Half Rate Research Articles

Predicting the effect of nosocomial infection prevention on neonatal mortality and hospital stay in Ethiopia: a prospective longitudinal study

BackgroundNeonatal Nosocomial infections (NNIs) are a significant cause of morbidity and mortality for neonates in an intensive care unit. Neonatal causes of death in healthcare facilities are attributed to different factors. We aimed to investigate factors associated with NNIs, estimate the burden of NNIs, and assess how the prediction effects help to save medical mortality and length of hospital stay.MethodA prospective longitudinal study was conducted and data were collected from January 2022 to June 2022 from Jimma University Medical Center (JUMC). The data were gathered in a variety of ways, including an in-person interview with the patient’s caregiver, direct observations of neonatal patients, and a review of the study participants’ charts. This study includes patients aged 3 to 28 days who were admitted to the JUMC neonatal ward and stayed for at least 48 h. Multi-state model formulation and multivariate logistic regression were used for data analysis.ResultsA total of 545 neonates were included out of 688, and 30% (n = 164) of them acquired nosocomial infections (NIs); 98 (33%) of infected patients were born prematurely; and 71 (31.4%) were underweight at birth. NIs were higher in neonates with long hospital stay (AOR: 1.16, 95%CI: 1.13–1.20), use of urinary catheters (AOR: 3.09, 95%CI: 1.55–6.15), and undergoing surgical procedures (AOR: 2.42, 95%CI: 1.13–5.17). Patients who developed NIs had a higher risk of death (HR: 2, 95% CI: 1.31, 3.04). The burden of neonatal NIs was determined to have a risk of 0.3, a mortality rate of 9.6%, and an average duration of hospital stay of 14.6 days. Competing risk regression suggests that neonates with NIs have a significantly higher risk of death than those who are not infected (HR: 16.42, 95% CI: 8.70-30.98, p < 0.001). Assumed prevention that decreases the NIs rate in half would result in 101 lives and 1357 patient days saved from 10,000 neonatal inpatients.ConclusionUrinary catheterization and surgical procedure increased neonatal NIs. Longer hospital stay can increase the risk of NIs and can also result from the NIs. Our finding indicated that effective prevention of NIs could help reduce neonatal deaths and their hospital stays.

Influence of biofertilizers on potato (Solanum tuberosum L.) growth and physiological modulations for water and fertilizers managing

Biofertilizers constitute a safe way to alleviate the impacts of water shortage and the overload of chemical fertilizers. This work focuses on the effects of Arbuscular Mycorrhizal Fungi (AMF) and Plant Growth-Promoting Rhizobacteria (PGPR) on potato's agro-physiological response, beneath the reduction of water, nitrogen (N), phosphorous (P) and potassium (K) fertilizers. Five microbioal treatments (C: Control, AMF: Mycorhizae, B1: Bacillus halotolerans, B2: Bacillus amyloliquefaciens and B1B2: B.halotolerans+ B.amyloliquefaciens) were tested in arrangement with two nitrogen-phosphorous-potassium (NPK) rates (F1: Entire rate, F ½: Half rate) and three irrigation levels (100 % of crop water requirement: 100 % ETc; 75 % ETc; 50 % ETc) in a two year factorial split plot design. We studied vegetative growth, photosynthetic activity, chlorophyll fluorescence, water status, osmoticums, N, P, K and enzymatic antioxidants accumulation. Data obtained in 2019–2022 showed that AMF and B1B2 biofertilizers were beneficial to improve Root/Shoot, Dry Underground Part/Aerial Part, leaf area (LA), water saturation deficit (WSD), chlorophyll index (SPAD) and tuber yield under 75 % ETc. The photosynthetic promoter effect of biofertilizers under 75 % ETc, compared to 50 % ETc was observed in the following trend B1B2>AMF>B1. The efficacy of B1B2 and AMF were coupled to high catalase (CAT) activity. Potatoes treated with B1B2 were found to be efficient for 75 % ETc in terms of proline accumulation. The AMF was more effective in terms of soluble sugars (SS) accumulation and control of osmotic potential (Ψs). Taking together, the B1B2 and AMF could be regarded as efficient biofertilizers under 75 % ETc, alleviating the impacts of water stress and the problem of excessive fertilization in potatoes.

Core Bacterial Taxa Determine Formation of Forage Yield in Fertilized Soil.

Understanding the roles of core bacterial taxa in forage production is crucial for developing sustainable fertilization practices that enhance the soil bacteria and forage yield. This study aims to investigate the impact of different fertilization regimes on soil bacterial community structure and function, with a particular focus on the role of core bacterial taxa in contributing to soil nutrient content and enhancing forage yield. Field experiments and high-throughput sequencing techniques were used to analyze the soil bacterial community structure and function under various fertilization regimes, including six treatments, control with no amendment (CK), double the standard rate of organic manure (T01), the standard rate of organic manure with nitrogen input equal to T04 (T02), half the standard rate of inorganic fertilizer plus half the standard rate of organic manure (T03), the standard rate of inorganic fertilizer reflecting local practice (T04), and double the standard rate of inorganic fertilizer (T05). The results demonstrated that organic manure treatments, particularly T01, significantly increased the forage yield and the diversity of core bacterial taxa. Core taxa from the Actinomycetota, Alphaproteobacteria, and Gammaproteobacteria classes were crucial in enhancing the soil nutrient content, directly correlating with forage yield. Fertilization significantly influenced functions relating to carbon and nitrogen cycling, with core taxa playing central roles. The diversity of core microbiota and soil nutrient levels were key determinants of forage yield variations across treatments. These findings underscore the critical role of core bacterial taxa in agroecosystem productivity and advocate for their consideration in fertilization strategies to optimize forage yield, supporting the shift towards sustainable agricultural practices.

NFS-19. ATYPICAL PRESENTATION OF GLIOMAS IN ADOLESCENTS WITH NEUROFIBROMATOSIS TYPE 1 (NF1): A CASE SERIES

Abstract BACKGROUND Patients with NF1 are at risk for developing gliomas, usually low-grade in childhood but may be high-grade in adults. In children, the most common sites of disease are the optic pathway and brainstem; tumors in these regions often arise in young children and display histological features characteristic of pilocytic astrocytoma (PA) when biopsied. Typical MRI findings include T2 hyperintense, T1 hypointense lesions with minimal contrast enhancement and no diffusion restriction. Due to the well-established pattern of low-grade tumor formation in children with NF1, as well as the surgically challenging areas in which these tumors develop, low-grade glioma (LGG) therapy is often initiated without histologic confirmation of the diagnosis in classic cases. In cases with atypical disease location, older age at presentation or imaging appearance, a biopsy may be considered to exclude higher-grade lesions. METHODS Retrospective chart review, case series RESULTS Four adolescent patients with NF1 presented with atypical suspected gliomas. All four patients underwent surgical biopsy/resection. Case 1 was a left temporal lesion in the previous radiation field for optic pathway glioma; biopsy confirmed LGG with MAP2K1 mutation and increased focal proliferation index (28%), but methylation did not match with any established classification. The patient progressed through multiple rounds of therapy and succumbed to her tumor. Case 2 was a left occipital lesion; biopsy confirmed PA with CDKN2A deletion. The tumor displayed rapid regrowth, but subsequently stabilized. Case 3 was a right frontal lesion; confirmed PA. The tumor demonstrated some regrowth but then stabilized. Case 4 was a basal ganglia lesion; confirmed PA. The patient has demonstrated stable MRI findings and has not required further intervention. CONCLUSIONS Biopsy yielded helpful prognostic information (additional mutations, proliferation rate) in half of these atypical cases. Biopsy should be carefully considered for NF1 patients with atypical presentation or a history of radiation.

Healthcare and health situation of adults with type 2 diabetes in Germany: The study GEDA 2021/2022-Diabetes.

The nationwide study German Health Update (GEDA) 2021/2022-Diabetes was conducted to assess the current healthcare and health situation of adults with diabetes in Germany. GEDA 2021/2022-Diabetes comprises a sample of adults with diagnosed diabetes from the general population. The analysis focuses on adults aged 45 years and over with type 2 diabetes (N = 1,448) and provides selected indicators on diabetes care as well as mental, social and general health. 87.5 % of participants aged 45 years and over with type 2 diabetes are treated with blood glucose-lowering medication. 36.5 % receive insulin alone or in combination with other antidiabetics; 0.7 % use an insulin pump. Almost 96 % had an HbA1c measurement in the last year and about two thirds each report annual foot and eye examinations, participation in a diabetes self-management education programme and self-monitoring of their feet and of blood glucose (12.0 % with continuous glucose monitoring). On average, the quality of diabetes care is perceived as moderate. 23.8 % rate their mental health as excellent/very good. More than a tenth each have anxiety or depressive symptoms and feelings of loneliness. Half rate their general health as very good/good. There is a potential for improvement in the quality of diabetes care and the mental and physical health of adults with type 2 diabetes.

Dental Attendance Among the Elderly in Benin-city, Edo state

Background: Despite the increase in the elderly population globally, it appears that several studies focused on dental clinic attendance by other age groups and with sparse data on the elderly.&#x0D; Aim: This study therefore, aimed to determine the rate of dental clinic attendance among the elderly in Benin-city.&#x0D; Materials and methods: This was a half year multi-center, prospective cross-sectional study. This study conducted among dental patients at the outpatient departments two tertiary health facilities in Benin-city. A three-sectioned questionnaire was used to collect data. The data collected were sex, age, and level of educational, marital status, occupational level, religion, and ethnicity. Other collected data were co-morbidities, previous visit to dental clinic, time of last visit, reason for last visit, intention to visit the clinic again, presenting complaints and barriers to dental attendant. Both descriptive and inferential statistics were analyzed.&#x0D; Results: a total number of patients seen were 1450. The prevalence of the elderly patients was 27.7 %. Mean age was 70.4 ± 5.7 years with age range of 65- 97 years. The female elderly were more (52.9%) than their male counterparts. More than half (53.6%) had hypertensions. Less than half (30.2%) rate their dental health as good. More than half (56.9%) have never visited the dental clinic. Of all the presenting complained asked of the respondents, highest (18.5%) proportion was for toothache. Majority (71.3%) of the respondents affirmed that cost of transportation and long distance was the barrier for attending dental clinic. The rate of attendance (χ = 8.9; p = 0.03) and time of last visit (T =2.84; p = 0.01) was affected by the age of the respondents&#x0D; Conclusions: There was poor attendance to dental clinic by elderly in Benin City mainly due to cost of transportation and long distance. Age was related to poor attendance and time of visitation for attendance.&#x0D; Key words: Dental clinic, attendance, elderly

Foliar application of pyroligneous acid acts synergistically with fertilizer to improve the productivity and phytochemical properties of greenhouse-grown tomato

Pyroligneous acid (PA) is rich in bioactive compounds and known to have the potential to improve crop productivity and phytochemical content. However, the synergistic effect of PA and fertilizer has not been thoroughly studied. In this study, we assessed the biostimulatory effect of different rates of foliar PA application (i.e., 0, 0.25, 0.5, 1, and 2% PA/ddH2O (v/v)) combined with full rate (i.e., 0.63, 0.28, 1.03 g) and half rate of nitrogen-phosphorus-potassium (NPK) fertilizer on the yield and nutritional quality of greenhouse-grown tomato (Solanum lycopersicum ‘Scotia’). Plants treated with 0.25% and 0.5% PA showed a significantly (p < 0.001) higher maximum quantum efficiency of photosystem II (Fv/Fm) and increased potential photosynthetic capacity (Fv/Fo), especially when combined with the full NPK rate. Leaf chlorophyll was significantly (p < 0.001) increased by approximately 0.60 and 0.49 folds in plants treated with 2% PA and full NPK rate compared to no spray and water, respectively. Total number of fruits was significantly (p < 0.001) increased by approximately 0.56 folds with the 2% PA irrespective of the NPK rate. The combined 2% PA and full NPK rate enhanced total fruit weight and the number of marketable fruits. Similarly, fruit protein, sugar and 2,2-diphenyl-1-picrylhydrazyl (DPPH) activity were significantly (p < 0.001) enhanced by the combined 2% PA and full NPK rate. In contrast, the 0.5% PA combined with half NPK rate increased fruit carotenoid and phenolic contents while the 2% PA plus half NPK rate enhanced fruit flavonoid content. Generally, the synergistic effect of PA and NPK fertilizer increased fruit elemental composition. These showed that foliar application of 2% PA with full NPK rate is the best treatment combination that can be adopted as a novel strategy to increase the productivity and quality of tomato fruits. However, further study is required to investigate the molecular basis of PA biostimulatory effect on plants.

The stroke rate influences performance, technique and core stability during rowing ergometer

ABSTRACT The aim of this study is to determine the effect of stroke rate on performance, technique and core stability during rowing ergometer. Twenty-four high-level rowers performed maximal intensity one-minute bouts at 20, 28 and 34 spm on a RowPerfect3 ergometer. Power at the handle, legs, trunk and arms levels were determined, and core kinematics and neuromuscular activations were measured. The power at the handle was enhanced with a higher stroke rate in the first half of the drive phase due to higher segment’s powers. This resulted in technical changes, as for instance greater mean to peak power ratio at each segment level. The higher trunk power preceded a delayed trunk extension but without significant increase in the erector spinae activation. This underlines the role of the core stability to transfer forces at a higher stroke rate. However, no co-activation parameters between trunk flexors and extensors helped further to understand this force transfer. Rowing at low stroke rate can be a training strategy to work on earlier trunk extension, while maintaining erectors spinae levels of activation. Training at higher stroke rate will induce a rowing technique closer to competition with greater neuromuscular activations, and maximise power production.

Mode and Dose of Boron Nutrition on Growth, Productivity, Nutrient Uptake and Quality of a Rice-groundnut Cropping System

To assess the effect of boron (B) nutrition on growth, productivity, uptake and crop quality of rice-groundnut cropping system under medium land Inceptisols Odisha, a field experiment was conducted during Kharif and Rabi 2016-17 and 2017-18. The experiment was laid out in randomized block design (RBD) with eight treatments being replicated thrice. The results revealed that rice crop showed higher growth rate (9.4 mm day-1) than groundnut crop of 9.1 mm day-1. Soil application of B in split doses maintained higher growth rate than foliar spray irrespective of crops. B fertilization to rice crop reduced chaffiness from 35% in no B fertilization to 15% in B applied in split doses. It also showed 15.6% higher number of nodules than no B application in groundnut crop. Economic yield produced in different mode of B application in rice-groundnut cropping system, the 2nd crop was influenced by 22.5% against 16.0% for the 1st crop. B improved the economic yield by 19.5%over no B application. Application of B@1kg.ha-1 to each crops increased the economic yield by 8.7% compared to its half rate application (0.5 kg.ha-1). Based on rice-equivalent yields (REY) of rice-groundnut cropping system practices followed the order: Split application (288)&gt;Full dose basal (250)&gt;Full dose B to groundnut (199)&gt;Half dose B basal to each crop (188)&gt;Full dose B to rice (186) = Foliar spray of B (186)&gt;STD (100). The recovery of added N increased by (42.2%) when B was applied to 1st crop with full dose (53.5%), again it increased further by 60.8% when applied in split. B nutrition to rice-groundnut system influenced P and K uptake by 36.4% and 48.4% respectively over no application. In rice-groundnut cropping system split application of B@0.5 kg.ha-1 to both crops at active growth stages improved the yield, uptake, crop quality and economic benefit was found superior over no or sub optimal dose of B application in a deficient medium land Inceptisols of Jajpur district.

Salvage treatments for barnyardgrass (Echinochloa crus-galli) control in rice following simulated failed herbicide application

Abstract Florpyrauxifen-benzyl was commercialized in 2018 to target barnyardgrass and aquatic or broadleaf weeds. Field studies were conducted from 2019 to 2021 in Stoneville, MS, to evaluate barnyardgrass control following a simulated failure of florpyrauxifen-benzyl or other common postemergence rice herbicides. In the first field study, florpyrauxifen-benzyl was applied at 0 and 15 g ai ha–1 to rice at the two- to three-leaf stage to simulate a failed application targeting barnyardgrass. Sequential herbicide treatments included no herbicide and full rates of imazethapyr, quinclorac, bispyribac-Na, and cyhalofop applied 7 or 14 d after florpyrauxifen-benzyl treatment. The second field study was designed to evaluate barnyardgrass control with florpyrauxifen-benzyl following simulated failure of postemergence rice herbicides. Initial herbicide treatments included no herbicide and half rates of imazethapyr, quinclorac, bispyribac-Na, and propanil. Sequential applications at 7 or 14 d after the initial herbicide treatments included florpyrauxifen-benzyl at 0 and 30 g ai ha–1. Results from the first study indicated barnyardgrass control 21 d after final treatment (DAFT) was greater with sequential treatments at 7 compared with 14 d after initial treatment (DA-I) with no initial application of florpyrauxifen-benzyl. Therefore, delaying sequential treatments until 14 d after initial florpyrauxifen-benzyl at 15 g ha–1 allowed barnyardgrass to become too large to control with other rice herbicides. Rough rice yield was reduced in plots where quinclorac application was delayed from 7 to 14 DA-I with no initial application of florpyrauxifen-benzyl. The second study suggested that florpyrauxifen-benzyl application should be delayed 14 d after a herbicide failure. Although no differences in barnyardgrass control 21 DAFT were detected whether florpyrauxifen-benzyl was applied 7 or 14 DA-I of any herbicide utilized, &gt;85% control was only achieved when florpyrauxifen-benzyl application was delayed 14 DA-I. These results demonstrate barnyardgrass control options following simulated failed applications of common rice herbicides.

Comparison of Patterns of Structural Progression in Primary Open Angle Glaucoma and Pseudoexfoliation Glaucoma.

Primary open angle glaucoma and pseudoexfoliation glaucoma showed different progression patterns of the retinal nerve fiber layer and ganglion cell-inner plexiform layer thinning in OCT-guided progression analysis. To compare the patterns of progression of retinal nerve fiber layer (RNFL) and macular ganglion cell-inner plexiform layer (GCIPL) thinning by guided progression analysis (GPA) of optical coherence tomography (OCT) in primary open angle glaucoma (POAG) and pseudoexfoliation glaucoma (PXG). The progression of RNFL and GCIPL thinning was assessed by the GPA of Cirrus HD-OCT (Carl Zeiss Meditec, Dublin, CA). By overlaying the acquired images of the RNFL and GCIPL thickness-change maps, the topographic patterns of progressive RNFL and GCIPL thinning were evaluated. The rates of progression of RNFL and GCIPL thinning were analyzed and compared between patients with POAG and those with PXG. Of the 248 eyes of 248 patients with POAG (175 eyes of 175 patients) or PXG (73 eyes of 73 patients) enrolled, 156 POAG eyes and 48 PXG eyes were included. Progressive RNFL thinning was significantly more common in PXG than in POAG ( P =0.005). According to the RNFL progression-frequency maps, progression appeared mainly in the superotemporal and inferotemporal areas in POAG, whereas it had invaded more into the temporal area in PXG. According to the GCIPL maps, progression was most common in the inferotemporal area in both POAG and PXG. The average progression rate of GCIPL thinning was faster in PXG than in POAG ( P =0.013), and when analyzed in 2 halves (superior/inferior), the progression rate of the inferior half was faster in PXG than in POAG ( P =0.011). OCT GPA showed progression patterns of RNFL and GCIPL thinning in POAG and PXG. Understanding the specific patterns of progressive RNFL and GCIPL thinning according to glaucoma type may prove helpful to glaucoma-patient treatment and monitoring.

Long-term outcomes for hybrid aortic arch repair

ObjectiveSince its inception in the early 2000s, hybrid arch repair (HAR) has evolved from novel approach to well-established treatment modality for aortic arch pathology in appropriately selected patients. Despite this nearly 20-year history of use, long-term results of HAR remain to be determined. As such, objectives of this study are to detail the long-term outcomes for HAR within an expanded classification scheme. MethodsFrom August 2005 to August 2022, 163 consecutive patients underwent HAR at a single referral institution. Operative approach was selected according to an institutional algorithm and included zone 0/1 HAR in 25% (n = 40), type I HAR in 34% (n = 56), and type II/III HAR in 41% (n = 67). Specific zone 0/1 technique was zone 1 HAR in 31 (78%), zone 0 with innominate snorkel (zone 0S HAR) in 7 (18%), and zone 0 with single side-branch endograft (zone 0B HAR) in 2 (5%). The 30-day and long-term outcomes, including overall and aortic-specific survival, as well as freedom from reintervention, were assessed. ResultsThe mean age was 63 ± 13 years and almost one-half of patients (47% [n = 77]) had prior sternotomy. Presenting pathology included degenerative aneurysm in 44% (n = 71), residual dissection after prior type A repair in 38% (n = 62), chronic type B dissection in 12% (n = 20), and other indications in 6% (n = 10). Operative outcomes included 9% mortality (n = 14) at 30 days, 5% mortality (n = 8) in hospital, 4% stroke (n = 7), 2% new dialysis (n = 3), and 2% permanent paraparesis/plegia (n = 3). The median follow-up was 44 month (interquartile range, 12-84 months). Overall survival was 59% and 47% at 5 and 10 years, respectively, whereas aorta-specific survival was 86% and 84% at the same time points. At 5 and 10 years, freedom from major reintervention was 92% and 91%, respectively. Institutional experience had a significant impact on both early and late outcomes: comparing the first (2005-2012) and second (2013-2022) halves of the series, 30-day mortality decreased from 14% to 1% (P = .01) and stroke from 6% to 3% (P = .62). Improved operative outcomes were accompanied by improved late survival, with 78% of patients in the later era vs 45% in the earlier era surviving to 5 years. ConclusionsHAR is associated with excellent operative outcomes, as well as sustained protection from adverse aortic events as evidenced by high long-term aorta-specific survival and freedom from reintervention. However, surgeon and institutional experience appear to play a major role in achieving these superior outcomes, with a five-fold decrease in operative mortality and a two-fold decrease in stroke rate in the latter half of the series. These long-term results expand on prior midterm data and continue to support use of HAR for properly selected patients with arch disease.

Preventing HIV Infection in Pregnant Women in Western Uganda Through a Comprehensive Antenatal Care-Based Intervention: An Implementation Study.

We implemented and assessed a comprehensive, antenatal care (ANC)-embedded strategy to prevent HIV seroconversions during pregnancy in Uganda. HIV-negative first-time ANC clients were administered an HIV risk assessment tool and received individual risk counseling. Those attending ANC without partners obtained formal partner invitation letters. After three months, repeat HIV testing was carried out; non-attending women were reminded via phone. We analyzed uptake and acceptance, HIV incidence rate, and risk behavior engagement. Among 1081 participants, 116 (10.7%) reported risk behavior engagement at first visit; 148 (13.7%) were accompanied by partners. At the repeat visit (n = 848), 42 (5%, p < 0.001) reported risk behavior engagement; 248 (29.4%, p < 0.001) women came with partners. Seroconversion occurred in two women. Increased odds for risk behavior engagement were found in rural clients (aOR 3.96; 95% CI 1.53-10.26), women with positive or unknown partner HIV-status (2.86; 1.18-6.91), and women whose partners abused alcohol (2.68; 1.15-6.26). Overall, the assessed HIV prevention strategy for pregnant women seemed highly feasible and effective. Risk behavior during pregnancy was reduced by half and partner participation rates in ANC doubled. The observed HIV incidence rate was almost four times lower compared to a pre-intervention cohort in the same study setting.

The emergence of procyclical fertility: The role of breadwinner women

Fertility in the US exhibits an increasingly more procyclical pattern. We argue that women’s breadwinner status is behind procyclical and lower fertility: (i) women’s relative income in the family has increased over time; and (ii) women are more likely to work in relatively stable and countercyclical industries whereas men tend to work in volatile and procyclical industries. This creates a countercyclical gender income gap as women become breadwinners in recessions, producing an insurance effect of women’s income. Our quantitative framework shows that rising breadwinner status of women can explain both the emergence of procyclical fertility and the decline in fertility rate in the second half of the 20th century.

Foreign Supply Shocks and the Structure of Trade in a Small Open Economy

We evaluate how imports of a small open economy adjusted to foreign supply disruptions in the first year of the COVID-19 pandemic. Exploiting information on the timing, stringency, and persistence of coronavirus containment measures, we estimate their impact on the value and composition of imports. About half of the total contraction is attributed to foreign supply-sided disruptions. Contractions were more pronounced in concentrated import markets, but more severe contractions were prevented by trade partner substitution. We document systematic reallocation of market shares towards countries with large supply capacity and low COVID-19 incidence rates in the second half of 2020.

N6-Methyladenine Progressively Accumulates in Mitochondrial DNA during Aging.

N6-methyladenine (6mA) in the DNA is a conserved epigenetic mark with various cellular, physiological and developmental functions. Although the presence of 6mA was discovered a few years ago in the nuclear genome of distantly related animal taxa and just recently in mammalian mitochondrial DNA (mtDNA), accumulating evidence at present seriously questions the presence of N6-adenine methylation in these genetic systems, attributing it to methodological errors. In this paper, we present a reliable, PCR-based method to determine accurately the relative 6mA levels in the mtDNA of Caenorhabditis elegans, Drosophila melanogaster and dogs, and show that these levels gradually increase with age. Furthermore, daf-2(-)-mutant worms, which are defective for insulin/IGF-1 (insulin-like growth factor) signaling and live twice as long as the wild type, display a half rate at which 6mA progressively accumulates in the mtDNA as compared to normal values. Together, these results suggest a fundamental role for mtDNA N6-adenine methylation in aging and reveal an efficient diagnostic technique to determine age using DNA.

Transjugular intrahepatic portosystemic shunt in patients with hepatocellular carcinoma: A systematic review.

Transjugular intrahepatic portosystemic shunts (TIPS) in patients with hepatocellular carcinoma (HCC) may improve access to curative therapies, treat portal hypertension (PH)-related complications without worsening liver function, and increase overall survival. Data on the efficacy and safety of TIPS to treat PH complications in HCC patients, as well as the HCC treatment response, were evaluated. Studies reporting efficacy in controlling bleeding/ascites or response to HCC therapy, safety, and survival in patients with HCC and TIPS were searched systematically on PubMed and Embase. An extraction of articles using predefined data fields and quality indicators was used. We selected 19 studies and found 937 patients treated for ascites/bleeding and 177 evaluating HCC treatment response. Over half were under 5cm and solitary lesions, and most studies included tumours with portal vein thrombosis. Regarding PH studies, TIPS resolved bleeding/ascites in >60% of patients, more effective for bleeding. There were no lethal complications reported and procedural bleeding occurred in <5%. Hepatic encephalopathy occurred in 15%-30% within three months. In the HCC treatment-response studies, major complication rates were low with no mortality. In the studies that evaluated the response to transarterial chemoembolization, complete response rate of patients with TIPS varied from 16% to 75%. Liver transplantation rate varied from 8% to 80%, with >40% rate in half of the studies. In the published studies, TIPS is effective in treating PH complications in patients with HCC. Prospective studies on TIPS placement in patients with HCC are urgently needed to evaluate the efficacy and safety of TIPS in this setting.

Diagnosis of the building stock using Energy Performance Certificates for urban energy planning in Mediterranean compact cities. Case of study: The city of València in Spain.

This research aims to diagnose the energy performance of buildings in València and identify areas where energy efficiency can be improved. The energy performance results of all 129,487 EPCs in the city were mapped and compared to socioeconomic variables to gain insights into the reasons behind the results. The study reveals that the city’s building stock has poor energy performance, attributed to the lack of building standards during the city’s expansion in the 1960s and 1970s. The worst energy performances are observed in the peripheral districts, particularly in the city’s northern half, where low-income and low-renting rates are common, resulting in reduced investment capacity for individuals to retrofit their homes. To promote quick dissemination of measures to retrofit households, they must be adequate, economical, and replicable, avoiding social, administrative, and economic barriers. The study highlights the importance of EPCs as an objective tool to diagnose the energy efficiency of a city’s building stock. Policymakers can use the findings to identify areas that require improvements and evaluate the appropriate actions to improve the building stock’s energy performance. This study presents significant potential to reduce buildings’ energy demand and achieve climate goals through EPCs.

Diagnostic Accuracy of Artificial Intelligence in Virtual Primary Care

ObjectiveTo evaluate the diagnostic accuracy of artificial intelligence (AI)-generated clinical diagnoses. Patients and MethodsA retrospective chart review of 102,059 virtual primary care clinical encounters from October 1, 2022, to January 31, 2023 was conducted. Patients underwent an AI medical interview, after which virtual care providers reviewed the interview summary and AI-provided differential diagnoses, communicated with patients, and finalized diagnoses and treatment plans. Our accuracy measures were agreement between AI diagnoses, virtual care providers, and blind adjudicators. We analyzed AI diagnostic agreement across different diagnoses, presenting symptoms, patient demographic characteristics such as race, and provider levels of experience. We also evaluated model performance improvement with retraining. ResultsProviders selected an AI diagnosis in 84.2% (n = 85,976) of cases and the top-ranked AI diagnosis in 60.9% (n = 62,130) of cases. Agreement rates varied by diagnosis, with greater than or equal to 95% provider agreement with an AI diagnosis for 35 diagnoses (47% of cases, n = 47,679) and greater than or equal to 90% agreement for 57 diagnoses (69% of cases, n = 70,697). The average agreement rate for half of all presenting symptoms was greater than or equal to 90%. Adjusting for case mix, diagnostic accuracy exhibited minimal variation across demographic characteristics. The adjudicators’ consensus diagnosis, reached in 58.2% (n = 128) of adjudicated cases was always included in the AI differential diagnosis. Provider experience did not affect agreement, and model retraining increased diagnostic accuracy for retrained conditions from 96.6% to 98.0%. ConclusionOur findings show that agreement between AI and provider diagnoses is high in most cases in the setting of this study. The results highlight the potential for AI to enhance primary care disease diagnosis and patient triage, with the capacity to improve over time.

Characterization of Channeling Effects Applied to Extended-Release Matrix Tablets Containing Pirfenidone.

Pirfenidone (PRF) is an anti-fibrotic agent that has been approved by the Food and Drug Administration (FDA) for the treatment of mild to moderate idiopathic pulmonary fibrosis. However, the current oral administration dosing regimen of PRF is complex and requires high doses. Patients are instructed to take PRF three times daily, with each dose consisting of up to three capsules or tablets (600 mg/d or 1.8 g/d of PRF) taken with food. To improve the dosing regimen, efforts are being made to develop an extended-release tablet with a zero-order release pattern. In this study, two types of extended-release matrix tablets were compared: non-channeled extended-release matrix tablets (NChMT) and channeled extended-release matrix tablets (ChMT). In vitro release tests, swelling and erosion index, rheology studies, and X-ray microcomputed tomography (XRCT), were conducted. The results indicated that ChMT maintained a zero-order release pattern with a constant release rate, while NChMT exhibited a decreased release rate in the latter half of the dissolution. ChMT exhibited accelerated swelling and erosion compared to other formulations, and this was made possible by the presence of channels within the tablet. These channels allowed for thorough wetting and swelling throughout the entire depth of the tablet. The formation of channels was confirmed through XRCT images. In conclusion, the presence of channels in ChMT tablets increased the rate of swelling and erosion, resulting in a zero-order release pattern. This development offers the potential to improve the dosage of PRF and reduce its associated side effects.