Scoring Criteria Research Articles

Validation of the Node Reporting and Data System (Node-RADS) for standardized CT evaluation of regional lymph nodes in esophageal squamous cell carcinoma patients.

The accurate identification of positive lymph nodes in esophageal squamous cell carcinoma (ESCC) influences patient risk assessment and treatment decisions, but there is no standardized approach for radiological evaluation. The aim of this study was to verify the diagnostic performance of the new Node Reporting and Data System 1.0 (Node-RADS) in the assessment of lymph node metastasis in patients with ESCC, as verified by final histopathology. Node-RADS is a scoring system composed of different criteria for evaluating lymph node metastasis, with scores ranging from 1 to 5, corresponding to the degree of suspicion of lymph node involvement. In this single-center study, Node-RADS was used to retrospectively evaluate regional lymph nodes in 173 ESCC patients who underwent computed tomography (CT) before radical resection. In addition, the area under the ROC curve (AUC), accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for the Node-RADS score and individual criteria. Node-RADS outperformed the individual assessment criteria (AUC: 94.3%, sensitivity: 96.5%, specificity: 92.0%), with scores ≥ 3 indicating the maximum diagnostic effectiveness. The diagnostic efficiency of the highest Node-RADS score surpassed that of the short axis score (AUC: 94.3% vs. 81.9%, p < 0.001). Our results indicated that the best diagnostic cut-off points for the short axis, long axis and short axis/long axis ratio were 9 mm, 11 mm, and 0.74, respectively. Node-RADS has emerged as a practical, repetitive method for the early identification of high-risk metastatic lymph nodes, providing therapeutic guidance and predicting disease prognosis in ESCC patients. Question How does the Node Reporting and Data System 1.0 (Node-RADS) perform in the assessment of lymph node metastasis in patients with esophageal squamous cell carcinoma (ESCC)? Findings The maximum diagnostic efficiency was achieved with a Node-RADS score of ≥ 3. Clinical relevance The Node-RADS has improved diagnostic efficiency for distinguishing lymph node metastasis in patients with ESCC.

DAYA TARIK OBJEK WISATA AIR PUTRI WAIYOHO DI DESA KAWA KABUPATEN SERAM BAGIAN BARAT

The purpose of this study is to examine the appeal of the Air Putri Waiyoho tourist attraction and visitors' perceptions of Air Putri Waiyoho in Kawa Village, West Seram Regency. This research uses a survey method to assess the viability of the tourist attraction's potential, based on criteria from the Guidelines for Operational Area Analysis of Nature Tourism Attractions (ADO-ODTWA) by the Directorate General of Forest Protection and Nature Conservation (PHKA) in 2003, and qualitative descriptive analysis to understand visitor perceptions, with a sample of 77 visitor respondents interviewed.The main attraction at Air Putri Waiyoho is the fresh water spring in a bathing pool with clear, bright water surrounded by lush trees, enhancing the appeal for tourism activities. Based on the Tourism Feasibility Index analysis, the attraction criteria score 80.95%, accessibility criteria score 72.2%, and visitor facilities and infrastructure criteria score 66.6%. Thus, the feasibility analysis places Air Putri Waiyoho as a high-category tourist attraction. Visitor perceptions indicate a 100% attraction appeal, available facilities at 90.91%, and accessibility with 48% noting ease of transportation and reachability.

Utility of the 2019 EULAR/ACR SLE classification criteria for predicting mortality and hospitalisation: development and cross-validation of ominosity score

ObjectiveThe 2019 European Alliance of Associations for Rheumatology (EULAR)/American College of Rheumatology (ACR) systemic lupus erythematosus (SLE) classification criteria score (≥20 points) has been associated with poor outcomes. We aimed...

Stress and its associated factors in mothers with preterm infants in a private tertiary care hospital of Karachi, Pakistan: an analytical cross-sectional study

ObjectivesThis goal of this research is to present a comprehensive method for evaluating stress and the factors that contribute to it in mothers of premature babies.DesignAnalytical cross-sectional study.SettingData were collected...

Review of the Canadian English Language Proficiency Index Program (CELPIP)

The Canadian English Language Proficiency Index Program (CELPIP) is a computer-delivered test for English language proficiency, primarily used for Canadian immigration purposes. This review begins by contextualizing the test’s use as an immigration gatekeeping instrument, followed by an overview of its underlying construct and the four test components: listening, reading, writing, and speaking. We then appraise the test in terms of its accessibility, reliability, validity, authenticity, and impact. While we appreciate the “Canadian-ness” of the test, the user-friendly computer-based test delivery, and the accessible approach to sharing scoring criteria, we also identify several shortcomings regarding transparency in scoring, attention to interactional competence, and attention to research on test impact. We close with a brief commentary on the use of such tests for selecting and controlling immigrants.

Improving the Learning Outcomes of Class VIII Students Through the Implementation of the Project-Based Learning (PjBL) Model in Science Learning

This research aims to improve the learning outcomes of junior high school students in science learning.This research is a type of classroom action research carried out in one of the public junior high schools in the Madiun district. The study population was class VIII with class VIII E samples. The data analysis technique used was to compare learning outcomes in the pre-cycle to the next cycle. The results of the analysis showed that the project-based learning (PjBL) learning model was able to improve the cognitive learning outcomes of junior high school students. The success indicator of the study was seen in the improvement in cognitive learning outcomes of students who achieved a minimum completeness criteria (MCC) score of 75. While the tang performance indicator used in this study is the success rate of cognitive learning outcomes up to 75%, in the pre-cycle, as many as 71.43% of the total students have not reached the specified minimum completeness criteria (MCC). While the remaining 38.10% have reached minimum completeness criteria (MCC). The implementation of the project-based learning (PjBL) learning model shows an increase in student success in learning. In cycle I, the percentage of student success reached 61.9%. In the second cycle, the percentage of student success reached 76.1%, so there was an increase of 33.4%.

CYLINDER AND PISTON: MATERIAL SELECTION IN THE DESIGN PHASE

The piston and cylinder constitute an inseparable pair, playing a crucial role in both the mechanical and hydraulic industries. They are frequently employed to convert linear motion into rotational motion in various types of engines and are especially valuable for heavy-duty applications. Material selection for these components is conducted during the product design phase. This study aimed to identify the optimal material for each type of product. To determine the best material, a ranking of materials was carried out using the CoCoSo (COmbined COmpromise SOlution) method, with scores for criteria calculated using the Entropy method. Nine materials for cylinder construction were evaluated, including S355JR, S275JR, S235JR, BS97007M20, R35, R45, IS1030GRADE, AISI304, and 60-40-18. Additionally, seven materials for piston construction were considered: 332-T5, A336, 242-T5, 333.0-F, A213.0 F, AISI308, and A319.0F. The Entropy-CoCoSo approach was employed to rank the materials for each case (cylinder material and piston material). The results indicated that AISI304 is the optimal material for cylinder manufacturing, while A336 is the best material for piston manufacturing. Furthermore, the study extensively examined the impact of different weighting methods (Entropy, WENSLO, CRITIC, ROC, RS, EW) and normalization techniques (sum, vector, max, max-min, peldschus, decimal) on CoCoSo method results using an innovative sensitivity analysis approach, analyzing the techniques according to their sensitivity levels.

No difference in osteoarthritis, but less graft failures after 5 years, comparing anatomic double-bundle to anatomic single-bundle ACL reconstruction.

The purpose of this study was to compare the incidence of knee osteoarthritis (OA) between the anatomic single-bundle (SB) and anatomic double-bundle (DB) anterior cruciate ligament (ACL) reconstruction technique after 5-year follow-up (FU). Secondary objectives were to compare patient-reported outcome measures (PROMs), clinical examination, activity level, functional tests and graft failures between the two groups. The study was a secondary analysis after 5-year FU of a randomized controlled trial (RCT) (Clinical Trials NCT01033188). One hundred and twenty patients between 18 and 40 years were randomized to either anatomic SB or anatomic DB reconstruction. The Kellgren-Lawrence (KL) classification grade ≥2 and the Osteoarthritis Research Society International (OARSI) atlas criteria score ≥2 were used for defining OA. Additionally, PROMs were obtained and clinical examinations of the knees were performed. Finally, the number of patients experiencing graft failure in each group was recorded. Radiographic imaging was performed in 39 patients in the SB group and in 37 patients in the DB group. Four patients (10%) in the SB group and two (5%) in the DB group developed osteoarthritis according to the KL classification (p = 0.28). Five (13%) in the SB group and three (8%) in the DB group developed osteoarthritis according to the OARSI atlas criteria (p = 0.59; difference 5.0% [95% confidence interval, CI: -0.10 to 0.20]). There were no significant differences in the PROMs, clinical examinations, activity levels, or functional tests when comparing the two groups. Of initially 62 SB patients, 14 (23%) experienced graft failure compared to 4 (7%) of the 58 DB patients (p = 0.015; difference 0.016 [95% CI: 0.03-0.29]). At 5-year FU, there were no significant differences in the incidence of OA, PROMS, or other clinical findings comparing the anatomic DB to anatomic SB ACL reconstructed patients. There were fewer graft failures among patients treated with anatomic DB ACL reconstruction. II.

3D-Printed Permanent Resin Crowns on Pre-Molar and Molar Teeth; Two-Year Results of a Prospective Clinical Study.

The aim of this prospective clinical study was to evaluate the 12 and 24-month clinical results of overlay and one-piece endodontic crown restorations applied with additively manufactured 3D printed permanent ceramic-filled resin (PCR) according to the Modified US Public Health Service (USPHS) criteria. A total of 33 indirect restorations (16 overlay, 17 endocrown) (4 premolar, 29 molar) produced using PCR (Formlabs) were applied to 30 patients by a single dentist. The restorations were evaluated according to the modified USPHS criteria at baseline (7 days), 12 and 24 months times by two independent evaluators. The study registration number is NCT05168852. In the comparisons of the dependent criteria scores, the Related Samples Cochran Q test was used, and in post-hoc paired comparisons, the Bonferroni test. The Fisher-Freeman-Halton test was applied in the comparisons of categorical variables according to the restoration type groups (α = 0.05). No statistically significant difference was determined between the evaluation criteria scores at baseline, 12 months, and 24 months for the marginal adaptation (P=0.05), retention (P=1), interproximal contact (P=0.368), color match (P=1), surface texture (P=1), and patient satisfaction (P=1). The only score criteria that showed a statistically significant difference between baseline and 24 months (P=0.001) among all other criteria was marginal discoloration. This criteria's score change was from 100% A score to 69.7% A score. In the 2-year follow-up of indirect single-tooth restorations produced with 3D-printed PCR, all restorations showed acceptable clinical performance. (≥99.5%A&#43;B score at 2 years).

Phrenic nerve infiltration: A good practice to combine pulmonary expansion and pain control in patients with high risk of prolonged air leak

ObjectiveProlonged air leak due to residual air space after lung resection is a main challenge. To date, few surgical options have been described to prevent this complication. The aim of this study is to investigate the safety and the efficacy of intraoperative phrenic nerve infiltration with long-acting anesthetics in producing transient hemidiaphragm paralysis in patients at high risk for prolonged air leak, thus improving pulmonary expansion after surgery and reducing air leaks, while controlling postoperative pain. MethodsBetween January 2021 and 2023, 65 consecutive patients at risk for prolonged air leak (defined in accordance with “2019 Society of Thoracic Surgery score criteria of prolonged air leak”) who underwent lung resection (lobectomy or anatomic segmentectomy) for malignancy were prospectively included in the study. They were randomly (1:2 ratio) assigned to receive (group A, 22 patients) intraoperative phrenic nerve infiltration with ropivacaine 10 mg/mL in the peri-neurotic fat on the pericardium or not to receive intraoperative phrenic nerve infiltration (group B, 43 patients). Five patients in group B were excluded because they did not undergo anatomic resection. Data on pulmonary reexpansion, prolonged air leaks, pain at 24 and 72 hours postsurgery, referred shoulder pain, length of hospital stay, and length of chest tube permanence were collected and compared. ResultsHemidiaphragm elevation (P = .006) and pulmonary expansion (P = .000) were significantly higher in group A. Patients in group A showed lower pain at 24 and 72 hours compared with group B (P = .004). Shoulder pain (0.001) and prolonged air leak (0.000) were higher in group B. Length of chest tube was longer in group B. No difference in hospital stay length was observed. ConclusionsThis is the first study to investigate 2 combined effects of phrenic nerve anesthetic infiltration (hemidiaphragm elevation and pain control), with potential enhancement of a patient's recovery after surgery. Intraoperative phrenic nerve infiltration in patients with a risk for prolonged air leak appears to be a safe and effective clinical practice to improve pulmonary expansion in this set of patients, reducing postoperative air leak. This result is associated with an additional improvement in pain control, especially for shoulder pain.

Mercury’s Meteorite Mysteries: A Directional Statistical Guide to Mercury’s North Pole, Hidden Hazards and Roadmap to Safe Landing Havens Based on Solar Elevation, Ice Stability, Temperature

Studying meteoroid impact patterns on planetary surfaces is critical for understanding surface dynamics and selecting safe landing sites. Mercury, one of the least explored rocky planets, presents unique challenges due to its extreme temperatures and the angular nature of its surface data. Traditional linear statistical methods are often inadequate for analyzing such directional data. This study introduces a novel approach using directional data analysis techniques to interpret the cyclical nature of meteoroid impact locations on Mercury. We employed Watson’s test, Bayesian Information Criterion scores, and a mixture of von Mises–Fisher distributions to model the distribution of impact craters and solar elevations on Mercury’s surface. Our findings indicate that while location parameters adhere to the von Mises distribution, solar elevations do not exhibit directional distribution characteristics. Additionally, by filtering datasets based on temperature thresholds and crater diameters, we pinpointed areas with a high probability of providing suitable landing surfaces. These insights enhance our understanding of the surface conditions on Mercury and provide valuable groundwork for future exploration missions.

Assessing the utility of the increased wall thickness score in diagnosing ATTR cardiomyopathy: a validation study

Abstract Introduction Cardiac amyloidosis due to transthyretin deposition (ATTR-CM) is often underdiagnosed. An increased left ventricular wall thickness (LVWT) should raise the suspicion for ATTR-CM, but it is a very frequent and non-specific finding. In order to improve diagnostic certainty, an echocardiographic score (Increased Wall Thickness [IWT] score) was recently proposed. The aim of our study was to assess the diagnostic performance of the IWT score in an independent population with increased LVWT. Methods We conducted a retrospective analysis of 295 consecutive patients studied at our centre for increased LVWT. All patients with severe aortic stenosis (AS) had ATTR-CM excluded by endomyocardial biopsy (EMB), during aortic valve replacement. ATTR-CM was considered as per the ESC algorithm. To be included, patients with Hypertrophic Cardiomyopathy (HCM) performed cardiac magnetic resonance and required a sarcomeric mutation for definite diagnosis. The echocardiographic IWT score was calculated for all patients, and categorized as certain (IWT≥8), unlikely (IWT ≤1) or indeterminate (1 &amp;lt; IWT &amp;lt; 8) for ATTR-CM diagnosis. Results A total of 295 patients were included (median age of 75 years [69-81], 61% men). Overall, 230 (70%) patients had hypertension and 164 (56%) chronic kidney disease (CKD). The median LVWT was 16 mm [IQR 15-19] and the median LVEF was 57% [IRQ 50-62%]. After diagnostic workup, 97 patients (33%) had confirmed ATTR-CM, 129 (44%) had isolated severe AS and 71 (24%) had hypertrophic cardiomyopathy (HCM). Fifteen patients had both severe AS and ATTR-CM. The median IWT score was 4 (IQR 2-7), with 21% of patients (n=64) showing an IWT score ≤1, 19% an IWT score ≥8, and 60% of patients (n=176) having an "indeterminate" value between 2 and 7. Despite this, on a continuous scale, the IWT showed good discriminative value (area under ROC curve 0.86, 95% 0.82-0.90, p&amp;lt;0.001). The criteria of IWT score ≥8 showed a positive predictive value of 82% (95% CI 72-89%), while an IWT score ≤ 1 yielded a negative predictive value of 92% (95% CI 84-97%) - Figure. Conclusions Even though the IWT score provides "indeterminate" results in a large proportion of patients, values at the ends of the spectrum showed good negative and positive predictive values for the diagnosis of ATTR-CM. Our findings provide external validation for this echocardiographic score, and support its use in the diagnostic workup of patients with increased wall thickness and suspected ATTR-CM.

Prevalence of high-risk plaque features on cardiac computed tomography scans in patients with a coronary artery calcium score of zero

Abstract Introduction Coronary artery calcium (CAC) score of zero (so-called "power of zero") is associated with a very low rate of major adverse cardiac events (MACE), especially during short and midterm follow-up. However, a CAC score of zero does not definitively exclude the presence of atherosclerotic plaques or obstructive coronary artery disease (CAD). The composition of atherosclerotic plaques and the frequency of high-risk plaque features in this population are not well described. Purpose We sought to characterize the composition of atherosclerotic plaques and assess the frequency of high-risk plaque features on contrast-enhanced computed tomography (CT) images in patients with a zero CAC score. Methods The study enrolled patients with stable chest pain suspected of CAD referred for coronary CT imaging and having a CAC score of zero. Coronary CT angiography images were assessed by an expert reader to identify atherosclerotic plaques and high-risk plaque features in all coronary arteries with a diameter ≥1.5mm. The coronary artery lumen and plaques were manually segmented, and the degree of stenosis was evaluated following the Coronary Artery Disease Reporting and Data System (CAD-RADS) criteria. The presence of four high-risk plaque features was identified: positive remodeling, spotty calcification, low-attenuation plaque, and napkin ring sign. Total plaque volume, percent atheroma volume, and plaque composition were quantified using dedicated software (Figure 1). Results A total of 145 patients (mean age 54.2±12.1 years, 35.9% males) were included in the analysis. At least one coronary artery plaque was identified in 30 individuals (20.7%). 22 (15.2%), 7 (4.8%), and 1 (0.7%) patients were categorized into CAD-RADS 1, CAD-RADS 2, and CAD-RADS 3 categories, respectively. Among 30 patients with any coronary artery plaque, at least one high-risk feature was found in 10 individuals (33.3%), while 3 individuals (10.0%) had two features. Positive remodeling was found in 7 (23.3%), spotty calcification in 3 (10.0%), low-attenuation plaque in 3 (10.0%), and napkin ring sign in 0 patients, respectively (Figure 1). The mean total plaque volume was 48.2±54.3mm³, and the mean percent atheroma volume was 1.2±0.8%. Total plaque volume comprised low-attenuation (0.4%), fibro-fatty (58.9%), fibrous (39.4%), and calcified (1.3%) plaque volumes. Notably, in 3 (10.0%) individuals, the presence of calcified plaque was identified, which on non-contrast CT images did not meet the Agatston criteria for the CAC score. Conclusions Our study demonstrates a significant prevalence of atherosclerotic plaques and high-risk plaque features in patients with a CAC score of zero. Specifically, one in every five study participants had identifiable atherosclerotic plaque, with one in every three of those exhibiting one or more high-risk plaque features. The prognostic significance of these findings warrants further evaluation in studies with longitudinal follow-up.

Clinical outcomes of edoxaban treatment in atrial fibrillation patients with high bleeding risk: insights from the ETNA-AF-China 1-year follow-up

Abstract Background In China and many other countries, anticoagulated atrial fibrillation (AF) patients with high bleeding risk often raises clinical concern; the optimal dose of direct oral anticoagulants (DOACs) preventing stroke/systemic embolic events (SEE) in those population remains unclear. Purpose To assess the effectiveness and safety of edoxaban treatment in Chinese AF patients with high bleeding risk, and to compare 60 mg vs 30 mg dose in this real-world registry. Methods ETNA-AF-China is a prospective, observational study conducted in 89 centres across Chinese Mainland enrolling AF patients receiving edoxaban. This subgroup analysis was based on 1-year follow-up data. Patients were categorized to high bleeding risk group who had a DOAC score ≥6 (age, creatinine clearance, underweight, history of stroke/TIA/SEE, diabetes, hypertension, antiplatelet use, NSAIDs use, history of major/critical bleeding, liver disease) at baseline, or moderate-to-low bleeding risk group meeting criteria of DOAC score &amp;lt;6. The safety, effectiveness, and composite outcomes were reported by comparison between patient subgroups using Cox proportional hazards models. Results Of 4883 patients with 1-year follow-up, 1534 (31.4%, 60 mg: n=518, 30 mg: n=1016) were identified as high bleeding risk and 3349 (68.6%) as moderate-to-low bleeding risk. As expected, patients with high bleeding risk were more often elderly (48.2% ≥80 years), had lower body weight, worse renal function, higher CHA2DS2-VASc score than those with moderate-to-low risk (Figure 1). In both high risk and moderate-to-low risk subgroups, patients receiving 60 mg edoxaban were younger, with better renal function, lower CHA2DS2-VASc score compared with 30 mg. Annualised event rates of major bleeding (HR 2.95, 95%CI 1.62–5.36), all cause death (3.42, 2.29–5.09), CV death (3.27, 1.52–7.04), major adverse cardiac events (MACE, 2.61, 1.69–4.02) and all NCOs were significant higher in patients with high bleeding risk compared with moderate-to-low risk (Figure 2). After multivariable adjustment, edoxaban dose of 60 mg other than 30 mg were associated with significantly lower rates of all cause death (adjusted HR 0.41, 0.18–0.90) and lower trend of NCO3 (0.51, 0.28–0.92) and NCO4 (0.51, 0.30–0.88) by composite of stroke/SEE, major bleeding and death events in high risk subgroup; no significant difference between edoxaban doses and stroke or bleeding outcomes with cumulative low event rates were observed. Conclusion In routine clinical care, AF patients at high bleeding risk faces worse outcomes of death events, MACE, as well as the composite outcomes over moderate-to-low risk patients. Among patients with high bleeding risk, edoxaban use showed effectiveness and safety with overall low incidence, and potential better survival, composite endpoint benefit could be associated with 60mg. Further investigation is ongoing.

An Individualised Homoeopathic Approach to Chronic Atopic Dermatitis: A Case Report

AbstractAtopic dermatitis is a chronic inflammatory skin disease affecting about one-fifth of all individuals during their lifetime. It has substantial impact on the quality of life of the affected individual. Not only patient is affected by the social stigma of a visible skin condition but also the characteristic itch-scratch cycle often leads to skin trauma and significant sleep disruption. Though there is multitude of treatment options in modern medicine, the recurrence, and adverse effects of medications cannot be ruled out. Therefore, an alternative approach is required. The case presented here reported with the complaint of severe generalised itching eruptions for the last 8 years with a history of atopy. After thorough evaluation from the clinical and homoeopathic standpoint, a single homoeopathic medicine Arsenicum iodatum was prescribed in different potencies at different timepoints as the symptomatology corresponds. Following the administration of individualised homoeopathic (IH) medicine, there was gradual improvement in the case with disappearance of skin lesions which was also evaluated through reduction in SCORing Atopic Dermatitis and Dermatology Life Quality Index scores. During the treatment, old symptoms also reappeared indicating improvement in accordance with Hering's law of cure and Kent's 11th observation. The modified Naranjo criteria score after the treatment course was 10 which exclusively shows positive causal attribution of the IH in this case.

The equivalence of a high-stakes objective structured clinical exam adapted to suit a virtual delivery format.

The COVID-19 pandemic necessitated rapid adaptation of clinical competence assessments, including the transition of Objective Structured Clinical Examinations (OSCE) from in-person to virtual formats. This study investigates the construct equivalence of a high-stakes OSCE, originally designed for in-person delivery, when adapted for a virtual format. A retrospective analysis was conducted using OSCE scores from the Internationally Educated Nurse Competency Assessment Program (IENCAP®). Data were collected from 15 exam administrations between January 2018 and June 2022, encompassing 2021 examinees (1936 in-person, 85 virtual). The Many-Facet Rasch Measurement (MFRM) model was employed to analyze the invariance of examinee ability, case difficulty, and criteria difficulty across in-person and virtual formats. Results revealed overall examinee ability estimates remained invariant regardless of the OSCE format, while invariant violations were identified in only three of the 15 cases (N = 20%) adapted to suit the virtual format. The most significant adaptation, namely the use of a verbal physical examination to suit the virtual context achieved equivalence to its hands-on in-person counterpart given evidence of invariance across criteria estimates. Interestingly, criteria scores in invariant violated cases displayed a higher level of stability or consistency across the virtual OSCE formats versus their in-person counterpart highlighting a potential benefit of the virtual versus in-person format and potentially linked to the verbal physical examination. The study found that while examinee ability and case difficulty estimates exhibited some invariance between in-person and virtual OSCE formats, criteria involving physical assessments faced challenges in maintaining construct equivalence. These findings highlight the need for careful consideration in adapting high-stakes clinical assessments to virtual formats to ensure fairness and reliability.

Integration of mathematical and experimental modeling for sustainable phycobiliprotein production via fed-batch cultures

The production of phycobiliproteins, such as cyanobacterial phycocyanins, is a growing interest due to their diverse industrial and biotechnological applications. This study focuses on optimizing phycocyanin production using the strain Potamosiphon sp. through experimental techniques and mathematical modeling in fed-batch cultures. The methodology applied includes determining the kinetic constants by linearizing the Monod equation evaluating the concentrations of biomass, C-phycocyanin (C-PC), nitrates (NO3), and phosphates (PO4). A mathematical model of periodic fed-batch feeding was subsequently established, applying mass conservation principles and evaluating the accuracy of the Monod, Contois, Moser, and Tessier models. The results indicate that phycocyanin production is highly dependent on phosphorus and nitrogen concentrations, with optimal conversion observed at specific levels of these elements (0.832 for phosphorus and 0.805 for nitrogen in terms of C-PC and biomass, respectively). The Tessier model demonstrated the highest accuracy in predicting production and optimizing operational conditions, with a Mean Squared Error (MSE) of 0.005000 for biomass production, 0.200000 for C-PC production, and 0.000010 for substrate consumption. It also achieved high R² values of 0.980 for biomass, 0.999 for C-PC production, and 0.997 for substrate consumption. It presented the lowest Akaike Information Criterion (AIC) scores, indicating its robustness and reliability in modeling these processes and manipulating cultivation conditions and providing adequate nutrition allowed for achieving growth rates of 1.23 g/L and a C-PC concentration of 37 mg/L, which are essential for industrial applications such as natural colorants and antioxidants, among others.

Development of a risk predication model for critical care needs in patients with intracerebral hemorrhage: a retrospective cohort.

It is very important to provide the correct nursing care for patients with intracerebral hemorrhage (ICH), but the level of critical care needs in patients with intracerebral hemorrhage is not clear. The purpose of this study is to establish a risk model based on the epidemiological and clinical characteristics of ICH patients, to help identify the critical care needs of ICH patients. The clinical data of ICH patients from January 2018 to September 2023 were analyzed retrospectively. The full cohort was used to derive the clinical prediction model and the model was internally validated with bootstrapping. Discrimination and calibration were assessed using the area under curve (AUC) and the Hosmer-Lemeshow tests, respectively. 611 patients with ICH were included for model development. 61.21% (374/611) ICH patients had received critical care interventions. The influencing factors included in the model were Glasgow Coma Scale (GCS) score, intraventricular hemorrhage, past blood pressure control, systolic blood pressure on admission and bleeding volume. The model's goodness-of-fit was evaluated, which yielded a high area under the curve (AUC) value of 0.943, indicating a good fit. For the purpose of model validation, a cohort of 260 patients with ICH was utilized. The model demonstrated a Youden's index of 0.750, with a sensitivity of 90.56% and a specificity of 78.22%. GCS, systolic blood pressure, intraventricular hemorrhage, bleeding volume and past blood pressure control are the main factors affecting the critical care needs of patients with ICH. This study has deduced a clinical predictive model with good discrimination and calibration to provide scoring criteria for clinical health care providers to accurately evaluate and identify the critical care needs of ICH patients, to improve the rational integration and allocation of medical resources.

Improving Student’s Reading Comprehension Through LRD (Listen–Read– Discussion) Strategy at the Eighth Grade of MTS At-Taqwa Jambi

This research was done to improve students’ reading comprehension through LRD (Listen-Read-Discussion) strategy. The background of this research was the eighth grade students of MTS At-Taqwa Jambi had the problem in reading comprehension including students reading comprehension was low, students were difficult to find the elements of reading and it was difficult for students to determine the main idea of the text. Furthermore, this research aimed to find out whether there was an improvement in students’ reading comprehension through LRD (Listen-Read-Discussion) strategy at among the eighth - grade students of MTS At-Taqwa Jambi. This research was a classroom action research (CAR). This classroom action research divided into two cycles that referred to the classroom action research procedures were planning, implementing of action, observing, and reflecting. The research data were collected through observation checklist and tests. The test was given to the students in form of a reading comprehension post-test at the end of learning at each cycle. The subject of this research was the eighth grade students of MTS At-Taqwa Jambi. The total number of students in the class was 22 students. The result of the analysis showed that the LRD (Listen-Read-Discussion) strategy could improve students reading comprehension. The result of students reading comprehension test was showed in two cycles. The result showed that there were improvements in students’ reading comprehension scores and reading activity through LRD (Listen-Read-Discussion) strategy. The result obtained by students in the cycle I the average score of the class was 58,52. In the cycle II results obtained by students the average score of the class was 75,57, also students were not difficult in finding the elements of reading in the text and more focused in reading the material in “Read” section. Based on the students’ results in cycle I and cycle II could be concluded that the minimum criteria for score was reached. The minimum criteria for the score (KKM) was 75. Furthermore, it could be conclude that the use of LRD (Listen-Read-Discussion) strategy could improve students’ reading comprehension.

Three-year clinical performance of direct restorations using low-shrinkage Giomer vs. nano-hybrid resin composite

ObjectivesThe objective of this investigation was to compare the clinical performance of a nano-hybrid resin composite and a low-shrinkage Giomer resin composite.Material and methodsIn total, 35 pairs of restorations were performed using either low-shrinkage Giomer (Beautifil II LS, Shofu Inc.) or nano-hybrid (Clearfil Majesty Posterior) resin composite in 35 patients by two operators using the relevant adhesives, i.e., FL-Bond II (Shofu Inc.) and Clearfil SE Bond (Kuraray), with the self-etching technique according to each manufacturer's instructions. Two clinicians assessed the restorations 2 weeks (baseline); 6 months; and 1, 2, and 3 years after the restorative procedures using FDI (World Dental Federation) criteria (Scores 1–5). Data were analyzed using the marginal homogeneity and McNemar tests. The survival rate was calculated using Kaplan–Meier survival analysis and the survival of the two groups was compared with the log-rank test (p = 0.05).ResultsThe mean observation period was 37.7 ± 6.8 months. All restorations completed their 3-year follow-up. The criteria were mainly rated with high (1 or 2) scores for quality in both groups. Only one restoration in the low-shrinkage Giomer resin composite group was accepted as a failure at the 2-year recall due to retention loss.ConclusionAt the 3-year follow-up, the performance of the restorations using the Giomer and the nano-hybrid resin composite were similar and clinically acceptable.Clinical relevanceThe low-shrinkage Giomer resin composite exhibited a similar clinical performance to the nano-hybrid resin composite after 3 years in service with both materials displaying minor surface deteriorations at the 3-year recall.Clinical Trial Registrationhttps://clinicaltrials.gov, identifier: NCT02823769.