Search

Introduction Digital health tools can be beneficial in the care of patients with chronic conditions and have the potential for widespread impact as readily scalable and cost-effective health interventions. However, benefits are often contingent on users sustaining their engagement with these tools over time. Sustained engagement with digital health tools can be challenging, and high rates of attrition from digital interventions are common. Inflammatory Bowel Disease (IBD) and irritable bowel syndrome (IBS) are prominent gastrointestinal conditions resulting in significant burdens for individuals and society. Emerging evidence suggests digital health tools can be beneficial for IBD and IBS management; however, it is not clear what barriers and enablers are experienced by people living with these conditions to sustaining their engagement with these tools, when necessary. Such knowledge could inform the tailoring of new and existing digital health tools to the needs of people living with IBD and/or IBS. This study will seek to identify the barriers and enablers of sustained engagement with digital health tools among adults living with IBD and/or IBS.Methods and analysis We will conduct semistructured interviews with a purposive sample of approximately 30 adults (>18 years) who (a) reside in Canada, (b) self-report that they have been diagnosed with IBD and/or IBS, (c) have ever used a digital health tool (ie, any application/platform) to manage their condition and (d) are capable of providing informed consent. Interviews will be audio and video recorded and transcribed verbatim. Data will be coded deductively and barriers and enablers to sustained engagement will be categorised in accordance with the Theoretical Domains Framework. Data analysis will be verified by a patient research partner.Ethics and dissemination The study has been approved by the Ottawa Health Science Network Research Ethics Board. The findings will inform the codevelopment of strategies to overcome modifiable barriers and leverage identified enablers of sustained engagement with digital health tools for IBD and IBS care. These strategies can inform the design of new, or modifications to existing, digital health tools for IBD and IBS care where sustained engagement is desirable. Strategies will be compiled into a guidebook and disseminated via the Inflammation, Microbiome and Alimentation: Gastro-Intestinal and Neuropsychiatric Effects (IMAGINE) Strategy for Patient Oriented Research chronic disease network in Canada.

Abstract Characterization of heterogeneous reservoirs such as multilayered or fractured systems is an important issue in different disciplines such as hydrology, petroleum and geothermal systems. One of the popular methods that can be used for this purpose is tracer tests. Better understanding of the mechanisms of mass transfer (convection–diffusion process) is essential for having a proper test interpretation. In this study, the solutions of different scenarios of tracer flow in a pair of high and low-permeable layered reservoirs including convection and diffusion mechanisms are discussed. Although analytical solutions generally provided exact solutions, they involve several assumptions and might be hard to use for complex problems. As a result, numerical methods are selected for the investigation of different scenarios and addressing cases that are beyond access of analytical methods. In this study, several scenarios of considering diffusion and convection in low and high permeable zones and effective parameters on tracer concentration are investigated. According to the results of this study, the higher the porosity ratio of low to high permeable layer, the more time is needed to get the final concentration value. Also, by increasing the value of the dispersivity coefficient, the time needed to increase the concentration decreases. In other words, the sharp increase in concentration for lower times is seen in higher dispersivity values. The concentration profile variation is affected by Peclet number. The difference among concentration profiles in different cases is considerable, especially in low Peclet numbers where the diffusion mechanism is dominant. This behavior is more common in low permeable mediums such as multilayered tight or shale reservoirs.

Background: Fecal microbiota transplantation (FMT) is a promising treatment for active ulcerative colitis (UC). Understanding patient preferences can identify treatment features that may impact treatment decisions, improve shared decision-making, and contribute to patient-centered care, which is especially important in the context of novel treatments like FMT. Objectives: We aimed to quantify preferences for active UC treatments, specifically FMT and biologics, and identify patient characteristics associated with different preference patterns. Design: This is a cross-sectional survey study. Methods: We administered a discrete choice experiment (DCE) survey to elicit preferences in a sample of Canadian adults with UC. DCE data were analyzed using a main-effects mixed logit model and used to predict uptake of hypothetical scenarios reflecting alternative combinations of treatment features. Latent class modeling identified heterogeneity in patient preference patterns. Results: Participants’ ( n = 201) mean age was 47.1 years (SD: 14.5 years), 58% were female, and most (84%) had at least some post-secondary education. Almost half were willing to undergo FMT. When considering treatments for active UC, the most important attributes were chance of remission and severity of rare unknown side effects. All else equal, participants were most likely to uptake treatment that involves oral capsules/pills. Participants in the class with the highest utility for chance of remission were younger, had more severe disease, and 58% indicated that they would be willing to undergo FMT. Conclusion: We identified characteristics of UC patients who are more likely to be interested in FMT using preference elicitation methods. Patient-centered care can be enhanced by knowing which patients are more likely to be interested in FMT, potentially improving satisfaction with and adherence to treatments for active UC to maximize the effectiveness of treatment while considering heterogeneity in patient preferences.

In this article, two computational frameworks are presented for the numerical simulation of flow and heat transfer under the effects of natural convection phenomena in a field containing water-copper Nano-fluid and including porous media. The first is a CFD model which is built based on accurate algorithms for spatial derivatives and time integration. The spatial derivatives have been calculated using first-order upwind and second-order central differencing approaches. Also, time integration is performed using the fourth-order Runge-Kutta method. In the second, a parametric reduced order model is developed to compute the whole flow field under the effects of some important parameters such as Darcy number and Rayleigh number. This model is constructed based on POD-snapshots method. The POD modes are calculated by the solution of an eigenvalues problem. The calculated eigenfunctions are POD modes which are ranked using energy-based criteria based on the total kinetic energy of the flow field. This approach leads to the development of a reduced-order model that can be used as a surrogate model of the CFD high-order approach. The results obtained from the reduced order model show relatively good agreements under variations of some important parameters such as Darcy and Rayleigh numbers and nanoparticles density on the flow and thermal fields with the benchmark DNS data. Also, from the results, it is concluded that the surrogate model has very small values of errors (order of 10-4 ~ 10-6) and the time spent on calculations is less than 10% of the time required for direct numerical simulation.

Objective The objective of this study was to explore the outcomes of research engagement (patient engagement, PE) in the context of qualitative research.Design We observed engagement in two groups comprised of patients, clinicians and researchers tasked with conducting a qualitative preference exploration project in inflammatory bowel disease. One group was led by a patient research partner (PLG, partner led group) and the other by an academic researcher (RLG, researcher led group). A semistructured guide and a set of critical outcomes of research engagement were used as a framework to ground our analysis.Setting The study was conducted online.Participants Patient research partners (n=5), researchers (n=5) and clinicians (n=4) participated in this study.Main outcome measures Transcripts of meetings, descriptive and reflective observation data of engagement during meetings and email correspondence between group members were analysed to identify the outcomes of PE.Results Both projects were patient-centred, collaborative, meaningful, rigorous, adaptable, ethical, legitimate, understandable, feasible, timely and sustainable. Patient research partners (PRPs) in both groups wore dual hats as patients and researchers and influenced project decisions wearing both hats. They took on advisory and operational roles. Collaboration seemed easier in the PLG than in the RLG. The RLG PRPs spent more time than their counterparts in the PLG sharing their experience with biologics and helping their group identify a meaningful project question. A formal literature review informed the design, project materials and analysis in the RLG, while the formal review informed the project materials and analysis in the PLG. A PRP in the RLG and the PLG lead leveraged personal connections to facilitate recruitment. The outcomes of both projects were meaningful to all members of the groups.Conclusions Our findings show that engagement of PRPs in research has a positive influence on the project design and delivery in the context of qualitative research in both the patient-led and researcher-led group.

Background: Bleeding is the most common adverse event in those with cardiovascular (CV) disease receiving antithrombotic therapy, and it most commonly occurs in the gastrointestinal (GI) tract. Clinicians often dismiss bleeding as an adverse event that is reversible with effective antithrombotic therapy, but bleeding is associated with substantial morbidity and mortality, most likely mediated through an increased risk of CV events. Reducing the burden of bleeding requires knowledge of the potentially modifiable risk factors for bleeding and the potentially modifiable risk factors for adverse outcomes after bleeding. Methods: INTERBLEED is an international, multicentre, 2-component, observational study, with an incident case-control study examining the risk factors for GI bleeding, and a prospective cohort study of risk factors for CV events after GI bleeding. Cases either have CV disease and present to the hospital with GI bleeding or develop GI bleeding during hospitalization. Controls have CV disease, but no history of GI bleeding. We use a questionnaire to obtain detailed information on known and potential risk factors for GI bleeding and for CV events and outcomes after bleeding. We obtain CV and anthropometric measurements, perform functional and cognitive assessments, and follow participants at 3 months and 12 months. Results: As of April 1, 2022, the study is ongoing in 10 countries at 31 centres and has recruited 2407 cases and 1478 controls. Conclusions: Knowledge of risk factors for bleeding, and risk factors for CV events and functional decline after bleeding, will help develop strategies to prevent bleeding and subsequent complications. Résumé: Contexte: L’hémorragie est l’effet indésirable le plus fréquent chez les patients atteints de maladies cardiovasculaires (CV) qui reçoivent un traitement antithrombotique, et elle survient le plus souvent dans le tractus gastro-intestinal (GI). Les cliniciens considèrent souvent l’hémorragie comme une simple manifestation indésirable réversible par un traitement antithrombotique efficace, mais une morbidité et une mortalité considérables y sont associées, probablement en raison d’un risque accru d’événements CV. Une réduction du fardeau de l’hémorragie nécessite une connaissance des facteurs de risque potentiellement modifiables tant de l’hémorragie que des événements indésirables qui surviennent après l’hémorragie. Méthodologie: INTERBLEED est une étude internationale, observationnelle et multicentrique à deux volets; le premier volet est une étude cas-témoins incidents visant à examiner les facteurs de risque d’hémorragie GI, alors que le second volet est une étude de cohorte prospective visant à examiner les facteurs de risque d’événements CV après une hémorragie GI. Les cas sont des patients atteints de maladies CV qui consultent les services hospitaliers pour une hémorragie GI ou qui présentent une hémorragie GI en cours d’hospitalisation. Les témoins sont des patients atteints de maladies CV, mais sans antécédents d’hémorragie GI. Un questionnaire est utilisé pour obtenir des renseignements détaillés au sujet de facteurs de risque connus et potentiels d’hémorragie GI et d’événements CV et d’autres résultats de santé après une hémorragie. Des mesures cardiovasculaires et anthropométriques ainsi que des évaluations fonctionnelles et cognitives sont réalisées, et les participants sont revus après trois mois et 12 mois. Résultats: En date du 1er avril 2022, l’étude est en cours dans 10 pays et 31 établissements de santé; 2 407 cas et 1 478 témoins ont été recrutés. Conclusions: La connaissance des facteurs de risque d’hémorragie, ainsi que des facteurs de risque d’événements CV et de déclin fonctionnel à la suite d’une hémorragie, aidera à mettre en place des stratégies pour prévenir les hémorragies et les complications qui peuvent en découler.

Abstract Background Inflammatory bowel diseases (IBDs) are chronic gastrointestinal diseases that negatively affect the enjoyment of food and engagement in social and cultural gatherings. Such experiences may promote psychosocial challenges, an aspect of IBD often overlooked and under‐supported in clinical settings and research. Objectives This study explored the psychosocial experiences that young adults with IBD have with food via a qualitative patient‐led research process. Methods Trained patient researchers conducted this study by engaging peers via semi‐structured interviews and focus groups in a three‐step co‐design process. Participants (n = 9) identified the research topic (SET), explored the topic and identified emerging themes (COLLECT), refined themes and made recommendations for healthcare system change (REFLECT). Results Themes that emerged included: ‘Experimenting with Food’, ‘Evolution Over Time’, ‘Diet Changes are Emotional’ and ‘Role of Stigma’. Participants identified the significance and frustrations of repeated testing and experimenting with food compatibility, and noted nuances in food relationships as they gain knowledge and experience over time. They emphasized the importance of maintaining a sense of hope throughout and wished to impart this to newly diagnosed patients. Conclusion Participants experience numerous psychosocial challenges as they strive to manage their diet, noting gaps in support available from IBD practitioners. Participants made practical recommendations for healthcare system change to improve patient outcomes, highlighting the importance of sharing stories and collaboratively including patients in the development of new services and protocols. Authors recommend further research in this area to build a body of knowledge and support that helps IBD patients maintain hope while navigating challenges with food. Patient or Public Contribution The first four authors on this paper were the lead researchers in this study's design and analysis and identify as patients; they conducted the research with this identity at the forefront following a peer‐to‐peer research model. These authors were mentored by patient researchers who also contributed to the manuscript, and the research process itself was co‐lead and directed by other patient participants and consultants. Results and recommendations coming from this paper came directly from patient participants.

The purpose of this American Gastroenterological Association (AGA) Institute Clinical Practice Update (CPU) is to summarize the available evidence and offer expert Best Practice Advice on the integration of potassium-competitive acid blockers (P-CABs) in the clinical management of foregut disorders, specifically including gastroesophageal reflux disease, Helicobacter pylori infection, and peptic ulcer disease. This expert review was commissioned and approved by the AGA Institute Governing Board and CPU Committee to provide timely guidance on a topic of high clinical importance to the AGA membership. This CPU expert review underwent internal peer review by the CPU Committee and external peer review through the standard procedures of Gastroenterology. These Best Practice Advice statements were developed based on review of the published literature and expert consensus opinion. Because formal systematic reviews were not performed, these Best Practice Advice statements do not carry formal ratings of the quality of evidence or strength of the presented considerations. Best Practice Advice Statements Based on nonclinical factors (including cost, greater obstacles to obtaining medication, and fewer long-term safety data), clinicians should generally not use P-CABs as initial therapy for acid-related conditions in which clinical superiority has not been shown. Based on current costs in the United States, even modest clinical superiority of P-CABs over double-dose proton pump inhibitors (PPIs) may not make P-CABs cost-effective as first-line therapy. Clinicians should generally not use P-CABs as first-line therapy for patients with uninvestigated heartburn symptoms or nonerosive reflux disease. Clinicians may use P-CABs in selected patients with documented acid-related reflux who fail therapy with twice-daily PPIs. Although there is currently insufficient evidence for clinicians to use P-CABs as first-line on-demand therapy for patients with heartburn symptoms who have previously responded to antisecretory therapy, their rapid onset of acid inhibition raises the possibility of their utility in this population. Clinicians should generally not use P-CABs as first-line therapy in patients with milder erosive esophagitis (EE) (Los Angeles classification of erosive esophagitis grade A/B EE). Clinicians may use P-CABs in selected patients with documented acid-related reflux who fail therapy with twice-daily PPIs. Clinicians may use P-CABs as a therapeutic option for the healing and maintenance of healing in patients with more severe EE (Los Angeles classification of erosive esophagitis grade C/D EE). However, given the markedly higher costs of the P-CAB presently available in the United States and the lack of randomized comparisons with double-dose PPIs, it is not clear that the benefits in endoscopic outcomes over standard-dose PPIs justify the routine use of P-CABs as first-line therapy. Clinicians should use P-CABs in place of PPIs in eradication regimens for most patients with H pylori infection. Clinicians should generally not use P-CABs as first-line therapy in the treatment or prophylaxis of peptic ulcer disease. Although there is currently insufficient evidence for clinicians to use P-CABs as first-line therapy in patients with bleeding gastroduodenal ulcers and high-risk stigmata, their rapid and potent acid inhibition raises the possibility of their utility in this population. [ABSTRACT FROM AUTHOR]

Simulation and numerical analysis of physical phenomena, especially for the unsteady problems due to the dependency of the numerical algorithms on the computer hardware and the large number of computational nodes, are the most important problems. For these reasons, the number of computations and computational costs increase. The order reduction method is the one that has been widely used in recent years to reduce computational time. In this way, by reducing the constraints of the system without changing the inherent features of the problem, the computational efficiency will dramatically increase. In this study, using the basic concepts of dynamical systems, the thermal diffusion problem is investigated using the dynamic modes decomposition method. Then, a reduced order model is established for the related governing equation of this phenomenon. Accordingly, based on the projection of the governing equation in the vector space of modes, by using dynamic modes, a reduced order model is obtained with respect to the properties of dynamic modes. The obtained model to simulate the time evolution and parametric variations can be properly replaced with the original equation and predict the behavior of the system with very good accuracy. A comparison between the results of the present reduced order models and the simulations of the exact solution shows high computation accuracy.

Jelena Popov,1,2 Yasamin Farbod,1 Usha Chauhan,1 Mona Kalantar,1,2 Lee Hill,3 David Armstrong,4 Smita Halder,4 John K Marshall,4 Paul Moayyedi,4 Sharon Kaasalainen5 1Hamilton Health Sciences, Adult Digestive Diseases, Hamilton, Ontario, Canada; 2University College Cork, College of Medicine and Health, Cork, Ireland; 3Department of Pediatrics, McMaster University Medical Centre, Hamilton, Ontario, Canada; 4Department of Medicine (Division of Gastroenterology) and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada; 5School of Nursing, McMaster University, Hamilton, Ontario, CanadaCorrespondence: Jelena PopovHamilton Health Sciences, Adult Digestive Diseases, 1280 Main Street West, HSC 3N51H, Ontario, L8S 4K1, CanadaTel +1-905-521-2100 ext. 73543Fax +1-905-570-8962Email popovj2@mcmaster.caPurpose: Inflammatory bowel disease (IBD) significantly impacts patients’ quality of life and imposes a considerable psychological, social, and financial burden. While the relationship between disease activity and quality of life is well established, the subjective challenges of living with IBD are more difficult to assess, and suggestions for improving patient experiences are lacking. The aim of this paper was to explore the various challenges patients encounter in living with IBD and to propose suggestions for overcoming them.Patients and Methods: This study utilized a qualitative descriptive design with thematic content analysis. Patients were recruited from the Gastroenterology Clinic at McMaster University Medical Centre from December 2014 to April 2015. Data were collected over the course of 5 focus group interviews using a semi-structured interview guide.Results: Seventeen patients aged 25 to 77 years old (mean age 43 years, SD 17 years) were interviewed. Fifteen patients were diagnosed with Crohn’s disease and 2 patients were diagnosed with ulcerative colitis. Findings were categorized into 18 subthemes which were grouped into 4 broader themes: awareness factor, psychosocial impacts, financial burden, and quality of care.Conclusion: IBD is associated with complex personal challenges across various demographics. Identifying and meeting the unique needs of individual patients may be achieved through improving communication between patients and their healthcare providers. Family-based education approaches, individualized psychotherapy with therapists familiar with IBD, awareness initiatives addressed to important stakeholders, and patient involvement in community support groups may improve overall IBD care.Keywords: Crohn’s disease, ulcerative colitis, qualitative, patient burden, psychosocial, quality of care

Abstract Background Genetic analyses have identified many variants associated with the risk of inflammatory bowel disease (IBD) development. Among these variants, the ones located within the NOD2 gene have the highest odds ratio of all IBD genetic risk variants. Also, patients with Crohn’s disease (CD) have been shown to have an altered gut microbiome, which might be a reflection of inflammation itself or an effect of other parameters that contribute to the risk of the disease. Since NOD2 is an intracellular pattern recognition receptor that senses bacterial peptidoglycan in the cytosol and stimulates the host immune response (Al Nabhani et al., PLoS Pathog 13:e1006177, 2017), it is hypothesized that NOD2 variants represent perfect candidates for influencing host-microbiome interactions. We hypothesized that NOD2 risk variants affect the microbiome composition of healthy first degree relative (FDR) of CD patients and thus potentially contribute to an altered microbiome state before disease onset. Methods Based on this, we studied a large cohort of 1546 healthy FDR of CD patients and performed a focused analysis of the association of three major CD SNPs in the coding region of the NOD2 gene, which are known to confer a 15–40-fold increased risk of developing CD in homozygous or compound heterozygous individuals. Results Our results show that carriers of the C allele at rs2066845 was significantly associated with an increase in relative abundance in the fecal bacterial family Erysipelotrichaceae. Conclusions This result suggests that NOD2 polymorphisms contribute to fecal microbiome composition in asymptomatic individuals. Whether this modulation of the microbiome influences the future development of CD remains to be assessed.

Accumulation of consumable or produced materials in out-door areas and exposed to the airflow is an important issue of environmental concern. Also, wind erosion of raw materials from the storage piles in some industries causes environmental problems and economic consequences. The materials are accumulated in various volumetric shapes in an outdoor environment, which is usually pyramidal and conical. The subject of this study is about the percentage of wind erosion from the surface of the pile and the intensity of the particle deposition due to the free-stream flow passing through the various points of the pile’s surface. In this research, the wind erosion or in other words, the movement and deposition of particles from the surface of the pile have been discussed. So, a comparison between the piles with different shapes has been performed according to the reduction of wind erosion. So, a comparison between the piles with different shapes has been performed according to the reduction of wind erosion.

In this article, an improved reduced order modelling approach, based on the proper orthogonal decomposition (POD) method, is presented. After projecting the governing equations of flow dynamics along the POD modes, a dynamical system was obtained. Normally, the classical reduced order models do not predict accurate time variations of flow variables due to some reasons. The response of the dynamical system was improved using a calibration method based on a least-square optimization process. The calibration polynomial can be assumed as the pressure correction term which is vanished in projecting the Navier-Stokes equations along the POD modes. The above least- square procedure is a combination of POD method and the solution of an optimization problem. The obtained model can predict accurate time variations of flow field with high speed. For long time periods, the calibration term can be computed using a combined form of POD and Fourier modes. This extension is a totally new extension to this procedure which has recently been proposed by the authors. The results obtained from the calibrated reduced order model show close agreements to the benchmark DNS data, proving high accuracy of our model.

Introduction Gut microbiome and diet may be important in irritable bowel syndrome (IBS), inflammatory bowel disease (IBD) and comorbid psychiatric conditions, but the mechanisms are unclear. We will create a large cohort of patients with IBS, IBD and healthy controls, and follow them over time, collecting dietary and mental health information and biological samples, to assess their gastrointestinal (GI) and psychological symptoms in association with their diet, gut microbiome and metabolome.Methods and analysis This 5-year observational prospective cohort study is recruiting 8000 participants from 15 Canadian centres. Persons with IBS who are 13 years of age and older or IBD ≥5 years will be recruited. Healthy controls will be recruited from the general public and from friends or relatives of those with IBD or IBS who do not have GI symptoms. Participants answer surveys and provide blood, urine and stool samples annually. Surveys assess disease activity, quality of life, physical pain, lifestyle factors, psychological status and diet. The main outcomes evaluated will be the association between the diet, inflammatory, genetic, microbiome and metabolomic profiles in those with IBD and IBS compared with healthy controls using multivariate logistic regression. We will also compare these profiles in those with active versus quiescent disease and those with and without psychological comorbidity.Ethics and dissemination Approval has been obtained from the institutional review boards of all centres taking part in the study. We will develop evidence-based knowledge translation initiatives for patients, clinicians and policymakers to disseminate results to relevant stakeholders.Trial registration number: NCT03131414

In the present work, two low-dimensional models are presented and used for vibration simulation of the linear and non-linear beam models. These models help to compute the dynamical responses of the beam with fast computation speed and under the effects of different conditions. Also the obtained results can be used in the conceptual and detailed design stages of an engineering system overall design. First, a finite element analysis based on Euler-Bernoulli beam elements with two primary variables (deflection and slope) at each node is used to find static and dynamic responses of the considered linear and non-linear beams. Responses to three different static load cases are obtained and applying them as initial conditions, the time responses of the beam are calculated by the Newmark's time approximation scheme. A low-dimensional POD model which was extracted from the ensemble under the effect of an arbitrary loading is reconstructed. To apply the model to simulate the response of beam under the effect of other loads, POD modal coefficients are updated due to change of initial condition. This modification is performed based on the recalculation of the eigenvalues due to a new initial condition. Also, another low-dimensional model is constructed which is developed based on an ensemble under the effect of several parameters. To apply the model to simulate the response of the beam under the effect of other loads and variations of beam thickness, POD-HOSVD modal coefficients are updated due to the change of desired parameters. The results obtained from the low-dimensional model are showing good agreement to the benchmark data and proving high level accuracy of the model.

Electrospraying, freeze and spray drying were used to microencapsulate Lactobacillus rhamnosus ATCC 7469 in whey protein isolate (WPI), whey protein isolate + inulin (WPI + IN) or whey protein isolate + inulin + Persian gum (WPI + IN + PG) matrixes. Physical properties, survivability, cell injuries and resistance to simulated gastrointestinal condition of L. rhamnosus ATCC 7469 microcapsules were examined. Cell damage evaluation showed that electrospray was more injurious to L. rhamnosus ATCC 7469 cells in comparison with other two methods, also Persian gum had the most protecting effect against cell damaging agents. The viability of encapsulated cells decreased from 10.60-10.97 log cfu/g in the first week to 8.72–10.78 log cfu/g in the last week of storage. Freeze drying and electrospraying showed the lowest and highest loss in cell survival during storage, respectively. Results showed the superiority of freeze-dried microcapsules to prolong L. rhamnosus ATCC 7469 survival when exposed to digestive system conditions.

Abstract Background Probiotics are living microorganisms that, when administered in adequate amounts, confer a health benefit. It has been speculated that probiotics might help prevent preterm birth, but in two previous systematic reviews possible major increases in this risk have been suggested. Our objective was to perform a systematic review and meta-analysis of the risk of preterm birth and other adverse pregnancy outcomes in pregnant women taking probiotics, prebiotics or synbiotics. Methods We searched six electronic databases (MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, Web of Science’s Core collection and BIOSIS Preview) up to September 2016 and contacted authors for additional data. We included randomized controlled trials in which women with a singleton pregnancy received a probiotic, prebiotic or synbiotic intervention. Two independent reviewers extracted data using a piloted form and assessed the risk of bias using the Cochrane risk of bias tool. We used random-effects meta-analyses to pool the results. Results We identified 2574 publications, screened 1449 non-duplicate titles and abstracts and read 160 full text articles. The 49 publications that met our inclusion criteria represented 27 studies. No study used synbiotics, one used prebiotics and the rest used probiotics. Being randomized to take probiotics during pregnancy neither increased nor decreased the risk of preterm birth

I‌n t‌h‌i‌s s‌t‌u‌d‌y, a n‌u‌m‌e‌r‌i‌c‌a‌l a‌p‌p‌r‌o‌a‌c‌h a‌n‌d a r‌e‌d‌u‌c‌e‌d o‌r‌d‌e‌r m‌o‌d‌e‌l b‌a‌s‌e‌d o‌n P‌O‌D m‌e‌t‌h‌o‌d a‌r‌e d‌e‌v‌e‌l‌o‌p‌e‌d f‌o‌r s‌i‌m‌u‌l‌a‌t‌i‌o‌n o‌f t‌h‌e f‌l‌u‌i‌d f‌l‌o‌w a‌n‌d m‌a‌s‌s t‌r‌a‌n‌s‌f‌e‌r. T‌h‌e f‌l‌o‌w f‌i‌e‌l‌d i‌s u‌n‌d‌e‌r t‌h‌e e‌f‌f‌e‌c‌t‌s o‌f t‌e‌m‌p‌e‌r‌a‌t‌u‌r‌e g‌r‌a‌d‌i‌e‌n‌t‌s a‌s‌s‌o‌c‌i‌a‌t‌e‌d w‌i‌t‌h c‌o‌n‌t‌a‌m‌i‌n‌a‌n‌t t‌r‌a‌n‌s‌p‌o‌r‌t. F‌o‌r t‌h‌i‌s p‌u‌r‌p‌o‌s‌e, u‌n‌s‌t‌e‌a‌d‌y i‌n‌c‌o‌m‌p‌r‌e‌s‌s‌i‌b‌l‌e N‌a‌v‌i‌e‌r-S‌t‌o‌k‌e‌s e‌q‌u‌a‌t‌i‌o‌n‌s w‌i‌t‌h t‌e‌r‌m‌s o‌f e‌f‌f‌e‌c‌t‌s o‌f b‌u‌o‌y‌a‌n‌c‌y f‌o‌r‌c‌e‌s, u‌n‌s‌t‌e‌a‌d‌y h‌e‌a‌t t‌r‌a‌n‌s‌f‌e‌r, a‌n‌d c‌o‌n‌c‌e‌n‌t‌r‌a‌t‌i‌o‌n‌s t‌r‌a‌n‌s‌p‌o‌r‌t e‌q‌u‌a‌t‌i‌o‌n‌s w‌e‌r‌e s‌o‌l‌v‌e‌d s‌i‌m‌u‌l‌t‌a‌n‌e‌o‌u‌s‌l‌y u‌s‌i‌n‌g n‌u‌m‌e‌r‌i‌c‌a‌l m‌e‌t‌h‌o‌d. I‌n o‌r‌d‌e‌r t‌o d‌i‌s‌c‌r‌e‌a‌t‌i‌z‌e t‌h‌e s‌p‌a‌t‌i‌a‌l t‌e‌r‌m‌s, t‌h‌e s‌e‌c‌o‌n‌d-o‌r‌d‌e‌r c‌e‌n‌t‌r‌a‌l d‌i‌f‌f‌e‌r‌e‌n‌c‌e m‌e‌t‌h‌o‌d w‌a‌s u‌s‌e‌d a‌n‌d t‌h‌e t‌i‌m‌e i‌n‌t‌e‌g‌r‌a‌t‌i‌o‌n w‌a‌s p‌e‌r‌f‌o‌r‌m‌e‌d u‌s‌i‌n‌g R‌u‌n‌g‌e-K‌u‌t‌t‌a f‌o‌u‌r‌t‌h-o‌r‌d‌e‌r a‌p‌p‌r‌o‌a‌c‌h. T‌h‌e r‌e‌q‌u‌i‌r‌e‌d s‌n‌a‌p‌s‌h‌o‌t‌s f‌o‌r r‌e‌c‌o‌n‌s‌t‌r‌u‌c‌t‌i‌o‌n o‌f d‌y‌n‌a‌m‌i‌c‌a‌l s‌y‌s‌t‌e‌m w‌e‌r‌e c‌a‌l‌c‌u‌l‌a‌t‌e‌d u‌s‌i‌n‌g t‌h‌e n‌u‌m‌e‌r‌i‌c‌a‌l s‌i‌m‌u‌l‌a‌t‌i‌o‌n d‌a‌t‌a. F‌i‌r‌s‌t‌l‌y, t‌h‌e C‌F‌D m‌o‌d‌e‌l w‌a‌s i‌n‌c‌o‌r‌p‌o‌r‌a‌t‌e‌d f‌o‌r s‌i‌m‌u‌l‌a‌t‌i‌o‌n o‌f a c‌l‌a‌s‌s‌i‌c f‌l‌u‌i‌d m‌e‌c‌h‌a‌n‌i‌c‌s p‌r‌o‌b‌l‌e‌m, s‌u‌c‌h a‌s c‌a‌v‌i‌t‌y f‌l‌o‌w, f‌o‌r v‌a‌l‌i‌d‌a‌t‌i‌n‌g i‌t‌s a‌c‌c‌u‌r‌a‌c‌y. T‌h‌e‌n, t‌h‌e d‌e‌v‌e‌l‌o‌p‌e‌d c‌o‌m‌p‌u‌t‌e‌r c‌o‌d‌e w‌a‌s a‌p‌p‌l‌i‌e‌d f‌o‌r s‌i‌m‌u‌l‌a‌t‌i‌o‌n o‌f n‌a‌t‌u‌r‌a‌l c‌o‌n‌v‌e‌c‌t‌i‌o‌n a‌n‌d m‌a‌s‌s t‌r‌a‌n‌s‌f‌e‌r i‌n a b‌o‌u‌n‌d‌e‌d d‌o‌m‌a‌i‌n u‌n‌d‌e‌r s‌p‌e‌c‌i‌f‌i‌e‌d b‌o‌u‌n‌d‌a‌r‌y c‌o‌n‌d‌i‌t‌i‌o‌n‌s. I‌n o‌r‌d‌e‌r t‌o c‌o‌n‌s‌t‌r‌u‌c‌t t‌h‌e r‌e‌d‌u‌c‌e‌d o‌r‌d‌e‌r m‌o‌d‌e‌l, b‌a‌s‌e‌d o‌n t‌h‌e c‌o‌n‌c‌e‌p‌t o‌f d‌y‌n‌a‌m‌i‌c‌a‌l s‌y‌s‌t‌e‌m a‌n‌d p‌r‌o‌j‌e‌c‌t‌i‌o‌n a‌p‌p‌r‌o‌a‌c‌h, m‌o‌m‌e‌n‌t‌u‌m a‌n‌d c‌o‌n‌c‌e‌n‌t‌r‌a‌t‌i‌o‌n t‌r‌a‌n‌s‌p‌o‌r‌t e‌q‌u‌a‌t‌i‌o‌n‌s w‌e‌r‌e p‌r‌o‌j‌e‌c‌t‌e‌d a‌l‌o‌n‌g P‌O‌D m‌o‌d‌e‌s. M‌o‌r‌e‌o‌v‌e‌r, f‌o‌r m‌o‌d‌e‌l‌i‌n‌g t‌h‌e d‌y‌n‌a‌m‌i‌c‌s o‌f f‌l‌o‌w f‌i‌e‌l‌d, v‌e‌l‌o‌c‌i‌t‌y f‌i‌e‌l‌d a‌n‌d c‌o‌n‌c‌e‌n‌t‌r‌a‌t‌i‌o‌n t‌r‌a‌n‌s‌p‌o‌r‌t d‌y‌n‌a‌m‌i‌c‌a‌l s‌y‌s‌t‌e‌m e‌q‌u‌a‌t‌i‌o‌n‌s w‌e‌r‌e s‌o‌l‌v‌e‌d f‌o‌r r‌e‌l‌a‌t‌e‌d m‌o‌d‌a‌l c‌o‌e‌f‌f‌i‌c‌i‌e‌n‌t‌s v‌a‌r‌i‌a‌t‌i‌o‌n‌s. F‌o‌r s‌i‌m‌u‌l‌a‌t‌i‌o‌n o‌f h‌e‌a‌t t‌r‌a‌n‌s‌f‌e‌r, t‌e‌m‌p‌e‌r‌a‌t‌u‌r‌e f‌i‌e‌l‌d m‌o‌d‌e‌s w‌e‌r‌e c‌o‌m‌p‌u‌t‌e‌d a‌c‌c‌o‌r‌d‌i‌n‌g t‌o t‌h‌e m‌o‌d‌a‌l c‌o‌e‌f‌f‌i‌c‌i‌e‌n‌t‌s o‌f c‌o‌n‌c‌e‌n‌t‌r‌a‌t‌i‌o‌n f‌i‌e‌l‌d. T‌h‌e s‌p‌e‌c‌i‌a‌l a‌c‌h‌i‌e‌v‌e‌m‌e‌n‌t o‌f t‌h‌i‌s r‌e‌s‌e‌a‌r‌c‌h w‌o‌u‌l‌d b‌e r‌e‌d‌u‌c‌t‌i‌o‌n i‌n t‌h‌e n‌u‌m‌b‌e‌r o‌f e‌q‌u‌a‌t‌i‌o‌n‌s r‌e‌q‌u‌i‌r‌e‌d t‌o s‌i‌m‌u‌l‌a‌t‌e t‌h‌e d‌y‌n‌a‌m‌i‌c o‌f t‌h‌e f‌l‌o‌w f‌i‌e‌l‌d. B‌a‌s‌e‌d o‌n P‌O‌D m‌o‌d‌e‌s e‌n‌e‌r‌g‌y l‌e‌v‌e‌l r‌e‌s‌u‌l‌t‌s i‌n a h‌i‌g‌h‌e‌r l‌e‌v‌e‌l o‌f c‌a‌p‌t‌u‌r‌e‌d k‌i‌n‌e‌t‌i‌c e‌n‌e‌r‌g‌y o‌f f‌l‌o‌w f‌i‌e‌l‌d w‌h‌e‌n u‌s‌i‌n‌g a s‌m‌a‌l‌l‌e‌r n‌u‌m‌b‌e‌r o‌f m‌o‌d‌e‌s. T‌h‌i‌s m‌e‌a‌n‌s t‌h‌a‌t b‌y t‌h‌e d‌e‌s‌c‌r‌i‌b‌e‌d m‌e‌t‌h‌o‌d a r‌e‌d‌u‌c‌e‌d o‌r‌d‌e‌r m‌o‌d‌e‌l c‌a‌n b‌e o‌b‌t‌a‌i‌n‌e‌d. T‌h‌e p‌r‌o‌p‌o‌s‌e‌d m‌o‌d‌e‌l h‌a‌s t‌h‌e a‌b‌i‌l‌i‌t‌y t‌o s‌i‌m‌u‌l‌a‌t‌e t‌h‌e f‌l‌o‌w a‌n‌d c‌o‌n‌t‌a‌m‌i‌n‌a‌n‌t t‌r‌a‌n‌s‌p‌o‌r‌t w‌i‌t‌h h‌i‌g‌h‌e‌r s‌p‌e‌e‌d o‌f c‌o‌m‌p‌u‌t‌a‌t‌i‌o‌n‌s. T‌h‌e r‌e‌s‌u‌l‌t‌s o‌f t‌h‌e r‌e‌d‌u‌c‌e‌d m‌o‌d‌e‌l w‌e‌r‌e c‌o‌m‌p‌a‌r‌e‌d w‌i‌t‌h t‌h‌e d‌a‌t‌a o‌b‌t‌a‌i‌n‌e‌d f‌r‌o‌m n‌u‌m‌e‌r‌i‌c‌a‌l m‌o‌d‌e‌l a‌n‌d t‌h‌e a‌c‌c‌u‌r‌a‌c‌y a‌n‌d t‌h‌e a‌b‌i‌l‌i‌t‌y o‌f t‌h‌e d‌e‌v‌e‌l‌o‌p‌e‌d m‌o‌d‌e‌l h‌a‌v‌e b‌e‌e‌n v‌a‌l‌i‌d‌a‌t‌e‌d.

Aim of this investigation is comparison of mass transfer artificial neural network (ANN) and mathematical model to prediction of carbon dioxide concentration in the exhaust air from the constructed module using glycol-amine liquid membrane. For solving of problem with ANN, command prompt function in Mathlab software was used with following instruction. First, input vector and targets are loaded in Mathlab current directory and a feed-forward tangent sigmoid transfer function in hidden layers and a linear transfer function in output layer was used. Then, the network was trained and LevenbergâMarquardt algorithm was used as training function. For this purpose, 74 input data inclusive input air pressure, input air flow rate, recovery value of CO2 in process was used. The CO2 mole fraction in output air was selected as target. Experimental data was divided in three sectors: 70% for training data, 15% for validation data and 15% for testing network. The optimum number of neurons in the hidden layer network obtained with using try and error method and the best performance of network achieved with four neurons in the hidden layer. Also, the best available models was used to predict mass transfer in liquid membranes, and exponential behavior was seen in modeling of permeating CO2 from membrane. The results of the ANN model were compared with the experimental results and this results were shown that the neural network has great ability to predict values. R-Value for mathematical model obtained 0.9839. Also, R-Value for network training, validation and testing was 0.9899, 0.9910 and 0.9975, respectively. Also, overalls R-Value was 0.9899 that proved a very good validation. Â

Some probiotics may be beneficial in irritable bowel syndrome (IBS), but differences in species and strains used, as well as endpoints reported, have hampered attempts to make specific recommendations as to which should be preferred. We updated our previous meta-analysis examining this issue. MEDLINE, EMBASE, and the Cochrane Controlled Trials Register were searched (up to March 2023). Randomized controlled trials (RCTs) recruiting adults with IBS, comparing probiotics with placebo were eligible. Dichotomous symptom data were pooled to obtain a relative risk of global symptoms, abdominal pain, or abdominal bloating or distension persisting after therapy, with a 95% confidence interval (CI). Continuous data were pooled using a standardized mean difference with a 95% CI. Adverse events data were also pooled. We identified 82 eligible trials, containing 10,332 patients. Only 24 RCTs were at low risk of bias across all domains. For global symptoms, there was moderate certainty in the evidence for a benefit of Escherichia strains, low certainty for Lactobacillus strains and Lactobacillus plantarum 299V, and very low certainty for combination probiotics, LacClean Gold S, Duolac 7s, and Bacillus strains. For abdominal pain, there was low certainty in the evidence for a benefit of Saccharomyces cerevisae I-3856 and Bifidobacterium strains, and very low certainty for combination probiotics, Lactobacillus , Saccharomyces , and Bacillus strains. For abdominal bloating or distension there was very low certainty in the evidence for a benefit of combination probiotics and Bacillus strains. The relative risk of experiencing any adverse event, in 55 trials, including more than 7000 patients, was not significantly higher with probiotics. Some combinations of probiotics or strains may be beneficial in IBS. However, certainty in the evidence for efficacy by GRADE criteria was low to very low across almost all of our analyses. We studied the efficacy of probiotics for irritable bowel syndrome. There was some evidence of efficacy, but the quality of the trials included makes it hard to draw definitive conclusions. Future trials should be more rigorous and could focus on potentially effective strains or species from this meta-analysis. [ABSTRACT FROM AUTHOR]

The response of bridges to abnormal loads have always been significant in structural engineering, especially in progressive collapse analysis. In this paper, the performance of bridges, undergoing progressive collapse, with and without isolator is investigated. Nonlinear time history analysis is used to obtain maximum responses of the structure by considering two different damage scenarios. In the first scenario, it is supposed that the side column of the bridge is collapsed and therefore is detached from the structure while in the second one, the middle column is removed. Accordingly, several models with rubber-sliding isolators, designed according to AASHTO standards are analyzed using OpenSees software. Moreover, the friction parameter of the isolator is considered as a variable in terms of the sliding velocity and acting vertical load. Results show that isolator yield doesn’t occur in both scenarios and subsequently the sliding of the bridge deck is not observed. However, a permanent displacement in the first scenario is detected because of instability of the bridge deck. It can also be noted that in most cases, using seismic isolators results in the growth of the maximum responses.

Simultaneous pressure waves (SPWs) in manometry recordings of the human colon have been associated with gas expulsion. Our hypothesis was that the SPW might be a critical component of most colonic motor functions, and hence might act as a biomarker for healthy colon motility. To that end, we performed high-resolution colonic manometry (HRCM), for the first time using an 84-sensor (1 cm spaced) water-perfused catheter, in 17 healthy volunteers. Intraluminal pressure patterns were recorded during baseline, proximal and rectal balloon distention, after a meal and following proximal and rectal luminal bisacodyl administration. Quantification was performed using software, based on Image J, developed during this study. Gas expulsion was always associated with SPWs, furthermore, SPWs were associated with water or balloon expulsion. SPWs were prominently emerging at the termination of proximal high amplitude propagating pressure waves (HAPWs); we termed this motor pattern HAPW-SPWs; hence, SPWs were often not a pan-colonic event. SPWs and HAPW-SPWs were observed at baseline with SPW amplitudes of 12.0 ± 8.5 mmHg and 20.2 ± 7.2 mmHg respectively. The SPW occurrence and amplitude significantly increased in response to meal, balloon distention and luminal bisacodyl, associated with 50.3% anal sphincter relaxation at baseline, which significantly increased to 59.0% after a meal, and 69.1% after bisacodyl. Often, full relaxation was achieved. The SPWs associated with gas expulsion had a significantly higher amplitude compared to SPWs without gas expulsion. SPWs could be seen to consist of clusters of high frequency pressure waves, likely associated with a cluster of fast propagating, circular muscle contractions. SPWs were occasionally observed in a highly rhythmic pattern at 1.8 ± 1.2 cycles/min. Unlike HAPWs, the SPWs did not obliterate haustral boundaries thereby explaining how gas can be expelled while solid content can remain restrained by the haustral boundaries. In conclusion, the SPW may become a biomarker for normal gas transit, the gastrocolonic reflex and extrinsic neural reflexes. The SPW assessment reveals coordination of activities in the colon, rectum and anal sphincters. SPWs may become of diagnostic value in patients with colonic dysmotility.

Celiac disease affects 1% of the North American population, with an estimated 350,000 Canadians diagnosed with this condition. The disease is triggered by the ingestion of gluten, and a lifelong, strict gluten-free diet (GFD) is the only currently available treatment. Compliance with a strict GFD is essential not only for intestinal mucosal recovery and alleviation of symptoms, but also for the prevention of complications such as anemia, osteoporotic fractures and small bowel lymphoma. However, a GFD is difficult to follow, socially inconvenient and expensive. Different approaches, such as tax reduction, cash transfer, food provision, prescription and subsidy, have been used to reduce the additional costs of the GFD to patients with celiac disease. The current review showed that the systems in place exhibit particular advantages and disadvantages in relation to promoting uptake and compliance with GFD. The tax offset system used in Canada for GFD coverage takes the form of a reimbursement of a cost previously incurred. Hence, the program does not help celiac patients meet the incremental cost of the GFD – it simply provides some future refund of that cost. An ideal balanced approach would involve subsidizing gluten-free products through controlled vouchers or direct food provision to those who most need it, independently of ‘ability or willingness to pay’. Moreover, if the cost of such a program is inhibitive, the value of the benefits could be made taxable to ensure that any patient contribution, in terms of additional taxation, is directly related to ability to pay. The limited coverage of GFD in Canada is concerning. There is an unmet need for GFD among celiac patients in Canada. More efforts are required by the Canadian medical community and the Canadian Celiac Association to act as agents in identifying ways of improving resource allocation in celiac disease.

The cause of Crohn's disease (CD) is unknown, but the current hypothesis is that microbial or environmental factors induce gut inflammation in genetically susceptible individuals, leading to chronic intestinal inflammation. Case-control studies of patients with CD have cataloged alterations in the gut microbiome composition; however, these studies fail to distinguish whether the altered gut microbiome composition is associated with initiation of CD or is the result of inflammation or drug treatment. In this prospective cohort study, 3483 healthy first-degree relatives (FDRs) of patients with CD were recruited to identify the gut microbiome composition that precedes the onset of CD and to what extent this composition predicts the risk of developing CD. We applied a machine learning approach to the analysis of the gut microbiome composition (based on 16S ribosomal RNA sequencing) to define a microbial signature that associates with future development of CD. The performance of the model was assessed in an independent validation cohort. In the validation cohort, the microbiome risk score (MRS) model yielded a hazard ratio of 2.24 (95% confidence interval, 1.03-4.84; P =.04), using the median of the MRS from the discovery cohort as the threshold. The MRS demonstrated a temporal validity by capturing individuals that developed CD up to 5 years before disease onset (area under the curve > 0.65). The 5 most important taxa contributing to the MRS included Ruminococcus torques , Blautia , Colidextribacter , an uncultured genus-level group from Oscillospiraceae , and Roseburia. This study is the first to demonstrate that gut microbiome composition is associated with future onset of CD and suggests that gut microbiome is a contributor in the pathogenesis of CD. Gut microbiome composition, function, and stool metabolites can identify those more likely to develop Crohn's disease in a cohort of healthy first-degree relatives of patients with Crohn's disease. [ABSTRACT FROM AUTHOR]

Constructing phase diagram and its subsequent quality lines for lean gas condensate reservoirs is always crucial and challenging topic in reservoir fluid studies. Due to small amounts of liquid drop-outs in lean gas condensates at reservoir conditions, full experimental tracking of phase diagram and its relevant quality lines is almost impossible for lean gas condensates.On the other hand, EOS models of reservoir fluid characterization softwares are always unable to estimate condensed liquid drop-outs at different pressures and temperatures precisely. This study aims to present a commingled experimental-simulation method which was designed to pinpoint and keep track full phase diagram with correspondent quality lines for a lean gas condensate fluid.

Background: Large amounts of information have called for increased computational complexity. Data dimension reduction is therefore critical to preliminary analysis. In this research, four variable selection (VS) methods are compared to obtain the important variables in predicting the prognosis of traumatic brain injury (TBI) patients. Materials and Methods: In a retrospective follow-up study, 741 TBI patients who were hospitalized for at least 2 days and had a Glasgow Coma Scale score of at least one were followed. Their clinical data recorded during intensive care unit (ICU) admission and eight-category extended GOS conditions 6 months after discharge were utilized here. Two filter- and two wrapper-based VS methods were applied for comparison. A support vector machine (SVM) classifier was then used, and the sensitivity, specificity, accuracy, and the area under the receiver characteristic curve (AUC) values were calculated. Results: Theoretically, the variables selected by sequential forward selection (SFS) method would better predict the prognosis (AUC = 0.737, 95% confidence interval [0.701, 0.772], specificity = 89.2%, sensitivity = 58.9% and accuracy = 79.1%) than the others. Genetic algorithm (GA), minimum redundancy maximum relevance (MRMR), and mutual information method were in the next orders, respectively. Conclusion: The use of an SVM classifier on optimal subsets given by GA and SFS reveals that wrapper-based methods perform better than filter-based methods in our data set, although all selected subsets, except for the MRMR, were clinically accepted. In addition, for prognosis prediction of TBI patients, a small subset of clinical records during ICU admission is enough to achieve an accepted accuracy.