摘要： INTRODUCTION: Regular endoscopic surveillance is the gold standard Barrett's esophagus (BE) surveillance, yet harms of surveillance for some patients may outweigh the benefits. We sought to characterize physicians' BE surveillance cessation recommendations. METHODS: We surveyed gastroenterologists about their BE surveillance recommendations varying patient age, comorbidity, and BE length. RESULTS: Clinicians varied in recommendations for repeat surveillance. Patient age showed the largest variation among decisions, whereas BE length varied the least. DISCUSSION: Age and comorbidities seem to influence BE surveillance cessation decisions, but with variation. Clear cessation guidelines balancing the risks and benefits for BE surveillance are warranted.

关键词： TDM   noninvasive   matrix   saliva   therapeutic drug monitoring  

摘要： Background: Historically, pharmacokinetic (PK) studies and therapeutic drug monitoring (TDM) have relied on plasma as a sampling matrix. Noninvasive sampling matrices, such as saliva, can reduce the burden on pediatric patients. The variable plasma-saliva relationship can be quantified using population PK models (nonlinear mixed-effect models). However, criteria regarding acceptable levels of variability in such models remain unclear. In this simulation study, the authors aimed to propose a saliva TDM evaluation framework and evaluate model requirements in the context of TDM, with gentamicin and lamotrigine as model compounds. Methods: Two population pharmacokinetic models for gentamicin in neonates and lamotrigine in pediatrics were extended with a saliva compartment including a delay constant (k(SALIVA)), a saliva:plasma ratio, and between-subject variability (BSV) on both parameters. Subjects were simulated using a realistic covariate distribution. Bayesian maximum a posteriori TDM was applied to assess the performance of an increasing number of TDM saliva samples and varying levels of BSV and residual variability. Saliva TDM performance was compared with plasma TDM performance. The framework was applied to a known voriconazole saliva model as a case study. Results: TDM performed using saliva resulted in higher target attainment than no TDM, and a residual proportional error <25% on saliva observations led to saliva TDM performance comparable with plasma TDM. BSV on k(SALIVA) did not affect performance, whereas increasing BSV on saliva:plasma ratios by >25% for gentamicin and >50% for lamotrigine reduced performance. The simulated target attainment for voriconazole saliva TDM was >90%. Conclusions: Saliva as an alternative matrix for noninvasive TDM is possible using nonlinear mixed-effect models combined with Bayesian optimization. This article provides a workflow to explore TDM performance for compounds measured in saliva and can be used for evaluation during m

关键词： Anemometer   Venturi   ANSYS  

摘要： This paper states that there might have around 1000 small size business jets (until nine occupants) flying across the world equipped with flow control and regulating shut-off valves that uses hot wire anemometer devices to regulate massflow rate from the bleed airflow to supply the air-conditioning and pressurization systems. However, these valves present low reliability in the field. The purpose of this paper is to evaluate the implications of a flow control and regulating shut-off valve with a non-intrusive airflow measurer device under the perspective of fluid mechanics. The Venturi technology that is commonly used technology, given its construction simplicity, precision, and broad use in the industry, is selected to substitute the flow control and regulating shut-off valves with hot wire anemometer of the mentioned small size business jets applications. This paper has adopted a numeric simulation approach utilizing the ANSYS-CFX computational fluid dynamics software to verify both the differential pressure at the Venturi device and its correspondent mass flow rate to supply the air conditioning systems of some small size business jets, considering the mass-flow rate as requested by the FAA certification requirement (0.55 lb/min per occupant). This paper shows that a mass-flow rate control and regulating shut-off valve with a Venturi device, of 1 inch and beta of 0.67, is compliant with the minimum fresh air flow requested by the FAA certification requirement to operate in some small size business jets. Besides that, the software ANSYS-CFX is also effective to support the engineering analysis of flow field characteristics inherent to the applications of internal compressible flow. The numeric simulation utilizing the ANSYS-CFX computational fluid dynamics software outlined herein can lay the basis for further research related to the design of a flow control and regulating shut-off valves with a Venturi device.

关键词： Retrograde Rayleigh wave   Prograde Rayleigh wave   Propagation azimuth   Three-component signals   Automatic  

摘要： Extraction of Rayleigh waves from earthquake signals has become an important topic in civil engineering and seismology. In this study, we propose an automatic filtering procedure to extract retrograde and prograde Rayleigh waves and their propagation azimuths from the earthquake signals, separately. In this method, the users do not need to specify an initial filtering limits. The proposed procedure has been first verified with synthetic signals. We show that the points where new retrograde and prograde elliptical motions appear in the signals can be easily distinguished by using the proposed method. Since the Rayleigh waves contents in real signals may change in different earthquakes, this method in comparison with previous methods will be more realistic in extracting Rayleigh from real signals. The proposed method is used to extract the retrograde and prograde Rayleigh waves from recorded earthquakes in Garner Valley Downhole Array. Recorded signals in 6 levels of earth depth have been studied in this work, at 0 m, 6 m, 15 m, 22 m, 50 m and 150 m. We find that the share of prograde Rayleigh waves become more than the share of retrograde waves in deeper levels.

关键词： Complementary and alternative medicine   Complementary therapies   Cross-sectional survey   Evidence-based practice   Barriers   Conduct of research   Application of research   Capacity   Culture   Access   Competency   Incentive   Time   Values   Complex system   Bias  

摘要： Introduction: Despite the growing international popularity and use of complementary and alternative medicine (CAM), the uptake of evidence-based practice (EBP) in CAM has been slow. This cross-sectional survey aimed to further our understanding of the factors impacting EBP uptake in CAM. Methods: The 32-item oBSTACLES instrument was administered online using the SurveyMonkeyTMplatform. The survey evaluated barriers to both the conduct and application of research among CAM practitioners and researchers, from multiple CAM disciplines across Australia and New Zealand. Participants were recruited via practice-based research networks, professional associations, CAM educational institutions, CAM research centres, pertinent product manufacturers and social media platforms. Data were analysed using descriptive statistics. Results: Six hundred and eighty-two CAM stakeholders responded to the survey. Barrier items were divided into two interlinked constructs, "capacity" and "culture". Capacity related to issues regarding access, competency, bias, incentives, and time, whereas culture related to values and complex systems. Under capacity, the greatest proportion of participants (>70 %) agreed that access was a barrier to the conduct and application of research, including lack of funding, institutional support, research training and collaborations. In terms of culture, the majority of participants (>60 %) agreed that values were a barrier to research conduct and application, including limited undergraduate research opportunities and diverse views of evidence. Conclusion: Findings from this research suggest a multitude of barriers negatively impact the conduct and application of research in CAM. Insights gained from this research will be instrumental in developing actionable strategies aimed at mitigating the impact of these barriers to improve research engagement in CAM.

关键词： Augmentative and alternative communication   Phonological awareness   Decoding   Reading   Systematic review  

摘要： The acquisition of reading skills is vital for all individuals given the ubiquitous influence of reading on academic outcomes and quality of life. Individuals with complex communication needs, requiring the supports of augmentative and alternative communication (AAC), are often excluded from learning phonological approaches to literacy. Most literacy approaches require verbal production of speech sounds-which is particularly difficult for individuals with complex communication needs. However, despite challenges with spoken production of sounds, research has reported positive outcomes in participation in phonological interventions when they are adapted to meet the needs of individuals who use AAC. The purpose of the current study was to conduct a systematic review to evaluate the effectiveness of foundational reading interventions (specifically phonological awareness skills, letter-sound correspondences, and decoding interventions) designed to meet the needs of individuals who use AAC. Results indicate that large and very large effects are observed with adapted phonological interventions for individuals who use AAC. These results are consistent across ages, diagnoses, most interventionists, and phonological skills (e.g., decoding, letter-sounds, sound blending). Future research shifting away from very controlled settings with the researcher (to small and large group instruction, instruction by common service providers like teachers, or other types of instruction) may be particularly valuable to support access to, and implementation of, foundational reading interventions for individuals with complex communication needs who require AAC.

关键词： DNA methylation   drought stress   gene regulation   maize  

摘要： DNA methylation is important for plant growth, development, and stress response. To understand DNA methylation dynamics in maize roots under water stress (WS), we reanalyzed DNA methylation sequencing data to profile DNA methylation and the gene expression landscape of two inbred lines with different drought sensitivities, as well as two of their derived recombination inbred lines (RILs). Combined with genotyping-by-sequencing, we found that the inheritance pattern of DNA methylation between RILs and parental lines was sequence-dependent. Increased DNA methylation levels were observed under WS and the methylome of drought-tolerant inbred lines were much more stable than that of the drought-sensitive inbred lines. Distinctive differentially methylated genes were found among diverse genetic backgrounds, suggesting that inbred lines with different drought sensitivities may have responded to stress in varying ways. Gene body DNA methylation showed a negative correlation with gene expression but a positive correlation with exon splicing events. Furthermore, a positive correlation of a varying extent was observed between small interfering RNA (siRNA) and DNA methylation, which at different genic regions. The response of siRNAs under WS was consistent with the differential DNA methylation. Taken together, our data can be useful in deciphering the roles of DNA methylation in plant drought-tolerance variations and in emphasizing its function in alternative splicing.

关键词： Water retention curve   Soil water characteristic curve   Pore size distribution   Arya and Paris   ACAP  

摘要： Arya and Paris developed a model in 1981 to predict the water retention curve of a soil from the grain size distribution and the porosity. This model was very convenient due to the simplicity of the input parameters, and because experimental measures are expensive and with no lack of uncertainties. The model was based on very simple equations but the need to discretize the grain size distribution restricted its usability. A new model is presented, preserving the physical meaning but solving this dependency and other issues and allowing a continuous expression that was not possible with the original model. The new model is very convenient and practical as expressions are easy to implement, and its predictions depend on only one parameter for which some recommended values are also included. Limitations and uncertainties of the model are also discussed.

关键词： Dendrochronology   tree ring   time series   natural records   principal components analysis  

摘要： In this article, we establish a new approach for removing natural growth trends from tree-ring samples, also called detrending. We demonstrate this approach using Ocotea porosa (Nees & Mart) Barroso trees. Nondestructive samples were collected in General Carneiro city, located in the Brazilian southern region (Parana state). To remove natural tree growth trends, principal components analysis (PCA) was applied on the tree-ring series as a new detrending method. From this, we obtained the tree-ring indices by reconstructing the tree-ring series without the first principal component (PC), which we expect to represent the natural growth trend. The performance of this PCA method was then compared to other detrending methods commonly used in dendrochronology, such as the cubic spline method, negative exponential or linear regression curve, and the regional curve standardization method. A comparison of these methods showed that the PCA detrending method can be used as an alternative to traditional methods since (1) it preserves the low-frequency variance in the 566-year chronology and (2) represents an automatic way to remove the natural growth trends of all individual measurement series at the same time. Moreover, when implemented using the alternating least squares (ALS) method, the PCA can deal with tree-ring series of different lengths.

摘要： BACKGROUND Intra-operative muscle relaxation is often required in orthopaedic surgery and the hand train-of-four (TOF) test is usually used for its quantification. However, even though full muscle relaxation is claimed by anaesthesiologists based on a TOF count of zero, surgeons observe residual muscle activity. OBJECTIVE The aim of the study was to assess if hand or foot TOF adequately represents intra-operative muscle relaxation compared with multiple motor evoked potentials. DESIGN Prospective observational study. SETTING A single-centre study performed between February 2016 and December 2018 at the Balgrist University Hospital, Zurich, Switzerland. PATIENTS Twenty patients scheduled for elective lumbar spinal fusion were prospectively enrolled in this study after giving written informed consent. INTERVENTIONS To assess neuromuscular blockade (NMB) with the intermediate duration nondepolarising neuromuscular blocking agent rocuronium, hand TOF (adductor pollicis) and foot TOF (flexor hallucis brevis) monitoring, and muscle motor evoked potentials (MMEPs) from the upper and lower extremities were assessed prior to surgery under general anaesthesia. Following baseline measurements, muscle relaxation was performed with rocuronium until the spinal surgeon observed sufficient relaxation for surgical intervention. At this timepoint, NMB was assessed by TOF and MMEP. MAIN OUTCOME MEASURES The primary outcome was to determine the different effect of rocuronium on muscle relaxation comparing hand and foot TOF with the paraspinal musculature assessed by MMEP. RESULTS Hand TOF was more resistant to NMB and had a shorter recovery time than foot TOF. When comparing MMEPs, muscle relaxation occurred first in the hip abductors, and the paraspinal and deltoid muscles. The most resistant muscle to NMB was the abductor digiti minimi. Direct comparison showed that repetitive MMEPs simultaneously recorded from various muscles at the upper and lower extremities and from paraspinal mu