Practical Parameters Research Articles

Epigenetic Biomarker for Preeclampsia Associated Preterm Birth and Potential Preventative Medicine

Abstract Preterm birth has dramatically increased within the population (i.e., >10%) and preeclampsia is a significant sub-category of preterm birth. Currently, there are no practical clinical parameters or biomarkers which predict preeclampsia induced preterm birth. The current study investigates the potential use of epigenetic (DNA methylation) alterations as a maternal preeclampsia biomarker. Non-preeclampsia term births were compared to preeclampsia preterm births to identify DNA methylation differences (i.e., potential epigenetic biomarker). Maternal buccal cell cheek swabs were used as a marker cell for systemic epigenetic alterations in the individuals, which are primarily due to environmentally induced early life or previous generations impacts, and minimally impacted or associated with the disease etiology or gestation variables. A total of 389 differential DNA methylation regions (DMRs) were identified and associated with the presence of preeclampsia. The DMRs were genome-wide and were predominantly low CpG density (<2 CpG/100 bp). In comparison with a previous preterm birth buccal cell epigenetic biomarker there was a 15% (60 DMR) overlap, indicating the majority of the DMRs are unique for preeclampsia. Few previously identified preeclampsia genes have been identified, however, the DMRs had gene associations in the P13K-Akt signaling pathway and metabolic gene family, such as phospholipid signaling pathway. Preliminary validation of the DMR use as a potential maternal biomarker used a cross-validation analysis on the samples and provided a 78% accuracy. Although prospective expanded clinical trials in first trimester pregnancies and clinical comparisons are required, the current study provides the potential proof of concept a preeclampsia epigenetic biomarker may exist. The availability of a preeclampsia preterm birth maternal susceptibility biomarker may facilitate clinical management and allow preventative medicine approaches to identify and treat the preeclampsia condition prior to its occurrence.

Exploring knowledge, attitudes and practices towards sustainable food aid programmes across Europe

Abstract Background Food insecurity has increased following the COVID-19 pandemic and the Ukraine conflict. In some EU high-income countries, more than 70% of food aid users experience food insecurity, highlighting the need for food aid programmes to provide good quality and sustainable services and maximise the social inclusion of food aid users. The aim of this study was to identify areas that can promote sustainability in food aid programmes. Methods Knowledge, attitudes and practices towards sustainable food aid were assessed via a quantitative questionnaire. Socio-demographic data were also collected. The survey was translated and disseminated online across 5 EU countries (Austria, Cyprus, Greece, Poland, Portugal), targeting staff and volunteers involved in food aid programmes (20 per country, total N = 100). Descriptive statistics were used for data analysis. Results Most participants were female (68%), 18-49 years old (87%) and occupied in a NGO (89%) as employee (55%). The mean total knowledge score was 11.8 out of 19 (SD 3.2) with low knowledge (% of correct answers) on household food waste (18%) and environmental impact of cooking appliances (29%). In all countries (except Austria) more than 70% of participants agreed that they can apply sustainability through their work; however, more than 50% agreed that sustainability is not always feasible in food aid programmes. Food loss/waste, access to local food and the economic crisis were the main parameters reported to impact sustainability in food aid (≥70% of N). The most frequently applied practices were storing food according to expiration date, monitoring quantities in food distribution, considering beneficiaries’ needs and reading food labels. The least frequently applied practices were composting food leftovers and using energy-efficient methods to distribute food. Conclusions Sustainability is considered important; however, more effort is needed to promote and embed sustainability parameters in food aid programmes. Key messages • Sustainability is considered important in food aid programmes; however, more effort is needed to promote and embed sustainability parameters in practice. • Identifying sustainability areas in food aid programmes can lead to successful educational and training initiatives.

Left ventricular end-systolic and diastolic elastance as predictors of cardiac events in patients who underwent mitral valve surgery for severe mitral regurgitation

Abstract Background/Introduction In severe mitral regurgitation (MR), the prognostic significance of left ventricular ejection fraction (LVEF) and LV dimensions is well-established. However, the assessment of diastolic function in this patient presents a notable challenge, and its impact on postoperative outcomes remains unclear. Purpose This study was designed to explore the potential of LV end-systolic (Ees) and diastolic elastance (Eed) as novel predictors for cardiac events following surgery. Methods A retrospective cohort study was performed on 199 patients (53% male, average age 60 years, mean LVEF 60.0%) with severe MR and undergoing surgery. Preoperative Ees and Eed were calculated using established formulas: Ees = (systolic blood pressure x 0.9) / LV end-systolic volume, and Eed = left atrial pressure / stroke volume, with left atrial pressure estimated from mitral Doppler flow parameters as SBP – (4 x peak MR velocity²). The primary outcome was defined as either cardiac death or hospitalization due to heart failure. Results Average values for Ees and Eed were 2.61 (IQR: 1.67-3.20) and 0.32 (IQR: 0.05-0.57), respectively. Univariate analysis indicated Ees (HR: 1.24, 95% CI: 0.99-1.57, p = 0.066) and Eed (HR: 5.93, 95% CI: 2.87-12.26) as potential predictors. Adjusting for age, LVEF, and LV dimensions, Eed remained an independent predictor of cardiac events (HR: 5.89, 95% CI: 2.81-12.28). Stratifying Eed at a threshold of 0.31—identified as best sum of sensitivity and specificity—revealed that Eed > 0.31 were associated with a 3.9-fold increase in cardiac events compared to those with Eed ≤ 0.31 (p = 0.008). (Fig.) Conclusions The assessment of Eed is a straightforward and readily available parameter in routine clinical practice. Our findings advocate for the inclusion of preoperative Eed evaluation as an independent prognostic indicator for patients undergoing surgery for severe MR.Event free survival by Eed

Self-Perceived Difficulty in Job Performance by Working Patients with Uveitis: Global Assessment and by Subscales of Work Demands

ABSTRACT Purpose To evaluate a worker’s self-perceived difficulty in job performance as a whole and by subscales of job demands in a sample of working patients with uveitis and to analyze the relationship with sociodemographic, occupational, and clinical variables. Methods A cross-sectional, cross-association study was conducted. Participants completed the Work Role Functioning Questionnaire (WRFQ) to assess self-perceived difficulty in job performance. Clinical data were collected from the patients’ medical records or instruments used to evaluate clinical parameters in practice. Two clinical groups were established for this study. Bivariate and multivariate analyses were performed to assess associations between variables. Results Sixty participants were included in the study. In the multivariate linear regression analysis, active uveitis was significantly associated with a worse WRFQ total score (coefficient, −25.1; 95% CI, −36.6 to −13.6; p < 0.001). Acute course uveitis was significantly associated with a better total score than recurrent and chronic uveitis (coefficient, 17.7; 95% CI, 3.7 to 31.7; p = 0.014). In bivariate analysis, patients with active uveitis also scored worse on all subscales and on the total score. Conclusions Patients with active uveitis presented with greater self-perceived difficulty in the performance of their work as a whole and in all subscales of work demands. Patients with acute uveitis presented with less difficulty than those with recurrent and chronic uveitis. Early and correct treatment of uveitis in specialized units may reduce its impact on patients’ work impairment.

Monitoring Immune Dysfunction in Critically Ill Patients with Carbapenem-Resistant Acinetobacter baumannii Sepsis Treated with Regimens Including Cefiderocol: A Pilot Study to Identify Accessible Biomarkers to Stratify Patients’ Prognosis

Background: Multidrug-resistant Acinetobacter baumannii (CRAB) infections are a serious problem in critical care. This study aims to develop an early prognostic score for immune paralysis, using practical and cost-effective parameters, to predict ICU mortality in patients with CRAB infections being treated with Cefiderocol. Methods: We carried out an observational pilot study on consecutive patients hospitalized in the ICU with ensuing septic Acinetobacter baumannii infections treated with Cefiderocol monotherapy or Cefiderocol including combinations. We investigated the predictive power of lymphocyte counts, lymphocyte subpopulations, serum cholinesterase levels, and reactivation of herpes viruses. Results: Overall, 36 of 39 patients entered in our analysis: 20 survivors and 16 deceased. A total of 12 patients developed bacteremia, 19 patients had HAP/VAP, and 5 patients had a soft tissue infection. Univariate analyses of factors associated with unfavorable outcome revealed a significant association for age (OR: 1.5, CI: 1.11–2.02), SAPS II (OR: 1.05, CI: 1.01–1.1), SOFA score (OR: 1.37, CI: 1.06–1.76), lymphocytopenia (OR: 32.5, CI: 3.45–306.4), viral reactivation (OR: 9.75, CI: 1.72–55.4), and cholinesterase drop &lt;1600 U/L (OR: 39.7, CI: 5.8–271.6). At variance, monotherapy or associations with Cefiderocol were not associated. In the final multivariable model, the only independent predictors of death were age (OR: 1.42, CI: 0.98–2.05), lymphocytopenia (OR: 18.2, CI: 0.87–371), and cholinesterase drop to below 1600 U/L (OR: 9.7, CI: 0.77–123.7). Conclusions: Age, lymphocytopenia, and serum cholinesterase drops, which were nearly significantly associated with an unfavorable outcome, may help pinpoint patients with acute immune paralysis during sepsis. Knowledge of such an immune state may in turn directly influence patients’ care.

Application of pole allocation to optimize passive viscous dampers represented by the Maxwell model

The Maxwell model is used to understand the realistic effectiveness of vibration reduction in the building structures. The model consists of a dashpot and spring in series. The dashpot and spring represent a viscous damper and joint between the damper and the structural frame, respectively. However, few studies have investigated the optimal damper capacity and the corresponding spring stiffness in the practical parameter ranges. Additionally, the optimal damper derived using the fixed-point theory has no relationships with that derived via pole allocation. Therefore, in this study, to examine the effects of the joint spring, the pole allocation method was used to design a structural system wherein the Maxwell model was incorporated into a single-degree-of-freedom damped model. We introduced a closed-form expression, which explicitly described the relationships between the target structural damping ratio, damper capacity, and joint spring. The Maxwell model constrained the control effectiveness using damper parameters and simultaneously suggested an optimal and realistic joint spring for the damper. Pole allocation was also applied to a multi-degree-of-freedom (M-DOF) damped structural system employing multiple Maxwell models. The newly proposed optimized joint spring could easily control the additional damping effect on the M-DOF system. The Maxwell model can be optimized almost manually. The scheme is more useful in the preliminary design stage than the previous numerical optimizations. This study extended the mathematical equation governing the building vibrations to the Maxwell model. The extended equation served as a unified description for considering structural passive control.

Long-distance photon-mediated and short-distance entangling gates in three-qubit quantum dot spin systems

Superconducting resonator couplers will likely become an essential component in modular semiconductor quantum dot (QD) spin qubit processors, as they help alleviate crosstalk and wiring issues as the number of qubits increases. Here, we focus on a three-qubit system composed of two modules: a two-electron triple QD resonator coupled to a single-electron double QD. Using a combination of analytical techniques and numerical results, we derive an effective Hamiltonian that describes the three-qubit logical subspace and show that it accurately captures the dynamics of the system. We examine the performance of short-range and long-range entangling gates, revealing the effect of a spectator qubit in reducing the gate fidelities in both cases. We further study the competition between nonadiabatic errors and spectator-associated errors in short-range operations and quantify their relative importance across practical parameter ranges for short and long gate times. We also analyze the impact of charge noise together with residual coupling to the spectator qubit on intermodule entangling gates and find that for current experimental settings, leakage errors are the main source of infidelities in these operations. Our results help pave the way toward identifying optimal modular QD architectures for quantum information processing on semiconductor chips. Published by the American Physical Society 2024

Finding Practical Parameters for Isogeny-based Cryptography

Isogeny-based schemes often come with special requirements on the field of definition of the involved elliptic curves. For instance, the efficiency of SQIsign, a promising candidate in the NIST signature standardisation process, requires a large power of two and a large smooth integer T to divide p 2 − 1 for its prime parameter p . We present two new methods that combine previous techniques for finding suitable primes: sieve-and-boost and XGCD-and-boost. We use these methods to find primes for the NIST submission of SQIsign. Furthermore, we show that our methods are flexible and can be adapted to find suitable parameters for other isogeny-based schemes such as AprèsSQI or POKE. For all three schemes, the parameters we present offer the best performance among all parameters proposed in the literature.

Amplified squeezed states: analyzing loss and phase noise

Abstract Phase-sensitive amplification of squeezed states is a technique to mitigate high detection loss, which is especially attractive at 2μm wavelengths. We derived an analytical model proving that amplified squeezed states can mitigate phase noise significantly. Our model discloses two practical parameters: the effective measurable squeezing and the effective detection efficiency of amplified squeezed states. A realistic case study includes the dynamics of the gain-dependent impedance matching conditions of the amplifier. Our results recommend operating the optical parametric amplifier at high gains because of the signal-to-noise ratio’s robustness to phase noise. Amplified squeezed states are relevant in proposed gravitational wave detectors and interesting for applications in quantum systems degraded by the output coupling loss in optical waveguides.

A measurement-device-independent quantum secure digital payment

In contemporary society, digital payment systems are crucial, yet vulnerable to security breaches. Based on the principles of quantum physics, quantum digital payment (QDP) protocols offer a theoretically superior security paradigm compared to those reliant on computational complexity. Nevertheless, those QDP protocols in practice are frequently compromised by imperfections in measurement devices, facilitating valuable information interception by malicious entities. Addressing this vulnerability, we propose a measurement-device-independent quantum secure digital payment (MDI-QSDP) protocol, designed to enhance security in digital payment systems by eliminating side-channel attacks on measurement devices. This protocol extends the framework of a novelly developed measurement-device-independent quantum secure communication (MDI-QSC) protocol, which supports secure dialogic exchanges without prior key sharing. Utilizing the proposed MDI-QSC protocol, participants can not only engage in secure direct communication but also establish a private key for subsequent encrypted interactions. Our MDI-QSDP protocol incorporates a robust authentication mechanism, ensuring that only legitimate participants can initiate transactions, thereby bolstering security. A comprehensive security analysis of the proposed protocol demonstrates its resilience against identity theft, information leakage, and other potential security breaches. Furthermore, simulations employing practical experimental parameters validate the protocol’s applicability and effectiveness in real-world scenarios, thereby confirming its potential to significantly enhance the security of future quantum digital payments.

Avoidant Restrictive Food Intake Disorder: A Case Series

Abstract Avoidant restrictive food intake disorder (ARFID), a recently described eating disorder categorized under DSM-5, has varied clinical presentations. The primary eating disorders have well-established practice parameters for management. However, there is no evidence-based first line of management for ARFID. There is a significant gap in this evolving construct and clinical practice. We present a case series from a tertiary care center in India, focusing on clinical management. Four adolescents with 3 girls and 1 boy between 12 and 17 years of age were included in the study. Diagnosis and management were delayed in all. Mean body mass index was 15.36 (5.26) kg/m2 at the time of diagnosis. Key drivers were dread of choking, sensory characteristics, and avoidance of unpleasant upper and lower gastrointestinal symptoms. This series supports a culturally cognizant hypothesis, an evidence based, viable management model for ARFID in low- and middle-income countries (LMIC). A combination of family-based treatment (FBT) and cognitive behavior therapy is an effective treatment model for India and other LMICs.

Evaluation of cephalosporin allergy: Survey of drug allergy experts

BackgroundSince publication of the 2022 Drug Allergy Practice Parameters (DAPP) of the AAAAI and ACAAI it is unclear the extent to which the simplified and risk-stratified evaluation of cephalosporin allergy has been incorporated into allergy practice. ObjectiveWe aimed to assess current cephalosporin allergy testing practices using real case examples. MethodsAn 18-question REDCap survey was sent to the 136 members of the Adverse Reactions to Drugs, Biologics and Latex (ARDBL) Committee of the AAAAI between February-April 2023. ResultsForty-six (33.8%) ARDBL members completed the survey, following three email attempts. Most practicing in the United States (32, 69.6%), six (13.0%) in Canada, and the remaining from Europe and Asia. Almost half (47.7%) reported that the 2022 DAPP had increased their use of direct oral challenges. 91% would use cephalosporins in the setting of low-risk penicillin allergy history without testing. For low-risk cephalosporin reactions, 68% would perform a direct oral challenge (DOC) with the culprit drug. In severe immediate penicillin reactions, 23% would evaluate with penicillin-skin-testing before assessing cephalosporin allergy. For cephalosporin-related anaphylaxis, 48% would perform cephalosporin-based testing. For perioperative anaphylaxis with cefazolin, 57% would perform cephalosporin-based testing. For positive skin testing to cefazolin 79% chose to avoid the culprit drug with follow-up oral challenge to a structurally dissimilar cephalosporin. ConclusionIncreased uptake of DOC represents the initial impact of the 2022 DAPP. However, there is significant variation in testing practices of cephalosporin allergy even amongst drug allergy experts, reflecting a need for higher evidence base to guide consensus around testing higher risk reactions.

Association of White Matter Hyperintensities With Serum Lipid Profile and Hematologic Parameters in Migraine Patients.

Introduction Migraine is one of the most common neurological diseases. Comorbidities, especially stroke, may be observed. White matter hyperintensities are common in migraine patients. Although many factors have been associated with white matter hyperintensities, such as age, gender, migraine type, frequency, and presence of aura, the etiology of white matter hyperintensities remains unclear. We aimed to study the relationship between the development of white matter hyperintensities and serum lipid profilesand hematologic parameters in migraine patients. Methods Demographic data, comorbidities, migraine types, presence of aura, and frequency of attacks were reviewed. Cranial MRI scans, hematologic profiles, and lipid profiles were analyzed. Results The study included 51 patients with white matter hyperintensity on cranial MRI and 76 migraine patients with normal cranial MRI. High-density lipoprotein cholesterol (HDL-c) was statistically significantly higher in the patients with white matter hyperintensity in the cranial MRI (WMH+) group. A statistically significant cut-off value was found for the PLR parameter in differentiating white matter hyperintensity on cranial MRI in migraine patients. Conclusion In our study, we examined the factors contributing to the development of white matter hyperintensity in migraine patients and observed the correlation between disease duration and white matter hyperintensity. While no correlation was observed between low-density lipoprotein cholesterol (LDL-c) and white matter hyperintensity, HDL-c was dramatically elevated in patients with white matter hyperintensity. Furthermore, our study shows that PLR is a useful, easily accessible, and practical parameter for detecting the development of white matter hyperintensity in migraine patients. Larger-scale randomized studies are needed for a clearer interpretation of these findings.

Effect of “T2-rim sign” related parameters on high-intensity focused ultrasound ablation of uterine fibroids

PurposeTo investigate the effect of “high-signal-intensity peripheral rim on T2-weighted MR images (T2-rim sign)” related parameters on non-perfused volume ratio (NPVR) after high-intensity focused ultrasound (HIFU) ablation of uterine fibroids. MethodsData from 616 patients with uterine fibroids treated with HIFU were retrospectively analyzed. Univariate and multivariate logistic regression was used to analyze the factors influencing the ablation effect. The effect of T2-rim sign on ablation parameters and results was also analyzed. Spearman correlation analysis was used to compare the correlation between coverage ratio, average thickness of T2-rim sign and NPVR in 207 cases of fibroids with T2-rim sign. ResultsThe presence of T2-rim sign was an independent risk factor affecting the ablation effect. The coverage ratio of T2-rim sign was negatively correlated with treatment efficiency (r = -0.174, p = 0.012) and NPVR (r = -0.186, p = 0.007), and positively correlated with energy efficiency factor (EEF) (r = 0.156, p = 0.024). The average thickness of T2-rim sign was positively correlated with treatment intensity (r = 0.203, p = 0.003) and negatively correlated with NPVR (r = -0.363, p < 0.001). There was a negative correlation between the average thickness of the T2-rim sign and NPVR in isointense fibroids (r = -0.484, p < 0.001). ConclusionThe presence of T2-rim sign increases the difficulty of ablation and reduces the ablation effect. In clinical practice, the presence and related parameters of T2-rim sign should be fully considered when screening for HIFU indications and formulating treatment plans.

Ultrasonographic estimation of kidney size in adult Bangladeshi population without known renal disease: a preliminary report

Background: The kidney size of a patient is a valuable diagnostic parameter in clinical practice. Renal size varies with age, gender, body mass index (BMI), pregnancy, race and co-morbid conditions like diabetes mellitus (DM) and hypertension (HTN). Measurements of renal dimensions can be carried out by using different modern techniques like ultrasonography (USG), computed tomography (CT) scan and magnetic resonance imaging (MRI). Out of these modalities USG is choice because of its simplicity, inexpensive, easily available, non-invasive and easy reproducibility. There is no established nomogram for renal size in the Bangladeshi population. Aim of the study was to determine the ultrasonographic renal size in adult Bangladeshi population with no known renal disease and to correlate renal size with age, gender and BMI. In addition, we assess whether hypertension and diabetes mellitus affect renal size. Methods: This cross-sectional study was done in BIRDEM General Hospital and included 55 patients with age &gt;18 years over 6 month period. Study population were not known to have renal disease documented by urine routine microscopy, spot urine for albumin creatinine ratio (ACR), serum creatinine and USG. Their body weight, height and BMI were calculated along with duration of DM and HTN. Analysis was done for differences due to age, gender and laterality. The correlation of renal dimensions with anthropometric parameters were also done. Results: A total of 55 patients were analyzed. There were 19 (34.5%) male and 36 (65.5%) female. The mean age was 46±.10 years. There mean weight, height and BMI were 61 ± 11 kg, 1.54±.069 meter, 25.7 ± 4.8 kg/m2 respectively. In total population 34.5% (19) were diabetic and 32.5% (18) were hypertensive. The means of length, width and parenchymal thickness (PT) of right kidneys (RK) were 10.1 ± 0.87, 4.2 ± 0.67 and 1.4± 0.32 cm respectively. The means of length, width and PT of left kidneys (LK) were 10.3 ± 0.89, 4.5 ± 0.49 and 1.5 ± 0.32 cm respectively. Measurements were significantly higher in LK than those of RK respectively (p=.003, p&lt;.001 and p=.041). There were significant differences in kidney length and PT between sex and age. There were also significant differences in kidney length and PT between subjects of higher BMI, long duration of DM and HTN. The correlation between renal length and weight showed a positive correlation (r = 0.16, p &lt; 0.023). Conclusion: The variation of parameters of both kidneys varies on gender, age, obesity, comorbidity like DM &amp; HTN and with their duration. Length of both kidneys depends on body weight. Further study needed with large samples. BIRDEM Med J 2024; 14(3): 151-157

Allergen Immunotherapy and Atopic Dermatitis: Updated Guidance

Atopic dermatitis (AD), also commonly referred to as atopic eczema, is the most common chronic inflammatory skin disease. Research over the past 30 years has revealed that it affects approximately 13% of children and 7% of adults worldwide. Among the growing number of treatment options for AD, the role of allergy to aeroallergens, such as house dust mite (HDM) pollens or animal dander, in driving this condition has remained uncertain for a long time. Consequently, so too has been the therapeutic role of allergen immunotherapy (AIT) for AD. The American Academy of Allergy, Asthma &amp; Immunology (AAAAI)/American College of Allergy, Asthma and Immunology (ACAAI) Joint Task Force (JTF) on Practice Parameters recently updated their AD guidelines. This update included a systematic review of the effectiveness and safety of AIT, including subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) versus no AIT for patients with AD. This article summarizes the systematic review findings, guideline update, and future directions.

Data-driven discovery of dynamics from time-resolved coherent scattering

Coherent X-ray scattering (CXS) techniques are capable of interrogating dynamics of nano- to mesoscale materials systems at time scales spanning several orders of magnitude. However, obtaining accurate theoretical descriptions of complex dynamics is often limited by one or more factors—the ability to visualize dynamics in real space, computational cost of high-fidelity simulations, and effectiveness of approximate or phenomenological models. In this work, we develop a data-driven framework to uncover mechanistic models of dynamics directly from time-resolved CXS measurements without solving the phase reconstruction problem for the entire time series of diffraction patterns. Our approach uses neural differential equations to parameterize unknown real-space dynamics and implements a computational scattering forward model to relate real-space predictions to reciprocal-space observations. This method is shown to recover the dynamics of several computational model systems under various simulated conditions of measurement resolution and noise. Moreover, the trained model enables estimation of long-term dynamics well beyond the maximum observation time, which can be used to inform and refine experimental parameters in practice. Finally, we demonstrate an experimental proof-of-concept by applying our framework to recover the probe trajectory from a ptychographic scan. Our proposed framework bridges the wide existing gap between approximate models and complex data.

Immunotherapy and new treatments.

This review comes at a time where new techniques in immunotherapy administration are being developed, new innovations are being incorporated to standard techniques, and new regulations are being adopted regarding the creation and storage of allergen extracts. Prior to the release of updated practice parameters regarding allergic rhinitis and immunotherapies, this review article provides a synopsis of current recommendations, a comparison of the practices in the United States and those of Europe, and an examination of experimental methods that are being studied. This article seeks to review and discuss the various methods of administration, build up schedules, efficacy, effect on other atopic symptoms, and safety associated with allergen immunotherapy. Innovations in standard techniques, such as new allergoids for SCIT, appear to be effective in improving symptoms and increasing IgG levels for grass allergens. Data for newer techniques is less clear. There appears to be increased treatment-related adverse events for ILIT, worse symptom scores compared with placebo for IDIT, and insufficient studies regarding the effectiveness of EPIT for aeroallergens. New regulations seek to standardize the documentation, storage, and creation of allergen extracts.

Exact methods and a variable neighborhood search for the robust capacitated [formula omitted]-median problem

The capacitated p-median problem (CPMP) involves placing p identical facilities in a network and assigning customer nodes to these facilities to satisfy all customer demands with minimal transportation costs. In practical applications, demand and distance parameters are often uncertain during the planning process, leading to infeasible or excessively costly solutions if these uncertainties are disregarded. This paper addresses the robust CPMP (RCPMP), which incorporates demand uncertainty into the problem using the robust optimization paradigm. We propose a general framework to model and solve the RCPMP, considering different polyhedral uncertainty sets, namely the cardinality-constrained and the knapsack sets. We develop exact approaches encompassing compact models, different families of valid inequalities, and branch-and-cut and branch-and-price algorithms, exploring both implemented uncertainty sets and problem structure. Furthermore, we implement an efficient Variable Neighborhood Search (VNS) heuristic to solve these robust variants, which incorporates state-of-the-art algorithms, parallelization techniques, and optimized data structures. Computational experiments using adapted benchmark instances with up to 400 nodes indicate the effectiveness of the proposed approaches. The results show that using parallelization and hash tables within the VNS heuristic promotes significant performance improvements and yields near-optimal solutions for most instances, as well as outperforming the exact approaches in several instances where the optimal solution was not found. Moreover, these results highlight the benefits of using robust solutions in practical settings, especially when considering different uncertainty sets to generate solutions with advantageous trade-offs between cost and risk.

Optimized multi-head self-attention and gated-dilated convolutional neural network for quantum key distribution and error rate reduction

ABSTRACT Quantum key distribution (QKD) is a secure communication method that enables two parties to securely exchange a secret key. The secure key rate is a crucial metric for assessing the efficiency and practical viability of a QKD system. There are several approaches that are utilized in practice to calculate the secure key rate. In this manuscript, QKD and error rate optimization based on optimized multi-head self-attention and gated-dilated convolutional neural network (QKD-ERO-MSGCNN) is proposed. Initially, the input signals are gathered from 6G wireless networks which face obstacles to channel. For extending maximum transmission distances and improving secret key rates, the signals are fed to the variable velocity strategy particle swarm optimization algorithm, then the signals are fed to MSGCNN for analysing the quantum bit error rate reduction. The MSGCNN is optimized by intensified sand cat swarm optimization. The performance of the QKD-ERO-MSGCNN approach attains 15.57%, 23.89%, and 31.75% higher accuracy when analysed with existing techniques, like device-independent QKD utilizing random quantum states, practical continuous-variable QKD and feasible optimization parameters, entanglement and teleportation in QKD for secure wireless systems, and QKD for large scale networks methods, respectively.