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Abstract Background Integrating advanced machine-learning (ML) algorithms into clinical practice is challenging and requires interdisciplinary collaboration to develop transparent, interpretable, and ethically sound clinical decision support (CDS) tools. We aimed to design a ML-driven CDS tool to predict opioid overdose risk and gather feedback for its integration into the University of Florida Health (UFHealth) electronic health record (EHR) system. Methods We used user-centered design methods to integrate the ML algorithm into the EHR system. The backend and UI design sub-teams collaborated closely, both informed by user feedback sessions. We conducted seven user feedback sessions with five UF Health primary care physicians (PCPs) to explore aspects of CDS tools, including workflow, risk display, and risk mitigation strategies. After customizing the tool based on PCPs’ feedback, we held two rounds of one-on-one usability testing sessions with 8 additional PCPs to gather feedback on prototype alerts. These sessions informed iterative UI design and backend processes, including alert frequency and reappearance circumstances. Results The backend process development identified needs and requirements from our team, information technology, UFHealth, and PCPs. Thirteen PCPs (male = 62%, White = 85%) participated across 7 user feedback sessions and 8 usability testing sessions. During the user feedback sessions, PCPs (n = 5) identified flaws such as the term “high risk” of overdose potentially leading to unintended consequences (e.g., immediate addiction services referrals), offered suggestions, and expressed trust in the tool. In the first usability testing session, PCPs (n = 4) emphasized the need for natural risk presentation (e.g., 1 in 200) and suggested displaying the alert multiple times yearly for at-risk patients. Another 4 PCPs in the second usability testing session valued the UFHealth-specific alert for managing new or unfamiliar patients, expressed concerns about PCPs’ workload when prescribing to high-risk patients, and recommended incorporating the details page into training sessions to enhance usability. Conclusions The final backend process for our CDS alert aligns with PCP needs and UFHealth standards. Integrating feedback from PCPs in the early development phase of our ML-driven CDS tool helped identify barriers and facilitators in the CDS integration process. This collaborative approach yielded a refined prototype aimed at minimizing unintended consequences and enhancing usability.

WADED Al-Mg and Al-Mg-Sc-Zr aluminium alloy thin-wall components were produced. Heat treatment (350°C aging for 4 h) was further conducted. The effects of Sc/Zr addition on porosity, microstructure, mechanical properties and corrosion behaviour were investigated. With Sc/Zr adding, pore area fraction decreased from 0.208 to 0.005% and grain size decreased from 84.34 to 19.54 μm. In WADED Al-Mg-Sc-Zr component, microstructure showed refined equiaxed grains. Mechanical properties were improved with 360 MPa ultimate tensile strength (UTS), 185 MPa yield strength, and 23.31% elongation. After heat treatment, UTS increased to 388 MPa with good ductility (22.53%) maintained. The grain refinement and Al3(Sc, Zr) particles were the key factors for mechanical property improvement. The corrosion behaviour was improved with introduced Sc/Zr and further optimised after heat treatment. The corrosion exhibited layered characteristics due to the distribution of primary Al3(Sc, Zr) while minor-size secondary Al3(Sc, Zr) along grain boundaries improved the corrosion behaviour.

AbstractBackground Anxiety and depression are common comorbidities in idiopathic pulmonary fibrosis (IPF) that impair health-related quality of life. However, there is a lack of studies focusing on the mental disorder of IPF after antifibrotic treatment and their related predictive factors.Methods Patients with an initial diagnosis of IPF were enrolled. Data on demographics, lung function, Generalized Anxiety Disorder-7 (GAD-7) Scale, Patient Health Questionnaire 9 (PHQ-9), Patient Health Questionnaire-15 (PHQ-15), and St. George's Respiratory Questionnaire total score(SGRQ-T) were collected. Changes in anxiety, depression, somatic symptoms, and quality of life scores before and after nintedanib treatment were compared, and the related predictive factors were analyzed.Results A total of 56 patients with a first diagnosis of IPF were enrolled, with 42 and 35 patients suffering from anxiety and depression, respectively. The GAD-7, PHQ-9, PHQ-15, and SGRQ scores were higher in the anxiety and depression groups. SGRQ total score (SGRQ-T) [OR = 1.075, 95%CI= (1.011, 1.142)] was an independent predictor of IPF combined with anxiety (p

ABSTRACTMicrostructural defects in laser powder bed fusion (LPBF) metallic materials are correlated with processing parameters. A multi-physics model and a crystal plasticity framework are employed to predict microstructure growth in molten pools and assess the impact of manufacturing defects on plastic damage parameters. Criteria for optimising the LPBF process are identified, addressing microstructural defects and tensile properties of LPBF Hastelloy X at various volumetric energy densities (VED). The results show that higher VED levels foster a specific Goss texture {110} , with irregular lack of fusion defects significantly affecting plastic damage, especially near the material surface. A critical threshold emerges between manufacturing defects and grain sizes in plastic strain accumulation. The optimal processing window for superior Hastelloy X mechanical properties ranges from 43 to 53 J/mm3. This work accelerates the development of superior strength-ductility alloys via LPBF, streamlining the trial-and-error process and reducing associated costs.

AbstractObjective The association between nutritional status and prognosis of idiopathic pulmonary fibrosis (IPF) remains unclear. This systematic review and meta-analysis aimed to explore the effect of body mass index (BMI) and weight loss on the prognosis of IPF patients.Methods We accumulated studies on IPF, BMI, and weight loss from databases including PubMed, Embase, Web of science, Scopus, Ovid and Cochrane Library up to 4 August 2023. Using Cox proportional hazard regression model for subgroup analysis, hazard ratio (HR) and 95% confidence intervals (CI) for BMI in relation to mortality, acute exacerbation (AE), and hospitalization in IPF patients were calculated, and HR, odds ratio (OR), and 95% CI for weight loss corresponding to IPF patient mortality were assessed. Sensitivity analysis was peformed by eliminating every study one by one, and publication bias was judged by Egger’s test and trim-and-fill method.Results A total of 34 eligible studies involving 18,343 IPF patients were included in the meta-analysis. The pooled results by univariate Cox regression analysis showed that baseline BMI was a predictive factor for IPF mortality (HR = 0.93, 95%CI = [0.91, 0.94]). Furthermore, the results by the multivariable regression model indicated that baseline BMI was an independent risk factor for predicting IPF mortality (HR = 0.94, 95%CI = [0.91, 0.98]). Weight loss was identified as a risk factor for IPF mortality (HR = 2.74, 95% CI = [2.12, 3.54]; OR = 4.51, 95% CI = [1.72, 11.82]) and there was no predictive value of BMI for acute exacerbation (HR = 1.00, 95% CI= [0.93, 1.07]) or hospitalization (HR = 0.95, 95% CI = [0.89, 1.02]).Conclusion Low baseline BMI and weight loss in the course of IPF may indicate a high risk of mortality in patients with IPF, so it is meaningful to monitor and manage the nutritional status of IPF patients, and early intervention should be conducted for low BMI and weight loss.

Alarmin cytokines including IL-25, IL-33, and thymic stromal lymphopoietin (TSLP) function as danger signals to trigger host immunity in response to tissue injury caused by pathogenic factors such as parasitic infections. Parasitic diseases also provide an excellent context to study their functions and mechanisms. Numerous studies have indicated that alarmin cytokine released by non-immune cells such as epithelial and stromal cells induce the hosts to initiate a type 2 immunity that drives parasite expulsion but also host pathology such as tissue injury and fibrosis. By contrast, alarmin cytokines especially IL-33 derived from immune cells such as dendritic cells may elicit an immuno-suppressive milieu that promotes host tolerance to parasites. Additionally, the role of alarmin cytokines in parasite infections is reported to depend on species of parasites, cellular source of alarmin cytokines, and immune microenvironment, all of which is relevant to the parasitic sites or organs. This narrative review aims to provide information on the crucial and diverse role of alarmin cytokines in parasitic infections involved in different organs including intestine, lung, liver and brain.

Abstract Background There is growing evidence linking the age-adjusted Charlson comorbidity index (aCCI), an assessment tool for multimorbidity, to fragility fracture and fracture-related postoperative complications. However, the role of multimorbidity in osteoporosis has not yet been thoroughly evaluated. We aimed to investigate the association between aCCI and the risk of osteoporosis in older adults at moderate to high risk of falling. Methods A total of 947 men were included from January 2015 to August 2022 in a hospital in Beijing, China. The aCCI was calculated by counting age and each comorbidity according to their weighted scores, and the participants were stratified into two groups by aCCI: low (aCCI

Spiral-channel holes are utilized on the turbine endwall to enhance cooling effectiveness. Numerical simulations and experimental verification are conducted to analyze the cooling performance and energy loss of spiral-channel holes, as well as the influence of parameters and flow field structure on the vane. Results reveal that the energy loss due to the spiral-channel hole is slightly higher than that of the cylindrical hole at low blowing ratio (M), with the opposite being true for M exceeds 1.5. Increasing M heightens the film effectiveness around the hole but reduces coolant coverage downstream of the hole. The cooling capacity of the spiral-channel hole outperforms cylindrical hole around the hole, resulting in more uniform transverse film effectiveness and greatly improved the cooling effect on the pressure section, particularly at high M. The introduction of compound angle further enhances the cooling performance of spiral-channel hole, but increases the energy loss. Upstream the hole, the laterally-averaged film effectiveness of spiral-channel hole with −28° compound angle is 16.9 % higher than that of cylindrical hole, and 20.1 % higher downstream the hole. The spiral-channel hole with −28° compound angle exhibits the best cooling performance on the pressure side, while the spiral-channel hole with 48° compound angle provides optimal cooling effect on the suction side. Moreover, the pressure section exhibits a larger vortex scale and intensity compared to the suction section. The hole with positive and negative compound angle exhibits minimal difference in the flow field structure between the pressure and suction sections, and form better protection on the endwall with a smaller zero coverage zone.

Trifluoromethyl (CF3) and other fluoroalkyl groups are of great significance in the fields of pharmaceutical chemistry and agricultural chemicals. Fluoroalkyl acids, especially trifluoroacetic acid (TFA) is considered the most ideal fluoroalkylation reagent due to its low cost and easy availability. However, the extremely high oxidation potential requirement of TFA limits its wide application. In recent years, since visible-light-induced fluoroalkylation through the ligand-to-metal charge transfer (LMCT) process can overcome the above limitations, it has become an effective synthetic tool for the construction of fluorinated compounds with complex molecules and structures. In this review, according to the classification of different metal catalysts, we summarize the trifluoromethylation and fluoroalkylation of olefins, heteroaromatics, and terminal alkynes in different metal catalytic systems and their corresponding reaction mechanisms. The photocatalytic fluoroalkylation via LMCT is believed to expedite the development of fluoro-containing drugs, and more novel fluoroalkylation methologies using this strategy will be disclosed.

BackgroundThe protective effects of metformin (Met) against doxorubicin (Dox)-induced cardiotoxicity via potential hypotheses of mechanisms of action with unknown reliability and credibility.ObjectivesThis study aimed to investigate the protective effects of Met against Dox-induced cardiotoxicity and the underlying mechanisms of action, as well as examine their reliability and credibility.MethodsA comprehensive search was conducted within the PubMed, Embase, Web of Science, Science Direct, Scopus, and CNKI databases from inception to 31 December 2023. Animal experiments evaluating the efficacy of Met against Dox-induced cardiotoxicity were included in this study. The primary efficacy outcomes were markers of myocardial injury. Effect size was measured using the standardized mean difference for continuous variables. Data were pooled using a random-effects model in the Stata 18 statistical software package.ResultsTwenty-one studies involving 203–208 animals treated with Dox and 271–276 animals treated with Dox and Met were included in this analysis. Quality assessment revealed high-quality scores. Pooled results favored Met treatment based on the serum lactate dehydrogenase (LDH), creatine kinase-myocardial band (CK-MB), cardiac troponin I (cTnI), and aspartate aminotransferase levels. Sensitivity analysis using the leave-one-out method demonstrated stable results. Funnel plots, Egger’s test, and Begg’s test confirmed potential publication bias. The oxidative stress hypothesis has been investigated extensively based on abundant evidence.ConclusionMet is effective and safe for protecting against Dox-induced cardiotoxicity, thus making it an appropriate drug for clinical investigation. The oxidative stress hypothesis of mechanism of action is well established with highest reliability and credibility.

Abstract Background Electronic health records (EHRs) are digital records of individual health information. However, their adoption and utilization remain low. This study explores the factors influencing the implementation of EHRs through a questionnaire survey to enhance individual awareness and adoption of EHRs. Methods A questionnaire and an expert rating scale were developed sequentially, and the consistency of the scores from five experts was calculated using Kendall’s W to generate a final questionnaire. A non-parametric test was utilized to analyze differences in continuous data that did not follow a normal distribution. Categorical variables were expressed as percentages (%), the chi-square test was employed for group comparisons, and multiple logistic regression was implemented to assess individuals’ awareness and adoption of EHRs. Results In total, 1,341 survey questionnaires were distributed between January and December 2022, with 1,337 valid responses (99.7%). The results indicated that the proportion of participants who were aware of EHRs and had a bachelor’s degree or higher education, an income of ≥$700 per month, residence in urban areas, possessed self-care abilities, and underwent annual physical examinations was significantly higher than that without awareness of EHRs (P

Lactic acid bacteria (LAB) plays an important role in the production of sourdough, and has a significant impact on its flavor and other qualities. In order to select LAB starter culture for specialty sourdough and develop differentiated sour dough bread, this study evaluated the glucose metabolism capacity, organic acid production capacity and flavor characteristics of LAB strains isolated from different kinds of traditional fermented foods, and their effects on the flavor of sourdough and bread were also verified. The results showed that there were 6 LAB strains with strong glucose metabolism and acid production performance, and excellent flavor characteristics. The volatile flavor substances produced by these strains were mainly composed of alcohols, esters, ketones, aldehydes, acids, and other compounds. Among them, two Lactobacillus plantarum strains might be the main contributors of special flavors such as sourness, fruitiness and rice wine flavor to sourdough bread. These obtained strains provide resources for the development of sourdough starter culture with characteristic aroma components, and have potential for industrial application.

The traditional scheduling approach, which primarily considers energy oligarchs like large-scale loads and large-scale generators, is challenged by the rapid rise of distributed energy resources (DERs) in energy internet of things (EIoT). Metaverse is emerging as one of the most promising technologies considering emergence from DERs in EIoT. Our work, from a macro perspective in the virtual space, provides a metaverse framework to harness the swarm intelligence that emerges from the aggregation behavior of massive diverse DERs in EIoT. The presented framework is built upon virtual twins, data science, systems theory, and 4th-Paradigm (data-intensive scientific discovery paradigm), enabling a novel energy scheduling mode. Our goal is to achieve data empowerment and intelligence improvement through data connectivity, virtual and real interaction, which will ultimately result in a new theory on complex system scheduling.

Abstract INTRODUCTION Alzheimer's disease (AD) is often misclassified in electronic health records (EHRs) when relying solely on diagnosis codes. This study aimed to develop a more accurate, computable phenotype (CP) for identifying AD patients using structured and unstructured EHR data. METHODS We used EHRs from the University of Florida Health (UFHealth) system and created rule‐based CPs iteratively through manual chart reviews. The CPs were then validated using data from the University of Texas Health Science Center at Houston (UTHealth) and the University of Minnesota (UMN). RESULTS Our best‐performing CP was “patient has at least 2 AD diagnoses and AD‐related keywords in AD encounters,” with an F1‐score of 0.817 at UF, 0.961 at UTHealth, and 0.623 at UMN, respectively. DISCUSSION We developed and validated rule‐based CPs for AD identification with good performance, which will be crucial for studies that aim to use real‐world data like EHRs. Highlights Developed a computable phenotype (CP) to identify Alzheimer's disease (AD) patients using EHR data. Utilized both structured and unstructured EHR data to enhance CP accuracy. Achieved a high F1‐score of 0.817 at UFHealth, and 0.961 and 0.623 at UTHealth and UMN. Validated the CP across different demographics, ensuring robustness and fairness.

The present study was aimed to investigate the effects of Phaeodactylum tricornutum oil (PO) and Laminaria japonica oil (LO) against obesity and other metabolic disorders in a high-fat diet (HFD) induced obese mouse model. The results revealed that PO or LO supplementation significantly reduced HFD-induced body weight gain, hyperlipemia, and fat accumulation in mice. PO or LO supplementation also inhibited SREBP-1-mediated de novo lipogenesis and PPARγ-mediated adipogenesis, as well as enhanced PPARα-mediated fatty acid β-oxidation in the WAT and liver of HFD-fed mice. Moreover, PO or LO supplementation attenuated low-grade chronic inflammation, hyperglycemia and insulin resistance in obese mice. Furthermore, Dietary PO or LO also modulated HFD-induced gut microbiota dysbiosis and increased the SCFAs production. More importantly, our results also manifested that the ameliorative effect of PO and LO against HFD-induced obesity, IR and gut microbiota dysbiosis was comparable, but was superior than that of krill oil and fish oil.

Titanium alloys are widely used in the manufacture of gas turbines’ compressor blades. Elucidating their mechanical behavior and strength under damaged conditions is the key to evaluating the equipment’s reliability. However, the conventional Johnson-Cook (J-C) constitutive model has limitations in describing the dynamic response of titanium alloy materials under the impact of a high strain rate. In order to solve this problem, the mechanical behavior of a TC4 titanium alloy under high strain rate and different temperature conditions was analyzed by combining experiments and numerical simulations. In this study, the parameters of the J-C model were analyzed in detail, and an improved J-C constitutive model is proposed, based on the new mechanism of the strain rate strengthening effect and the temperature softening effect, which improves the accuracy of the description of strain sensitivity and temperature dependence. Finally, the VUMAT subroutine of ABAQUS software was used for numerical simulation, and the predictive ability of the improved model was verified. The simulation results showed that the maximum prediction error of the traditional J-C model was 23.6%, while the maximum error of the improved model was reduced to 5.6%. This indicates that the improved J-C constitutive model can more accurately predict the mechanical response of a titanium alloy under an impact load and provides a theoretical basis for the study of the mechanical properties of titanium alloy blades under subsequent conditions of foreign object damage.

Abstract Background The effectiveness of immune checkpoint inhibitors in treating gallbladder cancer (GBC) remains unsatisfactory. Recently, several new immune checkpoints have been identified. However, investigations exploring these immune checkpoints in GBC are limited. In this study, we aim to investigate the expression patterns and clinical implications of various immune checkpoints, and further characterize the spatial and quantitative heterogeneity of immune components in GBC. Methods We employed single and multiplex immunohistochemistry to evaluate the expression of five immune checkpoint markers and four immune cell markers in the primary tumor core, hepatic invasion margin, and liver metastasis. Subsequently, we analyzed their interrelationships and their prognostic significance. Results We observed a robust positive correlation between PD1/TIM3 expression in GBC (R = 0.614, P

Lipid peroxidation and redox imbalance are hallmarks of ferroptosis, an iron-dependent form of cell death. Growing evidence suggests that dysregulation in glycolipid metabolism and iron homeostasis substantially contribute to the development of hepatocellular carcinoma (HCC). However, there is still a lack of comprehensive understanding regarding the specific transcription factors that are capable of coordinating glycolipid and redox homeostasis to initiate the onset of ferroptosis. We discovered that overexpression of SOX8 leads to impaired mitochondria integrate, increased oxidative stress, and enhanced lipid peroxidation. These effects can be attributed to the inhibitory impact of SOX8 on de novo lipogenesis, glycolysis, the tricarboxylic acid cycle (TCA), and the pentose phosphate pathway (PPP). Additionally, upregulation of SOX8 results in reduced synthesis of NADPH, disturbance of redox homeostasis, disruption of mitochondrial structure, and impairment of the electron transport chain. Furthermore, the overexpression of SOX8 enhances the process of ferroptosis by upregulating the expression of genes associated with ferroptosis and elevating intracellular levels of ferrous ion. Importantly, the overexpressing of SOX8 has been observed to inhibit the proliferation of HCC in immunodeficient animal models. In conclusion, the findings suggest that SOX8 has the ability to alter glycolipid and iron metabolism of HCC cells, hence triggering the process of ferroptosis. The results of our study present a novel strategy for targeting ferroptosis in the therapy of HCC.