Long-term Evaluation Research Articles

Long-term Evaluation of Machine Learning Based Methods for Air Emission Monitoring.

Machine learning (ML) techniques have been researched and used in various environmental monitoring applications. Few studies have reported the long-term evaluation of such applications. Discussions regarding the risks and regulatory frameworks of ML applications in environmental monitoring have been rare. We monitored the performance of six predictive models developed using ML and statistical methods for 28 months. The six models used to predict NOx emissions were developed using six different algorithms. The model developed with a moderate complexity algorithm, adaptive boosting, had the best performance in long-term monitoring, with a root mean square error (RMSE) of 0.48 kg/hr in the 28-month monitoring period, and passed two of the three relative accuracy test audits. High complexity models based on gradient boosting and neural network algorithms had the best training performance, with a minimum RMSE of 0.23 kg/hr and 0.26 kg/hr, but also had the worst RMSE scores, of 0.51 kg/hr and 0.57 kg/hr, during the monitoring period. In addition, all six models failed all three relative accuracy test audits. The following problems were observed: (1) Complex ML models tended to have overfitting problems, thus indicating the importance of the trade-off between model accuracy and complexity. (2) Model input sensor drift or out of high-frequency ranges from the training data resulted in inaccurate predictions or an accuracy lower than the minimum allowed by regulators. (3) Existing regulatory frameworks must be modernized to keep pace with current machine learning practices. Some statistical tests are unsuitable for applications developed by using ML methods.

Bridging the Gap: Addressing Educator and Caregiver Challenges in Transitioning Students with ASD to Higher Education and TVET - A Scoping Review

Students with Autism Spectrum Disorder (ASD) often struggle with communication and social skills, necessitating significant support from family, caregivers, and educators. In Malaysia, while Special Education Needs (SEN) students are typically integrated into general education during their school years, their presence in tertiary education or TVET remains underrepresented. This scoping review aims to identify and understand the challenges general educators and caregivers face in facilitating the transition of ASD students from higher education to tertiary education and TVET. A comprehensive analysis of literature from Scopus, ProQuest, and Science Direct databases, focusing on studies published between 2013 and 2023, was conducted. The findings reveal mixed experiences, highlighting significant difficulties and areas for improvement. General educators and caregivers report numerous challenges, including inadequate training, insufficient resources, and a lack of tailored support systems, which collectively hinder the smooth transition of ASD students into higher educational settings. It suggests that targeted interventions and increased collaboration between educators and caregivers can lead to more positive outcomes. This study provides original insights into the specific needs and barriers faced by ASD students in Malaysia, offering valuable implications for policymakers, educators, and caregivers to create more inclusive and effective educational transitions. Future research on transitioning students with ASD to higher education and TVET should focus on longitudinal studies to track long-term outcomes, the development and evaluation of targeted intervention programs, and the role of assistive technologies in the transition process.

Long-term evaluation of soil-based bioelectrochemical green roof systems for greywater treatment

Water scarcity has generated the need to identify new sources. Due to its low organic contaminant load, greywater reuse has emerged as a potential alternative. Moreover, the search for decentralized treatment systems in urban areas has prompted research on using green roofs for greywater treatment. However, the performance of organic matter removal is limited by the type of substrate and height of the growing media. Bioelectrochemical systems (BESs) improve treatment performance by providing an additional electron acceptor (the electrode). In this study, nine reactors under three different conditions, i.e., open circuit (OC), microbial fuel cell (MFC), and microbial electrolysis cell (MEC), were built to evaluate the treatment of synthetic greywater in a substrate-growing medium composed of perlite and coconut fiber and operated in batch-cycle mode for 397 days. The results suggested that using BESs enables greywater treatment and the removal of pollutants to levels that allow their reuse for irrigation. Furthermore, electrical conductivity was reduced from 732.4 ± 41.2 μS/cm2 in OC to 637.32 ± 22.73 μS/cm2 and 543.15 ± 19.69 μS/cm2 in MEC and MFC, respectively. The soluble chemical oxygen demand in the latter treatments reached 76% removal, compared to levels above the OC, which only reached approximately 67%. Microbial community analysis revealed differences, mainly in the cathodes, showing a higher development of Flavobacterium, Azospirillum, and Zoogloea in MFCs, which could explain the higher levels of organic matter removal in the other conditions, suggesting that the BES could produce an enrichment of beneficial bacterial groups for treatment. Therefore, implementing BESs in green roofs enables sustainable long-term greywater treatment.

The Effect of Local Papaverine Use in an Experimental High-Risk Colonic Anastomosis Model: Reduced Inflammatory Findings and Less Necrosis.

Objectives: To assess the impact of topical papaverine administration in complete and incomplete colonic anastomosis, by examining bursting pressure, hydroxyproline concentration, collagen content, inflammation levels, inflammatory cell infiltration, neoangiogenesis, and necrosis grades. Methods: We performed an experimental study on rats, in which they were divided into the following 4 groups of 16 subjects each. Group 1 [complete anastomosis (CA) without papaverine (CA -P) group], Group 2 [CA with papaverine (CA +P) group], Group 3 [incomplete anastomosis (ICA) without papaverine (ICA -P) group], and Group 4 [ICA with papaverine (ICA +P) group]. Results: The lymphocyte infiltration score of the ICA +P3 (day 3) group was significantly higher compared to the ICA -P3 group (p = 0.018). The median Ehrlich-Hunt score (p = 0.012), inflammation score (p = 0.026), and neutrophil infiltration score (p = 0.041) of the CA +P7 (day 7) group were significantly lower than the corresponding data of the CA -P7 group. Additionally, the necrosis score of the ICA +P7 group was significantly lower than that of the ICA -P7 group (p = 0.014). Conclusions: Data from the current study reveal that, although topical papaverine seems to suppress inflammation in anastomosis tissue and reduce necrosis at 7 days, definite conclusions regarding its impact on anastomotic leak cannot be drawn without further studies investigating anastomotic wound healing and anastomotic leak, preferably with both shorter- and longer-term evaluations.

The Efficacy of Eye Movement Desensitization and Reprocessing Treatment for Depression: A Meta-Analysis and Meta-Regression of Randomized Controlled Trials.

Background: Eye Movement Desensitization and Reprocessing (EMDR) therapy has gained attention for its potential effectiveness in treating depression beyond its initial use for PTSD. This systematic review and meta-analysis aims to evaluate the efficacy of EMDR in treating depression and to identify the variables influencing its effectiveness. Methods: A comprehensive search was conducted across databases, including MEDLINE, PubMed, and EMBASE, covering studies up to January 2023. A total of 521 studies were screened, and 25 studies with 1042 participants (522 EMDR, 520 control) met the inclusion criteria and were included in the meta-analysis. The inclusion criteria involved randomized controlled trials (RCTs) comparing EMDR to control conditions such as usual care or waitlist groups, with outcomes focused on changes in depression symptoms. Results: The results show that EMDR had a significant effect on reducing depression symptoms (Hedges' g = 0.75), with moderate heterogeneity being observed. The meta-regression indicated that the severity of depression was a significant predictor of EMDR's effectiveness, with greater effects in severe cases. Additionally, the systematic review analyzed and evaluated various theoretical models and related studies that explain how EMDR works for the treatment of depression, reporting on neurobiological models proposed in previous research. Conclusions: This study confirms that EMDR is effective in treating depression, particularly in severe cases, and highlights its potential as a non-pharmacological intervention. However, this study highlights the need for more standardized research and long-term evaluations to assess EMDR's lasting impact. Integrating EMDR into multimodal treatment plans and primary care, especially for treatment-resistant depression, could significantly improve patient outcomes.

A generic stochastic network-based formulation for production optimization of district heating systems

AbstractDistrict heating (DH) systems are an important component in the EU strategy to reach the emission goals, since they allow an efficient supply of heat while using the advantages of sector coupling between different energy carriers such as power, heat, gas and biomass. Most DH systems use several different types of units to produce heat for hundreds or thousands of households (e.g. natural gas-fired boilers, electric boilers, biomass-fired units, waste heat from industry, solar thermal units). Furthermore, combined heat and power units units are often included to use the synergy effects of excess heat from electricity production. To address the challenge of providing optimization tools for a vast variety of different system configurations, we propose a generic mixed-integer linear programming formulation for the operational production optimization in DH systems. The model is based on a network structure that can represent different system setups while the underlying model formulation stays the same. Therefore, the model can be used for most DH systems although they might use different combinations of technologies in different system layouts. The mathematical formulation is based on stochastic programming to account for the uncertainty of energy prices and production from non-dispatchable units such as waste heat and solar heat. Furthermore, the model is easily adaptable to different application cases in DH systems such as operational planning, bidding to electricity markets and long-term evaluation. We present results from three real cases in Denmark with different requirements.

Monobloc vs. Modular Radial-Head Arthroplasty for Complex Elbow Trauma: Long-Term Follow-Up and Comparative Evaluation.

Introduction: Mason Type 3 radial-head fractures are typically treated with open reduction and internal fixation (ORIF) or radial-head arthroplasty (RHA). Prosthetic options include traditional monobloc implants and newer modular implants designed to match patient anatomy. While short- and medium-term outcomes of metallic RHA are generally favorable, this study aims to compare the long-term outcomes of patients treated with monobloc versus modular implants. Methods: The medical records of all the patients who underwent RHA at a level I trauma center between 2000 and 2011 were retrospectively reviewed. Patients who were available for follow-up were invited for reassessment, which included physical examination, questionnaires for the assessment of elbow pain and function, and follow-up radiographs. Results: Out of 35 patients who had RHA, 13 (37%) had a monobloc prosthesis and 22 (63%) had a modular prosthesis. Out of the patients that could be traced, 4 patients from the monobloc group and 10 patients from the modular group agreed to participate in the study. The mean follow-up time was 15 years in the monobloc group and 12.4 years in the modular group. Patients in the modular group demonstrated superior functional outcomes compared to the monobloc group, with statistically significant improvements in MEPS and DASH scores and a non-significant trend towards better ASES scores and VAS scores. Physical examination revealed a decline in function in the operated arm for both groups, with statistically significant differences favoring the modular group in elbow flexion and extension. Radiographic analysis showed varying degrees of implant loosening, with the modular group exhibiting less loosening compared to the monobloc group. Mild degenerative changes and heterotopic ossification were also observed, predominantly in the modular group. Conclusions: The results suggest that modular implants offer superior functional outcomes compared to monobloc implants. The modular group showed statistically significant improvements in elbow flexion and extension. These findings indicate that modular implants may be a more favorable option for enhancing patient outcomes. Further research with larger sample sizes is recommended to confirm these trends and to better understand the long-term benefits of modular implants.

Long-term evaluation of the impact of urbanization on native and non-native fish assemblages

Long-term evaluation of the impact of urbanization on native and non-native fish assemblages

Long-Term Evaluation of Allopurinol Effectiveness in the Thai Population: Insights from 10 Years of Real-World Big Data Analysis

Objective: This study aimed to evaluate the effectiveness and safety profile of allopurinol in Songklanagarind hospital, Thailand. Material and Methods: Electronic medical records (EMRs) of patients having undergone allopurinol treatment for gouty arthritis, or other pertinent indications, were retrospectively reviewed. The primary outcome of this study was the longitudinal measurement of uric acid levels. A linear mixed model (LMM) analysis assessed the statistical significance of uric acid reduction across hospital visits. The safety profile regarding allopurinol-related adverse drug reactions was assessed.Results: A total of 11,277 EMRs were extracted, of which 8,801 EMRs were eligible for further analyses. These records pertain to a cohort of 3,219 unique patients whose visits were arranged chronologically from the earliest to the fifth recorded visit. Overall, uric acid level decreased after allopurinol treatment in all patients. Across subsequent visits, the analysis, using LMM, found a significant reduction in uric acid levels (χ²=1465.4, df=4, p-value<0.001), with the early reduction observed as early as the second visit. The incidence of allopurinol-related adverse reactions was 4.37% (385/8801 cases). Conclusion: The current dosing regimen of allopurinol at Songklanagarind Hospital has demonstrated favorable treatment outcomes and continues to be effective. This data provides insights into pharmacological management and its real-world outcomes.

Quality of life of women with a screen-detected versus clinically detected breast cancer in the Netherlands: a prospective cohort study.

Breast cancer (BC) screening enables early detection of BC, which may lead to improved quality of life (QoL). We aim to compare QoL between women with a screen-detected and clinically detected BC in the Netherlands. We used data from the 'Utrecht cohort for Multiple BREast cancer intervention studies and Long-term evaluation' (UMBRELLA) between October 2013 and March 2022. Patients were categorized as screen-detected or clinically detected. We analysed three questionnaires, namely EORTC QLQ C-30, BR23, and HADS (Hospital Anxiety and Depression Scale) completed by BC patients shortly after diagnosis (T1) and one-year after treatment (T2). Independent t-tests were performed to compare QoL average differences between the two groups. Bonferroni-corrected p-value significance threshold of 0.00057 was used. The magnitude of differences was calculated using Cohen's d. The clinical relevance of QLQ-C30 differences was assessed based on interpretation guideline of EORTC-QLQ-C30 results. After applying inclusion and exclusion criteria, there were 691 women with screen-detected BC and 480 with clinically detected BC. Generally, screen-detected BC patients reported a better QoL. At T1, their average QLQ-C30 summary score was higher (86.1) than clinically detected BC patients (83.0) (p < 0.0001). Cohen's d for all items ranged between 0.00 and 0.39. A few QLQ-C30 score differences were clinically relevant, indicating better outcomes in emotional functioning, general health, constipation, and fatigue for women with screen-detected BC. In the Netherlands, women with screen-detected BC reported statistically significant and better QoL than women with clinically detected BC. However, clinical relevance of the differences is limited.

Long-term stability of a PTW 34070 large-area parallel ionization chamber in clinical proton scanning beams.

In the modeling of beam data for proton therapy planning systems, absolute dose measurements are performed utilizing a Bragg peak chamber (BPC), which is a parallel-plate ionization chamber. The long-term stability of the BPC is crucial for ensuring accurate absolute dose measurement. The study aims to assess the long-term stability of the BPC in clinical proton pencil beam scanning delivery. The long-term stability evaluation focused on the BPC-Type 34070 (PTW Freiburg, Germany), utilizing clinical proton scanning beams from December 2022 to November 2023. Monthly investigations were conducted to evaluate the response and cross-calibration factor of the BPC and a reference chamber, employing the spread-out Bragg peak (SOBP) field. Additionally, assessments were made regarding the BPC's response to monoenergetic beams, along with an examination of the impact of polarity and ion recombination on the BPC. The response and cross-calibration factor of the BPC varied up to 1.9% and 1.8%, respectively, while the response of the reference chamber remained within a 0.5% range. The BPC's response to the mono-energetic beams varied up to 2.0% across all energies, demonstrating similar variation trends in both the SOBP field and mono-energetic beams. Furthermore, the variations in polarity and ion recombination effect remained stable within a 0.4% range throughout the year. Notably, the reproducibility of the BPC remained high for each measurement conducted, whether for the SOBP field or mono-energetic beams, with a maximum deviation observed at 0.1%. The response and cross-calibration factor of the BPC demonstrated significant variations, with maximum changes of 1.9% and 1.8%, respectively. However, the reproducibility of the BPC remained consistently high for each measurement. It is recommended that when conducting absolute dose measurements using a BPC, its response should be compared and corrected against the reference chamber for each measurement.

A thermophysical mechanism exploration of the brain: Motor cortex modeling with canonical ensemble theory

The brain, recognized as one of the most intricate systems globally, has been a focal point for scientific exploration. Researchers have made efforts to construct models of the brain based on neural dynamics and complex networks to gain insights into its workings. It is crucial to investigate the brain's working principles from various perspectives. This study presents a novel thermophysical model of the motor cortex and examines its potential thermodynamic properties. Utilizing canonical ensemble theory, we constructed the thermophysical model using spike and local field potential (LFP) signals obtained from intracortical brain-machine-interfaces (iBMIs) in two monkeys. The parameters derived from this model—namely internal energy, free energy, and entropy—were employed to assess the thermodynamic properties and observe alterations in these properties during reaching and grasping movements. Furthermore, this proposed model was applied to movement pattern decoding, highlighting its potential in neural decoding tasks. In both LFP- and spike-based thermodynamic models, there was an increase in internal energy and free energy, coupled with a decrease in entropy when the motor cortex was activated across various movement tasks. This suggests that the neural system adheres to the principles of a thermophysical system. Notably, the thermodynamic features demonstrated superior performance in decoding movement intentions compared to traditional LFP and spike features. This study represents the first construction of a comprehensive thermodynamic model of the motor cortex based on LFP and spike signals. The model exhibits remarkable stationarity and holds promise for long-term and stable evaluations of motor cortex functions.

Comprehensive decision-making considerations in the transition to electrification transportation system in a developing country

Introducing suitable alternatives to the existing fossil fuels can provide insightful aspects of the expected benefits. In the energy sector, the transportation system is one of the key contributors to fossil fuel consumption and greenhouse gas productions. To elaborate on the performance of each introduced alternative, two perspectives are considered; short-term and long-term evaluations. In the short outlook, the PROMETHEE method is used for evaluation. Six scenarios are introduced based on the technical, economic, social, and policy criteria and each scenario benefits from different weights. In this scheme, the impacts of evolutions in the battery applications in the vehicles are investigated. Based on the short-term study, CNG and gasoline are considered the best options for the fuels of vehicles in Iran by taking into consideration the current situation. By viewing the technical and economic criteria, it was concluded that the Li-Ion battery provides better performance in comparison with gasoline in the long run. By 2040, the number of EVs will reach 10% of the overall vehicle production. It is obtained that the benefits of the electrical vehicles’ presence as the alternative to the internal combustion vehicles can provide growing interest in this outlook from 2.02 × 106 US$ in 2025 to 17.55 × 108 US$ in 2040.

Gamma irradiation pilot project: Enhancing food safety and export quality in Indonesia

This study aims to evaluate the feasibility of establishing a gamma irradiator pilot project in Indonesia to reduce food loss and food waste, as well as to enhance the value of export commodities. Gamma irradiators have the potential to extend shelf life, improve food safety, and reduce losses during distribution and storage. The research methodology involves weighting to assess the feasibility of location selection, incorporating secondary data analysis and economic value-added analysis. The results indicate that the PUSPIPTEK Serpong location meets all mandatory criteria and nearly all non-mandatory criteria, making it a suitable site for this pilot project. The operation of the gamma irradiator in Serpong has successfully increased the volume of irradiation services, though its utilization is predominantly for export purposes. The main challenges include a negative public perception of irradiated food and a lack of education on its benefits. This study concludes that gamma irradiators are effective in reducing food loss and food waste, as well as increasing the value-added of export commodities. Strong government support and continuous education programs are necessary to improve public acceptance. Future research could focus on long-term evaluations of the impact of gamma irradiators and the development of more effective educational programs.

Preserving Cultural Heritage: Enhancing Limestone Durability with Nano-TiO2 Coating

External and internal microclimatic conditions, biodeterioration, anthropogenic factors, etc, influence the natural stone support for artifacts and built heritage. Based on this fact, the present study explores the effectiveness of nano-TiO2 in preserving and enhancing the durability of natural stone used in the façades of heritage buildings, focusing on the Markovits-Mathéser House in Oradea Municipality, Romania. The investigation involved treating rock samples (fossiliferous limestone) with 2% and 5% nano-TiO2 solutions and subjecting them to simulated extreme climatic conditions for the analyzed area in a controlled climatic chamber for six months. The treated samples demonstrated a significantly higher compressive strength than untreated benchmarks. SEM analyses confirmed that nano-TiO2 formed a protective layer, filling micro-cracks and pores, thereby enhancing the stone’s resistance to environmental stressors. The study also found that the nanoparticle coating maintained its integrity under extreme temperature and humidity variations, with only a slight decrease in surface coverage. These findings suggest that nano-TiO2 coatings significantly improve heritage building materials’ mechanical properties and longevity. However, the study highlights the importance of careful application and long-term evaluation to ensure environmental and health safety. Overall, nano-TiO2 presents a promising solution for the conservation of cultural heritage, offering enhanced durability and protection against climatic and environmental challenges. Further research is recommended to optimize application workflow and formulations for broader and more effective use in heritage conservation.

Pesticides trapping performance of vegetative filter strips in black soil region, Northeast China: controlled experiments and VFSMOD-W modeling

The Northeast black soil region in China is an important grain-producing area where various pesticides are extensively used to increase grain yields. However, this practice poses serious risks to the ecological health of soil and water systems, necessitating effective measures. Vegetative filter strips (VFS) are commonly used to mitigate agricultural diffuse pollutants, but their efficiency varies across different regions, requiring assessment. This study employed flume experiments, the VFSMOD-W model, and redundancy analysis (RDA) to evaluate the efficacy of VFS in runoff, sediment, and pesticide removal, as well as influencing factors. The results showed that VFS reduced outflow rate of runoff by 8 %–64 % and sediment by approximately 90 %, achieving load removal rates of 61 % and 95 % respectively. Pesticide load removal efficiency ranged from 37 % to 94 %, with higher efficiency for adsorbed pesticides like chlorpyrifos compared to water-soluble ones like atrazine. Interflow and vertical seepage were significant pathways for pesticide transport in VFS, with chlorpyrifos concentrations at 4 %–26 % and atrazine at 20 %–37 % of inflow concentrations. The VFSMOD-W model accurately predicted VFS efficiency (NSE > 0.90), and RDA results indicated that environmental factors could explain 86.7 % of the variation in VFS performance, with soil vertical saturated hydraulic conductivity (VKS) being the most influential factor, followed by rainfall intensity (T), saturated soil water content (OS), initial soil water content (OI), and filter slope for each segment (SOA). Optimizing soil moisture characteristic factors and increasing infiltration are crucial for VFS performance. Applying VFSMOD-W for precise VFS design can help reduce construction costs. In the future, long-term field monitoring and evaluation of VFS efficiency after implementation should be conducted in the black soil region of Northeast China to provide data supporting the improvement of VFSMOD-W simulation accuracy. This will also offer recommendations for the government in formulating VFS configuration schemes.

Supra-Annular Self-Expanding Versus Balloon-Expandable Valves for Valve-in-Valve Transcatheter Aortic Valve Replacement

Self-expanding (SE) and balloon-expandable (BE) transcatheter heart valves (THVs) have not been extensively studied in valve-in-valve transcatheter aortic valve replacement (ViV-TAVR). We compared outcomes of supra-annular SE and BE THVs used for ViV-TAVR via a retrospective analysis of institutional data (2013-2023) including all patients undergoing ViV-TAVR (TAVR in previous surgical AVR). Unmatched and propensity-matched (1:1) comparisons of clinical and echocardiographic outcomes were undertaken between SE and BE THV along with Kaplan-Meier survival analysis. A total of 315 patients undergoing ViV-TAVR were included of which 73% received a SE THV. Median age was 77 years and women comprised 42.5% of the population. Propensity-score matching (1:1) yielded 81 matched pairs. Implanted aortic valve size was comparable between the groups (23 mm [23-26] vs. 23mm [23-26], p=0.457). At 30 days following ViV-TAVR, the SE group had a lower mean aortic valve gradient (14 mmHg [11-18] vs. 17.5 mmHg [13-25], p=0.007). A higher number of BE patients had severe prosthesis-patient mismatch (PPM) (16% vs. 6.2%, p=0.04). At one-year follow-up, the SE group had a lower aortic valve gradient (14.0 mmHg [9.6-19] vs. 17 mmHg [13-25], p=0.04) compared to the BE group. 30-day mortality was 2.7% while one-year mortality was 7.5% and comparable between the groups. Survival and stroke incidence were similar in both groups up to 5 years. In conclusion, both SE and BE THVs had comparable survival following ViV-TAVR. The higher residual aortic valve gradients in BE THVs are likely due to valve design and warrant long-term evaluation for potential structural valve degeneration.

Long-Term Evaluation of Patients with Neurotrophic Keratopathy Undergoing Staged Keratoplasty After Corneal Neurotization

Purpose Corneal neurotization (CN) is a novel, potentially curative surgical procedure for the treatment of neurothophic keratopathy (NK). Patients with severe NK can present with corneal opacification requiring optical keratoplasty, which would likely fail without a proper trophic support of corneal nerves in the recipient cornea. Methods This is a pilot study on 4 patients undergoing keratoplasty after CN. Pre- and postoperative data at 12, 24 months and at the last follow-up were collected for the examination of (i) best corrected visual acuity (BCVA), (ii) slit lamp examination and photograph acquisition with and without fluorescein staining, (iii) corneal aesthesiometry, (iv) in vivo confocal microscopy of the central cornea. Neurophysiological study of the corneal reflex before corneal graft and at last follow up was performed. Results Four female patients (47.25 ± 5.06 y.o.) underwent keratoplasty after CN (3 penetrating keratoplasty, 1 deep anterior lamellar keratoplasty). The mean interval between CN and keratoplasty was 22 (± 12) months. The mean graft survival time was 42 (± 25) months. Graft follow-up ranged from 72 to 132 months. At the final follow-up, BCVA was improved in 2 out of 4 patients. The mean corneal sensitivity was 11.9 ± 8.3 mm at last follow-up. In vivo confocal microscopy confirmed the presence of functioning nerves at the last follow-up in all patients. NK-related complications occurred in 3 eyes (2 persistent epithelial defect, 1 corneal melting). The former complication was successfully treated by autologous serum eye drops while the latter required repeated keratoplasty. Conclusions Keratoplasty is a viable strategy to improve visual acuity in patients with corneal opacity who underwent CN for the treatment of NK. Even in the presence of functioning corneal nerves before keratoplasty, surgeons should be aware of the increased rate of NK-related complications that could require the need for repeated procedure.

Biological, Antifungal, and Physical Efficacy of a Denture Cleanser Formulated with Cnidium officinale Extracts.

We aimed to assess the antifungal efficacy and impact of a denture cleanser containing Cnidium officinale extract on the surface characteristics of denture base materials, as well as its physical and biological properties. The experimental denture cleansers were formulated with C. officinale at concentrations of 100 and 150 μg/mL, combined with 1% cocamidopropyl betaine as a natural surfactant. Antifungal efficacy was evaluated using zone-of-inhibition assays against Candida albicans, revealing inhibition zones of 20 ± 1.8 mm for the 100 μg/mL concentration and 23.6 ± 1.6 mm for the 150 μg/mL concentration. Surface property assessments-including hardness, roughness, color stability, and solubility measurements-demonstrated no significant differences compared to the control group. Biological evaluations included the quantification of polyphenol and flavonoid content. The C. officinale-based cleanser showed significant antifungal activity without affecting the hardness, roughness, color stability, or solubility of denture base materials. Biological tests revealed no cytotoxicity and minimal mucosal irritation. Polyphenol and flavonoid contents were quantitatively measured, revealing higher concentrations in the experimental groups, which were correlated with significant antifungal activity. These compounds are known for their roles in disrupting microbial processes and enhancing antimicrobial effects. These findings suggest that the C. officinale-based denture cleanser effectively inhibits C. albicans while preserving the physical properties of denture base materials. This study highlights the potential of C. officinale in denture cleanser formulations, promoting denture hygiene and oral health. Future research should prioritize long-term clinical evaluations and formulation optimization.

Strategy to Improve the Quality of Madrasah Education Through Madrasah Diniyah (Madin) in Min 16 Bener Meriah Aceh

The purpose of this study was to determine the concept of organizing Madrasah Diniyah (Madin) Min 16 in Aceh. The concept of Madrasah Diniyah (MADIN) at MIN 16 Bener Meriah has the following characteristics: focusing on customers, both internal and external customers, having a high obsession with quality, using a scientific approach in decision making and problem solving, having a long-term commitment, requiring teamwork, continuous process improvement, providing education and training, providing controlled freedom, unity of purpose, and involving and empowering human resources. Meanwhile, the implementation of Integrated Quality Improvement Management in Madrasah includes Quality Strategy Planning (vision, mission, objectives, long-term institutional strategy, monitoring and evaluation), improving process quality (curriculum and learning process), improving the quality of Human Resources. Resources (HR), improving environmental quality, improving service quality, improving output quality