23 results on '"Li, Lee"'
Search Results
2. METTL8 links mt-tRNA m3C modification to the HIF1α/RTK/Akt axis to sustain GBM stemness and tumorigenicity
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Bernice Woon Li Lee, You Heng Chuah, Jeehyun Yoon, Oleg V. Grinchuk, Yajing Liang, Jayshree L. Hirpara, Yating Shen, Loo Chien Wang, Yan Ting Lim, Tianyun Zhao, Radoslaw M. Sobota, Tseng Tsai Yeo, Andrea Li Ann Wong, Kejia Teo, Vincent Diong Weng Nga, Bryce Wei Quan Tan, Toshio Suda, Tan Boon Toh, Shazib Pervaiz, Zhewang Lin, and Derrick Sek Tong Ong
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Cytology ,QH573-671 - Abstract
Abstract Epitranscriptomic RNA modifications are crucial for the maintenance of glioma stem cells (GSCs), the most malignant cells in glioblastoma (GBM). 3-methylcytosine (m3C) is a new epitranscriptomic mark on RNAs and METTL8 represents an m3C writer that is dysregulated in cancer. Although METTL8 has an established function in mitochondrial tRNA (mt-tRNA) m3C modification, alternative splicing of METTL8 can also generate isoforms that localize to the nucleolus where they may regulate R-loop formation. The molecular basis for METTL8 dysregulation in GBM, and which METTL8 isoform(s) may influence GBM cell fate and malignancy remain elusive. Here, we investigated the role of METTL8 in regulating GBM stemness and tumorigenicity. In GSC, METTL8 is exclusively localized to the mitochondrial matrix where it installs m3C on mt-tRNAThr/Ser(UCN) for mitochondrial translation and respiration. High expression of METTL8 in GBM is attributed to histone variant H2AZ-mediated chromatin accessibility of HIF1α and portends inferior glioma patient outcome. METTL8 depletion impairs the ability of GSC to self-renew and differentiate, thus retarding tumor growth in an intracranial GBM xenograft model. Interestingly, METTL8 depletion decreases protein levels of HIF1α, which serves as a transcription factor for several receptor tyrosine kinase (RTK) genes, in GSC. Accordingly, METTL8 loss inactivates the RTK/Akt axis leading to heightened sensitivity to Akt inhibitor treatment. These mechanistic findings, along with the intimate link between METTL8 levels and the HIF1α/RTK/Akt axis in glioma patients, guided us to propose a HIF1α/Akt inhibitor combination which potently compromises GSC proliferation/self-renewal in vitro. Thus, METTL8 represents a new GBM dependency that is therapeutically targetable.
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- 2024
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3. Technological Challenges and Solutions in Emergency Remote Teaching for Nursing: An International Cross-Sectional Survey
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Eunjoo Jeon, Laura-Maria Peltonen, Lorraine J. Block, Charlene Ronquillo, Jude L. Tayaben, Raji Nibber, Lisiane Pruinelli, Erika Lozada Perezmitre, Janine Sommer, Maxim Topaz, Gabrielle Jacklin Eler, Henrique Yoshikazu Shishido, Shanti Wardaningsih, Sutantri Sutantri, Samira Ali, Dari Alhuwail, Alaa Abd-Alrazaq, Laila Akhu-Zaheya, Ying-Li Lee, Shao-Hui Shu, and Jisan Lee
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cross-sectional studies ,distance education ,nursing education ,natural language processing ,digital divide ,Computer applications to medicine. Medical informatics ,R858-859.7 - Abstract
Objectives With the sudden global shift to online learning modalities, this study aimed to understand the unique challenges and experiences of emergency remote teaching (ERT) in nursing education. Methods We conducted a comprehensive online international cross-sectional survey to capture the current state and firsthand experiences of ERT in the nursing discipline. Our analytical methods included a combination of traditional statistical analysis, advanced natural language processing techniques, latent Dirichlet allocation using Python, and a thorough qualitative assessment of feedback from open-ended questions. Results We received responses from 328 nursing educators from 18 different countries. The data revealed generally positive satisfaction levels, strong technological self-efficacy, and significant support from their institutions. Notably, the characteristics of professors, such as age (p = 0.02) and position (p = 0.03), influenced satisfaction levels. The ERT experience varied significantly by country, as evidenced by satisfaction (p = 0.05), delivery (p = 0.001), teacher-student interaction (p = 0.04), and willingness to use ERT in the future (p = 0.04). However, concerns were raised about the depth of content, the transition to online delivery, teacher-student interaction, and the technology gap. Conclusions Our findings can help advance nursing education. Nevertheless, collaborative efforts from all stakeholders are essential to address current challenges, achieve digital equity, and develop a standardized curriculum for nursing education.
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- 2024
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4. Association between deep learning measured retinal vessel calibre and incident myocardial infarction in a retrospective cohort from the UK Biobank
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Tien Y Wong, Carol Y Cheung, Dawei Yang, Marco Yu, Dejiang Xu, Yiu Lun Wong, Crystal Chong, Mong Li Lee, Wynne Hsu, and Chingyu Cheng
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Medicine - Abstract
Background Cardiovascular disease is a leading cause of global death. Prospective population-based studies have found that changes in retinal microvasculature are associated with the development of coronary artery disease. Recently, artificial intelligence deep learning (DL) algorithms have been developed for the fully automated assessment of retinal vessel calibres.Methods In this study, we validate the association between retinal vessel calibres measured by a DL system (Singapore I Vessel Assessment) and incident myocardial infarction (MI) and assess its incremental performance in discriminating patients with and without MI when added to risk prediction models, using a large UK Biobank cohort.Results Retinal arteriolar narrowing was significantly associated with incident MI in both the age, gender and fellow calibre-adjusted (HR=1.67 (95% CI: 1.19 to 2.36)) and multivariable models (HR=1.64 (95% CI: 1.16 to 2.32)) adjusted for age, gender and other cardiovascular risk factors such as blood pressure, diabetes mellitus (DM) and cholesterol status. The area under the receiver operating characteristic curve increased from 0.738 to 0.745 (p=0.018) in the age–gender-adjusted model and from 0.782 to 0.787 (p=0.010) in the multivariable model. The continuous net reclassification improvements (NRIs) were significant in the age and gender-adjusted (NRI=21.56 (95% CI: 3.33 to 33.42)) and the multivariable models (NRI=18.35 (95% CI: 6.27 to 32.61)). In the subgroup analysis, similar associations between retinal arteriolar narrowing and incident MI were observed, particularly for men (HR=1.62 (95% CI: 1.07 to 2.46)), non-smokers (HR=1.65 (95% CI: 1.13 to 2.42)), patients without DM (HR=1.73 (95% CI: 1.19 to 2.51)) and hypertensive patients (HR=1.95 (95% CI: 1.30 to 2.93)) in the multivariable models.Conclusion Our results support DL-based retinal vessel measurements as markers of incident MI in a predominantly Caucasian population.
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- 2024
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5. Comparing discriminating abilities of evaluation metrics in link prediction.
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Xinshan Jiao, Shuyan Wan, Qian Liu, Yilin Bi, Yan-Li Lee, En Xu, Dong Hao, and Tao Zhou
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- 2024
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6. Faithful Logical Reasoning via Symbolic Chain-of-Thought.
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Jundong Xu, Hao Fei 0001, Liangming Pan, Qian Liu 0012, Mong-Li Lee, and Wynne Hsu
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- 2024
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7. SNIFFER: Multimodal Large Language Model for Explainable Out-of-Context Misinformation Detection.
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Peng Qi, Zehong Yan, Wynne Hsu, and Mong-Li Lee
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- 2024
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8. Inconsistency of evaluation metrics in link prediction.
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Yilin Bi, Xinshan Jiao, Yan-Li Lee, and Tao Zhou
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- 2024
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9. Towards Robust Out-of-Distribution Generalization Bounds via Sharpness.
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Yingtian Zou, Kenji Kawaguchi, Yingnan Liu, Jiashuo Liu, Mong-Li Lee, and Wynne Hsu
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- 2024
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10. Cross-Domain Feature Augmentation for Domain Generalization.
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Yingnan Liu, Yingtian Zou, Rui Qiao, Fusheng Liu, Mong-Li Lee, and Wynne Hsu
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- 2024
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11. The evolution of medical device regulation in Taiwan: From the pharmaceutical affairs act to the medical devices act
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Kuo-Li Lee, Ying-Hsien Fu, and Hsin-Hui Lin
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Medicine (General) ,R5-920 - Published
- 2024
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12. Social network sites and obsessive-compulsive disorder: An investigation with suppression analyses
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Soon Li Lee
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Obsessive-compulsive disorder ,social network sites addiction ,social network sites intensity suppression analyses ,suppression effects ,Psychology ,BF1-990 - Abstract
This research examined the relationship between social network site (SNS) intensity, SNS addiction, and the severity of obsessive-compulsive disorder (OCD), alongside its factors of obsession and compulsion. The overlap of SNS intensity and SNS addiction was controlled in the study to predict the measured severity of OCD. In this study, 204 Malaysian undergraduate students were recruited to complete the revised Facebook Intensity Scale, the revised Bergen Facebook Addiction Scale, and the self-report version of the Yale-Brown Obsessive-Compulsive Scale. The overlap of SNS intensity and SNS addiction was supported by their significant positive correlation. Furthermore, SNS addiction significantly correlated with the measured OCD and its corresponding factors. The hierarchical regression analysis revealed that the entry of SNS intensity enhanced the facilitative effect of SNS addiction on OCD and its factors. Therefore, the role of SNS intensity as a suppressor was supported. In the same regression model, SNS intensity predicted the severity of OCD and its compulsion subscale negatively. Implications and directions for future research were also discussed in this manuscript.
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- 2024
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13. N-of-1 Trials of Antimicrobial Stewardship Interventions to Optimize Antibiotic Prescribing for Upper Respiratory Tract Infection in Emergency Departments: Protocol for a Quasi-Experimental Study
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Hersh Attal, Zhilian Huang, Win Sen Kuan, Yanyi Weng, Hann Yee Tan, Eillyne Seow, Li Lee Peng, Hoon Chin Lim, and Angela Chow
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Medicine ,Computer applications to medicine. Medical informatics ,R858-859.7 - Abstract
BackgroundAntimicrobial stewardship programs attempting to optimize antibiotic therapy and clinical outcomes mainly focus on inpatient and outpatient settings. The lack of antimicrobial stewardship program studies in the emergency department (ED) represents a gap in tackling the problem of antimicrobial resistance as EDs treat a substantial number of upper respiratory tract infection cases throughout the year. ObjectiveWe intend to implement two evidence-based interventions: (1) patient education and (2) providing physician feedback on their prescribing rates. We will incorporate evidence from a literature review and contextualizing the interventions based on findings from a local qualitative study. MethodsOur study uses a quasi-experimental design to evaluate the effects of interventions over time in the EDs of 4 public hospitals in Singapore. We will include an initial control period of 18 months. In the next 6 months, we will randomize 2 EDs to receive 1 intervention (ie, patient education) and the other 2 EDs to receive the alternative intervention (ie, physician feedback). All EDs will receive the second intervention in the subsequent 6 months on top of the ongoing intervention. Data will be collected for another 6 months to assess the persistence of the intervention effects. The information leaflets will be handed to patients at the EDs before they consult with the physician, while feedback to individual physicians by senior doctors is in the form of electronic text messages. The feedback will contain the physicians’ antibiotic prescribing rate compared with the departments’ overall antibiotic prescribing rate and a bite-size message on good antibiotic prescribing practices. ResultsWe will analyze the data using segmented regression with difference-in-difference estimation to account for concurrent cluster comparisons. ConclusionsOur proposed study assesses the effectiveness of evidence-based, context-specific interventions to optimize antibiotic prescribing in EDs. These interventions are aligned with Singapore’s national effort to tackle antimicrobial resistance and can be scaled up if successful. Trial RegistrationClinicalTrials.gov NCT05451863; https://clinicaltrials.gov/study/NCT05451836 International Registered Report Identifier (IRRID)DERR1-10.2196/50417
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- 2024
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14. Superhydrophobicity transfer effect in superwetting coatings for strengthening anti-pollution flashover performance
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Qiu, Chuxiong, Xiong, Wei, Zhang, Helong, Zhang, Rong, Parkin, Ivan P., Wang, Shengwu, Li, Lee, Chen, Junwu, Chen, Zhi, Tapa, Arnauld Robert, Trokourey, Albert, Zhou, Weibing, Zhao, Xiujian, and Xie, Yi
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- 2024
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15. Fetal Aortic Blood Flow Velocity and Power Doppler Profiles in the First Trimester: A Comprehensive Study Using High-Definition Flow Imaging
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Yi-Cheng Wu, Ching-Hsuan Chen, Hsin-Tzu Lu, Yu-Li Lee, Pi-Yu Chen, Ting-Yu Wu, Ming-Hsun Tien, Chiung-Hui Wu, Jack Yu-Jen Huang, Ching-Hua Hsiao, and Woei-Chyn Chu
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power Doppler ultrasound ,aortic isthmus ,high-definition flow imaging (HDFI) ,isthmic flow index ,isthmic systolic index ,first-trimester screening ,Technology ,Biology (General) ,QH301-705.5 - Abstract
Objectives: This study aimed to establish reference values for fetal aortic isthmus blood flow velocity and associated indices during the first trimester, utilizing a novel ultrasonographic technique known as high-definition flow imaging (HDFI). Additionally, the correlation between Doppler profiles of aortic blood flow and key fetal parameters, including nuchal thickness (NT), crown-rump length (CRL), and fetal heartbeat (FHB), was investigated. Methods: A total of 262 fetuses were included in the analysis between December 2022 and December 2023. Utilizing 2D power Doppler ultrasound images, aortic blood flow parameters were assessed, including aortic peak systolic velocity (PS), aortic end-diastolic velocity (ED), aortic time average maximal velocity (TAMV), and various indices such as aortic systolic velocity/diastolic velocity (S/D), aortic pulsatile index (PI), aortic resistance index (RI), aortic isthmus flow velocity index (IFI), and aortic isthmic systolic index (ISI). Concurrently, fetal FHB, NT, and CRL were evaluated during early trimester Down syndrome screening. Results: Significant findings include a positive correlation between gestational age (GA) and PS (PS = 3.75 × (GA) − 15.4, r2 = 0.13, p < 0.01), ED (ED = 0.42 × (GA) − 0.61, r2 = 0.04, p < 0.01), PI (PI = 0.07 × (GA) + 1.03, r2 = 0.04, p < 0.01), and TAMV (TAMV = 1.23 × (GA) − 1.66, r2 = 0.08, p < 0.01). In contrast, aortic ISI demonstrated a significant decrease (ISI = −0.03 × (GA) + 0.57, r2 = 0.05, p < 0.05) with gestational age. No significant correlation was observed for aortic RI (p = 0.33), S/D (p = 0.39), and IFI (p = 0.29) with gestational age. Aortic PS exhibited positive correlations with NT (0.217, p = 0.001) and CRL (0.360, p = 0.000) but a negative correlation with FHB (−0.214, p = 0.001). Aortic PI demonstrated positive correlations with CRL (0.208, p = 0.001) and negative correlations with FHB (−0.176, p = 0.005). Aortic TAMV showed positive correlations with NT (0.233, p = 0.000) and CRL (0.290, p = 0.000) while exhibiting a negative correlation with FHB (−0.141, p = 0.026). Aortic ISI demonstrated negative correlations with NT (−0.128, p = 0.045) and CRL (−0.218, p = 0.001) but a positive correlation with FHB (0.163, p = 0.010). Conclusions: Power Doppler angiography with Doppler ultrasound demonstrates the ability to establish accurate reference values for fetal aortic blood flow during the first trimester of pregnancy. Notably, aortic PS, TAMV, and ISI exhibit significant correlations with NT, CRL, and FHB, with ISI appearing more relevant than IFI, PS, TAMV, and FHB. The utilization of HDFI technology proves advantageous in efficiently detecting the site of the aortic isthmus compared to traditional color Doppler mode in early second trimesters.
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- 2024
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16. Identifying influential nodes on directed networks.
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Yan-Li Lee, Yi-Fei Wen, Wen-Bo Xie, Liming Pan, Yajun Du, and Tao Zhou 0001
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- 2024
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17. Cost-effective hierarchical clustering with local density peak detection.
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Wen-Bo Xie, Bin Chen, Xun Fu, Jun-Hao Shi, Yan-Li Lee, and Xin Wang
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- 2024
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18. Label-text bi-attention capsule networks model for multi-label text classification.
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Gang Wang, Yajun Du, Yurui Jiang, Jia Liu, Xianyong Li, Xiaoliang Chen, Hongmei Gao, Chunzhi Xie, and Yan-Li Lee
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- 2024
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19. Nonlinear and Nonreciprocal Transport Effects in Untwinned Thin Films of Ferromagnetic Weyl Metal SrRuO_{3}
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Uddipta Kar, Elisha Cho-Hao Lu, Akhilesh Kr. Singh, P. V. Sreenivasa Reddy, Youngjoon Han, Xinwei Li, Cheng-Tung Cheng, Song Yang, Chun-Yen Lin, I-Chun Cheng, Chia-Hung Hsu, David Hsieh, Wei-Cheng Lee, Guang-Yu Guo, and Wei-Li Lee
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Physics ,QC1-999 - Abstract
The identification of distinct charge transport features, deriving from nontrivial bulk band and surface states, has been a challenging subject in the field of topological systems. In topological Dirac and Weyl semimetals, nontrivial conical bands with Fermi-arc surface states give rise to negative longitudinal magnetoresistance due to chiral anomaly effect and unusual thickness dependent quantum oscillation from Weyl-orbit effect, which were demonstrated recently in experiments. In this work, we report the experimental observations of large nonlinear and nonreciprocal transport effects for both longitudinal and transverse channels in an untwinned Weyl metal of SrRuO_{3} thin film grown on a SrTiO_{3} substrate. From rigorous measurements with bias current applied along various directions with respect to the crystalline principal axes, the magnitude of nonlinear Hall signals from the transverse channel exhibits a simple sinα dependence at low temperatures, where α is the angle between bias current direction and orthorhombic [001]_{o}, reaching a maximum when current is along orthorhombic [11[over ¯]0]_{o}. On the contrary, the magnitude of nonlinear and nonreciprocal signals in the longitudinal channel attains a maximum for bias current along [001]_{o}, and it vanishes for bias current along [11[over ¯]0]_{o}. The observed α-dependent nonlinear and nonreciprocal signals in longitudinal and transverse channels reveal a magnetic Weyl phase with an effective Berry curvature dipole along [11[over ¯]0]_{o} from surface states, accompanied by 1D chiral edge modes along [001]_{o}.
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- 2024
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20. Application of ionic liquids and various carbon materials in reference electrodes with carbon paste‐based transducers.
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Kuczak, Julia, Woszczyk, Wiktoria, Pazik, Małgorzata, Li Lee, Chuan, Mohd Sahfani Mohd Nor Hafizuddin, Bin, Ling Chin, Kit, Grabowska‐Jadach, Ilona, Toczyłowska‐Mamińska, Renata, San H'ng, Paik, and Górski, Łukasz
- Subjects
CARBON-based materials ,CARBON electrodes ,STANDARD hydrogen electrode ,ELECTRODE potential ,REFERENCE sources ,GRAPHITE oxide - Abstract
In this article it is proved that carbon pastes with ionic liquids (ILs) are a promising material for transducers of reference electrodes, which favors their miniaturization. Two ILs were used: 1‐(2‐hydroxyethyl)‐3‐methylimidazolium bis(trifluoromethylsulfonyl)imide (IL1) and 1‐(2‐methoxyethyl)‐3‐methylimidazolium bis(trifluoromethylsulfonyl)imide (IL2). They acted both as a binder of carbon paste and potential‐determining component. ILs were also used in polymeric membrane of reference electrodes what ensured continuity of IL phase between carbon paste and the polymeric membrane and resulted in enhancement of electrode potential stability. It was shown that application of IL as a carbon paste binder is superior to conventional plasticizer and allows for significant increase of reference electrode potential stability. Different types of carbon materials were also tested during research: commercialy available graphite powder and graphene oxide obtained from waste biomass – palm kernel shells. It was observed that both the type of carbon paste material and IL influences reference electrode work parameters. Utilization of IL with less lipophilic cation resulted in higher potential stability of the reference electrodes. Application of graphite paste‐based transducers resulted in higher potential stability of reference electrodes in sodium perchlorate and TMA chloride solutions while using palm kernel shell graphene oxide paste – based transducers caused enhancement of reference electrode long‐term potential stability. The results indicate biomass‐derived graphene oxide can be successfully applied as a construction material of reference electrode. [ABSTRACT FROM AUTHOR]
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- 2024
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21. A lack of association between BMI and chemoimmunotherapy efficacy in advanced non-small cell lung cancer: Secondary analysis of the IMpower150 and IMpower130 clinical trials.
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Li, Lee X., Socinski, Mark A., Kichenadasse, Ganessan, Karapetis, Christos S., Shahnam, Adel, McKinnon, Ross A., Rowland, Andrew, Hopkins, Ashley M., and Sorich, Michael J.
- Subjects
- *
NON-small-cell lung carcinoma , *SECONDARY analysis , *IMMUNE checkpoint inhibitors , *CLINICAL trials , *BODY mass index - Abstract
Background: Multiple studies have indicated that patients with high body mass index (BMI) may have favourable survival outcomes following treatment with an immune checkpoint inhibitor (ICI). However, this evidence is limited by several factors, notably the minimal evidence from randomised controlled trials (RCTs), the use of categorised BMI with inconsistent cut point definitions, and minimal investigation of contemporary combination ICI therapy. Moreover, whether overweight and obese patients gain a larger benefit from contemporary frontline chemoimmunotherapy in non-small cell lung cancer (NSCLC) is unclear. Methods: This secondary analysis pooled individual patient data from the intention-to-treat population of the IMpower130 and IMpower150 RCTs comparing chemoimmunotherapy versus chemotherapy. Co-primary outcomes were overall survival (OS) and progression-free survival (PFS). The potentially non-linear relationship between BMI and chemoimmunotherapy treatment effect was evaluated using Multivariable Fractional Polynomial Interaction (MFPI). As a sensitivity analysis, chemoimmunotherapy treatment effect (chemoimmunotherapy versus chemotherapy) on survival was also estimated for each BMI subgroup defined by World Health Organisation classification. Exploratory analyses in the respective chemoimmunotherapy and chemotherapy cohort were undertaken to examine the survival outcomes among BMI subgroups. Results: A total of 1282 patients were included. From the MFPI analysis, BMI was not significantly associated with chemoimmunotherapy treatment effect with respect to either OS (p = 0.71) or PFS (p = 0.35). This was supported by the sensitivity analyses that demonstrated no significant treatment effect improvement in OS/PFS among overweight or obese patients compared to normal weight patients (OS: normal BMI HR = 0.74 95% CI 0.59–0.93, overweight HR = 0.78 95% CI 0.61–1.01, obese HR = 0.84 95% CI 0.59–1.20). Exploratory analyses further highlighted that survival outcomes were not significantly different across BMI subgroups in either the chemoimmunotherapy therapy cohort (Median OS: normal BMI 19.9 months, overweight 17.9 months, and obese 19.5 months, p = 0.7) or the chemotherapy cohort (Median OS: normal 14.1 months, overweight 15.9 months, and obese 16.7 months, p = 0.7). Conclusion: There was no association between high BMI (overweight or obese individuals) and enhanced chemoimmunotherapy treatment benefit in front-line treatment of advanced non-squamous NSCLC. This contrasts with previous publications that showed a superior treatment benefit in overweight and obese patients treated with immunotherapy given without chemotherapy. [ABSTRACT FROM AUTHOR]
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- 2024
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22. Oral antiviral utilisation among older adults with COVID-19 in primary care: A population-wide study during successive Omicron waves in Singapore.
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Ren Ying Tan, Dickens, Borame, Tan, Joyce, Ching Li Lee, Wong, Betty, Lim, Ruth, Bryan Tan, Kelvin, and Liang En Wee
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SARS-CoV-2 Omicron variant ,OLDER people ,PRIMARY care ,COVID-19 ,MEDICAL personnel - Abstract
This article presents the findings of a study conducted in Singapore that examined the use of oral antivirals (OAVs) among older adults with COVID-19 in primary care during the Omicron waves. The study revealed that a small percentage of older adults received OAVs, with nirmatrelvir-ritonavir being the most commonly prescribed medication. The study also identified factors such as primary care characteristics and socioeconomic status (SES) indicators that influenced the likelihood of receiving OAVs. The authors emphasize the importance of addressing disparities in OAV access among older adults and socioeconomically disadvantaged groups. They recommend targeted efforts to improve access for individuals with lower SES. [Extracted from the article]
- Published
- 2024
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23. N-of-1 Trials of Antimicrobial Stewardship Interventions to Optimize Antibiotic Prescribing for Upper Respiratory Tract Infection in Emergency Departments: Protocol for a Quasi-Experimental Study.
- Author
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Attal H, Huang Z, Kuan WS, Weng Y, Tan HY, Seow E, Peng LL, Lim HC, and Chow A
- Abstract
Background: Antimicrobial stewardship programs attempting to optimize antibiotic therapy and clinical outcomes mainly focus on inpatient and outpatient settings. The lack of antimicrobial stewardship program studies in the emergency department (ED) represents a gap in tackling the problem of antimicrobial resistance as EDs treat a substantial number of upper respiratory tract infection cases throughout the year., Objective: We intend to implement two evidence-based interventions: (1) patient education and (2) providing physician feedback on their prescribing rates. We will incorporate evidence from a literature review and contextualizing the interventions based on findings from a local qualitative study., Methods: Our study uses a quasi-experimental design to evaluate the effects of interventions over time in the EDs of 4 public hospitals in Singapore. We will include an initial control period of 18 months. In the next 6 months, we will randomize 2 EDs to receive 1 intervention (ie, patient education) and the other 2 EDs to receive the alternative intervention (ie, physician feedback). All EDs will receive the second intervention in the subsequent 6 months on top of the ongoing intervention. Data will be collected for another 6 months to assess the persistence of the intervention effects. The information leaflets will be handed to patients at the EDs before they consult with the physician, while feedback to individual physicians by senior doctors is in the form of electronic text messages. The feedback will contain the physicians' antibiotic prescribing rate compared with the departments' overall antibiotic prescribing rate and a bite-size message on good antibiotic prescribing practices., Results: We will analyze the data using segmented regression with difference-in-difference estimation to account for concurrent cluster comparisons., Conclusions: Our proposed study assesses the effectiveness of evidence-based, context-specific interventions to optimize antibiotic prescribing in EDs. These interventions are aligned with Singapore's national effort to tackle antimicrobial resistance and can be scaled up if successful., Trial Registration: ClinicalTrials.gov NCT05451863; https://clinicaltrials.gov/study/NCT05451836., International Registered Report Identifier (irrid): DERR1-10.2196/50417., (©Hersh Attal, Zhilian Huang, Win Sen Kuan, Yanyi Weng, Hann Yee Tan, Eillyne Seow, Li Lee Peng, Hoon Chin Lim, Angela Chow. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 21.02.2024.)
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- 2024
- Full Text
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