Low-cost Treatment Research Articles

A cost-utility analysis of single maintenance and reliever (SMART) therapy as compared to step 3 fixed-dose therapy in patients aged 12 years or more with uncontrolled asthma.

A significant percentage of patients with asthma appear to benefit from the addition of long-acting β2-agonists (LABAs) to ICS to achieve better control of their disease. The aim of the present study was to determine the cost-utility of single inhaler combination inhaled ICS/LABAs as both maintenance and reliever (SMART) versus remaining at the same treatment step with fixed-dose ICS-LABA maintenance with a short-acting β2-agonist (SABA) as reliever in patients aged 12 years or more with uncontrolled asthma. A Markov-type model was developed to estimate the costs and health outcomes of a simulated cohort of patients aged 12 years or more with uncontrolled asthma treated for 12 months. The effectiveness data and transition probabilities were obtained from a recent meta-analysis. Cost data were obtained from official databases provided by the Colombian Ministry of Health. The main outcome was the variable "quality-adjusted life-years" (QALYs). The base-case analysis showed that compared with remaining at the same GINA treatment step with ICS/LABA maintenance plus SABA reliever, ICS/LABAs as SMART was associated with lower costs, US$2,906.92 versus $4,462.02 average cost per patient, and the greatest gain in QALYs, 0.8540 versus 0.8258 QALYs on average per patient, thus leading to dominance. Compared with remaining at the same GINA treatment step with ICS/LABA maintenance plus SABA reliever, ICS/LABAs as SMART is more cost-effective in patients aged 12 years or more with uncontrolled asthma. This is because ICS/LABAs as SMART showed a greater gain in QALYs at lower total treatment costs.

The implications of vibration and sound therapy in modern medicine: A literary review

The following literary review studies the overall science behind vibration-based medicine and healing techniques. Specifically, the effects that 432 hertz has on the body as well as the implications of such healing techniques in western medicine and hospitals. Through studies and literature on the use of sound/music in ancient healing techniques, it is found that sound frequencies (different hertz. levels) can be a healing technique in modern medicine as well. This literary review was found using a multitude of articles and novels on the background of sound therapy, various mediums of implementation, as well as studies on the specific effects on the human body - neurologically and physically. There were 19 articles found through research and 14 were used. The major key words used were frequency healing, modern medicine, sound therapy, 432 hertz neurological impacts, and healing medicine. After reading abstracts of various articles and gathering background information, a culmination of authors’ analysis and studies were used to make a nuanced argument on the implementation of sound therapy in the modern medical industry. After analyzing the data gathered, it was found that there is a direct correlation between frequencies and their ability to help treat diseases throughout the body. Moreover, there were clear links between specific frequencies and how they can be applied to different areas to even diagnose diseases years before current technology can. Building upon that, this healing technique is very versatile in that it can be used for a multitude of problems ranging from physical pain to sleep insomnia to cardiovascular diseases. Furthermore, the research found can be integrated into the western healthcare sector to provide easier, low-cost, and low resource treatment that is effective for all.

Removal of Nitrogen, Phosphorus, Organic Matter, and Heavy Metals from Pig-Farming Wastewater Using a Microalgae-Bacteria Consortium.

Wastewater generated by the pork industry urgently requires the implementation of low-cost, high-benefit, and efficient treatment systems. Accordingly, a microalgae-bacteria consortia-based treatment system is proposed for the removal of contaminants released, by the pork-producing industry, in swine wastewater. In this study, different inoculum concentrations of the microalgae-bacteria consortium were tested to document variation in the removal of nutrients from the wastewater. At varying concentrations, it was efficient and did not present a significant difference in the removal kinetics. The treatment with the greatest amount of inoculum removed close to 87% of total nitrogen, approximately 70% of orthophosphate, and 77% of chemical oxygen demand. Removals of 84% iron, 44% copper, and 48% manganese were also obtained. These results demonstrate that microalgae-bacteria consortia are an economically viable and environmentally desirable option for the efficient treatment of wastewater from the pork industry.

Innovative strategy for the treatment of oily wastewater by in-situ synthesis of nitrogen-doped biochar supported FeS for activation of peroxymonosulfate

ABSTRACT Disposing of oily wastewater poses a significant challenge in treating oilfield-produced wastewater treatment. This study developed a FeSNC-9/PMS system for the effective degradation of total petroleum hydrocarbons (TPHs) in oily wastewater, while increasing the value of excess sludge, thus achieving the dual purpose of waste treatment. This work involved the in-situ preparation of a porous nitrogen-doped biochar-supported iron sulphide catalyst material using surplus sludge from SBR. Compared to undoped FeS (NC-9), FeSNC-9 exhibited excellent pore structure and abundant functional groups. Fe-Nx served as an effective connecting site between FeS species and the graphite network of biochar. The FeSNC-9/PMS system significantly degraded 74.21% of TPHs within 300 min. The FeSNC-9/PMS system demonstrated remarkable TPHs degradation efficiency across a wide temperature range and under both weak acidity and near-neutral conditions The dominant reactive oxygen species were identified as SO4 •− and •OH, with O2 •− and 1O2 also confirmed as active species. Gas chromatography semi-quantitative analysis showed that the long-chain alkanes of C20-C30 in total petroleum hydrocarbons were significantly degraded into short-chain alkanes or completely mineralized. This work provides new insights for the low-cost and high-efficiency treatment of TPHs in oilfield-produced water, and delves into the activation mechanism of PMS and the degradation pathways of TPHs.

A personalised and systematically designed adherence intervention improves photoprotection in adults with Xeroderma Pigmentosum (XP): Results of the XPAND randomised controlled trial.

Poor adherence to photoprotection in Xeroderma Pigmentosum (XP) increases morbidity and shortens lifespan due to skin cancers. To test a highly personalised intervention (XPAND) to reduce the dose of ultraviolet radiation (UVR) reaching the face in adults with XP, designed using known psychosocial determinants of poor photoprotection. A two-arm parallel group randomised controlled trial, including patients with sub-optimal photoprotection to receive XPAND or a delayed intervention control arm that received XPAND the following year. XPAND comprises seven one-to-one sessions targeting photoprotection barriers (e.g., misconceptions about UVR) supported by personalised text messages, activity sheets, and educational materials incorporating behaviour change techniques. The primary outcome, mean daily UVR dose-to-face across 21 days in June-July 2018, was calculated by combining UVR exposure at the wrist with a face photoprotection activity diary. Secondary outcomes were UVR dose-to-face across 21 days in August 2018, time spent outside, photoprotective measures used outside, mood, automaticity, confidence-to-photoprotect. Financial costs and quality-adjusted life years (QALYs) were calculated. 16 patients were randomised, 13 provided sufficient data for primary outcome analysis. The XPAND group (n=8) had lower mean daily UVR dose-to-face [0.03 SED (SD 0.02] compared to control (n=7) [0.36 SED (SD 0.16)] (adjusted difference=-0.25, p<0.001, Hedge's g=2.2). No significant between-group differences were observed in time spent outside, photoprotection outside, mood, or confidence. The delayed intervention control showed improvements in UVR dose-to-face (adjusted difference=-0.05, Hedge's g=-0.1) , time outside (adjusted difference=-69.9, Hedge's g=-0.28), and photoprotection (adjusted difference=-0.23, Hedge's g=0.45), after receiving XPAND. XPAND was associated with lower treatment costs (£-2642; 95% CI: -£8715 to £3873) and fewer QALYs (-0.0141; 95% CI: -0.0369 to 0.0028). XPAND was associated with a lower UVR dose-to-face in XP patients and was cost-effective.

Ultrasound stimulation of the vagus nerve as a treatment modality for anxiety.

Anxiety is an increasingly prevalent mental disorder, causing widespread hardship and interfering with society's economic progression. Standard treatments include various talk therapies with poor prognoses or drug interventions with complex side effects, both introducing unnecessary burdens to patients. To remedy this, non-invasive ultrasound stimulation to the vagus nerve is a novel, low-cost treatment that is showing promise. Although vagus nerve stimulation is already approved for epilepsy and other conditions, it requires regular maintenance. In contrast, studies using non-invasive ultrasound stimulation have shown preliminary positive results in affecting vagal activity with minimal drawbacks. This review covers a variety of studies investigating the effects of ultrasound stimulation on the vagus nerve. With rising levels of anxiety with each generation, there is a pressing need for more innovative and diverse treatments with fewer costs and more benefits.

Enhanced textile wastewater remediation in Phragmites karka-based vertical flow constructed wetlands using Phragmites-derived biochar

Vertical flow-constructed wetlands (VFCWs) are treatment systems that can be used for the phytoremediation of highly polluted textile wastewater. Using plant-derived biochar to simultaneously improve the contaminant removal performance of CWs and sustainable utilization of harvested plant biomass is an interesting proposition. The present study explored the phytoremediation potential of Phragmites karka and verified the impact of using P. karka-derived biochar as a substrate in VFCWs for the treatment of textile wastewater. For this, three types of VFCWs were designed; (i) non-vegetated (VFCW), (ii) vegetated with P. karka (VFCW–P), and (iii) vegetated with P. karka and amended with P. karka-derived biochar (VFCW-BP) and semi-batch experiments were conducted. The investigation confirmed that wetlands using biochar as substrate were more efficient than other wetlands in pollutant load reduction. The maximum pollutant removal efficiencies were recorded for VFCW-BP vis-à-vis COD (83.61%), color (77.87%), chloride (73.22%), calcium (73.52%), sodium (67.18%), and potassium (75.72%) after five days. Furthermore, biochar addition enhanced the growth conditions for wetland plants by alleviating osmotic and oxidative stresses and hence helped them to perform better while removing pollutants. The maximum reduction of various pollutant parameters was reached within 72 h, after which remediation efficiency was slowed down. The study suggests that VFCW with biochar amendment is a useful strategy for textile wastewater treatment. Because the experimental design satisfies the needs for low-cost wastewater treatment, it may find widespread applications.

Efficient and Sustainable Removal of Linear Alkylbenzene Sulfonate in a Membrane Biofilm: Oxygen Supply Dosage Impacts Mineralization Pathway

Linear alkylbenzene sulfonate (LAS) can be thoroughly mineralized within sufficient oxygen (O2), but which is energy intensive and may causes serious foaming problem. Although cometabolism can achieve efficient LAS removal within a wide range of O2 dosages, how O2 dosage systematically affects LAS metabolic pathway is still unclear. Here, membrane aerated biofilm reactor (MABR) enabled accurate O2 delivery and bulk dissolved oxygen (DO) control. MABR achieved efficient removal of LAS (> 96.4%), nitrate (> 97.8%) and total nitrogen (> 96.2%) at the three target DO conditions. At high DO condition (0.6 mg/L), LAS was efficiently removed by aerobic mineralization (predominant) coupled with aerobic denitrification biodegradation with the related functional enzymes. Pseudomonas, Flavobacterium, Hydrogenophaga, and Pseudoxanthomonas were dominant genus contributing to four possible LAS aerobic metabolic pathways. As O2 dosage reduced to only 29.7% of the demand for LAS mineralization, O2 facilitated LAS activation, benzene-ring cleavage and a portion of respiration. NO- 3-N respiration-induced anaerobic denitrification also contributed to ring-opening and organics mineralization. Desulfomicrobium and Desulfonema related two possible anaerobic metabolic pathways also contributed to LAS removal. The findings provide a promising strategy for achieving low-cost high LAS-containing greywater treatment.

Single inhaler combination inhaled corticosteroid–formoterol as both maintenance and reliever (SMART) compared with a step up of treatment with fixed-dose inhaled corticosteroid–long-acting β2-agonist maintenance with a short-acting β2-agonist as reliever in adolescents and adults with poorly controlled asthma in Colombia: a cost-utility analysis

Objective The aim of the present study was to determine the cost-utility of single inhaler combination inhaled corticosteroid and a long-acting β2-agonist (ICS/LABAs) as both maintenance and reliever (SMART) compared with a step-up maintenance treatment with a fixed medium to high dose of ICS combined with LABA and a short-acting β2-agonist (SABA) as reliever (ICS-LABA maintenance plus SABA) among patients aged 12 years or more with poorly controlled asthma in Colombia. Methods A Markov-type model was developed to estimate the costs and health outcomes of a simulated cohort of patients aged 12 years or more with uncontrolled asthma treated for 12 months. The main effectiveness data were obtained from a recent meta-analysis. The main outcome was the variable ‘‘quality-adjusted life-years’’ (QALYs). Results The base-case analysis showed that the budesonide/formoterol (BUD/FORM) SMART strategy was associated with lower overall treatment costs (US $3,062.37 vs. $4,462.02 average cost per patient over 12 months) and the greatest gain in QALYs (0.8511 vs. 0.8258 QALYs on average per patient over 12 months) compared with ICS-LABA maintenance plus SABA at step 4, thus leading to dominance. Conclusions In patients aged 12 years or more with uncontrolled asthma at GINA step 3 or 4, the BUD/FORM SMART strategy at either step 3 or 4 is cost-effective compared with the ICS-LABA maintenance plus SABA at step 4 strategy, because it shows a greater gain in QALYs at lower total treatment costs.

Treatment of acromioclavicular joint dislocation with looped steel plate and clavicular hook steel plate: recent therapeutic observation.

To compare the clinical efficacy of Endobutton-looped steel plate and clavicular hook steel plate in the treatment of acromioclavicular joint dislocation. The retrospective case-control study was conducted at the Baoding Forensic Hospital, Hebei University, China and comprised data from January 2022 to June 2023 of adult inpatients of either gender with acromioclavicular joint dislocation. The data was divided into intervention group A and control group B. Group A patients had been treated with Endobutton-looped steel plate, while those in group B had been treated using clavicular hook steel plate. Clinical efficacy, clinical indicators, Karlsson score for shoulder joint function, range of motion of the shoulder, and complications during 6-month follow-up were compared between the groups. Data was analysed using SPSS 26. Of the 50 patients, there were 25(50%) in group A; 15(60%) males and 10(40%) females with mean age 37.75±6.24 years (range: 19-58 years) and mean dislocation-to-visit time 2.52±0.61 days (range: 0-7 days). There were 25(50%) patients in group B; 16(64%) males and 9(36%) females with mean age 38.24±6.30 years (range: 18- 59 years) and mean dislocation-to-visit time 2.47±0.58 days (range: 0-6 days). The groups showed no significant differences (p>0.05). Clinical efficacy of group A was higher than that of group B (p<0.05). Group A showed shorter surgical duration and incisional length, and lower average treatment cost compared to group B(p<0.05). The shoulder joint function in group A was significantly better than group B (p<0.05). Post-treatment, the range of motion of abduction, external rotation and internal rotation in group A were superior to group B (p<0.05). Complications in the two groups showed no significant difference (p>0.05). Compared to clavicular hook steel plate, Endobutton-looped steel plate presented higher clinical efficacy, shorter surgical duration, smaller incision and lower treatment cost, which promoted the recovery of shoulder joint function and contributed to high therapeutic safety.

Synergistic cotreatment of cooling tower blowdown and produced waters: Techno-economic, sustainability, and optimization systems analyses

A blowdown and produced water cotreatment train design was preliminarily simulated to explore water-energy nexus synergy. This process model was able to provide results concerning water compositions, chemical demand, and energy intensity. The computational expense associated with this simulation made it intractable to use within optimization algorithms for further informative, comprehensive systems analyses. This work details the efforts of developing a framework suitable for the optimization of computationally demanding wastewater treatment train simulations, specifically demonstrated for the cotreatment train’s process, economic, and sustainability models. The unique challenges of the cotreatment train model motivated a modified surrogate optimization methodology to be developed. Using this framework, worst and best case economic scenarios were optimized to minimize the levelized cost of water (LCOW) employed in a reduced-order model-based simulation. Applying the optimal designs obtained from the surrogate optimization into the original comprehensive simulation resulted in an expected range of LCOW from $2.01 to $4.43m-3. Other established techno-economic and sustainability indicators further inform on process implications. The process was compared to current management practices of blowdown water treatment and produced water injection to discuss the advantages and disadvantages of the proposed cotreatment train designed for water reuse. The cotreatment process was estimated to have lower levelized treatment costs but require more chemicals and energy to manage a higher salinity wastewater than pure blowdown water alone. If sustainable management goals motivate produced water remediation, the cotreatment process can be beneficial for the broader scope of water management.

Regeneration of conventional and emerging PFAS-selective anion exchange resins used to treat PFAS-contaminated waters

Anion exchange resins (AERs) have emerged as a promising separation technology to remediate PFAS-contaminated waters due to their improved selectivities and capacities in comparison to legacy activated carbon adsorbents. Presently, site managers choose between AER systems employing resins defined as being ‘regenerable’ with relatively low PFAS selectivity, and PFAS-selective resins that are marketed as ‘single-use’ media intended for disposal upon PFAS breakthrough. However, the potential for these highly-selective adsorbents to be regenerated and/or reused remains poorly characterized. This study presents a comprehensive evaluation of the efficacy of various regenerant solution constituents, mixtures, and operational considerations on the regenerability of both ‘regenerable’ and ‘PFAS-selective’ AERs that were loaded during a pilot treatment study of PFAS-contaminated groundwater. Batch screening of regenerant solution constituents found that both classes of resins may be effectively regenerated using combinations of salt brine and organic cosolvent, with high cosolvent fractions being necessary for PFAS-selective AERs. While neither brine-only nor solvent-only regenerant solutions led to effective PFAS desorption, the efficacy of regeneration with brine/cosolvent mixtures varied with salt type and cosolvent composition. Chloride salts outperformed sulfate and bicarbonate salts, cosolvent efficacy depended on the volume fraction and type used, and highly non-polar solutions led to optimal PFAS desorption. Continuous-flow regeneration experiments showed near-complete PFAS desorption from regenerable AERs using 10 bed volumes (BVs) of 70 % methanolic brine solutions, whereas PFAS-selective resins required more bed volumes (30) of brines with higher methanol content (90 %) or a more hydrophobic cosolvent (n-propanol); increasing regenerant empty-bed contact time had minimal effect on PFAS desorption. > 90 % methanol recovery from the resulting waste regenerant mixtures was accomplished with negligible PFAS contamination using distillation, leaving a minimal volume of a PFAS-concentrated still bottoms waste that may be further treated for PFAS destruction. Life cycle analyses revealed that groundwater treatment using PFAS-selective AERs operated in a regenerable mode have lower environmental impacts and costs than systems using conventional regenerable AERs, and lower treatment costs than systems operated using PFAS-selective resins in a single-use mode. Although counterintuitive, these findings stem from the fact that higher cosolvent requirements for regeneration of PFAS-selective resins lead to greater internal recycling of regenerant solutions and much lower volumes of residual waste still bottoms that require off-site incineration or disposal.

Electronic health records model to improve the quality of patients' healthcare.

Electronic health records (EHR) has been acknowledged for bringing down healthcare costs and enhancing hospital service standards. The aim of this study was to develop an EHR model to lower patient treatment costs and enhance healthcare quality in South African public healthcare. In this study, a cross-sectional quantitative methodology was used. The research data for this study were provided by medical healthcare professionals, at Dr. George Mukhari Academic Hospital (DGMAH). This included doctors, nurses, pharmacists, radiologists, and radiographers who completed a semi-structured questionnaire. The final model's findings show that the use of EHR significantly improves information quality (IQ) and positively influences medical errors reduction (MER). Knowledge quality (KQ) has a positive significant impact on MER, whereas IQ has a considerable negative impact on MER. Furthermore, cost reduction in patient treatment (CRPT) has a positive significant influence on MER. Patients obtain better medical care when medical professionals have access to complete and accurate information. Medical errors can be reduced or even prevented with the use of EHRs, which can lead to better patient outcomes. The quality of patient care at South African public hospitals and in other developing countries can be enhanced by using this framework as a guide to reduce treatment costs.

Circular economy approach for thermal regeneration of graphene-encapsulated magnetic nanoparticles as an efficient adsorbent for sustainable wastewater management

High-performing nanostructured magnetic adsorbents, featuring enhanced dye adsorption from wastewater at various conditions of pH, and separability through the application of magnetic fields, offer significant technical advantages for streamlined water purification processes. Moreover, the efficient regeneration of exhausted magnetic adsorbents provides additional benefits in terms of the sustainability of adsorption process and promoting circular economy principles. Here, we explore the performance of the graphene encapsulated magnetic adsorbent Ni0.4Fe2.6O4/(Fe,Ni)@graphene (GMA) for decolorization of wastewater containing crystal violet (CV), and its reusability properties through thermal regeneration of the exhausted adsorbent at temperatures ranging from 200 to 600 °C. The graphene layer around GMA provides an enhanced adsorption capacity and stability for the agent. Meanwhile, the application of a straightforward and potentially low-cost thermal treatment offers a rapid regeneration strategy, facilitating efficient recycling of the adsorbent. While maintaining structural and morphological stability up to 400 °C, samples regenerated at this temperature exhibit a BET surface area and pore volume of 207.46 m²/g and 0.44 cm³/g, respectively, closely resembling those of the original adsorbent. The regenerated sample recovers over 92 % of the original adsorption capacity. At the same time, approximately 86 % of the saturation magnetization (Ms) of the sample can also be restored through the thermal regeneration, with magnetic remanence and coercivity remaining nearly unchanged compared to the original adsorbent, ensuring the functionality of the regenerated adsorbent.

Methotrexate versus Ciclosporin in the Treatment of Severe Atopic Eczema in Children: An economic evaluation.

Ciclosporin (CyA) and methotrexate (MTX) are both frequently prescribed drugs for the treatment of atopic dermatitis (AD) in children and young people (CYP). CyA has historically been the most commonly used conventional systemic treatment for severe paediatric AD, but MTX is being increasingly used as an alternative first-line conventional systemic treatment, especially in middle- and low-income settings. We found that methotrexate provides an effective and low-cost first-line systemic treatment for severe AD and is a suitable alternative to ciclosporin.

Applications of leech therapy in medicine: a systematic review.

Leech therapy (LT) is one of the most widely used treatment methods in traditional medicine. The present study aimed to systematically review clinical trials regarding the effects of LT on the prevention and healing of different diseases. To identify all relevant published studies, we conducted a comprehensive search of PubMed, Scopus, and Web of Science databases without any temporal or geographical constraints until April 2023. To categorize the articles, five stages were considered. The PRISMA checklist and Cochran's bias analysis tool were used. In total, 12 trials that met the inclusion criteria were studied. The results of the studies showed that LT has had successful outcomes in treating different conditions. These included hormonal and metabolic complications, cardiovascular problems, and inflammatory-based diseases. "Leech therapy" is a traditional medical treatment used successfully to control and treat various conditions. Although this method can have complications, it is possible to benefit from this low-cost and low-complication treatment by taking preventive measures.

Analysis of recurrence factors after balloon compression for trigeminal neuralgia and the relationship between pear-shaped balloon and guidewire path

BackgroundPercutaneous balloon compression (PBC) is widely used to treat trigeminal neuralgia due to its significant efficacy and low treatment cost. However, there is considerable variation in postoperative pain recurrence among patients. Currently, the factors influencing pain recurrence after PBC are under discussion. This study aims to explore the impact of individual patient parameters and surgical parameters on postoperative pain recurrence following PBC. The goal is to provide clinicians with a reference for preoperative assessment of pain recurrence risk and to offer insights for effectively intervening in controllable influencing parameters. MethodsA analysis was conducted on 114 patients who underwent PBC in the Department of Neurosurgery at Hebei General Hospital. Univariate Kaplan-Meier analysis and multivariate Cox regression analysis were performed on the general and surgical data of the patients to identify factors potentially associated with postoperative pain recurrence. ResultsThe results of the multivariate Cox regression analysis showed that a history of hypertension, MRI indicating trigeminal nerve compression and a non-ideal pear-shaped balloon were statistically significant factors for pain recurrence after PBC. Additionally, the guidewire path during the procedure had a statistically significant impact on the rate of achieving a pear-shaped balloon (P<0.05). ConclusionA history of hypertension, MRI indicating trigeminal nerve compression and a non-ideal pear-shaped balloon shape are independent risk factors for pain recurrence after PBC. Additionally, to avoid pain recurrence due to an unfavorable balloon shape, it is recommended to use 3D-slicer for preoperative guidewire path simulation and 3D reconstruction of Meckel's cavity.

Virtual Service Delivery in Mental Health and Substance Use Care: A Systematic Review of Preference Elicitation Studies.

Mental health and substance use disorders affect the lives of many people worldwide. Prevention and treatment of these conditions is important for optimal health and wellbeing, yet service access barriers are common. Virtual models of care may help to reduce barriers to receiving care. However, to facilitate uptake and use of virtual services, they need to appeal to patients and clinicians. This systematic review aimed to synthesise preference elicitation studies to determine what features of virtual mental health and substance use care are preferred by service users and service providers. Following the PRISMA guidelines for systematic reviews, we searched PubMed, PsycINFO, EconLit, MEDLINE, CINAHL, Academic Search Ultimate, and ProQuest Central for all available studies from database inception until May 2023. The Mixed Methods Appraisal Tool was used to assess the methodological quality of included studies. Nineteen studies met the eligibility criteria. However, none examined preferences for elements of different models of virtual care. Across the included studies, we identified 41 unique features that mapped to four themes of mental health and substance use care ('service', 'treatment', 'clinician' and 'additional supports'). Participant preferences were for individual, in-person, effective, flexible, and low-cost treatment. These preferences varied based on demographic factors, such as culture, gender, and participant type (e.g., patients, clinicians, general population). A user-centred approach should be adopted when designing and implementing mental health and substance use services. While preferences for features of mental health and substance use services more broadly are known, preferences for different models of virtual care remain unexplored. Future research should examine what features of virtual services would lead to optimal uptake and use across different users and stakeholders.

Clinical multi-dimensional prognostic nomogram for predicting the efficacy of immunotherapy in NSCLC

The advent of immunotherapy has greatly improved the prognosis of non-small cell lung (NSCLC) patients. However, given its low response rate and high cost of treatment, the search for valuable predictive markers of treatment efficacy is necessary. Considering the complexity and heterogeneity of the tumour and tumour microenvironment, the construction of a multi-dimensional prediction model is necessary. Therefore, we aimed to integrate clinical parameters, radiomic features, and immune signature data from NSCLC patients receiving immunotherapy to construct a multi-dimensional prediction model to better predict the efficacy of immunotherapy. The current study enrolled 137 NSCLC patients who received immunotherapy. We collected baseline clinical information, CT images, and tumour tissue specimens. Using 3D-Slicer software, radiomic features were extracted from patient CT images, and tumor tissue samples obtained before immunotherapy were subjected to immunohistochemical staining. Then, the least absolute shrinkage and selection operator (LASSO) Cox regression analysis was applied to downscale the data, and the radiomic features and immune signatures associated with the prognosis of immunotherapy patients were identified. The modified lung immune predictive index (mLIPI), radiomics score (Radioscore), immune score and multi-dimensional model nomogram were constructed. The C-index and area under the curve (AUC) were applied to evaluate the predictive efficacy of the models. Three radiomic features and three immune signatures that could predict the efficacy of immunotherapy were eventually screened. Multivariate analysis showed that the mLIPI, Radioscore, and immune score were independent predictive factors for PFS and OS (P < 0.05 for all models). The multi-dimensional model combining the three models showed better predictive efficacy than the mLIPI, Radioscore, and immune score (PFS: 0.721 vs. 0.662 vs. 0.610 vs. 0.610; OS: 0.727 vs. 0.661 vs. 0.601 vs. 0.602 respectively). The multi-dimensional model showed the best predictive efficacy, with C-index for PFS and OS higher than mLIPI, radioscore and immune score: 0.721 vs. 0.662 vs. 0.610 vs. 0.610 for PFS and 0.727 vs. 0.661 vs. 0.601 vs. 0.602 for OS, respectively. The AUC for the multi-dimensional model also performed better than those of the individual models: 0.771 vs. 0.684 vs. 0.715 vs. 0.711 for PFS and 0.768 vs. 0.662 vs. 0.661 vs. 0.658 for OS, respectively. The multi-dimensional model combining the three models had better predictive efficacy than any single model and was more likely to help provide patients personalized and precision medicine.

Anaerobic dynamic membrane bioreactor treating sulfamethoxazole wastewater: advantages of dynamic membrane and its fouling mechanism

Discharge of improperly treated sulfamethoxazole (SMX) wastewater seriously threats environmental security and public health. Anaerobic dynamic membrane bioreactors (AnDMBRs) technology would be cost-effective for SMX wastewater treatment, considering its low cost and satisfactory treatment efficiency. The performance of AnDMBR, though demonstrated to be excellent in treating many types of wastewaters, was for the first time investigated for treating SMX wastewater. Particular efforts were devoted to elucidating the advantages of dynamic membrane (DM) and the governing mechanism responsible for DM fouling with the presence of SMX. The threshold SMX concentration for AnDMBR was found to be 90 mg/L and the AnDMBR exhibited excellent removal efficiency of COD (90.91 %) and SMX (88.95 %) as well as satisfactory acute toxicity reduction rate (88.84 %). It was noteworthy that the DM made indispensable contributions to the removal of COD (14.26 %) and SMX (22.20 %) as well as the acute reduction of toxicity (25.81 %). The presence of SMX significantly accelerated DM fouling mainly by increasing its specific resistance, which was attributed to the increased content of small particles, high-valence metal ions and EPS content (mainly hydrophobic proteins), resulting in a denser DM structure with lower porosity. Besides, the biofouling-related bacteria (Firmicutes) was found to be enriched in the DM with the presence of SMX.