Percent Improvement Research Articles

Investing in the care services sectors for employment generation and gender-inclusive growth: the case of Turkey

Abstract The care crisis intersects with economic, social, and refugee crises, necessitating focused attention to bolster care infrastructure and address the multifaceted challenges. Women bear a disproportionate burden of unpaid domestic work, exacerbating gender inequalities in labor markets and education. This paper applies the International Labour Organization–UN Women (2021) policy tool to Turkish data, estimating coverage gaps in education and healthcare, associated costs, and employment generation potential in the care sectors and related sectors. We identify a coverage gap in education affecting 5.8 million children. The required investment to address this gap is estimated at 2.28 percent of gross domestic product (GDP). In all, 303,000 healthcare workers are needed, requiring an investment of 1.23 percent of GDP. These investments have the potential to generate 1.740 million direct and 152,000 indirect jobs. This would result in a substantial 6.7 percent increase in total employment. Considering the current gender composition, women are expected to fill 65 percent of these jobs, leading to a 14 percent improvement in female employment. Incorporating 3.7 million Syrian refugees, Turkey’s investment cost rises to 3.74 percent of GDP, creating 1.878 million new direct jobs – an 8 percent boost over the non-inclusive scenario. Prioritizing public investments in care services promises to promote gender equality, human development, and inclusive economic growth.

Surgical management of chronic orchialgia after inguinal hernia repair.

Orchialgia is a rare but significant complication experienced after open and minimally invasive inguinal hernia repairs with or without mesh. Causes have been theorized to include trauma to the spermatic cord, mesh-induced inflammation, vascular insult, fibrosis or mesh scarring of the cord, and neuropathic injury to the autonomic paravasal nerve fibers supplying the testicle. Though less frequently described than inguinodynia, orchialgia can be severely debilitating. Retrospective review of consecutive adult patients who underwent surgical intervention for inguinodynia with coexisting orchialgia between September 2011 and April 2023. Primary outcome was percent improvement of orchialgia, reported by patients in postoperative follow up. Secondary outcomes included surgical approach, type of neurectomy performed, the need for orchiectomy, and remedial operations. A total of 173 patients were identified. Of this cohort, 89.6% (155) underwent paravasal neurectomy, 96% (166) underwent inguinal neurectomy, 14% (24) underwent orchiectomy, and 5.2% (9) underwent vasectomy. These operations were conducted via an open approach in 18% (31) and via hybrid approach in 62% (108). Improvement was noted in 99% (173) of cases, with greater than 50% improvement in pain in 64% (111). Orchialgia is less common than inguinodynia but is encountered in approximately 10% of patients with chronic pain after inguinal hernia repair resulting from all variants of operative repairs. Utilization of a patient-tailored surgical approach to address the likely mechanisms of testicular pain after prior inguinal hernia repair allows for favorable surgical results. A careful examination and assessment of the potential mechanisms of orchialgia after inguinal hernia repair allows for identification of specific causes and potential options for remediation.

Permainan Tradisional Boy-Boyan: Upaya Peningkatan Kemampuan Mengenal Angka dalam Bahasa Madura

The study aims to determine the development of number recognition skills in Madurese language for children aged 5-6 years and to assess the percentage improvement in number recognition skills in Madurese among Group B children at Tanjung Jati Kindergarten through the traditional game "boy-boyan" during the 2022/2023 academic year. The research method used is Classroom Action Research (CAR) based on the Kemmis and McTaggart model. The classroom action research was conducted in four cycles, each consisting of four stages: planning, implementation, observation, and reflection. The subjects and data sources for this study were Group B children at Tanjung Jati Kindergarten, totaling 9 children, consisting of 3 boys and 6 girls. Data collection techniques in this study included observation and documentation. The data analysis techniques used were qualitative and quantitative analysis. The results of the classroom action research show an improvement in the children's ability to recognize numbers in Madurese at each stage. This can be seen from the pre-cycle results, where the children's speaking ability was generally in the "Starting to Develop" category at 38.95%. No children had reached the "Developing as Expected" or "Developing Very Well" categories. However, after the learning process through the traditional game of "boy-boyan," there was an increase in speaking skills. In cycle 1, the children's speaking ability reached the "Developing as Expected" category at 70.4%. In cycle 2, their speaking ability reached the "Developing Very Well" category at 88.9%. Based on the results of this classroom action research, the teacher was able to improve the children's ability to recognize numbers in Madurese in Group B at Tanjung Jati Kindergarten through the traditional game "boy-boyan."

Real-world improvement in ultra-low dose thoracic CT scores, systemic inflammatory markers, and patients reported outcome measures post elexacaftor/tezacaftor/ivacaftor treatment

BackgroundClinical trials with elexacaftor/tezacaftor/ivacaftor (ETI) in people with cystic fibrosis (PWCF) were associated with significant improvements in percent predicted forced expiratory volume in one second (ppFEV1), sweat chloride, weight and quality of life in the respiratory domain from the cystic fibrosis questionnaire revised (CFQ-R). Limited data exists on its effect on structural lung disease and inflammatory cytokines.MethodsIn a real-world setting with 61 PWCF, we prospectively recorded FEV1, sweat chloride, body mass index (BMI), and CFQ-R at baseline, 3- and 6-months post commencement of ETI. In addition, changes in ultra-low dose computed tomography (ULD-CT) Bhalla score, peripheral-blood and sputum inflammatory-cytokines, and patient-reported outcome measures (PROMs) including sino-nasal outcomes test-22 (SNOT-22), and fatigue scale (FACIT-Fatigue).ResultsSignificant improvements in ppFEV1 (p=0.0001), sweat chloride (p<0.0001), and BMI (p=0.0147) post-ETI treatment were noted. ULD-CT scores demonstrated reductions in peri-bronchial thickening, mucus plugging, and total Bhalla score (p<0.001), and improvements in emphysema extent (p<0.0027). Improvements in systemic inflammatory status were seen with a reduction in interleukin (IL)-1β (p=0.0049), IL-6 and IL-8 (p<0.0001), and increasing IL-10 (p=0.004). Sputum cytokine analysis was not performed as only 4 of 61 patients spontaneously expectorated sputum post ETI. PROMs improved significantly for the SNOT-22 (p<0.0001), FACIT-Fatigue score (p=0.0001), and CFQ-R domains including; respiratory(p<0.0001), physical (p=0.007), vitality (p=0.0004), treatment burden (p=0.0028), health (p=0.0007), social (p=0.0073), weight (p=0.0068), and role/school domain (p=0.0018).ConclusionETI responders, demonstrate significant improvements in CT imaging, circulating cytokines and PROMs which may be of further use evaluating CFTR modulation treatment response.

Impact of Alternating Exercise Intensity Interventions on the Physical and Mental Health of Middle-Aged and Young Men

Exercise interventions have been shown to improve health levels; however, the effects of different exercise intervention methods remain to be studied. This study designed seven types of exercise interventions, including high-intensity interval training (HIIT), moderate-intensity continuous training (MICT), low-intensity steady-state training (LISS) and various alternating combinations. A 16-week follow-up investigation analyzed the impact of these different exercise interventions on participants’ physical and psychological health. The results indicate that exercise interventions are an effective health promotion method, significantly reducing BMI and body fat percentage, improving metabolic health, cardiovascular health, and cardiorespiratory function and enhancing quality of life and psychological state. Specifically, the HIIT-LISS combination performed best in reducing BMI, regulating blood lipids, and increasing VO2max. Furthermore, HIIT demonstrated the most significant improvement in body fat percentage and blood pressure, with body fat reduced by up to 5.65% and blood pressure decreasing by nearly 9 mmHg, whereas the MICT-LISS showed better effects on heart rate. Although the improvement in psychological health from different exercise interventions was not significant, it increased by over 10% compared to the control group. Overall, the combined effect of HIIT and MICT was found to be the most effective, with mixed exercise interventions showing more pronounced effects on physical health indicators.

Evaluation of learning abilities after role-playing method: Comparing outcomes of Active and Observer.

During a role-play simulation session, despite supporting observer learning, educators disagree about whether the learning outcomes of observers are like those of active participants. Evaluation of the degree of knowledge acquisition by these two types of learners during the same role-play session. We carried out a quasi-experimental pre-post intervention study to identify the learning outcomes among learners serving in observer (group 1) and active (group 2) roles during a role-play simulation session. The role play involved 29 learners. In both groups, 65% of learners improved their overall score. The median post-test score was significantly higher in both groups (p=0.0001). Likewise, learners in group 1 (p=0.023) and in group 2 (p=0.008) showed an improvement in the overall score in the within-group evaluation study. The between-group evaluation study showed no statistically significant difference in overall score improvement (p=0.58), number of learners improving (p=0.05) or percentage improvement (p=0.3). Based on these findings, it is suggested that role-playing method is effective in achieving student-learning outcomes regardless of their status as active or observer.

Seed and foliar application of nano-selenium improves sesame triacylglycerols and oil yield via photosynthetic pigment and enzymatic and chemical antioxidant enhancement revealed by spectrophotometric, UHPLC-analysis and chemometric modeling.

The current study aimed to investigate the effects of plant-mediated selenium nanoparticles (SeNPs) on plant growth, photosynthetic pigments, antioxidant activity, and the triacylglycerol profile of sesame (Sesamum indicum L.). The green synthesis of SeNPs was achieved using garlic extract, resulting in spherical nanoparticles with an average size range of 70-75 nm. Three SeNP treatments (T3, 30 ppm; T4, 40 ppm; and T5, 50 ppm) were applied through seed and foliar spray on six sesame varieties (V1, TS-5; V2, TH-6; V3, Til-18; V4, Niab Millennium; V5, Niab Pearl; and V6, NS-16). All enzymatic antioxidant parameters showed an increase in the treated groups, such as SOD (74.4% in V1 at T4), POD (43% in V5 at T5), APX (62% in V1 at T3), and GPX (31.56% in V3 at T4). CAT showed the highest percentage improvement in T5 for V1, V2, V4, and V5, while V3 and V4 exhibited the highest values at T4. Likewise, seed antioxidant parameters also showed increase in antioxidant activity, highest total phenolic content (6.06 mg GAE/g) was found at T5 treatment with percent increase of 27.41%, but the highest percent increase was found to be at T4 treatments in V1 with increase of 46.83%. Percent oil yield was also noted to be higher as highest percent (60%) oil yield was obtained at T4 treatment in V3. Ultra High Performance Mass-Spectrometry (UHPLC-MS) analysis and chemometric modeling suggested a total of 10 triacylglycerol (TG) biomarkers separating untreated groups, with higher relative abundance values at T4 and T5 treatments compared to control. PCA and correlation analysis showed clustering of untreated groups from T4 and T5, which suggests that these two treatments result in higher accumulation of oil. A generalized linear model with ANOVA showed a highly significant impact of treatments on all the growth and oil parameters, with significance involvement of varieties. The interaction between variety and treatment showed no significant effect on the growth and oil biomarkers of sesame. However, it can be concluded that the T4 and T5 treatments (40 ppm and 50 ppm) of SeNPs, applied through seed and foliar methods, have a strong influence on the overall growth and oil yield of sesame. This warrants further transcriptomic and molecular analysis to gain deeper insight into the mechanisms of action of SeNPs.

Efficacy of Treatments in Reducing Facial Erythema in Rosacea: A Systematic Review.

Rosacea is a chronic inflammatory skin condition that affects over 5% of individuals worldwide. Its clinical presentation is characterized by an array of features, including erythema, papules and pustules, phymatous changes, telangiectasia, and ocular manifestations. Specifically, the multifaceted manifestation of erythema varies widely in intensity and distribution. Factors contributing to pathogenesis include neurovascular dysregulation, increased levels of pro-inflammatory mediators, and aberrant vasodilation. Erythema management plays an important role in reducing the psychosocial burden associated with rosacea and improving overall quality of life. Cochrane CENTRAL, Medline, and Embase databases were searched from inception to September 2023 and included 33 clinical trials reporting on a total of 7411 rosacea patients (74.1% female) and 21 different topical or systemic treatments. The mean age was 48.8 years (range, 18-83 years), and the mean time to outcome assessment was 8.1 weeks (standard deviation, 4.1 weeks). Treatment efficacy was assessed by outcome measures including percent improvement from baseline on 4- and 5-point scales, clinician erythema assessment (CEA) success (improvement ≥1 point), and CEA and patient self-assessment success (improvement ≥1 point). Pooled effect sizes for each treatment were calculated as a weighted average based on the number of patients in each study. The most effective topical treatments for reducing erythema include sodium sulphacetamide and sulphur, praziquantel, metronidazole, and B244 spray (Nitrosomonas eutropha). The most effective systemic treatment was paroxetine. Our findings highlight the varying efficacy of treatments in addressing the erythema in rosacea, recognizing the nuances of clinical presentations.

IoT-Enabled Secure and Scalable Cloud Architecture for Multi-User Systems: A Hybrid Post-Quantum Cryptographic and Block Chain-Based Approach towards a Trustworthy Cloud Computing

Cloud computing remains one of the most significant advancements in resource provision to organizations in the latest decades since they initiate conveniences on demand access. The adoption of the IoT has brought about a new era of collaborative computing by employing a pool of linked smart sensors and devices that will produce and analyze great amounts of data, thus creating new related problems in terms of size and security, hence increasing even more the importance of traditional security measures. Therefore, in this paper, we synthesize a new SSCA that combines IoT and cryptographic mechanisms, to build highly available and secure cloud systems, which makes these systems multi-users and fully usable by many users at the same time. The design resolves to a distributed structure where sever al cloud nodes will address user s requests proficiently and it uses Multicast and Broadcast Rekeying Algorithm (MBRA) to maintain the privacy and the confidentiality of the users’ detail, employing a cryptosystem that integrates MBRA, Post Quantum Cryptography (PQC) and block chain. The architecture using IoT devices collects data from the distributed sensing resources through the data storage layer; it enforces the security integrity of the information collected by employing the MBRA-PQC encryption algorithms; the blockchain provides the security for the confidential data by storing it in unalterable and dispersed registers. The proposed approach is then demonstrated with different data sets and its performance is measured based on the response time, the throughput and scalability, security and reliability. The outcome of the expressions reveals the efficiency of the proposed SSCA compared to MHE-IS-CPMT as it reduced by 1. 67 seconds and 0. 97 seconds at 250 and 1000 devices respectively. Similarly, the result as AUC value for SSCA showed a better improvement than the MHE-IS-CPMT, EAM, SCSS, and SHCEF models with improvements in percent at 25-user level: 6. 30%, 6. 90%, 7. 60%, and 7. 30%, respectively as well as; at 50-user level: 5. 20%, 9. 30%, 11. 50%.

A Semantic and Optimized Focused Crawler Based on Semantic Graph and Genetic Algorithm

A focused crawler automatically retrieves, organizes, and extracts specific topic-related information from the internet for analysis and application. Currently, most focused crawlers assess the relevance of web pages to a given topic through methods such as keyword matching, semantic analysis, and link structures. However, these existing focused crawlers suffer from issues such as misleading directions and reduced accuracy due to the lack of semantic analysis of topic terms, as well as biased computation of topic relevance caused by the absence of effective weighting factors. To solve the above-mentioned problems, this study proposes a semantic and optimized focused crawler based on Semantic Graph and Genetic Algorithm. The proposed crawler eliminates ambiguous terms by constructing a semantic graph, optimizes the weighting factors of topic relevance with asymmetry by using a genetic algorithm, and combines both above two points to predict the priority of each unvisited hyperlink. The experiment results indicate that the proposed SG-GA Crawler improves the evaluation indicators compared with the other three focused crawlers, including VSM Crawler, SSRM Crawler, and SG Crawler. More specifically, the percentage improvement achieved by the proposed method exceeds 19%, 19%, and 13% in terms of three evaluation indicators, including the number of relevant web pages, acquisition rate, and average relevance, respectively. In conclusion, the proposed focused crawler can grab more quantity and higher quality topic-related web pages from the Internet.

Fustin, a Potent Phytochemical, Attenuates Scopolamine-induced Memory Impairment and Neurodegeneration by Modulating Neuroinflammation and Neurotransmitters.

Fustin, a photogenic flavanol found in the plant Rhus verniciflua Stokes, has been involved in multiple disease ailments and has a beneficial pharmacological effect and a history of use in traditional medicine. The present research aimed to study the impact of fustin on scopolamine (SCOP)-induced memory impairment and neurodegeneration by modulating neuroinflammation and neurotransmitters in rats. A total of 30 healthy Wistar rats were allocated into five groups (n=6). Group I- served as control and received saline solution (1mL/kg i.p.), group -II- fustin (100 mg/kg, orally), group -III -SCOP (1 mg/kg, i.p.), and group -IV and V were given fustin (50 and 100 mg/kg/p.o.) with SCOP (1 mg/kg, i.p.) for 14-days. After 14 days, 2 hours after SCOP injection, the Y-maze and Morris water maze (MWM) tests were performed. After behavioral tests rats were subsequently euthanized, and brain supernatants were used to estimate choline-acetyltransferase (ChAT), acetylcholinesterase (AChE), antioxidant [superoxide dismutase (SOD), catalase (CAT), and glutathione (GSH)], and total protein, oxidative stress markers [nitrate and malondialdehyde (MDA)], pro-inflammatory markers [tumor necrosis factor (TNF-α), and Interleukins-1β (IL-1β) and IL-6]. Also, neurotransmitters such as serotonin (5-HT), dopamine (DA), ϒ-amino butyric acid (GABA), acetylcholine (Ach), and noradrenaline (NA) contents were performed. Fustin exhibited substantial behavioral improvement in the Y-maze measures spontaneous alterations percentage (SA%) and decreased latency time following the acquisition and prolonged time spent in the probe trial in the MWM test. Moreover, fustin inhibits enhanced neuroinflammatory cytokines and oxidative stress markers and improves the neurotransmitters. The findings of this study suggest that fustin inhibits SCOP impact on cognitive abilities in rats. The present investigation demonstrates that fustin, a potent phytochemical, effectively mitigated the behavioral and physiological changes induced by SCOP in rats. This was primarily achieved by modulating the levels of inflammatory response and neurotransmitters.

Enhancing Soil Texture and Bulk Density Mapping Using Soil Grids and Machine Learning: A Comparative Analysis with Observed Data

Digital soil mapping plays a crucial role in understanding soil variability and informing sustainable land management practices. This study focuses on the Kurdistan Region of Iraq (KRI), evaluating the accuracy of SoilGrids, a global-scale soil mapping initiative, and exploring the efficacy of machine learning algorithms in refining soil properties estimations. The aim of this research was to assess and represent the physical parameters of soils effectively by comparing ground truth soil sampling data with data obtained from SoilGrids regarding clay, silt, and sand fractions and bulk density. Comparative analyses were conducted between ground truth soil sampling data and SoilGrids predictions, revealing significant differences across soil mineral fractions including clay, silt, sand fractions, and bulk density. The results showed that the mean clay fraction in the ground truth dataset differed notably from SoilGrids estimation, with a Mean Absolute Deviation (MAD) of 124.0 g kg-1 and Root Mean Square Error (RMSE) of 152.5. However, the integration of machine learning algorithms, particularly the Extreme Gradient Boosting (XG Boost) algorithm, showed promising results in improving accuracy. The XG Boost algorithm exhibited a relatively low MAD of 97.9 g kg-1 for clay fractions, indicating a better approximation of observed values compared to SoilGrids. Significant percent improvements in RMSE and Mean Absolute Percentage Error (MAPE) values were observed across soil fractions and bulk density measurements, ranging from approximately 15% for clay to 35% for sand fractions and 20% for bulk density. These findings highlight the importance of integrating advanced mapping techniques and machine learning algorithms to enhance soil mapping methodologies. Moving forward, efforts to expand ground truth datasets through targeted soil sampling campaigns and develop international collaboration initiatives will be crucial for improving the accuracy and reliability of soil mapping products in the KRI. By incorporating advanced mapping approaches, we can better support sustainable land management practices and environmental conservation efforts in the region.

Effects of a Six-Month Physical Activity Program on Health Risk Factors and Body Composition Among Overweight and Obese Middle-Aged Adults.

Introduction. Physical activity is vital for preventing and managing lifestyle-related diseases, which pose significant health and socio-economic challenges. This study aimed to evaluate the effects of a six-month supervised physical activity program on health risk factors and body composition in middle-aged individuals with overweight or obesity. Methods. The study involved 166 men and women aged 30 to 65 years, with a body mass index (BMI) ranging from 26 to 35 and moderate to severe health risks. Participants of the study were engaged in a six-month physical activity training program designed in accordance with World Health Organization guidelines. Comprehensive assessments were performed at baseline and after the intervention, including measurements of various anthropometric and body composition parameters, as well as evaluations of functional performance. Fitness tests were also conducted to assess participants' physical capacity and to monitor improvements throughout the training period. Results. Baseline measures of body mass composition and age demonstrated a strong positive correlation with visceral fat rating (VFR) in both men (r = 0.364, p < 0.001) and women (r = 0.420, p = 0.002). Following the six-month training program, participants exhibited an average improvement of 30% (p < 0.001) in their Cooper endurance test results. The physical activity intervention positively impacted body mass index (BMI) and various body composition metrics, including fat mass, VFR, and muscle mass, across all participants and most subgroups (gender, BMI, and age). In males, training at higher maximum heart rate (HRmax) zones significantly contributed to a reduction in the percentage of fat mass (80-89% HRmax) and an increase in the percentage of muscle mass (70-79% and 80-89% HRmax). Conclusions. The study indicates that a six-month supervised physical activity program significantly improves health risk factors and body composition (visceral fat reduction and improvement in percent of fat and muscle mass) among middle-aged individuals with overweight or obesity. Therefore, we advocate for the integration of structured physical activity interventions into healthcare practices to effectively enhance health outcomes in this population.

Safety and Efficacy of Moderate-intensity statin plus ezetimibe versus high-intensity statin monotherapy in patients with atherosclerotic cardiovascular disease: a meta-analysis

Abstract Background Atherosclerotic cardiovascular disease (ASCVD), affects approximately 18.6 million individuals worldwide, poses an important healthcare challenge. Despite the established efficacy of both high-intensity statin monotherapy (HIS) and moderate-intensity statin plus ezetimibe (MIS+EZT) in ASCVD management, the optimal treatment strategy remains unclear. Purpose This meta-analysis seeks to assess the impact of moderate-intensity statin plus ezetimibe (MIS+EZT) versus high-intensity statin monotherapy (HIS) on LDL &amp;lt; 70mg/dl; Total Cholesterol; LDL; High Density Cholesterol (HDL) and triglycerides levels. Our goal is to synthesize the existing evidence and pinpoint areas that warrant further investigation. Methods A thorough literature search was conducted across PubMed, Scopus, Web of Science, and the Cochrane databases, focusing on studies that compared the effects of moderate-intensity statins plus ezetimibe with high-intensity statin monotherapy in ASCVD patients. Results In the 13 included studies, involving 8,592 patients, of which 4,525 (52.67%) received moderate-intensity statin plus ezetimibe treatment. The follow-up period ranged from 12 to 219 weeks, with participant ages varying from 66 to 76.5 years in the MIS+EZT group and from 67 to 75.9 years in the HIS group. Analysis revealed significant MIS+EZT-associated with greater percentages in Low Density Lipoprotein (LDL) &amp;lt; 70 (Odds Ratio (OR) 1.76; 95% CI [1.26; 2.45]; p=0.001; I²=73%), LDL reduction (Mean Difference (MD) -5.05 mg/dL; 95% CI [-9.02;-1.07]; p&amp;lt;0.013; I²=56%;); Total Cholesterol reduction (MD -7.91 mg/ dL; 95% CI [-14.90; -0.91]; p&amp;lt;0.027; I²=60%); Triglycerides reduction (MD -8.20 mg/ dL; 95% CI [-13.05; -3.35]; p&amp;lt;0.001; I²=2%;); There was no statistical difference between groups in Drug Adverse reaction (Risk Ratio (RR) 1.19; 95% CI [0.79; 1.78]; p=0.404; I²=0%); and Drug intolerance (RR 0.78 ; 95% CI [0.32; 1.92]; p=0.584; I²=35%). Conclusions This meta-analysis underscores the effectiveness of MIS+EZT in enhancing significant clinical outcomes for ASCVD patients, as evidenced by improvements in a greater percentage of patients achieved the LDL &amp;lt;70 target, LDL, Total Cholesterol and Triglycerides levels . Importantly, there were no significant differences in the occurrence of overall adverse events and adverse drug reactions between the two groups.

Prognostic significance of right ventricle to pulmonary artery coupling acute improvement after mitral transcatheter edge-to-edge repair

Abstract Background Transcatheter Edge-to-Edge Repair (TEER) of mitral valve is a valid treatment option for severe mitral regurgitation. The right ventricle is acutely affected by early hemodynamic changes following the correction of significant mitral regurgitation. Echocardiographic parameters of the right chambers could have a prognostic impact even in a periprocedural setting. In particular, right ventricle to pulmonary artery coupling improvement may be of pivotal importance, as this parameter is a validated marker of right ventricle function. Purpose To evaluate the prognostic impact of early improvement of right ventricle to pulmonary artery coupling assessed by means of the Tricuspid Annular Plane Systolic Excursion/Pulmonary Artery Systolic Pressure (TAPSE/PASP) ratio after TEER. Methods This retrospective single centre study included patients treated with TEER in our hospital from 2015 to 2023. Transthoracic echocardiography was performed before and shortly after device positioning. Acute effects of TEER on echocardiographic parameters were assessed by paired samples t-test. Diagnostic accuracy of the percent variation in the TAPSE/PASP ratio was assessed by means of receiver-operating characteristics analysis. Prognosis was evaluated by Kaplan-Meier analysis. Results The study included 95 patients (age 78 ± 10 years; 63% men; BMI 25 ± 5 kg/m2) with severe or moderate-to-severe mitral regurgitation. Mean baseline Left Ventricle (LV) ejection fraction was 45 ± 16%, LV end-diastolic volume was 157 ± 62 ml and effective regurgitant orifice area was 41 ± 25 mm2. Post-procedural echocardiographic assessment showed early improvement of LV end-diastolic diameter (p &amp;lt; 0.001), LV end-diastolic volume (p = 0.025), LV stroke volume (p &amp;lt; 0.001), LV global longitudinal strain (p &amp;lt; 0.001), right ventricle free wall longitudinal strain (p &amp;lt; 0.001) and PASP (p = 0.002). Percent improvement of TAPSE/PASP ratio showed a sufficient diagnostic accuracy in predicting a composite outcome of hospitalisation for heart failure and all cause mortality at 1 year (area under the curve 0.66, p = 0.047), with an optimal cut-off of 5.5%. An improvement of the TAPSE/PASP ratio over this threshold was associated with a reduction in the composite outcome (hazard ratio 0.38, p = 0.045). Conclusion TEER improves both left and right ventricular dynamics, which can be detected with echocardiography. In particular, an acute improvement of the TAPSE/PASP ratio is associated with an improvement in short-term prognosis. A comprehensive assessment of right ventricular function, including TAPSE/PASP ratio, should be routinely performed before and after TEER.

Traffic Congestion Scheduling for Underground Mine Ramps Based on an Improved Genetic Scheduling Algorithm

The dispatching of trackless transportation on the ramp of underground metal mines is closely related to the transportation efficiency of daily production equipment, personnel, and construction materials in the mine. The current dispatching of trackless transportation on the ramp of underground metal mines is discontinuous and imprecise, with unscientific vehicle arrangement leading to low efficiency and transportation congestion. This paper presents this study, which puts forward a kind of trackless transportation optimization method that can fully make use of the ramp in the roadway, and the slow slope fork point can be used for the trackless transportation vehicle passing section to improve the efficiency of trackless transportation on the ramp. This study adopts the principles of fuzzy logic and uses interval-based positioning instead of real-time positioning to effectively reduce the spatial complexity inherent in the algorithm. At the same time, this research presents a modified genetic algorithm that incorporates a time-loss fitness calculation. This innovation makes it possible to differentiate traffic priorities between different types of vehicles, thus bringing the scheduling scheme more in line with the economic objectives of the mining operations. Various parameters were determined and several sets of simulation experiments were carried out on the response speed and scheduling effect of the scheduling system, resulting in a 10 to 20 percent improvement for different vehicles in the efficiency of underground mining transport operations.

Importance of cardiac rehabilitation on cardiorrespiratory fitness in patients undergoing percutaneous aortic valve replacement

Abstract Background Percutaneous Aortic Valve Replacement (TAVR) significantly improves cardiac function in patients with severe aortic stenosis. However, the vast majority of these patients do not reach an adequate functional class despite the valve change, due to the deterioration of hemodynamic function and the repercussions of afterload over time. Cardiac rehabilitation (CR) program is an interdisciplinary intervention aimed at restoring functionality in Post-TAVR patients and the key to optimizing the recovery and enhancing cardiorrespiratory fitness (CRFit). The Purpose of the study is to provide an analysis of the effects of CR on exercise capacity and CRFit in TAVR patients. Methods Quasi-experimental study in TAVR patients that underwent a 4-6 week CR program, including personalized aerobic and strength training. Outcomes assessed pre- and post-rehabilitation included VO2 max, ventilatory thresholds (VT1 and VT2), and exercise capacity. The study also evaluated METs efficiency by comparing actual to predicted METs values before and after the therapy, alongside expired gas analysis test to examine exercise tolerance and its relation to VO2max gains. Results A total of 28 patients were analyzed, with an average age of 73 years (±8.1), initial weight of 68 kg (±12.32), and final weight of 65 kg (±11.13). The average ejection fraction (EF) from echocardiographic parameters was 62% (±10.1). All patients underwent cardiopulmonary exercise testing (CPET) after post-TAVR with improvements in CRFit. Initial exercise test parameters showed an average METs-load at 8.1 (±1.98), VO2max at 4.75 (±1.86), VT1 at 3.05 (±1.86), VAT at 3.85 (±1.62), VT2 at 4.5 (±2.28), and VE/VCO2 at 38 (±5.32). Final test parameters revealed VO2max at 5.8 (±2.09), VT1 at 3.2 (±1.33), VAT at 4.65 (±1.60), VT2 at 5.15 (±2.3), and VE/VCO2 at 36.4 (±69.95). Pearson's correlation analysis between CPET variables and the percentage improvement of various exercise test parameters found no statistically significant correlation. Except for METs-load and final time in Bruce, which show a significant and inversely proportional correlation (r=-0.67, p&amp;lt; 0.001). Conclusions The study demonstrates the effect of cardiac rehabilitation program in enhancing cardiorespiratory fitness and exercise capacity in post-TAVR patients. Notably, improvements in VO2max and ventilatory thresholds highlight the program's efficacy in promoting cardiovascular health. The inverse correlation between initial time in Bruce and METs improvement underscores the importance of baseline exercise capacity in predicting rehabilitation outcomes. Our results allow us to conclude that training volume is not the only variable to consider for proper CR. This insight could guide personalized rehabilitation strategies, making a significant contribution to the field of cardiac recovery post-TAVR.Measured METsBruce time - METs correlation

Adversarial robustness improvement for X-ray bone segmentation using synthetic data created from computed tomography scans

Deep learning-based image analysis offers great potential in clinical practice. However, it faces mainly two challenges: scarcity of large-scale annotated clinical data for training and susceptibility to adversarial data in inference. As an example, an artificial intelligence (AI) system could check patient positioning, by segmenting and evaluating relative positions of anatomical structures in medical images. Nevertheless, data to train such AI system might be highly imbalanced with mostly well-positioned images being available. Thus, we propose the use of synthetic X-ray images and annotation masks forward projected from 3D photon-counting CT volumes to create realistic non-optimally positioned X-ray images for training. An open-source model (TotalSegmentator) was used to annotate the clavicles in 3D CT volumes. We evaluated model robustness with respect to the internal (simulated) patient rotation α\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\alpha$$\\end{document} on real-data-trained models and real&synthetic-data-trained models. Our results showed that real&synthetic- data-trained models have Dice score percentage improvements of 3% to 15% across different α\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\alpha$$\\end{document} groups compared to the real-data-trained model. Therefore, we demonstrated that synthetic data could be supplementary used to train and enrich heavily underrepresented conditions to increase model robustness.

The effect of the combined treatment with dulaglutide and dapagliflozin in arterial elasticity, cardiac function, albuminuria and endothelial thickness in type 2 diabetes mellitus after 12 months

Abstract Background The association between diabetes mellitus and diabetic nephropathy with vascular and endothelial properties is well established. Purpose In this study, we compared the effect of combined treatment with dulaglutide and dapagliflozin versus DPP-4 inhibitors on endothelial glycocalyx, arterial stiffness, myocardial function and albuminuria in patients with type 2 diabetes mellitus and albuminuria. Methods A total of 60 patients with type 2 diabetes mellitus and albuminuria were randomized to combined dulaglutide and dapagliflozin treatment (n=30) or DPP-4 inhibitors (DPP-4is, n=30). We measured at baseline and 4 and 12 months posttreatment: (a) perfused boundary region of the sublingual arterial microvessels (marker of endothelial glycocalyx thickness), (b) pulse wave velocity (PWV) and central systolic blood pressure (cSBP), (c) global left ventricular longitudinal strain (GLS) (d) urine albumin-to creatinine ratio (UACR). Results Twelve months post-treatment, the combination of dulaglutide and dapagliflozin showed a greater improvement in all indices compared to DPP-4is, despite a similar reduction in glycosylated hemoglobin. Specifically, dual therapy showed greater improvements vs DPP-4is in PBR (2,10±0,31 to 1,93±0,23 μm vs 2,11±0,31 to 2,08±0,28 μm, p&amp;lt;0,001), in UACR (326±61 to 142±47 mg/g vs 345±48 to 306±60 mg/g, p&amp;lt;0,01), and in PWV (11,77±2,37 to 10,7±2,29 m/s vs 10,64±2,44 to 10,54±2,84 m/s, p&amp;lt;0,001), while only dual therapy showed improvement in cSBP (130,21±17,23 to 123,36±18,42 mmHg). Regarding GLS, both treatments were effective, but dual therapy showed a significantly higher percentage improvement compared to DPP-4is (18,19% vs 6,01%, respectively). Conclusions Twelve-month treatment with dulaglutide and dapagliflozin showed a greater improvement in vascular markers an albuminuria than DPP-4is in patients with type 2 diabetes mellitus and albuminuria. Early initiation of combined therapy as add-on to metformin should be considered in these patients.

Comparative Analysis of Palm Kernel Shell Powder and Ash as Reinforcements on the Mechanical Properties of Aluminium Alloy Matrix Composites

The present study examines comparative analysis of palm kernel shell powder (PKSP) and ash (PKA) as reinforcements on the mechanical properties of Aluminium alloy matrix composites. The produced composites have various percentage weights of PKSA and PKSP (3 wt.%, 6 wt.%, 9 wt.%, and 12 wt.%), and their impacts on hardness, tensile strength, material stiffness, impact strength, and compressive strength were assessed. All the mechanical property tests were conducted following appropriate ASTM standard specifications. The findings showed that both reinforcement materials considerably enhanced the mechanical properties of the aluminium alloy, while PKSA demonstrated better performance than PKSP. The maximum mechanical effectiveness was achieved at 3 wt.% concentration for both reinforcements. Notably, PKSA-reinforced composites exhibited superior tensile strength and hardness (164.61 MPa and 156.32 HRB respectively) compared to PKSPreinforced composites with 131.16 MPa and 142.11 HRB respectively. The unreinforced aluminium alloy has tensile strength and hardness value of 116.31 MPa and 124.85 HRB respectively. Hence, the percentage improvement of 41.5% and 12.8% were recorded by PKSA and PKSP respectively in tensile strength and 25.2% and 13.8% respectively in hardness. However, tensile strain was negatively affected by the addition of PKSA and PKSP to the aluminium alloy matrix but for the composite containing 9%PKSP that recorded 9.98% improvement. Microstructural analysis revealed homogeneous dispersion of reinforcements and improved interfacial bonding between the matrix and reinforcements. The results demonstrated the prospect of utilizing natural and eco-friendly reinforcements such as PKSA to enhance the effectiveness of Aluminium alloy composites for application in the automotive and aerospace industries.