Two-step Test Research Articles

External Validation of the PeRSonal Gestational Diabetes Model for Predicting Adverse Pregnancy Outcomes in Women with Gestational Diabetes: A Retrospective Cohort Study in a Tertiary Hospital in Thailand

Objective: This study aimed to validate the PeRSonal Gestational Diabetes (GDM) model with two-step glucose tolerance diagnostic criteria.Material and Methods: A retrospective cohort study was conducted on participants having delivered with GDM diagnosis in a tertiary hospital; from October 1, 2020, until September 30, 2022. The main outcome was a composite of maternal and perinatal adverse pregnancy complications. Model validation evaluated the predictors and calculated risk by using a two-step glucose tolerance test in the PeRSonal model formula. Model performance was analyzed for discrimination, calibration, and overall performance. Results: This study analyzed 685 from the initial 764 participants with GDM, with 218 (31.8%) developing adverse pregnancy outcomes. The most frequent adverse outcomes were hypertensive disorders in pregnancy 132 (19.3%) and neonatal hypoglycemia 91 (13.3%). This validation achieved an area under the curve (AUC) of 0.70 (95% confidence interval (CI) 0.65 to 0.74), calibration-in-the-large of 0.17, a calibration slope of 1.34, and a Brier score of 0.20, respectively. The cut-off clinical risk probability of 27.5% can predict adverse outcomes with a sensitivity of 67.3%, specificity of 63.8%, a positive predictive value (PPV) of 46.7%, and a negative predictive value (NPV) of 80.5%. Conclusion: The PeRSonal model maintains its predictive effectiveness in two-step glucose tolerance diagnostic criteria.

Spatiotemporal gait characteristics post-total hip arthroplasty and its impact on locomotive syndrome: a before-after comparative study in hip osteoarthritis patients.

Understanding the gait pattern of patients eligible for total hip arthroplasty (THA) due to hip osteoarthritis (OA) offers valuable information for improving locomotive syndrome (LS). This study aims to measure the gait patterns of THA-eligible patients using an optical motion capture system and to analyze these patterns using principal component analysis (PCA). Additionally, this study examines the relationship between THA-induced gait patterns and LS. This before-after study included 237 patients who underwent unilateral primary THA due to hip OA. The primary outcome measures were spatiotemporal gait parameters. Secondary outcome measures included three LS risk tests: a stand-up test, a two-step test, a 25-question Geriatric Locomotive Function Scale (GLFS-25), and total clinical decision limits stages. PCA was performed using 16 spatiotemporal gait parameters collected before and three months after THA. Principal components (PC) were selected to achieve a cumulative contribution rate of 90% (0.9) or higher. Each summarized PC was compared using a paired t-test before and three months after THA. Furthermore, multiple regression analysis was conducted to determine how changes in each PC between before and three months after THA related to changes in the four LS evaluation items. PCA identified three principal components (PC1, PC2, PC3) that accounted for a cumulative contribution rate of 0.910 using 16 spatiotemporal gait parameters. When comparing before and three months after THA for all three PCs, significant differences were observed in each PC (p<0.001), with overall walking ability and stance phase being higher three months after THA than before THA, while the asymmetry of support time was lower three months after THA. The results of multiple regression analysis revealed that PC1, PC2, and PC3 were the most influential factors in total clinical decision limits stage. For each LS risk test, the factors related to the stand-up test were identified as PC1, PC2, and PC3, while the factors related to the two-step test were identified as PC1 and PC2. The factors related to the GLFS-25 were also identified as PC1 and PC2. The most important findings of this study indicate that the three PCs represent over 90% of the 16 spatiotemporal gait parameters, which are associated with total clinical decision limits stage and LS risk tests. The present results suggest that PC1 represents overall walking ability, PC2 represents the stance phase, and PC3 represents asymmetry of support time. Gait pattern characteristics, such as overall walking ability, stance phase, and asymmetry of support time, were clearly defined by these PCs. Regarding the relationship between PC and LS, all three PCs are related to total clinical decision limits stage. In addition, PC1 and PC2 related to all three LS risk tests, and PC3 related only to the stand-up test.

European Arrest Warrants, the rule of law and communication: What future for mutual recognition?

This contribution addresses the insistence of the Court of Justice of the European Union on the two-step test in the context of European Arrest Warrants (EAWs) and focuses on the advantages this approach offers whilst acknowledging its downsides. Crucially, the Court's approach keeps the vertical and horizontal channels of communication open and is flanked by a subtle broadening of the criteria, which the requested judicial authority can take into consideration when assessing the second limb of the test. This shift provides national judicial authorities with tools to respond to rule of law violations by refusing the execution of an EAW. This move to judicial subsidiarity creates pitfalls, but the Court's focus on communication has the potential to transform the Court's initial top-down approach to mutual trust into a bottom-up approach, which could foster the emergence of, and strengthen, real trust between national judicial authorities.

Factors Influencing Inflation: Insights from the Nepalese Economy

Inflation is a persistent issue in developing nations such as Nepal, resulting in serious economic and social consequences. This article examines the macroeconomic determinants of inflation in Nepal, considering the variables as government expenditure, exchange rate remittances, real GDP, and the consumer price index of India. Using the time series data from 1975 to 2023. It employs the Engel-Granger two-step cointegration test to examine the short- and long-term causal connections between Nepal's consumer price index (inflation) and all of these variables. The augmented Dickey-Fuller unit root test confirms that the variables are stationary at first difference, suggesting they possess an integrated order of I. The Engel-Granger test established that there is co-integration among the variables. Additionally, the error correction term (ECT) was found to be statistically significant, with a negative coefficient. The causal association between the selected dependent and explanatory variables in Nepal is both significant and persistent. The empirical findings suggest that India's inflation highly affects inflation in Nepal. Furthermore, the enduring effects of broad money supply and government expenditure are also substantial factors. The results indicate an inverse relationship between inflation and real GDP in Nepal, whereas remittances have no significant impact on consumer prices in the nation. So, it is vital to control inflation to be able to deal with poverty and economic growth. Policies are needed to keep the inflation target range around the optimum inflation rate to accelerate the pace of economic growth and ensure that the adverse effect inflation has on economic growth is minimized.

The Relationship between Components of Postural Control and Locomotive Syndrome in Older Adults.

Locomotive Syndrome (LS), a condition related to impaired mobility, is influenced by balance control, which comprises six components. Deficiencies in these components can lead to reduced mobility and decreased quality of life. This study aimed to evaluate the relationship between the components of postural control and LS in older adults using the Brief-BESTest. Therefore, this cross-sectional study involved 122 elderly participants from Tha Sala District, Nakhon Si Thammarat Province, both with and without LS. Participants underwent assessments using the Instrumental Activities of Daily Living (IADL) assessment, the Thai Mental State Examination (TMSE), the Two-Step Test, and the Brief-BESTest. The Brief-BESTest covers six balance components: Biomechanical Constraints, Stability Limits, Anticipatory Postural Adjustments, Postural Responses, Sensory Orientation, and Stability in Gait. Descriptive statistics were used to summarize participant characteristics, and Chi-square tests were conducted to examine the relationship between each balance component and LS. Cramer's V was used to assess the strength of the relationships. The results showed the average age of the sample was 67.67 ± 6.01 years with 85.20 percent female and 14.80 percent male. There were significant relationships between LS and three balance components: Biomechanical Constraints (Chi-square = 5.35, p = 0.021, Cramer's V = 0.209), Stability Limits (Chi-square = 5.00, p = 0.025, Cramer's V = 0.204), and Anticipatory Postural Adjustments (left: Chi-square = 4.12, p = 0.042, Cramer's V = 0.213; right: Chi-square = 5.50, p = 0.019, Cramer's V = 0.213). No significant associations were found for Reactive Postural Response, Sensory Orientation, and Stability in Gait. These findings suggest that targeted interventions focusing on specific balance components consist of Biomechanical Constraints, Stability Limits, and Anticipatory Postural Adjustments could help reduce the risk of LS in older adults.

Is early pregnancy hemoglobin A1c useful to predict gestational diabetes mellitus diagnosed during mid pregnancy?

To verify whether hemoglobin A1c (HbA1c) levels in early pregnancy can predict the diagnosis of gestational diabetes mellitus (GDM) in mid-pregnancy. This was a retrospective cohort study of 2008 pregnant women who delivered singletons at the Yokohama City university Medical Center. Concomitant or history of diabetes mellitus and overt diabetes in pregnancy were excluded. Pregnant women at high risk for GDM underwent a one-step 75-g oral glucose tolerance test (OGTT) during mid-pregnancy. For other pregnant women, GDM was diagnosed by a two-step 75-g oral glucose tolerance test (OGTT) when the 50-g glucose challenge test result in mid-pregnancy was ≥140 mg/dL. The thresholds for 75-g OGTT followed those of the International Association of Diabetes and Pregnancy Study Group (IADPSG) criteria (92-180-153 mg/dL). The relationship between HbA1c level measured at <20 weeks of gestation and GDM diagnosis at mid pregnancy was assessed using a receiver operating characteristic curve (ROC); area under the curve (AUC) and optimal cutoff value of HbA1c, predictive of GDM were calculated. The median HbA1c level at <20 weeks of gestation was 5.3%, and 8.5% of women were diagnosed with GDM. In the ROC curve of the GDM diagnosis rate by HbA1c level, AUC was 0.706, and the optimal cutoff value was 5.4%, with a sensitivity of 0.6176, specificity of 0.6834, positive predictive value of 15.4%, and negative predictive value of 95.1%. Although HbA1c at less than 20 weeks of gestation is acceptable discrimination as a diagnostic tool of GDM in mid-pregnancy, it is not clinically useful to predict GDM in mid-pregnancy.

Screening hemodialysis patients for tuberculosis in Sudan

ObjectivesTo estimate the prevalence of latent tuberculosis infection (LTBI) and the need for TB preventive treatment (TPT) among hemodialysis (HD) patients in Sudan. MethodsWe screened patients in a single HD center by two-step tuberculin skin test (TST), symptom survey, physical examination and chest radiography (CXR). ResultsThe survey included 204 patients, five of whom (2.5%) had history of previously treated TB. The proportion of TST positive patients was 12.3% after the first test and increased to 21.1% after the second test. Patients previously treated for TB were more likely to have positive TST (80 vs 20.1%, p = 0.01). We screened 184 patients for TB disease; 16.3% were symptomatic, 15.8% had CXR abnormality and 6.5% were symptomatic with CXR abnormality. Additionally, 13.6% of patients had physical signs consistent with extra-pulmonary TB without symptoms or CXR abnormality. Based on these findings, high probability of pulmonary and extra-pulmonary TB was found in 38.6% and 13.6% of patients respectively and they were referred for bacteriological confirmation. We diagnosed LTBI and prescribed TPT to 9.2% of screened patients. ConclusionIn this cohort of Sudanese HD patients, 21.1% were positive after two-step TST and 52.2% were considered to have high probability of TB disease.

Association between Internet Use and Locomotive Syndrome, Frailty, and Sarcopenia among Community-Dwelling Older Japanese Adults.

In the lives of those who are the target of community health nursing, it is important to collaborate with individuals and communities to improve their quality of life. Herein, we aimed to determine the association between Internet use among older individuals and locomotive syndrome (LS), frailty, and sarcopenia. In this cross-sectional study conducted between July 2022 and March 2023, we recruited 105 community-dwelling older Japanese adults who participated in a care prevention project called "Kayoi-no-ba". All participants were divided into Internet and non-Internet user groups according to the classification of a previous study. We assessed LS (standing test, two-step test, and five-question Geriatric Locomotive Function Scale), frailty (through the Questionnaire for Medical Checkup of Old-Old), and sarcopenia (grip strength, normal walking speed, and skeletal muscle mass index) and made group comparisons between Internet users and non-users. Binomial logistic regression analyses were performed with Internet use as the independent variable and sarcopenia or LS as the dependent variables. The Internet and non-Internet user groups had 69 and 36 participants, respectively. The Internet user group comprised 65.7% of all participants, which was similar to that reported in a previous study of the same age group. Between-group comparisons showed significant differences in sarcopenia and LS items, whereas adjusted binomial logistic analysis showed a significant association between sarcopenia and Internet use. In summary, among LS, frailty, and sarcopenia, sarcopenia showed the highest association with Internet use. Older adults without sarcopenia having good physical functions, such as grip strength, walking speed, and skeletal muscle index, more likely used the Internet; while older adults with sarcopenia were less likely to use the Internet. This implied that Internet use may be associated with physical function.

Anisotropic mechanism of cold-rolled pure titanium plate during the two-step tensile process of the variable path

The effects of pre-deformation on the macro-mesoscopic deformation characteristics of the titanium plate during variable path tensile were studied by a two-step tensile test and electron backscatter diffraction (EBSD). The Schmid law, Kernel Average Misorientation (KAM), Taylor axis, and In-Grain Misorientation Axis (IGMA) were used to forecast and identify the types and change laws of the activated deformation modes under different loading conditions. The results demonstrated that dislocation slip is the primary cause of the evolution of the basal split texture components. The nucleation and de-twinning of {10–12}ET resulted in the sudden appearance and disappearance of the <0001>//RD texture. The pre-tensile causes a texture redirection that reduces the activability of both prismatic <a> slip and pyramidal <a> slip in the following variable path tensile. Among them, prismatic <a> slip is the dominant deformation mechanism that causes yield and hardening behavior during RD tensile and TD-RD tensile (rolling direction-RD, transeverse direction-TD). A portion of the prismatic <a> slip is preferentially activated in TD tensile and RD-TD tensile deformation, and the deformation is subsequently jointly controlled by the prismatic <a> slip and the pyramidal <a> slip. The pre-tensile along RD promotes nucleation of {10–12} extension twin (ET) during subsequent RD-TD variable path tensile, while tensile along TD-RD coordinates plastic deformation by consuming a significant quantity of {10–12}ET generated during pre-tensile along TD. The formation of slip-assisted twins in neighboring grains is facilitated by the dislocation pile-up at grain boundaries, and the de-twinning phenomenon also cause the local dislocation pile-up to weaken.

CRISPR-Based Modular Assembly for High-Throughput Construction of a UAS-cDNA/ORF Plasmid Library.

Functional genomics screening offers a powerful approach to probe gene function and relies on the construction of genome-wide plasmid libraries. Conventional approaches for plasmid library construction are time-consuming and laborious. Therefore, we recently developed a simple and efficient method, CRISPR-based modular assembly (CRISPRmass), for high-throughput construction of a genome-wide upstream activating sequence-complementary DNA/open reading frame (UAS-cDNA/ORF) plasmid library. Here, we present a protocol for CRISPRmass, taking as an example the construction of a GAL4/UAS-based UAS-cDNA/ORF plasmid library. The protocol includes massively parallel two-step test tube reactions followed by bacterial transformation. The first step is to linearize the existing complementary DNA (cDNA) or open reading frame (ORF) cDNA or ORF library plasmids by cutting the shared upstream vector sequences adjacent to the 5' end of cDNAs or ORFs using CRISPR/Cas9 together with single guide RNA (sgRNA), and the second step is to insert a UAS module into the linearized cDNA or ORF plasmids using a single step reaction. CRISPRmass allows the simple, fast, efficient, and cost-effective construction of various plasmid libraries. The UAS-cDNA/ORF plasmid library can be utilized for gain-of-function screening in cultured cells and for constructing a genome-wide transgenic UAS-cDNA/ORF library in Drosophila.

Prevalence and associated factors of locomotive syndrome in young Japanese adults: a cross-sectional study

BackgroundThe onset of locomotive syndrome (LS) precedes that of frailty. Therefore, the first step in extending healthy life expectancy is to implement measures against LS in young adults. The aim of this study was to investigate the prevalence of LS and its associated factors in young adults for early detection and prevention of LS.MethodsThe participants of this study comprised 413 university students specializing in health sciences (192 males and 221 females) with an average age of 19.1 ± 1.2 years. All participants voluntarily participated in the study and reported no serious health problems. The presence or absence of LS was evaluated using the stand-up test, two-step test, and the 25-question Geriatric Locomotive Function Scale. Additionally, musculoskeletal assessment (one-leg standing, squatting, shoulder elevation, and standing forward bend), body composition analysis (weight, body mass index, body fat mass, body fat percentage, skeletal muscle mass index (SMI), and phase angle), handgrip strength test, physical activity assessment, and nutritional assessment were conducted. Sex-stratified analyses were performed, comparing groups with and without LS. Factors associated with LS were explored using binomial logistic regression.ResultsOf the 413 young adults studied, 86 individuals (20.8%) were found to have LS. When stratified by sex, LS was observed to have a considerably higher prevalence in females (55, 24.9%) than in males (31, 16.1%). In males, the notable differences between the groups with and without LS were observed in one-leg standing and phase angle, whereas in females, differences were identified in body fat mass, body fat percentage, SMI, musculoskeletal pain, and handgrip strength. Two types of binomial logistic regression analysis revealed that the inability to perform one-leg standing was associated with LS in males, while the presence of musculoskeletal pain and a high body fat percentage were identified as factors associated with LS in females.ConclusionsOne in five young adults were found to have LS in this study, underscoring the necessity for early intervention and LS health education. Furthermore, effective management of musculoskeletal pain is also crucial.

The risk-based approach in the GDPR and the ‘two-step test’ within Article 44

The risk-based approach in the GDPR and the ‘two-step test’ within Article 44

Integrating cine EPID, dynamic delivery, and the off-axis Winston-Lutz test to enhance quality control in multiple brain metastasis stereotactic radiotherapy

PurposeStereotactic radiotherapy (SRT) has transformed cancer treatment, especially for brain metastases. Ensuring accurate SRT delivery is crucial, with the Winston-Lutz test being an important quality control tool. Off-axis Winston-Lutz (OAWL) tests are designed for accuracy assessment, but most are limited to fixed angles and hampered by local-field shifts caused by suboptimal Multi-Leaf Collimator (MLC) positioning. This study introduces a new OAWL approach for quality control in multi-brain-metastasis SRT. Utilizing cine Electronic Portal Imaging Device (EPID) images, it can be used with dynamic conformal arc (DCA) therapy. However, dynamic OAWL (DOAWL) is prone to more local-field shifts due to dynamic MLC movements. A two-step DOAWL is proposed: step 1 calculates local-field shifts using dynamic MLC movements in the beam-eye view data from the Treatment Planning System (TPS), while step 2 processes cine EPID images with an OAWL algorithm to isolate true deviations. MethodsValidation involved an anthropomorphic head phantom with metallic ball-bearings, Varian TrueBeam STx accelerator delivering six coplanar/non-coplanar DCA beams, cine EPID, and ImageJ's OAWL analysis algorithm. ResultsInherent local-field shifts ranged from 0.11 to 0.49 mm; corrected mean/max EPID-measured displacement was 0.34/1.03 mm. Few points exceeded 0.75/1.0-mm thresholds. ConclusionsThis two-step DOAWL test merges cine-EPID acquisitions, DCA, OAWL, and advanced analysis and offers effective quality control for multi-brain-metastasis SRT. Its routine implementation may also improve physicist knowledge of the treatment precision of their machines.

Comparisons of the Rates of Large-for-Gestational-Age Newborns between Women with Diet-Controlled Gestational Diabetes Mellitus and Those with Non-Gestational Diabetes Mellitus.

(1) Objectives: The primary objective is to compare the rate of large-for-gestational-age (LGA) between women with diet-controlled gestational diabetes mellitus (GDM) and those with non-GDM, and to assess whether or not diet-controlled GDM is an independent factor of LGA fetuses. The secondary objectives are to compare the rates of other common adverse pregnancy outcomes, such as preeclampsia, cesarean section rate, preterm birth, and low Apgar score, between pregnancies with diet-controlled GDM and non-GDM pregnancies. (2) Methods: A retrospective cohort study was conducted on singleton pregnancies, diagnosed with GDM and non-GDM between 24 and 28 weeks of gestation, based on a two-step screening test. The prospective database of the obstetric department was accessed to retrieve the records meeting the inclusion criteria, and full medical records were comprehensively reviewed. The patients were categorized into two groups, GDM (study group) and non-GDM (control group). The main outcome was the rate of LGA newborns, and the secondary outcomes included pregnancy-induced hypertension, preterm birth, cesarean rate, low Apgar scores, etc. (3) Results: Of 1364 recruited women, 1342 met the inclusion criteria, including 1177 cases in the non-GDM group and 165 (12.3%) in the GDM group. Maternal age and pre-pregnancy BMI were significantly higher in the GDM group. The rates of LGA newborns, PIH, and cesarean section were significantly higher in the GDM group (15.1% vs. 7.1%, p-value < 0.001; 7.8% vs. 2.6%, p-value = 0.004; and 54.5% vs. 41.5%, p-value = 0.002; respectively). On logistic regression analysis, GDM was not significantly associated with LGA (odds ratio 1.64, 95% CI: 0.97-2.77), while BMI and gender were still significantly associated with LGA. Likewise, GDM was not significantly associated with the rate of PIH (odds ratio: 1.7, 95% CI: 0.825-3.504), while BMI and maternal age were significantly associated with PIH, after controlling confounding factors. (4) Conclusions: The rates of LGA newborns, PIH, and cesarean section are significantly higher in women with diet-controlled GDM than those with non-GDM. Nevertheless, the rates of LGA newborns and PIH are not directly caused by GDM but mainly caused high pre-pregnancy BMI and advanced maternal age, which are more commonly encountered among women with GDM.

Smart Electrical Screening Methodology for Channel Hole Defects of 3D Vertical NAND (VNAND) Flash Memory

In order to successfully achieve mass production in NAND flash memory, a novel test procedure has been proposed to electrically detect and screen the channel hole defects, such as Not-Open, Bowing, and Bending, which are unique in high-density 3D NAND flash memory. Since channel hole defects lead to catastrophic failure (i.e., malfunction of basic NAND operations), detecting and screening defects in advance is one of the key challenges of guaranteeing the quality of flash products in the NAND manufacturing process. Based on analysis of the physical and electrical mechanisms of the channel hole defect, we have developed a two-step test procedure that consists of pattern-based and stress-based screen methodologies. By optimizing test patterns depending on the type of defect, the pattern-based screen is effective for detecting the type of Hard channel hole defects. The stress-based screen is carefully implemented to detect hidden Soft channel hole defects without degrading the reliability of NAND flash memory. In addition, we have attempted to further optimize the current version of our technique to minimize test time overhead, thus enabling 72.2% improvement in total test time. Experimental results using real 160 3D NAND flash chips show that our technique can efficiently detect and screen out various types of channel hole defects with minimum test time and negligible degradation in the flash reliability.

Relationship between sacral-abdominal wall distance, movement performance, and spinal alignment in osteoporosis: a retrospective study

BackgroundAging is associated with muscle atrophy, as typified by sarcopenia. Loss of abdominal muscle strength can cause abdominal wall laxity. The purpose of this study was to investigate the relationship between the sacral vertebra–abdominal wall distance (SAD) and movement performance using a simple lateral spine X-ray image for measuring the SAD.MethodsIn this retrospective study, we included women aged ≥ 65 years who were attending the outpatient clinic for osteoporosis at our hospital. A total of 287 patients (mean age ± SD, 76.8 ± 7.1 years) with measured SAD were included in the analysis. Patients were divided into two groups based on SAD cutoff (160 mm) and age (75 years), respectively. The patients were examined using the two-foot 20 cm rise test, 3 m Timed Up and Go (TUG) test, two-step test, open-eyed one-leg standing time, and spinal alignment. Normally distributed data are expressed as means (standard deviations) and non-normally distributed data as medians (interquartile range), depending on the results of the Kolmogorov–Smirnov test. Student’s t-test and χ2 test were used for between-group comparisons. Regression analysis was performed with SAD as the objective variable. A two-sided p < 0.05 was considered statistically significant.ResultsThe shorter SAD group performed better in the two-step test, TUG test, and open-eyed one-leg standing time (p < 0.001) as well as in the two-foot 20 cm rise test (p < 0.01) compared to the longer SAD group. Spinal alignment was better in the shorter SAD group than in the longer SAD group, with a shorter sagittal vertical axis (p < 0.001), smaller pelvic tilt (p < 0.001), and greater sacral slope (p < 0.05).ConclusionSAD was associated with posterior pelvic tilt and movement performance parameters. In addition to testing for osteoporosis, movement performance parameters should be evaluated in women with osteoporosis who are aged ≥ 65 and have greater SAD (≥ 160 mm in this study). The SAD is a new assessment method, and further research is required to verify its validity and reproducibility. This is the first attempt to determine how age and SAD affect movement performance in older adults.

Thermo-physical Characterisation of Plasters Containing Phase Change Materials (PCMs)

The integration of phase change materials (PCMs) within building materials is an interesting strategy to improve the thermal performance of buildings, thus reducing the energy demand for heating and/or cooling. To do so, the thermo-physical characterisation of the new enhanced materials is of outmost importance which, however, is difficult to carry out due to several limitations related to the most used techniques. To overcome these, a new alternative set up was realized, which allowed the thermo-physical characterization of different plaster samples enhanced with granular organic PCM. A steady-state test was conducted maintaining constant thermal gradients through which the thermal conductivity of the materials used was estimated. Then, a two-step ramp unsteady-state test was conducted through which the specific heat and the latent heat were estimated, showing a good agreement with values provided by the PCM suppliers. The estimated properties were then validated against experimental data acquired during the monitoring activity under real outdoor conditions of different wall samples on which the PCM-enhanced plasters were applied. With the estimated properties, RMSE values were lower than 1 °C for temperatures and lower than 2.50 W·m−2 for heat fluxes.

Prognostic significance of preoperative exercise tolerance in patients with early-stage lung cancer

ObjectiveTo investigate the influence of simple preoperative exercise tests as prognostic factors for early-stage lung cancer. MethodsThis single-institution retrospective study included consecutive patients who underwent pulmonary resection for stage 0 to I lung cancer between April 2017 and December 2019. Before surgery, 7 metabolic equivalents of task in the double Master 2-step test were loaded into the exercise echocardiogram. The relationship between prognosis and exercise stress test results in terms of availability, symptoms, and saturation of percutaneous oxygen was investigated. ResultsThis study included 862 patients with pathological stage 0 to I lung cancer. Among the 862 patients, 673 patients (78.1%) who were able to complete 7 metabolic equivalents of task exercise for 3 minutes without assistance were classified into the complete group. The 5-year survival of the complete group was significantly better than that of the incomplete group. Multivariable analysis revealed that age (hazard ratio, 1.06; P = .008), male sex (hazard ratio, 2.23; P = .011), carcinoembryonic antigen level >5 ng/mL (hazard ratio, 2.33; P = .011), and inability to complete 7 metabolic equivalents of task exercise (hazard ratio, 3.90; P < .001) were the prognostic factors. Patients in the older group who had the ability to complete exercise had a better prognosis than those in the younger group without the ability (P = .003). ConclusionsPreoperative exercise ability is a prognostic factor for early-stage lung cancer. Patients who can tolerate an exercise load of 7 metabolic equivalents of task, even if they are aged 70 years or older, have a better prognosis than patients younger than age 70 years without exercise tolerance.

Лайм-кардит у підлітка (клінічний випадок)

In recent years, the number of registered cases of Lyme carditis has been increasing. Purpose - to increase the vigilance of clinicians in various fields of medicine regarding Lyme carditis and awareness of its clinical manifestations on the example of the following clinical case. An empirical, descriptive study of a clinical case of Lyme pericarditis in a child from an endemic area was conducted. The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the bioethical commission of the hospital. Patient consent was obtained. An analysis of the literature data of PubMed, Medscape, СDC was also carried out. Clinical case. The paper describes a clinical case of a teenager with manifestations of pericarditis as a complication of Lyme infection with manifestations of untreated erythema migrans several months after a tick bite. The appointment of non-steroidal anti-inflammatory drugs did not bring relief. Conclusions. Alertness to Lyme carditis is important in the diagnosis of infectious nosologies. Lyme carditis should be considered in the differential diagnosis in patients with signs of myocardial ischemia in children with bradycardia living in endemic areas. For differential diagnosis, a two-step serological blood test is required, especially the use of screening tests for antibodies to Borrelia by ELISA with further confirmation by Western blot analysis. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

A Strict Test for Economic Reality: The Concept of VAT Supply in Airtours

In this article, the author discusses the UK Supreme Court decision in the Airtours case and the two-step test done by Judge Lord Neuberger focusing on identifying a contractual obligation to make a supply to the payor and only departing from this requirement if it would be in accordance with “economic reality”. The author submits that contract law can serve as a starting point, but that the focus on the existence of a contractual obligation in Airtours makes the test excessively restrictive. In the author’s view, “economic reality” in a multiple-party situation should not require the taxable person to prove “artificiality” or “sham”; and contract law and the contractual terms should not serve as a “strait-jacket” for VAT law.