Long-term Feasibility Research Articles

Digital adherence technologies for the management of tuberculosis therapy: mapping the landscape and research priorities

Poor medication adherence may increase rates of loss to follow-up, disease relapse and drug resistance for individuals with active tuberculosis (TB). While TB programmes have historically used directly observed therapy...

Relevance of Whole-Body Vibration Exercises on Muscle Strength/Power and Bone of Elderly Individuals

Beneficial effects are associated with whole-body vibration exercises (WBVEs). Increases in muscular strength/power, flexibility, and gait speed; improvements in bone mineral density, balance, and the quality of life; and decreased pain and risk of falls are reported. The aim is to present a review about the importance of WBVE for elderly individuals, considering clinical studies and meta-analyses, on bone and muscle strength/power. There is evidence supporting beneficial effect of WBVE in postmenopausal women (PW); however, effects in PW with osteoporosis are unclear. Age-related decrease in muscle mass and function contribute to undesirable health conditions, including death risk. The WBVEs improve muscle strength/power, functional independence measure, balance, and various fall risk factors, and mobility, measured by Timed Up and Go test, increased significantly after WBVE. An explanation for the absence of positive effects in some outcomes could be related to discrepancies in WBVE protocols as well as the populations tested. It is concluded that WBVE is effective for counteracting the loss of muscle strength associated with sarcopenia in elderly individuals. Balance and leg and plantar flexor strength improvements due to WBV indicate benefit to reduce risk and incidence of falls, frailty, and fracture risks. However, long-term feasibility of WBVE for musculoskeletal and bone health in elderly individuals needs further investigation.

A comprehensive study of the effect of chemical impurities on selection and sizing of centrifugal machines for supercritical carbon dioxide transport pipelines

Compressors and booster pumps constitute the “heart” of the supercritical carbon dioxide transport pipeline network because they consume most of the required energy input. In other words, most of the operating expenditure for the transport pipeline goes to the running of compressors and pumps. The long-term economic feasibility of running such pipeline networks is achievable only if operating costs linked to the energy consumption of both machines can be kept as low as possible. Energy consumption can be kept as low as possible by sizing compressors and booster pumps optimally to ensure that power losses in both machines are minimized.In this study, a quasi-dimensional model based on the laws of conservation was developed, validated with available experimental data and then used for a detailed investigation of the effect of various impurities on the performance of a centrifugal machine handling supercritical carbon dioxide of varying purity. Results of the study show that discharge pressure, power requirement and efficiency of a centrifugal machine are strongly dependent on certain key parameters; namely, the size and speed of its impeller rotor as well as the composition of the impure CO2 stream. More importantly, this study also demonstrates that the quasi-dimensional model can be used as a tool for appropriate selection and sizing of centrifugal compressors and booster pumps installed on a supercritical carbon dioxide transport pipeline.

Long-term evaluation and feasibility study of the insulated screw electrode for ECoG recording

BackgroundA screw-shaped electrode can offer a compromise between signal quality and invasiveness. However, the standard screw electrode can be vulnerable to electrical noise while directly contact with the skull or skin, and the feasibility and stability for chronic implantation in primate have not been fully evaluated. New MethodWe designed a novel screw electrocorticogram (ECoG) electrode composed of three parts: recording electrode, insulator, and nut. The recording electrode was made of titanium with high biocompatibility and high electrical conductivity. Zirconia is used for insulator and nut to prevent electrical noise. ResultIn computer simulations, the screw ECoG with insulator showed a significantly higher performance in signal acquisition compared to the condition without insulator. In a non-human primate, using screw ECoG, clear visual-evoked potential (VEP) waveforms were obtained, VEP components were reliably maintained, and the electrode’s impedance was stable during the whole evaluation period. Moreover, it showed higher SNR and wider frequency band compared to the electroencephalogram (EEG). We also observed the screw ECoG has a higher sensitivity that captures different responses on various stimuli than the EEG. ComparisonThe screw ECoG showed reliable electrical characteristic and biocompatibility for three months, that shows great promise for chronic implants. These results contrasted with previous reports that general screw electrode was only applicable for acute applications. ConclusionThe suggested electrode can offer whole-brain monitoring with high signal quality and minimal invasiveness. The screw ECoG can be used to provide more in-depth understanding, not only relationship between functional networks and cognitive behavior, but also pathomechanisms in brain diseases.

Acceptability of a Self-Regulation Theory-Based mHealth Behavior Intervention for Older Adults with Type 2 Diabetes and Obesity

Background: The successful use of mobile health (mHealth) in lifestyle changes for older adults with type 2 diabetes is unknown. We report here acceptability of a mHealth intervention for older adults. Method: We used a one-group pre-posttest design. Participants received an 8-week theory-based mHealth intervention, using the Lose It! App for daily self-monitoring of food intake, a Fitbit, and Bluetooth-enabled glucometers and weighing scales. Linear mixed models were used for analysis. Results: The sample (N=9) was white (88.9%), female (44.4%), with a mean age of 76.4±6.0 years (range: 69-89), 15.7±2.0 years of education, BMI of 33.3±3.1 kg/m2 and HbA1c 7.4%±0.8. The Montreal Cognitive Assessment score was 24.6±2.7, indicating no severe cognitive impairment. Over 56 days, the % days of using the Lose It!, Fitbit, glucometer, and scales were 92.7±7.9, 93.7±10.6, 76.4±23.5, 52.4±37.8, respectively. The data showed a significant % weight loss (b=-0.04, p<.001), decreased calorie intake (b=-4.6, p=.0004) and increased steps (b1=34.0, b2=-1.0, p=.02) over time. The mean % weight loss from baseline was 4.44%±3.19. The dose of oral hypoglycemic agents or insulin was reduced among 4 participants. Conclusion: Older adults are able to use mHealth to improve outcomes. The additional 3-month follow-up is ongoing to provide insight into long-term feasibility and acceptability. Disclosure Y. Zheng: None. K. Weinger: None. M.C. Gregas: None. J. Greenberg: None. Z. Li: None. L.E. Burke: None. C. Qi: None. C. Slyne: None. T. Greaves: None. M. Munshi: Consultant; Self; Sanofi.

Biomass yield, nutrient concentration and nutrient uptake by SRC willow cultivars grown on different sites in Denmark

Yield and nutrient uptake of willow cultivars are important factors for long-term feasibility and sustainability of willow short rotation coppice (SRC). This study investigated biomass yield of eight willow cultivars (Inger, Klara, Linnea, Resolution, Stina, Terra Nova, Tora, Tordis) during two three-year harvest rotations on four Danish sites. Also, concentration and uptake of N, P and K was measured in harvested biomass in 2nd harvest rotation on two of the sites.Dry matter (DM) yield differed significantly between sites in both 1st and 2nd harvest rotation, but the relative difference between sites decreased from 106 to 54 %. Mean DM yield across cultivars and sites increased 67 % from 1st to 2nd harvest rotation but ranging from 44 to 108 % between sites. There were certain significant differences in yield ranking of cultivars between sites and harvest rotations but, overall, ranking was rather consistent. Across all four sites and all six growth years, there were four cultivar groups differing significantly in DM yield, with highest yield in Tordis and Tora, second highest in Klara and Resolution followed by Terra Nova and Inger and lowest yield in Linnea and Stina, with Stina having 39 % lower yield than Tordis.Concentration and uptake of N, P and K in harvested biomass in 2nd harvest rotation differed significantly between cultivars and between sites. Across cultivars and sites, nutrient concentration decreased linearly with increasing DM yield, whereas nutrient uptake increased linearly. These results have implications for nutrient balance and fertilization strategies for willow SRC.

Self-adaptive differential evolutionary extreme learning machines for long-term solar radiation prediction with remotely-sensed MODIS satellite and Reanalysis atmospheric products in solar-rich cities

Designing predictive models of global solar radiation can be an effective renewable energy feasibility studies approach to resolve future problems associated with the supply, reliability and dynamical stability of consumable energy demands generated by solar-powered electrical plants. In this paper we design and present a new approach to predict the monthly mean daily solar radiation (GSR) by constructing an extreme learning machine (ELM) model integrated with the Moderate Resolution Imaging Spectroradiometer (MODIS)-based satellite and the European Center for Medium Range Weather Forecasting (ECMWF) Reanalysis data for solar rich cities: Brisbane and Townsville, Australia. A self-adaptive differential evolutionary ELM (i.e., SaDE-ELM) is proposed, utilizing a swarm-based ant colony optimization (ACO) feature selection to select the most important predictors for GSR, and the SaDE-ELM is then benchmarked with nine different data-driven models: a basic ELM, genetic programming (GP), online sequential ELM with fixed (OS-ELM) and varying (OSVARY-ELM) input sizes, and hybridized model including the particle swarm optimized-artificial neural network model (PSO-ANN), genetic algorithm optimized ANN (GA-ANN), PSO-support vector machine model (PSO-SVR), genetic algorithm optimized-SVR model (GA-SVR) and the SVR model optimized with grid search (GS-SVR). A comprehensive evaluation of the SaDE-ELM model is performed, considering key statistical metrics and diagnostic plots of measured and forecasted GSR. The results demonstrate excellent forecasting capability of the SaDE-ELM model in respect to the nine benchmark models. SaDE-ELM outperformed all comparative models for both tested study sites with a relative mean absolute and a root mean square error (RRMSE) of 2.6% and 2.3% (for Brisbane) and 0.8% and 0.7% (for Townsville), respectively. Majority of the forecasted errors are recorded in the lowest magnitude frequency band, to demonstrate the preciseness of the SaDE-ELM model. When tested for daily solar radiation forecasting using the ECMWF Reanalysis data for Brisbane study site, the performance resulted in an RRMSE ≈ 10.5%. Alternative models evaluated with the input data classified into El Niño, La Niña and the positive and negative phases of the Indian Ocean Dipole moment (considering the impacts of synoptic-scale climate phenomenon), confirms the superiority of the SaDE-ELM model (with RRMSE ≤ 13%). A seasonal analysis of all developed models depicts SaDE-ELM as the preferred tool over the basic ELM and the hybridized version of ANN, SVR and GP model. In accordance with the results obtained through MODIS satellite and ECMWF Reanalysis data products, this study ascertains that the proposed SaDE-ELM model applied with ACO feature selection, integrated with satellite-derived data is adoptable as a qualified tool for monthly and daily GSR predictions and long-term solar energy feasibility study especially in data sparse and regional sites where a satellite footprint can be identified.

Development of chemotherapy and significance of conversion surgery after chemotherapy in unresectable pancreatic cancer.

While surgery currently remains the only potentially curative treatment available for pancreatic cancer, only 20% to 30% of patients have resectable disease at diagnosis. Recently, with the introduction of intensive chemotherapy regimens such as oxaliplatin, irinotecan, fluorouracil plus leucovorin (FOLFIRINOX) and gemcitabine plus nab-paclitaxel, for the treatment of unresectable pancreatic cancer, the antitumor activity and overall survival in patients with pancreatic cancer have dramatically improved. These advances in intensive chemotherapy have led to the possibility of conversion of unresectable disease to resectable disease, and it has been reported that more than 20% of pancreatic cancer patients with unresectable locally advanced disease at diagnosis undergo successful conversion surgery after FOLFIRINOX therapy. In metastatic pancreatic cancer, resection for the primary lesion of pancreatic cancer may show some benefits for some patients with complete resolution of metastases by chemotherapy. Furthermore, surgical resection in some patients with only a few metastases, so-called oligometastases, have also been reported. Conversion surgery is becoming increasingly possible with the introduction of intensive chemotherapies, however, the actual clinical benefits of resection in such cases has not yet been sufficiently investigated. The long-term safety, feasibility and outcomes still need to be investigated in well-designed, multi-institutional studies on a large number of patients.

Long-term feasibility of Mediterranean olive production systems

Of Mediterranean countries, Italy represents the second largest producer of olive oil, with about 14% of total world production, and represents the largest consumer worldwide, with 20.8% of total world consumption. Olive cultivation is mostly confined to southern regions, which overall account for about 80% of national olive oil production. In Calabria, olive growing plays a significant economic role, particularly in rural contexts, although olive growers have to face different problems such as high production costs, low productivity and low levels of mechanization of agricultural practices. However, many olive farms produce high-quality olive oil, thanks to both more efficient farming management and the adoption of product and process innovations. This paper aims to assess the long-term feasibility of different olive-growing systems in the Calabrian region (southern Italy) by means of joint use of a life cycle costing (LCC) approach and dynamic evaluation methods. The economic analysis allowed us to recognize the main hotspots within the product life of each system analyzed, useful to identify potential enhancements to the production process and to give rise to greater levels of profitability. Our results highlighted a suitable level of economic viability for almost all systems investigated, in particular when public subsidies from the European Union were considered. Our research could be useful to suggest the adoption of possible improvement strategies for corporate decision-making processes, to achieve appropriate economic sustainability performance.

Surgical outcome of laparoscopic hepatic resection for hepatocellular carcinoma: A matched case-control study with propensity score matching.

Background:Although the number of reports on laparoscopic hepatic resection (LHR) has increased, studies of long-term outcomes regarding tumor recurrence and patient survival compared to the conventional open approach are limited. We evaluated the long-term survival and feasibility of LHR in patients with hepatocellular carcinoma (HCC).Patients and Methods:A retrospective analysis was performed on the clinical data of patients who underwent hepatic resection for primary HCC between August 2000 and December 2013. The patients were divided into the LHR or open hepatic resection (OHR) groups. To control for selection bias in the two groups, propensity score matching was used at a 1:1 ratio based on the following covariates: Child–Pugh grade, tumour size, tumour number and tumour location. Following propensity score matching, thirty patients were included in the LHR group and thirty were included in the OHR group.Results:The respective disease-free survival rates at 1 year, 3 years and 5 years were 78.4%, 61.1% and 38.9%, respectively, for the LHR group, and 89.3%, 57.5% and 47.9%, respectively, for the OHR group (P = 0.89). Also, the overall survival rates at 1 year, 3 years and 5 years were 96.4%, 68.2% and 62.5%, respectively, for the LHR group and 100.0%, 95.8% and 72.3%, respectively, for the OHR group (P = 0.44).Conclusions:According to our study, using propensity score matching, LHR for HCC is safe, feasible and comparative, with good oncologic results.

Randomised controlled trial to determine the efficacy and safety of prescribed water intake to prevent kidney failure due to autosomal dominant polycystic kidney disease (PREVENT-ADPKD)

IntroductionMaintaining fluid intake sufficient to reduce arginine vasopressin (AVP) secretion has been hypothesised to slow kidney cyst growth in autosomal dominant polycystic kidney disease (ADPKD). However, evidence to support this...

Synthesis and catalytic activity of Ag nanoparticles dispersed on nitrogen-doped GOPx toward direct electrooxidation of formaldehyde

Silver nanoparticles (Ag NPs) were synthesized and dispersed on the electronically conductive and electrochemically accessible surface of a GOPx composite, which was then employed as a probe for formaldehyde (HCHO) oxidation. The surface nanostructure, crystallographic properties, and oxidation state of the metal present in the GOPx-Ag nanocomposite were investigated using high resolution transmission electron microscopy (HRTEM), X-ray diffraction (XRD), energy dispersive X-ray spectroscopy (EDX), X-ray photoelectron spectroscopy (XPS) and Raman spectroscopy. HCHO electrooxidation was evidenced by the appearance of a very well defined anodic peak with an onset potential of −0.783V, which is unique in the literature. The effect of various electroanalytical parameters like concentration, scan rate, and upper potential limit was investigated toward HCHO electrooxidation on GOPx-Ag catalyst. Amperometric study showed remarkable HCHO electrooxidation response with a wide linear range of 1μM–70mM, limit of detection (LOD) 0.167μM, limit of quantification (LOQ) 0.556μM and sensitivity of 35.74μAmM−1cm−2. The experimental results further indicated the long-term stability and practical feasibility of the GOPx-Ag catalyst, with excellent recoveries for HCHO oxidation. The remarkable catalytic efficiency and anti-poisoning properties were far superior to those of many previously reported HCHO sensors. The astonishing analytical performance of GOPx-Ag opens up a new path for fabricating promising HCHO sensors.

Realizing high-rate sulfur reduction under sulfate-rich conditions in a biological sulfide production system to treat metal-laden wastewater deficient in organic matter.

Biological sulfur reduction can theoretically produce sufficient sulfide to effectively remove and recover heavy metals in the treatment of organics-deficient sulfate-rich metal-laden wastewater such as acid mine drainage and metallurgic wastewater, using 75% less organics than biological sulfate reduction. However, it is still unknown whether sulfur reduction can indeed compete with sulfate reduction, particularly under high-strength sulfate conditions. The aim of this study was to investigate the long-term feasibility of biological sulfur reduction under high sulfate conditions in a lab-scale sulfur-reducing biological sulfide production (BSP) system with sublimed sulfur added. In the 169-day trial, an average sulfide production rate (SPR) as high as 47 ± 9 mg S/L-h was achieved in the absence of sulfate, and the average SPR under sulfate-rich conditions was similar (53 ± 10 mg S/L-h) when 1300 mg S/L sulfate were fed with the influent. Interestingly, sulfate was barely reduced even at such a high strength and contributed to only 1.5% of total sulfide production. Desulfomicrobium was identified as the predominant sulfidogenic bacterium in the bioreactor. Batch tests further revealed that this sulfidogenic bacteria used elemental sulfur as the electron acceptor instead of the highly bioavailable sulfate, during which polysulfide acted as an intermediate, leading to an even higher bioavailability of sulfur than sulfate. The pathway of sulfur to sulfide conversion via polysulfide in the presence of both sulfur and sulfate was discussed. Collectively, when conditions favor polysulfide formation, sulfur reduction can be a promising and attractive technology to realize a high-rate and low-cost BSP process for treating sulfate-rich metal-laden wastewater.

Percutaneous Tibial Nerve Stimulation in the Office Setting: Real-world Experience of Over 100 Patients

To examine the outcomes and compliance with percutaneous tibial nerve stimulation (PTNS) for overactive bladder (OAB) symptoms. Adults who had PTNS from June 30, 2011, to October 8, 2015, were retrospectively reviewed for demographics, copay, travel distance, employment status, history, symptoms, and treatments used before, during, and after PTNS. Pearson chi-square test, Fisher exact test, Wilcoxon rank and paired t test were performed. Of 113 patients (mean age 75 ± 12 years), most were women (65.5%), married (78.1%), and retired or unemployed (80.2%). The median distance to the clinic was 8.1 mi, and the median copay was $0. The most common indication for PTNS was nocturia (92.9%) followed by OAB with urgency urinary incontinence (75.2%) and urinary urgency and/or frequency (24.8%). Prior treatments included anticholinergics (75.2%), mirabegron (36.6%), behavioral modification (29.2%), pelvic floor physical therapy (18.6%), and others (19.5%). Patients completed a mean of 10.5 ± 3 of 12 planned weekly PTNS treatments. Of 105 patients, 40 (38.1%) used concomitant treatments (most commonly anticholinergics). Of 87 patients, 62 (71.3%) had decreased symptoms at 6 weeks, and of 85 patients, 60 (70.6%) had decreased symptoms at 12 weeks. The majority (82; 75.6%) completed all 12 weekly treatments and 45 (54.9%) completed 3 (median) monthly maintenance treatments. The most common reason for noncompliance was lack of efficacy. Visit copay, employment status, and distance to the clinic were not associated with failure to complete weekly treatments or progression to monthly maintenance. Although most patients' symptoms decreased after weekly PTNS, nonadherence to maintenance and lack of efficacy may limit long-term feasibility. Copay and distance traveled were not associated with noncompliance.

Long-term dopamine neurochemical monitoring in primates.

Many debilitating neuropsychiatric and neurodegenerative disorders are characterized by dopamine neurotransmitter dysregulation. Monitoring subsecond dopamine release accurately and for extended, clinically relevant timescales is a critical unmet need. Especially valuable has been the development of electrochemical fast-scan cyclic voltammetry implementing microsized carbon fiber probe implants to record fast millisecond changes in dopamine concentrations. Nevertheless, these well-established methods have only been applied in primates with acutely (few hours) implanted sensors. Neurochemical monitoring for long timescales is necessary to improve diagnostic and therapeutic procedures for a wide range of neurological disorders. Strategies for the chronic use of such sensors have recently been established successfully in rodents, but new infrastructures are needed to enable these strategies in primates. Here we report an integrated neurochemical recording platform for monitoring dopamine release from sensors chronically implanted in deep brain structures of nonhuman primates for over 100 days, together with results for behavior-related and stimulation-induced dopamine release. From these chronically implanted probes, we measured dopamine release from multiple sites in the striatum as induced by behavioral performance and reward-related stimuli, by direct stimulation, and by drug administration. We further developed algorithms to automate detection of dopamine. These algorithms could be used to track the effects of drugs on endogenous dopamine neurotransmission, as well as to evaluate the long-term performance of the chronically implanted sensors. Our chronic measurements demonstrate the feasibility of measuring subsecond dopamine release from deep brain circuits of awake, behaving primates in a longitudinally reproducible manner.

Preoperative Chemoradiotherapy in Locally Advanced Bulky Squamous Cell Carcinoma of the Uterine Cervix.

The aim of this study was to evaluate long-term survival and feasibility in patients with bulky squamous cell carcinoma of the uterine cervix who underwent surgery after concurrent chemoradiotherapy. A review of patients with locally advanced bulky squamous cell cervical cancer who underwent chemoradiation followed by surgery with pelvic lymphadenectomy was performed. Chemoradiotherapy included 2 monthly doses of intra-arterial chemotherapy with cisplatin (50 mg/m) and mitomycin C (10 mg/body) and external irradiation to the whole pelvis and high-dose-rate brachytherapy. From 2000 to 2006, 23 patients were enrolled in a single institution. Patient distribution according to the International Federation of Gynecology and Obstetrics stage was as follows: 9 stage IB2, 10 stage IIB, and 4 stage IIIB. Radiological lymph node involvement was present in 69.6% (16/23), including 2 cases of para-aortic lymph node swelling. The radiological response, pathological response, overall and disease-free survival, and late complications were assessed. Among the patients, 12 (52.2%) showed pathological complete response, and 11 (47.8%) showed a pathological partial response for cervical lesions. Among the cases of radiological pelvic lymph node swelling, the response rate was 93.3% (14/15). Only 1 case showed viable cancer cells in the resected pelvic lymph nodes among radiological complete response cases. In the median follow-up duration (121 months; range, 17-180 months), the 5-year overall survival and disease-free survival were 95.7% and 86.7%, respectively. Seven events in 4 patients led to the development of postoperative fistula formation requiring a rescue surgery. Chemoradiotherapy followed by surgery was effective for patients with bulky squamous cell carcinoma of the uterine cervix. Further investigation to select suitable patients for this multimodal treatment will be required.

Sleep-Related Painful Erections-A Case Series of 24 Patients Regarding Diagnostics and Treatment Options.

BackgroundPatients with sleep-related painful erections (SRPEs) have deep penile pain during nocturnal erection that wakes them up and disturbs their nights of sleep. This rare parasomnia is poorly recognized by general practitioners and by urologists and sexologists.AimTo gain more insight into diagnostics and therapeutic options.MethodsData from a series of 24 consecutive patients who presented with SRPEs at the outpatient clinic from 1996 to 2015 were retrospectively analyzed. Additional questionnaires were completed to complement data and to obtain information about follow-up. Long-term treatment efficacy of baclofen was assessed using the Wilcoxon signed rank test.OutcomesSRPEs were not associated with urologic, surgical, or psychiatric history or with serum testosterone levels. The mean doctors’ delay was 3.5 years. 14 of the 24 patients were treated with baclofen (10–75 mg). In 11 of them, complete remission was observed within a few weeks. 2 of the 3 remaining patients noticed a slight improvement of SPRE symptoms and only 1 patient experienced no effect at all. After an average follow-up of 4.5 years, only 41.6% of patients who had used baclofen were satisfied with their SRPEs. The others (58.4%) were dissatisfied, mostly owing to relapse of symptoms after the discontinuation of baclofen. Other treatment forms were applied sporadically, with strongly varying results.Clinical ImplicationsThis overview of SRPE contributes to a better clinical understanding and recognition of the phenomenon and provides new, more constructed advice about therapeutic implications, especially concerning the use of baclofen.Strengths and LimitationsThis study provides a systematic overview of a relatively large series of patients with SRPE, which provides substantiated treatment advice. However, treatment efficacy was based mainly on the patients’ subjective perception and it was not possible to compare the results of baclofen with other forms of pharmacologic treatment, because these alternative drugs were applied only sporadically. Nevertheless, this study is directional for future research.ConclusionsThis study confirmed a long doctors’ delay in patients with SRPE. There was no association between SRPEs and comorbidity and total serum testosterone levels. Treatment with baclofen proved successful and safe in the short term. Long-term feasibility needs further investigation.Vreugdenhil S, Weidenaar AC, de Jong IJ, van Driel MF. Sleep-Related Painful Erections—A Case Series of 24 Patients Regarding Diagnostics and Treatment Options. Sex Med 2017;5:e237–e243.

Should Banks Be Banned From Creating Money? An Analysis From the Perspective of Hierarchical Money

:We extend the concept of “hierarchy of money” to our current monetary and financial system based on fiat money, with monetary policy that is conducted through the sale and purchase of securities and credit intermediation by non-bank financial intermediaries. This exposes a feedback loop between the upper and lower level of the hierarchy, which allows for more than full use of otherwise dormant capital, but that also increases inherent instabilities manifested in asset booms and busts. From the perspective of hierarchical money, we find that the call to ban banks from creating money neglects the significant role of securities-based financing in the global financial markets at the lower level, as well as the money creation capacity of central banks at the highest level of the hierarchy. Moreover, the inherently expansive nature of the hierarchy of money contradicts the long-term feasibility of full-reserve banking.

Long-term safety of human retinal progenitor cell transplantation in retinitis pigmentosa patients

BackgroundRetinitis pigmentosa is a common genetic disease that causes retinal degeneration and blindness for which there is currently no curable treatment available. Vision preservation was observed in retinitis pigmentosa animal models after retinal stem cell transplantation. However, long-term safety studies and visual assessment have not been thoroughly tested in retinitis pigmentosa patients.MethodsIn our pre-clinical study, purified human fetal-derived retinal progenitor cells (RPCs) were transplanted into the diseased retina of Royal College of Surgeons (RCS) rats, a model of retinal degeneration. Based on these results, we conducted a phase I clinical trial to establish the safety and tolerability of transplantation of RPCs in eight patients with advanced retinitis pigmentosa. Patients were studied for 24 months.ResultsAfter RPC transplantation in RCS rats, we observed moderate recovery of vision and maintenance of the outer nuclear layer thickness. Most importantly, we did not find tumor formation or immune rejection. In the retinis pigmentosa patients given RPC injections, we also did not observe immunological rejection or tumorigenesis when immunosuppressive agents were not administered. We observed a significant improvement in visual acuity (P < 0.05) in five patients and an increase in retinal sensitivity of pupillary responses in three of the eight patients between 2 and 6 months after the transplant, but this improvement did not appear by 12 months.ConclusionOur study for the first time confirmed the long-term safety and feasibility of vision repair by stem cell therapy in patients blinded by retinitis pigmentosa.Trial registrationWHO Trial Registration, ChiCTR-TNRC-08000193. Retrospectively registered on 5 December 2008.

A high-rate sulfidogenic process based on elemental sulfur reduction: Cost-effectiveness evaluation and microbial community analysis

Biological sulfur reduction is an attractive technology for the treatment of metal-laden wastewater, but its efficiency and cost have been questioned due to the insolubility of sulfur. In this study, a laboratory-scale sulfur-reducing bioreactor was constructed to investigate the long-term feasibility of high-rate sulfur reduction. Our results show that 316±46mg S/L sulfide was produced within 3h, corresponding to a high sulfide production rate of 32±5mg S/L-h, significantly higher than those reported in sulfate-reducing systems. Sulfur reduction processes can significantly reduce the total operational cost compared to sulfate reduction processes. Moreover, long-term sulfur feeding significantly shaped the microbial communities. The predominance of sulfate-reducing genera (24.1%) diminished continuously during the 110days of operation, and sulfur reducers such as Geobacter and Clostridium became dominant at the end of experiment. All of these findings suggest that high-rate sulfur reduction processes driven by sulfur reducers can be a cost-effective alternative for metal-laden wastewater treatment.