Maintenance Rate Research Articles

Exploring Preclinical Experiments with Different Fat Types for Autologous Fat Grafting.

Autologous fat transplantation has been a cornerstone of tissue regeneration for decades. However, there is no standardized selection system or criteria for fat graft selection, often relying heavily on the surgeon's experience. This study aimed to investigate various types of fat derivatives, both in vitro and in vivo at the same condition. We collected traditional fat granules of different sizes and SVF-gel, evaluating the viability of ADSCs isolated from them and their performance after grafting into mice. Large fat granules exhibited more complete adipocyte structures, and the isolated ADSCs demonstrated superior differentiation, proliferation, and secretion capacities. They also showed excellent volume retention after 12 weeks. In contrast, ADSCs isolated from SVF-gel displayed lower vitality. However, grafts from SVF-gel exhibited the highest volume maintenance rate among the four groups after 12 weeks, closely resembling normal adipose tissue and displaying significant vascularization. Compared to large fat granule and SVF-gel group, medium and small fat granule grafts exhibited lower volume retention and less angiogenesis. Through preclinical studies, the flexible clinical use of different fat grafts can be tailored to their unique characteristics. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Behavioural change for Parkinson's Disease: A randomised controlled feasibility study to promote physical activity and exercise adherence among people with Parkinson's: study protocol.

Parkinson's is a common progressive neurological condition characterized by motor and non-motor deficits. Physical activity and exercise can improve health, but many people with Parkinson's (PwP) have trouble reaching the recommended dosage. Our recent literature review found improvements in exercise adherence with behavioural change interventions, but it remains unclear which are most effective. Further qualitative research and patient and public involvement has informed a novel behavioural change intervention to be tested alongside an existing exercise program. To examine the feasibility of behavioural change techniques delivered alongside an exercise programme to improve physical activity, function, and self-efficacy in PwP (and study procedures) to inform a future pilot RCT trial. A parallel-arm single blinded randomised feasibility study. Twenty participants with Parkinson's (Hoehn and Yahr stage 1-3) will be recruited from a physiotherapy primary-care waiting list. Following written consent, and baseline assessment, the participants will be randomly allocated to the intervention (n=10) or the control group (n=10). Both groups will receive usual care, which includes a weekly program of a multidisciplinary education, a supervised exercise class and a prescribed home exercise program. The intervention group will receive additional behavioural change techniques, targeting behaviour regulation, belief about capabilities and social influences. Class and home exercise adherence, behavioural component uptake and adherence, and negative events will be recorded. Outcomes will include enrolment and maintenance rates, physical function, falls, physical activity, and exercise self-efficacy measured pre- and post- the 12-week program (in-person). Surveys will be used to compare experiences and satisfaction between groups. Exit interviews will be completed with the intervention group only, exploring their experience of the behavioural change techniques. The results will help inform a future pilot RCT, based on the intervention acceptability, consent rate, maintenance, and protocol integrity. ClincialTrials.gov NCT06192628.

Hybrid ablation for persistent atrial fibrillation: a narrative review.

Treatment for atrial fibrillation (AF) has evolved significantly, with pulmonary vein isolation (PVI) becoming an established treatment. However, the outcomes following catheter ablation for persistent AF remain unsatisfactory. Hybrid catheter-surgical ablation has emerged as a therapeutic approach for persistent AF, combining the strengths of both interventions. The purpose of this narrative review is to comprehensively examine the current state of knowledge regarding hybrid ablation for AF. A thorough PubMed search using the terms "hybrid ablation", "atrial fibrillation", "catheter ablation", and "guideline on cardiology" within the timeframe of 1980 to 2024 resulted in 138,969 articles. Consensus on the selected articles was reached through a series of structured meetings and discussions. PVI has demonstrated higher sinus rhythm maintenance rates, especially for paroxysmal AF. However, the efficacy is not as high for persistent AF. Additional ablation strategies, such as linear ablation, complex fractionated atrial electrogram ablation, low voltage zone ablation as well as posterior wall isolation, lack consistent evidence of effectiveness. Hybrid ablation, involving collaboration between cardiac surgeons and electrophysiologists, presents a promising alternative for hard-to-treat AF. Recent studies report favorable outcomes of hybrid ablation, with atrial arrhythmia-free rates ranging from 53.5% to 76%, surpassing those of catheter ablation alone, which might result from better lesion durability or intervention for non-PV foci and left atrial appendage excision or closure during hybrid ablation. The rate of complications associated with hybrid ablation is higher than catheter ablation alone. While favorable outcomes of hybrid ablation for persistent AF have been reported, it is not recommended for all AF patients due to its invasiveness compared to catheter ablation. Additionally, some patients with persistent AF maintain sinus rhythm with catheter ablation alone. More clinical data are needed to determine which patients are suitable candidates for hybrid ablation.

P973 Real-world data on the effectiveness on IBD of anti-IL23 drugs prescribed for psoriasis indication

Abstract Background There is a significant association between psoriasis and IBD, which share the pathogenic role of IL-23. In the dermatological field, drugs targeting the p19 subunit of IL-23, such as risankizumab, guselkumab, and tildrakizumab, have been approved for the treatment of moderate to severe psoriasis. However, there are still no real-life data on the efficacy and safety profile of IL-23 inhibitors in patients with IBD. Methods A prospective, single center observational study was conducted on patients with IBD and psoriasis from April 2021 to March 2023 at the gastroenterological-dermatological outpatient clinic at “Città della Salute e della Scienza of Turin”, Italy. Patients received a dermatological indication to start drug therapy with IL-23 inhibitors according to the dermatological dosing schedule. They were treated either with guselkumab subcutaneously at a dose of 100 mg every 8 weeks, or with risankizumab subcutaneously at a dose of 150 mg every 12 weeks, or with tildrakizumab 100 mg every 12 weeks subcutaneously. Objectives of this study included evaluating the achievement of clinical remission at 3, 6, and 12 months, defined as disease activity with Harvey-Bradshaw Index (HBI) < of 5 in CD and pMAYO < of 2 in UC. Results At 3 months after the start of drug treatment, clinical remission was achieved by 73.3% of patients (p=0.006). This number also remained almost constant at 6 (62.4%, p=0.008) and 12 months (60.3%, p=0.04). In addition, there was a statistically superior steroid-free clinical remission compared to T0 at 3 (15.3% vs 73.3%, p=0.006) and 6 months (7.1% vs 54.1%, p=0.04). No major side effects were reported. Two cases of arthralgias (11.8%) and one case of fever with chills (5.9%) were reported. IL-23 inhibitors appear to be effective in maintaining the steroid-free clinical remission. In addition, there was a reduction in fecal calprotectin values to a median value at 6 months of 81.0 (95%IC= 28.2-249.8; p=0.03) from a median value at T0 of 343.1 (95%IC= 44.8-869.7). The maintenance rate of IL-23 inhibitors therapy at the end of follow-up was 75.8%. Conclusion In this study risankizumab, guselkumab, and tildrakizumab appear to be effective in inducing clinical remission and steroid-free clinical remission in patients with IBD. In addition, they appear to be effective in maintaining steroid-free clinical remission. IL-23 inhibitors demonstrated a good safety profile in patients with IBD. Despite the limitations of the study with the need to publish further real-world data on a larger scale and with higher dosing of IL-23 inhibitors, the results obtained are promising as they, for the first time, provide real-life support for the clinical potential of these drugs as treatment for IBD in addition to psoriasis.

A systematic review and meta-analysis of the efficacy of vonoprazan for proton pump inhibitor-resistant gastroesophageal reflux disease.

Up to 40% of gastroesophageal reflux disease (GERD) patients experience inadequate symptom relief with a proton pump inhibitor (PPI), termed PPI-resistant or refractory GERD. Vonoprazan, a potassium-competitive acid blocker, has better efficacy than PPI in suppressing gastric acid secretion. This meta-analysis summarizes the efficacy and safety of vonoprazan for treating PPI-resistant GERD (both erosive esophagitis [EE] and non-erosive reflux disease [NERD]). Four electronic databases (Medline, Embase, SCOPUS, and CENTRAL) were searched for studies indexed until August 1, 2023. Both observational studies and clinical trials assessing the efficacy and safety of vonoprazan in PPI-resistant GERD were included. Efficacy outcomes included healing and maintenance rates of EE and improvement of the Frequency Scale for Symptoms of GERD (FSSG) scores. Serious adverse events (SAEs) were considered a safety outcome. The modified Newcastle-Ottawa Scale (NOS) was used to assess study quality. Twelve studies were included in this meta-analysis. Healing rates of PPI-resistant EE with vonoprazan 20mg were 91.7% (95% CI 86.8-94.8%) and 88.5% (95% CI 69.7-96.2%) at weeks 4 and 8, respectively. For healed PPI-resistant EE, the overall maintenance rates with vonoprazan 10mg were 82.6% (95% 61.2-95.0%) at week 8, 86.0% (95% CI 72.1-94.7%) at week 24, and 93.8% (95% CI 69.8-99.8%) at week 48. FSSG scores were improved in 74.6% (95% CI 65.8-81.7%) and 51.9% (95% CI 37.8-65.7%) of patients at weeks 4 and 8. Overall, no SAE was reported. Vonoprazan demonstrated high efficacy in the healing and maintenance of PPI-resistant EE and moderate efficacy for the improvement of FSSG score. Vonoprazan was well tolerated in PPI-resistant GERD patients.

Durability of doravirine with dolutegravir dual regimen compared with other dolutegravir-based dual combinations.

The availability of doravirine (DOR) allowed clinicians to prescribe a dolutegravir (DTG)-based two-drug regimen (2DR) in individuals not eligible to receive lamivudine (3TC) or rilpivirine (RPV). The aims of this study were to describe the durability of DTG + DOR compared with DTG/3TC and DTG/RPV and the rate of virological failure and target not-detected maintenance over time. This retrospective, monocentric analysis included all subjects who started a DTG-based 2DR from 2018 to 2022 as a simplification. Descriptive statistics and non-parametric tests to describe and compare the groups were applied. Kaplan-Meier probability curves and Cox regression models for regimens durability were used. The study enrolled 710 individuals: 499 treated with DTG/3TC, 140 with DTG/RPV, and 71 with DTG + DOR. A 2DR with DOR was prescribed to older subjects who had a longer infection, greater exposure to different antiretroviral regimens, a higher proportion of resistance-associated mutations, and a worse immune-virologic status. Over a cumulative follow-up of 68 152 weeks, 42 discontinuations were registered (5.9%). DTG + DOR had a risk of treatment interruption of 7.8% at 48 weeks and 9.8% at 96 weeks, significantly higher than the other 2DRs. In the multivariate Cox model, DTG + DOR and DTG/RPV were significantly associated with discontinuation. The maintenance of target not detected during follow-up was similar among groups. The rate of virological failure was higher for DTG + DOR through different event definitions. DTG + DOR durability was high over a long follow-up albeit lower than for other 2DRs. This combination might be an effective option in people with HIV that has proven difficult to treat.

Laryngeal mask airway versus endotracheal intubation as general anesthesia airway managements for atrial fibrillation catheter ablation: a comparative analysis based on propensity score matching.

The current evidence on the use of laryngeal mask airway (LMA) as an airway management technique for general anesthesia (GA) during atrial fibrillation (AF) catheter ablation (CA) is insufficient. This study aims to compare the feasibility, safety, and clinical benefits of LMA and endotracheal intubation (ETI) for airway management in AF CA. One hundred fifty-two consecutive patients with AF who underwent CA under GA were included and divided into two groups based on different airway management methods (66 in the LMA group, 86 in the ETI group). After propensity score matching, a final analysis cohort of 132 patients was obtained to compare procedural parameters, adverse events, and prognosis between the two groups. The LMA group exhibited significantly shorter total procedural time (p = 0.039), anesthesia induction time (p = 0.015), and recovery time (p = 0.006) compared to the ETI group. The mean arterial pressure (MAP) and heart rate were significantly lower in the LMA group during extubation and 1-min post-extubation (p < 0.05). Furthermore, the LMA group demonstrated lower MAP levels during intubation (p = 0.029). The incidences of intraoperative hypotension (p = 0.017) and bradycardia (p = 0.032) were significantly lower in the LMA group. The incidences of delayed recovery or delirium (p = 0.027), laryngeal or airway injury (p = 0.016), cough or bucking (p = 0.001), and sore throat (p < 0.001) were significantly lower in the LMA group. There were no statistically significant differences in catheter stability parameters and sinus rhythm maintenance rates between the two groups (p > 0.05). LMA is feasible, safe, and effective in AF CA as an optimized airway management technique for GA.

Analysis of distinct blaKPC-encoding plasmids in an Enterobacter kobei strain recovered from recreational coastal water

In this study we present an in-depth characterization of two blaKPC-2 encoding plasmids found in the Enterobacter kobei FL23 strain recovered from recreational coastal water. The plasmids belong to distinct incompatibility groups and carry a diverse collection of resistance genes. Furthermore, the genetic context of the blaKPC-2 gene was different in each of them. While pEkFL23-IncX3 presents a new Tn4401k, a new isoform, similar to Tn4401b but with a truncated tnpA and a deleted tnpR; pEkFL23-IncU/P6 carries a new isoform of a non-Tn4401 element (NTEKPC), named NTEKPC-IIh. Its difference from NTEKPC-IId is the truncated Tn3 resolvase upstream blaKPC-2. Capacity of conjugation, maintenance rates and fitness cost of both replicons were also assessed. Both were transferred after mating assays, whereas only pEkFL23-IncX3 was transferred under the adverse conditions of Marine broth at 25 °C as a mating platform. A remarkable stability of both plasmids was observed in the parental and transconjugant strains. Finally, both replicons did not impose a significant fitness cost to their transformant hosts, with pEkFL23-IncU/P6 conferring a statistically significant (p < 0.05) advantage in head-to-head competitions. Our findings show that E. kobei FL23 is a disquieting case of a carbapenem-resistant bacteria identified in a community setting, being a possible silent disseminator of two seemingly stable and metabolic weightless multidrug resistance plasmids.

Additional cement augmentation reduces cage subsidence and improves clinical outcomes in oblique lumbar interbody fusion combined with anterolateral screw fixation: A retrospective cohort study

PURPOSE: Although OLIF has been well established as a successful surgical treatment for lumbar spondylosis, cage subsidence is one of the troublesome complications. Avoiding risk factors and improving surgical techniques are generally passive ways for cage subsidence prevention. To our knowledge, there has been no active way reported to decrease cage subsidence following OLIF. METHODS: From 2018 to 2021, 63 patients were enrolled and divided into two groups, OLIF group (37 patients) and OLIF with cement augmentation (OLIF-C) group (26 patients). The patients’ characteristics, age, sex, BMI, lesion level, days of hospitalization, visual analogue scale (VAS), surgical data and radiological parameters were recorded and compared. RESULTS: The demographic and surgical data showed no statistical significance between OLIF and OLIF-C groups. OLIF-C group had better pain relief in postoperative 3 months (p = 0.015) and at the last follow-up (p = 0.030), less rate of cage subsidence (p <0.001) with better disc height restoration, segmental lordotic angle maintenance and interbody fusion rate. CONCLUSIONS: Additional cement augmentation for OLIF could minimize the rate of postoperative cage subsidence and the whole procedure was completed through the anterolateral approach without posterior laminectomy and instrumentation, avoiding the damage of posterior back muscle and facet joints.

A Randomized, Multi-Center, Open Label Study to Compare the Safety and Efficacy between Afatinib Monotherapy and Combination Therapy with HAD-B1 for the Locally Advanced or Metastatic NSCLC Patients with EGFR Mutations.

Lung cancer, especially non-small cell lung cancer (NSCLC), poses a significant health challenge globally due to its high mortality. Afatinib, a second-generation epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI), has shown superior efficacy over traditional chemotherapy in NSCLC treatment. However, issues like secondary resistance and adverse effects call for alternative therapies. HAD-B1, comprising 4 herbal medicines, has shown promise in lung cancer treatment in both preclinical and clinical settings. This study assesses the combination of HAD-B1 and Afatinib in advanced NSCLC patients to potentially improve outcomes by addressing the limitations of current EGFR-TKI therapies. A randomized, open-label trial evaluated the efficacy and safety of HAD-B1 with Afatinib in 90 EGFR-mutation-positive NSCLC patients. Participants were divided into treatment and control groups, receiving Afatinib with or without HAD-B1. The study focused on the initial dose maintenance rate and disease control rate (DCR) of Afatinib, alongside secondary outcomes like survival rates and quality of life, under continuous safety monitoring. Among the 90 participants, no significant difference was found in initial dose maintenance (60.98% in the treatment group vs 52.50% in the control, P = .4414) or DCR (80.49% vs 90.00%, P = .2283). Secondary outcomes like PFS, TTP, and OS showed no notable differences. However, physical functioning significantly improved in the treatment group (P = .0475, PPS group). The control group experienced higher rates of adverse events of special interest and adverse drug reactions (P = .01), suggesting HAD-B1 with Afatinib might enhance physical function without increasing adverse effects. Combining HAD-B1 with Afatinib potentially improves quality of life and reduces adverse events in advanced NSCLC patients. Further research is necessary to confirm the long-term benefits of this combination therapy, aiming to advance NSCLC treatment outcomes. Clinical Research Information Service (CRIS) of the Republic of Korea, https://cris.nih.go.kr/ (ID: KCT0005414).

The metabolic interpretation of the von Bertalanffy growth rate

The von Bertalanffy Growth Rate (vBGR) has a clear physiological interpretation and is proportional to the volume-specific somatic maintenance rate. This links high maintenance to fast growth, as is exploited by the waste-to-hurry strategists, which experience high food availability peaks during short periods. For different, but constant, food availability’s, the inverse vBGR is linear in the ultimate (structural) length that an individual can reach. The slope of the line is inverse to the energy conductance, which controls the reserve mobilization rate. The intercept is inverse to the somatic maintenance rate, which is the ratio of the volume-specific somatic maintenance rate and the cost per unit of structural volume. Size differences between genders work out similar to differences in food availability. We give examples from the Add_my_pet collection for different taxa to illustrate these concepts. In the case of gender dimorphy, the gender with the largest size is also heavier for the same length. We discuss why this supports the weak homeostasis requirement imposed by the Dynamic Energy Budget theory. The geometric interpretation of the vBGR as the slope of the tangent line at zero length, divided by the ultimate length, is well-known, but that the weight-specific growth rate at maximum weight growth equals 1.5 times the vBGR, is perhaps less widely recognized. We briefly discuss the problem of estimating two DEB parameters in the vBGR, the specific somatic maintenance rate and the energy conductance, from a growth curve and argue why these parameters can only be estimated in combination with other data sets, such as an incubation time, or a set of growth curves at different food levels. The vBGR varies with maximum ultimate length across species in a hyperbolic way according to the physical co-variation rule of DEB theory. We support this with data from the AmP collection for molluscs, crustaceans and fish.

Postoperative volume maintenance rate of microvascular free flap in oral and maxillofacial region: Systematic review and meta-analysis

Background and objectivesThe resorption of flap's volume can be frequently observed in the transplantation of microvascular free flaps, which could significantly affect postoperative function. Therefore, it's essential to comprehend the postoperative flap volume and the mechanisms behind before making clinical decisions. MethodsLiterature search was conducted from database on PubMed, EMBASE, Cochrane Library, Chinese database and Google Scholar. A random effects model meta-analyses and descriptive systematic review were performed. ResultsThe search identified 420 articles, of which 9 studies included in meta-analysis and 14 studies included in descriptive systematic review. Postoperative flap volume maintenance rate is used to represent the volume change. The pooled mean postoperative flap volume maintenance rate was 62.82 % for soft tissue flap (95 %CI: 58.83 to 66.82, p = 0.076, I2=56.3 %) and 85.96 % for bone flap (95 %CI: 84.19 to 87.73, p = 0.274, I2=20.4 %). Weight loss, muscle atrophy, and decreased serum albumin levels are risk factors for postoperative volume reduction of soft tissue flaps. The bone resorption rate of bone flaps in women is higher than that in men. ConclusionWhen designing microvascular free flaps for oral and maxillofacial surgery, soft tissue flaps should consider an anticipated postoperative shrinkage of 37 %, while bone flaps should consider an anticipated postoperative shrinkage of 14 %.

Minimally Invasive Surgery for Posterior Spinal Instrumentation and Fusion in Adolescent Idiopathic Scoliosis: Current Status and Future Application.

The posterior minimally invasive spine surgery (MISS) approach-or the paraspinal muscle approach-for posterior spinal fusion and segmental instrumentation in adolescent idiopathic scoliosis (AIS) was first reported in 2011. It is less invasive than the traditionally used open posterior midline approach, which is associated with significant morbidity, including denervation of the paraspinal muscles, significant blood loss, and a large midline skin incision. The literature suggests that the MISS approach, though technically challenging and with a longer operative time, provides similar levels of deformity correction, lower intraoperative blood loss, shorter hospital stays, better pain outcomes, and a faster return to sports than the open posterior midline approach. Correction maintenance and fusion rates also seem to be equivalent for both approaches. This narrative review presents the results of relevant publications reporting on spinal segmental instrumentation using pedicle screws and posterior spinal fusion as part of an MISS approach. It then compares them with the results of the traditional open posterior midline approach for treating AIS. It specifically examines perioperative morbidity and radiological and clinical outcomes with a minimal follow-up length of 2 years (range 2-9 years).

Markov-chain-driven optimization of inspection-based maintenance, Part I: Models and methods

System reliability and life-cycle cost are significantly influenced by preventive maintenance (PM). PM is commonly classified into two categories: time-based maintenance (TBM) and condition-based maintenance. Another PM approach referred to as inspection-based maintenance (IBM) incorporates condition-based activities within periodic inspections and tests. Determining the optimal maintenance rate for both TBM and IBM plans, and scheduling them effectively, poses a crucial challenge. Traditional methods assess equipment importance and condition within a reliability-centered maintenance framework. Mathematical models are commonly employed to devise robust plans, but accurate modeling based on practical conditions of the system equipment remains a key challenge. This two-part paper series introduces a novel model based on the Markov chain theory, that establishes the relationship between equipment status transition rates and the risk indices. The proposed model can be used alone or in combination with risk analysis outcomes to overcome data and budget limitations. To demonstrate its efficacy, the proposed method is implemented to optimize the PM rate of high-voltage equipment within a real-world sub-transmission substation, where the results can aid in cost estimation, equipment replacement decisions, and inventory management.

Maintenance IV Ketamine Therapy in the Fibromyalgia Patient: A Case Report.

Fibromyalgia is a complex disorder characterized by distributed and persistent pain often associated with fatigue and depression. The underlying causal agents of this dysfunction are not clear. Ketamine has been used to treat chronic pain in a variety of pain syndromes, including fibromyalgia, but the dosing protocols used are neither standardized nor consistent across cases. The current case presents an opportunity to contribute to a progression towards a consensus on ketamine dosing for fibromyalgia. A 60-year-old female presented with indications of fibromyalgia and was administered a 9-session IV ketamine treatment for pain. The initial dosing was 50 mg, with a concentration of 1.0 mg/ml at an infusion rate of 0.8 mg/kg/hr. This was increased to 200 mg and eventually to 240 mg, maintaining a ketamine concentration 4.0-4.8 mg/ml at an infusion rate of 1.5 mg/kg/hr. Following the first 9-session therapy, the patient reported >50% pain relief from pre-infusion levels and was placed on a maintenance regimen in perpetuity. This regimen involves two monthly IV ketamine infusions, one day apart for two hours at a maintenance rate of 4.8 mg/kg/hr. Ketamine by IV is an effective option for pain management in patients with fibromyalgia. Compared to previous case studies, it is recommended that increased total dose, frequent administration, and longer duration of infusions all may be necessary for ketamine to maximize its beneficial effects.

Association of health information technology-driven multidisciplinary approaches with low-density lipoprotein cholesterol target achievement in patients with an acute coronary syndrome

ObjectiveControlling of low-density lipoprotein cholesterol (LDL-C) in patients with acute coronary syndrome (ACS) remains a challenge. Health information technology (HIT) is increasingly being applied to close quality gaps in chronic illness care. The aim of this study was to perform a qualitative review of the association of implementing HIT on lipid management processes of care and LDL-C goal attainment in patients with ACS. MethodEligible patients with a discharge diagnosis of ACS from January 2018 to December 2021 at a tertiary medical center were retrospectively reviewed. An HIT system with a multidisciplinary approach including initiating high-intensity statin therapy, periodic laboratory follow-up, titration of lipid-lowering agents, patient education, patient-level and system-level interventions involving database monitoring and outreach by centralized care teams was introduced in October 2018. Electronical medical records including data on medications and laboratory findings at discharge and within 1 year were compared before and after implementing the HIT system. ResultsA total of 2001 ACS patients (average age 63 ± 12.7 years, 79.66 % men) were analyzed. The LDL-C < 70 mg/dL goal attainment rates (36.52 %, 53.57 %, 59.22 %, 62.18 % in 2018–2021) and medium serum LDL-C levels (80.5 mg/dL, 68 mg/dL, 65 mg/dL, 64 mg/dL in 2018–2021) significantly improved within 6 months (2018 as the reference, all p<0.001). The LDL-C attainment rate at 12 months also steadily increased (53.80 %, 61.82 %, 64.21 % in 2019–2021, p = 0.019). Most of the patients switched to a high-intensity statins regimen at discharge (0.57 %, 63.67 %, 72.41 %, 84.44 %, in 2018–2021, p<0.001 with 2018 as the reference), with low adverse event rates. The maintenance rates of high-intensity statin regimens at 12 months continued to improve (41.36 %, 49.04 %, 61.39 % in 2019–2021, p<0.001). ConclusionsEfforts to control LDL-C should be increased in ACS patients by initiating and intensifying statin treatment earlier. Our results confirmed that a team-based strategy with HIT improved LDL-C target achievement for most patients with ACS.

Field-scale evaluation of struvite phosphorus and nitrogen leaching relative to monoammonium phosphate.

Struvite (MgNH4 PO4 ·6H2 O) is a wastewater-derived phosphorus (P) fertilizer with potential to reduce P as well as nitrogen (N) losses due to its low water solubility. To test hypothesized lower P and N losses from struvite relative to monoammonium phosphate (MAP), field experiments with a randomized-complete block design were conducted in central (Urbana) Illinois on an Endoaquoll-Argiudoll complex and in southern (Ewing) Illinois on a Fragiudalf-Hapludalf complex. Fertilizer was broadcast applied in the fall prior to spring planting of soybean (Glycine max L.) at a maintenance rate of 29.5kg P ha-1 (Urbana) and 22.0kg P ha-1 (Ewing). In the spring, soil extractable N and Mehlich 3-P at 0- to 15-cm and 15- to 35-cm depths were determined, and leached N and P were estimated using fall-installed ion-exchangeable resin (IER) lysimeters. At Urbana, soil extractable nitrate-N was higher under MAP than struvite at 0- to 15-cm depth. At Ewing, soil Mehlich 3-P under struvite was lower than MAP at both depths. At Urbana, leached P was 10-fold lower, and leached N was twofold lower under struvite than MAP. Soybean yields were similar between MAP and struvite at Urbana (4.1-4.3 Mg ha-1 ) and Ewing (3.2-3.5 Mg ha-1 ), but at Ewing yields were 23% higher under struvite compared to the P-unfertilized control. Off-season yield-scaled P and N losses under struvite were lower than MAP by 51% at Urbana and by 10% at Ewing. Our results support the hypothesized potential of struvite to reduce nutrient losses while meeting crop P needs. Additionally, we identify disproportionally greater reductions in N leaching and yield-scaled N losses by substituting struvite for MAP in fall applications, indicating that struvite can offer greater relative benefits for N loss reduction than P loss reduction.

Markov-chain-driven optimization of inspection-based maintenance, Part II: Numerical analysis and practical insights

These two-part paper series aim to optimize the rates of inspection-based maintenance or routine-test on power system equipment. Part I introduced a novel probabilistic model using Markov chains for the inspection-based maintenance and derived the relationships between the transition rates. Part II demonstrates how the proposed method can effectively address budget and data availability constraints. It also presents the derived relationships between the optimal preventive maintenance rate and risk indices. The results presented in this paper are based on an industrial project conducted to optimize the preventive maintenance period of high-voltage equipment in Iran. Additionally, this companion paper provides practical insights, including implementation remarks, and a comprehensive dataset for failure and defect analysis, which proves useful for future research and applications.

What maintains low-carbon consumption behaviors: Evidence from China

Promoting the adoption and maintenance of low-carbon consumption behaviors (LCBs) is a global climate action. Most prior studies have considered only the adoption of LCBs and not explored how behavioral characteristics and emotions influence individual behaviors. To address these limitations, this study builds a dual-level integrated model to detect the maintenance rate of various LCBs and identify what factors affect behavioral maintenance. Using data collected from 2052 residents in China, generalized linear mixed models are employed to examine the effects of behavioral and individual-level factors and of social interaction on the maintenance of LCBs. Robustness is checked using the instrumental variable method, least-squares dummy variable method, and Probit approach. The estimated maintenance rate for different LCBs ranges between 29.02 % and 83.49 %, while the estimated cessation rate ranges between 2.31 % and 6.58 %. Maintenance of LCBs is positively affected by context stability but negatively influenced by effort expectancy. Anticipated guilt is identified as the strongest driver (positive) of maintenance of LCBs for all tested variables, followed by symbol expectancy. However, neither behavior routinization nor anticipated pride is found to be significantly associated with behavioral maintenance. The effects of anticipated guilt, effort expectancy, and symbol expectancy on behavioral maintenance are moderated by social interaction. Regarding demographics, family size is positively associated with behavioral maintenance, while females are more likely than males to maintain LCBs. These findings address the under-studied effects of behavioral characteristics and emotions on behavioral maintenance, and provide new insights for redefining target interventions to engage the public in maintaining LCBs.

Measuring in-service traction elevator reliability based on orthogonal defect classification and Markov analysis

To solve the challenge of accurate in-service traction elevator failure prediction, maintenance cycle and steady availability, a novel reliability model is proposed which combines orthogonal defect classification (ODC) and Markov analysis (MA). The elevator failure data are classified by the ODC method. Then, the failure rate and maintenance rate of the elevator parts are obtained based on triangular fuzzy theory. By analyzing the maintenance function of each part, the optimum maintenance cycle of the elevator is determined. Finally, the transient state and steady state equations are established by MA to determine the steady availability of elevators. A case study on elevator accidents and failure data is used to validate the effectiveness of the proposed method. The results show that the system steady state availability of elevators in the study was 0.9002.