Search

Abstract. Introduction:. Care and outcomes for patients with chronic low back pain (cLBP) are influenced by the social risk factors that they experience. Social risk factors such as food insecurity and housing instability have detrimental effects on patient health and wellness, healthcare outcomes, and health disparities. Objectives:. This retrospective cross-sectional study examined how social risk factors identified in unstructured and structured electronic health record (EHR) data for 1,295 patients with cLBP were associated with health care utilization. We also studied the impact of social risk factors, controlling for back pain–related disability on health care utilization. Methods:. Included patients who received outpatient spine and/or physical therapy services at an urban academic medical center between 2018 and 2020. Five identified social risks were financial insecurity, housing instability, food insecurity, transportation barriers, and social isolation. Outcomes included 4 categories of health care utilization: emergency department (ED) visits/hospitalizations, imaging, outpatient specialty visits related to spine care, and physical therapy (PT) visits. Poisson regression models tested associations between the presence of identified social risks and each outcome measure. Results:. Identified social risks in 12.8% of the study population (N = 166/1,295). In multivariate models, social isolation was positively associated with imaging, specialty visits, and PT visits; housing instability was positively associated with ED visits/hospitalizations and imaging; food insecurity was positively associated with ED visits/hospitalizations and specialty visits but negatively associated with PT visits; and financial strain was positively associated with PT visits but negatively associated with ED visits/hospitalization. Conclusion:. These associations were seen above and beyond other factors used as markers of socioeconomic marginalization, including neighborhood-level social determinants of health, race/ethnicity, and insurance type. Identifying and intervening on social risk factors that patients with cLBP experience may improve outcomes and be cost-saving.

Abstract Background Despite efforts to view electronic health records (EHR) data through an equity lens, crucial contextual information regarding patients’ social environments remains limited. Integrating EHR data and Geographic Information Systems (GIS) technology can give deeper insights into the relationships between patients’ social environments, health outcomes, and geographic factors. This study aims to identify regions with the fastest and slowest access to outpatient physical therapy services using bivariate choropleth maps to provide contextual insights that may contribute to health disparity in access. Methods This was a retrospective cohort study of patients’ access timelines for the first visit to outpatient physical therapy services (n = 10,363). The three timelines evaluated were (1) referral-to-scheduled appointment time, (2) scheduled appointment to first visit time, and (3) referral to first visit time. Hot and coldspot analyses (CI 95%) determined the fastest and slowest access times with patient-level characteristics and bivariate choropleth maps that were developed to visualize associations between access patterns and disadvantaged areas using Area Deprivation Index scores. Data were collected between January 1, 2016 and January 1, 2020. EHR data were geocoded via GIS technology to calculate geospatial statistics (G i ∗ statistic from ArcGIS Pro) in an urban area. Results Statistically significant differences were found for all three access timelines between coldspot (i.e., fast access group) and hotspot (i.e., slow access group) comparisons (p

BackgroundChronic shoulder pain (CSP) is a common condition with various etiologies, including rotator cuff disorders, adhesive capsulitis, shoulder instability, and shoulder arthritis. It is associated with substantial disability and psychological distress, resulting in poor productivity and quality of life. Physical therapy constitutes the mainstay treatment for CSP, but several barriers exist in accessing care. In recent years, telerehabilitation has gained momentum as a potential solution to overcome such barriers. It has shown numerous benefits, including improving access and convenience, promoting patient adherence, and reducing costs. However, to date, no previous randomized controlled trial has compared fully remote digital physical therapy to in-person rehabilitation for nonoperative CSP. ObjectiveThe aim of this study is to compare clinical outcomes between digital physical therapy and conventional in-person physical therapy in patients with CSP. MethodsWe conducted a single-center, parallel-group, randomized controlled trial involving 82 patients with CSP referred for outpatient physical therapy. Participants were randomized into digital or conventional physical therapy (8-week interventions). The digital intervention consisted of home exercise, education, and cognitive behavioral therapy (CBT), using a device with movement digitalization for biofeedback and asynchronous physical therapist monitoring through a cloud-based portal. The conventional group received in-person physical therapy, including exercises, manual therapy, education, and CBT. The primary outcome was the change (baseline to 8 weeks) in function and symptoms using the short-form of Disabilities of the Arm, Shoulder, and Hand questionnaire. Secondary outcome measures included self-reported pain, surgery intent, analgesic intake, mental health, engagement, and satisfaction. All questionnaires were delivered electronically. ResultsA total of 90 participants were randomized into digital or conventional physical therapy, with 82 receiving the allocated intervention. Both groups experienced significant improvements in function measured by the short-form of the Disabilities of the Arm, Shoulder, and Hand questionnaire, with no differences between groups (–1.8, 95% CI –13.5 to 9.8; P=.75). For secondary outcomes, no differences were observed in surgery intent, analgesic intake, and mental health or worst pain. Higher reductions were observed in average and least pain in the conventional group, which, given the small effect sizes (least pain 0.15 and average pain 0.16), are unlikely to be clinically meaningful. High adherence and satisfaction were observed in both groups, with no adverse events. ConclusionsThis study shows that fully remote digital programs can be viable care delivery models for CSP given their scalability and effectiveness, assessed through comparison with high-dosage in-person rehabilitation. Trial RegistrationClinicalTrials.gov (NCT04636528); https://clinicaltrials.gov/study/NCT04636528

Dysregulated protein synthesis is key contributor to Fragile X syndrome. Here the authors identify a relationship between ribosome expression and the translation of long mRNAs that contributes to synaptic weakening in a model of Fragile X syndrome.

Abstract Background Although evidence-based guidelines for physical therapy for patients with chronic low back pain (cLBP) are available, selecting patient-reported outcome measures to capture complexity of health status and quality of life remains a challenge. PROMIS-10 Global Health (GH) may be used to screen for impactful health risks and enable patient-centered care. The purpose of this study was to investigate the interrelationships between PROMIS-10 GH scores and patient demographics, health status, and healthcare utilization in patients with cLBP who received physical therapy. Methods A retrospective review of de-identified electronic health records of patients with cLBP was performed. Data were collected for 328 patients seen from 2017 to 2020 in three physical therapy clinics. Patients were grouped into HIGH and LOW initial assessment scores on the PROMIS-10 Global Physical Health (PH) and Global Mental Health (MH) measures. Outcomes of interest were patient demographics, health status, and healthcare utilization. Mann–Whitney U and chi-square tests were used to determine differences between groups, and binary logistic regression was used to calculate odds ratios (OR) to determine predictors of PH-LOW and MH-LOW group assignments. Results The PH-LOW and MH-LOW groups contained larger proportions of patients who were African American, non-Hispanic, and non-commercially insured compared to PH-HIGH and MH-HIGH groups (p

This study evaluates the factorial structure of the Mathematics Anxiety Scale for Students (MASS) using data from 1,272 high school students. To this end, we used the mathematical anxiety rating scale for middle and high school students developed by Ko and Yi (2011). An exploratory factor analysis of the response data from the first sample (636 students) eliminated 31 of the 65 items of the original MASS, generating the MASS-Short Version (MASS-SV), a mathematical anxiety scale for high school students with four factors-mathematical problem solving, mathematical learning methods, mathematics test, and mathematics class. A confirmatory factor analysis of the MASS-SV using the responses of the second sample (636 students) revealed that the model fit indices were acceptable and did not differ significantly from those of the original MASS. The MASS-SV derived from this study is a valid and reliable mathematical anxiety measurement tool for high school students; it also helps the students save time and provide quality responses. Future research on the progress of math anxiety in students should identify trends in math anxiety or the relationship between variables such as achievement, attitude toward mathematics, and career path in relation to math anxiety.

Seung Eun Lee,1,2 JiYeon Choi,1,2 Hyunjie Lee,2 Somin Sang,2 Haesun Lee,2 Hye Chong Hong3 1Mo-Im Kim Nursing Research Institute, Seoul, South Korea; 2College of Nursing, Yonsei University, Seoul, South Korea; 3Department of Nursing, Chung-Ang University, Seoul, South KoreaCorrespondence: Hye Chong HongDepartment of Nursing, Chung-Ang University, 84 Heukseok-ro, Bldg 106, Dongjak-gu, Seoul, 06974, South KoreaTel +82-2-9278-9106Fax +82-2-824-7961Email julieh@cau.ac.krAbstract: Speaking up for patient safety among health care professionals is important because it can contribute to the prevention of adverse patient events, such as medication errors, infections, wrong-site surgical procedures, and other sentinel events. This systematic review identified factors that facilitate or inhibit nurses’ willingness to speak up regarding patient safety in East Asian hospitals. Following the steps of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, four databases, including PubMed, CINAHL, PsycInfo, and Web of Science, were searched. Nine studies were analyzed in this review, including five qualitative and four quantitative studies published between 2014 and 2019. Quality of included studies were evaluated using the Mixed-Method Appraisal Tool. Data synthesis was based upon qualitative-led synthesis adopting two existing multilevel frameworks on safety voice and employee voice signals. Four studies were conducted in Japan, three in South Korea, one in Hong Kong, and one in Taiwan. We organized factors influencing East Asian nurses’ willingness to speak up regarding patient safety according to the following four contexts: individual (motivation toward patient safety, organizational commitment, perceived effectiveness and importance of speaking up, and assertive personality), team (positive relationship and team trust, team culture, and mentoring), organizational (hospital administrative support and organizational culture) and sociocultural (hierarchy and power differential and collectivistic culture). However, due to the limited number of studies conducted in East Asian hospitals, further studies with larger cohort samples of nurses in various East Asian countries should be conducted to deepen our understanding of nurses’ willingness to voice their concerns for patient safety.Keywords: assertive communication, voice, silence, having a voice

Yeye Zhou,* Zixuan Zhao,* Jihui Li, Bin Zhang, Shibiao Sang, Yiwei Wu,* Shengming DengDepartment of Nuclear Medicine, The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China*These authors contributed equally to this workPurpose: In the present study, we aimed to investigate the role of baseline, interim and end-of treatment positron emission tomography/computed tomography (PET/CT) in assessing the prognosis of follicular lymphoma (FL).Methods: A total of 84 FL patients were retrospectively analyzed in this study. Baseline (n=59), interim (n=24, after 2–4 cycles) and end-of treatment (n=43) PET/CT images were re-evaluated, and baseline maximum standardized uptake value (SUVmax), total metabolic tumor volume (tMTV) and total lesion glycolysis (TLG) were recorded. Interim (I-PET) and end-of treatment (E-PET) PET/CT responses were interpreted by Deauville five-point scale (D-5PS) and International Harmonization Project criteria (IHP). Survival curves were calculated by Kaplan-Meier curves, and differences between groups were compared by log-rank test.Results: The 2-year progression-free survival (PFS) of the high- and low-TLG groups was 57.14% and 95.56%, respectively (p=0.0001). The 2-year overall survival (OS) of the high- and low-TLG groups was 62.50% and 100%, respectively (p0.05). However, E-PET results using D-5PS and IHP criteria were statistically significant (p=0.0001 and p=0.006). The D-5PS showed stronger prognostic value compared with IHP criteria. The optimal cutoff value of ΔSUVmax% was 66.95% according to I-PET and 68.97% according to E-PET. However, only the ΔSUVmax% from the baseline to the end-of therapy yielded statistically significant results in the prediction of PFS (p=0.0002).Conclusion: Our findings indicated that the baseline TLG and E-PET results were significantly associated with prognosis in patients with FL.Keywords: follicular lymphoma, PET/CT, MTV, TLG, D-5PS, IHP

Atmospheric broadband transmissions of clouds, aerosols, and ozone in the erythemally weighted ultraviolet (EUV, 290–320 nm), total (spectrally integrated) ultraviolet (TUV, 290–363 nm), and total global solar (GS, 305–2800 nm) spectral regions were analysed with ground-based measurements in Seoul, Korea (37.57°N, 128.98°E) from March 2004 to February 2013. The annual average total transmission expressed as a fraction of the clear-sky irradiance was 77.6% in the EUV, 73.6% in the TUV, and 72.0% in the GS spectral regions. The corresponding values for cloud transmission were 78.4%, 73.9%, and 71.7%. In overcast cloudy conditions, atmospheric transmission was reduced by 45.9%, 50.2%, and 56.6% in the three spectral regions, respectively, indicating the dominant effect of clouds. Aerosol and ozone transmissions had almost the same annual average. Annual average atmospheric transmission effectively decreases with increasing wavelength from EUV to GS regions. However, we found that there was a difference in wavelength dependence of atmospheric transmission for monthly averages, which seems related to the monthly variation of total column ozone (TCO), aerosol, and cloud amount. It is also found that there is a critical value of TCO (TCO =370 DU) for the wavelength dependence of transmission. Higher ozone amount than this turnaround value can cause an increase in transmission from the EUV to GS regions. The monthly wavelength-dependent effects may be attributable more to the different climatological characteristics of the TCO rather than aerosols and clouds.

IntroductionCare and outcomes for patients with chronic low back pain (cLBP) are influenced by the social risk factors that they experience. Social risk factors such as food insecurity and housing instability have detrimental effects on patient health and wellness, healthcare outcomes, and health disparities.ObjectivesThis retrospective cross-sectional study examined how social risk factors identified in unstructured and structured electronic health record (EHR) data for 1,295 patients with cLBP were associated with health care utilization. We also studied the impact of social risk factors, controlling for back pain-related disability on health care utilization.MethodsIncluded patients who received outpatient spine and/or physical therapy services at an urban academic medical center between 2018 and 2020. Five identified social risks were financial insecurity, housing instability, food insecurity, transportation barriers, and social isolation. Outcomes included 4 categories of health care utilization: emergency department (ED) visits/hospitalizations, imaging, outpatient specialty visits related to spine care, and physical therapy (PT) visits. Poisson regression models tested associations between the presence of identified social risks and each outcome measure.ResultsIdentified social risks in 12.8% of the study population (N = 166/1,295). In multivariate models, social isolation was positively associated with imaging, specialty visits, and PT visits; housing instability was positively associated with ED visits/hospitalizations and imaging; food insecurity was positively associated with ED visits/hospitalizations and specialty visits but negatively associated with PT visits; and financial strain was positively associated with PT visits but negatively associated with ED visits/hospitalization.ConclusionThese associations were seen above and beyond other factors used as markers of socioeconomic marginalization, including neighborhood-level social determinants of health, race/ethnicity, and insurance type. Identifying and intervening on social risk factors that patients with cLBP experience may improve outcomes and be cost-saving.

Purpose: The vestibulospinal tract (VST) is involved in balance control and gait function. No research has identified the VST in the human brain. In the current study, we attempted to identify the medial and lateral VST in the human brain, using diffusion tensor tractography (DTT).Materials and Methods: We recruited 40 healthy volunteers for this study. For reconstruction of the medial VST, a seed region of interest (ROI) was placed on the medial vestibular nuclei in the pons and target ROI on the posteromedial medulla. For reconstruction of the lateral VST, a seed ROI was placed on the lateral vestibular nuclei of pons and the target ROI on the posterolateral medulla. Values of fractional anisotropy (FA), mean diffusivity (MD), and tract volume of the medial and lateral VST were measured.Results: The medial VST, which originates from the medial vestibular nuclei, descends through the posteromedial medulla, and terminates at the anterior funiculus of the cervical spinal cord. The lateral VST originates from the lateral vestibular nuclei, and terminates in the anterior portion of lateral funiculus, through the posterolateral medulla. The FA value of medial VST was significantly higher than that of lateral VST. In contrast, the MD value and tract volume were significantly lower than those of lateral VST (p < 0.05).Conclusion: We identified the medial and lateral VST in the human brain using DTT and investigated the anatomical characteristics of the medial and lateral VST. The methodology and results of this study could be helpful to both clinicians and researchers in the neuroscience field.

The objective of this study was to evaluate the in vitro effects of flavonoid-rich plant extracts (PE) on ruminal fermentation characteristics and methane emission by studying their effectiveness for methanogenesis in the rumen. A fistulated Holstein cow was used as a donor of rumen fluid. The PE (Punica granatum, Betula schmidtii, Ginkgo biloba, Camellia japonica, and Cudrania tricuspidata) known to have high concentrations of flavonoid were added to an in vitro fermentation incubated with rumen fluid. Total gas production and microbial growth with all PE was higher than that of the control at 24 h incubation, while the methane emission was significantly lower (p

The effect of different phytogenic feed additives on reducing odorous compounds in swine was investigated using in vitro fermentation and analyzed their microbial communities. Soybean meal (1%) added with 0.1% different phytogenic feed additives (FA) were in vitro fermented using swine fecal slurries and anaerobically incubated for 12 and 24 h. The phytogenic FAs used were red ginseng barn powder (Panax ginseng C. A. Meyer, FA1), persimmon leaf powder (Diospyros virginiana L., FA2), ginkgo leaf powder (Ginkgo biloba L., FA3), and oregano lippia seed oil extract (Lippia graveolens Kunth, OL, FA4). Total gas production, pH, ammonia-nitrogen (NH3-N), hydrogen sulfide (H2S), nitrite-nitrogen (NO2−-N), nitrate-nitrogen (NO3−-N), sulfate (SO4−−), volatile fatty acids (VFA) and other metabolites concentration were determined. Microbial communities were also analyzed using 16S rRNA DGGE. Results showed that the pH values on all treatments increased as incubation time became longer except for FA4 where it decreased. Moreover, FA4 incubated for 12 and 24 h was not detected in NH3-N and H2S. Addition of FAs decreased (p

The experiment was conducted by in vitro fermentation and bacterial community analysis to investigate the reduction of odorous compounds in response to the use of feed additives (FA) during carbohydrate overload in growing pigs. Soluble starch at 1% (control) and various FA at 0.1% Ginseng meal (FA1); Persimmon leaf (FA2); Gingko nut (FA3) and Oregano lippia (FA4) were added to fecal slurry and incubated anaerobically for 12 and 24 h. In vitro parameters and microbial diversity of the dominant bacteria following fermentation were analyzed using Denaturing Gradient Gel Electrophoresis (DGGE), band cloning and sequencing of the V3 region. Results showed that total gas production increased with the advancement of incubation (p

BackgroundAlthough evidence-based guidelines for physical therapy for patients with chronic low back pain (cLBP) are available, selecting patient-reported outcome measures to capture complexity of health status and quality of life remains a challenge. PROMIS-10 Global Health (GH) may be used to screen for impactful health risks and enable patient-centered care. The purpose of this study was to investigate the interrelationships between PROMIS-10 GH scores and patient demographics, health status, and healthcare utilization in patients with cLBP who received physical therapy.MethodsA retrospective review of de-identified electronic health records of patients with cLBP was performed. Data were collected for 328 patients seen from 2017 to 2020 in three physical therapy clinics. Patients were grouped into HIGH and LOW initial assessment scores on the PROMIS-10 Global Physical Health (PH) and Global Mental Health (MH) measures. Outcomes of interest were patient demographics, health status, and healthcare utilization. Mann-Whitney U and chi-square tests were used to determine differences between groups, and binary logistic regression was used to calculate odds ratios (OR) to determine predictors of PH-LOW and MH-LOW group assignments.ResultsThe PH-LOW and MH-LOW groups contained larger proportions of patients who were African American, non-Hispanic, and non-commercially insured compared to PH-HIGH and MH-HIGH groups (p

A literature review was conducted to describe important concepts involved in functional analysis of verbal behavior as well as to evaluate empirical research findings on acquisition of picture exchange-based vs. signed mands to suggest instructional implications for teachers and therapists to teach functional communication skills to children with autism. Research findings indicate that children with autism acquire picture exchange responses to mand for reinforcing items more easily and rapidly than signed responses. There is also a strong relation between motor imitation, matching skills and sign language acquisition. It is suggested that both motor imitation and matching skills be examined to teach manual signs to children with autism. Speech is the most common response form, but writing, typing, signs, pictures, gestures, or eye gaze should also be considered for manding. A decision making process is proposed to determine a proper communicative form considering abilities and environmental conditions of a child concerned.

This article investigated how mathematic anxiety (MA) of Korean middle school students could be reduced by comparing analytically their cognitive neuroscience and questionnaire results. We developed a three-hour Complex Treatment Program (CTP) on quadratic functions for the study. In the summer of 2016, we collected data of the pre and post MA questionnaires by Mathematics Anxiety Scale for Students (MASS), the percent of correct answers (PCA) and reaction time (RT) by E-prime program, and also brain-imaging data of the event related potentials (ERP) by Electroencephalograph (EEG) using computer-based functional F-G model. The result indicated the CTP to be effective with the group with higher math anxiety and the group with higher achievement respectively. The MASS result was verified with the better performance of PCA on type G, which was measured by E-prime program. Some interesting patterns were revealed on brain-imaging data by EEG, indicating more brain activities with the MA groups.

This study demonstrates that the learning channel intervention, utilizing a continuous assessment system, enabled 3 students with special needs to build and generalize fluency in multiplication facts. This study contrasts generalization of 2 learning channels--"see-say" and "hear-say"--to see if either of the 2 channels has an advantage over the other. The data from this study suggests that the particular learning channel was influential in generalization to application. The findings of this study indicate the "hear-say" learning channel has an advantage in the generalization of learning over the "see-say" learning channel. However, this preliminary finding suggests further studies employing a design in which two intervention modes can be alternated in 2 groups of participants. (Contains 1 table and 1 figure.)

Objective The objective was to investigate growth performance, antioxidant enzyme activity, intestinal morphology, immune cell distribution, short chain fatty acid (SCFA) profile, and microbiota in broiler chickens fed a diet containing Lacticaseibacillus paracasei NSMJ15. Methods A total of 120 1-day-old Ross 308 male broilers were allocated to 2 dietary treatments in a randomized complete block design. A control group was fed a corn-soybean meal control diet, and an NSMJ15-supplemented group was fed a control diet supplemented with 1 g/kg L. paracasei NSMJ15 at the expense of cornstarch. Each dietary treatment had 6 replicates with 10 birds per cage. Growth performance was recorded on day 9. On day 10, one bird representing median body weight was selected to collect serum for antioxidant enzyme activity, jejunal tissue for immune cell isolation and morphometric analysis, and cecal digesta for 16S rRNA gene sequencing and SCFA analysis. Results Supplementation of L. paracasei NSMJ15 did not affect growth performance, serum antioxidant enzyme activity, and jejunal histomorphology compared to the control group. In the NSMJ15-supplemented group, the population of CD3+CD4+CD8− T cells increased (p = 0.010), while the population of CD3+CD8+TCRγδ+ T cells decreased (p = 0.022) compared to the control group. The L. paracasei NSMJ15 supplementation decreased (p = 0.022) acetate concentration in the cecal digesta compared to the control group. The 16S rRNA gene sequencing analysis showed that NSMJ15-supplemented group differentially expressed (p

Corynebacterium sp. SCR221107 was isolated from the rumen fluid of healthy male Holstein dairy cows from a research farm at Suncheon, Jeollanam-do, Korea. Corynebacterium sp. SCR221107 is a functional probiotic candidate that produces vitamin B12. All Corynebacterium sp. SCR221107 was sequenced using the PacBio RS II and Illumina HiSeq platforms and assembled de novo. The complete genome sequence of Corynebacterium sp. SCR221107 contained one circular chromosome (3,043,024 bp) with a guanine + cytosine (GC) content of 60.1%. Annotation analysis showed the presence of 2,639 protein-coding sequences, 15 rRNA genes, and 57 tRNA genes. Genome analysis found that Corynebacterium sp. SCR221107 encodes various genes associated with vitamin B12 synthesis and transport. The genomic information provided a detailed understanding of Corynebacterium sp. SCR221107, suggesting that this isolate may have potential probiotic applications.

Abstract Background Severe alcoholic hepatitis is a catastrophic disease with a mortality rate of up to 35–50% at 30 days. Bacterial infection is an important prognostic factor in patients with severe alcoholic hepatitis, but it is difficult to detect the presence of infection immediately. Procalcitonin (PCT) is a well-known inflammatory marker that can detect bacterial infections in various diseases early. Therefore, we aimed to evaluate the diagnostic accuracy of PCT for bacterial infection in severe alcoholic hepatitis. Methods We prospectively enrolled patients with severe alcoholic hepatitis, defined as modified Maddrey’s Discriminant Function ≥ 32, from 10 medical centers. At admission, we performed an initial evaluation including physical examination, laboratory test, radiology, blood and urine culture, PCT, and C-reactive protein (CRP). We compared the receiver operating characteristic (ROC) curves of PCT and CRP for bacterial infection, systemic inflammatory response syndrome (SIRS), and sepsis among total patients. Results A total of 108 patients with severe alcoholic hepatitis were enrolled. The number of bacterial infections, SIRS, and sepsis were 31 (28.7%), 41 (38.0%), and 19 (17.6%), respectively. The patients with bacterial infection had significantly higher MELD scores (24.0 vs. 15.0), PCT levels (1.5 vs. 0.4 ng/mL), and CRP levels (4.9 vs. 2.5 mg/dL) compared to those without bacterial infection. The area under the ROC curve (AUROC) of PCT vs. CRP for bacterial infection was 0.752 and 0.655, respectively (P = 0.113). The AUROC of PCT vs. CRP for SIRS was 0.699 and 0.662, respectively (P = 0.490). The AUROC of PCT vs. CRP for sepsis was 0.780 and 0.630, respectively (P = 0.027). Conclusions Among patients with severe alcoholic hepatitis, PCT showed a trend of superior diagnostic performance in the early detection of bacterial infection and sepsis compared to CRP. Although PCT might have better potential to diagnose sepsis in the setting of severe alcoholic hepatitis, it is necessary to find more reliable diagnostic markers.

Children face the excitement of a changing world but also encounter environmental threats to their health that were neither known nor suspected several decades ago. Children are at particular risk of exposure to pollutants that are widely dispersed in the air, water, and food. Children and adolescents are exposed to chemical, physical, and biological risks at home, in school, and elsewhere. Actions are needed to reduce these risks for children exposed to a series of environmental hazards. Exposure to a number of persistent environmental pollutants including air pollutants, endocrine disruptors, noise, electromagnetic waves (EMWs), tobacco and other noxious substances, heavy metals, and microplastics, is linked to damage to the nervous and immune systems and affects reproductive function and development. Exposure to environmental hazards is responsible for several acute and chronic diseases that have replaced infectious diseases as the principal cause of illnesses and death during childhood. Children are disproportionately exposed to environmental toxicities. Children drink more water, eat more food, and breathe more frequently than adults. As a result, children have a substantially heavier exposure to toxins present in water, food, or air than adults. In addition, their hand-to-mouth behaviors and the fact that they live and play close to the ground make them more vulnerable than adults. Children undergo rapid growth and development processes that are easily disrupted. These systems are very delicate and cannot adequately repair thetional development in children’s environmental health was the Declaration of the Environment Leaders of the Eight on Children’s Environmental Health by the Group of Eight. In 2002, the World Health Organization launched an initiative to improve children’s environmental protection effort. Here, we review major environmental pollutants and related hazards among children and adolescents.

Abstract The material acceleration platform, empowered by robotics and artificial intelligence, is a transformative approach for expediting material discovery processes across diverse domains. However, the development of an operating system for material acceleration platform faces challenges in simultaneously managing diverse experiments from multiple users. Specifically, when it is utilized by multiple users, the overlapping challenges of experimental modules or devices can lead to inefficiencies in both resource utilization and safety hazards. To overcome these challenges, we present an operation control system for material acceleration platform, namely, OCTOPUS, which is an acronym for operation control system for task optimization and job parallelization via a user-optimal scheduler. OCTOPUS streamlines experiment scheduling and optimizes resource utilization through integrating its interface node, master node and module nodes. Leveraging process modularization and a network protocol, OCTOPUS ensures the homogeneity, scalability, safety and versatility of the platform. In addition, OCTOPUS embodies a user-optimal scheduler. Job parallelization and task optimization techniques mitigate delays and safety hazards within realistic operational environments, while the closed-packing schedule algorithm efficiently executes multiple jobs with minimal resource waste. Copilot of OCTOPUS is developed to promote the reusability of OCTOPUS for potential users with their own sets of lab resources, which substantially simplifies the process of code generation and customization through GPT recommendations and client feedback. This work offers a solution to the challenges encountered within the platform accessed by multiple users, and thereby will facilitate its widespread adoption in material development processes.

Background Atherogenic dyslipidemia, which is frequently associated with type 2 diabetes (T2D) and insulin resistance, contributes to the development of vascular complications. Statin therapy is the primary approach to dyslipidemia management in T2D, however, the role of non-statin therapy remains unclear. Ezetimibe reduces cholesterol burden by inhibiting intestinal cholesterol absorption. Fibrates lower triglyceride levels and increase high-density lipoprotein cholesterol (HDL-C) levels via peroxisome proliferator-activated receptor alpha agonism. Therefore, when combined, these drugs effectively lower non-HDL-C levels. Despite this, few clinical trials have specifically targeted non-HDL-C, and the efficacy of triple combination therapies, including statins, ezetimibe, and fibrates, has yet to be determined. Methods This is a multicenter, prospective, randomized, open-label, active-comparator controlled trial involving 3,958 eligible participants with T2D, cardiovascular risk factors, and elevated non-HDL-C (≥100 mg/dL). Participants, already on moderate-intensity statins, will be randomly assigned to either Ezefeno (ezetimibe/fenofibrate) addition or statin dose-escalation. The primary end point is the development of a composite of major adverse cardiovascular and diabetic microvascular events over 48 months. Conclusion This trial aims to assess whether combining statins, ezetimibe, and fenofibrate is as effective as, or possibly superior to, statin monotherapy intensification in lowering cardiovascular and microvascular disease risk for patients with T2D. This could propose a novel therapeutic approach for managing dyslipidemia in T2D.

This paper presents a seismic analysis method that can evaluate a very large number of cases for the free standing dry storage cask by proposing a methodology that has short analysis time as well as accuracy. This study also performed a seismic analysis of a dry storage facility with multiple casks to show a tip-over phenomenon from earthquake accident conditions. The earthquake accident condition is long-term event that occur during about 20 s long, and lots of seismic analysis cases should be performed to consider various real conditions because the free-standing spent-fuel dry storage cask has many nonlinear responses. The soil–concrete pad–cask interaction was considered in the seismic analysis and finite element model was made using concrete pad, soil and cask models. In the reinforced concrete pad, the rebar was excluded to reduce the analysis time, but the thickness was corrected to maintain the bending rigidity. Additionally, the analysis time reduced by modeling the cask as a rigid body rather than a flexible body. 35-cases of seismic analysis were performed to determine a tip-over phenomenon from each earthquake. The analysis revealed that no tip-over phenomenon of the cask was observed in all analyses from 0.2 g to 0.6 g, however the tip-over of the cask were observed from 0.8 g with friction coefficients of 0.8 and 1.0.