Satisfactory Response Research Articles

Low Temperature Synthesis of 2D p-Type α-In2Te3 with Fast and Broadband Photodetection.

2D compounds (A = Al, Ga, In, and B = S, Se, and Te) with intrinsic structural defects offer significant opportunities for high-performance and functional devices. However, obtaining 2D atomic-thin nanoplates with non-layered structure on SiO2/Si substrate at low temperatures is rare, which hinders the study of their properties and applications at atomic-thin thickness limits. In this study, the synthesis of ultrathin, non-layered α-In2Te3nanoplates is demonstrated using a BiOCl-assisted chemical vapor deposition method at a temperature below 350°C on SiO2/Si substrate. Comprehensive characterization results confirm the high-quality single crystal is the low-temperature cubic phase α-In2Te3 , possessing a noncentrosymmetric defected ZnS structure with good second harmonic generation. Moreover, α-In2Te3 is revealed to be a p-type semiconductor with a direct and narrow bandgap value of 0.76eV. The field effect transistor exhibits a high mobility of 18 cm2 V-1s-1,and the photodetector demonstrates stable photoswitching behavior within a broadband photoresponse from 405 to 1064nm, with a satisfactory response time of τrise = 1ms. Notably, the α-In2Te3 nanoplates exhibit good stability against ambient environments. Together, these findings establish α-In2Te3 nanoplates as promising candidates for next-generation high-performance photonics and electronics.

Nano‐Mediated PDT as a Multifunctional Immunomodulatory Agent in the Intricate Milieu of Melanoma

AbstractThe complexity of the tumor microenvironment (TME) and nutrient competition represent the main causes of therapy resistance in cancers, including malignant melanoma (MM). Photodynamic therapy (PDT), through a cascade of events including its ability to induce significant immune responses, causes tumor eradication. However, the high pigmentation level of melanoma, lack of adequate accumulation of photosensitizers (PSs) in the target tissue as well as their nonspecific toxicity represent three main obstacles to obtaining satisfactory responses in melanoma. To prevail over these challenges, this study employs a depigmentation strategy followed by a nano‐mediated topical application of PDT using a chlorophyllin derivative as PS, focusing on the evaluation of the immunomodulatory and metabolic regulatory axes of PDT in melanoma. Photo‐immunomodulation is assessed in a melanoma mouse model using a nanocarrier system of the PS. Markers of the immunosuppressive microenvironment and T cell exhaustion, as independent immune hallmarks, are quantified. The histopathology of the spleen and skin/tumor is evaluated. The amino acid profile is quantified from normal skin or tumor biopsies using UHPLC‐MS/MS. Around 80% of the 300 nm transethosomal ferrous chlorophyllin (fC‐TEs) are retained in the tumor over 24 h upon topical application. Arbutin 2% gel not only decreased the melanin content of tumors but also regulated the expression of interleukin 12 (IL‐12), IL‐10, transforming growth factor beta (TGF‐β), and tumor necrosis factor‐alpha (TNF‐α). Additionally, the nano‐mediated PDT strategy decreased the expression of programmed cell death protein 1 (PD‐1) and its ligand 1 (PD‐L1) and reduces the activity of arginase 1 (Arg1) through an upregulation of miRNA155. A mild recruitment of megakaryocytes (MKs) is observed in the spleen of the PDT group. This special localization of MKs depicts effector immune properties. Lastly, the combination of PDT and arbutin restores the normal tissue levels of arginine (Arg), and glutamine (Gln) and lavished those of tryptophan (Trp). Nano‐mediated PDT represents a novel immunotherapeutic approach in melanoma by a triple modulation of the immune suppressive TME, immune checkpoint signaling, and reprogrammed tumor metabolism.

Kidney transplantation in patients on anti-tubercular therapy: A single centre observational study.

Tuberculosis (TB) is a common infection in chronic kidney disease. The prolonged therapy of TB can delay kidney transplantation in patients on antitubercular therapy (ATT). This was a retrospective single-center study to analyze the safety of kidney transplantation and its outcomes in patients undergoing transplantation while on the continuation phase of ATT. Between 2013 and 2022, 30 patients underwent kidney transplantation while on ATT. Median age was 38 years and 70% were males. Majority of the patients (86.7%) had extrapulmonary tuberculosis, most common site of involvement being tubercular lymphadenitis. 14/30 patients had microbiological/histopathological diagnosis of TB and the rest were diagnosedby ancillary tests. Patients were treated with 4 drug ATT (isoniazid, rifampicin, pyrazinamide, ethambutol) before transplantation for aminimum of 2 months. Post-transplantation fluoroquinolone-based non-rifamycin ATT was used (median duration 11 months). All patients completed therapy. At 2 years, there was 100% patient survival and 96.7% graft survival. Median eGFR at 6, 12, and 24 months post-transplantation was 71.9, 64.7, and 67mL/min/1.73m2, respectively. The percentage of patients suffering a biopsy proven acute rejection at 6, 12, and 24 months was 3.3%, 6.7%, and 6.7%. Kidney transplantation can be done in patients with TB who have a satisfactory response to the intensive phase of the ATT. The decision for transplantation while on the continuation phase ofATT should be individualized. In our experience, there is excellent patient and graft survival in these patients with a low risk of failure of ATT or relapse of TB.

Employee engagement at a private higher education institution during the COVID-19 pandemic

Orientation: During the coronavirus disease 2019 (COVID-19) pandemic, organisations, including higher education institutions, had to shift their thinking regarding traditional work models to new ones conducive to the lockdown.Research purpose: This study investigated employees’ levels of engagement during work-from-home (WFH) within a private higher education institution in South Africa in the context of the COVID-19 pandemic.Motivation for the study: While some studies have looked at the effect of WFH on employee engagement, few studies could be located that look at this phenomenon within a private higher education setting.Research approach/design and method: This study adopted the positivistic research paradigm using a quantitative research approach. The target population included 133 personnel. Total population sampling was used, and the data were collected by administering an online survey using the 17-item Utrecht Work Engagement Scale (UWES). Descriptive statistics, confirmatory factor analysis (CFA), independent sample t-tests, analysis of variance (ANOVA) and effect sizes were used to analyse the data. A satisfactory response rate of 79% was realised.Main findings: The study found that despite the difficulties and anxieties brought about by the radical shifts to WFH, the personnel could still thrive and show high levels of engagement. This was attributed to positive drivers of engagement such as autonomy, psychosocial safety, convenience, social union, and most importantly, organisational support.Practical/managerial implications: Work-from-home is regarded as a viable work arrangement for the foreseeable future. Private higher education should take note of the suggestions put forward to improve, sustain and manage employee engagement successfully.Contribution/value-add: This study contributes to the body of knowledge surrounding employee engagement in the WFH context within the private higher education sphere.

Diuretic Strategies in Acute Decompensated Heart Failure: A Narrative Review.

Heart failure is a common condition with considerable associated costs, morbidity, and mortality. Patients often present to hospital with dyspnea and edema. Inadequate inpatient decongestion is an important contributor to high readmission rates. There is little evidence concerning diuresis to guide clinicians in caring for patients with acute decompensated heart failure. Contemporary diuretic strategies have been defined by expert opinion and older landmark clinical trials. To present a narrative review of contemporary recommendations, along with their underlying evidence and pharmacologic rationale, for diuretic strategies in inpatients with acute decompensated heart failure. PubMed, OVID, and Embase databases were searched from inception to December 22, 2022, with the following search terms: heart failure, acute heart failure, decompensated heart failure, furosemide, bumetanide, ethacrynic acid, hydrochlorothiazide, indapamide, metolazone, chlorthalidone, spironolactone, eplerenone, and acetazolamide. Randomized controlled trials and systematic reviews involving at least 100 adult patients (> 18 years) were included. Trials involving torsemide, chlorothiazide, and tolvaptan were excluded. Early, aggressive administration of a loop diuretic has been associated with expedited symptom resolution, shorter length of stay, and possibly reduced mortality. Guidelines make recommendations about dose and frequency but do not recommend any particular loop diuretic over another; however, furosemide is most commonly used. Guidelines recommend that the initial furosemide dose (on admission) be 2-2.5 times the patient's home dose. A satisfactory diuretic response can be defined as spot urine sodium content greater than 50-70 mmol/L at 2 hours; urine output greater than 100-150 mL/h in the first 6 hours or 3-5 L in 24 hours; or a change in weight of 0.5-1.5 kg in 24 hours. If congestion persists after the maximization of loop diuretic therapy over the first 24-48 hours, an adjunctive diuretic such as thiazide or acetazolamide should be added. If decongestion targets are not met, continuous infusion of furosemide may be considered. Heart failure with congestion can be managed with careful administration of high-dose loop diuretics, supported by thiazides and acetazolamide when necessary. Clinical trials are underway to further evaluate this strategy.

Safety and Efficacy of TKIs in very Elderly Patients (≥75 Years) with Chronic Myeloid Leukemia.

While the outcomes of chronic phase chronic myeloid leukemia (CP-CML) patients aged over 65 years have been extensively evaluated in real-life experiences, limited data exist for the very elderly population (i.e., aged ≥ 75 years), especially for next-generation tyrosine kinase inhibitors (TKIs). In this retrospective study, we sought to evaluate the safety and efficacy of TKIs in this particular setting of patients. We conducted a retrospective analysis of a multicenter cohort of 123 newly diagnosed CP-CML very elderly patients. The median age at diagnosis was 80 years (range: 75-96). In the first line, 86.1% of patients received imatinib, 7.1% dasatinib, 5.6% nilotinib, and 0.81% received bosutinib. A total of 31 patients (25.2%) switched to second-line therapy, nine patients to a third line, and one patient to a fourth line of therapy. Resistance to treatment was the primary reason for switching therapy in both the first (64.5%) and second lines (77.7%). At diagnosis, reduced doses were administered in 36.5% of patients, in 61.2% in the second line, and in all patients in subsequent lines of therapy. In the first-line setting, 71.9% of patients achieved an early molecular response (EMR, i.e., 3-month BCR::ABL1IS < 10%); at 6, 12, and 24 months, MR3 was reached by 35.7%, 55.7%, and 75.0% of patients, respectively, with 16.6%, 35.7%, and 51.7% achieving a deep molecular response (DMR) at the same time points. Treatment-free remission (TFR) was successfully attempted in 11 patients. During the follow-up period, adverse events (AEs) were observed in 78.8% of patients, including 22 cases of cardiovascular AEs. Toxicity grade ≥ 3 was more commonly observed in patients treated with standard doses of TKIs compared to reduced doses (p = 0.033). Overall, the median follow-up was 46.62 months (range: 1.8-206.2), and 43 patients died due to non-CML-related causes. Three patients died due to disease progression to advanced (n = 1) and blastic (n = 2) phases. The 5-year overall survival (OS) for the entire cohort was 71.9% (95% CI: 0.63-0.81), with no significant difference between the patients treated with standard doses of TKIs compared to those treated with reduced doses (p = 0.35). TKIs appear to be safe and effective even in very elderly CML patients, and dose optimization strategies yield satisfactory molecular responses for adequate disease control with an improved safety profile.

Enhanced immune reconstitution with albuvirtide in HIV-infected immunological non-responders.

Incomplete immune recovery in people living with HIV/AIDS (PLWHA) remains an important clinical challenge with the lack of an effective strategy currently available to restore their T-cell immune response. This study aimed to evaluate the effect of Albuvirtide (ABT) on immune recovery in immunological non-responders (INRs) and attempted to explore potential mechanisms of ABT on the functionality of immune cells. In this prospective, open-label, controlled clinical study, participants with incomplete immune reconstitution (continuous ART over 5 years and CD4+T lymphocyte absolute count of <500 cells/µl or ART for 2-5 years and CD4+T cell count of <200 cells/µl with undetectable viral load) were received intensive treatment with ABT or maintained on the original ART regimen at a ratio of 1:1. Immune response and safety were examined within 24 weeks. In the cytological study, T subsets, cell apoptosis and cell autophagy were analyzed using immunofluorescence staining and flow cytometry from 25 blood specimens. Both groups (n=25 each) were comparable in age, gender, and ART duration. At week 12, CD4+T cell count increased significantly in the intensive ABT group compared with control group (the change from baseline in CD4+T cell count: 45 vs. -5 cells/µL, p<0.001). After ABT discontinuation, CD4+T cell counts remained significantly higher in the intensive ABT group at week 24 (55 vs.-5 cells/µL, p=0.012). In laboratory analysis, naïve CD4+ T cell amounts were lowest among participants with unsatisfactory immune response (uIR) to ABT (p=0.001). The proportion of caspase 3+CD45RA+CD31+CD4+ T cells was significantly lower in participants with satisfactory immune response (sIR) to ABT (p<0.05). Significant CD4+T cell count increase suggests ABT enhances immune function in INRs which may be attributed to its antiviral properties as well as its ability to increase thymic cell output and decrease cell apoptosis.

Gemcitabine/Cisplatin versus docetaxel, cisplatin and 5-fluorouracil as induction chemotherapy in locally advanced nasopharyngeal carcinoma.

Induction chemotherapy followed by concomitant chemoradiation is the standard therapy for patients with locoregionally advanced NPC. There is a limitation of clinical studies that compare different induction regimens. The purpose of this work is to analyze the efficacy of two distinct chemotherapy regimens, docetaxel, cisplatin, and 5-fluorouracil (TPF) and gemcitabine/cisplatin (GP), in treating patients with loco-regionally advanced nasopharyngeal carcinoma (NPC). We analyzed 81 patients initially presented with stage III-IVA NPC from January 2019 to June 2023. Participants were randomized in 1:1 ratio to obtain GP regimen or TPF regimen followed by concurrent CRT. The overall response rate was 97.5% after induction chemotherapy in both groups (In GP arm, 78% of patients achieved complete remission compared to 70% of patients treated with TPF regimen). The satisfactory tumor response to induction chemotherapy was linked with significant enhanced progression free survival [CI (3.37-13.92), HR=2.16, P=0.001] and overall survival [CI (3.717-9.443), HR=1.873, P=0.001]. The GP regimen was both efficacious and well-tolerated. Leucopenia and neutropenia (Grade 3-4) were significantly lower in GP group contrasted to in TPF group. There was no significant difference in the 3-year DFS and OS between GP and TPF protocols.

Enhancing antitumor immunity with stimulus-responsive mesoporous silicon in combination with chemotherapy and photothermal therapy.

Due to the immunosuppressive tumor microenvironment (TME) and potential systemic toxicity, chemotherapy often fails to elicit satisfactory anti-tumor responses, so how to activate anti-tumor immunity to improve the therapeutic efficacy remains a challenging problem. Photothermal therapy (PTT) serves as a promising approach to activate anti-tumor immunity by inducing the release of tumor neoantigens in situ. In this study, we designed tetrasulfide bonded mesoporous silicon nanoparticles (MSNs) loaded with the traditional drug doxorubicin (DOX) inside and modified their outer layer with polydopamine (DOX/MSN-4S@PDA) for comprehensive anti-tumor studies in vivo and in vitro. The MSN core contains GSH-sensitive tetrasulfide bonds that enhance DOX release while generating hydrogen sulfide (H2S) to improve the therapeutic efficacy of DOX. The polydopamine (PDA) coating confers acid sensitivity and mild photothermal properties upon exposure to near-infrared (NIR) light, while the addition of hyaluronic acid (HA) to the outermost layer enables targeted delivery to CD44-expressing tumor cells, thereby enhancing drug accumulation at the tumor site and reducing toxic side effects. Our studies demonstrate that DOX/MSN@PDA-HA can reverse the immunosuppressive tumor microenvironment in vivo, inducing potent immunogenic cell death (ICD) of tumor cells and improving anti-tumor efficacy. In addition, DOX/MSN@PDA-HA significantly suppresses tumor metastasis to the lung and liver. In summary, DOX/MSN@PDA-HA exhibits controlled drug release, excellent biocompatibility, and remarkable tumor inhibition capabilities through synergistic chemical/photothermal combined therapy.

Androgen-repressed lncRNA LINC01126 drives castration-resistant prostate cancer by regulating the switch between O-GlcNAcylation and phosphorylation of androgen receptor.

Prostate cancer (PCa) initially shows satisfactory response to therapies targeting the androgen receptor (AR). However, progression to a castration-resistant stage indicates poor prognosis in PCa patients. AR signalling still plays a central role in most castration-resistant prostate cancers (CRPC). Therefore, unveiling the mechanisms of AR reactivation under androgen-deprived conditions is imperative to discover novel therapeutic targets for CRPC. Using an integrative analysis of the transcriptomics of three independent PCa cohorts and a published landscape of AR-regulated long non-coding RNA (lncRNA), lncRNA LINC01126 was selected as a candidate gene that could drive CRPC progression for further study. Quantitative reverse transcription polymerase chain reaction, in situ hybridisation (ISH) and fluorescent ISH were performed to detect LINC01126 in PCa tissues and cells. The functional role and mechanism of LINC01126 were further investigated using in vitro and in vivo gain and loss of function assays. LINC01126, identified as an AR-repressed lncRNA, was significantly upregulated after AR-targeted therapies. In addition, we found that LINC01126 was upregulated in CRPC and was associated with poor prognosis. We also proved that LINC01126 stabilised AR protein and enhanced AR nuclear translocation and transactivation by promoting the transition from O-GlcNAcylation at threonine 80 to phosphorylation at serine 81 (S81) within the AR protein. Mechanism analysis revealed that LINC01126 facilitates the interaction of CDK9 with AR and impedes the binding of O-linked N-acetylglucosamine (O-GlcNAc) transferase to AR. Consequently, LINC01126 expression was sufficient to activate AR signalling without androgen. LINC01126 overexpression increased, whereas LINC01126 knockdown decreased castration resistance traits in PCa cells in vitro and in vivo. Furthermore, our data showed that LINC01126-targeting antisense oligonucleotides (ASO) substantially inhibited CRPC cells in vitro. Our research expands the functions of AR-regulated lncRNA in sustaining androgen-independent AR activity and promoting CRPC progression and reveals that LINC01126 may be a new therapeutic target for PCa.

An evaluation of orthodontic information quality regarding artificial intelligence (AI) chatbot technologies: A comparison of ChatGPT and google BARD

Abstract Introduction In recent times, chatbots have played an increasing and noteworthy role in the field of medical practice. The present research was conducted to evaluate the accuracy of the responses provided by ChatGPT and BARD, two of the most utilised chatbot programs, when interrogated regarding orthodontics. Materials and methods Twenty-four popular questions about conventional braces, clear aligners, orthognathic surgery, and orthodontic retainers were chosen for the study. When submitted to the ChatGPT and Google BARD platforms, an experienced orthodontist and an orthodontic resident rated the responses to the questions using a five-point Likert scale, with five indicating evidence-based information, four indicating adequate information, three indicating insufficient information, two indicating incorrect information, and one indicating no response. The results were recorded in Microsoft Excel for comparison and analysis. Results No correlation was found between the ChatGPT and Google BARD scores and word counts. However, a moderate to significant relationship was observed between the scores and several listed references. No significant association was found between the number of words and references, and a statistically significant difference was observed in both investigators’ numerical rating scales using the AI tools (p = 0.014 and p = 0.030, respectively). Conclusion Generally, ChatGPT and BARD provide satisfactory responses to common orthodontic inquiries that patients might ask. ChatGPT’s answers marginally surpassed those of Google BARD in quality.

Qualificação da Atenção Primária à Saúde para o diagnóstico laboratorial da covid-19 no Distrito Federal, 2020-2021

ABSTRACT The COVID-19 pandemic required the reorganization of PHC Units (UBS) to ensure greater laboratory diagnostic capacity timely, which demanded trained health professionals, availability of inputs/materials, and adequate sample management strategies at the Central Laboratory (LACEN). In 2020-2021, an analytical cross-sectional census study evaluated the UBS structure in the Federal District (DF). Data were collected remotely through structured telephone interviews and a self-completed questionnaire. Statistical analysis was carried out in Software R, comparing UBS-Sentinel with UBS-Traditional units. Nurse training in rapid testing or swab sample collection was almost universal (&gt; 99%) and high among nursing technicians (70%). On the other hand, only 9% of doctors received any training. A defined flow was registered to forward samples to LACEN in 89% of UBS to diagnose SARS-CoV-2. The deadlines for returning laboratory results were met in 70% of cases. Inputs, materials, and equipment were available in sufficient amounts, especially at UBS-Sentinel units. In these UBS, 63% of the teams knew the MA-LACEN-0007 collection manual, compared to 35% at UBS-Traditional units (p &lt; 0.001). Despite the challenges, the DF showed a satisfactory response capacity regarding the COVID-19 laboratory diagnosis.

Stereotactic body radiotherapy (SBRT) re-irradiation for local failures following radical prostatectomy and post-operative radiotherapy.

Local recurrences after radical prostatectomy (RP) and postoperative radiotherapy (RT) are challenging for salvage treatment. Retrospective analysis of own experiences with salvage re-irradiation was performed. The study included all consecutive patients treated with salvage stereotactic body radiotherapy (sSBRT) for prostate bed recurrence following RP and postoperative RT at asingle tertiary center between 2014 and 2021. Treatment toxicity defined as the occurrence of CTCAE grade ≥ 2 genito-urinary (GU) or gastro-intestinal (GI) adverse events (AEs) was assessed. APSA response, biochemical control (BC) and overall survival (OS) were also evaluated. The study group included 32patients with amedian age of 68years and amedian follow-up of 41months, treated with CyberKnife (53%) or Linac (47%) sSBRT. Total dose of 33.75-36.25 Gy in five fractions (72%) was applied in the majority of them. Approximately 19% patients reported grade ≥ 2 GU AEs both at baseline and at three months, and grade ≥ 2 GI toxicity increased from 0% at baseline to 6% at three months after sSBRT. There was some clinically relevant increase in late toxicity with 31% patients reporting late ≥ 2 GU, and 12.5% late ≥ 2 GI AEs. Two grade3 AEs were recorded: recto-urinary fistulas. The majority of patients showed aPSA response (91% at one year post-sSBRT). The 3‑year BC was 40% and 3‑year OS was 87%. Manageable toxicity profile and satisfactory biochemical response suggest that SBRT in patients with local recurrence following RP and postoperative RT might be asalvage option for selected patients.

Turning SKD 11 Hardened Steel: An Experimental Study of Surface Roughness and Material Removal Rate Using Taguchi Method

Heat-treated steel is widely used in industrial applications due to its high strength and other desirable mechanical qualities. Grinding, which requires a lot of power and is expensive, is typically used to harden machining. In recent times, hard machining has emerged as a viable alternative to grind in select applications. In this investigation, turning operations with a carbide insert (CNMA 120408-KR3215) were carried out on SKD 11 (53 HRC) hardened steel. A total of nine machining tests were completed using the L9 orthogonal array. The response variables considered in this study were surface roughness (Ra) and material removal rate (MRR). The analysis of the signal to noise ratio reveals that the optimal combination of cutting process parameters for achieving a desired surface roughness consists of a cutting speed of 119 m/min, a feed rate of 0.11 mm/rev, and a depth of cut of 0.2 mm. The contribution of each process parameter to the machining performance of the carbide tool-work piece combination is determined through the use of ANOVA. Depth of cut has the greatest impact (57.33%) to MRR, while feed rate has the highest contribution (82.15%) to Ra. Moreover, desirability function analysis (DFA) was conducted to optimize the multiple responses. DFA suggested that, to attain a satisfactory response to the output parameters, higher range of cutting speed, depth of cut, and lower range of feed rate are appreciable; therefore, the analytical findings suggest that a cutting speed of 189 m/min, feed rate of 0.11 mm/rev, and a depth of cut of 0.5 mm can induce a favorable Ra of 0.971 μm and MRR of 10.248 cm3/min. In hard machining, cutting speed has a bigger influence on surface finish than feed rate.

A Comparative Study on the Performance of the Induction Motor with Fuzzy-Based Power Converters

This study investigates the influence of load conditions on grid voltage stability and the performance of a proposed compensator, encompassing a 1.5 hp 4-pole induction motor (IM) exposed to grid voltage disturbances. Through rigorous grid current analysis, our research demonstrates the effective mitigation of total harmonic distortion (THD) without necessitating passive filters. The comprehensive study covers multiple facets, including control strategy optimization, fine-tuning of control parameters, component ratings, output voltage analysis, operating principles, pulse width modulation, and the integral role of the fuzzy logic controller. Specifically, it underscores the significant impact of a Predictive Torque Control-based Diode Clamped Inverter in enhancing the dynamic and steady-state performance of the IM. The research delves into traditional PTC control methods and advanced techniques, such as fuzzy and evolutionary control, addressing the persistent challenge of reducing torque ripple under varying load conditions. By implementing model prediction control-based DCI, our method achieves rapid torque response without compromising the motor’s stator characteristics. Utilizing MATLAB’s environmental package, we thoroughly evaluate motor performance across diverse scenarios, encompassing stable, and rapid load changes. Despite inherent winding impedance challenges, our proposed approach consistently delivers satisfactory output responses, contributing to a more efficient, and resilient IM performance under diverse operating conditions.

Skull Base Osteomyelitis- Marauders of the Skull.

Skull base osteomyelitis is a vicious infection of temporal bone associated with very high morbidity and mortality. But few studies have been undertaken recently for eliciting its increasing incidence. Hence this study aims to describe the clinical profile of skull base osteomyelitis and changes noted in the post-covid period, and encourage a uniform treatment policy globally. This descriptive study was conducted among 140 patients diagnosed with skull base osteomyelitis. Data was collected using semi-structured proforma, HRCT temporal bone findings, microbiological reports, histopathology of granulation tissue, ESR and House-Brackmann grading. Male patients in 61-70 age group were most commonly affected and all patients had uncontrolled diabetes mellitus, usually presenting with nocturnal otalgia, ear canal granulation and cranial nerve palsy. Pseudomonas aeruginosa was the most common isolate followed by Staphylococcus aureus. Among fungal pathogens, candida albicans were the most common. 29.3% patients had extensive disease according to Thakar et al. staging and on follow up, 43.75% patients showed a satisfactory response. Coronary artery disease and cerebrovascular accidents were the leading cause of death. More atypical organisms, extensive disease and changes in antibiotic sensitivity were noted in the post-covid period. Prolonged treatment with culture sensitive antibiotic is the main stay of treatment. A uniform treatment guideline is needed for proper management of such patients. Level of Evidence 4.

Comparison of the ED50 of prophylactic butorphanol in preventing morphine-induced pruritus with or without palonosetron: a prospective, double-blinded, randomized dose–response trial using an up-down sequential allocation method

Background Butorphanol has been used to reduce the incidence and severity of neuraxial morphine-induced pruritus. Palonosetron is a commonly used antiemetic for the prevention of postoperative nausea and vomiting. The aim of our study was to compare the effective dose in 50% of subjects (ED50) of intravenous butorphanol infusion with or without a single intravenous bolus of palonosetron for preventing pruritus induced by epidural administration of morphine. Methods A total of 120 parturients were randomly assigned to receive an intravenous bolus injection of palonosetron plus continuous infusion of butorphanol (Group P + B) or an intravenous bolus of saline plus continuous infusion of butorphanol (Group B) after epidural administration of morphine. The antipruritic effect was graded as satisfactory (numerical rating scale (NRS) of pruritus ≤3) or unsatisfactory (NRS >3) within 48 h after morphine treatment. The first patient in each group received butorphanol infusion at a rate of 4 µg/kg/h. The infusion dose for each subsequent patient in the corresponding group was increased by 0.2 µg/kg/h after an unsatisfactory response or decreased by 0.2 µg/kg/h after a satisfactory response. The ED50 was calculated for each group and compared using up-down sequential analysis. Results The ED50 (mean [95% confidence interval (CI)]) of the dose of intravenous butorphanol infusion for preventing moderate to severe pruritus was lower in Group P + B (3.29 µg/kg/min [3.25–3.34 µg/kg/min]) than in Group B (3.57 µg/kg/min [3.47–3.67 µg/kg/min]) (p < 0.05). Conclusions Under the conditions of the present study, a prophylactic use of 0.25 mg palonosetron reduced the ED50 of prophylactic infusion of butorphanol by approximately 8% to achieve a satisfactory antipruritic effect after epidural morphine for post-caesarean analgesia.

Impact of process and outcome quality on intention for continued use of voice assistants

Purpose This paper aims to understand how the perceived usefulness of voice assistants (VAs) is affected by the perceived quality of the process (interaction) and the outcome (information). The authors also aim to determine the extent to which the perceived usefulness of VAs improves the perceived privacy associated with their use and increases users’ intention to continue using them. Consumer technology innovativeness is included as a personal trait moderator, to compare the results between tech and nontech innovators. For this purpose, the authors use the framework of the uses and gratifications theory (U&amp;GT). Design/methodology/approach A survey of 467 VA users was conducted and structural equation modeling was used to analyze the data. Findings The authors identify two main determinants of the perceived usefulness of VAs that influence users’ intention to continue using this technology, process quality and outcome quality. These two factors influence the continued use of VAs in different ways depending on the technology innovativeness of the consumers. The results show that tech innovators are oriented toward the interactive experience, and therefore, mainly value the process quality. In addition, nontech innovators are oriented toward a satisfactory response from VAs, and therefore, primarily value the outcome quality. In addition, the positive effect of perceived usefulness on perceived privacy is higher for tech innovators. Originality/value This study enhances the literature on the perceived usefulness of VAs within the framework of U&amp;GT. It identifies two antecedents (process quality and outcome quality) of perceived usefulness and observes significant differences based on technological innovativeness.

A Reconstructed Singular Return Ratio Matrix for Optimizing Design of the PLL in Grid-Connected Inverters

Phase-locked loop (PLL) is essential for the grid-connected inverter to ensure grid synchronization. Since the PLL introduces an negative-resistive admittance to be in parallel with the original inverter output admittance, it poses an instability risk for the grid-connected inverter under weak grid. The system stability can be evaluated by the return ratio matrix, which is the ratio of the inverter output admittance to the grid admittance. Due to the non-singular and non-diagonal properties of this matrix, its eigenvalues are irrational functions, leading to inconvenience of stability analysis and PLL parameters design. To address this issue, this paper reconstructs the return ratio matrix to make it singular. Thus, the eigenvalues become simpler, including a zero eigenvalue and a non-zero eigenvalue. Based on the non-zero eigenvalue, the relation between the gain margin and the PLL parameters is established, and an optimizing design method of the PLL parameters is proposed to achieve system stability and satisfactory PLL dynamic response. Finally, experimental results from a 10-kVA prototype of three-phase grid-connected inverter are provided to verify the validity of the proposed design method.

IBC-Oxford University2023_BJSOral_27Trends and Safety of Bariatric Revisional Surgery in Italy: multi-centre, prospective, observational study

Abstract Introduction Revisional bariatric surgery (RBS) represents a further solution for patients who experience inadequate weight loss (IWL) following primary bariatric surgery (BS) or significant weight regain (WR) following initial satisfactory response. RBS guidelines are lacking, however, an increased trend in further BS offering has been reported lately. Objectives Analysing trend, mortality, complication, readmission, and reoperation rates for any reason at 30 days after RBS in Italy. Setting: 10 Italian high-volume bariatric surgery centres (University hospitals and Private centres). Methods Prospective, observational, multi-centre study enrolling patients undergoing RBS between 01.10.2021-31.03.2022, registering reasons for RBS, technique, mortality, intraoperative and perioperative complications, readmissions, and reinterventions for any reason. Patients undergoing RBS during same calendar interval of 2016-2020 were considered control-group. Results 220 patients were enrolled and compared with 560 control-group patients. Mortality was 0.45% vs 0.35% (not significant), with an overall of 0.25%, while open surgery or conversion to open surgery registered in 1%. No difference was found for mortality, morbidity, complications, readmission (1.3%) and reoperation rates (2.2%). IWL/WR was the most frequent cause, followed by GERD; Roux-en-Y gastric bypass (RYGB) was the most used revisional procedure (56%). Sleeve gastrectomy (SG) was the most revised procedure in the study-group, while gastric banding in the control-group. RBS represents up to 9% of the total BS in the Italian participating centres. Conclusions Laparoscopy represents the standard approach for RBS, which appears safe. Current Italian trends show a shift towards SG being the most revised procedure and RYGB the most used as revisional procedure.