Preferred Route Research Articles

Structural elucidation of 14-membered ring macrolide antibiotics using electrospray ionization tandem mass spectrometry and density functional theory calculations.

Macrolides are critical antibiotics featuring a macrocyclic lactone core with deoxy sugars. Understanding their gas-phase fragmentation is challenging but essential for improving structural elucidation in mass spectrometry, which has implications for drug discovery and development. We used electrospray ionization collision-induced dissociation tandem mass spectrometry (ESI-CID-MS) combined with quantum chemical calculations to investigate the fragmentation pathways of erythromycin A and roxithromycin. This approach helps elucidate the preferred fragmentation routes influenced by protonation sites. Macrolides showed similar fragmentation patterns, including sequential losses of saccharide or amino sugar units and dehydration from the macrocycle core. Multiple competitive pathways were observed, influenced by protonation sites. Computational studies confirmed the most favorable protonation sites and their impact on fragmentation, providing insights into key diagnostic product ions. Subsequent fragments involved rearrangement pathways such as alkene formation and cleavages via remote hydrogen transfers and pericyclic reactions. Our integrated approach offers a comprehensive understanding of macrolide fragmentation, enhancing structural elucidation and potential applications in drug development. This study advances mass spectrometry analysis of macrolides, contributing to pharmaceutical research by integrating orthogonal annotation methods and fragmentation studies.

Large bore access for transcatheter aortic valve replacement, endovascular aortic repair, and thoracic endovascular aortic repair. A review of anatomic challenges and operative considerations.

Transcatheter aortic valve replacement (TAVR), endovascular aortic repair (EVAR), and thoracic endovascular aortic repair (TEVAR) are standard and prolific procedures in the modern cardiovascular world, and appropriate delivery of these endoprostheses requires adequate understanding of the requisite large bore access. Percutaneous large bore access is the preferred route but may be accompanied by complications like thrombosis, hemorrhage, or inability to deliver the device. Anatomic limitations such as vessel tortuosity, small size, and heavy calcification may require alternative approaches for successful large bore access. This study aimed to better define large bore access, as well as to elucidate optimal adjuncts and alternatives to enable successful delivery of large bore endoprostheses. A systematic review for "large bore access" in the cardiovascular literature was conducted on PubMed and the Cochrane Library Central according to PRISMA guidelines. Identified articles were filtered and sub-selected for TAVR, EVAR, and TEVAR; studies related to other large bore interventions were excluded. A representative selection of 39 full-text studies included both cardiac and vascular studies and was critically interpreted to identify a consensus definition for large bore access, challenging anatomy, and adjuncts or alternative approaches to the standard transfemoral approach. Transfemoral access remains the first-line approach but in the setting of unfavorable anatomy, adjunct maneuvers (e.g. intravascular lithotripsy, endoconduits) or alternative approaches (supra-aortic, transcaval) help decrease morbidity, mortality, length of procedure, and overall health care cost in large bore access.

A DFT and Microkinetic Study of Propylene Selective Oxidation on Cu2O(111) Surface with O2: Chlorinum Effect

AbstractSpin‐polarized density functional theory (DFT) +U calculation was performed to study propylene selective oxidation on Cu2O(111) and Cl−Cu2O(111) surfaces. The mechanism included two pathways: the allylic hydrogen stripping (AHS) pathway and the epoxidation pathway, and acrolein, propylene oxide (PO), propanal and acetone can be formed. The calculated results found that the C3H6*+OO*→OOMMP2*→PO* route can be regarded as the preferred formation route of PO on these two surfaces. On clean surface, acrolein can be regarded as the main product, then other products selectivity follows: acetone>PO>propanal. On Cl−Cu2O(111) surface, acrolein was also the main product, and the apparent activation energy of acrolein (1.97 eV) was approximated to the apparent activation energy of PO (2.04 eV), other products selectivity follows: PO>propanal>acetone, which means that the selectivity of PO can be improved by the effect of Cl. Microkinetic simulation confirm that PO selectivity can be elevated qualitatively, and found that OOMMP2*→PO2*+O* is the rate determining step on pure surface and C3H6*+OO*→OOMMP2* is the rate controlling step on the doped−Cl surface. From this work, it can be found the O−O bond in O2 can be activated effectively by the presence of Cl, enhancing the selectivity of PO.

Analysis of Prescribing Patterns of Drugs Used in Osteoarthritis in Tertiary Care Center

Background: Osteoarthritis (O.A.) is a common degenerative lesion of the articular cartilage that corresponds to hypertrophy deterioration of bone structure is osteoarthritis. The treatment is mainly focused on the management of pain. Methods: An Observational study was conducted among 163 patients visiting Orthopedics Out Patient Department at GMC Hospital. The duration of study was for 6 months from Jan 2024-Jun 2024. The analysis of collected data was done by SPSS version Software. Descriptive Statistics tools like frequency, Percentage were used to express the findings. Results: We found that female was (68.7%) in comparison to male (31.3%). Oral route (79%) was most commonly preferred route of drugs administration than topical route (21%). Non-Steroidal Anti-Inflammatory Drugs (NSAIDS) (41.78%), Vitamins and minerals (22.5%), Antiulcers (19.5%), Symptomatic Slow-acting Drugs in Osteoarthritis (SYSODA) (6.82%), Muscle Relaxants (5.02%) and Others (4.07%) were Prescribed groups of drugs. Diclofenac (19.52%) was most commonly prescribed Non-Steroidal Anti-Inflammatory Drugs followed by Aceclofenac (11.37%). Average no. of drugs prescribed was 5.12, % of drugs Prescribed from National List of Essential Medicine (NLEM) was 79.88%, % of drugs prescribed by generic name was 0% and Average dispensing time was 225.13 sec. Conclusion: Osteoarthritis (O.A) was mostly common in female than male. Lumbar was most commonly affected site of Osteoarthritis. Non-Steroidal Anti-Inflammatory Drugs was most commonly prescribed groups of drugs. Keywords: Osteoarthritis, Prescribing Pattern, Non-Steroidal Anti-Inflammatory Drugs, Diclofenac, Symptomatic Slow-acting Drugs in Osteoarthritis.

Peer-to-Peer Human Milk Sharing Through Social Media Groups: The Experiences of Women Donors and Recipients in Hong Kong.

To explore the lived experience of donors and recipients involved in peer-to-peer human milk donation. An exploratory descriptive qualitative study. Semi-structured interviews were conducted between November 2022 and April 2023. A total of 50 women consisting of 34 donors and 16 recipients were recruited using purposive sampling from specific social media groups in Hong Kong that focus on breast milk donation and sharing. Data were analysed based on thematic analysis. Five key themes were identified in this study: Motivation; Milk sharing as a social act; Not a Norm; Recommendation to formal milk banks; and Formal donation as the preferred route. The findings indicate informal milk sharing is seen as an inferior alternative to formal milk donation systems. The establishment of formal milk banks is viewed as a way to address the shortcomings of informal sharing. The findings have implications for the healthcare field, particularly in improving the experiences of those involved in informal milk sharing. The insights gained from the experiences of informal milk sharers can directly inform and enhance the services provided by formal milk banks. Given the growing prevalence of online informal milk sharing, healthcare professionals should enhance their understanding of this practice. However, the practice has remained understudied, particularly in Asian region. This study brings together the experiences of both milk donors and recipients, providing a comprehensive view on the phenomenon. The Standards for Reporting Qualitative Research (SRQR). No patient or public contribution.

Prospective Study on Coblation Vs. Cautery in Endoscopic Trans Sphenoidal Surgery for Pituitary Macroadenoma: Impact on Nasal Function.

Endoscopic endonasal Trans-sphenoidal surgery for sellar-suprasellar tumors is considered the preferred route. The ideal instruments in skull base surgery should be able to manipulate adequately through the narrow corridors with effective tissue removal and bleeding control and reduce collateral damage to nearby vital structures. The present study sought to compare the nasal morbidity following transnasal sphenoidal surgery for pituitary macroadenoma using Coblation and Electrocautery. 160 undergoing Endoscopic TSS for non-functioning PAs were enrolled. The patients were randomly allocated into Coblation (n = 80) and electrocautery (n = 80) groups. All operations were performed by the same group of surgeons skilled in their surgical techniques. There were 59 and 53 patients with Knosp grade II tumors in the cautery and coblation group, respectively, while 21 and 27 patients had Knosp grade III tumors. The average duration of surgery using cautery was 96+/-4.5min, while with coblation, the average time was 83+/-3.5min, and the difference was statistically significant. Nasal crusting and granulation severity were observed more in the electrocautery group. The coblation group patients had clear surgical fields with few ooze points; the difference between the two groups was significant. Nasal synechiae and decreased nasal patency were common in the electrocautery group. There were no statistical differences in nasal bleeding, nasal deformity, or sense of smell parameters. Advanced medical tools like coblation are safe and effective for the dissection and ablation of the mucosa. They result in better intra-operative visualization and lesser postoperative nasal morbidity, which will help patients achieve a better quality of life.

Integrating (Deep) Machine Learning and Cheminformatics for Predicting Human Intestinal Absorption of Small Molecules

The oral route is the most preferred route for drug delivery, due to which the largest share of the pharmaceutical market is represented by oral drugs. Human intestinal absorption (HIA) is closely related to oral bioavailability making it an important factor in predicting drug absorption. In this study, we focus on predicting drug permeability at HIA as a marker for oral bioavailability. A set of 2648 compounds were collected from some early as well as recent works and curated to build a robust dataset. Five machine learning (ML) algorithms have been trained with a set of molecular descriptors of these compounds which have been selected after rigorous feature engineering. Additionally, two deep learning models - graph convolution neural network (GCNN) and graph attention network (GAT) based model were developed using the same set of compounds to exploit the predictability with automated extracted features. The numerical analyses show that out the five ML models, Random forest and LightGBM could predict with an accuracy of 87.71% and 86.04% on the test set and 81.43% and 77.30% with the external validation set respectively. Whereas with the GCNN and GAT based models, the final accuracy achieved was 77.69% and 78.58% on test set and 79.29% and 79.42% on the external validation set respectively. We believe deployment of these models for screening oral drugs can provide promising results and therefore deposited the dataset and models on the GitHub platform (https://github.com/hridoy69/HIA).

Protein Medium Facilitates Electron Transfer in Photosynthetic Heliobacterial Reaction Center.

This computational study addresses the question of how large membrane-bound proteins of electron transport chains facilitate fast vector-based charge transport. We study electron transfer reactions following ultrafast initial charge separation induced by absorption of light by P800 primary pair and leading to the electron localization at the A0 cofactor. Two subsequent, much slower reactions, electron transfer to the iron-sulfur cluster Fx and reduction of the menaquinone (MQ) cofactor, are studied by combining molecular dynamics simulations, electronic structure calculations, and theoretical modeling. The low value of the electronic coupling between A0 and Fx brings this reaction to the microsecond time scale even at the zero activation barrier. In contrast, A0-MQ electron transfer occurs on a subnanosecond time scale and might become the preferred route for charge transport. We elucidate mechanistic properties of the protein medium allowing fast, vectorial charge transfer. The electric field is high and inhomogeneous inside the protein and is coupled to high polarizabilities of cofactors to significantly lower the reaction barrier. The A0-MQ separation puts this reaction at the edge between the plateau characterizing the reaction dynamical control and exponential falloff due to electronic tunneling. A strong separation in relaxation times of the medium dynamics for the forward and backward reactions promotes vectorial charge transfer.

Biobased propylene and acrylonitrile production in a sugarcane biorefinery: Identification of preferred production routes via techno-economic and environmental assessments

Four alternative, sugar-derived chemical intermediates were compared for the production of propylene and acrylonitrile in energy self-sufficient biorefineries, annexed to an existing sugarcane mill, to assess economic feasibility and environmental sustainability. Aspen Plus® process simulations considered ethanol and isopropanol produced from A-molasses as intermediates for propylene production, while propylene and 3-hydroxypropionic acid (3-HP) from A-molasses were compared for acrylonitrile production. The minimum selling prices (MSPs) for propylene-from-ethanol (3634 $/t), propylene-from-isopropanol (8151 $/t), acrylonitrile-from-propylene (4698 $/t), and acrylonitrile-from-3-HP (5957 $/t) were 280 %, 752 %, 302 % and 409 % above the market prices of fossil-based equivalents. Nonetheless, the propylene biorefineries achieved up to 97 % reduction in greenhouse gas (GHG) emissions, whilst acrylonitrile biorefineries had up to 43 % reduction compared to fossil-based production processes. Based on process yields, energy demand and GHG emissions, ethanol was identified as the preferred intermediate route for all four biorefinery scenarios, while substantial price-premiums will be required for industrial production.

Laboratory-scale study of mixed barriers in stratified layers with an inclined ocean aquifer boundary

The over-pumping of freshwater makes shoreline aquifers susceptible to seawater intrusion. Most studies on aquifer homogeneity that are used to form management guidelines focus on salinization sensitivity. However, under certain extraction conditions, the geographic structure can be quite diverse, with low-permeability obstacles and preferred flow routes that affect circulation and saline transport mechanisms. Here, we used a laboratory-scale glass box apparatus of dimension 100 × 50 × 10 cm3 to study intrusion in stratified layers under the influence of an inclined ocean-aquifer boundary with a mixed barrier as a remediation technique. The TL\\H ratio ranged from 0.2 to 12.84 for all stratification conditions and remediation installed. There was a 40–48 % decrease in the extent of toe length after installation. With a mixed barrier installed, the height of the intrusion was reduced, resulting in an increase in the TL\\H and a decrease in the potential for toe length. The intrusion was delayed by 86.67 % in parallel stratification and 28.22 % in perpendicular stratification after comparing the time frame for base case and the mixed barrier installed condition. A parabolic profile of intrusion was observed in the low-permeability layer, while a convex-outward profile was observed in the higher-permeability layers. Similar results are obtained after conducting the sensitivity analysis. The intrusion follows an increasing pattern of ratio with increasing interaction gap opening in parallel stratification, while for perpendicular stratification, with gap opening from 10 cm to 30 cm, there was a decreasing trend followed by an increasing trend, indicating an increase in magnitude with a similar pattern of intrusion. The results of this investigation shed light on the mixed barrier's suitability for use in realistically diverse coastal aquifers. Future research could explore the utilization of different combinations of new barriers, such as under-surface barriers, which work well for stratified layers, and already established barrier systems, to further improve the efficiency of mixed barriers.

Characterization of Vortex Vein Drainage System in Healthy Individuals Imaged by Ultra-Widefield Optical Coherence Tomography Angiography.

The purpose of this study was to investigate the choroidal characteristics of vortex vein (VV) drainage systems in healthy individuals using ultra-widefield optical coherence tomography angiography. The mean choroidal thickness (ChT) and choroidal vascularity index (CVI) of each VV quadrant (24 × 20 mm2 scan mode; superotemporal [ST], superonasal [SN], inferonasal [IN], and inferotemporal [IT] quadrants) were calculated. Furthermore, intervortex venous anastomosis (IVA) was classified into temporal, superior, inferior, and nasal types. A total of 207 healthy eyes were analyzed to find that the ST quadrant had the thickest choroidal layer and highest CVI (all P < 0.05). Among the four VV drainage quadrants, the mean ChT and CVI decreased in the sequence of ST, SN, IT, and IN (all P < 0.05). Moreover, men had a higher CVI than women in all VV quadrants (all P < 0.05). IVA was observed in all VV quadrants of 91 eyes (43.96%), and in the macular region of 33 eyes (15.94%). The ST drainage system was identified as the preferred VV drainage route in healthy eyes. Among the four VV drainage quadrants, the drainage system adhered to the ST-SN-IT-IN order of descending perfusion. Furthermore, age- and sex-related differences were noted in the choroidal VV drainage systems of healthy eyes. Additionally, almost half of the healthy eyes had IVA in their choroidal vessel networks. The VV drainage system may be considered a novel imaging biomarker for ocular diseases.

Shoprite Holdings Ltd Case Study: Shoprite Holdings Ltd Case Study

This study investigates the obstacles faced by the African expansion efforts of Shoprite Holdings Ltd., a South African retailer. Shoprite pursued mergers and acquisitions within its native country but established wholly owned subsidiaries as its preferred entry route for expanding into other African states. As a result, Shoprite significantly increased its operations by expanding to 16 nations by 2020. However, Shoprite currently focuses its operation in ten countries, exclusively in southern African countries and its home country. This study seeks to comprehend the reasons behind Shoprite's rapid withdrawal from multiple African countries and shed insight into the challenges of conducting business in Africa's demanding business climate. The analysis revealed a combination of economic variables, such as reduced purchasing power of customers, currency volatility, increased operational costs, and the economic shocks caused by the COVID-19 outbreak. Additionally, high customer preference for informal markets and social factors were also identified. The findings indicate that Shoprite should prioritize strategic location selection, adopt a lower entry mode, and consider the potential for developing e-commerce as feasible measures. The report proposes that African retail businesses should comprehend the intricacies of the African market and employ strategies for international expansion, entrance techniques, and the significance of adjusting operations to local conditions and regulatory environments. These discussions offer insights to organizations considering international expansion, seeking to mitigate risks, and aiming to optimize their market entry strategy in various locations, specifically Africa.

Progress on nonculture based diagnostic tests for invasive mould infection.

This review describes the current status of diagnosing invasive mould disease and Pneumocystis pneumonia using nonconventional diagnostics methods. There has been significant development in the range of nonculture mycological tests. Lateral flow tests (LFTs) for diagnosing aspergillosis complement galactomannan ELISA testing, and LFTs for other fungal diseases are in development. Rapid and low through-put B-D-Glucan assays increase access to testing and there has been significant progress in the standardization/development of molecular tests. Despite this, no single perfect test exists and combining tests (e.g., antigen and molecular testing) is likely required for the optimal diagnosis of most fungal diseases. Based on established clinical performance few mycological tests can be used alone for optimal diagnosis of fungal disease (FD) and combining tests, including classical approaches is the preferred route for confirming and excluding disease. Next-generation sequencing will likely play an increasing role in how we diagnose disease, but optimization, standardization and validation of the entire molecular process is needed and we must consider how host biomarkers can stratify risk. Given the burden of FD in low- and medium-income countries, improved access to novel but more so existing diagnostic testing is critical along with simplification of testing processes.

Deep intravital brain tumor imaging enabled by tailored three-photon microscopy and analysis

Intravital 2P-microscopy enables the longitudinal study of brain tumor biology in superficial mouse cortex layers. Intravital microscopy of the white matter, an important route of glioblastoma invasion and recurrence, has not been feasible, due to low signal-to-noise ratios and insufficient spatiotemporal resolution. Here, we present an intravital microscopy and artificial intelligence-based analysis workflow (Deep3P) that enables longitudinal deep imaging of glioblastoma up to a depth of 1.2 mm. We find that perivascular invasion is the preferred invasion route into the corpus callosum and uncover two vascular mechanisms of glioblastoma migration in the white matter. Furthermore, we observe morphological changes after white matter infiltration, a potential basis of an imaging biomarker during early glioblastoma colonization. Taken together, Deep3P allows for a non-invasive intravital investigation of brain tumor biology and its tumor microenvironment at subcortical depths explored, opening up opportunities for studying the neuroscience of brain tumors and other model systems.

The contemporary approach to chylothorax – Single-center experience with the proposal of a management algorithm

Objectives: Chylothorax is a relatively rare condition of lymphatic fluid accumulation in the thoracic cavity due to a leakage from the thoracic duct or its tributaries. Patients present with dyspnea, malnutrition, and immunosuppression. Treatment can be conservative or surgical, depending on etiology and clinical course. The optimal management algorithm for chylothorax is still controversial. Methods: This is a ten-year period retrospective study of all patients with chylothorax treated at our Department of Thoracic Surgery. Results: A total of 14 patients were identified for the study. Nine patients had chylothorax after lung or esophageal cancer surgery. Four patients had chylothorax in advanced lymphoma. One patient had chylothorax after blunt chest trauma. A conservative approach was initiated in most patients (92%), including pleural drainage, nil per mouth, total parenteral nutrition, and somatostatin 0.1 mg bid subcutaneously. Surgical treatment was indicated in patients with thoracic drain production &amp;gt;800 mL per day beyond the fifth day of treatment and those with blunt thoracic trauma. Two patients had thoracic duct ligation via right-sided thoracotomy, and five patients had video-assisted thoracoscopic thoracic duct ligation with the immediate arrest of chylous leakage. Conclusion: Chylothorax should be treated conservatively initially. Surgical treatment should not be delayed beyond the fifth day in case of failure. In our series of patients, a video-assisted thoracoscopic approach for thoracic duct ligation proved to be minimally invasive, highly efficient, and well tolerated. Therefore, it should be the preferable route of surgical treatment.

Exploring the relationship between preferred routes for walking exercise and green space layout in a dense urban area: a series of poisson regression models

ABSTRACT The literature considers urban green spaces as a key to promoting physical activity and health. Despite the increasingly recognized walking exercise promotion benefits of urban green spaces, the relationship between walking exercise preferences and green space layout remains unclear. We extracted preferred routes for walking exercise and measured the route heat using a one-year shared data of walking exercise from a mobile outdoor assistant app in the old city of Fuzhou, China. We then evaluated green space layout features within a 500-m buffer zone along the preferred routes in dimensions of scale, form, and function. The relationship between the route heat and green space layout features was analyzed using a series of poisson regression models, with the influence of urban morphology and the built environment allocation being controlled. Results showed that there existed a significant association between preferred routes for walking exercise and the combination of green space layout, urban morphology, and the built environment allocation; the route heat had positive associations with NDVI and comprehensive park area density, and showed negative associations with patch shape index and patch density. This study illustrates the necessity for targeted intervention strategies to promote the development of walkable and healthy urban areas.

Novel Use of Concentrated Solar Thermal Energy for Producing Highly Thermal Activated Materials for CCUS via Mineral Carbonation of Mine Waste

An assessment of the levelised cost and associated CO2-eq emissions for the thermal activation of serpentine mine tailings to be used as activated feedstock for CCUS processes via mineral carbonation, is reported here for the first time. Two main technological scenarios were assessed, based on either direct fuel sources heating (natural gas and hydrogen) or indirect, CST-based heating with a back-up burner and storage to provide continuous operations, for a 200 ton/hr of processed ore and a targeted roasting ore temperature of 700°C. For CST-based systems, 3 different solar input scales, namely 50, 150 and 450 MWth, were considered, and simulations performed over a year timeline with a 10 minutes time step, using Mt Keith Nickel mine in Western Australia as the reference location. The analysis highlighted that the proposed CST-hybrid plant layout can achieve similar cost to that of fuel-only cases with current Australian fuel prices for natural gas and hydrogen, with lower CO2-eq emissions, and a parity cost with fuel-only scenarios of some 16 USD/GJ. The proposed CST-hybrid plant layout was also identified as the potential, preferred route over direct CST routes to achieve 24/7 continuous heat supply while retaining fine tuning of activation temperature, given a very narrow temperature window of activation for the chosen mine tailings for mineral carbonation processes.

Pediatric head injury guideline use in Sweden: a cross-sectional survey on determinants for successful implementation of a clinical practice guideline

BackgroundThe Scandinavian Neurotrauma Committee guideline (SNC-16) was developed and published in 2016, to aid clinicians in management of pediatric head injuries in Scandinavian emergency departments (ED). The objective of this study was to explore determinants for use of the SNC-16 guideline by Swedish ED physicians.MethodsThis is a nationwide, cross-sectional, web-based survey in Sweden. Using modified snowball sampling, physicians managing children in the ED were invited via e-mail to complete the validated Clinician Guideline Determinants Questionnaire between February and May, 2023. Baseline data, data on enablers and barriers for use of the SNC-16 guideline, and preferred routes for implementation and access of guidelines in general were collected and analyzed descriptively and exploratory with Chi-square and Fisher's tests.ResultsOf 595 invitations, 198 emergency physicians completed the survey (effective response rate 33.3%). There was a high reported use of the SNC-16 guideline (149/195; 76.4%) and a strong belief in its benefits for the patients (188/197; 95.4% agreement). Respondents generally agreed with the guideline's content (187/197; 94.9%) and found it easy to use and navigate (188/197; 95.4%). Some respondents (53/197; 26.9%) perceived a lack of organizational support needed to use the guideline. Implementation tools may be improved as only 58.9% (116/197) agreed that the guideline includes such. Only 37.6% (74/197) of the respondents agreed that the guideline clearly describes the underlying evidence supporting the recommendation. Most respondents prefer to consult colleagues (178/198; 89.9%) and guidelines (149/198; 75.3%) to gain knowledge to guide clinical decision making. Four types of enablers for guideline use emerged from free-text answers: ease of use and implementation, alignment with local guidelines and practice, advantages for stakeholders, and practicality and accessibility. Barriers for guideline use were manifested as: organizational challenges, medical concerns, and practical concerns.ConclusionsThe findings suggest high self-reported use of the SNC-16 guideline among Swedish ED physicians. In updated versions of the guideline, focus on improving implementation tools and descriptions of the underlying evidence may further facilitate adoption and adherence. Measures to improve organizational support for guideline use and involvement of patient representatives should also be considered.

Mental representation of words and concepts in late multilingualism

Abstract Speakers of multiple languages must store the respective lexical items efficiently to enable correct access. Importantly, all items must be linked to semantic information and world knowledge. One prominent model of the mental lexicon of late bilinguals is the Revised Hierarchical Model (Kroll &amp; Stewart, 1994), which postulates bidirectional but asymmetrical connections between separate stores for L1 (native language) and L2 (second/foreign language), and a shared conceptual store. Using German native speakers with advanced English proficiency, Experiment 1 largely confirmed model predictions regarding different preferred mental routes and processing times depending on translation direction. Moreover, the original design was extended by including abstract stimuli and picture naming in L2. A series of additional measures, such as proficiency and age of acquisition, served to specify the language experience of the participants and made it possible to compare the results with a group of non-native speakers of German (Experiment 2). Interestingly, the results suggest that the model also applies to two or more non-native languages, potentially influenced by the experimental and environmental language context.

Exploring Optimal Strategies for Surgical Access in Transcatheter Aortic Valve Implantation.

Transcatheter aortic valve implantation (TAVI) has revolutionised the management of severe aortic stenosis, particularly for patients deemed high risk or inoperable for traditional surgical aortic valve replacement. The transfemoral approach is the preferred route whenever feasible, attributed to its minimally invasive nature, reduced procedural morbidity, and shorter recovery times. In total, 80-90% of TAVI procedures are performed via the transfemoral route. However, anatomical constraints such as severe peripheral arterial disease, small vessel diameter, or significant vessel tortuosity can preclude the use of this access site. In such cases, alternative access strategies must be considered to ensure the successful implantation of the valve. This review aims to provide a comprehensive summary of the various surgical techniques available for TAVI access, exploring the rationale, technical aspects, and challenges associated with each method. We will explore alternative routes, including the transapical, transaortic, transaxillary, and transcarotid approaches, highlighting their respective benefits and limitations.