Version Of System Research Articles

Tropospheric and Stratospheric Boreal Winter Jet Response to Eddying Ocean in a Seasonal Forecast System

AbstractUnderstanding the impacts of high‐resolution ocean model provides valuable insights for future research. However, the outcomes of sea surface state changes in both the tropics and mid‐latitudes remain unclear, and initialized seasonal forecasts have not been studied extensively. This study investigates the impact of ocean model resolution with the first long‐term hindcast experiment of an eddy‐resolving (0.1°) ocean model used for global seasonal forecasting. We show that using the high‐resolution ocean model significantly changes boreal winter jet streams in the atmosphere, based on the comparison of 30‐year hindcasts with ocean resolutions ranging from 1° to 0.1° for the Japan Meteorological Agency/Meteorological Research Institute Coupled Prediction System version 3. In boreal winters, the cold sea surface bias in the equatorial Pacific is significantly reduced, leading to an equatorward shift in the intertropical convergence zone (ITCZ) and enhanced convective activity in the western equatorial Pacific. The subtropical jet shifts equatorward due to the ITCZ shift and the weakening of equatorward propagation of mid‐latitude atmospheric eddies. The enhanced convective activity in the tropics has a remote influence in the mid‐latitudes, significantly reducing the upward eddy propagation of zonal wavenumber 1. Sea surface warm‐up in the mid‐latitudes partially cancels the reduction impact by enhancing the zonal wavenumber 2. Overall, the polar night jet accelerates due to the reduced supply of eddy forcing.

Solving Inverse System of Time-Fractional Burgers Equation

Solving Inverse System of Time-Fractional Burgers Equation

Research on Sliding Mode Variable Structure Model Reference Adaptive System Speed Identification of Bearingless Induction Motor

To improve the speed observation accuracy of the bearingless induction motor (BL-IM) and achieve its high-performance speed sensorless control, an improved sliding mode variable structure model reference adaptive system speed identification method based on sigmoid function (sigmoid-VS-MRAS) is proposed. Firstly, to overcome the problem of initial values and cumulative errors in the pure integration link of the reference flux-linkage voltage model, the rotor flux-linkage reference voltage model has been improved by using an equivalent integrator instead of the pure integration link. Then, in order to improve the rapidity and robustness of speed identification, the sliding mode variable structure adaptive law is adopted instead of the PI adaptive law. In addition, in order to optimize the sliding mode variable structure adaptive law and overcome the sliding mode chattering problem, a sigmoid function with smooth continuity characteristics is used instead of the sign function. Finally, on the basis of the inverse system decoupling control of a BL-IM, simulation experiments were conducted to verify the sigmoid-VS-MRAS speed identification method. The research results indicate that when the proposed speed identification method is adopted, not only higher identification accuracy and rapidity can be achieved than traditional PI-MRAS methods, but it can also eliminate the problem of high-frequency vibration (with an amplitude of about 3.0 r/min) when using the sign-VS-MRAS method; meanwhile, the steady-state tracking speed with zero deviation can still be maintained after loading.

A data-driven distributionally robust expansion planning model for ADNs with multi-microgrids considering energy trading strategy based on game theory

With the increasing integration of distributed energy resources, demand response, microgrids, and automation technologies in modern distribution networks, a market framework for local energy trading among microgrids and the distribution utility is a reality. However, the expansion planning problem for active distribution networks (ADNs) with multiple microgrids is complex due to uncertainties associated with distributed generation and competitive scenarios. This paper proposes a novel data-driven distributionally robust model that considers energy trading and uncertainties in generation and load to solve the expansion planning problem for ADNs with multiple microgrids. The uncertainties are represented using data bins and their probabilities, and the energy trading strategy is modeled based on game theory. The proposed model enables the distribution system operator (DSO) to find the best expansion planning from their perspective, while each microgrid seeks its own benefits. We exemplify the proposed model using a modified version of the IEEE 123-bus test system. Results demonstrate the effects of surplus generation levels on the energy price strategy and the influence of competitive environments on the expansion planning decision. The proposed model provides a new approach to address the complexities associated with the expansion planning problem for ADNs with multiple microgrids and could have significant implications for the design and operation of future power systems.

Evaluation of the QMAC-dRAST System Version 2.5 for Rapid Antimicrobial Susceptibility Testing of Gram-Negative Bacteria From Positive Blood Culture Broth and Subcultured Colony Isolates.

Rapid antimicrobial susceptibility testing (AST) for bloodstream infections (BSIs) facilitates the optimization of antimicrobial therapy, preventing antimicrobial resistance and improving patient outcomes. QMAC-dRAST (QuantaMatrix Inc., Korea) is a rapid AST platform based on microfluidic chip technology that performs AST directly using positive blood culture broth (PBCB). This study evaluated the performance of QMAC-dRAST for Gram-negative bacteria using PBCB and subcultured colony isolates, comparing it with that of VITEK 2 (bioMérieux, France) using broth microdilution (BMD) as the reference method. We included 141 Gram-negative blood culture isolates from patients with BSI and 12 carbapenemase-producing clinical isolates of Enterobacterales spiked into blood culture bottles. QMAC-dRAST performance was evaluated using PBCB and colony isolates, whereas VITEK 2 and BMD were tested only on colony isolates. For PBCB, QMAC-dRAST achieved 92.1% categorical agreement (CA), 95.3% essential agreement (EA), with 1.8% very major errors (VMEs), 3.5% major errors (MEs), and 5.2% minor errors (mEs). With colony isolates, it exhibited 92.5% CA and 95.1% EA, with 2.0% VMEs, 3.2% MEs, and 4.8% mEs. VITEK 2 showed 94.1% CA and 96.0% EA, with 4.3% VMEs, 0.4% MEs, and 4.3% mEs. QMAC-dRAST yielded elevated error rates for specific antimicrobial agents, with high VMEs for carbapenems and aminoglycosides. The median time to result for QMAC-dRAST was 5.9 h for PBCB samples and 6.1 h for subcultured colony isolates. The QMAC-dRAST system demonstrated considerable strengths and comparable performance to the VITEK 2 system; however, challenges were discerned with specific antimicrobial agents, underlining a necessity for improvement.

Design and validation of the evolved version of the tactical separation system

Purpose The small air transport (SAT) domain is gaining increasing interest over the past decade, based on its perspective relevance in enabling efficient travel over a regional range, by exploiting small airports and fixed wing aircraft with up to 19 seats (EASA CS-23 category). To support its wider adoption, it is needed to enable single pilot operations. Design/methodology/approach An integrated mission management system (IMMS) has been designed and implemented, able to automatically optimize the aircraft path by considering trajectory optimization needs. It takes into account both traffic scenario and weather actual and forecasted condition and is also able to select best destination airport, should pilot incapacitation occur during flight. As part of the IMMS, dedicated evolved tactical separation system (Evo-TSS) has been designed to provide elaboration of both surrounding and far located traffic and subsequent traffic clustering, to support the trajectory planning/re-planning by the IMMS. Findings The Clean Sky 2-funded project COAST (Cost Optimized Avionics SysTem) successfully designed and validated through flight demonstrations relevant technologies enabling affordable cockpit and avionics and supporting single pilot operations for SAT vehicles. These technologies include the TSS in its baseline and evolved versions, included in the IMMS. Originality/value This paper describes the TSS baseline version and the basic aspects of the Evo-TSS design. It is aimed to outline the implementation of the Evo-TSS dedicated software in Matlab/Simulink environment, the planned laboratory validation campaign and the results of the validation exercises in fast-time Matlab/Simulink environment, which were successfully concluded in 2023.

Combined assimilation of NOAA surface and MIPAS satellite observations to constrain the global budget of carbonyl sulfide

Abstract. Carbonyl sulfide (COS), a trace gas in our atmosphere that leads to the formation of aerosols in the stratosphere, is largely taken up by terrestrial ecosystems. Quantifying the biosphere uptake of COS could provide a useful quantity to estimate gross primary productivity (GPP). Some COS sources and sinks still contain large uncertainties, and several top-down estimates of the COS budget point to an underestimation of sources, especially in the tropics. We extended the inverse model TM5-4DVAR to assimilate Michelson Interferometer for Passive Atmospheric Sounding (MIPAS) satellite data, in addition to National Oceanic and Atmospheric Administration (NOAA) surface data as used in a previous study. To resolve possible discrepancies among the two observational data sets, a bias correction scheme is necessary and implemented. A set of inversions is presented that explores the influence of the different measurement streams and the settings of the prior fluxes. To evaluate the performance of the inverse system, the HIAPER Pole-to-Pole Observations (HIPPO) aircraft observations and NOAA airborne profiles are used. All inversions reduce the COS biosphere uptake from a prior value of 1053 GgS a−1 to much smaller values, depending on the inversion settings. These large adjustments of the biosphere uptake often turn parts of Amazonia into a COS source. Only inversions that exclusively use MIPAS observations, or strongly reduce the prior errors on the biosphere flux, maintain the Amazon as a COS sink. Inclusion of MIPAS data in the inversion leads to a better separation of land and ocean fluxes. Over the Amazon, these inversions reduce the biosphere uptake from roughly 300 to 100 GgS a−1, indicating a strongly overestimated prior uptake in this region. Although a recent study also reported reduced COS uptake over the Amazon, we emphasise that a careful construction of prior fluxes and their associated errors remains important. For instance, an inversion that gives large freedom to adjust the anthropogenic and ocean fluxes of CS2, an important COS precursor, also closes the budget satisfactorily with much smaller adjustments to the biosphere. We achieved better characterisation of biosphere prior and uncertainty, better characterisation of combined ocean and land fluxes, and better constraint of both by combining surface and satellite observations. We recommend more COS observations to characterise biosphere and ocean fluxes, especially over the data-poor tropics.

Outcome prediction of SSTR-RADS-3A and SSTR-RADS-3B lesions in patients with neuroendocrine tumors based on 68Ga-DOTATATE PET/MR

PurposeSomatostatin receptor (SSTR)-targeted PET imaging has emerged as a common approach to evaluating those patients with well-differentiated neuroendocrine tumors (NETs). The SSTR reporting and data system (SSTR-RADS) version 1.0 provides a means of categorizing lesions from 1 to 5 according to the likelihood of NET involvement, with SSTR-RADS-3A (soft-tissue) and SSTR-RADS-3B (bone) lesions being those suggestive of but without definitive NET involvement. The goal of the present study was to assess the ability of 68Ga-DOTATATE PET/MR imaging data to predict outcomes for indeterminate SSTR-RADS-3A and 3B lesions.MethodsNET patients with indeterminate SSTR-RADS-3A or SSTR-RADS-3B lesions who underwent 68Ga-DOTATATE PET/MR imaging from April 2020 through August 2023 were retrospectively evaluated. All patients underwent follow-up through December 2023 (median, 17 months; (3–31 months)), with imaging follow-up or biopsy findings ultimately being used to classify lesions as malignant or benign. Lesion maximum standardized uptake value (SUVmax) along with minimum and mean apparent diffusion coefficient (ADCmin and ADCmean) values were measured and assessed for correlations with outcomes on follow-up.ResultsIn total, 33 indeterminate SSTR-RADS-3 lesions from 22 patients (19 SSTR-RADS-3A and 14 SSTR-RADS-3B) were identified based upon baseline 68Ga-DOTATATE PET/MR findings. Over the course of follow-up, 16 of these lesions (48.5%) were found to exhibit true NET positivity, including 9 SSTR-RADS-3A and 7 SSTR-RADS-3B lesions. For SSTR-RADS-3A lymph nodes, a diameter larger than 0.7 cm and an ADCmin of 779 × 10−6mm2/s or lower were identified as being more likely to be associated with metastatic lesions. Significant differences in ADCmin and ADCmean were identified when comparing metastatic and non-metastatic SSTR-RADS-3B bone lesions (P < 0.05), with these parameters offering a high predictive ability (AUC = 0.94, AUC = 0.86).ConclusionBoth diameter and ADCmin can aid in the accurate identification of the nature of lesions associated with SSTR-RADS-3A lymph nodes, whereas ADCmin and ADCmean values can inform the accurate interpretation of SSTR-RADS-3B bone lesions.

Atrial pace mapping using intracardiac pattern matching: feasibility and accuracy

Abstract Introduction Pace mapping of atrial arrhythmia is a method to localize the origin of usually focal arrhythmias that are unstable or not persisting during EP-study and, therefore not eligible for LAT-Mapping. The technique applies pattern matching of p-waves from surface-electrocardiogram (sEKG) as well as intracardiac signals during atrial tachycardia and pacing from the site of suspected origin. The CARTO® 3 system Version 7.2 applies an automated algorithm for intracardiac pace mapping (ICPM) using the unipolar signal of the reference electrode, usually located in the coronary sinus. Methods We examined 12 consecutive patients undergoing RF pulmonary vein isolation (PVI). We performed local pacing at the anterior and posterior wall of the left atrium (LA) and the posterior and lateral wall of the right atrium (RA). The first pacing point was defined as the reference pacing site (RPS). The ICPM algorithm was applied to calculate the similarity of the IC pattern of the RPS to the IC pattern across various distances. The maps, including mesh, point locations and IC pattern similarity of each point, were exported for further analysis in the Python environment. The areas were calculated for the 5% similarity strata. Results The study assessed areas with a 95% or higher pattern similarity in different atrial regions, revealing notable differences in pattern similarity. The median area of pattern similarity was 1.48 cm² (IQR: 0.76 - 2.01 cm²) in the LA posterior, 0.62 cm² (IQR: 0.15 - 1.06 cm²) in the LA anterior, 0.60 cm² (IQR: 0.38 - 1.19 cm²) in the RA posterior, and 5.68 cm² (IQR: 2.89 - 11.1 cm²) in the RA lateral wall. Significant differences were found between the posterior and anterior walls of the LA and the RA lateral wall, as well as between the RA posterior and RA lateral wall, indicating variability in intracardiac pattern matching accuracy. Patterns below 2 cm² are acceptable for catheter ablation. An outlier was noted in the RA posterior region. Conclusion The intracardiac pattern matching for atrial arrhythmias employing the CARTO-ICPM algorithm is feasible with acceptable accuracy except for the lateral regions of the right atrium. This might be explained by the larger distance to the referent catheter in the coronary sinus and the preferred conduction direction in the crista terminalis. Enhancing localization accuracy may necessitate the adjunctive use of surface ECG-pace mapping or the deployment of an additional multipolar intracardiac reference catheter in the lateral RA.A: IC Pattern, B: Box plots similarity

Designing Gestures for Data Exploration with Public Displays via Identification Studies

In-lab elicitation studies inform the design of gestures by having the participants suggest actions to activate the system functions. Conversely, crowd-sourced identification studies follow the opposite path, asking the users to associate the control actions with functions. Identification studies have been used to validate the gestures produced by elicitation studies, but not to design interactive systems. In this paper, we show that identification studies can be combined with in situ observations to design the gestures for data exploration with public displays. To illustrate this method, we developed two versions of a gesture-controlled system for data exploration with 368 users: one designed through an elicitation study, and one designed through in situ observations followed by an identification study. Our results show that the users discovered the majority of the gestures with similar accuracy across the two prototypes. Additionally, the in situ approach enabled the direct recruitment of target users, and the crowd-sourced approach typical of identification studies expedited the design process.

Differentiating mixed epithelial and stromal tumor family from predominantly cystic renal cell carcinoma using magnetic resonance imaging-based Bosniak classification system version 2019.

To differentiate mixed epithelial and stromal tumor family (MESTF) of the kidney from predominantly cystic renal cell carcinoma (RCC) using the magnetic resonance imaging (MRI)-based Bosniak classification system version 2019 (v2019). The study included 36 consecutive patients with MESTF and 77 with predominantly cystic RCC who underwent preoperative renal MRI. One radiologist evaluated and documented the clinical and MRI characteristics (age, sex, laterality, R.E.N.A.L. Nephrometry Score [RNS], surgical approach, the signal intensity on T2-weighted imaging, restricted diffusion and enhancement features in corticomedullary phase). Blinded to clinical and pathological information, another two radiologists independently evaluated Bosniak category of all masses. Interobserver agreement based on Bosniak classification system v2019 was measured by the weighted Cohen/Conger's Kappa coefficient. Furthermore, predominantly cystic RCCs and MESTFs were divided into low (categories I, II, and IIF) and high-class (categories III, and IV) tumors. The independent sample t test (Mann-Whitney U test) or Pearson Chi-square test (Fisher's exact probability test) was utilized to compare clinical and imaging characteristics between MESTFs and predominantly cystic RCCs. The performance of the Bosniak classification system v2019 in distinguishing MESTF from predominantly cystic RCC was investigated via receiver operating characteristic curve analysis. MESTF and predominantly cystic RCC groups significantly differed in terms of age, lesion size, RNS, restricted diffusion, and obvious enhancement in corticomedullary phase, but not sex, laterality, surgical approach, and the signal intensity on T2WI. Interobserver agreement was substantially based on the Bosniak classification system v2019. There were 24 low-class tumors and 12 high-class tumors in the MESTF group. Meanwhile, 13 low-class tumors and 64 high-class tumors were observed in the predominantly cystic RCC group. The distribution of low- or high-class tumors significantly differed between the MESTF and predominantly cystic RCC groups. Bosniak classification system v2019 had excellent discrimination (cutoff value = category III), and an area under curve value was 0.81; accuracy, 80.5%; sensitivity, 87.0%; and specificity, 66.7%. The MRI-based Bosniak classification system v2019 can effectively distinguish MESTF from predominantly cystic RCC if category III was used as a cutoff reference.

Locomotor Activity of Adult Olive Fruit Flies Recorded under Conditions of Food or Water Deprivation

The olive fruit fly, known as Bactrocera oleae (Rossi) (Diptera: Tephritidae), is causing substantial economic losses in olive crops worldwide. Studying the activity patterns of the insect may expand our knowledge to eventually adopt more sustainable and effective pest control approaches. In the present study, we investigated the impact of food and water deprivation on the mobility of olive fruit flies using a modified version of the LAM25 system (locomotor activity monitor)—Trikinetics, an automated locomotor activity electronic device. Both male and female flies at four different age groups, reared on olives in the laboratory, were individually placed in glass tubes. Their locomotor activity was recorded every minute by three monitors within the digital device over a three-day period. Our observations revealed that adults exhibited significantly reduced movement during nighttime compared to daytime. The greatest mobility was observed during the period of 15:00 to 20:59. Additionally, younger flies demonstrated higher levels of mobility compared to older ones. Flies subjected to both food and water deprivation exhibited higher mobility compared to the control group. These insights offer valuable insights for enhancing pest management strategies aimed at controlling olive fruit flies adopting a more sustainable approach.

Comparison of plan quality and robustness using VMAT and IMRT for breast cancer

Abstract To evaluate the plan quality and robustness of volumetric modulated arc therapy (VMAT) and intensity modulated radiation therapy (IMRT) for breast cancer, 50 patients, including 25 patients who received radiotherapy after breast-conserving surgery (BCR) and 25 patients who received postmastectomy radiotherapy (PRT), were selected for this study. Nominal VMAT and IMRT plans were generated for each patient on Eclipse treatment planning system (version 15.6). The dosimetric metrics, dose distribution, gamma passing rate, and delivery time were compared. In addition, 12 uncertainty plans with plan isocenter uncertainty and CT density uncertainty were recalculated based on the nominal plans for each patient. The dose volume histogram (DVH) band width (DVHBW) was adopted to quantify the plan robustness of the nominal plans for the perturbed scenarios in this study. For BCR, the dosimetric metrics except planning target volume (PTV) conformal index (CI) and ipsilateral lung V 5 were not statistically different for IMRT and VMAT plans. PTV CI of VMAT plans was better than that of IMRT plans (VMAT: 0.923 ± 0.024, IMRT: 0.855 ± 0.032, p = 0.003). The ipsilateral lung V 5 of VMAT plan was higher than that of IMRT plan (VMAT: 42.4% ± 2.8%, IMRT: 40.5% ± 4.0%, p = 0.045). The VMAT plans save more than 1.20 min compared to the IMRT plans (VMAT: 0.87 min, IMRT: 2.08 min, p &lt; 0.001). The gamma passing rates of VMAT plans were better than those of IMRT plans (3 mm/3%, VMAT: 99.7% ± 0.2%, IMRT: 99.4% ± 0.4%, p &lt; 0.001; 2 mm/2%, VMAT: 97.2% ± 1.0%, IMRT: 96.9% ± 0.6%, p = 0.108). For PRT, the dosimetric metrics of VMAT plans, including PTV D mean, homogeneity index (HI), CI, and D max of spinal cord, were significantly better than those of IMRT plans. The VMAT plans save more than 45% time compared with IMRT plans (VMAT: 1.54 min, IMRT: 2.81 min, p &lt; 0.001). The difference in gamma passing rates between VMAT plans and IMRT plans was not statistically significant. For the plan robustness, the DVHBW of VMAT plans and IMRT plans for BCR were 2.09% ± 0.23% and 2.98% ± 0.40%, respectively (p &lt; 0.05). For PRT, the DVHBW of VMAT plans was significantly better than those of IMRT plans (VMAT: 3.05% ± 0.26%, IMRT: 3.57% ± 0.27%, p &lt; 0.05). The results show that the dosimetric metrics of VMAT plans were comparable to those of IMRT plans. More importantly, the VMAT plans had excited dose distribution and fast execution efficiency. The plan robustness of VMAT plans were superior.

A novel model incorporating quantitative contrast-enhanced ultrasound into PI-RADSv2-based nomogram detecting clinically significant prostate cancer

The diagnostic accuracy of clinically significant prostate cancer (csPCa) of Prostate Imaging Reporting and Data System version 2 (PI-RADSv2) is limited by subjectivity in result interpretation and the false positive results from certain similar anatomic structures. We aimed to establish a new model combining quantitative contrast-enhanced ultrasound, PI-RADSv2, clinical parameters to optimize the PI-RADSv2-based model. The analysis was conducted based on a data set of 151 patients from 2019 to 2022, multiple regression analysis showed that prostate specific antigen density, age, PI-RADSv2, quantitative parameters (rush time, wash-out area under the curve) were independent predictors. Based on these predictors, we established a new predictive model, the AUCs of the model were 0.910 and 0.879 in training and validation cohort, which were higher than those of PI-RADSv2-based model (0.865 and 0.821 in training and validation cohort). Net Reclassification Index analysis indicated that the new predictive model improved the classification of patients. Decision curve analysis showed that in most risk probabilities, the new predictive model improved the clinical utility of PI-RADSv2-based model. Generally, this new predictive model showed that quantitative parameters from contrast enhanced ultrasound could help to improve the diagnostic performance of PI-RADSv2 based model in detecting csPCa.

Vegetation and Evapotranspiration Analyses on Climate Maps

This study focuses on the investigation of evapotranspiration (ET) processes under the climatic and geographical characteristics of Turkey. Evapotranspiration refers to the process by which plants transfer water vapour to the atmosphere and is an important part of the water cycle. Vegetation cover, climatic conditions and topographic structures in different regions of Turkey are among the main factors affecting evapotranspiration. In this study, the seasonal and annual variations of evapotranspiration in different regions of Turkey are discussed and the importance of this process in water resources management, agriculture, ecosystems and climate change is emphasised. This research focuses on conducting an evapotranspiration analysis in Turkey by employing imagery data from NASA Global Land Data Assimilation System Version 2 (GLDAS-2), MODIS, TerraClimate, SMAP Level-4, and Penman-Monteith-Leuning Evapotranspiration V2 (PML_V2) sources. Evapotranspiration, a pivotal process in the hydrological cycle, significantly impacts water resource management and ecosystem dynamics. This study aims to provide a comprehensive assessment of evapotranspiration dynamics across diverse regions within Turkey. For Turkey, SSM data between 2016-2022 and LST data between 2000-2022 were obtained from MODIS images. In the study, regression analyses were performed with evapotranspiration values and SSM and LST data. The best result was a medium level relationship (R 0.56) between evapotranspiration generated from SMAP Level-4 data and LST. A high correlation (R 0.87) was observed with SSM. Climate Hazards Group InfraRed Precipitation with Station data (CHIRPS) precipitation data between 1981 and 2023 and Surface pressure (PS) data between 1981 and 2023 were obtained from MERRA image. Regression analyses were performed between evapotranspiration data and PS and Precipitation values. A moderate relationship (R 0.37) was observed between evapotranspiration and PS generated from MOD16A2 V105 data. A moderate relationship (R 0.55) was observed between evapotranspiration and precipitation generated from TerraClimate data. This study aims to contribute to the development of strategies to effectively manage water resources and improve agricultural sustainability by analysing evapotranspiration in various regions of Turkey. Understanding evapotranspiration processes under the climatic diversity and geographical structure of Turkey will be an important step in planning and managing the future use of water resources.

The Effects of Displaying the Time Targets of the Manchester Triage System to Emergency Department Personnel: Prospective Crossover Study.

The use of triage systems such as the Manchester Triage System (MTS) is a standard procedure to determine the sequence of treatment in emergency departments (EDs). When using the MTS, time targets for treatment are determined. These are commonly displayed in the ED information system (EDIS) to ED staff. Using measurements as targets has been associated with a decline in meeting those targets. This study investigated the impact of displaying time targets for treatment to physicians on processing times in the ED. We analyzed the effects of displaying time targets to ED staff on waiting times in a prospective crossover study, during the introduction of a new EDIS in a large regional hospital in Germany. The old information system version used a module that showed the time target determined by the MTS, while the new system version used a priority list instead. Evaluation was based on 35,167 routinely collected electronic health records from the preintervention period and 10,655 records from the postintervention period. Electronic health records were extracted from the EDIS, and data were analyzed using descriptive statistics and generalized additive models. We evaluated the effects of the intervention on waiting times and the odds of achieving timely treatment according to the time targets set by the MTS. The average ED length of stay and waiting times increased when the EDIS that did not display time targets was used (average time from admission to treatment: preintervention phase=median 15, IQR 6-39 min; postintervention phase=median 11, IQR 5-23 min). However, severe cases with high acuity (as indicated by the triage score) benefited from lower waiting times (0.15 times as high as in the preintervention period for MTS1, only 0.49 as high for MTS2). Furthermore, these patients were less likely to receive delayed treatment, and we observed reduced odds of late treatment when crowding occurred. Our results suggest that it is beneficial to use a priority list instead of displaying time targets to ED personnel. These time targets may lead to false incentives. Our work highlights that working better is not the same as working faster.

Point-Counterpoint: The Need for Do-It-Yourself (DIY) Open Source (OS) AID Systems in Type 1 Diabetes Management.

In the last decade, technology developed by people with diabetes and their loved ones has added to the options for diabetes management. One such example is that of automated insulin delivery (AID) algorithms, which were created and shared as open source by people living with type 1 diabetes (T1D) years before commercial systems were first available. Now, numerous options for commercial systems exist in some countries, yet tens of thousands of people with diabetes are still choosing Open-Source AID (OS-AID), previously called "do-it-yourself" (DIY) systems, which are noncommercial versions of these open-source AID systems. In this article, we provide point and counterpoint perspectives regarding (1) safety and efficacy, (2) regulation and support, (3) user choice and flexibility, (4) access and affordability, and (5) patient and provider education, for open source and commercial AID systems. The perspectives reflected here include that of a person living with T1D who uses and has developed OS-AID systems, a physician-researcher based in the United States who conducts clinical trials to support development of commercial AID systems and supports people with diabetes using all types of AID, and an endocrinologist with T1D who uses both systems and treats people with diabetes using all types of AID.

A Sarcocystidae-Specific striated fiber assemblin protein SFA5 is required for parasite division in Toxoplasma gondii

Apicomplexan encompass a variety of intracellular parasites responsible for significant diseases in humans and animals, such as malaria and toxoplasmosis. Among these, Toxoplasma gondii (T. gondii) serves as an exemplary organism for understanding the intricate biological characteristics of the phylum. At the parasite's apical tip, a striated fiber was discovered and proposed to be evotionarily derived from the algal flagellum. However, the protein composition (the striated fiber assemblin, SFA) of this fiber remains poorly understood. Here, we took advantage of a proximity biotin labeling approach to identify potential SFA proteins by fusion of an engeneered biotin ligase TurboID with SFA2, from which we identified several novel components of the fiber. Evolutionary analysis suggested that SFA4 is conserved in the Apicomplexa phylum with the exception of piroplasmida, while SFA5 is specific to species of Sarcocystidae. Confocal imaging analysis showed that SFA4 and SFA5 are substantially co-localized with the bait SFA2. Using a new version (OsTIR1F74G) of the plant auxin-inducible degron system that we adapted in this study, we found that SFA4 and SFA5 were efficiently depleted by addition of a much lower concentration of inducer (5-Ph-IAA, instead of IAA). Detailed phenotypical analyses demonstrated that SFA5 is essential for daughter parasite formation and separation of parasite nuclei during division, supporting the localization of SFA5 at the striated fiber that connects the centriole and the apical conoid. The mouse assay suggested the essentiality of SFA5 in the parasites. Thus, this study provided a new repertoile of the stiated fiber, and new data supporting association of the fiber with parasite division.

Prospective comparison of acute severe toxicities between smokers and non-smokers during radiotherapy for head and neck cancers

Background and purposeThe association between smoking and acute radiation toxicities of head and neck cancer (HNC) is currently unproven. The aim of the study was to compare the occurrence of acute severe toxicity between active and non-active smokers treated for HNC by radiotherapy. Materials and methodsA prospective monocentric cohort study included patients treated by (chemo)radiotherapy for HNC from January 2021 to January 2023. Smoking status was recorded. Patients underwent a medical exam weekly during the radiotherapy to report acute toxicities according to the Common Terminology Criteria for Adverse Effects system version 5.0. Primary endpoint was the occurrence of at least one grade ≥ 3 acute toxicity among mucositis, dysphagia and dermatitis. ResultsAmong the 102 patients included, 27.4 % were active smokers, 58.8 % were former smokers and 13.7 % had never smoked. Regarding toxicity, 23.5 % (n = 24) patients experienced severe mucositis, 37.2 % (n = 38) severe dysphagia, 13.7 % (n = 14) severe dermatitis and 54.9 % (n = 56) experienced at least one of them. Occurrence of severe acute toxicity was not statistically associated with smoking during radiotherapy (64.3 % among active smokers versus 51.3 % among non-active smokers; p = 0.24). On multivariate analysis, concurrent chemotherapy (87.5 % vs 65.2 %; OR = 5.04 [1.64–15.52]; p = 0.004) and 2.12 Gy versus 2 Gy fractionation schedule (64.3 % vs 41.3 %; OR = 2.53 [1.09–5.90]; p = 0.03) were significantly associated with severe acute toxicity. ConclusionThis study did not find an association between smoking during radiotherapy for HNC and occurrence of severe acute toxicities.

Physics schemes in the first version of NCEP operational hurricane analysis and forecast system (HAFS)

This document summarizes the physics schemes used in two configurations of the first version of the operational Hurricane Analysis and Forecast System (HAFSv1) at NOAA NCEP. The physics package in HAFSv1 is the same as that used in NCEP global forecast system (GFS) version 16 except for an additional microphysics scheme and modifications to sea surface roughness lengths, boundary layer scheme, and the entrainment rate in the deep convection scheme. Those modifications are specifically designed for improving the simulation of tropical cyclones (TCs). The two configurations of HAFSv1 mainly differ in the adopted microphysics schemes and TC-specific modifications in addition to model initialization. Experiments are made to highlight the impacts of TC-specific modifications and different microphysics schemes on HAFSv1 performance. Challenges and developmental plans of physics schemes for future versions of operational HAFS are discussed.