Optimal Level Research Articles

Cut-off Value of HSPG for Early Marker of Plasma Leakage in Adult Dengue Patient

Plasma leakage is a state of increased vascular permeability due to loss of interendothelial junction and focal adhesion. Endothelium glycocalyx plays a major role in the pathogenesis of plasma leakage. Proteoglycans glycocalyx consists of heparan sulfate (HSPG) around 50-90%. Plasma leakage in dengue infection can be fatal and early detection is essential. This study aimed to determine the optimal cut-off value of HSPG levels for early marker of plasma leakage in dengue infection. The study was a retrospective cohort study as a part of the Community Based Dengue Study of the Faculty of Medicine, University of Indonesia, which was conducted between February 2010 and January 2011. Subjects were recruited by consecutive sampling. Dengue infection was confirmed by conventional PCR serotyping. Subjects were categorized into 2 groups, i.e. those with and without plasma leakage. Plasma leakage was confirmed by hemoconcentration or hypoalbuminemia or USG results. The level of HSPG was measured using the ELISA method from the first until the third day of the hospital admission. A total of 40 subjects were involved in this study, consisting of 21 with leakage and 19 without leakage. The optimal cut-off level of HSPG as a marker of early plasma leakage in dengue infection patients on the 1st day, 2nd day, and 3rd day was was 2179.73 pg/mL, 2538.66 pg/mL, and 1294.06 pg/mL, respectively. HSPG could as an early marker of plasma leakage in dengue infection with an optimal cut-off value for each of the first 3 days of the patient's fever. A pediatric study was recommended to obtain the optimal cut-off value for HSPG.

Dietary succinate reduces fat deposition through gut microbiota and lipid metabolism in broilers

Succinate has been shown to be a potentially beneficial nutritional supplement with a diverse range of physiological functions. However, it remains unknown whether succinate supplementation regulates lipid metabolism in chickens. The aim of this study was to explore how succinate affects fat deposition and the underlying mechanism involved in broilers and to determine the most appropriate level of succinate supplementation in the diet. A total of 640 one-day-old male yellow-feathered broilers were randomly divided into 4 groups with 8 replicates and 20 broilers per replicate. A basal diet was provided to the control group (CON). The experimental broilers were fed diets containing 0.2% (L), 0.4% (M), or 0.6% (H) succinate and the study was lasted for 21 d. The linear (l) and quadratic (q) effects of succinate addition were determined. The results indicated that supplementation with 0.4% succinate reduced ADFI, serum triglycerides (l, q; P < 0.05), glucose (q; P < 0.05), and increased high-density lipidprotein cholesterol (l, q; P < 0.05) concentrations in broilers. Moreover, 0.4% succinate affects lipid metabolism by decreasing the abdominal fat percentage and adipocyte surface area, the expression of genes that promote liposynthesis in the abdominal fat and liver, as well as increasing the expression of genes that promote lipolysis in the abdominal fat and liver. In addition, increased cecal propionic acid content (q, P < 0.05) was found in the M group compared to the CON group. The 16S rRNA sequence analysis showed that group M altered cecum microbial composition by increasing the abundance of genera such as Blautia and Sellimonas (P < 0.05). LC-MS metabolomic analysis revealed that the differential metabolites between the M and CON groups were enriched in amino acid-related pathways. In conclusion, the optimum level of succinate added to broiler diets in the present study was 0.4%. Succinate can potentially reduce fat accumulation in broilers by modulating the composition of the gut flora and amino acid metabolism related to lipid metabolism.

Associations between time in range and insulin secretory capacity in Japanese patients with type 2 diabetes

Impaired insulin secretory capacity is associated with high glycemic variability in patients with type 2 diabetes (T2DM). However, there are no existing reports on the association between insulin secretory capacity and time in range (TIR). This retrospective study involved 330 T2DM admitted for diabetes education who underwent intermittently scanned continuous glucose monitoring (isCGM) and had their fasting serum C-peptide immunoreactivity (S-CPR) measured within 5 days of admission. The baseline characteristics were as follows: age, 60.2 years; glycated hemoglobin (HbA1c), 9.2%; S-CPR, 2.2 ng/mL; S-CPR index (S-CPR [ng/mL]/fasting plasma glucose [mg/dL] × 100), 1.6; and TIR, 60.3%. TIR correlated significantly with the S-CPR index, which was confirmed by multivariate analysis that included various factors such as HbA1c. Receiver operating characteristic (ROC) analysis showed that 1.88 was the optimal S-CPR index level to predict TIR ≥ 70%. In addition to HbA1c and biguanide use, the S-CPR index was a significant factor associated with TIR > 70%. S-CPR index values of ≥ 1.88 also correlated significantly with TIR > 70%. In conclusion, insulin secretory capacity is associated with TIR in Japanese T2DM, suggesting that the S-CPR index might be a potentially useful biomarker insulin secretory capacity, in association with TIR.Trial registration UMIN0000254333.

Online reviews and spillover effects in the dual-channel supply chain: A choice strategy of sales format

We investigate strategy choice of sales format considering online reviews and the spillover effect in a dual-channel supply chain. Generally, online and offline consumers read online reviews before purchasing, and thus offline retailers will be subjected to the spillover effect of online reviews. We develop joint product quality and service level decision models in reselling and agency selling with online reviews and the spillover effect. There are some interesting findings: first, the optimal service level and product quality increase with online reviews and spillover effect. Second, counterintuitively, the spillover effect of online reviews benefits not only the offline retailer and manufacturer but also the online retailer in some circumstances. Moreover, the win-win sales format for the manufacturer and online and offline retailers exists in some circumstances. Finally, it is interesting to find that consumers’ channel preference in the agency sales format is more important than in the resales.

Artificial neural network evaluation of concrete performance exposed to elevated temperature with destructive–non-destructive tests

AbstractIn this study, it is aimed to predict the performance of concretes obtained by using supplementary cementitious materials (SCM) before and after high temperature using artificial neural network. Thus, in addition to contributing to sustainable development and circular economy by using waste materials in concrete production, predicting concrete strength using artificial neural network without the need for experimental studies will provide a great advantage in practice. In addition, it will also contribute to the literature in terms of determining the optimum amount of metakaolin to be used with fly ash in concrete production. Metakaolin, silica fume and fly ash were used as SCM in different proportions in concrete mixes. Accordingly, a total of 22 concrete series were prepared, one of which was the control series. Porosity, ultrasonic pulse velocity, pressure and tensile strength tests were applied to the series at the end of 7th, 28th and 90th curing periods before high temperature. In order to determine the strength losses after elevated temperature, porosity and compressive strength tests were applied at temperatures of 400, 600 and 800 °C. Mineral additive series showed positive mechanical properties up to 20%. However, it has been observed that the use of fly ash after a certain rate causes a decrease in strength. After elevated temperature, strength loss was observed in all series due to the increase in temperature, while it was observed that the rate of being affected by elevated temperature decreased as the percentage of metakaolin increased. Optimum mineral additive usage percentages were determined as 10% fly ash and 15% metakaolin. On the other hand, the use of mineral additives above the optimum level caused the performance of the concrete to decrease. Then, the concrete compression strengths obtained at 7th, 28th, and 90th days and at 400, 600 and 800 °C temperatures are taken as the outputs of the ANN. The artificial neural network provided the closest results to experimental data. Moreover, to prove the predictive performance of ANN, a comparative analysis was made with GPR, SVM and LR and the smallest value of the RMSE value is obtained with the ANN model. Finally, a fivefold cross-validation criteria was used to objectively present the performance of the model.

Association of Dietary Retinol Intake and Serum Neurofilament Light Chain Levels: Results from NHANES 2013-2014.

There is increasing evidence suggesting that serum neurofilament light chain (sNfL) levels can be used as biomarkers for axonal injury. Retinol is recognized for its significant involvement in nervous system function, but the precise connection between dietary retinol and sNfL levels remains uncertain. Our objective was to investigate the relationship between dietary retinol intake and sNfL, and to find an optimal retinol intake level for neurological health. In the National Health and Nutrition Examination Survey (NHANES), conducted from 2013 to 2014, a cohort of 1684 participants who met the criteria were selected for the study. sNfL levels were measured from stored serum samples using a novel high-throughput immunoassay platform from Siemens Healthineers. Assessment of dietary retinol intake was performed by a uniformly trained interviewer through a 24 h dietary recall method. A generalized linear model was evaluated to assess the correlation between dietary retinol intake and sNfL concentrations. Furthermore, the nonlinear association between the two is further explored using restricted cubic spline (RCS) analysis. Upon adjusting for potential confounders, a 10% increase in dietary retinol intake was associated with a 3.47% increase in sNfL levels (95% CI: 0.54%, 6.49%) across all participants. This relationship was more pronounced in specific subgroups, including those under 60 years of age, non-obese, impaired estimated glomerular filtration rate (eGFR), and non-diabetic. In subgroup analysis, among those younger than 60 years of age (percent change: 3.80%; 95% CI: 0.43%, 7.28%), changes were found in non-obese participants (percent change: 6.28%; 95% CI: 2.66%, 10.02%), those with impaired eGFR (percent change: 6.90%; 95% CI: 1.44%, 12.65%), and non-diabetic patients (percentage change: 4.17%; 95% CI: 1.08%, 7.36%). RCS analysis showed a linear relationship between dietary retinol intake and sNfL levels. Furthermore, the positive correlation between the two was more significant after the inflection point, according to piecewise linear analysis. This current investigation uncovered a J-shaped relationship between dietary retinol and sNfL levels, suggesting that axonal damage can occur when dietary retinol intake increases more than a specific threshold. These findings need to be further confirmed in future prospective studies to determine the precise intake level that may trigger axonal injury.

Role of Hyperbaric Oxygen Therapy in Traumatic Brain Injury: A Systematic Review of Randomized Controlled Trials

Abstract Background Traumatic brain injury (TBI) is a significant public health concern. Standard care involves conservative management and pharmacological and surgical interventions. Hyperbaric oxygen therapy (HBOT) has emerged as a potential treatment for TBI, with varied findings in the literature. Our systematic review aims to comprehensively assess the efficacy and safety of HBOT in TBI management, addressing existing knowledge gaps and providing insights for clinical practice and future research. Methods A systematic literature search was performed in PubMed, SCOPUS, Central Cochrane Registry of Controlled Trials (The Cochrane Library), and ScienceDirect databases for the role of HBOT in TBI. We included studies involving randomized controlled trials (RCTs). Quasi-randomized controlled studies, prospective, retrospective observational studies, case series, case reports, letters, editorials, comments, animal studies, and studies from non-English literature were excluded. Results After identifying 306 articles, we narrowed it to 8 for qualitative synthesis. The studies were categorized into subgroups: those on patients with an acute history of cerebral injury and those with a history of mild TBI. The combined RCTs involved 651 patients (326 in the first subgroup, 325 in the second). Despite a uniform HBOT session duration of 60 minutes, variations in compression, decompression phases, and pressure used (1.5ATA to 2.5ATA) hindered meta-analysis comparability. Outcome measures differed, complicating comparisons. Overall, HBOT appears beneficial in the first group and less so in the second. Complications are primarily pulmonary, which include dyspnea, cyanosis, hyperoxic pneumonia, and increased fraction of inspired oxygen requirement. Conclusion Our study encountered challenges in reaching definitive conclusions due to outcome variability among the included studies. Despite mixed results, HBOT shows potential benefits for acute TBI patients. Conversely, our findings suggest the limited efficacy of HBOT for chronic traumatic brain injury patients. Further research is crucial, particularly exploring diverse HBOT treatment protocols to establish optimal pressure levels and the required number of sessions for effective outcomes

Magnum metal-on-metal uncemented total hip replacement: 8- to 18-year outcomes of 211 cases.

Reports of adverse reactions to metal debris contributed in part to a decline in use of large-bearing metal-on-metal total hip devices. We hypothesize an optimal trunnion design may reduce risk of this failure mode in large-bearing total hip arthroplasty systems. The purpose of this study is to report mid- to long-term outcomes for a single-surgeon series of 211 total hip arthroplasties using the large-bearing Biomet Magnum metal-on-metal system. Between December 2004 and January 2016, the primary surgeon performed 211 uncemented Magnum total hip arthroplasties in 181 patients. The average length of follow-up was 10.1 ± 3.5years (range 8-18years). Using failure of any component as the endpoint, the overall survivorship rate was 98.1% at 10years and 97.4% at 18years. These eight failures (3.8% of cohort) included one case of adverse wear-related failure (0.5%), two cases of acetabular ingrowth failure (0.9%), three cases of trunnion corrosion (1.4%), one failure of late infection (0.5%), and one inappropriate revision of components for trochanteric nonunion without instability (0.5%). Excluding failed cases, all components were radiographically stable with no radiolucencies. Except for the one wear failure, ion testing revealed that 97.2% of cases were within optimal whole blood metal ion levels with the remaining ion test results within acceptable levels. With the uncemented Magnum metal-on-metal total hip, we achieved 97.4% 18-year implant survivorship, exceeding the NICE criteria and registry benchmarks for implant survivorship. We observed a trunnion corrosion rate of 1.4% and no cases of instability. The single case of adverse wear-related failure was caused by acetabular component malposition.

Utilization of Moringa oleifera leaf meal as a protein source in diets for Cirrhinus mrigala: effects on growth, body composition, and hematology

IntroductionIn the current study, Cirrhinus mrigala was used as an animal model to investigate the impacts of Moringa oleifera leaf meal (MOLM) on their overall performance reared in six earthen ponds.MethodsIn this study, fishmeal (FM) was substituted with MOLM at various levels in the diet: 0% (control), 10, 15, 20, 25, and 30%, for a six-month feeding trial. A total of 270 fish with 15 fingerlings (15.31 ± 0.12 g/fish) stocked in each of the six earthen ponds in triplicates.ResultsWhen compared to other experimental and control groups, analyses revealed that fish given a diet having 10% MOLM had the highest growth performance (final weight: 422.32 g, weight gain: 406.97 g). Fingerlings fed a diet which substituted with 10% of FM with MOLM showed the greatest results for body composition (crude protein: 19.31%; crude fat: 3.01%). The results of hematology, i.e., WBCs: 7.65 × 103 mm−3, PLT: 58.38, hemoglobin level: 8.52 g 100 mL−1, PCV: 25.12%, MCHC: 30.45%, MCH: 48.81 pg., MCV: 159.50 fl, also showed that 10% MOLM was the optimum level for FM substitution. Furthermore, the outcomes of body mineralization (P, Ca, Na, Mn, Fe, Mg, Zn, K, and Cu, 1.06, 0.92%, 5.53 mg/g, 9.90 ug/g, 54.62 ug/g, 3.09%, 3.81 ug/g, 8.31%, and 3.76 ug/g respectively) also indicated that 10% level was the best.ConclusionConclusively, the current study found that substituting 10% of FM with MOLM in the diet of C. mrigala fingerlings improved growth performance, carcass, hematology, and mineral status.

Feasibility of satisfying projected biopower demands in support of decarbonization interventions: A spatially-explicit cost optimization model applied to woody biomass in the eastern US

Power generation from biomass (biopower) has experienced substantial growth in the United States. Although renewable and sustainably sourced biopower can reduce the carbon footprint of the electricity sector, there is a scarcity of analyses that simultaneously consider the financial feasibility and sustainability criteria of procured biomass. We developed a spatially-explicit optimization model to minimize the cost of meeting projected biopower demand while ensuring carbon neutrality and biomass sustainability constraints. The optimization model was applied to projected biopower demand scenarios in the eastern US, considering various public policy decarbonization interventions. Modeling woody biomass procured from local forests as the source of biopower was chosen due to its dominant role as a renewable energy source, regional availability, and lower risk of violating carbon neutrality objectives. Initially, we projected the net growth of woody biomass in trees and their carbon pools by 2035, as a function of biopower generation, utilizing data from 2009–2017. Subsequently, forecasted woody biomass and projected biopower demand through 2035 were employed to determine optimal levels of biopower generation and estimate the corresponding resource impacts within procurement forests. The results suggest the potential for substantial increases in sustainable biopower generation in the eastern US. However, the feasibility of this expansion depends on the continued economic viability of biopower generation in the future. It is worth noting that the largest increases, surpassing threefold, in biopower generation over the 2020–2030 decade could potentially compromise the carbon neutrality of locally procured woody biomass.

Uric acid, cognitive disorders, neurodegeneration

This article examines the role of uric acid (UA) in cognitive changes and neurodegeneration, focusing on its functions as an antioxidant and prooxidant. Research suggests that changes in serum UA levels may be associated with the development or delay of cognitive impairment, especially in the context of neurodegenerative diseases such as Alzheimer's disease. It was revealed that there is a relationship between the level of UA and the dynamics of cognitive functions, indicating the potential neuroprotective properties of UA. Particular attention is paid to the balance between the antioxidant and prooxidant properties of UA, which may play a key role in protecting neurons from damage. However, research results are not clear-cut, highlighting the need for further research to more fully understand the role of UA in cognitive processes. Determining the optimal serum UA level may be an important step in developing strategies for the prevention and treatment of cognitive impairment associated with neurodegeneration. Overall, these studies advance the understanding of the mechanisms underlying the interaction between uric acid metabolism and brain health.

Fog Computing and Industry 4.0 for Newsvendor Inventory Model Using Attention Mechanism and Gated Recurrent Unit

Background: Efficient inventory management is critical for sustainability in supply chains. However, maintaining adequate inventory levels becomes challenging in the face of unpredictable demand patterns. Furthermore, the need to disseminate demand-related information throughout a company often relies on cloud services. However, this method sometimes encounters issues such as limited bandwidth and increased latency. Methods: To address these challenges, our study introduces a system that incorporates a machine learning algorithm to address inventory-related uncertainties arising from demand fluctuations. Our approach involves the use of an attention mechanism for accurate demand prediction. We combine it with the Newsvendor model to determine optimal inventory levels. The system is integrated with fog computing to facilitate the rapid dissemination of information throughout the company. Results: In experiments, we compare the proposed system with the conventional demand estimation approach based on historical data and observe that the proposed system consistently outperformed the conventional approach. Conclusions: This research introduces an inventory management system based on a novel deep learning architecture that integrates the attention mechanism with cloud computing to address the Newsvendor problem. Experiments demonstrate the better accuracy of this system in comparison to existing methods. More studies should be conducted to explore its applicability to other demand modeling scenarios.

Vitamin D for the Prevention of Disease: An Endocrine Society Clinical Practice Guideline.

Numerous studies demonstrate associations between serum concentrations of 25-hydroxyvitamin D (25[OH]D) and a variety of common disorders, including musculoskeletal, metabolic, cardiovascular, malignant, autoimmune, and infectious diseases. Although a causal link between serum 25(OH)D concentrations and many disorders has not been clearly established, these associations have led to widespread supplementation with vitamin D and increased laboratory testing for 25(OH)D in the general population. The benefit-risk ratio of this increase in vitamin D use is not clear, and the optimal vitamin D intake and the role of testing for 25(OH)D for disease prevention remain uncertain. To develop clinical guidelines for the use of vitamin D (cholecalciferol [vitamin D3] or ergocalciferol [vitamin D2]) to lower the risk of disease in individuals without established indications for vitamin D treatment or 25(OH)D testing. A multidisciplinary panel of clinical experts, along with experts in guideline methodology and systematic literature review, identified and prioritized 14 clinically relevant questions related to the use of vitamin D and 25(OH)D testing to lower the risk of disease. The panel prioritized randomized placebo-controlled trials in general populations (without an established indication for vitamin D treatment or 25[OH]D testing), evaluating the effects of empiric vitamin D administration throughout the lifespan, as well as in select conditions (pregnancy and prediabetes). The panel defined "empiric supplementation" as vitamin D intake that (a) exceeds the Dietary Reference Intakes (DRI) and (b) is implemented without testing for 25(OH)D. Systematic reviews queried electronic databases for publications related to these 14 clinical questions. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology was used to assess the certainty of evidence and guide recommendations. The approach incorporated perspectives from a patient representative and considered patient values, costs and resources required, acceptability and feasibility, and impact on health equity of the proposed recommendations. The process to develop this clinical guideline did not use a risk assessment framework and was not designed to replace current DRI for vitamin D. The panel suggests empiric vitamin D supplementation for children and adolescents aged 1 to 18 years to prevent nutritional rickets and because of its potential to lower the risk of respiratory tract infections; for those aged 75 years and older because of its potential to lower the risk of mortality; for those who are pregnant because of its potential to lower the risk of preeclampsia, intra-uterine mortality, preterm birth, small-for-gestational-age birth, and neonatal mortality; and for those with high-risk prediabetes because of its potential to reduce progression to diabetes. Because the vitamin D doses in the included clinical trials varied considerably and many trial participants were allowed to continue their own vitamin D-containing supplements, the optimal doses for empiric vitamin D supplementation remain unclear for the populations considered. For nonpregnant people older than 50 years for whom vitamin D is indicated, the panel suggests supplementation via daily administration of vitamin D, rather than intermittent use of high doses. The panel suggests against empiric vitamin D supplementation above the current DRI to lower the risk of disease in healthy adults younger than 75 years. No clinical trial evidence was found to support routine screening for 25(OH)D in the general population, nor in those with obesity or dark complexion, and there was no clear evidence defining the optimal target level of 25(OH)D required for disease prevention in the populations considered; thus, the panel suggests against routine 25(OH)D testing in all populations considered. The panel judged that, in most situations, empiric vitamin D supplementation is inexpensive, feasible, acceptable to both healthy individuals and health care professionals, and has no negative effect on health equity. The panel suggests empiric vitamin D for those aged 1 to 18 years and adults over 75 years of age, those who are pregnant, and those with high-risk prediabetes. Due to the scarcity of natural food sources rich in vitamin D, empiric supplementation can be achieved through a combination of fortified foods and supplements that contain vitamin D.Based on the absence of supportive clinical trial evidence, the panel suggests against routine 25(OH)D testing in the absence of established indications. These recommendations are not meant to replace the current DRIs for vitamin D, nor do they apply to people with established indications for vitamin D treatment or 25(OH)D testing. Further research is needed to determine optimal 25(OH)D levels for specific health benefits.

DEEP LEARNING FOR AUTOMATIC CLASSIFICATION OF AVOCADO FRUIT MATURITY

Avocado (Persea Americana), a fleshy fruit with a single seed, has increased in popularity globally, especially in tropical and Mediterranean climates, thanks to its commercial and nutritional value. Rich in bioactive compounds, avocados contribute to the prevention and treatment of various diseases, including cardiovascular problems and cancer. Avocado production in Indonesia, for example, is showing a significant increase, reflecting the growing demand. Avocado ripeness affects shelf life and quality, making the determination of ripeness level a critical aspect of postharvest management. Skin color and pulp firmness change during storage, affecting quality and nutritional value. Proper classification of ripeness is important to reduce post-harvest losses, improve quality and optimize export costs. Recent research shows the use of technologies such as machine learning and YOLO (You Only Look Once) version 9 in real-time detection of avocado ripeness, offering innovative solutions to reduce post-harvest losses and improve distribution efficiency. This approach not only benefits farmers and consumers but also ensures consumer satisfaction and reduces economic losses. This study highlights the importance of real-time detection in monitoring avocado ripeness, where the training process was conducted for 89,280 iterations resulting in a new model for avocado ripeness detection. The final model has a mean Average Precision (mAP) validation value of 84.3%, mAP 84.3% signifies the optimal level of accuracy in object recognition in avocado fruit maturity images using the YOLO model that has undergone an intensive training process.

Improving the Magnetic Properties of Electrodeposited Fe-55wt%Ni Alloy via Abnormal Grain Growth Induced by Second-Phase Particles

In this study, pulse reverse current electrodeposition was employed to fabricate Fe-55 wt%Ni alloy. Abnormal grain growth induced by the precipitation of second-phase particles during annealing resulted in a coarse-grained electrodeposited Fe-55 wt%Ni alloy. The grain evolution process during annealing was investigated, and the temperature for abnormal grain growth was determined through the high-temperature confocal microscopy technique. Subsequently, the mechanism of abnormal grain growth was investigated. The results suggest that abnormal grain growth occurs at approximately 1003 K, attributed to the preferential growth of (110) oriented grains due to local strain energy changes caused by the precipitation and coarsening of the second-phase particles (MnS). The preferred orientation of the grains transitioned from (111) to (110). Annealing at 1073 K for 2 h resulted in an average grain size increase to approximately 200 μm. Under these conditions, the magnetic properties of the alloy reached optimal levels, with a magnetization saturation strength of 186.7 emu g−1 and a coercivity of less than 1 Oe. This research presents a novel approach to preparing coarse-grained electrodeposited Fe-Ni alloys, significantly enhancing their magnetic properties.

Enchasing Production Planning and Inventory Management : A Quantitative Approachto Forecasting for Bottled Mineral Water Products at PT Arima

PT Arima is a company engaged in the production of bottled mineral water. The demand for bottled mineral water is experiencing fluctuations, with demand increasing at the end, so companies must carry out optimal production planning to avoid stock buildup. Production planning at PT Arima is carried out by identifying demand levels using quantitative forecasting methods, namely moving average (n = 3) and exponential smoothing (α = 0.05) to maintain optimal production levels and stock in the warehouse does not accumulate. The results of processing the level of forecasting accuracy using 12 months of demand data obtained using the moving average method showed that the production level = 39,733 boxes in January 2024. MAD = 3733.22; MSE = 21566024.78 and MAPE = 0.10. Based on the exponential smoothing method, the production level = 38,081 boxes in January 2024. MAD = 5773.50; MSE = 43466303 and MAPE = 0.15. Based on the results of comparing the MAPE values ​​of the two forecasting methods, the lowest MAPE value was obtained, namely the average method (n=3) of 0.10 with the production level of bottled mineral water to maintain optimal supply conditions in January 2024 of 39,733 boxes.

Diagnostic performance of the bioline dengue duo rapid test on symptomatic patients assisted at Armed Forces Hospital (Hfa) in Brasília, Brazil.

Dengue necessitates accurate diagnosis. Rapid tests such as Bioline™ DENGUE DUO have gained traction, but validation in specific populations is essential. This study aimed to evaluate the performance of the Bioline™ test, alongside assessing the socio-epidemiological profile of symptomatic patients in a Brasília Military Hospital. The serum of 404 symptomatic patients was analyzed by the Bioline™ DENGUE DUO test, followed by Dengue virus detection and discrimination of the four serotypes by RT-qPCR. Accuracy was assessed using parameters including sensitivity (S), specificity (E), positive and negative predictive values (PPV and NPV), and positive (RV +) and negative (RV-) likelihood ratios. The NS1 component exhibited a sensitivity of 70.37%, a specificity of 97.30%, and an overall efficiency of 90.10% when compared to RT-qPCR as the gold standard. The IgM component demonstrated a sensitivity of 26.85%, a specificity of 89.53%, and an overall efficiency of 72.77% when compared to RT-qPCR as the gold standard. The IgG component demonstrated a sensitivity of 23.15%, a specificity of 68.92%, and an overall efficiency of 56.68% when compared to RT-qPCR as the gold standard. Several rapid tests are commercially available. However, considering variations across regions and demographic groups, it is important to question their accuracy in specific populations. Rapid tests are important screening tools, but they can have limitations for the certainty of diagnosis. Bioline™ DENGUE DUO displayed good specificity, but sensitivity was slightly below optimal levels. While helpful for confirming dengue, improvements are needed to effectively rule out the disease.

The impact of vitamin D levels on the progression-free survival of women with hormone receptor-positive, HER2-negative metastatic breast cancer treated with CDK4/6 inhibitors.

e13075 Background: Cyclin-dependent kinase 4/6 inhibitors (CDK4/6i) halt the transition from the G1 to the S phase, a process governed by the hyperphosphorylation of the retinoblastoma (Rb) protein. Similarly, vitamin D3 has been demonstrated to induce cell cycle arrest through the inhibition of various cyclin-dependent kinases, including those responsible for phosphorylating the Rb protein. Therefore, we hypothesized that suboptimal vitamin D levels may compromise the efficacy of CDK4/6i used to treat hormone receptor (HR)-positive, HER2-negative metastatic breast cancer (MBC). Methods: We conducted a retrospective single-center study of women diagnosed with HR-positive, HER2-negative MBC and treated with any CDK4/6i between 2020 and 2023. Eligible patients were those who received at least one cycle of CDK4/6i, had a baseline 25-OH vitamin D measurement, and had a follow-up period of more than three months. Independent samples T-test, X2, and Fisher’s exact tests were used to evaluate associations between variables. Progression-free survival (PFS) was calculated using the Kaplan-Meier method and compared according to vitamin D levels using the log-rank test. Results: Among 31 patients, the mean age at diagnosis was 53 years (SD 14), 24 (77%) received CDK4/6i in the first-line setting, and 9 (29%) had suboptimal vitamin D levels (&lt;20 ng/ml). Clinicopathological features based on vitamin D levels are shown (Table). The type of iCDK was different according to vitamin D levels (p = 0.036), with no other observed differences between groups. With a median follow-up of 26 months (95% CI 17-35) since iCDK initiation, median PFS was not reached for the entire cohort. A univariate analysis revealed that patients with suboptimal vitamin D levels had an inferior median PFS compared to patients with optimal levels (14 months [95%CI 4-24] vs. not reached [p=0.016]). Notably, no other parameter was associated with PFS in univariate analyses. Conclusions: In this cohort of Mexican patients with HR-positive, HER2-negativeMBC, suboptimal vitamin D levels adversely impacted PFS. Given the retrospective nature of this study and the limited number of patients, we emphasize the importance of studying these findings prospectively. [Table: see text]

Cost-optimization based target reliabilities for design of structures exposed to fire

Adequacy of structural fire design in uncommon structures is conceptually ensured through cost-benefit analysis where the future costs are balanced against the benefits of safety investment. Cost-benefit analyses, however, are complicated and computationally challenging, and hence impractical for application to individual projects. To address this issue, design guidance proposes target reliability indices for normal design conditions, but no target reliability indices are defined for structural fire design. We revisit the background of the cost-optimization based approach underlying normal design target reliability indices then we extend this approach for the case of fire design of structures. We also propose a modified objective function for cost-optimization which simplifies the evaluation of target reliability indices and reduces the number of assumptions. The optimum safety level is expressed as a function of a new dimensionless variable named “Damage-to-investment indicator” (DII). The cost optimization approach is validated for the target reliability indices for normal design condition. The method is then applied for evaluating DII and the associated optimum reliability indices for fire-exposed structures. Two case studies are presented: (i) a one-way loaded reinforced concrete slab and (ii) a steel column under axial loading. This study thus provides a framework for deriving optimum (target) reliability index for structural fire design which can support the development of rational provisions in codes and standards.

Anticoagulant Therapy in Pregnant Women with Mechanical Heart Valves: Italian Federation of Centers for Diagnosis and Surveillance of the Antithrombotic Therapies (FCSA) Position Paper.

The management of anticoagulant therapy in pregnant women with mechanical heart valves (MHVs) is difficult and often challenging even for clinicians experienced in the field. These pregnancies, indeed, are burdened with higher rates of complications for both the mother and the fetus, compared to those in women without MHVs. The maternal need for an optimal anticoagulation as provided by vitamin K antagonists is counterbalanced by their teratogen effect on the embryo and fetus. On the other hand, several concerns have been raised about the efficacy of heparins in pregnant women with MHVs, considering the high risk of thrombotic complications in these patients. Therefore, numerous clinical issues about the management of pregnant women with MHVs remain unanswered, such as the selection of the best anticoagulant agent, the optimal anticoagulation levels to be achieved and maintained, and the evaluation of long-term effects for both the mother and the fetus. Based on a comprehensive review of the current literature, the Italian Federation of the Centers for the Diagnosis and the Surveillance of the Antithrombotic Therapies (FCSA) proposes experience-based suggestions and expert opinions. Particularly, this consensus document aims at providing practical guidance for clinicians dealing with pregnant women with MHVs, to optimize maternal and fetal outcomes while guaranteeing adequate anticoagulation. Finally, FCSA highlights the need for the creation of multidisciplinary teams experienced in the management of pregnant women with MHVs during pregnancy, delivery, and postpartum, in order to better deal with such complex clinical issues and provide a comprehensive counseling to these patients.