Satisfactory Control Research Articles

Glycogenic hepatopathy associated with hepatic steatosis in type 1 diabetes

AimsGlycogenic hepatopathy is associated with significant psychosocial consequences and health costs. Metabolic Dysfunction-Associated Steatotic Liver Disease and glycogenic hepatopathy are frequently confused as “fatty liver” when seen on ultrasonography. We wished to examine liver fat and glycogen content in groups defined based on metabolic and liver disease phenotypes. MethodsThis case-control study undertaken in a tertiary hospital used nuclear proton magnetic resonance spectroscopy (1H-MRS) to examine liver fat and glycogen content in five clinical groups, each containing five participants: 1. type 1 diabetes with glycogenic hepatopathy, 2. satisfactorily controlled type 1 diabetes with no liver disease, 3. poorly controlled type 1 diabetes without liver disease, 4. a control group of body mass index- and age-matched individuals without diabetes or liver disease, and 5. hepatic steatosis. ResultsFat content was highest in the hepatic steatosis (median 15.4 %, IQR 10.0–19.3) and glycogenic hepatopathy (median 6.5 %, IQR 4.5–9.1) groups and compared to both of these groups was lower in the control group (median 1.0 %, IQR 0.7–1.1, p 0.002 and 0.022), the T1DM group with satisfactory control (median 0.3 %, IQR 0.2–0.6, p < 0.001 and <0.001), and the T1DM group with poor control without liver disease (median 1.1 %, IQR 0.9–1.1, p 0.001 and 0.012).No participants from the type 1 diabetes poor control, type 1 diabetes satisfactory control or the no diabetes groups had 1H-MRS-diagnosed hepatic steatosis.1H-MRS glycogen content could not be interpreted in the majority of those with glycogenic hepatopathy because of interference from the fat signal. ConclusionsIn cases diagnosed with glycogenic hepatopathy there may be significant concomitant fat accumulation, compounding the already elevated cardiovascular risk in this cohort.The technique of 1H-MRS has not been demonstrated to be useful for diagnosing glycogenic hepatopathy.

Highly selective sodium-glucose co-transporter type 2 inhibitor empagliflozin as means of brain protection in conditions of chronic brain dyscirculation

Chronic brain dyscirculation is one of the frequent type 2 diabetes mellitus (DM) complications and leads to patients' disability. Sodium-glucose co-transporter type 2 inhibitors (SGLT-2i) have been proven to have advantages for cardiovascular system, but their effect on the central nervous system (CNS) has not been studied enough. To study empagliflozin effect on CNS damage functional and laboratory parameters in patients with type 2 DM and, under experimental conditions, to investigate the mechanisms of the drug neurotropic effect. The clinical part of the study included patients with type 2 DM on metformin monotherapy (n=39). Patients with a target glycated hemoglobin level formed the "MET" group (n=19), in patients with a non-target glycated hemoglobin level empagliflozin was co-administered for the following 6 months (the "MET+EMPA" group, n=20). Healthy volunteers comprised the control group (n=16). The cognitive status and neuron-specific enolase (NSE) and neurofilament light chains (NLC) concentration were studied. DM was modeled in rats, thereafter the rats were treated with empagliflozin for 8 weeks. Microglia activation was assessed using anti-Iba-1 antibodies and morphological changes in neurons when stained by the Nissl method. Both in the "MET+EMPA" and the "MET" groups cognitive deficits were observed, according to the Montreal Cognitive Assessment (MOCA) (24.0 (23.0; 27.0) and 25.0 (21.0; 27.0) points) and the Mini-Mental State Examination (MMSE) (23.75 (23.0; 27.0) and 25.0 (21.0; 27.0) points). Empagliflozin therapy led to the cognitive status normalization after 6 months (26.5 (24.0; 27.0) points according to the MOCA scale and 27.5 (24.0; 28.0) points according to the MMSE). Initially, all patients had a significant increase of NSE (3.60 (2.66; 3.76) ng/ml in the "MET" group, 3.22 (2.94; 3.54) ng/ml in the "MET+EMPA» group, 2.72 (2.13; 2.72) ng/ml in the «Control» group) and NLC (4.50 (3.31; 5.56) ng/ml in the «MET» group, 5, 25 (3.75; 6.25) ng/ml in the «MET+EMPA» group comparing with 3.50 (2.25; 3.50) ng/ml in the «Control» group). Empagliflozin therapy led to a significant decrease in NLC already after 3 months (3.80 (3.25; 3.87) ng/ml), without significant influence on the NSE level. In the experiment, DM was characterized by an increased number of activated microgliocytes and destructured neurons and a decreased number of neurons with a normal structure. Empagliflozin therapy was accompanied by a decrease in the number of immunopositive microgliocytes in the CA1 zone of the hippocampus and an increase in the number of structured neurons. Type 2 diabetes mellitus is characterized by functional and biochemical changes in the central nervous system even under satisfactory glycemic control. Therapy with empagliflozin has a neuroprotective effect, manifested in an improvement in cognitive status and a decrease in NLC level. Empagliflozin reduces neuronal damage and abnormal microglial activation.

Management of resistant biotypes of Eleusine indica and glyphosate-tolerant Spermacocea latifolia with pre-emergent herbicides associated with sequential application of desiccants

It has been difficult to control Eleusine indica (L.) Gaertn and Spermacocea latifolia Aubl. in cotton and soybean crops due to their herbicide resistance or tolerance to glyphosate. Thus, this study's objective was to evaluate the herbicide efficacy applied in pre-emergence, associated with desiccant herbicide in sequential application, in these species. The experiments for S. latifolia and E. indica were conducted separately in a greenhouse. The experimental design was completely randomized, with 4 replications, in a 6 x 3 factorial. The first factor consisted of pre-emerging herbicides applied two days after the sowing of each species, diclosulam (35 g a.i./ha), s-metolachlor (600 g a.i./ha), pyroxasulfone (200 g a.i./ha) + flumioxazin (200 g a.i./ha), diuron (2000 g a.i./ha), trifluralin (600 g a.i./ha), and the treatment without herbicide. The second factor consisted of the application of diquat (200 g a.i./ha), ammonium glufosinate (400 g a.i./ha), or the absence of sequential application. The results revealed that only for the diclosulam herbicide a sequential application with desiccants was necessary for an effective control of E. indica. The other herbicide applied in pre-emergence showed high efficacy (&gt; 90%) in E. indica control when applied individually. Regarding S. latifolia chemical control, the herbicides s-metolachlor (80.04%), pyroxasulfone + flumioxazin (100%), diclosulam (82.08%) and diuron (89.58%), applied in pre-emergence, presented a satisfactory control at 42 days after emergence. The sequential applications promoted better control of S. latifolia to trifluralin and diuron. In conclusion, there are pre-emergence options for the effective control of E. indica and S. latifolia. However, sequential application can be an important tool for improving the control of some weed species, such as those studied in this work, by certain herbicides.

A Novel CEM-Based 2-DOF PID Controller for Low-Pressure Turbine Speed Control of Marine Gas Turbine Engines

Gas turbine engines have several advantages over piston reciprocating engines, such as higher output per unit volume, reduced vibration, rapid acceleration and deceleration, high power output, and clean exhaust gases. As a result, their use for propulsion in ships has been steadily increasing. However, gas turbine engines exhibit significant parameter variations depending on the rotational speed, making the design of controllers to ensure system stability while achieving satisfactory control performance, a very challenging task. In this paper, a novel CEM-based 2-DOF PID controller design technique is proposed to ensure the stability of a gas turbine engine while improving tracking and disturbance rejection performance. The proposed controller consists of a PID controller focused on enhancing disturbance rejection performance and a set-point filter to improve tracking performance. The set-point filter is composed of gains from the controller and a single weighting factor. When tuning the gains of the controller, the maximum sensitivity is considered to maintain an appropriate balance between system stability and response performance. The key novelty of this study can be summarized in two main points. One is that the controller is designed by matching characteristic equations, and by setting the roots of the desired characteristic equation as multipoles, the gains of the PID controller can be tuned with only one adjusting variable, making the tuning of the 2-DOF controller easier. The other is that the controller parameters are tuned based on maximum sensitivity, thus taking into account the robust stability of the control system. To demonstrate the feasibility of the proposed method, simulations are conducted for four scenarios using various performance indices.

The Facile Production of p-Chloroaniline Facilitated by an Efficient and Chemoselective Metal-Free N/S Co-Doped Carbon Catalyst.

The catalytic hydrogenation of the toxic and harmful p-chloronitrobenzene to produce the value-added p-chloroaniline is an essential reaction for the sustainable chemical industry. Nevertheless, ensuring satisfactory control of its chemoselectivity is a great challenge. In this work, a N/S co-doped metal-free carbon catalyst has been fabricated by using cysteine as a source of C, N, and S. The presence of calcium citrate (porogen agent) in the mixture subjected to pyrolysis provided the carbon with porosity, which permitted us to overcome the issues associated with the loss of heteroatoms during an otherwise necessary activation thermal treatment. Full characterization was carried out and the catalytic performance of the metal-free carbon material was tested in the hydrogenation reaction of p-chloronitrobenzene to selectively produce p-chloroaniline. Full selectivity was obtained but conversion was highly dependent on the introduction of S due to the synergetic effect of S and N heteroatoms. The N/S co-doped carbon (CYSCIT) exhibits a mesoporous architecture which favors mass transfer and a higher doping level, with more exposed N and S doping atoms which act as catalytic sites for the hydrogenation of p-chloronitrobenzene, resulting in enhanced catalytic performance when compared to the N-doped carbon obtained from melamine and calcium citrate (MELCIT) used as a reference.

Brain Stem Glioma Recurrence: Exploring the Therapeutic Frontiers.

Gliomas of the brainstem represent a small percentage of central nervous system gliomas in adults. Due to the proximity of the tumor to critical structures, radical surgery is highly challenging and limited to selected cases. In addition, postoperative treatments, which become exclusive to non-operable patients, do not guarantee satisfactory disease control, making the progression of the disease inevitable. Currently, there is a lack of therapeutic options to control tumor growth after the diagnosis of recurrence. The rarity of these tumors, their distinct behavioral characteristics, and the limited availability of tumor tissue necessary for the development of prognostic and predictive biomarkers contribute to the absence of a standardized approach for treating recurrent brainstem gliomas. A salvage radiotherapy (RT) retreatment could represent a promising approach for recurrent brainstem gliomas. However, to date, it has been mainly evaluated in pediatric cases, with few experiences available to assess the most appropriate RT dose, safety, and clinical responses in adult patients. This comprehensive review aims to identify instances of adult patients with recurrent brainstem gliomas subjected to a secondary course of RT, with a specific focus on the analysis of treatment-related toxicity and outcomes. Through this investigation, we endeavor to contribute valuable insights into the viability and efficacy of salvage RT retreatment in managing recurrent brainstem gliomas in the adult population.

Exploring key factors of radiative cooling performance of n-octadecane@SiO2 MEPCMs

With the development of passive daytime radiative cooling, various dielectric scatterers have been utilized. Among these, n-octadecane@SiO2 microencapsulated phase change materials (MEPCMs) have garnered significant attention for their effective radiative cooling, as well as unique temperature control and thermal energy storage capabilities. However, due to incomplete optical data for phase change materials (PCMs), past simulations used simplified parameters, leading to simulation-experiment mismatches. This study used simulation and experimentation to explore how particle size and shell thickness affect the radiative cooling of n-octadecane@SiO2 MEPCMs, leading to the production of n-octadecane@SiO2 MEPCMs with superior cooling capacity. To enhance simulation accuracy, we used a two-thickness inversion method to determine the complex refractive index of n-octadecane across 0.25–2.5 μm wavelengths. The simulation showed that particles of 0.25–0.4 μm radius scatter better with <50 nm shell, while those of 0.4–0.75 μm radius benefit from <100 nm shell for improved scattering. Finally, we designed n-octadecane@SiO2 MEPCMs with an average particle size of 0.66 μm and a shell thickness of 30 nm. This particle size can cause strong Mie scattering effect to reflect sunlight and SiO2 itself has a high mid-infrared emissivity. Thus n-octadecane@SiO2 MEPCMs show a high solar reflectivity of 94.93 % and a high mid-infrared emissivity of 94.62 %. In addition, it not only exhibited a satisfactory temperature control capacity under a latent heat capacity of over 154.4 J/g, but also achieved an excellent thermal cycling performance. This work expands the potential applications of MEPCMs and radiative cooling in energy conservation and environmental protection.

Osteoporotic vertebral fracture: Our Experience and update

Introduction: Osteoporotic vertebral fracture is a fragility fracture due to osteoporosis and is a growing public health problem. It mainly affects postmenopausal women and men &gt; 50 years. It significantly affects morbidity, financial condition, quality of life and mortality of patients. It presents mainly with back pain, which is mostly manageable with conservative measures. Those with unrelieved pain, severe spinal deformity or neurological impairment would require intervention. The quality of bone and surgical fitness along with associated co-morbidities of these elderly people, require special consideration, indications and appropriate modification of technique and instruments for surgical intervention. Materials and methodology: This prospective study summarizes the management of osteoporotic vertebral fractures from September 2015 to September 2021 in Nepal Medical College, Kathmandu, Nepal. The study included patients with back pain of more than 50 years old age. The backpain was evaluated clinically using visual analogue scale and Oswestry Disability Index, neurological deficits using Frankel grading system and deformity using X-ray. Other investigations included MRI, Dexa scan, Serum calcium and Vitamin D3. Risk factors for developing osteoporosis and OVF were also assessed. Results: Out of the 630 patients of more than 50 years age, presenting in neurosurgical OPD with backache from September 2015 to September 2020, 158 cases were later diagnosed to have osteoporotic spine fractures. There were 122 (77.2%) postmenopausal ladies and 36 (22.8%) gentlemen. All had backpain, with 36% having VAS score of &lt; 3 and 64% had ODI of mild to moderate disability. The neurological deficits were present in 16.4% and mostly were Frankel grade C and D. Significant kyphoscoliosis (Cobb angle more than 20 degrees) in X-ray was present in 18 (11.3%) patients. 88 (55.7%) patients had Dexa scan and T score was less than -2.5 in 88 (56%). Serum calcium was low in (41) 26% and Vitamin D3 was low in (107) 67.7% of the patients. For backpain, all were started on non-operative management. Vertebral augmentation procedure was not available in our institute. Thus, surgery was offered in 44 (28%) of the patients but only 18 (11.4%) agreed for surgery and underwent decompression with long segment fixation. Only 48 patients remained in follow up for more than 2 years and all had satisfactory control of pain with no deterioration in deformity or neurological deficit. There were no significant short or long-term complications or mortality. Conclusion: Osteoporotic vertebral fracture is a very common reason for back pain in people of more than 50 years old affecting their livelihood. The majority responded to conservative treatment. Those indicated for surgery need special consideration in preparation, technique and devices. Preventive measures can help reduce the problem load.

Event-triggered semi-active TLCD for ground motion-induced vibration control

One potential drawback of tuned liquid column dampers (TLCDs) is their relatively low control efficiency during the initial stage of structural vibration caused by external excitations. This is because satisfactory control effects can only be achieved when the liquid inside TLCD is fully oscillating, which is not the case during the initial stage. To solve this problem, in this study, an event-triggered semi-active technique is creatively proposed to improve the vibration reduction efficiency of TLCDs during the initial stage. The fundamental idea of the proposed approach is to provide an initial displacement to the liquid column via baffles, and then release the constraints on the initial liquid displacement at an appropriate time to achieve the rapid activation of TLCDs. A strategy from the standpoint of phase difference between liquid column motion and structural motion is proposed to determine the triggering conditions (i.e. when to release the constraints). The effectiveness of the proposed semi-active system is examined under both harmonic and stochastic excitations. The results show that the proposed strategy successfully improves the vibration suppression performance of TLCDs in the early stage of structural vibration.

Asthma control among teenagers attending the respiratory outpatient clinic of an academic hospital in Pretoria, South Africa

Objectives: Bronchial asthma is characteristically a diverse illness that results from chronically inflamed bronchi. Adolescents are a particularly vulnerable group to asthma, and both its prevalence and death rate have increased in this patient population. Asthma care creates a particular set of difficulties for adolescents who are at a stage where there is a search for greater autonomy and changing social and emotional dynamics. The aim of this study was to describe the clinical characteristics of teenage asthmatics in an academic hospital. Materials and Methods: This was a cross-sectional study of patients between the ages of 13 and 18 who had consented to participate. The study consisted of face-to-face interviews and a review of their clinical and laboratory records. Data were analyzed using descriptive statistics and comparisons between groups made using Fisher’s test of exactness. Results: Eighty-seven teenagers were studied. The mean age was 15.5 ± 1.5 years. The majority (59%) were male. Ten study subjects (11.5%) were current smokers. A positive family history of asthma was found in 31% (n = 27) of the patients. All patients were on inhaled corticosteroid therapy. The majority of the study subjects (60.9%) had satisfactory asthma control as evidenced by a mean asthma control test score (ACT) of 19.2 ± 2.29. Fifteen patients (26.7%) had had an acute flare-up of the disease requiring hospitalization in the preceding 12 months, and 5.8% had had a previous intensive care unit admission. Conclusion: The majority of the teenagers studied had overall satisfactory asthma control, as determined by their ACT scores. The use of inhaled corticosteroids was standard, but the inhaler technique was largely unsatisfactory. The prevalence of tobacco use is a cause for concern.

May Measurement Month 2021: an analysis of blood pressure screening results from Uganda.

High blood pressure (BP) is the leading cause of cardiovascular disease in Uganda accounting for more than 50% of cardiovascular related deaths each year. In Uganda, more than 25% of adults have high BP with lack of awareness being the main barrier to achieving satisfactory control rates. May measurement month (MMM) is a global initiative aimed at raising awareness of high BP and to act as a temporary solution to the lack of BP screening programmes. A cross-sectional survey of voluntary screenees aged 18 years and above was carried out between May and September 2021. Screening was carried out in two outpatient departments of two referral hospitals within the capital city, Kampala. BP measurements, the definition of hypertension and statistical analysis followed the standard MMM protocol. A total of 1671 people were screened and included in analysis. After multiple imputation, 1018 (60.9%) had hypertension. Of all 1018 participants with hypertension, 765 (75.1%) were aware and 750 (69.3%) were on antihypertensive medicine. Of the participants on antihypertensive medicine, 248 (35.2%) had controlled BP (<140/90 mmHg). Previous history of stroke and taking alcohol 1-6 times per week were significantly associated with higher diastolic BP. The MMM21 Uganda campaign highlights the importance of measuring BP as it generates real-time data on untreated and inadequately treated hypertension. This should motivate government and policy makers to promote routine local screening for BP.

Treatment outcomes of surgery followed by short-course every other day radiotherapy in keloid

BackgroundPostoperative radiotherapy can significantly reduce keloid recurrence. However, consensus on the optimal radiotherapy dose and treatment schedule remains elusive. This study aims to evaluate the effectiveness of surgery followed by a short-course of radiotherapy administered every other day for keloid treatment.Materials/MethodsWe conducted a retrospective analysis of 498 patients with keloids treated at our institution between January 2010 and December 2017. All patients underwent electron beam irradiation at a dose of 16 Gy, delivered in four fractions every other day, starting within 24 h post-surgery. The primary endpoint of the study was the local control rate.ResultsA total of 130 (26.5%) keloids recurred after a median follow-up of 68.1months (42.6-129.9 months). The local control rates at 1 year, 3 years and 5 years for all patients were 89.5%, 82.5% and 81%, respectively. The highest recurrence rate was observed in keloids located in the chest region (50.8%), followed by the suprapubic (47.8%), head and neck (38.8%), limbs (33.3%) and ear (14%). Both multivariate and univariate analyses identified the presence of pain and or pruritus as an independently prognostic factor for keloid recurrence (p<0.0001). The local control rates at 1-year, 3-years and 5-years for patients with or without symptom of pain or pruritus were 45% vs. 98.8%, 12.5% vs. 95.9%, and 8.8% vs. 95%, respectively (HR:37.829, 95%CI: 24.385–58.686, p<0.001). In the ear keloid subgroup, the 1-year, 3-year and 5-year local control rates for patients with pruritus were significantly lower than those without pain or pruritus (60.0% vs. 97.9%, 26.7% vs. 94.7%, 26.7% vs. 94.3%, HR:30.209, 95% CI:14.793–61.69, p<0.001). The same results were found in other location(p<0.001). During treatment and follow-up, two patients experienced infections, and one patient developed a cutaneous fibroblastoma.ConclusionThis study suggests that a combination of surgery followed by short-course, every-other-day radiotherapy can yield satisfactory local control rates for keloids. Pain and or pruritus symptom was an independently prognostic factors for recurrence of keloid. To further validate these results, a prospective randomized controlled trial is recommended.

Transformation towards a Low-Emission and Energy-Efficient Economy Realized in Agriculture through the Increase in Controllability of the Movement of Units Mowing Crops While Simultaneously Discing Their Stubble

When harvesting cereals and fodder grasses, a two-phase method is often used. This process is carried out using trailed and suspended collecting units. The former are asymmetrical and often pose problems regarding the stability of their movement in the horizontal plane. In practice, suspended harvesting units with a front-mounted header are becoming more and more widely used. The disadvantage of their use is that the soil is exposed after passing through the space between the swaths of the mown crop. This is followed by an intense loss of moisture. In order to eliminate this shortcoming, a collecting unit was proposed, consisting of a tractor with a front attachment and a disc harrow mounted at the rear. An appropriate mathematical model was developed to justify the scheme and parameters of such a unit. In this case, this model is used to assess the controllability of the movement of the dynamic system under the influence of control action in the form of the angular rotation of the tractor’s steered wheels. As a result of mathematical modelling, it was found that satisfactory controllability of the movement of the harvesting units can be ensured by acting on the tractor’s driven wheels with a frequency of 0–1 s−1 and a working speed of close to 3 m·s−1. In this case, it is desirable to set the deflection resistance coefficient of the rear tyres of the tractor (and therefore, the air pressure in them) to a smaller value, and that of the front tyres to a larger value. This helps both to improve the movement controllability of the harvesting unit and to reduce its energy consumption by an average of 6.75%. The emissivity of selected harmful chemicals and particulates emitted by the harvesting unit, depending on the fuel burned, was also examined. The way in which the use of the harvesting unit affects the reduction of emissions of harmful compounds into the atmosphere was also revealed.

Design, computational analysis and experimental study of a high amplification piezoelectric actuated microgripper

Increasing applications of compliant microgripper demands flexibility in working with a wide range of micro-objects which requires a large workspace, high precision motion, low parasitic motion, and satisfactory bandwidth control. To meet the requirement of pick and place manipulation tasks, a high amplification piezoelectric actuated microgripper is proposed and investigated in this paper. The high amplification of the microgripper is achieved using a compound amplifier. The compound amplifier is assisted to magnify the embedded piezoelectric actuator’s displacement. Two cascaded lever-type mechanisms are symmetrically connected with a bridge-type mechanism and form a three-stage amplification mechanism-based compound amplifier. Further, the four-bar parallelogram mechanisms are integrated with the third-stage displacement amplification mechanisms to linearize the output motion of the microgripper jaws. The characteristics of the microgripper were evaluated by computational analysis and validated using experimental investigations. Further, the design parameters are identified from the geometrical model of the individual displacement transmission mechanisms to perform a response surface optimization on the configured mechanism by the computational method. The design optimization of the microgripper resulted in a high displacement amplification ratio with a large workspace. The experimental investigations show that the designed microgripper is capable of achieving a high displacement amplification ratio of 34.5 and a total output displacement of 529.4 μm. Further, the characteristics of the microgripper such as motion resolution, and parasitic motion indicate that it will be able to perform high-precision micro-object grasping/releasing tasks.

Phenylalanine-Free Infant Formula in Patients with Phenylketonuria: A Retrospective Study.

The long-term efficacy and use of phenylalanine-free infant amino acid formula (PFIF) is understudied. This retrospective, longitudinal study evaluated PFIF (PKU Start: Vitaflo International) in children with phenylketonuria, collecting data on metabolic control, growth, dietary intake, and symptoms and the child's experience with PFIF. Twenty-five children (12 males, 48%) with a median age of 3.6 years (2.0-6.2 years) were included. During 24 months follow-up, children maintained normal growth and satisfactory metabolic control. The protein intake from protein substitutes increased from 2.7 at 6 months to 2.8 g/kg/day at 24 months, while natural protein decreased from 0.6 to 0.4 g/kg/day. By 24 months, most children (n = 16, 64%) had stopped PFIF, while nine (36%) continued with a median intake of 450 mL/day (Q1:300 mL, Q3: 560 mL). Children who continued PFIF after 24 months of age had higher energy and fat intakes with higher weight/BMI z-scores compared with those who stopped earlier (p < 0.05). Constipation was reported in 44% of infants but improved with age. Initial difficulty with PFIF acceptance was reported in 20% of infants but also improved with time. Prolonged use of PFIF in pre-school children may contribute to poor feeding patterns and overweight; thus, replacing the majority of the protein equivalent provided by PFIF with a weaning protein substitute by 12 months and discontinuing PFIF before 2 years is recommended.

Improving safety: Neuraxial blockade guided by thromboelastography for patients with uncertain coagulation profile.

Neuraxial blockade procedures are essential for anesthesia and pain management but pose risks in patients with uncertain coagulation profiles. Traditional coagulation tests often fail to predict bleeding risks associated with neuraxial blockade. Thromboelastography (TEG) offers real-time insights into coagulation status, potentially improving safety outcomes. In this case series, six patients underwent neuraxial blockade guided by TEG analysis. An individualized anesthetic plan was formulated based on TEG findings to mitigate bleeding risks while ensuring pain management. Tailoring anesthetic techniques to real-time TEG data improved safety outcomes with minimized bleeding complications and satisfactory pain control. In conclusion, neuraxial blockade guided by TEG enhances safety in patients with uncertain coagulation profiles. Further studies are needed to validate benefits in broader clinical settings.

Fault Tolerant Control of Fuzzy Stochastic Distribution Systems With Packet Dropout and Time Delay

The fault diagnosis (FD) and fault tolerant control (FTC) problem of the fuzzy stochastic distribution system (SDS) over packet dropout and time delay is studied. Firstly, the static model of linear fuzzy logic system that approximates the output PDF and the dynamic model with the multiplicative fault in a fuzzy system are established. The random packet dropout and time delay caused by the network are described in a unified framework, in which the lost data is compensated with the latest data received by the buffer. On this basis, an adaptive observer is devised to estimate the unknown multiplicative fault. The design of sliding mode predictive fault tolerant controller is discussed to ensure that the system still has good tracking performance after the fault occurs. Numerical simulations on a molecular weight distribution control system are supplied to prove the effectiveness of the presented scheme. <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">Note to Practitioners</i> —The motivation of this paper is to improve the reliability of the fuzzy stochastic distribution system with packet dropout and time delay. This kind of stochastic distribution systems is described by the relationship between the input and the output PDF rather than the normal relationship between the input and the output. When the multiplicative fault occurs in the system, the design of fault diagnosis strategy and fault-tolerant controller becomes an important challenge, especially when the system is subject to packet dropout and time delay. To address the above problems, a new fault diagnosis and fault-tolerant control scheme is proposed, which can accurately estimate the time and size of the fault and obtain the satisfactory fault-tolerant control effect.

Dynamic memory-based event-triggered security control for networked control systems subjected to false-injection-data attack

This study addresses the security control problem for networked control systems that are subjected to false-data-injection attacks. The designed controller rests on a dynamic memory-based event-triggered mechanism, which exploits historically transmitted data and an auxiliary term to improve transmission efficiency and ensure satisfactory control performance. Then, a controller that defends against the false-data-injection attacks is proposed by making full use of the historical information. With the aid of Cauchy–Schwarz and Gronwall–Bellman inequalities, the existence of such a controller is validated through a novel Lyapunov-based method, which allows the Lyapunov function to be nonpositive. Further, a test on a dynamic power system is provided to verify the effectiveness and superiority of the proposed method.

Efficiency of reduced rates of 2,4-D in mixture with wood vinegar in weed control

Chemical control is the most efficient method in weed management. However, given the societal demand for reducing pesticide use and mitigating production costs, alternatives for reducing herbicide doses should be considered. Among the alternatives that can contribute to the sustainable management of weeds is wood vinegar, a bio-input that has several applications in agriculture. In light of this, the objective of this study was to evaluate the reduction of doses of 2,4-D herbicide by mixing it with wood vinegar (WV). The experiments were conducted in a greenhouse at the Campus of Engineering and Agricultural Sciences (CECA/UFAL). The experimental design was completely randomized in a 4x2 factorial scheme, with 4 herbicide-WV mixtures (Distilled water; 0.5 L ha-1 of 2,4-D + 1 L ha-1 of WV; 1 L ha-1 of 2,4-D + 0.5 L ha-1 of WV; and 1.5 L ha-1 of 2,4-D (recommended commercial dose), and the spray solution with water only and with mineral oil (0.5% v/v). The receptor plants were Crotalaria juncea, Senna obtusifolia, and Bidens spp., and each weed species constituted an experiment, where phytotoxicity scale, control (%), and relative dry mass (%) were evaluated. The reduction of 2,4-D doses was not effective in controlling Crotalaria juncea, which showed satisfactory control only at the commercial dose of the product with mineral oil. The species Senna obtusifolia and Bidens spp. were effectively controlled in all treatments of the experiments regardless of mineral oil.

Impacts of State-Level Opioid Review Programs on Injured Workers and Their Health Care Providers: A Qualitative Study in Washington and Ohio.

Unsafe prescribing practices have been among the central causes of improper reception of opioids, unsafe use, and overdose in the United States. Workers' compensation agencies in Washington and Ohio have implemented opioid review programs (ORPs)-a form of quality improvement based on utilization review-to curb unsafe prescribing. Evidence suggests that such regulations indeed reduce unsafe prescribing, but pharmaceutical companies and patient advocates have raised concerns about negative impacts that could also result. This study explores whether three core sets of problems have actually come to pass: (1) unmanaged pain or reduced function among patients, (2) anger or resistance to ORPs from patients or providers, and (3) damage to patient-provider relationships or clinical autonomy. In-depth semistructured interviews were conducted with 48 patients (21 from Washington, 27 from Ohio) and 32 providers (18 from Washington, 14 from Ohio) who were purposively sampled to represent a range of injury and practice types. Thematic coding was conducted with codebooks developed using both inductive and deductive approaches. The consequences of opioid regulations have been generally positive: providers report more limited prescribing and a focus on multimodal pain control; patients report satisfactory pain control and recovery alongside collaborative relationships with providers. Participants attribute these patterns to a broad environment of opioid caution; they do not generally perceive workers' compensation policies as distinctly impactful. Both patients and providers comment frequently on the difficult aspects of interacting with workers' compensation agencies; effects of these range from simple inconvenience to delays in care, unmanaged pain, and reduced potential for physical recovery. In general, the three types of feared negative impacts have not come to pass for either patients or providers. Although interacting with workers' compensation agencies involves difficulties typical of interacting with other insurers, opioid controls seem to have generally positive effects and are generally perceived of favorably.