Long-term Assessment Research Articles

Characteristics of applicants with a first-time recognition of need for long-term care

Abstract Background The increasing number of care-dependent individuals requires approaches to prevent care dependency or reduce loss of independence. Long-term care assessments can provide valuable insights into this. In Germany, the Medical Service is responsible for the long-term care assessment (care level) that focuses on limitations in independent living. Objectives The aim of this contribution is to describe initial applicants with identified need for long-term care. Materials and methods The nationwide database consists of long-term care assessments conducted by the German Medical Service of health insured people aged 60 and above who received a care level (1=smallest till 5= largest limitations) for the first time in 2021. Long-term care-relevant information is analyzed descriptively. Results 339,486 individuals with an average age of 79.6 years (SD: 8.4) were analyzed. The age distribution shows that the 80-89 age group comprises half of the sample (49.9%), whereas those aged 90+ encompass the smallest proportion of the sample (9.3%). More women than men received a care level (59.0% women vs. 41.0% men), with women predominant in care level 1-2 and men in the higher care level 3-5. Overall, approximately half of the sample received care level 2, 32.4 % received care level 1. Care levels 3-5 were assessed less frequently (16.2 % vs. 4.8 % vs. 1.7 %). The most frequent care-relevant diagnoses were senility (R54), polyarthrosis (M15), and dementia (F03). Conclusions Over three quarters of initial applicants are classified into the lowest care levels (1 and 2). Accordingly, tertiary prevention measures are recommended, as these may delay the further progression into a higher care level. Key messages • Over three quarters of initial applicants for long-term care are classified into the lowest care levels. Accordingly, tertiary prevention measures may recommended to delay further care progression. • The most frequent care-relevant diagnoses were senility (R54), polyarthrosis (M15), and dementia (F03).

Use of chatgpt-4 to explain kawasaki disease to parents and paediatric trainees

Abstract Background Paediatric trainees and parents of Kawasaki disease (KD) patients may face challenges when managing the disease due to insufficient accessibility to KD information. Chat Generative Pre-Trained Transformer (ChatGPT) based on large language models may help explain KD information to paediatric trainees and patient parents. Purpose This study aims to determine the usefulness of Chat Generative Pre- Trained Transformer -4 (ChatGPT-4) in explaining Kawasaki Disease (KD) and its management to parents and paediatric trainees managing KD patients. Methods We created 2 sets of clinical scenarios. In the first set, ChatGPT-4 was instructed to respond to 10 questions based on enquiries from parents of KD patients. Responses were scored in terms of "factual accuracy", "coherence", "comprehensiveness", and "humaneness" by 3 paediatric cardiologists using Likert scale of 0-10. Readability were calculated using Flesch reading-ease test. In the second set, ChatGPT-4 was instructed to respond to 8 KD-related questions based on enquiries from paediatric trainees. Responses are graded based on "relevance", "reliability" and "comprehensiveness" using Likert scale of 0-10 by 3 paediatric cardiologists independently. Reviewers would determine whether major advice from chatGPT-4 would be adopted in clinical judgement. Results For parent-targeted responses, ChatGPT-4 achieved the highest scores in ‘humaneness’ (median 9.00, IQR 8.00 to 9.00) and ‘coherence’ (median 8.00, IQR 7.00 to 8.00). Inaccurate information regarding disease prognosis, actions as well as prescription of medications and surgery is found in 80% of scenarios. Missing information regarding long-term coronary complications, antiplatelet management and cardiac assessments is found in all 10 scenarios. Mean readability of parent-targeted responses is 71.70 ± 6.26, a readability level easily understood by 12-year-olds. For paediatrician-targeted responses, ChatGPT-4 achieved the highest scores in ‘relevance’ (median 9.50, IQR 7.25 to 9.0). Inaccurate information regarding coronary interventions, patient education and immunization recommendations is spotted in 37.5% of the scenarios. Missing information regarding patient education and stress imaging is found in 25% of the scenarios. All reviewers would adopt ChatGPT-4’s advice in 87.5% of the scenarios. Conclusions ChatGPT-4 has significant limitations in accuracy and lacks salient information when providing KD recommendations for parents and paediatric trainees.Performance in parent-targeted questionsPerformance in trainee-targeted question

Living alone and care levels’ distribution in first-time recipients of long-term care in Germany

Abstract Background As demographic shifts occur, along with longer life expectancies and advancements in medical care, there is a noticeable rise in the population requiring long-term care. In Germany, the Medical Service oversees the assessment for long-term care needs, which specifically evaluates the extent of limitations in maintaining independent living. These limitations are categorized into care levels ranging from 1 (indicating minor limitations) to 5 (denoting the most severe limitations). Methods Data from the long-term care assessment conducted nationwide in Germany are utilized for the analysis presented. The study focuses on individuals aged 60 and above with a first-time recognition of need of long-term care. Descriptive analysis is conducted on the distribution of care levels and living arrangements. Results The analysis encompassed 339,486 individuals, with an average age of 79.6 years (standard deviation: 8.4), of whom 59.0% were female. Approximately half of the sample were categorized under care level 2, while 32.4% fell into care level 1. Higher care levels (3-5) were less frequent (16.2%, 4.8%, 1.7% respectively). Individuals living alone were predominantly found in the lower care levels, whereas those not living alone were more commonly represented in care levels 3-5. Additionally, older individuals were more frequently assigned higher care levels. Conclusions Over 75% of initial applicants are classified within the lowest care levels (1 and 2) with a higher proportion of those living alone. One possible explanation is that within partnerships, the presence of a partner may serve as a form of support during the early phases of long-term care, with external assistance becoming necessary only as care needs escalate to higher levels. Further research should focus on examining the role of living alone in the need for long-term care. Key messages • Initial applicants of long-term care in Germany living alone are more often classified in lower care levels (indicating minor limitations) than in higher care levels (indicating severe limitation). • Partnerships may delay higher long-term care needs; research should explore living alone’s impact on long-term care.

Age and sex differences in the effects of short- and long-term exposure to air pollution on endothelial dysfunction

Abstract Background Endothelial dysfunction is an integrated index of risk factor burden and a marker of atherosclerotic cardiovascular disease. Air pollution is widely acknowledged as a significant non-traditional risk factor for cardiovascular disease. However, the impact of air pollutants at varying concentrations and exposure durations on endothelial function in different populations remains unclear. Purpose We aimed to use brachial artery flow-mediated dilatation (FMD) to identify demographic differences in the effects of short- and long-term exposure to air pollution on endothelial dysfunction. Methods We measured FMD in 850 participants from October 2016 to January 2020. Location-specific concentrations of fine particulate matter <2.5 μm aerodynamic diameter (PM2.5), inhalable particulate matter <10 μm aerodynamic diameter (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), and ozone (O3) measured by fixed ambient air monitoring stations were collected for short- and long-term exposure assessment. We used the moving average 7- and 14-day exposures before the date of FMD measurements to estimate the short-term exposure effects and the moving average 12-month exposures before the date of FMD measurements to estimate the long-term exposure effects. Multiple linear regression models and restricted cubic splines were used to assess the associations before and after stratified by age and sex. Results This study eventually included 828 participants [551 (66.5%) younger than 65 years and 553 (66.8%) men]. Each 10 μg/m³ increase in 12-month exposure to PM10 and NO2 was significantly and linearly associated with -0.20% (95% CI: -0.37 to -0.03) and -0.58% (95% CI: -0.99 to -0.18) changes in FMD in all participants. 12-month exposure to gaseous pollutants was also significantly but nonlinearly associated with lower FMD. 7-day exposure to Quartile 4 of SO2 was significantly associated with a 0.70% decrease in FMD compared to Quartile 1 (β = -0.70, 95% CI: -1.40 to -0.008). No relationships were observed between 7- and 14-day exposure to PM2.5, PM10, NO2, CO, and endothelial dysfunction. Although interaction effects were limited to SO2 and sex, significant associations with different air pollutants were only found in men and those younger than 65 years after stratified. Conclusions Long-term exposure to air pollution is strongly associated with decreased endothelial function, and susceptibility to air pollution varies significantly with age and sex. Further identification of different susceptible populations and proactive measures to mitigate air pollution may be beneficial in reducing the burden of cardiovascular disease.

Advancing Osteoarthritis Treatment: The Therapeutic Potential of Mesenchymal Stem Cell-Derived Exosomes and Biomaterial Integration

Background/Objectives: Osteoarthritis (OA) is a prevalent and debilitating joint disorder characterized by progressive cartilage degradation and inflammation, for which traditional treatments offer only symptomatic relief without halting disease progression. Exosomes, cell-free vesicles derived from mesenchymal stem cells, have emerged as a promising alternative therapy owing to their regenerative and anti-inflammatory properties. Methods: This review synthesizes findings from recent studies (2017–2023) on the therapeutic potential of exosomes in OA treatment, highlighting their ability to modulate the joint microenvironment, reduce inflammation, and promote cartilage repair by delivering bioactive molecules such as cytokines, growth factors, and regulatory ribonucleic acids. Results: We explore the integration of exosomes with biomaterials, such as hydrogels and scaffolds, to enhance their delivery and therapeutic efficacy, and we address the critical challenges associated with their clinical application, including standardization of isolation and characterization methods, scalability of production, mechanistic understanding, and long-term safety. Despite these challenges, exosome-based therapies offer several advantages over traditional and cell-based treatments, including lower immunogenicity, ease of handling, and targeted delivery of therapeutic agents to damaged tissues. Conclusions: We provide an analytical perspective on the current state of exosome research in OA, emphasizing the need for standardized production methods, deeper mechanistic insights, and rigorous long-term safety assessments. Future directions should focus on optimizing delivery systems, exploring personalized medicine approaches, and conducting comparative effectiveness studies to fully realize the potential of exosome therapies for OA treatment. Addressing these gaps will be crucial for translating exosome therapies from bench to bedside and achieving a transformative impact on OA management.

Single Strength Training Session Improves Short-Term Memory in Cognitively Preserved Older Adults.

The purpose of the present study was to examine the acute effect of a single aerobic or strength training session on memory of cognitively preserved older adults. In this randomized controlled clinical trial, in the first visit the participants (52.2% men, aged 68.65 ± 2.81years-old, BMI 26.94 ± 4.09), were randomly allocated in one of three groups: AG (aerobic exercise group), SG (strength exercise group, submitted to five exercises with 15 repetitions each), and CG (control group). Participants had a short-term memory assessment (word list memory test) followed by a single exercise session, and were retested immediately after. 24h later, participants were submitted to a long-term memory assessment about the story that was presented in the previous day. Results showed that the SG group had a significant improvement in the word list test, when comparing pre- and post-intervention scores, suggesting that a single strength training session significantly enhances short-term memory in this population.

Outcomes of fenestration versus none in extracardiac total cavopulmonary connection.

Fenestrated total cavopulmonary connection has gained popularity due to its capacity to reduce systemic venous pressure and enhance cardiac output. However, there is ongoing debate about the immediate and long-term advantages of fenestration in this context. A retrospective cohort study was conducted involving 97 patients who underwent extracardiac total cavopulmonary connection at Chiang Mai University Hospital between January 1999 and December 2019. The patients were initially categorized into two groups: fenestrated (n = 71) and nonfenestrated (n = 26). After exclusion and reassignment, the long-term outcomes were analyzed for the fenestrated (n = 68) and nonfenestrated (n = 25) groups. To address potential confounding factors between the two groups, propensity scores were computed using logistic regression analysis. The study found no significant differences in preoperative and operative data. Immediate postoperative outcomes showed no significant variations in major complications, intensive care unit stay, oxygen saturation, and posttotal cavopulmonary connection pressure. In the long-term assessment, the fenestrated group demonstrated significantly lower rates of mortality, protein-losing enteropathy, liver mass, and cirrhosis. However, after employing a multilevel model stratified by propensity score analysis, only long-term mortality rate was significantly lower in the fenestrated group (hazard ratio = 0.12, 95% confidence interval = 0.02-0.97). Fenestration patency closed gradually through spontaneous closure and device intervention. The study found no major differences in immediate postoperative outcomes. In the fenestrated cohort, significantly lower incidences of protein-losing enteropathy, liver mass, cirrhosis, and long-term mortality were observed. However, multilevel model stratified by propensity score analysis indicated that only the lower long-term mortality demonstrated a major effect.

Implant design influences the joint-specific outcome after total knee arthroplasty.

The aims were to assess whether joint-specific outcome after total knee arthroplasty (TKA) was influenced by implant design over a 12-year follow-up period, and whether patient-related factors were associated with loss to follow-up and mortality risk. Long-term follow-up of a randomized controlled trial was undertaken. A total of 212 patients were allocated a Triathlon or a Kinemax TKA. Patients were assessed preoperatively, and one, three, eight, and 12 years postoperatively using the Oxford Knee Score (OKS). Reasons for patient lost to follow-up, mortality, and revision were recorded. A total of 94 patients completed 12-year functional follow-up (62 females, mean age 66 years (43 to 82) at index surgery). There was a clinically significantly greater improvement in the OKS at one year (mean difference (MD) 3.0 (95% CI 0.4 to 5.7); p = 0.027) and three years (MD 4.7 (95% CI 1.9 to 7.5); p = 0.001) for the Triathlon group, but no differences were observed at eight (p = 0.331) or 12 years' (p = 0.181) follow-up. When assessing the OKS in the patients surviving to 12 years, the Triathlon group had a clinically significantly greater improvement in the OKS (marginal mean 3.8 (95% CI 0.2 to 7.4); p = 0.040). Loss to functional follow-up (53%, n = 109/204) was independently associated with older age (p = 0.001). Patient mortality was the major reason (56.4%, n = 62/110) for loss to follow-up. Older age (p < 0.001) and worse preoperative OKS (p = 0.043) were independently associated with increased mortality risk. An age at time of surgery of ≥ 72 years was 75% sensitive and 74% specific for predicting mortality with an area under the curve of 78.1% (95% CI 70.9 to 85.3; p < 0.001). The Triathlon TKA was associated with clinically meaningful greater improvement in knee-specific outcome when compared to the Kinemax TKA. Loss to follow-up at 12 years was a limitation, and studies planning longer-term functional assessment could limit their cohort to patients aged under 72 years.

The Impact of Eucalyptus and Pine Plantations on the Taxonomic and Functional Diversity of Dung Beetles (Coleoptera: Scarabaeidae) in the Southern Region of Ecuador.

This study sheds light on the complex relationship between land use, biodiversity, and the functional traits of dung beetles in Ecuador. The results indicate that the richness and abundance of dung beetles vary across different land uses and regions, with forests generally having a positive impact, while eucalyptus and pine plantations have a negative effect in certain areas. Specific indicator species, such as Homocopris buckleyi for forest areas and Onthophagus curvicornis for eucalyptus plantations, were identified. This study also found that functional diversity analysis, based on morphological traits, revealed that certain traits, such as biomass, pronotum width, head width, and elytra length, were significant contributors to differences in dung beetle communities across various land uses and regions. This study highlights the potential conservation value of certain modified habitats and emphasizes the importance of considering both taxonomic and functional diversity when assessing the impact of land use on the ecosystem services provided by dung beetles. It underscores the potential value of plantations as refuges for dung beetle communities and the need for long-term assessments to better understand biodiversity changes over time.

Aerosol particle number concentration, ultrafine particle number fraction, and new particle formation measurements near the international airports in Berlin, Germany – First results from the BEAR study

Studies revealed airports as a prominent source of ultrafine particles (UFP), which can disperse downwind to residential areas, raising health concerns. To expand our understanding of how air traffic-related emissions influence total particle number concentration (PNC) in the airport’s surrounding areas, we conduct long-term assessment of airborne particulate exposure before and after relocation of air traffic from “Otto Lilienthal” Airport (TXL) to Berlin Brandenburg Airport “Willy Brandt” (BER) in Berlin, Germany. Here, we provide insights into the spatial–temporal variability of PNC measured in 16 schools recruited for Berlin-Brandenburg Air Study (BEAR).The results show that the average PNC in Berlin was 7900 ± 7000 cm−3, consistent with other European cities. The highest median PNC was recorded in spring (6700 cm−3) and the lowest in winter (5100 cm−3). PNC showed a bi-modal increase during morning and evening hours at most measurement sites due to road-traffic emissions. A comparison between measurements at the schools and fixed monitoring sites revealed good agreement at distances up to 5 km. A noticeable decline in this agreement occurred as the distance between measurement sites increased. After TXL was closed, PNC in surrounding areas decreased by 30 %. The opposite trend was not seen after BER was re-opened after the COVID-lock-down, as the air traffic has not reached the full capacity yet. The analysis of particle number size distribution data showed that UFP number fraction exhibit seasonal variations, with higher values in spring and autumn. This can be explained by nucleation events, which notably affected PNC.The presented findings will play a pivotal role in forthcoming source attribution and epidemiological investigations, offering a holistic understanding of airports’ impact on airborne pollutant levels and their health implications. The study calls for further investigations of air-traffic-related physical–chemical pollutant properties in areas found further away (> 10 km) from airports.

Statistical Analysis for Quality Control of Monodispersed Polystyrene Particles Certified Reference Materials

Monodispersed polystyrene latex (PSL) particles serve as certified reference materials (CRMs) for ensuring quality, method validation, and calibration of particle size measuring instruments. They were produced in compliance with ISO 17034:2016 standards. However, limitations arise in the quality control of CRM characteristics due to challenges in synthesizing particles of consistent size across multiple batches. It is widely recognized that variations in particle size homogeneity between batches can occur in the particle manufacturing process even when conducted under identical conditions and ingredients. This paper aims to explain and demonstrate statistical analyses conforming to ISO Guide 35:2017 used for quality control and certifying reference values for monodispersed polystyrene particles. The procedure can be divided into three steps: 1) preliminary check by using dynamic light scattering (DLS), 2) preliminary check by using transmission electron microscopy (TEM), and 3) final homogeneity testing, along with short-term and long-term stability assessment and characterization. The described protocol can control the quality of particles from multiple batch productions by establishing criteria at each step to ensure particle size consistency. The certified value of a 100 nm diameter monodispersed polystyrene particle produced by the National Institute of Metrology, Thailand (NIMT) is 105.5 ± 4.6 nm, acceptable for measurement traceability for testing and calibration services. Keywords: Quality control, polystyrene particles, certified reference materials

Persistent Fatigue, Weakness, and Aberrant Muscle Mitochondria in Survivors of Critical COVID-19.

Persistent skeletal muscle dysfunction in survivors of critical illness due to acute respiratory failure is common, but biological data elucidating underlying mechanisms are limited. The objective of this study was to elucidate the prevalence of skeletal muscle weakness and fatigue in survivors of critical illness due to COVID-19 and determine if cellular changes associate with persistent skeletal muscle dysfunction. A prospective observational study in two phases: 1) survivors of critical COVID-19 participating in physical outcome measures while attending an ICU Recovery Clinic at short-term follow-up and 2) a nested cohort of patients performed comprehensive muscle and physical function assessments with a muscle biopsy; data were compared with non-COVID controls. ICU Recovery Clinic and clinical laboratory. Survivors of critical COVID-19 and non-COVID controls. None. One hundred twenty patients with a median of 56 years old (interquartile range [IQR], 42-65 yr old), 43% female, and 33% individuals of underrepresented race attended follow-up 44 ± 17 days after discharge. Patients had a median Acute Physiology and Chronic Health Evaluation-II score of 24.0 (IQR, 16-29) and 98 patients (82%) required mechanical ventilation with a median duration of 14 days (IQR, 9-21 d). At short-term follow-up significant physical dysfunction was observed with 93% of patients reporting generalized fatigue and performing mean 218 ± 151 meters on 6-minute walk test (45% ± 30% of predicted). Eleven patients from this group agreed to participate in long-term assessment and muscle biopsy occurring a mean 267 ± 98 days after discharge. Muscle tissue from COVID exhibited a greater abundance of M2-like macrophages and satellite cells and lower activity of mitochondrial complex II and complex IV compared with controls. Our findings suggest that aberrant repair and altered mitochondrial activity in skeletal muscle associates with long-term impairments in patients surviving an ICU admission for COVID-19.

Long-Term Comparative Life Cycle Assessment, Cost, and Comfort Analysis of Heavyweight vs. Lightweight Construction Systems in a Mediterranean Climate

Massive construction systems have always characterized traditional architecture and are currently the most prevalent, straightforward, and cost-effective in many Mediterranean countries. However, in recent years, the construction industry has gradually shifted towards using lightweight, dry construction techniques. This study aims to assess the effects on energy consumption, comfort levels, and environmental sustainability resulting from the adoption of five high-performance construction systems in a multi-family residential building: (i) reinforced concrete structure with low-transmittance thermal block infill; (ii) reinforced concrete structure with light-clay bricks and outer thermal insulation; (iii) steel frame; (iv) cross-laminated timber (CLT); (v) timber-steel hybrid structure. To achieve this goal, a multidisciplinary approach was employed, including the analysis of thermal parameters, the evaluation of indoor comfort through the adaptive model and Fanger’s PMV, and the quantification of environmental and economic impacts through life cycle assessment and life cycle cost applied in a long-term analysis (ranging from 30 to 100 years). The results highlight that heavyweight construction systems are the most effective in terms of comfort, cost, and long-term environmental impact (100 years), while lightweight construction systems generally have higher construction costs, provide lower short-term environmental impacts (30 years), and offer intermediate comfort depending on the thermal mass.

The Vital Role of Special Stains in Immunocompromised Cases: A Focus on Histoplasmosis Screenings for Enhanced Kaposi`s Sarcoma Diagnosis Beyond H&amp;E Morphology

Abstract Introduction/Objective This case report emphasizes the critical importance of thorough pathology-based investigation before making a definitive diagnosis of Kaposi’s Sarcoma (KS). In particular, we demonstrate the importance of using special stains in addition to H&amp;E staining to determine if the lesion is KS or a fungal infection, specifically cutaneous Histoplasmosis. This highlights the necessity of comprehensive diagnostics to ensure accurate and timely identification of underlying conditions, guiding appropriate treatment strategies. Methods/Case Report In Kampala Uganda, a 56-year-old male with a history of HIV/AIDS presented with skin lesions on the lower extremities. The lesions were initially suspected to be Kaposi’s Sarcoma due to their appearance and the patient’s immunocompromised status. Skin biopsy results supported the initial suspicion, showing spindle cell proliferation in the dermis, a common feature of KS. Given his compromised immune system, it was imperative to conduct a thorough investigation to rule out potential etiologies, including opportunistic infections. Additional tests, including a Grocott Methenamine-Silver Nitrate stain, revealed the presence of Histoplasmosis. The patient did not exhibit typical symptoms of Disseminated Histoplasmosis, such as respiratory distress or fever. Resource constraints hindered comprehensive follow-up, impacting long-term outcome assessment. Results (if a Case Study enter NA) NA Conclusion Histoplasmosis is widespread in Africa, accounting for 61% of global cases, with 87% concentrated in Western and Central Africa. The coexistence of KS and Histoplasmosis poses diagnostic challenges due to overlapping clinical manifestations. KS primarily affects the skin, while Histoplasmosis causes invasive vascular and pulmonary infections. However, in Africa, notably in immunocompromised individuals, histoplasmosis can cause cutaneous infections. Failure to recognize and address fungal infections may result in delayed or inappropriate treatment, exacerbating the patient’s condition. This case report underscores the importance of maintaining a high index of suspicion for opportunistic infections in this population for timely intervention.

Strain rate during isovolumic relaxation as a prognostic biomarker for long-term cardiovascular morbidity and mortality: an exploratory study on a general population.

Left ventricular (LV) strain rate (SR) during early relaxation correlates with LV filling pressures and has been assessed as a prognostic biomarker in several cardiac diseases. Conversely, even though LV SR during isovolumic relaxation (SRIVR)is more strongly related to invasive measurements of LV diastolic function, to date, studies on the role of SRIVR in the long-term prognosis assessment are lacking. Thus, the goal of this study was to assess the potential additive prognostic value of SRIVR on top of conventional cardiovascular risk factors in a general population. 657 subjects (mean age 51.6y; 47.6% males) were included in this study and, besides clinical and standard echocardiographic assessment, tissue Doppler imaging (TDI)-based SR was measured during IVR (SRIVR), early diastole (SRe), and atrial contraction (SRa) in the mid-segment of the inferior, inferolateral, lateral, and septal wall of the LV. During the follow-up period (median 12.1years), the total number of major adverse cardiac events was 85 (13.4%). Overall, after adjustment for known cardiovascular risk factors and important echocardiographic indices in a multivariable-adjusted Cox regression model, SRIVR of the inferolateral wall (SRIVRinflat) remained an independent predictor of fatal and nonfatal cardiac events (HR: 1.49, p = 0.016), along with GLS (HR: 1.35, p = 0.027), age (HR: 1.09, p < 0.001), and male sex (HR: 2.06, p = 0.037). None of SRIVR measured in the other myocardial walls were associated with cardiac outcome. SRIVRinflat predicted adverse outcome in the general population, on top of conventional cardiovascular factors. However, its incremental value as a prognosticator remained limited.

Glatiramer Acetate for the Treatment of Multiple Sclerosis: From First-Generation Therapy to Elucidation of Immunomodulation and Repair.

Multiple sclerosis (MS) is a chronic inflammatory demyelinating and neurodegenerative disease of the central nervous system (CNS), with a putative autoimmune origin and complex pathogenesis. Modification of the natural history of MS by reducing relapses and slowing disability accumulation was first attained in the 1990 s with the development of the first-generation disease-modifying therapies. Glatiramer acetate (GA), a copolymer of L-alanine, L-lysine, L-glutamic acid, and L-tyrosine, was discovered due to its ability to suppress the animal model of MS, experimental autoimmune encephalomyelitis. Extensive clinical trials and long-term assessments established the efficacy and the safety of GA. Furthermore, studies of the therapeutic processes induced by GA in animal models and in MS patients indicate that GA affects various levels of the innate and the adaptive immune response, generating deviation from proinflammatory to anti-inflammatory pathways. This includes competition for binding to antigen presenting cells; driving dendritic cells, monocytes, and B-cells toward anti-inflammatory responses; and stimulating T-helper 2 and T-regulatory cells. The immune cells stimulated by GA reach the CNS and secrete in situ anti-inflammatory cytokines alleviating the pathological processes. Furthermore, cumulative findings reveal that in addition to its immunomodulatory effect, GA promotes neuroprotective repair processes such as neurotrophic factors secretion, remyelination, and neurogenesis. This review aims to provide an overview of MS pathology diagnosis and treatment as well as the diverse mechanism of action of GA. SIGNIFICANCE STATEMENT: Understanding the complex MS immune pathogenesis provided multiple targets for therapeutic intervention, resulting in a plethora of agents, with various mechanisms of action, efficacy, and safety profiles. However, promoting repair beyond the body's limited spontaneous extent is still a major challenge. GA, one of the first approved disease-modifying therapies, induces diverse immunomodulatory effects. Furthermore, GA treatment results in elevated neurotrophic factors secretion, remyelination and neurogenesis, supporting the notion that immunomodulatory treatment can support in situ a growth-promoting and repair environment.

Preliminary Long-Term Biocompatibility Assessment of Penn State University Child Pump

Preliminary Long-Term Biocompatibility Assessment of Penn State University Child Pump

Drone Insights: Unveiling Beach Usage through AI-Powered People Counting

Ocean beaches are a major recreational attraction in many coastal cities, requiring accurate visitor counts for infrastructure planning and value estimation. We developed a novel method to assess beach usage on the Gold Coast, Australia, using 507 drone surveys across 24 beaches. The surveys covered 30 km of coastline, accounting for different seasons, times of day, and environmental conditions. Two AI models were employed: one for counting people on land and in water (91–95% accuracy), and another for identifying usage types (85–92% accuracy). Using drone data, we estimated annual beach usage at 34 million people in 2022/23, with 55% on land and 45% in water—approximately double the most recent estimate from lifeguard counts, which are spatially limited and prone to human error. When applying similar restrictions as lifeguard surveys, drone data estimated 15 million visits, aligning closely with lifeguard counts (within 9%). Temporal (time of day, day of the week, season) and spatial (beach location) factors were the strongest predictors of beach usage, with additional patterns explained by weather variables. Our method, combining drones with AI, enhances the coverage, accuracy, and granularity of beach monitoring, offering a scalable, cost-effective solution for long-term usage assessment.

Long-term climate-based sizing and economic assessment of air-water heat pumps for residential heating

This study presents a novel methodology for sizing air–water heat pumps (ASHP) for space heating and hot water supply in buildings. Utilizing long-term local climatic data, the developed tool determines the coefficient of performance (COP) and feasibility of ASHP. The sizing algorithm incorporates peak heat demand, unitary final energy demand, and seasonal heat demand across various detached house sizes. Annual local heating system operation time and key economic indicators are derived for each case across 3 European countries. A new approach is precise investigation of 10-year outdoor temperatures and apply it to heat pump (HP) modeling, which enabled a distinction between so-called warm and cold years. The results underscore substantial variations in net present value (NPV) between warm and cold years, illustrating the critical influence of precise climate data on the performance of HPs. The study revealed that for a 160 m2 house in Poland, annual electricity consumption by HPs ranged from 3736 kWh during warm years to 12,908 kWh during cold years, showing a significant variation in performance based on climate conditions. The comprehensive tool allows for precise adjustments of heating systems to actual local climate conditions, improving both economic and environmental outcomes. This comparative assessment aids in the optimal selection of HPs, ensuring energy efficiency and sustainability in residential heating systems. Building on studies from various climatic regions, this work addresses the knowledge gap in performance and explores the feasibility of HP in a changing climate using precise modeling techniques.

A Long-Term Assessment of Nitrogen Removal Performance and Microecosystem Evolution in Bioretention Columns Modified with Sponge Iron.

The nitrogen removal performance of bioretention urgently needs to be improved, and sponge iron has great potential to address this challenge. This study reported the results of a long-term investigation on bioretention columns improved by sponge iron, examining the durability of sponge iron from nitrogen removal performance, sponge iron properties, and the evolution of biological elements. The results showed that after 9 months of continuous operation, the removal rates of ammonia nitrogen (NH4+-N), nitrate nitrogen (NO3--N), and total nitrogen (TN) in the bioretention columns with an appropriate proportion of sponge iron could reach 80% (some even over 90%). However, the long-term stress of sponge iron exposure, combined with the cumulative effect of pollutants, might lead to the excessive accumulation of reactive oxygen species (ROS) in plants, thereby posing risks of diminished chlorophyll content and enzyme activity. Simultaneously, the extended exposure could also have detrimental effects on microbial diversity and the abundance of dominant bacteria such as Proteobacteria and Sphingorhabdus. Therefore, it is necessary to select plant species and functional genes that demonstrate high adaptability to iron-induced stress.