray coatings have emerged as a pivotal technology in materials engineering, primarily for augmenting the characteristics related to wear and tribology of metallic substrates. This study aimes to delve into applying High-Velocity Oxygen Fuel (HVOF) thermalsprayed WC-Co nanocoatings on Titanium Grade-5 alloy (Ti64). The coating process, utilizing nano-sized WC-Co powder, undergoes systematic optimization of HVOF parameters, encompassing the flow rate of carrier gas, powder feed rate, and nozzle distance. Experimental assessments via Pin-on-Disc (PoD) tests encompass Loss of Wear (WL), Friction Coefficient (CoF), and Frictional Force (FF). Later, an exhaustive optimization of responses is conductede using the Technique for Order Preference by Similarity to the Ideal Solution (TOPSIS) method and the golden jack optimization algorithm (GJOA). Outcomes show a substantial increase in WL, CoF, and FF with a rise in the carrier gas and powder feed rate. However, with increasing spraying distance of powder, the WL, CoF, and FF tend to lower due to higher bonding, which leads to increased wear resistance. The ideal parametric settings achieved from TOPSIS and GJOA are 245 mm of spray distance, 30 gpm rate of powder feed, and 11 lpm of carrier gas flow rate. The powder feed rate contributes 88.99% to the control action, as seen from ANOVA. The confirmation experiment presents that the WL, CoF, and FF output responses are 42.33, 27.97, and 9.38% less than the mean of experimental data. These results highlight the HVOF process in spraying WC-Co nanocoatings to fortify the durability and performance of Ti64 alloy that can be patented for diverse engineering applications.

Lifetime Psychotropic Medication Use Among Service Members and Veterans With and Without History of Mild Traumatic Brain Injury: A Pilot Study.

Military Service Members, Veterans, and other patient populations who experience traumatic brain injury (TBI) may have increased risk of early neurodegenerative diseases relative to those without TBI history. Some evidence suggests that exposure to psychotropic medications may play a role in this association. The Long-term Impact of Military-relevant Brain Injury Consortium-Chronic Effects of Neurotrauma Consortium (LIMBIC-CENC) prospective longitudinal study provides an ideal setting to examine the effects of psychotropic medication exposure on long-term neurological health of those with and without mild TBI history. In this study, we sought to develop and pilot test a self-report electronic survey instrument to measure participants' psychotropic medication histories for use across LIMBIC-CENC study sites. We developed a new survey instrument measuring psychotropic medication history and fielded it among Service Members and Veterans enrolled in a single site of the LIMBIC-CENC study to evaluate response rates and patterns, and to compare survey responses to prescription data extracted from participants' Veterans Affair (VA) records. Descriptive statistics estimated survey respondents' lifetime psychotropic medication exposures by their TBI history and other demographic and clinical characteristics of interest. We also compared survey responses to participants' VA outpatient prescription records to estimate sensitivity and negative predictive values (NPVs) for participants' self-reported medication exposures relative to this single prescription data source. Among 310 Veterans enrolled at the study site, 249 completed the survey (response rate = 80%), of whom 248 also had VA health records and were included in the analysis. Most (69%) had a history of mild TBI. Over three-fourths of survey respondents (78%) reported ever having used prescription opioids, 26% reported benzodiazepines, 50% reported muscle relaxants, 42% reported antidepressants, 13% reported non-benzodiazepine sedative-hypnotics, 15% reported stimulants, 7% reported mood stabilizers, and 6% reported antipsychotics. Veterans with, versus without, a history of mild TBI were more likely to self-report psychotropic medication history as well as have confirmed receipt of VA prescriptions for each medication class. Using VA records as a criterion standard, the sensitivity of the survey for detecting VA prescriptions ranged from 19% to 84%, while the NPVs ranged from 64% to 97%. Sensitivity and NPVs were similar for participants with, versus without, mild TBI history. Service Members and Veterans may receive psychotropic medications from multiple sources over their lifetimes. Valid methods to examine and quantify these exposures among those with a history of TBI are important, particularly as we evaluate causes of neurodegenerative disorders in this population over time. The measurement of Veterans' lifetime psychotropic medication exposures using a self-report survey, in combination with health care records, holds promise as a valid approach, but further testing and refinement are needed.